Prevention Of Substance Use Disorders Research Articles

Generalized genetic liability to substance use disorders.

Lifetime and temporal co-occurrence of substance use disorders (SUDs) is common and compared with individual SUDs is characterized by greater severity, additional psychiatric comorbidities, and worse outcomes. Here, we review evidence for the role of generalized genetic liability to various SUDs. Coaggregation of SUDs has familial contributions, with twin studies suggesting a strong contribution of additive genetic influences undergirding use disorders for a variety of substances (including alcohol, nicotine, cannabis, and others). GWAS have documented similarly large genetic correlations between alcohol, cannabis, and opioid use disorders. Extending these findings, recent studies have identified multiple genomic loci that contribute to common risk for these SUDs and problematic tobacco use, implicating dopaminergic regulatory and neuronal development mechanisms in the pathophysiology of generalized SUD genetic liability, with certain signals demonstrating cross-species and translational validity. Overlap with genetic signals for other externalizing behaviors, while substantial, does not explain the entirety of the generalized genetic signal for SUD. Polygenic scores (PGS) derived from the generalized genetic liability to SUDs outperform PGS for individual SUDs in prediction of serious mental health and medical comorbidities. Going forward, it will be important to further elucidate the etiology of generalized SUD genetic liability by incorporating additional SUDs, evaluating clinical presentation across the lifespan, and increasing the granularity of investigation (e.g., specific transdiagnostic criteria) to ultimately improve the nosology, prevention, and treatment of SUDs.

Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol

BackgroundPolicymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study.MethodsThis is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA.DiscussionThis study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment.

Federal Impacts on Buprenorphine Prescribing in Washington State, 2012 to 2022.

Objectives. To evaluate changes in monthly buprenorphine dispensation associated with federal prescribing policies in Washington State from 2012 to 2022. Methods. We conducted an interrupted time series analysis comparing monthly buprenorphine prescriptions dispensed per 1000 population after the Comprehensive Addiction and Recovery Act (CARA), Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT), and new prescribing rules during the COVID-19 pandemic. Buprenorphine formulated for opioid use disorder was included from the Washington State Prescription Monitoring Program. A log-linear autoregressive model measured linear trend changes. Results. Physician prescribing increased by 1.63% (95% confidence interval [CI] = 1.41%, 1.85%) per month after CARA with sustained declines after SUPPORT. Nurse practitioner (NP) prescribing increased by 19.48% (95% CI = 18.8%, 20.16%) per month after CARA with physician assistants (PAs) showing similar trends. Following the implementation of SUPPORT, NP and PA trends continued to increase at a reduced growth rate of 3.96% (95% CI = 2.01%, 5.94%) and 1.87% (95% CI = 0.56%, 3.19%), respectively. No prescribers experienced increases during the COVID-19 pandemic. Conclusions. CARA nearly tripled the buprenorphine prescribing rate. The SUPPORT Act initiated sustained declines for physician prescribing, and the COVID-19 period reversed gains for PAs and NPs. The current opioid crisis requires expanded efforts in Washington State. (Am J Public Health. 2024;114(7):696-704. https://doi.org/10.2105/AJPH.2024.307649).

Effectiveness of a universal, school-based, online programme for the prevention of anxiety, depression, and substance misuse among adolescents in Australia: 72-month outcomes from a cluster-randomised controlled trial

