Substance Abuse and Rehabilitation最新文献

{"title":"Pharmacological Treatments for Methamphetamine Use Disorder: Current Status and Future Targets.","authors":"Justin R Yates","doi":"10.2147/SAR.S431273","DOIUrl":"10.2147/SAR.S431273","url":null,"abstract":"<p><p>The illicit use of the psychostimulant methamphetamine (METH) is a major concern, with overdose deaths increasing substantially since the mid-2010s. One challenge to treating METH use disorder (MUD), as with other psychostimulant use disorders, is that there are no available pharmacotherapies that can reduce cravings and help individuals achieve abstinence. The purpose of the current review is to discuss the molecular targets that have been tested in assays measuring the physiological, the cognitive, and the reinforcing effects of METH in both animals and humans. Several drugs show promise as potential pharmacotherapies for MUD when tested in animals, but fail to produce long-term changes in METH use in dependent individuals (eg, modafinil, antipsychotic medications, baclofen). However, these drugs, plus medications like atomoxetine and varenicline, may be better served as treatments to ameliorate the psychotomimetic effects of METH or to reverse METH-induced cognitive deficits. Preclinical studies show that vesicular monoamine transporter 2 inhibitors, metabotropic glutamate receptor ligands, and trace amine-associated receptor agonists are efficacious in attenuating the reinforcing effects of METH; however, clinical studies are needed to determine if these drugs effectively treat MUD. In addition to screening these compounds in individuals with MUD, potential future directions include increased emphasis on sex differences in preclinical studies and utilization of pharmacogenetic approaches to determine if genetic variances are predictive of treatment outcomes. These future directions can help lead to better interventions for treating MUD.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Reported Sobriety Labels: Perspectives from Alumni of Inpatient Addiction Treatment.","authors":"Jessica L Bourdon, Sidney Judson, Taylor Fields, Sabrina Verdecanna, Nehal P Vadhan, Jon Morgenstern","doi":"10.2147/SAR.S470780","DOIUrl":"10.2147/SAR.S470780","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of consensus in the addiction field as to how to refer to alumni of residential treatment who no longer use substances or who reduce their use. In the literature, this label and broader identity are typically discussed in technical (amount and frequency of use) or social terms (environment and social network changes).</p><p><strong>Objective: </strong>The current paper seeks to simplify the discussion by focusing on personal labels without complex technical or social considerations. Alumni of an inpatient addiction treatment facility were asked how they refer to themselves regarding their sobriety status post-discharge.</p><p><strong>Methods: </strong>Forty-nine patients were contacted 3 months post-discharge from a residential inpatient addiction treatment (men = 67%; <i>M</i>age = 47.75 years). The patients completed a post-discharge assessment that was conducted by a trained research assistant over a 20-minute video call. The current study focused on a \"sobriety label\" measure in which patients indicated what they want to be called. Patients also explained why they chose their answer in an open-ended question.</p><p><strong>Results: </strong>Most patients identified as <i>in recovery</i> (<i>n</i> = 29; 59.18%) followed by <i>a sober person</i> (n = 7; 14.29%) and four other responses. No alum selected the <i>in remission</i> option, which is notably a common way to refer to patients who no longer use substances.</p><p><strong>Conclusion: </strong>The current study adds a critical patient/alumni perspective to the existing body of literature and serves as a call to action for researchers to add a similar \"sobriety label\" measure to future assessments, studies, and batteries in effort to bring consistency to the labels, definitions, and identities that are published. This methodology of understanding how this population identifies will create uniformity in future literature and decrease the stigma surrounding addiction.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Patients Presenting at an Emergency Department for a Heroin Overdose vs Detoxification.","authors":"Kenneth E Leonard, Joshua J Lynch, Florence W Leong, Daniel J Kruger, Brian M Clemency","doi":"10.2147/SAR.S461521","DOIUrl":"10.2147/SAR.S461521","url":null,"abstract":"<p><strong>Purpose: </strong>This study compares substance use, treatment histories, and sociodemographic characteristics of patients presenting to an emergency department (ED) following a heroin overdose or seeking detoxification services for heroin and examines risk factors for a subsequent return to the ED for a substance-related problem.