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Abstract: Purposeof Review The prevalence of problematic substance use is disproportionately higher among sexual and gender minority (SGM) adults compared to adults in the general population. mHealth as a treatment modality could reduce barriers to accessing substance use treatments among SGM populations. Through a qualitative literature search, the current narrative review aimed to understand the lived experiences of SGM individuals who use substances and to synthesize recommendations made in the literature to inform future mHealth interventions. Recent Findings Positive and negative reinforcement motives were prominent reasons for substance use, which included SGM identity expression and conformity motives. Individual- and system-level treatment barriers included a lack of safe and nonjudgmental environment, shame and stigma, and limited knowledge about treatment options. Barriers were directly linked to the reported substance use treatment needs in this population. Summary On-demand app features, real-time intervention and assessment, and anonymity should be considered in future mHealth trials. PubDate: 2023-05-26
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Abstract: Purpose of Review In this article, we review and integrate the extant literature on problematic social media use (PSMU) and impulsivity. We present this literature organized by methodology, in which researchers used surveys or behavioral tasks to measure either general impulsivity or specific facets of impulsivity. Recent Findings We found 17 publications overall which investigated the relationship between PSMU and some aspect of impulsivity across 21 studies. These studies generally demonstrate positive associations between PSMU and impulsivity, in that individuals with greater PSMU also demonstrate greater general impulsivity, or a facet of impulsivity (e.g., attentional impulsivity, impulsive choice, etc.). However, some aspects of impulsivity display mixed findings in relation to PSMU. Summary Overall, PSMU is related to greater general impulsivity and certain facets of impulsivity. We also discuss limitations with the existing literature and potential future research investigating PSMU and impulsivity. PubDate: 2023-05-25
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Abstract: Purposeof the review Chemsex mainly concerned men who have sex with men, but seems to spread in general population. Clinical characteristics and expected effects are diverse. This paper aims at reviewing existing literature on chemsex and providing treatment guidelines. Recent findings The use of substances for improving or extending sexual intercourses is commonly referred to as chemsex. Substances used are mainly methamphetamine, GHB/GBL, cocaine and cathinones. Prevalence is estimed between 3 and 42% of MSM. Risk factors are mainly living in a metropolis, using dating apps and practicing "hard-sex". Chemsex practice is not necessarily pathological and only the loss of control, the association with addictive, psychiatric and/or infectious comorbidities should require care. Summary Management of problematic chemsex should be multidisciplinary and must take into account psychiatric, addictive and infectious comorbidities. Information and education are crucial in order to reduce risks and potential harm associated to chemsex. PubDate: 2023-05-24
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Abstract: Purpose of Review Ecological Momentary Assessment (EMA) is a data collection method capturing mental states and behavior in participants’ natural contexts. While EMA is used increasingly in studies with individuals with substance use disorders (SUD), a systematic review of EMA use among people with opioid use disorder (OUD) is not present in the literature. This systematic review aims 1) to synthesize the literature describing EMA use and 2) to characterize the EMA methodology in published studies of people receiving medication for OUD. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was utilized. Without date restriction, we searched three databases (PubMed, CINAHL, Psych Info) and included English, peer-reviewed articles that were: a) intervention or observational studies of people receiving medication for OUD and b) used EMA. Recent Findings Included studies (n = 37) were randomized controlled trials (n = 10) and observational studies (n = 27), with primarily African American (41–75%) men (47–81%) as participants (n = 5–309) in all but two studies. Results indicated that response to frequent (2–5 times per day) EMA entries over long periods of time (between 2–25 weeks) during treatment for OUD treatment is feasible. Craving and stress were the most frequent EMA measures investigated for their relationship to drug use and treatment outcomes. Summary The literature demonstrated that EMA methodology is heterogeneous and closely linked to the research question. However, frequent EMA assessments were common and feasible to deliver assessments to people receiving medication for OUD. It is important to incorporate EMA as an assessment tool and potential intervention component in future studies to possibly respond to the risk of returning to use or relapse. PubDate: 2023-05-23
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Abstract: Purpose of Review This review summarizes theories and empirical work regarding socialization contexts contributing to substance use across marginalized adolescents. Future directions and recommendations to minimize the perpetuation of racial stereotypes are provided. Recent Findings Neighborhoods high in social cohesion may offset substance use risk. Promoting school connectedness via increased support from teachers and peers could reduce school-based discrimination and enhance feelings of belongingness. The influence of peers on substance use engagement largely differs across racial groups and level of acculturation. Family cultural values emphasizing respect, obedience, and collectivism offer protection from substance use. Summary Despite lower prevalence rates of adolescent substance use within racial/ethnic groups, rates of negative consequences due to substances are far greater compared to White adolescents. Transcultural factors (e.g., strong family ties), as well as culture-specific factors, should be leveraged to delay the onset of substance use and prevent negative sequelae resulting from substance use initiation. PubDate: 2023-05-23
