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Jo Nixon S, Garcia CC, Lewis B. WOMEN'S USE OF ALCOHOL: NEUROBIOBEHAVIORAL CONCOMITANTS AND CONSEQUENCES. Front Neuroendocrinol 2023:101079. [PMID: 37269931 DOI: 10.1016/j.yfrne.2023.101079] [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: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/27/2023] [Indexed: 06/05/2023]
Abstract
In this narrative review, we draw from historical and contemporary literature to explore the impact of alcohol consumption on brain and behavior among women. We examine three domains: 1) the impact of alcohol use disorder (AUD) on neurobiobehavioral outcomes, 2) its impact on social cognition/emotion processing, and 3) alcohol's acute effects in older women. There is compelling evidence of alcohol-related compromise in neuropsychological function, neural activation, and brain structure. Investigations of social cognition and alcohol effects in older women represent emerging areas of study. Initial analyses suggest that women with AUD show significant deficits in emotion processing, a finding also observed in older women who have consumed a moderate dose of alcohol. Critically, despite the long-recognized need for programmatic interrogation of alcohol's effect in women, studies with sufficient numbers of women for meaningful analysis represent a small proportion of the literature, constraining interpretation and generalization.
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Affiliation(s)
- Sara Jo Nixon
- University of Florida, Department of Psychiatry, Gainesville, FL; University of Florida, Department of Psychology, Gainesville, FL; University of Florida, Department of Neuroscience, Gainesville; University of Florida, Center for Addiction Research & Education, Gainesville, FL.
| | - Christian C Garcia
- University of Florida, Department of Psychiatry, Gainesville, FL; University of Florida, Center for Addiction Research & Education, Gainesville, FL
| | - Ben Lewis
- University of Florida, Department of Psychiatry, Gainesville, FL; University of Florida, Department of Psychology, Gainesville, FL; University of Florida, Department of Neuroscience, Gainesville; University of Florida, Center for Addiction Research & Education, Gainesville, FL
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Motazedian S, Solat N, Banihashem SS, Kheradmand A, Mohammadi SD, Chalakinia N. Cognitive function in methadone maintenance patients compared with abstinent opioid users. J Addict Dis 2021; 39:537-544. [PMID: 33829960 DOI: 10.1080/10550887.2021.1907501] [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: 10/21/2022]
Abstract
BACKGROUND Opioid is the second most prevalent illicit drug worldwide, whose consumption is very high in Iran, due to Iran's geographical proximity to producing countries. Methadone maintenance therapy is one of the most prevalent and accepted methods of substance abuse treatment. Nevertheless, cognitive disorders have been reported as one of its complications. AIM This study was conducted to evaluate cognitive impairment in methadone maintenance patients (MMPs) and to compare it with abstinent opioid users (AOUs). MATERIALS AND METHODS This cross-sectional analytical study was performed on 25 MMPs and 25 AOUs. Samples were selected through convenience sampling method whereby a self-made questionnaire was distributed among them to assess demographic information, clinical variables such as methadone and opioid use history, underlying disease and medication history, as well as 13-item Beck depression inventory. Then, they were interviewed using the Montreal Cognitive Assessment (MoCA) questionnaire. RESULTS Significant differences were found in MoCA questionnaire total scores (p = 0.018) and orientation to time and place dimension (p = 0.008) between the two groups, with the mean scores being higher in AOU group. Duration of opioid use was the only factor influencing cognitive assessment score in both Groups. (p = 0.029). CONCLUSION We suggest monitoring and assessing cognition function in patients receiving methadone especially for those with a long history of opioid use.
