Family members' perspectives of laws, policies and practices in substance use disorder treatment: Systemic alienation of the family in Canada.

Background: Alcohol-associated liver disease (ALD) is a growing health care concern, with alcohol use disorder (AUD) being a contributor to liver-related morbidity and mortality. This study examines the practices, perspectives, and challenges faced by Canadian health care providers in managing AUD within the context of ALD. Methods: A nationally representative survey was conducted among health care providers involved in ALD management. The survey evaluated practices related to AUD screening, prescribing pharmacotherapy, addiction services referral, and perceived barriers. Results: Alcohol use screening was common (75%), but standardized tools were rarely used (<10%), with barriers including time constraints (61%) and resource limitations (60%). Less than 15% of patients received AUD pharmacotherapy, with lack of training identified as a key barrier. Notably, 47% of providers had never prescribed AUD pharmacotherapy due to low comfort levels (78%). Early and mid-career providers were more likely to prescribe AUD pharmacotherapy compared to their senior counterparts (71% vs 61%, p = 0.02). Acamprosate and naltrexone were the most frequently prescribed medications. Behavioural therapy referrals were reported by 57% of respondents, although patient reluctance (70%) and financial barriers (53%) hindered access. Knowledge gaps regarding AUD pharmacotherapies were prevalent. Conclusion: This study reveals significant gaps in AUD management within ALD care, marked by insufficient screening, underuse of pharmacotherapies, and limited referrals to addiction services. Addressing these issues requires urgent attention through enhanced provider education, integration of addiction care, and systemic reforms. Collaborative efforts among all health care providers are essential to improving care delivery and outcomes for individuals with ALD and AUD.

Veterans face disproportionate suicide and mortality risks driven by intersecting social determinants of health (SDH), including housing instability, unemployment, and justice involvement, and co-occurring substance use disorders (SUD). This study examined how these intersecting factors influence mortality and whether SUD treatment mitigated mortality risks among US veterans. Using national Veterans Health Administration data (2014-2019), we identified 215,944 veterans with SUD and an indicator of one of three adverse SDH: housing instability, justice involvement, or unemployment. We tracked suicide and all-cause mortality for 1 year following SDH exposure. We used discrete-time survival models to assess associations between month-specific SUD treatment and mortality outcomes, controlling for demographic, clinical (i.e., mental health conditions, suicidal behavior), and contextual covariates. Nearly half of veterans (48%) received SUD treatment. Those who received treatment had lower all-cause mortality (2.1% vs. 4.3%; p < .001) but no significant difference in suicide mortality (0.1% vs. 0.6%; p = .75). SUD treatment was associated with a 24% (aOR = 1.24; 95% CI: 1.16-1.34) reduction in all-cause mortality, though its interaction with each adverse SDH was not statistically significant. Suicide deaths remained concentrated among White veterans, those aged 18-34, with no service connection, and with time-varying suicidal ideation or attempts (p < .001). Engagement in SUD treatment reduces all-cause mortality among veterans facing compounded social adversity but does not independently mitigate suicide deaths. Integrated approaches that embed suicide prevention within addiction and SDH-focused care are essential to address the multifactorial drivers of veterans' suicidal mortality.

Context: Reliable measurement tools are critical for assessing the efficacy of substance use disorder (SUD) treatments, especially in low-resource settings. The Treatment Efficacy Assessment Scale (TEAS) and Clinical and Treatment Satisfaction Scale (CATS) were developed to monitor recovery domains and treatment satisfaction among individuals receiving addiction care.This study evaluated the psychometric properties and construct validity of the TEAS and CATS instruments among patients undergoing treatment for SUDs at Aminu Kano Teaching Hospital, Nigeria. Materials and Methods: A cross-sectional sample of 201 respondents completed both TEAS and CATS. Internal consistency was assessed using Cronbach’s alpha. Factor structure was examined using principal component analysis (PCA) with Varimax rotation. Construct validity was assessed through correlational and logistic regression analyses involving clinical variables (e.g., comorbidities, legal issues, and functioning domains). Results: TEAS demonstrated acceptable internal consistency (α = 0.74) and a unidimensional factor structure. CATS showed excellent reliability (α = 0.90) with a single extracted component. Both tools demonstrated significant correlation with objective clinical indicators and patient-reported outcomes, thereby supporting their construct validity. These findings support the routine clinical use of TEAS and CATS for outcome monitoring in Nigerian addiction care settings.

