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Saleem HT, West NS, Likindikoki S. Prevalence and predictors of depressive and anxiety symptoms in a sample of women who use drugs in Tanzania: the key role of drug use stigma. BMC Psychiatry 2023; 23:517. [PMID: 37464339 DOI: 10.1186/s12888-023-05008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Globally, women who use drugs face multiple health vulnerabilities, including poor mental health. Little is known about the mental health burden among women who use drugs in sub-Saharan Africa. This cross-sectional study examined the prevalence and predictors of depressive and anxiety symptoms among a sample of women who use drugs in Dar es Salaam, Tanzania. METHODS We administered a cross-sectional survey to a non-random sample of 200 women who use drugs in Dar es Salaam between November 2018 and March 2019. We used descriptive statistics to characterize the study sample and fitted separate logistic regression models to assess depressive and anxiety symptoms and their predictors. RESULTS The percentages of women reporting depressive and anxiety symptoms were 67.5% and 43.7%, respectively. Internalized drug use stigma (AOR = 1.34, 95% CI: 1.03-1.75) and prior attempts to stop heroin use (AOR = 2.99, 95% CI: 1.28-7.00) were associated with depressive symptoms. Enacted drug use stigma from health workers (AOR = 2.02, 95% CI: 1.34-3.04) and anticipated drug use stigma from family (AOR = 1.49, 95% CI: 1.02-2.16) were associated with anxiety symptoms. CONCLUSIONS Depressive and anxiety symptoms were high among our study sample, with higher reports of symptoms of depression than anxiety. Drug use stigma was a key factor that contributed to elevated symptoms of depression and anxiety.
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Affiliation(s)
- Haneefa T Saleem
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Nora S West
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Swigart T, Lee L. “I'm putting a Band-Aid on a bullet hole the only way I know how:” a qualitative study of barriers and facilitators to opioid misuse and recovery in Nevada. Subst Abuse Treat Prev Policy 2022; 17:76. [DOI: 10.1186/s13011-022-00503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
AbstractNevada, like the rest of the United States, is undergoing substantial challenges with opioid misuse and overdose deaths, further exacerbated by the COVID-19 pandemic. While much of the attention around opioid overdose prevention is centered on treatment and recovery, it is important to understand the factors that influence initiation of use, and the function opioids play in people’s everyday lives. We conducted qualitative semi-structured individual interviews using purposive and snowball sampling among 35 people across Nevada with a current or prior history of illegal opioid or nonmedical opioid use. Our study aimed to understand why people start to use drugs, why they continue to use, what motivates them to continue to use or to seek treatment, and why individuals maintain recovery or return to use. We found five significant themes as perceived by the participants: that trauma is a risk factor for drug misuse; that the function of opioids in everyday life is a source of temporary relief but highly disruptive in the longer term; that recovery is most often a complicated and nonlinear process; that there are many barriers to accessing services that are both logistical and psychosocial; and that compassion, hope, and having a sense of purpose are crucial to the recovery process. The experiences of the study participants portray opioid use as a rational choice to escape the emotional ramifications of trauma. However, due to the physiological dependence and physical risk of opioids, drug policies that criminalize addiction, societal stigma, and the barriers to timely access of harm reduction, treatment, and recovery services, opioid users often become trapped in a distressing and dangerous cycle. Lastly, respondents indicated that hope, value, belonging, and purpose are powerful factors in cultivating intrinsic motivation for making positive changes and fostering resilience in the recovery process. Opioid misuse services should help meet basic needs and incorporate holistic approaches to recovery that acknowledge past trauma and the complexity of the recovery process.
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Avalos MP, Guzman AS, Garcia-Keller C, Mongi-Bragato B, Esparza MA, Rigoni D, Sanchez MA, Calfa GD, Bollati FA, Cancela LM. Impairment of glutamate homeostasis in the nucleus accumbens core underpins cross-sensitization to cocaine following chronic restraint stress. Front Physiol 2022; 13:896268. [PMID: 36091376 PMCID: PMC9462460 DOI: 10.3389/fphys.2022.896268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Though the facilitating influence of stress on drug abuse is well documented, the mechanisms underlying this interaction have yet to be fully elucidated. The present study explores the neurobiological mechanisms underpinning the sensitized response to the psychomotor-stimulating effects of cocaine following chronic restraint stress (CRS), emphasizing the differential contribution of both subcompartments of the nucleus accumbens (NA), the core (NAcore) and shell (NAshell), to this phenomenon. Adult male Wistar rats were restrained for 2 h/day for 7 days and, 2 weeks after the last stress exposure (day 21), all animals were randomly assigned to behavioral, biochemical or neurochemical tests. Our results demonstrated that the enduring CRS-induced increase in psychostimulant response to cocaine was paralleled by an increase of extracellular dopamine levels in the NAcore, but not the NAshell, greater than that observed in the non-stress group. Furthermore, we found that CRS induced an impairment of glutamate homeostasis in the NAcore, but not the NAshell. Its hallmarks were increased basal extracellular glutamate concentrations driven by a CRS-induced downregulation of GLT-1, blunted glutamate levels in response to cocaine and postsynaptic structural remodeling in pre-stressed animals. In addition, ceftriaxone, a known GLT-1 enhancer, prevented the CRS-induced GLT-1 downregulation, increased basal extracellular glutamate concentrations and changes in structural plasticity in the NAcore as well as behavioral cross-sensitization to cocaine, emphasizing the biological importance of GLT-1 in the comorbidity between chronic stress exposure and drug abuse. A future perspective concerning the paramount relevance of the stress-induced disruption of glutamate homeostasis as a vulnerability factor to the development of stress and substance use disorders during early life or adulthood of descendants is provided.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Flavia A. Bollati
- Departamento de Farmacología Otto Orsingher, Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Liliana M. Cancela
- Departamento de Farmacología Otto Orsingher, Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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4
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Meshberg-Cohen S, Ross MacLean R, Schnakenberg Martin AM, Sofuoglu M, Petrakis IL. Treatment outcomes in individuals diagnosed with comorbid opioid use disorder and Posttraumatic stress disorder: A review. Addict Behav 2021; 122:107026. [PMID: 34182307 DOI: 10.1016/j.addbeh.2021.107026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Opioid use disorder (OUD) is a public health emergency. Evidence suggests that posttraumatic stress disorder (PTSD) is common among individuals with OUD; however, few studies evaluate whether concurrent diagnoses affect treatment outcomes. This review examines the impact of concurrent diagnoses of OUD and PTSD on treatment outcomes. METHODS A search was performed using articles identified through June 30, 2020 in PubMed, PsycINFO, and EMBASE. Included peer-reviewed articles evaluated individuals with OUD and a PTSD diagnosis via standardized assessment and/or medical record diagnoses, and reported relationships between diagnosis and treatment outcomes and/or other psychiatric conditions. RESULTS Out of 412 articles, 17 studies met inclusion criteria for this review (from 13 databases). Articles included had a total of n = 2190 with OUD, with n = 79 non-OUD comparison participants. Studies examining individuals with OUD revealed comorbid PTSD was associated with more severe addiction, higher rates of depression, attempted suicide, and psychosocial problems. CONCLUSIONS Among individuals with OUD, presence of PTSD is associated with multiple mental health problems. The impact of PTSD on drug use is inconclusive. Although only 5 studies examined psychosocial PTSD treatment, all found PTSD-focused treatment to be effective for those with comorbid OUD. Overall, results suggest the need to better identify PTSD among those with OUD, and to develop and evaluate interventions that are brief, integrative, and easy to implement in clinical settings.
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Affiliation(s)
- Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA.
| | - R Ross MacLean
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Ashley M Schnakenberg Martin
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Ismene L Petrakis
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
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5
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Rigoni D, Avalos MP, Boezio MJ, Guzmán AS, Calfa GD, Perassi EM, Pierotti SM, Bisbal M, Garcia-Keller C, Cancela LM, Bollati F. Stress-induced vulnerability to develop cocaine addiction depends on cofilin modulation. Neurobiol Stress 2021; 15:100349. [PMID: 34169122 PMCID: PMC8209265 DOI: 10.1016/j.ynstr.2021.100349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
Actin dynamics in dendritic spines can be associated with the neurobiological mechanisms supporting the comorbidity between stress exposure and cocaine increase rewards. The actin cytoskeleton remodeling in the nucleus accumbens (NA) has been implicated in the expression of stress-induced cross-sensitization with cocaine. The present study evaluates the involvement of cofilin, a direct regulator of actin dynamics, in the impact of stress on vulnerability to cocaine addiction. We assess whether the neurobiological mechanisms that modulate repeated-cocaine administration also occur in a chronic restraint stress-induced cocaine self-administration model. We also determine if chronic stress induces alterations in dendritic spines through dysregulation of cofilin activity in the NA core. Here, we show that the inhibition of cofilin expression in the NA core using viral short-hairpin RNA is sufficient to prevent the cocaine sensitization induced by chronic stress. The reduced cofilin levels also impede a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor surface expression enhancement and promote the reduction of head diameter in animals pre-exposed to stress after a cocaine challenge in the NA core. Moreover, downregulation of cofilin expression prevents facilitation of the acquisition of cocaine self-administration (SA) in male rats pre-exposed to chronic stress without modifying performance in sucrose SA. These findings reveal a novel, crucial role for cofilin in the neurobiological mechanisms underpinning the comorbidity between stress exposure and addiction-related disorders.
