1
|
Van de Cruys S, Bervoets J, Gadsby S, Gijbels D, Poels K. Insight in the Conspiracist's Mind. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2024; 28:302-324. [PMID: 37776304 DOI: 10.1177/10888683231203145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Academic AbstractThe motto of the conspiracist, "Do your own research," may seem ludicrous to scientists. Indeed, it is often dismissed as a mere rhetorical device that conspiracists use to give themselves the semblance of science. In this perspective paper, we explore the information-seeking activities ("research") that conspiracists do engage in. Drawing on the experimental psychology of aha experiences, we explain how these activities, as well as the epistemic experiences that precede (curiosity) or follow (insight or "aha" experiences) them, may play a crucial role in the appeal and development of conspiracy beliefs. Aha moments have properties that can be exploited by conspiracy theories, such as the potential for false but seemingly grounded conclusions. Finally, we hypothesize that the need for autonomous epistemic agency and discovery is universal but increases as people experience more uncertainty and/or feel epistemically excluded in society, hence linking it to existing literature on explaining conspiracy theories.
Collapse
|
2
|
Maurage P, Boudehent C, Ferrié L, Cabé N, Pitel AL. Are we just talking in circles? Impact of psychoeducation on disease knowledge and relapse in severe alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 38811340 DOI: 10.1111/acer.15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Psychoeducation constitutes a routine therapeutic practice in most treatment settings for severe alcohol use disorder (sAUD). This technique is considered an efficient way to help patients to learn more about their disease and achieve therapeutic objectives. However, this approach capitalizes on three untested assumptions: namely, that (1) patients with sAUD possess insufficient knowledge about sAUD at treatment entry; (2) patients with sAUD have the cognitive resources to learn new information and benefit from psychoeducation; and (3) psychoeducation positively impacts clinical outcomes. METHODS We tested these assumptions in two experimental studies. In the first experiment in 66 recently detoxified patients with sAUD and 102 matched healthy controls, we measured baseline knowledge on sAUD through self-reported questionnaires, determined whether an up-to-date psychoeducation program can improve this knowledge, explored the role of cognitive abilities in such learning, and established the impact of psychoeducation on relapse rates. In a second experiment in 23 patients and 17 healthy controls, we examined whether the increased knowledge following psychoeducation is alcohol specific, and whether the motivation to change influences the relation between psychoeducation and clinical outcomes. RESULTS At treatment entry, patients with sAUD presented with more sAUD-related knowledge than healthy controls, and were able to increase this knowledge following psychoeducation, independently of their cognitive status. However, psychoeducation did not impact either the motivation to change or relapse rates. CONCLUSIONS Psychoeducation can increase patients' knowledge about sAUD, but it does not increase the likelihood of abstinence or controlled low consumption after discharge. Thus, clinicians should question whether psychoeducation should occupy a central position in the therapeutic programs and reconsider what can be expected from psychoeducation in terms of achieving therapeutic objectives.
Collapse
Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Céline Boudehent
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
- UNICAEN, INSERM, U1237, PhIND « Physiopathology and Imaging of Neurological Disorders », Neuropresage Team, Cyceron, Normandie Univ, Caen, France
| | - Louise Ferrié
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Nicolas Cabé
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
- UNICAEN, INSERM, U1237, PhIND « Physiopathology and Imaging of Neurological Disorders », Neuropresage Team, Cyceron, Normandie Univ, Caen, France
| | - Anne-Lise Pitel
- UNICAEN, INSERM, U1237, PhIND « Physiopathology and Imaging of Neurological Disorders », Neuropresage Team, Cyceron, Normandie Univ, Caen, France
| |
Collapse
|
3
|
Loreto BBL, Sordi AO, de Castro MN, Ornell F, Guarnieri EP, Roza TH, Schuch JB, Cima MDS, Pechansky F, Grevet EH, Grassi-Oliveira R, von Diemen L, Kessler FHP. Proposing an integrative, dynamic and transdiagnostic model for addictions: dysregulation phenomena of the three main modes of the predostatic mind. Front Psychiatry 2024; 14:1298002. [PMID: 38274436 PMCID: PMC10808830 DOI: 10.3389/fpsyt.2023.1298002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Several theories have been proposed to explain the complex diagnostic aspects related to addiction disorders and their development. Recent frameworks tend to focus on dimensional perspectives of symptoms rather than categorical systems, since substance use disorders are frequently comorbid with other psychiatric and especially personality disorders. However, useful transdiagnostic models that could integrate clinical evaluation derived from neuroscientific theories are lacking. In the present manuscript, the authors propose a model based on a new paradigm, in an attempt to better explain this complex, multifaceted phenomenon. The new paradigm presupposes that emotions and behavior are a response to risk prediction. Individuals make choices and engage in actions to manage potential risks/rewards in order to seek or maintain homeostasis in their internal and external environments - a mechanism that the authors call predostatic (predictive mechanism with homeostatic purpose). The model considers three main modes of the predostatic mind: (1) Alarm Mode, activated by high and/or imminent risk prediction; (2) Seek Mode, activated by long-term risk or reward prediction; and (3) Balance Mode, a self-regulating state of mind related to low risk prediction, a soothing system and a calm state. Addiction is seen as a chronic dysregulation of organism systems leading to internalizing or externalizing phenomena mainly related to the Seek and Alarm Modes, which are persistently activated by reward and risk prediction, respectively, thus hindering Balance. Addiction neuroscience research has shown that chronic drug use or engagement in addictive behaviors can lead to neuroadaptations in the brain reward circuitry, disrupting normal balance and the regulation of reward processes. This dysregulation can contribute to persistent drug-seeking/addictive behaviors despite negative consequences. This newly proposed dynamic and integrative model, named dysregulation based on externalizing and internalizing phenomena of the three main modes of the predostatic mind (DREXI3), proposes six dysregulation dimensions with basic emotional and behavioral symptoms, such as neurophysiological alterations, impulsivity, compulsion, cognitive impairment/psychosis, mood, and anxiety/anger. In this paper, the authors explain the rationale behind DREXI3 and present some hypothetical clinical examples to better illustrate the use of the model in clinical practice. The development of this innovative model could possibly guide tailored treatment interventions in the addiction field.
Collapse
Affiliation(s)
- Bibiana Bolten Lucion Loreto
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Anne Orgler Sordi
- Addiction and Forensic Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Melina Nogueira de Castro
- Addiction and Forensic Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Felipe Ornell
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eduardo Pegoraro Guarnieri
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jaqueline Bohrer Schuch
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marcos da Silveira Cima
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Flavio Pechansky
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eugênio Horácio Grevet
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Department of Clinical Medicine, Translational Neuropsychiatry Unit, Aarhus University, Aarhus, Denmark
| | - Lisia von Diemen
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Felix Henrique Paim Kessler
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| |
Collapse
|
4
|
Muela I, Navas JF, Barrada JR, López-Guerrero J, Rivero FJ, Brevers D, Perales JC. Operationalization and measurement of compulsivity across video gaming and gambling behavioral domains. BMC Psychol 2023; 11:407. [PMID: 37990335 PMCID: PMC10664636 DOI: 10.1186/s40359-023-01439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Compulsivity is the hallmark of addiction progression and, as a construct, has played an important role in unveiling the etiological pathways from learning mechanisms underlying addictive behavior to harms resulting from it. However, a sound use of the compulsivity construct in the field of behavioral addictions has been hindered to date by the lack of consensus regarding its definition and measurement. Here we capitalize on a previous systematic review and expert appraisal to develop a compulsivity scale for candidate behavioral addictions (the Granada Assessment for Cross-domain Compulsivity, GRACC). METHODS The initial scale (GRACC90) consisted of 90 items comprising previously proposed operationalizations of compulsivity, and was validated in two panel samples of individuals regularly engaging in gambling and video gaming, using exploratory structural equation modeling (ESEM) and convergence analyses. RESULTS The GRACC90 scale is unidimensional and structurally invariant across samples, and predicted severity of symptoms, lower quality of life, and negative affect, to similar degrees in the two samples. Additionally, poorer quality of life and negative affect were comparably predicted by compulsivity and by severity of symptoms. A shorter version of the scale (GRACC18) is proposed, based on selecting the 18 items with highest factor loadings. CONCLUSIONS Results support the proposal that core symptoms of behavioral addictions strongly overlap with compulsivity, and peripheral symptoms are not essential for their conceptualization. Further research should clarify the etiology of compulsive behavior, and whether pathways to compulsivity in behavioral addictions could be common or different across domains.
