Effects on Neonatal Abstinence Syndrome of Parental Caregivers' Ability to Leave the Postpartum Unit During the COVID-19 Pandemic.

OBJECTIVE: To determine if a policy change that limited the ability of parental caregivers to leave the postpartum unit during the COVID-19 pandemic influenced neonatal abstinence syndrome (NAS) scores, admissions to the NICU for NAS treatment, and length of stay (LOS) on the nursing unit. DESIGN: Retrospective chart review. SETTING: /Local Problem: During the pandemic, a change in policy limited parental caregivers from leaving the nursing unit. PARTICIPANTS: Neonates being screened for NAS during the period before the policy change from April 2, 2019, through April 1, 2020 (n = 44), and the period after the policy change (n = 23) from April 2, 2020, to April 1, 2021. MEASUREMENTS: Levene's test was used to determine homogeneity of variance before independent t tests on mean NAS scores and LOS across groups. A linear mixed-effects model tested differences in NAS scores, accounting for time and group. Chi-square tests determined differences in the number of neonates transferred to the NICU across groups. RESULTS: No differences between group variables were found, with the exception of feeding type and cocaine/cannabinoid use (p < .05). No significant differences were found in mean NAS scores (p = .96), LOS (p = .77) or NAS scores accounting for time and between groups (p = .069). Transfers to the NICU in the pre-policy change group were significantly greater (p = .05). CONCLUSION: Although no decrease was observed for mean NAS scores and LOS of the neonates, a decrease in transfers to the NICU for pharmacologic treatment for NAS was observed. Further research is required to determine casual relationships for the decrease in NICU transfers.

Perceptions of health status, physical fitness, and participation in physical activity among adolescents before and after COVID-19: analysis of 2019-2021 data from the Republic of Korea national sports survey

Research has examined the detrimental effects of the coronavirus disease (COVID-19) pandemic on health and physical fitness in adolescents;however, studies comparing these parameters before and after the COVID-19 outbreak have been scarce. Therefore, this study investigated differences in perceived health status, perceived physical fitness, and participation in physical activity among adolescents in the Republic of Korea before and after the COVID-19 outbreak. We chose a sample of data from 2102 adolescents aged 14-19, collected as part of a national survey by the Republic of Korea Ministry of Culture, Sports, and Tourism from 2019 to 2021. We focused on five items from the survey related to health awareness and physical activity. Although perceived health status was lower in 2021 than in 2019 or 2020, there were no differences in perceived physical fitness during the three years of the study. Regular participation in physical activity was less common in 2020 than in 2019 or 2021. The proportion of adolescents reporting sufficient rest and sleep was lower in 2021 than in 2020. In addition, fewer adolescents reported eating regular meals and engaging in nutritional supplementation in 2021 than in 2019 and 2020. Rates of abstinence from alcohol and smoking cessation were higher in 2021 than in 2019 or 2020. For all three years, adolescents reported the following as the primary reasons for engaging in regular physical activity (in order): "maintenance of mental health", "maintenance of physical health", "help in daily life", and "reduction of medical expenses". In preparation for the post-COVID-19 era, these results highlight the need to prepare measures and countermeasures to promote health and physical activity among adolescents in the Republic of Korea.Copyright ©2023 The Author(s). Published by MRE Press.

Neonatal abstinence syndrome hospitalizations in Canada: a descriptive study.

OBJECTIVE: The objective of this paper is to describe the trend of newborn hospitalizations with neonatal abstinence syndrome (NAS) in Canada, between 2010 and 2020, and to examine severity indicators for these hospitalizations. METHODS: National hospitalization data (excluding Quebec) from the Canadian Institute for Health Information's Discharge Abstract Database, from January 2010 to March 2021, and Statistics Canada's Vital Statistics Birth Database were used. Analyses were performed to examine NAS hospitalizations by year and quarter, and by severity indicators of length of stay, Special Care Unit admission and status upon discharge. Severity indicators were further stratified by gestational age at birth. RESULTS: An increasing number and rate of NAS hospitalizations in Canada between 2010 (n = 1013, 3.5 per 1000 live births) and 2020 (n = 1755, 6.3 per 1000 live births) were identified. A seasonal pattern was observed, where rates of NAS were lowest from April to June and highest from October to March. Mean length of stay in acute inpatient care was approximately 15 days and 71% of NAS hospitalizations were admitted to the Special Care Unit. Hospitalizations for pre-term births with NAS had longer durations and greater rates of Special Care Unit admissions compared to term births with NAS. CONCLUSION: The number and rate of NAS hospitalizations in Canada increased during the study, and some infants required a significant amount of specialized healthcare. Additional research is required to determine what supports and education for pregnant people can reduce the incidence of NAS hospitalizations.

