201
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Larance B, Gisev N, Cama E, Nelson EC, Darke S, Larney S, Degenhardt L. Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence. Drug Alcohol Depend 2018; 191:145-151. [PMID: 30107320 PMCID: PMC6698181 DOI: 10.1016/j.drugalcdep.2018.03.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Little is known about transition pathways among heroin users prior to treatment. This study examined the demographic and clinical predictors of transition speed from heroin use, to dependence, to first treatment episode. METHODS 1149 heroin-dependent participants recruited from opioid agonist treatment clinics in Sydney, Australia, underwent a structured interview. Age of onset (AOO) was collected for heroin use, dependence and treatment-seeking, childhood maltreatment, psychiatric history and other substance dependence. Discrete-time survival analyses modelled years from onset of use to dependence, and from dependence to treatment-seeking, including demographic and clinical covariates. FINDINGS Median AOO for first heroin use, dependence and treatment-seeking was 18 years (inter-quartile range, or IQR = 6), 21 years (IQR = 7), and 24 years (IQR = 10) respectively. In adjusted models, younger birth cohorts (vs. born <1960), greater childhood maltreatment and later AAO of first heroin use were associated with more rapid transitions from heroin use to dependence. Living independently, parental violence, and alcohol dependence were associated with slower transitions. Earlier treatment-seeking was associated with younger birth cohorts, having dependent children and later AOO of dependence. Delayed treatment-seeking was associated with <10 years school education, living independently, depression and alcohol dependence. CONCLUSIONS In this treatment sample, onset of heroin use occurred during late adolescence, suggesting the need for targeted interventions in mid-adolescence. Transitions to heroin dependence, then treatment-seeking, occurred during early adulthood. Rapid transitions from use to dependence were associated with younger birth cohorts, greater exposure to childhood maltreatment, and later onset of use.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Elena Cama
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Elliot C Nelson
- Washington University, School of Medicine, Department of Psychiatry, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO, 63110, USA
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
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202
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Wakeford AG, Morin EL, Bramlett SN, Howell LL, Sanchez MM. A review of nonhuman primate models of early life stress and adolescent drug abuse. Neurobiol Stress 2018; 9:188-198. [PMID: 30450384 PMCID: PMC6236515 DOI: 10.1016/j.ynstr.2018.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/30/2018] [Accepted: 09/12/2018] [Indexed: 01/03/2023] Open
Abstract
Adolescence represents a developmental stage in which initiation of drug use typically occurs and is marked by dynamic neurobiological changes. These changes present a sensitive window during which perturbations to normative development lead to alterations in brain circuits critical for stress and emotional regulation as well as reward processing, potentially resulting in an increased susceptibility to psychopathologies. The occurrence of early life stress (ELS) is related to a greater risk for the development of substance use disorders (SUD) during adolescence. Studies using nonhuman primates (NHP) are ideally suited to examine how ELS may alter the development of neurobiological systems modulating the reinforcing effects of drugs, given their remarkable neurobiological, behavioral, and developmental homologies to humans. This review examines NHP models of ELS that have been used to characterize its effects on sensitivity to drug reinforcement, and proposes future directions using NHP models of ELS and drug abuse in an effort to develop more targeted intervention and prevention strategies for at risk clinical populations. ELS has long-lasting neurobiological and behavioral consequences. ELS is a major risk factor for the initiation of adolescent drug use. Sex differences are apparent in the consequences of ELS, including drug use. Nonhuman primate models of ELS are critical for understanding ELS effects on neurobiology and risk for adolescent drug use.
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Affiliation(s)
- Alison G.P. Wakeford
- Division of Developmental and Cognitive Neuroscience, Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, 30329, United States
- Department of Psychiatry & Behavioral Sciences, Emory University, 12 Executive Park Dr NE #200, Atlanta, GA, 30329, United States
- Corresponding author. Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, 30329, United States.
| | - Elyse L. Morin
- Division of Developmental and Cognitive Neuroscience, Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, 30329, United States
- Department of Psychiatry & Behavioral Sciences, Emory University, 12 Executive Park Dr NE #200, Atlanta, GA, 30329, United States
| | - Sara N. Bramlett
- Division of Developmental and Cognitive Neuroscience, Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, 30329, United States
- Department of Psychiatry & Behavioral Sciences, Emory University, 12 Executive Park Dr NE #200, Atlanta, GA, 30329, United States
| | - Leonard L. Howell
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, 30329, United States
- Department of Psychiatry & Behavioral Sciences, Emory University, 12 Executive Park Dr NE #200, Atlanta, GA, 30329, United States
| | - Mar M. Sanchez
- Division of Developmental and Cognitive Neuroscience, Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, 30329, United States
- Department of Psychiatry & Behavioral Sciences, Emory University, 12 Executive Park Dr NE #200, Atlanta, GA, 30329, United States
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203
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Deguchi Y, Iwasaki S, Kanchika M, Nitta T, Mitake T, Nogi Y, Kadowaki A, Niki A, Inoue K. Gender differences in the relationships between perceived individual-level occupational stress and hazardous alcohol consumption among Japanese teachers: A cross-sectional study. PLoS One 2018; 13:e0204248. [PMID: 30235343 PMCID: PMC6147498 DOI: 10.1371/journal.pone.0204248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022] Open
Abstract
Most teachers have a high risk of work-related stress and mental disorders. Drunken driving and hazardous alcohol consumption (HAC) among teachers are social problems. Gender differences among teachers in burnout, occupational stress, self-efficacy and job satisfaction were reported. This study aimed to clarify gender differences in the relationships between perceived individual-level occupational stress and HAC among Japanese teachers. A cross-sectional study was conducted in 2013 and a total of 723 male and 476 female teachers remained after excluding non-drinkers. Perceived individual-level occupational stress was assessed using the Generic Job Stress Questionnaire. HAC was defined as ethanol consumption greater than or equal to 280 g in 1 week for male teachers, and greater than or equal to 210 g for female teachers. Multiple logistic regression analyses were conducted. HAC was identified in 16.6% of male and 12.4% of female teachers. The average ages (± standard deviation: SD) of male and female teachers were 46.9 ± 10.9 years and 39.9 ± 12.3 years, respectively. Schoolteacher was the most common position classification among male (48.7%) and female teachers (86.3%). For those with a moderate level of stress, "social support from supervisors" was associated with HAC among males (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.23-0.8), whereas for female teachers with a high level of stress, "variance in workload" was associated with HAC (OR = 2.09, 95% CI = 1.04-4.24), using an adjusted model. This study showed that moderate social support from supervisors was negatively related to HAC among male teachers, and high variance in workload was positively related to HAC among female teachers. Gender differences need to be considered when developing HAC prevention strategies for teachers.
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Affiliation(s)
- Yasuhiko Deguchi
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Shinichi Iwasaki
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | | | - Tomoko Nitta
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Tomoe Mitake
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Yukako Nogi
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Aya Kadowaki
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Akihiro Niki
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Koki Inoue
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
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204
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Newman EL, Leonard MZ, Arena DT, de Almeida RMM, Miczek KA. Social defeat stress and escalation of cocaine and alcohol consumption: Focus on CRF. Neurobiol Stress 2018; 9:151-165. [PMID: 30450381 PMCID: PMC6236516 DOI: 10.1016/j.ynstr.2018.09.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
Both the ostensibly aversive effects of unpredictable episodes of social stress and the intensely rewarding effects of drugs of abuse activate the mesocorticolimbic dopamine systems. Significant neuroadaptations in interacting stress and reward neurocircuitry may underlie the striking connection between stress and substance use disorders. In rodent models, recurring intermittent exposure to social defeat stress appears to produce a distinct profile of neuroadaptations that translates most readily to the repercussions of social stress in humans. In the present review, preclinical rodent models of social defeat stress and subsequent alcohol, cocaine or opioid consumption are discussed with regard to: (1) the temporal pattern of social defeat stress, (2) male and female protocols of social stress-escalated drug consumption, and (3) the neuroplastic effects of social stress, which may contribute to escalated drug-taking. Neuroadaptations in corticotropin-releasing factor (CRF) and CRF modulation of monoamines in the ventral tegmental area and the bed nucleus of the stria terminalis are highlighted as potential mechanisms underlying stress-escalated drug consumption. However, the specific mechanisms that drive CRF-mediated increases in dopamine require additional investigation as do the stress-induced neuroadaptations that may contribute to the development of compulsive patterns of drug-taking.
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Affiliation(s)
- Emily L Newman
- Psychology Dept., Tufts University, Medford, MA, 02155, USA
| | | | | | - Rosa M M de Almeida
- Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Klaus A Miczek
- Psychology Dept., Tufts University, Medford, MA, 02155, USA.,Dept. of Neuroscience, Sackler School of Graduate Biomedical Sciences, Boston, MA, 02111, USA
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205
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Evans-Polce RJ, Schuler MS, Schulenberg JE, Patrick ME. Gender- and age-varying associations of sensation seeking and substance use across young adulthood. Addict Behav 2018; 84:271-277. [PMID: 29775887 DOI: 10.1016/j.addbeh.2018.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Sensation seeking is associated with elevated risk for substance use among adolescents and young adults. However, whether these associations vary across age for young men and women is not well characterized. METHODS Using data from the Monitoring the Future (MTF) panel study, we examine the age-varying associations of sensation seeking and three types of substance use behavior (binge drinking, cigarette use, and marijuana use) across ages 18 to 30 using time-varying effect modeling. Analyses include participants in the eleven most recent MTF cohorts (12th-graders in 1994-2004), who are eligible to respond through age 29/30 (N = 6338 people; 30,237 observations). RESULTS While sensation seeking levels and substance use are lower among women, the magnitude of the association of sensation seeking with binge drinking and with marijuana use among women exceeds that of men in the later 20s. Differential age trends were observed; among men, the associations generally decreased or remained constant with age. Yet among women, the associations decayed more slowly or even increased with age. Specifically, the association of sensation seeking with marijuana use among women increased during the late 20s, such that the association at age 30 exceeded that in the early 20s. CONCLUSIONS The significantly stronger associations of sensation seeking with binge drinking and marijuana use observed among women compared to men during the mid- to late-20s suggests divergent risk factors across genders for substance use during young adulthood, with sensation seeking remaining a strong risk factor for women but not men.
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206
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Hilderbrand ER, Lasek AW. Studying Sex Differences in Animal Models of Addiction: An Emphasis on Alcohol-Related Behaviors. ACS Chem Neurosci 2018; 9:1907-1916. [PMID: 29227676 DOI: 10.1021/acschemneuro.7b00449] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Animal models are essential for understanding the biological factors that contribute to drug and alcohol addiction and discovering new pharmacotherapies to treat these disorders. Alcohol (ethanol) is the most commonly abused drug in the world, and as the prevalence of alcohol use disorder (AUD) increases, so does the need for effective pharmacotherapies. In particular, treatments with high efficacy in the growing number of female AUD sufferers are needed. Female animals remain underrepresented in biomedical research and sex differences in the brain's response to alcohol are poorly understood. To help bridge the gender gap in addiction research, this Review discusses strategies that researchers can use to examine sex differences in the context of several common animal models of AUD. Self-administration, two-bottle choice, drinking in the dark, and conditioned place preference are discussed, with a focus on the role of estrogen as a mediator of sex differences in alcohol-related behaviors.
