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Poireau M, Segobin S, Maillard A, Clergue-Duval V, Icick R, Azuar J, Volle E, Delmaire C, Bloch V, Pitel AL, Vorspan F. Brain alterations in Cocaine Use Disorder: Does the route of use matter and does it relate to the treatment outcome? Psychiatry Res Neuroimaging 2024; 342:111830. [PMID: 38820804 DOI: 10.1016/j.pscychresns.2024.111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/15/2024] [Accepted: 05/12/2024] [Indexed: 06/02/2024]
Abstract
AIMS Cocaine Use Disorder (CUD) is an important health issue, associated with structural brain abnormalities. However, the impact of the route of administration and their predictive value for relapse remain unknown. METHODS We conducted an anatomical MRI study in 55 CUD patients (26 CUD-Crack and 29 CUD-Hydro) entering inpatient detoxification, and 38 matched healthy controls. In patients, a 3-months outpatient follow-up was carried out to specify the treatment outcome status (relapser when cocaine was consumed once or more during the past month). A Voxel-Based Morphometry approach was used. RESULTS Compared with controls, CUD patients had widespread gray matter alterations, mostly in frontal and temporal cortices, but also in the cerebellum and several sub-cortical structures. We then compared CUD-Crack with CUD-Hydro patients and found that crack-cocaine use was associated with lower volume in the right inferior and middle temporal gyri, and the right fusiform gyrus. Cerebellar vermis was smaller during detoxification in subsequent relapsers compared to three-months abstainers. CONCLUSIONS Patients with CUD display widespread cortical and subcortical brain shrinkage. Patients with preferential crack-cocaine use and subsequent relapsers showed specific gray matter volume deficits, suggesting that different patterns of cocaine use and different clinical outcome are associated with different brain macrostructure.
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Affiliation(s)
- Margaux Poireau
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP.NORD, Paris, F-75010, France; INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France; FHU NOR-SUD (Network of Research in Substance Use Disorders), Paris, France.
| | - Shailendra Segobin
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine (NIMH), 14000 Caen, France
| | - Angéline Maillard
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP.NORD, Paris, F-75010, France; INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France
| | - Virgile Clergue-Duval
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP.NORD, Paris, F-75010, France; INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France
| | - Romain Icick
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP.NORD, Paris, F-75010, France; INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France
| | - Julien Azuar
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP.NORD, Paris, F-75010, France; INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France
| | - Emmanuelle Volle
- FRONT-Lab, ICM, Institut du Cerveau, Hôpital Pitié-Salpêtrière, 47 bd de l'Hôpital, 75013 Paris, France
| | - Christine Delmaire
- INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France; Service de Neuroradiologie, Fondation Ophtalmologique Rothschild, 75019 Paris, France
| | - Vanessa Bloch
- INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France; FHU NOR-SUD (Network of Research in Substance Use Disorders), Paris, France; Service de Pharmacie à Usage Intérieur, Hôpital Fernand Widal, APHP.NORD, Paris, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France; Institut Universitaire de France (IUF), France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP.NORD, Paris, F-75010, France; INSERM UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Université Paris Cité, Paris, F-75006, France; FHU NOR-SUD (Network of Research in Substance Use Disorders), Paris, France
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Bittencourt AML, da Silveira BLB, Tondo LP, Rothmann LM, Franco AR, Ferreira PEMS, Viola TW, Grassi-Oliveira R. Cingulate cortical thickness in cocaine use disorder: mediation effect between early life stress and cocaine consumption. Acta Neuropsychiatr 2024; 36:78-86. [PMID: 36416534 PMCID: PMC10203054 DOI: 10.1017/neu.2022.33] [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] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The cingulate gyrus is implicated in the neurobiology of addiction, such as chronic cocaine consumption. Early life stress (ELS) is an important moderator of cocaine use disorder (CUD). Therefore, we investigated the effect of CUD on cingulate cortical thickness and tested whether a history of ELS could influence the effects of CUD. METHODS Participants aged 18-50 years (78 with CUD due to crack cocaine consumption and 53 healthy controls) underwent magnetic resonance imaging and the cingulate thickness (rostral anterior, caudal anterior, posterior, and isthmus regions) was analysed. The clinical assessment comprised the Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index. Group comparisons adjusting by sex, age, and education were performed. Mediation models were generated where lifetime cocaine use, CTQ score, and cortical thickness corresponded to the independent variable, intermediary variable, and outcome, respectively. RESULTS Group comparisons revealed significant differences in six out of eight cingulate cortices, showing lower thickness in the CUD group. Furthermore, years of regular cocaine use was the variable most associated with cingulate thickness. Negative correlations were found between CTQ scores and the isthmus cingulate (right hemisphere), as well as with the rostral anterior cingulate (left hemisphere). In the mediation analysis, we observed a significant negative direct effect of lifetime cocaine use on the isthmus cingulate and an indirect effect of cocaine use mediated by CTQ score. CONCLUSION Our findings suggest that a history of ELS could aggravate the negative effects of chronic cocaine use on the cingulate gyrus, particularly in the right isthmus cingulate cortex.
