Rethinking DSM-5 Opioid Use Disorder: Is it time for a new definition?
Chairperson: Ellen Edens, MD, MPE, Associate Professor Department of Psychiatry, Yale University School of, VA Connecticut Healthcare System, Yale School of Medicine,
Co-Chair: Karen Drexler, MD, Associate Professor of Psychiatry, Emory University, Attending Psychiatrist in the Emory Healthcare Veterans Program
Presenters: Ellen Edens, MD, MPE, Associate Professor Department of Psychiatry, Yale University School of, VA Connecticut Healthcare System, Yale School of Medicine; Karen Drexler, MD, Associate Professor of Psychiatry, Emory University, Attending Psychiatrist in the Emory Healthcare Veterans Program; Wilson Compton, MD, MPE, Deputy Director, National Institute on Drug Abuse; William Becker, MD, Professor in the Department of Internal Medicine, Yale School of Medicine, Core Investigator, PRIME Center of Innovation, VA Connecticut Healthcare System
At the turn of the 21st century, pain management emerged as a pressing public health concern, becoming the 5th vital sign in the VA healthcare system.(1) Simultaneously, widespread
adoption of opioid prescribing for chronic pain led to a fivefold surge in morphine milligram equivalents by 2010.(2)
In 2013, against this backdrop, the DSM-5 Substance Use Disorder (SUD) workgroup undertook a pivotal reorganization of criteria for substance use disorders, omitting tolerance and withdrawal when medically prescribed.(3)
The ensuing opioid epidemic in the United States challenged the efficacy of long-term opioid therapy for chronic pain. Current guidelines discourage opioid initiation, advocating non-medication and non-opioid approaches.(4,5) Despite this, some patients continue long-term opioid therapy, facing difficulties tapering without significant functional improvement. The medical field is now struggling to characterize this clinical scenario, which has real-world implications on what opioid medications can be used to manage them and even which practice settings they can receive care, and has prompted discourse and research on whether this population warrants classification under mild Opioid Use Disorder (OUD) per DSM-5, or necessitates a novel diagnostic framework.(6,7) This workshop will explore this debate through clinical cases (Edens), historical context on opioid prescribing (7), rationale behind current DSM-5 SUD criteria (Compton)3, and the resulting impetus to form a new diagnosis when harms outweigh benefits for people prescribed opioids (Becker).(6)
Learning Objectives
- Recognize an ongoing debate around – and the need for research into – the creation of a new diagnostic category for people prescribed long-term opioids for chronic pain who exhibit difficulty tapering.
- Appreciate the historical influences upon the current DSM-5 criteria, specifically the exclusions of tolerance and withdrawal when prescribed under medical supervision – and consider need for further review of the 2013 criteria.
- Understand how DSM diagnoses are reviewed and updated - and decide for yourself if a review of the DSM-5 substance use disorder diagnosis is warranted.
"But it's the ONLY thing that works": Challenges and Opportunities in Withdrawal Management for Chronic Benzodiazepine Use
Chairperson: Alexis Ritvo, MD, MPH, Program Director of Addiction Psychiatry Fellowship, Assistant Professor of Psychiatry, University of Colorado (CU) School of Medicine
Co-Chair: Alena Balasanova, MD, Associate Professor, University of Nebraska Medical Center (UNMC), Department of Psychiatry
Presenters: Alexis Ritvo, MD, MPH, Program Director of Addiction Psychiatry Fellowship, Assistant Professor of Psychiatry, University of Colorado (CU) School of Medicine; Alena Balasanova, MD, Associate Professor, University of Nebraska Medical Center (UNMC), Department of Psychiatry ; Christopher Blazes, MD, Associate Professor of Psychiatry at OHSU; Daniela Rakocevic, MD, MSc, Chief of Addiction Psychiatry Division and Addiction Psychiatry Fellowship program director, Nortwestern University, Department of Psychiatry and Behavioral Sciences
Since the 1960s benzodiazepines have been prescribed as sedative-hypnotics. In the short-term benzodiazepines prove very effective for insomnia and anxiety. While they are generally not recommended for persistent use beyond 2 to 4 weeks, once started many individuals continue them long term. To date they remain one of the most frequently prescribed outpatient medications. Additionally, there is a prominent illicit market for benzodiazepines and a growing market for “designer” benzodiazepines. In September 2020 the FDA updated the boxed warning for benzodiazepines to expand upon the risks observed with long term use. The boxed warning included a warning that physical dependence can develop when benzodiazepines are taken steadily for several days to weeks, even as prescribed. It also advised that patients taking prescribed benzodiazepines be provided a gradual outpatient taper to reduce or discontinue benzodiazepines to reduce the risk of acute and protracted withdrawal reactions. Some patients experienced protracted benzodiazepine withdrawal symptoms lasting weeks to more than twelve months.
While the updated boxed warning provides some guidance for how to approach outpatient taper of prescribed benzodiazepines, it does not clarify what approach should be taken for patients with a sedative-hypnotic use disorder nor for patients with a co-occurring substance use disorder(s). In this workshop we will review the limited current evidence for different approaches to withdrawal management of long term benzodiazepines use on both an inpatient and an outpatient basis. We will include discussion of a variety cases to consider different approaches for benzodiazepine withdrawal management.
Learning Objectives
- Review the pharmacology of benzodiazepines with particular focus on mechanism for developing tolerance and risk of acute and protracted withdrawal.
- Evaluate the current evidence for different approaches to benzodiazepine withdrawal management on inpatient versus outpatient basis and the associated risks and benefits of the different approaches.
- Discuss how to approach benzodiazepine withdrawal management in patients with sedative-use hypnotic disorder or other co-occurring substance use disorders.
Advocacy in Action: How Addiction Psychiatrists Can Influence Public Policy
Chairperson: Holly Strain, MPH,
Presenters: Justine Welsh, MD, Associate Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine; Daryl Shorter, MD, Diplomate of the American Board of Psychiatry and Neurology; Jose Vito, MD, Clinical Assistant Professor, NYU School of Medicine; James Berry, DO, Addiction Psychiatrist and Chair of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine's Rockefeller Neuroscience Institute
This workshop aims to empower professionals, practitioners, and advocates in the field of addiction psychiatry with the knowledge and tools needed to make a meaningful impact on policies and legislation. During the workshop, speakers will discuss the landscape in Washington, opportunities for engagement by addiction psychiatrists, and how to advocate on behalf of the field at the local, state and national levels. Key strategies for effective advocacy will be discussed, such as building coalitions, engaging with policymakers through evidence-based arguments, and leveraging personal and professional experiences to amplify the voices of those affected by addiction.
Learning Objectives
- The participant will be able to explain why it is important for addiction psychiatrists to be involved in advocacy.
- The participant will be able to summarize AAAP’s top legislative priorities.
- The participant will be able to engage in advocacy at the local, state and/or national level.
Injectable Opioid Agonist Treatment (iOAT) and Short Acting Opioid Strategies for Fentanyl use: Bridging International Strategies with Practical Implementation in the USA
Chairperson: Jeremy Weleff, DO, Public Psychiatry Fellow, Yale School of Medicine
Presenters: Emily Casey, PharmD, Clinical Pharmacy Specialist in Pain Management and Substance Use Disorders, University of Pennsylvania Health System in Philadelphia, Pennsylvania; Julian Raffoul, MD, PhD, Clinical Fellow (Addiction Psychiatry), Vanderbilt University Medical Center, Nashville, TN
Amidst the surge of opioid-related overdoses in the United States, the field of opioid use disorder (OUD) treatment has seen few novel treatments emerge. High-potency synthetic opioids (HPSOs) have significantly altered clinical approaches, prompting a reevaluation of the effectiveness of existing medications for opioid use disorder (MOUD) and sparking interest in international treatments for OUD which include injectable opioid agonist treatment (iOAT) and slow-release oral morphine (SROM) as therapeutic options. Embracing OUD prescribing practices aligned with growing international consensus may constitute an integral part of a larger, multi-pronged strategy to combat the opioid crisis in the USA more effectively.
Here we provide an update on iOAT and other short acting opioids that have become standards in guideline-based care in Canada for the stabilization of severe OUD, useful tools for bridging to buprenorphine, and as third- or fourth- line options for the treatment of OUD. In addition, this workshop also covers the policy and legislative issues in the USA concerning the use of these medications as well as the historical context and long-standing effects of the Harrison Narcotics Act of 1914 (and subsequent federal regulations), which constrict the range of opioid agonist medications permitted for OUD treatment. We then provide American examples of the implementation of short acting opioids within various treatment settings and populations, including pregnant women. This workshop finishes by laying out a framework for next regulatory, policy, and research steps that may contribute to FDA regulatory decisions around these medications in the USA.
