Sleep characteristics in patients with substance use disorder after detoxification treatment: self-report and actigraphy data

Introduction

Sleep problems are common in patients with substance use disorders (SUD) and have been related to poor treatment outcomes. Little is known about the sleep characteristics in patients with opioid and alcohol use disorders after detoxification program.

Objectives

To compare sleep quantitative and qualitative characteristics between patients with opioid and alcohol use disorders.

Methods

This is a secondary data analysis of the longitudinal data from the observational study in St. Petersburg, Russia. The sample included 75 patients (22.7% female) who received detoxification treatment for alcohol (n=49) or opioid (n=26) withdrawal. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and underwent daily wrist actigrahy.

Results

Good internal consistency was demonstrated for self-report and actigraphy data (r =-0,405, p<0,01). Sleep duration and sleep onset latency were not different between alcohol and opioid groups (5.7 vs. 6.1 hours; 74 vs. 65 minutes, respectively) based on self-report data. The majority of the patients (57-100%) had sleep complaints and low quality of sleep after detoxification completion (at baseline). In both groups, the mean PSQI score had a tendency to decrease, representing better sleep quality, over the 1-week following detoxification program completion (from 12 at baseline to 10 at 1-week in alcohol group; from 13 to 12 in opioid group, p<0,001).

Conclusions

The findings show that sleep characteristics are similar in patients with different SUD and insomnia symptoms are prevalent after detoxification, suggesting the rationale for sleep assessment before hospital discharge. Despite the positive changes in sleep quality over 1-week abstinence, patients might benefit from the therapeutic sleep interventions.

Disclosure

This work was financially supported by a research grant from Russian Foundation for Basic Research, 18-013-00481.

Adverse childhood experience referring to parental relationship is associated with the risk of alcohol dependence and with COMT Val158Met polymorphism, but out of gene-environment interactions

Introduction

Gene-environment interactions (GxE) are considered to make a substantial impact on the risk of alcohol dependence (AD).

Objectives

The aim of the study: to test the associations between the functional polymorphism Val158Met (rs6265) in the catechol-O-methyl transferase (COMT) gene, affecting dopamine neurotransmission, and adverse childhood experiences (ACE) and their GxE interactions with AD risk.

Methods

The study included 149 AD inpatients (mean age 29.9 (SD=3.91), 16.1% females) and 201 healthy volunteers (23.3 (2.48), 30.1% females). The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used for assessing ACE. COMT Val158Met polymorphism was detected by RT-PCR.

Results

First, COMT Val158Met polymorphism was associated only with adverse childhood experience referring o parental relationship (ACE-IQ), but differently in two groups. Healthy minor Met158 carriers have lower scores on the subscale “relationship with parents/guardians” (P) (p=0.025) and “physical neglect” (PN) (p=0.059) vs. homozygous Val158 carriers. However, AD patients - Met158carriers have a tendency to a higher score on the subscale “one or no parents, parental separation or divorce” (PSD) (p=0.078). Then logistic regression revealed associations of these ACE scores with increased AD risk: P (p=0.001, OR=1.186, 95%CI [1.069-1.315]), PN (p=0.024, OR=1.254, 95%CI [1.030-1.526]), and PSD (p=0.016, OR=1.499, 95%CI [1.080-2.082]). No associations of COMT Val158Met alone or in interactions with these ACE-IQ scores with the AD risk were found.

Conclusions

Adverse childhood experience referring to parental relationship is associated with alcohol dependence risk and separately with COMT Val158Met, but no clear interactions in frame of GxE has been supported.

Disclosure

No significant relationships.

Childhood violence experience interacts with BDNF Val158Met polymorphism and modify internet addiction risk

Introduction

Internet-addiction (IA) is one of the most common non-chemical (or behavioral) addictions with genetic impact and substantial effects of psychological and personality characteristics, taking into account the childhood traumatic experience. Gene-environment interactions (GxE) may substantially impact on the risk of Internet-addiction (IA).

Objectives

Aim: to test the associations between the functional polymorphism rs6265 (Val66Met) in brain-derived neurotrophic factor (BDNF) gene, affecting BDNF function, and childhood traumatic experience and their GxE interactions with IA risk.

