Background: In 1990, the United States\' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.

BACKGROUND: Substance use problems have a major impact on the physical and mental health of individuals, families and communities. Early intervention may have a positive effect on recovery and treatment outcomes for those with substance use problems, reducing related risk and harm. Separate mental health first aid guidelines on how a member of the public could assist someone experiencing or developing alcohol use and drug use problems in high income Western countries were developed using Delphi expert consensus in 2009 and 2011, respectively. This study aimed to synthesise and update these two original guidelines to reflect current evidence and best practice.
METHODS: The Delphi expert consensus method was used to determine the inclusion of statements in the redeveloped guidelines. A questionnaire was developed using previously endorsed helping statements from the original guidelines on alcohol and drug use problems, as well as relevant content identified in systematic searches of academic and grey literature. Three panels of experts (people with lived experience, support people and professionals) rated statements over three consecutive online survey rounds to determine the importance of their inclusion in the guidelines. Statements endorsed by at least 80% of each panel were included.
RESULTS: 103 panellists completed all three survey rounds. They rated 469 statements and endorsed 300 of these for inclusion in the redeveloped guidelines.
CONCLUSIONS: This study has developed a broader and more comprehensive set of guidelines for how to support a person experiencing or developing a substance use problem. The redeveloped guidelines provide more detail on knowledge about and recognition of substance use problems, approaching and assisting people who want to change or are not ready to change, harm reduction, community-based supports and professional help, but have less on physical first aid actions. Mental Health First Aid International will use these guidelines in future updates of their training courses.

暂无摘要。

Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis.
The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient\'s prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments.
Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.
Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer.
Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.

Family caregivers of individuals with substance use disorder (SUD) experience a significant burden and have few evidence-based resources available.
To obtain a consensus of expert views on the needs, and resources available, to family caregivers of individuals with SUD given the COVID-19 pandemic and other sociopolitical factors.
Quantitative design using the Classic e-Delphi method of multiple iterations of questioning to reach a consensus among expert panelists. Purposive sampling was used to recruit a multidisciplinary, nationwide panel of SUD experts from professional contacts, professional organization list servers, websites relevant to support groups for family caregivers, flyers, and word of mouth. In round 1 panelists (n = 96) responded to open-ended questions about the support provided to family caregivers, and the additional needs of family caregivers. In subsequent rounds, the panel rated collated responses in terms of agreement (n = 54) and importance (n = 48).
Thematic content analysis identified ten needs in the resources available to family caregivers. Consensus was obtained across thematic categories and the remaining items were ranked according to importance.
Participatory-based SUD research that includes the expertise of healthcare providers, support leaders, and family caregivers is necessary to develop evidence-based interventions to increase caregiver resilience and facilitate coping. Several clear conclusions that address social and structural determinants of health emerged, including the need for increased access to healthcare and community services, more self-care strategies for families, and focused public advocacy to reduce SUD-related stigma.

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.

Lower-risk substance use guidelines (LRSUGs) are an evidence-based harm reduction strategy used to provide information to people who use drugs so they can reduce harms associated with substance use.
This study aimed to identify LRSUGs accessible to youth and to characterize the recommendations within these guidelines. The overall goal is to identify gaps in current LRSUGs and to inform researchers and policymakers of the kinds of health information youth can access.
We conducted a digital assessment using the Google search engine to identify LRSUGs that could be identified by youth when searching for official sources of information related to commonly used substances, including cannabis, caffeine, alcohol, hallucinogens, prescription opioids, nicotine, and/or prescription stimulants. LRSUGs were coded and data were extracted from them to identify gaps.
One hundred thirty LRSUGs were identified; most focused on alcohol (n = 40, 31%), cannabis (n = 30, 23%), and caffeine (n = 21, 16%). LRSUGs provided recommendations about dosing (n = 108, 83%), frequency of use (n = 72, 55%), and when to use (n = 86, 66%). Most LRSUGs were published by health (n = 51, 39%) and third-sector organizations (n = 41, 32%), followed by provincial/state (n = 18, 14%), government (n = 14, 11%), municipal (n = 4, 3%), and academic (n = 2, 2%) sources. Only 16% (n = 21) of LRSUGs were youth-specific and one-quarter (n = 32, 25%) of LRSUGs provided gender-specific recommendations. Most guidelines featured information on short (n = 76, 58%) and long-term (n = 69, 53%) negative effectives and positive effects of substances (n = 56, 43%). Less than half (n = 50, 38%) of LRSUGs cited evidence in support of the information they provided.
We identified several areas in the current LRSUGs for youth that need to be addressed. Among the gaps are a lack of LRSUGs developed specifically for youth, a lack of youth engagement in developing harm reduction strategies centered around them, and a lack of evidence-based LRSUGs. Youth-oriented, evidence-based LRSUGs are needed to better support youth who use substances and help them manage the negative effects of substance use.

