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Khemiri L, Brynte C, Stunkel A, Klingberg T, Jayaram-Lindström N. Working Memory Training in Alcohol Use Disorder: A Randomized Controlled Trial. Alcohol Clin Exp Res 2018; 43:135-146. [PMID: 30462837 PMCID: PMC6587824 DOI: 10.1111/acer.13910] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/14/2018] [Indexed: 11/29/2022]
Abstract
Background Alcohol use disorder (AUD) is associated with cognitive deficits such as impaired executive functions, which are hypothesized to contribute to the progression of the disease and worsen treatment outcome. Training of working memory (WM) to improve cognitive functions and thereby reduce alcohol use has been proposed as a novel treatment strategy. Methods Patients with AUD (n = 50) who were recruited to an outpatient addiction clinic were randomized to receive 5 weeks of active WM training or control training. Participants had weekly follow‐up visits, and all cognitive training sessions were done online at home. Primary outcomes were WM function and change in self‐reported heavy drinking. Secondary outcomes were craving, other drinking outcomes, and performance on a range of neuropsychological tasks from the Cambridge Neuropsychological Test Automated Battery. Results The active training group demonstrated a significantly greater improvement in verbal WM compared with the control group. No statistically significant effect of training was found on the primary drinking outcome, but a trend was observed indicating that WM training reduces the number of drinks per drinking occasion. WM training had no statistically significant effect on any of the other neuropsychological tasks. Conclusions Cognitive training can improve WM function in individuals with AUD, suggesting that such interventions are feasible to administer in this patient population. The results do not support an effect of WM training on heavy drinking or transfer effects to other cognitive domains. Future studies should evaluate WM training as an adjunct to evidence‐based treatments for AUD to assess potential synergistic effects.
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Affiliation(s)
- Lotfi Khemiri
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Angela Stunkel
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Torkel Klingberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Luquiens A, Miranda R, Benyamina A, Carré A, Aubin HJ. Cognitive training: A new avenue in gambling disorder management? Neurosci Biobehav Rev 2018; 106:227-233. [PMID: 30359663 DOI: 10.1016/j.neubiorev.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 09/10/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cognitive deficits are being robustly documented in gambling disorder. Cognitive training has been increasingly investigated as a treatment of substance use disorders. Four training components have been listed to date: cognitive bias, response inhibition, working memory, and goal-directed. This review aimed at the identification of use and efficacy findings in cognitive training in gambling disorder. METHODS We conducted a systematic search to identify use and efficacy data of cognitive training in gambling disorder. No use or efficacy data was available. DISCUSSION AND PERSPECTIVES Studies assessing cognitive training in gambling disorder are being conducted and first results should be upcoming. Methodological challenges have been identified. Several candidate target cognitive functions of training programs are being investigated, relying on the most documented impairments in gambling disorder, inhibition, reward sensitivity and decision making. Gambling-specific or neutral environments are to be distinguished clearly and do not rely on similar assumptions, i.e. general vulnerability or vulnerability expressed only in the specific context of gambling. Proper control groups with placebo conditions should be implemented. Assessment of efficacy should include clinical and neuropsychological assessments to give information of underlying mechanisms of action.
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Affiliation(s)
- Amandine Luquiens
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.
