Compulsive Drug Seeking Research Articles

Rebuilding the behavioral inhibition circuit to prevent opioid relapse

Failure in behavioral suppression is a key feature in substance use disorders, potentially leading to compulsive drug seeking and relapse. In this issue of Neuron, Paniccia etal.1 elucidated a heroin-damaged paraventricular nucleus of the thalamus (PVT)-accumbal circuit and how recovery of PVT function could prevent heroin relapse.

N-acetylcysteine attenuates accumbal core neuronal activity in response to morphine in the reinstatement of morphine CPP in morphine extinguished rats

Numerous studies have suggested that N-acetylcysteine (NAC), has the potential to suppress drug craving in people with substance use disorder and reduce drug-seeking behaviors in animals. The nucleus accumbens (NAc) plays a crucial role in the brain's reward system, with the nucleus accumbens core (NAcore) specifically implicated in compulsive drug seeking and relapse. In this study, we aimed to explore the impact of subchronic NAC administration during the extinction period and acute NAC administration on the electrical activity of NAcore neurons in response to a priming dose of morphine in rats subjected to extinction from morphine-induced place preference (CPP).We conducted single-unit recordings in anesthetized rats on the reinstatement day, following the establishment of morphine-induced conditioned place preference (7 mg/kg, s.c., 3 days), and subsequent drug-free extinction. In the subchronically NAC-treated groups, rats received daily injections of either NAC (50 mg/kg; i.p.) or saline during the extinction period. On the reinstatement day, we recorded the spontaneous activity of NAcore neurons for 15 min, administered a priming dose of morphine, and continued recording for an additional 45 min. While morphine excited most recorded neurons in saline-treated rats, it failed to alter firing rates in NAC-treated rats that had received NAC during the extinction period. For acutely NAC-treated animals, we recorded the baseline activity of NAcore neurons for 10 min before administering a single injection of either NAC (50 mg/kg; i.p.) or saline in rats with no treatment during the extinction. Following 30 min of recording and a priming dose of morphine (1 mg/kg, s.c.), the recording continued for an additional 30 min. The firing activity of NAcore neurons did not show significant changes after morphine or NAC injection. In conclusion, our findings emphasize that daily NAC administration during the extinction period significantly attenuates the morphine-induced increase in firing rates of NAcore neurons during the reinstatement of morphine CPP. However, acute NAC injection does not produce the same effect. These results suggest that modulating glutamate transmission through daily NAC during extinction may effectively inhibit the morphine place preference following the excitatory effects of morphine on NAcore neurons.

Making and breaking habits: Revisiting the definitions and behavioral factors that influence habits in animals.

Habits have garnered significant interest in studies of associative learning and maladaptive behavior. However, habit research has faced scrutiny and challenges related to the definitions and methods. Differences in the conceptualizations of habits between animal and human studies create difficulties for translational research. Here, we review the definitions and commonly used methods for studying habits in animals and humans and discuss potential alternative ways to assess habits, such as automaticity. To better understand habits, we then focus on the behavioral factors that have been shown to make or break habits in animals, as well as potential mechanisms underlying the influence of these factors. We discuss the evidence that habitual and goal-directed systems learn in parallel and that they seem to interact in competitive and cooperative manners. Finally, we draw parallels between habitual responding and compulsive drug seeking in animals to delineate the similarities and differences in these behaviors.

Doing what’s not wanted: Conflict in incentives and misallocation of behavioural control can lead to drug-seeking despite adverse outcomes

Despite being aware of negative consequences and wanting to quit, long-term addicts find it difficult to quit seeking and consuming drugs. This inconsistency between the (often compulsive) behavioural patterns and the explicit knowledge of negative consequences represents a cognitive conflict which is a central characteristic of addiction. Neurobiologically, differential cue-induced activity in distinct striatal subregions, as well as the dopamine connectivity spiraling from ventral striatal regions to the dorsal regions, play critical roles in compulsive drug seeking. The focus of this work is to illustrate the mechanisms that lead to a cognitive conflict and it’s impact on actions taken i.e. addictive choices. We propose an algorithmic model that captures how the action choices that the agent makes when reinforced with drug-rewards become impervious to the presence of negative consequences that often follow those choices. We advance the understanding of having a decision hierarchy in representing “cognitive control” and how lack of such control at higher-level in the hierarchy could potentially lead to consolidated drug-seeking habits. We further propose a cost-benefit based arbitration scheme, which mediates the allocation of control across different levels of the decision-making hierarchy. Lastly, we discuss how our algorithmic model could help us understand how addictive drugs progressively hijack the dopamine-spiralling circuit at the neural implementation level.

