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Schwartz EKC, Wolkowicz NR, De Aquino JP, MacLean RR, Sofuoglu M. Cocaine Use Disorder (CUD): Current Clinical Perspectives. Subst Abuse Rehabil 2022; 13:25-46. [PMID: 36093428 PMCID: PMC9451050 DOI: 10.2147/sar.s337338] [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: 02/24/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
- Correspondence: Elizabeth KC Schwartz, Tel +1-203-932-5711, Fax +1-203-937-3472, Email
| | - Noah R Wolkowicz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - R Ross MacLean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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2
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Applying the Addictions Neuroclinical Assessment to derive neurofunctional domains in individuals who use methamphetamine. Behav Brain Res 2022; 427:113876. [PMID: 35378110 DOI: 10.1016/j.bbr.2022.113876] [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] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022]
Abstract
The Addictions Neuroclinical Assessment (ANA) was proposed as a neuroscience-informed clinical framework to understand heterogeneity in addiction encompassing dysfunction in three domains: incentive salience, negative emotionality, and executive functions. The ANA has been validated in the alcohol field but has not been extended to other substances. Thus, the objective of the current study was to replicate and extend the ANA framework to methamphetamine use disorder. Non-treatment seeking individuals (N = 185) who reported regular methamphetamine use completed a deep phenotyping battery comprising self-report and behavioral measures that assessed methamphetamine craving and emotional withdrawal symptoms, mood and anxiety symptomatology, risk-taking behaviors, working memory, attention, and impulsivity. Factor analytic techniques were used in an iterative manner to derive latent factors that explained biobehavioral variation in the sample. The relationship between factor scores and demographic and clinical indicators of methamphetamine use were examined to assess the construct validity of the latent factors. Deep phenotyping combined with factor analytic techniques implicated three intercorrelated neurofunctional domains that map on to the proposed ANA domains: incentive salience, negative emotionality, and executive function. Each of the domains were associated with demographic and clinical indicators of methamphetamine use providing initial support for their construct validity. The ANA framework holds promise for explaining heterogeneity in addiction by identifying neuroscience-informed phenotypes. Knowledge from the ANA framework may be applied to advance precision medicine and inform medications development for a host of substance use disorders, particularly those with no approved pharmacotherapy such as methamphetamine.
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Nicolas C, Zlebnik NE, Farokhnia M, Leggio L, Ikemoto S, Shaham Y. Sex Differences in Opioid and Psychostimulant Craving and Relapse: A Critical Review. Pharmacol Rev 2022; 74:119-140. [PMID: 34987089 PMCID: PMC11060335 DOI: 10.1124/pharmrev.121.000367] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/15/2021] [Indexed: 01/11/2023] Open
Abstract
A widely held dogma in the preclinical addiction field is that females are more vulnerable than males to drug craving and relapse. Here, we first review clinical studies on sex differences in psychostimulant and opioid craving and relapse. Next, we review preclinical studies on sex differences in psychostimulant and opioid reinstatement of drug seeking after extinction of drug self-administration, and incubation of drug craving (time-dependent increase in drug seeking during abstinence). We also discuss ovarian hormones' role in relapse and craving in humans and animal models and speculate on brain mechanisms underlying their role in cocaine craving and relapse in rodent models. Finally, we discuss imaging studies on brain responses to cocaine cues and stress in men and women.The results of the clinical studies reviewed do not appear to support the notion that women are more vulnerable to psychostimulant and opioid craving and relapse. However, this conclusion is tentative because most of the studies reviewed were correlational, not sufficiently powered, and not a priori designed to detect sex differences. Additionally, imaging studies suggest sex differences in brain responses to cocaine cues and stress. The results of the preclinical studies reviewed provide evidence for sex differences in stress-induced reinstatement and incubation of cocaine craving but not cue- or cocaine-induced reinstatement of cocaine seeking. These sex differences are modulated in part by ovarian hormones. In contrast, the available data do not support the notion of sex differences in craving and relapse/reinstatement for methamphetamine or opioids in rodent models. SIGNIFICANCE STATEMENT: This systematic review summarizes clinical and preclinical studies on sex differences in psychostimulant and opioid craving and relapse. Results of the clinical studies reviewed do not appear to support the notion that women are more vulnerable to psychostimulant and opioid craving and relapse. Results of preclinical studies reviewed provide evidence for sex differences in reinstatement and incubation of cocaine seeking but not for reinstatement or incubation of methamphetamine or opioid seeking.
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Affiliation(s)
- Céline Nicolas
- Neurocentre Magendie, University of Bordeaux, Bordeaux, France (C.N.); Department of Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD, Present address: Division of Biomedical Sciences, University of California Riverside, School of Medicine, Riverside, CA (N.E.Z.); Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD (M.F., L.L., S.I., Y.S.); and Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (M.F., L.L.)
| | - Natalie E Zlebnik
- Neurocentre Magendie, University of Bordeaux, Bordeaux, France (C.N.); Department of Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD, Present address: Division of Biomedical Sciences, University of California Riverside, School of Medicine, Riverside, CA (N.E.Z.); Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD (M.F., L.L., S.I., Y.S.); and Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (M.F., L.L.)
| | - Mehdi Farokhnia
- Neurocentre Magendie, University of Bordeaux, Bordeaux, France (C.N.); Department of Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD, Present address: Division of Biomedical Sciences, University of California Riverside, School of Medicine, Riverside, CA (N.E.Z.); Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD (M.F., L.L., S.I., Y.S.); and Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (M.F., L.L.)
| | - Lorenzo Leggio
- Neurocentre Magendie, University of Bordeaux, Bordeaux, France (C.N.); Department of Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD, Present address: Division of Biomedical Sciences, University of California Riverside, School of Medicine, Riverside, CA (N.E.Z.); Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD (M.F., L.L., S.I., Y.S.); and Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (M.F., L.L.)
| | - Satoshi Ikemoto
- Neurocentre Magendie, University of Bordeaux, Bordeaux, France (C.N.); Department of Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD, Present address: Division of Biomedical Sciences, University of California Riverside, School of Medicine, Riverside, CA (N.E.Z.); Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD (M.F., L.L., S.I., Y.S.); and Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (M.F., L.L.)
| | - Yavin Shaham
- Neurocentre Magendie, University of Bordeaux, Bordeaux, France (C.N.); Department of Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD, Present address: Division of Biomedical Sciences, University of California Riverside, School of Medicine, Riverside, CA (N.E.Z.); Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD (M.F., L.L., S.I., Y.S.); and Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (M.F., L.L.)
