Association of pica with cortisol and inflammation among Latina pregnant women

Pica, the urge to consume items generally not considered food, such as dirt, raw starch, and ice, are particularly common among pregnant women. However, the biology of pica in pregnancy is not well understood. Therefore, this study aimed to assess how pica relates to endocrine stress and immune biomarkers in a cohort of pregnant Latina women in Southern California. Thirty-four women completed a structured pica questionnaire. Maternal urinary cortisol and plasma cytokine levels were measured between 21 and 31 weeks' gestation. Associations between pica during pregnancy and biomarkers were assessed using linear regression models adjusting for gestational age. Twelve (35.3%) of the pregnant women reported pica (geophagy and amylophagy) during pregnancy. In multivariate models, those who engaged in pica had higher levels of cortisol (β: 0.37, 95% CI: 0.01, 0.073) and lower levels of IL-1β (β: -0.06, 95% CI: -0.11, -0.02), IL-8 (β: -0.30, 95% CI: -0.56, -0.05), IL-21 (β: -0.35, 95% CI: -0.63, -0.08), and type-1 inflammation composite (β: -0.29, 95% CI: -0.44, -0.14) than women who did not engage in pica. These results suggest that biological stress and immune response differ for women with pica compared to those without. This study suggests novel physiological covariates of pica during pregnancy. Further research is needed to better understand the mechanisms and temporality underlying the observed associations between pica and endocrine and immune biomarkers.

Feasibility and Efficacy of Addiction-Focused Eye Movement Desensitization Reprocessing in Adults with Substance Use Disorder

PURPOSE

Addiction-focused eye movement desensitization reprocessing (AF-EMDR) is a viable add-on therapy to treat memories that drive addiction cravings. However, little research has explored AF-EMDR and its effects in people with substance abuse disorder (SUD). The purposes of this study were to determine the feasibility of conducting AF-EMDR and to test the preliminary efficacy of AF-EMDR on overall cravings experienced by persons with SUD, craving, perseverations associated with addiction, and irrational cognitions related to addiction.

METHODS

This pilot study used a two-arm randomized controlled trial (RCT) design with an experimental group (AF-EMDR + cognitive behavioral therapy [CBT]) and a control group (CBT Only). Thirty participants were recruited from a residential program or a partial hospitalization program in a recovery center in Florida, from October 2021 through January 2022 and randomly assigned to the experimental group (n = 15) or the control group (n = 15).

RESULTS

All participants adhered to the four-session 60-min AF-EMDR intervention and post-intervention data collection; 98.33% completed all four sessions. Results indicated significant reductions in cravings, perseverative thoughts about substance of choice, and irrational cognitions among participants in both the experimental (AF-EMDR + CBT) and control (CBT Only) groups during the intervention; however, there was no significant difference between groups.

CONCLUSIONS

The results showed positive trends in decreasing craving. However, more clinical trials with a larger sample are necessary to assess the efficacy and sustainability of such effects in persons with SUD.

Effect of exercise intervention on smoking cessation: a meta-analysis

Background: Exercise has emerged as an effective approach to promote individual health and has shown potential in aiding smoking cessation. However, the specific benefits of exercise in smoking cessation remain unclear, and conflicting findings across studies may be attributed to variations in study populations and intervention characteristics. This study aims to conduct a meta-analysis to evaluate the impact of exercise interventions on tobacco dependence in smokers and assess the effectiveness of exercise in facilitating smoking cessation. Methods: A comprehensive search was performed in databases including PubMed, Web of Science, Embase, The Cochrane Library, and Scopus to identify relevant randomized controlled trials published before 30 October 2022. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed during the review process. The quality of evidence (QoE) was assessed with GRADE (grading of recommendations, assessment, development and evaluations) methodology. Results: Acute exercise was found to significantly reduce smoking cravings [MD = -1.84, 95% CI (-2.92, -0.76), p < 0.001; SMD = -1.64, 95% CI (-2.22, -1.05), p < 0.001] and alleviate most withdrawal symptoms in smokers. However, there was no significant difference in the smoking cessation rate between the exercise group and the control group (p > 0.05). Exercise was associated with increased positive mood [SMD = 0.36, 95% CI (0.14, 0.58), p = 0.001] and reduced negative mood in smokers [SMD = -0.26, 95% CI (-0.39, -0.12), p < 0.001]. Conclusion: Acute exercise interventions effectively reduce cravings and withdrawal symptoms in smokers. However, long-term exercise interventions do not significantly improve the smoking cessation rate. Exercise can help reduce negative mood and enhance positive mood in smokers. Smokers with high levels of tobacco dependence may derive less benefit from exercise. Factors such as literature quality, exercise intervention characteristics, and exercise adherence may influence the effectiveness of interventions. Trial registration: This research protocol was registered in the International Prospective Register for Systematic Reviews (PROSPERO https://www.crd.york.ac.uk/PROSPERO/). Registration number: CRD42022326109.

Mid-Luteal Progesterone Is Inversely Associated with Premenstrual Food Cravings

It is not clear whether progesterone and estradiol associate with premenstrual food cravings, which significantly contribute to cardiometabolic adverse effects associated with obesity. We sought to investigate this question in the present study based on the prior literature showing a protective effect of progesterone on drug craving and extensive neurobiological overlaps between food and drug cravings. We enrolled 37 non-illicit drug- or medication-using women in the study to provide daily ratings of premenstrual food cravings and other symptoms across two-three menstrual cycles, based on which we classified them as premenstrual dysphoric disorder (PMDD) or control participants. In addition, the participants provided blood samples at eight clinic visits across the menstrual cycle. We aligned their mid-luteal progesterone and estradiol using a validated method which relies upon the peak serum luteinizing hormone and analyzed estradiol and progesterone using ultraperformance liquid chromatography tandem mass spectrometry. Hierarchical modeling, adjusted for BMI, showed a significant inverse effect of progesterone (p = 0.038) but no effect of estradiol on premenstrual food cravings. The association was not unique to PMDD or control participants. Results of research to date in humans and rodents showing that progesterone has dampening effects on the salience of the reinforcer translate to premenstrual food cravings.

