Cognitive-behavioural treatment for amphetamine-type stimulants (ATS)-use disorders

The effect of paeoniflorin on the rewarding effect of methamphetamine and the associated cognitive impairment in mice

Chronic exposure to methamphetamine (METH) has been suggested to cause METH use disorder and severe cognitive impairment. Paeoniflorin (PF) is a monoterpenoid glycoside with various beneficial effects, including anti-inflammatory, antioxidant and antidepressant. The current study was designed to investigate the effect of PF (30 mg/kg, i.p.) on the rewarding effect of METH (2.5 mg/kg, i.p.) and the associated cognitive impairment, using the animal model of conditioned place preference, new location reorganization test, new object reorganization test and Y-maze test. METH induced conditioned place preference, accompanied by increased expression of synapse-associated proteins in the ventral target areas (VTA) and nucleus accumbens (NAc). In addition, METH induced significant cognitive impairment and decreased the expression of synapse-associated proteins in the hippocampus (Hip). Administration of PF decreased the rewarding effect of METH and the expression of synapse-associated proteins in the VTA or NAc. PF was also effective to improve METH-induced cognitive impairment by upregulating the expression of synapse-associated proteins in the Hip. Therefore, PF could be a potential agent for the treatment of METH use disorder and the associated cognitive impairment.

Enhancing the drug addiction treatment service by introducing a new residential treatment model in the Philippines: A qualitative study

BACKGROUND

There is an increased demand for quality treatment and rehabilitation services for people who use drugs (PWUDs) in the Philippines. In response, the Philippines Government's Department of Health (DOH) has established a new residential treatment model, Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET), and integrated it into the existing treatment service platform of 21 DOH-owned Treatment and Rehabilitation Centers (TRCs). We conducted a qualitative study to identify the changes engendered by the implementation of this treatment model.

METHODS

Data were collected through individual face-to-face interviews. We interviewed purposefully selected 29 patients and 35 facilitators of INTREPRET group sessions in seven TRCs. We transcribed the interview records and organized the narrative information into key themes using thematic analysis during the coding process.

RESULTS

The changes perceived by the study participants included the attitude and behavior of patients, attitude and competency of facilitators, relationship between facilitators and patients, treatment planning and review process, efficient and standardized treatment services, and monitoring mechanisms of the patient's recovery process. Participants also noted challenges in INTREPRET implementation, including family participation in therapy sessions, lack of facilitators, securing a conducive place for conducting sessions, and reproducing workbooks.

CONCLUSIONS

The results imply that the introduction of INTREPRET could improve treatment service quality and the effectiveness of treatment, which were primarily associated with behavioral changes in patients, improved relationship between patients and facilitators, and INTREPRET's alignment with key international treatment standards. However, despite the positive changes perceived by the participants, certain challenges pertaining to family participation in therapy sessions and the lack of resources were identified. These criticisms must be addressed by DOH, along with an integration of INTREPRET into its policy and strategic framework, to ensure the effectiveness and sustainability of the new treatment model.

Recommendation for Long-term Management of Adult Attention-Deficit/Hyperactivity Disorder in Military Populations, Veterans, and Dependents: A Narrative Review

INTRODUCTION

In addition to the higher burden of mental health disease in the military, there is a compounding antecedent association between behavioral health comorbidities and the treatment of attention-deficit/hyperactivity disorder (ADHD) in this population. Despite the low prevalence of new-onset ADHD in adults globally, the rate of stimulant (i.e., amphetamines) prescription is increasing. Stimulants can exacerbate mental health disease (often masquerading as ADHD symptomatology), precluding optimal treatment of the underlying etiology and imposing unnecessary dangerous side effects. This study aimed to evaluate the long-term safety and efficacy of stimulants for managing adult ADHD.

METHODS

A nine-member multidisciplinary team reviewed a PubMed search with the terms "adult," "ADHD," and "stimulant." Targeted PubMed and Google Scholar searches for "adult ADHD" paired with Food and Drug Administration -approved ADHD medications and Google Scholar literature using forward and reverse snowballing methods were performed for high-quality studies focusing on long-term treatment in ADHD. An evidence table and clinical algorithm were developed from the review.

