Substance Use Disorders Research Articles

Comorbid treatment of traumatic brain injury and mental health disorders.

The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. This article reviews the EHVP. The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members.

Associations of stigma, loneliness, and treatment self-regulation with HIV medication adherence among individuals with substance use disorder using a mobile health application.

Medication adherence contributes to poor HIV outcomes, especially among people with HIV and Substance use disorder (SUD). Mobile health applications have been leveraged to improve behavioral health outcomes among this population. Our cross-sectional study examined the relationship between medication adherence with factors such as treatment self-regulation, isolation, and internalized stigma, among people with HIV and SUD using the Addiction Comprehensive Health Enhancement Support System (A-CHESS) mobile app. A sample of 208 participants using A-CHESS to improve treatment adherence completed a survey. Adherence was measured using the Four-item Morisky Medication Adherence Scale and dichotomized (maximum score of 20 points considered as adherent). Positive and negative affect was measured separately using Positive Affect Negative Affect Schedule and loneliness was measured using UCLA three-item Loneliness Scale. Internalized stigma was measured using Internalized AIDS-Related Stigma Scale. Competence/Treatment self-regulation was measured using Treatment Self-regulation Questionnaire. Multivariable logistic regression was used to assess the associations of affect, treatment self-regulation, isolation, and internalized stigma, with adherence to antiretroviral therapy adjusting for age, education, and gender. Among 208 participants in this study, most were Black (n = 137; 66%), male (n = 156; 75%) and had a mean age of 46 (standard deviation = 11.3). The most reported substances associated with missing HIV medication were alcohol (27%) and cocaine/crack (20%). Logistic regression analysis revealed that internalized stigma was significantly associated with HIV medication adherence (OR = 0.82; 95% CI: 0.70-0.99; p = 0.034). Internalized stigma was significantly associated with HIV medication adherence. Further research is needed to better understand this relationship and develop interventions addressing stigma in people with HIV and SUD.

Daily cigarette smoking among inpatients for substance use disorders in France, 2010-2020: Commonalities and specificities across substances.

This study aims to estimate the prevalence and factors associated with cigarette smoking among patients in treatment for substance use disorders (SUD) in France. We analyze a nation-wide dataset retrieving information on patients entering treatment for alcohol, opioid and stimulant use disorders between 2010 and 2020. We conduct multilevel Poisson regressions to determine the main factors associated with daily cigarette smoking among all patients who entered treatment for alcohol (n=607122), opioid (n=283381) or stimulant (n=57189) use disorders, and zero-truncated negative-binomial regressions to predict the average number of cigarettes per day. Daily cigarette smoking remains a widespread behavior among patients with SUD (overall prevalence: 72.2%, 95% CI: 72.1-72.3), with lower prevalence of daily cigarette smoking among patients treated for alcohol use disorders (69.9%, 95% CI: 69.8-70.0), and higher for patients treated for opioid (78.8%, 95% CI: 78.6-79.0) or stimulant use disorders (75.8%, 95% CI: 75.4-76.2). There was an overall increase in daily cigarette smoking over time (69.9%, 95% CI: 69.8-70.0 in 2010 vs 76.8%, 95% CI: 76.5-76.9 in 2020); however, the average number of cigarettes per day decreased (17.8 per day, 95% CI: 17.7-17.9 in 2010 vs 16.3 per day, 95% CI: 16.2-16.4 in 2020). The higher the education level, the fewer number of cigarettes per day; conversely, the higher the occupational status, the higher the number of cigarettes. The high prevalence of smoking among patients treated for SUD in France departs from the decreasing trend observed in the general population and remains a source of concern. It is necessary to implement tailored prevention strategies that target specific patient subgroups and increase staff awareness.

