51
|
Blum K, Raza A, Schultz T, Jalali R, Green R, Brewer R, Thanos PK, McLaughlin T, Baron D, Bowirrat A, Elman I, Downs BW, Bagchi D, Badgaiyan RD. Should We Embrace the Incorporation of Genetically Guided "Dopamine Homeostasis" in the Treatment of Reward Deficiency Syndrome (RSD) as a Frontline Therapeutic Modality? ACTA SCIENTIFIC NEUROLOGY 2021; 4:17-24. [PMID: 33681869 PMCID: PMC7931265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In 2019, the US Center for Disease Control and Prevention provided vital statistics related to drug overdoses in the United State1. They concluded that in the USA the number of deaths at almost 72,000 was due to 66.6% of opioid overdoses. In fact, the rate is alarming and increasing yearly. To make 2021 even more scary is the daunting effect on increased drug usage due to COVID 19 as a pandemic, albeit the new vaccines. Specifically, in 2020, the death rate from opioid overdoses rose to 13% nationally and in some sates 30%. The common neuromodulating aspects of neurotransmission, and its disruption via chronic exposure of drugs and behavioral addictions, requires further intense research focus on developing novel strategies to combat these unwanted genetic and epigenic infractions as accomplished with heroin addiction by our group. The take home message is the plausible acceptance of the well-established evidence for hypodopaminergia, a blunted reward processing system, reduced resting state functional connectivity, genetic antecedents, anti- reward symptomatology, poor compliance with MAT, and generalized RDS. With this evidence it is conceivable that pursuit through intensive future research should involve an approach that incorporates "dopamine homeostasis". This required paradigm shift may consist of many beneficial modalities including but not limited to: exercise, pro-dopamine regulation, nutrigenomics, cognitive behavioral therapy, hedonic hot spot targets brain, rTMRS, deep brain stimulation, diet, genetic edits, genetic guided therapeutics, epigenetic repair, amongst others. It is our opinion that nutrigenomics may assist the millions of people of getting out of a" hypodopaminergic ditch" WC 250.
Collapse
Affiliation(s)
- Kenneth Blum
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
- Graduate College, Western University Health Sciences, Pomona, California, USA
- Division of Nutrigenomics, Center for Genomic Testing, Geneus Health, LLC., San Antonio, Texas, USA
| | - Ali Raza
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
| | - Tiffany Schultz
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
| | - Rehan Jalali
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
| | - Richard Green
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
| | - Raymond Brewer
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
| | - Panyotis K Thanos
- Department of Psychology, University of Buffalo, the State University of New York, Buffalo, NY, USA
| | - Thomas McLaughlin
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
| | - David Baron
- Graduate College, Western University Health Sciences, Pomona, California, USA
| | - Abdalla Bowirrat
- Department of Neuroscience and Genetics, Interdisciplinary Center Herzliya, Israel
| | - Igor Elman
- Department of Psychiatry, Harvard University College of Medicine, Cambridge, Massachusetts, USA
| | - B William Downs
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
| | - Debasis Bagchi
- The Kenneth Blum Behavioral Neurogenetic Institute, Austin, Texas, USA
- Department of Pharmaceutical Sciences, South Texas University College of Pharmacy, Houston, Texas, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, San Antonio, TX, Long School of Medicine, University of Texas Medical Center, San Antonio, TX, USA
| |
Collapse
|
52
|
Roos CR, Kober H, Trull TJ, MacLean RR, Mun CJ. Intensive longitudinal methods for studying the role of self-regulation strategies in substance use behavior change. CURRENT ADDICTION REPORTS 2020; 7:301-316. [PMID: 33510995 DOI: 10.1007/s40429-020-00329-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose of review Many psychosocial interventions for substance use disorders (SUDs) focus on teaching self-regulation strategies. Research using intensive longitudinal methods (ILM), such as ecological momentary assessment and daily diaries, is critical for elucidating if and how these strategies function as mechanisms of change among individuals with SUDs. We review this emerging area of research. Recent findings We found a small number of studies using ILM to study self-regulation strategies in SUD (n=18 studies), with most conducted among college student drinkers (n=9) and cigarette smokers (n=7), and few among treatment-engaged individuals, and those with other drug use disorders. There is preliminary evidence that the use of specific self-regulation strategies commonly taught in psychosocial interventions for SUDs (i.e., cognitive reappraisal, problem solving, stimulus control, harm reduction) is associated with decreased momentary or daily substance use, at the within-person level. Summary There is a need for further ILM research on self-regulation strategies as mechanisms of substance use behavior change. Such research can inform the development, refinement, and personalization of interventions that teach self-regulation strategies, including mobile interventions that facilitate strategy use in the moment. One key next step is developing psychometrically validated ILM assessments of self-regulation strategy use.