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207
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Tonn Eisinger KR, Gross KS, Head BP, Mermelstein PG. Interactions between estrogen receptors and metabotropic glutamate receptors and their impact on drug addiction in females. Horm Behav 2018; 104:130-137. [PMID: 29505763 PMCID: PMC6131090 DOI: 10.1016/j.yhbeh.2018.03.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 02/07/2023]
Abstract
Contribution to Special Issue on Fast effects of steroids. Estrogen receptors α and β (ERα and ERβ) have a unique relationship with metabotropic glutamate receptors (mGluRs) in the female rodent brain such that estradiol is able to recruit intracellular G-protein signaling cascades to influence neuronal physiology, structure, and ultimately behavior. While this association between ERs and mGluRs exists in many cell types and brain regions, its effects are perhaps most striking in the nucleus accumbens (NAc). This review will discuss the original characterization of ER/mGluR signaling and how estradiol activity in the NAc confers increased sensitivity to drugs of abuse in females through this mechanism.
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Affiliation(s)
- Katherine R Tonn Eisinger
- Department of Neuroscience and Graduate Program in Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kellie S Gross
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Brian P Head
- Department of Anesthesiology, University of California-San Diego, La Jolla, CA 92093, USA
| | - Paul G Mermelstein
- Department of Neuroscience and Graduate Program in Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
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208
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Wang R, Shen YL, Hausknecht KA, Chang L, Haj-Dahmane S, Vezina P, Shen RY. Prenatal ethanol exposure increases risk of psychostimulant addiction. Behav Brain Res 2018; 356:51-61. [PMID: 30076855 DOI: 10.1016/j.bbr.2018.07.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/04/2018] [Accepted: 07/31/2018] [Indexed: 01/04/2023]
Abstract
Prenatal ethanol exposure (PE) causes many cognitive and behavioral deficits including increased drug addiction risk, demonstrated by enhanced ethanol intake and behavioral phenotypes associated with addiction risk. Additionally, preclinical studies show that PE persistently changes the function of dopaminergic neurons in the ventral tegmental area, a major neural substrate for addiction, and alters these neurons' responses to psychostimulants. Accordingly, PE could also lead to increased risk of addiction to drugs of abuse, other than ethanol. In the present study, addiction risk was examined utilizing paradigms of amphetamine conditioned place preference (CPP) and intravenous self-administration. Ethanol was administered to pregnant dams via intragastric gavage (6 g/kg, during gestational days 8-20). Behavioral tests were conducted in adult male offspring. Amphetamine at a low dose (0.3 mg/kg, i.p.) induced CPP in PE but not control rats, whereas at a higher dose (0.6 mg/kg, i.p.) both groups acquired CPP. There was no group difference in amphetamine-induced CPP reinstatement. Furthermore, PE rats self-administered more amphetamine at a low dose (0.02 mg/kg/infusion) than controls, while no group differences were observed at a higher dose (0.1 mg/kg/infusion). Rats with PE also exhibited greater reactivity to contextual drug cues after extended abstinence and amphetamine-induced reinstatement of drug seeking. These results support that PE persistently leads to increased psychostimulant addiction risk later in life, manifested in many elements of addictive behavior following limited psychostimulant exposure. The observations provide insights into prevention strategies for drug addiction in individuals with fetal alcohol spectrum disorders.
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Affiliation(s)
- Ruixiang Wang
- Research Institute on Addictions and Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA; Department of Psychology, Park Hall Room 204, University at Buffalo, Buffalo, NY, 14260, USA
| | - Ying-Ling Shen
- Research Institute on Addictions and Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA; Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Kathryn A Hausknecht
- Research Institute on Addictions and Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA
| | - Lawrence Chang
- Research Institute on Addictions and Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA
| | - Samir Haj-Dahmane
- Research Institute on Addictions and Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA
| | - Paul Vezina
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue MC 3077, Chicago, IL, 60637, USA
| | - Roh-Yu Shen
- Research Institute on Addictions and Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA.
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209
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Yoest KE, Quigley JA, Becker JB. Rapid effects of ovarian hormones in dorsal striatum and nucleus accumbens. Horm Behav 2018; 104:119-129. [PMID: 29626485 PMCID: PMC6197937 DOI: 10.1016/j.yhbeh.2018.04.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/30/2018] [Accepted: 04/02/2018] [Indexed: 12/31/2022]
Abstract
Contribution to Special Issue on Fast effects of steroids. Estradiol and progesterone rapidly induce changes in dopaminergic signaling within the dorsal striatum and nucleus accumbens of female rats. In ovariectomized females, estradiol rapidly enhances dopamine release and modulates binding of dopamine receptors. Progesterone further potentiates the effect of estradiol on dopamine release. The effects of both estradiol and progesterone are time course dependent, with increases in dopamine release immediately after acute hormone administration followed by later inhibition of dopamine release. Importantly, these changes are also seen in naturally cycling females, indicating their importance for normal physiological states and relevant reproductive behaviors. Here, we summarize the literature establishing the rapid effects of estradiol and progesterone on dopamine release and receptor expression in dorsal striatum and nucleus accumbens of both males and females. Integrating this literature with the larger body of work focusing on dopamine regulated behaviors, we propose hypotheses for adaptive reasons (i.e., ultimate causes) as to why changes in ovarian hormones modulate dopamine release. Finally, we note the importance of these studies for understanding sex differences in vulnerability to drug addiction. Research on how dopaminergic systems regulate behavior in both males and females is crucial for developing a full appreciation of dopamine's role in both natural and drug-induced behaviors.
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Affiliation(s)
- Katie E Yoest
- Department of Psychology, Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jacqueline A Quigley
- Department of Psychology, Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jill B Becker
- Department of Psychology, Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109, United States.
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210
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Mazure CM, Fiellin DA. Women and opioids: something different is happening here. Lancet 2018; 392:9-11. [PMID: 30047402 DOI: 10.1016/s0140-6736(18)31203-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/18/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | - David A Fiellin
- Yale University School of Medicine, New Haven, CT 06510, USA; Yale School of Public Health, New Haven, CT 06510, USA
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211
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Vipler S, Hayashi K, Milloy MJ, Wood E, Nosova E, Kerr T, Ti L. Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:27. [PMID: 29976225 PMCID: PMC6034285 DOI: 10.1186/s13011-018-0164-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/26/2018] [Indexed: 12/21/2022]
Abstract
Background For many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management (e.g. detoxification) services. However, little is known about the factors that predict withdrawal management service use among people who use illicit drugs (PWUD). Using data derived from two prospective cohorts of PWUD, we conducted a longitudinal data analysis of factors associated with use of withdrawal management services. Methods Individuals participating in two cohorts of PWUD were prospectively followed between December 2005 and May 2016 in Vancouver, Canada. Bivariate and multivariate generalized estimating equations were used to examine factors associated with use of withdrawal management services. Results Out of a total of 2001 participants, 339 (16.9%) individuals reported having been to a withdrawal management centre in the previous 6 months at some point during the study period. In multivariate analyses, male sex (adjusted odds ratio [AOR]: 1.62, 95% Confidence Interval [CI]: 1.17–2.24), homelessness (AOR: 1.86, 95% CI: 1.45–2.38), binge use of any substance (AOR: 1.34, 95% CI: 1.08–1.67), having attended a supervised injection facility (AOR: 1.66, 95% CI: 1.3–2.11), and having accessed other addiction medicine treatment or supports (other than withdrawal management services or opioid agonist therapy; AOR: 3.34, 95% CI: 2.64–4.22) were positively associated with having accessed withdrawal management services, whereas older age (AOR: 0.81, 95% CI: 0.7–0.94) was negatively associated with the outcome. Conclusions This study identified specific factors associated with accessing withdrawal management services. Current evidence suggests a need to re-examine the provision of withdrawal management services. Consideration needs to be given to redesigning access to care and bridging to evidence-based addiction treatment, particularly for highly vulnerable subpopulations, identified in this study as females and older people.
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Affiliation(s)
- Sharon Vipler
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Family Practice, University of British Columbia, 320 - 5950 University Boulevard, Vancouver, BC, V6T 1Z6, Canada
| | - Kanna Hayashi
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - M-J Milloy
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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212
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Abstract
Cannabis (marijuana) is a drug product derived from the plant Cannabis sativa. Cannabinoid is a general term for all chemical constituents of the cannabis plant. Legalization of marijuana in numerous US states, the availability of cannabis of higher potency, and the emergence of synthetic cannabinoids may have contributed to increased demand for related medical services. The most effective available treatments for cannabis use disorder are psychosocial approaches. There is no pharmacotherapy approved treatment. This article reviews the current state of knowledge regarding effective treatments for cannabis use disorder.
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Affiliation(s)
- Annie Lévesque
- Department of Psychiatry, Mount Sinai West Hospital, 1000 10th Avenue, Suite 8C-02, New York, NY 10019, USA.
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Addiction Division, Addiction Medicine Service, Centre for Addiction and Mental Health, Toronto, Ontario M6J 1H4, Canada; Department of Pharmacology and Toxicology, Institute of Medical Sciences, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Department of Family and Community Medicine, Institute of Medical Sciences, University of Toronto, Toronto, Ontario M5S 1A8, Canada
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213
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Transgenerational consequences of prepregnancy chronic morphine use on spatial learning and hippocampal Mecp2 and Hdac2 expression. Neuroreport 2018; 29:739-744. [DOI: 10.1097/wnr.0000000000001025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Naji L, Rosic T, Dennis B, Bhatt M, Sanger N, Hudson J, Mouravska N, Thabane L, Samaan Z. The association between cannabis use and suicidal behavior in patients with psychiatric disorders: an analysis of sex differences. Biol Sex Differ 2018; 9:22. [PMID: 29891008 PMCID: PMC5996511 DOI: 10.1186/s13293-018-0182-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cannabis is the most commonly used illicit drug. In the general population, its use has been linked to a heightened propensity for suicidal behavior (SB). We hypothesize that this association varies in patients with psychiatric disorders. SB is known to vary by sex and therefore an investigation of cannabis' association with SB must consider sex differences. The purpose of this study is to investigate the association between cannabis use and suicide attempts in men and women with psychiatric disorders. METHODS We merged data collected for two studies based in Ontario, Canada (n = 985). We employed a multivariable logistic regression to assess the association between cannabis use and suicide attempts in men and women with psychiatric disorders. RESULTS We analyzed data from 465 men and 444 women. Amongst these, 112 men and 158 women had attempted suicide. The average age of our participants was 40 years (standard deviation (SD) 12.4). We found no significant association between suicide attempts and cannabis use in men (odds ratio (OR) = 1.34, 95% confidence interval (CI) 0.81, 2.22, p = 0.260) or women (OR = 0.97, 95% CI 0.61, 1.54, p = 0.884). In a sensitivity analysis using a sample of patients with substance use disorder only, the heaviness of cannabis use was associated with small but significant association with SB in men (OR = 1.03, 95% CI 1.01, 1.05, p = 0.007). CONCLUSION Our findings indicate that there is no association between cannabis use and suicidal behavior in men or women with psychiatric disorders unlike what was reported for the general population, though the heaviness of cannabis use may have an effect in men. The impact of cannabis use in psychiatric disorders needs ongoing examination in light of its common use, impending legalization with expected increased access and the uncertainty about cannabis' effects on prognosis of psychiatric disorders. In addition, research should continue to investigate modifiable risk factors of SB in this population of which cannabis is not a significant factor based on this study.
