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Wardle MC, Webber HE, Yoon JH, Heads AM, Stotts AL, Lane SD, Schmitz JM. Behavioral therapies targeting reward mechanisms in substance use disorders. Pharmacol Biochem Behav 2024; 240:173787. [PMID: 38705285 DOI: 10.1016/j.pbb.2024.173787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.
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Affiliation(s)
- Margaret C Wardle
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Heather E Webber
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, United States of America
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America.
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Melkumyan M, Annaswamy VM, Evans AM, Showemimo OF, McCullers ZE, Sun D, Murphy TE, Vrana KE, Arnold AC, Raup-Konsavage WM, Silberman Y. Effects of cannabidiol, with and without ∆9-tetrahydrocannabinol, on anxiety-like behavior following alcohol withdrawal in mice. Front Neurosci 2024; 18:1375440. [PMID: 38957186 PMCID: PMC11217543 DOI: 10.3389/fnins.2024.1375440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Alcohol use disorder (AUD) is commonly associated with anxiety disorders and enhanced stress-sensitivity; symptoms that can worsen during withdrawal to perpetuate continued alcohol use. Alcohol increases neuroimmune activity in the brain. Our recent evidence indicates that alcohol directly modulates neuroimmune function in the central amygdala (CeA), a key brain region regulating anxiety and alcohol intake, to alter neurotransmitter signaling. We hypothesized that cannabinoids, such as cannabidiol (CBD) and ∆9-tetrahydrocannabinol (THC), which are thought to reduce neuroinflammation and anxiety, may have potential utility to alleviate alcohol withdrawal-induced stress-sensitivity and anxiety-like behaviors via modulation of CeA neuroimmune function. Methods We tested the effects of CBD and CBD:THC (3:1 ratio) on anxiety-like behaviors and neuroimmune function in the CeA of mice undergoing acute (4-h) and short-term (24-h) withdrawal from chronic intermittent alcohol vapor exposure (CIE). We further examined the impact of CBD and CBD:THC on alcohol withdrawal behaviors in the presence of an additional stressor. Results We found that CBD and 3:1 CBD:THC increased anxiety-like behaviors at 4-h withdrawal. At 24-h withdrawal, CBD alone reduced anxiety-like behaviors while CBD:THC had mixed effects, showing increased center time indicating reduced anxiety-like behaviors, but increased immobility time that may indicate increased anxiety-like behaviors. These mixed effects may be due to altered metabolism of CBD and THC during alcohol withdrawal. Immunohistochemical analysis showed decreased S100β and Iba1 cell counts in the CeA at 4-h withdrawal, but not at 24-h withdrawal, with CBD and CBD:THC reversing alcohol withdrawal effects.. Discussion These results suggest that the use of cannabinoids during alcohol withdrawal may lead to exacerbated anxiety depending on timing of use, which may be related to neuroimmune cell function in the CeA.
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Affiliation(s)
- Mariam Melkumyan
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA, United States
| | - Vibha M. Annaswamy
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA, United States
| | - Alexandra M. Evans
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA, United States
| | - Opeyemi F. Showemimo
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA, United States
| | - Zari E. McCullers
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA, United States
| | - Dongxiao Sun
- The Pennsylvania State University College of Medicine, Department of Pharmacology, Hershey, PA, United States
| | - Terrence E. Murphy
- The Pennsylvania State University College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Kent E. Vrana
- The Pennsylvania State University College of Medicine, Department of Pharmacology, Hershey, PA, United States
| | - Amy C. Arnold
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA, United States
| | - Wesley M. Raup-Konsavage
- The Pennsylvania State University College of Medicine, Department of Pharmacology, Hershey, PA, United States
| | - Yuval Silberman
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA, United States
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Hall OT, Gunawan T, Teater J, Bryan C, Gorka S, Ramchandani VA. Withdrawal interference scale: a novel measure of withdrawal-related life disruption in opioid use disorder and alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-13. [PMID: 38853684 DOI: 10.1080/00952990.2024.2350057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 04/28/2024] [Indexed: 06/11/2024]
Abstract
Background: Hyperkatifeia describes amplified emotional and motivational withdrawal due to addiction-related sensitization of brain-stress-systems. Hyperkatifeia has been proposed as a target for addiction treatment development. However, translation of basic research in this area will require new tools designed to measure hyperkatifeia and related phenomena outside of laboratory settings.Objectives: We define a novel concept, withdrawal interference, and introduce a new tool - the Withdrawal Interference Scale (WIS) - which measures the impact of withdrawal on daily life among individuals with OUD or AUD.Methods: Described are the combined results of three separate cross-sectional studies. The structural validity, convergent validity, construct validity, trans-diagnostic (AUD/OUD) configural, metric, and scalar invariance, internal consistency, and composite reliability of WIS was tested among three independent samples of 1) treatment-seeking adults with OUD (n = 132), 2) treatment-seeking adults with AUD (n = 123), and 3) non-treatment-seeking adults with OUD (n = 140). Males numbered 218 and females were 163.Results: WIS exhibited structural validity (1 factor), convergent validity (average variance extracted .670-.676), construct validity, trans-diagnostic configural (χ2/df = 2.10), metric (Δχ2 = 5.70, p = .681), and scalar invariance (Δχ2 = 12.34, p = .338), internal consistency (α .882-928), and composite reliability (.924-.925).Conclusion: These results suggest WIS is a valid and reliable instrument for measuring withdrawal-related life disruption in AUD and OUD. Further, given our findings of transdiagnostic measurement invariance, WIS scores of individuals with AUD and OUD can be meaningfully compared in future statistical analyses.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Tommy Gunawan
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
- Intramural Science Program, Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Craig Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Vijay A Ramchandani
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
- Intramural Science Program, Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
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Mao S, Chou T, D'Orsogna MR. A probabilistic model of relapse in drug addiction. Math Biosci 2024; 372:109184. [PMID: 38582296 DOI: 10.1016/j.mbs.2024.109184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
More than 60% of individuals recovering from substance use disorder relapse within one year. Some will resume drug consumption even after decades of abstinence. The cognitive and psychological mechanisms that lead to relapse are not completely understood, but stressful life experiences and external stimuli that are associated with past drug-taking are known to play a primary role. Stressors and cues elicit memories of drug-induced euphoria and the expectation of relief from current anxiety, igniting an intense craving to use again; positive experiences and supportive environments may mitigate relapse. We present a mathematical model of relapse in drug addiction that draws on known psychiatric concepts such as the "positive activation; negative activation" paradigm and the "peak-end" rule to construct a relapse rate that depends on external factors (intensity and timing of life events) and individual traits (mental responses to these events). We analyze which combinations and ordering of stressors, cues, and positive events lead to the largest relapse probability and propose interventions to minimize the likelihood of relapse. We find that the best protective factor is exposure to a mild, yet continuous, source of contentment, rather than large, episodic jolts of happiness.
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Affiliation(s)
- Sayun Mao
- Department of Computational Medicine, UCLA, Los Angeles, 90095-1766, CA, USA.
| | - Tom Chou
- Department of Computational Medicine, UCLA, Los Angeles, 90095-1766, CA, USA.
| | - Maria R D'Orsogna
- Department of Computational Medicine, UCLA, Los Angeles, 90095-1766, CA, USA; Department of Mathematics, California State University at Northridge, Los Angeles, 91330, CA, USA.
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Bahji A, Crockford D, Brasch J, Schutz C, Buckley L, Danilewitz M, Dubreucq S, Mak M, George TP. Training in Substance use Disorders, Part 1: Overview of Clinical Practice Recommendations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:428-456. [PMID: 38613369 PMCID: PMC11107443 DOI: 10.1177/07067437241231128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Anees Bahji
- Clinical Assistant Professor, Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Crockford
- Clinical Professor, University of Calgary, Cumming School of Medicine, Department of Psychiatry, Calgary, AB, Canada; Hotchkiss Brain Institute & Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada
| | - Jennifer Brasch
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Lead, Addiction Psychiatry, St. Joseph's Healthcare, Hamilton, ON, Canada; Past-President, Canadian Society of Addiction Medicine, Calgary, AB, Canada
| | - Christian Schutz
- Professor, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Research Lead Adult Mental Health and Substance Use, Provincial Health Service Authority, Vancouver, BC, Canada
| | - Leslie Buckley
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marlon Danilewitz
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Associate Medical Director, General Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Simon Dubreucq
- Psychiatrist, Department of Addiction Medicine, CHUM, Montreal, QC, Canada; Assistant Professor, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Michael Mak
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Adjunct Assistant Professor, Department of Medicine, McMaster University, Hamilton, ON, Canada; Adjunct Research Professor, Department of Psychiatry, Western University, London, ON, Canada
| | - Tony P George
- Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Feingold D, Neria Y, Bitan DT. PTSD, distress and substance use in the aftermath of October 7th, 2023, terror attacks in Southern Israel. J Psychiatr Res 2024; 174:153-158. [PMID: 38631140 DOI: 10.1016/j.jpsychires.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/10/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
The October 7th, 2023, terror attacks in Israel were characterized by a scope and magnitude not previously known to Israeli citizens. The aim of this study was to examine the prevalence and correlates of posttraumatic stress disorder (PTSD), emotional distress and use of addictive substances among Israeli adults, approximately one month following the attacks. PTSD was assessed with the Posttraumatic Stress Disorder Checklist (PCL-5) and emotional distress was assessed with a brief version of the Hopkins Symptom Checklist (HSCL-25). Participants also ranked the degree of change in their frequency of use of six addictive substances. The final sample consisted of 415 Jewish and Arab Israeli adults. Results indicate that one month following the attacks, 31.4% of the total sample qualified for positive screening of PTSD. An increase in the use of tobacco, alcohol, tranquilizers and sleep medications was reported by 16.5%, 10.1%, 11.1% and 10.6% of the sample, respectively. Being at a younger age, of female sex and with increased exposure to the attacks was associated with increased levels of PTSD (β = -0.24, p < 0.001; β = 0.19, p < 0.001 and β = 0.29, p < 0.001, respectively) and increased distress (β = -0.22, p < 0.001, β = 0.26, p < 0.001 and β = 0.19, p < 0.001, respectively). Being male was significantly associated with increased use of cannabis (Adjusted Odds Ratio (AOR) = 4.73, 95% Confidence Interval (CI) = 1.70-13.13, p = 0.003), and level of exposure to traumatic events was significantly associated with increased use of tranquilizers (AOR = 1.58, 95% CI = 1.17-2.13, p = 0.003). The high magnitude of symptomatic response should alert other countries as they prepare for national disasters.
