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Ballester J, Marchand WR, Philip NS. Transcranial magnetic stimulation for methamphetamine use disorder: A scoping review within the neurocircuitry model of addiction. Psychiatry Res 2024; 338:115995. [PMID: 38852478 PMCID: PMC11209858 DOI: 10.1016/j.psychres.2024.115995] [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: 03/05/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
The use of methamphetamine in the United States is increasing, contributing now to the "fourth wave" in the national opioid epidemic crisis. People who suffer from methamphetamine use disorder (MUD) have a higher risk of death. No pharmacological interventions are approved by the FDA and psychosocial interventions are only moderately effective. Transcranial Magnetic Stimulation (TMS) is a relatively novel FDA-cleared intervention for the treatment of Major Depressive Disorder (MDD) and other neuropsychiatric conditions. Several lines of research suggest that TMS could be useful for the treatment of addictive disorders, including MUD. We will review those published clinical trials that show potential effects on craving reduction of TMS when applied over the dorsolateral prefrontal cortex (DLPFC) also highlighting some limitations that affect their generalizability and applicability. We propose the use of the Koob and Volkow's neurocircuitry model of addiction as a frame to explain the brain effects of TMS in patients with MUD. We will finally discuss new venues that could lead to a more individualized and effective treatment of this complex disorder including the use of neuroimaging, the exploration of different areas of the brain such as the frontopolar cortex or the salience network and the use of biomarkers.
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Affiliation(s)
- J Ballester
- Substance Abuse Residential Rehabilitation Treatment Program, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Psychiatry, School of Medicine, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA.
| | - W R Marchand
- Department of Psychiatry, School of Medicine, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA; VISN-19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - N S Philip
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
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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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Liu X, Tai Q, Meng F, Tian Y, Wang D, Fan F, Yang Y, Fu F, Wei D, Tang S, Chen J, Du Y, Zhu R, Wang W, Liu S, Wan J, Zhang W, Liang Q, Li Y, Wang L, Zhou H, Zhang X. The Association Between Rumination and Craving in Chinese Methamphetamine-Dependent Patients: The Masking Effect of Depression. Subst Use Misuse 2024; 59:1455-1463. [PMID: 38789408 DOI: 10.1080/10826084.2024.2352617] [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: 05/26/2024]
Abstract
BACKGROUND Craving is a core feature of addiction. Rumination and depression play a crucial role in the process of methamphetamine addiction. The aim of this study was to examine the relationship between rumination, depression and craving in methamphetamine patients, which has not been explored yet. METHODS A total of 778 patients with methamphetamine user disorder (MUD) at the Xinhua Drug Rehabilitation Center, located in Mianyang City, Sichuan Province, China. We used a set of self-administered questionnaires that included socio-demographic, detailed drug use history, rumination, depression and craving information. The Rumination Response Scale (RRS) was used to measure rumination, the Beck Depression Inventory (BDI) to measure depression and the Visual Analogue Scale (VAS) to measure craving. RESULTS There was a significant positive correlation between rumination and craving, or depression, and between depression and craving. Furthermore, depression mediated between rumination and craving, with a mediation effect of 160%. CONCLUSIONS Our findings suggest that there is a close interrelationship between rumination, craving and depression in MUD patients, and that depression may play a mediating role between rumination and craving.
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Affiliation(s)
- Xiuli Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qingjie Tai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Feifei Meng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Fusheng Fan
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Yin Yang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Fabing Fu
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Dejun Wei
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | | | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuxuan Du
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Siying Liu
- School of Psychology, Capital Normal University, Beijing, China
| | - Jiaxue Wan
- School of Psychology, Capital Normal University, Beijing, China
| | - Wanni Zhang
- School of Psychology, Capital Normal University, Beijing, China
| | - Qilin Liang
- School of Psychology, Capital Normal University, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Huixia Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Yadav T, Lokuge B, Jackson MA, Austin EK, Fitzgerald PB, Brown AL, Paton B, Sequeira M, Nean M, Mills L, Dunlop AJ. Pilot study with randomised control of dual site theta burst transcranial magnetic stimulation (TMS) for methamphetamine use disorder: a protocol for the TARTAN study. Pilot Feasibility Stud 2024; 10:74. [PMID: 38725088 PMCID: PMC11080215 DOI: 10.1186/s40814-024-01498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) (including the theta burst stimulation (TBS) form of TMS used in this study) is a non-invasive means to stimulate nerve cells in superficial areas of the brain. In recent years, there has been a growth in the application of TMS to investigate the modulation of neural networks involved in substance use disorders. This study examines the feasibility of novel TMS protocols for the treatment of methamphetamine (MA) use disorder in an ambulatory drug and alcohol treatment setting. METHODS Thirty participants meeting the criteria for moderate to severe MA use disorder will be recruited in community drug and alcohol treatment settings and randomised to receive active TMS or sham (control) intervention. The treatment is intermittent TBS (iTBS) applied to the left dorsolateral prefrontal cortex (DLPFC), then continuous TBS (cTBS) to the left orbitofrontal cortex (OFC). Twelve sessions are administered over 4 weeks with opt-in weekly standardized cognitive behaviour therapy (CBT) counselling and a neuroimaging sub-study offered to participants. Primary outcomes are feasibility measures including recruitment, retention and acceptability of the intervention. Secondary outcomes include monitoring of safety and preliminary efficacy data including changes in substance use, cravings (cue reactivity) and cognition (response inhibition). DISCUSSION This study examines shorter TBS protocols of TMS for MA use disorder in real-world drug and alcohol outpatient settings where withdrawal and abstinence from MA, or other substances, are not eligibility requirements. TMS is a relatively affordable treatment and staff of ambulatory health settings can be trained to administer TMS. It is a potentially scalable and translatable treatment for existing drug and alcohol clinical settings. TMS has the potential to provide a much-needed adjuvant treatment to existing psychosocial interventions for MA use disorder. A limitation of this protocol is that the feasibility of follow-up is only examined at the end of treatment (4 weeks). TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12622000762752. Registered on May 27, 2022, and retrospectively registered (first participant enrolled) on May 23, 2022, with protocol version 7 on February 24, 2023.
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Affiliation(s)
- Tarun Yadav
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Buddhima Lokuge
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Melissa A Jackson
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Emma K Austin
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - Paul B Fitzgerald
- School of Medicine and Psychology, College of Health & Medicine, Australian National University, Canberra, Australia
- Monarch Mental Health Group, Sydney, Australia
| | - Amanda L Brown
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Bryan Paton
- School of Psychology, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - Marcia Sequeira
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - Martin Nean
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - Llewllyn Mills
- Discipline of Addiction Medicine, Central Clinical School, University of Sydney, Camperdown, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Camperdown, Australia
- The Langton Centre, Surry Hills, Australia
| | - Adrian J Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- NSW Drug & Alcohol Clinical Research & Improvement Network, St Leonards, Australia
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Tian W, Zhao D, Ding J, Zhan S, Zhang Y, Etkin A, Wu W, Yuan TF. An electroencephalographic signature predicts craving for methamphetamine. Cell Rep Med 2024; 5:101347. [PMID: 38151021 PMCID: PMC10829728 DOI: 10.1016/j.xcrm.2023.101347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/17/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
Craving is central to methamphetamine use disorder (MUD) and both characterizes the disease and predicts relapse. However, there is currently a lack of robust and reliable biomarkers for monitoring craving and diagnosing MUD. Here, we seek to identify a neurobiological signature of craving based on individual-level functional connectivity pattern differences between healthy control and MUD subjects. We train high-density electroencephalography (EEG)-based models using data recorded during the resting state and then calculate imaginary coherence features between the band-limited time series across different brain regions of interest. Our prediction model demonstrates that eyes-open beta functional connectivity networks have significant predictive value for craving at the individual level and can also identify individuals with MUD. These findings advance the neurobiological understanding of craving through an EEG-tailored computational model of the brain connectome. Dissecting neurophysiological features provides a clinical avenue for personalized treatment of MUD.
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Affiliation(s)
- Weiwen Tian
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Di Zhao
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Jinjun Ding
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Shulu Zhan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Yi Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Amit Etkin
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, CA 94305, USA; Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA 94305, USA; Alto Neuroscience, Inc., Los Altos, CA 94022, USA
| | - Wei Wu
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, CA 94305, USA; Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA 94305, USA; Alto Neuroscience, Inc., Los Altos, CA 94022, USA.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China; Institute of Mental Health and Drug Discovery, Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, Zhejiang 325000, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226019, China.
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Sahlem GL, Dowdle LT, Baker NL, Sherman BJ, Gray KM, McRae-Clark AL, Froeliger B, Squeglia LM. Exploring the Utility of a Functional Magnetic Resonance Imaging (fMRI) Cannabis Cue-Reactivity Paradigm in Treatment Seeking Adults with Cannabis Use Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.14.23298485. [PMID: 38014250 PMCID: PMC10680897 DOI: 10.1101/2023.11.14.23298485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Introduction Functional magnetic resonance imaging (fMRI) studies examining cue-reactivity in cannabis use disorder (CUD) to date have either involved non-treatment seeking participants or been small. We addressed this gap by administering an fMRI cue-reactivity task to CUD participants entering two separate clinical trials. Methods Treatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline via the Marijuana Craving Questionnaire (MCQ-SF). They additionally completed a visual cannabis cue-reactivity paradigm during fMRI following 24-hours of abstinence from cannabis. During fMRI, the Blood Oxygen Level Dependent (BOLD) signal was acquired while participants viewed cannabis-images or matched-neutral-images. BOLD responses were correlated with the MCQ-SF using a General Linear Model. Results N=65 participants (32% female; mean age 30.4±9.9SD) averaged 46.3±15.5SD on the MCQ-SF. When contrasting cannabis-images vs. matched-neutral-images, participants showed greater BOLD response in bilateral ventromedial prefrontal, dorsolateral prefrontal, anterior cingulate, and visual cortices, as well as the striatum. Similarly, there was stronger task-based functional-connectivity (tbFC) between the medial prefrontal cortex and both the amygdala and the visual cortex. There were no significant differences in either activation or tbFC between studies or between sexes. Craving negatively correlated with BOLD response in the left ventral striatum (R 2 =-0.25; p =0.01). Conclusions We found that, among two separate treatment-seeking CUD groups, cannabis cue-reactivity was evidenced by greater activation and tbFC in regions related to executive function and reward processing, and craving was negatively associated with cue-reactivity in the ventral striatum. Future directions include examining if pharmacological, neuromodulatory, or psychosocial interventions can alter corticostriatal cue-reactivity.
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Ye J, Garrison KA, Lacadie C, Potenza MN, Sinha R, Goldfarb EV, Scheinost D. Network state dynamics underpin craving in a transdiagnostic population. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.03.23296454. [PMID: 37873309 PMCID: PMC10593000 DOI: 10.1101/2023.10.03.23296454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Emerging fMRI brain dynamic methods present a unique opportunity to capture how brain region interactions across time give rise to evolving affective and motivational states. As the unfolding experience and regulation of affective states affect psychopathology and well-being, it is important to elucidate their underlying time-varying brain responses. Here, we developed a novel framework to identify network states specific to an affective state of interest and examine how their instantaneous engagement contributed to its experience. This framework investigated network state dynamics underlying craving, a clinically meaningful and changeable state. In a transdiagnostic sample of healthy controls and individuals diagnosed with or at risk for craving-related disorders (N=252), we utilized connectome-based predictive modeling (CPM) to identify craving-predictive edges. An edge-centric timeseries approach was leveraged to quantify the instantaneous engagement of the craving-positive and craving-negative networks during independent scan runs. Individuals with higher craving persisted longer in a craving-positive network state while dwelling less in a craving-negative network state. We replicated the latter results externally in an independent group of healthy controls and individuals with alcohol use disorder exposed to different stimuli during the scan (N=173). The associations between craving and network state dynamics can still be consistently observed even when craving-predictive edges were instead identified in the replication dataset. These robust findings suggest that variations in craving-specific network state recruitment underpin individual differences in craving. Our framework additionally presents a new avenue to explore how the moment-to-moment engagement of behaviorally meaningful network states supports our changing affective experiences.
