Dale Terasaki

Podiatry residents may benefit from addiction medicine rotations due to substantial overlap between podiatric needs and substance use disorders (SUDs), particularly in the hospital setting. In a semi-structured format, we describe the cases of two podiatry residents, perhaps the first ever documented, who rotated with an inpatient addiction medicine consult team at an urban, academic hospital. These two residents joined the addiction consult team in 2023 and 2024 and rated their confidence in twelve learning objectives via a five-point Likert scale before and after the rotation (2 weeks long). They also rated their attitude toward the value of addiction services. Post-rotation feedback from the module and ad hoc e-mail correspondence are included. Residents 1 and 2 joined the team and engaged well in orientating with the team, eventually providing near-independent addiction medicine consultations for primary inpatient teams. Pre/post data showed large increases in confidence in learning objectives (mean scores 2.1 to 4.9 for Resident 1, and mean scores 1.5 to 4.0 for Resident 2). They both reported positive experiences, and months later reflected on both pragmatic (e.g., available resources) and attitude-related (e.g., understanding the importance of substance use context for patients) educational gains. In summary, residents from surgical specialties like podiatry may benefit from inpatient addiction medicine exposure. It is unclear whether their rotation spots could be better utilized by those in other specialties, but SUDs are prevalent in a multitude of settings, arguing for broad dissemination of SUD treatment education.

The psychedelic substance, ibogaine, has garnered growing interest among policymakers, researchers, and the public in its potential use for opioid use disorder (OUD). Many states are allocating significant funds to investigate it further. However, some proponents of ibogaine are framing it in opposition to (versus complementary to) standard, mortality-reducing medications for OUD (MOUD). Although the path to OUD remission and recovery varies greatly among individuals, the stakes are high: “detoxification” from methadone or buprenorphine in favor of an as-yet unproven therapy like ibogaine could result in an increased risk of opioid overdose for some. The addiction medicine community should be aware of this potential risk and defend evidence-based care, even as treatments like ibogaine are developed for OUD.

An Addiction Consult Service (ACS) utilizes an interdisciplinary approach to fill an important gap in substance use treatment for patients who are admitted to an acute care hospital. While each ACS team’s composition mirrors the needs of the patient population, there is a lack of literature on the role of psychologists within ACS teams despite psychotherapeutic intervention being a key component of substance use treatment. The current article aims to clarify how psychologists with specialized training in the treatment of substance use can contribute to the overall goal of an ACS in an acute care hospital setting. Drawing from the competency benchmarks put forth by the American Psychological Association to guide doctoral-level psychology training, we draw connections between relevant competencies for independent psychological practice and the ACS landscape. The importance of psychologists’ competencies in Interdisciplinary Systems, Scientific Knowledge and Methods, Evidence-Based Practice, Individual and Cultural Diversity, and Relationships are highlighted and demonstrated through hypothetical case scenarios. This article provides an introduction to the ways in which psychology can contribute to the interdisciplinary environment of ACS, both clinically and foundationally. With this work, we hope to encourage additional inquiry into the intersection of psychology and addiction consult work.

Introduction: Alcohol use disorder (AUD) is associated with significant morbidity and mortality, contributing to 5% of annual deaths. Although some literature suggests that acamprosate is an effective treatment for AUD, its traditional dosing regimen of 2 tablets 3 times daily may challenge patient adherence. This review compares clinical and pharmacokinetic data of different acamprosate dosing regimens to provide guidance on optimal dosing for treating AUD. Methods: A comprehensive literature search was performed for articles published before March 2024. Relevant randomized controlled trials, case reports, and pharmacokinetic studies were identified from PubMed, PubMed Central, and Google Scholar. Results: Three dosing regimens were identified, including traditional dose, reduced dose, and reduced frequency. Definitive conclusions regarding the comparative efficacy of these regimens cannot be drawn. However, reduced doses appear safe and efficacious in small clinical trials, and a pharmacokinetic study found reduced frequency to be bioequivalent to traditional doses. Discussion: Adherence to pharmacotherapy for AUD is challenging and difficult to measure. A reduced dose regimen may be appropriate for patients who struggle with the pill burden of traditional doses, though the varying number of tablets required at different times may still pose adherence issues. The bioequivalence of reduced frequency dose to traditional dose suggests it could be a viable option for patients who find a 3-time daily frequency cumbersome. However, the lack of data on the clinical efficacy of reduced frequency makes it difficult to recommend as a primary regimen. Further research is needed to determine if either reduced dose or reduced frequency regimens could improve patient adherence compared with a traditional dose.

Introduction: Alcohol use disorder (AUD) is widespread and problematic in the United States, and current pharmacotherapy options have relatively modest effects. Therefore, novel interventions such as ketamine therapy have gained interest as potentially efficacious options, known to generate unique psychotherapeutic experiences. The present secondary analysis examines the acute subjective experiences—both quantitatively and qualitatively—of clinical trial participants with AUD who received intravenous (IV) ketamine therapy in the hospital setting. Materials and Methods: Among a subset of inpatient clinical trial participants with AUD who received IV ketamine therapy ( n = 12), acceptability and tolerability were assessed. Next, a brief directed content analysis was performed, utilizing textual data transcribed immediately after ketamine infusion. Six preselected themes from the literature were chosen to apply to our text. Results: Among this sample, IV ketamine therapy appeared well tolerated and highly acceptable (mean 9.5 on 0–10 Likert scale). The mean Clinician-Administered Dissociative States Scale (CADSS) score was 21.7 (out of max 92). It seemed to occasion experiences that were largely positive, transporting, visual, and meaningful. The most frequently assigned themes in our data set were “Meaningful, spiritual, and mystical experiences,” “Positive affect,” and “Inherent contradictions of the acute experience.” Conclusions: Prior themes derived from two theory-generating publications applied widely to our participants' reported experiences. The hospital setting itself did not appear to be a barrier in facilitating these experiences.

Methadone is hypothesized to provide greater analgesic coverage when split into two or more divided doses. However, empirical data are lacking, and our anecdotal experience at a safety-net hospital among patients with opioid use disorder suggests that it may not be straightforward. Guidelines and clinicians should exercise appropriate caution when recommending this strategy.

Background: Combinations of alcohol use disorder (AUD) medications have been investigated, but few if any reports describe patients maintained on more than two options at the same time. Case presentation: We report a case of a middle-aged man hospitalized with gastrointestinal bleeding and acute kidney injury who had been maintained on four AUD medications (naltrexone, acamprosate, disulfiram, and gabapentin) and multiple psychiatric medications simultaneously as an outpatient. Direct quotations of his experiences with each AUD medication are included, revealing some deviations from what was prescribed as well as nuanced perceptions of effects. Overall, he tolerated the regimen well, but its AUD effects were insufficient to prevent several episodes of returning to alcohol use. He had very high hospital utilization. This prompted the initiation of an involuntary commitment, which began a period of at least six months of sobriety. Conclusions: Quadruple pharmacotherapy for AUD may be well tolerated and supportive of recovery for an extended period of time. However, for our patient the regimen ultimately failed to prevent multiple episodes of returning to alcohol use and serious medical complications. In refractory cases like this, more intensive interventions such as involuntary commitment can be considered.