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Affiliation(s)
- Daniel Feingold
- Psychology Department, Achva Academic College, Achva, Israel.
| | - Yuval Neria
- Columbia University, Irving Medical Center, New York, USA
| | - Dana Tzur Bitan
- Department of Community Mental Health, University of Haifa, Haifa, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel
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Marti-Prats L, Belin D. Characterization in the rat of the individual tendency to rely on alcohol to cope with distress and the ensuing vulnerability to drink compulsively. Brain Commun 2024; 6:fcae169. [PMID: 38868300 PMCID: PMC11168338 DOI: 10.1093/braincomms/fcae169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/12/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
Only some vulnerable individuals who recreationally drink alcohol eventually develop the compulsive drinking pattern that characterizes alcohol use disorder. A new frontier in biomedical research lies in understanding the neurobehavioural mechanisms of this individual vulnerability, a necessary step towards developing novel effective therapeutic strategies. Translational research has been hindered by the lack of valid, reliable and robust approaches that enable the study of the influence of the reliance on alcohol to cope with stress or self-medicate negative emotional states on the subsequent transition to alcohol use disorder. We have therefore developed a behavioural task in the rat that enables the investigation of the neural and cellular basis of the exacerbation of the vulnerability to develop compulsive alcohol drinking by the use of alcohol to develop an adjunctive, anxiolytic, polydipsic drinking behaviour in a schedule-induced polydipsia procedure. Hence, in our task, alcohol is introduced in the schedule-induced polydipsia context after several weeks of training with water so that rats are exposed to alcohol for the first time in a distressing context and learn to drink alcohol as a coping strategy. Capitalizing on this protocol, we have consistently been able to identify a subpopulation of rats that were unable to learn to cope with negative states by drinking water and relied on alcohol to do so. This maladaptive reliance on alcohol drinking to cope with distress has been shown to be associated with an exacerbation of the subsequent transition to compulsive drinking. Furthermore, these vulnerable rats reached blood alcohol levels comparable to that of intoxication in humans, thereby developing two key features of alcohol use disorder, namely excessive alcohol intake and compulsive drinking. Altogether, this behavioural task provides a novel and unique tool for the investigation of the neurobehavioural mechanisms underlying the exacerbation of the individual vulnerability to developing compulsive alcohol drinking by the use of alcohol as a strategy to cope with distress, and for the evaluation of the efficacy of potential therapeutic strategies in a personalized medicine approach. This procedure, which focuses on an understudied but key factor of the development of alcohol use disorder, may become widely used as it benefits the fields of alcohol, emotion regulation and stress, the interest in which has substantially increased since the evidence of a profound exacerbation of alcohol use and alcohol-related negative consequences by the distress and social isolation engendered by the various measures implemented worldwide in response to the COVID-19 pandemic.
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Affiliation(s)
- Lucia Marti-Prats
- Department of Psychology, CLIC (Cambridge Laboratory for Research on Impulsive/Compulsive Disorders), University of Cambridge, Cambridge CB2 3EB, UK
| | - David Belin
- Department of Psychology, CLIC (Cambridge Laboratory for Research on Impulsive/Compulsive Disorders), University of Cambridge, Cambridge CB2 3EB, UK
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Robbins TW, Banca P, Belin D. From compulsivity to compulsion: the neural basis of compulsive disorders. Nat Rev Neurosci 2024; 25:313-333. [PMID: 38594324 DOI: 10.1038/s41583-024-00807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
Compulsive behaviour, an apparently irrational perseveration in often maladaptive acts, is a potential transdiagnostic symptom of several neuropsychiatric disorders, including obsessive-compulsive disorder and addiction, and may reflect the severe manifestation of a dimensional trait termed compulsivity. In this Review, we examine the psychological basis of compulsions and compulsivity and their underlying neural circuitry using evidence from human neuroimaging and animal models. Several main elements of this circuitry are identified, focused on fronto-striatal systems implicated in goal-directed behaviour and habits. These systems include the orbitofrontal, prefrontal, anterior cingulate and insular cortices and their connections with the basal ganglia as well as sensoriomotor and parietal cortices and cerebellum. We also consider the implications for future classification of impulsive-compulsive disorders and their treatment.
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Affiliation(s)
- Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
| | - Paula Banca
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
| | - David Belin
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
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De Aquino JP, Sloan ME, Nunes JC, Costa GPA, Katz JL, de Oliveira D, Ra J, Tang VM, Petrakis IL. Alcohol Use Disorder and Chronic Pain: An Overlooked Epidemic. Am J Psychiatry 2024; 181:391-402. [PMID: 38706339 DOI: 10.1176/appi.ajp.20230886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Alcohol use disorder (AUD) and chronic pain disorders are pervasive, multifaceted medical conditions that often co-occur. However, their comorbidity is often overlooked, despite its prevalence and clinical relevance. Individuals with AUD are more likely to experience chronic pain than the general population. Conversely, individuals with chronic pain commonly alleviate their pain with alcohol, which may escalate into AUD. This narrative review discusses the intricate relationship between AUD and chronic pain. Based on the literature available, the authors present a theoretical model explaining the reciprocal relationship between AUD and chronic pain across alcohol intoxication and withdrawal. They propose that the use of alcohol for analgesia rapidly gives way to acute tolerance, triggering the need for higher levels of alcohol consumption. Attempts at abstinence lead to alcohol withdrawal syndrome and hyperalgesia, increasing the risk of relapse. Chronic neurobiological changes lead to preoccupation with pain and cravings for alcohol, further entrenching both conditions. To stimulate research in this area, the authors review methodologies to improve the assessment of pain in AUD studies, including self-report and psychophysical methods. Further, they discuss pharmacotherapies and psychotherapies that may target both conditions, potentially improving both AUD and chronic pain outcomes simultaneously. Finally, the authors emphasize the need to manage both conditions concurrently, and encourage both the scientific community and clinicians to ensure that these intertwined conditions are not overlooked given their clinical significance.
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Affiliation(s)
- Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Matthew E Sloan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Gabriel P A Costa
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Jasmin L Katz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Debora de Oliveira
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Jocelyn Ra
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Victor M Tang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Ismene L Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
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10
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Cheng Y, Magnard R, Langdon AJ, Lee D, Janak PH. Chronic Ethanol Exposure Produces Persistent Impairment in Cognitive Flexibility and Decision Signals in the Striatum. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.10.584332. [PMID: 38585868 PMCID: PMC10996555 DOI: 10.1101/2024.03.10.584332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Lack of cognitive flexibility is a hallmark of substance use disorders and has been associated with drug-induced synaptic plasticity in the dorsomedial striatum (DMS). Yet the possible impact of altered plasticity on real-time striatal neural dynamics during decision-making is unclear. Here, we identified persistent impairments induced by chronic ethanol (EtOH) exposure on cognitive flexibility and striatal decision signals. After a substantial withdrawal period from prior EtOH vapor exposure, male, but not female, rats exhibited reduced adaptability and exploratory behavior during a dynamic decision-making task. Reinforcement learning models showed that prior EtOH exposure enhanced learning from rewards over omissions. Notably, neural signals in the DMS related to the decision outcome were enhanced, while those related to choice and choice-outcome conjunction were reduced, in EtOH-treated rats compared to the controls. These findings highlight the profound impact of chronic EtOH exposure on adaptive decision-making, pinpointing specific changes in striatal representations of actions and outcomes as underlying mechanisms for cognitive deficits.
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Affiliation(s)
- Yifeng Cheng
- Department Psychological and Brain Sciences, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Robin Magnard
- Department Psychological and Brain Sciences, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Angela J. Langdon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Daeyeol Lee
- Department Psychological and Brain Sciences, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
- Zanvyl Krieger Mind/Brain Institute, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD
| | - Patricia H. Janak
- Department Psychological and Brain Sciences, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD
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11
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Rausch J, Entrup P, Deaner M, King J, Hall OT. Pain and its Perceived Relatedness to the Onset, Maintenance, and Relapse of Opioid use Disorder: A Descriptive Study of Non-Treatment-Seeking Individuals. Can J Pain 2024; 8:2332198. [PMID: 38778924 PMCID: PMC11110686 DOI: 10.1080/24740527.2024.2332198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/15/2024] [Indexed: 05/25/2024]
Abstract
Background Previous research has found chronic pain to be prevalent among individuals with opioid use disorder (OUD). The perception that pain is related to OUD onset, maintenance, relapse, and treatment delay has been noted in this population. However, prior works primarily involved treatment-engaged populations. Scant research describes such perceptions among non-treatment-seeking individuals. Aims This study describes pain burden and perceptions regarding the role of pain in OUD onset, maintenance, relapse, and addiction treatment delay in a sample of individuals with untreated OUD. Methods This cross-sectional study surveyed syringe exchange participants (n = 141). Participants responded to a survey including Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition OUD criteria, pain survey scales, demographic characteristics, and questions regarding pain and its perceived relatedness to aspects of OUD. Results Most participants reported pain within the past 4 weeks (127, 91.4%). Data displayed a skew toward more intense pain ratings, with 120 reporting their pain as greater than mild (86.3%). A majority of participants agreed that pain was responsible for their OUD onset (79, 56.4%), maintenance (76, 54.3%), past relapse experience (82, 57.9%), and treatment delay (81, 57.9%). Correlative analyses revealed that pain severity and interference measures displayed moderate and statistically significant associations with extent of perceived relatedness of pain to these aspects of OUD. Conclusions Among this sample of individuals with untreated OUD, pain and pain interference were prevalent. Pain was perceived to be related to OUD onset, maintenance, relapse, and treatment delay by a majority of the sample. These findings are in accordance with and expand upon prior works. Abbreviations OUD: opioid use disorder; DSM-5: Diagnostic and Statistical Manual 5; BPI: Brief Pain Inventory; NIDA: National Institute on Drug Abuse; IASP: International Association for the Study of Pain; MOUD: Medications for Opioid Use Disorder; IQR: Interquartile Range.
