Addiction Treatment Research Articles

Acceptability of “DIDE”, a mobile application designed at facilitating care adherence of patients with substance use disorder

BackgroundAttrition continues to be a major hurdle for addiction treatment. Through the prism of the attachment theory, this phenomenon can be understood as a manifestation of the patient’s insecure attachment style, needing a highly-responsive care delivery. We developed an electronic health mobile application, co-designed with patients, aimed at helping healthcare teams respond to their patients’ needs, and fostering adherence to care. This acceptability study evaluated patients everyday use of the application for eight weeks, assessing their satisfaction with the system, and its integration within professionals’ current practice in our center.MethodsThis single-center, prospective study was conducted between January 2022 and December 2022. 24 adult patients with any type of addiction were included. They were granted access to the application for eight weeks, and were invited to complete the System Usability Scale questionnaire regarding their satisfaction with application’s usability at the end of the study. The application uses active self-reports, which are later discussed with the healthcare team, and foster both the working alliance and the decision-making process.Results17 patients out of 24 reached the primary endpoint. On average, over the eight-weeks period, patients logged in the application 38.2 times, and sent 5.9 messages to the healthcare team. Interestingly, 64.3% of the user logins were recorded outside of our center’s working hours (either from 5 p.m. to 9 a.m., or during week-ends and bank holidays), and 70.8% of the patients logged into the application at least one time between 10 p.m. and 8 a.m. 18 patients completed the System Usability Scale questionnaire, which averaged a score of 81.8 out of 100. Healthcare professionals logged in the application’s messaging system 4.5 times a day on average.ConclusionsThis preliminary study shows promising results, as patients engaged well with various components of the application. It was moreover possible for healthcare workers in our center to integrate this tool in their daily activities. More work is needed to better understand the various patients’ needs regarding the application, further strengthen their adherence to the intervention, and understand professionals’ motivations to use the application.Trial registrationClinicalTrials.gov, Identifier: NCT04659954. Registered 09 December 2020, https://clinicaltrials.gov/study/NCT04659954.

Identifying and Characterizing Models of Substance Use Treatment in Outpatient Substance Use Treatment Facilities.

Given that individuals with substance use disorders (SUDs) have a variety of needs beyond substance use, it is critical to examine the comprehensiveness of services offered within outpatient SUD treatment facilities, where many individuals with SUDs receive care. This study's objective is to develop clusters of services offered, and assess organizational, policy, and environmental characteristics associated with having a more comprehensive treatment model. We conducted a principal component analysis (PCA) using data on SUD treatment facilities (n=8, 197) from the 2022 Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities. We applied a K-means cluster analysis on the generated components to cluster facilities by service offerings, and calculated the mean for different organizational, policy and environmental characteristics for each cluster. We retained five components from the PCA which represented the availability of different services (Pharmacotherapies, Infectious Disease and Harm Reduction, Supportive and Social Determinant of Health (SDOH) Services, Psychosocial Services, and General Healthcare.) The cluster analysis resulted in five SUD service models, with the most comprehensive having the highest percentage of accredited and Medicaid-accepting facilities, and facilities that were government-operated and located in a Medicaid expansion state, and the least comprehensive having lowest percentage of accredited, licensed and Medicaid-accepting facilities, and the highest percentage of private for-profit facilities. Our study found that SUD treatment facilities varied in the availability of five treatment components, but more comprehensive service models had a higher percentage of facilities that were licensed, accredited, and accepting Medicaid.

The Different Faces of Religion in Therapy: An Exploratory Qualitative Study of a Religion-Based Therapeutic Community for Addiction Recovery in Israel.

This article examines the impact of the integration of religion and psychological treatment in a religion-based therapeutic community for persons in recovery from addiction in Israel. Based on an exploratory qualitative study that includes participant observation in a Jewish forgiveness therapy training course and in-depth interviews with counselors working in the community, we identify three themes that characterize the therapeutic process. First, religion emerges as a challenge in therapy, one that should be addressed with sensitivity. Second, religion can be turned into a spiritual and cultural resource in the recovery process, with a cautious and sensitive approach. Third, religion can offer a remedial experience, without necessarily involving an intensification of faith. We offer principles that can help guide decisions regarding the integration of religion into therapy, with a focus on addiction treatment oriented to clients with a religious background.