</p><p><strong>Methods: </strong>A convenience sample of patients presenting for an overdose or detoxification at an urban teaching ED was recruited for this study. During their ED visit, patients were interviewed regarding demographics, substance use experiences, and treatment history. Subsequently, a review of patient records for past and subsequent ED use was performed.</p><p><strong>Results: </strong>Patients requesting detox and those with an overdose were similar in terms of prior treatment. Both groups had similar extensive polysubstance histories. As a group, however, patients presenting for detox were more likely to report use of each of three substances (benzodiazepines, opioid pain medications, and heroin) more than three times per week, compared to those presenting for overdose. Detox patients had higher scores on the 3-item Alcohol Use Disorder Identification Test-C and the drug problems scale compared to overdose patients. Overall, 28% of the patients returned to the ED within 90 days for a drug-related issue, including 8% that returned for an overdose. Factors predictive of a return ED visit included ED visits for substance use in the previous year and recent frequent heroin use.</p><p><strong>Conclusion: </strong>Patients requesting detox were similar in most domains to those presenting following an overdose. Notably, overdose patients were less likely to use heroin more than three times per week compared to detox patients. Both groups were equally likely to return for an SUD reason within 3-months, however for both groups, previous ED visits and recent frequent heroin use predicted a return visit.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11214563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nalmefene Hydrochloride: Potential Implications for Treating Alcohol and Opioid Use Disorder","authors":"MeShell Green, Charles A. Veltri, O. Grundmann","doi":"10.2147/SAR.S431270","DOIUrl":"https://doi.org/10.2147/SAR.S431270","url":null,"abstract":"Abstract Nalmefene hydrochloride was first discovered as an opioid antagonist derivative of naltrexone in 1975. It is among the most potent opioid antagonists currently on the market and is differentiated from naloxone and naltrexone by its partial agonist activity at the kappa-opioid receptor which may benefit in the treatment of alcohol use disorder. Oral nalmefene has been approved in the European Union for treatment of alcohol use disorder since 2013. As of 2023, nalmefene is available in the United States as an intranasal spray for reversal of opioid overdose but is not approved for alcohol or opioid use disorder as a maintenance treatment. The substantially longer half-life of nalmefene and 5-fold higher binding affinity to opioid receptors makes it a superior agent over naloxone in the reversal of high potency synthetic opioids like fentanyl and the emerging nitazenes. Nalmefene presents with a comparable side effect profile to other opioid antagonists and should be considered for further development as a maintenance treatment for opioid and other substance use disorders.","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140793062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Opioid Withdrawal Symptoms During the Fentanyl Crisis: A Review","authors":"Andrea N. Weber, J. Trebach, Marielle Brenner, Mary Thomas, Nicholas L. Bormann","doi":"10.2147/SAR.S433358","DOIUrl":"https://doi.org/10.2147/SAR.S433358","url":null,"abstract":"Abstract Illicitly manufactured fentanyl (IMF) is a significant contributor to the increasing rates of overdose-related deaths. Its high potency and lipophilicity can complicate opioid withdrawal syndromes (OWS) and the subsequent management of opioid use disorder (OUD). This scoping review aimed to collate the current OWS management of study populations seeking treatment for OWS and/or OUD directly from an unregulated opioid supply, such as IMF. Therefore, the focus was on therapeutic interventions published between January 2010 and November 2023, overlapping with the period of increasing IMF exposure. A health science librarian conducted a systematic search on November 13, 2023. A total of 426 studies were screened, and 173 studies were reviewed at the full-text level. Forty-nine studies met the inclusion criteria. Buprenorphine and naltrexone were included in most studies with the goal of transitioning to a long-acting injectable version. Various augmenting agents were tested (buspirone, memantine, suvorexant, gabapentin, and pregabalin); however, the liberal use of adjunctive medication and shortened timelines to initiation had the most consistently positive results. Outside of FDA-approved medications for OUD, lofexidine, gabapentin, and suvorexant have limited evidence for augmenting