Staff perspectives of barriers and facilitators to implementation of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in New York City safety net hospitals

BackgroundIn response to the heavy burden of untreated substance use disorders (SUD) in hospital patients, many health systems are implementing addiction consult services staffed by interprofessional teams that diagnose SUD, make recommendations for SUD care in the hospital, and link patients to post-discharge treatment. In 2018, the New York City public hospital system began rolling out the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in six hospitals. CATCH teams are comprised of an addiction-trained medical provider, social worker or addiction counselor, and peer counselor. MethodsThe study conducted qualitative interviews with CATCH staff at all six participating hospitals as part of a pragmatic trial studying the effectiveness and implementation of CATCH. The Consolidated Framework for Implementation Research (CFIR) framework guided interviews conducted from 2018 to 2021 with 26 staff at the start of implementation and with 33 staff 9–12 months post-implementation. The study team created a codebook a priori and further refined it through additional coding of initial interviews. Codes were systematically analyzed using the CFIR. ResultsBarriers and facilitators spanned four CFIR domains: inner setting, outer setting, process, and individual characteristics. Barriers identified were primarily related to the outer and inner settings, including patient characteristics and limited resources (e.g. medical comorbidities, homelessness), insurance, CATCH team role confusion, and infrastructure deficits (e.g., availability of physical space). Additional barriers related to process (workload burden), and characteristics of individuals (stigma and lack of comfort treating SUD among medical teams). Facilitators were mostly related to the characteristics of individuals on the CATCH team (advantages and expertise of the CATCH peer counselor, CATCH team communication and cohesiveness) and inner setting (CATCH team relationships with hospital staff, hospital leadership buy-in and support, and infrastructure). Community networks (outer setting) and CATCH training resources (process) were also facilitators of program implementation. ConclusionAddiction consult services have great potential for improving care for hospital patients with SUD, but as new programs in busy hospital settings they face barriers to implementation that could impact their effectiveness. Barriers may be particularly impactful for programs operating in safety-net hospitals, given limited resources within the health system and the multiple and complex needs of their patients. Understanding the strengths of these programs as well as the barriers to their implementation is critical to utilizing addiction consult services effectively.

Fentanyl Initiation Rate Following the Requirement for Specialist Approval.

Healthcare organizations attempt to address unwarranted fentanyl use, which often leads to increased risk of addiction and overdose. To assess the impact of a requirement for a specialist's approval on fentanyl initiation for non-oncological pain. A retrospective cohort study based on observational data. All 4.4 million non-oncological members of Clalit Health Services were included, from July 20, 2021, to July 19, 2023. The rate of fentanyl initiation was assessed before and after the implementation of the requirement for specialist's approval, which was introduced on July 2022, and expanded 6months later for continued use. A sub-group analysis by age group was performed, and patient characteristics and indications were assessed. We also compared total opioid dispensation in the 6th and 12th months after the implementation with the predicted rate based on pre-implementation rates. Fentanyl initiation rate in the year before the requirement was 711 per million capita, which decreased following the requirement by - 81% (95% CI: - 77%; - 85%). The decrease attenuated with age. The prevalence of diagnosis with substance abuse disorders at the time of fentanyl initiation decreased from 6 to 3%. In the 6th and 12th months after the requirement was implemented, the morphine milligram equivalent (MME) from dispensation of total opioids was lower than predicted based on pre-implementation rates by 7% and 26%, respectively. Requiring specialist approval for fentanyl initiation for non-oncological chronic pain was associated with a decrease in fentanyl prescription initiations, especially among non-elderly patients. A decrease also occurred gradually in total opioid dispensations, further decreasing following the extension of the requirement to continuous fentanyl. The requirement for specialist approval upon fentanyl initiation and continuous fentanyl may present an effective tool for limiting the use of fentanyl and total opioids in healthcare systems.

Impact of substance type and patient characteristics on the choice of treatment setting for substance use disorder in Belgium

BackgroundSpecialised addiction treatment centers (SAC) and general mental health centers (GMHC) both offer care to people with substance use disorders (SUD) in Belgium, but these sectors often operate in parallel, with little collaboration. This fragmented system may lead to inefficiencies, particularly in the treatment of individuals with dual diagnoses. Despite the recognized challenges, there is limited understanding of the factors that influence whether patients with SUD are treated in SAC or GMHC. ObjectivesThis observational study has two main objectives:1.To examine whether and how the primary substance of abuse influences the choice of either SAC or GMHC.2.To assess whether other factors (e.g. sociodemographics, institution or person who orientated the patient to treatment) play a significant role in determining the type of center where the patient is treated. MethodsThe study used routinely collected data from treatment centers in Belgium from 2019 (Belgian Treatment Demand Indicator). Logistic regression evaluated the weight of drug use and sociodemographic variables for people entering treatment for SUD for the first time (n = 8322). A random forest algorithm was used to study all patients' orientation toward both sectors, across all treatment episodes (n = 29,658). ResultsThe study found that the primary substance significantly influences sector choice. Patients using illicit substances like cannabis, opiates, cocaine, and stimulants are 6–12 times more likely to be treated in an SAC than those using alcohol. Factors such as income source and referral source (e.g. self-referral, general practitioner, etc) also significantly impact patient orientation. ConclusionThese findings highlight the need for better integration between SAC and GMHC to adequately address the complex needs of people with SUD, especially with dual diagnosis.

