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Thank u Nimhans for this wonderful course. I feel updated and my knowledge refreshed. I hope to be a part of this type of educational learning in future also.It has been an enriching journey of 6 months where in the middle of a regular life and common duties, i am able to get to interact with psychiatrists all over the country and share experience and knowledge. Thank u nimhans for giving me a chance to do so.

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Thank u Nimhans for this wonderful course. I feel updated and my knowledge refreshed. I hope to be a part of this type of educational learning in future also.It has been an enriching journey of 6 months where in the middle of a regular life and common duties, i am able to get to interact with psychiatrists all over the country and share experience and knowledge. Thank u nimhans for giving me a chance to do so.

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A good way to continue medical education. Enjoyed the slido quiz.

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What I found most interesting about attending this course was that, it kept me pushing towards continuing learning 🚀

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The course has been a great learning experience. A big thanks to the entire NIMHANS team who helped in organising and running this course. The team has been very cooperative.

A lot of knowledge sharing and learning happened, guidelines were revised and discussed, lots of clinical discussions with a balance of theoretical learning. Overall great experience. Would love to do more such courses.

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Wonderful learning experience with ACCMAD 6.0

Weekly didactic lectures with case presentations will be helpful in clinical practice. E-learning platform has very good study materials. Slido quiz was also helpful to keep us on our toes. Thanks to management and faculty for everything.

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excellent distant learning course more like update for the professionals with a disciplined maintenance of time with an empathetic understanding of the clinicians difficulty and modifying. instant response to queries

dr. vidhya

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Thank you Nimhans for this course. It has helped me to build confidence in my practise and academics. I hope to be a part of this kind of course in future also because it has helped me in enriching with shared knowledge and experience across the country.

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Thank you Nimhans for this course. It has helped me to build confidence in my practise and academics. I hope to be a part of this kind of course in future also because it has helped me in enriching with shared knowledge and experience across the country.

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Thank you so much ACCMAD for this opportunity

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Thank you to everyone for arranging such a comprehensive course for discussing all the addictions including the recent ones of behavioral addictions.. Special thanks to Dr Prabhat sir , Dr Diptadhi sir , Dr Tathagata sir for enlightening us with experienced knowledge and such insightful case discussions.

- Dr Nabanita Mandal

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first of all thank you to the whole NIMHANS digital academy for arranging such an amazing programme. Atleat, after these learnings, I will see addiction patients with little different approach. Thank you Prabhat sir, Deeptadhi sir, Tathagata sir and the whole NIMHANS digital academy team and to all the participants.

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ACCMAD opened many perspectives for me in the field of substance use disorders. I got clarifications and insights for complex cases for which Ill always be grateful. The discussions were fruitful and one key message I took that one needs to evaluate the expectations of a client from each substance and give time for motivation. And lastly that non pharmacological measures is one of the most important skills that I need to hone while managing clients.

One point, I think breakout rooms may be more frequently used to improve participation in the discussions. And Im personally mot much in favor of essay type assignments.. 🙃

Thank you for this beautiful course.

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Great journey and a very rich learning experience. Specially, the case based discussions helped me a lot in real life situations. And also regular assessments compelled me to sit and learn during my busy schedule. I also loved to learn from personalised opinions of experienced clinicians like Dr Diptadhi, Dr. Tathagata and Dr. Chand. Hope the course continues to enrich young generations of clinicians.

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The Advanced Certificate Course in Addiction has been a meaningful and perspective changing learning experience for me. Before this course, I mostly viewed addiction as a behavioral issue, but now I understand it as a complex bio-psycho-social disorder involving brain changes, psychological factors, and social influences.

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The Advanced Certificate Course in Addiction has been a meaningful and perspective changing learning experience for me. Before this course, I mostly viewed addiction as a behavioral issue, but now I understand it as a complex bio-psycho-social disorder involving brain changes, psychological factors, and social influences.

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One of the most useful aspects of the course was its clinical orientation. The case based discussions and practical examples helped me understand how to assess patients more systematically, identify patterns of substance use, and plan treatment in a structured way. I now feel more confident in approaching patients rather than relying only on symptomatic management.

Another important shift has been in my attitude toward patients with addiction. I have started viewing them as individuals with a chronic medical condition rather than judging their behavior. This has improved my empathy and communication. I also now understand that relapse is not simply a failure, but a part of the illness that requires long-term management.

Thank you Prof. ( Dr. ) Prabhat Chand Sir, team and NIMHANS for such kind of initiative 🙏🏻🙏🏻

Dr. Kunwar Akhilesh

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ACCMAD 6.0 has been an enriching and clinically relevant learning experience. The course beautifully bridges the gap between theoretical knowledge and real world addiction practice. The combination of didactic lectures, case-based discussions and quizzes kept the learning dynamic and helped reinforce key concepts.

Another aspect I appreciated was the diversity of perspectives brought in by participants from different settings. This added depth to discussions and gave practical insights into how addiction psychiatry is managed across varied clinical environments.

The faculty deserves special mention for maintaining approachability and academic rigor throughout.

Overall, ACCMAD 6.0 is a thoughtfully designed program that enhances confidence and competence in managing addiction related cases.

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It was a wonderful learning experience. Thank you to all the teachers. I wish for a similar experience with you all in the future

Regards

Dr Saptarshi Paul Choudhury

MO, Karimganj Civil Hospital

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It was a wonderful learning experience. Thank you to all the teachers. I wish for similar experience with you all in the near future.

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ACCMAD COURSE a great learning experience 

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ACCMAD COURSE a great learning experience 

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For the last few months, it was a fantastic learning experience. I'm fortunate that I was able to sign up in this course. I gained a great deal of knowledge from the ACCMAD course. It was my first online course. We would like to express gratitude to Dr. Prabhat sir,Dr. Jayant sir, Dr. Diptadhi sir , Dr Tathagata sir, Dr Abhishek sir, and Dr Manjunath sir, as well as the other faculty members, for planning, supervising, and guiding the course in such a well-organized manner. I had no idea that online courses could be that well organised, informative and interesting also. Case-based discussions and quizzes were highly engaging and entertaining throughout the course, in addition to the very conceptual didactics and snapshot presentation. looking forward to join upcoming courses. Best wishes.

Thank you

Dr Debdutta Nayak

SR, DEPARTMENT OF PSYCHIATRY

TMCH

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I have always been skeptical about the online courses and my experience previously has not been good

But Dr Prabhat sir, Dr Abhishek, Dr Diptadi and Dr Tathaghat have been wonderful faculty and succeded in the real time experience. It's been many years since my Senior Residency that I have not practiced deaddiction in my psychiatric clinic and wanted to brush up things again

Gained useful insights while attending the sessions

The way Prabhat sir would present us the summaries and then ask for everyone's input helped in mind boggling and getting different perspectives.

Slido was always amazing and always felt like oh why does it end after few questions

Thank u the great help sir

Looking for future courses

Regards

Dr Neha Dhiman

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feedback for advance certificate course in management of addiction disorder.

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feedback for advance certificate course in management of addiction disorder.

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i am very fortunate to get chance to attend this online course, it fills all the knowledge and skill gaps that is present at peripheral medical colleges our country in this field. i get chance to express myself, update myself in recent advances happening in the field, got chance to present a case and corrected my management approach toward patient with substance use disorder, all faculty are like God in their field, i learn a lot in every session. Quizzes are awesome, didactics were very well organized, in single word this course is priceless. thank you to entire team .

Dr. Jitendra Kumar Verma

Junior resident 3rd year

Jawaharlal Nehru medical college,

Bhagalpur, Bihar.

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I was privileged to be part of this wonderful course. It was my first experience in a virtual platform and I enjoyed every bit of it. I would like to thank Dr Prabhat Sir, Dr Jayant Sir, Dr Diptadhi Sir, Dr Tathagata Sir and other faculties for the fruitful discussions. Case based learning and quiz have made the sessions even more engaging.

Thank you

Dr Subho Panja

SR, Dept of Psychiatry

NMCH

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Feedback for Advance Certificate course in management of addiction disorders 

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Feedback for Advance Certificate course in management of addiction disorders 

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Dear Prabhat sir & team ,

Advance Certificate course in management of addiction disorders Was very comprehensive , informative & very well structured & well coordinated by faculties of NIMHANS & LGBRIHM .

Thank you for mentoring entire team . This course has helped me to not only upgrade my knowledge in the filed of DeAddiction Psychiatry but also upgraded my clinical skills .

