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Ghosh A, Shaktan A, Nehra R, Verma A, Rana DK, Ahuja CK, Modi M, Singh P, Basu D. Neurocognitive Functions After 6-Month Buprenorphine (Naloxone)-Based Opioid Agonist Maintenance Treatment: A Controlled Prospective Study. J Clin Psychopharmacol 2024; 44:141-150. [PMID: 38421923 DOI: 10.1097/jcp.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Medications for opioid use disorder (OUD) may influence neurocognitive functions. Inadequate power, confounders, and practice effects limit the validity of the existing research. We examined the change in cognitive functions in patients with OUD at 6-month buprenorphine (naloxone) posttreatment and compared the cognitive performance of the buprenorphine-treated group with control subjects. METHODS We recruited 498 patients with OUD within a week of initiating buprenorphine. Assessments were done twice-at baseline and 6 months. Those abstinent from illicit opioids and adherent to treatment (n = 199) underwent follow-up assessments. Ninety-eight non-substance-using control subjects were recruited from the community. The neurocognitive assessments comprised the Wisconsin Card Sorting Test, Iowa Gambling Task, Trail-Making Tests A and B (TMT-A and TMT-B), and verbal and visual N-Back Test. We controlled for potential effect modifiers. RESULTS Twenty-five of the 32 test parameters significantly improved with 6 months of buprenorphine treatment; 20 parameters withstood corrections for multiple comparisons (P < 0.001). The improved test domains spread across cognitive tests: Wisconsin Card Sorting Test (perseverative errors and response, categories completed, conceptual responses), TMTs (time to complete), verbal and visual N-Back Tests (hits, omission, and total errors). After treatment, OUD (vs control subjects) had less perseverative response and error (P < 0.001) and higher conceptual response (P = 0.004) and took lesser time to complete TMT-A (P < 0.001) and TMT-B (P = 0.005). The baseline neurocognitive functions did not differ between those who retained and those who discontinued the treatment. CONCLUSION Cognitive functions improve in patients with OUD on buprenorphine. This improvement is unlikely to be accounted for by the practice effect, selective attrition, and potential confounders.
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Affiliation(s)
- Abhishek Ghosh
- From the Drug Deaddiction and Treatment Centre, Department of Psychiatry
| | - Alka Shaktan
- From the Drug Deaddiction and Treatment Centre, Department of Psychiatry
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research
| | | | - Devender K Rana
- From the Drug Deaddiction and Treatment Centre, Department of Psychiatry
| | | | - Manish Modi
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Debasish Basu
- From the Drug Deaddiction and Treatment Centre, Department of Psychiatry
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2
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Ford AI, Minley K, Martin J, Hudson M, Snider K, Bacani R, Smith R, Phillips G, Vassar M. Gender disparities in neuropsychological assessment research in drug abuse populations: A systematic review. Clin Neuropsychol 2024:1-16. [PMID: 38378445 DOI: 10.1080/13854046.2024.2315741] [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: 07/10/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024]
Abstract
Objective: To systematically review the literature on the neurocognitive effects of drug use to determine if there are significant gender differences. Methods: In April 2023, we conducted a broad search in MEDLINE (via PubMed), PsycINFO, and Embase for original research studies that used objective neuropsychological assessment to evaluate neurocognition in persons with drug use. Data extraction was performed in a masked, duplicate fashion. Results: Our initial search returned 22,430 records, of which 273 articles were included in our analysis. We found significant underrepresentation of women as participants in the studies. Twenty-one percent of studies had exclusively male participants; when women were included, they averaged only 23% of the sample. Only 49 studies sufficiently documented an analysis of their results by gender; due to the heterogeneity in study characteristics, no conclusions about cognitive differences between women and men could be made. Conclusions: Women are significantly underrepresented in the research on cognition in drug use. Increased efforts to include more women participants and consistent analysis and reporting of data for potential gender differences will be required to close this gap in knowledge, which may lead to improved substance abuse treatment approaches for women.
