Relapse Prevention Interventions Research Articles

No evidence that CBT is less effective than antidepressants in moderate to severe depression

ABSTRACT FROM: Weitz ES, Hollon SD, Twisk J, et al . Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy: an individual patient data meta-analysis....

State anxiety modulates the return of fear

Current treatments for anxiety disorders are effective but limited by the high frequency of clinical relapse. Processes underlying relapse are thought to be experimentally modeled in fear conditioning experiments with return fear (ROF) inductions. Thereby reinstatement-induced ROF might be considered a model to study mechanisms underlying adversity-induced relapse. Previous studies have reported differential ROF (i.e. specific for the danger stimulus) but also generalized ROF (i.e. for safe and danger stimuli), but reasons for these divergent findings are not clear yet. Hence, the response pattern (i.e. differential or generalized) following reinstatement may be of importance for the prediction of risk or resilience for ROF. The aim of this study was to investigate state anxiety as a potential individual difference factor contributing to differentiability or generalization of return of fear.Thirty-six participants underwent instructed fear expression, extinction and ROF induction through reinstatement while physiological (skin conductance response, fear potentiated startle) and subjective measures of fear and US expectancy were acquired. Our data show that, as expected, high state anxious individuals show deficits in SCR discrimination between dangerous and safe cues after reinstatement induced ROF (i.e. generalization) as compared to low state anxious individuals.The ability to maintain discrimination under aversive circumstances is negatively associated with pathological anxiety and predictive of resilient responding while excessive generalization is a hallmark of anxiety disorders. Therefore, we suggest that experimentally induced ROF might prove useful in predicting relapse risk in clinical settings and might have implications for possible interventions for relapse prevention.

Development of a Targeted Smoking Relapse-Prevention Intervention for Cancer Patients.

We describe the series of iterative steps used to develop a smoking relapse-prevention intervention customized to the needs of cancer patients. Informed by relevant literature and a series of preliminary studies, an educational tool (DVD) was developed to target the unique smoking relapse risk factors among cancer patients. Learner verification interviews were conducted with 10 cancer patients who recently quit smoking to elicit feedback and inform the development of the DVD. The DVD was then refined using iterative processes and feedback from the learner verification interviews. Major changes focused on visual appeal, and the inclusion of additional testimonials and graphics to increase comprehension of key points and further emphasize the message that the patient is in control of their ability to maintain their smoking abstinence. Together, these steps resulted in the creation of a DVD titled Surviving Smokefree®, which represents the first smoking relapse-prevention intervention for cancer patients. If found effective, the Surviving Smokefree® DVD is an easily disseminable and low-cost portable intervention which can assist cancer patients in maintaining smoking abstinence.

Smoking relapse-prevention intervention for cancer patients: Study design and baseline data from the surviving SmokeFree randomized controlled trial

Continued smoking after a cancer diagnosis contributes to several negative health outcomes. Although many cancer patients attempt to quit smoking, high smoking relapse rates have been observed. This highlights the need for a targeted, evidence-based smoking-relapse prevention intervention. The design, method, and baseline characteristics of a randomized controlled trial assessing the efficacy of a self-help smoking-relapse prevention intervention are presented. Cancer patients who had recently quit smoking were randomized to one of two conditions. The Usual Care (UC) group received the institution's standard of care. The smoking relapse-prevention intervention (SRP) group received standard of care, plus 8 relapse-prevention booklets mailed over a 3month period, and a targeted educational DVD developed specifically for cancer patients. Four hundred and fourteen participants were enrolled and completed a baseline survey. Primary outcomes will be self-reported smoking status at 6 and 12-months after baseline. Biochemical verification of smoking status was completed for a subsample. If found to be efficacious, this low-cost intervention could be easily disseminated with significant potential for reducing the risk of negative cancer outcomes associated with continued smoking.

