Treatment Of Addictive Disorders Research Articles

Perspectives on addiction-related problems in India.

To offer insights into various salient substance use and addictive behaviours related aspects as applicable to India. We synthesised the published literature on addictive disorders from India. While not a systematic review of all available literature, the synthesis captures relevant themes including salient epidemiological findings, issues related to the prevention and management services targeted at addictive disorders, key observations in the context of the state of addiction science in the country, the policy status and its implications for the country. In general, the prevalence of substance use in India seems to be lower compared with global averages. For opioids, the prevalence rate is higher than the global average. Addiction prevention and treatment options for persons with addictive disorders in India can be best described as 'diverse': there is a wide range of services available, which vary across settings. Some models, services and products aimed at prevention and treatment of addictive disorders have been developed in the country. The policy, regulatory framework and programs targeted at addictions are not entirely in sync with the science. India has a substantial body of addiction science research. The addiction landscape in India is complex and evolving. There is a heterogeneity not only across the different themes related to addiction, but also within the themes across different parts of the country.

Affects, dissociative symptoms and addictive behaviours: Insights from clinical and non-clinical samples

ObjectivesCurrent literature links substance abuse with primary emotions and dissociative symptoms, but little research combines these relationships. This study investigates the clinical significance of these concepts and the mediating role of dissociative symptoms in the relationship between primary emotions and substance abuse. MethodsStudy 1 included 517 adults (77.6 % female, Age: M = 27.84) from the community. Path analysis examined the relationships between primary emotions (BANPS-GL), dissociative symptoms (FDS), psychopathology (BSI-18), and substance abuse (WHO-ASSIST). Study 2 involved 73 inpatients with substance use disorders (SUD) compared to 73 matched individuals from the general population, totalling 146 participants (21.9 % female, Age: M = 34.90). MANOVA and Discriminant analysis assessed the differences and contributions of the variables to group separation. ResultsSignificant correlations were found between the FDS and the WHO-ASSIST, all BSI-scales, and all primary emotions except SEEKING. The FDS was a key mediator between primary emotions and substance abuse (WHO-ASSIST) and effectively differentiated between the clinical and general population groups. ConclusionsThese findings highlight the role of dissociative symptoms in the relationship between emotional experiences and addictive behaviour. Future research should consider dissociative symptoms in the prevention and treatment of addictive disorders.

Application of Covalent Organic Framework-Based Solid-Phase Microextraction for Efficient and Direct Analysis of Neurotransmitters in the Striatum of Nicotine-Addicted mice

This study developed and validated a novel solid-phase microextraction (SPME) method based on covalent organic framework (COF) for the simultaneous analysis of 10 neurotransmitters (NTs) in mice brain tissue using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). The synthesized COF was utilized as SPME fiber coating, exhibited a suitable pore size and macromolecule exclusion capability, ensuring excellent thermal stability and high adsorption efficiency for NTs. This allowed direct extraction from brain homogenates, eliminating the need for protein precipitation. And the COF-based SPME fiber exhibited good reusability throughout eight successive recycling cycles. The SPME-UHPLC method demonstrated excellent linearity (correlation coefficients > 0.99), low intra- and inter-day precision (RSDs ≤ 9.5 % and ≤ 10.6 %, respectively), and acceptable matrix effects (ranging 84.3 % to 117.3 %). The developed method was then applied to analyze NTs in the striatum of nicotine-addicted mice, and the statistical analysis revealed significant shifts in the concentrations of dopaminergic, serotonergic, glutamatergic, addiction and deepened the understanding of addiction's neurobiology. This method offers a sensitive and efficient approach for extracting polar NT analytes in complex matrices, profiling NT alterations linked to addiction, and holds potential for early detection and treatment of addiction disorders. It could contribute significantly to addiction neurobiology and neurological disease research.

Driving innovation in addiction treatment: role of transcranial magnetic stimulation.

Addictions comprises heterogenous psychiatric conditions caused by the complex interaction of genetic, neurobiological, psychological, and environmental factors with a chronic relapsing-remitting pattern. Despite the long-standing efforts of preclinical and clinical research studies, addiction field has seen relatively slow progress when it comes to the development of new therapeutic interventions, most of which failed to demonstrate a significant efficacy. This is likely due to the very complex interplay of many factors that contribute to both the development and expression of addictions. The imbalance between the salience and the reward brain network circuitry has been proposed as the neurobiological mechanisms explaining the pathognomonic symptoms of addictions.Non-invasive neuromodulation techniques have been proposed as a promising therapeutic intervention to restore these brain circuits dysfunctions. Here, we propose a multi-level strategy to innovate the diagnosis and the treatment of addictive disorders.

