Kelly S. Barth

Introduction: South Carolina (SC) ranks 10th in opioid prescriptions per capita—33% higher than the national average. SC is also home to a large military and veteran population, and prescription opioid use for chronic pain is alarmingly common among veterans, especially those returning from Afghanistan and Iraq. This article describes the background and development of an academic detailing (AD) educational intervention to improve use of a Prescription Drug Monitoring Program among SC physicians who serve military members and veterans. The aim of this intervention was to improve safe opioid prescribing practices and prevent prescription opioid misuse among this high-risk population. Methods: A multidisciplinary study team of physicians, pharmacists, psychologists, epidemiologists, and representatives from the SC's Prescription Monitoring Program used the Medical Research Council complex interventions framework to guide the development of the educational intervention. The theoretical and modeling phases of the AD intervention development are described and preliminary evidence of feasibility and acceptability is provided. Results: Ninety-three physicians consented to the study from 2 practice sites. Eighty-seven AD visits were completed, and 59 one-month follow-up surveys were received. Participants rated the AD intervention high in helpfulness of information, intention to use information, and overall satisfaction with the intervention. The component of the intervention felt to be most helpful was the AD visit itself. Characteristics of the participants and the intervention, as well as anticipated barriers to behavior change are detailed. Discussion: Preliminary results support the feasibility of AD delivery to veteran and community patient settings, the feasibility of facilitating Prescription Drug Monitoring Program registration during an AD visit, and that AD visits were generally found satisfying to participants and helpful in improving knowledge and confidence about safe opioid prescribing practices. The component of the intervention felt to be most helpful to the participants was the actual AD visit, and most participants rated their intentions high to use the information and tools from the visit. Intervention key messages, preliminary outcome measures, and successes and challenges in developing and delivering this intervention are discussed to advance best practices in developing educational interventions in this important area of public health.

Dialectical behavior therapy (DBT) is a structured outpatient treatment developed by Dr Marsha Linehan for the treatment of borderline personality disorder (BPD). Dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders. Traditional DBT is structured into 4 components, including skills training group, individual psychotherapy, telephone consultation, and therapist consultation team. These components work together to teach behavioral skills that target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors. The skills include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Given the often comorbid psychiatric symptoms with BPD in patients participating in DBT, psychopharmacologic interventions are oftentimes considered appropriate adjunctive care. This article aims to outline the basic principles of DBT as well as comment on the role of pharmacotherapy as adjunctive treatment for the symptoms of BPD.

Objective. The objective of this study is to assess clinical variables that may be associated with risk for opioid misuse in individuals with chronic p

Background and Objectives: Patients with prescription opioid use disorders and co‐occurring pain present a formidable challenge for healthcare providers, and little is known about patients with this dual diagnosis. This study examined the prevalence of pain and motives for use among individuals with prescription opioid dependence.Methods: Participants (N = 127) included 86 non‐treatment seeking individuals with current prescription opioid dependence and 41 healthy controls. They were administered a battery of assessments to evaluate pain and substance use.Results: Participants with prescription opioid dependence were significantly more likely than controls to report current pain (62.2 vs. 12.2%), as well as higher levels of pain interference and severity. The most common source of prescription opioids was a physician (91.3%) and the most common motive for using prescription opioids, initially and currently, was to relieve pain (70.3% and 81.0%, respectively). Motivation for subsequent non‐medical use of prescription opioids included to get high (73.8%), to increase energy (71.0%), to decrease anxiety (51.2%), and to improve sleep (35.7%).Conclusion: Pain is a significant comorbidity and motivator for the non‐medical use of prescription opioids. Provider and patient education regarding the safe use of prescription opioids, as well as interventions targeting prescription opioid dependence, are needed. (Am J Addict 2013;22:486–491)