Psychometric properties of the Persian version of the Time to Relapse Questionnaire (TRQ) in substance use disorder

ABSTRACTBackground: Predicting time to relapse provides an opportunity for the development of relapse prevention interventions in drug users. Objectives: The aim of the present study was to describe the development of the Persian version of the 9-item Time to Relapse Questionnaire (TRQ) and to evaluate its psychometric properties in an Iranian sample of treatment-seeking individuals with substance dependence (n = 150). Methods: The forward–backward method was used to translate the TRQ scale from English into Persian. After linguistic validation and a pilot check, a cross-sectional study was performed, and psychometric properties of the Iranian version of the questionnaire were assessed. The reliability was evaluated by Cronbach’s alpha and test–retest analyses. In addition, the factor structure of the scale was extracted by applying confirmatory factor analysis. Results: The mean age of participants was 40.52 (SD = 11.30) years. The mean scores for the content validity index (CVI) and the content validity ratio (CVR) were 0.93 and 0.81, respectively. A confirmatory factor analysis (CFA) demonstrated that the three-factor model of the TRQ was a good fit for the data and thus replicated the factor structure of the original English language TRQ. Cronbach’s alpha presented good internal consistency (alpha = 0.76), and test–retest reliability of the TRQ instrument with 2-week intervals was appropriate (ICC = 0.84). Conclusion: The findings demonstrate that the Persian version of the TRQ is a reliable and valid scale for measuring time to relapse in Iranian drug users. The TRQ can be applied at the start of treatment so that clinical interventions can be targeted toward the different relapse styles.

Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials.

Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development. To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression. English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014. Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care. This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis. Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments. Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.

Psycho-social factors associated with relapse to drug addiction in Bangladesh

Background: Relapse to drug use after successful treatment and rehabilitation is a common problem globally. This study aimed to identify the psychological and social factors associated with relapse of drug addiction in Bangladesh.Methods: We conducted a cross-sectional study among 60 individuals (30 relapsed and 30 non-relapsed cases) with a history of drug addiction in four drug treatment and detoxification center in Bangladesh from May to December 2010. Data were collected from all the participants using a pre-tested, semi-structured questionnaire. A 4-point Likert format was used for scoring the questionnaire. Logistic regression models were performed to identify factors associated with relapse to drug addiction.Results: All participants were male, aged between 18 and 41 years with mean (SD) age of 27.63 (4.23) years. The “negative emotion” factor had strong contribution on relapse, while “peer pressure,” “self-efficacy,” and “lack of assertiveness” contributed to relapse moderately. The “parental discord” and “relation with parents” factors showed no relationship with relapse. The thought/belief, feeling/emotion, and behavior/action patterns related to relapse were identified, and the covert or very internal affairs of relapse components were revealed.Conclusion: Psychological factors were associated with an increased likelihood of relapse than social factors. These findings may help clinicians identify substance abuse patients likely to relapse and develop treatment and policy guidelines for prevention of relapse to drug addiction in Bangladesh.

Effectiveness of Pelvic Floor Muscle Training for Urinary Incontinence: Comparison Within and Between Nonhomebound and Homebound Older Adults.

To compare the effectiveness of a biofeedback-taught pelvic floor muscle training (PFMT) intervention in reducing urinary incontinence (UI) and improving general health-related and UI-specific quality of life in homebound and nonhomebound older adults. We also compared adherence rates to the prescribed PFM exercises and strategies (urge and/or stress) in the 2 groups of subjects. Secondary data analysis of initial 6-week PFMT intervention data from a randomized controlled trial designed to examine the efficacy of a relapse prevention intervention in sustaining improvements in UI following PFMT. The sample comprised 93 homebound and 185 nonhomebound community-dwelling men and women 60 years and older with urge, stress, or mixed UI at least twice a week for a minimum of 3 months. The intervention consisted of 6 weekly in-home visits during which biofeedback via transcutaneous electromyographic patches was used to teach subjects pelvic floor muscle exercises and, as indicated, stress and/or urge suppression strategies to prevent involuntary urine loss. Incontinence severity was measured by a 1-week bladder diary at baseline and at the end of the 6-week intervention. Health-related quality of life was measured at baseline and postintervention using the Medical Outcomes Study Short Form-36 (MOS SF-36) (general health-related quality of life), and the Modified Incontinence Impact Questionnaire (MIIQ). Self-reported adherence data were collected at each intervention visit. At baseline, homebound subjects had significantly more severe UI, more comorbid conditions, and higher levels of functional impairment than nonhomebound subjects. Following the intervention, there was a significant reduction in the number of incontinent episodes in both homebound and nonhomebound subjects, with no significant group differences (P = .25) in the median percent reduction in UI (64.5% in homebound vs 70.4% in nonhomebound subjects). UI-specific quality of life (MIIQ total scores) improved significantly in both groups without any significant between-group differences (P = .83). There were no significant changes in health-related quality of life in either group. Pelvic floor muscle adherence rates were higher than adherence rates to strategies in both groups, with no significant group differences. The biofeedback-guided PFMT intervention was equally effective in reducing UI and improving UI-specific quality of life in homebound and nonhomebound community-dwelling older adults.

Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial.

Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence. To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse. Pregnant women who recently had quit smoking were recruited before the end of pregnancy. Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum. Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks postpartum. Participants were recruited between March 2008 and December 2012. The dates of the analysis were April 2014 to February 2015. Women received postpartum-adapted, behavioral smoking relapse prevention intervention and were randomly assigned to an enhanced cognitive behavioral intervention that included additional specialized strategies and content focused on women's postpartum concerns about mood, stress, and weight (Strategies to Avoid Returning to Smoking [STARTS]) or a supportive, time and attention-controlled comparison (SUPPORT). Intervention began before delivery and continued through 24 weeks postpartum. The primary outcome was biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum. Secondary outcomes were self-reported mood, levels of perceived stress, and degree of concern about smoking-related weight gain. The study cohort comprised 300 participants (150 randomly assigned to each group). Their mean (SD) age was 24.99 (5.65) years. Overall, 38.0% (114 of 300), 33.7% (101 of 300), and 24.0% (72 of 300) of the sample maintained abstinence at 12, 24, and 52 weeks' postpartum, respectively. There were no differences between the intervention groups in abstinence or time to relapse. Self-reported depressive symptoms and perceived stress significantly improved over time, and improvements were similar for both intervention groups. Women with more depressive symptoms and higher levels of perceived stress were more likely to relapse (hazard ratio, 1.02; 95% CI, 1.00-1.04; P = .04 for depressive symptoms and hazard ratio, 1.04; 95% CI, 1.01-1.07; P = .003 for stress). An intervention designed to address women's concerns about mood, stress, and weight did not differentially improve rates of sustained tobacco abstinence postpartum compared with a time and attention-controlled comparison. Women in STARTS and SUPPORT reported postpartum improvements in mood and stress, and the experience of fewer depressive symptoms and less perceived stress was related to sustained abstinence. Given that most pregnant quitters will relapse within 1 year postpartum and that postpartum smoking has negative health consequences for women and children, effective interventions that target postpartum mood and stress are needed. clinicaltrials.gov Identifier: NCT00757068.

Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology.

The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.

Early schizophrenia patients treated with once-monthly paliperidone palmitate over a 12-month period - a retrospective observational study

IntroductionLittle is known about patient characteristics and rehospitalization in newly diagnosed patients with schizophrenia treated with long-acting antipsychotics.ObjectivesTo retrospectively explore hospitalizations, drug utilization and clinical outcomes from medical records of young, newly diagnosed schizophrenia patients during the first 12 months of treatment with once-monthly paliperidone palmitate (PP).MethodsInternational, multicenter, retrospective, observational study. Outcomes presented are patient characteristics, reason for PP initiation and hospitalization data.ResultsEighty-four patients were analyzed: mean age (years) at first psychotic episode was 23.8 (SD2.6), 23.9 (SD2.6) at first antipsychotic treatment and 24.1 (SD2.7, range 19-29) at PP initiation. Time between first antipsychotic treatment and PP initiation was 4.8 (SD: 3.4, range: 0-12) months. At PP initiation, 42.9% of patients were in hospital, primarily for the management of the first episode/relapse (97.2%). Reason for PP initiation was: LAT favored over oral treatment for relapse prevention (56%), partial/non adherence with previous oral medication (20.0%), convenience (15.5%) or limited access to health care systems (2.4%). Mean time (days) between admission and initiation of PP, and between initiation of PP and discharge from hospital was 28.8 (SD23.0) and 23.2 (SD24.5), respectively. 96.4% of patients were not hospitalized during the 12-month PP treatment period. 3/84 patients (3.6%) had a single hospitalization of 15.7 (SD: 8.1) days for management of episode/relapse.ConclusionsIn this young, newly diagnosed schizophrenia population, the number of hospitalizations following PP initiation was low. Main reason to initiate PP was clinicians favoring LAT over oral antipsychotic treatment for relapse prevention or due to partial/non adherence with previous oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Role of inhibitory processes in relapse prevention treatment

