On Mourning and Recovery: Integrating Stages of Grief and Change Toward a Neuroscience-Based Model of Attachment Adaptation in Addiction Treatment

Association between childhood trauma and Internet gaming disorder: a moderated mediation analysis with depression as a mediator and psychological resilience as a moderator

BACKGROUND

The effect of childhood trauma on Internet gaming disorder remains unclear. In this study, we examined this association in Chinese students and explored the possible associated roles of psychological resilience and depression.

METHODS

In total, 8,579 students from Hunan Province, China, provided information regarding their sociodemographic factors, history of childhood trauma, any symptoms of depression, psychological resilience, and characteristics of Internet gaming disorder for this cross-sectional study. The impact of childhood trauma on Internet gaming disorder, as well as the extent to which it was mediated by depression and moderated by psychological resilience was evaluated.

RESULTS

The influence of childhood trauma on Internet gaming disorder was partially mediated by depression (B = 0.07, 95% CI [0.04, 0.05], p < 0.001), with psychological resilience acting as a mitigating factor (B = -0.002, 95% CI [13.74, 21.72], p < 0.001). Psychological resilience also moderated the association between childhood trauma and depression (B = - 0.003, 95% CI [22.17, 28.10], p < 0.001). Our moderated mediation model elucidated psychosocial mechanisms, revealing the underlying link between childhood trauma and Internet gaming disorder. It also demonstrated the partial mediating role of depression and modulating role of psychological resilience among Chinese students.

CONCLUSIONS

Education and interventions, along with effective social support, should be provided to enhance students' psychological resilience and prevent childhood trauma and depression.

An Interpretive Description of Drug Withdrawal Among Pregnant Women in Jail

OBJECTIVE

To explore the experience of drug withdrawal among pregnant women in jail.

DESIGN

A qualitative interpretive descriptive approach.

SETTING/PROBLEM

The care of incarcerated pregnant women constitutes a complex and significant public health problem. Many have substance use disorder (SUD) and cycle in and out of jails in their community, resulting in repeated experiences of drug withdrawal. Most jails do not provide medication-assisted therapy for management of withdrawal, a situation that violates standards of care set by leading health organizations. The experience of drug withdrawal among pregnant women in jail has not been qualitatively explored in the literature.

PARTICIPANTS

Five women completed interviews for the study.

INTERVENTION

In-depth, qualitative interviews.

RESULTS

Five themes with subthemes emerged from the interviews: Framing the Story Through Life History: I Need You to Know Where I Come From, Patterns of Thinking About Substance Use, The Manifestations of Withdrawal: Body and Mind, Perceived Punishment for Drug Use During Pregnancy, and Mixed Perceptions of Withdrawal Treatment.

CONCLUSION

Participants told a story beyond that of the physical withdrawal symptoms, revealing new insights into their maternal distress and the need for compassionate, nonstigmatized care to address physical and mental symptoms, as well as advocacy for the provision of an evidence-based standard of care. Nurses who care for pregnant women with SUD in the jail setting could benefit from collaborative relationships with other health care professionals in the community to reduce disparate health outcomes for this vulnerable population.

The Stubborn Persistence of Grief Stage Theory

Bereavement professionals who keep up with current research have wisely discarded the "five stages of grief" theory in favor of more contemporary, more functional models, including continuing bonds, tasks of grieving, meaning-reconstruction, the six Rs of mourning, and the dual-process model. But the stage theory has stubbornly persisted, despite a steady stream of criticism in academia and countless commentaries on the dangers of using it in bereavement counseling. Public support and pockets of professional endorsement for the stages continues to exist, undeterred by the knowledge that there is very little, if any, evidence to support its usefulness. Because there is a tendency for the general public to embrace ideas popularized in mainstream media, the stage theory clings tenaciously to public acceptance.

