Showing papers on "Addiction medicine published in 2017"

Treatments for Internet gaming disorder and Internet addiction: A systematic review.

Abstract: Problems related to excessive use of the Internet and video games have recently captured the interests of both researchers and clinicians. The goals of this review are to summarize the literature on treatment effectiveness for these problems and to determine whether any treatments meet the minimum requirement of an evidence-based treatment as defined by Chambless et al. (1998). Studies of treatments for Internet gaming disorder (IGD) and Internet addiction were examined separately, as past studies have linked IGD to more severe outcomes. The systematic review identified 26 studies meeting predefined criteria; 13 focused on treatments for IGD and 13 on Internet addiction. The results highlighted a paucity of well-designed treatment outcome studies and limited evidence for the effectiveness of any treatment modality. Studies were limited by methodological flaws, including small sample sizes, lack of control groups, and little information on treatment adherence, among other problems. In addition, the field is beset by a lack of consistent definitions of and established instruments to measure IGD and Internet addiction. The results of this review highlight the need for additional work in the area of treatment development and evaluation for IGD and Internet addiction. Attention to methodological concerns identified within this review should improve subsequent research related to treating these conditions, and ultimately outcomes of patients suffering from them. (PsycINFO Database Record

Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity

Abstract: Alcohol and drug use results in substantial morbidity, mortality, and cost Individuals with alcohol and drug use disorders are overrepresented in general medical settings Hospital-based interventions offer an opportunity to engage with a vulnerable population that may not otherwise seek treatment To determine whether inpatient addiction consultation improves substance use outcomes 1 month after discharge Prospective quasi-experimental evaluation comparing 30-day post-discharge outcomes between participants who were and were not seen by an addiction consult team during hospitalization at an urban academic hospital Three hundred ninety-nine hospitalized adults who screened as high risk for having an alcohol or drug use disorder or who were clinically identified by the primary nurse as having a substance use disorder Addiction consultation from a multidisciplinary specialty team offering pharmacotherapy initiation, motivational counseling, treatment planning, and direct linkage to ongoing addiction treatment Addiction Severity Index (ASI) composite score for alcohol and drug use and self-reported abstinence at 30 days post-discharge Secondary outcomes included 90-day substance use measures and self-reported hospital and ED utilization Among 265 participants with 30-day follow-up, a greater reduction in the ASI composite score for drug or alcohol use was seen in the intervention group than in the control group (mean ASI-alcohol decreased by 024 vs 008, p < 0001; mean ASI-drug decreased by 005 vs 002, p = 0003) There was also a greater increase in the number of days of abstinence in the intervention group versus the control group (+127 days vs +56, p < 0001) The differences in ASI-alcohol, ASI-drug, and days abstinent all remained statistically significant after controlling for age, gender, employment status, smoking status, and baseline addiction severity (p = 0018, 0018, and 002, respectively) In a sensitivity analysis, assuming that patients who were lost to follow-up had no change from baseline severity, the differences remained statistically significant In a non-randomized cohort of medical inpatients, addiction consultation reduced addiction severity for alcohol and drug use and increased the number of days of abstinence in the first month after hospital discharge

Planning and Designing the Improving Addiction Care Team (IMPACT) for Hospitalized Adults with Substance Use Disorder.

Abstract: People with substance use disorders (SUD) have high rates of hospitalization and readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care are extremely limited. We performed a needs assessment and then convened academic and community partners, including a hospital, community SUD organizations, and Medicaid accountable care organizations, to design a care model for medically complex hospitalized patients with SUD. Needs assessment showed that 58% to 67% of participants who reported active substance use said they were interested in cutting back or quitting. Many reported interest in medication for addiction treatment (MAT). Participants had high rates of costly readmissions and longer than expected length of stay. Community stakeholders identified long wait times and lack of resources for medically complex patients as key barriers. We developed the Improving Addiction Care Team (IMPACT), which includes an inpatient addiction medicine consultation service, rapid-access pathways to posthospital SUD treatment, and a medically enhanced residential care model that integrates antibiotic infusion and residential addiction care. We developed a business case and secured funding from Medicaid and hospital payers. IMPACT provides one pathway for hospitals, payers, and communities to collaboratively address the SUD epidemic. Journal of Hospital Medicine 2017;12:339-342.