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Affiliation(s)
- Leen Naji
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Tea Rosic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Mood Disorders Program, Hamilton, Ontario, L8N 3K7, Canada
| | | | - Meha Bhatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Nitika Sanger
- Medical Science Graduate Program, McMaster University, Hamilton, Canada
| | - Jackie Hudson
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Mood Disorders Program, Hamilton, Ontario, L8N 3K7, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Mood Disorders Program, Hamilton, Ontario, L8N 3K7, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. .,Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada.
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215
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Frohe T, Leeman RF, Patock-Peckham J, Ecker A, Kraus S, Foster DW. Correlates of cannabis vape-pen use and knowledge among U.S. college students. Addict Behav Rep 2018; 7:32-39. [PMID: 29450254 PMCID: PMC5805498 DOI: 10.1016/j.abrep.2017.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The proliferation of electronic devices, such as vape-pens, has provided alternative means for cannabis use. Research has found cannabis-vaping (i.e., vape-pen use) is associated with lower perceived risks and higher cannabis use. Knowledge of these products may increase likelihood of subsequent use. As policies for cannabis shift, beliefs that peers and family approve of this substance use (injunctive norms) increase and there has been an increase in vape-pen use among young adults (18-35 year olds); however, correlates thereof remain unknown. Young adults often engage in cross-substance use with cannabis and alcohol, making alcohol a potential correlate of cannabis vape-pen use and knowledge. Therefore, we examined alcohol use and other potential correlates of vape-pen use and knowledge among a sample of university students. METHODS This secondary data analysis utilized surveys at multiple colleges in the U.S. (N = 270). Alcohol use, social anxiety, cannabis expectancies, injunctive and descriptive norms and facets of impulsivity were examined as correlates of vape-pen use and knowledge using bivariate correlations and logistic regressions. RESULTS Alcohol use was correlated with cannabis vape-pen use and knowledge. Frequency of cannabis use, peer injunctive norms, and positive expectancies were associated with increased likelihood of vape-pen use. Lack of premeditation, a facet of impulsivity, was associated with cannabis vape-pen knowledge. CONCLUSIONS Given the unknown nature and consequences of cannabis vape-pens, the present findings offer valuable information on correlates of this behavior. Further, correlates of knowledge of vape-pens may point to areas for education and clinical intervention to prevent heavy cannabis vape-pen use.
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Affiliation(s)
- Tessa Frohe
- University of Florida, Department of Health Education and Behavior, College of Health and Human Performance, P.O. Box 118210, Gainesville, FL 32611, USA
| | - Robert F. Leeman
- University of Florida, Department of Health Education and Behavior, College of Health and Human Performance, P.O. Box 118210, Gainesville, FL 32611, USA
- Yale School of Medicine, Department of Psychiatry, 300 George St., Suite 901, New Haven, CT 06511, USA
| | - Julie Patock-Peckham
- Arizona State University, Department of Psychology, 950 S. McAllister Ave, Tempe, AZ 85287, PO Box 871104, Tempe, AZ 85287-1104, USA
| | - Anthony Ecker
- South Central MIRECC, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA
- Baylor College of Medicine, Texas Medical Center, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Shane Kraus
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Dawn W. Foster
- Yale School of Medicine, Department of Psychiatry, 300 George St., Suite 901, New Haven, CT 06511, USA
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216
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Zhu H, Wu LT. Sex Differences in Cannabis Use Disorder Diagnosis Involved Hospitalizations in the United States. J Addict Med 2018; 11:357-367. [PMID: 28700366 PMCID: PMC5636049 DOI: 10.1097/adm.0000000000000330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/02/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study examined sex differences in trend and clinical characteristics of cannabis use disorder (CUD) diagnosis involved hospitalizations among adult patients. METHODS We analyzed hospitalization data from the 2007-2011 Nationwide Inpatient Samples for patients aged 18-64 years (N = 15,114,930). Descriptive statistics were used to characterize demographic variables and to compare the proportions of CUD diagnosis and comorbid patterns between male and female hospitalizations. Logistic regressions were performed to examine the association of sex and other demographic variables with CUD diagnosis. RESULTS During the study period, 3.3% of male and 1.5% of female hospitalizations had any-listed CUD diagnoses, and both sexes presented an upward trend in the number, rate, and proportion of CUD diagnosis. Among hospitalizations for patients aged 18-25 years, about 1 in 10 males and 1 in 20 females included a CUD diagnosis, and this proportion decreased with age strata. Mental disorders accounted for the highest proportion of CUD involved inpatient hospitalizations, and female CUD involved hospitalizations included a higher proportion of mental disorders that required hospitalized care compared with male hospitalizations (41% vs 36%). In each sex group, younger age, black race, lower household income, large metropolitan residence, non-private insurance, substance use diagnosis, and mental disorders were associated with elevated odds of having CUD diagnosis. CONCLUSION The large sample of clinical hospitalization data suggest an increased trend in CUD diagnosis and sex differences in several comorbidities with CUD-involved hospital admissions. Prevention and treatment for CUD should consider sex differences in clinical comorbidities.
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Affiliation(s)
- He Zhu
- Department of Psychiatry and Behavioral Sciences (HZ, L-TW); Duke University Medical Center, Department of Medicine, Division of General Internal Medicine, Duke University Medical Center (L-TW); Duke Clinical Research Institute (L-TW); and Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC (L-TW)
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217
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Marks KR, Clark CD. The Telescoping Phenomenon: Origins in Gender Bias and Implications for Contemporary Scientific Inquiry. Subst Use Misuse 2018; 53:901-909. [PMID: 29161174 PMCID: PMC6129392 DOI: 10.1080/10826084.2017.1385079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In an article published in International Journal of the Addictions in 1989, Nick Piazza and his coauthors described "telescoping," an accelerated progression through "landmark symptoms" of alcoholism, among a sample of recovering women. OBJECTIVES The aim of this critical analysis is to apply a feminist philosophy of science to examine the origins of the framework of telescoping research and its implications for contemporary scientific inquiry. METHODS A feminist philosophy of science framework is outlined and applied to key source publications of telescoping literature drawn from international and United States-based peer-reviewed journals published beginning in 1952. RESULTS A feminist philosophy of science framework identifies gender bias in telescoping research in three ways. First, gender bias was present in the early conventions that laid the groundwork for telescoping research. Second, a "masculine" framework was present in the methodology guiding telescoping research. Third, gender bias was present in the interpretation of results as evidenced by biased comparative language. CONCLUSIONS Telescoping research contributed to early evidence of critical sex and gender differences helping to usher in women's substance abuse research more broadly. However, it also utilized a "masculine" framework that perpetuated gender bias and limited generative, novel research that can arise from women-focused research and practice. A feminist philosophy of science identifies gender bias in telescoping research and provides an alternative, more productive approach for substance abuse researchers and clinicians.
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Affiliation(s)
- Katherine R Marks
- a Department of Behavioral Science , University of Kentucky , Lexington , Kentucky , USA
| | - Claire D Clark
- a Department of Behavioral Science , University of Kentucky , Lexington , Kentucky , USA
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218
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McDermott KA, Joyner KJ, Hakes JK, Okey SA, Cougle JR. Pain interference and alcohol, nicotine, and cannabis use disorder in a national sample of substance users. Drug Alcohol Depend 2018; 186:53-59. [PMID: 29550622 DOI: 10.1016/j.drugalcdep.2018.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/04/2018] [Accepted: 01/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pain interference is associated with substance use, but has yet to be considered as a potential indicator of SUDs among substance users. We sought to examine whether moderate and high pain interference would confer risk for SUDs in ever and weekly users. METHODS Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, logistic regression analyses were conducted to examine the association between pain interference and concurrent and prospective alcohol and nicotine dependence, as well as concurrent cannabis use disorder. Those with no/low pain were used as the reference group. Gender was examined as a moderator. RESULTS Controlling for relevant covariates, moderate pain interference was associated with past year alcohol (odds ratio [OR] = 1.33, 95% CI, 1.16-1.52, p < .001) and nicotine (OR = 1.41, 95% CI 1.27-1.56, p < .001) dependence among ever users. In prospective analyses, moderate pain interference predicted the development of alcohol (Moderate: OR = 1.56, 95% CI, 1.39-1.75, p < .001) and nicotine (OR = 1.37, 95% CI, 1.14-1.65, p < .001) dependence. Similar results were found with high pain and for weekly users. Both moderate and high pain interference were associated with past-year occurrence of cannabis use disorder for women but not men. High pain predicted the development of nicotine dependence exclusively among males. CONCLUSION Pain interference may confer risk for the occurrence of cannabis use disorder among female cannabis users and the occurrence and development of alcohol and nicotine dependence among users of both genders. Pain interference may be an important factor to monitor in these populations.
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Affiliation(s)
| | - Keanan J Joyner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jahn K Hakes
- Center for Administrative Records Research and Applications, US Census Bureau, Suitland, MD, USA
| | - Sarah A Okey
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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219
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Wright B, Mestan S, Ahrens M, Bottei E. Trends in Teenagers' Nonopiod Substance Exposures Reported to Poison Control Centers, 2010-2015. J Pediatr 2018. [PMID: 29525071 DOI: 10.1016/j.jpeds.2017.12.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe current trends in nonopioid substance exposures and associated outcomes among teenagers nationwide. STUDY DESIGN In this cross-sectional study, we used 2010-2015 data from the American Association of Poison Control Centers' National Poison Data System and Poisson tests to document trends in the rate of calls to poison control centers involving adolescents stratified by sex, exposures by substance category, proportion of intentional exposures, and severity of exposures. RESULTS The number of calls per 1000 persons increased from 5.7 to 6.8 for teenage girls and decreased from 4.7 to 4.3 for boys. Reported exposures to prescription and over-the-counter medications and illicit street drugs increased between 24% and 73%, and reported opioid exposures decreased by 16%. Among teenage girls, intentional exposures increased from 57% to 68%, with cases increasingly managed in health care facilities and more likely to result in worse health outcomes. CONCLUSIONS The increase in intentional nonopioid substance exposures among teenage girls, with serious and potentially life-threatening consequences, is a matter of serious concern. Similar trends were not observed among teenage boys.