RéSUMé: OBJECTIF: Le présent article a pour but de décrire la tendance des hospitalisations de nouveau-nés atteints du syndrome d'abstinence néonatale (SAN) au Canada, entre 2010 et 2020, et d'examiner les indicateurs de gravité de ces hospitalisations. MéTHODE: Les données nationales sur les hospitalisations (à l'exclusion du Québec) provenant de la base de données sur les congés des patients de l'Institut canadien d'information sur la santé, de janvier 2010 à mars 2021, ainsi que la base de données sur les naissances des statistiques de l'état civil de Statistique Canada ont été utilisées. Des analyses ont été réalisées pour examiner les hospitalisations liées au SAN par année et par trimestre, et par indicateurs de gravité de la durée du séjour, de l'admission dans une unité de soins spéciaux et de l'état à la sortie de l'hôpital. Les indicateurs de gravité ont en outre été stratifiés en fonction de l'âge gestationnel à la naissance. RéSULTATS: Un nombre et un taux croissants d'hospitalisations liées au SAN au Canada entre 2010 (n=1 013, 3,5 pour 1 000 naissances vivantes) et 2020 (n=1 755, 6,3 pour 1 000 naissances vivantes) ont été identifiés. Une tendance saisonnière a été observée, où les taux de SAN étaient les plus bas d'avril à juin et les plus élevés d'octobre à mars. La durée moyenne du séjour en soins de courte durée était d'environ 15 jours et 71 % des hospitalisations liées au SAN ont été admises à l'unité de soins spéciaux. Les hospitalisations pour les accouchements prématurés de nouveau-nés atteints du SAN avaient des durées plus longues et des taux plus élevés d'admissions dans des unités de soins spéciaux par rapport aux naissances à terme de nouveau-nés atteints du SAN. CONCLUSION: Le nombre et le taux d'hospitalisations liées au SAN au Canada ont augmenté au cours de l'étude, et certains nourrissons nécessitent une quantité importante de soins spécialisés. Des recherches supplémentaires sont nécessaires pour déterminer quels soutiens et quelle éducation pour les personnes enceintes peuvent réduire l'incidence des hospitalisations liées au SAN.

Conference Proceedings 33rd AAAP Annual Meeting and Scientific Symposium

The proceedings contain 20 papers. The topics discussed include: the effect of specialty addiction consultation on prescribing medication for opioid use disorder (MOUD) during general hospital admission;mindfulness-based interventions for adolescent drug and alcohol use: a systematic review and meta-analysis;early changes in irritability predict longer-term abstinence from drug use in adults with stimulant use disorder: findings from the stride study;carfentanil, a highly potent opioid responding to high doses of naloxone, what can help?;an inpatient protocol for managing methamphetamine withdrawal;COVID-19 treatment outcome in a cohort of methamphetamine and cannabis users;the impact of COVID-19 on overdose risk and healthcare-seeking behaviors among hospitalized patients with opioid use disorder;and inpatient low dose transitions from full agonist opioids including methadone onto long-acting depot buprenorphine: case series from a multicenter clinical trial.

Neurocognitive Impulsivity in Opiate Users at Different Lengths of Abstinence.

The aim of the current study was to examine the effects of length of abstinence on decision making (impulsive choice) and response inhibition (impulsive action) in former opiate users (OU). Participants included 45 OU in early remission [0−12 months of abstinence], 68 OU in sustained remission [>12 months of abstinence], and 68 control participants. Decision making was assessed with the Iowa Gambling Task (IGT), the Cambridge Gambling Task (CGT), and the Monetary Choice Questionnaire (MCQ). Response inhibition was examined with the Stop Signal Task (SST), and the Go/No-Go Task (GNG). Results revealed group differences in decision making under risk (CGT) and ambiguity (IGT), where control participants displayed better decision making compared to OU in early remission. Both groups of former OU were also characterized by higher discounting of delayed rewards (MCQ). Regression analyses revealed minimal effects of length of abstinence on performance on decision-making tasks and no effects on delay discounting. In addition, both OU groups showed reduced action inhibition (GNG) relative to controls and there were no group differences in action cancellation (SST). Length of abstinence had no effect on response inhibition. Overall, our findings suggest that neurocognitive function may not fully recover even with protracted abstinence, which should be addressed by relapse prevention and cognitive remediation programs for OU.

