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Dermody SS, Uhrig A, Wardell JD, Tellez C, Raessi T, Kovacek K, Hart TA, Hendershot CS, Abramovich A. Daily and Momentary Associations Between Gender Minority Stress and Resilience With Alcohol Outcomes. Ann Behav Med 2024; 58:401-411. [PMID: 38582074 PMCID: PMC11112290 DOI: 10.1093/abm/kaae015] [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] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND AND PURPOSE Minority stressors have been linked with alcohol use among transgender and gender diverse (TGD); however, no ecological momentary assessment studies have examined daily links between minority stress and alcohol use specifically among TGD. This study examined gender minority stressors and resilience as predictors of same-day or momentary alcohol-related outcomes. Feasibility and acceptability of procedures were evaluated. METHODS Twenty-five TGD adults (mean age = 32.60, SD = 10.82; 88% White) were recruited Canada-wide and participated remotely. They completed 21 days of ecological momentary assessment with daily morning and random surveys (assessing alcohol outcomes, risk processes, gender minority stressors, resilience), and an exit interview eliciting feedback. RESULTS Gender minority stress had significant and positive within-person relationships with same-day alcohol use (incidence risk ratio (IRR) = 1.12, 95% confidence interval [CI] [1.02, 1.23]), alcohol-related harms (IRR = 1.14, 95% CI [1.02, 1.28]), and coping motives (IRR = 1.06, 95% CI [1.03, 1.08]), as well as momentary (past 30-min) alcohol craving (IRR = 1.32, 95% CI [1.18, 1.47]), coping motives (IRR = 1.35, 95% CI [1.21, 1.51]), and negative affect (IRR = 1.28, 95% CI [1.20, 1.36]). Gender minority stress indirectly predicted same-day drinking via coping motives (ab = 0.04, 95% CI [0.02, 0.08]). Resilience was positively associated with same-day alcohol use (IRR = 1.25, 95% CI [1.03, 1.51]) but not harms. CONCLUSIONS TGD adults may use alcohol to cope with gender minority stress, which can increase the risk for alcohol-related harms. Interventions are needed to eliminate gender minority stressors and support adaptive coping strategies.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Alexandra Uhrig
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Jeffrey D Wardell
- Department of Psychology, York University, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carmina Tellez
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Tara Raessi
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Karla Kovacek
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Christian S Hendershot
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Amin-Esmaeili M, Farokhnia M, Susukida R, Leggio L, Johnson RM, Crum RM, Mojtabai R. Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials. Addiction 2024; 119:833-843. [PMID: 38197836 PMCID: PMC11009085 DOI: 10.1111/add.16409] [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: 02/20/2023] [Accepted: 11/10/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND AND AIMS Total abstinence has historically been the goal of treatment for substance use disorders; however, there is a growing recognition of the health benefits associated with reduced use as a harm reduction measure in stimulant use disorders treatment. We aimed to assess the validity of reduced stimulant use as an outcome measure in randomized controlled trials (RCTs) of pharmacological interventions for stimulant use disorder. DESIGN We conducted a secondary analysis of a pooled dataset of 13 RCTs. SETTING AND PARTICIPANTS Participants were individuals seeking treatment for cocaine or methamphetamine use disorders (N = 2062) in a wide range of treatment facilities in the United States. MEASUREMENTS We validated reduced stimulant use against a set of clinical indicators drawn from harmonized measurements, including severity of problems caused by drug use, comorbid depression, global severity of substance use and improvement, severity of drug-seeking behavior, craving and high-risk behaviors, all assessed at the end of the trial, as well as follow-up urine toxicology. A series of mixed effect regression models was conducted to validate reduction in frequency of use against no reduction in use and abstinence. FINDINGS More participants reduced frequency of primary drug use than achieved abstinence (18.0% vs. 14.2%, respectively). Reduced use was significantly associated with decreases in craving for the primary drug [60.1%, 95% confidence interval (CI) = 54.3%-64.7%], drug seeking behaviors (41.0%, 95% CI = 36.6%-45.7%), depression severity (39.9%, 95% CI = 30.9%-48.3%), as well as multiple measures of global improvement in psychosocial functioning and severity of drug-related problems, albeit less strongly so than abstinence. Moreover, reduced use was associated with sustained clinical benefit at follow-up, as confirmed by negative urine tests (adjusted odds ratio compared with those with no reduction in use: 0.50, 95% CI = 0.35-0.71). CONCLUSION Reduced frequency of stimulant use appears to be associated with meaningful improvement in various clinical indicators of recovery. Assessment of reduced use, in addition to abstinence, could broaden the scope of outcomes measured in randomized controlled trials of stimulant use disorders and facilitate the development of more diverse treatment approaches.
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Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Farokhnia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, MD, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, MD, USA
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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McCann DJ, Chen HH, Devine EG, Gyaw S, Ramey T. Results of a randomized, double-blind, placebo-controlled trial of lorcaserin in cocaine use disorder. Drug Alcohol Depend 2024; 255:111063. [PMID: 38163425 PMCID: PMC10872513 DOI: 10.1016/j.drugalcdep.2023.111063] [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: 05/04/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Cocaine use disorder (CUD) is a major public health problem for which there is no approved pharmacotherapy. The primary purpose of this study was to evaluate the ability of lorcaserin, a 5-hydroxytryptamine2 C (5-HT2 C) receptor agonist, to facilitate abstinence in individuals seeking treatment for CUD. METHODS This was a 12-site, randomized, parallel arm study with a 13-week Treatment Phase that included a 1-week, single-blind run-in period when all participants received twice daily 15mg acetazolamide capsules (a medication adherence marker), followed by randomization to either twice daily 10mg lorcaserin or placebo capsules for the remaining 12 weeks. Pre-randomization data were utilized in an enrichment strategy aimed at achieving high levels of medication adherence and low placebo response rates in a subgroup of participants that qualified for the "efficacy population." For lorcaserin vs. placebo, the primary efficacy endpoint was the proportion of participants in the efficacy population achieving abstinence during the last three weeks of treatment, as evidenced by self-report of no cocaine use, confirmed by urine testing. RESULTS Within the efficacy population, 1.1% of 91 participants receiving lorcaserin and 4.3% of 92 receiving placebo achieved abstinence during the last 3 weeks of treatment. Among all randomized participants, 2.5% of 118 receiving lorcaserin and 5.6% of 124 receiving placebo achieved similar abstinence. Study participants receiving lorcaserin exhibited significantly greater reductions in body weight and BMI, indicating that medication adherence was sufficient to produce a pharmacological effect. CONCLUSIONS Twice daily 10mg lorcaserin failed to demonstrate efficacy in the treatment of CUD.
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Affiliation(s)
- David J McCann
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD, USA.
| | - Hegang H Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Eric G Devine
- Department of Psychiatry, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, MA, USA.
| | - Shwe Gyaw
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD, USA.
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD, USA.
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Parlier-Ahmad AB, Kelpin S, Martin CE, Svikis DS. Baseline Characteristics and Postdischarge Outcomes by Medication for Opioid Use Disorder Status Among Women with Polysubstance Use in Residential Treatment. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:617-626. [PMID: 38145229 PMCID: PMC10739697 DOI: 10.1089/whr.2023.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/26/2023]
Abstract
Background Within residential treatment, medication for opioid use disorder (MOUD) is rarely offered, so little is known about group differences by MOUD status. This study characterizes samples of women receiving and not receiving MOUD and explores postdischarge outcomes. Methods This is a secondary exploratory analysis of a residential clinical trial comparing women receiving treatment as usual (TAU) with those who also received computer-based training for cognitive behavioral therapy (CBT4CBT). Participants were N = 41 adult women with substance use disorder (SUD) who self-reported lifetime polysubstance use. Because 59.0% were prescribed MOUD (MOUD n = 24, no MOUD n = 17), baseline variables were compared by MOUD status; outcomes at 12 weeks postdischarge were compared by MOUD status and treatment condition using chi square and Mann-Whitney U tests. Results Participants were middle-aged (41.7 ± 11.6 years) and non-Latinx Black (80.4%). Most used substances in the No MOUD group were alcohol, cocaine, and cannabis, and in the MOUD group, most used substances were opioids, cannabis, and cocaine. Women in the MOUD group tended to have more severe SUD. Postdischarge substance use recurrence rates were twice as high in the MOUD group than in the No MOUD group. Among the women in the No MOUD group, those in the CBT4CBT condition increased the number of coping strategies twice as much as those receiving TAU. Conclusion Postdischarge substance use recurrence differed by MOUD status. CBT4CBT may be a helpful adjunct to personalized residential SUD treatment. The parent study is registered at [www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT03678051)].
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Affiliation(s)
- Anna Beth Parlier-Ahmad
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sydney Kelpin
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace S. Svikis
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Mocanu V, Bozinoff N, Wood E, Jutras-Aswad D, Le Foll B, Lim R, Cheol Choi J, Yin Mok W, Eugenia Socias M. Opioid agonist therapy switching among individuals with prescription-type opioid use disorder: Secondary analysis of a pragmatic randomized trial. Drug Alcohol Depend 2023; 248:109932. [PMID: 37224674 DOI: 10.1016/j.drugalcdep.2023.109932] [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: 01/04/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Engagement and retention in opioid agonist therapy (OAT) remains a challenge. This study evaluated the impact of initial randomized OAT allocation on subsequent switching among people with prescription-type opioid use disorder (POUD). METHODS Secondary analysis of a 24-week Canadian multicenter, pragmatic, randomized trial conducted between 2017 and 2020 comparing flexible take-home buprenorphine/naloxone versus supervised methadone models of care for POUD. We used Cox Proportional Hazards modeling to assess for impact of treatment assignment on time to OAT switching, adjusting for important confounders. For clinical correlates, we analyzed data from baseline questionnaires on demographic, substance use, and health factors as well as urine drug screen. RESULTS Of 272 randomized participants, 210 initiated OAT within 14 days per trial protocol, of whom 103 participants were randomized to buprenorphine/naloxone and 107 to methadone. Within 24-week follow-up, 41 (20.5%) of all participants switched OAT with 25 (24.3%, median 27 days, 88.4 per 100 person-years) and 16 participants (15.0%, median 53.5 days, 46.1 per 100 person-years) switching from buprenorphine/naloxone and methadone arms, respectively. In adjusted analysis, allocation to buprenorphine/naloxone was associated with significantly higher risk of switching (aHR = 2.31, 95% CI 1.22 - 4.38). CONCLUSIONS OAT switching was common in this sample of individuals with POUD, with individuals randomly allocated to buprenorphine/naloxone being more than twice as likely to switch versus methadone. This may reflect a stepped care approach in OUD management. More research is needed to evaluate overall retention and outcomes with the different observed risks of switching between methadone and buprenorphine/naloxone.