Special thanks to Diptadhi sir , Tathagata , Manjunath , Jayant , Shivraj & Co.

Thank you faculty at NIMHANS , LGBRIHM , peers & technical staff & very best luck & immense regards for future academic courses .

Thank you & Regards

Dr. S. Gajanan

Consultant Psychiatrist & MOI - VIMHANS Hospital , New Delhi

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Dear Prabhat sir and team,

The course was practical, crisp and insightful.All the didactic, quizzes, snap shot presentations, case discussions and interactions with all faculties of NIMHANS & LGBRIMH are enriching. It has increased self confidence as well as created new perspective regarding Addiction Medicine.Leadership, mentoring and humbleness of Prabhat sir make us to learn & grow each day.Special mention to Diptadhi sir whose words of wisdom and down to earth nature in both domains , clinically as well as academically, are real pearls in day to day challenges. As this is my 4th association, feeling delightful and looking forward to new course very soon. Kudos to all participants and thanks to Abhishek sir, Jayant sir, Shivraj sir Partha sir, Tathagata sir,Manjunatha sir and all the team members for delivering such an engaging course.

Long Live VKN NIMHANS, CAM and LGBRIMH.

-Manan Desai (Gujarat)

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The Best fruitful course in my 3 decades of academic life as a student

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The Best fruitful course in my 3 decades of academic life as a student

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Best course so far in my 3 decades of academic life. Enjoyed every aspect of the course , its content, discussion and quizzes/assignments. Learnt from 3 to 9 on a scale of 0 to 10 before and after accmad.

I wholeheartedly thank CAM and DAM team with Special thanks to Dr. Prabhat sir, Dr. Diptadhi sir , Dr. Abhishek and Mr. Manjunath for making this course live and fruitful with their inputs and efforts.

Faculty use to encourage and appreciated every positive effort in a lovely environment which stimulated me to present 3 clinical cases and 1 snapshot presentation and 5+1 quizzes won.

I loved the controversial and tricky mcqs framed by the team especially Dr. Abhishek with multiple answer qns more difficult than single answer ones. Continue the same quiz standard and fun.

Giving a chance to participants all teach all learn snapshot presentations is a masterpiece brain child idea of Dr. Prabhat sir. Now I wish it could have been started much earlier. I'm very much thankful to all the snapshot presenters, almost all of them were my friends. I learnt a lot through the snapshot presentations. This must be continued in further ACCMAD as well.

Coming to cases, Im fortunate that we could able to cover almost all common substances, rare substances and behavioural addictions. I learnt many many new things for the first time in my career. Thanks to all case presenters.

I joined the course with timely reminder and immediate help of Dr. Manan whose wholehearted good motto made this course best in my career. I took this course more like a binge episode of study with entire ACCMAD learning material in to 2 note books that made me to taste the crux of the accmad and my handwritten notes and time spent on it made me to top the leader board. I surely miss ACCMAD ofcourse not CAM. CAM and DAM were the most addictive departments and I dream to visit both departments in person in somedays of my life.

At the end of this course I got many good friends like Dr. Manan, Dr. Yashika, Dr. Harsh, Dr. Aishwarya, Dr. Jigisha and ofcourse my subjunior Dr. Vidit singh. All of us now a group of students in WhatsApp beyond accmad.

Finally I got some tears of happiness by the end of typing all this.

I love you all faculty, peers and technical staff and thank you so much.

Dr. Challa S V KRISHNA VASAN

Student at CAM-DAM and NDA.

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Feedback on ACCMAD course - Dr. Aishwarya Rao

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Feedback on ACCMAD course - Dr. Aishwarya Rao

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I was lucky enough to stumble upon this course. The course has definitely expanded our knowledge about addiction and its management.

Things I liked about the course:

1) Firstly, I liked the interactive nature of the course and the feeling of belonging to a part of a family where everybody’s knowledge and inputs are respected for a mutual learning experience.

2) The various components of the course- Didactic lecture, quiz and case discussion makes learning more fun and interesting.

3) The course covers a wide variety of topics under addition and gives both theoretical as well as practical inputs.

4) The case discussions from participants from various parts of India gives us insight about the history and management of those additions which might not be prevalent where we are currently practicing.

Hats off to Dr. Prabhat and the entire team for the wonderful management of the course. I especially like the idea of a virtual platform where we can learn at the comfort of our homes amidst our routine practice.

Dr. Aishwarya Rao

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Dear ACCMAD esteemed faculty members,

Dr Prabhat Dr Diptadhi Dr Jayant Dr Abhishek and everyone who was a part of this course, you made it a wondeful learning experience, getting opportunity to learn from one of the best Institutes and best Teachers , is a great pleasure, 🧠from didactics to case presentations to slido quizzes💯 , you made it all so interactive , and made so many great friends around India, thank you for everything 😀 🏘🌍

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The difference between the different versions of ACCMOAD has mostly been the presenters of the didactics. Dr.Atul Ambekar,Dr.Jayant Mahadevan,Dr.Lekhansh Shukla, Dr.Udit Panda ,Dr.Darshan Sadakshari ,Dr.Nandini Bojappan and also Dr.Rahul Verma's didactics have been supremely enriching. Future versions starting from 6.0 should include more from the above presenters. Dr .Jayant Mahadevan in my opinion has summarised best after a case presentation.Dr.Diptadhi's value addition post case discussion with insightful cross questioning and also expanding on the different points raised in diagnosis,differentials,pharmacological & non pharmacological managements were truly enriching. Back office support from Mr.Manjunatha have helped the participants a lot . Options in multiple correct answer questions in the quiz should never exceed 4 and introduce the scope for more ambiguity.The introduction of the Snapshots part have been a very thoughtful addition.

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A big thanks to VKN ECHO NIMHANS DIGITAL ACADEMY Team 

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A big thanks to VKN ECHO NIMHANS DIGITAL ACADEMY Team 

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For introducing us to this ACCMAD course, spreading us the knowledge and mentoring each and every participant to understand Substance use disorders in an innovative way.Didactics, case based learning esp the Quiz session and the monthly assessments, everything helped us to shape up our knowledge.This is such an excellent platform to improve our knowledge and practice addiction medicine.

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Completing the advanced course in substance use disorder at NIMHANS has been transformative for my practice. The comprehensive curriculum deepened my understanding of evidence-based approaches to caring for individuals with substance use problems. From pharmacological interventions to psychotherapeutic techniques, I gained invaluable insights into diverse treatment modalities. Engaging with expert faculty and fellow professionals enriched my perspective, fostering collaboration and holistic patient care. The course equipped me with updated knowledge and practical skills essential for addressing the complex needs of individuals struggling with substance use. Overall, it has elevated my ability to provide compassionate and effective care in this critical area of healthcare.

Regards

Dr.J.S.Dhillon

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FOUR THINGS I LIKED ABOUT ACCMAD 5.0 - Dr. Arun Daniel

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FOUR THINGS I LIKED ABOUT ACCMAD 5.0 - Dr. Arun Daniel

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4 THINGS I liked were

1. Active participation is encouraged.

2. Didactics are highly informative and a cornucopia of knowledge for learning and reference.

3. The Slido Quiz is very not easy to score in. There are tricky questions but still winning the prize is possible sometimes.

4. Case presentations are there to enhance learning.

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I would like to thank team ECHO for this wonderful initiative to develop trained resources in the field of Addiction Medicine. I mt has been a great learning experience so far. A few noteworthy points:

1. The interactive mode of delivery… one cannot be not involved with the likes of Prabhat Sir, Abhishek Sir and the entire team.

2. Slido quizes are an Absolute delight. Keeps the mind and heart racing.

3. Case presentations… Specialists from all over the country pour in the best of their cases for all to learn and discuss.

4. Team building… the cohesiveness of the teaching team has taught us the value of team effort.

I will always be looking forward to more courses at this wonderful forum.

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Incorporate on site contact programme at CAMS on the lines of STOP but for a max.of 15 days and upgrade this programme to a Diploma if feasible .This option should be made available to accredition certificate holders of older versions of ACCMOAD too who on completion of the contact programme should receive a Diploma subject to clearance by all academic stakeholders-Dr.Sudarsan Ray.

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3 things I liked:

1. Extensive curriculum covering clinically relevant aspects of various SUD & behavioural addictions, with all contents shared in LMS

2. Presence of addiction management experts throughout the course, both in Tele ECHO clinics and in discussion forums

3. Way of engaging participants in every session through interactive discussions, slido quiz, case presentations etc

3 areas in future:

1. Utilisation of digital aspects of care in SUD and behavioural addictions - digital platforms, approaches, technologies, phenotyping etc

2. SUD, behavioural addictions and mental health in special population

3. Medical comorbidities in SUD and it's primary care management

Thank you so much Prabhat sir and Hub team members at NIMHANS and LDBRIMH for the wonderful learning opportunity!

