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Objective: Due to a combination of unique circumstances, opioid use and misuse in the United States have escalated dramatically over the past 15 years, resulting in a national crisis. Method: To bring together work that addresses the role that psychologists can play in responding to this crisis, we assembled this special issue. Results: The papers included in this issue underscore critical matters for continued consideration, and point to directions for further action and investigation. Conclusions: Themes that emerged from this collection of papers suggest numerous opportunities for the field as we seek to respond collectively to the crisis now facing our country. Due to a combination of unique circumstances, opioid use has escalated dramatically over the past 15 years, resulting in a national public health crisis. These concluding remarks highlight ways in which psychologists may seek to address this crisis. [ABSTRACT FROM AUTHOR]

• Endogenous cannabinoid and opioid systems have multi-level cross-talks. • Exposure to exogenous opioids dysregulates the endocannabinoid system. • Alterations of the endocannabinoid system are region-specific in the brain. Rates of opioid-related deaths and overdoses in the United States are at record-high levels. Thus, novel neurobiological targets for the treatment of OUD are greatly needed. Given the close interaction between the endogenous opioid system and the endocannabinoid system (ECS), targeting the ECS may have therapeutic potential in OUD. The various components of the ECS, including cannabinoid receptors, their lipid-derived endogenous ligands (endocannabinoids [eCBs]), and the related enzymes, present potential targets for developing new medications in OUD treatment. The purpose of this paper is to review the clinical and preclinical literature on the dysregulation of the ECS after exposure to opioids. We review the evidence of ECS dysregulation across various study types, exposure protocols, and measurement protocols and summarize the evidence for dysregulation of ECS components at specific brain regions. Preclinical research has shown that opioids disrupt various ECS components that are region-specific. However, the results in the literature are highly heterogenous and sometimes contradictory, possibly due to variety of different methods used. Further research is needed before a confident conclusion could be made on how exposure to opioids can affect ECS components in various brain regions. [ABSTRACT FROM AUTHOR]

This paper traces the unspoken, implicit white racial logic of the brain disease model of addiction, which is based on seemingly universal, disembodied brains devoid of social or environmental influences. In the United States, this implicit white logic led to "context-free" neuroscience that made the social hierarchies of addiction and its consequences invisible to, and thus exacerbated by, national policies on opioids. The brain disease model of addiction was selectively deployed among the white middle-class population that had long accessed narcotics and pharmaceutical treatments for narcotics disorders from biomedical clinics, as opposed to from illegal sources subject to law enforcement. In turn, new treatments for opioid addiction were racially marketed to the same white clientele to which newly patented opioid analgesics were marketed, tapping into a circumscribed but highly lucrative consumer base that has long benefited from a legally protected, racially segregated safe space for white narcotics consumption. The connecting thread for the contemporary white opioid "crisis," therefore, is white race as a ghost variable in addiction neuroscience and in its pharmaceutical and biotechnological translation. [ABSTRACT FROM AUTHOR]

This article examines the cultural attitude of reluctance in the United States, as reflected in recent opinion polls and federal budgets, toward agency spending in relation to addiction prevention, treatment, and research. The author posits that the prevalent spiritual lens, through which addiction is widely perceived, contributes to hesitancy in committing more to these areas of public funding. Its etiological interpretation of addiction, as a spiritual/moral disease that is innate to afflicted individuals, essentially releases culture and society from accountability for its prevalence. Further, publicity surrounding the New Recovery Advocacy Movement might lead to a complacent belief that a radical movement, addressing addiction on a broad, collaborative, and socioeconomic scale is already occurring. In order to widen the scope of spirituality as it generally pertains to addiction and accommodate the potentialities embedded in positive social change, the construct of spirituality needs to expand beyond the narrow and culturally entrenched notion of inner personal growth through individual effort. Therefore, this paper advances participatory spiritual theory as a means to integrate the reciprocity of socioeconomic and political factors as well as social engagement within a spiritual framework for recovery from addiction. [ABSTRACT FROM AUTHOR]

Objective: Heroin use in the United States has reached epidemic proportions. The objective of this paper is to estimate the annual societal cost of heroin use disorder in the United States in 2015 US dollars. Methods: An analytic model was created that included incarceration and crime; treatment for heroin use disorder; chronic infectious diseases (HIV, Hepatitis B, Hepatitis C, and Tuberculosis) and their treatments; treatment of neonatal abstinence syndrome; lost productivity; and death by heroin overdose. Results: Using literature-based estimates to populate the model, the cost of heroin use disorder was estimated to be $51.2 billion in 2015 US dollars ($50,799 per heroin user). One-way sensitivity analyses showed that overall cost estimates were sensitive to the number of heroin users, cost of HCV treatment, and cost of incarcerating heroin users. Conclusion: The annual cost of heroin use disorder to society in the United States emphasizes the need for sustained investment in healthcare and non-healthcare related strategies that reduce the likelihood of abuse and provide care and support for users to overcome the disorder. [ABSTRACT FROM AUTHOR]

