Higher Impulsivity As a Distinctive Trait of Severe Cocaine Addiction among Individuals Treated for Cocaine or Alcohol Use Disorders

Prevalence of high impulsivity and its relation to sleep indices in opioid use disorder patients receiving methadone maintenance treatment

BACKGROUND

The relation between impulsivity and sleep indices is not well determined in patients receiving methadone maintenance treatment (MMT).

AIMS

to evaluate high impulsivity prevalence, its risk factors and relation with sleep indices.

METHODS

a random MMT sample (n = 61) plus MMT current cocaine users (n = 20) were assessed for impulsivity (Barratt impulsivity scale [BIS-11] and Balloon Analogue Risk task [BART]), sleep quality (Pittsburg Sleep Quality Index [PSQI]), sleepiness (The Epworth sleepiness scale [ESS]), and substance in urine.

RESULTS

81 patients, aged 56.6 ± 10, 54.3% tested positive to any substance, 53.1% with poor sleep (PSQI>5) and 43.2% with daytime sleepiness (ESS >7) were studied. Impulsivity (BIS-11 ≥ 72) prevalence was 27.9% (of the representative sample), and 30.9% of all participants. These patients characterized with any substance and shorter duration in MMT with no sleep indices or other differences including BART balloon task performance (that was higher only in any substance than non-substance user group). However, impulsive score linearly correlated with daytime sleepiness (R = 0.2, p = 0.05). Impulsivity proportion was lowest among those with no cocaine followed by cocaine use and the highest in those who used cocaine and opiates (20.8%, 33.3% and 60% respectively, p = 0.02), as daily sleep (38.3%, 42.1% and 60%, p = 0.3) although not statistically significant.

CONCLUSION

Daytime sleepiness correlated with impulsivity, but cocaine usage is the robust factor. Further follow-up is warranted to determine whether substance discontinuing will lead to a reduction in impulsivity, and improved vigilance. Sleep quality did not relate to daytime sleepiness and impulsivity and need further research.

Examining Profiles and Treatment Outcomes in Dual Diagnosis: Comparison of Coordinated Treatment With Mental Health Services Versus Addiction Center Alone. A Real-World Data Analysis

OBJECTIVE

The aim of this work was to examine the profile and treatment outcomes of patients with dual pathology depending on whether the patients were attending addiction centers or are being treated in a coordinated model by mental health services.

METHODS

Data from 7225 dual diagnosis patients were used, of whom 2417 (33.5%) received treatment in the mental health coordinated modality. Clinical information was taken from the patients' electronic health record.

RESULTS

Differences were found in patients' sociodemographic and comorbidity profiles according to treatment modality. In general, coordinated care yielded favorable outcomes (higher attendance and lower dropout rates but no differences in retention). The logistic regression analysis identified predictors of patient profiles in coordinated care, emphasizing having a severe mental health disorder (OR = 3.878, 95% CI [3.443, 4.368]; p = .000), being referred by social/health services, or having retired status. Main differences were observed according to the comorbid diagnosis presented, particularly in cases in which the patient had impulse control, hyperkinetic, or cluster C personality disorder.

CONCLUSIONS

While therapeutic outcomes are influenced by associated comorbidities, the disorders prognosis can be favorable with appropriate treatment. Furthermore, analysis of differences according to treatment modality allows for predicting the type of patient who will receive a particular service, which enables the development of tailored treatments.

Dysregulation of Plasma Growth Factors and Chemokines in Cocaine Use Disorder: Implications for Dual Diagnosis with Schizophrenia and Antisocial Personality Disorder in an Exploratory Study

INTRODUCTION

Dual diagnosis in individuals with cocaine use disorders (CUDs) presents a mental health challenge marked by an increased susceptibility to disabling morbidities and premature mortality. Despite extensive research on depression and anxiety, other prevalent comorbidities, such as psychotic and personality disorders, have received less attention. This study explores inflammation-related mediators as potential biomarkers for CUD and dual diagnosis with schizophrenia (SCZ) or antisocial personality disorder (APD).

