Addiction Treatment Research Articles

Commentary: Similarities and Differences Between Harm-Reduction and Substitute Addiction-- Implications for the Health Professions.

"Substitute addiction" refers to the process of achieving abstinence or resolution of one addictive behavior and subsequently engaging in one or more additional addictive behaviors in its place. Substitute addiction, a concept in the abstinence-based recovery field for decades, is viewed as a cause for concern because resolving one addictive behavior might not fully remove harm or ensure recovery. Conversely, "harm-reduction treatment" refers to a counseling orientation that focuses on helping service users reduce substance-related harm and improve their quality of life without necessarily requiring abstinence or use reduction. Harm-reduction treatment assesses a constellation of addictive behaviors in the larger context of a person's life to holistically reduce harm in that constellation. In this commentary, we define and compare both constructs and point out their implications for addictions treatment.

Substance use care innovations during COVID-19: barriers and facilitators to the provision of safer supply at a toronto COVID-19 isolation and recovery site

BackgroundEarly in the COVID-19 pandemic, there was an urgent need to establish isolation spaces for people experiencing homelessness who were exposed to or had COVID-19. In response, community agencies and the City of Toronto opened COVID-19 isolation and recovery sites (CIRS) in March 2020. We sought to examine the provision of comprehensive substance use services offered to clients on-site to facilitate isolation, particularly the uptake of safer supply prescribing (prescription of pharmaceutical opioids and/or stimulants) as part of a spectrum of comprehensive harm reduction and addiction treatment interventions.MethodsWe conducted in-depth, semi-structured interviews with 25 clients and 25 staff (including peer, harm reduction, nursing and medical team members) from the CIRS in April–July 2021. Iterative and thematic analytic methods were used to identify key themes that emerged in the interview discussions.ResultsAt the time of implementation of the CIRS, the provision of a safer supply of opioids and stimulants was a novel and somewhat controversial practice. Prescribed safer supply was integrated to address the high risk of overdose among clients needing to isolate due to COVID-19. The impact of responding to on-site overdoses and presence of harm reduction and peer teams helped clinical staff overcome hesitation to prescribing safer supply. Site-specific clinical guidance and substance use specialist consults were crucial tools in building capacity to provide safer supply. Staff members had varied perspectives on what constitutes ‘evidence-based’ practice in a rapidly changing, crisis situation.ConclusionThe urgency involved in intervening during a crisis enabled the adoption of prescribed safer supply, meeting the needs of people who use substances and assisting them to complete isolation periods, while also expanding what constitutes acceptable goals in the care of people who use drugs to include harm reduction approaches.

Sex addiction 101: Empirical support, treatment considerations, and future directions

AbstractSex addiction prevalence is estimated between 3% and 10%. There are multiple pathways to its development including biological predispositions, trauma and attachment issues, comorbid conditions, among others. Although controversy still surrounds sex addiction's conceptualization, diagnosis, and treatment, some approaches to treatment have shown promise, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and use of selective serotonin reuptake inhibitors (SSRIs). Empirical support, clinical implications, and future directions are discussed.

Somatic/Psychic Interventions for The Treatment of Trauma and Addictions

The following is from a keynote given at the 2nd International Conference on Addictions & Psychiatry, 2023. A brief description of somatic/psychic interventions is presented, and the common healing elements of these treatment are described. They are resourcing, titration, dyadic neural processing, and repeated exposures over time to facilitate the encoding of new positive neural pathways. A case study is presented illustrating how the therapeutic relationship intersects with the interventions during the treatment of trauma, especially developmental trauma.

Predictors of Relapse in Women after Substance Use Treatment: A Cross-sectional Study in the West of Iran

