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Fascher M, Nowaczynski S, Muehlhan M. Substance use disorders are characterised by increased voxel-wise intrinsic measures in sensorimotor cortices: An ALE meta-analysis. Neurosci Biobehav Rev 2024; 162:105712. [PMID: 38733896 DOI: 10.1016/j.neubiorev.2024.105712] [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: 02/14/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
Substance use disorders (SUDs) are severe psychiatric illnesses. Seed region and independent component analyses are currently the dominant connectivity measures but carry the risk of false negatives due to selection. They can be complemented by a data-driven and whole-brain usage of voxel-wise intrinsic measures (VIMs). We meta-analytically integrated VIMs, namely regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), voxel-mirrored homotopy connectivity (VMHC) and degree centrality (DC) across different SUDs using the Activation Likelihood Estimation (ALE) algorithm, functionally decoded emerging clusters, and analysed their connectivity profiles. Our systematic search identified 51 studies including 1439 SUD participants. Although no overall convergent pattern of alterations across VIMs in SUDs was found, sensitivity analyses demonstrated two ALE-derived clusters of increased ReHo and ALFF in SUDs, which peaked in the left pre- and postcentral cortices. Subsequent analyses showed their involvement in action execution, somesthesis, finger tapping and vibrotactile monitoring/discrimination. Their numerous clinical correlates across included studies highlight the under-discussed role of sensorimotor cortices in SUD, urging a more attentive exploration of their clinical significance.
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Affiliation(s)
- Maximilian Fascher
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Am Kaiserkai 1, Hamburg 20457, Germany; ICAN Institute for Cognitive and Affective Neuroscience, Medical School Hamburg, Am Kaiserkai 1, Hamburg 20457, Germany.
| | - Sandra Nowaczynski
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Am Kaiserkai 1, Hamburg 20457, Germany; ICAN Institute for Cognitive and Affective Neuroscience, Medical School Hamburg, Am Kaiserkai 1, Hamburg 20457, Germany; Department of Addiction Medicine, Carl-Friedrich-Flemming-Clinic, Helios Medical Center Schwerin, Wismarsche Str. 393, Schwerin 19055, Germany
| | - Markus Muehlhan
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Am Kaiserkai 1, Hamburg 20457, Germany; ICAN Institute for Cognitive and Affective Neuroscience, Medical School Hamburg, Am Kaiserkai 1, Hamburg 20457, Germany
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2
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Mancheño-Velasco C, Narváez-Camargo M, Dacosta-Sánchez D, Sánchez-García M, Lozano ÓM. Examining Profiles and Treatment Outcomes in Dual Diagnosis: Comparison of Coordinated Treatment With Mental Health Services Versus Addiction Center Alone. A Real-World Data Analysis. J Dual Diagn 2024; 20:266-278. [PMID: 38478999 DOI: 10.1080/15504263.2024.2323976] [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: 06/28/2024]
Abstract
OBJECTIVE The aim of this work was to examine the profile and treatment outcomes of patients with dual pathology depending on whether the patients were attending addiction centers or are being treated in a coordinated model by mental health services. METHODS Data from 7225 dual diagnosis patients were used, of whom 2417 (33.5%) received treatment in the mental health coordinated modality. Clinical information was taken from the patients' electronic health record. RESULTS Differences were found in patients' sociodemographic and comorbidity profiles according to treatment modality. In general, coordinated care yielded favorable outcomes (higher attendance and lower dropout rates but no differences in retention). The logistic regression analysis identified predictors of patient profiles in coordinated care, emphasizing having a severe mental health disorder (OR = 3.878, 95% CI [3.443, 4.368]; p = .000), being referred by social/health services, or having retired status. Main differences were observed according to the comorbid diagnosis presented, particularly in cases in which the patient had impulse control, hyperkinetic, or cluster C personality disorder. CONCLUSIONS While therapeutic outcomes are influenced by associated comorbidities, the disorders prognosis can be favorable with appropriate treatment. Furthermore, analysis of differences according to treatment modality allows for predicting the type of patient who will receive a particular service, which enables the development of tailored treatments.
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Affiliation(s)
| | - Marta Narváez-Camargo
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
| | | | - Manuel Sánchez-García
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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Cristina Bianchi P, Palombo P, Antonagi Engi S, Eduardo Carneiro de Oliveira P, Emily Boaventura Tavares G, Anjos-Santos A, Suemi Yokoyama T, da Silva Planeta C, Cardoso Cruz F, Molini Leão R. Involvement of Pre-limbic Cortex-Nucleus accumbens projections in Context-Induced alcohol seeking. Brain Res 2024; 1841:149086. [PMID: 38876319 DOI: 10.1016/j.brainres.2024.149086] [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: 02/26/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
Alcohol use disorder (AUD) remains a critical public health issue worldwide, characterized by high relapse rates often triggered by contextual cues. This research investigates the neural mechanisms behind context-induced reinstatement of alcohol-seeking behavior, focusing on the nucleus accumbens and its interactions with the prelimbic cortex, employing Male Long-Evans rats in an ABA renewal model. In our experimental setup, rats were trained to self-administer 10 % ethanol in Context A, followed by extinction of lever pressing in the presence of discrete cues in Context B. The context-induced reinstatement of ethanol-seeking was then assessed by re-exposing rats to Context A or B under extinction conditions, aiming to simulate the environmental cues' influence on relapse behaviors. Three experiments were conducted: Experiment 1 utilized Fos-immunohistochemistry to examine neuronal activation in the nucleus accumbens; Experiment 2 applied the baclofen + muscimol inactivation technique to probe the functional importance of the nucleus accumbens core; Experiment 3 used Fos-immunofluorescence along with Retrobeads injection to investigate activation of neurons projecting from the prelimbic cortex to the nucleus accumbens core. Our findings revealed significant increases in Fos-immunoreactive nuclei within the nucleus accumbens core and shell during the reinstatement phase in Context A, underscoring the environment's potent effect on ethanol-seeking behavior. Additionally, inactivation of the nucleus accumbens core markedly reduced reinstatement, and there was a notable activation of neurons from the prelimbic cortex to the nucleus accumbens core in the ethanol-associated context. These results highlight the critical role of the nucleus accumbens core and its corticostriatal projections in the neural circuitry underlying context-driven ethanol seeking.
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Affiliation(s)
- Paula Cristina Bianchi
- Laboratory of Behavioral Neuroscience, Paulista Medicine School, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Paola Palombo
- Laboratory of Behavioral Neuroscience, Paulista Medicine School, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Sheila Antonagi Engi
- Laboratory of Behavioral Neuroscience, Paulista Medicine School, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | | | | | - Alexia Anjos-Santos
- Laboratory of Behavioral Neuroscience, Paulista Medicine School, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Thais Suemi Yokoyama
- Laboratory of Behavioral Neuroscience, Paulista Medicine School, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Cleopatra da Silva Planeta
- Laboratory of Neuropsychopharmacology, School of Pharmaceutical Sciences, São Paulo State University, UNESP, Araraquara, SP, Brazil
| | - Fabio Cardoso Cruz
- Laboratory of Behavioral Neuroscience, Paulista Medicine School, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Rodrigo Molini Leão
- Laboratory of Pharmacology, Biomedical Sciences Institute, Department of Pharmacology, Federal University of Uberlândia, Uberlândia, MG, Brazil; Graduate Program in Genetics and Biochemistry, Institute of Biotechnology, Federal University of Uberlândia/MG, Brazil.
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Del Palacio-Gonzalez A, Thylstrup B, Rømer Thomsen K. Psychological factors predicting patients' risk of relapse after enrollment in drug use treatment: A systematic review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209354. [PMID: 38556252 DOI: 10.1016/j.josat.2024.209354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/09/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND AIMS Despite high rates of relapse after treatment for drug use, to our knowledge there is no systematic literature identifying psychological factors that predict risk of relapse to drug use (excluding alcohol or tobacco). Our aim was to identify psychological factors that predict risk of relapse to drug use after enrollment in drug use treatment. The identification of such factors can support treatment planning and relapse prevention. METHODS We searched for peer-reviewed articles published between 2000 and 2023 in PsycINFO, PsycArticles, Web of Science, and PubMed. The inclusion criteria were: peer-reviewed publications, quantitative studies, in English, adult samples, with a prospective design, and analyses of minimum one psychological factor as predictor of relapse to drug use. All authors were involved in abstract and full-text screening, and in assessing risk of bias. The findings are presented in a narrative synthesis and tables are organized by type of drug. RESULTS Of 2226 publications initially identified, 45 were eligible. Twenty-three focused on predicting relapse to stimulants, 15 to opioids, and 7 to unspecified drugs. Substance use at baseline was an important factor predicting risk of relapse to opioids, and possibly stimulants. There was an indication that craving and attention problems potentially predict relapse to use of some drugs. Mental health factors (e.g., psychiatric diagnosis) did not predict relapse. Several psychological factors (e.g., cognition, emotion, personality, motivation) were scarcely examined. Over half of the studies had moderate to high risk of bias. CONCLUSIONS Based on the 45 studies, few psychological factors predicted risk of relapse to drug use. Higher comparability between studies and more rigorous methodology are necessary in order to derive more precise recommendations that inform and improve clinical practice. PRE-REGISTRATION PROSPERO, CRD42020182839.
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Affiliation(s)
- Adriana Del Palacio-Gonzalez
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 10, Building 1322. Aarhus C, 8000, Denmark.
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 10, Building 1322. Aarhus C, 8000, Denmark
| | - Kristine Rømer Thomsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 10, Building 1322. Aarhus C, 8000, Denmark
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Moore J, Castro Y, DiNitto D, Hernandez M, Velasquez M. Sociodemographic and treatment-related determinants of recent substance use among adults with comorbid substance misuse and psychotic disorders discharged from substance use treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209349. [PMID: 38494053 DOI: 10.1016/j.josat.2024.209349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Rates of alcohol and illicit substance use are higher among persons with psychotic disorders relative to the general population. The adverse health and psychological effects of substance use behaviors disproportionately impact persons with psychotic disorders. Prior research has shown that persons with psychotic disorders experience increased difficulty in reducing substance use behaviors, and interventions targeting substance use behavior change among this population have demonstrated limited effectiveness. One reason for this is that little is known about the factors that influence substance use and behavior change among this population. To address these disparities, the present study investigated sociodemographic and treatment-related factors of substance use recurrence among persons with psychotic disorders who received substance use treatment services. METHODS Data came from the 2015-2018 Treatment Episode Dataset-Discharges (TEDS-D). TEDS-D collects annual data on adolescent and adult discharges from state-certified substance use treatment centers in the United States. The study conducted all analyses with a subsample of 1956 adult discharges with a psychotic disorder who received services from an outpatient substance use treatment center for at least one month. χ2 tests of independence and multivariable logistic regression analyses were used to examine associations of sociodemographic and treatment-related characteristics with substance use recurrence while in treatment (α < 0.05 analyses). The study presents results from multivariable logistic regression models as adjusted odds ratios (AORs) with 95 % confidence intervals (CI). RESULTS Those who were age 50 or older, were referred to treatment by the criminal justice system, and attended substance use self-help groups had lower odds of substance use recurrence while in treatment. Sex, educational attainment, employment status, living situation, type of substance use, and treatment history were not significantly associated with substance use recurrence. CONCLUSIONS In designing treatment services, providers should consider whether focusing on sociodemographic, including cultural, factors can affect more positive substance use behavior change and other desired treatment outcomes among those with psychotic disorders and comorbid substance misuse. Further study is needed to identify these factors among specific subpopulations of those with psychotic disorders and substance misuse.
