A turning point in the HIV epidemic was the introduction of protease inhibitors. It was clear to some that treatment of HIV infected individuals with these potent antiviral agents was needed as early as possible, and with this paradigm shift, HIV became a livable chronic disease. There are some lessons learned from the HIV epidemic relevant to the current synthetic opioid epidemic.

Patients with mental health and addiction disorders are the only core cigarette smokers left in the Western world as the number of smokers in the general population has declined dramatically over the last decades. Simultaneously there is a gap in life expectancy of more than 20 years between patients who have been in treatment for mental disorders and the rest of the population and this gap has not declined in the last two decades. Adding to this are new research findings that show that cigarette smoking has a detrimental effect also on mental health being a risk factor for depressive symptoms. There is therefore a need for concentrated action to curb the smoking epidemic among people with mental health and addiction disorders. There is limited research and guidelines on how to both prevent and cease smoking in this group. The aim of this paper is to give an overview of the current literature of the size of the problem, how to handle smoking cessation both individually and at system level and on the prevention of smoking. The review confirms that the rate of smokers among patients with mental health and addiction disorders is huge with some figures pointing up to 80 % in specific groups. It also confirms that cigarette smoking is strongly addictive making the success rates low, especially without aides like snooze and e-cigarettes. It also shows, however, that it is safe to create a smoking-free environment in all mental health and addiction units which also might be beneficial to the patients in the long run.

This narrative review is based on a literature search on PsycINFO and PubMed that involved entering the terms adolescent internet gaming for papers published during the last five years. Following exclusion criteria, 72 papers could be classified as internet gaming or internet gaming disorder/addiction studies including research on the prevalence, effects/comorbidities, risk factors and interventions for those problems. The prevalence of both internet gaming and internet gaming disorder has varied by culture. The effects/comorbidities have included hyperactivity, inattentiveness, cyberbullying, depression, anxiety and substance use. The risk factor studies have focused on impulsivity, sensation-seeking, and aggressivity. Altered autonomic and central nervous system function have also been notable including decreased heart rate variability and fMRI data showing less activation of the prefrontal cortex, ventral striatum and amygdala (areas that are involved in modulating impulsivity, reward-seeking and aggression respectively) as well as reduced gray and white matter. Surprisingly, given the prevalence and severity of internet gaming disorder, very little prevention/intervention research appears in this recent literature. Research is also missing on peer relationships/rejection as potential risk factors. Like other literature on adolescent problems, this research is limited by primarily deriving from self–report and parent report and by the absence of longitudinal data that might inform whether the behavioral and brain data being reported are effects of or risk factors for internet gaming addiction.

The abortion rate in the former Soviet Union has been reported as the highest in the world, caused not only by insufficient availability of modern contraception but also by lack of consideration of the potential consequences of unprotected sex, particularly pregnancy. During the last two decades, the abortion rate in Russia has declined considerably, binge drinking tending to decrease as well. The prevailing opinion is that binge drinking and alcohol consumption prior to sexual relations are risk factors for the non-use of condoms. The association between alcohol consumption and high-risk sexual behavior is explainable within the framework of the alcohol myopia theory. Moreover, the behavior may be influenced by slowly progressive personality changes that are developed due to chronic alcohol abuse and heavy binge drinking.

Kratom is an herbal alkaloid dietary supplement that acts agonistically at opioid receptors. It is increasingly used by those with opioid dependency to treat symptoms of opioid withdrawal. Classification and regulation of kratom is controversial. Currently it is unregulated, widely available and heavily advertised. Advocates tout its potential to help those with opioid dependency however risks to kratom use are well documented. It has been associated with dependency, withdrawal, toxicity and more recently neonatal abstinence syndrome (NAS) or withdrawal in newborns. For these reasons, pediatricians need to be aware of its existence and potential to impact their patients.