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Abstract: Purposeof Review Sensation seeking, a trait-like preference for intense experiences with a disregard for their potentially aversive consequences, is a risk factor for the development of substance use disorders and other hazardous activities. However, there remain several open questions regarding its neurophysiological characteristics, its precise effect on decision-making, and the clinical management of high sensation-seeking individuals. Recent Findings We review evidence, including recent neuropharmacological and neuroimaging work, which demonstrates a neurophysiological basis for the construct, particularly regarding reward-related and punishment-related processes. We then evaluate evidence for a relationship between sensation seeking and behavioral measures of risk taking, which supports a consistently modest increase in risk preference with higher trait sensation seeking. These small effect sizes imply the need both for more sensitive behavioral measures, as well as novel theoretical insights into when and why high sensation-seeking individuals might show a preference for risky options. Predictions derived from different theoretical approaches, including subjective utility, reinforcement learning, active inference, and contextually dependent risk taking, are outlined. Summary Novel theoretical approaches might help to derive more specific measures of sensation seeking via the generation of new paradigms. They might also clarify adaptive and harmful aspects of the decision-making style of high sensation seekers, which might help to develop and refine new clinical interventions. PubDate: 2023-05-23
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Abstract: Purpose of Review Culturally responsive interventions are important for mitigating disparities in substance use outcomes among minoritized racial/ethnic groups, but they are poorly defined and scarcely implemented. This paper provides a dimensional definition and contemporary review of culturally responsive substance use treatment for minoritized racial/ethnic groups. Recent Findings Contemporary culturally responsive approaches remain dominated by cultural adaptations to empirically based programs. Culturally adapted and grounded interventions are generally acceptable and efficacious but are narrowly applied. Within existing treatment settings, cultural responsiveness relies on organizational practices that value staff diversity and involve community leaders and lay health workers. Few current approaches consider Black and Asian American communities, pharmacological treatment, or improving treatment access. Summary Despite varied approaches, culturally responsive interventions for substance use show acceptability and efficacy for youth and adults. Extending these approaches to community and pharmacological intervention will be critical to mitigating the drug overdose crisis among minoritized racial/ethnic groups. PubDate: 2023-05-22
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Abstract: Purposeof Review New treatment approaches are needed for addictive disorders. There is a clear link between trait impulsivity and addictions, and impulsivity predicts worse addiction-related outcomes. Therefore, pharmacological treatments targeting impulsivity may enhance outcomes of addictive disorders. This paper aims to review and synthesize the most recent literature on pharmacological interventions for impulsivity in addictive disorders. We focus on studies that include both impulsivity and addictive disorder outcomes. Recent Findings Several studies fit our criteria; however, studies varied in terms of methodologies, medications, patient populations, and addictive behavior being studied. Nonetheless, some positive signals have emerged which deserve further study, including dopaminergic and glutamatergic medications, among others. Summary Impulsivity continues to be viewed as a multi-faceted construct, evaluated using a range of methodologies (including self-reports or behavioral tasks), each of which may measure distinct yet overlapping facets of impulsivity. Medications that target the dopamine and glutamatergic systems are of particular interest, as these systems play fundamental roles in addictive disorders. More standardization is needed in study methodologies, and medications should be studied across addictive disorders PubDate: 2023-05-20
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Abstract: Purpose of Review Opioid use disorder (OUD) is a chronic, relapsing condition that is epidemic in the USA. OUD is associated with serious adverse consequences, including higher incarceration rates, impaired medical and mental health, and overdose-related fatalities. Several medications with demonstrated clinical efficacy in reducing opioid use are approved to treat OUD. However, there is evidence that medications for OUD cause metabolic impairments, which raises concerns over the long-term metabolic health of individuals recovering from OUD. Here, we summarize the scientific literature on the metabolic effects of the use of opioids, including medications for treating OUD. Recent Findings Our findings showed lower body weight and adiposity, and better lipid profiles in individuals with OUD. In individuals with diabetes mellitus, opioid use was associated with lower blood glucose levels. In contrast, among individuals without underlying metabolic conditions, opioids promoted insulin resistance. Treatment of OUD patients with the agonists methadone or buprenorphine caused weight gain, increased liking and intake of sugar, and impaired lipid profile and glucose metabolism, whereas treatment with the antagonist naltrexone demonstrated evidence for reduced sweet preferences. Summary Our findings highlighted a gap in knowledge regarding the safety of medications for OUD. Further research is needed to determine how best to reduce the risk of metabolic disorder in the treatment of OUD with opioid agonists versus antagonists. PubDate: 2023-05-19