[Food cravings and aversions in pregnant women in the Buenos Aires Conurban, Argentina]

INTRODUCTION

Pregnant women often experience food aversions and cravings, of which little is known about their characteristics and consequences. The objective was to know the prevalence of food cravings and aversions, the characteristics of the pattern of foods that are craved or avoided, and the reasons behind their presence.

METHODS

Observational, descriptive and cross-sectional study. A validated questionnaire was applied to 370 pregnant and postpartum women in public hospitals. Maternal and neonatal variables were measured with descriptive statistics and those associated with the phenomena under study were identified using logistic regression models and cluster analysis using the multivariate technique.

RESULTS

A presence of cravings from 71 to 80% and aversions from 55 to 65% was detected. The most craved foods were fruits and sweet foods and the most avoided meats and mate. The maternal characteristics predictive of cravings were: being younger (OR 0.94), vomiting (OR 2.23), and having gained more weight than expected were negatively associated with the presence of cravings (OR 0.44). The variables associated with the aversions were the absence of a history of hypertension (OR 0.13), a history of macrosomia (OR 2.70), nausea (OR 1.86) and complications during pregnancy (OR 2.23).

DISCUSSION

This work allowed to characterize food cravings and aversions during pregnancy and to know their high frequency.

SHORT TERM EFFECTS OF SEMAGLUTIDE ON EMOTIONAL EATING AND OTHER ABNORMAL EATING PATTERNS AMONG SUBJECTS LIVING WITH OBESITY

OBJECTIVE

Emotional eating (EE) and other abnormal eating patterns are highly prevalent among people living with obesity (PWO). In this sense, semaglutide, by acting on areas of the brain involved in the reward system and emotion regulation, could have the potential to ameliorate these eating patterns.

METHOD

69 PWO attending an obesity clinic were evaluated baseline and after 3 months since the beginning of semaglutide. To rule out abnormal EE, the Emotional Eating Questionnaire was administered, and a structured interview was conducted.

RESULTS

69 PWO (82.6%♀, 43.7±1years, and 34.3±6kg/m 2) were included. After 3 months of semaglutide, there was a significant reduction in weight (96.1±20.9 vs 91.3±19.7kg; p<0.001) and BMI (34.3±6 vs 32.4±5.6kg/m 2; p<0.0001). The proportion of patients with EE (72.5% vs 11.5%; p<0.001), external eating (27.5% vs 10.1%; p<0.001) cravings (49.3% vs 21.7%; p<0.001) and savory cravings (53.6% vs 14.5%; p<0.001) was significantly reduced after 3 months of semaglutide. Also, the proportion of PWO with regular exercise was increased (15.9% vs 39.1%; p<0.001). However, Logistic regression analysis showed that only sweet cravings at baseline were the only factor associated, although not significant, with a poorer weight loss (p=0.05).

DISCUSSION

Semaglutide is an effective weight-loss treatment in PWO at short term. Moreover, semaglutide was highly effective in ameliorating EE and other abnormal eating patterns that exert a negative influence on weight.

Experiences and Preferences of Opioid-Use-Disorder Patients Who Switched from Brand to Generic Buprenorphine/Naloxone Films: A Case Series

PURPOSE

Differences in the suppression of withdrawal symptoms have been observed in opioid-use-disorder (OUD) patients who were switched from Suboxone (the brand name of buprenorphine/naloxone sublingual films) to either 1 of 2 generic versions. These descriptive observations evidence the need to further assess the use of these generics and its impact on the adherence to and outcomes of OUD treatments. The objective of this case series was to describe patient and provider experiences, perceptions, and preferences when said patients were abruptly switched from Suboxone to one of the generic versions manufactured by Sandoz or Alvogen.

PATIENTS AND METHODS

A retrospective chart review of 24 Suboxone-maintained OUD patients from a single clinic who were forced to switch to a generic was performed to collect withdrawal and craving symptoms that occurred after the switch, as well as toxicology results and changes in dose (documented by the provider).

RESULTS

The medical records of 9 (37.5%) of the 24 patients showed that they were suffering from withdrawal symptoms and/or cravings, had had their doses adjusted, and/or had had a positive urine toxicology screen. All 9 subjects communicated a preference for the brand formulation over that of either of the generic versions; few expressed a preference for one generic formulation over the other. None of patients were able to switch back to the brand formulation, nor were any of them able to choose the generic that worked best for them. Insomnia, muscle pain, and gooseflesh skin were the most common withdrawal symptoms reported by the patients using the generics. Better outcomes were observed in patients who received a buprenorphine dose increase (2 mg) to suppress the withdrawal symptoms experienced while using the generics.

CONCLUSION

Our study serves as a reference to prescribers regarding approaches (eg, a small dose adjustment) that may potentially encourage OUD treatment adherence and even improve outcomes in patients who appear to be decompensating after the brand-to-generic switch.

Loneliness and cravings for sugar-sweetened beverages among adolescents

PURPOSE

The consumption of sugar-sweetened beverages (SSBs) is associated with weight gain in both children and adults. In addition to environmental factors, such as food availability, psychological variables, including mood states, also impact intake. In the current study, we focus on momentary associations between feelings of loneliness and craving for SSBs among adolescents and explore the moderating role of family functioning. Loneliness has been associated with a wide range of health outcomes, but to date, few studies have examined its association with cravings for SSBs.

