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Xu C, Zhang Z, Hou D, Wang G, Li C, Ma X, Wang K, Luo H, Zhu M. Effects of exercise interventions on negative emotions, cognitive performance and drug craving in methamphetamine addiction. Front Psychiatry 2024; 15:1402533. [PMID: 38827441 PMCID: PMC11140390 DOI: 10.3389/fpsyt.2024.1402533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Methamphetamine is currently one of the most commonly used addictive substances with strong addiction and a high relapse rate. This systematic review aims to examine the effectiveness of physical activity in improving negative emotions, cognitive impairment, and drug craving in people with methamphetamine use disorder (MUD). Methods A total of 17 studies out of 133 found from Embase and PubMed were identified, reporting results from 1836 participants from MUD populations. Original research using clearly described physical activity as interventions and reporting quantifiable outcomes of negative mood, cognitive function and drug craving level in people with MUD were eligible for inclusion. We included prospective studies, randomized controlled trials, or intervention studies, focusing on the neurological effects of physical activity on MUD. Results Taken together, the available clinical evidence showed that physical activity-based interventions may be effective in managing MUD-related withdrawal symptoms. Discussion Physical exercise may improve drug rehabilitation efficiency by improving negative emotions, cognitive behaviors, and drug cravings. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024530359.
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Affiliation(s)
- Conghui Xu
- School of Medicine, Yunnan University, Kunming, China
- Yunnan Technological Innovation Centre of Drug Addiction Medicine, Yunnan University, Kunming, China
| | - Zunyue Zhang
- School of Medicine, Yunnan University, Kunming, China
- Yunnan Technological Innovation Centre of Drug Addiction Medicine, Yunnan University, Kunming, China
| | - Dezhi Hou
- School of Medicine, Yunnan University, Kunming, China
- Department of General Surgery I, First People’s Hospital of Yunnan Province, Kunming, China
| | - Guangqing Wang
- Department of Rehabilitation Education and Corrections, Drug Rehabilitation Administration of Yunnan Province, Kunming, China
| | - Congbin Li
- Department of Rehabilitation Education and Corrections, Drug Rehabilitation Administration of Yunnan Province, Kunming, China
| | - Xingfeng Ma
- Department of Rehabilitation Education and Corrections, Drug Rehabilitation Administration of Yunnan Province, Kunming, China
| | - Kunhua Wang
- School of Medicine, Yunnan University, Kunming, China
- Yunnan Technological Innovation Centre of Drug Addiction Medicine, Yunnan University, Kunming, China
| | - Huayou Luo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mei Zhu
- Department of Ultrasound, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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2
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Gústafsson BJ, Puljević C, Davies EL, Barratt MJ, Ferris J, Winstock A, Piatkowski T. Sweating for Sobriety: Exploring the Relationship Between Exercise Engagement and Substance Use Disorders. J Psychoactive Drugs 2024:1-11. [PMID: 38299228 DOI: 10.1080/02791072.2024.2311143] [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: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
Despite various interventions available for substance use disorders, relapse rates remain substantial and, therefore, alternative strategies for attenuating dependence are needed. This study examined the associations between exercise frequency, illicit substance use, and dependence severity among a large sample of people who use drugs. The study utilized data from the Global Drug Survey 2018 (N = 57,110) to investigate the relationship between exercise frequency, illicit substance use, and substance dependence severity. Binomial regressions were employed to examine the relationship between exercise and SDS scores for 9 drugs. Greater exercise frequency correlated with reduced severity of substance dependence for specific drugs: cannabis (χ2 = 14.75, p < .001), MDMA (χ2 = 4.73, p = .029), cocaine (χ2 = 8.37, p = .015), amphetamine powder (χ2 = 6.39, p = .041), and methamphetamine (χ2 = 15.17, p < .001). These findings suggest a potential link between exercise and reduced substance use dependency. Further research is needed to understand the complex dynamics between exercise and substance use, considering potential bidirectional relationships and concurrent factors.
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Affiliation(s)
- Baldur Jón Gústafsson
- School of Law, Department of Criminology and Sociology, Middlesex University, London, UK
| | - Cheneal Puljević
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Emma L Davies
- Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Monica J Barratt
- Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jason Ferris
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Adam Winstock
- South London and Maudsley NHS Trust/Kings College London, London, UK
- Global Drug Survey, London, UK
| | - Timothy Piatkowski
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
- Griffith Centre for Mental Health, Griffith University, Brisbane, Australia
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3
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Mumba MN, Nancarrow AF, Jaiswal JL, Hocchaus E, Campbell MH, Davis LL. Moderation Effects of Substance Use on Physical and Mental Well-Being in Adults. J Am Psychiatr Nurses Assoc 2024; 30:37-43. [PMID: 34636277 DOI: 10.1177/10783903211052089] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Each year about one in five adults experiences mental illness. Although the independent physical and mental health consequences of alcohol misuse and cigarette smoking are well documented, little is known on how substance use moderates the relationship between physical and mental well-being. AIM The purpose of this study was to examine whether substance use moderates the relationship between physical activity and mental health in adults. METHODS This was a secondary analysis of data provided by the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS Participants (N = 450,016) were adults who completed the BRFSS in 2017. Those who did not drink alcohol had fewer mental health problems when they indicated greater amounts of time spent doing physical activities each week. Last, smokers' number of mental health problems decreased as they engaged in more physical activity, whereas nonsmokers' number of mental health problems increased as they engaged in more physical activity. CONCLUSIONS The relationship between physical activity and mental health outcomes is well established and cannot be overemphasized. Nonetheless, substance abuse can moderate this relationship and should be routinely screened for by health care providers regardless of treatment setting.
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Affiliation(s)
- Mercy Ngosa Mumba
- Mercy Ngosa Mumba, PhD, RN, CMSRN, FAAN, University of Alabama Capstone College of Nursing, Tuscaloosa, AL, USA
| | - Alexandra F Nancarrow
- Alexandra Nancarrow, PhD, Department of Education, Derwent College, University of York, York, Heslington, UK
| | - Jessica L Jaiswal
- Jessica L. Jaiswal, PhD, MPH, The University of Alabama, Tuscaloosa, AL, USA
| | - Erika Hocchaus
- Erika Hocchaus, BSN, RN, University of Alabama Capstone College of Nursing, Tuscaloosa, AL, USA
| | - Madelyn H Campbell
- Madelyn H. Campbell, BS, University of Alabama Capstone College of Nursing, Tuscaloosa, AL, USA
| | - Lori L Davis
- Lori L. Davis, MD, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
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Liu XX, Huang PH, Wang YJ, Gao Y. Effects of Aerobic Exercise Combined With Attentional Bias Modification in the Care of Male Patients With a Methamphetamine Use Disorder. J Addict Nurs 2024; 35:E2-E14. [PMID: 38574107 DOI: 10.1097/jan.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE It remains unclear which individual or combined strategies are most beneficial for methamphetamine use disorders (MUDs). We compared the effects of aerobic exercise, attentional bias modification, and combined intervention on male patients with MUD. METHOD One hundred male patients with MUD were randomly assigned to combined intervention, aerobic exercise, attentional bias modification, or control groups (25 patients per group). The 8-week intervention protocol included three 60-minute sessions of aerobic exercises per week. Primary outcomes included high- and low-frequency heart rate variability, executive function, and cardiorespiratory fitness measured by customized software, computerized tests, and the Harvard step test, respectively. Secondary outcomes included psychiatric symptoms, drug craving, training acceptability, and persistence. RESULTS Participant characteristics were matched between groups at baseline. Executive function, heart rate variability, cardiorespiratory fitness, drug craving, and most psychiatric symptoms had significant time-group interactions at posttest (p < .05, η2 = .08-.28). Compared with the attentional bias modification and control groups, the combined intervention and aerobic exercise groups improved significantly in executive function, heart rate variability, cardiorespiratory fitness, and most secondary outcomes. In addition, high-frequency heart rate variability and cardiorespiratory fitness in the aerobic exercise group were significantly higher than those in the combined intervention group. CONCLUSIONS Combination strategies showed comparable efficacy to aerobic exercise alone in improving executive function, psychiatric symptoms, and drug craving and significantly exceeded other conditions. For heart rate variability and cardiorespiratory fitness, aerobic exercise alone was the most effective. For acceptability and persistence, combination strategies were preferred over single-domain training and health education intervention.
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Randall EJ. Health Equity: Access to Outdoor Fitness Equipment. Curr Sports Med Rep 2023; 22:403-404. [PMID: 38055748 DOI: 10.1249/jsr.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
ABSTRACT Adequate outdoor fitness equipment is essential for physical activity in lower income neighborhoods. San Francisco, CA, in the United States will be highlighted as a city with a large death rate, which could be improved by installing, promoting, and allowing access to fitness equipment. More than 2700 accidental overdose deaths have occurred since the year 2019, with a projected cumulative death rate expected to exceed 3000 human lives by the end of 2023. A contrast of the health inequities is illuminated in one of the nation's wealthiest cities. This is a call to action to bring about change, save lives, and promote healthier behavior.
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Affiliation(s)
- Eric J Randall
- Department of Kinesiology, San Francisco State University, San Francisco, CA
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Zhu Y, Zhu J, Song G. The impact of aerobic exercise training on cognitive function and gut microbiota in methamphetamine-dependent individuals in the community. Physiol Behav 2023; 270:114302. [PMID: 37474085 DOI: 10.1016/j.physbeh.2023.114302] [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] [Received: 05/11/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE This study aimed to investigate the impact and mechanism of gut microbiota on the enhancement of cognitive function in methamphetamine (MA)-dependent individuals during aerobic exercise training. METHODS A total of sixty-four MA-dependent individuals were randomly assigned to either an aerobic exercise training group (DK, n = 32) or a conventional rehabilitation group (CK, n = 32). After an eight-week intervention, the participants' working memory and inhibition ability were assessed using the Stroop paradigm and Go/NoGo paradigm, respectively. Gut microbiota composition was analyzed using high-throughput sequencing. RESULTS 1) Eight weeks of aerobic exercise training significantly improved the working memory and inhibition ability of MA-dependent individuals (P < 0.05). 2) Following the intervention, the DK group exhibited significantly higher levels of Lactobacillus, Lactococcus lactis, Prevotellaceae, and Ruminococcaceae compared to the CK group. Conversely, the DK group demonstrated significantly lower levels of Desulfovibrio and Akkermansia compared to the CK group. Furthermore, the DK group showed significantly increased metabolic pathways associated with d-Glutaralate and d-Galactate Degradation, as well as the Alanine, aspartate, and glutamate metabolism pathway, compared to the control group. 3) Cognitive function related to MA addiction positively correlated with Bifidobacterium, Dialister, and Adlercreutzia, while negatively correlated with Enterobacteria, Bacillus cereus, Catabacter, and Akkermansia. CONCLUSION Aerobic exercise training enhances working memory and inhibition ability in MA-dependent individuals, thereby mitigating the detrimental effects of MA addiction on cognitive function. Additionally, analysis of gut microbiota suggests that the modulation of gut microbiota and associated metabolic pathways play a role in regulating the improvement of cognitive function in MA-dependent individuals through exercise.
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Affiliation(s)
- Yuping Zhu
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Jiang Zhu
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Gang Song
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, College of Physical Education, Southwest University, Chongqing, 400715, China.