Neurobehavioral Precursors of Compulsive Cocaine Seeking in Dual Frontostriatal Circuits

BackgroundOnly some individuals who use drugs recreationally eventually develop a substance use disorder, characterized in part by the rigid engagement in drug foraging behavior (drug seeking), which is often maintained in the face of adverse consequences (i.e., is compulsive). The neurobehavioral determinants of this individual vulnerability have not been fully elucidated. MethodsUsing a prospective longitudinal study involving 39 male rats, we combined multidimensional characterization of behavioral traits of vulnerability to stimulant use disorder (impulsivity and stickiness) and resilience (sign tracking and sensation seeking/locomotor reactivity to novelty) with magnetic resonance imaging to identify the structural and functional brain correlates of the later emergence of compulsive drug seeking in drug-naïve subjects. We developed a novel behavioral procedure to investigate the individual tendency to persist in drug-seeking behavior in the face of punishment in a drug-free state in subjects with a prolonged history of cocaine seeking under the control of the conditioned reinforcing properties of a drug-paired Pavlovian conditioned stimulus. ResultsIn drug-naïve rats, the tendency to develop compulsive cocaine seeking was characterized by behavioral stickiness–related functional hypoconnectivity between the prefrontal cortex and posterior dorsomedial striatum in combination with impulsivity-related structural alterations in the infralimbic cortex, anterior insula, and nucleus accumbens. ConclusionsThese findings show that the vulnerability to developing compulsive cocaine-seeking behavior stems from preexisting structural or functional changes in two distinct corticostriatal systems that underlie deficits in impulse control and goal-directed behavior.

The relationship between beliefs in substance craving and quality of life among narcotics anonymous: a cross-sectional study in southeastern Iran

BackgroundAddiction is a chronic and relapsing disorder characterized by compulsive drug seeking and lasting changes in the brain. Low quality of life may influence the substance craving, which leads to relapsing. Therefore, the present study aimed to investigate the relationship between beliefs in substance craving and quality of life among narcotics anonymous.MethodsThis cross-sectional study was performed on 202 narcotics anonymous in Kerman, southeastern Iran. Convenience sampling was used to select anonymous patients in the Narcotics Anonymous (NA) association in Kerman city. Narcotics anonymous completed the demographic questionnaire, the Craving Beliefs Questionnaire (CBQ), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression model was used to determine the predictors of craving beliefs. The data were then analyzed using SPSS 22.ResultsThe mean age of the participants was 38.48 ± 11.32 years. The majority of the samples were male (86.1%), married (65.4%), educated (93.6%) and urban (86.1%). The mean scores of craving beliefs and overall Quality of Life (QOL) were 77.58 ± 20.70 and 64.42 ± 23.13, respectively. Forty-two-point 1% had high level of craving beliefs. We found a significant negative and weak correlation between beliefs in substance craving, physical health domain (r = -0.16, p = 0.02), and overall quality of life (r = -0.15, p = 0.03). History of crack use, job, and physical health domain of QOL were predictors of beliefs in substance craving among the NAs.ConclusionBased on the study results, the participants had a high level of substance craving, and some aspects of the quality of life had an impact on the beliefs of addiction. However, it is necessary to conduct more studies in this field; psychological interventions and programs to increase the quality of life may reduce the substance craving.