Alcohol dependence is a chronic disorder with frequent relapses during recovery. Most studies have pointed out that craving is the main process involved in relapse, but recently other factors have been implicated in it, such as attentional bias and impulsivity. Some authors consider that different stages could be involved in the relapse process, and each may be governed by different mechanisms: Attentional bias; motivational response to alcohol cues and inhibitory control.Motivationally salient cues attract and hold selective attention, and this “attentional bias, (AB)” is related to individual differences in appetitive and aversive motivation. In a recent review, attentional bias has been shown to be significantly present in alcohol-dependent and is associated with craving and risk to a relapse in alcohol consumption.In alcohol-dependent subjects, alcohol-related cues reach a very high motivational valence (Motivational response, MR), which, in effect, increases craving for alcohol and activates behavioral strategies towards alcohol intake. One method used to assess motivational valence of alcohol is the craving self-assessment. In addition, in recent years, the affective modulation of the startle reflex has been used as an objective measure of craving. It has been shown that subjects with a low baseline startle response when viewing alcohol-associated pictures are at major risk of relapse compared to those with increased reactions.Once alcohol craving has appeared, the subject will either drink or not, depending on his ability to resist his behavior towards alcohol consumption (impulsivity or inhibitory control, IC). Moreover, subjects that exhibit greater impulsivity are those more likely to relapse.Our group has recently conducted a study on a sample of 172 alcohol-dependent patients seen in outpatient therapeutic program during 12 weeks. All of them were assessed with the following measures: Attentional bias was assessed using the dot task, motivational response was evaluated using the affective modulation of the startle reflex paradigm, inhibitory control was assessed by the stop-signal reaction time task. Alcohol relapse variables were: relapse, days to the first relapse and days of accumulated abstinence.One of the most relevant results was that processes related to inhibitory control (Stop-signal reaction time and attentional bias) were the most relevant measures to explain variables related to relapse in alcohol consumption during the treatment period.Our results support the use of assessment strategies, therapeutic and pharmacological inhibtoria aimed at improving the ability of serious alcohol-dependent patients.Disclosure of interestThe author has not supplied his declaration of competing interest.

Comparative cost-effectiveness of 11 oral antipsychotics for relapse prevention in schizophrenia within Singapore using effectiveness estimates from a network meta-analysis.

This study modelled the cost-effectiveness of 11 oral antipsychotics for relapse prevention among patients with remitted schizophrenia in Singapore. A network meta-analysis determined the relative efficacy and tolerability of 11 oral antipsychotics (amisulpride, aripiprazole, chlorpromazine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, sulpiride, trifluoperazine and ziprasidone). The clinical estimates were applied in a Markov model to estimate lifetime costs and quality-adjusted life-years gained. Quality-of-life data were obtained from published literature. Resource utilization and cost data were retrieved from local hospital databases. The annual direct cost of healthcare services for a patient experiencing a relapse episode was three-fold that of a patient not in relapse of schizophrenia. The most favourable pharmacological treatment for relapse prevention was olanzapine with an annual probability of relapse of 0.24 (0.13-0.38) with placebo as a reference of 0.75 (0.73-0.78). Olanzapine emerged as the dominant treatment with the highest quality-adjusted life-years gained and lowest lifetime costs. Ziprasidone, aripiprazole and paliperidone incurred higher lifetime costs compared with no treatment. Probability and cost of relapse were key drivers of cost-effectiveness in sensitivity analyses. The data can help prescribers in choosing appropriate treatment and payers in allocating resources for the clinical management of this serious psychiatric disorder.