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Affiliation(s)
- John Moore
- Florida State University, College of Social Work, 296 Champions Way, Tallahassee, FL 32304, United States of America.
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, United States of America
| | - Diana DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, United States of America
| | - Mercedes Hernandez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, United States of America
| | - Mary Velasquez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, United States of America
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Viera A, Ondrusek A, Tengatenga C, McBurney E, Lauckner J, Tran E, Muilenburg J, Kershaw T, Lauckner C. A Qualitative Exploration of Attitudes Toward Global Positioning System Tracking and Ecological Momentary Assessment Among Individuals in Substance Use Treatment. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:260-267. [PMID: 38258809 DOI: 10.1177/29767342231218514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The use of tracking technology in substance use research can uncover the role of contextual factors, such as social networks and environmental cues, in triggering cravings and precipitating return to use. Few studies have explored the opinions of individuals in substance use treatment related to tracking technology. METHODS We conducted 30 semi-structured interviews with individuals in substance use treatment facilities in Connecticut and Georgia. Interviews were not limited to individuals with any specific substance use disorder. Interviewers described a hypothetical study involving ecological momentary assessment and global positioning system tracking to examine place-based predictors of substance use. Participants were invited to share reactions to this description. We used thematic analysis to identify themes in participant perceptions of this hypothetical research study. RESULTS Most participants shared positive opinions about study participation and expressed little to no concern about the tracking components. Participant concerns focused on the security of their information and the potential burden of responding to study questions. Participants largely understood the importance of study participation for promoting greater understanding of substance use and identified potential therapeutic effects of study participation on their own recovery. CONCLUSIONS Individuals in substance use treatment expressed little concern with research studies or interventions incorporating mobile-tracking elements. Future studies should explore the responsible use of tracking elements in recovery support interventions.
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Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Ashlin Ondrusek
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Cecil Tengatenga
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Erin McBurney
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - John Lauckner
- Substance Use Research Priority Area, University of Kentucky, Lexington, KY, USA
| | - Emma Tran
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Jessica Muilenburg
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, Athens, GA, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Carolyn Lauckner
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Ciner OA, Cilli AS, Yazici AB, Bakay H, Gica Ş. The effect of chronotypes on follow-up outcomes of patients with substance use disorder. Sleep Biol Rhythms 2024; 22:247-258. [PMID: 38524170 PMCID: PMC10959913 DOI: 10.1007/s41105-023-00496-8] [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: 06/07/2023] [Accepted: 10/06/2023] [Indexed: 03/26/2024]
Abstract
Substance use disorder (SUD) can have circadian characteristics and individuals with evening chronotype are more prone to addiction. In this study, the effect of chronotypes on the treatment outcomes of SUD was investigated. The study included 66 patients who were diagnosed with SUD according to DSM-5. Two clinical interviews were conducted at 6-month intervals, and remission/relapse status was evaluated at the second interview. The Structured Clinical Interview Form for DSM-IV Axis I Disorders (SCID-I), Addiction Profile Index Practitioner Form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburg Sleep Quality Index and Morningness-Eveningness Questionnaire (MEQ) were applied to the patients. MEQ scores of relapsed patients were found to be different in terms of eveningness than those in remission (45.62 ± 8.70 versus 49.75 ± 7.60, p = 0.045). As the craving and addiction profile index total scores (addiction severity) increased, eveningness chronotype scores also increased (r = - 0.387 and r = - 0.286, respectively). The mean scores of craving and BDI were higher in relapsed patients compared to those in remission (p = 0.003 and p = 0.015, respectively). Our results suggest that patients with SUD had a lower morningness chronotype than the general population; additionally, more relapsed patients had an eveningness chronotype. Thus, chronotypes may play a role in the onset, prevention, and treatment outcome of SUD.
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Affiliation(s)
- Ozlem Akcay Ciner
- Department of Psychiatry, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Ali Savas Cilli
- Department of Psychiatry, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Ahmet Bulent Yazici
- Department of Psychiatry, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Hasan Bakay
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, Yunus Emre Mah. Beyşehir Cad. No: 281, Meram, 42090 Konya, Turkey
| | - Şakir Gica
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, Yunus Emre Mah. Beyşehir Cad. No: 281, Meram, 42090 Konya, Turkey
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Hunt A, Merola GP, Carpenter T, Jaeggi AV. Evolutionary perspectives on substance and behavioural addictions: Distinct and shared pathways to understanding, prediction and prevention. Neurosci Biobehav Rev 2024; 159:105603. [PMID: 38402919 DOI: 10.1016/j.neubiorev.2024.105603] [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: 12/29/2023] [Revised: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
Addiction poses significant social, health, and criminal issues. Its moderate heritability and early-life impact, affecting reproductive success, poses an evolutionary paradox: why are humans predisposed to addictive behaviours? This paper reviews biological and psychological mechanisms of substance and behavioural addictions, exploring evolutionary explanations for the origin and function of relevant systems. Ancestrally, addiction-related systems promoted fitness through reward-seeking, and possibly self-medication. Today, psychoactive substances disrupt these systems, leading individuals to neglect essential life goals for immediate satisfaction. Behavioural addictions (e.g. video games, social media) often emulate ancestrally beneficial behaviours, making them appealing yet often irrelevant to contemporary success. Evolutionary insights have implications for how addiction is criminalised and stigmatised, propose novel avenues for interventions, anticipate new sources of addiction from emerging technologies such as AI. The emerging potential of glucagon-like peptide 1 (GLP-1) agonists targeting obesity suggest the satiation system may be a natural counter to overactivation of the reward system.
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Affiliation(s)
- Adam Hunt
- Institute of Evolutionary Medicine, University of Zürich, Zürich, Switzerland.
| | | | - Tom Carpenter
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Adrian V Jaeggi
- Institute of Evolutionary Medicine, University of Zürich, Zürich, Switzerland
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Schenkel EJ, Rinck M, Wiers RW, Becker ES, Muhlig S, Schoeneck R, Lindenmeyer J. Implementing Approach-Bias Modification as Add-On to Varieties of Clinical Treatment for Alcohol Use Disorders: Results of a Multicenter RCT. Eur Addict Res 2024; 30:94-102. [PMID: 38503273 DOI: 10.1159/000537811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches. METHODS A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment. RESULTS Return rates of the post-treatment assessments varied greatly between clinics, often being low (18-76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists. DISCUSSION/CONCLUSION ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence.
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Affiliation(s)
- Edwin J Schenkel
- Department of Psychology, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
- Salus Clinic Lindow, Lindow, Germany
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Reinout W Wiers
- Department of Psychology, Addiction Development and Psychopathology (ADAPT) Lab, ABC and Yield Research Priority Areas, University of Amsterdam, Amsterdam, The Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Stephan Muhlig
- Department of Psychology, Chemnitz University of Technology, Chemnitz, Germany
| | | | - Johannes Lindenmeyer
- Department of Psychology, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
- Salus Clinic Lindow, Lindow, Germany
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Alonso-Lozares I, Wilbers P, Asperl L, Teijsse S, van der Neut C, Schetters D, van Mourik Y, McDonald AJ, Heistek T, Mansvelder HD, De Vries TJ, Marchant NJ. Lateral hypothalamic GABAergic neurons encode alcohol memories. Curr Biol 2024; 34:1086-1097.e6. [PMID: 38423016 DOI: 10.1016/j.cub.2024.01.076] [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: 11/16/2023] [Revised: 01/02/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
In alcohol use disorder, the alcohol memories persist during abstinence, and exposure to stimuli associated with alcohol use can lead to relapse. This highlights the importance of investigating the neural substrates underlying not only relapse but also encoding and expression of alcohol memories. GABAergic neurons in the lateral hypothalamus (LH-GABA) have been shown to be critical for food-cue memories and motivation; however, the extent to which this role extends to alcohol-cue memories and motivations remains unexplored. In this study, we aimed to describe how alcohol-related memories are encoded and expressed in LH GABAergic neurons. Our first step was to monitor LH-GABA calcium transients during acquisition, extinction, and reinstatement of an alcohol-cue memory using fiber photometry. We trained the rats on a Pavlovian conditioning task, where one conditioned stimulus (CS+) predicted alcohol (20% EtOH) and another conditioned stimulus (CS-) had no outcome. We then extinguished this association through non-reinforced presentations of the CS+ and CS- and finally, in two different groups, we measured relapse under non-primed and alcohol-primed induced reinstatement. Our results show that initially both cues caused increased LH-GABA activity, and after learning only the alcohol cue increased LH-GABA activity. After extinction, this activity decreases, and we found no differences in LH-GABA activity during reinstatement in either group. Next, we inhibited LH-GABA neurons with optogenetics to show that activity of these neurons is necessary for the formation of an alcohol-cue association. These findings suggest that LH-GABA might be involved in attentional processes modulated by learning.
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Affiliation(s)
- Isis Alonso-Lozares
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Pelle Wilbers
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Lina Asperl
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Sem Teijsse
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Charlotte van der Neut
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Dustin Schetters
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Yvar van Mourik
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Allison J McDonald
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Tim Heistek
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam 1081 HZ, the Netherlands
| | - Huibert D Mansvelder
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam 1081 HZ, the Netherlands
| | - Taco J De Vries
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands
| | - Nathan J Marchant
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam 1081 HZ, the Netherlands; Compulsivity Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam 1081 HZ, the Netherlands.
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Skeva R, Jay C, Pettifer S, Gregg L. Alcohol Treatment Preferences and the Acceptability of Virtual Reality Therapy for Treating Alcohol Misuse in Adult Drinkers. Alcohol 2024:S0741-8329(24)00040-5. [PMID: 38461958 DOI: 10.1016/j.alcohol.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Rigina Skeva
- Advanced Interfaces-Visual Computing, Department of Computer Science, Faculty of Science and Engineering, University of Manchester.
| | - Caroline Jay
- Information Management, Department of Computer Science, Faculty of Science and Engineering, University of Manchester
| | - Steve Pettifer
- Advanced Interfaces-Visual Computing, Department of Computer Science, Faculty of Science and Engineering, University of Manchester
| | - Lynsey Gregg
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester
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12
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Stone BM. Development of the Enthusiastic Substance Use Attitudes Scale: Preliminary Evidence of a Novel Maintenance Factor. Subst Use Misuse 2024; 59:494-509. [PMID: 38269533 DOI: 10.1080/10826084.2023.2280592] [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: 01/26/2024]
Abstract
Background: Expectancies, motives, and attitudes toward substances are cognitive factors that partially account for substance use; however, existing measures tend to have monotonous phrasing, diverging from the enthusiastic attitude toward the perceived benefits of substance use exhibited by those who use substances regularly in informal settings. Objective: I aimed to characterize a new cognitive maintenance factor that precedes substance use by creating a brief, multidimensional measure to capture this tone nuance, which I called the Enthusiastic Substance Use Attitudes Scale (ESUAS). Method: Undergraduate students (n = 198) between ages 18 and 62 (M = 19.15, SD = 3.65; 66.2% women; 71.71% White) completed the study for course credit. Results: I used exploratory and confirmatory factor analyses to reduce a 90-item item pool based on a comprehensive qualitative thematic analysis of social media, traditional media, and the scientific literature to an 18-item hierarchical bifactor model. This model contained nine specific factors, which are (1) sociability, (2) enjoyment, (3) physical health, (4) mental health, (5) relaxation, (6) personal growth, (7) performance enhancement, (8) boredom, and (9) life processing; two general factors, which are (1) substance-induced emotion regulation and (2) substance-based assistance; and a higher-order single factor above the nine specific factors - resulting in twelve highly internally consistent, empirically supported scales. Further, the ESUAS demonstrated excellent structural, convergent, divergent, incremental, and diagnostic validity. The degree of enthusiasm towards substance use positively related to substance use disorder symptomology, polysubstance use, neuroticism, and difficulty with regulating emotions while negatively relating to one's psychological quality of life and agreeableness. Conclusion: The ESUAS may be an effective tool for professionals to characterize these enthusiastic attitudes further and measure a more ecologically valid view of the perceived benefits of substance use among those who use substances, thereby developing a more compassionate, non-stigmatizing understanding within the general public, advancing medicinal uses of illicit substances, and improving conceptualizations and treatments.