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Pérez de Los Cobos J, Alcaraz S, Verdejo-García A, Muñoz L, Siñol N, Fernández-Serrano MJ, Fernández P, Martínez A, Duran-Sindreu S, Batlle F, Trujols J. Factors associated with the absence of cocaine craving in treatment-seeking individuals during inpatient cocaine detoxification. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:127-138. [PMID: 33164558 DOI: 10.1080/00952990.2020.1833340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anecdotal evidence suggests a substantial proportion of individuals with cocaine use disorder do not report craving during inpatient detoxification. OBJECTIVE To examine prevalence and clinical correlates of consistent absence of cocaine craving among inpatients during detoxification. We hypothesized that craving absence would be associated with less severity of cocaine use, depression, and anxiety. Alternative explanations were also explored. METHODS Craving absence (i.e., non-cravers) was defined as a daily score of zero across two separate craving visual analogue scales in each of the inpatient days. Participants scoring ≥1 on ≥1 day were considered cravers. Severity of cocaine use disorder as well as in-treatment depression and anxiety were assessed. Alternative contributors included presence of cocaine and other substances in urine at admission, in-treatment prescription of psychotropic medications, treatment motivation, executive function, interoception, and social desirability. RESULTS Eighty-seven participants (78.2% males) met criteria as either non-cravers (n = 29; 33.3%) or cravers (n = 58; 66.7%). Mean length of admission in non-cravers and cravers was, respectively, 10.83 and 13.16 days. Binary logistic regression model showed that non-cravers scored significantly lower than cravers on cocaine use during last month before treatment (OR, 95% CI; 0.902, 0.839-0.970), in-treatment depression (OR, 95% CI; 0.794, 0.659-0.956), and in-treatment prescribing of antipsychotics (OR, 95% CI; 0.109, 0.014-0.823). Model prediction accuracy was 88.9%. CONCLUSIONS One in three patients undergoing inpatient detoxification experienced absence of craving, linked to less pretreatment cocaine use, better mood, and decreased administration of antipsychotics. Findings may inform pretreatment strategies and improve treatment cost-effectiveness.
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Affiliation(s)
- Jose Pérez de Los Cobos
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Saul Alcaraz
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Antonio Verdejo-García
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
| | - Laura Muñoz
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Núria Siñol
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Maria José Fernández-Serrano
- Departamento de Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Granada, Granada, Spain
| | - Pilar Fernández
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ana Martínez
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Santiago Duran-Sindreu
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Francesca Batlle
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Joan Trujols
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Unitat de Neurociència Quantitativa, Grup de Recerca en Psicologia Quantitativa (SGR 269), Universitat de Barcelona, Barcelona, Spain
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Li Y, Lu X, Nie J, Hu P, Ge F, Yuan TF, Guan X. MicroRNA134 of Ventral Hippocampus Is Involved in Cocaine Extinction-Induced Anxiety-like and Depression-like Behaviors in Mice. MOLECULAR THERAPY. NUCLEIC ACIDS 2020; 19:937-950. [PMID: 32004865 PMCID: PMC6994828 DOI: 10.1016/j.omtn.2019.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 12/16/2022]
Abstract
We previously found that cocaine abuse could increase microRNA134 (miR134) levels in the hippocampus; yet the roles of miR134 in cocaine-related abnormal psychiatric outcomes remain unknown. In this study, using the cocaine-induced conditioned place preference (CPP) mice model, we found that mice exhibit enhanced anxiety-like and depression-like behaviors during the cocaine extinction (CE) period of CPP, accompanied by obviously increased miR134 levels and decreased levels of 19 genes that are associated with synaptic plasticity, glia activity, and neurochemical microenvironments, in the ventral hippocampus (vHP). Knockdown of miR134 in vHP in vivo reversed the changes in 15 of 19 potential gene targets of miR134 and rescued the abnormal anxiety-like and depression-like behavioral outcomes in CE mice. In parallel, knockdown of miR134 reversed CE-induced changes in dendritic spines and synaptic proteins and increased the field excitatory postsynaptic potential (fEPSP) of CA1 pyramidal neurons in the vHP of CE mice. In addition, knockdown of miR134 suppressed the CE-enhanced microglia activity, inflammatory, apoptotic, and oxidative stress statuses in the vHP. With the data taken together, miR134 may be involved in cocaine-associated psychiatric problems, potentially via regulating the expressions of its gene targets that are related to synaptic plasticity and neurochemical microenvironments.
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Affiliation(s)
- Yuehan Li
- Department of Human Anatomy and Histoembryology, Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xue Lu
- Department of Human Anatomy and Histoembryology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiaxun Nie
- Department of Human Anatomy and Histoembryology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Panpan Hu
- Department of Human Anatomy, Nanjing Medical University, Nanjing, China
| | - Feifei Ge
- Department of Human Anatomy and Histoembryology, Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University, Shanghai, China.
| | - Xiaowei Guan
- Department of Human Anatomy and Histoembryology, Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China.
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Elman I, Borsook D. The failing cascade: Comorbid post traumatic stress- and opioid use disorders. Neurosci Biobehav Rev 2019; 103:374-383. [DOI: 10.1016/j.neubiorev.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/03/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
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Hartwell EE, Moallem NR, Courtney KE, Glasner-Edwards S, Ray LA. Sex Differences in the Association Between Internalizing Symptoms and Craving in Methamphetamine Users. J Addict Med 2017; 10:395-401. [PMID: 27504928 PMCID: PMC5083163 DOI: 10.1097/adm.0000000000000250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Methamphetamine (MA) users often have substantial psychiatric comorbidities, with nearly a third reporting lifetime mood disorders and over a quarter reporting lifetime anxiety disorders. Female MA users are more likely to endorse depression and anxiety symptoms compared with men. Craving has been related to mood/anxiety symptoms in MA users. To extend the literature on sex differences in MA use disorder, the present study examines the role of sex as a moderator of the relationship between mood/anxiety symptoms and MA craving. METHODS Participants (N = 203) were nontreatment-seeking, current MA users, recruited from the Los Angeles community for enrollment in a larger pharmacotherapy trial. At the assessment visit, participants completed multiple measures including the Methamphetamine Urge Questionnaire, the Beck Depression Inventory, and the Beck Anxiety Inventory. RESULTS The relationship between depression symptomatology and MA craving was moderated by sex (F = 6.18, P = 0.01), such that the relationship was positive and significant for men (P < 0.001), but was not significant for women. Similarly, sex significantly moderated the relationship between anxiety and MA craving (F = 5.99, P = 0.02), such that the relationship was also positive and significant in men, but not in women (P < 0.001). CONCLUSIONS These results suggest that men may be more sensitive to the effects of internalizing symptoms on MA craving than women. Given craving's propensity to predict relapse, these initial findings indicate the necessity of treating comorbid psychiatric problems in male MA users, which may in turn assist in the attenuation of craving.
