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Macatee RJ, Cannon MJ, Schermitzler BS, Preston TJ, Afshar K. Biological sex and hormonal contraceptive associations with drug cue reactivity in cannabis use disorder. J Psychiatr Res 2024; 174:121-128. [PMID: 38626562 PMCID: PMC11195151 DOI: 10.1016/j.jpsychires.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 02/18/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024]
Abstract
Biological sex differences in Cannabis Use Disorder (CUD) progression, cannabis withdrawal severity, and pharmacotherapy response have been reported, suggesting that CUD mechanisms may differ by sex. Drug cue reactivity is an established predictor of drug use behavior, but the literature on sex differences in drug cue reactivity is mixed, including in CUD. One possible moderator of sex differences in drug cue reactivity is hormonal contraceptive (HC) use. The aim of the present study was to test whether sex differences in neural cannabis cue reactivity and craving varied by female HC use in a CUD sample. As part of a larger study, 152 adults reporting frequent cannabis use completed a drug cue reactivity task during electrocenphalogram recording. Late positive potential (LPP) amplitude modulation by cannabis cues was used to measure neural cue reactivity. Craving after the cue reactivity task was also assessed. Males (n = 74) and naturally-cycling females (n = 26), who did not differ from each other, showed significantly greater LPP enhancement to cannabis vs. neutral cues compared to HC-using females (n = 52), an effect mostly driven by neutral cues. Craving was significantly higher in naturally-cycling but not HC-using females compared to males, but only in covariate-unadjusted analyses. Exploratory analyses of HC and menstrual phase characteristics indicate a progesterone-related mechanism may underlie HC effects on cannabis cue reactivity. The present study's results suggest that mixed findings on drug cue reactivity sex differences may be due to variability in HC use, which has implications for sex-specific models of CUD progression and treatment.
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Affiliation(s)
| | | | | | | | - Kaveh Afshar
- Auburn University, Department of Psychological Sciences, USA
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2
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Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder. Drug Alcohol Depend 2024; 254:111035. [PMID: 38043228 PMCID: PMC10837319 DOI: 10.1016/j.drugalcdep.2023.111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have therapeutic clinical effects when applied in serial-sessions. The present study sought to preliminarily determine whether serial-sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. METHODS This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, two-sessions-per-visit, two-visits-per-week, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post- treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. RESULTS There were no significant differences in craving between conditions. Participants who received active-rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham-rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active-rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period than those receiving sham-rTMS (Active vs. Sham: -0.72; Z=-2.33, p=0.02). CONCLUSIONS This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
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Affiliation(s)
- Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nathaniel L Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brendan L Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Margaret A Caruso
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Lauren A Campbell
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Brian J Sherman
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Tiffany J Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Ahmad H Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Jane P Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrew J Manett
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Ian H Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Edward B Short
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Terese K Killeen
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
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Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A Preliminary Investigation Of Repetitive Transcranial Magnetic Stimulation Applied To The Left Dorsolateral Prefrontal Cortex In Treatment Seeking Participants With Cannabis Use Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.10.23292461. [PMID: 37503294 PMCID: PMC10370231 DOI: 10.1101/2023.07.10.23292461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have a therapeutic clinical effect when applied in serial sessions. The present study sought to preliminarily determine whether serial sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. Methods This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post-treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. Results There were no significant differences in craving between conditions. Participants who received active rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period (Active vs. Sham: -0.72; Z=-2.33, p=0.02). Conclusions This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
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Affiliation(s)
- Gregory L. Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nathaniel L. Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brendan L. Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Margaret A. Caruso
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren A. Campbell
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Brian J. Sherman
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tiffany J. Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Ahmad H. Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Jane P. Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nolan R. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Andrew J. Manett
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ian H. Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Edward B. Short
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terese K. Killeen
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark S. George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | - Aimee L. McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
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Simon SG, Jamner LD, Dent AL, Granger DA, Riis JL. Hypothalamic-pituitary-adrenal and sympathetic nervous system responses to social evaluative stress in chronic cannabis users and non-users. Addict Behav 2023; 136:107489. [PMID: 36181746 DOI: 10.1016/j.addbeh.2022.107489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND To advance our understanding of the health-related consequences of chronic cannabis use, this study examined hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) reactivity and regulation in response to a well-characterized, acute, social evaluative stress task among cannabis users and non-users. We also explored differences in HPA-SNS coordination across the stress task in cannabis users and non-users. METHOD Participants were 75 adults (53% female) who reported no use of tobacco/nicotine products. Cannabis use was measured using self-report and salivary/urinary THC levels. Participants were classified as cannabis users (n = 33) if they reported using cannabis at least twice per week in the prior year and had a positive salivary/urinary THC test or as non-users (n = 42) if they reported no use in the prior year and had a negative THC test. During a laboratory visit, participants completed the standard Trier Social Stress Test (TSST) and provided saliva samples before, and 5, 20, and 40 min after the task. Samples were assayed for salivary cortisol and alpha-amylase (sAA) as indices of HPA axis and SNS activity, respectively. RESULTS Multilevel piecewise growth models revealed that, relative to non-users, cannabis users showed (a) blunted cortisol reactivity and recovery to the TSST, and (b) greater reductions in sAA concentrations following the TSST. Chronic cannabis users may exhibit blunted HPA axis responses and greater SNS recovery to acute psychosocial stress. Implications of individual differences in stress reactivity and regulation for the biobehavioral health of chronic cannabis users are discussed.
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Affiliation(s)
- Shauna G Simon
- Department of Psychological Science, School of Social Ecology, University of California at Irvine, Irvine, CA, USA.
| | - Larry D Jamner
- Department of Psychological Science, School of Social Ecology, University of California at Irvine, Irvine, CA, USA
| | - Amy L Dent
- Department of Psychological Science, School of Social Ecology, University of California at Irvine, Irvine, CA, USA
| | - Douglas A Granger
- Department of Psychological Science, School of Social Ecology, University of California at Irvine, Irvine, CA, USA; Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, USA; Johns Hopkins University School of Medicine, USA
| | - Jenna L Riis
- Department of Psychological Science, School of Social Ecology, University of California at Irvine, Irvine, CA, USA; Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, USA
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Kexel AK, Kluwe-Schiavon B, Baumgartner MR, Engeli EJE, Visentini M, Kirschbaum C, Seifritz E, Ditzen B, Soravia LM, Quednow BB. Cue-induced cocaine craving enhances psychosocial stress and vice versa in chronic cocaine users. Transl Psychiatry 2022; 12:443. [PMID: 36220809 PMCID: PMC9554190 DOI: 10.1038/s41398-022-02204-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022] Open
Abstract
Stress and craving, it has been found, contribute to the development and maintenance of and relapse in cocaine use disorder. Chronic cocaine users (CU), previous research has shown, display altered physiological responses to psychosocial stress and increased vegetative responding to substance-related cues. However, how psychosocial stress and cue-induced craving interact in relation to the CU's physiological responses remains largely unknown. We thus investigated the interaction between acute psychosocial stress and cocaine-cue-related reactivity in 47 CU and 38 controls. In a crossed and balanced design, the participants were randomly exposed to a video-based cocaine-cue paradigm and the Trier Social Stress Test (TSST) or vice versa to investigate possible mutually augmenting effects of both stressors on physiological stress responses. Over the course of the experimental procedure, plasma cortisol, ACTH, noradrenaline, subjective stress, and craving were assessed repeatedly. To estimate the responses during the cocaine-cue paradigm and TSST, growth models and discontinuous growth models were used. Overall, though both groups did not differ in their endocrinological responses to the TSST, CU displayed lower ACTH levels at baseline. The TSST did not elevate craving in CU, but when the cocaine-cue video was shown first, CU displayed an enhanced cortisol response to the subsequent TSST. In CU, cocaine-cues robustly evoked craving but no physiological stress response, while cue-induced craving was intensified after the TSST. Taken together, though CU did not show an altered acute stress response during the TSST, stress and craving together seemed to have mutually augmenting effects on their stress response.
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Affiliation(s)
- Ann-Kathrin Kexel
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.
| | - Bruno Kluwe-Schiavon
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
- Cognition in Context, Research Center for Psychological Science, University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal
| | - Markus R Baumgartner
- Centre for Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Kurvenstrasse 17, 8006, Zurich, Switzerland
| | - Etna J E Engeli
- Centre for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Selnaustrasse 9, 8001, Zurich, Switzerland
| | - Monika Visentini
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Clemens Kirschbaum
- Department of Biopsychology, Technical University Dresden, Zellescher Weg 19, 01069, Dresden, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Beate Ditzen
- Institute for Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
- Ruprecht-Karls University Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Leila M Soravia
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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Baker NL, Neelon B, Ramakrishnan V, Brady KT, Gray KM, Saladin ME, Back SE, Flanagan JC, Guille C, McRae-Clark AL. Sex and drug differences in stress, craving and cortisol response to the trier social stress task. Psychopharmacology (Berl) 2022; 239:2819-2827. [PMID: 35589850 DOI: 10.1007/s00213-022-06163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 05/10/2022] [Indexed: 11/27/2022]
Abstract
RATIONALE The hypothalamic-pituitary-adrenal (HPA) axis is a critical hormonal system involved in stress response. A number of studies have investigated the HPA axis response of drug-dependent individuals to stressors. Stress-induced vulnerabilities in the HPA axis may differ in response to chronic use of different substances, possibly leading to different target therapies. There has not been a direct comparison of HPA axis and subjective response between individuals with different types of substance use disorders following a laboratory stress intervention. OBJECTIVES The primary goal of the current study was to compare subjective and neuroendocrine response to the Trier Social Stress Task (TSST) across multiple primary types of substance use disorders and investigate differential response between males and females. METHODS Four hundred participants were drawn from seven studies completed at the Medical University of South Carolina between 2011 and 2021. The TSST was utilized across studies and subjective and neuroendocrine responses measured following completion. Generalized linear mixed effects models and area under the response curve analysis were used to compare both substance type and sex differences. RESULTS The study groups involving individuals with cocaine use disorder had blunted stress, craving and cortisol response following the TSST as compared to other substance use groups. Females in the cocaine groups reported higher subjective stress but lower cortisol than males. CONCLUSIONS The study results indicate that there may be differential effects of substances on the HPA axis, with cocaine using individuals exhibiting more blunting of the HPA axis response as compared to users of other substances.
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Affiliation(s)
- Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, Charleston, SC, 29425, USA.
