Perspectives and Recommendations from Hospitalized Patients with Substance Use Disorders: A Qualitative Study.

BACKGROUND: Individuals with substance use disorders (SUDs) are hospitalized in growing numbers. Stigma is pervasive among their hospital providers, and SUD management during medical admissions is often inadequate. However, little is known about how these patients perceive their care quality. In particular, few studies have explored their positive care perceptions or recommendations for improvement. OBJECTIVE: To explore perspectives on positive aspects, negative aspects, and consequences of care, as well as recommendations for improvement among hospitalized patients with SUDs. DESIGN AND PARTICIPANTS: We conducted semi-structured, in-depth bedside interviews (n = 15) with patients who have been diagnosed with a SUD and were admitted to medical or surgical floors of an urban academic medical center. APPROACH: Interviews explored patients' hospital experiences and recommendations for improvement. The interviews were audio-recorded, transcribed verbatim, and imported into NVivo software. Two reviewers independently coded the transcripts using interpretative phenomenological analysis and inductive thematic analysis according to grounded theory, and recurring themes were identified from the data. Patients' demographic and clinical data were analyzed with descriptive statistics. KEY RESULTS: Perceived clinical and emotional proficiency were the most important components of positive experiences, whereas perceived bias and stigmatized attitudes, clinical improficiency, and inhumane treatment were characteristic of negative experiences. Such care components were most consequential for patients' emotional well-being, trust, and care quality. Recommendations for improving care included specific suggestions for initiating and promoting continued recovery, educating, and partnering in compassionate care. CONCLUSIONS: Hospitalized patients with SUDs often experience lower quality and less compassionate care linked to pervasive stigma and poor outcomes. Our study highlights under-recognized perspectives from this patient population, including socioemotional consequences of care and recommendations grounded in lived experiences. By striving to advance our care in accordance with patients' viewpoints, we can turn hospitalizations into opportunities for engagement and promoting recovery.

Employing Bayesian analysis to establish a cut-off point and assess stigma prevalence in substance use disorder: a comprehensive study of the Chinese version of the Substance Use Stigma Mechanism Scale.

PURPOSE: In China, individuals with substance use disorders (SUD) face severe stigma, but reliable stigma assessment tool is lacking. Therefore, this study aimed to validate the Chinese version of the Substance Use Stigma Mechanism Scale (SU-SMS-C) and set its cut-off point. METHODS: We recruited 1005 individuals with SUDs from Chinese rehabilitation centers. These participants completed a battery of questionnaires that included the SU-SMS-C, The Multidimensional Scale of Perceived Social Support (MSPSS), Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and Perceived Devaluation and Discrimination (PDD). Confirmatory factor analysis was used to assess the construct validity of the scale. Additionally, the Naive Bayes classifier was used to establish the cut-off point for the SU-SMS-C. We additionally explored the correlation between patient demographic characteristics and stigma. RESULTS: A confirmatory factor analysis was utilized, revealing a second-order five-factor model. Based on the Naive Bayes classifier, the area under the receiver operating characteristic (AUCROC) of 0.746, the cut-off point for the SU-SMS-C was established at 44.5. The prevalence of stigma observed in the study population was 49.05%. Significant disparities were observed in the distribution of stigma across genders, with males experiencing more pronounced stigma than females. Moreover, patients consuming different primary substances reported diverse levels of stigma. Notably, those primarily using heroin endured a higher degree of stigma than users of other substances. CONCLUSION: The study is the first to identify a cut-off point for the SU-SMS-C by Naive Bayes classifier, bridging a major gap in stigma measurement research. SU-SMS-C may help treat and manage SUDs by reducing stigma.

Which Factors Are Associated With Comorbid Psychiatric Conditions in Patients Affected by Substance Use Disorders? The Impact of COVID-19 Pandemic on Dual-Diagnosis Subjects.

OBJECTIVE: To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic. METHODS: Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA). RESULTS: 118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD). CONCLUSIONS: Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04694482.

Do mindfulness-based interventions change brain function in people with substance dependence? A systematic review of the fMRI evidence.

