Heroin Craving Questionnaire Research Articles

The Role of Repetitive Transcranial Magnetic Stimulation in Reduction of Opioid Craving; A Single Blinded Randomized Sham Controlled Clinical Trial

Abstract Background Opioid use disorder (OUD) poses a great concern due to problems associated with their abuse as well as fatal and non fatal overdose consequences. Craving has a complex relationship with opioid use and relapse. Developing new, effective treatments for substance use disorders (SUDs), including opioid use disorders is crucial. This study aimed to assess the effect of 18 sessions of high frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) on opioid craving in early abstinence using brief substance craving scale (BSCS) for Tramadol and morphine and Heroin craving questionnaire (HCQ) for Heroin craving. Results There was a statistically significant reduction in craving scores in the group of OUD patients receiving real rTMS compared to those receiving sham rTMS for both BSCS( p value = 0.044) and HCQ (p value = 0.002). A statistically significant positive correlation was revealed between the number of hospital admissions and the mean scores of post rTMS HCQ scores (r = 0.05, p value = 0.040). Conclusion High frequency 10 Hz rTMS over the left DLPFC for 18 treatment sessions reduced craving OUD patients during early abstinence. These preliminary results suggest that 10 Hz rTMS of the left DLPFC may be used in treatment of OUD; so our study recommends that use of rTMS in reduction of opioid craving in early abstinence.

Connectome-based predictive modelling can predict follow-up craving after abstinence in individuals with opioid use disorders

BackgroundIndividual differences have been detected in individuals with opioid use disorders (OUD) in rehabilitation following protracted abstinence. Recent studies suggested that prediction models were effective for individual-level prognosis based on...

The role of repetitive transcranial magnetic stimulation in reduction of opioid craving: a single-blinded randomized sham-controlled clinical trial

BackgroundOpioid use disorder (OUD) poses a great concern due to problems associated with their abuse as well as fatal and non-fatal overdose consequences. Craving has a complex relationship with opioid use and relapse. Developing new, effective treatments for substance use disorders (SUDs), including opioid use disorders is crucial. This study aimed to assess the effect of 18 sessions of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) on opioid craving in 26 OUD male patients compared to sham rTMS in 26 OUD patients, during early abstinence, with craving assessment using brief substance craving scale (BSCS) for tramadol and morphine and heroin craving questionnaire (HCQ) for heroin craving.ResultsThere was a statistically significant reduction in craving scores in the group of OUD patients receiving real rTMS compared to those receiving sham rTMS for both BSCS (p value = 0.044) and HCQ (p value=0.002). A statistically significant positive correlation was revealed between the number of hospital admissions and the mean scores of post-rTMS HCQ scores (r=0.05, p value= 0.040).ConclusionsA high frequency of 10-Hz rTMS over the left DLPFC for 18 treatment sessions reduced craving OUD patients during early abstinence. These preliminary results suggest that 10-Hz rTMS of the left DLPFC may be used in the treatment of OUD, so our study recommends that the use of rTMS in the reduction of opioid craving in early abstinence.Trial registrationUnique identification number PACTR202206487514449 in the Pan African Clinical Trial Registry retrospectively (www.pactr.org) registered on 10 June 2022.

Association of Testosterone Levels and Steroid 5-Alpha-Reductase 2 Polymorphisms with Opioid Craving

Background/Aims: Opioid dependence is a severe disease which is associated with a high risk of relapse, even in cases of successful withdrawal therapy. Studies have shown alterations of the hypothalamic-pituitary-gonadal axis in opioid-dependent patients, such as decreased testosterone serum levels in affected males. Sex hormones and the steroid 5-alpha-reductase 2 (SRD5A2) V89L polymorphism are associated with craving during alcohol withdrawal, but little is known about their impact on symptomatology of opioid dependence. Methods: In this study, we analyzed 2 independent male cohorts of opioid-dependent patients for possible alterations in testosterone serum levels compared to non-opioid-dependent controls. In one of the cohorts, we additionally investigated associations of testosterone serum levels and 3 SRD5A2 polymorphisms with symptoms of opioid dependence, measured by the Heroin Craving Questionnaire (HCQ). Results: In the patient groups, we found significantly decreased testosterone serum levels compared to the control groups. Furthermore, we found significant associations of both the testosterone serum levels and the SRD5A2 V89L polymorphism with opioid craving assessed by the HCQ. Conclusion: Our data show a possible role of testosterone metabolism in opioid dependence, which may be relevant for the establishment of future treatment strategies.

'Too little dose - too early discontinuation?'-Effect of buprenorphine dose on short term treatment adherence in opioid dependence.

