clinicaltrials.gov Identifier: NCT00006206.

Treatment with nalmefene was effective in preventing relapse to heavy drinking relative to placebo in alcohol-dependent outpatients and was accompanied by acceptable side effects.

There is a need for safe medications that can effectively support recovery by treating symptoms of protracted abstinence in alcoholics that may precipitate relapse e.g., craving and disturbances in sleep and mood. This proof-of-concept study reports on the effectiveness of gabapentin 1200 mg for attenuating these symptoms in a non treatment-seeking sample of cue-reactive, alcohol-dependent individuals. Subjects were 33 paid volunteers with current DSM-IV alcohol dependence and a strength of craving rating 1σ or greater for alcohol than water cues. Subjects were randomly assigned to gabapentin or placebo for 1-week and then participated in a within-subjects trial where each was exposed to standardized sets of pleasant, neutral, and unpleasant visual stimuli followed by alcohol or water cues. We found a significant attenuating effect of gabapentin (vs. placebo) on several measures of subjective craving for alcohol as well as for affectively-evoked craving. Gabapentin was also found to significantly improve several measures of sleep quality. Side effects were minimal, and gabapentin effects were not found to resemble any major classes of abused drugs. Results suggest that gabapentin may be effective for treating the protracted abstinence phase in alcohol dependence and, hence, that a randomized clinical trial would be an appropriate next step. The study also suggests the value of cue reactivity studies as proof-of-concept screens for potential anti relapse drugs.

BACKGROUND AND OBJECTIVES: Diagnostic codes are used widely within health care for billing, quality assessment, and to measure clinical outcomes. The US health care system will transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), in October 2015. Little is known about how this transition will affect pediatric practices. The objective of this study was to examine how the transition to ICD-10-CM may result in ambiguity of clinical information and financial disruption for pediatricians. METHODS: Using a statewide data set from Illinois Medicaid specified for pediatricians, 2708 International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes were identified. Diagnosis codes were categorized into 1 of 5 categories: identity, class-to-subclass, subclass-to-class, convoluted, and no translation. The convoluted and high-cost diagnostic codes (n = 636) were analyzed for accuracy and categorized into “information loss,” “overlapping categories,” “inconsistent,” and “consistent.” Finally, reimbursement by Medicaid was calculated for each category. RESULTS: Twenty-six percent of pediatric diagnosis codes are convoluted, which represents 21% of Illinois Medicaid pediatric patient encounters and 16% of reimbursement. The diagnosis codes represented by information loss (3.6%), overlapping categories (3.2%), and inconsistent (1.2%) represent 8% of Medicaid pediatric reimbursement. CONCLUSIONS: The potential for financial disruption and administrative errors from 8% of reimbursement diagnosis codes necessitates special attention to these codes in preparing for the transition to ICD-10-CM for pediatric practices.

The present study examines the relationships among burnout, secondary traumatic stress (STS), and race-related stress among a national sample of 250 Black mental health therapists (counselors, social workers, psychologists, and marriage and family therapists). We investigated the predictive nature of the three subscales (Individual Racism, Cultural Racism, and Institutional Racism) of the Index of Race-Related Stress–Brief Version (IRRS-B) and selected demographic variables on therapists’ reports of burnout and STS assessed on the Professional Quality of Life Scale–Version 5 (ProQOL-5). All three forms of race-related stress significantly predicted both burnout and STS for Black mental health therapists. Of the demographic variables, hours worked per week significantly predicted burnout and STS. Additionally, highest degree obtained significantly predicted STS for Black mental health therapists. The utility of these findings in understanding the connections among race-related stress, burnout, and STS are discussed as well as directions for future research.