Understanding Prolonged Cessation from Heroin Use: Findings from a Community-Based Sample

Background: There is abundant literature describing heroin initiation, co-morbidities, and treatment. Few studies focus on cessation, examining the factors that motivate and facilitate it.

Methods: The CHANGE study utilized mixed methods to investigate heroin cessation among low-income New York City participants. This paper describes findings from qualitative interviews with 20 former and 11 current heroin users. Interviews focused on background and current activities, supports, drug history, cessation attempts, and motivators and facilitators to cessation. Results: Participants found motivation for cessation in improved quality of life, relationships, and fear of illness, incarceration and/or death. Sustained cessation required some combination of treatment, strategic avoidance of triggers, and engagement in alternative activities, including support groups, exercise, and faith-based practice. Several reported that progress toward goals served as motivators that increased confidence and facilitated cessation. Ultimatums were key motivators for some participants. Beyond that, they could not articulate factors that distinguished successful from unsuccessful cessation attempts, although data suggest that those who were successful could describe more individualized and concrete—rather than general—motivators and strategies. Conclusions: Our findings indicate that cessation may be facilitated by multifaceted and individualized strategies, suggesting a need for personal and comprehensive approaches to treatment.     

静息态fMRI观察强制戒断与美沙酮维持治疗6个月对海洛因成瘾者脑功能的影响

目的 分析强制戒断（PA）和美沙酮维持治疗（MMT）干预6个月对海洛因成瘾者大脑功能影响的差异。方法 招募22例PA干预6个月的海洛因成瘾者（PA组）、25例MMT干预6个月的海洛因成瘾者（MMT组）和35名健康志愿者（正常对照组）。对所有受试者行fMRI采集静息态数据,利用低频振幅（ALFF）方法计算3组大脑局部自发性脑活动的强度,分析比较3组大脑ALFF差异。结果 3组在右侧额中回、左侧内侧额上回、左侧岛叶、左侧舌回、右侧舌回、右侧辅助运动区ALFF值差异有统计学意义（P均<0.01）,且PA组右侧额中回、左侧内侧额上回、左侧舌回、右侧舌回和右侧辅助运动区ALFF值与MMT组差异有统计学意义（P均<0.01）,PA组与正常对照组右侧额中回和右侧舌回ALFF值差异无统计学意义（P均>0.05）。结论 经6个月干预后,MMT者与PA者在部分脑区仍存在异常,但PA可能更有利于海洛因成瘾者脑功能恢复。     

Does alcohol increase the risk of overdose death: the need for a translational approach

Background We argue for a translational approach to addiction science, using an important current research question as a case study. Case study What is the evidence in support of the hypothesis that alcohol increases the risk of a heroin/opiate overdose through a pharmacological interaction? Findings The positive epidemiological evidence shows that opiate overdose deaths rarely involve a single drug; that alcohol is the most common other drug involved; that there is a negative association between alcohol and morphine concentration at post mortem; and that post‐mortem levels of morphine are often below the levels expected of highly tolerant individuals. The evidence is consistent with the hypothesis that heroin users who drink may require less heroin to overdose than those who do not drink (all other factors being equal) because of a pharmacological interaction. However, the evidence is consistent with, and does not rule out, other causal (and non‐causal) pathways. Alcohol could be associated negatively with tolerance, or confounded by other factors. Experimental evidence is required which is unlikely to be obtained through further epidemiological study or through randomized clinical trials. Conclusions We believe that animal models could provide the key evidence to test the hypothesis for a ‘pharmacodynamic’ or ‘pharmacokinetic’ interaction, which could be corroborated in clinical challenge studies and epidemiological studies. Such a translational approach demands greater collaboration between addiction scientists from basic to applied science and from neuroscience to social science, and would be able to address other key research questions and hypotheses in addiction.     

针灸对海洛因复吸大鼠脑组织多巴胺、5-羟色胺的影响

目的探讨针灸干预海洛因复吸的作用机制。方法采用间断性递增量肌肉注射海洛因的方法复制海洛因复吸大鼠模型,观察针灸对海洛因复吸大鼠条件性位置偏爱（conditional position preference,CPP）的行为学改变及脑组织多巴胺（dopamine,DA）、5-羟色胺（5-hydroxytryptamine,5-HT）含量变化的影响。结果针灸能防止海洛因复吸大鼠体质量的下降（P〈0.01）,显著延长海洛因复吸大鼠在暗箱的停留时间（P〈0.01）,显著降低海洛因复吸大鼠脑组织DA和5-HT含量（P〈0.01）。结论抑制脑组织DA、5-HT的释放,降低对海洛因用药行为有关环境的依赖行为,可能是针灸干预海洛因复吸的作用机制之一。     

海洛因依赖者环境线索诱发心理生理反应

目的：了解海洛因依赖者对吸毒相关环境线索诱发反应。方法：对来自自愿戒毒机构的36例刚完成生理脱毒（康复早期）的海洛因依赖者和劳教戒毒机构112例康复期满1年的海洛因依赖者观看吸毒相关视频同时给予海洛因模拟物及吸毒用具刺激,于暴露前后自评渴求程度、情绪以及戒断症状反应;用生物反馈仪自动记录暴露前后的生理反应。结果：环境线索暴露后海洛因依赖者心理渴求、害怕／焦虑、抑郁／悲伤、戒断症状、心率、皮肤导电和肌电增高（P〈0．05）,中性／放松／自然降低（P〈0．05）。自愿戒毒机构康复早期海洛因依赖者环境诱发心率增高,比康复期满一年以上者更明显（P〈0．05）,其余与康复期长短无显著关系。结论：海洛因依赖者戒断康复期的延长并不会使渴求和环境诱发心理生理反应减弱或消褪。     

Tai-Kang-Ning,a Chinese Herbal Medicine Formula,Alleviates Acute Heroin Withdrawal

The efficacy and safety of Tai-Kang-Ning (TKN) capsule, a traditional Chinese medicine formula, for the treatment of acute heroin withdrawal syndrome were investigated by conducting a double-blind, double-dummy, positive-controlled, and randomized trial. Sixty-four patients with acute heroin withdrawal syndrome were recruited. These patients were treated with either TKN or lofexidine in a fixed schedule of doses for 10 days. The results indicate that both treatments significantly reduced withdrawal symptoms by day 3, but there was no significant difference overall between lofexidine and TKN in efficacy or safety. These results demonstrate that TKN is effective in the treatment of moderate-to-severe acute heroin withdrawal syndrome with mild adverse effects.     

博乐欣治疗海洛因依赖者情绪障碍的临床观察

目的：探讨海洛困依赖者情绪障碍的临床特点及治疗。方法：对68例海洛因依赖者在脱毒后的一周内，测查汉密顿焦虑（HAMA）量表和汉密顿抑郁（HAMD）量表；把68例随机分为对照组27例和药物处理组41例。对照组仅给予简单的言语解释和支持，药物处理组给予博乐欣150mg／日治疗。四周后对所有依赖戒断者复查HAMA、HAMD量表，并进行疗效评定。结果：发现海洛因依赖戒断者有明显的焦虑、抑郁等情绪障碍，药物处理组使用博乐欣治疗4周后，HAMA、HAMD评分明显下降（除睡眠障碍）并与对照组相比有显著差异（P〈0．01）结论：海洛因依赖戒断者很容易出现焦虑和抑郁情绪障碍，在其脱毒后早期使用抗抑郁药博乐欣。对于海洛因依赖戒断者的情绪障碍具有较好疗效。