Appropriate Use of Drug Testing in Clinical Addiction Medicine.

Abstract: Biological drug testing is a tool that provides information about an individual's recent substance use Like any tool, its value depends on using it correctly; that is, on selecting the right test for the right person at the right time This document is intended to clarify appropriate clinical use of drug testing in addiction medicine and aid providers in their decisions about drug testing for the identification, diagnosis, treatment, and recovery of patients with, or at risk for, addiction The RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) process for combining scientific evidence with the collective judgment of experts was used to identify appropriate clinical practices and highlight areas where research is needed Although consensus panels and expert groups have offered guidance on the use of drug testing for patients with addiction, very few addressed considerations for patients across settings and in different levels of care This document will focus primarily on patients in addiction treatment and recovery, where drug testing is used to assess patients for a substance use disorder, monitor the effectiveness of a treatment plan, and support recovery Inasmuch as the scope includes the recognition of addiction, which often occurs in general healthcare settings, selected special populations at risk for addiction visiting these settings are briefly included

Neuroscience-informed psychoeducation for addiction medicine: A neurocognitive perspective

Abstract: Psychoeducation (PE) is defined as an intervention with systematic, structured, and didactic knowledge transfer for an illness and its treatment, integrating emotional and motivational aspects to enable patients to cope with the illness and to improve its treatment adherence and efficacy. PE is considered an important component of treatment in both medical and psychiatric disorders, especially for mental health disorders associated with lack of insight, such as alcohol and substance use disorders (ASUDs). New advancements in neuroscience have shed light on how various aspects of ASUDs may relate to neural processes. However, the actual impact of neuroscience in the real-life clinical practice of addiction medicine is minimal. In this chapter, we provide a perspective on how PE in addiction medicine can be informed by neuroscience in two dimensions: content (knowledge we transfer in PE) and structure (methods we use to deliver PE). The content of conventional PE targets knowledge about etiology of illness, treatment process, adverse effects of prescribed medications, coping strategies, family education, and life skill training. Adding neuroscience evidence to the content of PE could be helpful in communicating not only the impact of drug use but also the beneficial impact of various treatments (i.e., on brain function), thus enhancing motivation for compliance and further destigmatizing their symptoms. PE can also be optimized in its "structure" by implicitly and explicitly engaging different neurocognitive processes, including salience/attention, memory, and self-awareness. There are many interactions between these two dimensions, structure and content, in the delivery of neuroscience-informed psychoeducation (NIPE). We explore these interactions in the development of a cartoon-based NIPE to promote brain recovery during addiction treatment as a part of the brain awareness for addiction recovery initiative.

Medications For Addiction Treatment: Changing Language to Improve Care.

Abstract: The term medication-assisted treatment has been widely adopted in reference to the use of opioid agonist therapy. Although it is arguably better than the older terms of replacement or substitution therapy, medication-assisted treatment implies that medications are a corollary to whatever the main part of treatment is. No other medication for other health conditions is referred to this way. It has finally been recognized that to improve care and reduce stigma, we must use medically accurate and person-first language, describing those with the disease of addiction as people with substance use disorder. However, to truly change outcomes, we must also alter the language of treatment.

Global opioid epidemic: doomed to fail without genetically based precision addiction medicine (pam™): lessons learned from america.

