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Social Cognitive and Affective... Nov 2020Substance dependence constitutes a profound societal burden. Although large numbers of individuals use licit or illicit substances, few transition to dependence. The... (Review)
Review
Substance dependence constitutes a profound societal burden. Although large numbers of individuals use licit or illicit substances, few transition to dependence. The specific factors influencing this transition are not well understood. Substance-dependent individuals tend to be swayed by the immediate rewards of drug taking, but are often insensitive to delayed negative consequences of their behavior. Dependence is consequently associated with impulsivity for reward and atypical learning from feedback. Behavioral impulsivity is indexed using tasks measuring spontaneous decision-making and capacity to control impulses. While evidence indicates drug taking exacerbates behavioral impulsivity for reward, animal and human studies of drug naïve populations demonstrate it might precede any drug-related problems. Research suggests dependent individuals are also more likely to learn from rewarding (relative to punishing) feedback. This may partly explain why substance-dependent individuals fail to modify their behavior in response to negative outcomes. This enhanced learning from reward may constitute a further pre-existing risk factor for substance dependence. Although impulsivity for reward and preferential learning from rewarding feedback are both underpinned by a compromised dopaminergic system, few studies have examined the relationship between these two mechanisms. The interplay of these processes may help enrich understanding of why some individuals transition to substance dependence.
Topics: Humans; Impulsive Behavior; Reward; Substance-Related Disorders
PubMed: 31848627
DOI: 10.1093/scan/nsz077 -
Drug and Alcohol Dependence Sep 2022Longitudinal research assessing whether mood disorders predict substance use behaviors is limited. We extend our prior work evaluating transition patterns with alcohol...
INTRODUCTION
Longitudinal research assessing whether mood disorders predict substance use behaviors is limited. We extend our prior work evaluating transition patterns with alcohol use to assess patterns with alcohol and drug use problems.
METHOD
Using National Epidemiologic Survey on Alcohol and Related Conditions prospective data, waves 1 and 2, we completed latent class analyses to empirically define classes of alcohol and drug problems from DSM disorder criteria. Latent transition analyses were used to assess associations of lifetime mood disorders at baseline with transitions across classes of alcohol and drug problems during follow-up.
RESULTS
A three-class model of alcohol and drug problems was identified (No problems, Alcohol Problems Only, and Alcohol and Drug Problems) for males and females. Females with mood disorders were over two times more likely to transition from No Problems, and Alcohol Problems Only at baseline to having both Alcohol and Drug Problems at follow-up relative to those without mood disorders (aOR=2.30, 95 % CI=1.31-4.05, p = 0.004, and aOR=2.64, CI=1.24-5.62, p = 0.011, respectively). Furthermore, females with mood disorders were significantly less likely to recover from baseline Alcohol and Drug Problems to Alcohol Problems Only at follow-up (aOR=0.35, CI=0.12-0.98, p = 0.047) relative to those without mood disorders. There were no significant findings for males.
DISCUSSION
Our study provides evidence that mood disorders impact transitions through classes of alcohol and drug problems among females. The findings emphasize the need for ongoing evaluation of substance use among those with mood conditions, and recognition and treatment of mood disorders among those recovering from substance use problems.
Topics: Alcohol Drinking; Alcohol-Related Disorders; Female; Humans; Male; Mood Disorders; Prospective Studies; Substance-Related Disorders
PubMed: 35917762
DOI: 10.1016/j.drugalcdep.2022.109566 -
BMC Women's Health Apr 2020According to recent studies, the number of women drug users is dramatically increasing. However, the information on the issue of drug rehab in women is not sufficient,...
BACKGROUND
According to recent studies, the number of women drug users is dramatically increasing. However, the information on the issue of drug rehab in women is not sufficient, and there are numerous traditional, organizational, political and cultural barriers to the provision of relevant information in this regard in Iran. This study, thus, aimed to explain the factors influencing the decision of these women to stop drug use.
METHODS
This qualitative study was conducted in two rehab camps of Isfahan (in Iran) on July to October 2017. Thirty participants (women drug users) were selected through purposive and theoretical sampling until data saturation was reached. Data collection was conducted through semi-structured interviews. The transcribed interviews were analyzed using conventional content analysis.