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, Charleston, SC, 29425, USA
- Ralph H Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, Charleston, SC, 29425, USA
| | - Kathleen T Brady
- Ralph H Johnson Veterans Administration Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michael E Saladin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Sudie E Back
- Ralph H Johnson Veterans Administration Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Julianne C Flanagan
- Ralph H Johnson Veterans Administration Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Ralph H Johnson Veterans Administration Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Parisi A, Landicho HL, Hudak J, Leknes S, Froeliger B, Garland EL. Emotional distress and pain catastrophizing predict cue-elicited opioid craving among chronic pain patients on long-term opioid therapy. Drug Alcohol Depend 2022; 233:109361. [PMID: 35278786 PMCID: PMC9466292 DOI: 10.1016/j.drugalcdep.2022.109361] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Individuals who use illicit substances exhibit cue-elicited craving and autonomic cue-reactivity when exposed to cues associated with past drug use. However, little is known about this phenomenon among chronic pain patients on long-term opioid therapy (LTOT). Negative cognitive-emotional reactivity in general (e.g., distress) and cognitive-emotional reactivity specific to pain (e.g., pain catastrophizing) might drive cue-reactivity independent of pain severity. Here we examined emotional distress and pain catastrophizing as predictors of cue-reactivity among a sample of chronic pain patients receiving LTOT. We also tested whether associations between distress, catastrophizing, and cue-reactivity differed as a function of opioid misuse status. MATERIALS AND METHODS Patients receiving LTOT (N = 243) were classified as exhibiting aberrant behavior consistent with opioid misuse (MISUSE+, n = 145) or as using opioids as prescribed (MISUSE-, n = 97). Participants completed assessments of pain catastrophizing and emotional distress and then participated in an opioid cue-reactivity task one week later. Cue-elicited opioid craving and autonomic cue-reactivity were measured with craving ratings and high-frequency heart rate variability (HRV), respectively. RESULTS Distress and catastrophizing predicted cue-elicited craving and HRV, whereas pain severity did not. Misuser status moderated the relationship between emotional distress and self-reported craving, such that higher levels of distress predicted craving among the MISUSE+ group, but not among the MISUSE- group. No moderating effects were found for catastrophizing. CONCLUSIONS Findings suggest that although opioids are prescribed for analgesia, the exacerbating influence of negative cognitive-emotional reactivity, both in general and specific to pain, on cue-elicited opioid craving extends beyond the effects of pain severity alone.
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Affiliation(s)
- Anna Parisi
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Hannah Louise Landicho
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Justin Hudak
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Siri Leknes
- Department of Psychology, University of Oslo, USA
| | - Brett Froeliger
- Department of Psychiatry; Department of Psychological Sciences, University of Missouri, USA
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
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Nardone R, Sebastianelli L, Versace V, Ferrazzoli D, Brigo F, Schwenker K, Saltuari L, Trinka E. TMS for the functional evaluation of cannabis effects and for treatment of cannabis addiction: A review. Psychiatry Res 2022; 310:114431. [PMID: 35219263 DOI: 10.1016/j.psychres.2022.114431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022]
Abstract
The knowledge about the effects of cannabis on human cortical brain processes is increasing. In this regard, transcranial magnetic stimulation (TMS) enables the evaluation of central nervous system function, including drug effects. Moreover, repetitive TMS (rTMS) has been used therapeutically in several substance use disorders. In this scoping review, we summarize and discuss studies that have employed TMS and rTMS techniques in users of cannabis for recreational purposes. In subjects with a history of persistent cannabis use, TMS studies showed reduced short-interval cortical inhibition (SICI). This observation points more at neurobiological changes of chronic cannabis use than to a direct effect of cannabis on gamma-aminobutyric acid (GABA) A receptors. Moreover, individuals vulnerable to becoming long-term users of cannabis may also have underlying pre-existing abnormalities in SICI. Of note, the use of cannabis is associated with an increased risk of schizophrenia, and the down-regulation of GABAergic function may play a role. Less frequent cannabis use and spontaneous craving were observed following rTMS applied to the dorsolateral prefrontal cortex (DLPFC). There is emerging evidence that the posterior cingulate cortex and the precuneus are potential targets for rTMS intervention in cannabis use disorder. However, larger and randomized trials should corroborate these encouraging findings.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; UMIT, University for Medical Informatics and Health Technology, Hall in Tirol, Austria
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Forray A, Mele A, Byatt N, Londono Tobon A, Gilstad-Hayden K, Hunkle K, Hong S, Lipkind H, Fiellin DA, Callaghan K, Yonkers KA. Support Models for Addiction Related Treatment (SMART) for pregnant women: Study protocol of a cluster randomized trial of two treatment models for opioid use disorder in prenatal clinics. PLoS One 2022; 17:e0261751. [PMID: 35025898 PMCID: PMC8758001 DOI: 10.1371/journal.pone.0261751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The prevalence of opioid use disorder (OUD) in pregnancy increased nearly five-fold over the past decade. Despite this, obstetric providers are less likely to treat pregnant women with medication for OUD than non-obstetric providers (75% vs 91%). A major reason is many obstetricians feel unprepared to prescribe medication for opioid use disorder (MOUD). Education and support may increase prescribing and overall comfort in delivering care for pregnant women with OUD, but optimal models of education and support are yet to be determined. Methods and analysis We describe the rationale and conduct of a matched-pair cluster randomized clinical trial to compare the effectiveness of two models of support for reproductive health clinicians to provide care for pregnant and postpartum women with OUD. The primary outcomes of this trial are patient treatment engagement and retention in OUD treatment. This study compares two support models: 1) a collaborative care approach, based upon the Massachusetts Office-Based-Opioid Treatment Model, that provides practice-level training and support to providers and patients through the use of care managers, versus 2) a telesupport approach based on the Project Extension for Community Healthcare Outcomes, a remote education model that provides mentorship, guided practice, and participation in a learning community, via video conferencing. Discussion This clustered randomized clinical trial aims to test the effectiveness of two approaches to support practitioners who care for pregnant women with an OUD. The results of this trial will help determine the best model to improve the capacity of obstetrical providers to deliver treatment for OUD in prenatal clinics. Trial registration Clinicaltrials.gov trial registration number: NCT0424039.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Amanda Mele
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, Massachusetts, United States of America
- Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Amalia Londono Tobon
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, United States of America
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Karen Hunkle
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Suyeon Hong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Heather Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Katherine Callaghan
- Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Kimberly A. Yonkers
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, Massachusetts, United States of America
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10
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Glodosky NC, Cuttler C, McLaughlin RJ. A review of the effects of acute and chronic cannabinoid exposure on the stress response. Front Neuroendocrinol 2021; 63:100945. [PMID: 34461155 PMCID: PMC8605997 DOI: 10.1016/j.yfrne.2021.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/28/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
While cannabis has been used for centuries for its stress-alleviating properties, the effects of acute and chronic cannabinoid exposure on responses to stress remain poorly understood. This review provides an overview of studies that measured stress-related endpoints following acute or chronic cannabinoid exposure in humans and animals. Acute cannabinoid exposure increases basal concentrations of stress hormones in rodents and humans and has dose-dependent effects on stress reactivity in humans and anxiety-like behavior in rodents. Chronic cannabis exposure is associated with dampened stress reactivity, a blunted cortisol awakening response (CAR), and flattened diurnal cortisol slope in humans. Sex differences in these effects remain underexamined, with limited evidence for sex differences in effects of cannabinoids on stress reactivity in rodents. Future research is needed to better understand sex differences in the effects of cannabis on the stress response, as well as downstream impacts on mental health and stress-related disorders.
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Affiliation(s)
| | - Carrie Cuttler
- Department of Psychology, Washington State University, Pullman, WA, USA.
| | - Ryan J McLaughlin
- Department of Psychology, Washington State University, Pullman, WA, USA; Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, WA, USA
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11
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Ha J, Park W, Park SI, Im CH, Kim L. EEG response to game-craving according to personal preference for games. Soc Cogn Affect Neurosci 2021; 16:995-1005. [PMID: 33064824 PMCID: PMC8421702 DOI: 10.1093/scan/nsaa131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/19/2020] [Accepted: 10/12/2020] [Indexed: 12/22/2022] Open
Abstract
Recently, the World Health Organization included ‘gaming disorder’ in its latest revision of the international classification of diseases (ICD-11). Despite extensive research on internet gaming disorder (IGD), few studies have addressed game-related stimuli eliciting craving, which plays an important role in addiction. Particularly, most previous studies did not consider personal preferences in games presented to subjects as stimuli. In this study, we compared neurophysiological responses elicited for favorite game (FG) videos and non-favorite game (NFG) videos. We aimed to demonstrate neurophysiological characteristics according to the game preference in the IGD group. We measured participants’ electroencephalogram (EEG) while they watched FG, NFG and neutral videos. For FG videos, the parieto-occipital theta power (TPPO) were significantly increased compared with those for NFG videos (P < 0.05, paired t-test). TPPO also differed significantly between the healthy control and IGD groups only on FG videos controlling covariate (TPPO on neutral videos) (P < 0.05, analysis of covariance [ANCOVA]). And TPPO was significantly correlated to self-reported craving score only on FG videos (r = 0.334, P < 0.05). In the present study, we demonstrate that FG videos induce higher TPPO than that induced by NFG videos in the IGD group and TPPO is a reliable EEG feature associated with craving for gaming.
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Affiliation(s)
- Jihyeon Ha
- Center for Bionics, Korea Institute of Science and Technology, Seoul, 02792, Korea.,Department of Biomedical Engineering, Hanyang University, Seoul, 04763, Korea
| | - Wanjoo Park
- Engineering Division, New York University Abu Dhabi, Saadiyat Island, Abu Dhabi, 129188, United Arab Emirates
| | - Sang In Park
- Center for Bionics, Korea Institute of Science and Technology, Seoul, 02792, Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University, Seoul, 04763, Korea
| | - Laehyun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, 02792, Korea
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12
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Saraiya TC, Jarnecke AM, Jones J, Brown DG, Brady KT, Back SE. Laboratory-induced stress and craving predict opioid use during follow-up among individuals with prescription opioid use disorder. Drug Alcohol Depend 2021; 225:108755. [PMID: 34052686 PMCID: PMC8282754 DOI: 10.1016/j.drugalcdep.2021.108755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/24/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) remains a public health crisis in the USA. Although stress and craving are common precipitants of substance use, no research to date has investigated the impact of laboratory-induced stress and craving on subsequent opioid use. METHOD Participants (N = 31) were individuals with prescription OUD who completed a human laboratory study followed by a one-month follow-up visit. Participants were randomly assigned to either a stress task (i.e., Trier Social Tress Task; TSST) or a no-stress condition, and then all participants completed an opioid cue paradigm. Measures of subjective (e.g., stress, craving), and neuroendocrine (e.g., cortisol, dehydroepiandrosterone) reactivity were assessed before and after each task. Survival and regression models tested the association between reactivity to the laboratory tasks and a) time to first opioid use and b) amount of opioid use during follow-up. RESULTS On average, participants first used opioids 3.65 (SD = 2.08) days following the study. Craving after the opioid cue paradigm (B = 0.44, Exp(B) = 1.55, 95 % CI [1.06, 2.28], p = .02) and after the TSST/no-stress condition plus opioid cue paradigm (B = 1.06, Exp(B) = 2.88, 95 % CI [1.70, 4.85], p < .001) predicted time to first use. Additionally, there was a significant interaction between randomization to the TSST, stress reactivity, and amount of opioids used. CONCLUSIONS Findings demonstrate that elevated cue-induced craving, either in the context of a stressor or not, is associated with shortened time to opioid use, whereas stress reactivity impacts the amount of opioids consumed. Preliminary findings add to the literature on stress, craving and opioid use and implicate treatment.
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Affiliation(s)
- Tanya C Saraiya
- Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States.
| | - Amber M Jarnecke
- Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States.
| | - Jennifer Jones
- Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States.
| | - Delisa G Brown
- Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathleen T Brady
- Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States.
| | - Sudie E Back
- Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson VA Medical Center, Charleston, SC, United States.