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Affiliation(s)
- Jean Ye
- Interdepartmental Neuroscience Program, Yale School of Medicine
| | | | - Cheryl Lacadie
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | - Marc N. Potenza
- Interdepartmental Neuroscience Program, Yale School of Medicine
- Department of Psychiatry, Yale School of Medicine
- Child Study Center, Yale School of Medicine
- Department of Neuroscience, Yale School of Medicine
- Connecticut Mental Health Center
- Connecticut Council on Problem Gambling
- Wu Tsai Institute, Yale University
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine
- Child Study Center, Yale School of Medicine
- Department of Neuroscience, Yale School of Medicine
| | - Elizabeth V. Goldfarb
- Interdepartmental Neuroscience Program, Yale School of Medicine
- Department of Psychiatry, Yale School of Medicine
- Wu Tsai Institute, Yale University
- Department of Psychology, Yale University
- National Center for PTSD
| | - Dustin Scheinost
- Interdepartmental Neuroscience Program, Yale School of Medicine
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
- Child Study Center, Yale School of Medicine
- Wu Tsai Institute, Yale University
- Department of Biomedical Engineering, Yale University
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8
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Li X, Langleben DD, Lynch KG, Wang GJ, Elman I, Wiers CE, Shi Z. Association between body mass index and treatment completion in extended-release naltrexone-treated patients with opioid dependence. Front Psychiatry 2023; 14:1247961. [PMID: 37599869 PMCID: PMC10433165 DOI: 10.3389/fpsyt.2023.1247961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Background Excessive consumption of opioids is associated with impaired metabolic function including increased body mass index (BMI). Opioid antagonist naltrexone (NTX) is an effective treatment for opioid use disorder (OUD) that has the potential to mitigate such metabolic disturbances. Understanding the relationship between treatment adherence and BMI in NTX-treated OUD patients may provide valuable insights into optimizing clinical outcomes. Methods Patients with opioid dependence were offered up to three monthly injections of extended-release (XR) NTX. Treatment completers (n = 41) were defined as those who had received all three XR-NTX injections, and non-completers (n = 20) as those missing at least one injection. Logistic regression was performed to examine the association between pre-treatment BMI and treatment completion. Results BMI was positively associated with treatment completion. This association remained significant after adjusting for potentially confounding variables. Conclusion Our findings suggest that baseline BMI may serve as a potential predictor of XR-NTX treatment adherence in patients with OUD and could help healthcare providers and policy makers alike in developing strategies to improve retention and tailor interventions for specific patient subgroups.
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Affiliation(s)
- Xinyi Li
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Daniel D. Langleben
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kevin G. Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Igor Elman
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, United States
| | - Corinde E. Wiers
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Zhenhao Shi
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Li DX, Zhou XY, Lin QQ, Wu Y, Hu C, Shen ZH, Wang YG. Increased EEG gamma power under exposure to drug-related cues: a translational index for cue-elicited craving in METH-dependent individuals. BMC Psychiatry 2023; 23:367. [PMID: 37231397 DOI: 10.1186/s12888-023-04892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/20/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND This study explored the feasibility of using EEG gamma-band (30-49 Hz) power as an index of cue-elicited craving in METH-dependent individuals. METHODS Twenty-nine participants dependent on methamphetamine (METH) and 30 healthy participants were instructed to experience a METH-related virtual reality (VR) social environment. RESULTS Individuals with METH dependence showed significantly stronger self-reported craving and higher gamma power in a VR environment than healthy individuals. In the METH group, the VR environment elicited a significant increase in gamma power compared with the resting state. The METH group then received a VR counterconditioning procedure (VRCP), which was deemed useful in suppressing cue-induced reactivity. After VRCP, participants showed significantly lower self-reported craving scores and gamma power when exposed to drug-related cues than the first time. CONCLUSIONS These findings suggest that the EEG gamma-band power may be a marker of cue-induced reactivity in patients with METH dependence.
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Affiliation(s)
- Dong-Xu Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China
| | - Xiang-Yi Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China
| | - Qian-Qian Lin
- Affiliated Mental Health Center, Hangzhou Seventh People's Hospital, 305 Tianmushan Road, Hangzhou, Zhejiang Province, China
| | - Yue Wu
- The Fifth Hospital of Ruian, Ruian, Zhejiang Province, China
| | - Cheng Hu
- Shiliping Compulsory Rehabilitation Center, Zhejiang, China
| | - Zhi-Hua Shen
- Affiliated Mental Health Center, Hangzhou Seventh People's Hospital, 305 Tianmushan Road, Hangzhou, Zhejiang Province, China
| | - Yong-Guang Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China.
- Affiliated Mental Health Center, Hangzhou Seventh People's Hospital, 305 Tianmushan Road, Hangzhou, Zhejiang Province, China.
- The Fifth Hospital of Ruian, Ruian, Zhejiang Province, China.
- Zhejiang Provincial Institute of Drug Abuse Research, Hangzhou, Zhejiang Province, China.
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10
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Bachtell RK, Larson TA, Winkler MC. Adenosine receptor stimulation inhibits methamphetamine-associated cue seeking. J Psychopharmacol 2023; 37:192-203. [PMID: 36629009 DOI: 10.1177/02698811221147157] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Methamphetamine (METH) is a psychostimulant drug that remains a popular and threatening drug of abuse with high abuse liability. There is no established pharmacotherapy to treat METH dependence, but evidence suggests that stimulation of adenosine receptors reduces the reinforcing properties of METH and could be a potential pharmacological target. This study examines the effects of adenosine receptor subtype stimulation on METH seeking using both a cue-induced reinstatement and cue-craving model of relapse. METHODS Male and female rats were trained to self-administer METH during daily 2-h sessions. Cue-induced reinstatement of METH seeking was evaluated after extinction training. A systemic pretreatment of an adenosine A1 receptor (A1R) or A2A receptor (A2AR) agonist was administered prior to an extinction or cue session to evaluate the effects of adenosine receptor subtype stimulation on METH seeking. The effects of a systemic pretreatment of A1R or A2AR agonists were also evaluated in a cue-craving model where the cued-seeking test was conducted after 21 days of forced home-cage abstinence without extinction training. RESULTS Cue-induced reinstatement was reduced in both male and female rats that received A1R or A2AR agonist pretreatments. Similarly, an A1R or A2AR agonist pretreatment also inhibited cue craving in both male and female rats. CONCLUSION Stimulation of either adenosine A1R or A2AR subtypes inhibits METH-seeking behavior elicited by METH-associated cues. These effects may be attributed to the ability of A1R and A2AR stimulation to disrupt cue-induced dopamine and glutamate signaling throughout the brain.
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Affiliation(s)
- Ryan K Bachtell
- Department of Psychology and Neuroscience and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA.,Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Tracey A Larson
- Department of Psychology and Neuroscience and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Madeline C Winkler
- Department of Psychology and Neuroscience and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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11
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Risk factors for relapse among methamphetamine users receiving a joint legal-medical treatment program as a diversion intervention: A one-year follow-up study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023:208955. [PMID: 36804075 DOI: 10.1016/j.josat.2023.208955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Methamphetamine (METH) is a Schedule II illicit drug in Taiwan. A 12-month legal-medical joint intervention program has been developed for first-time METH offenders during deferred prosecution. Risk factors associated with METH relapse use among these individuals were unknown. METHODS We enrolled a total of 449 METH offenders referred by the Taipei District Prosecutor's Office to Taipei City Psychiatric Center. The study defines relapse as having any positive urine toxicology result or self-report of METH use during 12-month treatment. We compared demographic and clinical variables between a relapse group and nonrelapse group and used a Cox proportional hazards model to determine variables associated with time to relapse. RESULTS Of all participants, 37.8 % relapsed to use METH and 23.2 % were noncompleters in the one-year follow-up. Compared to the nonrelapse group, the relapse group had lower educational attainment, more severe psychological symptoms, longer duration of METH use, higher odds of polysubstance use, higher craving severity, and higher odds of positive baseline urine. The Cox analysis revealed individuals with positive urine results and higher craving severity at baseline were at higher risks of METH relapse (hazard ratio [95 % CI]: 3.85 [2.61-5.68] and 1.71 [1.19-2.46], respectively, p < 0.001). Baseline positive urine results and high craving could also predict a shorter length of time to relapse than their respective counterparts. CONCLUSIONS Positive urine screening for METH at baseline and high craving severity are two indicators of an increased risk of drug relapse. Tailored treatment plans incorporating these findings to prevent relapse are warranted in our joint intervention program.
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12
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Acheson LS, Williams BH, Farrell M, McKetin R, Ezard N, Siefried KJ. Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta-analysis of randomised controlled trials. Drug Alcohol Rev 2023; 42:7-19. [PMID: 35862266 PMCID: PMC10083934 DOI: 10.1111/dar.13511] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/08/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023]
Abstract
ISSUES Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta-analysis since 2008. APPROACH MEDLINE (1966-2020), CINAHL (1982-2020), PsychINFO (1806-2020) and EMBASE (1947-2020) were systematically searched. Studies were included if they were randomised controlled trials (RCT) investigating pharmacological treatments for methamphetamine withdrawal, reviewing outcomes of treatment discontinuation, mental health outcomes, withdrawal symptoms (including craving) and patient safety. The relative risk (RR) and weighted mean difference (MD) were used to meta-analyse dichotomous and continuous data respectively, with 95% confidence intervals. Risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were conducted. KEY FINDINGS Nine RCTs of six medications (n = 242 participants) met inclusion criteria, however, only six trials of four medications (n = 186) could be meta-analysed. Mean sample size across studies was 27 participants, and 88% of participants were male. The quality of evidence in this review varies from low to very low on GRADE assessments. Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD -0.49, 95% CI -0.80, -0.17), compared with placebo, however, this medication is no longer approved. No other medications improved any domain when compared with placebo. Due to lack of reporting safety profiles could not be established. CONCLUSIONS There is insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal. The poor quality of the evidence indicates a need for better powered, high-quality trials.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia
| | - Benjamin H Williams
- Department of Psychiatry, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nadine Ezard
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia
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13
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Sirvent-Ruiz CM, Moral-Jiménez MDLV, Herrero J, Miranda-Rovés M, Rodríguez Díaz FJ. Concept of Affective Dependence and Validation of an Affective Dependence Scale. Psychol Res Behav Manag 2022; 15:3875-3888. [PMID: 36605173 PMCID: PMC9809362 DOI: 10.2147/prbm.s385807] [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: 08/22/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Background There is a degree of affective interdependence that is considered normal and only becomes pathological if it causes excessive suffering, both for the subject and for those close to them. Our objective was to introduce and psychometrically validate a short and effective affective dependency scale, the Affective Dependence Scale (ADS-9). Methods We used a sample of 762 participants (clinical: emotional dependent subjects n = 212, comparison: non-emotionally-dependent addicted subjects n = 272, and general population n = 278) to assess the factor structure, the psychological construct validity and the measurement invariance for the ADS-9 by means of independent exploratory factor analyses for each sample group and subsequent multigroup confirmatory factor analyses. Results Our results confirm that ADS-9 is a psychometrically consistent instrument, with construct and clinical validity, as well as configural, metric and scalar invariance across different sample groups (clinical, comparison and general population). A hypothesized two-dimensional structure was confirmed by means of factor analyses. Both sub-scales of this abbreviated form, Submission and Craving, showed a good agreement with the previously validated Relationships and Sentimental Dependencies Inventory (IRIDS-100). Conclusion The ADS-9 is a brief instrument that appears to reliably detect the dependent and pathological components of affective dependence. It consists of two sub-scales, describing Submission (adaptation, accommodation, and subjugation) and Craving (imperative need for the other with the presence of disturbing states). We suggest that it is a versatile scale that may be useful for clinicians and researchers.