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Affiliation(s)
- Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Kirstien Minley
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Josie Martin
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Madeline Hudson
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Kelsey Snider
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Rigel Bacani
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Riley Smith
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Gunnar Phillips
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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3
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Wang L, Qin Y, Li X, Li X, Liu Y, Li W, Wang Y. Glymphatic-System Function Is Associated with Addiction and Relapse in Heroin Dependents Undergoing Methadone Maintenance Treatment. Brain Sci 2023; 13:1292. [PMID: 37759893 PMCID: PMC10526898 DOI: 10.3390/brainsci13091292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
This study investigates the impact of methadone maintenance treatment (MMT) on the brain glymphatic system (GS) in opioid addiction in China. A total of 51 male MMT patients, 48 demographically matched healthy controls (HCs), and 20 heroin dependents (HDs) were recruited for this study. The GS functioning was assessed using diffusion-tensor-imaging analysis along perivascular spaces (DTI-ALPS index) and the bilateral ALPS divergency (DivALPS). Group differences were analyzed utilizing ANOVA and two-sample t-tests. The relationship between DivALPS and relapse rate was explored using regression analysis. The DTI-ALPS index was significantly higher for the left-side brain than the right side in all three groups. There was a significant difference for the right side (p = 0.0098) between the groups. The MMT and HD groups showed significantly higher DTI-ALPS than the HC group (p = 0.018 and 0.016, respectively). The DivALPS varied significantly among the three groups (p = 0.04), with the HD group showing the lowest and the HC group the highest values. Significant negative relationships were found between relapse count, DivALPS (p < 0.0001, Exp(B) = 0.6047), and age (p < 0.0001, Exp(B) = 0.9142). The findings suggest that MMT may contribute to promoting brain GS recovery in heroin addicts, and modulation of the GS may serve as a potential biomarker for relapse risk, providing insights into novel therapeutic strategies.
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Affiliation(s)
- Lei Wang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China; (L.W.); (Y.Q.)
- Department of Radiology, Xi’an Daxing Hospital, Xi’an 710016, China
| | - Yue Qin
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China; (L.W.); (Y.Q.)
- Department of Radiology, Xi’an Daxing Hospital, Xi’an 710016, China
| | - Xiaoshi Li
- Department of Radiology, Xi’an Daxing Hospital, Xi’an 710016, China
| | - Xin Li
- Department of Radiology, Xi’an Daxing Hospital, Xi’an 710016, China
| | - Yuwei Liu
- Department of Medical Imaging, People’s Hospital of Tongchuan City, Tongchuan 727000, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Air Force Military Medical University, Xi’an 710038, China
| | - Yarong Wang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China; (L.W.); (Y.Q.)
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4
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Mistler C, Copenhaver M. Integrating Cognitive Dysfunction Accommodation Strategies into an HIV Prevention Session: A 2-Arm Pilot Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159430. [PMID: 35954802 PMCID: PMC9368365 DOI: 10.3390/ijerph19159430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023]
Abstract
Cognitive dysfunction is prevalent among persons on medication for opioid use disorder (MOUD). This cognitive dysfunction has been shown to reduce HIV treatment engagement and medication adherence. We investigated the impact of integrating specific behavioral strategies into an HIV prevention session to accommodate cognitive dysfunction among people on MOUD. Patients on MOUD (n = 20) were randomized to one of two different HIV prevention conditions. The same HIV risk reduction content was presented to both conditions; however, the experimental condition had accommodation strategies integrated into the session. Participants completed a skills checklist at pre-, post-, and 2-week follow-up to examine the level of HIV risk reduction content learned and utilized over time. Participants in the experimental condition indicated high acceptability (95%) for the accommodation strategies. These participants also demonstrated greater improvement in the ability to properly clean a syringe, from pre- to post- (p < 0.02) and from pre- to follow-up (p < 0.02) when compared to participants in the standard condition. Results from this pilot study indicate that accommodation strategies improved participants’ ability to learn, retain, and utilize risk reduction skills over time. This foundation of research indicates a promising, innovative strategy to increase the ability for persons on MOUD to engage in HIV prevention behaviors.
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Affiliation(s)
- Colleen Mistler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA;
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06269, USA
- Correspondence:
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA;
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06269, USA
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5
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Marco CA, Studebaker H, Harrington M, Ganz E, Boodt B, Hunt T, Costin A, Joseph C, Ely I. The effects of acute pain on cognitive skills in emergency department patients. Am J Emerg Med 2022; 55:72-75. [DOI: 10.1016/j.ajem.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022] Open
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Voronkov M, Ataiants J, Cocchiaro B, Stock JB, Lankenau SE. A vicious cycle of neuropathological, cognitive and behavioural sequelae of repeated opioid overdose. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103362. [PMID: 34314956 DOI: 10.1016/j.drugpo.2021.103362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/03/2021] [Accepted: 06/23/2021] [Indexed: 01/15/2023]
Abstract
In the midst of an escalating U.S. opioid crisis, the immediate focus of public health interventions is on fatal overdose prevention. Few studies, however, have sought to examine the long-term health consequences of exposure to repeated nonfatal opioid overdose. We reviewed recent literature to examine three corresponding downstream health outcomes of repeated overdose: a) neurodegenerative processes; b) cognition and memory; and c) overdose risk behaviours. We found a remarkable congruency among available biochemical and cognitive data on how nonfatal overdose precipitates various pathological feedforward and feedback loops that affect people who use opioids for years to come. We found however that downstream behavioural implications of neurodegenerative and cognitive sequelae are less studied despite being most proximal to an overdose. Findings point to a vicious cycle of nonfatal overdose leading to neurodegeneration - closely resembling Alzheimer Disease - that results in cognitive decline that in turn leads to potentially reduced adherence to safe drug use behaviours. The collected evidence not only brings into the focus the long-term health consequences of nonfatal overdose from the perspectives of biology, neuroscience, and public health, but also creates new cross-disciplinary context and awareness in the research and public health community that should benefit people at risk.
