Current cognitive models of addiction imply that speeded detection and increased distraction from substance cues might both independently contribute to the persistence of addictive behavior. Speeded detection might lower the threshold for experiencing craving, whereas increased distraction might further increase the probability of entering a bias-craving-bias cycle, thereby lowering the threshold for repeated substance use. This study was designed to examine whether indeed both attentional processes are involved in substance use disorders. Both attentional processes were indexed by an Odd-One-Out visual (...) search task in individuals diagnosed with alcohol use disorder and cannabis use disorder. To test whether the detection and/or the distraction component are characteristic for AUD and CUD, their indices were compared with matched individuals without these diagnoses. Individuals with CUD showed speeded detection of cannabis cues; the difference in detection between AUD and the comparison group remained inconclusive. Neither the AUD nor the CUD group showed more distraction than the comparison groups. The sample size of the CUD group was relatively small. In addition, participants made relatively many errors in the attentional bias task, which might have lowered its sensitivity to detect ABs. The current study provided no support for the proposed role of increased distraction in CUD and AUD. The findings did, however, provide support for the view that speeded detection might be involved in CUD. Although a similar trend was evident for AUD, the evidence was weak and remained therefore inconclusive. (shrink)

Cannabis use in some individuals can meaningfully introduce de novo risk for the initiation of opioid use and development of opioid use disorder. These risks may be particularly high during adolescence when cannabis use may disrupt critical periods of neurodevelopment. Current research studying the combination of genetic and environmental factors involved in substance use disorders is poorly understood. More research is needed, particularly to identify which adolescents are most at risk and to develop effective interventions addressing contributing (...) factors such as trauma and psychiatric comorbidity. (shrink)

Alcohol use disorder is a burden to society creating social and health problems. Detection of AUD and its effects on the brain are difficult to assess. This problem is enhanced by the comorbid use of other substances such as nicotine that has been present in previous studies. Recent machine learning algorithms have raised the attention of researchers as a useful tool in studying and detecting AUD. This work uses AUD and controls samples free of any other substance use to (...) assess the performance of a set of commonly used machine learning classifiers detecting AUD from resting state functional network connectivity derived from independent component analysis. The cohort used included 51 alcohol dependent subjects and 51 control subjects. Despite alcohol, none of the 102 subjects reported use of nicotine, cannabis or any other dependence or habit formation substance. Classification features consisted of whole brain rsFNC estimates undergoing a feature selection process using a random forest approach. Features were then fed to 10 different machine learning classifiers to be evaluated based on their classification performance. A neural network classifier showed the highest performance with an area under the curve of 0.79. Other good performers with similar AUC scores were logistic regression, nearest neighbor, and support vector machine classifiers. The worst results were obtained with Gaussian process and quadratic discriminant analysis. The feature selection outcome pointed to functional connections between visual, sensorimotor, executive control, reward, and salience networks as the most relevant for classification. We conclude that AUD can be identified using machine learning classifiers in the absence of nicotine comorbidity. (shrink)

Individuals with substance use disorders exhibit risk-taking behaviors, potentially leading to negative consequences and difficulty maintaining recovery. Non-invasive brain stimulation techniques such as transcranial direct current stimulation have yielded mixed effects on risk-taking among healthy controls. Given the importance of risk-taking behaviors among substance-using samples, this study aimed to examine the effects of tDCS on risk-taking among a sample of adults using cannabis. Using a double-blind design, 27 cannabis users [M age = 32.48, 41% female] were randomized, receiving (...) one session of active or sham tDCS over the bilateral dorsolateral prefrontal cortex. Stimulation parameters closely followed prior studies with anodal right dlPFC and cathodal left dlPFC stimulation. Risk-taking—assessed via a modified Cambridge Gambling Task—was measured before and during tDCS. Delay and probability discounting tasks were assessed before and after stimulation. No significant effects of stimulation on risk-taking behavior were found. However, participants chose the less risky option ∼86% of the trials before stimulation which potentially contributed to ceiling effects. These results contradict one prior study showing increased risk-taking among cannabis users following tDCS. There was a significant increase in delay discounting of a $1000 delayed reward during stimulation for the sham group only, but no significant effects for probability discounting. The current study adds to conflicting and inconclusive literature on tDCS and cognition among substance-using samples. In conclusion, results suggest the ineffectiveness of single session dlPFC tDCS using an established stimulation protocol on risk-taking, although ceiling effects at baseline may have also prevented behavior change following tDCS. (shrink)