Collapse
Affiliation(s)
- Ismael Muela
- Department of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071, Campus de Cartuja s/n, Granada, Spain.
| | - Juan F Navas
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - Juan R Barrada
- Department of Psychology and Sociology, Faculty of Education, Universidad de Zaragoza, Zaragoza, Spain
| | - José López-Guerrero
- Department of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071, Campus de Cartuja s/n, Granada, Spain
| | - Francisco J Rivero
- Department of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071, Campus de Cartuja s/n, Granada, Spain
| | - Damien Brevers
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (IPSY), UCLouvain, Louvain-La-Neuve, Belgium
| | - José C Perales
- Department of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071, Campus de Cartuja s/n, Granada, Spain
| |
Collapse
|
5
|
Engineered highs: Reward variability and frequency as potential prerequisites of behavioural addiction. Addict Behav 2023; 140:107626. [PMID: 36701907 DOI: 10.1016/j.addbeh.2023.107626] [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: 09/23/2022] [Revised: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Influential learning-based accounts of substance addictions posit the attribution of incentive salience to drug-associated cues, and its escalation by the direct dopaminergic effects of drugs. In translating this account to disordered gambling, we have noted how the intermittent nature of monetary rewards in gambling (i.e. the variable ratio) may allow for analogous learning processes, via effects on dopaminergic signalling. The aim of the present article is to consider how multiple sources of reward variability operate within modern gambling products, and how similar sources of variability, as well as some novel sources of variability, also apply to other digital products implicated in behavioural addictions, including gaming, shopping, social media and online pornography. Online access to these activities facilitates not only unparalleled accessibility but also introduces novel forms of reward variability, as seen in the effects of infinite scrolls and personalized recommendations. We use the term uncertainty to refer to the subjective experience of reward variability. We further highlight two psychological factors that appear to moderate the effects of uncertainty: 1) the timecourse of uncertainty, especially with regard to its resolution, 2) the frequency of exposure, allowing temporal compression. Collectively, the evidence illustrates how qualitative and quantitative variability of reward can confer addictive potential to non-drug reinforcers by exploiting the psychological and neural processes that rely on predictability to guide reward seeking behaviour.
Collapse
|
6
|
Yang L, Du Y, Yang W, Liu J. Machine learning with neuroimaging biomarkers: Application in the diagnosis and prediction of drug addiction. Addict Biol 2023; 28:e13267. [PMID: 36692873 DOI: 10.1111/adb.13267] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/19/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023]
Abstract
Drug abuse is a serious problem worldwide. Owing to intermittent intake of certain substances and the early inconspicuous clinical symptoms, this brings huge challenges for timely diagnosing addiction status and preventing substance use disorders (SUDs). As a non-invasive technique, neuroimaging can capture neurobiological signatures of abnormality in multiple brain regions caused by drug consumption in each clinical stage, like parenchymal morphology alteration as well as aberrant functional activity and connectivity of cerebral areas, making it realizable to diagnosis, prediction and even preemptive therapy of addiction. Machine learning (ML) algorithms primarily used for classification have been extensively applied in analysing medical imaging datasets. Significant neurobiological characteristics employed and revealed by classifiers were used to diagnose addictive states and predict initiation and vulnerability to drug usage, treatment abstinence, relapse and resilience of addicts and the risk of SUD. In this review, we summarize application of ML methods in neuroimaging focusing on addicts' diagnosis of clinical status and risk prediction and elucidate the discriminative neurobiological features from brain electrophysiological, morphological and functional perspectives that contribute most to the classifier, finally highlighting the auxiliary role of ML in addiction treatment.
Collapse
Affiliation(s)
- Longtao Yang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanyao Du
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenhan Yang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China.,Department of Radiology Quality Control Center in Hunan Province, Changsha, China
| |
Collapse
|
7
|
Lin HM, Chang YT, Chen MH, Liu ST, Chen BS, Li L, Lee CY, Sue YR, Sung TM, Sun CK, Yeh PY. Structural and Functional Neural Correlates in Individuals with Excessive Smartphone Use: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16277. [PMID: 36498362 PMCID: PMC9739413 DOI: 10.3390/ijerph192316277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Background: Despite known association of internet addiction with a reduced brain volume and abnormal connectivity, the impact of excessive smartphone use remains unclear. Methods: PubMed, Embase, ClinicalTrial.gov, and Web of Science databases were systematically searched from inception to July 2022 using appropriate keywords for observational studies comparing differences in brain volumes and activations between excessive smartphone users and individuals with regular use by magnetic resonance imaging. Results: Of the 11 eligible studies retrieved from 6993 articles initially screened, seven and six evaluated brain volumes and activations, respectively. The former enrolled 421 participants (165 excessive smartphone users vs. 256 controls), while the latter recruited 276 subjects with 139 excessive smartphone users. The results demonstrated a smaller brain volume in excessive smartphone users compared to the controls (g = −0.55, p < 0.001), especially in subcortical regions (p < 0.001). Besides, the impact was more pronounced in adolescents than in adults (p < 0.001). Regression analysis revealed a significant positive association between impulsivity and volume reduction. Regarding altered activations, the convergences of foci in the declive of the posterior lobe of cerebellum, the lingual gyrus, and the middle frontal gyrus were noted. Conclusions: Our findings demonstrated a potential association of excessive smartphone use with a reduced brain volume and altered activations.
Collapse
Affiliation(s)
- Hsiu-Man Lin
- Division of Child and Adolescent Psychiatry & Division of Developmental and Behavioral Pediatrics, China Medical University Children’s Hospital, Taichung 404327, Taiwan
| | - Yu-Tzu Chang
- School of Post Baccalaureate Chinese Medicine, China Medical University, Taichung 406040, Taiwan
- Division of Pediatric Neurology, China Medical University Children’s Hospital, Taichung 404327, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Kaohsiung 83300, Taiwan
| | - Shu-Tsen Liu
- Division of Child and Adolescent Psychiatry & Division of Developmental and Behavioral Pediatrics, China Medical University Children’s Hospital, Taichung 404327, Taiwan
| | - Bo-Shen Chen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Lin Li
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Chiao-Yu Lee
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Yu-Ru Sue
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Tsai-Mei Sung
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung 824005, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung 82445, Taiwan
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Clinical Psychology Center, Asia University Hospital, Taichung 41354, Taiwan
| |
Collapse
|
8
|
Jensen KL, Jensen SB, Madsen KL. A mechanistic overview of approaches for the treatment of psychostimulant dependence. Front Pharmacol 2022; 13:854176. [PMID: 36160447 PMCID: PMC9493975 DOI: 10.3389/fphar.2022.854176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Psychostimulant use disorder is a major health issue around the world with enormous individual, family-related and societal consequences, yet there are no effective pharmacological treatments available. In this review, a target-based overview of pharmacological treatments toward psychostimulant addiction will be presented. We will go through therapeutic approaches targeting different aspects of psychostimulant addiction with focus on three major areas; 1) drugs targeting signalling, and metabolism of the dopamine system, 2) drugs targeting either AMPA receptors or metabotropic glutamate receptors of the glutamate system and 3) drugs targeting the severe side-effects of quitting long-term psychostimulant use. For each of these major modes of intervention, findings from pre-clinical studies in rodents to clinical trials in humans will be listed, and future perspectives of the different treatment strategies as well as their potential side-effects will be discussed. Pharmaceuticals modulating the dopamine system, such as antipsychotics, DAT-inhibitors, and disulfiram, have shown some promising results. Cognitive enhancers have been found to increase aspects of behavioural control, and drugs targeting the glutamate system such as modulators of metabotropic glutamate receptors and AMPA receptors have provided interesting changes in relapse behaviour. Furthermore, CRF-antagonists directed toward alleviating the symptoms of the withdrawal stage have been examined with interesting resulting changes in behaviour. There are promising results investigating therapeutics for psychostimulant addiction, but further preclinical work and additional human studies with a more stratified patient selection are needed to prove sufficient evidence of efficacy and tolerability.