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Affiliation(s)
| | - Janna Ataiants
- Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
| | - Benjamin Cocchiaro
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffry B Stock
- Department of Molecular Biology, Princeton University, Princeton, NJ 08544, USA
| | - Stephen E Lankenau
- Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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Singh A, Rao R, Chatterjee B, Mishra AK, Kaloiya G, Ambekar A. Cognitive functioning in patients maintained on buprenorphine at peak and trough buprenorphine levels: An experimental study. Asian J Psychiatr 2021; 61:102697. [PMID: 34030027 DOI: 10.1016/j.ajp.2021.102697] [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: 01/20/2021] [Revised: 02/28/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the cognitive functions in participants maintained on buprenorphine for opioid dependence at peak and trough buprenorphine levels. METHODS This was a double-blind, randomized, experimental study. Sixty participants maintained on buprenorphine were matched for age and education and randomly allocated to "peak" group or "trough" group. The "peak" group received buprenorphine two hours before assessment, whereas the trough group received placebo. The cognitive domains of attention, learning and memory, and executive function including fluency, working memory, response inhibition and set shifting were tested. RESULTS The two groups were comparable on socio-demographic, substance use profile and opioid agonist treatment-related characteristics. Significant differences in performance of peak and trough group were observed on Wisconsin Card Sorting Test parameters of number of correct responses (U = 289.00, p = 0.03), number of errors (t = 02.26, df = 58, p = 0.03), and perseverative errors (U = 301.50, p = 0.04). CONCLUSIONS The time since buprenorphine dose has significant relation on specific cognitive tasks in patients maintained on buprenorphine for opioid dependence.
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Affiliation(s)
- Amit Singh
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ravindra Rao
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Biswadip Chatterjee
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ashwani Kumar Mishra
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Gaurishanker Kaloiya
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
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8
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Wong JS, Nikoo M, Kianpoor K, Gholami A, Jazani M, Mohammadian F, Lafooraki NY, Jang KL, Schütz CG, Akhondzadeh S, Krausz MR. The effects of opium tincture and methadone on the cognitive function of patients with opioid use disorder. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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9
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Zhang P, Cui J, Mansooridara S, Kalantari AS, Zangeneh A, Zangeneh MM, Sadeghian N, Taslimi P, Bayat R, Şen F. Suppressor capacity of copper nanoparticles biosynthesized using Crocus sativus L. leaf aqueous extract on methadone-induced cell death in adrenal phaeochromocytoma (PC12) cell line. Sci Rep 2020; 10:11631. [PMID: 32669563 PMCID: PMC7363853 DOI: 10.1038/s41598-020-68142-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/18/2020] [Indexed: 12/29/2022] Open
Abstract
In this research, we prepared and formulated a neuroprotective supplement (copper nanoparticles in aqueous medium utilizing Crocus sativus L. Leaf aqueous extract) for determining its potential against methadone-induced cell death in PC12. The results of chemical characterization tests i.e., FE-SEM, FT-IR, XRD, EDX, TEM, and UV–Vis spectroscopy revealed that the study showed that copper nanoparticles were synthesized in the perfect way possible. In the TEM and FE-SEM images, the copper nanoparticles were in the mean size of 27.5 nm with the spherical shape. In the biological part of the present research, the Rat inflammatory cytokine assay kit was used to measure the concentrations of inflammatory cytokines. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) test was used to show DNA fragmentation and apoptosis. Caspase-3 activity was assessed by the caspase activity colorimetric assay kit and mitochondrial membrane potential was studied by Rhodamine123 fluorescence dye. Also, the cell viability of PC12 was measured by trypan blue assay. Copper nanoparticles-treated cell cutlers significantly (p ≤ 0.01) decreased the inflammatory cytokines concentrations, caspase-3 activity, and DNA fragmentation and they raised the cell viability and mitochondrial membrane potential in the high concentration of methadone-treated PC12 cells. The best result of neuroprotective properties was seen in the high dose of copper nanoparticles i.e., 4 µg. According to the above results, copper nanoparticles containing C. sativus leaf aqueous extract can be used in peripheral nervous system treatment as a neuroprotective promoter and central nervous system after approving in the clinical trial studies in humans.