Learning Objectives
- Participants will be able to describe international strategies using different formulations of iOAT (hydromorphone and diacetylmorphine) and slow-release oral morphine (SROM) for severe opioid use disorder.
- Participants will be able to demonstrate knowledge about the use of short acting opioid strategies during methadone inductions, switches to buprenorphine, and as monotherapy for severe opioid use disorder.
- Participants will be able to describe the regulatory and policy issues that impact the use of these of these medications in the USA and will be able to employ these strategies within the hospital setting guided by contemporary literature.
Addressing Recovery Support Service Equity in the African American Communities (The history, the Current Landscape and the Future)
Chairperson: Anita Bradley, MSW, Founder and Executive Director, Northern Ohio Recovery Association (NORA)
Presenters: Andre Johnson, PhD, President/CEO of the Detroit Recovery Project Inc; Nyla Christian, NCIP, Executive Director of Center, African American Recovery Development; Jonathan Lofgren, PhD, Full-Time Unlimited Faculty in the Addiction Counseling Program, Founding Board Member of The Center for African American Recovery Development
The African American recovery community in the United States is comprised of peer-led, peer-run, and peer-driven organizations that have been instrumental in addressing the unique challenges faced by BIPOC people in their journey towards recovery. This landscape work has been a critical component in achieving successful outcomes and creating a supportive community for individuals and families who are struggling with addiction. These organizations Leaders have played a significant role in shaping the national discourse on addiction and recovery, and their impact will continue to be felt for generations to come. The panel will outline the implicit biases that existed historically, the current landscape of accomplishments, and closing will outline future solutions based around a policy brief development by the panelist.
Learning Objectives
- Explore the historical evolution of RCO's in the United States as it pertains to the development of Minority Peer Driven RCO's.
- Panelist will discuss the process conducted to develop the RCO's in various US cities. The Barriers and Success stories.
- The Current Landscape of BIPOC RCO's and the future recommendations for a administrative and clinical lens.
Stimulant Use Disorder Treatment: Updates from the ASAM/AAAP National Practice Guideline
Chairperson: Larissa Mooney, MD, Professor of Clinical Psychiatry and Director of the Addiction Psychiatry Division, Department of Psychiatry and Biobehavioral Sciences at UCLA
Presenters: Larissa Mooney, Professor of Clinical Psychiatry and Director of the Addiction Psychiatry Division, Department of Psychiatry and Biobehavioral Sciences at UCLA; Brian Hurley, MD, MBA, DFASAM, FAPA, Addiction Physician and the Medical Director, Bureau of Substance Abuse Prevention and Control in the Los Angeles County Department of Public Health; Kevin Sevarino, MD, PhD, Associate Clinical Professor, Yale University School of Medicine
Rates of stimulant use disorder (StUD) in the U.S. are rising, as are consequences associated with stimulant use in combination with opioids. Over the past decade, overdose death rates have increased three-fold for cocaine and twelve-fold for other stimulants—including methamphetamine, amphetamine, and prescription stimulants.
In addition to overdose deaths, StUD is associated with a broad range of serious and long-term health problems, including cardiac, psychiatric, and dental complications. Injection stimulant use increases the risk of contracting human immunodeficiency virus (HIV), viral hepatitis, and other infectious diseases such as infective endocarditis. The rising rate and potency of stimulants in the U.S. drug supply, low prices, and potential contamination of stimulants with synthetic opioids such as fentanyl, and adulterants such as levamisole are expected to exacerbate risks. Taken together, these factors position StUD as a major threat to public health.
ASAM and AAAP partnered to develop a national clinical guideline on the management of StUD. The guideline aims to assist clinicians in treating individuals with StUD, as well as individuals experiencing stimulant intoxication or withdrawal, and persons who are at high risk of developing StUD. The guideline covers StUD assessment, harm reduction guidance, management of acute complications, and behavioral and pharmacological treatment approaches for StUD. This session will summarize the key components, recommendations and applications of the clinical practice guideline on StUD including approaches for vulnerable populations.
Learning Objectives
- Identify three evidence-based, off-label pharmacotherapy treatment approaches for the treatment of stimulant use disorder.
- Recognize strategies to reduce harms related to risky stimulant use.
- Identify three evidence-based behavioral treatment approaches for the treatment of stimulant use disorder.
Overcoming and Addressing Stigma in Substance Use Disorders (OASIS): A Neuroscience-Based Educational Event for Communities and Clinicians
Chairperson: Jeremy Weleff, DO, Public Psychiatry Fellow, Yale School of Medicine
Co-Chair: Ellen Edens, MD, MPE, Associate Professor Department of Psychiatry, Yale University School of, VA Connecticut Healthcare System, Yale School of Medicine
Presenters: Ellen Edens, MD, MPE, Associate Professor Department of Psychiatry, Yale University School of, VA Connecticut Healthcare System, Yale School of Medicine; Justin Young, MD, PGY-4 Psychiatry Resident, Yale New Haven Hospital; David Ross, MD, PhD, Professor and Chair of the Department of Psychiatry, University of Alberta, Faculty of Medicine and Dentistry, Co-Founder and Executive Director, National Neuroscience Curriculum Initiative
With record numbers of opioid-related deaths in the United States, multi-pronged strategies to improve addiction care and reduce stigma toward substance use disorders (SUDs) are crucial. Stigma remains a significant barrier to care, persisting in both communities and treatment settings. Modern neurobiological approaches have deepened our understanding of addiction, highlighting how genetic and environmental factors contribute to vulnerability or resilience through shared neurobiological pathways. This has shifted the explanatory theories of addiction from a moral failure to a condition influenced by neuroadaptation and biology. This evolving understanding presents an opportunity for educational interventions that utilize these insights to reduce stigma and enhance treatment engagement.
The Overcoming and Addressing Stigma In Substance Use Disorders (OASIS) program addresses this need and uniquely uses neuroscience to counter stigma. Having been presented in multiple North American cities, the program uses principles of adult learning, interactive case seminars, and multimedia to communicate relevant neuroscience topics that help to explain aspects of SUDs to trainees, clinicians, and communities. OASIS aims to translate contemporary neurobiological insights into practical strategies that reduce stigma and improve addiction care and has been shown to reduce stigma across diverse populations of participants. Participants in the OASIS workshops engage in real-time interactive sessions, experiencing firsthand how to implement meaningful anti-stigma initiatives. This workshop will present a brief version of OASIS and is designed to train experts in SUDs to disseminate and adapt this material and associated teaching strategies for their local needs.
Learning Objectives
- Apply principles of adult learning to the creation of anti-stigma material for trainees, clinical staff, and the broader community.
- Communicate how neuroscience education can play a role in combatting stigma towards substance use disorders.
- Utilize cases to generate neuroscience-based responses to real-world questions posed by people with SUDs and those who care about them.
Words That Wound: Examining the Stigma of Addiction
Chairperson: Alena Balasanova, MD, Associate Professor, University of Nebraska Medical Center (UNMC), Department of Psychiatry
Presenters: Daryl Shorter, MD, Diplomate of the American Board of Psychiatry and Neurology; Ayana Jordan, MD, PhD, Barbara Wilson Associate Professor, Department of Psychiatry, Addiction Psychiatrist and Associate Professor, Department of Population Health at New York University (NYU) Grossman School of Medicine; Patrice Harris, MD, CEO and Co-Founder of eMed
Substance use disorders (SUD) are the most stigmatized disorders within psychiatry and healthcare at large. Stigma is a multifactorial construct characterized as “attitudes, beliefs, behaviors, and structures that interact at different levels of society (i.e., individuals, groups, organizations, systems) and manifest in prejudicial attitudes and discriminatory practices.” It’s well-established that healthcare professionals generally hold negative attitudes toward patients with SUD; this bias emerges in medical school and worsens progressively through residency into independent practice. Communication is essential and the language used to describe individuals with SUD has the power to promote or dispel stigma. In this workshop we highlight the relationship between stigma and the language of addiction with particular emphasis on how stigmatizing language can negatively impact patient care. We provide participants with tools to empower them to counteract stigmatizing language by using clinically accurate terminology. Specifically, we discuss the changing landscape of addiction language and how terms have evolved over time, outlining current best practices in non-stigmatizing addiction vocabulary. Participants will have an opportunity to work together in an interactive small group setting where they will work through clinical vignettes to identify stigmatizing addiction language and replace it with clinically accurate alternatives; this activity will be followed by large group debriefing and question and answer session. Past president of the American Medical Association, Patrice Harris, MD, MA, will be featured and will offer a unique perspective on the role of psychiatrist advocacy through language within the news media and how this can propagate or reduce addiction stigma.