Background: Many individuals undergo drug addiction treatment relapse after treatment. Additionally, a few studies have focused on the unique challenges faced by women in addiction recovery. Therefore, we aimed to identify predictors of relapse among women who have undergone drug addiction treatment to develop a more effective intervention program tailored to their needs. Methods: The present cross-sectional study evaluated 320 addicted women from Lorestan province, Iran, in 2020 who had used illegal substances. Convenience sampling was used to select participants from outpatient addiction treatment centers, triangular clinics, and rehabilitation centers. Demographic characteristics, drug use patterns, and risk factors for addiction were recorded. Predictors of relapse were evaluated using a negative binomial regression model. Results: The study included women with a mean age of 34.78±9.31 years who had a history of drug addiction relapse. Around 43.44% of the women were married and 36.88% lived with their husbands. Methamphetamine, opium, and heroin were the commonly used drugs. The study found that women with primary school education had a higher rate of relapse (IRR: 1.71, p = 0.01) and women with husbands being substance users (IRR: 1.34, p = 0.014), history of imprisonment (IRR: 1.51, p = 0.002), smoking (IRR: 1.91, p < 0.001), and alcohol consumption (IRR: 1.49, p = 0.005) were also associated with a higher rate of relapse. Conclusion: In conclusion, this study found that women with primary school education, husbands being substance users, history of imprisonment, smoking, and alcohol consumption behavior had a higher rate of relapse. By addressing the identified predictors of relapse, such programs can improve the success rate of addiction treatment and promote long-term recovery among women. In addition, this study highlights that addiction relapse is not necessarily caused by a single factor, and several different personal and environmental factors can influence this issue.

Behandeling van opioïdverslaafde zwangere vrouwen met buprenorfine: invloed op de foetus en de pasgeborene

Treatment of opioid addiction in pregnancy with buprenorphine: implications for the fetus and newborn The aim of this article is to summarize the actual knowledge on the use of buprenorphine for the treatment of opioid addiction in pregnancy. Buprenorphine is a semisynthetic thebaine derivative, increasingly used instead of methadone for the treatment of opioid-dependent pregnant women. Fetuses exposed to buprenorphine have a more favorable biophysical profile compared to methadone. The neonatal abstinence syndrome (NAS) occurs less in comparison to methadone-exposed neonates. Treatment is not always indicated and, if necessary, morphine is administered. Buprenorphine is a promising alternative to methadone in the treatment of pregnant women with opioid addiction.

Driving innovation in addiction treatment: role of transcranial magnetic stimulation.

Addictions comprises heterogenous psychiatric conditions caused by the complex interaction of genetic, neurobiological, psychological, and environmental factors with a chronic relapsing-remitting pattern. Despite the long-standing efforts of preclinical and clinical research studies, addiction field has seen relatively slow progress when it comes to the development of new therapeutic interventions, most of which failed to demonstrate a significant efficacy. This is likely due to the very complex interplay of many factors that contribute to both the development and expression of addictions. The imbalance between the salience and the reward brain network circuitry has been proposed as the neurobiological mechanisms explaining the pathognomonic symptoms of addictions.Non-invasive neuromodulation techniques have been proposed as a promising therapeutic intervention to restore these brain circuits dysfunctions. Here, we propose a multi-level strategy to innovate the diagnosis and the treatment of addictive disorders.

Categorizing Vaping Intensity Among Youth.

Increasing electronic cigarette use among youth has led to a need for a novel intensity measure of e-cigarette use and its association with nicotine addiction variables. Using a cross-sectional study of the 2018-2019 PATH Wave 5 Youth survey, a new intensity metric of e-cigarette use, the average number of puffs per month as a function of frequency (days of use per month), number of uses per day and number of puffs per use, was developed for adolescent e-cigarette users. Using logistic regression, standard addiction measures were tested for association with higher quartile (Q) of e-cigarette intensity: Q1 (1-5 puffs), Q2 (6-50 puffs), Q3 (51-528 puffs), and Q4 (529 + puffs). Among 1051 current youth e-cigarette users, cravings were associated with greater intensity of use (Q2: aOR = 1.90, 95% CI: 0.94-3.87; Q3: aOR = 6.91, 95% CI: 3.25-14.69; and Q4: aOR = 21.48, 95% CI: 10.03-45.97). Craving associations exceeded the corresponding aORs for the identical regression using the frequency of use. Higher intensity was significantly associated with being an older adolescent (aOR = 1.85), best friend use (aOR: 3.35), not thinking about quitting (aOR: 2.51), and lower perceived addiction (aOR: 1.95). This study found that an intensity metric (puffs per month) was strongly associated with cravings, best friend use, harm perception, and lack of intention to quit. This metric provides a more accurate picture of the intensity of youth e-cigarette use than other commonly used measures and may be important for understanding the current and future impact of the youth e-cigarette epidemic. Adolescent addiction to e-cigarettes affects learning, memory, and attention. However, it is unknown whether the intensity of use, puffs per month, differs from frequency, days of use per month, and in relation to addiction measures. This study provides evidence that high-intensity use characterized by puffs per month has a stronger association with cravings compared to frequency, which suggests puffs per month may be a better measure of nicotine exposure. This new intensity metric may give insights into youth e-cigarette use patterns, addiction, and appropriate treatment of intense but intermittent users.

