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Wardle MC, Webber HE, Yoon JH, Heads AM, Stotts AL, Lane SD, Schmitz JM. Behavioral therapies targeting reward mechanisms in substance use disorders. Pharmacol Biochem Behav 2024; 240:173787. [PMID: 38705285 DOI: 10.1016/j.pbb.2024.173787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.
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Affiliation(s)
- Margaret C Wardle
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Heather E Webber
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, United States of America
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America.
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2
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Garel N, McAnulty C, Greenway KT, Lesperance P, Miron JP, Rej S, Richard-Devantoy S, Jutras-Aswad D. Efficacy of ketamine intervention to decrease alcohol use, cravings, and withdrawal symptoms in adults with problematic alcohol use or alcohol use disorder: A systematic review and comprehensive analysis of mechanism of actions. Drug Alcohol Depend 2022; 239:109606. [PMID: 36087563 DOI: 10.1016/j.drugalcdep.2022.109606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alcohol use disorder is highly prevalent and has important economical, societal, psychiatric, and medical consequences. All currently approved therapeutic approaches targeting alcohol dependence have relatively modest effects and high relapse rates. Recent evidence suggests that ketamine may be an effective intervention to treat alcohol use disorder and alcoholic withdrawal. This systematic review aimed to assess the current level of evidence for this intervention. METHODS This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the international database of systematic reviews PROSPERO. Medline(Ovid), CINAHL Complete(EBSCOhost), PsycINFO(Ovid), EBM Reviews(Ovid), EMBASE(Ovid), and Google Scholar were searched for studies using ketamine to treat harmful alcohol use, craving, or withdrawal states in humans. Studies of any methodology that evaluated ketamine in isolation or combination with other interventions were included. The risk of bias was assessed using specific Cochrane critical appraisal tools. RESULTS Of 1922 abstracts identified, 8 full-text articles were eligible for inclusion, yielding a total sample size of 634 participants. Five studies investigated the impact of ketamine on alcohol use and/or cravings and/or withdrawal in outpatient settings. Three studies looked at the effect of adding ketamine to conventional treatment of withdrawal symptoms in participants admitted to intensive care unit for severe alcohol withdrawal. Results on primary outcomes were mixed within and across trials. CONCLUSIONS Despite promising results, the current evidence does not permit definitive conclusions about the efficacy of ketamine in alcohol use disorders or withdrawal. Future studies are warranted.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Paul Lesperance
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Jean-Philippe Miron
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; Douglas Mental Health Research Institute, McGill Group for Suicide Studies, 6875 Boulevard LaSalle, Montréal, Québec H4H 1R3, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada.
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3
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Mathai DS, Mora V, Garcia-Romeu A. Toward Synergies of Ketamine and Psychotherapy. Front Psychol 2022; 13:868103. [PMID: 35401323 PMCID: PMC8992793 DOI: 10.3389/fpsyg.2022.868103] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/25/2022] [Indexed: 12/13/2022] Open
Abstract
Ketamine is a dissociative drug that has been used medically since the 1970s primarily as an anesthetic agent but also for various psychiatric applications. Anecdotal reports and clinical research suggest substantial potential for ketamine as a treatment in conjunction with psychological interventions. Here, we review historical and modern approaches to the use of ketamine with psychotherapy, discuss the clinical relevance of ketamine’s acute psychoactive effects, propose a unique model for using esketamine (one isomeric form of ketamine) with Acceptance and Commitment Therapy (ACT), and suggest considerations for moving medication-assisted psychotherapy forward as a field.
