Treatment Of Substance Abuse Disorders Research Articles

IJCM_50A: Mortality trends in Indian prisons and its associated risk factors: a time trend analysis from 2017-2021

Background: The environmental health status of jail populations poses a significant public health threat for prisoners and the general population. The environment of jails provides a suitable foundation concerning morbidity and mortality of the general population due to the concentrated potential source of infectious diseases, difficult access to treatment for chronic health conditions, interruption in the continuity of care for serious behavioural health conditions, as well as on-going issues for the prevention and treatment of substance abuse disorders. Prisoners should receive a healthcare provision equivalent to people living in the community. Those rights, if fulfilled, will contribute to the process of social rehabilitation and will facilitate further reintegration into society on release. Objective: To analyze the mortality trends in Indian prisons from 2017-2021 and determine associated risk factors. Methodology: The various mortality statistics and associated risk factors were retrieved from the Prison Statistics of India report published annually by the National Crime Records Bureau, Ministry of Home Affairs. A literature search was also done in electronic databases like -PubMed, Google Scholar, and other platforms using keywords- mortality in prisons, prison health, and death in Indian jails. Results: The obtained estimates identified an ascending trend in mortality in Indian prisons due to cardiovascular diseases, lung diseases, and suicide, accompanied by a rising trend in mental illnesses. Overcrowding, inadequate manpower for healthcare facilities, and poor budget allocation for prison health are some notable causes of rising mortality. Conclusion: The study’s findings revealed that prisoners, despite being a vulnerable section of the population, are deprived of adequate medical facilities due to restrictions imposed by law. Therefore, reducing overcrowding, recruiting adequate manpower for healthcare facilities and adequate budget allocation for prison health shall play an instrumental role in reducing the trend of mental illnesses and mortality in Indian prisons.

Examining Recovery Status and Supports before and after Substance Abuse Disorder Treatment Among Clients Who Experienced Lifetime and Recent Firearm-Related Threats

Firearm-related risks have often been overlooked in the sequela of substance use and substance use disorders. This study compares adult substance abuse disorder treatment (SADT) clients who experienced recent ( n = 274) and lifetime ( n = 889) firearm threats to adults who were not threatened with a firearm ( n = 2029) before and 12 months after program entry. More men experienced firearm threats (38.8%) than women (34.2%). However, among those with any firearm threats, more women (27.2%) experienced firearm threats in the year before program entry than men (20.2%). Being threatened with a firearm was associated with increased economic vulnerability, criminal justice system involvement, mental health problems, and victimization both before and after SADT program entry. A higher number of adverse childhood experiences were associated with firearm threats and particularly recent firearm threats. Results of this study underscore the importance of screening for firearm-related risks in substance abuse disorder treatment programs.

Structure-Activity Relationship Studies on Oxazolo[3,4-a]pyrazine Derivatives Leading to the Discovery of a Novel Neuropeptide S Receptor Antagonist with Potent In Vivo Activity.

Neuropeptide S modulates important neurobiological functions including locomotion, anxiety, and drug abuse through interaction with its G protein-coupled receptor known as neuropeptide S receptor (NPSR). NPSR antagonists are potentially useful for the treatment of substance abuse disorders against which there is an urgent need for new effective therapeutic approaches. Potent NPSR antagonists in vitro have been discovered which, however, require further optimization of their in vivo pharmacological profile. This work describes a new series of NPSR antagonists of the oxazolo[3,4-a]pyrazine class. The guanidine derivative 16 exhibited nanomolar activity in vitro and 5-fold improved potency in vivo compared to SHA-68, a reference pharmacological tool in this field. Compound 16 can be considered a new tool for research studies on the translational potential of the NPSergic system. An in-depth molecular modeling investigation was also performed to gain new insights into the observed structure–activity relationships and provide an updated model of ligand/NPSR interactions.