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Affiliation(s)
- Daiana Rigoni
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
| | - Maria P. Avalos
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
| | - Maria J. Boezio
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
| | - Andrea S. Guzmán
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
| | - Gaston D. Calfa
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
| | - Eduardo M. Perassi
- Instituto de Investigaciones en Fisicoquímica de Córdoba (INFIQC), Departamento de Química Teórica y Computacional, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
| | - Silvia M. Pierotti
- Cátedra de Bioestadística I y II (Departamento de Matemática), Facultad de Ciencias Exactas Físicas y Naturales, Universidad Nacional de Córdoba, Avenida Velez Sarfield 161, (5000), Córdoba, Argentina
| | - Mariano Bisbal
- Instituto de Investigación Médica Mercedes y Martin Ferreyra, INIMEC-CONICET, Universidad Nacional de Córdoba, Friuli 2434, Colinas de Vélez Sarsfield (5016) Córdoba, Argentina
| | - Constanza Garcia-Keller
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC, 29425, USA
| | - Liliana M. Cancela
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
| | - Flavia Bollati
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre and Medina Allende, Ciudad Universitaria, (5000), Córdoba, Argentina
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6
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Quilty L, Agic B, Coombs M, Kristy BL, Shakespeare J, Spafford A, Besa R, Dematagoda S, Patel A, Persaud R, Buckley L. Benefits of Digital Health Resources for Substance Use Concerns in Women: Scoping Review. JMIR Ment Health 2021; 8:e25952. [PMID: 34096879 PMCID: PMC8218208 DOI: 10.2196/25952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital health resources are being increasingly used to support women with substance use concerns. Although empirical research has demonstrated that these resources have promise, the available evidence for their benefit in women requires further investigation. Evidence supports the capacity of interventions that are sex-, gender-, and trauma-informed to improve treatment access and outcomes and to reduce health system challenges and disparities. Indeed, both sex- and gender-specific approaches are critical to improve health and gender equity. Violence and trauma are frequent among those with substance use concerns, but they disproportionately affect those who identify as female or women, further underscoring the need for trauma-informed care as well. OBJECTIVE The objective of this investigation was to evaluate the evidence supporting the efficacy or effectiveness of online or mobile interventions for risky or harmful substance use in adults who identify as female or women, or who report a history of trauma. METHODS This scoping review is based on an academic search in MEDLINE, APA PsycINFO, Embase, Cochrane Central, and CINAHL, as well as a grey literature search in US and Canadian government and funding agency websites. Of the 7807 records identified, 465 remained following title and abstract screening. Of these, 159 met all eligibility criteria and were reviewed and synthesized. RESULTS The 159 records reflected 141 distinct studies and 125 distinct interventions. Investigations and the interventions evaluated predominantly focused on alcohol use or general substance use. Evaluated digital health resources included multisession and brief-session interventions, with a wide range of therapeutic elements. Multisession online and mobile interventions exhibited beneficial effects in 86.1% (105/122) of studies. Single-session interventions similarly demonstrated beneficial effects in 64.2% (43/67) of study conditions. Most investigations did not assess gender identity or conduct sex- or gender-based analyses. Only 13 investigations that included trauma were identified. CONCLUSIONS Despite the overall promise of digital health interventions for substance use concerns, direct or quantitative evidence on the efficacy or effectiveness of interventions in females or women specifically is weak.
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Affiliation(s)
- Lena Quilty
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Betty-Lou Kristy
- Centre for Innovation in Peer Support, Support House, Oakville, ON, Canada
| | | | | | - Reena Besa
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Alina Patel
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Leslie Buckley
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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7
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Karsberg S, Hesse M, Pedersen MM, Charak R, Pedersen MU. The impact of poly-traumatization on treatment outcomes in young people with substance use disorders. BMC Psychiatry 2021; 21:140. [PMID: 33685430 PMCID: PMC7941934 DOI: 10.1186/s12888-021-03129-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. METHODS Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. RESULTS Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. CONCLUSION Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. TRIAL REGISTRATION ISRCTN88025085 , date of registration: 29.08.2016, retrospectively registered.
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Affiliation(s)
- Sidsel Karsberg
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000, Aarhus, Denmark.
| | - Michael Mulbjerg Pedersen
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
| | - Ruby Charak
- grid.449717.80000 0004 5374 269XDepartment of Psychological Science, The University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX USA
| | - Mads Uffe Pedersen
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
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8
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Eidenmueller K, Grimm F, Hermann D, Frischknecht U, Montag C, Dziobek I, Kiefer F, Bekier NK. Exploring Influences on Theory of Mind Impairment in Opioid Dependent Patients. Front Psychiatry 2021; 12:721690. [PMID: 34887783 PMCID: PMC8649648 DOI: 10.3389/fpsyt.2021.721690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Theory of mind (ToM) is an aspect of social cognition impaired in different addictive disorders, including opioid addiction. This study aimed at replicating ToM deficits in opioid dependent patients undergoing opioid maintenance treatment (OMT) and exploring the influence of substance use related variables, executive functions and childhood maltreatment on ToM in opioid dependent patients. 66 opioid dependent patients were tested using the Movie for Assessment of Social Cognition (MASC) and compared with the data of healthy controls. Furthermore, the opioid dependent patients underwent testing for executive functions and filled in the Childhood Trauma Questionnaire (CTQ). Performance on the MASC was significantly poorer in the opioid dependence group than in the control group, even when recent additional drug use and psychiatric comorbidities were controlled for. No correlations were found between ToM and substance use related factors. Aspects of ToM performance in opioid dependent patients correlated significantly with different EF domains. ToM correlated significantly with the CTQ scales for physical maltreatment. The results confirm impaired ToM in opioid dependent patients and highlight executive functions and childhood maltreatment as influential factors. The lack of associations between ToM and substance use related variables and the association with childhood maltreatment suggest that ToM impairments might be a risk factor predating substance abuse.
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Affiliation(s)
- Katharina Eidenmueller
- Department of Addictive Behaviors and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
| | - Franz Grimm
- Department of Addictive Behaviors and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
| | | | - Ulrich Frischknecht
- Department of Addictive Behaviors and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany.,German Institute of Addiction and Prevention Research, Catholic University of Applied Sciences Nordrhein-Westfalen, Koeln, Germany
| | - Christiane Montag
- Department of Psychiatry and Neurosciences, Charité University Medicine, Berlin, Germany
| | - Isabel Dziobek
- Berlin School of Mind and Brain, Institute of Psychology, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Falk Kiefer
- Department of Addictive Behaviors and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
| | - Nina Kim Bekier
- Department of Addictive Behaviors and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
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9
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Garcia-Keller C, Smiley C, Monforton C, Melton S, Kalivas PW, Gass J. N-Acetylcysteine treatment during acute stress prevents stress-induced augmentation of addictive drug use and relapse. Addict Biol 2020; 25:e12798. [PMID: 31282090 PMCID: PMC7439767 DOI: 10.1111/adb.12798] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022]
Abstract
Converging epidemiological studies show that a life-threatening event increases the incidence of posttraumatic stress disorder (PTSD), which carries 30% to 50% comorbidity with substance use disorders (SUDs). Such comorbidity results in greater drug use and poorer treatment outcomes. There is overlap between the enduring synaptic neuroadaptations produced in nucleus accumbens core (NAcore) by acute restraint stress and cocaine self-administration. Because of these coincident neuroadaptations, we hypothesized that an odor paired with acute restraint stress would reinstate drug seeking and chose two mechanistically distinct drugs of abuse to test this hypothesis: alcohol and cocaine. Rats were trained to self-administer either drug beginning 3 weeks after odor pairing with acute stress or sham, and acute restraint stress increased alcohol consumption. Following context extinction training, the stress-paired odor reinstated both alcohol and cocaine seeking, while an unpaired odor had no effect. N-Acetylcysteine (NAC) restores drug and stress-induced reductions in glial glutamate transporter-1 and has proven effective at reducing cue-induced reinstatement of drug seeking. We administered NAC for 5 days prior to reinstatement testing and abolished the capacity of the stress-paired odor to increase alcohol and cocaine seeking. Importantly, daily NAC given during or just following experiencing acute restraint stress also prevented the capacity of stress-paired odors to reinstate alcohol and cocaine seeking and prevented stress-induced deficits in behavioral flexibility. These data support using daily NAC treatment during or immediately after experiencing a strong acute stress to prevent subsequent conditioned stress responding, in particular relapse and cognitive deficits induced by stress-conditioned stimuli.
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Affiliation(s)
| | - Cora Smiley
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cara Monforton
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Samantha Melton
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Peter W Kalivas
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- These two authors are equivalent senior authors of this research
| | - Justin Gass
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- These two authors are equivalent senior authors of this research
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10
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Dagan Y, Yager J. Cannabis and Complex Posttraumatic Stress Disorder: A Narrative Review With Considerations of Benefits and Harms. J Nerv Ment Dis 2020; 208:619-627. [PMID: 32433200 DOI: 10.1097/nmd.0000000000001172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite substantial controversies concerning patients' reports of benefits from cannabis for posttraumatic stress disorder (PTSD) and inconsistent research findings regarding its efficacy and adverse risks, some states have already recognized PTSD as a qualifying condition for medical cannabis. Consequently, medical cannabis can also be provided for patients with complex PTSD who experience additional posttraumatic symptoms of affective dysregulation, negative perception of the self, and difficulties in relationships due to a history of repetitive trauma. In this article, we explore cannabis use in relation to benefits versus harms that might occur relative to specific complex PTSD symptoms and comorbidities. Whereas some symptoms related to PTSD per se (e.g., anxiety, insomnia, nightmares) may be benefited, others that are more characteristic of complex PTSD (e.g., dissociation, reckless behavior, and substance abuse associated with dysregulated affect) may be aggravated. Therefore, clinicians treating patients with complex PTSD who use or seek cannabis should carefully assess patients' motivations and the impacts of particular use patterns on specific symptoms. Clinicians and patients should be aware of and fully discuss the significant number of potential adverse effects of cannabis use, several of which might impede patients' participation in beneficial psychotherapeutic, social, and medical interventions.