Wishes & Regards

Dr. Johncy James,

State Nodal Officer,

National Mental Health Programme,

UT of Lakshadweep

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What I like about the program?

Everyone keeps their video ON. This is a huge thing. Big applause for all the participants.

All the participants engage actively during their sessions and it inspires me to be more active.

They share their own experience, which allows me to have feeling as I have seen patients from all over India.

Most importantly it directly helps people get better treatment for addiction all over India.

The case presentation draft can be shorter if some of the headings/filling options are removed.

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Thanks Nimhans team for delivering such knowledge.. 

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Thanks Nimhans team for delivering such knowledge.. 

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I would like to add that ,if obserwership for de-addiction unit in Nimhans would be arranged it would be great privilege for us. THANKS

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I would like to thank everyone for this comprehensive advanced certificate program. From didactic to learning materials to case discussion; everything was so informative and I have learned a lot from them. Udit sir your slido quizzes were awesome & role play was cherry on the top, and the one statement I will carry throughout my life is Dr Prabhat Sir's "Learning happens then and there....".

Hopefully I will incorporate the knowledge learned here into my practice to serve the community better.

Thank you all,

Dr Chandan Kumar,
MBBS, DCMH, CCBOAM,
PGDCCP, CBT Trained (Beck, USA)

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Dr Pandit Devjyoti Sharma                                                                    Thanks to all VKN ECHO NIMHANS DIGITAL ACADEMY TEAM for providing us Advanced Certificate Course for Addiction Management to provide evidence based biopsychosocial solutions to relieving the sufferering of needy people and their family members from SUDs. 

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Dr Pandit Devjyoti Sharma                                                                    Thanks to all VKN ECHO NIMHANS DIGITAL ACADEMY TEAM for providing us Advanced Certificate Course for Addiction Management to provide evidence based biopsychosocial solutions to relieving the sufferering of needy people and their family members from SUDs. 

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3 things which I liked are-

(1) regular sessions which starts timely (2) regularfrequent email services to us for reminding to join sessions including whatsapp feedback provided for the same. (3) NIMHANS Digital Academy team members understand our field realities and difficulties in professional senario , they accept us as we are ,which motivate us to feel emotionally attached with commitments.

3 areas in future-

(1)training courses in future for psychosocial interventions like Cognitive Behaviour Therapy will be very much helpful for us to provide evidence based psychotherapy to our patients with clear concept.

(2) one week short period course training at NIMHANS will be quite convenient to join without getting worried about managing our clinic and family issues. So requesting to consider this if possible in future.

(3) such innovative approach of unique training for doctors (who are practicing in remote areas of our country, so devoid of opportunities to upgrade their professional skills ) is impossible without NIMHANS Digital Academy support, so continuing such efforts through VKN NDA is needed in future also.

I am very grateful to all members of VKN NIMHANS DIGITAL ACADEMY TEAM and Dr Prabhat Chand sir to making me able to serve evidence based practice for treating my patients for relieving their suffering .

Thanks with regards

Dr Pandit Devjyoti Sharma

MBBS, DPM, DipCMH, CCBOAM, MA (Psychology),DipYoga

Mann Urja Clinic, Hospital Road, Bhuj

Kachchh-370001 Gujarat

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I am very thankful to entire VKN team for spreading knowledge and mentoring us to understand  substance use disorder in a beautiful way digitally to understand the disease and how to manage..special thanks to Dr Prabhat sir for his efforts for mentoring us since last 3 years to understand psychiatric diseases including substance use disorder, which help us to diagnose and treat confidently, which is improving day by day.

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 Dr.Aruna.D.S                     Would like to share what I learnt from January - July 2021 through Management of Addictive Disorders : An Advanced Certificate Program.        

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 Dr.Aruna.D.S                     Would like to share what I learnt from January - July 2021 through Management of Addictive Disorders : An Advanced Certificate Program.        

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Iam Dr. Aruna.D.S Dental Public Health Professional would like to express sincere gratitude to Dr. Prabhat Sir and team.   Dr. Udit Panda,lead facilitator, case facilitators  Dr. Sudheendra, Dr.Deepak.G & Dr. Daniel  enriched  this excellent learning forum and engaged the learners throughout.  Token of appreciation to Subject Experts who delivered Didactics . This program broadened my horizon for SBIRT concept of screening,   brief interventions for SUD to the  clients at  clinical as well as  outreach settings, referral and  render  treatment based on evidence with favouable clinical outcome.
This colloborative learning platform enabled every peer learner   to share their perspective  who were from diverse specialities / setting during case presentation    enriched by  NIMHANS   expert hub and their evidence based recommendations for managing the cases presented in the forum. Hope the knowledge and skills I learnt during this course would bridge the Treatment Gap in this specialized area of public health importnace through collobaration .
Thanks to VKN-NIMHANS supporting Team for facilitating Technology platform with no glitches. Looking forward to join upcoming courses with my entusiastic Peers . Best Wishes.

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Knowledge is power. It gives confidence to manage a patient. After completing this AACMAD course, I am now more confident to treat a patient having Addiction.

This course bridges the gap of knowledge which was present despite having MD Psychiatry degree.

Didactic, case based learning, quiz session, role play, monthly assessment, discussion among Psychiatrists of different states of India... all helped me a lot to shape up my knowledge.

I am really thankful to Prof. Dr. Prabhat Chand sir, Dr. Udit Panda, guest faculties of NIMHANS and other premiere institutions and the whole team of VKN ECHO for their tireless efforts to make this AACMAD course very much fruitful.

Dr. Ayan Basak
Consultant Psychiatrist
Kolkata, India

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Home | Dr. Ayan basak | Consultant Psychiatrist | Kolkata, India

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Dr. Ayan Basak Best Deaddiction Specialist in India Best Psychiatrist in Kolkata Online Psychiatric Consultation in India Best Neuropsychiatrist in India Kolkata Psychiatrist

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This course is an eye opener for me to the world of addiction medicine,it gave me whole new insight into such complex disease.Also that medicine alone is insufficient to deliver proper result and need interventions so much beyond that.It covered so many aspects of addiction medicine and different substance of abuse,how it influence other comrbid psychiatric illness or it is influenced by them.It also emphasize on the fact that enyone suffering from this disease has the ability to fight it if given proper therapy and the important role a therapist have in managing it.It has empowered me with the much needed knowledge in treating patients with substance use disorder and those with dual diagnosis and deliver proper service to them.The fact that so many didactics covering so many diverse topics by that many experts in the field of addiction medicine and hundreds of case discussion held throughout speaks volumes of the course. The maticulous way of planning,execution and follow through and the efforts put into it in conducting the course done by the whole team of VKN NIMHANS is phenomenal.I specially thank Dr Prabhat,Dr Udit Sir for so many things that is impossible to elaborate in few lines.
Hope this teaching and learning continues in times to come and many more benifit from it.Looking forward to participate further in such endeavor.

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Thank you very much Dr Prabhat Sir and Dr Udit Panda Sir and VKN team for this beautiful journey of learning at vknimhans.
When I joined the course ,I was worried that I would not be able to attend 60 hours long course of De-addiction but as the time passes this course gained my interest  so much that I started waiting for Friday afternoon to attend this course.

This course has helped me to build firm confidence in treating Patients with Substance abuse through Pharmacological and Non Pharmacological management.

Dr Sabahuddin Ammar

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I have been hearing songs of praise of NIMHANS 17 years ago when I finished my MBBS. 1. During this course I witnessed how the professionals relentlessly and rigorously worked hard to make the program unique, delivering best quality and high standards. 2. They made sure not just only delivering but ensured that the participants were involved, engaged, continuously supporting and motivating them. 3. The team was providing all the evidenced based material and resources to enhance the participants learning.   For the future I want to run smoking cessation groups attached to medical hospital, as they don't attend for appointments and relapse despite of huge health and economic risks.  Thanks to Dr Prabhat and Dr Udit they were full of energy every session. 

