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Justin R Yates Department of Psychological Science, Northern Kentucky University, Highland Heights, KY, USACorrespondence: Justin R Yates, Email yatesj1@nku.eduAbstract: The illicit use of the psychostimulant methamphetamine (METH) is a major concern, with overdose deaths increasing substantially since the mid-2010s. One challenge to treating METH use disorder (MUD), as with other psychostimulant use disorders, is that there are no available pharmacotherapies that can reduce cravings and help individuals achieve abstinence. The purpose of the current review is to discuss the molecular targets that have been tested in assays measuring the physiological, the cognitive, and the reinforcing effects of METH in both animals and humans. Several drugs show promise as potential pharmacotherapies for MUD when tested in animals, but fail to produce long-term changes in METH use in dependent individuals (eg, modafinil, antipsychotic medications, baclofen). However, these drugs, plus medications like atomoxetine and varenicline, may be better served as treatments to ameliorate the psychotomimetic effects of METH or to reverse METH-induced cognitive deficits. Preclinical studies show that vesicular monoamine transporter 2 inhibitors, metabotropic glutamate receptor ligands, and trace amine-associated receptor agonists are efficacious in attenuating the reinforcing effects of METH; however, clinical studies are needed to determine if these drugs effectively treat MUD. In addition to screening these compounds in individuals with MUD, potential future directions include increased emphasis on sex differences in preclinical studies and utilization of pharmacogenetic approaches to determine if genetic variances are predictive of treatment outcomes. These future directions can help lead to better interventions for treating MUD.Keywords: methamphetamine use disorder, pharmacotherapy, clinical trial, animal models

Jiahao Hu, Neha Kulkarni, Peter Maliha, George Grossberg Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St Louis, MO, USACorrespondence: Jiahao Hu, Monteleone Hall, 1438 South Grand Blvd, St Louis, MO, 63104, USA, Tel +1 314-617-2777, Fax +1 314-977-4876, Email Jiahao.hu@slucare.ssmhealth.comAbstract: Substance misuse, traditionally seen as a problem of early to mid-adulthood, is becoming increasingly prevalent among the older adult population (ages ≥ 65). Diagnosing and treating substance misuse in this vulnerable population is challenging because of multiple pre-existing medical comorbidities as well as polypharmacy. As such, it remains underdiagnosed and underrepresented in the literature. This review provides an overview of the three most commonly misused substances in older adults: alcohol, cannabis, and prescription drugs. It examines epidemiology, societal trends, and treatment options, highlighting the need for targeted research to address the unique challenges faced by older adults. This review also briefly comments on the prevalence and treatment of other illicit drugs in this population.Keywords: older adult, elderly, alcohol use, cannabis use, prescription drug misuse, prevalence

Michael A Veronin,1 Justin P Reinert2 1Department of Pharmaceutical Sciences and Health Outcomes The University of Texas at Tyler Ben and Maytee Fisch College of Pharmacy, Tyler, TX, USA; 2Department of Pharmacy Practice The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USACorrespondence: Michael A Veronin, Email mveronin@uttyler.eduAbstract: The misuse of and dependency on prescription opioids represents a significant crisis at the national level, impacting not only the health of the public but also the societal and economic well-being. There is a critical need for strategies to reduce the dosage of prescribed opioids to limit opioid-associated adverse effects and lower the risk of addiction development in patients experiencing chronic pain. Opioid-sparing medications, when co-administered with opioids, enable a reduced opioid dose without loss of efficacy. This suggests the potential for using opioid adjunct drugs in opioid tapering, whereby opioid doses are lowered incrementally in a systematic manner to improve a patient’s safety profile or quality of life. The objective of this report is two-fold: 1) to illustrate the potential for adjunct drugs in opioid tapering, and 2) to describe the steps needed to be taken to develop a framework for the use of adjunct drugs in opioid tapering. This can provide the impetus for further investigation into opioid tapering and the development of improved clinical care. The proposed project implements knowledge synthesis methods to develop the framework for a new paradigm of opioid drug tapering that incorporates opioid dosage reductions with adjunct drugs. Framework development is organized into three major phases: 1) Adjunct drug characterization, 2) Assessment of the opioid-sparing effect, and 3) Usability of data for clinicians. The knowledge gained from this project can provide a foundation for improved analgesia protocols for opioids and adjunctive drug therapy.Keywords: opioid adjunc

Nicholas L Bormann,1 Cindy J Stoppel,1 Stephan Arndt,2,3 Tyler S Oesterle1 1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA; 2Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA; 3Department of Biostatistics, University of Iowa, Iowa City, Iowa, USACorrespondence: Nicholas L Bormann, Department of Psychiatry, Mayo Clinic, 200 1 st Street SW, Rochester, MN, 55905, USA, Tel +1 507 284 2088, Fax +1 507 284 4158, Email bormann.nicholas@mayo.eduPurpose: Telehealth use has grown tremendously since the onset of the COVID-19 pandemic. While the benefits of virtual care delivery are numerous, little is known about patient experiences in group treatment settings when members join both virtually and in person with the counselor (a hybrid model). We sought to fill this gap by comparing patient survey data across care delivery models.Patients and Methods: Adult patients with a substance use disorder enrolled at one of seven intensive outpatient (IOP) programs in rural Minnesota voluntarily completed a questionnaire assessing patient satisfaction, perceived therapeutic alliance, group cohesion, and insight gained from treatment. Starting 7/1/2021, groups were either all virtual, all in-person, or a hybrid model. The survey began on 1/1/2022. Analysis of covariance (ANCOVA) tested for differences among treatment groups. Separate models were used for each survey question, where the dependent variable was the survey response, the test of interest being treatment group-type, with covariates of length of stay and age. Model estimates and model-based standard deviations were used to calculate the Cohen’s d effect size.Results: Survey results from a total of 1037 individuals were included, one survey per respondent. Data was deidentified upon receipt of the survey, preventing specific demographic comparisons. For the hybrid groups, no significant differences were noted with survey responses relative to in-person, with negligible to small

Zackary Falls,1,* Xueqing Zhang,2,* Peter L Elkin,1 David Jacobs,3 Edward M Bednarczyk,4 Walter Gibson,4 Gail P Jette,5 Kenneth E Leonard6,* 1Department of Biomedical Informatics and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, New York, USA; 2Department of Biostatistics and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, New York, USA; 3School of Pharmacy and Department of Epidemiology and Environmental Health, University at Buffalo, the State University of New York, Buffalo, New York, USA; 4School of Pharmacy, University at Buffalo, The State University of New York, Buffalo, New York, USA; 5Division of Outcomes, Management, and Systems Information, Office of Addiction Services and Supports, Albany NY, United States; 6Department of Psychiatry and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, New York, USA*These authors contributed equally to this workCorrespondence: Kenneth E Leonard, Department of Psychiatry and Clinical and Research Institute on Addictions, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA, Email Kleonard@buffalo.eduIntroduction: Opioid use disorder (OUD) and opioid overdose (OD) have shown to be strongly associated with alcohol use disorder (AUD). As a potential target population for secondary prevention, we examined the incidence and timing of OUD/OD among clients seeking treatment for alcohol problems and how this has changed over the three waves of the opioid epidemic corresponding to the primary opioid involved in fatal ODs, prescription painkillers (2007– 2009), heroin (2010– 2012), and fentanyl (2013– 2016). We also examined social determinants of health as predictors of OUD/OD.Methods: Clients (N = 59,186) presenting for a first treatment for alcohol use problems were extracted from the Client

Nabin Pathak,1,2 Shreya Dhungana,3 Bijaya Basyal,4 Prabhat Kumar Jha,5 Sunil Shrestha,6 Panna Thapa,7,8 Vibhu Paudyal9,10 1Drug Information Unit and Pharmacovigilance Cell, Department of Pharmacy, Hetauda Hospital, Madan Bhandari Academy of Health Sciences, Hetauda, Bagmati Province, Nepal; 2Department of Pharmacy and Clinical Pharmacology, Madan Bhandari Academy of Health Sciences, Hetauda, Bagmati Province, Nepal; 3Department of Pharmacy, National Model College for Advanced Learning, Tribhuvan University, Kathmandu, Nepal; 4Pharmacy Unit, Prithvi Chandra Hospital, Nawalparasi, Nepal; 5Pharmacy Officer, Province Health Logistic Management Center, Dhanusha, Nepal; 6Department of Research and Academics, Kathmandu Cancer Center, Bhaktapur, Province Bagmati, Nepal; 7Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal; 8Multidimensional Cannabis Research Centre (MCRC), Kathmandu University, Dhulikhel, Nepal; 9School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; 10Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UKCorrespondence: Nabin Pathak, Drug Information Unit and Pharmacovigilance Cell, Department of Pharmacy, Hetauda Hospital, Madan Bhandari Academy of Health Sciences, Makwanpur, Hetauda, Bagmati Province, Nepal, Email nabin.pathak@mbahs.edu.np; pathaknabin89@gmail.comAbstract: The unique historical and cultural background of Nepal has shaped its perspective on cannabis usage. Narcotic Drugs Control Act 1976 of Nepal prohibits the cultivation, production, manufacture, sales, and distribution of narcotic drugs, which also include various forms of cannabis. With proponents for cannabis legalization increasing in the country, it is equally crucial to analyze context and practices in countries already adopting legalization. As such, this article contextualizes the current debates in Nepal with global policies and practices and talks about