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Affiliation(s)
- Yael Dagan
- Jerusalem Mental Health Center, Kfar Shaul Psychiatric Hospital affiliated with The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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11
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Barawi KS, Lewis C, Simon N, Bisson JI. A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder. Eur J Psychotraumatol 2020; 11:1774240. [PMID: 33029317 PMCID: PMC7473314 DOI: 10.1080/20008198.2020.1774240] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Psychological interventions for post-traumatic stress disorder (PTSD) are not always effective and can leave some individuals with enduring symptoms. Little is known about factors that are associated with better or worse treatment outcome. Our objective was to address this gap. METHOD We undertook a systematic review following Cochrane Collaboration Guidelines. We included 126 randomized controlled trials (RCTs) of psychological interventions for PTSD and examined factors that were associated with treatment outcome, in terms of severity of PTSD symptoms post-treatment, and recovery or remission. RESULTS Associations were neither consistent nor strong. Two factors were associated with smaller reductions in severity of PTSD symptoms post-treatment: comorbid diagnosis of depression, and higher PTSD symptom severity at baseline assessment. Higher education, adherence to homework and experience of a more recent trauma were associated with better treatment outcome. CONCLUSION Identifying and understanding why certain factors are associated with treatment outcome is vital to determine which individuals are most likely to benefit from particular treatments and to develop more effective treatments in the future. There is an urgent need for consistent and standardized reporting of factors associated with treatment outcome in all clinical trials.
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Affiliation(s)
- Kali S Barawi
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
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12
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Sáez G, Ruiz MJ, Delclós-López G, Expósito F, Fernández-Artamendi S. The Effect of Prescription Drugs and Alcohol Consumption on Intimate Partner Violence Victim Blaming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4747. [PMID: 32630323 PMCID: PMC7370167 DOI: 10.3390/ijerph17134747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/28/2022]
Abstract
Intimate Partner Violence (IPV) is a public health problem with harsh consequences for women's well-being. Social attitudes towards victims of IPV have a big impact on the perpetuation of this phenomenon. Moreover, specific problems such as the abuse of alcohol and drugs by IPV victims could have an effect on blame attributions towards them. The aim of this study was to evaluate whether the external perception (Study 1) and self-perception (Study 2) of blame were influenced by the victims' use and abuse of alcohol or by the victims' use of psychotropic prescription drugs. Results of the first study (N = 136 participants) showed a significantly higher blame attribution towards female victims with alcohol abuse compared to those without it. No significant differences were found on blame attributed to those with psychotropic prescription drugs abuse and the control group. Results of the second study (N = 195 female victims of interpersonal violence) showed that alcohol consumption is associated with higher self-blame and self-blame cognitions among IPV victims. However, results did not show significant differences on self-blame associated to the victims' use of psychotropic prescription drugs. Our findings indicate that alcohol consumption, but not prescription drugs use, plays a relevant role in the attribution of blame by general population and self-blame by victims of IPV.
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Affiliation(s)
- Gemma Sáez
- Departamento de Psicología, Universidad Loyola Andalucía, 41704 Sevilla, Spain; (G.S.); (G.D.-L.); (S.F.-A.)
| | - Manuel J. Ruiz
- Department of Psychology and Anthropology, Education Faculty, University of Extremadura, 06006 Badajoz, Spain
| | - Gabriel Delclós-López
- Departamento de Psicología, Universidad Loyola Andalucía, 41704 Sevilla, Spain; (G.S.); (G.D.-L.); (S.F.-A.)
| | - Francisca Expósito
- Mind, Brain and Behavior Research Center, University of Granada, 18011 Granada, Spain;
| | - Sergio Fernández-Artamendi
- Departamento de Psicología, Universidad Loyola Andalucía, 41704 Sevilla, Spain; (G.S.); (G.D.-L.); (S.F.-A.)
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13
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Carter JS, Kearns AM, Vollmer KM, Garcia-Keller C, Weber RA, Baker NL, Kalivas PW, Reichel CM. Long-term impact of acute restraint stress on heroin self-administration, reinstatement, and stress reactivity. Psychopharmacology (Berl) 2020; 237:1709-1721. [PMID: 32125483 PMCID: PMC7857092 DOI: 10.1007/s00213-020-05486-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE There is a robust relationship between anxiety disorders, including post-traumatic stress disorder (PTSD) and substance abuse. In fact, 30-50% of people seeking treatment for substance abuse have a comorbid diagnosis for PTSD. Heroin use is at epic proportions in the USA and is commonly used by people with co-occurring PTSD symptoms and substance use disorder. OBJECTIVES Here, we combined animal assays of acute restraint stress and contingent heroin self-administration (SA) to study comorbidity between stress disorders and opioid use disorder and identify shifts in anxiety-like behaviors following stress and/or heroin in response to a stress-conditioned cue. Our objective for this approach was to determine the long-term impact of acute restraint stress and heroin self-administration on stress reactivity and basic reward processes. METHODS We used 2-h acute restraint stress paired with an odor stimulus to condition a stress cue (CS) for testing of subsequent stress reactivity in a burying task and reinstatement and extinction to heroin seeking. Rats were also tested for social place preference for measures of social reward and anxiety-like behaviors. RESULTS Stress rats exhibited multiple levels of disrupted behavior including enhanced acquisition of heroin intake and reinstatement in response to the stress CS, as well as delayed extinction in response to the stress CS. All rats developed a social place preference, but stress rats spent more time in nose-to-nose contact with the unfamiliar rat while heroin rats spent time exploring the chamber. In the burying task, stress shortened latencies to bury the CS and increased burying and immobility in male and female rats relative to sham counterparts. CONCLUSIONS Acute restraint stress results in anxiety-like behaviors and a stress-associated cue is sufficient to reinstate extinguished heroin seeking. This project has the potential to elucidate the complex relationship between stress/anxiety disorders, including some PTSD-like characteristics, and the onset, maintenance, and relapse to heroin seeking.
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Affiliation(s)
- Jordan S Carter
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA
| | - Angela M Kearns
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA
| | - Kelsey M Vollmer
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA
| | - Constanza Garcia-Keller
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA
| | - Rachel A Weber
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA
| | - Nathaniel L Baker
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA
| | - Peter W Kalivas
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA
| | - Carmela M Reichel
- Department of Neuroscience, Medical University of South Carolina, Suite 416b BSB, MSC 510, 173 Ashley Ave, Charleston, SC, 29425, USA.
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Mac Gillavry DW, Ullrich D. A novel theory on the predictive value of variation in the β-endorphin system on the risk and severity of PTSD. MILITARY PSYCHOLOGY 2020; 32:247-260. [PMID: 38536347 PMCID: PMC10013490 DOI: 10.1080/08995605.2020.1730111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/18/2019] [Indexed: 02/08/2023]
Abstract
Despite growing interest in genetic and psychosocial indicators of heightened susceptibility to posttraumatic stress disorder (PTSD), a predictive model, which explains why some individuals develop PTSD in response to life-threatening traumatic events, while others, when faced with the same or similar experiences, do not, has thus far remained out of reach. In this paper, we review the literature on gene-environment interactions in β-endorphin system functioning with regard to PTSD and suggest that variation, both genetic and with regard to environmental stimuli, in systems which, like the β-endorphin system, distort human perception of life-threatening traumatic experiences may account for some of the variance in resilience to the disorder. Given the role of β-endorphin in both social connections and physical exercise, this becomes especially relevant with regard to military selection, training, and leadership processes.
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Affiliation(s)
| | - David Ullrich
- Department of Military Leadership, University of Defence, Brno, Czech Republic
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15
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María-Ríos CE, Morrow JD. Mechanisms of Shared Vulnerability to Post-traumatic Stress Disorder and Substance Use Disorders. Front Behav Neurosci 2020; 14:6. [PMID: 32082127 PMCID: PMC7006033 DOI: 10.3389/fnbeh.2020.00006] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
Psychoactive substance use is a nearly universal human behavior, but a significant minority of people who use addictive substances will go on to develop an addictive disorder. Similarly, though ~90% of people experience traumatic events in their lifetime, only ~10% ever develop post-traumatic stress disorder (PTSD). Substance use disorders (SUD) and PTSD are highly comorbid, occurring in the same individual far more often than would be predicted by chance given the respective prevalence of each disorder. Some possible reasons that have been proposed for the relationship between PTSD and SUD are self-medication of anxiety with drugs or alcohol, increased exposure to traumatic events due to activities involved in acquiring illegal substances, or addictive substances altering the brain's stress response systems to make users more vulnerable to PTSD. Yet another possibility is that some people have an intrinsic vulnerability that predisposes them to both PTSD and SUD. In this review, we integrate clinical and animal data to explore these possible etiological links between SUD and PTSD, with an emphasis on interactions between dopaminergic, adrenocorticotropic, GABAergic, and glutamatergic neurobehavioral mechanisms that underlie different emotional learning styles.
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Affiliation(s)
| | - Jonathan D. Morrow
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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16
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17
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Torres-Berrio A, Nava-Mesa MO. The opioid system in stress-induced memory disorders: From basic mechanisms to clinical implications in post-traumatic stress disorder and Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:327-338. [PMID: 30118823 DOI: 10.1016/j.pnpbp.2018.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/25/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023]
Abstract
Cognitive and emotional impairment are a serious consequence of stress exposure and are core features of neurological and psychiatric conditions that involve memory disorders. Indeed, acute and chronic stress are high-risk factors for the onset of post-traumatic stress disorder (PTSD) and Alzheimer's disease (AD), two devastating brain disorders associated with memory dysfunction. Besides the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, stress response also involves the activation of the opioid system in brain regions associated with stress regulation and memory processing. In this context, it is possible that stress-induced memory disorders may be attributed to alterations in the interaction between the neuroendocrine stress system and the opioid system. In this review, we: (1) describe the effects of acute and chronic stress on memory, and the modulatory role of the opioid system, (2) discuss the contribution of the opioid system to the pathophysiology of PTSD and AD, and (3) present evidence of current and potential therapies that target the opioid receptors to treat PTSD- and AD-associated symptoms.
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Affiliation(s)
| | - Mauricio O Nava-Mesa
- Neuroscience Research Group (NEUROS), School of Medicine, Universidad del Rosario, Bogotá, Colombia.