Clinical applications of transcutaneous auricular neurostimulation for opioid use disorder and pain

Symposium title: Addressing chronic pain and the opioid epidemic using auricular neuromodulation Symposium description: Our proposed symposium integrates a diverse group of scientist and clinician experts (Drs. Cunningham, Wilkes, Khodaparast, Badran) who have committed to exploring the anti-nociceptive and opioid sparing effects of auricular neuromodulation to progress toward non-opioid interventions for chronic pain and opioid use disorders. The demand for chronic pain therapies has increased at an unprecedented rate over the last several decades, contributing in part to a surge in prescription and illicit opioid demand. Countless patients were escalated to prolonged, high-dose opioid regimens over years of treatment. By 2014, 5.4% of U.S. adults were estimated to use prescription opioids on a long-term basis. As the harms of opioid proliferation became increasingly clear, a dramatic paradigm shift occurred in which these drugs are now perceived as more dangerous than beneficial for chronic pain. New clinical guidelines highlight the risks of high-dose regimens as well as the limited benefits, particularly insufficient analgesia and hyperalgesia, associated with long-term use. According to this new perspective, the preferred therapeutic modality for many patients is to safely taper, or even completely stop, using opioids. Transcutaneous auricular neurostimulation (tAN) is a novel therapeutic paradigm that includes stimulation of both the auricular branch of the vagus nerve and auriculotemporal nerve (branch of trigeminal). tAN therapy results in clinically significant reductions in opioid withdrawal symptoms associated with opioid detoxification and tapering. Either adjunctive vagal or trigeminal stimulation modulates pain transmission suggesting overlapping common effector pathways, possibly targeting the endogenous opioid system, which could lead to a synergistic therapeutic benefit for pain. This symposium will explore the scientific basis for this hypothesis across targeted and interconnected topics, including fundamental neuropharmacological mechanisms underlying pain and opioids, clinical challenges of tapering opioids, managing opioid withdrawal symptoms with tAN, and the prospects for tAN to deliver a safe alternative treatment option for pain disorders. The United States is experiencing an epidemic for prescription and non-prescription opioids, which have continued to rise since the 1990s. During 2015, approximately 2.1 million people were severely dependent on prescription opioids, and 513,000 on heroin. In 2020, the Centers for Disease Control reported 93,331 substance use overdose deaths. The continuing increase in opioid-related deaths from 2015 (18%) to 2020 (60%) is partly attributed to the mental health crisis during the Covid-19 pandemic. Aside from pain mitigation, individuals with opioid use disorder (OUD) may be motivated to continue drug-seeking by both the positive reinforcement of the euphoric effects of opioids and the negative reinforcement of opioid withdrawal symptoms due to cessation. Alternative approaches for OUD are a major priority for government agencies given the substantial impact on health, social, and economic welfare. Transcutaneous auricular neurostimulation (tAN) is a non-invasive form of vagus and trigeminal neuromodulation that was recently proven to be an efficacious non-pharmacologic based treatment for reducing opioid withdrawal symptoms. In 2021, tAN therapy received FDA clearance as an adjunctive treatment for opioid withdrawal symptoms in adults. tAN therapy was also proven safe and effective in reducing symptoms of neonatal opioid withdrawal syndrome (NOWS) in neonates. tAN as an adjuvant was safe, well-tolerated, while facilitating the successful rapid weaning of oral morphine and decreasing length of stay in the neonatal ICU. Based on these preliminary findings, tAN therapy is currently in two NIH-funded pivotal clinical trials to: 1) evaluate the long-term effects of tAN on opioid use relapse prevention and cravings in adults with OUD, and 2) determine f tAN therapy can reduce withdrawal symptoms and reduce morphine length of treatment for neonates with NOWS. Lastly, we will explore how tAN could be utilized as neuromodulatory approach for opioid sparing, and ultimately pain mitigation. Research Category and Technology and Methods Clinical Research: 12. Vagus Nerve Stimulation (VNS) Keywords: Vagus Nerve Stimulation, Opioid Use Disorder, Pain, NeurostimulationCopyright © 2023

Low Treatment Fidelity as an Indication to Switch Interventions: Pivoting From Child-Parent Psychotherapy to Parent-Child Interaction Therapy for Early Childhood Trauma

Young children who experience trauma and adverse experiences are at an increased risk of developing an insecure attachment style as well as negative physical and mental health problems. These can include internalizing and externalizing behavioral problems, developmental delay, emotional dysregulation, and aggression. Several evidence-based interventions exist to treat young children with symptoms related to trauma, each with different foundational theories. This article presents the case of a 4-year-old boy with posttraumatic stress disorder who was in the middle of a legal fight between caregivers and transitioning between caregivers' homes. Initially, therapy began with Child-Parent Psychotherapy to address caregivers' first concerns. Later, the therapeutical approach was switched to Parent-Child Interaction Therapy due to difficulty with treatment fidelity related to caregivers' symptoms and conflict. This case demonstrates great improvement in treatment fidelity and subsequently problem behaviors after switching to an intervention that allowed to address behavior management shortcomings in a family with ongoing conflict.Copyright © The Author(s) 2022.

'Some days I am a lunatic that thinks I can moderate': Amalgamating recovery and neo-liberal discourses within accounts of non-drinking among women active in the 'positive sobriety' community on Instagram in the UK.