METHODS

This exploratory study included 95 participants, comprising 40 healthy subjects and 55 abstinent patients with CUD. Lifetime CUD was diagnosed either as single diagnosis (CUD group, N = 25) or as a dual diagnosis (DD group. N = 30) with SCZ (CUD+SCZ subgroup) or APD (CUD+APD subgroup). Participants were clinically assessed, and the plasma concentrations of growth factors (i.e., G-CSF, BDNF, and VEGF-A) and chemokines (i.e., CCL11/eotaxin-1, CCL2/MCP-1, and CXCL12/SDF-1) were determined and log(10)-transformed for analysis.

RESULTS

Growth factors and chemokines were dysregulated by CUD and psychiatric diagnoses. Specifically, patients in the CUD group exhibited significantly lower concentrations of G-CSF and CCL11/eotaxin-1 than the control group. In contrast, the DD group showed significantly higher concentrations of all analytes than both the CUD and control groups. Additionally, no differences in these analytes were observed between the CUD+SCZ and CUD+APD subgroups within the DD group. Regarding cocaine-related variables, significant associations were identified in the CUD group: an inverse correlation between the age at first cocaine use and the concentrations of BDNF and CCL2/MCP-1; and a positive correlation between the duration of the cocaine abstinence and the concentrations of BDNF and CCL11/eotaxin-1. Lastly, a logistic regression model incorporating all these analytes demonstrated high discriminatory power in distinguishing patients with CUD alone from those with dual diagnosis.

CONCLUSIONS

Individuals with dual diagnosis of CUD exhibit elevated concentrations of growth factors and chemokines, distinguishing them from those with CUD alone. It is unclear whether the differences in these inflammatory mediators are specific to the presence of SCZ and APD. The study highlights potential biomarkers and associations, providing valuable insights into the intricate interplay of CUD and psychiatric disorders to enhance clinical diagnosis and therapeutics.

Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder

To characterize polysubstance addiction (PSA) patterns of cocaine use disorder (CoUD), we performed a latent class analysis (LCA) in 7,989 participants with a lifetime DSM-5 diagnosis of CoUD. This analysis identified three PSA subgroups among CoUD participants (i.e., low, 17%; intermediate, 38%; high, 45%). While these subgroups varied by age, sex, and racial-ethnic distribution (p < 0.001), there was no difference with respect to education or income (p > 0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR = 21.96 vs. 6.39, difference-p = 8.08✕10-6), agoraphobia (OR = 4.58 vs. 2.05, difference-p = 7.04✕10-4), mixed bipolar episode (OR = 10.36 vs. 2.61, difference-p = 7.04✕10-4), posttraumatic stress disorder (OR = 11.54 vs. 5.86, difference-p = 2.67✕10-4), antidepressant medication use (OR = 13.49 vs. 8.02, difference-p = 1.42✕10-4), and sexually transmitted diseases (OR = 5.92 vs. 3.38, difference-p = 1.81✕10-5) than the low-PSA CoUD subgroup. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.

Subtypes in addiction and their neurobehavioral profiles across three functional domains

Rates of return to use in addiction treatment remain high. We argue that the development of improved treatment options will require advanced understanding of individual heterogeneity in Substance Use Disorders (SUDs). We hypothesized that considerable individual differences exist in the three functional domains underlying addiction-approach-related behavior, executive function, and negative emotionality. We included N = 593 participants from the enhanced Nathan Kline Institute-Rockland Sample community sample (ages 18-59, 67% female) that included N = 420 Controls and N = 173 with past SUDs [54% female; N = 75 Alcohol Use Disorder (AUD) only, N = 30 Cannabis Use Disorder (CUD) only, and N = 68 Multiple SUDs]. To test our a priori hypothesis that distinct neuro-behavioral subtypes exist within individuals with past SUDs, we conducted a latent profile analysis with all available phenotypic data as input (74 subscales from 18 measures), and then characterized resting-state brain function for each discovered subtype. Three subtypes with distinct neurobehavioral profiles were recovered (p < 0.05, Cohen's D: 0.4-2.8): a "Reward type" with higher approach-related behavior (N = 69); a "Cognitive type" with lower executive function (N = 70); and a "Relief type" with high negative emotionality (N = 34). For those in the Reward type, substance use mapped onto resting-state connectivity in the Value/Reward, Ventral-Frontoparietal and Salience networks; for the Cognitive type in the Auditory, Parietal Association, Frontoparietal and Salience networks; and for the Relief type in the Parietal Association, Higher Visual and Salience networks (pFDR < 0.05). Subtypes were equally distributed amongst individuals with different primary SUDs (χ2 = 4.71, p = 0.32) and gender (χ2 = 3.44, p = 0.18). Results support functionally derived subtypes, demonstrating considerable individual heterogeneity in the multi-dimensional impairments in addiction. This confirms the need for mechanism-based subtyping to inform the development of personalized addiction medicine approaches.

