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Drug and Alcohol Dependence Jul 2019Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However,...
BACKGROUND
Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research.
METHODS
PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse.
RESULTS
The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment.
CONCLUSIONS
Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
Topics: Benzodiazepines; Drug Overdose; Humans; Prescription Drug Misuse; Prescription Drugs; Prevalence; Public Health; Quality of Life; Substance-Related Disorders
PubMed: 31121495
DOI: 10.1016/j.drugalcdep.2019.02.033 -
Biological Psychiatry Jan 2020Opioids are powerful drugs that usurp and overpower the reward function of endogenous opioids and engage dramatic tolerance and withdrawal via molecular and... (Review)
Review
Opioids are powerful drugs that usurp and overpower the reward function of endogenous opioids and engage dramatic tolerance and withdrawal via molecular and neurocircuitry neuroadaptations within the same reward system. However, they also engage the brain systems for stress and pain (somatic and emotional) while producing hyperalgesia and hyperkatifeia, which drive pronounced drug-seeking behavior via processes of negative reinforcement. Hyperkatifeia (derived from the Greek "katifeia" for dejection or negative emotional state) is defined as an increase in intensity of the constellation of negative emotional or motivational signs and symptoms of withdrawal from drugs of abuse. In animal models, repeated extended access to drugs or opioids results in negative emotion-like states, reflected by the elevation of reward thresholds, lower pain thresholds, anxiety-like behavior, and dysphoric-like responses. Such negative emotional states that drive negative reinforcement are hypothesized to derive from the within-system dysregulation of key neurochemical circuits that mediate incentive-salience and/or reward systems (dopamine, opioid peptides) in the ventral striatum and from the between-system recruitment of brain stress systems (corticotropin-releasing factor, dynorphin, norepinephrine, hypocretin, vasopressin, glucocorticoids, and neuroimmune factors) in the extended amygdala. Hyperkatifeia can extend into protracted abstinence and interact with learning processes in the form of conditioned withdrawal to facilitate relapse to compulsive-like drug seeking. Compelling evidence indicates that plasticity in the brain pain emotional systems is triggered by acute excessive drug intake and becomes sensitized during the development of compulsive drug taking with repeated withdrawal. It then persists into protracted abstinence and contributes to the development and persistence of compulsive opioid-seeking behavior.
Topics: Animals; Brain; Motivation; Neurobiology; Opioid-Related Disorders; Reinforcement, Psychology; Reward; Substance Withdrawal Syndrome; Substance-Related Disorders
PubMed: 31400808
DOI: 10.1016/j.biopsych.2019.05.023 -
Behavioural Brain Research Jul 2020Psychoactive drugs with addiction potential are widely used by people of virtually all cultures in a non-addictive way. In order to understand this behaviour, its... (Review)
Review
Psychoactive drugs with addiction potential are widely used by people of virtually all cultures in a non-addictive way. In order to understand this behaviour, its population penetrance, and its persistence, drug instrumentalization was suggested as a driving force for this consumption. Drug instrumentalization theory holds that psychoactive drugs are consumed in a very systematic way in order to make other, non-drug-related behaviours more efficient. Here, we review the evolutionary origin of this behaviour and its psychological mechanisms and explore the neurobiological and neuropharmacological mechanisms underlying them. Instrumentalization goals are discussed, for which an environmentally selective and mental state-dependent consumption of psychoactive drugs can be learned and maintained in a non-addictive way. A small percentage of people who regularly instrumentalize psychoactive drugs make a transition to addiction, which often starts with qualitative and quantitative changes in the instrumentalization goals. As such, addiction is proposed to develop from previously established long-term drug instrumentalization. Thus, preventing and treating drug addiction in an individualized medicine approach may essentially require understanding and supporting personal instrumentalization goals.
Topics: Adaptation, Psychological; Animals; Human Activities; Humans; Psychotropic Drugs; Social Behavior; Substance-Related Disorders
PubMed: 32442549
DOI: 10.1016/j.bbr.2020.112672 -
The Psychiatric Clinics of North America Sep 2022While substance experimentation typically begins in adolescence, substance use disorders (SUDs) usually develop in late teens or early adulthood, often in individuals... (Review)
Review
While substance experimentation typically begins in adolescence, substance use disorders (SUDs) usually develop in late teens or early adulthood, often in individuals who are vulnerable because of biological and socioeconomic risk factors. Severe SUDs-synonymous with addiction-involve changes in limbic and prefrontal brain areas after chronic drug exposure. These changes involve learned associations between drug reward and cues that trigger the anticipation of that reward (known as incentive salience), as well as heightened dysphoria during withdrawal and weakened prefrontal circuits needed for inhibiting habitual responses.