Collapse
|
9
|
Abstract
While substance experimentation typically begins in adolescence, substance use disorders (SUDs) usually develop in late teens or early adulthood, often in individuals who are vulnerable because of biological and socioeconomic risk factors. Severe SUDs-synonymous with addiction-involve changes in limbic and prefrontal brain areas after chronic drug exposure. These changes involve learned associations between drug reward and cues that trigger the anticipation of that reward (known as incentive salience), as well as heightened dysphoria during withdrawal and weakened prefrontal circuits needed for inhibiting habitual responses.
Collapse
Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA.
| | - Eric M Wargo
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA
| |
Collapse
|
10
|
Munier JJ, Marty VN, Spigelman I. Sex differences in α-adrenergic receptor function contribute to impaired hypothalamic metaplasticity following chronic intermittent ethanol exposure. Alcohol Clin Exp Res 2022; 46:1384-1396. [PMID: 35791038 PMCID: PMC9612407 DOI: 10.1111/acer.14900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Individuals with alcohol use disorder (AUD) exhibit maladaptive responses of the hypothalamic-pituitary-adrenal (HPA) axis to stress, which has been linked to high rates of relapse to drinking among abstinent individuals. Corticotropin-releasing factor (CRF) parvocellular neuroendocrine cells (PNCs) within the paraventricular nucleus of the hypothalamus (PVN) are critical to stress-induced HPA axis activation. Here, we investigate sex differences in synaptic transmission and plasticity in PNCs following the application of the stress-associated neurotransmitter norepinephrine (NE) in a rat model of AUD. METHODS Adult Sprague-Dawley rats were exposed to 40 days of chronic intermittent ethanol (CIE) vapor and 30 to 108 days of protracted withdrawal. We measured changes in holding current, evoked synaptic currents, and short-term glutamatergic plasticity (STP) in putative PNCs following the application of NE (10 μM) with and without the selective α1 adrenergic receptor (AR) antagonist prazosin (10 μM) or the α2AR antagonist atipamezole (10 μM). The experiments were performed using whole-cell patch clamp recordings in slices from CIE rats and air-exposed controls. RESULTS NE application caused two distinct effects: a depolarizing, inward, postsynaptic current and a reduction in amplitude of an evoked glutamatergic excitatory postsynaptic current (eEPSC). Both effects were sex- and CIE-specific. Prazosin blocked the postsynaptic inward current, while atipamezole blocked the NE-mediated suppression of eEPSCs. Additionally, STP formation was facilitated following NE application only in stress-naïve males and this response was lost in stressed animals exposed to a 30-min restraint stress following CIE exposure. Furthermore, NE + prazosin restored STP formation in stressed CIE males. CONCLUSIONS NE exerts excitatory and inhibitory effects on CRF PVN PNCs, and both effects are influenced by sex and CIE. Behavioral and hormonal responses to stress are influenced by STP formation within the PVN, which is lost following CIE and restored with the preapplication of prazosin. The selective blockade of α1AR may, therefore, ameliorate CIE-induced deficits in HPA responses to stress in a sex-specific manner.
Collapse
Affiliation(s)
- Joseph J. Munier
- Department of Molecular, Cellular, and Integrative Physiology, University of California, Los Angeles, CA, USA,Laboratory of Neuropharmacology, Section of Biosystems and Function, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Vincent N. Marty
- Laboratory of Neuropharmacology, Section of Biosystems and Function, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Igor Spigelman
- Laboratory of Neuropharmacology, Section of Biosystems and Function, School of Dentistry, University of California, Los Angeles, CA, USA
| |
Collapse
|
11
|
Ballantyne JC, Sullivan MD. Is Chronic Pain a Disease? THE JOURNAL OF PAIN 2022; 23:1651-1665. [PMID: 35577236 DOI: 10.1016/j.jpain.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
It was not until the twentieth century that pain was considered a disease. Before that it was managed medically as a symptom. The motivations for declaring chronic pain a disease, whether of the body or of the brain, include increasing its legitimacy as clinical problem and research focus worthy of attention from healthcare and research organizations alike. But 1 problem with disease concepts is that having a disease favors medical solutions and tends to reduce patient participation. We argue that chronic pain, particularly chronic primary pain (recently designated a first tier pain diagnosis in International Diagnostic Codes 11), is a learned state that is not intransigent even if it has biological correlates. Chronic pain is sometimes a symptom, and may sometimes be its own disease. But here we question the value of a disease focus for much of chronic pain for which patient involvement is essential, and which may need a much broader societal approach than is suggested by the disease designation. PERSPECTIVE: This article examines whether designating chronic pain a disease of the body or brain is helpful or harmful to patients. Can the disease designation help advance treatment, and is it needed to achieve future therapeutic breakthrough? Or does it make patients over-reliant on medical intervention and reduce their engagement in the process of recovery?
Collapse
Affiliation(s)
- Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
12
|
van Doornik SFW, Ostafin BD, Jonker NC, Glashouwer KA, de Jong PJ. Satisfaction with normative life domains and the course of anorexia nervosa. Int J Eat Disord 2022; 55:553-563. [PMID: 35212004 PMCID: PMC9305581 DOI: 10.1002/eat.23691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Satisfaction with normative life domains has been proposed as an important factor in the persistence of anorexia nervosa (AN). Initial evidence from a cross-sectional study indicated that individuals with AN reported lower satisfaction with normative life domains than individuals without an eating disorder. As an important next step in understanding causal relations, the present study used a longitudinal design to examine whether an improvement in AN symptoms is paralleled by an increase in satisfaction with normative life domains from baseline to follow-up and whether relatively low satisfaction with normative life domains at baseline is related to less improvement in AN symptoms. METHODS During baseline and at 1-year follow-up, adolescents with AN (N = 69) completed the Brief Multidimensional Students' Life Satisfaction Scale to measure satisfaction with normative life domains (e.g., friendships, school experience). Furthermore, eating disorder symptoms and BMI were measured. RESULTS Improvement in eating disorder symptoms, but not in BMI, was paralleled by an increase in satisfaction with normative life domains. Relatively low satisfaction with normative life domains at baseline was not prospectively related to less improvement in eating disorder symptoms or BMI at follow-up. DISCUSSION Our findings provide initial evidence that satisfaction with normative life domains is a malleable factor which fluctuates with symptom severity in AN. The results of this exploratory study point to the relevance of examining whether targeting satisfactory engagement with specific life domains optimizes treatment effectiveness. PUBLIC SIGNIFICANCE We explored whether an improvement in anorexia nervosa symptoms from start of treatment to 1-year follow-up would be paralleled by an increase in satisfaction with normative life domains. Improvement in eating disorder symptoms (but not BMI) was indeed related to a concurrent increase in satisfaction with normative life domains. These preliminary results point to the promising possibility that targeting satisfactory engagement with specific life domains may potentially enhance treatment effectiveness.
Collapse
Affiliation(s)
- Sanne F. W. van Doornik
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands,Department of Eating DisordersAccare Child and Adolescent PsychiatryGroningenThe Netherlands
| | - Brian D. Ostafin
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Nienke C. Jonker
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Klaske A. Glashouwer
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands,Department of Eating DisordersAccare Child and Adolescent PsychiatryGroningenThe Netherlands
| | - Peter J. de Jong
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| |
Collapse
|
13
|
Walia P, Ghosh A, Singh S, Dutta A. Portable Neuroimaging-Guided Noninvasive Brain Stimulation of the Cortico-Cerebello-Thalamo-Cortical Loop—Hypothesis and Theory in Cannabis Use Disorder. Brain Sci 2022; 12:brainsci12040445. [PMID: 35447977 PMCID: PMC9027826 DOI: 10.3390/brainsci12040445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/06/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Maladaptive neuroplasticity-related learned response in substance use disorder (SUD) can be ameliorated using noninvasive brain stimulation (NIBS); however, inter-individual variability needs to be addressed for clinical translation. Objective: Our first objective was to develop a hypothesis for NIBS for learned response in SUD based on a competing neurobehavioral decision systems model. The next objective was to develop the theory by conducting a computational simulation of NIBS of the cortico-cerebello-thalamo-cortical (CCTC) loop in cannabis use disorder (CUD)-related dysfunctional “cue-reactivity”—a construct closely related to “craving”—that is a core symptom. Our third objective was to test the feasibility of a neuroimaging-guided rational NIBS approach in healthy humans. Methods: “Cue-reactivity” can be measured using behavioral paradigms and portable neuroimaging, including functional near-infrared spectroscopy (fNIRS) and electroencephalogram (EEG) metrics of sensorimotor gating. Therefore, we conducted a computational simulation of NIBS, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) of the cerebellar cortex and deep cerebellar nuclei (DCN) of the CCTC loop for its postulated effects on fNIRS and EEG metrics. We also developed a rational neuroimaging-guided NIBS approach for the cerebellar lobule (VII) and prefrontal cortex based on a healthy human study. Results: Simulation of cerebellar tDCS induced gamma oscillations in the cerebral cortex, while transcranial temporal interference stimulation induced a gamma-to-beta frequency shift. A preliminary healthy human study (N = 10) found that 2 mA cerebellar tDCS evoked similar oxyhemoglobin (HbO) response in the range of 5 × 10−6 M across the cerebellum and PFC brain regions (α = 0.01); however, infra-slow (0.01–0.10 Hz) prefrontal cortex HbO-driven phase–amplitude-coupled (PAC; 4 Hz, ±2 mA (max)) cerebellar tACS evoked HbO levels in the range of 10−7 M that were statistically different (α = 0.01) across these brain regions. Conclusion: Our healthy human study showed the feasibility of fNIRS of cerebellum and PFC and closed-loop fNIRS-driven ctACS at 4 Hz, which may facilitate cerebellar cognitive function via the frontoparietal network. Future work needs to combine fNIRS with EEG for multi-modal imaging for closed-loop NIBS during operant conditioning.