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Affiliation(s)
- Augusto Martins Lucas Bittencourt
- Brain Institute (InsCer/BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil
- School of Medicine, Catholic University of Pelotas (UCPel), 96015560, Pelotas, Brazil
| | | | - Lucca Pizzato Tondo
- Brain Institute (InsCer/BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil
| | - Leonardo Melo Rothmann
- Brain Institute (InsCer/BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil
| | - Alexandre Rosa Franco
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
- Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | | | - Thiago Wendt Viola
- Brain Institute (InsCer/BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Brain Institute (InsCer/BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil
- Department of Clinical Medicine – Translational Neuropsychiatry Unit, Aarhus University, 8000, Aarhus, Denmark
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Fernandes JAB, Filev R, Fidalgo TM. Cannabinoids for Substance Use Disorder Treatment: What Does the Current Evidence Say? Cannabis Cannabinoid Res 2023; 8:703-715. [PMID: 37262132 DOI: 10.1089/can.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background: The prevalence of Substance Use Disorder (SUD) is increasing along with the need to develop approaches to reduce the harm associated with substance use, including investigating alternatives such as cannabinoids, which show promising results, although the current evidence is limited. This scoping review focuses on the limitations and potentials of cannabinoid-based treatments for SUDs. Methods: We examined between-subject randomized controlled trials (RCTs) investigating the use of CBD and THC as pharmacological treatment for SUDs in adults, with the procedures attending the expectations of the Preferred Reporting Items for Scoping reviews and Meta-Analyses (PRISMA) for Scoping Reviews guidelines and assessed risk of bias using the Cochrane Risk of Bias Assessment Tool 2. Results: Ten RCTs were included, with six demonstrating low risk of bias, and positive results were found for treating Cannabis Use Disorder, while contradictory results were found for Opioid Use Disorder, and inconclusive results for treating Cocaine Use Disorder. Conclusions: CBD and THC demonstrate potential for treating some SUDs, but evidence is limited. Robust RCTs with larger samples and longer follow-up periods are necessary to assess carefully developed outcomes for different SUD patients. New cannabinoid-based medications and scientific-based policies may advance SUD treatment. A comprehensive approach to treatment and careful methodological choices may benefit patients with SUD.
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Affiliation(s)
- João Ariel Bonar Fernandes
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Filev
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago M Fidalgo
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Schechter J, Brown GW, Janda M. A preliminary evaluation of N-acetylcysteine's effects on patient adherence to treatment for cocaine use disorder. Ment Health Clin 2023; 13:4-10. [PMID: 36891481 PMCID: PMC9987261 DOI: 10.9740/mhc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/11/2022] [Indexed: 03/06/2023] Open
Abstract
Introduction Cocaine use disorder (CUD) is a disabling disease associated with high rates of relapse and intense cravings. Patients with CUD struggle to adhere to treatment, which contributes to relapse and frequent readmissions to residential rehab (RR) facilities. Preliminary studies suggest that N-acetylcysteine (NAC) attenuates cocaine-induced neuroplasticity and, therefore, may assist with cocaine abstinence and adherence to treatment. Methods This retrospective cohort study obtained data from 20 RR facilities across Western New York. Eligible subjects were 18 or older, diagnosed with CUD, and were divided based on their exposure to 1200 mg NAC twice daily during RR. The primary outcome was treatment adherence measured by outpatient treatment attendance rates (OTA). Secondary outcomes included length of stay (LOS) in RR and craving severity on a 1 to 100 visual analog scale. Results One hundred eighty-eight (N = 188) patients were included in this investigation: NAC, n = 90; control, n = 98. NAC did not significantly impact OTA (% appointments attended), NAC 68%; control 69%, (P = .89) or craving severity NAC 34 ± 26; control 30 ± 27, (P = .38). Subjects treated with NAC had a significantly longer average LOS in RR compared with controls, NAC 86 ± 30; control 78 ± 26, (P = .04). Discussion In this study, NAC did not impact treatment adherence but was associated with a significantly longer LOS in RR for patients with CUD. Owing to limitations, these results may not be applicable to the general population. More rigorous studies examining NAC's impact on treatment adherence in CUD are warranted.
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Affiliation(s)
- Jake Schechter
- Psychiatric/Mental Health Nurse Practitioner, Endeavor Health Services, Buffalo, New York; and Adjunct Clinical Instructor, University at Buffalo School of Nursing, Buffalo, New York,
| | - Geoffrey W Brown
- Co-investigator, GPI Clinical Research, Rochester, New York; and Pharmacist, Buffalo Psychiatric Center New York State Office of Mental Health, Buffalo, New York,
| | - Maria Janda
- Clinical Psychiatric Pharmacist, Landmark Health Systems, Buffalo, New York,
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“Virado”: Why Are Crack Cocaine Users Migrating to This New Form of Crack Cocaine? A Brief Report. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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O'Keefe EL, Dhore A, Lavie CJ. Early Onset Cardiovascular Disease from Cocaine, Amphetamines, Alcohol, and Marijuana. Can J Cardiol 2022; 38:1342-1351. [PMID: 35840019 DOI: 10.1016/j.cjca.2022.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 01/16/2023] Open
Abstract
Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens the young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early onset CVD. While this remains a global phenomenon, the epicenter of substance abuse is rooted in North America where it has been exacerbated by the COVID-19 pandemic. For the first time in history, the United States (US) crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis unfolding, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death and early mortality.
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Affiliation(s)
| | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.
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Sanvicente‐Vieira B, Rothmann LM, Esper NB, Tondo LP, Ferreira PE, Buchweitz A, Franco AR, Grassi‐Oliveira R. Sex differences in brain regional homogeneity during acute abstinence in cocaine use disorder. Addict Biol 2022; 27:e13177. [PMID: 35470550 PMCID: PMC9285589 DOI: 10.1111/adb.13177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
There are significant sex differences in the clinical characteristics of cocaine use disorder (CUD). As this is a brain disorder that involves changes in functional connectivity, we investigated the existence of sex differences among people with CUD and controls. We used a data‐driven method comparing males (n = 20, CK‐M) and females with CUD (n = 20, CK‐F) and healthy controls (20 males, HC‐M and 20 females, HC‐F). The participants undertook a resting‐state functional magnetic resonance imaging exam. Regional homogeneity (ReHo) was performed to identify group and sex differences. Persons with CUD of both sexes presented lower ReHo parameters than controls, especially within the parietal lobule. Males with CUD showed higher ReHo than females in three right‐side brain areas: postcentral gyrus, putamen and fusiform gyrus. It was found that abstinence symptoms severity was associated with lower ReHo values in the right postcentral gyrus and the right fusiform gyrus. Participants with CUD exhibited altered ReHo parameters compared to controls, similar to what is found in ageing‐related disorders. Our data also indicate that cocaine has sex‐specific effects on brain functioning when analysing ReHo.