Learning Objectives
- Describe stigma and its relationship to substance use disorder (SUD).
- Examine how SUD stigma impacts patient care.
- Identify stigmatizing addiction language and appropriate alternatives.
From Regulating Safety-Sensitive Professionals to Addressing Wellness and Burnout, the Evolving Role of Physician Health Programs
Chairperson: Amy Harrington, MD, CPE, FAPA, Vice Chair of Quality and Ambulatory Psychiatry, UMass Memorial Health/UMass Chan Medical School
Presenters: Rebecca Payne, MD, Addiction and Forensic Psychiatrist in Columbia, SC, Medical Director, South Carolina Recovering Professional Program; Mark Albanese, MD, Medical Director of Physician Health Services (PHS), Massachusetts Medical Society; Paul Simeone, PhD, Executive Director of Physicians Health Services (PHS), Massachusetts Medical Society
The role that Physician Health Programs (PHPs) play has evolved in recent years, particularly since the COVID-19 pandemic has propelled the topic of physician wellness and burnout prevention into the national spotlight. PHPs play a vital role, ensuring the safety of patients by preventing impaired physicians from practicing while simultaneously helping physicians
regain wellness. Addiction psychiatrists who treat physicians must understand both the unique strengths that these patients possess as well as the public safety and regulatory concerns that should be considered in treatment planning.
In this workshop, leadership from the PHPs of two different states, Massachusetts and South Carolina, will provide learners with an overview of the unique issues an addiction psychiatrist must consider if their patient is also a physician. In the didactic section, we will provide a brief historical context for PHPs and explain their purpose and function. We will then review special considerations regarding physicians as patients, including their role as safety-sensitive workers and issues related to burnout. Finally, we will discuss regulatory considerations such as credentialing, as well as factors to consider when relating to state medical boards.
For the interactive portion of the workshop, we will share a case of a physician seeking treatment. The audience will divide into small groups to talk about the ways in which their approach to the case would be different or the same because the patient is a physician. We will conclude with a large group discussion of the case, focusing on the physician’s involvement with a PHP. Content and Methods Identification Digital Interactivity and Audience Response Systems - We encourage engagement using polling and audience response systems. Please inform AAAP staff prior to your workshop if you wish to use one of these methods for leaner engagement., Case Discussion - Use of cases to engage the audience in brainstorming about diagnosis, treatment planning, clinical issues.
Learning Objectives
- To describe the history of PHPs and how they are structured today.
- To identify regulatory issues related to treating a physician for a mental health or substance use disorder.
- To differentiate physicians from other patients seeking treatment for SUD with regards to both their unique strengths as well as their profession-related risk factors.
International Drug Policy and Harm Reduction Models - A Spicy Debate
Chairperson: Carol Weiss, MD, Clinical Associate Professor of Psychiatry and Clinical Associate Professor of Psychiatry in Medicine at Weill Cornell Medical College, New York-Presbyterian Hospital
Presenters: Pouya Azar, MD, FRCPC, DABAM, Head of the Complex Pain and Addiction Service (CPAS), consult service under the Department of Psychiatry at Vancouver Coastal Health, British Columbia, Canada; Nickie Mathew, MD, Addiction Psychiatrist, Provincial Health Services Authority in British Columbia, Canada; Gregory Bunt, MD, Clinical Assistant Professor of Psychiatry, NYU Medical Center; Rania Mamdouh, PhD, MSc, Assistant Professor of Psychiatry, Psychiatry Department, Addiction Psychiatry Unit, School of Medicine, Cairo University, Egypt
Drug Policy and Harm Reduction are an evolving landscape. The drug overdose/poisoning crisis and Covid pandemic underscore the urgency of these topics. Decriminalization, legalization, alternatives to incarceration programs, prescribed safe supply, consumption in public places, and overdose prevention services such as supervised injection sites and naloxone distribution, are examples that will be discussed and debated in this workshop. The focus of the workshop will be on what international and US models can learn from each other. Panelists are all members of the International Society of Addiction Medicine (ISAM) from Canada, Egypt, and the US. Greg Bunt MD, past president of ISAM will compare the various international and national models, including the Seattle and Oregon experience. Rania Mamdouh MD, North and West Africa ISAM Regional Representative, will discuss Alternatives to Incarceration in Cairo, Egypt. Drs. Pouya Azar and Nick Mathew from Vancouver will discuss new harm reduction drug policy in British Columbia. Panelists and the audience will then engage in debate.
Learning Objectives
- Understand decriminalization and quasi-legalization from an international comparative analysis.
- Appreciate the complex challenges of establishing overdose prevention sites.
- Identify lessons learned from countries around the globe regarding drug policy reform.
An Introduction to Internal Family Systems Therapy: An Emerging Evidence-Based Tool for Trauma-Sensitive Addiction Treatment and Recovery
Chairperson: Zev Schuman-Olivier, MD, Associate Professor in Psychiatry, Harvard Medical School, Director of Addiction Research and the Founding Center Director of the Center for Mindfulness and Compassion (CMC), Cambridge Health Alliance (CHA)
Presenters: Zev Schuman-Olivier, Associate Professor in Psychiatry, Harvard Medical School, Director of Addiction Research and the Founding Center Director of the Center for Mindfulness and Compassion (CMC), Cambridge Health Alliance (CHA); Charles Silberstein, MD, Medical Director, Martha's Vineyard Community Services; Sanchit Maruti, MD, Associate Professor of Psychiatry, Larner College of Medicine at the University of Vermont, Attending Psychiatrist and Medical Director of the In-patient Psychiatry Service, University of Vermont Medical Center; Dilara Ally, MSW, PhD, Richard C. Schwartz Clinical Research Postdoctoral Fellow, Center for Mindfulness and Compassion at the Cambridge Health Alliance/Harvard Medical School
General population surveys report that ~75% of individuals with a substance use disorder (SUD) have experienced trauma at some point in their lives. Rates are even higher among clinical samples of individuals seeking SUD treatment with up to 95% of clients reporting exposure, including more than 50% having had childhood maltreatment. Internal Family Systems (IFS) therapy is an emerging evidence-based, trauma-sensitive approach to treating addiction and sustaining recovery from SUD. With more than 12,000 trained IFS therapists in the US, the IFS approach is spreading rapidly. The presenters will review the existing research literature, explaining the level of evidence currently available while also highlighting the evidence gaps where future research is needed. This interactive workshop will present up-to-date data from individual and group-based IFS intervention studies for numerous conditions, including posttraumatic stress disorder (PTSD) and SUD, including clinical trial pilot data that demonstrate promising therapeutic effects from group-based IFS for targeting symptoms of PTSD, disassociation, complex trauma, depression, anxiety, and substance craving (Schuman-Olivier, et al., 2024). Research data will clarify the psychological mechanisms that IFS psychotherapeutic techniques commonly engage, including both the well-known (i.e., emotion regulation, self-compassion, decentering, acceptance) and the novel (i.e., warm non-dual awareness). Participants will witness case-based examples with both live in-person and video demonstrations of innovative techniques. Presenters with demonstrate key skills for applying IFS principles to resolving ambivalence, developing adaptive emotion regulation strategies, and unburdening shame during addictions treatment. Participants will learn basic principles and steps for integrating IFS into addictions treatment and recovery.
Learning Objectives
- Explain the level of evidence supporting IFS approaches for co-morbid PTSD and substance use disorder and the promising scientific mechanisms of action.
- Describe the Internal Family Systems therapy model and its application for PTSD and substance use disorder.
- Demonstrate three IFS techniques (e.g., resolving ambivalence between parts, welcoming intense emotional states, unburdening shame) that can be used to reduce substance use craving and address the trauma fueling substance use in patients with addictive disorders.
Human Trafficking, Sex Work, and the Risk of Substance Use Disorders
Chairperson: Roberto Sanchez, DO, Addiction Psychiatrist, Baylor College of Medicine
Co-Chair: Mollie Gordon, MD, Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine in Houston, Texas
Presenters: Roberto Sanchez, DO, Addiction Psychiatrist, Baylor College of Medicine; Jeremy Weleff, DO, Public Psychiatry Fellow, Yale School of Medicine
This session explores the critical role of substance use disorders (SUDs) as a common and emerging prevalent issue among survivors of human trafficking in the 21st century. This session delves into the intricate relationship between SUDs and human trafficking, shedding light on how these dual challenges complicate survivor’s identification, screening, and access to essential treatment and legal remedies. The research reveals that traffickers exploit pre-existing SUDs in individuals to coerce them into trafficking or actively facilitate substance use to maintain control over their victims. In addition, substances are often employed by trafficking survivors as a coping mechanism to endure the profound trauma they experience.
