Substance Dependence Disorders Research Articles

Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders.

This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen's model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6%. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.

Editorial: Advances in Virtual Agents and Affective Computing for the Understanding and Remediation of Social Cognitive Disorders.

Editorial: Advances in Virtual Agents and Affective Computing for the Understanding and Remediation of Social Cognitive Disorders.

Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial

Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial

Biomarkers for Success: Using Neuroimaging to Predict Relapse and Develop Brain Stimulation Treatments for Cocaine-Dependent Individuals.

Cocaine dependence is one of the most difficult substance use disorders to treat. While the powerful effects of cocaine use on behavior were documented in the 19th century, it was not until the late 20th century that we realized cocaine use was affecting brain tissue and function. Following a brief introduction (Section 1), this chapter will summarize our current knowledge regarding alterations in neural circuit function typically observed in chronic cocaine users (Section 2) and highlight an emerging body of literature which suggests that pretreatment limbic circuit activity may be a reliable predictor of clinical outcomes among individuals seeking treatment for cocaine (Section 3). Finally, as the field of addiction research strives to translate this neuroimaging data into something clinically meaningful, we will highlight several new brain stimulation approaches which utilize functional brain imaging data to design noninvasive brain stimulation interventions for individuals seeking treatment for substance dependence disorders (Section 4).

A cross-sectional study of correlates of imprisonment in opioid-dependent men and women in New South Wales, Australia.

Involvement in the criminal justice system is common among opioid-dependent people. This study aimed to determine prevalence and adolescent-onset correlates of adult imprisonment among opioid-dependent men and women in New South Wales, Australia. Participants were recruited from opioid substitution therapy clinics and completed a face-to-face, structured interview. Data were collected on demographic characteristics, family history, substance dependence and psychiatric disorders. Adolescent-onset correlates of adult incarceration (including interactions with gender) were examined using logistic regression. Opioid-dependent men were significantly more likely than opioid-dependent women to report adult imprisonment (66% vs 40%; P < 0.001). In a multivariable logistic regression model, older age, male gender, having completed high school education only, having dependent children or living independently prior to age 18 years, a history of juvenile detention and adolescent-onset opioid dependence were all significantly associated with increased odds of adult imprisonment. Adolescent-onset depression was associated with a halving of odds of adult imprisonment. The only variable for which we observed an interaction with gender was juvenile detention, which had a significantly greater impact on the odds of imprisonment for men than women. More than half of this sample of opioid dependent adults had a history of imprisonment. Variables that are associated with imprisonment in the general population, such as childhood maltreatment, were not important in predicting imprisonment in this sample. Further study is required to understand the interaction between sex and juvenile detention in predicting adult imprisonment. [Larney S, Cama E, Nelson E, Larance B, Degenhardt L. A cross-sectional study of correlates of imprisonment in opioid-dependent men and women in New South Wales, Australia. Drug Alcohol Rev 2016;35:686-692].

Psychotic-Like Experiences and Nonsuicidal Self-Injury in England: Results from a National Survey [corrected

BackgroundLittle is known about the association between psychotic-like experiences (PLEs) and nonsuicidal self-injury (NSSI) in the general adult population. Thus, the aim of this study was to examine the association using nationally-representative data from England.MethodsData from the 2007 Adult Psychiatric Morbidity Survey was analyzed. The sample consisted of 7403 adults aged ≥16 years. Five forms of PLEs (mania/hypomania, thought control, paranoia, strange experience, auditory hallucination) were assessed with the Psychosis Screening Questionnaire. The association between PLEs and NSSI was assessed by multivariable logistic regression. Hierarchical models were constructed to evaluate the influence of alcohol and drug dependence, common mental disorders, and borderline personality disorder symptoms on this association.ResultsThe prevalence of NSSI was 4.7% (female 5.2% and male 4.2%), while the figures among those with and without any PLEs were 19.2% and 3.9% respectively. In a regression model adjusted for sociodemographic factors and stressful life events, most types of PLE were significantly associated with NSSI: paranoia (OR 3.57; 95%CI 1.96–6.52), thought control (OR 2.45; 95%CI 1.05–5.74), strange experience (OR 3.13; 95%CI 1.99–4.93), auditory hallucination (OR 4.03; 95%CI 1.56–10.42), and any PLE (OR 2.78; 95%CI 1.88–4.11). The inclusion of borderline personality disorder symptoms in the models had a strong influence on the association between PLEs and NSSI as evidenced by a large attenuation in the ORs for PLEs, with only paranoia continuing to be significantly associated with NSSI. Substance dependence and common mental disorders had little influence on the association between PLEs and NSSI.ConclusionsBorderline personality disorder symptoms may be an important factor in the link between PLEs and NSSI. Future studies on PLEs and NSSI should take these symptoms into account.

Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial

In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.

Variants Near CCK Receptors are Associated With Electrophysiological Responses to Pre-pulse Startle Stimuli in a Mexican American Cohort.

Neurophysiological measurements of the response to pre-pulse and startle stimuli have been suggested to represent an important endophenotype for both substance dependence and other select psychiatric disorders. We have previously shown, in young adult Mexican Americans (MA), that presentation of a short delay acoustic pre-pulse, prior to the startle stimuli can elicit a late negative component at about 400 msec (N4S), in the event-related potential (ERP), recorded from frontal cortical areas. In the present study, we investigated whether genetic factors associated with this endophenotype could be identified. The study included 420 (age 18-30 years) MA men (n = 170), and women (n = 250). DNA was genotyped using an Affymetrix Axiom Exome1A chip. An association analysis revealed that the CCKAR and CCKBR (cholecystokinin A and B receptor) genes each had a nearby variant that showed suggestive significance with the amplitude of the N4S component to pre-pulse stimuli. The neurotransmitter cholecystokinin (CCK), along with its receptors, CCKAR and CCKBR, have been previously associated with psychiatric disorders, suggesting that variants near these genes may play a role in the pre-pulse/startle response in this cohort.

Consequences of trauma and violence: impact on psychological well-being

This paper addresses consequences of exposure to violence and trauma. Traumata are defined as events with an extraordinary threat or catastrophic extent. Beside Posttraumatic Stress Disorder (PTSD), affected people may develop Complex PTSD, Prolonged Grief Disorder or Adjustment Disorder as direct consequences of exposure with extreme stress. Indirect trauma-related disorders are amongst others Major Depression, Substance Dependency and Personality Disorders. These disorders develop often comorbid to PTSD. The likelihood to develop a PTSD at one point during the life course is 1-4% in Germany. A PTSD is diagnosed if for any length of time the traumatic situation is re-experienced (e.g. in pictures or nightmares), potential triggers are avoided, emotional reactivity is numb and a permanent hyperarousal is experienced. The intensity, the duration and the frequency of traumatic experiences as well as the lack of social support after the trauma are important risk factors for the development of a PTSD. In the last two decades successful treatment approaches for PTSD have been developed. The main focus of all evidence-based treatment approaches is the exposure in sensu of the traumatic experiences. Behavioral therapy approaches have shown to be most effective in the treatment of PTSD. A better understanding of the consequences of exposure to violence and trauma may help us to identify people at risk for developing trauma-related disorders already at an early stage.

Mobility behaviour and driving status of patients with mental disorders – an exploratory study

Background Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored. Method Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire. Results 67% of PPs (89% NPs) reported to have a valid driver's licence and 77% of them (92% NPs) reported to regularly use their cars. Within driver's license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder. Conclusion Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.

Risk of suicide in male prison inmates

AimsMany studies have demonstrated that the risk of suicide in prison is higher than in the general population. This study has two aims. First, to explore the risk of suicide in men sentenced in Andalusian prisons. And second, to study the sociodemographic, criminal and, especially, psychopathological factors associated with this risk. MethodsAn assessment was made of 472 sentenced inmates in two Andalusian prisons, and included a sociodemographic interview, the IPDE personality disorders questionnaire, the SCID-I diagnostic interview (DSMIV), and the Plutchick suicide risk questionnaire. The interviewers were experienced clinical psychologists with training in prison environments. Adjusted ORs were calculated using a logistic regression. ResultsA risk of committing suicide was detected in 33.5% of the sample. The diagnoses (lifetime prevalence) of affective disorder (adjusted OR 3329), substance dependence disorders (adjusted OR 2733), personality disorders (adjusted OR 3115) and anxiety disorder (adjusted OR 1650), as well as a family psychiatric history (adjusted OR 1650), were the predictors that remained as risk factors after the regression analysis. No socio-demographic risk factor was significant in the regression analysis. ConclusionsThe psychopathological variables are essential and the most powerful factors to explain suicide risk in prisons. A correct and systematic diagnosis, and an appropriate treatment by mental health professionals during the imprisonment are essential to prevent the risk of suicide.

Glial Attenuation With Ibudilast in the Treatment of Medication Overuse Headache: A Double-Blind, Randomized, Placebo-Controlled Pilot Trial of Efficacy and Safety.

