It allowed researchers and clinicians to better understand the relationship between the drugs and the brain, and find solutions or ways to overcome the disease. Dr. Ling begins by discussing the triune brain, how drugs affect them, and how the brain got its disease of addiction. He then transitions to revealing the process and difference between getting off and staying off drugs. KEY MESSAGES: Becoming addicted and getting off drugs are matters of drug effects; staying addicted and staying off drugs are matters of memory. Drugs get you addicted but memory keeps you addicted. Learning and memory is the basis of relapse, which is what makes addiction a chronic relapsing brain disease. Detoxification may be good for a lot of things, staying off drugs is not one of them. Next time you talk about substitution therapy, remember it’s the memories, not the drugs, you are trying to substitute.

ATS affects the mesolimbic reward system in the brain causing increased levels of dopamine.  Although initial use results in positive physical and psychological reactions (increased confidence, alertness and energy, enhanced mood and sex drive), a variety of negative and damaging consequences occur after prolonged use (cardiovascular disease, pulmonary and neurologic problems, skin infections and dental decay).  In addition, other chronic diseases highly associated with ATS use include hepatitis C and HIV.  Specific clinical challenges and special populations are reviewed when treating ATS users.  Psychological and behavioral treatments currently have best evidence of efficacy, but ongoing research is being done to identify effective pharmacological treatment strategies.

The scientific community views addiction as a chronic relapsing brain disease characterized by compulsive use despite harmful consequences, and medications may be used to treat opioid use disorder in conjunction with psychosocial strategies to target relapse prevention skills and behavioral change. When treating opioid dependence, opioid- and non-opioid-based medications may be used during detoxification to treat early and late withdrawal symptoms. Maintenance medications including buprenorphine, methadone, oral naltrexone, and sustained-release intramuscular naltrexone may also be used to prevent relapse to opioid use. Dr. Mooney reviews specific dosing and administration procedures when prescribing buprenorphine, methadone, and naltrexone to treat opioid dependence. In addition, she reviews how naloxone rescue kits are being incorporated as a community-based strategy to reduce opiate overdose.

It is challenging to determine when addiction becomes present in pain patients. Dr. Ling begins by defining pain and discussing the different ways people respond to and internalize acute pain versus chronic pain. Treating and medicating pain requires an understanding of this dyad in which to then monitor for addiction. Addicts are addicts not for who they are, but for what they do. Dr. Ling reviews the common aberrant behaviors that are predictive indicators for addiction among pain patients, followed by ways to identify patients at risk. He then transitions to discuss the history of Opioid use for the treatment of pain and how the medical field has evolved in terms of treatment strategies/ goals and medication development. Dr. Ling concludes with discussing indicators of meaningful functional improvement and reviewing seven steps to treat and educate. Patients need to be educated to a common understanding with the physician as to what they are dealing with; what their story is around their pain history and present. Listen to your patients’ stories, enter into them, retell them and give hope to new endings.

This presentation begins with general prevalence statistics and an overview of the complex relationship between drug use and crime, including the apparent causal link between stimulant use and violence. Use of drugs in prisons appears to be less frequent than in the community, but the risk of infectious disease transfer is high among injectors given the scarcity of clean syringes. Strategies to reduce drug use within prison settings (e.g., provision of methadone, random drug tests) are discussed, followed by a review of strategies to assess and treat drug-involved offenders under community supervision. These strategies include drug courts, frequent and random drug testing coupled with mild sanctions, and the use of pharmacotherapies for those with opioid dependence.

In both assessment and treatment, technology-based delivery methods can optimize standardization and fidelity, respectively, with which evidence-based practices are implemented. Additionally, the capability to disseminate evidence-based practices via technology can extend the reach of these approaches to care outside of formal health care settings. In addition to alcohol and drug treatment, technology-based interventions have been utilized and studied in other chronic disease areas such as smoking cessation, psychiatric conditions (mood, anxiety, and thought disorders), diabetes, hypertension, obesity, and HIV. Preliminary studies in the addictions area suggest both promising clinical outcomes and evidence of cost savings associated with the use of technology-assisted interventions. Dr. Glasner-Edwards reviews selected web/computer-based interventions and mobile technology advancements in addiction treatment, discussing both the positive outcomes and the challenges and limitations. She concludes with a description of a current study underway testing the use of text messaging targeting medication adherence and relapse prevention for HIV+ substance users.

Dr. Murphy is a well published researcher in public health, HIV, and maternal health, and is highly experienced in the review process for several professional and scientific journals. Dr. Murphy breaks down the lengthy process in which papers are reviewed, revised, and considered for journal publication. She then continues with helpful tips, gained from her experience, about writing style and design for a paper in an effort to give some insight into how to reach publication success earlier. She starts from how to select an appropriate journal and walks through the many elements to draft a manuscript that is well suited for that journal. She concludes with recommendations for responding to revision requests as well as rejections.