Understanding Of Substance Use Disorders Research Articles

Using Virtual Reality Simulation for Screening Brief Intervention and Referral to Treatment.

This study examined the effects of virtual reality on students' confidence and knowledge in Screening, Brief Intervention, and Referral to Treatment (SBIRT), and understanding of substance use disorders (SUDs) in mental health and primary care settings. Using a pre- and postdesign, questionnaires were distributed before, immediately after, and 3 months after the simulation. Data analysis revealed significant increases in SBIRT characteristics, screening tools, and alcohol consumption guidelines from pre- to postsimulation (p < .05) among the participants (n = 380). Confidence levels improved significantly (p < .001), with no notable difference between post-simulation and follow-up surveys. Simulation training with structured prebriefing and debriefing sessions facilitated the application of learned skills during the simulation, boosting students' self-efficacy and readiness. [J Nurs Educ. 2024;63(7):453-459.].

Epidemiology of substance use and mental health disorders among forced migrants displaced from the MENAT region: A systematic review and meta-analysis protocol.

Understanding the epidemiology of substance use disorders (SUDs) and mental health disorders (MHDs) among forced migrants from the Middle East and North Africa and Türkiye (MENAT) region is of utmost importance given their distinct challenges and vulnerabilities. Existing research on the topic is substantial; however, comprehensive systematic reviews are limited. We aim to conduct a systematic literature review to bridge this gap, providing a thorough understanding of SUDs and MHDs epidemiology among this population. The systematic review will include original, peer-reviewed research articles published in English or Arabic between 2013 and 2023. It will encompass qualitative, quantitative, and mixed-methods studies focusing on SUDs and/or MHDs among forced migrants from the MENAT region. A Medline (via Ovid) search strategy was developed and will be translated into databases of EMBASE (via Ovid), Web of Science Core Collection (as licensed at Yale), and CINAHL. Risk of Bias in the included studies will be assessed using the Joanna Briggs Institute (JBI) checklist for observational studies and the Cochrane Risk of Bias (ROB) 2 tool for intervention studies. Meta-analysis using random-effects models will be conducted and subgroup analyses based on studies' data will be performed. The systematic review will be conducted based on the framework introduced by the Joanna Briggs Institute. Additionally, the PRISMA-P extension for systematic reviews was used to report the present protocol. The present systematic review protocol has been registered with PROSPERO, an international prospective register of systematic reviews. The review's registration ID is CRD42021286882. The systematic review aims to explore, identify and synthesize the evidence to reveal the epidemiology of SU and/or MH of forced migrants of the MENAT region as described in this protocol. In sum, the review will provide evidence to fill the gap in the literature and help the stakeholders, policymakers, and health providers to expand current knowledge of the prevalence and risk factors of SU and/or MH in humanitarian settings.

Early maladaptive schemas in substance use disorders in the Indian context: Theoretical and therapeutic implications.

Schema theory seems to be a relevant perspective in the overall understanding of substance use disorders (SUDs). Early maladaptive schemas (EMSs) are defined as self-defeating emotional and cognitive patterns that begin early in our development, repeat throughout life, and act as risk factors for mental health problems and substance use (SU). SU behavior acts as a means by which users attempt to avoid triggering the unpleasant and negative emotions inherent in their elevated schema. Thus, SU is often seen as a coping mechanism in schema theory. This has important implications in terms of assessment, treatment, and planning of interventions. Schema therapy would be a valuable addition to the current therapy practice, which emphasizes a dual focus on both SU and EMSs and uses an integrated framework of cognitive, behavioral, and experiential techniques to target and modify EMSs.

Rutgers Grad Students RIOT for Opioid Education

Rutgers Grad Students RIOT for Opioid Education

Drug versus non-drug behaviors: A dual-reward model of sex differences and neurobiological mechanisms in rats.

