Effects of Craving Self-Report Measurement on Desire for Heroin in Opioid Dependent Individuals

This study aims to investigate whether the administration of questionnaires measuring subjective craving induces more craving for opiates compared to questionnaires measuring other subjective states. The study was conducted in 2000. The sample was composed of 53 patients that were treated as inpatients and outpatients for their opioid dependence syndrome. Participants were assigned randomly into four groups. Both a craving and negative affect condition were presented to each group. The administration of the Visual Analogue Scale (VAS) preceded and followed each condition. Findings of the present study show that the administration of questionnaires measuring instant as well as general craving does not have a distinctive effect on measures of unidimensional craving compared to a questionnaire focused on anxiety and depression states. Because of the small sample, the results should be interpreted cautiously.     

Heroin Use,Dependence, and Attitudes to Treatment in Non-Treatment-Seeking Heroin Users: A Pilot Study

Much research examining heroin users utilizes treatment samples; non-treatment-seeking heroin users are not well understood. It is unclear whether this group can avoid impaired control or negative sequelae commonly observed in treatment-seeking populations. During 2000 and 2001, we recruited 69 non-treatment-seeking heroin users with no treatment history. Heroin use, management strategies, treatment attitudes, and risk behaviors were assessed; the DSM-IV checklist and severity of dependence scale were completed. Study limitations and implications for heroin use and its treatment are discussed. This study was funded by Prince Charles Hospital Foundation.     

女性海洛因依赖者患盆腔炎性疾病调查分析

目的:了解女性海洛因依赖者中因性乱所致盆腔炎性疾病(PID)患病流行情况.方法:对在我所强戒的1 237名海洛因依赖者,进行妇科体检、阴道分泌物涂片及妇科B超检查.结果:患病人数为114人,患病率9.22%,且不同年龄人群组患病有显著性差异(x2=12.003,P＜0.01),有卖淫行为者患病率明显高于无卖淫行为者(x2=12.063,P＜0.01).结论:加强对吸毒妇女(尤其是青年女性)的性卫生教育,避免性乱,对控制性疾病传播有重要意义.     

高氧液联合美沙酮治疗海洛因依赖者

目的:观察高氧液对海洛因依赖者戒断综合症的治疗作用及康复治疗作用.方法:采用高氧液联合美沙酮(MTD)替代递减治疗50例海洛因依赖者,并以50例单纯MTD脱毒者进行对照观察.结果:高氧液联合MTD脱毒效果较单纯MTD脱毒控制症状彻底,过程平稳.特别是纠正食欲差、乏力、焦虑症状效果明显(P＜0.01).结论:高氧液联合MTD脱毒效果优于MTD脱毒治疗.     

Reward-Related Responses and Tonic Craving in Cocaine Addiction: An Imaging Study of the Monetary Incentive Delay Task

BackgroundCocaine addiction is associated with altered sensitivity to natural reinforcers and intense drug craving. However, previous findings on reward-related responses were mixed, and few studies have examined whether reward responses relate to tonic cocaine craving.MethodsWe combined functional magnetic resonance imaging and a monetary incentive delay task to investigate these issues. Imaging data were processed with published routines, and the results were evaluated with a corrected threshold. We compared reward responses of 50 cocaine-dependent individuals (CDs) and 45 healthy controls (HCs) for the ventral striatum (VS) and the whole brain. We also examined the regional responses in association with tonic cocaine craving, as assessed by the Cocaine Craving Questionnaire (CCQ) in CDs. We performed mediation analyses to evaluate the relationship between regional responses, CCQ score, and recent cocaine use.ResultsThe VS showed higher activation to large as compared with small or no wins, but this reward-related activity did not differ between CDs and HCs. The precentral gyrus (PCG), anterior insula, and supplementary motor area showed higher activation during large vs no wins in positive correlation with the CCQ score in CDs. Mediation analyses suggested that days of cocaine use in the prior month contributed to higher CCQ scores and, in turn, PCG reward responses.ConclusionsThe results highlight a unique relationship between reward responses of the primary motor cortex, tonic cocaine craving, and recent cocaine use. The motor cortex may partake in the cognitive motor processes critical to drug-seeking behavior in addicted individuals.     

