- Email: [email protected]
Fractional anisotropy increase in long-term anabolic-androgenic steroid users
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
Histories of alcohol dependence, perceived stress, and depression among people living with HIV Lauren Michelle Kaplan 1,∗ , Gail Ironson 2 1 School of Public Health, UC Berkeley, Alcohol Research Group, Emeryville, CA, United States 2 Psychology, University of Miami, Miami, FL, United States
Aims: To examine how histories of alcohol abuse and dependence are associated with stress and depression among people living with HIV. Methods: Participants were a paid HIV+ (n = 177) in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) volunteer sample recruited through physician offices, specialty clinics, service organizations, and hospitals in Miami, Florida. Histories of alcohol dependence and abuse were assessed using DSM III criteria. Depression was measured using a cumulative average over two years of scores on the Beck Depression Inventory (BDI) and perceived stress was measured with the Perceived Stress Scale (PSS). OLS regression analysis was utilized. Results: History of alcohol dependence but not abuse was associated with more cumulative depression. When perceived stress was added to the model, history of alcohol dependence was no longer significantly associated with depression and perceived stress was significantly and positively associated with depression. History of alcohol dependence was also significantly associated with perceived stress. Conclusions: To our knowledge, this is the first study examining how histories of alcohol problems and perceived stress are associated with depression among people living with HIV. Findings suggest that perceived stress may mediate the associations between histories of alcohol dependence with depression. With the implementation of the Affordable Care Act, additional research is needed to understand how stress and mental health are involved in health outcomes and recovery from alcohol use disorders among people living with HIV. Such research can inform integrated approaches to specialist care. Interventions aimed at reducing stress and enhancing coping may reduce the risk of depression among patients with both HIV and alcohol use disorders, potentially reducing the risk of relapse. Financial support: Supported by R01MH53791, R01MH066697 (G. Ironson, P.I.), NIAAA Center grant P50 AA005595, and T32 AA007240. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.277 Differences in delay discounting between heroin and prescription opioid users Sterling L. Karakula 1,∗ , Margaret L. Griffin 2 , Roger Weiss 2 , Kathryn McHugh 2 1
McLean Hospital, Belmont, MA, United States McLean Hospital/Harvard Medical School, Belmont, MA, United States 2
Aims: Among those with opioid use disorder (OUD), primary heroin use has been associated with greater substance use severity and poorer treatment outcomes compared to prescription opioid (PO) users. Differentiating heroin users from PO users is necessary to inform the treatment needs of these distinct populations. Delay discounting is a facet of impulsivity that reflects the degree to which future rewards are devalued based on their distance in time from
e99
the present. The present study compared delay discounting (DD) in those with OUD based on primary opioid of use. Methods: Adults with OUD (N = 147) on an inpatient detoxification unit completed self-report measures including the Monetary Choice Questionnaire, a measure of DD. Participants provided selfreported opioid use in the 30 days prior to admission and were categorized into three groups based on primary opioid of use: heroin, prescription, or combined (both PO and heroin). DD scores were calculated and compared among the three groups. Results: Results from a univariate ANOVA demonstrated a main effect of group on DD (F[2,144] = 4.92, p < .01). Specifically, the heroin group (p < .05) and the combined group (p < .05) demonstrated greater DD compared to the prescription group; however, DD did not differ between the heroin and combined groups (p = 1.00). The heroin and combined groups were therefore collapsed and compared to the prescription group, controlling for sociodemographic variables. A main effect of group on DD remained (F[1,125] = 7.43, p < .01). Conclusions: In a sample of inpatients with OUD, elevated DD was observed in those using heroin, either alone or in conjunction with POs, compared to those using only POs. This difference demonstrates a preference for immediate rewards in heroin users, which may contribute to their poorer treatment outcomes. Further, PO users with greater DD may be at an increased risk of transitioning to heroin use; longitudinal research should evaluate this possibility. Financial support: NIDA grants 2UG1DA015831, K24 DA022288, and K23 DA035297. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.278 Fractional anisotropy increase in long-term anabolic-androgenic steroid users Marc J. Kaufman 2,∗ , Johanna Seitz 1 , Amanda E. Lyall 1 , Gen Kanayama 2 , Nikos Makris 1,2 , James I. Hudson 2 , Marek Kubicki 1 , Harrison G. Pope Jr. 2 1 Brigham & Women’s Hospital, Boston, MA, United States 2 McLean Hospital, Belmont, MA, United States