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18
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Schäfer I, Lotzin A, Hiller P, Sehner S, Driessen M, Hillemacher T, Schäfer M, Scherbaum N, Schneider B, Grundmann J. A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders. Eur J Psychotraumatol 2019; 10:1577092. [PMID: 30815234 PMCID: PMC6383607 DOI: 10.1080/20008198.2019.1577092] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/18/2018] [Accepted: 01/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with a more severe course and worse outcome than either disorder alone. In Europe, few treatments have been evaluated for PTSD and SUD. Seeking Safety, a manualized, integrated, cognitive-behavioural treatment, has been shown to be effective in studies in the USA. Objective: To test the efficacy of Seeking Safety plus treatment as usual (TAU) in female outpatients with PTSD and SUD compared to Relapse Prevention Training (RPT) plus TAU and TAU alone. Method: In five German study centres a total of N = 343 women were randomized into one of the three study conditions. PTSD severity (primary outcome), substance use, depression and emotion dysregulation (secondary outcomes) were assessed at baseline, post-treatment, as well as at three months and six months post-treatment. Results: Treatment participants attended M = 6.6 sessions (Seeking Safety) and M = 6.1 sessions (RPT). In an intent-to-treat analysis, Seeking Safety plus TAU, RPT plus TAU and TAU alone showed comparable decreases in PTSD severity over the course of the study. Seeking Safety plus TAU showed superior efficacy to TAU alone on depression and emotion regulation and RPT plus TAU was more effective than TAU alone on number of substance-free days and alcohol severity. Minimum-dose analyses suggest additional effects of both programmes among participants who attended at least eight group sessions. Conclusions: With respect to PTSD symptoms, a brief dose of Seeking Safety and RPT in addition to TAU was not superior to TAU alone in women with PTSD and SUD. However, Seeking Safety and RPT showed greater reductions than TAU alone in other domains of psychopathology and substance use outcomes respectively. Future studies should investigate further variables, such as what aspects of each treatment appeal to particular patients and how best to disseminate them.
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Affiliation(s)
- Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Klinikum Bielefeld, Bielefeld, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus University Nuremberg, Nürnberg, Germany.,Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martin Schäfer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Lehrkrankenhaus der Universität Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Klinik Essen, University Duisburg-Essen, Essen, Germany
| | - Barbara Schneider
- Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Cologne, Germany
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Lotzin A, Grundmann J, Hiller P, Pawils S, Schäfer I. Profiles of Childhood Trauma in Women With Substance Use Disorders and Comorbid Posttraumatic Stress Disorders. Front Psychiatry 2019; 10:674. [PMID: 31681026 PMCID: PMC6813657 DOI: 10.3389/fpsyt.2019.00674] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background: It is increasingly becoming accepted that substance use disorders, including substance abuse and substance dependence, are closely related to childhood trauma and posttraumatic stress disorders. Among women with substance use disorders, the majority report sexual, physical or emotional abuse, or neglect. However, it is poorly understood which types of childhood trauma co-occur in women with substance use disorders and how combinations of different types and severities of childhood trauma are related to clinical characteristics. This information is important to inform treatment of substance use disorders. Aim: The first aim of this research was to investigate profiles of childhood trauma in female patients with substance use disorders and posttraumatic stress disorders. The second aim was to examine relationships between these childhood trauma profiles and addiction characteristics or current clinical symptoms. Methods: We includeda 343 treatment-seeking women with substance use disorders and comorbid posttraumatic stress disorders according to DSM-IV. Five types of childhood trauma (sexual abuse, physical abuse, emotional abuse) were measured using the Childhood Trauma Questionnaire. Addiction characteristics were assessed by using the Addiction Severity Index-lite. Current severity of clinical symptoms was determined by the Symptom-Checklist-27. Latent profile analysis was conducted to distinguish profiles of childhood trauma. Analysis of variance was applied to examine the relationship between childhood trauma profiles and addiction characteristics or severity of clinical symptoms. Results: Nine out of ten women reported at least one type of childhood abuse or neglect. Four different childhood trauma profiles could be distinguished that characterized different types and severities of childhood trauma: 'Low trauma'; 'Moderate sexual abuse and emotional abuse'; 'Severe sexual abuse and emotional abuse'; and 'Severe levels of all types of trauma'. Profiles with more severe levels of childhood trauma showed an earlier age at initiation and escalation of substance use. Furthermore, childhood trauma profiles were related to current severity of depressive symptoms, dysthymic symptoms, sociophobic symptoms, and distrust. Conclusion: In women with substance use disorders and posttraumatic stress disorders, childhood trauma profiles can inform about addiction characteristics and severity of a wide range of clinical symptoms. This information is essential to understand current treatment needs and should be systematically assessed in women with substance use disorders and trauma exposure.
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Affiliation(s)
- Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Johanna Grundmann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Philipp Hiller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
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20
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Mergler M, Driessen M, Havemann-Reinecke U, Wedekind D, Lüdecke C, Ohlmeier M, Chodzinski C, Teunißen S, Weirich S, Kemper U, Renner W, Schäfer I. Differential relationships of PTSD and childhood trauma with the course of substance use disorders. J Subst Abuse Treat 2018; 93:57-63. [PMID: 30126542 DOI: 10.1016/j.jsat.2018.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 01/29/2023]
Abstract
A large body of research documents the link between Posttraumatic Stress Disorder (PTSD) and the course of Substance Use Disorders (SUD). Similar relationships have been reported between Childhood Trauma (CT) and the course of illness in patients with SUD even in the absence of PTSD, but few studies have examined differential effects of PTSD and CT (independent of PTSD) in this population. We used the International Diagnostic Checklist (IDCL) and the Posttraumatic Diagnostic Scale (PDS) to diagnose PTSD in a sample of patients with SUD (N = 459). The Childhood Trauma Questionnaire (CTQ) and the European Addiction Severity Index (EuropASI) were administered to assess childhood trauma and addiction related problems including comorbid psychopathological symptoms. The sample was divided into three groups: patients with experiences of CT and PTSD (CT-PTSD), experiences of CT without PTSD (CT-only), and neither experiences of CT nor PTSD (No trauma) to examine their differential associations with the course and severity of SUD. Patients of both the CT-PTSD (n = 95) and the CT-only group (n = 134) reported significantly higher levels of anxiety and depression as well as more suicidal thoughts and suicide attempts during their lifetime than the No trauma group (n = 209). Regarding most variables a graded association became apparent, with the highest level of symptoms in the CT-PTSD group, an intermediate level in the CT-only group and the lowest level in the No trauma group. The CT-PTSD group also differed in almost all substance use variables significantly from the No trauma group, including a younger age at first use of alcohol and cannabis, more cannabis use in the last month, and more lifetime drug overdoses. Our results confirm the relationships of both CT and PTSD with psychiatric symptoms in patients with SUD. Thus, it seems important to include both domains into the routine assessment of SUD patients. Specific treatments for comorbid PTSD but also for other consequences of childhood trauma should be integrated into SUD treatment programs.
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Affiliation(s)
- Michaela Mergler
- Alpen-Adria-Universitat Klagenfurt, Klagenfurt, AT 9020, Universitätsstraße 65-67, Austria.
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel Clinics, Bielefeld, DE 33617, Remterweg 69, Germany
| | - Ursula Havemann-Reinecke
- Department of Psychiatry and Psychotherapy, University of Göttingen, DE 37075, Von-Siebold-Straße 5, Germany
| | - Dirk Wedekind
- Universitatsklinikum Göttingen, Göttingen, DE 37075, Von-Siebold-Straße 5, Germany
| | - Christel Lüdecke
- Lower Saxonian Psychiatric Hospital, Goettingen, DE 31515, Rosdorfer Weg 70, Germany
| | - Martin Ohlmeier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, DE 30625, Carl-Neuberg-Str. 12, Germany
| | - Claudia Chodzinski
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, DE 30625, Carl-Neuberg-Str. 1, Germany
| | | | - Steffen Weirich
- Department of Psychiatry and Psychotherapy, University of Rostock, DE 18147, Gehlsheimer Str. 20, Germany
| | - Ulrich Kemper
- Westfalian Clinic of Psychiatry and Psychotherapy, Guetersloh, DE 33334, Gütersloh, Buxelstraße 50, Germany
| | - Walter Renner
- Pan European University Bratislava, Bratislava, SK 82102, Tomášikova 150/20, Slovakia
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf and Center for Interdisciplinary University of Hamburg, DE 20246, Martinistraße 52, Germany
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21
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The long-term impact of post traumatic stress disorder on recovery from heroin dependence. J Subst Abuse Treat 2018; 89:60-66. [DOI: 10.1016/j.jsat.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 12/30/2022]
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22
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Vujanovic AA, Farris SG, Bartlett BA, Lyons RC, Haller M, Colvonen PJ, Norman SB. Anxiety sensitivity in the association between posttraumatic stress and substance use disorders: A systematic review. Clin Psychol Rev 2018; 62:37-55. [PMID: 29778929 DOI: 10.1016/j.cpr.2018.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No evidence-based, "gold standard" treatments for PTSD/SUD comorbidity are currently available. Thus, it is imperative to better understand cognitive-affective mechanisms, targetable via cognitive-behavioral intervention (i.e., malleable), that may be related to both disorders in order to improve the theory and treatment of PTSD/SUD. Anxiety sensitivity is a malleable cognitive-affective factor with relevance to both PTSD and SUD. This systematic review focused on the published literature on anxiety sensitivity and trauma/PTSD and substance use/SUD from 1966 - May 1, 2018, and includes a total of 35 manuscripts. The state of the literature, limitations, and future research directions are discussed.