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Affiliation(s)
- Carlos Miguel Sirvent-Ruiz
- Research and Teaching Department, Fundación Instituto Spiral, Madrid, Spain,Correspondence: Carlos Miguel Sirvent-Ruiz, Fundación Instituto Spiral, c/ Marqués de Valdeiglesias, 2, Madrid, 28004, Spain, Tel +34 985 111 111; +34 915 000 050, Email
| | | | - Juan Herrero
- Department of Psychology, University of Oviedo, Oviedo, Spain
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14
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Wu MK, Satogami K, Liang CS, Stubbs B, Carvalho AF, Brunoni AR, Su KP, Tu YK, Wu YC, Chen TY, Li DJ, Lin PY, Hsu CW, Chen YW, Suen MW, Zeng BY, Takahashi S, Tseng PT, Li CT. Multiple comparison of different noninvasive brain stimulation and pharmacologic interventions in patients with methamphetamine use disorders: A network meta-analysis of randomized controlled trials. Psychiatry Clin Neurosci 2022; 76:633-643. [PMID: 35876620 DOI: 10.1111/pcn.13452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
AIM In recent decades, the prevalence of amphetamine and methamphetamine use disorders has at least doubled in some regions/countries, with accompanying high risks of drug overdose-associated mortality. Noninvasive brain stimulation (NIBS) methods may be effective treatments. However, the comparative efficacy of the NIBS protocol for amphetamine/methamphetamine use disorder (AUD/MUD) remains unknown to date. The aim of this network meta-analysis (NMA) was to compare the efficacy and acceptability of various NIBS methods/protocols for AUD/MUD management. METHODS A frequentist model-based NMA was conducted. We included randomized controlled trials (RCTs) that investigated the efficacy of NIBS and guideline-recommended pharmacologic treatments to reduce craving severity in patients with either AUD or MUD. RESULTS Twenty-two RCTs including 1888 participants met the eligibility criteria. Compared with the sham/placebo group (study = 19, subjects = 891), a combination of intermittent theta burst stimulation over the left dorsolateral prefrontal cortex (DLPFC) and continuous TBS over the left ventromedial prefrontal cortex (study = 1, subjects = 19) was associated with the largest decreases in craving severity [standardized mean difference (SMD) = -1.50; 95% confidence intervals (95%CIs) = -2.70 to -0.31]. High-frequency repetitive transcranial magnetic stimulation over the left DLPFC was associated with the largest improvements in depression and quality of sleep (study = 3, subjects = 86) (SMD = -2.48; 95%CIs = -3.25 to -1.71 and SMD = -2.43; 95%CIs = -3.38 to -1.48, respectively). The drop-out rate of most investigated treatments did not significantly differ between groups. CONCLUSION The combined TBS protocol over the prefrontal cortex was associated with the greatest improvement in craving severity. Since few studies were available for inclusion, additional large-scale randomized controlled trials are warranted.
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Affiliation(s)
- Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kazumi Satogami
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil.,Departamento de Ciências Médicas, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Gender Equality Education and Research Center, Asia University, Taichung, Taiwan.,Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Dachang Hospital, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan.,Clinical Research and Education Center, Asakayama General Hospital, Sakai, Japan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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15
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Acheson LS, Ezard N, Lintzeris N, Dunlop A, Brett J, Rodgers C, Gill A, Christmass M, McKetin R, Farrell M, Shoptaw S, Siefried KJ. Lisdexamfetamine for the treatment of acute methamphetamine withdrawal: A pilot feasibility and safety trial. Drug Alcohol Depend 2022; 241:109692. [PMID: 36399936 DOI: 10.1016/j.drugalcdep.2022.109692] [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: 09/08/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is no effective treatment for methamphetamine withdrawal. This study aimed to determine the feasibility and safety of a tapering dose of lisdexamfetamine for the treatment of acute methamphetamine (MA) withdrawal. METHODS Open-label, single-arm pilot study, in an inpatient drug and alcohol withdrawal unit assessing a tapering dose of oral lisdexamfetamine dimesylate commencing at 250 mg once daily, reducing by 50 mg per day to 50 mg on Day 5. Measures were assessed daily (days 0-7) with 21-day telephone follow-up. Feasibility was measured by the time taken to enrol the sample. Safety was the number of adverse events (AEs) by system organ class. Retention was the proportion to complete treatment. Other measures included the Treatment Satisfaction Questionnaire for Medication (TSQM), the Amphetamine Withdrawal Questionnaire and craving (Visual Analogue Scale). RESULTS Ten adults seeking inpatient treatment for MA withdrawal (9 male, median age 37.1 years [IQR 31.7-41.9]), diagnosed with MA use disorder were recruited. The trial was open for 126 days; enroling one participant every 12.6 days. Eight of ten participants completed treatment (Day 5). Two participants left treatment early. There were no treatment-related serious adverse events (SAEs). Forty-seven AEs were recorded, 17 (36%) of which were potentially causally related, all graded as mild severity. Acceptability of the study drug by TSQM was rated at 100% at treatment completion. Withdrawal severity and craving reduced through the admission. CONCLUSION A tapering dose regimen of lisdexamfetamine was safe and feasible for the treatment of acute methamphetamine withdrawal in an inpatient setting.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia.
| | - Nadine Ezard
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia; New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; The Langton Centre, South East Sydney Local Health District, Sydney, Australia; Discipline of Addiction Medicine, the University of Sydney, Sydney, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia; School of Medicine and Public Health, the University of Newcastle, Newcastle, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia; St. Vincent's Clinical School, the University of New South Wales, Sydney, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Anthony Gill
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Perth, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Steve Shoptaw
- Department of Family Medicine, The University of California Los Angeles, Los Angeles, USA
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
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16
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Acheson LS, Ezard N, Lintzeris N, Dunlop A, Brett J, Rodgers C, Gill A, Christmass M, McKetin R, Farrell M, Shoptaw S, Siefried KJ. Trial protocol of an open label pilot study of lisdexamfetamine for the treatment of acute methamphetamine withdrawal. PLoS One 2022; 17:e0275371. [PMID: 36190973 PMCID: PMC9529099 DOI: 10.1371/journal.pone.0275371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Methamphetamine (MA) use disorder is an important public health concern. MA withdrawal is often the first step in ceasing or reducing use. There are no evidence-based withdrawal treatments, and no medication is approved for the treatment of MA withdrawal. Lisdexamfetamine (LDX) dimesilate, used in the treatment of attention deficit hyperactivity disorder and binge eating disorder has the potential as an agonist therapy to ameliorate withdrawal symptoms, and improve outcomes for patients. Methods A single arm, open-label pilot study to test the safety and feasibility of LDX for the treatment of MA withdrawal. Participants will be inpatients in a drug and alcohol withdrawal unit, and will receive a tapering dose of LDX over five days: 250mg LDX on Day 1, reducing by 50mg per day to 50mg on Day 5. Optional inpatient Days 6 and 7 will allow for participants to transition to ongoing treatment. Participants will be followed-up on Days 14, 21 and 28. All participants will also receive standard inpatient withdrawal care. The primary outcomes are safety (measured by adverse events, changes in vital signs, changes in suicidality and psychosis) and feasibility (the time taken to enrol the sample, proportion of screen / pre-screen failures). Secondary outcomes are acceptability (treatment satisfaction questionnaire, medication adherence, concomitant medications, qualitative interviews), retention to protocol (proportion retained to primary and secondary endpoints), changes in withdrawal symptoms (Amphetamine Withdrawal Questionnaire) and craving for MA (visual analogue scale), and sleep outcomes (continuous actigraphy and daily sleep diary). Discussion This is the first study to assess lisdexamfetamine for the treatment of acute MA withdrawal. If safe and feasible results will go to informing the development of multi-centre randomised controlled trials to determine the efficacy of the intervention.
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Affiliation(s)
- Liam S. Acheson
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
- * E-mail:
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia
- The Langton Centre, South East Sydney Local Health District, Sydney, Australia
- Discipline of Addiction Medicine, the University of Sydney, Sydney, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, the University of Newcastle, Newcastle, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent’s Hospital Sydney, Sydney, Australia
- St. Vincent’s Clinical School, the University of New South Wales, Sydney, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Anthony Gill
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Steve Shoptaw
- Department of Family Medicine, The University of California Los Angeles, Los Angeles, California, United States of America
| | - Krista J. Siefried
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
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17
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Toor T, Murphy E, Simmons AN, Palyo S, Librodo SC, Strigo IA. Craving of prescription opioids among veterans with chronic pain. Pain 2022; 163:2021-2030. [PMID: 35297818 PMCID: PMC9329486 DOI: 10.1097/j.pain.0000000000002598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/20/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT The United States faces a crisis because of the high prevalence of chronic pain, concurrent opioid use disorder, and overdose deaths. Prescription opioids remain a primary driver of opioid-related deaths. Craving is a core symptom of addiction, yet the degree to which craving plays a role in prescription opioid use among patients with chronic pain is unknown. Understanding the degree to which craving should be considered in patients with chronic pain is critical for developing effective interventions for supporting patients through opioid tapering. The current work combines data collected from (1) 2152 veterans screened for eligibility at a pain specialty care clinic at the San Francisco VA Health Care System and (2) medical records obtained from the VA Corporate Data Warehouse. We found that prescription opioid craving among veterans with chronic pain was low, with 66.4% of the sample reporting no craving and 33.6% reporting craving. We also found that craving had a small association with morphine equivalent daily dose and pain severity but was more strongly associated with depression. Craving of prescription opioids among veterans with chronic pain is complex. Findings are discussed in relation to chronic pain symptoms, psychiatric comorbidities, and demographics.
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Affiliation(s)
- Tiffany Toor
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
| | - Emily Murphy
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
| | - Alan N. Simmons
- Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA
- University of California, San Diego, CA
| | - Sarah Palyo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
| | - Sara C. Librodo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
| | - Irina A. Strigo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA
- University of California, San Francisco, CA
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18
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Beyond thirst: Cravings for non-alcoholic beverages including soft drink. Eat Behav 2022; 46:101662. [PMID: 35981488 DOI: 10.1016/j.eatbeh.2022.101662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022]
Abstract
Cravings for a range of substances including drugs, alcohol, and food have been shown to predict subsequent consumption or use. However, this link has not yet been systematically examined for beverages other than alcohol. The present study aimed to provide a comprehensive investigation of cravings for non-alcoholic beverages and their link to consumption. Participants were 128 undergraduate students (17-25 years) who completed a craving diary and daily consumption measure over a period of a week. Cravings were reported for a range of beverages, including tea, juice, and flavoured milk, but by far the most craved beverages were water, coffee, and soft drink. Stronger cravings were associated with a greater likelihood of drinking and drinking more of the craved beverage. This was particularly the case for soft drink. Unlike water, cravings for coffee and soft drink were triggered by factors other than thirst, and the number of cravings predicted the total amount drunk over the week. The findings demonstrate the existence of cravings for non-alcoholic beverages such as soft drink, and point to these cravings as a potential target for reducing consumption.
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Wen Y, Hao X, Chen X, Qiao S, Li Q, Winkler MH, Wang F, Yan X, Wang F, Wang L, Jiang F, Pauli P, Dong X, Li Y. Theta-Burst Stimulation Combined With Virtual-Reality Reconsolidation Intervention for Methamphetamine Use Disorder: Study Protocol for a Randomized-Controlled Trial. Front Psychiatry 2022; 13:903242. [PMID: 35865301 PMCID: PMC9294395 DOI: 10.3389/fpsyt.2022.903242] [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: 03/24/2022] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Craving associated with drug-related memory is one of the key factors that induce the relapse of methamphetamine (MA). Disruption or modulation of the reconsolidation of drug-related memory may serve as an option for clinical treatment of MA addiction. This protocol proposes to use virtual reality (VR) to retrieve drug-associated memory and then use transcranial magnetic stimulation (TMS) at the neural circuit that encodes the reward value of drug cues to provide a non-invasive intervention during reconsolidation. We aim to evaluate the effectiveness of TMS treatment after VR retrieval on the reduction of cue reactivity and craving of MA. Methods This is a randomized, double-blind, sham-controlled, parallel group trial, targeting participants with MA use disorder aged from 18 to 45 years old. Forty-five eligible volunteers in Shanxi Drug Rehabilitation Center will be recruited and be randomly allocated into three parallel groups, receiving either 1) MA-related cues retrieval in VR combined with active TMS (MA VR scene + TBS) or 2) sham TMS (MA VR scene + sham TBS), or 3) neutral cues retrieval in VR combined with active TMS (neutral VR scene + TBS). Two sessions of post-VR-retrieval TBS will be scheduled on two separate days within 1 week. The primary outcome will detect the memory-related activity by the electroencephalography (EEG) reactivity to drug cues in VR scenes. Secondary outcomes are the self-reported MA craving in VR scene, the physiological parameter (cue-induced heart rate) and the scores of psychological questionnaires including anxiety, depression, and mood. All primary and secondary outcomes will be assessed at baseline, 1-week, and 1-month post-intervention. Assessments will be compared between the groups of 1) MA VR scene + TBS, 2) MA VR scene + sham TBS and 3) neutral VR scene + TBS. Discussion This will be the first study to examine whether the TMS modulation after VR retrieval can reduce self-reported craving and drug-related cue reactivity. It will promote the understanding of the neural circuit mechanism of the reconsolidation-based intervention and provide an effective treatment for MA use disorder patients. Clinical Trial Registration [Chinese Clinical Trial Registry], identifier [ChiCTR1900026902]. Registered on 26 October 2019.
