Range Of Substance Use Disorders Research Articles

Potential role for acupuncture in the treatment of food addiction and obesity.

Addressing the global obesity epidemic requires innovative approaches that are also acceptable to affected individuals. There is growing evidence suggesting that food addiction, one contributor to obesity, bears many similarities to drug and alcohol addiction, presenting a potential role for addiction-focused acupuncture as a novel treatment modality. In this perspective article, we begin by briefly reviewing the evidence linking food and drug/alcohol addiction. We then describe the development of an acupuncture-based protocol for treating opioid addiction in Hong Kong in the 1970s and discuss the evidence base for acupuncture's efficacy in treating a range of substance use disorders. Next, we describe acupuncture's proposed mechanism of action in attenuating withdrawal and promoting abstinence. Finally, we note the dearth of studies specifically examining the effectiveness of acupuncture in treating food addiction and suggest that more research should focus in this area as part of the effort to combat rising rates of obesity worldwide.

Commentary on Guydish et al. (2016): The continuing deadly threat of tobacco use in addiction treatment.

Guydish and colleagues document the high prevalence of tobacco use among addiction treatment patients in many countries. Tobacco accounts for widespread premature mortality among individuals with addiction disorders, yet smoking cessation does not receive the attention it deserves in treatment settings. The bidirectional linkages between cigarette use and illicit substance use are well established. Tobacco misuse is a powerful marker for other substance use disorders in many populations, such as pregnant women 1. Tobacco use disorders are also pervasive comorbidities that accompany many other forms of substance use. Among US respondents in the 2013 National Survey of Drug Use and Health (NSDUH), 55% of those who reported illicit substance use in the past month also reported tobacco use during the same period. Smoking prevalence is higher among individuals who satisfy the criteria for alcohol and illicit drug disorders. The current systematic review by Guydish and colleagues underscores the importance of these linkages in a global context 2. These authors find a particularly high prevalence among patients receiving opiate addiction treatment, but find a high prevalence in almost all treatment populations for which data are systematically collected. Smoking cessation poses difficult challenges in addiction treatment, partly because smoking is so deeply embedded within these settings. Partly for that reason, tobacco use comprises a leading threat to life and health among individuals who experience a wide range of substance use disorders. Hurt and colleagues followed a cohort of in-patient addiction treatment patients. One hundred and nine of 214 attributable deaths occurred from tobacco-related causes 3 In similar fashion, Hser and colleagues performed a 24-year follow-up study of a patient cohort admitted to addiction treatment in 1964. The death rate among smokers was four times that found among non-smokers 4. Despite these findings, in many treatment organizations smoking cessation does not appear to be a high priority. High smoking prevalence among staff, passive staff attitudes regarding the intractability of smoking behaviors and limited access to smoking cessation treatments remain key obstacles to quitting within treatment populations 5. Cookson and colleagues’ survey of clients and staff associated with the South London and Maudsley NHS Foundation Trust underscores these difficulties. Eighty-eight per cent of clients and 45% of staff were current smokers. Fifty-six per cent of clients had never received assistance from clinicians with smoking cessation. Only 15% of clients received smoking cessation support during their current treatment stay, even though 79% expressed a desire to quit. Treatment staff rated smoking cessation as markedly less important than addressing clients’ use of other substances alongside their primary addiction 6 This pattern persists, despite evidence that smoking cessation interventions can be effective with this population within treatment settings without compromising other treatment goals 7. Analyzing 2004–05 US data, Friedmann and colleagues reported that only 41% of US out-patient treatment facilities offered smoking cessation counseling or pharmacotherapy 8; 38% offered individual/group counseling, and only 17% provided pharmacotherapy. Analyzing 2012 data, Shi and colleagues found similar results. Only 47% of the organizations surveyed offered behavioral counseling or pharmacotherapy for smoking cessation 9. Public policies can influence these practices. Shi and colleagues find that treatment facilities in US states that adopted strong tobacco control measures were more likely to offer smoking cessation services. Clinical guidelines and accreditation bodies can also play a helpful role 7. Policy findings in many other national settings are more sparse. Regulatory policies requiring addiction treatment providers to pay greater attention to smoking cessation deserve high priority in both services research and tobacco control policy. Guydish and collaborators perform an important service by drawing attention to this issue. The treatment community must improve its efforts to address this deadly and pervasive comorbidity. Millions of patients with addiction disorders seek help from the treatment system; whatever their treatment course and whatever their primary diagnosis, most have serious tobacco issues that are typically unaddressed. As a result, many will die prematurely of tobacco-related causes. We as a field can do much better. None.