Substance Use Disorders (SUDs) are an impactful problem characterized by chronic relapse and engagement in drug-related behaviors at the expense of non-drug behaviors. Brain regions implicated in drug and non-drug-related behaviors often overlap, complicating investigations of neurobiological mechanisms underlying SUDs. Here we presented a within-subject model for studying self-administration, reinforcer competition, extinction, and cued reinstatement of cocaine- and food-seeking in rats. Due to differences in cocaine- and food-reinforced behavior, we transformed data to proportions of baseline, revealing increased resistance to extinction and disproportionately greater cued reinstatement of cocaine seeking relative to food seeking. Consistent with previous reports, females showed greater preference for cocaine reinforcement than males, though these findings failed to reach statistical significance. To demonstrate the model's utility for investigating neurobiological mechanisms, we included proof-of-concept calcium imaging data demonstrating the utility of the behavioral model for detecting cellular activity patterns associated with cocaine- and food-seeking behaviors. Future studies utilizing this model should improve understanding of the development and expression of pathological behaviors characteristic of SUDs in humans, sex differences in these behaviors, and their neurobiological correlates. Thus, the model has utility for improving understanding of SUDs, leading to novel treatments to reduce the pathological behaviors associated with SUDs.

Perceptions and Knowledge Around Substance Use Disorders and the Role of Occupational Therapy: A Survey of Clinicians.

Today's healthcare system requires practitioners to acquire a level of confidence, knowledge, and personal desire that enables them to treat a growing clientele with substance use disorders (SUDs). Although SUDs impact millions of Americans, there are many barriers to receiving treatment. It is important to understand how occupational therapy (OT) practitioners' perceptions of working with clients who experience SUDs relate to the knowledge and skills required to identify and provide treatment. Two surveys, the Medical Regard Scale and modified Drug Problems Perceptions Scale, were utilized to analyze participants attitudes, perceptions, and knowledge around working with individuals with SUDs. Data was collected from 116 practitioners with a variety of experience, practice settings, and backgrounds in understanding SUDs. The majority of respondents reported no formal training in treating clients with SUDs (72.4%). In terms of attitudes around working with this population, a fraction reported a preference not to work with patients experiencing SUDs (16.0%) or finding them "irritating" to work with (12.9%), while 62.0% reported they felt especially compassionate toward this population. The majority of respondents felt that insurance plans should cover patients like this to the same degree that they cover patients with other conditions; however, only 48.3% had a clear idea of their responsibilities in helping individuals with SUDs. In regard to knowledge around working with SUDs, just over half of respondents reported a true working knowledge of SUDs and SUDs related problems (53.4%). Occupational therapy practitioners would benefit from additional training, resources, and support related to provision of services to individuals with SUD. In addition, training to continue to reduce stigma within the profession can potentially increase access to care.

Law enforcement assisted diversion: Qualitative evaluation of barriers and facilitators of program implementation

BackgroundDespite widespread interest in adoption, there has been limited systematic examination of Law Enforcement Assisted Diversion (LEAD) implementation, a model for police-led arrest diversion for those with substance use disorders (SUD). In the fall of 2017, the City of New Haven started a LEAD program. During the first 9 months of the pilot, only 2 clients were successfully diverted from arrest. Therefore, we examined the and barriers and facilitators of LEAD implementation. MethodsWe conducted semi-structured interviews and field observations of LEAD police officers and health care providers between August 2018 and June 2019. Interviews and field observations were analyzed using directed content analysis and guided by the Integrated Promoting Action on Research Implementation in Health Services framework. ResultsLead professionals participated in 19 semi-structured interviews and three field observations. Barriers to arrest diversion implementation included procedural complexity of arrest diversion, concerns about reduced penalties for substance use among officers, stigma of SUDs, and a belief in a punitive role for policing. Facilitators included a positive longitudinal relationship with potential clients and an understanding of SUD as a chronic disease. ConclusionWe identified several barriers to LEAD implementation. Our results suggest promotion of SUD as a chronic disease, ongoing training of officers, and positive incentives for entering substance use treatment should be utilized to facilitate implementation.