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Towers EB, Shapiro DA, Abel JM, Bakhti-Suroosh A, Kupkova K, Auble DT, Grant PA, Lynch WJ. Transcriptional Profile of Exercise-Induced Protection Against Relapse to Cocaine Seeking in a Rat Model. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:734-745. [PMID: 37881559 PMCID: PMC10593899 DOI: 10.1016/j.bpsgos.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background Exercise has shown promise as a treatment for cocaine use disorder; however, the mechanism underlying its efficacy has remained elusive. Methods We used a rat model of relapse (cue-induced reinstatement) and exercise (wheel running, 2 hours/day) coupled with RNA sequencing to establish transcriptional profiles associated with the protective effects of exercise (during early withdrawal [days 1-7] or throughout withdrawal [days 1-14]) versus noneffective exercise (during late withdrawal [days 8-14]) against cocaine-seeking and sedentary conditions. Results As expected, cue-induced cocaine seeking was highest in the sedentary and late-withdrawal exercise groups; both groups also showed upregulation of a Grin1-associated transcript and enrichment of Drd1-Nmdar1 complex and glutamate receptor complex terms. Surprisingly, these glutamate markers were also enriched in the early- and throughout-withdrawal exercise groups, despite lower levels of cocaine seeking. However, a closer examination of the Grin1-associated transcript revealed a robust loss of transcripts spanning exons 9 and 10 in the sedentary condition relative to saline controls that was normalized by early- and throughout-withdrawal exercise, but not late-withdrawal exercise, indicating that these exercise conditions may normalize RNA mis-splicing induced by cocaine seeking. Our findings also revealed novel mechanisms by which exercise initiated during early withdrawal may modulate glutamatergic signaling in dorsomedial prefrontal cortex (e.g., via transcripts associated with non-NMDA glutamate receptors or those affecting signaling downstream of NMDA receptors), along with mechanisms outside of glutamatergic signaling such as circadian rhythm regulation and neuronal survival. Conclusions These findings provide a rich resource for future studies aimed at manipulating these molecular networks to better understand how exercise decreases cocaine seeking.
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Affiliation(s)
- Eleanor Blair Towers
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia
- Medical Scientist Training Program, University of Virginia, Charlottesville, Virginia
| | - Daniel A. Shapiro
- Center for Brain Immunology and Glia, Department of Neuroscience, University of Virginia, Charlottesville, Virginia
| | - Jean M. Abel
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia
| | - Anousheh Bakhti-Suroosh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia
| | - Kristyna Kupkova
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, Virginia
| | - David T. Auble
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, Virginia
| | - Patrick A. Grant
- Department of Biomedical Science, Florida Atlantic University, Boca Raton, Florida
| | - Wendy J. Lynch
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia
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Barillot L, Chauvet C, Besnier M, Jaafari N, Solinas M, Chatard A. Effect of environmental enrichment on relapse rates in patients with severe alcohol use disorder: protocol for a randomised controlled trial. BMJ Open 2023; 13:e069249. [PMID: 37173113 PMCID: PMC10186436 DOI: 10.1136/bmjopen-2022-069249] [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: 10/14/2022] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) ranks among the most prevalent psychiatric disorders worldwide. Despite current treatments, more than half of patients relapse within weeks after treatment. In animal models, exposure to environmental enrichment (EE) has been shown to be a promising approach to reduce relapse. However, controlled, multimodal EE is difficult to transpose to humans. To address this gap, this study aims at assessing the effectiveness of exposure to a newly designed EE protocol during AUD treatment in reducing relapse to alcohol use. Our EE will allow an enhancement of the standard intervention, and will combine several promising enrichment factors identified in the literature-physical activity, cognitive stimulation, mindfulness and virtual reality (VR). METHODS AND ANALYSIS A randomised controlled trial involving 135 participants receiving treatment for severe AUD will be conducted. Patients will be randomised to an intervention enhancement group or a control group. The enhanced intervention will consist of six 40-min sessions of EE spread over 9 days. During the first 20 min of these sessions, patients will practise mindfulness in multisensory VR, in virtual environments designed to practise mindfulness and use it to regulate craving induced by virtual cues or stress. Then, participants will practise indoor cycling combined with cognitive training exercises. The control group will undergo standard management for AUD. The primary outcome is relapse assessed at 2 weeks after treatment, using a questionnaire and biological indicators. Relapse will be defined as drinking at least five drinks per occasion or drinking at least five times a week. It is predicted that the group receiving the EE intervention will have a lower relapse rate than the control group. The secondary outcomes are relapse at 1 month and 3 months after treatment, craving and drug-seeking behaviour, mindfulness skills acquisition and the effect of the intervention enhancement on the perceived richness of the daily environment, assessed by questionnaires and neuropsychological tasks. ETHICS AND DISSEMINATION All participants have to give written informed consent to the investigator. This study is approved by the Ethics Committee Nord Ouest IV of Lille (reference number 2022-A01156-37). Results will be disseminated through presentations, peer-reviewed journals and seminar conferences. All information on ethical considerations and open science practices can be accessed at https://osf.io/b57uj/ TRIAL REGISTRATION NUMBER: NCT05577741.
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Affiliation(s)
- Lila Barillot
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Claudia Chauvet
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Marc Besnier
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Nematollah Jaafari
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Marcello Solinas
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Université de Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques U1084, Poitiers, France
| | - Armand Chatard
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
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Piché F, Daneau C, Plourde C, Girard S, Romain AJ. Characteristics and impact of physical activity interventions during substance use disorder treatment excluding tobacco: A systematic review. PLoS One 2023; 18:e0283861. [PMID: 37099488 PMCID: PMC10132651 DOI: 10.1371/journal.pone.0283861] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/19/2023] [Indexed: 04/27/2023] Open
Abstract
Substance use disorder is a worldwide issue that entails negative health and physical activity is a promising complementary therapy for alleviating the consequences. The objective of this reviews is to characterize physical activity interventions offered in the literature and explore their effects during treatment for people with substance use disorders with excluding studies focusing only on tobacco use. A systematic search of seven databases on articles including a physical activity intervention during a treatment for substance use disorder was done and an examination of the presence of bias was performed. A total of 43 articles including 3135 participants were identified. Most studies were randomized controlled trial (81%), followed by pre-post design (14%) and cohort studies (5%). The most common physical activity intervention identified was of moderate intensity, 3 times per week (≈ 1 hour) for 13 weeks. Cessation/reduction of substance use was the most studied outcome (21 studies, 49%), and 75% showed a decrease in substance use following physical activity intervention. Aerobic capacity was the second most studied effect (14 studies, 33%), with more than 71% of studies showing improvement. Twelve studies (28%) reported a decrease of depressive symptoms. Physical activity interventions in a treatment for substance use disorder seem to be a promising, but more methodologically rigorous scientific studies are needed.
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Affiliation(s)
- Florence Piché
- Department of Human Kinetics, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
- Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
| | - Catherine Daneau
- Department of Human Kinetics, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Chantal Plourde
- Department of Psychoeducation, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Stéphanie Girard
- Department of Human Kinetics, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Ahmed Jérôme Romain
- Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
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Green B, Parent S, Ware J, Hasson AL, McDonell M, Nauts T, Collins M, Kim F, Rawson R. Expanding access to treatment for stimulant use disorder in a frontier state: A qualitative study of contingency management and TRUST program implementation in Montana. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023:209032. [PMID: 37061191 DOI: 10.1016/j.josat.2023.209032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/19/2023] [Accepted: 03/23/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The client population eligible for treatment services supported by State Opioid Response (SOR) grant funding, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), was expanded to include individuals with a stimulant use disorder (stimUD) in 2020. Due to a significant need to improve services for individuals with stimUD in Montana, the Behavioral Health and Developmental Disabilities Division (BHDD) of the Montana Department of Public Health and Human Services used the grant opportunity to work with experts in the field of stimUD to pilot contingency management (CM) and the Treatment for Individuals who Use Stimulants (TRUST) treatment model. The CM protocol included twice weekly visits for twelve weeks, using an escalating schedule of gift card incentives contingent upon stimulant-negative urine samples. TRUST is a multi-component treatment program, incorporating exercise, group therapy, and individual therapy with content guided by cognitive behavioral therapy (CBT) and clinical research associate (CRA) materials. In addition to SOR dollars, BHDD used additional funding for CM reinforcers provided by state tax dollars to meet research-supported target incentive totals. METHODS In this pilot project, TRUST/CM was implemented by four state-approved treatment providers and three Federally Qualified Health Centers (FQHCs), all of which had little prior experience with CM as a component of their treatment programs for stimUD. This article examines the processes of training staff, the experiences among staff with initial implementation of the treatment model, and the client characteristics of initial pilot treatment cohorts. Data for this study include primary qualitative data collected from providers, as well as client characteristics collected on the SAMHSA Government Performance and Results Act (GPRA) data collection form. RESULTS Seven sites were trained in TRUST/CM, and these sites enrolled a total of 70 patients in the program. Qualitative data collected through interviews with site staff revealed the following themes: the value of intensive technical assistance being integrated in the program, concerns about staff retention and loss of expertise, adjustments of target client populations, and the importance of creative strategies for the provision of evidence-informed incentive totals. CONCLUSIONS TRUST/CM was implemented throughout Montana, including rural and urban communities. Qualitative and quantitative data support that providers viewed the CM component as beneficial for treatment retention and improved outcomes for people with stimUD. These implementation study results provide insight into challenges and solutions for providers who are considering the implementation of CM within either a state-approved substance use treatment clinic or FQHC.
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Affiliation(s)
- Brandn Green
- JG Research & Evaluation, United States of America.
| | - Sara Parent
- Department of Community and Behavioral Health, Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Elon S. Floyd College of Medicine, Washington State University, United States of America
| | - Joclynn Ware
- Formerly of Behavioral Health and Disabilities Division, Montana Department of Public Health and Human Services, United States of America
| | - Albert L Hasson
- Formerly of Integrated Substance Abuse Programs, University of California - Los Angeles, United States of America
| | - Michael McDonell
- Department of Community and Behavioral Health, Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Elon S. Floyd College of Medicine, Washington State University, United States of America
| | - Tammera Nauts
- Montana Primary Care Association, United States of America
| | - Mary Collins
- Center for Children, Families, and Workforce Development, University of Montana, United States of America
| | - Frances Kim
- JG Research & Evaluation, United States of America
| | - Richard Rawson
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California - Los Angeles, United States of America; Vermont Center for Behavior and Health, Center for Rural Addiction, University of Vermont, United States of America
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11
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Köhlerová MZ, Fišerová Z, Páv M. Physical activity habits and their effects on quality of life in patients with addiction: data from the Czech Republic. CURRENT PSYCHOLOGY 2023:1-8. [PMID: 37359646 PMCID: PMC10043521 DOI: 10.1007/s12144-023-04402-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/30/2023]
Abstract
Addiction, including substance use disorder (SUD), is a complex condition that can cause serious health problems and negatively affect patient quality of life. Physical activity is known to improve the physical and mental health of patients with SUD. This study aims to determine the relationship between regular physical activity (RPA) and quality of life in SUD patients enrolled in inpatient SUD treatment (n = 159). We divided patients into four groups based on their RPA before and during hospitalization. The SF-36 self-report questionnaire was used to assess quality of life. We found that SUD patients had worse quality of life than a representative sample of the Czech population. Furthermore, we demonstrated that RPA before and during hospitalization and changes during hospitalization affect the perception of quality of life of patients with SUDs. Additionally, physically active patients showed significantly better quality of life than inactive patients. However, patients who initiated RPA during hospitalization reported worse quality of life than those who did not; in addition, this group of patients reported the worst quality of life across the most monitored parameters. We suggest that these patients represent the most vulnerable group. Changes in physical activity habits could be considered an indicator for a more intensive therapeutic focus. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04402-w.