The CSC study found that the universal delivery of a school-based, online programme for the prevention of mental health and substance use disorders among adolescents resulted in improvements in mental health and substance use outcomes at 30-month follow-up. We aimed to compare the long-term effects of four interventions-Climate Schools Combined (CSC) mental health and substance use, Climate Schools Substance Use (CSSU) alone, Climate Schools Mental Health (CSMH) alone, and standard health education-on mental health and substance use outcomes among adolescents at 72-month follow-up into early adulthood. This long-term study followed up adolescents from a multicentre, cluster-randomised trial conducted across three states in Australia (New South Wales, Queensland, and Western Australia) enrolled between Sept 1, 2013, and Feb 28, 2014, for up to 72 months after baseline assessment. Adolescents (aged 18-20 years) from the original CSC study who accepted contact at 30-month follow-up and provided informed consent at 60-month follow-up were eligible. The interventions were delivered in school classrooms through an online delivery format and used a mixture of peer cartoon storyboards and classroom activities that were focused on alcohol, cannabis, anxiety, and depression. Participants took part in two web-based assessments at 60-month and 72-month follow-up. Primary outcomes were alcohol use, cannabis use, anxiety, and depression, measured by self-reported surveys and analysed by intention to treat (ie, in all students who were eligible at baseline). This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000723785), including the extended follow-up study. Of 6386 students enrolled from 71 schools, 1556 (24·4%) were randomly assigned to education as usual, 1739 (27·2%) to CSSU, 1594 (25·0%) to CSMH, and 1497 (23·4%) to CSC. 311 (22·2%) of 1401 participants in the control group, 394 (26·4%) of 1495 in the CSSU group, 477 (37·%) of 1289 in the CSMH group, and 400 (32·5%) of 1232 in the CSC group completed follow-up at 72 months. Adolescents in the CSC group reported slower year-by-year increases in weekly alcohol use (odds ratio 0·78 [95% CI 0·66-0·92]; p=0·0028) and heavy episodic drinking (0·69 [0·58-0·81]; p<0·0001) than did the control group. However, significant baseline differences between groups for drinking outcomes, and no difference in the predicted probability of weekly or heavy episodic drinking between groups were observed at 72 months. Sensitivity analyses increased uncertainty around estimates. No significant long-term differences were observed in relation to alcohol use disorder, cannabis use, cannabis use disorder, anxiety, or depression. No adverse events were reported during the trial. We found some evidence that a universal online programme for the prevention of anxiety, depression, and substance use delivered in early adolescence is effective in reducing the use and harmful use of alcohol into early adulthood. However, confidence in these findings is reduced due to baseline differences, and we did not see a difference in the predicted probability of drinking between groups at 72-month follow-up. These findings suggest that a universal prevention programme in adolescence is not sufficient to have lasting effects on mental health and substance use disorders in the long term. In addition to baseline differences, substantial attrition warrants caution in interpretation and the latter factor highlights the need for future long-term follow-up studies to invest in strategies to increase engagement. Australian National Health and Medical Research Council.

The relationship between homelessness and psychiatric disorders in an inpatient sample

IntroductionThere are more than ten thousand homeless people in Hungary. Earlier studies confirmed the connection between mental health issues and homelessness. Furthermore, homeless care places a significant burden on the healthcare system, with psychiatric departments being no exception.Objectivesto compare demographic and treatment characteristis of homeless and not homeless inpatients in the psychiatric department of Jahn Ferenc South Pest Hospital (JFSPH), and thus providing a different perspective compared to previous studies, shedding light on the relationships from a different angle.MethodsIn our retrospective study, we analyzed all inpatients’ data treated in the psychiatric department of JFSPH over a 4-month period (03/2023-07/2023). Patients were divided into two groups: those with housing and those who were homeless. We compared the two groups based on the following variables: gender, age, length of inpatient treatment, diagnosis, psychiatric history, employment status; smoking, alcohol and drug use; valid health insurance, invalidity pension and guardianship status; and long-acting injectable antipsychotic treatment.ResultsThe percentage of homeless individuals treated in the psychiatric department of JFSPH was 18%. There was a significant difference in the length of inpatient stay between the two groups, homeless patients spent more than 100% longer time under inpatient treatment. Regarding psychiatric history, there was no significant difference between the two patient groups. When examining the employment status of the sample, we found significantly more unemployed patients im the homeless group. Comparing to the control group, there were significantly more alcohol consumers, smokers, and substance users among the homeless. Long-acting antipsychotic injections were administered significantly more frequently to homeless patients. A significantly higher percentage of homeless individuals were declared invalidated, and a significantly higher proportion of them were placed under guardianship compared to the group with housing. Homeless individuals were significantly more likely to have no social insurance compared to the control group.ConclusionsIn summary, we can conclude that significant difference have been found between the homeless and not homeless groups in most of the examined variables. These results implicates that the inpatient care of homeless patients poses significant bourden on the inpatient system. Early prevention and effective rehabilitation of substance use disorders could decrease this burden. Establishing a proper social safety network and enhancing community psychiatric care could potentially also relieve the burden of inpatient care system.Disclosure of InterestNone Declared