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13
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al'Absi M, Allen AM. Impact of Acute and Chronic Cannabis Use on Stress Response Regulation: Challenging the Belief That Cannabis Is an Effective Method for Coping. Front Psychol 2021; 12:687106. [PMID: 34276511 PMCID: PMC8283823 DOI: 10.3389/fpsyg.2021.687106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Although research has only recently started to examine the impact of cannabis use on stress response, there is some evidence that indicates acute and chronic impacts of cannabis on these processes. In this paper, we review processes involved in regulating the stress response and we review the influence of acute and chronic exposure to cannabis on patterns and regulation of the stress response. We also highlight the role of stress as a risk factor for initiation and maintenance of cannabis use. In this context, we examine moderating variables, including sex and life adversity. In light of recent observations indicating increasing prevalence of cannabis use during pregnancy, we provide additional focus on cannabis use in this vulnerable population, including how acute and chronic stress may predispose some individuals to use cannabis during pregnancy. While this line of research is in its infancy, we review available articles that focus on the perinatal period and that examined the association between cannabis use and various life stressors, including partner violence, job loss, and lack of housing. We also review psychiatric co-morbidities (e.g., post-traumatic stress disorder, anxiety). A better understanding of the way stress and cannabis use relate within the general population, as well as within certain subgroups that may be at a greater risk of using and/or at greater risk for adverse outcomes of use, may lead to the development of novel prevention and intervention approaches.
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Affiliation(s)
- Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, United States
| | - Alicia M Allen
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, United States
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14
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Abstract
BACKGROUND Aspects of the canonical stress response differ in stimulant, opioid, and alcohol users relative to controls, and dysregulated responses to stress may contribute to continued use of these drugs. Little prior research has focused on stress responses in regular cannabis smokers. We assessed responses to a standardized laboratory social stress assay (the Trier Social Stress Task; TSST) in regular cannabis smokers (CANs) compared with controls (CONs). METHODS Healthy, non-treatment-seeking adult CANs (⩾4×/week; smoking cannabis as usual) and demographically matched CONs completed the TSST. Outcome measures were subjective mood, heart rate, and salivary cortisol. RESULTS Nineteen CANs (1 female) and 20 CONs (2 female) participated; groups were matched on trauma exposure, sex, race, and age. CANs smoked cannabis 6.4 ± 1.1 days/week. Eight CANs and one CON smoked tobacco cigarettes daily. Overall, the TSST produced expected increases in anxiety, negative mood states, cortisol, and heart rate. CANs had blunted subjective response to stress relative to CONs, but they did not differ in physiological (cortisol and cardiovascular) stress responding. CONCLUSION These results indicate that CANs have blunted mood responses to social stress, but normative physiological stress responding. Observed differences could be due to residual effects of cannabis, reluctance to endorse negative mood states, or to issues related to identifying (i.e., emotional identification) or feeling (i.e., interoception) stress-related affective states. Further research is warranted to characterize the mechanisms of these differences and assess implications for daily functioning and treatment outcomes.
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Affiliation(s)
- Richard J Xia
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northshore University Hospital/Long Island Jewish Medical Center, New York
| | - Thomas Chao
- Department of Psychology, The New School for Social Research, New York
| | - Divya Patel
- Department of Medicine, New York University School of Medicine, New York
| | - Gillinder Bedi
- New York State Psychiatric Institute, New York,Centre for Youth Mental Health, University of Melbourne, and Orygen Melbourne, Australia
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15
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Borodovsky JT, Sofis MJ, Grucza RA, Budney AJ. The importance of psychology for shaping legal cannabis regulation. Exp Clin Psychopharmacol 2021; 29:99-115. [PMID: 32437193 PMCID: PMC7679279 DOI: 10.1037/pha0000362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Different patterns of cannabis use can be traced directly back to different interactions between 2 types of variables: pharmacological and environmental. As legal cannabis expands in the U.S. and around the world, state and national regulatory agencies are gaining control over these variables. Specifically, regulatory agencies are increasingly capable of altering (a) the pharmacological properties of cannabis products and (b) the way these products are distributed to the population. Consequently, cannabis regulatory agencies are in a unique position to use evidence from psychological science to alter cannabis consumption patterns in ways that mitigate potential harm to public health. However, most state-level legal cannabis regulatory systems in the U.S. are not yet evidence-based or public health-oriented. This applied review and commentary draws on evidence from the psychological science literature to help regulators better understand the types of behaviors they must address and guide empirically supported regulation of THC-laden cannabis, whether used putatively for medical or recreational reasons. This review is organized into 3 parts that correspond to the 3 primary agents within the cannabis regulation ecosystem: (a) the cannabis consumer, (b) the cannabis industry, and (c) the cannabis regulatory agency. Within this structure, the review addresses critical psychological variables that drive cannabis consumer and industry behaviors and discusses how regulatory agencies can use this information to protect public health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jacob T Borodovsky
- Department of Psychiatry, Washington University School of Medicine in St. Louis
| | - Michael J Sofis
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine in St. Louis
| | - Alan J Budney
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine
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16
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Macatee RJ, Carr M, Afshar K, Preston TJ. Development and validation of a cannabis cue stimulus set. Addict Behav 2021; 112:106643. [PMID: 32977269 DOI: 10.1016/j.addbeh.2020.106643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/26/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Abstract
Regular cannabis use and cannabis use disorder (CUD) have become increasingly prevalent in the United States over the past two decades. Theory and empirical data suggest that the incentive salience of cannabis cues is important to the development and chronicity of CUD. Cannabis cue incentive salience is often assessed with a cannabis cue reactivity paradigm wherein cannabis-related and neutral images are presented. However, prior cannabis cue reactivity studies have been limited by the use of heterogeneous stimuli that were not properly characterized across motivational/affective characteristics, physical image attributes, or non-cannabis-related salient image features (e.g., human presence, face visibility). In order to increase standardization and flexibility of future cannabis cue reactivity tasks, the aim of the present study was to develop and validate a cannabis cue and matched neutral image database comprised of motivational/affective ratings as well as physical image attributes. 234 regular cannabis users varying in primary use method (i.e., bowl, blunt/joint, bong, vaporizer) made motivational (i.e., urge to smoke cannabis) and affective (i.e., arousal, valence) ratings of cannabis-related and neutral images matched on salient, non-cannabis-related features. Physical features (hue, saturation, value) of each image were also analyzed. Motivational/affective ratings of cannabis-related and neutral images differed as expected, and cannabis use frequency and cannabis craving correlations with cannabis image ratings generally supported stimulus validity. Motivational/affective ratings did not significantly differ across cannabis use method-specific images. This database may be a useful tool for future behavioral and neuroscience research on cannabis cue reactivity.
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17
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Renaud F, Jakubiec L, Swendsen J, Fatseas M. The Impact of Co-occurring Post-traumatic Stress Disorder and Substance Use Disorders on Craving: A Systematic Review of the Literature. Front Psychiatry 2021; 12:786664. [PMID: 34970169 PMCID: PMC8712572 DOI: 10.3389/fpsyt.2021.786664] [Citation(s) in RCA: 4] [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: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
The frequent co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) leads to manifestations of both conditions that are more severe and more resistance to treatment than single disorders. One hypothesis to explain this synergy is the impact of intrusive memories on craving which, in turn, increases the risk of relapse among patients with substance use disorders. The aim of this systematic review is to examine this possibility by assessing the impact of PTSD and its symptoms on craving among dual disorder patients. Using PRISMA criteria, four databases were comprehensively searched up to June, 2021, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined the impact of PTSD or PTSD symptoms on craving, and if they used standardized assessments of PTSD, SUD, and craving. Twenty-seven articles matched the selection criteria and were included in this review. PTSD was found to be significantly associated with increased craving levels among patients with alcohol, cannabis, cocaine, tobacco, and other substance use disorders. Exposition to traumatic cues among dual disorder patients was also shown to trigger craving, with an additive effect on craving intensity when exposure to substance-related cues occurred. In addition, certain studies observed a correlation between PTSD symptom severity and craving intensity. Concerning mechanisms underlying these associations, some findings suggest that negative emotional states or emotion dysregulation may play a role in eliciting craving after traumatic exposure. Moreover, these studies suggest that PTSD symptoms may, independently of emotions, act as powerful cues that trigger craving. These findings argue for the need of dual disorder treatment programs that integrate PTSD-focused approaches and emotion regulation strategies, in addition to more traditional interventions for craving management.
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Affiliation(s)
- Fabien Renaud
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Louise Jakubiec
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France.,University of Bordeaux/CNRS-UMR 5287, Bordeaux, France
| | - Joel Swendsen
- University of Bordeaux/CNRS-UMR 5287, Bordeaux, France.,EPHE, PSL Research University, Paris, France
| | - Melina Fatseas
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France.,University of Bordeaux/CNRS-UMR 5287, Bordeaux, France
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18
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Macatee RJ, Albanese BJ, Okey SA, Afshar K, Carr M, Rosenthal MZ, Schmidt NB, Cougle JR. Impact of a computerized intervention for high distress intolerance on cannabis use outcomes: A randomized controlled trial. J Subst Abuse Treat 2020; 121:108194. [PMID: 33357604 DOI: 10.1016/j.jsat.2020.108194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/02/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prevalence of regular cannabis use and cannabis use disorder (CUD) have increased in the past two decades, but treatment-seeking is low and extant brief interventions do not target causal risk factors implicated in etiological models of addiction. Elevated distress intolerance (DI) is one risk factor that has been empirically linked with greater CUD severity and maintenance in regular users, but, to our knowledge, research has never targeted it in a brief intervention among cannabis users with CUD or at high risk. The current RCT evaluated the impact of a DI intervention (i.e., Distress Tolerance Intervention [DTI]) compared to a healthy habits control intervention (i.e., Healthy Video Control [HVC]) on DI and cannabis use outcomes. METHOD We randomized cannabis users with high DI (N = 60) to the DTI or HVC condition and they received two computerized intervention sessions. We assessed relief cannabis craving at pre- and post-treatment; and we assessed DI, cannabis use coping motives, use-related problems, and use frequency at pre- and post-treatment as well as one- and four-month follow-ups. We assessed CUD symptoms via interviews at pre-treatment and four-month follow-up. RESULTS Significant, durable reductions in DI and all cannabis use outcomes occurred in both conditions. Compared to the HVC condition, the DTI led to greater reductions in use frequency during the treatment period. Reductions in self-reported DI were correlated with reductions in coping motives and CUD symptoms. CONCLUSION The DTI's impact on all outcomes was largely comparable to the control condition, though it may have utility as an adjunctive intervention.