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Affiliation(s)
- Bryant M Stone
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Psychology, Southern Illinois University, Carbondale, Illinois, USA
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13
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Lai D, Kuo SIC, Wetherill L, Aliev F, Zhang M, Abreu M, Schwantes-An TH, Dick D, Francis MW, Johnson EC, Kamarajan C, Kinreich S, Kuperman S, Meyers J, Nurnberger JI, Liu Y, Edenberg HJ, Porjesz B, Agrawal A, Foroud T, Schuckit M, Plawecki MH, Bucholz KK, McCutcheon VV. Associations between alcohol use disorder polygenic score and remission in participants from high-risk families and the Indiana Biobank. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:283-294. [PMID: 38054532 PMCID: PMC10922306 DOI: 10.1111/acer.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND In the United States, ~50% of individuals who meet criteria for alcohol use disorder (AUD) during their lifetimes do not remit. We previously reported that a polygenic score for AUD (PGSAUD ) was positively associated with AUD severity as measured by DSM-5 lifetime criterion count, and AUD severity was negatively associated with remission. Thus, we hypothesized that PGSAUD would be negatively associated with remission. METHODS Individuals of European (EA) and African ancestry (AA) from the Collaborative Study on the Genetics of Alcoholism (COGA) who met lifetime criteria for AUD, and two EA cohorts ascertained for studies of liver diseases and substance use disorders from the Indiana Biobank were included. In COGA, 12-month remission was defined as any period of ≥12 consecutive months without meeting AUD criteria except craving and was further categorized as abstinent and non-abstinent. In the Indiana Biobank, remission was defined based on ICD codes and could not be further distinguished as abstinent or non-abstinent. Sex and age were included as covariates. COGA analyses included additional adjustment for AUD severity, family history of remission, and AUD treatment history. RESULTS In COGA EA, PGSAUD was negatively associated with 12-month and non-abstinent remission (p ≤ 0.013, βs between -0.15 and -0.10) after adjusting for all covariates. In contrast to the COGA findings, PGSAUD was positively associated with remission (p = 0.004, β = 0.28) in the Indiana Biobank liver diseases cohort but not in the Indiana Biobank substance use disorder cohort (p = 0.17, β = 0.15). CONCLUSIONS PGSAUD was negatively associated with 12-month and non-abstinent remission in COGA EA, independent of behavioral measures of AUD severity and family history of remission. The discrepant results in COGA and the Indiana Biobank could reflect different ascertainment strategies: the Indiana Biobank participants were older and had higher rates of liver disease, suggesting that these individuals remitted due to alcohol-related health conditions that manifested in later life.
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Affiliation(s)
- Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Fazil Aliev
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Michael Zhang
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Marco Abreu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Tae-Hwi Schwantes-An
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Danielle Dick
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | | | - Emma C. Johnson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Chella Kamarajan
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - Sivan Kinreich
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - Samuel Kuperman
- Department of Psychiatry, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA
| | - Jacquelyn Meyers
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - John I Nurnberger
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Yunlong Liu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Howard J Edenberg
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Marc Schuckit
- Department of Psychiatry, University of California, San Diego Medical School, San Diego, CA
| | - Martin H. Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kathleen K. Bucholz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Vivia V. McCutcheon
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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14
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Biosca-Brull J, Ona G, Alarcón-Franco L, Colomina MT. A transcriptomic analysis in mice following a single dose of ibogaine identifies new potential therapeutic targets. Transl Psychiatry 2024; 14:41. [PMID: 38242896 PMCID: PMC10798990 DOI: 10.1038/s41398-024-02773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024] Open
Abstract
Ibogaine (IBO) is an atypical psychedelic with a complex mechanism of action. To date, the mechanisms that may underlie its anti-addictive effects are still not defined. This study aims to identify changes in gene expression induced by a single oral dose of IBO in the cortex of mice by means of a transcriptomic analysis for the first time. Our results showed significant alterations in gene expression in mouse frontal cortex samples 4 h after a single oral dose of IBO. Specifically, genes involved in hormonal pathways and synaptogenesis exhibited upregulation, while genes associated with apoptotic processes and endosomal transports showed downregulation. The findings were further corroborated through quantitative polymerase chain reaction (qPCR) analysis. However, the validation of gene expression related to hormonal pathways did not entirely align with the transcriptomic analysis results, possibly due to the brain region from which tissue was collected. Sex differences were observed, with female mice displaying more pronounced alterations in gene expression after IBO treatment. High variability was observed across individual animals. However, this study represents a significant advancement in comprehending IBO's molecular actions. The findings highlight the influence of IBO on gene expression, particularly on hormonal pathways, synaptogenesis, apoptotic processes, and endosomal transports. The identification of sex differences underscores the importance of considering sex as a potential factor influencing IBO's effects. Further research to assess different time points after IBO exposure is warranted.
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Affiliation(s)
- Judit Biosca-Brull
- Universitat Rovira i Virgili, Research Group in Neurobehavior and Health (NEUROLAB), Tarragona, Spain
- Universitat Rovira i Virgili, Department of Psychology and Research Center for Behavior Assessment (CRAMC), Tarragona, Spain
- Universitat Rovira i Virgili, Center of Environmental, Food and Toxicological Technology (TECNATOX), Reus, Spain
| | - Genis Ona
- ICEERS-International Center for Ethnobotanical Education, Research, and Services, Barcelona, Spain
- Universitat Rovira i Virgili, Department of Anthropology, Philosophy and Social Work, Tarragona, Spain
| | - Lineth Alarcón-Franco
- Universitat Rovira i Virgili, Research Group in Neurobehavior and Health (NEUROLAB), Tarragona, Spain
- Grupo de Investigación Infetarre, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Maria Teresa Colomina
- Universitat Rovira i Virgili, Research Group in Neurobehavior and Health (NEUROLAB), Tarragona, Spain.
- Universitat Rovira i Virgili, Department of Psychology and Research Center for Behavior Assessment (CRAMC), Tarragona, Spain.
- Universitat Rovira i Virgili, Center of Environmental, Food and Toxicological Technology (TECNATOX), Reus, Spain.
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Campbell AG, Naz S, Gharbi S, Chambers J, Denne S, Litzelman DK, Wiehe SE. The Concordance of Electronic Health Record Diagnoses and Substance use Self-Reports Among Reproductive Aged Women Enrolled in a Community-Based Addiction Reduction Program. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237051. [PMID: 38528783 DOI: 10.1177/00469580241237051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Substance use disorders among reproductive aged women are a major public health issue. There is little work investigating the validity and reliability of electronic health record (EHR) data for measuring substance use in this population. This study examined the concordance of self-reported substance use with clinical diagnoses of substance use, substance abuse and substance use disorder in EHR data. Reproductive age women enrolled in the Community-Based Addiction Reduction (CARE) program were interviewed by peer recovery coaches (PRC) at enrollment. That survey data was linked with EHR data (n = 102). Concordance between self-reported substance use and clinical diagnoses in the EHR was examined for opioids, cannabis/THC, and cocaine. Cohen's kappa, sensitivity, and specificity were calculated. The survey captured a higher number of women who use substances compared to the EHR. The concordance of self-report with EHR diagnosis varied by substance and was higher for opioids (17.6%) relative to cannabis/THC (8.8%), and cocaine (3.0%). Additionally, opioids had higher sensitivity (46.2%) and lower specificity (76.2%) relative to cannabis/THC and cocaine. Survey data collected by PRCs captured more substance use than EHRs, suggesting that EHRs underestimate substance use prevalence. The higher sensitivity and lower specificity of opioids was due to a larger number of women who had a diagnosis of opioid use in the EHR who did not self-report opioid use in the self-report survey relative to cannabis/THC and cocaine. Opioid self-report and diagnosis may be influenced by research setting, question wording, or receipt of medication for opioid use disorder.
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Affiliation(s)
| | - Saman Naz
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sami Gharbi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joanna Chambers
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Scott Denne
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Debra K Litzelman
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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16
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Conlin WE, Hoffman M, Steinley D, Vergés A, Sher KJ. Predictors of symptom course in alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2288-2300. [PMID: 38151783 PMCID: PMC10935605 DOI: 10.1111/acer.15201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Symptoms often play an important role in the scientific inquiry of psychological disorders and have been theorized to play a functional role in the disorders themselves. However, little is known about the course of specific symptoms and individual differences in course. Understanding the course of specific symptoms and factors influencing symptom course can inform psychological theory and future research on course and treatment. METHODS The current study examined alcohol use disorder (AUD) criteria to explore how etiologically relevant covariates differentially affected the course of individual criteria. The study examined 34,653 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), to analyze the extent to which AUD symptom course is predicted by alcohol consumption patterns, family history of alcoholism, the presence of internalizing and externalizing disorders, and race. RESULTS The course of all AUD criteria was significantly influenced by these predictors, with the magnitude of the influence varying across different criteria and different aspects of the course (i.e., onset, persistence, recurrence). The strength of the relationship is partially related to the theoretical proximity of a given covariate to AUD symptomatology, with heavy drinking being the strongest and family history of AUD being the weakest. The course of all criteria was strongly associated with the prevalence of the criterion in the overall sample. CONCLUSIONS The course of AUD criteria is heterogeneous, appearing to be influenced by conceptually proximal predictors, the prevalence of the criterion, and perhaps an underlying common factor. Diagnostic accuracy may be improved by including a criterion related to alcohol consumption. Future work should include exploring the interchangeability of criteria and alternative operationalization of them.