Development and Psychometric Assessment of Lapse Management Program and Educational Content After Quitting in Patients with Substance Use Disorders

Background: Despite advances in the treatment of substance abuse disorders, some clients experience lapse and relapse after treatment. As a stage before relapse, the lapse is a major challenge in the treatment of addiction. Objectives: This study attempted to develop and psychometrically assess a lapse management program and its educational content after quitting in patients with substance use disorders. Methods: This study was performed in two parts. In the first part, the program and its educational content were designed, and in the second part, it was validated using the opinions of 10 experts in two phases. For program validation, face validity and content validity were used both qualitatively and quantitatively. Results: The lapse management program and its educational content were designed based on self-awareness skills in eight sessions. The validation results showed that the minimum and maximum CVR values for each component of the program were calculated as 0.8 and 1, respectively. Also, the minimum and maximum CVI values were 0.86 and 1, respectively. Moreover, the average content validity index for the entire program was 0.94. Conclusions: The results showed that the lapse management program and its educational content had a good face and content validity for recovering clients and enjoyed the necessary validity for educational, clinical, and research applications.

Investigating the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups.

Drug addiction as a biological, psychological, and social issue affects all dimensions of one's life. The purpose of this study was to determine the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups. This was a cross-sectional study conducted on 60 addicted people and 60 non-addicted people. The Adult Attachment Scale of Hazan and Shaver, Allport Religious Orientation Scale, and the 26-item Dysfunctional Attitude Scale (DAS-26) were used to measure the variables. Based on the results, which were analyzed by logistic regression analysis, the variables of attachment style and dysfunctional attitude can significantly predict drug addiction (p < .001). However, avoidant attachment style and spirituality cannot predict readiness for addiction. The results of this study indicate the importance of safe and ambivalent attachment styles and dysfunctional attitudes. Thus, attending to these factors in studies and interventions related to the treatment of substance abuse disorders is essential.

A Survey of Health Disparities, Social Determinants of Health, and Converging Morbidities in a County Jail: A Cultural-Ecological Assessment of Health Conditions in Jail Populations.

The environmental health status of jail populations in the United States constitutes a significant public health threat for prisoners and the general population. The ecology of jails creates a dynamic condition in relation to general population health due to the concentrated potential exposure to infectious diseases, difficult access to treatment for chronic health conditions, interruption in continuity of care for serious behavioral health conditions, as well as on-going issues for the prevention and treatment of substance abuse disorders. This paper reports on elements of a cross-sectional survey embedded in a parent project, “Health Disparities in Jail Populations.” The overall project includes a comprehensive secondary data analysis of the health status of county jail populations, along with primary data collection that includes a cross-sectional health and health care services survey of incarcerated individuals, coupled with collection of biological samples to investigate infectious disease characteristics of a county jail population. This paper reports on the primary results of the survey data collection that indicate that this is a population with complex and interacting co-morbidities, as well as significant health disparities compared to the general population.

Spiritual Influence Towards Relapse in Opioid Addicts in Therapy

Introduction: Substance abuse is both a social and public health problem with a substantial burden to society. Opioid dependence results in unemployment, crimes, family disruption, and transmission of diseases. In Malaysia, methadone maintenance therapy (MMT) has been introduced as a harm reduction method. However, relapse during treatment remains an issue to be resolved that hinders successful outcome in the therapy. Spirituality in the treatment of substance abuse disorders has yet to be fully explored. This study aims to examine how MMT clients who relapsed perceive spiritual deficits as an influence and association of spiritual practice with relapse. Methods: This is a cross-sectional study done from June-July 2016. All MMT clients undergoing therapy at 3 treatment centers in Terengganu, Malaysia who fulfilled the inclusion and exclusion criteria and consented were included in the study. A semi-structured questionnaire was filled via face to face interview and spiritual practice was assessed using Hatta Islamic Religiosity Scale. 121 questionnaires were assessed and data was analyzed using SPSS version 22 for quantitative data. Results: All respondents were males of Malay race and Islamic religion. Current relapse, defined as any episode of intake of opioid for the past one month after a period of abstinence was 34%. Only three out of 42 clients who relapsed had some spirituality theme in their perceived cause of their relapse. However, a significant majority of those relapsed had a spiritual practice score of less than the mean practice score. Conclusion: Relapse in opioid addiction remains high in those receiving MMT in Terengganu, Malaysia. Spirituality may have a subconscious influence towards relapse in addiction in MMT clients. Further effort should be taken to inculcate spirituality intervention effective to prevent relapse which may contribute towards achieving a more successful therapy outcomes.