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Affiliation(s)
- Peng Zhang
- Department of Neurosurgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Medical College of Henan University, Zhengzhou, 450003, Henan, China
| | - Jian Cui
- Department of Neurosurgery, Xi'an No. 1 Hospital, No. 30 South Street Powder Lane, Beilin District, Xi'an, 710002, Shaanxi, China.
| | - Shirin Mansooridara
- Medical Sciences Research Center, Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Atoosa Shahriyari Kalantari
- Department of Neurology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Akram Zangeneh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran.,Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Mahdi Zangeneh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran.,Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Nastaran Sadeghian
- Department of Chemistry, Faculty of Science, Atatürk University, 25240, Erzurum, Turkey
| | - Parham Taslimi
- Department of Biotechnology, Faculty of Science, Bartin University, 74100, Bartin, Turkey
| | - Ramazan Bayat
- Sen Research Group, Department of Biochemistry, University of Dumlupınar, 43000, Kütahya, Turkey
| | - Fatih Şen
- Sen Research Group, Department of Biochemistry, University of Dumlupınar, 43000, Kütahya, Turkey
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10
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Sanborn V, Gunstad J, Shrestha R, Mistler CB, Copenhaver MM. Cognitive profiles in persons with opioid use disorder enrolled in methadone treatment. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:462-468. [PMID: 32463730 DOI: 10.1080/23279095.2020.1769099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cognitive impairment is common in persons with opioid use disorder and associated with poor treatment outcomes, including elevated risk for relapse. Much less is known about the underlying structure of these deficits and the possible presence of cognitive phenotypes. A total of 177 adults (average 42.2 years of age, 52.0% male, 65.5% Caucasian) enrolled in a methadone maintenance treatment program completed the NIH Toolbox as part of a larger project. Cluster analyses revealed a 2-cluster solution-persons with intact cognitive function in all domains (n = 93; Intact) and those with impairments on tests of attention and executive function (n = 83; Impaired). Follow-up analyses revealed that the Impaired group was slightly older, more likely to self-identify as a racial/ethnic minority, and less likely to report consuming alcohol four or more times per week. These findings suggest the existence of distinct cognitive profiles in persons with opioid use disorder and encourage further examination, particularly studies to examine the possible benefits of routine screening for cognitive impairment as part of substance use treatment.
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Affiliation(s)
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH, USA
| | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.,Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Colleen B Mistler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael M Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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11
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Ahmeda A, Zangeneh MM, Mansooridara S, Malek Z, Zangeneh A. Suppressor capacity of iron nanoparticles biosynthesized using
Salvia chloroleuca
leaf aqueous extract on methadone‐induced cell death in PC12: Formulation a new drug from relationship between the nanobiotechnology and neurology sciences. Appl Organomet Chem 2020. [DOI: 10.1002/aoc.5355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ahmad Ahmeda
- College of MedicineQU Health, Qatar University Doha Qatar
| | - Mohammad Mahdi Zangeneh
- Department of Clinical Sciences, Faculty of Veterinary MedicineRazi University Kermanshah Iran
- Biotechnology and Medicinal Plants Research CenterIlam University of Medical Sciences Ilam Iran
| | - Shirin Mansooridara
- Medical Sciences Research Center, Faculty of Medicine, Tehran Medical Sciences BranchIslamic Azad University Tehran Iran
| | - Zahra Malek
- Medical Sciences Research Center, Faculty of Medicine, Tehran Medical Sciences BranchIslamic Azad University Tehran Iran
| | - Akram Zangeneh
- Department of Clinical Sciences, Faculty of Veterinary MedicineRazi University Kermanshah Iran
- Biotechnology and Medicinal Plants Research CenterIlam University of Medical Sciences Ilam Iran
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12