One specific instantiation of the storm-and-stress view of adolescence is the idea that “normal” adolescence involves high-risk substance use behaviors. However, although uptake of some substance use behaviors is more common during adolescence than other life stages, it is clear that not all adolescents engage in risky substance use—and among those who do, there is much variation in emotional, behavioral, and contextual precursors of this behavior. One such set of predictors forms the internalizing pathway to substance use disorder, whereby (...) internalizing symptoms in childhood such as negative affect and anxiety set off a chain of consequences culminating in high-risk substance use in late adolescence. However, findings linking internalizing symptoms to substance use are mixed, and it is clear that this link varies across adolescents and contexts. One heretofore unanswered question is whether and how geographic location, specifically whether the adolescent lives in an urban or rural location, moderates this link. The current report is a secondary analysis of data from the Longitudinal Study of Australian Children, in which we examined the link between internalizing symptoms in childhood and initiation of substance use through age 19. Using a multiple event process survival mixture model, we identified three trajectories of substance use initiation in adolescence: one characterized by near-complete abstinence until late adolescence, another by earlier initiation of alcohol, nicotine, and cannabis, and another by early initiation of these substances and later initiation of more hazardous drugs such as cocaine and methamphetamine. Although childhood externalizing symptoms increased the risk of being in the second or third class, internalizing symptoms decreased risk when rural and non-rural adolescents were considered together. Few effects of rurality were found, but the negative relationship between internalizing at age 10 and high-risk substance use was only observed among non-rural adolescents. This finding, which was inconsistent with our initial predictions that rurality might confer higher risk for substance use, instead suggests a potentially protective effect of internalizing symptoms for engagement in risky substance use which may differ based on an adolescent’s geographical context. (shrink)

This chapter contains sections titled: Introduction Cannabis and the Individual Cannabis and Society.

The recommended treatment for dual diagnosis - the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if Enactive Psychiatry may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of (...) dual diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic “grip” on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice. (shrink)

In this paper, I examine Reinforcement Learning modelling practice in psychiatry, in the context of alcohol use disorders. I argue that the epistemic roles RL currently plays in the development of psychiatric classification and search for explanations of clinically relevant phenomena are best appreciated in terms of Chang’s account of epistemic iteration, and by distinguishing mechanistic and aetiological modes of computational explanation.

Matthew Stolick presents a detailed social and scientific exploration of the social history of cannabis, chemical make-up of the cannabis plant, and effects of cannabis use. Applying the moral thought of Aristotle, Kant, Mill, and Christianity, Stolick demonstrates the amoral nature of cannabis use.

Major neurocognitive changes occur during adolescence, making this phase as one of the most critical developmental period of life. Furthermore, this phase in life is also the time in youth substance use has its onset. Several studies demonstrated the differential associations of alcohol and cannabis use concerning the neurocognitive functioning of both males and females. Past and contemporary literature on gender-specific effects in neuroscience of addiction is predominantly based on cross-sectional datasets and data that is limited in terms of (...) measurement variability. Given the importance of gender-specific effects in addiction studies, and in order to address the two above-mentioned gaps in the literature, the present study aimed to compare neurocognitive functioning of male and female adolescents in the context of cannabis and alcohol use, while employing a longitudinal design with multiple repeated measurements. Participants were 3,826 high school students (47% female; mean age, 12.7), which were recruited from 31 high schools in the greater Montreal area. Participants were requested to complete annual surveys for five consequent years, from 7th to 11th grade, assessing their alcohol/cannabis use and neurocognitive functioning (working memory, delayed recall memory, perceptual reasoning, and inhibition control). The analytical strategy was focused on the longitudinal association between each predictor (female, male) and each of the outcomes (domains of neurocognitive functioning). Multilevel linear models assessed the association of alcohol and cannabis consumption and the four domains of neurocognitive functioning. Results revealed a gender by within-subject interaction, suggesting a weaker effect of yearly fluctuation of cannabis use on working memory among males compared to females. Our findings suggest a different pattern of neurocognitive impairment of female and male working memory after using cannabis over the course of adolescence. Early initiation of cannabis use potentially results in more spatial working memory deficits in female adolescents. This may negatively influence young females’ capacity in academic settings and lead to significant impairment in adulthood, which critically decreases the individual’s quality of life. (shrink)

Matthew Stolick presents a detailed social and scientific exploration of the social history of cannabis, chemical make-up of the cannabis plant, and effects of cannabis use. Applying the moral thought of Aristotle, Kant, Mill, and Christianity, Stolick demonstrates the amoral nature of cannabis use.