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I have been hearing songs of praise of NIMHANS 17 years ago when I finished my MBBS. 1. During this course I witnessed how the professionals relentlessly and rigorously worked hard to make the program unique, delivering best quality and high standards. 2. They made sure not just only delivering but ensured that the participants were involved, engaged, continuously supporting and motivating them. 3. The team was providing all the evidenced based material and resources to enhance the participants learning.   For the future I want to run smoking cessation groups attached to medical hospital, as they don't attend for appointments and relapse despite of huge health and economic risks.  Thanks to Dr Prabhat and Dr Udit they were full of energy every session. 

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I wish to carry and spread the same energy and enthusiasm.

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This is excellent platform to improve the knowledge and practice addiction medicine. Though I have completed from NIMHANS. Topics which were covered is mostly minimally touched during postgraduation due to lack of time and case availability. However the VKN team has well organized it. Case based learning, role play to improvize therapy session,Quiz session to revise previous session, peer assessment . Scientific approach with enough evidence . It has improved my confidence in managing challenging cases like dual diagnosis, stimulant and opioid, sedative use disorder.etc. I felt like as though i have completed my fellowship in addiction medicine. Well organized. 

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This is excellent platform to improve the knowledge and practice addiction medicine. Though I have completed from NIMHANS. Topics which were covered is mostly minimally touched during postgraduation due to lack of time and case availability. However the VKN team has well organized it. Case based learning, role play to improvize therapy session,Quiz session to revise previous session, peer assessment . Scientific approach with enough evidence . It has improved my confidence in managing challenging cases like dual diagnosis, stimulant and opioid, sedative use disorder.etc. I felt like as though i have completed my fellowship in addiction medicine. Well organized. 

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Special thanks to Dr.Prabat and Dr.Udit for initiating this learning and timely guidance. Wish to attend more session in future.

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I am Dr. Bhavya here, faculty at NIMHANS Digital Academy. First of all I would like to thank Prabhat sir for giving me this opportunity to be a part of this program. Through this program, I not only increased my knowledge and clinical skills in handling cases of addiction, but also learnt how to engage participants better on an online platform as a course coordinator. The course was conducted very well and it's a course worth doing for everybody, including postgraduates. Thanks again to the entire team for a wonderful learning experience.

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TOO GOOD A PROGRAMME TO MISS
Learning has been difficult and sparse during these Covid times for a Post graduate like me. When this programme came up I was extremely happy and after enrolling I quickly realised what a wonderful decision I made. I look forward to each and every class and learning has never been this much fun. Special thanks to Dr Prabhat Sir, Dr Udit Sir and other faculty who have been simply amazing. Thank you 👍

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Dr Ajaz Ahmad Suhaff.
This course has changed my way of treating patients suffering from substance use disorders.
Excellent faculty/team from NIMHANS
Excellent program.
Superb presentations.
Thankyou NIMHANS.

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Sir I learnt a lot of new things during this programme. I had an invaluable chance to interact with some of the brightest minds. One thing I found was it was not time friendly atleast for me. I was posted in Corona wards during the weekends and because of this I was not able to complete 2 assignments even I was able to present 2 cases and attend most of the classes.

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interesting way to learn new things  through this digital academy.. got  many insights about  addiction treatment.. very knowledgeable and  helpful faculty. would like to thank each one of participants for very enriching experience 

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interesting way to learn new things  through this digital academy.. got  many insights about  addiction treatment.. very knowledgeable and  helpful faculty. would like to thank each one of participants for very enriching experience 

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This is a excellently designed programme with modules covering majority part of the substance abuse problems. We are very thankful for all the information shared on the Moodle app which helps us to read and recollect few points which we miss. The additional materials shared on case discussions in other breakout rooms is also helpful. We are seeing constant enthusiasm from team nimhans starting from Prabhat sir, Udit sir, dr Daniel, and many more. Once again I congratulate to the entire participants who had learnt from this.

Wish team nimhans good luck and do more such programmes in coming days

Dr sai krishna puli
Professor of psychiatry
Editor, TJP

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sharing  acute effects of chewing tobacco on coronary microcirculation and hemodynamics in habitual tobacco chewers . 

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sharing  acute effects of chewing tobacco on coronary microcirculation and hemodynamics in habitual tobacco chewers . 

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sharing resource on smokeless tobacco and CVD.

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There are many learning objectives before me when I started with this group, I can't simply conclude with 3 or 4 things. Firstly, I should thank Dr Prabat sir and Dr Pratima mam for giving me this opportunity to learn. There are many seniors who had been mentoring me from my residency program to till date and especially thanks to Dr Narasimha sir, Dr Dipthadi sir, Dr Jayanth sir, Dr Lekhansh sir, Dr Sudhendra sir  and Dr Udit sir for your constant support. I thank all the participants for amazing cases and discussions, which really helped me to brush my concepts at the same time given chance to learn many new things.

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I joined this course on the back of a very pleasant learning experience in earlier course of psychotropic medicine, what a doctor needs to know. Some of the best minds in India along with some of biggest names from nimhans interacted on equal footing with a spirit to learn, improve. What was striking was how pleasant & humble the teachers from nimhans were, which was contrary to some of the earlier experience I had in different set up. Special thanks to Dr Prabhat, Dr Udit, Dr Deepak, Ms Likhita & all the case presenting doctors, from whom I managed to pick some or other useful nuggets of knowledge in terms of prescribing practices, interview techniques, communication skills. PS: Dear team nimhans, you all are hard working & some of the late night/early morning (5am) emails I received are a testimony to this fact ☺️☺️. Warm regards 🙏🙏🙏

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I joined the course and realised how vast the knowledge of addiction management was. Everyone at VKNECHO is working tirelessly to the same goal---to educate. Being kilometers apart if seemed dr prabhat sir (our master oogeway) and dr udit was always there to answer any querry.

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You guys are interesting, inspiring and fantastic teachers

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You guys are interesting, inspiring and fantastic teachers

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For the enjoyable interaction, insights and learning Never before have we had such friendly academic discussion

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For the enjoyable interaction, insights and learning Never before have we had such friendly academic discussion

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1) well organized Didactic topics and clinical pearls from case discussions 2) Certification 3) dedication of Team VKN NIMHANS influenced to get actively involved 4) Slido quiz

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1) well organized Didactic topics and clinical pearls from case discussions 2) Certification 3) dedication of Team VKN NIMHANS influenced to get actively involved 4) Slido quiz

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I heard about this programme from a colleague who showered all the praises on the programme. Even though I was skeptical , still I enrolled. I was still ambivalent in the first couple of sessions but eventually the sheer quality of content and teaching compelled me to come back evry Friday.

# data[].attributes.subject
I heard about this programme from a colleague who showered all the praises on the programme. Even though I was skeptical , still I enrolled. I was still ambivalent in the first couple of sessions but eventually the sheer quality of content and teaching compelled me to come back evry Friday.

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Because drug Addiction is a Major problem in every society and what I feel that we were dealing with two pandemics one was Covid and another was drug Addiction. So it was very important for me to be a part of this esteemed course and by the grace of God I have learnt so many things. Thankyou so much NIMHANS THANKYOU

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Because drug Addiction is a Major problem in every society and what I feel that we were dealing with two pandemics one was Covid and another was drug Addiction. So it was very important for me to be a part of this esteemed course and by the grace of God I have learnt so many things. Thankyou so much NIMHANS THANKYOU

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To learn and practice standardized guide lines and to improve my skill, knowledge in delivering service to my clients.this course helped me in improving my pharmacology approach and opened new windows for psychosocial interventions in SUD.sir previously I have done diploma in community psychiatry where I learned different aspects in approaching a client

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To learn and practice standardized guide lines and to improve my skill, knowledge in delivering service to my clients.this course helped me in improving my pharmacology approach and opened new windows for psychosocial interventions in SUD.sir previously I have done diploma in community psychiatry where I learned different aspects in approaching a client

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To strengthen my learning in addictive disorders assessment and management throug lens of every health care professional of this learning platform. Explored my strength despite few limitations to contribute for addiction medicine in collaboration with health care professionals. Essence of "All teach all learn model " is applaudable engaging me throughout the course.

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To strengthen my learning in addictive disorders assessment and management throug lens of every health care professional of this learning platform. Explored my strength despite few limitations to contribute for addiction medicine in collaboration with health care professionals. Essence of "All teach all learn model " is applaudable engaging me throughout the course.