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Affiliation(s)
- William E. Conlin
- Department of Psychological Sciences, University of Missouri, Missouri, Columbia, USA
| | - Michaela Hoffman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, South Carolina, Charleston, USA
| | - Douglas Steinley
- Department of Psychological Sciences, University of Missouri, Missouri, Columbia, USA
| | - Alvaro Vergés
- Universidad de los Andes, Escuela de Psicología, Las Condes, Chile
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes, Michigan, Imhay, USA
| | - Kenneth J. Sher
- Department of Psychological Sciences, University of Missouri, Missouri, Columbia, USA
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17
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Quddos F, Hubshman Z, Tegge A, Sane D, Marti E, Kablinger AS, Gatchalian KM, Kelly AL, DiFeliceantonio AG, Bickel WK. Semaglutide and Tirzepatide reduce alcohol consumption in individuals with obesity. Sci Rep 2023; 13:20998. [PMID: 38017205 PMCID: PMC10684505 DOI: 10.1038/s41598-023-48267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023] Open
Abstract
Alcohol Use Disorder (AUD) contributes significantly to global mortality. GLP-1 (Glucagon-like peptide-1) and GLP-1/GIP (Glucose-dependent Insulinotropic Polypeptide) agonists, FDA-approved for managing type 2 diabetes and obesity, where the former has shown to effectively reduce the consumption of alcohol in animal models but no reports exist on the latter. In this report, we conducted two studies. In the first study, we conducted an analysis of abundant social media texts. Specifically, a machine-learning based attribution mapping of ~ 68,250 posts related to GLP-1 or GLP-1/GIP agonists on the Reddit platform. Secondly, we recruited participants (n = 153; current alcohol drinkers; BMI ≥ 30) who self-reported either taking Semaglutide (GLP-1 agonist), Tirzepatide (the GLP-1/GIP combination) for ≥ 30 days or, as a control group; no medication to manage diabetes or weight loss for a within and between subject remote study. In the social media study, we report 8 major themes including effects of medications (30%); diabetes (21%); and Weight loss and obesity (19%). Among the alcohol-related posts (n = 1580), 71% were identified as craving reduction, decreased desire to drink, and other negative effects. In the remote study, we observe a significantly lower self-reported intake of alcohol, drinks per drinking episode, binge drinking odds, Alcohol Use Disorders Identification Test (AUDIT) scores, and stimulating, and sedative effects in the Semaglutide or Tirzepatide group when compared to prior to starting medication timepoint (within-subjects) and the control group (between-subjects). In summary, we provide initial real-world evidence of reduced alcohol consumption in people with obesity taking Semaglutide or Tirzepatide medications, suggesting potential efficacy for treatment in AUD comorbid with obesity.
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Affiliation(s)
- Fatima Quddos
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine, and Health, Blacksburg, VA, USA
| | - Zachary Hubshman
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Allison Tegge
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - Daniel Sane
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Erin Marti
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | | | | | - Amber L Kelly
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine, and Health, Blacksburg, VA, USA
| | | | - Warren K Bickel
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA.
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18
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Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of patients with substance-related disorders who dropped out or not from addiction treatment. Psychiatry Res 2023; 329:115532. [PMID: 37837812 DOI: 10.1016/j.psychres.2023.115532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
This longitudinal study identified profiles of patients with substance-related disorders (SRD) who did or did not drop out of specialized addiction treatment, integrating various patterns of outpatient service use. Medical administrative databases of Quebec (Canada) were used to investigate a cohort of 16,179 patients with SRD who received specialized addiction treatment. Latent class analysis identified patient profiles, based on multi-year outpatient service use. Four patient profiles related to treatment dropout were identified: patients who did not drop out and were low service users (Profile 1); patients who did not drop out and were high service users (Profile 2); patients who dropped out and were low service users (Profile 3); patients who dropped out and were high service users (Profile 4). Profile 1 had the best health and social conditions, while Profile 4 had the worst. The risks of being frequent emergency department users, being hospitalized or dying were highest in Profile 4, followed by Profiles 3, 2 and 1. Assertive treatment programs may be suited to Profile 4 and intensive case management programs to Profile 3. Collaborative care with higher psychosocial interventions and regularity of care may be extended to Profile 2 and interventions integrating motivational treatment to Profile 1.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, Canada, H3A 1A1; Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3.
| | - Zhirong Cao
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950, rue de Louvain, Montreal, QC, Canada, H2M 2E8
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19
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Böhmer J, Reinhardt P, Garbusow M, Marxen M, Smolka MN, Zimmermann US, Heinz A, Bzdok D, Friedel E, Kruschwitz JD, Walter H. Aberrant functional brain network organization is associated with relapse during 1-year follow-up in alcohol-dependent patients. Addict Biol 2023; 28:e13339. [PMID: 37855075 DOI: 10.1111/adb.13339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/12/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
Alcohol dependence (AD) is a debilitating disease associated with high relapse rates even after long periods of abstinence. Thus, elucidating neurobiological substrates of relapse risk is fundamental for the development of novel targeted interventions that could promote long-lasting abstinence. In the present study, we analysed resting-state functional magnetic resonance imaging (rsfMRI) data from a sample of recently detoxified patients with AD (n = 93) who were followed up for 12 months after rsfMRI assessment. Specifically, we employed graph theoretic analyses to compare functional brain network topology and functional connectivity between future relapsers (REL, n = 59), future abstainers (ABS, n = 28) and age- and gender-matched controls (CON, n = 83). Our results suggest increased whole-brain network segregation, decreased global network integration and overall blunted connectivity strength in REL compared with CON. Conversely, we found evidence for a comparable network architecture in ABS relative to CON. At the nodal level, REL exhibited decreased integration and decoupling between multiple brain systems compared with CON, encompassing regions associated with higher-order executive functions, sensory and reward processing. Among patients with AD, increased coupling between nodes implicated in reward valuation and salience attribution constitutes a particular risk factor for future relapse. Importantly, aberrant network organization in REL was consistently associated with shorter abstinence duration during follow-up, portending to a putative neural signature of relapse risk in AD. Future research should further evaluate the potential diagnostic value of the identified changes in network topology and functional connectivity for relapse prediction at the individual subject level.
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Affiliation(s)
- Justin Böhmer
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Pablo Reinhardt
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Maria Garbusow
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Michael Marxen
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
| | - Ulrich S Zimmermann
- Department of Addiction Medicine and Psychotherapy, kbo-Isar-Amper-Klinikum München-Ost, Haar, Germany
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, Canada
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Danilo Bzdok
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, Canada
- Mila - Quebec Artificial Intelligence Institute, Montreal, Canada
| | - Eva Friedel
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Johann D Kruschwitz
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
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20
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Scott CK, Dennis ML, Grella CE, Watson DP, Davis JP, Hart MK. A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1964-1977. [PMID: 37864532 PMCID: PMC10605959 DOI: 10.1111/acer.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Primary care settings like federally qualified health centers (FQHC) are optimal locations to identify individuals with substance use disorders (SUD) and link them to SUD treatment, yet successful linkage has proven difficult. Recovery management checkups for primary care (RMC-PC) is a promising method for increasing linkage to care, engagement in treatment, and reducing substance use. METHODS Participants (n = 266) who received screening, brief intervention, and referral to treatment (SBIRT) at four FQHC sites and needed SUD treatment were randomized to receive SBIRT only or SBIRT+RMC-PC. All participants received SBIRT prior to randomization as part of usual care while those in the experimental group also received quarterly checkups. All participants completed research interviews at enrollment and 3, 6, 9, and 12 months post-enrollment. The primary outcome was whether participants received any days of SUD treatment. Key secondary outcomes were days of SUD treatment (total and by SUD level of care), days of alcohol or drug abstinence, and a reduction in days of specific substance use, all based on self-report. RESULTS Relative to participants receiving SBIRT only, participants assigned to SBIRT+RMC-PC were significantly more likely to have received any SUD treatment over 12 months (adjusted odds ratio [AOR] = 3.85) and more days of SUD treatment over 12 months (Cohen's effect size d = +0.41). The SBIRT+RMC-PC group also reported significantly more days of abstinence over 12 months (d = +0.30), fewer days of alcohol use (d = -0.20) and cannabis use (d = -0.20), and lower combined substance use frequency (d = -0.25). Days of treatment were found to positively mediate the direct effect of SBIRT+RMC-PC on days of abstinence. CONCLUSION This study provides further evidence of the effectiveness of the "referral to treatment" component of SBIRT when combined with RMC for patients in primary care settings, including those with drug use problems. Moreover, results demonstrate the value of repeated checkups on longer-term treatment and substance use outcomes.
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Affiliation(s)
| | | | | | | | - Jordan P Davis
- Suzanne Dworak-Peck, School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - M Kate Hart
- Chestnut Health Systems, Normal, Illinois, USA
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Wilson J, Mills KL, Sunderland M, Freeman TP, Keaveny M, Haasnoot K, Teesson M, Haber PS, Marel C. Long-term patterns of treatment use for opioid use disorder (OUD): Findings from the 18-20-year Australian Treatment Outcome Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104187. [PMID: 37713938 DOI: 10.1016/j.drugpo.2023.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Opioid-related deaths continue to increase to unprecedented rates in many regions of the world. While long-term stable treatment has been shown to reduce associated morbidity and mortality, discontinuation and numerous treatment episodes are common, limiting our understanding of the common course of treatment and associated characteristics. Therefore, using an 18-20-year follow-up of people with heroin dependence, we aimed to identify i) distinct trajectories of treatment use, ii) whether baseline characteristics predict treatment trajectory group membership, and ii) if group membership is associated with characteristics at 18-20-years post-baseline. METHODS A total of 615 people with heroin dependence were recruited from maintenance therapy, detoxification, residential rehabilitation, or needle and syringe programs as part of the Australian Treatment Outcome Study (ATOS), a longitudinal cohort followed up on seven occasions over 18-20-years between 2001 and 2021. Of those who had complete data (n = 393), group-based trajectory modelling and a series of multinomial logistical regressions were conducted. RESULTS Five trajectories of treatment use were identified: i) 'long-term low treatment' (17.2%), ii) 'rapid increase with gradual decrease' (13.9%), iii) 'late increase' (17.8%), (iv) 'long-term treatment' (27.7%), and (v) 'reduced treatment' (23.5%). Entering maintenance treatment at baseline predicted trajectory group membership, while trajectory group membership was associated with demographics and the use of heroin, methamphetamine, alcohol, and benzodiazepines at 18-20-years. CONCLUSIONS In one of the longest cohort studies of its kind, we characterised distinct trajectories of treatment use in people with heroin dependence over 18-20-years. Clinicians should be aware of the potential impact of demographics and substance use on long-term treatment use. Despite the well-documented benefits of long-term treatment, some patients may be able to achieve abstinence from opioids without engaging in treatment over the life-course.
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Affiliation(s)
- Jack Wilson
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia.
| | - Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), University of Bath, BA2 7AY, United Kingdom
| | - Madeleine Keaveny
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Katherine Haasnoot
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Paul S Haber
- Sydney Medical School, The University of Sydney, 2006, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
| | - Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
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22
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Solmi M, Cortese S, Vita G, De Prisco M, Radua J, Dragioti E, Köhler-Forsberg O, Madsen NM, Rohde C, Eudave L, Aymerich C, Pedruzo B, Rodriguez V, Rosson S, Sabé M, Hojlund M, Catalan A, de Luca B, Fornaro M, Ostuzzi G, Barbui C, Salazar-de-Pablo G, Fusar-Poli P, Correll CU. An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders. Mol Psychiatry 2023; 28:3671-3687. [PMID: 37957292 PMCID: PMC10730397 DOI: 10.1038/s41380-023-02298-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
We aimed to identify diagnosis-specific/transdiagnostic/transoutcome multivariable candidate predictors (MCPs) of key outcomes in mental disorders. We conducted an umbrella review (protocol link ), searching MEDLINE/Embase (19/07/2022), including systematic reviews of studies reporting on MCPs of response, remission, recovery, or relapse, in DSM/ICD-defined mental disorders. From published predictors, we filtered MCPs, validating MCP criteria. AMSTAR2/PROBAST measured quality/risk of bias of systematic reviews/individual studies. We included 117 systematic reviews, 403 studies, 299,888 individuals with mental disorders, testing 796 prediction models. Only 4.3%/1.2% of the systematic reviews/individual studies were at low risk of bias. The most frequently targeted outcome was remission (36.9%), the least frequent was recovery (2.5%). Studies mainly focused on depressive (39.4%), substance-use (17.9%), and schizophrenia-spectrum (11.9%) disorders. We identified numerous MCPs within disorders for response, remission and relapse, but none for recovery. Transdiagnostic MCPs of remission included lower disease-specific symptoms (disorders = 5), female sex/higher education (disorders = 3), and quality of life/functioning (disorders = 2). Transdiagnostic MCPs of relapse included higher disease-specific symptoms (disorders = 5), higher depressive symptoms (disorders = 3), and younger age/higher anxiety symptoms/global illness severity/ number of previous episodes/negative life events (disorders = 2). Finally, positive trans-outcome MCPs for depression included less negative life events/depressive symptoms (response, remission, less relapse), female sex (response, remission) and better functioning (response, less relapse); for schizophrenia, less positive symptoms/higher depressive symptoms (remission, less relapse); for substance use disorder, marital status/higher education (remission, less relapse). Male sex, younger age, more clinical symptoms and comorbid mental/physical symptoms/disorders were poor prognostic factors, while positive factors included social contacts and employment, absent negative life events, higher education, early access/intervention, lower disease-specific and comorbid mental and physical symptoms/conditions, across mental disorders. Current data limitations include high risk of bias of studies and extraction of single predictors from multivariable models. Identified MCPs can inform future development, validation or refinement of prediction models of key outcomes in mental disorders.
