Section - Video Lectures

01. Physical Illness and Substance Use Disorders: A Bidirectional Relationship

Published on March 6, 2026 Certification expiration date: March 6, 2029

Kevin A. Sevarino, M.D.C.M., Ph.D.

Associate Clinical Professor of Psychiatry - Yale School of Medicine

Key Points

Addiction and mental health treatment should not be separated. Psychiatrists need competency in both, regardless of state-level administrative divisions.
Addiction pharmacotherapy should be modified for comorbid hepatic, renal, and infectious disease. Detailed dose adjustments are covered in subsequent sections.
Screen for housing and food insecurity at intake. These social determinants, along with trauma histories, drive both mental and medical illness.

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Slides and Transcript

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Welcome to this presentation on Addiction Psychopharmacology in Patients with Medical Comorbidities. My name is Dr. Kevin Sevarino. I’m the Medical Director for the American Academy of Addiction Psychiatry and a Past President of that organization, and Associate Clinical Professor of Yale School of Medicine. Most of my experience in this field has come from many years working as a CL psychiatrist, consult-liaison psychiatrist, in a long-term acute care facility where patients would stay up to three months after spinal cord injury or traumatic brain injury or respiratory failure, but many of them had substance use disorders that underlay the cause of what got them into the hospital and also had medical comorbidities. The first section deals with physical illness and care models in patients with these co-occurring mental health disorders.

Physical Illness and Substance Use Disorders: A Bidirectional Relationship Slide 1 of 9

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So if you look at the fact that those with mental illness have excess physical illness, so there are excess death rates in those with mental illness, the pooled relative risk of mortality in those with mental disorders is 2.22. In other words, those with mental illness tend to die about 10 years earlier than those without any mental illness, and much of that is due to defined physical illnesses such as respiratory issues from smoking, liver illnesses from opioid use disorder, and IV drug abuse and alcohol use, etc.

References:

Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry, 72(4), 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502

Physical Illness and Substance Use Disorders: A Bidirectional Relationship Slide 2 of 9

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Next Section

02. Hepatic Complications in Substance Use Disorders: Risk Factors and Disease Progression

Learning Objectives:

Apply evidence-based dosing adjustments for naltrexone, buprenorphine, methadone, and disulfiram in patients with hepatic impairment, renal insufficiency, cardiovascular disease, and respiratory conditions.
Identify which medications for alcohol use disorder and opioid use disorder are safe, require dose modification, or should be avoided across specific comorbid conditions, including decompensated cirrhosis and severe renal disease.
Describe integrated care models for managing patients with co-occurring substance use disorders and medical comorbidities, including liver disease and infectious conditions.

Original Release Date: March 06, 2026
Expiration Date: March 06, 2029

Faculty: Kevin A. Sevarino, M.D.C.M., Ph.D.
Medical Editor: Tomás Abudarham, M.D.

Relevant Financial Disclosures:
None of the faculty, planners, and reviewers for this educational activity has relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Medical Academy designates this enduring activity for a maximum of 1.25 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Artificial Intelligence (AI) Use Disclosure
Artificial intelligence (AI) tools may have been used in limited stages of developing this activity (e.g., drafting or language refinement). The specific tool, version, and date of use are documented internally.
AI does not determine clinical recommendations. All content is reviewed, verified, and approved by the listed faculty and medical editors, and reflects independent human clinical judgment consistent with ACCME Standards for Integrity and Independence in Accredited Continuing Education.