Treatment Of Addictive Disorders Research Articles

Addiction severity pattern associated with adult and childhood Attention Deficit Hyperactivity Disorder (ADHD) in patients with addictions.

Attention Deficit Hyperactivity Disorder (ADHD) is highly prevalent among adults with addictive disorders, but little is known about addiction patterns associated with ADHD diagnosis. This study examined addiction severity in patients with co-occurring addictive disorders and ADHD controlling for the potential influence of associated psychiatric comorbidity. Data were collected in French outpatient addiction treatment centers. A total of 217 patients seeking treatment for substance or gambling addiction were included. At treatment entry, participants were interviewed with the Addiction Severity Index, the Conners Adult ADHD Diagnosis Interview for the DSM-IV (CAADID), the Mini International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for DSM-IV Axis II for borderline personality disorder (SCID II). History of ADHD was associated with an earlier onset of addiction, poly-dependence (defined by presence of at least two current substance dependence diagnoses in addition to tobacco dependence if present) and borderline personality disorder. Persistence of ADHD during adulthood was associated with a higher prevalence of poly-dependence. This study highlights the need for early implementation of preventive interventions for substance use or behavioral addiction in children/adolescents with ADHD and the need to consider ADHD in the treatment of addictive disorders.

ADHD and addictive disorders: What links?

The links between ADHD and addictive disorders have been the subject of a large number of studies showing a high prevalence rate of ADHD in substance abusing populations as well as an increased risk of substance use disorder (SUD) in ADHD patients that may be independent of other psychiatric conditions. High prevalence of ADHD has also been highlighted among individuals suffering from other addictive disorders such as pathological gambling. Adequate diagnosis of ADHD in SUD patients is challenged by phenomenological aspects of addiction and by frequently associated other psychiatric disorders that overlap with key symptoms of ADHD. A detailed comprehensive search for child and adult symptoms including the temporal relationship of ADHD, substance use and other psychiatric disorders should maximize the validity and the reliability of adult ADHD diagnosis in this population. Further, a follow-up evaluation of ADHD symptoms during treatment of SUD may reduce the likelihood of misdiagnosis. Finally, it should be noticed that when SUD occurs with ADHD, it is associated with a greater severity of SUD compared to other SUD patients. This has been shown with an earlier age at onset, antisocial behavior, risk for depression, chronicity of substance use, need for hospitalization and likelihood of a complicated course. Recent data suggest that the effects of ADHD on SUD outcomes are independent of other psychiatric comorbidities. This highlights the need of an earlier implementation of preventive interventions for substance use or behavioral addiction in children/adolescents with ADHD and the necessity to consider this disorder in the treatment of addictive disorders. Benefices and risk of MPH in adult patients with addiction and ADHD are discussed.

Pharmacological targeting of dopamine D3 receptors: Possible clinical applications of selective drugs

Dopamine D3 receptors have been pharmacologically engaged in humans since the development of the first antipsychotics and ergot-derivative dopamine (DA) agonists, even without knowing it. These agents were generally non-selective, developed primarily to target D2 receptors. In the last 10 years the understanding of the clinical implication of D3 receptors has been progressing also due to the identification of D3 gene polymorphisms, the use of more selective PET ligands such as [(11)C]-(+)-PHNO and the learning regarding the clinical use of the D3-preferential D2/D3 agonists ropinirole and pramipexole. A new specific neuroplasticity role of D3 receptor regarding dendrite arborisation outgrowth in dopaminergic neurons was also proposed to support, at least in part, the slowing of disease observed in subjects with Parkinson׳s Disease treated with DA agonists. Similar mechanisms could be at the basis of the antidepressant-like effects observed with DA agonists when co-administered with standard of care. Severe adverse event occurring with the use of anti-parkinsonian DA agonists in predisposed subjects, i.e., impulse control disorders, are now suggested to be putatively related to overactive D3 receptors. Not surprisingly, blockade of D3 receptors was proposed as treatment for addictive disorders, a goal that could be potentially achieved by repositioning buspirone, an anxiolytic drug with D3-preferential antagonistic features, or with novel selective D3 antagonists or partial agonists currently in development for schizophrenia. At the moment ABT-925 is the only selective D3 antagonist tested in schizophrenic patients in Phase II, showing an intriguing cognitive enhancing effects supported by preclinical data. Finally, exploratory pharmacogenetic analysis suggested that ABT-925 could be effective in a subpopulation of patients with a polymorphism on the D3 receptor, opening to a possible personalised medicine approach.

High Dose Stimulant Substitution for the Treatment of Cocaine and Crystal Meth Use Disorders

Treatment of substance use disorder has advanced substantially in the last few decades. Psychosocial interventions such as motivational enhancement treatment, CBT for relapse prevention, and contingency management have been developed and are now widely utilized. A number of effective medications have been approved and implemented for the treatment of alcohol, tobacco, and opioid use disorders. The biggest gap, specifically in the pharmacological treatment of addictive disorders, is the lack of medications to treat stimulant use disorders such as cocaine and methamphetamine use disorders.