Jessica L Bourdon,1 Sidney Judson,1 Taylor Fields,1 Sabrina Verdecanna,1 Nehal P Vadhan,2 Jon Morgenstern3 1Wellbridge Addiction Treatment and Research, Calverton, NY, USA; 2Institute of Behavioral Science, Feinstein Institutes for Medical Research. Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA; 3Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USACorrespondence: Jessica L Bourdon, Email jbourdon@wellbridge.orgBackground: There is a lack of consensus in the addiction field as to how to refer to alumni of residential treatment who no longer use substances or who reduce their use. In the literature, this label and broader identity are typically discussed in technical (amount and frequency of use) or social terms (environment and social network changes).Objective: The current paper seeks to simplify the discussion by focusing on personal labels without complex technical or social considerations. Alumni of an inpatient addiction treatment facility were asked how they refer to themselves regarding their sobriety status post-discharge.Methods: Forty-nine patients were contacted 3 months post-discharge from a residential inpatient addiction treatment (men = 67%; Mage = 47.75 years). The patients completed a post-discharge assessment that was conducted by a trained research assistant over a 20-minute video call. The current study focused on a “sobriety label” measure in which patients indicated what they want to be called. Patients also explained why they chose their answer in an open-ended question.Results: Most patients identified as in recovery (n = 29; 59.18%) followed by a sober person (n = 7; 14.29%) and four other responses. No alum selected the in remission option, which is notably a common way to refer to patients who no longer use substances.Conclusion: The current study adds a critical patient/alumni perspective to the existing body of li

Matthew E Sprong,1,2 Heaven Hollender,3 Bob Blankenberger,2 Stuart Rumrill,4 Yu-Sheng Lee,5 Travis Bland,2 Jeremiah Bailey,6 Kenneth Weber,1 James Gilbert,1 Ken Kriz,2 Frank D Buono7 1Edward Hines Jr. VA Medical Center, Hines, IL, USA; 2University of Illinois Springfield, School of Public Management and Policy, Springfield, IL, USA; 3Indiana University Indianapolis, School of Health & Human Sciences, Indianapolis, IN, USA; 4Univerity of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Champaign, IL, USA; 5University of Illinois Springfield, School of Integrated Sciences, Sustainability, and Public Health, Springfield, IL, USA; 6Florida Agricultural and Mechanical University, Department of Sociology and Criminal Justice, Tallahassee, FL, USA; 7Yale School of Medicine, New Haven, CT, USACorrespondence: Matthew E Sprong, Email mspro2@uis.eduIntroduction: Veterans diagnosed with mental health and/or substance use disorders (SUD) often face significant barriers to employment and reintegration into civilian society. In the current study, we investigated whether how the VA healthcare system for mental health and/or SUD treatment predicted program enrollment into vocational rehabilitation, simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation predicted employment at discharge, and mental health and/or SUD treatment continues and employment remain 60-days-post-vocational-rehabilitation discharge.Methods: An outcome-based, summative program evaluation design to measure quality assurance of vocational rehabilitation services provided to 402 veteran patients enrolled in a VA healthcare located within the Great Lakes Health Care System – Veterans Integrated Services Network.Results: Multivariable logistic regression analyses showed psychological empowerment (confidence in one’s ability to work or find work) is a significant factor determining whether a veteran is enrolled in the vocationa

Kenneth E Leonard,1 Joshua J Lynch,2 Florence W Leong,3 Daniel J Kruger,2 Brian M Clemency2 1Department of Psychiatry and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, NY, USA; 2Department of Emergency Medicine and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, NY, USA; 3Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, NY, USACorrespondence: Kenneth E Leonard, Clinical and Research Institute on Addictions, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA, Email Kleonard@buffalo.eduPurpose: This study compares substance use, treatment histories, and sociodemographic characteristics of patients presenting to an emergency department (ED) following a heroin overdose or seeking detoxification services for heroin and examines risk factors for a subsequent return to the ED for a substance-related problem.Methods: A convenience sample of patients presenting for an overdose or detoxification at an urban teaching ED was recruited for this study. During their ED visit, patients were interviewed regarding demographics, substance use experiences, and treatment history. Subsequently, a review of patient records for past and subsequent ED use was performed.Results: Patients requesting detox and those with an overdose were similar in terms of prior treatment. Both groups had similar extensive polysubstance histories. As a group, however, patients presenting for detox were more likely to report use of each of three substances (benzodiazepines, opioid pain medications, and heroin) more than three times per week, compared to those presenting for overdose. Detox patients had higher scores on the 3-item Alcohol Use Disorder Identification Test-C and the drug problems scale compared to overdose patients. Overall, 28% of the patients returned to the ED within 90 days for a drug-rela

Caleb J Banta-Green,1– 3 Mandy D Owens,1,4 Jason R Williams,1 Anthony S Floyd,1 Wendy Williams-Gilbert,1 Susan Kingston1 1Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington Seattle, Seattle, WA, USA; 2Department of Health Systems and Population Health, School of Public Health, University of Washington Seattle, Seattle, WA, USA; 3Department of Epidemiology, School of Public Health, University of Washington Seattle, Seattle, WA, USA; 4Department of Psychology, University of Washington, Seattle, WA, USACorrespondence: Caleb J Banta-Green, Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, NE Pacific St Box 356560, Seattle, WA, 98195, USA, Email calebbg@uw.eduPurpose: A large treatment gap exists for people who could benefit from medications for opioid use disorder (MOUD). People OUD accessing services in harm reduction and community-based organizations often have difficulty engaging in MOUD at opioid treatment programs and traditional health care settings. We conducted a study to test the impacts of a community-based medications first model of care in six Washington (WA) State communities that provided drop-in MOUD access.Participants and Methods: Participants included people newly prescribed MOUD. Settings included harm reduction and homeless services programs. A prospective cohort analysis tested the impacts of the intervention on MOUD and care utilization. Intervention impacts on mortality were tested via a synthetic comparison group analysis matching on demographics, MOUD history, and geography using WA State agency administrative data.Results: 825 people were enrolled in the study of whom 813 were matched to state records for care utilization and outcomes. Cohort analyses indicated significant increases for days’ supply of buprenorphine, months with any MOUD, and months with any buprenorphi

Eric P Borrelli,1 Peter Saad,2 Nathan E Barnes,2 Heather Nelkin,3 Doina Dumitru,3 Julia D Lucaci4 1Health Economics & Outcomes Research; Becton, Dickinson and Company, San Diego, CA, USA; 2Medical Affairs; Becton, Dickinson and Company, Durham, NC, USA; 3Medical Affairs; Becton, Dickinson and Company, San Diego, CA, USA; 4Health Economics & Outcomes Research; Becton, Dickinson and Company, Franklin Lakes, NJ, USACorrespondence: Eric P Borrelli, Becton, Dickinson and Company, 3750 Torrey View Ct, San Diego, CA, 92130, USA, Email Eric.Borrelli@bd.comBackground: The opioid epidemic has severely impacted the US over the last 15 years. Buprenorphine is a partial opioid agonist indicated for the treatment of opioid use disorder (OUD) and is recognized as an effective treatment when taken as prescribed. However, adherence rates have been low in real-world settings. Blister-packaging has been shown to promote medication adherence across a variety of disease states, although it has never been studied in OUD.Methods: An economic analysis was conducted to assess the impact of increased adherence of blister-packaged buprenorphine on health care resource utilization (HCRU) and health care costs for 10,000 patients initiating therapy for OUD. The model analyzed a commercially insured population within the US over a one-year time horizon. Medication adherence was defined in the model as proportion of days covered (PDC) of at least 80%. Literature-based references were used to inform both the impact of blister-packaging on the number of patients who became adherent as well as the impact of medication adherence on HCRU and health care costs. Model input uncertainty was assessed in one-way sensitivity analyses.Results: With the implementation of blister-packaging buprenorphine, adherence rates increased from 37.1% of patients in the pre-intervention period to 45.3%, resulting in an additional 818 patients becoming adherent post-intervention. The increase in adherence led to a