opioid agonist initiation. Trials often have low retention rates, particularly when opioid agonist washout is required. Neurostimulation strategies were promising; however, they were developed and studied early. Precipitated withdrawal is a concern; however, the rates were low and adequately mitigated or managed with low- or high-dose buprenorphine induction. Maintenance treatment continues to be superior to detoxification without continued management. Shorter induction protocols allow patients to initiate evidence-based treatment more quickly, reducing the use of illicit or non-prescribed substances.","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140773494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitioning Virtual-Only Group Therapy for Substance Use Disorder Patients to a Hybrid Model","authors":"Tyler S. Oesterle, Nicholas L. Bormann, Domenic Ochal, Stephan Arndt, Scott Breitinger","doi":"10.2147/sar.s460024","DOIUrl":"https://doi.org/10.2147/sar.s460024","url":null,"abstract":"Purpose: Telehealth is associated with a myriad of benefits; however, little is known regarding substance use disorder (SUD) treatment outcomes when participants join group therapy sessions in a combination in-person and virtual setting (hybrid model). We sought to determine if treatment completion rates differed. Patients and Methods: Policy changes caused by the COVID-19 pandemic created a naturalistic, observational cohort study at seven intensive outpatient (IOP) programs in rural Minnesota. Virtual-only delivery occurred 6/1/2020-6/30/2021, while hybrid groups occurred 7/1/2021-7/31/2022. Data was evaluated retrospectively for participants who initiated and discharged treatment during the study period. Participants were IOP group members 18 years and older who had a SUD diagnosis that both entered and discharged treatment during the 26-month period. A consecutive sample of 1502 participants (181–255 per site) was available, with 644 removed: 576 discharged after the study conclusion, 49 were missing either enrollment or discharge data, 14 transferred sites during treatment, and 5 initiated treatment before the study initiation. Helmert contrasts evaluated the impact of hybrid group exposure. Results: A total of 858 individuals were included. Data was not from the medical chart and was deidentified preventing specific demographics; however, the overall IOP sample for 2020–2022, from which the sample was derived, was 29.8% female, and 64.1% were 18–40 years of age. For completed treatment, hybrid group exposure relative to virtual-only had a univariate odds ratio of 1.88 (95% CI: 1.50–2.41, p < 0.001). No significant difference was seen across IOP sites. Conclusion: These results describe a novel hybrid group approach to virtual care for SUDs with outcome data not previously documented in the literature. While virtual treatment delivery can increase access, these results suggest a benefit is derived from including an in-person option. Further research is needed to identify how an in-person component may change dynamics and if it can be replicated in virtual-only models.","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Forgiveness and Self-Condemnation in the Context of Addictive Behavior and Suicidal Behavior.","authors":"Jon R Webb, Comfort M Boye","doi":"10.2147/SAR.S396964","DOIUrl":"10.2147/SAR.S396964","url":null,"abstract":"<p><p>Addictive behavior and suicidal behavior are serious individual- and public-level health concerns. For those struggling with either or both, self-condemnation is a common experience, especially with respect to shame, guilt, and self-stigma. Self-forgiveness, a construct common to both religiousness/spirituality and positive psychology, may be an effective tool in addressing the self-condemnation inherent to those struggling with addictive behavior and suicidal behavior. In this review paper, we discuss (1) the nature and definition of forgiveness, (2) theoretical modeling developed regarding the general association of forgiveness with health, (3) theoretical modeling developed regarding the specific association of forgiveness with better outcomes related to addictive and/or suicidal behavior, (4) the relevance of shame, guilt, and self-stigma to the development and maintenance of addictive and suicidal behavior, and (5) the role of self-forgiveness in addressing self-condemnation, especially shame, guilt, and self-stigma. Little work explicitly focused on the association of self-forgiveness with shame, guilt, and/or self-stigma has been done. However, empirical evidence is accumulating in support of other associations proposed in the Forgiveness-Addiction-Recovery Association (FARA) Model described herein. As such, it is likely that similar support will be found when the focus is deliberately turned to shame, guilt, and self-stigma.