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Affiliation(s)
- Johnathan Rausch
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, OH, USA
| | - Parker Entrup
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Megan Deaner
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, OH, USA
| | - Jasmine King
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - O. Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, OH, USA
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12
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Hall OT, Vilensky M, Teater JE, Bryan C, Rood K, Niedermier J, Entrup P, Gorka S, King A, Williams DA, Phan KL. Withdrawal catastrophizing scale: initial psychometric properties and implications for the study of opioid use disorder and hyperkatifeia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-13. [PMID: 38502911 DOI: 10.1080/00952990.2023.2298257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/19/2023] [Indexed: 03/21/2024]
Abstract
Background: Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.Objectives: We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).Methods: Prospective observational study (n = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.Results: WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (rs (99) = 0.237, p = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (rs (119) = 0.357, p < .001); withdrawal-motivated OUD treatment avoidance (rs (119) = 0.421, p < .001), history of leaving the hospital against medical advice (rs (119) = 0.373, p < .001) and buprenorphine-precipitated withdrawal (rs (119) = 0.369, p < .001).Conclusion: This study provides first evidence of withdrawal catastrophizing as a clinically important phenomenon with implications for the future study and treatment of OUD.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Vilensky
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie E Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Craig Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kara Rood
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Niedermier
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Parker Entrup
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anthony King
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
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13
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Flores-Ramirez FJ, Illenberger JM, Pascasio G, Terenius L, Martin-Fardon R. LY2444296, a κ-opioid receptor antagonist, selectively reduces alcohol drinking in male and female Wistar rats with a history of alcohol dependence. Sci Rep 2024; 14:5804. [PMID: 38461355 PMCID: PMC10925033 DOI: 10.1038/s41598-024-56500-9] [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: 01/11/2024] [Accepted: 03/07/2024] [Indexed: 03/11/2024] Open
Abstract
Alcohol use disorder (AUD) remains a major public health concern. The dynorphin (DYN)/κ-opioid receptor (KOP) system is involved in actions of alcohol, particularly its withdrawal-associated negative affective states. This study tested the ability of LY2444296, a selective, short-acting, KOP antagonist, to decrease alcohol self-administration in dependent male and female Wistar rats at 8 h abstinence. Animals were trained to orally self-administer 10% alcohol (30 min/day for 21 sessions) and were made dependent via chronic intermittent alcohol vapor exposure for 6 weeks or exposed to air (nondependent). After 6 weeks, the effect of LY2444296 (0, 3, and 10 mg/kg, p.o.) was tested on alcohol self-administration at 8 h of abstinence. A separate cohort of rats was prepared in parallel, and their somatic withdrawal signs and alcohol self-administration were measured after LY2444296 administration at 8 h, 2 weeks, and 4 weeks abstinence. LY2444296 at 3 and 10 mg/kg significantly reduced physical signs of withdrawal in dependent rats at 8 h abstinence, only. Furthermore, 3 and 10 mg/kg selectively decreased alcohol self-administration in dependent rats at only 8 h abstinence. These results highlight the DYN/KOP system in actions of alcohol during acute abstinence, suggesting KOP antagonism could be beneficial for mitigating acute withdrawal signs and, in turn, significantly reduce excessive alcohol consumption associated with AUD.
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Affiliation(s)
- Francisco J Flores-Ramirez
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA.
| | - Jessica M Illenberger
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA
| | - Glenn Pascasio
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA
| | - Lars Terenius
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Rémi Martin-Fardon
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA
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14
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Seemiller LR, Flores-Cuadra J, Griffith KR, Smith GC, Crowley NA. Alcohol and stress exposure across the lifespan are key risk factors for Alzheimer's Disease and cognitive decline. Neurobiol Stress 2024; 29:100605. [PMID: 38268931 PMCID: PMC10806346 DOI: 10.1016/j.ynstr.2024.100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
Alzheimer's Disease and related dementias (ADRD) are an increasing threat to global health initiatives. Efforts to prevent the development of ADRD require understanding behaviors that increase and decrease risk of neurodegeneration and cognitive decline, in addition to uncovering the underlying biological mechanisms behind these effects. Stress exposure and alcohol consumption have both been associated with increased risk for ADRD in human populations. However, our ability to understand causal mechanisms of ADRD requires substantial preclinical research. In this review, we summarize existing human and animal research investigating the connections between lifetime stress and alcohol exposures and ADRD.
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Affiliation(s)
- Laurel R. Seemiller
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Julio Flores-Cuadra
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Neuroscience Graduate Program, Huck Institute of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Keith R. Griffith
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Grace C. Smith
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Nicole A. Crowley
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- Neuroscience Graduate Program, Huck Institute of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
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15
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Kovačić Petrović Z, Peraica T, Blažev M, Kozarić-Kovačić D. Association between prolonged stress caused by COVID-19 pandemic and earthquakes and quality of life, anxiety, depression, psychoactive substances, and problematic alcohol use in adult Croatian population. Front Psychiatry 2024; 15:1295977. [PMID: 38487575 PMCID: PMC10937337 DOI: 10.3389/fpsyt.2024.1295977] [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: 09/17/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
Background The prolonged stress experience caused by the COVID-19 pandemic and two earthquakes led to increased alcohol and psychoactive substance use (PSU) accompanied by a decrease in mental wellbeing and quality of life (QoL) in the Croatian population. Our aim was to determine the relationship between alcohol and PSU and mental health outcomes including anxiety and depression, and QoL. Methods A cross-sectional online survey conducted from September 30 to October 27, 2021, included 1,118 Croatian adults (220 men and 898 women; mean age, 35.1 ± 12.3 years) recruited through non-probabilistic convenience sampling. The survey consisted of a self-reported questionnaire on PSU, the CAGE Alcohol Questionnaire, the Hospital Anxiety Depression Scale, and the World Health Organization Quality of Life (WHOQoL)-BREF. Structural equation modeling was used to evaluate the association between PSU, problematic alcohol use (PAU), mental health outcomes, and QoL. Results The model demonstrated a good fit and indicated that PSU increase, PAU, and anxiety and depression symptoms significantly explained all QoL domains (p < 0.001 for all). Both PSU increase and PAU during prolonged stress were directly associated with decreased QoL. These relationships were also indirectly mediated through increased anxiety and depression symptoms. Conclusion These results showed the need to direct public health interventions and treatment interventions during and after long-term stress (pandemics and earthquakes) to reduce the negative impact on substance use and QoL by reducing depression and anxiety, which ultimately may contribute to better wellbeing and rapid recovery of individuals affected by prolonged stress.
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Affiliation(s)
- Zrnka Kovačić Petrović
- Department of Psychiatry and Psychological Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Addiction, University Hospital Vrapče, Zagreb, Croatia
| | - Tina Peraica
- Department of Psychiatry, Referral Center for Stress-related Disorders of the Ministry of Health, University Hospital Dubrava, Zagreb, Croatia
- Department of Forensic Sciences, University of Split, Split, Croatia
| | - Mirta Blažev
- Ivo Pilar Institute of Social Sciences, Zagreb, Croatia
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16
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McCabe EM, Luk JW, Stangl BL, Schwandt ML, Ziausyte U, Kim H, Vergeer RR, Gunawan T, Fede SJ, Momenan R, Joseph PV, Goldman D, Diazgranados N, Ramchandani VA. Exercising healthy behaviors: A latent class analysis of positive coping during the COVID-19 pandemic and associations with alcohol-related and mental health outcomes. PLoS One 2024; 19:e0297060. [PMID: 38354113 PMCID: PMC10866465 DOI: 10.1371/journal.pone.0297060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To identify latent classes of positive coping behaviors during the COVID-19 pandemic and examine associations with alcohol-related and mental health outcomes across participants with and without a history of alcohol use disorder (AUD). METHODS Baseline data from 463 participants who were enrolled in the NIAAA COVID-19 Pandemic Impact on Alcohol (C19-PIA) Study were analyzed. Latent class analysis (LCA) was applied to five positive coping behaviors during COVID-19: taking media breaks, taking care of their body, engaging in healthy behaviors, making time to relax, and connecting with others. Latent class differences and the moderating role of history of AUD on six alcohol-related and mental health outcomes were examined using multiple regression models. RESULTS LCA revealed two latent classes: 83.4% High Positive Coping and 16.6% Low Positive Coping. Low Positive Coping was associated with higher levels of perceived stress, anxiety symptoms, and loneliness. A history of AUD was consistently associated with higher levels of alcohol-related and mental health outcomes. Significant interactions between Coping Latent Classes and history of AUD indicated that the associations of Low Positive Coping with problematic alcohol use, depressive symptoms, and drinking to cope motives were either stronger or only significant among individuals with a history of AUD. CONCLUSIONS Individuals with a history of AUD may be particularly vulnerable to depressive symptoms and alcohol-related outcomes, especially when they do not utilize positive coping strategies. The promotion of positive coping strategies is a promising avenue to address alcohol-related and mental health problems during a public health crisis and warrants future research.
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Affiliation(s)
- Emma M. McCabe
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Jeremy W. Luk
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Bethany L. Stangl
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Melanie L. Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Ugne Ziausyte
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Hannah Kim
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Rhianna R. Vergeer
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Tommy Gunawan
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Samantha J. Fede
- Clinical NeuroImaging Research Core, Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Reza Momenan
- Clinical NeuroImaging Research Core, Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Paule V. Joseph
- Section of Sensory Science and Metabolism, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, United States of America
| | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - Vijay A. Ramchandani
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
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17
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Luk JW, Satre DD, Cheung R, Wong RJ, Monto A, Chen JY, Batki SL, Ostacher MJ, Snyder HR, Shui AM, Liao M, Haight CG, Khalili M. Problematic alcohol use and its impact on liver disease quality of life in a multicenter study of patients with cirrhosis. Hepatol Commun 2024; 8:e0379. [PMID: 38315141 PMCID: PMC10843394 DOI: 10.1097/hc9.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Management of cirrhosis is challenging and has been complicated by the COVID-19 pandemic due to decreased access to care, increased psychological distress, and alcohol misuse. Recently, The National Institute on Alcohol Abuse and Alcoholism has broadened the definition of recovery from alcohol use disorder to include quality of life (QoL) as an indicator of recovery. This study examined the associations of alcohol-associated cirrhosis etiology and problematic drinking with liver disease QoL (LDQoL). METHODS Patients with cirrhosis (N=329) were recruited from 3 sites (63% from 2 Veterans Affairs Health Care Systems and 37% from 1 safety net hospital) serving populations that are economically or socially marginalized. Cirrhosis etiology was ascertained by chart review of medical records. Problematic drinking was defined by ≥8 on the Alcohol Use Disorders Identification Test. Multivariable general linear modeling adjusting for age, sex, race/ethnicity, site, pandemic-related stress, and history of anxiety/depressive disorder were conducted. Sensitivity analyses further adjusted for indicators of liver disease severity. RESULTS Participants were on average 64.6 years old, 17% female, 58% non-White, 44% with alcohol-associated cirrhosis, and 17% with problematic drinking. Problematic drinking was significantly associated with worse LDQoL scores in the overall scale and in the memory/concentration and health distress subscales. These associations remained significant after adjusting for indicators of liver disease severity, including Model for End-Stage Liver Disease-Sodium score and decompensated cirrhosis status. CONCLUSIONS Among patients with cirrhosis, problematic drinking was associated with worse LDQoL, especially in the domains of memory/concentration and health distress. Assessment and awareness of cognitive deficits and negative emotionality within the context of cirrhosis and problematic drinking may help clinicians provide better integrated care for this population.
