This article presents an addiction treatment model based on craving identification and management (CIM). Craving is broadly defined as the desire to use alcohol or other drugs; it increases the likelihood of use of these substances. In the CIM Model treatment interventions are referenced to craving, i.e., helping clients to identify their craving level and equipping them with strategies to avoid use. Four causes of craving are identified: (1) environmental cues (triggers): exposure to people, places, and things associated with prior drug-using experiences may cause immediate and overwhelming craving; (2) stress: addicted persons experience stress as craving; (3) mental illness; and (4) drug withdrawal: symptoms of both mental illness and withdrawal lead to craving if clients associate use with relief of these symptoms. The CIM Model incorporates four service delivery elements: Relapse Prevention Workshop, individual counseling, medical/psychiatric services, and screening for ongoing drug use. At its core, the CIM Model asks clients to be aware of craving, analyze its causes, and, based on those causes, implement specific strategies to prevent and manage craving. The CIM Model combines several treatment components, including control of exposure to environmental cues, establishment of a daily schedule, the use of behaviors that dissipate craving (tools), and treatment (with medications when appropriate) of mental health and withdrawal symptoms. The CIM Model is a client-derived approach to achieving and maintaining sobriety based on a process of analyzing craving and managing it with an individualized program of recovery activities.

Background Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI. Methods A retrospective cohort study of patients ≥ 18 years who underwent emergent craniotomy for TBI at Harborview Medical Center (level-1 trauma center) between October 2007 and January 2010. Demographic, clinical and radiographic characteristics, hemodynamic and anesthetic data were abstracted from medical and electronic anesthesia records. Hypotension was defined as systolic blood pressure (SBP) < 90 mmHg. Univariate analyses were performed to compare the clinical characteristics of patients with and without IH and multiple logistic regression analysis was used to determine independent risk factors for IH. Results Data abstracted from 113 eligible patients aged 48±19 years was analyzed. Intraoperative hypotension was common (n=73, 65%) but not affected by the choice of anesthetic agent. Independent risk factors for IH were multiple Computed Tomographic (CT) lesions (AOR 19.1 [95% CI: 2.08–175.99]; p=0.009), SDH (AOR 17.9 [95% CI: 2.97–108.10]; p=0.002), maximum CT lesion thickness (AOR 1.1 [95% CI: 1.01–1.13]; p=0.016), and anesthesia duration (AOR 1.1 [95% CI: 1.01–1.30]; p=0.009). Conclusion Intraoperative hypotension was common in adult patients with isolated TBI undergoing emergent craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion and longer duration of anesthesia increase the risk for IH.

Psychosocial treatments for methamphetamine dependence are of limited effectiveness. Thus, a significant need exists for add-on therapy for this substance user disorder. The aim of this study was to develop and test a novel text messaging intervention for use as an adjunct to cognitive behavioral group therapy for methamphetamine users. Text messaging has the potential to support patients in real-time, around the clock. We convened 2 meetings of an expert panel, held 3 focus groups in current and former users, and conducted 15 semi-structured interviews with in-treatment users in order to develop a fully-automated, cognitive behavioral therapy-based text messaging intervention. We then conducted a randomized, crossover pre-test in 5 users seeking treatment. Participants’ ratings of ease of use and functionality of the system were high. During the pre-test we performed real-time assessments via text messaging on daily methamphetamine use, craving levels, and the perceived usefulness of messages; 79% of scheduled assessments were collected. The odds of messages being rated as “very” or “extremely” useful were 6.6 times [95% CI: 2.2, 19.4] higher in the active vs. placebo periods. The intervention is now ready for testing in randomized clinical trials.

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There is relatively little research on the Personality Assessment Inventory (PAI) with mild traumatic brain injury (MTBI) populations. There is also little research on how compensation-seeking status affects personality assessment results in MTBI patients. The current study examined the PAI scales and subscales in two MTBI groups, one composed of compensation-seeking MTBI patients and the other consisting of non-compensation-seeking MTBI patients. Results indicated significant differences on several scales and subscales between the two MTBI groups, with the compensation-seeking MTBI patients having significantly higher elevations on scales related to somatic preoccupation (Somatic Complaint Scale, SOM), emotional distress (Anxiety Scale, ANX; Anxiety Related Disorders Scale, ARD; Depression Scale, DEP), and the Negative Impression Management, NIM, validity scale. All the SOM subscales and the Anxiety Cognitive (ANX-C) and ANX Affective, ANX-A, subscales were also elevated in the compensation-seeking group. Results indicated that several scales on the PAI were sensitive to group differences in compensation-seeking status in MTBI patients.