Shafii Abdullahi Maalim Mohamed,1– 3 Ahmed Muhammad Bashir2– 4 1Indian Management School and Research Centre, Mumbai, India; 2Center for Postgraduate Studies, Horseed International University, Mogadishu, Somalia; 3Focus Healthcare Initiative, Mogadishu, Somalia; 4Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Shafii Abdullahi Maalim Mohamed, Email alshafi45@gmail.comAim: This study explores the roles, challenges, and collaborative efforts of key stakeholders engaged in addressing substance abuse.Methods: Using a qualitative narrative approach, the study examined stakeholder roles in tackling substance abuse in Mogadishu, Somalia. Purposive sampling was utilised to select all available community stakeholders actively addressing substance abuse. Semi-structured interviews were conducted to collect data, allowing participants the freedom to share their experiences openly. Thematic analysis was employed to identify patterns, commonalities, and diversities in the stakeholders’ roles. The study focused on a population of five key stakeholders, including the Somali police force, a National Medicines Regulatory Authority officer, two social workers, and a representative from the Ministry of Endowments & Religious Affairs.Results: The research reveals a significant prevalence of psychoactive substances in Mogadishu, with emerging trends like the misuse of pregabalin driven by accessibility and affordability. Emphasising collaborative efforts, the study highlights the importance of effective communication and coordination among stakeholders to provide comprehensive support for individuals with substance abuse issues. Despite these challenges, such as limited resources, evolving drug trends, and addiction complexity, ongoing efforts and adaptation are crucial. Additionally, the research elucidates the established link between substance abuse and criminal behaviour, emphasising the potential consequences of drug addiction on

Vincent Grote,1,* Tim Wagner,1,2,* David Riedl,1,3 Alexandra Kautzky-Willer,4 Michael J Fischer,1,5,6 Oliver Scheibenbogen,2 Michael Musalek7– 9 1Ludwig Boltzmann Institute for Rehabilitation Research, Ludwig Boltzmann Gesellschaft, Vienna, Austria; 2Anton Proksch Institute, Vienna, Austria; 3University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria; 4Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; 5Vamed Rehabilitation Center Kitzbühel, Kitzbühel, Austria; 6Clinic for Rehabilitation Medicine, Hannover Medical School MHH, Hannover, Germany; 7Department of General Psychiatry, Sigmund Freud University, Vienna, Austria; 8Institute for Social Aesthetics and Mental Health, Sigmund Freud University, Vienna, Austria; 9Institute for Social Aesthetics and Mental Health, Sigmund Freud University, Berlin, Germany*These authors contributed equally to this workCorrespondence: Vincent Grote; Oliver Scheibenbogen, Email vincent.grote@rehabilitation.lbg.ac.at; oliver.scheibenbogen@api.or.atBackground: Substance use disorders (SUD) are prevalent disorders worldwide. Among other associated health problems, patients with SUD are at an increased risk of dying of suicide, with females displaying an even higher risk than males. Therefore, the aim of this study was to conduct a gender-sensitive evaluation of changes in suicidal ideation during multimodal inpatient treatment at a hospital facility specialized in treating addiction.Methods: A total of 694 patients (68.2% male) completed routine assessment including suicidal ideation, abstinence confidence, impulsivity, emotion regulation, self-efficacy and autonomy and joy both before (T1) and at the end (T2) of treatment. Mean changes were evaluated with repeated measures MANOVAs.Results: Before treatment, a total of n=127 (18.3%) of the respondents reported suicidal ideation, which was reduced to n=72 (10.4%) by the end of treatment. Among

Esther Pars,1– 4 Fadi Hirzalla,5 Joanne EL VanDerNagel,2,3,6,7 Boukje AG Dijkstra,2,8,9 Arnt FA Schellekens1,2 1Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; 2Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands; 3Department of Human Media Interaction, University of Twente, Enschede, the Netherlands; 4Salvation Army, Ugchelen, The Netherlands; 5Department of Public Administration and Sociology, Erasmus University, Rotterdam, the Netherlands; 6Tactus Addiction Care, Deventer, the Netherlands; 7Aveleijn, Borne, the Netherlands; 8Novadic-Kentron, Vught, the Netherlands; 9Behavioral Science Institute, Radboud University, Nijmegen, the NetherlandsCorrespondence: Esther Pars, Department of Psychiatry, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, the Netherlands, Tel +31 24 361 35 13, Email Esther.Pars-vanWeeterloo@radboudumc.nlPurpose: Substance use disorder (SUD) can be a chronic relapsing condition with poor treatment outcomes. Studies exploring factors associated with abstinence or relapse after treatment are often quantitative in nature, applying linear statistical approaches, while abstinence and relapse result from non-linear, complex, dynamic and synergistic processes. This study aims to explore these underlying dynamics using qualitative comparative analysis (QCA) as a mixed methods approach to further our understanding of factors contributing to post-treatment abstinence and relapse.Patients and Methods: In a prospective study, we gathered both qualitative and quantitative data pertaining to post-treatment substance use and the factors linked to substance use outcomes. These factors encompassed psychiatric comorbidity, intellectual disability, social disintegration, post-treatment support, and engagement in activities among patients who had undergone inpatient treatment for severe SUD (n = 58). QCA, a set-theoretic approach that considers the complex interp

Jon R Webb, Comfort M Boye Department of Community, Family, and Addiction Sciences; Texas Tech University, Lubbock, TX, USACorrespondence: Jon R Webb, Texas Tech University, Department of Community, Family, and Addiction Sciences, 1301 Akron Avenue, Room 271, Lubbock, TX, 79409, USA, Tel +1 806 834 2265, Fax +1 806 742 0053, Email jon.r.webb@ttu.eduAbstract: Addictive behavior and suicidal behavior are serious individual- and public-level health concerns. For those struggling with either or both, self-condemnation is a common experience, especially with respect to shame, guilt, and self-stigma. Self-forgiveness, a construct common to both religiousness/spirituality and positive psychology, may be an effective tool in addressing the self-condemnation inherent to those struggling with addictive behavior and suicidal behavior. In this review paper, we discuss (1) the nature and definition of forgiveness, (2) theoretical modeling developed regarding the general association of forgiveness with health, (3) theoretical modeling developed regarding the specific association of forgiveness with better outcomes related to addictive and/or suicidal behavior, (4) the relevance of shame, guilt, and self-stigma to the development and maintenance of addictive and suicidal behavior, and (5) the role of self-forgiveness in addressing self-condemnation, especially shame, guilt, and self-stigma. Little work explicitly focused on the association of self-forgiveness with shame, guilt, and/or self-stigma has been done. However, empirical evidence is accumulating in support of other associations proposed in the Forgiveness-Addiction-Recovery Association (FARA) Model described herein. As such, it is likely that similar support will be found when the focus is deliberately turned to shame, guilt, and self-stigma.Keywords: positive psychology, shame, guilt, self-stigma, twelve-step model

Andrea Nicole Weber,1 Joshua Trebach,2 Marielle A Brenner,2 Mary Margaret Thomas,3 Nicholas L Bormann4 1Department of Psychiatry, University of Iowa, Iowa City, IA, USA; 2Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA; 3Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, USA; 4Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USACorrespondence: Andrea Nicole Weber, Department of Psychiatry, University of Iowa, 500 Newton Road, 1-308 MEB, Iowa City, IA, 52242, USA, Tel +1-319-335-6980, Fax +1-319-384-7467, Email andrea-n-weber@uiowa.eduAbstract: Illicitly manufactured fentanyl (IMF) is a significant contributor to the increasing rates of overdose-related deaths. Its high potency and lipophilicity can complicate opioid withdrawal syndromes (OWS) and the subsequent management of opioid use disorder (OUD). This scoping review aimed to collate the current OWS management of study populations seeking treatment for OWS and/or OUD directly from an unregulated opioid supply, such as IMF. Therefore, the focus was on therapeutic interventions published between January 2010 and November 2023, overlapping with the period of increasing IMF exposure. A health science librarian conducted a systematic search on November 13, 2023. A total of 426 studies were screened, and 173 studies were reviewed at the full-text level. Forty-nine studies met the inclusion criteria. Buprenorphine and naltrexone were included in most studies with the goal of transitioning to a long-acting injectable version. Various augmenting agents were tested (buspirone, memantine, suvorexant, gabapentin, and pregabalin); however, the liberal use of adjunctive medication and shortened timelines to initiation had the most consistently positive results. Outside of FDA-approved medications for OUD, lofexidine, gabapentin, and suvorexant have limited evidence for augmenting opioid agonist initiation. Trials often have low retention rates, particularly

