Building Treatment Capacity in Rural Communities
Chairperson: James Berry, DO, Addiction Psychiatrist and Chair of Behavioral Medicine and Psychiatry at West Virginia University School of Medicine’s Rockefeller Neuroscience Institute
Presenters: Daniel Elswick, MD, Professor and holds the Dana L. and Peggy M. Farnsworth Endowed Chair of Educational Psychiatry in the Department of Behavioral Medicine and Psychiatry at West Virginia University (WVU); Wanhong Zheng, MD, Professor and Vice Chair of Research in the Department of Behavioral Medicine and Psychiatry at West Virginia University (WVU); Kari Law, MD, Professor within the West Virginia University Rockefeller Neuroscience Institute Department of Behavioral Medicine & Psychiatry where she serves as the Telepsychiatry Program director and Vice Chair for Clinical Operations; and James Berry, DO, Addiction Psychiatrist and Chair of Behavioral Medicine and Psychiatry at West Virginia University School of Medicine’s Rockefeller Neuroscience Institute
Rural communities have specific challenges that have led to poorer health outcomes and shorter life expectancies compared to non-rural settings. These communities have been overrepresented in the so-called “Deaths of Despair” – deaths due to drug overdose, suicide, and liver disease. Substance use and SUD are the main drivers of these deaths. Tragically, although SUD is entirely treatable, access to providers in rural communities qualified and comfortable in addressing SUD remains a limiting factor in supplying lifesaving care. Novel models of care delivery as well as innovative training programs to expand the SUD workforce are essential to meet the unique needs of rural communities.
West Virginia, the only state entirely within rural Appalachia, has been the epicenter of our nation’s addiction epidemic and remains the number one outlier among states in the overdose death rate. West Virginia has challenges common to other rural regions, such as transportation and economic limitations, as well as political realities unique to West Virginia, such as extremely tight regulations restricting MOUD. The experience of navigating these challenges through an academic medical center will be described with the intent of sharing lessons learned and building capacity that could be successfully applied to rural and other populations with limited resources. Specific focus will be on clinical application, development of research, and building educational programs.
Learning Objectives
- Participants will be equipped to implement tested strategies to overcome barriers in providing MOUD care to patients in rural communities.
- Participants will be able to describe the appropriate uses of telehealth in SUD care delivery, including the benefits and limitations through real world examples within current regulatory structures.
- Participants will be equipped to develop rural SUD educational offerings in psychiatry training programs.
Current Trends, Treatments, and Improvements to Models of Care for Perinatal Substance Use Disorders
Chairperson: Marie Hayes, PhD, Clinical Psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at MUSC
Presenters: Constance Guille, MD, Professor in the Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology and is the Director of the Women’s Reproductive Behavioral Health Division at the Medical University of South Carolina (MUSC); Sara Witcraft, PhD, Assistant Professor and Licensed Clinical Psychologist in the Women’s Reproductive Behavioral Health (WRBH) Division at the Medical University of South Carolina; Courtney King; Marie Hayes, PhD, Clinical Psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at MUSC; and Rubin Aujla, MD, Perinatal Psychiatrist and the Clinic Director for the Women’s Reproductive Behavioral Health Clinic
In the United States, drug overdose and suicide combine to constitute the leading cause of maternal mortality, with over 80% of these deaths determined to be preventable. Pregnant and postpartum people are often excluded from substance use disorders (SUDs) research, leaving gaps in our understanding of how best to address SUDs during this critical period. Additionally, traditional models of care are likely insuficient in screening and treating pregnant and postpartum people who use substances. The overall goals of this symposium are to: 1) discuss the literature for research and treatment of pregnant and postpartum individuals with SUD and how to apply the extant research to guide clinical decisions for the treatment of perinatal SUDs and common comorbid mental health disorders; and 2) highlight novel and/or complimentary approaches to treating and caring for this population. We will discuss the evidence base for the use of medications for the treatment of perinatal substance use disorders and comorbid conditions, and considerations for prescribing these medications during pregnancy and lactation. This symposium will highlight ways to deliver patient-centered care and bridge the gap between addiction psychiatry and other disciplines using innovative methods
Learning Objectives
- Participants will be aware of current trends in substance use among pregnant and postpartum populations and how substance use impacts maternal, fetal, and newborn health and child development. Participants will recognize the limitations of current SUD research in pregnant and postpartum populations and how to apply limited research to clinical practice using a shared decision-making approach.
- Participants will be knowledge about resources that provide up-to-date information about prescribing during pregnancy and lactation, and legal and social services involvement related to state-specific legal and illicit substance use and state child abuse endangerment laws.
- Participants will be award of considerations for adapting and scaling integrated and holistic care approaches for a variety of clinical practices treating birthing people who use substances.
