Recommendations for integrating peer mentors in hospital-based addiction care.

Legislators and health systems have recently begun to explore the use of peer mentors as part of hospital-based addiction teams. Integrating peers into hospitals is a complex undertaking still in its infancy. Peers' lived experience of addiction and its consequences, combined with their distance from medical culture and hierarchy, is at the core of their power - and creates inherent challenges in integrating peers into hospital settings. Successful integration of peers in hospitals has unique challenges for individual providers, health systems, and the peers themselves. We have included peers as part of a hospital-based addiction medicine team at our hospital since 2015. In this article, we outline some unique challenges, share lessons learned, and provide recommendations for integrating peers into hospital-based SUD care. Challenges include the rigid professional hierarchy of hospitals which contrasts with peers' role, which is built on shared life experience and relationship; different expectations regarding professional boundaries and sharing personal information; the intensity of the hospital environment; and, illness severity of hospitalized people which can be emotionally draining and increase peers' own risk for relapse. Recommendations focus on establishing a way to finance the peer program, clearly defining the peer role, creating a home base within hospital settings, creating a collaborative and structured process for hiring and retaining peers, identifying peers who are likely to succeed, providing initial and ongoing training to peers that extends beyond typical peer certification, ways to introduce peer program to hospital staff, and providing regular, meaningful supervision. We hope that our recommendations help other hospital systems capitalize on the practical lessons learned from our experience.

"If It Wasn't for Him, I Wouldn't Have Talked to Them": Qualitative Study of Addiction Peer Mentorship in the Hospital.

BACKGROUND: Hospitalizations related to substance use disorders (SUD) are skyrocketing. Hospital providers commonly feel unprepared to care for patients with SUD and patients with SUD commonly feel discriminated against by hospital staff. This tension can lead to provider burnout and poor patient outcomes. Research in ambulatory settings suggests that peer mentors (PMs) can improve substance use outcomes and patient experience. However, no study has examined the role of peer mentorship for patients with SUD in hospitals. OBJECTIVE: Understand how peer mentorship affects care for hospitalized patients with SUD, and how working in a hospital affects PMs' sense of professional identity. DESIGN: Qualitative study utilizing participant observation, individual interviews, and focus groups related to the PM component of the Improving Addiction Care Team (IMPACT), a hospital-based interprofessional addiction medicine consult service. PARTICIPANTS: IMPACT providers, patients seen by IMPACT, PMs, and a PM supervisor. APPROACH: Qualitative thematic analysis. KEY RESULTS: PMs occupy a unique space in the hospital and are able to form meaningful relationships with hospitalized patients based on trust and shared lived experiences. PMs facilitate patient care by contextualizing patient experiences to teams and providers. Reciprocally, PMs "translate" provider recommendations to patients in ways that patients can hear. Respondents described PMs as "cultural brokers" who have the potential to transfer trust that they have earned with patients to providers and systems who may otherwise be viewed as untrustworthy. While PMs felt their role led to professional and personal development, the intensity of the role in the hospital setting also put them at risk for emotional drain and stress. CONCLUSIONS: While integrating PMs into hospital care presents substantial challenges, PMs may act as a "secret weapon" to engage often marginalized hospitalized patients with SUD and improve patient and provider experience.

The role of testicular hormones and luteinizing hormone in spatial memory in adult male rats.

Attempts to determine the influence of testicular hormones on learning and memory in males have yielded contradictory results. The present studies examined whether testicular hormones are important for maximal levels of spatial memory in young adult male rats. To minimize any effect of stress, we used the Object Location Task which is a spatial working memory task that does not involve food or water deprivation or aversive stimuli for motivation. In Experiment 1 sham gonadectomized male rats demonstrated robust spatial memory, but gonadectomized males showed diminished spatial memory. In Experiment 2 subcutaneous testosterone (T) capsules restored spatial memory performance in gonadectomized male rats, while rats with blank capsules demonstrated compromised spatial memory. In Experiment 3, gonadectomized male rats implanted with blank capsules again showed compromised spatial memory, while those with T, dihydrotestosterone (DHT), or estradiol (E) capsules demonstrated robust spatial memory, indicating that T's effects may be mediated by its conversion to E or to DHT. Gonadectomized male rats injected with Antide, a gonadotropin-releasing hormone receptor antagonist which lowers luteinizing hormone levels, also demonstrated spatial memory, comparable to that shown by T-, E-, or DHT-treated males. These data indicate that testicular androgens are important for maximal levels of spatial working memory in male rats, that testosterone may be converted to E and/or DHT to exert its effects, and that some of the effects of these steroid hormones may occur via negative feedback effects on LH.