Differences in Psychopathology among Patients with Dual Diagnosis that are Entering Mental Health Services in Cyprus in Correlation with Alcohol Dependence

Introduction: Dual diagnosis is undoubtedly one of the most important problems that mental health services are currently facing. The common problem of all patients is that they resort to psychiatric services due to complications caused by the use or abuse of legal and illegal substances and at the same time due to the presence of another psychiatric disorder. The literature supports the hypothesis that psychiatric disorders and substance abuse disorders coexist more frequently than initially estimated. Aim: The aim of this study is to examine, assess and compare the characteristics and the psychopathology between patients with dual diagnosis receiving treatment for mental disorders and those receiving treatment for substance abuse disorders within the framework of the substance abuse treatment programs provided by the Mental Health Services of Cyprus. Furthermore, this study examines the differences in psychopathology in correlation with alcohol dependence, duration of treatment and the number of hospitalizations in relation with dual diagnosis. Methods: In this study three hundred patients were used: 150 of them were dually diagnosed and admitted to drug addiction therapeutic and rehabilitation centers for legal and illegal substances and 150 were dually diagnosed and admitted to psychiatric units in the Mental Health Center in Cyprus. The EuropASI the AUDIT, and the PDQ4 were administered individually to each participant. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis. Results: The results revealed that the dually diagnosed patients who were admitted to psychiatric units had higher figures of diagnosis (mhuM=3.03, duM=2.55, pvalue), higher figures of hospitalization in Mental Health Services (mhuM=12.25, duM=7.73) and significantly more psychological problems (mhuM=63.02, duM=18.78), as well as longer prison time (mhuM=5.55, duM=2.10), compared to those that entered substance abuse treatment programs. The mean age of first use for men was 17.88 for psychiatric patients and 17.52 for patients entering substance abuse treatment programs (p value=0.001). For women, the mean starting age was 17.50 in psychiatric units and 17.60 in substance abuse treatment programs (p value=0.01).In most cases, the main substance of dependence was cannabis, followed by cocaine, in both study groups (57.5% the case of cannabis, 20% for cocaine in psychiatric units and 30% for cannabis, 20% for cocaine in substance abuse treatment programs). A total of 53.4% of the patients admitted to substance abuse treatment programs had a family history of alcoholism, while the corresponding figure for those in psychiatric units was 46.6%; 50% of both groups had a family history of drug addiction. The patients with anti-social disorder according to the PDQ-4 questionnaire had a higher incidence of alcohol dependence than patients without anti-social disorder. The use of alcohol over the last 30 days was associated with an increase in the frequency of alcohol dependency. Implications for Mental Health Nursing: The results indicate that the lack of a specialized treatment center creates a significant gap for treatment, which leads to Mental Health Services overuse and misuse, and to continuous hospitalizations and relapses, leading dual diagnosis patients to disorganization and isolation. Mental health specialists should learn and be educated in new therapeutic approaches in order to treat dually diagnosed patients holistically.

Interpersonal pathoplasticity and trajectories of change in routine adolescent and young adult residential substance abuse treatment.

Partnerships between mental health care stakeholders provide a context for generalizable clinical research with implications for quality improvement. In the context of a partnership between an adolescent residential substance abuse disorder (SUD) treatment center and clinical researchers, stakeholders identified knowledge gaps (internal and the field broadly) with regard to patient interpersonal factors that influence working alliance and acute SUD residential treatment outcome trajectories. To (a) examine interpersonal pathoplasticity and identify interpersonal subtypes in a naturalistic sample of adolescent and young-adult patients presenting for routine residential SUD treatment and (b) investigate the association between identified interpersonal subtypes and working alliance and acute treatment outcome trajectories. N = 100 patients (Mage = 17.39 years, 68% male, 84% White) completed self-reports of symptom and functioning outcomes, interpersonal problems, and the working alliance on multiple occasions between admission and discharge. Multiple methods were used to identify interpersonal subtypes and test pathoplasticity. Interpersonal subtype was entered as a predictor in respective multilevel models of working alliance and symptom outcome. Interpersonal subtypes of vindictive and exploitable patients demonstrated pathoplasticity. Subtype did not predict working alliance trajectories; however, a significant interaction between interpersonal subtype and a quadratic effect for time demonstrated that exploitable patients with longer than average treatment lengths experienced attenuated symptom change over the course of treatment whereas vindictive patients appeared to demonstrate steady progress. Interpersonal assessments should be integrated into residential SUD treatment to identify patients with an exploitable interpersonal style who might require additional attention or alternative interventions. (PsycINFO Database Record

Using a Film Intervention in Early Addiction Treatment: a Qualitative Analysis of Process.