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Affiliation(s)
- David S Mathai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Victoria Mora
- School of Health Professions, Baylor College of Medicine, Houston, TX, United States
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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4
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Schmitz JM, Lane SD, Weaver MF, Narayana PA, Hasan KM, Russell DD, Suchting R, Green CE. Targeting white matter neuroprotection as a relapse prevention strategy for treatment of cocaine use disorder: Design of a mechanism-focused randomized clinical trial. Contemp Clin Trials 2021; 111:106603. [PMID: 34688917 DOI: 10.1016/j.cct.2021.106603] [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: 04/10/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
Cocaine use continues to be a significant public health problem with limited treatment options and no approved pharmacotherapies. Cognitive-behavioral therapy (CBT) remains the mainstay treatment for preventing relapse, however, people with chronic cocaine use display cognitive impairments that are associated with poor response to CBT. Emerging evidence in animal and human studies suggests that the peroxisome proliferator-activated receptor-gamma (PPAR- γ) agonist, pioglitazone, improves white matter integrity that is essential for cognitive function. This project will determine whether adjunctive use of pioglitazone enhances the effect of CBT in preventing relapse during the early phase of recovery from cocaine use disorder. This paper describes the design of a mechanism-focused phase 2 randomized clinical trial that aims first to evaluate the effects of pioglitazone on targeted mechanisms related to white matter integrity, cognitive function, and cocaine craving; and second, to evaluate the extent to which improvements on target mechanisms predict CBT response. Positive results will support pioglitazone as a potential cognitive enhancing agent to advance to later stage medication development research.
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Affiliation(s)
- Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA.
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Michael F Weaver
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Ponnada A Narayana
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Khader M Hasan
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | | | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Charles E Green
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA; Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, USA
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Asensio S, Hernández-Rabaza V, Orón Semper JV. What Is the "Trigger" of Addiction? Front Behav Neurosci 2020; 14:54. [PMID: 32372925 PMCID: PMC7186308 DOI: 10.3389/fnbeh.2020.00054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/23/2020] [Indexed: 01/24/2023] Open
Affiliation(s)
- Samuel Asensio
- Departamento Ciencias Biomédicas, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,Instituto de Ciencias Biomédicas, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain
| | - Vicente Hernández-Rabaza
- Departamento Ciencias Biomédicas, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,Instituto de Ciencias Biomédicas, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain
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A Review of Nonanesthetic Uses of Ketamine. Anesthesiol Res Pract 2020; 2020:5798285. [PMID: 32308676 PMCID: PMC7152956 DOI: 10.1155/2020/5798285] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/07/2020] [Accepted: 03/05/2020] [Indexed: 12/20/2022] Open
Abstract
Ketamine, a nonselective NMDA receptor antagonist, is used widely in medicine as an anesthetic agent. However, ketamine's mechanisms of action lead to widespread physiological effects, some of which are now coming to the forefront of research for the treatment of diverse medical disorders. This paper aims at reviewing recent data on key nonanesthetic uses of ketamine in the current literature. MEDLINE, CINAHL, and Google Scholar databases were queried to find articles related to ketamine in the treatment of depression, pain syndromes including acute pain, chronic pain, and headache, neurologic applications including neuroprotection and seizures, and alcohol and substance use disorders. It can be concluded that ketamine has a potential role in the treatment of all of these conditions. However, research in this area is still in its early stages, and larger studies are required to evaluate ketamine's efficacy for nonanesthetic purposes in the general population.
