Interventions basées sur la pleine conscience en addictologie

Mindfulness-based relapse prevention for cannabis regular users: Preliminary outcomes of a randomized clinical trial

Mindfulness-based approaches have shown their effectiveness in caring for patients with substance use disorders (SUD). Mindfulness-based relapse prevention (MBRP) integrates practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches. This article presents the preliminary results of a study that measures the effectiveness of an MBRP protocol for volunteer cannabis users willing to reduce or stop their consumptions. Twenty cannabis users were randomly assigned to either receive an eight-week outpatient MBRP program or treatment as usual (TAU). Cannabis use was assessed weekly through the timeline follow back (TLFB). Eighty percent of individuals received MBRP treatment and 60% of individuals received TAU completed treatment. Preliminary results did not find significant difference at the end of treatment (week 8) regarding the number of joints smoked. Despite the absence of any significant difference between the two groups, the contribution of mindfulness in the caring of SUD seems encouraging and promising. Many MBRP group participants reported qualitative changes in the way they consumed. This study will be continued in order to evaluate the effectiveness of MBRP on a larger number of subjects.

[Differences in the success rates of inpatient therapy for alcohol and illegal drug abusers. A Replication Study]

INTRODUCTION

Irrespective of the type of psychotherapy used, the abstinence-oriented treatment of drug abusers is less successful than that for alcohol abusers. If, on the other hand, the two groups are parallelized in such a way that the patients are identical with respect to the five characteristics of gender, age, schooling, work situation and partner situation, then there is no difference between the success rates of the drug and alcohol abusers. The aim of this study is to determine whether this result can be replicated in another therapeutic institution.

METHOD

Retrospective field study of 320 abusers of illegal drugs and 320 alcohol abusers who were treated with behaviour therapy. By combining the binary characteristics gender, work situation and age, the drug-dependent patients were divided into 2³=8 groups, and the same number of alcohol abusers were randomly selected for each group. The scheduled period of inpatient treatment was 90 days for the alcohol abusers and 120 days for the drug abusers. Every week the patients had one session of individual psychotherapy and four to five group therapy sessions. According to the indications, the certified behaviour therapists implemented the following interventions including behaviour analysis, relapse prevention, cognitive therapy, self-management and behavioural family therapy. Comparison of the success rates was carried out using the Chi² test, and changes in the psychological findings were tested with one-way variance analysis.

RESULTS

There was no difference between drug and alcohol abusers with respect to the rate of therapy termination according to plan (around 80%). A total of 48% of the drug abusers and 41 % of the alcohol abusers who could be followed up had been continuously abstinent at the one-year catamnesis without a single relapse. There were also no differences between the two groups when it was assumed that the patients who could not be followed up had relapsed. In the case of both the drug and alcohol abusers the abstinence rate was highest in over-29-year-old employed men (57.6%; 48.4%). The abstinence rate was lowest in employed female drug abusers (27.8%) and young, unemployed female drug abusers (0%, n=11).

DISCUSSION

What appears to influence the abstinence rate after inpatient treatment is not only the type of substance consumed but also sociodemographic characteristics. In addition to individually tailored therapy, our results confirm the importance of a highly differentiated presentation of the outcomes of therapy in the specialist literature. An average rate of abstinence (e.g. 30%) is insufficient to evaluate an intervention unless information is also provided about the patients for which the intervention is suitable and those for which it is not. In accordance with the Reproducibility Project, we consider replication studies essential in psychotherapy, even though in practice the considerable methodical requirements can only be partially fulfilled.

Frequency of energy drink use predicts illicit prescription stimulant use

BACKGROUND

The purpose of this study was to examine energy drink (ED) usage patterns and to investigate the illicit use of prescription stimulants among college students.

METHODS

A sample of 267 undergraduate and graduate students (mean age of 22.48 among stimulant users) from a large midwestern university and its branch campus locations voluntarily participated in the study.