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Affiliation(s)
| | | | - Sarah A Okey
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Kaveh Afshar
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Meghan Carr
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - M Zachary Rosenthal
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Norman B Schmidt
- 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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Sherman BJ, Baker NL, Brady KT, Joseph JE, Nunn LM, McRae-Clark A. The effect of oxytocin, gender, and ovarian hormones on stress reactivity in individuals with cocaine use disorder. Psychopharmacology (Berl) 2020; 237:2031-2042. [PMID: 32388622 PMCID: PMC8210538 DOI: 10.1007/s00213-020-05516-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/01/2020] [Indexed: 12/22/2022]
Abstract
RATIONALE Cocaine use disorder (CUD) is associated with dysregulation of the hypothalamic-pituitary-adrenal axis, which plays a critical role in the human stress response. Men and women with CUD differ in reactivity to social stressors. The hypothalamic neuropeptide oxytocin is involved in anxiolytic and natural reward processes, and has shown therapeutic potential for addictive disorders and stress reduction. OBJECTIVES To examine the impact of oxytocin (oxytocin (OXY) vs. placebo (PBO)) and gender (female (F) vs. male (M)) on response to a social stress task in individuals with CUD. To explore whether ovarian hormones moderate this stress response. METHODS One hundred twelve adults with CUD were randomized to receive 40 IU intranasal oxytocin (n = 56) or matching placebo (n = 56). Forty minutes after drug administration, participants were exposed to a social stressor. Generalized linear mixed models were used to examine neuroendocrine (cortisol) and subjective (craving, stress) response at pre-stressor, stressor + 0, + 10, + 30, + 60 min. RESULTS Gender moderated the effect of oxytocin on neuroendocrine response (p = 0.048); women receiving oxytocin (F + OXY) showed blunted cortisol response compared to the other three groups (F + PBO; M + OXY; M + PBO). There was a main effect of gender on subjective stress response; women reported greater stress following the stressor compared to men (p = 0.016). Oxytocin had no significant effect on craving or stress, and gender did not moderate the effect of oxytocin on either measure. Higher endogenous progesterone was associated with lower craving response in women (p = 0.033). CONCLUSIONS Oxytocin may have differential effects in men and women with CUD. Women may be at greater risk for relapse in response to social stressors, but ovarian hormones may attenuate this effect.
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Affiliation(s)
- Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC, 29425, USA.
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC, 29425, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, USA
| | - Lisa M Nunn
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC, 29425, USA
| | - Aimee McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC, 29425, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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20
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Sex-related differences in subjective, but not neural, cue-elicited craving response in heavy cannabis users. Drug Alcohol Depend 2020; 209:107931. [PMID: 32113057 PMCID: PMC8173440 DOI: 10.1016/j.drugalcdep.2020.107931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/27/2020] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Studies indicate that female cannabis users progress through the milestones of cannabis use disorder (CUD) more quickly than male users, likely due to greater subjective craving response in women relative to men. While studies have reported sex-related differences in subjective craving, differences in neural response and the relative contributions of neural and behavioral response remain unclear. METHODS We examined sex-related differences in neural and behavioral response to cannabis cues and cannabis use measures in 112 heavy cannabis users (54 females). We used principal component analysis to determine the relative contributions of neural and behavioral response and cannabis use measures. RESULTS We found that principal component (PC) 1, which accounts for the most variance in the dataset, was correlated with neural response to cannabis cues with no differences between male and female users (p = 0.21). PC2, which accounts for the second-most variance, was correlated with subjective craving such that female users exhibited greater subjective craving relative to male users (p = 0.003). We also found that CUD symptoms correlated with both PC1 and PC2, corroborating the relationship between craving and CUD severity. CONCLUSIONS These results indicate that neural activity primarily underlies response to cannabis cues and that a complex relationship characterizes a convergent neural response and a divergent subjective craving response that differs between the sexes. Accounting for these differences will increase efficacy of treatments through personalized approaches.
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Zhao W, Zimmermann K, Zhou X, Zhou F, Fu M, Dernbach C, Scheele D, Weber B, Eckstein M, Hurlemann R, Kendrick KM, Becker B. Impaired cognitive performance under psychosocial stress in cannabis-dependent men is associated with attenuated precuneus activity. J Psychiatry Neurosci 2020; 45:88-97. [PMID: 31509368 PMCID: PMC7828906 DOI: 10.1503/jpn.190039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Deficient regulation of stress plays an important role in the escalation of substance use, addiction and relapse. Accumulating evidence suggests dysregulations in cognitive and reward-related processes and the underlying neural circuitry in cannabis dependence. However, despite the important regulatory role of the endocannabinoid system in the stress response, associations between chronic cannabis use and altered stress processing at the neural level have not been systematically examined. METHODS Against this background, the present functional MRI study examined psychosocial stress processing in cannabis-dependent men (n = 28) and matched controls (n = 23) using an established stress-induction paradigm (Montreal Imaging Stress Task) that combines computerized (adaptive) mental arithmetic challenges with social evaluative threat. RESULTS During psychosocial stress exposure, but not the no-stress condition, cannabis users demonstrated impaired performance relative to controls. In contrast, levels of experienced stress and cardiovascular stress responsivity did not differ from controls. Functional MRI data revealed that stress-induced performance deteriorations in cannabis users was accompanied by decreased precuneus activity and increased connectivity of this region with the superior frontal gyrus. LIMITATIONS Only male cannabis-dependent users were examined; the generalizability in female users remains to be determined. CONCLUSION Together, the present findings provide first evidence for exaggerated stress-induced cognitive performance deteriorations in cannabis users. The neural data suggest that deficient stress-related recruitment of the precuneus may be associated with the deterioration of performance at the behavioural level.
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Affiliation(s)
- Weihua Zhao
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Kaeli Zimmermann
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Xinqi Zhou
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Feng Zhou
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Meina Fu
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Christian Dernbach
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Dirk Scheele
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Bernd Weber
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Monika Eckstein
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - René Hurlemann
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Keith M. Kendrick
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
| | - Benjamin Becker
- From the Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China (Zhao, Zhou, Zhou, Fu, Kendrick, Becker); the Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany (Zimmermann, Dernbach, Scheele, Hurlemann); the Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany (Weber); the Department of NeuroCognition, Life and Brain Center, Bonn, Germany (Weber); and the Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital, Heidelberg University, Heidelberg, Germany (Eckstein)
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22
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Sahlem GL, Caruso MA, Short EB, Fox JB, Sherman BJ, Manett AJ, Malcolm RJ, George MS, McRae-Clark AL. A case series exploring the effect of twenty sessions of repetitive transcranial magnetic stimulation (rTMS) on cannabis use and craving. Brain Stimul 2020; 13:265-266. [PMID: 31619347 PMCID: PMC7263465 DOI: 10.1016/j.brs.2019.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Margaret A Caruso
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - E Baron Short
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - James B Fox
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew J Manett
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robert J Malcolm
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
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23
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Tomaselli G, Vallée M. Stress and drug abuse-related disorders: The promising therapeutic value of neurosteroids focus on pregnenolone-progesterone-allopregnanolone pathway. Front Neuroendocrinol 2019; 55:100789. [PMID: 31525393 DOI: 10.1016/j.yfrne.2019.100789] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023]
Abstract
The pregnenolone-progesterone-allopregnanolone pathway is receiving increasing attention in research on the role of neurosteroids in pathophysiology, particularly in stress-related and drug use disorders. These disorders involve an allostatic change that may result from deficiencies in allostasis or adaptive responses, and may be downregulated by adjustments in neurotransmission by neurosteroids. The following is an overview of findings that assess how pregnenolone and/or allopregnanolone concentrations are altered in animal models of stress and after consumption of alcohol or cannabis-type drugs, as well as in patients with depression, anxiety, post-traumatic stress disorder or psychosis and/or in those diagnosed with alcohol or cannabis use disorders. Preclinical and clinical evidence shows that pregnenolone and allopregnanolone, operating according to a different or common pharmacological profile involving GABAergic and/or endocannabinoid system, may be relevant biomarkers of psychiatric disorders for therapeutic purposes. Hence, ongoing clinical trials implicate synthetic analogs of pregnenolone or allopregnanolone, and also modulators of neurosteroidogenesis.
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Affiliation(s)
- Giovanni Tomaselli
- INSERM U1215, Neurocentre Magendie, Group "Physiopathology and Therapeutic Approaches of Stress-Related Disease", 146 Rue Léo Saignat, 33000 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - Monique Vallée
- INSERM U1215, Neurocentre Magendie, Group "Physiopathology and Therapeutic Approaches of Stress-Related Disease", 146 Rue Léo Saignat, 33000 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France.
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24
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Miranda R, Wemm SE, Treloar Padovano H, Carpenter RW, Emery NN, Gray JC, Mereish EH. Weaker Memory Performance Exacerbates Stress-Induced Cannabis Craving in Youths' Daily Lives. Clin Psychol Sci 2019; 7:1094-1108. [PMID: 31737439 DOI: 10.1177/2167702619841976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Theories of addiction posit that stimuli associated with drug use, including both exteroceptive (e.g., paraphernalia) and interoceptive (e.g., feeling tense or "stressed"), evoke craving and contribute to the pathogenesis of substance misuse. Control over drug cue response and stress is essential for moderating use. Building from laboratory data supporting associations between cue exposure, stress, and craving, this study tested whether these associations generalize to real-world settings and examined whether a well-vetted neurocognitive control capacity, i.e., working memory (WM), moderated associations. Youth (N = 85; 15-24 years) completed baseline and ecological momentary assessments. Cue exposure and participants' average stress predicted higher craving. Youth with weaker WM experienced stronger craving at higher-stress moments but not when faced with cues. Interactions were present for both previous-moment and same-moment stress. Craving among adolescents with stronger WM was not swayed by momentary stress. Findings suggest stronger WM protects against craving at more stressful moments.
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Affiliation(s)
- Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
| | | | | | | | - Noah N Emery
- Center for Alcohol and Addiction Studies, Brown University
| | - Joshua C Gray
- Department of Medical and Clinical Psychology, Uniformed Services University
| | - Ethan H Mereish
- Center for Alcohol and Addiction Studies, Brown University; Department of Health Studies, American University
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25
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Machine-Learning-Based Detection of Craving for Gaming Using Multimodal Physiological Signals: Validation of Test-Retest Reliability for Practical Use. SENSORS 2019; 19:s19163475. [PMID: 31395802 PMCID: PMC6719101 DOI: 10.3390/s19163475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 01/08/2023]
Abstract
Internet gaming disorder in adolescents and young adults has become an increasing public concern because of its high prevalence rate and potential risk of alteration of brain functions and organizations. Cue exposure therapy is designed for reducing or maintaining craving, a core factor of relapse of addiction, and is extensively employed in addiction treatment. In a previous study, we proposed a machine-learning-based method to detect craving for gaming using multimodal physiological signals including photoplethysmogram, galvanic skin response, and electrooculogram. Our previous study demonstrated that a craving for gaming could be detected with a fairly high accuracy; however, as the feature vectors for the machine-learning-based detection of the craving of a user were selected based on the physiological data of the user that were recorded on the same day, the effectiveness of the reuse of the machine learning model constructed during the previous experiments, without any further calibration sessions, was still questionable. This “high test-retest reliability” characteristic is of importance for the practical use of the craving detection system because the system needs to be repeatedly applied to the treatment processes as a tool to monitor the efficacy of the treatment. We presented short video clips of three addictive games to nine participants, during which various physiological signals were recorded. This experiment was repeated with different video clips on three different days. Initially, we investigated the test-retest reliability of 14 features used in a craving detection system by computing the intraclass correlation coefficient. Then, we classified whether each participant experienced a craving for gaming in the third experiment using various classifiers—the support vector machine, k-nearest neighbors (kNN), centroid displacement-based kNN, linear discriminant analysis, and random forest—trained with the physiological signals recorded during the first or second experiment. Consequently, the craving/non-craving states in the third experiment were classified with an accuracy that was comparable to that achieved using the data of the same day; thus, demonstrating a high test-retest reliability and the practicality of our craving detection method. In addition, the classification performance was further enhanced by using both datasets of the first and second experiments to train the classifiers, suggesting that an individually customized game craving detection system with high accuracy can be implemented by accumulating datasets recorded on different days under different experimental conditions.