The session emphasizes the urgent need for collaborative efforts between service providers, survivor advocates, and criminal justice practitioners to address this multifaceted crisis effectively. Drawing upon the research findings, the panel proposes recommendations for implementing comprehensive strategies for health risk behavior management, sexual abuse intervention,
substance use harm reduction, and combating violent crime within the context of sex trafficking. Data suggests that up to 88% of trafficking victims come in contact with a medical professional while less than 1% are identified or provided with necessary resources. We are in a unique and important position to screen and provide assistance for victims of human trafficking. By providing practical insights, this session aims to empower professionals in the field to better identify, support, and offer tailored assistance to trafficking survivors grappling with SUDs.
Learning Objectives
- Evaluate the intersection of substance use disorders and human trafficking.
- Understand how substance use disorders commonly develop or co-occur in survivors of human trafficking.
- Apply the Action Means Purpose (AMP) Model to assess for human trafficking.
The Emerging Role of Addiction Psychiatry in Sports Mental Health and Performance
Chairperson: Tim Fong, MD, Professor of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
Presenters: Eric Morse, MD, CMO of the Morse Clinics - Johnston Recovery Services in Clayton, Morse Clinics of Asheboro, Durham, Roanoke Rapids, North Raleigh, Dunn, Zebulon, Chatham Recovery in Siler City, and Vance Recovery in Henderson; Laurence Westreich, MD, Addiction Psychiatrist, New York University School of Medicine
Over the last decade, there has been a surge in interest in the intersection of sports and mental health as evidenced by rising demand from athletes, coaches, trainers and sport organizations for mental health services and guidance on best practices. Additionally, risky substance use, use of substances that impact the integrity of sport and addictive disorders are issues present at every level of athletic competition. Addiction psychiatrists are positioned to meet these needs.
This symposium will present the latest information, clinical knowledge and current best practices that are being used in the field of sport psycyhiatr and addiction psychiatry. This symposium will cover current trends in clinical presentations of substance use disorder and mental health conditions in athletes. Special attention will be paid to reviewing cannabis and alcohol use in athletes and the impact on mental health and sport performance. Cannabis legalization has spurred many changes at the sport regulation level which can create confusing clinical questions that require an addiction psychiatrist’s evaluation. Secondly, an overview of sports-related illicit performance enhancing drugs, supplements, and banned substances for which Therapeutic Use Exemptions (TUEs) are available will be presented, to inform addiction professionals and mental performance specialists
Lastly, given the expansion of sports gambling, a review and examination of the impact of sports betting on athlete’s mind, body and brain will be presented. Together, the information presented will enhance the addiction psychiatrist’s knowledge, skills and abilities to screen, assess and manage substance use disorders and mental health conditions in athletes.
Learning Objectives
- Review current trends in addictive disorders and co-occurring disorders among amateur and professional athletes.
- Increase knowledge of addictive potential of performance enhancing drugs used by athletes.
- Describe how the increase in availability and access of sports betting can impact athlete mental and physical well-being.
AAAP & AADPRT: Collaboration for Culture Change in Addiction Psychiatry Training (Workshop Jointly Sponsored by AAAP Education Committee & AADPRT Addiction Committee)
Chairperson: Alena Balasanova, MD, Associate Professor, University of Nebraska Medical Center (UNMC), Department of Psychiatry
Co-Chair: Daniela Rakocevic, MD, MSc, Chief of Addiction Psychiatry Division and Addiction Psychiatry Fellowship Program Director, Northwestern University, Department of Psychiatry and Behavioral Sciences
Presenters: Alexis Ritvo, MD, MPH, Program Director of Addiction Psychiatry Fellowship, Assistant Professor of Psychiatry, University of Colorado (CU) School of Medicine; John Renner, MD, Professor of Psychiatry, Boston University Chobanian & Avedisian School of Medicine
In this workshop jointly sponsored by the AAAP Education Committee and AADPRT Addiction Committee, members of both committees will outline the current gap between growing public health needs and existing Addiction Psychiatry (AP) expertise and available workforce and explore solutions to these challenges. Presenters will summarize the current state of AP training within general psychiatry residency programs, AP fellowship recruitment trends and projected impact on AP workforce, as well as recent changes in the recruitment process including the NRMP match. Participants will learn about specific strategies and inter-organizational collaborations (AAAP-AADPRT) geared towards addressing current challenges in AP training and progress made including recent initiatives such the Addiction Psychiatry Visiting Scholar program. With the need to educate residents more robustly in AP and facilitate influx into further subspecialized training, this workshop will introduce innovative teaching methods to incorporate AP education into general psychiatry residency programs and identify creative incentives in AP fellowship recruitment. Brief, interactive presentations will be followed by facilitated small group discussion by a leading content expert. In their small groups, participants will have the opportunity to reflect on their own individual training program’s areas for growth, explore available resources, and actively consult with other participants and session leaders on how to match these resources with their educational needs. With education as one of the AAAP mission core components this workshop aims to fill a gap in disseminating practical ways of approaching AP education within the limits of AAAP members’ various practice settings.
Learning Objectives
- Summarize current trends in addiction psychiatry training/recruitment, state of addiction psychiatry education in general psychiatry residency programs and impact on future addiction psychiatry workforce.
- Describe inter-organizational (AAAP-AADPRT) collaborative opportunities to address addiction psychiatry training including creative incentives for fellowship recruitment.
- Identify one to two innovative strategies to enhance addiction psychiatry education in general psychiatry residency programs.
Exploring Careers in Addictions
Chairperson: Danae DiRocco, MD, MPH, Associate Medical Director of Addictions, Cuyahoga County Corrections Center
Co-Chair: Chun Tong, MD, Staff Psychiatrist - Addiction Specialist, Christian Health NJ, Chief Resident, Rutgers New Jersey Medical School Psychiatry Residency Program
Presenters: Ayana Jordan, MD, PhD, Barbara Wilson Associate Professor, Department of Psychiatry, Addiction Psychiatrist and Associate Professor, Department of Population Health at New York University (NYU) Grossman School of Medicine; Manassa Hany, MD, Director, Addiction Psychiatry Fellowship, Mount Sinai Program; Robert Rymowicz, DO, American Psychiatric Association's Political Action Committee, Treasurer, Arizona Psychiatric Society; Christine LaGrotta, MD, Addiction Psychiatrist in the Supportive Recovery Services Clinic, James J Peters Bronx VA Hospital, Assistant Clinical Professor, Icahn School of Medicine at Mount Sinai; Jose Vito, MD, Clinical Assistant Professor, NYU School of Medicine
This panel will include 5-6 addiction psychiatrists working in diverse areas of the field who will share information about their career trajectory, career advice and answer questions from the audience. Our target audience is trainees, early career attendees and anyone considering new career routes within the field. We will have addiction psychiatrists working in private practice, academics, the VA, and research as well as diversity in gender, race/ethnicity and age to provide a wide breadth of experiences in the field. Each panelist will spend 5-10 minutes describing their career then we will have 30-45 minutes for question and answer (Q&A) with the audience.
Moderators for the panel will have prepared questions to guide the Q&A portion and allow the audience to ask their own questions. At the beginning of the session a live online survey of 2 questions asking what the audience would like to hear most about including practice types and career-related advice will help to guide the Q&A portion to maximally benefit the attendees.
Learning Objectives
- Provide the audience with career insight and advice from a diverse group of practicing Addiction Psychiatrists.
- Provide the audience with opportunity for question and answer about career paths within the field of Addiction Psychiatry.
- Allow the audience to consider the wide variety of ways to practice within the field of Addiction Psychiatry.
Availability of Medications for Opioid Use Disorder in U.S. Psychiatric Hospitals
Srinivas Muvvala, MD, Associate Professor of Psychiatry and Associate Program Director for the Addiction Psychiatry Fellowship, Yale School of Medicine; Addiction Treatment Unit (SATU) at the Connecticut Mental Health Center
During the worsening overdose crisis in the United States, medications for opioid use disorder (MOUD) are our most effective treatment but remain critically underutilized. Among those with OUD, psychiatric comorbidity is common. Expanding availability of MOUD within psychiatric care has enormous potential impact in improving the care of people with co-morbid OUD and mental illness. To date, there is no data describing MOUD availability within psychiatric hospitals. Analyzing a cross-sectional analysis of facility-level responses to the 2022 National Substance Use and Mental Health Services Survey (N-SUMHSS), we found that less than half (48%) of psychiatric hospitals in the United States offer MOUD. There was no correlation between MOUD availability and 1) self-reported prevalence of co-morbid substance use disorders (SUD’s) and mental illness within a psychiatric hospital or 2) state overdose mortality.