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Carroll KM, Nich C, DeVito EE, Shi JM, Sofuoglu M. Galantamine and Computerized Cognitive Behavioral Therapy for Cocaine Dependence: A Randomized Clinical Trial. J Clin Psychiatry 2019; 79:17m11669. [PMID: 29286595 PMCID: PMC5866530 DOI: 10.4088/jcp.17m11669] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine whether galantamine, a cognitive-enhancing medication that is both acetylcholinesterase inhibitor and agonist at nicotinic acetylcholine receptors, is effective at improving cocaine use outcomes and cognitive functioning, alone and in combination with computerized cognitive behavioral therapy (CBT). METHOD A 12-week, randomized 2 × 2, factorial trial was conducted to evaluate galantamine versus placebo (double-blind) and computerized CBT plus standard methadone treatment versus standard methadone treatment alone in a community-based methadone maintenance program (September 2009-April 2015). One hundred twenty individuals diagnosed with DSM-IV cocaine use disorder were randomly assigned to the following conditions: (1) galantamine (8 mg/d) plus standard methadone maintenance treatment (treatment as usual [TAU]), (2) placebo plus TAU, (3) galantamine plus computerized CBT plus TAU, or (4) placebo plus computerized CBT plus TAU; medication administration was supervised at the time of daily methadone dosing. The primary cocaine use outcome was change in percent days of abstinence over time. Number of cocaine-negative urine toxicology screens submitted and cognitive function were secondary outcomes. RESULTS Random effect regression analysis indicated significant reductions in frequency of cocaine use over time, with significant treatment-by-time effects for both galantamine over placebo (F = 5.3, P = .02, d = 0.34) and computerized CBT over standard methadone treatment (F = 4.2, P = .04, d = 0.30) but no evidence of significant benefit of the combination over either treatment alone. Pretreatment to posttreatment comparisons of multiple indices of cognitive functioning, including sustained attention, indicated no benefit of galantamine over placebo. CONCLUSIONS Findings suggest benefits of galantamine and computerized CBT for reducing cocaine use in this sample. Although galantamine did not improve measures of cognitive function in this sample, multiple measures of cognitive function were associated with cocaine use outcomes, underlining the significance of cognitive function in cocaine treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00809835.
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Affiliation(s)
- Kathleen M Carroll
- Yale University School of Medicine, 40 Temple St, Ste 6C, New Haven, CT 06510.
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Julia M Shi
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- APT Foundation, New Haven, Connecticut, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
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13
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Elkana O, Adelson M, Doniger GM, Sason A, Peles E. Cognitive function is largely intact in methadone maintenance treatment patients. World J Biol Psychiatry 2019; 20:219-229. [PMID: 28610451 DOI: 10.1080/15622975.2017.1342047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To confirm our previous findings of less cognitive impairments (based on cognitive screening tools) among methadone maintenance treatment (MMT) patients who achieved take-home dose (THD) privileges. METHODS a random sample of 65 Israeli MMT patients were studied using computerised, age and education standardised, cognitive domains (attention, executive function, memory, motor skills), and non-computerised phonetic and semantic verbal fluency. RESULTS Cognitive scores were within ±1 standard deviation (SD) of average for most domains, including non-verbal IQ, attention and motor skills. Verbal fluency and memory were >1 SD below average (mean = 84; z = -1.1 for both). Females were younger than the males and had poorer motor skills (P = 0.005) but better verbal memory (P < 0.0005). Opiate usage duration correlated with reaction time (P = 0.05) and inversely with verbal memory (P = 0.01). Overall cognitive function was poorest among 25 (38.5%) current drug users, and 6 (9.2%) lifetime schizophrenia patients. Cognitive domains were comparable between THD privileges subgroups. CONCLUSIONS Despite heterogeneity in MMT duration, abuse duration, substance use and psychiatric comorbidity, all performed within ±1 SD of average for age and education in most cognitive domains. Our findings challenge the notion of MMT as being synonymous with compromised cognition and may lead to reduced bias regarding cognitive function of MMT patients.
