Addiction medicine in the time of COVID-19: An overview of the 2020 Joint Scientific Annual Conference of the International Society of Addiction Medicine and Canadian Society of Addiction Medicine.

For years, Substance Abuse has annually published a communication regarding the annual conference of the International Society of Addiction Medicine (ISAM). These pieces have highlighted the important events of the conference and the work of the organization, as reflected in part by selected abstracts from the conference. This editorial communicates the events of the 2020 conference, the third to be held in conjunction with the Canadian Society of Addiction Medicine (CSAM) and the first virtual conference. The conference was attended by over 800 participants and covered a wide range of topics, including addiction medicine during the COVID-19 pandemic. Despite the challenges of not being able to meet physically in Victoria, British Columbia as had been planned, the virtual event provided an opportunity to share current information in order to help advance prevention, treatment, policy and public helath efforts relating to addressing addictions and helping those impacted by these often devastating conditions.

Understanding addiction: The shift from epistemology to ontology.

This essay contrasts a late modernist epistemological paradigm with an ontology-oriented Anthropocene-conscious Approach (ACA) as frameworks for understanding the coming into being and the making of addiction. Operationalizable theories and concepts of addiction have been crucial in an era with a great demand for compartmentalizing and systemically defining psychological struggles and social problems. In the modernistic progress story, the addiction phenomenon materializes through the conceptual division between capacity and non-capacity, with those capable of mastering their urges on one side and those incapable of doing so on the other. The ACA strives actively to move beyond artificial divides between agency/structure, culture/nature, mind/matter and instead explore phenomena ecologically across these continuums. This entails a conscious re-focus away from authoritative human-made assumptions towards new types of knowledge and knowing. In the ACA assemblage-like ontology, different elements are brought together in their capacities to affect each other into entities. Due to its claims of practical uses, I predict that the ACA will become as influential as Foucauldian genealogy in the field of addiction studies.

Advances and Future Directions in the Clinical Utility of Food Addiction.

The body of research examining the validity of food addiction and eating addiction far exceeds the research examining their clinical utility [...].

Guidelines for the assessment and management of addiction in the hospitalized patient with opioid use disorder: a twenty-first century update.

While there have been many articles published on managing the medical sequelae of opioid use disorder in specific patient populations or settings, there is a dearth of literature on assessing and managing opioid use disorder in the acute hospital setting. In 1975, Fultz and Senay published proposed guidelines on the management of what they called the "hospitalized narcotic addict" Fultz and Senay (Ann Intern Med 82(6):815-818, 1975). Since then, many new developments in the treatment of opioid use disorder have occurred. In our experience, services in the acute inpatient hospital turn to psychiatric consultation teams for recommendations on how to manage these complicated and, sometimes, difficult patients. This article serves to provide the internal medicine physician a foundation of understanding how to address the main issues in hospitalized patients with opioid use disorder on a general medical or surgical floor.

[What's new in addiction medicine]. / Addictions.

The development of research, clinical practice and prevention in addiction medicine is, compared to other disciplines, more influenced by socio-political factors. Research on psychedelics has thus long been hampered by prohibitive policy but has recently been revived thanks to the relaxation of these political positions. The extensive prescription of baclofen for alcohol addiction is mainly the consequence of popular support and has so far not been clearly supported by specific research. The aim of the new Gambling Act was to harmonize the regulatory provisions for lotteries and betting on the one hand and casino gambling on the other, while at the same time opening up the market for online gambling.

Le développement de la recherche, de la pratique clinique et de la prévention en addictologie est davantage influencé par les circonstances sociopolitiques que dans de nombreuses autres disciplines. La recherche sur les psychédéliques a ainsi longtemps été entravée par une politique prohibitive mais a été relancée récemment grâce à l'assouplissement de ces positions politiques. La prescription importante du baclofène pour traiter l'addiction à l'alcool est principalement la conséquence d'un soutien populaire et n'est jusqu'à présent pas clairement appuyée par la recherche spécifique. Le but de la nouvelle loi sur les jeux d'argent était d'harmoniser les dispositifs de régulation concernant les loteries et paris d'une part et les jeux de casinos d'autre part, tout en ouvrant le marché des jeux en ligne.