BACKGROUND: In recent years, reductions in drinking in the UK and the rise of online 'positive' sobriety communities have been observed, yet peer led support groups such as Alcoholics Anonymous (AA) and neo-liberal discourses of control and responsibility dominate public understandings of (problematic) alcohol use. This paper presents research exploring how women active in the 'positive sobriety' community on Instagram position and construct their non-drinking identities and relationships with alcohol within these overlapping discourses. METHODS: Semi-structured interviews (n=15) and online content produced by women active in the positive sobriety community on Instagram were analysed using thematic analysis. FINDINGS: Women challenged, reproduced and amalgamated AA discourses of addiction, and the broader discourses of neo-liberalism, in ways that positioned (alcohol) consumption, agency, control and individual responsibility as defining features of feminine identity making. Drawing on these discourses, binary understandings of problematic drinking, the identity of the 'alcoholic', and the need to reach 'rock bottom' in the recovery process were rejected and challenged, but at times reproduced. Whilst a broader framing of problematic drinking that situated drinking problems on a spectrum was constructed, abstinence was engaged with and promoted as the most effective way of gaining control and responsibility over drinking in gendered ways, and in establishing an authentic sense of self. CONCLUSION: This paper contributes to emerging research on online 'positive' sobriety communities, their gendered nature, and the intertwined presence of traditional recovery and neo-liberal discourses in women's accounts. Online sober communities offered alternative spaces of support and allowed for sobriety and sober femininities to be framed more positively than within traditional AA conceptualisations. However, those involved may experience tensions around (a) the need to 'tell' their personal stories of complete abstinence whilst still appealing to those who seek to 'moderate' and (b) the pressure to create and craft an 'authentic' sober self on an online platform that demands a carefully curated self-image and personal 'brand'. Further research should aim to gain more understanding of the role social media plays in "doing" sobriety and non-drinking, how this is done by people of different genders, the intersectional experiences of those participating, and how these communities can be made more equally available and accessible to those who do not consider full abstinence as necessary, whilst still appealing to those that do.

LC-MS/MS Determination of 88 Psychotropic Drugs in 1865 Hair Samples From Addicts in Drug Abstinence.

The emergence of novel drugs and the continuous expansion of the scope of the types of drugs under control have greatly increased requests for screening of a range of drugs in hair. Here, a multi-analyte method for the detection and quantification of 88 psychotropic drugs in the hair of addicts in drug abstinence was developed and fully validated using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Hair samples (25 mg) were washed, cut into pieces, cryogenically ground, and extracted in methanol. The extracted analytes were separated on an Allure PFPP column (100×2.1 mm, 5 mm i.d., Restek, USA) and analyzed by LC-MS/MS in multiple reaction monitoring mode. The limits of detection and limits of quantification ranged from 0.1 to 20 pg/mg and 0.2 to 50 pg/mg, respectively. The intra- and inter-assay precisions (RSD) of all analysis ranged from 0.9 to 14.9% and 1.9 to 15.9%, respectively. Accuracy values were 100±20%. The extraction recovery of quality control samples ranged from 50.9% to 99.6% for all analytes. The matrix effects for all analytes ranged from 46.8% to 99.7%. The method was successfully used to analyze 1,865 hair samples from addicts in drug rehabilitation at their own communities.. Among the samples, 129 cases were positive; the majority of positive cases were from males (78.29%), 92.25% of whom were over 35 years old. Traditional drugs, like methamphetamine and opioids, accounted for most positive cases, and 27 of the abstinence cases with a use history of methamphetamine were still positive. In addition to abused drugs, like methamphetamine, morphine, and cocaine, the sedative hypnotic and psychotherapeutic drugs, including clonazepam, alprazolam, estazolam, zolpidem, and quetiapine, were detected in 26% of the hair samples, suggesting that these addicts may have insomnia and mental problems such as depression and psychosis, probably due to the long-term effects of drugs and withdrawal reactions. Three synthetic cannabinoids were also detected in 4 (2.7%) cases. A total of 37 cases were positive for methadone, tramadol, and dextromethorphan, reflecting a new trend of alternative drug use when traditional drugs were not easy to obtain during the COVID-19 outbreak.

Loss and Survival: Experiences of Psychoanalytic Psychotherapists Working Remotely During the COVID-19 Pandemic

This paper presents the findings of a research project that explored the experiences of psychoanalytic psychotherapists based in the UK during the first period of lockdown in the COVID 19 pandemic. Groups of therapists met regularly to share and reflect on the impact of the sudden changes to their practice, and this paper pulls together the key themes which emerged from these discussions. The overarching preoccupations of the psychotherapists were those of loss and survival, with sub-themes of difficulty holding the frame;reduced security and safety;challenged analytic technique;and altered relationship dynamics. The groups were highly valued by participants as offering support during times of unprecedented stress, while also providing a forum to learn from and make creative use of the challenges presented by working remotely. Copyright © 2022 The Authors. British Journal of Psychotherapy published by BPF and John Wiley & Sons Ltd.