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Affiliation(s)
- Emily E. Hartwell
- Department of Psychology, University of California, Los Angeles
- Integrated Substance Abuse Programs, University of California, Los Angeles
| | | | | | | | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Brain Research Institute, University of California, Los Angeles
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Philogene-Khalid HL, Hicks C, Reitz AB, Liu-Chen LY, Rawls SM. Synthetic cathinones and stereochemistry: S enantiomer of mephedrone reduces anxiety- and depressant-like effects in cocaine- or MDPV-abstinent rats. Drug Alcohol Depend 2017; 178. [PMID: 28646714 PMCID: PMC5548612 DOI: 10.1016/j.drugalcdep.2017.04.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The neuropharmacological profile of the synthetic cathinone mephedrone (MEPH) is influenced by stereochemistry. Both MEPH enantiomers are monoamine transporter substrates, but R-MEPH is primarily responsible for rewarding effects of MEPH as it produces greater locomotor activation and intracranial self-stimulation than S-MEPH. S-MEPH is a 50-fold more potent 5-HT releaser than R-MEPH and does not place preference in rats. MEPH is also structurally similar to the cathinone derivative bupropion, an antidepressant and smoking cessation medication, suggesting MEPH has therapeutic and addictive properties. METHODS We tested the hypothesis that S-MEPH reduces anxiety- and depression-like behaviors in rats withdrawn from chronic cocaine or methylenedioxypyrovalerone (MDPV) using the elevated plus maze (EPM) and forced swim test (FST), respectively. Rats were tested 48-h after a binge-like paradigm (3×/day for 10days in 1-h intervals) of cocaine (10mg/kg), MDPV (1mg/kg) or saline. In vitro studies assessed the receptor binding and activity of S-MEPH. KEY RESULTS Rats withdrawn from chronic cocaine or MDPV displayed an increase in anxiety- and depression-like behaviors that was antagonized by treatment with S-MEPH (10, 30mg/kg). S-MEPH displayed affinity, but not agonist activity, for 5-HT2 receptors (2A-2C) and showed negligible affinity for dopaminergic, adrenergic and nicotinic receptors. CONCLUSION AND IMPLICATION S-MEPH attenuated withdrawal behaviors following chronic cocaine or MDPV, perhaps through 5-HT release and/or 5-HT2 receptor interactions. The present data suggest S-MEPH may be a possible structural and pharmacological template to develop maintenance therapy for acute anxiety and depression during early withdrawal from psychostimulant abuse.
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Affiliation(s)
- Helene L. Philogene-Khalid
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA,Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University Philadelphia, PA, USA
| | - Callum Hicks
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA,Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University Philadelphia, PA, USA
| | - Allen B. Reitz
- Fox Chase Chemical Diversity Center Inc., Doylestown, PA
| | - Lee-Yuan Liu-Chen
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA,Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University Philadelphia, PA, USA
| | - Scott M. Rawls
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA,Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University Philadelphia, PA, USA
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9
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Reward deficiency and anti-reward in pain chronification. Neurosci Biobehav Rev 2016; 68:282-297. [DOI: 10.1016/j.neubiorev.2016.05.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
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11
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Predicting Outcome in Public Addiction Services Using Data Collected During Routinely Assessment Procedures. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9587-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Herrold AA, Sander AM, Wilson KV, Scimeca LM, Cobia DJ, Breiter HC. Dual Diagnosis of Traumatic Brain Injury and Alcohol Use Disorder: Characterizing Clinical and Neurobiological Underpinnings. CURRENT ADDICTION REPORTS 2015. [DOI: 10.1007/s40429-015-0078-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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DeVito EE, Babuscio TA, Nich C, Ball SA, Carroll KM. Gender differences in clinical outcomes for cocaine dependence: randomized clinical trials of behavioral therapy and disulfiram. Drug Alcohol Depend 2014; 145:156-67. [PMID: 25457739 PMCID: PMC4268325 DOI: 10.1016/j.drugalcdep.2014.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 10/11/2014] [Accepted: 10/12/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite extensive research on gender differences in addiction, there are relatively few published reports comparing treatment outcomes for women versus men based on evidence-based treatments evaluated in randomized clinical trials. METHODS An aggregate sample comprised of data from five randomized clinical trials of treatment for cocaine dependence (N = 434) was evaluated for gender differences in clinical outcomes. Secondary analyses compared gender differences in outcome by medication condition (disulfiram versus no medication) and across multiple behavioral treatment conditions. RESULTS Women, compared with men, had poorer treatment outcomes on multiple measures of cocaine use during treatment and at post-treatment follow-up. These results appear to be primarily accounted for by disulfiram being less effective in women compared with men. There was no evidence of meaningful gender differences in outcome as a function of the behavioral therapies evaluated. CONCLUSIONS These findings suggest that women and men may benefit to similar degrees from some empirically validated behavioral treatments for addiction. Conversely, some addiction pharmacotherapies, such as disulfiram, may be associated with poorer outcomes among women relative to men and point to the need for careful assessment of pharmacological treatments in both sexes prior to widespread clinical implementation.
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Affiliation(s)
- Elise E. DeVito
- Department of Psychiatry, Yale University School of Medicine, 1
Church Street, Suite 701, New Haven, CT 06510, United States,Corresponding author. Tel.: +1 203 737 4882;
fax: +1 203 737 3591
| | - Theresa A. Babuscio
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States
| | - Samuel A. Ball
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States,The APT Foundation, New Haven, CT 1 Long Wharf, New Haven, CT 06511,
United States
| | - Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States
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Pérez de los Cobos J, Trujols J, Siñol N, Vasconcelos e Rego L, Iraurgi I, Batlle F. Psychometric properties of the Spanish version of the Cocaine Selective Severity Assessment to evaluate cocaine withdrawal in treatment-seeking individuals. J Subst Abuse Treat 2014; 47:189-96. [PMID: 25012551 DOI: 10.1016/j.jsat.2014.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 05/20/2014] [Accepted: 05/26/2014] [Indexed: 11/18/2022]
Abstract
Reliable and valid assessment of cocaine withdrawal is relevant for treating cocaine-dependent patients. This study examined the psychometric properties of the Spanish version of the Cocaine Selective Severity Assessment (CSSA), an instrument that measures cocaine withdrawal. Participants were 170 cocaine-dependent inpatients receiving detoxification treatment. Principal component analysis revealed a 4-factor structure for CSSA that included the following components: 'Cocaine Craving and Psychological Distress', 'Lethargy', 'Carbohydrate Craving and Irritability', and 'Somatic Depressive Symptoms'. These 4 components accounted for 56.0% of total variance. Internal reliability for these components ranged from unacceptable to good (Chronbach's alpha: 0.87, 0.65, 0.55, and 0.22, respectively). All components except Somatic Depressive Symptoms presented concurrent validity with cocaine use. In summary, while some properties of the Spanish version of the CSSA are satisfactory, such as interpretability of factor structure and test-retest reliability, other properties, such as internal reliability and concurrent validity of some factors, are inadequate.