海洛因依赖者操守成败相关因素的调查分析

目的:探讨海洛因依赖者操守成败的相关因素及预防复吸的对策。方法:问卷调查35名戒毒后操守12个月以上及36名屡戒不成的海洛因依赖者,比较两组的人口学资料,操守成败相关因素。结果:成功操守者吸毒时间相对较短(P<0.01);戒毒次数和接受替代治疗相对较少(P<0.01);吸毒前对毒品认识不足(P<0.05)及因吸毒而受到的法律制裁较多(P<0.05)。维持操守的主要因素是正确的认知;而失败的因素是未脱离吸毒环境。结论:维持操守主要与正确的认知有关,据此制定综合性的预防复吸措施。     

Disrupted Regulation of Social Exclusion in Alcohol-Dependence: An fMRI Study

Alcohol-dependence is associated with cognitive and biological alterations, and also with interpersonal impairments. Although overwhelming in clinical settings and involved in relapse, these social impairments have received little attention from researchers. Particularly, brain alterations related to social exclusion have not been explored in alcohol-dependence. Our primary purpose was to determine the neural correlates of social exclusion feelings in this population. In all, 44 participants (22 abstinent alcohol-dependent patients and 22 paired controls) played a virtual game (‘cyberball'') during fMRI recording. They were first included by other players, then excluded, and finally re-included. Brain areas involved in social exclusion were identified and the functional connectivity between these areas was explored using psycho-physiological interactions (PPI). Results showed that while both groups presented dorsal anterior cingulate cortex (dACC) activations during social exclusion, alcohol-dependent participants exhibited increased insula and reduced frontal activations (in ventrolateral prefrontal cortex) as compared with controls. Alcohol-dependence was also associated with persistent dACC and parahippocampal gyrus activations in re-inclusion. PPI analyses showed reduced frontocingulate connectivity during social exclusion in alcohol-dependence. Alcohol-dependence is thus linked with increased activation in areas eliciting social exclusion feelings (dACC–insula), and with impaired ability to inhibit these feelings (indexed by reduced frontal activations). Altered frontal regulation thus appears implied in the interpersonal alterations observed in alcohol-dependence, which seem reinforced by impaired frontocingulate connectivity. This first exploration of the neural correlates of interpersonal problems in alcohol-dependence could initiate the development of a social neuroscience of addictive states.     

Effects of a Single Lyric Analysis Intervention on Withdrawal and Craving With Inpatients on a Detoxification Unit: A Cluster-Randomized Effectiveness Study

Background: For patients hospitalized on inpatient detoxification units, reducing negative symptoms such as withdrawal and craving is a key treatment area. Although lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation, there is a lack of randomized controlled music therapy studies systematically investigating how lyric analysis interventions can affect patients on a detoxification unit. Objective: The purpose of this cluster-randomized effectiveness study was to measure the effects of single-session group lyric analysis interventions on withdrawal and craving with patients on a detoxification unit. A secondary purpose of this study was to determine if relationships existed between treatment effects and participants’ familiarity with the song. Methods: Participants (N = 144) were cluster-randomized to experimental (posttest only) or wait-list control (pretest only) conditions to provide treatment to all participants in an inclusive single-session design. Results: Although participants in the experimental condition had lower withdrawal and craving means than participants in the control condition, these differences were not significant. Familiarity of the song in the lyric analysis was not related to withdrawal or craving. Conclusion: Group-based lyric analysis interventions may be effective for temporarily relieving withdrawal and craving in patients on a detoxification unit. Familiarity of the song did not affect results. Implications for clinical practice, suggestions for future research, and limitations are provided.     