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Affiliation(s)
- Somayeh Motazedian
- Department of Psychosomatic Medicine, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Solat
- Department of Psychiatry, School of Medicine, Fasa University of Medical Sciences, Fasa, Shiraz, Iran
| | - Seyed Shahab Banihashem
- Department of Psychosomatic Medicine, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kheradmand
- Department of Psychiatry, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Davood Mohammadi
- Department of Clinical Psychology, School of Medicine, Fasa University of Medical Sciences, Fasa, Shiraz, Iran
| | - Nasrin Chalakinia
- Department of Psychosomatic Medicine, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Alcohol use disorder (AUD) commonly is associated with compromise in neurobiological and/or neurobehavioral processes. The severity of this compromise varies across individuals and outcomes, as does the degree to which recovery of function is achieved. This narrative review first summarizes neurobehavioral, neurophysiological, structural, and neurochemical aberrations/deficits that are frequently observed in people with AUD after detoxification. Subsequent sections review improvements across these domains during recovery, taking into account modulators of recovery to the extent permitted. Where appropriate, the discussion includes work integrating outcomes across domains, leveraging the strengths of diverse experimental methods. Interventions to ameliorate neurobiological or neurobehavioral deficits do not constitute a primary objective of this review. However, their consideration is a logical inclusion. Therefore, a limited introduction to existing methods is also presented.
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Affiliation(s)
- Sara Jo Nixon
- Department of Psychiatry, University of Florida, Gainesville, Florida.,Center for Addiction Research & Education, University of Florida, Gainesville, Florida
| | - Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, Florida.,Center for Addiction Research & Education, University of Florida, Gainesville, Florida
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Salivary Cortisol Levels Are Associated with Craving and Cognitive Performance in Cocaine-Abstinent Subjects: A Pilot Study. Brain Sci 2020; 10:brainsci10100682. [PMID: 32992573 PMCID: PMC7600918 DOI: 10.3390/brainsci10100682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023] Open
Abstract
Cortisol is a glucocorticoid hormone secreted by the adrenal cortex upon the activation of the hypothalamic-pituitary-adrenal (HPA) axis. Assessment of cortisol in saliva has emerged as a reliable way of evaluating HPA function. We examined the relationships between salivary cortisol levels with both craving and cognitive performance, as a possible biomarker of cocaine addiction. Cognitive performance (attention, declarative and working memory, executive functions and recognition of emotions) was assessed in 14 abstinent cocaine-dependent subjects in outpatient treatment and 13 control participants. Three salivary samples were collected at home by all the participants in the morning, afternoon and at bedtime. Patients showed higher levels of cortisol in the morning, as well as higher area under the curve with respect to the ground (AUCg). Regarding cognitive performance, cocaine-abstinent subjects showed worse performance in attention (d2 test), verbal memory (Spanish Complementary Verbal Learning Test, TAVEC) and executive tests (Tower of Hanoi and phonological fluency test) with respect to the control group. Morning cortisol levels and the AUCg index were negatively associated with the age of onset of drug consumption and the AUCg index was also positively associated with craving in our patients' group. Moreover, morning cortisol levels, as well as the AUCg index, were negatively associated with verbal memory performance. Therefore, our pilot study suggests that salivary cortisol measurements could be a good avenue to predict craving level, as well as cognitive status, especially the declarative memory domain.
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Lewis B, Merlo L, Greene W, Welch E, Nixon SJ. Randomized trial to assess safety/feasibility of memantine administration during residential treatment for alcohol use disorder: a pilot study. J Addict Dis 2020; 38:91-99. [PMID: 32050864 DOI: 10.1080/10550887.2020.1721404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The N-methyl-D-aspartate receptor (NMDAr) system is critically involved in the pathogenesis and neurobehavioral sequelae of alcohol use disorder (AUD), and constitutes a potential pharmacotherapeutic target. Memantine (Namenda) is an FDA-approved NMDAr antagonist with suggested utility in AUD, however its safety and tolerability during long-term administration among recently-detoxified patients remains uncharacterized. This pilot study assessed safety, feasibility, and several secondary measures of interest, during a 4-week period of residential AUD treatment. Participants (N = 18) met diagnostic criteria for AUD. A double-blind, placebo-controlled, escalating-dose design was utilized. Assessments of medication side-effects were conducted weekly. At intake, week 2, and study completion, participants completed a battery assessing affective symptomatology, craving, and neurocognitive function. Medication groups reported equivalent side effects and severity. Medication compliance was high, and did not differ by group. No memantine effects were observed in secondary outcome measures. Memantine maintains a profile of high tolerability and low side-effects during post-detoxification AUD treatment. These data suggest a more aggressive dosing/escalation schedule may be used safely in future trials designed to ascertain improvements in neurocognitive function, affect, and/or craving as primary measures.