Methods

In total 456 participants were screened with Chinese Internet Addiction Scale (CIAS) to cut a cohort on two groups: IA (CIAS total score ≥ 65, n=100) and controls (CIAS total score less 64, n=356). The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess childhood traumatic experience using its main domains: parents (P), family (F), abuse (A) and violence (V). BDNF Val158Met polymorphism was detected by RT-PCR.

Results

Logistic regression revealed associations of P scores with increased IA risk only after adjustment for sex and age (p=0.01, OR=1.166, 95%CI[1.038-1.309]) and V scores with decreased IA risk (p=0.000, OR=0.799, 95%CI [0,233;0,744] only before adjustment. No associations of F and A with IA risk were found. BDNF Val158Met per se was not associated with IA risk, but significant effect of interaction V score*BDNF rs6265 CC on IA risk in “protective” manner was revealed (р=0.039, OR=0.873, 95%CI[0.768-0.993]) in a model adjusted for sex and age.

Conclusions

Childhood violence experience interacts with BDNF Val158Met polymorphism and CC (ValVal) genotype may be possibly protective factor decreasing the internet addiction risk

Disclosure

This work was carried out with the financial support of the Russian Foundation for Basic Research: RFBR grant # 18-29-22079

Possible association between high social anxiety level and genetic markers in young adult Internet addicts

Introduction

Internet addiction (IA) is a rapidly growing disorder especially among adolescents and young adults. Social anxiety is one of the risk factors for IA. Also, genes involved in dopaminergic and serotoninergic systems are among the candidate genes most frequently associated with IA.

Objectives

The study aimed to investigate the association between social anxiety level and genetic markers in young adult Internet addicts.

Methods

IA group included 44 people (Chen/Chinese Internet Addiction Scale (CIAS) score ≥ 65), 75,0% males), the average age 22,0 [18,0;25,0] y.o. (Md [Q1; Q3]). Healthy control group (CIAS score was less 65) included 120 people, (73,3% males), the average age 23,0 [22,0;24,0] y.o. Psychometric measures: Liebowitz Social Anxiety Scale (LSAS). Genetic markers: rs2072450 in GRIN2A, rs2832407 in GRiK-GluR5, HUMTH01 in TH01(S<9, L>=9 repeats). The impact of genotypes on social anxiety scores was identified using Proportional Odd Logit modeling taking into account group affiliation.

Results

Group of IA reported significantly higher levels in almost all LSAS measures including total score. We found that carriers of the genotypes rs2072450 CC (p=0.004 vs.CA/AA), rs2832407 CC (p=0.023 vs AA), and TH01 SS (p=0.013 vs. LL) scored significantly higher of LSAS total in the IA group. There were no significant differences in the healthy controls group.

Conclusions

The rs2072450(CC) in GRIN2A, rs2832407(CC) in GRiK-GluR5, and HUMTH01 in TH01(SS) genotypes may be possibly associated with higher social anxiety levels in Internet addicts.

Disclosure

The study was supported by the Russian Foundation for Basic Research (RFBR), project #18-29-22079.

Ketamine for the treatment of addiction: Evidence and potential mechanisms

Ketamine is a dissociative anaesthetic drug which acts on the central nervous system chiefly through antagonism of the n-methyl-d-aspartate (NMDA) receptor. Recently, ketamine has attracted attention as a rapid-acting anti-depressant but other studies have also reported its efficacy in reducing problematic alcohol and drug use. This review explores the preclinical and clinical research into ketamine's ability to treat addiction. Despite methodological limitations and the relative infancy of the field, results thus far are promising. Ketamine has been shown to effectively prolong abstinence from alcohol and heroin in detoxified alcoholics and heroin dependent individuals, respectively. Moreover, ketamine reduced craving for and self-administration of cocaine in non-treatment seeking cocaine users. However, further randomised controlled trials are urgently needed to confirm ketamine's efficacy. Possible mechanisms by which ketamine may work within addiction include: enhancement of neuroplasticity and neurogenesis, disruption of relevant functional neural networks, treating depressive symptoms, blocking reconsolidation of drug-related memories, provoking mystical experiences and enhancing psychological therapy efficacy. Identifying the mechanisms by which ketamine exerts its therapeutic effects in addiction, from the many possible candidates, is crucial for advancing this treatment and may have broader implications understanding other psychedelic therapies. In conclusion, ketamine shows great promise as a treatment for various addictions, but well-controlled research is urgently needed. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.

