Introduction Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for hypersexual disorder (HD) have been proposed to capture symptoms reported by patients seeking help for out-of-control sexual behavior. The proposed criteria created by the DSM-5 Work Group on Sexual and Gender Identity Disorders require evaluation in a formal field trial. Aim This DSM-5 Field Trial was designed to assess the reliability and validity of the criteria for HD in a sample of patients seeking treatment for hypersexual behavior, a general psychiatric condition, or a substance-related disorder. Method Patients (N = 207) were assessed for psychopathology and HD by blinded raters to determine inter-rater reliability of the HD criteria and following a 2-week interval by a third rater to evaluate the stability of the HD criteria over time. Patients also completed a number of self-report measures to assess the validity of the HD criteria. Main Outcome Measures HD and psychopathology were measured by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory—Revised. Results Inter-rater reliability was high and the HD criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder. Conclusions The HD criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing HD.

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Setting The first regulated supervised inhalation site (safer smoking room) in North America has opened in Lethbridge, Alberta, as part of a supervised consumption site addressing all routes of consumption. When designing the service, we felt it was important to accommodate not just injection drug use but also inhalation because (1) it is not the method of drug use that kills but the drug itself, (2) all people who use drugs deserve service regardless of their mode of use, and (3) people who use drugs should have the opportunity to use the method with the lowest risk. Intervention We received approval from Health Canada to offer supervised inhalation services in addition to supervised injection services. Based on a European model, we worked with a local commercial heating, cooling, and ventilation (HVAC) company to create rooms with ventilation systems that complied with Canadian health and safety regulations. Outcome People who use drugs by inhalation have repeatedly told us that they want to use indoors and will do so given the option. Since opening the supervised consumption service at the end of February 2018, the response has been overwhelming and both of the inhalation rooms are constantly in use. Implications Supervised inhalation services provide an alternative to public drug use and an opportunity for people who use drugs to engage with harm reduction services. Other supervised consumption services in Canada may also wish to pursue exemptions for this service. Résumé Lieu Le premier site réglementé d'inhalation sous supervision (fumerie à moindre risque) en Amérique du Nord a ouvert à Lethbridge, en Alberta; il fait partie d'un site de consommation sous supervision pour tous les modes de consommation. En concevant ce service, nous avons jugé important de permettre non seulement l'utilisation de drogue par injection, mais aussi par inhalation car : 1) ce n'est pas la méthode de consommation qui tue, mais la drogue; 2) les personnes qui consomment de la drogue ont le droit d'être servies peu importe leur mode de consommation; et 3) ces personnes devraient pouvoir utiliser le mode de consommation le moins dangereux. Intervention Nous avons obtenu l'accord de Santé Canada pour offrir des services d'inhalation sous supervision en plus de services d'injection sous supervision. En nous inspirant d'un modèle européen, nous avons travaillé avec une entreprise locale de chauffage, ventilation et climatisation (CVC) à créer des salles dotées de systèmes de ventilation conformes à la réglementation canadienne de santé-sécurité. Résultats Les consommateurs de drogue par inhalation nous ont dit à plusieurs reprises qu'ils veulent consommer à l'intérieur et qu'ils le font s'ils en ont la possibilité. Depuis l'ouverture de notre site de consommation sous supervision la fin de février 2018, la demande est massive, et nos deux salles d'inhalation sont constamment utilisées.

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