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Affiliation(s)
- Breno Sanvicente‐Vieira
- Brain Institute Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil
- Laboratory of Individual Differences and Psychopathology Pontifical Catholic University of Rio de Janeiro (PUC‐Rio) Rio de Janeiro Brazil
| | - Leonardo Melo Rothmann
- Brain Institute Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil
| | | | - Lucca Pizzato Tondo
- Brain Institute Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil
| | - Pedro Eugênio Ferreira
- Brain Institute Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil
| | - Augusto Buchweitz
- Brain Institute Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil
- Department of Psychology University of Connecticut Stamford USA
| | - Alexandre Rosa Franco
- Center for Biomedical Imaging and Neuromodulation Nathan Kline Institute for Psychiatric Research Orangeburg New York USA
- Center for the Developing Brain Child Mind Institute New York New York USA
- Department of Psychiatry NYU Grossman School of Medicine New York New York USA
| | - Rodrigo Grassi‐Oliveira
- Brain Institute Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil
- Translational Neuropsychiatry Unit, Department of Clinical Medicine Aarhus University Aarhus Denmark
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Tractenberg SG, Schneider JA, de Mattos BP, Bicca CHM, Kluwe-Schiavon B, de Castro TG, Habigzang LF, Grassi-Oliveira R. The Perceptions of Women About Their High Experience of Using Crack Cocaine. Front Psychiatry 2022; 13:898570. [PMID: 35573329 PMCID: PMC9098819 DOI: 10.3389/fpsyt.2022.898570] [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: 03/17/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The aim of this study was to explore the perceptions of women about their experience in using crack cocaine, discussing their motivations for using it and the repercussions in their lives. OBJECTIVE To investigate these experiences, a qualitative exploratory study was conducted, using the inductive thematic analyses of the content. METHODS Eight female crack cocaine users took part in this study. They were assessed by a semi-structured interview, addressing the crack cocaine use experience. Four main themes emerged in the interviews: (1) crack cocaine "high" experience; (2) symptoms related to crack cocaine use; (3) circumstances of crack cocaine use; and (4) crack cocaine use consequences. RESULTS The main perceptions reported by the users were related to a feeling of being disconnected to the world preceded by a pleasant experience, especially during the first moments of use. They revealed that the drug fulfills a key role of coping strategy to handle with negative thoughts, emotions or life experiences. An important influence of social issues was reported in relation to the onset of crack cocaine use. Negative consequences and significant impact on their lives appeared in their reports, regarding the loss of family ties, involvement with prostitution, traumatic experiences and violence. CONCLUSION Taking together all women's perceptions suggests that beyond the positive immediate rewarding effect, the maintenance of use might be related to the dissociative experience and self-medication role, acting as negative reward by relieving of negative life experiences that, in turn, are both cause and consequence of the drug use.
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Affiliation(s)
- Saulo G Tractenberg
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Jaluza A Schneider
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Bernardo P de Mattos
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Carla H M Bicca
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Bruno Kluwe-Schiavon
- Decision in Context, Research Center for Psychological Science, University of Lisbon (ULisbon), Lisbon, Portugal
| | - Thiago G de Castro
- Department of Psychology, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Luísa F Habigzang
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Liu Y, Richards VL, Gebru NM, Spencer EC, Cook RL. Associations amongst form of cocaine used (powder vs crack vs both) and HIV-related outcomes. Addict Behav Rep 2021; 14:100374. [PMID: 34938835 PMCID: PMC8664776 DOI: 10.1016/j.abrep.2021.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/20/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022] Open
Abstract
Among PWH, cocaine use vs no-use was associated with worse HIV treatment outcomes. Powder cocaine only users were more likely to be younger, Hispanic, and employed. Users of powder + crack cocaine had lower viral suppression than users of either alone. Harm reduction efforts addressing substance use should be a key component of HIV care.
