Journal of Addictive Diseases最新文献

Rationale: The opioid crisis in North America has recently seen a fourth wave, which is dominated by drug-related deaths due to the combined use of illicitly manufactured fentanyl [IMF] and stimulants such as cocaine and methamphetamine.

Objectives: A systematic review addressing the question why drug users combine opioids and stimulants and why the combination results in such a high overdose mortality: from specific and dangerous pharmacokinetic or pharmacodynamic interactions or from accidental poisoning?

Results: Motives for the combined use include a more intensive high or rush when used at the same time, and some users have the unfounded and dangerous belief that co-use of stimulants will counteract opioid-induced respiratory depression. Overdose deaths due to combined (intravenous) use of opioids and stimulants are not likely to be caused by specific pharmacokinetic or pharmacodynamic interactions between the two drugs and it is unlikely that the main cause of overdose deaths is due to accidental poisoning.

Conclusion: The unexpectedly high overdose rates in this population could not be attributed to accidental overdosing or pharmacokinetic/pharmacodynamic interactions. The most likely explanation for the high rate of drug-related deaths in opioid-cocaine co-users is careless overdosing with either cocaine, opioid(s) or both, probably facilitated by the high level of preexisting impulsivity in these co-users and a further acute increase in impulsivity following cocaine use. The primary corollary is that cocaine users should avoid IMF use in the same time window. In addition, IMF users should refrain from cocaine use to avoid impulsive IMF overdosing.

Background: This study pilot tested Moving On In My Recovery (MOIMR), a 12-session, acceptance-based, cognitive-behavioral, manual-guided group program for individuals in recovery from substance use. MOIMR aims to bridge the gap between formal treatment and sustained recovery. Method: Participants were 61 people in recovery from substance use and in the catchment area of the Betsi Cadwaladr Health Board, North Wales, United Kingdom. Using a variety of questionnaires, participants' psychological flexibility and wellbeing were assessed at baseline, post-treatment, and a three-month follow-up. Participants who dropped out were contacted at the follow-up and interviewed about their experience. Results: The study successfully recruited participants from real-world treatment services. During the study, significant improvements were observed in participants' social functioning, experiential avoidance, recovery capital, low mood, and anxiety. The proportion of participants who achieved abstinence also improved. Qualitative feedback confirmed the benefits that participants derived from attending the MOIMR groups. Conclusion: The program offered significant benefits for the participants despite many of them having apprehensions about undertaking a group-based approach. The gains established by quantitative analysis appeared to be supported by the qualitative findings. These findings suggest that a full randomized controlled trial of MOIMR would be feasible.

Background: Long-term complications of alcohol use disorder (AUD) include severe neurological diseases like Wernicke-Korsakoff syndrome and alcohol-related dementia. Furthermore, acute alcohol intoxication and acute withdrawal syndrome can mimic neurological symptoms. Clinicians may overlook underlying comorbidities by focusing excessively on AUD in these patients. We report two cases wherein AUD was a significant confounding factor in the diagnosis of underlying neurological conditions.

Case presentations: A 46-year-old male with AUD developed delirium tremens due to severe AAI. Despite initiating treatment for acute withdrawal syndrome which resolved delirium tremens, space-time disorientation persisted for a week. A brain MRI showed signal abnormalities in the centra semiovalia. A rachicentesis and repeat brain and spine MRI later revealed oligoclonal bands in cerebrospinal fluid and bone marrow signal abnormalities, indicating multiple sclerosis. A 61-year-old female with AUD presented with disorientation and memory deficits following a car accident. One month after discharge, the patient developed left hemidysesthesia, walking instability, strength deficits and hallucinations. Biohumoral tests confirmed that she was still in recovery. An electroencephalogram and brain CT scan and MRI raised the suspicion of Creutzfeldt-Jakob disease; elevated tau protein levels confirmed the diagnosis. The patient's condition deteriorated rapidly, leading to death.

Conclusions: Persistent neurological symptoms in AUD patients even after receiving treatment for acute alcohol intoxication or withdrawal syndrome, may indicate the presence of underlying neurodegenerative conditions such as multiple sclerosis and Creutzfeldt-Jakob disease.