Patterns and Challenges in Help-Seeking for Addiction among Men: A Systematic Review.

Background/Objectives: Addictive and substance-related disorders represent a substantial public health challenge, marked by rising incidence and prevalence rates. Men and women exhibit different patterns of help-seeking for health and social issues including addictions. This research aimed to analyze the help-seeking process among men with addiction to improve understanding and develop more effective, person-centered treatments. Methods: This systematic review was performed based on the Cochrane Collaboration guidelines and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of the revision was registered in advance in PROSPERO. Searches were conducted in the PubMed, Scopus, and Web of Science (WOS) databases. Results: Based on the literature search, 16 studies were included in the current systematic review. The analyzed studies included seven on substance-use disorders, three on gambling disorder, two on tobacco-use disorder, two addressing substance-related disorders in general, one on opioid-use disorder, and one focused on marijuana use. Gender differences influenced help-seeking behavior, with women generally exhibiting a higher propensity to seek assistance for addiction-related issues than men. Seeking help for addiction-whether substance use or gambling-can be hindered by several barriers, particularly public stigma and discrimination, which tend to be more pronounced for alcohol and gambling compared to tobacco. Additional barriers in the help-seeking process include negative beliefs and attitudes toward seeking help, often associated with traditional male gender roles. Each substance-use disorder was analyzed in depth to gain a better understanding of the barriers faced by this population. Conclusions: Integrating a gender perspective into the diagnosis, prevention, and treatment of addiction is essential. As addiction patterns vary between men and women, approaches must be tailored accordingly. Recognizing men as a distinct group in research and clinical practice is also crucial for developing more effective and personalized treatments.

Glutamate concentration of medial prefrontal cortex is inversely associated with addictive behaviors: a translational study

In both preclinical and clinical settings, dysregulated frontostriatal circuits have been identified as the underlying neural substrates of compulsive seeking/taking behaviors manifested in substance use disorders and behavioral addictions including internet gaming disorder (IGD). However, the neurochemical substrates for these disorders remain elusive. The lack of comprehensive cognitive assessments in animal models has hampered our understanding of neural plasticity in addiction from these models. In this study, combining data from a rat model of compulsive taking/seeking and human participants with various levels of IGD severity, we investigated the relationship between regional glutamate (Glu) concentration and addictive behaviors. We found that Glu levels were significantly lower in the prelimbic cortex (PrL) of rats after 20-days of methamphetamine self-administration (SA), compared to controls. Glu concentration after a punishment phase negatively correlated with acute drug-seeking behavior. In addition, changes in Glu levels from a drug naïve state to compulsive drug taking patterns negatively correlated with drug-seeking during both acute and prolonged abstinence. The human data revealed a significant negative correlation between Glu concentration in the dorsal anterior cingulate cortex (dACC), the human PrL counterpart, and symptoms of IGD. Interestingly, there was a positive correlation between Glu levels in the dACC and self-control, as well as mindful awareness. Further analysis revealed that the dACC Glu concentration mediated the relationship between self-control/mindful awareness and IGD symptoms. These results provide convergent evidence for a protective role of dACC/PrL in addiction, suggesting interventions to enhance dACC glutamatergic functions as a potential strategy for addiction prevention and treatment.

The Effect of Racial Concordance for Black Patients in Addiction Treatment: A Scoping Review of the Literature.