An Integrated Smoking Cessation Intervention in the Primary Care Service System: An Intervention Mapping

Background: Smoking cessation is beneficial for smokers of all ages. Moreover, smokers who quit tobacco use benefit from COVID-19 risk avoidance. Objective(s): This project aims to develop a smoking cessation intervention protocol in the primary care service system. Method(s): Intervention Mapping guidelines for health promotion planning program was used as an instruction includes 1) need assessment, 2) aim determination, 3) selecting theory-based approaches selection and practical strategies and intervention design, 4) intervention development, 5) planning the implementation of the program and 6) planning the evaluation. Result(s): According to the needs, smoking cessation behavior was indicated as an outcome of the intervention. The socio-ecological model (Fig. 1) and the transtheoretical model were performed as the theoretical underpinning of the intervention. Moreover, the proactive multisession telephone counseling integrated with the smoking cessation service in the primary care service was used as an intervention for smokers. The average quit attempts after the quit date were 2.13 times (SD = 1.33), with an abstinence rate of 88.24 percent, according to early findings among the experimental group 30 days after the quit date. Conclusion(s): An intervention mapping can be used as a guideline to develop smoking cessation in the primary care setting. This study provides the smoking cessation protocol delivered for Thai smokers, particularly in the primary care service system, to promote sustainable well-being among Thais. Copyright © 2022 Thanomsat et al.

Chemsex, G&T, and The Club Drugs Clinic Ireland

Introduction: Chemsex refers to the intentional consumption of specific substances, Gamma Hydroxybutyrate/Gamma Butyrolactone (GHB/GBL), Crystal Methamphetamine and/or Cocaine to facilitate or enhance the sexual experience. However, there was a plethora of associated problems ranging in severity to complex, life-threatening situations. Since its inception in 2014, The Club Drugs Clinic Ireland, the first outpatient-based clinic for GHB/GBL Detoxification in Ireland, had evolved to include managing problematic chemsex. Objective(s): The Chemsex Working Group Ireland is a collaborative response from governmental and non-governmental agencies. Details of current medical and psychiatric management along with preliminary outcome findings on detoxification, relapse risk and associated factors will be presented. Method(s): Data collected include socio-demographic variables, gender and sexuality, detoxification setting, relapse history and attendance for counselling or aftercare. Descriptive analyses were conducted on referral counts, drug trends, success of first treatment episode, subsequent relapse rate, and uptake of counselling and aftercare. Result(s): There have been over 200 referrals to the Club Drugs Clinic Ireland. A number of predisposing and precipitating factors, contributed to the relapse rate (up to 70%) both in Ireland and internationally. The salutogenic, biopsychosocial-based model of addiction recovery produced the best outcomes. This integrated Dual Diagnosis Psychiatry, Sexual Health Medicine, Emergency Medicine and external services for a more comprehensive care. Conclusion(s): The pattern of referrals reflects population trends in chemsex, despite the COVID-19 restrictions. While detoxification is largely successful, the high relapse rate highlights the challenge of maintaining abstinence. In order to competently address problematic chemsex, service coordination across various medical professions and ongoing monitoring of the substances consumed is quintessential.

Sperm Concentration, Sperm Motility and Total Motile Sperm Count Are Not Affected by Coronovirus Disease 2019 (Covid-19) Infection

Objective: The purpose of this study is to compare the parameters of sperm analysis in a group of healthy sperm donors before and after Coronavirus Disease 2019 (COVID-19) infection. Material(s) and Method(s): The study included semen analysis from eligible sperm donors aged 25-56 who had abstinence of 3-9 days and provided sperm before and after COVID-19 infection. Data were obtained from the patients who applied to our infertility clinic for semen analysis or in vitro fertilization (IVF) treatment. Ejaculate volume (mL), average concentration (M/mL), percent motility (percent), and total motile sperm count (M) were the primary outcomes. Data were compared and analyzed by paired samples t test and Wiloxon's test. Result(s): A total of 13 qualified sperm donors met inclusion criteria for this study. There was no significant difference in concentration, motility, or total motile sperm count in the patients' semen parameters before and after the infection (p>0.05) (Table 1). [Formula presented] Conclusion(s): COVID-19, a novel coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has sparked a global pandemic that hit the world in 2020, offering a huge challenge to healthcare systems and affected populations (1). One of the known effects of SARS-CoV-2 infection is invasion or damage to the male reproductive system. To enter host cells, the virus uses the transmembrane serine protease 2 (TMPRSS2) and the angiotensin-converting enzyme 2 (ACE2) receptor (2). Furthermore, ACE2 is extensively expressed in testicular tissue, and SARS-CoV-2 has been found in semen (3). SARS-CoV-2 can also infect cells through the host cell receptor CD147 (basigin, BSG), a transmembrane glycoprotein crucial for the blood-testis barrier's integrity (BTB) (4). Sperm quality measures were not significantly different in qualified, otherwise healthy sperm donors prior to COVID infection and after recovery. Impact Statement: SARS-CoV-2 infection has no impact on sperm concentration, motility, or total motile sperm count in healthy, eligible donors. REFERENCES: 1. 2. 3. 4. Copyright © 2022

Exploring changes in temporary abstinence in increasing and higher risk drinkers in England and Dry January participation in users of the Try Dry app in the UK between 2020 and 2021.