_Substance use disorders belong to the class of externalizing behaviours that are generally more common among men than women. Those women who do have substance disorders therefore deviate more from the norms of society compared with men, tend to live in an environment characterized by high risk of violence and other forms of abuse, and tend to be survivors of childhood trauma. In terms of seeking treatment, women often have difficulty acknowledging their problems with substance use disorders, and professionals are (...) reluctant to ask women about drug or alcohol use. Even when they do seek treatment, women in many countries face practical and financial barriers to access treatment. For women who do enter treatment, outcomes are generally comparable to outcomes for men, suggesting that facilitating entry into treatment can yield substantial benefits for women with addictions._. (shrink)

Substance use disorders (SUDs) constitute a growing global health crisis, yet many limitations and challenges exist in SUD treatment research, including the lack of objective brain-based markers for tracking treatment outcomes. Electroencephalography (EEG) is a neurophysiological technique for measuring brain activity, and although much is known about EEG activity in acute and chronic substance use, knowledge regarding EEG in relation to abstinence and treatment outcomes is sparse. We performed a scoping review of longitudinal and pre-post treatment EEG studies that explored (...) putative changes in brain function associated with abstinence and/or treatment in individuals with SUD. Following PRISMA guidelines, we identified studies published between January 2000 and March 2022 from online databases. Search keywords included EEG, addictive substances (e.g., alcohol, cocaine, methamphetamine), and treatment related terms (e.g., abstinence, relapse). Selected studies used EEG at least at one time point as a predictor of abstinence or other treatment-related outcomes; or examined pre- vs. post-SUD intervention (brain stimulation, pharmacological, behavioral) EEG effects. Studies were also rated on the risk of bias and quality using validated instruments. Forty-four studies met the inclusion criteria. More consistent findings included lower oddball P3 and higher resting beta at baseline predicting negative outcomes, and abstinence-mediated longitudinal decrease in cue-elicited P3 amplitude and resting beta power. Other findings included abstinence or treatment-related changes in late positive potential (LPP) and N2 amplitudes, as well as in delta and theta power. Existing studies were heterogeneous and limited in terms of specific substances of interest, brief times for follow-ups, and inconsistent or sparse results. Encouragingly, in this limited but maturing literature, many studies demonstrated partial associations of EEG markers with abstinence, treatment outcomes, or pre-post treatment-effects. Studies were generally of good quality in terms of risk of bias. More EEG studies are warranted to better understand abstinence- or treatment-mediated neural changes or to predict SUD treatment outcomes. Future research can benefit from prospective large-sample cohorts and the use of standardized methods such as task batteries. EEG markers elucidating the temporal dynamics of changes in brain function related to abstinence and/or treatment may enable evidence-based planning for more effective and targeted treatments, potentially pre-empting relapse or minimizing negative lifespan effects of SUD. (shrink)

This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.

As physicians, we have seen patients with substance use disorders leave the hospital against medical advice, slipping through the cracks of our health care system. In fact, despite a high burden of life‐threatening illnesses, patients with SUDs are at a nearly threefold increased risk of leaving the hospital against medical advice. Leaving against medical advice is associated with an increased thirty‐day mortality rate as well as an increased rate of hospital readmission. When a patient leaves in this way, the health (...) care system loses the opportunity to engage with someone who is struggling with an SUD and whose health is at imminent risk. Fortunately, there are ways to address some of these challenges within existing organizational frameworks. Addiction consult teams and supervised injection facilities are two interventions that have proven successful. (shrink)

