Smoking and nicotine dependence are particularly common in patients with a psychiatric disorder compared to the general population.

To study the prevalence of smoking in patients followed at the department of psychiatry and to assess their dependence on nicotine.

This was a cross-sectional, descriptive and analytical study. The study focused on patients followed at the department of psychiatry of the regional hospital of Gabes. Sociodemographic and clinical data were assessed. Fagerstrom questionnaire in its validated French version was used to assess the nicotine dependence. Data were analyzed using the software SPSS (20th edition).

100 patients were included. They were male (60%) and single (50%) and with a mean age of 45.3 years [18-71]. The three most common pathologies were anxiety disorders (31%), schizophrenia (30%) and depression (29%). Among the patients surveyed 48% were smokers. Of which, 93.7% smoked cigarettes, 20.8% snorted chewing tobacco and 12.5% smoked hookah. The average number of pack-years was 11.6, with an average of 22.8 cigarettes per day. The mean duration of regular smoking was 19.1 years. Regarding nicotine dependence, 42% of patients were dependent. Regarding the degree of dependency, 43.7% were heavily dependent, 25% were weakly dependent and 18.8% were moderately dependent. Smoking was significantly associated with the male gender (p≤10-3), alcoholism (p=0.002) and schizophrenia (p=0.006).

Results of our study show that smoking is frequent in patients followed at the psychiatry department. This aspect should be taken into account during the psychiatric evaluation, especially when therapeutic resistance occurs.

Various digital technologies are increasingly being introduced into the everyday life of children. There are evidences that digital addiction has negative effect on cognitive functions of children. What kind of specific effect does this new “digital environment” have for children?

The goal of this research is to check the hypothesis that 7-year-old children with computer game addiction have weakness in sustained attention.

We used questionnaire for parents to reveal children with computer game addiction. Experimental group consisted of 28 7-year-old children with computer game addiction. Control group consisted of 28 children without computer game addiction. Children from experimental and control group were matched for gender and IQ. To assess the sustained attention we used subtest from Luria’s child neuropsychological battery. This subtest is designed to assess visual sustained attention.

One-way ANOVAs by group revealed significant differences (p≤0,05) between the groups in the level of visual sustained attention.

It can be assumed that computer game addiction has negative effect on the development of visual sustained attention in children. However, we need to do additional research to approve this preliminary results.

It is known that children with computer game addiction have a risk for development of deficit in executive abilities. It is important to develop effective approaches for helping children with this addiction.

The goal of this study was to reveal effect of body-oriented therapy on executive abilities in children with computer game addiction. Particularly we compared the efficacy of two methods of treatment (body-oriented therapy for children vs. conventional motor exercises) in a randomized controlled pilot study.

16 7-year-old children with computer game addiction were included and randomly assigned to treatment conditions according to a 2×2 cross-over design. The body-oriented therapy included the exercises from yoga and breathing techniques. To assess the executive functions and attention in children we used 5 subtests from NEPSY (Tower, Auditory Attention and Response Set, Visual Attention, Statue, Design Fluency). Effects of treatment were analyzed by means of an ANOVA for repeated measurements.

The ANOVA has revealed (p<.05) that for all 5 subtests on executive functions and attention the body-oriented therapy was superior to the conventional motor training, with effect sizes in the medium-to-high range (0.42-0.80).

The findings from this pilot study suggest that body-oriented therapy can effectively influence the executive abilities in children with computer game addiction. However, it is necessary to do further research into the impact of body-oriented therapies on children with this addiction.

Children with computer game addiction have a risk for development of deficit in mental functions. What kind of specific effect does this new “digital environment” have for children?

The goal of this research is to check the hypothesis that there is relationship between computer game addiction and low mood in 8-year-old children.

We used questionnaire for parents to reveal children with computer game addiction. Experimental group consisted of 24 8-year-old children with computer game addiction. Control group consisted of 24 children without computer game addiction. The children from experimental and control group were matched for gender. We used Revised Children’s Anxiety and Depression Scale (RCADS) for assessment of separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and low mood (major depressive disorder) in children (Child Self-Reported).

Spearman correlation analysis has revealed the significant (p<0.05) positive correlation between level of computer game addiction and low mood in children. However, we did not find the correlation between level of computer game addiction and other scales of RCADS.