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Affiliation(s)
- Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, FL, USA.,Center for Addiction Research & Education, University of Florida, Gainesville, FL, USA
| | - Lisa Merlo
- Department of Psychiatry, University of Florida, Gainesville, FL, USA.,UF Health Florida Recovery Center, Gainesville, FL, USA.,Center for Addiction Research & Education, University of Florida, Gainesville, FL, USA
| | - William Greene
- Department of Psychiatry, University of Florida, Gainesville, FL, USA.,UF Health Florida Recovery Center, Gainesville, FL, USA
| | - Emily Welch
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Sara Jo Nixon
- Department of Psychiatry, University of Florida, Gainesville, FL, USA.,Center for Addiction Research & Education, University of Florida, Gainesville, FL, USA
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Sampedro-Piquero P, Ladrón de Guevara-Miranda D, Pavón FJ, Serrano A, Suárez J, Rodríguez de Fonseca F, Santín LJ, Castilla-Ortega E. Neuroplastic and cognitive impairment in substance use disorders: a therapeutic potential of cognitive stimulation. Neurosci Biobehav Rev 2019; 106:23-48. [DOI: 10.1016/j.neubiorev.2018.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/15/2018] [Accepted: 11/23/2018] [Indexed: 01/08/2023]
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Shlosberg D, Amit BH, Zalsman G, Krivoy A, Mell H, Lev-Ran S, Shoval G. Cognitive Impairments in Abstinent Male Residents of a Therapeutic Community for Substance-Use Disorders: A Five-Year Retrospective Study. Subst Use Misuse 2019; 54:538-548. [PMID: 30729882 DOI: 10.1080/10826084.2018.1517800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Prior studies of residual cognitive deficits in abstinent substance-use disorder (SUD) patients, exhibited conflicting reports and a substantial patient selection bias. The aim of this study was to test the cognitive function of a sample of chronic abstinent SUD patients in a therapeutic-community. METHODS The IntegNeuroTM cognitive test battery was used for a retrospective cross-sectional study of cognitive functioning of an unselected sample (n = 105) of abstinent male residents of a therapeutic-community. The results were compared to a large age-, gender-, and education-matched normative cohort. RESULTS A significant negative deviance from the normal cohorts' mean was present in most of the cognitive test results and in all the cognitive domains that were tested. The most substantial deficit was found in the executive function domain (d = 1.02, 95%CI (±0.11)). Correct identification of facial emotions was significantly lower selectively in expressions of disgust and sadness. Substance-use starting at an early age (12.4 ± 0.8 years) was associated with lower performance in tests of sustained attention and impulsivity as well as with varied ability to identify correctly "negative" emotions in the emotion identification domain. CONCLUSIONS This 5-year retrospective study demonstrates substantial cognitive impairments in an unselected sample of abstinent SUD patients. Impairment in multiple cognitive domains may lower the probability for remission and successful social integration. Early-age substance initiation may be associated with larger impairments in cognitive performance.
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Affiliation(s)
- Dan Shlosberg
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ben H Amit
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Gil Zalsman
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Division of Molecular Imaging and Neuropathology, Department of Psychiatry , Columbia University , New York , New York , USA
| | - Amir Krivoy
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Haim Mell
- d Therapy and Rehabilitation Unit, Israel Anti-Drug Authority , Jerusalem , Israel
| | - Shaul Lev-Ran
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Outpatient Addiction Clinic, Lev Hasharon Medical Center , Israel
| | - Gal Shoval
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
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Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
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Pujol CN, Paasche C, Laprevote V, Trojak B, Vidailhet P, Bacon E, Lalanne L. Cognitive effects of labeled addictolytic medications. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:306-332. [PMID: 28919445 DOI: 10.1016/j.pnpbp.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Alcohol, tobacco, and illegal drug usage is pervasive throughout the world, and abuse of these substances is a major contributor to the global disease burden. Many pharmacotherapies have been developed over the last 50years to target addictive disorders. While the efficacy of these pharmacotherapies is largely recognized, their cognitive impact is less known. However, all substance abuse disorders are known to promote cognitive disorders like executive dysfunction and memory impairment. These impairments are critical for the maintenance of addictive behaviors and impede cognitive behavioral therapies that are regularly administered in association with pharmacotherapies. It is also unknown if addictolytic medications have an impact on preexisting cognitive disorders, and if this impact is modulated by the indication of prescription, i.e. abstinence, reduction or substitution, or by the specific action of the medication. METHOD We reviewed the cognitive effects of labeled medications for tobacco addiction (varenicline, bupropion, nicotine patch and nicotine gums), alcohol addiction (naltrexone, nalmefene, baclofen, disulfiram, sodium oxybate, acamprosate), and opioid addiction (methadone, buprenorphine) in human studies. Studies were selected following MOOSE guidelines for systematic reviews of observational studies, using the keywords [Cognition] and [Cognitive disorders] and [treatment] for each medication. RESULTS 971 articles were screened and 77 studies met the inclusion criteria and were reported in this review (for alcohol abuse, n=21, for tobacco n=22, for opioid n=34. However, very few comparative clinical trials have explored the chronic effects of addictolytic medications on cognition in addictive behaviors, and there are no clinical trials on the cognitive impact of nalmefene in patients suffering from alcohol use disorders. DISCUSSION Although some medications seem to enhance cognition in patients suffering from cognitive disorders, others could promote cognitive impairments, and our work highlights a lack of literature on this subject. In conclusion, more comparative clinical trials are needed to better understand the cognitive impact of addictolytic medications.