METHODS

Using an ecological-momentary assessment design, data were collected on 158 (males = 68, mean age = 15.13 ± 2.27 years) participants. Multilevel mixed-effects models were used to examine the relations between the main and interactive effects of loneliness and family functioning on cravings for SSBs, independent of other negative emotions.

RESULTS

Results suggest that loneliness in adolescents was associated with a small increase in craving for SSBs. Importantly, the relationship held after controlling for negative emotions, suggesting the unique role of loneliness. However, positive family functioning did not mitigate the relations between loneliness and craving for SSBs.

CONCLUSIONS

Loneliness uniquely contributes to cravings for SSBs. At the same time, family functioning did not buffer the influence of loneliness on cravings for SSBs among adolescents.

Influence of Appetite and Perceived Ability to Control Cravings on Excessive Gestational Weight Gain

OBJECTIVE

To explore whether appetite is associated with gestational weight gain (GWG) and to assess the effect of perceived ability to control cravings on excessive GWG.

DESIGN

Secondary data analysis.

SETTING

Rochester, New York, United States.

PARTICIPANTS

Women who were pregnant (N = 1,005) and participated in a randomized controlled trial to test the effect of electronically mediated interventions to prevent excessive GWG and postpartum weight retention.

METHODS

We used two questions to assess appetite and perceived ability to control cravings before 28 weeks gestation: "How would you describe your appetite now compared to times when you are not pregnant?" and "How sure are you that you will be able to avoid overeating when you have cravings?" We conducted logistic regression to assess the relationships between appetite, perceived ability to control cravings, and excessive GWG.

RESULTS

More than 47% of participants gained excessive weight during pregnancy. Approximately 62% of participants reported being hungrier, and more than 42% indicated that they were unsure they could avoid overeating with cravings. Participants who reported similar/less appetite than before pregnancy were less likely to gain excessive weight (p < .05). Participants who were sure they could control cravings were less likely to gain excessive weight (p = .02).

CONCLUSION

Our results show that appetite and perceived ability to control cravings may affect GWG. Additional research is needed to assess if interventions targeting appetite and craving control could limit GWG.

Mood, sleepiness, and weight gain after three years on CPAP therapy for sleep apnoea

Background: The prevalence of obstructive sleep apnoea syndrome (OSAS) keeps on rising. Daytime sleepiness resulting from fragmented sleep is the prime symptom, and obesity the major risk factor for OSAS. Quality of life with OSAS is often affected by depressive symptoms and anxiety. Nasal continuous positive airway pressure (CPAP) therapy reduces daytime sleepiness, but the results on the effect on mood, physical activity, and weight are controversial especially on long-term therapy. Purpose of this study was to evaluate these factors and predictors of weight gain during long-term CPAP therapy.

Methods: Consecutive patients (n = 223), referred to sleep study with suspected OSAS, were enrolled. Patients underwent a cardiorespiratory polygraphy at baseline and a battery of questionnaires was completed, both at baseline, and after three years of follow-up. Total of 149 (67%; M 65, F 84) patients completed the follow-up. Of the 149 patients, 76 (51.0%; M 32, F 44) used CPAP.

Results: In this study, depressive symptoms, anxiety, and sleepiness were alleviated during CPAP therapy. However, therapy did not have an influence on cravings of different food categories, or exercise habits and exercise duration. From the various factors studied, solely higher adherence to CPAP therapy was associated with weight gain.

Conclusions: This research provides further evidence that long-term CPAP therapy in patients with OSAS not only decreases sleepiness and improves sleep quality but could also alleviate depressive symptoms and anxiety. In addition, our study reinforces that CPAP therapy alone is not sufficient for weight management in patients with OSAS. Regardless of comprehensive battery of questionnaires, we were unable to establish markers predicting weight gain during therapy. We advise on life-style counselling and weight management program to all patients with obesity on CPAP therapy.

Changing Alcohol Cravings Using Social Media Comments

Background: Alcohol marketing has proliferated on social media. When exposed to social media advertisements, users view comments written in response to the ad and user engagement metrics, in addition to the ad itself. Here, the independent effect of different types of comments on alcohol craving was assessed. Methods: In all, n = 722 participants were randomized to view either no comments, pro-drinking comments, anti-drinking comments, warning labels, or industry responsibility messages associated with six alcohol ads. Alcohol cravings, measured using the Desires for Alcohol Questionnaire (DAQ), were assessed before and after ad exposure. Smoking urges were also assessed. The significance of main effects was determined using repeated-measures ANCOVA. Results: Warning labels significantly decreased scores on the desires and intentions to drink DAQ sub-scale (p = .025) and decreased smoking urges (p = .024). Pro-drinking comments significantly increased scores on the control of drinking sub-scale (p = .006). Conclusions: The findings suggest that user-generated comments can influence the desire to drink and smoking urges, beyond the effects of ads themselves. If so, alcohol warning labels may decrease alcohol cravings when used in this way. Additionally, to limit the loss of control over drinking, the ability of social media users to post pro-drinking comments may need to be curtailed.

Does addition of craving management tools in a stop smoking app improve quit rates among adult smokers? Results from BupaQuit pragmatic pilot randomised controlled trial

OBJECTIVES

Delivery of craving management tools via smartphone applications (apps) may improve smoking cessation rates, but research on such programmes remains limited, especially in real-world settings. This study evaluated the effectiveness of adding craving management tools in a cessation app (BupaQuit).

METHODS

The study was a two-arm pragmatic pilot parallel randomised controlled trial, comparing a fully-automated BupaQuit app with craving management tool with a control app version without craving management tool. A total of 425 adult UK-based daily smokers were enrolled through open online recruitment (February 2015-March 2016), with no researcher involvement, and individually randomised within the app to the intervention (n = 208) or control (n = 217). The primary outcome was self-reported 14-day continuous abstinence assessed at 4-week follow-up. Secondary outcomes included 6-month point-prevalence and sustained abstinence, and app usage. The primary outcome was assessed with Fisher's exact test using intent to treat with those lost to follow-up counted as smoking. Participants were not reimbursed.

