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Heishman SJ, Lee DC, Taylor RC, Singleton EG. Prolonged duration of craving, mood, and autonomic responses elicited by cues and imagery in smokers: Effects of tobacco deprivation and sex. Exp Clin Psychopharmacol 2010; 18:245-56. [PMID: 20545389 PMCID: PMC2896221 DOI: 10.1037/a0019401] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increases in self-reported craving and changes in autonomic functioning are reliably elicited when smokers are exposed to tobacco-related stimuli compared with neutral stimuli. However, few studies have reported the time course of cue-elicited craving or have directly compared the effectiveness of smoking cues versus imagery to evoke a craving response. In addition to these two issues, we investigated the influence of tobacco deprivation and sex on craving, mood, and autonomic responses. Sixty cigarette smokers (30 men, 30 women) were tested in two counterbalanced sessions, one after overnight tobacco deprivation and one during ad libitum smoking. At each session, participants were exposed to four randomized experimental trials: smoking imagery, neutral imagery, smoking cues, and neutral cues. Tobacco craving and mood were assessed repeatedly and physiological measures were recorded continuously for 30 min after imagery or cue exposure. Compared with neutral trials, smoking cues and smoking imagery reliably increased tobacco craving, negative mood, heart rate, and blood pressure and decreased positive mood ratings. Changes were observed immediately after cue and imagery presentation and remained unchanged for 30 min. Responding was greater in the nondeprived condition, and cues elicited more robust responding than imagery for most measures. Women responded more robustly to smoking cues only in the nondeprived condition, whereas imagery evoked greater responses in men during both conditions. These findings provide new data on the time course, magnitude, and tobacco deprivation effects on elicited craving. Sex differences were dependent on stimulus type and deprivation condition.
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Affiliation(s)
- Stephen J Heishman
- Nicotine Psychopharmacology Section, NIDA Intramural Research Program, 251 Bayview Boulevard, Suite 200, Baltimore, MD 21224, USA.
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Hudson A, Stamp JA. Ovarian hormones and propensity to drug relapse: a review. Neurosci Biobehav Rev 2010; 35:427-36. [PMID: 20488201 DOI: 10.1016/j.neubiorev.2010.05.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 05/04/2010] [Accepted: 05/06/2010] [Indexed: 11/16/2022]
Abstract
Sex differences have been reported in various phases of substance abuse, including relapse. In general, women show greater propensity to drug relapse than men, owing perhaps to divergent withdrawal experiences and increased reactivity to internal (emotional) and external (drug-associated) cues. Animal research tends to parallel human findings, revealing enhanced reinstatement of drug administration in females than males. Moreover, differences in vulnerability to relapse/reinstatement have been documented in women and female rodents across the ovarian cycles. Thus ovarian hormones seem to play an important role in determining susceptibility to relapse. Indeed, ovarian hormones interact with many of the neural circuits implicated in drug-primed, cue-instigated, and stress-induced relapse. By understanding the effects of ovarian hormones on the neural and behavioral mechanisms of drug relapse, sex differences and cyclical variations in relapse susceptibility can be elucidated and more effective treatment strategies can be explored.
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Affiliation(s)
- Amanda Hudson
- Psychology Department, Dalhousie University, Halifax, Nova Scotia, Canada
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Price KL, Saladin ME, Baker NL, Tolliver BK, DeSantis SM, McRae-Clark AL, Brady KT. Extinction of drug cue reactivity in methamphetamine-dependent individuals. Behav Res Ther 2010; 48:860-5. [PMID: 20538262 DOI: 10.1016/j.brat.2010.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 05/08/2010] [Accepted: 05/11/2010] [Indexed: 11/20/2022]
Abstract
Conditioned responses to drug-related environmental cues (such as craving) play a critical role in relapse to drug use. Animal models demonstrate that repeated exposure to drug-associated cues in the absence of drug administration leads to the extinction of conditioned responses, but the few existing clinical trials focused on extinction of conditioned responses to drug-related cues in drug-dependent individuals show equivocal results. The current study examined drug-related cue reactivity and response extinction in a laboratory setting in methamphetamine-dependent individuals. Methamphetamine cue-elicited craving was extinguished during two sessions of repeated (3) within-session exposures to multi-modal (picture, video, and in-vivo) cues, with no evidence of spontaneous recovery between sessions. A trend was noted for a greater attenuation of response in participants with longer (4-7 day) inter-session intervals. These results indicate that extinction of drug cue conditioned responding occurs in methamphetamine-dependent individuals, offering promise for the development of extinction- based treatment strategies.