Aims This study investigated the value of citation counts as an index of quality in the field of addiction and examined factors that contribute to papers being cited more or less frequently. Design The number of times papers published by the journal Addiction in 1995–98 that had been cited up to May 2000 were counted using the Science and the Social Science Citation Indexes. Articles in nine of the monthly issues from 1997 were rated by two independent expert raters for quality. Factors related to citation counts were also examined including: country of origin of the paper, substance type, solicited versus unsolicited papers and methodology used. Findings A total of 417 unsolicited research reports were included in the citation analysis, of which 79 were also subjected to quality ratings. The experts showed a moderate level of agreement in their ratings (intraclass correlation = 0.39, p < 0.001). However, there was no correlation between number of citations and expert ratings of article quality (R < 0.1). Papers from developing countries received significantly fewer citations than papers from other countries but substance type (e.g. nicotine, opiate, alcohol) and methodology (e.g. survey, treatment trial) were not related to number of citations. Conclusions This study involved just one journal but raised an important issue: the number of citations received by papers on addiction appears to reflect the geographical region of study rather than what experts would consider as 'quality'. If these findings are found to generalize they call into question the use of citation‐related indices as measures of quality in this field and perhaps in others as well. To our knowledge our methodology has not been used before and could be adapted to study the value of citations more widely. [ABSTRACT FROM AUTHOR]

Background: The United States and Canada have observed sharp increases in substance use disorder among women of child-bearing or child-rearing age. Substance use disorder can have deleterious effects on children, families, and communities. Many evidence-based treatments exist, but engaging mothers in treatment is difficult. No recent review is available to help systems and providers understand the facilitators of and barriers to treatment for mothers.Objective: To systematically identify facilitators and barriers to substance use and mental health treatment for mothers with substance use disorder who are pregnant or parenting young children in the United States and Canada.Methods: We systematically searched the literature using five online databases and performed a gray literature search. We included studies published in the past two decades focused on parent or provider perspectives.Results: Our search identified 23 high-quality papers. The majority of papers qualitatively examined the perspectives of treatment-seeking pregnant women and mothers diverse in race/ethnicity, region, and treatment settings. Our synthesis of findings revealed the compelling and complex centrality of motherhood, which served as both a facilitator and barrier. Motherhood often interacted with relational (e.g., perceiving stigma vs. support from providers, family, friends, partners) and structural (e.g., time commitments, childcare) factors to both hinder and help engagement in treatment.Conclusions: Our findings can help policy-makers and practitioners make tangible improvements to the financing and delivery of substance use treatment for mothers. Our review points to specific areas for future research, including an examination of the relationships between various structural factors and treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Side effects of medications for opioid use disorder (MOUD) such as weight gain contribute to their stigma. Substantial evidence suggests that women have a more severe side effect profile to MOUD than men, and concerns about weight gain during treatment are prevalent. However, the few studies reporting sex differences in weight gain during treatment show conflicting results and are restricted to methadone. In addition, little is known about possible sex differences in weight gain to buprenorphine, which is the most commonly prescribed MOUD in the United States.Methods: To address these issues, we performed a systematic review and meta-analysis on the few studies reporting longitudinal data on sex differences in body mass index (BMI) gain during methadone treatment (Study 1). In a separate study, we also re-analyzed data from trial CTN-0030 of the National Institute on Drug Abuse Clinical Trial Network (NIDA CTN), which involved a 12-week buprenorphine treatment regimen (Study 2; n = 360; 209 Male, 151 Female).Results: For Study 1, across all papers reporting longitudinal data (k = 4, n = 362 OUD patients), there were BMI increases that ranged from 2.2 to 5.4 BMI after at least one year of methadone treatment, but there were no significant sex differences in BMI increases (Standardized Mean Difference, Female > Male = 0.352, SE =0.270; 95 % CI = [-0.18 0.88]; p = .193). Study 2 showed no significant differences in weight before and after 12 weeks of buprenorphine treatment nor did it show sex differences in weight change with treatment (β = 2.34, p = .511).Conclusion: These analyses corroborate evidence of weight gain with methadone treatment but did not observe a sex-based disparity in weight gain with methadone or buprenorphine treatment for OUD. [ABSTRACT FROM AUTHOR]