Polysubstance addiction and psychiatric, somatic comorbidities among 7,989 individuals with cocaine use disorder: a latent class analysis

Aims

We performed a latent class analysis (LCA) in a sample ascertained for addiction phenotypes to investigate cocaine use disorder (CoUD) subgroups related to polysubstance addiction (PSA) patterns and characterized their differences with respect to psychiatric and somatic comorbidities.

Design

Cross-sectional study.

Setting

United States.

Participants

Adult participants aged 18-76, 39% female, 47% African American, 36% European American with a lifetime DSM-5 diagnosis of CoUD (N=7,989) enrolled in the Yale-Penn cohort. The control group included 2,952 Yale-Penn participants who did not meet for alcohol, cannabis, cocaine, opioid, or tobacco use disorders.

Measurements

Psychiatric disorders and related traits were assessed via the Semi-structured Assessment for Drug Dependence and Alcoholism. These features included substance use disorders (SUD), family history of substance use, sociodemographic information, traumatic events, suicidal behaviors, psychopathology, and medical history. LCA was conducted using diagnoses and diagnostic criteria of alcohol, cannabis, opioid, and tobacco use disorders.

Findings

Our LCA identified three subgroups of PSA (i.e., low, 17%; intermediate, 38%; high, 45%) among 7,989 CoUD participants. While these subgroups varied by age, sex, and racial-ethnic distribution (p<0.001), there was no difference on education or income (p>0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR=21.96 vs. 6.39, difference-p=8.08×10 -6 ), agoraphobia (OR=4.58 vs. 2.05, difference-p=7.04×10 -4 ), mixed bipolar episode (OR=10.36 vs. 2.61, difference-p=7.04×10 -4 ), posttraumatic stress disorder (OR=11.54 vs. 5.86, difference-p=2.67×10 -4 ), antidepressant medication use (OR=13.49 vs. 8.02, difference-p=1.42×10 -4 ), and sexually transmitted diseases (OR=5.92 vs. 3.38, difference-p=1.81×10 -5 ) than the low-PSA CoUD subgroup.

Conclusions

We found different patterns of PSA in association with psychiatric and somatic comorbidities among CoUD cases within the Yale-Penn cohort. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.

Plasma Amino Acid Concentrations in Patients with Alcohol and/or Cocaine Use Disorders and Their Association with Psychiatric Comorbidity and Sex

(1) Background: Co-occurrence of mental and substance use disorders (SUD) is prevalent, but complicates their clinical courses, and specific biomarkers are required. Amino acids are altered in primary mental disorders; however, little is known about SUD and psychiatric comorbidity. Because most psychiatric disorders and biomarkers show sex differences, we investigated amino acids in men and women with alcohol and/or cocaine use disorders (AUD and/or CUD) and psychiatric comorbidity. (2) Methods: A cross-sectional study was conducted in 295 participants, who were divided into four groups (AUD, n = 60; CUD, n = 41; AUD + CUD, n = 64; and control, n = 130). Participants were clinically assessed, and plasma amino acid concentrations were analyzed in relation to sex, diagnosis of SUD and psychiatric comorbidity (3) Results: In the total sample, there were sex differences, and women showed lower Iso, Leu, Gln and Glu than men. While patients with CUD and AUD + CUD had higher Glu, Gly, Orn and Ser than controls, patients with AUD showed no differences. In SUD, patients with psychiatric comorbidity had lower Orn and higher Ala than non-comorbid patients in the AUD group. (4) Conclusions: There was a dysregulation of plasma amino acids in abstinent patients with SUD. However, our results suggest the importance of considering the clinical characteristics and sex in the validity of amino acids as potential biomarkers for SUD.

Trait impulsivity correlates with active myoclonic seizures in genetic generalized epilepsy

BACKGROUND

Juvenile myoclonic epilepsy (JME) is a common subtype of genetic generalized epilepsy (GGE) arising in adolescence and is often associated with executive function (EF) deficits. Some EF components like response inhibition have been extensively evaluated in JME, but few studies have focused upon trait impulsivity or compared between GGE subtypes. The aim of the present study was to compare the association of trait impulsivity in JME with other GGE subtypes.