Abstract: It is a reality that globally opioid deaths have soared for men and women of all social, economic status and age from heroin and fentanyl overdoses. Specifically, in the United States, deaths from narcotic overdoses have reached alarming metrics since 2010. In fact, the Fentanyl rise is driven by drug dealers who sell it as heroin or who use it to lace cocaine or to make illegal counterfeit prescription opioids. The President's Commission on the crisis has linked the death toll as equivalent to "September 11th every three weeks." In fact, The U.S. Centre for Disease Control (CDC) released data showing that opioid-related overdoses were up 15% in the first three quarters of 2016 compared to 2015. Various governmental organizations including NIDA, are actively seeking solutions. However, we argue that unless the scientific community embraces genetic addiction risk coupled with potential precision or personalized medicine to induce "dopamine homeostasis" it will fail. We now have evidence that a ten-gene and eleven single nucleotide polymorphism (SNP) panel predicts Addiction Severity Index (ASI) for both alcohol and drugs of abuse (e.g., Opioids). In a large multi-addiction centre study involving seven diverse treatment programs, the genetic addiction risk score (GARS™) was shown to have a predictive relationship with ASI-MV derived alcohol (≥ seven alleles), and other drugs (≥ 4 alleles) severity risk scores. In a number of neuroimaging studies, we also display that in both animal (bench) and abstinent Chinese severe heroin-dependent patients (bedside), BOLD dopamine activation across the brain reward circuitry revealed increases in resting state functional connectivity as well volume connectivity. It is also known that published nutrigenomic (coupling gene polymorphisms with altered KB220z) studies reveal improved clinical outcomes related to obesity.

Aberrant decision-making and drug addiction—how strong is the evidence?

Abstract: There are a growing number of studies with different substance use populations that show evidence for aberrant decision-making, which involves but is not limited to increased temporal discounting, increased risk-taking, and inability to mediate between immediate large gains and long-term larger losses. However, the current literature is inconsistent on how these dysfunctions manifest across different substance use disorders and whether they contribute to the initiation, progression and recovery from these disorders. Moreover, there is an incomplete understanding of the neurocognitive processes that underlie these deficits, the best methods to measure them, and ways to improve dysfunction. Here, recently published literature on aberrant decision-making is reviewed to address these questions using four domains: self-report measures, behavioral tasks, computational modeling, and functional neuroimaging. In conclusion, we provide suggestions to improve the consistency, validity and applicability of these measures to the reduction of decision-making dysfunction as a core component of prevention and recovery for the future of addiction medicine.

Precision medicine and pharmacogenetics: what does oncology have that addiction medicine does not?

Abstract: Background and aims Precision, personalized or stratified medicine, which promises to deliver the right treatment to the right patient, is a topic of international interest in both the lay press and the scientific literature. A key aspect of precision medicine is the identification of biomarkers that predict the response to medications (i.e. pharmacogenetics). We examined why, despite the great strides that have been made in biomarker identification in many areas of medicine, only in oncology has there been substantial progress in their clinical implementation. We also considered why progress in this effort has lagged in addiction medicine. Methods We compared the development of pharmacogenetic biomarkers in oncology, cardiovascular medicine (where developments are also promising) and addictive disorders. Results The first major reason for the success of oncologic pharmacogenetics is ready access to tumor tissue, which allows in-vitro testing and insights into cancer biology. The second major reason is funding, with cancer research receiving, by far, the largest allocation by the National Institutes of Health (NIH) during the past two decades. The second largest allocation of research funding has gone to cardiovascular disease research. Addictions research received a much smaller NIH funding allocation, despite the major impact that tobacco use, alcohol consumption and illicit drug use have on the public health and healthcare costs. Conclusions Greater support for research on the personalized treatment of addictive disorders can be expected to yield disproportionately large benefits to the public health and substantial reductions in healthcare costs.

Stretching the Scope — Becoming Frontline Addiction-Medicine Providers

Abstract: Seeing growing numbers of life-threatening infections arising from injection drug use, a group of ID physicians began offering patients with opioid use disorder counseling, naloxone, buprenorphine induction therapy, and essential referrals for long-term treatment.

Assessment of Addiction Medicine Training in Family Medicine Residency Programs: A CERA Study.