BACKGROUND: Substance use disorders (SUDs) affect ~ 35 million people globally and are associated with strong cravings, stress, and brain alterations. Mindfulness-based interventions (MBIs) can mitigate the adverse psychosocial outcomes of SUDs, but the underlying neurobiology is unclear. Emerging findings were systematically synthesised from fMRI studies about MBI-associated changes in brain function in SUDs and their associations with mindfulness, drug quantity, and craving. METHODS: PsycINFO, Medline, CINAHL, PubMed, Scopus, and Web of Science were searched. Seven studies met inclusion criteria. RESULTS: Group by time effects indicated that MBIs in SUDs (6 tobacco and 1 opioid) were associated with changes in the function of brain pathways implicated in mindfulness and addiction (e.g., anterior cingulate cortex and striatum), which correlated with greater mindfulness, lower craving and drug quantity. CONCLUSIONS: The evidence for fMRI-related changes with MBI in SUD is currently limited. More fMRI studies are required to identify how MBIs mitigate and facilitate recovery from aberrant brain functioning in SUDs.

Predictors of alcohol and substance use among people with post-traumatic stress disorder (PTSD): findings from the NESARC-III study.

PURPOSE: The self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD. METHODS: We analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study (M = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms. RESULTS: Individuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD. CONCLUSIONS: Interpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.

Shapes of subcortical structures in adolescents with and without familial history of substance use disorder.

It has been suggested that intergenerational transmission of risk for substance use disorder (SUD) manifests in the brain anatomy of substance naïve adolescents. While volume and shapes of subcortical structures (SSS) have been shown to be heritable, these structures, especially the pallidum, putamen, nucleus accumbens, and hippocampus, have also been associated with substance use disorders. However, it is not clear if those anatomical differences precede substance use or are the result of that use. Therefore, we examined if volume and SSS of adolescents with a family history (FH+) of SUD differed from adolescents without such a history (FH-). Because risk for SUD is associated with anxiety and impulsivity, we also examined correlations between these psychological characteristics and volume/SSS. Using structural MRI and FSL software, we segmented subcortical structures and obtained indices of SSS and volumes of 64 FH+ and 58 FH- adolescents. We examined group differences in volume and SSS, and the correlations between volume/SSS and trait anxiety and impulsivity. FH+ adolescents had a significant inward deformation in the shape of the right anterior hippocampus compared to FH- adolescents, while the volume of this structure did not differ between groups. Neither shape nor volume of the other subcortical structures differed between groups. In the FH+ adolescents, the left hippocampus shape was positively correlated with both trait anxiety and impulsivity, while in FH- adolescents a negative correlation pattern of SSS was seen in the hippocampus. SSS appears to capture local anatomical features that traditional volumetric analysis does not. The inward shape deformation in the right anterior hippocampus in FH+ adolescents may be related to the known increased risk for behavioral dysregulation leading to SUD in FH+ offspring. Hippocampus shape also exhibits opposite patterns of correlation with anxiety and impulsivity scores across the FH+ and FH- adolescents. These novel findings may reveal neural correlates, not captured by traditional volumetric analysis, of familial transmission of increased vulnerability to SUD.

Religious institutions as a link to substance use treatment: Characterizing the potential service population through national survey data.

Background: Relatively few Americans with current alcohol or drug use disorders receive outpatient or residential treatment. Outreach initiatives at local places of religious worship have been proposed as a way of facilitating such service use, but the number and characteristics of adults who may be reached in this way has not been studied. Methods: Data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional survey of U.S. adults were used to estimate the number of and proportion of adults with substance use disorders (SUDs) who attended monthly religious service and did not receive SUD treatment in the past year and used multinomial logistic regression to compare them to three SUD groups who did or did not receive treatment and/or attend religious services. Results: A total of 5,795 respondents representing 35.8 million Americans met criteria for a past-year SUD, of whom 8.3 million (23.1%) attended religious services monthly and did not receive substance use treatment. This more often African-American group had substantially fewer socio-demographic disadvantages (e.g., unemployment), behavioral problem indicators (e.g., police involvement), a higher quality of life score and less likelihood of an illicit drug use diagnosis than those who received treatment and either did or did not attend religious services. Conclusion: Almost one quarter of adults with a SUD attend religious services monthly and do not receive SUD treatment. Although they have fewer adversities than people who receive treatment, outreach to this population may link this substantial group of people to needed services.Highlights/reviewNational survey data suggest 8 of 36 million Americans with substance use diagnoses' (23%) do not receive specialized SUD treatment, but they do attend religious services monthly or more.This group, notably, has less numerous problems, such as unemployment, police involvement, and drug use disorder, and have higher quality of life scores than those who receive treatment for SUD.Outreach and linkage initiatives with religious institutions may facilitate use of services by this population.