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Affiliation(s)
- José Pérez de los Cobos
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Autonomous University of Barcelona School of Medicine, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain.
| | - Joan Trujols
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Autonomous University of Barcelona School of Medicine, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Núria Siñol
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Autonomous University of Barcelona School of Medicine, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Lisiane Vasconcelos e Rego
- Fundación Hospital Sant Pere Claver, Vila i Vilà 16, 08004 Barcelona, Spain; Autonomous University of Barcelona School of Medicine, Campus de Bellaterra, 08193 Cerdanyola del Vallès, Spain
| | - Ioseba Iraurgi
- DeustoPsych - Psychology and Health Research, Development and Innovation Unit, University of Deusto, Avenida de las Universidades 24, 48007 Bilbao, Spain
| | - Francesca Batlle
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Autonomous University of Barcelona School of Medicine, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
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15
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Elman I, Borsook D, Volkow ND. Pain and suicidality: insights from reward and addiction neuroscience. Prog Neurobiol 2013; 109:1-27. [PMID: 23827972 PMCID: PMC4827340 DOI: 10.1016/j.pneurobio.2013.06.003] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/03/2013] [Accepted: 06/18/2013] [Indexed: 01/09/2023]
Abstract
Suicidality is exceedingly prevalent in pain patients. Although the pathophysiology of this link remains unclear, it may be potentially related to the partial congruence of physical and emotional pain systems. The latter system's role in suicide is also conspicuous during setbacks and losses sustained in the context of social attachments. Here we propose a model based on the neural pathways mediating reward and anti-reward (i.e., allostatic adjustment to recurrent activation of the reward circuitry); both are relevant etiologic factors in pain, suicide and social attachments. A comprehensive literature search on neurobiology of pain and suicidality was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) physical and emotional pain, (2) emotional pain and social attachments, (3) pain- and suicide-related alterations of the reward and anti-reward circuits as compared to addiction, which is the premier probe for dysfunction of these circuits and (4) mechanistically informed treatments of co-occurring pain and suicidality. Pain-, stress- and analgesic drugs-induced opponent and proponent states of the mesolimbic dopaminergic pathways may render reward and anti-reward systems vulnerable to sensitization, cross-sensitization and aberrant learning of contents and contexts associated with suicidal acts and behaviors. These findings suggest that pain patients exhibit alterations in the brain circuits mediating reward (depressed function) and anti-reward (sensitized function) that may affect their proclivity for suicide and support pain and suicidality classification among other "reward deficiency syndromes" and a new proposal for "enhanced anti-reward syndromes". We suggest that interventions aimed at restoring the balance between the reward and anti-reward networks in patients with chronic pain may help decreasing their suicide risk.
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Affiliation(s)
- Igor Elman
- Providence VA Medical Center and Cambridge Health Alliance, Harvard Medical School, 26 Central Street, Somerville, MA 02143, USA.
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16
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Langleben DD, Busch EL, O'Brien CP, Elman I. Depot naltrexone decreases rewarding properties of sugar in patients with opioid dependence. Psychopharmacology (Berl) 2012; 220:559-64. [PMID: 21960180 PMCID: PMC3302938 DOI: 10.1007/s00213-011-2503-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 09/12/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Opioid neurotransmission mediates hedonic value of sweet tastants; their intake may be exaggerated by the consumption of exogenous opioids (e.g., opioid dependence). Sweet Taste Test (STT) is a validated quantitative instrument assessing taste perception and hedonic features of sugar (sucrose) using a randomized and double-blind administration at five different sucrose concentrations ranging from 0.05 to 0.83 M. METHODS The STT and cue-induced craving procedure were administered to opioid-dependent patients (n = 15) before and 1 week after the injection of a long-acting depot naltrexone (XRNT) preparation. RESULTS Analyses of covariance, employing sucrose concentration and its perceived taste as covariates, showed that XRNT therapy significantly reduced the self-reported hedonic and motivational characteristics of sucrose. Greater reductions in both these characteristics were associated with more diminution in the cue-induced opioid craving. CONCLUSIONS Opioid antagonism in opioid-dependent subjects leads to a smaller sweet taste reward, which, in turn, may be proportional to decreased opioid craving. These pilot results support the heuristic value of the STT as a potential marker of the XRNT treatment response and call for further inquiry into potential clinical applications of the test.
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Affiliation(s)
- Daniel D Langleben
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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17
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Pharmacotherapeutics directed at deficiencies associated with cocaine dependence: focus on dopamine, norepinephrine and glutamate. Pharmacol Ther 2012; 134:260-77. [PMID: 22327234 DOI: 10.1016/j.pharmthera.2012.01.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 01/19/2012] [Indexed: 11/20/2022]
Abstract
Much effort has been devoted to research focused on pharmacotherapies for cocaine dependence yet there are no FDA-approved medications for this brain disease. Preclinical models have been essential to defining the central and peripheral effects produced by cocaine. Recent evidence suggests that cocaine exerts its reinforcing effects by acting on multiple neurotransmitter systems within mesocorticolimibic circuitry. Imaging studies in cocaine-dependent individuals have identified deficiencies in dopaminergic signaling primarily localized to corticolimbic areas. In addition to dysregulated striatal dopamine, norepinephrine and glutamate are also altered in cocaine dependence. In this review, we present these brain abnormalities as therapeutic targets for the treatment of cocaine dependence. We then survey promising medications that exert their therapeutic effects by presumably ameliorating these brain deficiencies. Correcting neurochemical deficits in cocaine-dependent individuals improves memory and impulse control, and reduces drug craving that may decrease cocaine use. We hypothesize that using medications aimed at reversing known neurochemical imbalances is likely to be more productive than current approaches. This view is also consistent with treatment paradigms used in neuropsychiatry and general medicine.
