- Email: [email protected]
loss processing
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
Results: Due to slow enrollment and a relatively low rate of initial abstinence (only 18/40 of the enrolled participants met the abstinence criterion for randomization), we ended the study after enrolling 40 participants. There was no difference between treatment groups in time to relapse or in the number of cocaine-negative urines. EMA reports of cocaine craving were greater in participants who received aripiprazole (17.29% vs. 7.79%, F = 7.89, p ≤ 0.05) and in those who reported real time exposure to cocaine-related cues (46.61% vs. 1.98%, F = 144.41, p ≤ 0.0001). The effect of cues on craving was more pronounced in the aripiprazole group (aripiprazole, 73.25% vs. placebo, 21.77%, F = 19.42, p ≤ 0.005). Conclusions: Aripiprazole is not likely to be an effective treatment for prevention of cocaine relapse, and may in fact increase cue-induced craving that could result in relapse. Financial support: NIDA, IRP. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.410 Is parenting really that stressful? Daily behavioral stress in drug using parents compared to non-parents Angela Moreland 1,∗ , Delisa Brown 3 , Nate Baker 2 , Aimee McRae-Clark 1 1 Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States 2 Medical University of South Carolina, Charleston, SC, United States 3 Howard University, Washington, DC, United States
Aims: Evidence indicates that both acute and chronic stress play a critical role in drug use, with particular emphasis on the negative impact of behavioral stress (Sinha, 2000). Less literature has examined the role of stress caused by parenting which is surprising given the cumulative negative effect of seemingly minor stressors, such as those related to parenting (Fox et al., 2010). This study hypothesized that: (1) drug using parents will report higher baseline levels of behavioral stress than non-parents; and (2) female parents will indicate higher levels of behavioral stress than non-parents. Methods: Participants (n = 115) were collected in two distinct medication/laboratory studies in cocaine dependent participants. Data collection involved identifying all cocaine dependent study participants’ parental status, age(s) of their child or children, and level of daily behavioral stress (Daily Hassles Scale). Results: Female parents reported significantly higher DHS total scores as compared to male parents (75.5 ± 8.2 vs. 38.3 ± 5.6; t110 = 3.74; p < 0.001) while female and male non-parents were not appreciably different from one another (41.6 ± 13.1 vs. 45.1 ± 7.0; t110 = 0.23; p = 0.819). There were no noted main effects or confounding effects of race, marital status, or study group on the relationship between parental status with gender on DHS total scores (all p = 0.25). Conclusions: Results suggest that, for drug using parents, females may be impacted more significantly by daily behavioral stressors in their environment than their male counterparts. Further research is necessary to increase generalization and knowledge regarding this important link, as well as to examine additional factors that may be involved. Financial support: This study was supported by grant 5K12DA031794-03 to support the first author, as well as by NIH grants P50DA016511, R01DA021690, and K24DA038240 to support work by the last author. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.411
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Ongoing survey of alternative nicotine and tobacco use among cardiac patients Zachary H. Morford 1,∗ , Diann Gaalema 1 , Rebecca Elliott 1 , Philip Ades 1 , Stephen Higgins 2 1 University of Vermont, South Burlington, VT, United States 2 University of Vermont, Burlington, VT, United States
Aims: The use of nicotine and tobacco products among cardiac patients is of interest because these individuals are often motivated to quit smoking following a serious event, however smoking cessation remains a critical challenge. Patients may switch to one or more noncombustible product following their event if they are unable to completely abstain from nicotine. Methods: We have surveyed inpatient cardiac patients who had a myocardial infarction or heart surgery across three sites in Vermont, Texas, and Kentucky. Patients were asked a series of questions regarding their past and current tobacco and nicotine use and their knowledge of alternative (i.e., noncombustible cigarette) tobacco products. All patients surveyed will also be given the same survey over the phone three months after the initial survey Results: Initial data from 40 participants have been collected at the University of Vermont. Thus far patients have been mostly white (94.9%) and male (65%), the median age of the group thus far is 56.5 years of age, and most participants reported that they plan on quitting smoking within the next 30 days (88.2%). Most participants have heard of electronic