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Affiliation(s)
- Jeremy W. Luk
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
| | - Ramsey Cheung
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Robert J. Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Alexander Monto
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer Y. Chen
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, California, USA
| | - Steven L. Batki
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Mental Health Service, Veterans Affairs San Francisco Health Care System, San Francisco, California, USA
| | - Michael J. Ostacher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Department of Psychiatry, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Hannah R. Snyder
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Meimei Liao
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Christina G. Haight
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, California, USA
| | - Mandana Khalili
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, California, USA
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18
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May PA, Hasken JM, de Vries MM, Marais AS, Abdul-Rahman O, Robinson LK, Adam MP, Manning MA, Kalberg WO, Buckley D, Snell CL, Seedat S, Parry CD, Hoyme HE. Maternal risk factors for fetal alcohol spectrum disorders: Distal variables. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:319-344. [PMID: 38105110 PMCID: PMC10922553 DOI: 10.1111/acer.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND A variety of maternal risk factors for fetal alcohol spectrum disorders (FASD) have been described in the literature. Here, we conducted a multivariate analysis of a large array of potential distal influences on FASD risk. METHODS Interviews were conducted with 2515 mothers of first-grade students whose children were evaluated to assess risk for FASD. Topics included: physical/medical status, childbearing history, demographics, mental health, domestic violence, and trauma. Regression modeling utilized usual level of alcohol consumption by trimester and six selected distal variables (maternal head circumference, body mass index, age at pregnancy, gravidity, marital status, and formal years of education) to differentiate children with FASD from control children. RESULTS Despite individual variation in distal maternal risk factors among and within the mothers of children with each of the common diagnoses of FASD, patterns emerged that differentiated risk among mothers of children with FASD from mothers whose children were developing typically. Case-control comparisons indicate that mothers of children with FASD were significantly smaller physically, had higher gravidity and parity, and experienced more miscarriages and stillbirths, were less likely to be married, reported later pregnancy recognition, more depression, and lower formal educational achievement. They were also less engaged with a formal religion, were less happy, suffered more childhood trauma and interpersonal violence, were more likely to drink alone or with her partner, and drank to deal with anxiety, tension, and to be part of a group. Regression analysis showed that the predictor variables explain 57.5% of the variance in fetal alcohol syndrome (FAS) diagnoses, 30.1% of partial FAS (PFAS) diagnoses, and 46.4% of alcohol-related neurodevelopmental disorder (ARND) diagnoses in children with FASD compared to controls. While the proximal variables explained most of the diagnostic variance, six distal variables explained 16.7% (1 /6 ) of the variance in FAS diagnoses, 13.9% (1 /7 ) of PFAS, and 12.1% (1 /8 ) of ARND. CONCLUSIONS Differences in distal FASD risks were identified. Complex models to quantify risk for FASD hold promise for guiding prevention/intervention.
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Affiliation(s)
- Philip A. May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Julie M. Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC 28081, United States
| | - Marlene M. de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Omar Abdul-Rahman
- Department of Pediatrics, New York- Presbyterian Weill Cornell Medicine, Columbia University, 505 E 70 St, New York, NY 10021
| | - Luther K. Robinson
- Department of Pediatrics, State University of New York, 1001 Main Street, Buffalo, NY 14203, United States
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98175, USA
| | - Melanie A. Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Wendy O. Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions, The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, United States
| | - Cudore L. Snell
- School of Social Work, Howard University, Washington D.C., 20059, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Charles D.H. Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa
| | - H. Eugene Hoyme
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Sanford Children’s Genomic Medicine Consortium, Sanford Health, 1600 W. 22 St. Sioux Falls, SD, 57117, United States
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19
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Koob GF. Alcohol Use Disorder Treatment: Problems and Solutions. Annu Rev Pharmacol Toxicol 2024; 64:255-275. [PMID: 38261428 DOI: 10.1146/annurev-pharmtox-031323-115847] [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: 01/25/2024]
Abstract
Alcohol use disorder (AUD) afflicts over 29 million individuals and causes more than 140,000 deaths annually in the United States. A heuristic framework for AUD includes a three-stage cycle-binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation-that provides a starting point for exploring the heterogeneity of AUD with regard to treatment. Effective behavioral health treatments and US Food and Drug Administration-approved medications are available but greatly underutilized, creating a major treatment gap. This review outlines challenges that face the alcohol field in closing this treatment gap and offers solutions, including broadening end points for the approval of medications for the treatment of AUD; increasing the uptake of screening, brief intervention, and referral to treatment; addressing stigma; implementing a heuristic definition of recovery; engaging early treatment; and educating health-care professionals and the public about challenges that are associated with alcohol misuse. Additionally, this review focuses on broadening potential targets for the development of medications for AUD by utilizing the three-stage heuristic model of addiction that outlines domains of dysfunction in AUD and the mediating neurobiology of AUD.
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Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA;
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20
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Yu RA, Goulter N, Godwin JW, McMahon RJ. Child and Adolescent Psychopathology and Subsequent Harmful Behaviors Associated with Premature Mortality: A Selective Review and Future Directions. Clin Child Fam Psychol Rev 2023; 26:1008-1024. [PMID: 37819404 DOI: 10.1007/s10567-023-00459-y] [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] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
In the United States (U.S.), premature mortality in adulthood from suicide, alcohol-related disease, and substance overdoses has increased steadily over the past two decades. To better understand these trends, it is necessary to first examine the harmful behaviors that often precede these preventable deaths (i.e., suicidal ideation and attempts, and harmful alcohol and substance use). Representing critical developmental periods in which psychopathology is most likely to emerge, childhood and adolescence provide an informative lens through which to investigate susceptibility to harmful behaviors. This article synthesizes current evidence describing these rising U.S. mortality rates and the prevalence rates of harmful behaviors linked to these types of mortality. A brief selective review of longitudinal research on harmful behaviors in relation to the most relevant categories of child and adolescent psychopathology is then provided. Finally, recommendations for future research and implications for prevention are discussed.
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Affiliation(s)
- Rachelle A Yu
- Simon Fraser University and B.C. Children's Hospital, Burnaby, Canada.
| | | | | | - Robert J McMahon
- Simon Fraser University and B.C. Children's Hospital, Burnaby, Canada
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21
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Luk JW, Geda DW, Stangl BL, Cheng C, Schwandt ML, Goldman D, Diazgranados N, Ramchandani VA. Social media addiction as a mediator of the associations between fear of COVID-19, mental health symptoms, and problematic alcohol use. Front Psychiatry 2023; 14:1268890. [PMID: 38034930 PMCID: PMC10682110 DOI: 10.3389/fpsyt.2023.1268890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
Background Fear of COVID-19 is a risk factor for anxiety and depressive symptoms. During the COVID-19 pandemic, drinking to cope with psychological distress has been proposed as a key mechanism leading to problematic drinking. The goal of this study was to test social media addiction as a mediator linking fear of COVID-19 to mental health symptoms and problematic alcohol use. Methods In between April 6 and July 2 of 2022, 250 participants completed an online survey as part of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study. Path analyses were conducted to test the mediational pathways. Results Using the polythetic classification scheme, 13.2% (n = 33) of participants were classified as having social media addiction. Compared with participants without social media addiction, participants with social media addiction spent significantly more time on social media platforms and on digital communications with a family member or friend. They also reported greater fear of COVID-19, higher anxiety symptoms, and higher depressive symptoms. Path analyses indicated that social media addiction mediated the associations of fear of COVID-19 with anxiety and depressive symptoms. Furthermore, there were indirect pathways linking fear of COVID-19 to problematic alcohol use through higher social media addiction and higher anxiety and depressive symptoms. Conclusion Social media addiction may be a maladaptive coping mechanism that individuals with high fear of COVID-19 utilized to deal with uncertainty and perceived risks during the pandemic. Findings underscore the need to examine cognitions related to fear of COVID-19 and address excessive social media use in the context of mental health and alcohol interventions.
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Affiliation(s)
- Jeremy W. Luk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Daniel W. Geda
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Bethany L. Stangl
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Cecilia Cheng
- Social and Health Psychology Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Melanie L. Schwandt
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - David Goldman
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, United States
| | - Nancy Diazgranados
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Vijay A. Ramchandani
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
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22
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Marti-Prats L, Giuliano C, Domi A, Puaud M, Peña-Oliver Y, Fouyssac M, McKenzie C, Everitt BJ, Belin D. The development of compulsive coping behavior depends on dorsolateral striatum dopamine-dependent mechanisms. Mol Psychiatry 2023; 28:4666-4678. [PMID: 37770577 PMCID: PMC10914627 DOI: 10.1038/s41380-023-02256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
Humans greatly differ in how they cope with stress, a natural behavior learnt through negative reinforcement. Some individuals engage in displacement activities, others in exercise or comfort eating, and others still in alcohol use. Across species, adjunctive behaviors, such as polydipsic drinking, are used as a form of displacement activity that reduces stress. Some individuals, in particular those that use alcohol to self-medicate, tend to lose control over such coping behaviors, which become excessive and compulsive. However, the psychological and neural mechanisms underlying this individual vulnerability have not been elucidated. Here we tested the hypothesis that the development of compulsive adjunctive behaviors stems from the functional engagement of the dorsolateral striatum (DLS) dopamine-dependent habit system after a prolonged history of adjunctive responding. We measured in longitudinal studies in male Sprague Dawley rats the sensitivity of early established vs compulsive polydipsic water or alcohol drinking to a bilateral infusion into the anterior DLS (aDLS) of the dopamine receptor antagonist α-flupentixol. While most rats acquired a polydipsic drinking response with water, others only did so with alcohol. Whether drinking water or alcohol, the acquisition of this coping response was insensitive to aDLS dopamine receptor blockade. In contrast, after prolonged experience, adjunctive drinking became dependent on aDLS dopamine at a time when it was compulsive in vulnerable individuals. These data suggest that habits may develop out of negative reinforcement and that the engagement of their underlying striatal system is necessary for the manifestation of compulsive adjunctive behaviors.
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Affiliation(s)
- Lucia Marti-Prats
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - Chiara Giuliano
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
- Astra Zeneca, R&D Biopharmaceuticals, Fleming Building (B623), Babraham Research Park, Babraham, Cambridgeshire, CB22 3AT, UK
| | - Ana Domi
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg, Box 410, Gothenburg, 405 30, Sweden
| | - Mickaël Puaud
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - Yolanda Peña-Oliver
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
- Research and Enterprise Services, University of Sussex, Brighton, UK
| | - Maxime Fouyssac
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - Colin McKenzie
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - Barry J Everitt
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - David Belin
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
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23
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Steel TL, Bhatraju EP, Hills-Dunlap K. Critical care for patients with substance use disorders. Curr Opin Crit Care 2023; 29:484-492. [PMID: 37641506 DOI: 10.1097/mcc.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW To examine the impact of substance use disorders (SUDs) on critical illness and the role of critical care providers in treating SUDs. We discuss emerging evidence supporting hospital-based addiction treatment and highlight the clinical and research innovations needed to elevate the standards of care for patients with SUDs in the intensive care unit (ICU) amidst staggering individual and public health consequences. RECENT FINDINGS Despite the rapid increase of SUDs in recent years, with growing implications for critical care, dedicated studies focused on ICU patients with SUDs remain scant. Available data demonstrate SUDs are major risk factors for the development and severity of critical illness and are associated with poor outcomes. ICU patients with SUDs experience mutually reinforcing effects of substance withdrawal and pain, which amplify risks and consequences of delirium, and complicate management of comorbid conditions. Hospital-based addiction treatment can dramatically improve the health outcomes of hospitalized patients with SUDs and should begin in the ICU. SUMMARY SUDs have a significant impact on critical illness and post-ICU outcomes. High-quality cohort and treatment studies designed specifically for ICU patients with SUDs are needed to define best practices and improve health outcomes in this vulnerable population.