Promoting Gender-Specific Addiction research: Reflections from 25 Years of the Nida Clinical Trials Network Gender Special Interest Group
Chairperson: Shelly Greenfield, MD, MPH, Professor of Psychiatry and Chief Academic Officer, Harvard Medical School and the Kristine M. Trustey Endowed Chair of Psychiatry at McLean Hospital
Presenters: Aimee Campbell, PhD, Professor of Clinical Psychiatric Social Work in the Department of Psychiatry at Columbia University Irving Medical Center and a Research Scientist in the Division on Substance Use Disorders at the New York State Psychiatric Institute; Denise Hien, PhD, ABPP, Senior Vice Provost of Research, Distinguished Professor and Helen E. Chaney Endowed Chair in Alcohol Studies of the Center of Alcohol & Substance Use Studies, Graduate School of Applied and Professional Psychology at Rutgers University-New Brunswick in New Jersey; Dawn Sugarman, PhD, Research Psychologist in the Division of Alcohol, Drugs, and Addiction at McLean Hospital and an Assistant Professor in the Department of Psychiatry at Harvard Medical School; Michelle Lofwall, MD, Professor in the Departments of Behavioral Science and Psychiatry and the Bell Alcohol and Addictions Endowed Chair at the University of Kentucky (UK); Christi Patten, PhD, MA, LP, is a licensed Clinical Psychologist, Professor of Psychology, and Director of the Behavioral Health Research Program within the Department of Psychiatry and Psychology at Mayo Clinic Rochester, MN; Margaret Paschen-Wolff, DrPH, Assistant Professor of Clinical Psychiatric Social Work in the Department of Psychiatry at the Columbia University Irving Medical Center, and a Research Scientist at the New York State Psychiatric Institute; Shelly Greenfield, MD, MPH, Professor of Psychiatry and Chief Academic Officer, Harvard Medical School and the Kristine M. Trustey Endowed Chair of Psychiatry at McLean Hospital
Despite rising rates of substance use disorders (SUD) in women and the narrowing of the SUD gender prevalence ratio in the United States, large knowledge gaps in gender-specific treatment remain. Since 2001, the NIDA Clinical Trials Network (CTN) Gender Special Interest Group (GSIG) has provided opportunities to bring a gender lens to national multi-site clinical trials, ancillary studies, secondary data analyses, recommendations for data collection and demographic data, among other contributions to CTN and the SUD treatment field. The GSIG further contributes to the national dialogue on SUD treatment for women (including adolescent girls and transgender women) and other gender diverse people, historically underrepresented in and excluded from
research trials, by developing study concepts, conducting secondary data analyses and critical reviews, and raising awareness of challenges to accomplishing rigorous scientific research that will benefit women. This symposium will provide background on gender differences and the knowledge gap, an overview of the purpose of the CTN GSIG and highlight more than two decades of accomplishments, followed by summaries of three studies highlighting gender-specific research in the CTN. The symposium will close with future directions and recommendations for research including, improving the inclusion of intersectional identities in recruitment reach and analyses, reproductive health, pregnant and parenting people, and methodological considerations for clinical trials to enhance capacity to collect and understand data related to gender.
Learning Objectives
- Recognize the impact of gender-specific research on the SUD treatment field and identify directions for future research.
- Understand past and current studies in the NIDA CTN that have focused on gender differences in SUD as well as those studies focused on treatment of women with SUDs within the NIDA CTN including pregnant women with opioid use disorder and women with co-occurring PTSD and SUD.
- Learn about gaps in research and priorities for future research on women and substance use disorders.
Sex, Gambling and Social Media: Update on Treatment and Research of Behavioral Addictions
Chairperson: Kenneth Rosenberg, MD, Weill Cornell Medical College, Co-editor of Behavioral Addictions (Elsevier), author of Infidelity (Hachette) and Bedlam (Penguin Random House) and director of films for PBS and HBO to for which he is the recipient of a Oscar shortlist, George Foster Peabody, duPont Columbia and AAAP Arts and Advocacy awards
Presenters: Tim Fong, MD, Professor of Psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. He is board certified in adult and addiction psychiatry; Jon Grant, MD, Professor of Psychiatry & Behavioral Neuroscience at the University of Chicago where he directs a clinic and research lab on addictive, compulsive and impulsive disorders; Kenneth Rosenberg, MD, Weill Cornell Medical College, Co-editor of Behavioral Addictions (Elsevier), author of Infidelity (Hachette) and Bedlam (Penguin Random House) and director of films for PBS and HBO to for which he is the recipient of a Oscar shortlist, George Foster Peabody, duPont Columbia and AAAP Arts and Advocacy awards.
Behavioral addictions remain an under-appreciated concept in addiction medicine, generally given short shrift in the literature, yet commonly encountered by addiction psychiatrists. We will present research and assessment scales and provide practical tools for the clinician encountering patients with gambling, social media and sexual behaviors that rise to the level of addictions. Each presenter will start by addressing the diagnostic issues – whether under the category of impulse disorders, compulsions or addictions – and delve into common comorbid conditions. Next, each presenter will outline the psychotherapeutic, self-help and pharmacologic treatments. Finally, each presenter will present a case example from their own clinical experience. There will be a short questions-and-answer session after each presenter with a more substantive audience discussion at the end.
Learning Objectives
- The learner will be able to list the diagnostic criteria for each of the three behavioral addictions as well as identify controversies and uncertainties about the diagnoses.
