Objective Examine the association between private health insurance and the receipt of specialty substance use disorder treatment. Methods Weighted logistic regressions were estimated to examine the association between health insurance and the receipt of any specialty substance use disorder treatment in national samples of non-elderly adults with alcohol abuse/dependence (N=22,778), alcohol dependence (N=10,104), drug abuse/dependence (N=9,427), and drug dependence (N=6,736). Analyses compared receipt of any specialty substance use treatment among the uninsured to the privately insured who reported known coverage, no coverage, or unknown coverage for alcohol/drug treatment. Regressions adjusted for sociodemographic characteristics, treatment need, and criminal justice involvement. Results Compared to being uninsured, private insurance with known coverage for alcohol treatment was associated with greater use of any specialty treatment only among those with alcohol dependence (p<0.05). Conclusion Private insurance is associated with increased use of specialty treatment among those with severe alcohol use disorders who understand their benefits.

Cognitive and affective biases impact clinical decision-making in general medicine. This article explores how such biases might specifically affect psychiatrists' attitudes and prescribing patterns regarding two medication classes (stimulants and benzodiazepines) and addresses related issues. To supplement personal observations, selective PubMed narrative literature searches were conducted using relevant title/abstract terms, followed by snowballing for additional pertinent titles. Acknowledging that there are many more types of biases, we describe and use clinical vignettes to illustrate 17 cognitive and affective biases that might influence clinicians' psychopharmacological practices. Factors possibly underlying these biases include temperamental differences and both preprofessional and professional socialization. Mitigating strategies can reduce the potentially detrimental impacts that biases may impose on clinical care. How extensively these biases appear, how they differ among psychiatrists and across classes of medication, and how they might be most effectively addressed to minimize harms deserve further systematic study.

Buprenorphine is highly effective for the treatment of opioid use disorder and is increasingly being used in the treatment of chronic pain. For various reasons, patients on buprenorphine may request discontinuation of this medication. Tapering off buprenorphine can be challenging due to intolerable withdrawal symptoms, including nausea, malaise, anxiety, and dysphoria. A single dose of extended-release buprenorphine may facilitate discontinuation of buprenorphine by mitigating prolonged, debilitating opioid withdrawal symptoms. We report on three cases of successful transition from low dose sublingual buprenorphine to a single injection of 100 mg extended-release buprenorphine to opioid cessation in patients who had previously been unable to taper fully off buprenorphine. This novel use of extended-release buprenorphine provides a viable alternative to fully transition patients off buprenorphine when they are medically and emotionally ready.