Outpatient substance use disorder (SUD) treatment is commonly delivered through integrated, colocated, or coordinated models. In integrated care, the primary care provider (PCP) manages both general health and SUD, while colocated and coordinated models involve a separate addiction specialist-either within the same clinic or at an external location, respectively. While coordinated care has historically been the norm, integrated models may reduce treatment barriers. However, little is known about patient preferences across these models. Understanding such preferences is essential to improving engagement and care delivery. This qualitative study explores patient preferences and the factors influencing their choices among the 3 models. Fifteen adults with diagnosed SUD were recruited from an integrated, primary care-based addiction medicine clinic in an urban, academic medical center in California. Participants completed 45 to 60 minute interviews in-person or by phone. Data were analyzed using the socioecological model of health as a conceptual framework. At the time of the interview, 3 participants were receiving integrated care, 7 colocated, and 5 coordinated. Most (n = 10) preferred integrated care when given the option. Among those favoring the colocated and coordinated models, over half were willing to consider integrated care if their PCP had addiction training. Factors shaping preferences included SUD severity, quality of the patient-provider relationship, clinic convenience, and clinician competency. Across all models, participants preferred nonjudgmental, affirming providers knowledgeable in addiction. Most participants favored integrated care, highlighting its convenience and continuity with a trusted provider. However, concerns about PCP training in addiction care were common, suggesting the need for enhanced clinician preparation starting in medical school and residency. Regardless of model, participants emphasized the importance of wrap-around services, including peer recovery specialists, counseling, and care navigation, to support recovery and promote treatment engagement.

The Queen Elizabeth II (QEII) Health Sciences Centre in Halifax, Nova Scotia, is an academic, tertiary care hospital that lacked policies related to unregulated substance use, harm reduction, and addiction care. Substance use care was of poor quality and inconsistent, and the community-based standard-of-care was unavailable to hospitalized patients. A group of frontline hospital- and community-based healthcare providers, trainees, harm reduction workers, and people with lived experience organized to navigate this "policy vacuum". We invited community-based groups and resources into the hospital, developed informal policies and procedures to standardize care, and trained ourselves and others in substance use care best practices. We introduced several harm reduction initiatives from the community-including take-home naloxone kits, needle and syringe distribution, and oral and injectable opioid agonist treatment-without institutional policy support. We drafted our own informal harm reduction policies for the internal medicine inpatient unit, holding a focus group with people with lived experience for feedback and revision. This work contributed to funding for an addiction medicine consultation service and an institutional commitment to implement harm reduction-oriented substance use policies for healthcare settings across the province. Despite a lack of institutional policies or buy-in from senior leadership, harm reduction measures can be implemented in hospitals from the bottom-up and the outside-in-by healthcare providers organizing, leveraging existing community resources, and listening to people who use drugs. Clinicians at other hospitals could model our collaborative approach to improve care and push their health systems towards institutional change.

Illness severity may influence the relationship between opioid use disorder (OUD) and adverse outcomes, yet factors affecting severity are not fully understood. The objective of this study is to examine sociodemographic and hospital-related factors associated with severity among OUD-related hospitalizations. We used data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2015 to 2022. The HCUP NIS includes severity measures that assign patients overall severity of illness (SOI) and risk of mortality (ROM) subclasses (ie, minor, moderate, major, and extreme) based on their secondary diagnoses and other clinical characteristics (eg, age, procedures). Partial proportional odds models were used to measure the association between sociodemographic/clinical factors and SOI/ROM subclass severity among OUD-related hospitalizations. SOI shifted toward more severe subclasses in 2019-2022 and ROM in 2015-2022 (higher share major/extreme). Medicare and self-pay, compared with private insurance, were associated with higher odds (adjusted odds ratio [aOR] [95% CI]) of extreme SOI (vs. minor, moderate, or major) (Medicare: 1.07 [1.05, 1.09]; self-pay: 1.08 [1.05, 1.11]). Rural hospitals, compared with urban ones, had lower odds of higher SOI severity (aOR 0.80 [0.77, 0.82]). Results were similar for ROM. Age, sex, race, income, region, hospital size, admission timing, and admission type were also significantly associated with SOI/ROM. Structural/systematic factors play a role in shaping the course of inpatient OUD. These findings highlight the need to strengthen hospital addiction care capacity, address insurance and income-related inequities, and develop targeted inpatient risk stratification strategies to improve outcomes for patients with OUD.