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not Two Sides of the Same Coin: A Qualitative Comparative Analysis of Post-Treatment Abstinence and Relapse.","authors":"Esther Pars, Fadi Hirzalla, Joanne E L VanDerNagel, Boukje A G Dijkstra, Arnt F A Schellekens","doi":"10.2147/SAR.S447560","DOIUrl":"10.2147/SAR.S447560","url":null,"abstract":"<p><strong>Purpose: </strong>Substance use disorder (SUD) can be a chronic relapsing condition with poor treatment outcomes. Studies exploring factors associated with abstinence or relapse after treatment are often quantitative in nature, applying linear statistical approaches, while abstinence and relapse result from non-linear, complex, dynamic and synergistic processes. This study aims to explore these underlying dynamics using qualitative comparative analysis (QCA) as a mixed methods approach to further our understanding of factors contributing to post-treatment abstinence and relapse.</p><p><strong>Patients and methods: </strong>In a prospective study, we gathered both qualitative and quantitative data pertaining to post-treatment substance use and the factors linked to substance use outcomes. These factors encompassed psychiatric comorbidity, intellectual disability, social disintegration, post-treatment support, and engagement in activities among patients who had undergone inpatient treatment for severe SUD (n = 58). QCA, a set-theoretic approach that considers the complex interplay of multiple conditions, was applied to discern which factors were necessary or sufficient for the occurrence of either abstinence or relapse.</p><p><strong>Results: </strong>We found two solutions predicting abstinence, and five for relapse. Post-treatment conditions (support and engagement in activities) were important for retaining abstinence. For relapse, individual baseline characteristics (intellectual disability, social disintegration, psychiatric comorbidity) combined with (post-)treatment factors (post-treatment support, activities) were important.</p><p><strong>Conclusion: </strong>Although abstinence and relapse represent opposing outcomes, they each exhibit distinct dynamics. To gain a comprehensive understanding of these dynamics, it is advisable to examine them as separate outcomes. For clinical practice, it can be worthwhile to recognize that fostering the conditions conducive to abstinence may differ from preventing the factors that trigger relapse.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State and Service Estimates of Substance Use Treatment Facilities That Receive Public Funds in the United States","authors":"Orrin D. Ware","doi":"10.2147/sar.s438706","DOIUrl":"https://doi.org/10.2147/sar.s438706","url":null,"abstract":"","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139018681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Alternate Measures of Readiness to Quit Smoking: Stages of Change and the Contemplation Ladder","authors":"Kelsey Miskimins, Amanda Kaufmann, David Haaga","doi":"10.2147/SAR.S440691","DOIUrl":"https://doi.org/10.2147/SAR.S440691","url":null,"abstract":"Purpose Two methods of operationalizing readiness to quit smoking have been used extensively in prior research. An algorithm derived from the transtheoretical model classifies current smokers in distinct stages of precontemplation (not intending to quit in next 6 months), contemplation (serious intent to quit within 6 months), and preparation (serious intent to quit within 30 days). The Contemplation Ladder (CL) is a single-item continuous (0–10) rating. The current study, a secondary analysis of a clinical trial testing a method of inducing quit attempts, examined the convergent validity, one-month retest reliability, and predictive validity (for quit attempts) of the CL and the stages of change algorithm. Patients and Methods Adult daily smokers (≥10 cigarettes/day; N = 278) completed the CL and stage of change algorithm measures and underwent an experimental manipulation intended to induce quit attempts. Four weeks later they completed the same measures and reported on whether they had attempted to quit smoking in the interim. Results The CL and the staging algorithm showed strong convergent validity, with intercorrelations of 0.50 and 0.51 at baseline and follow-up assessments. Retest reliability was similar for each measure (CL r = 0.52; stage of change r = 0.57). Each showed predictive validity in that smokers who went on to make a quit attempt had scored significantly higher at baseline in readiness to quit. Conclusion Researchers and clinicians can reasonably choose either measure of readiness to quit smoking with confidence that the results would parallel what would have been obtained with the other.","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138615170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}