It can be assumed that digital environment is a risk for increasing low mood in children. However, we need to do additional research using experimental design to approve the hypothesis that computer game addiction can cause the low mood in children.

The conceptualization of impulsivity and compulsiveness has fluctuated between two different perspectives: they are (1) distinct and orthogonal dimensions, (2) extreme poles of the same dimension/ spectrum. We favor this latter, accepting that these dimensions contribute to the etiopathogenesis of impulsive-compulsive disorders, namely alcohol use disorder/AUD.

To analyze: Differences of impulsivity and compulsivity levels between AUD patients vs. participants from the community; prevalence of impulsive-compulsive disorders/ICD in AUD; if impulsivity/compulsivity predict the severity of alcohol use and ICD in AUD.

32 AUD patients (21% women, mean age 46±10) answered the Portuguese versions of: Alcohol-Use-Disorders-Identification-Test, Questionnaire-for-Impulsive-Compulsive-Disorders-in-Parkinson’s-Disease, Barrat-Impulsiveness-Scale, Obsessive-Compulsive-Inventory and Depression-Anxiety-Stress-Scales; 50 adults from the community (68% women, mean age 29±14) answered the former three. Mann-Whitney-U, Spearman and regression tests were performed using SPSS.

AUD individuals vs. subjects from the community presented higher levels of impulsivity and compulsivity (p<.001). AUD-group: AUDIT median score was 25 (>8 harmful use); 81% reported ICD-symptoms; impulsivity and compulsivity highly correlated (r=.639; p<.001); impulsivity levels explained the presence of certain ICD (gambling, compulsive buying, eating disorders) and depression/anxiety/stress (OR=.152; p<.05); compulsivity levels also explained the occurrence of specific ICD (compulsive buying and other repetitive automatic behaviours) and depression/anxiety/stress (OR=.131 p<.05).

Our results indicate that impulsivity and compulsivity co-occur and contribute to the explanation of AUD, and related comorbidity and psychological distress. This highlights the utility of considering impulsivity and compulsivity when subtyping, stratifying, and treating AUD patients. Finally, we assert that disorders of impulsivity and compulsivity (eg.: AUD and ICD) co-occur.

No significant relationships.

The analysis of the impact of individuals’ behaviors on their health involves several variables, namely alcoholism. It is necessary to take in account that when anxiety is excessive it may be very disabling and produce many adverse effects, such as unsatisfactory work performance, anxiety disorders, depressive mood and somatic symptoms. These elements affect the Quality of Life (QOL) drastically, while social support of the patients protect QOL.

To assess the quality of life of patients with alcohol use disorders in treatment for alcohol use disorder (AUD).

An exploratory, descriptive and correlational study was carried out. A sociodemographic scale was used, an instrument constructed by the authors that assesses the existence of risk behaviors and protective health behaviors, the Social Support Satisfaction Scale (ESSS), and a quality of life assessment scale (WHOQOL-Bref). Data analysis was performed using IBM SPSS 25 statistics.

Sample consisting of 34 patients with Alcohol Use Disorders. Abstinence time is positively correlated with QOL and negatively correlated with social support satisfaction.

This study shows that in treatment of patients with AUD, longer abstinence times have a positive effect on QOL and overall wellbeing of patients, while being associated with a lower satisfaction with social support. Treatment Units dedicated to AUD should keep striving for maintenance of abstinence due to these positive effects.

Generalized problematic internet use/GPIU has recently been associated with the impulsive-compulsive spectrum/ICS, but its mapping onto these behaviour dimensions is relatively unexplored.

To compare patterns of internet use and scores of BIG-5 personality traits, perfectionism and psychological distress between groups with low/high levels of GPIU.

475 university students (78.9% girls; mean age 20.22±1.695) answered the Portuguese versions of: GPIU Scale, Multidimensional Perfectionism Scale-13, NEO-FFI-20, Depression, Anxiety and Stress Scales and other questions about internet use. Chi-square and Mann-Whitney tests were performed using SPSS.

Individuals with high levels of GPIU (median+2SD; n=18; 3.8%) spent significantly more time/day in online activities, exceeding what they have planned; had no other hobbies and used social networks to meet friends; reported that GPIU interfered with affective/work relationships and academic performance (all p<.05). There were no significant differences in the purposes of the internet use (e-mail, social networks, shopping, videogames, multimedia, sexual, work…), unless for general information searching and betting games (both p<.05). High-PGIU group also presented significant higher levels of neuroticism, negative (but not positive) perfectionism, depression, anxiety, and stress (all p<.001).