Nurse led models of care for outpatient substance use disorder treatment: A scoping review.

To map key characteristics and describe nurse led models of care for the treatment of persons with substance use disorders (SUDs) in the outpatient setting. A scoping review. Conducted in accordance with the JBI methodology. The PRISMA-ScR checklist was used. Pubmed, CINAHL Complete (EBSCOhost), Cochrane Library, APA PsycNet and Scopus were searched from 1999 to May 2022 and updated on 28 November 2023. A handsearch and a grey literature search was conducted. Title and abstract screening was performed on 774 articles resulting in 88 articles for full text screening. Full text screening yielded 13 articles that met inclusion criteria. Existing nurse-led models of care for SUDS are scarce and limited in scope, with the majority focused on treating opioid use disorder. Additional research is needed to develop, test, and implement efficacious nurse-led models of care for the treatment and management of SUDs. Nurse led models of care have demonstrated their efficacy and quality in the management of other chronic diseases. As we move forward with innovative solutions for individuals with addiction, nurse led models of care can be a mechanism to deliver high quality, evidence-based care for SUDs. SUDs are chronic diseases that impact individuals, families, and communities. SUDs require a biopsychosocial approach to treatment. Globally, nurses are well positioned to provide high quality care to mitigate the impact of SUDs. This scoping review mapped the extant literature on nurse led models of care for substance use disorder treatment in the outpatient setting finding that additional research is needed to develop, test and implement evidence-based interventions to care for individuals, families, and communities experiencing SUDs. PRISMA checklist for scoping reviews. No patient or public contribution were part of this study. Open Science Framework accessible at: https://doi.org/10.17605/OSF.IO/NSW7V.

Tamizaje del trastorno por déficit de atención e hiperactividad (TDAH) en pacientes hospitalizados por farmacodependencia en una unidad de salud mental en Barranquilla, Colombia

Attention Deficit Hyperactivity Disorder (ADHD) is considered a neurodevelopmental disorder that typically presents in childhood and can continue into adulthood. Mainly affects three areas given by attention, impulse control, and hyperactivity, which end up affecting the psychosocial development, interpersonal relationships, and academic level of the subject. The prevalence varies depending on age group, sex, and location; however, it is estimated at 7% overall in the pediatric population and 4.5% in adults. ADHD symptoms have been found to predict tobacco, alcohol, and cannabis use; and additionally, if left untreated, it is estimated that up to 50% of people with ADHD will manifest a substance use disorder at some point in their lives, however there are no data on such comorbidity in our population, so we consider necessary to determine the prevalence of ADHD in the population hospitalized for Substance Use Disorder (SUD) in the mental health institution through screening with self-report scales. Here we report the sociodemographic characterization, drug use pattern and comorbidities of this population, as well as the result of screening with the Wender Utah scale (WURS-25) and Adult ADHD Self Report Scale (ASRS V1.1). The study included a total of 74 subjects who were hospitalized in a mental health institution located in Barranquilla, Colombia, with a diagnosis of SUD. It was found that 50% of patients scored positive for ADHD diagnosis according to the ASRS scale, probable diagnosis 20.3% and unlikely 29.7%, with 44.6% positive on the WURS-25 scale. The results of the present study suggest that screening for ADHD is a useful tool to detect comorbidity in patients with SUD, who could benefit from comprehensive treatment for both pathologies and thus impact the course and prognosis of the disease, as well as their functionality and quality of life.