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Affiliation(s)
- Michaela Zahrádka Köhlerová
- Psychiatric Hospital Bohnice, Centre for Psychosomatic Therapy and Rehabilitation, PN Bohnice, Ústavní 91, 181 02 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10, Czech Republic
| | - Zdeňka Fišerová
- Department of Addictology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Kateřinská 1660/32, 121 08 Prague 2, Czech Republic
| | - Marek Páv
- Psychiatric Hospital Bohnice, Centre for Psychosomatic Therapy and Rehabilitation, PN Bohnice, Ústavní 91, 181 02 Prague, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Kateřinská 1660/32, 121 08 Prague 2, Czech Republic
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Li N, Zhang T, Hurr C. Effect of high-intensity intermittent aerobic exercise on blood pressure, heart rate variability, and respiratory function in people with methamphetamine use disorder. Sci Sports 2023. [DOI: 10.1016/j.scispo.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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13
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Carroll ME, Dougen B, Zlebnik NE, Fess L, Smethells J. Reducing short- and long-term cocaine craving with voluntary exercise in male rats. Psychopharmacology (Berl) 2022; 239:3819-3831. [PMID: 36331585 DOI: 10.1007/s00213-022-06251-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a previous study in female rats, voluntary wheel running attenuated incubation of cocaine craving after 30 but not 3 days (Zlebnik and Carroll Zlebnik and Carroll, Psychopharmacology 232:3507-3413, 2015). The present study in male rats, using the same procedure, showed that wheel running reduced incubated craving after both 30 and 3 days of abstinence. METHODS Male rats self-administered i.v. cocaine (0.4 mg/kg) during 6-h sessions for 10 days. They were then moved from the operant chamber to a home cage with an attached running wheel or stationary wheel, for 6 h daily for a 3- or 30-day period when cocaine craving was hypothesized to incubate. Rats were then returned to the operant chamber for a 30-min test of cocaine seeking, or "craving," indicated by responses on the former "drug" lever was formerly associated with drug stimulus lights and responses (vs. no drug stimuli), and lever responding was compared to responses on the "inactive" that was illuminated and counted lever pressing. RESULTS Mean wheel revolutions were similar across the 3- and 30-day incubation groups, when both groups of rats were given access to wheel running vs. access to a stationary wheel in controls. Subsequently, when rats were tested in the operant chamber for "relapse" responding (drug-lever responding) on the lever formerly associated with drug access, cocaine craving was reduced by recent running wheel access (vs. stationary wheel access) in both the 3- and 30-day wheel exposure groups. CONCLUSION Voluntary, self-initiated, and self-sustained physical exercise reduced cocaine craving after short- (3 days) and long-term (30 days) abstinence periods in male rats that previously self-administered cocaine. This was contrasted with reduction of cocaine seeking in females after 30-day, but not 3-day, incubation periods under the wheel running vs. stationary wheel conditions in a previous study (Zlebnik and Carroll Zlebnik and Carroll, Psychopharmacology 232:3507-3413, 2015). These initial findings suggest males may be more sensitive to incubated craving for cocaine than females.
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Affiliation(s)
- Marilyn E Carroll
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA.
| | - Ben Dougen
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA
| | - Natalie E Zlebnik
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, HSF II, Room S216, 20 Penn St, Baltimore, MD, 21201, USA
| | - Lydia Fess
- Department of Psychiatry, University of Minnesota, MMC 392, Minneapolis, MN, 55455, USA
| | - John Smethells
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
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Ramirez-Herrera SM, Arenas-Granada JA, Giraldo-Duque E. Efecto del ejercicio físico sobre la aptitud física y estrés en pacientes por consumo de sustancias psicoactivas. REVISTA POLITÉCNICA 2022. [DOI: 10.33571/rpolitec.v18n36a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
El ejercicio físico (EF) regular tiene beneficios en la salud; además, es recomendado como estrategia útil en el tratamiento por consumo de sustancias psicoactivas (SPA). Se estudiaron diferencias y efecto del EF sobre la aptitud física y estrés en sujetos drogodependientes. El diseño pre-experimental pretest-postest con un solo grupo conformado por (n=4, Medad=22.0, DE=5.3), evaluados y elegibles según el autoreporte PAR-Q & YOU y el inventario IDARE. Los resultados mostraron que la resistencia muscular de miembros superiores e inferiores obtuvieron diferencias significativas (p< 0.03, y 0.00), aunque el tamaño del efecto no evidenció valores positivos (d = -1.79 y -6.00); la capacidad aeróbica, resistencia muscular abdominal y flexibilidad no reportaron significación estadística y el tamaño del efecto fue negativo; el estrés mostró diferencias significativas. Los hallazgos revelan que el EF puede generar cambios positivos en algunos componentes de la aptitud física en los pacientes. Se debe seguir investigando esta línea de trabajo.
Regular physical activity (PE) has positive health effects, and it is also suggested as a helpful tactic in the management of psychoactive substance use (PAS). Study individuals who were drug addicted looked at differences and the impact of PE on stress and physical fitness. The pre-experimental pretest-posttest design included a single group of (n=4, Mage=22.0, SD=5.3) individuals who were evaluated and eligible based on the PAR-Q & YOU self-report and the IDARE inventory. The results showed that the muscular resistance of the upper and lower limbs had significant differences (p 0.03, and 0.00), but the effect size was negative (d = -1.79 and -6.00); aerobic capacity, abdominal muscular resistance, and flexibility did not show statistical significance, and the effect size was negative; stress showed significant differences. The findings show that PE can improve some aspects of physical fitness in patients. This area of research should be looked into further.
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15
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Wang M, Chen Y, Xu Y, Zhang X, Sun T, Li H, Yuan C, Li J, Ding ZH, Ma Z, Sun Y. A Randomized Controlled Trial Evaluating the Effect of Tai Chi on the Drug Craving in Women. Int J Ment Health Addict 2022:1-13. [PMID: 36119946 PMCID: PMC9469824 DOI: 10.1007/s11469-022-00917-8] [Citation(s) in RCA: 4] [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] [Accepted: 08/30/2022] [Indexed: 10/27/2022] Open
Abstract
This study was conducted in the purpose of investigating the effect of Tai Chi on drug craving for women with drug disorders. One hundred and twelve women were recruited from a drug rehabilitation center in China, and 47 and 48 were finally analyzed in the control group and exercise group, respectively. The exercise group underwent a 3-month Tai Chi training, whereas the control group experienced no exercise intervention during the same time period. The drug craving was measured by the visual analog scale. In data analysis, repeated-measures were utilized to test the differences between the control and exercise group over the course of the experiment time. The mean of the craving score significantly dropped from pre-test (control: mean = 5.38, SD = 3.04; exercise: mean = 4.68, SD = 2.93) to post-test (control: mean = 4.03, SD = 2.73; exercise: mean = 1.91, SD = 1.90) in both groups (control group: t = 3.84, df = 46, p < 0.001; exercise group: t = 5.941, df = 47, p < 0.001), with more decrease witnessed in the exercise group. Repeated-measures analysis with a Huynh-Feldt correction showed the significant effect of time (F = 27.383, p < 0.001) as well as the study group by time interaction (F = 3.52, p = 0.024). Tai Chi can ameliorate the drug craving in women and it could be a supportive treatment for drug addiction.
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Affiliation(s)
- Mu Wang
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
- University of Science and Technology of China, Hefei, 230026 People’s Republic of China
| | - Yanyan Chen
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
| | - Yubing Xu
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
| | - Xiaoyu Zhang
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
- University of Science and Technology of China, Hefei, 230026 People’s Republic of China
| | - Ting Sun
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
| | - Huazhi Li
- Women Specific Drug Rehabilitation Center, Hefei, Anhui People’s Republic of China
| | - Cunfeng Yuan
- Drug Rehabilitation Administration of the Ministry of Justice of the People’s Republic of China, Beijing, People’s Republic of China
| | - Jin Li
- Women Specific Drug Rehabilitation Center, Hefei, Anhui People’s Republic of China
| | - Zeng-Hui Ding
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
| | - Zuchang Ma
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
| | - Yining Sun
- Institute of Intelligent Machines, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hubin Building, Science Island, Shushan, Hefei, 230031 Anhui People’s Republic of China
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Petzold J, Dean AC, Pochon JB, Ghahremani DG, De La Garza R, London ED. Cortical thickness and related depressive symptoms in early abstinence from chronic methamphetamine use. Addict Biol 2022; 27:e13205. [PMID: 36001419 PMCID: PMC9413352 DOI: 10.1111/adb.13205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/28/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
Methamphetamine use is surging globally as a cause of morbidity and mortality. Treatment is typically sought in early abstinence, when craving and depressive symptoms are intense, contributing to relapse and poor outcomes. To advance an understanding of this problem and identify therapeutic targets, we conducted a retrospective analysis of brain structure in 89 adults with Methamphetamine Use Disorder who were in early abstinence and 89 healthy controls. Unlike most prior research, the participants did not significantly differ in age, sex and recent use of alcohol and tobacco (p-values ≥ 0.400). We analysed thickness across the entire cerebral cortex by fitting a general linear model to identify differences between groups. Follow-up regressions were performed to determine whether cortical thickness in regions showing group differences was related to craving, measured on a visual analogue scale, or to the Beck Depression Inventory score. Participants in early methamphetamine abstinence (M ± SD = 22.1 ± 25.6 days) exhibited thinner cortex in clusters within bilateral frontal, parietal, temporal, insular, and right cingulate cortices relative to controls (p-values < 0.001, corrected for multiple comparisons). Unlike craving (β = 0.007, p = 0.947), depressive symptoms were positively correlated with cortical thickness across clusters (β = 0.239, p = 0.030) and with thickness in the anterior cingulate cluster (β = 0.246, p = 0.027) in the methamphetamine-dependent group. Inasmuch as anterior cingulate pathology predicts response to antidepressants for Major Depressive Disorder, cingulate structure may also identify patients with Methamphetamine Use Disorder who can benefit from antidepressant medication.
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Affiliation(s)
- Johannes Petzold
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andy C. Dean
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
- The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jean-Baptiste Pochon
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Dara G. Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Richard De La Garza
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Edythe D. London
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
- The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
- Department of Molecular and Medical Pharmacology, University of California at Los Angeles, Los Angeles, CA, USA
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Marrero-Cristobal G, Gelpi-Dominguez U, Morales-Silva R, Alvarado-Torres J, Perez-Torres J, Perez-Perez Y, Sepulveda-Orengo M. Aerobic exercise as a promising nonpharmacological therapy for the treatment of substance use disorders. J Neurosci Res 2022; 100:1602-1642. [PMID: 34850988 PMCID: PMC9156662 DOI: 10.1002/jnr.24990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022]
Abstract
Despite the prevalence and public health impact of substance use disorders (SUDs), effective long-term treatments remain elusive. Aerobic exercise is a promising, nonpharmacological treatment currently under investigation as a strategy for preventing drug relapse. Aerobic exercise could be incorporated into the comprehensive treatment regimens for people with substance abuse disorders. Preclinical studies of SUD with animal models have shown that aerobic exercise diminishes drug-seeking behavior, which leads to relapse, in both male and female rats. Nevertheless, little is known regarding the effects of substance abuse-induced cellular and physiological adaptations believed to be responsible for drug-seeking behavior. Accordingly, the overall goal of this review is to provide a summary and an assessment of findings to date, highlighting evidence of the molecular and neurological effects of exercise on adaptations associated with SUD.
