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Kirsch DE, Grodin EN, Ray LA. Characterizing alcohol cue reactive and non-reactive individuals with alcohol use disorder. Addict Behav 2024; 155:108028. [PMID: 38640885 DOI: 10.1016/j.addbeh.2024.108028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE Exposure to alcohol-related cues is thought to elicit a conditional response characterized by increased craving in individuals with alcohol use disorder (AUD). In the context of AUD research, it is important to consider that not all individuals with an AUD are alcohol cue reactive. This study systematically examined subjective alcohol cue reactivity and its clinical and drinking correlates in individuals with an AUD enrolled in a human laboratory pharmacotherapy trial. METHODS Individuals with current moderate-to-severe AUD (N = 52) completed a standard alcohol cue exposure paradigm and individual difference assessments as part of a human laboratory pharmacotherapy trial (NCT04249882). We classified participants as cue reactive (CR+) and cue non-reactive (CR-), as indicated by self-reported, subjective alcohol urge, and examined group differences in baseline clinical characteristics and drinking outcomes over the course of the trial. RESULTS Twenty participants (38%) were identified as CR+, while 32 participants (62%) were identified as CR-. The CR+ and CR- groups did not differ in baseline drinking and AUD clinical characteristics, but the groups differed in race composition (p = 0.02) and smoking prevalence (p = 0.04) such that the CR+ group had lower prevalence of smokers. The CR+, compared with the CR-, group drank more during the trial titration period (p = 0.03). Both groups reduced drinking across the trial (p's < 0.001), but the CR+ group exhibited a smaller reduction in drinking, compared with the CR- group (time x group, p = 0.029; CR-, p < 0.0001; CR+: p = 0.01). CONCLUSION Results indicate that cue reactivity is a heterogenous construct. Recognizing this heterogeneity, and the clinical factors associated with it, is critical to advancing this paradigm as an early efficacy marker in AUD research.
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Affiliation(s)
- Dylan E Kirsch
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
| | - Erica N Grodin
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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2
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Aubin HJ, Berlin I, Guiraud J, Bruhwyler J, Batel P, Perney P, Trojak B, Bendimerad P, Guillou M, Bisch M, Grall-Bronnec M, Labarrière D, Delsart D, Questel F, Moirand R, Bernard P, Trovero F, Pham HP, Tassin JP, Puech A. Prazosin and cyproheptadine in combination in the treatment of alcohol use disorder: A randomized, double-blind, placebo-controlled trial. Addiction 2024; 119:1211-1223. [PMID: 38597214 DOI: 10.1111/add.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND AIMS Pre-clinical studies suggest that the simultaneous blockade of the α1b and 5HT2A receptors may be effective in reducing alcohol consumption. This study aimed to assess the efficacy and safety of prazosin (α1b blocker) and cyproheptadine (5HT2A blocker) combination in decreasing total alcohol consumption (TAC) in alcohol use disorder (AUD). DESIGN, SETTING AND PARTICIPANTS This was a double-blind, parallel group, placebo-controlled, Phase 2, randomized clinical trial conducted in 32 addiction treatment centres in France. A total of 108 men and 46 women with severe AUD took part. INTERVENTION Participants were randomly assigned to one of the following 3-month treatments: (1) low-dose group (LDG) receiving 8 mg cyproheptadine and 5 mg prazosin extended-release (ER) formulation daily; (2) high-dose group (HDG) receiving 12 mg cyproheptadine and 10 mg prazosin ER daily; and (3) placebo group (PG) receiving placebo of cyproheptadine and prazosin ER. A total of 154 patients were randomized: 54 in the PG, 54 in the LDG and 46 in the HDG. MEASUREMENTS The primary outcome was TAC change from baseline to month 3. FINDINGS A significant main treatment effect in the change in TAC was found in the intent-to-treat population (P = 0.039). The HDG and LDG showed a benefit in the change in TAC from baseline to month 3 compared with PG: -23.6 g/day, P = 0.016, Cohen's d = -0.44; -18.4 g/day, P = 0.048 (Bonferroni correction P < 0.025), Cohen's d = -0.36. In a subgroup of very high-risk drinking-level participants (> 100 g/day of pure alcohol for men and > 60 g/day for women), the difference between the HDG and the PG in the primary outcome was -29.8 g/day (P = 0.031, Cohen's d = -0.51). The high and low doses were well-tolerated with a similar safety profile. CONCLUSIONS A randomized controlled trial of treatment of severe alcohol use disorder with a cyproheptadine-prazosin combination for 3 months reduced drinking by more than 23 g per day compared with placebo. A higher dose combination was associated with a larger magnitude of drinking reduction than a lower dose combination while showing similar safety profile.
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Affiliation(s)
| | - Ivan Berlin
- Hopital Pitie-Salpetriere, Sorbonne Université, Paris, France
| | - Julien Guiraud
- University of Amsterdam, Amsterdam, the Netherlands
- Vergio, Clichy, France
| | | | | | - Pascal Perney
- Hôpital Carémeau, Nîmes, Université Montpellier 1, Villejuif, France
| | - Benoît Trojak
- Centre hospitalier Universitaire Dijon Bourgogne, Université Bourgogne Franche-Comté, Besançon, France
| | - Patrick Bendimerad
- Addiction Department, Groupe Hospitalier Littoral Atlantique, La Rochelle, France
| | - Morgane Guillou
- ER 7479 SPURBO, Université Bretagne Occidentale, Brest, France
| | - Michaël Bisch
- Centre Psychothérapique de Nancy, Addiction Medicine department, Laxou, France
| | - Marie Grall-Bronnec
- Addictology and Liaison Psychiatry Department, Nantes University Hospital, Nantes and Tours Universities, Nantes, France
| | | | | | - Frank Questel
- Université Paris Diderot, GH Lariboisière-Saint-Louis-Fernand Widal, Paris, France
| | - Romain Moirand
- Université Rennes, Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), UF Addictologie, Rennes, France
| | | | | | | | - Jean-Pol Tassin
- Inserm, Sorbonne-Université, Laboratoire Neuroscience Paris-Seine, Paris, France
| | - Alain Puech
- Kinnov-Therapeutics, Orléans, France
- Inserm, Sorbonne-Université, Laboratoire Neuroscience Paris-Seine, Paris, France
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3
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Campbell EJ, Bonomo Y, Collins L, Norman A, O'Neill H, Streitberg A, Galloway K, Kyoong A, Perkins A, Pastor A, Lawrence AJ. The dual orexin receptor antagonist suvorexant in alcohol use disorder and comorbid insomnia: A case report. Clin Case Rep 2024; 12:e8740. [PMID: 38698873 PMCID: PMC11063611 DOI: 10.1002/ccr3.8740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Key Clinical Message This case suggests using dual orexin receptor antagonists to treat alcohol use disorder and comorbid sleep disorders may be effective, commencing treatment in withdrawal and continuing it to prevent relapse. Abstract Effective medications for the treatment of alcohol use disorder are limited. This is partially due to the heterogenous nature of the symptomatology associated with alcohol use disorder and the abundance of presenting comorbidities. One common, and often overlooked, symptom that occurs during withdrawal of alcohol use is sleep disruption. Here, we report a case study of a participant with comorbid alcohol use disorder and insomnia. This participant was treated with a dual orexin receptor antagonist, suvorexant (Belsomra®), currently approved to treat insomnia. We demonstrate improvements in alcohol cravings, physical and psychological health, and sleep outcomes with treatment. These data support abundant preclinical and emerging clinical data in this space. The findings from this case report highlight the potential for suvorexant to treat comorbid alcohol use disorder and insomnia with fully powered, randomized controlled trials moving forward.
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Affiliation(s)
- Erin J. Campbell
- Florey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
- Florey Department of Neuroscience and Mental HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Yvonne Bonomo
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Lisa Collins
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Amanda Norman
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Helen O'Neill
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Amanda Streitberg
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Kate Galloway
- Department of Respiratory and Sleep MedicineSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Andrew Kyoong
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Andrew Perkins
- Department of Respiratory and Sleep MedicineThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Adam Pastor
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Andrew J. Lawrence
- Florey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
- Florey Department of Neuroscience and Mental HealthThe University of MelbourneMelbourneVictoriaAustralia
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Nieto SJ, Grodin EN, Ray LA. Neural correlates of the addictions neuroclinical assessment (ANA) incentive salience factor among individuals with alcohol use disorder. Behav Brain Res 2024; 464:114926. [PMID: 38431152 DOI: 10.1016/j.bbr.2024.114926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
The Addictions Neuroclinical Assessment (ANA) is a recently-developed framework offering a more holistic understanding of three neurofunctional and behavioral domains that reflect the neurobiological dysfunction seen in alcohol use disorder (AUD). While the ANA domains have been well-validated across independent laboratories, there is a critical need to identify neural markers that subserve the proposed neurofunctional domains. The current study involves secondary data analysis of a two-week experimental medication trial of ibudilast (50 mg BID). Forty-five non-treatment-seeking participants with AUD (17F / 28 M) completed a battery of validated behavioral assessments forming the basis of their incentive salience factor score, computed via factor analysis, as well as a functional neuroimaging (fMRI) task assessing their neural reactivity to visual alcohol cues after being on placebo or ibudilast for 7 days. General linear models were conducted to examine the relationship between incentive salience and neural alcohol cue-reactivity in the ventral and dorsal stratum. Whole-brain generalized linear model analyses were conducted to examine associations between neural alcohol cue-reactivity and incentive salience. Age, sex, medication, and smoking status were included as covariates. Incentive salience was not associated with cue-elicited activation in the dorsal or ventral striatum. Incentive salience was significantly positively correlated (p < 0.05) with alcohol cue-elicited brain activation in reward-learning and affective regions including the insula and posterior cingulate cortices, bilateral precuneus, and bilateral precentral gyri. The ANA incentive salience factor is reflected in brain circuitry important for reward learning and emotion processing. Identifying a sub-phenotype of AUD characterized by increased incentive salience to alcohol cues allows for precision medicine approaches, i.e. treatments specifically targeting craving and reward from alcohol use. This study serves as a preliminary bio-behavioral validation for the incentive salience factor of the ANA. Further studies validating the neural correlates of other ANA factors, as well as replication in larger samples, appear warranted.
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Affiliation(s)
- Steven J Nieto
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Erica N Grodin
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA.
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5
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Davis CN, Gex KS, Squeglia LM, Trull TJ, McCarthy DM, Baker NL, Gray KM, McRae-Clark AL, Tomko RL. Development and Initial Validation of a Momentary Cannabis Craving Scale Within a Homogeneous Sample of U.S. Emerging Adults. Assessment 2024:10731911241237055. [PMID: 38515003 DOI: 10.1177/10731911241237055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Given the popularity and ease of single-item craving assessments, we developed a multi-item measure and compared it to common single-item assessments in an ecological momentary assessment (EMA) context. Two weeks of EMA data were collected from 48 emerging adults (56.25% female, 85.42% White) who frequently used cannabis. Eight craving items were administered, and multilevel factor analyses were used to identify the best fitting model. The resulting scale's factors represented purposefulness/general desire and emotionality/negative affect craving. Convergent validity was examined using measures of craving, cannabis use disorder symptoms, frequency of use, cannabis cue reactivity, cannabis use, negative affect, and impulsivity. The scale factors were associated with cue-reactivity craving, negative affect, impulsivity, and subfactors of existing craving measures. For researchers interested in using a single item to capture craving, one item performed particularly well. However, the new scale may provide a more nuanced assessment of mechanisms underlying craving.
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Affiliation(s)
- Christal N Davis
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, USA
| | - Kathryn S Gex
- Medical University of South Carolina, Charleston, USA
| | | | | | | | | | - Kevin M Gray
- Medical University of South Carolina, Charleston, USA
| | - Aimee L McRae-Clark
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
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Ehlers CL, Li L, Peng Q, Gilder DA, Batts KR, Karriker-Jaffe KJ. Alcohol Consumption Questionnaire: Scale development in a sample of Mexican American young adults and association with ADH7. Alcohol 2024:S0741-8329(24)00049-1. [PMID: 38467168 DOI: 10.1016/j.alcohol.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND To understand why some individuals who develop alcohol use disorders (AUD) first begin to drink heavily, a number of scales have been developed that index aspects of alcohol craving and restraint from drinking. We developed a new measure called the Alcohol Consumption Questionnaire (ACQ), based in part on items modified from scales used to index binge eating because there are data to suggest that binge eating and binge drinking may share common antecedents. We present an initial validity study using data from a sample of Mexican Americans. METHODS Data were from 699 Mexican American young adults in San Diego County, CA. A subsample (n=60) had short-term test-retest data. Factor analysis and reliability assessment guided item reduction. Item response theory (IRT) analyses quantified item severity and identified questions with differential item functioning (DIF). Logistic regression assessed associations of mean scale scores with AUD, adjusting for key demographics, alcohol expectancies and subjective response to alcohol. We also examined associations with a protective genetic variant downstream from the alcohol dehydrogenase 7 gene (ADH7). RESULTS The scale was reduced from 20 to 14 questions, which can be summarized by a single overall score (Cronbach's alpha=0.896) or by two sub-scores (Consumption: 12 items, Cronbach's alpha=0.896; Enjoyment: 2 items, Cronbach's alpha=0.780). Test-retest reliability was very high (0.80-0.98) in this sample. The overall ACQ score and each subdomain score were strongly associated with AUD (ORs= 5.95 mild; 11.41 moderate; 48.56 severe) and family history of AUD. Respondents with the protective genetic variant had significantly lower overall ACQ scores (p<.001). CONCLUSION The ACQ is a novel measure of alcohol consumption with strong relationships with both the AUD phenotype and ADH7 gene variants in a sample of Mexican American young adults.