Collapse
Affiliation(s)
- Pushpinder Walia
- Neuroengineering and Informatics for Rehabilitation Laboratory, University at Buffalo, Buffalo, NY 14228, USA;
| | - Abhishek Ghosh
- Postgraduate Institute of Medical Education & Research, Chandigarh 700020, India; (A.G.); (S.S.)
| | - Shubhmohan Singh
- Postgraduate Institute of Medical Education & Research, Chandigarh 700020, India; (A.G.); (S.S.)
| | - Anirban Dutta
- Neuroengineering and Informatics for Rehabilitation Laboratory, University at Buffalo, Buffalo, NY 14228, USA;
- Correspondence:
| |
Collapse
|
14
|
The particularity of freedom and recovery from addiction in practice: On the therapeutic limitations of generalising addiction science. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103609. [DOI: 10.1016/j.drugpo.2022.103609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 11/23/2022]
|
15
|
Murphy CE, Wang RC, Montoy JC, Whittaker E, Raven M. Effect of extended-release naltrexone on alcohol consumption: a systematic review and meta-analysis. Addiction 2022; 117:271-281. [PMID: 34033183 DOI: 10.1111/add.15572] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/07/2020] [Accepted: 05/05/2021] [Indexed: 12/29/2022]
Abstract
AIMS The aims of this study were to (1) estimate the effect of extended-release naltrexone compared with placebo on alcohol consumption in patients with alcohol use disorder (AUD) and (2) conduct pre-planned subgroup analyses to test whether being abstinent when initiating treatment (lead-in abstinence) or the duration of treatment improves treatment efficacy. DESIGN Systematic review and random-effects meta-analysis of blinded randomized placebo-controlled trials reporting the effect extended-release naltrexone on alcohol consumption. SETTING Outpatient clinics. PARTICIPANTS Seven trials evaluating a total of 1500 adults with AUD receiving monthly injections of either placebo or extended-release naltrexone at doses of 150-400 mg for 2-6 months and some form of behavioral therapy. MEASUREMENTS Pooled weighted mean difference (WMD) in drinking days per month and heavy drinking days per month. FINDINGS The WMD was -2.0 [95% confidence interval (CI) = -3.4, -0.6; P = 0.03] in favor of extended-release naltrexone for drinking days per month and -1.2 (95% CI = -0.2, -2.1; P = 0.02) for heavy drinking days per month, indicating that treatment resulted in two fewer drinking days per month and 1.2 fewer heavy drinking days per month compared with placebo. Trials not requiring lead-in abstinence and those lasting longer than 3 months reported larger reductions in heavy drinking days per month; WMD -2.0 (95% CI = -3.52, -0.48; P = 0.01) and -1.9 (95% CI = -3.2, -0.5; P = 0.01), respectively. In all cases, the I2 statistics (0-7.2%) did not suggest substantial heterogeneity. CONCLUSIONS Extended-release naltrexone reduces drinking days and heavy drinking days per month compared with placebo. Reductions are larger with a longer duration of treatment.
Collapse
Affiliation(s)
- Charles E Murphy
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Juan Carlos Montoy
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Evans Whittaker
- UCSF Health Sciences Library, University of California, San Francisco, CA, USA
| | - Maria Raven
- Department of Emergency Medicine, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| |
Collapse
|
16
|
Naumann RB, Guynn I, Clare HM, Lich KH. Insights from system dynamics applications in addiction research: A scoping review. Drug Alcohol Depend 2022; 231:109237. [PMID: 34974268 DOI: 10.1016/j.drugalcdep.2021.109237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Substance misuse and use disorders are dynamic and complex problems, situated within systems of interacting social, environmental, and neurobiological factors. System dynamics (SD) methods broaden, test, and improve understanding of complex systems and can help inform effective action. We sought to systematically review the use of SD tools in addiction-related research. METHODS Following PRISMA guidelines, we searched several databases from 1958 to 2019. We included studies focused on addiction-related screening and diagnosis, treatment, and return to use, as well as studies focused on earlier stages that may begin a path to addiction (e.g., experimentation, misuse onset). RESULTS We extracted information from 59 articles with a median publication year of 2014. In addition to using SD to understand the underlying complexity driving addiction-related trends, other commonly cited reasons for use of SD included assessing impacts of potential actions (n = 35), predicting future trends (n = 28), and supporting strategic planning processes (n = 22). Most studies included simulation models (n = 43); however, some presented insights from qualitative SD diagrams (n = 9) and concept models (n = 6). The majority of studies focused on stages leading to potential addiction: initiation/ experimentation (n = 42) and misuse onset (n = 38). One-third (n = 20) engaged persons with lived experience or other stakeholders during the modeling process. CONCLUSIONS Addiction-related SD research has increased over the last few decades with applications varying in several ways, from model purpose and types of data used to stakeholder involvement. Future applications should consider the benefits of stakeholder engagement throughout the modeling process and expanding models to include concomitant substance use.
Collapse
Affiliation(s)
- Rebecca B Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 MLK Jr Blvd, CB #7505, Chapel Hill, NC 27599, USA.
| | - Isabella Guynn
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA
| | - Hannah Margaret Clare
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA
| |
Collapse
|
17
|
Turner HN, Oliver J, Compton P, Matteliano D, Sowicz TJ, Strobbe S, St Marie B, Wilson M. Pain Management and Risks Associated With Substance Use: Practice Recommendations. Pain Manag Nurs 2021; 23:91-108. [PMID: 34965906 DOI: 10.1016/j.pmn.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 01/08/2023]
Abstract
Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. Opioid use disorder is used as an exemplar for substance use disorders and clinical recommendations are included with expanded attention to risk assessment and mitigation with interventions targeted to minimize the risk for relapse or escalation of substance use. Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.
Collapse
Affiliation(s)
| | - June Oliver
- Swedish Hospital, Northshore University Healthsystem, Chicago, IL.
| | | | | | | | | | - Barbara St Marie
- University of Iowa College of Nursing, Washington State University, College of Nursing
| | - Marian Wilson
- Oregon Health & Science University School of Nursing; Washington State University, College of Nursing
| |
Collapse
|
18
|
Shuster R. Monitoring Programs for Nurses With Substance Use Disorders: One Nurse's Journey and Recommendations. J Psychosoc Nurs Ment Health Serv 2021; 59:13-17. [PMID: 33647158 DOI: 10.3928/02793695-20210212-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Estimates of nurses with substance use disorders (SUDs) are approximately equal to those of the general public. Historically, nurses with SUDs faced public disciplinary action for any violations of the nurse practice act in their respective states, but now many states have alternative-to-discipline (ATD) programs available. Although the consent agreement for disciplinary and non-disciplinary programs are often similar, ATD programs are, in contrast, confidential and assist nurses to safely return to practice. As a RN and person in long-term recovery, I have first-hand experience with an ATD program. I credit the program with saving my career; however, it is not without criticism. Recommendations for improvements include increased education about ATD programs, research to evaluate efficacy of mandated interventions, including nurses in recovery within shared governance of these programs, implementing true peer support with nurses in long-term recovery, defraying the costs of the program to participants, and ensuring all staff within the programs receive standardized onboarding training followed by ongoing education. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 13-17.].