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Affiliation(s)
- Victor Mocanu
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Nikki Bozinoff
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, BC, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Bernard Le Foll
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Acute Care Program, CAMH, Toronto, ON, Canada
| | - Ron Lim
- Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jin Cheol Choi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Wing Yin Mok
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, BC, Canada.
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Obuobi-Donkor G, Shalaby R, Vuong W, Agyapong B, Hrabok M, Gusnowski A, Surood S, Greenshaw AJ, Agyapong VI. Effects of Text4Hope-Addiction Support Program on Cravings and Mental Health Symptoms: Results of a Longitudinal Cross-sectional Study. JMIR Form Res 2023; 7:e40440. [PMID: 36857114 PMCID: PMC10018381 DOI: 10.2196/40440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/23/2022] [Accepted: 11/11/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Drug misuse is complex, and various treatment modalities are emerging. Providing supportive text messages to individuals with substance use disorder offers the prospect of managing and improving symptoms of drug misuse and associated comorbidities. OBJECTIVE This study evaluated the impact of the daily supportive text message program (Text4Hope-Addiction Support) in mitigating cravings and mental health symptoms in subscribers and quantify user satisfaction with the Text4Hope-Addiction Support program. METHODS Subscribers to the Text4Hope-Addiction Support program received daily supportive text messages for 3 months; the messages were crafted based on addiction counseling and cognitive behavioral therapy principles. Participants completed an anonymous web-based questionnaire to assess cravings, anxiety, and depressive symptoms using the Brief Substance Craving Scale (BSCS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale at enrollment (baseline), after 6 weeks, and after 3 months. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope-Addiction program. RESULTS In total, 408 people subscribed to the program, and 110 of 408 (26.9%) subscribers completed the surveys at least at one time point. There were significant differences between the mean baseline and 3-month BSCS scores P=.01 (-2.17, 95% CI -0.62 to 3.72), PHQ-9 scores, P=.004 (-5.08, 95% CI -1.65 to -8.51), and GAD-7 scores, P=.02 (-3.02, 95% CI -0.48 to -5.56). Participants who received the supportive text messages reported a reduced desire to use drugs and a longer time interval between substance use, which are reflected in 41.1% and 32.5% decrease, respectively, from baseline score. Approximately 89% (23/26) of the participants agreed that Text4Hope-Addiction program helped them cope with addiction-related stress, and 81% (21/25) of the participants reported that the messages assisted them in dealing with anxiety. Overall, 69% (18/26) of the participants agreed that it helped them cope with depression related to addiction; 85% (22/26) of the participants felt connected to a support system; 77% (20/26) of the participants were hopeful of their ability to manage addiction issues; and 73% (19/26) of the participants felt that their overall mental well-being was improved. Most of the participants agreed that the interventions were always positive and affirmative (19/26, 73%), and succinct (17/26, 65%). Furthermore, 88% (21/24) of the participants always read the messages; 83% (20/24) of the participants took positive or beneficial actions after reading; and no participant took a negative action after reading the messages. In addition, most participants agreed to recommend other diverse technology-based services as an adjunctive treatment for their mental and physical health disorders. CONCLUSIONS Subscribers of Text4Hope-Addiction Support program experienced improved mental health and addiction symptoms. Addiction care practitioners and policy makers can implement supportive text-based strategies to complement conventional treatments for addiction, given that mobile devices are widely used.
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Affiliation(s)
- Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Marianne Hrabok
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Vincent Io Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Sirvent-Ruiz CM, Moral-Jiménez MDLV, Herrero J, Miranda-Rovés M, Rodríguez Díaz FJ. Concept of Affective Dependence and Validation of an Affective Dependence Scale. Psychol Res Behav Manag 2022; 15:3875-3888. [PMID: 36605173 PMCID: PMC9809362 DOI: 10.2147/prbm.s385807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Background There is a degree of affective interdependence that is considered normal and only becomes pathological if it causes excessive suffering, both for the subject and for those close to them. Our objective was to introduce and psychometrically validate a short and effective affective dependency scale, the Affective Dependence Scale (ADS-9). Methods We used a sample of 762 participants (clinical: emotional dependent subjects n = 212, comparison: non-emotionally-dependent addicted subjects n = 272, and general population n = 278) to assess the factor structure, the psychological construct validity and the measurement invariance for the ADS-9 by means of independent exploratory factor analyses for each sample group and subsequent multigroup confirmatory factor analyses. Results Our results confirm that ADS-9 is a psychometrically consistent instrument, with construct and clinical validity, as well as configural, metric and scalar invariance across different sample groups (clinical, comparison and general population). A hypothesized two-dimensional structure was confirmed by means of factor analyses. Both sub-scales of this abbreviated form, Submission and Craving, showed a good agreement with the previously validated Relationships and Sentimental Dependencies Inventory (IRIDS-100). Conclusion The ADS-9 is a brief instrument that appears to reliably detect the dependent and pathological components of affective dependence. It consists of two sub-scales, describing Submission (adaptation, accommodation, and subjugation) and Craving (imperative need for the other with the presence of disturbing states). We suggest that it is a versatile scale that may be useful for clinicians and researchers.
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Affiliation(s)
- Carlos Miguel Sirvent-Ruiz
- Research and Teaching Department, Fundación Instituto Spiral, Madrid, Spain,Correspondence: Carlos Miguel Sirvent-Ruiz, Fundación Instituto Spiral, c/ Marqués de Valdeiglesias, 2, Madrid, 28004, Spain, Tel +34 985 111 111; +34 915 000 050, Email
| | | | - Juan Herrero
- Department of Psychology, University of Oviedo, Oviedo, Spain
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Lassi DLS, Malbergier A, Negrão AB, Florio L, De Aquino JP, Castaldelli-Maia JM. Pharmacological Treatments for Cocaine Craving: What Is the Way Forward? A Systematic Review. Brain Sci 2022; 12:1546. [PMID: 36421870 PMCID: PMC9688748 DOI: 10.3390/brainsci12111546] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND cocaine craving is a core feature of cocaine use disorder and remains a critical challenge for abstinence and relapse prevention. This review summarizes the anti-craving efficacy of pharmacotherapies tested for cocaine use disorder, in the context of randomized-controlled clinical trials. OBJECTIVES we assessed the databases of the U.S. National Library of Medicine, Google Scholar, and PsycINFO, without date restrictions up to August 2022, to identify relevant studies. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS we included double-blinded randomized-controlled trials investigating pharmacotherapies for cocaine craving and/or cocaine use disorder whose outcomes included cocaine craving. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors screened studies' titles and abstracts for inclusion, and both read all the included studies. We systematically gathered information on the following aspects of each study: title; author(s); year of publication; sample size; mean age; sample characteristics; study set-ting; whether participants were treatment-seeking; study design; craving measures; study interventions; drop-out rates; and other relevant outcomes. RESULTS Overall, we appraised 130 clinical trials, including 8137 participants. We further considered the drugs from the studies that scored equal to or greater than six points in the quality assessment. There was a correlation between craving and cocaine use outcomes (self-reports, timeline follow-back or urinary benzoylecgonine) in the vast majority of studies. In the short-term treatment, acute phenylalanine-tyrosine depletion, clonidine, fenfluramine, meta-chlorophenylpiperazine (m-CPP) and mecamylamine presented promising effects. In the long term, amphetamine, biperiden, carbamazepine, lisdexamfetamine, lorcaserin, methamphetamine, mirtazapine, pioglitazone, progesterone, guanfacine, levodopa, nefazodone presented promising anti-craving effects. Unfortunately, the highly tested medications were not successful in most of the trials, as follows: propranolol in the short term; amantadine, aripiprazole, bromocriptine, citicoline, ketamine, modafinil, olanzapine, topiramate in the long term. The remaining 52 medications had no positive anti-craving outcomes. LIMITATIONS Our review was limited by high heterogeneity of craving assessments across the studies and by a great range of pharmacotherapies. Further, the majority of the studies considered abstinence and retention in treatment as the main outcomes, whereas craving was a secondary outcome and some of the studies evaluated patients with cocaine use disorder with comorbidities such as opioid or alcohol use disorder, schizophrenia, bipolar disorder or attention deficit hyperactivity. Lastly, most of the studies also included non-pharmacological treatments, such as counseling or psychotherapy. CONCLUSIONS There is a direct association between craving and cocaine use, underscoring craving as an important treatment target for promoting abstinence among persons with cocaine use disorder. Clonidine, fenfluramine and m-CPP showed to be promising medications for cocaine craving in the short-term treatment, and amphetamine, biperiden, carbamazepine, lisdexamfetamine, lorcaserin, methamphetamine, mirtazapine, pioglitazone, progesterone, guanfacine, levodopa, nefazodone in the long-term treatment.
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Affiliation(s)
- Dângela Layne Silva Lassi
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Department and Institute of Psychiatry, Medical School, São Paulo University, São Paulo 05403-010, SP, Brazil
| | - André Malbergier
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Department and Institute of Psychiatry, Medical School, São Paulo University, São Paulo 05403-010, SP, Brazil
| | - André Brooking Negrão
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Department and Institute of Psychiatry, Medical School, São Paulo University, São Paulo 05403-010, SP, Brazil
| | - Lígia Florio
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Department and Institute of Psychiatry, Medical School, São Paulo University, São Paulo 05403-010, SP, Brazil
| | - João P. De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - João Maurício Castaldelli-Maia
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Department and Institute of Psychiatry, Medical School, São Paulo University, São Paulo 05403-010, SP, Brazil
- Department of Neuroscience, Medical School, ABC Health University Center, Santo André 09060-870, SP, Brazil
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Petrie DJ, Knapp KS, Freet CS, Deneke E, Brick TR, Cleveland HH, Bunce SC. Prefrontal cortical response to natural rewards and self-reported anhedonia are associated with greater craving among recently withdrawn patients in residential treatment for opioid use disorder. Brain Res Bull 2022; 190:32-41. [PMID: 36122801 PMCID: PMC10161509 DOI: 10.1016/j.brainresbull.2022.09.012] [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: 03/15/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
Both anhedonia and craving are common among patients with opioid use disorder (OUD), and are associated with vulnerability to relapse. Although these constructs are theoretically linked relatively few studies have examined them together. In the current study, recently withdrawn patients (N = 71) in residential treatment for prescription OUD underwent a cue reactivity paradigm while being monitored with functional near-infrared spectroscopy (fNIRS). Patients also self-reported symptoms of anhedonia via the Snaith-Hamilton Pleasure Scale (SHAPS), while smartphone-based ecological momentary assessments (EMA) were used to measure craving levels. On average, lower right prefrontal cortex (PFC) activity in response to positive social stimuli was associated with higher craving (β = - 2.87; S.E. = 1.23; p = 0.02). Self-reported anhedonia moderated the association between PFC activity and craving (β = - 1.02; S.E. = 0.48; p = 0.04), such that patients with two or more anhedonic symptoms had a significant and stronger negative association between PFC activation to hedonically positive images and craving, compared to patients with fewer than two anhedonic symptoms, among whom the association was not significant. This finding provides evidence that higher levels of anhedonia among patients in residential treatment for OUD are associated with a stronger link between lower PFC response to positive social experiences and higher levels of craving, potentially increasing overall vulnerability to relapse.