Collapse
Affiliation(s)
- Corey R Roos
- Yale University School of Medicine, New Haven CT 06510
| | - Hedy Kober
- Yale University School of Medicine, New Haven CT 06510
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, 65211
| | - R Ross MacLean
- Yale University School of Medicine, New Haven CT 06510.,VA Connecticut Healthcare System, West Haven, CT 06515
| | - Chung Jung Mun
- Johns Hopkins University School of Medicine, Baltimore, MD 21205
| |
Collapse
|
53
|
Magill M, Tonigan JS, Kiluk B, Ray L, Walthers J, Carroll K. The search for mechanisms of cognitive behavioral therapy for alcohol or other drug use disorders: A systematic review. Behav Res Ther 2020; 131:103648. [PMID: 32474226 PMCID: PMC7329023 DOI: 10.1016/j.brat.2020.103648] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/07/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
The emphasis in addictions research has shifted toward a greater interest in identifying the mechanisms involved in patient behavior change. This systematic review investigated nearly 30 years of mediation research on cognitive behavioral therapy (CBT) for alcohol or other drug use disorders (AUD/SUD). METHOD Study inclusion criteria targeted analyses occurring in the context of a randomized clinical trial where both intervention/intervention ingredient to mediator (a path) and mediator to outcome (b path) paths were reported. Between- and within-condition analyses were eligible, as were studies that formally tested mediation and those that conducted path analysis only. RESULTS The review sample included K = 15 reports of primarily between-condition analyses. Almost half of these reports utilized Project MATCH (k = 2) or COMBINE (k = 4) samples. Among the mediator candidates, support for changes in coping skills was strongest, although the specificity of this process to CBT or CBT-based treatment remains unclear. Similarly, support for self-efficacy as a statistical mediator was found in within-, but not between-condition analyses. CONCLUSIONS A coherent body of literature on CBT mechanisms is significantly lacking. Adopting methodological guidelines from the Science of Behavior Change Framework, we provide recommendations for future research in this area of study.
Collapse
Affiliation(s)
- Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI, USA.
| | | | | | - Lara Ray
- University of California at Los Angeles, Los Angeles, CA, USA
| | - Justin Walthers
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI, USA
| | | |
Collapse
|
54
|
Martz ME, Hart T, Heitzeg MM, Peltier SJ. Neuromodulation of brain activation associated with addiction: A review of real-time fMRI neurofeedback studies. Neuroimage Clin 2020; 27:102350. [PMID: 32736324 PMCID: PMC7394772 DOI: 10.1016/j.nicl.2020.102350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) has emerged in recent years as an imaging modality used to examine volitional control over targeted brain activity. rtfMRI-nf has also been applied clinically as a way to train individuals to self-regulate areas of the brain, or circuitry, involved in various disorders. One such application of rtfMRI-nf has been in the domain of addictive behaviors, including substance use. Given the pervasiveness of substance use and the challenges of existing treatments to sustain abstinence, rtfMRI-nf has been identified as a promising treatment tool. rtfMRI-nf has also been used in basic science research in order to test the ability to modulate brain function involved in addiction. This review focuses first on providing an overview of recent rtfMRI-nf studies in substance-using populations, specifically nicotine, alcohol, and cocaine users, aimed at reducing craving-related brain activation. Next, rtfMRI-nf studies targeting reward responsivity and emotion regulation in healthy samples are reviewed in order to examine the extent to which areas of the brain involved in addiction can be self-regulated using neurofeedback. We propose that future rtfMRI-nf studies could be strengthened by improvements to study design, sample selection, and more robust strategies in the development and assessment of rtfMRI-nf as a clinical treatment. Recommendations for ways to accomplish these improvements are provided. rtfMRI-nf holds much promise as an imaging modality that can directly target key brain regions involved in addiction, however additional studies are needed in order to establish rtfMRI-nf as an effective, and practical, treatment for addiction.
Collapse
Affiliation(s)
- Meghan E Martz
- Addiction Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Tabatha Hart
- Addiction Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Mary M Heitzeg
- Addiction Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Scott J Peltier
- Functional MRI Laboratory, USA; Department of Biomedical Engineering, Bonisteel Interdisciplinary Research Building, 2360 Bonisteel Blvd, Ann Arbor, MI 48109, USA
| |
Collapse
|
55
|
Roos CR, Carroll KM, Nich C, Frankforter T, Kiluk BD. Short- and long-term changes in substance-related coping as mediators of in-person and computerized CBT for alcohol and drug use disorders. Drug Alcohol Depend 2020; 212:108044. [PMID: 32422538 PMCID: PMC7293942 DOI: 10.1016/j.drugalcdep.2020.108044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND No studies have examined long-term changes in substance-related coping skills as a statistical mediator of cognitive-behavioral therapy (CBT) for substance use disorders (SUD). METHODS We tested both short- and long-term changes in coping as mediators of treatment effects in two trials of in-person and/or computerized CBT for SUD. The first trial included 137 individuals (75 % male; 65.7 % non-White; mean age = 35.9) with drug and/or alcohol use disorders randomized to one of the following: in-person CBT, computer-delivered CBT (CBT4CBT) plus brief monitoring, or treatment-as-usual (TAU). The second trial included 68 individuals (65 % male; 66.2 % non-white; mean age = 42.7) with an alcohol use disorder randomized to one of the following: CBT4CBT plus brief monitoring, CBT4CBT plus TAU, or TAU only. Coping was assessed with the Coping Strategies Scale. Latent growth curve mediational models were conducted, with both short-term (baseline through end-of-treatment) and long-term (baseline through 3-month post-treatment follow-up) changes in coping. RESULTS There were no mediation effects for short-term changes in coping. However, in both trials, there were significant mediation effects for long-term changes in coping: In trial 1, the effect of CBT4CBT vs. TAU on substance use at the 6-month follow-up was mediated by long-term increases in coping. This same mediation effect was not found for in-person CBT vs. TAU. In trial 2, the effect of CBT4CBT vs. not receiving CBT4CBT on heavy drinking at the 6-month follow-up was mediated by long-term increases in coping. CONCLUSIONS Long-term increases in coping may be a mechanism of change in computerized CBT for SUD.