Abstract: BACKGROUND AND OBJECTIVES Substance use disorder (SUD) is a widespread problem but physicians may feel inadequately prepared to provide addiction care. We sought to assess current addiction medicine curricula in US family medicine residencies (FMRs) and evaluate barriers to improving or implementing addiction medicine curricula. METHODS Questions regarding addiction medicine training were added to the December 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) survey to US FMR program directors to evaluate each FMR's curriculum, potential workforce production, perceived barriers to improving or implementing curricula and faculty training in addiction medicine. RESULTS Of 461 FMR directors, 227 (49.2%) responded; 28.6% reported a required addiction medicine curricula. Regional variations of having a required curriculum ranged from 41.3% in the Northeast to 20.0% in the South (P=0.07). Of residencies, 31.2% had at least one graduate obtain a buprenorphine prescription waiver in the past year and 8.6% had at least one graduate pursue an addiction medicine fellowship in the past 5 years. Lack of faculty expertise was the most commonly cited barrier to having a curriculum, with only 36.2% of programs having at least one buprenorphine waivered faculty member, 9.4% an addiction medicine board certified faculty, and 5.5% a fellowship trained faculty. CONCLUSIONS Few FMRs have addiction medicine curricula and most graduates do not seek additional training. Multifaceted efforts, including developing model national curricula, training existing faculty, and recruiting addiction trained faculty, may improve addiction medicine training in family medicine residencies to better address the growing SUD epidemic.

The Addiction Recovery Clinic: A Novel, Primary-Care-Based Approach to Teaching Addiction Medicine.

Abstract: ProblemSubstance use is highly prevalent in the United States, but little time in the curriculum is devoted to training internal medicine residents in addiction medicine.ApproachIn 2014, the authors developed and launched the Addiction Recovery Clinic (ARC) to address this educational gap while also

Federal and State Policy Efforts to Address Maternal Opioid Misuse: Gaps and Challenges

Abstract: Background Opioid misuse during pregnancy is increasingly common and is associated with preterm birth and neonatal abstinence syndrome. As such, there is increased policy attention on reducing opioid misuse and increasing detection and treatment of opioid use disorder around the time of childbirth. Methods We conducted a review of peer-reviewed and grey literature to identify policy strategies to address opioid misuse among pregnant women; to describe current federal and state laws that impact women before pregnancy, during pregnancy, at birth, and postpartum; and to identify gaps and challenges related to these efforts. Results We identify two gaps in current efforts: 1) limited attention to prevention of opioid misuse among reproductive-age women, and 2) lack of policies addressing opioid misuse among postpartum women. We also discuss barriers to accessing care for women who misuse opioids, including provider shortages (e.g., too few addiction medicine specialists accept pregnant women or Medicaid beneficiaries as patients), logistical barriers (e.g., lack of transportation, child care), stigma, and fear of legal consequences. Conclusions As policymakers pursue strategies to address the opioid epidemic, the unique needs of pregnant and postpartum women and barriers to treatment should be addressed.

Impact of a brief addiction medicine training experience on knowledge self-assessment among medical learners

Abstract: Background: Implementation of evidence-based approaches to the treatment of various substance use disorders is needed to tackle the existing epidemic of substance use and related harms. Most clinicians, however, lack knowledge and practical experience with these approaches. Given this deficit, the authors examined the impact of an inpatient elective in addiction medicine amongst medical trainees on addiction-related knowledge and medical management. Methods: Trainees who completed an elective with a hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, from May 2015 to May 2016, completed a 9-item self-evaluation scale before and immediately after the elective. Results: A total of 48 participants completed both pre and post AMCT elective surveys. On average, participants were 28 years old (interquartile range [IQR] = 27–29) and contributed 20 days (IQR = 13–27) of clinical service. Knowledge of addiction medicine increased significantly post elective (mean difference [MD] = 8...

Addiction training in clinical psychology: Are we keeping up with the rising epidemic?

Abstract: Addiction has emerged as a serious public health crisis. Clinical psychology as a hub science has a long-standing interest in addiction and is particularly well suited to offer multifaceted treatment to those struggling with substance use disorders. To examine how well clinical psychology training is addressing this proliferation of addiction-related problems, we surveyed the directors of clinical training at all APA-accredited U.S. clinical psychology doctoral programs on 7 occasions between 1999 and 2013. The number of clinical programs rose from 181 to 237 programs across the years, with at least 95% response at each wave of data collection. Results indicated that less than 40% of programs had even 1 faculty member studying addiction, and less than 1 third offered any specialty clinical training in addiction. Results also revealed that both the percentage of programs reporting any faculty studying addiction and the percentage of programs offering specialty clinics in addiction have not increased over the 14-year period. We argue that clinical psychology training must bolster its focus on addiction research and practice. (PsycINFO Database Record

Core addiction medicine competencies for doctors: An international consultation on training.