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Affiliation(s)
- Daniel J Petrie
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - Kyler S Knapp
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States; Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States
| | - Christopher S Freet
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Erin Deneke
- Caron Treatment Centers, Wernersville, PA, United States
| | - Timothy R Brick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States; Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, United States
| | - H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - Scott C Bunce
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States.
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10
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Barré T, Ramier C, Mounir I, Renaud D, Menvielle L, Marcellin F, Carrieri P, Protopopescu C, Cherikh F. Examining the Relationships between Mindfulness and Tobacco Craving Factors. Subst Use Misuse 2021; 57:656-659. [PMID: 34958288 DOI: 10.1080/10826084.2021.2019782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Relationships between mindfulness and general craving have been documented. However, there is still no data regarding relationships between mindfulness and the different craving factors. METHODS Using data from an online survey among hospital workers smoking tobacco in France (n = 127), we performed linear regression models with the four craving factors as outcomes, and dispositional mindfulness as explanatory variable. RESULTS After adjusting for nicotine dependence, mindfulness was negatively associated with general craving and three out of four craving factors (emotionality, compulsivity and purposefulness, but not expectancy). CONCLUSIONS These results support the implementation of mindfulness-based interventions in the context of tobacco cessation attempt.
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Affiliation(s)
- Tangui Barré
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Clémence Ramier
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Izza Mounir
- Addictology Unit, University Hospital of Nice, Nice, France
| | - David Renaud
- Centre Mémoire de Ressources et de Recherche, Institut Claude Pompidou, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Fabienne Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Patrizia Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Camelia Protopopescu
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Faredj Cherikh
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
- Addictology Unit, University Hospital of Nice, Nice, France
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11
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Schmitz JM, Lane SD, Weaver MF, Narayana PA, Hasan KM, Russell DD, Suchting R, Green CE. Targeting white matter neuroprotection as a relapse prevention strategy for treatment of cocaine use disorder: Design of a mechanism-focused randomized clinical trial. Contemp Clin Trials 2021; 111:106603. [PMID: 34688917 DOI: 10.1016/j.cct.2021.106603] [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: 04/10/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
Cocaine use continues to be a significant public health problem with limited treatment options and no approved pharmacotherapies. Cognitive-behavioral therapy (CBT) remains the mainstay treatment for preventing relapse, however, people with chronic cocaine use display cognitive impairments that are associated with poor response to CBT. Emerging evidence in animal and human studies suggests that the peroxisome proliferator-activated receptor-gamma (PPAR- γ) agonist, pioglitazone, improves white matter integrity that is essential for cognitive function. This project will determine whether adjunctive use of pioglitazone enhances the effect of CBT in preventing relapse during the early phase of recovery from cocaine use disorder. This paper describes the design of a mechanism-focused phase 2 randomized clinical trial that aims first to evaluate the effects of pioglitazone on targeted mechanisms related to white matter integrity, cognitive function, and cocaine craving; and second, to evaluate the extent to which improvements on target mechanisms predict CBT response. Positive results will support pioglitazone as a potential cognitive enhancing agent to advance to later stage medication development research.
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Affiliation(s)
- Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA.
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Michael F Weaver
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Ponnada A Narayana
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Khader M Hasan
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | | | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA
| | - Charles E Green
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, USA; Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, USA
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12
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Brittain M, Consedine N, Bagot KL, Booth N, Rodda SN. Sugar Habit Hacker: Initial evidence that a planning intervention reduces sugar intake. J Behav Addict 2021; 10:471-481. [PMID: 34550904 PMCID: PMC8997217 DOI: 10.1556/2006.2021.00054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/26/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Sugar is a potentially addictive substance that is consumed in such high levels the World Health Organisation has set recommended consumption limits. To date there are no empirically tested brief interventions for reducing sugar consumption in adult populations. The current study aimed to preliminarily assess the feasibility of recruitment, retention, and intervention engagement and impact of a brief intervention. METHODS This pre-post study recruited 128 adults from New Zealand to complete a 30-day internet-delivered intervention with in-person and email coaching. The intervention components were derived from implementation intention principles whereby the gap between intention and behaviour was targeted. Participants selected sugar consumption goals aligned with WHO recommendations by gender. To meet these goals, participants developed action plans and coping plans and engaged in self-monitoring. Facilitation was provided by a coach to maintain retention and treatment adherence over the 30 days. RESULTS Intervention materials were rated as very useful and participants were mostly satisfied with the program. The total median amount of sugar consumed at baseline was 1,662.5 g (396 teaspoons per week) which was reduced to 362.5 g (86 teaspoons) at post-intervention evaluation (d = 0.83). The intervention was associated with large effects on reducing cravings (d = 0.59) and psychological distress (d = 0.68) and increasing situational self-efficacy (d = 0.92) and well-being (d = 0.68) with a reduction in BMI (d = 0.51). CONCLUSION This feasibility study indicates that a brief intervention delivering goal setting, implementation planning, and self-monitoring may assist people to reduce sugar intake to within WHO recommendations.
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Affiliation(s)
- Matthew Brittain
- Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Nathan Consedine
- Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Kathleen L. Bagot
- Department of Stroke, Public Health and Health Services Research, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Natalia Booth
- School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Simone N. Rodda
- School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand,Corresponding author. Email
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13
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Carpenter SM, Menictas M, Nahum-Shani I, Wetter DW, Murphy SA. Developments in Mobile Health Just-in-Time Adaptive Interventions for Addiction Science. CURRENT ADDICTION REPORTS 2020; 7:280-290. [PMID: 33747711 PMCID: PMC7968352 DOI: 10.1007/s40429-020-00322-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Addiction is a serious and prevalent problem across the globe. An important challenge facing intervention science is how to support addiction treatment and recovery while mitigating the associated cost and stigma. A promising solution is the use of mobile health (mHealth) just-in-time adaptive interventions (JITAIs), in which intervention options are delivered in situ via a mobile device when individuals are most in need. RECENT FINDINGS The present review describes the use of mHealth JITAIs to support addiction treatment and recovery, and provides guidance on when and how the micro-randomized trial (MRT) can be used to optimize a JITAI. We describe the design of five mHealth JITAIs in addiction and three MRT studies, and discuss challenges and future directions. SUMMARY This review aims to provide guidance for constructing effective JITAIs to support addiction treatment and recovery.
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Affiliation(s)
| | | | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - David W. Wetter
- Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT
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14
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Wattick RA, Hagedorn RL, Olfert MD. Enhancing College Student Recovery Outcomes Through Nutrition and Culinary Therapy: Mountaineers for Recovery and Resilience. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:326-329. [PMID: 31866257 DOI: 10.1016/j.jneb.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Rachel A Wattick
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, WV
| | - Rebecca L Hagedorn
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, WV
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, WV.
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15
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Vujanovic AA, Wardle MC, Bakhshaie J, Smith LJ, Green CE, Lane SD, Schmitz JM. Distress tolerance: Associations with trauma and substance cue reactivity in low-income, inner-city adults with substance use disorders and posttraumatic stress. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:264-276. [PMID: 29771557 DOI: 10.1037/adb0000362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cue reactivity has great potential to advance our understanding of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and PTSD/SUD comorbidity. The present investigation examined distress tolerance (DT) with regard to trauma and substance cue reactivity. Participants included 58 low-income, inner-city adults (49.1% women; Mage = 45.73, SD = 10.00) with substance dependence and at least 4 symptoms of PTSD. A script-driven cue reactivity paradigm was utilized. Four DT measures were administered, including the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath-Holding Task (BH), and Paced Auditory Serial Addition Task (PASAT). Lower DT, as indexed by MTPT duration, was significantly predictive of greater levels of self-reported substance cravings/urges in response to trauma cues, above and beyond covariates. Lower DTS scores predicted lower levels of self-reported control/safety ratings in response to substance cues. None of the DT indices was significantly predictive of heart rate variability. Clinical and research implications are discussed. (PsycINFO Database Record
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Affiliation(s)
| | - Margaret C Wardle
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | | | - Lia J Smith
- Department of Psychology, University of Houston
| | - Charles E Green
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Scott D Lane
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
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16
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Elkashef A, Brašić JR, Cantelina LR, Kahn R, Chiang N, Ye W, Zhou Y, Mojsiak J, Warren KR, Crabb A, Hilton J, Wong DF, Vocci F. A cholecystokinin B receptor antagonist and cocaine interaction, phase I study. CNS Neurosci Ther 2018; 25:136-146. [PMID: 29923314 DOI: 10.1111/cns.12994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022] Open
Abstract
AIMS RPR 102681, a cholecystokinin-B antagonist, increased dopamine (DA) release and reduced cocaine self-administration in animals. This pilot study sought to assess the safety and pharmacokinetics (PK) of co-administration of RPR 102681 and cocaine, and to confirm the DA release mechanism of RPR 102681. METHODS Sixteen cocaine-dependent participants were randomized to either placebo or RPR102681 at 3 ascending doses; cocaine was co-administered at steady state of RPR 102681. [11 C]raclopride positron emission tomography scans were conducted at baseline and at each RPR102681 dose. RESULTS RPR 102681 was well tolerated, and safe to co-administer with cocaine. RPR 102681 did not alter the PK of either cocaine or its metabolite benzoylecgonine and showed no intrinsic abuse liability. There was a trend toward reduction of cocaine craving scores. In contrast to animal studies, RPR 102681 significantly increased the binding potential of [11 C]raclopride in the ventral striatum (t test, P < .001) and caudate nucleus (t test, P < .0001) in a small subset of patients, suggesting that it may reduce intrasynaptic striatal DA. CONCLUSION Overall, this pilot study suggests that RPR 102681 would be unlikely candidate, as an agonist medication for the treatment for cocaine addiction but worth investigating further for possible role in reducing craving.