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Affiliation(s)
- Anka A Vujanovic
- University of Houston, Department of Psychology, Houston, TX, USA.
| | - Samantha G Farris
- The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA; The Miriam Hospital, Centers for Behavioral and Preventative Medicine, Providence, RI, USA; Butler Hospital, Behavioral Medicine and Addictions Research Unit, Providence, RI, USA; Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, NJ, USA
| | | | - Robert C Lyons
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA
| | - Moira Haller
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA
| | - Peter J Colvonen
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Sonya B Norman
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA
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Kok T, De Haan HA, Sensky T, van der Meer M, De Jong CAJ. Using the Pictorial Representation of Illness and Self Measure (PRISM) to Quantify and Compare Suffering From Trauma and Addiction. J Dual Diagn 2017; 13:101-108. [PMID: 28368709 DOI: 10.1080/15504263.2017.1293867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In a sample of people with substance use disorder who had experienced psychological trauma, this study aimed to quantify differences in perceived suffering due to addiction-related problems and to trauma-related problems. METHODS The sample comprised 146 inpatients with substance use disorder: 25% had posttraumatic stress disorder (PTSD), 21% had subthreshold PTSD; and the remainder constituted the trauma-only group. PTSD, substance use disorder, and suffering were assessed using validated instruments. Suffering was measured using the Pictorial Representation of Illness and Self Measure (PRISM). RESULTS No differences were found among the PTSD, subthreshold PTSD, and trauma-only group in the suffering attributed to addiction-related problems. Those in the PTSD group appraised their suffering due to trauma-related problems as greater than the other groups. In the PTSD group, but not the subthreshold PTSD group, suffering due to trauma-related problems was appraised as greater than that due to addiction-related problems. CONCLUSIONS This is the first study to demonstrate quantitative comparisons between different health problems using the "common currency" of suffering. Our results indicate that even among those in an inpatient substance use disorder treatment program, comorbid PTSD may be more personally salient and cause greater suffering, with implications for therapeutic interventions available on substance use disorder treatment programs.
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Affiliation(s)
- Tim Kok
- a Tactus Addiction Treatment and Nijmegen Institute for Scientist-Practitioners in Addiction , Enschede , The Netherlands
| | - Hein A De Haan
- a Tactus Addiction Treatment and Nijmegen Institute for Scientist-Practitioners in Addiction , Enschede , The Netherlands
| | - Tom Sensky
- b Centre for Mental Health , Imperial College London , London , United Kingdom
| | | | - Cornelis A J De Jong
- a Tactus Addiction Treatment and Nijmegen Institute for Scientist-Practitioners in Addiction , Enschede , The Netherlands
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Schwaninger PV, Mueller SE, Dittmann R, Poespodihardjo R, Vogel M, Wiesbeck GA, Walter M, Petitjean SA. Patients with non-substance-related disorders report a similar profile of childhood trauma experiences compared to heroin-dependent patients. Am J Addict 2017; 26:215-220. [PMID: 28240800 DOI: 10.1111/ajad.12512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure to traumatic events is common among patients with substance use disorders (SUD). In patients with non-substance-related disorders, especially with gambling disorders (GD) and internet addiction (IA), traumatic childhood experiences have not been investigated extensively. The objective of this study was to compare trauma histories in patients with GD and IA to patients with heroin dependence. METHODS Cross-sectional surveys including the childhood trauma questionnaire (CTQ) and clinical data among 107 participants; 59 patients with non-substance-related disorders (GD [n = 39]; IA [n = 20]) were compared to 28 patients prescribed injectable heroin for opioid dependence in heroin-assisted treatment (HAT) and to a healthy control group (HC) (n = 20). RESULTS The findings revealed a high prevalence of trauma exposure in all three clinical groups, with 74.4% of patients with GD, 80.0% of patients with IA, and 93.0% of patients in HAT compared to 40% in HC. All three groups (GD, IA, HAT) reported significantly higher levels of "emotional neglect" compared to HC. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The results provide clinically relevant information suggesting that the burden of childhood traumatic experiences may be as common in patients with GD and IA as in patients with heroin dependence. These findings could pose an important starting-point for treatment. (Am J Addict 2017;26:215-220).
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Affiliation(s)
- Philipp V Schwaninger
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Sandra E Mueller
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Rebecca Dittmann
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Renanto Poespodihardjo
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Marc Vogel
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Gerhard A Wiesbeck
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Marc Walter
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Sylvie A Petitjean
- Division of Addictive Disorders, Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
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25
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Perryman C, Dingle G, Clark D. Changes in posttraumatic stress disorders symptoms during and after therapeutic community drug and alcohol treatment. THERAPEUTIC COMMUNITIES 2016. [DOI: 10.1108/tc-06-2016-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to investigate the changes in posttraumatic stress disorder (PTSD) symptomatology during treatment in a drug and alcohol therapeutic community.
Design/methodology/approach
A repeated measures design was employed that looked at PTSD, depression, anxiety, and stress at a pre- and post-timepoint. A second sample was then evaluated at time of program completion to seven months post-treatment.
Findings
PTSD symptomatology significantly decreased in individuals who had undertaken treatment, and continued to decline post-treatment. This finding was irrespective of any PTSD-specific treatment.
Research limitations/implications
PTSD specific treatment is not necessary to lower the symptomatology. Furthermore, this provides evidence that PTSD and substance use disorders are so highly intertwined that the comorbidity can almost be considered a single, diagnosis.
Originality/value
This is a partial replication of previous research which had not previously been replicated. This research also adds to the limited research which looks at PTSD from the perspective of drug and alcohol rehabilitation.
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Mills KL, Barrett EL, Merz S, Rosenfeld J, Ewer PL, Sannibale C, Baker AL, Hopwood S, Back SE, Brady KT, Teesson M. Integrated Exposure-Based Therapy for Co-Occurring Post Traumatic Stress Disorder (PTSD) and Substance Dependence: Predictors of Change in PTSD Symptom Severity. J Clin Med 2016; 5:jcm5110101. [PMID: 27854264 PMCID: PMC5126798 DOI: 10.3390/jcm5110101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/26/2016] [Accepted: 11/08/2016] [Indexed: 11/26/2022] Open
Abstract
This paper examines factors associated with change in PTSD symptom severity among individuals randomised to receive an integrated exposure-based psychotherapy for PTSD and substance dependence–Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Outcomes examined include change in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS), and the reliability and clinical significance of change in PTSD symptom severity. Factors examined include patient baseline characteristics, treatment characteristics, and events over follow-up. The mean difference in CAPS score was 38.24 (SE 4.81). Approximately half (49.1%) demonstrated a reliable and clinically significant improvement in PTSD symptom severity. No one was classified as having demonstrated clinically significant worsening of symptoms. Three independent predictors of reductions in PTSD symptom severity were identified: baseline PTSD symptom severity (β 0.77, SE 0.23, p = 0.001), number of traumas experienced prior to baseline (β −0.30, SE 0.15, p = 0.049), and number of sessions attended (β 2.05, SE 0.87, p = 0.024). The present study provides further evidence regarding the safety of the COPE treatment and factors associated with improvement in PTSD symptom severity. The identification of only a small number of predictors of the outcome points to the broad applicability of the COPE treatment to PTSD and substance use disorder (SUD) patients.
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Affiliation(s)
- Katherine L Mills
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Emma L Barrett
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Sabine Merz
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Julia Rosenfeld
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Philippa L Ewer
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Claudia Sannibale
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan 2308, NSW, Australia.
| | - Sally Hopwood
- School of Psychology, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Maree Teesson
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
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27
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Faller S, Peuker AC, Sordi A, Stolf A, Souza-Formigoni ML, Cruz MS, Brasiliano S, Pechansky F, Kessler F. Who seeks public treatment for substance abuse in Brazil? Results of a multicenter study involving four Brazilian state capitals. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2016; 36:193-202. [PMID: 27001019 DOI: 10.1590/2237-6089-2014-0040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the characteristics of alcohol and drug users who seek treatment at the Brazilian Unified Health System in Brazil. METHOD A multicenter cross-sectional study involving five clinical and research centers located in four Brazilian state capitals was conducted with 740 in- and outpatients. The only exclusion criterion was the presence of neurological or severe psychiatric symptoms at the moment of the interview. The Addiction Severity Index (ASI-6) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess the severity of substance use and the problems related. RESULTS There were significantly more men than women in the sample; mean age was 36 years. The drug most frequently used at all sites was alcohol (78%), followed by cocaine/crack (51%). Alcohol was the drug that most commonly motivated treatment seeking, at all centers. ASI-6 Summary Scores for Recent Functioning (SS-Rs) were quite similar among centers. SS-Rs were compared between users who had never received treatment for psychoactive substance abuse (n = 265, 36.1%) and those who had already been treated at one or more occasions (n = 470, 63.9%). This analysis revealed significant differences between the groups in the drug, psychiatric symptoms, legal, and family/social problems areas (p < 0.05). CONCLUSION Our findings confirm previous evidence suggesting that the management of patients seeking drug abuse treatment should take several different aspects into consideration, e.g., education, employment, and family relationships, which often appear as areas of concern for these individuals.
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Affiliation(s)
- Sibele Faller
- Center for Drug and Alcohol Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Carolina Peuker
- Center for Drug and Alcohol Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Anne Sordi
- Center for Drug and Alcohol Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Anderson Stolf
- Center for Drug and Alcohol Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marcelo Santos Cruz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sílvia Brasiliano
- Women Drug Dependent Treatment Center, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felix Kessler
- Center for Drug and Alcohol Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Moreno CL, El-Bassel N, Gilbert L, Wada T. Correlates of Poverty and Partner Abuse Among Women on Methadone. Violence Against Women 2016. [DOI: 10.1177/10778010222183161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores the association between poverty and experiences of partner abuse among 204 women recruited from methadone maintenance treatment programs. Logistic regressions were used to examine the associations between extreme poverty and indicators of partner abuse. The findings show that extreme poverty was prevalent and associated with partner abuse. The study findings suggest that providers of methadone maintenance programs need to incorporate poverty indicators in their assessment because extreme poverty seems to correlate with all forms of partner abuse. The impact of welfare reform on partner violence should be on the agendas of policy makers and researchers.