In the United States, Black people with substance use disorders (SUDs) have less access to treatment and worse treatment outcomes compared to White people. Though systemic racism is the root of these inequities, adapting treatment settings to serve this population may be a pragmatic way to improve access and outcomes. Shared racial identity between a patient and a provider, or racial concordance, is one feature of culturally tailored care that may improve treatment access, experiences, and outcomes for Black people. There is some evidence that racial concordance improves medical treatment for Black patients in non-addiction settings, but it is unknown whether racial concordance affects experiences or outcomes in addiction treatment. We conducted a scoping review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-to understand the effect of racial concordance on Black patients in addiction treatment. Three reviewers read each title and abstract to identify eligible articles. The inclusion criteria were: (1) Black patients; (2) treatment access, experiences, or outcomes; and (3) patient-provider racial concordance in addiction treatment. One reviewer completed full-text reviews and data extraction. We identified 259 nonduplicate articles and completed full-text reviews of 77 articles. Eleven articles, published between 1971 and 2016, met criteria. Racial concordance was not associated with treatment access or engagement, though it was associated with some positive outcomes including increased perceived provider empathy. Few studies met the review criteria and there were no randomized controlled trials. The studies identified in this review did not provide adequate evidence that racial concordance improved treatment access, experiences, or outcomes for Black patients. Future research should include a wider range of outcome measures, including relational measures (eg, medical trust, discrimination) and examine whether and under what circumstances racial concordance improves experiences and outcomes for Black patients in addiction treatment.

Mortality Risk for Individuals With Cocaine Use Disorders: Clients and Non-Clients of Public Treatment Centres for Drug Addiction

BACKGROUND: This study targeted individuals who turned for the first time to health services following problems caused by cocaine use (CUD). Our aim was to estimate mortality risk for individuals who were clients of PATS (public addiction treatment services) and never-PATS (those who were not). METHOD: Follow-up study. People resident in Emilia Romagna Region (Northern Italy), aged 18 years and older who for the first time turned to a HOS (hospital ward), an ED (emergency department), a MHS (community mental health centre) or to a PATS for cocaine use disorder were selected. The reference period was between 01/01/2009 and 31/12/2019 and the territory was the metropolitan area of Bologna. CMR (Crude mortality rates) per 1000 PY (Person Years) and SMRs (standardized mortality ratios) were calculated. RESULTS: The cohort was made up of 3,196 subjects. CMR was 4.5 (95% CI 3.6-6.6) per thousand patient/years, SMRs were 4.3 (95% CI 3.5-5.4). The results highlight high CMRs (5.5, 95% CI 3.8-8.1) and SMRs (4.7, 95% CI 3.2-6.9) for individuals who never accessed PATS. Higher and statistically significant incidence rate ratios were found from the multivariate analysis among females and natives, in patients never accessed to PATS, aged more than 35 years and reporting using alcohol or opioids at first admission. CONCLUSIONS: Innovative strategies to facilitate the reduction of barriers to access and to facilitate taking charge in PATS for people with cocaine use disorders must be identified.

Engagement in substance use disorder treatment after an emergency department visit among persons at high risk of opioid overdose: A prediction analysis

BackgroundCertified peer recovery specialists (CPRS) and licensed clinical social workers (LCSWs) can facilitate substance use disorder (SUD) treatment engagement for emergency department (ED) patients at risk for overdose. Predictors of treatment engagement after such behavioral services are unknown. MethodsThis secondary analysis included Rhode Island ED patients at high risk for opioid overdose participating in a randomized controlled trial comparing the effectiveness of CPRS and LCSWs services (2018–2021). SUD treatment engagement within 90 days post-discharge was identified using statewide administrative data. Potential predictors were obtained from baseline questionnaires. Classification and regression trees (CART) were used to identify predictors of treatment engagement. ResultsIn the ED, 323 and 325 participants received CPRS and LCSWs services, respectively, among whom 141 (43.7 %) and 137 (42.2 %) engaged in SUD treatment within 90 days post-discharge. For the CPRS group, predictors of treatment engagement included unhealthy alcohol use, prescription opioid or benzodiazepine use in past 6 months, and lifetime history of: unstable housing, barriers to treatment, bipolar disorder diagnosis, addiction treatment, and recovery services. In the LCSW group, predictors included health insurance, current pain, opioid overdose in past year, and lifetime history of anxiety disorder diagnosis and mental illness treatment. However, CART had low predictive accuracy (CPRS: 60.9 %, LCSW: 54.8 %). ConclusionsAmong ED patients at high risk of opioid overdose receiving behavioral services, 90-day SUD treatment engagement was high. Sociobehavioral and clinical patient characteristics did not accurately predict treatment engagement. Behavioral services should be offered to all ED patients at high risk of opioid overdose.