Collapse
|
19
|
Van de Cruys S, Van Dessel P. Mental distress through the prism of predictive processing theory. Curr Opin Psychol 2021; 41:107-112. [PMID: 34388670 DOI: 10.1016/j.copsyc.2021.07.006] [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: 11/01/2020] [Revised: 06/10/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
We review the predictive processing theory's take on goals and affect, to shed new light on mental distress and how it develops into psychopathology such as in affective and motivational disorders. This analysis recovers many of the classical factors known to be important in those disorders, like uncertainty and control, but integrates them in a mechanistic model of adaptive and maladaptive cognition and behavior. We derive implications for treatment that have so far remained underexposed in existing predictive processing accounts of mental disorder, specifically with regard to the model-dependent construction of value, the importance of model validation (evidence), and the introduction and learning of new, adaptive beliefs that relieve suffering.
Collapse
Affiliation(s)
- Sander Van de Cruys
- Laboratory of Experimental Psychology, KU Leuven, Belgium; Antwerp Social Lab, University of Antwerp, Belgium.
| | - Pieter Van Dessel
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium.
| |
Collapse
|
20
|
Kelly JF, Greene MC, Abry A. A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy. Addiction 2021; 116:1757-1767. [PMID: 33197084 PMCID: PMC8124079 DOI: 10.1111/add.15333] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/21/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Drug-related impairment is persistently stigmatized delaying and preventing treatment engagement. To reduce stigma, various medical terms (e.g. 'chronically relapsing brain disease', 'disorder') have been promoted in diagnostic systems and among national health agencies, yet some argue that over-medicalization of drug-related impairment lowers prognostic optimism and reduces personal agency. While intensely debated, rigorous empirical study is lacking. This study investigated whether random exposure to one of six common ways of describing drug-related impairment induces systematically different judgments. DESIGN, SETTING AND PARTICIPANTS Cross-sectional survey, US general population, among a nationally representative non-institutionalized sample (n = 3635; 61% response rate; December 2019-January 2020). INTERVENTION Twelve vignettes (six terms × gender) describing someone treated for opioid-related impairment depicted in one of six ways as a(n): 'chronically relapsing brain disease', 'brain disease', 'disease', 'illness', 'disorder' or 'problem'. MEASUREMENTS Multi-dimensional stigma scale assessing: blame; social exclusion; prognostic optimism, continuing care, and danger (a = 0.70-0.83). FINDINGS US adults [mean age = 47.81, confidence interval (CI) = 47.18-48.44; 52.4% female; 63.14% white] rated the same opioid-impaired person differently across four of five stigma dimensions depending on which of six terms they were exposed to. 'Chronically relapsing brain disease' induced the lowest stigmatizing blame attributions (P < 0.05); at the same time, this term decreased prognostic optimism [mean difference (MD) = 0.18, 95% CI = 0.05, 0.30] and increased perceived need for continuing care (MD = -0.26, 95% CI = -0.43, -0.09) and danger (MD = -0.13, 95% CI = -0.25, -0.02) when compared with 'problem'. Compared with a man, a woman was blamed more for opioid-related impairment (MD = -0.08, 95% CI = -0.15, -0.01); men were viewed as more dangerous (MD = 0.13, 95% CI = 0.06, 0.19) and to be socially excluded (MD = 0.16, 95% CI = 0.09, 0.23). CONCLUSIONS There does not appear to be one single medical term for opioid-related impairment that can meet all desirable clinical and public health goals. To reduce stigmatizing blame, biomedical 'chronically relapsing brain disease' terminology may be optimal; to increase prognostic optimism and decrease perceived danger/social exclusion use of non-medical terminology (e.g. 'opioid problem') may be optimal.
Collapse
Affiliation(s)
- John F. Kelly
- Department of PsychiatryMA General Hospital, Recovery Research InstituteBostonMAUSA,Department of PsychiatryHarvard Medical SchoolBostonMAUSA
| | | | - Alexandra Abry
- Department of PsychiatryMA General Hospital, Recovery Research InstituteBostonMAUSA
| |
Collapse
|
21
|
Frank D. "I'm pretty sure it's either food poisoning or Covid-19": Lived experience versus medical knowledge in diagnosing substance use problems. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103348. [PMID: 34183237 PMCID: PMC8200310 DOI: 10.1016/j.drugpo.2021.103348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/31/2021] [Accepted: 06/08/2021] [Indexed: 11/12/2022]
Abstract
People who use drugs, or who have in the past, often report that doctors and/or treatment providers devalue, or are unwilling to believe their claims in regards to substance use issues, in particular the presence and severity of withdrawal. In the case of benzodiazepine withdrawal this can not only lead to significant discomfort, frustration, and trauma for patients, but can lead to serious medical problems. This commentary uses the authors’ recent first-person experience with a disbelieving doctor in order to illustrate the lack of value often given to the claims and narratives of people with lived substance use experience. I outline some of the potential problems with this approach, including the effects on patients themselves and the loss of an important source of evidence-based knowledge. It also discusses potential risks associated with the recent increase in benzodiazepine prescription due to Covid-19 and offers suggestions for improving treatment outcomes.
Collapse
|
22
|
Decoding the Role of Gut-Microbiome in the Food Addiction Paradigm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136825. [PMID: 34202073 PMCID: PMC8297196 DOI: 10.3390/ijerph18136825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022]
Abstract
Eating behaviour is characterised by a solid balance between homeostatic and hedonic regulatory mechanisms at the central level and highly influenced by peripheral signals. Among these signals, those generated by the gut microbiota have achieved relevance in recent years. Despite this complex regulation, under certain circumstances eating behaviour can be deregulated becoming addictive. Although there is still an ongoing debate about the food addiction concept, studies agree that patients with eating addictive behaviour present similar symptoms to those experienced by drug addicts, by affecting central areas involved in the control of motivated behaviour. In this context, this review tries to summarise the main data regarding the role of the gut microbiome in eating behaviour and how a gut dysbiosis can be responsible for a maladaptive behaviour such as “food addiction”.
Collapse
|
23
|
Parenting Styles and Psychiatric Profile of Parents of Adult Substance Use Disorder Patients: Cross-sectional Study. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00554-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
24
|
Billieux J, Maurage P. New directions in the evaluation and rehabilitation of neurocognitive processes in addictive disorders. Addict Behav 2021; 117:106842. [PMID: 33550199 DOI: 10.1016/j.addbeh.2021.106842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
25
|
|
26
|
Kim-Spoon J, Herd T, Brieant A, Peviani KM, Lauharatanahirun N, Lee J, Deater-Deckard K, Bickel WK, King-Casas B. Bidirectional links between adolescent brain function and substance use moderated by cognitive control. J Child Psychol Psychiatry 2021; 62:427-436. [PMID: 32640083 PMCID: PMC8124751 DOI: 10.1111/jcpp.13285] [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: 09/16/2019] [Revised: 03/17/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND No clear consensus exists as to whether neurodevelopmental abnormalities among substance users reflect predisposing neural risk factors, neurotoxic effects of substances, or both. Using a longitudinal design, we examined developmental patterns of the bidirectional links between neural mechanisms and substance use throughout adolescence. METHOD 167 adolescents (aged 13-14 years at Time 1, 53% male) were assessed annually four times. Risk-related neural processing was assessed by blood-oxygen-level-dependent responses in the insula during a lottery choice task, cognitive control by behavioral performance during the Multi-Source Interference Task, and substance use by adolescents' self-reported cigarette, alcohol, and marijuana use. RESULTS Latent change score modeling indicated that greater substance use predicted increased insula activation during risk processing, but the effects of insula activation on changes in substance use were not significant. The coupling effect from substance use to insula activation was particularly strong for adolescents with low cognitive control, which supports the theorized moderating role of cognitive control. CONCLUSIONS Our results elucidate how substance use may alter brain development to be biased toward maladaptive decision-making, particularly among adolescents with poor cognitive control. Furthermore, the current findings underscore that cognitive control may be an important target in the prevention and treatment of adolescent substance use given its moderating role in the neuroadaptive effects of substance use on brain development.