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Affiliation(s)
- Marco Solmi
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Vita
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Imaging of Mood- and Anxiety-Related Disorders (IMARD), CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Elena Dragioti
- University of Ioannina, Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, Ioannina, Greece
- Linköping University, Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping, Sweden
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna M Madsen
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Rohde
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Luis Eudave
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Claudia Aymerich
- Biobizkaia Health Research Institute, Basurto University Hospital, OSI Bilbao-Basurto. University of the Basque Country UPV/EHU. Centro de Investigación en Red de Salud Mental. (CIBERSAM), Instituto de Salud Carlos III. Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Borja Pedruzo
- Psychiatry Department, Basurto University Hospital, Bilbao, Spain
| | | | - Stella Rosson
- Mental Health Department, Local Health Unit ULSS3 Serenissima, Venice, Italy
| | - Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226, Thonex, Switzerland
| | - Mikkel Hojlund
- Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
| | - Ana Catalan
- Biobizkaia Health Research Institute, Basurto University Hospital, OSI Bilbao-Basurto. University of the Basque Country UPV/EHU. Centro de Investigación en Red de Salud Mental. (CIBERSAM), Instituto de Salud Carlos III. Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Beatrice de Luca
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Michele Fornaro
- Department of Psychiatry, Federico II of Naples, Naples, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Gonzalo Salazar-de-Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South London (OASIS) service, NHS South London and Maudsley Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
- The Zucker Hillside Hospital, Northwell Health, New York, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA.
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23
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van Ruitenbeek P, Franzen L, Mason NL, Stiers P, Ramaekers JG. Methylphenidate as a treatment option for substance use disorder: a transdiagnostic perspective. Front Psychiatry 2023; 14:1208120. [PMID: 37599874 PMCID: PMC10435872 DOI: 10.3389/fpsyt.2023.1208120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
A transition in viewing mental disorders from conditions defined as a set of unique characteristics to one of the quantitative variations on a collection of dimensions allows overlap between disorders. The overlap can be utilized to extend to treatment approaches. Here, we consider the overlap between attention-deficit/hyperactivity disorder and substance use disorder to probe the suitability to use methylphenidate as a treatment for substance use disorder. Both disorders are characterized by maladaptive goal-directed behavior, impaired cognitive control, hyperactive phasic dopaminergic neurotransmission in the striatum, prefrontal hypoactivation, and reduced frontal cortex gray matter volume/density. In addition, methylphenidate has been shown to improve cognitive control and normalize associated brain activation in substance use disorder patients and clinical trials have found methylphenidate to improve clinical outcomes. Despite the theoretical basis and promising, but preliminary, outcomes, many questions remain unanswered. Most prominent is whether all patients who are addicted to different substances may equally profit from methylphenidate treatment.
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Affiliation(s)
- Peter van Ruitenbeek
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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24
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Hobden B, Freund M, Lawson S, Bryant J, Walsh J, Leigh L, Sanson‐Fisher R. The impact of organisational factors on treatment outcomes for those seeking alcohol or other drug treatment: A systematic review. Drug Alcohol Rev 2023; 42:1220-1234. [PMID: 37005012 PMCID: PMC10947488 DOI: 10.1111/dar.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Organisational factors have been found to be associated with health outcomes in a number of health-care settings. Despite likely being an important influence on the quality of care provided within alcohol and other drug (AOD) treatment centres, the impact of organisational factors on AOD treatment outcomes have not been extensively explored. This systematic literature review examines the characteristics, methodological quality and findings of published studies exploring the association between organisational factors and client AOD treatment outcomes. METHODS Medline, Embase, PsycINFO and the Cochrane database were searched from 2010 to March 2022 for relevant papers. Studies meeting the inclusion criteria underwent quality assessment using the Joanna Brigg's Institute critical appraisal tool for cross-sectional studies, followed by data extraction of key variables pertaining to the aims. A narrative summary was used to synthesise the data. RESULTS Nine studies met the inclusion criteria. Organisational factors examined included cultural competency, organisational readiness for change, directorial leadership, continuity of care practices, service access, service to needs ratios, dual diagnosis training, therapeutic optimism and the funding model/health-care system that treatment was delivered in. Outcome measures included duration, completion or continuation of treatment; AOD use; and patient perceptions of treatment outcomes. Seven out of nine papers found a significant interaction between at least one organisational variable and AOD treatment outcomes. DISCUSSION AND CONCLUSIONS Organisational factors are likely to impact treatment outcomes for patients seeking treatment for AOD. Further examination of the organisational factors that influence AOD outcomes is needed to inform systemic improvements to AOD treatment.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Megan Freund
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Samuel Lawson
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Jamie Bryant
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Justin Walsh
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Lucy Leigh
- Clinical Research Design and StatisticsHunter Medical Research InstituteNewcastleAustralia
| | - Rob Sanson‐Fisher
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
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25
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Zgierska AE, Hilliard F, Deegan S, Turnquist A, Goldstein E. Promoting research engagement among women with addiction: Impact of recovery peer support in a pilot randomized mixed-methods study. Contemp Clin Trials 2023; 130:107235. [PMID: 37211273 PMCID: PMC10330478 DOI: 10.1016/j.cct.2023.107235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The impact of involving peers on research engagement is largely unknown. The purpose of this pilot study, a part of a larger research, was to evaluate the impact of recovery peer involvement as a study team member on recruitment/retention of persons with lived experience of SUD during pregnancy and to assess participant perceptions about factors impacting engagement of this population and their children in research, especially brain magnetic resonance imaging (MRI). METHODS This study randomly assigned participants (1:1) to either Peer or Research Coordinator (RC) arms. Eligible participants were English-speaking adult, non-pregnant females with lived experience of substance use during pregnancy. Certified Peers were recruited word of mouth and completed study-specific training. The impact of trained, certified Peer versus RC on research engagement was assessed by between-arm comparison of retention rates. Quantitative and qualitative survey data on participant perceptions were summarized. RESULTS Thirty-eight individuals enrolled into the study (19 Peer, 19 RC). Peer versus RC had 7.2 times greater odds of completing Visit 2 (Fisher's exact test; 95%CI: 1.2, 81.8; p = 0.03). The majority (70.4%) of respondents identified being accompanied by a peer and getting a tour of the MRI facility/procedures as 'extremely' helpful for improving participant comfort and engagement in future studies. Motivators of future research engagement also included creating a trusting, supportive, non-judgmental research environment, and linkages to treatment and other services. CONCLUSION Findings support the notion that peers involved as research team members could boost research engagement among persons with substance use during pregnancy.
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Affiliation(s)
- Aleksandra E Zgierska
- Departments of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States of America.
| | - Florence Hilliard
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Shelbey Deegan
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Alyssa Turnquist
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Ellen Goldstein
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL 60612, United States of America.
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Viera A, Tengatenga C, McBurney E, Lauckner J, Tran E, Muilenburg JL, Kershaw TS, Lauckner C. "The Phone is my Lifeline": Use of Mobile Phone Technology to Support Recovery among Individuals in Treatment for Substance Use Disorders. Subst Use Misuse 2023; 58:1360-1366. [PMID: 37331982 DOI: 10.1080/10826084.2023.2223265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background: People experiencing substance use disorders (SUD) face myriad challenges in maintaining changes in substance use after treatment. Mobile phones can play a role in supporting the recovery process. To date, research has not explored how individuals use mobile phones to seek social support as they enter SUD recovery. Objectives: We sought to understand how individuals in SUD treatment use mobile technology in support of their recovery. Methods: We conducted semi-structured interviews with thirty individuals in treatment for any SUD in northeastern Georgia and southcentral Connecticut. Interviews explored participants' attitudes toward mobile technology and how they used mobile technology while using substances, in treatment, and in recovery. Qualitative data were coded and analyzed using thematic analysis. Results: We identified three major themes related to how participants: (1) adapted their use of mobile technology as they entered recovery, (2) relied on mobile technology for social support while in recovery, while (3) some found aspects of mobile technology triggering. Many individuals in SUD treatment reported using mobile phones to buy or sell drugs; as such, they took measures to adapt their use of mobile technology as they changed substance use behaviors. As they entered recovery, individuals relied on mobile phones for affiliational, emotional, informational, and instrumental support, though some did share they found some aspects of mobile phones triggering. Conclusion: These findings highlight the importance of treatment providers engaging in conversations around mobile phone use to help individuals avoid triggers and connect with social supports. These findings uncover new opportunities for recovery support interventions utilizing mobile phones as a delivery mechanism.
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Affiliation(s)
- A Viera
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - C Tengatenga
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - E McBurney
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - J Lauckner
- Substance Use Research Priority Area, University of Kentucky, Lexington, Kentucky, USA
| | - E Tran
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - J L Muilenburg
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - T S Kershaw
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - C Lauckner
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Hayes BB. Annual use and perceived need for mental health and substance treatment among people in remission from substance use disorders in the United States. Drug Alcohol Depend 2023; 249:110820. [PMID: 37329728 DOI: 10.1016/j.drugalcdep.2023.110820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Receiving specialty substance treatment or general mental health treatment during remission from substance use disorders (SUD) may reduce odds of SUD recurrence, but little is known about prevalence of treatment or perceptions of treatment need among remitted people in the United States. SAMPLE Participants in the National Survey on Drug Use and Health, years 2018-2020, were considered remitted if they ever had an SUD (i.e., self-reported history of "problems with alcohol or drugs", or lifetime history of treatment for SUD) but did not meet DSM-IV criteria for substance abuse or dependence during the prior year (n = 9,295). ANALYSES Annual prevalence was estimated for any SUD treatment (e.g., mutual-help groups), any mental health (MH) treatment (e.g., private therapy), self-reported perceived need for SUD treatment, and self-reported unmet need for MH treatment. Generalized linear models examined effects of socio-demographics, mental illness, past-year substance use, and self-identified recovery status on outcomes. FINDINGS MH treatment was more common than SUD treatment (27.2% [25.6%, 28.8%] v. 7.8% [7.0%, 8.6%], respectively). Unmet need for mental health treatment was reported by 9.8% [8.8%, 10.9%], but only 0.9% [0.6%, 1.2%] perceived need for substance treatment. Age, sex, marital status, education, health insurance, mental illness, and prior year alcohol use were among the factors associated with variation in outcomes. CONCLUSION Most people who maintained clinical remission from substance use disorders in the U.S. during the prior year did so without treatment. Remitted people report substantial unmet need for mental health treatment, but not specialized substance use treatment.