Topics: Adolescent; Adult; Behavior, Addictive; Brain; Humans; Motivation; Reward; Substance-Related Disorders
PubMed: 36055726
DOI: 10.1016/j.psc.2022.05.001 -
Journal of Neural Transmission (Vienna,... May 2024The prevention and treatment of addiction (moderate to severe substance use disorder-SUD) have remained challenging because of the dynamic and complex interactions... (Review)
Review
The prevention and treatment of addiction (moderate to severe substance use disorder-SUD) have remained challenging because of the dynamic and complex interactions between multiple biological and social determinants that shape SUD. The pharmacological landscape is ever changing and the use of multiple drugs is increasingly common, requiring an unraveling of pharmacological interactions to understand the effects. There are different stages in the trajectory from drug use to addiction that are characterized by distinct cognitive and emotional features. These are directed by different neurobiological processes that require identification and characterization including those that underlie the high co-morbidity with other disorders. Finally, there is substantial individual variability in the susceptibility to develop SUD because there are multiple determinants, including genetics, sex, developmental trajectories and times of drug exposures, and psychosocial and environmental factors including commercial determinants that influence drug availability. Elucidating how these factors interact to determine risk is essential for identifying the biobehavioral basis of addiction and developing prevention and treatment strategies. Basic research is tasked with addressing each of these challenges. The recent proliferation of technological advances that allow for genetic manipulation, visualization of molecular reactions and cellular activity in vivo, multiscale whole brain mapping across the life span, and the mining of massive data sets including multimodality human brain imaging are accelerating our ability to understand how the brain functions and how drugs influence it. Here, we highlight how the application of these tools to the study of addiction promises to illuminate its neurobiological basis and guide strategies for prevention and treatment.
Topics: Humans; Substance-Related Disorders; Neurosciences; Animals; Behavior, Addictive; Brain
PubMed: 37947883
DOI: 10.1007/s00702-023-02713-7 -
Psychology of Addictive Behaviors :... Feb 2020Exercise holds potential to reduce substance use, but engaging patients in exercise regimens is challenging. Contingency management (CM) interventions can directly... (Randomized Controlled Trial)
Randomized Controlled Trial
Exercise holds potential to reduce substance use, but engaging patients in exercise regimens is challenging. Contingency management (CM) interventions can directly address adherence by targeting initiation and maintenance of exercise behavior. This study evaluated the efficacy of a CM-reinforced exercise intervention as an adjunct to standard outpatient substance use disorder treatment. Participants were 120 patients with substance use disorders who were randomly assigned to standard care with CM for completing exercise goals or CM for completing general nonexercise goals weekly for a 4-month treatment period. Urine samples were tested for evidence of illicit substance use up to twice a week during treatment and at follow-ups through month 12. Results found that the CM-exercise condition demonstrated during-treatment improvements on several physical activity and relevant psychosocial functioning indices (e.g., self-efficacy for exercise). The CM-exercise condition had no advantage relative to the CM-general condition in decreasing substance use. Overall, this study adds to a small body of well-powered trials assessing effects of exercise interventions as adjunct treatment for substance use disorders and finds no benefit over an alternate CM approach in terms of drug abstinence. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Topics: Adult; Behavior Therapy; Exercise; Female; Humans; Male; Middle Aged; Outpatients; Reinforcement, Psychology; Substance-Related Disorders; Treatment Outcome
PubMed: 31599603
DOI: 10.1037/adb0000517 -
Advances in Pharmacology (San Diego,... 2022Trace amine-associated receptor 1 (TAAR1) is the best characterized receptor selectively activated by trace amines. It is broadly expressed in the monoaminergic system...