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26
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Macatee RJ, Okey SA, Albanese BJ, Schmidt NB, Cougle JR. Distress intolerance moderation of motivated attention to cannabis and negative stimuli after induced stress among cannabis users: an ERP study. Addict Biol 2019; 24:717-729. [PMID: 29737034 DOI: 10.1111/adb.12622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/02/2018] [Accepted: 02/24/2018] [Indexed: 12/30/2022]
Abstract
Prevalence of cannabis use is increasing, but many regular users do not develop cannabis use disorder (CUD); thus, CUD risk identification among current users is vital for targeted intervention development. Existing data suggest that high distress intolerance (DI), an individual difference reflective of the ability to tolerate negative affect, may be linked to CUD, but no studies have tested possible neurophysiological mechanisms. Increased motivated attentional processing of cannabis and negative emotional stimuli as indexed by neurophysiology [i.e. the late positive potential (LPP)], particularly during acute stress, may contribute to CUD among high DI users. Frequent cannabis users with high (n = 61) and low DI (n = 44) viewed cannabis, negative, and matched neutral images during electroencephalography (EEG) recording before and after a laboratory stressor. Cannabis cue-elicited modulation of the 1000- to 3000-milliseconds LPP was larger in high DI users at post-stressor only, although the effect was only robust in the 1000- to 2000-milliseconds window. Further, modulation magnitude in the high DI group covaried with stress-relief craving and some CUD indices in the 400- to 1000-milliseconds and 1000- to 3000-milliseconds windows, respectively. No significant effects of DI on negative stimuli-elicited LPP modulation were found, although inverse associations with some CUD indices were observed. Finally, exploratory analyses revealed some evidence for DI moderation of the relation between subjective stressor reactivity and negative stimuli-elicited LPP modulation such that greater stressor reactivity was associated with blunted versus enhanced modulation in the high and low DI groups, respectively. Negative and cannabis stimuli-elicited LPP modulation appear to index distinct, CUD-relevant neural processes in high DI cannabis users.
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Affiliation(s)
| | - Sarah A. Okey
- Department of PsychologyArizona State University Tempe AZ USA
| | | | | | - Jesse R. Cougle
- Department of PsychologyFlorida State University Tallahassee FL USA
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27
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Strickland JC, Lile JA, Stoops WW. Contribution of cannabis-related cues to concurrent reinforcer choice in humans. Drug Alcohol Depend 2019; 199:85-91. [PMID: 31029879 PMCID: PMC6615729 DOI: 10.1016/j.drugalcdep.2019.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/22/2019] [Accepted: 02/09/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Drug-related cues play a critical role in the development and persistence of substance use disorder. Few human laboratory studies have evaluated how these cues contribute to decisions between concurrently presented reinforcers, and none have examined the specific role of cannabis cues. This study evaluated the contribution of cannabis-related cues to concurrent monetary reinforcer choice in humans. METHODS Participants with a cannabis use history (i.e., use in the past two weeks and 50 or more lifetime uses; n = 71) and controls without this history (i.e., 5 or less lifetime uses; n = 79) were recruited using Amazon Mechanical Turk. A cued concurrent choice task was used in which cannabis trials presented two cues (one cannabis and one neutral) side-by-side followed by concurrent monetary offers below each image. The primary dependent measure was choice for cannabis-cued monetary reinforcers on equal value trials. Secondary analyses evaluated individual difference variables related to choice bias. RESULTS Participants in the cannabis group showed a significant bias for cannabis-cued choices (mean 76.0%) whereas participants in the control group showed a significant bias against cannabis-cued choices (mean 30.3%). Reaction times on cannabis trials were faster than neutral filler trials and did not differ by group. Cannabis-cued choice was significantly associated with more frequent cannabis use (r = .44), higher cannabis demand intensity (r = .28), and lower cannabis elasticity (r = -.30). CONCLUSIONS These findings suggest that cannabis-related cues can influence reinforcer choice and potentially promote disadvantageous decision-making related to non-drug reinforcers.
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Affiliation(s)
- Justin C Strickland
- Department of Psychology, University of Kentucky College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY, 40506, USA.
| | - Joshua A Lile
- Department of Psychology, University of Kentucky College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY, 40506, USA; Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Drive, Medical Behavioral Science Building Room 140, Lexington, KY, 40536, USA; Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY, 40509, USA
| | - William W Stoops
- Department of Psychology, University of Kentucky College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY, 40506, USA; Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Drive, Medical Behavioral Science Building Room 140, Lexington, KY, 40536, USA; Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY, 40509, USA; Center on Drug and Alcohol Research, University of Kentucky College of Medicine, 845 Angliana Ave, Lexington, KY, 40508, USA
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28
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Goodyear K. Multisensory Environments to Measure Craving During Functional Magnetic Resonance Imaging. Alcohol Alcohol 2019; 54:193-195. [PMID: 30920596 DOI: 10.1093/alcalc/agz021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 11/14/2022] Open
Abstract
There are limited functional magnetic resonance imaging (fMRI) studies that measure alcohol craving with multisensory environments. Researchers are faced with a two-fold challenge: to recreate a naturalistic environment during an MRI scan and to produce paradigms that mimic real-life conditions involved with craving. Craving is a multifaceted psychological construct and techniques such as fMRI provide an alternative way to measure craving and to have a better understanding of its complexity. Most studies to date have implemented visual stimuli to measure craving and only a few studies have investigated gustation and olfaction. Moving forward, there needs to be greater attention on the ways in which we measure craving and the use of multisensory environments during fMRI. By going beyond examining subjective craving responses, and investigating neurobiological responses such as brain activity during fMRI, can potentially lead to better treatments for alcohol use disorder. Further, there needs to be additional consideration on standardizing how we measure craving, which will allow for a more unified approach amongst researchers.
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Affiliation(s)
- Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Science, Brown University, Providence, RI, USA.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism; and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
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29
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Karoly HC, Schacht JP, Meredith LR, Jacobus J, Tapert SF, Gray KM, Squeglia LM. Investigating a novel fMRI cannabis cue reactivity task in youth. Addict Behav 2019; 89:20-28. [PMID: 30243035 DOI: 10.1016/j.addbeh.2018.09.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/24/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Adult and adolescent studies suggest increased motivational responses to cannabis cues among regular cannabis users. However, functional magnetic resonance imaging (fMRI) studies have not explored neural activation in response to visual cannabis cues among adolescents in the United States. Gaining a better understanding of the neural circuits related to cue-elicited craving during adolescence may shed light on the neural basis for the development of problematic cannabis use that could ultimately be targeted for interventions. METHODS 41 non-treatment-seeking youth (ages 17-21; mean age = 18.83; 46.3% female) who reported regular cannabis use underwent fMRI scanning involving a visual cannabis cue task and completed self-report and biological measures. Whole-brain activation was examined for cannabis cues compared to non-cannabis cues, and for active versus passive cannabis cues. Associations between self-reported substance use and task activation were examined. RESULTS Cannabis images were identifiable to adolescents and were rated as more rewarding than matched non-cannabis images (p < .05). Greater activation was found for the cannabis cues compared to non-cannabis cues in bilateral posterior cingulate, cuneus, fusiform, precuneus, inferior temporal and parahippocampal gyri, as well as left thalamus, medial frontal and superior frontal gyri. Cue-elicited activation was not significantly associated with self-reported cannabis use (ps > 0.05). No differences were observed for the active versus passive cue contrast. CONCLUSIONS Cannabis-using youth show more activation to cannabis cues than non-cannabis cues in brain regions underlying incentive salience, reward, and visual attention. This task could be useful for future studies examining neural underpinnings of reward processes in adolescent cannabis users.
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Wemm SE, Sinha R. Drug-induced stress responses and addiction risk and relapse. Neurobiol Stress 2019; 10:100148. [PMID: 30937354 PMCID: PMC6430516 DOI: 10.1016/j.ynstr.2019.100148] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/07/2018] [Accepted: 01/30/2019] [Indexed: 12/21/2022] Open
Abstract
A number of studies have assessed the effects of psychoactive drugs on stress biology, the neuroadaptations resulting from chronic drug use on stress biology, and their effects on addiction risk and relapse. This review mainly covers human research on the acute effects of different drugs of abuse (i.e., nicotine, cannabis, psychostimulants, alcohol, and opioids) on the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS) responses. We review the literature on acute peripheral stress responses in naïve or light recreational users and binge/heavy or chronic drug users. We also discuss evidence of alterations in tonic levels, or tolerance, in the latter relative to the former and associated changes in the phasic stress responses. We discuss the impact of the stress system tolerance in heavy users on their response to drug- and stress-related cue responses and craving as compared to control subjects. A summary is provided of the effects of glucocorticoid responses and their adaptations on brain striatal and prefrontal cortices involved in the regulation of drug seeking and relapse risk. Finally, we summarize important considerations, including individual difference factors such as gender, co-occurring drug use, early trauma and adversity and drug use history and variation in methodologies, that may further influence the effects of these drugs on stress biology.
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Affiliation(s)
- Stephanie E. Wemm
- Yale Stress Center, Yale School of Medicine, 2 Church St South Suite 209, New Haven, CT, 06519, USA
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Reed SC, Haney M, Manubay J, Campagna BR, Reed B, Foltin RW, Evans SM. Sex differences in stress reactivity after intranasal oxytocin in recreational cannabis users. Pharmacol Biochem Behav 2018; 176:72-82. [PMID: 30521833 DOI: 10.1016/j.pbb.2018.11.008] [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: 07/17/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
Cannabis is the most widely used illicit drugs and the changing legal, political and cultural climate will likely increase cannabis use further. One factor that may underlie the transition from recreational use to problematic use is stress. The hormone oxytocin (OXT) modulates stress and may have therapeutic efficacy for substance use disorders, but few studies have examined OXT in cannabis users. Another factor is sex; although more men smoke cannabis, the transition from recreational to problematic use is faster in women. Using a within-subjects design, the effects of intranasal (i.n.) oxytocin (OXT; 40 IU) administration on stress reactivity (using the Trier Social Stress Test; TSST) and cannabis (5.6% THC) self-administration was assessed in recreational cannabis using men (n = 31) and women (n = 32) relative to i.n. placebo (PBO) and no-stress (NST) conditions. The TSST produced expected subjective and cardiovascular effects compared to the NST. However, in the i.n. OXT-TSST condition, positive subjective effects were lower and negative subjective effects were higher in women compared to PBO administration and compared to men. Further, latency to self-administer cannabis was longer in women than men and women self-administered less cannabis than men regardless of stress condition. There were no differences in cannabis craving as a function of sex, stress, or medication. These results suggest that OXT administration may lead to greater stress reactivity in recreational cannabis users, particularly women, and support growing evidence that sex differences should be carefully considered when examining the therapeutic potential of OXT.