Background: Policies designed to restrict marketing, access to, and public use of electronic cigarettes (e-cigarettes) are increasingly under debate in various jurisdictions in the US. Little is known about public perceptions of these policies and factors that predict their support or opposition. Methods: Using a sample of US adults from Amazon Mechanical Turk in May 2015, this paper identifies beliefs about the benefits and costs of regulating e-cigarettes and identifies which of these beliefs predict support for e-cigarette restricting policies. Results: A higher proportion of respondents agreed with 8 different reasons to regulate e-cigarettes (48.5% to 83.3% agreement) versus 7 reasons not to regulate e-cigarettes (11.5% to 18.9%). The majority of participants agreed with 7 out of 8 reasons for regulation. When all reasons to regulate or not were included in a final multivariable model, beliefs about protecting people from secondhand vapor and protecting youth from trying e-cigarettes significantly predicted stronger support for e-cigarette restricting policies, whereas concern about government intrusion into individual choices was associated with reduced support. Discussion: This research identifies key beliefs that may underlie public support or opposition to policies designed to regulate the marketing and use of e-cigarettes. Advocates on both sides of the issue may find this research valuable in developing strategic campaigns related to the issue. Implications: Specific beliefs of potential benefits and costs of e-cigarette regulation (protecting youth, preventing exposure to secondhand vapor, and government intrusion into individual choices) may be effectively deployed by policy makers or health advocates in communicating with the public. [ABSTRACT FROM AUTHOR]

The concept of recovery has been an influence on addicted individuals for many decades. But only in the past 15 years has the concept had a purchase in the world of public policy. In the USA, federal and state officials have promulgated policies intended to foster 'recovery-oriented systems of care' and have ratified recovery-supportive laws and regulations. Though of more recent vintage and therefore less developed, recovery policy initiatives are also being implemented in the UK. The present paper describes recovery-oriented policy in both countries and highlights key evaluations of the recovery-oriented interventions. [Humphreys K, Lembke A. Recovery-oriented policy and care systems in the UK and USA. Drug Alcohol Rev 2014;33:13-18] [ABSTRACT FROM AUTHOR]

Screening for alcohol and drugs seems to be gaining traction and is becoming more commonplace in the healthcare setting. With emergency departments often being a point of contact for many individuals needing healthcare services, it makes sense to provide screening for substance misuse within this setting. The purpose of this paper is to share how emergency department staff in the Midwest United States implemented a successful Screening, Brief Intervention, Referral and Treatment (SBIRT) program within their hospital. [ABSTRACT FROM AUTHOR]

Issues: Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge.Approach: This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial µ agonist buprenorphine in the management of concurrent pain and opioid addiction.Implications: Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia.Conclusions: The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy. [ABSTRACT FROM AUTHOR]

This paper is designed to call attention to the paucity of current models of addiction and to sketch the promises of future ones. In surveying the terrain of available treatments in the United States that include the medical and crypto-Christian, it then proceeds to examine two off-shore treatment facilities for chemical dependency that utilize indigenous shamanic techniques in their syncretic—and highly successful—methodologies. An enjoinder to craft a comparative cartography of addiction and the manifold therapeutic options for its treatment, it attempts to bring to light the fact that such a comparative endeavor could greatly improve the abysmal prognoses associated with this debilitating condition. [ABSTRACT FROM AUTHOR]

A four-page paper survey was mailed to 500 randomly-selected substance abuse treatment agencies listed in a national directory to evaluate how often specific methods are employed to assess and treat craving in American substance abuse agencies. Of 426 eligible agencies, 149 (35%), located in 41 states, returned 152 usable replies. Although counselors regularly assessed craving during intake evaluations, they rarely used published self-report questionnaires. Almost one-half of respondents made craving a target of treatment with at least a majority (and sometimes all) of their clients, and only 5% of respondents reported never making craving a target of treatment. A variety of interventions are employed to address craving, including coping skills training, encouraging clients to avoid/leave situations where craving occurs, and providing clients with education about craving. We recommend additional professional education and training to familiarize counselors with standardized craving instruments and exposure interventions that hold promise to ameliorate craving. [ABSTRACT FROM AUTHOR]