Decreased consumption of natural rewards in rhesus monkeys with prolonged methamphetamine abstinence.

Relapse to drug use is a major clinical challenge in the treatment of addictive disorders, including psychostimulant use and may be exacerbated by reduced sensitivity to natural, non-drug reward. Given the relatively limited set of outcomes, and short withdrawal time in rodent studies, we conducted a more detailed assessment of the response to natural rewards in methamphetamine (METH) naive versus exposed monkeys during long-term abstinence. This study introduced an improved sucrose preference test (iSPT) to assess natural reward seeking and consumption in monkeys with long-term abstinence after methamphetamine (METH) use. The test was administered to sixteen naive monkeys and five METH exposed monkeys that had been abstinent for at least 3 months. METH exposed monkeys showed a lower sucrose preference score in both the iSPT (z = -2.10, p = 0.036) and the sucrose preference test (z = -2.61, p = 0.009). The sucrose preference score was significantly correlated with the latency of the establishment of stable sucrose-preference (r = -0.76, df = 46, p < 0.001) but not with the other variables. Furthermore, water-sucrose switch latency and switch times were significantly negatively correlated (r = -0.50, df = 20, p = 0.02). These results show reductions in natural reward consumption during long-term methamphetamine abstinence.

A systematic review of quality of life and health-related quality of life as outcomes in substance and behavioural addictions.

Consideration of an individual's quality of life (QoL) can benefit assessment and treatment of addictive disorders, however, uncertainty remains over operationalisation of the construct as an outcome and the appropriateness of existing measures for these populations. This systematic review aimed to identify and evaluate QoL and health-related QoL outcome instruments used in addiction-related risk and harm research and map their conceptualised domains. Three electronic databases and a specialised assessment library were searched on 1 February 2022 for QoL or health-related QoL outcome instruments used with addiction-related risk and harm populations. PRISMA reporting guidance was followed and included outcome instruments were appraised using mixed methods. Psychometric evidence supporting their use was summarised. The COSMIN risk of bias tool was used to assess validation studies. A total of 298 articles (330 studies) used 53 outcome instruments and 41 unique domains of QoL. Eleven instruments' psychometric properties were evaluated. No instrument was assessed for any parameter in at least five studies for meta-analytic pooling. Cronbach's alpha (α) internal consistency was the most widely assessed parameter with the AQoLS, WHOQOL-BREF, ALQoL-9, Q-LES-Q-SF, SF-12, DUQoL, QLI and SF-36 displaying promising statistics (α > 0.70). Many instruments have been utilised. However, a significant proportion of studies applied a small number of instruments with minimal high-quality validation evidence supporting their use within addiction-related risk and harm. Promising instruments are recommended, however, the paucity of supporting evidence limits confidence in the reliability and validity of QoL measurement in these populations.

Буспирон в терапии аддиктивных расстройств: прошлое, настоящее, будущее

Buspirone is a representative of an innovative class of anxiolytics (non-benzodiazepine series), used for monotherapy or as part of combined therapy with antidepressants for generalized anxiety disorder, as well as for augmentation of antidepressant therapy. The article is devoted to the buspirone use in the treatment of addictions connected with alcohol, nicotine, opioid. Experimental study results of the buspirone effect on alcohol consumption are presented The article also describes buspirone mechanisms of action underlying its effects as the additional means for addiction therapy. It is emphasized that azapirone buspirone has little addictive potential, has a favorable safety and tolerability profile, and does not cause withdrawal symptoms. Comorbidity problem of anxiety and alcohol dependence is revealed and complex therapy expediency of such patients is substantiated. Buspirone, a partial agonist of 5-HT1A receptors and an antagonist of dopamine receptors D2, D3 and D4, helps to reduce alcohol consumption, facilitates opioid withdrawal syndrome. It is noted that buspirone has low potential to cause dependence, which may be due to the lack of effect on opiate receptors. It is proved that the effect on dopaminergic receptors of the 3rd subtype can become a new treatment tactics for addiction therapy. KEYWORDS: buspirone, anxiety, alcohol abuse, alcohol dependence, addictions. FOR CITATION: Petrova N.N. Buspirone in the treatment of addictive disorders: past, present, future. Russian Medical Inquiry. 2023;7(10):644–649 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-5.