Our results indicate that unlike the purposes of internet use, personality, perceived interference and the associated cognitive-emotional processes and symptoms (psychological distress) may help distinguishing between functional vs. dysfunctional internet use. Considering the preponderance of processes over contents and the presence of certain dimensions, such as perception of uncontrollability, interference and social isolation we add more evidence to consider PGIU as falling within the spectrum of impulsive-compulsive disorders.

No significant relationships.

Burn-out is quite common in hospitals especially among young doctors. It results from a mismatch between expectation and professional reality.

To determine the prevalence of sever burnout and to identify its associated socio-demographic and psychological factors among young residents.

Analytical and descriptive cross-sectional study conducted among residents and interns working at the Hedi Chaker and Hbib Bourguiba University hospital in Sfax, Tunisia, during the month of July 2019. The characteristics of the participants were collected using a questionnaire. Burnout was evaluated using the Maslach Burnout Inventory(MBI) differentiating 3 components: emotional exhaustion, depersonalization and luck of personal achievement.

Out of 85 questionnaires disturbed,60 were selected corresponding to a response rate of 72.94%. The sex ratio (M/F) was 0.87. The middle age was 28.22. Forty three percent of the participants were married. More than half consumed tobacco and 45% of them consumed alcohol. The majority of doctors were residents(81.7%). The average working time was 55 hours per week. Burn-out was severe in 30% of our population. Furthermore, doctors who suffered from physical aggression(p=0.001) were more likely to develop severe burn-out. The dissatisfaction with the internship (p=0.01) and the feeling of do not satisfy seniors(p=0.02) were statistically associated with severe burnout. Severe burn-out was associated with anxiety (p=0.0073), conflictual partnership (p=0.0001),conflicts with colleagues(p=0.001) and the paramedical framework (p=0.0001)

The risk of burn-out is quite high among young doctors. Some factors seem to be associated with this phenomenon. This could affect not only the quality of life, but also the quality of care provided.

burnout-young doctors-prevalence-associated factors

In the U.S. approximately11.4 million misused prescription pain relievers; 2.1 million had an OUD in 2017. The Addictions Nursing Subspecialty was created to address this epidemic by expanding a workforce trained in OUD/SUD screening, treatment, and prevention. A curriculum was developed that included integrated/telehealth health care settings in medical and mental health provider shortage areas during their last nine months of training. Courses were developed and taught by aninterprofessional team of university faculty and informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery. Courses were also offered as electives for nursing, clinical-counseling, social work, and other health science disciplines emphasizing an interdisciplinary approach to healthcare.

Expand the OUD/SUD trained workforce in areas with high OUD/SUD mortality rates and high mental health provider shortages emphasizing team-based integrated care and telehealth settings.

Program curriculum was informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery using integrated care. Competencies included: Core Competencies for Integrated Behavioral Health and Primary Care that have been set forth by the Center for Integrated Health Solutions, telehealth competencies outlined in the recommended competencies by the National Organization of Nurse Practitioner Faculties (NONPF), and Core Competencies for Addictions Medicine by the American Board of Addictions Medicine.

Approximately 11 students enrolled in courses received additions integrated/telehealth health care settings. Students responded positively to evaluations regarding timely feedback, unique approach (i.e. intrative content, short videos and discussions).

The Addictions Nursing subspecialty will continue to be offered allowing enrollment for nurses twice a year.

In Tunisia, the use of cannabis has become an important phenomenon in the society that not well attested by epidemiological studies.

The purpose of this work is to study the socio-demographic criteria of student of the faculty of Pharmacy of Monastir and risk factors encouraging them to consume cannabis and to estimate the extent of the phenomenon of dependence occurring among students.