| | - Ruben Miranda
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Amine Benyamina
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Arnaud Carré
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000, Grenoble, France
| | - Henri-Jean Aubin
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
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Transition to drug co-use among adolescent cannabis users: The role of decision-making and mental health. Addict Behav 2018; 85:43-50. [PMID: 29843040 DOI: 10.1016/j.addbeh.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/17/2018] [Accepted: 05/15/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Co-use of cannabis and drugs other than cannabis (DOTC) influences the risk of experiencing cannabis disorders. Accordingly, we explored whether speed of transition to drug co-use, the number of DOTC used, and/or being an experimental cannabis-only user, a regular cannabis-only user, or a regular cannabis user who co-uses DOTC (i.e., cannabis-plus user) were associated with decision-making (DM), mental health disorder symptoms, or cannabis use-related characteristics. METHODS We analyzed baseline data from a sub-sample of 266 adolescent (ages 14 to 16) cannabis users (CU) participating in an ongoing longitudinal study. Assessments included semi-structured interviews, self-report questionnaires, and measures of drug use, DM (measured via the Iowa Gambling Task), mental health disorders, and cannabis use-related problems. RESULTS Endorsing a larger number of mood disorders symptoms was associated with being a regular cannabis-plus user rather than a regular cannabis-only user (AOR = 1.08, C.I.95% 1.01, 1.15). Poorer DM was associated with a faster transition to co-use, such that for each one unit increase in DM performance, the years to onset of drug co-use increased by 1% (p = 0.032). Endorsing a larger number of cannabis use-related problems was positively associated with endorsing a larger number of DOTC used (p = 0.001). CONCLUSIONS This study provides new evidence on the process of drug co-use among CU. Specifically, mood disorder symptoms were associated with use of DOTC among regular CU. Furthermore, poorer DM was associated with a faster transition to drug co-use. Poorer DM and mood disorder symptoms may aggravate or accelerate the onset of adverse consequences among adolescent CU.
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Neuropsychological Interventions for Decision-Making in Addiction: a Systematic Review. Neuropsychol Rev 2018; 29:79-92. [DOI: 10.1007/s11065-018-9384-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
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56
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Schulte MHJ, Wiers RW, Boendermaker WJ, Goudriaan AE, van den Brink W, van Deursen DS, Friese M, Brede E, Waters AJ. Reprint of The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment. Addict Behav 2018; 83:79-86. [PMID: 29661657 DOI: 10.1016/j.addbeh.2018.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise S van Deursen
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Mindfulness and Cognitive Training in a CBT-resistant Patient With Gambling Disorder: A Combined Therapy to Enhance Self-control. J Addict Med 2018; 12:484-489. [PMID: 29975209 DOI: 10.1097/adm.0000000000000433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
: Despite the major health consequences of problem gambling, such as suicide, over-indebtedness, delinquency, or family problems, there is currently no approved drug available for the treatment of problem gambling. The efficacy of cognitive behavioral therapies (CBTs) has been demonstrated repeatedly. However, some people seem resistant to conventional CBT alone. We present the case of a 59-year-old woman with a gambling disorder, who relapsed, despite a CBT-based intervention, and who then received a combined therapy aiming to enhance self-control: a mindfulness-based therapy and cognitive training targeting inhibition.
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58
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Carbia C, López-Caneda E, Corral M, Cadaveira F. A systematic review of neuropsychological studies involving young binge drinkers. Neurosci Biobehav Rev 2018; 90:332-349. [DOI: 10.1016/j.neubiorev.2018.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 12/27/2022]
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Schulte MHJ, Wiers RW, Boendermaker WJ, Goudriaan AE, van den Brink W, van Deursen DS, Friese M, Brede E, Waters AJ. The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment. Addict Behav 2018; 79:24-31. [PMID: 29241082 DOI: 10.1016/j.addbeh.2017.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise S van Deursen
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Cognitive and neuromodulation strategies for unhealthy eating and obesity: Systematic review and discussion of neurocognitive mechanisms. Neurosci Biobehav Rev 2018; 87:161-191. [DOI: 10.1016/j.neubiorev.2018.02.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/28/2018] [Accepted: 02/05/2018] [Indexed: 12/13/2022]
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Kaag AM, Goudriaan AE, De Vries TJ, Pattij T, Wiers RW. A high working memory load prior to memory retrieval reduces craving in non-treatment seeking problem drinkers. Psychopharmacology (Berl) 2018; 235:695-708. [PMID: 29181814 PMCID: PMC5847068 DOI: 10.1007/s00213-017-4785-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Reconsolidation-based interventions have been suggested to be a promising treatment strategy for substance use disorders. In this study, we aimed to investigate the effectiveness of a working memory intervention to interfere with the reconsolidation of alcohol-related memories in a sample of non-treatment seeking heavy drinkers. METHODS Participants were randomized to one of the two conditions that underwent a 3-day intervention: in the experimental condition, a 30-min working memory training was performed immediately after a 15-min memory retrieval session (i.e., within the memory reconsolidation time-window), whereas in the control condition, the working memory training was performed prior to a memory retrieval session. RESULTS In contrast to our original hypothesis, a high working memory load after memory retrieval did not interfere with the reconsolidation of those memories while a high working memory load prior to memory retrieval (the original control condition) strongly reduced retrieval-induced craving and craving for alcohol at follow-up. CONCLUSION Whereas the neurocognitive mechanism behind this effect needs to be further investigated, the current findings suggest that, if replicated, working memory training prior to addiction-related memory retrieval has the potential to become an effective (adjunctive) intervention in the treatment of substance use disorders.
