In its inaugural year, The Mental Health Clinician published an excellent issue with articles devoted to substance use disorder. In this issue, the theme once again centers on substance use disorder. With a case report and literature reviews, our article focus has shifted this time around to explore pharmacists and pharmacists-in-training and their knowledge and experiences with substance use disorder, both in their patients and amongst themselves, as well as some innovative practices.

As much of our readership is practitioners in mental health, one must acknowledge the correlation between substance dependence and mental illness. According to a 2011 survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), the use of illicit drugs is much more likely in patients with any mental illness (AMI) than those without (25.2% vs 11.8%).1 This SAMHSA survey noted that among the 45.6 million adults aged 18 or older with AMI in the past year, 17.5 percent (8.0 million adults) met criteria for substance dependence or abuse. In comparison, 5.8 percent of adults who did not have mental illness in the past year (10.9 million adults) met criteria for a substance use disorder.

In Western countries, up to 40% of those with schizophrenia also have alcohol use disorders.2 Patients who have both schizophrenia and alcohol use disorders are more likely to experience re-hospitalizations than patients without alcohol use disorders (184 versus 223 days to re-hospitalization, p=0.004). These numbers indicate the need for us as practitioners to not only understand substance use disorders and their treatments, but also to seek out treatment modalities that have demonstrated evidence in helping those with dual diagnoses.

The DSM-5 has modified the way it refers to and provides diagnostic guidance to substance use disorders.3,4 In the previous edition, substance abuse and substance dependence were separate diagnoses. With this update, these are classified under one diagnosis, substance use disorder, which now requires that a severity level be included, ranging from mild to severe. Each substance shall be indicated with a separate use disorder (e.g., cocaine use disorder, marijuana use disorder) that removes the “polysubstance” term from the diagnostic vernacular. The presence of craving is added as a symptom while problems with law enforcement have been removed, as this criterion is difficult to apply in all areas of the world. These modifications in the DSM-5 attempt to better reflect the symptoms experienced.

This issue takes a close look at pharmacists and pharmacists-in-training who fall into substance use disorders with two inspiring accounts of recovery as well as a report about pharmacists' knowledge and personal beliefs toward their chemically dependent patients. Other topics included in this issue shed light on a newer drug of abuse, bath salts. A unique case of tramadol dependence treated with buprenorphine/naloxone is reviewed. This issue contains three articles that highlight pharmacists' innovative practices regarding treatment of chemically dependent patients, including a controversial yet intriguing look at harm reduction practices in Canada. Also published in this issue are a review of buprenorphine in the treatment of opioid dependence and a thorough review of electronic cigarettes for smoking cessation, a topic that garners many questions from patients for which few pharmacists have well-read answers.

Figure 1.

Past Year Substance Dependence or Abuse and Mental Illness among Adults Aged 18 or Older: 2011

Figure 1.

Past Year Substance Dependence or Abuse and Mental Illness among Adults Aged 18 or Older: 2011

Close modal

Substance use disorders are far reaching and affect many of us personally, professionally, or both. We hope this issue advances your knowledge of substance use disorders and serves as a resource for those seeking to provide assistance to those who suffer. Happy Holidays!

1.
Substance Abuse and Mental Health Services Administration
,
Results from the 2011 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-45, HHS Publication No. (SMA) 12-4725
.
Rockville, MD
:
Substance Abuse and Mental Health Services Administration
,
2012
.
2.
Lin
C-H
,
Huang
C-J
,
Huang
Y-H
,
Chen
C-C.
Time to rehospitalization of schizophrenia patients with alcohol use disorders
.
Acta Psychiatr Scand
.
2013
;
128
(
1
):
94
5
.
doi: 10.1111/acps.12111. PubMed PMID: 23550713
.
3.
American Psychiatric Association
.
Diagnostic and statistical manual of mental disorders: DSM-IV
. 4th ed.
Washington (DC)
:
American Psychiatric Association
;
1994
.
866
p
.
4.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
.
Arlington, VA
:
American Psychiatric Association
,
2013
.