Women with opioid use disorder (OUD) face unique challenges meeting their reproductive goals. Because the rate of unintended pregnancy in this population is almost 80 percent, there has been a push to increase the use of contraceptives among reproductive-aged women with OUD.1 The patient-level ethical issues of such initiatives, however, are often overlooked. This review discusses the ethical issues in two realms: obtaining contraception when it is desired and avoiding contraceptive coercion when contraception is not desired. It is important (...) that access to reproductive education and care be improved to ensure autonomous decision making by women with OUD. It is also necessary to be mindful of the history of oppressive and coercive contraception and sterilization policies in the United States. These policies have left a legacy of mistrust and continue to be manifested in the form of more subtly oppressive policies in contemporary medical practice. Such policies point to the ongoing stigmatization of, and implicit biases held against, women with OUD. Based on these ethical issues, solutions are suggested at the clinical, systemic, and societal levels. (shrink)

Systemic therapy considers the complex dynamics of relational factors and resources contributing to psychological symptoms. Negative maintaining factors have been well researched for people suffering from Alcohol-use Disorders. However, we know little about the complex dynamics of these negative factors and resources. We interviewed fifty-five participants suffering or fully remitted from Alcohol-use disorders in this cross-sectional study. The interviews focused on relational factors referring to a Support Social Network and a Craving Social Network. The CSN included all significant others who (...) were associated with craving situations. We compared the network characteristics of the group suffering from Alcohol-use Disorders to a fully remitted control group. The abstinent group with full remission named on average fewer individuals in the CSNs. They had lower social negativity mean scores in the Support Social Network compared to the non-remitted group. In the CSN, the mean scores of social support were significantly higher than the median for both groups. These findings reveal the complex interplay of relational patterns contributing to the etiology, maintenance, and recovery from Alcohol-use disorders. A successful recovery can be linked to increased social resources and reduced relations associated with craving. However, craving-associated relations represent an important source of social support. Future research should investigate this ambivalence for the systemic perspective on the explanation and treatment of Alcohol-use disorders. (shrink)

While the prevalence of opioid use disorder among pregnant women has multiplied in the United States in the last decade, buprenorphine treatment for peripartum women with OUD has been administered to reduce risks of repeated cycles of craving and withdrawal. However, the maternal behavior and bonding in mothers with OUD may be altered as the underlying maternal behavior neurocircuit is opioid sensitive. In the regulation of rodent maternal behaviors such as licking and grooming, a series of opioid-sensitive brain regions (...) are functionally connected, including the ventral pallidum. In humans, these brain regions, interact with the supplementary motor area to regulate maternal behaviors and are functionally dysregulated by opioids. It is unclear how these brain regions respond to the emotions of their child for mothers receiving BT. In this functional magnetic resonance imaging pilot study in 22 mothers within the first postpartum year, including six mothers receiving BT and 16 non-OUD mothers as a comparison group, we devised a child face mirroring task in fMRI settings to assess maternal responses to pictures of facial expressions of own child and an unknown child in an empathic mirroring condition and a non-mirroring observation condition. In each condition, faces of neutral, ambiguous, distressed, and joyful expressions of each child were repeatedly displayed in a random order. The response of SMA during empathic mirroring vs. non-mirroring of own child was reduced among BT/OUD vs. CG. Within MBN, the left VP, critical for parental sensitivity, had a similar deficit. This study outlines potential mechanisms for investigating the risks of deficits in the neural responses to actual maternal sensitivity and parenting behavior in mothers with OUD, and potential targets for interventions that reduce stress and augment maternal behavior and child outcome. (shrink)

Opioid use disorder rarely presents as a unitary psychiatric condition, and the comorbid symptoms likely depend upon the diverse risk factors and mechanisms by which OUD can arise. These factors are heterogeneous and include genetic predisposition, exposure to prescription opioids, and environmental risks. Crucially, one key environmental risk factor for OUD is early life adversity. OUD and other substance use disorders are widely considered to derive in part from abnormal reward circuit function, which is likely also implicated in comorbid (...) mental illnesses such as depression, bipolar disorder, and schizophrenia. ELA may disrupt reward circuit development and function in a manner predisposing to these disorders. Here, we describe new findings addressing the effects of ELA on reward circuitry that lead to OUD and comorbid disorders, potentially via shared neural mechanisms. We discuss some of these OUD-related problems in both humans and animals. We also highlight the increasingly apparent, crucial contribution of biological sex in mediating the range of ELA-induced disruptions of reward circuitry which may confer risk for the development of OUD and comorbid neuropsychiatric disorders. (shrink)

