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Maser J, Morrison MF, Khalid HP, Cunningham R, Yu D, Walters MI, Lu X, Bolo NR. Clavulanic Acid-Mediated Increases in Anterior Cingulate Glutamate Levels are Associated With Decreased Cocaine Craving and Brain Network Functional Connectivity Changes. CURRENT THERAPEUTIC RESEARCH 2024; 101:100751. [PMID: 39045086 PMCID: PMC11261246 DOI: 10.1016/j.curtheres.2024.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024]
Abstract
Background There is an urgent need for pharmacological treatment for cocaine (COC) use disorder (CUD). Glutamatergic transmission in the prefrontal cortex is affected by addictive behaviors. Clavulanic acid (CLAV), a glutamate transporter GLT-1 (excitatory amino acid transporter) activator, is a clinical-stage medication that has potential for treating CUD. Methods In a pilot study, nine participants with CUD received 500 mg CLAV with dose escalations to 750 mg and 1000 mg over 10 days. In 5 separate magnetic resonance imaging (MRI) sessions, brain anterior cingulate cortex (ACC) glutamate level and resting state network (RSN) functional connectivity (FC) were assessed using MR spectroscopy and functional MRI. Craving was assessed at the same time points, between baseline (before CLAV), 6 days, and 10 days of CLAV. Independent component analysis with dual regression was used to identify RSN FC changes from baseline to Days 6 and 10. Relationships among glutamate, craving, and resting state FC values were analyzed. Results Participants who achieved high ACC glutamate levels after CLAV treatment had robust decreases in COC craving (r = -0.90, P = 0.0009, n = 9). The salience network (SN) and executive control network (ECN) demonstrated an association between increased FC after CLAV treatment and low baseline ACC Glu levels (SN CLAV 750 mg, r = -0.82, P = 0.007) (ECN CLAV 1000 mg, r = -0.667, P = 0.050; n = 9). Conclusions Glutamate associated changes in craving and FC of the salience and executive control brain networks support CLAV as a potentially efficacious pharmacological treatment for CUD.
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Affiliation(s)
- Joya Maser
- Department of Psychiatry, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mary F. Morrison
- Department of Psychiatry, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Psychiatry, Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Helene Philogene Khalid
- Department of Psychiatry, Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Ronan Cunningham
- Department of Psychiatry, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Daohai Yu
- Department of Biomedical Education and Data Science, Center for Biostatistics & Epidemiology, Philadelphia, Pennsylvania
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - M. Ingre Walters
- Department of Psychiatry, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Xiaoning Lu
- Department of Biomedical Education and Data Science, Center for Biostatistics & Epidemiology, Philadelphia, Pennsylvania
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Nicolas R. Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Le K, Le KDR, Nguyen J, Hua J, Munday S. The Role of Medicinal Cannabis as an Emerging Therapy for Opioid Use Disorder. Pain Ther 2024; 13:435-455. [PMID: 38676910 PMCID: PMC11111657 DOI: 10.1007/s40122-024-00599-1] [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: 12/19/2023] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
This narrative review explores current insights into the potential use of medicinal cannabis-related products as an emerging therapy for opioid use disorder in the landscape of increasing knowledge about medicinal cannabis-based products, commercialisation and global legalisation. Preclinical studies have provided preliminary insight into the putative neurobiological mechanisms that underpin the potential for medicinal cannabis to be considered a therapeutic in opioid use disorder and addiction. With the progressive legalisation of cannabis in many jurisdictions worldwide, contemporary research has highlighted further evidence that medicinal cannabis may have efficacy in reducing cravings and withdrawal effects, and therefore may be considered as an adjunct or standalone to current medications for opioid use disorder. Despite this potential, the landscape of research in this space draws from a large number of observational studies, with a paucity of rigorous randomised controlled trials to ascertain a true understanding of effect size and safety profile. With current challenges in implementation that arise from political and legal qualms about adopting medicinal cannabis on the background of associated social stigma, significant hurdles remain to be addressed by government, policy-makers, healthcare providers and researchers before medical cannabis can be introduced globally for the treatment of opioid use disorder.