- The learner will identify the pharmacologic, 12-step and psychotherapeutic approaches to treatment.
- The learner will recall the psychiatric and neurologic disorders that are co-morbid with these behavioral addictions.
Mini- Symposium: Implementing Samhsa’s 2024 Final Rule: Challenges and Outcomes for Opioid Treatment Programs
Chairperson: Hillary Tamar, MD, Medical Director of Community Medical Services’ Eastern Territory, overseeing Wisconsin, Minnesota, Michigan, Ohio, Oregon, Indiana, and Texas
Presenters: Andrew Schreier, Independent Clinical Supervisor, Clinical Substance Abuse Counselor, Licensed Professional Counselor, Board Approved Clinical Consultant, and International Certified Gambling Counselor; Hillary Tamar, MD, Medical Director of Community Medical Services’ Eastern Territory, overseeing Wisconsin, Minnesota, Michigan, Ohio, Oregon, Indiana, and Texas; Frazer Grant, MD, Medical Director of the Colorado Region for Community Medical Services
The opioid epidemic continues to devastate communities, with overdoses from fentanyl and other illicit opioids contributing to a rising death toll. Medications for Opioid Use Disorder (MOUD), including methadone, have been proven to reduce overdose deaths by over 50%. Methadone has been used for MOUD for over 50 years, and over that time has been regulated by the federal government, remaining restricted to specialized treatment programs. There are currently over 2,000 Opioid Treatment Programs (OTPs) in the US; however, there are still many people who need treatment and have difficulty accessing it.
In April 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) introduced significant regulatory updates, the first substantial change to OTP regulations since the 1970s. The new Final Rule alters key aspects of methadone administration, including initial dosing guidelines, take-home medication policies, interpretation of ongoing substance use, and the integration of telemedicine. These changes are substantial, and determining how to implement them in a complex system involving medical providers, nurses, counselors, peers, and other clinic staff is challenging.
This session will explore the challenges and outcomes associated with implementing the Final Rule across 60 OTPs in 12 states. Since some states have allowed the Final Rule changes to proceed and others have limited implementation by state regulations, a “natural experiment” allows a comparison of states that have adopted the new policies with those that have not, offering insight into operational issues, clinical impact, and patient outcomes.
Learning Objectives
- Describe the differences between the former OTP regulations and SAMHSA’s Final Rule, effective April 2nd, 2024.
- Discuss the process for implementation of policies and procedures adapted to SAMHSA’s Final Rule, with a focus on policy development and addressing resistance to change from clinicians and other stakeholders and substance use disorders.
- Analyze the outcome data, specifically the completeness of the implementation and its effect on patient care.
Mini- Symposium: The High-Stakes Debate: Promises and Perils of Psychedelics in Addiction Treatment
Chairperson: Joao De Aquino, MD, Assistant Professor of Psychiatry at the Yale University School of Medicine
Presenters: Peter Hendricks, PhD, Cclinical Psychologist and Heersink Endowed Chair of Psychiatry in the Department of Psychiatry and Behavioral Neurobiology at UAB; Stephen Ross, MD, Professor of Psychiatry and Child & Adolescent Psychiatry at the NYU Grossman School of Medicine; Joao De Aquino, MD, Assistant Professor of Psychiatry at the Yale University School of Medicine
Discussants: Albert Garcia-Romeu, PhD, Associate Professor of Psychiatry and Behavioral Sciences and the Susan Hill Ward Professor in Psychedelics and Consciousness at the Johns Hopkins University School of Medicine; Deepak Cyril D’Souza, MD, Professor of Psychiatry, Yale University School of Medicine; Bertha Madras, PhD, Professor of Psychobiology at Harvard Medical School, based at McLean Hospital; Christopher Pittenger, MD, PhD, Mears & Jameson Professor of Psychiatry and Deputy Chair for Translational Research in the Department of Psychiatry, Professor of Psychology, Neuroscience, and in the Child Study Center, and Director of the Center for Brain and Mind Health, the Clinical Neuroscience Research Unit, and the Center for Psychedelic Science at Yale University
This debate will explore the therapeutic potential of psychedelics in treating substance use disorders (SUD), a topic that has sparked significant interest and polarized opinions within the medical community. Leading experts will examine both the promises and perils of psychedelic-assisted therapy, discussing clinical trial results, safety concerns, regulatory challenges, and the risk of misuse. The session will feature structured presentations and rebuttals to critically assess the efficacy, safety, and scalability of psychedelic treatments for SUD. By presenting evidence-based perspectives, this debate aims to inform clinicians, researchers, and policymakers about the potential and limitations of integrating psychedelics into mainstream addiction treatment practices.
Learning Objectives
- Provide an evidence-based understanding of the risks and benefits of psychedelics in treating substance use disorders.
- Highlight critical gaps in current research and identify priorities for future investigations on psychedelic-assisted therapy for substance use disorders.
- Inform clinicians about the key considerations and challenges of potentially integrating psychedelic therapies into mainstream addiction treatment, emphasizing the need for cautious interpretation of emerging evidence.