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18
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Sordo L, Chahua M, Bravo M, Barrio G, Brugal M, Domingo-Salvany A, Molist G, De la Fuente L. Depression among regular heroin users: the influence of gender. Addict Behav 2012; 37:148-52. [PMID: 21968230 DOI: 10.1016/j.addbeh.2011.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/02/2011] [Indexed: 10/17/2022]
Abstract
The aim of this study was to determine the prevalence of recent (last 12 months) depression in regular young heroin users and to ascertain factors associated with depression in this population, broken down by gender. A sample of 561 participants completed a cross-sectional survey. Eligibility criteria were: age 30 years or younger, and having used heroin for at least 12 days in the last 12 months and at least one day in the last 3 months. Participants were recruited outside of health-care facilities in the cities of Barcelona, Madrid and Seville by targeted sampling and chain referral methods. Depression was assessed using the World Mental Health Composite International Diagnostic Interview. The prevalence of recent depression was 22.3% (35.2% among women and 17.3% among men, p<0.001). In the multivariate analysis, the factors positively associated with recent depression in the whole sample were female gender, age 25 or less, inability to work due to health problems and high risk consumption of alcohol. Among woman, the related variables were age 25 or less, cocaine dependence in the last 12 months, and alcohol consumption in that period. Among men, employment status was the only related variable. Analysis of an overall sample without the gender breakdown may hide important differences in the factors associated with depression in men and women. Both prevention and treatment of depression should rely on specific gender analysis.
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19
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Hanlon CA, Dufault DL, Wesley MJ, Porrino LJ. Elevated gray and white matter densities in cocaine abstainers compared to current users. Psychopharmacology (Berl) 2011; 218:681-92. [PMID: 21691942 PMCID: PMC3197798 DOI: 10.1007/s00213-011-2360-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
RATIONALE Numerous neuroimaging studies have demonstrated lower neural tissue density in chronic cocaine users, which may be linked to cognitive dysfunction. OBJECTIVES The goal of this study was to determine whether neural tissue density was also impaired in individuals abstinent from cocaine and whether any observed changes were associated with cognitive performance. METHODS A total of 73 participants were included: 24 active cocaine users, 24 abstainers (abstinent for at least 1 month), and 25 nondrug-abusing controls rigorously matched for age, gender, and IQ. All participants performed a cognitive assessment battery and received an MRI which was analyzed using voxel-based morphometry. RESULTS The abstainers had significantly higher gray matter density than the current cocaine users in neocortical areas including the frontal and temporal cortex. In contrast to the users, there was no difference in white matter density in the abstainers relative to the controls. The abstainers performed better than current users on several behavioral tasks. Within users and abstainers, cortical density was correlated with performance on memory and reaction time tasks. Subcortical gray matter density was lower in both the users and abstainers relative to the controls. Within abstainers, subcortical tissue density was correlated with the ability to set-shift. CONCLUSIONS These data suggest that individuals able to remain abstinent from cocaine for at least 1 month have elevated neocortical tissue density and perform better on multiple cognitive tests, relative to current cocaine users. Larger, longitudinal studies are needed to address this interaction between abstinence, cognition, and cortical tissue density directly.
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Affiliation(s)
- Colleen A. Hanlon
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1083 USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Darin L. Dufault
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1083 USA
| | - Michael J. Wesley
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1083 USA
| | - Linda J. Porrino
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1083 USA,
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20
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Johnson JE, O'Leary CC, Striley CW, Abdallah AB, Bradford S, Cottler LB. Effects of major depression on crack use and arrests among women in drug court. Addiction 2011; 106:1279-86. [PMID: 21306595 PMCID: PMC3711247 DOI: 10.1111/j.1360-0443.2011.03389.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS We examined whether a current major depressive episode (MDE) at baseline predicted crack use and arrests at follow-up among women enrolled in drug court. DESIGN Primary analyses used zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) regression analyses to predict both yes/no and number of (i) days of crack use and (ii) arrests at 4-month follow-up from current (30-day) MDE at baseline. Secondary analyses addressed risk conferred by current versus past MDE at baseline. SETTING/PARTICIPANTS Participants were 261 women in drug court. MEASUREMENTS MDE was assessed using the Diagnostic Interview Schedule. Days using crack and number of arrests were assessed using the Washington University Risk Behavior Assessment for Women. FINDINGS Having a current MDE at baseline predicted likelihood of crack use at follow-up, but not days of crack use among those who used. Current MDE at baseline did not predict presence or number of arrests at the 4-month follow-up. Women with current MDE at baseline were more likely to be using crack at follow-up than were those with recent (31+ days to 12 months) but not current MDE (odds ratio = 5.71); past MDE at baseline did not increase risk of crack use. CONCLUSIONS Predictors of any versus no crack use or arrests appear to differ from predictors of frequency of these behaviors. Current major depression, but not past major depression, appears to be associated with increased risk of crack use among women attending drug court.
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21
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Tschibelu E, Elman I. Gender differences in psychosocial stress and in its relationship to gambling urges in individuals with pathological gambling. J Addict Dis 2011; 30:81-7. [PMID: 21218314 DOI: 10.1080/10550887.2010.531671] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gender differences in the impact of psychosocial stress and in negative affective states were assessed in a group of pathological gamblers matched by demographic characteristics and by severity of gambling. Women displayed higher impact scores on the Daily Stress Inventory. Other stress measures, obtained with the Profile of Mood States (POMS), were also significantly elevated in the women group. Furthermore, women's gambling urges correlated with both stress and the POMS measure, whereas men's gambling urges correlated with the stress ratings only. These data suggest distinctive determinants of gambling urges in women with pathological gambling vis-a-vis those of men.
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Affiliation(s)
- Evelyne Tschibelu
- Clinical Psychopathology Laboratory, McLean Hospital and Harvard Medical School, Belmont, MA 02478-9106, USA
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22
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Stulz N, Thase ME, Gallop R, Crits-Christoph P. Psychosocial treatments for cocaine dependence: the role of depressive symptoms. Drug Alcohol Depend 2011; 114:41-8. [PMID: 20970927 PMCID: PMC3037421 DOI: 10.1016/j.drugalcdep.2010.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 06/10/2010] [Accepted: 06/18/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The association between cocaine use and depression has been frequently observed. However, less is known about the significance of depression in the treatment of cocaine use disorders. This study examined possible interrelations between drug use and depression severity among cocaine-dependent patients in psychosocial treatments for cocaine dependence. METHODS Monthly assessed drug use and depression severity scores of N = 487 patients during 6-month psychosocial treatments for cocaine dependence were analyzed using hybrid latent growth models. RESULTS Results indicated a moderate but statistically significant (z = 3.13, p < .01) influence of depression severity on increased drug use in the upcoming month, whereas drug use did not affect future depression severity. CONCLUSIONS Findings suggest that depression symptoms are an important predictor of drug use outcomes during psychosocial treatments for cocaine dependence and, hence, underline the importance of adequately addressing depression symptoms to improve treatment outcomes.