Introduction Cocaine (including powder and crack) use is common among people with HIV (PWH). We identified socio-demographic and behavioral factors associated with cocaine use (overall and various forms) among PWH; we also examined differences in HIV treatment outcomes across cocaine exposure groups. Methods The study sample (N = 1166) was derived from two cohorts of PWH in Florida between 2014 and 2020. Baseline data were linked to the Enhanced HIV/AIDS Reporting System (eHARS) which tracks HIV viral load. Socio-demographics and polysubstance use were compared by cocaine use and the three cocaine use groups (powder only n = 101, crack only n = 91, or both n = 65). The association between the three cocaine use groups, ART adherence, and HIV viral suppression (<200 copies/mL) in the following year was assessed by multivariate logistic regression. Results People who used cocaine had lower HIV treatment adherence and viral suppression than those who did not use. People who used powder cocaine only were more likely to be younger, Hispanic/Latinx, and employed than those who used crack only or both. Compared to people who used both powder and crack cocaine, those who used one form of cocaine had 3 + odds of having durable viral suppression in the following year. Conclusion The dual use of both powder and crack cocaine was associated with significantly worse HIV outcomes compared to use of only one form of cocaine. Screening for powder and crack cocaine use and timely intervention are needed to improve HIV treatment outcomes among this high-risk population.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Veronica L Richards
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nioud Mulugeta Gebru
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Emma C Spencer
- Florida Department of Health, Bureau of Communicable Diseases, Tallahassee, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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Effectiveness of incorporating contingency management into a public treatment program for people who use crack cocaine in Brazil. A single-blind randomized controlled trial. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103464. [PMID: 34619447 DOI: 10.1016/j.drugpo.2021.103464] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. METHODS Single-blind randomized controlled trial conducted at Unidade Recomeço Helvétia (URH), a public ambulatory treatment program for persons who use crack and live in the "Crackland" region in downtown São Paulo, Brazil. In total, 98 treatment-seeking individuals who use crack were randomized to one of two treatment conditions. Participants allocated to the control condition (n = 48) received 12 weeks of the standard treatment provided at URH. Participants allocated to the experimental condition (n = 50) received the same treatment in combination with Contingency Management (URH+CM). In URH+CM, participants were provided with vouchers with monetary value for submission of negative cocaine urinalysis twice weekly. RESULTS Compared to the URH group, the URH+CM group was significantly more likely to submit a negative cocaine urinalysis during treatment, with odds ratios ranging from 4.17 to 6.78, depending on how missing data was accounted for (p<0.01). Participants receiving Contingency Management also had higher odds of achieving three or more weeks of continuous abstinence (OR= 8.07; 95% CI [2.48, 26.24]), achieved longer durations of abstinence (B = 2.14; 95% CI [0.67, 3.61]), submitted a higher percentage of negative urinalysis (B = 19.85; 95% CI [6.89, 32.82]), and were retained in treatment for a longer period (B = 3.00; 95% CI [1.04, 4.97]), compared to those receiving URH alone (p<0.01 for all). CONCLUSIONS The incorporation of Contingency Management was effective in promoting cocaine abstinence and treatment retention. The large-scale dissemination of Contingency Management may be an effective strategy to treat Brazilians with cocaine use disorders.
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de la Fuente A, Vignaga SS, Prado P, Figueras R, Lizaso L, Manes F, Cetkovich M, Tagliazucchi E, Torralva T. Early onset consumption of coca paste associated with executive-attention vulnerability markers linked to caudate-frontal structural and functional abnormalities. Drug Alcohol Depend 2021; 227:108926. [PMID: 34364191 DOI: 10.1016/j.drugalcdep.2021.108926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
Coca paste is the most popular form of smoked cocaine (SC) in Latin America and also the most widespread among adolescents in vulnerable sectors of society, thus representing a significant public health concern. Despite evidence suggesting that abnormal executive-attention function is predictive of addiction to stimulant drugs, no study to date has compared clinically relevant neuropsychological (NPS) and physiological variables between individuals with histories of smoked cocaine dependence (SCD) and insufflated cocaine hydrochloride dependence (ICD). In this study we evaluated 25 SCD and 22 ICD subjects matched by poly-consumption profiles, and 25 healthy controls (CTR) matched by age, gender, education, and socioeconomic status. An exhaustive NPS battery was used to assess cognitive domains (attention, executive functions, fluid intelligence, memory, language and social cognition). We complemented this assessment with structural (MRI) and functional (fMRI) neuroimaging data. We found that executive function and attention impairments could be explained by the administration route of cocaine, with strongest impairments for the SCD group. SCD also presented reduced grey matter density relative to ICD and CTR in the bilateral caudate, a key area for executive and attentional function. Functional connectivity between left caudate and inferior frontal regions mediated the association between brain structure and behavioral performance. Our results highlight the relevance of assessing the route of administration of stimulants, both in clinical and research settings.
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Affiliation(s)
- Alethia de la Fuente
- Buenos Aires Physics Institute (IFIBA) and Physics Department, University of Buenos Aires, Argentina; Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council, Buenos Aires, Argentina.
| | - Sofía Schurmann Vignaga
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Pilar Prado
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Rosario Figueras
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Lucia Lizaso
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Facundo Manes
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Marcelo Cetkovich
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Enzo Tagliazucchi
- Buenos Aires Physics Institute (IFIBA) and Physics Department, University of Buenos Aires, Argentina; National Scientific and Technical Research Council, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibanez, Santiago, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
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12
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Foltin RW, Luba R, Chen Y, Wang Y, Evans SM. Impulsivity in cocaine users compared to matched controls: Effects of sex and preferred route of cocaine use. Drug Alcohol Depend 2021; 226:108840. [PMID: 34246916 PMCID: PMC8355072 DOI: 10.1016/j.drugalcdep.2021.108840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impulsivity has been identified as playing a role in cocaine use. The purpose of this study was to explore self-report measures of impulsivity in large groups of male and female cocaine users and matched controls and to determine if differences in impulsivity measures within a group of cocaine users related to self-reported money spent on cocaine and route of cocaine use. METHODS Eight self-report impulsivity measures yielding 34 subscales were obtained in 230 cocaine users (180 M, 50 F) and a matched group of 119 healthy controls (89 M, 30 F). Correlational analysis of the questionnaires revealed 2 factors: Impulsive Action (Factor 1) consisting of many traditional impulsivity measures and Thrill-seeking (Factor 2) consisting of delay discounting, sensation and thrill seeking. RESULTS Sex influenced within group comparisons. Impulsive Action scores did not vary as a function of sex within either group. But, male controls and male cocaine users had greater Thrill-seeking scores than females within the same group. Sex also influenced between group comparisons. Male cocaine users had greater Impulsive Action scores while female cocaine users had greater Thrill-seeking scores than their sex-matched controls. Among cocaine users, individuals who preferred insufflating ("snorting") cocaine had greater Thrill-seeking scores and lower Impulsive Action scores than individuals who preferred smoking cocaine. Individuals who insufflate cocaine also spent less money on cocaine. CONCLUSIONS Greater Impulsive Action scores in males and Thrill-seeking scores in females were associated with cocaine use relative to controls.