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Affiliation(s)
- Brad Wright
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA.
| | | | - Monica Ahrens
- Department of Biostatistics, University of Iowa College of Public Health, Sioux City, IA
| | - Edward Bottei
- Carver College of Medicine, University of Iowa, Iowa City, IA; Iowa Poison Control Center, Sioux City, IA
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220
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Does exposure to parental substance use disorders increase offspring risk for a substance use disorder? A longitudinal follow-up study into young adulthood. Drug Alcohol Depend 2018; 186:154-158. [PMID: 29573650 PMCID: PMC5876721 DOI: 10.1016/j.drugalcdep.2018.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/05/2018] [Accepted: 01/13/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The main aim of this study was to examine the risk of exposure to parental substance use disorders (SUD; alcohol or drug abuse or dependence) on the risk for SUD in offspring with and without attention deficit hyperactivity disorder (ADHD) followed into young adult years. METHODS Subjects were derived from two longitudinal case-control studies of probands of both sexes, 6-17 years, with and without DSM-III-R ADHD and their parents. Probands were followed for ten years into young adulthood. Probands with a parental history of non-nicotine SUD were included in this analysis. Exposure to SUD was determined by active non-nicotine parental SUD while the parent was living with their child after birth. Cox proportional hazard models were used to calculate the risk of non-nicotine SUD in offspring. RESULTS 171 of the 404 probands reassessed at ten-year follow up had a family history of parental SUD. 102 probands were exposed to active parental SUD. The average age of our sample was 22.2 ± 3.5 years old. Exposure to maternal but not paternal SUD increased offspring risk for an alcohol use disorder in young adulthood independently of ADHD status (OR: 2.7; 95% CI: 1.1, 6.9; p = 0.04). CONCLUSION Exposure to maternal SUD increases the risk for an alcohol use disorder in offspring ten years later in young adult years irrespective of ADHD status.
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221
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Barbosa-Leiker C, McPherson S, Layton ME, Burduli E, Roll JM, Ling W. Sex differences in opioid use and medical issues during buprenorphine/naloxone treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 44:488-496. [PMID: 29672167 DOI: 10.1080/00952990.2018.1458234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There are sex differences in buprenorphine/naloxone clinical trials for opioid use. While women have fewer opioid-positive urine samples, relative to men, a significant decrease in opioid-positive samples was found during treatment for men, but not women. In order to inform sex-based approaches to improve treatment outcomes, research is needed to determine if opioid use, and predictors of opioid use, differs between men and women during treatment. OBJECTIVES To test for sex differences in opioid use during a buprenorphine/naloxone clinical trial and determine if sex differences exist in the associations between addiction-related problem areas and opioid use over the course of the trial. METHOD This secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003 examined sex differences (men = 347, women = 169) in opioid-positive samples in a randomized clinical trial comparing 7-day vs. 28-day buprenorphine/naloxone tapering strategies. Addiction-related problem areas were defined by Addiction Severity-Lite (ASI-L) domain composite scores. RESULTS Women were more likely than men to use opioids during the course of the buprenorphine/naloxone clinical trial (B = .33, p = .01) and medical issues were positively related to submitting an opioid-positive sample during treatment for women (B = 1.67, p = .01). No ASI-L domain composite score was associated with opioid-positive samples during treatment for men. CONCLUSION Women were more likely than men to use opioids during the course of the buprenorphine/naloxone clinical trial, and medical issues predicted opioid use during treatment for women but not men. Complementary treatment for medical problems during opioid replacement therapy may benefit women.
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Affiliation(s)
- Celestina Barbosa-Leiker
- a College of Nursing , Washington State University , Spokane , WA , USA.,b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA
| | - Sterling McPherson
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - Matthew E Layton
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - Ekaterina Burduli
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - John M Roll
- b Program of Excellence in Addictions Research , Washington State University , Spokane , WA , USA.,c Translational Addictions Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - Walter Ling
- e Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California , Los Angeles , CA , USA.,f Integrated Substance Abuse Programs , University of California , Los Angeles , CA , USA
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Moran LM, Kowalczyk WJ, Phillips KA, Vahabzadeh M, Lin JL, Mezghanni M, Epstein DH, Preston KL. Sex differences in daily life stress and craving in opioid-dependent patients. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 44:512-523. [PMID: 29641291 DOI: 10.1080/00952990.2018.1454934] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Responses to stress and drug craving differ between men and women. Differences in the momentary experience of stress in relation to craving are less well-understood. OBJECTIVES Using ecological momentary assessment (EMA), we examined sex differences in real-time in two areas: (1) causes and contexts associated with stress, and (2) the extent to which stress and drug cues are associated with craving. METHODS Outpatients on opioid-agonist treatment (135 males, 47 females) reported stress, craving, and behavior on smartphones for 16 weeks. They initiated an entry each time they felt more stressed than usual (stress event) and made randomly prompted entries 3 times/day. In stress-event entries, they identified the causes and context (location, activity, companions), and rated stress and craving severity. RESULTS The causes reported for stress events did not differ significantly by sex. Women reported arguing and being in a store more often during stress events, and men reported working more often during stress events, compared to base rates (assessed via random prompts). Women showed a greater increase in opioid craving as a function of stress (p < 0.0001) and had higher stress ratings in the presence of both stress and drug cues relative to men (p < 0.01). Similar effects were found for cocaine craving in men (p < 0.0001). CONCLUSION EMA methods provide evidence based on real-time activities and moods that opioid-dependent men and women experience similar contexts and causes for stress but differ in stress- and cue-induced craving. These findings support sex-based tailoring of treatment, but because not all participants conformed to the overall pattern of sex differences, any such tailoring should also consider person-level differences.
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Affiliation(s)
- Landhing M Moran
- a Clinical Pharmacology and Therapeutics Research Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA
| | - William J Kowalczyk
- a Clinical Pharmacology and Therapeutics Research Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA.,b Department of Psychology , Hartwick College , Oneonta , NY , USA
| | - Karran A Phillips
- a Clinical Pharmacology and Therapeutics Research Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA
| | - Massoud Vahabzadeh
- c Biomedical Informatics Section, Administrative Management Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA
| | - Jia-Ling Lin
- c Biomedical Informatics Section, Administrative Management Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA
| | - Mustapha Mezghanni
- c Biomedical Informatics Section, Administrative Management Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA
| | - David H Epstein
- a Clinical Pharmacology and Therapeutics Research Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA
| | - Kenzie L Preston
- a Clinical Pharmacology and Therapeutics Research Branch , National Institute on Drug Abuse, Intramural Research Center , Baltimore , MD , USA
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223
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Crocker CE, Tibbo PG. The interaction of gender and cannabis in early phase psychosis. Schizophr Res 2018; 194:18-25. [PMID: 28506705 DOI: 10.1016/j.schres.2017.04.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022]
Abstract
Cannabis is the third most common recreational drug used world-wide after tobacco and alcohol. Globally, cannabis legalization is becoming more common. In light of its known link to psychosis development, it is imperative that we are well-informed regarding the impact of cannabis on the course of psychosis, in both males and females. However, the majority of the work to date on the role of cannabis in psychosis outcomes has not had a gender focus, important when considering patient specific treatments. This review examines what is currently known, from gender focused studies, about the interaction of gender, cannabis use and psychotic disorders.
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Affiliation(s)
- Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Diagnostic Radiology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Degenhardt L, Glantz M, Bharat C, Peacock A, Lago L, Sampson N, Kessler RC. The impact of cohort substance use upon likelihood of transitioning through stages of alcohol and cannabis use and use disorder: Findings from the Australian National Survey on Mental Health and Wellbeing. Drug Alcohol Rev 2018; 37:546-556. [PMID: 29505682 DOI: 10.1111/dar.12679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND AIMS We used population-level Australian data to estimate prevalence, age of onset and speed of transitions across stages of alcohol and cannabis use, abuse and dependence, and remission from disorder, and consider the potential impacts that an individual's age cohort's level of substance use predicted transitions into and out of substance use. DESIGN AND METHODS Data on use, DSM-IV use disorders, and remission from these disorders were collected from participants (n = 8463) in the 2007 Australian National Survey of Mental Health and Wellbeing using the Composite International Diagnostic Interview. RESULTS Lifetime prevalence (95% confidence interval) of alcohol use, regular use, abuse and dependence were 94.1% (93.3-94.8%), 64.5% (62.9-66.2%), 18.7% (17.4-19.9%) and 4.0% (3.4-4.6%). Lifetime prevalence of cannabis use, abuse and dependence were 19.8% (18.6-20.9%), 4.4% (3.8-5.0%) and 1.9% (1.5-2.4%). Among those with the disorder, rates of remission from cannabis abuse, alcohol abuse, cannabis dependence and alcohol dependence were 90.5% (87.4-93.6%), 86.2% (83.8-88.7%), 79.6% (71.1-88.1%) and 53.8% (46.6-61.0%). Increases in the estimated proportion of people in the respondent's age cohort who used alcohol/cannabis as of a given age were significantly associated with most transitions from use through to remission beginning at the same age. DISCUSSION AND CONCLUSIONS Clear associations were documented between cohort-level prevalence of substance use and personal risk of subsequent transitions of individuals in the cohort from use to greater substance involvement. This relationship remained significant over and above associations involving the individual's age of initiation. These findings have important implications for our understanding of the causal pathways into and out of problematic substance use.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Meyer Glantz
- Department of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institute of Health, Bethesda, USA
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Luise Lago
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, USA
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225
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Huggett SB, Hatoum AS, Hewitt JK, Stallings MC. The Speed of Progression to Tobacco and Alcohol Dependence: A Twin Study. Behav Genet 2018; 48:109-124. [PMID: 29427143 PMCID: PMC5851595 DOI: 10.1007/s10519-018-9888-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
We investigated the etiological role of genetic and environmental influences for two milestones of tobacco and alcohol use: age of initiation, and speed of progression to dependence (latency). Study participants included 1352 monozygotic and 1422 dizygotic twins (mean age at assessment = 24.31). Earlier ages of initiation significantly increased the likelihood of developing dependence, but were associated with longer dependence latencies for tobacco and alcohol. Latencies to dependence were heritable traits for tobacco (a2 = 0.63) and alcohol (a2 = 0.64). Genetic influences contributing to early age of initiation were associated with faster latencies to dependence but sometimes were counteracted by environmental factors, the extent to which depended on substance and, sometimes, sex. Our findings may have important implications for public policy and add to the literature by characterizing the genetic and environmental contributions to the speed of progression to tobacco and alcohol dependence.