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Abstract: Purpose of Review Kratom, a preparation of the leaves collected from the Southeast Asian plant Mitragyna speciosa, has increased in use within the United States (US) predominantly due to its stimulant and opioid-like effects. It contains many active alkaloids, most notably mitragynine. Clinical pharmacological research and toxicological information are limited, hindering forensic interpretation and an understanding of the role kratom use may play in death. Despite arguments from some vocal proponents and vendors that kratom poses no risk to users, there is a growing body of evidence that kratom use can result in significant adverse events, including death. Recent Findings Toxicological data for blood specimens analyzed between January 2018 and September 2022 in postmortem and driving under the influence of drugs cases were reviewed for the presence of mitragynine, the primary alkaloid of Mitragyna speciosa. Reported blood mitragynine concentrations, compound positivity, and concomitant findings were evaluated. Summary The forensic interpretation of mitragynine continues to be challenging. Kratom has been implicated in an increasing number of overdoses and deaths, and its significance is difficult to ascertain due to a substantial number of confounding variables, including a limited scope of toxicological testing and frequent co-positivity with drugs of abuse. Mitragynine has been listed as the primary toxicological finding in several overdose deaths albeit at a lower frequency compared to overall positivity, particularly when present at elevated concentrations (> 1000 ng/mL); these cases provide forensic confirmation of harms due to kratom use. PubDate: 2023-05-19
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Abstract: Purpose of Review Impulsivity is considered an important construct in the cycle of addiction, yet the effect of evidence-based treatments on impulsivity is unclear. The goal of this paper was to review the evidence regarding the effect of cognitive behavioral therapy (CBT), one of the most studied psychotherapies for addiction, on measures of impulsivity in addictive disorders. Recent Findings There is a robust literature implicating impulsivity as risk factor for development of a range of addictions and poorer treatment outcomes. However, this review identified only four randomized controlled trials evaluating CBT for an addictive behavior that included repeated assessment of impulsivity. All four were studies targeting substance use. Summary There is limited evidence that CBT has a direct effect on change in measures of impulsivity among individuals being treated for substance use. Future clinical trials should include repeated measurement of impulsivity to examine CBT’s effect on the underlying characteristics of addiction. PubDate: 2023-05-13
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Abstract: Purpose of Review This work aims to provide an up-to-date review of the preclinical and clinical scientific literature on the therapeutic value of kratom to better understand the underlying mechanisms related to its use and inform future therapeutic applications. Recent Findings A growing number of studies, mainly of cross-sectional nature, describe the widespread use of kratom by individuals to self-treat pain, psychiatric symptoms, and substance use disorders (SUD) outside a controlled clinical setting. Preclinical evidence suggests kratom is effective as an analgesic agent and might decrease the self-administration of other drugs. A randomized controlled trial has further supported kratom’s therapeutic value as an analgesic. Investigations in nonclinical samples of long-term kratom users also indicate its therapeutic benefit in managing SUD symptoms (e.g., craving) and long-term or acute symptoms (e.g., withdrawal) for alcohol, opioids, and other illicit drugs. However, episodes of kratom-related intoxications have also been reported, often due to the adulteration and the contamination of kratom products mainly sold online or mixed toxicities when consumed outside clinical and traditional settings. Summary Evidence on the clinical implications of kratom use is still limited and uncertain, with kratom research constantly evolving. Therefore, further randomized trials are needed. PubDate: 2023-05-12
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Abstract: Purpose of Review Personality disorders (PDs) are frequently comorbid with substance use disorders (SUDs) including alcohol use disorder (AUD), but the factors explaining their comorbidity are not yet fully understood. This article reviews recent research on the co-occurrence of PD and SUD/AUD and discusses how contemporary research on impulsivity-related personality and psychopathology dimensions might partially account for their high comorbidity. Recent Findings Comorbidity between PDs and SUDs/AUD is substantial across population-based and clinical studies and is most apparent in Cluster B PDs. Studies of trait-based impulsivity suggest this comorbidity may be partly explained by UPPS-P model of impulsivity factors (e.g., negative urgency). Research consistent with the Hierarchical Taxonomy of Psychopathology suggests that impulsivity-relevant psychopathology dimensions, including broader symptom domains (e.g., disinhibited externalizing) and narrower symptom components and maladaptive traits (e.g., risk-taking, delay-discounting), contribute to PD and SUD/AUD comorbidity. Summary Impulsive personality traits and psychopathology dimensions partially account for the high comorbidity between PD and SUD/AUD diagnoses. PubDate: 2023-05-08
