Journal of Addictive Diseases最新文献

Background: Tobacco use presents increased risks for individuals with weakened immune systems (WIS). We investigated the association between cigarette and electronic nicotine delivery systems (ENDS or e-cigarettes) use and WIS in US adults using data from the 2021-2022 National Health Interview Survey.

Methods: Data from 57,133 adults were analyzed, focusing on WIS prevalence due to health conditions, prescriptions, or both. Cigarette and ENDS use were categorized as never, former, or current. Weighted multivariable regression models adjusted for demographics and other health conditions to assess associations between tobacco use and WIS.

Results: Among US adults, 4.3% had prescription-related WIS, 4.6% had health condition-related WIS, and 7% had WIS due to either reason. Adjusted results from multivariable regression models indicated that adults with WIS due to health conditions were more likely to be current (AOR = 1.21, 95%CI: 1.05-1.40) and former (AOR = 1.25, 95%CI: 1.11-1.39) cigarette smokers compared to counterparts without WIS. Adults with WIS due to prescriptions were more likely to be former cigarette smokers (AOR = 1.19, 95%CI: 1.06-1.34). Those with WIS for any reason were more likely to be current (AOR = 1.19, 95%CI: 1.05-1.35) and former (AOR = 1.24, 95%CI: 1.13-1.36) cigarette smokers. Adults with WIS due to health conditions (AOR = 1.23, 95%CI: 1.06-1.41) or any reasons (AOR = 1.19, 95%CI:1.05-1.34) were more likely to be former ENDS users compared to those without WIS.

Conclusions: In this nationally representative study, we found a notable link between cigarette and ENDS use with WIS, particularly among those with health condition-related or prescription-related WIS, underscoring the importance of addressing tobacco use in this vulnerable population.

Introduction: The aim of this study is to report on a patient case in which transcranial direct current stimulation (tDCS) was used to treat gambling disorder (GD).

Methods: The research method used is a single case study, with the participant selected using purposive sampling. The patient is a 28-year-old married man who has been gambling for five years. Research tools included Gambling Symptoms Assessment scale, Impulsiveness Scale, Depression and Anxiety Inventory, and functional magnetic resonance imaging (fMRI). The intervention protocol included stimulation for 10 consecutive days, 20 min per day, with a current of 1.5 mA, and montage with the anodal electrode over F3 and the cathodal electrode over F4. Data were analyzed by fMRI and statistical parametric mapping (SPM) software.

Results: Findings suggest that intervention with tDCS may be effective in reducing the symptoms of GD, depression, anxiety and impulsivity.

Discussion: This is the first report of tDCS effectiveness and feasibility in a case report utilizing an fMRI outcome. While results of this case report are promising, more robust studies are required to establish therapeutic efficacy of tDCS in GD.

Introduction: Injectable extended-release buprenorphine is an effective treatment for opioid use disorder (OUD), but injection site reactions (ISRs) are common treatment-emergent adverse events that may impact patient comfort, adherence, and outcome. This report examines the clinical presentation, prevalence, and management of Sublocade-related ISRs through two case studies and a review of existing literature.

Case presentation: We present two cases of ISRs in patients receiving extended-release buprenorphine, Sublocade. The first involves a 65-year-old male who experienced localized pain, swelling, and erythema after the injection. The second case features a 58-year-old male with injection site swelling, tenderness, and presumed cellulitis. We also examine ISR prevalence and severity from clinical trials and real-world data.

Management & outcomes: Both patients received timely care and responded well to appropriate interventions. The first case was managed conservatively with cold compresses, topical hydrocortisone, and ibuprofen, resulting in symptom resolution. The second case required oral antibiotics after ultrasound imaging revealed a subcutaneous fluid collection; the cellulitis resolved without systemic complications.

Conclusion: While ISRs associated with Sublocade are common, most are manageable with conservative interventions. Emphasizing patient education, proper injection techniques, and site rotation is essential to prevent ISRs, minimize their severity, and enhance treatment outcomes in patients with OUD.