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Affiliation(s)
- Stephanie C Reed
- New York State Psychiatric Institute, New York, NY, United States of America; Columbia University Medical Center, New York, NY, United States of America.
| | - Margaret Haney
- New York State Psychiatric Institute, New York, NY, United States of America; Columbia University Medical Center, New York, NY, United States of America
| | - Jeanne Manubay
- New York State Psychiatric Institute, New York, NY, United States of America; Columbia University Medical Center, New York, NY, United States of America
| | - Bianca R Campagna
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Brian Reed
- Rockefeller University, New York, NY, United States of America
| | - Richard W Foltin
- New York State Psychiatric Institute, New York, NY, United States of America; Columbia University Medical Center, New York, NY, United States of America
| | - Suzette M Evans
- New York State Psychiatric Institute, New York, NY, United States of America; Columbia University Medical Center, New York, NY, United States of America
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Prashad S, Dedrick ES, To WT, Vanneste S, Filbey FM. Testing the role of the posterior cingulate cortex in processing salient stimuli in cannabis users: an rTMS study. Eur J Neurosci 2018; 50:2357-2369. [PMID: 30290037 PMCID: PMC6767056 DOI: 10.1111/ejn.14194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 11/29/2022]
Abstract
The posterior cingulate cortex (PCC) and precuneus are hubs in the default mode network and play a role in processing external salient stimuli. Accordingly, activation in these regions has been associated with response to salient stimuli using drug cue‐reactivity paradigms in substance using populations. These studies suggest that the PCC and precuneus may underlie deficits in processing salient stimuli that contribute toward the development of substance use disorders. The goal of this study was to directly test this hypothesis using repetitive transcranial magnetic stimulation (rTMS). Using a double‐blind, placebo‐controlled design, we used rTMS to target the PCC and precuneus with a double‐cone coil at 10 Hz (high frequency) and 1 Hz (low frequency) in 10 adult cannabis users and 10 age‐ and sex‐matched non‐using controls. Electroencephalography data were collected before and after rTMS during a modified oddball paradigm with neutral, oddball, self‐relevant, and cannabis‐related stimuli. Cannabis users exhibited increased amplitude in P3 and faster latencies in the P3, N2, and P2 components in response to self‐relevant stimuli compared to controls during baseline that normalized after rTMS. These results suggest that cannabis users exhibited heightened salience to external self‐relevant stimuli that were modulated after rTMS. PCC dysfunction in cannabis users may be related to abnormalities in processing salient stimuli, such those during cue‐reactivity, and provides a potential target for cannabis use disorder intervention.
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Affiliation(s)
- Shikha Prashad
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Elizabeth S Dedrick
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Wing Ting To
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Sven Vanneste
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX, 75235, USA
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Rabinovitz S, Nagar M. The effects of craving on implicit cognitive mechanisms involved in risk behavior: can dialectical behavior therapy in therapeutic communities make a difference? A pilot study. THERAPEUTIC COMMUNITIES 2018. [DOI: 10.1108/tc-12-2017-0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to examine pre- to post-change in two components of implicit cognitive functioning following craving induction – attentional bias (AB) and executive control – of patients in a long-term drug-free residential treatment center that incorporated dialectical behavioral therapy (DBT) with usual therapeutic community (TC) practices.Design/methodology/approachThree groups of alcohol and cannabis dependent female adolescents were compared: pre-treatment (n=12), following four months of treatment (n=11), and following 12 months of treatment (n=7).FindingsThe results indicate significantly lower AB (as measured by visual probe task) and improved response inhibition (as measured by stop signal task) under craving conditions, after 12 months of DBT.Research limitations/implicationsNaturalistic character of the study did not allow the use of repeated measures design, drug using control groups, randomized clinical trial, or performing a longitudinal follow-up. However, the findings show that DBT for drug abusing female adolescents in a long-term residential setting may be an effective intervention to enhance cognitive and executive functions critical to the risk chain involved in relapse and recidivism, supporting the implementation of DBT in TC residential settings.Originality/valueThis is the first research paper that examined effects of DBT+TC on substance dependent female adolescents’ cognitive mechanisms using well-validated behavioral tasks. The research provides some empirical evidence for the improvement in AB and response inhibition under craving conditions following treatment.
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What does the Fos say? Using Fos-based approaches to understand the contribution of stress to substance use disorders. Neurobiol Stress 2018; 9:271-285. [PMID: 30450391 PMCID: PMC6234265 DOI: 10.1016/j.ynstr.2018.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/08/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023] Open
Abstract
Despite extensive research efforts, drug addiction persists as a largely unmet medical need. Perhaps the biggest challenge for treating addiction is the high rate of recidivism. While many factors can promote relapse in abstinent drug users, the contribution of stress is particularly problematic, as stress is uncontrollable and pervasive in the lives of those struggling with addiction. Thus, understanding the neurocircuitry that underlies the influence of stress on drug seeking is critical for guiding treatment. Preclinical research aimed at defining this neurocircuitry has, in part, relied upon the use of experimental approaches that allow visualization of cellular and circuit activity that corresponds to stressor-induced drug seeking in rodent relapse models. Much of what we have learned about the mechanisms that mediate stressor-induced relapse has been informed by studies that have used the expression of the immediate early gene, cfos, or its protein product, Fos, as post-mortem activity markers. In this review we provide an overview of the rodent models used to study stressor-induced relapse and briefly summarize what is known about the underlying neurocircuitry before describing the use of cfos/Fos-based approaches. In addition to reviewing findings obtained using this approach, its advantages and limitations are considered. Moreover, new techniques that leverage the expression profile of cfos to tag and manipulate cells based on their activity patterns are discussed. The intent of the review is to guide the interpretation of old and design of new studies that utilize cfos/Fos-based strategies to study the neurocircuitry that contributes to stress-related drug use.
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Chao T, Radoncic V, Hien D, Bedi G, Haney M. Stress responding in cannabis smokers as a function of trauma exposure, sex, and relapse in the human laboratory. Drug Alcohol Depend 2018; 185:23-32. [PMID: 29413435 PMCID: PMC6090565 DOI: 10.1016/j.drugalcdep.2017.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stress responding is linked to drug use, but little is known about stress responses in cannabis smokers. We investigated acute stress responding in cannabis smokers as a function of trauma exposure and sex, and relationships between stress responses and cannabis relapse. METHODS 125 healthy, non-treatment-seeking daily cannabis smokers (23F, 102 M) completed the Trier Social Stress Task (TSST), a standardized laboratory stressor; subsets also completed a trauma questionnaire (n = 106) and a laboratory cannabis relapse measure (n = 54). Stress responding was assessed with heart rate (HR), salivary cortisol (CORT), and self-rated mood. RESULTS Cannabis smokers reporting at least one trauma exposure had higher CORT and anxiety overall compared to those reporting no trauma. Stress responding did not differ as a function of binary trauma exposure, although total number of exposures correlated positively with CORT and anxiety during stress. Females reported increased nervousness after stress relative to males matched to the females for cannabis and cigarette use. An interactive effect of sex and trauma on HR suggested that females with trauma exposure have increased cardiovascular stress responding relative to those without such exposure, with no differential effect in males. Stress responding did not predict laboratory cannabis relapse. CONCLUSION We report differences in acute stress responding as a function of trauma, sex, and their interaction in a large sample of relatively homogenous cannabis smokers. Further investigation of how trauma impacts stress responding in male and female cannabis smokers, and how this relates to different aspects of cannabis use, is warranted.
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Affiliation(s)
- Thomas Chao
- Department of Psychology, The New School for Social Research, New York, NY, United States; Division on Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Vanya Radoncic
- Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, United States; Division on Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Denise Hien
- Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, United States; Division on Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Gillinder Bedi
- Division on Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Medical Center, New York, NY, United States; Centre for Youth Mental Health, University of Melbourne, and Orygen National Centre of Excellence in Youth Mental Health, Melbourne, Australia.
| | - Margaret Haney
- Division on Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Medical Center, New York, NY, United States.
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Sherman BJ, Baker NL, Squeglia LM, McRae-Clark AL. Approach bias modification for cannabis use disorder: A proof-of-principle study. J Subst Abuse Treat 2018; 87:16-22. [PMID: 29471922 PMCID: PMC5826579 DOI: 10.1016/j.jsat.2018.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND More effective treatments for cannabis use disorder (CUD) are needed. Evidence suggests that biases in cognitive processing of drug-related stimuli are central to the development and maintenance of addiction. The current study examined the feasibility and effect of a novel intervention - approach bias modification (ApBM) - on cannabis approach bias and cue-reactivity. METHODS A randomized, double-blind, sham-controlled proof-of-principle laboratory experiment investigated the effect of a four-session computerized ApBM training protocol on cannabis approach bias and cue-reactivity in non-treatment seeking adults age 18-65 with CUD (N = 33). ApBM procedures involved responding to cannabis or neutral stimuli using a computer joystick to model approach or avoidance behavior. Reactivity to tactile, olfactory, and auditory cue sets was assessed with physiological (blood pressure and heart rate) and subjective (cannabis craving) measures. Cannabis use was assessed via self-report. RESULTS Participants receiving ApBM showed blunted cannabis cue-induced craving at the end of training compared to those in the sham-ApBM condition (p = .05). A preliminary gender effect on cannabis use was also found; men receiving ApBM reported fewer cannabis use sessions per day at the end of training compared to women (p = .02), while there were no differences between men and women in the sham condition. ApBM did not attenuate cannabis approach bias following training. CONCLUSION Preliminary results indicate that ApBM may be efficacious in reducing cannabis cue-reactivity and improving cannabis use outcomes. While encouraging, the results should be interpreted with caution. Investigation of ApBM as an adjunct to psychosocial treatments for treatment-seeking adults with CUD is warranted.
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Affiliation(s)
- Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA.
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC, 29425, USA
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, 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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Preston KL, Kowalczyk WJ, Phillips KA, Jobes ML, Vahabzadeh M, Lin JL, Mezghanni M, Epstein DH. Exacerbated Craving in the Presence of Stress and Drug Cues in Drug-Dependent Patients. Neuropsychopharmacology 2018; 43:859-867. [PMID: 29105663 PMCID: PMC5809798 DOI: 10.1038/npp.2017.275] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/17/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023]
Abstract
In addiction, risk factors for craving and use include stress and drug-related cues. Stress and cues have additive or more-than-additive effects on drug seeking in laboratory animals, but, surprisingly, seem to compete with one another (ie, exert less-than-additive effects) in human laboratory studies of craving. We sought heretofore elusive evidence that human drug users could show additive (or more-than-additive) effects of stress and cues on craving, using ecological momentary assessment (EMA). Outpatients (N=182) maintained on daily buprenorphine or methadone provided self-reports of stress, craving, mood, and behavior on electronic diaries for up to 16 weeks. In three randomly prompted entries (RPs) per day, participants reported the severity of stress and craving and whether they had seen or been offered opioids, cocaine, cannabis, methamphetamine, alcohol, or tobacco. In random-effects models controlling for between-person differences, we tested effects of momentary drug-cue exposure and stress (and their interaction) on momentary ratings of cocaine and heroin craving. For cocaine craving, the Stress × Cue interaction term had a positive mean effect across participants (M=0.019; CL95 0.001-0.036), denoting a more-than-additive effect. For heroin, the mean was not significantly greater than 0, but the confidence interval was predominantly positive (M=0.019; CL95 -0.007-0.044), suggesting at least an additive effect. Heterogeneity was substantial; qualitatively, the Stress × Cue effect appeared additive for most participants, more than additive for a sizeable minority, and competitive in very few. In the field, unlike in human laboratory studies to date, craving for cocaine and heroin is greater with the combination of drug cues and stress than with either alone. For a substantial minority of users, the combined effect may be more than additive.