Targeting the endocannabinoid system in the treatment of addiction disorders

Targeting the endocannabinoid system in the treatment of addiction disorders

Targeting the endocannabinoid system in the treatment of addiction disorders

This disquisition provides historical context illustrating the psychosocial, political, and bureaucratic barriers to applying a biomolecular approach to substance use disorders, focusing on what are arguably the most stigmatized molecules in America. It provides a biomolecular treatment strategy designed to mitigate multiple types of addiction by influencing the dopamine and serotonin neurotransmitters’ activity through phytocannabinoid supplementation of the endocannabinoid system and proposes a strategy for circumventing the bureaucratic obstacles.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Trends in Psychotropic Medication Prescriptions in Urban China From 2013 to 2017: National Population-Based Study.

Purpose: Psychotropic medications are commonly used for treating mental disorders; however, there is currently no study on how commonly they are used in China. This study reported the trends in psychotropic medications prescriptions in urban China.Methods: A national population-based study was conducted using the China Health Insurance Research Association database to estimate the period prescription prevalence of 11 major classes of psychotropic medications annually during 2013–2017. The World Health Organization Anatomical Therapeutic Chemical (ATC) classification codes were used to identify psychotropic medications.Results: The prescription prevalence of any psychotropic medication increased from 8.110% (8.106–8.114%) in 2013 to 11.362% (11.357–11.366%) in 2017. The prescription prevalence of six classes increased significantly during 2013–2017, including sedatives-hypnotics (from 3.177 to 5.388%), anxiolytics (from 1.436 to 2.200%), antiepileptic drugs (from 1.416 to 2.140%), antipsychotics (from 0.809 to 1.156%), antidepressants (from 0.891 to 1.045%), and psycholeptic polypills (from 0.682 to 0.866%). The prescription prevalence of antidementia drugs increased from 0.069 to 0.122%, and mood stabilizers increased from 0.029 to 0.037%, although not statistically significant. The prescription prevalence of nootropic drugs, attention deficit hyperactivity disorder (ADHD) medications and drugs used in the treatment of addictive disorders was largely stable. Psychotropic medication prescription increased with age for all classes except for ADHD medications and mood stabilizers.Conclusion: Increasing trends in prescription prevalence were observed for most classes of psychotropic medications in urban China, although the prevalence was still lower than that in most developed countries. Further research is warranted to explore the potential treatment gap between China and most developed countries.

Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective.

(1) Background: Virtual reality (VR) has been investigated in a variety of psychiatric disorders, including addictive disorders (ADs); (2) Objective: This systematic review evaluates the current evidence of immersive VR (using head-mounted displays) in the clinical assessment and treatment of ADs; (3) Method: PubMed and PsycINFO were queried for publications up to November 2020; (4) Results: We screened 4519 titles, 114 abstracts and 85 full-texts, and analyzed 36 articles regarding the clinical assessment (i.e., diagnostic and prognostic value; n = 19) and treatment (i.e., interventions; n = 17) of ADs. Though most VR assessment studies (n = 15/19) showed associations between VR-induced cue-reactivity and clinical parameters, only two studies specified diagnostic value. VR treatment studies based on exposure therapy showed no or negative effects. However, other VR interventions like embodied and aversive learning paradigms demonstrated positive findings. The overall study quality was rather poor; (5) Conclusion: Though VR in ADs provides ecologically valid environments to induce cue-reactivity and provide new treatment paradigms, the added clinical value in assessment and therapy remains to be elucidated before VR can be applied in clinical care. Therefore, future work should investigate VR efficacy in randomized clinical trials using well-defined clinical endpoints.

Naloxone-induced conditioned place aversion score and extinction period are higher in C57BL/6J morphine-dependent mice than in Swiss: Role of HPA axis

Intense associative memories develop between drug-paired contextual cues and the drug withdrawal associated aversive feeling. They have been suggested to contribute to the high rate of relapse. Our study was aimed to elucidate the involvement of hypothalamic-pituitary-adrenocortical (HPA) axis activity in the expression and extinction of aversive memory in Swiss and C57BL/6J (B6) mice. The animals were rendered dependent on morphine by i.p. injection of increasing doses of morphine (10–60 mg/kg). The negative state associated with naloxone (1 mg/kg s.c.) precipitated morphine withdrawal was examined by using conditioned place aversion (CPA) paradigm. B6 mice obtained a higher aversion score and took longer to extinguish the aversive memory than Swiss mice. In addition, corticosterone levels were increased after CPA expression. Moreover, corticosterone levels were decreased during CPA extinction in Swiss mice without changes in B6 mice. Pre-treatment with the selective CRF1 receptor antagonist CP-154,526 before naloxone, impaired morphine-withdrawal aversive memory acquisition and decreased the extinction period. CP-154,526 also antagonized the increased levels of corticosterone observed after CPA expression in Swiss mice, without any changes in B6 mice. These results indicate that HPA axis could be a critical factor governing opioid withdrawal memory storage and retrieval, but in a strain or stock-specific manner. The differences observed between Swiss and B6 mice suggest that the treatment of addictive disorders should consider different individual predisposition to associate the aversive learning with the context.