Occurrence and Prevention of Substance Use Disorder Among Anaesthesiology and Intensive Care Medicine Residents in Indonesia: A Pilot Study

Background: Substance use disorders (SUD) in the population of anaesthesiology and intensive care medicine (ICM) residents have the potential to cause fatal occupational risks. Currently, there are no epidemiological reports regarding the prevalence of SUD among doctors in Indonesia and anaesthesiologists in particular. The purpose of this study was to estimate the occurrence of SUD among anaesthesiology and ICM residents in Indonesia and to recognize the SUD prevention strategy implemented in each teaching hospital. Methods: This was a survey-based observational study using a three-part questionnaire consisting of 20 binary questions, which was pertained to the sociodemographic details, the occurrence and prevention of SUD. Participants were recruited from 16 residency programs with a total of 1 127 active residents registered at the Indonesian College of Anaesthesiology and Intensive Care. All returned surveys were reviewed and scored by hand. The data were compiled and analyzed with numbers and percentages. Results: Returned surveys from 353 residents yielded a 31.3% response rate. Residents from 13 out of 16 registered residency programs in Indonesia participated in this survey. The occurrence of SUD among anaesthesiology and ICM residents in Indonesia was 0.5%. As much as 77.3% of respondents never had toxicological screening. Moreover, 18.2% of respondents were not aware of any routine toxicology screening in their program. Conclusions: The majority of anaesthesiology and ICM residents in Indonesia have risk factors for developing SUD. The need for policies, training, education, and SUD prevention strategies must be immediately addressed.

The potential role of social support in reducing risk of opioid misuse following traumatic injury

Background Social support appears to play a pivotal role in the prevention, development, and remission of substance use disorders. Previous research suggests that interpersonal relationships moderate treatment outcomes for opioid use disorder based on the nature and quality of the relationship. However, the role of social support in the initiation of prescription opioid misuse (POM) is unclear. Methods In a prospective cohort of 221 patients with traumatic injuries at a level 1 trauma center in Wisconsin, we used multiple linear regression analysis to examine the association between social support and POM at six months post-discharge. Covariates included morphine equivalent daily dose (MEDD) at baseline (24 h pre-discharge), opioid use at six months post-discharge, pre-injury depression and anxiety symptoms, and discharge pain intensity. Results In models adjusted for relevant demographic and clinical outcomes, social support scores (β = −3.898, p < 0.001; Bonferroni corrected) and depression and anxiety composite scores (β = 2.29, p < 0.023; uncorrected) significantly predict POM scores 6 months post-discharge. When controlling for pre-injury depression and anxiety, patients with positive POM scores had significantly lower baseline social support scores than patients with negative POM (M = 24.31 vs 30.05, p = 0.003). Conclusions Findings suggest that the perceived presence and quality of social support within an individual’s life may influence the initiation of POM and should be considered in screening for risks related to potential POM. Providers may consider the use of social support when stratifying patients for risk of possible misuse.

Mental health and well-being for the prevention of substance use disorders.

Mental health and well-being for the prevention of substance use disorders.

Perception, experience, and practice of Iraqi community pharmacists towards customers with substance use disorder.