N‐acetylcysteine as a treatment for substance use cravings: A meta‐analysis

AbstractN‐acetylcysteine (NAC) may serve as a novel pharmacotherapy for substance use and substance craving in individuals with substance use disorders (SUDs), possibly through its potential to regulate glutamate. Though prior meta‐analyses generally support NAC's efficacy in reducing symptoms of craving, individual trials have found mixed results. The aims of this updated meta‐analysis were to (1) examine the efficacy of NAC in treating symptoms of craving in individuals with SUD and (2) explore subgroup differences, risk of bias and publication bias across trials. Database searches of PubMed, Cochrane Library and ClinicalTrials.gov were conducted in June and July of 2023 to identify relevant randomized control trials (RCTs). The meta‐analysis consisted of 9 trials which analysed data from a total of 623 participants. The most targeted substance in the clinical trials was alcohol (3/9; 33.3%), followed by tobacco (2/9; 22.2%) and multiple substances (2/9; 22.2%). Meta‐analysis, subgroup analyses and leave‐one‐out analyses were conducted to examine the treatment effect on craving symptoms and adverse events (AEs). Risk of bias assessments, Egger's tests and funnel plot tests were conducted to examine the risk of bias and publication bias. NAC did not significantly outperform placebo in reducing symptoms of craving in the meta‐analysis (SMD = 0.189, 95% CI = −0.015–0.393). Heterogeneity was very high in the meta‐analysis (99.26%), indicating that findings may have been influenced by clinical or methodological differences in the study protocols. Additionally, results indicate that there may be publication bias present. Overall, our findings are contrary to those of prior meta‐analyses, suggesting a limited impact of NAC on substance craving. However, the high heterogeneity and presence of publication bias identified warrants cautious interpretation of the meta‐analytic outcomes.

Assessing the existence of trauma-related diagnostic overshadowing in adult populations.

Previous research with youth has shown that clinicians tend to diagnose and treat posttraumatic stress disorder (PTSD) in trauma-exposed clients, even when clinical presentations indicate that PTSD is not the primary diagnosis. The current study sought to examine this trauma-related diagnostic overshadowing bias in adult cases across different types of trauma exposure. Mental health professionals (N = 232) reviewed two vignettes describing an adult seeking treatment for either obsessive-compulsive disorder (OCD) symptoms or substance use disorder (SUD) symptoms (target disorders). Each participant was randomly assigned to one vignette in which one client endorsed exposure to trauma (i.e., sexual trauma or physical trauma) and one vignette in which the client reported no trauma exposure. Following each vignette, participants responded to questions related to the diagnosis and treatment of the client. In both cases, participants were significantly less likely to choose the target diagnosis and treatment and more likely to choose a PTSD diagnosis and trauma treatment when trauma exposure was present in the vignettes. Evidence for the bias was strongest for vignettes that contained sexual trauma compared to vignettes that contained physical trauma. Evidence for the bias was also more consistent in the OCD case compared to the SUD case. Results indicate evidence for the existence of trauma-related diagnostic overshadowing in adult populations, though the strength of this bias may be dependent on aspects of the trauma and overall clinical presentation. More work is needed to understand factors that may impact the presence of this bias. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Integration of pharmacochemistry, pharmacodynamics and metabolomics to reveal active ingredients and mechanism of Nan Bao detox capsule alleviating methamphetamine addiction.

Nan Bao detox capsule (NBDC), derived from ancient Chinese opioid detox protocols, shows promising therapeutic potential in substance abuse disorders, particularly for attenuating methamphetamine (MA) addiction. This study aimed to identify active ingredients, evaluate therapeutic efficacy in an MA addiction rat model and delineate pharmacodynamic mechanisms using metabolomics. In vitro phytochemical profiling characterized 258 drug-related compounds, with 87 prototype entities mainly identified in rat plasma. NBDC significantly attenuated METH-induced behavioural anomalies and modulated neurotransmitter levels, notably increasing brain DA and serotonin (5-HT) content with concomitant upregulation of D1 dopamine receptor (DRD1) and 5-HT1A receptor (5-HT1AR) expression, ameliorating hippocampal pathology. Metabolomic analysis identified histamine receptor as a potential target and revealed the involvement of NBDC in metabolic pathways associated with cocaine addiction, amphetamine abuse and Parkinson's disease. Conclusively, NBDC presents a promising therapeutic agent for mitigating MA addiction through a synergistic interplay of multiple constituents, pharmacological targets and metabolic pathways.