RESULTS

Re-contact rates were 50.4% at 4 weeks and 40.2% at 6 months. There was no significant difference between intervention and control arms on the primary outcome (13.5% vs 15.7%; p = 0.58; relative risk = 0.86, 95% confidence interval = 0.54-1.36) or secondary cessation outcomes (6-month point prevalence: 14.4% vs 17.1%, p = 0.51; relative risk = 0.85, 95% confidence interval = 0.54-1.32; 6-month sustained: 11.1% vs 13.4%, p = 0.55; relative risk = 0.83, 95% confidence interval = 0.50-1.38). Bayes factors supported the null hypothesis (B[0, 0, 1.0986] = 0.20). Usage was similar across the conditions (mean/median logins: 9.6/4 vs 10.5/5; time spent: 401.8/202 s vs 325.8/209 s).

CONCLUSIONS

The addition of craving management tools did not affect cessation, and the limited engagement with the app may have contributed to this.

Factors of Negative Affect in Elderly Patients With Substance Use Disorders During COVID-19 Pandemic

Background: The outbreak of the novel coronavirus disease 2019 (COVID-19) has become the greatest public health emergency and has attracted global attention. During the COVID-19 pandemic, the negative affect (NA) of elderly patients with substance use disorders (SUDs) has also become a more serious public concern. The current study aims to clarify the NA and its influencing factors in elderly patients with SUDs during the pandemic. Methods: Two psychiatrists conducted semi-structured interviews with 77 SUD patients aged above 50 years to collect their demographical information and certain drug use characteristics. Barratt Impulse Scale and the Positive and Negative Affect Scale were used to obtain information about patients' self-reported impulsivity and NA. Results: Univariate linear regression analysis showed that NA was positively correlated with the frequency of drug use, type of SUDs, cravings during COVID-19, and impulsivity. Multiple linear regression analysis showed that being female, higher frequency of drug use, stronger cravings, and greater impulsiveness jointly accounted for the variation of NA in elderly patients with SUDs. Conclusions: This study confirmed that, during the COVID-19 pandemic, gender, frequency of drug use, cravings, and impulsivity were associated with NA in elderly patients with SUDs. This study provided a theoretical basis for clinicians to reduce the patients' NA.

Relationship between Sleep and Hedonic Appetite in Shift Workers

Short and/or poor sleep are established behavioral factors which can contribute to excess food intake, and emerging evidence suggests that disturbed circadian rhythms may also impact food intake regulation. Together, disturbed sleep and circadian rhythms may help explain the excess risk for obesity seen in shift workers. To date, however, the details of how shift work may impact food intake regulation are still not fully defined. Here we examined the relationship between sleep characteristics and hedonic control of appetite in shift workers. A total of 63 shift workers (mean (M) age: 36.7 years, standard deviation (SD): 12.0; 59% women) completed an online survey comprising self-reported measures of body weight regulation, sleep (Pittsburgh Sleep Quality Index, Sleep Hygiene Index), and hedonic control of appetite (Food Craving Inventory, Power of Food Scale). Seventy-one percent reported some weight change since starting shift work, and 84% of those reported weight gain (M = +11.3 kg, SD = 9.1). Worse sleep quality and shorter sleep duration were associated with more food cravings, and worse sleep quality and hygiene were associated with higher appetitive drive to consume palatable food (greater hedonic drive). This preliminary study suggests hedonic pathways are potentially contributing to weight gain in shift workers with disturbed sleep.

Examination of a partial dietary self-monitoring approach for behavioral weight management

INTRODUCTION

Dietary self-monitoring in behavioral weight loss programmes traditionally involves keeping track of all foods and beverages to achieve a calorie deficit. While effective, adherence declines over time. WW™ (formerly Weight Watchers), a widely available commercial weight management programme, sought to pilot an approach that permitted participants to consume over 200 foods without monitoring them.

METHODS

The current study used a pre-post evaluation design with anthropometric, psychosocial and physical health assessments at baseline, 3 and 6 months.

RESULTS

Participants (N = 152) were, on average, 48.4 (±12.3) years old, with body mass index (BMI) of 32.8 (±4.8) m/kg2 and 94% female. Mean weight loss was 6.97 + 5.55 kg or 7.9 ± 6.1% of initial body weight (ps < .0001) at 6 months. One third (32.6%) of the sample lost 10% or more of initial body weight. Significant improvements in hunger, cravings, happiness, sleep, quality of life, aerobic stamina, flexibility and blood pressure were observed. Attendance at group meetings, as well as decreases in hunger, and fast food cravings from baseline to 3 months were associated with achieving 10% weight loss at 6 months (p < .01).

CONCLUSIONS

Using an approach that does not require self-monitoring of all foods and beverages produced significant weight losses and other physical and psychosocial improvements.

Preliminary support for the role of alcohol cues in food cravings and attentional biases

This study examined whether alcohol odors, in isolation or when combined with pictures, would influence food attentional biases and cravings. Participants' cravings and attentional biases to food and alcohol pictures were assessed after exposure to alcohol or water odors ( n = 77; mean age = 30.84 years, 51.9% female, 83.1% Caucasian). Food attentional biases were increased by alcohol odors, but food cravings were increased only by a combination of alcohol odors and food pictures. These effects were related with self-reported problematic food consumption. These findings support a research program for further examining the effect of alcohol cues on problematic food consumption.