Abstract: Background: Despite the high prevalence of substance use disorders, associated comorbidities and the evidence-base upon which to base clinical practice, most health systems have not invested in standardised training of healthcare providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, we undertook this study to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. Methods: We interviewed 13 members of the International Society of Addiction Medicine (ISAM), from 12 different countries (37% response rate), over Skype, email survey or in-person - at the annual conference. We content-analysed the interview transcripts, using constant comparison methodology. Results: We identified recommendations related to the core set ...

Two birds with one stone: experiences of combining clinical and research training in addiction medicine.

Abstract: Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting. We interviewed physicians from the St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital’s academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10). We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training. Combined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.

Codeine misuse and dependence in South Africa :perspectives of addiction treatment providers

Abstract: Background. General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector. Objectives. To investigate the perspectives of addiction treatment providers regarding treatment for codeine misuse or dependence. Method. Twenty addiction treatment providers linked to the South African Community Epidemiology Network on Drug Use and the South African Addiction Medicine Society were contacted telephonically and asked 20 questions. Results. While many participants had received training in pharmacological management of individuals with opioid dependence, only two had received specific training on codeine management. Between half and two-thirds of the treatment settings they worked in provided detoxification, pharmacotherapy, psychosocial treatment and aftercare. Very few treatment settings offered long-term treatment for codeine misuse and dependence. Participants indicated that over half of their codeine patients entered treatment for intentional misuse for intoxication, and dependence resulting from excessive or long-term use. The main barriers to patients entering treatment were seen as denial of having a problem, not being ready for change, mental health problems, stigma, and affordability of treatment. Participants identified a need for further training in how to manage withdrawal and detoxification, treatment modalities including motivational interviewing, and relapse prevention. Conclusions. Gaps in training among treatment providers need to centre on how to manage withdrawal from codeine use and detoxification, motivational interviewing and relapse prevention. Interventions are needed to address barriers to entering treatment, including user denial.

Partnering with Psychiatry to Close the Education Gap: An Approach to the Addiction Epidemic.

Abstract: Addiction has reached epidemic proportions in the U.S., yet the workforce prepared to care for this population is woefully inadequate. Of the 23 million Americans suffering from addiction, only 11% receive treatment, creating a substantial treatment gap. There have been calls to improve addiction education at all levels of training in order to prepare medical providers with the skills to identify patients with substance use, briefly treat if indicated, and/or refer more complex cases to specialty care. These calls have been put forth to address the education gap, wherein physicians in training are exposed to numerous patients who are suffering from addiction but have few curricular hours dedicated to the identification and management of this population. We propose that strategic partnerships between psychiatry and internal medicine can address the education gap that exists with regard to addiction, ultimately addressing the treatment gap which is plaguing this country.

TelePain: Primary Care Chronic Pain Management through Weekly Didactic and Case-based Telementoring.

Abstract: Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain) designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list controlled clinical trial to test: 1) effectiveness of the intervention, and 2) interviews to assess barriers and facilitators of the intervention implementation. The intervention involves a didactic presentation based on the Joint Pain Education Curriculum followed by patient case presentations and multi-disciplinary discussion via videoconference by clinicians working in the military health system. A panel of pain specialists representing pain medicine, internal medicine, anesthesiology, rehabilitation medicine, psychiatry, addiction medicine, health psychology, pharmacology, nursing, and complementary and integrative pain management provide pain management recommendations for each patient case. We use the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) to measure patient outcomes, including pain, sleep, fatigue, anxiety, and depression. This article reports some of the challenges and lessons learned during early implementation of the TelePain intervention. Weekly telephone meetings among the multisite research team were instrumental in problem solving, identifying problem areas, and developing solutions. Solutions for recruitment challenges included additional outreach and networking to military health providers, both building on.