There is a need for knowledge about how self-help materials can be made useful in treatment for Substance Abuse Disorders (SUD), as a supplement to ongoing treatment, or as independent tools for change. In this study, we explored the use of self-help films in early addiction treatment, taking into account both patient and therapist perspectives, as well as dyadic functions. We explored how active mechanisms might be related to intervention format and implementation context. A secondary aim was to examine the potential mechanisms related to the specific content of the intervention: mindfulness and acceptance psychoeducation. A qualitative exploratory research design, including a general inductive analytic approach, constructivist grounded theory, and source triangulation features, was used to code and analyze interview material. Emerging themes were developed into concepts, and finally an operational model. Participants included 12 patients and 22 therapists, in in-/outpatient addiction clinics, all in urban areas of Norway. The purpose of the design was empirical grounding of developed concepts, to promote different potential user perspectives (patients' and therapists') and obtain process data. The core concept constructed, "Alliance as experiential process," gives a description of the data where patients and therapists accept or reject the film as a result of an experience process conceptualized as alliance formation. The alliance process model reflects the observation that patients constructed alliances autonomously, while therapists built alliances indirectly through their patients' experiences. Use of a self-help film may be a helpful adjunct to face-to-face therapy for patients who create a personally meaningful attachment to the film. Mindfulness/acceptance may offer one basic framework for such connection to take place.

Examining Treatment Outcomes: Differences Between Primary and Non-Primary Marijuana-Using Youths Transitioning Into Recovery

ABSTRACTTo date, little is known about psychosocial and behavioral effects of marijuana (MJ) use among youths in substance abuse disorder (SUD) treatment. We recruited 80 youths (Mage = 20.4 ± 3.5 years old) to participate in an aftercare pilot program from SUD treatment programs in Southern California. This article explores differences in psychosocial and behavioral treatment outcomes between youths in SUD treatment for MJ compared to youths in treatment for another primary substance other than MJ (i.e., stimulants, opioids, alcohol). Youths in SUD treatment for MJ reported being less likely to quit, continued MJ use at treatment completion, less substance use severity, less psychosocial distress, and fewer criminal behaviors compared to youths who received treatment for substances other than MJ. There were differences in HIV-risk outcomes in the past year; however, both groups reported risky sexual behavior in the past month at treatment discharge.

The scope of homeopathy in treatment of substance abuse disorders

The scope of homeopathy in treatment of substance abuse disorders

Circadian Rhythms and Substance Abuse: Chronobiological Considerations for the Treatment of Addiction.

Reward-related learning, including that associated with drugs of abuse, is largely mediated by the dopaminergic mesolimbic pathway. Mesolimbic neurophysiology and motivated behavior, in turn, are modulated by the circadian timing system which generates ∼24-h rhythms in cellular activity. Both drug taking and seeking and mesolimbic dopaminergic neurotransmission can vary widely over the day. Moreover, circadian clock genes are expressed in ventral tegmental area dopaminergic cells and in mesolimbic target regions where they can directly modulate reward-related neurophysiology and behavior. There also exists a reciprocal influence between drug taking and circadian timing as the administration of drugs of abuse can alter behavioral rhythms and circadian clock gene expression in mesocorticolimbic structures. These interactions suggest that manipulations of the circadian timing system may have some utility in the treatment of substance abuse disorders. Here, the literature on bidirectional interactions between the circadian timing system and drug taking is briefly reviewed, and potential chronotherapeutic considerations for the treatment of addiction are discussed.

