Literature Collection

Opioid overdose and Opioid Use Disorder (OUD) statistics underscore an urgent need to significantly expand access to evidence-based OUD treatment. Office Based Opioid Treatment (OBOT) has proven effective for treating OUD. However, limited access to these treatments persists. Recognizing the need for significant investment in clinical, behavioral, and translational research, the Indiana State Department of Health and Indiana University embarked on a research initiative supported by the "Responding to the Addictions Crisis" Grand Challenge Program. This brief presents recommendations based on existing research and our own analyses of medical claims data in Indiana, where opioid misuse is high and treatment access is limited. The recommendations cover target providers, intervention focus, priority regions, and delivery methods.

Psychiatric comorbidities in epilepsy are prevalent, disabling, and persistently undertreated due to conceptual and operational fragmentation between neurology and psychiatry. This paper proposes Network-Pluralistic Psychiatry in Epilepsy (NPPE), a hypothesis-generating, disease-contextualized framework that integrates four mechanistic layers: (1) shared genetic vulnerability, (2) epileptogenic network dysfunction as a neuropsychiatric substrate, (3) a bidirectional psychosocial stress loop, and (4) societal and institutional amplifiers. NPPE moves beyond high-level biopsychosocial heuristics by positing testable causal pathways linking genetic liability to network instability, symptom expression, and environmental feedback in epilepsy. The manuscript situates NPPE within existing integrated-care paradigms (e.g., collaborative and stepped-care models), proposing NPPE as a mechanistic engine to personalize measurement-based treatment-to-target decisions while explicitly acknowledging feasibility constraints for advanced tools. A tiered assessment concept (Tiers 1-3) and candidate mechanism-informed interventions are outlined as research targets rather than clinical recommendations. The paper delineates a research agenda prioritizing longitudinal, multimodal cohorts; incorporation of network biomarkers in clinical trials; evaluation of integrated-care implementations; and attention to equity and real-world feasibility. NPPE aims to provide a coherent, testable roadmap to transform descriptive comorbidity accounts into mechanism-oriented, personalized neuropsychiatric care in epilepsy, contingent on rigorous validation, refinement, or falsification.

IMPORTANCE: The prevalence of and mortality associated with methamphetamine use has doubled during the past 10 years. There is evidence suggesting that methamphetamine use disorder could be the next substance use crisis in the United States and possibly worldwide. OBSERVATION: The neurobiology of methamphetamine use disorder extends beyond the acute effect of the drug as a monoaminergic modulator and includes intracellular pathways focused on oxidative stress, neurotoxic and excitotoxic effects, and neuroinflammation. Similarly, the clinical picture extends beyond the acute psychostimulatory symptoms to include complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by the clinician. Although there are no pharmacologic treatments for methamphetamine use disorder, cognitive behavioral therapy, behavioral activation, and contingency management show modest effectiveness. CONCLUSIONS AND RELEVANCE: There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets. Parsing the disorder into different processes (eg, craving or mood-associated alterations) and targeting the neural systems and biological pathways underlying these processes may lead to greater success in identifying disease-modifying interventions. Finally, mental health professionals need to be trained in recognizing early cardiovascular and cerebrovascular warning signs to mitigate the mortality associated with methamphetamine use disorder.

BACKGROUND: Among persons with opioid use disorder (OUD), neuropsychological dysfunction is associated with depression, and better neuropsychological function is associated with opioid abstinence. However, it is unknown whether depressive symptomatology or adherence to opiate agonist treatment are associated with neuropsychological change over time. METHODS: We recruited 20 buprenorphine/naloxone-treated adults with OUD (M Age = 45.2 years [SD = 8.1]; 25% female) to complete baseline and 6 month visits containing a neuropsychological test battery and self-reported measures of depressive symptomatology and medication adherence. RESULTS: Depressive symptomatology was not significantly related to neuropsychological change (p's > .05). Greater adherence to buprenorphine/naloxone was associated with improvements in learning, memory, and global functioning (r's = .52-60; p's < .05). CONCLUSIONS: Among OUD patients, greater adherence to buprenorphine/naloxone is associated with improved neuropsychological functioning over time. In contrast, depressive symptomatology is not associated with neuropsychological functioning over time. Supporting adherence to buprenorphine/naloxone may improve and/or preserve learning and memory functioning in individuals treated for OUD. TRIAL REGISTRATION: NCT01108679 . Registered 21 April 2010.