Sustained behaviour change in healthy eating to improve obesity outcomes: It is time to abandon willpower to appreciate wanting

The purpose of this study was to report on a nationally representative survey of the experience of Canadian adults regarding food cravings and the impact of these cravings on behaviour and quality of life. A total of 1532 respondents (16% of members of an online panel emailed an invitation and link) completed a nationally distributed survey. Almost two-thirds of the sample reported experiencing cravings, with women being more likely to report cravings than men. Of those with cravings, 83.1% reported moderate or strong cravings. Cravings impacted eating behaviours and quality of life, especially for those with strong cravings. Cravings were associated with being bored, emotional or watching TV. Those who identified themselves as overweight or as trying to lose weight were more likely to have cravings. Of those reporting to be overweight and trying to lose weight few experienced distress because of lack of access to help and rates of interest in being guided by healthcare professionals were low, except in those with strong cravings. These results reinforce the notion that eating behaviour may differ from other behaviours in that there is a strong drive to eat that is difficult to control for many individuals. Behavioural interventions targeting healthy eating should be developed to address this construct of drive to eat, that is, food cravings.

A randomized controlled trial of lorcaserin and lifestyle counselling for weight loss maintenance: changes in emotion- and stress-related eating, food cravings and appetite

Anti-obesity medication may help people maintain diet-induced reductions in appetite. The present exploratory analysis assessed the effects of lorcaserin on changes at 24 weeks post-randomization in emotion- and stress-related eating, food cravings and other measures of appetite (i.e. binge eating, cognitive restraint, disinhibition, hunger, preoccupation with eating and fullness). The parent study investigated the efficacy of combined lorcaserin and behavioural treatment in facilitating weight loss maintenance (WLM) in 137 adults (mean age = 46.1 years, 86.1% female, 68.6% black) who had lost ≥5% of initial weight during a 14-week, low-calorie diet (LCD) run-in. Participants were randomly assigned to lorcaserin or placebo and were provided with group WLM counselling sessions. Emotion- and stress-related eating, food cravings and appetite were measured at the start of the LCD (week -14), randomization (0) and week 24. From randomization, lorcaserin-treated participants had significantly greater improvements in emotion- and stress-related eating compared to placebo-treated participants (P = 0.04). However, groups did not differ significantly after randomization in changes in the frequency of food cravings, binge eating or other measures of appetite (Ps > 0.05). Compared to placebo, lorcaserin may improve emotion- and stress-related eating.

Adding Psychotherapy to the Naltrexone Treatment of Alcohol Use Disorder: Meta-analytic Review

Background

It remains unclear if naltrexone combined with psychotherapy is superior to naltrexone alone in treating alcohol use disorders (AUD). The current meta-analysis examined the hypothesis that psychotherapy is a significant moderator that influences AUD-related outcomes and that naltrexone combined with psychotherapy is associated with significantly better AUD-related outcomes than naltrexone alone.

Methods

A total of 30 studies (N_naltrexone = 2317; N_placebo = 2056) were included. Random effects model meta-analyses were carried out for each of the studied outcomes. Subsequently, the random effects model pooled estimates from studies with and without psychotherapy were compared using a Wald test. A mixed-effect model, incorporating psychotherapy as a moderator, was used to examine the impact of psychotherapy on treatment outcomes.

Results

Naltrexone had a significant treatment effect on abstinence relapse and Gamma-Glutamyl Transferase levels, but not cravings. The pooled estimates for studies with and without psychotherapy were not significantly different for any of the studied outcomes. Psychotherapy was not a significant moderator in the mixed effects models for any of the studied outcomes.

Conclusions

Naltrexone treatment is efficacious in reducing alcohol consumption, but not reducing cravings. Adding psychotherapy on top naltrexone did not result in any significant additional benefit for AUD patients.

Using SmartQuit®, an Acceptance and Commitment Therapy Smartphone application, to reduce smoking intake

Objective

SmartQuit® is a smartphone application (app) for smoking cessation based on Acceptance and Commitment Therapy, a behavioural therapy that encourages individuals to accept internal experiences, such as cravings to smoke, without acting on those experiences or urges. We used a single-subject (A-B-A) design with 10 participants to examine whether SmartQuit® use would reduce cigarette intake in a New Zealand sample.

Methods

10 smokers tallied their own cravings experienced and cigarettes smoked then sent those tallies to the first author every day until we observed stable patterns (Phase A1). We then gave the participants individual access to the SmartQuit® app (Phase B). When they advised that they had ceased using the app, they again recorded daily cravings and cigarettes smoked for a minimum of three days (Phase A2). We also collected follow-up smoking and craving data at 1, 2 and up to 13 months after completion of Phase A2.

Results

Using SmartQuit® reduced our participants' daily cigarette intake significantly in the short-term and three individuals remained smoke-free up to 13 months later. Cravings to smoke did not differ significantly across Phases A1, B and A2, but graphical analysis showed a trend for decreasing cravings.

Conclusion

Our results suggest that SmartQuit® provides another readily accessible intervention to help people stop smoking and is suited for use with a New Zealand population.