Involuntary civil commitment to treatment for opioid use disorder prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and “on-demand” treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC (...) ethically, it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way. (shrink)

This commentary provides a legal analysis of the extent to which changes proposed by scholars to promote care for substance use disorder or other under-treated illnesses through risk adjustment could be implemented administratively, without legislation, in federal risk adjustment systems: Medicare's privatized component, Medicare's pharmaceutical component, and the individual and small group market. As the article explains, federal laws governing risk adjustment provide broad discretion to regulators and can reasonably be interpreted to permit full and final implementation through the (...) administrative process of almost all of the changes that scholars have proposed. (shrink)

Despite extinction-based processes demonstrating efficacy in the animal extinction and human anxiety literatures, extinction for substance use disorders has shown poor efficacy. Reasons for this lack of success include common threats to extinction, such as renewal and reinstatement. In recent decades, research on mindfulness for SUD has flourished, and a key aspect of these mindfulness-based interventions includes teaching individuals to stay present with whatever experience they have, even if unpleasant, without trying to change/escape/avoid it. Similarly, CET teaches individuals to not (...) escape/avoid conditioned responses by engaging in drug use behavior. This paper discusses how mindfulness-based research and practices could positively influence CET through future research, with the long-term goal of improving SUD treatment. (shrink)

Opioid agonist treatment, including methadone, is the safest and most effective method for treating opioid use disorders and reduces opioid overdose deaths. While access to methadone is highly regulated by federal law, a substantial portion of states impose stricter barriers.

More than three billion users are currently on one of Meta’s online platforms with Facebook being still their most prominent social media service. It is well known that Facebook has designed a highly immersive social media service with the aim to prolong online time of its users, as this results in more digital footprints to be studied and monetized. In this context, it is debated if social media platforms can elicit addictive behaviors. In the present work, we demonstrate in N (...) = 1,094 users that it is possible to predict from digital footprints of the Facebook users their self-reported addictive tendencies toward social media by applying machine-learning strategies. More specifically, we analyzed the predictive power of a set of models based on different sets of features extracted from digital traces, namely posting activity, language use, and page Likes. To maximize the predictive power of the models, we used an ensemble of linear and non-linear prediction algorithms. This work showed also sufficient accuracy rates in distinguishing between disordered and non-disordered social media users. In sum, individual differences in tendencies toward “social networks use disorder” can be inferred from digital traces left on the social media platform Facebook. Please note that the present work is limited by its cross-sectional design. (shrink)

Despite some improvements in access to evidence-based medications for opioid use disorder, treatment rates remain low at under a quarter of those with need. High costs for brand name products in these medication markets have limited the volume of drugs purchased, particularly through public health insurance and grant programs. Brand firm anti-competitive practices around the leading buprenorphine product Suboxone — including product hops, citizen petitions and Risk Evaluation and Mitigation Strategy abuses — helped to maintain high prices by extending (...) brand exclusivity periods and hindering generic drug entry. Remedies to address costly anti-competitive activities include adoption of the proposed CREATES Act and modernization of the Hatch-Waxman Act by the Congress, and implementation of substantive modifications to the Food and Drug Administration citizen petition filing procedures. Given the persistence of these abuses, prescriptive changes are favorable to the procedural and clarifying steps thus far favored by the federal government. Extrapolating from the 37% price declines attributable to generic entry for buprenorphine tablets in 2011, our calculations suggest that implementing these remedies to facilitate generic competition with Suboxone film would have resulted in savings of approximately $703 million overall and $203 million to Medicaid in 2017. (shrink)