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Dakwar E, Nunes EV, Hart CL, Foltin RW, Mathew SJ, Carpenter KM, Choi CJJ, Basaraba CN, Pavlicova M, Levin FR. A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial. Am J Psychiatry 2019; 176:923-930. [PMID: 31230464 DOI: 10.1176/appi.ajp.2019.18101123] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research has suggested that subanesthetic doses of ketamine may work to improve cocaine-related vulnerabilities and facilitate efforts at behavioral modification. The purpose of this trial was to test whether a single ketamine infusion improved treatment outcomes in cocaine-dependent adults engaged in mindfulness-based relapse prevention. METHODS Fifty-five cocaine-dependent individuals were randomly assigned to receive a 40-minute intravenous infusion of ketamine (0.5 mg/kg) or midazolam (the control condition) during a 5-day inpatient stay, during which they also initiated a 5-week course of mindfulness-based relapse prevention. Cocaine use was assessed through self-report and urine toxicology. The primary outcomes were end-of-study abstinence and time to relapse (defined as first use or dropout). RESULTS Overall, 48.2% of individuals in the ketamine group maintained abstinence over the last 2 weeks of the trial, compared with 10.7% in the midazolam group (intent-to-treat analysis). The ketamine group was 53% less likely (hazard ratio=0.47; 95% CI=0.24, 0.92) to relapse (dropout or use cocaine) compared with the midazolam group, and craving scores were 58.1% lower in the ketamine group throughout the trial (95% CI=18.6, 78.6); both differences were statistically significant. Infusions were well tolerated, and no participants were removed from the study as a result of adverse events. CONCLUSIONS A single ketamine infusion improved a range of important treatment outcomes in cocaine-dependent adults engaged in mindfulness-based behavioral modification, including promoting abstinence, diminishing craving, and reducing risk of relapse. Further research is needed to replicate these promising results in a larger sample.
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Affiliation(s)
- Elias Dakwar
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Edward V Nunes
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Carl L Hart
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Richard W Foltin
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Sanjay J Mathew
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Kenneth M Carpenter
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - C J Jean Choi
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Cale N Basaraba
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Martina Pavlicova
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Medical Center, New York (Dakwar, Nunes, Hart, Foltin, Carpenter, Levin); the Department of Psychology, Columbia University, New York (Hart); the Department of Psychiatry, Baylor College of Medicine, Houston (Mathew); New York State Psychiatric Institute, Division of Biostatistics, New York (Choi, Basaraba); and the Department of Biostatistics, Columbia University Medical Center, New York (Pavlicova)
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Ramirez-Castillo D, Garcia-Roda C, Guell F, Fernandez-Montalvo J, Bernacer J, Morón I. Frustration Tolerance and Personality Traits in Patients With Substance Use Disorders. Front Psychiatry 2019; 10:421. [PMID: 31258496 PMCID: PMC6588127 DOI: 10.3389/fpsyt.2019.00421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022] Open
Abstract
Previous research has suggested the prevalence of certain personality traits, some of which are related to a disorganized attachment, in substance abuse disorders. Further, frustration tolerance (FT) has been proposed as an important factor in addiction, both at the inception-following the "self-medication" hypothesis-and regarding treatment compliance. In turn, an inadequate response to frustrating events has been also associated with a disrupted attachment. Our goal is to explore the mediational role of FT in the relationship between personality traits and two different treatments for substance addiction: therapeutic community (TC) and ambulatory treatment (AT). Eighty-four subjects with substance abuse disorder were recruited in total (22 female), including 46 volunteers (13 female) in TC and 38 (9 female) in AT. They were assessed with Rosenzweig's test for FT and the Millon Clinical Multiaxial Inventory-III (MCMI-III) test to evaluate personality factors. By comparing with a control sample (335 volunteers, 268 female), we found that FT was lower in patients. Between therapeutic groups, FT was significantly lower in TC. Depressive, antisocial, sadistic, negativistic, schizotypal, borderline, paranoid, anxiety, dysthymia, alcohol use, drug use, posttraumatic stress disorder (PTSD), thought disorder, and delusional disorder traits were suggestive of pathology in the clinical samples and were significantly different between control, AT, and TC groups. Further, anxiety and PTSD traits were higher in TC than in AT. A mediational analysis revealed that the effect of anxiety and PTSD scales on therapeutic group was partially mediated by FT. In conclusion, FT and its interplay with personality traits commonly related to disorganized attachment (anxiety and PTSD) might be important factors to consider within therapeutic programs for persons with substance addiction.
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Affiliation(s)
- David Ramirez-Castillo
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Carlos Garcia-Roda
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Francisco Guell
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | | | - Javier Bernacer
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Ignacio Morón
- Department of Psychobiology and Research Center for Mind, Brain, and Behavior (CIMCYC), University of Granada, Granada, Spain
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