The effectiveness of court-mandated compulsory treatment in promoting abstinence among people with substance use disorders in Iran

BackgroundIn Iran, people living with substance use disorders who engage in public drug use may be subjected to court-mandated treatment in compulsory drug detention and rehabilitation centers (CDDRC). This study aims to assess residential CDDRC's effectiveness in promoting sustained abstinence among people who use drugs (PWUD) in Kerman, Iran. MethodsBetween October 1, 2021, and September 30, 2022, 1,083 adult male PWUD with a diagnosis of substance use disorders and a history of engagement in public drug use were admitted to the CDDRC in Kerman. They were followed-up for 12 months after discharge. The relationship between baseline variables and abstinence, assessed using rapid urine tests, was examined using crude logistic regression models. ResultsMost PWUD were 30 or older (n = 876, 80.9 %) and had a history of previous CDDRC admission (n = 638, 58.9 %). At the end of the 12-month follow-up, only 2.6 % (95 % confidence intervals: 1.7–3.7) were abstinent. Individuals with limited education (Odds ratio [OR] = 3.43; 1.50–7.95) and those with a prior history of admission to the CDDRC (OR = 3.73; 1.55–9.89) had increased odds of relapse. ConclusionsThe effectiveness of CDDRC in promoting abstinence among the participants was minimal. This highlights the necessity of reassessing support and investment in these interventions and considering more evidence-informed alternative approaches in Iran.

COVID-19 vaccination among young people who use drugs in Vancouver, Canada

ObjectivesSARS-CoV-2 vaccines provide significant protection against severe illness and death from COVID-19, in addition to reducing community transmission. Emerging research has identified factors associated with vaccine uptake among adults who use drugs; however, less is known about youth and young adults who use drugs (YWUD). To address this gap, we sought to characterize factors associated with vaccine uptake and explore vaccine hesitancy among YWUD. MethodsData were derived from the At-Risk Youth Study, a prospective cohort of street-involved YWUD in Vancouver, Canada. Using multivariable logistic regression, we characterized factors associated with SARS-CoV-2 vaccine uptake between June and November 2021. Data on vaccine hesitancy were also collected. ResultsAmong 301 participants enrolled in this study (median age: 29 [min and max: 20–40]), 151 (50.2%) self-reported receipt of at least one dose of a SARS-CoV-2 vaccine. In multivariable analysis, vaccine uptake was significantly associated with recent addiction treatment engagement (adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI]: 1.47–4.14) and receiving prescribed safer supply (e.g., opioids, stimulants) (AOR = 2.33, 95% CI: 1.03–5.62). Those who reported at least weekly crack use were significantly less likely to be vaccinated (AOR = 0.35, 95% CI: 0.12–0.92). The most reported reason for vaccine hesitancy was safety concerns, specifically regarding long-term side effects (27.4%). ConclusionVaccine uptake was significantly lower among YWUD than adults who use drugs in Vancouver and the general population in British Columbia, among whom 75% and 93% received at least one dose during the same period. Study findings suggest connecting YWUD to healthcare and novel harm reduction interventions may increase vaccine uptake. Responses to vaccine hesitancy questions revealed complex perspectives of vaccines that were aligned with sources of vaccine hesitancy among the general population. Broader strategies combatting misinformation and promoting evidence-based vaccine information could be tailored to address the unique needs and barriers experienced by YWUD.