Addressing a rapidly changing service landscape during the COVID-19 pandemic: Creation of the Oregon substance use disorder resource collaborative.

Following the rising crisis of COVID-19 and the Oregon governor's stay-at-home orders, members of the Oregon Health and Science University (OHSU) inpatient addiction consult service recognized that local addiction treatment and recovery organizations were operating at limited capacity. As a result, discharge planning, patient access to local community-based treatment, and safety-net programming were affected. Given structural and intersectional risk vulnerabilities of people with substance use disorders (SUDs), the OHSU members felt that COVID-19 would disproportionately impact chronically marginalized members of our community. These inequities inspired the formation of the Oregon substance use disorder resources collaborative (ORSUD) led by four medical students. ORSUD's mission is to support the efforts of local safety-net organizations that and front-line providers who serve chronically marginalized community members in the midst of the global pandemic. We operationalized our mission through: 1) collecting and disseminating operational and capacity changes in local addiction and harm reduction services to the broader treatment community, and 2) identifying and addressing immediate resource needs for local safety-net programs. Our program uses a real-time public-facing document to collate local programmatic updates and general community resources. COVID-19 disproportionately burdens people with SUDs; thus, ORSUD exists to support programs serving people with SUDs and will continue to evolve to meet their needs and the needs of those who serve them.

The Science of Addiction Through the Lens of Opioid Treatment for Chronic Noncancer Pain.

Addiction is a chronic, relapsing brain disease. It is not the same as physical dependence (i.e., withdrawal) and tolerance, but is characterized by loss of control over the use of the substance, continued use despite consequences, compulsive use, and cravings. Addiction involves functional changes to brain pathways involved in reward, stress and learning, and these changes can last a long time after the addictive substance is no longer used. Repeated interruption of normal brain function from repetitive use of addictive substances can hijack normal reward mechanisms resulting in fundamental alterations in brain structure and function. Over time, addictive substances can bring about a false fixed prediction error that cannot be rectified during learning. And, for individuals who develop an addiction, initial impulsive drug use progresses to compulsive drug use and this progression also has neurobiological underpinnings. Drug addiction is partly heritable, although there is no single gene coding specifically for the disease of addiction. Genetic factors contribute to a vulnerability to develop both addiction and addiction comorbidities, and play an appreciable role in responses to and metabolism of addictive substances, and most likely, the experience of rewarding effects. Patients with pain who are addicted to opioids have, in addition to the pain disorder, a chronic relapsing brain disease that can be life-threatening. Addiction can be treated and controlled, but not cured. Treatment of pain in individuals with addiction is a complex clinical challenge. Holistic assessment, interprofessional approaches, use of established guidelines, and non-pharmacological complementary modalities are needed.

Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis.

