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Tilhou A, Baldwin M, Alves J. No Time to Wait: Leveraging Primary Care to Treat Stimulant Use Disorder. Am J Prev Med 2024; 67:464-469. [PMID: 38762205 PMCID: PMC11338722 DOI: 10.1016/j.amepre.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Alyssa Tilhou
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Marielle Baldwin
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - Justin Alves
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
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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] [Grants] [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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Ribeiro A, Pinto DGA, Trevisol AP, Tardelli V, Arcadepani F, Bosso RA, Ribeiro M, Fidalgo TM. Can Contingency Management Solve the Problem of Adherence to Antiretroviral Therapy in Drug-Dependent Individuals? HEALTH EDUCATION & BEHAVIOR 2023; 50:738-747. [PMID: 36744756 DOI: 10.1177/10901981221148966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatment adherence in the patient group compared with the control groups during the intervention phase. Positive findings did not persist after the cessation of the incentives. The meta-analysis showed that the intervention improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; p = .007) compared with the control group during the intervention period. All short-term CM studies converged on a positive result for adherence to antiretroviral therapy.
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Tardelli VS, Bisaga A, Tadonio L, Gerra G, Fidalgo TM. Evidence-based Treatment for Stimulant Use Disorder: Time to Hit the Community. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:370-371. [PMID: 36583534 PMCID: PMC10192830 DOI: 10.1177/07067437221148831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Vitor S. Tardelli
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Translational Addictions Research Lab – Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Adam Bisaga
- Division of Substance Abuse, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Leonardo Tadonio
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Gilberto Gerra
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Thiago M. Fidalgo
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Tardelli VS, Berro LF, Gerra G, Tadonio L, Bisaga A, Fidalgo TM. Prescription psychostimulants for cocaine use disorder: A review from molecular basis to clinical approach. Addict Biol 2023; 28:e13271. [PMID: 37016755 PMCID: PMC10499006 DOI: 10.1111/adb.13271] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
Cocaine use is a public health concern in many countries worldwide, particularly in the Americas and Oceania. Overdose deaths involving stimulants, such as cocaine, have been increasing markedly in North America, especially with concurrent opioid involvement. To date, no pharmacological treatment is available to treat stimulant (including cocaine) use disorders. Prescription psychostimulants (PPs) could be useful to treat cocaine use disorder (CUD) as they share the pharmacological effects with cocaine, as evidenced by a recent meta-analysis that assessed 38 randomized clinical trials (RCTs). PPs were found to promote sustained abstinence and reduce drug use in patients with CUD. The aim of this paper is to provide a narrative review of the clinical pharmacology of PPs and comment on the current stage of evidence supporting PPs to treat CUD. We also propose a model of care that integrates PPs with evidence-based psychosocial interventions (such as cognitive-behavioural therapy [CBT] and contingency management [CM]), a harm reduction approach and case management with social support.
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Affiliation(s)
- Vitor S. Tardelli
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil
- Translational Addiction Research Laboratory, Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Lais F. Berro
- Department of Psychiatry and Human Behavior, University of Mississipi Medical Center, Jackson, MS, USA
| | - Gilberto Gerra
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Leonardo Tadonio
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Adam Bisaga
- The Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil
- Young Leaders Program from the National Academy of Medicine, Brazil
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A Mixed-methods Evaluation of an Addiction/Cardiology Pilot Clinic With Contingency Management for Patients With Stimulant-associated Cardiomyopathy. J Addict Med 2022:01271255-990000000-00118. [PMID: 36729467 DOI: 10.1097/adm.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Contingency management (CM) is one of the most effective treatments for stimulant use disorder but has not been leveraged for people with stimulant-associated cardiomyopathy (SA-CMP), a chronic health condition with significant morbidity and mortality. We aimed to determine the feasibility and acceptability of a multidisciplinary addiction/cardiology clinic with CM for patients with SA-CMP and to explore barriers and facilitators to engagement and recovery. METHODS We recruited patients with a hospitalization in the past 6 months, heart failure with reduced ejection fraction (<40%) and stimulant use disorder to participate in Heart Plus, a 12-week addiction/cardiology clinic with CM in an urban, safety-net, hospital-based cardiology clinic, which took place March 2021 through June 2021. Contingency management entailed gift card rewards for attendance and negative point-of-care urine drug screens. Our mixed-methods study used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We obtained data from the medical record, staff surveys, and qualitative interviews with participants. RESULTS Thirty-eight patients were referred, 17 scheduled an appointment, and 12 attended the intake appointment and enrolled in the study. Mean treatment duration was 8 of 12 weeks. Of the 9 participants who attended more than one visit, the median attendance was 82% of available visits for in-person visits and 83% for telephone visits, and all patients reported decreased stimulant use. CONCLUSIONS Delivering CM through a multidisciplinary addiction/cardiology clinic for patients with SA-CMP was feasible and engaged patients in care. Further research is needed to assess whether this program is associated with improved heart failure outcomes.