BACKGROUND: We looked at changes in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and changes in prevalence of use of the official app accompanying Dry January between 2020 vs 2021, following the onset of the COVID-19 pandemic. We also explored potential shifts in the sociodemographic composition of both groups. METHODS: We analysed data from: i) 1863 increasing and higher risk drinkers (defined as ≥ 8 on the AUDIT) responding to a nationally representative survey of adults in England in January and February 2020 and 2021, and ii) 104,598 users of the 'Try Dry' app, the official aid to those participating in Dry January 2020 and 2021 in the UK. We used logistic regression to examine shifts in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and explored whether there were shifts in the characteristics of this group in terms of AUDIT score, number of last year reduction attempts, smoking status, living alone, living with children, reducing alcohol consumption due to future health motives, age, sex, and occupational social grade between 2020 and 2021. We used t-tests and chi-squared tests to compare the prevalence of users of the 'Try Dry' app in 2020 and 2021 and examine whether the two groups differed in terms of age and sex. RESULTS: The proportion of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence increased from 4% in 2020 to 8% in 2021 (OR = 2.07, 95% CI = 1.38-3.11, p < .001) with no changes detected in sociodemographic composition. The number of Try Dry app users in 2021 increased by 34.8% relative to 2020. App users in 2021 were two years older on average [p < .001, d = .02], with a 2% increase in the proportion of female app users [p < .001, vs. < .01]. CONCLUSIONS: Higher participation in Dry January 2021 relative to 2020 indicates increased engagement with a period of temporary abstinence following the COVID-19 related lockdowns in England and the UK, which is positive in the wider context of increasing alcohol consumption throughout the pandemic.

Alcohol Use and misuse during the COVID-19 pandemic

GPs can play a pivotal role in the identification and management of alcohol problems at any time, and their role is even more important during the COVID-19 pandemic as more and more patients are resorting to alcohol to manage the stress and anxiety created by the pandemic. © 2021 Medicine Today Pty Ltd. All rights reserved.

The impact of forced abstinence on gambling: A natural ABA design study

The impacts of the COVID-19 pandemic, and responses used to mitigate the spread such as selective closure of non-essential businesses, have been far-reaching. Some of these impacts include changes in health, economic, social and recreation. Included among other non-essential business, in-person gambling venues were closed across Canada. Yet, online gambling opportunities remained available, making this period both a historical first in Canada, and a natural experiment. The current study examined quantifiable ramifications of the sudden forced abstinence from in-person gambling during the nation-wide lockdown in Canada, and what changes occurred six-months later upon reopening. For this cohort study, pre-pandemic base line data was provided six-month before the lockdown by online panel participants (n = 2,790), who were then re-surveyed during the national lockdown and again six-months postlockdown. Nearly one-third of gamblers reported a complete cessation of gambling during the lockdown period. For those who continued gambling, quantitative data indicated signifi-cant decreases on all gambling engagement measures: frequency, time spent in gambling sessions, money spent, and the number of game types played. This was followed by significant increases on each engagement measure six-months post-lockdown. Although these increases did not return to pre-pandemic engagement levels. Problem gambling within the whole sample generally declined during lockdown, however, significant increases in highrisk gambling were evidenced six-months later. In fact, engaging in online gambling and COVID-specific changes in health, employment, and social isolation across the closure and re-opening periods were independent predictors for classification as a problem gambler sixmonths after the lockdown.