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Affiliation(s)
- Spencer B Huggett
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA.
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA.
| | - Alexander S Hatoum
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
| | - John K Hewitt
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
| | - Michael C Stallings
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St, Boulder, CO, 80303, USA
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226
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Sex and age differences in risk factors of marijuana involvement during adolescence. ADDICTIVE DISORDERS & THEIR TREATMENT 2018; 17:29-39. [PMID: 29651230 DOI: 10.1097/adt.0000000000000120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives We aimed to examine whether there are sex and age differences in psychosocial risk factors of marijuana use during adolescence. Methods Data were drawn from 57,767 adolescents (8th and 10th graders) from the 2012-2013 Monitoring the Future study. We examined the association between socio-demographic and behavioral correlates with different frequencies of past-year marijuana use (non-use, occasional use: <10 time, frequent use: 10-39 times, and regular use: 40+ times). We further investigated whether these associations were similar for boys and girls of different ages. Results Overall, 20.6% of the adolescents reported past-year marijuana use: 12.1% occasional use, 4.3% frequent use, and 3.8% regular use. Girls were less likely to be frequent and regular marijuana users (frequent use: OR=0.83 [0.75, 0.93]; regular use: OR=0.41 [0.36, 0.48]) while no sex difference was noted for occasional use. Also, the odds of deviant behaviors were higher as the frequencies of marijuana use were higher. Compared to younger girls, older boys and girls had higher association between all levels of marijuana use and low self-esteem, low perceived harm, peer influence and perceived easy access. Besides, younger boys were more likely than younger girls to report an association between regular marijuana use with low self-esteem, peer influence, and perceived easy access but not with perceived low harm. Conclusions/Importance Findings suggest the relationship between these psychosocial correlates and frequency of marijuana involvement varies across sex and age groups. These variations ask for a nuanced approach to prevention of marijuana involvement in different groups of youth.
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227
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Leppard A, Ramsay M, Duncan A, Malachowski C, Davis JA. Interventions for Women With Substance Abuse Issues: A Scoping Review. Am J Occup Ther 2018; 72:7202205030p1-7202205030p8. [PMID: 29426381 DOI: 10.5014/ajot.2018.022863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this scoping review was to describe the characteristics and features of substance abuse interventions for women in North America and discuss the findings from an occupational perspective. METHOD A scoping review was conducted to examine North American peer-reviewed literature published between 2001 and 2014. Four databases were searched using terms related to intervention, substance abuse, and women only. Descriptive statistics of categorical groupings were used to describe the data sources and characteristics and features of the interventions. RESULTS Forty-two articles met the inclusion criteria, with the majority citing a harm-reduction approach and using multifaceted interventions with various targets for change. CONCLUSION Substance abuse interventions for women are typically multifaceted and follow a harm-reduction philosophy. Further research into the efficacy of interventions that more specifically target occupation beyond substance use is needed.
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Affiliation(s)
- Alison Leppard
- Alison Leppard, MScOT, OT Reg. (Ont.), is Occupational Therapist, Brockville General Hospital, Brockville, Ontario, Canada, and Private Practice, Ottawa, Ontario, Canada. At the time of this study, she was Professional Master's Student, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Ramsay
- Margaret Ramsay, MScOT, OT Reg. (Ont.), is Occupational Therapist, Private Practice, Toronto, Ontario, Canada; . At the time of this study, she was Professional Master's Student, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Duncan
- Andrea Duncan, BScOT, MBA, OT Reg. (Ont.), is Lecturer, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Cindy Malachowski
- Cindy Malachowski, BKin, BHScOT, MScRehab, PhD, OT Reg. (Ont.), is Adjunct Faculty Member, University of Ontario Institute of Technology, Oshawa, Ontario, Canada. At the time of this study, she was Postdoctoral Fellow, University of Waterloo, Waterloo, Ontario, Canada
| | - Jane A Davis
- Jane A. Davis, MSc, OT Reg. (Ont.), OTR, is Lecturer, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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228
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Hilderbrand ER, Lasek AW. Estradiol enhances ethanol reward in female mice through activation of ERα and ERβ. Horm Behav 2018; 98:159-164. [PMID: 29305887 PMCID: PMC5829002 DOI: 10.1016/j.yhbeh.2018.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/27/2017] [Accepted: 01/01/2018] [Indexed: 11/16/2022]
Abstract
Alcohol use disorder (AUD) manifests differently in men and women, but little is known about sex differences in the brain's response to ethanol. It is known that the steroid hormone 17β-estradiol (E2) regulates voluntary ethanol consumption in female rodents. However, the role of E2 as a regulator of ethanol reward has not been investigated. In this study, we tested for the effects of E2 and agonists selective for the classical estrogen receptors, ERα and ERβ, on ethanol reward in ovariectomized (OVX) mice using the conditioned place preference (CPP) test. E2 enhanced ethanol CPP and, while specific activation of either receptor alone had no effect, co-activation of ERα and ERβ also enhanced ethanol CPP, suggesting that E2 enhances ethanol reward in female mice through actions at both ERα and ERβ. These results have implications for sex differences in the development of AUD, suggesting that women may find ethanol more rewarding than men because of higher circulating E2 levels.
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Affiliation(s)
- Elisa R Hilderbrand
- Graduate Program in Neuroscience, University of Illinois at Chicago, 1601 West Taylor Street, MC 912, Chicago, IL 60612, United States; Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, MC 912, Chicago, IL 60612, United States
| | - Amy W Lasek
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, MC 912, Chicago, IL 60612, United States.
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229
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Legakis LP, Negus SS. Repeated Morphine Produces Sensitization to Reward and Tolerance to Antiallodynia in Male and Female Rats with Chemotherapy-Induced Neuropathy. J Pharmacol Exp Ther 2018; 365:9-19. [PMID: 29363579 DOI: 10.1124/jpet.117.246215] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/22/2018] [Indexed: 01/14/2023] Open
Abstract
Paclitaxel is a cancer chemotherapy drug with adverse effects that include chemotherapy-induced neuropathic pain (CINP) as well as depression of behavior and mood. In the clinical setting, opioids are often used concurrently with or after chemotherapy to treat pain related to the cancer or CINP, but repeated opioid exposure can also increase the risk of opioid abuse. In this study, male and female Sprague-Dawley rats were used to test the hypothesis that repeated 3.2-mg/kg doses of morphine would induce tolerance to its antinociceptive effects in a mechanical sensitivity assay and increased expression of its abuse-related rewarding effects in an assay of intracranial self-stimulation (ICSS). Three weeks after four injections of vehicle or 2.0 mg/kg of paclitaxel, the initial morphine dose-effect curves were determined in both assays. Subsequently, rats were treated with 3.2 mg/kg per day morphine for 6 days. On the final day of testing, morphine dose-effect curves were redetermined in both assays. On initial exposure, morphine produced dose-dependent antiallodynia in the assay of mechanical sensitivity, but it produced little or no rewarding effects in the assay of ICSS. After 6 days of repeated treatment, morphine antiallodynia decreased, and morphine reward increased. Females exhibited greater morphine reward on initial exposure than males, but repeated morphine eliminated this sex difference. These results suggest that repeated morphine may produce tolerance to therapeutically beneficial analgesic effects of morphine but increased sensitivity to abuse-related rewarding effects of morphine in subjects treated with paclitaxel.
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Affiliation(s)
- L P Legakis
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia
| | - S S Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia
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230
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Kerridge BT, Pickering R, Chou P, Saha TD, Hasin DS. DSM-5 cannabis use disorder in the National Epidemiologic Survey on Alcohol and Related Conditions-III: Gender-specific profiles. Addict Behav 2018; 76:52-60. [PMID: 28755613 DOI: 10.1016/j.addbeh.2017.07.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective of this study was to present current information on the prevalence, correlates, comorbidity and quality of life among men and women with cannabis use disorder (CUD). METHODS In 2012-2013, 36,309 respondents ≥18years old participated in face-to-face interviews in the National Epidemiologic Survey on Alcohol and Related Conditions-III. RESULTS Prevalence of 12-month CUD was greater among men (3.5%) than women (1.7%). Women experienced shorter duration from onset of cannabis use to onset of CUD than men (mean=5.8years, men; mean=4.7years, women). In both men and women, prevalences of CUD were greater among young adults, Blacks, and those with lower income and greater among Native American women relative to White women. CUD was highly comorbid with other substance use disorders, PTSD, ASPD and borderline and schizotypal PDs for men and women. Quality of life for individuals with CUD was low regardless of gender. CONCLUSIONS DSM-5 CUD among men and women is highly prevalent, comorbid and characterized by low quality of life. Results highlighted the need for integrated treatment of CUD and comorbid disorders and the urgency of identifying and implementing effective prevention and intervention approaches, especially for those sociodemographic subgroups for which both men and women are at greater risk for the disorder.
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231
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Butelman ER, Maremmani AGI, Bacciardi S, Chen CY, Correa da Rosa J, Kreek MJ. Non-medical Cannabis Self-Exposure as a Dimensional Predictor of Opioid Dependence Diagnosis: A Propensity Score Matched Analysis. Front Psychiatry 2018; 9:283. [PMID: 29997535 PMCID: PMC6030387 DOI: 10.3389/fpsyt.2018.00283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/11/2018] [Indexed: 12/18/2022] Open
Abstract
Background: The impact of increasing non-medical cannabis use on vulnerability to develop opioid use disorders has received considerable attention, with contrasting findings. A dimensional analysis of self-exposure to cannabis and other drugs, in individuals with and without opioid dependence (OD) diagnoses, may clarify this issue. Objective: To examine the age of onset of maximal self-exposure to cannabis, alcohol, cocaine, and heroin, in volunteers diagnosed with OD, using a rapidly administered instrument (the KMSK scales). To then determine whether maximal self-exposure to cannabis, alcohol, and cocaine is a dimensional predictor of odds of OD diagnoses. Methods: This outpatient observational study examined maximal self-exposure to these drugs, in volunteers diagnosed with DSM-IV OD or other drug diagnoses, and normal volunteers. In order to focus more directly on opioid dependence diagnosis as the outcome, volunteers who had cocaine dependence diagnoses were excluded. Male and female adults of diverse ethnicity were consecutively ascertained from the community, and from local drug treatment programs, in 2002-2013 (n = 574, of whom n = 94 had OD diagnoses). The age of onset of maximal self-exposure of these drugs was examined. After propensity score matching for age at ascertainment, gender, and ethnicity, a multiple logistic regression examined how increasing self-exposure to non-medical cannabis, alcohol and cocaine affected odds of OD diagnoses. Results: Volunteers with OD diagnoses had the onset of heaviest use of cannabis in the approximate transition between adolescence and adulthood (mean age = 18.9 years), and onset of heaviest use of alcohol soon thereafter (mean age = 20.1 years). Onset of heaviest use of heroin and cocaine was detected later in the lifespan (mean ages = 24.7 and 25.3 years, respectively). After propensity score matching for demographic variables, we found that the maximal self-exposure to cannabis and cocaine, but not to alcohol, was greater in volunteers with OD diagnoses, than in those without this diagnosis. Also, a multiple logistic regression detected that increasing self-exposure to cannabis and cocaine, but not alcohol, was a positive predictor of OD diagnosis. Conclusions/Importance: Increasing self-exposure to non-medical cannabis, as measured with a rapid dimensional instrument, was a predictor of greater odds of opioid dependence diagnosis, in propensity score-matched samples.