Opioid substitution therapy is an evidence-based treatment for opioid dependence syndrome. Retention in treatment is a crucial mediator of treatment success. Our study aims to examine factors associated with early treatment non-compliance among patients who are initiated on office-based Buprenorphine Maintenance Treatment (BMT). This is a prospective observational study conducted among 89 subjects who were initiated on BMT and were followed up to 6 weeks. At baseline, we evaluated subjects using: Mini International Neuropsychiatric Interview Plus, Addiction Severity Index-Lite, Multi-Dimensional Scale of Perceived Social Support, Heroin Craving Questionnaire, and urine toxicological analysis. Treatment adherence for six weeks was noted. Among Eighty-nine subjects, 57 per cent of the sample reported addiction to pharmaceutical opioids. The mean dose of Buprenorphine was 6.7 mg (SD = 4.1). During follow up 67 per cent (n = 62) patients were adherent to treatment while 33 per cent (n = 27) non-adherent to treatment. The mean dose of buprenorphine in the non-adherent group was significantly lower than the adherent group (4.3 mg and 7.7 mg, respectively, t [87] = 3.8, p < 0.001). A comparison of groups based on the dose of Buprenorphine (6 mg or higher vs lower than 6 mg) revealed that odds of treatment non-adherence were three times higher in patients receiving 6 mg or lesser dose (Odds Ratio = 3.15 [95% CI = 2.0-8.6],χ2 [1] = 4.75, p = 0.035). Dose of Buprenorphine prescribed by the treating clinician influences early treatment compliance significantly.

Mindfulness-based relapse prevention to reduce lapse and craving

ABSTRACTBackground: Lapse and craving are common phenomena observed in patients undergoing addiction treatment programs such as Methadone Maintenance Therapy (MMT). Therefore, the purpose of the present study was to find whether Mindfulness-Based Relapse Prevention (MBRP) can help reduce lapse and craving in such patients. Methods: a total of 55 Iranian adult males undergoing MMT were selected through multistage random sampling and were randomly assigned to experimental (n = 26) and control (n = 29) groups. The experimental group received eight sessions of MBRP while the control group received no intervention. To collect data, the Heroin Craving Questionnaire (HCQ) was distributed among both groups and they were required to take the urine drug tests in the three follow-up phases of the study to find the possible instances of lapse. Results: The results revealed that three out of the five subscales of HCQ, i.e., intention to use, anticipation of relief from withdrawal and desire to use significantly decreased due to MBRP. Moreover, the results of urine drug tests revealed fewer lapse percentages in the experimental group. Conclusions: it is recommended to complement the common substance treatment programs with those that enhance awareness and acceptance and reduce the desire to use the substance.

The Impact of Diacetylmorphine on Hypothalamic-Pituitary-Adrenal Axis Activity and Heroin Craving in Heroin Dependence

Background/Aim: Heroin dependence is a chronic relapsing disorder characterized by the compulsion to seek and use heroin. Stress and craving are seen as key factors for heroin use. Moreover, altered hypothalamic-pituitary-adrenal (HPA) axis function has been frequently reported. However, the acute effects of diacetylmorphine (DAM) on HPA axis activity and craving have not been investigated in a controlled study. The present randomized controlled study examined whether DAM administration differs from placebo (saline) administration with regard to HPA axis response and heroin craving. Methods: In a crossover experiment, 28 DAM-maintained heroin-dependent patients were first injected with DAM and then saline, or the converse. Plasma adrenocorticotropic hormone (ACTH) and cortisol in saliva and serum were measured at baseline and 20 and 60 min after both injections. Heroin craving was measured at baseline and 60 min after both injections, by means of the Heroin Craving Questionnaire. Results: Compared to saline, DAM administration induced a significant decrease in plasma ACTH (p < 0.01), serum cortisol (p < 0.0001) and saliva cortisol (p < 0.01), as well as in craving (p < 0.0001), over time. Conclusion: Since acute DAM administration suppresses the stress response, DAM-assisted treatment may be an effective alternative to methadone maintenance in stress-sensitive heroin-dependent patients.

Serum levels of BDNF are associated with craving in opiate-dependent patients

Preclinical study results suggest that brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) are involved in the modulation of addictive behaviour. We investigated alterations in serum levels of BDNF and GDNF in opiate-dependent patients (28 males) who received diacetylmorphine treatment within a structured opiate maintenance programme. BDNF (T = 2.735, p = 0.009) serum levels were significantly increased in the opiate-dependent patients as compared with healthy controls (21 males), whereas GDNF serum levels (T = 1.425, p = 0.162) did not differ significantly from GDNF serum levels of the healthy controls. BDNF serum levels were significantly associated with craving for heroin (measured by the Heroin Craving Questionnaire (r = 0.420, p = 0.029) and by the General Craving Scale (r = 0.457, p = 0.016), whereas GDNF serum levels were not associated with psychometric dimensions of heroin craving. In conclusion, our results show a positive association between BDNF serum levels and opiate craving in opiate-dependent patients.