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Affiliation(s)
| | - Libo Li
- Alcohol Research Group, Public Health Institute
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7
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Ohtani Y, Ueno F, Kimura M, Matsushita S, Mimura M, Uchida H. Highly endorsed screening and assessment scales for alcohol problems: A systematic review. Neuropsychopharmacol Rep 2023; 43:470-481. [PMID: 37392159 PMCID: PMC10739151 DOI: 10.1002/npr2.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Problems associated with alcohol use are multidimensional with psychiatric, psychological, physical, and social aspects, which makes it challenging to choose appropriate assessment scales. However, there has been no systematic evaluation of existing alcohol scales. METHODS A systematic literature search was conducted for articles that assessed the psychometric properties of scales for alcohol use disorder on March 19, 2023, using Medline, EMBASE, and PsycINFO. Only scales whose original development papers were cited more than 20 times were included. The methodological quality and psychometric properties of the scales were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments. The overall rating of the scales were assessed with a score ranging from 0 to 18. RESULTS In total, 314 studies and 40 scales were identified. These scales differ widely in measurement methods, target populations, and psychometric properties. The overall mean score was 6.3, and only the following three scales received >9 points suggesting a moderate level of evidence: Alcohol Use Disorders Identification Test (AUDIT), Alcohol Dependence Scale (ADS), and Short Alcohol Dependence Data Questionnaire (SADD). Measurement error and responsiveness were not evaluated or reported in the included scales. CONCLUSIONS Although the AUDIT, ADS, and SADD were rated the highest among the 40 scales, they showed, at most, a moderate level of evidence. These findings underscore the need to accumulate further evidence to assure the quality of the scales. It may be advisable to select and combine scales to meet the purpose of the assessment.
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Affiliation(s)
- Yohei Ohtani
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Fumihiko Ueno
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Mitsuru Kimura
- Department of PsychiatryNational Hospital Organization Kurihama Medical and Addiction CenterYokosukaJapan
| | - Sachio Matsushita
- Department of PsychiatryNational Hospital Organization Kurihama Medical and Addiction CenterYokosukaJapan
| | - Masaru Mimura
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hiroyuki Uchida
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
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Chang H, Huang M, Fang S, Lin S. Quality of life and associated factors of heroin-dependent patients receiving methadone and buprenorphine maintenance treatment. Neuropsychopharmacol Rep 2023; 43:607-615. [PMID: 38088122 PMCID: PMC10739136 DOI: 10.1002/npr2.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
AIM Although studies in Western countries have investigated the quality of life (QoL) of heroin users, limited research on this topic has been conducted in Asia. The present study assessed QoL in patients with heroin dependence receiving medications to treat opioid use disorder. METHODS We performed a cross-sectional study of patients with heroin dependence receiving methadone and buprenorphine treatment. The demographic and substance use variables of patients receiving methadone and buprenorphine were compared. The Chinese Health Questionnaire (CHQ-12), Obsessive Compulsive Drug Use Scale (OCDUS), and World Health Organization Quality of Life Short Form Taiwan version (WHOQOL-BREF-T) were administered to measure patient mental health problems, addiction severity, and QoL, respectively. Multivariate regression was used to identify the factors associated with QoL. RESULTS A total of 149 patients receiving methadone and 31 receiving buprenorphine completed the questionnaires. Individuals in the buprenorphine group were more likely to be married (p = 0.024) or employed (p = 0.024), have a higher educational level (p = 0.013), have lower drug craving (OCDUS: p = 0.035), or have higher QoL (WHOQOL-BREF-T: p = 0.004) than those in the methadone group. After adjustment for other variables, employment was positively associated with the physical, psychological, and environmental domains of QoL. Receiving buprenorphine treatment (p = 0.032) and longer treatment duration (p = 0.016) were associated with higher psychological QoL. CONCLUSION Several factors were associated with QoL in patients with heroin dependence. Some measures may improve their QoL, such as reducing employment barriers, improving treatment adherence, or increasing accessibility to buprenorphine treatment.
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Affiliation(s)
- Hu‐Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan
| | - Ming‐Chyi Huang
- Department of Addiction Sciences, Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Su‐Chen Fang
- Department of NursingMackay Medical CollegeTaipeiTaiwan
| | - Shih‐Ku Lin
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Department of General PsychiatryChang Gung Memorial HospitalTaoyuanTaiwan
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Lütt A, Tsamitros N, Wolbers T, Rosenthal A, Bröcker AL, Schöneck R, Bermpohl F, Heinz A, Beck A, Gutwinski S. An explorative single-arm clinical study to assess craving in patients with alcohol use disorder using Virtual Reality exposure (CRAVE)-study protocol. BMC Psychiatry 2023; 23:839. [PMID: 37964300 PMCID: PMC10647047 DOI: 10.1186/s12888-023-05346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) belongs to the most burdensome clinical disorders worldwide. Current treatment approaches yield unsatisfactory long-term effects with relapse rates up to 85%. Craving for alcohol is a major predictor for relapse and can be intentionally induced via cue exposure in real life as well as in Virtual Reality (VR). The induction and habituation of craving via conditioned cues as well as extinction learning is used in Cue Exposure Therapy (CET), a long-known but rarely used strategy in Cognitive Behavioral Therapy (CBT) of AUD. VR scenarios with alcohol related cues offer several advantages over real life scenarios and are within the focus of current efforts to develop new treatment options. As a first step, we aim to analyze if the VR scenarios elicit a transient change in craving levels and if this is measurable via subjective and psychophysiological parameters. METHODS A single-arm clinical study will be conducted including n = 60 patients with AUD. Data on severity of AUD and craving, comorbidities, demographics, side effects and the feeling of presence in VR will be assessed. Patients will use a head-mounted display (HMD) to immerse themselves into three different scenarios (neutral vs. two target situations: a living room and a bar) while heart rate, heart rate variability, pupillometry and electrodermal activity will be measured continuously. Subjective craving levels will be assessed before, during and after the VR session. DISCUSSION Results of this study will yield insight into the induction of alcohol craving in VR cue exposure paradigms and its measurement via subjective and psychophysiological parameters. This might be an important step in the development of innovative therapeutic approaches in the treatment of patients with AUD. TRIAL REGISTRATION This study was approved by the Charité-Universitätsmedizin Berlin Institutional Review Board (EA1/190/22, 23.05.2023). It was registered on ClinicalTrials.gov (NCT05861843).
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Affiliation(s)
- A Lütt
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany.
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany.
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany.
| | - N Tsamitros
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - T Wolbers
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
| | - A Rosenthal
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A L Bröcker
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - R Schöneck
- Salus Clinic Lindow, 16835, Lindow, Germany
| | - F Bermpohl
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A Heinz
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany
| | - A Beck
- Faculty of Health, Health and Medical University, 14471, Potsdam, Germany
| | - S Gutwinski
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
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10
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Weber A, Shevchenko Y, Gerhardt S, Hoffmann S, Kiefer F, Vollstädt-Klein S. Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial. JMIR Form Res 2023; 7:e42194. [PMID: 37934561 PMCID: PMC10664013 DOI: 10.2196/42194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/23/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders. OBJECTIVE This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated. METHODS In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions. RESULTS We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations. CONCLUSIONS The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. TRIAL REGISTRATION ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476.
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Affiliation(s)
- Antonia Weber
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yury Shevchenko
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Research Methods, Assessment, and iScience, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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11
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Tomko RL, Wolf BJ, McClure EA, Carpenter MJ, Magruder KM, Squeglia LM, Gray KM. Who responds to a multi-component treatment for cannabis use disorder? Using multivariable and machine learning models to classify treatment responders and non-responders. Addiction 2023; 118:1965-1974. [PMID: 37132085 PMCID: PMC10524796 DOI: 10.1111/add.16226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND AIMS Treatments for cannabis use disorder (CUD) have limited efficacy and little is known about who responds to existing treatments. Accurately predicting who will respond to treatment can improve clinical decision-making by allowing clinicians to offer the most appropriate level and type of care. This study aimed to determine whether multivariable/machine learning models can be used to classify CUD treatment responders versus non-responders. METHODS This secondary analysis used data from a National Drug Abuse Treatment Clinical Trials Network multi-site outpatient clinical trial in the United States. Adults with CUD (n = 302) received 12 weeks of contingency management, brief cessation counseling and were randomized to receive additionally either (1) N-Acetylcysteine or (2) placebo. Multivariable/machine learning models were used to classify treatment responders (i.e. two consecutive negative urine cannabinoid tests or a 50% reduction in days of use) versus non-responders using baseline demographic, medical, psychiatric and substance use information. RESULTS Prediction performance for various machine learning and regression prediction models yielded area under the curves (AUCs) >0.70 for four models (0.72-0.77), with support vector machine models having the highest overall accuracy (73%; 95% CI = 68-78%) and AUC (0.77; 95% CI = 0.72, 0.83). Fourteen variables were retained in at least three of four top models, including demographic (ethnicity, education), medical (diastolic/systolic blood pressure, overall health, neurological diagnosis), psychiatric (depressive symptoms, generalized anxiety disorder, antisocial personality disorder) and substance use (tobacco smoker, baseline cannabinoid level, amphetamine use, age of experimentation with other substances, cannabis withdrawal intensity) characteristics. CONCLUSIONS Multivariable/machine learning models can improve on chance prediction of treatment response to outpatient cannabis use disorder treatment, although further improvements in prediction performance are likely necessary for decisions about clinical care.
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Affiliation(s)
- Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Bethany J. Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn M. Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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12
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Laurens MC, Postel MG, Brusse-Keizer M, Pieterse ME, Ben Allouch S, Bohlmeijer ET, Salemink E. Augmenting outpatient alcohol treatment as usual with online approach bias modification training: A double-blind randomized controlled trial. Addict Behav 2023; 142:107630. [PMID: 36881944 DOI: 10.1016/j.addbeh.2023.107630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
Previous research shows that automatic tendency to approach alcohol plays a causal role in problematic alcohol use and can be retrained by Approach Bias Modification (ApBM). ApBM has been shown to be effective for patients diagnosed with alcohol use disorder (AUD) in inpatient treatment. This study aimed to investigate the effectiveness of adding an online ApBM to treatment as usual (TAU) in an outpatient setting compared to receiving TAU with an online placebo training. 139 AUD patients receiving face-to-face or online treatment as usual (TAU) participated in the study. The patients were randomized to an active or placebo version of 8 sessions of online ApBM over a 5-week period. The weekly consumed standard units of alcohol (primary outcome) was measured at pre-and post-training, 3 and 6 months follow-up. Approach tendency was measured pre-and-post ApBM training. No additional effect of ApBM was found on alcohol intake, nor other outcomes such as craving, depression, anxiety, or stress. A significant reduction of the alcohol approach bias was found. This research showed that approach bias retraining in AUD patients in an outpatient treatment setting reduces the tendency to approach alcohol, but this training effect does not translate into a significant difference in alcohol reduction between groups. Explanations for the lack of effects of ApBM on alcohol consumption are treatment goal and severity of AUD. Future ApBM research should target outpatients with an abstinence goal and offer alternative, more user-friendly modes of delivering ApBM training.