Pharmacotherapy of Alcohol and Drug Dependence

Advances in neurobiology have increased our understanding of the underlying mechanisms of drug and alcohol dependence and led to the development of medications to treat addictive disorders (Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010;35(1):217-38). Addictive disorders are increasingly recognized as medical conditions, influenced by genetic, biological and psychosocial factors, for which the optimal treatment combines both pharmacological and psychosocial therapies (McLellan AT, Lewis DC, O'Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689-95). This review discusses the neurobiology and physiology of addiction, the putative mechanisms of action of pharmacotherapies in the treatment of addictive disorders and the evidence for their efficacy.

SY36-2 * NUTRITIONAL AND ALTERNATIVE INTERVENTIONS IN ADDICTION MEDICINE

The burgeoning area of the application of nutritional and alternative medicine technologies in integrated medicine and psychiatry has taken root in the treatment of addictive disorders. Nutritional supplements spanning a wide range may be therapeutic in treating both deficiencies or insufficiencies as well as an adjunct to pharmacological interventions. Nutritional supplements that are commonly utilized in the treatment of addiction disorders and corresponding co-morbid psychiatric disorders or symptoms include l-methylfolate, vitamin D, inositol, l-tryptophan, omega 3 fatty acids, s-adenosyl methionine (SAM-E), N-acetylcysteine (NAC), melatonin, rhodiola rosea, valerian, chromium, creatine, and hypericum. Additionally alternative technologies such as the Cranial-electrostimulator (CES) and the Biomat which delivers infrared heat have demonstrable effectiveness in reducing anxiety and pain. This symposium will present an overview with referenced background information on the various applications of various nutritional/alteranative interventions in addiction medicine.

Topiramate impairs cognitive function in cocaine-dependent individuals maintained on methadone

Topiramate impairs cognitive function in cocaine-dependent individuals maintained on methadone

Differences in mood and quality of life indicators by HIV status in a group of methamphetamine-dependent individuals

Differences in mood and quality of life indicators by HIV status in a group of methamphetamine-dependent individuals

White problem gamblers discount delayed rewards less steeply than their African American and Hispanic counterparts.

Impulsivity is a core process underlying addictive behaviors, including nonpharmacological addictive behaviors such as problem gambling. Although considerable attention has been given to the investigation of delay discounting within the context of addiction-related behaviors, relatively little research has examined the relationship between discounting and individual variables, such as race/ethnicity. The purpose of this study was to compare discounting rates in the three most prevalent racial/ethnic groups in the United States: Whites, African Americans, and Hispanics. The study was conducted with 315 problem gamblers. Participants completed a delay-discounting questionnaire involving choices between a smaller amount of money delivered immediately and a larger amount delivered later. A hyperbolic discounting function estimated delay-discounting rates based on participants' indifference points obtained via the questionnaires. Results showed significant effects of race/ethnicity on delay discounting. White gamblers discounted delayed money at lower rates than African Americans and Hispanics, even after controlling for confounding variables. These data suggest that among individuals who develop problem gambling, Whites are less impulsive than African Americans and Hispanics, at least in terms of choosing between delayed and immediate reinforcers. These results have implications for evaluating the onset and treatment of addictive disorders from a health-disparities perspective.

Assessment of a proposed “three-criteria” cocaine addiction model for use in reinstatement studies with rats

Relapse is a primary obstacle in the treatment of addiction disorders, and as such, understanding this phenomenon is a major effort of clinical and preclinical studies of cocaine addiction. A recently developed protocol uses laboratory rats to model cocaine addiction by examining three criteria of addiction-like behaviors (persistent seeking in the absence of drug, high motivation for drug, and resistance to punishment during drug seeking) to detect subjects that possess an addiction phenotype. We closely followed this protocol in order to detect rats possessing this addiction phenotype, with the goal of utilizing this model in future studies investigating potential therapies for relapse in human cocaine addicts. The majority of the rats used in this study exhibited multiple characteristics thought to be associated with addiction-like behavior in rats, including robust reinstatement to multiple stimuli and high motivation to obtain cocaine. However, no rats displayed the complete addiction phenotype as previously described, due to a complete lack of addiction-like behavior in all subjects on two of the three addiction criteria (drug seeking in the absence of drug and resistance to punishment). Our data highlight the independence of behavioral aspects of a rat addiction-like phenotype and suggest that some of these behavioral criteria may be altogether absent in some rat populations. Furthermore, our results suggest a closer review and analysis of some parameters used in this protocol and its global utility.