Collapse
Affiliation(s)
- Corey R Roos
- Yale University School of Medicine, New Haven, CT, 06510, United States.
| | | | - Charla Nich
- Yale University School of Medicine, New Haven, CT, 06510, United States
| | - Tami Frankforter
- Yale University School of Medicine, New Haven, CT, 06510, United States
| | - Brian D Kiluk
- Yale University School of Medicine, New Haven, CT, 06510, United States
| |
Collapse
|
56
|
Ray LA, Meredith LR, Kiluk BD, Walthers J, Carroll KM, Magill M. Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e208279. [PMID: 32558914 PMCID: PMC7305524 DOI: 10.1001/jamanetworkopen.2020.8279] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Substance use disorders (SUDs) represent a pressing public health concern. Combined behavioral and pharmacological interventions are considered best practices for addiction. Cognitive behavioral therapy (CBT) is a first-line intervention, yet the superiority of CBT compared with other behavioral treatments when combined with pharmacotherapy remains unclear. An understanding of the effects of combined CBT and pharmacotherapy will inform best-practice guidelines for treatment of SUD. OBJECTIVE To conduct a meta-analysis of the published literature on combined CBT and pharmacotherapy for adult alcohol use disorder (AUD) or other SUDs. DATA SOURCES PubMed, Cochrane Register, MEDLINE, PsychINFO, and Embase databases from January 1, 1990, through July 31, 2019, were searched. Keywords were specified in 3 categories: treatment type, outcome type, and study design. Collected data were analyzed through September 30, 2019. STUDY SELECTION Two independent raters reviewed abstracts and full-text articles. English language articles describing randomized clinical trials examining CBT in combination with pharmacotherapy for AUD and SUD were included. DATA EXTRACTION AND SYNTHESIS Inverse-variance weighted, random-effects estimates of effect size were pooled into 3 clinically informative subgroups: (1) CBT plus pharmacotherapy compared with usual care plus pharmacotherapy, (2) CBT plus pharmacotherapy compared with another specific therapy plus pharmacotherapy, and (3) CBT added to usual care and pharmacotherapy compared with usual care and pharmacotherapy alone. Sensitivity analyses included assessment of study quality, pooled effect size heterogeneity, publication bias, and primary substance moderator effects. MAIN OUTCOMES AND MEASURES Substance use frequency and quantity outcomes after treatment and during follow-up were examined. RESULTS The sample included 62 effect sizes from 30 unique randomized clinical trials that examined CBT in combination with some form of pharmacotherapy for AUD and SUD. The primary substances targeted in the clinical trial sample were alcohol (15 [50%]), followed by cocaine (7 [23%]) and opioids (6 [20%]). The mean (SD) age of the patient sample was 39 (6) years, with a mean (SD) of 28% (12%) female participants per study. The following pharmacotherapies were used: naltrexone hydrochloride and/or acamprosate calcium (26 of 62 effect sizes [42%]), methadone hydrochloride or combined buprenorphine hydrochloride and naltrexone (11 of 62 [18%]), disulfiram (5 of 62 [8%]), and another pharmacotherapy or mixture of pharmacotherapies (20 of 62 [32%]). Random-effects pooled estimates showed a benefit associated with combined CBT and pharmacotherapy over usual care (g range, 0.18-0.28; k = 9). However, CBT did not perform better than another specific therapy, and evidence for the addition of CBT as an add-on to combined usual care and pharmacotherapy was mixed. Moderator analysis showed variability in effect direction and magnitude by primary drug target. CONCLUSIONS AND RELEVANCE The present study supports the efficacy of combined CBT and pharmacotherapy compared with usual care and pharmacotherapy. Cognitive behavioral therapy did not perform better than another evidence-based modality (eg, motivational enhancement therapy, contingency management) in this context or as an add-on to combined usual care and pharmacotherapy. These findings suggest that best practices in addiction treatment should include pharmacotherapy plus CBT or another evidence-based therapy, rather than usual clinical management or nonspecific counseling services.
Collapse
Affiliation(s)
- Lara A. Ray
- Department of Psychology, University of California, Los Angeles
| | | | | | - Justin Walthers
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | | | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| |
Collapse
|
57
|
Swan JE, Votaw VR, Stein ER, Witkiewitz K. The Role of Affect in Psychosocial Treatments for Substance Use Disorders. CURRENT ADDICTION REPORTS 2020; 7:108-116. [PMID: 34327114 PMCID: PMC8317473 DOI: 10.1007/s40429-020-00304-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This paper provides a narrative review of studies published over the past five years that have examined the role of affect, including both affective symptoms and affective disorders, in psychosocial treatments for substance use disorder. RECENT FINDINGS A growing body of literature suggests that affective symptoms and affective disorders may moderate substance use disorder treatment efficacy, mediate the effects of treatment on substance use outcomes, and may be directly changed by substance use disorder treatment. SUMMARY Substance use disorders and affective disorders commonly co-occur, and both affect and affective disorders are associated with substance use disorder treatment outcomes. Future research should continue to examine affect as a moderator, mediator, and outcome of substance use disorder treatments. In particular, new studies that are designed to test precision medicine hypotheses would greatly expand our understanding of the role of affective symptoms and disorders in substance use disorder treatment.