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Affiliation(s)
- Melissa C Laurens
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands; Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands.
| | - Marloes G Postel
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands; Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marcel E Pieterse
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | - Somaya Ben Allouch
- Informatics Institute, University of Amsterdam, Netherlands; Research Group Digital Life, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
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13
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Barillot L, Chauvet C, Besnier M, Jaafari N, Solinas M, Chatard A. Effect of environmental enrichment on relapse rates in patients with severe alcohol use disorder: protocol for a randomised controlled trial. BMJ Open 2023; 13:e069249. [PMID: 37173113 PMCID: PMC10186436 DOI: 10.1136/bmjopen-2022-069249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) ranks among the most prevalent psychiatric disorders worldwide. Despite current treatments, more than half of patients relapse within weeks after treatment. In animal models, exposure to environmental enrichment (EE) has been shown to be a promising approach to reduce relapse. However, controlled, multimodal EE is difficult to transpose to humans. To address this gap, this study aims at assessing the effectiveness of exposure to a newly designed EE protocol during AUD treatment in reducing relapse to alcohol use. Our EE will allow an enhancement of the standard intervention, and will combine several promising enrichment factors identified in the literature-physical activity, cognitive stimulation, mindfulness and virtual reality (VR). METHODS AND ANALYSIS A randomised controlled trial involving 135 participants receiving treatment for severe AUD will be conducted. Patients will be randomised to an intervention enhancement group or a control group. The enhanced intervention will consist of six 40-min sessions of EE spread over 9 days. During the first 20 min of these sessions, patients will practise mindfulness in multisensory VR, in virtual environments designed to practise mindfulness and use it to regulate craving induced by virtual cues or stress. Then, participants will practise indoor cycling combined with cognitive training exercises. The control group will undergo standard management for AUD. The primary outcome is relapse assessed at 2 weeks after treatment, using a questionnaire and biological indicators. Relapse will be defined as drinking at least five drinks per occasion or drinking at least five times a week. It is predicted that the group receiving the EE intervention will have a lower relapse rate than the control group. The secondary outcomes are relapse at 1 month and 3 months after treatment, craving and drug-seeking behaviour, mindfulness skills acquisition and the effect of the intervention enhancement on the perceived richness of the daily environment, assessed by questionnaires and neuropsychological tasks. ETHICS AND DISSEMINATION All participants have to give written informed consent to the investigator. This study is approved by the Ethics Committee Nord Ouest IV of Lille (reference number 2022-A01156-37). Results will be disseminated through presentations, peer-reviewed journals and seminar conferences. All information on ethical considerations and open science practices can be accessed at https://osf.io/b57uj/ TRIAL REGISTRATION NUMBER: NCT05577741.
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Affiliation(s)
- Lila Barillot
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Claudia Chauvet
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Marc Besnier
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Nematollah Jaafari
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Marcello Solinas
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Université de Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques U1084, Poitiers, France
| | - Armand Chatard
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
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14
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Grodin EN, Burnette EM, O’Neill J, Alger J, Ray LA. Alcohol Craving and Severity are Associated with Dorsal Anterior Cingulate Choline Levels in Individuals with an Alcohol Use Disorder. Alcohol Alcohol 2023; 58:289-297. [PMID: 36939375 PMCID: PMC10168708 DOI: 10.1093/alcalc/agad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Magnetic resonance spectroscopy (MRS) has been used to probe inflammation in the brain. While altered MRS metabolite levels have previously been found in individuals with alcohol use disorder (AUD), the relationship between potential metabolite markers of inflammation and the clinical correlates of AUD remains understudied. Therefore, this exploratory study sought to elucidate the clinical significance of inflammation in AUD by examining relationships between metabolites, AUD severity, alcohol consumption, and craving in individuals with AUD. METHODS Data for this secondary analysis are derived from a two-week clinical trial of ibudilast to treat AUD. Forty-three non-treatment-seeking individuals with an AUD (26M/17F) completed an MRS scan and alcohol-related questionnaires. MRS was performed using a multi-voxel array placed above the corpus callosum, extending from the pregnenual anterior cingulate to premotor cortex. The dorsal anterior cingulate was selected as the volume of interest. Metabolite levels of choline-compounds (Cho), myo-inositol (mI), and creatine+phosphocreatine (Cr) were quantified. Separate hierarchical regression models were used to evaluate the independent effects of metabolite levels on alcohol craving, alcohol problem severity, and alcohol consumption. RESULTS Dorsal anterior cingulate Cho predicted alcohol craving and alcohol problem severity over and above demographics, medication, and alcohol consumption measures. mI and Cr did not predict alcohol craving or alcohol problem severity. Metabolite markers were not predictive of alcohol consumption. CONCLUSIONS This preliminary study indicates that dACC Cho is sensitive to clinical characteristics of AUD. This is a further step in advancing neurometabolites, particularly Cho, as potential biomarkers and treatment targets for AUD.
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Affiliation(s)
- Erica N Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Elizabeth M Burnette
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Neuroscience Interdepartmental Program, University of California at Los Angeles, Los Angeles, CA
| | - Joseph O’Neill
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
- Brain Research Institute, University of California, Los Angeles, CA
| | - Jeffry Alger
- Department of Neurology, University of California Los Angeles, MC 708522, Los Angeles, CA
| | - Lara A Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
- Brain Research Institute, University of California, Los Angeles, CA
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15
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Krouse RA, Morales KH, Kampman KM, Chakravorty S. The role of baseline insomnia in moderating the hypnotic properties of quetiapine. Addict Behav 2023; 140:107622. [PMID: 36701905 PMCID: PMC10082592 DOI: 10.1016/j.addbeh.2023.107622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The primary aim of this study was to investigate the effect of quetiapine on insomnia and alcohol craving (craving) in subjects with co-occurring insomnia and AUD. METHODS Insomnia was assessed with the Insomnia Severity Index (ISI) and craving with the Penn Alcohol Craving Scale (PACS, primary) and Obsessive-Compulsive Drinking Scale (OCDS, secondary). A multivariable model adjusted for covariates (N = 123) evaluated the relationship between craving (PACS and OCDS total scores) and insomnia (ISI total score). To simultaneously assess the effects of treatment arm allocation and insomnia status, subjects (N = 115) were stratified into 4 groups, quetiapine-insomnia(N = 38), quetiapine-No insomnia(N = 19), placebo-insomnia(N = 38), and placebo-No insomnia(N = 20). Linear mixed-effects regression models adjusted for covariates compared the trajectories of ISI, PACS, and OCDS total scores across 12 weeks of treatment and at post-treatment follow-up at week 24, between the four groups. RESULTS The ISI total score was positively associated with the PACS (p = 0.006) and OCDS (p = 0.001) total scores in the multivariable models. In the longitudinal analysis, when compared to the three other groups, subjects with insomnia treated with quetiapine showed a marked reduction in their insomnia scores with a return of insomnia after stopping treatment. There was no significant difference between the groups for the PACS and OCDS total score trajectories. DISCUSSION Although craving is associated with insomnia, treatment with quetiapine may improve insomnia but not craving in patients with co-occurring AUD and insomnia.
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Affiliation(s)
- R A Krouse
- Coatesville Veterans Affairs Medical Center, Coatesville, PA 19320, USA; School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.
| | - K H Morales
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - K M Kampman
- Department of Psychiatry, Cpl. Michael J. Crescenz VA Medical Center, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - S Chakravorty
- Department of Psychiatry, Cpl. Michael J. Crescenz VA Medical Center, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA 19104, USA.
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16
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Deep brain stimulation of the nucleus accumbens in treatment-resistant alcohol use disorder: a double-blind randomized controlled multi-center trial. Transl Psychiatry 2023; 13:49. [PMID: 36755017 PMCID: PMC9908935 DOI: 10.1038/s41398-023-02337-1] [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: 08/28/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Treatment resistance in alcohol use disorders (AUD) is a major problem for affected individuals and for society. In the search of new treatment options, few case studies using deep brain stimulation (DBS) of the nucleus accumbens have indicated positive effects in AUD. Here we report a double-blind randomized controlled trial comparing active DBS ("DBS-EARLY ON") against sham stimulation ("DBS-LATE ON") over 6 months in n = 12 AUD inpatients. This 6-month blind phase was followed by a 12-month unblinded period in which all patients received active DBS. Continuous abstinence (primary outcome), alcohol use, alcohol craving, depressiveness, anxiety, anhedonia and quality of life served as outcome parameters. The primary intention-to-treat analysis, comparing continuous abstinence between treatment groups, did not yield statistically significant results, most likely due to the restricted number of participants. In light of the resulting limited statistical power, there is the question of whether DBS effects on secondary outcomes can nonetheless be interpreted as indicative of an therapeutic effect. Analyses of secondary outcomes provide evidence for this, demonstrating a significantly higher proportion of abstinent days, lower alcohol craving and anhedonia in the DBS-EARLY ON group 6 months after randomization. Exploratory responder analyses indicated that patients with high baseline alcohol craving, depressiveness and anhedonia responded to DBS. The results of this first randomized controlled trial are suggestive of beneficial effects of DBS in treatment-resistant AUD and encourage a replication in larger samples.
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Di Nicola M, Pepe M, Panaccione I, Moccia L, Janiri L, Sani G. Update on Pharmacological Treatment for Comorbid Major Depressive and Alcohol Use Disorders: The Role of Extended-release Trazodone. Curr Neuropharmacol 2023; 21:2195-2205. [PMID: 37013426 PMCID: PMC10556391 DOI: 10.2174/1570159x21666230403080624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) are major public health concerns because of their high prevalence and clinical and functional severity. MDD and AUD commonly co-occur, but effective therapeutic approaches for comorbidity are still scarce. Available evidence on selective serotonin reuptake inhibitors and tricyclic antidepressants held mixed results, and further pharmacological categories have been less investigated. Trazodone is an approved antidepressant drug for adults and has shown efficacy on symptoms like anxiety and insomnia observed in AUD patients as well. Thus, this study aims to evaluate the effect of extended-release trazodone on clinical and functional features in MDD + AUD subjects. METHODS One hundred MDD + AUD outpatients were retrospectively evaluated at 1, 3, and 6 months of treatment with extended-release trazodone (150-300 mg/day, flexibly dosed). Improvement in depressive symptoms was the primary outcome measure. Changes in anxiety, sleep, functioning, quality of life, clinical global severity, and alcohol craving were also investigated. RESULTS Trazodone reduced depressive symptoms (p < 0.001) with 54.5% remission at the endpoint. Similar improvements were observed in all secondary outcomes, including anxiety, sleep alterations, and craving (p < 0.001). Only mild side effects were reported and disappeared over time. CONCLUSION Extended-release trazodone displayed good antidepressant properties in MDD + AUD patients, ameliorating overall symptomatology, functioning, and quality of life, with a good safety/ tolerability profile. Further, it significantly improved sleep disturbances and craving symptoms, which are associated with drinking relapse and worse outcomes. Therefore, trazodone might represent a promising pharmacological option for MDD + AUD patients.
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Affiliation(s)
- Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Pepe
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Tan H, Hubertus S, Thomas S, Lee AM, Gerhardt S, Gerchen MF, Sommer WH, Kiefer F, Schad L, Vollstädt-Klein S. Association between iron accumulation in the dorsal striatum and compulsive drinking in alcohol use disorder. Psychopharmacology (Berl) 2023; 240:249-257. [PMID: 36577866 PMCID: PMC9879829 DOI: 10.1007/s00213-022-06301-7] [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: 07/26/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
RATIONALE Brain iron accumulation has been observed in neuropsychiatric disorders and shown to be related to neurodegeneration. OBJECTIVES In this study, we used quantitative susceptibility mapping (QSM), an emerging MRI technique developed for quantifying tissue magnetic susceptibility, to examine brain iron accumulation in individuals with alcohol use disorder (AUD) and its relation to compulsive drinking. METHODS Based on our previous projects, QSM was performed as a secondary analysis with gradient echo sequence images, in 186 individuals with AUD and 274 healthy participants. Whole-brain susceptibility values were calculated with morphology-enabled dipole inversion and referenced to the cerebrospinal fluid. Then, the susceptibility maps were compared between AUD individuals and healthy participants. The relationship between drinking patterns and susceptibility was explored. RESULTS Whole-brain analyses showed that the susceptibility in the dorsal striatum (putamen and caudate) among AUD individuals was higher than healthy participants and was positively related to the Obsessive Compulsive Drinking Scale (OCDS) scores and the amount of drinking in the past three months. CONCLUSIONS Increased susceptibility suggests higher iron accumulation in the dorsal striatum in AUD. This surrogate for the brain iron level was linearly associated with the compulsive drinking pattern and the recent amount of drinking, which provides us a new clinical perspective in relation to brain iron accumulation, and also might indicate an association of AUD with neuroinflammation as a consequence of brain iron accumulation. The iron accumulation in the striatum is further relevant for functional imaging studies in AUD by potentially producing signal dropout and artefacts in fMRI images.
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Affiliation(s)
- Haoye Tan
- grid.7700.00000 0001 2190 4373Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Simon Hubertus
- grid.7700.00000 0001 2190 4373Computer Assisted Clinical Medicine, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Sebastian Thomas
- grid.7700.00000 0001 2190 4373Computer Assisted Clinical Medicine, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Alycia M. Lee
- grid.7700.00000 0001 2190 4373Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Sarah Gerhardt
- grid.7700.00000 0001 2190 4373Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Martin Fungisai Gerchen
- grid.7700.00000 0001 2190 4373Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany ,grid.455092.fBernstein Center for Computational Neuroscience Heidelberg/Mannheim, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Department of Psychology, Heidelberg University, 69117 Heidelberg, Germany
| | - Wolfgang H. Sommer
- grid.7700.00000 0001 2190 4373Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Institute of Psychopharmacology, Central Institute of Mental Health, Heidelberg University, 68159 Mannheim, Germany ,Bethania Hospital for Psychiatry, Psychosomatics, and Psychotherapy, Greifswald, Germany
| | - Falk Kiefer
- grid.7700.00000 0001 2190 4373Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Feuerlein Center on Translational Addiction Medicine, Heidelberg University, 69117 Heidelberg, Germany
| | - Lothar Schad
- grid.7700.00000 0001 2190 4373Computer Assisted Clinical Medicine, Medical Faculty of Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany. .,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany.