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Affiliation(s)
| | - Ursula Gelpi-Dominguez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, PR, USA
| | - Roberto Morales-Silva
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - John Alvarado-Torres
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Joshua Perez-Torres
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Yobet Perez-Perez
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Marian Sepulveda-Orengo
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
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Patterson MS, Spadine MN, Graves Boswell T, Prochnow T, Amo C, Francis AN, Russell AM, Heinrich KM. Exercise in the Treatment of Addiction: A Systematic Literature Review. HEALTH EDUCATION & BEHAVIOR 2022; 49:10901981221090155. [PMID: 35484950 DOI: 10.1177/10901981221090155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exercise has been recognized as a promising and emerging treatment for individuals recovering from addiction. The purpose of this article was to systematically review scientific studies using exercise as a means to improve, sustain, or treat addictions, and to provide suggestions for the future use of exercise as a treatment method for addiction. METHODS Using PRISMA guidelines, a database search was conducted for articles that tested the impact of exercise interventions on addiction-related outcomes. To be included, peer-reviewed experimental design studies had to use human subjects to investigate the relationship between exercise and the treatment of or recovery from addiction. Garrard's Matrix Method was used to extract data from reviewed articles (n = 53). RESULTS Nearly three quarters of the studies reviewed documented a significant change in addiction-related outcomes (e.g., more days abstinent, reduced cravings) in response to exercise exposure, particularly while someone was receiving treatment at an in or outpatient clinic. Many studies investigated the effect of acute bouts of exercise on nicotine dependence, and many studies had small sample sizes, leaving room for future research on how exercise might benefit people recovering from substance and process addictions. CONCLUSION Results affirm that exercise can be a helpful aspect of addiction treatment. Future researchers should investigate different exercise settings (e.g., group-based exercise vs individual) and explore exercise maintenance and the long-term outcomes following discharge from treatment facilities.
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19
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Potential Effects of Nrf2 in Exercise Intervention of Neurotoxicity Caused by Methamphetamine Oxidative Stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:4445734. [PMID: 35480870 PMCID: PMC9038420 DOI: 10.1155/2022/4445734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/01/2022] [Indexed: 12/15/2022]
Abstract
Methamphetamine can cause oxidative stress-centered lipid peroxidation, endoplasmic reticulum stress, mitochondrial dysfunction, excitatory neurotoxicity, and neuroinflammation and ultimately lead to nerve cell apoptosis, abnormal glial cell activation, and dysfunction of blood-brain barrier. Protecting nerve cells from oxidative destroy is a hopeful strategy for treating METH use disorder. Nrf2 is a major transcriptional regulator that activates the antioxidant, anti-inflammatory, and cell-protective gene expression through endogenous pathways that maintains cell REDOX homeostasis and is conducive to the survival of neurons. The Nrf2-mediated endogenous antioxidant pathway can also prevent neurodegenerative effects and functional defects caused by METH oxidative stress. Moderate exercise activates this endogenous antioxidant system, which involves in many diseases, including neurodegenerative diseases. Based on evidence from existing literature, we argue that appropriate exercise can play an endogenous antioxidant regulatory role in the Nrf2 signaling pathway to reduce a number of issues caused by METH-induced oxidative stress. However, more experimental evidence is needed to support this idea. In addition, further exploration is necessary about the different effects of various parameters of exercise intervention (such as exercise mode, time, and intensity) on the Nrf2 signaling pathway intervention. Whether there are synergistic effects between exercise and plant-derived Nrf2 activators is worth further investigation.
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20
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Heart's eyes to see color: Cardiac vagal tone modulates the impact of ethnicity on selected attention under high load. Int J Psychophysiol 2022; 176:27-35. [DOI: 10.1016/j.ijpsycho.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/15/2022]
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21
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Salem BA, Gonzales-Castaneda R, Ang A, Rawson RA, Dickerson D, Chudzynski J, Penate J, Dolezal B, Cooper CB, Mooney LJ. Craving among individuals with stimulant use disorder in residential social model-based treatment - Can exercise help? Drug Alcohol Depend 2022; 231:109247. [PMID: 34999268 PMCID: PMC10978100 DOI: 10.1016/j.drugalcdep.2021.109247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In a randomized controlled 8-week trial, we examined the efficacy of aerobic and resistance exercise in reducing craving for methamphetamine (MA) among individuals with MA-use disorder during residential treatment. METHODS Individuals with MA use disorder (138) who were newly enrolled in residential treatment volunteered for random assignment to either an 8-week exercise intervention (EX) or health education control (HE), with both conditions meeting 3 times weekly; 3 dropped out of the trial, bringing the analysis sample to 135. The majority of participants were male (80%), and 48% were Latino/Hispanic. The mean age of the sample was 31.7 (SD = 6.9) years. Using multivariate mixed models, differences between conditions were examined in: (1) craving for MA, measured by self-reported ratings on a Visual Analog Scale over the 8-week trial and, (2) MA use, measured by self-report and urine drug screens at baseline and 30 and 60 days after discharge from the 8-week study. RESULTS Results revealed significantly lower craving scores among the participants in the EX group than those in the HE group over the 8-week trial (median daily craving score for EX = 13.5, for HE = 21.8; p = .009). In addition, participants with less craving during treatment had significantly lower rates of MA use after discharge than participants with high craving measured at 30-days (p = .004) and 60-days post-discharge (p < .001). CONCLUSIONS Results support the utility of incorporating a structured exercise program for individuals with MA-use disorder to reduce craving and improve MA-use outcomes.
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Affiliation(s)
- Bilal A Salem
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; London Health Sciences Center, Victoria Hospital, Western University, Schulich School of Medicine & Dentistry, Department of Psychiatry London, ON, Canada.
| | - Rachel Gonzales-Castaneda
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Psychology Department, Azusa Pacific University, CA, USA
| | - Alfonso Ang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Richard A Rawson
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Vermont Center for Behavior and Health, University of Vermont, USA.
| | - Daniel Dickerson
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Joy Chudzynski
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jose Penate
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brett Dolezal
- Exercise Physiology Research Laboratory, Division of Pulmonary Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christopher B Cooper
- Exercise Physiology Research Laboratory, Division of Pulmonary Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Larissa J Mooney
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Veterans Affairs Greater Los Angeles Healthcare System
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22
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Liu XX, Wang S. Effect of aerobic exercise on executive function in individuals with methamphetamine use disorder: Modulation by the autonomic nervous system. Psychiatry Res 2021; 306:114241. [PMID: 34688059 DOI: 10.1016/j.psychres.2021.114241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/06/2021] [Accepted: 10/10/2021] [Indexed: 12/30/2022]
Abstract
This study assessed the effects of aerobic exercise on cardiac autonomic nervous system function (based on heart rate variability [HRV]) and executive function among individuals with methamphetamine use disorder (MUD). We further examine the role of autonomic nervous system control in aerobic exercise (assessed via cardiopulmonary fitness) and executive function. A total of 330 individuals with MUD were randomly divided into exercise (n = 165) and control (n = 165) groups, who underwent eight-week aerobic exercise/health education program consisting of five 60 min sessions a week. The outcome measures included cardiopulmonary fitness, HRV time-domain and frequency-domain parameters, and executive function. Our statistical analyses comprised repeated-measures analyses of variance, correlation analyses, and mediation and moderation effect tests. The results indicated that aerobic exercise could simultaneously improve autonomic nervous system function and executive function among individuals with MUD. Moreover, the changes in cardiopulmonary fitness, high frequency HRV, and executive function were positively correlated. HRV did not significantly mediate the relationship between aerobic exercise and executive function; however, it did have a moderating effect, which was eliminated after adjusting for demographic and drug-use covariates. Among the covariates, age was the greatest confounder and was inversely proportional to cardiopulmonary function, HRV, and executive function. Cardiac autonomic nervous system function exerted a moderating, rather than a mediating, effect on the relationship between aerobic exercise and executive function. However, this potential effect was largely influenced by covariates, particularly age.
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Affiliation(s)
- Xiao-Xia Liu
- School of Physical Education and Sport Science, Fujian Normal University, 1 Keji Road, Minhou District, Fuzhou, Fujian 350117, China
| | - Shen Wang
- School of Physical Education and Sport Science, Fujian Normal University, 1 Keji Road, Minhou District, Fuzhou, Fujian 350117, China.
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Effects of Aerobic Exercise Combined with Attentional Bias Training on Cognitive Function and Psychiatric Symptoms of Individuals with Methamphetamine Dependency: a Randomized Controlled Trial. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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24
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Zhou YU, Finlayson G, Liu X, Zhou Q, Liu T, Zhou C. Effects of Acute Dance and Aerobic Exercise on Drug Craving and Food Reward in Women with Methamphetamine Dependence. Med Sci Sports Exerc 2021; 53:2245-2253. [PMID: 34115731 DOI: 10.1249/mss.0000000000002723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Drug dependence causes an overestimation of drug-related stimuli and an underestimation of non-drug-related stimuli, such as food. The purpose of this study was to investigate the effects of acute moderate-intensity dance and aerobic exercise on drug craving, appetite, prefrontal neural activation to food cues, and food reward in women with methamphetamine MA dependence. METHODS Thirty-nine women who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition MA dependence criteria participated in the experiment and were randomly assigned to either a dance (n = 20) or exercise (n = 19) group. A moderate-intensity (65%-75% maximum heart rate) 35-min dance or treadmill intervention counterbalanced with a reading control session was conducted. After the intervention or control, subjective drug craving was measured before and after exposure to drug-related cues. Visual analog scales were used to measure subjective feelings of appetite. Participants then completed a visual food cue paradigm while using functional near-infrared spectroscopy to monitor prefrontal blood oxygen changes. Finally, the Leeds Food Preference Questionnaire was used to measure reward responses to different categories of food. RESULTS The results showed that the dance and exercise interventions reduced subjective craving for drugs after being exposed to drug cues (P = 0.019). Implicit wanting (P < 0.001) and relative preferences (P = 0.001) for high-calorie savory foods were all increased after interventions relative to control. Compared with the control session, the left dorsolateral prefrontal cortex (P = 0.020) was activated when viewing high-calorie foods after moderate-intensity aerobic exercise. CONCLUSIONS The current results support the use of moderate-intensity exercise as a therapeutic intervention to restore the balance between drug and nondrug rewards by decreasing cue-induced MA craving and increasing food reward.