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Affiliation(s)
- Odelia Elkana
- a Behavioral Sciences , Academic College of Tel Aviv-Yaffo , Tel Aviv , Israel
| | - Miriam Adelson
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Glen M Doniger
- c Department of Clinical Research , NeuroTrax Corporation , Modiin , Israel.,d Sagol Neuroscience Center & Center of Advanced Technologies in Rehabilitation , Sheba Medical Center , Ramat-Gan , Israel
| | - Anat Sason
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Einat Peles
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,e Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,f Sagol School of Neuroscience , Tel Aviv University , Tel Aviv , Israel
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Ključević Ž, Benzon B, Ključević N, Veršić Bratinčević M, Sutlović D. Liver damage indices as a tool for modifying methadone maintenance treatment: a cross-sectional study. Croat Med J 2019. [PMID: 30610772 PMCID: PMC6330771 DOI: 10.3325/cmj.2018.59.298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim To assess the effect of liver damage on methadone metabolism in opiate addicts undergoing methadone maintenance treatment (MMT). Methods This cross-sectional study recruited 74 patients treated at the outpatient clinic of Public Health Institute of Split-Dalmatia County from 2013-2016. Concentrations of methadone and its main inactive metabolite were measured in participants’ biological samples on regular check-ups. Urine samples obtained before oral methadone intake, and blood and urine samples obtained 90 minutes after methadone intake were analyzed using gas chromatography/mass spectrometry. Participants were divided into groups according to liver damage criteria: hepatitis C virus status (positive, negative, or clinical remission); aspartate aminotransferase to platelet ratio (APRI) index (<0.7 and ≥0.7); and fibrosis-4 score (<1.45, 1.45-3.25, >3.25). Results Metabolic ratio and methadone metabolite concentration in plasma decreased linearly with HCV infection status by the factor of 1.67 (P = 0.001) and 2.2 (P = 0.043), respectively. Metabolic ratio in plasma decreased in patients with APRI index ≥0.7 by the average factor of 2.12 (P = 0.01) and methadone metabolite concentration in plasma decreased by the factor of 6.16 (P = 0.009). Metabolic ratio in urine decreased with the severity of fibrosis-4 score by the average factor of 1.63 (P = 0.008), whereas methadone metabolite concentration decreased by the factor of 3.53 (P = 0.007). Conclusion Liver damage decreases methadone metabolism. Indices of liver function should be calculated regularly during MMT for methadone dose titration.
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Affiliation(s)
- Željko Ključević
- Željko Ključević, Public Health Institute of Split-Dalmatia County, Vukovarska 46, 21 000 Split, Croatia,
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Weiss O, Levy-Gigi E, Adelson M, Peles E. Methadone maintenance treatment patients with a history of childhood trauma succeed more in a cognitive paradigm that is associated with a negative reward. Psychiatry Res 2019; 271:381-388. [PMID: 30529875 DOI: 10.1016/j.psychres.2018.11.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/11/2018] [Accepted: 11/25/2018] [Indexed: 01/23/2023]
Abstract
Previously we showed that methadone maintenance treatment (MMT) patients displayed difficulties in generalization and reversal learning in the presence of drug-related context, compared to prolonged abstinence individuals. We now tested how history of childhood trauma, affects their reversal learning abilities. Fifty-one MMT patients were evaluated on a performance- based paradigm which assesses the ability to acquire and reverse stimulus-outcome associations in neutral and drug-related context. Patients with a history of childhood trauma (n = 32) as compared to patients without such a history showed decreased ability to learn associations with positive outcome, and had poorer performance in drug compare to neutral-related context. Most importantly, while individuals with childhood trauma history showed higher success rates in conditions of positive to negative reversals, an opposite pattern was observed in conditions of negative to positive reversal; whereas patients with trauma history preformed significantly worse than patients with no history. The results are in line with other studies which tested the effects of childhood trauma both in clinical and in healthy populations. Recognizing this trait that more disturbed by drug related context, may contribute to develop and improve personalized treatments which takes into account the difficulties as well as the strength associated with childhood trauma.
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Affiliation(s)
- Ori Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Levy-Gigi
- School of Education and Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Peles
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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16
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Butler K, Le Foll B. Impact of Substance Use Disorder Pharmacotherapy on Executive Function: A Narrative Review. Front Psychiatry 2019; 10:98. [PMID: 30881320 PMCID: PMC6405638 DOI: 10.3389/fpsyt.2019.00098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Substance use disorders are chronic, relapsing, and harmful conditions characterized by executive dysfunction. While there are currently no approved pharmacotherapy options for stimulant and cannabis use disorders, there are several evidence-based options available to help reduce symptoms during detoxification and aid long-term cessation for those with tobacco, alcohol and opioid use disorders. While these medication options have shown clinical efficacy, less is known regarding their potential to enhance executive function. This narrative review aims to provide a brief overview of research that has investigated whether commonly used pharmacotherapies for these substance use disorders (nicotine, bupropion, varenicline, disulfiram, acamprosate, nalmefene, naltrexone, methadone, buprenorphine, and lofexidine) effect three core executive function components (working memory, inhibitory control and cognitive flexibility). While pharmacotherapy-induced enhancement of executive function may improve cessation outcomes in dependent populations, there are limited and inconsistent findings regarding the effects of these medications on executive function. We discuss possible reasons for the mixed findings and suggest some future avenues of work that may enhance the understanding of addiction pharmacotherapy and cognitive training interventions and lead to improved patient outcomes.