Hunger, Food Cravings, and Diet Satisfaction are Related to Changes in Body Weight During a 6-Month Behavioral Weight Loss Intervention: The Beef WISE Study

Previously published findings from the Beef WISE Study (Beef's Role in Weight Improvement, Satisfaction, and Energy) indicated equivalent weight loss between two energy-restricted higher protein (HP) diets: A HP diet with ≥4 weekly servings of lean beef (B; n = 60) and a HP diet restricted in all red meats (NB; n = 60). Long-term adherence to dietary prescriptions is critical for weight management but may be adversely affected by changes in appetite, food cravings, and diet satisfaction that often accompany weight loss. A secondary a priori aim of the Beef WISE Study was to compare subjective ratings of appetite (hunger and fullness), food cravings, and diet satisfaction (compliance, satisfaction, and deprivation) between the diets and determine whether these factors influenced weight loss. Subjective appetite, food cravings, and diet satisfaction ratings were collected throughout the intervention, and body weight was measured at the baseline, after the weight loss intervention (week 16), and after an eight-week follow-up period (week 24). Hunger and cravings were reduced during weight loss compared to the baseline, while fullness was not different from the baseline. The reduction in cravings was greater for B vs. NB at week 16 only. Higher deprivation ratings during weight loss were reported in NB vs. B at weeks 16 and 24, but participants in both groups reported high levels of compliance and diet satisfaction with no difference between groups. Independent of group assignment, higher baseline hunger and cravings were associated with less weight loss, and greater diet compliance, diet satisfaction, and lower feelings of deprivation were associated with greater weight loss. Strategies to promote reduced feelings of hunger, cravings, and deprivation may increase adherence to dietary prescriptions and improve behavioral weight loss outcomes.

Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa?

Decades of research have reported only weak associations between the intakes of specific foods or drinks and weight gain and obesity. Randomized controlled dietary intervention trials have only shown very modest effects of changes in nutrient intake and diet composition on body weight in obese subjects. This review summarizes the scientific evidence on the role mental stress (either in or not in association with impaired sleep) may play in poor sleep, enhanced appetite, cravings and decreased motivation for physical activity. All these factors contribute to weight gain and obesity, possibly via decreasing the efficacy of weight loss interventions. We also review evidence for the role that lifestyle and stress management may play in achieving weight loss in stress-vulnerable individuals with overweight.

Experiential avoidance, distress tolerance, and substance use cravings among adults in residential treatment for substance use disorders

Substance use cravings are a known predictor of relapse to substance use following treatment for a substance use disorder. Thus, research on factors that may be correlated with cravings, and could then be targeted in substance use treatment, is needed. Both distress tolerance and experiential avoidance, similar but distinct constructs, are independently associated with substance use cravings. However, no known research has examined these constructs as simultaneous predictors of substance use cravings, which may have important implications for treatment. The current study examined this in a sample of men and women in residential substance use treatment (n = 117). The authors used pre-existing data from a larger study where men and women were recruited for participation from a residential substance use treatment facility. The majority of the sample was male (n = 87; 74.3%) and Caucasian (92.2%). The mean age was 41.27 (standard deviation = 10.68). Better distress tolerance and lower experiential avoidance were negatively and significantly associated with alcohol and drug cravings, but only experiential avoidance remained significantly and negatively associated with cravings when both predictors were examined simultaneously. The current findings provide preliminary support for the importance of decreasing experiential avoidance in substance use treatment, which may result in reduced substance use cravings.

Using Virtual Reality in the Treatment of Gambling Disorder: The Development of a New Tool for Cognitive Behavior Therapy

Virtual reality (VR) can be used in the treatment of gambling disorder to provide emotionally charged contexts (e.g., induce cravings) where patients can practice cognitive behavior therapy (CBT) techniques in the safety of the therapist's office. This raises practical questions, such as whether the cravings are sufficient to be clinically useful but also manageable enough to remain clinically safe. Pilot data are also needed to test the development of a treatment manual and prepare large randomized control trials. This paper reports on three studies describing (a) cravings induced in VR compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two CBT sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers). Study 1 reveals that immersions in VR can elicit desire and a positive anticipation to gamble in frequent gamblers that are (a) significantly stronger than for infrequent gamblers and for playing a control game of skill and (b) as strong as for gambling on a real video lottery terminal. Study 2 documents the feasibility of integrating VR in CBT, its usefulness in identifying more high-risk situations and dysfunctional thoughts, how inducing cravings during relapse prevention exercises significantly relates to treatment outcome, and the safety of the procedure in terms of cybersickness. Results from Study 3 confirm that, compared to inducing urges to gamble in imagination, using VR does not lead to urges that are stronger, last longer, or feel more out of control. Outcome data and effect sizes are reported for both randomized control pilot trials conducted in inpatient settings. Suggestions for future research are provided, including on increasing the number of VR sessions in the treatment program.

Social Networking Site Use While Driving: ADHD and the Mediating Roles of Stress, Self-Esteem and Craving

BACKGROUND

Adults who present ADHD symptoms have an increased risk for vehicle accidents. One conceivable overlooked account for this association is the possibility that people with ADHD symptoms use rewarding technologies such as social networking sites (SNS) while driving, more than others. The objective of this study was to understand if and how ADHD symptoms can promote SNS use while driving and specifically to conceptualize and examine mechanisms which may underlie this association. To do so, ADHD is viewed in this study as an underlying syndrome that promotes SNS use while driving in a manner similar to how addictive syndromes promote compulsive seeking of drug rewards.

METHODS

Time-lagged survey data regarding ADHD, stress, self-esteem, SNS craving experience, SNS use while driving, and control variables were collected from a sample of 457 participants who use a popular SNS (Facebook) and drive, after face-validity examination with a panel of five users and pretest with a sample of 47. These data were subjected to structural equation modeling (SEM) analyses using the frequency of ADHD symptoms measured with ASRS v1.1 Part A as a continuous variable, as well as multivariate analysis of variance using ADHD classification based on ASRS v1.1 scoring guidelines.

RESULTS

ADHD symptoms promoted increased stress and reduced self-esteem, which in turn, together with ADHD symptoms, increased one's cravings to use the SNS. These cravings ultimately translated into increased SNS use while driving. Using the ASRS v1.1 classification, people having symptoms highly consistent with ADHD presented elevated levels of stress, cravings to use the SNS, and SNS use while driving, as well as decreased levels of self-esteem. Cravings to use the SNS among men were more potent than among women.