METHODS

Patients with GGE aged between 14 and 40 years (n = 137) were divided into those with JME (n = 92) and those with other GGEs (n = 45: 8 childhood absence epilepsy (CAE), 22 juvenile absence epilepsy (JAE), and 15 epilepsy with generalized tonic-clonic seizures only (EGTCS)). The study participants were recruited through medical records of the general population of Buskerud County and the neighboring municipalities, covering 477,000 people or 9.1% of Norway's total population. All participants underwent a clinical interview including the Barratt Impulsiveness Scale (BIS), an established measure of trait impulsivity. We controlled for other potential predictors of BIS score using analysis of covariance (ANCOVA).

RESULTS

There were no differences between JME and other types of GGE for BIS scores, but the presence of myoclonic seizures within the last year, irrespective of GGE subtype, was independently associated with significantly increased behavioral impulsivity.

CONCLUSIONS

This study demonstrates that trait impulsivity in GGE is most strongly related to the recent occurrence of myoclonic seizures rather than GGE subtype.

Problematic Facebook use and problematic video gaming as mediators of relationship between impulsivity and life satisfaction among female and male gamers

Over the past few decades, many new technologies have emerged, such as portable computers, the internet and smartphones, which have contributed to improving the lives of individuals. While the benefits of these new technologies are overwhelmingly positive, negative consequences are experienced by a minority of individuals. One possible negative aspect of new technologies is their problematic use due to impulsive use which may lead to lower life satisfaction. The present study investigated the mediating role of problematic video gaming (PVG) and problematic Facebook use (PFU) in the relationship between impulsivity dimensions and life satisfaction as well as the relationship between impulsivity dimensions and problematic behaviors. Additionally, the potential impact of gender differences was also examined. The study comprised 673 gamers (391 females) aged 17-38 years (M = 21.25 years, SD = 2.67) selected from 1365 individuals who completed an offline survey. PFU was assessed using the Facebook Intrusion Scale, and PVG was assessed using the nine-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF). Impulsivity dimensions such as attention, cognitive instability, motor, perseverance, self-control, and cognitive complexity were assessed using the Barratt Impulsiveness Scale (BIS-11), and life satisfaction was assessed using the Satisfaction With Life Scale (SWLS). Depending on the specific impulsivity dimension, findings showed both positive and negative relationships between impulsivity and life satisfaction. Attention and perseverance subtypes of impulsivity were primarily associated with problematic behaviors. Additionally, cognitive complexity was associated with PFU among female gamers, whereas cognitive instability was associated with PVG among male gamers. Additionally, PVG was primarily associated with lower life satisfaction. However, there was no mediation effects between impulsivity dimensions and life satisfaction via PFU or PVG. These findings provide a better understanding of the relationship between problematic behaviors, life satisfaction, and impulsivity among gamers and the differences between male and female gamers.

Cognitive reserve mediates the severity of certain neuropsychological deficits related to cocaine use disorder

The concept of cognitive reserve (CR) is being considered in the field of substance use disorder (SUD) by observing that there are individuals whose brain alterations are not related to the cognitive symptomatology they present. Our aims were to characterise the possible neuropsychological deficits in a sample of subjects with SUD compared to healthy controls and to determine whether the degree of CR is a mediator in the cognitive functioning of these patients. To perform these objectives, the study involved a sample of subjects with SUD in outpatient treatment and a healthy control group. A CR questionnaire and a comprehensive neuropsychological assessment were administered, and we also collected data related to drug consumption and psychological well-being. The SUD group showed poorer performance compared to the control group in several cognitive domains (attention, declarative memory, executive functions and emotional perception), as well as in psychological comfort. Interestingly, we observed that the deficits found in attention and processing speed were highly mediated by the CR level of the participants, an effect that we did not observe in the rest of the variables registered. Our results suggest that long-term drug consumption leads to cognitive deficits and affects the psychological well-being of the subjects. Moreover, the CR should be taken into account during the assessment and rehabilitation of patients with SUD due to its protective role against certain neuropsychological deficits.

Lifetime cocaine use is a potential predictor for conversion from major depressive disorder to bipolar disorder: A prospective study

AIM

We aimed to identify whether lifetime cocaine use is a risk factor for conversion from major depressive disorder (MDD) to bipolar disorder (BD) in an outpatient sample of adults.