Coping with Behaviour-Attitude Dissonance: A Study Amongst Heroin Addicts in Karachi

A study is reported based on semi-structured interviews with 35 male current or Cornier heroin addicts living in Karachi, Pakistan. Karachi saw a dramatic increase in heroin misuse in the 1980s and is an example of a major city in the developing world that is undergoing rapid social change. The study focuses upon how addicts deal eognitively with the dissonance created by their addiction-related behaviour. Responses to dissonance were coded into 16 categories which were further amalgamated into four principal groups: accepting, confessional, testimonial, defensive. Amongst other findings, support was found for the hypotheses that dissonance over religious observance would be responded to with acceptance, over physical well-being with testimony, and over respect for ciders and care for dependants with defensivencss. Being currently off heroin was related to accepting responses and being from a more traditional background was related to testimonial responses. Results are discussed in terms ofJungian response sub-types, attribution theory, and stages of change.     

Neural Substrates of Attentional Bias for Smoking-Related Cues: An fMRI Study

Attentional bias for drug-related stimuli, as measured by emotional Stroop (ES) tasks, is predictive of treatment outcomes for tobacco smoking and other abused drugs. Characterizing relationships between smoking-related attentional bias and brain reactivity to smoking images may help in identifying neural substrates critical to relapse vulnerability. To this end, we investigated putative relationships between interference effects in an offline smoking ES task and functional MRI (fMRI) measures of brain reactivity to smoking vs neutral images in women smokers. Positive correlations were found between attentional bias and reactivity to smoking images in brain areas involved in emotion, memory, interoception, and visual processing, including the amygdala, hippocampus, parahippocampal gyrus, insula, and occipital cortex. These findings suggest that smokers with elevated attentional biases to smoking-related stimuli may more readily shift attention away from other external stimuli and toward smoking stimuli-induced internal states and emotional memories. Such attentional shifts may contribute to increased interference by smoking cues, possibly increasing relapse vulnerability. Treatments capable of inhibiting shifts to drug cue-induced memories and internal states may lead to personalized tobacco dependence treatment for smokers with high attentional bias to smoking-related stimuli.     

Estimating the Number of Heroin Users in Metropolitan France Using Treatment Centers Data: An Exploratory Analysis

Background: An updated prevalence estimate for heroin users in France is lacking. Accurate figures are needed to estimate the potential need for treatment. Method: This research relies on a capture-recapture framework and, for the first time, makes use of individual data collected by a standardized survey conducted within treatment centers. Taking the hierarchical structure of data collection into consideration, a multilevel Zelterman regression model was used, thus enabling estimates at national level. Results: The number of heroin users was estimated to be 76,000, 95% CI = [68,000; 85,000] in 2009 (prevalence of 1.9‰ [1.7–2.1]), 101,000 in 2011, 95% CI = [66,000–137,000] (prevalence of 2.5‰ [1.6–3.4]), and 107,000 in 2013, 95% CI = [85,000–124,000] (prevalence of 2.6‰ [2.1–3.1]), with a 4:1 ratio of male:female. Less than one heroin users out of three was seen in treatment centers in 2013. Conclusions: The rise in the number of heroin users is related to an increasing availability of heroin, increasing use in more remote areas, and providers targeting new types of users. The figures, however, should be completed with alternative estimates and enhance the need for a perennial monitoring.     

Postwithdrawal Exposure Treatment to Prevent Relapse in Opiate Addicts: A Pilot Study

A major problem in treating opiate addiction is relapse within a few months after withdrawal. Learning models of relapse offer some promise toward understanding this problem. The present pilot study examines whether cue-exposure treatment to drug-related cues, in hospital and real life, might reduce relapse. Fourteen opiate addicts were withdrawn on clonidine over 6 days, and 10 of those were exposed to drug-related cues in hospital for 1 week and in real life for another. There were then followed as outpatients up to 6 months. Craving was elicited in half of the 10 patients exposed to drug cues who showed within- and between-session habituation. Four cases were opiate-free at 6 months follow up and 1 at 3 months. Half of the cases had relapsed to heroin at various times up to 6 months. Habituation to craving responses was not obviously related to outcome whereas vocational factors were. The operational use of craving in research is discussed.     