Systematic Review: Treatment for Addictive Disorder in Transplant Patients.

The number of patients with substance use disorders in need for organ transplantation is expected to increase. Patients with addictive disorders are considered a higher risk of negative outcomes after organ transplantation due to the impact of substance use upon medical status and adherence with treatment. The goal of this systematic review was to assess the current literature on treatment for addiction transplant candidates and recipients. We conducted a literature search within four databases PubMed, MEDLINE, EMBASE, and PsycINFO for publications dated 1/1/1988 to 12/31/2018. Out of 3108 articles identified through database screening, 39 were included in the qualitative synthesis. Sixteen studies described addiction treatment in groups over five patients. All the articles included liver transplant patients, with only two studies including patients who needed a kidney or a heart transplant. Nine articles described treatment of alcohol use disorder exclusively, five focused on treatment of opioid use disorders. Although 9 of 16 studies were prospective, the variability of the treatment intervention, outcome measures, and control group when applicable prohibited a meaningful meta-analysis of the results. Eight articles that described the case reports are analyzed separately. Promising treatment options for alcohol use disorder have been reported but more studies are needed to confirm their effectiveness and their feasibility. Methadone appears effective for opioid disorder in transplant patients. To the best of our knowledge, this is the first systematic review on the treatment of addictive disorders in transplant patients. (Am J Addict 2020;29:445-462).

Change & Grow® Therapeutic Model for Addiction: Preliminary Results of an Interventional Study.

The last years have seen a paradigm shift concerning addictive disorders, indicating the necessity to study alternative therapeutic models. In this longitudinal study, the objective was to explore the impact of the Change & Grow® therapeutic model developed and used by VillaRamadas on certain psychological variables that frequently appear associated with addiction. A repeated measures (first and last weeks of treatment) design was used, and the psychological measurements were Beck’s Depression Inventory II (BDI-II), Suicide Ideation Questionnaire (SIQ), State-Trait Anxiety Inventory (STAI), and Montreal Cognitive Assessment (MoCA). Results include 26 (16 male and 10 female) patients. Age varied between 17 and 64 years (M = 35.62, SD = 12.60) and duration of treatment between 91 and 193 days (M = 147.35, SD = 27.05). The MoCA total result was significantly higher in the last week of treatment. The results of BDI-II, SIQ, and STAI (both state and trait) were all significantly lower. Neither duration of treatment nor self-reported motivation presented significant correlation values with the difference between measures for any of the variables. The Change & Grow® therapeutic model appears to have an impact on relevant psychological variables in patients admitted into treatment for addictive disorders.

Brief Assessment of Cigarette Demand (BACD): Initial development and correlational results in adults and adolescents.

Developing briefer behavioral economic measures is an important priority to ensure that these measures can be used in a variety of different contexts and to reduce participant burden. We developed and sought to validate a Brief Assessment of Cigarette Demand (BACD). A 17-item Cigarette Purchase Task (CPT) and a 3-item BACD were completed concurrently in 2 community samples of smokers (Study 1, adult smokers [n = 80] with substance use disorders; Study 2, adolescent smokers [n = 81]). Responses on the CPT and BACD were compared on the following demand indices: (a) intensity (the number of cigarettes requested at no cost), (b) Omax (the maximum expenditure on cigarettes in a 24-hr period), and (c) breakpoint (the point at which consumption is totally suppressed/no cigarettes are purchased). Correlations of demand indices with cigarettes per day and nicotine dependence were calculated. Measures of cigarette demand on the CPT and BACD were significantly correlated, albeit at very different magnitudes, for all 3 indices in the adult sample (intensity, r = .86; breakpoint, r = .23; and Omax, r = .43) and for 2 of the indices in the adolescent sample (intensity, r = .97; breakpoint, r = .33). The CPT and BACD relationships with smoking and nicotine dependence were similar for breakpoint and intensity but not for Omax. As initial findings were mixed, additional validation work is recommended to improve psychometric properties before adoption. Valid brief measures of demand could have utility for research and treatment of addictive disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