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Strigo IA, Murphy E, Mitchell JM, Spadoni AD. Learning from addiction: Craving of prescription opioids in chronic pain sufferers. Neurosci Biobehav Rev 2022; 142:104904. [PMID: 36202255 PMCID: PMC10917419 DOI: 10.1016/j.neubiorev.2022.104904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 01/19/2023]
Abstract
Prescription opioids are a primary driver of opioid-related deaths. Although craving is a substantial component of OUD, the degree to which craving leads to misuse among chronic pain patients on long-term prescription opioids is unknown. A clear understanding of the factors that lead to misuse in this vulnerable population is needed for the development of safe and effective practices for opioid taper. This narrative review summarizes the relevant literature on the role of craving in addiction and chronic pain through epidemiological and behavioral studies. The first part of this review examines the role of craving in predicting opioid use/misuse in individuals with chronic pain with and without OUD. The second part covers methods on how craving is evaluated experimentally using both subjective and objective measures and provides related findings. The overall goal of this review is to facilitate the development of a population-specific description of craving in those who use opioids to control chronic pain and to describe how it may be mechanistically linked to patterns of opioid (mis)use.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Emily Murphy
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Jennifer M Mitchell
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA; Department of Neurology, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - Andrea D Spadoni
- San Diego Veterans Affairs Healthcare Center, 3350 La Jolla Village Drive, San Diego, CA 92121, USA; Department of Psychiatry, University of California San Diego, San Diego, CA 92300, USA
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Deep brain stimulation of the nucleus accumbens in the treatment of severe alcohol use disorder: a phase I pilot trial. Mol Psychiatry 2022; 27:3992-4000. [PMID: 35858989 DOI: 10.1038/s41380-022-01677-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 02/07/2023]
Abstract
Alcohol use disorder (AUD) is a highly prevalent, often refractory, medical illness. The symptoms of AUD are driven by dysfunction in several neurocircuits centered on the nucleus accumbens (NAc). Case reports and animal studies suggest NAc-DBS may be an effective harm-reduction treatment in severe AUD. Six patients with severe, refractory AUD underwent NAc-DBS. Safety metrics and clinical outcomes were recorded. Positron emission tomography (FDG-PET) was used to measure glucose metabolism in the NAc at baseline and 6 months. Functional magnetic resonance imaging (fMRI) was used to characterize postoperative changes in NAc functional connectivity to the rest of the brain, as well as NAc and dorsal striatal reactivity to alcoholic visual cues. This study was registered with ClinicalTrials.gov, NCT03660124. All patients experienced a reduction in craving. There was a significant reduction in alcohol consumption, alcohol-related compulsivity, and anxiety at 12 months. There was no significant change in depression. FDG-PET analysis demonstrated reduced NAc metabolism by 6 months, which correlated with improvements in compulsive drinking behaviors. Clinical improvement correlated with reduced functional connectivity between the NAc and the visual association cortex. Active DBS was associated with reduced activation of the dorsal striatum during passive viewing of alcohol-containing pictures. NAc-DBS is feasible and safe in patients with severe, otherwise refractory AUD. It is associated with a reduction in cravings and addictive behavior. A potential mechanism underlying this process is a down-regulation of the NAc, a disruption of its functional connectivity to the visual association cortex, and interference of cue-elicited dorsal striatum reactivity. Trial Registration NCT03660124 ( www.clinicaltrials.gov ).
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21
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Sistla KT, Rai S, Praharaj SK, Rege S. The subjective experience of craving among individuals with alcohol dependence syndrome: A phenomenological study. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2110953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Krishnaa Thandra Sistla
- Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shweta Rai
- Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Samir Kumar Praharaj
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sumita Rege
- Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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22
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Gibson BC, Claus ED, Sanguinetti J, Witkiewitz K, Clark VP. A review of functional brain differences predicting relapse in substance use disorder: Actionable targets for new methods of noninvasive brain stimulation. Neurosci Biobehav Rev 2022; 141:104821. [PMID: 35970417 DOI: 10.1016/j.neubiorev.2022.104821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/17/2022]
Abstract
Neuroimaging studies have identified a variety of brain regions whose activity predicts substance use (i.e., relapse) in patients with substance use disorder (SUD), suggesting that malfunctioning brain networks may exacerbate relapse. However, this knowledge has not yet led to a marked improvement in treatment outcomes. Noninvasive brain stimulation (NIBS) has shown some potential for treating SUDs, and a new generation of NIBS technologies offers the possibility of selectively altering activity in both superficial and deep brain structures implicated in SUDs. The goal of the current review was to identify deeper brain structures involved in relapse to SUD and give an account of innovative methods of NIBS that might be used to target them. Included studies measured fMRI in currently abstinent SUD patients and tracked treatment outcomes, and fMRI results were organized with the framework of the Addictions Neuroclinical Assessment (ANA). Four brain structures were consistently implicated: the anterior and posterior cingulate cortices, ventral striatum and insula. These four deeper brain structures may be appropriate future targets for the treatment of SUD using these innovative NIBS technologies.
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Affiliation(s)
- Benjamin C Gibson
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM 87106, USA
| | - Eric D Claus
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jay Sanguinetti
- The Center for Consciousness Studies, University of Arizona, Tucson, AZ 85719, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM 87106, USA.
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23
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Beyond thirst: Cravings for non-alcoholic beverages including soft drink. Eat Behav 2022; 46:101662. [PMID: 35981488 DOI: 10.1016/j.eatbeh.2022.101662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022]
Abstract
Cravings for a range of substances including drugs, alcohol, and food have been shown to predict subsequent consumption or use. However, this link has not yet been systematically examined for beverages other than alcohol. The present study aimed to provide a comprehensive investigation of cravings for non-alcoholic beverages and their link to consumption. Participants were 128 undergraduate students (17-25 years) who completed a craving diary and daily consumption measure over a period of a week. Cravings were reported for a range of beverages, including tea, juice, and flavoured milk, but by far the most craved beverages were water, coffee, and soft drink. Stronger cravings were associated with a greater likelihood of drinking and drinking more of the craved beverage. This was particularly the case for soft drink. Unlike water, cravings for coffee and soft drink were triggered by factors other than thirst, and the number of cravings predicted the total amount drunk over the week. The findings demonstrate the existence of cravings for non-alcoholic beverages such as soft drink, and point to these cravings as a potential target for reducing consumption.
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Nieto SJ, Grodin EN, Burnette EM, Cahill CM, Ray LA. Pain Catastrophizing Is Associated With Increased Alcohol Cue-Elicited Neural Activity Among Individuals With Alcohol Use Disorder. Alcohol Alcohol 2022; 57:727-733. [PMID: 35788255 DOI: 10.1093/alcalc/agac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The current study examined the association between pain catastrophizing and alcohol cue-elicited brain activation in individuals with alcohol use disorder (AUD). METHODS Non-treatment seeking heavy drinkers with AUD (n = 45; 28 males) completed self-report measures of pain catastrophizing and alcohol use/problems as part of a clinical trial of the neuroimmune modulator ibudilast. Participants were randomized to either placebo (n = 25) or ibudilast (n = 20) and completed an functional magnetic resonance imaging (fMRI) scan to assess neural activation to alcohol cues 1 week into the medication trial. Multiple linear regression examined whether pain catastrophizing predicted cue-induced activation in a priori regions of interest, namely the dorsal and ventral striatum (VS). An exploratory whole-brain analysis was conducted to assess the relationship between pain catastrophizing and neural alcohol cue reactivity. RESULTS Pain catastrophizing predicted greater cue-induced activation in the dorsal (b = 0.006; P = 0.03) but not VS controlling for medication. Pain catastrophizing was positively associated with neural activation to alcohol cues in regions including the bilateral thalamus, left precuneus and left frontal pole. CONCLUSION Greater pain catastrophizing is associated with greater cue-induced neural activation in brain regions sub-serving habits and compulsive alcohol use. These findings provide initial support for a neural mechanism by which pain catastrophizing may drive alcohol craving among individuals with AUD.
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Affiliation(s)
- Steven J Nieto
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Erica N Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Elizabeth M Burnette
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Catherine M Cahill
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA.,Shirley & Stefan Hatos Center for Neuropharmacology, University of California at Los Angeles, Los Angeles, CA, USA.,Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA.,Shirley & Stefan Hatos Center for Neuropharmacology, University of California at Los Angeles, Los Angeles, CA, USA.,Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
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25
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Cognitive impairment in the co-occurrence of alcohol dependence and major depression: neuropsychological assessment and event-related potentials analyses. Heliyon 2022; 8:e09899. [PMID: 35874061 PMCID: PMC9305349 DOI: 10.1016/j.heliyon.2022.e09899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/25/2021] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
To evaluate the putative detrimental effect of Major Depressive Disorder (MDD) on the cognitive impairment associated with Alcohol Dependence (AD), we contrasted the neuropsychological profile and behavioral responses of AD subjects, MDD individuals, and in those with a co-occurring AD-MDD diagnosis (DD). Patients and healthy subjects completed a comprehensive neuropsychological battery and were recorded for P200, P300, and N450 event-related potentials during memory and Stroop tasks. AD subjects exhibited a generalized detrimental neuropsychological performance; in contrast, in MDD individuals, impairment was limited to discrete domains. Notably, the deficits were distinctive in DD cases. A P200 increased amplitude in MDD, a decrease in P300 amplitude in AD, and increased latency of P300 in DD patients were the overt electrophysiological abnormalities identified. Dual patients also exhibited a distinct pattern of behavioral responses, particularly apparent during high-demand cognitive tasks. Specific ERP adjustments were associated with the short-term fluoxetine treatment in DD and MDD subjects; the SSRI also improved altered baseline performance in learning and cognitive flexibility in DD subjects. In conclusion, the neuropsychological and behavioral alterations detected in the co-occurrence of AD-MDD did not seem to be merely the sum of the negative contributions of the independent disorders. Dual diagnosis (DD) patients exhibited a distinctive pattern of cognitive impairments compared to single diagnosis subjects. The ERP alterations identified were not shared among affected groups. Dual patients exhibited idiosyncratic behavioral responses. Impaired executive functions in DD subjects improved with SSRI medication. Neuropsychological and behavioral alterations are not explained as the sum of negative contributions of individual diagnosis.
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Spitta G, Gleich T, Zacharias K, Butler O, Buchert R, Gallinat J. Extrastriatal Dopamine D2/3 Receptor Availability in Alcohol Use Disorder and Individuals at High Risk. Neuropsychobiology 2022; 81:215-224. [PMID: 35016171 DOI: 10.1159/000521103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Reduced striatal dopamine D2/3 receptor availability in alcohol use disorder (AUD) has been demonstrated in recent clinical studies and meta-analyses. However, only a limited number of studies investigated extrastriatal D2/3 availability in AUD or in at-risk populations. In line with a dimensional understanding of addiction, extrastriatal dopaminergic neuroadaptations have been suggested to be relevant from a pathobiological perspective. METHODS We investigated D2/3 receptor availability via 18F-fallypride positron emission tomography applying a region of interest (ROI) approach. We selected ROIs for the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC). Our sample included 19 healthy controls (low risk [LR]), 19 individuals at high risk (HR) to develop addiction, and 20 recently detoxified AUD patients. RESULTS We found significantly higher D2/3 receptor availability of HR compared to AUD in the left and right rostral ACC (rACC), as well as in the left ventrolateral PFC (vlPFC). We did not observe a significant difference between AUD and LR. After corrections for multiple comparisons none of the ROIs reached significance throughout the group comparison. The D2/3 receptor availability in the left rACC was inversely correlated with symptom severity assessed with the Alcohol Dependency Scale. DISCUSSION To our knowledge, the present work is the first study investigating extrastriatal D2/3 receptor availabilities in individuals at HR and patients with AUD. The observation that D2/3 receptor availabilities are highest in HR might suggest that their pathobiology differs from subjects with AUD. Future studies are necessary to clarify the intraindividual course of this biomarker over different disease stages and its possible role as a risk or protective factor.
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Affiliation(s)
- Gianna Spitta
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte (CCM), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Gleich
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte (CCM), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kristin Zacharias
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte (CCM), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oisin Butler
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Baskerville WA, Grodin EN, Venegas A, Ray LA. Global sleep quality is associated with tonic craving, but not cue-induced craving. Addict Behav 2022; 133:107372. [PMID: 35660858 DOI: 10.1016/j.addbeh.2022.107372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Sleep disturbance is widespread among individuals with alcohol use disorder (AUD) and is thought to reduce the capacity for self-regulation. The present study examines how sleep disturbance is associated with the regulation of tonic (i.e., "trait-like") and cue-induced (i.e., "provoked") craving, among individuals with AUD. METHODS Participants with an AUD (N = 58) completed the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, the Obsessive-Compulsive Drinking Scale (OCDS) for tonic craving, and the Alcohol Urge Questionnaire (AUQ) for cue-induced craving during an alcohol cue-exposure paradigm. A series of hierarchical regressions examined the independent contribution of sleep quality to tonic and cue-induced alcohol craving. RESULTS PSQI global score was associated with tonic craving per the OCDS, over and above alcohol use and demographic measures. PSQI global score was not associated with cue-induced craving. CONCLUSION These findings suggest that sleep dysfunction plays a role in tonic alcohol craving and that the underlying mechanism may be the reduction of self-regulation. Treatments targeting sleep dysfunction in AUD may prove useful in reducing craving and overall alcohol use.