Since the United States's illegal invasion and occupation of the sovereign nation of Iraq on 20 March 2003, I have published papers that critically interrogate the participation of the “sovereign” US Indigenous nations in this unjust, illegal, imperialistic war. Due to my writings, on 24 June 2007, I was invited to make a presentation at a peace vigil and rally focusing on “What Is the Highest Form of Patriotism?” The speech that I gave is provided in full text in this article, where I probe the United States of America's addiction to patriotism by interrogating and “defying the lies” of some of US patriotism's most cherished ideas, documents, leaders, and slogans. I end with a slight twist of the words of the third Buddhist noble truth, freedom from the addiction to patriotism is possible in this lifetime. [ABSTRACT FROM AUTHOR]

Approximately 200 million people in the United States have an addiction disorder that significantly disrupts employment, family relationships, financial stability, and personal health. As a result, addiction has become one of the most critical health care challenges presently facing the American health care system. Research in the last five years has provided substantial evidence that addiction is a neurobiological condition rooted in genetic factors. During the addiction process neurologic changes occur that are responsible for tolerance, craving, and relapse. It appears that once addiction becomes chronic, the brain enters an addicted state that may be irreversible without pharmaceutical intervention. Such alterations in neurochemistry-rather than poor volitional control-account for why addiction is characterized by a chronic, relapsing-remitting course. This paper discusses (a) the neurobiological factors underlying the addiction process, (b) available pharmaceutical treatment, and (c) how recent research regarding the neurobiology of addiction affects occupational therapy's role in addiction rehabilitation. A case study follows that illustrates how occupational therapists can contribute to addiction intervention. [ABSTRACT FROM AUTHOR]

ABSTRACT At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and ecological variables contributing to the development of pathological gambling. Advances in this area are hampered by imprecise definitions of pathological gambling, failure to distinguish between gambling problems and problem gamblers and a tendency to assume that pathological gamblers form one, homogeneous population with similar psychological principles applying equally to all members of the class. The purpose of this paper is to advance a pathways model that integrates the complex array of biological, personality, developmental, cognitive, learning theory and ecological determinants of problem and pathological gambling. It is proposed that three distinct subgroups of gamblers manifesting impaired control over their behaviour can be identified. These groups include (a) behaviourally conditioned problem gamblers, (b) emotionally vulnerable problem gamblers and (c) antisocial, impulsivist problem gamblers. The implications for clinical management are discussed. [ABSTRACT FROM AUTHOR]

Jails and prisons have become a final destination for persons with severe mental illness in America. Addiction, homelessness, and fragmentation of services have contributed to the problem, and have underscored the need for new models of service delivery. Project Link is a university-led consortium of five community agencies in Monroe County, New York that spans healthcare, social service and criminal justice systems. The program features a mobile treatment team with a forensic psychiatrist, a dual diagnosis treatment residence, and culturally competent staff. This paper discusses the importance of service integration in preventing jail and hospital recidivism, and describes steps that Project Link has taken towards integrating healthcare, criminal justice, and social services. Results from a preliminary evaluation suggest that Project Link may be effective in reducing recidivism and in improving community adjustment among severely mentally ill patients with histories of arrest and incarceration. [ABSTRACT FROM AUTHOR]

When and how do politicians talk about public health crises? Using evidence from the opioid crisis in the United States, this paper assembles and analyzes novel data on Congressional statements to explore the conditions under which politicians (1) issue public statements about opioids and (2) frame the opioid crisis as a predominantly public health or law enforcement problem. We examined 3.8 million Congressional floor speeches and 111,000 public statements to identify (1) floor speeches about drug crises in the 97th to 114th Congresses (1981–2017) and (2) public statements about the opioid crisis in the 116th Congress (2019–2020). Moderate ideology, women, greater overdose deaths, and larger white populations are associated with significantly higher frequencies of opioid statements. Using a dictionary-based text analysis approach, we find that ideologically liberal and African American legislators are more likely to use public health framing, while ideologically conservative members are more likely to use law enforcement framing and refer to national borders or foreign countries in opioid statements. Democrats/liberals more often referenced medication treatment for opioids. These findings imply two broader conclusions about the nature of political discourse in public health crises. First, that political extremists are least likely to talk about opioids suggests that increasing partisan polarization may result in less discussion, emphasis, and expertise in public health issues. Second, the tenor of discourse about opioids and other public health crises is likely to change with partisan electoral waves, potentially hindering long term planning of public health capacity. • Public statements by members of Congress are a source of information about opioids. • We study determinants of the frequency and content of opioid public statements. • Moderates, women, and more impacted districts issue more opioid statements. • Liberal and African American members more often use public health language. • 25% of Democrats and 50% of Republicans used mostly law enforcement language. [ABSTRACT FROM AUTHOR]