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Affiliation(s)
- Y U Zhou
- School of Psychology, Shanghai University of Sport, Shanghai, PEOPLE'S REPUBLIC OF CHINA
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UNITED KINGDOM
| | - Xudong Liu
- School of Psychology, Shanghai University of Sport, Shanghai, PEOPLE'S REPUBLIC OF CHINA
| | - Qichen Zhou
- School of Psychology, Shanghai University of Sport, Shanghai, PEOPLE'S REPUBLIC OF CHINA
| | - Tianze Liu
- People's Liberation Army Second Military Medical University Naval Medical University, Department of Orthopedics, Changhai Hospital, Shanghai, PEOPLE'S REPUBLIC OF CHINA
| | - Chenglin Zhou
- School of Psychology, Shanghai University of Sport, Shanghai, PEOPLE'S REPUBLIC OF CHINA
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Jung S, Kim Y, Kim M, Seo M, Kim S, Kim S, Lee S. Exercise Pills for Drug Addiction: Forced Moderate Endurance Exercise Inhibits Methamphetamine-Induced Hyperactivity through the Striatal Glutamatergic Signaling Pathway in Male Sprague Dawley Rats. Int J Mol Sci 2021; 22:ijms22158203. [PMID: 34360969 PMCID: PMC8348279 DOI: 10.3390/ijms22158203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
Physical exercise reduces the extent, duration, and frequency of drug use in drug addicts during the drug initiation phase, as well as during prolonged addiction, withdrawal, and recurrence. However, information about exercise-induced neurobiological changes is limited. This study aimed to investigate the effects of forced moderate endurance exercise training on methamphetamine (METH)-induced behavior and the associated neurobiological changes. Male Sprague Dawley rats were subjected to the administration of METH (1 mg/kg/day, i.p.) and/or forced moderate endurance exercise (treadmill running, 21 m/min, 60 min/day) for 2 weeks. Over the two weeks, endurance exercise training significantly reduced METH-induced hyperactivity. METH and/or exercise treatment increased striatal dopamine (DA) levels, decreased p(Thr308)-Akt expression, and increased p(Tyr216)-GSK-3β expression. However, the phosphorylation levels of Ser9-GSK-3β were significantly increased in the exercise group. METH administration significantly increased the expression of NMDAr1, CaMKK2, MAPKs, and PP1 in the striatum, and exercise treatment significantly decreased the expression of these molecules. Therefore, it is apparent that endurance exercise inhibited the METH-induced hyperactivity due to the decrease in GSK-3β activation by the regulation of the striatal glutamate signaling pathway.
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Affiliation(s)
| | | | | | | | | | | | - Sooyeun Lee
- Correspondence: ; Tel.: +82-53-580-6651; Fax: +82-53-580-5164
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Carroll ME. Voluntary exercise as a treatment for incubated and expanded drug craving leading to relapse to addiction: Animal models. Pharmacol Biochem Behav 2021; 208:173210. [PMID: 34116079 DOI: 10.1016/j.pbb.2021.173210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 02/08/2023]
Abstract
Drug addiction is a chronic relapsing disorder, as more than 80% of former drug users relapse within a year after quit attempts have ended. This review examines incubated craving that develops over long periods of weeks to months after addictive drug use ends, when rats are given a small priming exposure to the formerly used drug, and a large amount of drug seeking occurs, reflecting large increases in craving over time. Expanded craving occurs when not only the recently-used drug, but other related or unrelated drugs of abuse elicit drug seeking that leads to relapse behavior, including common drugs like caffeine or nicotine, Thus, expanded craving is an increase in the conditions that elicit relapse, such as, a variety of drugs, and it persists weeks after drug use ends. Incubated and expanded craving occur with several drugs of abuse, and these forms of craving, can last for weeks to months and end in relapse. Voluntary physical exercise, blocked incubated cocaine craving, and expanded heroin craving elicited by multiple conditions was reduced in female and male rats. This review examines voluntary physical exercise as a long-term, self-initiated, and self-sustainable treatment that reduces long-term drug craving leading to relapse.
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Affiliation(s)
- Marilyn E Carroll
- Department of Psychiatry and Behavior Science, 621 Park Ave, University of Minnesota, Minneapolis, MN 55455, United States of America.
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Carroll ME, Zlebnik NE, Holtz NA. Preference for Palatable Food, Impulsivity, and Relation to Drug Addiction in Rats. NEUROMETHODS 2021. [DOI: 10.1007/978-1-0716-0924-8_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Wang J, Lu C, Zheng L, Zhang J. Peripheral Inflammatory Biomarkers of Methamphetamine Withdrawal Patients Based on the Neuro-Inflammation Hypothesis: The Possible Improvement Effect of Exercise. Front Psychiatry 2021; 12:795073. [PMID: 35002809 PMCID: PMC8733583 DOI: 10.3389/fpsyt.2021.795073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 12/15/2022] Open
Abstract
Methamphetamine (MA) induced addiction and neuroinflammation has been implicated. Based on the neuroinflammation hypothesis, this study aims to investigate how exercise influences the craving of patients in MA withdrawal, and explore the mechanism of peripheral inflammation. A total of 90 patients in MA withdrawal were recruited. No difference was noted in the number of years of drug use and the frequency of drug use among patients, and the withdrawal time was within 2 months. The subjects were grouped based on the degree of craving induced by the cues: non-craving control group (NCC group), craving control group (CC group), and craving exercise group (CE group). The CE group was subjected to aerobic combined resistance training. Then, the ELISA method was used to detect plasma IL-6, TNF-α, and IL-1β concentrations; Visual Analog Scale (VAS) measurement of cue-induced cravings under Virtual Reality (VR) exposure (VR-VAS) and the Desires for Drug Questionnaire (DDQ) were used to assess cravings. Consequently, plasma IL-6, TNF-α, IL-1β, levels, and the VR-VAS and DDQ scores of MA withdrawal patients were significantly reduced after exercise. This study confirmed that 8 weeks of incremental load aerobic combined with resistance training reduces peripheral inflammation and significantly reduces the level of craving for MA.
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Affiliation(s)
- Jingsong Wang
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Chunxia Lu
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Lan Zheng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Jun Zhang
- Hunan Judicial Police Vocational College, Changsha, China
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29
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Zhang T, Wang K, Qu M, Jiang H, Chen X, Luo J. The Effect of Physical Activity on Drug Cravings of Drug Addicts With AIDS: The Dual Mediating Effect of Internal Inhibition. Front Psychol 2020; 11:2002. [PMID: 33117203 PMCID: PMC7566164 DOI: 10.3389/fpsyg.2020.02002] [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: 06/11/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background As a global infectious disease, Acquired Immune Deficiency Syndrome (AIDS) poses a serious threat to the safety and health of the society. In recent years, the proportion of drug addicts infected with HIV has been increased, and drug addicts became one of the main carriers of the spread of AIDS, which has attracted worldwide attention. It has been reported that physical activity has positive effects on improving the inhibitory function of drug addicts and reducing their drug craving, but the mechanism of the internal inhibition remains to be further explored. Method The drug addicts in an AIDS treatment center in Chongqing were investigated by means of a Physical Activity Rating Scale (PARS – 3), Internal Inhibition Scale and Drug Craving Scale, and a structural equation model was established. Results (1) There is no gender difference in the internal inhibition and drug craving of drug addicts with AIDS, and there are significant differences across the types and years of drug abuse. (2) The amount of physical activity in drug addicts with AIDS is positively correlated with the intrinsic inhibition, while the internal inhibition is negatively correlated with the drug craving, and the physical exercise amount is negatively correlated with the drug craving. The years of drug abuse were negatively correlated with internal inhibition and positively correlated with drug craving. (3) Internal inhibition plays a partly mediatory role between the physical activity amount and the craving for drugs, and internal inhibition plays a partly mediatory role between the number of years of drug abuse and the craving for drugs, which indicates that internal inhibition has a dual mediating effect. Conclusion Actively participate in physical activity, especially high-intensity physical activity, can effectively enhance the internal inhibition of drug addicts with AIDS and reduce their drug craving. Meanwhile, the difference in the drug-taking years among addicts should be paid attention to, and the physical activity prescription should be formulated according to the actual situation.
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Affiliation(s)
- Tingran Zhang
- Research Centre For Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Kun Wang
- Research Centre For Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Meichen Qu
- Research Centre For Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Haonan Jiang
- Research Centre For Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Xi Chen
- Chongqing Municipal Public Security Bureau, Chongqing, China
| | - Jiong Luo
- Research Centre For Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
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Thompson TP, Horrell J, Taylor AH, Wanner A, Husk K, Wei Y, Creanor S, Kandiyali R, Neale J, Sinclair J, Nasser M, Wallace G. Physical activity and the prevention, reduction, and treatment of alcohol and other drug use across the lifespan (The PHASE review): A systematic review. Ment Health Phys Act 2020; 19:100360. [PMID: 33020704 PMCID: PMC7527800 DOI: 10.1016/j.mhpa.2020.100360] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022]
Abstract
The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval -0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings.
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Affiliation(s)
- T P Thompson
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - J Horrell
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - A H Taylor
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - A Wanner
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - K Husk
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - Y Wei
- University of Plymouth, Centre for Mathematical Sciences, School of Engineering, Computing and Mathematics, Drake Circus, Plymouth, PL4 8AA, UK
| | - S Creanor
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - R Kandiyali
- Bristol University, School of Social and Community Medicine, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
| | - J Neale
- King's College London Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, SE5 8BB, UK
| | - J Sinclair
- University of Southampton, Faculty of Medicine, 4-12 Terminus Terrace, Southampton, SO14 3DT, UK
| | - M Nasser
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - G Wallace
- Plymouth City Council, Public Dispensary, Catherine Street, Plymouth, PL1 2AA, UK
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Kuitunen-Paul S, Roessner V, Basedow LA, Golub Y. Beyond the tip of the iceberg: A narrative review to identify research gaps on comorbid psychiatric disorders in adolescents with methamphetamine use disorder or chronic methamphetamine use. Subst Abus 2020; 42:13-32. [PMID: 32870121 DOI: 10.1080/08897077.2020.1806183] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders in adolescents is available. We thus aimed to review the literature on comorbid mental disorders and MUD in adolescents in order to identify future research topics. Method: A PubMed search was conducted in July 2019. Relevant comorbidities were defined as attention-deficit disorder with/without hyperactivity, anxiety disorders, depression, eating disorders, post-traumatic stress disorder, psychosis, borderline personality disorder, conduct disorder and antisocial personality disorder, as well as other substance use disorders. For each comorbidity, we summarized prevalence rates, findings on comorbidity mechanisms, and recommended treatment options, if applicable. Results: Few articles focused on MUD in adolescents. Prevalence rates differed largely between comorbid disorders, with tobacco use disorder, conduct disorder, post-traumatic stress disorder, anxiety disorders, and attention-deficit disorders being the most prevalent comorbidities while eating disorders were rare. Examined onset patterns and comorbidity mechanisms indicated three groups of comorbidities: preexisting disorders self-medicated with methamphetamine, disorders induced by chronic methamphetamine use, and disorders arising due to risk factors shared with MUD. Reviewed comorbidities were frequently associated with worse treatment outcomes. Conclusions: The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD. Suggestions for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns. Surprisingly few MUD treatment programs explicitly integrate comorbid mental disorder modules.
