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Article ; Online: Alcohol Use Among Treatment-Seeking Individuals With Opioid Use Disorder.

Baskerville, Wave-Ananda / Grodin, Erica N / Lin, Johnny / Miotto, Karen / Mooney, Larissa J / Ray, Lara A

2023 Volume 84, Issue 4, Page(s) 579–584

Abstract: Objective: Individuals in the United States with opioid use disorder (OUD) have high rates of co-occurring alcohol use disorder. However, there is limited research on co-use patterns among opioid and alcohol use. The present study examined the ... ...

Abstract	Objective: Individuals in the United States with opioid use disorder (OUD) have high rates of co-occurring alcohol use disorder. However, there is limited research on co-use patterns among opioid and alcohol use. The present study examined the relationship between alcohol and opioid use in treatment-seeking individuals with an OUD. Method: The study used baseline assessment data from a multisite, comparative effectiveness trial. Participants with an OUD who had used nonprescribed opioids in the last 30 days ( Results: The likelihood of same-day opioid use was significantly lower on days in which participants drank any alcohol ( Conclusions: These findings suggest that alcohol or binge alcohol use is associated with significantly lower odds of opioid use on a given day, which was not related to gender or age. The prevalence of opioid use remained high on both alcohol use and non-alcohol use days. In line with a substitution model of alcohol and opioid co-use, alcohol may be used to treat symptoms of opioid withdrawal and possibly play a secondary and substitutive role in individuals with OUD substance use patterns.
MeSH term(s)	Male ; Humans ; Female ; United States/epidemiology ; Analgesics, Opioid/therapeutic use ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/drug therapy ; Alcohol Drinking/epidemiology ; Alcoholism/drug therapy ; Substance Withdrawal Syndrome ; Ethanol
Chemical Substances	Analgesics, Opioid ; Ethanol (3K9958V90M)
Language	English
Publishing date	2023-04-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2266450-6
ISSN	1938-4114 ; 1934-2683 ; 1937-1888 ; 0096-882X
ISSN (online)	1938-4114 ; 1934-2683
ISSN	1937-1888 ; 0096-882X
DOI	10.15288/jsad.22-00176
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Article ; Online: Psychological Distress Among Women Healthcare Workers: A Health System's Experience Developing Emotional Support Services During the COVID-19 Pandemic.

Sanford, Jesse / Agrawal, Alpna / Miotto, Karen

Frontiers in global women's health

2021 Volume 2, Page(s) 614723

Abstract: Ensuring the mental health and well-being of the healthcare workforce globally, especially women healthcare workers (HCWs), is an ongoing challenge that has been accentuated by the novel coronavirus (COVID-19) pandemic. Already at high risk of ... ...

Abstract	Ensuring the mental health and well-being of the healthcare workforce globally, especially women healthcare workers (HCWs), is an ongoing challenge that has been accentuated by the novel coronavirus (COVID-19) pandemic. Already at high risk of experiencing symptoms of stress, burnout, and depression, women HCWs are now also facing the psychosocial impacts of the COVID-19 pandemic. Although different types of mental health interventions have been introduced to support HCW well-being, the current needs of women HCWs have not been emphasized and replicable processes for developing and implementing specific emotional support services for women HCWs have not yet been well-described in the literature. Therefore, in this perspective, we discuss the approach our institution (University of California, Los Angeles) took for developing emotional support services for women HCWs that incorporate aspects of disaster behavioral health models and address various barriers to support and treatment. In addition, we describe and illustrate the process that we utilized to develop individual-level and institutional-level emotional support services. Finally, based on our institution's experience, we share recommendations for developing emotional support services for women HCWs during the COVID-19 pandemic and other future crises.
Language	English
Publishing date	2021-02-09
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-5059
ISSN (online)	2673-5059
DOI	10.3389/fgwh.2021.614723
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Article ; Online: Primary care management of opioid dependence: the addition of CBT gives no extra benefit compared to standard physician management alone.