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Affiliation(s)
- Ahmed Elkashef
- Medications Development Division, The National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - James Robert Brašić
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Louis R Cantelina
- Division of Clinical Pharmacology and Medical Toxicology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Roberta Kahn
- Medications Development Division, The National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Nora Chiang
- Medications Development Division, The National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Weiguo Ye
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yun Zhou
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jurij Mojsiak
- Medications Development Division, The National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Kimberly R Warren
- Department of Psychology, Morgan State University, Baltimore, MD, USA
| | - Andrew Crabb
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - John Hilton
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dean F Wong
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.,Department of Neurology, Baltimore, MD, USA.,Soloman H Snyder Department of Neurosciences, Baltimore, MD, USA.,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank Vocci
- Medications Development Division, The National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.,Friends Research Institute, Baltimore, MD, USA
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17
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Tull MT, Berghoff CR, Wheeless LE, Cohen RT, Gratz KL. PTSD Symptom Severity and Emotion Regulation Strategy Use During Trauma Cue Exposure Among Patients With Substance Use Disorders: Associations With Negative Affect, Craving, and Cortisol Reactivity. Behav Ther 2018; 49:57-70. [PMID: 29405922 PMCID: PMC5805399 DOI: 10.1016/j.beth.2017.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) pathology with a substance use disorder (SUD) is associated with emotion regulation deficits. However, studies in this area generally rely on trait-based emotion regulation measures, and there is limited information on the relation of PTSD pathology to the use of specific emotion regulation strategies in response to trauma-related distress among SUD patients or the consequences of these strategies for trauma cue reactivity. This study examined the relation of PTSD symptom severity to the use of specific emotion regulation strategies during trauma cue exposure among trauma-exposed SUD patients, as well as the indirect relations of PTSD symptom severity to changes in negative affect, cravings, and cortisol levels pre- to posttrauma cue exposure through different emotion regulation strategies. Participants were 133 trauma-exposed SUD patients. Participants listened to a personalized trauma script and reported on emotion regulation strategies used during the script. Data on negative affect, cravings, and cortisol were collected pre- and postscript. PTSD symptom severity related positively to the use of more adaptive (e.g., distraction) and maladaptive (e.g., suppression) regulation strategies. Moreover, evidence for the indirect effects of PTSD symptom severity on negative affect and cortisol reactivity through both adaptive and maladaptive emotion regulation strategies was found. Implications of findings are discussed.
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Affiliation(s)
- Matthew T. Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA,Address correspondence to: Matthew T. Tull, Ph.D., Department of Psychology, Mail Stop 948, University of Toledo, 2801 West Bancroft Street, Toledo, Ohio 43606; Voice: 419-530-4392; Facsimile: 419-530-8479;
| | | | - Linnie E. Wheeless
- Department of Psychology, Jackson State University, Jackson, Mississippi, USA
| | - Rivka T. Cohen
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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18
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The role of anxiety sensitivity in reactivity to trauma cues in treatment-seeking adults with substance use disorders. Compr Psychiatry 2017; 78:107-114. [PMID: 28822277 PMCID: PMC5600861 DOI: 10.1016/j.comppsych.2017.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/05/2017] [Accepted: 07/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Exposure to traumatic events and posttraumatic stress disorder (PTSD) are common among individuals with substance use disorders (SUDs). Although the presence of trauma exposure and/or PTSD among those with SUDs is associated with a range of negative outcomes, much remains to be understood about the factors contributing to these outcomes. Anxiety sensitivity (the tendency to respond fearfully to the signs and symptoms of anxiety) has been linked to greater PTSD symptoms and the use of substances to cope with PTSD symptoms, and is a promising factor for understanding the negative outcomes associated with co-occurring PTSD and SUDs. METHODS This study examined the association between anxiety sensitivity and trauma cue reactivity among 194 trauma-exposed patients with SUDs (27.3% met criteria for current PTSD). Participants completed ratings of negative affect and substance cravings prior to and after exposure to a personally-relevant trauma cue. RESULTS Results indicated that anxiety sensitivity was associated with greater emotional reactivity (but not craving reactivity) to the trauma cue; neither PTSD symptom severity nor PTSD diagnosis moderated these associations. PTSD symptom severity was associated with greater emotional and craving reactivity to the trauma cue. CONCLUSIONS Results highlight the potential utility of targeting anxiety sensitivity in treatments for trauma-exposed patients with SUDs with and without PTSD.
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19
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Schmitz JM, Green CE, Hasan KM, Vincent J, Suchting R, Weaver MF, Moeller FG, Narayana PA, Cunningham KA, Dineley KT, Lane SD. PPAR-gamma agonist pioglitazone modifies craving intensity and brain white matter integrity in patients with primary cocaine use disorder: a double-blind randomized controlled pilot trial. Addiction 2017; 112:1861-1868. [PMID: 28498501 PMCID: PMC5593771 DOI: 10.1111/add.13868] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/14/2017] [Accepted: 05/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Pioglitazone (PIO), a potent agonist of PPAR-gamma, is a promising candidate treatment for cocaine use disorder (CUD). We tested the effects of PIO on targeted mechanisms relevant to CUD: cocaine craving and brain white matter (WM) integrity. Feasibility, medication compliance and tolerability were evaluated. DESIGN Two-arm double-blind randomized controlled proof-of-concept pilot trial of PIO or placebo (PLC). SETTING Single-site out-patient treatment research clinic in Houston, TX, USA. PARTICIPANTS Thirty treatment-seeking adults, 18 to 60 years old, with CUD. Eighteen participants (8 = PIO; 10 = PLC) completed diffusion tensor imaging (DTI) of WM integrity at pre-/post-treatment. INTERVENTION Study medication was dispensed at thrice weekly visits along with once-weekly cognitive behavioral therapy for 12 weeks. MEASUREMENTS Measures of target engagement mechanisms of interest included cocaine craving assessed by the Brief Substance Craving Scale (BSCS), the Obsessive Compulsive Drug Use Scale (OCDUS), a visual analog scale (VAS) and change in WM integrity. Feasibility measures included number completing treatment, medication compliance (riboflavin detection) and tolerability (side effects, serious adverse events). FINDINGS Target engagement change in mechanisms of interest, defined as a ≥ 0.75 Bayesian posterior probability of an interaction existing favoring PIO over PLC, was demonstrated on measures of craving (BSCS, VAS) and WM integrity indexed by fractional anisotropy (FA) values. Outcomes indicated greater decrease in craving and greater increase in FA values in the PIO group. Feasibility was demonstrated by high completion rates among those starting treatment (21/26 = 80%) and medication compliance (≥ 80%). There were no reported serious adverse events for PIO. CONCLUSIONS Compared with placebo, patients receiving pioglitazone show a higher likelihood of reduced cocaine craving and improved brain white matter integrity as a function of time in treatment. Pioglitazone shows good feasibility as a treatment for cocaine use disorder.
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Affiliation(s)
- Joy M. Schmitz
- McGovern Medical School, University of Texas Health Science Center at Houston
| | - Charles E. Green
- McGovern Medical School, University of Texas Health Science Center at Houston
- UT-Houston Center for Clinical Research & Evidence-Based Medicine
| | - Khader M. Hasan
- McGovern Medical School, University of Texas Health Science Center at Houston
| | - Jessica Vincent
- McGovern Medical School, University of Texas Health Science Center at Houston
| | - Robert Suchting
- McGovern Medical School, University of Texas Health Science Center at Houston
| | - Michael F. Weaver
- McGovern Medical School, University of Texas Health Science Center at Houston
| | | | - Ponnada A. Narayana
- McGovern Medical School, University of Texas Health Science Center at Houston
| | | | - Kelly T. Dineley
- Center for Addiction Research, University of Texas Medical Branch, Galveston
| | - Scott D. Lane
- McGovern Medical School, University of Texas Health Science Center at Houston
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20
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Magee JC, Winhusen T. The coupling of nicotine and stimulant craving during treatment for stimulant dependence. J Consult Clin Psychol 2016; 84:230-7. [PMID: 26460569 PMCID: PMC4760905 DOI: 10.1037/ccp0000054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Smoking prevalence is high among substance abusers, making it important to understand when nicotine abstinence will aid, impair, or not affect abstinence from other substances. This study tested novel hypotheses about the coupling of nicotine and stimulant craving over time during stimulant dependence treatment. METHOD Adults (N = 538) with cocaine and/or methamphetamine dependence completed a 10-week randomized controlled trial of substance use treatment with or without smoking cessation treatment. Participants reported nicotine and stimulant craving weekly and use twice per week. RESULTS Latent change score modeling tested the association between weekly increases in nicotine craving and subsequent weekly changes in stimulant craving. Interestingly, results revealed a "substitution" effect: increases in nicotine craving predicted subsequent decreases in stimulant craving, γ = -.37, p = .001. Additionally, increases in nicotine craving predicted subsequent increases in nicotine use, γ = 1.26, p = .04, and decreases in stimulant use, γ = -.07, p = .03. As expected, the substitution effect between nicotine and stimulant craving was stronger when stimulants were administered through the same route as nicotine (i.e., smoking), γ = -.56, p = .005, versus other routes, γ = -.32, p = .06. Finally, smoking cessation treatment eliminated the coupling between nicotine craving and stimulant craving, γ = -.07, p = .39. CONCLUSIONS Contrary to concerns about nicotine abstinence during substance dependence treatment, increases in nicotine craving may be associated with later reductions in stimulant craving and use, and unrelated when smoking cessation treatment is introduced. Weekly changes in nicotine craving convey information that can help clinicians to predict and understand shifts in stimulant craving and use during substance use disorder treatment.
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Affiliation(s)
- Joshua C. Magee
- University of Cincinnati College of Medicine, Department of Family and Community Medicine, 2220 Victory Parkway, ML 0566, Cincinnati, OH 45206, Ph: (513) 558-8598, Fax: 513-558-3266
| | - Theresa Winhusen
- University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience, Addiction Sciences Division, 3131 Harvey Avenue, Cincinnati, Ohio, 45229, Ph: (513) 585-8292, Fax: 513-585-8278
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Berlin I, Singleton EG, Heishman SJ. Cross validation of the prognostic and diagnostic utility of tobacco craving in a general and a pregnant sample of treatment-seeking smokers. Drug Alcohol Depend 2015; 154:174-83. [PMID: 26160457 DOI: 10.1016/j.drugalcdep.2015.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Valid and reliable brief measures of tobacco craving are necessary for research and clinical purposes. However, comparisons of the utility of single-item and brief multidimensional craving measures are scarce. METHODS We analyzed two tobacco craving measures, the French versions of the 12-item Tobacco Craving Questionnaire (FTCQ-12) and the single craving item on the Minnesota Nicotine Withdrawal Scale, in pregnant and non-pregnant (females and males) French smokers from two independent smoking cessation trials. Using data from pregnant smokers, we estimated first a prognostic model for each measure and compared their ability to predict relapse from one visit to the next. We next used cutoff values for both measures to determine how well craving distinguished current smokers from abstainers. For cross-validation, we tested how well the same cut-off values generalized to non-pregnant smokers. RESULTS Two FTCQ-12 factors (Expectancy and Purposefulness) predicted smoking status; scores were higher in pregnant non-abstainers than abstainers. The sum of these two factors, FTCQ-12 risk score (RS), yielded higher sensitivity both in prognostic and diagnostic models than single-item MNWS craving. FTCQ-12 RS had higher sensitivity among pregnant than non-pregnant smokers. Specificity of both tobacco craving measures was similar among pregnant smokers, but higher with MNWS craving than with FTCQ-12 RS in non-pregnant smokers. CONCLUSIONS FTCQ-12 RS and MNWS craving can be used together in clinical practice to rapidly predict smoking status. Interventions targeting Expectancy and Purposefulness may result in higher likelihood of abstinence, especially among pregnant smokers.