Barriers and Facilitators to Mental Health Service Integration: A Scoping Review.

Mental health service integration currently has no consensus definition and exists in a variety of settings, including primary care, addiction treatment and chronic disease management, and mental health nurses have often experienced efforts at service integration with varying degrees of success. The intent of mental health service integration is to enable collaboration between mental health services and other healthcare providers to improve service access and the care provided to individuals with mental health issues or mental illness. This scoping review aimed to explore service integration between mental health services and with a specific focus on those evaluated in peer-reviewed, primary literature, to determine facilitators and barriers to service integration. Using the Arksey and O'Malley's framework for scoping reviews, we located 3148 studies, with screening narrowing final papers for inclusion to 18. Facilitators to service integration included clinician education, adequate resourcing and an interdisciplinary approach, while barriers included staff factors such as a reluctance to work with individuals with mental illness, consumer level barriers such as poor mental health literacy, 'territorialism' among staff and organisational climate. Research indicates that service integration is an effective means to detect and treat mental health issues in settings that do not traditionally provide mental health care, lowering the costs of providing healthcare and providing improved care for mental health needs; however, there are several barriers to be addressed to achieve full implementation of integration models.

The family and substance abuser in the mental health institution environment.

South African drug usage demographics are rare. Substance abuse disorder patients and their families have complex interactions. This study examines family members living with drug addict. The study seeks to investigate the experiences of family members living with a substance use disorder (SUD) individual. The research took place in a Gqeberha psychiatric facility. Low-income households were interviewed. This research is qualitative, exploratory, and descriptive study. Recorded and transcribed in-depth patient family interviews were collected. Qualitative thematic analysis was used to analyse data. The data themes were interpreted using family systems theory. Each of the three main themes has subthemes. The first theme concerns family members' inadequate comprehension of addiction. The subtheme explores family members' denial and failure to recognize substance use disease symptoms. The second theme concerns variations in behaviour that challenge cultural norms. This subtheme addresses hallucinations, delusions, and fury in SUD patients. The third theme addresses the negative effects of drug use on families, potentially leading to divorce. This subtheme focuses on the family's lack of awareness of resources that may have supported them and the SUD individual. Immediate family members are crucial to patient recovery. The family seemed to be struggling living with an SUD relative. Experts should help the family to manage the addict's treatment. Healthcare education can help families cope with substance abusers. This study will assist the nursing administration in discovering ways to help families manage a loved one with an SUD.

Navigating new norms: Addiction specialists' perspectives on opioid use disorder treatments and policy challenges in the fentanyl era.

Amidst increasing opioid-related overdoses in the USA, opioid use disorder (OUD) treatment has seen few novel treatments emerge. High-potency synthetic opioids (HPSOs) have altered clinical approaches, prompting evaluation of existing medications for opioid use disorder (MOUD) and interest in slow-release oral morphine (SROM) as another therapeutic option. Here we survey addiction specialists on the influence of HPSOs on clinical practice, views on current MOUD regulations, and openness to novel therapies such as SROM. Anonymous, online survey conducted at a national conference of addiction specialists (N = 91). Pearson χ2 tests and Fisher's exact tests to compare respondent characteristics. Approximately 89% of respondents (N = 91) acknowledge that HPSOs shifted addiction treatment in recent years, with 86% modifying their MOUD prescribing accordingly. Moreover, 84% report having patients who could benefit from other full opioid agonists beyond methadone for OUD management. Many report off-label prescribing of full agonist opioids other than methadone for withdrawal symptoms or initiating MOUD. Eighty percent reported being in favor of incorporating SROM as a third-line monotherapy for OUD. This sample of addiction specialists supports innovative alternatives for MOUD in the USA to combat the challenges posed by fentanyl and related HPSOs. Future work should further addiction specialists' opinions on barriers to OUD treatment and exploration of these international strategies in the USA. This appears to be the first study exploring addiction specialists' perspectives on regulatory barriers to OUD treatment and their willingness to uptake internationally adopted strategies such as SROM.

