Attainment Of Abstinence Research Articles

A critical perspective on updating drug memories through the integration of memory editing and brain stimulation.

Addiction is a persistent, recurring condition characterized by repeated relapses despite the desire to control drug use or maintain sobriety. The attainment of abstinence is hindered by persistent maladaptive drug-associated memories, which drive drug-seeking and use behavior. This article examines the preliminary evidence supporting the combination of non-invasive brain stimulation (NIBS) techniques and memory editing (or reconsolidation) interventions as add-on forms of treatment for individuals with substance-related disorders (SUD). Studies have shown that NIBS can modestly reduce drug use and craving through improved cognitive control or other undetermined reasons. Memory reconsolidation, a process by which a previously consolidated memory trace can be made labile again, can potentially erase or significantly weaken SUD memories underpinning craving and the propensity for relapse. This approach conveys enthusiasm while also emphasizing the importance of managing boundary conditions and null results for interventions found on fear memory reconsolidation. Recent studies, which align with the state-dependency and activity-selectivity hypotheses, have shown that the combination of NIBS and behavioral interventions holds promise for treating SUD by reducing self-reported and physiological aspects of craving. Effective long-term outcomes for this procedure require better identification of critical memories, a deeper understanding of the brain mechanisms underlying SUD and memory reconsolidation and overcoming any boundary conditions of destabilized memories. This will enable the procedure to be personalized to the unique needs of individual patients.

Treatment outcomes for veterans with PTSD and substance use: Impact of specific substances and achievement of abstinence

BackgroundScant longitudinal data exists about the interplay between specific substances of abuse, the achievement of abstinence, and clinical outcomes in the treatment of dually diagnosed Veterans with post-traumatic stress disorder (PTSD). MethodsAs part of a national program evaluation, Veterans admitted from the community to specialized intensive PTSD programs were assessed at intake and 4 months after discharge. Seven mutually exclusive groups were identified from admission self-report data (N=22,948): no substance use, exclusive use of alcohol, opiates, sedatives, cocaine, marijuana, and use of three or more substances. Analysis of covariance, adjusting for potentially confounding baseline variables was used to compare change among these seven groups in non-substance use outcomes (PTSD symptoms, violent behavior, suicidality, medical problems, and employment). The effect of abstinence on specific groups was evaluated as the interaction of group membership by abstinence. ResultsAll outcome measures except for employment showed significant improvement, with few differences between the groups. Although rate of abstinence differed markedly between the groups, abstinence achievement was associated with greater improvement on all the outcomes except employment in every group. No significant differences in the effect of abstinence across the substance abuse groups were observed. ConclusionThe specific type of substance used prior to entry into treatment among dually diagnosed PTSD patients seems to have limited effect on treatment outcomes. However, attainment of abstinence at 4 months after treatment, irrespective of the substances abused, was strongly associated with improvement in PTSD symptoms, violence, suicidality and medical problems.

Environmental events surrounding natural recovery from alcohol-related problems.

Environmental events influence relapse and recovery patterns in treated alcoholics, and the present study investigated the role of events in recoveries achieved without treatment. Subjects were 21 abstinent and 18 active problem drinkers; none had received treatment, and recovered subjects had abstained an average of 6 years. During structured interviews, event occurrences were assessed during a 3-year period that began 2 years before the attainment of abstinence by recovered subjects and were compared with event occurrences during a matched 3-year interval for active drinkers, which equated the groups on the length of recall. Collaterals verified subjects' reports of their drinking practices, events and absence of treatment. Recovered subjects showed (1) heightened health concerns and a relatively stable work situation during the year preceding initial abstinence, (2) a reduction in health events following resolution and (3) a decrease in legal events and total negative events across the 3 years surrounding resolution. Although qualified by the relatively small sample and the retrospective, correlational design, these findings suggest that (1) changes in several areas of functioning evolve over time to motivate initial abstinence and to maintain continued resolution, and (2) variables that motivate initial behavior change differ somewhat from those that maintain it.

Environmental Events Surrounding Natural Recovery from Alcohol-Related Problems

Environmental events influence relapse and recovery patterns in treated alcoholics, and the present study investigated the role of events in recoveries achieved without treatment. Subjects were 21 abstinent and 18 active problem drinkers; none had received treatment, and recovered subjects had abstained an average of 6 years. During structured interviews, event occurrences were assessed during a 3-year period that began 2 years before the attainment of abstinence by recovered subjects and were compared with event occurrences during a matched 3-year interval for active drinkers, which equated the groups on the length of recall. Collaterals verified subjects' reports of their drinking practices, events and absence of treatment. Recovered subjects showed (1) heightened health concerns and a relatively stable work situation during the year preceding initial abstinence, (2) a reduction in health events following resolution and (3) a decrease in legal events and total negative events across the 3 years surround...