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Affiliation(s)
- Kimber L Price
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, 29425, USA.
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Back SE, Hartwell K, DeSantis SM, Saladin M, McRae-Clark AL, Price KL, Maria MMMS, Baker NL, Spratt E, Kreek MJ, Brady KT. Reactivity to laboratory stress provocation predicts relapse to cocaine. Drug Alcohol Depend 2010; 106:21-7. [PMID: 19726138 PMCID: PMC2815094 DOI: 10.1016/j.drugalcdep.2009.07.016] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 07/23/2009] [Accepted: 07/27/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cocaine dependence is a chronic relapsing disorder characterized by periods of abstinence and high rates of return to drug using behavior. Elevated levels of stress have been associated with relapse to cocaine; however, the nature of this association is not well understood. METHODS The relationship between reactivity to three human laboratory provocations and relapse to cocaine was investigated. Participants were 53 cocaine-dependent individuals who were admitted for a 2-day inpatient stay during which a psychosocial provocation (i.e., the Trier Social Stress Task), a pharmacological provocation (i.e., administration of 1 microg/kg corticotrophin releasing hormone; CRH), and a drug cue exposure paradigm were completed. Adrenocortico-trophic hormone (ACTH), cortisol, heart rate, and subjective cocaine craving and stress were assessed at baseline and at multiple time points post-task. Participants' cocaine use was monitored for approximately 1 month following testing. RESULTS The majority (72.3%) of participants relapsed to cocaine during the follow-up period. In response to the CRH and drug cue exposure, elevated subjective craving and stress were significant predictors of cocaine use during follow-up. In response to the Trier, attenuated neuroendocrine responses were significant predictors of cocaine use. CONCLUSIONS The findings provide further evidence of the ability of laboratory paradigms to predict relapse. The observed associations between stress reactivity and subsequent cocaine use highlight the clinical importance of the findings. Predictors of relapse may vary based on the type of provocation utilized. Interventions aimed at normalizing stress response, as measured using laboratory paradigms, may prove useful in relapse prevention.
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Affiliation(s)
- Sudie E. Back
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425
| | - Karen Hartwell
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425
| | - Stacia M. DeSantis
- Medical University of South Carolina; Department of Biostatistics, Bioinformatics & Epidemiology; 135 Cannon Street, Suite 303, MSC 835; Charleston, SC 29425
| | - Michael Saladin
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425,Medical University of South Carolina; Department of Health Sciences and Research; College of Health Professions; 77 President Street, Room 224, MSC700; Charleston, SC 29425
| | - Aimee L. McRae-Clark
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425
| | - Kimber L. Price
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425
| | - Megan M. Moran-Santa Maria
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425
| | - Nathaniel L. Baker
- Medical University of South Carolina; Department of Biostatistics, Bioinformatics & Epidemiology; 135 Cannon Street, Suite 303, MSC 835; Charleston, SC 29425
| | - Eve Spratt
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425
| | - Mary Jeanne Kreek
- The Rockefeller University; Laboratory on the Biology of Addictive Diseases; 1230 York Avenue; New York, NY 10021
| | - Kathleen T. Brady
- Medical University of South Carolina; Department of Psychiatry, Clinical Neuroscience Division; 67 President Street, MSC861;, Charleston, SC 29425
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Sex differences in the self-administration of cannabinoids and other drugs of abuse. Psychoneuroendocrinology 2009; 34 Suppl 1:S227-36. [PMID: 19744795 DOI: 10.1016/j.psyneuen.2009.08.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 08/06/2009] [Accepted: 08/13/2009] [Indexed: 11/20/2022]
Abstract
Many studies have provided evidence for important sex-dependent differences in the origins, outcomes and treatment of drug abuse and dependence. Preclinical studies typically have employed animal models of addiction, such as oral or intravenous self-administration, to untangle the environmental, neurobiological and genetic factors that contribute to the shift from occasional, recreational use to compulsive, uncontrolled intake of drugs. Craving and relapse of drug seeking in abstinent individuals have also been found to differ between men and women. Identification of the neurobiological basis of craving and drug dependence continues to pose a challenge to addiction research. Significant sex differences are emerging in substance-abuse-related behavior, which has increased the demand for research on how drug consumption may have different causes, progression and consequences in men and women. In keeping with epidemiological data in humans, differences between the two sexes in drug seeking and intake have been well-documented in animal studies, with most recent findings related to abuse of cannabinoids. Clinical and preclinical findings indicate that sex and gonadal hormones may account for individual differences in susceptibility to the reinforcing effects of addictive substances, and that differences in vulnerability to drug abuse may be mediated by the same biological mechanisms. This review focuses on the differences between males and females in relation to drug self-administration and how such behavior may be affected by hormonal status.