NIBS in addiction: Neurobiological mechanisms and clinical outcomes

Addiction is correlated with the dysfunction of definite neural circuitry involving deep as well as superficial brain regions. Among the deep structures are the midbrain ventral tegmental area (VTA) and the nucleus accumbens of the ventral striatum, connected to each other by means of dopaminergic fibers. This pathway is the neural correlate of normal appetitive behaviour and is part of the reward system. Cortical areas such as the dorsolateral prefrontal cortex (DLPFC) exert an inhibitory control over the appetitive behaviours through descending cortico-striatal projections. Non–invasive brain stimulation (NIBS) of these regulatory cortical areas has been shown to modify symptoms of substance use disorders and behavioural addictions in several recent studies. In particular, repetitive Transcranial Magnetic Stimulation (rTMS) over the left DLPFC was shown to be effective in reducing relapse in abstinent tobacco smokers while it did not consistently reduce craving and consumption in current smokers. Moreover, in cocaine-use disorder, craving, substance consumption and anhedonia were found to be reduced by the application of rTMS over the right and/or left DLPFC. Preliminary data also point to a possible role of rTMS in the treatment of non-substance addictive behaviours, such as gambling disorder. In recent years, another promising NIBS technique, i.e. transcranial direct current stimulation (tDCS) was used to reduce the symptoms of various addictive disorders, with mixed results. In conclusion, the growing evidence of NIBS efficacy for the treatment of addictive disorders does warrant further larger-scale randomized controlled studies.

An Old Treatment for an Even Older Problem: Does Psychoanalysis Have a Role in the Treatment of Addictive Disorders? A Review of the Literature.

The fact that addictive disorders have a significant negative impact on the health of the global population is well documented in contemporary health literature. What is less well documented is the uncomfortable realization that the tools in our armament to help individuals who struggle with addictive disorders are limited. Many individuals will spend their lives "cycling" through the addiction treatment continuum only to again be met with relapse. Third-party reimbursement for addiction treatment has focused on time-limited treatments and "brief" therapies with an additional emphasis on support group attendance (aka "free" services) with minimal focus on the fact that brief therapies have poor evidence for efficacy. In this article, we explore an alternative to brief therapies by reaching back to the earliest and most comprehensive treatment we have for behavioral change-psychoanalysis. This article engages in a literature review to determine whether sufficient evidence exists for the use of psychoanalysis as a treatment for addictive disorders. Implications for advanced practice psychiatric nurses are discussed.

Heterogeneous dopamine signals support distinct features of motivated actions: implications for learning and addiction.

Despite decades of research, investigations into effective neural and pharmacological therapies for many drugs of abuse, such as cocaine, have produced no FDA-approved approaches. This difficulty derives from the complexity of substance use disorders, which encompass a variety of behavioral, psychological, and neural circuit-based changes that occur as a result of repeated experience with the drug. Dopamine signaling has been demonstrated to play a key role in several aspects of drug abuse—from mediating its reinforcing properties and drug-seeking to triggering relapse—while also mediating a number of important aspects of normal (nondrug related) motivated behaviors and actions. Real-time recording methods such as in vivo voltammetry, electrophysiology, and calcium imaging demonstrate that the signaling properties of dopamine for motivationally relevant stimuli are highly dynamic and spatiotemporally circumscribed within afferent target regions. In this review, we identify the origins and functional consequences of heterogeneous dopamine release in the limbic system, and how these properties are persistently altered in the drug-experienced brain. We propose that these spatiotemporally parallel dopaminergic signals are simultaneously available to the animal, but that these circuits are impaired following prolonged drug experience by disrupting the location and content of dopamine signals in afferent target regions. These findings are discussed in the context of relapse and pathways to discovering new treatments for addiction disorders.

Oxytocin Reduces Cigarette Consumption in Daily Smokers.

Despite widespread knowledge of the dangers of cigarette consumption, smoking continues to be a public health concern. One compound that has shown potential for treatment in preclinical models is the neuropeptide oxytocin (OT). The purpose of the present study was to examine the effects of intranasal oxytocin on cigarette craving, behavioral economic demand for cigarettes, and cigarette consumption, in regular smokers after 18 hours of abstinence. Otherwise healthy daily smokers (n = 35) completed two sessions where they received OT (40 IU intranasal) or placebo (PBO) and completed measures of craving and cigarette demand, and they were given six opportunities to smoke partial cigarettes in exchange for money. On average participants smoked few cigarettes after receiving OT than after receiving PBO, and they reported less desire for additional cigarettes during the smoking period. OT did not affect cigarette demand or standardized measures of cigarette craving. This study suggests that OT decreases some indices of smoking desire and consumption, providing modest support for the idea that OT might be effective for reducing cigarette smoking. This study provides new evidence that oxytocin might have clinical value in the treatment of addictive disorders, in this case tobacco addiction. The study adds to a growing literature suggesting that this neuropeptide, which is mainly known for its role in social bonding and attachment, may also affect mood and motivational states relevant to addiction.