Aims: We recently reported increased amygdala volumes and reduced amygdala resting state functional connectivity in longterm anabolic-androgenic steroid (AAS) users versus non-users. We also acquired diffusion-weighted (DW) scans from these subjects to assess white matter structural connectivity. We hypothesized that we would detect fractional anisotropy (FA) abnormalities, reflecting white matter organization changes, in tracts associated with the amygdala network. Methods: Subjects in this study included 9 AAS users and 8 agematched non-using controls, whose 3-Tesla DW scans (B = 1000, 64 diffusion directions) satisfied quality controls. Images were processed with standard FSL tools, custom in-house scripts, and Tract-Based Spatial Statistics via the Enigma pipeline. We focused on integrity of the Inferior fronto-occipital fasciculus (IFOF), which connects inferior frontal and occipital lobes (major amygdala projections), and is involved in visuospatial memory, which we previously reported to be impaired in AAS users. Statistical analyses were conducted with Prism and SPSS. Results: We found a group FA difference in IFOF (ANOVA F1,15 = 9.4, P = 0.008), with AAS users exhibiting higher FA than non-users. Among AAS users, there was a positive association between FA and lifetime AAS use in IFOF (r = 0.82, P = 0.007). Posthoc FA laterality analysis revealed a significant group difference
e100
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
in left IFOF (t = 3.97, P < 0.001) and a trend-level right IFOF group difference (t = 1.85, P = 0.085). Conclusions: AAS users exhibited FA increases in IFOF, the degree of which was associated with lifetime AAS use. This finding is consistent with our prior report of amygdala and visuospatial memory abnormalities in AAS subjects. Future studies are needed to determine the functional significance of the FA increase in the context of network connectivity and visuospatial memory in AAS users. Financial support: NIH grants R01DA029141 (HP, GK, JH), and R01 AG04252 (MK, NM), R01 MH102377 (MK), and the Stuart T. Hauser Clinical Research Training Program (T32) (AL). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.279 Across time and space: Independent component analysis reveals spatial and temporal differences in functional brain networks between cocaine and alcohol users Tonisha Kearney-Ramos ∗ , Logan Thorne Dowdle, Oliver Mithoefer, Chris Mullins, William DeVries, Mark George, Colleen A. Hanlon Medical University of South Carolina, Charleston, SC, United States Aims: While altered functional connectivity (FC) has been linked to craving and cognitive function in substance use disorders (SUDs), it is unclear which patterns of neural disruption are common across SUDs and which are unique to the abused substance (e.g. cocaine vs alcohol). To determine patterns of FC common to or differentiating cocaine and alcohol users, independent component analysis (ICA) was applied to fMRI data from 38 users (19 cocaine, 19 alcohol) during a cue-induced craving task. Methods: ICA identified 75 functional networks based on temporal coherence of activity across brain regions. Spatial maps of several networks were contrasted between groups (thresholded at |t(37)| > 3, cluster size≥32 voxels for FWE p < .05), and temporal profiles of networks were compared via power spectral analysis. Results: There was no significant difference in spatial or temporal profile of default mode or cognitive control networks, but there were significant differences in several salience/attentional bias networks. Spatially, cocaine users had higher striatal network recruitment of visual cortex (ˇ = .31) than alcohol users (ˇ = −.52; t(37) = 5.86, p < .05); and alcohol users had higher right anterior insula recruitment into ventral visual network (ˇ = .88) than cocaine users (ˇ = .12; t(37) = −5.22, p < .05). Temporally, there was no difference for the striatal component, but there were significant differences for multiple components loading on medial and lateral PFC – with cocaine users favoring higher frequencies (e.g. 0.5 Hz vs 0.1 Hz). Conclusions: These data suggest that patterns of network composition and temporal dynamics provide distinct sources of variability that may differentially relate to cognitive and behavioral dysfunction in SUDs. Future work should use these functional markers to enhance treatment selection and outcome prediction. Financial support: R01DA036617 (Hanlon), P50DA015369 (Kalivas), P50AA010761 (Becker), T32DA00728823 (McGinty). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.280
Household smoking rules among pregnant and newly postpartum smokers Diana Renee Keith 1,∗ , Allison Nicole Kurti 1 , Joan M. Skelly 2 , Stephen Higgins 1 1 Psychiatry, University of Vermont, South Burlington, VT, United States 2 Medical Biostatistics, University of Vermont, Burlington, VT, United States