Alpha‐synuclein and heroin craving in opiate‐dependent patients on injectable heroin maintenance

Research suggests that alpha-synuclein (SNCA) and NACP-Rep1, a polymorphic complex microsatellite repeat ~10 kb upstream of the SNCA gene translational start, may be involved in substance-use behaviors and craving. This study was the first to examine the effects of diacetylmorphine (DAM) on peripheral SNCA protein expression along with craving in opiate-dependent patients and to compare their NACP-Rep1 allele lengths with those of healthy controls. Using an experimental design, opiate-dependent patients on injectable heroin maintenance were investigated at four time points, twice pre- and post-injection of DAM. SNCA protein levels of 30 DAM-maintained patients were measured using enzyme-linked immunosorbent assay. Participant-rated effects were assessed in 42 patients by Tiffany's Heroin Craving Questionnaire (HCQ), Gossop's Short Opiate Withdrawal Scale and Visual Analogs. NACP-Rep1 alleles of 42 patients and 101 controls were analyzed. One-way repeated-measures ANOVAs provided significant overall effects for SNCA protein content (P = 0.028), craving (P < 0.001), withdrawal symptomatology (P < 0.001) and mood (P < 0.001), indicating that DAM injections may not only reduce craving but also SNCA protein expression. However, there was no association between protein expression and craving. Relative to controls, patients had significantly longer NACP-Rep1 alleles (P < 0.001). NACP-Rep1 allele lengths correlated positively with HCQ total scores averaged across all time points (r = 0.420; P = 0.006) as well as with post-DAM HCQ total scores in the morning (r = 0.488, P = 0.001) and afternoon (r = 0.423, P = 0.005). The findings provide evidence of a contributory role of SNCA and NACP-Rep1 for opiate dependence.

Effects of a Single 50% Extra Dose of Methadone on Heroin Craving and Mood in Lower- Versus Higher-Dose Methadone Patients

Some patients on steady-state methadone occasionally crave for extra opioids for different reasons (eg, cue-elicited craving, stress). This study examined the acute-on-chronic effects on heroin craving, mood, and opioid-like symptoms of a single, extra half-dose on top of the patient's prescribed daily methadone dosage. A randomized, double-blind, placebo-controlled, counterbalanced crossover design was used to test the safety of this practice and the hypotheses that extra methadone would reduce heroin craving and improve mood, with greater responses in lower-dose (20-60 mg/d) as compared with higher-dose patients (80-120 mg/d). Fourteen stabilized methadone-maintained volunteers of each dose group were examined predrug and postdrug on 2 separate days using a range of self-report measures (Heroin Craving Questionnaire, visual analogs, Befindlichkeits-Skala, Short Opiate Withdrawal Scale, and Opioid Agonist Scale). Additionally, patients' expectations and guesses regarding treatment were assessed predrug and postdrug, respectively. No adverse effects occurred after extra methadone. Participants could not reliably distinguish between extra methadone and placebo. Repeated-measures analyses of variance showed no effects of extra methadone on heroin craving and opioid agonist effects. However, extra methadone improved mood on the Befindlichkeits-Skala (F1/24 = 4.71, P = 0.04), with marginally greater effects in lower-dose patients ((F1/24 = 2.94, P = 0.099). A single 50% extra methadone dose is most likely safe in patients on stable methadone doses of 20 to 120 mg/d and may improve patients' mood. Extra methadone may constitute an important factor in the attractiveness of maintenance treatment and may enhance treatment outcome.

Effectiveness of Neurofeedback Training as a Treatment for Opioid-Dependent Patients

Neurofeedback (NF) training has been employed as a therapeutic method in substance-dependence disorder over the last three decades. The purpose of the present study was to examine the effectiveness of this method on improvement of comorbid neuro-psychological syndromes in opioid-dependence disorder. Psychopathological and craving dimensions and brain activity signals of 20 opioid dependent patients were measured using Symptom Checklist-90-Revised (SCL-90-R), Heroin Craving Questionnaire (HCQ), and Quantitative Electroencephalography (QEEG). All the patients were undergoing pharmacotherapy. They were assigned to two groups that were matched based on SCL-90-R scores, education and age. The experimental group received 30 sessions of NF training in addition to their medicine. The control group received only the usual pharmacotherapy. The probable changes were monitored by reappraisal of all the patients after the treatment. We hypothesized that patients in the experimental group would show more reduction in their comorbid syndromes. The Multivariate Analysis of Covariance (MANCOVA) showed that the experimental group, in comparison with control group, showed significantly more improvement in all three outcome measures. In the SCL-90-R, improvement was noted with the hypochondriacs, obsession, interpersonal sensitivity, aggression, psychosis, and general symptomatic indexes. In the HCQ, improvement was found in the anticipation of positive outcome, desire to use substance, and total average score. Finally, the QEEG showed positive changes in frontal, central and parietal delta, frontal and central theta, parietal alpha and frontal and central Sensory Motor Rhythm (SMR) amplitudes. This study suggests that NF can be used as a therapeutic method to ameliorate abnormalities related to opioid-dependence disorders. The results emphasize the importance of neuropsychological interventions in treatment of substance-dependence disorders.