Background: Comorbidity between opioid use disorder (OUD) and chronic pain is substantial. Pain has been shown to be a motivator for OUD onset, maintenance, relapse, and treatment delay. A cluster of pain conditions known as chronic overlapping pain conditions (COPCs), also now referred to in contemporary ICD classification as primary pain conditions, are particularly refractory to traditional forms of pain treatment, and likely adversely impact comorbid OUD.

Objective: This cross-sectional descriptive study sought to obtain a better understanding of the prevalence of COPCs among individuals with OUD.

Methods: The COPCs screener was originally developed to address the challenges of readily assessing for multiple of these conditions; which is important given that the number of said conditions acts as a marker for the likely presence of nociplastic pain. This screener was used alongside supplementary survey items to describe COPCs and pain distribution in a sample of individuals with active OUD recruited from a syringe exchange program.

Results: Comparisons of COPC prevalence between the study sample and global prevalence estimates found that among those with OUD, there is a significantly higher-than-expected prevalence of chronic low back pain, myalgic encephalomyelitis/chronic fatigue syndrome, chronic migraine headache, and fibromyalgia.

Conclusions: Results support further investigations into COPCs in the context of OUD. Further research may reveal methods of enhancing OUD treatment and identifying additional targets for intervention and prevention.

Introduction: Alcohol withdrawal syndrome (AWS) and serotonin syndrome (SS) share several overlapping symptoms, complicating diagnosis in patients with alcohol use disorder (AUD) on serotonergic treatment.

Case presentation: We describe a 54-year-old male with a history of AUD and anxiety disorder who presented to a residential treatment center after patient report about 11 days of alcohol abstinence. Despite an initially mild withdrawal course, he developed worsening tremors, nausea, diarrhea, diaphoresis, muscle twitching, rigidity, and restlessness beyond the typical AWS timeframe. His medication regimen included multiple serotonergic agents. Neurological examination revealed hyperreflexia, clonus, and persistent hypertension, fulfilling the Hunter Serotonin Toxicity Criteria for SS. All serotonergic medications were discontinued and supportive care was initiated, leading to rapid symptom improvement and resolution.

Conclusions: Thorough evaluation of medication history and symptom timeline during clinical assessment is critical for differentiating AWS and SS. Clinicians are encouraged to remain vigilant for SS in patients with AUD on serotonergic agents to prevent adverse outcomes and potential mortality.

Background: Services for individuals severely physically dependent on alcohol, wishing to undergo detoxification are limited. This is partly due to a lack of evidence surrounding safe alcohol reduction advice.

Objectives: To summarize the practices from an elective alcohol detoxification service provided by Sandwell and West Birmingham NHS Trust (SWB) (Birmingham, United Kingdom) aimed at preparing high-risk individuals for detoxification.

Methods: Semi-structured interviews were conducted with healthcare professionals working at the SWB elective detoxification service, representing a collective experience of 50+ years in the management of alcohol related presentations. A descriptive qualitative analysis approach was adopted.

Results: Four categories of discourse were observed: 1) establishing a motivation to change, 2) the importance of an in-depth alcohol history, and 3) an individualized approach to patients, and 4) the role that readiness to change attitudes play in preparedness for detoxification. Practical advice relating to alcohol reduction included: consolidation of multiple beverages to fewer, 'measure and discard' techniques, and spacing out consumption/diluting beverages.

Conclusions: Core components to elective detoxification preparation were: 1) safety, 2) the requirement of an individualized approach and 3) a willingness to take ownership of recovery. The approaches discussed may help improve translation of alcohol detoxification services to those considered high-risk. The Standards for Reporting Qualitative Research framework was applied throughout.