Alcohol and other substance use disorders are complex problems with multiple variables and determinants, requiring a multidimensional approach to prevention and treatment. A robust body of research shows that religiosity and spirituality (R/S) play a prominent role in these disorders; however, how to apply this knowledge remains unclear. We present practical guidelines on how to integrate R/S into substance use prevention and treatment in an ethical, evidence-based manner. These guidelines have been endorsed by prominent academic leaders in these topics and by health associations affiliated with the three major Brazilian religions. The integration of R/S is part of a respectful, person-centered, interdisciplinary approach, which imposes neither religious beliefs nor secular worldviews. The most critical interventions include collecting a history of spiritual and religious beliefs, practices, and experiences and evaluating how these may be used positively in treatment. It is also essential that health professionals are encouraged to value and respect the R/S of patients, and that religious groups recognize that professional and technical interventions can make a valuable contribution to preventing and treating these disorders.

Attention deficit hyperactivity disorder (ADHD) is the most frequent developmental disorder in childhood, adolescence and adulthood. Substance use disorders are a frequent comorbidity in ADHD. The many different forms and severities of these comorbidities necessitate individual strategies in the diagnostics and treatment. Principally, ADHD and addictive disorders should be treated together whenever possible. The more acute or severe the dependence disorder is, the less priority can be given to the topic of ADHD and the lower are the chances of carrying out valid diagnostics and simultaneous treatment at the beginning of the treatment of the addictive disorder. The less severe and acute the addictive disorder is, the quicker the diagnostics and, if necessary, treatment of ADHD can be initiated. In this continuing education article, the customary means for diagnostics and pharmacotherapy as well as the special features that must be considered with respect to comorbidities of both disorders are presented.
UNASSIGNED: Die Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (ADHS) ist die häufigste Entwicklungsstörung im Kindes‑, Jugend- und Erwachsenenalter. Abhängigkeitserkrankungen sind eine häufige Komorbidität bei ADHS. Die vielen unterschiedlichen Formen und Schweregrade dieser Komorbidität erfordern individuelle Strategien in der Diagnostik und Behandlung. Grundsätzlich sind ADHS und Suchterkrankung – wenn möglich – gemeinsam zu behandeln. Je akuter bzw. schwerer die Abhängigkeitserkrankung, desto eher ist die ADHS-Thematik nachrangig anzugehen bzw. desto geringer sind die Chancen, eine valide Diagnostik und eine Behandlung gleichzeitig mit dem Beginn der suchtmedizinischen Behandlung durchzuführen. Je weniger schwer und akut die Suchterkrankung, desto rascher kann mit Diagnostik und ggf. auch Behandlung der ADHS begonnen werden. Übliche Mittel der Diagnostik und der Pharmakotherapie sowie zu beachtende Besonderheiten hinsichtlich der Komorbidität beider Störungen werden in diesem Fortbildungsbeitrag vorgestellt.

Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. The aim of this systematic review was to synthesise the recommendations made by clinical practice guidelines for addressing the physical health of people attending alcohol and other drug (AOD) treatment.
An iterative search strategy of grey literature sources was conducted from September 2020 to February 2021 to identify clinical practice guidelines. Content pertaining to physical health care during AOD treatment was extracted. Quality of guidelines were appraised using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool.
Thirty-three guidelines were included for review. Fourteen guidelines were considered high quality based on AGREE-II scores. Neurological conditions (90.9%) and hepatitis (81.8%) were the most frequent health problems addressed. Most guidelines recommended establishing referral pathways to address physical health comorbidities (90.9%). Guidance on facilitating these referral pathways was less common (42.4%). Guidelines were inconsistent in their recommendations related to oral health, tobacco use, physical activity, nutrition and the use of standardised assessment tools.
Greater consistency and specificity in the recommendations made for integrating physical health care within addiction treatment is needed. Ensuring that recommendations are applicable to the AOD workforce and to treatment services limited by funding and resource constraints should enhance implementation. Future guideline development groups should consider increased consultation with the AOD workforce and inclusion of clinical tools and decision aids to facilitate referral pathways.