MeShell Green,1 Charles A Veltri,1 Oliver Grundmann1,2 1College of Pharmacy, Department of Pharmaceutical Sciences, Midwestern University, Glendale, AZ, USA; 2College of Pharmacy, Department of Medicinal Chemistry, University of Florida, Gainesville, FL, USACorrespondence: Oliver Grundmann, Department of Medicinal Chemistry, College of Pharmacy, University of Florida, 1345 Center Drive, Room P3-20, Gainesville, FL, 32611, USA, Tel +1-352-246-4994, Fax +1-352-392-9455, Email grundman@ufl.eduAbstract: Nalmefene hydrochloride was first discovered as an opioid antagonist derivative of naltrexone in 1975. It is among the most potent opioid antagonists currently on the market and is differentiated from naloxone and naltrexone by its partial agonist activity at the kappa-opioid receptor which may benefit in the treatment of alcohol use disorder. Oral nalmefene has been approved in the European Union for treatment of alcohol use disorder since 2013. As of 2023, nalmefene is available in the United States as an intranasal spray for reversal of opioid overdose but is not approved for alcohol or opioid use disorder as a maintenance treatment. The substantially longer half-life of nalmefene and 5-fold higher binding affinity to opioid receptors makes it a superior agent over naloxone in the reversal of high potency synthetic opioids like fentanyl and the emerging nitazenes. Nalmefene presents with a comparable side effect profile to other opioid antagonists and should be considered for further development as a maintenance treatment for opioid and other substance use disorders.Keywords: opioid antagonist, withdrawal, substance use disorder, kappa opioid receptor

Tyler S Oesterle,1,* Nicholas L Bormann,1,* Domenic A Ochal,2 Stephan Arndt,3,4 Scott A Breitinger1 1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; 2Mayo Clinic Alix School of Medicine, Rochester, MN, USA; 3Department of Psychiatry, University of Iowa, Iowa City, IA, USA; 4Department of Biostatistics, University of Iowa, Iowa City, IA, USA*These authors contributed equally to this workCorrespondence: Nicholas L Bormann, Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA, Tel +1 507 284 2088, Fax +1 507 284 4158, Email bormann.nicholas@mayo.eduPurpose: Telehealth is associated with a myriad of benefits; however, little is known regarding substance use disorder (SUD) treatment outcomes when participants join group therapy sessions in a combination in-person and virtual setting (hybrid model). We sought to determine if treatment completion rates differed.Patients and Methods: Policy changes caused by the COVID-19 pandemic created a naturalistic, observational cohort study at seven intensive outpatient (IOP) programs in rural Minnesota. Virtual-only delivery occurred 6/1/2020-6/30/2021, while hybrid groups occurred 7/1/2021-7/31/2022. Data was evaluated retrospectively for participants who initiated and discharged treatment during the study period. Participants were IOP group members 18 years and older who had a SUD diagnosis that both entered and discharged treatment during the 26-month period. A consecutive sample of 1502 participants (181– 255 per site) was available, with 644 removed: 576 discharged after the study conclusion, 49 were missing either enrollment or discharge data, 14 transferred sites during treatment, and 5 initiated treatment before the study initiation. Helmert contrasts evaluated the impact of hybrid group exposure.Results: A total of 858 individuals were included. Data was not from the medical chart and was deidentified preventing specific demogra

Jessica L Bourdon,1 Sidney Judson,1 Gabriella Caporaso,1 Monica F Wright,2 Taylor Fields,1 Nehal P Vadhan,3 Jon Morgenstern4 1Center for Addiction Science, Wellbridge Addiction Treatment and Research, Calverton, NY, USA; 2Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; 3Institute of Behavioral Science, Feinstein Institutes for Medical Research, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA; 4Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USACorrespondence: Jessica L Bourdon, Center for Addiction Science, Wellbridge Addiction Treatment and Research, 525 Jan Way, Calverton, NY, 11933, USA, Email jbourdon@wellbridge.orgBackground: Quality training is an oft-cited barrier to effective implementation and ongoing delivery of high-quality evidence-based practice (EBP) across fields. This is especially true in the addiction field, but there is little cited evidence for optimal methods to improve EBP in inpatient addiction facilities with minimal resources.Objective: The current paper focuses on evaluating the state of our facility’s group CBT manual and clinical training on the manual in a “realistic” (ie, non-RCT, non-grant-funded) inpatient addiction treatment setting.Methods: Five full-time clinicians volunteered to take part in the study (woman = 60%; Mage = 36.20 years). The study involved a mix of semi-structured interviews and surveys designed to measure seven outcomes (barriers, feasibility, useability, appropriateness, acceptability, burden, trialability).Results: Three themes emerged from the data that impacted the group CBT manual: training, timing, and functionality. Addressing these themes allowed for a new, optimal manual and training procedure to be put into place.Conclusion: The current study highlights that under-resourced inpatient addiction facilities can still methodically utilize implementation approaches to

Sophia Dobischok,1,2 Daphne Guh,2 Kirsten Marchand,2 Scott MacDonald,3 Kurt Lock,2,4 Scott Harrison,3 Julie Lajeunesse,3 Martin T Schechter,2,5 Eugenia Oviedo-Joekes2,5 1Department of Education and Counselling Psychology, McGill University, Montreal, QC, Canada; 2Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada; 3Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada; 4BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada; 5School of Population and Public Health, University of British Columbia, Vancouver, BC, CanadaCorrespondence: Eugenia Oviedo-Joekes, Centre for Advancing Health Outcomes, St. Paul’s Hospital, 575-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada, Tel +1 604-682-2344 Ext. 62973, Fax +1-604-806-8210, Email eugenia.joekes@ubc.caPurpose: A significant portion of the economic consequences of untreated Opioid Use Disorder (OUD) relate to individuals’ involvement in the criminal justice system. The present study uncovers if treatment with iOAT is related to the number of criminal charges amongst participants, what type of crime participants were involved in, and the frequency with which participants were victims of crime. This study contributes to the body of research on the effectiveness of iOAT reducing criminal involvement.Patients and Methods: This is a secondary analysis of police record data obtained from the Vancouver Police Department over a three-year period during the Study to Assess Longer-term Opioid Medication Effectiveness clinical trial. The data was obtained from participants (N = 192) enrolled in the trial through a release of information form.Results: During the three-year period, most charges (45.6%) were property offences, and 25.5% of participants were victims of crime. Participants with no treatment prior to randomization into the SALOME trial were 2.61 (95% CI = 1.64– 4.14) more likely to have been charged with a crime than during the i

Nicholas L Bormann,1 Andrea N Weber,2,3 Benjamin Miskle,2,4 Stephan Arndt,2,5 Alison C Lynch2,6 1Psychiatry and Psychology, Mayo Clinic Health System, Albert Lea, MN, USA; 2Psychiatry, University of Iowa, Iowa City, Iowa, USA; 3Internal Medicine, University of Iowa, Iowa City, Iowa, USA; 4Pharmacy, University of Iowa, Iowa City, Iowa, USA; 5Biostatistics, University of Iowa, Iowa City, Iowa, USA; 6Family Medicine, University of Iowa, Iowa City, Iowa, USACorrespondence: Nicholas L Bormann, Psychiatry and psychology, Mayo Clinic Health System, 408 W Fountain St, Albert Lea, MN, 56007, USA, Tel +1 507 377 6411, Fax +1 507 377 6443, Email bormann.nicholas@mayo.eduPurpose: Cravings for drugs and alcohol have been significantly associated with worse treatment outcomes. We investigated if improvements in recovery capital (RC) (eg, a measure of social capital/network, financial resources, education, and cultural factors) over time were associated with decreased reported cravings.Patients and Methods: The original cohort consisted of 133 participants (63 females) with opioid use disorder seeking outpatient treatment, who completed the Assessment of Recovery Capital (ARC) (range 0 to 50) and the Brief Addiction Monitor (BAM) thrice over the 6-month study. Intervention was medication and case management. Analysis included one-way mixed models testing change over time for ARC total scores and single question craving rating (5-point Likert scale). Cross-lagged panel estimates used structural equation models with variables z-scored, allowing for path coefficient evaluation as standard deviations (sd).Results: Total ARC significantly increased over the study (χ 2 = 33.77, df = 2, p < 0.0001), with baseline of 36.6 (n = 114, sd = 11.1) and 6-month of 41.2 (n = 107, sd = 9.5). Craving also changed significantly (χ 2 = 8.51, df = 2, p < 0.015), with baseline of 1.1 (n = 101, sd = 1.2) and 6-month of 0.9 (n = 107, sd = 1.1). The cross-lag from baseline RC to 3-month craving wa