Maladaptive Personality Traits in a Group of Patients with Substance Use Disorder and ADHD.

Background and Objectives: the comorbidity of personality disorders in patients who use psychoactive substances is common in psychiatric practice. The epidemiology of disharmonious personality traits in patients with ADHD and addictions in adulthood is still insufficiently researched. The study investigated the typology of personality traits in a group of adult patients consuming psychoactive substances, in whom symptoms of ADHD were identified. Materials and Methods: the study evaluates a group of 104 patients with chronic psychoactive substances abuse, in whom symptoms of ADHD were identified in early adulthood, in terms of comorbid personality traits. Results: statistically significant data have been obtained regarding the presence of clinical traits characteristic for cluster B personality disorders, the patients presenting lower levels of self-control, self-image instability, difficulties in the areas of social relationships and own identity integration. Conclusions: ADHD symptomatology precedes the clinical traits of personality disorders in patients with addictions, negatively influencing chronic evolution and quality of life.

Adult attention-deficit/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug.

High-dose use of benzodiazepines (BZDs) and Z-drugs was found to be associated with adult attention deficit/hyperactivity disorder (ADHD) and multidomain cognitive deficits, but the interplay between these factors and its effect on quality of life (QoL) is unclear. We explored (a) whether cognitive dysfunction differs in high-dose BZD/Z-drug users with and without adult ADHD and (b) the impact of cognitive deficits and adult ADHD on QoL in this substance-use disorder (SUD). From January 2015 to December 2019, we recruited 207 high-dose BZD/Z-drug users seeking treatment. We assessed the presence of adult ADHD with a screening tool, which was validated in SUD patients, and collected demographic, clinical and QoL data from the 76 included patients. A neuropsychological battery explored five cognitive domains. We found that: (a) screening for adult ADHD was frequently positive; (b) Short Form-36 (SF-36), a self-administered QoL questionnaire, was worse than the general population and worse in patients positive (ADHD+) vs. those negative (ADHD-) to ADHD screening tool; (c) executive function was significantly worse in ADHD+ than ADHD- patients; (d) some SF-36 dimensions were negatively influenced by executive dysfunction; (e) multivariate analysis showed an interplay between adult ADHD and cognitive dysfunction in worsening QoL. We documented a complex interplay between adult ADHD, cognitive dysfunction and QoL in high-dose BZD/Z-drug users. Assessing adult ADHD, neuropsychological measures and QoL may offer a full scenario of these patients, who are frequently impaired in everyday activities. Future research should explore whether pharmacological treatment might improve cognitive dysfunction and QoL in this SUD.

Is cleanliness next to abstinence? The effect of cleanliness priming on attitudes towards harm reduction strategies for people with substance use disorders.

Can exposure to a cleanliness prime affect moral judgements towards harm reduction strategies (HRS) for individuals with substance use disorders? Our research examined (a) the effect of a cleanliness prime on attitudes towards HRS and (b) whether this effect would be attenuated by a brief educational presentation. Participants were randomly assigned to a priming condition and an educational presentation condition. Results demonstrated that (a) the cleanliness prime did not shift attitudes towards HRS, however, (b) the educational presentations significantly shifted attitudes to be more positive after the Harm Reduction presentation and more negative after the Healthy Living presentation. The literature on priming is mixed and our results support a growing body of research challenging the robustness of cleanliness priming and also demonstrates that brief presentations can change attitudes. Our research has implications for education on the benefits of HRS in reducing disease transmission, refuse in the community, and overdose deaths.

Psychedelics as an emerging novel intervention in the treatment of substance use disorder: a review.

Classical psychedelics are a group of drugs characterized by their activation of the serotonin-2A (5-hydroxytryptamine-2A; 5-HT2A) receptor and the unique hallucinogenic and mystical-type experiences that result. After a substantial period of restrictions limiting investigations into the therapeutic potential of psychedelics, a relatively recent recommencement of interest has sparked the burgeoning possibility for these drugs to play a part in the treatment of a wide array of psychopathologies. One of the most promising is in the study of addiction. Evidence has emerged that psychedelic agents may provide a novel avenue for the clinical treatment of patients dealing with substance use disorders (SUD). These serotonergic hallucinogens have displayed remarkable and enduring positive outcomes in this area, even when administered as one or two doses. The neural targets for these psychedelics are varied and underlie a complex mechanism of action-modulating multiple neural networks. It is believed that these agents allow for the reorganization of disordered neural pathways in the default mode network and attenuate maladaptive signaling in mesolimbic reward circuitry. The aim of this review is to examine the current standing of evidence regarding psychedelic psychopharmacology and to provide an overview of the use and effectiveness of these drugs in the treatment of SUD, alcohol use disorder, and for smoking cessation.