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Affiliation(s)
- Ivan Berlin
- Hôpital Pitié-Salpêtrière, Faculté de médicine, Université P. & M. Curie, INSERM U1178, Paris, France.
| | - Edward G Singleton
- Interactive Professional Services, 5 Elderberry Court, Catonsville, MD 21218, USA.
| | - Stephen J Heishman
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224, USA.
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Self-reported cravings for heroin and cocaine during maintenance treatment with slow-release oral morphine compared with methadone: a randomized, crossover clinical trial. J Clin Psychopharmacol 2015; 35:150-7. [PMID: 25679130 DOI: 10.1097/jcp.0000000000000288] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Craving, an urge or increased desire to take a drug, is part of a cluster of behavioral, cognitive, and physiological phenomena that can develop after substance use. Self-reported cravings for heroin and cocaine are compared in opioid dependent patients while receiving maintenance treatment with slow-release oral morphine (SROM) or methadone. METHODS Data from a 22-week open-label, randomized, crossover trial (per protocol sample n = 157) were examined by analysis of variance (ANOVA). Cravings for heroin and cocaine during the past 7 days were assessed at baseline and thrice during each 11-week treatment period using a Visual Analog Scale (heroin, VAS-H; cocaine, VAS-C), German versions of the brief Heroin Craving Questionnaire (HCQ), and the brief Cocaine Craving Questionnaire (CCQ). RESULTS Mean (SD) heroin craving scores under methadone were 3.3 (2.4) (VAS-H) and 2.9 (1.4) (HCQ). Heroin craving scores under SROM were significantly lower, at 2.5 (2.2) (VAS-H) and 2.6 (1.2) (HCQ) (ANOVA: VAS-H P < 0.0001, HCQ P = 0.010). Cocaine craving scores were not significantly different (methadone: 1.6 (2.0) (VAS-C) and 2.1 (1.2) (CCQ) vs SROM: 1.4 (1.9) (VAS-C) and 2.1 (1.2) (CCQ); ANOVA: VAS-C P = 0.175, CCQ P = 0.536). No significant carry-over effects were detected. CONCLUSIONS This study demonstrates that SROM is clinically more effective than methadone in reducing general craving for heroin during opioid maintenance treatment while not affecting cocaine craving.
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Pombo S, Ferreira J, Cardoso JMN, Ismail F, Levy P, Bicho M. The role of 5-HTTLPR polymorphism in alcohol craving experience. Psychiatry Res 2014; 218:174-9. [PMID: 24794154 DOI: 10.1016/j.psychres.2014.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 01/22/2014] [Accepted: 04/09/2014] [Indexed: 12/16/2022]
Abstract
The way in which genetic risk mediates the development of craving in alcohol dependence is still relatively unknown. The authors sought to clarify the extent to which alcohol craving could be predicted by a relevant polymorphism in the promoter region of the gene encoding the 5-HT transporter (5-HTTLPR). A sample of 101 alcohol-dependent patients admitted for alcohol treatment was recruited for the study. At admission, blood samples were taken for DNA extraction and alcohol craving information was collected with a composite measure. The 5-HTT polymorphism was genotyped. Alcohol dependent patients who were homozygous for the long allele (LL) self-reported higher scores of craving when compared to patients that were homozygous for the short allele (SS). However, the results were not statistically significant. Also, no significant associations were observed between the 5-HTTLPR genotype and other drinking variables. No 5-HTTLPR genotype effects were observed on alcohol craving experience in a sample of alcohol-dependent outpatients.
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Affiliation(s)
- Samuel Pombo
- Psychiatric Service, Santa Maria University Hospital of Lisbon, Portugal.
| | - Joana Ferreira
- Laboratory of Genetics, Medicine School of Lisbon University, Portugal
| | | | - Fátima Ismail
- Psychiatric Service, Santa Maria University Hospital of Lisbon, Portugal
| | - Pilar Levy
- Laboratory of Genetics, Medicine School of Lisbon University, Portugal
| | - Manuel Bicho
- Laboratory of Genetics, Medicine School of Lisbon University, Portugal
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Wray JM, Gass JC, Tiffany ST. A systematic review of the relationships between craving and smoking cessation. Nicotine Tob Res 2013; 15:1167-82. [PMID: 23291636 PMCID: PMC3682845 DOI: 10.1093/ntr/nts268] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 11/12/2012] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Craving is often portrayed as a defining feature of addiction, but the role of craving in the addictive process is controversial. Particularly contentious is the extent to which drug craving predicts subsequent relapse. METHODS This review synthesizes findings from 62 smoking cessation studies published through December 2011. Eligible studies measured craving for cigarettes in treatment-seeking smokers and related this to subsequent smoking status. The relationships of general craving and cue-specific craving with treatment outcome were examined separately. Further, analyses that related general craving to smoking status were divided into those that used craving data collected before the quit attempt, after the quit attempt, and those that used change in craving over time as a predictor. RESULTS Results across studies revealed a total of 198 indices of association with 94 (47%) of these being significant. In general, the findings indicated (a) there were only a few cases of significant associations between craving collected as part of cue-reactivity studies and treatment outcome, (b) postquit craving was a stronger predictor of treatment outcome than prequit craving, and (c) several moderators likely influence the relationship between craving and cessation outcome. CONCLUSIONS The overall results suggest that craving is not a necessary condition of relapse. In addition, inconsistent relationships between craving and treatment outcome call into question the value of craving as a target of treatment and underscore limitations in the prognostic utility of craving.
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Affiliation(s)
- Jennifer M Wray
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA.
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LaRowe SD, Kalivas PW, Nicholas JS, Randall PK, Mardikian PN, Malcolm RJ. A double-blind placebo-controlled trial of N-acetylcysteine in the treatment of cocaine dependence. Am J Addict 2013; 22:443-52. [PMID: 23952889 DOI: 10.1111/j.1521-0391.2013.12034.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/04/2012] [Accepted: 03/12/2012] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There remains no FDA approved medication for the treatment of cocaine dependence. Preclinical studies and early pilot clinical investigations have suggested that N-acetylcysteine (NAC) may be useful in the treatment of the disorder. OBJECTIVE The present report assessed the efficacy of NAC in the treatment of cocaine dependence. METHODS Cocaine-dependent volunteers (n = 111) were randomized to receive daily doses of 1,200 mg of NAC, 2,400 mg of NAC, or placebo. Participants were followed for 8 weeks (up to three visits weekly). At each of these visits, urine samples were collected, along with self-reports of cocaine use. Urine samples were assessed for quantitative levels of benzoylecognine (ie, cocaine metabolite). RESULTS Overall, the primary results for the clinical trial were negative. However, when considering only subjects who entered the trial having already achieved abstinence, results favored the 2,400 mg NAC group relative to placebo, with the 2,400 mg group having longer times to relapse and lower craving ratings. CONCLUSION While the present trial failed to demonstrate that NAC reduces cocaine use in cocaine-dependent individuals actively using, there was some evidence it prevented return to cocaine use in individuals who had already achieved abstinence from cocaine. SCIENTIFIC SIGNIFICANCE N-acetylcysteine may be useful as a relapse prevention agent in abstinent cocaine-dependent individuals.
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Abstract
Although drug craving has received considerable research attention over the past several decades, to date there has been no systematic review of the general clinical significance of craving. This paper presents an overview of measurement issues of particular relevance to a consideration of use of craving in clinical settings. The paper then considers the relevance of craving across a broad array of clinical domains, including diagnosis, prognostic utility, craving as an outcome measure, and the potential value of craving as a direct target of intervention. The paper is both descriptive and prescriptive, informed by the current state of the science on craving with recommendations for the definition of craving, assessment practices, future research, and clinical applications. We conclude that craving has considerable utility for diagnosis and as a clinical outcome, and that findings from future research will likely expand the clinical potential of the craving construct in the domains of prognosis and craving as a treatment target.
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Affiliation(s)
- Stephen T Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA.
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Abstract
BACKGROUND Cocaine dependence is a disorder for which no pharmacological treatment of proven efficacy exists, advances in the neurobiology could guide future medication development. OBJECTIVES To investigate the efficacy and acceptability of antidepressants alone or in combination with any psychosocial intervention for the treatment of cocaine dependence and problematic cocaine use. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and CINAHL in July 2011 and researchers for unpublished trials. SELECTION CRITERIA Randomised clinical trials comparing antidepressants alone or associated with psychosocial intervention with placebo, no treatment, other pharmacological or psychosocial interventions. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. MAIN RESULTS 37 studies were included in the review (3551 participants).Antidepressants versus placebo: results for dropouts did not show evidence of difference, 31 studies, 2819 participants, RR 1.03 (Cl 95% 0.93 to 1.14). Looking at Abstinence from cocaine use, even though not statistically significant, the difference shown by the analysis in the three-weeks abstinence rate was in favour of antidepressants (eight studies, 942 participants, RR 1.22 (Cl 95% 0.99 to 1.51)). Considering only studies involving tricyclics, five studies, 367 participants, or only desipramine, four studies, 254 participants, the evidence was in favour of antidepressants. However, selecting only studies with operationally defined diagnostic criteria, statistical significance favouring antidepressants, as well as the trend for significance shown by the full sample, disappeared. Looking at safety issues, the results did not show evidence of differences (number of patients withdrawn for medical reasons, thirteen studies, 1396 participants, RR 1.39 (Cl 95% 0.91 to 2.12)). Subgroup analysis considering length of the trial, associated opioid dependence or associated psychosocial interventions as confounding factors, failed in showing consistent and statistically significant differences in favour of antidepressants.Antidepressants versus other drugs: Comparing antidepressants with dopamine agonists or with anticonvulsants, no evidence of differences was shown on dropouts and on other outcomes (abstinence from cocaine use, adverse events). AUTHORS' CONCLUSIONS At the current stage of evidence data do not support the efficacy of antidepressants in the treatment of cocaine abuse/dependence. Partially positive results obtained on secondary outcome measures, such as depression severity, do not seem to be associated with an effect on direct indicators of cocaine abuse/dependence. Antidepressants cannot be considered a mainstay of treatment for unselected cocaine abusers/dependents.