Suzanna Donato,1 Lara A Ray1– 3 1Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; 2Brain Research Institute, University of California, Los Angeles, CA, USA; 3Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USACorrespondence: Lara A Ray, Shirley M. Hatos Term Chair in Clinical Neuropharmacology, Professor, University of California, Los Angeles, Psychology Department, 1285 Franz Hall, Box 951563, Los Angeles, CA, s 90095-1563, USA, Tel +1-310-794-5383, Fax +1-310-206-5895, Email lararay@psych.ucla.eduAbstract: Alcohol use disorder (AUD) is a significant public health concern, accounting for a majority of substance use disorder cases in the United States. Treatment for AUD is complex, with multiple intervention points that may be further complicated by genotype and phenotype, resulting in diverse outcomes. In order to better understand the current landscape of AUD treatment, the present review considers different etiological models of AUD and assesses the evidence base of current treatment options. The first section of this review summarizes various etiological models of AUD and presents different approaches to classifying the disorder. Various theories, including neurobiological models, are discussed. The second section presents a comprehensive analysis of available treatment options for AUD, encompassing behavioral and pharmacological interventions and their current evidence base. Finally, this review discusses the ongoing treatment gap and significant factors contributing to low treatment utilization. Together, this review provides an overview of different etiological processes and mechanisms of AUD, as well as summarizes the literature on key treatment approaches. By integrating historical, theoretical, and empirical data, this review aims to inform both researchers and providers with valuable insights to advance AUD treatment approaches and narrow the treatment gap.Keywords: al

Michele Staton,1,2 Martha Tillson,2 Mary M Levi,3 Megan Dickson,1,2 Matt Webster,1,2 Carl Leukefeld1,2 1Department of Behavioral Science, University of Kentucky, Lexington, KY, USA; 2Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA; 3Department of Psychology, University of Kentucky, Lexington, KY, USACorrespondence: Michele Staton, University of Kentucky, 117 Medical Behavioral Science Building, Lexington, KY, 40506, USA, Tel +1-859-257-2483, Email mstaton@uky.eduAbstract: While research on substance use disorder (SUD) treatment among justice-involved populations has grown in recent years, the majority of corrections-based SUD studies have predominantly included incarcerated men or men on community supervision. This review 1) highlights special considerations for incarcerated women that may serve as facilitating factors or barriers to SUD treatment; 2) describes selected evidence-based practices for women along the cascade of care for SUD including screening and assessment, treatment and intervention strategies, and referral to services during community re-entry; and 3) discusses conclusions and implications for SUD treatment for incarcerated women.Keywords: incarcerated women, SUD, treatment, justice-involvement

Kelsey Miskimins, Amanda Kaufmann, David AF Haaga Department of Psychology, American University, Washington, DC, USACorrespondence: David AF Haaga, Department of Psychology, Asbury Building, American University, 4400 Massachusetts Ave. NW, Washington, DC, 20016-8062, USA, Tel +1-202-885-1718, Fax +1-202-885-1023, Email dhaaga@american.eduPurpose: Two methods of operationalizing readiness to quit smoking have been used extensively in prior research. An algorithm derived from the transtheoretical model classifies current smokers in distinct stages of precontemplation (not intending to quit in next 6 months), contemplation (serious intent to quit within 6 months), and preparation (serious intent to quit within 30 days). The Contemplation Ladder (CL) is a single-item continuous (0– 10) rating. The current study, a secondary analysis of a clinical trial testing a method of inducing quit attempts, examined the convergent validity, one-month retest reliability, and predictive validity (for quit attempts) of the CL and the stages of change algorithm.Patients and Methods: Adult daily smokers (≥ 10 cigarettes/day; N = 278) completed the CL and stage of change algorithm measures and underwent an experimental manipulation intended to induce quit attempts. Four weeks later they completed the same measures and reported on whether they had attempted to quit smoking in the interim.Results: The CL and the staging algorithm showed strong convergent validity, with intercorrelations of 0.50 and 0.51 at baseline and follow-up assessments. Retest reliability was similar for each measure (CL r = 0.52; stage of change r = 0.57). Each showed predictive validity in that smokers who went on to make a quit attempt had scored significantly higher at baseline in readiness to quit.Conclusion: Researchers and clinicians can reasonably choose either measure of readiness to quit smoking with confidence that the results would parallel what would have been obtained with the other.Keywords: smoking

Orrin D Ware School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Orrin D Ware, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, Email oware@unc.eduPurpose: The Treatment Episode Data Set (TEDS) is a publicly available national dataset provided annually by the Substance Abuse and Mental Health Services Administration. TEDS contains sociodemographic and clinical characteristics of treatment episodes in substance use treatment facilities that receive public funds. Yet little is known about what proportion of facilities across states/jurisdictions and services/settings receive public funds to assist with interpreting TEDS.Methods: This study uses the National Survey of Substance Abuse Treatment Services 2020. Descriptive statistics were used to estimate percentages of facilities that receive public funds at national and state/jurisdiction levels across all services/settings.Results: In the full sample, 51.4% (n = 8262) of facilities received public funds, and in the sample of states/jurisdictions included in TEDS 2020 data, 52.3% (n = 7659) of facilities received public funds. Across services/settings, the proportion of facilities receiving public funds ranges from 27.1% in rehab/residential, hospital (non-detox) settings to 58.0% in rehab/residential, short-term (30 days or fewer) services/settings. Variability was also identified within states and services/settings from 0.0% to 100.0% of facilities that receive public funds.Conclusion: This study estimates the proportions of substance use facilities that receive public funds to guide interpretations of TEDS. This study’s findings, combined with TEDS, may assist advocates, clinicians, policymakers, researchers, service providers, service recipients, and other key stakeholders in reaching a shared goal: improving the well-being of individuals living with substance use disorders.Keywords: detoxification, outpatient, national su

Muhammad Haroon Stanikzai, Mohammad Wahid Wahidi Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, AfghanistanCorrespondence: Muhammad Haroon Stanikzai, Department of Public Health, Faculty of Medicine, Kandahar University, District &num; 10, Kandahar, 3801, Afghanistan, Tel +93704775578, Email haroonstanikzai1@gmail.comBackground: Substance use and its associated bio-psycho-social problems are public health concerns with harmful individual and social consequences.Objective: This study assessed the bio-psycho-social profile of people with substance use disorders (SUD) treated at locally assigned treatment facilities in Kandahar, Afghanistan.Methods: We conducted this facility-based cross-sectional study among 621 substance users receiving care at three locally assigned treatment facilities in November-December 2022. We performed multiple linear regression to determine factors associated with psychological symptoms.Results: The mean age of the participants was 34.41 (± 10.10 SD) years. The majority of our subjects (81.2%) perceived their physical health as very good or fair. More than two-thirds (73.4%) rated their social support as high. Of all participants, 541 (87.1%) had symptoms of depression, 569 (91.6%) of anxiety, and 442 (71.2%) of stress. The prevalence of severe depression, anxiety, and stress was 34.8%, 65.8%, and 27.3%, respectively. The multiple linear regression showed that several attributes of people with substance use disorders [ie, having a low level of education (β=0.12, p=< 0.001), being unemployed (β=0.31, p=< 0.001), having a low level of social support (β=− 0.35, p=< 0.001), had a pre-existing medical condition (β=− 0.28, p=< 0.001), and having lived abroad in the past ten years (β=0.10, p=0.001)] were significantly associated with higher DASS-21 total scores.Conclusion: This study highlights the importance of providing bio-psycho-social support programs and implementing therapeutic inte