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Affiliation(s)
- Anne Marije Kaag
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
| | - Anna E Goudriaan
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Mental Health Care & Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Taco J De Vries
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Tommy Pattij
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
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Aben B, Iseni B, Van den Bussche E, Verguts T. Persistent modification of cognitive control through attention training. Q J Exp Psychol (Hove) 2018; 72:413-423. [PMID: 29350105 DOI: 10.1177/1747021818757979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An important aspect of cognitive control is to direct attention towards relevant information and away from distracting information. This attentional modulation is at the core of several influential frameworks, but its trainability and generalisability remain unclear. To address this issue, two groups of subjects were invited to the lab on three consecutive days. On Day 2, they performed an arrow priming task which trained them to adopt an attentional bias towards (prime-attended group) or away from (prime-diverted group) a potentially conflicting prime. Direct generalisation of the attention training was measured by assessing task performance on the same task without the attentional manipulation directly after training (Day 2) and the next day (Day 3), and comparing it to baseline (Day 1). Performance on this direct transfer task showed a difference in attentional modulation between groups directly after training that persisted the next day. No cross-task generalisation was found to two other tasks that were closely or more remotely related to the trained task. Together, these results are in accordance with cognitive control frameworks that limit attentional modulation to the specific features of the trained task.
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Affiliation(s)
- Bart Aben
- 1 Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium.,2 Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Blerina Iseni
- 1 Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium.,2 Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Eva Van den Bussche
- 1 Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Verguts
- 2 Department of Experimental Psychology, Ghent University, Ghent, Belgium
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Toward biomarkers of the addicted human brain: Using neuroimaging to predict relapse and sustained abstinence in substance use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:143-154. [PMID: 28322982 PMCID: PMC5603350 DOI: 10.1016/j.pnpbp.2017.03.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/17/2017] [Accepted: 03/01/2017] [Indexed: 01/23/2023]
Abstract
The ability to predict relapse is a major goal of drug addiction research. Clinical and diagnostic measures are useful in this regard, but these measures do not fully and consistently identify who will relapse and who will remain abstinent. Neuroimaging approaches have the potential to complement these standard clinical measures to optimize relapse prediction. The goal of this review was to survey the existing drug addiction literature that either used a baseline functional or structural neuroimaging phenotype to longitudinally predict a clinical outcome, or that examined test-retest of a neuroimaging phenotype during a course of abstinence or treatment. Results broadly suggested that, relative to individuals who sustained abstinence, individuals who relapsed had (1) enhanced activation to drug-related cues and rewards, but reduced activation to non-drug-related cues and rewards, in multiple corticolimbic and corticostriatal brain regions; (2) weakened functional connectivity of these same corticolimbic and corticostriatal regions; and (3) reduced gray and white matter volume and connectivity in prefrontal regions. Thus, beyond these regions showing baseline group differences, reviewed evidence indicates that function and structure of these regions can prospectively predict - and normalization of these regions can longitudinally track - important clinical outcomes including relapse and adherence to treatment. Future clinical studies can leverage this information to develop novel treatment strategies, and to tailor scarce therapeutic resources toward individuals most susceptible to relapse.