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Affiliation(s)
- Tessa L Steel
- Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine
| | - Elenore P Bhatraju
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Kelsey Hills-Dunlap
- University of Colorado Anschutz Medical Campus, Division of Pulmonary Sciences & Critical Care, Department of Medicine, University of Colorado, Aurora, Colorado, USA
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24
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Feng C, Wu AMS, Yu K, Zhao W, Xu JK. Associations of Death Anxiety, Inclusion of Smartphone in the Self, and Affiliation Motivation with Smartphone use and Addiction: A Multiple Mediation Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231189634. [PMID: 37477633 DOI: 10.1177/00302228231189634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This study is the first to apply terror management theory to understanding smartphone addiction by examining the potential indirect effect of death anxiety on smartphone addiction via inclusion of smartphone in the self (i.e., self-expansion), affiliation motivation (the desire to connect with others) for emotional support, and smartphone use. The sample consisted of 1483 Chinese university students between the ages of 18 and 24 (M = 19.14, SD = 1.03) who voluntarily completed an anonymous questionnaire survey. As hypothesized, death anxiety, inclusion of smartphone in the self, affiliation motivation, and smartphone use were directly, positively correlated with smartphone addiction. In addition, death anxiety exerted significant indirect effects via various pathways, including (i) affiliation motivation for emotional support and smartphone use and (ii) inclusion of smartphone in the self and smartphone use. Findings suggest that effective interventions for smartphone addiction should include targeting death anxiety, self-expansion, and affiliation need frustration.
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Affiliation(s)
- Chun Feng
- Department of Applied Psychology, Faculty of Law, Southwest University of Science and Technology, Mianyang, China
| | - Anise M S Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, China
| | - Ke Yu
- Department of Applied Psychology, Faculty of Law, Southwest University of Science and Technology, Mianyang, China
| | - Wen Zhao
- Department of Applied Psychology, Faculty of Law, Southwest University of Science and Technology, Mianyang, China
| | - Ji-Kang Xu
- Student Affairs Office, School of Manufacturing Science and Engineering, Southwest University of Science and Technology, Mianyang, China
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25
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Olsavsky AK, Chirico I, Ali D, Christensen H, Boggs B, Svete L, Ketcham K, Hutchison K, Zeanah C, Tottenham N, Riggs P, Epperson CN. Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review. Subst Abuse 2023; 17:11782218231186371. [PMID: 37476500 PMCID: PMC10354827 DOI: 10.1177/11782218231186371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the mechanisms underlying these risks to mother-infant relationships center on 3 primary processes: (1) mothers' childhood maltreatment experiences; (2) attachment styles and consequent internal working models of interpersonal relationships; and (3) perinatal substance use. Further, the review considers the role of hyperkatifeia, or hypersensitivity to negative affect which occurs when people with substance use disorders are not using substances, and which drives the negative reinforcement in addiction. The authors performed a systematic review of articles (published 2000-2022) related to these constructs and their impact on mother-infant relationships and offspring outcomes, including original clinical research articles addressing relationships between these constructs, and excluding case studies, reviews, non-human animal studies, intervention studies, studies with fewer than 30% female-sex participants, clinical guidelines, studies limited to obstetric outcomes, mechanistic/biological studies, and studies with methodological issues precluding interpretation. Overall 1844 articles were screened, 377 were selected for full text review, and data were extracted from 157 articles. Results revealed strong relationships between mothers' childhood maltreatment experiences, less optimal internal working models, and increased risk for perinatal substance use, and importantly, all of these predictors interacted with hyperkatifeia and exerted a marked impact on mother-infant relationships with less data available on offspring outcomes. These data strongly support the need for future studies addressing the additive impact of maternal childhood maltreatment experiences, suboptimal internal working models, and perinatal substance use, with hyperkatifeia as a potential moderator, and their interacting effects on mother-infant socioemotional outcomes.
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Affiliation(s)
- Aviva K. Olsavsky
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Isabella Chirico
- SUNY Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA
| | - Diab Ali
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Hannah Christensen
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Brianna Boggs
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Lillian Svete
- University of Colorado School of Medicine, Aurora, CO, USA
- University of Kentucky College of Medicine, Louisville, KY, USA
| | | | - Kent Hutchison
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Charles Zeanah
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Paula Riggs
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
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26
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Koob GF, Vendruscolo L. Theoretical Frameworks and Mechanistic Aspects of Alcohol Addiction: Alcohol Addiction as a Reward Deficit/Stress Surfeit Disorder. Curr Top Behav Neurosci 2023. [PMID: 37421551 DOI: 10.1007/7854_2023_424] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Alcohol use disorder (AUD) can be defined by a compulsion to seek and take alcohol, the loss of control in limiting intake, and the emergence of a negative emotional state when access to alcohol is prevented. Alcohol use disorder impacts multiple motivational mechanisms and can be conceptualized as a disorder that includes a progression from impulsivity (positive reinforcement) to compulsivity (negative reinforcement). Compulsive drug seeking that is associated with AUD can be derived from multiple neuroadaptations, but the thesis argued herein is that a key component involves the construct of negative reinforcement. Negative reinforcement is defined as drug taking that alleviates a negative emotional state. The negative emotional state that drives such negative reinforcement is hypothesized to derive from the dysregulation of specific neurochemical elements that are involved in reward and stress within basal forebrain structures that involve the ventral striatum and extended amygdala, respectively. Specific neurochemical elements in these structures include decreases in reward neurotransmission (e.g., decreases in dopamine and opioid peptide function in the ventral striatum) and the recruitment of brain stress systems (e.g., corticotropin-releasing factor [CRF]) in the extended amygdala, which contributes to hyperkatifeia and greater alcohol intake that is associated with dependence. Glucocorticoids and mineralocorticoids may play a role in sensitizing the extended amygdala CRF system. Other components of brain stress systems in the extended amygdala that may contribute to the negative motivational state of withdrawal include norepinephrine in the bed nucleus of the stria terminalis, dynorphin in the nucleus accumbens, hypocretin and vasopressin in the central nucleus of the amygdala, and neuroimmune modulation. Decreases in the activity of neuropeptide Y, nociception, endocannabinoids, and oxytocin in the extended amygdala may also contribute to hyperkatifeia that is associated with alcohol withdrawal. Such dysregulation of emotional processing may also significantly contribute to pain that is associated with alcohol withdrawal and negative urgency (i.e., impulsivity that is associated with hyperkatifeia during hyperkatifeia). Thus, an overactive brain stress response system is hypothesized to be activated by acute excessive drug intake, to be sensitized during repeated withdrawal, to persist into protracted abstinence, and to contribute to the compulsivity of AUD. The combination of the loss of reward function and recruitment of brain stress systems provides a powerful neurochemical basis for a negative emotional state that is responsible for the negative reinforcement that at least partially drives the compulsivity of AUD.
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Affiliation(s)
- George F Koob
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.
| | - Leandro Vendruscolo
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
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27
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Giorgi S, Yaden DB, Eichstaedt JC, Ungar LH, Schwartz HA, Kwarteng A, Curtis B. Predicting U.S. county opioid poisoning mortality from multi-modal social media and psychological self-report data. Sci Rep 2023; 13:9027. [PMID: 37270657 DOI: 10.1038/s41598-023-34468-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/30/2023] [Indexed: 06/05/2023] Open
Abstract
Opioid poisoning mortality is a substantial public health crisis in the United States, with opioids involved in approximately 75% of the nearly 1 million drug related deaths since 1999. Research suggests that the epidemic is driven by both over-prescribing and social and psychological determinants such as economic stability, hopelessness, and isolation. Hindering this research is a lack of measurements of these social and psychological constructs at fine-grained spatial and temporal resolutions. To address this issue, we use a multi-modal data set consisting of natural language from Twitter, psychometric self-reports of depression and well-being, and traditional area-based measures of socio-demographics and health-related risk factors. Unlike previous work using social media data, we do not rely on opioid or substance related keywords to track community poisonings. Instead, we leverage a large, open vocabulary of thousands of words in order to fully characterize communities suffering from opioid poisoning, using a sample of 1.5 billion tweets from 6 million U.S. county mapped Twitter users. Results show that Twitter language predicted opioid poisoning mortality better than factors relating to socio-demographics, access to healthcare, physical pain, and psychological well-being. Additionally, risk factors revealed by the Twitter language analysis included negative emotions, discussions of long work hours, and boredom, whereas protective factors included resilience, travel/leisure, and positive emotions, dovetailing with results from the psychometric self-report data. The results show that natural language from public social media can be used as a surveillance tool for both predicting community opioid poisonings and understanding the dynamic social and psychological nature of the epidemic.
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Affiliation(s)
- Salvatore Giorgi
- National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - David B Yaden
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Johannes C Eichstaedt
- Department of Psychology, Stanford University, Stanford, CA, USA
- Institute for Human-Centered AI, Stanford University, Stanford, CA, USA
| | - Lyle H Ungar
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - H Andrew Schwartz
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Amy Kwarteng
- National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Brenda Curtis
- National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA.
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28
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McNally GP, Jean-Richard-Dit-Bressel P, Millan EZ, Lawrence AJ. Pathways to the persistence of drug use despite its adverse consequences. Mol Psychiatry 2023; 28:2228-2237. [PMID: 36997610 PMCID: PMC10611585 DOI: 10.1038/s41380-023-02040-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023]
Abstract
The persistence of drug taking despite its adverse consequences plays a central role in the presentation, diagnosis, and impacts of addiction. Eventual recognition and appraisal of these adverse consequences is central to decisions to reduce or cease use. However, the most appropriate ways of conceptualizing persistence in the face of adverse consequences remain unclear. Here we review evidence that there are at least three pathways to persistent use despite the negative consequences of that use. A cognitive pathway for recognition of adverse consequences, a motivational pathway for valuation of these consequences, and a behavioral pathway for responding to these adverse consequences. These pathways are dynamic, not linear, with multiple possible trajectories between them, and each is sufficient to produce persistence. We describe these pathways, their characteristics, brain cellular and circuit substrates, and we highlight their relevance to different pathways to self- and treatment-guided behavior change.