“This show hits really close to home on so many levels”: An analysis of Reddit comments about HBO’s Euphoria to understand viewers’ experiences of and reactions to substance use and mental illness

BackgroundPublic health has begun using social media forums such as Reddit to enhance surveillance and modernize interventions for young people. The current study’s objective was to examine Reddit posts about the HBO series Euphoria to identify show themes that resonate with adolescent and young adult viewers in order to inform future social media interventions. MethodsReddit comments in the r/television community from June to August 2019 were downloaded. Following filtering, 725 comments were analyzed and coded using a codebook and ATLAS.ti. Coded comments were analyzed for themes relevant to Redditor substance use, reactions to Euphoria and the main character (Rue), and mental health concerns. ResultsDuring their discussion of the show, Redditors disclosed both personal recreational and prescription drug use, including substance use to cope with mental illness symptoms. There were approximately equal numbers of comments with positive and negative reactions to the show overall and to the main character, Rue. Redditors often found Euphoria’s storyline and portrayed events to be relatable and realistic to the experience of young people who use drugs, as well as sometimes triggering. Overall, Redditors thought Rue accurately depicted an individual’s struggle with a substance use disorder. ConclusionsThis exploratory study highlights how television and social media can contribute to young peoples’ understanding of substance use disorders and mental health. Findings could inform the design of social media interventions for adolescents and young adults on a variety of substance use issues, including stigma and the interconnectedness of substance use and mental health challenges.

A Pilot Interprofessional Course on Substance Use Disorders to Improve Students’ Empathy and Counseling Skills

Objective. To implement and assess the effectiveness of an interprofessional course designed to provide pharmacy and nursing students with opportunities to improve their understanding of substance use disorders (SUDs), assess their attitudes toward patients with SUDs, receive instruction and feedback on behavior change counseling, and engage in interprofessional education. Methods. The course consisted of four interactive class sessions that focused on empathy and recognition of personal bias, behavioral change counseling, and SUD recognition, screening, and treatment. Classes were taught by an interprofessional faculty member. Students also attended a 12-step recovery meeting in the community, counseled an authentic patient using behavioral change counseling, and received feedback based on a faculty member's direct observation of their counseling. Students completed validated assessments of their attitudes toward patients with SUDs and interprofessional collaboration. A faculty member used the Behavioral Change Counseling Index (BECCI) to assess students' counseling of SUD patients. Counseled patients were asked their preference for follow-up care for their SUD. Results. Twenty-seven pharmacy and nursing students completed this course, along with 51 students from other professions. The pharmacy and nursing students demonstrated significant improvements in their attitudes toward patients with SUDs and toward interprofessional collaboration, as measured by the Substance Abuse Attitudinal Scale (SAAS) and Student Perception of Interprofessional Clinical Education (SPICE-R2). Approximately 93% of pharmacy and nursing students counseled a patient with a SUD, with 96% of counseled patients reporting their intent to receive follow-up care. Conclusion. An interprofessional SUD course enriched pharmacy and nursing students' understanding, attitudes, and behaviors toward patients with SUDs and interprofessional collaboration. Students demonstrated an ability to provide behavior change counseling to patients, and 96% of counseled patients stated a willingness for follow-up care for their SUD.

Brief Training on Medication-Assisted Treatment Improves Community Mental Health Clinicians' Confidence and Readiness to Address Substance Use Disorders.

Despite the availability and effectiveness of medication-assisted treatment (MAT) for substance use disorders (SUDs), utilization of these medications remains suboptimal, especially in public sector settings. A key limitation is clinicians' reluctance to include MAT in their routine practice due, in part, to low confidence about managing SUDs and limited awareness of the disease model of addiction. This study evaluates the impact of a 1-day MAT training for community mental health clinicians using a 30-item pre- and post-training questionnaire. Of the 109 clinicians who attended the training, 107 completed the pre- and post-training questionnaires. Factor analysis of the questionnaire identified two domains: readiness to address SUDs among patients (factor 1) and understanding SUDs as diseases (factor 2). Post training, there was a significant change in both factor 1 (p = .00001) and factor 2 (p = .00003), indicating that a brief MAT training can increase clinicians' confidence and readiness to address SUDs and improve their understanding of the disease model of addiction.