Collapse
Affiliation(s)
- Jungmeen Kim-Spoon
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Toria Herd
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Alexis Brieant
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Kristin M. Peviani
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Nina Lauharatanahirun
- U.S. Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA,Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Lee
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Kirby Deater-Deckard
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Warren K. Bickel
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA,Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Brooks King-Casas
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA,Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| |
Collapse
|
27
|
O'Connor DA, Janet R, Guigon V, Belle A, Vincent BT, Bromberg U, Peters J, Corgnet B, Dreher JC. Rewards that are near increase impulsive action. iScience 2021; 24:102292. [PMID: 33889815 PMCID: PMC8050375 DOI: 10.1016/j.isci.2021.102292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/13/2021] [Accepted: 03/05/2021] [Indexed: 01/26/2023] Open
Abstract
In modern society, the natural drive to behave impulsively in order to obtain rewards must often be curbed. A continued failure to do so is associated with a range of outcomes including drug abuse, pathological gambling, and obesity. Here, we used virtual reality technology to investigate whether spatial proximity to rewards has the power to exacerbate the drive to behave impulsively toward them. We embedded two behavioral tasks measuring distinct forms of impulsive behavior, impulsive action, and impulsive choice, within an environment rendered in virtual reality. Participants responded to three-dimensional cues representing food rewards located in either near or far space. Bayesian analyses revealed that participants were significantly less able to stop motor actions when rewarding cues were near compared with when they were far. Since factors normally associated with proximity were controlled for, these results suggest that proximity plays a distinctive role in driving impulsive actions for rewards.
Collapse
Affiliation(s)
- David A O'Connor
- Neuroeconomics, Reward and Decision-making Team, Institut des Sciences Cognitives Marc Jeannerod, Centre National de la Recherche Scientifique, 69675 Bron, France
| | - Remi Janet
- Neuroeconomics, Reward and Decision-making Team, Institut des Sciences Cognitives Marc Jeannerod, Centre National de la Recherche Scientifique, 69675 Bron, France
| | - Valentin Guigon
- Neuroeconomics, Reward and Decision-making Team, Institut des Sciences Cognitives Marc Jeannerod, Centre National de la Recherche Scientifique, 69675 Bron, France
| | - Anael Belle
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | | | - Uli Bromberg
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Peters
- Psychology Department, Biological Psychology, University of Cologne, Cologne, Germany
| | - Brice Corgnet
- Emlyon Business School, GATE UMR 5824, Ecully, France
| | - Jean-Claude Dreher
- Neuroeconomics, Reward and Decision-making Team, Institut des Sciences Cognitives Marc Jeannerod, Centre National de la Recherche Scientifique, 69675 Bron, France
| |
Collapse
|
28
|
Jones KF, Ho JJ, Sager Z, Childers J, Merlin J. Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness. Am J Hosp Palliat Care 2021; 39:101-107. [PMID: 33685244 DOI: 10.1177/1049909121999783] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population. OBJECTIVE This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment. METHODS A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used. RESULTS There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided. CONCLUSION PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness.
Collapse
Affiliation(s)
| | - J Janet Ho
- University of California San Francisco, San Francisco, CA, USA
| | - Zachary Sager
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Julie Childers
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jessica Merlin
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
29
|
Pal N, Weitzel NS, Kertai MD. A Change of Tide or the Beginning of the End: COVID-19. Semin Cardiothorac Vasc Anesth 2021; 25:5-10. [PMID: 33554769 DOI: 10.1177/1089253221989132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | |
Collapse
|
30
|
McLean S, Rose N. Drug overdose deaths, addiction neuroscience and the challenges of translation. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16265.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this article, we argue that the rapid rise in drug overdose deaths in America is a tragedy that draws attention to fundamental conceptual and experimental problems in addiction science that have significant human consequences. Despite enormous economic investment, political support and claims to have revolutionised addiction medicine, neurobiological models are yet to produce a treatment for substance addiction. This is partly, we claim, because neurobiology is unable to explain essential features of addiction and relapse that neurobehavioral models of addiction are better placed to investigate. We show how addiction neuroscience turned to long-term memory to explain the chronicity of addiction and persistent relapses long after neurochemical traces have left the body. The turn to memory may in time help to close the translational gap facing addiction medicine, but it is our view in this article that the primary value of memory theory lays in its potential to create new critical friendships between biological and social sciences that are attuned to the lived experience and suffering of stigmatised people. The value of the memory turn may rest upon the capacity of these critical friendships to wean addiction science off its long-term dependence on disease concepts of human distress.
Collapse
|
31
|
Rundle SM, Cunningham JA, Hendershot CS. Implications of addiction diagnosis and addiction beliefs for public stigma: A cross-national experimental study. Drug Alcohol Rev 2021; 40:842-846. [PMID: 33493359 DOI: 10.1111/dar.13244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Stigmatisation of alcohol and other drug (AOD) use disorders poses a significant barrier to treatment access. A review by the World Health Organization concluded that addictive disorders were the most stigmatised health condition. Few studies have examined whether different etiological models of addiction (MOA) have implications for public stigma toward AOD disorders. The current study examined whether beliefs representative of five MOA predict public stigma levels and whether stigma differs for AOD use disorders relative to other health conditions. METHODS Survey data were collected from Canada, the USA and Australia using an online data collection platform. Participants were randomised to one of four vignette manipulations describing an individual with an alcohol use disorder and/or other disorder. Participants' stigma toward the vignette character and beliefs related to five MOA (disease, moral, psychological, sociological, nature) were measured. RESULTS Stigma ratings were significantly higher in the alcohol use disorder condition compared to other conditions. Two MOA accounted for significant variance in stigma ratings, where greater beliefs in the nature and psychological MOA predicted significantly lower levels of stigma toward alcohol use disorder. Contrary to predictions, beliefs in the disease MOA did not relate to lower stigma. Lastly, beliefs in the moral MOA partly accounted for geographical region differences (the USA vs. Canada) in public stigma. DISCUSSION AND CONCLUSIONS The current study provides further experimental support that AOD disorders are more stigmatised than others. Additionally, the findings suggest that MOA may relate differentially to perceived stigma, and that regional variability in such beliefs exists.
Collapse
Affiliation(s)
- Samantha M Rundle
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - John A Cunningham
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Christian S Hendershot
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
32
|
Wiers RW, Verschure P. Curing the broken brain model of addiction: Neurorehabilitation from a systems perspective. Addict Behav 2021; 112:106602. [PMID: 32889442 DOI: 10.1016/j.addbeh.2020.106602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
Abstract
The dominant biomedical perspective on addictions has been that they are chronic brain diseases. While we acknowledge that the brains of people with addictions differ from those without, we argue that the "broken brain" model of addiction has important limitations. We propose that a systems-level perspective more effectively captures the integrated architecture of the embodied and situated human mind and brain in relation to the development of addictions. This more dynamic conceptualization places addiction in the broader context of the addicted brain that drives behavior, where the addicted brain is the substrate of the addicted mind, that in turn is situated in a physical and socio-cultural environment. From this perspective, neurorehabilitation should shift from a "broken-brain" to a systems theoretical framework, which includes high-level concepts related to the physical and social environment, motivation, self-image, and the meaning of alternative activities, which in turn will dynamically influence subsequent brain adaptations. We call this integrated approach system-oriented neurorehabilitation. We illustrate our proposal by showing the link between addiction and the architecture of the embodied brain, including a systems-level perspective on classical conditioning, which has been successfully translated into neurorehabilitation. Central to this example is the notion that the human brain makes predictions on future states as well as expected (or counterfactual) errors, in the context of its goals. We advocate system-oriented neurorehabilitation of addiction where the patients' goals are central in targeted, personalized assessment and intervention.
Collapse
|
33
|
Abstract
Tobacco dependence is the most consequential target to reduce the burden of lung cancer worldwide. Quitting after a cancer diagnosis can improve cancer prognosis, overall health, and quality of life. Several oncology professional organizations have issued guidelines stressing the importance of tobacco treatment for patients with cancer. Providing tobacco treatment in the context of lung cancer screening is another opportunity to further reduce death from lung cancer. In this review, the authors describe the current state of tobacco dependence treatment focusing on new paradigms and approaches and their particular relevance for persons at risk or on treatment for lung cancer.