Miotto, Karen

Evidence-based mental health

2013 Volume 16, Issue 3, Page(s) 76

MeSH term(s)	Analgesics, Opioid/therapeutic use ; Buprenorphine/therapeutic use ; Cognitive Therapy ; Female ; Humans ; Male ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Primary Health Care
Chemical Substances	Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ)
Language	English
Publishing date	2013-08
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	2009065-1
ISSN	1468-960X ; 1362-0347
ISSN (online)	1468-960X
ISSN	1362-0347
DOI	10.1136/eb-2013-101253
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Article ; Online: Understanding the Experiences of First-Generation Medical Students: Implications for a Diverse Physician Workforce.

Romero, Ruby / Miotto, Karen / Casillas, Alejandra / Sanford, Jesse

Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry

2020 Volume 44, Issue 4, Page(s) 467–470

MeSH term(s)	Career Choice ; Cultural Diversity ; Ethnicity ; Health Workforce ; Humans ; Minority Groups ; Physicians/statistics & numerical data ; School Admission Criteria ; Students, Medical/psychology
Language	English
Publishing date	2020-05-12
Publishing country	United States
Document type	Editorial
ZDB-ID	1045331-3
ISSN	1545-7230 ; 1042-9670
ISSN (online)	1545-7230
ISSN	1042-9670
DOI	10.1007/s40596-020-01235-8
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Article ; Online: Baseline C-reactive protein levels are predictive of treatment response to a neuroimmune modulator in individuals with an alcohol use disorder: a preliminary study.

Grodin, Erica N / Meredith, Lindsay R / Burnette, Elizabeth M / Miotto, Karen / Irwin, Michael R / Ray, Lara A

The American journal of drug and alcohol abuse

2022 Volume 49, Issue 3, Page(s) 333–344

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Humans ; Alcohol Drinking/drug therapy ; Alcoholism/drug therapy ; C-Reactive Protein/metabolism ; Ethanol ; Inflammation
Chemical Substances	C-Reactive Protein (9007-41-4) ; Ethanol (3K9958V90M)
Language	English
Publishing date	2022-10-25
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	193086-2
ISSN	1097-9891 ; 0095-2990
ISSN (online)	1097-9891
ISSN	0095-2990
DOI	10.1080/00952990.2022.2124918
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Article ; Online: Outcomes of Physicians with Substance Use Disorders in State Physician Health Programs: A Narrative Review.

Goldenberg, Matthew / Miotto, Karen / Skipper, Gregory E / Sanford, Jesse

Journal of psychoactive drugs

2020 Volume 52, Issue 3, Page(s) 195–202

Abstract: The prevalence rate of addiction among physicians is similar to the general population, with approximately 10% to 12% of U.S.-based physicians developing substance use disorders (SUDs) during their lifetimes. To address this public health concern, ... ...

Abstract	The prevalence rate of addiction among physicians is similar to the general population, with approximately 10% to 12% of U.S.-based physicians developing substance use disorders (SUDs) during their lifetimes. To address this public health concern, physician health programs (PHPs) have been created to facilitate the early identification, evaluation, treatment, and monitoring of physicians. Although a number of published studies provide outcome information from PHPs, there has been no comprehensive review of the related literature. The objective of this narrative review is to summarize the treatment outcomes, including treatment types, rates of relapse, rates of contract completion or extension, as well as licensure and work status rates of a nationally representative physician cohort and related subpopulations from a single dataset. Based on the studies included in this review, our findings reveal that physicians who completed their PHP contracts have more favorable treatment outcomes than members of the general population who receive mainstream treatment. In addition, our review describes unique features of physician rehabilitation facilitated by PHPs. However, further prospective research is needed to ensure a standardized and comparable dataset and facilitate performance improvement.
MeSH term(s)	Adult ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Physician Impairment/statistics & numerical data ; Physicians/statistics & numerical data ; Recurrence ; Substance Abuse Detection ; Substance-Related Disorders/therapy ; Treatment Outcome
Language	English
Publishing date	2020-03-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	392405-1
ISSN	2159-9777 ; 0279-1072
ISSN (online)	2159-9777
ISSN	0279-1072
DOI	10.1080/02791072.2020.1734696
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Zs.B 1121: Show issues

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Article ; Online: Ibudilast moderates the effect of mood on alcohol craving during stress exposure.

Meredith, Lindsay R / Green, ReJoyce / Grodin, Erica N / Chorpita, Marie / Miotto, Karen / Ray, Lara A

Experimental and clinical psychopharmacology

2021 Volume 30, Issue 5, Page(s) 620–631

Abstract: Neuroinflammation is implicated in the development and maintenance of alcohol use disorder (AUD) and neuroimmune therapeutics show promise in treating AUD. Proinflammatory signaling contributes to progressive elevations in the dysfunction of mood and ... ...