Selective antagonists of calcium-permeable GluA1 AMPA-receptors as potential antiaddictive agents

An increase in synaptic dopamine levels, particularly in the nucleus accumbens sheath, is a critical initial response for encoding a drugs positive effect and the development of associative learning, which is crucial for finding drugs in response to their rewarding effects.
 This study aims to review current data describing the role of AMPA glutamate receptors in the pathological drug search that occurs during the transition from drug use to drug abuse.
 Publications reviewed and analyzed the journal publications in international databases (PubMed, Web of Science, Scopus, RSCI) on the mechanisms of interaction between dopamine and AMPA glutamate receptors in drug addiction pathogenesis are reviewed and analyzed.
 After repeated exposure to psychostimulant drugs, the dopamine response to narcogen administration becomes sensitized, which is responsible for drugs of abuse over other natural reinforcers. The nucleus accumbens contains convergent inputs of dopamine and glutamate, which modulate the response to psychostimulant drugs. Simultaneously, a constant increase in AMPA-receptors lacking the GluA2 subunit was observed, which leads to an increase in conductivity and initiates a cascade of calcium-dependent signaling. With the development of compulsive drug seeking, the expression of AMPA-receptors in the nucleus accumbens increases.
 Based on this hypothesis, it is reasonable to propose drugs for the treatment of drug dependence that counteract the neuroplastic changes in AMPA-receptors caused by repeated drug exposure and leading to addiction. IEM-1460 and IEM-2131, which are two GluA1 AMPA blockers, have been proposed as potential therapeutic agents against addiction and other CNS diseases.

Impact of the Drug Addiction on Oxidative Stress

Drug addiction is a chronic, recurrent mental illness marked by compulsive drug seeking despite grave adverse effects. Methamphetamine is a member of the synthetic drug class known as amphetamine-type stimulants, a class of medications that stimulate or create alertness and behavioural activation as well as increased central nervous system activity. Oxidative stress is a condition when there is an imbalance between the generation of free radicals and the capacity of the biological system to detoxify the reactive intermediates by neutralising antioxidants. METH causes a significant increase in the oxidation of dopamine(DA), which results in the generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS). The body is protected by antioxidants, which can lessen ROS/RNS damage. By preventing reactive radicals from forming or by halting free radical reactions, the protective system's function may reduce the harmful consequences of free radicals. The goal of the current review was to draw attention to the impact of drug addiction (namely, methamphetamine) on oxidative stress in humans and the value of employing natural antioxidants to mitigate the harm that results. As a result of drug misuse, including methamphetamine usage, neuronal damage result from oxidative stress within mitochondrial membrane and dopamine pathway. Vitamin C, E, and other natural compounds have been found as being particularly promising in terms of their effects and safety.

Toward neuromarkers for tailored smoking cessation treatments

Neurobiological models of addiction attribute vulnerability to compulsive drug use to dysregulated activity within the neural networks that underlie reward and executive functions. Empirical evidence suggests that (a) attributing high motivational salience to drug-related stimuli leads to compulsive drug seeking and (b) cognitive control deficits lead to compulsive drug taking. Noninvasive neuroimaging techniques enable brain activity monitoring during affective and cognitive processing and could pave the way to precision medicine for substance use disorders. Identifying robust neuromarkers of affective and cognitive dysregulation would allow clinicians to personalize treatments by targeting individual psychophysiological vulnerabilities. However, methodological choices have biased the field toward experimental paradigms that cannot optimally assess individual differences in the motivational salience of drug-related cues and in the ability to control drug-related decisions, hindering the identification of clinically relevant neuromarkers. Here we show that (a) accounting for neuroaffective reactivity to non-drug-related motivationally relevant stimuli when measuring the attribution of motivational salience to drug-related cues, and (b) assessing brain activity while participants make drug-related decisions with immediate consequences, yield replicable neuromarkers with potential clinical relevance. While we use tobacco use disorder as a model, we also show that the methodological issues highlighted here are relevant to other disorders characterized by maladaptive appetitive behaviors.

Theoretical Frameworks and Mechanistic Aspects of Alcohol Addiction: Alcohol Addiction as a Reward Deficit/Stress Surfeit Disorder.