Changes in Stress Reactivity among Stimulant Dependent Adults After Treatment with Mindfulness Based Relapse Prevention: Results from a Pilot Randomized Clinical Trial

Background: In light of recent evidence suggesting the presence of stress processing deficits in stimulant users, coupled with laboratory studies demonstrating an association between stress reactivity and relapse to stimulant use, interventions that target stress-induced craving and stress reactivity may reduce relapse risk in this population. Objective: This study examines changes in stress reactivity among adults with stimulant use disorders (N=22) in response to an 8 week Mindfulness Based Relapse Prevention (MBRP) intervention. Methods: Study participants were enrolled in a in a pilot randomized clinical trial, evaluating the efficacy of MBRP, relative to a health education control condition (HE). At baseline and treatment-end, biological and subjective responses to a laboratory psychosocial stress task (i.e., the Trier Social Stress Task) were measured. Results: MBRP participants evidenced significantly lower levels of salivary cortisol in response to the posttreatment laboratory stress provocation, relative to those in the HE condition. Likewise, HE participants evidenced disproportionately greater increases in subjective stress, anxiety and stimulant cravings in response to the posttreatment stress provocation, relative to those who received MBRP. Conclusion: Results of this pilot investigation suggest that MBRP effectively attenuates stress reactivity among adults with stimulant use disorders. This approach may have utility as an adjunct to comprehensive programs treating stimulant addiction. Future research evaluating the impact of changes in stress reactivity on post-treatment relapse to stimulant use and the long-term effects of MBRP on stress reactivity is warranted.

Paradoxes of evidence in Russian addiction medicine

For many years, clinical protocols for treatment of drug abuse patients and treatment standards in Russian Federation were not grounded on the principles of evidence-based medicine [1]. Recommendations for use of certain drugs were not accompanied by any indication of the level of credibility of the evidence supporting it. The appearance in 2014 of such indications in clinical recommendations can be considered a significant step forward for the science of addiction medicine [2]. To compare Russian evidence and practice in addiction medicines with international standards. Situation and literature analysis. The analysis shows that in the wording of recommendations on the use of medicines, some were subject of serious methodological errors. For some drugs globally there is high quality evidence supporting effects of certain drugs globally, but this is not recognized in Russia. As a result, Russian standards of clinical care for the treatment of dependency syndrome are radically different to the standards of therapy, presented in the WHO recommendations. This is due both to the disregard of the meta-analyses presented in the Cochrane reviews and also to the specific bioethical preferences in drug treatment in Russia.It is known that there is no convincing data on the effectiveness and safety of antipsychotics in the treatment of alcohol dependence syndrome [3]. 13 randomized trials with a double blind placebo-controlled design involving 1593 patients assessing effects of amisulpride, aripiprazole, flupentixolum dekonoat, olanzapine, quetiapine, tiapride showed that antipsychotics do not result in abstinence, do not reduce abuse and do not stop craving in alcoholic patients: "Antipsychotics should not be used in patients with a primary diagnosis of dependence. Appointment of antipsychotics for the treatment of substance abuse disorders are contraindicated, since not only does it not improve the condition of patients, but it can even worsen the course of the disease, leading to a reduction in the duration and quality of the remission, and is fraught with serious side effects that threaten the health of patients."SSRI antidepressants indirectly improve the results of treatment of comorbid alcoholism in depressed patients, without affecting alcohol dependence per se. Also, there is currently no convincing evidence of the efficacy of anticonvulsants in the treatment of dependence syndrome, particularly alcohol.Despite the fact that traditional psychotherapeutic interventions remain widespread in practice, and treatment of alcohol dependence syndrome showed high efficiency, there is no convincing evidence for long-term benefits as opposed to short-term benefits.The Cochrane Review with data based on 146 scientific studies involving 21,404 patients confirmed the effectiveness of opioid receptor agonists in treatment of opioid dependence. This therapy showed a statistically significant reduction in the use of illegal drugs, HIV transmission and risky sexual behavior, and was significantly more effective compared to the conventional maintenance therapy with opioid receptor antagonists. In countries, where law prohibits prescribing and use of opioid agonists for opioid dependence treatment, the drugs of choice are antagonists.A meta-analysis of thirteen randomized placebo-controlled trials of oral form of naltrexone (1158 subjects), did not show any advantages of this type of treatment both for management and prevention of relapse compared with placebo [4]. Special studies also showed no inclination to reduce the use of opiates in patients receiving naltrexone [5]. However, studies carried out in Russia, showed the best results for daily intake of naltrexone after detoxification, which increased the duration of remission [6]. It was noted that the effect is associated with higher levels of adherence and family support in the examined population.An overview based on controlled clinical studies on the use of antipsychotic drugs (neuroleptics) in patients dependent on opioids revealed no evidence of effectiveness of this approach. It was concluded that the use of antipsychotics is justified only in the presence of co-morbid psychiatric problems in patients [7]. In a recent meta-analytic review on the use of atypical antipsychotics for off-label indications (off-label), there was a lack of data to support the effectiveness of their use in substance abuse [8, 9]. The effectiveness of anticonvulsants in the treatment of opioid dependence syndrome has not been proven.In connection with the above puzzling fact, for Russian standards of treatment (clinical guidelines) the level of credibility of the effectiveness of antipsychotics and antidepressants in treatment of substance abuse is assessed as A or B. This paradox raises the question of the methodology for determining the level of credibility of evidence. It should be noted that Russian recommendations for inclusion of certain drugs and therapies are based on sufficient consensus of experts rather than on the results of meta-analyses [2]. This fact casts doubt on credibility and validity of scientific recommendations. Thus, one may say that Russian addiction medicine is not based on evidence, which is, in our view, erroneous and may impair the quality of care.