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Shi J, Jun W, Zhao LY, Xue YX, Zhang XY, Kosten TR, Lu L. Effect of rapamycin on cue-induced drug craving in abstinent heroin addicts. Eur J Pharmacol 2009; 615:108-12. [DOI: 10.1016/j.ejphar.2009.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 05/05/2009] [Accepted: 05/18/2009] [Indexed: 02/02/2023]
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Abnormal pain response in pain-sensitive opiate addicts after prolonged abstinence predicts increased drug craving. Psychopharmacology (Berl) 2009; 204:423-9. [PMID: 19172249 PMCID: PMC3697848 DOI: 10.1007/s00213-009-1472-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
RATIONALE Craving is a primary feature of opiate addiction and is clinically significant because of its potential to trigger opiate use and relapse. Opiate use can also produce abnormal pain perception. We predicted that for opiate addicts (OAs), there may be an association between these two major features of addiction (drug craving and abnormal pain responses). OBJECTIVES To examine pain responses in abstinent opiate addicts in comparison with healthy controls using a cold-pressor test (CPT) and investigate the correlations of cue-induced drug craving with pain responses. MATERIAL AND METHODS Fifty-four abstinent OAs and 46 healthy subjects participated in the CPT, and the OAs were also exposed to heroin-related cues the day before the pain test. Outcome measures included pain-tolerance time, VAS ratings of pain intensity and distress, and (in the cue-exposure procedure) VAS ratings of heroin craving and anxiety. RESULTS In the CPT, abstinent addicts showed shorter pain-tolerance time (85.1 +/- 14.1 s vs. 133.7 +/- 16.7 s, p < 0.05) and higher ratings of pain distress (61 +/- 3.2 vs. 45.6 +/- 3.2, p < 0.01) compared to healthy controls. When we divided the addicts and controls into pain-sensitive (PS) and pain-tolerant (PT) groups by dichotomizing each group in terms of pain-tolerance time, we again found differences between the two PS groups (37.3 +/- 3.5 s vs. 57.4 +/- 5.1 s, p < 0.01 for pain-tolerance time; 66.7 +/- 3.2 vs. 52.4 +/- 3.3, p < 0.01 for distress ratings). For all participants, pain-tolerance time was negatively correlated with VAS ratings for pain intensity and distress. More importantly, the PS addicts reported greater cue-induced craving than the PT addicts (17.8 +/- 2.2 vs. 4.5 +/- 4.2, p < 0.05). For the addict group as a whole, pain distress (the affective aspect of pain) was positively correlated with intensity of cue-induced craving measured on a different day (r = 0.33, p = 0.01). CONCLUSIONS A hyperalgesic state persists for at least 5 months in abstinent OAs and is predictive of cue-induced craving. Longitudinal research is needed to clarify the direction of causation between hyperalgesia and opiate addiction.
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Fattore L, Altea S, Fratta W. Sex differences in drug addiction: a review of animal and human studies. ACTA ACUST UNITED AC 2009; 4:51-65. [PMID: 19072451 DOI: 10.2217/17455057.4.1.51] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Addiction research has historically neglected research on women, and most studies have been conducted on men only, with the concluding results generalized to the female population. The role of sex differences in vulnerability to drug abuse, their repercussions on prevention and treatment strategies all require detailed studies, as does the progression from recreational drug use to dependence. This review synthesizes evidence of gender differences in drug addiction, with particular emphasis on women's health and implications. We first reviewed behavioral studies showing sex differences in the preference for and self-administration of licit (i.e., alcohol and nicotine) and illicit (i.e., cocaine, amphetamine, heroin and cannabis) substances as revealed by animal models of addiction. Clinical studies demonstrating differences between men and women in craving, drug use, abstinence and relapse will then be examined. For both animal and human studies, the effects of hormones and estrous/menstrual cycle will be reviewed. Finally, neurobiological factors underlying gender differences in vulnerability to drug addiction (i.e., brain morphology and neurotransmission) and need for gender-specific detoxification treatments will be discussed.