BackgroundIndividuals who use methamphetamine for a long period of time may experience decreased inhibition and increased impulsivity. In order to reduce impulsivity or improve inhibitory control ability, high-frequency repetitive transcranial magnetic stimulation has attracted much attention of researchers. Recent studies on addiction have shown that rTMS can stimulate different brain regions to produce different therapeutic effects. Recent work also suggests that HF-rTMS over right dorsolateral prefrontal cortex does not affect the impulsivity of patients with alcohol use disorder; while HF-rTMS (...) over left DLPFC could improve the impulsivity of patients with alcohol use disorder and cigarette smokers. However, it should be noted that empirical studies applying HF-rTMS over left DLPFC of patients with MA use disorders are still lacking.MethodsTwenty-nine patients with MAUD underwent five sessions of HF-rTMS on the left DLPFC per week for 4 consecutive weeks. The cue-induced craving and stop-signal and NoGo task were assessed pre-rTMS and post-rTMS. In addition, 29 healthy controls were recruited. There was no rTMS intervention for the controls, the performance of the stop-signal and NoGo task was evaluated on them.ResultsIn total, HF-rTMS of the left DLPFC significantly decreased MA-dependent patients’ cue-induced craving and stop-signal reaction time. For SSRT, the pre-test of experimental group was significantly higher than the score of control group. In the experimental group, the pre-test score was significantly higher than the post-test score. For Go and stop-signal delay, the pre-test scores of the experimental group was significantly lower than the scores of the control group. No significant difference was found between the pre-test and the post-test scores of the experimental group.ConclusionAdd-on HF-rTMS of left DLPFC may be an effective intervention for reducing impulsivity and cue-induced craving of patients with MAUD. Future research with a control group of MAUD that does not undergo the treatment is needed to confirm the effectiveness. (shrink)

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of (...) hepatitis C transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration. (shrink)

Excessive alcohol consumption can have adverse effects on health, and patients who suffer from alcohol use disorders are subject to much stigmatization. Nurses are often the first point of contact when patients enter the acute medical unit, and it is pivotal that this contact establishes the basis for future collaboration. The aim of this study is to elucidate nurses’ lived experience of providing care to patients suffering from alcohol use disorders. This present study has a qualitative research design, anchored in (...) phenomenological and hermeneutical methodology as described in reflective lifeworld research. Ten in‐depth, open‐ended interviews with nurses working in an acute medical unit were conducted. The analysis showed that providing care to patients suffering from alcohol use disorders was a highly complex task to accomplish. This required the nurse to engage with the patient in a sensitive cooperation in order to be dealing with the intricacy of the patient's life situation and balancing care between standardized procedures and the complexity of the patients. Further, a two‐sided feeling of responsibility emerged: a professional responsibility and a personal responsibility causing the provision of care as being caught between feelings of despondency and resignation. Nurses lack opportunities for being creative in determining how to provide care; instead, patients' perspectives of well‐being should be taken into account and should guide the provision of a meaningful care. Nurses must call for opportunities to deviate from the firmly established procedures restraining the care of this population. (shrink)

Virtual Reality Therapy has been shown to be effective in treating anxiety disorders and phobias, but has not yet been widely tested for Substance Use Disorders and it is not known whether health care practitioners working with SUDs would use VRT if it were available. We report the results of an interview study exploring practitioners’ and researchers’ views on the utility of VRT for SUD treatment. Practitioners and researchers with at least two years’ experience delivering or researching and designing SUD (...) treatments were recruited. Interviews were thematically analyzed, resulting in themes relating to the safety and realism of VRT, and the opportunity for the additional insight it could offer to during SUD treatment. Participants were positive about employing VRT as an additional treatment for SUD. VRT was thought suitable for treating adults and people with mental health issues or trauma, provided that risks were appropriately managed. Subsequent relapse, trauma and over-confidence in the success of treatment were identified as risks. The opportunity VRT offered to include other actors in therapy, and observe reactions, were benefits that could not currently be achieved with other forms of therapy. Overall, VRT was thought to offer the potential for safe, realistic, personalized and insightful exposure to diverse triggering scenarios, and to be acceptable for integration into a wide range of SUD treatments. (shrink)

Aims: Attentional bias, alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder. The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content.Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance (...) misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking and VR technologies at different time points.Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB.Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed. (shrink)

Background: Previous research has identified a link between the loss of a significant person, grief complications, and substance abuse. People with substance use disorder are more vulnerable to complicated grieving symptoms following loss. From sociocognitive theories, the model of coping with stress assumes that substance use is one of the responses used to cope with traumatic life events. The main objective of this study is to identify the coping strategies of people with SUD and to analyze their relationship to (...) complicated grief.Methods: A sample of 196 bereaved drug-dependent patients was assessed, after providing written consent, in sociodemographic variables, drug and bereavement related characteristics, CG symptomatology and coping strategies.Results: There are differences in relation to the coping strategies used among patients with CG, using more those focused on emotional expression, social withdrawal, wishful thinking, and self-criticism.Conclusion: We can conclude that, in general, CG in patients with SUD is more associated with the use of less adaptive coping strategies. This data can contribute to a better understanding of the different variables involved in the grieving process among people with SUD. It is important to point out the clinical implications of addressing what the coping strategies associated with improved grief outcomes among people with addiction problems are. (shrink)