Shayna Mazel,1,&ast; Karen Alexander,2,&ast; Camille Cioffi,3,&ast; Mishka Terplan2,&ast; 1Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; 2Friends Research Institute, Baltimore, MD, USA; 3Center on Parenting and Opioids, Prevention Science Institute, University of Oregon, Eugene, OR, USA&ast;These authors contributed equally to this workCorrespondence: Mishka Terplan, Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA, Tel +1 410 837 3977, Fax +1 410 752 4218, Email mterplan@friendsresearch.orgAbstract: There is a fundamental disconnect between the optimal management of addiction in general and care delivery in pregnancy and postpartum. Addiction is a chronic condition requiring some degree of management across the life course. Yet, in the US, reproductive care is episodic and centers more on pregnancy than at other stages of the reproductive life course. Pregnancy is prioritized in access to insurance as almost all pregnant people are Medicaid eligible but access ends at varying points postpartum. This results in a structural mismatch: the episodic management of the chronic condition of addiction only within gestational periods. Though people with substance use disorder (SUD) may access care in pregnancy, treatment attrition is common postpartum. Postpartum is a time of increased vulnerabilities where insurance churn and newborn caretaking responsibilities collide in a context of care withdrawal from the health system and health providers. In part in consequence, return to use, SUD recurrence, overdose, and overdose death are more common postpartum than in pregnancy, and drug deaths have become a leading cause of maternal deaths in the US. This review addresses interventions to support engagement in addiction care postpartum. We begin with a scoping review of model programs and evidence-informed interventions that have been shown to increase con

Alexandra Paul,1,2 Aleena Ghanta,1,2 Ariana M Chao1– 3 1Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; 2Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 3Johns Hopkins University School of Nursing, Baltimore, MD, USACorrespondence: Ariana M Chao, Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 2120, USA, Tel +1-410-955-4766, Email ariana.chao@jhu.eduAbstract: Similarities have been reported between the diagnostic and associated characteristics of binge-eating disorder (BED) and substance-related and non-substance-related disorders. This has resulted in interest in using addiction models to inform clinical care for people with BED. The purpose of this paper was to review features of addiction in BED with a focus on clinical implications. First, we briefly summarize similarities and differences in diagnostic and mechanistic features and symptoms for BED and food addiction, substance-related disorders, and non-substance-related disorders. Then we review aspects of addiction in BED that have clinical implications for screening and treatment of this condition. Similarities in diagnostic criteria between BED and substance-related and non-substance-related disorders include loss of control, greater use than intended, continued use despite adverse consequences, and marked distress. Addiction models may help inform aspects of clinical care of BED, particularly for shared antecedents and mechanisms underlying both disorders and to enhance engagement in treatment. Yet, there are large gaps in evidence regarding the effects of many aspects of addiction models to BED. More research is needed to examine the safety and efficacy of using addiction theories and frameworks for clinical strategies for BED.Keywords: addiction, binge-eating disorder, eating disorder, substance-related disorders, treatment

Kari Bøhle,1– 3 Eli Otterholt,1,2 Stål Kapstø Bjørkly1,4 1Faculty of Health and Social Science, Molde University College, Molde, Norway; 2Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway; 3Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; 4Regional Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, NorwayCorrespondence: Kari Bøhle, Molde University College, Britvegen 2, Molde, 6412, Norway, Tel +47 911 09 321 ; +47 71 21 40 00, Email kari.bohle@ntnu.noIntroduction: This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions.Materials and Methods: Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multiv

Kevin S Murnane,1 Amber N Edinoff,2 Elyse M Cornett,3 Alan D Kaye3 1Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA; 2Department of Psychiatry, Harvard Medical School, Boston, MA, USA; 3Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USACorrespondence: Kevin S Murnane, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA, Email kevin.murnane@lsuhs.eduAbstract: Substance use problems impair social functioning, academic achievement, and employability. Psychological, biological, social, and environmental factors can contribute to substance use disorders. In recent years, neuroimaging breakthroughs have helped elucidate the mechanisms of substance misuse and its effects on the brain. Functional magnetic resonance imaging (MRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS) are all examples. Neuroimaging studies suggest substance misuse affects executive function, reward, memory, and stress systems. Recent neuroimaging research attempts have provided clinicians with improved tools to diagnose patients who misuse substances, comprehend the complicated neuroanatomy and neurobiology involved, and devise individually tailored and monitorable treatment regimens for individuals with substance use disorders. This review describes the most recent developments in drug misuse neuroimaging, including the neurobiology of substance use disorders, neuroimaging, and substance use disorders, established neuroimaging techniques, recent developments with established neuroimaging techniques and substance use disorders, and emerging clinical neuroimaging technology.Keywords: MRI, neurobiology, substance misuse, addiction, neuroimaging, AI, PET, fMRI, SPECT

Tesfaye Shibiru,1 Anthonisamy Arulandhu,2 Ashenafi Belete,1 Jiregna Etana,1 Wakjira Amanu1 1School of Medicine, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia; 2Department of Biomedical Sciences, Institutes of Health Sciences, Wollega University, Nekemte, EthiopiaCorrespondence: Anthonisamy Arulandhu, Department of Biomedical Sciences, Institutes of Health Sciences, Wollega University, Post Box No. 395, Nekemte, Ethiopia, Tel +251-908793040, Email antobio73@gmail.comBackground: Alcohol consumption is a major public health concern among adolescents and young adults. Adolescence is an important period of human growth. Alcohol consumption during this age will lead to a variety of problems: health, social, economic, etc. Further, research studies have shown that alcohol consumption, both at normal and above normal levels, will lead to a wide range of health problems. The purpose of this study is to evaluate the prevalence and associated factors for alcohol consumption among secondary school students in Nekemte town, East Wollega Zone, Ethiopia, in 2022.Methods: A school-based cross-sectional research design approach is used. The data is collected using a structured and self-administered questionnaire. Through systematic random sampling, 291 out of 15,798 students ranging from 9 through 12 grades are chosen. The students selected from each school are proportional to their total strength.Results: The study is conducted on 291 participants with a mean age of 17.5 ± 1.5 years. Of them, 49.8% are males, and the remaining 50.2% are females. It revealed that 27.84% of participants consume alcohol: 30.3% males and 25.3% females. Age (AOR: 2.755, 95% CI: 1.307– 5.809), Urban location (AOR: 1.674, 95% CI: 0.962– 2.914), Smoking (AOR: 0.426, 95% CI: 0.104– 1.740), Chewing Khat (AOR: 2.185, 95% CI: 0.539– 8.855), Having friends who drink (AOR: 1.740, 95% CI: 0.918– 3.300), and having a family member who drinks alcohol. All these categories are signi

Abdi Birhanu,1 Tilahun Bete,2 Addis Eyeberu,3 Tamirat Getachew,3 Elias Yadeta,3 Abraham Negash,3 Magarsa Lami,3 Tegenu Balcha,3 Addisu Sertsu,4 Adera Deballa3 1School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 3Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 4Department of Nursing, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Abdi Birhanu, Haramaya University, P.O. Box: 235, Harar, Ethiopia, Email abdiibiree@gmail.comIntroduction: Psychoactive substance use is a growing health problem in both developing and developed countries. Despite adolescents being at high risk of practicing risky behaviors including substance use, there is no adequate information on the problem in the Harari Region, in the Eastern part of Ethiopia. Hence, the present study aimed to identify the burden of current substance use in high school adolescent students of Harari Region, Ethiopia, from 10th April to 10th May 2022.Methods: A school-based cross-sectional study was employed on a total of 1498 randomly selected adolescent students. Poisson regression was used for the assessment of substance use over the last three months among adolescent students. The substance use burden was reported by IRR (incidence rate ratio) at a 95% Confidence interval. The final model fitness was checked using Akaike information criterion (AIC) and Bayesian information criterion (BIC) reports. The variables that had less than 0.05 P-value were declared to be statistically significant.Results: The overall psychoactive substance use was 373 (24.9%, 95% Confidence Interval (CI); 22.8– 27.1%). The substances included khat (21.6%, 95% CI; 18.6– 23.6%), alcohol drinking (1.8%; 95% CI; 1.3– 2.6%), and smoking (1.2%, 95% CI; 0.75– 1.9%). Being male (IRR (Incidence R