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Affiliation(s)
- Wave-Ananda Baskerville
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States; Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.
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Karimpour Vazifehkhorani A, Attaran A, Karimi Saraskandrud A, Faghih H, Yeganeh N. Effectiveness of Cue-Exposure Therapy on Alcohol Craving in Virtual Environment: Based on habit loop. ADDICTION & HEALTH 2022; 14:78-86. [PMID: 36544510 PMCID: PMC9743816 DOI: 10.22122/ahj.2022.196454.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/29/2021] [Indexed: 12/24/2022]
Abstract
Background In the treatment and abstinence of alcoholism, especially in abstinence after treatment, "Craving" has an essential role. Thus, our aim was to examine the effect of cue-exposure therapy on alcohol craving in virtual environment based on the habit loop. Methods The present investigation was a case-control experimental study with a pretest-posttest-5 weeks follow-up design. Research population were alcohol-addicted people hospitalized in a psychiatric hospital. We had 62 subjects who had abstained from alcohol consumption. The sampling method was convenience sampling and the sample allocation was randomized and matched. The intervention was VR-CET that was implemented in eight sessions. Penn Alcohol Craving Scale, Alcohol Urge Questionnaire, and Obsessive-Compulsive Drinking Scale were used to collect the data. In order to analyze the data, analysis of covariance (ANCOVA) in SPSS V.23 was performed. Findings Our results showed that after implementation of VR-CET program the rate of PACS reduced significantly in posttest stage (p = 0.01) and follow up stage (p= 0.05). Also, the rate of AUQ and OCDS after exposure to VR-CET program declined significantly. The significant level of AUQ and OCDS in posttest and follow up stages were set at p- value < 0.01 and p-value <0.05 respectively. Conclusion VR-CET program can reduce alcohol craving by paying attention to various cues and contexts. In fact, it would be more beneficial if the treatment environment resembles a conditioned context and contains as many related cues as possible.
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Affiliation(s)
| | - Arina Attaran
- Department of Clinical Psychology, School of Psychology and Educational Sciences, Islamic Azad University Central Tehran Branch, Tehran, Iran
| | - Azizeh Karimi Saraskandrud
- Department of Clinical Psychology, School of Psychology and Educational Sciences, Islamic Azad University, Tabriz Branch, Tabriz, Iran
| | - Haniyeh Faghih
- Department of Clinical Psychology, School of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran
| | - Narges Yeganeh
- Department of Clinical Psychology, School of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran,Correspondence to: Narges Yeganeh; Department of Clinical Psychology, School of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran;
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Pennington DL, Reavis JV, Cano MT, Walker E, Batki SL. The Impact of Exercise and Virtual Reality Executive Function Training on Cognition Among Heavy Drinking Veterans With Traumatic Brain Injury: A Pilot Feasibility Study. Front Behav Neurosci 2022; 16:802711. [PMID: 35391785 PMCID: PMC8981916 DOI: 10.3389/fnbeh.2022.802711] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/22/2022] [Indexed: 12/19/2022] Open
Abstract
Executive function (EF) underlies self-control deficits in alcohol use disorder (AUD) and traumatic brain injury (TBI). Cognitive training is a promising adjunctive treatment targeting TBI- and AUD- related cognitive dysfunction. However, major limitations related to compliance and generalizability in the field of cognitive training exist. Physical activity is associated with enhanced cognitive performance across several executive functions and may enhance the benefits of cognitive training. Virtual reality provides multisensory embodied experiences which are likely to engage brain networks more efficiently than standard cognitive training systems, ultimately resulting in greater near- and far-transfer effects. This pilot study aimed to obtain feasibility data and a preliminary assessment of an enriched virtual reality (VR) EF training (EFT) intervention combined with exercise (NCT03786276). Using an 8-week randomized adaptive design study, 30 AUD treatment seeking U.S. Veterans completed nine sessions of exercise-only (n = 15) or gameplay control (n = 15) over 3 weeks, followed by a week-4 repeat assessment in Phase 1. Twenty-three participants completed and moved onto Phase II, where they completed up to nine sessions of VR-EFT plus exercise and completed a week-8 end-of-study assessment. Primary outcomes included feasibility to retain participants, usability, and satisfaction of using VR-EFT. Secondary and exploratory outcomes included within group assessment of change in cognitive function, alcohol use, alcohol craving, and post-concussive symptoms among the three treatment conditions.VR-EFT was feasible with moderate usability and high acceptability ratings.The most common VR-related adverse effect was motion sickness (n = 2/16, 12.5%). The VR-EFT condition was associated with significant improvement in inhibition-switching and visual scanning (both p < 0.05) during Phase II. Exercise-only was associated with significant improvements in cognitive inhibition, cognitive flexibility, reductions in alcohol craving, and number of standard alcohol drinks per week (all p ≤ 0.05). The gaming-control condition was associated with improvement in cognitive flexibility and visuospatial immediate recall (both p < 0.05) during Phase 1. Recruitment and retention of U.S. veterans with AUD and TBI into an exercise plus VR-EFT intervention is feasible, but technological barriers may impact usability. VR-EFT was associated with improvement in executive function domains that were targeted in as little as 3-week and nine sessions of VR-EFT exposure. Results are promising and indicate the need for a larger controlled investigation to assess the efficacy of VR-EFT to enhance treatment outcomes among AUD treatment-seeking U.S. veterans with co-occurring AUD and TBI. Clinical Trial Registration www.ClinicalTrials.gov, Identifier: NCT03786276.
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Affiliation(s)
- David L. Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
| | - Jill V. Reavis
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Monique T. Cano
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
| | - Erica Walker
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
| | - Steven L. Batki
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, United States
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Abstract
BACKGROUND Alcohol use disorder (AUD) is associated with cognitive deficits but little is known to what degree this is caused by genetically influenced traits, i.e. endophenotypes, present before the onset of the disorder. The aim of the current study was to investigate to what degree family history (FH) of AUD is associated with cognitive functions. METHODS Case-control cross-sectional study at an outpatient addiction research clinic. Treatment-seeking AUD patients (n = 106) were compared to healthy controls (HC; n = 90), matched for age and sex. The HC group was further subdivided into AUD FH positive (FH+; n = 47) or negative (FH-; n = 39) based on the Family Tree Questionnaire. Participants underwent psychiatric and substance use assessments, completed the Barratt Impulsiveness Scale and performed a comprehensive battery of neuropsychological tests assessing response inhibition, decision making, attention, working memory, and emotional recognition. RESULTS Compared to HC, AUD patients exhibited elevated self-rated impulsivity (p < 0.001; d = 0.62), as well as significantly poorer response inhibition (p = 0.001; d = 0.51), attention (p = 0.021; d = 0.38) and information gathering in decision making (p = 0.073; d = 0.34). Similar to AUD patients, FH+ individuals exhibited elevated self-rated impulsivity (p = 0.096; d = 0.46), and in addition significantly worse future planning capacity (p < 0.001; d = 0.76) and prolonged emotional recognition response time (p = 0.010; d = 0.60) compared to FH-, while no other significant differences were found between FH+ and FH-. CONCLUSIONS Elevated impulsivity, poor performance in future planning and emotional processing speed may be potential cognitive endophenotypes in AUD. These cognitive domains represent putative targets for prevention strategies and treatment of AUD.
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Affiliation(s)
- Lotfi Khemiri
- Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Johan Franck
- Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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rTMS Reduces Craving and Alcohol Use in Patients with Alcohol Use Disorder: Results of a Randomized, Sham-Controlled Clinical Trial. J Clin Med 2022; 11:jcm11040951. [PMID: 35207224 PMCID: PMC8878126 DOI: 10.3390/jcm11040951] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Current evidence-based treatments for alcohol use disorder (AUD) are moderately effective. Studies testing repetitive transcranial magnetic stimulation (rTMS) in AUD commonly apply a limited number of rTMS sessions with different rTMS settings, showing inconsistent effects on craving for alcohol. This study tested the efficacy of a robust rTMS protocol on craving and alcohol use. (2) Methods: In a single-blind randomized controlled trial in recently detoxified patients with AUD, ten days of high-frequency rTMS over the right dorsolateral prefrontal cortex on top of treatment as usual (n = 14) was compared with sham rTMS (n = 16). Outcome measures were alcohol craving and use over a follow-up period of one year. Analysis was performed by means of repeated measures multivariate analysis of variance. (3) Results: The results showed a main group-by-time interaction effect on craving (Wilks’ Λ = 0.348, F (12, 17) = 2.654, p = 0.032) and an effect of group on alcohol use (Wilk’s Λ = 0.44, F (6, 23) = 4.9, p = 0.002), with lower alcohol craving and use in the group with active rTMS compared to the control group. Differences in craving between groups were most prominent three months after treatment. At 12 months follow-up, there was no effect of rTMS on craving or abstinence. (4) Conclusions: This small-scale randomized controlled trial showed the efficacy of high-frequency rTMS over the right dlPFC diminished alcohol craving and use in recently detoxified patients with AUD during the first months after detoxification. These findings suggest that rTMS might be an effective add-on in treating patients with AUD and warrant replication in future large-scale studies.
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Flaudias V, Zerhouni O, Chakroun-Baggioni N, De Chazeron I, Llorca PM, Brousse G. Evaluation of a Smartphone Application on the Reduction of Attentional Bias Toward Alcohol Among Students†. Front Psychol 2022; 13:790030. [PMID: 35222189 PMCID: PMC8869174 DOI: 10.3389/fpsyg.2022.790030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Context The recent development of “serious games” has produced encouraging results in maintaining adherence to health-related interventions. In alcohol research, several studies have shown that computerized training on attentional bias decreases alcohol consumption bias among students. However, these highly controlled experimental situations, do not allow for direct large-scale dissemination. Our objective is to evaluate an attentional bias remediation program using a gamified smartphone training procedure. Methods Fifty students from Clermont-Ferrand University were invited to participate in the study. After a cognitive assessment in the laboratory, the smartphone application was installed on each Student’s smartphone. Participants were randomly assigned to either the alcohol attentional training group or the control group Each student had to complete the 2-min program at least once a day for 15 days. After 15 days, a new cognitive assessment of attention bias was conducted in the laboratory. Forty-seven students were included in the study. Results Our analyses did not show any effect of the cognitive remediation program on attentional bias reduction between the two group [F(1, 44) < 1, p = 0.87], attentional performance [F(1, 45) = 1.63, p = 0.20] or inhibitory abilities [F(1, 45) < 1, p = 0.73]. These results were confirmed by Bayesian analyses. Discussion Despite the absence of group effects, both the alcohol and control (non-alcohol) version of this program appeared to reduce attentional bias and increase inhibition capacities in the subset of participants who had attentional bias for alcohol at baseline This pilot study identifies areas for improvement in smartphone applications for future developments. Attentional bias remediation programs remain an interesting way to explore.
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Affiliation(s)
- Valentin Flaudias
- Université de Nantes, Univ Angers, Laboratoire de Psychologie des Pays de la Loire, LPPL, EA 4638, Nantes, France
- *Correspondence: Valentin Flaudias,
| | - Oulmann Zerhouni
- Laboratoire Parisien de Psychologie Sociale, Département de Psychologie, Nanterre, France
| | - Nadia Chakroun-Baggioni
- Université Clermont Auvergne, Laboratoire de Psychologie Sociale et Cognitive, Clermont-Ferrand, France
| | - Ingrid De Chazeron
- CMP-B CHU, Clermont Auvergne INP, Institut Pascal, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- CMP-B CHU, Clermont Auvergne INP, Institut Pascal, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Georges Brousse
- CMP-B CHU, Clermont Auvergne INP, Institut Pascal, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, Clermont-Ferrand, France
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Cyr L, Bernard L, Pedinielli JL, Cutarella C, Bréjard V. Association Between Negative Affectivity and Craving in Substance-Related Disorders: A Systematic Review and Meta-analysis of Direct and Indirect Relationships. Psychol Rep 2022; 126:1143-1180. [PMID: 35105221 DOI: 10.1177/00332941211061079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A sizeable literature highlighted that negative affectivity and craving are both known to be implicated in relapses. OBJECTIVES The present study synthetized the existing litterature to determine strength of the interaction between negative affectivity and craving for substance-related disorders including illicit drugs, alcohol and tobacco. METHODS We conducted a systematic review in accordance with PRISMA guidelines followed by a meta-analysis. Online computer databases PubMed, PsycINFO and Web of Science were searched systematically and thoroughly. Jamovi 1.8.1 Current version was used to conduct meta-analysis. RESULTS Thirty studies were included in the review, and 14 of these, including 2257 subjects, were used for meta-analysis. The raw correlation ranged from 0.17 to 0.58, which indicated weak to moderate association between negative affects and craving. In total, approximately 90% of the selection revealed a positive correlation between negative affects and craving. Alcohol and tobacco use disorders have received the most attention. Additionally, negative affectivity was often defined as a transient state rather than a stable personality trait. CONCLUSIONS In both of our meta-analyses and in the narratively reported studies, we found that negative affectivity is an important component related to craving, but individual differences in craving reactivity existed.