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Affiliation(s)
- Pier Paolo Pani
- Social-Health Division, Health District 8 (ASL 8) Cagliari, Via Logudoro 17, Cagliari, Sardinia, Italy, 09127
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28
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Matwin S, Chang G. Readiness to change and risk drinking women. J Subst Abuse Treat 2010; 40:230-40. [PMID: 21193283 DOI: 10.1016/j.jsat.2010.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/21/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
The predictive value of the Readiness to Change Questionnaire (RTCQ) for subsequent drinking was evaluated in 499 women. These women had medical problems potentially exacerbated by alcohol use and were enrolled in an intervention study. Correlates and predictors of stage of change were analyzed. Results indicated that the categorical application of the RTCQ did not predict drinking in the 6-12 months after enrollment. Preliminary findings support rescoring the RTCQ into a continuous measure. Following this conversion, situational risks factors for drinking were examined as potential mediators of readiness to change (RTC). Heightened risk for alcohol consumption during argument or boredom was found to attenuate the association between one's RTC and later drinking. Finally, medical condition moderated the association of RTC on later drinking; women with diabetes, infertility, or osteoporosis drank the most in the contemplation stage. In contrast, hypertensive women drank more when action oriented to change. The implications for treating risk drinking in women are discussed.
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Affiliation(s)
- Sonia Matwin
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, USA
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Fattore L, Spano MS, Altea S, Fadda P, Fratta W. Drug- and cue-induced reinstatement of cannabinoid-seeking behaviour in male and female rats: influence of ovarian hormones. Br J Pharmacol 2010; 160:724-35. [PMID: 20590575 DOI: 10.1111/j.1476-5381.2010.00734.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Animal and human studies have shown that sex and hormones are key factors in modulating addiction. Previously, we have demonstrated that self-administration of the cannabinoid CB(1) receptor agonist WIN55,212-2 (WIN; 12.5 microg.kg(-1) per infusion) is dependent on sex, intact female rats being more sensitive than males to the reinforcing properties of cannabinoids, and on the oestrous cycle, ovariectomized (OVX) females being less responsive than intact females. EXPERIMENTAL APPROACH This follow-up study investigated whether sex and ovarian function also affect reinstatement of cannabinoid-seeking in rats after exposure to drug or cue priming. KEY RESULTS After priming with 0.15 or 0.3 mg.kg(-1) WIN, intact female rats exhibited stronger reinstatement than males and OVX females. Responses of intact female rats were higher than those of male and OVX rats even after priming with a drug-associated visual (Light) or auditory (Tone) cue, or a WIN + Light combination. However, latency to the first response did not differ between intact and OVX female rats, and males showed the longest latency to initiate lever-pressing activity. CONCLUSIONS AND IMPLICATIONS Our study provides compelling evidence for a pivotal role of sex and the oestrous cycle in modulating cannabinoid-seeking, with ovariectomy diminishing drug and cue-induced reinstatement. However, it is possible that sex differences during self-administration training are responsible for sex differences in reinstatement. Finding that not only drug primings but also acute exposure to drug-associated cues can reinstate responding in rats could have significant implications for the development of pharmacological and behavioural treatments of abstinent female and male marijuana smokers.
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Affiliation(s)
- L Fattore
- CNR Neuroscience Institute - Cagliari, Italy.
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Attenuated incubation of cocaine seeking in male rats trained to self-administer cocaine during periadolescence. Psychopharmacology (Berl) 2009; 204:725-33. [PMID: 19326103 DOI: 10.1007/s00213-009-1502-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 02/23/2009] [Indexed: 01/19/2023]
Abstract
RATIONALE AND OBJECTIVES Although onset of drug use during adolescence appears to increase long-term vulnerability to drug dependence in humans, relatively little is known about extinction and reinstatement of drug seeking after periadolescent onset of drug self-administration in laboratory animals. Furthermore, although cue-induced reinstatement of cocaine seeking increases progressively during abstinence from cocaine self-administration in adult subjects, this "incubation of cocaine craving" remains unexplored after adolescent drug intake in animal models. MATERIALS AND METHODS We allowed periadolescent (postnatal day (PND) 35 at start) and adult (PND 83-95 at start) male Wistar rats to self-administer cocaine (0.36 mg/kg/infusion) in 2-h daily sessions on a fixed ratio 1 schedule of reinforcement over 14 days. Then, we compared extinction and cue-induced or cocaine priming-induced reinstatement (10 mg/kg cocaine, intraperitoneal) of cocaine seeking in both age groups after 30 days of abstinence in home cages. In separate cohorts, we tested for time-dependent increases in cue-induced reinstatement over approximately 1, 14, 30, or 60 days of abstinence in both age groups. RESULTS Adolescent and adult rats self-administered similar amounts of cocaine. Subsequent cue-induced reinstatement was lower in the adolescent-onset group after a 30-day abstinence period, but cocaine priming-induced reinstatement did not differ across ages. Also, extinction responding and time-dependent increases in cue-induced reinstatement (incubation) were less pronounced in rats that took cocaine as adolescents compared with adults. CONCLUSIONS Surprisingly, these results may reflect resistance among adolescent subjects to some enduring effects of drug self-administration, such as reward learning.
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Rosenberg H. Clinical and laboratory assessment of the subjective experience of drug craving. Clin Psychol Rev 2009; 29:519-34. [PMID: 19577831 DOI: 10.1016/j.cpr.2009.06.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 04/29/2009] [Accepted: 06/03/2009] [Indexed: 11/29/2022]
Abstract
Measures of subjective drug craving - often defined as the experience of an intense or compelling urge or desire - may be used to predict relapse, evaluate psychological and pharmacological treatments, and test theories of addiction and craving. This review summarizes both direct self-report questionnaires and indirect behavioral, physiological and reaction time measures designed to assess craving for alcohol, amphetamines, cocaine, heroin, marijuana, and tobacco. Multi-item questionnaires have typically been based on one of four underlying conceptualizations of addiction or craving (obsessive-compulsive, approach-avoidance, multi-dimensional, intensity-frequency-duration). Most multi-item self-report questionnaires have high internal consistency, correlate significantly with single-item craving ratings, and demonstrate several aspects of construct validity. Proposed indirect or proxy measures of craving include drug dreams, speed of drug consumption, willingness to work for drug access, selection of monetary rewards over drug access, psychophysiological reactivity, and attentional bias to drug cues. These proxy measures of craving are presumed to obviate self-report biases, to be less subject to conscious self-control, and to reflect craving which the person may not be able to articulate; however, there have been too few demonstrations of their validity and they have too many practical limitations to supplant self-report measures of craving at this time.
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Affiliation(s)
- Harold Rosenberg
- Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, United States.
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Heishman SJ, Evans RJ, Singleton EG, Levin KH, Copersino ML, Gorelick DA. Reliability and validity of a short form of the Marijuana Craving Questionnaire. Drug Alcohol Depend 2009; 102:35-40. [PMID: 19217724 PMCID: PMC2694410 DOI: 10.1016/j.drugalcdep.2008.12.010] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 12/05/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Marijuana Craving Questionnaire (MCQ) is a valid and reliable, 47-item self-report instrument that assesses marijuana craving along four dimensions: compulsivity, emotionality, expectancy, and purposefulness. For use in research and clinical settings, we constructed a 12-item version of the MCQ by selecting three items from each of the four factors that exhibited the greatest within-factor internal consistency (Cronbach's alpha coefficient). METHODS Adult marijuana users (n=490), who had made at least one serious attempt to quit marijuana use but were not seeking treatment, completed the MCQ-Short Form (MCQ-SF) in a single session. RESULTS Confirmatory factor analysis of the MCQ-SF indicated good fit with the 4-factor MCQ model, and the coefficient of congruence indicated moderate similarity in factor patterns and loadings between the MCQ and MCQ-SF. Homogeneity (unidimensionality and internal consistency) of MCQ-SF factors was also consistent with reliability values obtained in the initial validation of the MCQ. CONCLUSIONS Findings of psychometric fidelity indicate that the MCQ-SF is a reliable and valid measure of the same multidimensional aspects of marijuana craving as the MCQ in marijuana users not seeking treatment.
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Affiliation(s)
- Stephen J. Heishman
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD 21224, USA, Corresponding author: Stephen J. Heishman, Ph.D., NIDA Intramural Research Program, 251 Bayview Blvd., Baltimore, MD 21224, USA, Phone: 443.740.2458, Fax: 443.740.2855,
| | - Rebecca J. Evans
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD 21224, USA
| | | | - Kenneth H. Levin
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD 21224, USA
| | - Marc L. Copersino
- McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - David A. Gorelick
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD 21224, USA
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Kastelic A, Dubajic G, Strbad E. Slow-release oral morphine for maintenance treatment of opioid addicts intolerant to methadone or with inadequate withdrawal suppression. Addiction 2008; 103:1837-46. [PMID: 19032534 DOI: 10.1111/j.1360-0443.2008.02334.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Evaluation of the efficacy, safety and acceptability of slow-release oral morphine (SROM) in opioid addicts intolerant to methadone or with inadequate withdrawal suppression. DESIGN Prospective, open, non-comparative multi-centre study. SETTING Twelve out-patient Centres for Prevention and Treatment of Drug Addiction in Slovenia. PARTICIPANTS Male and female opioid addicts (age>18 years) under methadone maintenance therapy requiring a change of treatment in order to continue more effectively with maintenance. INTERVENTIONS Maintenance therapy with methadone was switched to once-daily SROM. MEASUREMENTS Efficacy evaluations were based on the reduction of side effects and on the degree of suppression of opiate craving, signs and symptoms of withdrawal. In addition, self-reported somatic and psychic symptoms (SCL-27) as well as World Health Organization quality of life-related (WHO QOL) parameters were monitored. FINDINGS Thirty-nine subjects intolerant to methadone and 28 subjects showing inadequate withdrawal suppression under methadone>or=90 mg/day were included as two separate groups in the efficacy analyses. Treatment was switched easily from methadone to SROM on a 1:8 ratio. Four-week SROM treatment resulted in significant reduction of side effects reported under methadone. Signs and symptoms of opioid withdrawal as well as craving for opiates were improved significantly in patients with inadequate response to methadone. Physical and psychological wellbeing improved significantly under SROM treatment. SROM was tolerated very well. CONCLUSIONS Maintenance treatment with SROM appears to be a clinically useful alternative treatment in subjects not tolerating methadone or with inadequate withdrawal suppression.