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Affiliation(s)
- Richard W. Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, U.S.A
| | - Rachel Luba
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, U.S.A
| | - Yuan Chen
- Division on Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, U.S.A
| | - Yuanjia Wang
- Division on Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, U.S.A
| | - Suzette M. Evans
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, U.S.A
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13
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Empathy deficits and their behavioral, neuroanatomical, and functional connectivity correlates in smoked cocaine users. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110328. [PMID: 33865925 DOI: 10.1016/j.pnpbp.2021.110328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
Reduced empathic abilities are frequently observed in drug abusers. These deficits may compromise interpersonal interactions and contribute to diminished social functioning. However, previous evidence regarding empathy and addiction is behaviorally unspecific and virtually null in terms of their brain structural or functional correlates. Moreover, no previous study has investigated how empathy is affected by drugs whose consumption is particularly characterized by counter-empathic behaviors. Here, we conducted the first assessment of neurocognitive correlates of empathy for pain in dependent users (predominantly men) of smoked cocaine (SC, coca paste, n = 37). We compared their performance in the empathy task with that of two groups matched in relevant demographic variables: 24 dependent users of insufflated cocaine hydrochloride (CC) and 21 healthy controls. In addition, we explored the structural anatomy and functional connectivity (FC) correlates of empathic impairments across groups. Our results showed that, compared to CC and controls, SC users exhibited a selective reduction of empathic concern for intentional harms. These impairments were associated with lower gray matter volumes in regions subserving social cognition (i.e., right inferior parietal lobule, supramarginal and angular gyri). Furthermore, reduced empathic concern correlated with FC within affective empathy and social cognition networks, which are also linked to cognitive changes reported in addiction (i.e., inferior frontal and orbital gyri, posterior insula, supplementary motor area, cingulate cortex). Our findings suggest that chronic consumption of SC may involve reduced empathic concern and relevant neuroanatomical and FC abnormalities, which, in turn, may result in social interaction dysfunction. These results can inform theoretical and applied developments in neuropsychopharmacology.
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14
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Bittencourt AML, Bampi VF, Sommer RC, Schaker V, Juruena MFP, Soder RB, Franco AR, Sanvicente-Vieira B, Grassi-Oliveira R, Ferreira PEMS. Cortical thickness and subcortical volume abnormalities in male crack-cocaine users. Psychiatry Res Neuroimaging 2021; 310:111232. [PMID: 33621927 DOI: 10.1016/j.pscychresns.2020.111232] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 02/05/2023]
Abstract
Crack-cocaine offers a higher risk of abuse than intranasal and intravenous use of cocaine. Yet, current treatments remain disappointing and our understanding of the mechanism of crack-cocaine neurotoxicity is still incomplete. Magnetic resonance images studies on brain changes of crack-cocaine addicts show divergent data. The present study investigated gray matter (GM) abnormalities in crack-cocaine dependents (n = 18) compared to healthy controls (n = 17). MRI data was analysed using FreeSurfer and voxel-based morphometry (VBM). FreeSurfer analysis showed that CD had decreased cortical thickness (CT) in the left inferior temporal cortex (lTC), left orbitofrontal cortex (lOFC) and left rostro frontal cortex (lRFC), enlargement in left inferior lateral ventricle, and smaller GM volume in right hippocampus and right ventral diencephalon. VBM analysis showed that CD had significantly decreased GM volume in left Putamen and left nucleus accumbens. Furthermore, we found a negative correlation between duration of crack-cocaine use and lTC CT. These results provide compelling evidence for GM abnormalities in CD and also suggest that duration of crack-cocaine use may be associated with CT alterations.
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Affiliation(s)
- Augusto Martins Lucas Bittencourt
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Medicine and Health Sciences - Neuroscience, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil.