People who inject drugs (PWID) face elevated risks of hospitalizations and readmissions due to serious injection-related infections, yet few evidence-based interventions exist to prevent readmissions. This study aimed to explore factors contributing to rehospitalization among PWID, potential strategies, and assess the acceptability of 2 proposed interventions and implementation considerations. We conducted 22 semistructured interviews with 36 health care providers and staff across 4 study sites in Georgia, Maryland, the District of Columbia, and West Virginia from June 2023 to September 2023. Participants were purposively sampled to represent diverse roles in providing or overseeing care to PWID. Interviews explored barriers to care, challenges contributing to rehospitalization, and perceptions of 2 proposed interventions: (1) integrated care for addiction and infectious diseases, and (2) patient navigation to support linkage to care postdischarge. Data were analyzed using rapid qualitative analysis informed by framework and thematic approaches. Three main themes emerged regarding rehospitalization factors (unaddressed structural, health system, and social determinants; gaps in addiction care training; and continuity of care). Participants expressed high acceptability toward the proposed interventions. Three main themes emerged as recommendations for the implementation of the proposed interventions (organizational needs and capacity; leveraging existing resources; patient engagement and retention). Reducing readmissions among PWID requires addressing provider training gaps, care fragmentation, and structural barriers. Both proposed interventions were deemed acceptable by health care team members. Key implementation factors include strengthening organizational capacity, leveraging existing resources effectively, and using person-centered approaches to build trust and maintain patient engagement and retention.

Bright light therapy (BLT) is now established as an evidence-based treatment for several psychiatric and sleep disorders, with robust efficacy in seasonal affective disorder, non-seasonal, unipolar, and bipolar depression, insomnia and circadian rhythm sleep-wake disorders, including Delayed Sleep-Wake Phase Disorder. BLT-related mechanisms are multifactorial, combining circadian phase-shifting effects, stabilization of the sleep-wake cycle, improved homeostatic sleep pressure, and modulation of monoaminergic pathways. Beyond these effects, recent translational studies suggest that BLT also modulates the brain reward system through circadian-dopaminergic interactions, providing a neurobiological rationale for its use in disorders where motivation, reward sensitivity, and compulsive behaviors are disrupted. Despite these advances, BLT has been largely neglected in the field of addictive disorders, even though circadian disruption, sleep disturbances, and mood instability are central clinical features of addiction. This scoping review explores the therapeutic prospects of BLT in addictive disorders. We first summarize the established evidence supporting BLT for mood and sleep disorders, which provides a strong translational basis. We then discuss three potential applications in addiction: (1) alleviating comorbid or subthreshold mood and anxiety symptoms, which are highly prevalent and disabling in substance use and behavioral addictions; (2) improving sleep and circadian regulation, frequently impaired in these populations and closely linked to relapse vulnerability; and (3) directly modulating the reward system and core addictive behaviors. In conclusion, BLT offers many potential benefits for patients with addictive disorders. Well-designed trials are now needed to confirm efficacy, refine protocols, and integrate BLT into addiction care.