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Affiliation(s)
- Andrej Kastelic
- Centre for Treatment of Drug Addiction, Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.
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Heishman SJ, Singleton EG, Pickworth WB. Reliability and validity of a Short Form of the Tobacco Craving Questionnaire. Nicotine Tob Res 2008; 10:643-51. [PMID: 18418787 DOI: 10.1080/14622200801908174] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Tobacco Craving Questionnaire (TCQ) is a valid and reliable 47-item self-report instrument that assesses tobacco craving in four dimensions: emotionality, expectancy, compulsivity, and purposefulness. For use in research and clinical settings, we constructed a 12-item version of the TCQ by selecting three items from each of the four factors that exhibited optimal within-factor reliability (Cronbach's alpha coefficient) and inter-item correlation. Smokers (N = 196) completed the TCQ-Short Form (TCQ-SF) after overnight tobacco deprivation and on a separate day during ad libitum smoking. Confirmatory factor analyses indicated acceptable model fit for a 4-factor model, with congruence coefficients suggesting high to very high similarity in factor patterns and magnitude of factor loadings between the TCQ and TCQ-SF in both conditions. Scores on each factor were significantly greater after tobacco deprivation than ad libitum smoking, were associated with measures of tobacco withdrawal, and varied with degree of nicotine dependence. Cronbach's alpha coefficients and average inter-item correlations were similar in both conditions and were consistent with reliability values obtained in the initial validation of the TCQ. Test-retest correlation coefficients were also similar to those found in a previous study. These findings suggest that the TCQ-SF is as valid and reliable as the 47-item TCQ in measuring tobacco craving.
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Affiliation(s)
- Stephen J Heishman
- Nicotine Psychopharmacology Unit, Clinical Pharmacology and Therapeutics Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA.
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Schmitz JM, Mooney ME, Moeller FG, Stotts AL, Green C, Grabowski J. Levodopa pharmacotherapy for cocaine dependence: choosing the optimal behavioral therapy platform. Drug Alcohol Depend 2008; 94:142-50. [PMID: 18164144 PMCID: PMC2293271 DOI: 10.1016/j.drugalcdep.2007.11.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 11/02/2007] [Accepted: 11/02/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND The dopamine precursor levodopa has shown some, albeit relatively weak, promise in treating cocaine dependence. This study sought to identify the most appropriate behavioral therapy platform for levodopa pharmacotherapy by evaluating its effect when administered in combination with behavioral platforms of varying intensities. METHOD A total of 161 treatment-seeking cocaine dependent subjects received sustained release levodopa/carbidopa (400/100mg bid, Sinemet) or placebo delivered in combination with Clinical Management (ClinMan); ClinMan+cognitive behavioral therapy (CBT); or ClinMan+CBT+voucher-based reinforcement therapy (VBRT) in a 12-week randomized, placebo-controlled, double-blind (for medication condition) trial. Medication compliance was monitored with riboflavin (100mg/capsule) and the Medication Event Monitoring System. Protocol compliance was addressed in weekly, 10-min nurse-delivered ClinMan sessions. Weekly, 1-h CBT sessions focused on coping skills training. VBRT (with escalating reinforcer value) provided cash-valued vouchers contingent on cocaine-negative urine toxicology results. Urine benzoylecgonine assays collected thrice-weekly were analyzed by intention-to-treat criteria using generalized linear mixed models. RESULTS Levodopa main effects were found on all outcome measures of cocaine use. Contrasts testing the levodopa-placebo difference within each behavioral platform found reliable effects, favoring levodopa, only in the VBRT platform. Levodopa treatment with vouchers produced higher proportions of cocaine-negative urines and longer periods of consecutive abstinence compared to other treatment combinations. CONCLUSION This is the first study to find a significant treatment effect for levodopa and, in doing so, to demonstrate that the magnitude of this effect is dependent upon conditions of the behavioral therapy platform. The data support use of levodopa with abstinence-based reinforcement therapy as one efficacious combination in cocaine dependence disorder treatment.
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Affiliation(s)
- Joy M. Schmitz
- Joy M. Schmitz and F. Gerard Moeller, Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Houston, TX 77030 USA; Marc E. Mooney, Department of Psychiatry, University of Minnesota, Minneapolis, Minneapolis, MN 55414 USA; Angela L. Stotts, Department of Family and Community Medicine, University of Texas, Houston, Houston, TX 77030 USA; Charles Green, Center for Clinical Research & Evidence-Based Medicine, University of Texas, Houston, Houston, TX 77030 USA; John Grabowski, Duluth Clinic and the University of Minnesota, Duluth, MN 55812 USA
| | - Marc E. Mooney
- Joy M. Schmitz and F. Gerard Moeller, Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Houston, TX 77030 USA; Marc E. Mooney, Department of Psychiatry, University of Minnesota, Minneapolis, Minneapolis, MN 55414 USA; Angela L. Stotts, Department of Family and Community Medicine, University of Texas, Houston, Houston, TX 77030 USA; Charles Green, Center for Clinical Research & Evidence-Based Medicine, University of Texas, Houston, Houston, TX 77030 USA; John Grabowski, Duluth Clinic and the University of Minnesota, Duluth, MN 55812 USA
| | - F. Gerard Moeller
- Joy M. Schmitz and F. Gerard Moeller, Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Houston, TX 77030 USA; Marc E. Mooney, Department of Psychiatry, University of Minnesota, Minneapolis, Minneapolis, MN 55414 USA; Angela L. Stotts, Department of Family and Community Medicine, University of Texas, Houston, Houston, TX 77030 USA; Charles Green, Center for Clinical Research & Evidence-Based Medicine, University of Texas, Houston, Houston, TX 77030 USA; John Grabowski, Duluth Clinic and the University of Minnesota, Duluth, MN 55812 USA
| | - Angela L. Stotts
- Joy M. Schmitz and F. Gerard Moeller, Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Houston, TX 77030 USA; Marc E. Mooney, Department of Psychiatry, University of Minnesota, Minneapolis, Minneapolis, MN 55414 USA; Angela L. Stotts, Department of Family and Community Medicine, University of Texas, Houston, Houston, TX 77030 USA; Charles Green, Center for Clinical Research & Evidence-Based Medicine, University of Texas, Houston, Houston, TX 77030 USA; John Grabowski, Duluth Clinic and the University of Minnesota, Duluth, MN 55812 USA
| | - Charles Green
- Joy M. Schmitz and F. Gerard Moeller, Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Houston, TX 77030 USA; Marc E. Mooney, Department of Psychiatry, University of Minnesota, Minneapolis, Minneapolis, MN 55414 USA; Angela L. Stotts, Department of Family and Community Medicine, University of Texas, Houston, Houston, TX 77030 USA; Charles Green, Center for Clinical Research & Evidence-Based Medicine, University of Texas, Houston, Houston, TX 77030 USA; John Grabowski, Duluth Clinic and the University of Minnesota, Duluth, MN 55812 USA
| | - John Grabowski
- Joy M. Schmitz and F. Gerard Moeller, Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Houston, TX 77030 USA; Marc E. Mooney, Department of Psychiatry, University of Minnesota, Minneapolis, Minneapolis, MN 55414 USA; Angela L. Stotts, Department of Family and Community Medicine, University of Texas, Houston, Houston, TX 77030 USA; Charles Green, Center for Clinical Research & Evidence-Based Medicine, University of Texas, Houston, Houston, TX 77030 USA; John Grabowski, Duluth Clinic and the University of Minnesota, Duluth, MN 55812 USA
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Rosenberg H, Mazzola J. Relationships among self-report assessments of craving in binge-drinking university students. Addict Behav 2007; 32:2811-8. [PMID: 17524566 DOI: 10.1016/j.addbeh.2007.04.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 03/26/2007] [Accepted: 04/22/2007] [Indexed: 10/23/2022]
Abstract
To assess the relationships among self-report craving questionnaires, and between craving and alcohol consumption, we administered four previously published measures of craving (Alcohol Urge Questionnaire, Obsessive-Compulsive Drinking Scale, Penn Alcohol Craving Scale, Temptation-Restraint Inventory), five single-item Visual Analog Scales (need, urge, craving, desire, compulsion), and measures of alcohol consumption and drinking consequences to 112 university students attending a large, public state university who reported at least two binge-drinking episodes (5+ drinks in a row by men; 4+ drinks in a row by women) in the previous 30 days. The associations among the multi-item self-report measures of craving were often larger for men than women, but the coefficients were typically statistically significant and meaningful regardless of gender, indicating good convergent validity despite differences in phrasing of items, response formats, and time periods over which craving was assessed. Generally smaller correlations among the VAS items indicated that these five terms were not inter-changeable among themselves (nor were they inter-changeable with scores on the multi-item questionnaires). Similarly to investigations using clinical samples, regression analyses revealed that recent drinking by binge-drinking students was associated with certain measures of self-reported craving.
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Affiliation(s)
- Harold Rosenberg
- Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, USA.
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Heinz AJ, Epstein DH, Schroeder JR, Singleton EG, Heishman SJ, Preston KL. Heroin and cocaine craving and use during treatment: measurement validation and potential relationships. J Subst Abuse Treat 2006; 31:355-64. [PMID: 17084789 DOI: 10.1016/j.jsat.2006.05.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 04/24/2006] [Accepted: 05/14/2006] [Indexed: 11/12/2022]
Abstract
Although commonly assessed with unidimensional scales, craving has been suggested to be multifaceted and to have a complex relationship with drug use and relapse. This study assessed the consistency and predictive validity of unidimensional and multidimensional craving scales. At the beginning of a 12-week outpatient treatment trial, opiate users (n = 101) and cocaine users (n = 72) completed unidimensional visual analog scales (VASs) assessing "want," "need," and "craving" and multidimensional 14- and 45-item versions of the Cocaine Craving Questionnaire (CCQ) or Heroin Craving Questionnaire (HCQ). Spearman correlations between the VASs and the first-order factors from the 45-item CCQ/HCQ were .20-.40, suggesting that the two types of assessment were not redundant. Treatment dropout and in-treatment drug use were more frequently predicted by scores on the 14- or 45-item CCQ than by VAS ratings. Results suggest that the CCQ/HCQ and the 14-item CCQ provide information that unidimensional VASs do not.
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Affiliation(s)
- Adrienne J Heinz
- Clinical Pharmacology and Therapeutics Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD 21224, USA.