Collapse
Affiliation(s)
- Julia E Swan
- Department of Psychology, University of New Mexico
| | | | | | | |
Collapse
|
58
|
Saraiya TC, Swarbrick M, Franklin L, Kass S, Campbell ANC, Hien DA. Perspectives on trauma and the design of a technology-based trauma-informed intervention for women receiving medications for addiction treatment in community-based settings. J Subst Abuse Treat 2020; 112:92-101. [PMID: 32199551 PMCID: PMC11000234 DOI: 10.1016/j.jsat.2020.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite national calls to develop gender-specific interventions for women with opioid use disorder (OUD) with co-occurring trauma and post-traumatic stress disorder (PTSD) symptoms, there remains a dearth of research on what modalities or treatment components would be most feasible for this population. This study interviewed women with OUD receiving medication assisted treatment and addiction treatment providers to explore (a) experiences of barriers to receiving trauma treatment, and (b) both the perceptions and desired design of a prospective technology-delivered, trauma-informed treatment for women with OUD. METHODS Women with lifetime OUD (n = 11) and providers (n = 5) at two community substance use clinics completed semi-structured interviews. Interviews were transcribed, coded, and analyzed in NVivo v11 using a grounded theory approach. Women also completed a demographic form and clinical measures. RESULTS Clients were primarily women with children reporting histories of multiple trauma exposures, high PTSD symptoms, and polysubstance use. Two themes emerged among clients and one among providers regarding barriers to trauma treatment. Regarding the feasibility and desired attributes of a technology-based intervention, six themes emerged among clients and providers, respectively. CONCLUSIONS Themes suggest a high interest by clients and providers for a technology-delivered, trauma informed treatment available by smartphone. Utilizing technology as an adjunct to care, without reducing face-to-face therapy, was important to both clients and providers.
Collapse
Affiliation(s)
- Tanya C Saraiya
- Derner School of Psychology, Adelphi University, 158 Cambridge Ave, Garden City, NY 11530, United States of America.
| | - Margaret Swarbrick
- Rutgers Health University Behavioral Healthcare, Rutgers University, 671 Hoes Ln W, Piscataway, NJ 08854, United States of America
| | - Liza Franklin
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Rd, Piscataway, NJ 08854, United States of America
| | - Sara Kass
- Center of Alcohol & Substance Use Studies, Rutgers University, 607 Allison Road, Piscataway, NJ, 08854, United States of America
| | - Aimee N C Campbell
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America
| | - Denise A Hien
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Rd, Piscataway, NJ 08854, United States of America; Center of Alcohol & Substance Use Studies, Rutgers University, 607 Allison Road, Piscataway, NJ, 08854, United States of America
| |
Collapse
|
59
|
Grant JE, Chamberlain SR. Gambling and substance use: Comorbidity and treatment implications. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109852. [PMID: 31881248 DOI: 10.1016/j.pnpbp.2019.109852] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Gambling disorder is a common condition that was previously listed as an impulse control disorder, but is now considered a substance-related and addictive disorder. Gambling disorder has been associated with various untoward long-term outcomes including impaired quality of life, relationship break-ups, debt and mortgage foreclosure, and elevated risk of suicidality. This paper provides a concise primer on gambling disorder, with a special focus on its parallels with substance use disorders. We consider clinical presentations, comorbid expression, heritability, and treatment approaches (psychological and pharmacological). Lastly, we highlight new treatment directions suggested by the literature.
Collapse
Affiliation(s)
- Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge; & Cambridge and Peterborough NHS Foundation Trust (CPFT), UK
| |
Collapse
|
60
|
Prince MA, Collins RL, Wilson SD, Vincent PC. A preliminary test of a brief intervention to lessen young adults' cannabis use: Episode-level smartphone data highlights the role of protective behavioral strategies and exercise. Exp Clin Psychopharmacol 2020; 28:150-156. [PMID: 31144836 PMCID: PMC6884655 DOI: 10.1037/pha0000301] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Brief interventions are increasingly being used to help young adults to moderate their cannabis use. We conducted a randomized clinical trial of a brief (4 weekly sessions), in-person intervention that included a smartphone application that reinforced the use of protective behavioral strategies (PBSs) to lessen cannabis use. Young adults (N = 37; 24 men) who regularly used cannabis were randomized to 2 intervention conditions rooted in cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET). Along with learning CBT + MET strategies, participants in 1 of the conditions were instructed to engage in exercise. All participants used smartphone-based ecological momentary assessment to provide episode-level reports about use of cannabis and PBSs. Two multilevel structural equation models were run to test the study hypotheses that (a) cannabis use would be reduced over the course of the 6-month study, (b) reductions would be moderated by intervention condition, and (c) episode-level PBS use would predict episode-level cannabis use. Participants reduced their cannabis use by approximately 1 half of a standard joint per time point. The MET + CBT + Exercise condition reduced cannabis use to a greater degree than did the MET + CBT condition. With episode-level PBS use in the model, reductions in cannabis use were independent of intervention condition. Our findings suggest that young adults will engage with a smartphone app that serves as a component of an in-person intervention to moderate their cannabis use. Intervention content that promotes the use of PBSs and exercise facilitates reductions in cannabis use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Mark A. Prince
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523-1876
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, University at Buffalo, State University of New York
| | - Sandy D. Wilson
- Department of Community Health and Health Behavior, University at Buffalo, State University of New York
| | - Paula C. Vincent
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| |
Collapse
|
61
|
Votaw VR, Pearson MR, Stein E, Witkiewitz K. The Addictions Neuroclinical Assessment Negative Emotionality Domain Among Treatment-Seekers with Alcohol Use Disorder: Construct Validity and Measurement Invariance. Alcohol Clin Exp Res 2020; 44:679-688. [PMID: 31957027 DOI: 10.1111/acer.14283] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Addictions Neuroclinical Assessment (ANA), a framework for measuring heterogeneity in alcohol use disorder (AUD), focuses on 3 domains that reflect neurobiological dysfunction in addiction and correspond to the cycles of addiction: executive function, incentive salience, and negative emotionality. Kwako and colleagues (Am J Psychiatry 176:744, 2019) validated a 3-factor model of the ANA with neuropsychological and self-report indicators among treatment-seekers and non-treatment-seekers with and without AUD. The present analysis replicated and extended these findings in a treatment-seeking sample, focusing on the negative emotionality domain. METHODS Participants (n = 563; 58.8% male; mean age = 34.3) were part of a multisite prospective study of individuals entering AUD treatment. We examined the factor structure of the negative emotionality domain at the baseline, 6-month follow-up, and 12-month follow-up assessments. The Beck Depression Inventory, Beck Anxiety Inventory, State-Trait Anger Expression Inventory-Trait Anger Subscale, and 3 Drinker Inventory of Consequences items assessing negative affective consequences were indicators in the model. RESULTS Results indicated that a 1-factor model was an excellent fit at all assessments and that the negative emotionality domain was time and gender invariant. Furthermore, negative emotionality was associated with drinking patterns and reasons for alcohol use (i.e., drinking because of negative emotions and urges/withdrawal) at all assessments. CONCLUSIONS This analysis provides evidence for the construct validity and measurement invariance of the ANA negative emotionality domain among AUD treatment-seekers. Future studies are needed to evaluate prospective associations between negative emotionality and specific treatment modalities, and whether individuals with greater negative emotionality are more likely to respond to treatment that targets drinking to relieve negative affective states.