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Affiliation(s)
- Yatong Wen
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xuemin Hao
- School of Education, Shaanxi Normal University, Xi'an, China
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, China
| | - Xijing Chen
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Siyue Qiao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
| | - Qianling Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Markus H. Winkler
- Department of Psychology I, Biological Psychology, Clinical Psychology, and Psychotherapy, University of Wurzburg, Wurzburg, Germany
| | - Fenglan Wang
- Shanxi Women's Drug Rehabilitation Center, Taiyuan, China
| | - Xiaoli Yan
- Shanxi Women's Drug Rehabilitation Center, Taiyuan, China
| | - Fang Wang
- Shanxi Women's Drug Rehabilitation Center, Taiyuan, China
| | - Liang Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Feng Jiang
- Library, Shanxi Medical University, Taiyuan, China
| | - Paul Pauli
- Department of Psychology I, Biological Psychology, Clinical Psychology, and Psychotherapy, University of Wurzburg, Wurzburg, Germany
| | - Xinwen Dong
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yonghui Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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20
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Ibañez GE, Sanchez M, Villalba K, Amaro H. Acting with awareness moderates the association between lifetime exposure to interpersonal traumatic events and craving via trauma symptoms: a moderated indirect effects model. BMC Psychiatry 2022; 22:287. [PMID: 35459133 PMCID: PMC9026679 DOI: 10.1186/s12888-022-03931-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND History of exposure to traumatic events (ETE) is common among women in substance use disorder (SUD) treatment and is related to craving. We examined whether ETE (i.e., emotional, physical, sexual abuse) in childhood, adulthood, or both is related to craving via trauma symptoms and how trait mindfulness might attenuate this association. METHODS Baseline data from a larger randomized clinical trial of a mindfulness-based intervention for women (N = 245) in SUD treatment were used. Inclusion criteria were: 18-65 years of age, SUD diagnosis, English fluency, no cognitive impairment, and willingness to be audio recorded and provide consent. Demographics and validated measures of ETE, posttraumatic stress symptoms, trait mindfulness, and substance use craving were collected via in-person interviews. Descriptive statistics, correlational analysis, and relative direct, indirect, and conditional indirect effects models were run. RESULTS Most participants identified as Hispanic (58.5%), had at least a high school education (52.2%), with a mean age of 32.2. Women reported ETE in childhood only (20.4%), adulthood only (17.5%), both childhood and adulthood (50.0%), and never (11.4%). Compared to women with ETE in both childhood and adulthood, those with exposure in adulthood only (β = -.10, 95% CI = -.20, -.02) or no exposure (β = -.11, 95% CI = -.23, -.03; [∆R2= .347, F(8, 245) = 15.7, p < .001) had lower craving via lower trauma symptomatology but no difference when compared to those with ETE only in childhood. Acting with awareness moderated this indirect effect (∆R2 = .04, F(3, 245) = 4.66, p = .004. At low levels of awareness, women with ETE during both childhood and adulthood reported higher craving via trauma symptomatology than women with no exposure or only adulthood exposure. CONCLUSIONS Low levels of acting with awareness may worsen trauma symptoms after ETE, which in turn may lead to more craving for women in substance use treatment. Despite a small moderating effect size, acting with awareness may have clinical significance due to the prevalence of trauma symptoms among women in SUD treatment.
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Affiliation(s)
- Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, Miami, US.
| | - Mariana Sanchez
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, Miami, US
| | - Karina Villalba
- Department of Population Health, College of Medicine, University of Central Florida, Florida, Miami, US
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health, Florida International University, Florida, Miami, US
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21
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Skewes MC, Gonzalez VM, Gameon JA, FireMoon P, Salois E, Rasmus SM, Lewis JP, Gardner SA, Ricker A, Reum M. Health Disparities Research with American Indian Communities: The Importance of Trust and Transparency. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:302-313. [PMID: 32652706 PMCID: PMC7772225 DOI: 10.1002/ajcp.12445] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
American Indian and Alaska Native (AI/AN) communities experience notable health disparities associated with substance use, including disproportionate rates of accidents/injuries, diabetes, liver disease, suicide, and substance use disorders. Effective treatments for substance use are needed to improve health equity for AI/AN communities. However, an unfortunate history of unethical and stigmatizing research has engendered distrust and reluctance to participate in research among many Native communities. In recent years, researchers have made progress toward engaging in ethical health disparities research by using a community-based participatory research (CBPR) framework to work in close partnership with community members throughout the research process. In this methodological process paper, we discuss the collaborative development of a quantitative survey aimed at understanding risk and protective factors for substance use among a sample of tribal members residing on a rural AI reservation with numerous systems-level barriers to recovery and limited access to treatment. By using a CBPR approach and prioritizing trust and transparency with community partners and participants, we were able to successfully recruit our target sample and collect quality data from nearly 200 tribal members who self-identified as having a substance use problem. Strategies for enhancing buy-in and recruiting a community sample are discussed.
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Affiliation(s)
- Monica C Skewes
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | - Vivian M Gonzalez
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, USA
| | - Julie A Gameon
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | | | - Emily Salois
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
| | - Stacy M Rasmus
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Jordan P Lewis
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Scott A Gardner
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | | | - Martel Reum
- Fort Peck Community College, Poplar, MT, USA
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22
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Kamp F, Hager L, Proebstl L, Schreiber A, Riebschläger M, Neumann S, Straif M, Schacht-Jablonowsky M, Falkai P, Pogarell O, Manz K, Soyka M, Koller G. 12- and 18-month follow-up after residential treatment of methamphetamine dependence: Influence of treatment drop-out and different treatment concepts. J Psychiatr Res 2020; 129:103-110. [PMID: 32652338 DOI: 10.1016/j.jpsychires.2020.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
This study investigates the effects of two different residential treatments and of treatment drop-out in a German methamphetamine (MA) dependent sample. 108 subjects from two addiction treatment concepts were recruited at treatment begin and followed-up at 12 (T2) and 18 (T3) months after treatment. Based on follow-up samples (n = 38 at T2, n = 25 at T3), 77.1% at T2 and 68.0% at T3 were MA abstinent. Classifying everyone, who did not participate at follow-ups as having had a relapse, showed MA-abstinence rates of 25.0% (at T2) and 15.7% (at T3). There was no difference in MA-use between treatment conditions nor between treatment completers and drop-outs. Having injected any substance predicted MA-use at T2 (p = .03). The median time of relapse was 1.5 days after hospital release. Depression scores at T2 predicted MA-use at T3 (p = .02). T2 participants that dropped out of treatment had higher craving scores at T2, than T2 subjects who completed treatment (p = .03). The results show positive effects of current inpatient treatment programs without differences between different concepts. More research is needed to clarify the impact of treatment drop-out. Attention should be paid to a successful transition from residential to outpatient services and to a reduction of study attrition.
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Affiliation(s)
- F Kamp
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - L Hager
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany.
| | - L Proebstl
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - A Schreiber
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt Am Main, Germany
| | - M Riebschläger
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, 19217, Rehna OT Parber, Germany
| | - S Neumann
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, 19217, Rehna OT Parber, Germany
| | - M Straif
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt Am Main, Germany
| | | | - P Falkai
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - K Manz
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany
| | - M Soyka
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - G Koller
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
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23
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Aryan N, Banafshe HR, Farnia V, Shakeri J, Alikhani M, Rahimi H, Sehat M, Mamsharifi P, Ghaderi A, Omidi A. The therapeutic effects of methylphenidate and matrix-methylphenidate on addiction severity, craving, relapse and mental health in the methamphetamine use disorder. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:72. [PMID: 32977820 PMCID: PMC7519552 DOI: 10.1186/s13011-020-00317-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022]
Abstract
Background Little evidence has examined the therapeutic effects of methylphenidate (MPH) and Matrix Model treatment on addiction severity, craving, relapse and mental health in people who use methamphetamine (PWUM). This study was conducted to determine the effects of MPH, Matrix Model treatment, and Matrix-MPH on addiction severity, craving, relapse and mental health in PWUM. Methods This clinical trial was conducted among 100 patients with METH users. Participants were randomly divided into four groups who received: 1) 22 sessions of 45-min, twice a week for Matrix Model treatment (n = 25); 2) MPH 10 mg/day in the first month, 7.5 mg/day in the second month and 5 mg/day in the third month (n = 25); 3) Matrix Model treatment combined with MPH (n = 25); 4) control group (n = 25) for 12 weeks. Addiction severity, craving, relapse and mental status were evaluated at baseline and end-of-trial. Results Matrix Model treatment combined with MPH significantly reduced MA craving (P < 0.001) and addiction severity (P < 0.001). In addition, Matrix Model treatment combined with MPH resulted in a significant increase of mental health (P = 0.001), compared with Matrix Model treatment, MPH, and control group. Also, negative METH urine test significantly increased in the Matrix Model treatment combined with MPH group compared with the other groups (P < 0.001). Conclusions In conclusion, Matrix Model treatment combined with MPH for 12 weeks had beneficial effects on addiction severity, craving, relapse, and mental health in PWUM, compared with Matrix Model treatment, MPH, and control group. Trial registration This study was retrospectively registered in the Iranian website (www.irct.ir) for clinical trials registration (http://www.irct.ir: IRCT20171105037245N1). Registration date: 9 December 2017.
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Affiliation(s)
- Nazanin Aryan
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Banafshe
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pharmacology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jalal Shakeri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibollah Rahimi
- Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Sehat
- Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Peyman Mamsharifi
- Department of Psychology, Allameh Tabataba'i University, Tehran, Iran
| | - Amir Ghaderi
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Clinical Research development unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Department of clinical psychology, School of Medicine, Kashan University of Medical Science, Kashan, Iran.
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24
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Talebizadeh M, Fathali Lavasani F, Bastani P, Noroozi A. Cue exposure therapy for treatment of stimulant (methamphetamine) use disorder: study protocol for a randomized controlled trial. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1720325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Meghdad Talebizadeh
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Parsa Bastani
- Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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25
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Grodin EN, Courtney KE, Ray LA. Drug-Induced Craving for Methamphetamine Is Associated With Neural Methamphetamine Cue Reactivity. J Stud Alcohol Drugs 2020. [PMID: 31014470 DOI: 10.15288/jsad.2019.80.245] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Drug craving serves as the major motivator to propagate drug use and is thought to elicit relapse in abstinent individuals. Although craving for methamphetamine has been investigated using both laboratory and neuroimaging methodologies, the relationship between drug-induced craving and neural responses to methamphetamine cues has yet to be explored. Therefore, the present study investigated whether methamphetamine-induced craving responses in the laboratory were associated with neural response to methamphetamine cues. METHOD Non-treatment-seeking individuals with methamphetamine use disorder (n = 15) completed two sessions, one in the laboratory where they underwent a methamphetamine infusion, and one in the magnetic resonance imaging scanner where they viewed methamphetamine cues. Participants reported their craving for methamphetamine over the course of the laboratory session. Analyses examined the association between peak ratings of methamphetamine-induced craving and neural activation to methamphetamine cues. RESULTS In individuals with a methamphetamine use disorder, methamphetamine-induced craving was positively associated with neural methamphetamine cue reactivity in the precuneus, putamen, and ventromedial prefrontal cortex (Z > 2.3, p < .05). CONCLUSIONS There is a shared neurobiology underlying cue- and drug-induced craving in individuals with methamphetamine use disorder. Treatments that disrupt this circuitry may decrease craving and help prevent relapse.