TikTok's rapid rise has spurred concerns about its potential to cause problematic use behaviors, which some consider akin to addiction. This systematic review seeks to understand the diagnostic and therapeutic implications of TikTok use within the scope of clinical psychology. From September 15, 2023 to March 30, 2024 a systematic review was conducted to investigate whether this new pathological condition can be recognized as a behavioral addiction. We searched the following databases for relevant studies: PubMed, National Center for Biotechnology Information (NCBI), PsycINFO, MDPI, Frontiers in Psychology, ScienceDirect, and ReserchGate. We identified a total of 294 unique articles. 45 full-text articles were assessed for eligibility and only 21 of these met the eligibility criteria and were included in the final systematic review. We identified factors like salience, craving, and abstinence related to problematic TikTok use, confirming its potential risk as a behavioral addiction. Currently, there are neither established guidelines, nor an acceptable number of clinical cases, to determine the inclusion of TikTok addiction within an official classification. Additional considerations include the assessed target population, geographical differences, and the lack of specific treatments or interventions. Our study confirms that problematic TikTok use must be considered an addiction both for the considerable risk it entails and for its developmental trajectory. Through the analysis of the included studies, we confirmed elevated levels of salience, abstinence, tolerance, craving, excessive use, desire to control consumption, and alterations in daily life habits associated with problematic TikTok use.

Amphetamine-type stimulants (ATS), such as methamphetamine, amphetamine, and MDMA, are highly risky substances linked to neurochemical disruptions, metabolic disturbances, and systemic toxicity. Despite substantial research on their neurotoxic effects, the metabolic pathways involved in ATS dependence remain poorly understood. This study aimed to characterize the metabolic signatures associated with ATS dependence using NMR-based metabolomics to identify systemic metabolic disruptions related to chronic ATS use. A cross-sectional study was conducted involving 583 participants, comprising ATS-dependent individuals from Malaysian drug detention centers and healthy controls. Plasma samples were analyzed using 1H-NMR, CPMG, and HSQC spectroscopy to obtain comprehensive metabolomic profiles. Multivariate analyses, including PCA-X, OPLS-DA, and logistic regression, were employed to identify metabolites that differentiated ATS patients from controls. Metabolites were cross-referenced with BMRB and HMDB databases for validation. ATS-dependent individuals showed significant alterations in metabolic pathways, with reductions in cholic acid, L-valine, L-alanine, lactic acid, creatinine, histidine, taurine, and homovanillic acid (all p < .005), indicating disruptions in energy metabolism, neurotransmitter biosynthesis, and oxidative stress defenses. Elevated L-arginine levels (p < .001) suggested nitrogen metabolism dysregulation. OPLS-DA analysis demonstrated robust group separation (R²Y = 0.762, Q²Y = 0.756, AUROC = 0.987), with sensitivity, specificity, and classification accuracy of 86.9%, 97.4%, and 91.5%, respectively. This study presents the first NMR-based metabolomic profile of ATS misuse in Malaysia, identifying critical metabolic disruptions linked to chronic ATS use. Key biomarkers, including cholic acid, L-valine, and homovanillic acid, highlight potential targets for biomarker development and precision medicine strategies to improve the diagnosis, treatment, and understanding of ATS use disorder.

This systematic review synthesizes current evidence on non-prescribed ketamine use, emphasizing its neurobiological impacts and psychotherapeutic interventions. Patterns of misuse demonstrate the complex interplay of neurobiological, socio-economic, demographic and psychological factors with adolescents, women and polysubstance users identified as high-risk groups. Neurobiological findings highlight prefrontal-limbic dysconnectivity, maladaptive neuroplasticity alongside hypothalamic-pituitary-adrenal (HPA) axis dysregulation as central mechanisms underlying this addiction. The review evaluates the comparative efficacy of psychotherapies whilst proposing an innovative framework that aligns therapeutic timing with neuroplastic recovery phases. Emerging evidence identifies biomarkers, e.g., brain-derived neurotrophic factor (BDNF) and heart rate variability (HRV), as promising tools for guiding personalized and phase-specific interventions. Gaps in research include the limited representation of low-resource settings and insufficient longitudinal data on biomarker integration and therapy sequencing. Recommendations propose a comprehensive neurobiologically informed model which carefully integrates digital platforms, culturally tailored strategies and biomarkers to enhance treatment outcomes.

Background: The current study uses geographic information system (GIS) methods to better understand structural risks significantly associated with substance misuse and how those risks may be driven by urbanicity versus rurality.

Methods: Using Alabama Medicaid administrative claims data from January 1, 2015, to December 31, 2020, we identified Medicaid recipients with claims for methamphetamine use. Our dataset included 100% of claims for the 2015-2020 study period. County-level geocodes were also obtained for each Medicaid recipient aged > 18 years (n = 9,861). We added a rural-urban designation variable for each county by utilizing the rural-urban continuum codes from the United States Department of Agriculture.