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Affiliation(s)
- Laura Cyr
- LPCPP, 128791Aix Marseille University, Aix-en-Provence, France; Clinique Saint-Barnabé, 52806Ramsay Santé, Marseille, France
| | - Laura Bernard
- LPCPP, 128791Aix Marseille University, Aix-en-Provence, France; Clinique Saint-Barnabé, 52806Ramsay Santé, Marseille, France
| | | | | | - Vincent Bréjard
- LPCPP, 128791Aix Marseille University, Aix-en-Provence, France
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Reichl D, Enewoldsen N, Weisel KK, Fuhrmann L, Lang C, Saur S, Berking M, Zink M, Ahnert A, Falkai P, Kraus T, Hillemacher T, Müller FN, Kornhuber J, Bönsch D, Kerkemeyer L, Steins-Loeber S. Association of impulsivity with quality of life and well-being after alcohol withdrawal treatment. J Clin Psychol 2022; 78:1451-1462. [PMID: 35045188 DOI: 10.1002/jclp.23316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/12/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Impulsivity is related to a higher risk of relapse in alcohol use disorders. However, besides drinking behavior, other recovery outcomes like physical and mental health-related quality of life are at least as important. The present study aimed to fill a research gap regarding the association of different impulsivity facets with health-related quality of life and well-being in alcohol use disorder. METHODS Individuals with a primary alcohol use disorder diagnosis (n = 167) were interviewed with standardized self-report measures at the progressed stage of their withdrawal treatment and 6 weeks thereafter. Multiple regression models were calculated to examine the association of impulsivity, craving, and drinking patterns with health-related quality of life and well-being 6 weeks after withdrawal treatment, as well as the predictive role of impulsivity assessed during withdrawal for these two outcomes. RESULTS Craving was associated with health-related quality of life and well-being 6 weeks after withdrawal. Likewise, non-planning and attentional impulsivity were associated with well-being 6 weeks after withdrawal. Motor impulsivity during withdrawal treatment predicted health-related quality of life 6 weeks thereafter. CONCLUSION Impulsivity seems to be negatively related to health-related quality of life and well-being in the first weeks after alcohol withdrawal treatment, probably to a higher extent than drinking patterns, but differentiating between its facets seems to be important. These findings emphasize the importance of treatment approaches aiming at reduced impulsivity in the early recovery process.
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Affiliation(s)
- Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Lukas Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Mathias Zink
- Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik, Klinikum am Europakanal, Erlangen, Germany
| | - Andreas Ahnert
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU-Klinikum, München, Germany
| | - Thomas Kraus
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Frankenalb-Klinik Engelthal, Engelthal, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Felix-N Müller
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Johannes Kornhuber
- Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dominikus Bönsch
- Krankenhaus für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Bezirkskrankenhaus Lohr, Lohr am Main, Germany
| | - Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), Berlin, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
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35
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Buschner M, Dürsteler KM, Fischli G, Hess J, Kirschner M, Kaiser S, Herdener M. Negative symptoms in alcohol use disorder: A pilot study applying the two-factor model of negative symptoms to patients with alcohol use disorder. Front Psychiatry 2022; 13:957924. [PMID: 36479554 PMCID: PMC9721168 DOI: 10.3389/fpsyt.2022.957924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Alcohol Use Disorder (AUD) is characterized by a reduction in goal-directed behavior, with alcohol use taking precedence over other areas of life. These features in AUD resemble negative symptoms in schizophrenia, especially the reduction in motivation and pleasure (MAP). Given the clinical similarities of negative symptoms across diagnostic categories, it comes as a surprise that there are few investigations on negative symptoms in alcohol and other substance use disorders. To our knowledge, our study is the first to assess negative symptoms in AUD based on a two-factorial approach, and to investigate the interrelation of these dimensions with the severity of AUD, and alcohol craving. MATERIALS AND METHODS We examined a sample of 42 patients with AUD at the Psychiatric University Hospital in Zurich. Participants provided self-report and interview-based measures of the severity of AUD, negative symptoms, and alcohol craving. Finally, we used data from the electronic health records of the patients. RESULTS Patients with AUD show negative symptoms to a similar extent as patients with schizophrenia or bipolar disorder. We found a positive correlation between the extent of impairment within the MAP factor and overall severity of AUD. Furthermore, MAP negative symptoms were correlated with alcohol craving. In a linear regression, negative symptoms predicted alcohol craving whereas depression did not. SUMMARY Negative symptoms as conceptualized for schizophrenia are prevalent in patients with AUD and associated with the severity of AUD. More specifically, severity of AUD correlates with diminished motivation and pleasure, highlighting the importance of disturbances in motivational functions in AUD. This is further supported by the correlation between negative symptoms and craving, a hallmark of AUD. Taken together, our findings suggest that negative symptoms might be a highly relevant but hitherto often neglected therapeutic target in AUD.
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Affiliation(s)
- Maximilian Buschner
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Kenneth M Dürsteler
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Clinic for Adult Psychiatry, University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Gina Fischli
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Jelena Hess
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Marcus Herdener
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Grieder M, Soravia LM, Tschuemperlin RM, Batschelet HM, Federspiel A, Schwab S, Morishima Y, Moggi F, Stein M. Right Inferior Frontal Activation During Alcohol-Specific Inhibition Increases With Craving and Predicts Drinking Outcome in Alcohol Use Disorder. Front Psychiatry 2022; 13:909992. [PMID: 35845462 PMCID: PMC9283687 DOI: 10.3389/fpsyt.2022.909992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
Alcohol use disorder (AUD) is characterized by enhanced cue-reactivity and the opposing control processes being insufficient. The ability to inhibit reactions to alcohol-related cues, alcohol-specific inhibition, is thus crucial to AUD; and trainings strengthening this ability might increase treatment outcome. The present study investigated whether neurophysiological correlates of alcohol-specific inhibition (I) vary with craving, (II) predict drinking outcome in AUD and (III) are modulated by alcohol-specific inhibition training. A total of 45 recently abstinent patients with AUD and 25 controls participated in this study. All participants underwent functional magnetic resonance imaging (fMRI) during a Go-NoGo task with alcohol-related as well as neutral conditions. Patients with AUD additionally participated in a double-blind RCT, where they were randomized to either an alcohol-specific inhibition training or an active control condition (non-specific inhibition training). After the training, patients participated in a second fMRI measurement where the Go-NoGo task was repeated. Percentage of days abstinent was assessed as drinking outcome 3 months after discharge from residential treatment. Whole brain analyses indicated that in the right inferior frontal gyrus (rIFG), activation related to alcohol-specific inhibition varied with craving and predicted drinking outcome at 3-months follow-up. This neurophysiological correlate of alcohol-specific inhibition was however not modulated by the training version. Our results suggest that enhanced rIFG activation during alcohol-specific (compared to neutral) inhibition (I) is needed to inhibit responses when craving is high and (II) fosters sustained abstinence in patients with AUD. As alcohol-specific rIFG activation was not affected by the training, future research might investigate whether potential training effects on neurophysiology are better detectable with other methodological approaches.
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Affiliation(s)
- Matthias Grieder
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leila M Soravia
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Clinic Suedhang, Kirchlindach, Switzerland
| | - Raphaela M Tschuemperlin
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Clinic Suedhang, Kirchlindach, Switzerland
| | - Hallie M Batschelet
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon Schwab
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Yosuke Morishima
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Moggi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Maria Stein
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
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37
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Tan H, Nakovics H, Zeng H, Copello A, Akhtar S, Lee AM, Kiefer F, Vollstädt-Klein S. Assessment of automated craving across substances and across cultures: stability-analysis of the Craving Automated Scale (CAS). J Addict Dis 2021; 40:405-414. [PMID: 34967698 DOI: 10.1080/10550887.2021.2015053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The transition from hedonic to compulsive use in Substance Use Disorders (SUD) is a critical point in SUD progression and hence relevant for assessment and treatment. To measure the habitual patterns of substance consumption, the Craving Automated Scales (CAS) for alcohol (CAS-A), substances (CAS-S) and cigarette smoking (CAS-CS) were developed and introduced to different countries. In this study, we aimed to investigate the structural stability of CAS across substances and cultures. METHODS This study analyzed the CAS-scores of a sample of 370 participants in Germany, China and the UK, including 262 opioid-users, 65 smokers and 43 alcohol-users. We performed stability analyses to check the stability (i. e. factorial invariance) of factor solutions. Based on confirmed stability of the general factor (gfactor) solution and the calculations rule obtained in the previous validation of CAS-alcohol (CAS-A), the factor structures of CAS-A, CAS-S and CAS-CS were compared. RESULTS The gfactor solutions based on calculations rule shows good stability, with the mean stability coefficients of 0.990 and 0.977 for CAS-S and CAS-CS respectively. The gfactor patterns were similar for CAS-A, CAS-S and CAS-CS, as well as across samples (Germany, China and the UK), with most factor-loadings larger than 0.7. Based on these findings, CAS-S and CAS-CS were also associated with established clinical measures of SUD. CONCLUSIONS Our findings suggest the two-gfactor solution based on a proposed calculation rule has a high stability across substances and cultures. This could be in line with common neurobiological mechanisms underlying habitual substance use. Moreover, comparing CAS with established clinical tools suggests that CAS might assess the automated behavior in substance consumption in a more sophisticated way.
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Affiliation(s)
- H Tan
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical, Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - H Nakovics
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical, Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - H Zeng
- Department of Psychology, Guangzhou University, Guangzhou, China
| | - A Copello
- School of Psychology, University of Birmingham, Birmingham, UK
| | - S Akhtar
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - A M Lee
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical, Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - F Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical, Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.,Feuerlein Center on Translational Addiction Medicine, University of Heidelberg, Heidelberg, Germany
| | - S Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical, Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
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Roschina OV, Levchuk LA, Boiko AS, Michalitskaya EV, Epimakhova EV, Losenkov IS, Simutkin GG, Loonen AJM, Bokhan NA, Ivanova SA. Beta-Endorphin and Oxytocin in Patients with Alcohol Use Disorder and Comorbid Depression. J Clin Med 2021; 10:jcm10235696. [PMID: 34884397 PMCID: PMC8658665 DOI: 10.3390/jcm10235696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The neuropeptides β-endorphin and oxytocin are released into the bloodstream as hormones from the pituitary gland but also have an important function as neuroregulators in the forebrain. The blood levels of both polypeptides have been shown to reflect depressive symptoms. β-Endorphin, in particular, is also involved in abstinence from alcohol. Methods: The serum levels of β-endorphin and oxytocin were measured during the early withdrawal phase in patients with alcohol use disorder (AUD) with (N = 35) or without (N = 45) depressive comorbidity and compared with those in healthy volunteers (N = 23). In addition to comparing the groups, the study examined whether serum levels correlated with various psychometric measures of dependence, depression and aggression, as well as with clinical characteristics of dependence. Results: Both serum levels of beta-endorphin and oxytocin were significantly lower in patients than those in healthy controls (p = 0.011 for β-endorphin and p = 0.005 for oxytocin, Kruskal–Wallis test). In patients with depressive comorbidity, the significance was greatest (p = 0.005 for β-endorphin and p = 0.004 for oxytocin, U-test). There was no correlation with clinical or psychometric parameters (p > 0.05, Spearman test), but beta-endorphin levels did correlate significantly with physical aggression (p = 0.026, Spearman test). Conclusions: Serum levels of β-endorphin and oxytocin are lower in patients with AUD, particularly in those with depressive comorbidity. β-Endorphin levels correlated with physical aggression according to the Buss–Durkee (BDHI) estimates.
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Affiliation(s)
- Olga V. Roschina
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
| | - Lyudmila A. Levchuk
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
| | - Anastasiia S. Boiko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
| | - Ekaterina V. Michalitskaya
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
| | - Elena V. Epimakhova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
| | - Innokentiy S. Losenkov
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
| | - German G. Simutkin
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
| | - Anton J. M. Loonen
- Groningen Research Institute of Pharmacy (GRIP), PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, 9713AV Groningen, The Netherlands
- Correspondence:
| | - Nikolay A. Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
- Psychiatry, Addictology and Psychotherapy Department, Siberian State Medical University, 634050 Tomsk, Russia
| | - Svetlana A. Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 634014 Tomsk, Russia; (O.V.R.); (L.A.L.); (A.S.B.); (E.V.M.); (E.V.E.); (I.S.L.); (G.G.S.); (N.A.B.); (S.A.I.)