Abstract	Neuroinflammation is implicated in the development and maintenance of alcohol use disorder (AUD) and neuroimmune therapeutics show promise in treating AUD. Proinflammatory signaling contributes to progressive elevations in the dysfunction of mood and alcohol craving. The current study sought to examine potential biobehavioral mechanisms of neuroimmune modulation in AUD under experimental conditions. In a community sample of individuals with AUD who completed a placebo-controlled crossover trial of ibudilast, we tested the effect of ibudilast on the relationship between mood states and alcohol craving. Multilevel modeling analyses tested the hypothesis that ibudilast would moderate the effect of positive and negative mood states on alcohol craving during stress and cue exposures. Results revealed that after stress-induction, participants' feelings of depression and happiness were more strongly predictive of their craving for alcohol while taking ibudilast as compared with placebo (
MeSH term(s)	Affect ; Alcohol Drinking/drug therapy ; Alcoholism/drug therapy ; Craving ; Ethanol/pharmacology ; Humans ; Indolizines ; Pyrazoles ; Pyridines/pharmacology
Chemical Substances	Indolizines ; Pyrazoles ; Pyridines ; Ethanol (3K9958V90M) ; ibudilast (M0TTH61XC5)
Language	English
Publishing date	2021-04-22
Publishing country	United States
Document type	Controlled Clinical Trial ; Journal Article
ZDB-ID	1209960-0
ISSN	1936-2293 ; 1064-1297
ISSN (online)	1936-2293
ISSN	1064-1297
DOI	10.1037/pha0000458
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Zs.A 4462: Show issues

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Article ; Online: Novel Agents for the Pharmacological Treatment of Alcohol Use Disorder.

Burnette, Elizabeth M / Nieto, Steven J / Grodin, Erica N / Meredith, Lindsay R / Hurley, Brian / Miotto, Karen / Gillis, Artha J / Ray, Lara A

Drugs

2022 Volume 82, Issue 3, Page(s) 251–274

Abstract: Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD is a very heterogeneous disorder, it is unlikely that one single medication will be effective for all ... ...

Abstract	Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD is a very heterogeneous disorder, it is unlikely that one single medication will be effective for all individuals with an AUD. As such, there is a need to develop new, more effective, and diverse pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. In this qualitative literature review, we discuss the efficacy, mechanism of action, and tolerability of approved, repurposed, and novel pharmacotherapies for the treatment of AUD with a clinical perspective. Pharmacotherapies discussed include: disulfiram, acamprosate, naltrexone, nalmefene, topiramate, gabapentin, varenicline, baclofen, sodium oxybate, aripiprazole, ondansetron, mifepristone, ibudilast, suvorexant, prazosin, doxazosin, N-acetylcysteine, GET73, ASP8062, ABT-436, PF-5190457, and cannabidiol. Overall, many repurposed and novel agents discussed in this review demonstrate clinical effectiveness and promise for the future of AUD treatment. Importantly, these medications also offer potential improvements towards the advancement of precision medicine and personalized treatment for the heterogeneous AUD population. However, there remains a great need to improve access to treatment, increase the menu of approved pharmacological treatments, and de-stigmatize and increase treatment-seeking for AUD.
MeSH term(s)	Acamprosate ; Alcohol Deterrents/pharmacology ; Alcohol Deterrents/therapeutic use ; Alcoholism/drug therapy ; Baclofen/therapeutic use ; Disulfiram/pharmacology ; Disulfiram/therapeutic use ; Humans ; Naltrexone/therapeutic use ; Topiramate/therapeutic use
Chemical Substances	Alcohol Deterrents ; Topiramate (0H73WJJ391) ; Naltrexone (5S6W795CQM) ; Baclofen (H789N3FKE8) ; Acamprosate (N4K14YGM3J) ; Disulfiram (TR3MLJ1UAI)
Language	English
Publishing date	2022-02-08
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	120316-2
ISSN	1179-1950 ; 0012-6667
ISSN (online)	1179-1950
ISSN	0012-6667
DOI	10.1007/s40265-021-01670-3
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Article ; Online: Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures.