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Affiliation(s)
- Kelvin Le
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Khang Duy Ricky Le
- Department of General Surgical Specialties, The Royal Melbourne Hospital, 300 Grattan St., Parkville, Melbourne, VIC, 3050, Australia.
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Geelong Clinical School, Deakin University, Geelong, VIC, Australia.
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
| | - Johnny Nguyen
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Parkville, VIC, Australia
- Department of Pharmacy, Alfred Health, Melbourne, VIC, Australia
| | - Jean Hua
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Parkville, VIC, Australia
- Department of Pharmacy, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sarah Munday
- The Royal Children's Hospital, Melbourne, VIC, Australia
- Monash Bioethics Centre, Faculty of Arts, Monash University, Clayton, VIC, Australia
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3
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Donlon J, Kumari P, Varghese SP, Bai M, Florentin OD, Frost ED, Banks J, Vadlapatla N, Kam O, Shad MU, Rahman S, Abulseoud OA, Stone TW, Koola MM. Integrative Pharmacology in the Treatment of Substance Use Disorders. J Dual Diagn 2024; 20:132-177. [PMID: 38117676 DOI: 10.1080/15504263.2023.2293854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
The detrimental physical, mental, and socioeconomic effects of substance use disorders (SUDs) have been apparent to the medical community for decades. However, it has become increasingly urgent in recent years to develop novel pharmacotherapies to treat SUDs. Currently, practitioners typically rely on monotherapy. Monotherapy has been shown to be superior to no treatment at all for most substance classes. However, many randomized controlled trials (RCTs) have revealed that monotherapy leads to poorer outcomes when compared with combination treatment in all specialties of medicine. The results of RCTs suggest that monotherapy frequently fails since multiple dysregulated pathways, enzymes, neurotransmitters, and receptors are involved in the pathophysiology of SUDs. As such, research is urgently needed to determine how various neurobiological mechanisms can be targeted by novel combination treatments to create increasingly specific yet exceedingly comprehensive approaches to SUD treatment. This article aims to review the neurobiology that integrates many pathophysiologic mechanisms and discuss integrative pharmacology developments that may ultimately improve clinical outcomes for patients with SUDs. Many neurobiological mechanisms are known to be involved in SUDs including dopaminergic, nicotinic, N-methyl-D-aspartate (NMDA), and kynurenic acid (KYNA) mechanisms. Emerging evidence indicates that KYNA, a tryptophan metabolite, modulates all these major pathophysiologic mechanisms. Therefore, achieving KYNA homeostasis by harmonizing integrative pathophysiology and pharmacology could prove to be a better therapeutic approach for SUDs. We propose KYNA-NMDA-α7nAChRcentric pathophysiology, the "conductor of the orchestra," as a novel approach to treat many SUDs concurrently. KYNA-NMDA-α7nAChR pathophysiology may be the "command center" of neuropsychiatry. To date, extant RCTs have shown equivocal findings across comparison conditions, possibly because investigators targeted single pathophysiologic mechanisms, hit wrong targets in underlying pathophysiologic mechanisms, and tested inadequate monotherapy treatment. We provide examples of potential combination treatments that simultaneously target multiple pathophysiologic mechanisms in addition to KYNA. Kynurenine pathway metabolism demonstrates the greatest potential as a target for neuropsychiatric diseases. The investigational medications with the most evidence include memantine, galantamine, and N-acetylcysteine. Future RCTs are warranted with novel combination treatments for SUDs. Multicenter RCTs with integrative pharmacology offer a promising, potentially fruitful avenue to develop novel therapeutics for the treatment of SUDs.