Molly Magill,1 Brian D Kiluk,2 Lara A Ray3 1Brown University Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; 2Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; 3Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USACorrespondence: Molly Magill, Brown University Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box-G-S121-5, Providence, RI, 02913, USA, Email molly_magill@brown.eduPurpose: We provide an overview of Cognitive Behavioral Therapy (CBT) efficacy for adult alcohol or other drug use disorders (AOD) and consider some key variations in application as well as contextual (ie, moderators) or mechanistic (ie, mediators) factors related to intervention outcomes.Methods: This work is a narrative overview of the review literature on CBT for AOD.Results: Robust evidence suggests the efficacy of classical/traditional CBT compared to minimal and usual care control conditions. CBT combined with another evidence-based treatment such as Motivational Interviewing, Contingency Management, or pharmacotherapy is also efficacious compared to minimal and usual care control conditions, but no form of CBT consistently demonstrates efficacy compared to other empirically-supported modalities. CBT and integrative forms of CBT have potential for flexible application such as use in a digital format. Data on mechanisms of action, however, are quite limited and this is despite preliminary evidence that shows that CBT effect sizes on mechanistic outcomes (ie, secondary measures of psychosocial adjustment) are moderate and typically larger than those for AOD use.Conclusion: CBT for AOD is a well-established intervention with demonstrated efficacy, effect sizes are in the small-to-moderate range, and there is potential for tailoring given the modular format of the intervention. Future work should consider mechanisms of CBT efficacy and key conditi

Jaber S Alqahtani,1 Abdulelah M Aldhahir,2 Zaid Alanazi,3 Emad Zahi Alsulami,4 Mujahid A Alsulaimani,5 Abdullah A Alqarni,6 Abdullah S Alqahtani,1 Ayadh Yahya AlAyadi,1 Musallam Alnasser,1 Ibrahim A AlDraiwiesh,1 Saeed M Alghamdi,7 Hussam M Almarkhan,1 Abdullah S Alsulayyim,2,8 Saad M AlRabeeah,1 Mohammed D AlAhmari1 1Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 2Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia; 3Family Medicine Department, Northern Area Armed Forces Hospital (NAAFH), Hafar Al Batin, Saudi Arabia; 4Family Medicine Department, Armed Forces Hospital in King Abdulaziz Airbase, Dhahran, Saudi Arabia; 5Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 6Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 7Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia; 8National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UKCorrespondence: Jaber S Alqahtani, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia, Email Alqahtani-Jaber@hotmail.comBackground: Smoking behavior has been associated with poor academic performance among adult students worldwide. However, the detrimental effect of nicotine dependence on several students’ academic achievement indicators is still unclear. This study aims to assess the impact of smoking status and nicotine dependence on grade point average (GPA), absenteeism rate and academic warnings among undergraduate health sciences students in Saudi Arabia.Methods: A validated cross-sectional survey was conducted, in which, participants responded to questions evaluated cigarette consumption, urge to consume and dependency, learning perfo

Kalkidan Yohannes,1 Getinet Ayano,2,3 Kusse Koirita Toitole,4 Henok Mulatu Teferi,5 Hirbaye Mokona1,6 1Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia; 2Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia; 3School of Population Health, Curtin University, Perth, WA, Australia; 4Arba Minch General Hospital, Arba Minch, Ethiopia; 5Mohammed Akile Memorial General Hospital, Amibara, Afar, Ethiopia; 6Department of Psychiatry, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Kalkidan Yohannes, Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia, Email kalkid29@yahoo.comIntroduction: Alcohol consumption among patients with tuberculosis is on the rise. There is evidence that alcohol consumption negatively affects treatment outcomes for these populations. Due to this, a substantial number of people relapse, withdraw from treatment, or even die as a result of their alcohol addiction. Despite this, little research has been conducted on the factors associated with the harmful use of alcohol by this group of people in Ethiopia. The purpose of this study was to determine the prevalence and associated factors of harmful alcohol use among patients with tuberculosis in the Gedeo Zone, southern Ethiopia.Methods: A cross-sectional study was conducted at healthcare facilities. Four hundred and fifteen participants aged 18 and older were recruited using a systematic random sampling method. Data on sociodemographic factors, clinical factors, social support, perceptions of the stigma associated with tuberculosis, and depression were collected using structured and validated instruments. Measurement of harmful alcohol consumption was conducted using the AUDIT.Results:  The prevalence of harmful alcohol use among tuberculosis patients was 20% (95% CI; 16.1– 24.2%). There is a significant correlati

Joshua Owolabi1,2 1Department of Anatomy, University of Global Health Equity, Butaro, Rwanda; 2Department of Anatomy, Babcock University, Ilishan-Remo, NigeriaCorrespondence: Joshua Owolabi, Department of Anatomy, University of Global Health Equity, Butaro, Rwanda, Tel +234-80-6488-4305, Email jowolabi@ughe.orgAbstract: Drug epidemiology basically involves the methodical study of the incidence, distribution, and impact of drug or substance abuse in populations and associated factors with a view to proffering solutions or interventions. Drug epidemiology has significantly evolved over the years. The nature of substances that are being used or abused has also drastically evolved, just as the factors that are associated are also evolving. Populations appear to have observable trends or patterns and characteristic underlying factors that are primarily responsible for the trends. Unfortunately, there have not been adequate efforts to appreciate the evolutions that have characterized the patterns of drug or substance abuse or the factors that are responsible for these trends. This is also because drug epidemiology has arguably not been given the attention that it probably deserves worldwide. Judging by recent developments and data on prevalence, drug epidemiology warrants significant attention. This article provides insights into drug epidemiology, not just as a concept but a subject of public and global health, and health equity. It also highlights challenges and matters arising in drug epidemiology, sheds light on contemporary issues, and attempts to suggest solutions. Finally, it advocates for policies and practices that are in line with global realities and trends.Keywords: drug epidemiology, substance abuse, mental health, global health, equity

Zinabu Asfaw,1 Mengistu Mitiku,2,3 Haftom Temesgen Abebe,2,4 Mussie Tesfay Atsbeha5 1Department of Public Health, Adigrat University, Adigrat City, Tigrai, Ethiopia; 2School of Public Health, Mekelle University, Mekelle City, Tigrai, Ethiopia; 3Research and Community Engagement Coordination Office, Mekelle University, Mekelle City, Tigrai, Ethiopia; 4Laboratory Interdisciplinary Statistical Data Analysis, Mekelle University, Mekelle city, Tigrai, Ethiopia; 5School of Medicine, Mekelle University, Mekelle City, Tigrai, EthiopiaCorrespondence: Zinabu Asfaw, Department of Public Health, Adigrat University, P.O. Box: 50, Adigrat City, Ethiopia, Email zinabu.asfaww@gmail.comBackground: Homelessness among children is a significant problem in most nations of the world. Children who experienced homelessness are most often unable to get secured and adequate housing. Such problems expose them to a range of destructive practices such as substance use. This study, therefore, was designed to evaluate the level and determinants of substance use by children who experienced homelessness in major cities of Northern Ethiopia.Methods: This cross-sectional study was undertaken from October 1, 2019 to February 30, 2020. We conducted street-based outreach searching to get a representative sample of the city’s children who experienced homelessness and a total of 422 were recruited. The collected data were analyzed using SPSS version 20. Regression analysis was done to identify factors associated with substance use and statistical significance was declared at p < 0.05 and 95% confidence interval.Results: More than 80% of the children who experienced homelessness use alcohol, cigarette or chat. Marriage status of parents before the child experiences homelessness being divorce (AOR = 8.53, 95% CI: 1.87– 38.89), occupational status of mother being a daily laborer (AOR = 2.78, 95% CI: 0.83, 9.31), child relationship status with parents before child experiences homelessness (AOR = 0.08

Himanshu A Gupte,1 Nilesh Chatterjee,1 Gauri Mandal2 1Narotam Sekhsaria Foundation, Mumbai, Maharashtra, India; 2Salaam Bombay Foundation, Mumbai, Maharashtra, IndiaCorrespondence: Nilesh Chatterjee, Narotam Sekhsaria Foundation, First Floor, Nirmal Building, Nariman Point, Mumbai, 400 021, India, Tel +91-9819472736, Email nileshchatterjee100@gmail.comContext: Areca nut, used alone or in combination with tobacco, contributes to the high oral cancer burden in India. Used widely by adolescents, who perceive it as a harmless substance, areca nut is addictive and considered a precursor to tobacco use. Given its serious implications for addictiveness and physical health, urgent preventive interventions for areca nut use are required in India and South-East Asia. Studies examining the role of health behavior theory in explaining and predicting areca nut use and for development of its prevention among adolescents are scarce.Aim: This study explored the role of the components of Theory of Planned Behavior (TPB) such as attitudes, subjective norms, perceived behavioral control, and intention in predicting areca nut use among adolescents.Settings and Design: Observational study with cross-sectional design conducted with 1884 male and female adolescents attending low-income schools in Mumbai, India.Methods and Material: Self-administered surveys were used to gather data on age, gender, behavioral factors and areca nut use.Statistical Analysis Used: Chi-square and Mann Whitney test for bivariate and logistic regression for multivariate analysis.Results: Around 27.2% of 1884 participants were areca nut users. The mean age of users was 13.75 years. Intention-to-use and perceived behavioral control were statistically significant predictors of actual areca nut use (p< 0.001). The components of TPB such as attitude, perceived subjective social norms, and perceived behavioral control had a statistically significant effect on the intention-to-use areca nut (p< 0.05).Conclusion