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Affiliation(s)
- Niklaus Stulz
- Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Michael E. Thase
- Mood and Anxiety Disorders Treatment and Research Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Robert Gallop
- Applied Statistics Program, Department of Mathematics, West Chester University, 25 University Avenue, West Chester, PA 19383, USA
| | - Paul Crits-Christoph
- Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
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23
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Elman I, Tschibelu E, Borsook D. Psychosocial stress and its relationship to gambling urges in individuals with pathological gambling. Am J Addict 2010; 19:332-9. [PMID: 20653640 DOI: 10.1111/j.1521-0391.2010.00055.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We sought to explore a potential link between psychosocial stress exposure and pathological gambling (PG). Patients with PG displayed significantly higher scores on the daily stress inventory (DSI) than did healthy subjects. PG patients also displayed other heightened measures of stress, including the profile of mood states, the Spielberger state-trait anxiety inventory, the Hamilton rating scale for depression and the Beck depression inventory. Multiple regression analysis revealed that only the DSI impact score was an independent predictor of gambling urges. These findings support the role of psychosocial stress in the course of PG and suggest that the former association with the urge to gamble is relatively specific to stressful events assessed with the DSI.
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Affiliation(s)
- Igor Elman
- Clinical Psychopathology Laboratory, McLean Hospital and Harvard Medical School, Belmont, Massachusetts 02478-9106, USA.
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24
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Nakama H, Chang L, Cloak C, Jiang C, Alicata D, Haning W. Association between psychiatric symptoms and craving in methamphetamine users. Am J Addict 2009; 17:441-6. [PMID: 18770088 DOI: 10.1080/10550490802268462] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study examined the differences in psychiatric symptoms between adult methamphetamine users (n = 46) and control subjects (n = 31), the relationship between psychiatric symptoms and the intensity of methamphetamine craving, and whether psychiatric symptoms were correlated to methamphetamine drug-usage variables (ie, length of abstinence, frequency, duration, and lifetime grams). We found that depressive symptoms on the Center for Epidemiology Studies-Depression (CES-D) and many other psychiatric symptoms on the Symptom Checklist-90 (SCL-90) significantly correlated with craving methamphetamine on the visual analog scale (VAS) for craving. Methamphetamine users had significantly more depressive symptoms (on CES-D) and psychotic symptoms (on SCL-90) compared to controls. There were no significant correlations between psychiatric symptoms and methamphetamine-usage variables. This study provides the first evidence to suggest that depressive symptoms (on CES-D) and psychiatric symptoms (on SCL-90) are strongly associated with the intensity of craving (on VAS) for the drug in methamphetamine users. However, the methamphetamine usage variables had no relationship with psychiatric symptoms. Therefore, methamphetamine users, regardless of their usage patterns, may benefit from treatment of their psychiatric symptoms in order to minimize craving and subsequent relapse to drug use.
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Affiliation(s)
- Helenna Nakama
- Department of Psychiatry, John A. Burns School of Medicine, The Queen's Medical Center, University of Hawaii at Manoa, Honolulu, Hawaii 96813, USA.
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Conner KR, Pinquart M, Holbrook AP. Meta-analysis of depression and substance use and impairment among cocaine users. Drug Alcohol Depend 2008; 98:13-23. [PMID: 18585871 PMCID: PMC2570759 DOI: 10.1016/j.drugalcdep.2008.05.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/29/2008] [Accepted: 05/03/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND The study evaluated, among cocaine users, the hypothesized positive association of depression and concurrent cocaine use and impairment, alcohol use and impairment, and general drug use and impairment. The hypothesis that gender would moderate these associations, with women showing a stronger correlation between depression and measures of substance use and impairment, was also tested. Also examined was the association of depression with future cocaine use and impairment and substance use treatment participation. METHODS Empirical reports on adult cocaine users published in English in peer-reviewed journals since 1986 that contained data on depression and substance use outcome(s) were obtained using a systematic search. Studies that placed restrictions on range of depression scores to select the sample, experiments that administered cocaine to subjects, and trials of antidepressant medications were excluded. The search yielded 60 studies for the analysis including 53 reports that collected data from clinical venues and seven that were community-based. RESULTS As hypothesized, the analyses showed that depression is associated with concurrent cocaine-, alcohol-, and general drug use and impairment. Effect sizes were small. Hypothesized moderating effects of gender were not supported. Depression was not associated, at a statistically significant level, with treatment participation or future cocaine use and impairment. CONCLUSIONS Depression is consistently but modestly associated with measures of cocaine-, alcohol-, and general drug use and impairment among cocaine users. Associations of depression with treatment participation and with future cocaine use and impairment are not immediately evident, although limitations of data warrant cautious interpretation.
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Affiliation(s)
- Kenneth R. Conner
- University of Rochester Medical Center, Department of Psychiatry, 300 Crittenden Boulevard, Rochester, NY 14642 and Center of Excellence, Veterans Administration, 400 Fort Hill Avenue, Canandaigua, NY 14424
| | | | - Amanda P. Holbrook
- Rochester Institute of Technology, One Lomb Memorial Drive, Rochester, NY 14623
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Complexities of Cocaine Users Presenting to the Emergency Department with Chest Pain: Interactions Between Depression Symptoms, Alcohol Use, and Race. J Addict Med 2007; 1:213-21. [DOI: 10.1097/adm.0b013e31815b32df] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In animal models considerable evidence suggests that increased motivation to seek and ingest drugs of abuse are related to conditioned and sensitized activations of the mesolimbic dopamine (DA) system. Direct evidence for these phenomena in humans, though, is sparse. However, recent studies support the following. First, the acute administration of drugs of abuse across pharmacological classes increases extracellular DA levels within the human ventral striatum. Second, individual differences in the magnitude of this response correlate with rewarding effects of the drugs and the personality trait of novelty seeking. Third, transiently diminishing DA transmission in humans decreases drug craving, the propensity to preferentially respond to reward-paired stimuli, and the ability to sustain responding for future drug reward. Finally, very recent studies suggest that repeated exposure to stimulant drugs, either on the street or in the laboratory, can lead to conditioned and sensitized behavioral responses and DA release. In contrast to these findings, though, in individuals with a long history of substance abuse, drug-induced DA release is decreased. This diminished DA release could reflect two different phenomena. First, it is possible that drug withdrawal related decrements in DA cell function persist longer than previously suspected. Second, drug-paired stimuli may gain marked conditioned control over the release of DA and the expression of sensitization leading to reduced DA release when drug-related cues are absent. Based on these observations a two-factor hypothesis of the role of DA in drug abuse is proposed. In the presence of drug cues, conditioned and sensitized DA release would occur leading to focused drug-seeking behavior. In comparison, in the absence of drug-related stimuli DA function would be reduced, diminishing the ability of individuals to sustain goal-directed behavior and long-term objectives. This conditioned control of the expression of sensitized DA release could aggravate susceptibility to relapse, narrow the range of interests and perturb decision-making, accounting for a wide range of addiction related phenomena.
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Affiliation(s)
- Marco Leyton
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, CANADA H3A 1A1.