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Affiliation(s)
- Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Alcohol Research and Treatment Clinic, Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Jensen KP, DeVito EE, Yip S, Carroll KM, Sofuoglu M. The Cholinergic System as a Treatment Target for Opioid Use Disorder. CNS Drugs 2018; 32:981-996. [PMID: 30259415 PMCID: PMC6314885 DOI: 10.1007/s40263-018-0572-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Opioid overdoses recently became the leading cause of accidental death in the US, marking an increase in the severity of the opioid use disorder (OUD) epidemic that is impacting global health. Current treatment protocols for OUD are limited to opioid medications, including methadone, buprenorphine, and naltrexone. While these medications are effective in many cases, new treatments are required to more effectively address the rising societal and interpersonal costs associated with OUD. In this article, we review the opioid and cholinergic systems, and examine the potential of acetylcholine (ACh) as a treatment target for OUD. The cholinergic system includes enzymes that synthesize and degrade ACh and receptors that mediate the effects of ACh. ACh is involved in many central nervous system functions that are critical to the development and maintenance of OUD, such as reward and cognition. Medications that target the cholinergic system have been approved for the treatment of Alzheimer's disease, tobacco use disorder, and nausea. Clinical and preclinical studies suggest that medications such as cholinesterase inhibitors and scopolamine, which target components of the cholinergic system, show promise for the treatment of OUD and further investigations are warranted.
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Affiliation(s)
- Kevin P Jensen
- Department of Psychiatry and VA Connecticut Healthcare System, Yale University, School of Medicine, 950 Campbell Ave, Bldg 36/116A4, West Haven, CT, 06516, USA
| | - Elise E DeVito
- Department of Psychiatry and VA Connecticut Healthcare System, Yale University, School of Medicine, 950 Campbell Ave, Bldg 36/116A4, West Haven, CT, 06516, USA
| | - Sarah Yip
- Department of Psychiatry and VA Connecticut Healthcare System, Yale University, School of Medicine, 950 Campbell Ave, Bldg 36/116A4, West Haven, CT, 06516, USA
| | - Kathleen M Carroll
- Department of Psychiatry and VA Connecticut Healthcare System, Yale University, School of Medicine, 950 Campbell Ave, Bldg 36/116A4, West Haven, CT, 06516, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry and VA Connecticut Healthcare System, Yale University, School of Medicine, 950 Campbell Ave, Bldg 36/116A4, West Haven, CT, 06516, USA.
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Marco CA, Mann D, Rasp J, Ballester M, Perkins O, Holbrook MB, Rako K. Effects of opioid medications on cognitive skills among Emergency Department patients. Am J Emerg Med 2018; 36:1009-1013. [DOI: 10.1016/j.ajem.2017.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022] Open
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Pujol CN, Paasche C, Laprevote V, Trojak B, Vidailhet P, Bacon E, Lalanne L. Cognitive effects of labeled addictolytic medications. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:306-332. [PMID: 28919445 DOI: 10.1016/j.pnpbp.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Alcohol, tobacco, and illegal drug usage is pervasive throughout the world, and abuse of these substances is a major contributor to the global disease burden. Many pharmacotherapies have been developed over the last 50years to target addictive disorders. While the efficacy of these pharmacotherapies is largely recognized, their cognitive impact is less known. However, all substance abuse disorders are known to promote cognitive disorders like executive dysfunction and memory impairment. These impairments are critical for the maintenance of addictive behaviors and impede cognitive behavioral therapies that are regularly administered in association with pharmacotherapies. It is also unknown if addictolytic medications have an impact on preexisting cognitive disorders, and if this impact is modulated by the indication of prescription, i.e. abstinence, reduction or substitution, or by the specific action of the medication. METHOD We reviewed the cognitive effects of labeled medications for tobacco addiction (varenicline, bupropion, nicotine patch and nicotine gums), alcohol addiction (naltrexone, nalmefene, baclofen, disulfiram, sodium oxybate, acamprosate), and opioid addiction (methadone, buprenorphine) in human studies. Studies were selected following MOOSE guidelines for systematic reviews of observational studies, using the keywords [Cognition] and [Cognitive disorders] and [treatment] for each medication. RESULTS 971 articles were screened and 77 studies met the inclusion criteria and were reported in this review (for alcohol abuse, n=21, for tobacco n=22, for opioid n=34. However, very few comparative clinical trials have explored the chronic effects of addictolytic medications on cognition in addictive behaviors, and there are no clinical trials on the cognitive impact of nalmefene in patients suffering from alcohol use disorders. DISCUSSION Although some medications seem to enhance cognition in patients suffering from cognitive disorders, others could promote cognitive impairments, and our work highlights a lack of literature on this subject. In conclusion, more comparative clinical trials are needed to better understand the cognitive impact of addictolytic medications.