A questionnaire composed of 45 questions was sent to students of the Faculty of Pharmacy of Monastir via the internet. The data was collected and analyzed using the software’ Google forms’ and ‘statistical package for social Science’ (SPSS)

The prevalence of cannabis use among students of the faculty of Pharmacy was worrying, increasing to 21.4 %, for moments of pleasure and relaxation of the stressful life (p=0 et p=0.008). The frequency of cannabis use had a significant impact on the desire to stop cannabis use (p=0.012). Of the 55 consumers, only 5 tried to stop or reduce cannabis use. About 88% of participants indicated that cannabis was responsible for psychological dependence. Polydrug use (tobacco, alcohol, other drugs) had a significant influence on this use (p=0).

The scourge of cannabis use has invaded not only universities, but also high schools and colleges. At the end of this work, we propose debates to find the necessary means to protect cannabis users cannabis and treat dependents.

Psychotropic medications are widely used in Tunisia. Studies about frequency of substance use are rare

The purpose of this work is to determine frequency of use of psychotropic medication among pharmacy students in Monastir University during their university years and during the last year and to assess the factors associated to this consumption

A retrospective study was used to collect the information about 145 participants using a questionnaire asking about the consumption of psychotropic medications and the factors associated to substance use

145 subjects aged 22.71 years +/- 2.04 among them 25% was men and 75 % women. Psychotropic medication use was 20 % during university years and 17.24 % during the last year. 45 % of the users had their medications without a prescription from a doctor. 17 % of the users of psychotropic medication weren’t informed about the effects of the drugs. A higher consumption of psychotropic drugs was observed among older individuals (p=0.009; F=6.928), redoubling individuals (p=0.003), with conflictive relationships with family (p=0.001), using others psychotropic substances, feeling often nervous (p=0.003; F=9.318) and with personal history of mental illness (p=0.002).

Our finding underlines the need of larger more comprehensive surveys to determine the efficiency of the prevention strategies and to minimize the consumption of psychotropic drugs or to control it.

dependence Risk factors drugs students

Ethanol is widely consumed by the world’s population, especially young people as part of their university life. In Tunisia, surveys and studies about consumption of ethanol among students are rare or even exceptional.

To evaluate the extent of the consumption of ethanol among pharmacy students in Monastir University, from the first year to residency, and to define the factors associated to this consumption.

This study was used to collected information about the participants using a questionnaire that covers the different parameters of the consumption of ethanol during student life and the factors influencing this consumption.

154 participants aged 23.61 years +/- 2.63 among them 37.7% were men and 62.3% women. The prevalence of ethanol consumption was 44.8 %. The main reason for dirking was to party (79.2%). The consumption of ethanol was significantly associated with sex (p=0), place of residence (p=0.047), frequency of hang-outs (p=0), sex life (p=0) and students perception of the alcohol-health relationship (p=0). Various health problems were related to the frequency of consumption of ethanol, such as memory problems (p=0.002), violence and injuries (p=0.014).

The findings of this study underline the need to develop specific studies and general population surveys in order to better assess the situation in Tunisia and to put in place appropriate prevention strategies, such as information and awareness campaigns, aimed at reducing or at least rationing the consumption of ethanol.

No significant relationships.

The word motivation derives from the Latin movere, which means to move. In psychiatry, it is an isolated phenomenon found in the substrate of several pathologies, and may be part of an heterogeneous dimensional spectrum. However, there is no unique definition for it, nor a targeted approach. In addictive disorders motivation gains a fundamental role, both as a precipitant of abuse as in its withdrawal.

To review the literature about the concept of motivation and its implications on the psychopathology, especially on addictive disorders.

Narrative review on PubMed/MEDLINE, using the keywords “motivation” AND “psychopatology” AND “addiction”. Articles in English and Portuguese were included.

Three main perspectives were found addressing the concept of motivation in psychopathological terms: psychological, neurobiological and phenomenological. The first describes motivation as the energizing of behaviour in pursuit of a goal. Neurobiology says motivational drive is dependent on the concentration of extrasynaptic dopamine. In phenomenological terms, the concept stands for the web of solicitations that make a certain situation feel in a certain way for the subject. In addictive disorders, learning about what leads to reward, exaggeration in representing those values, and dominance in being guided by those representations lead to alterations on motivation mechanisms.

Motivation is described from different perspectives. Although it is recognized as a fundamental piece in addictive disorders, besides motivational interview model, there are no pharmacological approaches aimed to improving motivation. The recognition of motivation as a concrete psychopathological alteration, and its measure through psychopathological instruments, could optimize the patient’s approach.