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Affiliation(s)
- Gavan P McNally
- School of Psychology, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - E Zayra Millan
- School of Psychology, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3010, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, 3010, Australia
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Parisi A, Zgierska AE, Burzinski CA, Lennon RP, Jamison RN, Nakamura Y, Barrett B, Edwards RR, Garland EL. To be aware, or to accept, that is the question: Differential roles of awareness of automaticity and pain acceptance in opioid misuse. Drug Alcohol Depend 2023; 247:109890. [PMID: 37167796 PMCID: PMC10714486 DOI: 10.1016/j.drugalcdep.2023.109890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Individuals with chronic low back pain (CLBP) are commonly prescribed long-term opioid therapy (LTOT) for analgesia, placing this population at increased risk for opioid misuse and opioid use disorder. Acceptance of aversive experiences (e.g., chronic pain) and awareness of automatic thoughts and behaviors (i.e., automaticity) are two facets of dispositional mindfulness that may serve as protective mechanisms against opioid misuse risk. Therefore, the aim of the current study was to examine the differential contributions of these constructs to opioid misuse risk among adults with CLBP receiving LTOT. METHODS Data were obtained from a sample of 770 adults with opioid-treated CLBP. Bivariate correlations and hierarchical linear regression analyses were used to determine whether chronic pain acceptance and awareness of automatic thoughts and behaviors explained a statistically significant portion of variance in opioid misuse risk after accounting for the effects of other relevant confounders. RESULTS Hierarchical regression results revealed that chronic pain acceptance and awareness of automatic thoughts and behaviors contributed a significant portion in the variance of opioid misuse risk. Awareness of automatic thoughts and behaviors was negatively associated with opioid misuse risk, such that individuals with lower levels of awareness of automaticity were at higher risk of opioid misuse. By contrast, pain acceptance was not associated with opioid misuse. CONCLUSIONS Findings suggest that awareness of automaticity may buffer against opioid misuse risk. Interventions designed to strengthen awareness of automaticity (e.g., mindfulness-based interventions) might be especially efficacious among this population.
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Affiliation(s)
- Anna Parisi
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, 395 1500 E, Salt Lake City, UT84112, United States
| | - Aleksandra E Zgierska
- Pennsylvania State University College of Medicine Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA17033, United States
| | - Cindy A Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI53715, United States
| | - Robert P Lennon
- Pennsylvania State University College of Medicine Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA17033, United States
| | - Robert N Jamison
- Harvard Medical School, Brigham and Women's Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA02467, United States
| | - Yoshio Nakamura
- University of Utah School of Medicine, Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, 615 Arapeen Drive, Suite 200, Salt Lake City, UT84108, United States
| | - Bruce Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI53715, United States
| | - Robert R Edwards
- Harvard Medical School, Brigham and Women's Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA02467, United States
| | - Eric L Garland
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, 395 1500 E, Salt Lake City, UT84112, United States.
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Martenies SE, Wilson A, Hoskovec L, Bol KA, Burket TL, Podewils LJ, Magzamen S. The COVID-19-wildfire smoke paradox: Reduced risk of all-cause mortality due to wildfire smoke in Colorado during the first year of the COVID-19 pandemic. ENVIRONMENTAL RESEARCH 2023; 225:115591. [PMID: 36878268 PMCID: PMC9985917 DOI: 10.1016/j.envres.2023.115591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND In 2020, the American West faced two competing challenges: the COVID-19 pandemic and the worst wildfire season on record. Several studies have investigated the impact of wildfire smoke (WFS) on COVID-19 morbidity and mortality, but little is known about how these two public health challenges impact mortality risk for other causes. OBJECTIVES Using a time-series design, we evaluated how daily risk of mortality due to WFS exposure differed for periods before and during the COVID-19 pandemic. METHODS Our study included daily data for 11 counties in the Front Range region of Colorado (2010-2020). We assessed WFS exposure using data from the National Oceanic and Atmospheric Administration and used mortality counts from the Colorado Department of Public Health and Environment. We estimated the interaction between WFS and the pandemic (an indicator variable) on mortality risk using generalized additive models adjusted for year, day of week, fine particulate matter, ozone, temperature, and a smoothed term for day of year. RESULTS WFS impacted the study area on 10% of county-days. We observed a positive association between the presence of WFS and all-cause mortality risk (incidence rate ratio (IRR) = 1.03, 95%CI: 1.01-1.04 for same-day exposures) during the period before the pandemic; however, WFS exposure during the pandemic resulted in decreased risk of all-cause mortality (IRR = 0.90, 95%CI: 0.87-0.93 for same-day exposures). DISCUSSION We hypothesize that mitigation efforts during the first year of the pandemic, e.g., mask mandates, along with high ambient WFS levels encouraged health behaviors that reduced exposure to WFS and reduced risk of all-cause mortality. Our results suggest a need to examine how associations between WFS and mortality are impacted by pandemic-related factors and that there may be lessons from the pandemic that could be translated into health-protective policies during future wildfire events.
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Affiliation(s)
- Sheena E Martenies
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - Lauren Hoskovec
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - Kirk A Bol
- Center for Health and Environmental Data, Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Tori L Burket
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Denver Department of Public Health and Environment, Denver, CO, USA
| | - Laura Jean Podewils
- Center for Health Systems Research, Denver Health Office of Research, Denver, CO, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Naviaux RK. Mitochondrial and metabolic features of salugenesis and the healing cycle. Mitochondrion 2023; 70:131-163. [PMID: 37120082 DOI: 10.1016/j.mito.2023.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/24/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
Pathogenesis and salugenesis are the first and second stages of the two-stage problem of disease production and health recovery. Salugenesis is the automatic, evolutionarily conserved, ontogenetic sequence of molecular, cellular, organ system, and behavioral changes that is used by living systems to heal. It is a whole-body process that begins with mitochondria and the cell. The stages of salugenesis define a circle that is energy- and resource-consuming, genetically programmed, and environmentally responsive. Energy and metabolic resources are provided by mitochondrial and metabolic transformations that drive the cell danger response (CDR) and create the three phases of the healing cycle: Phase 1-Inflammation, Phase 2-Proliferation, and Phase 3-Differentiation. Each phase requires a different mitochondrial phenotype. Without different mitochondria there can be no healing. The rise and fall of extracellular ATP (eATP) signaling is a key driver of the mitochondrial and metabolic reprogramming required to progress through the healing cycle. Sphingolipid and cholesterol-enriched membrane lipid rafts act as rheostats for tuning cellular sensitivity to purinergic signaling. Abnormal persistence of any phase of the CDR inhibits the healing cycle, creates dysfunctional cellular mosaics, causes the symptoms of chronic disease, and accelerates the process of aging. New research reframes the rising tide of chronic disease around the world as a systems problem caused by the combined action of pathogenic triggers and anthropogenic factors that interfere with the mitochondrial functions needed for healing. Once chronic pain, disability, or disease is established, salugenesis-based therapies will start where pathogenesis-based therapies end.
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Affiliation(s)
- Robert K Naviaux
- The Mitochondrial and Metabolic Disease Center, Departments of Medicine, and Pediatrics, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, MC#8467, San Diego, CA 92103.
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Affiliation(s)
- Edward V Nunes
- Department of Psychiatry, Division on Substance Use, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
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Wang W, Xie X, Zhuang X, Huang Y, Tan T, Gangal H, Huang Z, Purvines W, Wang X, Stefanov A, Chen R, Rodriggs L, Chaiprasert A, Yu E, Vierkant V, Hook M, Huang Y, Darcq E, Wang J. Striatal μ-opioid receptor activation triggers direct-pathway GABAergic plasticity and induces negative affect. Cell Rep 2023; 42:112089. [PMID: 36796365 PMCID: PMC10404641 DOI: 10.1016/j.celrep.2023.112089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/27/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
Withdrawal from chronic opioid use often causes hypodopaminergic states and negative affect, which may drive relapse. Direct-pathway medium spiny neurons (dMSNs) in the striatal patch compartment contain μ-opioid receptors (MORs). It remains unclear how chronic opioid exposure and withdrawal impact these MOR-expressing dMSNs and their outputs. Here, we report that MOR activation acutely suppressed GABAergic striatopallidal transmission in habenula-projecting globus pallidus neurons. Notably, withdrawal from repeated morphine or fentanyl administration potentiated this GABAergic transmission. Furthermore, intravenous fentanyl self-administration enhanced GABAergic striatonigral transmission and reduced midbrain dopaminergic activity. Fentanyl-activated striatal neurons mediated contextual memory retrieval required for conditioned place preference tests. Importantly, chemogenetic inhibition of striatal MOR+ neurons rescued fentanyl withdrawal-induced physical symptoms and anxiety-like behaviors. These data suggest that chronic opioid use triggers GABAergic striatopallidal and striatonigral plasticity to induce a hypodopaminergic state, which may promote negative emotions and relapse.
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Affiliation(s)
- Wei Wang
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Interdisciplinary Faculty of Toxicology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Xueyi Xie
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Xiaowen Zhuang
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Yufei Huang
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Tao Tan
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Himanshu Gangal
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Zhenbo Huang
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - William Purvines
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Xuehua Wang
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Alexander Stefanov
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Ruifeng Chen
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Interdisciplinary Faculty of Toxicology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Lucas Rodriggs
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Anita Chaiprasert
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Emily Yu
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Valerie Vierkant
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Michelle Hook
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
| | - Yun Huang
- Institute of Biosciences and Technology, Department of Translational Medical Sciences, College of Medicine, Texas A&M University, Houston, TX 77030, USA
| | - Emmanuel Darcq
- Department of Psychiatry, University of Strasbourg, INSERM U1114, 67084 Strasbourg Cedex, France
| | - Jun Wang
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA; Interdisciplinary Faculty of Toxicology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA; Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA; Institute of Biosciences and Technology, Department of Translational Medical Sciences, College of Medicine, Texas A&M University, Houston, TX 77030, USA.
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Saqib K, Qureshi AS, Butt ZA. COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3262. [PMID: 36833955 PMCID: PMC9962717 DOI: 10.3390/ijerph20043262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic is an epidemiological and psychological crisis; what it does to the body is quite well known by now, and more research is underway, but the syndemic impact of COVID-19 and mental health on underlying chronic illnesses among the general population is not completely understood. METHODS We carried out a literature review to identify the potential impact of COVID-19 and related mental health issues on underlying comorbidities that could affect the overall health of the population. RESULTS Many available studies have highlighted the impact of COVID-19 on mental health only, but how complex their interaction is in patients with comorbidities and COVID-19, the absolute risks, and how they connect with the interrelated risks in the general population, remain unknown. The COVID-19 pandemic can be recognized as a syndemic due to; synergistic interactions among different diseases and other health conditions, increasing overall illness burden, emergence, spread, and interactions between infectious zoonotic diseases leading to new infectious zoonotic diseases; this is together with social and health interactions leading to increased risks in vulnerable populations and exacerbating clustering of multiple diseases. CONCLUSION There is a need to develop evidence to support appropriate and effective interventions for the overall improvement of health and psychosocial wellbeing of at-risk populations during this pandemic. The syndemic framework is an important framework that can be used to investigate and examine the potential benefits and impact of codesigning COVID-19/non-communicable diseases (NCDs)/mental health programming services which can tackle these epidemics concurrently.