Victor Bassey Archibong,1– 3 Ibe Michael Usman,1 Ann Monima Lemuel1 1Department of Human Anatomy, Faculty of Basic Medical Sciences, Kampala International University, Bushenyi, Uganda; 2Department of Human Anatomy, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria; 3Department of Clinical Biology, College of Medicine and Health Sciences, University of Rwanda, Kigali, RwandaCorrespondence: Ann Monima Lemuel, Tel +256 754031204, Email annexdot5@gmail.comPurpose: Over-the-counter (OTC) anti-cough medications which contain codeine (an opioid) are extensively available in Nigeria, and hence prone to overuse or abuse. The study aimed to understand the effects of oral codeine administration on the integrity of neurons of the cerebral cortex and cerebellum and its behavioral implications in male Wistar rats.Methods: Thirty adult male Wistar rats of comparable weights were obtained and randomly allocated into 5 groups: A, B, C, D, and E (n = 6). Drugs used for the study were ArchilinTM with codeine and dihydrocodeine 30mg. Group A served as control and was administered 0.5mL/kg of normal saline. Groups B and C were treated with 1mg/kg and 2mg/kg of dihydrocodeine, respectively; Group D and E received 2mL/kg and 4mL/kg of ArchilinTM codeine syrup, respectively. The ArchilinTM codeine syrup and dihydrocodeine solutions were administered to the animals based on their body weight, orally and daily with the aid of oropharyngeal tubes for 21 days. The experimental animals were subjected to neurobehavioral studies using beam walk and open field. At the end of the treatment period, the animals were anesthetized with ketamine-hydrochloride intraperitoneally. The brains were quickly dissected out, rinsed with normal saline, and tissue processed for myelin studies.Results: The beam walking and open field result revealed that prolonged codeine administration interfered with motor function in the experimental animals. Sections of the prefront

Elizabeth KC Schwartz,1,2 Noah R Wolkowicz,1,2 Joao P De Aquino,1,2 R Ross MacLean,1,2 Mehmet Sofuoglu1,2 1Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; 2Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USACorrespondence: Elizabeth KC Schwartz, Tel +1-203-932-5711, Fax +1-203-937-3472, Email Elizabeth.schwartz@yale.eduAbstract: Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.Keywords: cocaine, cocaine use disorder, treatment, pharmacotherapy, behavioral interventions

Jørgen G Bramness,1– 3 Susmita Pandey,1 Jenny Skumsnes Moe,1,3 Helge Toft,1,4 Lars Lien,1,4 Ingeborg Bolstad1,4 1Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway; 2Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Oslo, Norway; 3Institute Clinical of Medicine, UiT – The Arctic University of Norway, Tromsø, Norway; 4Department of Health Studies, Inland Norway University of Applied Sciences, Elverum, NorwayCorrespondence: Jørgen G Bramness, Norwegian Institute of Public Health, P.O.Box 222, Oslo, 0213, Norway, Email jobr@fhi.noIntroduction: Delirium tremens (DT) occurs after stopping prolonged, high alcohol intake and may be life-threatening if untreated. We need to know about clinical correlates of DT in order to provide the best clinical care.Methods: At admission to inpatient treatment a cohort of 114 alcohol use disorder (AUD) patients were interviewed and examined concerning psychiatric diagnosis and symptoms, trauma experiences and alcohol related measures and if they had experienced DT.Results: Twenty-four percent of the patients reported a life-time experience of DT. These patients were predominantly males and had lower educational level. More of the patients in the DT than the non-DT group reported at least one suicide attempt, were diagnosed with PTSD, and dropped out of treatment. Also, having parents with alcohol problems was more common among these patients, and they reported a longer duration of problematic drinking and a higher number of drinks needed to feel an effect of drinking. In the multivariable adjusted analysis only a diagnosis of PTSD (OR=5.71; 95% confidence interval (CI): 1.34– 24.31) and duration of problematic drinking with a 6% increase in risk for every year (OR=1.06; 95% CI: 1.01– 1.11) remained significant risk factors for having DT experience.Discussion and conclusion: Having experienced DT was more prevalen

Andrea Weber,1 Benjamin Miskle,1 Alison Lynch,1 Stephan Arndt,1,2 Laura Acion3 1Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA; 2Department of Biostatistics, University of Iowa, Iowa City, IA, USA; 3Universidad de Buenos Aires – CONICET, Instituto de Cálculo, Ciudad Autónoma de Buenos Aires, ArgentinaCorrespondence: Andrea Weber, Department of Psychiatry, University of Iowa Health Care, 500 Newton Road, Iowa City, IA, 52242, USA, Tel +1 319 384 8014, Fax +1 319 384 7467, Email andrea-n-weber@uiowa.eduPurpose: Substance use disorders (SUDs) are widespread and cause significant morbidity and mortality, yet most people in the United States with a SUD do not receive treatment. Recommendations call for widespread use of pharmacotherapy, including medications for opioid use disorder (MOUD). However, many facilities do not offer a full array of medication treatments. This study aims to characterize programs that do and do not offer pharmacotherapy as part of addiction treatment services. We hypothesized that the availability of pharmacotherapy would predict the existence of other recommended components of treatment.Patients and Methods: We analyzed characteristics regarding treatment facilities (n = 15,782) recorded by the 2019 National Survey of Substance Abuse Treatment Services (N-SSATS) to determine how many SUD treatment facilities offer any pharmacotherapy. We compared facilities that offer any pharmacotherapy to facilities that offer none.Results: We found that 65% of SUD treatment facilities that responded to the N-SSATS survey provided at least one pharmacotherapy, while 35% of SUD treatment facilities did not. The facilities that provided at least one pharmacotherapy offered, on average, 6 additional treatment options (Cohen’s d = 0.87; 95% CI: 0.84– 0.91). Psychiatric medications were the most commonly available pharmacotherapy, followed by buprenorphine/naloxone and naltrexone.Conclusion: These results support that pharmaco

Emma Tay,1 Wing Kwan Winky Lo,2 Bridin Murnion3 1Drug Health Services, Western Sydney Local Health District, Sydney, NSW, Australia; 2Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; 3Faculty of Medicine and Health, University of Sydney, Sydney, NSW, AustraliaCorrespondence: Bridin MurnionDrug Health Services, Western Sydney Local Health District, 4A Fleet Street, North Parramatta, NSW, 2151, Australia, Tel +61 2 9840 3888, Fax +61 2 9840 3927, Email bridin.murnion@sydney.edu.auAbstract: Recreational gamma-hydroxybutyrate (GHB) use, although less common than other substance use, is increasingly recognised and is over-represented in emergency toxicology presentations. This narrative review summarizes GHB pharmacology, current patterns of use, potential harms and management of GHB toxicity and withdrawal. There is a complex interplay between GHB and GABA as GHB is both a prodrug and metabolite of GABA and GHB activates both GHB and GABA receptors. GHB is rapidly absorbed, with effects seen within minutes of ingestion. Metabolism is non-linear at higher doses. While GHB is listed as a controlled substance, its precursor’s gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are easily available as both have industrial applications. National surveys indicate low rates of GHB use, with identification of high-risk populations in men who have sex with men and polysubstance users. GHB is one of the three drugs most commonly used in chemsex. GHB is often co-ingested with other interacting psychoactive substances. Acute toxicity is dose-dependent, and management is supportive care. Withdrawal management is generally with benzodiazepines with addition of baclofen for more severe withdrawal. Barbiturates may have a role. Titration and tapering of pharmaceutical GHB is commonly used in the Netherlands. Complicated withdrawal with delirium may require intensive care and treatment with intravenous sedation. There are high rates of relapse after withdr

Ali Cheetham,1,2 Louisa Picco,1 Anthony Barnett,1,2 Dan I Lubman,1,2 Suzanne Nielsen1,2 1Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia; 2Turning Point, Eastern Health, Richmond, Victoria, 3121, AustraliaCorrespondence: Suzanne NielsenMonash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, Victoria, 3199, Australia, Tel +61 3 9904 4641, Email suzanne.nielsen@monash.eduAbstract: Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.Keywords: stigma, opioid use disorder, FINIS, opioid-related disorders, analgesics, Opioid, social stigma