cigarettes (95%) and chew tobacco (92.5%), but fewer participants had heard of snus (30%) or dissolvables (7.5%). Some participants reported using electronic cigarettes (27.5%); cigars, little cigars, or cigarillos (27.5%); smokeless tobacco (10%); snus (2.5%); and bidi or clove cigarettes (2.5%) at least once a year before taking the survey. Conclusions: While we have data preliminary data regarding baseline levels of combustible cigarette and alternative tobacco use, we have yet to know how patterns of use change as a function of cardiac events, and whether such changes are predicted by other factors such as age or education level. Cardiac patients switching to alternative unregulated nicotine products instead of completely abstaining from nicotine use could have important regulatory implications. Financial support: NIH P20GM103644, NIDA/FDA P50DA036114. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.412 Alexithymia and addiction: A review and preliminary data suggesting neurobiological links to reward/loss processing Kristen Paula Morie 1,∗ , Sarah W. Yip 2 , Charla Nich 3 , Karen Hunkele 3 , Kathleen Carroll 2 , Marc N. Potenza 2 1
Diagnostic Radiology, Yale University, New Haven, CT, United States 2 Psychiatry, Yale University, New Haven, CT, United States 3 Connecticut Mental Health Center, New Haven, CT, United States Aims: Alexithymia, characterized by impairments in emotional awareness, is common among individuals with substance use disorders. Although impairments in emotional processing have been linked to brain function underlying reward and loss processing and such brain functions have been found to be abnormal in individuals with addictions, the relationship between alexithymia and the
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Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
neural correlates of reward and loss processing in drug addictions has yet to be examined. Methods: Twelve methadone-maintained individuals with opioid and cocaine dependence completed the Toronto Alexithymia Scale (TAS-20) upon treatment intake and participated in fMRI scanning during performance of a Monetary Incentive Delay (MID) task. Results: Whole-brain correlational analyses revealed positive associations between scores on the TAS-20 and brain activations during prospect phases (A1 phase of the MID task) in regions including the thalamus, midbrain and middle and inferior frontal gyri during reward prospect and in midbrain and middle and inferior frontal gyri during loss prospect (FWE < .01). Conclusions: The findings suggest that alexithymia is related to the neural correlates of reward and loss processing among cocainedependent methadone-maintained individuals. This interplay between reward processing and emotional processing difficulties could have implications for treatment response. Financial support: The primary source of funding for this work was the National Institute on Drug Abuse grants R37-DA 015969 and P50-DA09241. Clinicaltrials.gov ID number NCT00350610. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.413 Gender differences in the effects of concurrent drug use on the risk of heroin relapse Andrew L. Moskowitz 1,2,∗ , Christine E. Grella 2 1
Psychology, UCLA, Los Angeles, CA, United States Integrated Substance Abuse Programs, UCLA, Los Angeles, CA, United States 2
Aims: This study aims to determine whether use of alcohol and other drugs increases risk of relapse to heroin use among individuals in a long-term follow-up and gender differences in these relationships. Methods: The study sample was originally sampled from methadone maintenance treatment programs in California in the 1980s. A follow-up was conducted in 2005–09 of 343 participants (44.3% female; 70.6% of those not deceased in the original cohort). Average age at follow-up was 58.3 (SD = 4.9) for males and 55.0 (SD = 4.1) for females. A detailed timeline of periods of drug use and abstinence was obtained at the follow-up. Frailty analyses with random effects for persons were conducted to examine the effects of use or abstinence from marijuana, alcohol, and other drugs on the risk of relapsing to heroin. First, separate models examining the effect of each substance on heroin use were conducted by gender; then a final combined model examined the effects of all substances on relapse to heroin by gender. Results: There was a significant interaction between gender and use of marijuana on heroin use (b = .599, X2 = 19.08, p < .0001). The risk of relapsing to heroin was reduced by 38.7% in men who abstained from marijuana compared to those who were using (HR = .61, p < .0001). However, there was no difference in risk of relapse to heroin for women associated with marijuana use. With regard to alcohol, abstinence increased the risk of relapse to heroin for both men (HR = 5.26, p < .0001) and women (HR = 7.10, p < .0001), with a greater effect among women. On average, those who were abstinent from other drugs were 14% less likely than others to relapse to heroin (HR = .864, p < .02); however, there was no gender difference. These results were consistent with the final combined model accounting for the effects of use of any substance by gender. Conclusions: Complex patterns of marijuana and alcohol use and their relationship with relapse to heroin use were observed