BACKGROUND: Hospitalizations due to medical and surgical complications of substance use disorder (SUD) are rising. Most hospitals lack systems to treat SUD, and most people with SUD do not engage in treatment after discharge. OBJECTIVE: Determine the effect of a hospital-based addiction medicine consult service, the Improving Addiction Care Team (IMPACT), on post-hospital SUD treatment engagement. DESIGN: Cohort study using multivariable analysis of Oregon Medicaid claims comparing IMPACT patients with propensity-matched controls. PARTICIPANTS: 18-64-year-old Oregon Medicaid beneficiaries with SUD, hospitalized at an Oregon hospital between July 1, 2015, and September 30, 2016. IMPACT patients (n = 208) were matched to controls (n = 416) using a propensity score that accounted for SUD, gender, age, race, residence region, and diagnoses. INTERVENTIONS: IMPACT included hospital-based consultation care from an interdisciplinary team of addiction medicine physicians, social workers, and peers with lived experience in recovery. IMPACT met patients during hospitalization; offered pharmacotherapy, behavioral treatments, and harm reduction services; and supported linkages to SUD treatment after discharge. OUTCOMES: Healthcare Effectiveness Data and Information Set (HEDIS) measure of SUD treatment engagement, defined as two or more claims on two separate days for SUD care within 34 days of discharge. RESULTS: Only 17.2% of all patients were engaged in SUD treatment before hospitalization. IMPACT patients engaged in SUD treatment following discharge more frequently than controls (38.9% vs. 23.3%, p < 0.01; aOR 2.15, 95% confidence interval [CI] 1.29-3.58). IMPACT participation remained associated with SUD treatment engagement when limiting the sample to people who were not engaged in treatment prior to hospitalization (aOR 2.63; 95% CI 1.46-4.72). CONCLUSIONS: Hospital-based addiction medicine consultation can improve SUD treatment engagement, which is associated with reduced substance use, mortality, and other important clinical outcomes. National expansion of such models represents an opportunity to address an enduring gap in the SUD treatment continuum.

Addiction disorders: a need for change. Proposal for a new management. Position paper of SIA, Italian Society on Alcohol.

Various epidemiological and biological evaluations and the recent publication of the DSM-V (diagnostic and statistical manual of mental disorders) has imposed on the scientific community a period of reflection on the diagnosis and treatment of what in the DSM-IV was defined as "addiction". To date, the term "addiction" has been replaced by the DSM-5, because there is no global scientific consensus that has unequivocally characterized its clinical characteristics. This, we will talk about substance/alcohol use disorders (SUDs/AUDs) and disorders related to behavioral alterations (DBA) that can generate organic diseases, mental disorders, and social problems. In the first psychotic episode 40-70% of subjects meet the criteria of a SUDs/AUDs, excluding tobacco dependence. Substances can not only be the cause of a psychotic onset, but they can also disrupt a psychotic picture or interfere with drug therapy. The pharmacodynamic profiles of many substances are able to provoke the phenomenology of the main psychotic symptoms in a way that can be superimposed onto those presented by psychotic subjects without a history of SUDs/AUDs. The Department of Addictions (DAs) must not be absorbed by or incorporated into the Departments of Mental Health (DMH), with which, however, precise operational cooperation protocols will have to be defined and maintained, but it will have to maintain its own autonomy and independent connotation. Addiction Medicine is a discipline that brings together elements of public health, prevention, internal medicine, clinical pharmacology, neurology, and even psychiatry. The inclusion of the DAs in those of DMH refers purely to a problem of pathology that has to do with lifestyle, choices, and behaviors. These, over time, show their dysfunctionality and only then do related problems emerge. Moreover, epidemiological, social, and clinical motivations impose the creation of alcohological teams dedicated to alcohol-related activities. The collaboration with self-help-groups (SHGs) is mandatory. The action of SHGs is accredited in numerous international recommendations both on the basis of consensus and evidence in the literature.

[Day clinic, a gateway towards risk reduction]. / Hôpital de jour, une passerelle vers la réduction des risques.

The addictology day clinic at Fernand-Widal hospital in Paris caters mainly for patients suffering from alcohol dependence. The aim is to consolidate the withdrawal which has taken place, to help reduce risks and harm and to support people waiting for follow-up care.

Adolescent Addiction Curriculum: Impact on Knowledge Self-Assessment in Pediatric Learners.