Hemophagocytic Lymphohistiocytosis after COVID-19 Vaccination: A Case Report

Aim and background: Cases of thrombotic thrombocytopenia induced by coronavirus disease 2019 (COVID-19) vaccines have been reported recently. Herein, we describe hemophagocytic lymphohistiocytosis (HLH) following COVID-19 vaccination. Case report: A 35-year-old male, chronic alcoholic, 3 years into abstinence received first dose Covishield vaccine. He started developing a fever, testicular pain, diminished sensorium requiring invasive ventilation, and decreased urine output 4 days after getting vaccinated. Initial workup for NCCT brain and HRCT chest was normal, tropical fever panel was negative, cultures for blood and endotracheal aspirate were sterile, liver and renal functions showed mild derangement, CSF study was normal. Ultrasound examination of the abdomen revealed mild hepatosplenomegaly, mild testicular swelling, and suprainguinal lymphadenopathy, with no focus of infection. Subsequently, he developed bicytopenia with haemoglobin 9.0 g/dL and platelet counts 50 × 109/L, ferritin 2130 μg/L, triglyceride 353 mg/dL, and decreased fibrinogen 1.41 g/L. Bone marrow as well as lymph node biopsy showed haemophagocytosis with engulfment of neutrophils, lymphocytes, and normoblasts making HLH a likely diagnosis. Soluble CD25 and NK cell function could not be performed. Extensive evaluation was done to look into the etiology of HLH. SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) test was negative. RT-PCR test for Epstein-Barr virus (EBV), influenza A (H1N1, H3N2), influenza B, cytomegalovirus (CMV) performed from endotracheal aspirate (ETA) was negative. Similarly, the RT-PCR test from serum samples for EBV, Parvo B-19, CMV, and from CSF sample for EBV, Parvo B-19, CMV, and HSV-1 was negative. Hepatitis B, C, and HIV serologies were negative. Culture and sensitivity repeated from blood, ETA and urine was sterile. Autoimmune panel including complements levels were negative. Peripheral smear, bone marrow, and lymph node biopsy were normal and did not reveal abnormal or malignant cells. He had persistent fevers to 38.6°C during the first 6 days of his admission, with a rise in his ferritin to 1950 μg/L. The patient received steroids but not etoposide. By the 8th day, his fevers resolved, with improvement in his lethargy and malaise. Two weeks later, his ferritin had reduced to 510 μg/L, platelet count rose to 180 × 109/L, and repeat ultrasound abdomen demonstrated resolution of his splenomegaly. In our patient, there was no clear precipitant of HLH other than the Covishield vaccine. There was no evidence of an infection or malignancy. Due to our patient's clinical stability, resolution of symptoms, and improvement of HLH parameters he did not require HLH specific therapy. It is unclear if he had a pre-existing genetic predisposition to HLH as genetic testing is pending, however, it is unlikely as he has reached the age of 35 and suffered from previous viral infections without developing HLH.

Do Personality, Alcohol Abstinence Self-Efficacy, and Depressive Symptomatology Affect Abstinence Status in Treatment-Seeking Patients with Alcohol Use Disorder?

Given the high global incidence and disabling nature of alcohol use disorders, alongside high relapse rates, we sought to investigate potential predictors of abstinence, considered a prerequisite of full remission. With an aim to examine (i) the effect of personality, alcohol abstinence self-efficacy, and depressive symptomatology on abstinence status as our primary objective, and (ii) interactions between these three factors, as well as (iii) their changes over time as two secondary objectives, we recruited 51 inpatients at an alcohol rehabilitation center to complete the International Personality Item Pool, the Alcohol Abstinence Self-Efficacy Scale and the Beck Depression Inventory, and to provide information on abstinence attainment 2 months post-treatment. Although regression analyses revealed no evidence for the effect of the investigated factors (personality, self-efficacy, or depressive symptoms) on post-therapy abstinence, other findings emerged, demonstrating (i) a significant reduction in the severity of depressive symptoms, (ii) the effect of personality and alcohol abstinence self-efficacy on depressive symptom severity, and (iii) the role of personality in predicting the temptation to use alcohol in recovering drinkers. These preliminary indications of links between personality, self-efficacy, and subjective well-being mark a promising area for future research on powerful and relevant cues of relapse and abstinence efficacy.

Considerations for Transplant Risk Assessment in the Setting of Co-occurring Alcohol Use Disorder and Eating Disorder

