Co-occurring Nicotine Dependence Research Articles

Potential effect of antidepressants on remission from cocaine use disorder – A nationwide matched retrospective cohort study

BackgroundCocaine use disorder (CUD) is a significant public health issue for which there is no Food and Drug Administration-approved pharmacotherapy. Depressive disorders are common psychiatric comorbidity amongst individuals with CUD. MethodsA retrospective cohort study was conducted among 161,544 patients diagnosed with CUD and depression to evaluate the effectiveness of 13 antidepressants on CUD remission. For any antidepressant found to be associated with CUD remission that had an additional indication, we conducted an additional analysis to evaluate the effectiveness of the candidate drug in patients with CUD with that indication. We then analyzed publicly genomic and functional databases to identify potential explanatory mechanisms of action of the candidate drug in the treatment of CUD. ResultsAmong these antidepressants, bupropion was associated with higher rates of CUD remission compared to propensity-score matched patients prescribed other antidepressants: hazard ratio (HR) and 95% confidence interval (CI) 1.57 (95% CI: 1.27–1.94). Bupropion is also approved for smoking cessation. We identified CUD patients with co-occurring nicotine dependence and observed that patients prescribed bupropion displayed a higher rate of CUD remission compared to matched individuals prescribed other drugs for nicotine dependence: 1.38 (95% CI: 1.11–1.71). Genetic and functional analyses revealed that bupropion interacts with four protein-encoding genes (COMT, DRD2, SLC6A3, and SLC6A4) which are also associated with CUD and targets CUD-associated pathways including serotonergic synapses, cocaine addiction, and dopaminergic synapses. ConclusionsOur findings suggest that bupropion might be considered a treatment for improving CUD remission in patients with CUD and co-occurring depression or nicotine dependence.

Working with people experiencing psychotic disorders and co-occurring nicotine dependence: Attitudes and reflections from psychologists on the Healthy Lifestyles research trial.

The combination of psychotic and substance use disorders compounds the well-documented challenges of treatment engagement, retention, and outcome for these single conditions. This study focuses on the formation of alliance among this important clinical group. Psychologists working on a research trial participated in qualitative interviews focused on their impression of delivering treatment to people with psychotic disorders and concurrent nicotine dependence. Utilizing Interpretive Phenomenological Analysis, the authors highlighted the complex and unusual experience of working with people with psychotic disorders and concurrent nicotine dependence, the importance of considering each client as an individual, and the many layers of interaction between therapist and client. The authors found that meaningful therapeutic relationships over the longer term are possible, even when active symptoms are present. There is also potential for telephone-based treatments to work well. Clinical supervision and support, tailored to the unique experience of therapists working with psychotic populations, is pivotal.

Reduced Frontal Brain Volume in Non-Treatment-Seeking Cocaine-Dependent Individuals: Exploring the Role of Impulsivity, Depression, and Smoking

In cocaine-dependent patients, gray matter (GM) volume reductions have been observed in the frontal lobes that are associated with the duration of cocaine use. Studies are mostly restricted to treatment-seekers and studies in non-treatment-seeking cocaine abusers are sparse. Here, we assessed GM volume differences between 30 non-treatment-seeking cocaine-dependent individuals and 33 non-drug using controls using voxel-based morphometry. Additionally, within the group of non-treatment-seeking cocaine-dependent individuals, we explored the role of frequently co-occurring features such as trait impulsivity (Barratt Impulsivity Scale, BIS), smoking, and depressive symptoms (Beck Depression Inventory), as well as the role of cocaine use duration, on frontal GM volume. Smaller GM volumes in non-treatment-seeking cocaine-dependent individuals were observed in the left middle frontal gyrus. Moreover, within the group of cocaine users, trait impulsivity was associated with reduced GM volume in the right orbitofrontal cortex, the left precentral gyrus, and the right superior frontal gyrus, whereas no effect of smoking severity, depressive symptoms, or duration of cocaine use was observed on regional GM volumes. Our data show an important association between trait impulsivity and frontal GM volumes in cocaine-dependent individuals. In contrast to previous studies with treatment-seeking cocaine-dependent patients, no significant effects of smoking severity, depressive symptoms, or duration of cocaine use on frontal GM volume were observed. Reduced frontal GM volumes in non-treatment-seeking cocaine-dependent subjects are associated with trait impulsivity and are not associated with co-occurring nicotine dependence or depression.