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Marceau EM, Kelly PJ, Solowij N. The relationship between executive functions and emotion regulation in females attending therapeutic community treatment for substance use disorder. Drug Alcohol Depend 2018; 182:58-66. [PMID: 29154148 DOI: 10.1016/j.drugalcdep.2017.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Difficulties in emotion regulation influence the development of substance use disorder (SUD), its severity, course, treatment outcomes, and relapse. Impaired executive functions (EFs) are common in SUD populations and may relate to emotion dysregulation. The current study tested whether performance on three basic EF tasks ('working memory', 'inhibition', and 'task-switching') and/or inventory-based assessment of EF were related to difficulties in emotion regulation in females attending residential SUD therapeutic community treatment. METHODS Cross-sectional design in which participants (N=50, all female) completed a questionnaire battery including the Difficulties in Emotion Regulation Scale (DERS) and Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) was used. Participants also completed neuropsychological assessment of EF including the Working Memory Index (WMI; Wechsler Adult Intelligence Scale), and measures of inhibition and task-switching (Color-Word Interference Test; Delis-Kaplan Executive Function System). RESULTS Executive dysfunction, as assessed by the Global Executive Composite (GEC; BRIEF-A), and personality disorder indicators (Standardised Assessment of Personality - Abbreviated Scale; SAPAS) were positively correlated with DERS scores. Sequential hierarchical regression indicated that task-switching, GEC, and SAPAS scores statistically predicted DERS scores, while working memory and inhibition did not. Mediation analysis indicated that there was a significant indirect effect of GEC scores and task-switching performance on DERS scores, through SAPAS scores. CONCLUSIONS Impairment of EF, particularly task-switching, is related to difficulties in emotion regulation in a female sample attending residential SUD treatment. Cognitive training interventions that improve task-switching performance may be beneficial in promoting effective emotion regulation and improved SUD treatment outcomes.
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Affiliation(s)
- Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Peter J Kelly
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
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Barbosa PCR, Tófoli LF, Bogenschutz MP, Hoy R, Berro LF, Marinho EAV, Areco KN, Winkelman MJ. Assessment of Alcohol and Tobacco Use Disorders Among Religious Users of Ayahuasca. Front Psychiatry 2018; 9:136. [PMID: 29740355 PMCID: PMC5928846 DOI: 10.3389/fpsyt.2018.00136] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
The aims of this study were to assess the impact of ceremonial use of ayahuasca-a psychedelic brew containing N,N-dimethyltryptamine (DMT) and β-carboline -and attendance at União do Vegetal (UDV) meetings on substance abuse; here we report the findings related to alcohol and tobacco use disorder. A total of 1,947 members of UDV 18+ years old were evaluated in terms of years of membership and ceremonial attendance during the previous 12 months. Participants were recruited from 10 states from all major regions of Brazil. Alcohol and tobacco use was evaluated through questionnaires first developed by the World Health Organization and the Substance Abuse and Mental Health Services Administration. Analyses compared levels of alcohol and tobacco use disorder between the UDV and a national normative sample (n = 7,939). Binomial tests for proportions indicated that lifetime use of alcohol and tobacco was higher in UDV sample compared to the Brazilian norms for age ranges of 25-34 and over 34 years old, but not for the age range of 18-24 years old. However, current use disorders for alcohol and tobacco were significantly lower in the UDV sample than the Brazilian norms. Regression analyses revealed a significant impact of attendance at ayahuasca ceremonies during the previous 12 months and years of UDV membership on the reduction of alcohol and tobacco use disorder.