over a 25-year follow-up study, with differential patterns by gender. Financial support: NIDA grants no. R01-DA015390 and T32DA007272. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.414 Readiness to change is a predictor of reduced substance use involvement: Findings from a randomized controlled trial of patients attending South African emergency departments Bronwyn Myers 1,∗ , Dan Jane Stein 2 , Katherine Sorsdahl 2 1 Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa 2 University of Cape Town, Cape Town, South Africa
Aims: This study examines whether readiness to change (RTC) is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments (ED). Methods: We use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three EDs in Cape Town, South Africa. Results: In adjusted analyses, the SOCRATES “Recognition” score (B = 11.6; 95% CI = 6.2 to 17.0), “Taking Steps” score (B = −9.5; 95% CI = −15.5 to −3.5) and alcohol problems (B = 4.4; 95% CI = 0.9 to 7.9) predicted change in substance use involvement at 3-month follow-up. Severity of depression (B = 0.2; 95% CI = 0.1 to 0.3), methamphetamine use (B = 3.4; 95% CI = 0.5 to 6.3) and substancerelated injury (B = 1.9; 95% CI = 0.6 to 3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95% CI = 0.04 to 0.1) and methamphetamine use (B = 2.3; 95% CI = 0.1 to 4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = −1.7; 95% CI = −5.0 to −0.6). Conclusions: Findings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes. Financial support: Western Cape Department of Health. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.415 Initial assessment of smoking status of pregnant women enrolled in a clinical trial for smoking cessation Tatiana Nanovskaya 1,∗ , Valentina M. Fokina 2 , Holly West 2 , Cheryl Oncken 3 , Mahmoud S. Ahmed 1 , Gary Hankins 1 1 OB/GYN Maternal Fetal Medicine, University of Texas Medical Branch, Galveston, TX, United States 2 UTMB, Galveston, TX, United States 3 University of Connecticut Health Center, Farmington, CT, United States
Aims: A pilot double-blind placebo controlled clinical trial for the safety and efficacy of bupropion as an aid for smoking cessation
Results: Due to slow enrollment and a relatively low rate of initial abstinence (only 18/40 of the enrolled participants met the abstinence criterion for randomization), we ended the study after enrolling 40 participants. There was no difference between treatment groups in time to relapse or in the number of cocaine-negative urines. EMA reports of cocaine craving were greater in participants who received aripiprazole (17.29% vs. 7.79%, F = 7.89, p ≤ 0.05) and in those who reported real time exposure to cocaine-related cues (46.61% vs. 1.98%, F = 144.41, p ≤ 0.0001). The effect of cues on craving was more pronounced in the aripiprazole group (aripiprazole, 73.25% vs. placebo, 21.77%, F = 19.42, p ≤ 0.005). Conclusions: Aripiprazole is not likely to be an effective treatment for prevention of cocaine relapse, and may in fact increase cue-induced craving that could result in relapse. Financial support: NIDA, IRP. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.410 Is parenting really that stressful? Daily behavioral stress in drug using parents compared to non-parents Angela Moreland 1,∗ , Delisa Brown 3 , Nate Baker 2 , Aimee McRae-Clark 1 1 Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States 2 Medical University of South Carolina, Charleston, SC, United States 3 Howard University, Washington, DC, United States
Aims: Evidence indicates that both acute and chronic stress play a critical role in drug use, with particular emphasis on the negative impact of behavioral stress (Sinha, 2000). Less literature has examined the role of stress caused by parenting which is surprising given the cumulative negative effect of seemingly minor stressors, such as those related to parenting (Fox et al., 2010). This study hypothesized that: (1) drug using parents will report higher baseline levels of behavioral stress than non-parents; and (2) female parents will indicate higher levels of behavioral stress than non-parents. Methods: Participants (n = 115) were collected in two distinct medication/laboratory studies in cocaine dependent participants. Data collection involved identifying all cocaine dependent study participants’ parental status, age(s) of their child or children, and level of daily behavioral stress (Daily Hassles Scale). Results: Female parents reported significantly higher DHS total scores as compared to male parents (75.5 ± 8.2 vs. 38.3 ± 5.6; t110 = 3.74; p < 0.001) while female and male non-parents were not appreciably different from one another (41.6 ± 13.1 vs. 45.1 ± 7.0; t110 = 0.23; p = 0.819). There were no noted main effects or confounding effects of race, marital status, or study group on the relationship between parental status with gender on DHS total scores (all p = 0.25). Conclusions: Results suggest that, for drug using parents, females may be impacted more significantly by daily behavioral stressors in their environment than their male counterparts. Further research is necessary to increase generalization and knowledge regarding this important link, as well as to examine additional factors that may be involved. Financial support: This study was supported by grant 5K12DA031794-03 to support the first author, as well as by NIH grants P50DA016511, R01DA021690, and K24DA038240 to support work by the last author. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.411
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Ongoing survey of alternative nicotine and tobacco use among cardiac patients Zachary H. Morford 1,∗ , Diann Gaalema 1 , Rebecca Elliott 1 , Philip Ades 1 , Stephen Higgins 2 1 University of Vermont, South Burlington, VT, United States 2 University of Vermont, Burlington, VT, United States
Aims: The use of nicotine and tobacco products among cardiac patients is of interest because these individuals are often motivated to quit smoking following a serious event, however smoking cessation remains a critical challenge. Patients may switch to one or more noncombustible product following their event if they are unable to completely abstain from nicotine. Methods: We have surveyed inpatient cardiac patients who had a myocardial infarction or heart surgery across three sites in Vermont, Texas, and Kentucky. Patients were asked a series of questions regarding their past and current tobacco and nicotine use and their knowledge of alternative (i.e., noncombustible cigarette) tobacco products. All patients surveyed will also be given the same survey over the phone three months after the initial survey Results: Initial data from 40 participants have been collected at the University of Vermont. Thus far patients have been mostly white (94.9%) and male (65%), the median age of the group thus far is 56.5 years of age, and most participants reported that they plan on quitting smoking within the next 30 days (88.2%). Most participants have heard of electronic cigarettes (95%) and chew tobacco (92.5%), but fewer participants had heard of snus (30%) or dissolvables (7.5%). Some participants reported using electronic cigarettes (27.5%); cigars, little cigars, or cigarillos (27.5%); smokeless tobacco (10%); snus (2.5%); and bidi or clove cigarettes (2.5%) at least once a year before taking the survey. Conclusions: While we have data preliminary data regarding baseline levels of combustible cigarette and alternative tobacco use, we have yet to know how patterns of use change as a function of cardiac events, and whether such changes are predicted by other factors such as age or education level. Cardiac patients switching to alternative unregulated nicotine products instead of completely abstaining from nicotine use could have important regulatory implications. Financial support: NIH P20GM103644, NIDA/FDA P50DA036114. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.412 Alexithymia and addiction: A review and preliminary data suggesting neurobiological links to reward/loss processing Kristen Paula Morie 1,∗ , Sarah W. Yip 2 , Charla Nich 3 , Karen Hunkele 3 , Kathleen Carroll 2 , Marc N. Potenza 2 1
Diagnostic Radiology, Yale University, New Haven, CT, United States 2 Psychiatry, Yale University, New Haven, CT, United States 3 Connecticut Mental Health Center, New Haven, CT, United States Aims: Alexithymia, characterized by impairments in emotional awareness, is common among individuals with substance use disorders. Although impairments in emotional processing have been linked to brain function underlying reward and loss processing and such brain functions have been found to be abnormal in individuals with addictions, the relationship between alexithymia and the
e150
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
neural correlates of reward and loss processing in drug addictions has yet to be examined. Methods: Twelve methadone-maintained individuals with opioid and cocaine dependence completed the Toronto Alexithymia Scale (TAS-20) upon treatment intake and participated in fMRI scanning during performance of a Monetary Incentive Delay (MID) task. Results: Whole-brain correlational analyses revealed positive associations between scores on the TAS-20 and brain activations during prospect phases (A1 phase of the MID task) in regions including the thalamus, midbrain and middle and inferior frontal gyri during reward prospect and in midbrain and middle and inferior frontal gyri during loss prospect (FWE < .01). Conclusions: The findings suggest that alexithymia is related to the neural correlates of reward and loss processing among cocainedependent methadone-maintained individuals. This interplay between reward processing and emotional processing difficulties could have implications for treatment response. Financial support: The primary source of funding for this work was the National Institute on Drug Abuse grants R37-DA 015969 and P50-DA09241. Clinicaltrials.gov ID number NCT00350610. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.413 Gender differences in the effects of concurrent drug use on the risk of heroin relapse Andrew L. Moskowitz 1,2,∗ , Christine E. Grella 2 1