Impact of COVID-19 Pandemic on Emergency Department Visits for Opioid Use Disorder Across University of California Health Centers

Introduction: Coronavirus 2019 (COVID-19) has had a devastating impact on mental health and access to addiction treatment in the United States, including in California, which resulted in the highest rates of emergency department visits (ED) for opioid poisoning in 2020. As California slowly returns to pre-pandemic normalcy, it remains uncertain whether the rates of opioid-related events have slowed down over time. We hypothesized that the number of opioid-related ED visits were exacerbated after the period of the COVID-19 pandemic and continue at a high rate in the present. Methods: In this analysis we searched the University of California (UC) Health Data Warehouse—a database of electronic health records from six UC health centers—for opioid-related ED visits, identifiying using the following International Classification of Diseases, 10th Ed, Clinical Modification codes: F11 codes, and T40.0*, T40.1*, T40.2*, T40.3*, T40.4*, T40.6*. Opioid overdose-associated visits were classified by types of opioids involved: heroin (T40.1*); prescription opioids (T40.2* or T40.3*); and synthetic opioids (T40.4*). We performed interrupted time analysis to estimate the immediate (level) change and change-in-time trend (trend change), from before (January 2018–October 2019) and during the pandemic (April 2020–December 2022). Monthly visit rates were evaluated with negative binomial regression adjusted for first-order autoregression and using all-cause ED counts as the offset. We present effect sizes as rate ratios (RR) and 95% confidence intervals (CI), tested at α = .05. Results: Before COVID-19, a steadily increasing trend in ED visit rates was observed for all outcomes (P < 0.05) except synthetic opioids. Total opioid-related ED visit rates increased by 15% (RR 1.15, 95%CI 1.02–1.29, P = 0.20) immediately after March 2020 before decreasing by 0.5% every month, albeit without statistical significance (RR .995, 95% CI .991–1.00, P = 0.06). Similar trends were observed with prescription opioid overdoses, with a step increase of 44% (RR 1.44, 95% CI 1.10–1.89, P = .008) before plateauing after March 2020 (RR 1.01, 95% CI .998–1.02, P = 0.12). After March 2020, ED visit rates for synthetic opioid overdoses were increasing steadily by 4% every month (RR 1.04, 95% CI 1.02–1.06, P = .001), unlike with heroin, which was observed with an 8% monthly reduction (RR .92, 95% CI .90–.93, P < .001). No immediate increase in visit rates was observed for either opioid. Conclusion: While opioid-related ED admissions among the UC health centers showed an overall decrease, prescription and synthetic opioid overdoses remained significantly higher than pre-pandemic trends as of December 2022. A multilevel approach to improve awareness of new opioid health policies could ameliorate these alarming rises in the post-pandemic era.

P1.01A.04 Point-of-care Nicotine Replacement for the Treatment of Nicotine Addiction in a Provincial Cancer System

P1.01A.04 Point-of-care Nicotine Replacement for the Treatment of Nicotine Addiction in a Provincial Cancer System

Filling the Treatment Gap: Geographic Expansion of Buprenorphine Providers Across the U.S.