Injection drug use is a driver of hepatitis C virus (HCV) transmission, thus integrating HCV care into addiction care is likely necessary for HCV elimination. Here we describe how we integrated HCV care into our addiction medicine (AM) clinic and evaluate its effect on HCV treatment. Integrated care involves HCV screening and treatment with either DAA prescription directly in AM clinic or via telemedicine with an infectious diseases (ID) specialist. Using retrospective chart review, we assessed if the program affected rates of direct-acting antivirals (DAA) initiation, DAA completion, and sustained virological response (SVR). Among 72 treatment naïve patients, the rate of DAA initiation increased after integrated care (HR 2.21, 95% CI 1.05-4.66), but rates of DAA completion or SVR did not significantly increase. Integrated care was associated with more DAA prescriptions (0.6 vs. 0 prescriptions per month, p = .004) and decreased referrals to hepatology (0.2 vs. 1 referrals per month, p = .001). Compared to referring patients to hepatology, prescribing DAAs in AM clinic was associated with higher rates of DAA initiation (HR 42.46; 95% CI: 15.25-118.24) and completion (HR 8.33; 95% CI: 2.76-25.16). An integrated care program that involved both in-person and telemedicine options improve access to DAA therapy. Enhancing interprofessional collaboration and expanding telemedicine services offers a practical model for strengthening HCV care delivery. This study demonstrates a practical approach to integrating HCV care into addiction treatment through development of inter-professional collaboration between healthcare specialties.

IntroductionOpioid use disorder (OUD) represents a major challenge in addiction care, yet empirical insights into the sociodemographic, clinical, and care-related profiles of help-seekers remain limited. Understanding these profiles is essential for developing targeted care strategies. This study therefore aims to identify and describe latent classes of help-seekers with OUD and outline their specific needs.MethodsLatent Class Analysis was applied to routinely collected person-level data from the 2023 Berlin Addiction Care Statistical Service to identify latent classes of outpatient help-seekers with OUD. Comorbid substance use disorders (SUDs) and injection drug use served as indicators. Classes were compared across sociodemographic, clinical, and care-related variables using Bonferroni-adjusted χ²-tests.ResultsAmong 2,833 help-seekers, three latent classes were identified: Individuals Primarily Using Opioids (n = 1,381), Individuals with Multiple SUDs (n = 709), and Individuals Who Inject Drugs (n = 743). Individuals Primarily Using Opioids did not exhibit clearly distinctive patterns of service utilization and disproportionately reported methadone or other opioids as their main substances of use. Individuals with Multiple SUDs were characterized by high social stability (e.g., partnerships, independent living) and a high enrolment in opioid agonist treatment (OAT). Individuals Who Inject Drugs were marked by heightened vulnerability, including precarious housing and elevated rates of HIV and hepatitis C and primarily accessed low-threshold services.Discussion and conclusionThe results highlight the heterogeneity of help-seekers with OUD and emphasize the need for targeted, class-specific care strategies. Individuals Primarily Using Opioids warrant further investigation, as this class may still comprise heterogeneous subgroups with diverse care needs. Individuals with Multiple SUDs may benefit from more flexible OAT frameworks that accommodate work and family responsibilities. For Individuals Who Inject Drugs, integrated health and social services, combined with expanded harm reduction efforts (e.g., syringe exchange, testing opportunities for infectious diseases), may help reduce access barriers and effectively address their complex needs.