Background: Rates of alcohol use disorder amongst women have increased markedly since the start of the Covid-19 Pandemic with some studies showing as much as a 41% increase in heavy drinking days (1). Among women with alcohol use disorder, there is a high degree of comorbidity with eating disorders (ED) with studies suggesting rates of co-occurring disease as high as 23-50%(2). However, there is little data on the assessment of transplant recipients presenting with co-occuring ED and AUD. Case: A 34-year-old woman with no known past psychiatric or substance use history presented to our hospital in acute hepatic failure (MELD Score 34) in the context of escalating alcohol use over the course of the COVID-19 Pandemic. As the patient did not respond to multiple medical therapies, evaluation for liver transplantation was initiated. The patient was assessed using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), and found to be a high risk candidate. During the course of our evaluation, the patient demonstrated a lack of interest in eating food, refusing to eat food that required chewing, and expressed multiple consequences about the aversive consequences of eating. She described extremely restrictive eating patterns with her lowest weight being 95 lbs (BMI < 16), leading to nutritional deficiencies, peripheral neuropathy and anemia. Given the absence of excessive concern regarding appearance or body weight, a diagnosis of avoidant restrictive food intake disorder (ARFID) was made. Despite efforts to engage the patient, she demonstrated little understanding of her ED. The patient was declined for listing and medically stabilized. She was declined by all inpatient substance use programs given the extent of her ED and rejected recommendations for targeted ED treatment. She was ultimately discharged to an intensive outpatient program for AUD. Discussion: There is a paucity of information regarding liver transplantation in patients with co-occurring AUD and EDs. However, there are many unique considerations in the management of this patient population in both the pre- and post- transplant period. Existing screening methods such as the SIPAT do little to evaluate transplant risk in patients with EDs relative to other psychiatric illnesses. And while predictive risk factors for recurrence of alcohol use after transplant have been identified, little is known about the risk factors for ED relapse. It appears that the emphasis on abstinence from alcohol in the post-transplant period can be a potent trigger for ED relapse(3). Post-transplant, patients with ED have an increased risk of relapse to alcohol and poorer retention in residential treatment(4). Conclusion: Patients with co-occurring ED and AUD requiring liver transplantation are a challenging patient population with complex pre- and post-transplant considerations. References: 1. Pollard M, et al. "Changes in Adult Alcohol Use and Consequences During COVID-19 Pandemic in the US." JAMA Netw Open. 2020;3(9). 2. Bulik, Cynthia, et al. “Alcohol Use Disorder Comorbidity in Eating Disorders: A Multi-center Study.” Journal of Clinical Psychiatry. 65:7, July 2004. 3. Coffman K L, et al. Treatment of the Postoperative Alcoholic Liver Transplant Recipient With Other Addictions." Liver Transpl Surg. 1997;3:322–327. 4. Elmquist, J. et al., "Eating Disorder Symptoms and Length of Stay in Residential Treatment for Substance Use: A Brief Report." Journal of Dual Diagnosis, 11(3-4), 233–237. https://doi.org/10.1080/15504263.2015.1104480.2015.

A Pilot Intervention to Reduce Adolescent Sexual and Mental Health Disparities by Increasing Access to Telemedicine and Mobile Care (AccessKCTeen)

Purpose: In the wake of the COVID-19 pandemic, marginalized adolescents face new and exacerbated barriers to accessing sexual and reproductive health (SRH) and mental health (MH) care. While telemedicine has adapted to increase access to SRH/MH services, it is less likely to be used by those with limited familiarity or no previous connection to care. We assessed the impact of a novel intervention (AccessKCTeen) that leverages peer outreach leaders and community events on confidence in accessing SRH/MH care and telemedicine. Methods: We engaged and trained teen peer leaders to stimulate healthcare-seeking behaviors by sharing SRH/MH information from our virtual toolkit and mobilizing their peer networks to attend our AccessKCTeen health outreach events. We partnered with community organizations to host events where we demonstrated telemedicine via a mobile van, shared local resources for SRH/MH care, and distributed free over-the-counter emergency contraception (EC), condoms, and pregnancy tests. All services were offered in English and Spanish. Teens completed three surveys: (1) prior to the engaging with AccessKCTeen (demographics, healthcare needs and trust and confidence to access care);(2) immediately post-intervention (health service uptake [e.g., EC, condoms, pregnancy test], satisfaction, healthcare trust, confidence to access care);and (3) one-month after the event (follow-up SRH/MH care utilization). Study staff documented teen engagement and feedback via field notes. Results: We trained five peer leaders. During three community health events, we enrolled 63 teens (mean age 15.9 years;67% female at birth, 27% Genderfluid/Non-Binary/Trans, 27% Hispanic, 30% Black, 45% White, 38% heterosexual). Most (68%) reported no previous vaginal/penile sex. In past week, the majority reported 1 or more days feeling anxious (62%)/depressed (50%)/lonely (59%)/hopeful (71%). Many (44%) had forgone needed care in the previous year, and few (32 %) had previously used telemedicine. Most reported improved understanding of telemedicine after the demonstration. Teens reported these benefits of telemedicine: privacy, ease of use, and increased access to SRH and MH care. Participants felt MH care is “desperately needed” but carries stigma and had friends or classmates with MH concerns. Participants voiced they “need facts” and accurate information on SRH, that education on “abstinence is not enough”, and frequently did not know that EC was available without prescription or the timeframe of effectiveness. Most teens discussed the SRH items directly with the AcessKCTeen. Post-intervention: 82% were satisfied with the intervention and 86% would recommend it to friend. Compared to baseline, more participants reported confidence to access telemedicine (58% vs. 78%) and in-person care: (67% vs. 72%) and trusted “doctors and nurses completely” (70% vs. 79%). Many accepted condoms (27%), pregnancy tests (16%) and EC (27%, 4 of whom were male). Recruitment and follow-up with participants and peer leaders is ongoing Conclusions: As COVID-19 continues to negatively impact SRH/MH care-seeking, the AccessKCTeen pilot offers critical insight on novel methods to increase access to SRH/MH care for marginalized adolescents. Sources of Support: O.5506 (CARES Act Funds), Berkley-Patton (PI), Jackson County, MO [Our Healthy KC Eastside (OHKCE): Addressing COVID-19 and Social Determinants on KC Eastside].