ObjectiveWith opioid-related deaths reaching epidemic levels, gaining a better understanding of access to treatment for opioid use disorder (OUD) is critical. Buprenorphine is an effective medication for the treatment of opioid addiction. The analysis is critical post-X-waiver elimination which extended the ability to prescribe buprenorphine for the treatment of OUD to all practitioners with DEA Schedules II-V on their DEA Registration. The primary purpose of the analysis was to explore the geographic patterns of substance use treatment and establish a geographical baseline to assess the removal of the X-Waiver in the future. Data and MethodsWe assessed the expansion of buprenorphine providers across the data from all US counties up to December 31, 2022. We used all certified buprenorphine providers' data from the database of the buprenorphine waiver notification system (BWNS). We used county-level population data from the US Census of American Community Survey (ACS) of 2021 and the CDC's Drug-related mortality data. We implemented spatial scan statistics to identify the spatial clusters using SaTScan. ResultsThe results from our analysis show that Doctor of Medicine/Doctor of Osteopathic Medicine (MD/DO) have the highest numbers of certified providers at 8134 (65.08%) in 2018 and 14525 (57.87%) in 2022. Our analysis shows that the distribution of buprenorphine providers across the counties of the United States was significantly clustered. Higher clusters with RR of more than 1 (p-value <0.001) were found in the states of Washington, Oregon, Northern California, and the Western borders of Montana. Similar clusters of counties with RR more than 1 (p-value <0.001) were found in the northeastern states of Maine, Vermont, and New Hampshire. ConclusionsFrom our analysis, it is evident that buprenorphine-certified providers are clustered in areas of higher drug-related mortality filling a treatment gap. The elimination of the X-waiver will be a significant step towards increasing access to MOUD and this analysis may be used as a geographical baseline to assess in the future.

A chromosome level reference genome of Diviner’s sage (Salvia divinorum) provides insight into salvinorin A biosynthesis

BackgroundDiviner’s sage (Salvia divinorum; Lamiaceae) is the source of the powerful hallucinogen salvinorin A (SalA). This neoclerodane diterpenoid is an agonist of the human Κ-opioid receptor with potential medical applications in the treatment of chronic pain, addiction, and post-traumatic stress disorder. Only two steps of the approximately twelve step biosynthetic sequence leading to SalA have been resolved to date.ResultsTo facilitate pathway elucidation in this ethnomedicinal plant species, here we report a chromosome level genome assembly. A high-quality genome sequence was assembled with an N50 value of 41.4 Mb and a BUSCO completeness score of 98.4%. The diploid (2n = 22) genome of ~ 541 Mb is comparable in size and ploidy to most other members of this genus. Two diterpene biosynthetic gene clusters were identified and are highly enriched in previously unidentified cytochrome P450s as well as crotonolide G synthase, which forms the dihydrofuran ring early in the SalA pathway. Coding sequences for other enzyme classes with likely involvement in downstream steps of the SalA pathway (BAHD acyl transferases, alcohol dehydrogenases, and O-methyl transferases) were scattered throughout the genome with no clear indication of clustering. Differential gene expression analysis suggests that most of these genes are not inducible by methyl jasmonate treatment.ConclusionsThis genome sequence and associated gene annotation are among the highest resolution in Salvia, a genus well known for the medicinal properties of its members. Here we have identified the cohort of genes responsible for the remaining steps in the SalA pathway. This genome sequence and associated candidate genes will facilitate the elucidation of SalA biosynthesis and enable an exploration of its full clinical potential.

403EMF Barriers and Facilitators to Addiction Treatment Access From the Emergency Department Among Black Individuals With Opioid Use Disorder

403EMF Barriers and Facilitators to Addiction Treatment Access From the Emergency Department Among Black Individuals With Opioid Use Disorder

The Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program implementation strategy for expanding treatment for hospitalized adults with opioid use disorder