People who inject drugs (PWID) experience high rates of serious injection-related bacterial and fungal infections (SIRI), including cellulitis, osteomyelitis, and endocarditis. These infections often require prolonged antibiotic treatment and result in frequent rehospitalizations, with over 50% of patients readmitted within 1 year. Few evidence-based interventions exist to optimize continuity of care for addiction, management, and prevention of SIRI following hospitalization. CHOICE-STAR is a hybrid type 1 randomized effectiveness-implementation trial, guided by the Exploration, Preparation, Implementation, and Sustainment Framework (EPIS), conducted at five hospitals across the USA. The study aims to assess the effectiveness of the integrated infectious diseases (ID) and substance use disorder (SUD) outpatient clinic on 6-month infection-related rehospitalization among people hospitalized with an infection related to injecting opioids or stimulants. The study also includes implementation outcomes guided by Proctor's Implementation Outcomes taxonomy, as well as cost-effectiveness outcomes. The integrated clinic (IC) will offer facilitated linkage to a clinic providing medical care aimed at treating SUD and ID by completing treatment for the index infection, treating existing ID complications of SUD, and preventing subsequent infections by providing low barrier care for SUD including medication for OUD (MOUD) and harm reduction integrated into a single appointment and co-located at a single site for a minimum of monthly appointments over a 6month time period. An additional 6months' follow-up will be included to assess outcomes following the completion of the intervention. The IC includes a weekly care coordination meeting between the ID and SUD providers. The study will enroll approximately 304 participants. This trial addresses a critical gap in post-hospitalization care for PWID with SIRI. If effective, the integrated care model could significantly reduce rehospitalizations, improve treatment completion, and provide a replicable framework for healthcare systems. The study's implementation science components will inform the scalability and sustainability of this intervention. Results will inform evidence-based policy and practice recommendations for managing this high-risk population, potentially leading to improved patient health outcomes. ClinicalTrials.gov NCT06513156 . Registered on August 09, 2024.

This commentary provides an overview of the 49th annual AMERSA conference, held from November 13 to 15, 2025, in Portland, OR. The conference featured 16 interactive workshops, over 160 oral abstract presentations, and 120 poster presentations. In alignment with the theme of Building Stronger Communities through Addiction Care Innovation, Research, Education and Advocacy, the conference program planning committee was committed to incorporating sessions, including plenaries, workshops, and abstract presentations, which focused on expanding access to resources and including community voices. Plenary topics included building rural peer networks to expand the reach of substance use and substance use disorder care, supportive housing, expanding access to medications for opioid use disorder in rural areas, and the use of psychedelics as an emerging treatment modality, among others. Workshops addressed topics such as building partnerships between academic and tribal communities, Community Reinforcement and Family Training for practitioners, addressing stigma associated with substance use, and strategies to access difficult-to-reach populations to provide care. Through session attendance and dialogue with peers from across geographies and disciplines, the conference created space for conversations that cut across silos and helped to shape evidence-informed, community-engaged practice.

Hospital-based opioid treatment (HBOT) can improve outcomes for patients with opioid use disorder, but little is known about specific attributes and supports needed for clinical champions to successfully implement HBOT. To identify characteristics and supports of effective clinical champions implementing HBOT in US hospitals. Qualitative study using postimplementation semistructured interviews conducted with individuals highly involved in HBOT implementation, including champions and hospital staff at 12 US community hospitals randomized to the high-intensity group of the Exemplar Hospital Initiation Trial to Enhance Treatment Engagement, a national implementation trial comparing low- and high-intensity HBOT implementation strategies. Interviews explored implementation experiences over 24 months from December 2021 to December 2023. Interviews were audio recorded, transcribed, and coded. The framework method and in-depth thematic analysis were used to explore the role of champions. All hospitals received a best-practices manual, video webinar series, and hub team support for questions, while hospitals randomized to the high-intensity group also received monthly practice facilitation, telementoring, and 10% effort funding for a local champion. Champions led HBOT implementation with support from regional hubs with HBOT expertise. Effective champions were defined as those perceived by staff to successfully lead HBOT implementation. Open-ended questions and thematic analysis explored participants' perspectives on attributes of effective champions and how they overcame implementation barriers. A total of 31 hospital staff (15 physicians, 5 executives, 5 pharmacists, 2 nurse practitioners, 2 social workers, 1 nurse, and 1 addiction counselor) were interviewed. Effective champions were perceived as respected hospital "insiders" with institutional influence, persistence, and systems change skills. They built multidisciplinary teams, developed standard workflows, and used emotionally resonant strategies (eg, patient narratives) to overcome stigma and engage hospital leadership. Champions could be effective without addiction medicine expertise, particularly when provided with protected time, hospital leadership support, and external practice facilitation from addiction experts. This multisite qualitative study underscores the vital role of champions in expanding hospital-based opioid care. To ensure HBOT expansion, hospitals should invest in champions, protected time, leadership backing, and external supports that legitimize and routinize evidence-based addiction care.