The Internet Addiction Test (IAT) is a 20-item, self-reported questionnaire that measures the presence and severity of Internet addiction which is an increasing problem in adolescents. Although a Portuguese version IAT has been validated in adults, its psychometric properties have never been evaluated before, in adolescents.

To analyse the reliability and construct and concurrent validity of the IAT in a Portuguese adolescent sample.

772 adolescents (53.5% girls), mean aged 13.21±2.246, answered the Portuguese versions of the IAT and the Portuguese versions of validated scales to evaluate: Cyberbullying, Game Addiction, Agressivity and Anxiety, Depression Scales. To study the temporal stability, 377 (60.5% girls) respondents answered the questionnaires again after approximately four-six weeks. The total sample was aleatory splitted to realize the exploratory and the confirmatory factor analyses.

Exploratory and confirmatory factor analyses supported a second order two-factor structure - “Isolation and Social Commitment” and F2-“Negligence and Functional Commitment”. The χ2/df value was 2.260 and had a significant p value; it had the lowest RMSEA score = .074 (p< .001) and it had the highest TLI (.980) and CFI (.905). IAT mean scores were no different between genders [Girls=29.25±18.775 vs. Boys: 30.85±17.929, p=.405]. The Cronbach’s alphas were > .85. Pearson correlation between the test and the re-test was r=.660. The IAT, video game addiction (r=.434), Cyberbullying (r=.383), anxiety (r=.209) and depression (r=.263) were significantly correlated (p<.001).

The Portuguese IAT has good reliability and validity, showing to be an adequate instrument for measuring Internet Addiction symptoms in Portuguese Adolescents.

Internet addiction (IA) is a significant public health issue among adolescents. There is considerable evidence that IA is associated with various psychosocial harms.

The aim of this study was to measure the prevalence of internet addiction among secondary school.

This cross-sectional study was conducted among 152 students enrolled in secondary school. The participants had filled the Internet Addiction Test of Young and a data file regarding the socio-demographic information, physical and information about the internet access and use.

The sample consisted of 90 males and 62 females with a mean age of 13.14 ± 1.2 years. The majority of participants had their own smartphone (83.6%). The average duration of connection among participants was 5.3 hours per day. The prevalence of IA was 14,5%. Results showed that 46,8% feel their internet use significantly hinders their family relationships. Twenty participants (13,2%) reported that they connected to the internet while they were in classroom. The prevalence of IA was higher among boys than girls (p= 0.018). There was, also, a significant relation between IA and having academic difficulties (p=0.037).

The prevalence of IA is elevated in Tunisia. Many negative consequences are identified. Urgent measures should be taken to counter the problem.

The intentional use of drugs before or during sexual intercourse (chemsex), due to its impact on mental health, is a phenomenon of high importance in men who have sex with men. The main drugs usually described in chemsex related research are methamphetamine, mephedrone and GHB/GBL.

We present a narrative review of the evidence about the mechanisms of action of different drugs used in chemsex context.

Narrative Review.

Different drugs have been associated with chemsex use: stimulants such as cocaine, stimulants with empathogenic properties such as mephedrone, methamphetamine, MDMA; stimulants with a psychedelic effect such as 2C-B; depressants such as GHB/GBL and ethyl chloride; and dissociative hallucinogens such as ketamine.

Classical chemsex research includes only mephedrone, metanphetamine and GHB as “chemsex drugs”. Recently, different drugs have been described associated with chemsex practice. Clinicians may encounter polydrug chemsex users and the different mecanisms of action, mental health problems related to every drug and polydrug use must be takek into account.

The process of emotional regulation allows the patient to deal with various situations throughout life, since it includes the ability to create and control emotions, in order to guide action and interaction with others. However, people with alcohol use disorder (AUD) is not always able to give appropriate responses to surronding situations in the face of certain specific emotions.

We aimed to evaluate the use of emotional regulation strategies in people with AUD.

A descriptive and correlational study was conducted. A sociodemographic questionnaire, that included variables to assess aspects related to AUD, and the Emotion Regulation Questionnaire were used.

