Characteristics of Individuals Who Receive Pharmacotherapy While in Treatment For Opioid Use Disorder in the United States Objective: Treatments that include pharmacotherapy are the standard of care for opioid use disorder (OUD), but they are underutilized. This paper uses a large sample of treatment admissions for OUD in the United States to examine characteristics predictive of receiving treatments that include pharmacotherapy. Methods: Data come from the 2014 Treatment Episode Dataset—Admissions. Generalized linear regression models were utilized to assess the association of receiving pharmacotherapy treatment with a number of demographic, treatment, and disorder characteristics. Results: Less than one third of treatment admissions for an OUD involved pharmacotherapy. Among the factors most associated with receiving pharmacotherapy treatment were referring oneself to treatment, as opposed to a medical or nonmedical professional, and receiving treatment in a nonintensive outpatient setting, as opposed to intensive outpatient or residential settings. Conclusion: Encouraging professionals to refer clients to programs that offer treatments that include pharmacotherapy, and incorporating pharmacotherapy into a greater diversity of treatment settings, could help increase access to evidence-based care for OUD. The paper was not subject to the Congressional Budget Office’s regular review and editing process. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Congressional Budget Office. No official endorsement by the U.S. Department of Health and Human Services is intended or should be inferred. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Office of the Assistant Secretary for Planning and Evaluation or the U.S. Department of Health and Human Services. The authors declare no conflict of interest. Reprints: Ryan Mutter, PhD, Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office, 441 D St SW, Washington, DC 20515 (e-mail: ryan.mutter@cbo.gov).Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.addictiondisorders.com. Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Factors Influencing Change in Behavior Among Residents With Drug Addiction in a Mental Hospital in Ghana Objective: The objective of this study was to explore the factors that influence the achievement of the state of sobriety in a drug addiction rehabilitation center. Materials and Methods: A qualitative research approach using an exploratory descriptive design was used. In-depth interviews of 12 residents who received care at a drug addiction rehabilitation center in southern Ghana were interviewed using a semistructured interview guide. The participants (residents) were purposively selected for the study from December 2015 to May 2016. The average length of each interview was about an hour. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis. Results: The research revealed that the attitude of health professionals/counselors, residents, and their social support network influenced the change process. Moreover, discomfort produced by drugs/substances and a broadened knowledge base in drugs/substances influenced change. Conclusions: The factors that influenced behavior change were multifactorial. However, positive and negative human factors and the rehabilitation program were instrumental. No single change agent could bring about the desired behavioral change in drug addiction rehabilitation. The authors declare no conflict of interest. Reprints: Wisdom M.K. Avor, Mphil, BScN, RMN, District Health Directorate, P.O. Box 124, Aburi—Akuapem, Eastern Region 03428, Ghana (e-mail: avwisdom@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Neuropsychology as a Method of Diagnosis and Treatment of Internet Addiction Objective: Nowadays, the widespread use of the internet has resulted in the creation of the phenomenon of addiction to the internet. Internet addiction constitutes a new kind of mental disorder that is caused by the excessive use of the internet to a point that it interferes with daily life. In our research, we detected and recorded the electrophysiological brain characteristics of addicted users. Materials and Methods: Our research focused on 28 Greek pupils of an average age of 13.3 years. For the detection of those pupils addicted to the internet, we administered the Internet Addiction Test. When the results of the test were evaluated, 14 students were selected for having the characteristics of internet-addicted users. Those selected underwent a clinical assessment with the use of Event-Related Potentials (P300 waveform). Thereafter, we compared the results collected from the first group (internet-addicted users) to the data received from the application of the P300 wave on the 14 pupils of the control group (pupils who were not addicted to the internet). After the assessment, the group of children with internet addiction characteristics received rehabilitation treatment. Results: After the rehabilitation process of the internet-addicted pupils, both groups were tested once more, and the electrophysiological results received revealed that the internet-addicted group presented similar P300 latency values to that of the control group. Discussion: The findings of this research are significant, taking into account the rapid rise of internet addiction globally and the importance of introducing and ultimately having at our disposal a reliable tool that can detect internet addiction. Conclusion: The findings of this research provide us with significant insights on how we can use neuropsychology in our effort to deal with the phenomenon of internet addiction. The authors declare no conflict of interest. Reprints: Apostolos I. Fotis, Department of Special Education, University of Thessaly, Iasonos & Argonauton st., 382 21 Volos, Greece (e-mail: fotis@uth.gr). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Can High Altitude Exacerbate a Remittent Alcohol Use Disorder in a Patient With a History of Panic Attacks? Background: Several studies have already investigated the brief and long-term neurological effects of exposure to high altitudes and the related sequelae of hypoxia on memory and cognition, but few authors have discussed the question of psychic symptoms during high-altitude activities. These authors suspect that the reexacerbation or worsening of psychiatric symptoms may well be the expression of maladaptive behaviors in response to changes in environmental conditions. Case Report: We describe the case of a patient with a history of sporadic Panic Attacks with elements of the panic-agoraphobic spectrum (social phobia and separation anxiety) who, in a specific social context during adolescence, tended to misuse alcohol for recreational and disinhibitory purposes to solve his relational problems in the social sphere. After many years of abstinence, this patient decided to accept exposure to high altitudes at work and developed a serious alcohol use disorder, including the progressive worsening of his functioning in the social and working dimensions. Discussion: We propose that, because of the daily experiencing of high altitudes at work, the patient’s anxiety levels rose sharply, but unconsciously and automatically, according to a mode of copying previously enacted in adolescence (through social phobia and the use of alcohol to become disinhibited); he also implemented binge drinking behaviors for self-medicative and antianxiety purposes, which gradually triggered a mechanism of alcohol dependence. I.M. served as a board member for Indivior, Molteni, Mundipharma, D&A Pharma, CT Sanremo, Lundbeck, Gilead, Merck & Co., Angelini. The remaining authors declare no conflict of interest. Reprints: Manuel Glauco Carbone, MD, Department of Experimental and Clinical Medicine, School of Psychiatry, University of Pisa, Via Roma, 67, 56100 Pisa, Italy (e-mail: manuelglaucocarbone@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Effectiveness of Neurolinguistic Programming in Reducing Sport Anxiety in Athletes This research was motivated by the phenomenon of anxiety experienced by athletes during exercise. Sport anxiety is a condition/nature/response associated with exercise, indicating anxiety, worry, and panic experienced by athletes before competing. Sport anxiety has the possibility of affecting the performance of athletes in competition. If proper attention is not given to this occurrence, it may limit the performance of athletes in competitions. One tool that can be used to reduce sport anxiety is neurolinguistic programming. Six athletes were used as athletes in this research. Sport Anxiety Scale-2 was the instrument used to analyze data using a single-subject research design A-B-A-B. The results of the study found that neurolinguistic programming can reduce an athlete’s sport anxiety. T.H.S. is a licensed counselor at the Indonesian Counselors Association and a private counselor, is a professional in sports counseling, mental health counseling and crisis counseling. The remaining authors declare no conflict of interest. Reprints: Tjung Hauw Sin, MPd, Kons, Department of Sport Coaching, Faculty of Sport Science, Universitas Negeri Padang, Jl. Prof. Dr. Hamka, Air Tawar Padang, West Sumatera 25131, Indonesia (e-mail:tjunghauwsin@konselor.org). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Implementing Medication-assisted Treatment For Opioid Use Disorder in Residential Programs No abstract available

FACES OF HPPD: Hallucinogen Persisting Perception Disorder Patient Survey Results and a Descriptive Analysis of Patient Demographics, Medical Background, Drug Use History, Symptoms, and Treatments Objective: The purpose of the present study was to obtain patient information across a wide geography about medical history, drug use, symptoms, and treatments of individuals diagnosed with hallucinogen persisting perception disorder (HPPD). Methods: The study was an internet survey that yielded 26 HPPD patients from North America (81%), Europe (12%), and South America (almost 8%), predominantly male (73%), white (92%), with a median age of 24.5 (range, 18 to 63) years, who have been living with HPPD from a period of <1 year to well over 10 years. Results: History of preexisting mood disorders was reported (100%). Previous hallucinogen drugs used include lysergic acid diethylamide, psilocybin, 3,4-methylenedioxymethamphetamine, and mescaline in highest frequencies. There is a high percentage of current use of benzodiazepines (34.6%) and dependency (78% of those using). Current marijuana use is present for 19%, of which all claim dependency. All patients reported experiencing long-term and ongoing symptoms such as