The COVID-19 pandemic compelled fast adaptation of telehealth to addiction treatment services. This study aims to examine the feasibility and effectiveness of transitioning an in-person hospital addiction consult service (ACS) to telehealth. The Stanford Hospital ACS adapted to the pandemic by transforming an in-person ACS to a telehealth ACS. We compared 30-day readmission rates in patients with and without an addiction medicine consult pre-pandemic (in-person ACS) and during the pandemic (telehealth ACS). The ACS completed 370 and 473 unique patient consults in the year preceding (in-person consults) and during the pandemic (telehealth consults) respectively. Patients seen by telehealth ACS had decreased 30-day readmission rates consistent with those seen before COVID-19. A telehealth ACS is feasible and effective in the in-patient setting. Telehealth ACS holds promise to extend the reach of substance use disorder evaluation and treatment in underserved areas.

Background Globally, iron deficiency anemia (IDA) is a significant public health problem. Tobacco smoking as a risk factor for anemia is often ignored. Aims To study the tobacco smoking-associated risk for IDA. Material and methods This study was conducted in a tertiary care hospital in Dehradun, India from January 2019 to December 2020. One hundred ten patients having IDA (serum ferritin < 15 mcg/l) and an equal number of controls were randomly selected and assessed regarding their tobacco smoking status and type, quantity, and duration of tobacco used. Results Seventy-six (69.1%) patients with IDA were tobacco smokers and were predominantly males (51cases, 67.1%) and beedi smokers (52 cases, 68.4%). The odds ratios (ORs) for the association of smoking tobacco (cigarette and beedi collectively), cigarette, and beedi with IDA were 7.60 (p < 0.0001), 2.79 (p = 0.01), and 5.68 (p < 0.0001), respectively. OR for developing IDA was more among light smokers (OR = 7.72, p < 0.0001) and increased with duration of smoking (p < 0.0001). IDA was not significantly associated with confounding risk factors like malnutrition (OR = 1.00, p = 1.00), low socioeconomic status (OR = 0.64, p = 0.21), dietary habits (OR = 1.43, p = 0.45), and place of residence (OR = 0.93, p = 0.88). Conclusions Tobacco smoking has a strong association with IDA. Both beedi smoking and cigarette smoking have a significant association with IDA. The risk of IDA is more among light smokers and is duration-dependent.

Background The clinical relevance of the degree of severity in addiction disorders supports the need to investigate the variables underlying this aspect of the phenomenon. Objective This study aimed to explore the relationships between factors that may influence the severity of addiction disorder, with a particular focus on temperamental disinhibition, emotion dysregulation, interpersonal vulnerability, and their interactions. Methods A clinical sample of 502 (77% males and 22% females) was involved. All participants received a DSM-5 clinical diagnosis of “Substance-Related and Addictive Disorders” and were recruited from the Italian National Health System. The collected data were analyzed by implementing a chained mediation model using structural equation modeling. Results The statistical appropriateness of the hypothesized latent 4- factors model was confirmed. Specifically, temperamental disinhibition (composed of impulsiveness, compulsiveness, and obsessiveness), emotion dysregulation (composed of affect dysregulation, alexithymia, and dissociation), interpersonal vulnerability (composed of traumatic experiences, preoccupied, avoidant and unresolved attachment), and Addictive Disorders Severity (composed by substance use severity, alcohol use severity, gambling severity, and Internet use severity) were the four factors which have been identified. Furthermore, a total chained mediation model emerged, where emotion dysregulation and interpersonal vulnerability mediated the relationship between temperamental disinhibition and Addictive Disorders Severity. Conclusions Our findings offer a better understanding of the variables associated with addictive disorder severity, providing important indications for therapeutic interventions.

In the treatment of tobacco use disorder, current approaches focus on pharmacotherapy, nicotine replacement, and psychotherapy. However, traditional treatments have been widely used in societies for the purpose of smoking cessation for years. Although cases using traditional herbs in the self-treatment of addiction have been reported in the literature, studies on this subject are very limited. Research on certain herbs shows that they may be effective in the treatment of tobacco use disorder by different mechanisms, however, there is no evidence that they are safe to consume as cigarettes. This article aims to question the place of traditional herbs in tobacco use disorder treatment through a case who started to smoke Melissa officinalis herb to help his nicotine withdrawal.

Background: Craving has been put forward as a core feature of addictive disorders. Objective: The present qualitative study investigated the experience of craving among individuals with addictive disorders and recent experiences of cravings. Methods: Eleven individuals with Gambling Disorder and ten with Alcohol Use Disorder (n = 21) were recruited. A semi-structured interview explored: (1) modes of thought during craving (mental imagery or verbal thoughts), (2) craving content, (3) coping strategies and (4) craving context. Results: The thematic analysis showed that cravings were initially dominated by imagery, with a subsequent conflict between imagery and verbal thoughts. Craving content included imagery of preparative rituals, anticipation, and sensory activation, imagery of the addictive behavior “me, there and then imagery” and anticipating that “something good will come out of it.” Some participants related to craving as a symptom of sickness, and coping with craving were through distraction, reminding oneself of negative consequences, or via sensory control: avoiding stimuli associated with the addiction. Craving contexts included typical settings of drinking or gambling and engagement of both positive and negative emotions. Alcohol craving was described as an expected relief from internal stimuli, such as anxiety or stress, whereas gambling craving was more often described as an expectancy of financial reward. Conclusions: Craving was experienced mainly through imagery containing the preparative routines and expected outcomes. Future research and clinical practice should incorporate mode of thought in cravings to better understand its role in the maintenance of the disorders and their treatment.