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Bisaga A, Tardelli VS, Gerra G, Busse A, Campello G, Kashino W, Saenz E, Fidalgo TM. Continuing Increase in Stimulant Dependence - Time to Implement Medical Treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:507-511. [PMID: 35285278 PMCID: PMC9234894 DOI: 10.1177/07067437221083505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Adam Bisaga
- Division of Substance Abuse, 27424New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Vitor S Tardelli
- Departmento de Psiquiatria, 28105Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Translational Addiction Research Laboratory, 7978Centre for Addiction and Mental Health, Toronto, Canada
| | - Gilberto Gerra
- Mental Health Department, 18088Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Anja Busse
- 28538United Nations Office on Drugs and Crime, Prevention Treatment and Rehabilitation Section
| | - Giovanna Campello
- 28538United Nations Office on Drugs and Crime, Prevention Treatment and Rehabilitation Section
| | - Wataru Kashino
- 28538United Nations Office on Drugs and Crime, Prevention Treatment and Rehabilitation Section
| | - Elizabeth Saenz
- 28538United Nations Office on Drugs and Crime, Prevention Treatment and Rehabilitation Section
| | - Thiago M Fidalgo
- Departmento de Psiquiatria, 28105Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Young Leaders Program from the National Academy of Medicine, Brazil
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Brown RM, Dayas CV, James MH, Smith RJ. New directions in modelling dysregulated reward seeking for food and drugs. Neurosci Biobehav Rev 2022; 132:1037-1048. [PMID: 34736883 PMCID: PMC8816817 DOI: 10.1016/j.neubiorev.2021.10.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023]
Abstract
Behavioral models are central to behavioral neuroscience. To study the neural mechanisms of maladaptive behaviors (including binge eating and drug addiction), it is essential to develop and utilize appropriate animal models that specifically focus on dysregulated reward seeking. Both food and cocaine are typically consumed in a regulated manner by rodents, motivated by reward and homeostatic mechanisms. However, both food and cocaine seeking can become dysregulated, resulting in binge-like consumption and compulsive patterns of intake. The speakers in this symposium for the 2021 International Behavioral Neuroscience Meeting utilize behavioral models of dysregulated reward-seeking to investigate the neural mechanisms of binge-like consumption, enhanced cue-driven reward seeking, excessive motivation, and continued use despite negative consequences. In this review, we outline examples of maladaptive patterns of intake and explore recent animal models that drive behavior to become dysregulated, including stress exposure and intermittent access to rewards. Lastly, we explore select behavioral and neural mechanisms underlying dysregulated reward-seeking for both food and drugs.
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Affiliation(s)
- Robyn M Brown
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville, VIC, 3052, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Christopher V Dayas
- School of Biomedical Sciences & Pharmacy, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Morgan H James
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, 08854, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, 08854, USA.
| | - Rachel J Smith
- Department of Psychological & Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, TX, 77843, USA
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DesJardin J, Leyde S, Davis J. Weathering the perfect storm: management of heart failure in patients with substance use disorders. Heart 2021; 107:1353-1354. [PMID: 34031158 DOI: 10.1136/heartjnl-2021-319103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jacqueline DesJardin
- Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Sarah Leyde
- Division of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Jonathan Davis
- Cardiology, University of California San Francisco, San Francisco, California, USA .,Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis. Psychopharmacology (Berl) 2020; 237:2233-2255. [PMID: 32601988 DOI: 10.1007/s00213-020-05563-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/18/2020] [Indexed: 01/09/2023]
Abstract
RATIONALE Agonist-based pharmacologic intervention is an accepted approach in treatment of opioid and tobacco use disorders. OBJECTIVES We conducted a systematic review and meta-analysis to evaluate usefulness of an agonist approach as treatment of (psycho)stimulant use disorder (PSUD). METHODS We reviewed PubMed/Medline, LILACS, and ClinicalTrials.gov databases searching for randomized, double-blind, placebo-controlled, parallel-design studies evaluating outcomes of individuals treated for cocaine- or amphetamine-type substance use disorder. We combined results of all trials that included the following prescription psychostimulants (PPs): modafinil, methylphenidate, or amphetamines (mixed amphetamine salts, lisdexamphetamine, and dextroamphetamine). The combined sample consisted of 2889 patients. Outcomes of interest included the following: drug abstinence (defined as 2-3 weeks of sustained abstinence and the average maximum days of consecutive abstinence), percentage of drug-negative urine tests across trial, and retention in treatment. We conducted random-effects meta-analyses and assessed quality of evidence using the GRADE system. RESULTS Thirty-eight trials were included. Treatment with PPs increases rates of sustained abstinence [risk ratio (RR) = 1.45, 95% confidence interval (CI) = (1.10, 1.92)] and duration of abstinence [mean difference (MD) = 3.34, 95% CI = (1.06, 5.62)] in patients with PSUD, particularly those with cocaine use disorder (very low-quality evidence). Prescription amphetamines were particularly efficacious in promoting sustained abstinence in patients with cocaine use disorder [RR = 2.44, 95% CI = (1.66, 3.58)], and higher doses of PPs were particularly efficacious for treatment of cocaine use disorder [RR = 1.95, 95% CI = (1.38, 2.77)] (moderate-quality evidence). Treatment with prescription amphetamines also yielded more cocaine-negative urines [MD = 8.37%, 95% CI = (3.75, 12.98)]. There was no effect of PPs on the retention in treatment. CONCLUSION Prescription psychostimulants, particularly prescription amphetamines given in robust doses, have a clinically significant beneficial effect to promote abstinence in the treatment of individuals with PSUD, specifically the population with cocaine use disorder.
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Compton WM, Jones CM, Underwood N. Reducing negative consequences from use of methamphetamine. Addiction 2020; 115:1190-1191. [PMID: 31925828 DOI: 10.1111/add.14966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha Underwood
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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