RESULTS
Based on the analysis of the obtained results, the women's experience of the ups and downs of stopping drug use yielded two themes and nine sub-themes. The themes were "the need for emancipation (the deviated path, being abused, compulsive drug use, acquaintance with God, a supportive family)" and "Sinking factors (non-assisting mates, pro-addictive family, unawareness of assisting official organization and non-government organization, woman's lack of authority, ineffective opportunities)".
CONCLUSIONS
It was concluded that addiction rehab strategies can lead to a brighter life for women drug users only when they are coupled with open-hearted assistance of the families and women specific rehab centers are established to help them meet their specific needs.
Topics: Adult; Drug Users; Female; Humans; Interviews as Topic; Iran; Qualitative Research; Substance-Related Disorders; Women's Health
PubMed: 32321495
DOI: 10.1186/s12905-020-00946-2 -
Molecular Psychiatry Nov 2022Substance use disorders (SUDs) incur serious social and personal costs. The risk for SUDs is complex, with risk factors ranging from social conditions to individual...
Substance use disorders (SUDs) incur serious social and personal costs. The risk for SUDs is complex, with risk factors ranging from social conditions to individual genetic variation. We examined whether models that include a clinical/environmental risk index (CERI) and polygenic scores (PGS) are able to identify individuals at increased risk of SUD in young adulthood across four longitudinal cohorts for a combined sample of N = 15,134. Our analyses included participants of European (N = 12,659) and African (N = 2475) ancestries. SUD outcomes included: (1) alcohol dependence, (2) nicotine dependence; (3) drug dependence, and (4) any substance dependence. In the models containing the PGS and CERI, the CERI was associated with all three outcomes (ORs = 01.37-1.67). PGS for problematic alcohol use, externalizing, and smoking quantity were associated with alcohol dependence, drug dependence, and nicotine dependence, respectively (OR = 1.11-1.33). PGS for problematic alcohol use and externalizing were also associated with any substance dependence (ORs = 1.09-1.18). The full model explained 6-13% of the variance in SUDs. Those in the top 10% of CERI and PGS had relative risk ratios of 3.86-8.04 for each SUD relative to the bottom 90%. Overall, the combined measures of clinical, environmental, and genetic risk demonstrated modest ability to distinguish between affected and unaffected individuals in young adulthood. PGS were significant but added little in addition to the clinical/environmental risk index. Results from our analysis demonstrate there is still considerable work to be done before tools such as these are ready for clinical applications.
Topics: Humans; Young Adult; Adult; Tobacco Use Disorder; Alcoholism; Substance-Related Disorders; Risk Factors; Alcohol Drinking
PubMed: 36195638
DOI: 10.1038/s41380-022-01801-6 -
PloS One 2022Previous research has demonstrated that adults with comorbid depressive and anxiety disorders are significantly more likely to show pathological use of drugs or alcohol....
Previous research has demonstrated that adults with comorbid depressive and anxiety disorders are significantly more likely to show pathological use of drugs or alcohol. Few studies, however, have examined associations of this type in children. A better understanding of the relationships between affective disorders and substance experimentation in childhood could help clarify the complex ways in which pathological substance use symptoms develop early in life. The present study included 11,785 children (Mage = 9.9) participating in the Adolescent Brain Cognitive Development (ABCD) study. Depressive and anxiety disorder diagnoses were evaluated as concurrent predictors of experimentation with alcohol and tobacco. A series of linear regressions revealed that children with either depressive or anxiety disorders were significantly more likely to experiment with alcohol or tobacco. However, children with both depressive and anxiety diagnoses were not more likely to experiment than children without a diagnosis. These results suggest that anxiety or depressive diagnoses in childhood may be associated with a greater likelihood of substance experimentation, but severe psychological distress may suppress these effects.
Topics: Adolescent; Adult; Anxiety; Anxiety Disorders; Child; Comorbidity; Depression; Humans; Substance-Related Disorders
PubMed: 35609016
DOI: 10.1371/journal.pone.0265239 -
Human Brain Mapping Jun 2020Adequate control of impulsive urges to act is demanded in everyday life but is impaired in neuropsychiatric conditions such as stimulant use disorder. Despite intensive...