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Affiliation(s)
- Bridget B Hayes
- Department of Psychology, Cornell University, United States; Substance Abuse and Mental Health Services Administration, United States.
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Jaehne EJ, McInerney E, Sharma R, Genders SG, Djouma E, van den Buuse M. A Rat Model of the Brain-Derived Neurotrophic Factor Val66Met Polymorphism Shows Attenuated Motivation for Alcohol Self-Administration and Diminished Propensity for Cue-Induced Relapse in Females. BIOLOGY 2023; 12:799. [PMID: 37372084 DOI: 10.3390/biology12060799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) has been implicated in alcohol use disorder. The Val66Met polymorphism is a common variant of the BDNF gene (rs6265) which reduces activity-dependent BDNF release, and has been suggested as a risk factor for psychiatric disorders and substance use. Using an operant self-administration paradigm, this study aimed to investigate ethanol preference and ethanol seeking in a novel rat model of the BDNF Val66Met polymorphism, Val68Met rats. Male and female BDNF Val68Met rats of three genotypes (Val/Val, Val/Met and Met/Met) were trained to lever press for a 10% ethanol solution. There was no effect of Val68Met genotype on acquisition of stable response to ethanol or its extinction. Met/Met rats of both sexes had a slight, but significantly lower breakpoint during progressive ratio sessions while female rats with the Met/Met genotype demonstrated a lower propensity for reinstatement of responding to cues. There were no effects of Val68Met genotype on anxiety-like behaviour or locomotor activity. In conclusion, Met/Met rats showed lower motivation to continue to press for a reward, and also a decreased propensity to relapse, suggesting a possible protective effect of the Met/Met genotype against alcohol use disorder, at least in females.
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Affiliation(s)
- Emily J Jaehne
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| | - Elizabeth McInerney
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne 3086, Australia
| | - Ronan Sharma
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| | - Shannyn G Genders
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne 3086, Australia
| | - Elvan Djouma
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne 3086, Australia
| | - Maarten van den Buuse
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
- Department of Pharmacology, University of Melbourne, Melbourne 3052, Australia
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Fleury MJ, Cao Z, Grenier G, Huỳnh C. Predictors of dropout from treatment among patients using specialized addiction treatment centers. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209062. [PMID: 37150400 DOI: 10.1016/j.josat.2023.209062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/06/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES This study investigated the use of outpatient care, and sociodemographic and clinical characteristics of patients with substance-related disorders (SRD) to predict treatment dropout from specialized addiction treatment centers. The study also explored risks of adverse outcomes, frequent emergency department (ED) use (3+ visits/year), and death, associated with treatment dropout within the subsequent 12 months. METHODS The study examined a cohort of 16,179 patients who completed their last treatment episode for SRD between 2012 and 13 and 2014-15 (financial years: April 1 to March 31) in 14 specialized addiction treatment centers using Quebec (Canada) health administrative databases. We used multivariable logistic regressions to measure risk of treatment dropout (1996-96 to 2014-15), while we used survival analysis controlling for sex and age to assess the odds of frequent ED use and death in 2015-16. RESULTS Of the 55 % of patients reporting dropout from SRD treatment over the 3-year period, 17 % were frequent ED users, and 1 % died in the subsequent 12 months. Patients residing in the most socially deprived areas, having polysubstance-related disorders or personality disorders, and having previously dropped out from specialized addiction treatment centers had increased odds of current treatment dropout. Older patients, those with a history of homelessness, past SRD treatment, or more concurrent outpatient care outside specialized addiction treatment centers had decreased odds of treatment dropout. Patients who dropped out were subsequently at higher risk of frequent ED use and death. CONCLUSIONS This study highlighted that patients with more severe problems and previous dropout may need more sustained and adequate help to prevent subsequent treatment dropout. Specialized addiction treatment centers may consider enhancing their follow-up care of patients over a longer duration and better integrating their treatment with other outpatient care resources to meet the multiple needs of the more vulnerable patients using their services.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Canada; Douglas Hospital Research Centre, Douglas Mental Health University Institute, Canada.
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, Canada
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Hurlocker MC, Carlon H, Pearson MR, Hijaz D. Trajectories of change in subclinical anxiety and alcohol use during alcohol treatment: A parallel process growth model. Drug Alcohol Depend 2023; 246:109838. [PMID: 36989706 PMCID: PMC10121922 DOI: 10.1016/j.drugalcdep.2023.109838] [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: 09/24/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Anxiety is implicated in the course and prognosis of alcohol use disorder (AUD); however, it is unclear how current AUD treatments affect the joint trajectories of anxiety and alcohol use. We used data from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study to examine the longitudinal relationship between subclinical anxiety symptoms and alcohol use during and following AUD treatment in adults with AUD and no comorbid anxiety disorders. METHODS Univariate and parallel process growth models using five waves of COMBINE study data were analyzed from 865 adults randomized to medication (n = 429) or medication plus psychotherapy (n = 436). Weekly drinking quantity and average weekly anxiety symptoms were measured at baseline, mid-treatment, end-of-treatment, and three follow-up periods. RESULTS Significant positive associations of anxiety symptoms and drinking were found at mid-treatment and over time. Temporal associations revealed that higher mid-treatment anxiety predicted decreases in drinking over time. Baseline anxiety and drinking predicted mid-treatment anxiety and drinking. Only baseline anxiety predicted increases in drinking over time. Group differences revealed mid-treatment drinking predicted decreases in anxiety over time in the medication group. CONCLUSIONS Findings demonstrate the influence of subclinical anxiety on alcohol use during and up to one year after AUD treatment. Baseline anxiety symptoms may influence drinking behavior over the course of treatment. Findings suggest that greater attention to negative affect in AUD treatment is warranted even for those individuals who do have a comorbid anxiety disorder.
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Affiliation(s)
- Margo C Hurlocker
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States; Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM 87106, United States.
| | - Hannah Carlon
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States
| | - Matthew R Pearson
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States; Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM 87106, United States
| | - Donia Hijaz
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States
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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: 0] [Impact Index Per Article: 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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Tavares GEB, Bianchi PC, Yokoyama TS, Palombo P, Cruz FC. INVOLVEMENT OF CORTICAL PROJECTIONS TO BASOLATERAL AMYGDALA IN CONTEXT-INDUCED REINSTATEMENT OF ETHANOL-SEEKING IN RATS. Behav Brain Res 2023; 448:114435. [PMID: 37044222 DOI: 10.1016/j.bbr.2023.114435] [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: 01/23/2023] [Revised: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 04/14/2023]
Abstract
Ethanol is the most consumed substance of abuse in the world, and its misuse may lead to the development of alcohol use disorder (AUD). High relapse rates remain a relevant problem in the treatment of AUD. Exposure to environmental cues previously associated with ethanol intake could trigger ethanol-seeking behavior. However, the neural mechanisms involved in this phenomenon are not entirely clear. In this context, cortical projections to the basolateral amygdala (BLA) play a role in appetitive and aversive learned behaviors. Therefore, we aimed to evaluate the activation of the cortical projections from the prelimbic (PL), orbitofrontal (OFC), and infralimbic (IL), to the BLA in the context-induced reinstatement of ethanol-seeking. Male Long-Evans rats were trained to self-administer 10% ethanol in Context A. Subsequently, lever pressing in the presence of the discrete cue was extinguished in Context B. After nine extinction sessions, rats underwent intracranial surgery for the unilateral injection of red fluorescent retrograde tracer into the BLA. The context-induced reinstatement of ethanol-seeking was assessed by re-exposing the rats to Context A or B under extinction conditions. Finally, we combined retrograde neuronal tracing with Fos to identify activated cortical inputs to BLA during the reinstatement of ethanol-seeking behavior. We found that PL, but not OFC or IL, retrogradely-labeled neurons from BLA presented increased Fos expression during the re-exposure to the ethanol-associated context, suggesting that PL projection to BLA is involved in the context-induced reinstatement of ethanol-seeking behavior.
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Affiliation(s)
| | - Paula Cristina Bianchi
- Molecular and Behavioral Neuroscience Laboratory, Department of Pharmacology, Federal University of São Paulo, São Paulo, SP, Brazil.
| | - Thais Suemi Yokoyama
- Molecular and Behavioral Neuroscience Laboratory, Department of Pharmacology, Federal University of São Paulo, São Paulo, SP, Brazil.
| | - Paola Palombo
- Molecular and Behavioral Neuroscience Laboratory, Department of Pharmacology, Federal University of São Paulo, São Paulo, SP, Brazil.
| | - Fábio Cardoso Cruz
- Molecular and Behavioral Neuroscience Laboratory, Department of Pharmacology, Federal University of São Paulo, São Paulo, SP, Brazil.
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Waite MR, Heslin K, Cook J, Kim A, Simpson M. Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208933. [PMID: 36805798 DOI: 10.1016/j.josat.2022.208933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel. METHODS To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses. RESULTS Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment. CONCLUSIONS Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment.
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Affiliation(s)
- Mindy R Waite
- Advocate Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Jonathan Cook
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Aengela Kim
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; Chicago Medical School, Rosalind Franklin University, 3333 Green Bay Rd, North Chicago, IL 60064, USA.
| | - Michelle Simpson
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; AAH Ed Howe Center for Health Care Transformation, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
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34
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Lee H, Jeon Y, Yoo C, Seon H, Park J, Hwang M, Baek K, Chung D. Persistent impacts of smoking on resting-state EEG in male chronic smokers and past-smokers with 20 years of abstinence. Sci Rep 2023; 13:3907. [PMID: 36890138 PMCID: PMC9995515 DOI: 10.1038/s41598-023-29547-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
Smoking is a severe addictive health risk behavior and notorious for the high likelihood of relapse after attempted cessation. Such an addictive pattern in smoking has been associated with neurobiological changes in the brain. However, little is known whether the neural changes associated with chronic smoking persist after a long period of successful abstinence. To address this question, we examined resting state EEG (rsEEG) in chronic smokers who have been smoking for 20 years or more, past-smokers who have been successfully abstaining for 20 years or more, and never-smokers. Both current-smokers and past-smokers showed significantly decreased relative theta power than never-smokers, showcasing persistent effect of smoking on the brain. Other rsEEG features in alpha frequency band demonstrated distinctive patterns associated with active smoking, such that compared to never-smokers, only current-smokers, but not past-smokers, showed significantly higher relative power, EEG reactivity-power changes between eyes-closed and eyes-open conditions-, and coherence between channels. Furthermore, individual variabilities across these rsEEG biomarkers were accounted for by individuals' self-reported smoking history and nicotine dependence in current- and past- smokers. These data suggest the persistent effect of smoking on the brain even after sustained remission for 20 years.
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Affiliation(s)
- Hyeji Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50 UNIST-Gil, Ulsan, 44919, South Korea.,Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Yoonji Jeon
- School of Biomedical Convergence Engineering, Pusan National University, 49 Busandaehak-Ro, Yangsan, Gyeongsangnam-Do, 50612, South Korea
| | - Cheolin Yoo
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - HeeYoung Seon
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50 UNIST-Gil, Ulsan, 44919, South Korea
| | - Jiwon Park
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50 UNIST-Gil, Ulsan, 44919, South Korea
| | - Minho Hwang
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50 UNIST-Gil, Ulsan, 44919, South Korea
| | - Kwangyeol Baek
- School of Biomedical Convergence Engineering, Pusan National University, 49 Busandaehak-Ro, Yangsan, Gyeongsangnam-Do, 50612, South Korea.
| | - Dongil Chung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50 UNIST-Gil, Ulsan, 44919, South Korea.