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Affiliation(s)
- Kiran Saqib
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Afaf Saqib Qureshi
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Zahid Ahmad Butt
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Hien DA, Morgan-López AA, Saavedra LM, Ruglass LM, Ye A, López-Castro T, Fitzpatrick S, Killeen TK, Norman SB, Ebrahimi CT, Back SE. Project Harmony: A Meta-Analysis With Individual Patient Data on Behavioral and Pharmacologic Trials for Comorbid Posttraumatic Stress and Alcohol or Other Drug Use Disorders. Am J Psychiatry 2023; 180:155-166. [PMID: 36475373 PMCID: PMC10016363 DOI: 10.1176/appi.ajp.22010071] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Treatment efficacy for co-occurring posttraumatic stress disorder (PTSD) and substance use disorders is well established, yet direct evidence for comparative effectiveness across treatments is lacking. The present study compared the effectiveness of several behavioral and pharmacological therapies for adults with co-occurring PTSD and alcohol or other drug use disorders. METHODS A systematic search of PsycINFO, MEDLINE, and ClinicalTrials.gov was conducted through December 2020 for trials targeting PTSD, alcohol or other drug use disorders, or both disorders (36 studies, N=4,046). Primary outcomes were severity scores for PTSD, alcohol use, and drug use, estimated via moderated nonlinear factor analysis. Propensity score weight-adjusted multilevel models were used. Model-predicted effect sizes were estimated for each treatment, and comparative effect sizes for each active arm against treatment as usual, at end of treatment and at 12-month follow-up. RESULTS Compared with treatment as usual, combining trauma-focused therapy and pharmacotherapy for substance use disorders showed the largest comparative effect sizes for PTSD severity (d=-0.92, 95% CI=-1.57, -0.30) and alcohol use severity (d=-1.10, 95% CI=-1.54, -0.68) at end of treatment. Other treatments with large comparative effect sizes included pharmacotherapies for alcohol or other drug use disorders, trauma-focused integrated therapies, and trauma-focused nonintegrated therapies. Reductions in outcomes for PTSD symptoms and alcohol use were observed for nearly all treatments. CONCLUSIONS The findings provide support for treating comorbid PTSD and substance use disorders using a variety of approaches, with alcohol-targeted pharmacotherapies and trauma-focused behavioral therapies as a combination of treatments that lead to early and sustained improvements in PTSD and alcohol use severity. Further treatment development is indicated for combining behavioral and pharmacological treatments for synergized impact and understanding the mechanisms of action and conditions under which each treatment type is optimized.
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Affiliation(s)
- Denise A Hien
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Antonio A Morgan-López
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Lissette M Saavedra
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Lesia M Ruglass
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Ai Ye
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Teresa López-Castro
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Skye Fitzpatrick
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Therese K Killeen
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Sonya B Norman
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Chantel T Ebrahimi
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Sudie E Back
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
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Relationship of negative emotionality, NIAAA recovery, and 3- and 6-month drinking outcomes among adults in treatment for alcohol use disorder. Drug Alcohol Depend 2023; 242:109695. [PMID: 36442440 DOI: 10.1016/j.drugalcdep.2022.109695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recently released a new definition of recovery from alcohol use disorder (AUD). A patient is considered recovered if they are remitted from DSM-5 AUD and report cessation of heavy drinking. The NIAAA has also recently proposed the Addictions Neuroclinical Assessment (ANA) to guide treatment research. Negative emotionality is one of three domains of the ANA and theory proposes that AUD is maintained by negative reinforcement via the relief of negative affect. The purpose of the current study was to examine: (1) the relationship of end-of-treatment negative emotionality and NIAAA recovery, and (2) the ability of NIAAA recovery at the end of treatment to predict three- and six-month drinking outcomes. METHOD At baseline and end-of-treatment, women and men (n = 181) in treatment for AUD completed measures of negative emotionality, drinking, and were assessed for DSM-5 AUD diagnostic criteria. At three- and six-months post-treatment, drinking was re-assessed. RESULTS 22.5% (n = 24) of participants met full criteria for NIAAA recovery at end-of-treatment. Lower levels of end of treatment negative emotionality were associated with increased odds of achieving NIAAA recovery. Meeting NIAAA recovery predicted greater percent days abstinent (PDA) and lower percent heavy drinking days (PHDD) at 3-months, but not at 6-months post-treatment. CONCLUSIONS This study is among the first to report a relationship between the negative emotionality domain of the ANA and NIAAA recovery. Results underscore the importance of addressing negative emotionality in treatment. Findings also suggest that NIAAA recovery predicts positive short term drinking outcomes.
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King AC, Vena A, Howe MM, Feather A, Cao D. Haven't lost the positive feeling: a dose-response, oral alcohol challenge study in drinkers with alcohol use disorder. Neuropsychopharmacology 2022; 47:1892-1900. [PMID: 35701549 PMCID: PMC9485138 DOI: 10.1038/s41386-022-01340-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022]
Abstract
Models of addiction are based on neurobiological, behavioral, and pharmacological studies in animals, but translational support from human studies is limited. Studies are lacking in examining acute responses to alcohol in drinkers with alcohol use disorder (AUD), particularly in terms of relevant intoxicating doses and measurement of stimulating and rewarding effects throughout the breath alcohol concentration (BrAC) time curve. Participants were N = 60 AUD drinkers enrolled in the Chicago Social Drinking Project and examined in three random-order and blinded sessions for subjective and physiological responses to a beverage containing 0.0 g/kg, 0.8 g/kg, and 1.2 g/kg alcohol. BrAC in the alcohol sessions at 60 min was 0.09 g/dL and 0.13 g/dL, respectively. Both doses of alcohol produced significant biphasic effects on subjective measures of stimulation, euphoria, reward (liking and wanting), sedation, and neuroendocrine and cardiovascular factors. Increased pleasurable effects of alcohol were pronounced during the rising limb-to-peak BrAC and sedating effects emerged during the declining limb. Alcohol dose-dependently increased feel drug ratings and rewarding effects at peak BrAC or early declining limb, and physiological responses at the rising limb. Thus, rather than the notion of an overall tolerance, results show an alcohol response phenotype characterized by sensitivity to alcohol's stimulating, rewarding and physiological effects. The results of this study may aid in the conceptualization of alcohol addiction as a disorder characterized by the persistence of enhanced hedonic alcohol responses rather than chronic tolerance and reward deficiency.
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Affiliation(s)
- Andrea C King
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago 5841 S, Maryland Avenue (MC-3077), Chicago, IL, 60637, USA.
| | - Ashley Vena
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago 5841 S, Maryland Avenue (MC-3077), Chicago, IL, 60637, USA
| | - Meghan M Howe
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago 5841 S, Maryland Avenue (MC-3077), Chicago, IL, 60637, USA
| | - Abigayle Feather
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago 5841 S, Maryland Avenue (MC-3077), Chicago, IL, 60637, USA
| | - Dingcai Cao
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago 5841 S, Maryland Avenue (MC-3077), Chicago, IL, 60637, USA
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Abstract
Deaths of despair, morbidity and emotional distress continue to rise in the US, largely borne by those without a college degree, the majority of American adults, for many of whom the economy and society are no longer delivering. Concurrently, all-cause mortality in the US is diverging by education in a way not seen in other rich countries. We review the rising prevalence of pain, despair, and suicide among those without a BA. Pain and despair created a baseline demand for opioids, but the escalation of addiction came from pharma and its political enablers. We examine the "politics of despair," how less-educated people have abandoned and been abandoned by the Democratic Party. While healthier states once voted Republican in presidential elections, now the less-healthy states do. We review deaths during COVID, finding mortality in 2020 replicated existing relative mortality differences between those with and without college degrees.
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Affiliation(s)
- Anne Case
- School of Public and International Affairs, Princeton University, Princeton, NJ 08544
| | - Angus Deaton
- School of Public and International Affairs, Princeton University, Princeton, NJ 08544
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Massie AB, Werbel WA, Avery RK, Po‐Yu Chiang T, Snyder JJ, Segev DL. Quantifying excess deaths among solid organ transplant recipients in the COVID-19 era. Am J Transplant 2022; 22:2077-2082. [PMID: 35294799 PMCID: PMC9111343 DOI: 10.1111/ajt.17036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/10/2022] [Accepted: 03/11/2022] [Indexed: 01/25/2023]
Abstract
Estimating the total coronavirus disease 2019 (COVID-19) mortality burden of solid organ transplant recipients (SOTRs), both directly through COVID-19 infection and indirectly through other impacts on the healthcare system and society, is critical for understanding the disease's impact on the SOTR population. Using SRTR data, we modeled expected mortality risk per month pre-COVID (January 2015-February 2020) for kidney/liver/heart/lung SOTRs, and compared monthly COVID-era deaths (March 2020-March 2021) to expected rates, overall and among subgroups. Deaths above expected rates were designated "excess deaths." Between March 2020 and March 2021, there were 3739/827/265/252 excess deaths among kidney/liver/heart/lung SOTRs, respectively, representing a 41.2%/27.4%/18.5%/15.0% increase above expected deaths. 93.0% of excess deaths occurred in patients age≥50. The observed:expected ratio was highest among Hispanic SOTRs (1.82) and lowest among White SOTRs (1.20); 56.0% of excess deaths occurred among Black or Hispanic SOTRs. 64.7% of excess deaths occurred among patients who had survived ≥5 years post-transplant. Excess deaths peaked in January 2021; geographic distribution of excess deaths broadly mirrored COVID-19 incidence. COVID-19 likely caused over 5000 excess deaths among SOTRs in the US in a 13-month period, representing 1 in 75 SOTRs and a substantial proportion of all deaths among SOTRs during this time. SOTRs will remain at elevated mortality risk until the COVID-19 pandemic can be controlled.
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Affiliation(s)
| | - William A. Werbel
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Robin K. Avery
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Teresa Po‐Yu Chiang
- Department of SurgeryJohns Hopkins University School of MedicineBaltimore, MarylandUSA
| | - Jon J. Snyder
- Department of SurgeryJohns Hopkins University School of MedicineBaltimore, MarylandUSA
| | - Dorry L. Segev
- Department of SurgeryJohns Hopkins University School of MedicineBaltimore, MarylandUSA
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
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Abstract
This study uses mortality data from the National Center for Health Statistics to assess whether alcohol-related deaths increased during the COVID-19 pandemic.