A Randomized, Placebo-Controlled Trial ofN-Acetylcysteine Plus Imaginal Desensitization for Nicotine-Dependent Pathological Gamblers

Pathological gambling is associated with elevated proportions of nicotine dependence, and tobacco smoking in pathological gamblers has been associated with increased problem-gambling severity. This study examined the addition of N-acetylcysteine to imaginal desensitization in adults with co-occurring nicotine dependence and pathological gambling. Twenty-eight individuals with co-occurring DSM-IV nicotine dependence and pathological gambling who were receiving behavioral therapy were recruited from December 2009 to February 2012 and randomized to augmentation with N-acetylcysteine or placebo in an 12-week, double-blind trial. Subjects were assessed with measures of nicotine and gambling severity and followed for 3 months after treatment. The primary outcomes were the Fagerström Test for Nicotine Dependence and the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale. During the first 6 weeks, there was a significant benefit of N-acetylcysteine treatment versus placebo on Fagerström Test for Nicotine Dependence total scores (t = -2.224; P = .031). After the initial 6 weeks, all subjects significantly (P < .001) benefited from imaginal desensitization. During the 3-month follow-up, there was a significant additional benefit for N-acetylcysteine versus placebo on measures of problem-gambling severity (t = 2.069; P = .043). N-acetylcysteine treatment during therapy facilitates long-term application of behavioral therapy techniques once patients are in the community after therapy has been completed. ClinicalTrials.gov identifier: NCT00967005.

Acceptance and Mindfulness-Based Tobacco Cessation Interventions for Individuals With Mental Health Disorders

Individuals with mental health disorders are more likely to use tobacco, often have greater difficulty during quit attempts, and are at greater risk for relapse than those in the general population. Acceptance and mindfulness-based approaches enhance tobacco use cessation interventions for individuals with mental health disorders by improving affect regulation skills and nicotine withdrawal symptoms associated with quit attempts. Acceptance and mindfulness-based interventions have been shown to be effective for the treatment of mental health disorders and substance use disorders, including nicotine dependence. We review the evidence for acceptance and mindfulness-based tobacco cessation interventions and their application for individuals with co-occurring nicotine dependence and mental health disorders. In addition, we present a case example of an acceptance and mindfulness-based tobacco cessation intervention for an individual with posttraumatic stress disorder. Finally, we discuss the need for further study and advancement of acceptance and mindfulness-based tobacco cessation interventions for individuals with mental health disorders, and we provide suggestions for future research in this promising area.

The relationship between reward-based learning and nicotine dependence in smokers with schizophrenia

Cigarette smoking rates remain remarkably high in schizophrenia relative to smoking in other psychiatric groups. Impairments in the reward system may be related to elevated rates of nicotine dependence and lower cessation rates in this psychiatric group. Smokers with schizophrenia and schizoaffective disorder (SWS; n=15; Mage=54.87, S.D.=6.51, 100% male) and a non-psychiatric control group of smokers (NCL; n=16; Mage=50.38, S.D.=11.52; 93.8% male) were administered a computerized signal detection task to measure reward-based learning. Performance on the signal detection task was assessed by response bias, discriminability, reaction time, and hit rate. Clinician-assessed and self-reported measures of smoking and psychiatric symptoms were completed. SWS exhibited similar patterns of reward-based learning compared to control smokers. However, decreased reward-based learning was associated with increased levels of nicotine dependence in SWS, but not among control smokers. Nicotine withdrawal and urge to smoke were correlated with anhedonia within the SWS group. Among SWS, reduced reward responsiveness and increased anhedonia were associated with and may contribute to greater co-occurring nicotine dependence. These findings emphasize the importance of targeting reward system functioning in smoking cessation treatment for individuals with schizophrenia.

Nicotine Dependence: The Forgotten Substance-Related Disorder

ABSTRACT Behavioral healthcare providers are increasingly using integrated approaches to identify and treat co-occurring severe and persistent mental illness (SPMI) and substance-related disorders, as well as discriminating among specific substances of abuse, e.g., alcohol, marijuana, cocaine, opiates, and methamphetamine, as well as poly-substance abuse or dependence. Although people with serious psychiatric disorders are significantly over-represented among those with tobacco dependence, nicotine dependence is rarely considered nor treated as a co-occurring substance disorder for this population in the context of behavioral healthcare. The authors outline elements of an intervention for people with SPMI and co-occurring nicotine dependence that adapts the evidence based practice Integrated Dual Disorders Treatment (IDDT) for use in community mental health settings.

Biological challenge procedures used to study co-occurring nicotine dependence and panic disorder

A wide array of biological challenge procedures – including carbon dioxide inhalation, hyperventilation, and breath holding – have been used to model panic in laboratory settings. Originally used to study developmental processes in panic disorder (PD), these procedures, along with nicotine patch administration and self-administered smoking, have recently been applied to help understand the etiology of co-occurring nicotine dependence and PD. The goals of the present paper are to review studies that have employed biological challenges to study the comorbid condition, identify the advantages and limitations of the various procedures, describe desirable outcome measures for use in biological challenges, and present recommendations for future challenge studies in this field. We argue that biological challenges, though in need of standardization, are useful for studying the development, maintenance, prevention, and treatment of comorbid nicotine dependence and PD.