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Deep brain stimulation of the nucleus accumbens in treatment-resistant alcohol use disorder: a double-blind randomized controlled multi-center trial. Transl Psychiatry 2023; 13:49. [PMID: 36755017 PMCID: PMC9908935 DOI: 10.1038/s41398-023-02337-1] [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: 08/28/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Treatment resistance in alcohol use disorders (AUD) is a major problem for affected individuals and for society. In the search of new treatment options, few case studies using deep brain stimulation (DBS) of the nucleus accumbens have indicated positive effects in AUD. Here we report a double-blind randomized controlled trial comparing active DBS ("DBS-EARLY ON") against sham stimulation ("DBS-LATE ON") over 6 months in n = 12 AUD inpatients. This 6-month blind phase was followed by a 12-month unblinded period in which all patients received active DBS. Continuous abstinence (primary outcome), alcohol use, alcohol craving, depressiveness, anxiety, anhedonia and quality of life served as outcome parameters. The primary intention-to-treat analysis, comparing continuous abstinence between treatment groups, did not yield statistically significant results, most likely due to the restricted number of participants. In light of the resulting limited statistical power, there is the question of whether DBS effects on secondary outcomes can nonetheless be interpreted as indicative of an therapeutic effect. Analyses of secondary outcomes provide evidence for this, demonstrating a significantly higher proportion of abstinent days, lower alcohol craving and anhedonia in the DBS-EARLY ON group 6 months after randomization. Exploratory responder analyses indicated that patients with high baseline alcohol craving, depressiveness and anhedonia responded to DBS. The results of this first randomized controlled trial are suggestive of beneficial effects of DBS in treatment-resistant AUD and encourage a replication in larger samples.
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36
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Use of the P300 event-related potential component to index transcranial direct current stimulation effects in drug users. IBRO Neurosci Rep 2023; 14:122-128. [PMID: 36718196 PMCID: PMC9883253 DOI: 10.1016/j.ibneur.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Drug use causes significant social and financial problems and these are exacerbated by difficulties in stopping use and subsequent maintenance of abstinence. There is also difficulty in identifying the beneficial treatment for an individual, made more problematic given the high drop-out rates in treatment programs. Here, the effects of transcranial direct current stimulation (tDCS) on the amplitude of the P300 event-related potential component, previously suggested to be indicative of successful remission, was measured in recently abstinent amphetamine users. This component was collected during a Posner cuing task which was presented to this group and to control (non-user) participants, using task cues of neutral and drug-related images. The abstinent drug users were divided into two groups, one of which received tDCS daily for five days, with the cathode over the left dorsolateral prefrontal cortex (DLPFC) and the anode over the right DLPFC, and one receiving sham stimulation over the same time period. Behavioral performance and P300 amplitudes were measured before and after the period of tDCS delivery. Control participants were tested with the same time-schedule of task presentation but without administration of tDCS. Drug users initially showed a larger cost of invalid cues on task performance compared to control (non-drug user) participants and this was reduced following delivery of tDCS. Additionally, tDCS resulted in increased amplitude of the P300 component, significantly so for neutral cues, with the resulting pattern being more similar to that of the non-users. This provides a good basis for further investigation of both the utility of tDCS in modulation of cognition in addict groups, and to investigate the effects of modulating the P300 component on remission rates, a relationship that seems to be the case for this measure without use of tDCS modulation. Importantly, this study also provides a further addiction group showing P300 amplitude modulation as a result of tDCS administration.
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37
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Beaulieu M, Tremblay J, Bertrand K. Adjustments to Service Organization in Specialized Addiction Services and Clinical Strategies for Better Meeting the Needs of People with a Persistent Substance Use Disorder. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00982-z] [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: 12/24/2022] Open
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38
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Dacosta-Sánchez D, González-Ponce BM, Fernández-Calderón F, Sánchez-García M, Lozano OM. Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real-world data. Int J Methods Psychiatr Res 2022; 31:e1929. [PMID: 35765238 PMCID: PMC9720222 DOI: 10.1002/mpr.1929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success. METHODS Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use. RESULTS Moderate effect size relations were found between the different type of clinical discharge and months in retention (η2 = 0.12) and proportion of attendance (η2 = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge. DISCUSSIONS/CONCLUSION Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.
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Affiliation(s)
| | | | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Manuel Sánchez-García
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Oscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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39
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Witte T, Amick M, Smith J. Recovery Identity and Psychosocial-Spiritual Health: A Survey of Individuals in Remission From Substance Use Disorders. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221133039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recovery identity – the degree to which someone identifies as “in recovery” from a substance use disorder – has been shown to be associated with a host of positive health outcomes. The purpose of the present study was to test the association between recovery identity, quality of life, spiritual well-being, and relational health in a sample of individuals in remission from moderate or severe SUDs recruited from Amazon’s Mechanical Turk crowdsourcing platform ( n = 494). Results indicated that the presence of a recovery identity was significantly associated with greater spiritual health, but not significantly associated with psychological, social, or environmental quality of life, nor with family functioning. Results have important implications for understanding paths to recovery and important correlates of health outcomes.
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Affiliation(s)
- Tricia Witte
- Human Development, The University of Alabama, Tuscaloosa, AL, USA
| | - Matthew Amick
- Human Development, The University of Alabama, Tuscaloosa, AL, USA
| | - Jesse Smith
- Human Development, The University of Alabama, Tuscaloosa, AL, USA
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40
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Seesink HJ, Schaap-Jonker H, Ostafin B, Lokman JC, Wiers RW. Protocol for an RCT on cognitive bias modification for alcohol use disorders in a religion-based rehabilitation program. BMJ Open 2022; 12:e060820. [PMID: 36130749 PMCID: PMC9494557 DOI: 10.1136/bmjopen-2022-060820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Alcohol-related cues trigger relapse in patients with alcohol use disorders (AUDs). These cues may automatically activate motivational approach tendencies. Through computerised cognitive bias modification (CBM), the tendencies of patients with AUD to approach alcohol can be reduced. The present protocol describes a training intervention with approach bias modification (ApBM) incorporating religion-related stimuli as an alternative to alcohol to improve the effectiveness of CBM in a religion-based rehabilitation centre. AUD is often related to patients' religious attitudes in this treatment context. The religion-adapted ApBM, therefore, combines training in avoidance of alcohol-related motivational cues and an approach to religion-based motivational cues. This combination's effectiveness will be compared with a standard ApBM and to a sham ApBM. METHODS AND ANALYSIS Using a double-blind multiarm parallel randomised controlled trial procedure (ratio 1:1:1), 120 patients with AUD will be randomised into 1 of 3 conditions (religion-adapted ApBM, standard ApBM or sham ApBM) with personalised stimuli. The interventions are delivered over 4 consecutive days during an inpatient detoxification programme in addition to treatment as usual. Assessments occur before the start of the training and after the fourth training session, with follow-up assessments after 1 and 4 months. A multivariate analysis of variance will be used with the primary outcomes, the percentage of days abstinent and meaning in life 4-month follow-up. Secondary outcomes include differences in reported training satisfaction and symptoms of AUD. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Medical Research Ethics Committee Academic Medical Center Amsterdam (Reference number: 2020_251). Further, study results will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NL75499.018.20.
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Affiliation(s)
- Henk-Jan Seesink
- Department of Research, De Hoop ggz, Dordrecht, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop, Hoevelaken, The Netherlands
| | - Hanneke Schaap-Jonker
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop, Hoevelaken, The Netherlands
- Department of Religion and Theology, Faculteit der Geesteswetenschappen, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brian Ostafin
- Experimental and Clinical Psychology, Department of Psychology, Rijksuniversiteit Groningen Faculteit Gedrags en Maatschappijwetenschappen, Groningen, The Netherlands
| | - John C Lokman
- Department of Psychiatry, Amsterdam UMC - University Medical Centers, Amsterdam, The Netherlands
| | - Reinout W Wiers
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Age-related differences in the effect of chronic alcohol on cognition and the brain: a systematic review. Transl Psychiatry 2022; 12:345. [PMID: 36008381 PMCID: PMC9411553 DOI: 10.1038/s41398-022-02100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/21/2022] [Accepted: 07/28/2022] [Indexed: 12/09/2022] Open
Abstract
Adolescence is an important developmental period associated with increased risk for excessive alcohol use, but also high rates of recovery from alcohol use-related problems, suggesting potential resilience to long-term effects compared to adults. The aim of this systematic review is to evaluate the current evidence for a moderating role of age on the impact of chronic alcohol exposure on the brain and cognition. We searched Medline, PsycInfo, and Cochrane Library databases up to February 3, 2021. All human and animal studies that directly tested whether the relationship between chronic alcohol exposure and neurocognitive outcomes differs between adolescents and adults were included. Study characteristics and results of age-related analyses were extracted into reference tables and results were separately narratively synthesized for each cognitive and brain-related outcome. The evidence strength for age-related differences varies across outcomes. Human evidence is largely missing, but animal research provides limited but consistent evidence of heightened adolescent sensitivity to chronic alcohol's effects on several outcomes, including conditioned aversion, dopaminergic transmission in reward-related regions, neurodegeneration, and neurogenesis. At the same time, there is limited evidence for adolescent resilience to chronic alcohol-induced impairments in the domain of cognitive flexibility, warranting future studies investigating the potential mechanisms underlying adolescent risk and resilience to the effects of alcohol. The available evidence from mostly animal studies indicates adolescents are both more vulnerable and potentially more resilient to chronic alcohol effects on specific brain and cognitive outcomes. More human research directly comparing adolescents and adults is needed despite the methodological constraints. Parallel translational animal models can aid in the causal interpretation of observed effects. To improve their translational value, future animal studies should aim to use voluntary self-administration paradigms and incorporate individual differences and environmental context to better model human drinking behavior.
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42
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Wray TB, Emery NN. Feasibility, Appropriateness, and Willingness to Use Virtual Reality as an Adjunct to Counseling among Addictions Counselors. Subst Use Misuse 2022; 57:1470-1477. [PMID: 35754378 DOI: 10.1080/10826084.2022.2092148] [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] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Research suggests that virtual reality (VR) experiences can be helpful as adjunctive tools in psychotherapy for some mental health conditions. VR is a computer-generated experience that produces a feeling of being immersed in a different environment. VR experiences could be useful in the treatment of substance use disorders, and several are currently being tested. However, few psychotherapists report using VR experiences in their practices, even when doing so is well-supported. Understanding key barriers and concerns about using VR among drug/alcohol counselors is important to ultimately encouraging adoption. METHODS Licensed counselors (N = 101) who provide treatment to clients with substance use disorders were recruited via email Listservs, professional organizations, and social media. Participants viewed a 15-minute educational video about VR and then completed a survey of their views about using it with their clients. RESULTS Most clinicians (82%) believed they would be likely to use a VR experience in drug/alcohol counseling, and 81% believed it would be appropriate for most of their clients. A minority (19%) noted important concerns, including that their clients may be skeptical of it (15%), cost (14%), and space (10%). Those who had cost and space concerns were less likely to report high use intentions (OR = 0.29 and OR = 031, both p < .05, respectively). CONCLUSIONS Findings suggest that addictions counselors are eager to use VR, but key barriers should be addressed. VR developers should incorporate features to encourage trust among users, design experiences for small spaces, and explore ways of supporting the purchase of VR systems for counselors.