The Stubborn Persistence of Grief Stage Theory

Bereavement professionals who keep up with current research have wisely discarded the "five stages of grief" theory in favor of more contemporary, more functional models, including continuing bonds , tasks of grieving. meaning-reconstruction , the six Rs of mourning ,and Stroebe & Schut's dual-process model. But the stage theory has stubbornly persisted, despite a steady stream of criticism in academia and countless commentaries on the dangers of using it in bereavement counseling . Public support and pockets of professional endorsement for the stages continues to exist, undeterred by the knowledge that there is very little, if any, evidence to support its usefulness. Because there is a tendency for the general public to embrace ideas popularized in mainstream media, the stage theory clings tenaciously to public acceptance.

Co-Occurring Substance Use Disorders and Grief during Recovery

BACKGROUND

Individuals with substance use disorders (SUDs) often experience loss and grief when recovering from addiction. With fatal overdoses and suicide rates increasing for individuals with SUDs and other mental health concerns, individuals in recovery are often faced with mourning the loss of a loved one while navigating their life in recovery. The loss of a loved one can be compounded by the effect of losing their relationship with their drug of choice. These co-occurring losses may prove overwhelming during recovery and precipitate a relapse.

OBJECTIVES

We wish to propose the use of two bereavement models to address the grief present for individuals with SUDs experiencing loss so that providers are better able meet the complex needs of this population.

METHODS

This article presents two separate bereavement models that may be used to shape treatment for individuals in recovery from addiction with co-occurring grief from the loss of a loved one: the dual-process model of coping with bereavement (DPM) and the two-track model of bereavement.

RESULTS

We propose the application of these two grief models in treatment for individuals with SUDs who are experiencing co-occurring grief issues. We discuss therapeutic interventions that may be utilized to support clients with co-occurring losses.Conclusion/Importance: If an individual experiences the loss of a loved one while navigating their life in recovery from a SUD, they can experience complicated grief due to co-occurring losses. These models provide an opportunity for mental health providers to help those with SUDs work through this complex grief.

Treating Opioid Use Disorder in Peripartum Mothers: A Look at the Psychodynamics, Neurobiology, and Potential Role of Oxytocin

The peripartum period (pregnancy and postpartum) is a unique time filled with psychodynamic and biological changes that are critical in affecting the lives of mother and baby. Attachment, the biologically based emotional connection between a caregiver and infant, is critical to the development of the child. The early interactions in an infant's life shape their reward neuro-circuitry and the development of their internal working models and styles of attachment. Opioid use disorders in the mother affect the psychodynamics and neurobiology of attachment. There is significant overlap between the neurobiology of attachment and that of opioid use disorders. In this article, we hope to describe how opioid use disorders affect mother-infant attachment and how psychodynamic psychotherapy that is informed by attachment theory may be a potential treatment for mothers with opioid use disorders. Further, oxytocin plays a role in the attachment process and may function abnormally in mothers with opioid use disorders. As oxytocin affects attachment, administration of oxytocin during postpartum mother-infant interactions in the setting of psychotherapy may facilitate bonding and promote recovery from opioid use disorders in the peripartum population.

What can we learn from PWS and SNORD116 genes about the pathophysiology of addictive disorders?

Addictive disorders have been much investigated and many studies have underlined the role of environmental factors such as social interaction in the vulnerability to and maintenance of addictive behaviors. Research on addiction pathophysiology now suggests that certain behavioral disorders are addictive, one example being food addiction. Yet, despite the growing body of knowledge on addiction, it is still unknown why only some of the individuals exposed to a drug become addicted to it. This observation has prompted the consideration of genetic heritage, neurodevelopmental trajectories, and gene-environment interactions in addiction vulnerability. Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder in which children become addicted to food and show early social impairment. PWS is caused by the deficiency of imprinted genes located on the 15q11-q13 chromosome. Among them, the SNORD116 gene was identified as the minimal gene responsible for the PWS phenotype. Several studies have also indicated the role of the Snord116 gene in animal and cellular models to explain PWS pathophysiology and phenotype (including social impairment and food addiction). We thus present here the evidence suggesting the potential involvement of the SNORD116 gene in addictive disorders.