Collapse
|
34
|
Maurage P, Bollen Z, Masson N, D'Hondt F. Eye Tracking Studies Exploring Cognitive and Affective Processes among Alcohol Drinkers: a Systematic Review and Perspectives. Neuropsychol Rev 2020; 31:167-201. [PMID: 33099714 DOI: 10.1007/s11065-020-09458-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
Acute alcohol intoxication and alcohol use disorders are characterized by a wide range of psychological and cerebral impairments, which have been widely explored using neuropsychological and neuroscientific techniques. Eye tracking has recently emerged as an innovative tool to renew this exploration, as eye movements offer complementary information on the processes underlying perceptive, attentional, memory or executive abilities. Building on this, the present systematic and critical literature review provides a comprehensive overview of eye tracking studies exploring cognitive and affective processes among alcohol drinkers. Using PRISMA guidelines, 36 papers that measured eye movements among alcohol drinkers were extracted from three databases (PsycINFO, PubMed, Scopus). They were assessed for methodological quality using a standardized procedure, and categorized based on the main cognitive function measured, namely perceptive abilities, attentional bias, executive function, emotion and prevention/intervention. Eye tracking indexes showed that alcohol-related disorders are related to: (1) a stable pattern of basic eye movement impairments, particularly during alcohol intoxication; (2) a robust attentional bias, indexed by increased dwell times for alcohol-related stimuli; (3) a reduced inhibitory control on saccadic movements; (4) an increased pupillary reactivity to visual stimuli, regardless of their emotional content; (5) a limited visual attention to prevention messages. Perspectives for future research are proposed, notably encouraging the exploration of eye movements in severe alcohol use disorders and the establishment of methodological gold standards for eye tracking measures in this field.
Collapse
Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Zoé Bollen
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Nicolas Masson
- Numerical Cognition Group, Psychological Sciences Research Institute and Neuroscience Institute, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Cognitive Science and Assessment (COSA), Department of Behavioural and Cognitive Sciences (DBCS), Faculty of Humanities, Education and Social Sciences (FHSE), University of Luxembourg, Luxembourg, Luxembourg
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Université de Lille, Lille, France.,Centre National de Ressources et de Résilience (CN2R), Lille, France
| |
Collapse
|
35
|
Glackin SN, Roberts T, Krueger J. Out of our heads: Addiction and psychiatric externalism. Behav Brain Res 2020; 398:112936. [PMID: 33065141 DOI: 10.1016/j.bbr.2020.112936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
In addiction, apparently causally significant phenomena occur at a huge number of levels; addiction is affected by biomedical, neurological, pharmacological, clinical, social, and politico-legal factors, among many others. In such a complex, multifaceted field of inquiry, it seems very unlikely that all the many layers of explanation will prove amenable to any simple or straightforward, reductive analysis; if we are to unify the many different sciences of addiction while respecting their causal autonomy, then, what we are likely to need is an integrative framework. In this paper, we propose the theory of "Externalist" or "4E" - for extended, embodied, embedded, and enactive - cognition, which focuses on the empirical and conceptual centrality of the wider extra-neural environment to cognitive and mental processes, as a candidate for such a framework. We begin in Section 2 by outlining how such a perspective might apply to psychiatry more generally, before turning to some of the ways it can illuminate addiction in particular: Section 3 points to a way of dissolving the classic dichotomy between the "choice model" and "disease model" in the addiction literature; Section 4 shows how 4E concepts can clarify the interplay between the addict's brain and her environment; and Section 5 considers how these insights help to explain the success of some recovery strategies, and may help to inform the development of new ones.
Collapse
Affiliation(s)
- Shane N Glackin
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, UK.
| | - Tom Roberts
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, UK
| | - Joel Krueger
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, UK
| |
Collapse
|
36
|
Haley EM, Stone J, Childers J, Davis A, Ehrman S, Houser MW, Olenik JM, Roche M, Jones CA, Skarf LM. Top Ten Tips Palliative Care Clinicians Should Know About Opioid Use Disorder. J Palliat Med 2020; 23:1250-1256. [PMID: 32716738 DOI: 10.1089/jpm.2020.0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since the prevalence of substance use disorders, and opioid use disorder (OUD) specifically, remains high and represents a public health crisis, it is critical that palliative care (PC) providers have a broad understanding of this class of chronic, yet treatable, diseases. Conceptualizing stigma associated with OUD, treatment modalities available, and educational opportunities are key factors in providing patient-centered care. A solid foundation of knowledge about OUD in the setting of serious illness is also crucial as PC providers often recommend or prescribe opioids for symptom management in patients who also have OUD. Furthermore, the PC interdisciplinary team is particularly well poised to care for patients suffering from OUD due to the inherently holistic approach already present in the specialty of PC. This article offers PC teams a framework for understanding the diagnosis and treatment of OUD, methods for performing risk stratification and monitoring, and an overview of opportunities to enhance our care of PC patients with OUD.
Collapse
Affiliation(s)
- Erin M Haley
- Palliative Care Service, Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Jordan Stone
- Section of Palliative Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amy Davis
- Drexel University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah Ehrman
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mackenzie W Houser
- Palliative Care Team, Main Line Health, Newtown Square, Pennsylvania, USA
| | - Jennifer M Olenik
- Section of Palliative Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meaghan Roche
- Division of Renal Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher A Jones
- Section of Palliative Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lara M Skarf
- Division of Geriatrics and Palliative Care, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| |
Collapse
|
37
|
Hopper JW. Values and visions for the field of psychological trauma, from brain to re-moralization and social transformation. J Trauma Dissociation 2020; 21:279-292. [PMID: 32026755 DOI: 10.1080/15299732.2020.1718968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- James W Hopper
- Independent Consultant and Department of Psychiatry, Harvard Medical School
| |
Collapse
|
38
|
Moon SJE, Lee H. Relapse to substance use: A concept analysis. Nurs Forum 2020; 55:523-530. [PMID: 32350881 DOI: 10.1111/nuf.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/25/2022]
Abstract
The concept of relapse is ubiquitous in the health literature related to addiction. Nevertheless, relapse is-and has been-described and measured under various definitions, which precipitates confusion, inconsistency, and stigma. This study aimed to (a) clarify the meaning of relapse and (b) present a comprehensive definition of relapse vis-à-vis substance use. Walker and Avant's method of concept analysis was followed to analyze the relapse using CINAHL, PsychINFO, and PubMed databases. Three key attributes of relapse were identified: (a) interruption of abstinence, (b) vulnerability to uncontrollable substance-related behavior and/or cues, (c) a transition to potential progression or regression. Antecedents and consequences of attributes were identified, followed by the construction of the model and additional cases. Relapse is defined conceptually as either a transition to regression or a progression in the process of recovery, prompted by a return to the previous behavior of substance use, despite the intention to stay abstinent. A standardized definition and understanding of relapse not only minimize confusion, inconsistency, and social and self-stigma associated with the term but also helps provide relapse-sensitive care with accurate methods of assessment and evaluation.
Collapse
Affiliation(s)
- Seol Ju Esther Moon
- Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heeyoung Lee
- Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
39
|
|
40
|
Miller M, Kiverstein J, Rietveld E. Embodying addiction: A predictive processing account. Brain Cogn 2020; 138:105495. [PMID: 31877434 PMCID: PMC6983939 DOI: 10.1016/j.bandc.2019.105495] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
In this paper we show how addiction can be thought of as the outcome of learning. We look to the increasingly influential predictive processing theory for an account of how learning can go wrong in addiction. Perhaps counter intuitively, it is a consequence of this predictive processing perspective on addiction that while the brain plays a deep and important role in leading a person into addiction, it cannot be the whole story. We'll argue that predictive processing implies a view of addiction not as a brain disease, but rather as a breakdown in the dynamics of the wider agent-environment system. The environment becomes meaningfully organised around the agent's drug-seeking and using behaviours. Our account of addiction offers a new perspective on what is harmful about addiction. Philosophers often characterise addiction as a mental illness because addicts irrationally shift in their judgement of how they should act based on cues that predict drug use. We argue that predictive processing leads to a different view of what can go wrong in addiction. We suggest that addiction can prove harmful to the person because as their addiction progressively takes hold, the addict comes to embody a predictive model of the environment that fails to adequately attune them to a volatile, dynamic environment. The use of an addictive substance produces illusory feedback of being well-attuned to the environment when the reality is the opposite. This can be comforting for a person inhabiting a hostile niche, but it can also prove to be harmful to the person as they become skilled at living the life of an addict, to the neglect of all other alternatives. The harm in addiction we'll argue is not to be found in the brains of addicts, but in their way of life.