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Affiliation(s)
- Sören Kuitunen-Paul
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lukas A Basedow
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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32
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Non-pharmacological interventions for methamphetamine use disorder: a systematic review. Drug Alcohol Depend 2020; 212:108060. [PMID: 32445927 DOI: 10.1016/j.drugalcdep.2020.108060] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Methamphetamine (METH) use is on the rise globally, with the number of treatment seekers increasing exponentially across the globe. Evidence-based therapies are needed to meet rising treatment needs. This systematic review intends to appraise the existing evidence to identify effective non-pharmaceutical approaches for the treatment of METH use disorder. METHODS Five electronic bibliographic databases-Ovid (Medline), Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science and PsycINFO- were searched to identify relevant studies that were published between January 1995 to February 2020. Studies were selected and assessed by two independent reviewers. A systematic review of data from both randomised control trials (RCT) and non-RCTs was conducted to appraise the evidence. RESULTS A total of 44 studies were included in the review. Behavioural interventions, i.e. cognitive behavioural therapy (CBT), contingency management (CM), exercise, residential rehabilitation based therapies, repetitive transcranial magnetic stimulation (rTMS), and matrix model demonstrated treatment efficacy in promoting abstinence, reducing methamphetamine use or craving in the participants. While CM interventions showed the strongest evidence favouring the outcomes assessed, tailored CBT alone or with CM was also effective in the target population. CONCLUSIONS Behavioural interventions should be considered as the first line of treatment for methamphetamine use disorder. Future studies should address the longevity of the effects, and limitations due to smaller sample sizes and high dropout rates to enable better assessment of evidence.
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Yang J, Tan J, Zheng L, Lu CX, Hou WQ, Liu Y, Li QF, Li JX, Cheng D, Luo X, Zhang J. Plasma BDNF and TrkB mRNA in PBMCs Are Correlated With Anti-depressive Effects of 12-Weeks Supervised Exercise During Protracted Methamphetamine Abstinence. Front Mol Neurosci 2020; 13:20. [PMID: 32210759 PMCID: PMC7069447 DOI: 10.3389/fnmol.2020.00020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/31/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the potential neurotrophic factors and expression of neurotrophin receptors in peripheral blood mononuclear cells linked with the antidepressant action of exercise intervention during protracted methamphetamine (METH) abstinence. Materials and Methods: A total of 72 male METH addicts, including 47 individuals with depression and 25 individuals without depression, were recruited in this study. Individuals with depression were divided into the depression control group and the depression exercised group. Consequently, 12 weeks of supervised exercise intervention was applied. Depression and anxiety were analyzed; plasma brain-derived neurotrophic factor (BDNF), neuronal growth factor (NGF), neurotrophin-3 (NT-3), NT-4, and proBDNF levels were tested using enzyme-linked immunosorbent assay; the mRNA expressions of TrkA, TrkB-FL, TrkB-T1, TrkCB, and P75NTR in peripheral blood mononuclear cells were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Results: NT-4 plasma levels were correlated with depression (r = −0.330, p = 0.005), which remained significant after Bonferroni correction. In addition, the BDNF and NT-3 levels in the plasma were significantly correlated with depression (r = −0.268, p = 0.023; r = −0.259, p = 0.028), but did not reach significance after Bonferroni correction. The BDNF, NT-3, and NT-4 plasma levels were significantly different between the depressive control group and the depressive exercise group using pre-exercise values as the covariate. The fold changes in TrkB-FL and TrkB-T1 mRNA in peripheral blood mononuclear cells between the post-exercise and pre-exercise demonstrated a remarkable decrease (fold change = −11.056 and −39.055). Conclusions: Exercise intervention can alleviate depression and anxiety during protracted METH abstinence. Decrease in BDNF and the expression of TrkB in peripheral blood mononuclear cells occur following the exercise intervention.
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Affiliation(s)
- Jue Yang
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China.,Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Jun Tan
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Lan Zheng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Chun Xia Lu
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Wen Qi Hou
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Yi Liu
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Qiu Fang Li
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Jin Xiu Li
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Dan Cheng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, China
| | - Xu Luo
- Hunan Judicial Police Vocational College, Changsha, China
| | - Jun Zhang
- Hunan Judicial Police Vocational College, Changsha, China
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Harrison K, Noyes N, Friedrichsen S, Tosun N, Oyenuga A, Allen S. Self-reported leisure time exercise change during smoking cessation in men and women. Addict Behav 2019; 99:106025. [PMID: 31412300 PMCID: PMC6791759 DOI: 10.1016/j.addbeh.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/26/2019] [Accepted: 06/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Katherine Harrison
- Department of Family Medicine & Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States of America.
| | - Nicole Noyes
- Department of Family Medicine & Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States of America.
| | - Samantha Friedrichsen
- Data Analysts, Inc, 219 SE Main Street, Minneapolis, MN 55414, United States of America.
| | - Nicole Tosun
- Department of Family Medicine & Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States of America.
| | - Abayomi Oyenuga
- Department of Family Medicine & Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States of America.
| | - Sharon Allen
- Department of Family Medicine & Community Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, United States of America.
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Therapeutic efficacy of environmental enrichment for substance use disorders. Pharmacol Biochem Behav 2019; 188:172829. [PMID: 31778722 DOI: 10.1016/j.pbb.2019.172829] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Addiction to drug and alcohol is regarded as a major health problem worldwide for which available treatments show limited effectiveness. The biggest challenge remains to enhance the capacities of interventions to reduce craving, prevent relapse and promote long-term recovery. New strategies to meet these challenges are being explored. Findings from preclinical work suggest that environmental enrichment (EE) holds therapeutic potential for the treatment of substance use disorders, as demonstrated in a number of animal models of drug abuse. The EE intervention introduced after drug exposure leads to attenuation of compulsive drug taking, attenuation of the rewarding (and reinforcing) effects of drugs, reductions in control of behavior by drug cues, and, very importantly, relapse prevention. Clinical work also suggests that multidimensional EE interventions (involving physical activity, social interaction, vocational training, recreational and community involvement) might produce similar therapeutic effects, if implemented continuously and rigorously. In this review we survey preclinical and clinical studies assessing the efficacy of EE as a behavioral intervention for substance use disorders and address related challenges. We also review work providing empirical evidence for EE-induced neuroplasticity within the mesocorticolimbic system that is believed to contribute to the seemingly therapeutic effects of EE on drug and alcohol-related behaviors.
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36
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Brellenthin AG, Crombie KM, Hillard CJ, Brown RT, Koltyn KF. Psychological and endocannabinoid responses to aerobic exercise in substance use disorder patients. Subst Abus 2019; 42:272-283. [PMID: 31729933 DOI: 10.1080/08897077.2019.1680480] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exercise has been examined as an adjunctive treatment for substance use disorders (SUDs), yet few exercise interventions have been conducted among patients undergoing intensive outpatient (IOP) treatment, who may be the most vulnerable to relapse and for whom exercise could provide the most benefits. This study examined the effects of aerobic exercise, in addition to IOP treatment, on psychological variables and endocannabinoids in individuals with SUDs. Methods: Twenty-one SUD patients (mean age 35 years) were recruited from local IOPs. Participants were randomized to either treatment-as-usual (TAU, at their outpatient clinic) or TAU plus aerobic exercise training (EX). EX participants engaged in supervised, moderate-intensity exercise for 30 min, 3 times/week for 6 weeks. TAU participants came into the laboratory once per week for assessments and a 30-min quiet rest session. Participants provided blood samples and completed questionnaires evaluating substance use, mood states, depression, anxiety, perceived stress, self-efficacy to abstain from substance use, and craving. Data were analyzed with Mann-Whitney U tests or mixed model ANOVAs to determine group differences in outcomes acutely and over 6 weeks. Results: Over 6 weeks, there were reductions in perceived stress (p < 0.01) and craving (p < 0.05) for both groups. There were no group differences in abstinence rates or changes from baseline in self-efficacy, depression, or anxiety (p > 0.05). Acutely, both exercise and quiet rest sessions led to reductions in craving, tension, depression, anger, confusion, and total mood disturbance (all ps < 0.05). In addition, the EX group experienced acute increases in vigor and circulating concentrations of the endocannabinoid, anandamide (p < 0.01). Conclusions: An adjunctive aerobic exercise program during SUD treatment was associated with similar reductions in perceived stress and drug craving as standard care. Thirty minutes of exercise or quiet rest led to acute improvements in mood, but exercise produced the additional benefit of increases in vigor and circulating anandamide.
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Affiliation(s)
- Angelique G Brellenthin
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, USA.,Department of Kinesiology, Iowa State University, Ames, Iowa, USA
| | - Kevin M Crombie
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Cecilia J Hillard
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Randall T Brown
- Department of Family Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Kelli F Koltyn
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, USA
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37
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Wang H, Chen Y, Li X, Wang J, Zhou Y, Zhou C. Moderate-Intensity Aerobic Exercise Restores Appetite and Prefrontal Brain Activity to Images of Food Among Persons Dependent on Methamphetamine: A Functional Near-Infrared Spectroscopy Study. Front Hum Neurosci 2019; 13:400. [PMID: 31798434 PMCID: PMC6863778 DOI: 10.3389/fnhum.2019.00400] [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] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/25/2019] [Indexed: 12/21/2022] Open
Abstract
The brain prefrontal control system is critical to successful recovery from substance use disorders, and the prefrontal cortex (PFC) regulates striatal reward-related processes. Substance-dependent individuals exhibit an increased response to drug rewards and decreased response to natural, nondrug rewards. Short-term aerobic exercise can ameliorate craving and inhibitory deficits in methamphetamine users, but the effect of exercise on food reward is unknown. This study used functional near-infrared spectroscopy (fNIRS) to measure the effects of moderate- and high-intensity short-term aerobic exercise on prefrontal activity related to food images and recorded the subjective feelings of appetite in methamphetamine-dependent users. In total, 56 men who met the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for methamphetamine dependence, with a mean (SD) body mass index of 24.7 (3.5) kg/m2 and age of 30.2 (5.1) years, were randomly assigned to one of two exercise groups: moderate intensity (n = 28; 65%-75% of maximum heart rate) and high intensity (n = 28; 76%-85% of heart rate maximum). Each group also performed a resting control session for 35 min 1 week before or after the exercise, in a counterbalanced order. Mean oxygenated hemoglobin concentration changes in the PFC when viewing visual food cues were assessed by fNIRS, and subjective feelings of appetite were self-rated using visual analog scales after moderate- or high-intensity aerobic exercise and after the resting control session. A continuous-wave NIRS device was used to obtain functional data: eight sources and seven detectors were placed on the scalp covering the PFC, resulting in 20 channels per participant. We found that moderate-intensity aerobic exercise significantly increased both, the activation of the left orbitofrontal cortex (OFC) to images of high-calorie food (P = 0.02) and subjective sensations of hunger (F (1,54) = 7.16, P = 0.01). To our knowledge, this study provides the first evidence that moderate-intensity aerobic exercise increases OFC activity associated with high-calorie food images and stimulates appetite in methamphetamine-dependent individuals. These changes suggest that exercise may reestablish the food reward pathway hijacked by drugs and restore sensitivity to natural rewards. This evidence may contribute to the development of specific exercise programs for populations with methamphetamine dependence.