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Dr. Indira nayak . Hello to all. This platform teaches me the subject what it meant for in most cordial scientific and informative way  inputs all aspects of current scenarios .in such it boosts my self confidence in dealing with community services. This platform is an umbrella which leads and protects me by providing updated knowledges for the served peoples acting as rainy season umbrella by protecting fro. Rain and summer season umbrella by protecting from Sunrays.so I wish this plat form to be most updated day by day boosting knowledge to all. Thanks a lot to all contributors of this platform heartily on my side.let it be keep on and thanks to all

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Learning was at it's best at MADACP, lots and lots of things got changed in the management of the patient after learning from here, feel a lot more confident now in managing severe addictions.

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Im my Psychiatry residency we just had to focus more on thr pharmacological aspects of treatment and didn't get much exposure about the non Pharmacological aspects. Also i didn't have much experience with opiod use and stimulant use disorder. This course has helped increase my confidence and given me better tools for managing Patients with addictive disorders.
-Dr. Dhruv J Parmar

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sharing a research article on betelnut withdrawal.

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Learned
1.Deep Work is the first thing i learned from the course and Faculty members.
2. There are many Angle to diagnose pt with SUD, so input from all sources are necessary.

Yet to learn
1. Motivational interviewing was studied in detailed,but yet it's very hard to practice, so if anything can be done regarding the same.
2. Maximum pts have comorbid depression and sexual issues (ED,PME)..so can you pls share few cases and suggest management.
3. Behaviour addiction.

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1.Dealing with a person with SUD was a problem always especially the lack of knowledge into the concepts of addiction behaviour and the biology behind it.That it is a developmental problem and needs a different approach to manage and help people suffering from it is an eye-opener for me.
2.In treating people with SUD it is never a dectating or guiding approach but a collaborative approach that works best.
3.Various substance specific pharmacological and psychosocial management lessons have modified my approach to these problems and empowered me in dealing these persons with SUD in a much better way and improved my confidence and satisfiction in delivering best treatment at my settings.
Want To Learn.
1.managing some other SUD like cannabis,stimulants, behaviour addiction and other newer agents of SUD
2.Some knowledge to conduct scientific studies on SUD and add to the science of addiction
3.Knowledge on how to start a Deaddiction center,its legal management and  financesfinances issues.

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Learned
1. sharing of knowledge is important to grow  constantly . Each  session added pearls of learning . Excellent endeavor by Team Nimhans.
2.  Confidence in treating  addictive disorder  specially opioid and inhalants.
3. Importance of  psychological  measures in relapse prevention
Wants to learn more about  behavioral addiction

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Shivam
I am learning new things in every session. Though I am still a 2nd year Post graduate, this would hopefully provide me a strong base for my future learning and practice. I thank all of you 🙏

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i can start ost now in opd
i can start agents other than baclofen for alcohol
i want to learn
more of psychological management demonstrations
opioid portion is not very clear for me i want to improve it
some community level activity is needed to bridge the gap between load of addiction along with outlook of community
and currrent treatment knowledge basket we have

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Prafulla                                                             3 things learnt 

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Prafulla                                                             3 things learnt 

# data[].attributes.body
1)approach to SUD is not a  myth but a reality.
2)Role of high dose of thiamine in Alcohol use disorder.
3)fascinating pharmacology of opioids & treatment of heroine.
Need more
1)expertisation in change talk
2)   Motivational interviewing as our ground skill for clinical management.
3)establishment of deaddiction centre in our private capacity.

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Best 3 Things i have learnt till now :-
1. How to manage Inhalant abuse
2. Non Pharmacological Managements
3. New pharmacological agents
Three things i want to learn:-
1. Behavioural addiction
2. Management of sexual dysfunctions due to sud
3. How to start a Deaddiction Clinic

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 Dr.Aruna.D.S                     Would like to share what I learnt from January - April 2021 through Management of Addictive Disorders : An Advanced Certificate Program.        

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 Dr.Aruna.D.S                     Would like to share what I learnt from January - April 2021 through Management of Addictive Disorders : An Advanced Certificate Program.        

# data[].attributes.body
This program broaden my horizon for SBIRT concept of screening,   brief interventions for SUD to the  clients at  clinical as well as  outreach settings, referral and  render  treatment based on evidence with favouable clinical outcome.
This colloborative learning platform enable every peer learner   to share their perspective  who are from diverse specialities / setting during case presentation    enriched by  NIMHANS   expert hub and their evidence based recommendations for managing the cases presented in the forum.
3 things  I learnt from January to April 2021 comprise  pharmacological and non pharmacological management of     1.Alcohol use disorder
2.opoid use disorder
3.cannabis use disorder.
Three things I want to learn by June.
1. Areca Nut Use Disorder
2.Behaviour Addiction
3.Motivational Interviewing.

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A. Learnt
1. OST: Not to hesitate in starting opioid agonist therapy whenever needed
2. Learning is fun. every case is unique
3. Evidence based medicine practice and emerging treatment in alcohol, cannabis and opioid use disorder.
B. Things i want to learn
1. Research in SUD
2. Behavioural addiction
3. How to set up a Deaddiction unit

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Abstract

Keywords: Internet Gaming Disorder, gaming addiction, video game addiction, Internet addiction, Internet addiction disorder, DSM-5 diagnosis

Introduction

Video gaming is a fast-growing leisure activity, and has seen significant increases in revenue within the entertainment industry. Sales of video games in the US created $15.4 billion in revenue in 2014, and the total consumer spend on the games industry in the same year (including content, accessories, and hardware) amounted to $22.4 billion ( Entertainment Software Association, 2015). Moreover, the Entertainment Retailers Association indicated that video games were more popular than videos and music with regards to sales in 2014 ( UKIE, 2015), again highlighting the mass appeal of gaming.

According to the Nielsen 360° Gaming Report (The Nielsen Company, 2014), gamers spend 12% more time on gaming now than they did in 2012. On average, they spend more than 6 hr on gaming during an average week. Furthermore, contemporary video gaming (that will simply be called "gaming" for the rest of this paper) can be engaged in using a variety of platforms, including personal computers, dedicated game consoles as well as portable devices, including tablets, laptops, and smartphones, with multiplatform gaming use comprising about 50% of US console gamers. This indicates that gaming does not necessarily have to be a computer- or console-bound activity. The average age of a gamer is now 34 years, and 40% of all gamers are female ( Entertainment Software Rating Board, 2016), indicating that the commonly held stereotype of the adolescent gamer needs a complete overhaul ( Griffiths, Davies, & Chappell, 2003), and indicating that there is an increasingly broad market for gaming.

Massively Multiplayer Online Role-Playing Games (MMORPGs) are arguably the most popular type of online games, played by 46% of online gamers ( Nagygyörgy et al., 2013), although Multiplayer Online Battle Arena (MOBA) games like League of Legends have also become incredibly popular ( Nuyens et al., 2016). MMORPGs are large gaming universes that accommodate thousands of players at the same time (hence, the term "massively multiplayer") with no spatial or temporal limitations as they are played online, and encourage players to adopt different personas by means of their avatars (role playing) ( Kuss, Louws, & Wiers, 2012). Internet technology has thus provided a medium for millions of gamers worldwide to play in large game universes simultaneously, allowing social interactions and virtual community building (often in the form of guilds and clans). These kinds of games provide various incentives to players, and can be tailored to the individual player's needs. In early research on MMORPG playing, Yee ( 2006) asked 3,000 MMOPRG players about their gaming motivations, and his analysis indicated that gamers played to (a) achieve goals, (b) be social, and (c) immerse themselves in the game. Two-fifths of the most frequent gamers play social games (39%), which is higher than action games and puzzle/board/card games ( Entertainment Software Association, 2015). This suggests that social interaction is an important motivator for gamers to initiate and maintain game play. MMORPGs appear very versatile and this may contribute to the mass appeal of gaming ( Kuss, 2013). In addition to this, MMOPRGs have been shown to have a higher addictive potential than other games ( Kuss & Griffiths, 2012a; Kuss et al., 2012), which can partly be explained by their fulfillment of particular gaming motivations.

Among MMORPG players, the motivations of achievement, socializing, and escapism are factors that are predictive of gaming addiction, and together with male gender explained 19% of gaming addiction scores in one study (i.e., Zanetta Dauriat et al., 2011). Escapism and game mechanics (i.e., optimizing game play via in-game affordances) were more important predictors of gaming addiction than gender and time spent gaming, explaining 46% of the variance in gaming addiction in another study (i.e., Kuss et al., 2012). In addition to offering game content and gaming possibilities for a wide variety of players, MMORPGs are designed in such a way that they reward players using partial reinforcement schedules, leading to the maintenance of game play ( Ng & Wiemer-Hastings, 2005).