Medication overuse headache (MOH) is a condition bordering between a chronic pain condition and a substance dependence disorder. Activation of immunocompetent glial cells in the central nervous system has been linked to both pathological pain and drug addiction/reward. Preclinically, ibudilast attenuates glial activation and is able to reduce neuropathic pain and markers of substance dependence. We therefore hypothesized ibudilast would reduce headache burden and opioid analgesic requirements in patients with opioid overuse headache. To determine if treatment with ibudilast provides a greater reduction in headache index than placebo in MOH patients consuming opioids. Participants with MOH who were using opioids were randomized via computer-generated code to ibudilast 40 mg or placebo twice daily for 8 weeks in a double-blind, parallel groups study. Before randomization participants completed a 4-week baseline headache diary. During treatment, headache diary data collection continued and participants attended 4 study visits during which quantitative sensory testing was performed. Blood samples for immune biomarker analyses were collected before and after treatment in a subgroup of participants. Thirty-four participants were randomized, 13 of 15 randomized to ibudilast and 17 of 19 randomized to placebo completed treatment. Ibudilast was generally well-tolerated with mild, transient nausea reported as the most common adverse event (66.7% vs 10.5% in placebo group). Results are shown as mean (SD). At the end of treatment no differences in the primary outcome average daily headache index (placebo 62 [44] vs ibudilast 77 [72] groups, difference -15, CI -65 to 35 h × numerical rating scale), or secondary outcomes headache frequency (placebo 23 [8.1] vs ibudilast 24.5 [6.2], difference -1.5, CI -7.7 to 4.8 days/month) and opioid intake (placebo 20.6 [43] vs ibudilast 19 [24.3], difference 1.6, CI -31.5 to 34.8 mg morphine equivalent) were observed between placebo and ibudilast groups. Using the current dosing regimen, ibudilast does not improve headache or reduce opioid use in patients with MOH without mandated opioid withdrawal. However, it would be of interest to determine in future trials if ibudilast is able to improve ease of withdrawal during a forced opioid down-titration when incorporated into an MOH detoxification program.

Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review.

In the United States, approximately 60 million Americans suffer from sleep disorders and about 22 million Americans report substance dependence or use disorders annually. Sleep disturbances are common consequences of substance use disorders and are likely found in primary care as well as in specialty practices. The aim of this review was to evaluate the effects of the most frequently used substances-nicotine, alcohol, opioids, cocaine, caffeine, and cannabis-have on sleep parameters measured by polysomnography (PSG) and related clinical manifestations. We used electronic databases such as PubMED and PsycINFO to search for relevant articles. We only included studies that assessed sleep disturbances using polysomnography and reviewed the effects of these substances on six clinically relevant sleep parameters: Total sleep time, sleep onset latency, rapid-eye movement, REM latency, wake after sleep onset, and slow wave sleep. Our review indicates that these substances have significant impact on sleep and that their effects differ during intoxication, withdrawal, and chronic use. Many of the substance-induced sleep disturbances overlap with those encountered in sleep disorders, medical, and psychiatric conditions. Sleep difficulties also increase the likelihood of substance use disorder relapse, further emphasizing the need for optimizing treatment interventions in these patients. Our review highlights the importance of systematically screening for substance use in patients with sleep disturbances and highlights the need for further research to understand mechanisms underlying substances-induced sleep disturbances and on effective interventions addressing these conditions.

Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3.0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012

IntroductionIn order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. ObjectiveTo compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. MethodologyCross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. ResultsThe median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis — with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. ConclusionsSCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.

Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders.