The sample had 25 participants, mostly male, average age of 46.68 years. 44% were married, and most cases had an withdrawal time larger than 3 months. Regarding emotional regulation strategies, it was found that the participants resort more to cognitive reassessment (M=26.59,SD = 7.54), compared to emotional suppression (M = 15.16, SD = 5.03). Statistically significant differences were found between genders in relation to cognitive reassessment (U = 29.00; p = 0.02). No correlations were found between withdrawal time, treatment time, cognitive reevaluation and emotional suppression.

Results show differences between gender, and the absence of a relationship between educational qualifications in cognitive reassessment, contradicting previous findings on general Portuguese population. This data points to the need to implement intervention programs in this population, taking into account the gender variable, and including the development of the ability to identify and express emotions, as well as of strategies to deal with emotional aspects.

The persistent and recurrent use of the internet to engage in games, often with other players, which leads to clinically considerable deficits and online dependency still lacks more research support its impact of attentional levels and Sleep Quality.

To assess levels of Online Gaming Dependency, its impact on attention levels and quality of sleep among online gamers.

The following instruments were used: a sociodemographic questionnaire, as well as the Video Game Behavior Assessment Scale (α = .842) and the Portuguese version of Color and Words Stroop Test. The sample consists of 66 individuals, 92.3% male and 7.7% female, with an average age of 23.1 (SD ± 4.07).

Mild levels of online gaming dependency were obtained. Male gamers presented higher motivation to play online games, and higher levels of Stroop interference. Regarding the association between gaming behaviors and quality of sleep, results show that individuals who have difficulty falling asleep show greater motivation to play online games, a greater degree of concern with daily life and a greater frequency of negative behaviors in relation to online gambling.

The results show the importance of an increase in investigations in this area, as well as to the development of psychological assessment instruments and psychological intervention strategies, based on scientific evidence, on the different variables under study, in order to improve the quality of life in of individuals.

COVID-19 has been declared as a pandemic by the World Health Organization on March, 2020. Opioid substitution therapy (OST) for opioid-dependent patients is an evidence-based, effective outpatient (OPD) based treatment maintained on medications(, buprenorphine-naloxone combination). These are difficult times for patients with addictive disorders. Authors came up with an idea of implementing “walk through” out patient model inspired by “Drive through” model of Mc Donalds in which Doctor and Nurses run open space OPD near to Medical record section to reduce the waiting time of patient, quick delivery and minimize droplet exposure.

To study the efficacy of Mc Donald’s model of OST in OST centre in Tarn Taran, india.

This was a restrospective-comparative study. We studied records of our patients using streatment as usual from September 2019 to March 2020 and using Mc Donald’s model (From April 2020 to October, 2020) for a period of 6 months during and before lockdown.

The average number of patients attending OST clinics during Covid lockdown was 352.8. The compliance rates significantly improved (57.82%), The drop out rates were much lower (20.78%), using Mc Donald’s model than usual treatment.

As per our knowledge, this study is first of its kind to study the efficacy of OST drug deliverance in pre Covid and Covid times and suggest, the new findings which can be inculcated in the other OSTs.

The Addictions Recovery Community Hillingdon (ARCH) is a specialist addictions treatment service, providing a range of inteventions for substance use disorders. The onset of the COVID-19 pandemic required healthcare services to rapidly adapt clinical care in order to safeguard patients and staff from contracting the virus whilst managing clinical risk. Key changes were made to treatment pathways at ARCH.

1. Reduce face-to-face contact between patients and staff (including community pharmacists) 2. To get feedback from patients and staff about changes implemented

To reduce face-to-face contact, we aimed to decrease the number of patients having supervised consumption of Opiate Substitute Treatment (OST). Furthermore, telephone consultations were encouraged for keyworking and reviews. Patients were randomly selected and interviewed about their experiences and focus groups were be completed with staff.

Supervised consumption of OST was reduced from 41.5% to 6%. Face-to-face appointments were significantly reduced and telephone consultations were introduced as standard. Telephone reviews became the standard method of contact for keyworking sessions and medical reviews. 53% of services whose interval between instalment collection of OST at community pharmacies was extended found it ‘easy’ or ‘very easy’ to adapt to. 61% of service users who had access virtual platforms finding it ‘easy’ or ‘very easy’ to access support. Focus groups of staff members revealed that stafff felt the changes in instalment collection of OST was positive for patients.

ARCH implemented a number of changes to treatment pathways and inteventions to minimise the risk of virus transmission amongst patients and staff whilst managing clinical risk.