Comparison of Craving in Substance use Patients with the History of ADHD and Substance use without ADHD History

This study aimed at the comparison of craving in substance use patients with the history of ADHD (attention deficit, hyperactivity- impulsivity, combined type) and substance users without ADHD history. To achieve this goal, 65 addicted men were selected among clients referring to addiction treatment centers in Tehran city, at hand sampling. Data from the subjects were collected using the Heroin Craving Questionnaire (HCQ), and Adult Questionnaire – Childhood ADHD Symptoms Rating Scale (AQ- CASRS). Data were analyzed by independent T-test: Results suggested a significant difference between craving in addicted men with ADHD history and addicted men without this history. We conducted that, men with substance use disorder and ADHD history show higher craving to drugs than men with substance use disorder without ADHD history.

Heroin and cocaine craving and use during treatment: Measurement validation and potential relationships

Although commonly assessed with unidimensional scales, craving has been suggested to be multifaceted and to have a complex relationship with drug use and relapse. This study assessed the consistency and predictive validity of unidimensional and multidimensional craving scales. At the beginning of a 12-week outpatient treatment trial, opiate users ( n = 101) and cocaine users ( n = 72) completed unidimensional visual analog scales (VASs) assessing “want,” “need,” and “craving” and multidimensional 14- and 45-item versions of the Cocaine Craving Questionnaire (CCQ) or Heroin Craving Questionnaire (HCQ). Spearman correlations between the VASs and the first-order factors from the 45-item CCQ/HCQ were .20–.40, suggesting that the two types of assessment were not redundant. Treatment dropout and in-treatment drug use were more frequently predicted by scores on the 14- or 45-item CCQ than by VAS ratings. Results suggest that the CCQ/HCQ and the 14-item CCQ provide information that unidimensional VASs do not.

Analysis of depression characteristics and the related factors in male patients with heroin dependence

目的 了解男性海洛因依赖者(MPHD)抑郁情绪特点及影响因素.方法采用一般情况问卷(自拟)、抑郁自评问卷(SDS)、多伦多述情障碍量表(TAS)及渴求问卷(HCQ),对湖南地区218名MPHD(研究组)进行测评,以SDS对82名抑郁症患者(对照组)测评.结果 83.51%的MPHD存在着不同程度的抑郁情绪,9.79%的患者有严重的抑郁情绪.MPHD、SDS总分及忧郁、易哭、睡眠障碍、食欲减退、性兴趣减退、体质量减轻、不安、易激惹、决断困难、无价值感10因子分均低于抑郁症组:SDS总分[(49.75±5.02)分 vs(54.10±9.33)分](P ＜0.01);心悸、思考困难、绝望因子分高于抑郁症组(P ＜0.05或P ＜0.01).以是否抑郁为应变量,对有关变量进行Logistic回归分析,TAS总分、HCQ效果期待因子、戒断前飘的感觉依次进入方程.结论 MPHD抑郁发生率较高,但程度较轻,在某些生物学症状、躯体性障碍、抑郁的心理障碍方面表现得同样严重与突出.述情障碍、渴求、戒断前飘的感觉与MPHD抑郁发生密切相关。

Psychosomatic symptoms and alexithymia of the male patients with heroin dependence

目的 了解男性海洛因依赖(MPHD)者心身症状与述情障碍的关系及心身症状的影响因素.方法采用一般情况问卷(自拟)、症状自评量表(SCL-90)、多伦多述情障碍量表(TAS)对湖南地区218名MPHD者进行测评,以SCL-90、TAS对107名社区健康男性进行测评,有194名MPHD者纳入研究.结果MPHD者TAS、SCL-90总分及各因子分与对照组差异均有显著性:TAS总分[(76.43±7.46)分vs(66.82±8.06)分,P＜0.01];SCL-90总分[(208.86±58.62)分vs(156.85±33.71)分,P＜0.01].TAS与SCL-90大部分因子间均显著相关(P＜0.05或P＜0.01).以SCL-90总分为因变量进行多元回归分析,SAS总分、TAS因子认识和区分情感与躯体感受的能力、用药渴望、既往中毒次数、受教育年限依次进入回归方程.结论MPHD者存在严重的心身症状与述情障碍,二者密切相关,述情障碍可能为海洛因依赖者一种素质性特征,不良的心身状况受多种因素影响。