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Affiliation(s)
- Liana Fattore
- National Research Council and Centre of Excellence "Neurobiology of Dependence", Cagliari, Italy
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Shi J, Liu TT, Wang X, Epstein DH, Zhao LY, Zhang XL, Lu L. Tetrodotoxin reduces cue-induced drug craving and anxiety in abstinent heroin addicts. Pharmacol Biochem Behav 2009; 92:603-7. [PMID: 19268686 DOI: 10.1016/j.pbb.2009.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/14/2009] [Accepted: 02/24/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tetrodotoxin (TTX) is a neurotoxin found in puffer fish and other marine animals. New clinical studies suggest that low-dose TTX can safely relieve severe, treatment-resistant cancer pain. The therapeutic potential of TTX in addiction is supported by studies in laboratory animals. The purpose of this double-blind, placebo-controlled study was to assess the effect of a single intramuscular dose of TTX on cue-induced craving and anxiety in abstinent heroin addicts. METHODS Forty-five abstinent heroin addicts were randomly assigned to three treatment groups: placebo, 5 microg TTX, or 10 microg TTX. Participants were exposed to a neutral video or a heroin-related video. Craving, anxiety, blood pressure, and heart rate were measured pre- and post-exposure. RESULTS Heroin-related cues increased both craving and anxiety and had no effect on blood pressure and heart rate. A single dose of TTX dose-dependently attenuated the increases in craving and anxiety while having no effect on blood pressure or heart rate. CONCLUSION The results suggest that low-dose TTX is acutely effective in reducing cue-induced increases in heroin craving and associated anxiety.
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Affiliation(s)
- Jie Shi
- National Institute on Drug Dependence, Peking University, Beijing 100083, China
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Bell RL, Rodd ZA, Toalston JE, McKinzie DL, Lumeng L, Li TK, McBride WJ, Murphy JM. Autonomic activation associated with ethanol self-administration in adult female P rats. Pharmacol Biochem Behav 2008; 91:223-32. [PMID: 18713644 PMCID: PMC2592255 DOI: 10.1016/j.pbb.2008.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 07/08/2008] [Accepted: 07/23/2008] [Indexed: 11/30/2022]
Abstract
The present study examined changes in heart rate (HR) prior to and during limited access ethanol drinking in adult female P rats. P rats were implanted with radio-telemetric transmitters to measure HR. Daily testing involved a 90-min pre-test period (water only available) and a subsequent 90-min test period [either water (W) or ethanol available]. After a week of habituation, one ethanol group had access to ethanol for 7 weeks (CE), and another ethanol group had access for 4 weeks, was deprived for 2 weeks and then had access for a final week (DEP). Analyses of HR revealed that CE and DEP rats had significantly higher HR than W rats during test periods that ethanol was present and that DEP rats displayed higher HR during the early test period of the ethanol deprivation interval, as well. These data indicate that ethanol drinking induces HR activation in adult female P rats, and that this activation can be conditioned to the test cage environment, paralleling reports on contextual conditioning and cue-reactivity in alcoholics exposed to alcohol-associated stimuli. Therefore, this behavioral test may prove advantageous in screening pharmacotherapies for reducing craving and relapse, which are associated with cue-reactivity in abstinent alcoholics.
