Dr. Alan Wartenberg, M.D.

Pharmcotherapy for tobacco cessation is effective, but unfortunately not in everybody.  The best success is with a combination of usingnicotine skin patches, which deliver a consistent steady-state of serum nicotine, combined with the use of short-acting nicotine (which arenot tablets because nicotine is not well absorbed orally).  Short-acting forms include gum, lozenges and nasal sprays.  The combinedsuccess in one study was slightly over 50%, with men doing better than women.  However, the relapse rate at 6 months was about 20%.Other common treatments are the anti-depressant buproprion, which had a success rate of 35% and varenicline (Chantix) which was about25%.  There was significant relapse, in the range of 20-30% in both groups at 6 months.  All of these treatments worked better when combined with psychological support, both group and individual (i.e., a smoking cessation program).

Drug Test for Adderall
Without knowing what particular drug test they are using, it is impossible to say with certainty,but dextroamphetamine, the ingredient in Adderall, is relatively short-acting (about 10 hours),and really does not accumulate in tissues much. It is usually present for no more than 2-4 days,so your test is very likely to be negative.  However, not telling your employer about your medicalhistory can backfire on you later.

Wish I could give you a more certain answer, but I cannot say unless you can tell me exactly what kindof drug testing is being done.  If you only took one Lortab, the half-life is about 3 days in urine, but if theyare doing a more sensitive test, it may show up.  If it is being done for legal purposes, they should do amore definitive test like gas chromatography/mass spectroscopy which will almost certainly detect it.If you have a prescription for the Lortab, it should not be a problem.  However, if you know you are beingdrug tested and you still needed to use an opiate pill, I am concerned that there is more of a problem here.

There are actually a number of medications that can reduce both the craving for alcohol and decrease the incidence of relapses, reduce the number of drinks when relapse occurs, and ultimately improve treatment. They are generally BEST used when combined with a professional program that includes Cognitive Behavioral Therapy, Motivational Enhancement, or ContigencyManagement (three behavioral techniques proven to be effective), as well as participation in mutual-help groups such as AA or Smart Recovery. Talk with his primary care provider for more information. The three approved medications are Acamprosate (Campral), Naltrexone(ReVia and generics), and Disulfiram (Antabuse). I generally recommend the first two, and Naltrexone is available in a monthly injection which can improve adherence to the medication. There are also approved drugs for other indications that are being increasingly used in practice.

E-cigarettes have the same side effects as combusted tobacco but to a reduced extent because of the lower temperatures at which nicotine (and tars - the carcinogenic and lung damaging hydrocarbons foundin tobacco) volatalize.  It is thus thought to be less dangerous than smoked cigarettes.  But they are not WITHOUT danger. There is still nicotine addiction and nicotine effects on the heart and vascular system, and there is a lower level of tars. Since there are other ingredients in the liquids that companies use in their E-cigarettes, and we do not have extensive experience with their side effects, it is hard to make a definitive statement.  However, there is little doubt that vaping tobacco is safer than smoking it.

There are psychiatrists who are very knowledgeable about addiction, and there are others who are less so. Psychiatrists who are Board Certified in Addiction Psychiatry are the best bet, but there are other physicians who are Board Certified in Addiction Medicine who are equally competent. The American Society of Addiction Medicine and the American Academy of Addiction Psychiatry websites (asam.org and aaap.org) can give you names of doctors in your area.

Depends on how much he has been taking. If it is three or four tablets per day, withdrawal will likely be minimal and can be managed with over the counter medication for the symptoms. However, if he is taking more, or if he has underlying medical/psychiatric conditions that can be worsened by withdrawal, it may be more of a problem. The physician who was prescribing the hydrocodone should be able to give you referral information for professionals who can help your husband.

You cannot "overdose" on this combination if by overdose you mean a serious excessive exposure that results in major danger to health. You may be overly sleepy, but even that is unlikely. In general, it is not a good idea to use 2 different kinds of medication initially for the same problem. You should see how one of them works before trying another. However, if you have any history of risk factors for substance use disorders, such as positive family history, or a history of binge alcohol consumption, Xanax is a highly dependency-producing drug and I would recommend not using it on a regular basis.

Physical dependency is NOT addiction, and in fact is not even required for the diagnosis of a Substance Use Disorder. The 11 criteria relate to the amount of harm being done by the drug clearly exceeding whatever good it does. This harm can be in our personal lives or our lives with other people (social harm). Some drug and alcohol counselors view ANY use of a potentially dependency-producing drug or substance as being problematic, and make use=abuse=dependency. Your dose is quite low, and I doubt very much it is causing any change in your mood. Arguing with your brother may be the source of your "hostility,"

Most initial drug tests are "screening tests," which are simpler and less expensive than confirmatory tests, which are far more accurate. Many substances can give false positive on screening tests, but confirmatory tests will give more accurate results. Fentanyl is now found in a bunch of counterfeit pills, and if your goddaughter is using any medications bought on the street or from friends they may be contaminated/adulterated with fentanyl. Phony Xanax cut with fentanyl has been associated with several deaths. Make sure your goddaughter is not taking such counterfeit medications not obtained from pharmacies. Any positive screening test MUST be followed with a confirmatory test if there are consequences for the positive test, according to the current standard of care.

Kind of like asking how do I get rid of cancer. There are as many answers as there are different people. There are physicians who specialize in the treatment of substance use disorders, and are certified in either Addiction Medicine or Addiction Psychiatry. Speaking to one of those physicians could be a good first step. Attendance at mutual-help groups such as Alcoholic Anonymous, Narcotics Anonymous and SMART Recovery, all of which now have online meetings, is also a good start. All of these approaches recommend eventual and complete discontinuation of your drug of choice, but many drugs require a medical detoxification to be safe.

The recommended safe limit for drinking in women is no more than 1 standard drink per day, and you are exceeding that. A recent study by a reknowned expert in the field, Dr. Henry Kranzler, showed that brain damage can be seen with even smaller doses of alcohol. Alcohol can do a great deal of damage without killing someone. See your primary care provider for evaluation and advice.

Simple answer is NO. But your better question should be how you can help your partner get into recovery. Involvement in a family treatment system like Alanon can help you find ways to help both your partner and yourself, since their substance use disorder is very likely to affect your life as well.