BackgroundHomelessness, substance use, and mental disorders each have been associated with higher rates of emergency department (ED) use and hospitalization. We sought to understand the correlation between ED use, hospital admission, and substance dependence among homeless individuals with concurrent mental illness who participated in a ‘Housing First’ (HF) intervention trial.MethodsThe Vancouver At Home study consisted of two randomized controlled trials addressing homeless individuals with mental disorders who have “high” or “moderate” levels of need. Substance dependence was determined at baseline prior to randomization, using the Mini International Neuropsychiatric Interview diagnostic tool, version 6.0. To assess health service use, we reviewed the number of ED visits and the number of hospital admissions based on administrative data for six urban hospitals. Negative binomial regression modeling was used to test the independent association between substance dependence and health service use (ED use and hospitalization), adjusting for HF intervention, age, gender, ethnicity, education, duration of lifetime homelessness, mental disorders, chronic health conditions, and other variables that were selected a priori to be potentially associated with use of ED services and hospital admission.ResultsOf the 497 homeless adults with mental disorders who were recruited, we included 381 participants in our analyses who had at least 1 year of follow-up and had a personal health number that could be linked to administrative health data. Of this group, 59% (n = 223) met criteria for substance dependence. We found no independent association between substance dependence and ED visits or hospital admissions [rate ratio (RR) = 0.85; 95% CI 0.62–1.17 and RR = 1.21; 95% CI 0.83–1.77, respectively]. The most responsible diagnoses (defined as the diagnosis that accounts for the length of stay) for hospital admissions were schizo-affective disorder, schizophrenia-related disorder, or bipolar affective disorder; collectively reported in 48% (n = 263) of admissions. Fifteen percent (n = 84) of hospital admissions listed substance dependence as the most responsible diagnosis.ConclusionsSubstance dependence was not independently associated with ED use or hospital admission among homeless adults with mental disorders participating in an HF trial. Hospital admissions among this cohort were primarily associated with severe mental disorders.Trial registration: ISRCTN57595077 and ISRCTN66721740

Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs.

BackgroundSubstance use disorders are regarded as one of the most prevalent, deadly and costly of health problems. Research has consistently found that the prevalence of other psychiatric disorders among those with substance related disorders is substantial. Combined, these disorders lead to considerable disability and health years lost worldwide as well as extraordinary societal costs. Relatively little of the literature on substance dependence and its impact on healthcare utilization and associated costs has focused specifically on chronic drug users, adolescents or women. In addition, the research that has been conducted relies largely on self-reported data and does not provide long-term estimates of hospital care utilization. The purpose of this study is to describe the long-term (24–32 year) healthcare utilization and it’s associated costs for a nationally representative cohort of chronic substance abusing women (adults and adolescents) remanded to compulsory care between 1997–2000 (index episode). As such, this is the first study investigating healthcare costs for women in compulsory treatment in Sweden.MethodsWomen (n = 227) remanded to compulsory care for substance abuse were assessed at intake and their hospital care utilization was retrieved 5-years post compulsory care from national records. Unit costs for ICD-10 diagnoses were applied to all hospital care used from 1975–2006. Attempts are made to estimate productivity losses associated with hospitalization and premature death.ResultsUpon clinical assessment it was found that a majority of these women had a comorbid psychiatric disorder (primarily personality disorder). The women followed in this study were admitted to hospital five to six times that of the general population and had stays six to eight times that of the general population. Total direct healthcare costs per person over the study period averaged approximately $173,000 and was primarily the result of psychiatric department visits (71 %) and inpatient treatment (98.5 %; detoxification and short-term rehabilitation).ConclusionsWomen placed in compulsory care use more hospital resources than that of the general Swedish population and when compared to international research of hospital care use and substance abuse. Direct hospital costs vary greatly over the life course. Effective services can have significant economic benefit.

Comparison of Personality Factors Among People with Substance Dependence Disorder and Non-addicted People

Abstract Prescription of drug abuse is an important and significant world issue. This study aims to compare sixteen personality factors among patients with substance abuse disorder and normal people. The research method was ex post facto and statistical population consisted of two groups of addicted individuals and normal individuals in Tehran. 100 addicted patients were selected by convenient sampling method among patients who had referred to addiction treatment centers in Tehran. The control group with 100 people was selected from normal people. Research instruments included Cattell’s Sixteen Personality Factor Inventory (16PF) and the collected data was analyzed using ANOVA. Findings revealed that there are significant differences in factor A, factor C, factor E, factor F, factor G, factor H, factor I, factor L, factor M, factor N, factor O, factor Q1, factor Q2, factor Q3, and factor Q4 among addicted and healthy groups. It is concluded that an awareness of the effects of personality factors on substance abuse can help to decrease, or even prevent, addiction disorder. Key words: addiction, personality factors, substance dependence disorder

Attachment history as a moderator of the alliance outcome relationship in adolescents.

The role of the alliance in predicting treatment outcome is robust and long established. However, much less attention has been paid to mechanisms of change, including moderators, particularly for youth. This study examined the moderating role of pretreatment adolescent-caregiver attachment and its impact on the working alliance-treatment outcome relationship. One hundred adolescents and young adults with primary substance dependence disorders were treated at a residential facility, with a cognitive-behavioral emphasis. The working alliance and clinical symptoms were measured at regular intervals throughout treatment. A moderator hypothesis was tested using a path analytic approach. Findings suggested that attachment to the primary caregiver moderated the impact of the working alliance on treatment outcome, such that for youth with the poorest attachment history, working alliance had a stronger relationship with outcome. Conversely, for those with the strongest attachment histories, alliance was not a significant predictor of symptom reduction. This finding may help elucidate alliance-related mechanisms of change, lending support for theories of corrective emotional experience as one function of the working alliance in youth psychotherapy.