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29
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Lee D, Delcher C, Maldonado-Molina MM, Thogmartin JR, Goldberger BA. Manners of Death in Drug-Related Fatalities in Florida. J Forensic Sci 2016; 61:735-42. [DOI: 10.1111/1556-4029.12999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/09/2015] [Accepted: 05/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Dayong Lee
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
| | - Chris Delcher
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | - Mildred M. Maldonado-Molina
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | | | - Bruce A. Goldberger
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
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30
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Danovitch I. Post-traumatic stress disorder and opioid use disorder: A narrative review of conceptual models. J Addict Dis 2016; 35:169-79. [PMID: 27010975 DOI: 10.1080/10550887.2016.1168212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Post-traumatic stress disorder is highly prevalent among individuals who suffer from opioid use disorder. Compared to individuals with opioid use disorder alone, those with post-traumatic stress disorder have a worse course of illness, occupational functioning, and physical health. The neurobiological pathways underlying each disorder overlap substantially, and there are multiple pathways through which these disorders may interact. This narrative review explores evidence underpinning 3 explanatory perspectives on comorbid post-traumatic stress disorder and opioid use disorder: The opioid susceptibility model (a.k.a.: the Self-Medication Hypothesis), the post-traumatic stress disorder susceptibility model, and the common factors model. Diagnostic implications, treatment implications, and directions for future research are discussed.
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Affiliation(s)
- Itai Danovitch
- a Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center , Los Angeles , California , USA
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31
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Meshberg-Cohen S, Presseau C, Thacker LR, Hefner K, Svikis D. Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment. J Womens Health (Larchmt) 2016; 25:729-37. [PMID: 27387193 DOI: 10.1089/jwh.2015.5328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rates of posttraumatic stress disorder (PTSD) are high among women seeking treatment for substance use disorders (SUDs). Minority women, in particular, experience high rates of trauma and may be less likely to disclose trauma history. This article identifies items from pre-existing screening measures that can be used across settings to sensitively but noninvasively identify women with likely PTSD. METHOD For a sample of 104 African American women in residential SUD treatment who provided informed consent as a part of a larger randomized clinical trial, the prevalence of trauma and PTSD, as well as the relationships between trauma, health, depression, and distress, was examined. Measures included Posttraumatic Stress Diagnostic Scale (PDS), Center for Epidemiologic Studies-Depression Scale (CES-D), Pennebaker Inventory of Limbic Languidness (PILL), and Brief Symptom Inventory (BSI). Additional analyses were undertaken to determine if a subset of noninvasive items could serve to identify the presence of a probable PTSD diagnosis. RESULTS Most women (94.2%) reported at least one lifetime trauma, with over half (51.0%) meeting DSM-IV criteria for PTSD. Women with greater trauma symptom severity reported more health problems and higher levels of depression and distress. Five BSI items and one CES-D item were significantly associated with a probable PTSD diagnosis with a sensitivity of 88.7%, a specificity of 66.7%, a positive predictive value of 73.4%, a negative predictive value of 85.0%, and an accuracy of 77.9%. CONCLUSION Findings affirm that African American women with SUDs present for residential treatment with comorbid psychiatric and emotional conditions that warrant assessment and treatment. Results highlight potential benefits of brief screening with routine measures and coordinated access to ancillary psychiatric and medical services, in conjunction with substance treatment, such as in residential or primary care.
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Affiliation(s)
- Sarah Meshberg-Cohen
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Candice Presseau
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut
| | - Leroy R Thacker
- 3 Department of Family and Community Health Nursing, Virginia Commonwealth University , Richmond, Virginia
| | - Kathryn Hefner
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Dace Svikis
- 4 Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
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32
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Kaiser D, Grundmann J, Schulze C, Stubenvoll M, Kosar M, Junker M, Najavits LM, Schäfer I. A Pilot Study of Seeking Safety in a Sample of German Women Outpatients with Substance Dependence and Posttraumatic Stress Disorder. J Psychoactive Drugs 2015; 47:401-8. [PMID: 26514284 DOI: 10.1080/02791072.2015.1090644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Seeking Safety is an integrated coping skills therapy for substance use disorder (SUD) and posttraumatic stress disorder (PTSD). Our aim was to examine the effects of Seeking Safety in a sample of female German outpatients with current SUD and PTSD. A total of 53 women were offered 12 weekly sessions of Seeking Safety, conducted in group modality. Women (N=33) who attended at least six sessions were considered minimum-dose completers and were in the analysis. We measured PTSD and substance use symptoms using the Posttraumatic Diagnostic Scale (PDS) and the Addiction Severity Index (ASI-Lite) at end-of-treatment and three-month follow-up. Additional measures were the Brief Symptom Checklist (BSI) and the Inventory of Interpersonal Problems (IIP-25). Our sample reported chronic SUD, multiple prior detoxifications, and serious childhood trauma. We found medium to large effect sizes for improvements in PTSD symptoms, general psychopathology, and interpersonal problems at end-of-treatment, all of which were sustained at follow-up. Alcohol use improved significantly only at follow-up. This study suggests that the model was associated with positive effects, at least in a subgroup of women attending a minimum of sessions. Limitations include the lack of a control condition as well as an intention-to-treat analysis.
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Affiliation(s)
- Dorina Kaiser
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany; and Center for Interdisciplinary Addiction Research (CIAR) , University of Hamburg , Hamburg , Germany
| | - Johanna Grundmann
- b Department of Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Claudia Schulze
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany; and Center for Interdisciplinary Addiction Research (CIAR) , University of Hamburg , Hamburg , Germany
| | - Martina Stubenvoll
- b Department of Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Marita Kosar
- c DieBoje, Center for Addiction Counselling and Treatment , Hamburg , Germany
| | - Marita Junker
- c DieBoje, Center for Addiction Counselling and Treatment , Hamburg , Germany
| | - Lisa M Najavits
- d Director, Treatment Innovations, Newton Centre, MA; Lecturer, Department of Psychiatry, Harvard Medical School, Boston , Boston , MA
| | - Ingo Schäfer
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany; and Center for Interdisciplinary Addiction Research (CIAR) , University of Hamburg , Hamburg , Germany
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Saunders EC, Lambert-Harris C, McGovern MP, Meier A, Xie H. The Prevalence of Posttraumatic Stress Disorder Symptoms among Addiction Treatment Patients with Cocaine Use Disorders. J Psychoactive Drugs 2015; 47:42-50. [PMID: 25715071 DOI: 10.1080/02791072.2014.977501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Co-occurring cocaine use and posttraumatic stress disorders are prevalent and associated with negative treatment, health and societal consequences. This study examined the relationships among PTSD symptoms, gender, and cocaine use problems. Within a cross-sectional design, we gathered archival point prevalence data on new admissions (n = 573) to three addiction treatment agencies. Demographic, substance use, and PTSD symptom information were collected across the three agencies. Logistic regression analyses revealed that patients with cocaine use disorders had a two-fold increased odds for a probable PTSD diagnosis, compared to patients without a cocaine use disorder (OR = 2.19, 95% CI = 1.49-3.22, p < 0.001). Among females with cocaine use disorder, multinomial regression yielded a significant increase in the risk of moderate (RRR = 2.12, 95% CI = 1.10-4.10, p < 0.05) and severe (RRR = 2.87, 95% CI = 1.33-6.21, p < 0.01) PTSD symptoms. Males with cocaine use disorders had a two-fold increase in the risk of moderate PTSD symptoms (RRR = 2.13, 95% CI = 1.23-3.68, p < 0.01), but had no increased risk of developing severe PTSD symptoms (RRR = 1.93, 95% CI = 0.85-4.39, p = 0.117). Cocaine use appears to impact the risk of PTSD symptoms, especially in females. Future research should explore the generalizability of these findings to more racially and ethnically diverse samples, as well as among persons with this comorbidity who are not engaged in treatment services.
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Fernández-Montalvo J, López-Goñi JJ, Arteaga A. Psychological, physical, and sexual abuse in addicted patients who undergo treatment. JOURNAL OF INTERPERSONAL VIOLENCE 2015; 30:1279-1298. [PMID: 24992952 DOI: 10.1177/0886260514539843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study explored the prevalence of a history as victims of abuse among patients who sought outpatient treatment for drug addiction. A sample of 252 addicted patients was assessed. Information was collected on the patients' lifetime history of abuse (psychological, physical, and/or sexual abuse), sociodemographic factors, consumption factors, psychopathological factors, and personality variables. Drug-addicted patients who present a lifelong history of abuse were compared with patients who were not abused. Of the total sample, 46% of the patients (n = 115) who were addicted to drugs had been victims of abuse. There was a statistically significant difference between the victimization rates of men (37.8%) and women (79.6%). Moreover, for some variables, significant differences were observed between patients who had been abused and those who had not. Compared with patients who had not been abused, the addicted patients with a history of victimization scored significantly higher on several European Addiction Severity Index, Millon Clinical Multiaxial Inventory-II, and maladjustment variables but not on the Symptom Checklist-90-Revised. The current results indicate that patients who present a lifelong history of abuse exhibit both a more severe addiction than patients who were not abused and several comorbidities. The implications of these results for further research and clinical practice are discussed.
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Kok T, de Haan H, van der Meer M, Najavits L, de Jong C. Assessing traumatic experiences in screening for PTSD in substance use disorder patients: what is the gain in addition to PTSD symptoms? Psychiatry Res 2015; 226:328-32. [PMID: 25687377 DOI: 10.1016/j.psychres.2015.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 01/16/2015] [Accepted: 01/18/2015] [Indexed: 10/24/2022]
Abstract
Traumatic experiences have been linked with substance use disorders (SUD) and may be an important factor in the perpetuation of SUD, even in the absence of posttraumatic stress disorder (PTSD) symptoms. The purpose of the current study was to examine the relationship between childhood trauma and substance use severity in 192 SUD inpatients. Childhood trauma was assessed using the Traumatic Experiences Checklist (TEC). With variables derived from this measure in addition to PTSD symptoms, two regression models were created with alcohol use or drug use severity as dependent variables. Alcohol severity was explained by PTSD symptoms as well as the age of trauma. Drug severity was explained solely by PTSD symptoms. The clinical value of assessing childhood trauma in determining the addiction severity appears to be limited in comparison with PTSD symptoms.