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Affiliation(s)
- Jack Donlon
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Pooja Kumari
- Community Living Trent Highlands, Peterborough, Canada
| | - Sajoy P Varghese
- Addiction Recovery Treatment Services, Veterans Affairs Northern California Health Care System, University of California, Davis, Sacramento, California, USA
| | - Michael Bai
- Columbia University, New York, New York, USA
| | - Ori David Florentin
- Department of Psychiatry, Westchester Medical Center, Valhalla, New York, USA
| | - Emma D Frost
- Department of Neurology, Cooper University Health Care, Camden, New Jersey, USA
| | - John Banks
- Talkiatry Mental Health Clinic, New York, New York, USA
| | - Niyathi Vadlapatla
- Thomas Jefferson High School for Science and Technology, Alexandria, Virginia, USA
| | - Olivia Kam
- Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | - Mujeeb U Shad
- Department of Psychiatry, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Shafiqur Rahman
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, South Dakota, USA
| | - Osama A Abulseoud
- Department of Psychiatry and Psychology, Alix School of Medicine at Mayo Clinic, Phoenix, Arizona, USA
| | - Trevor W Stone
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Maju Mathew Koola
- Department of Psychiatry and Behavioral Health, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Khalifa FN, Hussein RF, Mekawy DM, Elwi HM, Alsaeed SA, Elnawawy Y, Shaheen SH. Potential role of the lncRNA "HOTAIR"/miRNA "206"/BDNF network in the alteration in expression of synaptic plasticity gene arc and BDNF level in sera of patients with heroin use disorder through the PI3K/AKT/mTOR pathway compared to the controls. Mol Biol Rep 2024; 51:293. [PMID: 38334898 PMCID: PMC10858136 DOI: 10.1007/s11033-024-09265-3] [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: 10/07/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Heroin use disorder (HUD) is a seriously increasing health issue, accounting for most deaths among drug abusers. Studying non-coding ribonucleic acid gene expression among drug abusers is a promising approach, as it may be used in diagnosis and therapeutics. PARTICIPANTS AND METHODS A total of 49 male heroin-dependent patients and 49 male control participants were recruited from Kasr Al Ainy Psychiatry and Addiction outpatient clinics, Faculty of Medicine, Cairo University. Sera were gathered. qRT-PCR was utilized for the detection of gene expression of non-coding RNAs such as "HOX transcript antisense RNA" (HOTAIR), micro-RNA (miRNA-206), phosphatidylinositol 3-kinase (PI3K), protein kinase B (AKT), mechanistic target of rapamycin (mTOR), and Activity Regulated Cytoskeleton Associated Protein (Arc). Sera Brain-Derived Neurotrophic Factor (BDNF) levels were assessed using ELISA. Using a western blot made it possible to determine the protein expression of PI3K, AKT, and mTOR. RESULTS The study demonstrated that gene expressions of HOTAIR, AKT, PI3K, and Arc were considerably lowered between cases and controls, while gene expressions of miR-206 and mTOR1 were significantly raised. PI3K and AKT protein expressions were downregulated, while mTOR expressions were upregulated. BDNF levels were significantly decreased in some cases. CONCLUSION The results of this study suggest that decreased HOTAIR in HUD relieves miR-206 inhibition, which thus increases and affects downstream PI3K/AKT/mTOR, ARC, and BDNF expression. This may be shared in addictive and relapsing behaviors.
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Affiliation(s)
- Fatma Nada Khalifa
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
| | - Riham F Hussein
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
| | - Dina M Mekawy
- Department of Biochemistry, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
| | - Heba M Elwi
- Department of Biochemistry, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
| | - Shimaa Ahmed Alsaeed
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt.
| | - Yassmin Elnawawy
- Department of Psychiatry, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
| | - Somaya H Shaheen
- Department of Psychiatry, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
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Le K, Au J, Hua J, Le KDR. The Therapeutic Potential of Cannabidiol in Revolutionising Opioid Use Disorder Management. Cureus 2023; 15:e50634. [PMID: 38226097 PMCID: PMC10789504 DOI: 10.7759/cureus.50634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
Opioid use disorder (OUD) is a significant cause of morbidity and mortality worldwide and is linked to a complex interplay of biopsychosocial factors as well as the increasing overprescription and availability of opioid medications. Current OUD management relies on the controlled provision of opioid medications, such as methadone or buprenorphine, known as opioid replacement therapy. There is variable evidence regarding the long-term efficacy of these medications in improving the management of OUD, thereby necessitating an exploration into innovative approaches to complement, or even take the place of, existing treatment paradigms. Cannabidiol (CBD), a non-psychoactive compound derived from the cannabis plant, has garnered attention for its diverse pharmacological properties, including anti-inflammatory, analgesic, and anxiolytic effects. Preliminary studies suggest that CBD may target opioid withdrawal pathways that make CBD a potential therapeutic option for OUD. This narrative review synthesises current literature surrounding OUD and offers a nuanced review of the current and future role of CBD in managing this condition. In doing so, we highlight the potential avenues to explore with respect to CBD research for the guidance and development of further research opportunities, framework and policy development, and clinical considerations before medicinal CBD can be integrated into evidence-based clinical guidelines.