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Affiliation(s)
- Kenzie L Preston
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA,Clinical Pharmacology and Therapeutics Research Branch, NIDA Intramural Research Program, Treatment Section, 251 Bayview Boulevard Suite 200, Baltimore, MD, USA. Tel: +443.740.2326, Fax: +443.740.2318, E-mail:
| | - William J Kowalczyk
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Karran A Phillips
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Michelle L Jobes
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Massoud Vahabzadeh
- Biomedical Informatics Section, Administrative Management Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Jia-Ling Lin
- Biomedical Informatics Section, Administrative Management Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Mustapha Mezghanni
- Biomedical Informatics Section, Administrative Management Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - David H Epstein
- Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
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Cservenka A, Lahanas S, Dotson-Bossert J. Marijuana Use and Hypothalamic-Pituitary-Adrenal Axis Functioning in Humans. Front Psychiatry 2018; 9:472. [PMID: 30327619 PMCID: PMC6174415 DOI: 10.3389/fpsyt.2018.00472] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/10/2018] [Indexed: 01/30/2023] Open
Abstract
Preclinical studies suggest cannabinoids affect functioning of the hypothalamic-pituitary-adrenal (HPA) axis, but little is known about the effects of marijuana (MJ) use on HPA axis functioning in humans. Since previous work indicates substances of abuse may dysregulate the HPA axis, it is critical to understand how MJ use affects HPA axis activity. Here, we review studies that (a) examined the effects of acute MJ administration on HPA axis functioning, (b) investigated the impact of stress on HPA axis functioning in MJ users, (c) examined the effect of chronic MJ use on basal cortisol levels, and (d) studied the relationship between MJ use and the cortisol awakening response (CAR). Findings indicate acute MJ administration typically raises cortisol levels, but this increase is blunted in MJ-dependent users relative to controls. Frequent MJ users have blunted adrenocorticotropic hormone and cortisol reactivity in response to acute stress. These findings suggest HPA axis activity may be dysregulated by heavy MJ use. Alternatively, dysregulation of the HPA axis may be a risk marker for heavy MJ use. There is mixed evidence for how MJ use affects basal cortisol levels and the CAR. Future studies should consider MJ use characteristics, method of hormone collection, time when samples are collected, and environmental factors that may influence HPA axis activity in MJ users. By examining existing studies we provide one of the first reviews aimed at synthesizing the literature on HPA axis functioning in MJ users.
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Affiliation(s)
- Anita Cservenka
- School of Psychological Science, Oregon State University, Corvallis, OR, United States
| | - Sarah Lahanas
- School of Psychological Science, Oregon State University, Corvallis, OR, United States
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Detection of Craving for Gaming in Adolescents with Internet Gaming Disorder Using Multimodal Biosignals. SENSORS 2018; 18:s18010102. [PMID: 29301261 PMCID: PMC5795403 DOI: 10.3390/s18010102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 02/02/2023]
Abstract
The increase in the number of adolescents with internet gaming disorder (IGD), a type of behavioral addiction is becoming an issue of public concern. Teaching adolescents to suppress their craving for gaming in daily life situations is one of the core strategies for treating IGD. Recent studies have demonstrated that computer-aided treatment methods, such as neurofeedback therapy, are effective in relieving the symptoms of a variety of addictions. When a computer-aided treatment strategy is applied to the treatment of IGD, detecting whether an individual is currently experiencing a craving for gaming is important. We aroused a craving for gaming in 57 adolescents with mild to severe IGD using numerous short video clips showing gameplay videos of three addictive games. At the same time, a variety of biosignals were recorded including photoplethysmogram, galvanic skin response, and electrooculogram measurements. After observing the changes in these biosignals during the craving state, we classified each individual participant's craving/non-craving states using a support vector machine. When video clips edited to arouse a craving for gaming were played, significant decreases in the standard deviation of the heart rate, the number of eye blinks, and saccadic eye movements were observed, along with a significant increase in the mean respiratory rate. Based on these results, we were able to classify whether an individual participant felt a craving for gaming with an average accuracy of 87.04%. This is the first study that has attempted to detect a craving for gaming in an individual with IGD using multimodal biosignal measurements. Moreover, this is the first that showed that an electrooculogram could provide useful biosignal markers for detecting a craving for gaming.
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Alexander AC, Ward KD. Understanding Postdisaster Substance Use and Psychological Distress Using Concepts from the Self-Medication Hypothesis and Social Cognitive Theory. J Psychoactive Drugs 2017; 50:177-186. [PMID: 29125424 DOI: 10.1080/02791072.2017.1397304] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article applies constructs from the Self-Medication Hypothesis and Social Cognitive Theory to explain the development of substance use and psychological distress after a disaster. A conceptual model is proposed, which employs a sequential mediation model, identifying perceived coping self-efficacy, psychological distress, and self-medication as pathways to substance use after a disaster. Disaster exposure decreases perceived coping self-efficacy, which, in turn, increases psychological distress and subsequently increases perceptions of self-medication in vulnerable individuals. These mechanisms lead to an increase in postdisaster substance use. Last, recommendations are offered to encourage disaster researchers to test more complex models in studies on postdisaster psychological distress and substance use.
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Affiliation(s)
- Adam C Alexander
- a Graduate Assistant, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
| | - Kenneth D Ward
- b Professor, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
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Sahlem GL, Baker NL, George MS, Malcolm RJ, McRae-Clark AL. Repetitive transcranial magnetic stimulation (rTMS) administration to heavy cannabis users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:47-55. [PMID: 28806104 PMCID: PMC5962012 DOI: 10.1080/00952990.2017.1355920] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cannabis use disorder (CUD) is a common condition with few treatments. Several studies in other substance use disorders have found that applying repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) decreases cue-elicited craving and possibly decreases use. To date, there have been no studies attempting to use rTMS in CUD. OBJECTIVES This study was conducted to determine if rTMS could be feasibly delivered to a group of non-treatment seeking CUD participants. Secondarily, the study aimed to estimate the effect of rTMS on craving. METHODS In a double-blind, sham-controlled, crossover design, a single session of active or sham rTMS (Left DLPFC, 10 Hz, 110% rMT, 4000 pulses) was delivered during a validated cannabis cue paradigm. Participants crossed over to complete the other condition one week later. The feasibility and tolerability were measured by the rate of retention, and the percentage of participants able to tolerate full dose rTMS, respectively. Craving was measured using the Marijuana Craving Questionnaire (MCQ). RESULTS Eighteen non-treatment seeking CUD participants were recruited from the community; 16 (three women) completed the trial (89% retained for the three study visits). All of the treatment completers tolerated rTMS at full dose without adverse effects. There was not a significant reduction in the total MCQ when participants received active rTMS as compared to sham rTMS. CONCLUSION rTMS can be safely and feasibly delivered to CUD participants, and treatment is well tolerated. A single session of rTMS applied to the DLPFC may not reduce cue-elicited craving in heavy cannabis users.
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Affiliation(s)
- Gregory L. Sahlem
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry, Ralph H. Johnson Veterans Administration Hospital, Charleston, SC, USA
| | - Robert J. Malcolm
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L. McRae-Clark
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
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Havemann-Reinecke U, Hoch E, Preuss UW, Kiefer F, Batra A, Gerlinger G, Hauth I. [On the legalization debate of non-medical cannabis consumption : Position paper of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. DER NERVENARZT 2016; 88:291-298. [PMID: 27981374 DOI: 10.1007/s00115-016-0248-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Calls are increasing for the legalization of cannabis. Some legal experts, various politicians, political parties and associations are demanding a change in drug policy. The legalization debate is lively and receiving wide coverage in the media. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) comments on the most important questions from a medical scientific perspective: can cannabis consumption trigger mental illnesses, what consequences would legalization have for the healthcare system and where is more research needed?
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Affiliation(s)
- U Havemann-Reinecke
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland. .,Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Reinhardtstraße 27 B, 10117, Berlin, Deutschland.
| | - E Hoch
- Abt. Psychotherapie & Psychosomatik, Klinik und Poliklinik für Psychiatrie und Psychotherapie, LMU München, München, Deutschland.,Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Reinhardtstraße 27 B, 10117, Berlin, Deutschland
| | - U W Preuss
- Vitos Klinik für Psychiatrie und Psychotherapie Herborn, Herborn, Deutschland.,Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Reinhardtstraße 27 B, 10117, Berlin, Deutschland
| | - F Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.,Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Reinhardtstraße 27 B, 10117, Berlin, Deutschland
| | - A Batra
- Universitätsklinik für Psychiatrie und Psychotherapie, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland.,Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Reinhardtstraße 27 B, 10117, Berlin, Deutschland
| | - G Gerlinger
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Reinhardtstraße 27 B, 10117, Berlin, Deutschland
| | - I Hauth
- Zentrum für Neurologie, Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph Krankenhaus, Berlin, Deutschland.,Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Reinhardtstraße 27 B, 10117, Berlin, Deutschland
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Norberg MM, Kavanagh DJ, Olivier J, Lyras S. Craving cannabis: a meta-analysis of self-report and psychophysiological cue-reactivity studies. Addiction 2016; 111:1923-1934. [PMID: 27239052 DOI: 10.1111/add.13472] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/16/2016] [Accepted: 05/20/2016] [Indexed: 01/12/2023]
Abstract
AIMS To estimate the magnitude of cannabis cue-reactivity responses in people who regularly use cannabis. METHODS EMBASE, PUBMED, PsycINFO, PsycEXTRA and Project CORK were searched for within-subject comparison studies published between January 2000 and December 2014. Eligible studies compared regular cannabis users' subjective craving or psychophysiological responding when exposed to cannabis cues to their responses to neutral cues and/or to their responses during a baseline assessment. Eligible studies presented original data and were written in English. Fourteen studies met inclusion criteria, but data were not available for two. The 12 included studies contained 393 participants (12-97 participants per study; mean age range: 16.4-32.6 years). Standardized effects sizes were computed for heart rate, skin conductance, skin temperature, blood pressure, event-related potentials (Pz P300) and self-reported craving (Visual Analogue Scales and Marijuana Craving Questionnaire) and synthesized using a multivariate meta-regression model. RESULTS On average, cannabis users experienced moderate cue-reactivity, as determined by comparisons with baseline conditions [d = 0.59, 95% confidence interval (CI) = 0.43, 0.74, P < 0.001] and with neutral cue comparisons (d = 0.47, 95% CI = 0.32, 0.62, P < 0.001). This model, which excluded studies at a greater than low risk of bias and included PzP300 studies as a moderator (due to having larger effect sizes), had a moderately low level of heterogeneity of effect size (I2 = 45.6%, Q = 56.97, P = 0.003) and showed no evidence of publication bias. Cue-reactivity was most noticeable (large effect size) when assessed by Pz P300 waves (d = 1.71, 95% CI = 0.77, 2.64, P = 0.0003; I2 = 86%, Q = 36.30, P < 0.001) and least noticeable (trivial effect size) when examining heart rate (d = 0.14, 95% CI = -0.34, 0.62, P = 0.58; I2 = 80%, Q = 20.0, P < 0.001). These subgroup models demonstrated high heterogeneity of effect size. CONCLUSIONS Regular cannabis users experience moderate to extremely intense cue-reactivity, such that their attentional biases towards cannabis cues are much stronger than their perceptions of craving for the drug.