Private equity investment in US health care, including substance use disorder treatment, has grown. However, the implications of private equity acquisition of substance use disorder treatment facilities for buprenorphine access and quality of care are unknown. To examine the associations of private equity acquisition of substance use disorder treatment facilities and buprenorphine prescribing patterns. In this cross-sectional study using difference-in-differences analysis, aggregate prescription claims from an analytical dataset for buprenorphine from acquired substance use disorder treatment facilities were compared with those from nonacquired facilities from 2019 quarter 3 through 2021 quarter 2. Prescriptions for buprenorphine filled by adult individuals (aged >18 years) were included in the analyses. An event study difference-in-differences design was used to assess changes in buprenorphine prescribing characteristics at facilities from 4 quarters before to 4 quarters after acquisition using a linear model adjusted for facility, year, and treatment cohort characteristics. Analyses were performed from January 2025 to December 2025. Patient volume, prescription volume, payer mix, and treatment retention duration. In a sample of 90 acquired facilities and 2374 never-acquired facilities, private equity acquisition was associated with increases in patient volumes. Acquisition was associated with a mean increase of 65.66 (95% CI, 30.57-100.76; P < .001) patients receiving buprenorphine per facility quarter. Similarly, acquisition was associated with a mean increase of 163.90 (95% CI, 47.07-280.73; P = .006) buprenorphine prescriptions per facility quarter. Acquisition was associated with an increase of 0.73 (95% CI, 0.07-1.40; P = .03) percentage points in prescriptions paid with cash compared with the control group. Other payer types were not associated with acquisition. Measures of treatment episode duration decreased after acquisition, with decreases of 6.24 (95% CI, -11.47 to -1.00; P = .02) percentage points in 90-day retention and 7.91 (95% CI, -13.96 to -1.86; P = .01) percentage points in 180-day retention. In this study, the volume of patients treated with buprenorphine increased after private equity acquisition, with minimal changes in the payer mix among these patients. However, the quality of treatment, in terms of buprenorphine retention duration, decreased after acquisition. These results underscore the need for oversight mechanisms and continued research to ensure incentives for private investment in addiction care align with delivery of high-quality evidence-based treatment.

Integrating addiction care in hepatology: Impact of liver consultation on post-discharge AUD treatment in alcohol-associated hepatitis.

Many individuals with psychiatric disorders, including substance use disorders, smoke. Healthcare providers (HCPs) have an important role in smoking cessation care (SCC). This study examined perceptions of SCC among HCPs working in addiction and mental healthcare, and explored whether HCPs’ smoking status was related to these perceptions. In this cross-sectional study, we combined data of two Dutch surveys among 578 addiction and 231 mental HCPs. Data were analysed using t-tests, Mann-Whitney tests, one-way ANOVAs and Kruskal-Wallis tests using SPSS software. Compared to mental HCPs, addiction HCPs had stronger beliefs that smoking cessation would worsen psychological problems and that smoking and quitting are the client’s choice. They reported better knowledge and skills, stronger role identity, more time available, and more positive outcome expectations. HCPs who smoke reported relatively strong perceptions that smoking is someone’s own choice, and those who quit reported relatively strong knowledge and skills. HCPs who never smoked were relatively positive towards smoke-free organisations. The results suggest that distinct opportunities and challenges exist for improving SCC, based on setting and HCP smoking status.

