At the turn of the 21st century, pain management became a major public health concern, recognized as the 5th vital sign in VA healthcare, while opioid prescribing for chronic pain surged, leading to a fivefold increase in morphine milligram equivalents by 2010. In 2013, the DSM-5 redefined Substance Use Disorder (SUD) criteria, excluding tolerance and withdrawal for medically prescribed opioids. As the opioid epidemic unfolded, the limitations of long-term opioid therapy for chronic pain became evident, prompting current guidelines to discourage opioid initiation in favor of non-opioid approaches. However, some patients remain on long-term opioid therapy, struggling to taper without functional improvement, raising questions about whether these cases fit under mild Opioid Use Disorder (OUD) or require a new diagnostic category. This talk will address this ambiguity, outlining a clinical decision-making framework, and exploring the need for new diagnostic approaches when opioid harms outweigh benefits.

Tourette’s and related tic disorders are relatively common and often impairing conditions. While pharmacotherapy has historically been considered the first-line (and only) active treatment for tics, medication use in children has been limited by safety and tolerability concerns. Over the past two decades behavioral treatments, most notably, the Comprehensive Behavioral Intervention for Tics (CBIT), have demonstrated efficacy and tolerability for tics in youth and adults, leading to designation as a first-line treatment, when available, for treating tics by the American Academy of Neurology and European and Canadian medical academies. This presentation will review the clinical aspects of Tourette’s and other tic disorders most relevant for treatment and describe the theoretical underpinings, implementation, benefits, and long-term outcomes of CBIT with reference to other treatment modalities. Core treatment elements will be demonstrated to illustrate their role in treatment. Following completion of the presentation, attendees should be able to describe the core components of this treatment.

Cognitive behavioral therapy was first applied to psychotic disorders by Aaron Beck in 1952, however the first clinical trial of cognitive behavioral therapy for psychosis (CBT-P) was not completed until 1992. CBT-P has been shown to reduce distress related to psychotic symptoms by up to 40% and improve overall functioning. The evidence supporting its use is so robust that it is recommended in the American Psychiatric Association (APA) guidelines as well as the National Institutes of Health and Clinical Excellence (NICE) guidelines for treatment of schizophrenia. However, this treatment remains underutilized and often unavailable for people in the United States experiencing psychosis due to lack of experienced practitioners and lack of understanding regarding the benefit of CBT-P in the treatment of psychotic disorders. This presentation aims to improve understanding of the evidence base surrounding CBT-P in the treatment of people experiencing psychosis and to describe the process of CBT-P.