RESULTS

Of the 1,039 results, 50 articles were fully reviewed, consisting of 21 descriptive and experimental studies, 18 observational, and 11 systematic reviews and meta-analyses. Illustrative cases within the structured discussion of the results highlighted ADHD and psychiatric comorbidities, risks, harms, and benefits of stimulant use, medication mechanisms of action, and limitations of the current evidence.

DISCUSSION

The dearth of high-quality studies on long-term ADHD management in adults fails to establish a causal relationship between stimulant use and physiological harm. Despite mixed evidence supporting the benefit of stimulants, there is clear evidence regarding the risk of harm. The serious risks of stimulants include arrhythmias, myocardial infarction, stroke/transient ischemic attack, sudden death, psychosis, and worsening of behavioral health disease. Additionally, there is a possible long-term risk of harm due to chronic sympathetic load (i.e., cardiovascular system remodeling). Stimulants pose a greater risk for addiction and abuse compared to other evidence-based nonstimulant medications that have similar effectiveness. Both stimulants and nonstimulants might promote favorable neuroanatomical changes for long-term improvement of ADHD symptoms, but nonstimulants (atomoxetine) have the pharmacological advantage of also mitigating the effects of sympathetic load (sympatholysis) and anxiety (anxiolysis). Given the physiological uncertainty of extended stimulant use for adults, especially older adults with vulnerable cardiovascular systems, clinicians should proceed cautiously when considering initiating or sustaining stimulant therapy. For long-term treatment of ADHD in adults, clinicians should consider nonstimulant alternatives (including behavioral therapy) due to the comparatively lower side effect risk and the possible additional benefit in patients with behavioral health comorbidities.

CONCLUSION

Long-term safety of stimulant use for adults with ADHD is uncertain, as existing studies are limited in quality and duration. This is particularly important for military populations with higher rates of mental health conditions. Managing ADHD and related conditions requires prioritizing cardiovascular safety, especially for older adults. Nonstimulant options can be helpful, especially in comorbid psychiatric disease. Before treating ADHD, ruling out and controlling other behavioral health conditions is essential to avoid masking or worsening underlying issues and reducing unnecessary medication side effects.

Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews

Introduction: Amphetamine-type stimulants (ATS) use is a global concern due to increased usage and the harm to physical, mental, and social well-being. The objective of this overview of systematic reviews is to summarise trial results of psychosocial interventions and describe their efficacy and safety. Methods: We searched seven bibliographic databases to November 2020 for systematic reviews examining ATS misuse treatment by psychosocial interventions. Given the apparent incompleteness of the included reviews, we undertook a supplemental meta-analysis of all eligible primary studies. Results: We included 11 systematic reviews of moderate to high quality and 39 primary studies which assessed the outcomes of psychosocial interventions on people who use ATS. The key findings include: (1) There were conflicting results about the effectiveness of psychosocial interventions among reviews, which may confuse decision-makers in selecting treatment. (2) In the supplemental meta-analysis, relative to usual care (only counselling or self-help materials), membership of a psychological intervention group was associated with an important reduction in drug usage [risk ratio (RR) 0.80, 95% CI: 0.75 to 0.85]. Patients in psychological interventions used injectables substantially less [odds ratio (OR) 0.35, 95% CI: 0.24 to 0.49]. The risk of unsafe sex in the psychosocial intervention group was lower than in the control group (RR 0.49, 95% CI: 0.34 to 0.71). The combination of therapies reduced 1.51 day using drugs in the preceding 30 days (95% CI: -2.36 to -0.67) compared to cognitive behavioural therapy intervention alone. (3) Compared to usual care, cognitive behavioural therapy was less likely to be retained at follow-up (RR 0.89, 95% CI: 0.82 to 0.97; high-quality evidence). However, the additional of contingency management strategy can make an important improvement upon retention (RR 1.42, 95%CI: 1.25 to 1.62). Authors' Conclusions: Integrated models are more effective than a single-treatment strategy. Comprehensive and sustained psychosocial interventions can help to reduce use of ATS and other drugs, risk behaviours and mental disorders, and significantly improve treatment adherence.