Alcohol use disorder (AUD) can be defined by a compulsion to seek and take alcohol, the loss of control in limiting intake, and the emergence of a negative emotional state when access to alcohol is prevented. Alcohol use disorder impacts multiple motivational mechanisms and can be conceptualized as a disorder that includes a progression from impulsivity (positive reinforcement) to compulsivity (negative reinforcement). Compulsive drug seeking that is associated with AUD can be derived from multiple neuroadaptations, but the thesis argued herein is that a key component involves the construct of negative reinforcement. Negative reinforcement is defined as drug taking that alleviates a negative emotional state. The negative emotional state that drives such negative reinforcement is hypothesized to derive from the dysregulation of specific neurochemical elements that are involved in reward and stress within basal forebrain structures that involve the ventral striatum and extended amygdala, respectively. Specific neurochemical elements in these structures include decreases in reward neurotransmission (e.g., decreases in dopamine and opioid peptide function in the ventral striatum) and the recruitment of brain stress systems (e.g., corticotropin-releasing factor [CRF]) in the extended amygdala, which contributes to hyperkatifeia and greater alcohol intake that is associated with dependence. Glucocorticoids and mineralocorticoids may play a role in sensitizing the extended amygdala CRF system. Other components of brain stress systems in the extended amygdala that may contribute to the negative motivational state of withdrawal include norepinephrine in the bed nucleus of the stria terminalis, dynorphin in the nucleus accumbens, hypocretin and vasopressin in the central nucleus of the amygdala, and neuroimmune modulation. Decreases in the activity of neuropeptide Y, nociception, endocannabinoids, and oxytocin in the extended amygdala may also contribute to hyperkatifeia that is associated with alcohol withdrawal. Such dysregulation of emotional processing may also significantly contribute to pain that is associated with alcohol withdrawal and negative urgency (i.e., impulsivity that is associated with hyperkatifeia during hyperkatifeia). Thus, an overactive brain stress response system is hypothesized to be activated by acute excessive drug intake, to be sensitized during repeated withdrawal, to persist into protracted abstinence, and to contribute to the compulsivity of AUD. The combination of the loss of reward function and recruitment of brain stress systems provides a powerful neurochemical basis for a negative emotional state that is responsible for the negative reinforcement that at least partially drives the compulsivity of AUD.

Therapeutics for Substance-Using Women: The Need to Elucidate Sex-Specific Targets for Better-Tailored Treatments.

In the last decade, alcohol consumption in the US has risen by 84% in women compared with 35% in men. Furthermore, research has shown that sex- and gender-related differences may disadvantage women in terms of developing a range of psychological, cognitive, and medical problems considerably earlier in their drinking history than men, and despite consuming a similar quantity of substances. While this "telescoping" process has been acknowledged in the literature, a concomitant understanding of the underlying biobehavioral mechanisms, and an increase in the development of specific treatments tailored to women, has not occurred. In the current chapter we focus on understanding why the need for personalized, sex-specific medications is imperative, and highlight some of the potential sex-specific gonadal and stress-related adaptations underpinning the accelerated progress from controlled to compulsive drug and alcohol seeking in women. We additionally discuss the efficacy of these mechanisms as novel targets for medications development, using exogenous progesterone and guanfacine as examples. Finally, we assess some of the challenges faced and progress made in terms of developing innovative medications in women. We suggest that agents such as exogenous progesterone and adrenergic medications, such as guanfacine, may provide some efficacy in terms of attenuating stress-induced craving for several substances, as well as improving the ability to emotionally regulate in the face of stress, preferentially in women. However, to fully leverage the potential of these therapeutics in substance-using women, greater focus needs to the placed on reducing barriers to treatment and research by encouraging women into clinical trials.

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Upregulation of dynorphin/kappa opioid receptor system in the dorsal hippocampus contributes to morphine withdrawal-induced place aversion.

Aversive emotion of opioid withdrawal generates motivational state leading to compulsive drug seeking and taking. Kappa opioid receptor (KOR) and its endogenous ligand dynorphin have been shown to participate in the regulation of aversive emotion. In the present study, we investigated the role of dynorphin/KOR system in the aversive emotion following opioid withdrawal in acute morphine-dependent mice. We found that blockade of KORs before pairing by intracerebroventricular injection of KOR antagonist norBNI (20, 40 μg) attenuated the development of morphine withdrawal-induced conditioned place aversion (CPA) behavior. We further found that morphine withdrawal increased dynorphin A expression in the dorsal hippocampus, but not in the amygdala, prefrontal cortex, nucleus accumbens, and thalamus. Microinjection of norBNI (20 μg) into the dorsal hippocampus significantly decreased morphine withdrawal-induced CPA behavior. We further found that p38 MAPK was significantly activated in the dorsal hippocampus after morphine withdrawal, and the activation of p38 MAPK was blocked by pretreatment with norBNI. Accordingly, microinjection of p38 MAPK inhibitor SB203580 (5 μg) into the dorsal hippocampus significantly decreased morphine withdrawal-produced CPA behavior. This study demonstrates that upregulation of dynorphin/KOR system in the dorsal hippocampus plays a critical role in the formation of aversive emotion associated with morphine withdrawal, suggesting that KOR antagonists may have therapeutic value for the treatment of opioid withdrawal-induced mood-related disorders.