Factors associated with study attrition among HIV-infected risky drinkers in St. Petersburg, Russia

BACKGROUND

Participant attrition in HIV longitudinal studies may introduce bias and diminish research quality. The identification of participant characteristics that are predictive of attrition might inform retention strategies.

OBJECTIVE

The study aimed to identify factors associated with attrition among HIV-infected Russian risky drinkers from the secondary HIV prevention HERMITAGE trial. We examined whether current injection drug use (IDU), binge drinking, depressive symptoms, HIV status nondisclosure, stigma, and lifetime history of incarceration were predictors of study attrition. We also explored effect modification due to gender.

METHODS

Complete loss to follow-up (LTFU), defined as no follow-up visits after baseline, was the primary outcome, and time to first missed visit was the secondary outcome. We used multiple logistic regression models for the primary analysis, and Cox proportional hazards models for the secondary analysis.

RESULTS

Of 660 participants, 101 (15.3%) did not return after baseline. No significant associations between independent variables and complete LTFU were observed. Current IDU and HIV status nondisclosure were significantly associated with time to first missed visit (adjusted hazard ratio [AHR], 1.39; 95% CI, 1.03-1.87; AHR, 1.38; 95% CI, 1.03-1.86, respectively). Gender stratified analyses suggested a larger impact of binge drinking among men and history of incarceration among women with time to first missed visit.

CONCLUSIONS

Although no factors were significantly associated with complete LTFU, current IDU and HIV status nondisclosure were significantly associated with time to first missed visit in HIV-infected Russian risky drinkers. An understanding of these predictors may inform retention efforts in longitudinal studies.

The influence of depressive symptoms on alcohol use among HIV-infected Russian drinkers

BACKGROUND

Depressive symptoms have been linked to HIV progression through a number of biobehavioral mechanisms including increased alcohol use. Although research supports an association between alcohol use and depressive symptoms among HIV patients, there have been few studies that have examined whether depressive symptoms predict subsequent drinking, especially among heavy drinking HIV-infected patients.

METHOD

Heavy drinking Russian HIV-infected patients (n=700) were recruited from addiction and HIV care settings for a randomized controlled trial of a risk reduction intervention [HERMITAGE]. GEE overdispersed Poisson regression analyses were conducted to assess the association between depressive symptoms and alcohol consumption 6-months later.

RESULTS

In adjusted analyses, depressive symptom severity was significantly associated with drinks per day (global p=.02). Compared to the non-depressed category, mild depressive symptoms were significantly associated with more drinks per day [IRR=1.55, (95% CI: 1.14, 2.09)], while moderate [IRR=1.14, (95% CI: 0.83, 1.56)] and severe [IRR=1.48, (95% CI: 0.93, 2.34)] depressive symptoms were not. Associations between depressive symptom severity and heavy drinking days were not statistically significant (global p=.19). Secondary analyses using the BDI-II screening threshold (BDI-II>14) and the BDI-II cognitive subscale suggested an association between depressive symptoms and drinks per day over time but not heavy episodic drinking.

CONCLUSIONS

Among heavy drinking HIV-infected patients, elevated depressive symptoms were associated with greater subsequent alcohol use. These findings suggest that depressive symptoms may be important to address in efforts to reduce alcohol-related risks among HIV-infected populations.

Sexually transmitted infections among HIV-infected heavy drinkers in St Petersburg, Russia

The objective of this study was to estimate the prevalence and identify correlates of four sexually transmitted infections (STIs) among HIV-infected Russians reporting heavy alcohol use and recent unprotected sex, we conducted a cross-sectional analysis of baseline data from the HERMITAGE study. The primary outcome was any current STI, based on urine tests for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and serological testing for infection with Treponema pallidum. Data on potential demographic and behavioural predictors of STI were obtained from surveys administered at study entry. Of 682 participants, 12.8% (95% confidence interval [CI] 10.3, 15.3) tested positive for at least one STI. In a multivariable model adjusted for gender, age and marital status, only sex trade involvement over the last three months was significantly associated with an increased odds of STI (adjusted odds ratio [AOR] 2.00, 95% CI 1.13, 3.55). Given that STIs were common in this HIV-infected cohort, and that few patient characteristics predicted STI, the current practice of screening HIV-infected Russians for syphilis alone merits re-evaluation.