IntroductionIn 2017, we launched the “B-Team” (buprenorphine team), the first hospitalist-led opioid use disorder (OUD) treatment program in Texas. Based on initial success, we obtained funding from Texas Health & Human Services to expand the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program. MethodsThis is a mixed methods study of the implementation of the SHOUT program, which is an OUD treatment intervention, in different hospitals in Texas. Our implementation approach combined training, tailoring, and technical assistance following the Replicating Effective Programs (REP) strategy with statewide telementoring delivered via Project ECHO. To evaluate the reach, adoption, and impact of SHOUT Texas, we assessed: 1) participating hospitals (adoption); 2) patients screened for OUD (impact); 3) patients started on medications for OUD (impact); 4) patients discharged with coordinated outpatient care (impact); 5) providers and staff trained via ECHO (reach); and 6) satisfaction with ECHO training (impact). Additionally, semi-structured interviews were conducted with key stakeholders at expansion sites to identify strengths and weaknesses of the implementation strategy and supports and barriers to successful implementation. Rapid qualitative analysis was completed by a team of analysts who transcribed and summarized interviews to identify key domains of interest and emergent themes. ResultsBetween 2020 and 2023, the SHOUT Texas program expanded to three additional Texas hospital sites, resulting in 3065 hospitalized adult patients starting treatment for OUD. More than 2500 interprofessional clinicians (physicians, nurses, physician assistants, social workers) received SHOUT training regarding inpatient initiation of OUD treatment, with 241 attending at least one hour-long Project ECHO session. Eight key stakeholders at expansion sites were interviewed. Successful components of the SHOUT program included training resources, in-person launches, and collaboration with specialized addiction treatment subject matter experts. Challenges included identifying outpatient follow-up, pharmacy and medication constraints, and nursing education barriers. Interviews also identified lessons learned, advice to other hospitals, and next steps to build capacity. ConclusionsImplementation of the SHOUT Texas model across diverse hospital settings using REP and Project ECHO resulted in significant provider engagement and rapid increase in the number of patients initiating OUD treatment during hospitalization. Lessons learned from this novel approach may be applicable in other states, particularly those that have not expanded Medicaid.

Addressing Stigmas That Hinder Addiction Treatment and Recovery

Addressing Stigmas That Hinder Addiction Treatment and Recovery

Limits of prosthetic rehabilitation of cocaine-induced midline destructive lesions: Time to change the paradigm

The steady rise in cocaine consumption, particularly in its snorted form, has led to the increased incidence of cocaine-induced midline destructive lesions (CIMDLs), a severe condition resulting from chronic cocaine use that leads to significant tissue destruction in the nasal and palatal regions. Four patients with CIMDLs are presented, all characterized by nasopalatine perforation. Each patient reported a spontaneous onset of tissue loss in the hard palate near the midline, with the affected area ranging from 2.3 to 5.1 cm². All patients had a history of psychiatric conditions, including depressive episodes but without other significant medical conditions, which contributed to an average delay of 9 months before seeking initial medical consultation. Treatment, which included the use of palatal obturators to improve quality of life, remains nonstandardized and, combined with the patients' continued cocaine use and refusal of addiction care, led to poor follow-up and persistent tissue damage. This clinical report underscores the need for a paradigm shift in managing CIMDLs, emphasizing the integration of addiction treatment and psychological support with prosthetic rehabilitation to optimize long-term outcomes and prevent relapse.

It takes a village: Feedback from personnel in addiction treatment programs indicates support for changing the intake process

IntroductionThe initial intake encounter represents a critical point for treatment engagement in outpatient addiction treatment programs. Despite the intake assessment being more comprehensive, personalized, and capable of matching clients to level of treatment, addiction treatment programs continue to have among the highest attrition rates. Thus, it may not be what, but how services are delivered that contributes to attrition. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive framework to attend to sources of needed innovation for the intake process. The current study used a mixed method design, guided by CFIR, to obtain feedback from personnel in addiction treatment programs on the current intake process, as well as the facilitators and barriers to changing the intake process. MethodsPersonnel within New Mexico-based addiction treatment programs completed measures of individual and organizational readiness to make changes within their programs (N = 79; 76 % women, 79 % White, 55 % Latino/a). From this sample, 38 participants completed a CFIR-based semi-structured interview to identify potential barriers and facilitators to changing the intake process. ResultsParticipants reported moderate-to-high scores on readiness and capability to make organizational changes. For qualitative data, we identified nine broad themes, grouped based on (1) perspectives of current intake process (Intake Process, Organization Culture, Change Perspectives, Internal Communication, Client Needs) and (2) perspectives of changing the intake to an MI session (MI knowledge/attitudes, MI at intake, MI in organization, MI fit with Client Needs). ConclusionsFindings highlight that there are specific components of the intake content and process that appear to disengage clients, specific policies and procedures that appear to overburden staff, and key stakeholders and resources needed to improve the intake process. Recommendations are provided for intake-specific and procedural-level changes both in the organization and with outside agencies to improve the intake process.