Localizing circuits of cocaine contextual memories

Addiction is characterized by compulsive drug seeking and taking behaviors. Cravings triggered by the presence of environmental cues that were once associated to drug use are a main contributor of relapse and once these drug‐cue memories are formed they are difficult to erase. Addictive drugs like cocaine engage molecular pathways of associate learning, in which recall of an established memory is followed by its reconsolidation, strengthening that memory. The reactivation period is a critical time wherein memories are labile and vulnerable to behavioral and pharmacological interference. Given the widespread negative impact of drug use in our society, it is of great importance to understand the mechanisms underlying drug seeking behaviors to generate effective preventions and treatments. The goal of this study is to elucidate the neural substrate in the nucleus accumbens crucial for the maintenance of cocaine contextual memories, and explore neural plasticity involved. Designer receptors exclusively activated by designer drugs (DREADDs) were used to inhibit neurons at the nucleus accumbens. To accomplish this, adult male mice underwent bilateral intracranial injections of an inhibitory DREADD followed by a cocaine conditioned place preference paradigm. Nucleus accumbens neurons were inhibited via systemic injection of clozapine N‐oxide immediately following reactivation of cocaine contextual memory, and mice were re‐tested for place preference 72 hours and 7 days later. A separate cohort of mice underwent the same cocaine conditioned place preference paradigm, 24 hours post preference testing animals were returned to the cocaine context in a drug‐free state to reactivate cocaine memories. Sixty minutes after, brains were collected and prepared for quantitative RT‐PCR to measure activity‐regulated cytoskeleton‐associate protein (Arc) mRNA. To evaluate the functional plasticity in medium spiny neurons at the nucleus accumbens, upon reconsolidation of cocaine contextual memories, we utilized the fosTRAP2‐Ai14 mouse model. A cohort of male and female fosTRAP2‐Ai14 mice underwent cocaine conditioned place preference exactly as in the previous experiment and brains collected 9 days after recall of cocaine contextual memory and 4‐hydroxytamoxifen induction. Dendritic spine density of fosTRAP cells activated by recall of cocaine context were analyzed. Results show that chemogenetic inhibition of the nucleus accumbens immediately following reactivation of cocaine contextual memory significantly reduced a once established preference for the cocaine context. Furthermore, Arc mRNA expression is upregulated at the nucleus accumbens following exposure to the prior cocaine‐paired context. Finally, we show a significant increase in dendritic spine density in medium spiny neurons at the nucleus accumbens following recall of cocaine context. These findings suggest the nucleus accumbens is important for the reconsolidation of cocaine contextual memories and exhibits dendritic neuroplastic changes upon reconsolidation of cocaine memories.

Compulsive alcohol seeking and relapse: Central role of conditioning factors associated with alleviation of withdrawal states by alcohol.

Background and PurposeLearned associations between environmental stimuli and drugs of abuse represent a major factor in the chronically relapsing nature of drug addiction. In drug dependent subjects these associations must be presumed to include associations linked to reversal of adverse withdrawal states by drug use—“withdrawal‐associated learning” (WDL). However, their significance in drug seeking has received little experimental scrutiny.Experimental ApproachUsing alcohol as a drug of abuse, the behavioural consequences of WDL were investigated in animal models of relapse and compulsive drug seeking by comparing the effects of WD L‐associated stimuli versus stimuli associated with alcohol without WDL experience in nondependent and post‐dependent rats. Brain sites activated by exposure to the respective stimuli were identified by c‐fos immunohistochemistry.Key Results(1) WDL‐associated stimuli elicited significant alcohol seeking. In rats with WDL experience, stimuli associated with alcohol in the nondependent state no longer elicited robust alcohol seeking. (2) Responding elicited by WDL‐associated stimuli, but not stimuli conditioned to alcohol in the nondependent state, was resistant to footshock punishment and increased response effort requirements for presentation of WDL‐related stimuli. (3) Stimuli conditioned to alcohol in rats with a dependence but not WDL history did not sustain punished responding or tolerance of increased effort. (4) The central nucleus of the amygdala was identified as a site selectively responsive to WDL stimulus exposure.Conclusion and ImplicationsEnvironmental stimuli associated with reversal of adverse withdrawal states by alcohol elicit compulsive‐like alcohol seeking and establish WDL as a major, not well‐recognized factor, in relapse vulnerability.