- Psychiatry, Addictology and Psychotherapy Department, Siberian State Medical University, 634050 Tomsk, Russia
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Gale G, Walsh K, Hennessy VE, Stemerding LE, Ni KS, Thomas E, Kamboj SK, Das RK. Long-term behavioural rewriting of maladaptive drinking memories via reconsolidation-update mechanisms. Psychol Med 2021; 51:2875-2885. [PMID: 32539883 DOI: 10.1017/s0033291720001531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alcohol use disorders can be conceptualised as a learned pattern of maladaptive alcohol-consumption behaviours. The memories encoding these behaviours centrally contribute to long-term excessive alcohol consumption and are therefore an important therapeutic target. The transient period of memory instability sparked during memory reconsolidation offers a therapeutic window to directly rewrite these memories using targeted behavioural interventions. However, clinically-relevant demonstrations of the efficacy of this approach are few. We examined key retrieval parameters for destabilising naturalistic drinking memories and the ability of subsequent counterconditioning to effect long-term reductions in drinking. METHODS Hazardous/harmful beer-drinking volunteers (N = 120) were factorially randomised to retrieve (RET) or not retrieve (No RET) alcohol reward memories with (PE) or without (No PE) alcohol reward prediction error. All participants subsequently underwent disgust-based counterconditioning of drinking cues. Acute responses to alcohol were assessed pre- and post-manipulation and drinking levels were assessed up to 9 months. RESULTS Greater long-term reductions in drinking were found when counterconditioning was conducted following retrieval (with and without PE), despite a lack of short-term group differences in motivational responding to acute alcohol. Large variability in acute levels of learning during counterconditioning was noted. 'Responsiveness' to counterconditioning predicted subsequent responses to acute alcohol in RET + PE only, consistent with reconsolidation-update mechanisms. CONCLUSIONS The longevity of behavioural interventions designed to reduce problematic drinking levels may be enhanced by leveraging reconsolidation-update mechanisms to rewrite maladaptive memory. However, inter-individual variability in levels of corrective learning is likely to determine the efficacy of reconsolidation-updating interventions and should be considered when designing and assessing interventions.
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Affiliation(s)
- Grace Gale
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
| | - Katie Walsh
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
| | - Vanessa E Hennessy
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
| | - L E Stemerding
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
| | - Koa Sher Ni
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
| | - Emily Thomas
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
| | - Sunjeev K Kamboj
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
| | - Ravi K Das
- Clinical, Educational and Health Psychology, UCL, 26 Bedford Way, LondonWC1H 0AP, UK
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Ertl V, Groß M, Mwaka SO, Neuner F. Treating alcohol use disorder in the absence of specialized services - evaluation of the moving inpatient Treatment Camp approach in Uganda. BMC Psychiatry 2021; 21:601. [PMID: 34852824 PMCID: PMC8638348 DOI: 10.1186/s12888-021-03593-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gap between service need and service provision for alcohol-related disorders is highest in resource-poor countries. However, in some of these contexts, local initiatives have developed pragmatic interventions that can be carried out with limited specialized personnel. In an uncontrolled treatment study, we aimed to evaluate the feasibility, acceptability, safety, costs and potential effects of an innovative locally developed community-based program (the Treatment Camp) that is based on an inpatient clinic that moves from community to community. METHODS Out of 32 treatment-seeking individuals 25 took part in the one-week Treatment Camp that included detoxification and counseling components. Re-assessments took place 5 and 12 months after their participation. We explored the course of a wide range of alcohol-related indicators, using the Alcohol Use Disorders Identification Test (AUDIT) as primary outcome complemented by a timeline follow-back approach and the Obsessive Compulsive Drinking Scale. Additionally, we assessed impaired functioning, alcohol-related stigmatization, symptoms of common mental health disorders and indicators of family functioning as reported by participants' wives and children. RESULTS All alcohol-related measures decreased significantly after the Treatment Camp and remained stable up to the 12-month-assessment with high effect sizes ranging from 0.89 to 3.49 (Hedges's g). Although 92% of the participants had lapsed at least once during the follow-up period, 67% classified below the usually applied AUDIT cutoff for hazardous drinking (≥ 8) and no one qualified for the dependent range (≥ 20) one year after treatment. Most secondary outcomes including impaired functioning, alcohol-related stigmatization, symptoms of depression and indicators of family functioning followed the same trajectory. CONCLUSIONS We found the Treatment Camp approach to be acceptable, feasible, safe and affordable (approx. 111 USD/patient) and we could obtain preliminary evidence of its efficacy. Due to its creative combination of inpatient treatment and monitoring by medical personnel with local mobility, the Treatment Camp appears to be more accessible and inclusive than other promising interventions for alcohol dependent individuals in resource-poor contexts. Effects of the approach seem to extend to interactions within families, including a reduction of dysfunctional and violent interactions.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Biopsychology, Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstraße 25, 85072, Eichstätt, Germany.
- vivo international (www.vivo.org), Konstanz, Germany.
| | - Melissa Groß
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Samuel Okidi Mwaka
- Program for Prevention, Awareness, Counseling and Treatment of Alcoholism (PACTA; www.pactaguluganda.org.ug), Plot 1 Burcoro Road, Wiaworanga, Gulu, Uganda
| | - Frank Neuner
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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Guiraud J, Addolorato G, Aubin HJ, Batel P, de Bejczy A, Caputo F, Goudriaan AE, Gual A, Lesch O, Maremmani I, Perney P, Poulnais R, Raffaillac Q, Soderpalm B, Spanagel R, Walter H, van den Brink W. Treating alcohol dependence with an abuse and misuse deterrent formulation of sodium oxybate: Results of a randomised, double-blind, placebo-controlled study. Eur Neuropsychopharmacol 2021; 52:18-30. [PMID: 34237655 DOI: 10.1016/j.euroneuro.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/20/2023]
Abstract
Sodium oxybate (SMO) has been approved in Italy and Austria for the maintenance of abstinence in alcohol dependent (AD) patients. Although SMO is well tolerated in AD patients, cases of abuse and misuse have been reported outside the therapeutic setting. Here we report on a phase IIb double-blind, randomized, placebo-controlled trial for the maintenance of abstinence in AD patients with a new abuse and misuse deterrent formulation of SMO. A total of 509 AD patients were randomized to 12 weeks of placebo or one of four SMO doses (0.75, 1.25, 1.75 or 2.25 g t.i.d.) followed by a one-week medication-free period. The primary endpoint was the percentage of days abstinent (PDA) at end of treatment. An unexpectedly high placebo response (mean 73%, median 92%) was observed. This probably compromised the demonstration of efficacy in the PDA, but several secondary endpoints showed statistically significant improvements. A post-hoc subgroup analysis based on baseline severity showed no improvements in the mild group, but statistically significant improvements in the severe group: PDA: mean difference +15%, Cohen's d = 0.42; abstinence: risk difference +18%, risk ratio = 2.22. No safety concerns were reported. Although the primary endpoint was not significant in the overall population, several secondary endpoints were significant in the intent-to-treat population and post-hoc results showed that treatment with SMO was associated with a significant improvement in severe AD patients which is consistent with previous findings. New trials are warranted that take baseline severity into consideration.
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Affiliation(s)
- Julien Guiraud
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands; D&A Pharma, Paris, France.
| | - Giovanni Addolorato
- Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; Internal Medicine Unit, Columbus-Gemelli Hospital, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Henri-Jean Aubin
- French Institute of Health and Medical Research (Inserm), Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Paris, France; Addiction Research and Treatment Center, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Philippe Batel
- Addiction unit of Charente, Camille Claudel Hospital, 16400 La Couronne, France
| | - Andrea de Bejczy
- Section of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Center for the Study and Treatment of Chronic Inflammatory Bowel Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Anna E Goudriaan
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands; Arkin, Dept. of Research and Quality of Care, Amsterdam, Netherlands, & Amsterdam Public Health Research Institute, Netherlands
| | - Antoni Gual
- Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Otto Lesch
- Department of Social Psychiatry, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Italy
| | - Pascal Perney
- Addiction Medicine, Hospital Grau-du-Roi, Nimes, France
| | | | | | - Bo Soderpalm
- Section of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Henriette Walter
- Department of Social Psychiatry, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Wim van den Brink
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
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Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: A randomized placebo-controlled clinical trial. Brain Stimul 2021; 14:1531-1543. [PMID: 34687964 DOI: 10.1016/j.brs.2021.10.386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD. OBJECTIVE To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence. METHODS A randomized clinical trial with patients (n = 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year). RESULTS Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI = 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT. CONCLUSIONS AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054.
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Gowin JL, Sloan ME, Morris JK, Schwandt ML, Diazgranados N, Ramchandani VA. Characteristics Associated With High-Intensity Binge Drinking in Alcohol Use Disorder. Front Psychol 2021; 12:750395. [PMID: 34744927 PMCID: PMC8564144 DOI: 10.3389/fpsyg.2021.750395] [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: 07/30/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
High-intensity binge drinking, defined as consuming 2-3 times the level of a binge (4 or 5 drinks for women or men), increases the risks of overdose and alcohol-related cancer relative to lower levels of drinking. This study examined the relationship between high-intensity binge drinking and three domains hypothesized to contribute to alcohol use disorder (AUD): incentive salience, negative emotionality, and executive function. This cross-sectional study at the National Institute on Alcohol Abuse and Alcoholism examined 429 adults with AUD and 413 adults without a history of AUD. Drinking was assessed using the 90-day Timeline Followback interview. The AUD sample was divided into training and testing sets, and a machine learning model was generated in the training set and then applied to the testing set, to classify individuals based on if they had engaged in high-intensity binge drinking. We also conducted regression models for the following dependent variables: the presence of high-intensity binge drinking, frequency of high-intensity binge drinking, and number of drinks per of binge. Independent variables in these regression models were determined by variable selection from the machine learning algorithm and included time thinking about alcohol, depression rating, and positive urgency as representative variables for the three domains. These variables were assessed using self-report measures. The models were applied to the adults without a history of AUD to determine generalizability. The machine learning algorithm displayed reasonable accuracy when classifying individuals as high-intensity binge drinkers (area under ROC=0.74, 95% CI 0.67, 0.80). In adults with AUD, greater depression rating (OR=1.04, 95% CI 1.01, 1.070) and amount of time thinking about alcohol (OR=1.48, 95% CI 1.20, 1.91) were associated with greater likelihood of high-intensity binge drinking. They were also associated with greater frequency of high-intensity binge drinking days and greater number of drinks on binge occasions. Our findings suggest that incentive salience may contribute to high-intensity binge drinking in both controls and individuals with AUD. Negative emotionality was only associated with high-intensity binge drinking in individuals diagnosed with AUD, suggesting that it may be a consequence rather than a cause of high-intensity binge drinking.
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Affiliation(s)
- Joshua L. Gowin
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Laboratory on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Matthew E. Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
- Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - James K. Morris
- Laboratory on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Melanie L. Schwandt
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Nancy Diazgranados
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Vijay A. Ramchandani
- Laboratory on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
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Khemiri L, Brynte C, Konstenius M, Guterstam J, Rosendahl I, Franck J, Jayaram-Lindström N. Self-rated impulsivity in healthy individuals, substance use disorder and ADHD: psychometric properties of the Swedish Barratt impulsiveness scale. BMC Psychiatry 2021; 21:458. [PMID: 34537043 PMCID: PMC8449879 DOI: 10.1186/s12888-021-03462-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impulsivity is associated with several psychiatric disorders, including substance use disorders (SUD) and attention deficit hyperactivity disorder (ADHD). A widely used questionnaire to assess impulsivity is the Barratt Impulsiveness Scale (BIS), and the aim of the current study was to evaluate the psychometric properties of the Swedish version of the BIS (swe-BIS). METHODS The original BIS was translated to Swedish and back-translated by an authorized translator. The swe-BIS was administered to healthy controls (n = 113), patients with alcohol use disorder (n = 97), amphetamine use disorder (n = 37) and attention deficit hyperactive disorder (ADHD; n = 26). A subset of subjects (n = 62) completed the swe-BIS twice within 1 week. Psychometric evaluation of the swe-BIS included assessment of different indices of reliability (internal consistency, test-retest and agreement) and validity (response processess, divergent and convergent). Confirmatory factor analyses (CFA) were performed to assess several indices of model fit in five different models based on previously suggested subscales. RESULTS Cronbach's alpha for all swe-BIS items in the full sample was 0.89, ranging from 0.78-0.87 within the different subgroups. The Pearson test-retest correlation for total score was 0.78 (p < 0.001), with greater test-retest correlations within compared to across different subscales. The Bland-Altman plot indicated high level of agreement between test and retest. The healthy individuals had lower swe-BIS score compared to the patients (t(267.3) = - 8.6; p < 0.001), and the swe-BIS total score was also significantly different between each of the four participant groups (p < 0.01 for all group comparisons). Furthermore, swe-BIS had greater correlations with impulsivity related scales compared to non-impulsivity related scales. The CFA analyses indicated that while no suggested model showed an optimal fit, the best model fit indices was found for the 3-factor model. CONCLUSIONS The swe-BIS was found to have good to excellent psychometric properties with respect to the assessed indices of reliability and validity, supporting use of the scale in clinical research in both healthy individuals and patients with SUD and ADHD.