Differential hypothalamic–pituitary–adrenal activation of the neuroactive steroids pregnenolone sulfate and deoxycorticosterone in healthy controls and alcohol-dependent subjects

Ethanol and the neuroactive steroids have interactive neuropharmacological effects and chronic ethanol administration blunts the ethanol-induced increase in neuroactive steroid levels in rodent plasma and brain. Few studies have explored neuroactive steroid regulation in alcohol-dependent human subjects. In fact, the regulation of adrenal neuroactive steroids has not been well defined in healthy controls. We thus explored the regulation of two neuroactive steroids, pregnenolone sulfate (PREG-S) and deoxycorticosterone, by pharmacological challenges to the hypothalamic-pituitary-adrenal (HPA) axis in healthy controls and 1-month abstinent alcohol-dependent patients with co-occurring nicotine dependence. Plasma levels of PREG-S and deoxycorticosterone were measured by radioimmunoassay in controls and alcohol-dependent patients after challenges of naloxone, ovine corticotrophin releasing hormone (oCRH), dexamethasone, cosyntropin, and cosyntropin following high-dose dexamethasone. In addition, basal diurnal measures of both hormones were obtained. PREG-S plasma levels in healthy controls were increased by cosyntropin challenge (with and without dexamethasone pretreatment) and decreased by dexamethasone challenge. However, PREG-S concentrations were not altered by naloxone or oCRH challenges, suggesting that PREG-S is not solely regulated by hypothalamic or pituitary stimulation. Deoxycorticosterone, in contrast, is regulated by HPA challenge stimulation in a manner similar to cortisol. Alcohol-dependent patients had a blunted PREG-S response to cosyntropin (with and without dexamethasone pretreatment). Furthermore, the time to peak deoxycorticosterone response following oCRH was delayed in alcohol-dependent patients compared to controls. These results indicate that plasma PREG-S and deoxycorticosterone levels are differentially regulated by HPA axis modulation in human plasma. Further, alcohol-dependent patients show a blunted PREG-S response to adrenal stimulation and a delayed deoxycorticosterone response to oCRH challenge.

Association Between Psychiatric Disorders and the Progression of Tobacco Use Behaviors

To examine the progression of tobacco use and the patterns of comorbidity of tobacco use and psychiatric disorders. The authors conducted analyses of prospective and retrospective reports, collected from 1988 to 1998, of a sample of high- and low-risk youths identified on the basis of the presence or absence of a parental history of substance abuse or dependence. A parental history of substance use disorders was associated with regular tobacco use and nicotine dependence, but not with experimentation for all youths. Individual and composite psychiatric diagnoses were strongly associated with nicotine dependence, but not with regular use or experimentation. While the presence of an affective disorder and drug abuse/dependence generally increased the risk for co-occurring nicotine dependence, analyses based on the temporal onset of disorders showed that it was the initiation of alcohol or drug use that predicted the progression to nicotine dependence. For low-risk youths, oppositional defiant disorder was the single psychiatric risk factor that predicted the transition to nicotine dependence. This study adds to the accumulating evidence that has implicated comorbid psychiatric disorders in the etiology and subsequent course of nicotine dependence. In addition, family history may represent an important indicator of an increased risk for nicotine dependence.

Schizophrenic patients' sensitivity to social cues: the role of abstraction.

Since individuals with schizophrenia often have difficulty with abstract tasks, they should have more problems recognizing abstract social cues (e.g., inferences regarding actors' affect and goals) than concrete cues (e.g., observations of actors' behavior and dialogue). Moreover, recognition of abstract and concrete cues should interact with the level of emotional arousal engendered by the situation; previous research has shown that schizophrenic patients perform better on cue recognition tasks when the situation produces moderate rather than low levels of arousal. These hypotheses were tested in 24 patients with schizophrenia diagnosed according to the DSM-III-R criteria and 15 normal comparison subjects. All subjects viewed eight short vignettes of interpersonal situations that produce low and moderate levels of arousal. They then answered questions representing perception of abstract and concrete cues that had been matched for difficulty and consistency. The schizophrenic patients were significantly less sensitive to interpersonal cues than the normal subjects. The patients were also less sensitive to abstract than to concrete social cues, and for them there was a significant interaction between cue abstraction level and situational arousal. Specifically, the schizophrenic subjects performed worse on the abstract cue recognition task for the low-arousal situations. Findings regarding the social cue recognition patterns of schizophrenic patients could play an important role in the development of valid measures of social cognition for this population.