Trace amine-associated receptor 1 (TAAR1) is the best characterized receptor selectively activated by trace amines. It is broadly expressed in the monoaminergic system in the brain including ventral tegmental area (VTA), nucleus accumbens (NAc), dorsal raphe (DR) and substantial nigra (SN). Extensive studies have suggested that TAAR1 plays an important role in the modulation of monoaminergic system, especially dopamine (DA) transmission which may underlie the mechanisms by which TAAR1 interventions affect drug abuse-like behaviors. TAAR1 activation inhibits the rewarding and reinforcing effects of drugs from different classes including psychostimulants, opioid and alcohol as well as drug-induced increase in DA accumulation. The mechanisms of TAAR1's function in mediating drug abuse-like behaviors are not clear. However, it is hypothesized that TAAR1 interaction with DA transporter (DAT) and dopamine D2 receptor (D2) and the subsequent modulation of cellular cascades may contribute to the effects of TAAR1 in regulating drug abuse. Further studies are needed to investigate the role of TAAR1 in other drugs of abuse-related behaviors and its safety and efficacy for prolonged medications. Together, TAAR1 inhibits drug-induced DA transmission and drug abuse-related behaviors. Therefore, TAAR1 may be a promising therapeutic target for the treatment of drug addiction.
Topics: Central Nervous System Stimulants; Dopamine; Humans; Receptors, G-Protein-Coupled; Substance-Related Disorders
PubMed: 35341572
DOI: 10.1016/bs.apha.2021.10.005 -
The Medical Clinics of North America Jul 2019Gender-related alcohol and drug abuse problems are related not only to biological differences, but also to social and environmental factors, which can influence the... (Review)
Review
Gender-related alcohol and drug abuse problems are related not only to biological differences, but also to social and environmental factors, which can influence the clinical presentation, consequences of use, and treatment approaches. Women are becoming the fastest-growing population of substance abusers in the United States. Given that women experience a more rapid progression of their addiction than men, it is important that we understand and address the differences to help develop prevention and treatment programs that are tailored for women, incorporating trauma assessment and management, identification and intervention for medical and psychiatric comorbidities, financial independence, pregnancy, and child care.
Topics: Adult; Behavior, Addictive; Female; Health Status; Humans; Male; Sex Characteristics; Sex Distribution; Sex Factors; Social Problems; Substance-Related Disorders; United States; Women's Health
PubMed: 31078201
DOI: 10.1016/j.mcna.2019.03.002 -
Clinical & Experimental Optometry Jul 2021Illicit drugs and substances of abuse are increasingly used by adults and teenagers, with novel substances constantly becoming available. Many substances can cause... (Review)
Review
Illicit drugs and substances of abuse are increasingly used by adults and teenagers, with novel substances constantly becoming available. Many substances can cause ocular effects or visually threatening conditions. Current literature informing eye-care practitioners on these effects is scant. The present scoping review reports the ocular effects of most commonly used drugs and substances of abuse in the teenage and adult populations of North America. Ovid MEDLINE and Ovid EMBASE databases were searched for publications from 1980 to 2019 regarding ocular effects of drug use. The selected papers regarded human subjects, in either teenage or adult population and included all types of studies, including case reports. Publications in English or in French were included. Exclusion criteria were publications about the use of prescriptions drugs, drug withdrawal, and publications about the use of alcohol, tobacco, or cannabis. Some 241 papers were retained and analysed. The use of various drugs and substances can lead to damage to structures throughout the eye, including but not limited to corneal conditions, glaucoma and other optic neuropathies, maculopathies and endophthalmitis. The data presented in this review may help guide clinicians in their diagnosis and treatment of certain ocular conditions, which could otherwise not be linked to drug use.
Topics: Adolescent; Adult; Endophthalmitis; Eye; Humans; Pharmaceutical Preparations; Retinal Diseases; Substance-Related Disorders
PubMed: 33722158
DOI: 10.1080/08164622.2021.1878852 -
Current Opinion in Rheumatology Jan 2021To review understand the epidemiology, background, neuropharmacology, and histopathology of literature verified cases, and likely etiopathogenic mechanisms. (Review)
Review
PURPOSE OF REVIEW
To review understand the epidemiology, background, neuropharmacology, and histopathology of literature verified cases, and likely etiopathogenic mechanisms.
RECENT FINDINGS
There are only a handful of histologically confirmed patients in the literature with cerebral vasculitis because of drug abuse.
SUMMARY
There is little justification for invasive laboratory investigation given the ready availability of highly accurate vascular neuroimaging techniques to dictate management, which usually rests upon avoidance of further exposure and minimizing the secondary neurotoxic effects of the abused substances and polypharmacy use.
Topics: Adult; Amphetamines; Analgesics, Opioid; Central Nervous System Stimulants; Cocaine; Female; HIV Infections; Humans; Illicit Drugs; Male; Middle Aged; Neuroimaging; Polypharmacy; Substance-Related Disorders; Vasculitis, Central Nervous System
PubMed: 33186242
DOI: 10.1097/BOR.0000000000000766