Commentary: Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders

Abstract: Kwako et al. recently proposed a neuroscience-based framework by which to classify substance use disorders (SUDs) (1). This is based on functional domains—incentive salience, negative emotionality, and executive function—derived from a cycle-of-addiction model. The authors provide a thoughtful literature synthesis as rationale for an associated Addictions Neuroclinical Assessment (ANA) aiming to accelerate precision medicine research on relationships between genetic by environmental-exposure interactions and phenotypic expression of these SUD domains. Precision medicine may be defined as \" an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person \" (2). The authors explain how ANA may guide multidimensional analyses informing how to customize SUD research and care to address cross-population and temporal variability in genetic and phenotypic expression of these domains tailored to different patient subgroups (1). The introduction of a standardized neuroscience-based SUD assessment battery to advance precision medicine research is innovative and critical, and nicely complements similar efforts advanced by the U.S. National Institute of Mental Health's Research Domain Criteria initiative (3–6). Utilizing standardized instruments for measuring core functional domains of SUD enables comparability across research studies, meta-analyses, and data mining to advance biomedical big-data research. However, improved standardized measurement on its own may not lead to translation of neuroscience-based research into better SUD care. For this to happen, research needs to incorporate two factors. First, studies are needed to validate how such domains may be used to tailor treatments to different levels of impairment and to test specificity and sensitivity of proposed ANA domains to SUD-related impairment. Study designs should also provide controls to account for the possible confounds in which participants who choose to frequently use alcohol or drugs might also have other co-occurring problems, either naturally or due to other lifestyle choices or circumstances. Target and biomarker validation—critical to expedite precision medicine research—necessitates such analyses. Second, a concise assessment battery is essential to improve ease of use in deep-phenotyping efforts. Kwako et al. 's assessment battery is proposed to take a full 10 h to administer (1), which may place heavy burden on clinical researchers and most SUD patients—thus introducing a sample selection bias and compromising validity. A neuroscience-based nosology should be proposed with more precise functional domains, measured using a streamlined assessment battery of validated

Technology Addiction among Treatment Seekers for Psychological Problems: Implication for Screening in Mental Health Setting.

Abstract: Background: Technology usage has seen an increase among users. The usage varies from social, personal, and psychological reasons. Users are frequently using to overcome mood states as well as to manage the other psychological states. This work is going to explore the information technology use among subjects with a psychiatric disorder. Materials and Methods: A total of 75 subjects were assessed using background data sheet, internet addiction impairment index, video game use pattern, pornography addiction screening tool and screening for mobile phone use, from in-patient and out-patient setting of tertiary mental health setting. Results: It showed the presence of addiction to mobile, internet, video game, and pornography. Age was found to be negatively correlated with this addiction. Average usage time had been associated with management of mood states. The addiction to information technology had been associated with a delay in initiation of sleep. Conclusion: This work has implication for screening technology addiction among subjects seeking treatment for psychological problems and motivate them to develop the healthy use of technology.

Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors.

Abstract: Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships. We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul’s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software. We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training. Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.