Introduction: Addiction is developmentally a pediatric-onset disease. Adolescent addiction recently gained the nation's attention due to the steep increase in opioid-related drug overdose deaths. Educating future adolescent health providers on adolescent addiction is a strategic initiative to mitigate the impact of this challenging public health concern. Methods: We used a logic model worksheet to identify key target areas informing the curriculum content development. The curriculum was written to be delivered in three successive parts-the Science of Addiction, Adolescence and Addiction, and Diagnosis and Treatment-each within a 2-hour interactive lecture session using PowerPoint presentations, brief videos, and learner activities. We collected data using pre- and postsession self-evaluation questionnaires. We calculated mean differences in scores and obtained qualitative data from learner comments. Results: Sessions were well received by attendees. A total of 31 participants attended at least one session. Knowledge of adolescent addiction increased in each session, with the greatest increase in the Science of Addiction (1.6, p = .0011), followed by Diagnosis and Treatment (1.1, p < .0001) and Adolescence and Addiction (0.9, p < .0001). Discussion: Attendance at one or more sessions improved participants' addiction-related knowledge. Graduate medical training programs can provide adolescent addiction education using systematic curricula such as this. Furthermore, this curriculum can be adapted to suit different groups of learners.

An insight into the deep web; why it matters for addiction psychiatry?

OBJECTIVE: Nowadays, the web is rapidly spreading, playing a significant role in the marketing or sale or distribution of "quasi" legal drugs, hence facilitating continuous changes in drug scenarios. The easily renewable and anarchic online drug-market is gradually transforming indeed the drug market itself, from a "street" to a "virtual" one, with customers being able to shop with a relative anonymity in a 24-hr marketplace. The hidden "deep web" is facilitating this phenomenon. The paper aims at providing an overview to mental health's and addiction's professionals on current knowledge about prodrug activities on the deep web. METHODS: A nonparticipant netnographic qualitative study of a list of prodrug websites (blogs, fora, and drug marketplaces) located into the surface web was here carried out. A systematic Internet search was conducted on Duckduckgo® and Google® whilst including the following keywords: "drugs" or "legal highs" or "Novel Psychoactive Substances" or "NPS" combined with the word deep web. RESULTS: Four themes (e.g., "How to access into the deepweb"; "Darknet and the online drug trading sites"; "Grams-search engine for the deep web"; and "Cryptocurrencies") and 14 categories were here generated and properly discussed. CONCLUSIONS: This paper represents a complete or systematical guideline about the deep web, specifically focusing on practical information on online drug marketplaces, useful for addiction's professionals.

Socio-psychological mediators of the relationship between behavioral health stigma and psychiatric symptoms.

The stigma associated with mental illness or addiction is significantly and positively related to psychiatric symptoms. According to Modified Labeling Theory, several processes should mediate this relationship, including rejection experiences, stigma management (secrecy coping), and social support. In the first comprehensive test of this theory, we examined a serial mediation model on three waves of data from 138 adults receiving outpatient behavioral health treatment. Participants were recruited from outpatient behavioral health clinics in a large northeastern city in the United States and completed interviews that assessed stigma, rejection experiences, stigma management, social support, and psychiatric symptoms. There was a direct effect between stigma and psychiatric symptoms and an indirect effect in which perceived rejection, secrecy coping and social support sequentially and longitudinally intervened in the stigma and psychiatric symptom relationship. Higher perceptions of stigma predicted more rejection experiences, which marginally increased secrecy coping and decreased social support. In turn, decreased social support increased psychiatric symptoms. We provide support for Modified Labeling Theory and the clinical utility of specific mediators in the relationship between stigma and psychiatric symptoms among adults in behavioral health treatment living in urban settings.

Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation.

BACKGROUND: Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance-use disorder therapy. PURPOSE: Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non-AI reservation/trust land areas in Washington State. METHODS: The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA-waivered physicians in a region per 10,000 residents aged 18-64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non-AI reservation/trust land. Zero-inflated negative binomial regressions with robust standard errors were estimated. RESULTS: The number of OAT clinics in a region per 10,000 ZIP-code residents was significantly lower in rural versus urban areas (P = .002). This did not differ significantly between AI reservation/trust land and non-AI reservation/trust land areas (P = .79). DATA-waivered physicians in a region per 10,000 ZIP-code residents was not significantly different between rural and urban (P = .08), or AI reservation/trust land versus non-AI reservation/trust land areas (P = .21). CONCLUSIONS: It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA-waivered physicians.