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Jorge RE, Li R, Liu X, McGavin JK, Shorter DI, Acion L, Arndt S. Treating Alcohol Use Disorder in U.S. Veterans: The Role of Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2020; 31:319-327. [PMID: 31117905 DOI: 10.1176/appi.neuropsych.18110250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the efficacy of valproate to reduce relapse to heavy drinking among veterans with alcohol use disorder (AUD) and neuropsychiatric comorbidities and whether antecedent traumatic brain injury (TBI) or posttraumatic stress disorder (PTSD) affected treatment response. METHODS Participants were male veterans 18-60 years old with an AUD and no other substance use besides nicotine or cannabis. Sixty-two patients were randomly assigned to receive either valproate or naltrexone. Participants were evaluated at baseline and followed weekly for 24 weeks. All participants received standardized psychosocial interventions as well as treatment for coexistent psychiatric conditions. RESULTS During the follow-up period, nine study subjects in the naltrexone group and 14 in the valproate group relapsed to heavy drinking, but the difference did not reach statistical significance. Participants with a history of moderate to severe TBI were more likely to relapse to heavy drinking compared with those with no TBI (hazard ratio=4.834, 95% CI=1.103-21.194, p=0.033). PTSD status did not significantly affect outcome. CONCLUSIONS Intensive outpatient programs are efficacious alternatives to treat AUD in veterans, although the role of pharmacological treatment is not completely elucidated. Glutamatergic agents appear to be less effective than opiate antagonists to prevent relapse to heavy drinking and to increase cumulative abstinence. Future studies should examine novel pharmacological and nonpharmacological options.
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Affiliation(s)
- Ricardo E Jorge
- The Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston (Jorge, McGavin, Shorter, Acion); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge, McGavin, Shorter, Acion); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Li, Liu); the Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City (Acion, Arndt); and the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Arndt)
| | - Ruosha Li
- The Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston (Jorge, McGavin, Shorter, Acion); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge, McGavin, Shorter, Acion); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Li, Liu); the Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City (Acion, Arndt); and the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Arndt)
| | - Xiangyu Liu
- The Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston (Jorge, McGavin, Shorter, Acion); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge, McGavin, Shorter, Acion); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Li, Liu); the Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City (Acion, Arndt); and the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Arndt)
| | - Jill K McGavin
- The Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston (Jorge, McGavin, Shorter, Acion); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge, McGavin, Shorter, Acion); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Li, Liu); the Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City (Acion, Arndt); and the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Arndt)
| | - Daryl I Shorter
- The Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston (Jorge, McGavin, Shorter, Acion); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge, McGavin, Shorter, Acion); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Li, Liu); the Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City (Acion, Arndt); and the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Arndt)
| | - Laura Acion
- The Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston (Jorge, McGavin, Shorter, Acion); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge, McGavin, Shorter, Acion); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Li, Liu); the Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City (Acion, Arndt); and the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Arndt)
| | - Stephan Arndt
- The Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston (Jorge, McGavin, Shorter, Acion); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge, McGavin, Shorter, Acion); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Li, Liu); the Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City (Acion, Arndt); and the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Arndt)
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Trojak B, Sauvaget A, Fecteau S, Lalanne L, Chauvet-Gelinier JC, Koch S, Bulteau S, Zullino D, Achab S. Outcome of Non-Invasive Brain Stimulation in Substance Use Disorders: A Review of Randomized Sham-Controlled Clinical Trials. J Neuropsychiatry Clin Neurosci 2017; 29:105-118. [PMID: 28294707 DOI: 10.1176/appi.neuropsych.16080147] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Non-invasive brain stimulation (NIBS) might be a new approach to treat substance use disorders (SUD). A systematic review and critical analysis was performed to identify potential therapeutic effects of NIBS on addictions. A search of the Medline database was conducted for randomized sham-controlled trials using NIBS in the field of addiction and published until August 2016. Twenty-six studies in various SUD met the inclusion criteria. Converging evidence indicates that NIBS might be a promising mean to treat patients with alcohol and tobacco use disorders, by acting on craving reduction and other mechanisms such as improvement in cognitive dysfunctions.
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Affiliation(s)
- Benoit Trojak
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Anne Sauvaget
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Shirley Fecteau
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Laurence Lalanne
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Jean-Christophe Chauvet-Gelinier
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Sonja Koch
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Samuel Bulteau
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Daniele Zullino
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
| | - Sophia Achab
- From the Department of Psychiatry and Addictology, University Hospital of Dijon, Dijon, France (BT, J-C C-G); the INSERM U1093, Cognition, Action et Plasticité Sensorimotrice, University of Burgundy-Franche-Comté, Dijon, France (BT); the CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison Psychiatry Department, Nantes, France (AS, SB); the Laboratory of Canada Research Chair in Cognitive Neuroplasticity, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Québec, Canada (SF); the Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France (LL); the Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland (SA, DZ); and the Addictive Disorders Research Group and Neuroscience Center, University of Geneva, Switzerland (SA, DZ)
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Abstract
Repetitive transcranial magnetic stimulation (rTMS), a noninvasive, neuromodulatory tool, has been used to reduce craving in different substance use disorders. There are some studies that have reported conflicting and inconclusive results; therefore, this meta-analysis was conducted to evaluate the effect of high-frequency rTMS on craving in substance use disorder and to investigate the reasons behind the inconsistency across the studies. The authors searched clinical trials from MEDLINE, Cochrane databases, and International Clinical Trials Registry Platform. The PRISMA guidelines, as well as recommended meta-analysis practices, were followed in the selection process, analysis, and reporting of the findings. The effect estimate used was the standardized mean difference (Hedge's g), and heterogeneity across the considered studies was explored using subgroup analyses. The quality assessment was done using the Cochrane risk of bias tool, and sensitivity analysis was performed to check the influences on effect size by statistical models. After screening and assessment of eligibility, finally 10 studies were included for meta-analysis, which includes six studies on alcohol and four studies on nicotine use disorder. The random-model analysis revealed a pooled effect size of 0.75 (95% CI=0.29 to 1.21, p=0.001), whereas the fixed-model analysis showed a large effect size of 0.87 (95% CI=0.63 to 1.12, p<0.00001). Subgroup analysis for alcohol use disorder showed an effect size of -0.06 (95% CI=-0.89 to 0.77, p=0.88). In the case of nicotine use disorder, random-model analysis revealed an effect size of 1.00 (95% CI=0.48 to 1.55, p=0.0001), whereas fixed-model analysis also showed a large effect size of 0.96 (95% CI=0.71 to 1.22). The present meta-analysis identified a beneficial effect of high-frequency rTMS on craving associated with nicotine use disorder but not alcohol use disorder.
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Affiliation(s)
- Rituparna Maiti
- From the Dept. of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India (RM, DH); and the Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India (BRM)
| | - Biswa Ranjan Mishra
- From the Dept. of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India (RM, DH); and the Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India (BRM)
| | - Debasish Hota
- From the Dept. of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India (RM, DH); and the Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India (BRM)
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Seong SJ, Hong JP, Hahm BJ, Jeon HJ, Sohn JH, Lee JY, Cho MJ. Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea. J Korean Med Sci 2015; 30:1675-81. [PMID: 26539014 PMCID: PMC4630486 DOI: 10.3346/jkms.2015.30.11.1675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 07/13/2015] [Indexed: 12/01/2022] Open
Abstract
While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.
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Affiliation(s)
- Su Jeong Seong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Hoon Sohn
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jun Young Lee
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
- Department of Psychiatry, Seoul National University Boramae Hospital, Seoul, Korea
| | - Maeng Je Cho
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
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