CONCLUSION

SNS use while driving may be more prevalent than previously assumed and may be indirectly associated with ADHD symptoms. It is a new form of impulsive and risky behavior which is more common among people with symptoms compatible with ADHD than among others. Consistent with addiction and decision making models, SNS use while driving can be viewed as a form of a compensatory reward seeking behavior. As such, prevention and reduction interventions that target the mediating perceptions and states should be devised.

Depressive symptoms affect changes in nicotine withdrawal and smoking urges throughout smoking cessation treatment: Preliminary results

BACKGROUND

Individuals who report more depressive symptoms consistently demonstrate higher rates of nicotine dependence and less successful smoking cessation than do individuals who report fewer depressive symptoms. Nicotine withdrawal and smoking urges are two potential factors that may account for the differences observed between these two groups. This study assessed whether elevated depression symptoms among nicotine dependent smokers are associated with changes in withdrawal and urges to smoke when undergoing smoking cessation treatment.

METHOD

Data on 81 nicotine dependent smokers were collected as part of a smoking cessation randomized trial that compared standard and contingency management treatment across one baseline week and four treatment weeks. Linear mixed model analyses were conducted with high and low depression scores predicting changes in withdrawal and urge ratings from a baseline week and four treatment weeks.

RESULTS

Participants with elevated depression symptoms reported more intense nicotine withdrawal and smoking urges throughout treatment. Further, participants with greater depressive symptoms exhibited an increase in smoking urges at the start of treatment, compared with a gradual decline in urges among participants with fewer depressive symptoms.

CONCLUSIONS

Smokers with elevated depressive symptoms experience significantly elevated discomfort during smoking cessation efforts in the form of increased withdrawal and craving. This discomfort has the potential to make quitting smoking more difficult. Clinical Trial Identifier: NCT00865254.

The role of gabapentin in the management of alcohol withdrawal and dependence

OBJECTIVE

To review the literature evaluating gabapentin for alcohol withdrawal and dependence.

DATA SOURCES

A literature search of MEDLINE (1966 to end of March 2015) and PubMed was performed using the terms alcohol, gabapentin, withdrawal, and dependence. Additional references were identified from a review of literature citations.

STUDY SELECTION AND DATA EXTRACTION

English-language prospective studies evaluating gabapentin for alcohol withdrawal and dependence were evaluated.

DATA SYNTHESIS

A total of 10 publications utilizing gabapentin in alcohol withdrawal (n = 5) and alcohol dependence (n = 5) were included in this review. Limited data suggest that gabapentin can provide benefit in managing mild alcohol withdrawal syndrome. There were 5 reported or suspected seizures in the withdrawal studies, suggesting that additional safety data are necessary before gabapentin monotherapy can be routinely considered. Sleep and mood/anxiety-related outcomes were positively influenced by gabapentin, which may result in long-term benefits if continued beyond the withdrawal period for the treatment of alcohol dependence. Studies evaluating gabapentin for alcohol dependence demonstrated dose-dependent benefits for complete abstinence, rates of no heavy drinking, and cravings. Gabapentin used to treat alcohol dependence was well tolerated with no severe adverse reactions reported in the extant literature.

CONCLUSION

Gabapentin may have a role in the treatment of mild alcohol withdrawal, but future studies should focus on adequate dosing strategies. Gabapentin should be considered for the treatment of alcohol dependence when barriers prevent the use of traditional agents. Additional studies should be conducted to further validate findings from the research conducted to date, but the current literature is promising for gabapentin in the treatment of alcohol dependence.

Cigarette Cravings, Impulsivity, and the Brain

Craving is a core feature of tobacco use disorder as well as a significant predictor of smoking relapse. Studies have shown that appetitive smoking-related stimuli (e.g., someone smoking) trigger significant cravings in smokers impede their self-control capacities and promote drug seeking behavior. In this review, we begin by an overview of functional magnetic resonance imaging (fMRI) studies investigating the neural correlates of smokers to appetitive smoking cues. The literature reveals a complex and vastly distributed neuronal network underlying smokers' craving response that recruits regions involved in self-referential processing, planning/regulatory processes, emotional responding, attentional biases, and automatic conducts. We then selectively review important factors contributing to the heterogeneity of results that significantly limit the implications of these findings, namely between- (abstinence, smoking expectancies, and self-regulation) and within-studies factors (severity of smoking dependence, sex-differences, motivation to quit, and genetic factors). Remarkably, we found that little to no attention has been devoted to examine the influence of personality traits on the neural correlates of cigarette cravings in fMRI studies. Impulsivity has been linked with craving and relapse in substance and tobacco use, which prompted our research team to examine the influence of impulsivity on cigarette cravings in an fMRI study. We found that the influence of impulsivity on cigarette cravings was mediated by fronto-cingulate mechanisms. Given the high prevalence of cigarette smoking in several psychiatric disorders that are characterized by significant levels of impulsivity, we conclude by identifying psychiatric patients as a target population whose tobacco-smoking habits deserve further behavioral and neuro-imaging investigation.

Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms

Microbes in the gastrointestinal tract are under selective pressure to manipulate host eating behavior to increase their fitness, sometimes at the expense of host fitness. Microbes may do this through two potential strategies: (i) generating cravings for foods that they specialize on or foods that suppress their competitors, or (ii) inducing dysphoria until we eat foods that enhance their fitness. We review several potential mechanisms for microbial control over eating behavior including microbial influence on reward and satiety pathways, production of toxins that alter mood, changes to receptors including taste receptors, and hijacking of the vagus nerve, the neural axis between the gut and the brain. We also review the evidence for alternative explanations for cravings and unhealthy eating behavior. Because microbiota are easily manipulatable by prebiotics, probiotics, antibiotics, fecal transplants, and dietary changes, altering our microbiota offers a tractable approach to otherwise intractable problems of obesity and unhealthy eating.