Pharmacological means of reducing human drug dependence: a selective and narrative review of the clinical literature

Substance abuse or addictive disorder is a global problem. A greater understanding of the associated changes in brain pathophysiology supports the notion that pharmacological treatments are part of the necessary treatment options. Craving is a core symptom of addictive disorder. It refers to a strong desire to use drugs again either to re-experience positive effects or to diminish negative experiences. Currently there are a number of medicines that are effective in the treatment of addictive disorders. These medications can either be for substitution (same pharmacological effect as the abused substance) or anticraving (decrease the craving of the abused substance). In this MEDLNE based review, specific compounds (naltrexone, acamprosate, topiramate, disulfiram, baclofen, N-acetylcysteine and bupropion) were selected that are known to diminish desire to use (anticraving effect) and that have been trialled for a number of different substance addictive disorders. Their therapeutic potential in clinical practice is discussed in light of their efficacy.

Couples and Addiction

Despite the value of couples-based treatment for addiction disorders, couples therapy continues to be a rare treatment modality in mental health/addiction agencies. This article reviews and provides case illustrations for three established theories for working with addicted couples.

Addiction and corticotropin‐releasing hormone type 1 receptor antagonist medications

Derangements in corticotropin-releasing hormone (CRH) through its type 1 receptor (CRHR1) have been identified in many pathologic conditions. Preclinical models of addiction find that small-molecule antagonists of CRHR1 can limit induction, maintenance, and relapse to drugs of abuse. Neuropsychiatric clinical trials of CRHR1 antagonists have shown mixed efficacy; treatment of addictive disorders has not been established, but finding effective treatments for addictive disorders is critical. Establishing effectiveness for substance abuse treatment will require a different design approach than was used for depression and anxiety trials. Focusing on active versus passive outcome measures, such as resilience to external stressful stimuli, may provide signals in curbing craving and relapse. Study design should include measures of abstinence and drug exposure, but additional elements of stress prevention should also be incorporated. Agents that could provide preemptive protection from drug use and relapse are novel and untested. An understanding of the evolutionary significance of the stress system and preclinical models suggests that these agents may provide protection in this manner. Investigators designing future trials might refocus their understanding of addiction and treatment in this new direction.

Real-time fMRI in the treatment of nicotine dependence: A conceptual review and pilot studies.

Technical advances allowing for the analysis of functional MRI (fMRI) results in real time have led to studies exploring the ability of individuals to use neural feedback signals to modify behavior and regional brain activation. The use of real-time fMRI (rtfMRI) feedback has been explored for therapeutic benefit in a number of disease states, but to our knowledge, the potential therapeutic benefit of rtfMRI feedback in the treatment of addictive disorders has not been explored. This article will provide an overview of the development of rtfMRI and discussion of its potential uses in the treatment of addictions. We also describe a series of pilot studies that highlight some of the technical challenges in developing a rtfMRI feedback paradigm for use in addictions, specifically in nicotine dependence. Because the use of rtfMRI feedback is in its infancy, the work described is focused on establishing some of the basic parameters in optimizing the rtfMRI feedback, such as the type of feedback signal, region of interest for feedback and predicting which subjects are most likely to respond well to training. While rtfMRI feedback remains an intriguing possibility for the treatment of addictions, much work remains to be done in establishing its efficacy.

Cannabinoid CB1 receptors transactivate multiple receptor tyrosine kinases and regulate serine/threonine kinases to activate ERK in neuronal cells

Signalling networks that regulate the progression of cannabinoid CB(1) receptor-mediated extracellular signal-regulated kinase (ERK) activation in neurons are poorly understood. We investigated the cellular mechanisms involved in CB(1) receptor-stimulated ERK phosphorylation in a neuronal cell model. Murine N18TG2 neuronal cells were used to analyse the effect of specific protein kinase and phosphatase inhibitors on CB(1) receptor-stimulated ERK phosphorylation. The LI-COR In Cell Western assay and immunoblotting were used to measure ERK phosphorylation. The time-course of CB(1) receptor-stimulated ERK activation occurs in three phases that are regulated by distinct cellular mechanisms in N18TG2 cells. Phase I (0-5 min) maximal ERK phosphorylation is mediated by CB(1) receptor-stimulated ligand-independent transactivation of multiple receptor tyrosine kinases (RTKs). Phase I requires G(i/o) βγ subunit-stimulated phosphatidylinositol 3-kinase activation and Src kinase activation and is modulated by inhibition of cAMP-activated protein kinase A (PKA) levels. Src kinase activation is regulated by the protein tyrosine phosphatases 1B and Shp1. The Phase II (5-10 min) rapid decline in ERK phosphorylation involves PKA inhibition and serine/threonine phosphatase PP1/PP2A activation. The Phase III (>10 min) plateau in ERK phosphorylation is mediated by CB(1) receptor-stimulated, ligand-independent, transactivation of multiple RTKs. The complex expression of CB(1) receptor-stimulated ERK activation provides cellular selectivity, modulation of sensitivity to agonists, and coincidence detection with RTK signalling. RTK and PKA pathways may provide routes to novel CB(1) -based therapeutic interventions in the treatment of addictive disorders or neurodegenerative diseases. LINKED ARTICLES This article is part of a themed section on Cannabinoids in Biology and Medicine. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-8. To view Part I of Cannabinoids in Biology and Medicine visit http://dx.doi.org/10.1111/bph.2011.163.issue-7.