Adequate control of impulsive urges to act is demanded in everyday life but is impaired in neuropsychiatric conditions such as stimulant use disorder. Despite intensive research it remains unclear whether failures in impulse control are caused by impaired suppression of behavior or by the over invigoration of behavior by stimuli associated with salient incentives such as drugs, food, and money. We investigated failures in impulse control using functional magnetic resonance imaging (fMRI) to map the neural correlates of premature (impulsive) responses during the anticipation phase of the Monetary Incentive Delay (MID) task in healthy controls (HC), stimulant-dependent individuals (SDIs), and their unaffected first-degree siblings (SIB). We combined task-based fMRI analyses with dynamic causal modeling to show that failures of impulse control were associated with interactions between cingulo-opercular and dorsal striatal networks regardless of group status and incentive type. We further report that group-specific incentive salience plays a critical role in modulating impulsivity in SDIs since drug-related incentives specifically increased premature responding and shifted task modulation away from the dorsal striatal network to the cingulo-opercular network. Our findings thus indicate that impulsive actions are elicited by salient personally-relevant incentive stimuli and those such slips of action recruit a distinct fronto-striatal network.
Topics: Adult; Anticipation, Psychological; Brain Mapping; Central Nervous System Stimulants; Female; Gyrus Cinguli; Humans; Impulsive Behavior; Magnetic Resonance Imaging; Male; Motivation; Neostriatum; Nerve Net; Personality; Prefrontal Cortex; Siblings; Substance-Related Disorders; Young Adult
PubMed: 32150321
DOI: 10.1002/hbm.24941 -
Journal of Research on Adolescence :... Mar 2022Research on co-occurring obesity and substance use in adolescence has grown substantially in the past decade, but questions on the pathways and processes underlying... (Review)
Review
Research on co-occurring obesity and substance use in adolescence has grown substantially in the past decade, but questions on the pathways and processes underlying co-occurrence remain. This review first synthesizes empirical findings on the relationship between obesity and substance use (e.g., alcohol, cannabis, tobacco use). Multidisciplinary theoretical frameworks referencing behavioral medicine, neuroscience, psychology, and public health are then used to inform an interdisciplinary, conceptual model focused on pathways and processes by which obesity increases risk of substance use. Recommendations for future research underscore the importance of prospective studies that encompass multiple domains of development. Recommendations for practice include family-based interventions that promote adaptive self-regulation, targeted antibullying or victimization interventions, and increased attention by health professionals on risky behavior associated with adolescent obesity.
Topics: Adolescent; Adolescent Behavior; Humans; Pediatric Obesity; Prospective Studies; Risk-Taking; Substance-Related Disorders
PubMed: 34490962
DOI: 10.1111/jora.12610 -
The Journal of Clinical Psychiatry May 2023Individuals with substance use disorders (SUDs) and co-occurring chronic health and/or psychiatric conditions face unique challenges in treatment and may be at a...
Individuals with substance use disorders (SUDs) and co-occurring chronic health and/or psychiatric conditions face unique challenges in treatment and may be at a greater risk for suicidal ideation relative to persons with SUD alone. In a sample of individuals entering residential SUD treatment in 2019 and 2020 (N = 10,242), we tested adjusted and unadjusted associations between suicidal ideation and (1) psychiatric symptoms and (2) chronic health conditions at treatment intake and during treatment using logistic and generalized logistic models. Over a third of the sample endorsed suicidal ideation at intake, though the prevalence of suicidal ideation decreased during treatment. In both adjusted and unadjusted models, individuals who reported past-month self-harm, those who reported a lifetime suicide attempt, and individuals who screened positive for co-occurring anxiety, depression, and/or posttraumatic stress disorder were at elevated risk of endorsing suicidal ideation at intake and during treatment ( values < .001). In unadjusted models, chronic pain (odds ratio [OR] = 1.51, < .001) and hepatitis C virus (OR = 1.65, < .001) were associated with an elevated risk for suicidal ideation at intake, and chronic pain was associated with elevated risk for suicidal ideation during treatment (OR = 1.59, < .001). Increasing accessibility to integrated treatments (ie, those that address psychiatric and chronic health conditions) for patients experiencing suicidal ideation may be beneficial in residential SUD treatment settings. Developing predictive models to identify those most at risk of suicidal ideation in real time remains a relevant direction for future work.
