The Community is the Cure: How African American Washington, DC Residents Informed Opioid Treatment Engagement.

BACKGROUND: Recent data indicate rising opioid overdose deaths among African American residents of Washington, DC. OBJECTIVES: We highlight a community-informed approach to assessing attitudes toward opioid use disorder treatment among DC residents (February 2019 to March 2020). METHODS: A listening tour with trusted community leaders led to the formation of a Community Advisory Board (CAB). When the COVID-19 pandemic commenced in March 2020, community dialogues became exclusively virtual. The CAB partnered with academic leaders to co-create project mission and values and center the community's concerns related to opioid use and its causes, treatment structure, and facilitators of effective engagement. RESULTS: Interview guides were created for the engagement of community members, using values highlighted by the CAB. The CAB underscored that in addition to opioid problems, effective engagement must address community experience, collective strengths/resilience, and the role of indigenous leadership. CONCLUSIONS: Engaging community prior to project implementation and maintaining alignment with community values facilitated opioid use disorder assessments. Community-informed assessments may be critical to building community trust.

Religious coping in patients with severe substance use disorders receiving acute inpatient detoxification.

BACKGROUND AND OBJECTIVES: Religious coping, one of the most widely studied components of spirituality among psychiatric populations, has rarely been addressed in patients with severe substance use disorders (SUD). The aim of our study was to elucidate whether religious coping is related to symptom expression and mutual-help participation. METHODS: Self-reported religious coping was assessed in individuals sequentially admitted to a private psychiatric hospital for inpatient detoxification. Target symptoms of SUD included severity of substance use prior to admission and craving during detoxification. Three hundred thirty-one patients (68.6% male) participated in the survey; mean age was 38.0 years, and primary presenting diagnosis was most commonly alcohol use disorder (n = 202; 61%), followed by opioid use disorder (n = 119; 36%). RESULTS: Positive religious coping was associated with significantly greater mutual-help participation, fewer days of drug use prior to admission, and was modestly, yet significantly associated with lower drug craving. Negative religious coping was associated with lower confidence in the ability to remain abstinent post-discharge and higher drug craving. CONCLUSIONS: Consistent with hypotheses, greater positive religious coping was associated with greater mutual-help participation, lower severity of pre-admission drug use, and lower substance craving during detoxification. Use of positive religious coping may modify the course of SUD recovery by promoting engagement in mutual-help activities. SCIENTIFIC SIGNIFICANCE: The findings of this study suggest that positive and negative religious coping are linked with several key SUD recovery variables. Further research to replicate this finding and to assess mechanisms within this potential association is warranted. (Am J Addict 2017;26:744-750).

Repeat long QT syndrome genetic testing of phenotype-positive cases: prevalence and etiology of detection misses.

BACKGROUND: Approximately 75% of long QT syndrome (LQTS) has been explained genetically through research-based and, more recently, commercial genetic testing. While novel LQTS-susceptibility genes or mutations in unexplored regions of known genes underlie the genetic mechanism for some of the 25% "genotype-negative" remnant, it is likely that some cases represent false-negative test results owing to mutation detection failures. OBJECTIVE: To determine the prevalence and etiology of false negatives that occurred with research-based mutational analysis involving denaturing high-performance liquid chromatography (DHPLC) followed by DNA sequencing (DHPLC-SEQ) in our previously published cohort of unrelated patients referred for LQTS genetic testing. METHODS: Forty-four LQTS cases (29 men, average age 23 ± 15 years, average corrected QT interval 516 ± 56 ms) deemed genotype negative following DHPLC-SEQ were selected for repeat genetic testing using direct DNA sequencing. RESULTS: LQTS-causing mutations were identified in 7 of 44 (16%) phenotype-positive/previously genotype-negative subjects, including 4 mutations in KCNQ1 (S225L, G568R, R591H, and R594Q), 2 in KCNH2 (H70R and G925R), and 1 in SCN5A (V411M). None of these variants were seen in more than 2600 reference alleles. Analysis of the misses revealed (1) normal DHPLC detection profile in 2, (2) allelic dropout in 2, (3) failure to correctly optimize DHPLC conditions in 1, and (4) failure to detect abnormal DHPLC signal in 2. CONCLUSIONS: Repeat genetic testing using direct DNA sequencing may be warranted for LQTS phenotype-positive individuals who were pronounced genotype negative during the decade of research-based mutational analysis that involved intermediate mutation detection methods such as DHPLC.