Behavioral characterization of early nicotine withdrawal in the mouse: a potential model of acute dependence

BackgroundClinical and preclinical research have demonstrated that short-term exposure to nicotine during the initial experimentation stage can lead to early manifestation of withdrawal-like signs, indicating the state of “acute dependence”. As drug withdrawal is a major factor driving the progression toward regular drug intake, characterizing and understanding the features of early nicotine withdrawal may be important for the prevention and treatment of drug addiction. In this study, we corroborate the previous studies by showing that withdrawal-like signs can be precipitated after short-term nicotine exposure in mice, providing a potential animal model of acute dependence on nicotine.ResultsTo model nicotine exposure from light tobacco use during the initial experimentation stage, mice were treated with 0.5 mg/kg (-)-nicotine ditartrate once daily for 3 days. On the following day, the behavioral tests were conducted after implementing spontaneous or mecamylamine-precipitated withdrawal. In the open field test, precipitated nicotine withdrawal reduced locomotor activity and time spent in the center zone. In the elevated plus maze test, the mecamylamine challenge increased the time spent in the closed arm and reduced the number of entries irrespective of nicotine experience. In the examination of the somatic aspect, precipitated nicotine withdrawal enhanced the number of somatic signs. Finally, nicotine withdrawal did not affect cognitive functioning or social behavior in the passive avoidance, spatial object recognition, or social interaction test.ConclusionsCollectively, our data demonstrate that early nicotine withdrawal-like signs could be precipitated by the nicotinic antagonist mecamylamine in mice, and that early withdrawal from nicotine primarily causes physical symptoms.

Wybrane prawno-organizacje aspekty leczenia uzależnienia od alkoholu w Polsce

Alcoholism is one of the most widespread problems in the world today. Research into the disease indicates that alcoholism has a multifactorial basis, combining a genetic predisposition with a variety of environmental factors, including psychological and sociological aspects. The consequences of alcoholism not only affect the addict, but have an impact on family and work relationships. As a result, state institutions are taking measures aimed at getting the alcohol-dependent person into treatment. The aim of this article is to present the current model of addiction treatment in Poland, the framework of which was developed in the early 1980s, and to assess whether the system brings specific therapeutic benefits and is economically efficient.

Cross-cultural adaptation and psychometric validation of the brief assessment of recovery capital (BARC-10) scale into Bangla.

Recovery capital is a construct central to the substance use disorder treatment and recovery field. Lack of structured instrument for its assessment in the local context necessitated the translation of the English self-assessment version of the "Brief Assessment of Recovery Capital" (BARC-10) scale to Bangla and the study of its psychometric properties. The objective was to develop a culturally adapted and validated Bangla version of the BARC-10 scale for substance use disorders patients. This study conducted in the period of January 2021 to March 2022 in the department of Psychiatry of a tertiary hospital and central drug addiction treatment center. Initially BARC-10 questionnaire was translated into Bangla (T1 and T2) by 2 separate translators and then synthesis of a single version (T12) was done based on the previous translations. After that 2 back translations (BT1 and BT2) were done by 2 more translators based on the synthesized version (T12). By reviewing all these forward and backward translations, an expert committee made the pre-final version after making some linguistic modification. Then data collection was done among 100 subjects who were selected purposively. Reliability was assessed by Cronbach alpha. Content validity, face validity and Construct validity by factor analysis were measured. Internal consistency measured by Cronbach alpha found was 0.846. No significant change in Cronbach alpha was observed following deleting any item. Confirmatory factor analysis revealed a good fit to data by a chi-square/df value1.33, RMSEA value 0.058. Kaiser-Meyer-Olkin value (.840) showed sampling adequacy. Exploratory factor analysis of the principal component identified 2 factors which had eigenvalues of more than 1. Scree plot also revealed similar factors. These 2 factors together explained 53.1% of the variance. All items were loaded under 2 factors after varimax rotation. The validated Bangla version of the BARC-10 demonstrated high internal reliability and validity. It can potentially be applied in "recovery-oriented" deaddiction service.