A mixed-methods study on factors influencing prenatal weight gain in ethnic-minority women

INTRODUCTION

Gaining too much weight in pregnancy is associated with perinatal complications and increases the risks of future obesity for both women and their infants. Unfortunately, women enrolled in intervention trials have seen little improvement in adherence to prenatal weight gain recommendations compared to women receiving standard prenatal care. Therefore, the purpose of this descriptive mixed-methods study was to explore factors related to excessive weight gain in pregnancy.

METHODS

Nonpregnant nulliparous women, currently pregnant women, and postpartum women (N = 43) were recruited from a health center serving an inner-city minority community. Women completed questionnaires on knowledge, self-efficacy, and behaviors related to nutrition, exercise, and prenatal weight gain. Fifteen of these women participated in focus groups. Focus group data were analyzed using ATLAS.ti (Scientific Software Development GmbH, Berlin, Germany). Codes were created, themes were identified, and consensus was reached through multiple iterations of the analysis by study personnel.

RESULTS

Excessive weight gain was common. Nutritional knowledge was poor and significantly lower among nonpregnant nulliparous women. Women felt sure that they could engage in healthy behaviors, but few did so. Participants in focus groups identified multiple barriers to healthy behaviors in pregnancy and made suggestions on how to help women more readily make improvements in these behaviors.

DISCUSSION

Strategies identified in this study such as providing focused education directed at nonpregnant nulliparous women, stressing portion control, helping women better manage their cravings, and providing more pragmatic support and resources need to be explored in future research.

Cravings as a mediator and moderator of drinking outcomes in the COMBINE study

AIMS

Investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) study examined whether combining medications with a behavioral intervention would improve outcomes over monotherapies. Unexpectedly, the combination did not offer any advantage over either treatment alone. This study aimed to explain the lack of incremental benefit offered by the combination over either monotherapy by assessing the role of cravings as a treatment mediator and moderator.

DESIGN

Secondary mediation and moderation analyses of COMBINE study data.

SETTING

Eleven United States academic sites.

PARTICIPANTS

A total of 863 patients randomized to one of four treatment groups: naltrexone (100 mg/day; n = 209), the combined behavioral intervention (CBI, n = 236), naltrexone and CBI combined (n = 213) and placebo naltrexone (n = 205).

MEASUREMENTS

Percentage of days abstinent (PDA) measured between 13 and 16 weeks post-baseline. Cravings, the potential mediator/moderator, were measured at baseline, weeks 4 and 12 using the Obsessive-Compulsive Drinking Scale.

FINDINGS

Compared with placebo, naltrexone, CBI and the combination all increased PDA by an additional 6-10 percentage points for those with high cravings (P < 0.05 for all three treatment groups). None had significant effects on PDA for those with low cravings. The effects of all three treatments were mediated at least partially by cravings; craving reduction explained 48-53% of treatment effects (P < 0.05 for all three treatment groups). Furthermore, naltrexone appeared to reduce cravings at 4 weeks, while CBI did not reduce cravings until 12 weeks.

CONCLUSIONS

The Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) naltrexone + CBI combination may not be more beneficial than either monotherapy because craving reduction is a common mechanism of both.

Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian Mother and Child Cohort Study

OBJECTIVE

To investigate primarily the dietary intake, as well as demographics and selected lifestyle factors, of women experiencing nausea and vomiting in pregnancy, nausea only, or women who are symptom free.

DESIGN

Prospective cohort study.

SETTING

The Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort.

SAMPLE

Analyses were based on 51 675 Norwegian pregnancies.

METHODS

Dietary intake was assessed by a self-reported food frequency questionnaire answered in the first trimester of pregnancy, as were data regarding nausea and vomiting. Chi-squared tests, one-way analysis of variance, and multiple linear regression were used.

MAIN OUTCOME MEASURES

Nausea and vomiting in pregnancy (NVP), gestational weight gain (GWG), and dietary intake.

RESULTS

We found that 17 070 (33%) women experienced NVP, 20 371 (39%) experienced only nausea, and 14 234 (28%) were symptom free. Women with NVP were younger and heavier at pregnancy onset, with the lowest GWG and highest energy intake during pregnancy, primarily from carbohydrates and added sugars, compared with the other groups (P < 0.001). In multiple linear regression analysis of GWG and group adjusted for body mass index (BMI), gestational length, smoking during pregnancy, and energy intake, a significant interaction was found between BMI and group (P < 0.001). A significant effect of group (P < 0.001) was found in all BMI strata, except among underweight women (P = 0.65).

CONCLUSIONS

Our study suggests that women with NVP are characterised by high intakes of carbohydrates and added sugar, primarily from sugar-containing soft drinks. Whether higher intakes of carbohydrates are a response aimed to alleviate symptoms, or are actually provoking the condition, is not known.

Power of food moderates food craving, perceived control, and brain networks following a short-term post-absorptive state in older adults

The Power of Food Scale (PFS) is a new measure that assesses the drive to consume highly palatable food in an obesogenic food environment. The data reported in this investigation evaluate whether the PFS moderates state cravings, control beliefs, and brain networks of older, obese adults following either a short-term post-absorptive state, in which participants were only allowed to consume water, or a short-term energy surfeit treatment condition, in which they consumed BOOST®. We found that the short-term post-absorptive condition, in which participants consumed water only, was associated with increases in state cravings for desired food, a reduction in participants' confidence related to the control of eating behavior, and shifts in brain networks that parallel what is observed with other addictive behaviors. Furthermore, individuals who scored high on the PFS were at an increased risk for experiencing these effects. Future research is needed to examine the eating behavior of persons who score high on the PFS and to develop interventions that directly target food cravings.