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Affiliation(s)
- Richard L Bell
- Institute of Psychiatric Research, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Ren ZY, Zhang XL, Liu Y, Zhao LY, Shi J, Bao Y, Zhang XY, Kosten TR, Lu L. Diurnal variation in cue-induced responses among protracted abstinent heroin users. Pharmacol Biochem Behav 2008; 91:468-72. [PMID: 18809427 DOI: 10.1016/j.pbb.2008.08.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 08/19/2008] [Accepted: 08/28/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The physiological and psychological responses to drug cue exposure have been assessed in substance abusers. However, there is no study to demonstrate whether the responses to drug cue exposure are diurnal dependence. The present study was to examine whether there was a variation in drug-related cue reactivity across the diurnal cycle among recently abstinent opiate addicts. METHODS Four groups of 20 abstinent heroin dependent patients (n=80) were exposed to both neutral and drug-related videos at four separate times during the day: 8:00, 12:00, 16:00, and 20:00 h. Physiological and psychological responses, including heart rate, blood pressure, heroin craving, and subjective anxiety were assessed before and after each cue exposure. RESULTS Drug cue significantly increased craving ratings compared to neutral cues across all the four separate times of day. Drug cue-induced craving was greater in the morning (8:00 am) than noon (12:00 pm), but was similar to evening assessments (8 pm). Drug cues also significantly increased anxiety, which positively correlated with cue-induced craving. Drug cues increased heart rate, systolic and diastolic blood pressures, which were not correlated with cue-induced craving or anxiety. However, no time effects were found on the three physiological measures. CONCLUSIONS Cue-induced craving could be profoundly affected by the time points of cue exposure, using cue-reactivity paradigm. The relative sensitivity of morning and evening assessments of drug craving suggests a need for replication and further research on mechanisms contributing to these diurnal variations.
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Affiliation(s)
- Zhen-Yu Ren
- National Institute on Drug Dependence, Peking University, Beijing 100083, China
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Psychometric properties of the inventory of gambling situations with a focus on gender and age differences. J Nerv Ment Dis 2008; 196:321-8. [PMID: 18414127 DOI: 10.1097/nmd.0b013e31816a4982] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Environmental, interpersonal, and psychological factors contribute to gambling, but no standardized instrument for assessing high-risk gambling situations exists. This study evaluates the factor structure of the Inventory of Gambling Situations (IGS), a newly developed measure to examine situations that precipitate gambling. Pathological gamblers (n = 233) beginning a treatment study completed the IGS. Principal component analysis revealed that a 5-factor solution best fit the data, representing items related to Negative Affect, Luck and Control, Positive Affect, Social Situations, and Gambling Cues. Overall, Cronbach alpha was 0.960, ranging from 0.820 to 0.935 for the 5 factors. IGS scores correlated with other indices of gambling problems. Women scored higher on the Gambling Cues factor than men, and younger respondents, regardless of gender, scored higher on the Luck and Control factor than older respondents. The IGS may assist in better understanding situations in which pathological gamblers wager, and individual differences with respect to these situations.
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Lu L, Fang Y, Wang X. Drug Abuse in China: Past, Present and Future. Cell Mol Neurobiol 2007; 28:479-90. [PMID: 17990098 DOI: 10.1007/s10571-007-9225-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
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Shi J, Zhao LY, Epstein DH, Zhang XL, Lu L. Long-term methadone maintenance reduces protracted symptoms of heroin abstinence and cue-induced craving in Chinese heroin abusers. Pharmacol Biochem Behav 2007; 87:141-5. [PMID: 17532034 DOI: 10.1016/j.pbb.2007.04.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 04/06/2007] [Accepted: 04/12/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cession of heroin use may be followed by a protracted-abstinence (PA) syndrome consisting of craving, negative mood, and physiological changes. PA symptoms have rarely been compared between drug-free and methadone-maintained former heroin users after similar lengths of heroin abstinence. METHODS Seventy former heroin users were included in one of four groups: in day 15-45 of methadone maintenance therapy (short-term MMT), in month 5-6 of MMT (long-term MMT), opiate-free for 15-45 days after methadone-assisted heroin detoxification (short-term post-methadone), and opiate-free for 5-6 months after methadone-assisted heroin detoxification (long-term post-methadone). PA symptoms (negative mood, dyssomnia, somatization, and craving), and blood pressure and pulse were assessed pre- and post-neutral videotape and pre- and post-heroin videotape. RESULTS Dyssomnia and the total PA score were worst in short-term post-methadone participants, mood was best in long-term MMT participants, and cue-induced craving was least severe in long-term MMT participants. Blood pressure and pulse did not differ across groups. CONCLUSIONS Even after acute withdrawal, the first months of heroin abstinence after methadone-assisted detoxification may be more difficult in terms of cue-induced craving and other PA symptoms than the first months of heroin abstinence during MMT. Our findings add to the literature supporting MMT for prevention of cue-induced heroin craving.
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Affiliation(s)
- Jie Shi
- Department of Clinical Pharmacology, National Institute on Drug Dependence, Peking University, Beijing 100083, China
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