This study identifies a treatment gap in the availability of evidence-based MOUD within psychiatric care. Closing this gap has the potential save lives and improve both OUD and psychiatric outcomes in those hospitalized. Further research should focus on how to improve MOUD provision within psychiatric hospitals through qualitative studies identifying barriers specific to psychiatric hospitals and implementation studies on MOUD expansions similar to those at other clinical sites such as the emergency department. Improving education on evidence-based treatment of OUD for psychiatric clinicians will be a key component to improving care.
Learning Objectives:
- Describe the availability of medications for opioid use disorder within psychiatric hospitals.
Substance Use and Shame in Minority and Immigrant Communities
Zane Alroshood, BS, Fourth Year Medical Student, Oakland University William Beaumont School of Medicine, Corewell Health East
Substance use disorder (SUD) has increased worldwide, especially in the United States, with millions struggling with drug and alcohol problems. Substance use (SU) can lead to significant adverse health outcomes along with stigmatization in healthcare settings. Shame plays a complex role in the development and mitigation of developing substance use problems, influenced by cultural contexts such as dignity, face, and honor. Using a cross-sectional survey methodology, we assess demographics, shame, self-esteem, and substance use history. Participants were recruited from a multicultural metropolitan area in Michigan with a relatively large Middle Eastern population, 15% of participants were immigrants.
The primary goal of this study was to investigate the impact of factors such as shame and SU in individuals in minority and immigrant communities. Specifically, we aimed to identify and compare rates of shame among immigrants and minorities versus non-immigrants and non-minorities with substance problems. We found that Caucasians and U.S.-born individuals are significantly more likely to report poor self-esteem and screen positive for probable SUD compared to non-Caucasians and foreign-born individuals. One study found higher rates of SUDs in foreign-born, although makes no mention of shame. It further suggests that first-generation immigrants have markedly increased SUD prevalence than second-generation immigrants and U.S.-born. Our findings may suggest that lower levels of internalized shame have led to decreased prevalence of SUD amongst minority and immigrant communities, although it could also mean that decreased SU resulted in less subsequent shame. Based on all the respondents who had poor self-esteem reporting that shame existed before SU, the former hypothesis seems more likely. These unexpected findings challenged our initial predictions, which were based on the body of research that suggests that immigrants experience higher levels of hardships such as: food security, bill-paying and finances, housing, ownership of durable consumer goods, and neighborhood problems. When considering immigrant struggles, one might think the gap in assimilation and higher level of social and economic hardships might predict more difficulty in struggling with feelings of shame and SU, although this was not the case. It is also possible that ISS does not accurately capture non-Western concepts of shame. It is also possible that our results reflect that Middle Easterners in the U.S. represent a subset of Middle Easterners who had traits that made them more likely to immigrate and less likely to experience shame or use substances (e.g., financial resources, problem-solving skills). A perspective that could possibly explain lower shame among foreign-born is that perhaps these individuals who have uprooted their lives and dealt with the difficulties of immigrating have built emotional resilience and protective mindsets. This idea is supported by a study showing immigrants are less likely to self-select in “health-risk behaviors”. This sentiment has been coined the “healthy immigrant effect” as a growing number of studies have arrived at similar conclusions related to healthier behavior and lower chronic health conditions. Finally, another potential explanation is that lack of a solid citizenship status could play a role in the fear of losing U.S. residence due to legal repercussions associated with SU.
Learning Objectives:
- Identify and compare levels and rates of shame in those among immigrants and minorities versus non-immigrants and non-minorities with substance problems.
- Identify and compare levels and rates of self-esteem in those among immigrants and minorities versus non-immigrants and non-minorities with substance problems.
- Identify and compare rates and type of probable substance use disorder in those among immigrants and minorities versus non-immigrants and non minorities.
Outpatient Addiction Care Outcomes between State Opioid Response Grant-Funded and Traditionally Insured Patients in a Medicaid Non-Expansion State
Thao Le, MD, PhD, Resident Physician, Massachusetts General Hospital/McLean
This study evaluates the outcomes of opioid use disorder (OUD) treatment at a longitudinal outpatient clinic serving patients with substance use and other co-occurring psychiatric disorders in Tennessee, a Medicaid non-expansion state. Specifically, addiction care outcomes are compared between patients funded through the State Opioid Response (SOR) grant and those with traditional health insurance. Data from 615 patients treated between 2019 and 2023 indicate that SOR-funded patients exhibited higher treatment retention but also increased rates of non-prescribed opioid use. No significant differences were observed in acute care utilization or the frequency of clinical visits.
These findings suggest that while SOR funding improves patient retention in treatment, it might not be sufficient to reduce overall opioid use without additional support measures. Clinically, the results highlight the necessity for integrated and comprehensive care models that address both retention and substance use behaviors among patients with OUD, especially among uninsured or underinsured populations. Further studies are needed to explore the long-term impact of SOR funding on diverse patient populations and treatment settings. Policy implications call for enhancing funding mechanisms and resources to support a full continuum of care, particularly in Medicaid non-expansion states. These measures are essential to optimize treatment outcomes and
advance efforts to combat the opioid epidemic effectively.
Learning Objectives:
- Identify the differences in patient engagement, substance use, and acute care utilization outcomes between grant-funded and traditionally insured patients.
- Appreciate the impact of funding sources on patient care and long-term recovery outcomes in a Medicaid non-expansion state.
- Evaluate the effectiveness of the H&S model in a Medicaid non-expansion state.
Predictors of Treatment Admissions for Cannabis Use in the United States
Saral Desai, MD, Certified Clinical Research Professional and a PGY-2 Psychiatry Resident Physician, Tower Health/Drexel University College of Medicine Program in Philadelphia
Cannabis use has become increasingly prevalent in the United States, raising significant public health concerns and highlighting the need for targeted treatment services. As legalization spreads, it is crucial to understand the predictors of treatment admissions for cannabis use to develop effective interventions. Previous research has identified risk factors for substance use disorders in general, but comprehensive analyses specific to cannabis are limited. This study aims to fill this gap by examining a wide range of predictors, including sociodemographic characteristics, patterns of cannabis use, comorbid conditions, and referral sources, using a large national dataset.
The study's objectives are to identify demographic, socioeconomic, and behavioral predictors of treatment admissions for cannabis use in the United States and to assess the impact of early cannabis use, frequency of use, route of administration, comorbid mental health and substance use disorders, and referral sources on the likelihood of treatment admission. A retrospective analysis was performed using the 2020 Treatment Episode Data Set Admissions (TEDS-A), representing admissions to all publicly funded substance abuse treatment facilities. The focus was on admissions where cannabis was the primary substance for treatment. Univariate analysis identified the
prevalence and characteristics of these admissions, and multivariable logistic regression analysis
identified predictors associated with cannabis treatment admission.
Learning Objectives:
- The first objective of this study is to identify the demographic, socioeconomic, and behavioral predictors of treatment admissions for cannabis use in the United States.
- The second objective of this study is to assess the impact of early cannabis use, frequency of use, route of administration, comorbid mental health and substance use disorders, and referral sources on the likelihood of treatment admission.
Telehealth, Stimulant Prescriptions for ADHD, and the Development of Stimulant and Other Substance Use Disorders
Vinod Rao, MD, PhD, Psychiatrist, Massachusetts General Hospital
The rising use of telehealth for attention deficit/hyperactivity disorder (ADHD) diagnosis and treatment necessitates a closer look at potential downstream consequences. This study investigates whether receiving an initial stimulant prescription via telehealth compared to an in-person visit alters the risk for subsequent stimulant use disorder (stimUD) or other substance use disorders (SUD).
A retrospective cohort study was conducted using electronic health record (EHR) data from Mass General Brigham (MGB), a large, nonprofit healthcare system in the Northeastern United States. The analysis encompassed 7944 patients aged ≥12 years with ADHD who received an initial stimulant prescription within the MGB system. Findings revealed that having any prior in-person relationship with the prescribing provider, compared to solely telehealth interactions, did not significantly impact the risk for either stimUD or SUD. However, the modality of the initial stimulant prescribing appointment did show a difference. Patients receiving their initial stimulant prescription via telehealth had a significantly greater risk of subsequent stimulant use disorder but not SUD compared to those who received a prescription during an in-person appointment. This finding requires replication, given that our sample exhibited low rates of the development of stimUD (.05-0.4%). Overall, telehealth prescribing appears similar to in person in terms of overall SUD; while limited by small sample sizes, further work related to subsequent stimulant use disorders is necessary.