Collapse
Affiliation(s)
- Victoria R Votaw
- From the, Department of Psychology, (VRV, ES, KW), Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, & Addictions, (MRP), University of New Mexico, Albuquerque, New Mexico
| | - Elena Stein
- From the, Department of Psychology, (VRV, ES, KW), Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Katie Witkiewitz
- From the, Department of Psychology, (VRV, ES, KW), Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
62
|
Votaw VR, McHugh RK, Vowles KE, Witkiewitz K. Patterns of Polysubstance Use among Adults with Tranquilizer Misuse. Subst Use Misuse 2020; 55:861-870. [PMID: 31900021 PMCID: PMC7166167 DOI: 10.1080/10826084.2019.1708118] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The misuse of benzodiazepine tranquilizers is prevalent and is associated with increased risk of overdose when combined with other substances. Yet, little is known about other substance use among those who misuse tranquilizers. Objectives: This study characterized subgroups of individuals with tranquilizer misuse, based on patterns of polysubstance use. Methods: Data were extracted from the 2015-2017 National Survey on Drug Use and Health; adults with past-month tranquilizer misuse were included (N = 1253). We utilized latent class analysis to identify patterns of polysubstance use in the previous month. Results: We identified three distinct latent classes, including the: (1) limited polysubstance use class (approximately 54.6% of the sample), (2) binge alcohol and cannabis use class (28.5% of the sample), and (3) opioid use class (16.9% of the sample). The binge alcohol and cannabis use class and the opioid use class were characterized by high probabilities of other substance misuse, including cocaine and prescription stimulants. Those in the binge alcohol and cannabis use class and the opioid use class reported more motives for tranquilizer misuse and higher rates of sexually transmitted infection, criminal involvement, and suicidal ideation. Those in the opioid use class also had greater psychological distress and higher rates of injection drug use. Conclusions: Nearly half of those with tranquilizer misuse in a general population sample were categorized into one of two high polysubstance use classes, and these two classes were associated with poorer functioning. Findings from these analyses underscore the need to reduce polysubstance use among those who misuse tranquilizers.
Collapse
Affiliation(s)
- Victoria R Votaw
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
63
|
Chen S, Huang S, Yang C, Cai W, Chen H, Hao W, Liu T, Wang X, Worhunsky PD, Potenza MN. Neurofunctional Differences Related to Methamphetamine and Sexual Cues in Men With Shorter and Longer Term Abstinence Methamphetamine Dependence. Int J Neuropsychopharmacol 2019; 23:135-145. [PMID: 31995187 PMCID: PMC7171928 DOI: 10.1093/ijnp/pyz069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/02/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stimulant use and sexual behaviors have been linked in behavioral and epidemiological studies. Although methamphetamine-related neurofunctional differences have been investigated, few studies have examined neural responses to drug and sexual cues with respect to shorter or longer term methamphetamine abstinence in individuals with methamphetamine dependence. METHODS Forty-nine men with shorter term methamphetamine abstinence, 50 men with longer term methamphetamine abstinence, and 47 non-drug-using healthy comparison men completed a functional magnetic resonance imaging cue-reactivity task consisting of methamphetamine, sexual, and neutral visual cues. RESULTS Region-of-interest analyses revealed greater methamphetamine cue-related activation in shorter term methamphetamine abstinence and longer term methamphetamine abstinence individuals relative to healthy comparison men in the ventromedial prefrontal cortex. A significant interaction of group and condition in the anterior insula was found. Relative to healthy comparison participants, both shorter term methamphetamine abstinence and longer term methamphetamine abstinence groups displayed greater sexual cue-related anterior insula activation relative to methamphetamine cues and neutral cues, but there were no differences between shorter term methamphetamine abstinence and longer term methamphetamine abstinence groups in anterior insula responses. Subsequent whole-brain analyses indicated a group-by-condition interaction with longer term methamphetamine abstinence participants showing greater sexual-related activation in the left superior frontal cortex relative to healthy comparison men. Shorter term methamphetamine abstinence participants showed greater superior frontal cortex activation to sexual relative to neutral cues, and longer term methamphetamine abstinence participants showed greater superior frontal cortex activation to sexual relative to neutral and methamphetamine cues. CONCLUSIONS The findings suggest that abstinence from methamphetamine may alter how individuals respond to drug and sexual cues and thus may influence drug use and sexual behaviors. Given the use of methamphetamine for sexual purposes and responses to natural vs drug rewards for addiction recovery, the findings may have particular clinical relevance.
