Literature Collection

RATIONALE: Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized. OBJECTIVES AND METHODS: We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine-naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study. RESULTS: Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use. CONCLUSIONS: People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.

Collaborative Care is well accepted as an evidence-based model to manage depression and anxiety in pediatric primary care. However, symptoms of attention-deficit hyperactivity disorder (ADHD), traumatic stress, and grief are common in primary care and can also be identified by pediatricians and treated within this model. Attention-deficit hyperactivity disorder (ADHD) is the most common childhood-onset neurodevelopmental disorder with a prevalence of 10.2 %.(1) Trauma-spectrum disorders are another cluster of disorders that will often be seen first by the pediatrician, and, potentially, only by the pediatrician. In some urban pediatric centers, the rate of children who have been exposed to traumatic events is as high as 90 %.(2) Similarly, symptoms of grief are often first identified by the pediatrician. Considering that the COVID-19 pandemic alone has claimed >760,000 parents, custodial grandparents, and other caregivers to children in the US, the number of children and teenagers affected by trauma and loss overwhelms the mental health care system's capacity. In light of the shortage of child and adolescent psychiatrists in the United States and the increased demand for mental health services, it is essential to broaden the scope of what collaborative care initiatives can accomplish in pediatrics. This paper shares insights from a collaborative care model implemented in a New York City safety net hospital center to illustrate how ADHD, traumatic stress, and grief can be identified and managed in pediatric primary care. Lastly, we will discuss the potential for collaborative care models to increase access to care for immigrant families.

Conventional outpatient diabetes management, which focuses mainly on biomedical measures like glycemic control, may be inadequate for achieving sustainable long-term health outcomes, especially among patients with co-occurring psychosocial challenges. Although these methods are physiologically important, they often ignore key psychosocial factors that greatly affect self-management, treatment adherence, and clinical results. Based on the biopsychosocial model, this article proposes a comprehensive care framework that includes structured psychosocial support as a core part of diabetes management. Strong evidence shows that psychosocial factors-such as diabetes-related distress, mental health conditions, and social determinants-directly influence glycemic control, quality of life, and complication rates. The article also points out structural weaknesses in current healthcare systems that prevent integrated care. In response, a coordinated, multi-level strategy is introduced. This includes systematic psychosocial screening, communication methods supported by evidence, digital health technologies, and personalized stepped-care interventions. Finally, we recommend systemic reforms in clinical practice, payment policies, and medical education to support a shift toward person-centered, biopsychosocial diabetes care. These changes are necessary to address the complex nature of diabetes and improve both health outcomes and patient well-being.