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Affiliation(s)
- Tim Kok
- Tactus Addiction Treatment, P.O. box 154, 7400 AD Deventer, The Netherlands; Nijmegen Institute for Scientist Practitioners in Addiction, P.O. box 6909, 6503 GK Nijmegen, The Netherlands.
| | - Hein de Haan
- Tactus Addiction Treatment, P.O. box 154, 7400 AD Deventer, The Netherlands; Nijmegen Institute for Scientist Practitioners in Addiction, P.O. box 6909, 6503 GK Nijmegen, The Netherlands.
| | | | - Lisa Najavits
- Veterans Affairs Boston Healthcare System and Boston University School of Medicine, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Cor de Jong
- Nijmegen Institute for Scientist Practitioners in Addiction, P.O. box 6909, 6503 GK Nijmegen, The Netherlands
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Dubois N, Hallet C, Seidel L, Demaret I, Luppens D, Ansseau M, Rozet E, Albert A, Hubert P, Charlier C. Estimation of the Time Interval between the Administration of Heroin and the Sampling of Blood in Chronic Inhalers. J Anal Toxicol 2015; 39:300-5. [PMID: 25648554 DOI: 10.1093/jat/bkv001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To develop a model for estimating the time delay between last heroin consumption and blood sampling in chronic drug users. Eleven patients, all heroin inhalers undergoing detoxification, were included in the study. Several plasma samples were collected during the detoxification procedure and analyzed for the heroin metabolites 6-acetylmorphine (6AM), morphine (MOR), morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G), according to a UHPLC/MSMS method. The general linear mixed model was applied to time-related concentrations and a pragmatic four-step delay estimation approach was proposed based on the simultaneous presence of metabolites in plasma. Validation of the model was carried out using the jackknife technique on the 11 patients, and on a group of 7 test patients. Quadratic equations were derived for all metabolites except 6AM. The interval delay estimation was 2-4 days when only M3G present in plasma, 1-2 days when M6G and M3G were both present, 0-1 day when MOR, M6G and M3G were present and <2 h for all metabolites present. The 'jackknife' correlation between declared and actual estimated delays was 0.90. The overall precision of the delay estimates was 8-9 h. The delay between last heroin consumption and blood sampling in chronic drug users can be satisfactorily predicted from plasma heroin metabolites.
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Affiliation(s)
- Nathalie Dubois
- Service de Toxicologie Clinique, Médico-légale, de l'Environnement et en Entreprise, Centre Hospitalier Universitaire, Liège, Belgium Centre Interfacultaire de Recherche du Médicament, Université de Liège, Liège, Belgium
| | - Claude Hallet
- Service Anesthésie-Réanimation, Centre Hospitalier Universitaire, Liège, Belgium
| | - Laurence Seidel
- Service des Informations Médico-Economiques (SIME)-Biostatistique, Centre Hospitalier Universitaire, Liège, Belgium
| | - Isabelle Demaret
- Service de Psychiatrie, Centre Hospitalier Universitaire, Liège, Belgium
| | - David Luppens
- Service de Psychiatrie, Centre Hospitalier Universitaire, Liège, Belgium
| | - Marc Ansseau
- Service de Psychiatrie, Centre Hospitalier Universitaire, Liège, Belgium
| | - Eric Rozet
- Service de Chimie Analytique, Département de Pharmacie, Université de Liège, Liège, Belgium
| | - Adelin Albert
- Service des Informations Médico-Economiques (SIME)-Biostatistique, Centre Hospitalier Universitaire, Liège, Belgium
| | - Philippe Hubert
- Centre Interfacultaire de Recherche du Médicament, Université de Liège, Liège, Belgium Service de Chimie Analytique, Département de Pharmacie, Université de Liège, Liège, Belgium
| | - Corinne Charlier
- Service de Toxicologie Clinique, Médico-légale, de l'Environnement et en Entreprise, Centre Hospitalier Universitaire, Liège, Belgium Centre Interfacultaire de Recherche du Médicament, Université de Liège, Liège, Belgium
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Abstract
Our dynamic environment regularly exposes us to potentially life-threatening challenges or stressors. To answer these challenges and maintain homeostasis, the stress response, an innate coordinated engagement of central and peripheral neural systems is initiated. Although essential for survival, the inappropriate initiation of the stress response or its continuation after the stressor is terminated has pathological consequences that have been linked to diverse neuropsychiatric and medical diseases. Substantial individual variability exists in the pathological consequences of stressors. A theme of this Special Issue is that elucidating the basis of individual differences in resilience or its flipside, vulnerability, will greatly advance our ability to prevent and treat stress-related diseases. This can be approached by studying individual differences in "pro-stress" mediators such as corticosteroids or the hypothalamic orchestrator of the stress response, corticotropin-releasing factor. More recently, the recognition of endogenous neuromodulators with "anti-stress" activity that have opposing actions or that restrain stress-response systems suggests additional bases for individual differences in stress pathology. These "anti-stress" neuromodulators offer alternative strategies for manipulating the stress response and its pathological consequences. This review uses the major brain norepinephrine system as a model stress-response system to demonstrate how co-regulation by opposing pro-stress (corticotropin-releasing factor) and anti-stress (enkephalin) neuromodulators must be fine-tuned to produce an adaptive response to stress. The clinical consequences of tipping this fine-tuned balance in the direction of either the pro- or anti-stress systems are emphasized. Finally, that each system provides multiple points at which individual differences could confer stress vulnerability or resilience is discussed.
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Affiliation(s)
- Rita J. Valentino
- Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- University of Pennsylvania, Philadelphia, PA 19104, USA
- Corresponding author. Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Kok T, de Haan HA, van der Meer M, Najavits LM, De Jong CAJ. Screening of current post-traumatic stress disorder in patients with substance use disorder using the Depression, Anxiety and Stress Scale (DASS-21): a reliable and convenient measure. Eur Addict Res 2015; 21:71-7. [PMID: 25413311 DOI: 10.1159/000365283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/17/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several instruments have been developed and validated as screens for post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients. Unfortunately, many of these instruments have one or several disadvantages (e.g. low specificity, low sensitivity or high costs). No research has been conducted on instruments that screen simultaneously for other psychiatric disorders, which would be a potentially time-saving and cost-effective approach. In the current study we tested the psychometric properties of the Depression, Anxiety and Stress Scale (DASS) as a screen for PTSD. METHODS The DASS was assessed in an inpatient facility during intake with 58 patients and again 4 weeks after admission. Another 138 patients were assessed 4 weeks after admission only. The results were compared to the Clinician-Administered PTSD Scale (CAPS) that was also administered after 4 weeks of abstinence. RESULTS ROC curve analyses showed an area under the curve of 0.84 for the DASS at intake and 0.78 for the DASS after 4 weeks' abstinence. CONCLUSION The DASS is therefore a reliable and convenient measure to use as a screen for PTSD in SUD patients.
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Affiliation(s)
- Tim Kok
- Tactus Addiction Treatment, Deventer, The Netherlands
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Jaremko KM, Sterling RC, Van Bockstaele EJ. Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance. J Subst Abuse Treat 2014; 48:117-27. [PMID: 25239858 DOI: 10.1016/j.jsat.2014.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/12/2014] [Accepted: 08/19/2014] [Indexed: 12/31/2022]
Abstract
The present study investigated whether psychological and/or physiological measures of stress would impede induction onto methadone maintenance and predict early (<6 months) discontinuation. Compared with controls, opioid-dependent subjects displayed increased distress on the perceived stress scale (PSS) and post-traumatic stress disorder checklist (PCLC); 60% exhibited abnormal cortisol. Addiction severity index (ASI), drug-use, and stress indices explained between 17 and 37% of the variance in engagement including attendance, opioid abstinence, and methadone stabilization. Participants who discontinued treatment displayed poor engagement, abnormal cortisol, elevated withdrawal symptoms, higher distress, and increased ongoing opioid use versus compliant individuals. Discontinuation was initially related to drug-use severity; however, by 6 months, retention depended primarily upon cortisol abnormalities, which increased an individual's discontinuation risk by 7.7-fold. These findings support admission screening with the ASI/cortisol for drop out, and stress/drug-use indices for engagement that together may enable clinically-relevant early recognition and interventions for prevention of stress-induced relapse in opioid-dependent populations.
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Affiliation(s)
- Kellie M Jaremko
- Department of Neuroscience, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia, PA 19107, USA; Department of Psychiatry and Human Behavior, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19147, USA.
| | - Robert C Sterling
- Department of Psychiatry and Human Behavior, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19147, USA
| | - Elisabeth J Van Bockstaele
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
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Winters LE, Karow A, Reimer J, Fricke S, Kuhnigk O, Schäfer I. Psychometric Properties of the Posttraumatic Diagnostic Scale (PDS) in Alcohol-Dependent Patients. Subst Abus 2014; 35:262-7. [DOI: 10.1080/08897077.2014.891555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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41
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Coping among military veterans with PTSD in substance use disorder treatment. J Subst Abuse Treat 2014; 47:160-7. [DOI: 10.1016/j.jsat.2014.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/04/2014] [Accepted: 03/24/2014] [Indexed: 11/21/2022]
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Lockwood E, Forbes D. Posttraumatic Stress Disorder and Comorbidity: Untangling the Gordian Knot. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9189-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
BACKGROUND Although women with substance use disorders (SUDs) have high rates of trauma and posttraumatic stress, many addiction programs do not offer trauma-specific treatments. One promising intervention is Pennebaker's expressive writing, which involves daily, 20-minute writing sessions to facilitate disclosure of stressful experiences. METHODS Women (N = 149) in residential treatment completed a randomized clinical trial comparing expressive writing with control writing. Repeated-measures analysis of variance was used to document change in psychological and physical distress from baseline to 2-week and 1-month follow-ups. Analyses also examined immediate levels of negative affect following expressive writing. RESULTS Expressive writing participants showed greater reductions in posttraumatic symptom severity, depression, and anxiety scores, when compared with control writing participants at the 2-week follow-up. No group differences were found at the 1-month follow-up. Safety data were encouraging: although expressive writing participants showed increased negative affect immediately after each writing session, there were no differences in pre-writing negative affect scores between conditions the following day. By the final writing session, participants were able to write about traumatic/stressful events without having a spike in negative affect. CONCLUSIONS Results suggest that expressive writing may be a brief, safe, low-cost, adjunct to SUD treatment that warrants further study as a strategy for addressing posttraumatic distress in substance-abusing women.