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Affiliation(s)
- Hongbiao Wang
- Department of Physical Education, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yifan Chen
- Department of Sport Psychology, School of Sport Science, Shanghai University of Sport, Shanghai, China
| | - Xiawen Li
- Department of Sport Psychology, School of Sport Science, Shanghai University of Sport, Shanghai, China
| | - Jiakuan Wang
- Department of Sport Psychology, School of Sport Science, Shanghai University of Sport, Shanghai, China
| | - Yu Zhou
- Department of Sport Psychology, School of Sport Science, Shanghai University of Sport, Shanghai, China
| | - Chenglin Zhou
- Department of Sport Psychology, School of Sport Science, Shanghai University of Sport, Shanghai, China
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Effects of moderate- and high-intensity acute aerobic exercise on food reward and appetite in individuals with methamphetamine dependence. Physiol Behav 2019; 211:112649. [DOI: 10.1016/j.physbeh.2019.112649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/19/2019] [Accepted: 08/12/2019] [Indexed: 12/21/2022]
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Alessi SM, Rash CJ, Pescatello LS. Reinforcing exercise to improve drug abuse treatment outcomes: A randomized controlled study in a substance use disorder outpatient treatment setting. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:52-64. [PMID: 31599603 DOI: 10.1037/adb0000517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Exercise holds potential to reduce substance use, but engaging patients in exercise regimens is challenging. Contingency management (CM) interventions can directly address adherence by targeting initiation and maintenance of exercise behavior. This study evaluated the efficacy of a CM-reinforced exercise intervention as an adjunct to standard outpatient substance use disorder treatment. Participants were 120 patients with substance use disorders who were randomly assigned to standard care with CM for completing exercise goals or CM for completing general nonexercise goals weekly for a 4-month treatment period. Urine samples were tested for evidence of illicit substance use up to twice a week during treatment and at follow-ups through month 12. Results found that the CM-exercise condition demonstrated during-treatment improvements on several physical activity and relevant psychosocial functioning indices (e.g., self-efficacy for exercise). The CM-exercise condition had no advantage relative to the CM-general condition in decreasing substance use. Overall, this study adds to a small body of well-powered trials assessing effects of exercise interventions as adjunct treatment for substance use disorders and finds no benefit over an alternate CM approach in terms of drug abstinence. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Sheila M Alessi
- Department of Medicine and the Calhoun Cardiology Center - Behavioral Health Division
| | - Carla J Rash
- Department of Medicine and the Calhoun Cardiology Center - Behavioral Health Division
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Wang K, Luo J, Zhang T, Ouyang Y, Zhou C, Lu Y. Effect of Physical Activity on Drug Craving of Women With Substance Use Disorder in Compulsory Isolation: Mediating Effect of Internal Inhibition. Front Psychol 2019; 10:1928. [PMID: 31551851 PMCID: PMC6733992 DOI: 10.3389/fpsyg.2019.01928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 01/06/2023] Open
Abstract
Background Women with substance use disorder has attracted widespread attention as a prominent social issue. According to reports, physical exercise can improve the internal inhibition, effectively reduce the substance user's drug graving, and improve withdrawal symptoms, however, the specific mechanism of internal inhibition should be further considered. This study was designed to determine the critical role of internal inhibition in the path of physical exertion affecting the drug cravings of women drug users. Methods By means of Physical Activity Rating Scale (PARS-3), internal Inhibition Scale and Drug Craving Scale, this study investigated the individuals with substance use disorder under rehabilitation in the women compulsory isolation rehabilitation center in Chongqing, China. Results (1) Women with traditional drug users had the strongest internal inhibition and new drug use disorder had the highest drug craving. The longer the duration of drug abuse, the lower the internal inhibition and the higher the drug craving. Women with moderate-intensity activity had the strongest internal inhibition and the lowest drug craving. (2) The physical activity intensity was negatively correlated with drug craving, positively correlated with intrinsic inhibition, and negatively correlated with drug craving. (3) Internal inhibition played a partial mediating effect between physical activity intensity and drug craving. Conclusion Physical activity has a positive effect on inhibiting drug craving among drug addicts, while moderate-intensity activity seems to be more conducive to enhancing the internal inhibition of addicts, to improving their resistance to drugs, and thus more conducive to reducing drug craving.
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Affiliation(s)
- Kun Wang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Jiong Luo
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Tingran Zhang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Yiyi Ouyang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Chenglin Zhou
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yingzhi Lu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
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Abrantes AM, Blevins CE. Exercise in the context of substance use treatment: key issues and future directions. Curr Opin Psychol 2019; 30:103-108. [PMID: 31079012 DOI: 10.1016/j.copsyc.2019.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/19/2019] [Accepted: 04/01/2019] [Indexed: 01/09/2023]
Abstract
Substance Use Disorders (SUD) continue to be a significant public health concern. Exercise has been examined as an adjunctive approach to addiction treatment in an effort to improve mental health, physical health, and substance use outcomes. This review will present the existing evidence for the efficacy of exercise in the context of SUD treatment. In addition, we identify key factors, specific to this population, that may be contributing to treatment outcomes of exercise intervention studies. Lastly, we present a number of considerations for the development of more effective exercise interventions, in the future, with patients in SUD treatment.
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Affiliation(s)
- Ana M Abrantes
- Butler Hospital/Alpert Medical School of Brown University, United States.
| | - Claire E Blevins
- Butler Hospital/Alpert Medical School of Brown University, United States
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Huang J, Zheng Y, Gao D, Hu M, Yuan T. Effects of Exercise on Depression, Anxiety, Cognitive Control, Craving, Physical Fitness and Quality of Life in Methamphetamine-Dependent Patients. Front Psychiatry 2019; 10:999. [PMID: 32047445 PMCID: PMC6997340 DOI: 10.3389/fpsyt.2019.00999] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/17/2019] [Indexed: 01/23/2023] Open
Abstract
Methamphetamine (MA) abuse results in a variety of harmful changes in mood states and cognitive function, together with declined physical health and quality of life. Recent studies highlighted the therapeutic potential of physical exercise on MA addiction. Physical exercise improves emotional state and general health conditions, enhances cognitive function, reduces relapse rate, and facilitates abstinence, thereby improves the overall quality of life of the drug users. This review summarizes the present situation of physical exercise on MA-dependent patients with both animal and clinical population results.
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Affiliation(s)
- Junhao Huang
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, China
| | - Yuqing Zheng
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, China
| | - Dongdong Gao
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, China
| | - Min Hu
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
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Colledge F, Gerber M, Pühse U, Ludyga S. Anaerobic Exercise Training in the Therapy of Substance Use Disorders: A Systematic Review. Front Psychiatry 2018; 9:644. [PMID: 30564150 PMCID: PMC6288373 DOI: 10.3389/fpsyt.2018.00644] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/15/2018] [Indexed: 12/15/2022] Open
Abstract
Background: In the past 3 decades, there has been an increase in the number of studies assessing exercise as a form of treatment for substance use disorders (SUDs). While a variety of substance types and outcomes have been assessed, exercise intensities have never been systematically examined. Consequently, it remains unclear whether particular forms of exercise are better suited to the treatment of these populations. Anaerobic exercise has been shown to have positive effects in populations with psychiatric disorders, but its effectiveness in the treatment of SUDs has to date not been reviewed. Methods: The aim of this systematic review is to identify and evaluate studies which have employed either an acute or chronic anaerobic exercise component as a therapy modality for SUDs. The primary outcomes are abstinence, craving, withdrawal, consumption, quality of life, and the following psychological symptoms and disorders: depression, anxiety, stress, and mood. A secondary objective is to assess whether the type of training described in the study protocol can be reliably categorized as anaerobic training. Results: Twenty-six studies are included in this review. Twelve studies addressed nicotine dependence, one addressed alcohol dependence, and 13 addressed dependence on various illicit drugs. Thirteen studies reported the intensity at which participants actually exercised, but only one employed a test to determine whether training was carried out above the anaerobic threshold (AT). The risk of bias in the included studies was generally high. Results of the studies were mixed, with the most positive effects being found for abstinence in nicotine dependence. Conclusion: The evidence for the effects of anaerobic exercise in SUDs is weak, although a tendency toward positive effects on abstinence in nicotine dependent individuals was observable. The majority of studies do not report data on exercise intensity, making a categorization of anaerobic exercise impossible in all but one case. This means that the effects of this form of exercise cannot be determined, and therefore not evaluated or compared with other forms. In order to improve the quality of evidence for exercise in SUD treatment, clearly defined and objectively assessed evaluations of anaerobic and anaerobic exercise are necessary.
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Affiliation(s)
- Flora Colledge
- Departement für Sport, Bewegung und Gesundheit, Universität Basel, Basel, Switzerland
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Tosun NL, Allen SS, Eberly LE, Yao M, Stoops WW, Strickland JC, Harrison KA, al'Absi M, Carroll ME. Association of exercise with smoking-related symptomatology, smoking behavior and impulsivity in men and women. Drug Alcohol Depend 2018; 192:29-37. [PMID: 30199844 PMCID: PMC7257807 DOI: 10.1016/j.drugalcdep.2018.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/01/2018] [Accepted: 07/04/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Despite extensive efforts to develop effective smoking cessation interventions, 70-85% of American cigarette smokers who quit relapse within one year. Exercise has shown promise as an intervention; however, many results have been equivocal. This study explored how exercise is associated with smoking-related symptomatology, smoking behavior and impulsivity in male and female smokers. METHODS Participants were recruited throughout the United States using the on-line crowdsourcing platform, Amazon's Mechanical Turk. They completed a survey with self-report measures assessing exercise, smoking-related symptomatology, smoking behavior and impulsivity. Differences between men and women were tested using t- and chi-square tests. Regression analyses tested for associations between exercise and smoking-related symptomatology, smoking behavior and impulsivity. RESULTS Participants (N = 604) were, on average, 32 (SD = 6.2) years old, mostly Caucasian, with at least some college education and approximately half were women. Women exercised slightly less than men and had more negative affect, craving, physical symptoms and withdrawal. Women smoked more cigarettes per day, had greater nicotine dependency and more years of smoking. Positive affect was positively associated with exercise for both men and women; however, this association was significantly stronger in women. Negative affect and withdrawal were inversely associated with exercise for women only. Impulsivity was inversely associated with exercise for both men and women. CONCLUSION Exercise was significantly associated with several smoking-related symptomatology, smoking behavior and impulsivity variables for both men and women, suggesting that exercise may be a useful intervention for smoking cessation. Future prospective research should determine how exercise directly impacts smoking cessation.
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Affiliation(s)
- Nicole L Tosun
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States.
| | - Sharon S Allen
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States.
| | - Lynn E Eberly
- Division of Biostatistics, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States
| | - Meng Yao
- Division of Biostatistics, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - William W Stoops
- Department of Behavioral Science, University of Kentucky, 1100 Veterans Drive, Lexington, KY 40536, United States.
| | - Justin C Strickland
- Department of Psychology, University of Kentucky, 171 Funkhouser Drive, Lexington, KY 40506, United States.
| | - Katherine A Harrison
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States.
| | - Mustafa al'Absi
- Department of Behavioral Sciences, University of Minnesota, Duluth Campus, 1035 University Ave, Duluth, MN 55812, United States.
| | - Marilyn E Carroll
- Department of Psychiatry, University of Minnesota, MMC 392, 505 Essex St SE, Minneapolis, MN 55455, United States.