Nociplastic Pain and Pain-Motivated Drinking in Alcohol Use Disorder

Heavy chronic alcohol use may produce pain amplification through neurochemical and neuroplastic changes at multiple levels of the nervous system. Similar changes are thought to underlie nociplastic pain. The American College of Rheumatology Fibromyalgia Survey has been used as a surrogate for nociplastic pain, including among individuals with alcohol use disorder (AUD). However, studies linking nociplastic pain to pain-motivated drinking are lacking. The present study aimed to determine if nociplastic pain is associated with pain-motivated drinking in AUD. To achieve this aim, a new scale—the Pain-Motivated Drinking Scale (PMDS)—was developed to measure how often participants were motivated by pain to drink alcohol. Measurement properties of this new scale were determined, including its factor structure, internal consistency reliability, and construct validity. In this cross-sectional observational study, participants with AUD (n = 138) were consecutively recruited from the patient pool at an academic addiction treatment facility. Seventy-two percent (95, 72.0%) reported they drank alcohol “to get relief from physical pain” at least some of the time, and over forty-two percent (56, 42.4%) reported pain relief motivated their drinking at least half of the time. PMDS had a single-factor structure, strong internal consistency reliability, and construct validity. A multiple hierarchical linear regression was run to determine if nociplastic pain was associated with pain-motivated drinking. Nociplastic pain was associated with PMDS even after controlling for potential confounders and pain severity. These findings suggest nociplastic pain is uniquely associated with pain-motivated drinking in AUD. PerspectiveNociplastic pain is independently associated with pain-motivated drinking in alcohol use disorder (AUD). The Pain-Motivated Drinking Scale (PMDS) is a new scale to measure how often people drink to cope with pain. PMDS has promising psychometric properties. Nociplastic pain may be uniquely associated with pain-motivated drinking in AUD.

Beds for teens are scarce and expensive: NIDA study

Residential addiction treatment for teens is limited and expensive, according to a study published in Health Affairs last week. For the study, “Treatment In The US: Uneven Access, Waitlists, And High Costs” — which was funded by the National Institute on Drug Abuse (NIDA) — Caroline King, M.D. and colleagues used the FindTreatment.gov database maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) and a search analytics company to find 354 centers that claim to provide residential addiction treatment services to people under age 18. The researchers then contacted them.

Clinical manifestations and analytical reports for MDPHP acute intoxication cases

MDPHP is a synthetic cathinone (SC) belonging to α-pyrrolidinophenone derivatives. It is a central nervous system stimulant and may induce hallucinations, paranoia, tachycardia, hypertension, chest pain, and rhabdomyolysis. In literature, a few cases of intoxication have been reported. In the present study, 17 cases of MDPHP intake were described including the analytical findings and clinical manifestations. MDPHP was quantified by liquid chromatography–tandem mass spectrometry in blood (range 1.26–73.30 ng/mL) and urine (range 19.31–8769.64 ng/mL) samples. In three cases the presence of α-PHP was observed. In one case, MDPHP was the only detected substance. Concomitant use of MDPHP with other substances, particularly psychostimulants, was common and it was difficult to describe the peculiar clinical characteristics of this SC. Most of the symptoms overlapped those expected, some of them were unusual and all of them particularly severe thus inducing the research of NPS in laboratory tests. We demonstrated the presence of psychiatric, neurological, and respiratory symptoms, as well as the possible presence of rhabdomyolysis and cardiotoxicity associated with the use of MDPHP. ED admissions were also more frequent in patients with addiction problems. In some cases, MDPHP intake required intensive supportive care. A multidisciplinary approach, including specialist consultation, is recommended for patients showing challenging features. Moreover, we demonstrated that the adoption of advanced analytical techniques, i.e., liquid chromatography–tandem mass spectrometry, is necessary to detect these molecules. Further studies are needed to understand MDPHP intake patterns and associated symptoms. It is essential to raise awareness in addiction treatment centers and among potential users, especially young people, and chemsex addicted.