Learning Objectives:
- Compared to in-person care, is telehealth prescribing of stimulants for ADHD associated with increased risk for developing substance use disorders (SUD)?
Low Dose Buprenorphine Induction for Opioid Use Disorder: A Post-Hoc Analysis
Justin Morales, MD, PGY4 psychiatry resident at NYU
The opioid crisis in the United States continues to escalate as a critical public health challenge into 2024, with opioid overdose deaths rising significantly due to the increased availability and consumption of Highly Potent Synthetic Opioids (HPSOs) such as fentanyl. These substances, significantly more potent and more dangerous than traditional opioids, have led to a surge in fatal overdoses. The widespread availability of these opioids has compounded the challenges faced by healthcare systems, as even tiny dosages can be lethal, making accidental overdoses more common.
One of the barriers to effective treatment for patients with OUD who use Traditional methods of buprenorphine induction often require patients to undergo a period of withdrawal before starting treatment, causing severe withdrawal symptoms due to their use. In contrast, the low-dose approach of buprenorphine (LDB) induction, as demonstrated in various case reports on the Bernese method (Ahmed et al., 2021), consistently shows that it reduces the risk of precipitated withdrawal, making it a more tolerable option for patients transitioning to buprenorphine treatment. Its feasibility and safety across diverse clinical settings, including outpatient environments and during pregnancy, highlight its versatility.
Learning Objectives:
- To learn about the problems surrounding traditional Buprenorphine Induction.
- To learn about Low Dose Buprenorphine Induction and dosing regimens.
- To learn about the outcomes of Low Dose Buprenorphine Induction.
Substance Use Disorders in Hospitalized Patients with Tourette’s Syndrome: A National Population-Based Study
Precious Obehi Eseaton, MD, Psychiatry Resident, University of Texas Health Science Center At Houston
We aim to study the prevalence of substance use disorders among hospitalized patients with Tourette’s syndrome in the United States.
Learning Objectives:
- To study the prevalence of various types of substance use disorders in hospitalized patients with Tourette’s syndrome.
PP-01 Reduced Symptoms of Cannabis Withdrawal in a Randomized, Placebo Controlled, Double-Blind, Proof-Of-Concept Clinical Trial
Shelli Graham, PhD, Senior VP, Medical/Clinical Research, PleoPharma, Inc.
In 2022, approximately 19 million people were diagnosed with Cannabis Use Disorder (CUD) (SAMHSA, 2022), yet there is no FDA-approved medication to treat cannabis withdrawal or cannabis use disorder. Abstinence from heavy cannabis use is associated with significant withdrawal symptoms including craving, irritability, anger, anxiety, nervousness, sleep difficulties, decreased appetite, depressed mood, and physical symptoms. This study evaluated the safety and effectiveness of PP-01, a novel, dual-mechanism, investigational agent containing tapering and titrating doses of nabilone and gabapentin, in mitigating cannabis withdrawal symptoms.
Learning Objectives:
- To describe cannabis withdrawal symptom severity in the era of high potency cannabis use.
- To describe the mechanism of action of a potential new treatment for cannabis withdrawal.
Interventions for Opioid Use Disorder among adolescents: A Systematic Review
Suhaib Yehya, MPH, Bachelor of Medicine- Jordan University of Science and Technology, Masters of Public Health- Rutgers University
The findings of this systematic review have significant implications for various aspects of clinical practice, research, education, and policy related to addressing opioid use disorder (OUD) among adolescents. Firstly, the demonstrated effectiveness of integrating pharmacotherapy with cognitive-behavioral therapy (CBT), as evidenced by programs like the Youth Opioid Recovery Support (YORS), underscores the importance of adopting comprehensive treatment approaches. Clinically, this suggests that healthcare providers should prioritize offering multimodal interventions that combine medication-assisted treatment (MAT) with evidence based psychotherapeutic techniques. By doing so, clinicians can enhance treatment outcomes by addressing both the physiological and psychological aspects of OUD simultaneously, thereby improving the likelihood of sustained recovery among adolescent patients.
Furthermore, the emphasis on the necessity of early, age-specific interventions highlights the importance of early intervention and prevention efforts in mitigating the impact of OUD among adolescents. Clinicians and policymakers alike should prioritize developing and implementing targeted prevention strategies aimed at identifying and addressing risk factors for opioid misuse among young people. Additionally, the integration of substance use treatment within broader healthcare systems underscores the importance of interdisciplinary collaboration and the need for healthcare systems to adopt holistic approaches to addressing substance use disorders. This includes integrating addiction treatment services within primary care settings and ensuring seamless coordination between mental health, substance use, and medical care providers to provide comprehensive, coordinated care to adolescents with OUD.
Learning Objectives:
- To evaluate the effectiveness of various interventions for treating OUD among adolescents. By synthesizing evidence from existing studies, this review seeks to identify which interventions short or long term—pharmacological, behavioral, or a combination thereof—have demonstrated effectiveness in reducing opioid use and supporting recovery among adolescents.
- Examining the specific contexts or conditions under which these interventions are most effective, such as differences in age, gender, or severity of OUD. Furthermore, the review aims to highlight significant gaps in the current research, particularly concerning long-term outcomes and the adaptation of adult treatment protocols for adolescent populations.
Delta-9-Tetrahydrocannabinol Modulates Pain Sensitivity among Persons Receiving Opioid Agonist Therapy for Opioid Use disorder: A within-Subject, randomized, Placebo-Controlled Laboratory Study
Joao De Aquino, MD, Assistant Professor of Psychiatry, Yale University School of Medicine
This presentation will explore the effects of delta-9 tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, on individuals with opioid use disorder. By employing an experimental, randomized, placebo-controlled, crossover design, the study enables precise dosing and detailed measurement of THC’s impact on various addiction-related outcomes. The findings from this research have significant implications across various domains.
In clinical practice, the results can inform clinicians about the potential benefits or risks of THC use in patients with opioid use disorder, guiding treatment plans and harm reduction strategies. For research, this study contributes to the growing body of evidence on the interactions between cannabis and opioids, identifying areas for further investigation and potential therapeutic targets.
Educationally, the insights gained can be integrated into medical and therapeutic training programs, enhancing understanding of cannabis’ role in opioid addiction. Regarding policy, the findings can inform public health guidelines on cannabis use among individuals receiving treatment for opioid use disorder.
Learning Objectives:
- Understand Basic Cannabis Pharmacology and Regulatory Changes: Gain a basic understanding of the dose-dependent properties of cannabis and its THC, and stay informed about recent policy changes affecting their clinical use, particularly in the treatment of opioid use disorder.
- Understand the State of the Evidence on Cannabinoids’ Effects in Opioid Use Disorder: Explore the potential pain-relieving, opioid-withdrawal suppressing, and opioid-sparing effects of cannabinoids, providing a well-rounded view of the current evidence in this area.
- Apply Research Insights on Cannabinoids in Opioid Use Disorder Treatment: Learn to apply the research findings on the effects of THC in OUD treatment, focusing on clinical implications and factors influencing patient response to these treatments.
The Current State of Alcohol Withdrawal Management at the Department of Veterans Affairs: Results of a National Environmental Scan
Matthew Johnson, PhD, Susan Hill Ward Professor of Psychedelics, Johns Hopkins University School of Medicine
Management of alcohol withdrawal syndrome (AWS) is a critical aspect of the continuum of care for patients with alcohol use disorder (AUD). Despite how common this syndrome is, there remains ongoing debate and uncertainty about best practices and significant variability among services and providers. An environmental scan was developed and disseminated nationally to assess the landscape of alcohol withdrawal management at VA facilities. The scan evaluated access to resources, clinical tools and protocols utilized, gaps in practice, and approaches to training. The scan also asked facilities to submit their local standard operating procedures (SOP), policies, training materials, and order sets. There was a 100% response rate. Every facility submitted at least one response and there were 250 responses total from 140 facilities. Responders were physicians (n=161), nurses (n=31), psychologists (n=16), social workers (n=12), APRNs (n=7), pharmacist (n=1) and other (n=20). Other represented administrative officers, service chiefs, etc. They represented psychiatry (n=99), medicine (n=68), ER (n=15), ICU (n=4), primary care (n=3) and other (n=58). When asked about challenges or limitations faced when managing patients with acute alcohol withdrawal, the most common response was “lack of availability of ambulatory detox” (n=119). Other very common responses include “lack of availability of residential treatment options for AUD” (n=92), “inconsistency across units” (n=92), “inconsistency across disciplines” (n=83), “stigma” (n=72), “lack of ancillary support staff” (n=60), “inadequate training” (n=52) and “lack of access to experts” (n=37). Responders were asked to submit model standard operating procedures (SOPs), policies, order sets, and training modules. Note that graphical/chart representations of data will be presented in the paper/poster along with model SOPs, policies, order 1 2024 AAAP Annual Meeting and Scientific Symposium sets and training modules (time permitting for a paper presentation).