The Informational Yield of Paired Samples from a Large Sample: Hair Analysis and Urinalysis for Cocaine and Cannabinoids

In a variety of decision settings when categorical information is the data in hand, the correspondence between an indicator test and a true condition (i.e., an accepted "gold standard") is often assessed by the use of comparison or "truth" tables. The results from such a table can be considered an informational yield and allow a practitioner to assess the utility of the indicator test in various ways, such as specificity and sensitivity, false positive and negative rates, and the positive and negative predictive values. There are many reasons for the use of an indicator test. This article proposes a novel application of an informational measure in determining the utility of hair and urine specimens for clinical decision making. It does this for two commonly abused substances, cocaine and cannabinoids. It suggests that in clinical applications the ability to assess informational yield is an important factor in developing clinical strategies for treatment of addictive disorders.

Advancing Addiction Treatment: What Can We Learn from Animal Studies?

Substance addiction is a maladaptive behavior characterized by compulsive and uncontrolled self-administration of a substance (drug). Years of research indicate that addictive behavior is the result of complex interactions between the drug, the user, and the environment in which the drug is used; therefore, addiction cannot simply be attributed to the neurobiological actions of a drug. However, despite the obvious complexity of addictive behavior, animal models have both advanced understanding of addiction and contributed importantly to the development of medications to treat this disease. We briefly review recent animal models used to study drug addiction and the contribution of data generated by these animal models for the clinical treatment of addictive disorders.

Contingency Management For Substance Misuse Treatment: A Guide For Implementing This Evidence Based Practice

Contingency Management For Substance Misuse Treatment: A Guide For Implementing This Evidence Based Practice . Nancy M. Petry. Routledge, 2012. ISBN 978-0-415-88289-7 ![Graphic][1] First impressions can be deceptive. My initial feeling about reading this rather dense and grey-sky looking book was a mixture of apathy and shyness. ‘This Evidence Based Practice’ the book title alone may mislead potential readers into expecting a defensive or abrasive style of writing. In reality, Contingency Management For Substance Misuse Treatment: A Guide For Implementing This Evidence Based Practice is most definitely neither a bully or a bore, instead it is an enthusiastic and accessible ‘how to’ manual which also succeeds in educating its reader on all matters related to contingency management (CM). Nancy M. Petry Professor of Psychiatry, Connecticut University is highly acclaimed and well respected in the field of behavioural treatment of addiction disorders and is a consultant and adviser for National Institute of Health in the USA. Writing a book on CM in substance misuse given the current financial climate is commendably brave of Nancy Petry. She defends the financial argument through her conviction throughout the book—implemented correctly this intervention works! CM … [1]: /embed/inline-graphic-1.gif

Selvhjelpsgrupper mot rusavhengighet

In spite of the prevailing rhetoric in the field of addiction that claims that addiction disorder is a chronic condition, this is not reflected in the interventions being made. Most of today’s treatment of substance abuse takes the form of an emergency, intermittent and temporary effort in a start-stop fashion (1). The forms of treatment that have a longer duration, where these still exist, may be seen as merely longer ver-sions of the same cycle, with an emphasis on access to treatment, stabilisation, repair and discharge, where the patients may parti-cipate in a follow-up scheme for a short period. The basic idea appears to be that substance addiction can only be cured if we are able to determine the correct therapeutic methods and the appropriate length and intensity of the cure.To achieve continuity in the treatment of addiction disorders we need more emphasis on models that take a long-term perspec-tive, and where there is adequate overlap between the ongoing and the continuous efforts.

Attitudes Toward Evidence-Based Pharmacological Treatments Among Community-Based Addiction Treatment Programs Targeting Vulnerable Patient Groups

ABSTRACT A national sample of addiction treatment Program Directors (N = 296) were assessed regarding their attitudes about pharmacological treatment for addiction disorders. Multivariable analyses indicate that directors who worked in organizations affiliated with research institutions and who had more professional experience had significantly more positive attitudes about a range of pharmacological therapies. Also, directors in organizations serving higher percentage homeless clients and clients with severe and persistent mental illness had more negative attitudes toward use of buprenorphine. Community-based organizations providing addiction treatment to specific vulnerable client groups exhibit more negative attitudes about pharmacological evidence-based practices and may underutilize those practices.