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Affiliation(s)
- Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Kelly E Courtney
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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26
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Coffin PO, Santos GM, Hern J, Vittinghoff E, Walker JE, Matheson T, Santos D, Colfax G, Batki SL. Effects of Mirtazapine for Methamphetamine Use Disorder Among Cisgender Men and Transgender Women Who Have Sex With Men: A Placebo-Controlled Randomized Clinical Trial. JAMA Psychiatry 2020; 77:246-255. [PMID: 31825466 PMCID: PMC6990973 DOI: 10.1001/jamapsychiatry.2019.3655] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Methamphetamine use is increasingly prevalent and associated with HIV transmission. A previous phase 2a study of mirtazapine demonstrated reductions in methamphetamine use and sexual risk behaviors among men who have sex with men. OBJECTIVE To determine the efficacy of mirtazapine for treatment of methamphetamine use disorder and reduction in HIV risk behaviors. DESIGN, SETTING, AND PARTICIPANTS This double-blind randomized clinical trial of mirtazapine vs placebo took place from August 2013 to September 2017 in an outpatient research clinic in San Francisco, California. Participants were community-recruited adults who were sexually active; cisgender men, transgender men, and transgender women who (1) had sex with men, (2) had methamphetamine use disorder, and (3) were actively using methamphetamine were eligible. Participants were randomized to receive the study drug or placebo for 24 weeks, with 12 more weeks of follow-up. Data analysis took place from February to June 2018. EXPOSURES Mirtazapine, 30 mg, or matched placebo orally once daily for 24 weeks, with background counseling. MAIN OUTCOMES AND MEASURES Positive urine test results for methamphetamine over 12, 24, and 36 weeks (primary outcomes) and sexual risk behaviors (secondary outcomes). Sleep, methamphetamine craving, dependence severity, and adverse events were assessed. RESULTS Of 241 persons assessed, 120 were enrolled (5 transgender women and 115 cisgender men). The mean (SD) age was 43.3 (9.8) years; 61 (50.8%) were white, 31 (25.8%) were African American, and 15 (12.5%) were Latinx. A mean (SD) of 66% (47%) of visits were completed overall. By week 12, the rate of methamphetamine-positive urine test results significantly declined among participants randomized to mirtazapine vs placebo (risk ratio [RR], 0.67 [95% CI, 0.51-0.87]). Mirtazapine resulted in reductions in positive urine test results at 24 weeks (RR, 0.75 [95% CI, 0.56-1.00]) and 36 weeks (RR, 0.73 [95% CI, 0.57-0.96]) vs placebo. Mean (SD) medication adherence by WisePill dispenser was 38.5% (27.0%) in the mirtazapine group vs 39.5% (26.2%) in the placebo group (P = .77) over 2 to 12 weeks and 28.1% (23.4%) vs 38.5% (27.0%) (P = .59) over 13 to 24 weeks. Changes in sexual risk behaviors were not significantly different by study arm at 12 weeks, but those assigned to receive mirtazapine had fewer sexual partners (RR, 0.52 [95% CI, 0.27-0.97]; P = .04), fewer episodes of condomless anal sex with partners who were serodiscordant (RR, 0.47 [95% CI, 0.23-0.97]; P = .04), and fewer episodes of condomless receptive anal sex with partners who were serodiscordant (RR, 0.37 [95% CI, 0.14-0.93]; P = .04) at week 24. Participants assigned to mirtazapine had net reductions in depressive symptoms (Center for Epidemiologic Studies Depression Scale score, 6.2 [95% CI, 1.3-11.1] points lower; P = .01) and insomnia severity (Athens score, 1.4 [95% CI, 0.1-2.7] points lower; P = .04) at week 24. There were no serious adverse events associated with the study drug. CONCLUSIONS AND RELEVANCE In this expanded replication trial, adding mirtazapine to substance use counseling reduced methamphetamine use and some HIV risk behaviors among cisgender men and transgender women who have sex with men, with benefits extending after treatment despite suboptimal medication adherence. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888835.
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Affiliation(s)
- Phillip O. Coffin
- San Francisco Department of Public Health, San Francisco, California,Department of Medicine, University of California, San Francisco, San Francisco
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, California,School of Nursing, University of California, San Francisco, San Francisco
| | - Jaclyn Hern
- San Francisco Department of Public Health, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - John E. Walker
- San Francisco Department of Public Health, San Francisco, California
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | - Deirdre Santos
- San Francisco Department of Public Health, San Francisco, California
| | - Grant Colfax
- San Francisco Department of Public Health, San Francisco, California
| | - Steven L. Batki
- Department of Psychiatry, University of California, San Francisco, San Francisco
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27
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Wang YG, Liu MH, Shen ZH. A virtual reality counterconditioning procedure to reduce methamphetamine cue-induced craving. J Psychiatr Res 2019; 116:88-94. [PMID: 31226580 DOI: 10.1016/j.jpsychires.2019.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/29/2019] [Accepted: 06/13/2019] [Indexed: 01/19/2023]
Abstract
The present work developed a virtual reality (VR) counterconditioning procedure (VRCP), and investigated its efficacy in treatment of cue-induced craving in individuals with methamphetamine (METH) dependence. In study 1, thirty-one patients diagnosed with METH dependence received VRCP, while twenty-nine METH-dependent patients in waiting-list group did not. In study 2, the VRCP was computerized as a VR treatment system. Six-hundred and twelve abstinent individuals with a history of METH dependence received the computerized VRCP, while two-hundred seventy-six abstinent individuals with a history of METH dependence in waiting-list group did not. Patients with METH dependence who received VRCP showed a significantly larger decrease on the score of METH-craving and METH-liking from baseline to follow-up assessments, compared to those who did not received VRCP. Participants received VRCP showed a significantly larger decrease in HRV indexes on time domain and non-linear domain from baseline to follow-up assessments during exposure to VR cues, compared to those in waiting-list group. These findings indicate that the counterconditioning procedure under VR environment may be a useful strategy in suppressing cue-induced reactivity for patients with METH dependence.
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Affiliation(s)
- Yong-Guang Wang
- Department of Brain Functioning Research, The Seventh Hospital of Hangzhou, 305 Tianmushan Road, Hangzhou, 310013, Zhejiang Province, China; Anhui Psychiatric Medical Center, Anhui Medical University, Hefei, Anhui Province, China; Zhejiang Provincial Institute of Drug Abuse Research, Hangzhou, Zhejiang Province, China.
| | - Meng-Hui Liu
- Anhui Psychiatric Medical Center, Anhui Medical University, Hefei, Anhui Province, China
| | - Zhi-Hua Shen
- Department of Brain Functioning Research, The Seventh Hospital of Hangzhou, 305 Tianmushan Road, Hangzhou, 310013, Zhejiang Province, China
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28
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Kamp F, Proebstl L, Hager L, Schreiber A, Riebschläger M, Neumann S, Straif M, Schacht-Jablonowsky M, Manz K, Soyka M, Koller G. Effectiveness of methamphetamine abuse treatment: Predictors of treatment completion and comparison of two residential treatment programs. Drug Alcohol Depend 2019; 201:8-15. [PMID: 31154239 DOI: 10.1016/j.drugalcdep.2019.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is an increasing demand of evidence-based treatment options for methamphetamine users, but research in this field is limited. This study therefore evaluates the efficacy of two residential treatment programs for methamphetamine users. METHOD A total of 108 patients with a history of methamphetamine abuse from two inpatient rehabilitation centers were studied for psychiatric symptoms, craving, psychosocial resources, and cognitive functioning at the start and end of therapy. Patients from one center ("amphetamine type stimulant group") received conventional group therapy plus an additional 10 h of group therapy focusing on stimulant use. Patients from the other center ("treatment as usual") received conventional group therapy only. Predictors of drop-out were estimated. RESULTS A drop-out rate of 40.7% was observed without a significant difference between both centers. Patients remained significantly longer in treatment as usual compared to amphetamine type stimulant treatment. Irrespective of treatment program, craving and psychiatric symptoms significantly decreased while psychosocial resources, processing speed, and cognitive flexibility improved over time. Other cognitive measures yielded mixed results. History of injection drug use was a significant predictor for treatment drop-out. CONCLUSIONS Existing treatments are effective in reducing craving and psychiatric symptoms. Additional stimulant specific groups do not appear to influence treatment completion and secondary outcome measures. Institutions should therefore offer treatment for methamphetamine users, even if they do not provide a therapy content focusing on methamphetamine. History of injection drug use should receive attention in treatment to prevent drop-out. Changes in cognitive functioning need to be further explored.
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Affiliation(s)
- F Kamp
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany.
| | - L Proebstl
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - L Hager
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - A Schreiber
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt am Main, Germany
| | - M Riebschläger
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, Rehna OT Parber, 19217, Germany
| | - S Neumann
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, Rehna OT Parber, 19217, Germany
| | - M Straif
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt am Main, Germany
| | | | - K Manz
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany
| | - M Soyka
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany; Medical Parc Chiemseeblick, Rathausstraße 8, 83233, Bernau am Chiemsee, Germany
| | - G Koller
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
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Effects of stimulant drug use on the dopaminergic system: A systematic review and meta-analysis of in vivo neuroimaging studies. Eur Psychiatry 2019; 59:15-24. [PMID: 30981746 DOI: 10.1016/j.eurpsy.2019.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/13/2019] [Accepted: 03/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Stimulant drugs can cause persistent changes in the brain. Imaging studies show that these changes are most apparent in dopamine transporter (DAT) or receptor availability within the striatum. METHODS This work focuses on influences of stimulant use on dopaminergic function assessed using nuclear-medicine imaging (PET/SPECT). Included are 39 studies on 655 cocaine, amphetamine, methamphetamine or nicotine users, as well as 690 healthy controls. Metaanalyses were conducted separately for D2/D3 receptors and dopamine transporters of the entire striatum, its subregions caudate and putamen respectively. RESULTS Meta-analyses results regarding nicotine did not show significant effects between smokers and nonsmokers. In cocaine users there was a significant decrease in dopamine receptor availability in all regions. The striatal DAT availability was significantly increased in cocaine users. Methamphetamine users showed a significantly decreased dopamine receptor and transporter density in all regions. Significant results also indicate a lower transporter availability in all regions. Amphetamine users showed reduced DAT availability in the striatum, as well as in the sub regions. CONCLUSION This meta-analysis provides evidence that there are ongoing changes in the dopaminergic system associated with the use of stimulants. Especially the results of cocaine, methamphetamine and amphetamine use mainly showed a downregulation. In addition, this meta-analysis is the first to include nicotine. This subset of studies showed evidence for a decreased receptor and DAT availability but no significant results were found in the metaanalyses.
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Larson TA, Winkler MC, Stafford J, Levis SC, O’Neill CE, Bachtell RK. Role of dopamine D 2-like receptors and their modulation by adenosine receptor stimulation in the reinstatement of methamphetamine seeking. Psychopharmacology (Berl) 2019; 236:1207-1218. [PMID: 30470862 PMCID: PMC6533169 DOI: 10.1007/s00213-018-5126-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVE Previous work has demonstrated that dopamine and adenosine receptors are involved in drug-seeking behaviors, yet the pharmacological interactions between these receptors in methamphetamine (MA) seeking are not well characterized. The present studies examined the role of the dopamine D2-like receptors in MA seeking and identified the interactive effects of adenosine receptor stimulation. METHODS Adult male Sprague-Dawley rats were trained to lever press for MA in daily 2-h self-administration sessions on a fixed-ratio 1 schedule for 10 consecutive days. After 1 day of abstinence, lever pressing was extinguished in six daily extinction sessions. Treatments were administered systemically prior to a 2-h reinstatement test session. RESULTS An increase in MA seeking was observed following the administration of the dopamine D2-like agonist, quinpirole, or the D3 receptor agonist, 7-OH-DPAT. Stimulation of D2 or D4 receptors was ineffective at inducing MA seeking. Quinpirole-induced MA seeking was inhibited by D3 receptor antagonism (SB-77011A or PG01037), an adenosine A1 agonist, CPA, and an adenosine A2A agonist, CGS 21680. MA seeking induced by a MA priming injection or D3 receptor stimulation was inhibited by a pretreatment with the adenosine A1 agonist, CPA, but not the adenosine A2A agonist, CGS 21680. CONCLUSIONS These results demonstrate the sufficiency of dopamine D3 receptors to reinstate MA seeking that is inhibited when combined with adenosine A1 receptor stimulation.