Results: Fifty-one counties (76.12%), specifically, had changes in methamphetamine use rates > 0% during the study period, with 10 (14.93%) counties exhibiting >100% increases in methamphetamine use rates. Findings suggest that Alabamians residing in rural portions of the state engaged in greater usage as compared with those in urban locations.

Conclusion: Findings point to the need for intervention in rural Alabama targeting methamphetamine use. The development of prevention and intervention approaches that target risks stemming from geographical differences may bolster current efforts to reduce methamphetamine and other forms of substance misuse.

Methods: This descriptive-analytical study included a self-report questionnaire based on the TPB model, and was distributed to a sample of 115 people recovering from SUD, aged 18-69, 62% of whom were men.

Results: Attitude, Subjective Norms (SN), and Perceived Behavioral Control (PBC) toward online addiction treatment was significantly positive in relation to intention and past behavior of participants in online addiction treatment. Attitude and PBC were found to be significant predictors, and the TPB model was found to be significant {F (3,111) = 47.29, p < 0.01}, explaining 56% of the variance of intention for participants in online addiction treatment.

Conclusion: As online treatment is a relatively new tool in addiction treatment, professionals and treatment providers should encourage beliefs, attitudes, moral norms, and perceived behavior control to increase intentions among future participants in online addiction treatment.

Background: Consuming opioid agonists is a risk factor for cardiovascular disease particularly in intravenous heroin users. The monthly injectable extended-release opioid antagonist, naltrexone (XR-NTX) is an effective treatment for opioid use disorder. The impact of opioid receptor blockade through XR-NTX on blood pressure, a critical risk factor for cardiovascular morbidity, has not yet been characterized.

Methods: The study evaluated the change in blood pressure during XR-NTX treatment among 14 patients who predominately used intravenous heroin and 24 patients who used prescription oral opioids, all with opioid use disorder. Blood pressure was measured in each patient immediately before the first XR-NTX injection and ∼two weeks after the first injection. The change in diastolic and systolic pressure was compared between the heroin users and the prescription opioids users using analysis of variance.

Results: XR-NTX treatment was associated with significant decreases in diastolic blood pressure in the heroin group, but not in the prescription opioids group. Systolic blood pressure values in the heroin users showed a decline at trend level only.

Conclusions: Further research is warranted to replicate our findings and to determine whether XR-NTX effect is relatively specific to blood pressure or generalizes to other components of metabolic syndrome. Distinguishing between heroin and prescription opioid users could shed light on the unique clinical and pharmacological profiles of opioid drugs, particularly regarding their cardiovascular safety. This information can be useful in developing personalized therapeutic strategies based on the route of opioid administration.

Background: Most studies on Food Addiction (FA) used the strict classical diagnosis approach without quantifying sub-threshold symptoms (i.e. uncontrolled/excessive food intake, negative affect, craving, tolerance, withdrawal, and continued use despite harm) nor indicating where they stand on the "three-stage addiction cycle" modeling the transition from substance use to addiction.

Objectives: (1) to estimate the proportion of clinically significant episodes of distress/impairment in severely obese patients without FA, and (2) to assess their associations with FA symptoms at the subthreshold level.

Methods: The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) assesses 11 symptoms (diagnostic criteria) plus clinically significant impairment and distress (clinical significance criterion). We used this tool to diagnose FA (≥ 2 criteria plus clinical significance) in adult patients with severe obesity, but included only those below the threshold in the analyses. Demographics, clinical features, and obesity complications were collected.

Results: Only 18% of the 192 participants (women n = 148, 77.1%; mean age: 43.0 ± 13.2) reported a total absence of FA symptoms, while one in four reported recurrent episodes of clinically significant distress (24%) or impairment (25%) in social, occupational, or other important areas of functioning. The most common recurrent symptoms were first-stage symptoms (binge/intoxication), while second- (withdrawal/negative affect) and third-stage (preoccupation/anticipation) symptoms affected nearly one patient in five for tolerance and craving, and one in ten for withdrawal. In multivariate analysis, impairment was positively related to withdrawal and tolerance, while distress was positively related to failure in role obligations.

Conclusion: Many patients with severe obesity experience recurrent episodes of FA symptoms at the subthreshold level. Prospective studies will examine whether these symptoms may play a causal role in symptoms progression toward a full-blown FA and obesity outcomes.