Variety Of Substance Use Disorders Research Articles

Off-Label Use of Lamotrigine and Naltrexone in the Treatment of Ketamine Use Disorder: A Case Report.

Ketamine is a dissociative anesthetic increasingly utilized in United States medical settings for the treatment of mental health conditions. Additionally, it is increasingly used in nonmedical settings for its dissociative properties. While nonmedical ketamine use and ketamine use disorder (KUD) have been observed internationally, KUD, and approaches to its treatment, have not been previously described in the US. We present the case of a 32-year-old man with KUD who experienced severe cravings despite receipt of residential and intensive outpatient substance use disorder treatment. He resumed use after an initial period of abstinence and was subsequently started on lamotrigine and naltrexone for treatment of depressive symptoms and cravings. This combination altered his experience while on ketamine, resulting in nausea and decreased hallucinogenic effects. In addition, it substantially decreased his cravings, aiding him in achieving longer-term abstinence in combination with receipt of dialectical behavioral therapy, familial support, and involvement in 12-step programming. KUD is a poorly described condition that may become more prevalent as US ketamine use increases. Combining treatment of depressive symptoms and cravings, in this case with lamotrigine and naltrexone, may be a promising pharmacotherapeutic strategy. Lamotrigine, an antiepileptic with glutamate modulating effects, has been utilized to decrease cravings in a variety of substance use disorders. Naltrexone is an opioid antagonist approved for alcohol use disorder and opioid use disorder and is used off-label for stimulant use disorder. This combination offers a possible pharmacotherapeutic option for KUD with more research needed to further evaluate.

Patient and Staff Perspectives on the Impacts and Challenges of Hospital-Based Harm Reduction

Harm reduction is associated with improved health outcomes among people who use substances. As overdose deaths persist, hospitals are recognizing the need for harm reduction services; however, little is known about the outcomes of hospital-based harm reduction for patients and staff. To evaluate patient and staff perspectives on the impact and challenges of a hospital-based harm reduction program offering safer use education and supplies at discharge. This qualitative study consisted of 40-minute semistructured interviews with hospitalized patients receiving harm reduction services and hospital staff at an urban, safety-net hospital in California from October 2022 to March 2023. Purposive sampling allowed inclusion of diverse patient racial and ethnic identities, substance use disorders (SUDs), and staff roles. Receipt of harm reduction education and/or supplies (eg, syringes, pipes, naloxone, and test strips) from an addiction consult team, or providing care for patients receiving these services. Interviews were analyzed using thematic analysis to identify key themes. A total of 40 participants completed interviews, including 20 patients (mean [SD] age, 43 [13] years; 1 American Indian or Alaska Native [5%], 1 Asian and Pacific Islander [5%], 6 Black [30%]; 6 Latine [30%]; and 6 White [30%]) and 20 staff (mean [SD] age 37 [8] years). Patients were diagnosed with a variety of SUDs (7 patients with opioid and stimulant use disorder [35%]; 7 patients with stimulant use disorder [35%]; 3 patients with opioid use disorder [15%]; and 3 patients with alcohol use disorder [15%]). A total of 3 themes were identified; respondents reported that harm reduction programs (1) expanded access to harm reduction education and supplies, particularly for ethnically and racially minoritized populations; (2) built trust by improving the patient care experience and increasing engagement; and (3) catalyzed culture change by helping destigmatize care for individuals who planned to continue using substances and increasing staff fulfillment. Black and Latine patients, those who primarily used stimulants, and those with limited English proficiency (LEP) reported learning new harm reduction strategies. Program challenges included hesitancy regarding regulations, limited SUD education among staff, remaining stigma, and the need for careful assessment of patient goals. In this qualitative study, patients and staff believed that integrating harm reduction services into hospital care increased access for populations unfamiliar with harm reduction, improved trust, and reduced stigma. These findings suggest that efforts to increase access to harm reduction services for Black, Latine, and LEP populations, including those who use stimulants, are especially needed.

Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey.