Maine enacts statewide limits on opioid prescribing

Healthcare providers in Maine have about six months to rethink their approach to pain treatment before a new state law limiting opioid dosages and the duration of therapy takes effect. The law, which goes into effect on January 1, 2017, restricts opioid prescriptions to a dosage of no more than 100 morphine milligram equivalents (MME) per day of any opioid or combination of opioid-containing medications. In addition, patients with chronic pain, as defined in the statute, may be prescribed no more than a 30-day supply of an opioid medication. And patients with acute pain will be limited to no more than a 7-day supply of an opioid. The law includes exceptions for inpatient use, cancer-related opioid therapy, palliative or end-of-life pain treatment, and medication-assisted treatment of substance abuse disorder. Complying with the law, said Noah Nesin, vice president of medical affairs for Penobscot Community Health Care (PCHC) in Bangor, “is going to take everybody working together, and it’s going to take a lot of explaining to the public and to individual patients.”

Relapse: What Should We Do About It? Commentary on Flynn and Brown (2016)

The thesis presented by Flynn and Brown (2015)makes two core assertions: first, the risk of relapse after treatment of substance abuse disorders is exceedingly high; second, most treatment programs and practitioners do not invest sufficient effort into preventing or dealing with relapse. They argue that these disorders should more properly be viewed as chronic relapsing disorders and that we need to restructure our health care system to deal with them as such, much in the way we deal with diabetes or hypertension. They are not alone in advancing this view. Given this perspective, current limits imposed by insurers or government agencies on how long or how frequently patients can be followed are seen as counterproductive. Flynn and Brown point to studies demonstrating that continuing caremodels (periodic follow-ups and communitymanagement check-ups) aimed at sustaining improvement and early re-engagement can be cost effective and, in some cases, show substantial benefit/cost ratios. They appear to believe that what is needed to make such periodic monitoring routine are appropriate economic incentives and revision of payment practices that limit reimbursement to active patients. They suggest that a good place to start would be with an Institute ofMedicine-like group of experts that couldmake recommendations for appropriate changes, and that the Affordable Care Act opens new possibilities for paying for more extended treatment. Some of these problems, such as the refusal of insurers and state governments to support demonstrably effective treatments as methadone maintenance, or irrationally limiting duration of coverage are more political than scientific and call for advocacy and litigation rather than scientific review. Continuing care (community management check-up) following a period of more intensive care is a different issue that will require persuading insurers and government agencies that expenditure on such activities is a better use of health care resources than expanding access to treatment. Could a group of experts help to accomplish this?What kinds of problemswould they confront when trying to recommend changes in the US health care system?What kinds of information will they be able to utilize? The number of random assignment controlled trials of posttreatment efforts aimed at sustaining improvement and intervening in relapses for any form of substance use disorder is relatively small. Most deal with patients that have either completed treatment or have participated in some significant amount of treatment. Very few deal with those who experienced only brief episodes. McKay (2009)

Experiences of victimization among adolescents with Substance Abuse Disorders in Sweden

Abstract Background Adolescents who initiate treatment for substance abuse often have a history of victimization in the form of physical, psychological, or sexual abuse. These experiences can have serious adverse consequences that may affect their lives and social functioning. Objective This article describes and analyzes victimization among adolescents who are in outpatient treatment for substance abuse disorders with respect to gender, social circumstances, alcohol and drug abuse, and mental health. Method This cross-sectional study is based on structured interviews with 748 adolescents from seven outpatient clinics in Sweden. Chi-squared tests were performed to examine significant differences between gender and victimization (or lack of victimization). The study also included a quantitative content analysis of interview utterances. Results The analysis showed that more than half of the adolescents had experienced violence or another type of abuse. There are also significant gender differences: two thirds of the girls and slightly less than half the boys had experienced abuse in some form, and the girls had more severe needs at treatment admission. Conclusions This study established that experiences of victimization and exposure to violence are widespread among adolescents with substance abuse disorders in Sweden. This is an important issue that requires attention and action, with preventive and therapeutic interventions needed to provide support for both substance abuse disorders and psychiatric symptoms.