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Affiliation(s)
- Melissa M Norberg
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.
| | - David J Kavanagh
- Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Jake Olivier
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW, Australia
| | - Stephanie Lyras
- School of Psychology, UNSW Australia, Sydney, NSW, Australia
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Metrik J, Aston ER, Kahler CW, Rohsenow DJ, McGeary JE, Knopik VS, MacKillop J. Cue-elicited increases in incentive salience for marijuana: Craving, demand, and attentional bias. Drug Alcohol Depend 2016; 167:82-8. [PMID: 27515723 PMCID: PMC5037029 DOI: 10.1016/j.drugalcdep.2016.07.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Incentive salience is a multidimensional construct that includes craving, drug value relative to other reinforcers, and implicit motivation such as attentional bias to drug cues. Laboratory cue reactivity (CR) paradigms have been used to evaluate marijuana incentive salience with measures of craving, but not with behavioral economic measures of marijuana demand or implicit attentional processing tasks. METHODS This within-subjects study used a new CR paradigm to examine multiple dimensions of marijuana's incentive salience and to compare CR-induced increases in craving and demand. Frequent marijuana users (N=93, 34% female) underwent exposure to neutral cues then to lit marijuana cigarettes. Craving, marijuana demand via a marijuana purchase task, and heart rate were assessed after each cue set. A modified Stroop task with cannabis and control words was completed after the marijuana cues as a measure of attentional bias. RESULTS Relative to neutral cues, marijuana cues significantly increased subjective craving and demand indices of intensity (i.e., drug consumed at $0) and Omax (i.e., peak drug expenditure). Elasticity significantly decreased following marijuana cues, reflecting sustained purchase despite price increases. Craving was correlated with demand indices (r's: 0.23-0.30). Marijuana users displayed significant attentional bias for cannabis-related words after marijuana cues. Cue-elicited increases in intensity were associated with greater attentional bias for marijuana words. CONCLUSIONS Greater incentive salience indexed by subjective, behavioral economic, and implicit measures was observed after marijuana versus neutral cues, supporting multidimensional assessment. The study highlights the utility of a behavioral economic approach in detecting cue-elicited changes in marijuana incentive salience.
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Affiliation(s)
- Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA; Providence Veterans Affairs Medical Center, Providence, RI, 02908, USA.
| | - Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
| | - Damaris J. Rohsenow
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Providence Veterans Affairs Medical Center, Providence, RI, 02908
| | - John E. McGeary
- Providence Veterans Affairs Medical Center, Providence, RI, 02908,Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 02903
| | - Valerie S. Knopik
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 02903
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, L8N 3K7 Canada
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Magnitude and duration of cue-induced craving for marijuana in volunteers with cannabis use disorder. Drug Alcohol Depend 2016; 166:143-9. [PMID: 27436749 PMCID: PMC5113710 DOI: 10.1016/j.drugalcdep.2016.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/30/2016] [Accepted: 07/04/2016] [Indexed: 11/22/2022]
Abstract
AIMS Evaluate magnitude and duration of subjective and physiologic responses to neutral and marijuana (MJ)-related cues in cannabis dependent volunteers. METHODS 33 volunteers (17 male) who met DSM-IV criteria for Cannabis Abuse or Dependence were exposed to neutral (first) then MJ-related visual, auditory, olfactory and tactile cues. Mood, drug craving and physiology were assessed at baseline, post-neutral, post-MJ and 15-min post MJ cue exposure to determine magnitude of cue- responses. For a subset of participants (n=15; 9 male), measures of craving and physiology were collected also at 30-, 90-, and 150-min post-MJ cue to examine duration of cue-effects. RESULTS In cue-response magnitude analyses, visual analog scale (VAS) items craving for, urge to use, and desire to smoke MJ, Total and Compulsivity subscale scores of the Marijuana Craving Questionnaire, anxiety ratings, and diastolic blood pressure (BP) were significantly elevated following MJ vs. neutral cue exposure. In cue-response duration analyses, desire and urge to use MJ remained significantly elevated at 30-, 90- and 150-min post MJ-cue exposure, relative to baseline and neutral cues. CONCLUSIONS Presentation of polysensory MJ cues increased MJ craving, anxiety and diastolic BP relative to baseline and neutral cues. MJ craving remained elevated up to 150-min after MJ cue presentation. This finding confirms that carry-over effects from drug cue presentation must be considered in cue reactivity studies.
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Abstract
Prenatal substance use is a critical public health concern that is linked with several harmful maternal and fetal consequences. The most frequently used substance in pregnancy is tobacco, followed by alcohol, cannabis and other illicit substances. Unfortunately, polysubstance use in pregnancy is common, as well as psychiatric comorbidity, environmental stressors, and limited and disrupted parental care, all of which can compound deleterious maternal and fetal outcomes. There are few existing treatments for prenatal substance use and these mainly comprise behavioral and psychosocial interventions. Contingency management has been shown to be the most efficacious of these. The purpose of this review is to examine the recent literature on the prenatal use of tobacco, alcohol, cannabis, stimulants, and opioids, including the effects of these on maternal and fetal health and the current therapeutic options.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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47
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Mason BL, Mustafa A, Filbey F, Brown ES. Novel Pharmacotherapeutic Interventions for Cannabis Use Disorder. CURRENT ADDICTION REPORTS 2016. [DOI: 10.1007/s40429-016-0094-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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High cortisol responders to stress show increased sedation to alcohol compared to low cortisol responders: An alcohol dose-response study. Pharmacol Biochem Behav 2016; 143:65-72. [PMID: 26892758 DOI: 10.1016/j.pbb.2016.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 01/04/2016] [Accepted: 02/12/2016] [Indexed: 11/20/2022]
Abstract
AIMS The present study was designed to examine the relationship between high and low cortisol response to an acute stressful situation and the subjective effects after different doses of alcohol, in healthy social drinkers. METHOD Sixty-four subjects (32 men and 32 women) participated in one laboratory session. They performed a modified version of the Trier Social Stress Test (TSST) immediately before consumption of either placebo or alcohol (0.2, 0.4 or 0.8 g/kg). Subjects in each dose group were then divided into high (HCR; n=32) or low (LCR; n=32) cortisol responders. Primary dependent measures were self-report questionnaires of mood. RESULTS The HCR reported increased ratings on Sedation on the Biphasic Alcohol Effects Scale (BAES) with increased dose in comparison with the LCR. This increase in sedation also correlated to the increase in cortisol levels. CONCLUSION We conclude that a high cortisol response to stress modulates the subjective response to alcohol, dose-dependently. HCR subjects experience increased sedative effects of alcohol after consumption of higher doses of alcohol following stress compared to LCR subjects.
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Vujanovic AA, Wardle MC, Liu S, Dias NR, Lane SD. Attentional bias in adults with cannabis use disorders. J Addict Dis 2015; 35:144-53. [PMID: 26566718 PMCID: PMC4867847 DOI: 10.1080/10550887.2015.1116354] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/30/2015] [Indexed: 12/20/2022]
Abstract
There has been modest examination of attentional bias in individuals with cannabis use disorders. Clinical implications of this work are directly relevant to better informing extant evidence-based treatment for substance use disorders (e.g., relapse prevention) and/or developing novel interventions. The overarching aim of this investigation was to examine a novel attentional bias task in adults with cannabis use disorders. Participants were comprised of 25 adults (8 women: M age = 31, SD = 6.8; range = 22-45) with cannabis use disorders (n = 12) and controls (n = 13) without any current (past month) psychopathology. Relative to controls, adults with cannabis use disorders had greater attentional bias scores. These differences were present only at the 125-ms probe time, where the cannabis use disorders group showed greater attentional bias to cannabis cues than the control group (adjusted p = .001, cannabis use disorders mean = 59.9, control mean = -24.8, Cohen's d-effect size for 125 ms = 1.03). The cannabis use disorders group also reported significantly greater perceived stress and post-task stress scores than the control group, but stress was not related to attentional bias. This study informs understanding of the influence of cannabis cues on visual detection and reaction time under different cue-target onset times, as attentional bias was most prevalent under time pressure to detect the probe.
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Affiliation(s)
- Anka A. Vujanovic
- Center for Neurobehavioral Research on Addiction, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Margaret C. Wardle
- Center for Neurobehavioral Research on Addiction, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Shijing Liu
- Center for Neurobehavioral Research on Addiction, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nadeeka R. Dias
- Center for Neurobehavioral Research on Addiction, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Scott D. Lane
- Center for Neurobehavioral Research on Addiction, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
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50
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Back SE, Gros DF, Price M, LaRowe S, Flanagan J, Brady KT, Davis C, Jaconis M, McCauley JL. Laboratory-induced stress and craving among individuals with prescription opioid dependence. Drug Alcohol Depend 2015; 155:60-7. [PMID: 26342626 PMCID: PMC4582004 DOI: 10.1016/j.drugalcdep.2015.08.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/10/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stress and conditioned drug cues have been implicated in the initiation, maintenance and relapse to substances of abuse. Although stress and drug cues are often encountered together, little research exists on whether stress potentiates the response to drug cues. METHOD Participants (N=75) were 39 community recruited individuals with current prescription opioid (PO) dependence and 36 healthy controls. Participants stayed overnight in the hospital for one night and then completed laboratory testing the following morning. During laboratory testing, participants were randomly assigned to a stress task (Trier Social Stress Task; TSST) or a no-stress condition. Following the stress manipulation, all participants completed a PO cue paradigm. Immediately before and after the stress and cue tasks, the following were assessed: subjective (stress, craving, anger, sadness, happiness), physiological (heart rate, blood pressure, galvanic skin response), and neuroendocrine responses (cortisol and dehydroepiandrosterone). RESULTS Internal validity of the stress task was demonstrated, as evidenced by significantly higher subjective stress, as well as cortisol, heart rate and blood pressure in the TSST compared to the no-stress group. Individuals with PO dependence evidenced significantly greater reactivity to the stress task than controls. Craving increased significantly in response to the drug cue task among PO participants. No stress×cue interaction was observed. CONCLUSIONS In this study, heightened stress reactivity was observed among individuals with PO dependence. Exposure to acute stress, however, did not potentiate craving in response to conditioned drug cues.
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Affiliation(s)
- Sudie E. Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Corresponding Author: Sudie E. Back Ph.D., Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, Medical University of South Carolina, 67 President St., P.O. Box 250861, Charleston, SC 29425. Telephone (843) 792-9383, Fax (843) 792-3514.
| | - Daniel F. Gros
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Matthew Price
- Department of Psychology, University of Vermont, Burlington, VT
| | - Steve LaRowe
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Julianne Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Kathleen T. Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Charles Davis
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Maryanne Jaconis
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Jenna L. McCauley
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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