BackgroundObservational data and preliminary studies suggest serotonin 2A agonist psychedelics may hold potential in treating a variety of substance use disorders (SUDs), including opioid use disorder (OUD).AimsThe study aim was to describe and analyze self-reported cases in which naturalistic psychedelic use was followed by cessation or reduction in other substance use.MethodsAn anonymous online survey of individuals reporting cessation or reduction in cannabis, opioid, or stimulant use following psychedelic use in non-clinical settings.ResultsFour hundred forty-four respondents, mostly in the USA (67%) completed the survey. Participants reported 4.5 years of problematic substance use on average before the psychedelic experience to which they attributed a reduction in drug consumption, with 79% meeting retrospective criteria for severe SUD. Most reported taking a moderate or high dose of LSD (43%) or psilocybin-containing mushrooms (29%), followed by significant reduction in drug consumption. Before the psychedelic experience 96% met SUD criteria, whereas only 27% met SUD criteria afterward. Participants rated their psychedelic experience as highly meaningful and insightful, with 28% endorsing psychedelic-associated changes in life priorities or values as facilitating reduced substance misuse. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with greater reduction in drug consumption.ConclusionsWhile these cross-sectional and self-report methods cannot determine whether psychedelics caused changes in drug use, results suggest the potential that psychedelics cause reductions in problematic substance use, and support additional clinical research on psychedelic-assisted treatment for SUD.

An examination of factors associated with tobacco smoking amongst patients presenting with deliberate self-poisoning

An examination of factors associated with tobacco smoking amongst patients presenting with deliberate self-poisoning

The effect of N-acetylcysteine on alcohol use during a cannabis cessation trial

The effect of N-acetylcysteine on alcohol use during a cannabis cessation trial

Erratum to: Self-Reported Chronic Pain as a Predictor of Relapse Post Residential Addiction Treatment: a 6-Month Follow-Up Pilot Study

With the rise of prescription opioids and the subsequent increase in opioid use disorders, the relationship between chronic pain, opioid use disorders, and drug replacement therapy has received great attention. However, few studies have examined the relationship between chronic pain and relapse from a variety of substance use disorders following residential addiction treatment. This pilot study seeks to examine the role of self-reported chronic pain as a predictor of relapse from a variety of substance use disorders for individuals who attended residential addiction treatment. In 198 adult patients, a Spearman’s rank correlation coefficient determined that there was not a significant relationship between self-reported chronic pain and relapse at 6 months following treatment: r (198) = −.056, p = .433. However, among those self-reporting chronic pain, women reported slightly more slips and complete relapses than men. The findings of this study can inform professionals working within a residential addiction treatment setting.

S.16.05 - Attenuated resting-state default mode network connectivity in remitted depression after sad autobiographical recall

S.16.05 - Attenuated resting-state default mode network connectivity in remitted depression after sad autobiographical recall

S.23.04 - Bidirectional relations between MDMA and social context: crosstalk between drug response and social interaction

S.23.04 - Bidirectional relations between MDMA and social context: crosstalk between drug response and social interaction

S.14.04 - The role of (epi)genetics in antidepressant drug efficacy

S.14.04 - The role of (epi)genetics in antidepressant drug efficacy

Effectiveness of Inhaled Loxapine in Dual-Diagnosis Patients: A Case Series.

Episodes of psychotic agitation are frequent in patients with dual diagnosis, that is, in patients with concomitant psychiatric and substance use disorders. Rapid intervention is needed to treat the agitation at a mild stage to prevent the escalation to aggressive behavior. Inhaled loxapine has been demonstrated to rapidly improve symptoms of mild-to-moderate agitation in adults with psychiatric disorders (schizophrenia and bipolar disorder), but data on patients with dual diagnosis are scarce. This study is a retrospective review of data from a case series of patients with dual diagnosis, which were attended for symptoms of agitation while at the emergency room (n = 9), in the outpatient clinic (n = 4), or during hospitalization (n = 1) at 1 center in Spain. All patients received inhaled loxapine for treating the agitation episodes. Data from 14 patients with dual diagnosis were reviewed. All patients had 1 or more psychiatric disorders (schizophrenia, bipolar I disorder, drug-induced psychotic disorder, posttraumatic stress, borderline or antisocial personality disorder, depression, or anxiety) along with a variety of substance use disorders (alcohol, cocaine, cannabis, amphetamines, hypnotics and antianxiety drugs, caffeine, or street drugs). Overall, only 1 dose of inhaled loxapine (9.1 mg) was needed to calm each patient during an acute episode of agitation. Inhaled loxapine was rapid, effective, and well accepted in all dual-pathology patients presenting with acute agitation in the emergency setting. Inhaled loxapine facilitated both patient cooperation and an adequate management of his or her disease.