Collapse
Affiliation(s)
- Shubao Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China,Chinese National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China,Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Shucai Huang
- Department of Psychiatry, The Fourth People’s Hospital of Wuhu, Wuhu, Anhui, China
| | - Cheng Yang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China,Chinese National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Weifu Cai
- Department of Psychiatry, People’s Hospital of Zhuhai, Zhuhai, Guangzhou, China
| | - Hongxian Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China,Chinese National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Wei Hao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China,Chinese National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Tieqiao Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China,Chinese National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China,Correspondence: Xuyi Wang, MD, PhD, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Changsha 410011, Hunan, China () and Tieqiao Liu, MD, PhD, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Changsha 410011, Hunan, China ()
| | - Xuyi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China,Chinese National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China,Correspondence: Xuyi Wang, MD, PhD, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Changsha 410011, Hunan, China () and Tieqiao Liu, MD, PhD, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Changsha 410011, Hunan, China ()
| | | | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,Connecticut Mental Health Center, New Haven, CT,Connecticut Council on Problem Gambling, Wethersfield, CT,Department of Neuroscience, and Child Study Center, Yale School of Medicine, New Haven, CT
| |
Collapse
|
64
|
Knox J, Hasin DS, Larson FRR, Kranzler HR. Prevention, screening, and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry 2019; 6:1054-1067. [PMID: 31630982 PMCID: PMC6883141 DOI: 10.1016/s2215-0366(19)30213-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
Abstract
Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.
Collapse
Affiliation(s)
- Justin Knox
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| |
Collapse
|
65
|
Kiluk BD, Ray LA, Walthers J, Bernstein M, Tonigan JS, Magill M. Technology-Delivered Cognitive-Behavioral Interventions for Alcohol Use: A Meta-Analysis. Alcohol Clin Exp Res 2019; 43:2285-2295. [PMID: 31566787 PMCID: PMC6824956 DOI: 10.1111/acer.14189] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) has long-standing evidence for efficacy in the treatment of alcohol use, yet implementation in clinical practice has been challenging. Delivery of CBT through technology-based platforms, such as web-based programs and mobile applications, has the potential to provide widespread access to this evidence-based intervention. While there have been reviews indicating the efficacy of technology-based delivery of CBT for various psychiatric conditions, none have focused on efficacy for alcohol use. The current meta-analysis was conducted to fill this research gap. METHODS Descriptive data were used to characterize the nature of the literature on technology-delivered, CBT-based interventions for alcohol use ("CBT Tech"). Inverse-variance-weighted effect sizes were calculated, and random effects, effect sizes were pooled in 4 subgroups. RESULTS Fifteen published trials conducted primarily with at-risk or heavy drinkers were identified. Of these studies, 60% explicitly targeted alcohol use moderation. The content of CBT Tech programs varied, ranging from 4 to 62 sessions/exercises, with many programs combining elements of motivational interviewing (47%). With respect to efficacy, CBT Tech as a stand-alone treatment in contrast to a minimal treatment control showed a positive and statistically significant, albeit small effect (g = 0.20: 95% CI = 0.22, 0.38, kes = 5). When CBT Tech was compared to treatment as usual (TAU), effects were nonsignificant. However, when CBT Tech was tested as an addition to TAU, in contrast to TAU only, the effect size was positive, significant (g = 0.30: 95% CI = 0.10, 0.50, kes = 7), and stable over 12-month follow-up. Only 2 studies compared CBT Tech to in-person CBT, and this pooled effect size did not suggest superior efficacy. CONCLUSIONS These results show a benefit for technology-delivered, CBT-based interventions as a stand-alone therapy for heavy drinking or as an addition to usual care in specialty substance use settings.
Collapse
Affiliation(s)
| | - Lara A. Ray
- University of California at Los Angeles, Los Angeles, CA
| | - Justin Walthers
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | - Michael Bernstein
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | | | - Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| |
Collapse
|
66
|
Portelli J, Wiers CE, Li X, Deschaine SL, McDiarmid GR, Bermpohl F, Leggio L. Peripheral proinflammatory markers are upregulated in abstinent alcohol-dependent patients but are not affected by cognitive bias modification: Preliminary findings. Drug Alcohol Depend 2019; 204:107553. [PMID: 31541874 PMCID: PMC6913873 DOI: 10.1016/j.drugalcdep.2019.107553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/28/2019] [Accepted: 07/07/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Inflammatory pathways are known to be negatively affected in patients with alcohol use disorder (AUD). Cognitive bias modification (CBM), an emerging behavioral treatment that involves the 're-training' of cognitive biases using computerized tasks, has been reported to reduce alcohol craving and relapse rates. The aim of this study was to compare peripheral concentrations of the proinflammatory biomarkers IL-18, IL-6, IL-1β, TNF-α and CRP in AUD patients versus controls and to identify whether CBM treatment affected these biomarkers in AUD patients. METHODS This 3-week double-blind randomized controlled study tested 36 male abstinent AUD patients receiving CBM or placebo-training, who were also compared to 18 male healthy controls. The approach avoidance task (AAT) was used to test the AUD patients before and after training. CBM training took place over 6 sessions, using a joystick-based approach-avoidance task. Blood samples were collected after the pre- and post-AAT test sessions for the AUD groups, and during an outpatient appointment with the controls. RESULTS AUD patients, versus controls, presented with significantly higher plasma levels of TNF- α (P < 0.0001) and CRP (P = 0.0031). No changes in the CBM versus placebo groups were noted in IL-18, TNF-α and CRP concentrations following pre-post change or within group pretest- posttest analysis. IL-6 and IL-1β levels fell under the lower detection limit, thus were not included in the final analyses. CONCLUSIONS This study confirms that the inflammatory system is altered in AUD. This was the first study that investigated whether CBM training affected proinflammatory markers in AUD patients.