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Lukasiewicz M, Benyamina A, Reynaud M, Falissard B. An in vivo study of the relationship between craving and reaction time during alcohol detoxification using the ecological momentary assessment. Alcohol Clin Exp Res 2006; 29:2135-43. [PMID: 16385183 DOI: 10.1097/01.alc.0000191760.42980.50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To study cognitive interference associated with craving for alcohol, the Ecological Momentary Assessment (EMA) method was used to measure the relationship between craving and reaction time. A secondary aim was the study of the predictive factors for craving during alcohol detoxification. The EMA enables both repeated measures of craving in a natural setting and the recording of reaction time without the patient being aware of this. METHODS Craving for alcohol, reaction time, sadness and anxiety were recorded 8 to 12 times a day, over three weeks of detoxification in 14 alcoholics (n=1767 measures), on an electronic diary issuing random prompts. Mixed models were used for statistical analysis (alpha=5%, 1-beta=88%). RESULTS Reaction time was significantly increased in univariate analysis when a craving episode occurred but this difference did not persist after multivariate analysis. Craving episodes were more frequent and intense than previously reported. Predictive factors of craving during detoxification were: age, gender, sadness, anxiety and the number of previous detoxifications. Antidepressants, anti-craving medications but not benzodiazepines were negatively associated to craving.
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Affiliation(s)
- M Lukasiewicz
- INSERM (Institut National pour la Santé et la Recherche Medicale), Paris, France.
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de Bruijn C, van den Brink W, de Graaf R, Vollebergh WAM. Alcohol abuse and dependence criteria as predictors of a chronic course of alcohol use disorders in the general population. Alcohol Alcohol 2005; 40:441-6. [PMID: 16009673 DOI: 10.1093/alcalc/agh183] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To investigate whether DSM-IV abuse and dependence criteria and the ICD-10 criterion for craving differentially predict a chronic course of alcohol use disorders (AUD) in the general population. METHODS Data were derived from the Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population with a baseline and a 1- and 3-year follow-up assessment. In the present study, a cohort of subjects with a DSM-IV AUD diagnosis at baseline was followed (n = 382). Diagnostic criteria of AUD according to DSM-IV and ICD-10 were assessed using the Composite International Diagnostic Interview (CIDI). RESULTS In our cohort of subjects with an AUD diagnosis at baseline, the presence of all dependence criteria, except tolerance, significantly increased the risk for dependence at 1 and 3 years follow-up. Abuse criteria displayed much lower and often non-significant risks for dependence at follow-up, with the exception of the criterion 'legal problems'. The ICD-10 criterion 'craving' had the highest relative risk (RR) of all criteria for dependence at 1 year (RR = 12.4, 95% CI = 5.5-27.8) and 3 years follow-up (RR = 12.9, 95% CI = 4.4-37.7). CONCLUSION With the exception of tolerance, all DSM-IV dependence criteria are useful in predicting the course of AUD in the general population.
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Affiliation(s)
- Carla de Bruijn
- University Medical Centre, Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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de Bruijn C, van den Brink W, de Graaf R, Vollebergh WAM. THE CRAVING WITHDRAWAL MODEL FOR ALCOHOLISM: TOWARDS THE DSM-V. IMPROVING THE DISCRIMINANT VALIDITY OF ALCOHOL USE DISORDER DIAGNOSIS. Alcohol Alcohol 2005; 40:314-22. [PMID: 15883129 DOI: 10.1093/alcalc/agh166] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To compare the discriminant validity of the DSM-IV and the ICD-10 classification of alcohol use disorders (AUD) with an alternative classification, the craving withdrawal model (CWM). CWM requires craving and withdrawal for the diagnosis of alcohol dependence and raises the alcohol abuse threshold to two DSM-IV AUD criteria. METHODS Data were derived from The Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population. In the present study, only non-abstinent subjects were included (n=6041). Three diagnostic systems (DSM-IV, ICD-10, and CWM) were compared using the following discriminant variables: alcohol intake, psychiatric comorbidity, functional status, familial alcohol problems, and treatment sought. RESULTS The year prevalence of CWM alcohol dependence was lower than the prevalence of ICD-10 and DSM-IV dependence (0.3% vs 1.4% and 1.4%). The year prevalence of abuse was similar for CWM and DSM-IV (4.7 and 4.9%), but lower for ICD-10 harmful use (1.7%). DSM-IV resulted in a poor distinction between normality and abuse and ICD-10 resulted in a poor distinction between harmful use and dependence. In contrast, the CWM distinctions between normality and abuse, and between abuse, and dependence were significant for most of the discriminant variables. CONCLUSION This study indicates that CWM improves the discriminant validity of AUD diagnoses. The predictive validity of the CWM for alcohol and other substance use disorders remain to be studied.
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Affiliation(s)
- Carla de Bruijn
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Ciraulo DA, Knapp C, Rotrosen J, Sarid-Segal O, Ciraulo AM, LoCastro J, Greenblatt DJ, Leiderman D. Nefazodone treatment of cocaine dependence with comorbid depressive symptoms. Addiction 2005; 100 Suppl 1:23-31. [PMID: 15730347 DOI: 10.1111/j.1360-0443.2005.00984.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS In the current study, nefazodone, an antidepressant with dual action on serotonin and norepinephrine reuptake as well as 5-HT(2A) receptor antagonist effects, was studied in subjects with cocaine dependence and depressive symptoms, to determine its efficacy in reducing cocaine use. DESIGN An 8-week, double blind, placebo-controlled design was used. SETTING The study was conducted at the Medication Development Research Unit (MDRU) at the VA Boston Healthcare System and the Manhattan Department of Veterans Affairs (DVA) Medical Center. PARTICIPANTS Subjects (n = 69) met Diagnostic and Statistical Manual version IV (DSM-IV) criteria for cocaine dependence and had Hamilton Depression Scores of 12 or higher. INTERVENTION Subjects were assigned randomly to receive nefazodone 200 mg twice daily (n = 34) or matching placebo (n = 35). All subjects received individual counseling. MEASUREMENTS Urinary measurements of benzoylecgonine (BE, three times per week) and self-reports of cocaine use were the primary outcome measures. Secondary outcome measures included assessments of psychiatric functioning, cocaine craving and social functioning. FINDINGS Median weekly BE declined more rapidly in the nefazodone than in the placebo group. Median urine BE at baseline was, however, significantly greater in nefazodone than in the placebo group. Scores for strength of cocaine craving also decreased more rapidly in the nefazodone group compared to the placebo group. Both groups had equivalent improvement in mood, psychosocial functioning and self-reported cocaine use. CONCLUSIONS These results suggest that nefazodone administration can reduce cocaine craving after it has been administered for several weeks. Although the nefazodone group had a greater rate of decrease in BE levels than the placebo group, the interpretation of this finding is obscured by significant group differences in baseline BE levels.
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Affiliation(s)
- Domenic A Ciraulo
- Division of Psychiatry, Boston University School of Medicine, VA Boston Healthcare System Medication Development Research Unit (MDRU), Boston, MA, USA.
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Connor JP, Feeney GFX, Young RM. A comparison of the Yale-Brown Obsessive Compulsive Scale for "heavy drinking" with a single item craving measure: construct validity and clinical utility. Subst Use Misuse 2005; 40:551-61. [PMID: 15830736 DOI: 10.1081/ja-200030723] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The measurement of alcohol "craving" began with single-item scales. Multifactorial scales developed with the intention to capture more fully the phenomenon of craving. This study examines the construct validity of a multifactorial scale, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (Y-BOCS-hd). The study compares its clinical utility with a single item visual-analogue craving scale. The study includes 212 alcohol dependent subjects (127 males, 75 females) undertaking an outpatient treatment program between 1999-2001. Subjects completed the Y-BOCS-hd and a single item visual-analogue scale, in addition to alcohol consumption and dependence severity measures. The Y-BOCS-hd had strong construct validity. Both the visual-analogue alcohol craving scale and Y-BOCS-hd were weakly associated with pretreatment dependence severity. There was a significant association between pretreatment alcohol consumption and the visual-analogue craving scale. Neither craving measure was able to predict total program abstinence or days abstinent. The relationship between obsessive-compulsive behavior in alcohol dependence and craving remains unclear.
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Affiliation(s)
- Jason P Connor
- Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
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Gómez Arnáiz A, Conde Martel A. Craving y alcoholismo. Med Clin (Barc) 2004; 123:222-3. [PMID: 15282077 DOI: 10.1016/s0025-7753(04)74466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
There is ongoing debate regarding the validity of the distinction of alcohol abuse and dependence, the distinction between normality and alcohol abuse, and the absence of craving in the DSM-IV classification of alcohol use disorders. In this study, we examine the discriminant validity of the DSM-IV alcohol use disorder diagnoses in three different populations (98 patients from an alcohol treatment service, 68 nontreatment-seeking heavy drinkers, and 75 psychiatric outpatients). We compare the results of the DSM-IV classification with an alternative classification that requires craving and withdrawal for the diagnosis of dependence and at least two DSM-IV abuse-dependence symptoms for the diagnosis of abuse: the Craving Withdrawal Model (CWM). Although the total prevalence of any alcohol use disorder did not differ between DSM-IV and CWM, the distinction between normality and abuse and between abuse and dependence was better for the CWM categories.
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Affiliation(s)
- Carla de Bruijn
- St. Lucas Andreas Hospital, Department of Psychiatry, Amsterdam, The Netherlands
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Singleton EG, Anderson LM, Heishman SJ. Reliability and validity of the Tobacco Craving Questionnaire and validation of a craving-induction procedure using multiple measures of craving and mood. Addiction 2003; 98:1537-46. [PMID: 14616180 DOI: 10.1046/j.1360-0443.2003.00449.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To determine the reliability and validity of the Tobacco Craving Questionnaire (TCQ) and the validity of imagery scripts to elicit self-reported tobacco craving. DESIGN Active imagery of three auditory scripts that described no-, low- and high-intensity of smoking urge. PARTICIPANTS Current cigarette smokers (24 men, 24 women) not attempting to quit or reduce smoking. MEASUREMENTS After each imagery condition, participants completed the 47-item TCQ, a Mood Form and Visual Analog Scale (VAS) questions. FINDINGS Reliability of measures was demonstrated by internal consistency and unidimensionality of the four TCQ factors across imagery conditions. Criterion-related validity was demonstrated by an orderly increase in scores on the TCQ and VAS craving measures as a function of craving intensity of the imagery scripts. Increases in effect size parameters and parallel decreases in the stability of test-retest reliability for all craving measures indicated the validity of the imagery procedure. Convergent and discriminant validity were established by the craving scripts increasing self-reported craving, the no-craving (positive-affect) script increasing positive mood, the no-craving script not affecting craving and the craving scripts not affecting positive mood. CONCLUSIONS Findings further demonstrated the reliability and validity of the TCQ as a multi-factorial instrument to assess the construct of tobacco craving and suggested that the lability of craving, rather than inconsistency and instability in its measurement, was responsible for observed effects.
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Affiliation(s)
- Edward G Singleton
- National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD 21224, USA
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