Journal of addiction research & therapy最新文献

Opioid use continues to represent a significant public health problem in the United States, as well as globally. The opioid epidemic has motivated advances in the effective treatment of opioid use disorder (OUD), with a particular focus on medications for OUD (MOUD), including methadone, buprenorphine, and naltrexone. Although these medications are remarkably effective, MOUD expansion initiatives alone have not been sufficient to combat the opioid epidemic. Further, critical questions remain regarding the effectiveness of these medications for individuals who initiate opioid use under age 16. Key strategies to combat the opioid epidemic, including MOUD and naloxone distribution, target intervention for individuals who have already developed an OUD. Like every other health problem, shifting attention earlier in the etiological process can lend itself to a more cost-effective approach by preventing the onset of behaviors that contribute to subsequent increases in morbidity and mortality. Therefore, we argue that targeted interventions for adolescents with substance use problems, including for non-opioid drugs (i.e., cannabis, alcohol), is critical to prevent the onset of OUD and turn the tide of the opioid overdose epidemic. In line with this call to action to move toward earlier intervention as a public health strategy, we propose several concrete recommendations. These include use of universal screening and prevention strategies for teens, an enhanced focus on addressing mental health (i.e., depression, trauma-related anxiety) and ecological (i.e., low caregiver monitoring, affiliating with substance using peers) precursors of substance use initiation in adolescents, a significant restructuring of resource allocation to more effectively and equitably address youth substance use and mental health problems, and continuous efforts dedicated to the de-stigmatization of the disease of substance use disorders.

Background: Rural hospitals and patient population tend to be medically underserved. The states with more rural population dispensed the most opioids per person in the last 10 years. We aimed to explore if rurality contributed to the likelihood of higher opioid adversity and how it affected substance-use rehabilitation in federally designated Medically Underserved Areas (MUAs).

Methods: We analyzed data dispensed by the South Dakota Department of Health (DOH) on opioid-led poisoning International Classification of Disease (ICD) codes that were active within the state in the last decade. After locating MUA rural and partially rural counties, we cross profiled the counties to the state datasets. Assessments were conducted using the PROC SURVEY methods in SAS version 9.3 (SAS Institute) and checked for multicollinearity with the Belsley-Kuh-Welsch technique. Finally, we used the American Hospital Association (AHA) database for analyzing substance use rehabilitation availability on per hospital basis.

Results: The chi-square statistic for comparing opioid codes against non-opioid codes distributed among three categories, rural, non-rural, and partially rural was significant at the limit of p <0.05. 81.134% of opioid-led poisoning codes were activated in a rural county. Only four hospitals had substance-use rehabilitation, three of which were in a non-rural area. More people from the teenage and early-adulthood years (10-19) were prone to opioid usage.

Conclusions: Rural counties in South Dakota were more likely to dispense opioid care and not have access to rehabilitation. We also found that as the opioid dispensing rate at hospitals within a state decreased as the state had less rural counties. Introducing public programs to train more physicians and cutting down cost of non-opioid based care may lower opioid distribution and increase rehabilitation options in rural hospitals.

Objective: Resting state functional magnetic resonance imaging (fMRI) functional connectivity has been used as a tool to study brain mechanisms associated with addictions. Recent research in substance use disorders has focused on three brain networks termed the default mode network (DMN), salience network (SN), and executive control network (ECN). The purpose of this study was to examine the functional connectivity of those three networks in opioid use disorder (OUD) subjects compared to healthy control subjects (HC).

Methods: The present study investigated functional connectivity differences between OUD subjects compared to HC using independent component analysis. This study also examined the relationship between functional connectivity and negative urgency scores, as well as compared the functional connectivity of severe OUD to mild or moderate OUD.

Results: In OUD subjects (n=25) compared to HC (n=25), a cluster in the left dorsolateral prefrontal cortex within the left ECN had significantly weaker functional connectivity. No significant differences were found between groups for the functional connectivity of the DMN, SN, or right ECN. No significant associations were found between functional connectivity and negative urgency, and no differences were found between severe OUD and mild or moderate OUD.