Aims: Cigarette smoking during pregnancy is the leading preventable cause of poor birth outcomes in the U.S. Despite this, even the most efficacious interventions leave the majority of women smoking, leading to further secondhand smoke exposure for their children. Most interventions for pregnant smokers do not aim to reduce environmental tobacco smoke (ETS) exposure. To begin assessing the need for such an intervention, we examined rules about smoking in the home among pregnant and newly postpartum women enrolled in smoking cessation and relapse prevention trials. Methods: Participants (N = 370) were current or recent smokers at the start of prenatal care who participated in controlled trials on smoking cessation or relapse prevention during/after pregnancy. Participants were followed from the start of prenatal care through 24 weeks postpartum. Participants were asked, “How is cigarette smoking handled in your home?” and could respond 1: No one is allowed to smoke, 2: only special guests are allowed to smoke, 3: People are allowed to smoke only in certain areas, and 4: People are allowed to smoke anywhere. Smoking status was biochemically verified. Results: The majority of women (75%) continued to smoke at 24 weeks postpartum. Approx. half (52%) of those who continued to smoke reported that they allowed smoking somewhere in the home, with 30% reporting that smoking was allowed anywhere. Abstainers were significantly less likely to allow smoking in the home (p < 0.0001), with 28% reporting that they allowed smoking in some areas, and 9% reporting that they allowed smoking anywhere. In addition to smoking status, other significant predictors of smoking in the home included younger age, lower education, being single, fewer quit attempts, and heavier smoking. Conclusions: Lax rules about smoking in the home are highly prevalent, especially in those who are not able to quit. Those providing smoking cessation interventions for pregnant women may want to consider adding ETS avoidance counseling. Financial support: NIGMS P20GM103644, NIDA R01DA14028, NICHD R01HD075669. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.281 Methadone patients in patient-centered treatment: One-year arrest data Sharon M. Kelly 1,∗ , K.E. O’Grady 2 , Jan Gryczynski 1 , Shannon Gwin Mitchell 1 , Jerome H. Jaffe 1,3 , Robert P. schwartz 1 1 Friends Research Institute, Baltimore, MD, United States 2 University of MD, College Park, MD, United States 3 University of MD, School of Medicine, Baltimore, MD, United States
Aims: To examine time to arrest for 295 opioid-dependent individuals enrolled in a study of patient-centered methadone treatment in Baltimore, MD. Methods: This is a secondary analysis from a randomized trial comparing patient-centered methadone (PCM) to treatment-asusual (TAU). PCM modified the methadone treatment program’s
Histories of alcohol dependence, perceived stress, and depression among people living with HIV Lauren Michelle Kaplan 1,∗ , Gail Ironson 2 1 School of Public Health, UC Berkeley, Alcohol Research Group, Emeryville, CA, United States 2 Psychology, University of Miami, Miami, FL, United States
Aims: To examine how histories of alcohol abuse and dependence are associated with stress and depression among people living with HIV. Methods: Participants were a paid HIV+ (n = 177) in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) volunteer sample recruited through physician offices, specialty clinics, service organizations, and hospitals in Miami, Florida. Histories of alcohol dependence and abuse were assessed using DSM III criteria. Depression was measured using a cumulative average over two years of scores on the Beck Depression Inventory (BDI) and perceived stress was measured with the Perceived Stress Scale (PSS). OLS regression analysis was utilized. Results: History of alcohol dependence but not abuse was associated with more cumulative depression. When perceived stress was added to the model, history of alcohol dependence was no longer significantly associated with depression and perceived stress was significantly and positively associated with depression. History of alcohol dependence was also significantly associated with perceived stress. Conclusions: To our knowledge, this is the first study examining how histories of alcohol problems and perceived stress are associated with depression among people living with HIV. Findings suggest that perceived stress may mediate the associations between histories of alcohol dependence with depression. With the implementation of the Affordable Care Act, additional research is needed to understand how stress and mental health are involved in health outcomes and recovery from alcohol use disorders among people living with HIV. Such research can inform integrated approaches to specialist care. Interventions aimed at reducing stress and enhancing coping may reduce the risk of depression among patients with both HIV and alcohol use disorders, potentially reducing the risk of relapse. Financial support: Supported by R01MH53791, R01MH066697 (G. Ironson, P.I.), NIAAA Center grant P50 AA005595, and T32 AA007240. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.277 Differences in delay discounting between heroin and prescription opioid users Sterling L. Karakula 1,∗ , Margaret L. Griffin 2 , Roger Weiss 2 , Kathryn McHugh 2 1