| | - Vinicius Faccin Bampi
- SW - Adult Community Mental Health Service, Hertfordshire Partnership University NHS Foundation Trust, St, AL3 5TQ St Albans, United Kingdom
| | - Rafael Canani Sommer
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
| | - Vanessa Schaker
- Federal University of Rio Grande do Sul, 90040-060, Porto Alegre, Brazil
| | | | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
| | - Alexandre Rosa Franco
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeberg, NY, 10962, USA; Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA; Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Breno Sanvicente-Vieira
- Lab of Individual Differences and Psychopathology (LaDIP), Psychology Department - Pontifical Catholic University of Rio de Janeiro (PUC-Rio), 22453900, Rio de Janeiro, Brazil
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Medicine and Health Sciences - Neuroscience, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
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15
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Tondo LP, Viola TW, Fries GR, Kluwe-Schiavon B, Rothmann LM, Cupertino R, Ferreira P, Franco AR, Lane SD, Stertz L, Zhao Z, Hu R, Meyer T, Schmitz JM, Walss-Bass C, Grassi-Oliveira R. White matter deficits in cocaine use disorder: convergent evidence from in vivo diffusion tensor imaging and ex vivo proteomic analysis. Transl Psychiatry 2021; 11:252. [PMID: 33911068 PMCID: PMC8081729 DOI: 10.1038/s41398-021-01367-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022] Open
Abstract
White matter (WM) abnormalities in patients with cocaine use disorder (CUD) have been studied; however, the reported effects on the human brain are heterogenous and most results have been obtained from male participants. In addition, biological data supporting the imaging findings and revealing possible mechanisms underlying the neurotoxic effects of chronic cocaine use (CU) on WM are largely restricted to animal studies. To evaluate the neurotoxic effects of CU in the WM, we performed an in vivo diffusion tensor imaging assessment of male and female cocaine users (n = 75) and healthy controls (HC) (n = 58). Moreover, we performed an ex vivo large-scale proteomic analysis using liquid chromatography-tandem mass spectrometry in postmortem brains of patients with CUD (n = 8) and HC (n = 12). Compared with the HC, the CUD group showed significant reductions in global fractional anisotropy (FA) (p < 0.001), and an increase in global mean (MD) and radial diffusion (RD) (both p < 0.001). The results revealed that FA, RD, and MD alterations in the CUD group were widespread along the major WM tracts, after analysis using the tract-based special statistics approach. Global FA was negatively associated with years of CU (p = 0.0421) and female sex (p < 0.001), but not with years of alcohol or nicotine use. Concerning the fibers connecting the left to the right prefrontal cortex, Brodmann area 9 (BA9), the CUD group presented lower FA (p = 0.006) and higher RD (p < 0.001) values compared with the HC group. A negative association between the duration of CU in life and FA values in this tract was also observed (p = 0.019). Proteomics analyses in BA9 found 11 proteins differentially expressed between cocaine users and controls. Among these, were proteins related to myelination and neuroinflammation. In summary, we demonstrate convergent evidence from in vivo diffusion tensor imaging and ex vivo proteomics analysis of WM disruption in CUD.
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Affiliation(s)
- Lucca Pizzato Tondo
- Developmental Cognitive Neuroscience Lab (DCNL), Brain Institute, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Thiago Wendt Viola
- Developmental Cognitive Neuroscience Lab (DCNL), Brain Institute, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Gabriel R Fries
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bruno Kluwe-Schiavon
- Developmental Cognitive Neuroscience Lab (DCNL), Brain Institute, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Leonardo Mello Rothmann
- Developmental Cognitive Neuroscience Lab (DCNL), Brain Institute, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Renata Cupertino
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Pedro Ferreira
- Developmental Cognitive Neuroscience Lab (DCNL), Brain Institute, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Scott D Lane
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Laura Stertz
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ruifeng Hu
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas Meyer
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joy M Schmitz
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Consuelo Walss-Bass
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL), Brain Institute, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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16
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The association between quantity, frequency and duration of cocaine use during the heaviest use period and DSM-5 cocaine use disorder. Drug Alcohol Depend 2020; 213:108114. [PMID: 32563848 DOI: 10.1016/j.drugalcdep.2020.108114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Quantity (Q), frequency (F), and duration (D) of cocaine use during a person's heaviest use period are important aspects of cocaine use patterns that associated with cocaine use disorder (CocUD). METHODS A total 2988 lifetime cocaine users who met CocUD after the onset of cocaine heaviest use were identified from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). QFD were each categorized into four levels. Hierarchical regressions were used to examine the association between QFD of cocaine use and CocUD. Two-way interactions between QFD were also examined. RESULTS As the level of cocaine use increased from low to very high, the prevalence of CocUD increased. Compared to people with low F, cocaine users with very high F were 12.09 times (95 %CI 6.33, 23.07) as likely to meet criteria for CocUD. Similarly, Q was associated with 4.84 (95 %CI 2.55, 9.18) times the risk of CocUD. D was not significantly associated with the risk of CocUD. Significant additive interaction was identified between Q*F on CocUD prevalence. Approximately one-third of the excess risk associated with having high Q & high F was due to the interactive effect. CONCLUSION Of these three cocaine use patterns, F had the strongest association with CocUD, followed by the Q. High Q and high F was a very dangerous pattern of cocaine use as the combination had as a synergistic effect on the risk of CocUD. It is important for intervention programs to focus on the reduction of both Q and F.
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17