Interprofessional collaboration associated with frequency of life-saving links to HIV continuum of care services in the urban environment of Newark, New Jersey.

BACKGROUND: HIV continuum of care has been used as a strategy to reduce HIV transmission rates, with timely engagement in HIV testing being the first and most critical step. This study examines interprofessional-collaboration (IPC) after controlling for agency/ provider demographics, provider training and self-efficacy as a significant predictor of how frequently HIV service providers link their clients to HIV testing. METHODS: Multilevel binary logistic regression analysis was conducted to examine the effects of IPC on links to HIV testing while controlling for demographic and agency information, provider training, and standardized measures of providers' feelings, attitudes, and opinions about IPC. Cross-sectional data from 142 providers in 13 agencies offering treatment and prevention services for HIV and substance-use disorders were collected via a survey. RESULTS: Those who scored higher on the IPC scale reported significantly higher rates of linkages to HIV testing. Compared to the null model (i.e., no predictor model), the final multilevel binary logistic regression model showed a significantly improved likelihood of linkage to HIV testing by 11.4%, p. < .05. The final model correctly classified 90.2% of links to HIV testing. Providers in agencies with smaller budgets and in agencies offering substance use disorder services were more likely to link clients to HIV testing. Younger providers who received HIV training were also more likely to link clients to HIV testing. CONCLUSIONS: Findings suggest IPC training as a potential strategy to improve linkages to HIV testing for clients at risk for HIV infection. Future research is recommended to identify specific areas of IPC that might have differential effects on links to HIV testing.

It is just that people treat you like a human being: The meaning of dignity for patients with substance use disorders.

INTRODUCTION: Patients who suffer from substance use disorder (SUD) might receive services from different service providers in an opioid maintenance treatment programme (OMT) and have a widespread and complex need for nursing. BACKGROUND: Literature reveals that prejudices against people with SUD exist. There is a lack of studies exploring patients with SUD experiences of preserving their dignity in the encounter with healthcare staff. The aim of the study was to gain insight into the meaning of dignity for patients with SUD. METHODS: The research design was descriptive and interpretative. In the interpretation of qualitative in-depth interviews with six patients, a hermeneutical approach based on Gadamer (Truth and method, Sheed & Ward, London, UK, 1989) was used. RESULTS: Analysis resulted in three mains themes about the meaning of dignity: (a) The material dimension. (b) To be respected by others. (c) The inner experience. Factors enhancing dignity in the encounters were as follows: (a) Being respected and acknowledged. (b) Being cared for. (c) Knowledge and persistent relation. Factors depriving dignity were as follows: (a) Stigma and prejudice. (b) Insufficient relations and lack of confirmation. (c) Experiencing disrespectful/patronising attitudes and lack of knowledge. CONCLUSIONS: The material dimension of dignity containing an aesthetically aspect was important for these patients. Dignity was also experienced as strongly connected to respect. Dignity can be enhanced by treating patients with SUD with understanding and respect, and dignity can be inhibited through stigmatization of patients with SUD, as well as by caregivers' lack of knowledge. RELEVANCE TO CLINICAL PRACTICE: The study clarifies a need for more knowledge about SUD among healthcare staff, as well as promotes ethical awareness in encounters with patients regardless of their background.

A case-control genome wide association study of substance use disorder (SUD) identifies novel variants on chromosome 7p14.1 in patients from the United Arab Emirates (UAE).

