Research and Science

Pattern of Risks for Psychiatric and Substance Use Disorders in the Offspring of Parents With Alcohol Use Disorder

American Journal of Psychiatry

This study sought to clarify the components of the familial liability to alcohol use disorder (AUD) by examining parent-offspring transmission in a large Swedish population sample with a mean age at follow-up of 37.7 years. The hazard ratio for the offspring was highest for AUD followed by drug use disorder, attention deficit hyperactivity disorder, major depression, and anxiety disorder. All risks for offspring having two parents with AUD were higher than those having one parent with AUD, but the increase with two parents with AUD was greatest for AUD, followed by drug use disorder and attention deficit hyperactivity disorder. Age at AUD onset of the parents predicted risk among the offspring more strongly for AUD and drug use disorder, followed by attention deficit hyperactivity disorder, and then major depression and anxiety disorders.

Healthcare provider perspectives on emergency department-initiated buprenorphine/naloxone: a qualitative study 🔓

BMJ Health Services Research 

Emergency departments (ED) provide a prime opportunity to intervene with patients with opioid use disorder (OUD). This qualitative study assessed ED healthcare workers’ perceptions around providing take-home buprenorphine in EDs. While many of the ED healthcare workers recognized the importance of EDs as a first point of contact and supported the idea of initiating buprenorphine, they did also identify barriers. One significant barrier was time and space, particularly when the ED is busy with a high volume of patients. The other potential barrier was also a potential facilitator - provider familiarity with buprenorphine. The final barriers were patient-related, including willingness to start treatment and to wait in ED to start medication. The authors note these findings support ongoing training for providers and additional support to address time and space availability to increase buprenorphine initiation in EDs. 

A Nationwide Survey Study of Recovery Community Centers Supporting People in Recovery From Substance Use Disorder

Journal of Addiction Medicine

This paper reported on a survey about the operation and services of 198 recovery community centers (RCC) in 39 states. There is rapid growth in RCCs with over half less than 5 years old. Typical services provided by RCCs are recovery support groups (89% of RCCs), naloxone training (84%), employment assistance (72%), housing assistance (64%), recreational/social activities (82%), and volunteer opportunities (89%). Services are primarily peer-led rather than professional. There is an average of 9 paid and 10 volunteer staff. Using a 1 to 5 scale of openness to MOUD, RCCs scored 4.6 with 68% saying they were “extremely open” and 46% advocating that people use MOUD. In summary, RCCs provide services, information, and social interaction, and are welcoming to people who use MOUDs.

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Setting the Record Straight on Long-Term Use, Dose Escalation, and Potential Misuse of Prescription Benzodiazepines 🔓

The American Journal of Psychiatry

This editorial accompanies a study elsewhere in the issue reporting that benzodiazepines are infrequently associated with long-term use and dose escalation. The authors note that while benzodiazepines have side effects such as sedation and “mild physiologic dependence,” an “anti-benzodiazepine movement” has caused fear and stigma about their use. They suggest that studies demonstrating adverse effects of these medications have failed to control for confounding conditions that are responsible for the adverse events. As an example, they cite the concern about hip fractures with benzodiazepines. They state that benzodiazepines are effective and safe when “prescribed to patients who are not substance abusers.”

µ-Opioid receptor antagonism facilitates the anxiolytic-like effect of oxytocin in mice 🔓

Translational Psychiatry

Neuropeptides, such as oxytocin and opioid peptides, are important for emotion regulation. Previous studies have demonstrated that oxytocin reduced depression- and anxiety-like behavior in male and female mice, and opioid receptor activation reduced depression-like behavior. This study hypothesized that opioid receptor blockade would inhibit the anxiolytic- and antidepressant-like effects of oxytocin. However, naloxone potentiated the anxiolytic-like, but not the antidepressant-like, effect of oxytocin. The study demonstrated that μ−opioid receptor blockade potentiated the anxiolytic-like effect of oxytocin, whereas κ−opioid receptor blockade inhibited the oxytocin-induced anxiolytic-like effects. The results suggest that endogenous opioids can regulate the oxytocin system to modulate anxiety-like behavior.

“I want to stay here”: Patient and Staff Perspectives on Transitioning from a Low-Threshold Buprenorphine Program to Clinic-Based Care 

Drug and Alcohol Dependence

In this qualitative study, the authors evaluated why patients at a low-threshold buprenorphine program in Baltimore designed to engage marginalized populations in treatment and then transition to longer-term programs were staying at the program rather than transfer. At this program, <10% of patients were transitioning to clinic-based buprenorphine treatment and in interviews patients conveyed they wished to stay in the program because the program conveyed respect for the patient and for continuity of care. In addition, there was a perception that other care programs were more punitive and rigid. Given limited resources of this low-threshold program and patients preference to stay, they could not always accommodate new patients. These findings support expanding low-threshold programs and improving their sustainability.