Inpatient hospitalization for substance use disorders one year after residential rehabilitation: predictors among US veterans

ABSTRACTBackground: The Veterans Health Administration (VHA) is among the principal providers of the full range of substance use disorders (SUD) treatment in the US. Relatively little, however, is known about patient outcomes after residential rehabilitation. Objective: To identify predictors of SUD inpatient hospitalization (primarily medically managed detoxification) in the year after SUD residential rehabilitation among US veterans. Methods: Medical records of 64 veterans admitted to one of two residential rehabilitation programs in the Northeast during the first quarter of FY 2012 were abstracted. Data included demographic, clinical, and treatment (inpatient and outpatient) information for the year before and after residential rehabilitation. Annual rates of treatment utilization were compared. Results: The veterans (mean age, 48.2 years) used substances for a mean of 27.6 years. Alcohol was the primary drug of choice (69%). More than half had SUD inpatient hospitalizations in the year before (79%) and after (53%) residential rehabilitation; SUD inpatient admission occurred an average of 64 days after discharge. According to the multivariate Cox regression model, the estimated risk of SUD inpatient hospitalization increased by 25% for each past year SUD inpatient hospitalization, decreased by 74% if there was no opiate use disorder diagnosis, and decreased by 2% for each day increase in residential rehabilitation length of stay when extent of service connected disability, marital status, and days since last SUD inpatient admission are taken into account. Conclusions: Risk factors for SUD inpatient hospitalization after residential rehabilitation have been identified and, if confirmed, may represent opportunities for targeted program change.

Development of a collaborative drug therapy management protocol for extended-release intramuscular naltrexone

The Center for Drug and Alcohol Programs (CDAP) at the Medical University of South Carolina (MUSC) focuses on research and clinical services for substance use disorders. CDAP is comprised of both inpatient and outpatient services. Outpatient services include an intensive program with daily group meetings and an individualized treatment program where patients are able to take part in one-on-one counseling. Approximately 1200 outpatients are seen in the CDAP clinics annually, 300 of which are in the intensive outpatient program. The patients seen in CDAP have a range of substance use disorders which include alcohol and opioid dependence, among others. Given the patient population, there is a significant demand for extended-release intramuscular naltrexone (ERIN), but the CDAP clinics are neither staffed nor structured for medication administration or storage. A previously established pharmacist-run clinic exists at MUSC for the purpose of administering long-acting injectable antipsychotics and monitoring the patients who receive them. An explanation of the financial impact of the antipsychotic injection clinic to our institution is described by Phan and Vandenberg. With the increasing patient and physician demand, a protocol was developed to allow pharmacists to administer ERIN in the pharmacist-run clinic.

A proposal to evaluate mechanistic efficacy of hallucinogens in addiction treatment

Current treatments for addiction are frequently ineffective. Hallucinogenic therapy has been indicated as helpful for a range of substance use disorders, yet this approach remains understudied and publicly unavailable. It is nonetheless a promising treatment, which has significant, long-term beneficial effects with single doses and a profile characterized by general safety, low toxicity, and non-addictiveness. However, pharmacological interventions, such as hallucinogens, should not be offered if the same effects (e.g. psychological insights/mystical experiences) and outcomes (e.g. decreased drug use) could be achieved absent pharmacological intervention. To date, there have been no clinical comparisons of drug-induced altered states with non-drug-induced states for addiction treatment. We propose and then outline a clinical trial to address this gap in knowledge. The proposed design would evaluate abstinence outcomes in a population of prescription opioid abusers after exposure to one of three conditions: a drug-induced altered state using psilocybin, a non-drug-induced altered state via hyperventilation (Holotropic Breathwork), and an active placebo with niacin. The outcomes of such a study would reveal important differences in therapeutic potential by discriminating hallucinogen-dependent effects from those psychological effects resulting from altered states.