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Kearney-Ramos TE, Dowdle LT, Mithoefer OJ, Devries W, George MS, Hanlon CA. State-Dependent Effects of Ventromedial Prefrontal Cortex Continuous Thetaburst Stimulation on Cocaine Cue Reactivity in Chronic Cocaine Users. Front Psychiatry 2019; 10:317. [PMID: 31133897 PMCID: PMC6517551 DOI: 10.3389/fpsyt.2019.00317] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/24/2019] [Indexed: 12/21/2022] Open
Abstract
Cue-induced craving is a significant barrier to obtaining abstinence from cocaine. Neuroimaging research has shown that cocaine cue exposure evokes elevated activity in a network of frontal-striatal brain regions involved in drug craving and drug seeking. Prior research from our laboratory has demonstrated that when targeted at the medial prefrontal cortex (mPFC), continuous theta burst stimulation (cTBS), an inhibitory form of non-invasive brain stimulation, can decrease drug cue-related activity in the striatum in cocaine users and alcohol users. However, it is known that there are individual differences in response to repetitive transcranial magnetic stimulation (rTMS), with some individuals being responders and others non-responders. There is some evidence that state-dependent effects influence response to rTMS, with baseline neural state predicting rTMS treatment outcomes. In this single-blind, active sham-controlled crossover study, we assess the striatum as a biomarker of treatment response by determining if baseline drug cue reactivity in the striatum influences striatal response to mPFC cTBS. The brain response to cocaine cues was measured in 19 cocaine-dependent individuals immediately before and after real and sham cTBS (110% resting motor threshold, 3600 total pulses). Group independent component analysis (ICA) revealed a prominent striatum network comprised of bilateral caudate, putamen, and nucleus accumbens, which was modulated by the cocaine cue reactivity task. Baseline drug cue reactivity in this striatal network was inversely related to change in striatum reactivity after real (vs. sham) cTBS treatment (ρ = -.79; p < .001; R 2 Adj = .58). Specifically, individuals with a high striatal response to cocaine cues at baseline had significantly attenuated striatal activity after real but not sham cTBS (t 9 = -3.76; p ≤ .005). These data demonstrate that the effects of mPFC cTBS on the neural circuitry of craving are not uniform and may depend on an individual's baseline frontal-striatal reactivity to cues. This underscores the importance of assessing individual variability as we develop brain stimulation treatments for addiction.
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Affiliation(s)
- Tonisha E Kearney-Ramos
- Division on Substance Use Disorders, Columbia University Irving Medical Center, New York, NY, United States
| | - Logan T Dowdle
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
| | - Oliver J Mithoefer
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - William Devries
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Mark S George
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, United States.,Ralph S. Johnson VA Medical Center, Charleston, SC, United States
| | - Colleen A Hanlon
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, United States
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Wang TY, Tsai TY, Tseng HH, Chen K, Lin SH, Chen P, Lee IH, Yang Y, Lu RB. No association between craving levels, personality traits, and treatment outcomes in patients with methamphetamine use disorder under deferred prosecution status. TAIWANESE JOURNAL OF PSYCHIATRY 2019. [DOI: 10.4103/tpsy.tpsy_45_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Huang M, Bai M, Zhang Z, Ge L, Lu K, Li X, Li Y, Zhou X, Guo N, Yang L, Bai J. Downregulation of thioredoxin-1 in the ventral tegmental area delays extinction of methamphetamine-induced conditioned place preference. J Psychopharmacol 2018; 32:1037-1046. [PMID: 30136629 DOI: 10.1177/0269881118791523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug addiction is characterized by compulsive drug use and relapse. Thioredoxin-1 is emerging as an important modulator involved in the cellular protective response against a variety of toxic stressors. Previous study has reported that thioredoxin-1 overexpression prevents the acquisition of methamphetamine-conditioned place preference. Here, we aimed to investigate the effect of thioredoxin-1 on methamphetamine-conditioned place preference extinction and the possible mechanism. METHODS (a) An extinction procedure in mice was employed to investigate the effect of thioredoxin-1 on the extinction of methamphetamine-conditioned place preference. After the acquisition of methamphetamine-conditioned place preference, mice underwent the following procedures: the injection of thioredoxin-1 small interfering RNA in the ventral tegmental area followed by the post-conditioned place preference test, four days of extinction training followed by four days of recovery after surgery. (b) The levels of thioredoxin-1, dopamine D1 receptor, tyrosine hydroxylase, phosphorylated extracellular regulated kinase, and phosphorylated cyclic adenosine monophosphate response element binding protein were examined by using Western blot analysis. RESULTS Thioredoxin-1 downregulation in the ventral tegmental area delayed methamphetamine-conditioned place preference extinction. The expression of thioredoxin-1 was decreased in the ventral tegmental area of mice in control and negative groups after methamphetamine-conditioned place preference extinction, but not in the thioredoxin-1 siRNA group. The levels of dopamine D1 receptor, tyrosine hydroxylase, phosphorylated extracellular regulated kinase, and phosphorylated cyclic adenosine monophosphate response element binding protein were decreased in the ventral tegmental area, nucleus accumbens, and prefrontal cortex of mice in the control and negative groups after methamphetamine-conditioned place preference extinction, but were inversely increased in thioredoxin-1 siRNA group. CONCLUSIONS The results suggest that downregulation of thioredoxin-1 in the ventral tegmental area may delay methamphetamine-conditioned place preference extinction by regulating the mesocorticolimbic dopaminergic signaling pathway.
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Affiliation(s)
- Mengbing Huang
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China.,2 Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, China
| | - Ming Bai
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Zhimin Zhang
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Lu Ge
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Kang Lu
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Xiang Li
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China.,2 Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, China
| | - Ye Li
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Xiaoshuang Zhou
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Ningning Guo
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China.,2 Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, China
| | - Lihua Yang
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China.,3 Narcotics Control School, Yunnan Police College, Kunming, China
| | - Jie Bai
- 1 Medical Faculty, Kunming University of Science and Technology, Kunming, China
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Factors related to methamphetamine relapse risk among clients in the substance rehabilitation center of National Narcotics Board in West Java, Indonesia. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-05-2018-035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
This purpose of this paper is to describe methamphetamine relapse risk, examine the relationship between factors in the dynamic model of relapse and methamphetamine relapse risk.
Design/methodology/approach
A total of 165 clients from the Substance Rehabilitation Center of National Narcotics Board in West Java, Indonesia were recruited. The research instruments included a demographic characteristic questionnaire and eight different tests: Drug Taking Confidence Questionnaire; Stimulant Effect Expectancy Questionnaire; Stage of Change Readiness and Treatment Eagerness Scale version 8.0 for Drug; Coping Strategies Inventory Short Form; Positive Affect and Negative Affect Schedule; Desire for Speed Questionnaire; Social Support Questionnaire; and the Stimulant Relapse Risk Scale. Descriptive statistics were used to analyze the data. Pearson’s product moment correlation was used to test the relationship among variables.
Findings
Clients (63 percent) were at a moderate level of methamphetamine relapse risk (mean=56.33, SD=10.54). Outcome expectancy, positive emotional state, negative emotional state and craving were positive and had a significant correlation with relapse risk (r=0.261, r=0.380, r=0.370, r=0.509, p<0.01, respectively). Self-efficacy was negative and had a significant correlation with relapse risk (r=−0.316, p<0.01). Motivation, coping and social support had no correlation with relapse risk.
Originality/value
Two-thirds of the clients in a rehabilitation center have a tendency to relapse following treatment. Nursing intervention for early detection of methamphetamine relapse risk during treatment by using standardized instruments should be implemented.
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Coffin PO, Santos GM, Hern J, Vittinghoff E, Santos D, Matheson T, Colfax G, Batki SL. Extended-release naltrexone for methamphetamine dependence among men who have sex with men: a randomized placebo-controlled trial. Addiction 2018; 113:268-278. [PMID: 28734107 PMCID: PMC5760469 DOI: 10.1111/add.13950] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/04/2017] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Methamphetamine use is increasingly prevalent and associated with HIV transmission. Early-phase human studies suggested naltrexone reduced amphetamine use among dependent individuals. We tested if extended-release naltrexone (XRNTX) reduces methamphetamine use and associated sexual risk behaviors among high-risk methamphetamine-dependent men who have sex with men (MSM). DESIGN Double-blind, placebo-controlled, randomized trial of XRTNX versus placebo over 12 weeks from 2012 to 2015. SETTING San Francisco Department of Public Health, California, USA. PARTICIPANTS One hundred community-recruited, sexually-active, actively-using methamphetamine-dependent MSM. Mean age was 43.2 years; 96% were male, 3% transfemale, and 1% transmale; 55.0% were white, 19.0% African American, and 18.0% Latino. INTERVENTIONS XRNTX 380 mg (n = 50) or matched placebo (n = 50) administered by gluteal injection at 4-week intervals. MEASUREMENTS Regression estimated average level and change in level of positive urines during the period 2-12 weeks (primary outcomes) and sexual risk behaviors (secondary outcome). FINDINGS Ninety per cent of visits were completed. By intent-to-treat, participants assigned to XRNTX had similar differences during 2-12 weeks in methamphetamine-positive urines as participants assigned to placebo [incidence rate ratio (IRR) = 0.95, 95% confidence interval (CI) = 0.76-1.20; Bayes factor < 0.3]. Observed urine positivity declined from 78 to 70% in the XRNTX arm and 74 to 64% in the placebo arm. Adherence to injections was 96.7% in the XRNTX arm and 91.3% in the placebo arm. Sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug and no differences in frequency of adverse events by treatment arm. CONCLUSIONS Notwithstanding very high medication adherence for this study, extended-release naltrexone does not appear to reduce methamphetamine use or sexual risk behaviors among methamphetamine-dependent men who have sex with men compared with placebo.
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Affiliation(s)
- Phillip O. Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco CA 94102,University of California San Francisco, 500 Parnassus Ave, San Francisco CA 94143
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco CA 94102,University of California San Francisco, 500 Parnassus Ave, San Francisco CA 94143
| | - Jaclyn Hern
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco CA 94102
| | - Eric Vittinghoff
- University of California San Francisco, 500 Parnassus Ave, San Francisco CA 94143
| | - Deirdre Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco CA 94102
| | - Tim Matheson
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco CA 94102
| | - Grant Colfax
- Health and Human Services, Marin County, 20 North San Pedro Road, San Rafael, CA 94903
| | - Steven L. Batki
- University of California San Francisco, 500 Parnassus Ave, San Francisco CA 94143
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Zhang C, Luo T, Liu L, Dong H, Hao W. Prevalence Rates of Personality Disorder and Its Association With Methamphetamine Dependence in Compulsory Treatment Facilities in China. Front Psychiatry 2018; 9:698. [PMID: 30618872 PMCID: PMC6299101 DOI: 10.3389/fpsyt.2018.00698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 11/30/2018] [Indexed: 11/24/2022] Open
Abstract
Methamphetamine use is popular and rapidly increasing in China, and the co-occurrence of personality disorders has an impact on treatment outcomes and may increase vulnerability of developing dependence. The aim of the present study was to investigate the prevalence rates of personality disorders in methamphetamine users and further explore the association between personality disorders and methamphetamine use status. Five hundred and seventy-seven male methamphetamine users were recruited. The self-developed questionnaire was used for demographics, and a Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-I/II) was performed covering psychiatric diagnosis. Our study found the prevalence of antisocial personality disorder in male methamphetamine users was 71.4%, followed by borderline (20.2%) and obsessive-compulsive (17.9%) personality disorder. Borderline and antisocial personality disorders were found to be risk factors of methamphetamine dependence (adjusted odds ratio = 2.891, p = 0.007 and adjusted odds ratio = 1.680, p = 0.042). These findings suggested personality disorders were highly prevalent in male methamphetamine users, and the comorbidity of antisocial and borderline personality disorders are especially associated with methamphetamine dependence.
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Affiliation(s)
- Chenxi Zhang
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Tao Luo
- Department of Psychology, JiangXi Mental Health Center, Nanchang, China
| | - Liang Liu
- Clinical Psychiatry Department, Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Huixi Dong
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Wei Hao
- Hunan Key Laboratory of Psychiatry and Mental Health, Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Central South University, Changsha, China
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Paltun SC, Altunsoy N, Özdemir SD, Okay IT. Does trait mindfulness level affect quitting cannabis use? A six week follow-up study. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hartwell EE, Moallem NR, Courtney KE, Glasner-Edwards S, Ray LA. Sex Differences in the Association Between Internalizing Symptoms and Craving in Methamphetamine Users. J Addict Med 2017; 10:395-401. [PMID: 27504928 PMCID: PMC5083163 DOI: 10.1097/adm.0000000000000250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Methamphetamine (MA) users often have substantial psychiatric comorbidities, with nearly a third reporting lifetime mood disorders and over a quarter reporting lifetime anxiety disorders. Female MA users are more likely to endorse depression and anxiety symptoms compared with men. Craving has been related to mood/anxiety symptoms in MA users. To extend the literature on sex differences in MA use disorder, the present study examines the role of sex as a moderator of the relationship between mood/anxiety symptoms and MA craving. METHODS Participants (N = 203) were nontreatment-seeking, current MA users, recruited from the Los Angeles community for enrollment in a larger pharmacotherapy trial. At the assessment visit, participants completed multiple measures including the Methamphetamine Urge Questionnaire, the Beck Depression Inventory, and the Beck Anxiety Inventory. RESULTS The relationship between depression symptomatology and MA craving was moderated by sex (F = 6.18, P = 0.01), such that the relationship was positive and significant for men (P < 0.001), but was not significant for women. Similarly, sex significantly moderated the relationship between anxiety and MA craving (F = 5.99, P = 0.02), such that the relationship was also positive and significant in men, but not in women (P < 0.001). CONCLUSIONS These results suggest that men may be more sensitive to the effects of internalizing symptoms on MA craving than women. Given craving's propensity to predict relapse, these initial findings indicate the necessity of treating comorbid psychiatric problems in male MA users, which may in turn assist in the attenuation of craving.