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Affiliation(s)
- Kelvin Le
- Melbourne Medical School, The University of Melbourne, Melbourne, AUS
| | - Joanne Au
- Department of Anaesthesia & Pain Management, The Royal Melbourne Hospital, Melbourne, AUS
| | - Jean Hua
- Department of Pharmacy, The Royal Melbourne Hospital, Melbourne, AUS
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, AUS
| | - Khang Duy Ricky Le
- Geelong Clinical School, Deakin University, Geelong, AUS
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, AUS
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, AUS
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, AUS
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Natal S, Young CC, Kaur K, Gebhardt ES, Perrone A, Morikawa H, Tirado C, Smits JAJ. Applications of isradipine in human addiction studies: A systematic literature review. Exp Clin Psychopharmacol 2023; 31:507-522. [PMID: 36595455 PMCID: PMC10152997 DOI: 10.1037/pha0000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Given the personal and public health burden of addictive disorders, innovative approaches to treatment are sorely needed. This systematic review examined the use of the pharmacological agent isradipine in the context of potential applications for addiction treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided a comprehensive search of PubMed, Cochrane Library, and PsycINFO between the years 1985 to July 2022. Studies were included if isradipine was administered to adults with a current Diagnostic and Statistical Manual of Mental Disorders-5th edition diagnosis of a substance use disorder and/or to healthy volunteers alone and in conjunction with a substance (i.e, cocaine, methamphetamine, alcohol). A total of 16 studies with 252 participants were included in this review. Substantial variability was identified with study designs, isradipine dosages/dosing, and addictive substance of interest. Outcomes clustered in four categories: (a) cerebral blood flow (CBF), (b) hemodynamic effects, (c) subjective effects, and (d) cognitive effects. Isradipine was found to improve CBF in individuals with cocaine-induced hypoperfusion and in several studies was found to reduce parameters of blood pressure elevation after stimulant use. There were no significant findings on isradipine's effect on subjective reporting (i.e., craving, mood, drug affect) or cognition/attention. Given the limited number of studies identified in this review, there is insufficient data to draw clear conclusions. The direct effects of isradipine as a pharmacologic agent for addictive disorder treatment appear minimal, however, future work may benefit from examining the impact of isradipine as an augmentative agent within existing cue exposure paradigms for preventing cue-induced drug relapse. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Samantha Natal
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Cara C. Young
- School of Nursing, The University of Texas at Austin, Austin Texas
| | - Karamveer Kaur
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Eli S. Gebhardt
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Alexander Perrone
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Hitoshi Morikawa
- Department of Neuroscience, The University of Texas at Austin, Austin Texas
| | - Carlos Tirado
- School of Pharmacy, The University of Texas at Austin, Austin Texas
| | - Jasper A. J. Smits
- Department of Psychology, The University of Texas at Austin, Austin Texas
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Fox HC, Milivojevic V, Sinha R. Therapeutics for Substance-Using Women: The Need to Elucidate Sex-Specific Targets for Better-Tailored Treatments. Handb Exp Pharmacol 2023; 282:127-161. [PMID: 37592081 DOI: 10.1007/164_2023_687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
In the last decade, alcohol consumption in the US has risen by 84% in women compared with 35% in men. Furthermore, research has shown that sex- and gender-related differences may disadvantage women in terms of developing a range of psychological, cognitive, and medical problems considerably earlier in their drinking history than men, and despite consuming a similar quantity of substances. While this "telescoping" process has been acknowledged in the literature, a concomitant understanding of the underlying biobehavioral mechanisms, and an increase in the development of specific treatments tailored to women, has not occurred. In the current chapter we focus on understanding why the need for personalized, sex-specific medications is imperative, and highlight some of the potential sex-specific gonadal and stress-related adaptations underpinning the accelerated progress from controlled to compulsive drug and alcohol seeking in women. We additionally discuss the efficacy of these mechanisms as novel targets for medications development, using exogenous progesterone and guanfacine as examples. Finally, we assess some of the challenges faced and progress made in terms of developing innovative medications in women. We suggest that agents such as exogenous progesterone and adrenergic medications, such as guanfacine, may provide some efficacy in terms of attenuating stress-induced craving for several substances, as well as improving the ability to emotionally regulate in the face of stress, preferentially in women. However, to fully leverage the potential of these therapeutics in substance-using women, greater focus needs to the placed on reducing barriers to treatment and research by encouraging women into clinical trials.
