Demographic and psychological factors associated with lifetime cocaine use: An exploratory factor analysis of baseline questionnaires

Identification of Typologies of Cocaine Use Based on Quantity, Frequency, and Duration of Use: A Latent Profile Analysis

OBJECTIVES

We identified the patterns of cocaine use during individuals' heaviest use period by considering quantity, frequency, and duration simultaneously and examined the correlates and risk profile for these patterns.

METHODS

Latent profile analysis was conducted among the 3117 individuals who reported lifetime use of cocaine in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) with quantity, frequency, and duration used as indicators. Logistic regression analyses examined factors associated with subtype membership based on patterns of cocaine use and the relationships between these patterns and cocaine use disorder (CocUD) and its severity.

RESULTS

Four patterns were identified: a "low use" class (72.6%), a "moderate use" class (8.2%), a "daily use" class (17.9%), and a "very high quantity use" class (1.3%). Relative to non-Hispanic White and the "low use" class, non-Hispanic Black was associated with increased odds to be in the "moderate use" and "daily use" classes. Higher prevalence of smoking crack cocaine and poly-route use was observed among the "very high quantity use" class relative to other classes; increased risk of using other substances was associated with the "daily use" class. Higher levels of cocaine use were associated with higher risks of CocUD and worse severity compared to the "low use" class.

CONCLUSIONS

People who use cocaine are heterogeneous with different patterns of use and risks of CocUD. Reducing cocaine smoking and poly-route of use should be placed as the same priority as decreasing very high quantity of use in interventions.

Impulsivity across substance use categories: Consideration of sex/gender

PURPOSE OF REVIEW

The goal was to review recent (1/2015-2/2020) evidence of impulsivity as a feature of substance use disorders or use of substances (alcohol, cannabis, nicotine, opioids, stimulants) in males compared to females in terms of: a) impulsivity in substance-using groups (or substance-using compared to control groups), and b) relationship between impulsivity and substance use behavior, clinical severity, or treatment outcomes.

RECENT FINDINGS

Of 361 papers identified by the searches, 69 met inclusion criteria, and 39 were highlighted for considering sex/gender in relation to impulsivity in substance-using populations. Taken together, findings supported higher impulsivity in males and females who use substances, relative to controls; and higher impulsivity was linked with more substance use/severity in both sex/genders. There were mixed findings regarding male versus female differences in impulsivity among individuals who use substances, or in the magnitude of the relationship between impulsivity and substance use severity.

SUMMARY

The current body of evidence does not point to a consistent sex/gender difference in the role of impulsivity within and across substance use disorders. Impulsivity is a clinically-relevant construct for male and female individuals who use substances, across a range of substances.

Preliminary examination of the orexin system on relapse-related factors in cocaine use disorder

RATIONALE

Current evidence and literature reviews provide a strong justification for examining the orexin receptor (OXR) system as a therapeutic target in substance use disorders, including cocaine and other psychostimulants.

OBJECTIVES

In this preliminary, proof-of-concept examination of orexin modulation in humans with cocaine use disorder, we measured changes in domains tied to relapse: stress, sleep, cue reactivity, and inhibitory control. Additionally, mood symptoms (anxiety, depression), medication compliance, and side effects were assessed.

METHODS

Twenty non-treatment seeking subjects with cocaine use disorder (CUD) received either the OX₁R / OX₂R antagonist suvorexant PO or placebo at 10 PM daily for two weeks (10 mg week 1, 20 mg week 2). Using psychometrics, smart-watch actigraphy, a cold-pressor stress challenge, and eye-tracking technology, the following domains were examined: sleep, stress/anxiety, cue-reactivity (attentional bias, craving), and inhibitory control. Psychometric data were collected every M/W/F (7 time points). Laboratory data were collected weekly (3 time points).

RESULTS

Bayesian and frequentist generalized linear models were employed in parallel to examine the effects of suvorexant compared to placebo, with a Bayesian posterior probability threshold >80% as evidence of a signal for suvorexant. Notable results favoring suvorexant over placebo included fewer total anti-saccade errors, improved sleep actigraphy (sleep/awake periods), pre/post cold-pressor change in heart rate and salivary cortisol (all posterior probabilities >94%), and craving (posterior probability >87%).

CONCLUSIONS

Initial but restricted evidence is provided supporting the orexin system as a modulator of relapse-related processes in cocaine use disorder. Baseline differences in the main outcome variables were not experimentally controlled and differences in craving were observed at baseline. This, in combination with a limited sample size, constrain the nature of the project. The results may serve to inform more comprehensive future research.

Borderline Personality Disorder With Cocaine Dependence: Impulsivity, Emotional Dysregulation and Amygdala Functional Connectivity

Background: Borderline personality disorder is present in 19% of cocaine dependence cases; however, this dual pathology is poorly understood. We wished to characterize the dual pathology and find its functional connectivity correlates to better understand it. Methods: We recruited 69 participants divided into 4 groups: dual pathology (n = 20), cocaine dependence without borderline personality disorder (n = 19), borderline personality without cocaine dependence (n = 10) and healthy controls (n = 20). We used self-reported instruments to measure impulsivity and emotional dysregulation. We acquired resting state fMRI and performed seed-based analyses of the functional connectivity of bilateral amygdala. Results: Borderline personality disorder and cocaine dependence as factors had opposing effects in impulsivity and emotional dysregulation, as well as on functional connectivity between left amygdala and medial prefrontal cortex. On the other hand, in the functional connectivity between right amygdala and left insula, the effect of having both disorders was instead additive, reducing functional connectivity strength. The significant functional connectivity clusters were correlated with impulsivity and emotional dysregulation. Conclusions: In this study, we found that clinical scores of dual pathology patients were closer to those of borderline personality disorder without cocaine dependence than to those of cocaine dependence without borderline personality disorder, while amygdala-medial prefrontal cortex functional connectivity patterns in dual pathology patients were closer to healthy controls than expected.