Orexin in Patients with Alcohol Dependence Treated for Relapse Prevention: A Pilot Study.

The aim of the study was to assess the blood concentration of orexin and its association with other clinical factors in patients with alcohol dependence. Thirty-two males hospitalized on an addiction treatment ward due to alcohol dependence and 23 healthy men as a control group were enrolled in the study. The measurement of orexin in the blood was made at the beginning of the treatment (after withdrawal symptoms had stopped) and again after 4 weeks of observation. At the beginning of the observation, the alcohol-dependent patients had significantly greater orexin blood concentration than the control group. After 4 weeks of treatment for relapse prevention, the blood orexin level decreased significantly to a value similar to that in the control group. At the beginning of the study, more severely alcohol-dependent patients (Short Alcohol Dependence Data [SADD] score range: 20-45) had significantly greater orexin blood concentration than individuals with moderate addiction severity (SADD score range: 10-19). However, after 4 weeks of abstinence, the peptide blood concentration was similar in both groups of alcoholic patients. Orexin or its receptor is a potential target for relapse prevention treatment, but further study with long-term observation is needed to verify the usefulness of blood orexin determination as a marker of alcohol relapse risk.

Perinatal attentional retraining intervention for smoking – A pilot study

Aims: Almost half of women who smoke prior to pregnancy achieveabstinenceduringpregnancy, butnearly50%relapsewithin 2 weeks of delivery. Despite considerable study, there are few strategies that effectively combat smoking relapse in this population. Thus, we tested a novel technique: the use of smart-phones to administer attentional retraining (AR) as an ecological momentary assessment intervention for relapse prevention in postpartum women. We hypothesized that relative to control, women randomized to AR would show less attentional bias (AB) toward smoking-related stimuli, and a decrease in craving. Methods:Women (N=11)were recruitedduringpregnancyand carried a smart-phone as they went about their daily lives for 1–2 weeks in the lastmonthofpregnancyand immediatelypostpartum. Participants were randomized to receive AR (N=6) or attentional control (N=5). The smartphone randomly alerted participants (4 times/day) to respond to questions assessing subjective states, followed by AR (or control) procedures utilizing a visual probe task. Outcomemeasures included attentional bias for smoking and craving. Results: Participants carried a smartphone for a mean of 20.2 days, completed 444 assessments (60.14% pregnancy; 39.86% postpartum) and 2.92 assessments per day. Craving increased from pregnancy (M=1.40, SD=1.23) to postpartum (M=2.28, SD=2.27); postpartum participants reported having smoked since the last assessment on 12.64% of assessments, and 8 women reported smoking at least 1 cigarette during the study. AB was more negative in theAR group (n=35 assessments,M=−52.6ms, SD=122) vs. controls (n=44 assessments, M=18.5ms, SD=146) (p<0.05, using a linear mixed model). Conclusions: Findings suggest that AR reduced AB to smoking cues and that women in the AR group attended away from smoking cues. This study demonstrates that AR can be administered on a mobile device, women experience craving postpartum, which is associated with AB, and AR can reduce AB to smoking cues in perinatal women. Financial support: This study was funded by NIDA, K12-DA000167.