Conclusion: These novel preliminary results suggest that ECN functional connectivity may differ between OUD and HC. This finding is consistent with previous research showing altered executive function in OUD and supports further examination of ECN functional connectivity in association with treatment response in OUD. Given our relatively small sample size (50 subjects total; 25 subjects per group), our results should be treated as preliminary for hypothesis generation, and replication will be needed in future studies.

Nicotine exerts its reinforcing actions via activating the nicotinic acetylcholine receptors (nAChRs). Among an increasing number of nAChR subtypes, the α4β2 and α7 nAChRs are the two major ones, accounting for about 95% of the whole nAChR population in brain. Research findings from our own laboratory, together with other reports in the field, suggest critical and differential involvement of the α4β2 and α7 nAChRs in the process of nicotine dependence and tobacco addiction. Specifically, rat models of nicotine consumption and cue-induced relapse were used to examine the effects of selective antagonism of these two nAChR subtypes on the primary reinforcement of nicotine and the conditioned reinforcing actions of nicotine-associated environmental stimuli (cues). Results demonstrated that blockade of the α4β2 but not α7 subtype effectively reduced nicotine intake, whereas α7 but not α4β2 nAChR blockade reversed cue-triggered nicotine relapse behavior. These findings lend support for the continued effort to develop cholinergic agents aiming at the α4β2 nAChRs for reducing or stopping smoking. However, it is suggested that manipulation of α7 nAChR activity would be a promising target for preventing smoking relapse triggered by exposure to environmental cues.

Objective: According to the CDC, 2.6 million people in the United States have an opioid use disorder and drug overdose is the leading cause of accidental death. Opioids are involved in 63% of overdose deaths. It is imperative that we identify evidence based treatments to stem the tide of this epidemic. This pilot study serves to explore the feasibility and effectiveness of Yoga as an adjunctive intervention for individuals with opioid use disorder in active medication-assisted treatment (MAT).

Methods: Participants (N=26) were recruited from a buprenorphine/naloxone MAT program to participate in this study. 13 participants engaged in a 12 week adjunctive yoga intervention while remaining in treatment as usual (TAU) MAT. 13 matched controls were recruited and remained in TAU MAT. Both groups were evaluated at baseline, 45 days and 90 days for changes in craving for opioids, treatment retention, relapse rates, sleep, and symptoms of anxiety and perceived stress.

Results: A two-way treatment by time analysis of variance was performed using a mixed effects model. The treatment by follow-up time interaction effect was significant for perceived stress (p=0.026) indicating that the yoga intervention had a larger effect than TAU (MAT). Changes in perceived stress decreased significantly over time in both the yoga intervention group and the TAU MAT matched control group.

Conclusion: This pilot study indicated strong evidence for Yoga being an effective adjunctive treatment to MAT TAU in reducing perceived stress. Further research with a larger population is needed to determine impact on other mental health symptoms and relapse and retention rates.

Scales measuring positive and negative symptoms in schizophrenia remain the primary mo Scales measuring positive and negative symptoms in schizophrenia remain the primary mode of assessing and diagnosing schizophrenia by clinicians and researchers. The scales are mainly used to monitor the severity of positive and negative symptoms and track treatment response in schizophrenics. Although these scales are widely used, quality as well as general utility of each scale varies. The quality is determined by the validity and reliability of the scales. The utility of the scale is determined by the time of administration and the settings for which the scales can be administered in research or clinical settings. There are relatively fewer articles on the utility of newer scales like CAINS (Clinical Assessment Interview for Negative Symptoms) and the BNSS (Brief Negative Symptom Scale) that compare them to the older scales PANSS (Positive and Negative Symptoms Scale), SAPS (Scale for the Assessment of Positive Symptoms) SANS (the Scale for the Assessment of Negative Symptoms), NSA-16 (Negative Symptom Assessment-16) and CGI-SCH (Clinical Global Impression Schizophrenia. The older scales were developed more than 30 years ago. Since then, our understanding of negative symptoms has evolved and currently there are newer rating scales evaluating the validity of negative symptoms. The older scales do not incorporate the latest research on negative symptoms. CAINS and BNSS are attractive for both their reliability and their concise accessible format, however, a scale that is simpler, accessible, user-friendly, that incorporates a multidimensional model of schizophrenia, addresses the psychosocial and cognitive component has yet to be developed.