Orexin A role in mechanisms of reinforcement in the bed nucleus of stria terminalis

The orexin family of hypothalamic neuropeptides has been implicated in reinforcement mechanisms relevant to both food and drug reward. Previous behavioral studies with antagonists at the orexin A-selective receptor OX(1), have demonstrated its involvement in behavioral sensitization, conditioned place-preference, self-administration and reinstatement of drugs abuse. There are dense concentrations of hypocretin receptors, in brain regions implicated in drug reinforcement processes, such as the nucleus accumbens, ventral tegmental area and bed nucleus of the stria terminalis Adult male Wistar rats were implanted the stimulating electrodes to the lateral hypothalamus. Simultaneously, the microcanules were implanted into the BNST to inject the OX(1) receptor antagonist. Rats were trained to perform intracranial self-stimulation. The effects of the OX(1)-selective antagonist SB-408124 on brain stimulation-reward (BSR) were measured. SB-408124 injected into the BNST (1µg/1 µl in volume for each injection.) alone had no effect on self-stimulation of lateral hypothalamus. Amphetamine (1 mg/kg i.p.) potentiated BSR, measured as lowering of BSR threshold and enhancing of BSR frequency. Amphetamine-induced stimulatory effects on intracranial self-stimulation was blocked by injections of SB-408124 into BNST. These data demonstrate that OX(1) play an important role in regulating the reinforcing and reward-enhancing properties of amphetamine and suggest that orexin transmission is likely essential for establishing and maintaining the amphetamine habit in human addicts. However, the observations that OX1 antagonism reduce brain reward and block stress- and cue-induced reinstatement of drug-seeking suggests that this class of compounds may be useful additions to stress-reduction and other behavioral therapies in the treatment of substance abuse disorders.

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.

QUINT: A tool to detect qualitative treatment–subgroup interactions in randomized controlled trials

Objective: The detection of subgroups involved in qualitative treatment–subgroup interactions (i.e., for one subgroup of clients treatment A outperforms treatment B, whereas for another the reverse holds true) is crucial for personalized health. In typical Randomized Controlled Trials (RCTs), the combination of a lack of a priori hypotheses and a large number of possible moderators leaves current methods insufficient to detect subgroups involved in such interactions. A recently developed method, QUalitative INteraction Trees (QUINT), offers a solution. However, the paper in which QUINT has been introduced is not easily accessible for non-methodologists. In this paper, we want to review the conceptual basis of QUINT in a nontechnical way, and illustrate its relevance for psychological applications. Method: We present a concise introduction into QUINT along with a summary of available evidence on its performance. Subsequently, we subject RCT data on the effect of motivational interviewing in a treatment for substance abuse disorders to a reanalysis with QUINT. As outcome variables, we focus on measures of retention and substance use. Results: A qualitative treatment–subgroup interaction is found for retention. By contrast, no qualitative interaction is detected for substance use. Conclusions: QUINT may lead to insightful and well-interpretable results with straightforward implications for personalized treatment assignment.

Effect of GABAA Partial Inverse Agonists on Drug‐facilitated ICSS Reward

We examined the ability of gamma-aminobutyric acid A receptor (GABAA) partial inverse agonists Ro15-4513 and FG-7142 and the antagonist flumazenil to block the reward-facilitating effects of methamphetamine on intracranial self-stimulation (ICSS) using a rate-frequency procedure. A total of 13 adult male C57BL6/J mice implanted with chronic bipolar stimulating electrodes directed toward the medial forebrain bundle and served as subjects. Following surgery, mice were trained to respond on an operant lever for electrical stimulation in 10 one min trials descending each subsequent min. A dose of 3 mg/kg methamphetamine robustly facilitated operant responding for ICSS (Top Figure). When administered alone, doses of 1 and 3 mg/kg flumazenil; 0.3 and 1 mg/kg RO15-4513; 0.1, 0.3 and 1 mg/kg FG-7142 did not significantly affect ICSS compared to the vehicle control. Higher doses of RO15-4513 and FG-7142 significantly decreased responding for ICSS relative to the vehicle control. Preadministration of flumazenil had no effect on methamphetamine facilitated ICSS. However, doses of 0.3 and 1 mg/kg RO15-4513, which themselves did not significantly attenuate ICSS, decreased the ICSS facilitation produced by 3 mg/kg methamphetamine (Bottom Figure). Similarly, 0.3 and 1 mg/kg FG-7142 dose-dependently decreased methamphetamine-facilitated ICSS. These results suggest an important role of GABAA receptors in modulating methamphetamine's reward-facilitating effects as well as the possibility that negative GABAA receptor modulation may have therapeutic value for the treatment of substance abuse disorders.