Collegiate Sexual Addiction: Exploring Religious Coping and Attachment

Abstract: The two hallmarks of addiction are continued use despite negative consequences and the loss of control (Goodman, 1993, 2001). Based on these features, both chemicals and behaviors can become addictive. Over the past several decades, there has been growing acceptance of the validity of behavioral addictions. The American Society of Addiction Medicine (2011) revised its definition of addiction to include addictive behaviors such as sex, food, gambling, and spending. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) contains a chapter for Substance-Related and Addictive Disorders, including criteria for substance use disorders as well as one behavioral addiction, namely, gambling disorder. Although Internet gaming disorder was included in Section III of the DSM-5, indicating a need for further research, other proposed addictive behaviors were not recognized in the fifth edition. Specifically, Kafka (2010,2013) proposed diagnostic criteria for hypersexual disorder (HD) with characteristics such as mental preoccupation with sexual urges, fantasies, and behaviors; the use of sexual acts to cope with emotional distress; and failed attempts to control the behavior. Despite several pivotal research projects examining the nature, prevalence, and treatment of sexual addiction or hypersexual behavior, including survey research with approximately 1,000 individuals with sexual addiction (Carnes, 1991) and a comprehensive field trial of the proposed HD criteria (Reid et al., 2012), the rationale for excluding HD included concerns regarding the need for more evidence and research and the effect of the diagnosis within forensic settings (Kafka, 2014). Specifically, DSM-5 reviewers had concerns about the misuse of an HD diagnosis in evaluations of sexually violent predators for civil commitments (Kafka, 2014). Thus, we sought to examine sexual addiction in a population reported to experience elevated levels--the college population (Cashwell, Giordano, Lewis, Wachtel, & Bartley, 2015; Giordano & Cecil, 2014; Seegers, 2003)--with the aim of continuing the research in the field of compulsive sexual behavior. * Collegiate Sexual Addiction Individuals with sexual addiction, much like those with chemical dependence, rely on sexual behaviors as their primary coping mechanism for emotional distress (Goodman, 1993). Both positive (pleasure) and negative (reduction of undesirable affect) reinforcement perpetuate the continuation of the sexual behavior. Beyond psychological and behavioral features of sexual addiction, researchers have also found that compulsive sexual behaviors affect the reward circuitry in the brain in similar fashion to drugs of abuse (Blum et al., 2012). Specifically, sexual behaviors trigger dopamine release in the brain activating the reward cascade, which can lead to neuroadaptations if chronically and excessively activated (Blum et al., 2012). In other words, what might begin as behavior to tolerate emotional distress results, over time, in changes in brain chemistry and functioning. Therefore, sexual addiction is a complex condition with biological, psychological, and behavioral elements. Additionally, the fact that many researchers have found sexual addiction to be more prevalent among specific subsets of the population suggests a sociocultural component. For example, Carnes (2005) posited that up to 6% of the general U.S. population has a sexual addiction, and Smith et al. (2014) reported that 16.7% of male veterans engaged in sexually compulsive behavior. Additionally, Stavro, Rizkallah, Dinh-Williams, Chiasson, and Potvin (2013) found that 25% of clients in treatment for substance abuse met the criteria for sexual addiction. College students are another population with elevated sexual addiction rates. For example, Giordano and Cecil (2014) found that 16.2% of college men were in the clinical range for hypersexuality. …

Brains, environments, and policy responses to addiction.

Abstract: With 1 in 8 deaths globally due to the use of tobacco, alcohol, and other drugs, the director-general of the World Health Organization ( 1 ) recently called for more scientifically informed public policies regarding addiction. In the United States, where an average of 91 people per day die of opioid overdose, a presidential task force is to present, on 27 June, policy recommendations to combat opioid addiction, although the House of Representatives passed an Affordable Care Act repeal bill that would withdraw health insurance from two million people with addictions. Despite these urgent challenges, research on the brain and its interactions with the environment, which can help policymakers advance more effective and humane policies than some traditional approaches to addiction, has only occasionally been applied in public policy.

A Qualitative Study of Addiction Help-Seeking in People with Different Co-occurring Mental Disorders and Substance Use Problems

Abstract: People with mental disorders (MD) have high rates of substance use problems (SUP) that are undertreated and understudied despite their adverse outcomes. The objective of this study is to examine barriers and facilitators that influence help-seeking to addiction treatment from the perspective of people with co-occurring MD and SUP. Forty-three individuals with MD and SUP were selected from the sample (n = 127) of a larger research project. This sub-group participated in semi-structured interviews and completed questionnaires. Interview contents were thematically analyzed using a trajectory approach. Based on participants’ addiction trajectories, two mental health experiences were identified: the “multiple disorders experience” and the “anxiety disorder experience.” The analysis highlighted how participants relate to barriers and facilitators to addiction help-seeking at the individual level (denial/minimization of problematic drug use, fear of being labeled an addict, influence of social networks, and knowledge of addiction services) and health system level (waiting time, costs, relationships with health providers, therapeutic approaches, and availability of psychological support). Interventions should be sensitive to the different experiences of people with MD and SUP. Integrated addiction services and a “no wrong door” approach are suggested.