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Affiliation(s)
- Eduardo R Butelman
- Laboratory on the Biology of Addictive Diseases, Rockefeller University, New York, NY, United States
| | - Angelo G I Maremmani
- "VP Dole" Dual Diagnosis Unit, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Silvia Bacciardi
- "VP Dole" Dual Diagnosis Unit, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Carina Y Chen
- Laboratory on the Biology of Addictive Diseases, Rockefeller University, New York, NY, United States
| | - Joel Correa da Rosa
- Center for Clinical and Translational Science, The Rockefeller University Hospital, Rockefeller University, New York, NY, United States
| | - Mary Jeanne Kreek
- Laboratory on the Biology of Addictive Diseases, Rockefeller University, New York, NY, United States
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232
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Cooper ZD, Craft RM. Sex-Dependent Effects of Cannabis and Cannabinoids: A Translational Perspective. Neuropsychopharmacology 2018; 43:34-51. [PMID: 28811670 PMCID: PMC5719093 DOI: 10.1038/npp.2017.140] [Citation(s) in RCA: 206] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/14/2017] [Accepted: 06/27/2017] [Indexed: 01/21/2023]
Abstract
Recent policy changes have led to significant increases in the use of cannabis for both medical and recreational purposes. Although men are more likely to endorse past month cannabis use and are more frequently diagnosed with Cannabis Use Disorder relative to women, a growing proportion of medical cannabis users are reported to be women. The increased popularity of cannabis for medical purposes and the narrowing gap in prevalence of use between men and women raises questions regarding sex-dependent effects related to therapeutic efficacy and negative health effects of cannabis and cannabinoids. The objective of this review is to provide a translational perspective on the sex-dependent effects of cannabis and cannabinoids by synthesizing findings from preclinical and clinical studies focused on sex comparisons of their therapeutic potential and abuse liability, two specific areas that are of significant public health relevance. Hormonal and pharmacological mechanisms that may underlie sex differences in the effects of cannabis and cannabinoids are highlighted.
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Affiliation(s)
- Ziva D Cooper
- Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Rebecca M Craft
- Department of Psychology, Washington State University, Pullman, WA, USA
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233
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Abstract
OBJECTIVE Stress reactivity research has traditionally focused on the idea that exaggerated responses to stress may have adverse effects on health. Accumulating evidence suggests that attenuated responses to stress and delayed recovery may also be problematic. METHODS This review focuses on the role of the stress response of the hypothalamic-pituitary-adrenocortical axis, the endogenous opioid system, and the cardiovascular system in hypertension, pain perception, and addictive behaviors. Results from multiple methods of assessment and stress paradigms conducted in our laboratory over the past two decades are integrated with research from other investigators and with existing theories. RESULTS Research indicates that exaggerated biological and physiological responses to stress and attenuated pain perception are associated with hypertension and risk for cardiovascular diseases. This research complements work linking reduced stress responses with enhanced pain sensitivity and discomfort. Multiple studies have also demonstrated that an attenuated stress response is linked to exacerbation of withdrawal symptoms and relapse in nicotine addiction. Evidence indicates important moderators (i.e., sex, personality traits, and early life adversity) and hypothalamic-pituitary-adrenocortical- and endogenous opioid system-related mechanisms in the altered response to stress. I integrate these findings in a conceptual model emphasizing that robust stress responses in the context of addiction and relapse should be considered as a marker of resiliency. CONCLUSIONS A blunted stress response may indicate long-term physiological dysregulation that could usher harmful consequences for cardiovascular disease, pain perception, and addictive disorders. The impact of dysregulation is influenced by multiple individual and situational factors that should be considered in evaluating the clinical significance of stress response dysregulation.
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Affiliation(s)
- Mustafa alʼAbsi
- From the University of Minnesota Medical School, Duluth (al'Absi), Duluth, Minnesota
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234
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Domenico LH, Lewis B, Hazarika M, Nixon SJ. Characterizing Anxiety Among Individuals Receiving Treatment for Alcohol and Substance Use Disorders. J Am Psychiatr Nurses Assoc 2018; 24:343-351. [PMID: 29126358 PMCID: PMC5930139 DOI: 10.1177/1078390317739106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite high prevalence of generalized anxiety disorder (GAD) substance use disorder (SUD) comorbidity, little is known regarding demographic characteristics associated with GAD in SUD treatment seekers. OBJECTIVE To characterize demographic differences between inpatient SUD treatment seekers reporting varying levels of GAD symptomatology. DESIGN General linear models, chi-square test, t test, and correlational analyses were utilized to assess group differences. Groups included those with no history of significant anxiety (No GAD; n = 256), subclinical anxiety (Subclinical; n = 85), and those meeting GAD diagnostic criteria (GAD; n = 61). RESULTS The No GAD group differed substantially from Subclinical and GAD individuals. With the exception of polysubstance use, no differences were found regarding Subclinical and GAD groups. CONCLUSION Individuals with subclinical GAD symptoms and those meeting diagnostic criteria were nearly identical regarding precursors to problematic substance use, severity of use, and key mental health indicators. Findings suggest subclinical levels of GAD should not be overlooked when assessing and treating SUDs.
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Affiliation(s)
- Lisa H Domenico
- 1 Lisa H. Domenico, PhD, University of Florida, Gainesville, FL, USA
| | - Ben Lewis
- 2 Ben Lewis, PhD, University of Florida, Gainesville, FL, USA
| | - Mythili Hazarika
- 3 Mythili Hazarika, PhD, Gauhati Medical College Hospital, Guwahati, Assam, India
| | - Sara Jo Nixon
- 4 Sara Jo Nixon, PhD, University of Florida, Gainesville, FL, USA
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235
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Dallo L, Martins RA. Association between the risk of alcohol use and unprotected sex in adolescents in a city in the southern region of Brazil. CIENCIA & SAUDE COLETIVA 2017; 23:303-314. [PMID: 29267834 DOI: 10.1590/1413-81232018231.14282015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 01/13/2016] [Indexed: 11/21/2022] Open
Abstract
This paper aims to analyze alcohol abuse and unprotected sex and the association between them in students in a city in the southern region of Brazil. This is a cross-sectional study using a quantitative approach with 590 secondary school students from two public schools. Regarding alcohol use, 14% scored from eight to 40 in The Alcohol Use Disorders Identification Test (AUDIT), which means, at least, a risky drinking behavior, with higher rate among boys. Moreover, 31.1% indulged themselves in binge drinking, which means drinking six or more doses according to AUDIT; and even among those who are low- risk drinkers, 21.1% had this drinking pattern. Regarding sexual behavior, young boys started sexual life earlier and the kind of relationship more referred to by them is one with no commitment; boys have uncommitted relationships, while girls have more relationships with commitment. In relation to the results of the association between alcohol use and sexual intercourse, 47.3% stated alcohol use before having sex, and those who started sexual activity got more drunk and had higher scores in the AUDIT. New studies are recommended regarding the association between both behaviors in Brazil, considering that the causal relationship is not clear and shows several explanation models.
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Affiliation(s)
- Luana Dallo
- Pontifícia Universidade Católica do Paraná. R. Imaculada Conceição 1155, Prado Velho. 80215901 Curitiba PR Brasil.
| | - Raul Aragão Martins
- Instituto de Biociências, Letras e Ciências Exatas, Universidade Estadual Paulista. São José do Rio Preto SP Brasil
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236
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Gryczynski J, Carswell SB, O'Grady KE, Mitchell SG, Schwartz RP. Gender and ethnic differences in primary care patients' response to computerized vs. in-person brief intervention for illicit drug misuse. J Subst Abuse Treat 2017; 84:50-56. [PMID: 29195593 DOI: 10.1016/j.jsat.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
This study is a secondary analysis from a randomized clinical trial of computerized vs. in-person brief intervention (BI) for illicit drug misuse among adult primary care patients (N=359; 45% Female; 47% Hispanic) with moderate-risk illicit drug misuse as measured by the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). This study examined differences in response to the two brief intervention strategies (both based on motivational interviewing) on the basis of gender and ethnicity, comparing non-Hispanic males, non-Hispanic females, Hispanic males, and Hispanic females. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up with the ASSIST. Trajectories in Global Continuum of Illicit Drug Risk Scores were examined using a generalized linear mixed model. There were significant differences in response to computerized vs. in-person BI over time on the basis of gender-ethnic subgroups (Gender×Ethnicity×Condition×Time interaction; p=0.03), with Hispanic males tending to respond more favorably to the computerized BI and Hispanic females tending to respond more favorably to the in-person BI. There was no clear differentiation in response to the two BIs among non-Hispanic males, while among non-Hispanic females the pattern of change converged following baseline differences. Consideration of gender and ethnic differences in future studies of BI is warranted.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States.
| | - Steven B Carswell
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
| | - Kevin E O'Grady
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
| | - Shannon Gwin Mitchell
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States
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237
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Knight KR. Women on the Edge: Opioids, Benzodiazepines, and the Social Anxieties Surrounding Women's Reproduction in the U.S. "Opioid Epidemic". CONTEMPORARY DRUG PROBLEMS 2017; 44:301-320. [PMID: 31537950 PMCID: PMC6752216 DOI: 10.1177/0091450917740359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The current "opioid epidemic" provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of opioid and benzodiazepine prescribing to U.S. women to examine how gender, race, and class inform social anxieties about reproduction and parenting. Multiple discourses abound about the relationship between women and the "opioid epidemic." Epidemiological reports attribute premature death among White women to the deadly combination of opioids and antianxiety medications. The National Institute on Drug Abuse reports that "every 25 minutes a baby is born suffering from opioid withdrawal," leading to costly hospital stays for infants and the potential for mother-child separation and other forms of family adjudication postpartum. Primary care providers are reluctant to distinguish diagnoses of chronic noncancer pain from anxiety among their female patients. Taken together, these discourses beg the question: What exactly are we worried about? I compare and contrast the narratives of two anxious women on opioids to raise larger structural questions about pregnancy, parenting, and drug use and to interrogate the public narrative that women on opioids threaten the American family and thwart the American Dream.