RESULTS

Among prescription stimulant users without a valid medical prescription, Mann-Whitney U tests and logistic regression analysis revealed that the frequency of ED use was a significant predictor of the illicit use of prescription stimulants. Moreover, frequency of ED consumption was a significant predictor of the illicit use of prescription stimulant medications, with the odds for using increasing by .06 with each additional day of ED use past 0 day (odds for use = 1.06, P =.008).

CONCLUSIONS

Results indicate that the frequency of ED use is a significant predictor of the illicit use of prescription stimulants. All prescription stimulant users with or without a valid script also used EDs. This finding is important to practitioners because of the harmful interactions (eg, serotonin syndrome) that can occur when ED ingredients (eg, ginseng, yohimbine, evodamine, etc) are mixed with prescription stimulants.

Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series

Psychogenic nonepileptic seizures (PNES) were first described in the medical literature in the 19th century, as seizure-like attacks not related to an identified central nervous system lesion, and are currently classified as a conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). While a universally accepted and unifying etiological model does not yet exist, several risk factors have been identified. Management of PNES should be based on interdisciplinary collaboration, targeting modifiable risk factors. The first treatment phase in PNES is patient engagement, which is challenging given the demonstrated low rates of treatment retention. Acute interventions constitute the next phase in treatment, and most research studies focus on short-term evidence-based interventions. Randomized controlled pilot trials support cognitive-behavioral therapy. Other psychotherapeutic and psychopharmacological interventions have been less well-studied using controlled and uncontrolled trials. Within the discussion of acute interventions, we present a preliminary evaluation for feasibility of a mindfulness-based psychotherapy protocol in a very small sample of PNES patients. We demonstrated in 6 subjects that this intervention is feasible in real-life clinical scenarios and warrants further investigation in larger scale studies. The final treatment phase is long-term follow-up. Long-term outcome studies in PNES show that a significant proportion of patients remains symptomatic and experiences continued impairments in quality of life and functionality. We believe that PNES should be understood as a disease that requires different types of intervention during the various phases of treatment.

Increased Energy Drink Use as a Predictor of Illicit Prescription Stimulant Use

BACKGROUND

The purpose of this study was to examine energy drink usage patterns and to investigate the relationship between energy drink use and illicit use of prescription stimulants among college students.

METHODS

A sample of 605 undergraduate and graduate students (mean age±SD: 21.96±4.216) from a large midwestern university voluntarily participated in the study.

RESULTS

Of the participants, 48.9% (n=296) reported using energy drinks in the past 30 days, whereas 25.3% (n=153) reported using prescription stimulant drugs in the past 30 days. Among prescription stimulant users without a valid medical prescription, Mann-Whitney U tests and logistic regression analysis revealed that the frequency of energy drink consumption was a significant predictor of illicit prescription stimulant use, with the odds for use increasing by 14% with each additional day of energy drink use (odds ratio for using=1.143, P≤.001). Analyses revealed statistically significant differences (P<.05) between prescription stimulant users and nonusers for all energy drink use variables, with the strongest predictors of prescription stimulant use being the number of days using energy drinks in the past 30 days and number of energy drink binges in the past 30 days.

CONCLUSIONS

Results indicate that the frequency of energy drink use was a significant predictor of the illicit use of prescription stimulants.

Risk perception and emotional coping: a pathway for behavioural addiction?

This article summarizes current concepts of the working memory with regard to its role within emotional coping strategies. In particular, it focuses on the fact that the limited capacity of the working memory to process now-relevant information can be turned into an advantage, when the individual is occupied by dealing with unpleasant emotion. Based on a phenomenon known as dual-task interference (DTI), this emotion can be chased by intense arousal due to clearly identifiable external stressors. Thus, risk perception might be used as a 'DTI inductor' that allows avoidance of unpleasant emotion. Successful mastery of risk adds a highly relevant dopaminergic component to the overall experience. The resulting mechanism of implicit learning may contribute to the development of a behavioural addiction. Besides its putative effects in the development of a behavioural addiction, the use of DTI might be of a more general interest for the clinical practice, especially in the field of psychotherapy.