A study of the psychotropic prescriptions of people attending an addiction service in England

PurposeThe purpose of this paper is to examine the prescribed psychotropic medications taken by newly referred people with a range of substance use disorders (SUD) who attend a specialist community addiction service.Design/methodology/approachAnonymised data on newly referred people (n=1,537) with SUD attending a specialist community addiction service for their first episode of treatment between August 2007 and July 2010 were obtained from the database of the service. Data were cleaned and the percentage of people taking prescribed psychotropic medications at their first episode of treatment was calculated.FindingsMore than half (56.1 percent) of people attending the service were taking prescribed antidepressants and anxiolytics at their first episode of treatment whilst 15.2 percent of people were taking prescribed antipsychotics. Alcohol and opioids were the primary referral substances for 77.4 percent and 15.2 percent of people respectively. People referred for “other” substances (cannabis, stimulants, sedatives, hallucinogens, solvents and polydrug use) made up the remaining 7.5 percent and had the highest percentage of prescribed psychotropics (antipsychotics=47 percent, antidepressants and anxiolytics=64.3 percent) compared to those referred for alcohol and opioids (p<0.0005).Originality/valueTo the best of the authors’ knowledge, this is the first study of psychotropic prescribing among people with a range of SUD in the UK. The high prevalence of psychotropic prescribing raises questions about the appropriateness of these prescriptions and calls for scrutiny of prescribing practice in this group of people.

Effects of lowered serotonin transmission on cocaine-induced striatal dopamine response: PET [11C]raclopride study in humans

Low serotonin transmission is thought to increase susceptibility to a wide range of substance use disorders and impulsive traits. To investigate the effects of lowered serotonin on cocaine-induced (1.0 mg/kg cocaine, self-administered intranasally) dopamine responses and drug craving. In non-dependent cocaine users, serotonin transmission was reduced using the acute tryptophan depletion method. Striatal dopamine responses were measured using positron emission tomography with [(11)C]raclopride. Acute tryptophan depletion increased drug craving and striatal dopamine responses to cocaine. These acute tryptophan depletion-induced increases did not occur in the absence of cocaine. The results suggest that low serotonin transmission can increase dopaminergic and appetitive responses to cocaine. These findings might identify a mechanism by which individuals with low serotonin are at elevated risk for both substance use disorders and comorbid conditions.

FP01-5 Pregnancy Loss and Psychiatric Disorders in Young Men and Women: Results from Australian Longitudinal Cohort Study

Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. Little is known about later adverse psychiatric outcomes in young men whose partners have fallen pregnant and either go on to have a child, have an abortion or miscarry. 1223 women and 1159 men, from an Austrailan cohort born between 1981 and 1984, were assessed at 21 years for psychiatric and substance misuse and lifetime pregnancy histories. Young women reporting a pregnancy loss (either miscarriage or abortion) had nearly three times the odds of experiencing a illicit drug disorder (excluding cannabis), and nearly twice the odds of an alcohol misuse compared to never pregnant women. Young men whose partner had an abortion, but not a miscarriage, had nearly twice the odds of cannabis disorder, illicit drug disorder, and mood disorder compared to men that had never fathered a pregnancy. Young women who have lost a pregnancy have an increased risk of developing alcohol or substance abuse in later life. Young men whose partner aborted a pregnancy only had an increased of substance abuse and mood disorder in later life. These findings add to the growing body of evidence suggesting that pregnancy loss per se increases the risk of a range of substance use disorders in young women. The findings for young men are novel and raise the possibility that the associations measured may be due to common unmeasured factors associated with early pregnancy in young people rather than pregnancy loss.

Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study

Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. To examine whether abortion or miscarriage are associated with subsequent psychiatric and substance use disorders. A sample (n=1223) of women from a cohort born between 1981 and 1984 in Australia were assessed at 21 years for psychiatric and substance use disorders and lifetime pregnancy histories. Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0-6.7) and miscarriage OR=2.6 (95% CI 1.2-5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3-3.5) and 12-month depression (OR=1.9, 95% CI 1.1-3.1). These findings add to the growing body of evidence suggesting that pregnancy loss per se, whether abortion or miscarriage, increases the risk of a range of substance use disorders and affective disorders in young women.