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Affiliation(s)
| | - Luís F Tófoli
- Department of Medical Psychology and Psychiatry, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Robert Hoy
- University of New Mexico, Simpson Hall, Albuquerque, NM, United States
| | - Lais F Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Eduardo A V Marinho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, Brazil
| | - Kelsy N Areco
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Michael J Winkelman
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States
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Carroll KM, Kiluk BD. Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:847-861. [PMID: 28857574 PMCID: PMC5714654 DOI: 10.1037/adb0000311] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cognitive-behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As Psychology of Addictive Behaviors marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. Technology may provide a means for CBT interventions to circumvent the "implementation cliff" in Stages III-V by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage I to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather 1 that constantly evolves and is refined through the stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions. (PsycINFO Database Record
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Affiliation(s)
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of Medicine
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The Efficacy of Dog Assisted Therapy in Detained Drug Users: A Pilot Study in an Italian Attenuated Custody Institute. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070683. [PMID: 28672787 PMCID: PMC5551121 DOI: 10.3390/ijerph14070683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
Abstract
Drug addiction is a major care and safety challenge in prison context. Nowadays, rehabilitation and specific therapeutic programs are suggested to improve health and well-being of inmates during their detention time and to reduce substance abuse relapse after release from prison. Among these programs, several studies reported the benefits for inmates coming from animal assisted interventions. In this pilot controlled study, we investigated the efficacy of a dog assisted therapy program addressed to 22 drug addicted male inmates housed in an attenuated custody institute in Italy. The study lasted six months, the treated group (12 inmates) was involved once a week for one hour in 20 dog assisted therapy sessions, whereas the control group (10 inmates) followed the standard rehabilitation program. One week before the beginning and one week after the end of the sessions, all inmates involved were submitted to symptom checklist-90-revised and Kennedy axis V. Inmates involved in the dog assisted therapy sessions significantly improved their social skills, reducing craving, anxiety and depression symptoms compared to the control group. Despite the limitation due to the small number of inmates enrolled and to the absence of follow up, we found these results encouraging to the use of dog assisted therapy as co-therapy in drug addicted inmates rehabilitation programs, and we claim the need of more extensive study on this subject.
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MacKillop J, Munafò MR. Commentary: Delay discounting and smoking: robust correlation, but uncertain causation. Int J Epidemiol 2017; 46:870-871. [PMID: 28017930 PMCID: PMC5837437 DOI: 10.1093/ije/dyw303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- James MacKillop
- Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton / McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Homewood Health Centre, Guelph, ON, Canada
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit
- UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
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Stock AK. Barking up the Wrong Tree: Why and How We May Need to Revise Alcohol Addiction Therapy. Front Psychol 2017; 8:884. [PMID: 28611718 PMCID: PMC5447061 DOI: 10.3389/fpsyg.2017.00884] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/15/2017] [Indexed: 01/03/2023] Open
Abstract
One of the main characteristics of alcohol abuse and addiction is the loss of control over alcohol intake and the continuation of drinking in the face of negative consequences. Mounting evidence strongly suggests that an alcohol-induced imbalance between goal-directed and habitual behavior may be one of the main driving factors of this key feature of addiction and furthermore play a key role in staying abstinent. Current therapies often focus only on deficient inhibitory control (i.e., goal-directed behavior), but largely neglect the potential of the well-functioning habit formation found in patients. Yet, focusing on intact habitual/automatic mechanisms in addition to or maybe even instead of deficient cognitive control might equip us with a more effective tool to battle the current alcohol abuse and addiction epidemic, especially with respect to more severely impacted patients who likely suffer from permanent alcohol-induced brain damage. Against this background, I would like to advocate the application and scientific evaluation of habit reversal therapy (HRT) for alcohol abuse and addiction.
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Affiliation(s)
- Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität DresdenDresden, Germany
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Bjork JM, Straub LK, Provost RG, Neale MC. The ABCD study of neurodevelopment: Identifying neurocircuit targets for prevention and treatment of adolescent substance abuse. ACTA ACUST UNITED AC 2017; 4:196-209. [PMID: 29038777 DOI: 10.1007/s40501-017-0108-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Substance use disorders (SUD) can be considered developmental disorders in light of their frequent origins in substance initiation during adolescence. Cross-sectional functional magnetic resonance imaging (fMRI) studies of adolescent substance users or adolescents with SUD have indicated aberrations in brain structures or circuits implicated in motivation, self-control, and mood-regulation. However, attributing these differences to the neurotoxicological effects of chronic substance use has been problematic in that these circuits are also aberrant in at-risk children, such as those with prenatal substance exposure, externalizing disorders (such as conduct disorder), or prodromal internalizing disorders such as depression. To better isolate the effects of substance exposure on the adolescent brain, the newly-launched Adolescent Brain Cognitive Development (ABCD) study, funded by the National Institutes of Health, will follow the neurodevelopmental trajectories of over 11,000 American 9/10-year-olds for 10 years, into emerging adulthood. This study will provide a rich open-access dataset on longitudinal interactions of neurodevelopment, environmental exposures, and childhood psychopathology that confer addiction risk. The ABCD twin study will further clarify genetic versus experiential influences (e.g., substance use) on neurodevelopmental and psychosocial outcomes. Neurocircuitry thought to regulate mood and behavior has been directly normalized by administration of psychoactive medications and by cognitive therapies in adults. Because of this, we contend that ABCD project data will be a crucial resource for prevention and treatment of SUD in adolescence because its cutting-edge neuroimaging and childhood assessments hold potential for discovery of additional targetable brain differences earlier in development that are prognostic of (or aberrant in) SUD. The ABCD sample size will also have the power to illuminate how sex differences, environmental interactions and other individual differences interact with neurodevelopment to inform treatment in different groups of adolescents.