Pharmacists are healthcare professionals who frequently encounter individuals struggling with addiction in their day-to-day practice. Studies critique pharmacists' competence in the detection, prevention, and management of substance use disorder. This study aimed to get in-depth information about the perception, experience, and practice of Iraqi pharmacists towards substance use disorder. A qualitative-study was performed through face-to-face individual-based interviews with community pharmacists in Baghdad/Iraq. Interviews were conducted from July 2023 till the saturation point (September 2023). Data analyzed by thematic-analysis approach. Interviews were conducted with 21 pharmacists. Most participants reported that substance use disorder is common among young males. Pregabalin is the most commonly requested drug. Availability, euphoric-effect, and low cost are the main reasons for favoring a drug by persons with substance use disorder. Moreover, poverty and social problems are the main reasons for substance use disorder. Drug intoxication signs are the main clues in recognizing substance use disorder. Most participants refuse dispensing drugs without prescription and reported that the barriers for implementing regulations on drugs with high potential for dependence are related to the limited follow-up to pharmacists, presence of outsiders, and fear from reactions of persons with substance use disorder. Pharmaceutical services to persons with substance use disorder were performed by few pharmacists and limited to patient education about the risks of misusing drugs. Most participants reported that enhancing pharmacists' competence in substance use disorder is necessary. Substance use disorder is common among young Iraqi males. Pregabalin is a commonly requested drug. The current Iraqi regulations are not sufficient to prevent substance use disorder. Pharmaceutical services to persons with substance use disorder are weak and limited to patient education. Enhancing pharmacists' knowledge through educational courses is necessary to improve their role in facing substance use disorder.

Substance use in the correctional settings: A qualitative exploration of individual and contextual characteristics and intervention strategies using the behavior change wheel framework

Background and objectivesPlanning and implementing prison-based substance use disorder (SUD) interventions are challenging. We wanted to understand why and how people in correctional settings (CS) use drugs and to explore what policies, environmental, and interpersonal factors influence substance use among incarcerated people. Using the Behavior Change Wheel (BCW) framework, we proposed a thematic map with intervention functions to reduce substance use in CS. MethodsWe used the Framework Method of qualitative analysis. We did snowball sampling for the incarcerated people with drug use (PWD) and convenience sampling for the staff. The in-depth interview sample comprised 17 adult PWD, three prison administrative, and two healthcare staff. We determined the sample size by thematic data saturation. We followed a mixed coding approach for generating categories, i.e., deductive (based on the BCW framework) and inductive. The study constructed the final theoretical framework by determining the properties of the categories and relationships among the categories. ResultsWe identified eleven categories aligned with the BCW framework. The themes were prison routine, interpersonal dynamics of the incarcerated population, exposure to substance use, attitude of staff towards PWD, experience with prison healthcare, willingness (to reduce drug use) and coping, compassion, drug use harms, conflict between staff and residents, stigma, and family/peer support. The BCW framework aided the identification of potential intervention functions and their interactions with the organizational policies that could influence PWD's capability-opportunity-motivation (COM) and drug use behavior (B). ConclusionThere is a need to raise awareness of SUD prevention and intervention among decision-makers and revisit the prison policies.

The effect of chronotypes on follow-up outcomes of patients with substance use disorder.

Substance use disorder (SUD) can have circadian characteristics and individuals with evening chronotype are more prone to addiction. In this study, the effect of chronotypes on the treatment outcomes of SUD was investigated. The study included 66 patients who were diagnosed with SUD according to DSM-5. Two clinical interviews were conducted at 6-month intervals, and remission/relapse status was evaluated at the second interview. The Structured Clinical Interview Form for DSM-IV Axis I Disorders (SCID-I), Addiction Profile Index Practitioner Form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburg Sleep Quality Index and Morningness-Eveningness Questionnaire (MEQ) were applied to the patients. MEQ scores of relapsed patients were found to be different in terms of eveningness than those in remission (45.62 ± 8.70 versus 49.75 ± 7.60, p = 0.045). As the craving and addiction profile index total scores (addiction severity) increased, eveningness chronotype scores also increased (r = - 0.387 and r = - 0.286, respectively). The mean scores of craving and BDI were higher in relapsed patients compared to those in remission (p = 0.003 and p = 0.015, respectively). Our results suggest that patients with SUD had a lower morningness chronotype than the general population; additionally, more relapsed patients had an eveningness chronotype. Thus, chronotypes may play a role in the onset, prevention, and treatment outcome of SUD.

Recovery Ready Workplaces: A key strategy for reducing overdoses and sustaining recovery from substance use disorder.