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28
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Yamamoto RT, Karlsgodt KH, Rott D, Lukas SE, Elman I. Effects of perceived cocaine availability on subjective and objective responses to the drug. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2007; 2:30. [PMID: 17931408 PMCID: PMC2173892 DOI: 10.1186/1747-597x-2-30] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 10/11/2007] [Indexed: 11/10/2022]
Abstract
RATIONALE Several lines of evidence suggest that cocaine expectancy and craving are two related phenomena. The present study assessed this potential link by contrasting reactions to varying degrees of the drug's perceived availability. METHOD Non-treatment seeking individuals with cocaine dependence were administered an intravenous bolus of cocaine (0.2 mg/kg) under 100% ('unblinded'; N = 33) and 33% ('blinded'; N = 12) probability conditions for the delivery of drug. Subjective ratings of craving, high, rush and low along with heart rate and blood pressure measurements were collected at baseline and every minute for 20 minutes following the infusions. RESULTS Compared to the 'blinded' subjects, their 'unblinded' counterparts had similar craving scores on a multidimensional assessment several hours before the infusion, but reported higher craving levels on a more proximal evaluation, immediately prior to the receipt of cocaine. Furthermore, the 'unblinded' subjects displayed a more rapid onset of high and rush cocaine responses along with significantly higher cocaine-induced heart rate elevations. CONCLUSION These results support the hypothesis that cocaine expectancy modulates subjective and objective responses to the drug. Provided the important public health policy implications of heavy cocaine use, health policy makers and clinicians alike may favor cocaine craving assessments performed in the settings with access to the drug rather than in more neutral environments as a more meaningful marker of disease staging and assignment to the proper level of care.
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Affiliation(s)
- Rinah T Yamamoto
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill St,, Belmont, MA, USA.
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29
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Zilberman ML, Tavares H, Hodgins DC, el-Guebaly N. The impact of gender, depression, and personality on craving. J Addict Dis 2007; 26:79-84. [PMID: 17439871 DOI: 10.1300/j069v26n01_10] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Craving plays an important role in the addictive behavior process. The impact of gender, emotional state and personality on craving, however, has been understudied. Ninety-six women and 86 men seeking treatment for substance dependence were investigated regarding the association between personality factors (assessed by the Temperament and Character Inventory), depressive/anxiety symptomatology (assessed by the Beck Depression Inventory and the Beck Anxiety Inventory), and craving intensity (rated in the 7-day and the 24-hour periods prior to assessment). Recency of substance use and impulsivity were significantly associated with craving intensity for both women and men. Regression analyses revealed that depression best predicted craving for women, but not for men. These results suggest that while recent substance use and impulsivity can be important predictors of craving across gender, depression plays a critical role in craving among women. This finding underscores the need for vigorous assessment and treatment of comorbid symptomatology in women entering addiction treatment.
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Affiliation(s)
- Monica L Zilberman
- Department of Psychiatry, University of São Paulo, SP, 05435-030, Brazil.
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30
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Sussner BD, Smelson DA, Rodrigues S, Kline A, Losonczy M, Ziedonis D. The validity and reliability of a brief measure of cocaine craving. Drug Alcohol Depend 2006; 83:233-7. [PMID: 16384655 DOI: 10.1016/j.drugalcdep.2005.11.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 11/14/2005] [Accepted: 11/16/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Although craving plays an important role in relapse, there are few brief, valid and reliable instruments to measure the desire to use cocaine in routine clinical practice. The 45-item Cocaine Craving Questionnaire-Now (CCQ-Now) is widely used in research, but its length makes its use in everyday clinical work relatively impractical. This study sought to determine the psychometric properties of the CCQ-Brief, a measure composed of 10 items from the CCQ-Now, in treatment-seeking cocaine abusers. METHOD Subjects with cocaine abuse or dependence (n=247) completed the CCQ-Brief, the CCQ-Now, the Voris Cocaine Craving Scale, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Addiction Severity Index. RESULTS The CCQ-Brief was significantly correlated with the CCQ-Now (r=.85, p<.01), the CCQ-Now with the items in common with the CCQ-Brief removed (r=.78, p<.01), all four subscales of the VCCS (craving intensity: r=.47, p<.01; mood: r=.27, p<.01; energy: r=.30, p<.01; sick feelings: r=.28, p<.01), the BDI-II (r=.39, p<.01), the BAI (r=.35, p<.01) and recent drug use (r=.26, p<.01). The internal consistency of the CCQ-Brief was strong (alpha=.90). DISCUSSION The CCQ-Brief is a valid and reliable instrument that can be easily administered as a measure of current cocaine craving.
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Affiliation(s)
- Bradley D Sussner
- Mental Health and Behavioral Sciences, Department of Veterans Affairs-New Jersey Health Care System, Lyons Campus Bldg. 143, 1521 Knollcroft Road, Lyons, NJ 07930-5000, USA.
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Mol AJJ, Gorgels WJMJ, Oude Voshaar RC, Breteler MHM, van Balkom AJLM, van de Lisdonk EH, Kan CC, Zitman FG. Associations of benzodiazepine craving with other clinical variables in a population of general practice patients. Compr Psychiatry 2005; 46:353-60. [PMID: 16122535 DOI: 10.1016/j.comppsych.2005.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2003] [Accepted: 01/24/2005] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to (1) describe the characteristics of patients reporting craving for benzodiazepines (BZs) and (2) to search for associations between BZ craving and other clinical variables in a population of general practice (GP) patients who have made an attempt to discontinue their long-term BZ use. METHODS The Benzodiazepine Craving Questionnaire (BCQ) and other self-report questionnaires were administered once to a population of 113 long-term and 80 former long-term GP BZ users participating in a large BZ reduction trial in GP. Cross-sectional data were gathered on self-reported BZ craving (BCQ), self-reported BZ dependence severity (Bendep-SRQ), psychopathology (General Health Questionnaire 12-item version), mood state (Profile of Mood States), personality (Dutch shortened MMPI), and lifestyle characteristics. Differences between patients who reported craving and patients who did not were analyzed univariately. Multivariate analyses were performed on variables significantly associated with craving, controlling for current use status. RESULTS (1) Patients reporting craving differed significantly from patients not reporting craving on aspects of BZ dependence severity, psychopathology, negative mood state, and personality. (2) Negative mood and somatization were positively associated with BZ craving, although only the contribution of negative mood to craving was statistically significant for the total group of (former) BZ users (P = .002). CONCLUSIONS Self-reported negative mood and somatization are positively associated with BZ craving. In future BZ craving research, personality factors should be further explored.