For a minority of gamers, these online worlds may be a substitute for the lack of real-life social contexts and may draw such individuals to these games. Research suggests that specific types of online games have a relatively high addictive potential for some players. For instance, it has been noted that MMORPGs can become addictive to a minority of gamers ( Kuss & Griffiths, 2012a) as they require significant investments in terms of time and energy, and offer players the possibility to escape their real-life problems ( Kuss et al., 2012). Twenty years of research on technology-use related problems have indicated that technology overuse may result in problems that are traditionally associated with substance-related addictions, including addiction symptoms, such as salience, mood modification, withdrawal, tolerance, conflict, and relapse ( Kuss, Shorter, van Rooij, Griffiths, & Schoenmakers, 2014).

In 2013, the American Psychiatric Association published the most recent (i.e., fifth) edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), which for the first time incorporated diagnostic criteria for Internet Gaming Disorder (IGD) in its appendix (Section 3) in which conditions were included that required additional research in order to feature in future versions of the manual. IGD appeared as the second behavioral addiction included in the manual following the inclusion of gambling disorder, which - for the first time - was considered a behavioral addiction in diagnostic history (rather than being categorized as an impulse-control disorder as it had been in previous editions since 1980) ( American Psychiatric Association, 2013).

Since this new provisional diagnosis, researchers have questioned the validity of the IGD construct as a diagnostic entity. More specifically, the viability of including the word "Internet" in IGD has been challenged, and instead researchers have proposed to use the term "video gaming disorder" (or simply "gaming disorder") suggesting excessive video gaming does not necessarily have to occur online (e.g., Griffiths & Pontes, 2014; King & Delfabbro, 2013). Given these debates, this paper discusses the viability of including the term "Internet" in IGD. The purpose is to outline the advantages and disadvantages of focusing on online gaming rather than gaming addiction in its entirety in order to carry the research field forward.

IGD Diagnosis: Issues and Concerns

Diagnostic criteria

The umbrella term "Internet addiction" has been criticized for its lack of specificity given the heterogeneity of potentially problematic behaviors that can be engaged in online as well as different underlying etiological mechanisms ( Kuss & Billieux, in press; Starcevic & Aboujaoude, 2016). In a response to Petry et al.'s ( 2014) paper that outlined a supposed " consensus" in the field of IGD, Griffiths et al. ( 2016) outlined their reasons for why an international consensus regarding IGD diagnosis does not exist, pointing to the limitations of the current preliminary diagnosis. Their main argument was the fact that Petry et al.'s paper did not represent the international research community adequately (as evidenced by only including 12 researchers in the initial "consensus" paper - a number of whom had published little in the gaming studies field - and the omission of many leading and most cited scholars in the field including the present authors). Their additional arguments with regards to the respective criteria will be summarized subsequently.

For many years, there has been an ongoing debate about differentiating between high engagement and addiction to gaming ( Charlton, 2002; Charlton & Danforth, 2007, 2010; Griffiths, 2010), and it is sometimes difficult to draw a clear line between the two based on the existent diagnostic criteria. Moreover, King and Delfabbro ( 2014) have drawn attention to the intricacy of preoccupation as a diagnostic criterion for IGD, stating that both time spent gaming as well as cognitive content should be included in this criterion. The current wording of the preoccupation criterion does not leave space for cognitive adaptations with regards to gaming-related thoughts as it is contended that a gamer who spends all his time gaming will not have any time left to think about the game ( Griffiths et al., 2016).

Symptoms that are experienced for extended time periods can then be referred to as cravings ( Ko, Yen, Chen, Chen, & Yen, 2005), suggesting that the criterion should include a specific timeframe. A recent systematic review conducted by Kaptsis, King, Delfabbro, and Gradisar ( 2016) investigated the state of current knowledge of gaming withdrawal symptomatology by reviewing a total of 34 studies, including 10 qualitative studies, 17 research reports on psychometric instruments, and 7 treatment studies. The review found that the existing evidence on withdrawal symptoms is very underdeveloped as there is a lack of qualitative studies providing detailed clinical descriptions of symptoms arising from cessation of gaming, which in turn has led to compromised efforts to quantify withdrawal symptoms in most empirical studies. This led the authors to conclude that gaming-related problems may arise without associated withdrawal symptoms. Notwithstanding this, it needs to be stated that previous research has indicated that withdrawal can be viewed as one of the core criteria of IGD given its diagnostic accuracy ( King, Haagsma, Delfabbro, Gradisar, & Griffiths, 2013; Ko et al., 2014), highlighting the disagreement about the inclusion of this criterion in the scientific (and more specifically gaming studies) community.

The tolerance criterion (i.e., "Do you feel that you should play less, but are unable to cut back on the amount of time you spend on playing games?") has also come under criticism. A number of authors suggest it is a very strong criterion because of its high diagnostic accuracy ( Ko et al., 2014), and some researchers suggest that the wording of the criterion needs to be changed to adequately reflect the individual's desire to stop gaming ( Griffiths et al., 2016). Moreover, it has been suggested that despite the potential negative consequences of the gaming behaviors, some individuals may engage in it out of their own free will or may think it is egosyntonic ( Kardefelt-Winther, 2015b; Van Rooij & Prause, 2014) and that there appears a societal requirement to engage in gaming which is often ignored by parents ( Kardefelt-Winther, 2015a, 2015b).

The continuing of gaming despite problems criterion (i.e., "Do you continue to play games even though you are aware of negative consequences, such as not getting enough sleep, being late to school/work, spending too much money, having arguments with others, or neglecting important duties?") appears to be viewed as valid and accurate by most researchers in the field. Nonetheless, the extent to which affected individuals recognize the ensuing problems as consequences of their excessive gaming may depend on whether the consequences are viewed as occurring over the short term or long term ( Griffiths et al., 2016).

With regards to escaping adverse moods (i.e., "Do you game to escape from or forget about personal problems, or to relieve uncomfortable feelings, such as guilt, anxiety, helplessness, or depression?"), much of the relevant literature ( Billieux et al., 2011; Kuss et al., 2012; Van Rooij, Schoenmakers, & van de Mheen, 2014) indicates that this criterion is valid for IGD diagnosis. Nonetheless, other research suggests that this criterion has limited specificity with regards to distinguishing addicted gamers from those that are not addicted ( Ko et al., 2014; Lemmens, Valkenburg, & Gentile, 2015; Pontes, Király, Demetrovics, & Griffiths, 2014) and that many gamers view using their activity to escape and lose time as a positive feature of gaming rather than a negative one ( Wood & Griffiths, 2007; Wood, Griffiths, & Parke, 2007).

In addition to this, it has been suggested that this criterion may be indicative of a primary problem of depression, anxiety, or other mental disorder, decreasing its significance for an IGD diagnosis. However, this criterion appears useful as it is an indication that there is something happening in the individual's life that leads them to engage in (excessive) gaming, which might be used as a maladaptive coping strategy and consequently result in giving up other important activities in life ( Kardefelt-Winther, 2014a, 2014b; King & Delfabbro, 2014), offering an explanation for maintaining gaming ( Griffiths et al., 2016).

The final criterion involving risking or losing relationships and opportunities ("Do you risk or lose significant relationships, or job, educational or career opportunities because of gaming?"), appears to lack sufficient clinical evidence ( Van Rooij, Schoenmakers, et al., 2014) to be included as IGD criterion, and diagnostic specificity to distinguish between gaming addiction and high engagement ( Duven, Müller, Beutel, & Wölfling, 2015). In addition to this, it has been stated that it would be worthwhile including the loss of potential opportunities (rather than the loss of something). Moreover, the wording has been criticized as it has been recommended to simplify and specify it by including "because of the amount of time spent gaming and your preoccupation with gaming" as the original "because of gaming" does not appear to be precise enough. Once the problems regarding the actual wording have been overcome, including this criterion for IGD diagnosis may appear useful ( Griffiths et al., 2016).

It has furthermore been noted that a severity dimension of the proposed DSM-5 IGD diagnosis has not been included, and neither have primary and secondary criteria been differentiated, which is particularly relevant as recent empirical studies have shown that the nine IGD criteria appear to have different relevance regarding the final diagnosis ( Rehbein, Kliem, Baier, Mößle, & Petry, 2015) and may be more or less relevant depending on the stage of the disorder ( Király et al., 2015). In addition to this, the classification does not draw a distinction between short-term and long-term excessive gaming, which is problematic particularly in light of children's and adolescents' gaming use ( King & Delfabbro, 2013). They find themselves in critical developmental stages in which high engagement and possibly excessive gaming may be nothing more but a "phase" ( Stavropoulos, Kuss, Griffiths, & Motti-Stefanidi, in press).

