Drug-Free Community Support in Inpatients with Co-occurring Psychiatric Disorders and Substance Use Problems.

Objective: This study evaluated the presence of drug-free family and friends in the social networks of patients treated in an inpatient setting for co-occurring psychiatric disorders and substance use problems. Methods: Social network interviews were conducted with inpatients at the Johns Hopkins Bayview Acute Psychiatric Unit with co-occurring psychiatric disorders and substance use problems (N = 90). Results: Participants reported about five social network members, of which four were drug-free. Most participants (> 70%) were willing to include a drug-free person in the current inpatient treatment plan to support recovery efforts (M = 1.8 network members) and identified several areas of recovery support. Conclusions: These results demonstrate that people treated in an inpatient psychiatric setting have local drug-free family or friends that they are willing to include in the treatment process. These findings support further study of methods to mobilize network members to enhance social support during and following hospitalization.

Psychometric Properties of the Revised Clinical Institute Withdrawal Alcohol Assessment and the Brief Alcohol Withdrawal Scale in a Psychiatric Population.

OBJECTIVE: Psychiatric illness complicates the assessment of alcohol and sedative withdrawal (ASW). This study measured the diagnostic characteristics of the Revised Clinical Institute Withdrawal Alcohol Assessment (CIWA-Ar) and the Brief Alcohol Withdrawal Scale (BAWS) compared with a reference standard in patients with psychiatric illness and evaluated their administration time. METHODS: This prospective quality improvement (QI) project conducted in November, 2016 evaluated 35 consecutive unique patients in psychiatric settings. Each patient was evaluated on 1 occasion, sequentially by 2 independent examiners with the CIWA-Ar and BAWS. A Diagnostic Statistical Manual of Mental Disorders, Fifth Edition diagnosis of ASW derived after medical record review by 2 psychiatrists blind to the screening results served as a reference standard. Psychometric properties of the CIWA-Ar and BAWS were measured against the reference. RESULTS: Nineteen (54%) patients had ASW diagnosis by the reference standard. The sensitivity (95% confidence interval [CI]) of the CIWA-Ar was 47% (25%-71%) at a cut-off score ≥8; sensitivity of the BAWS was 79% (54%-94%) at a cut-off score ≥3. Specificity (95% CI) for CIWA-Ar and BAWS was 88% (62%-98%) and 88% (62%-98%), respectively. Administration times (interquartile range) for the CIWA-Ar and BAWS were 120 (60-180) and 65 (50-75) seconds, respectively. Receiver operator characteristic area under the curve for CIWA-Ar was 0.77 and for BAWS was 0.76 (P = 0.86). CONCLUSION: Both instruments performed similarly in assessing for mild to moderate ASW in a sample of patients with psychiatric illness. The BAWS took 65 seconds to administer-almost half as much time as the CIWA-Ar.

Testimonios, A Mental Health Support Group for Latino Immigrants in an Emergent Latino Community.

Latino immigrants face many stressors before, during, and after migration to the U.S., but there are few mental health services available to help them cope with this transition. We established free group sessions moderated by bilingual therapists to address the unmet mental health needs of Latino immigrants.

Integrated opioid use disorder and HIV treatment: rationale, clinical guidelines for addiction treatment, and review of interactions of antiretroviral agents and opioid agonist therapies.

Injection drug use (IDU) is an important vector of HIV infection in the United States. Many patients with HIV infection have comorbid substance use disorders. Integrated treatment for HIV and substance use disorders has been shown to improve HIV and other health outcomes, but significant barriers to integrated treatment exist. For individuals who are dependent on injection opioid drugs, agonist therapies of methadone or buprenorphine maintenance are available as part of a treatment program. Patients who are infected with HIV and require antiretroviral therapy (ART) are at risk for drug-drug interaction between ART and methadone or buprenorphine. We present a programmatic approach to the evaluation and treatment of opioid use disorders for HIV care providers, as well as a summary of the available knowledge of interactions of methadone and buprenorphine with ART, along with the level of evidence for each actual or potential interaction. Based on the available information of practice and the level of clinical significance of drug-drug interactions, we conclude that buprenorphine-based maintenance treatment for opioid dependent patients is the preferred maintenance therapy for integrated treatment systems.