Patients admitted for inpatient cannabis detoxification: withdrawal symptoms and impacts of common comorbidities

Individuals with psychosis and a lifetime history of cannabis use show greater deficits in emotional experience compared to non-using peers

Background: While previous research suggests that active cannabis use is a barrier to the emotional experiences of anticipating pleasure and expressing emotion in early psychosis, the relationship between lifetime cannabis use, emotional experience and social function over time has been understudied.Aims: This study sought to characterize the influence of lifetime cannabis use on emotional experience in prolonged psychosis and the influence of the interaction of cannabis use and emotional expression on social function.Methods: Emotional expression, experience of pleasure in the moment, anticipatory anhedonia and social functioning were measured concurrently using the Emotional Expressivity Scale (EES), Temporal Experience of Pleasure Scale (TEPS) and Social Functioning Scale (SFS), respectively. Participants were adults with schizophrenia either with (n = 35) or without (n = 36) a lifetime history of cannabis use.Results: Compared to non-using participants, individuals with a history of cannabis use expressed lesser abilities to express emotion, were less likely to expect pleasure and had poorer social function. Cannabis use moderated the relationship between anticipatory pleasure and prosocial activities.Conclusions: Lifetime cannabis use in schizophrenia may be associated with greater deficits in emotional expressivity, anticipation of pleasure and social function. Cannabis use may disrupt the relationship between anticipatory pleasure and social functioning.

Dynamic associations between opioid use and anhedonia: A longitudinal study in opioid dependence

BACKGROUND

Anhedonia is a commonly reported symptom among substance-dependent populations that appears to diminish with sustained abstinence. However, previous research has not determined whether anhedonia is dynamically linked to changing patterns of drug use, nor whether it predicts subsequent drug use.

AIMS

We aimed to test whether changes in illicit opioid use would predict changes in anhedonia, and whether increases in anhedonia would predict further opioid use.

METHODS

We conducted a longitudinal, observational study, with a convenience sample of 121 participants with current or past-year Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) opioid dependence recruited from substance use treatment and related services and from pharmacies administering opioid substitution pharmacotherapy. Anhedonia was assessed with the Temporal Experience of Pleasure Scale and frequency of illicit opioid use was assessed using timeline follow-back interviews.

RESULTS

There was a significant within-subject effect (β=-0.015; 95% CI -0.02 to -0.01; p=0.001), indicating that participants' Temporal Experience of Pleasure Scale scores typically declined (i.e. anhedonia increased) following a month with above-average opioid use and Temporal Experience of Pleasure Scale scores rose (i.e. anhedonia reduced) following a month with below-average opioid use. However, Temporal Experience of Pleasure Scale scores did not significantly predict opioid use in the subsequent month (β=-0.04, 95% CI -0.20 to 0.12; p=0.651).

CONCLUSIONS

Changes in illicit opioid use predict self-reported anhedonia, suggesting a possible causal relationship whereby anhedonia is likely to worsen with frequent drug use and diminish with prolonged abstinence. However, anhedonia does not appear to drive further drug use.

Evidence that anhedonia is a symptom of opioid dependence associated with recent use

BACKGROUND

Anhedonia is prevalent among substance-dependent populations. The hedonic allostasis model suggests this is due to the effects of addictive substances on neural substrates of reward processing. However, previous research may have been confounded by other factors likely to influence anhedonia, including tobacco use, psychopathology, and history of trauma and other stressors. Thus it remains unclear whether elevated anhedonia in substance-dependent populations is caused by substance use itself, or is due to other correlates of substance dependence.

METHODS

Multivariate analysis of covariance was conducted to test whether opioid-dependent participants' anhedonia scores were elevated, relative to a non-dependent control group, after controlling for psychosocial factors likely to influence anhedonia. Correlational analyses within opioid-dependent participants were also conducted to examine whether anhedonia was associated with recent illicit opioid use or duration of abstinence.