Problematic Internet and gaming use furthermore appears highly comorbid with various other mental and physical disorders, including depression, anxiety disorders, obesity, and attention-deficit hyperactivity disorder ( Henchoz et al., 2016; Pontes & Griffiths, 2016; Turel, Romashkin, & Morrison, 2016; Yen et al., 2016), and psychological and psychopharmacological treatments used for these disorders appear similarly efficacious in treating Internet addiction and gaming addiction ( Kuss & Lopez-Fernandez, 2016), putting into question the ability to differentiate mental disorder diagnoses ( King & Delfabbro, 2013). This exacerbates everyday diagnostic practice in both clinical as well as research contexts.

The "Internet" in Internet Gaming Disorder

A number of researchers have contested the previously adopted term of "Internet addiction" as being inadequate as (a) individuals rarely become addicted to the medium of the Internet itself and (b) the term "Internet addiction" does not differentiate adequately between the different types of online behaviors, some of which can be more addictive than others (e.g., Starcevic, 2013; Starcevic & Aboujaoude, 2016). For instance, Kuss and colleagues have shown that online gaming and online social networking appear as particularly strong risk factors for addiction ( Kuss, Griffiths, & Binder, 2013; Kuss, van Rooij, Shorter, Griffiths, & van de Mheen, 2013). Rather than being addictive per se, the Internet may facilitate the engagement in certain behaviors due to its Triple-A engine consisting of affordability, anonymity, and accessibility ( Cooper, Putnam, Planchon, & Boies, 1999).

It has furthermore been argued theoretically ( Griffiths & Pontes, 2014) and demonstrated empirically ( Király et al., 2014) that problematic Internet use and problematic online gaming are not the same. In the case of gaming, scholars have long argued that the diagnosis of IGD is inaccurate as it does not pay adequate attention to possibly addictive gaming patterns that occur without Internet connection (e.g., Griffiths, King, & Demetrovics, 2014; Griffiths & Pontes, 2014; King & Delfabbro, 2013). The APA itself is very vague in their description of IGD subtypes, stating that "Internet Gaming Disorder most often involves specific Internet games, but it could involve non-Internet computerized games as well, although these have been less researched. It is likely that preferred games will vary over time as new games are developed and popularized, and it is unclear if behaviors and consequences associated with Internet Gaming Disorder vary by gaming type" ( American Psychiatric Association, 2013, p. 796).

The possibility of including non-Internet games in a classification of IGD is odd, if not highly questionable ( Griffiths & Pontes, 2014). One can argue that games do not have to be played online to be potentially addictive. In fact, early research on the topic has specifically looked into offline games ( Soper & Miller, 1983), and various studies have specifically referred to video gaming (including offline gaming) rather than online gaming (e.g., King & Delfabbro, 2012; Van Rooij, Kuss, et al., 2014; Wölfling & Müller, 2010; Wölfling, Thalemann, & Grüsser, 2008). A recent empirical study by Lemmens and Hendriks ( 2016) sought to investigate whether IGD was more likely to involve online (i.e., Internet) as opposed to offline games by examining the relationship between IGD, game patterns, and 2,720 game genres played in a heterogeneous and representative sample of 2,442 adults and adolescents in the Netherlands. The authors found that disordered gamers spent more than four times as much time playing online role-playing games than non-disordered gamers and more than three times as much time playing online shooter games. However, no significant differences for offline games from these genres were found, underscoring the addictive potential for offline games, even though online games clearly appear to exhibit a greater addictive potential.

Conclusion

Clinical diagnoses have a number of advantages. Diagnoses and agreed upon criteria allow for the development of effective and efficacious treatment plans that benefit the individuals who require professional help. Once we know what it is that needs to be treated, the best strategies to treat it can be developed and applied. In addition to this, an official diagnosis (including agreed upon and prioritized critical criteria, levels of severity, and cutoff points) support research endeavors in the area of IGD (or whatever the revised nosological classification will end up being) as researchers can communicate their findings, collaborate, and compare their results in cross-cultural research. Having established and agreed upon diagnostic criteria allows for communication of professionals about the respective condition in a standard and comparable way. Moreover, having a diagnosis will likely provide an incentive for treatment and insurance providers to fund evidence-based treatments.

Without a diagnosis, there will be no grounds upon which a client's claim for support will be based and therefore having a diagnosis may be the crucial first step to qualify for treatment ( Kuss & Griffiths, 2015). At the individual level, a potential IGD diagnosis could also lead to the destigmatization of patients as they may find validation for their gaming-related problems. Finally, it is recommended that the APA considers the outlined issues and concerns when developing an updated version of the DSM, taking into account the nosological and criteria-related problems that have been outlined in this paper.

Griffiths et al. ( 2016) have also made a number of recommendations about how consensus concerning IGD in studying gaming behaviors can be achieved. These included: (a) carrying out further studies from treatment-seeking individuals in the clinical population (i.e., live field testing) rather than further epidemiological studies in countries that have already carried out such studies (because epidemiological studies are not the best place to identify and examine new disorders); (b) carrying out studies on heavy use of gaming among those without any problems (i.e., high engagement players); (c) forming an international alliance of IGD researchers to generate an item pool of IGD items for use in multinational collaborative studies; (d) forming working parties that comprise multi-stakeholders rather than just academics (e.g., gaming industry, gamers, psychiatrists, therapists, etc.); and (e) re-evaluating already existing data on IGD more effectively and critically to help develop consensus (as this might be helpful for understanding the nature of some aspects, such as withdrawal).

Despite the contingencies offered by the Internet (i.e., offering the possibility to connect many individuals at the same time in online games, such as MMOPRGs, its time and space compression; Kuss et al., 2012), an online network does not constitute a prerequisite of potentially addictive gaming behaviors. Overall, the existing literature on gaming addiction suggests that playing an online game may increase the chances of potential addiction compared to an offline game ( Kuss & Griffiths, 2012a; Lemmens & Hendriks, 2016). However, it does not preclude playing offline games from being possibly addictive, which is also reflected in the current yet preliminary IGD diagnosis.

Funding Statement

Funding sources: None.

Authors' contribution

All authors contributed to the preparation of this manuscript.

Conflict of interest

The authors declare no conflict of interest.

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Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field

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Keywords: Internet Gaming Disorder, gaming addiction, video game addiction, Internet addiction, Internet addiction disorder, DSM-5 diagnosis Video gaming is a fast-growing leisure activity, and has seen significant increases in revenue within the entertainment industry.

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Learnt till now
1.  evidence based management Opioid and alcohol dependence with case discussion as I have not got chance to use methadone
Wish to learn
1. Psychological intervention, adolescent substance use, behavior addiction particularly gaming addiction

# data[].attributes.body
A. 3 things that I have learnt till now-

a. Alcohol intoxication and dependance
b. OST
c. Harm reduction

B. 3 things that i want to learn by June-

a. Detailed relapse prevention strategies
b. Behavioural addiction and repeated egodystonic/ egosystonic sexual behaviours.
c. Legal issues/ regulations in managing SUD for psychiatrist and non-psychiatrist MBBS doctors.

C. An interesting article that I recently read on SUD-

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Abstract

The mind-altering agents such as tobacco, cannabis, and opium have been widely used since the evolution of human being. These substances have been widely used for recreational purposes. However, derivatives from reptiles such as snakes, reptiles, and scorpions can also be used for recreational purposes and as a substitute for other substances. Their use is rare and related literature is very scanty. In this report, we present a case of snake venom abuse and review the existing literature.

INTRODUCTION

There are reports of rare and unusual addictions among drug users, such as using snake and scorpion venom and wasp stings to get high.[ 1, 2, 3, 4, 5, 6, 7] However, the literature with regard to use of snake venom is limited to few case reports/case series. Most of these cases have been described among patients who have been using opioids.[ 1, 4, 6, 7] We present a case of snake venom use as a substitute for opioids.