Serotonin (5-HT) 5-HT2C receptor (5-HT2CR) agonist lorcaserin suppresses cocaine or oxycodone cue reactivity

Aims: Almost half of women who smoke prior to pregnancy achieveabstinenceduringpregnancy, butnearly50%relapsewithin 2 weeks of delivery. Despite considerable study, there are few strategies that effectively combat smoking relapse in this population. Thus, we tested a novel technique: the use of smart-phones to administer attentional retraining (AR) as an ecological momentary assessment intervention for relapse prevention in postpartum women. We hypothesized that relative to control, women randomized to AR would show less attentional bias (AB) toward smoking-related stimuli, and a decrease in craving. Methods:Women (N=11)were recruitedduringpregnancyand carried a smart-phone as they went about their daily lives for 1–2 weeks in the lastmonthofpregnancyand immediatelypostpartum. Participants were randomized to receive AR (N=6) or attentional control (N=5). The smartphone randomly alerted participants (4 times/day) to respond to questions assessing subjective states, followed by AR (or control) procedures utilizing a visual probe task. Outcomemeasures included attentional bias for smoking and craving. Results: Participants carried a smartphone for a mean of 20.2 days, completed 444 assessments (60.14% pregnancy; 39.86% postpartum) and 2.92 assessments per day. Craving increased from pregnancy (M=1.40, SD=1.23) to postpartum (M=2.28, SD=2.27); postpartum participants reported having smoked since the last assessment on 12.64% of assessments, and 8 women reported smoking at least 1 cigarette during the study. AB was more negative in theAR group (n=35 assessments,M=−52.6ms, SD=122) vs. controls (n=44 assessments, M=18.5ms, SD=146) (p<0.05, using a linear mixed model). Conclusions: Findings suggest that AR reduced AB to smoking cues and that women in the AR group attended away from smoking cues. This study demonstrates that AR can be administered on a mobile device, women experience craving postpartum, which is associated with AB, and AR can reduce AB to smoking cues in perinatal women. Financial support: This study was funded by NIDA, K12-DA000167.

Brain default mode network functional connectivity in polysubstance using emerging adults during opioid dependence treatment