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Affiliation(s)
- Tyler B Wray
- Center for Alcohol and Addictions Studies, Brown University, Providence, Rhode Island, USA
| | - Noah N Emery
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
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Rottenberg J, Kashdan TB. Well-Being After Psychopathology: A Transformational Research Agenda. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1177/09637214221093616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
If one struggles with depression, anxiety, or suicidal impulses, what is the best outcome that one can hope for? Can psychopathology be a bridge to a better place where people operate with autonomy and self-mastery, enjoy healthy relationships, experience frequent positive emotions, and view life as meaningful and purposeful? Studies of national samples have revealed that a substantial number of people with depression, panic disorder, and suicidal impulses go on to achieve high levels of psychological well-being. We consider the practical and theoretical implications of these findings and call for a transformational mental-health agenda that focuses on good outcomes.
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Schwippel T, Schroeder PA, Hasan A, Plewnia C. Implicit measures of alcohol approach and drinking identity in alcohol use disorder: A preregistered double‐blind randomized trial with cathodal transcranial direct current stimulation (tDCS). Addict Biol 2022; 27:e13180. [DOI: 10.1111/adb.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Tobias Schwippel
- Department of Psychiatry and Psychotherapy, Brain Stimulation Center, Tübingen Center for Mental Health (TüCMH) University of Tübingen Tübingen Germany
| | - Philipp A. Schroeder
- Department of Psychology, Clinical Psychology & Psychotherapy University of Tübingen Tübingen Germany
| | - Arafat Hasan
- Department of Psychiatry and Psychotherapy, Brain Stimulation Center, Tübingen Center for Mental Health (TüCMH) University of Tübingen Tübingen Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Brain Stimulation Center, Tübingen Center for Mental Health (TüCMH) University of Tübingen Tübingen Germany
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45
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Boucher LM, Shoemaker ES, Liddy CE, Leonard L, MacPherson PA, Presseau J, Martin A, Pineau D, Lalonde C, Diliso N, Lafleche T, Fitzgerald M, Kendall CE. "The Drug Use Unfortunately isn't all Bad": Chronic Disease Self-Management Complexity and Strategy Among Marginalized People Who Use Drugs. QUALITATIVE HEALTH RESEARCH 2022; 32:871-886. [PMID: 35324352 PMCID: PMC9189593 DOI: 10.1177/10497323221083353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Self-management programs improve health outcomes and self-management is recommended for chronic conditions. Yet chronic disease self-management supports have rarely been applied to people who use drugs (PWUD). Thus, our objective was to explore self-management experiences among marginalized PWUD. We used community-based participatory methods and conducted qualitative interviews. Participants self-identified as having long-term and past year experience using non-prescribed drugs, one other chronic condition, and socioeconomic marginalization. We analyzed the data using reflexive thematic analysis. Although many participants considered drug use a chronic health issue, self-medicating with non-prescribed drugs was also a key self-management strategy to address other health issues. Participants also described numerous other strategies, including cognitive and behavioral tactics. These findings highlight the need for a safe supply of pharmaceutical-grade drugs to support self-management among marginalized PWUD. Self-management supports should also be tailored to address relevant topics (e.g., harm reduction, withdrawal), include creative activities, and not hinder PWUD's agency.
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Affiliation(s)
- Lisa M. Boucher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Lisa M. Boucher, Elisabeth Bruyere Research Institute, 43 Bruyere Street, Annex E, Ottawa, ON K1N 5C7, Canada.
| | - Esther S. Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Clare E. Liddy
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lynne Leonard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul A. MacPherson
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, ON, Canada
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Dave Pineau
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Christine Lalonde
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Nic Diliso
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Terry Lafleche
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
- Sandy Hill Community Health Centre, Ottawa, ONCanada
| | - Michael Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E. Kendall
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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46
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Güçlü B, Tuğay BU, Özden F, Keşli EE, Noyan CO. Investigation of hand functions in individuals with cannabis and its derivatives use disorder. Ir J Med Sci 2022; 192:675-683. [PMID: 35416573 DOI: 10.1007/s11845-022-03006-w] [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: 03/21/2022] [Accepted: 04/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The present study was aimed to compare the grip/pinch strengths and manual dexterity of individuals with and without the use of cannabis and its derivatives. METHODS A cross-sectional prospective study was conducted with 66 individuals, including 33 cases with the use of cannabis (and its derivatives) and 33 age- and sex-matched controls. Grip and pinch strengths were evaluated with a dynamometer. The Nine-Hole Peg Test (9HPT), Minnesota Manual Dexterity Test (MMDT), and Michigan Hand Outcomes Questionnaire (MHQ) were used to assess the hand function. RESULTS The hand grip strength and dominant hand 2-point pinch (2PP) grip strength were less in individuals with substance use disorder (SUD) (p < 0.05). The 9HPT duration of the SUD patients was higher (p < 0.05). On the other hand, the MMDT insertion and rotation test results were different between the groups (p < 0.05). Grip strength was related with the MMDT insertion and rotation tests (r = -0.411 to -0.480). There was significant correlation between grip strength with dominant hand 9HPT (r = -0.370) and between dominant hand 3-point pinch (3PP) strength with MMDT insertion (r = -0.378). In addition, dominant hand 2PP strength was correlated with overall hand function of MHQ (r = 0.382). CONCLUSION The individuals with cannabis use disorder showed reduced grip strength on both sides and decreased 2PP strength on the dominant side compared to healthy individuals. In addition, there is a decrease in the hand skills of individuals with cannabis use disorder. Decreased grip strength of individuals with cannabis use disorder affected their hand skills negatively.
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Affiliation(s)
- Bekir Güçlü
- Department of Physiotherapy, Vocational School of Health Services, Üsküdar University, 34664, Üsküdar, İstanbul, Turkey.
| | - Baki Umut Tuğay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Fatih Özden
- Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Esra Erğun Keşli
- Department of Orthopedic Prosthesis and Orthotics, Vocational School of Health Services, Üsküdar University, İstanbul, Turkey
| | - Cemal Onur Noyan
- Department of Psychiatry, Faculty of Medicine, Üsküdar University, İstanbul, Turkey
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Roberts W, Zhao Y, Verplaetse T, Moore KE, Peltier MR, Burke C, Zakiniaeiz Y, McKee S. Using machine learning to predict heavy drinking during outpatient alcohol treatment. Alcohol Clin Exp Res 2022; 46:657-666. [PMID: 35420710 PMCID: PMC9180421 DOI: 10.1111/acer.14802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Accurate clinical prediction supports the effective treatment of alcohol use disorder (AUD) and other psychiatric disorders. Traditional statistical techniques have identified patient characteristics associated with treatment outcomes. However, less work has focused on systematically leveraging these associations to create optimal predictive models. The current study demonstrates how machine learning can be used to predict clinical outcomes in people completing outpatient AUD treatment. METHOD We used data from the COMBINE multisite clinical trial (n = 1383) to develop and test predictive models. We identified three priority prediction targets, including (1) heavy drinking during the first month of treatment, (2) heavy drinking during the last month of treatment, and (3) heavy drinking between weekly/bi-weekly sessions. Models were generated using the random forest algorithm. We used "leave sites out" partitioning to externally validate the models in trial sites that were not included in the model training. Stratified model development was used to test for sex differences in the relative importance of predictive features. RESULTS Models predicting heavy alcohol use during the first and last months of treatment showed internal cross-validation area under the curve (AUC) scores ranging from 0.67 to 0.74. AUC was comparable in the external validation using data from held-out sites (AUC range = 0.69 to 0.72). The model predicting between-session heavy drinking showed strong classification accuracy in internal cross-validation (AUC = 0.89) and external test samples (AUC range = 0.80 to 0.87). Stratified analyses showed substantial sex differences in optimal feature sets. CONCLUSION Machine learning techniques can predict alcohol treatment outcomes using routinely collected clinical data. This technique has the potential to greatly improve clinical prediction accuracy without requiring expensive or invasive assessment methods. More research is needed to understand how best to deploy these models.
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Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Yize Zhao
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Terril Verplaetse
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kelly E Moore
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - MacKenzie R Peltier
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Catherine Burke
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sherry McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Fleury MJ, Grenier G, Cao Z, Huỳnh C. Predictors of no, low and frequent emergency department use for any medical reason among patients with cannabis-related disorders attending Quebec (Canada) addiction treatment centres. Drug Alcohol Rev 2022; 41:1136-1151. [PMID: 35266240 DOI: 10.1111/dar.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with substance-related disorders and mental disorders (MD) contribute substantially to emergency department (ED) overcrowding. Few studies have identified predictors of ED use integrating service use correlates, particularly among patients with cannabis-related disorders (CRD). This study compared predictors of low (1-2 visits/year) or frequent (3+ visits/year) ED use with no ED use for a cohort of 9836 patients with CRD registered at Quebec (Canada) addiction treatment centres in 2012-2013. METHODS This longitudinal study used multinomial logistic regression to evaluate clinical, sociodemographic and service use variables from various databases as predictors of the frequency of ED use for any medical reason in 2015-2016 among patients with CRD. RESULTS Compared to non-ED users with CRD, frequent ED users included more women, rural residents, patients with serious MD and chronic CRD, dropouts from programs in addiction treatment centres and with less continuity of physician care. Compared with non-users, low ED users had more common MD and there more workers than students. DISCUSSION AND CONCLUSIONS Multimorbidity, including MD, chronic physical illnesses and other substance-related disorders than CRD, predicted more ED use and explained frequent use of outpatient services and prior specialised acute care, as did being 12-29 years, after controlling for all other covariates. Better continuity of physician care and reinforcement of programs like assertive community or integrated treatment, and chronic primary care models may protect against frequent ED use. Strategies like screening, brief intervention and treatment referral, including motivational therapy for preventing treatment dropout may also be expanded to decrease ED use.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Christophe Huỳnh
- Institut Universitaire sur les Dépendances, Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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49
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Fleury MJ, Grenier G, Cao Z, Huỳnh C. Profiles of individuals with cannabis-related disorders. Subst Abus 2022; 43:855-864. [PMID: 35179451 DOI: 10.1080/08897077.2021.2007515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012-2013. Methods: Data on sociodemographic, clinical and service use variables were extracted from several databases for the years 1996-1997 to 2014-2015. Individual profiles were produced using Latent Class Analysis and compared predicting health outcomes on emergency department (ED) use, hospitalizations and suicidal behaviors for 2015-2016. Results: Six profiles were identified: 1-Older individuals, many living in couples and working, with moderate health problems, receiving intensive general practitioner (GP) care and high continuity of physician care; 2-Older individuals with chronic CRD, multiple social and health problems, and low health service use (chronic CRD referred to experiencing CRD for several years; social problems related to homelessness, unemployment, having criminal records or living alone); 3-Students with few social and health problems, and low health service use; 4-Young adults, many working, with few health problems, least health service use and continuity of physician care; 5-Youth, many working but some criminal offenders, with 1 or 2 years of CRD, few health problems and high addiction treatment center use; and 6-Older individuals with chronic CRD and multiple social and health problems, high health service use and continuity of physician care. Profiles 6 and 2 had the worst health outcomes. Conclusions: For Profiles 2 to 5, outreach and motivational services should be prioritized, integrated health and criminal justice services for profile 5 and, for Profiles 2 and 6, assertive community treatments. Screening, brief intervention and referrals to addiction treatment centers may also be encouraged for individuals with CRD, particularly those in Profile 2. This cohort had high social and health needs relative to services received, suggesting continued need for care.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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50
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Changes of Students’ Attitude towards Patients with Chronic Conditions during Medical Education: Comparing Addiction, Dementia, and Diabetes. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00290-4] [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: 10/24/2022] Open
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