Genome wide association studies (GWASs) have provided insights into the molecular basis of the disorder in different population. This study presents the first GWAS of substance use disorder (SUD) in patients from the United Arab Emirates (UAE). The aim was to identify genetic association(s) that may provide insights into the molecular basis of the disorder. The GWAS discovery cohort consisted of 512 (250 cases and 262 controls) male participants from the UAE. Controls with no prior history of SUD were available from the Emirates family registry. The replication cohort consisted of 520 (415 cases and 105 controls) Australian male Caucasian participants. The GWAS discovery samples were genotyped for 4.6 million single nucleotide polymorphism (SNP). The replication cohort was genotyped using TaqMan assay. The GWAS association analysis identified three potential SNPs rs118129027 (p-value = 6.24 × 10-8 ), rs74477937 (p-value = 8.56 × 10-8 ) and rs78707086 (p-value = 8.55 × 10-8 ) on ch7p14.1, that did not meet the GWAS significance threshold but were highly suggestive. In the replication cohort, the association of the three top SNPs did not reach statistical significance. In a meta-analysis of the discovery and the replication cohorts, there were no strengthen evidence for association of the three SNPs. The top identified rs118129027 overlaps with a regulatory factor (enhancer) region that targets three neighboring genes LOC105375237, LOC105375240, and YAE1D1. The YAE1D1, which represents a potential locus that is involved in regulating translation initiation pathway. Novel associations that require further confirmation were identified, suggesting a new insight to the genetic basis of SUD.

Parental substance use disorder and child abuse: risk factors for child maltreatment?

Although the literature consistently shows an association between parental substance use disorders (SUDs) and child abuse, it is unknown what factors discern non-abusive and abusive parents with SUDs. This study aims to investigate which specific risk factors are associated with child abuse in clinically treated parents with SUDs in the Netherlands. It examines two groups of parents with SUDs in a clinical setting, with and without known instances of child abuse. These groups were compared on SUD-related factors such as the type and severity of the SUDs, and variables addressing psychological disability such as comorbid diagnoses and quality of life. Other than a marginally significant difference in severity of addiction and a lower mean age of the parents in the child abuse group, no significant differences were found. The small sample size and the inherent difficulty of studying SUDs in a clinical sample is likely to have affected the results.

Gestalt Therapy Applied: A Case Study with an Inpatient Diagnosed with Substance Use and Bipolar Disorders.

AIM: The aim of the present paper is to open the discourse regarding the unmet needs of specific patients, especially those with substance use disorder and/or personality disorder where 'multimorbidities', and/or 'overdiagnosis' and/or 'diagnosis overlap' are frequent. An additional aim is to review the main therapeutic purpose and concepts of Gestalt therapy which might be appropriate in the treatment of these patients often characterized by their difficulties in being aware and in contact in the 'here and now'. METHODS: I first start with an overview of Gestalt therapy concepts. Then, I illustrate Gestalt's 'here and now' and awareness concepts applied during 18 sessions with an inpatient diagnosed with substance use and bipolar disorders. In addition, the patient had to face an open criminal charge, was regarded as having an antisocial personality disorder and argued suffering from post-traumatic stress disorder. RESULTS: After this two-month therapy period, the patient entered for the first time a daily rehabilitation program in the community, where he was doing well (this after a few prior hospitalizations). The awareness development in the 'here and now' through which different contact styles and cycles of experiences are experienced is a process that allowed the patient to start experiencing contact with himself, his true needs and his environment. This contributed to his well-being improvement, led and supported his rehabilitation and reinsertion within the society and decrease his relapses, either with drugs or criminal activities. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: People with substance use disorder (where 'multimorbidities', 'overdiagnosis' or 'diagnosis overlap' are frequent), people with personality disorder(s) or people who have difficulties in defining what really disturbs them are the same people who could benefit of GT encouraging awareness and contact development in the 'here and now'. Gestalt therapy should not be regarded as a practitioner's toolbox but as a therapeutic process allowing awareness and I-boundaries development in the 'here and now' through authentic and genuine relationships. The therapist's awareness and contact with themselves and their environment are reflected in the therapist's relaxed but awake and aware state of mind as well as their wise, spontaneous and mindful approach.

[Psychosocial Characteristics of Adolescent Girls with Posttraumatic Stress Disorders and Substance Use Disorders]. / Psychosoziale Charakteristiken jugendlicher Mädchen mit posttraumatischen Belastungsstörungen und Substanzgebrauchsstörungen.