Profiles of acculturation among Hispanics in the United States: links with discrimination and substance use

Recent research suggests that acculturation is a multifaceted construct with implications for substance use among Hispanics. However, few, if any, studies examining profiles of acculturation have been conducted using national samples. Moreover, no cluster-based studies have examined how acculturation relates to discrimination and substance use disorders among Hispanics in the United States. The present study, employing Wave 2 data on Hispanics (n = 6,359) from the National Epidemiologic Survey of Alcohol and Related Conditions, aims to address these gaps. We use latent profile analysis to identify profiles of acculturation among Hispanics in the United States and, in turn, examine the relationships between membership in these profiles and experiences of discrimination and the prevalence of substance use disorders. A five-class solution was the optimal modeling of the data. Classes were identified as Class 1: Spanish-dominant/strongly separated (17 %), Class 2: Spanish-dominant/separated (18 %), Class 3: bilingual/bicultural (33 %), Class 4: English-dominant/bicultural (16 %), and Class 5: English-dominant/assimilated (16 %). Bilingual/bicultural Hispanics (Class 3) reported the highest prevalence of discrimination (31 %). Spanish-language dominant Hispanics (Classes 1 and 2) reported the lowest prevalence of substance use disorders. Significant differences in the prevalence of substance use disorders were observed between the bilingual/bicultural (Class 3) and English-dominant/assimilated classes (Class 5), but no differences were noted between the two English-dominant classes (Classes 4 and 5). Study findings indicate that acculturation is heterogeneous in its expression among Hispanics and suggest that Hispanics who maintain their Spanish-language capacity are at a substantially lower risk for a variety of substance use disorders.

The Efficacy of Mirtazapine in the Treatment of Cocaine Dependence with Comorbid Depression

Background: Prior findings concerning the use of mirtazapine in the treatment of a variety of substance use disorders and its antagonistic actions at the serotonin 5-HT2A receptor suggest that this drug may have efficacy in the treatment of cocaine dependence in the presence of a depressive disorder. Methods: Depressed cocaine-dependent subjects received either mirtazapine (target dose 45 mg daily) or placebo for 12 weeks. Urine concentrations of benzoylecgonine and self-report were used to assess cocaine consumption. Depression and sleep quality were evaluated using the Hamilton Depression Rating Scale (HAM-D) and the Pittsburgh Sleep Quality Index, respectively. Results: Cocaine consumption during the treatment period did not differ significantly between the mirtazapine (n = 11) and placebo (n = 13) groups in this study. In week 4 sleep latency was significantly lower in the active medication than in the placebo group. Positive effects of mirtazapine treatment on early insomnia were suggested by an item analysis of the HAM-D. Conclusions and Scientific Significance: The results of this study suggest that mirtazapine is superior to placebo in improving sleep in patients with comorbid depression and cocaine dependence, but is not more effective than placebo in reducing cocaine use.

Axis II comorbidity of substance use disorders among patients referred for treatment of personality disorders.

The purpose of this study was to determine the extent of comorbid substance use disorders in patients referred for treatment of personality disorders. Two hundred inpatients and outpatients were assessed by semistructured interviews for substance use and personality disorders. Univariate odds ratios were calculated for groups of substance use disorders and each DSM-III-R axis II disorder; comorbidity among axis II disorders was controlled in multivariate models predicting current or lifetime substance use disorder groups. The impact of personality disorder on chronicity and overall impairment associated with substance use disorders was evaluated. Close to 60% of subjects with substance use disorders had personality disorders. Borderline personality disorder was significantly associated with current substance use disorders, excluding alcohol and cannabis, and with lifetime alcohol, stimulant, and other substance use disorders, excluding cannabis. Antisocial personality disorder was associated with lifetime substance use disorders other than alcohol, cannabis, and stimulants. These relationships remained significant after controlling for the presence of all other personality disorders. There was no evidence that personality disorders increased the chronicity of substance use disorders, but comorbid personality disorders were associated with greater global impairment. Borderline personality disorder may be associated with a wide variety of substance use disorders, especially among patients seeking treatment for personality problems.

The D 2 Dopamine Receptor Gene : A Review of Association Studies in Alcoholism and Phenotypes

The D 2 Dopamine Receptor Gene : A Review of Association Studies in Alcoholism and Phenotypes