Collapse
Affiliation(s)
- Jeanelle Portelli
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Corinde E. Wiers
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Sara L. Deschaine
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Gray R. McDiarmid
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Germany
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, USA; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
| |
Collapse
|
67
|
Magill M, Ray L, Kiluk B, Hoadley A, Bernstein M, Tonigan JS, Carroll K. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. J Consult Clin Psychol 2019; 87:1093-1105. [PMID: 31599606 DOI: 10.1037/ccp0000447] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined. METHOD The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias. RESULTS CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance. CONCLUSIONS The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Lara Ray
- Department of Psychology, University of California, Los Angeles
| | - Brian Kiluk
- Department of Psychiatry, Yale School of Medicine
| | | | | | | | | |
Collapse
|
68
|
Kiluk BD. Computerized Cognitive Behavioral Therapy for Substance Use Disorders: A Summary of the Evidence and Potential Mechanisms of Behavior Change. Perspect Behav Sci 2019; 42:465-478. [PMID: 31976445 PMCID: PMC6768920 DOI: 10.1007/s40614-019-00205-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cognitive-behavioral therapy (CBT) is one of the most evaluated behavioral interventions for substance use disorders, with considerable empirical evidence supporting its efficacy. However, despite CBT's strong support from efficacy trials, broad dissemination and implementation have been challenging. Furthermore, there remains limited understanding regarding CBT's mechanisms of behavior change; the theory-driven assumption that individuals acquire new skills for coping with triggers for substance use has notoriously lacked statistical support. The emergence of computer-delivered interventions has the potential to address dissemination and implementation challenges, as well as offer advantages toward understanding treatment mechanisms. This article will provide a summary of the current evidence supporting one particular computerized CBT program, CBT4CBT. Multiple clinical trials in different treatment settings have indicated CBT4CBT's efficacy at reducing rates of alcohol and drug use when provided as an add-on to standard addiction treatment, as well as when provided with minimal clinical monitoring (i.e., virtual stand-alone). These effects have also been relatively durable after treatment termination, consistent with findings of traditional CBT. It is important to note that the evaluation of individuals' cognitive and behavioral coping skills prior and following treatment has indicated the acquisition/improvement of these skills may be a mechanism of behavior change for those who engage with CBT4CBT. Thus, computerized delivery may be a strategy for enhancing individuals' learning of cognitive and behavioral skills for successfully avoiding substance use. Future work should aim to identify the optimal type of setting, clinician role, and patient characteristics for targeted dissemination and implementation.
Collapse
Affiliation(s)
- Brian D. Kiluk
- Yale School of Medicine, 40 Temple Street, Suite 6C, New Haven, CT 06510 USA
| |
Collapse
|
69
|
Telehealth Treatment for Alcohol Misuse: Reviewing Telehealth Approaches to Increase Engagement and Reduce Risk of Alcohol-Related Hypertension. Curr Hypertens Rep 2019; 21:59. [DOI: 10.1007/s11906-019-0966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
70
|
Miguel AQC, Kiluk BD, Babuscio TA, Nich C, Mari JJ, Carroll KM. Short and long-term improvements in psychiatric symptomatology to validate clinically meaningful treatment outcomes for cocaine use disorders. Drug Alcohol Depend 2019; 198:126-132. [PMID: 30921648 PMCID: PMC6487863 DOI: 10.1016/j.drugalcdep.2019.01.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/11/2018] [Accepted: 01/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Substantial efforts have been made to identify clinically meaningful non-abstinence cocaine use outcomes by establishing associations between targeted drug use outcomes and long-term functional improvements. Psychiatric symptomatology is prevalent among those seeking treatment for cocaine use disorder (CUD). Establishing an association between cocaine use outcomes and improvements in psychiatric symptomatology would support clinical validity to these outcome measures. METHOD With data pooled from 5 clinical trials evaluating treatment for CUD (n = 474) multiple linear mixed models were conducted to determine how five specific cocaine use outcome measures performed in terms of improvements in psychiatric symptomatology assessed with the Brief Symptom Inventory (BSI) at baseline, end-of-treatment and 6-month follow-up. RESULTS Three outcome measures performed comparably well (maximum days of consecutive abstinence, 3 or more weeks of abstinence and end-of-treatment abstinence), in that they consistently predicted improvements in several BSI composite scores at the end-of-treatment and follow-up. The poorer-performing outcome measures were complete abstinence during treatment, percentage of negative urinalysis results and percentage of days abstinent. Improvements in the BSI's global index of distress, positive symptom total, as well as depression, interpersonal sensitivity, obsessive-compulsion, phobic-anxiety and psychoticism dimensions were consistently associated with outcome effects, while anxiety, hostility, paranoid ideation and somatization were not. CONCLUSION The consistent short and long-term association of three outcome measures evaluated here (maximum days of consecutive abstinence, 3 or more weeks of abstinence and end-of-treatment abstinence) with improvements psychiatric symptomatology adds support to their clinical relevance as well as their adoption in trials and treatments for CUD.
Collapse
Affiliation(s)
- André Q. C. Miguel
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States,Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Brian D. Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Theresa A. Babuscio
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jair J. Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
71
|
The Changing Landscape of Substance Use Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:152-153. [PMID: 31975973 PMCID: PMC6527001 DOI: 10.1176/appi.focus.17201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
72
|
Repetitive transcranial magnetic stimulation: Re-wiring the alcoholic human brain. Alcohol 2019; 74:113-124. [PMID: 30420113 DOI: 10.1016/j.alcohol.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/15/2018] [Accepted: 05/28/2018] [Indexed: 12/28/2022]
Abstract
Alcohol use disorders (AUDs) are one of the leading causes of mortality and morbidity worldwide. In spite of significant advances in understanding the neural underpinnings of AUDs, therapeutic options remain limited. Recent studies have highlighted the potential of repetitive transcranial magnetic stimulation (rTMS) as an innovative, safe, and cost-effective treatment for AUDs. Here, we summarize the fundamental principles of rTMS and its putative mechanisms of action via neurocircuitries related to alcohol addiction. We will also discuss advantages and limitations of rTMS, and argue that Hebbian plasticity and connectivity changes, as well as state-dependency, play a role in shaping some of the long-term effects of rTMS. Visual imaging studies will be linked to recent clinical pilot studies describing the effect of rTMS on alcohol craving and intake, pinpointing new advances, and highlighting conceptual gaps to be filled by future controlled studies.