National Institute on Drug Abuse genomics consortium white paper: Coordinating efforts between human and animal addiction studies.

The National Institute on Drug Abuse Genetics and Epigenetics Cross-Cutting Research Team convened a diverse group of researchers, clinicians, and healthcare providers on the campus of the University of California, San Diego, in June 2018. The goal was to develop strategies to integrate genetics and phenotypes across species to achieve a better understanding of substance use disorders through associations between genotypes and addictive behaviors. This conference (a) discussed progress in harmonizing large opioid genetics cohorts, (b) discussed phenotypes that are used for genetics studies in humans, (c) examined phenotypes that are used for genetics studies in animal models, (d) identified synergies and gaps in phenotypic analyses of human and animal models and (e) identified strategies to integrate genetics and genomics data with phenotypes across species. The meeting consisted of panels that focused on phenotype harmonization (Dr. Laura Bierut, Dr. Olivier George, Dr. Dan Larach and Dr. Sesh Mudumbai), translating genetic findings between species (Dr. Elissa Chesler, Dr. Gary Peltz and Dr. Abraham Palmer), interpreting and understanding allelic variations (Dr. Vanessa Troiani and Dr. Tamara Richards) and pathway conservation in animal models and human studies (Dr. Robert Hitzemann, Dr. Huda Akil and Dr. Laura Saba). There were also updates that were provided by large consortia (Dr. Susan Tapert, Dr. Danielle Dick, Dr. Howard Edenberg and Dr. Eric Johnson). Collectively, the conference was convened to discuss progress and changes in genome-wide association studies.

Pathways from epigenomics and glycobiology towards novel biomarkers of addiction and its radical cure

The recent demonstration that addiction-relevant neuronal ensembles defined by known master transcription factors and their connectome is networked throughout mesocorticolimbic reward circuits and resonates harmonically at known frequencies implies that single-cell pan-omics techniques can improve our understanding of Substance Use Disorders (SUD’s). Application of machine learning algorithms to such data could find diagnostic utility as biomarkers both to define the presence of the disorder and to quantitate its severity and find myriad applications in a developmental pipeline towards therapeutics and cure. Recent epigenomic studies have uncovered a wealth of clinically important data relating to synapse-nucleus signalling, memory storage, lineage-fate determination and cellular control and are contributing greatly to our understanding of all SUD’s. Epigenetics interacts extensively with glycobiology. Glycans decorate DNA, RNA and many circulating critical proteins particularly immunoglobulins. Glycosylation is emerging as a major information-laden post-translational protein modification with documented application for biomarker development. The integration of these two emerging cutting-edge technologies provides a powerful and fertile algorithmic-bioinformatic space for the development both of SUD biomarkers and novel cutting edge therapeutics. Hypotheses: These lines of evidence provide fertile ground for hypotheses relating to both diagnosis and treatment. They suggest that biomarkers derived from epigenomics complemented by glycobiology may potentially provide a bedside diagnostic tool which could be developed into a clinically useful biomarker to gauge both the presence and the severity of SUD's. Moreover they suggest that modern information-based therapeutics acting on the epigenome, via RNA interference or by DNA antisense oligonucleotides may provide a novel 21st century therapeutic development pipeline towards the radical cure of addictive disorders. Such techniques could be focussed and potentiated by neurotrophic vectors or the application of interfering electric or magnetic fields deep in the medial temporal lobes of the brain.