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e181 Dynamic causal modeling in humans offers a novel approach to delineate prefrontal-striatal serotonergic drivers of impulsivity in rats Amanda E. Price1, Harshini Neelakantan1, Liangsuo Ma2, Joel L. Steinberg3, Scott D. Lane4, James M. Bjork3, P.A. Narayana5, Thomas Kosten6, Antoine Bechara7, Noelle C. Anastasio1,8, F. Gerard Moeller3,9, Kathryn A. Cunningham1,8 1 Ctr Addiction Res, University of Texas Medical Branch, Galveston, TX, United States 2 Dep Radiology, Virginia Commonwealth University, Richmond, VA, United States 3 Dep Psych, Virginia Commonwealth University, Richmond, VA, United States 4 Dep Psych & Behav Sci, University of Texas Health Science Center, Houston, TX, United States 5 Dep Diag & Intervent Img, University of Texas Health Science Center, Houston, TX, United States 6 Dep Psych, Baylor College of Medicine, Houston, TX, United States 7 Dep Psych, University of Southern California, Los Angeles, CA, United States 8 Dep Pharm, University of Texas Medical Branch, Galveston, TX, United States 9 Dep Pharm, Virginia Commonwealth University, Richmond, VA, United States Aims: The prefrontal-striatal network is a major driver of impulsivity and altered neurotransmission in this circuit may underlie heightened impulsivity in cocaine use disorder (CUD). Serotonin transmission through 5-HT2A receptors (5-HT2AR) and 5HT2CR governs prefrontal-striatal networks. This study employed fMRI based DCM to investigate prefrontal-striatal effective connectivity underlying impulsivity in CUD. We also aim to translate our human findings to rodentmodels to analyze themodulatory role of the 5-HT systemwithin the prefrontal-striatal network that drives impulsivity. Methods: Ten control and 13 CUD subjects underwent fMRI while performing Go/NoGo tasks with Easy and Hard NoGo difficulty. Connectivity was determined via DCM analyses. Results: There were no differences in overall performance (p=0.9) or modulation effects on Easy NoGo (p=0.4) between groups. Hard NoGo influenced right dorsoand ventrolateral prefrontal connectivity to left caudate in controls but left anterior cingulate connectivity to left caudate in CUD subjects (p<0.05). Conclusions: CUD subjects utilize different connectivity during impulsive responding to perform similarly to controls. Altered topdown control may be mediated by impaired 5-HT transmission at 5-HT2AR and 5-HT2CR. Ongoing studies are testing if 5-HT2AR:5HT2CR imbalance in the prefrontal-striatal circuit shifts effective connectivity governing impulsivity in CUD. Financial support: DA020087, DA033935, DA034131, DA033374. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.674 Brain default mode network functional connectivity in polysubstance using emerging adults during opioid dependence treatment Jenessa S. Price2, Marc L. Copersino2, Gordana Vitaliano3, Scott E. Lukas3, Roger Weiss1, Amy Janes2 1 Harvard Medical School, Belmont, MA, United States 2 McLean Hospital/Harvard Medical School, Belmont, MA, United States 3 Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, United States Aims: The default mode network (DMN) is an interconnected set of brain regions typically active at rest and during low cognitive demand conditions. Heroin-dependent adults show DMN connectivity abnormalities correlated with lifetime heroin use. Functional organization abnormalities are especially pertinent to younger substance-using persons who have ongoing neurodevelopment, higher risk of relapse and lower treatment completion rates. This study examined brain connectivity indices and associations with acute drug use in ten emerging adult patients (ages 18–27) in partial relapse prevention treatment for opioid dependence. Methods: Patients who met DSM-IV criteria for current opioid dependence and used opiates in the past month received restingstate functional magnetic resonance imaging (fMRI) scans within 24hours of admission. Potential participants were not excluded for other drug use or dependence; in most cases this included marihuana, sedatives and/or nicotine. Seven participants also met dependence criteria for at least one other substance. Imaging data wereanalyzedusingan independent componentsanalysis followed by dual regression to identify subject-specific spatial maps of the DMN. A non-parametric permutation testing method was used to correlate DMN with total days of any substance use in the past 30 days. Results: Increased drug use over the past 30 days was correlated with less connectivity between the DMN and insula, dorsal striatum and post central gyrus (cluster corrected Z=2.3, p<0.05, 5000 permutations). Conclusions: These findings provide evidence that polysubstance use is associated with functional adaptations in the DMN of emerging adults seeking treatment for opiate dependence. Further research is needed to delineate if these connectivity changes are related to recent detoxification. Financial support: T32 DA015036, K23 DA027045, K01 DA029645. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.675 Current drug scheduling reviews of synthetic cathinones by the U.S. drug enforcement administration Cassandra Prioleau, Srihari R. Tella, Michelle Walker, Sandy Ghozland, Li Fang, Jordan Trecki, Ambuja S. Bale, Artisha R. Polk, Daniel Willenbring, Liqun L. Wong, Terrence L. Boos Office of Diversion Control, Drug Enforcement Administration, Springfield, VA, United States Aims: In accordance with the Controlled Substances Act (CSA), DEA collects and reviews scientific, medical and other data for substances with abuse potential to evaluate them for possible control under the CSA. Numerous synthetic cathinones have become

Motivation to quit as a predictor of smoking cessation and abstinence maintenance among treated Spanish smokers

Although quitting motivation predicts smoking cessation, there have been inconsistent findings regarding motivation predicting long-term maintenance of abstinence. Moreover, most such research has been conducted in North America and the United Kingdom. The aim of this study was to examine motivation to quit as a predictor of smoking cessation and of abstinence maintenance in a Spanish sample. The sample comprised 286 Spanish smokers undergoing psychological treatment for smoking cessation. Motivation to quit was assessed pre-treatment and post-treatment with the Readiness to Quit Ladder. Abstinence post-treatment and at 6month follow-up was biochemically verified. Participants with higher levels of pre-treatment and post-treatment motivation were more likely to be abstinent at the end of the treatment (OR=1.36) and at 6month follow-up (OR=4.88). Among abstainers at the end of the treatment (61.9%), higher levels of motivation to quit post-treatment predicted maintaining abstinence at 6months (OR=2.83). Furthermore, participants who failed to quit smoking reported higher levels of motivation to quit post-treatment than they had pretreatment (p<.001). Motivation to quit smoking predicted short and long-term cessation, and also predicted long-term maintenance of abstinence. These results have implications for understanding motivational processes of smoking cessation in general, while extending research to Spanish smokers. They may also help in the design of cessation and relapse-prevention interventions. Specifically, the results suggest that motivational enhancement is important throughout the cessation and maintenance periods.