Psychology, UCLA, Los Angeles, CA, United States Integrated Substance Abuse Programs, UCLA, Los Angeles, CA, United States 2
Aims: This study aims to determine whether use of alcohol and other drugs increases risk of relapse to heroin use among individuals in a long-term follow-up and gender differences in these relationships. Methods: The study sample was originally sampled from methadone maintenance treatment programs in California in the 1980s. A follow-up was conducted in 2005–09 of 343 participants (44.3% female; 70.6% of those not deceased in the original cohort). Average age at follow-up was 58.3 (SD = 4.9) for males and 55.0 (SD = 4.1) for females. A detailed timeline of periods of drug use and abstinence was obtained at the follow-up. Frailty analyses with random effects for persons were conducted to examine the effects of use or abstinence from marijuana, alcohol, and other drugs on the risk of relapsing to heroin. First, separate models examining the effect of each substance on heroin use were conducted by gender; then a final combined model examined the effects of all substances on relapse to heroin by gender. Results: There was a significant interaction between gender and use of marijuana on heroin use (b = .599, X2 = 19.08, p < .0001). The risk of relapsing to heroin was reduced by 38.7% in men who abstained from marijuana compared to those who were using (HR = .61, p < .0001). However, there was no difference in risk of relapse to heroin for women associated with marijuana use. With regard to alcohol, abstinence increased the risk of relapse to heroin for both men (HR = 5.26, p < .0001) and women (HR = 7.10, p < .0001), with a greater effect among women. On average, those who were abstinent from other drugs were 14% less likely than others to relapse to heroin (HR = .864, p < .02); however, there was no gender difference. These results were consistent with the final combined model accounting for the effects of use of any substance by gender. Conclusions: Complex patterns of marijuana and alcohol use and their relationship with relapse to heroin use were observed
over a 25-year follow-up study, with differential patterns by gender. Financial support: NIDA grants no. R01-DA015390 and T32DA007272. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.414 Readiness to change is a predictor of reduced substance use involvement: Findings from a randomized controlled trial of patients attending South African emergency departments Bronwyn Myers 1,∗ , Dan Jane Stein 2 , Katherine Sorsdahl 2 1 Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa 2 University of Cape Town, Cape Town, South Africa
Aims: This study examines whether readiness to change (RTC) is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments (ED). Methods: We use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three EDs in Cape Town, South Africa. Results: In adjusted analyses, the SOCRATES “Recognition” score (B = 11.6; 95% CI = 6.2 to 17.0), “Taking Steps” score (B = −9.5; 95% CI = −15.5 to −3.5) and alcohol problems (B = 4.4; 95% CI = 0.9 to 7.9) predicted change in substance use involvement at 3-month follow-up. Severity of depression (B = 0.2; 95% CI = 0.1 to 0.3), methamphetamine use (B = 3.4; 95% CI = 0.5 to 6.3) and substancerelated injury (B = 1.9; 95% CI = 0.6 to 3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95% CI = 0.04 to 0.1) and methamphetamine use (B = 2.3; 95% CI = 0.1 to 4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = −1.7; 95% CI = −5.0 to −0.6). Conclusions: Findings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes. Financial support: Western Cape Department of Health. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.415 Initial assessment of smoking status of pregnant women enrolled in a clinical trial for smoking cessation Tatiana Nanovskaya 1,∗ , Valentina M. Fokina 2 , Holly West 2 , Cheryl Oncken 3 , Mahmoud S. Ahmed 1 , Gary Hankins 1 1 OB/GYN Maternal Fetal Medicine, University of Texas Medical Branch, Galveston, TX, United States 2 UTMB, Galveston, TX, United States 3 University of Connecticut Health Center, Farmington, CT, United States
Aims: A pilot double-blind placebo controlled clinical trial for the safety and efficacy of bupropion as an aid for smoking cessation