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Robison LS, Swenson S, Hamilton J, Thanos PK. Exercise Reduces Dopamine D1R and Increases D2R in Rats: Implications for Addiction. Med Sci Sports Exerc 2018; 50:1596-1602. [PMID: 29613999 DOI: 10.1249/mss.0000000000001627] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Exercise has been shown to be effective for preventing and treating substance abuse in both clinical and preclinical studies. Less is known, however, regarding the underlying neurobiological mechanisms driving these changes in drug-seeking behavior. One possibility is that exercise may alter the mesolimbic dopamine pathway in such a way that makes drugs of abuse less salient and/or rewarding. METHODS To examine possible exercise-induced changes in dopamine signaling, male and female Lewis rats were split into exercise and sedentary groups at 8 wk of age. Exercise rats were run on a treadmill at 10 m·min, 5 d·wk, for 6 wk, whereas sedentary rats remained in their home cage. Rats were killed after the 6 wk of treatment, and their brains were used for in vitro autoradiography using [H]SCH 23,390, [H]Spiperone, and [H]WIN55,428 ligands to quantify dopamine type 1-like receptor (D1R)-like, dopamine type 2-like receptor (D2R)-like, and dopamine transporter binding, respectively. RESULTS Exercised rats had 18% and 21% lower D1R-like binding levels compared to sedentary rats within the olfactory tubercle and nucleus accumbens shell, respectively. In addition, male and female exercise rats showed greater D2R-like binding levels within the dorsomedial caudate putamen (30%), ventrolateral caudate putamen (24%), and ventromedial caudate putamen (27%), as well as the olfactory tubercle (19%). Greater D2R-like binding in the nucleus accumbens core (24%) and shell (25%) of exercised rats compared with sedentary rats approached significance. No effects were found for dopamine transporter binding. CONCLUSIONS These findings support the hypothesis that aerobic exercise results in changes in the mesolimbic pathway that could mediate exercise-induced attenuation of drug-seeking behavior.
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Affiliation(s)
- Lisa S Robison
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY
| | - Sabrina Swenson
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, University at Buffalo, Buffalo, NY
| | - John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, University at Buffalo, Buffalo, NY
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, University at Buffalo, Buffalo, NY
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Carmody T, Greer TL, Walker R, Rethorst CD, Trivedi MH. A Complier Average Causal Effect Analysis of the Stimulant Reduction Intervention using Dosed Exercise Study. Contemp Clin Trials Commun 2018; 10:1-8. [PMID: 29682627 PMCID: PMC5898532 DOI: 10.1016/j.conctc.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Exercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causal effects (CACE) analysis was conducted to determine the potential effectiveness of adequately dosed exercise. Method The STimulant use Reduction Intervention using Dosed Exercise study was a randomized controlled trial comparing a 12 kcal/kg/week (KKW) exercise dose versus a health education control conducted at nine residential substance use treatment settings across the U.S. that are affiliated with the National Drug Abuse Treatment Clinical Trials Network. Participants were sedentary but medically approved for exercise, used stimulants within 30 days prior to study entry, and received a DSM-IV stimulant abuse or dependence diagnosis within the past year. A CACE analysis adjusted to include only participants with a minimum threshold of adherence (at least 8.3 KKW) and using a negative-binomial hurdle model focused on 218 participants who were 36.2% female, mean age 39.4 years (SD = 11.1), and averaged 13.0 (SD = 9.2) stimulant use days in the 30 days before residential treatment. The outcome was days of stimulant use as assessed by the self-reported TimeLine Follow Back and urine drug screen results. Results The CACE-adjusted analysis found a significantly lower probability of relapse to stimulant use in the exercise group versus the health education group (41.0% vs. 55.7%, p < .01) and significantly lower days of stimulant use among those who relapsed (5.0 days vs. 9.9 days, p < .01). Conclusions The CACE adjustment revealed significant, positive effects for exercise. Further research is warranted to develop strategies for exercise adherence that can ensure achievement of an exercise dose sufficient to produce a significant treatment effect.
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Affiliation(s)
| | | | | | | | - Madhukar H. Trivedi
- Corresponding author. Julie K. Hersh Chair for Depression Research and Clinical Care, Betty Jo Hay Distinguished Chair in Mental Health, Director, Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.
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Morais APD, Pita IR, Fontes‐Ribeiro CA, Pereira FC. The neurobiological mechanisms of physical exercise in methamphetamine addiction. CNS Neurosci Ther 2018; 24:85-97. [PMID: 29266758 PMCID: PMC6489779 DOI: 10.1111/cns.12788] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/15/2022] Open
Abstract
Methamphetamine (METH) is the primary drug within amphetamine-type stimulants which are the second most abused group of drugs worldwide. There is no pharmacological treatment addressed specifically to METH addiction, and behavioral therapy is shadowed by poor long-term recovery and relapse. Therefore, novel approaches to manage METH addiction are an urgent need. This review aims to describe the current state of physical exercise use on methamphetamine addiction management. The following searching terms in PubMed were used: ("physical exercise" OR "exercise") AND "methamphetamine." Relevant references from key publications and gray literature were also reviewed to identify additional citations for inclusion. Original investigation regarding physical exercise and methamphetamine addiction (clinical data) or neurobiological mechanisms of physical exercise in animal models of methamphetamine administration (preclinical data) was included. Overall, METH users demonstrated improvements, including better fitness and emotional measures, lower relapse rates, and sustained abstinence when compared to nonexercised individuals. The neurobiological mechanisms of physical exercise in METH users seem to reflect an interplay of several agents, including neurochemicals, oxidative stress, neurogenesis, gliogenesis, and blood-brain barrier as disclosed by preclinical data. Exercise-based interventions alone or as a conjoint therapy may be a useful tool for managing METH addiction.
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Affiliation(s)
- António Pedro Delgado Morais
- Institute of Pharmacology and Experimental Therapeutics/IBILIFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Inês Roque Pita
- Institute of Pharmacology and Experimental Therapeutics/IBILIFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Carlos Alberto Fontes‐Ribeiro
- Institute of Pharmacology and Experimental Therapeutics/IBILIFaculty of MedicineUniversity of CoimbraCoimbraPortugal
- CNC.IBILI—University of CoimbraCoimbraPortugal
| | - Frederico Costa Pereira
- Institute of Pharmacology and Experimental Therapeutics/IBILIFaculty of MedicineUniversity of CoimbraCoimbraPortugal
- CNC.IBILI—University of CoimbraCoimbraPortugal
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Lynch WJ, Abel J, Robinson AM, Smith MA. Exercise as a Sex-Specific Treatment for Substance Use Disorder. CURRENT ADDICTION REPORTS 2017; 4:467-481. [PMID: 29404264 PMCID: PMC5796660 DOI: 10.1007/s40429-017-0177-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Exercise is a promising treatment for substance use disorder that may reduce withdrawal symptoms and prevent relapse. In this review, we discuss recent evidence from clinical and preclinical studies for its efficacy, from a behavioral to a molecular level, in order to understand the exercise conditions that lead to beneficial effects. We also highlight the few recent findings of sex-specific differences. RECENT FINDINGS Clinical and preclinical findings show that exercise decreases withdrawal symptoms, including craving, in both males and females. Evidence from clinical studies support the efficacy of exercise to prevent relapse to smoking, although further research is needed to examine sex differences, establish long-term efficacy, and to determine if effects extend to other substance use disorders. Preclinical findings also support the potential utility of exercise to prevent relapse with evidence suggesting that its efficacy is enhanced in males, and mediated by blocking drug-induced adaptations that occur during early abstinence. SUMMARY Sex differences and timing of exercise availability during abstinence should be considered in future studies examining exercise as an intervention for relapse. A better understanding of the neurobiological mechanisms underlying the efficacy of exercise to reduce withdrawal symptoms and prevent relapse is needed to guide its development as a sex-specific treatment.
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Affiliation(s)
- Wendy J Lynch
- Associate Professor of Psychiatry and Neurobehavioral Sciences University of Virginia: P.O. Box 801402, Charlottesville, VA 22904 434-243-0580 (phone); 434-973-7031 (fax)
| | - Jean Abel
- Assistant Professor of Psychiatry and Neurobehavioral Sciences University of Virginia; P.O. Box 801402, Charlottesville, VA 22904-1402 434) 243-5767 (phone); 434-973-7031 (fax)
| | - Andrea M Robinson
- Postdoctoral Fellow of Psychology Davidson College: Box 7136 Davidson, NC 28035 704-894-3012 (phone); 704-894-2512 (fax)
| | - Mark A Smith
- Professor of Psychology Davidson College, Davidson, NC 28035 704-894-2470 (phone); 704-894-2512 (fax)
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Abstract
PURPOSE OF REVIEW Stimulant use disorders are significant contributors to the global burden of disease, with a growing impact on women. Psychosocial interventions are the gold standard for treating this condition, but several barriers may prevent women from accessing appropriate treatment. Therefore, we systematically reviewed the most recent findings about psychosocial interventions for stimulant use disorders, focussing on results relevant to women. RECENT FINDINGS Twenty-two eligible studies were identified. Psychosocial interventions in stimulant use disorders were examined in 17 recent studies, but no analyses for sex-related differences were performed. These aspects were investigated in further five studies, either through secondary analyses on the female subgroup or specifically examining a female-only sample. Contingency management, either alone or in combination with other interventions, provided the most positive results on several outcome measures. Only one pilot study showed good potential for an alternative approach of systemic family therapy, warranting further research in this direction. SUMMARY Research in stimulant use disorders shows an increasing interest in exploring interventions capable of addressing sex-specific issues. Combined therapy including contingency management and other treatments appears the most promising option, but larger secondary studies are needed to rank the efficacy of different psychosocial interventions while considering their feasibility and acceptability in specific subpopulations, including women.
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De La Garza R, Yoon JH, Thompson-Lake DG, Haile CN, Eisenhofer JD, Newton TF, Mahoney JJ. Treadmill exercise improves fitness and reduces craving and use of cocaine in individuals with concurrent cocaine and tobacco-use disorder. Psychiatry Res 2016; 245:133-140. [PMID: 27541349 PMCID: PMC5067203 DOI: 10.1016/j.psychres.2016.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/29/2016] [Accepted: 08/03/2016] [Indexed: 01/08/2023]
Abstract
Exercise may be a useful treatment for substance use disorders. Participants (N=24) included treatment-seeking individuals with concurrent cocaine and tobacco-use disorder (cigarette smokers). Participants were randomized to either running or walking (30min per session, 3 times per week) or sitting (control condition) for 4 consecutive weeks. Several metrics indicated significant differences among runners, walkers, and sitters during sessions, including mean distance covered and calories burned. In addition, remote physiological monitoring showed that the groups differed significantly according to mean maximum heart rate (HR), respiration, and locomotor activity. Across the 4-week study, exercise improved fitness measures including significantly decreasing resting HR. Though not statistically significant, exercise improved abstinence from cocaine and increased self-reports of no cocaine use in last 24h. In general, reductions in tobacco use and craving were not as robust. To our knowledge, this is the first study to evaluate the effects of a multi-week exercise program in individuals with concurrent cocaine and tobacco-use disorder. The data clearly show significant improvements in basic fitness measures and several indices reveal that exercise improved both self-report and biochemically verified reports of cocaine abstinence. Taken together, the data from this study provide preliminary evidence for the efficacy of exercise for improving fitness and reducing cocaine use.
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Affiliation(s)
- Richard De La Garza
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston, TX, USA.
| | - Jin H. Yoon
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, U.S.A.,Michael E. DeBakey VA Medical Center, Houston, TX, U.S.A
| | - Daisy G.Y. Thompson-Lake
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, U.S.A.,Michael E. DeBakey VA Medical Center, Houston, TX, U.S.A
| | - Colin N. Haile
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, U.S.A.,Michael E. DeBakey VA Medical Center, Houston, TX, U.S.A
| | - Joel D. Eisenhofer
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, U.S.A.,Michael E. DeBakey VA Medical Center, Houston, TX, U.S.A
| | - Thomas F. Newton
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, U.S.A.,Michael E. DeBakey VA Medical Center, Houston, TX, U.S.A
| | - James J. Mahoney
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, U.S.A.,Michael E. DeBakey VA Medical Center, Houston, TX, U.S.A
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