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Affiliation(s)
- Camille Noélie Pujol
- Department of Neurosciences, Institute for Functional Genomics, INSERM U-661, CNRS UMR-5203, 34094 Montpellier, France
| | - Cecilia Paasche
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France
| | - Vincent Laprevote
- Centre Psychothérapique de Nancy, Laxou, F-54520, France.; EA 7298, INGRES, Université de Lorraine, Vandoeuvre-lès-, Nancy F-54000, France; CHU Nancy, Maison des Addictions, Nancy, F-54000, France.
| | - Benoit Trojak
- Department of Psychiatry and Addictology, University Hospital of Dijon, France; EA 4452, LPPM, University of Burgundy, France.
| | - Pierre Vidailhet
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France; Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France..
| | - Elisabeth Bacon
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France.
| | - Laurence Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France; Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France..
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Marceau EM, Kelly PJ, Solowij N. The relationship between executive functions and emotion regulation in females attending therapeutic community treatment for substance use disorder. Drug Alcohol Depend 2018; 182:58-66. [PMID: 29154148 DOI: 10.1016/j.drugalcdep.2017.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Difficulties in emotion regulation influence the development of substance use disorder (SUD), its severity, course, treatment outcomes, and relapse. Impaired executive functions (EFs) are common in SUD populations and may relate to emotion dysregulation. The current study tested whether performance on three basic EF tasks ('working memory', 'inhibition', and 'task-switching') and/or inventory-based assessment of EF were related to difficulties in emotion regulation in females attending residential SUD therapeutic community treatment. METHODS Cross-sectional design in which participants (N=50, all female) completed a questionnaire battery including the Difficulties in Emotion Regulation Scale (DERS) and Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) was used. Participants also completed neuropsychological assessment of EF including the Working Memory Index (WMI; Wechsler Adult Intelligence Scale), and measures of inhibition and task-switching (Color-Word Interference Test; Delis-Kaplan Executive Function System). RESULTS Executive dysfunction, as assessed by the Global Executive Composite (GEC; BRIEF-A), and personality disorder indicators (Standardised Assessment of Personality - Abbreviated Scale; SAPAS) were positively correlated with DERS scores. Sequential hierarchical regression indicated that task-switching, GEC, and SAPAS scores statistically predicted DERS scores, while working memory and inhibition did not. Mediation analysis indicated that there was a significant indirect effect of GEC scores and task-switching performance on DERS scores, through SAPAS scores. CONCLUSIONS Impairment of EF, particularly task-switching, is related to difficulties in emotion regulation in a female sample attending residential SUD treatment. Cognitive training interventions that improve task-switching performance may be beneficial in promoting effective emotion regulation and improved SUD treatment outcomes.