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Affiliation(s)
- Kelly R. Knight
- Department of Anthropology, History, and Social Medicine (DAHSM), University of California–San Francisco, San Francisco, CA, USA
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238
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McRae-Clark AL, Cason AM, Kohtz AS, Moran Santa-Maria M, Aston-Jones G, Brady KT. Impact of gender on corticotropin-releasing factor and noradrenergic sensitivity in cocaine use disorder. J Neurosci Res 2017; 95:320-327. [PMID: 27870396 DOI: 10.1002/jnr.23860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/30/2016] [Accepted: 07/11/2016] [Indexed: 12/21/2022]
Abstract
Responses to stress may be important in understanding gender differences in substance use disorders and may also be a target for development of treatment interventions. A growing body of both preclinical and clinical research supports important underlying gender differences in the corticotropin-releasing factor (CRF) and noradrenergic systems, which may contribute to drug use. Preclinical models have demonstrated increased sensitivity of females to CRF and noradrenergic-induced drug reinstatement compared with males, and, consistent with these findings, human laboratory studies have demonstrated greater sensitivity to corticotropin-releasing hormone (CRH) and noradrenergic stimulation in cocaine-dependent women compared with men. Furthermore, neuroimaging studies have demonstrated increased neural response to stressful stimuli in cocaine-dependent women compared with men as well as showing significant sex differences in the sensitivity of brain regions responsible for regulating the response to CRH. Development of interventions targeting the noradrenergic system and stress response in drug-dependent individuals could have important clinical implications for both women and men. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Aimee L McRae-Clark
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Angie M Cason
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Amy S Kohtz
- Brain Health Institute, Rutgers University, Piscataway, New Jersey
| | | | - Gary Aston-Jones
- Brain Health Institute, Rutgers University, Piscataway, New Jersey
| | - Kathleen T Brady
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
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239
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McHugh RK, Votaw VR, Sugarman DE, Greenfield SF. Sex and gender differences in substance use disorders. Clin Psychol Rev 2017; 66:12-23. [PMID: 29174306 DOI: 10.1016/j.cpr.2017.10.012] [Citation(s) in RCA: 478] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022]
Abstract
The gender gap in substance use disorders (SUDs), characterized by greater prevalence in men, is narrowing, highlighting the importance of understanding sex and gender differences in SUD etiology and maintenance. In this critical review, we provide an overview of sex/gender differences in the biology, epidemiology and treatment of SUDs. Biological sex differences are evident across an array of systems, including brain structure and function, endocrine function, and metabolic function. Gender (i.e., environmentally and socioculturally defined roles for men and women) also contributes to the initiation and course of substance use and SUDs. Adverse medical, psychiatric, and functional consequences associated with SUDs are often more severe in women. However, men and women do not substantively differ with respect to SUD treatment outcomes. Although several trends are beginning to emerge in the literature, findings on sex and gender differences in SUDs are complicated by the interacting contributions of biological and environmental factors. Future research is needed to further elucidate sex and gender differences, especially focusing on hormonal factors in SUD course and treatment outcomes; research translating findings between animal and human models; and gender differences in understudied populations, such as those with co-occurring psychiatric disorders and gender-specific populations, such as pregnant women.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States.
| | - Victoria R Votaw
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Dawn E Sugarman
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States
| | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02155, United States
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240
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Moran-Santa Maria MM, Sherman BJ, Brady KT, Baker NL, Hyer JM, Ferland C, McRae-Clark AL. Impact of endogenous progesterone on reactivity to yohimbine and cocaine cues in cocaine-dependent women. Pharmacol Biochem Behav 2017; 165:63-69. [PMID: 29126857 DOI: 10.1016/j.pbb.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Data from clinical and preclinical models of relapse suggest that progesterone attenuates cocaine-seeking behavior. In a recent study, we found that cocaine-dependent women reported greater subjective responses to cues that were preceded by a stressor than cocaine-dependent men. The objective of this study was to examine the impact of endogenous progesterone on the subjective and endocrine responses to a drug-paired cue that was preceded by a stressor in cocaine-dependent women. METHODS Cocaine-dependent women with low (<4ng/ml; n=16) and high (≥4ng/ml; n=9) plasma progesterone levels received either the alpha-2 adrenergic receptor antagonist yohimbine (21.6mg) or placebo before each of two cocaine-cue exposure sessions. Participants were tested under both conditions in a counterbalanced, double-blind fashion. Data were collected after study drug administration, immediately and at 5, 30, and 60min after the cue. RESULTS The anxiety response to the cue was differentially modified by progesterone levels under the two administration conditions (condition×progesterone level interaction, F1,23=9.8, p=0.005). Progesterone levels also modified the craving response to the cue differently under the placebo condition as compared to the yohimbine condition (condition×progesterone level interaction, F1,23=13.9, p=0.001). In both cases, high progesterone levels attenuated craving and anxiety response to the cue following yohimbine administration. There was no effect of progesterone levels on salivary cortisol or dehydroepiandrosterone under the placebo condition or under the yohimbine condition. CONCLUSIONS These preliminary data suggest that high levels of endogenous progesterone attenuate subjective responses to drug-cues that are preceded by a stressor. Importantly, these data support a growing literature demonstrating the protective effects of progesterone on the vulnerability to cocaine relapse in women.
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Affiliation(s)
- Megan M Moran-Santa Maria
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA
| | - Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA; Ralph H Johnson VAMC, 109 Bee Street, Charleston, SC 29401, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425, USA
| | - J Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425, USA
| | - Chantelle Ferland
- Department of Neurosciences, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA
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241
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Wakim KM, Molloy CJ, Bell RP, Ross LA, Foxe JJ. White Matter Changes in HIV+ Women with a History of Cocaine Dependence. Front Neurol 2017; 8:562. [PMID: 29163330 PMCID: PMC5671562 DOI: 10.3389/fneur.2017.00562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/09/2017] [Indexed: 01/08/2023] Open
Abstract
Cocaine use is associated with the transmission of human immunodeficiency (HIV) virus through risky sexual behavior. In HIV+ individuals, cocaine use is linked with poor health outcomes, including HIV-medication non-adherence and faster disease progression. Both HIV and cocaine dependence are associated with reduced integrity of cerebral white matter (WM), but the effects of HIV during cocaine abstinence have not yet been explored. We used diffusion tensor imaging (DTI) to understand the effect of combined HIV+ serostatus and former cocaine dependence on cerebral WM integrity. DTI data obtained from 15 HIV+ women with a history of cocaine dependence (COC+/HIV+) and 21 healthy females were included in the analysis. Diffusion-based measures [fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity, and axial diffusivity] were examined using tract-based spatial statistics and region-of-interest analyses. In a whole-brain analysis, COC+/HIV+ women showed significantly reduced FA and increased RD in all major WM tracts, except the left corticospinal tract for RD. The tract with greatest percentage of voxels showing significant between-group differences was the forceps minor (FA: 75.6%, RD: 59.7%). These widespread changes in diffusion measures indicate an extensive neuropathological effect of HIV and former cocaine dependence on WM.
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Affiliation(s)
- Kathryn-Mary Wakim
- The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester, Rochester, NY, United States
| | - Ciara J Molloy
- The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester, Rochester, NY, United States
| | - Ryan P Bell
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States.,The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Lars A Ross
- The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States.,The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester, Rochester, NY, United States.,The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States.,The Sheryl and Daniel R. Tishman Cognitive Neurophysiology Laboratory, Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
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Abstract
Purpose of the Review Cannabis is the most commonly used illicit substance worldwide. In recent decades, highly concentrated products have flooded the market, and prevalence rates have increased. Gender differences exist in cannabis use, as men have higher prevalence of both cannabis use and cannabis use disorder (CUD), while women progress more rapidly from first use to CUD. This paper reviews findings from preclinical and human studies examining the sex-specific neurobiological underpinnings of cannabis use and CUD, and associations with psychiatric symptoms. Recent Findings Sex differences exist in the endocannabinoid system, in cannabis exposure effects on brain structure and function, and in the co-occurrence of cannabis use with symptoms of anxiety, depression and schizophrenia. In female cannabis users, anxiety symptoms correlate with larger amygdala volume and social anxiety disorder symptoms correlate with CUD symptoms. Female cannabis users are reported to be especially vulnerable to earlier onset of schizophrenia, and mixed trends emerge in the correlation of depressive symptoms with cannabis exposure in females and males. Summary As prevalence of cannabis use may continue to increase given the shifting policy landscape regarding marijuana laws, understanding the neurobiological mechanisms of cannabis exposure in females and males is key. Examining these mechanisms may help inform future research on sex-specific pharmacological and behavioral interventions for women and men with high-risk cannabis use, comorbid psychiatric disease, and CUD.
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243
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Cannabis as Secondary Drug Is Not Associated With a Greater Risk of Death in Patients With Opiate, Cocaine, or Alcohol Dependence. J Addict Med 2017; 11:34-39. [PMID: 27753720 DOI: 10.1097/adm.0000000000000266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The health burden of cannabis use in patients with other substance dependencies is not fully understood. OBJECTIVE To assess the impact of cannabis use as secondary drug on mortality of patients with other major substance use disorders. PARTICIPANTS Patients with opiate, cocaine, or alcohol dependence admitted to detoxification from 2001 to 2010 at a teaching hospital in Badalona, Spain. MAIN MEASUREMENTS Sociodemographic characteristics, drug use, medical comorbidities, and urine drug screens were obtained at admission. Deaths were ascertained through clinical records and a death registry. Mortality rates and Cox regression models were used to analyze the association between urinary cannabis and mortality. RESULTS A total of 474 patients (20% women) were admitted with a median age of 38 years (interquartile range: 32-44 years). The main substances that motivated admissions were opiates (27%), cocaine (24%), and alcohol (49%). Positive urinary cannabis was detected in 168 patients (35%). Prevalence of cannabis use among patients with opiate, cocaine, or alcohol dependence was 46.5%, 42.9%, and 25.5%, respectively. At admission, 110 (23.7%) patients had human immunodeficiency virus infection and 217 (46.5%) had hepatitis C virus infection. Patients were studied for a median of 5.6 years (interquartile range: 2.6-7.7 years) (2454.7 person-years), and at the end of the study, 50 patients (10.5%) had died, yielding a mortality rate of 2.04 × 100 patient-years (95% confidence interval: 1.53-2.66). There was no association between cannabis detection and overall mortality in the adjusted regression models [hazard ratio (95% confidence interval): 1.12 (0.60-2.00), P = 0.73], but acquired immune deficiency syndrome-related deaths were more frequent in those positive for cannabis (26% vs 2%, P = 0.03). CONCLUSION Positive urinary cannabis did not confer an increased risk of death in patients with severe opiate, cocaine or alcohol dependence.