Psychosocial Characteristics of Adolescent Girls with Posttraumatic Stress Disorders and Substance Use Disorders Already in adolescence posttraumatic stress disorder (PTSD) and substance use disorders (SUD) often occur comorbid. SUD is usually in the focus of treatment and underlying PTSD is not always recognized. To date there is no explicit offer for the simultaneous treatment of both clinical pictures in adolescence. In the present study we tested whether the group intervention Seeking Safety, that is implemented successfully in adulthood, would also be interesting for the youth clientele. In addition we analyzed the characteristics of a target group of girls and young women between 14 and 21 years, that could be reached for such a program in a German city. In the present study we conducted 39 complete interviews that enable an estimation of the various strains and symptoms of those affected. The results clarify that female adolescents with a dual diagnosis PTSD and SUD are currently not sufficiently addressed by the supply system and could benefit from a specific treatment like Seeking Safety.

Temperament disturbances measured in infancy progress to substance use disorder 20 years later.

OBJECTIVE: This prospective study determined whether temperament before two years of age predicts transmissible risk for substance use disorder (SUD) up to a decade later and SUD outcome in adulthood. METHOD: Boys between 10 and 12 years of age (N = 482) were tracked to age 22. The previously validated transmissible liability index (TLI) was administered at baseline, and temperament prior to two years of age was retrospectively rated. The Structured Clinical Interview for DSM-III-R (SCID) was administered to document presence/absence of SUD for parents at baseline and sons at age 22. RESULTS: Path analysis revealed that number of parents with SUD predicted severity of temperament disturbance in their sons which in turn predicted TLI score at age 10-12, presaging SUD. Temperament before age two did not predict SUD at age 22. The association between number of SUD parents and transmissible risk was mediated by severity of temperament disturbance. CONCLUSION: Temperament disturbance in early childhood, reflecting quality of behavioral and emotion regulation, comprise psychological antecedents of transmissible risk for SUD.

Bracketing Estimation of Intentional Polysubstance Use in the United States.

Evidence from diverse sources suggests that persons who have a substance use disorder (SUD) often have problems with one or more additional substances, a situation broadly, if imprecisely, termed polysubstance use or more preferably multiple substance use disorder (mSUD). Because of the heavy toll of maladaptive neuronal dysregulation, morbidity, and mortality of SUDs, and increasingly of mSUD, on the individual, their families, the healthcare system, insurers, regulators, and society at large, it seems of value to have an estimate of the prevalence of mSUD. This turns out to be surprisingly difficult, due to nebulous or disparate definitions and to weaknesses in data acquisition methodology. We here attempt a pragmatic way of bracketing an estimate of mSUD prevalence in the US. We conclude that a reasonable estimated range of mSUD in the US is about 8 to 14 million persons. This approach provides a quick estimate for stakeholders involved in efforts to understand or deal with the immediate crisis of mSUD, as more refined estimations are pursued.

The Functional-Cognitive and Sensory Treatment (F-CaST) to improve rehabilitation outcomes of individuals with substance use disorder: a study protocol for a mixed-method randomized controlled trial.

BACKGROUND: Substance use disorder (SUD) is associated with executive function (EF) deficits and sensory modulation dysfunction (SMD). Yet, these deficits are not addressed therapeutically. This study aims to examine the effectiveness of the Functional-Cognitive and Sensory Treatment (F-CaST) compared to standard care to improve everyday performance and behavior and length of stay at the therapeutic community (TC) in individuals with SUD. In addition, to assess the improvement in EF, sensory modulation, participation, self-efficacy, life satisfaction, and use of strategies within and between groups. Satisfaction with F-CaST will also be assessed. METHODS: Forty-eight participants from a community of men in a TC, aged 18-45 years will be randomly allocated to (i) F-CaST-(experimental group) providing sensory and EF strategies for improving daily function; (ii) standard care (control group) as provided in the TC. Assessments will be conducted by assessors blind to group allocation at 4 time points: T1- pre-intervention; T2- post-intervention; T3- 1-month follow-up; and T4- 3-month follow-up. Primary outcome measures will be everyday performance, assessed by the Canadian Occupational Performance Measure (COPM), behavior and length of stay in the TC; secondary outcome measures will assess EF, SMD. Semi-structured in-depth qualitative interviews will be conducted at T1, T2 and T4. DISCUSSION: We hypothesize that F-CaST will lead to improved everyday performance and longer length of stay in the TC, compared to the control group. If F-CaST will prove to be effective, cognitive and sensory strategies may be incorporated as an adjunctive intervention in SUD rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05647863 Registered on 13 December 2022, https://classic. CLINICALTRIALS: gov/ct2/show/NCT05647863 .