Anxiety and substance use: layers of complexity

Methadone treatment, bruxism, and temporomandibular disorders among male prisoners

There is little information on bruxism related to illicit drug use. Prolonged drug use may damage the stomatognathic system via oral motor overactivity. The aim of the present study was to compare the rates of bruxism and temporomandibular disorders (TMDs) between prisoners with and without drug-use disorders, to evaluate the association between methadone treatment and bruxism and to assess the possible relationship between bruxism and pain. The sample included 152 male prisoners, 69 of whom were drug users maintained on methadone. All prisoners were examined by an experienced dentist and completed a questionnaire on their oral habits, with the aim of detecting signs or symptoms of TMD and/or bruxism. Additional data were collected from medical files. The prevalence of sleep bruxism and awake bruxism, but not of TMDs, was significantly higher among drug-user than non-drug user prisoners (52.2% vs. 34.9% for sleep bruxism, 59.7% vs. 30.1% for awake bruxism, and 46.3% vs. 25.6% for TMDs, respectively). Participants with awake bruxism were statistically more sensitive to muscle palpation compared with participants with sleep bruxism [rating scores (mean ± SD): 0.32 ± 0.21 vs. 0.19 ± 0.28, respectively]. An association was found between sleep bruxism and awake bruxism. It seems that there is a direct or an indirect association between methadone maintenance treatment and sleep bruxism or awake bruxism in male prisoners.

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

Exercise as a potential treatment for drug abuse: evidence from preclinical studies

Epidemiological studies reveal that individuals who engage in regular aerobic exercise are less likely to use and abuse illicit drugs. Until recently, very few studies had examined the causal influences that mediate this relationship, and it was not clear whether exercise was effective at reducing substance use and abuse. In the past few years, several preclinical studies have revealed that exercise reduces drug self-administration in laboratory animals. These studies have revealed that exercise produces protective effects in procedures designed to model different transitional phases that occur during the development of, and recover from, a substance use disorder (e.g., acquisition, maintenance, escalation, and relapse/reinstatement of drug use). Moreover, recent studies have revealed several behavioral and neurobiological consequences of exercise that may be responsible for its protective effects in these assays. Collectively, these studies have provided convincing evidence to support the development of exercise-based interventions to reduce compulsive patterns of drug intake in clinical and at-risk populations.

Tabakentwöhnung bei stationären Patienten mit einer Alkohol- abhängigkeit – Motivationsfaktoren und Erfolgsaussichten

Einleitung: Die Raucherprävalenz ist bei alkoholkranken Personen überdurchschnittlich hoch. Die gesundheitliche Bedeutung der Tabakabstinenz, aber auch potentielle synergistische Effekte auf die Alkoholabstinenz legen nahe, während einer stationären Alkoholbehandlung auch eine Tabakentwöhnung anzubieten. Ziel: Untersucht wurden die Aufhörbereitschaft und der Abstinenzerfolg nach einer Raucherentwöhnung während einer sechswöchigen stationären Alkoholismustherapie bei alkoholkranken Personen mit zusätzlicher psychiatrischer Komorbidität. Methodik: 90 von 94 Personen eines Behandlungsjahrgangs nahmen an der Untersuchung teil. Sie durchliefen eine Psychoedukation zur Tabakabhängigkeit und hatten nachfolgend die Gelegenheit, eine Raucherentwöhnungsgruppe zu besuchen. Erfasst wurden soziodemographische Daten, Motivation sowie die Abstinenzquoten von Tabak und Alkohol am Ende und drei Monate nach der Therapie. Ergebnisse: Wichtige Motivationsgründe für eine Tabakabstinenz sind die Vorteile des Nichtrauchens. 40 % (n = 28) der rauchenden Patienten (n = 69) ließen sich zu einer Tabakentwöhnung motivieren, 25 % (n = 7) schlossen die Behandlung abstinent ab. Auch wenn keiner der Patienten über drei Monate tabakabstinent blieb, so war doch der Anteil alkoholrückfälliger Patienten in der Raucherentwöhnungsgruppe niedriger (21,4 %; n = 6/28) als bei den übrigen Patienten (29,3 %; n = 12/41)). Diskussion: Die Tabakentwöhnung im Rahmen einer stationären Alkoholismusbehandlung scheint nicht von Nachteil für die Patienten zu sein. Bei der Einführung eines Therapieangebotes sollten motivationale Faktoren, Bewältigungsfertigkeiten für rückfallgefährliche Situationen sowie Begleitsymptome komorbider Störungen stärker im Vordergrund stehen als bei anderen Rauchern.

Endocannabinoid-mediated synaptic plasticity and addiction-related behavior

Endogenous cannabinoids (eCBs) are retrograde messengers that provide feedback inhibition of both excitatory and inhibitory transmission in brain through the activation of presynaptic CB₁ receptors. Substantial evidence indicates that eCBs mediate various forms of short- and long-term plasticity in brain regions involved in the etiology of addiction. The present review provides an overview of the mechanisms through which eCBs mediate various forms of synaptic plasticity and discusses evidence that eCB-mediated plasticity is disrupted following exposure to a variety of abused substances that differ substantially in pharmacodynamic mechanism including alcohol, psychostimulants and cannabinoids. The possible involvement of dysregulated eCB signaling in maladaptive behaviors that evolve over long-term drug exposure is also discussed, with a particular focus on altered behavioral responses to drug exposure, deficient extinction of drug-related memories, increased drug craving and relapse, heightened stress sensitivity and persistent affective disruption (anxiety and depression).

Lower risk taking and exploratory behavior in alcohol-preferring sP rats than in alcohol non-preferring sNP rats in the multivariate concentric square field (MCSF) test

The present investigation continues previous behavioral profiling studies of selectively bred alcohol-drinking and alcohol non-drinking rats. In this study, alcohol-naïve adult Sardinian alcohol-preferring (sP) and non-preferring (sNP) rats were tested in the multivariate concentric square field (MCSF) test. The MCSF test has an ethoexperimental approach and measures general activity, exploration, risk assessment, risk taking, and shelter seeking in laboratory rodents. The multivariate design enables behavioral profiling in one and the same test situation. Age-matched male Wistar rats were included as a control group. Five weeks after the first MCSF trial, a repeated testing was done to explore differences in acquired experience. The results revealed distinct differences in exploratory strategies and behavioral profiles between sP and sNP rats. The sP rats were characterized by lower activity, lower exploratory drive, higher risk assessment, and lower risk taking behavior than in sNP rats. In the repeated trial, risk-taking behavior was almost abolished in sP rats. When comparing the performance of sP and sNP rats with that of Wistar rats, the principal component analysis revealed that the sP rats were the most divergent group. The vigilant behavior observed in sP rats with low exploratory drive and low risk-taking behavior is interpreted here as high innate anxiety-related behaviors and may be related to their propensity for high voluntary alcohol intake and preference. We suggest that the different lines of alcohol-preferring rats with different behavioral characteristics constitute valuable animal models that mimic the heterogeneity in human alcohol dependence.