A Family-Centered Program to Break the Cycle of Addiction

Celebrating Families!™ (CF!) is a manualized family-centered program focused on the goal of breaking the cycle of generational substance use disorders (SUDs). It is one of the few evidence-based family-focused practices listed on Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-Based Programs and Practices. Compared to another evidence-based program, Strengthening Families, CF! showed significant impact on family organization, positive parenting, parent involvement, and alcohol and drug use reduction. CF! is shown to be successful in unifying families from family dependency courts and as a prevention program for SUDs when offered by community social service agencies. A preliminary efficacy study illustrates changes within participating families consistent with the goal. The study’s purpose was to test the hypothesis that a family skills program such as CF! changed behavior by reducing risk factors and increasing protective factors. Data from 20 cycles of the program revealed that parents ( N = 263), referred from family drug court, expressed significant behavior changes toward their children in ways that increased protective factors after the 16-week program, and youth ( N = 106) showed better understanding of SUDs. Results suggest that this family skills program can be an intervention program for families at-risk for perpetuating the cycle of addiction, as well as prevention of family violence, abuse, and neglect. Agencies that serve families at risk can use the program to prevent costly foster care placements and SUDs by providing such programs.

Evaluación neuropsicológica en adicciones: guía clínica [Neuropsychological assessment in addiction: A clinical guideline

Resumen El objetivo de este articulo de opinion es proporcionar pautas para la evaluacion neuropsicologica en el contexto terapeutico de las adicciones. Se proponen guias basicas para la evaluacion neuropsicologica en dos contextos: (1) la determinacion de los perfiles neuropsicologicos de usuarios consumidores de drogas; (2) la prediccion de los resultados del tratamiento de las adicciones, en terminos de retencion y adherencia a las recomendaciones terapeuticas y de riesgo de recaidas en el consumo. Se describen tambien nuevas aproximaciones terapeuticas derivadas de una comprension neuropsicologica de los trastornos por uso de sustancias. Las pautas recogidas en este articulo pretenden servir para facilitar la transicion entre el descubrimiento cientifico y la implementacion asistencial, proporcionando guias basicas para incorporar estas herramientas en la practica clinica con pacientes drogodependientes. Abstract The aim of this article is to provide rommendations for neuropsychological assessment in the con­text of addiction treatment. I propose key basic guidelines to conduct neuropsychological as­sessment in two contexts: (1) profiling of cognitive sequela as­sociated with substance use; (2) prediction of treat­ment otcomes, in terms of retention and ad­herence to addiction treatment, and risk of relapse. I also discuss novel therapeutic approaches spurred by a neuropsychological understanding of substance use disorders. These recommendations are aimed to fos­ter the transition between neuroscientific discovery and clinical translation, by providing basic guidelines to incorporate neuropsychological tools in clinical practice with addicted clients.

Conceptualizing Internet use disorders: Addiction or coping process?

This paper problematizes the tendency to study Internet use disorders from a perspective of addiction. It is argued that an addiction perspective, grounded in our understanding of substance use disorders, has not contributed much to an improved understanding of the antecedents and etiology of Internet use disorders. Despite this, researchers continue to frame Internet use disorders as an addiction, recently exemplified by the inclusion of Internet gaming disorder in the DSM-5 research appendix as a behavioral addiction. This paper claims that the decision to use an addiction framework to study Internet use disorders has consequences for the way in which results are interpreted, which impacts the potential for theoretical and etiological contributions negatively. The paper argues that a perspective of addiction may not be the most useful approach because it causes a mismatch between theory and findings in empirical work: it is not uncommon to find that a study is positioned as a study of addiction, but presents findings more illustrative of coping behaviors. The paper draws on two examples from the literature to illustrate this mismatch and discusses how this hinders theoretical and etiological development. The question that is asked going forward is what alternative explanations we might identify by not exclusively adhering to an addiction framework for purposes of research. Recommendations are given for how to usefully approach the study of Internet use disorders outside a framework of addiction. It also discusses how scholars who still prefer a framework of addiction might strengthen their conceptual position to ensure improved contributions to etiology and theoretical development.

Neonatal Abstinence Syndrome: Presentation and Treatment Considerations.