Collapse
Affiliation(s)
- Mark Miller
- Department of Informatics, University of Sussex, Sussex House, Falmer, Brighton BN1 9RH, United Kingdom.
| | - Julian Kiverstein
- Amsterdam University Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition Centre, University of Amsterdam, Amsterdam, the Netherlands.
| | - Erik Rietveld
- Amsterdam University Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Department of Philosophy, Institute for Logic, Language and Computation, University of Amsterdam, the Netherlands; Department of Philosophy, University of Twente, Enschede, the Netherlands; Amsterdam Brain and Cognition Centre, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
41
|
Perales JC, King DL, Navas JF, Schimmenti A, Sescousse G, Starcevic V, van Holst RJ, Billieux J. Learning to lose control: A process-based account of behavioral addiction. Neurosci Biobehav Rev 2019; 108:771-780. [PMID: 31846653 DOI: 10.1016/j.neubiorev.2019.12.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/24/2022]
Abstract
Learning psycho(bio)logy has developed a solid corpus of evidence and theory regarding behavior control modes. The present article briefly reviews that literature and its influence on recent models in which the transition from goal-directed to compulsive behavior is identified as the main process underlying substance use disorders. This literature is also relevant to non-substance addictive disorders, and serves as basis to propose a restricted definition of behavioral addiction relying on the presence of behavior-specific compulsivity. Complementarily, we consider whether some activities can become disordered while remaining mostly goal-driven. Based on reinforcement learning models, relative outcome utility computation is proposed as an alternative mechanism through which dysfunctional behaviors (even not qualifying as addictive) can override adaptive ones, causing functional impairment. Beyond issues of conceptual delimitation, recommendations are made regarding the importance of identifying individual etiological pathways to dysregulated behavior, the necessity of accurately profiling at-risk individuals, and the potential hazards of symptom-based diagnosis. In our view, the validity of these recommendations does not depend on the position one takes in the nosological debate.
Collapse
Affiliation(s)
- José C Perales
- Department of Experimental Psychology, Mind Brain and Behavior Research Center (CIMCYC), University of Granada, Spain
| | - Daniel L King
- College of Education, Psychology, & Social Work, Flinders University, Australia
| | - Juan F Navas
- Department of Basic Psychology, Autonomous University of Madrid, Spain; Universitat Oberta de Catalunya, Spain.
| | | | - Guillaume Sescousse
- Lyon Neuroscience Research Center - INSERM U1028 - CNRS UMR5292, PSYR2 Team, University of Lyon, France
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Australia
| | - Ruth J van Holst
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Institute for Addiction Research, Netherlands
| | - Joël Billieux
- Addictive and Compulsive Behaviours Lab. Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Centre for Excessive Gambling, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| |
Collapse
|
42
|
Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
Collapse
Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
| |
Collapse
|
43
|
|
44
|
Valbuena G, O'Brien B, Ten Cate O, O'Sullivan P. Inquiry in the Medical Curriculum: A Pedagogical Conundrum and a Proposed Solution. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:804-808. [PMID: 30920445 DOI: 10.1097/acm.0000000000002671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Habits of inquiry are considered an essential component of the modern physician's profile. These habits drive physicians to recognize and address the continuous challenges inherent to the practice of medicine; consequently, they meet the aims of better patient-centered care, better health of communities, and improved functioning of the health system. Many medical schools have endeavored to integrate inquiry into their curricula as a means of supporting development of adaptive expertise, a construct that encompasses habits of inquiry. However, the diversity of conceptualizations of inquiry has resulted in correspondingly diverse instructional implementations. Much of the emphasis has been on inquiry methods (e.g., engagement in research projects, courses in research methods and statistics), but the learners' inquiry disposition and its essential attitude component have received little attention in instruction and assessment. The authors propose that both inquiry methods and attitude need to be developed explicitly and simultaneously to prepare physicians to successfully be willing and able to address the challenges of today's health care environment. Because attitudes are established predictors of behavior, a positive inquiry attitude may be the ultimate determinant of physicians' engagement in behaviors of adaptive expertise (i.e., recognizing when learned procedures do not apply, and learning or inventing effective solutions). Addressing the attitude toward inquiry as early as possible in medical school is critical because strong attitudes are difficult to modify. Thus, a curriculum that supports positive inquiry attitude formation and strengthening will carry well beyond medical school and residency training.
Collapse
Affiliation(s)
- Gustavo Valbuena
- G. Valbuena is head, Problem-Based Learning Curriculum, UC Berkeley-UCSF Joint Medical Program, Berkeley, California. B. O'Brien is associate professor, Department of Medicine, and educational researcher, Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California. O. ten Cate is professor and senior health professions education scientist, Center for Research and Development of Education, University Medical Center, Utrecht, The Netherlands. P. O'Sullivan is professor, Department of Medicine, and director, Research and Development in Medical Education, Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | | |
Collapse
|
45
|
Weinberg D. Psychosomatic subjects and the agencies of addiction. MEDICAL HUMANITIES 2019; 45:162-168. [PMID: 31289219 DOI: 10.1136/medhum-2018-011582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
Addiction science and public policy have for some time been articulated in conformity with a broader antinomy in Western thought between biological reductionism and liberal voluntarism. Hence, mainstream debates have concerned whether and how addiction might be understood as a disease in the biomedically orthodox sense of anatomical or physiological pathology or whether and how addiction might be understood as a voluntary choice of some kind. The fact that those who staff these debates have appeared either unable or unwilling to consider alternatives to this antinomy has resulted in a rather unhappy and intransigent set of intellectual anomalies both on the biomedical and the social scientific sides of this divide. Perhaps more importantly, it has also resulted in a striking isolation of scientific debates themselves from the vicissitudes of therapeutically caring for those putatively suffering from addictions both within and outside clinical settings. After briefly demonstrating the conformity of debates in addiction science with the broader antinomy between biological reductionism and liberal voluntarism and the anomalies that thereby result, this article considers the scientific and therapeutic benefits of a psychosomatic framework for the understanding of both self-governing subjects and the experience of a loss of self-control to agencies of addiction.
Collapse
|
46
|
|
47
|
Affiliation(s)
- Marc Lewis
- University of Toronto, Toronto, ON, Canada
| |
Collapse
|
48
|
Beard KW, Newsome JE, Harper-Dorton KV, O’Keefe SL, Young DH, Swindell S, Stroupe WE, Steele K, Lawhon M, Kuo SY. Father-daughter incest: Comparison of treated cases to untreated control subjects. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1633809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Keith W. Beard
- Department of Psychology, Marshall University, One John Marshall Dr., Huntington, WV 25755, USA
| | - Jason E. Newsome
- Dayspring Counseling Center, Inc., 1219 Ohio Avenue, Dunbar, WV 25064, USA
| | | | - Stephen L. O’Keefe
- Department of Psychology, Marshall University, One John Marshall Dr., Huntington, WV 25755, USA
| | - Debra H. Young
- Department of Social Work, Marshall University, One John Marshall Dr., Huntington, WV, 25755, USA
| | - Sam Swindell
- Justice, Law and Public Safety Studies Department, Romeoville, IL and Attorney and Counselor at Law, Lewis University, Christiansburg, VA, USA
| | - Walter E. Stroupe
- Department of Criminal Justice, West Virginia State University, P.O. Box 1000, Institute, WV 25112-1000, USA
| | - Kerri Steele
- Department of Criminal Justice, West Virginia State University, P.O. Box 1000, Institute, WV 25112-1000, USA
- Department of Social Work, West Virginia State University, P.O. Box 1000, Institute, WV 25112-1000, USA
| | - Megan Lawhon
- Department of Psychology, Marshall University, One John Marshall Dr., Huntington, WV 25755, USA
| | - Shih-Ya Kuo
- Department of Sociology, University of Macau, 4A, Staff Quarter S26, University of Macau, Avenida da Universidade, Taipa, Macau, China
| |
Collapse
|
49
|
Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
Collapse
Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| |
Collapse
|