In 2021, overdose deaths surpassed the 100,000 mark for the first time in the United States' history, and alcohol-related deaths continue to surpass 140,000 each year. Regulatory and societal barriers to effective treatment and prevention of substance use disorder (SUD) persist. Innovative strategies and approaches to support long-term recovery can help re-duce morbidity and mortality associated with SUD. Improving access to quality treatment and the availability of a broad range of policies and programs to support recovery and address social determinants of health, including employment supports, are key to curbing the overdose epidemic and rebuilding stronger communities. This article outlines the role Recovery Ready Workplaces can play in reducing overdoses and helping individuals sustain recovery from SUD, as well as in strengthening communities. This article describes how congressional and state legisla-tive action, Americans with Disabilities Act (ADA) enforcement and expansion, and other programmatic and fiscal policy changes at the state and federal levels will accelerate the adoption of Recovery Ready Workplaces as an element of a comprehensive response to SUD. The article also identifies existing state models and proposes specific federal- and state-level solutions to address some of the current limitations. Recovery Ready Workplaces benefit employees, employers, and the nation's economy. Recovery Ready Workplaces are a supportive tool and policy strategy to help those with SUD thrive in recovery and to bolster communities and the econ-omy as a whole.

Wellness Tour for Tribal Communities During the COVID-19 Pandemic: Uniting Sacred Space with Western Medicine to Prevent Substance Use

Substance use disorders (SUD) and overdose deaths worsened further during the Covid-19 pandemic in American Indian and Alaska Native (AIAN) communities. The Native Dad’s Network (NDN) delivered the Wellness Tour, offering cultural activities and SUD prevention education, from March 2021 to June 2022, to 11 AIAN tribal communities across California. The in-person program created a “sacred space” through culturally congruent song, dance, and prayer. SUD education included: a lecture about opioids and SUD; group talking circles; an educational skit led by adolescents; and training in naloxone and fentanyl testing strip use along with supplies. After the day-long program, 341 participants agreed strongly on a 5-point Likert type question that it improved their quality of life (mean = 4.7). Among 243 respondents, agreement was strong (mean = 4.8) to two Likert-type questions about cultural relevance and confidence in using naloxone. This AIAN-led program adopted safe practices during the pandemic to deliver culturally congruent SUD prevention education to severely affected AIAN communities.

Building capacity to implement sexual health risk and substance use disorder prevention services in adolescent behavioral health treatment: A case study

Adolescents with mental health and psychiatric disorders, as compared to their peers, are at increased risk for contracting sexually transmitted infections and developing substance use disorders (SUD). Practitioners need integrated programs addressing sexual health and substance misuse to promote healthy behaviors among vulnerable adolescent populations. Building agency capacity necessary to integrate sexual health education and SUD prevention can be challenging, but dissemination and implementation frameworks and models can provide a structured approach. This case study examines the application of the Interactive Systems Framework for Dissemination and Implementation and the Evidence-based System for Innovation Support to build the capacity of behavioral health agency staff to deliver an integrated sexual health risk and SUD prevention program with adolescents. Over a five-year period, researchers and behavioral health agency staff collaborated and increased agency capacity by using a training-of-trainers approach, comprehensive tools, proactive technical assistance, and quality assurance. While there were significant challenges, such as staff turnover and competing agency priorities, the team certified eight facilitators in the selected health promotion intervention and two agency trainers with the capacity for ongoing expansion and the expectation of sustainability of needed adolescent services.

Primary, Secondary, and Tertiary Prevention of Substance Use Disorders through Socioecological Strategies.

Primary, Secondary, and Tertiary Prevention of Substance Use Disorders through Socioecological Strategies.

Advancing the preclinical study of comorbid neuroHIV and substance use disorders: Current perspectives and future directions