McLean Hospital, Belmont, MA, United States McLean Hospital/Harvard Medical School, Belmont, MA, United States 2
Aims: Among those with opioid use disorder (OUD), primary heroin use has been associated with greater substance use severity and poorer treatment outcomes compared to prescription opioid (PO) users. Differentiating heroin users from PO users is necessary to inform the treatment needs of these distinct populations. Delay discounting is a facet of impulsivity that reflects the degree to which future rewards are devalued based on their distance in time from
e99
the present. The present study compared delay discounting (DD) in those with OUD based on primary opioid of use. Methods: Adults with OUD (N = 147) on an inpatient detoxification unit completed self-report measures including the Monetary Choice Questionnaire, a measure of DD. Participants provided selfreported opioid use in the 30 days prior to admission and were categorized into three groups based on primary opioid of use: heroin, prescription, or combined (both PO and heroin). DD scores were calculated and compared among the three groups. Results: Results from a univariate ANOVA demonstrated a main effect of group on DD (F[2,144] = 4.92, p < .01). Specifically, the heroin group (p < .05) and the combined group (p < .05) demonstrated greater DD compared to the prescription group; however, DD did not differ between the heroin and combined groups (p = 1.00). The heroin and combined groups were therefore collapsed and compared to the prescription group, controlling for sociodemographic variables. A main effect of group on DD remained (F[1,125] = 7.43, p < .01). Conclusions: In a sample of inpatients with OUD, elevated DD was observed in those using heroin, either alone or in conjunction with POs, compared to those using only POs. This difference demonstrates a preference for immediate rewards in heroin users, which may contribute to their poorer treatment outcomes. Further, PO users with greater DD may be at an increased risk of transitioning to heroin use; longitudinal research should evaluate this possibility. Financial support: NIDA grants 2UG1DA015831, K24 DA022288, and K23 DA035297. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.278 Fractional anisotropy increase in long-term anabolic-androgenic steroid users Marc J. Kaufman 2,∗ , Johanna Seitz 1 , Amanda E. Lyall 1 , Gen Kanayama 2 , Nikos Makris 1,2 , James I. Hudson 2 , Marek Kubicki 1 , Harrison G. Pope Jr. 2 1 Brigham & Women’s Hospital, Boston, MA, United States 2 McLean Hospital, Belmont, MA, United States
Aims: We recently reported increased amygdala volumes and reduced amygdala resting state functional connectivity in longterm anabolic-androgenic steroid (AAS) users versus non-users. We also acquired diffusion-weighted (DW) scans from these subjects to assess white matter structural connectivity. We hypothesized that we would detect fractional anisotropy (FA) abnormalities, reflecting white matter organization changes, in tracts associated with the amygdala network. Methods: Subjects in this study included 9 AAS users and 8 agematched non-using controls, whose 3-Tesla DW scans (B = 1000, 64 diffusion directions) satisfied quality controls. Images were processed with standard FSL tools, custom in-house scripts, and Tract-Based Spatial Statistics via the Enigma pipeline. We focused on integrity of the Inferior fronto-occipital fasciculus (IFOF), which connects inferior frontal and occipital lobes (major amygdala projections), and is involved in visuospatial memory, which we previously reported to be impaired in AAS users. Statistical analyses were conducted with Prism and SPSS. Results: We found a group FA difference in IFOF (ANOVA F1,15 = 9.4, P = 0.008), with AAS users exhibiting higher FA than non-users. Among AAS users, there was a positive association between FA and lifetime AAS use in IFOF (r = 0.82, P = 0.007). Posthoc FA laterality analysis revealed a significant group difference
e100
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
in left IFOF (t = 3.97, P < 0.001) and a trend-level right IFOF group difference (t = 1.85, P = 0.085). Conclusions: AAS users exhibited FA increases in IFOF, the degree of which was associated with lifetime AAS use. This finding is consistent with our prior report of amygdala and visuospatial memory abnormalities in AAS subjects. Future studies are needed to determine the functional significance of the FA increase in the context of network connectivity and visuospatial memory in AAS users. Financial support: NIH grants R01DA029141 (HP, GK, JH), and R01 AG04252 (MK, NM), R01 MH102377 (MK), and the Stuart T. Hauser Clinical Research Training Program (T32) (AL). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.279 Across time and space: Independent component analysis reveals spatial and temporal differences in functional brain networks between cocaine and alcohol users Tonisha Kearney-Ramos ∗ , Logan Thorne Dowdle, Oliver Mithoefer, Chris Mullins, William DeVries, Mark George, Colleen A. Hanlon Medical University of South Carolina, Charleston, SC, United States Aims: While altered functional connectivity (FC) has been linked to craving and cognitive function in substance use disorders (SUDs), it is unclear which patterns of neural disruption are common across SUDs and which are unique to the abused substance (e.g. cocaine vs alcohol). To determine patterns of FC common to or differentiating cocaine and alcohol users, independent component analysis (ICA) was applied to fMRI data from 38 users (19 cocaine, 19 alcohol) during a cue-induced craving task. Methods: ICA identified 75 functional networks based on temporal coherence of activity across brain regions. Spatial maps of several networks were contrasted between groups (thresholded at |t(37)| > 3, cluster size≥32 voxels for FWE p < .05), and temporal profiles of networks were compared via power spectral analysis. Results: There was no significant difference in spatial or temporal profile of default mode or cognitive control networks, but there were significant differences in several salience/attentional bias networks. Spatially, cocaine users had higher striatal network recruitment of visual cortex (ˇ = .31) than alcohol users (ˇ = −.52; t(37) = 5.86, p < .05); and alcohol users had higher right anterior insula recruitment into ventral visual network (ˇ = .88) than cocaine users (ˇ = .12; t(37) = −5.22, p < .05). Temporally, there was no difference for the striatal component, but there were significant differences for multiple components loading on medial and lateral PFC – with cocaine users favoring higher frequencies (e.g. 0.5 Hz vs 0.1 Hz). Conclusions: These data suggest that patterns of network composition and temporal dynamics provide distinct sources of variability that may differentially relate to cognitive and behavioral dysfunction in SUDs. Future work should use these functional markers to enhance treatment selection and outcome prediction. Financial support: R01DA036617 (Hanlon), P50DA015369 (Kalivas), P50AA010761 (Becker), T32DA00728823 (McGinty). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.280
Household smoking rules among pregnant and newly postpartum smokers Diana Renee Keith 1,∗ , Allison Nicole Kurti 1 , Joan M. Skelly 2 , Stephen Higgins 1 1 Psychiatry, University of Vermont, South Burlington, VT, United States 2 Medical Biostatistics, University of Vermont, Burlington, VT, United States
Aims: Cigarette smoking during pregnancy is the leading preventable cause of poor birth outcomes in the U.S. Despite this, even the most efficacious interventions leave the majority of women smoking, leading to further secondhand smoke exposure for their children. Most interventions for pregnant smokers do not aim to reduce environmental tobacco smoke (ETS) exposure. To begin assessing the need for such an intervention, we examined rules about smoking in the home among pregnant and newly postpartum women enrolled in smoking cessation and relapse prevention trials. Methods: Participants (N = 370) were current or recent smokers at the start of prenatal care who participated in controlled trials on smoking cessation or relapse prevention during/after pregnancy. Participants were followed from the start of prenatal care through 24 weeks postpartum. Participants were asked, “How is cigarette smoking handled in your home?” and could respond 1: No one is allowed to smoke, 2: only special guests are allowed to smoke, 3: People are allowed to smoke only in certain areas, and 4: People are allowed to smoke anywhere. Smoking status was biochemically verified. Results: The majority of women (75%) continued to smoke at 24 weeks postpartum. Approx. half (52%) of those who continued to smoke reported that they allowed smoking somewhere in the home, with 30% reporting that smoking was allowed anywhere. Abstainers were significantly less likely to allow smoking in the home (p < 0.0001), with 28% reporting that they allowed smoking in some areas, and 9% reporting that they allowed smoking anywhere. In addition to smoking status, other significant predictors of smoking in the home included younger age, lower education, being single, fewer quit attempts, and heavier smoking. Conclusions: Lax rules about smoking in the home are highly prevalent, especially in those who are not able to quit. Those providing smoking cessation interventions for pregnant women may want to consider adding ETS avoidance counseling. Financial support: NIGMS P20GM103644, NIDA R01DA14028, NICHD R01HD075669. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.281 Methadone patients in patient-centered treatment: One-year arrest data Sharon M. Kelly 1,∗ , K.E. O’Grady 2 , Jan Gryczynski 1 , Shannon Gwin Mitchell 1 , Jerome H. Jaffe 1,3 , Robert P. schwartz 1 1 Friends Research Institute, Baltimore, MD, United States 2 University of MD, College Park, MD, United States 3 University of MD, School of Medicine, Baltimore, MD, United States
Aims: To examine time to arrest for 295 opioid-dependent individuals enrolled in a study of patient-centered methadone treatment in Baltimore, MD. Methods: This is a secondary analysis from a randomized trial comparing patient-centered methadone (PCM) to treatment-asusual (TAU). PCM modified the methadone treatment program’s