Faculty Bibliography

BACKGROUND:The availability of the fellowships of Alcoholics Anonymous and Narcotics Anonymous in community settings is extensive and patients admitted to treatment programs for substance use disorder may therefore have previously attended meetings of these two Twelve Step (TS) programs. Data on such prior attendance and related clinical findings, however, are not typically available. They can, however, be relevant to how ensuing treatment is planned. We therefore undertook this study to ascertain the feasibility of evaluating how the level of TS attendance prior to treatment entry can be evaluated, and to determine clinically relevant findings that are associated with such attendance. METHODS:Over the course of 2022, 3,125 patients were admitted to a large urban multimodal United States-based treatment center. All patients were administered the structured interview-based Global Appraisal of Individual Needs upon admission. This instrument is employed to evaluate substance use, demographics, and related psychosocial variables. Clinically related variables were analyzed relative to whether given respondents have a history of any TS group attendance prior to admission. RESULTS:Distinctions were found between the 57.3% of respondents who had previously attended any TS meetings and the 42.6% who had not attended any meetings. Compared to respondents who had never attended TS meetings, those who had ever attended scored higher on emotional problems (p <.001, d = -0.58), and had more likely undergone previous SUD treatment (p <.001, d = 0.80). They were less likely to use substances in unsafe situations (p <.001, d = -0.55) and were less likely to express reluctance to remain abstinent (p <.001, d = -0.50). The 11% of respondents who considered themselves regular TS members reported a lower frequency of recent substance use (p <.001, d = -0.80) and were more likely to have attended intensive outpatient (p <.001, 0.46) and residential (p <.001, 0.44) treatment than patients who did not consider themselves regular attenders. CONCLUSIONS:Examination of TS attendance prior to treatment admission is feasible. Findings can be clinically relevant for differential treatment planning and can also serve as a basis for further research into the role of TS participation in community settings.

BACKGROUND/UNASSIGNED:Spirituality is a construct encompassing a diversity of strongly held beliefs and pursuits related to life's meaning and purpose. Empirical studies in key domains of spirituality related to substance use disorder (SUD) can be valuable in guiding research, and potentially clinical care. OBJECTIVES/UNASSIGNED:To conduct a scoping review of research on the psychological, biological, and cultural dimensions of spirituality and their role in relation to SUD. To identify limitations in empirical findings within these domains and identify promising areas for related research. DATA SOURCES, STUDY APPRAISAL, AND SYNTHESIS METHODS/UNASSIGNED:Illustrative studies available in the empirical literature are reviewed in order to characterize these three key domains. RESULTS/UNASSIGNED:Certain areas of importance stand out: On Psychology, attribution of SUD to a spiritual outlook; spiritual awakening; the relation of spirituality to drug craving; and spirituality in the context of psychedelic-assisted psychotherapy. On Biology, heritability of traits related to shared spiritual experience; neurophysiologic correlates of spiritually related experiences; and correlates in brain imaging; On Culture, spiritual aspects of SUD in different cultural settings; distinctions between spiritual and religious phenomena; roles that international organizations play; and context of acquiring recovery capital. The need for further research in each area is defined. CONCLUSIONS/UNASSIGNED:There is utility in examining the diversity of findings in the roles of psychology, biology, and culture in the SUD field. Further research, particularly applying randomization and clinical controls, would be useful in improving the effective application of the construct of spirituality in clinical care.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Methamphetamine use disorder (MUD) is a major public health problem, but there are no evidence-based, best-practice, pharmacologic, or behavioral treatments for it. Narcotics Anonymous (NA) may provide an option for referral for such patients. METHODS:Two waves of surveys were sent to a sample of NA members to evaluate demographic, drug use, and NA-related issues. Of 4445 responses received from US residents, 647 listed themselves as abstinent from their worst drug problem, methamphetamine. Twelve possible sources of support were scored by these latter respondents for how important each was for their own recovery. RESULTS:Methamphetamine respondents were longstanding NA members, with their first NA meeting 30.2 years ago, 84.3% having served as sponsors for other members, and with little current craving (0.65 out of 10). Although now abstinent for an average of 13.4 years, at some point over the course of the membership, 47.4% had experienced a relapse, for an average of 16.7 months. In a factor analysis of resources scored, 29.6% of the variance fell under NA social and 29.2% spiritual; and 11.8% under outside professional support. DISCUSSION AND CONCLUSIONS/CONCLUSIONS:NA served as a resource for supporting abstinence for some members with MUD. They scored social resources of NA support higher than both spiritual and outside institutional ones. SCIENTIFIC SIGNIFICANCE/CONCLUSIONS:NA can serve as a community-based resource for MUD. Determining the nature of recovery that members with MUD have in NA can be useful for further research of socially grounded support for recovery in substance use disorders.