CASE REPORT

A 33-year-old, male presented with history of substance use for the past 15 years. He started smoking cigarettes and taking alcohol at the age of 18 years. He became dependent on alcohol and tobacco by the age of 24 years. From the age of 25 years, in addition, he started taking opioids in the form of raw opium and puppy husk and became dependent on the same over the next 1 year. Over the years, he had been using all the substances concurrently. He had made few attempts to abstain from the substances but would experience relapse after 1-2 months. Use of substances was associated with marked psychosocial dysfunction, financial difficulties, and physical complications in the form of fatty liver. Few months before presentation to our center, he learned from his friends about the intoxicating effects of snake venom, who would also at times use snake venom as a substitute to opioids. Out of curiosity, he also tried it as a cheaper substitute for opioid and alcohol. Initially, with the help of the nomadic snake charmers, he subjected himself to the snake bite (possibly cobra, but patient was not sure) over his tip of the tongue. The snake bite was associated with jerky movements of the body, blurring of vision, and unresponsiveness, i.e. "blackout" as per the patient for 1 h. However, after waking up he experienced a heightened arousal and sense of well-being, which lasted for 3-4 weeks, which according to the patient was more intense that the state of high experienced till that time with any dose of alcohol or opioids. According to patient, during these 3-4 weeks, he did not have any craving for alcohol and opioids and did not consume the same. His smoking continued in the similar manner. After 3-4 weeks, the sense of well-being started to decline, he started to remain irritable, lethargic, and started having craving for drugs. Following this, he again went for a snake bite. He again had the similar experience lasting for 3-4 weeks. After this, he started indulging in the snake bite every 3-4 weeks, so as to experience the sense of well-being and high associated with the snake bite. Over the period, his use of opioids and alcohol reduced and most of use of these would be seen after 1-2 weeks of snake bite. On exploration, patient further disclosed that subjecting self to snake bite was common in his ethnic community (Northwestern part of Rajasthan, India), either as a substitute to other substances of abuse, or is used concomitantly with other substances to experience the feeling of ecstasy. According to the patient, often snake charmers give this kind of bite only to those people who are known to them and best to his knowledge no person had lost his their life after the snake bite.

At the time of presentation, he had been using puppy husk regularly, with the last intake a day before the presentation. He was detoxified using clonidine, analgesics, and benzodiazepines. Motivational enhancement therapy and relapse prevention counseling was done. He was explained about the risks associated with snake bite and potential life-threatening consequences. He remained in follow-up for the next 3 months, during which he was free of all the substances and also did not indulge in any snake bite.

DISCUSSION

There are few case reports in the literature about snake venom use. A thorough PubMed search and searching of cross references yielded four reports of use of snake venom for recreational purposes.[ 1, 4, 5, 6] All these reports are from India []. Most of these cases have been described in patients using opioids[ 1, 4, 6] as was seen in our patient too. The snakes used for such bites have been identified as cobra, krait, or green-colored snakes seen on the trees.[ 1, 5, 6] Our patient also described that the snake was possibly cobra. One of the patients, in a previous report described snake-dens, where different types of snakes are graded as mild, moderate, and severe form, based on the type of intoxication provided. The bites have been reported to be taken on the feet or tongue.[ 1, 6] As was our patient, previously reported cases have also described the experience of snake bite to be associated with happiness, grandiosity, and excessive sleepiness.[ 1] In a case series from Mumbai, authors presented two cases, one of whom was administered snake venom on the tongue in a rave party.[ 6] Another case series from Ranchi included two patients with opioid dependence, who used snake bite as a substitute for opioids.[ 4] Personality features of these two patients revealed that they were high on the dimensions, i.e. neuroticism, extraversion, and openness. However, in terms of agreeableness and conscientiousness, one of the patients scored high and other scored low.[ 4] Some of these reports have also provided ethnography of people indulging in snake bite and these suggest that most of the people are from high socioeconomic status.[ 1, 4, 5, 6] In most of these reports, no withdrawal symptoms were reported to be associated with snake bite; however, in occasional cases, patients developed the phenomenon of tolerance and indulged in more frequent snake bite trips.

Table 1

The symptoms reported by patients in different case reports suggest the neurotoxin nature of these snake bites. It is known that some of the neurotoxins result in an analgesia, which is independent of the centrally mediated opiate-independent analgesia. Long-form of alpha-neurotoxin found in cobra venom is known to act on nicotinic acetyl choline receptors (nAChRs).[ 8] These possibly act through the acetylcholine receptors and can substitute morphine and mitigate opioid withdrawal.[ 9] This may explain the use of snake venom by patients with opioid use as was seen in our patient too. nAChRs are considered to be involved in the mesolimbic dopaminergic reward system of the brain, which may explain the high associated with the use of snake venom.[ 10] Lack of fatality in the reported cases may be due to the use of too little venom. However, this has not been precisely evaluated.

CONCLUSION

The review of literature suggests that occasional patients use snake venom as a substitute or additional agent to get high. Our case adds to this limited literature. Clinicians dealing with patients with substance abuse must be aware of this and should enquire from patients routinely about the use of such agents. There is a further need to study this ethnography phenomenon to understand the exact nature and impact of snake venom among people who use it for recreational purposes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

5. Senthilkumaran S, Shah S, Balamurugan N, Menezes RG, Thirumalaikolundusubramanian P. Repeated snake bite for recreation: Mechanisms and implications. Int J Crit Illn Inj Sci. 2013;3:214-6. [[ PMC free article] [ PubMed] Google Scholar]

6. Umate MK, Khot P, Salukhe R, Kale V. Snake venom abuse in rave parties: A case report. Indian J Ment Health. 2015;2:227-9. [ Google Scholar]

7. Krishnamurthy K, Braganza WJ. A unique case of substance abuse. Muller J Med Sci Res. 2013;4:23-5. [ Google Scholar]

8. Meenakshisundaram R, Sweni S, Thirumalaikolundusubramanian P. Hypothesis of snake and insect venoms against Human Immunodeficiency Virus: A review. [[ PMC free article] [ PubMed] Google Scholar]

9. Xiong Y, Wang W, Pu X, Song J, Liu L, Mao J. Using snake venom to substitute for addictive drugs. [ Google Scholar]

# data[].attributes.attachment_link.title
Snake Venom Use as a Substitute for Opioids: A Case Report and Review of Literature

# data[].attributes.attachment_link.description
The mind-altering agents such as tobacco, cannabis, and opium have been widely used since the evolution of human being. These substances have been widely used for recreational purposes. However, derivatives from reptiles such as snakes, reptiles, and scorpions can also be used for recreational purposes and as a substitute for other substances.

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learnt-1. diff  pharmacological treatment  options  in alcohol dep

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learnt-1. diff  pharmacological treatment  options  in alcohol dep

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2. cannabis  dependencee management
3, opiod  dependence management
wish to learn- behaviour  management
how to run deaddcition set  up
newer addcitions,
dr umesh nagapurkar

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1. UNDERSTANDINGS WHEN TO START DIFFERENT DRUGS IN ALCOHOL DEPENDENCE
2. OPIODS - BUPRENORPHINE USAGE
3. HARM REDUCTION STRATEGIES IMPORTANCE

WANT TO LEARN
1. NEWER ADDICTIONS - INTERNET, PORN,
2. RELAPSE PREVENTION AND KEEPING THE PATIENT IN TREATMENT PROCESS
3. FAMILY INVOLVEMENT AND ROLES IN SUD MANAGEMENT

REGARDS
DR SAI KRISHNA P
EDITOR, TJP

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Things LEARNT till now
1) excellent management of alcohol, cannabis and opioid use disorder
2) excellent mangment of severe withdrawal in the above substances
3) other therapies in association with SUD

Want to learn

1) MANAGEMENT of Internet Addiction

2) INVASIVE TECHNIQUES and implants for SUD

3) OTHER treatment modalities in SUD like rTMS, TDCs etc

Regards
Dr. Jeet

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Three things I have learnt:
1. Alcohol dependence detoxification and management
2. OST
3. Brief Intervention
Three things I want to learn:
1. Behavioural addiction
2. Group therapy
3. Inhalant dependence

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Dr. Vinila.c
A. Learnt:
1. Alcohol behavioural management
2.consent for OST
3.Harm reduction.

B.Want to learn:
1.Management of inhalant addiction, internet and eating addiction
2. Newer drugs especially implants
3.  Legal aspects and documentation of SUDS

# data[].attributes.body
A. Have learnt
1. Better engagement with patient with SUD
2. Challenging cases like Opioid, Cannabis, early use of substance, Comorbidity
3. Evidence based treatment  and emerging treatment
4. Learning never ends in this era of knowledge explosion
5. Better learning translates to better care for the patient
B.Want to learn
1. Amphetamine and stimulants
2. Comorbidities and effective management
3. Listen to more case discussions and management from colleagues
C. Favourite article recently reviewed is below Schizophrenia + Cooccuring SUD. (Copyfree)