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Lile JA, Johnson AR, Banks ML, Hatton KW, Hays LR, Nicholson KL, Poklis JL, Rayapati AO, Rush CR, Stoops WW, Negus SS. Pharmacological validation of a translational model of cocaine use disorder: Effects of d-amphetamine maintenance on choice between intravenous cocaine and a nondrug alternative in humans and rhesus monkeys. Exp Clin Psychopharmacol 2020; 28:169-180. [PMID: 31259593 PMCID: PMC6938584 DOI: 10.1037/pha0000302] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Drug self-administration procedures are the gold standard for laboratory research to study mechanisms of drug use disorders and evaluate candidate medications. However, preclinical-to-clinical translation has been hampered by a lack of coordination. To address this limitation, we previously developed homologous intravenous (IV) cocaine choice self-administration procedures in rhesus monkeys and humans, and then demonstrated their functional equivalence. The present studies sought to determine the sensitivity of these procedures to d-amphetamine maintenance. Three (N = 3) rhesus monkeys with histories of cocaine self-administration and 16 (N = 16) humans with cocaine use disorder completed the studies. Monkeys were maintained on IV d-amphetamine (0, 0.019, 0.037 and 0.074 mg/kg/h), and then completed 7 sessions during each condition in which they completed 9 choice trials to receive 0.14 mg/kg/injection IV cocaine (corresponding to 10 mg/70 kg in humans) or 10 food pellets under independent, concurrent progressive-ratio schedules. Humans were maintained on oral extended release d-amphetamine (0, 30 and 60 mg/day, corresponding to the lowest 3 doses in monkeys) and participated in 12 sessions in which they chose money ($6.00) or IV cocaine (0, 3, 10 and 30 mg/70 kg). Blood samples were taken to compare d-amphetamine plasma levels across species. In monkeys and humans, d-amphetamine reduced the number of cocaine choices and produced comparable blood levels at equivalent daily doses. d-Amphetamine had similar efficacy, though lower potency, at reducing choice for an equivalent cocaine dose in monkeys relative to humans. These coordinated studies support the utility of these procedures as a translational model for cocaine use disorder. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Joshua A Lile
- Department of Behavioral Science, University of Kentucky College of Medicine
| | - Amy R Johnson
- Department of Pharmacology and Toxicology, Virginia Commonwealth University Medical Center
| | - Matthew L Banks
- Department of Pharmacology and Toxicology, Virginia Commonwealth University Medical Center
| | - Kevin W Hatton
- Department of Anesthesiology, University of Kentucky College of Medicine
| | - Lon R Hays
- Department of Psychiatry, University of Kentucky College of Medicine
| | - Katherine L Nicholson
- Department of Pharmacology and Toxicology, Virginia Commonwealth University Medical Center
| | - Justin L Poklis
- Department of Pharmacology and Toxicology, Virginia Commonwealth University Medical Center
| | - Abner O Rayapati
- Department of Psychiatry, University of Kentucky College of Medicine
| | - Craig R Rush
- Department of Behavioral Science, University of Kentucky College of Medicine
| | - William W Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University Medical Center
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18
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de la Fuente A, Sedeño L, Vignaga SS, Ellmann C, Sonzogni S, Belluscio L, García-Cordero I, Castagnaro E, Boano M, Cetkovich M, Torralva T, Cánepa ET, Tagliazucchi E, Garcia AM, Ibañez A. Multimodal neurocognitive markers of interoceptive tuning in smoked cocaine. Neuropsychopharmacology 2019; 44:1425-1434. [PMID: 30867552 PMCID: PMC6784987 DOI: 10.1038/s41386-019-0370-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/22/2019] [Accepted: 03/02/2019] [Indexed: 12/21/2022]
Abstract
Contemporary neurocognitive models of drug addiction have associated this condition with changes in interoception -namely, the sensing and processing of body signals that fulfill homeostatic functions relevant for the onset and maintenance of addictive behavior. However, most previous evidence is inconsistent, behaviorally unspecific, and virtually null in terms of direct electrophysiological and multimodal markers. To circumvent these limitations, we conducted the first assessment of the relation between cardiac interoception and smoked cocaine dependence (SCD) in a sample of (a) 25 participants who fulfilled criteria for dependence on such a drug, (b) 22 participants addicted to insufflated clorhidrate cocaine (only for behavioral assessment), and (c) 25 healthy controls matched by age, gender, education, and socioeconomic status. We use a validated heartbeat-detection (HBD) task and measured modulations of the heart-evoked potential (HEP) during interoceptive accuracy and interoceptive learning conditions. We complemented this behavioral and electrophysiological data with offline structural (MRI) and functional connectivity (fMRI) analysis of the main interoceptive hubs. HBD and HEP results convergently showed that SCD subjects presented ongoing psychophysiological measures of enhanced interoceptive accuracy. This pattern was associated with a structural and functional tuning of interoceptive networks (reduced volume and specialized network segregation). Taken together, our findings provide the first evidence of an association between cardiac interoception and smoked cocaine, partially supporting models that propose hyper-interoception as a key aspect of addiction. More generally, our study shows that multimodal assessments of interoception could substantially inform the clinical and neurocognitive characterization of psychophysiological and neurocognitive adaptations triggered by addiction.
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Affiliation(s)
- Alethia de la Fuente
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Lucas Sedeño
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Sofia Schurmann Vignaga
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Camila Ellmann
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Silvina Sonzogni
- 0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5Laboratorio de Neuroepigenética, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires e IQUIBICEN, CONICET, Buenos Aires, Argentina
| | - Laura Belluscio
- 0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5Laboratorio de Neuroepigenética, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires e IQUIBICEN, CONICET, Buenos Aires, Argentina
| | - Indira García-Cordero
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Eugenia Castagnaro
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Magdalena Boano
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Marcelo Cetkovich
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Teresa Torralva
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Eduardo T. Cánepa
- 0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5Laboratorio de Neuroepigenética, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires e IQUIBICEN, CONICET, Buenos Aires, Argentina
| | - Enzo Tagliazucchi
- 0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina ,0000 0001 0056 1981grid.7345.5Buenos Aires Physics Institute (IFIBA) and Physics Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Adolfo M. Garcia
- 0000 0004 0608 3193grid.411168.bInstitute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5National Scientific and Technical Research Council, Buenos Aires, Argentina ,0000 0001 2185 5065grid.412108.eFaculty of Education, National University of Cuyo (UNCuyo), Mendoza, M5502JMA Argentina
| | - Agustín Ibañez
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina. .,National Scientific and Technical Research Council, Buenos Aires, Argentina. .,Universidad Autónoma del Caribe, Barranquilla, Colombia. .,Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile. .,Australian Research Council, Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, Australia.