History of intimate partner violence is associated with sex work but not sexually transmitted infection among HIV-positive female drinkers in Russia

This paper assesses the associations between intimate partner violence (IPV) and sexually transmitted infections (STIs) and sexual risks among HIV-positive female drinkers in St Petersburg, Russia. Survey and STI data were analysed from 285 women in HERMITAGE, a secondary prevention study of HIV-positive heavy drinkers. Logistic and Poisson regression analyses assessed associations of IPV with STI and risky sex. Most women (78%) experienced IPV and 19% were STI positive; 15% sold sex. IPV was not significantly associated with STI, but was with selling sex (adjusted odds ratio = 3.56, 95% confidence interval = 1.02-12.43). In conclusion, IPV is common and associated with sex trade involvement among Russian HIV-positive female drinkers.

Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients

SETTING

Alcohol use, tuberculosis (TB) drug resistance and human immunodeficiency virus (HIV) risk behavior are of increasing concern in Russian TB patients.

DESIGN

A prevalence study of alcohol use and HIV risk behavior was conducted in a sample of 200 adult men and women admitted to TB hospitals in St Petersburg and Ivanovo, Russia.

RESULTS

Of the subjects, 72% were men. The mean age was 41. Active TB was diagnosed using a combination of chest X-ray, sputum smears and sputum cultures. Sixty-two per cent met DSM-IV criteria for current alcohol abuse or dependence. Drug use was uncommon, with only two patients reporting recent intravenous heroin use. There was one case of HIV infection. The mean total risk assessment battery score was 3.4. Depression was present in 60% of the sample, with 17% severely depressed. Alcohol abuse/dependence was associated with an eight-fold increase in drug resistance (OR 8.58; 95% CI 2.09-35.32). Patients with relapsing or chronic TB were more likely to meet the criteria for alcohol abuse/dependence (OR 2.56; 95% CI 1.0-6.54).

CONCLUSION

Alcohol use disorders are common in patients being treated for active TB, and are associated with significant morbidity. Additional surveys are needed to examine the relationship between alcohol use disorders and anti-tuberculosis drug resistance.

The onset of HIV infection in the Leningrad region of Russia: a focus on drug and alcohol dependence

OBJECTIVES

Within 5 years, 5 million Russians may be infected with HIV. Currently, injection drug use is the major risk factor for HIV. As Russia's alcohol consumption per capita is among the highest in the world, alcohol-associated behaviours may be an important contributor to the HIV epidemic. Our objective was to examine the prevalence of HIV infection among drug- and alcohol-dependent patients in a regional narcology hospital and in the general population in Leningrad.

METHODS

All patients in the Narcology Hospital, Leningrad Regional Center of Addictions (LRCA), were tested for HIV antibody between 1997 and 2001. We reviewed these clinical records (i.e. serostatus, gender, age, and addiction) and data from the HIV/AIDS Center in the Leningrad Region (1997-2001).

RESULTS

From 1997 to 2001, HIV prevalence at the LRCA increased from 0 to 12.7% overall, 33.4% among drug-dependent patients and 1.2% among alcohol-dependent patients. During the same 5-year period (1997-2001), 2826 persons were registered at the HIV/AIDS Center: 6, 6, 51, 780, and 1983 persons in 1997, 1998, 1999, 2000 and 2001, respectively.

CONCLUSIONS

HIV infection is exploding in the Leningrad Region, currently in injection drug users (IDUs) but potentially more broadly. The known high per capita alcohol intake in Russia heightens concern regarding the sexual transmission of HIV. Interventions to prevent such a development should include use, and assessment of the effectiveness, of known HIV prevention measures for at-risk and infected individuals.