The increase in opioid use among the general population is reflected in pregnant women and neonatal abstinence syndrome (NAS) statistics. This increase has produced an unprecedented focus on NAS from both the political-judicial sphere and the medical community. Under the banner of fetal protection, judges and prosecutors have implemented punitive approaches against women who use prescribed and nonprescribed opioids during pregnancy, including arrest, civil commitment, detention, prosecution, and loss of custody or termination of parental rights. Within the medical community, questions have been raised regarding protocols to detect prenatal drug exposure at delivery, NAS treatment protocols, the need for quality-improvement strategies to standardize care and reduce length of stay for mother and infant, and the benefits of engaging the mother in the care of her infant. It is not uncommon for the expression of strong discordant views on these issues both between and among these political-judicial and medical constituencies. Closely examining the issues often reveal a lack of understanding of substance use disorders, their treatment, and the occurrence and treatment of NAS. This study provides an in-depth examination of NAS, including variations in presentation and factors that impact the efficacy of treatment, and also identifying questions that remain unanswered. Finally, 4 key areas on which future research should focus to guide both medical care and public policy are discussed.

Lactation and the Marijuana-Using Mother

The following is a commentary on the recently published guidelines for breastfeeding in women with substance use disorders. Delta-9-tetrahydrocannabinol (DTHC) is the major compound in marijuana, but there are many other toxic compounds in marijuana, and it may be laced with harmful adulterants. THC is psychoactive, is distributed into breastmilk and to the brain, and is lipophilic/stored in body fat. Therefore, active, passive and cumulative exposures to the breastfed infant all must be considered. THC can be concentrated in breastmilk up to eight times the level in plasma in heavy users and is absorbed and metabolized by the breastfed infant; metabolites are found in infant stool. Physiologic effects including sedation and poor feeding have been described in infants receiving breastmilk from marijuana-using mothers. Explorations of the effects of marijuana exposure via breastmilk on longer-term child development have led to conflicting results; however, this research was done in a time period in which the potency of marijuana was approximately fourfold less than it is today. Cannabinoid CB1 receptors emerge early in brain development and are the major targets for the action of cannabinoids. They are abundantly expressed in certain brain regions that play key roles in neural development. THC delivered via lactation to the infant may therefore affect the ontogeny of various neurotransmitter systems, leading to changes in neurobiological functioning. THC is present in exhaled breath for 2–4 hours after a single marijuana cigarette, and indirect passive smoking exposures can be significant. Prenatal marijuana exposures should not be discounted in this discussion, as it is important to consider that, for the mother using marijuana during lactation, exposures throughout gestation are likely. Gestational marijuana use is not uncommon: among pregnant women, nearly 4% used marijuana in the past month. THC readily crosses the placenta. Infant neurobehavior is altered in prenatally marijuana-exposed infants, and prenatal cannabis exposure is associated with adolescent behavioral abnormalities as well as increased vulnerability to neuropsychiatric disorders in adulthood, indicating an ‘‘unmasking’’ of earlier deficits. Additional postnatal exposures to the rapidly developing infant brain may compound prenatally acquired deficits. Finally, the identification of the lactating mother as a chronic marijuana user and potentially a person with a substance use disorder in the postnatal period presents additional difficulties. Maternal self-report of marijuana use in the perinatal period is inaccurate. Urine toxicology screening, used by many institutions to identify substance use among women in the perinatal period, is not a useful tool for detecting marijuana use due to its long half-life in urine and relays no information regarding quantification or patterns of use. Chronic marijuana use and dependence are associated with a wide range of psychiatric concerns, making identification important for the provision of services for at-risk dyads. Although there are no data to point to use by women in the perinatal period as indicative of chronic or heavy use, we do know that use of marijuana declines over the course of gestation, making users of marijuana at term likely to be chronic or dependent users. In a large U.S. sample between 2007 and 2012, among past-year marijuana users, 12.8% of nonpregnant women used nearly daily, and 11.4% met criteria for abuse/dependence. These figures jump to 16.2% and 18.1% for pregnant women. The breastfed infant must necessarily be in the company of his or her mother, and people with substance use disorders can have periodically altered sensoriums, chaotic environments, and poor judgment regarding their own safety and the safety of their children, portending immediate physical harm for the infant and potentially long-term developmental harm as well. It is necessary to consider that it may represent a missed opportunity to assist a newly postpartum woman with finding acceptable treatment for a substance use and/or an underlying psychiatric disorder, to provide intensive postnatal services to at-risk dyads, or to detect an infant at risk for physical or developmental harm by minimizing marijuana use detected at the time of delivery. In conclusion, the cumulative evidence above supports that when an empirically derived approach to the issue of maternal marijuana use and lactation is taken, the recent new recommendation by the Academy of Breastfeeding Medicine is both erroneous and disappointing. It is unclear why a recommendation would err on the side of breastfeeding with potentially toxic exposures and other risk factors that could portend shortand long-term infant harm. Perhaps this view reflects a lack of understanding of substance use disorders in general. What is clear is the need for future research to fully establish the risk–benefit of breastfeeding with active