METHODS

This prospective cohort study included 585 subjects aged 18 to 60 years who had been diagnosed with MDD as assessed by the Mini International Neuropsychiatric Interview (MINI-Plus) at baseline (2012-2015). Subjects were reassessed a mean of 3 years later (2017-2018) for potential conversion to BD as assessed by the MINI-Plus. Lifetime cocaine use was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test.

RESULTS

In the second wave, we had 117 (20%) losses, and 468 patients were reassessed. The rate of conversion from MDD to BD in 3 years was 12.4% (n = 58). A logistic regression analysis showed that the risk for conversion from MDD to BD was 3.41-fold higher (95% confidence interval, 1.11-10.43) in subjects who reported lifetime cocaine use at baseline as compared to individuals who did not report lifetime cocaine use at baseline, after adjusting for demographic and clinical confounders.

CONCLUSION

These findings showed that lifetime cocaine use is a potential predictor of conversion to BD in an MDD cohort. Further studies are needed to assess the possible underlying mechanisms linking exposure to cocaine with BD conversion.

Increased neural activity in the right dorsolateral prefrontal cortex during a risky decision-making task is associated with cocaine use in methadone-maintained patients

BACKGROUND

Methadone maintenance is an effective treatment for opioid use disorder (OUD), yet many methadone-maintained patients (MMPs) struggle with cocaine use during OUD recovery. The current study aimed to identify whether prefrontal cortex (PFC) activity during a risky decision-making task was associated with cocaine use during a 90-day follow-up in MMPs.

METHODS

MMPs (N = 28) attended a single neuroimaging session wherein PFC activity was measured using functional near-infrared spectroscopy (fNIRS) during the Balloon Analogue Risk Task (BART). Trait impulsivity was assessed via the Barratt Impulsiveness Scale version 11 (BIS-11). Following the neuroimaging session, MMPs were tracked via electronic health records for 90 days to determine treatment outcomes including cocaine use verified by urine drug screens.

RESULTS

During the BART, MMPs who used cocaine displayed increased neural activity in the right PFC during active decision-making (F1, 22 = 14.75, p = 0.001) and the right dorsolateral PFC during active minus passive decision-making (F1, 22 = 5.56, p = 0.028) compared to participants who did not use cocaine. Receiver operating characteristic curves confirmed that neural activity in the right PFC during active decision-making (AUC = 0.841, 95% CI, 0.697-0.985, p = 002), and in the right dorsolateral PFC during active minus passive decision-making (AUC = 0.805, 95% CI, 0.643-0.968, p = 0.006) was associated with continued cocaine use. MMPs who used cocaine versus those who did not reported increased trait impulsivity on the BIS-11 Total Score (t=-2.28, p = 0.031).

CONCLUSIONS

The fNIRS device is portable, relatively easy to use, and potentially feasible for use in methadone outpatient programs to assess propensity for negative treatment outcomes such as continued cocaine use.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Psychosocial complications in juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy (JME) constitutes about 10% of all epilepsies. Because of executive dysfunction, people with JME may be prone to impulsivity and risk-taking behavior. Our aim was to investigate whether psychosocial issues associated with impulsivity are more prominent in people with JME than in those with other types of genetic generalized epilepsy (GGE). Patients with GGE were recruited retrospectively through the Drammen Hospital records in Buskerud County, Norway, 1999-2013. They were invited to a semi-structured interview, either at the hospital or at home. Ninety-two patients with JME and 45 with other types of GGE were interviewed. Variables were evaluated in terms of their association with JME versus other GGE diagnosis using a logistic regression model. Juvenile myoclonic epilepsy was associated with use of illicit recreational drugs and police charges, although with borderline significance (odds ratio [OR] 3.4, p = 0.087 and OR 4.2, p = 0.095); JME was also associated with being examined for attention-deficit hyperactivity disorder (ADHD) in females (OR 15.5, p = 0.015), a biological parent with challenges like addiction or violent behavior (OR 3.5, p = 0.032), and use of levetiracetam (OR 5.1, p = 0.014). After controlling for group differences, we found psychosocial complications to be associated with JME, potentially influencing the lives of the individuals and their families to a greater extent than the seizures per se. Thus, JME should be considered a disorder of the brain in a broader sense than a condition with seizures only.