Collapse
|
73
|
Ray LA, Bujarski S, Grodin E, Hartwell E, Green R, Venegas A, Lim AC, Gillis A, Miotto K. State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:124-140. [PMID: 30373394 DOI: 10.1080/00952990.2018.1528265] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities. OBJECTIVE This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support. METHOD This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated. SCIENTIFIC SIGNIFICANCE One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.
Collapse
Affiliation(s)
- Lara A Ray
- a Department of Psychology , University of California , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Spencer Bujarski
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Erica Grodin
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Emily Hartwell
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - ReJoyce Green
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Alexandra Venegas
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Aaron C Lim
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Artha Gillis
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Karen Miotto
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| |
Collapse
|
74
|
Kiluk BD. Commentary on Litt et al. (2018): Identifying treatment-targeted mechanisms-aim and measure the bullseye. Addiction 2018; 113:1418-1419. [PMID: 29998621 PMCID: PMC6151125 DOI: 10.1111/add.14258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
Abstract
The search for mechanisms unique to a specific treatment requires identification of an exact treatment target, instruments that are precise in measuring the target, and a statistical approach that will determine whether the given treatment hit the target.
Collapse
|
75
|
Campbell EJ, Lawrence AJ, Perry CJ. New steps for treating alcohol use disorder. Psychopharmacology (Berl) 2018; 235:1759-1773. [PMID: 29574507 DOI: 10.1007/s00213-018-4887-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/16/2018] [Indexed: 12/31/2022]
Abstract
Alcohol use disorder is a complex syndrome with multiple treatment points including drug-induced pathology, withdrawal management, behavioral/cognitive strategies, and relapse prevention. These different components may be complicated by genotype and phenotype. A huge milestone for the treatment of alcohol use disorder across several countries in the last 10 years was the introduction of practice guidelines integrating clinical expertise and research evidence. These provide a summary of interventions that have been shown to be effective following rigorous and replicated clinical trials. Inspection of these guidelines reveals good consistency, but little evidence of progress in treatment approaches for alcohol use disorder over the past decade. In this mini-review, we discuss emerging treatments for alcohol use disorder that may supplement or improve the evidence-based treatments that are currently recommended. New medications, the emergence of digital technology, and other novel approaches such as transcranial magnetic stimulation are all discussed with reference to treatments already in practice. We also consider how individual differences in genotype and phenotype may affect outcomes. Together with improvements in technology, this knowledge offers a powerful tool for designing personalized approaches to treatment, and hence improving prognosis for rehabilitation programs.
Collapse
Affiliation(s)
- Erin J Campbell
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Parkville, Victoria, 3052, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Andrew J Lawrence
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Parkville, Victoria, 3052, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Christina J Perry
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Parkville, Victoria, 3052, Australia. .,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| |
Collapse
|
76
|
Flanagan JC, Jones JL, Jarnecke AM, Back SE. Behavioral Treatments for Alcohol Use Disorder and Post-Traumatic Stress Disorder. Alcohol Res 2018; 39:181-192. [PMID: 31198657 PMCID: PMC6561400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are highly prevalent and debilitating psychiatric conditions that commonly co-occur. Individuals with comorbid AUD and PTSD incur heightened risk for other psychiatric problems (e.g., depression and anxiety), impaired vocational and social functioning, and poor treatment outcomes. This review describes evidence-supported behavioral interventions for treating AUD alone, PTSD alone, and comorbid AUD and PTSD. Evidence-based behavioral interventions for AUD include relapse prevention, contingency management, motivational enhancement, couples therapy, 12-step facilitation, community reinforcement, and mindfulness. Evidence-based PTSD interventions include prolonged exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing, psychotherapy incorporating narrative exposure, and present-centered therapy. The differing theories behind sequential versus integrated treatment of comorbid AUD and PTSD are presented, as is evidence supporting the use of integrated treatment models. Future research on this complex, dual-diagnosis population is necessary to improve understanding of how individual characteristics, such as gender and treatment goals, affect treatment outcome.
Collapse
Affiliation(s)
- Julianne C Flanagan
- Julianne C. Flanagan, Ph.D., is an associate professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Jennifer L. Jones, M.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Amber M. Jarnecke, Ph.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Sudie E. Back, Ph.D., is a professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and a staff psychologist at the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Jennifer L Jones
- Julianne C. Flanagan, Ph.D., is an associate professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Jennifer L. Jones, M.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Amber M. Jarnecke, Ph.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Sudie E. Back, Ph.D., is a professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and a staff psychologist at the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Amber M Jarnecke
- Julianne C. Flanagan, Ph.D., is an associate professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Jennifer L. Jones, M.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Amber M. Jarnecke, Ph.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Sudie E. Back, Ph.D., is a professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and a staff psychologist at the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Sudie E Back
- Julianne C. Flanagan, Ph.D., is an associate professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Jennifer L. Jones, M.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Amber M. Jarnecke, Ph.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Sudie E. Back, Ph.D., is a professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and a staff psychologist at the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| |
Collapse
|