Introduction The micro-induction method of initiating buprenorphine is becoming a popular method for initiating buprenorphine in patients with Opioid Use Disorder, who are on full opioid agonists, either prescribed or non-prescribed, in order to avoid precipitated withdrawal. Given the rising concerns around illicit fentanyl use, this method of initiating buprenorphine has become another tool for clinicians to help patients with Opioid Use Disorder, even when multiple full opioid agonists are involved. While the process for initiating buprenorphine through this process is well studied, the characteristics of patients who are able to tolerate this initiation method in an outpatient setting is not. Case(s) We present the cases of two patients with Opioid Use Disorder in a community-based methadone maintenance program in whom micro-induction methods were used to initiate buprenorphine without lowering the methadone dose. Both patients successfully transitioned to buprenorphine without precipitated withdrawal. One of the patients was also using fentanyl at the time of induction and was able to abstain from fentanyl use following the induction process. Conclusion Initiating Buprenorphine using micro-induction strategies in a community based outpatient clinic in patients who are already on full opioid agonists is feasible, in these particular cases, the methadone dose or concurrent fentanyl use did not affect the outcome. We present the characteristics of the patient and the community clinic hoping that this helps more clinicians in replicating this induction strategy.

Exercise may be a valuable adjunct therapy for individuals with opioid use disorder (OUD) due to its known benefits in brain health, sleep, overall quality of life, and reduced anxiety and depression. Additionally, physical activity may mitigate the experience of pain, leading to better control of chronic pain. The purpose of this scoping review was to evaluate the evidence to support physical activity (which includes exercise) interventions for individuals with OUD. Systematic searches were conducted by a librarian in September 2021 in PubMed, PsycINFO, EMBASE, Web of Science, Cochrane CENTRAL, and clinicaltrials.gov. Two reviewers independently screened titles and abstracts to reduce risk of bias. A total of 13 studies met inclusion criteria. Ten publications presented data specifically studying a physical activity intervention for OUD. Three studies provided retrospective data on the exercise experience and attitudes. Results indicated different exercise modalities led to positive outcomes related to immune function, reduction of pain, cravings, anxiety and depression, as well as improvements in mood and quality of life. Additionally, participants noted exercise as an acceptable and feasible adjunct treatment. Exercise may be a valuable adjunct therapy for individuals with OUD; however, the majority of the published literature consisted of small samples presenting an opportunity for future investigators to corroborate findings with larger sample sizes, utilizing different exercise modalities in different populations of patients with OUD.

Background: Concurrent and/or simultaneous use of opioids and benzodiazepines has been associated with increased risk of accident and injury, as well as with co-occurring psychopathology. Objectives: The purpose of the present study was to explore potential correlates of simultaneous opioid and benzodiazepine use in a small community, including perceived risk, positive screens for psychiatric symptoms, and opioid-related consequences. Methods: A sample of 267 participants were recruited from a medication treatment provider that serves a small Midwestern community. Multinomial logistic regression was used to explore demographic and mental health correlates associated with self-reports of past-year simultaneous use. Zero-inflated Poisson regression was used to explore past-year consequences associated with reported simultaneous benzodiazepine and opioid use. Results: Intentional simultaneous use of opioids and benzodiazepines was associated with greater anxiety and depression symptoms, greater likelihood of a positive PTSD screen, and low self-perceived risk of simultaneous use. Individuals reporting opioid/benzodiazepine simultaneous use were also more likely to report opioid-related consequences. Conclusions: Results highlight the importance of assessing and treating simultaneous opioid/benzodiazepine co-use, as well as relevant comorbidities.

Background While telemedicine is seen as an emerging practice that will outlast the COVID-19 pandemic, it can reduce health services for those with limited internet and technological devices access or sufficient literacy. Objective(s) The aim of this study was to explore the feasibility of using telehealth with people who inject drugs (PWID). Methods A survey on availability and accessibility of different methods of communication was administered to a sample of PWID from an ongoing longitudinal cohort in Montréal, Canada. Results Among the 96 respondents, phone calls were generally considered acceptable (89.6%) although availability was low (50%). Acceptability and availability of social media were 26% and 41.7%, respectively. Internet-based communication applications were considered acceptable to use for telehealth in 28.1% of participants, even if not frequently available (8.3%). Conclusions Telehealth is an acceptable form of treatment for PWID, but may be challenging due to low availability of phone or internet access.

Copper deficiency often manifests with anemia and ataxia. The risk factors associated with the deficiency include gastrointestinal surgery, excessive zinc supplementation, and malabsorptive conditions. Little is known about the relationship between copper deficiency and alcohol consumption. Here we report a case of copper deficiency in a patient with alcohol use disorder who also had zinc deficiency, thereby posing a therapeutic dilemma because copper and zinc are competitively absorbed into the small intestine. Early recognition of copper deficiency is essential when treating zinc deficiency in such patients.