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Affiliation(s)
- Sarah Meshberg-Cohen
- Department of Veteran Affairs, VA Connecticut Healthcare System, West Haven, CT
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Thomas J McMahon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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van Dam D, Ehring T, Vedel E, Emmelkamp PMG. Trauma-focused treatment for posttraumatic stress disorder combined with CBT for severe substance use disorder: a randomized controlled trial. BMC Psychiatry 2013; 13:172. [PMID: 23782590 PMCID: PMC3698199 DOI: 10.1186/1471-244x-13-172] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/12/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This randomized controlled trial (RCT) investigated the effectiveness of a combined treatment for co-morbid Posttraumatic Stress Disorder (PTSD) and severe Substance Use Disorder (SUD). METHODS Structured Writing Therapy for PTSD (SWT), an evidence-based traumafocused intervention, was added on to Treatment As Usual (TAU), consisting of an intensive cognitive behavioral inpatient or day group treatment for SUD. The outcomes of the combined treatment (TAU + SWT) were compared to TAU alone in a sample of 34 patients. RESULTS Results showed a general reduction of SUD symptoms for both TAU + SWT and TAU. Treatment superiority of TAU + SWT was neither confirmed by interaction effects (time x condition) for SUD or PTSD symptoms, nor by a group difference for SUD diagnostic status at post-treatment. However, planned contrasts revealed that improvements for PTSD severity over time were only significant within the TAU + SWT group. In addition, within the TAU + SWT group the remission of PTSD diagnoses after treatment was significant, which was not the case for TAU. Finally, at post-treatment a trend was noticed for between group differences for the number of PTSD diagnoses favoring TAU + SWT above TAU. CONCLUSIONS In sum, the current study provides preliminary evidence that adding a trauma-focused treatment on to standard SUD treatment may be beneficial.
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Affiliation(s)
- Debora van Dam
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands.
| | - Thomas Ehring
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands,Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Ellen Vedel
- Jellinek Substance Abuse Treatment Center, Arkin, Postbus 3907, 1001 AS Amsterdam, The Netherlands
| | - Paul MG Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands,King Abdulaziz University, P.O Box 80203, Jeddah, Saudi Arabia
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Kok T, de Haan HA, van der Velden HJW, van der Meer M, Najavits LM, de Jong CAJ. Validation of two screening instruments for PTSD in Dutch substance use disorder inpatients. Addict Behav 2013; 38:1726-31. [PMID: 23261490 DOI: 10.1016/j.addbeh.2012.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 09/02/2012] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly prevalent in substance use disorder (SUD) populations. Because resources for extensive and thorough diagnostic assessment are often limited, reliable screening instruments for PTSD are needed. The aim of the current study was to test two short PTSD measures for diagnostic efficiency in predicting PTSD compared to the Clinician-Administered PTSD Scale (CAPS). The sample consisted of 197 SUD patients receiving residential substance use treatment who completed questionnaires regarding substance use and trauma-related symptoms, all abstinent from substance for 4weeks. The PTSD section of the Mini International Neuropsychiatric Interview plus (MINIplus) and the Self-Report Inventory for PTSD (SRIP) are compared to the CAPS. Results showed low sensitivity (.58) and high specificity (.91) for the PTSD section of the MINIplus. The SRIP showed high sensitivity (.80) and moderately high specificity (.73) at a cut-off score of 48. The prevalence of PTSD as measured with the CAPS was 25.4% current and 46.2% lifetime. Results indicate that the MINIplus, a short clinical interview, has insufficient quality as a screener for PTSD. The SRIP, however, is a reliable instrument in detecting PTSD in a SUD inpatient population in The Netherlands. Screening for PTSD is time efficient and increases detection of PTSD in SUD treatment settings.
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Affiliation(s)
- Tim Kok
- Tactus Addiction Treatment, P.O. Box 154, 7400 AD Deventer, The Netherlands.
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Himelhoch S, Weber E, Medoff D, Charlotte M, Clayton S, Wilson C, Ware R, Benford J. Posttraumatic stress disorder and one-year outcome in methadone maintenance treatment. Am J Addict 2012; 21:524-30. [PMID: 23082830 DOI: 10.1111/j.1521-0391.2012.00271.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although opiate use may be associated with posttraumatic stress disorder (PTSD), it is not clear whether PTSD is associated with retention in methadone maintenance. OBJECTIVES To evaluate among those receiving methadone maintenance at an urban methadone maintenance clinic the frequency of life-time traumatic experiences, the predictors and prevalence of current PTSD, and whether PTSD affects retention at 1 year. METHODS Eighty-nine people participated in the study. The Post Traumatic Diagnostic Scale was used to determine the prevalence of PTSD. The Life Stressor Checklist Revised was used to evaluate trauma history. Logistic regression analyses examined associations between demographic characteristics, substance use, trauma-related variables, and PTSD. Similar logistic regression analyses were used to examine retention in methadone maintenance at 1 year. RESULTS The mean number of reported lifetime stressful events was 8.0 (SD = 3.7). Twenty-seven percent were diagnosed with PTSD. Nearly 92% of those with PTSD had co-occurring depressive symptoms. Female gender (adjusted odds ratio [AOR][95% CI]; 3.89 [1.07-14.01]), number of traumatic events (AOR [95% CI]; 1.34 [1.13-1.61]), and less education (AOR [95% CI]; 4.13 [1.14-14.98]) were significantly associated with PTSD. Those with a toxicology positive screen were 80% less likely to remaine in methadone maintenance at 1 year (OR [95% CI]; 0.20 [0.07-0.52]). PTSD diagnosis was not significantly associated with treatment retention at 1 year (OR [95% CI]; 0.61 [0.23-1.64]). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Future studies are needed to determine if treatment of PTSD that is integrated into methadone maintenance programs may impact continued substance abuse use and thereby improve retention in care.
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Affiliation(s)
- Seth Himelhoch
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Pahl K, Brook JS, Lee JY. Joint trajectories of victimization and marijuana use and their health consequences among urban African American and Puerto Rican young men. J Behav Med 2012; 36:305-14. [PMID: 22532191 DOI: 10.1007/s10865-012-9425-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
We examined the joint trajectories of violent victimization and marijuana use from emerging adulthood to the early thirties and their health consequences in the early thirties among urban African American and Puerto Rican men. Data were collected from a community sample of young men (N = 340) when they were 19, 24, 29, and 32 years old. The joint trajectories of violent victimization and marijuana use were extracted using growth mixture modeling. Three distinct joint trajectory groups of violent victimization and marijuana use were identified: high violent victimization/consistently high marijuana use; low violent victimization/increasingly high marijuana use, and low violent victimization/low marijuana use. Group comparisons using regression analyses showed that men who had experienced high levels of violent victimization and were high frequency marijuana over time users experienced the most adverse psychological and physical health outcomes, including more health problems, psychological maladjustment, and substance use disorders.
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Affiliation(s)
- Kerstin Pahl
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, New York, NY 10016, USA.
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Boden MT, Kimerling R, Jacobs-Lentz J, Bowman D, Weaver C, Carney D, Walser R, Trafton JA. Seeking Safety treatment for male veterans with a substance use disorder and post-traumatic stress disorder symptomatology. Addiction 2012; 107:578-86. [PMID: 21923756 DOI: 10.1111/j.1360-0443.2011.03658.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS To determine whether substituting Seeking Safety (SS), a manualized therapy for comorbid substance use disorders (SUD) and post-traumatic stress disorder (PTSD) for part of treatment-as-usual (TAU) improves substance use outcomes. DESIGN Randomized controlled effectiveness trial. SETTINGS Out-patient Veterans Administration Health Care System SUD clinic. PARTICIPANTS Ninety-eight male military Veterans with a SUD and co-occurring PTSD symptomatology. MEASUREMENTS Drug and alcohol use and PTSD severity, measured on the first day of treatment, and 3 (i.e. the planned end of SS sessions) and 6 months following the baseline assessment. Treatment attendance and patient satisfaction were measured following treatment (3-month follow-up). Active coping was measured at treatment intake and following treatment. FINDINGS SS compared to TAU was associated with better drug use outcomes (P < 0.05), but alcohol use and PTSD severity decreased equally under both treatments (P's < 0.01). SS versus TAU was associated with increased treatment attendance, client satisfaction and active coping (all P's < 0.01). However, neither these factors nor decreases in PTSD severity mediated the effect of treatment on drug use. CONCLUSIONS The manualized treatment approach for substance use disorder, Seeking Safety, is well received and associated with better drug use outcomes than 'treatment as usual' in male veterans with post-traumatic stress disorder. However, the mechanism of its effect is unclear.
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Affiliation(s)
- Matthew Tyler Boden
- Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA.
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Torchalla I, Nosen L, Rostam H, Allen P. Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: A systematic review and meta-analysis. J Subst Abuse Treat 2012; 42:65-77. [DOI: 10.1016/j.jsat.2011.09.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/23/2011] [Accepted: 09/15/2011] [Indexed: 01/08/2023]
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