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Affiliation(s)
- Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Peter J Kelly
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
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Marceau EM, Berry J, Lunn J, Kelly PJ, Solowij N. Cognitive remediation improves executive functions, self-regulation and quality of life in residents of a substance use disorder therapeutic community. Drug Alcohol Depend 2017. [PMID: 28651150 DOI: 10.1016/j.drugalcdep.2017.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Executive dysfunction is common in substance use disorder (SUD) populations and hinders treatment. We previously found that 50% of residents in SUD therapeutic communities had been hospitalized for head injuries; this was a significant determinant of cognitive impairment. The current study aimed to establish whether cognitive remediation improves executive functions (EFs) and self-regulation in an ecologically valid sample of female residents attending SUD therapeutic community treatment, including those with past head injuries and psychiatric comorbidities. METHODS Controlled sequential groups design with residents (N=33, all female) receiving treatment as usual (TAU). The intervention group (n=16) completed four weeks of cognitive remediation (CR) and the control, TAU only (n=17). Outcome measures assessed pre- and post-intervention included both performance- and inventory-based measures of EFs, and self-reported self-regulation and quality of life. RESULTS CR relative to TAU significantly improved performance-based assessment of inhibition (Color-Word Interference Test; F=4.29, p=0.047), inventory-based assessment of EFs (Behavior Rating Inventory of Executive Function - Adult Version: Global Executive Composite; F=6.38, p=0.017), impulsivity (Barratt Impulsiveness Scale; F=4.61, p=0.040), self-control (Brief Self-Control Scale; F=5.53, p=0.026), and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form; F=7.68, p=0.010). CONCLUSIONS Findings suggest that CR improves EFs in a heterogeneous sample of female residents in therapeutic community SUD treatment. Future research may explore the possibility of tailoring CR interventions for various SUD subgroups.
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Affiliation(s)
- Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave Wollongong, NSW 2522 Australia
| | - Jamie Berry
- Advanced Neuropsychological Treatment Services, PO Box 4070, Strathfield South, NSW 2136 Australia
| | - Joanne Lunn
- We Help Ourselves (WHOs), Building 128, Church St, Lilyfield, NSW 2040 Australia
| | - Peter J Kelly
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave Wollongong, NSW 2522 Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave Wollongong, NSW 2522 Australia.
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Forster SE, Finn PR, Brown JW. A preliminary study of longitudinal neuroadaptation associated with recovery from addiction. Drug Alcohol Depend 2016; 168:52-60. [PMID: 27620345 PMCID: PMC5086261 DOI: 10.1016/j.drugalcdep.2016.08.626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/24/2016] [Accepted: 08/15/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Few studies have explored longitudinal change in event-related brain responses during early recovery from addiction. Moreover, existing findings yield evidence of both increased and decreased signaling within reward and control centers over time. The current study explored reward- and control-related signals in a risky decision-making task and specifically investigated parametric modulations of the BOLD signal, rather than signal magnitude alone. It was hypothesized that risk-related signals during decision-making and outcome evaluation would reflect recovery and that change in specific signals would correspond with improved treatment outcomes. METHODS Twenty-one substance dependent individuals were recruited upon enrollment in community-based substance use treatment programs, wherein they received treatment-as-usual. Participants completed functional neuroimaging assessments at baseline and 3-month follow-up while performing the Balloon Analogue Risk Task (BART). Risk- and reward-sensitive signals were identified using parametric modulators. Substance use was tracked throughout the 3-month study interval using the timeline follow-back procedure. RESULTS Longitudinal contrasts of parametric modulators suggested improved formation of risk-informed outcome expectations at follow-up. Specifically, a greater response to high risk (low-likelihood) positive feedback was identified in caudal anterior cingulate cortex (ACC) and a greater response to low risk (low-likelihood) negative feedback was identified in caudal ACC and inferior frontal gyrus. In addition, attenuation of a ventromedial prefrontal cortex (vmPFC) "reward-seeking" signal (i.e., increasing response with greater reward) during risky decisions at follow-up was associated with less substance use during the study interval. CONCLUSIONS Changes in risk- and reward-related signaling in ACC/vmPFC appear to reflect recovery and may support sobriety.
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Affiliation(s)
- Sarah E Forster
- Indiana University, Department of Psychological and Brain Sciences, United States; VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States
| | - Peter R Finn
- Indiana University, Department of Psychological and Brain Sciences, United States
| | - Joshua W Brown
- Indiana University, Department of Psychological and Brain Sciences, United States.
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