OBJECTIVE:Partial hospitalization programs (PHP) are acute psychiatric settings that commonly treat patients with active suicidal ideation (SI), anxiety, and alcohol use. Alcohol use is common among patients with SI and anxiety, and this triple vulnerability may negatively impact treatment engagement and outcomes in PHP. This study examined whether patients presenting with SI, elevated anxiety, and alcohol use ("triple vulnerability") demonstrated differences in PHP treatment outcomes (completing treatment, number of days attended, number of absences) compared to patients without the vulnerability. METHODS:Participants were 493 patients admitted to an Acceptance and Commitment Therapy-based PHP program in the United States between 2014-2020. Triple vulnerability was defined as reporting (1) active SI, (2) clinically elevated anxiety (CUXOS-D ≥ 20), and (3) consuming ≥ 1 alcoholic drink on a typical drinking day within the past year. Binary and linear regressions were used to assess differences in treatment completion status, number of days attended, and number of absences. RESULTS:The triple vulnerability was not significantly associated with treatment completion status or with the number of absences; it was, however, positively associated with the number of days attended at PHP. CONCLUSION:People who experience SI, clinically elevated anxiety, and who consume at least one alcoholic beverage on a typical drinking day are more likely to attend PHP for a longer duration of time, but are not any more susceptible to not finishing treatment, relative to people who do not have the triple vulnerability. Future work can benefit from exploring additional treatment outcomes that may be impacted by patients with the triple vulnerability.
BACKGROUND:Maternal smoking during pregnancy (MSDP) remains a common source of prenatal drug exposure worldwide. MSDP has been shown to increase fetal health risks and interfere with fetal development. Although newborns prenatally exposed to other substances (e.g., opiates, benzodiazepines) have been shown to have increased stress and withdrawal symptoms, few studies have explored the effect of MSDP on the fetal and neonatal periods. METHODS:We performed a comprehensive search for empirical research articles investigating the effects of MSDP on fetal and neonatal neurobehavior and signs of abstinence in PubMed and PsycINFO databases. Our search yielded 11 fetal and 14 neonatal empirical articles published between 1980 and 2025. RESULTS:In the fetal period, MSDP-exposed fetuses showed decreased fetal heart rate variability, and fetal movement and reactivity vs unexposed fetuses. In the early neonatal period (birth to five days), MSDP-exposed newborns showed increased excitability, irritability, need for handling, arousal, and alertness. In the late neonatal period (10 to 35 days), studies found MSDP to have an effect on neonatal self-regulation, attention, quality of movement, abnormalities in reflexes, lethargy, need for handling, and stress signs. CONCLUSIONS:Our review of the literature revealed that MSDP has been associated with alterations in behavior suggestive of potential abstinence symptoms, especially found for excitability, irritability, hypertonicity, attention, reflex abnormalities, and stress/abstinence signs. Additional rigorous research needs to delineate the impact of MSDP on fetal and neonatal signs of abstinence to improve infant health.
Adverse childhood experiences (ACEs) are associated with elevated risk for substance use disorders (SUDs), yet prevailing accounts often emphasize psychosocial pathways and reward-circuit recalibration without fully articulating immunobiological mechanisms that may converge on these processes. This narrative review advances a biological embedding framework linking early adversity to SUD vulnerability through two partially overlapping pathways: 1) stress-reward neurodevelopmental recalibration and 2) immune embedding with downstream neuroimmune feedback. Drawing on epide- miologic and mechanistic studies across developmental psychopathology, addiction neuroscience, and psychoneuroimmunology, we synthesize evidence that ACE exposure can produce enduring alterations in stress- regulatory systems (e.g., hypothalamic-pituitary-adrenal axis and autonomic function) alongside low-grade inflammatory phenotypes characterized by altered cytokine signaling and glucocorticoid sensitivity. We then highlight convergent evidence that peripheral immune activation can influence central reward and affective processes via microglial priming, cytokine-mediated modulation of monoaminergic systems (particularly dopamine), and tryptophan-kynurenine metabolism, potentially contributing to anhedonia, negative affect, and craving-relevant reinforcement dynamics. Next, we describe limitations of the present review and of the broader evidence base, as well as priority research directions. We conclude by arguing that integrating immune embedding with stress- reward recalibration may clarify one pathway by which ACEs confer SUD vulnerability and may inform trauma- informed, neurobiologically grounded approaches to prevention and treatment.
BACKGROUND:Co-occurrence of Bipolar Disorder (BD) and Substance Use Disorder (SUD) increases the risk of negative mental health outcomes, including both intentional (i.e., suicide self-poisoning) and unintentional overdose (i.e., accidental). While it is clear that both forms of overdose are a relevant concern, less is understood about the differences in phenomenology between intentional and unintentional overdose among this high-risk group. METHODS:Demographic and clinical characteristics were drawn from a sample of patients at a Rhode Island hospital during their baseline session of a larger psychosocial intervention clinical trial. RESULTS:Among 171 participants with co-occurring BD-SUD, 77% reported a history of any type of overdose, 48% reported a history of unintentional overdose, 56% reported a lifetime suicide attempt via intentional overdose, and 28% reported experiencing both intentional and unintentional overdose. Collectively, antidepressant/antipsychotic/mood-stabilizing medications were the most frequently reported substances for intentional overdose, followed by sedating medications and alcohol. Opioids were the most frequently reported substance for accidental overdose, followed by alcohol and stimulants. Polysubstance use was indicated for 62% of intentional overdose events and 43% of accidental overdose events. Compared to participants with a history of intentional overdose only, those who have experienced both types of overdose were significantly younger and more likely to have co-occurring alcohol use disorder and drug use disorder. CONCLUSIONS:Our findings suggest that psychotropic medications traditionally used to treat BD and other psy- chiatric disorders are often implicated in intentional over- dose. Additionally, our results highlight the need for a focus on prevention of polysubstance overdose across the intentionality spectrum.