Learning Objectives:
- To be able to create an environmental scan to survey a large hospital system about clinical practice.
- To learn the results of the national scan and be able to apply it to your own system of care.
- To be familiar with national model examples of standard operating procedures, policies, EHR order sets and training modules.
A Detox Dilemma beyond benzodiazepines: Clonidine’s Quandary in Alcohol Withdrawal Management
Matthew Johnson, D.O., M.B.A., Owner, Encompass Psychiatry, LLC, Medical Director, Robert Wood Johnson University Hospital system’s Eating Disorders program
Addiction Medicine Education for Medical Students: Results of a National Survey of Medical School Administrators
Sydni Williams, BA, Medical Student, Emory School of Medicine
Addictions and Street Psychiatry: An Elective on the Street
Alexa Hooberman, MD, PGY-3 Psychiatry Resident, University of Massachusetts
Addressing a Gap in Addiction Education: Design and Implementation of a Clinical Rotation on Harm Reduction
Kelly Park, MD, Psychiatrist, LA County DMH
Apple Vision Pro: A Non Opioid Substitute for the Reduction of Pain and Anxiety
Ella Rohani, Undergraduate Student, York University
Aripiprazole Lauroxil Treatment in Patients with Co-Occurring Stimulant Use Disorder and Serious Mental Illness
Kathryn Renard, MD, Resident Physician, Mount Sinai
Assessing Communication about Multigenerational Substance Use in Families
Madeline Powell, BS, Medical Student, Larner College of Medicine
Assessing the Influence of Insomnia on Abstinence from Smoking among Cancer Patients
Nitin Reganti, BS, Student Researcher, MD Anderson Cancer Center/Rice University
Assessment of Barriers in the Office-Based Opioid Treatment in Rural United States
Savitha Kumari Satyasi, MD, Staff Psychiatrist, Ozark Center
Association of tobacco use diagnosis with suicidality in adolescents
Nancy Dunbar-Abbaei, BA, Medical Student, Case Western Reserve University, School of Medicine
Attention Deficit Hyperactivity Disorder, Substance Use, and Driving
Cristian Palmiere, MD, Expert in Addiction, Psychologist, CURML/UMPT
Attitudes Toward Methadone Treatment among African Americans
Khary Rigg, PhD, Associate Professor, University of South Florida
Beyond Opioids: Emerging Substances in Philadelphia
Keriann Shalvoy, MD, MPH, Addiction Psychiatrist, Thomas Jefferson University Hospital
Breaking the Cycle: MAT for Fentanyl Patch-Induced Hyperalgesia in Chronic Pain and Opioid Use Disorder in a Geriatric Patient- A Case Report
Katherine M. Bui, DO, Psychiatry Resident Physician, University of South Florida
Can Cognitive Behavioral Therapy for Insomnia Help Patients with Alcohol Use Disorder? a Systematic Review with Meta-Analysis
Ariella Maghen, MD, Resident Physician, Community Memorial Healthcare
Case Report: Extensive OroNasal Damage in a Person Using Fentanyl and Xylazine
Julie Kmiec, DO, Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Department of Psychiatry
Chronic MDMA Use and Long Term Psychosis: A Unique Case Presentation with a Review of Previous Literature
Omar Bajwa, MD, Resident Psychiatrist, Bergen New Bridge Medical Center
Clinical Challenges in Opioid Use Disorder Care: A Project Echo Case Series
Karen Hartwell, MD, Professor in the Addiction Sciences Division, Medical University of South Carolina, Medical University of South Carolina
Clinical Manifestations of Pcp-Induced Catatonia and the Subjective Experience of Pcp Use
William Fletes, MD, Resident - PGY3, Mount Sinai Beth Israel
Cocaine and fentanyl co-use with alcohol withdrawal: a microcosm of the challenges of the fourth wave of the opioid epidemic
Chengxi Li, MD, Fellow, UT Southwestern
Comparative Efficacy of Haloperidol and Olanzapine in Managing Agitation among Psychiatric Inpatients with Co-Occurring Substance Use
Sean Lynch, MD, Resident Physician, Mount Sinai Behavioral Health Center
Complications of “Muscling” in Persons Who Inject Drugs
Madison Humerick, MD, Assistant Professor, West Virginia University School of Medicine
Connecting the Dots: Systematic Screening for Coexisting Conditions in Internet Gaming Disorder
Leia Chemmacheril, MBA, MD, Resident Doctor, Rutgers New Jersey Medical School
Correlation between Adverse Childhood Experiences and Substance Use Disorders in Alcohol-Associated Liver Disease
Thwisha Anantasagar, BA, Medical Student, Case Western Reserve University, School of Medicine
Cost-Effectiveness and Retention Rates of Telehealth Vs. In-Person Buprenorphine Treatment for Opioid Use Disorder at UNMH-ASAP Clinic
Rana Alkhafaji, MA, MS, Program Manager, University of New Mexico
Delta 8: Psychosis and Suicidality
Nicholas Smith, BS, Medical Student, Schmidt College of Medicine
Delusions, Dependence, and Pain: Successful Buprenorphine Intervention in a Patient with History of Delusional Parasitosis (DP) and Chronic Pain Due to Severe Self-Inflicted Scalp Wounds
Kavan Mulloy, MD, Resident of Psychiatry, The University of Miami/Jackson/VA Health Systems
Development of a Point-Of-Care Shared Decision-Making Tool to Facilitate Choice of Medication for Opioid Use Disorder
Christopher Rakay, MD, PGY-4 Psychiatry Resident, Jefferson Einstein Hospital
Direct Induction of Extended-Release Buprenorphine
Dayyon Newman-Azar, Research Assistant, Vancouver general hospital
Disordered Eating in Early Recovery from SUD: Work in Progress and Participant Characteristics
Nima Shariatzadeh, BS, Student, University of Texas Health and Science Center San Antonio
Do Medical Students Identify Opportunities to Connect Patients with Opioid Use Disorders to Harm Reduction and Treatment Resources? Exploring Student Actions and Their Teams’ Reactions
Tabitha Moses, MS, MD/PhD Candidate, Wayne State University School of Medicine
Efficacy of Repetitive Transcranial Magnetic Stimulation in Opioid Use Disorder: A Systematic Review and Meta-Analysis
Vitor Campos, MD, Medical Doctor in Brazil
Emergent Technologies: A Scoping Review of Virtual Reality Therapy for Internet Gaming Disorder
Winni Yang, MSc, BA, Medical Student, Rutgers New Jersey Medical School
Enhancing Sbirt-A Effectiveness: The Role of Caregiver Involvement in Adolescent Substance Use Interventions
Kelly Johnson, BS, Clinical Research Assistant, Mass General/Harvard University
Evaluating and Comparing the Psychometric Properties of commonly Used Measures of Dependence among Exclusive Electronic Cigarette Users
Jacob Miller, MHS, Medical Student, Student Researcher, Penn State College of Medicine
Exploring Motivations of Peripartum Cannabis Use
Marie Hayes, PhD, Assistant Professor, Medical University of South Carolina
Exploring the Protective Role of Religion and Spirituality in Substance Abuse: The Moderating Effect of Social Identity
Amy Sowell, MS, 4th year Doctoral Student, Oklahoma City University
Fentanyl-Laced Marijuana Use in Adolescents - A Rising Concern Nationwide!
Kaushal Shah, MD, MPH, Psychiatry Resident Physician, Wake Forest University, School of Medicine
First Case of Mania and Psychosis after Psilocybin Ingestion in a Man with No History of Bipolar Disorder
Ameen Seyedroudbari, MD, Resident Physician, Lewis Gale Medical Center
Gambling and Gambling Problems in the Latinx Community: Results from Focus Groups with Promotore/as
Jonah Im, BS, Graduate Student Researcher, University of California, Los Angeles
Hoarding Symptomatology is Associated with Worse Treatment Outcomes amongst Individuals with Substance Use Disorders
Gianna De Gracia, Student, University of Florida
Hope for the Hopeless – Lessons in Changing Physicians’ and Patients’ Attitudes toward Substance Use Disorders that Can Be Learned from Changing Attitudes toward HIV Treatment
Sarah Kaufman, MD, MS, Resident Psychiatrist, LSU health Shreveport
Ibogaine: This Centuries-Old Psychoplastogen is Coming to the Limelight for Its benefits, but What Do We Know About Its safety?