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Affiliation(s)
- Helen C Fox
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
| | - Verica Milivojevic
- The Yale Stress Center, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rajita Sinha
- The Yale Stress Center, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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8
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Seyednejad SA, Sartor GC. Noncoding RNA therapeutics for substance use disorder. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2022; 2:10807. [PMID: 36601439 PMCID: PMC9808746 DOI: 10.3389/adar.2022.10807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Although noncoding RNAs (ncRNAs) have been shown to regulate maladaptive neuroadaptations that drive compulsive drug use, ncRNA-targeting therapeutics for substance use disorder (SUD) have yet to be clinically tested. Recent advances in RNA-based drugs have improved many therapeutic issues related to immune response, specificity, and delivery, leading to multiple successful clinical trials for other diseases. As the need for safe and effective treatments for SUD continues to grow, novel nucleic acid-based therapeutics represent an appealing approach to target ncRNA mechanisms in SUD. Here, we review ncRNA processes implicated in SUD, discuss recent therapeutic approaches for targeting ncRNAs, and highlight potential opportunities and challenges of ncRNA-targeting therapeutics for SUD.
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Affiliation(s)
- Seyed Afshin Seyednejad
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT, United States
- Connecticut Institute for the Brain and Cognitive Sciences (CT IBACS), Storrs, CT, United States
| | - Gregory C. Sartor
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT, United States
- Connecticut Institute for the Brain and Cognitive Sciences (CT IBACS), Storrs, CT, United States
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Sarkar S, Tom A, Mandal P. Barriers and Facilitators to Substance Use Disorder Treatment in Low-and Middle-Income Countries: A Qualitative Review Synthesis. Subst Use Misuse 2021; 56:1062-1073. [PMID: 33849383 DOI: 10.1080/10826084.2021.1908359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS One of the ways to address the treatment gap for substance use disorders is to understand the barriers and facilitators to treatment. This study aimed to synthesize the literature on barriers and facilitators of treatment in Low- and Middle-Income Countries (LMICs). METHODS We search Medline electronic database to identify English language peer reviewed empirical studies, both qualitative and quantitative which reported barriers and/or facilitators of treatment of substance use disorders. RESULTS Of 1389 titles, we selected 28 studies (14 were qualitative and 14 quantitative studies). The sample sizes of the qualitative studies ranged from 11 to 235. The majority of studies were from community or clinic settings. A wide range of barriers and facilitators were identified from the qualitative studies and were synthesized according to perceived susceptibility/seriousness, self-efficacy, perceived costs, perceived benefits, and cues to action. Most of the quantitative studies were community-based cross sectional-observational by design. Commonly identified barriers in these quantitative studies were perceived lack of problem or lack of need for treatment and low motivation whereas factors such as good family support and availability of effective treatment was found to facilitate substance use disorder treatment. CONCLUSION There are a wide range of barriers that hinder the substance use disorder treatment as well as certain factors that facilitate the treatment. Addressing them can help to minimize the treatment gap, which in turn can help in reducing the familial and social burden due to substance use disorders.
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Affiliation(s)
- Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Ashlyn Tom
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Piyali Mandal
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, New Delhi, India
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10
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Dennis EK, Garneau-Tsodikova S. Substance use disorders: leading the road to recovery. RSC Med Chem 2020; 11:741-744. [PMID: 33479671 DOI: 10.1039/d0md00161a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
Substance use disorders are diseases of the brain that create a dependency on drug(s), either prescription or illicit. These diseases affect millions of people worldwide, yet, there are few treatments that can help patients in the long term. This opinion piece looks at strategies researchers and institutes are taking to help find treatments as well as at new therapies in clinical trials. It provides an outlook on how a changing public perspective of these diseases can ultimately lead to a brighter outlook for substance use disorder treatments.