Statutory Definitions of Mental Illness for Involuntary Hospitalization as Related to Substance Use Disorders

In New York City, individuals gravely disabled by substance use disorders repeatedly present to emergency rooms yet rarely remain in treatment for more than several days and often sign out against medical advice. Although these individuals are at high risk of death and often lack the capacity to make treatment decisions, the laws in New York State are unclear about whether substance use disorders qualify as mental illnesses for the purpose of involuntary hospitalization. To better understand the national landscape of civil commitment law, with a specific focus on substance use disorders, a review was conducted of mental health statutes in all 50 states and the District of Columbia (D.C.). Two independent reviewers examined all state mental health statutes using LexisNexis and Westlaw search engines. A total of 22 states, including D.C., do not reference substance use disorders in their statutory definitions of mental illness. Of the 29 that do, eight include substance use disorders and 21 explicitly exclude them. In addition, nine states have separate inpatient commitment laws specifically addressing substance use disorders. Civil commitment statutes vary greatly by state in terms of clarity and specificity regarding which mental illnesses are included for the purpose of involuntary hospitalization. Mental health professionals and policy makers should discuss whether individuals gravely disabled by substance use disorders, a complex and vulnerable population, should be more widely included under standard civil commitment law.

The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair

The field of behavioral economics has made important inroads into the understanding of substance use disorders through the concept of reinforcer pathology. Reinforcer pathology refers to the joint effects of (a) the persistently high valuation of a reinforcer, broadly defined to include tangible commodities and experiences, and/or (b) the excessive preference for the immediate acquisition or consumption of a commodity despite long-term negative outcomes. From this perspective, reinforcer pathology results from the recursive interactions of endogenous person-level variables and exogenous environment-level factors. The current review describes the basic principles of behavioral economics that are central to reinforcer pathology, the processes that engender reinforcer pathology, and the approaches and procedures that can repair reinforcement pathologies. The overall goal of this review is to present a new understanding of substance use disorders as viewed by recent advances in behavioral economics.

Epigenetic regulation in substance use disorders.

Substance use disorder is a chronic condition of compulsive drug seeking and use that is mediated by stable changes in central reward pathways. Repeated use of abused drugs causes persistent alterations in gene expression responsible for the long-term behavioral and structural changes. Recently, it has been suggested that epigenetic mechanisms are responsible in part for these drug-induced changes in gene expression. One of the alluring aspects of epigenetic regulation of gene expression is that epigenetic mechanisms may provide transient and potentially stable conditions that in turn may ultimately participate in the molecular mechanisms required for neuronal changes subserving long-lasting changes in behavior. This review describes epigenetic mechanisms of gene regulation and then discusses the emerging role of epigenetics in drug-induced plasticity and behavior. Understanding these mechanisms that establish and maintain drug-dependent plasticity changes may lead to deeper understanding of substance use disorders as well as novel approaches to treatment.