RESULTS

There was a modest, but significant, elevation in anhedonia in opioid-dependent participants, relative to controls (Partial η²=0.034, p=0.041) after controlling for psychosocial variables that were associated with anhedonia. Depressive symptoms and history of post-traumatic stress disorder also remained significantly associated with anhedonia in the adjusted model. Among participants on opioid pharmacotherapy, there were significant associations between frequency of recent illicit opioid use and scores on anhedonia measures (all r_s>0.25, p<0.013), but among abstinent opioid-dependent participants, relationships between duration of abstinence and anhedonia were not significant (all r_s<0.24, p>0.22).

CONCLUSION

These findings support the hypothesis that use of opioids can cause anhedonia, although other psychosocial factors may also contribute to the high prevalence of anhedonia among opioid-dependent populations.

Cognitive-behavioral therapies for depression and substance use disorders: An overview of traditional, third-wave, and transdiagnostic approaches

BACKGROUND

The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously.

OBJECTIVES

The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity.

RESULTS

Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression.

CONCLUSION

Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.

Attention to pleasant stimuli in early adolescence predicts alcohol-related problems in mid-adolescence

Attenuated responses to natural rewards have been found to predict subsequent substance use among dependent populations, suggesting that this may be a premorbid risk factor for later problematic substance use. However, research on adolescent risk-taking suggests that exaggerated, rather than blunted, reward responsiveness predicts later substance abuse. Acoustic startle-induced event-related potentials (ERP) were recorded in a sample of 11-13 year-olds while they viewed affective pictures, and participants were reassessed four years later regarding alcohol use and experience of alcohol-related problems. Increased attenuation of the amplitude of the P300 component of the ERP during viewing of pleasant pictures, relative to amplitude during neutral pictures (an indicator of increased attention to pleasant pictures), predicted increased likelihood of alcohol-related problems at follow-up. These findings further support research indicating that increased reward responsiveness predicts risky behaviours in adolescence, with anhedonia primarily a consequence of substance dependence.

Anhedonia in substance use disorders: a systematic review of its nature, course and clinical correlates

OBJECTIVE

There is growing evidence that anhedonia is a commonly experienced symptom among substance-using populations. This systematic review synthesises findings across a range of substances to address questions regarding the time course of anhedonia, how anhedonia relates to other symptoms of substance dependence and whether it is similarly prevalent across all addictive drugs.

METHOD

A literature search was conducted on PubMed, PsycINFO and MEDLINE, yielding 32 studies that used self-report measures of anhedonia among participants with a history of a substance abuse, dependence or long-term daily use of addictive substances.

RESULTS

Findings from these studies indicate that anhedonia (1) is elevated in samples dependent on a range of substances; (2) typically appears as a consequence of substance abuse or dependence, and diminishes with abstinence; and (3) predicts increased drug cravings and the likelihood of relapse in those attempting abstinence.

CONCLUSIONS

The common experience of anhedonia in substance-dependent populations, and its relationship to relapse, emphasises the importance of developing therapeutic interventions that specifically target anhedonia in the treatment of all substance use disorders.

Clinical and reliable change in an Australian residential substance use program using the Addiction Severity Index

Although the Addiction Severity Index (ASI) is one of the most frequently used measures in alcohol and other drug research, it has rarely been used to assess clinical and reliable change. This study assessed clients' clinical and reliable change at The Salvation Army residential substance abuse treatment centers in Australia. A total of 296 clients completed ASI interviews on admission to treatment and 3 months after discharge from treatment. Clients demonstrated significant improvement on all seven ASI composites. The range of reliable change for each ASI composite varied from 30% to 70%. More than two-thirds of clients experienced clinically significant improvement for alcohol and drug problems. Psychiatric distress was clinically reduced in 44% of clients. This research indicates that residential substance abuse treatment can make important differences in client's lives at a clinical and functional level. However, the research highlights the challenge of effectively targeting psychiatric comorbidity within alcohol and other drug abuse populations.