Purpose of review/UNASSIGNED:There have been many debates, discussions, and published writings about the therapeutic value of cannabis plant and the hundreds of cannabinoids it contains. Many states and countries have attempted, are attempting, or have already passed bills to allow legal use of cannabinoids, especially cannabidiol (CBD), as medicines to treat a wide range of clinical conditions without having been approved by a regulatory body. Therefore, by using PubMed and Google Scholar databases, we have reviewed published papers during the past 30 years on cannabinoids as medicines and comment on whether there is sufficient clinical evidence from well-designed clinical studies and trials to support the use of CBD or any other cannabinoids as medicines. Recent findings/UNASSIGNED:Current research shows that CBD and other cannabinoids currently are not ready for formal indications as medicines to treat a wide range of clinical conditions as promoted except for several exceptions including limited use of CBD for treating two rare forms of epilepsy in young children and CBD in combination with THC for treating multiple-sclerosis-associated spasticity. Summary/UNASSIGNED:to treat multiple clinical conditions, but more preclinical, and clinical studies and clinical trials, which follow regulatory guidelines, are needed to formally recommend CBD and other cannabinoids as medicines.

OBJECTIVES/OBJECTIVE:Face-to-face meetings are key components of Twelve Step (TS) fellowships' support of members' abstinence. Home confinement during COVID-19 made this less feasible. Our objective was to ascertain whether a transition to virtual online meetings among TS members took place, and whether it was potentially effective. METHODS:Two thousand one hundred fifty-two long-standing USA members of Narcotics Anonymous (NA) were surveyed to ascertain their recovery-related experiences and their relation to the transition to virtual meetings. RESULTS:During the previous week (ie, 'during COVID-19') respondents attended more virtual meetings ( = 4.13[SD4.64]) than they had attended both face-to-face meetings before COVID-19 ( = 3.35[SD2.05]), and also face-to-face meetings during COVID-19 ( = 0.75[SD1.8]). Many of the meetings were accessed from sites remote from their homes (44.4%), even overseas (21.5%). The majority (64.9%) found virtual meetings at least as effective in promoting their abstinence as were face-to-face meetings, and 41.8% estimated the same for newcomers. A shorter period of antecedent abstinence from drugs and increased loneliness were associated with increased craving during the transition period. Relative to Whites, Black respondents were less distressed, with a lesser increase in craving, and currently attended more virtual meetings. Data provided by a national program reflected a large increase in virtual TS attendance since the onset of the pandemic. CONCLUSIONS:In a survey of well-established NA members, most had made a successful transition from face-to-face to virtual meetings, relative to their antecedent characteristics. This successful transition suggests the possibility of an enhanced opportunity for stabilizing TS membership.

Spirituality is a construct that is reflected in a diversity of strongly felt personal commitments in different cultural and national groups. For persons with substance use disorders (SUDs), it can serve as a component of the recovery capital available to them. This position statement reviews empirical research that can shed light on psychological, social, and biological aspects of this construct. On this basis, the Spirituality Interest Group of the International Society of Addiction Medicine (ISAM) makes recommendations for how this construct can be incorporated into research and clinical care.

OBJECTIVE:Mentorship for Addiction Problems (MAP) is a new behavioral treatment formalizing client-to-client mentorship relationships as an adjunct to standard outpatient substance use disorder treatment. We tested the preliminary efficacy of MAP in reducing substance use and associated barriers to successful treatment outcomes. METHOD/METHODS:A total of 65 participants (17 later recovery participants [LRPs] and 48 early recovery participants [ERPs]) with substance use disorders were randomized to MAP + Treatment as Usual (TAU) or TAU alone. Within MAP, for each cohort, a pool of 4-5 mentors (LRPs) was formed and engaged in mentoring activities for 24 weeks until 12-13 mentees (ERPs), newly admitted, had participated in MAP for 12 weeks. Behavioral and biological measures were conducted at baseline, weekly, monthly, and termination for all participants and during the 12-week follow-up for ERPs. RESULTS:Substance use declined across both conditions for ERPs (N = 48) during treatment, Weeks 0-12 (p = .001); however, on average, ERPs in the MAP intervention used significantly fewer days than controls during Treatment Weeks 1-12 (p = .013) and during Follow-Up Weeks 13-24 (p = .043). Addiction Severity Index alcohol and drug use scores increased in TAU and decreased in MAP during Follow-Up Weeks 13-24 for ERPs, alcohol: b = -0.08, SE = 0.03, t(47) = -2.97, p = .005; drug use: b = -0.02, SE = 0.01, t(47) = -2.36, p = .023. In addition, there was high patient interest in MAP and good fidelity to delivery of treatment. CONCLUSIONS:MAP shows promise assisting in the reduction of substance use early in treatment when vulnerability and risk for relapse is high and has a positive impact on serious problems undercutting addiction treatment efficacy.