Adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care

INTRODUCTION

Opioid use disorder (OUD) and psychiatric conditions commonly co-occur yet are infrequently treated with evidence-based therapeutic approaches, resulting in poor outcomes. These conditions, separately, present challenges to treatment initiation, retention, and success. These challenges are compounded when individuals have OUD and psychiatric conditions.

METHOD

Recognizing the complex needs of these individuals, gaps in care, and the potential for primary care to bridge these gaps, we developed a psychotherapy program that integrates brief, evidence-based psychotherapies for substance use, depression, and anxiety, building on traditional elements of the Collaborative Care Model (CoCM). In this article, we describe this psychotherapy program in a primary care setting as part of a compendium of collaborative services.

RESULTS

Patients receive up to 12 sessions of evidence-based psychotherapy and case management based on a structured treatment manual that guides treatment via Motivational Enhancement; Cognitive Behavioral Therapies for depression, anxiety, and/or substance use disorder; and/or Behavioral Activation components.

DISCUSSION

Novel, integrated treatments are needed to advance service delivery for individuals with OUD and psychiatric conditions and these programs must be rigorously evaluated. We describe our team's efforts to test our psychotherapy program in a large primary care network as part of an ongoing three-arm randomized controlled trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Safety footwear: A survey of end-users

This paper presents the results of an extensive survey concerning the experience of safety footwear end-users. Safety footwear has been in widespread use across many industries worldwide since the 1970s, and has become an essential part of industrial Personal Protective Equipment. The number of women entering predominantly male industrial environments, and requiring safety footwear is rising, and this is accompanied by anecdotal reports of ill-fitting and uncomfortable footwear. This research proactively compares the opinions of women and men regarding their experience of safety footwear. A systematically designed survey aims to substantiate previously anecdotal knowledge around safety footwear, including key drivers for end-user purchases, wear habits and comfort issues (establishing any differences between women and men). Chi-squared testing was used to assess statistical significance and ensure robustness of findings. The responses and resulting analysis confirmed that comfort and fit were key drivers for all end users; women and men have different wear habits (women wear their safety footwear less frequently and for shorter periods of time than men - likely due to the reported comfort issues); a significant proportion of women (60%) found their safety footwear less comfortable than their regular footwear, however, 45% of men also reported the same, which has not been reported anecdotally. In general, the users of safety footwear accepted a level of discomfort in at least one area of the foot before deeming footwear 'uncomfortable'. The significant analysis performed on the captured data has, to the authors knowledge, never before been undertaken for this breadth of industry, age and gender with 632 responses received. This makes it the largest study of this field to date.

Tau interacts with src-family non-receptor tyrosine kinases

Tau and other microtubule-associated proteins promote the assembly and stabilization of neuronal microtubules. While each microtubule-associated protein has distinct properties, their in vivo roles remain largely unknown. Tau is important in neurite outgrowth and axonal development. Recently, we showed that the amino-terminal region of tau, which is not involved in microtubule interactions, is important in NGF induced neurite outgrowth in PC12 cells. Here we report that a proline rich sequence in the amino terminus of tau interacts with the SH3 domains of fyn and src non-receptor tyrosine kinases. Tau and fyn were co-immunoprecipitated from human neuroblastoma cells and co-localization of tau and fyn was visualized in co-transfected NIH3T3 cells. Co-transfection of tau and fyn also resulted in an alteration in NIH3T3 cell morphology, consistent with an in vivo interaction. Fyn-dependent tyrosine phosphorylation of tau occurred in transfected cells and tyrosine phosphorylated tau was identified in human neuroblastoma cells as well. Our data suggest that tau is involved in signal transduction pathways. An interaction between tau and fyn may serve as a mechanism by which extracellular signals influence the spatial distribution of microtubules. The tyrosine phosphorylation of tau by fyn may also have a role in neuropathogenesis, as fyn is upregulated in Alzheimer's disease.