Substance use and substance use disorders in relation to COVID-19: qualitative experiences of people who use drugs in Jordan

ABSTRACT Background Monitoring substance use and Substance Use Disorders (SUD) during global pandemics is essential, as individuals who engage in such activities may be at greater risk for infections as well as economic and social complications. This study aimed to describe the impact of COVID-19 on substance use and SUD, any changes that occurred in patterns of use, and services provided, the main challenges faced and if and how they had been overcome. Methods A qualitative study consisting of face-to-face semi-structured interviews with a sample of SUD patients from 3 main addiction treatment centers in Jordan. Recruitment stopped once data saturation was reached. Interviews were transcribed and analyzed using NVivo-R1 software, and thematic analysis was undertaken. Results A total of 17 individuals were interviewed (male, aged 19–52 years). Five key themes emerged from a narrative analysis: Impact of COVID-19 on the availability of substances, the pattern of use, social life and its relation to SUD, impact on tobacco smoking, and finally on the user’s health, awareness and hygienic measures. Conclusions This study provided in-depth information to inform, support, and customize the design of interventions to mitigate the negative effects of substance use and SUD-related outcomes in a rapidly changing pandemic.

Exploring the impact of coercion and voluntary entry on dropout rates in a therapeutic community for substance abuse rehabilitation: A survival analysis and logistic regression study

High dropout rates challenge drug rehabilitation programs. Both therapists and academics aim to pinpoint predictors of retention, with individual motivation, both external and internal, being a key factor. This study compares the retention period for residents who joined the Hartuv residential therapeutic community as an alternative to imprisonment (i.e. due to external motivation) and residents who joined the community voluntarily. In this study, residents of the Hartuv residential therapeutic community between 2010 and 2015, were examined. The analysis of the data used both logistic regression and survival analysis. The logistic regression evaluated the predictors for completing or dropping out of the program. The survival analysis examined the retention time, measured over a 12-month follow-up period, which represents the completion of the program. Residents who entered the program as an alternative to imprisonment were significantly more likely to retain in treatment than those who arrived voluntarily. Retention in treatment is influenced by external motivation. Strengthening familial, social, and occupational relationships may increase external motivation among residents who enter the program voluntarily and therefore lack significant external motivation.

The Role of Estrogen Signaling and Exercise in Drug Abuse: A Review.

Discovering how sex differences impact the efficacy of exercise regimens used for treating drug addiction is becoming increasingly important. Estrogen is a hormone believed to explain a large portion of sex differences observed during drug addiction, and why certain exercise regimens are not equally effective between sexes in treatment. Addiction is currently a global hindrance to millions, many of whom are suffering under the influence of their brain's intrinsic reward system coupled with external environmental factors. Substance abuse disorders in the U.S. alone cost billions of dollars annually. Studies involving the manipulation of estrogen levels in female rodents, primarily via ovariectomy, highlight its impact regarding drug addiction. More specifically, female rodents with higher estrogen levels during the estrus phase increase cocaine consumption, whereas those in the non-estrus phase (low estrogen levels) decrease cocaine consumption. If estrogen is reintroduced, self-administration increases once again. Exercise has been proven to decrease relapse tendency, but its effect on estrogen levels is not fully understood. Such findings and results discussed in this review suggest that estrogen influences the susceptibility of females to relapse. Therefore, to improve drug-abuse-related treatment, exercise regimens for females should be generated based on key sex differences with respect to males.

Vaccines to Treat Substance Use Disorders: Current Status and Future Directions.

Addiction, particularly in relation to psychostimulants and opioids, persists as a global health crisis with profound social and economic ramifications. Traditional interventions, including medications and behavioral therapies, often encounter limited success due to the chronic and relapsing nature of addictive disorders. Consequently, there is significant interest in the development of innovative therapeutics to counteract the effects of abused substances. In recent years, vaccines have emerged as a novel and promising strategy to tackle addiction. Anti-drug vaccines are designed to stimulate the immune system to produce antibodies that bind to addictive compounds, such as nicotine, cocaine, morphine, methamphetamine, and heroin. These antibodies effectively neutralize the target molecules, preventing them from reaching the brain and eliciting their rewarding effects. By obstructing the rewarding sensations associated with substance use, vaccines aim to reduce cravings and the motivation to engage in drug use. Although anti-drug vaccines hold significant potential, challenges remain in their development and implementation. The reversibility of vaccination and the potential for combining vaccines with other addiction treatments offer promise for improving addiction outcomes. This review provides an overview of anti-drug vaccines, their mechanisms of action, and their potential impact on treatment for substance use disorders. Furthermore, this review summarizes recent advancements in vaccine development for each specific drug, offering insights for the development of more effective and personalized treatments capable of addressing the distinct challenges posed by various abused substances.