Development of the Food Addiction Symptom Inventory: The first clinical interview to assess ultra-processed food addiction.

Prior research on ultra-processed food addiction (FA) has utilized the self-report Yale Food Addiction Scale (YFAS) measures to identify individuals who experience indicators of substance-use disorders with respect to their consumption of ultra-processed foods. Studies using the YFAS have provided insight into the clinical utility of FA as both a distinct construct and an indicator of more severe psychopathology among individuals with eating disorders. However, the absence of clinician-administered assessment tools for FA has been identified as a barrier to the evaluation of FA as a novel clinical syndrome. Thus, the present study reflects the development of the Food Addiction Symptom Inventory (FASI), a clinician-administered assessment of FA, adapted from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth editon modules for diagnosing substance-use disorders. The psychometric properties of the FASI and its concordance with the YFAS 2.0 were evaluated in a cross-sectional study of adults (n = 53) with binge-type eating disorders. The FASI performed appropriately on indices of reliability and validity. Concordance between the FASI and YFAS 2.0 was established for the symptom scores (r = .53, p < .001), and > 70% agreement was achieved for FA categorization. Using the FASI, 80% of individuals with bulimia nervosa and 91.7% of those with binge eating disorder were identified as exhibiting FA. While the YFAS 2.0 and FASI both lead to similar assessments of FA symptoms, the FASI provides an essential approach for clinician-guided identification of this phenotype, which may be particularly important when participants have high levels of dietary restraint or limited insight into the impact of their eating behavior. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measuring the effects of ketogenic diet on neuropsychiatric disorder: A scoping review.

This scoping review aims to examine the available literature on the ketogenic diet's (KD) efficiency as a potential therapeutic intervention for various neuropsychiatric disorders. The KD is a high-fat, low-carbohydrate diet that has been studied for its potential benefits in managing neuropsychiatric disorders. However, the extent of its effectiveness across a spectrum of these conditions remains unclear. The study designs considered eligible encompassed randomized and non-randomized controlled trials, retrospective and prospective observational studies, and comparative effectiveness assessments. The criteria for including each study were specifically related to neuropsychiatric disorders, referring to the DSM-5 coding guidelines. A systemic search was performed by an experienced reference librarian across multiple databases to pinpoint studies relevant to the influence of the ketogenic diet on neuropsychiatric disorders. All relevant articles were included that ranged over the last thirteen years. All relevant records identified were compiled into the Covidence systematic review software. A total of 30 studies were reviewed, which reported effects of the KD on neuropsychiatric disorders, including improvements in Global Developmental Delay, Childhood Autism, Attention Deficit/Hyperactivity Disorder (ADHD) symptoms, psychotic symptoms, Bipolar and Related Disorders, Depressive Disorder symptoms, anxiety symptoms, eating disorders, Substance-Related and Addictive Disorders, Major and Mild Neurocognitive Disorders, and Seizure Disorders. The KD may serve as a promising therapeutic intervention for various neuropsychiatric disorders. However, the evidence is heterogeneous, and further rigorous research is needed to establish the KD as a standard treatment for these disorders and to understand the underlying mechanisms of its effects. This review underscores the need for healthcare professionals to consider the potential benefits and limitations of the KD when managing patients with neuropsychiatric disorders. It also highlights the importance of individualized treatment plans based on the specific needs and responses of each patient.

Übersichtsarbeiten / Review Articles. Die Computerspielstörung in der ICD-11: Hintergründe, Kriterien und mögliche Implikationen / Gaming Disorder According to the ICD-11: Background, Criteria and Possible Implications

Gaming Disorder According to the ICD-11: Background, Criteria and Possible Implications Within 60 years, playing computer games - online or offline, with a computer, games console or smartphone - has developed from a niche activity for mostly young males into a global industry worth billions. Studies show that children and adolescents in particular tend to play digital games for several hours a day, making gaming one of the most common leisure activities for young people. A small proportion of young gamers may develop addictive behaviour with harmful effects on their psychosocial functioning. Following an intense discussion process lasting several years, the World Health Organisation (WHO) responded by introducing the new disorder category, "gaming disorder", which was placed as a second disorder alongside "gambling disorder" in the chapter on behavioural addictions. As with substance-related addiction disorders, computer game addiction is conceptualized within an "addiction triangle" framework, which considers a combination of individual risk factors, environmental factors and factors intrinsic to the game itself. This article presents a discussion of the recently proposed diagnosis of gaming disorder in the context of its diagnostic criteria and aetiological factors and concludes by discussing possible implications for clinical practice.