depersonalization (92.3%), visual snow, floaters, trailing afterimages and anxiety (96.2% for each factor). Suicide ideation was pronounced (over 69%). HPPD treatments included benzodiazepines (50%), neuroleptics (23%), anticonvulsants (35%), and receiving counseling (62%). Conclusions: HPPD is an understudied mental disorder that has a complex and unpredictable nature with overlapping psychiatric, psychological, and neurological symptoms. Controlled, evidence-based clinical studies are needed for improvements in diagnosing and treating HPPD. There is concern for patients’ well-being, particularly concerning high reported suicide ideation and dependency on drugs currently used (even if they are prescribed). Improved education for health care professionals and patients is also needed. D.M.L.: ORCID ID: 0000-0002-3315-6357. The author declares no conflicts of interest. Reprints: Doreen M. Lewis, PhD, Vellichor Research, 12121 Little Road, Box 329, Hudson, FL 34667 (e-mail: doreen@vellichorresearch.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Peer Recovery Provides Sustainable Avenues for Addiction Treatment, but is Not a One-Size-Fits-All Proposition No abstract available

Survey to Mental Health Professionals on Problematic Drug Use Introduction: When discussing problematic drug use it is necessary to articulate both the legal and the health system to establish a coherent approach to address it. As the health system is formed in part by the Mental Health professionals who are usually those who respond to and receive this population for treatment, the aim of the present study was to learn their opinion with regard to problematic drug use approach both clinically and in the legal system. The results would help to stimulate discussion in the Mental Health field to better assist policy makers. Materials and Methods: This was a cross-sectional study with a convenience sample. During the 2017 Argentinian Conference on Psychiatry (Congreso Argentino de Psiquiatría XXXII from Asociación de Psiquiatras Argentinos), the attendees received an anonymous voluntary paper questionnaire designed by the research team that had 4 questions on demographic information and 9 Likert-like statements. Statistical analysis was performed. Results: A total of 642 attendees answered the questionnaire. As regards criminalization of drug use, 51.7% would decriminalize ≥1 drug, 42.5% disagreed that the aim of the treatment is total abstinence (those that disagreed had a statistically significantly lower mean age compared with those that agreed), and 64.5% disagreed with punishing drug possession for personal use. Conclusions: The debate taking place worldwide on how to address the drug use problem could also be found among the Mental Health professionals in Argentina, where almost half considered that ban is the best approach, whereas the other half was in favor of decriminalization. Creating consensus among Mental Health providers would allow better articulation of the health system, with the policy makers giving a comprehensive approach in these complex situations. The authors declare no conflict of interest. Reprints: Juan C. Tenconi, MD, Argentinian Psychiatry Association, 355 Rincón Street, Buenos Aires C1081ABG, Argentina (e-mail: juantenconi@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

The Effect of Methadone Maintenance Treatment Method on Mental Health and Quality of Life in People With Opioid Addiction: A Longitudinal Study in Iran Objectives: Promoting recovery in mental health of patients with opioid addiction is an important aspect of the treatment plan, which can lead to continued improvement of health and promotion of quality of life (QoL) in these people. This study aimed to evaluate the effect of methadone maintenance treatment (MMT) method on mental health and QoL in people with opioid addiction. Methods: In this longitudinal descriptive study, 186 subjects with opioid addiction had the required criteria and were then selected on the basis of clustering and simple random sampling methods. First (a month after using methadone therapy), demographic, QoL, and mental health data were collected using General Health Questionnaire and health-related quality of life questionnaires. Second (12 mo after using methadone therapy), mental health and QoL of participants were again evaluated. Data were analyzed using SPSS Statistics 20, and Mann-Whitney U and Wilcoxon tests. Results: The results showed that there is no improvement after using MMT method (P=0.783), but the QoL scores of the participants increased to some extent, 12 months after using this therapeutic method (P=0.04). Conclusion: The results of this study showed that the MMT method does not significantly affect the health of the participants. Hence, screening programs for psychological disorders in patients should be arranged before the onset of a course of treatment; there should also be extensive and continuous therapeutic and counseling services for these patients and their families, to achieve therapeutic goals. The authors declare no conflict of interest. Reprints: Ghahraman Mahmoudi, PhD, Hospital Administration Research Center, School of Medicine, Sari Branch, Islamic Azad University, Sari 48161-19318, I R Iran (e-mail: Ghahraman48@yahoo.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved