Effect of electro-acupuncture intervention on cognition attention bias in heroin addiction abstinence—A dot-probe-based event-related potential study

Objective  

To study the changes of cognitive attention-related brain function in the heroin addicts before and after electro-acupuncture (EA) intervention for exploring the concerned neuro-mechanism of addictive relapse and the central action role of EA intervention.     

左旋四氢帕马丁对条件线索诱导的大鼠海洛因复吸行为的影响

目的研究左旋四氢帕马丁(levo-tetrahydropalmatine,l-THP)对条件线索诱导的大鼠海洛因复吸行为的干预作用。方法应用固定比率程序(fixed ratio,FR)1建立大鼠海洛因自身给药模型,戒断14 d后,观察-lTHP对条件线索诱导的大鼠海洛因复吸行为的影响。结果 2 h内l-THP组大鼠有效鼻触次数显著低于溶媒对照组(P<0.05)。结论 l-THP能有效干预条件线索诱导的大鼠海洛因复吸行为,具有预防海洛因复吸的应用前景。     

Defining and Predicting Opioid and Cocaine Treatment Response

Background: Treatment with methadone is effective in reducing heroin use, HIV risk, and death; however, not all patients respond to treatment. Better outcomes may emerge with personalized treatment based on factors that influence treatment courses. Objectives: To investigate psychosocial variables contributing to treatment response, using a comprehensive definition of treatment response. Methods: Seventy participants seeking treatment for heroin and cocaine addiction completed up to 40?weeks of daily methadone. At week 22, we administered a semi-structured interview for DSM-IV symptoms. We defined opioid treatment responders as people still enrolled at 22?weeks, not meeting past 30-day criteria for DSM-IV opioid abuse or dependence or DSM-5 opioid use disorder, and providing ≥75% opioid-negative urine samples in the 30?days prior to week 22. The same criteria were applied to assess cocaine treatment response. Results: Sample was 71% male, 41% White, and averaged 39.4?±?7.9?years old. Opioid treatment response was more likely in participants who had been employed over the past 3?years (OR: 8.1, 95% CI: 1.2–55) and less likely in those who spent more time on hobbies (OR: 0.45, 95% CI: 0.23–0.88). Cocaine treatment response was more likely in participants who had a good relationship with their father (OR: 5.3, 95% CI: 1.2–24) and less likely if positive for hepatitis C (OR: 0.15, 95% CI: 0.03–0.75). Conclusions: Pretreatment characteristics differentially predict treatment response for heroin and cocaine use. Similar research in diverse patient groups may aid in the development of personalized treatment combining biologic treatment with targeted psychosocial interventions.     

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.     

High-Frequency Users of Detoxification: Who Are They?

Utilizing a longitudinal database (1996–2002) with all intake information from entries to all licensed drug treatment programs in Massachusetts (N = 27,801), this study examined factors associated with multiple detoxification admissions by injection drug users (IDUs). Four logistic regression models were developed. Although our hypothesis was that the highest frequency treatment users (in the 95th percentile) would be those in the detoxification-only group, this was incorrect: the highest frequency detoxification users were those most likely to use detoxification along with methadone maintenance, outpatient counseling, and/or residential treatment. Health insurance was a key factor. Study implications, limitations, and future research directions are noted.     

Factors Associated with Recent-Onset Injection Drug Use among Drug Users in Pakistan

Seventy-two recent-onset injection drug users and 241 non-injection drug users were recruited in Quetta and Lahore, Pakistan, in 2003. Trained interviewers administered questionnaires regarding drug use behaviors and perceived changes in drug cost/supply. Logistic regression identified independent correlates of recent-onset injection. In Lahore, a perceived increase in drug cost was associated with higher odds of recent-onset injection, with no association in Quetta. Recent-onset injection was also associated with family history of drug use, group drug use, and sharing snorting/chasing tools. Changes in perception of the drug supply may be associated with recent-onset injection drug use. Familial/social influences were also associated with recent-onset injection, suggesting peer-led interventions could discourage transition to injection drug use.     

A Cross-Sectional Study on Prevalence of Non-Fatal Drug Overdose and Associated Risk Characteristics Among Out-of-Treatment Injecting Drug Users in North Vietnam

In a community-based cross-sectional survey among out-of-treatment male opiate injecting drug users (IDU) aged 18–45, data on non-fatal overdose were collected using a semi-structured questionnaire. From August to September 2003, 299 IDU were recruited in two districts of Bac Ninh, a semi-urban province in North Vietnam. Prevalence of lifetime and recent non-fatal overdose were 43.5 and 83.1%, respectively. Logistic regression analyses showed associations between non-fatal overdose and younger age, unemployment, residence in the provincial township, frequency of injecting, injecting heroin mixed with valium, and history of drug treatment. While recognizing the limitations of this study, it is the first in Southeast Asia to report on prevalence of drug use–related overdose. Future research is recommended on occurrence of fatal overdose in this population.     

Not All Injection Drug Users Are Created Equal: Heterogeneity of HIV,Hepatitis C Virus,and Hepatitis B Virus Infection in Georgia

Injection drug users (IDU) are widely believed to have accelerated the looming HIV/AIDS epidemic now faced by the Russian Federation and countries of the former Soviet Union. However, IDUs may be heterogeneous with regard to risk behaviors, and a subpopulation may be responsible for the majority of blood-borne pathogen transmission. We studied 926 adult injection drug users (IDU) from the cities of Tbilisi, Batumi, and Poti in Georgia, a small country in the Caucuses region between the Black and Caspian Seas, between 1997 and 1998. Study participants were administered a confidential questionnaire and were tested for antibody to HIV, hepatitis C virus (HCV), hepatitis B virus surface antigen (HBsAg), and hepatitis B core antibody (anti-HBc). Five (0.5%) individuals were positive for HIV; 539 (58.2%), for HCV; 67 (7.2%), for HBsAg; and 475, for (51.3%) anti-HBc. Surveyed individuals, 88.7%, reported sharing needles with others, and needle sharing with more than 10 other individuals versus no sharing was a highly significant predictor (OR: 278.12, 95% CI: 77.57, 997.20) of HCV seropositivity. In adjusted analysis, individuals who usually injected stolen medical/synthetic drugs had significantly lower odds of HCV (OR: 0.38, 95% CI: 0.22, 0.68) and HBV (OR: 0.58, 95% CI: 0.37, 0.90) than individuals most commonly injecting opium. Despite some limitations, these results suggest the presence of substantial heterogeneity between different injection drug-using groups in Georgia. Identification of high-risk IDU subpopulations is vital to efficiently target risk reduction programs and to prevent confounding by risk status in large HIV/AIDS behavioral intervention and vaccine trials.     

Cue-Elicited Craving in Heroin Addicts at Different Abstinent Time: An fMRI Pilot Study

Objective: We evaluated the effect of short-term and long-term heroin abstinence on brain responses to heroin-related cues using functional magnetic resonance imaging (fMRI). Methods: Eighteen male heroin addicts following short-term abstinence and 19 male heroin addicts following long-term abstinence underwent fMRI scanning while viewing heroin-related and neutral images. Cue-elicited craving and withdrawal symptoms in the subjects were measured. Results: Following short-term abstinence, greater activation was found in response to heroin cues compared to neutral cues in bilateral temporal, occipital, posterior cingulate, anterior cingulate, thalamus, cerebellum, and left hippocampus. In contrast, activations in bilateral temporal and occipital and deactivations in bilateral frontal, bilateral parietal, left posterior cingulate, insula, thalamus, dorsal striatum, and bilateral cerebellum were observed following long-term abstinence. Direct comparisons between conditions showed greater brain reactivity in response to smoking cues following short-term abstinence. In addition, short-term abstinence had more serious withdrawal symptoms than the long-term. Conclusion: The present findings indicate that compared to short-term, long-term abstinence manifests less serious withdrawal symptoms and significantly decreases neural responses to heroin-related cues in brain regions subserving visual sensory processing, attention, memory, and action planning. These findings suggest that long-term abstinence can decrease the salience of conditioned cues, thereby reducing the risk of relapses. The study's limitations are noted.