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Affiliation(s)
- Camille Noélie Pujol
- Department of Neurosciences, Institute for Functional Genomics, INSERM U-661, CNRS UMR-5203, 34094 Montpellier, France
| | - Cecilia Paasche
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France
| | - Vincent Laprevote
- Centre Psychothérapique de Nancy, Laxou, F-54520, France.; EA 7298, INGRES, Université de Lorraine, Vandoeuvre-lès-, Nancy F-54000, France; CHU Nancy, Maison des Addictions, Nancy, F-54000, France.
| | - Benoit Trojak
- Department of Psychiatry and Addictology, University Hospital of Dijon, France; EA 4452, LPPM, University of Burgundy, France.
| | - Pierre Vidailhet
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France; Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France..
| | - Elisabeth Bacon
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France.
| | - Laurence Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France; Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France..
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Ekhtiari H, Rezapour T, Aupperle RL, Paulus MP. Neuroscience-informed psychoeducation for addiction medicine: A neurocognitive perspective. PROGRESS IN BRAIN RESEARCH 2017; 235:239-264. [PMID: 29054291 PMCID: PMC5771228 DOI: 10.1016/bs.pbr.2017.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psychoeducation (PE) is defined as an intervention with systematic, structured, and didactic knowledge transfer for an illness and its treatment, integrating emotional and motivational aspects to enable patients to cope with the illness and to improve its treatment adherence and efficacy. PE is considered an important component of treatment in both medical and psychiatric disorders, especially for mental health disorders associated with lack of insight, such as alcohol and substance use disorders (ASUDs). New advancements in neuroscience have shed light on how various aspects of ASUDs may relate to neural processes. However, the actual impact of neuroscience in the real-life clinical practice of addiction medicine is minimal. In this chapter, we provide a perspective on how PE in addiction medicine can be informed by neuroscience in two dimensions: content (knowledge we transfer in PE) and structure (methods we use to deliver PE). The content of conventional PE targets knowledge about etiology of illness, treatment process, adverse effects of prescribed medications, coping strategies, family education, and life skill training. Adding neuroscience evidence to the content of PE could be helpful in communicating not only the impact of drug use but also the beneficial impact of various treatments (i.e., on brain function), thus enhancing motivation for compliance and further destigmatizing their symptoms. PE can also be optimized in its "structure" by implicitly and explicitly engaging different neurocognitive processes, including salience/attention, memory, and self-awareness. There are many interactions between these two dimensions, structure and content, in the delivery of neuroscience-informed psychoeducation (NIPE). We explore these interactions in the development of a cartoon-based NIPE to promote brain recovery during addiction treatment as a part of the brain awareness for addiction recovery initiative.
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Affiliation(s)
- Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, United States; Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
| | - Tara Rezapour
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran; Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States; School of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States
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Methadone maintenance patients show a selective deficit to reverse positive outcomes in drug-related conditions compared to medication free prolonged opiate abstinence. Drug Alcohol Depend 2014; 144:111-8. [PMID: 25220895 DOI: 10.1016/j.drugalcdep.2014.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/23/2014] [Accepted: 08/24/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Drug addiction is a chronic relapsing disease. Most users will relapse back to using drugs over and over again throughout their life. These relapses may become more frequent in the presence of contextual reminders. We aimed to examine associations between the ability to maintain a medication-free life-style and the capability to learn and reverse positive and negative stimulus-outcome associations in the presence of neutral and drug-related contextual reminders. METHODS We conducted a highly unique comparison of former opiate-dependent individuals who are either medication free or methadone maintenance patients for the last ten years. Groups were matched for age, gender and education. Participants were tested on a novel partial reversal paradigm, which tests the ability to acquire and reverse stimulus-outcome associations in neutral and drug-related context. RESULTS Both groups were equally able to acquire and reverse positive and negative outcomes in conditions of neutral context. However, methadone maintenance patients showed a selective deficit in reversing the outcomes of positive stimulus in drug-related context. Hence, after learning a positive stimulus-outcome association in one drug-related context, methadone maintenance patients struggled to learn that the same stimulus predicts negative outcome when presented later in a different drug-related context. CONCLUSIONS Methadone maintenance patients demonstrate a selective difficulty to learn negative outcomes when exposed to a drug, but not neutral, related environment. The results may reflect the core mechanisms of addiction and provide a possible explanation for the inability of methadone maintenance patients to illicit drug abuse without the need of agonist treatment.
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