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Affiliation(s)
- Emily E. Hartwell
- Department of Psychology, University of California, Los Angeles
- Integrated Substance Abuse Programs, University of California, Los Angeles
| | | | | | | | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Brain Research Institute, University of California, Los Angeles
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Naltrexone moderates the relationship between cue-induced craving and subjective response to methamphetamine in individuals with methamphetamine use disorder. Psychopharmacology (Berl) 2017; 234:1997-2007. [PMID: 28357460 PMCID: PMC5480611 DOI: 10.1007/s00213-017-4607-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/14/2017] [Indexed: 01/03/2023]
Abstract
RATIONALE Reductions in cue-induced craving and subjective response to drugs of abuse are commonly used as initial outcome measures when testing novel medications for the treatment of addiction. Yet neither the relationship between these two measures at the individual level nor the moderating effects of pharmacotherapies on this relationship has been examined. OBJECTIVE This secondary data analysis sought to examine (1) the predictive relationship between cue-induced craving and subsequent acute subjective response to methamphetamine (MA) and (2) whether the opioid-receptor antagonist naltrexone moderated this association in a sample of non-treatment-seeking individuals who met DSM-IV criteria for MA use disorder (abuse or dependence). METHODS Participants (n = 30) completed two 4-day medication regimens (oral naltrexone 50 mg or placebo, in a randomized, counterbalanced, and double-blind fashion). On day 4 of each medication regimen, participants completed a cue-reactivity paradigm followed by intravenous MA administration. Methamphetamine craving was assessed after the cue-reactivity paradigm, and subjective response to MA was assessed during MA infusion. RESULTS Cue-induced craving for MA was positively associated with post-infusion subjective MA effects, including positive (i.e., stimulation, good effects, feel drug, high), negative (i.e., anxious and depressed), and craving-related (i.e., want more, would like access to drug, crave) responses. Naltrexone, vs. placebo, significantly reduced the association between cue-induced craving and positive subjective response to MA. CONCLUSIONS The findings indicate that naltrexone moderates the predictive relationship between cue-induced craving and positive subjective effects of MA, thereby suggesting a behavioral mechanism by which naltrexone may be efficacious in treating MA use disorder.
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Su H, Zhong N, Gan H, Wang J, Han H, Chen T, Li X, Ruan X, Zhu Y, Jiang H, Zhao M. High frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex for methamphetamine use disorders: A randomised clinical trial. Drug Alcohol Depend 2017; 175:84-91. [PMID: 28410525 DOI: 10.1016/j.drugalcdep.2017.01.037] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/14/2016] [Accepted: 01/26/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation and modulation electrophysiological technique, it can change cortical excitability of target brain region, modulate neuron plasticity and brain connections. Previous researches indicated that rTMS could reduce cue-induced craving in drug addiction. OBJECTIVE In this study, we employed real and sham rTMS of the left dorsolateral prefrontal cortex (DLPFC) to test whether it could reduce cue-induced craving for methamphetamine (MA) and influence cognitive function in a randomised clinical trial. METHODS Thirty MA-addicted patients were randomized to receive 5 sessions of 8min sham or 10Hz rTMS to the left DLPFC. Subjects rated their craving at baseline, after exposed to MA-associated cues and after rTMS sessions. RESULTS Real rTMS over the left DLPFC reduced craving significantly after 5 sessions of rTMS as compared to sham stimulation. Furthermore, real rTMS improved verbal learning and memory and social cognition in MA-addicted patients. CONCLUSIONS The present study suggests that 10Hz rTMS of the left DLPFC may reduce craving and have no negative effects on cognitive function in MA-addicted patients, supporting the safety of rTMS in treating MA addiction.
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Affiliation(s)
- Hang Su
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Zhong
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Gan
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijun Wang
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Han
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianzhen Chen
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaotong Li
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolu Ruan
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Youwei Zhu
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhao
- Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China.
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Xu S, Liu Y, Li Y, Deng Y, Yuan J, Lv R, Wang Y, Zhang G, Guo Z, Fu D, Zeng H, Han M, Liu X. Availability of dopamine transporters in heroin-dependent subjects: A 18F-FECNT PET imaging study. Psychiatry Res Neuroimaging 2017; 263:121-126. [PMID: 28376406 DOI: 10.1016/j.pscychresns.2017.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
This study was to reconfirm the reduced dopamine transporter (DAT) availability in heroin-dependent subjects and validate the use of 2β-carbomethoxy-3β-(4-chlorophenyl)-8-(2-fluoroethyl)-nortropane (18F-FECNT) as a PET radiotracer to assess the changes of striatal DAT in drug addicted subjects. Herein, we assessed DAT standardized uptake values (SUV) of 18F-FECNT in the striatum and cerebellum of 20 heroin-dependent subjects and 10 healthy controls and analyzed the correlation between DAT availability and heroin withdrawal symptom scores and anxiety/depression rating scales in heroin-dependent subjects, as well as the relationship between the withdrawal symptoms scores and age. The striatal DAT availability in heroin-dependent subjects was significantly lower (by ~15.7-17.6%) than that in healthy controls. Age was positively related to heroin withdrawal symptom scores. The withdrawal symptom scores in older patients (Age: 49.5±2.5) were significantly higher (by ~20%) than those in younger patients (Age: 30.9±4.8). These results confirm that chronic heroin use induces striatal DAT reduction, suggesting that 18F-FECNT could be used as an alternative PET imaging radioligand for in vivo imaging of DAT in drug addicted subjects. Moreover, older patients might suffer more severe withdrawal symptoms than younger patients, suggesting that older patients with heroin withdrawal could be given more medication.
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Affiliation(s)
- Shasha Xu
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China; Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Liu
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China
| | - Yu Li
- Drug Rehabilitation Center, Shanghai, China
| | - Yangping Deng
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Jie Yuan
- Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Rongbin Lv
- Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuankai Wang
- Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Guangming Zhang
- Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhirui Guo
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China
| | - Daxu Fu
- Shanghai Center of Biomedicine Development, Shanghai, China
| | - Hui Zeng
- Beijing LADO Technology Company, Beijing, China
| | - Mei Han
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China.
| | - Xingdang Liu
- Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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Mindfulness treatment for substance misuse: A systematic review and meta-analysis. J Subst Abuse Treat 2017; 75:62-96. [PMID: 28153483 DOI: 10.1016/j.jsat.2017.01.008] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/09/2016] [Accepted: 01/18/2017] [Indexed: 01/19/2023]
Abstract
High rates of relapse following substance misuse treatment highlight an urgent need for effective therapies. Although the number of empirical studies investigating effects of mindfulness treatment for substance misuse has increased dramatically in recent years, few reviews have examined findings of mindfulness studies. Thus, this systematic review examined methodological characteristics and substantive findings of studies evaluating mindfulness treatments for substance misuse published by 2015. The review also includes the first meta-analysis of randomized controlled trials of mindfulness treatments for substance misuse. Comprehensive bibliographic searches in PubMed, PsycInfo, and Web of Science, identified 42 pertinent studies. Meta-analytic results revealed significant small-to-large effects of mindfulness treatments in reducing the frequency and severity of substance misuse, intensity of craving for psychoactive substances, and severity of stress. Mindfulness treatments were also effective in increasing rates of posttreatment abstinence from cigarette smoking compared to alternative treatments. Mindfulness treatment for substance misuse is a promising intervention for substance misuse, although more research is needed examining the mechanisms by which mindfulness interventions exert their effects and the effectiveness of mindfulness treatments in diverse treatment settings.
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Abstract
Objective Peer support can be defined as the process of giving and receiving nonprofessional, nonclinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery from psychiatric, alcohol, and/or other drug-related problems. Recently, there has been a dramatic rise in the adoption of alternative forms of peer support services to assist recovery from substance use disorders; however, often peer support has not been separated out as a formalized intervention component and rigorously empirically tested, making it difficult to determine its effects. This article reports the results of a literature review that was undertaken to assess the effects of peer support groups, one aspect of peer support services, in the treatment of addiction. Methods The authors of this article searched electronic databases of relevant peer-reviewed research literature including PubMed and MedLINE. Results Ten studies met our minimum inclusion criteria, including randomized controlled trials or pre-/post-data studies, adult participants, inclusion of group format, substance use-related, and US-conducted studies published in 1999 or later. Studies demonstrated associated benefits in the following areas: 1) substance use, 2) treatment engagement, 3) human immunodeficiency virus/hepatitis C virus risk behaviors, and 4) secondary substance-related behaviors such as craving and self-efficacy. Limitations were noted on the relative lack of rigorously tested empirical studies within the literature and inability to disentangle the effects of the group treatment that is often included as a component of other services. Conclusion Peer support groups included in addiction treatment shows much promise; however, the limited data relevant to this topic diminish the ability to draw definitive conclusions. More rigorous research is needed in this area to further expand on this important line of research.
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Affiliation(s)
- Kathlene Tracy
- Community Research and Recovery Program (CRRP), Department of Psychiatry, New York University School of Medicine; New York Harbor Healthcare System (NYHHS), New York
| | - Samantha P Wallace
- Department of Community Health Sciences, State University of New York Downstate School of Public Health, Brooklyn, NY, USA
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Pal R, Mendelson J, Clavier O, Baggott MJ, Coyle J, Galloway GP. Development and Testing of a Smartphone-Based Cognitive/Neuropsychological Evaluation System for Substance Abusers. J Psychoactive Drugs 2016; 48:288-94. [PMID: 27260123 DOI: 10.1080/02791072.2016.1191093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In methamphetamine (MA) users, drug-induced neurocognitive deficits may help to determine treatment, monitor adherence, and predict relapse. To measure these relationships, we developed an iPhone app (Neurophone) to compare lab and field performance of N-Back, Stop Signal, and Stroop tasks that are sensitive to MA-induced deficits. METHODS Twenty healthy controls and 16 MA-dependent participants performed the tasks in-lab using a validated computerized platform and the Neurophone before taking the latter home and performing the tasks twice daily for two weeks. RESULTS N-Back task: there were no clear differences in performance between computer-based vs. phone-based in-lab tests and phone-based in-lab vs. phone-based in-field tests. Stop-Signal task: difference in parameters prevented comparison of computer-based and phone-based versions. There was significant difference in phone performance between field and lab. Stroop task: response time measured by the speech recognition engine lacked precision to yield quantifiable results. There was no learning effect over time. On an average, each participant completed 84.3% of the in-field NBack tasks and 90.4% of the in-field Stop Signal tasks (MA-dependent participants: 74.8% and 84.3%; healthy controls: 91.4% and 95.0%, respectively). Participants rated Neurophone easy to use. CONCLUSION Cognitive tasks performed in-field using Neurophone have the potential to yield results comparable to those obtained in a laboratory setting. Tasks need to be modified for use as the app's voice recognition system is not yet adequate for timed tests.