Hassamal, Sameer / Miotto, Karen / Dale, William / Danovitch, Itai

The American journal of medicine

2018 Volume 131, Issue 11, Page(s) 1382.e1–1382.e6

Abstract: Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol's serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse ... ...

Abstract	Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol's serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is modest in the general population, but if left untreated, the morbidity and mortality can be high; therefore, prompt recognition and management is essential. Various risk factors such as medical comorbidities, use or abuse of supratherapeutic doses of tramadol, and concomitant administration of proconvulsant serotonergic cytochrome P-450 inhibitors will help clinicians identify individuals at an elevated risk for serotonin toxicity and seizures. Serotonin syndrome and seizures can be effectively treated by administering benzodiazepines, providing supportive care, and discontinuing tramadol and other contributing agents. Cyproheptadine should be administered in moderate to severe cases of serotonin syndrome. Our objective is to summarize the literature on the pharmacology, epidemiology, risk factors, clinical presentations, and evidence-based management of tramadol-related seizures and serotonin syndrome.
MeSH term(s)	Analgesics, Opioid/adverse effects ; Anticonvulsants/therapeutic use ; Humans ; Risk Factors ; Seizures/chemically induced ; Serotonin Syndrome/chemically induced ; Serotonin Syndrome/complications ; Serotonin Syndrome/diagnosis ; Serotonin Syndrome/drug therapy ; Tramadol/adverse effects
Chemical Substances	Analgesics, Opioid ; Anticonvulsants ; Tramadol (39J1LGJ30J)
Language	English
Publishing date	2018-05-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2018.04.025
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Article ; Online: Before and During the First COVID-19 Surge: Work Conditions, Burnout, and Mental Health Among Resident Physicians in a Department of Psychiatry in the USA.

Agrawal, Alpna / De La Torre, Kazandra / Cooper, Conisha / Flores, Jeremy / Miotto, Karen / Wells, Kenneth / Bromley, Elizabeth / Yano, Elizabeth M / Heldt, Jonathan / Castillo, Enrico G / DeBonis, Katrina

Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry

2023 Volume 47, Issue 5, Page(s) 504–509

Abstract: Objective: Resident physicians are critical frontline workers during pandemics, and little is known about their health. The study examined occupational and mental health risks among US psychiatry residents before and during the first COVID-19 surge.: ... ...

Abstract	Objective: Resident physicians are critical frontline workers during pandemics, and little is known about their health. The study examined occupational and mental health risks among US psychiatry residents before and during the first COVID-19 surge. Methods: Longitudinal data were collected from a cohort of US psychiatry residents at one academic medical center in October 2019, before the pandemic, and April 2020 after the initiation of a state-level stay-at-home order. Primary outcome measures were psychological work empowerment, defined as one's self-efficacy towards their work role, and occupational burnout. A secondary outcome was mental health. In May and June 2020, resident engagement sessions were conducted to disseminate study findings and consider their implications. Results: Fifty-seven out of 59 eligible residents participated in the study (97%). Half the study sample reported high burnout. From before to during the first COVID-19 surge, psychological work empowerment increased in the total sample (p = 0.03); and mental health worsened among junior residents (p = 0.004), not senior residents (p = 0.12). High emotional exhaustion and depersonalization were associated with worse mental health (p < 0.001). In engagement sessions, themes related to residents' work conditions, COVID-19, and racism emerged as potential explanations for survey findings. Conclusions: The study is exploratory and novel. During early COVID, psychiatry residents' well-being was impacted by occupational and societal factors. Postpandemic, there is a growing psychiatrist shortage and high demand for mental health services. The findings highlight the potential importance of physician wellness interventions focused on early career psychiatrists who were first responders during COVID.
MeSH term(s)	Humans ; Burnout, Professional/epidemiology ; Burnout, Professional/psychology ; COVID-19/epidemiology ; Mental Health ; Burnout, Psychological ; Physicians/psychology ; Psychiatry/education ; Surveys and Questionnaires ; Internship and Residency
Language	English
Publishing date	2023-08-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	1045331-3
ISSN	1545-7230 ; 1042-9670
ISSN (online)	1545-7230
ISSN	1042-9670
DOI	10.1007/s40596-023-01844-z
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