In the Peruvian Amazon, tobacco (Nicotiana rustica) is considered a master plant and is the main curing tool of local healers. Among its several medicinal uses, we find drinking tobacco juice with the purpose of purging in order to heal on a physical, mental, and spiritual level. This specific practice is part of the addiction treatment protocol developed at Takiwasi Center. The goal of this investigation was to focus on the effects of the tobacco purge as reported by therapists at (...) Takiwasi and to elaborate its relevance within the context of addiction treatment. In order to obtain information on this topic, we performed research fieldwork based on a participant-observation approach, and retrospective data analysis on information from interviews conducted by psychotherapists with patients. As alleged effects of the tobacco purge, therapists reported that patients experienced feelings of mental clarity with the greatest frequency (n = 80), followed by noteworthy physical effects including discomfort and intoxication (n = 63). An effect on sleep and dreams was also common (n = 36) and many found the experience directly related to addiction treatment and the desire to consume substances (n = 20). (shrink)

There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people’s recovery efforts. Issues which impede the development of prorecovery environments are complex, but include the far-reaching effects of the social stigma that surrounds SUDs; and the failure to harness relational and social support that allows debates to transcend blaming individual substance users. As part of efforts to create prorecovery environments, it is important to acknowledge that bioethics debate on SUDs (...) is narrow in scope, prioritising topics related to its traditional interests in individual autonomy and novel technologies. As a result, it has not played a significant role in helping to transform the ethical cultures in which substance use recovery takes place. For example, it largely neglects the ethical challenges of developing an empathic, person-centred approach to substance use problems that listens and responds to the voices of clients. It has also participated little in efforts to develop a positive response to reducing the toxic effects of stigma. Indeed, some contributions from the field fan stigma, rather than alleviate it. The aim of this paper is to seed broader ethical debate, in academic literature and lay/professional communities, on how societies should respond to SUDs: steering a course between the critical, but narrow approach of bioethics and the empowerment discourse of evidence-based treatments. (shrink)

Addiction is compulsive need for and use of a habit-forming substance. It is accepted as a mental illness in the diagnostic nomenclature and results in substantial health, social and economic problems. In the diagnostic nomenclature, addiction was originally included in the personality disorders along with other behaviours considered deviant. But it is now considered a clinical syndrome. Addiction is multifactorially determined, with substantial genetic influence. The development of addictions is also influenced by environmental factors, and an interplay between the two. (...) In the clinical context, addiction puts problem substance use on the agenda, and helps focus on the difficulties associated with drug use. But the concept of addiction is also used to distance the user from addicts, and in this way, may be counter-therapeutic. The addiction concept has also had a substantial influence on policy. The almost universal prohibition against drugs such as opiates, cocaine, cannabis and amphetamine has much support. But unfortunately, it has not been able to hinder the development of substance use problems. Optimism is fostered by the development of respectful ways of thinking about people with addictions, in particular, from advocates of motivational interviewing. (shrink)

Intravenous drug abusers may incur bloodstream infections, in particular those involving the heart valves, that often require extended courses of antibiotics, commonly on the order of six weeks.Conventional wisdom has dictated that even when patients are sufficiently well to not need ongoing hospitalization, it is unsafe to complete their antibiotic course in any setting other than in a closely supervised facility, even if this is contrary to their wishes. The assumption has been that such patients would be at risk of (...) using their indwelling intravenous catheter for illicit purposes. Recent advances in the care of patients who suffer from addiction disorders suggest that when patients receive state-of-the-art addiction treatment, many may be able to continue their intravenous antibiotic course unsupervised, at home. This represents a departure from the parentalistic model of care of impaired patients who are prone to self-harm, moving towards a model that respects autonomy and trusts patients who are in recovery to continue their care in a manner that is self-beneficial. (shrink)