Human immunodeficiency virus (HIV) remains a persistent public health concern throughout the world. Substance use disorders (SUDs) are a common comorbidity that can worsen treatment outcomes for people living with HIV. The relationship between HIV infection and SUD outcomes is likely bidirectional, making clear interrogation of neurobehavioral outcomes challenging in clinical populations. Importantly, the mechanisms through which HIV and addictive drugs disrupt homeostatic immune and CNS function appear to be highly overlapping and synergistic within HIV-susceptible reward and motivation circuitry in the central nervous system. Decades of animal research have revealed invaluable insights into mechanisms underlying the pathophysiology SUDs and HIV, although translational studies examining comorbid SUDs and HIV are very limited due to the technical challenges of modeling HIV infection preclinically. In this review, we discuss preclinical animal models of HIV and highlight key pathophysiological characteristics of each model, with a particular emphasis on rodent models of HIV. We then review the implementation of these models in preclinical SUD research and identify key gaps in knowledge in the field. Finally, we discuss how cutting-edge behavioral neuroscience tools, which have revealed key insights into the neurobehavioral mechanisms of SUDs, can be applied to preclinical animal models of HIV to reveal potential, novel treatment avenues for comorbid HIV and SUDs. Here, we argue that future preclinical SUD research would benefit from incorporating comorbidities such as HIV into animal models and would facilitate the discovery of more refined, subpopulation-specific mechanisms and effective SUD prevention and treatment targets.

Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature.

Most substance use begins in adolescence. Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use, which is associated with greater eventual severity of substance use disorders (SUDs). When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches. To systematically review existing literature on interventions for prevention or treatment of SUDs among adolescents (aged 10-24) with a history of trauma, with or without PTSD, we searched databases (PubMed, PsycInfo, CINAHL, Cochrane CENTRAL) using search terms related to substance use, trauma, adolescents, and interventions. Searches identified 8134 unique articles, 68 of which prompted full-text screening. Authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings. Thirty three articles met eligibility criteria, including 13 RCTs. Twenty studies (10 RCTs) evaluated interventions for substance use and co-occurring problems among youth with a history of trauma, predominantly via individual therapy based on cognitive-behavioral principles, although group therapy, case management, and other approaches have also been studied. Interventions with exposure-based components were infrequent but had robust results and minimal adverse outcomes. Thirteen studies examined differential response of youth with a history of trauma to standard SUD treatments, compared to youth without a history of trauma, with mixed findings. Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments. Several promising interventions have been recently developed.

California awards $17 million for SUD prevention for youth

This month Gov. Gavin Newsom of California announced that almost $17 million has been awarded to 44 community‐based and tribal organizations to develop and increase substance use disorder (SUD) prevention services through civic engagement and culturally competent programs. These awards are part of Elevate Youth California, a statewide Department of Health Care Services (DHCS) initiative to help grassroots community‐based and tribal organizations develop programs for young people living in communities that are disproportionately impacted by the war on drugs.

Acupuncture in Addiction Medicine: Its History, Evidence, and Possibilities.

Substance-use disorders (SUDs) and drug addiction are not only national, but also global health concerns that have worsened during and after the COVID-19 pandemic. Acupuncture augments the endogenous opioid system and, therefore, has a theoretical basis as a treatment for opioid use disorders (OUDs). The basic science of acupuncture, its clinical research in addiction medicine, and decades of success of the National Acupuncture Detoxification Association protocol offer positive findings supporting this protocol's utility for treating SUDs. Considering the mounting opioid/substance-use concerns and deficiencies in SUD treatment availability in the United States, acupuncture can be a safe, feasible treatment option and adjunct in addiction medicine. Furthermore, large governmental agencies are lending support to acupuncture for treating acute and chronic pain, which, in turn, could translate to prevention of SUDs and addictions. This article is a narrative review of the background, the basic science and clinical research, and future direction of acupuncture in addiction medicine.

Medication Assisted Recovery: A Social Ecological Approach to Understanding How Stigma Shapes Effective Use

Stigma is a well-documented barrier to effective individual and community response to mental illness and, in recent years, is a recognized impediment to prevention and treatment of substance use disorders (SUDs). This study uses focus group data to explore stigmatizing views of medication assisted recovery (MAR) among those in recovery and the people, organizations, and communities that surround them, with attention to implications for long-term recovery. Across groups, we find consistent themes that MAR simply trades one drug for another, MAR should be used only as a stepping-stone to full abstinence, and that long-term use of MAR indicates ineffectiveness or treatment failure. Data suggest the prevalence of these perceptions leads those in recovery and providers to see MAR as a last resort treatment, encourages individuals to discontinue MAR before they are ready, and as result increases risk of relapse and overdose.