Effective Strategies for Managing Substance Use Disorders in Older Adults in Nursing Homes

Substance use disorder is very prevalent in nursing home (NH) residents due to aging, the number of prescription drugs that are being used to manage their physical and psychological pain, and several discharges with the diagnosis of substance use disorder from hospitals to NH for aftercare support. However, many nursing homes are not equipped to provide adequate care for residents with a diagnosis of substance use. The staff is not well-trained to care for this type of population, which is becoming a challenge for the staff to manage residents in-house, leading to overdose, recurrent hospitalization, and unsuccessful discharges to communities due to relapses and an increase in the number of frequent flyers. Substance use disorder has become a significant public health concern in the United States, especially in the older population from the past couple of decades, which tends to increase. Discharging older adults with substance use disorders into nursing homes without ensuring established resources in the long-term care setting raises safety and quality concerns, emphasizing a pressing need for innovative preventive and management approaches for substance use disorders to meet unique needs of older adults in nursing homes. Purpose: The purpose of the study is to explore and identify the interventions, treatments and care models to effectively manage substance use disorders in older residents who are living in nursing homes. The study further focuses on the unique challenges that are faced by older adults and staff in nursing homes to understand the need for integrating addiction treatments in Long-term care settings to assess the need to enhance care strategies to improve resident outcomes, which includes handling overdose emergencies, prevention, rehabilitation and relapse management of substance use disorders (SUDs). Scope: Provides valuable insights for future researchers and points out the need for collaborative models among the rehabilitation, addiction centers, and LTC and the need for virtual health platforms to improve access to care, interdisciplinary approaches, and policy innovation on resident retention and optimum resource allocation to reduce the health care cost of frequent flyers or unnecessary hospitalizations, therefore, improve patient outcomes.

Cariprazine in Bipolar Disorder and Substance Use: A Dual Approach to Treatment?

Bipolar disorder (BD) is characterized by recurrent episodes of mania, hypomania, and depression and is often complicated by comorbid substance use disorders (SUDs). Up to 60% of individuals with BD experience SUDs, which exacerbate mood instability and increase the risk of rapid cycling, suicide, and poor clinical outcomes. Current treatment strategies, including lithium and valproate, show limited efficacy in treating both BD and SUD. Psychotherapeutic approaches such as cognitive behavioral therapy (CBT) offer benefits but lack a specific focus on substances such as cannabis and cocaine. Since there is still debate on how to treat this comorbidity, there is a need to find new therapeutic options; this mini-review examines the pharmacological properties of cariprazine and its emerging role in the treatment of comorbid BD and SUD. Cariprazine, an atypical antipsychotic with partial agonism at dopamine D2 and D3 receptors, has shown promise in treating both mood symptoms and cognitive dysfunction in BD. Its unique affinity for D3 receptors, which are involved in motivation and reward processing, may offer advantages in reducing drug craving. Clinical trials indicate that cariprazine effectively treats manic, depressive, and mixed episodes in BD with a favorable side effect profile, particularly at lower doses. Preliminary results suggest its potential to reduce craving and substance use in individuals with co-occurring BD and SUD. Therefore, cariprazine, with its unique pharmacodynamic mechanism, could be further studied for the treatment of BD in comorbidity with SUD. However, evidence on the role of cariprazine in the treatment of SUDs remains limited, based primarily on case reports and animal studies. Further research, including large-scale clinical trials, is needed to determine its full efficacy in this dual diagnosis.

The Effect of Eye Movement Desensitization and Reprocessing (EMDR) Therapy on Reducing Craving in Populations with Substance Use Disorder: A Meta-Analysis.