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244
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Riley AL, Hempel BJ, Clasen MM. Sex as a biological variable: Drug use and abuse. Physiol Behav 2017; 187:79-96. [PMID: 29030249 DOI: 10.1016/j.physbeh.2017.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/15/2017] [Accepted: 10/07/2017] [Indexed: 01/11/2023]
Abstract
The study of sex as a biological variable is a necessary emphasis across a wide array of endpoints, including basic neuroscience, medicine, mental health, physiology and behavior. The present review summarizes work from clinical and preclinical populations on sex differences in drug use and abuse, ranging from initiation to escalation/dysregulation and from drug cessation/abstinence to relapse. These differences are analyzed in the context of the addiction cycle conceptualization of Koob and his colleagues and address patterns of drug use (binge/intoxication), motivation underlying its use (withdrawal/negative affect) and likelihood and causes of craving and relapse of drug taking (preoccupation/anticipation). Following this overview, an assessment of the basis for the reported sex differences is discussed in the context of the affective (rewarding and aversive) properties of drugs of abuse and how such properties and their balance vary with sex and contribute to drug intake. Finally, the interaction of sex with several experiential (drug history) and subject (age) factors and how these interactions affect reward and aversion are discussed to highlight the importance of understanding such interactions in predicting drug use and abuse. We note that sex as a biological variable remains one of critical evaluation and that such investigations of sex differences in drug use and abuse continue and be expanded to assess all facets of their mediation, including these affective properties, how their balance may be impacted by the multiple conditions under which drugs are taken and how this overall balance affects drug use and addiction vulnerability.
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Affiliation(s)
- Anthony L Riley
- Psychopharmacology Laboratory, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave, NW, Washington, D.C. 20016, USA.
| | - Briana J Hempel
- Psychopharmacology Laboratory, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave, NW, Washington, D.C. 20016, USA
| | - Matthew M Clasen
- Psychopharmacology Laboratory, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave, NW, Washington, D.C. 20016, USA
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Schückher F, Sellin T, Berglund K, Berggren U, Balldin J, Engström I, Fahlke C. The Importance of Age at Onset of Excessive Alcohol Use with Regard to Psychiatric Symptoms and Personality Characteristics. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1350540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fides Schückher
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tabita Sellin
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kristina Berglund
- Department of Psychology, University of Gothenburg, Göteborg, Sweden
| | - Ulf Berggren
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Jan Balldin
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Ingemar Engström
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Claudia Fahlke
- Department of Psychology, University of Gothenburg, Göteborg, Sweden
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246
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Stein MD, Conti MT, Kenney S, Anderson BJ, Flori JN, Risi MM, Bailey GL. Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder. Drug Alcohol Depend 2017; 179:325-329. [PMID: 28841495 PMCID: PMC5599365 DOI: 10.1016/j.drugalcdep.2017.07.007] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Adverse childhood experiences are associated with the development of substance use disorders. With opioid use disorder, a growing concern in the United States, we were interested in examining the relationship between adverse experiences and three landmarks of opioid use: age of opioid initiation, injection drug use, and lifetime overdose. METHODS Between May and December 2015, we interviewed consecutive persons seeking inpatient opioid detoxification. Participants were asked about age of opioid initiation, last month injection drug use, and lifetime history of overdose, and completed the ten-item Adverse Childhood Experience (ACE) questionnaire. RESULTS Participants (n=457) averaged 32.2 (±8.64) years of age, 71.3% were male, and 82.5% were non-Hispanic White. The mean score on the ACE scale was 3.64 (±2.75). Mean age at time of initiating opioid use was 21.7 (±7.1) years, 68.7% had injected drugs within the past month, and 39.0% had overdosed. After adjusting for age, gender, and ethnicity, the ACE score was inversely associated with age of initiating opioid use (b=-0.50, 95% CI -0.70; -0.29, p<.001), and positively associated with recent injection drug use (OR=1.11, 95% CI 1.02; 1.20, p=0.014) and the likelihood of experiencing an overdose (OR=1.10, 95% CI 1.02; 1.20, p=0.015) in a graded dose response manner. CONCLUSION Greater adverse childhood experiences are associated with three landmarks of opioid use risk. ACE screening may be useful in identifying high-risk subsets of opioid-using populations.
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Affiliation(s)
- Michael D. Stein
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Boston University School of Public Health, Boston, MA 02118
| | - Micah T. Conti
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720
| | - Shannon Kenney
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906, USA; Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA.
| | | | - Jessica N. Flori
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720
| | - Megan M. Risi
- Behavioral Medicine, Butler Hospital, Providence, RI, 02906,Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720
| | - Genie L. Bailey
- Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts 02720,Warren Alpert Medical School of Brown University, Providence, RI, 02912
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247
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Shimamoto A, Rappeneau V. Sex-dependent mental illnesses and mitochondria. Schizophr Res 2017; 187:38-46. [PMID: 28279571 PMCID: PMC5581986 DOI: 10.1016/j.schres.2017.02.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 12/11/2022]
Abstract
The prevalence of some mental illnesses, including major depression, anxiety-, trauma-, and stress-related disorders, some substance use disorders, and later onset of schizophrenia, is higher in women than men. While the higher prevalence in women could simply be explained by socioeconomic determinants, such as income, social status, or cultural background, extensive studies show sex differences in biological, pharmacokinetic, and pharmacological factors contribute to females' vulnerability to these mental illnesses. In this review, we focus on estrogens, chronic stress, and neurotoxicity from behavioral, pharmacological, biological, and molecular perspectives to delineate the sex differences in these mental illnesses. Particularly, we investigate a possible role of mitochondrial function, including biosynthesis, bioenergetics, and signaling, on mediating the sex differences in psychiatric disorders.
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Affiliation(s)
- Akiko Shimamoto
- Department of Neuroscience and Pharmacology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37028-3599, United States.
| | - Virginie Rappeneau
- Department of Neuroscience and Pharmacology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37028-3599, United States
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248
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Melón LC, Nolan ZT, Colar D, Moore EM, Boehm SL. Activation of extrasynaptic δ-GABA A receptors globally or within the posterior-VTA has estrous-dependent effects on consumption of alcohol and estrous-independent effects on locomotion. Horm Behav 2017; 95:65-75. [PMID: 28765080 PMCID: PMC5623082 DOI: 10.1016/j.yhbeh.2017.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022]
Abstract
Recent reports support higher than expected rates of binge alcohol consumption among women and girls. Unfortunately, few studies have assessed the mechanisms underlying this pattern of intake in females. Studies in males suggest that alcohol concentrations relevant to the beginning stages of binge intoxication may selectively target tonic GABAergic inhibition mediated by GABAA receptor subtypes expressing the δ-subunit protein (δ-GABAARs). Indeed, administration of agonists that interact with these δ-GABAARs prior to alcohol access can abolish binge drinking behavior in male mice. These δ-GABAARs have also been shown to exhibit estrous-dependent plasticity in regions relevant to drug taking behavior, like the hippocampus and periaqueductal gray. The present experiments were designed to determine whether the estrous cycle would alter binge drinking, or our ability to modulate this pattern of alcohol use with THIP, an agonist with high selectivity and efficacy at δ-GABAARs. Using the Drinking-in-the-Dark (DID) binge-drinking model, regularly cycling female mice were given 2h of daily access to alcohol (20%v/v). Vaginal cytology or vaginal impedance was assessed after drinking sessions to track estrous status. There was no fluctuation in binge drinking associated with the estrous cycle. Both Intra-posterior-VTA administration of THIP and systemic administration of the drug was also associated with an estrous cycle dependent reduction in drinking behavior. Pre-treatment with finasteride to inhibit synthesis of 5α-reduced neurosteroids did not disrupt THIP's effects. Analysis of δ-subunit mRNA from posterior-VTA enriched tissue samples revealed that expression of this GABAA receptor subunit is elevated during diestrus in this region. Taken together, these studies demonstrate that δGABAARs in the VTA are an important target for binge drinking in females and confirm that the estrous cycle is an important moderator of the pharmacology of this GABAA receptor subtype.
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Affiliation(s)
- Laverne C Melón
- Addiction Neuroscience, Department of Psychology, Indiana University/Purdue University-Indianapolis, Indianapolis, IN 46202, USA; Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, USA
| | | | - Delphine Colar
- Addiction Neuroscience, Department of Psychology, Indiana University/Purdue University-Indianapolis, Indianapolis, IN 46202, USA
| | - Eileen M Moore
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - Stephen L Boehm
- Addiction Neuroscience, Department of Psychology, Indiana University/Purdue University-Indianapolis, Indianapolis, IN 46202, USA.
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249
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Lewis B, Hoffman L, Garcia CC, Nixon SJ. Race and socioeconomic status in substance use progression and treatment entry. J Ethn Subst Abuse 2017; 17:150-166. [PMID: 28846065 DOI: 10.1080/15332640.2017.1336959] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined trajectories of progression from early substance use to treatment entry as a function of race, among inpatient treatment seekers (N = 945). Following primary race-contingent analyses of use progression, secondary analyses were conducted to investigate the effects of socioeconomic status (SES) on the observed differences. African Americans reported significant delays in treatment entry relative to Caucasians. Racial differences in alcohol, marijuana, and cocaine use trajectories were observed. Accounting for SES rendered observations of accelerated use among African Americans nonsignificant. However, inclusion of SES failed to mitigate the marked racial disparity in treatment entry.
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Affiliation(s)
- Ben Lewis
- a University of Florida , Gainesville , Florida
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250
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Heredia LPD, Ramirez EGL, Pereira CF, Vargas DD. EFEITO DAS VARIÁVEIS SOCIODEMOGRÁFICAS E DE VULNERABILIDADE NO PADRÃO DE USO DE ÁLCOOL EM MULHERES UNIVERSITÁRIAS. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017006860015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: determinar o efeito das variáveis sociodemográficas e de vulnerabilidade no uso de bebidas alcoólicas em mulheres universitárias. Método: estudo transversal, composto por uma amostra de 301 mulheres universitárias. Os dados sociodemográficos e de vulnerabilidade ao consumo foram obtidos pelos formulários eletrônicos CAGE, AUDIT-C, questionário sociodemográfico e de vulnerabilidade ao uso de álcool. Para análise dos dados foram usados o teste qui-quadrado e a regressão logística. Resultados: 80,4% das mulheres apresentaram uso moderado e 19,6 %, uso nocivo de álcool. As variáveis que mostraram ter efeito sobre o padrão de uso foram: idade de início do consumo, nível socioeconômico, tipo de bebida e redes sociais. Conclusão: os fatores de vulnerabilidade, preferência por bebidas alcoólicas destiladas, ter redes sociais que promovem o consumo, ter iniciado o uso entre 14 e 16 anos de idade são características que podem favorecer o consumo nocivo de álcool.
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