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Affiliation(s)
- Aaron M. White
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - I-Jen P. Castle
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | | | - Ralph W. Hingson
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - George F. Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Manhapra A. Complex Persistent Opioid Dependence-an Opioid-induced Chronic Pain Syndrome. Curr Treat Options Oncol 2022; 23:921-935. [PMID: 35435616 DOI: 10.1007/s11864-022-00985-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
OPINION STATEMENT Long-term opioid therapy (LTOT) for chronic cancer and non-cancer pain is commonly ineffective in providing its stated goal of improving function through good control of pain. Opioid tapering (slow dose reduction and/or discontinuation), the logical solution, also appears to be ineffective among many patients on LTOT as it often leads to even worse pain control and function, leaving the patients and providers managing LTOT in a clinical conundrum with little treatment choices. Complex persistent opioid dependence (CPOD) was recently offered as a heuristic to explain this clinical conundrum exemplified by the ineffectiveness of both LTOT and opioid tapering. This manuscript provides a detailed description of the neurobehavioral underpinnings of CPOD, explaining how long-term opioid use can lead to more pain even while experiencing relief with each opioid dose. CPOD is characterized by the allostatic opponent mechanisms of neuroadaptations related to the progression of opioid dependence and tolerance involving nociceptive/anti-nociceptive brain systems causing opioid-induced hyperalgesia and reward/anti-reward systems causing hyperkatefia or suffering that induces pain experience through the cognitive/emotional component of pain mechanisms. "Opioid Induced Chronic Pain syndrome" (OICP) is offered as an alternate clinical diagnostic term instead of CPOD that has several limitations as a diagnosis term including poor patient acceptance due to stigma towards addiction and clinical confounding with opioid use disorder, a related but separate clinical entity. OICP with LTOT is conceptualized as a recoverable iatrogenic problem that can be managed by pain providers. Broad guidance on management of OICP is also provided.
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Affiliation(s)
- Ajay Manhapra
- Pain Medicine, Hampton VA Medical Center, 100 Emancipation Drive, Hampton, VA, 23667, USA. .,New England Mental Illness Research Education and Clinical Center (MIRECC), West Haven, CT, USA. .,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. .,Departments of Physical Medicine and Rehabilitation and Psychiatry, Eastern Virginia Medical School, Norfolk, VA, USA.
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Asper A, Feingold D, Binenfeld E, Pshitizky H. Sociodemographic and clinical correlates of cannabis dependence among Israeli combat veterans. J Subst Abuse Treat 2022; 139:108786. [DOI: 10.1016/j.jsat.2022.108786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/07/2022] [Accepted: 04/24/2022] [Indexed: 11/25/2022]
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Grigoropoulos I, Daoultzis KC. Adverse Effects from the Imposition of Social Restrictions in Greece: the Indirect Effect of COVID-19-Related Fear on Alcohol Consumption Through Loneliness. TRENDS IN PSYCHOLOGY 2022. [PMCID: PMC8887662 DOI: 10.1007/s43076-022-00159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Quarantine
and social distancing are crucial factors in blocking the consequences of COVID-19 but also can lead to higher levels of loneliness and social isolation. Therefore, any advantages of mandatory quarantine have to be weighed against any negative impact on physical and mental well-being. This study aimed to examine the relationship between COVID-19-related fear and alcohol use during the lockdown period and loneliness as a mediating factor increasing the impact of COVID-19-related fear on alcohol use. A sample of 279 young adults completed self-reported questionnaires on COVID-19-related fear, loneliness, and substance use. This exploratory cross-sectional research was administered from 11 until December 18, 2020. The results showed that loneliness during lockdown mode may exacerbate the emotional burden caused by COVID-19-related fear leading to increased alcohol consumption as a coping mechanism against unsatisfactory living conditions. This study’s results reflect the need for societal groups, as well as health care services to remain specifically considerate to the needs of individuals who report high levels of COVID-19-related fear and loneliness.
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Affiliation(s)
- Iraklis Grigoropoulos
- Department of Psychology, Panteion University, Athens, Greece
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
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Manhapra A, Stefanovics EA, Rhee TG, Rosenheck RA. Persistence of significant pain interference following substance use disorder remission: Negative association with psychosocial and physical recovery. Drug Alcohol Depend 2022; 232:109339. [PMID: 35121202 DOI: 10.1016/j.drugalcdep.2022.109339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/09/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although substance use disorder (SUD) is frequently complicated by pain, the prevalence and correlates of persistent pain and dysfunction following SUD remission have not been studied. METHODS Using a cross-sectional sample of United States (US) adults with SUD identified in the National Epidemiologic Survey on Alcohol and Related Conditions Wave III, we evaluated the prevalence of moderate/severe pain interference (PI) in subgroups with current and remitted SUD and the independent association of SUD remission and PI with self-reported psychosocial and physical function (Mental Health Composite Score [MCS] and Physical Function Score [PFS] from the Short Form 12). RESULTS A fifth (20.6%; 7.6 million) of estimated 36.7 million US adults with past year SUD and a slightly higher proportion (25.6%; 9.6 million) of 37.4 million with SUD remission reported PI. MCS and PFS showed independent negative associations with PI among adults with both past year SUD and SUD remission. MCS had a positive independent association with SUD remission, but a stronger negative association with PI. While PFS had no statistically significant association with SUD remission, it had a strong negative association with PI. Analysis of interaction between SUD remission and PI revealed that SUD remission had no effect on the association of PI and MCS but had significant moderating influence on the association between PI and PFS. CONCLUSIONS Moderate to severe pain interference continues to be a significant problem among a sizable population achieving SUD remission potentially impeding recovery, and deserves focused clinical attention both active SUD and its remission.
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Affiliation(s)
- Ajay Manhapra
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA; Hampton VA Medical center, Hampton, VA, USA; Departments of Physical Medicine & Rehabilitation and Psychiatry, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Elina A Stefanovics
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA
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Koob GF. Anhedonia, Hyperkatifeia, and Negative Reinforcement in Substance Use Disorders. Curr Top Behav Neurosci 2022; 58:147-165. [PMID: 35112332 DOI: 10.1007/7854_2021_288] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Drug addiction has been defined as a chronically relapsing disorder that is characterized by a compulsion to seek and take a drug or stimulus, the loss of control in limiting intake, and the emergence of a negative emotional state when access to the drug or stimulus is prevented, a component of which is anhedonia. The present review explores a heuristic framework for understanding the role of anhedonia in addiction, in which anhedonia is a key component of hyperkatifeia (conceptualized as the potentiated intensity of negative emotional/motivational symptoms during drug withdrawal) and negative reinforcement in addiction. The neural substrates that mediate such anhedonia and crosstalk between elements of hyperkatifeia that contribute to anhedonia are then explored, including crosstalk between physical pain and emotional pain systems. The present review explores current knowledge of neurochemical neurocircuitry changes that are associated with conditioned hyperkatifeia/anhedonia. The overall hypothesis is that the shift in motivation toward negative reinforcement in addiction reflects the allostatic misregulation of hedonic tone, such that drug taking makes anhedonia worse during the process of seeking temporary relief by compulsive drug taking, thereby perpetuating the addiction cycle and hedonic comorbidities that are associated with addiction.
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Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA. .,National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
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Compton P, St Marie B. Coexisting Substance Use Disorder and Chronic Pain During COVID-19. Pain Manag Nurs 2022; 23:17-25. [PMID: 34620549 PMCID: PMC8418911 DOI: 10.1016/j.pmn.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-4217.
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47
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Emergency department utilization for substance use disorders and mental health conditions during COVID-19. PLoS One 2022; 17:e0262136. [PMID: 35025921 PMCID: PMC8757912 DOI: 10.1371/journal.pone.0262136] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.
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Gerbaldo TB, Antunes JLF. O impacto da pandemia de covid-19 na assistência à saúde mental de usuários de álcool nos Centros de Atenção Psicossocial. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210649pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Resumo A preocupação com o consumo prejudicial de álcool está na interseção da pandemia com a saúde mental. Mudanças nos padrões de consumo durante a crise sanitária têm sido documentadas no Brasil e internacionalmente. Este estudo avaliou o impacto da pandemia nos procedimentos a usuários de álcool no Brasil, por meio dos registros dos Centros de Atenção Psicossocial (CAPS). Selecionaram-se dados de janeiro de 2019 a dezembro de 2020, com discriminação por macrorregião geográfica, sexo, idade e raça/cor. Realizou-se análise descritiva, cálculo da variação percentual e distribuição em séries temporais. A análise comparativa apontou redução nos procedimentos no início da pandemia (-52,4%), com diferenças entre sexo e faixa etária. Observou-se diferenças entre macrorregiões, com pior resultado no Norte do país (-70,1%). O segundo semestre de 2020 apresentou retomada nos procedimentos, porém em quantidade aquém do realizado no ano anterior (-41,7%). Houve aprofundamento das desigualdades já existentes, especialmente com a queda mais elevada nas macrorregiões mais pobres, com maior fragilidade na rede de saúde mental. Dada a magnitude do álcool como problema de saúde pública e o papel central dos CAPS, ressalta-se a necessidade de instituir políticas e programas de saúde visando minimizar o impacto da pandemia na redução da assistência psicossocial.
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Feingold D, Tzur Bitan D. Addiction Psychotherapy: Going Beyond Self-Medication. Front Psychiatry 2022; 13:820660. [PMID: 35222121 PMCID: PMC8863854 DOI: 10.3389/fpsyt.2022.820660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/18/2022] [Indexed: 12/04/2022] Open
Abstract
Scientific and clinical work concerning the etiology of substance use and addiction has come a long way in the past decades. Current theories highlight the notion that addiction is rooted in deficits in neurobiological and psychological reward mechanisms, but also as a coping-oriented effort to contend with, or "self-medicate," negative emotional experiences. As such, contemporary approaches in the dynamic psychotherapy of addiction highlight the compensatory nature of addiction, encouraging clinicians to detect the mental suffering underlying addiction and promote alternative coping behaviors. In this perspective article, the authors advocate for an integrative approach toward understanding and addressing addiction in psychotherapy, acknowledging its biological, psychological and social aspects. We propose that in addition to the regulatory process of self-medication, in which negative emotions are being suppressed, compulsive substance use may also reflect a substitutive function, in which negative emotions are being 'acted-out' through the use of drugs or alcohol. We suggest an integrative clinical approach which addresses these psychological aspects in a sequential manner and discuss consequent benefits for clinicians and patients working with and through addiction.
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Affiliation(s)
| | - Dana Tzur Bitan
- Psychology Department, Ariel University, Ariel, Israel.,Shalvata Mental Health Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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50
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Affiliation(s)
- Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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