Methamphetamine use disorder (MUD) currently lacks FDA-approved treatments. Previous studies involving transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (L.dlPFC) have shown promise in TMS's effectiveness at decreasing craving for methamphetamine. Theta burst stimulation (TBS), which includes intermittent (iTBS) and continuous (cTBS) protocols, is increasingly being used for substance use disorders, including MUD. Previous reviews of TMS in MUD performed subgroup meta-analyses of studies that delivered TBS in MUD. However, these meta-analyses included studies with overlapping participant cohorts, limiting their validity. To address this limitation, we reviewed randomized controlled trials (RCTs) using unique patient cohorts from PubMed/Medline, EMBASE, and Google Scholar until September 1, 2024, comparing the impact of TBS versus sham on cue-induced methamphetamine craving in patients with MUD. We performed a meta-analysis with four eligible RCTs that delivered iTBS. Results suggest iTBS was more effective in reducing cue-induced methamphetamine craving than sham iTBS (standardized mean difference [SMD] in change = 1.04; 95% CI [0.16, 1.92]). Two additional RCTs without sham control arms were reviewed, and one demonstrated a significant reduction in craving following accelerated iTBS. Future studies should examine whether neuroimaging-targeted iTBS can impact outcome measures other than craving, such as methamphetamine use, by measuring return to use. Exploring accelerated iTBS and cTBS for MUD, targeting alternative cortical sites such as the frontal pole, and studying their effects on relevant MUD biomarkers is also pertinent. This review demonstrates the effectiveness of TBS for MUD, emphasizing its potential to advance treatment options for MUD.

Background: Literature highlighted a higher sweet preference among patients with alcohol use disorder (AUD) that may act as an endophenotypical vulnerability. However, results remain heterogenous and seldom information is available regarding possible origins, such as hedonic abilities, reward sensitivity or impulsivity.

Objective: This cross-sectional study aims to explore the relationship between AUD and sweet preference as well as its endophenotypical properties.

Methods: Ninety-two participants were divided into three groups (36 patients with AUD, 29 healthy controls and 27 healthy first-degree relatives), and were asked to take a sweet preference test, a hedonic test, the Iowa Gambling Task (IGT) and self-reported inventories measuring impulsivity (Barratt Impulsiveness Scale [BIS-11]), anxiety and depression (Hospital Anxiety and Depression scale [HADS]). A stepwise linear regression with all available variables was performed to compare patients and controls. Factors included in the retained model were then added as mediators in a path analysis.

Results: Compared to healthy controls, patients with AUD had a lower sweet score. The difference lost its significance in the linear regression: the retained model only included antidepressant use (p = .016) and tobacco use status (p = 0.074). The path analysis showed that antidepressant use, but not tobacco use status, significantly mediated the effect of AUD on sweet preference. Sweet score did not significantly differ between first-degree relatives and the two other groups.

Conclusions: Our results do not support the hypothesis that sweet preference is an endophenotype of AUD. Instead, they suggest that the association between sweet preference and AUD may be mediated by confounding factors such as antidepressant use.

Substance use disorders (SUDs) are chronic, relapsing conditions characterized by significant neurobiological and behavioral disruptions. Emerging evidence highlights the critical roles of oxidative stress, mitochondrial dysfunction, and neuroinflammation in the pathophysiology of drug misuse. Coenzyme Q10 (CoQ10), a mitochondrial cofactor with potent antioxidant and anti-inflammatory properties, has gained attention as a potential adjunctive therapy for managing substance-related neurotoxicity. This review explores the mechanistic role of CoQ10 in mitigating the oxidative damage and neuroinflammation induced by substances misuse, emphasizing its ability to restore mitochondrial function and support neuronal health. Preclinical studies demonstrate that CoQ10 supplementation reduces apoptosis, preserves neurotransmitter systems, and improves behavioral outcomes in models of cocaine, alcohol, nicotine, and opioid addiction. Clinical evidence, though limited, suggests CoQ10's safety and therapeutic potential in oxidative stress-related conditions, reinforcing its relevance to addiction. Despite these promising findings, challenges such as low bioavailability and the lack of SUD-specific clinical trials remain significant barriers. This review underscores the need for further research to optimize CoQ10's formulation, dosing strategies, and clinical applications in the treatment of SUDs. Integrating CoQ10 into multidisciplinary approaches could advance our ability to address the complex neurobiological challenges of SUDs and improve long-term recovery outcomes.