Single Dose of 24 Milligrams of Buprenorphine for Heroin Detoxification: An Open-label Study of Five Inpatients

Abstract

Previous studies indicate that buprenorphine has efficacy in medically supervised opioid withdrawal, but the optimal dosing for maximum tolerability and ease of administration remains undetermined. Five heroin-dependent individuals entered this open-label study of inpatient detoxification with a single 24mg dose of buprenorphine. The mean Clinical Opiate Withdrawal Scale (COWS) score prior to buprenorphine administration was 17.6 (SD = 3.36). COWS scores declined significantly thereafter. There was one episode of precipitated withdrawal that resolved within four hours. Use of ancillary medications was minimal. This study suggests that a single high dose of buprenorphine can be used safely and effectively for inpatient detoxification.     

电针背俞穴治疗海洛因患者早期稽延性戒断症状的临床研究

目的:比较电针背俞穴、五输穴对改善海洛因患者早期稽延性戒断症状的临床疗效,为优化配穴组方,提高电针戒毒的临床疗效提供依据。方法:将27例海洛因依赖者随机分成3组,采用海洛因稽延症状评定量表,动态观察不同的针灸配穴对早期稽延性戒断症状的治疗效果。结果:电针背俞穴组和电针五输穴组都能明显降低治疗第一天、第二天的稽延症状总评分(p<0.01),都不能降低治疗第一天、第二天的睡眠症状评分(p>0.01)。电针背俞穴组能明显改善患者的焦虑情绪(p<0.01),而电针五输穴组对焦虑情绪则无明显影响,两者表现出明显的差别。结论:电针背俞穴能明显改善稽延症状总评分。与传统五输穴配穴相比,电针背俞穴能明显改善患者的焦虑情绪。     

Mortality Risk for Cocaine Abusers in Relation to Heroin Use: A Follow-Up Study

Cohort study on 471 subjects resident in the metropolitan area of Bologna who had visited a public treatment center for problems due to the abuse of cocaine from January 1, 1988 to December 31, 2009. Two user typologies were created: cocaine users (no heroin) and heroin and cocaine users. Crude mortality rates and standardized mortality ratios were calculated. We performed a regression analysis using the Poisson method. The study results show a higher mortality risk for those injecting substances and for subjects who took both heroin and cocaine. They appear to have different characteristics from their counterparts who do not use heroin. Future studies should be oriented to this aspect.     

Effectiveness of Therapies for Heroin Addiction in Retaining Patients in Treatment: Results From the VEdeTTE Study

Treatment is effective in reducing heroin use and clinical and social problems among heroin addicts. The effectiveness is related to the duration of treatment. “VEdeTTE” is an Italian longitudinal study funded by the Ministry of Health to evaluate the effectiveness of treatments provided by the National Health Services. The study involved 115 drug treatment centers and 10,454 heroin users. Clinical and personal information were collected at intake through a structured interview. Treatments were recorded using a standardized form. Survival analysis and Cox Proportional Hazard model were used to evaluate treatment retention. Five thousand four hundred and fifty-seven patients who started a treatment in the 18 months of the study were included in the analysis: 43.2% received methadone maintenance therapy (MMT), 10.5% therapeutic community, and 46.3% abstinence-oriented therapy (AOT). The likelihood of remaining in treatment was 0.5 at 179 days. The median daily dose of methadone was 37 mg. Psychotherapy was provided in 7.6% of patients receiving methadone and 4.9% of those in therapeutic community. Type of therapy was the strongest predictor of retention, with AOT showing the lowest retention. In MMT patients, retention improved according to dose. Living alone, psychiatric comorbidity and cocaine use increased the risk of dropout. Psychotherapy associated halved the risk of dropout.     

脱毒灵和益安回生治疗海洛因依赖的临床对照研究

目的:初步评价脱毒灵对海洛因脱毒的疗效及不良反应.方法:采用分层随机抽样法,将123例海洛因依赖者分成脱毒灵组62例,益安回生组61例,进行疗效对照研究.结果:两组在一般情况相似、具可比性的条件下,脱毒灵组治疗海洛因依赖戒断症状的疗效显著优于益安回生组(P＜0.001),其中对焦虑、渴求的缓解率也显著优于益安回生组(P＜0.001).两组在本研究中未观察到明显不良反应,亦无依赖性.结论:脱毒灵对海洛因依赖脱毒的疗效肯定,使用安全,无依赖性.     

Tentative Evidence for Striatal Hyperactivity in Adolescent Cannabis-Using Boys: A Cross-Sectional Multicenter fMRI Study

Abstract

Adolescents' risk-taking behavior has been linked to a maturational imbalance between reward (“go”) and inhibitory-control (“stop”)-related brain circuitry. This may drive adolescent drug-taking, such as cannabis use. In this study, we assessed the non-acute effects of adolescent cannabis use on reward-related brain function. We performed a two-site (United States and Netherlands; pooled data) functional magnetic resonance imaging (fMRI) study with a cross-sectional design. Twenty-one abstinent but frequent cannabis-using boys were compared with 24 non-using peers on reward-related brain function, using a monetary incentive delay task with fMRI. Focus was on anticipatory and response stages of reward and brain areas critically involved in reward processing like the striatum. Performance in users was normal. Region-of-interest analysis indicated striatal hyperactivity during anticipatory stages of reward in users. Intriguingly, this effect was most pronounced during non-rewarding events. Striatal hyperactivity in adolescent cannabis users may signify an overly sensitive motivational brain circuitry. Frequent cannabis use during adolescence may induce diminished ability to disengage the motivational circuit when no reward can be obtained. This could strengthen the search for reinforcements like drugs of abuse, even when facing the negative (non-rewarding) consequences.     

Erotic Stimulus Processing under Amisulpride and Reboxetine: A Placebo-Controlled fMRI Study in Healthy Subjects

Background:

Impaired sexual function is increasingly recognized as a side effect of psychopharmacological treatment. However, underlying mechanisms of action of the different drugs on sexual processing are still to be explored. Using functional magnetic resonance imaging, we previously investigated effects of serotonergic (paroxetine) and dopaminergic (bupropion) antidepressants on sexual functioning (Abler et al., 2011). Here, we studied the impact of noradrenergic and antidopaminergic medication on neural correlates of visual sexual stimulation in a new sample of subjects.

Methods:

Nineteen healthy heterosexual males (mean age 24 years, SD 3.1) under subchronic intake (7 days) of the noradrenergic agent reboxetine (4mg/d), the antidopaminergic agent amisulpride (200mg/d), and placebo were included and studied with functional magnetic resonance imaging within a randomized, double-blind, placebo-controlled, within-subjects design during an established erotic video-clip task. Subjective sexual functioning was assessed using the Massachusetts General Hospital-Sexual Functioning Questionnaire.

Results:

Relative to placebo, subjective sexual functioning was attenuated under reboxetine along with diminished neural activations within the caudate nucleus. Altered neural activations correlated with decreased sexual interest. Under amisulpride, neural activations and subjective sexual functioning remained unchanged.

Conclusions:

In line with previous interpretations of the role of the caudate nucleus in the context of primary reward processing, attenuated caudate activation may reflect detrimental effects on motivational aspects of erotic stimulus processing under noradrenergic agents.     

An Open-Label Pilot Study of Methylphenidate in the Treatment of Cocaine Dependent Patients with Adult Attention Deficit/ Hyperactivity Disorder

Abstract

A multi-site, open-label study of methylphenidate for treating patients with comorbid diagnoses of attention deficit/hyperactivity disorder and cocaine dependence was performed. Forty-one participants, who met DSM-IV criteria for adult attention deficit/hyperactivity disorder and cocaine dependence, were enrolled into this ten week outpatient study. The targeted total daily dose of methylphenidate was 60 mg (20 mg TID). Participants received individual substance abuse therapy throughout the trial. Safety measures included adverse events, vital signs, and electrocardiograms. Methylphenidate's efficacy was assessed by both objective and subjective measures. Seventy percent of the participants completed final study measures. Safety measures indicated that methylphenidate was well tolerated by the participants. Subjective efficacy measures suggested that participants evidenced improvement in both cocaine dependence and adult attention deficit/hyperactivity disorder symptoms. Quantitative benzoylecgonine indicated that only those participants categorized as being compliant showed improvement. A double-blind, placebo-controlled study of methylphenidate for this population may be warranted.