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19
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Miguel AQC, Madruga CS, Cogo-Moreira H, Yamauchi R, Simões V, Ribeiro A, da Silva CJ, Fruci A, McDonell M, McPherson S, Roll JM, Laranjeira RR. Contingency management targeting abstinence is effective in reducing depressive and anxiety symptoms among crack cocaine-dependent individuals. Exp Clin Psychopharmacol 2017; 25:466-472. [PMID: 29251975 PMCID: PMC5737792 DOI: 10.1037/pha0000147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although contingency management (CM) is effective in promoting abstinence and treatment retention among crack cocaine users who meet the criteria for cocaine dependence, less is known about its off-target effects. In this secondary analysis, we evaluated the impact of CM on depressive and anxiety symptoms in a sample of cocaine-dependent individuals under treatment. Sixty-five crack cocaine users who met the criteria for cocaine dependence were randomly assigned to receive 12 weeks of standard treatment alone (STA; n = 32) or 12 weeks of standard treatment plus CM (STCM; n = 33). The outcome measures of the secondary analysis were depressive and anxiety symptoms assessed with the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). At baseline, 59 (90.8%) of the participants reported at least mild depressive symptoms and 47 (72.5%) reported at least mild anxiety symptoms. The mean BDI-II (24.5 ± 12.1) and BAI (20.7 ± 13.5) scores in the sample as a whole was moderate. After treatment, the reported levels of depressive symptoms (β = -9.6, p < .05) and anxiety symptoms (β = -9.9, p < .05) were lower among the individuals receiving STCM than among those receiving STA. This study provides evidence that an STCM intervention targeting crack cocaine abstinence also produces significant reductions in depressive and anxiety symptoms. This low cost intervention also demonstrated significant promise and optimization potential for crack cocaine users in a setting of scarce resources and high mental health comorbidity. Relevance Statement: We found that the prevalence of depressive and anxiety symptoms were extremely high among crack cocaine users, and that, among such individuals, contingency management (CM) reduced depressive and anxiety symptomatology to a greater degree than did standard treatment. Our results suggest that CM targeting crack cocaine abuse can have off-target effects on psychiatric symptomatology. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Viviane Simões
- National Institute of Policies on Alcohol and Drugs (INPAD)
| | | | | | - Andrew Fruci
- Program of Excellence in Addictions Research, Washington State University
| | - Michael McDonell
- Program of Excellence in Addictions Research, Washington State University
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University
| | - John M Roll
- Program of Excellence in Addictions Research, Washington State University
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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Development of a translational model to screen medications for cocaine use disorder II: Choice between intravenous cocaine and money in humans. Drug Alcohol Depend 2016; 165:111-9. [PMID: 27269368 PMCID: PMC4939714 DOI: 10.1016/j.drugalcdep.2016.05.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/22/2016] [Accepted: 05/02/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND A medication for treating cocaine use disorder has yet to be approved. Laboratory-based evaluation of candidate medications in animals and humans is a valuable means to demonstrate safety, tolerability and initial efficacy of potential medications. However, animal-to-human translation has been hampered by a lack of coordination. Therefore, we designed homologous cocaine self-administration studies in rhesus monkeys (see companion article) and human subjects in an attempt to develop linked, functionally equivalent procedures for research on candidate medications for cocaine use disorder. METHODS Eight (N=8) subjects with cocaine use disorder completed 12 experimental sessions in which they responded to receive money ($0.01, $1.00 and $3.00) or intravenous cocaine (0, 3, 10 and 30mg/70kg) under independent, concurrent progressive-ratio schedules. Prior to the completion of 9 choice trials, subjects sampled the cocaine dose available during that session and were informed of the monetary alternative value. RESULTS The allocation of behavior varied systematically as a function of cocaine dose and money value. Moreover, a similar pattern of cocaine choice was demonstrated in rhesus monkeys and humans across different cocaine doses and magnitudes of the species-specific alternative reinforcers. The subjective and cardiovascular responses to IV cocaine were an orderly function of dose, although heart rate and blood pressure remained within safe limits. CONCLUSIONS These coordinated studies successfully established drug versus non-drug choice procedures in humans and rhesus monkeys that yielded similar cocaine choice behavior across species. This translational research platform will be used in future research to enhance the efficiency of developing interventions to reduce cocaine use.
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Reed SC, Evans SM. The effects of oral d-amphetamine on impulsivity in smoked and intranasal cocaine users. Drug Alcohol Depend 2016; 163:141-52. [PMID: 27114203 PMCID: PMC4880502 DOI: 10.1016/j.drugalcdep.2016.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Effective treatments for cocaine use disorders remain elusive. Two factors that may be related to treatment failures are route of cocaine used and impulsivity. Smoked cocaine users are more likely to have poorer treatment outcomes compared to intranasal cocaine users. Further, cocaine users are impulsive and impulsivity is associated with poor treatment outcomes. While stimulants are used to treat Attention Deficit Hyperactivity Disorder (ADHD) and attenuate certain cocaine-related behaviors, few studies have comprehensively examined whether stimulants can reduce behavioral impulsivity in cocaine users, and none examined route of cocaine use as a factor. METHODS The effects of immediate release oral d-amphetamine (AMPH) were examined in 34 cocaine users (13 intranasal, 21 smoked). Participants had three separate sessions where they were administered AMPH (0, 10, or 20mg) and completed behavioral measures of impulsivity and risk-taking and subjective measures of abuse liability. RESULTS Smoked cocaine users were more impulsive on the Delayed Memory Task, the GoStop task and the Delay Discounting Task than intranasal cocaine users. Smoked cocaine users also reported more cocaine craving and negative mood than intranasal cocaine users. AMPH produced minimal increases on measures of abuse liability (e.g., Drug Liking). CONCLUSIONS Smoked cocaine users were more impulsive than intranasal cocaine users on measures of impulsivity that had a delay component. Additionally, although AMPH failed to attenuate impulsive responding, there was minimal evidence of abuse liability in cocaine users. These preliminary findings need to be confirmed in larger samples that control for route and duration of cocaine use.
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Affiliation(s)
- Stephanie Collins Reed
- Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Unit 66, New York, NY 10032 USA.
| | - Suzette M Evans
- Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Unit 66, New York, NY 10032 USA
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