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Affiliation(s)
- Reshmi Pal
- a Assistant Research Scientist, Friends Research Institute , Addiction & Pharmacology Research Laboratory , San Francisco , CA , USA
| | - John Mendelson
- b Senior Research Scientist, Friends Research Institute , Addiction & Pharmacology Research Laboratory , San Francisco , CA , USA
| | | | | | - Jeremy Coyle
- e Ph.D. Candidate, University of California-Berkeley , Biostatistics , Berkeley , CA , USA
| | - Gantt P Galloway
- f Senior Research Scientist, Friends Research Institute , Addiction & Pharmacology Research Laboratory , San Francisco , CA , USA
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Vitali M, Napolitano C, Berman MO, Minuto SF, Battagliese G, Attilia ML, Braverman ER, Romeo M, Blum K, Ceccanti M. Neurophysiological Measures and Alcohol Use Disorder (AUD): Hypothesizing Links between Clinical Severity Index and Molecular Neurobiological Patterns. ACTA ACUST UNITED AC 2016; 5. [PMID: 28090374 PMCID: PMC5231399 DOI: 10.4172/2155-6105.1000181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background In 1987, Cloninger proposed a clinical description and classification of different personality traits genetically defined and independent from each other. Moreover, he elaborated a specific test the TCI to investigate these traits/states. The study of craving in Alcohol Use Disorder (AUD) assumed a greater significance, since ever more data seems to suggest a direct correlation between high levels of craving and a higher risk of relapse in alcoholics. Thus, our study aim is to explore the possible correlations among TCI linked molecular neurobiological pattern (s), craving and alcohol addiction severity measures in a sample of Italian alcoholics. Materials and Methods 191 alcoholics were recruited in a Day Hospital (DH) setting at the Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome. After 7 days detoxification treatment a psychodiagnostic protocol was administered, including TCI, VAS-C, ASI and SADQ. All patients signed an Institutional Review Board (IRB) approved informed consent. Results Principally, we detected a significant positive correlation between HA-scale scores and the VAS scale: increasing in HA-scale corresponds to an increase in craving perception for both intensity (r=0.310; p ≤ 0.001) and frequency (r=0.246; p ≤ 0.001). Moreover, perception of dependence severity, measured with SADQ was also found to be significantly associated positively to both HA-scale (r=0.246; p ≤ 0.001) and NS-scale (r=0.224; p ≤ 0.01). While, for character scales, Persistence (r=−0.195; p=.008) and Self-directedness (r=−0.294; p ≤ 0.001) was negatively associated with ASI linked to alcohol problems. Self-directedness was also negatively correlated with ASI linked to family and social problems (r=−0.349; p ≤ 0.001), employment and support problems (r=−0.220; p=0.003) and psychiatric problems (r=−0.358; p ≤ 0.001). Cooperativeness was a negative correlate with Legal Problems (r=−0.173; p=0.019). and Self-Transcendence was positive correlated with Medical Problems (r=0.276; p ≤ 0.001) Conclusions In view of recent addiction neurobiological theories, such as the “Reward Deficiency Syndrome (RDS)” and the Koob model, our data could suggest that our cohort of patients could possibly be in a particular stage of the course of their addiction history. Thus, if our hypothesis will be confirmed, the TCI-based assessment of alcoholics would allow an optimization of the treatment. Clinicians understanding these newer concepts will be able to translate this information to their patients and potentially enhance clinical outcome (s), because it could suggest a functional hypothesis of neurotransmitter circuits that helps to frame the patient in his/her history of addiction.
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Affiliation(s)
- Mario Vitali
- Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome
| | - Carmen Napolitano
- Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome
| | - Marlene Oscar Berman
- Department of Psychiatry and Neurology, Boston University School of Medicine and Veterans Administration System, Boston, Massachusetts, USA
| | | | - Gemma Battagliese
- Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome
| | - Maria Luisa Attilia
- Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome
| | - Eric R Braverman
- Department of Psychiatry & McKnight Brain Institute, University of Florida, College of Medicine, Gainesville, Florida, USA; Department of Clinical Neurology, Path Foundation, NY, New York, New York, USA
| | - Marina Romeo
- Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome
| | - Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida, College of Medicine, Gainesville, Florida, USA; Department of Clinical Neurology, Path Foundation, NY, New York, New York, USA; Department of Addiction Research & Therapy, Malibu Beach Recovery Center, Malibu Beach, California, USA; Department of Psychiatry & Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine, Burlington, Vermont, USA; Department of Nutrigenomics, RD Solutions, LLC, La Jolla, California, USA; Department of Personalized Medicine, IGENE, LLC, Austin, Texas, USA; Dominion Diagnostics, LLC, North Kingstown, Rhode Island, USA; Basic & Clinical Research Center, Victory Nutrition, LLC., Austin, Texas, USA
| | - Mauro Ceccanti
- Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome
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Rudzinskas SA, Mong JA. Androgen-primed castrate males are sufficient for methamphetamine-facilitated increases in proceptive behavior in female rats. Horm Behav 2016; 78:52-9. [PMID: 26497407 PMCID: PMC4718754 DOI: 10.1016/j.yhbeh.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 11/25/2022]
Abstract
Methamphetamine (MA) is a psychomotor stimulant associated with increases in sex drive in both men and women. Women, however, are far more likely to face social disadvantages as a consequence of MA use, and their increased sexual motivation poses additional health concerns such as unplanned pregnancies. To better understand the mechanisms underlying MA-facilitated sexual motivation in females, we previously established a rodent model where a "binge"-type administration paradigm of MA to sexually receptive female rats significantly increases proceptive behavior in the presence of a sexually active, gonadally-intact male. Our previous work with this model has led us to consider whether the increases in proceptive behavior are truly indicative of increased sexual motivation, or instead a consequence of heightened motor responsivity. Here, we test whether MA-induced increases in proceptive behaviors are specific to a sexually relevant stimulus. Females' sexual, social, exploratory behaviors, and interaction times were scored during the exposure to stimulus males, including castrates, and dihydrotestosterone (DHT)-treated castrates. MA-treated females demonstrated significant increases in proceptive behaviors toward DHT-treated castrate males but not toward castrate males. While the non-MA-treated females did display proceptive behavior, there was no significant difference between behaviors elicited by DHT-CX males compared to CX males. Our results support the hypothesis that MA facilitates proceptive behavior only in response to specific, androgen mediated sexually-relevant cues.
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Affiliation(s)
- Sarah A Rudzinskas
- Program in Neuroscience, University of Maryland, Baltimore, School of Medicine, Baltimore, MD 21201, USA; Department of Pharmacology, University of Maryland, Baltimore, School of Medicine, Baltimore, MD 21201, USA
| | - Jessica A Mong
- Program in Neuroscience, University of Maryland, Baltimore, School of Medicine, Baltimore, MD 21201, USA; Department of Pharmacology, University of Maryland, Baltimore, School of Medicine, Baltimore, MD 21201, USA
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Lopez RB, Onyemekwu C, Hart CL, Ochsner KN, Kober H. Boundary conditions of methamphetamine craving. Exp Clin Psychopharmacol 2015; 23:436-44. [PMID: 26302338 PMCID: PMC4658228 DOI: 10.1037/pha0000049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Methamphetamine use has increased significantly and become a global health concern. Craving is known to predict methamphetamine use and relapse following abstinence. Some have suggested that cravings are automatic, generalized, and uncontrollable, but experimental work addressing these claims is lacking. In 2 exploratory studies, we tested the boundary conditions of methamphetamine craving by asking: (a) is craving specific to users' preferred route of administration?, and (b) can craving be regulated by cognitive strategies? Two groups of methamphetamine users were recruited. In Study 1, participants were grouped by their preferred route of administration (intranasal vs. smoking), and rated their craving in response to photographs and movies depicting methamphetamine use (via the intranasal vs. smoking route). In Study 2, methamphetamine smokers implemented cognitive regulation strategies while viewing photographs depicting methamphetamine smoking. Strategies involved either focusing on the positive aspects of smoking methamphetamine or the negative consequences of doing so-the latter strategy based on treatment protocols for addiction. In Study 1, we found a significant interaction between group and route of administration, such that participants who preferred to smoke methamphetamine reported significantly stronger craving for smoking stimuli, whereas those who preferred the intranasal route reported stronger craving for intranasal stimuli. In Study 2, participants reported significantly lower craving when focusing on the negative consequences associated with methamphetamine use. Taken together, these findings suggest that strength of craving for methamphetamine is moderated by users' route of administration and can be reduced by cognitive strategies. This has important theoretical, methodological, and clinical implications.
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Affiliation(s)
| | | | | | | | - Hedy Kober
- Correspondence concerning this article should be addressed to Hedy Kober, Department of Psychiatry, Yale University, Clinical & Affective Neuroscience Lab, 1 Church St. Suite 701, New Haven, CT 06519. . Tel: 203-737-5641, Fax: 203-737-3591
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Xu S, Liu Y, Li Y, Deng Y, Huang Y, Yuan J, Lv R, Wang Y, Zhang G, Guo Z, Han M, Liu X, Fu D. Longitudinal changes of dopamine transporters in heroin users during abstinence. Psychopharmacology (Berl) 2015; 232:3391-401. [PMID: 26096461 DOI: 10.1007/s00213-015-3992-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE Chronic exposure to heroin results in decreased dopamine transporter levels. Jitai tablets, a traditional Chinese medicine, have been effective at increasing striatal dopamine transporter availability after 6 months of treatment. However, it remains unknown how long the heroin-induced impairment persists and whether dopamine transporter can be normalized following long-term abstinence or treatment. OBJECTIVES This study was to evaluate the time course of dopamine transporter changes in heroin users undergoing long-term abstinence and treatment with Jitai tablets for 1 year. METHODS Single-photon emission computed tomography using [(99m)Tc]TRODAT-1 was performed on 64 heroin users and 20 healthy subjects to assess striatal dopamine transporter availability at baseline, 3, 6, and 12 months. Heroin users were randomly assigned to treatment with either placebo or Jitai tablets. Depression and anxiety scores were measured before each imaging session. RESULTS Compared with healthy controls, significant reduction in dopamine transporter availability was found in heroin users at baseline in both the right (by ∼ 31.6%) and left striatum (by ∼ 33.2%). At 6 months, dopamine transporter availability was significantly higher in Jitai tablet-treated group than placebo group in the bilateral striatum (p < 0.01). At 12 months, dopamine transporter levels in both groups were upregulated substantially from baseline but still not recovered to normal levels in the left striatum (p < 0.05). Depression and anxiety scores significantly decreased at 3, 6, and 12 months (p < 0.05). CONCLUSIONS Our results confirmed that heroin abuse induces pronounced, long-term reduction in dopamine transporter. Treatment with Jitai tablets appears to stimulate recovery.
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Affiliation(s)
- Shasha Xu
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China
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Meade CS, Towe SL, Watt MH, Lion RR, Myers B, Skinner D, Kimani S, Pieterse D. Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: A mixed-methods study. Drug Alcohol Depend 2015; 152:79-86. [PMID: 25977205 PMCID: PMC4498803 DOI: 10.1016/j.drugalcdep.2015.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/15/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Since 2000, there has been a dramatic increase in methamphetamine use in South Africa, but little is known about the experiences of out-of-treatment users. This mixed-methods study describes the substance use histories, addiction symptoms, and treatment experiences of a community-recruited sample of methamphetamine users in Cape Town. METHODS Using respondent driven sampling, 360 methamphetamine users (44% female) completed structured clinical interviews to assess substance abuse and treatment history and computerized surveys to assess drug-related risks. A sub-sample of 30 participants completed in-depth interviews to qualitatively explore experiences with methamphetamine use and drug treatment. RESULTS Participants had used methamphetamine for an average of 7.06 years (SD=3.64). They reported using methamphetamine on an average of 23.49 of the past 30 days (SD=8.90); 60% used daily. The majority (90%) met ICD-10 criteria for dependence, and many reported severe social, financial, and legal consequences. While only 10% had ever received drug treatment, 90% reported that they wanted treatment. In the qualitative interviews, participants reported multiple barriers to treatment, including beliefs that treatment is ineffective and relapse is inevitable in their social context. They also identified important motivators, including desires to be drug free and improve family functioning. CONCLUSION This study yields valuable information to more effectively respond to emerging methamphetamine epidemics in South Africa and other low- and middle-income countries. Interventions to increase uptake of evidence-based services must actively seek out drug users and build motivation for treatment, and offer continuing care services to prevent relapse. Community education campaigns are also needed.
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Affiliation(s)
- Christina S Meade
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Sheri L Towe
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Melissa H Watt
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Ryan R Lion
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Box 19070, Tygerberg 7505, South Africa.
| | - Donald Skinner
- Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
| | - Stephen Kimani
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Desiree Pieterse
- Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
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Veilleux JC, Skinner KD. Smoking, food, and alcohol cues on subsequent behavior: A qualitative systematic review. Clin Psychol Rev 2015; 36:13-27. [DOI: 10.1016/j.cpr.2015.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/06/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
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