Discounting of Delayed Rewards as an Endophenotype

The article by Anokhin et al. (1) in this issue of Biological Psychiatry provides strong evidence of the heritability of the neurobehavioral decision process referred to as the discounting of delayed rewards, or temporal discounting (i.e., the devaluation of a reward as a function of delay to its delivery) (2). Using a standard psychophysical titration procedure to assess discounting, Anokhin et al. tested twins (N 5 560) at both 16 years of age and 18 years of age. Use of more than one time point allows estimates of the stability and strength of genetic influence over time. Overall, Anokhin et al. estimated heritability of temporal discounting to be 57%, with strength of genetic influence increasing across time. This study extends a previous finding by these authors (3) in which evidence of similar heritability was observed using a less quantitative measure of discounting and younger twins (12 years old and 14 years old). The most crucial aspects of these results are revealed when they are considered as part of the extant evidence about temporal discounting, including how discounting relates to various maladaptive and psychopathologic behaviors. Excessive temporal discounting is evident across multiple disorders and has been appropriately identified as a transdisease/diagnostic process (4). Excessive discounting has been demonstrated in most forms of substance dependence disorders, including alcohol, nicotine, opioids, and stimulants. Children with attention-deficit/hyperactivity disorder and adults with schizophrenia, major depressive disorder, problem gambling, and obesity also discount delayed rewards more than control subjects (4). Additionally, high rates of temporal discounting have been associated with a variety of poor health behaviors, including failure to check blood pressure, obtain cholesterol testing, attend dental visits, exercise, receive flu shots, wear a seat belt, engage in safe sexual behavior, or be medically adherent (4–6). The discounting of delayed rewards also has been identified as a candidate behavioral marker for drug dependence (7); that is, evidence supports that discounting tracks disease progression and treatment outcomes, suggesting novel therapeutic approaches and identifying potential mechanisms underlying drug dependence. For example, excessive discounting is predictive of drug use initiation, is correlated with the amount of substance used, is predictive of therapeutic outcomes when the treatment is moderately efficacious, and improves after highly effective treatment. Estimates of discounting for individuals in recovery from drug dependence are near or within a normative range. Mechanistically, discounting is thought by most investigators to involve dual neurobehavioral processes, and those mechanisms have suggested novel interventions (8). Whether discounting can serve as a candidate marker for the diseases and disorders or behaviors listed in the preceding paragraph remains to be determined.

The Effectiveness of Acceptance-Commitment Therapy on Anxiety and Depression among Patients on Methadone Treatment: A Pilot Study

Background:: Substance dependence disorder is a psychiatric disorders with different factors that influence its nature, severity, outcome, and treatment options. Objectives:: This study evaluates the effectiveness of Acceptance-Commitment Therapy (ACT) to decrease anxiety and depression in patients with opioid dependencies who are undergoing methadone maintenance treatment (MMT). Materials and Methods:: The present study was done in Mashhad from 2011-2012. Twenty-eight patients (18-50 yr) with opioid dependency who were on MMT were selected using purposive sampling and were divided equally between case and control groups. The case group received 8 sessions of individual psychotherapy with ACT. The level of depression and anxiety of these patients were measured using the Beck Depression Inventory-II and Beck Anxiety Inventory before the initiation of ACT as a pretest, 2 weeks after the termination of ACT as the posttest, and 3-months after the termination as a follow-up. The collected data was analyzed with SPSS (ver. 20) using χ2, paired t-test, ANOVA, and MANOVA. Results:: The pretest-posttest-follow up of anxiety showed no significant differences between the two groups (P = 0.05); however, the case group had lower depression scores in the posttest and follow-up than the control group (P = 0.04). Evaluating the results of the case group revealed that depression significantly decreased in the posttest group when compared to the pretest (P = 0.01) and there were no significant decreases in the follow up compared to the pretest (P = 0.34). Conclusion:: Short-term ACT for opioid dependent patients on MMT are not associated with a significant decrease in the level of anxiety; however, it is associated with a significant decrease in the level of depression. Nonetheless, this reduction was not maintained long term.