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Affiliation(s)
- Emily K Dennis
- Department of Pharmaceutical Sciences , University of Kentucky , Lee T. Todd, Jr. Building, 789 South Limestone Street , Lexington , KY 40536-0596 , USA . ;
| | - Sylvie Garneau-Tsodikova
- Department of Pharmaceutical Sciences , University of Kentucky , Lee T. Todd, Jr. Building, 789 South Limestone Street , Lexington , KY 40536-0596 , USA . ;
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11
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Swan JE, Votaw VR, Stein ER, Witkiewitz K. The Role of Affect in Psychosocial Treatments for Substance Use Disorders. CURRENT ADDICTION REPORTS 2020; 7:108-116. [PMID: 34327114 PMCID: PMC8317473 DOI: 10.1007/s40429-020-00304-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This paper provides a narrative review of studies published over the past five years that have examined the role of affect, including both affective symptoms and affective disorders, in psychosocial treatments for substance use disorder. RECENT FINDINGS A growing body of literature suggests that affective symptoms and affective disorders may moderate substance use disorder treatment efficacy, mediate the effects of treatment on substance use outcomes, and may be directly changed by substance use disorder treatment. SUMMARY Substance use disorders and affective disorders commonly co-occur, and both affect and affective disorders are associated with substance use disorder treatment outcomes. Future research should continue to examine affect as a moderator, mediator, and outcome of substance use disorder treatments. In particular, new studies that are designed to test precision medicine hypotheses would greatly expand our understanding of the role of affective symptoms and disorders in substance use disorder treatment.
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Affiliation(s)
- Julia E Swan
- Department of Psychology, University of New Mexico
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12
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Fronk GE, Sant'Ana SJ, Kaye JT, Curtin JJ. Stress Allostasis in Substance Use Disorders: Promise, Progress, and Emerging Priorities in Clinical Research. Annu Rev Clin Psychol 2020; 16:401-430. [PMID: 32040338 PMCID: PMC7259491 DOI: 10.1146/annurev-clinpsy-102419-125016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinicians and researchers alike have long believed that stressors play a pivotal etiologic role in risk, maintenance, and/or relapse of alcohol and other substance use disorders (SUDs). Numerous seminal and contemporary theories on SUD etiology posit that stressors may motivate drug use and that individuals who use drugs chronically may display altered responses to stressors. We use foundational basic stress biology research as a lens through which to evaluate critically the available evidence to support these key stress-SUD theses in humans. Additionally, we examine the field's success to date in targeting stressors and stress allostasis in treatments for SUDs. We conclude with our recommendations for how best to advance our understanding of the relationship between stressors and drug use, and we discuss clinical implications for treatment development.
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Affiliation(s)
- Gaylen E Fronk
- Department of Psychology, University of Wisconsin, Madison, Wisconsin 53706, USA; , ,
| | - Sarah J Sant'Ana
- Department of Psychology, University of Wisconsin, Madison, Wisconsin 53706, USA; , ,
| | - Jesse T Kaye
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705, USA;
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53711, USA
| | - John J Curtin
- Department of Psychology, University of Wisconsin, Madison, Wisconsin 53706, USA; , ,
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13
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Salivary clusterin as a biomarker of tobacco consumption in nicotine addicts undergoing smoking cessation therapy. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AbstractIntroductionRecent studies have led to suggest that the multifunctional protein clusterin could be envisaged as a potential diagnostic biomarker of addictive behaviours. However, this hypothesis has not been yet tested in nicotine addicts.AimsWe have studied possible associations between clusterin levels in saliva from smokers under cessation treatment and variables related to tobacco consumption, dependence and addiction.MethodsEighty-one patients were included in an ambulatory smoking cessation programme that involved the use of pharmacological and behavioural therapy. The participants underwent psychological assessment of addiction and dependence (DAST-20, ASSIST, Fagerström tests) and provided saliva samples at the onset of the intervention and 6 months after smoking discontinuation to study the evolution of clusterin levels by enzyme-linked immunosorbent assays.ResultsClusterin concentration did not correlate with nicotine addiction/dependence scores but was significantly elevated in smokers with prolonged tobacco use and high intensity of tobacco consumption. Moreover, the levels of the protein significantly decreased 6 months after smoking cessation.ConclusionsThe results obtained provide strong evidence of a close association between tobacco use and salivary clusterin, a protein that emerges as a biomarker of tobacco toxicity with potential interest to monitor the beneficial effects of smoking cessation.