Urine toxicology is a cornerstone of monitoring abstinence in substance use disorder treatment, yet commonly cited detection windows are based on studies in healthy volunteers and do not account for metabolic variability. Prolonged metabolite positivity is typically interpreted as continued use, which can jeopardize treatment engagement and erode the therapeutic alliance. We describe a 42-year-old man with severe stimulant use disorder whose urine toxicology remained positive for cocaine metabolites for 18 days, including 12 days after verified abstinence in a residential program. Laboratory evaluation revealed hepatic steatosis, and pharmacogenomic testing demonstrated a poor metabolizer phenotype at CYP2D6 and CYP3A5. Creatinine-corrected benzoylecgonine levels showed steady monotonic decline without fluctuation, consistent with delayed elimination rather than recurrent use. No cross-reactive medications or confounding substances were present. Cocaine metabolism depends on cytochrome P450 enzymes-particularly CYP2D6 and CYP3A isoforms-and nonspecific esterases. Impaired activity of these pathways, combined with hepatic steatosis and chronic stimulant exposure, can significantly prolong metabolite clearance. This case highlights the importance of distinguishing biological variability from behavioral relapse, especially in settings where misinterpretation may undermine therapeutic rapport. Unexpectedly persistent cocaine positivity should prompt consideration of pharmacogenomic variation, hepatic function, and confirmatory testing rather than immediate assumptions of relapse. Integrating biological, behavioral, and contextual data supports accurate interpretation and protects the therapeutic alliance. Prolonged cocaine metabolite detection can reflect delayed metabolic clearance rather than continued use. Awareness of pharmacokinetic and pharmacogenomic factors is essential for accurate urine toxicology interpretation and patient-centered addiction care.

ABSTRACT Aim Post‐liver transplant (LT) alcohol relapse complicates long‐term outcomes and organ allocation. The traditional “six‐month abstinence rule” remains widely used, but relapse risk is also shaped by psychosocial, socioeconomic, and psychiatric factors. We examined the impact of pre‐LT abstinence duration on post‐LT alcohol relapse and developed a multivariable risk model integrating abstinence, psychosocial assessment, and socioeconomic status. Methods In this single‐center retrospective study, 383 adults undergoing LT for alcohol‐related liver disease were included. Results Any post‐LT alcohol relapse occurred in 20.9% ( n = 80). Relapse phenotypes were non‐mutually exclusive: sustained alcohol use (77.5%), harmful drinking (68.8%), and recurrent ALD (46.3%). On multivariable analysis, shorter pre‐LT abstinence, higher Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores, and higher educational attainment were independently associated with relapse. Each additional month of abstinence reduced relapse odds by 4%, whereas each one‐point increase in SIPAT increased relapse odds by 3%. Cumulative risk curves demonstrated a non‐linear relationship between abstinence duration and relapse, with risk peaking around 9 months and declining thereafter across all relapse phenotypes. A prediction model combining abstinence duration, SIPAT score, and education achieved an area under the receiver operating characteristic curve (AUC) of 0.70, with consistent performance on fivefold cross‐validation. Conclusion These findings support a multifactorial approach to relapse risk stratification that goes beyond a fixed 6‐month abstinence rule. Incorporating abstinence duration together with structured psychosocial assessment and education level may better inform both transplant listing decisions and the intensity of post‐LT addiction care for patients.

Objectives Substance use disorders (SUDs) are increasingly prevalent in India and associated with substantial treatment gap. Enhancing accessibility of addiction services and tailoring them to the needs of target populations are critical strategies for bridging this gap. The specialized Addiction Medicine Clinics (AMCs) have the potential to facilitate treatment-seeking, mitigate stigma, and improve the quality of addiction care. The current retrospective data analysis was done to highlight need for such AMCs in the region at tertiary care centers. Material and Methods The present study examined service utilization during the initial four months of a newly established weekly AMC in a tertiary care Hospital in Uttar Pradesh. The AMC operates every Thursday, providing both outpatient and inpatient services. A retrospective analysis was conducted on data from 125 patients who attended the clinic during this period. Results The study found a substantial number of patients attending the clinic during the initial 4 months following its establishment. There were approximately equal proportions of new and follow-up consultations, indicating good retention. Most patients were men aged 25-59 years, predominantly from the district where the institute is located, with a smaller proportion from adjacent districts. Alcohol (51.2%) and tobacco (58.5%) were the most frequently reported substances for which treatment was sought, followed by opioids (40.8%) and cannabis (16%). Conclusion These findings suggest that the establishment of an AMC is a feasible approach to improving access to treatment for SUDs. Nonetheless, the very low representation of women among treatment seekers underscores the need to consider gender-specific interventions, including dedicated services for women with SUDs.