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Affiliation(s)
- Audrey J J Mol
- Department of Psychiatry, University Medical Centre St. Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Newton TF, Kalechstein AD, De La Garza R, Cutting DJ, Ling W. Apathy predicts hedonic but not craving response to cocaine. Pharmacol Biochem Behav 2005; 82:236-40. [PMID: 16181666 DOI: 10.1016/j.pbb.2005.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 08/19/2005] [Accepted: 08/24/2005] [Indexed: 10/25/2022]
Abstract
Cocaine-induced craving has been implicated in the maintenance of ongoing cocaine use and is presumed to be mediated by enhanced synaptic availability of monoamines, including dopamine. Apathy is a neuropsychiatric syndrome that is associated with hypodopaminergic functioning and is neurobiologically distinct from depression. Apathy has been observed to be prevalent during the initial phases of abstinence in cocaine-dependent individuals. In the current report, we sought to investigate the relationship between apathy, depression, and craving in response to an acute intravenous administration of cocaine. To this end, sixteen non-treatment seeking volunteers were evaluated. Following acute administration of cocaine (40 mg, IV), patients with low apathy scores exhibited increased craving, whereas patients with high apathy scores exhibited decreased craving. In addition, patients with high apathy scores exhibited increased ratings of the subjective measure of "High", suggesting that high apathy predicts a greater hedonic response in dependence. Self-reported ratings of depression did not account for the observed differences. The data reveal that cocaine-induced craving is not ubiquitous, and may not play a critical role in the maintenance of cocaine dependence. Overall, the findings suggest that apathy predicts hedonic but not craving response to cocaine.
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Affiliation(s)
- Thomas F Newton
- David Geffen School of Medicine at the University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90024, USA
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Janiri L, Martinotti G, Dario T, Reina D, Paparello F, Pozzi G, Addolorato G, Di Giannantonio M, De Risio S. Anhedonia and substance-related symptoms in detoxified substance-dependent subjects: a correlation study. Neuropsychobiology 2005; 52:37-44. [PMID: 15942262 DOI: 10.1159/000086176] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Anhedonia is a condition in which the capacity of experiencing pleasure is totally or partially lost, frequently occurring in mood disorders, as a negative symptom in schizophrenia, and in substance use disorders. In order to test a set of instruments for anhedonia in a population of detoxified opiate, alcohol and multiple substance-dependent subjects, 70 individuals were recruited from three different clinical settings. The following scales were applied: Snaith-Hamilton Pleasure Scale (SHAPS), Bech-Rafaelsen Melancholia Scale (BRMS), Scale for the Assessment of Negative Symptoms (SANS), specific withdrawal scales, and visual analogue scales (VAS) for hedonic capability and substance craving. The scales measuring anhedonia either directly (SHAPS, VAS for hedonic capability) or in some key items (SANS, BRMS) were significantly correlated with each other. The period of time since detoxification was inversely correlated with anhedonia and withdrawal symptomatology. Craving was positively correlated with anhedonia. Out of the total sample, only 18.5% could be defined as psychometrically anhedonic. The same correlations were found in this subsample. The composite instrument employed for assessing anhedonia and hedonic capability was found to be sensitive enough to detect such a dimension in the population considered, with the single scales significantly interrelated. In conclusion, we found interrelations between hedonic capability, craving and protracted withdrawal, particularly in opiate-dependent subjects. The strongest association occurred between hedonic capability and craving.
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Affiliation(s)
- L Janiri
- Institute of Psychiatry and Psychology, Treatment Unit for Alcoholism and Multiple Drug Abuse, Catholic University, Rome, Italy.
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Rounsaville BJ. Treatment of cocaine dependence and depression. Biol Psychiatry 2004; 56:803-9. [PMID: 15556126 DOI: 10.1016/j.biopsych.2004.05.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Revised: 05/04/2004] [Accepted: 05/12/2004] [Indexed: 11/29/2022]
Abstract
In common with all other classes of substance use disorders, cocaine dependence has been shown to be strongly associated with depression by community and clinical surveys. Diagnosing depression in cocaine abusers can be challenging because it is difficult to distinguish transient symptoms caused by cocaine from enduring depression syndromes. Nonetheless, both "substance-induced" and "independent" depression syndromes require clinical attention, especially when symptoms have been persistent and severe before entering treatment. Use of antidepressant medications for combined cocaine dependence and depression is supported by a preponderance of evidence from 4 randomized clinical trials (RCTs) that prospectively targeted both depression and cocaine dependence and 7 RCTs in which a post hoc analyses demonstrated efficacy in the subgroup of cocaine abusers with comorbid depression. Notably, most negative studies have evaluated SSRIs while positive studies have used agents such as desipramine or buproprion. A substantial clinical trials literature supports the efficacy of behavioral treatments for general populations of cocaine abusers and of patients with depression but few studies have addressed patients with both disorders. Treatment development and research are needed on models of care that truly integrate strategies for addressing both cocaine use and depression. Recent advances have paved the way for a new generation of research. These include validation of efficacious cocaine treatments, improved diagnostic methods, organization of the Clinical Trials Network and development of guidelines for managing methodological challenges posed by high rates of current medication use and polysubstance abuse in treatment entering cocaine abusers.
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Affiliation(s)
- Bruce J Rounsaville
- Department of Psychiatry, Yale University School of Medicine, New Haven, and Veterans Affairs Connecticut Healthcare, West Haven, Connecticut 06516, USA.
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Karlsgodt KH, Lukas SE, Elman I. Psychosocial Stress and the Duration of Cocaine Use in Non‐treatment Seeking Individuals with Cocaine Dependence. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2003; 29:539-51. [PMID: 14510039 DOI: 10.1081/ada-120023457] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this study was to explore a potential link between psychosocial stress and cocaine dependence among 36 non-treatment-seeking individuals enrolled in a brain imaging protocol. Stress was assessed using computerized multidimensional instruments, including the Profile of Mood States (POMS) and Speilberger State-Trait Anxiety Inventory (STAI). Additional clinical assessments employed were the Addiction Severity Index and the Hamilton Rating Scale for Depression (HRSD). Based on the median POMS' tension-anxiety scale score the entire sample was divided into two groups, those with high and low levels of stress. The two groups (n = 16 and 20) were similar in terms of age, gender distribution, and severity of addiction. Compared with the low stress group, high-stress individuals displayed significantly longer duration of cocaine use, greater POMS, STAI-state, STAI-Trait, and HRSD scores. Our results replicate those of prior reports implicating stress in the course of cocaine dependence and extend these prior findings by 1) including a new subject population of non-treatment-seekers and 2) by suggesting that the stress-cocaine link may be generalizable to psychosocial stress and negative affective states defined by POMS, STAI, and HRSD scores.
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Affiliation(s)
- Katherine H Karlsgodt
- Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts 02114, USA
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