Topics: Humans; Suicidal Ideation; Chronic Pain; Suicide, Attempted; Substance-Related Disorders; Anxiety Disorders; Risk Factors
PubMed: 37227401
DOI: 10.4088/JCP.22m14611 -
The Lancet. Healthy Longevity Oct 2022Cannabis is often characterised as a young person's drug. However, people who began consuming cannabis in the 1970s and 1980s are no longer young and some have consumed...
BACKGROUND
Cannabis is often characterised as a young person's drug. However, people who began consuming cannabis in the 1970s and 1980s are no longer young and some have consumed it for many years. This study tested the preregistered hypothesis that long-term cannabis users show accelerated biological ageing in midlife and poorer health preparedness, financial preparedness, and social preparedness for old age.
METHODS
In this longitudinal study, participants comprised a population-representative cohort of 1037 individuals born in Dunedin, New Zealand, between April, 1972, and March, 1973, and followed to age 45 years. Cannabis, tobacco, and alcohol use and dependence were assessed at ages 18 years, 21 years, 26 years, 32 years, 38 years, and 45 years. Biological ageing and health, financial, and social preparedness for old age were assessed at age 45 years. Long-term cannabis users were compared using independent samples t tests with five groups: lifelong cannabis non-users, long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. In addition, regression analyses tested dose-response associations for continuously measured persistence of cannabis dependence from age 18 years to 45 years, with associations adjusted for sex, childhood socioeconomic status, childhood IQ, low childhood self-control, family substance dependence history, and persistence of alcohol, tobacco, and other illicit drug dependence.
FINDINGS
Of 997 cohort members still alive at age 45 years, 938 (94%) were assessed at age 45 years. Long-term cannabis users showed statistically significant accelerated biological ageing and were less equipped to manage a range of later-life health, financial, and social demands than non-users. Standardised mean differences between long-term cannabis users and non-users were large: 0·70 (95% CI 0·46 to 0·94; p<0·0001) for biological ageing, -0·72 (-0·96 to -0·49, p<0·0001) for health preparedness, -1·08 (-1·31 to -0·85; p<0·0001) for financial preparedness, and -0·59 (-0·84 to -0·34, p<0·0001) for social preparedness. Long-term cannabis users did not fare better than long-term tobacco or alcohol users. Tests of dose-response associations suggested that cannabis associations could not be explained by the socioeconomic origins, childhood IQ, childhood self-control, and family substance-dependence history of long-term cannabis users. Statistical adjustment for long-term tobacco, alcohol, and other illicit drug dependence suggested that long-term cannabis users' tendency toward polysubstance dependence accounted for their accelerated biological ageing and poor financial and health preparedness, although not for their poor social preparedness (β -0·10, 95% CI -0·18 to -0·02; p=0·017).
INTERPRETATION
Long-term cannabis users are underprepared for the demands of old age. Although long-term cannabis use appears detrimental, the greatest challenge to healthy ageing is not use of any specific substance, but rather the long-term polysubstance use that characterises many long-term cannabis users. Substance-use interventions should include practical strategies for improving health and building financial and social capital for healthy longevity.
FUNDING
The National Institute on Aging and the UK Medical Research Council. The Dunedin Research Unit is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation and Employment.
Topics: Adolescent; Cannabis; Child; Hallucinogens; Healthy Aging; Humans; Illicit Drugs; Longitudinal Studies; Marijuana Abuse; Middle Aged; Substance-Related Disorders
PubMed: 36202130
DOI: 10.1016/S2666-7568(22)00201-X -
Harm Reduction Journal Dec 2019A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased... (Review)
Review
BACKGROUND
A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems.
METHODS
A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible.
RESULTS
In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided.
CONCLUSION
This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base.
Topics: Delivery of Health Care; Harm Reduction; Humans; Psychotherapy; Social Support; Substance-Related Disorders; Testosterone Congeners
PubMed: 31888665
DOI: 10.1186/s12954-019-0343-1