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Affiliation(s)
- Lotfi Khemiri
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, floor 7, 113 64, Stockholm, Sweden.
| | - Christoffer Brynte
- grid.467087.a0000 0004 0442 1056Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden
| | - Maija Konstenius
- grid.467087.a0000 0004 0442 1056Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden
| | - Joar Guterstam
- grid.467087.a0000 0004 0442 1056Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden
| | - Ingvar Rosendahl
- grid.467087.a0000 0004 0442 1056Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden
| | - Johan Franck
- grid.467087.a0000 0004 0442 1056Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- grid.467087.a0000 0004 0442 1056Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden
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Opozda-Suder S, Karteczka-Świętek K, Piasecka M. Psychometric properties and longitudinal measurement invariance of the drug craving scale: Modification of the Polish version of the Penn Alcohol Craving Scale (PACS). PLoS One 2021; 16:e0256018. [PMID: 34495966 PMCID: PMC8425527 DOI: 10.1371/journal.pone.0256018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background The Penn Alcohol Craving Scale (PACS) is an instrument with good psychometric properties that is widely used to assess alcohol craving. Based on the assumption that the experience of craving is independent of substance type, the Polish version of the PACS was modified to measure drug craving, thus creating the Penn Drug Craving Scale (PDCS). The analyses presented in the paper aim to verify the hypothesis that the PDCS has a unidimensional structure, is highly reliable and features longitudinal measurement invariance. Methods The research was conducted in 14 inpatient and 13 outpatient randomly selected facilities that provide psychosocial therapy to people with substance use disorder (SUD) in Poland, during June 2018 –July 2019. The data used for the analyses came from 282 patients diagnosed on the basis of ICD-10 criteria (F11.2-F19.2). The paper presents analyses with the application of: [1] confirmatory factor analysis (CFA) conducted on the basis of a polychoric correlation matrix and the WLSMV estimator; [2] a reliability estimate using Cronbach’s alpha and coefficient omega; [3] verification of longitudinal measurement invariance between the beginning and end of therapy; [4] evaluation of criterion validity; [5] normalisation of the raw scores. Results The CFA results confirmed a unidimensional PDCS structure (RMSEA = 0.047, 95% CI: 0.000–0.103; CFI = 0.999; TLI = 0.999) and a high reliability of the scale (ω = 0.93). Moreover, a strict longitudinal measurement invariance of the instrument was confirmed. Conclusions Accurate assessment of craving is possible only with valid and reliable instruments. Therefore, the psychometric properties of the PDCS were verified based on the latest statistical approaches. The scale is a valid and highly reliable tool featuring longitudinal measurement invariance and can be usefully used for research and clinical purposes. Thus, the Polish version of the PACS has been modified and successfully applied to the population of people with SUD.
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Affiliation(s)
- Sylwia Opozda-Suder
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
- * E-mail:
| | - Kinga Karteczka-Świętek
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
| | - Małgorzata Piasecka
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
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Grodin EN, Burnette E, Towns B, Venegas A, Ray LA. Effect of alcohol, tobacco, and cannabis co-use on gray matter volume in heavy drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:760-768. [PMID: 34435833 PMCID: PMC8484037 DOI: 10.1037/adb0000743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Alcohol, tobacco, and cannabis are the three most frequently used drugs in the United States and co-use is common. Alcohol, tobacco, and cannabis use has been separately associated with altered brain structure, and alcohol and tobacco co-use results in decreases in gray matter volume. Less is known about the effect of alcohol and cannabis co-use, and alcohol, tobacco, and cannabis tri-use. Therefore, this study examined the effect of co- and tri-use on gray matter volume, a measure of brain cell density, in heavy drinkers. METHOD Heavy drinkers (n = 237; 152m/85f; age = 32.52; white = 111; black = 28; Latino = 9; American Indian = 2; Pacific Islander = 4; Asian = 59; mixed = 15; other = 9) were classified into four groups based on their alcohol, tobacco, and cannabis use: alcohol only users (n = 70), alcohol and tobacco co-users (n = 90), alcohol and cannabis co-users (n = 35), and alcohol, tobacco, and cannabis tri-users (n = 42). All participants completed a structural MRI scan. Voxel-based morphometry was conducted to evaluate the effect of co-use on gray matter volume, with alcohol only users as the reference group. Age, sex, and scanner were included as covariates. RESULTS Alcohol and tobacco co-users had significantly decreased left orbitofrontal gray matter volume relative to alcohol only users (Cohen's d = .79). There were no differences in gray matter volume between the alcohol only and alcohol and cannabis co-users, or between the alcohol only and tri-user groups. CONCLUSION The additive effect of tobacco co-use on gray matter volumes in heavy drinkers was limited and localized. The effect of tri-use of alcohol, tobacco, and cannabis may have interacted, such that overlapping cannabis and tobacco use masked volume differences present in separate co-using groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Elizabeth Burnette
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Neuroscience Interdepartmental Program, University of California at Los Angeles, Los Angeles, CA
| | - Brandon Towns
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Alexandra Venegas
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Lara A. Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
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Shukla S, Ghosh A, Ahuja CK, Basu D, Holla B. An instrument for visual cue associated craving of HEroin (IV-CACHE): A preliminary functional neuroimaging-based study of validity and reliability. Indian J Psychiatry 2021; 63:448-455. [PMID: 34789932 PMCID: PMC8522616 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1391_20] [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: 12/16/2020] [Revised: 04/19/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Craving is the subjective experience of desire for specific drugs. Lack of reliability and untested construct validity are limiting factors for the existing questionnaires to assess craving. AIM The aim of the study was to design and test the validity and reliability of an instrument to assess visual cue-induced craving for heroin dependence. MATERIALS AND METHODS In the first stage of the study, a set of forty images (twenty each of heroin and neutral cues-) were captured and validated by expert consensus. Thirty male participants with heroin dependence rated their cue-induced craving on a six-point Likert scale while viewing this image-set. In the next stage, putative construct validity was examined using a pilot cue-reactivity functional magnetic resonance imaging paradigm with ten additional heroin-dependent patients. RESULTS Cronbach's alpha for the instrument for visual cue-associated craving of HEroin (IV-CACHE) was 0.9, suggestive of high internal consistency. There were modest and significant correlations of IV-CACHE with the drug desire questionnaire (r = 0.43), and obsessive-compulsive drug use scale (r = 0.37), supporting concurrent validity. Patients with heroin dependence exhibited cue reactivity in the left fusiform area, right lingual gyrus, right precuneus region, right inferior frontal, inferior temporal gyri, and middle occipital gyri. The activated brain areas were largely aligned to the underlying neurobiological substrates of craving but might also have depicted nondrug-specific factors (aberrant face processing and attentional bias). CONCLUSION The present cue-task is a promising tool for the examination of cue-related craving for heroin in the Indian setting.
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Affiliation(s)
- Shantanu Shukla
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Kamal Ahuja
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharath Holla
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Park CI, Kim HW, Hwang SS, Kang JI, Kim SJ. Influence of dopamine-related genes on craving, impulsivity, and aggressiveness in Korean males with alcohol use disorder. Eur Arch Psychiatry Clin Neurosci 2021; 271:865-872. [PMID: 31559529 DOI: 10.1007/s00406-019-01072-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/19/2019] [Indexed: 12/22/2022]
Abstract
Dopamine is a major neuromodulator that is acutely involved in various cognitive processes, reward-motivated behaviors, and impulsivity. Abnormality in dopaminergic neurotransmission is implicated in the pathophysiology of alcohol use disorder (AUD). The present study examined the genetic influence of dopamine system on problematic drinking, impulsivity, and aggressiveness in a Korean male population with AUD. Five single nucleotide polymorphisms (SNPs) (rs4532 in DRD1, rs2283265 in DRD2, rs6280 in DRD3, rs1800497 in ANKK1, and rs4680 in COMT) and a variable number of tandem repeats (VNTRs) in DAT1 in 295 male patients with AUD were genotyped. For AUD-related clinical characteristics, the Alcohol Use Disorders Identification Test and the Obsessive-Compulsive Drinking Scale (OCDS) were used to assess the severity of hazardous drinking and craving symptoms, respectively. Participants also completed the UPPS-P Impulsive Behavior Scale (UPPS-P) and Buss-Perry Aggression Questionnaire (BPAQ). Analyses were performed using R package SNPassoc; statistical significance was set as p < 0.0083 after Bonferroni correction. A significant association was detected between DRD3 SNP rs6280 and OCDS scores. In regard to impulsivity and aggressiveness, rs4532 of DRD1 was significantly associated with UPPS-P score. Also, rs4532 demonstrated a nominally significant association with BPAQ score, although it did not reach statistical significance after correction for multiple comparisons. Results of this study support the idea that genetic variations in the dopamine system may contribute to alcohol cravings and impulsivity in patients with AUD.
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Affiliation(s)
- Chun Il Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Won Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Medical Education, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Syung Shick Hwang
- Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee In Kang
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Se Joo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Bollen Z, Pabst A, Masson N, Billaux P, D'Hondt F, Deleuze J, De Longueville X, Lambot C, Maurage P. Alcohol-related attentional biases in recently detoxified inpatients with severe alcohol use disorder: an eye-tracking approach. Drug Alcohol Depend 2021; 225:108803. [PMID: 34182378 DOI: 10.1016/j.drugalcdep.2021.108803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dominant theoretical models consider that attentional biases (AB) towards alcohol-related stimuli play a key role in the development and maintenance of alcohol use disorder (AUD). Their assessment has however showed high inconsistencies and has been mostly based on unreliable behavioral measures. This study evaluated the presence and extent of alcohol-related AB in recently detoxified inpatients with severe AUD by combining the visual probe task (VPT) paradigm with eye-tracking measures, known to improve the VPT reliability in subclinical populations. METHODS We recruited 24 patients and 27 matched healthy controls. They performed the VPT (measuring reaction time when processing visual targets preceded by alcoholic and matched non-alcoholic pictures) combined with eye-tracking measures (dwell time, first fixation direction/duration, second fixation direction) during two sessions. Estimates of internal consistency, split-half reliability, and test-retest reliability were measured. RESULTS Patients showed shorter dwell time for alcohol cues (p = .004, d=.853) and reduced number of fixations towards alcohol after a first fixation on non-alcohol cues (p = .012, d=.758) compared to controls. These findings suggest the presence of alcohol-related avoidance AB in detoxified patients with severe AUD. The VPT achieved excellent reliability for these eye-tracking measures. Reaction times and first fixation measures did not indicate any AB pattern and showed poor reliability. CONCLUSIONS The VPT, when combined with dwell time and second fixation direction, constitutes a reliable method for assessing AB in detoxified patients. It showed the presence of an alcohol-related avoidance bias in this clinical population, in contradiction with the approach bias predicted by theoretical models.
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Affiliation(s)
- Zoé Bollen
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Arthur Pabst
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Nicolas Masson
- Numerical Cognition Group, Psychological Science Research Institute and Neuroscience Institute, UCLouvain, Louvain-la-Neuve, Belgium; Cognitive Science and Assessment Institute, University of Luxembourg, Luxembourg
| | - Pauline Billaux
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France; CHU Lille, Clinique de Psychiatrie, CURE, Lille, France; Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
| | - Jory Deleuze
- Cellule de Recherche du Beau Vallon, Saint-Servais, Belgium; Hôpital Psychiatrique du Beau Vallon, Regina Pacis, Saint-Servais, Belgium
| | | | - Carine Lambot
- Hôpital Psychiatrique du Beau Vallon, Regina Pacis, Saint-Servais, Belgium
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
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Efficacy of the Unified Protocol for the treatment of comorbid alcohol use and anxiety disorders: Study protocol and methods. Contemp Clin Trials 2021; 108:106512. [PMID: 34284152 DOI: 10.1016/j.cct.2021.106512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022]
Abstract
Alcohol Use Disorder (AUD) and anxiety disorders (ANX) are each highly prevalent and frequently co-occur, resulting in a complex clinical presentation. The existing literature to date has not yet identified how to best treat comorbid AUD/ANX, partially due to limitations in understanding what factors and mechanisms are implicated in their co-occurrence. This manuscript describes the rationale and methods for an ongoing randomized-controlled trial designed to evaluate the efficacy of a cognitive behavioral intervention, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), compared to Take Control (TC), a psychosocial and motivational treatment serving as a control condition in this study, for comorbid AUD/ANX. Sixty individuals with comorbid AUD/ANX will be randomized to UP or TC, and complete assessments at pre- and post-treatment, as well as one- and six-month follow-up points. We hypothesize that the UP, compared to TC, will result in significantly greater reductions in drinking-related outcomes, as well as anxiety and depressive-related outcomes. Additionally, the current study is designed to evaluate exploratory aims to contribute to our theoretical understanding of why AUD and ANX frequently co-occur. Specifically, we will examine the relationship between changes in AUD and ANX symptoms in relation to changes in emotional disorder mechanisms, such as emotion regulation. Because the UP is a transdiagnostic treatment that specifically targets underlying components of emotional disorders generally, it may be well suited to effectively target comorbid AUD/ANX.
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