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Sun Y, Zhang Y, Zhang D, Chang S, Jing R, Yue W, Lu L, Chen D, Sun Y, Fan Y, Shi J. GABRA2 rs279858-linked variants are associated with disrupted structural connectome of reward circuits in heroin abusers. Transl Psychiatry 2018; 8:138. [PMID: 30061709 PMCID: PMC6066482 DOI: 10.1038/s41398-018-0180-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
The reward system plays a vital role in drug addiction. The purpose of this study is to investigate the structural connectivity characteristics and driving-control subnetwork patterns of reward circuits in heroin abusers and assess the genetic modulation on the reward network. We first defined the reward network based on systematic literature review, and built the reward network based on diffusion tensor imaging data of 78 heroin abusers (HAs) and 79 healthy controls (HCs) using structural connectomics. Then we assessed genetic factors that might modulate changes in the reward network by performing imaging-genetic screening for 22 addiction-related polymorphisms. The genetic association was validated by performing genetic associations (1032 HAs and 2863 HCs) and expanded-variant analysis. Finally, we estimated the association between these genetic variations, reward network, and clinical performance. We found that HAs had widespread deficiencies in the structural connectivity of the reward circuit (center in VTA-linked connections), which correlated with cognition deficiency. The disruptions synchronously were shown on the reward driving system and reward control system. GABRA2 rs279858-linked variants might be a key genetic modulator for heroin vulnerability by affecting the connections of reward network and cognition. The role of the reward network connections that mediates the effects of rs279858 on cognition would be disrupted by heroin addiction. These findings provide new insights into the neurocircuitry and genetic mechanisms of addiction.
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Affiliation(s)
- Yan Sun
- National Institute on Drug Dependence, Peking University, 100191 Beijing, China
| | - Yang Zhang
- National Institute on Drug Dependence, Peking University, 100191 Beijing, China
- Department of Pharmacology School of Basic Medical Sciences, Peking University Health Science Center, 100191 Beijing, China
| | - Dai Zhang
- National Laboratory of Pattern Recognition Institute of Automation, Chinese Academy of Sciences, 100190 Beijing, China
| | - Suhua Chang
- Institute of Mental Health/Peking University Sixth Hospital and Key Laboratory of Mental Health, Peking University, 100191 Beijing, China
| | - Rixing Jing
- National Laboratory of Pattern Recognition Institute of Automation, Chinese Academy of Sciences, 100190 Beijing, China
| | - Weihua Yue
- Institute of Mental Health/Peking University Sixth Hospital and Key Laboratory of Mental Health, Peking University, 100191 Beijing, China
| | - Lin Lu
- National Institute on Drug Dependence, Peking University, 100191 Beijing, China
- Institute of Mental Health/Peking University Sixth Hospital and Key Laboratory of Mental Health, Peking University, 100191 Beijing, China
| | - Dong Chen
- Sanshui addiction treatment hospital, 528100 Guangdong, China
| | - Yankun Sun
- National Institute on Drug Dependence, Peking University, 100191 Beijing, China
- Department of Pharmacology School of Basic Medical Sciences, Peking University Health Science Center, 100191 Beijing, China
| | - Yong Fan
- Department of Radiology Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Jie Shi
- National Institute on Drug Dependence, Peking University, 100191 Beijing, China
- Beijing Key Laboratory on Drug Dependence Research, 100191 Beijing, China
- The State Key Laboratory of Natural and Biomimetic Drugs, 100191 Beijing, China
- The Key Laboratory for Neuroscience of the Ministry of Education and Health, Peking University, 100191 Beijing, China
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