Sahar Ashraf, MD, CAP Fellow, Texas Tech University Health Sciences Center School of Medicine
Identifying and Addressing Alcohol Use in LGBTQ+ Youth through the Development of a Novel Curriculum for Physicians in Psychiatry and Pediatrics
Victoria Lewis, MD, MPP, MSW, Fellow, Yale Child Study Center
Identifying Factors in Peer Recovery Support Services (PRSS) Interactions and Associations with Successful Outcomes among Pregnant Women with Opioid Use Disorder
Alfred Tager, MD, MPH, Resident Doctor, Charleston Area Medical Center/West Virginia University
Impact of Alcohol Use Disorder on Ability to Quit Smoking: A Cohort Study
Janet Albarran, BS, MD, Student, UC Riverside School of Medicine
Implementing Quality Improvement Initiative to Equip First-Year Medical Students with Harm Reduction Communication Skills
Natalie Swartz, BA, Medical student, Harvard Medical School
Insights of Opioid Use Treatment During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study
Ellis Jang, BS, Medical Student, California Northstate University College of Medicine
Intersect between Trauma and Gender and the Role of Therapy among Patients with Post-Traumatic Disorder Receiving Buprenorphine-Naloxone Treatment for Opioid Use Disorder in a rural Community Center
Ngozi Adaralegbe, MD, PhD, Resident, McGovern Medical School/UTHealth Houston
Low Dose Crossover Induction (“Microinduction”) from 70 mg of methadone to buprenorphine in an outpatient methadone treatment program setting
Samuel MacLeon, MD, Resident, Thomas Jefferson University
Low-Dose Buprenorphine Induction with Buccal Films in the Inpatient setting: A Case Series
Renato Velit, MD, Chief Resident, Department of Psychiatry and Behavioral Sciences
Mental and Physical Health Correlates of Lifetime Hallucinogen Use: Findings from the All of Us Research Program
Kevin Yang, BS, Trainee, UCSD
Naloxone Distribution on the Inpatient Psychiatric Unit: Identifying a Gap between Current Prescribing Practices and Demonstrated Patient Need
Kathryn Stevens, MD, Resident, Mount Sinai Beth Israel
Naltrexone For Opioid Overdose Prevention Among People Who Use Stimulants: A Qualitative Study With Survivors Of Overdose From Unintentional Fentanyl Use In San Francisco
Patrick Low, BA, Medical Student, University of California San Francisco
Neural Substrates of Cue Reactivity among Adults Receiving Treatment for Substance Use Disorders: A Systematic Review and Meta-Analysis
Adam Ketron, MD, PhD, Psychiatry Fellow, Brigham & Women's Hospital
Open- Openness towards Psilocybin Efficacy as Novel Treatment in Substance Use
Erin Wang, MPH, Medical Student, Baltimore, MD
Opioid Prescribing and Risk in Older Adults with Serious Illness: A Nationwide Clinician Survey
Karolina Sadowska, BA, Medical Student, Weill Cornell Medicine
Penny for Your thoughts: Qualitative Analysis of Clinician Perceptions on Financial Control over Patients with Co-Occurring Disorders
Jeremy Weleff, DO, Assistant Professor, University of Alberta / Yale University
Phosphatidylethanol Testing for Hospitalized Patients with Alcohol Use Disorder: A Retrospective Study to Identify Unnecessary Use of Medications for Alcohol Withdrawal
Pooja Sarkar, DO, Psychiatrist, Beth Israel Deaconess Medical Center
Physician Trust in Women with Substance Use Disorders in South Texas
Ashley Zhou, BA, Medical Student, UT Health Science Center At San Antonio
PP-01 Reduced Symptoms of Cannabis Withdrawal in a Randomized, Placebo Controlled, Double-Blind, Proof-Of-Concept Clinical Trial
Shelli Graham, PhD, Senior VP, Medical/Clinical Research, PleoPharma, Inc.
Preliminary Report: Psilocybin for Co-Occurring Major Depressive Disorder and Alcohol Use Disorder
Andrew Gaddis, MD, Postdoctoral Fellow and Assistant Professor, Department of Psychiatry, Johns Hopkins University School of Medicine
Primary Prevention of Opioid Use in the Skateboarding Community
Chris Haslam, Research Associate, Vancouver Coastal Health
Retrospective Infoveillance of Kratom Adverse Effects on Twitter
Emily Schamber, MAS, Research Associate I, University of Illinois Chicago
Rural-Urban Differences in Provision of Medication Treatment for Opioid Use Disorder in Commercially Insured Individuals across the United States
Darcie Caldwell, BA, Medical Student, University of Washington School of Medicine
Safety Analysis of the DORA Class with Attention to Abuse Related Features
Paul Saskin, PhD, Medical Director, Idorsia Pharmaceuticals US
Safety Profile of Stimulant Medications: A Systematic Review of Randomized Controlled Trials
Henrique Oliva, MD, PhD, Postdoctoral Associate, Yale University School of Medicine Department of Psychiatry
Sex Differences in Methamphetamine Use: Trends and Trajectories from 2002 to 2022
Soohyun Joe, MD, Addiction Psychiatry Fellow, University of California - San Diego
Six-Month Differences in knowledge, confidence, and Intention to Implement Substance Use Prevention and Treatment among Primary Care Clinicians who Participated in Online Modules
Jacqueline Hirth, PhD, MPH, Associate Professor, Baylor College of Medicine
Sleep Disturbance and E-Cigarette Use: A Case Report
Jiwon Kim, BA, SUNY Upstate Medical University
Subcutaneous Extended-Release Buprenorphine Injection Complicated by Skin Necrosis
Brandon Neisewander, MD, Fellow Physician, Medical College of Wisconsin
Sublocade Lidocaine Infiltration: A Case Series
Chanelle Wong, BSc, Research Associate, Vancouver General Hospital
Survey of Vaping Characteristics among Adults Residing in the Southeastern United States
Jesse Vanacore, DO, Addiction Psychiatry Fellow at UCSF
Symptom-Inhibited Fentanyl Induction (SIFI) for Hospitalized Patients with Opioid Use Disorder
Jessica Machado, RN, Registered Nurse Clinician, Complex Pain and Addiction Service, VGH
Systematic Review of Phenibut Withdrawal
Christopher Stewart, BA, Medical Student, Kansas City University
The Effect of the COVID-19 Pandemic on Physician Psychiatric Distress and Alcohol Use
Caesar Imperio, MD, PhD, Addiction Psychiatry Fellow, Columbia University
The Effects of the COVID-19 Pandemic on Rates of Social Media and Internet Addiction across the World
Sonya Priven-Grinblat, BS, Medical Student, Rowan-Virtua School of Osteopathic Medicine
The Masimo Bridge: Auricular Neurostimulation for Opioid Withdrawal Management
Matin Narimani, Biomedical Engineering Student, University of British Columbia
The Role of Depression on Ability to Achieve Smoking Abstinence
Arian Mohammadyar, BS, Student, SHSU College of Osteopathic Medicine
Tobacco Smoke Exposure in Children and Adolescents: Prevalence, Risk Factors and Co-Morbid Neuropsychiatric Conditions in a Us Nationwide Study
Mahdieh Saeidi, MD, Department of Psychiatry, Bronx Care Health System
Transdermal Buprenorphine Low-Dose Induction for Opioid Use Disorder: A Narrative Review
Koviya Sirohi, BA, Research Assistant, Vancouver General Hospital
Unique Challenges in Alprazolam Withdrawal: Success with a Combined Tapering Strategy
Adam Takatsuka, MD, Resident Physician, Jackson Health System
Utilization of Psychiatric Services among Patients with Co-Occurring Severe Mental Illness and Substance Use disorders: Comparison between Patients Prescribed Aripiprazole and Paliperidone Long-Acting Injectables
Angelo Chaia, MD, Resident, Mount Sinai Behavioral Health Center
What is "Gas Station Heroin"? Case Report of the Misuse of Tianeptine
Vamsee Chaguturu, MD, Addiction Psychiatrist, Rutgers Robert Wood Johnson Medical School