Acute nicotine treatment enhances compulsive-like remifentanil self-administration that persists despite contextual punishment.

Opioid use disorder (OUD) and opioid-related deaths remain a significant public health crisis having reached epidemic status globally. OUDs are defined as chronic, relapsing conditions often characterized by compulsive drug seeking despite the deleterious consequences of drug taking. The use of nicotine-containing products has been linked to increased likelihood of prescription opioid misuse, and there exists a significant comorbidity between habitual nicotine use and opioid dependence. In rodent models, nicotine administration nearly doubles the amount of opioids taken in intravenous self-administration paradigms. Here, we examined the effect of acute systemic nicotine administration in male rats on responding for the synthetic opioid remifentanil (RMF) in a contextual punishment paradigm using either an exteroceptive punisher (foot-shock) or an interoceptive punisher (histamine). Nicotine administration, relative to saline, increased RMF intake in both unpunished and punished contexts, regardless of form of punishment, and resulted in significantly higher motivation to obtain RMF in the previously punished context, as measured by progressive ratio breakpoint. Additionally, regardless of context, nicotine-treated rats were slower to extinguish RMF responding following drug removal and displayed higher levels of cue-induced reinstatement than saline-treated controls. Furthermore, these data support that, compared with histamine adulteration, contingent foot-shock is a more potent form of punishment, as histamine punishment failed to support contextual discrimination between the unpunished and punished contexts. In contrast to RMF administration, augmentation of responding for an audiovisual cue by nicotine pretreatment was lost following contextual punishment. In conclusion, acute nicotine administration in adult male rats significantly enhances compulsive-like responding for RMF that persists despite contingent punishment of drug-directed responding.

Treatment Pattern of Patients with Narcotics and Psychotropic Abuse (Case Study at the Bandung Rehabilitation Clinic)

Narcotics, psychotropics, and addictive substances abuse can cause addiction, which is a chronic disorder characterized by compulsive drug seeking and use despite adverse consequences. This is a concurrent descriptive study carried out by evaluating medical records and MMAS-8 questionnaire for assessing patients’ adherence. In addition, therapeutic success and quality of life were also evaluated using WHOQOL-BREF questionnaire. The study took place in the period of September-November 2018 at Medika Antapani Clinic. Data collected from patients under drug maintenance was used to identify the types of drug mostly used by the patients and their treatment, assess the impact of the management, and identify factor influencing therapeutic success. The results showed that there were 40 drug abusers at Medika Antapani Clinic. The abused drugs were amphetamine (80%), cannabis (72%), heroin (35%), benzodiazepine (25%), and nitrazepam (20%). Therapeutic measures used to treat drug abuse were alprazolam in 38 patients (95%), clonazepam in 33 patients (82.5%), nitrazepam in 29 patients (72.5%), lorazepam in 22 patients (55%), and diazepam in 14 patients (35%). Drug rehabilitation patients had low adherence of only 50%. Measurement of quality of life revealed social relation as the dimension with the highest score of 69 + 20.44, with most patients categorized as having moderate quality of life. Therapy with benzodiazepine has potential to cause dependence so it must be practiced with caution.