Integrated Effects of Neonatal Ventral Hippocampal Lesions and Impoverished Social-Environmental Rearing on Endophenotypes of Mental Illness and Addiction Vulnerability

A wide range of mental illnesses show high rates of addiction comorbidities regardless of their genetic, neurodevelopmental, and/or adverse-environmental etiologies. Understanding how the spectrum of mental illnesses produce addiction vulnerability will be key to discovering more effective preventions and integrated treatments for adults with addiction and dual diagnosis comorbidities. A population of 131 rats containing a spectrum of etiological mental illness models and degrees of severity was experimentally generated by crossing neonatal ventral hippocampal lesions (NVHL; n = 68) or controls (SHAM-operated; n = 63) with adolescent rearing in environmentally/socially enriched (ENR; n = 66) or impoverished (IMP; n = 65) conditions. This population was divided into 2 experiments: first, examining NVHL and IMP effects on novelty and mild stress-induced locomotion across 3 adolescent ages; second, looking at initial cocaine reactivity and long-term cocaine behavioral sensitization in adulthood. NVHL and IMP-environmental conditions independently produced remarkably similar and robustly significant abnormalities of hyperreactivity to novelty, mild stress, and long-term cocaine sensitization. The combined NVHL-IMP groups showed the most severe phenotypes across the board, so that the mental illness and addiction vulnerability phenotypes increased together in severity in a consistent stepwise progression from the healthiest rats to those with the greatest loading of etiological models. These findings add weight to our understanding of mental illness and addiction vulnerability as brain disorders that are biologically and developmentally unified in ways that transcend etiological causes, and yet co-intensify with increased loading of etiological conditions. Combining neurodevelopmental and adverse-environmental models of mental illness may provide an approach to identifying and therapeutically targeting cortical-striatal-limbic network mechanisms that generate addiction and dual diagnosis diseases.

Prevalence and predictors of recreational drug use among medical and nursing students in Cameroon: a cross sectional analysis

Objective

Medical and nursing students in Cameroon are likely to have mental health problems given the stressful nature of their studies. Paucity of mental health institutions in the country implies they hardly get access to professional help when needed and are obliged to develop coping strategies such as recreational drug use. This study aims to determine the prevalence and predictors of recreational drug use among a group of Cameroonian medical and nursing students.

Results

Cross-sectional analysis of 852 medical and nursing students (mean age 21.78 ± 3.14, 31.49% males) recruited by convenience sampling from three state-owned medical schools; and from two state-owned and two private nursing schools in Cameroon over a four-month period (January–April 2018). Information was collected via a printed self-administered and structured questionnaire from consenting students. Multivariable logistic regression analysis was used to identify independent predictors of recreational drug use. The overall prevalence of recreational drug use was 1.64% with tramadol and marijuana noted as the drugs used by these students. Independent predictors of recreational drug use were: presence of a chronic illness (OR 5.26; 95% CI 1.32, 20.97; p = 0.019), alcohol consumption (OR 5.08; 95% CI 1.54, 16.73; p = 0.008) and Total Oldenburg Burnout Inventory score (OR 1.11; 95% CI 1.02, 1.21; p = 0.021). The use of recreational drugs by medical and nursing students in Cameroon remains worrisome despite its very low prevalence, as it may negatively impact their performance and health.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3631-z) contains supplementary material, which is available to authorized users.

The Role of Oxytocin and Vasopressin in Attachment

Selective relationships and attachments are central to human health and well-being, both in current societies and during the course of evolution. The presence or absence of social bonds has consequences across the lifespan. The neurobiology of attachment is grounded in neuroendocrine substrates that are shared with reproduction and survival. Experimental studies of species, such as sheep or prairie voles, capable of showing selective social behaviors toward offspring or partners, have provided empirical evidence for the role of oxytocin and vasopressin in the formation of selective attachments. Developmental exposure to social experiences and to peptides, including oxytocin and vasopressin, also can "retune" the nervous system, altering thresholds for sociality, emotion regulation, and aggression. Without oxytocin and without the ability to form attachments the human brain as we know it could not exist. Knowledge of the neurobiology of attachment, and especially the role of oxytocin, also has implications for understanding both healthy behavior and treating mental disorders.