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Affiliation(s)
- James M Bjork
- Virginia Commonwealth University, Department of Psychiatry
| | - Lisa K Straub
- Virginia Commonwealth University, Department of Psychiatry
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Verdejo-Garcia A, Chong TTJ, Stout JC, Yücel M, London ED. Stages of dysfunctional decision-making in addiction. Pharmacol Biochem Behav 2017; 164:99-105. [PMID: 28216068 DOI: 10.1016/j.pbb.2017.02.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/27/2017] [Accepted: 02/03/2017] [Indexed: 01/26/2023]
Abstract
Drug use is a choice with immediate positive outcomes, but long-term negative consequences. Thus, the repeated use of drugs in the face of negative consequences suggests dysfunction in the cognitive mechanisms underpinning decision-making. This cognitive dysfunction can be mapped into three stages: the formation of preferences involving valuation of decision options; choice implementation including motivation, self-regulation and inhibitory processes; and feedback processing implicating reinforcement learning. This article reviews behavioral studies that have examined alterations in these three stages of decision-making in people with substance use disorders. Relative to healthy individuals, those with alcohol, cannabis, stimulant and opioid use disorders value risky options more highly during the formation of preferences; have a greater appetite for superficially attractive rewards during choice implementation; and are both more efficient in learning from rewards and less efficient in learning from losses during feedback processing. These observed decision-making deficits are most likely due to both premorbid factors and drug-induced effects. Because decision-making deficits have been prospectively associated with a greater risk of drug relapse, we advocate for greater research on modulating the component stages that give rise to dysfunctional decision-making in disorders of addiction.
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Affiliation(s)
- Antonio Verdejo-Garcia
- Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia.
| | - Trevor T-J Chong
- Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia
| | - Julie C Stout
- Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia
| | - Murat Yücel
- Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia
| | - Edythe D London
- Semel Institute of Neuroscience, University of California Los Angeles, United States
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Interventions aimed at automatic processes in addiction: considering necessary conditions for efficacy. Curr Opin Behav Sci 2017. [DOI: 10.1016/j.cobeha.2016.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wiers CE, Wiers RW. Imaging the neural effects of cognitive bias modification training. Neuroimage 2016; 151:81-91. [PMID: 27450074 DOI: 10.1016/j.neuroimage.2016.07.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 01/31/2023] Open
Abstract
Cognitive bias modification (CBM) was first developed as an experimental tool to examine the causal role of cognitive biases, and later developed into complementary interventions in experimental psychopathology research. CBM involves the "re-training" of implicit biases by means of multiple trials of computerized tasks, and has been demonstrated to change anxious, depressive and drug-seeking behavior, including clinically relevant effects. Recently, the field has progressed by combining CBM with neuroimaging techniques, which provides insight into neural mechanisms underlying how CBM affects implicit biases in anxiety, depression, and addiction, and potentially other pathologies. This narrative literature review summarizes the state of the art of studies on the neural effects of CBM and provides directions for future research in the field. A total of 13 published studies were found and discussed: n=9 in anxiety, n=2 in depressive behavior, and n=2 in addiction.
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Affiliation(s)
- Corinde E Wiers
- National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, Bethesda, MD, USA.
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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