Substance use disorder (SUD) significantly impacts public health, economics, and legal systems worldwide. Eye Movement Desensitization and Reprocessing (EMDR) was initially developed in the late 1980s as a therapeutic approach for post-traumatic stress disorder (PTSD), using bilateral stimulation to integrate traumatic memories with calming physiological responses. However, the effectiveness of EMDR in treating SUD remains unclear. This study aims to conduct a systematic review and meta-analysis of the impact of EMDR therapy on craving reduction in individuals with SUD. The search was conducted using databases such as PubMed and Web of Science, focusing on studies that measured craving and employed EMDR interventions. Both random and fixed effects models were used to pool effect sizes, utilizing an R software meta-package (R-4.4.1). The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The results indicated a significant reduction in cravings among patients undergoing EMDR therapy. Specifically, under the fixed effect model, the standardized mean difference (SMD) was -0.866 with a 95% confidence interval ranging from -1.121 to -0.611 (z = -6.66, p < 0.0001). These findings may demonstrate the significant efficacy of EMDR therapy in decreasing cravings in people with SUD.

A Holistic Harm Reduction Center Model: A Commentary

Substance addiction is a chronic, relapsing disorder characterized by compulsive drug seeking, loss of control over consumption, and a negative emotional state when access to the drug is restricted. Substance Use Disorders (SUDs) are associated with severe health issues including suicide and co-occurring diseases like HIV and hepatitis C, and mental health problems. Although the present SUD treatment models prioritize abstinence, achieving abstinence during a treatment episode is challenging as majority of individuals with SUDs continue using drugs during treatment. To address this challenge in the current SUD treatment model, harm reduction has emerged as a strategy that focuses on interventions such as naloxone distribution, syringe services, safe drug use education and other strategies that reduce harmful outcomes such as substance-related overdose death and disease transmission while improving quality of life. This commentary proposes a Holistic Harm Reduction Model that can be incorporated by harm reduction centers aimed at reducing risky drug use behavior and overdose deaths, and ultimately improving public health outcomes in the community. The proposed holistic model includes new components such as trauma-informed care and referral and a brief mindfulness intervention along with the already existing harm reduction approaches such as Licensed Practical Nurses (LPNs) and harm reduction managers to provide comprehensive healthcare services, distribution of supplies; education; referral and linkage to other services, including medications for substance use disorder; and participant data collection and analysis.

Conceptualizing Recovery: Perspectives of Service Providers

ABSTRACT This study investigated the concept of Recovery from the perspective of SUD (substance use disorder) service providers in the state of Pennsylvania. Three questions related to how service providers conceptualize the recovery process, including in terms of stages and methods for measuring progress were posed to participants. Narrative data was analyzed using Iterative Thematic Inquiry (ITI). For each recovery question, between 3 and 5 themes were identified. Some of the themes aligned with our preconceived themes as part of the ITI process; some themes aligned with existing definitions of recovery; no themes reflected specific timelines related to the recovery process. Implications for research and practice are included.

Local Supports to Break the Cycle: A Description of Intersectional Interventions to Address Adverse Childhood Experiences and Drug Overdose.

Adverse childhood experiences (ACEs), substance use disorders (SUDs), and overdose are interconnected issues impacting individuals and communities at multiple levels of the social ecology and across generations. Few studies describe approaches that intentionally and simultaneously address these issues. This paper examines activities of 15 sites across the country that were designed to simultaneously prevent ACEs, SUD, and overdose. This paper describes the work at the intersection as well as gaps and opportunities. Describing ways to implement intersectional programming may assist other organizations in taking similar steps in their communities. From December 2020 through July 15, 2023, funded sites received technical assistance from the National Association of County and City Health Officials and the Centers for Disease Control and Prevention for 18months to support the implementation, adaptation, and/or expansion of evidence-based programs to address ACEs, SUD, and overdose. Activities were coded to identify intersectional interventions that addressed ACEs, SUD, and overdose. Most of the ACEs prevention strategies and overdose prevention priority areas/guiding principles from which communities could choose were represented. Most activities were implemented with caregivers and families and addressed ACEs through interventions to lessen harm or to promote social norms. Primary prevention and coordination of resources were the most used overdose prevention priority area/guiding principle. It is possible to address the intersection of ACEs, SUD, and overdose on a local level. Opportunities to further address the intersection include incorporating more secondary and tertiary prevention strategies, expanding economic supports, and increasing the work focused on equity.