Assessment of Psychological Symptoms and Cravings among Patients with Substance Related Disorders

Background:Substance use disorders (SUDs) is a chronic and relapsing, yet treatable, brain disease that is characterized by compulsive drug seeking and use, despite negative or harmful consequences. The study aim: This study aimed at assessing the psychological symptoms & level of cravings among patients with substance related disorders. Subjects and Methods: Descriptive research design was used. This study was conducted at Elmaamoura Hospital for psychiatric Medicine in Alexandria. The subjects of the yielded study embraced 90 patients. Three tools were used in the existing study namely interview questionnaire sheet, substance -related disorders &alcohol Cravings ( PACS),and The Symptom Checklist 90 scale - Results: more than one half of the studied subjects (61.1%) were craft workers, (94.4% ) of the patients were consumed opioid substances like tramadol, heroin ..etc., and 93.3%were consumed cannabis substances. There are distress in the three indices of the psychological symptoms among the studied subjects; Positive symptom index (64.82±15.01), Positive symptom distress index (2.86±0.62), and Global severity index (2.06±0.64).In addition to, more than half (62.2%) of the studied subjects had a high level of craving. Conclusion: There is distress in the three indices of the psychological symptoms among the studied subjects, and more than half of the studied subjects had a high level of craving. Recommendation: Assessment of level of craving, and psychological symptoms should be incorporated into routine clinical assessment of the patients with addiction and in designing rehabilitation programs grounded on individual requirements

Pharmaceutical Care in the Treatment of Substance Use Disorders in Jordan: A Randomized Controlled Trial

Background Substance Use Disorder is a chronic relapsing disease that is characterized by compulsive drug seeking and use, despite harmful consequences. The aim of this study was to evaluate the impact of clinical pharmacist intervention/recommendation on the treatment of patients admitted to addiction rehabilitation centers in Jordan. Methods A randomized controlled trial was conducted in two public addiction treatment centers in Amman. Patients (n = 93) were randomized into 2 groups (control and intervention). Medication review was conducted for both groups at baseline, during stay and at discharge. Treatment related problems (TRPs) were identified by the clinical pharmacist and recommendations provided to the therapeutic team in the intervention group. Additionally, quality of life and quality of sleep were assessed at baseline and 2 weeks later. Results A total of 392 TRPs were identified during the study period. The mean number of TRPs ± SD was 4.22 ± 2.58 per patient. The clinical pharmacist intervention led to a reduction in the mean number of TRPs at discharge by 2.2 ± 0.85 (p < 0.001) in comparison to the control group (by 0.23 ± 0.27, p = 0.066). After 2 weeks of admission, there was an improvement of physical health (p = 0.035) and of the overall sleep status (p = 0.048) in the intervention vs. control groups. Conclusion Clinical pharmacy services provided to patients with substance use disorder reduced the number of TRPs and improved other outcomes such as physical health and quality of sleep during detoxification. Long term studies with larger sample sizes are needed.

A Study to Assess the Knowledge regarding Substance Abuse in Adolescents among teachers in selected PU Colleges at Bangalore with a view to develop a Video

Introduction: Substance abuse is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences Substance abuse is the use of psychoactive substance that poses significant hazards to health and interferes with social, occupational, psychological or physical functioning1. The teenage years are a critical window of vulnerability to substance uses disorder; because the brain is still developing and malleable, adolescents are high risk group to avoid the temptations of experimenting with drugs3. A survey shows that of all alcohol 21%, cannabis 3%, and opium 0.1% users are below the age of 18years. Overall 0.4% and 4.6% of total treatment seekers in various states were children5. According to a survey conducted by the Karnataka State Temperance Board, Bangalore, in 2012, about 30% of school and college students in Bangalore are drug addicts. WHO estimates that by 2020, based on the current trends, worldwide can expect 10 million deaths per year1. Materials and methods: The research design selected for this study was descriptive design. The setting selected was PU Colleges in Bangalore. 40 PU College teachers were selected for the study using simple random sampling technique. A demographic proforma to collect the data and structured knowledge questionnaire to assess the knowledge was used. The collected data were analyzed by descriptive and inferential statistics. Result: The current study reveals that out of 40 subjects, 75% of teacher’s had average knowledge and 17.5% good knowledge; subjects had knowledge regarding prevention and management 70%, and meaning/concept 65%. The study revealed statistically that there is no significant association between the knowledge and demographic variables of age, sex, marital status, qualification, designation and there is significant association with source of knowledge. Conclusion: The study findings suggested that the knowledge of teachers regarding substance abuse in adolescents is average. Has an outcome substance abuse video was developed as an educating the teachers and adolescents.