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Abstract: Purpose of Review The aim of the present review is to provide an update on recent studies examining adolescent neurodevelopment in the context of impulsivity and substance use. We provide a review of the neurodevelopmental changes in brain structure and function related to impulsivity, substance use, and their intersection. Recent Findings When examining brain structure, smaller gray matter volume coupled with lower white matter integrity is associated with greater impulsivity across three components: trait impulsivity, choice impulsivity, and response inhibition. Altered functional connectivity in networks including the inhibitory control network and reward processing network confers risk for greater impulsivity and substance use. Summary Across brain structure and function, there is evidence to suggest that overlapping areas involved in the rise in impulsivity during adolescence contribute to early substance use initiation and escalation. These overlapping neurodevelopmental correlates have promising implications for prevention and early intervention efforts for adolescent substance use. PubDate: 2023-05-02
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Abstract: Purpose of Review Problem gambling can have profound consequences for affected individuals, yet only a small proportion of people with problem gambling seek treatment. Mobile phone applications (apps) may provide an effective and scalable therapeutic option. The purpose of this study was to evaluate publicly available mobile apps aimed at improving problematic gambling behavior. Recent Findings To date, there are no published studies that have evaluated the quality of publicly available smartphone apps for problem gambling in the USA. There is thus a significant gap in knowledge of existing apps for addressing problem gambling. Summary This study included a review of 14 problem-gambling-specific apps. Apps that incorporated cognitive-behavioral therapy concepts and in-app communities were associated with better aesthetics and information quality scores. Additionally, in-app communities were associated with better engagement scores. Our results highlight the importance of evidence-based and engaging features in apps designed to help people with problem gambling. PubDate: 2023-05-02
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Abstract: Purpose of Review Impulsivity is a core feature and a risk factor of Internet Gaming Disorder (IGD). Hence, studies started examining the neural mechanisms that underlie this impulsivity. However, the big picture of such mechanisms is not clear. This paper seeks to survey recent cognitive neuroscience research on IGD and impulsivity and provide a synthesized view. Recent Findings Research has indicated that individuals with IGD have a greater degree of impulsivity than healthy controls (HC) and recreational Internet gaming users (RGU). This increased impulsivity has been associated with dysfunction or structural changes in the frontal lobe, striatum, amygdala, and insula, as well as the functional connectivity attributes between these areas. Nevertheless, there are some conflicting conclusions that should be explored further. Summary Studies have revealed that impulsivity is a risk factor for IGD, and that impulsivity facets are linked to IGD both behaviorally and neurobiologically. Additionally, the functional connections between the frontal lobe, striatum, amygdala, and insula could underlie the link between high impulsivity and IGD. PubDate: 2023-05-02
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Abstract: Purpose of Review The goal of this review is to examine the relationship between impulsivity and interoception in addiction, to summarize the current understanding of the topic, identify any gaps in knowledge, and provide directions for future research. Research Findings Interoception may be a contributing factor to impulsive behaviour and, thus, addiction. Substance abuse can negatively impact the brain’s ability to process interoceptive information and impact the reward system, leading to decreased sensitivity to natural rewards and increased sensitivity to drugs. There is potential for new therapies, such as mindfulness, interoceptive training, brain stimulation, or vagal nerve stimulation to target both impulsivity and interoception in the treatment of addiction. Summary Despite a growing interest in interoception in addiction research, further research is needed to better understand the role of interoception in addiction and to develop new methods for studying how individuals with addiction process and perceive internal bodily sensations. PubDate: 2023-04-29
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Abstract: Purpose of Review The goal of this review was to (1) synthesize recent studies that have examined impulsive behaviors in third-wave behavioral treatments, including Acceptance and Commitment Therapy, Mindfulness-Based Interventions, and Dialectical Behavior Therapy, and (2) examine the efficacy of these third-wave treatments in modifying impulsivity among individuals with addictive disorders. Recent Findings Recent studies indicate the potential for third-wave treatments in both treating addictive disorders and targeting the underlying neurocognitive mechanisms of impulsivity. Concerns around the conceptualization of impulsivity as a construct warrant the use of improved measurement of impulsive behaviors in future work. Summary Through shared emphases on mindfulness, acceptance, and emotion regulation, third-wave treatments offer great promise in the alleviation of suffering resulting from impulsive and addictive behaviors. Rigorous research with improved methodological designs, larger samples, and sound measurements of specific impulsive behaviors is needed to clarify the utility of third-wave interventions in targeting impulsivity. PubDate: 2023-04-29
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Abstract: Purpose of Review This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space. Recent Findings The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain. Summary Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions. PubDate: 2023-04-25
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Abstract: Purpose of Review Use of “kratom” products, derived from the bioactive botanical Mitragyna speciosa have increased amidst US polydrug use epidemics. Kratom alkaloids interact with opioid, serotonergic, adrenergic, and other receptors and regular users have described experiencing a wide range of effects. Some with polydrug use histories have reported using kratom as a substitute for other drugs or to nonmedically self-manage substance use disorder (SUD) symptoms. Data describing this remain scare and come from self-report. We review this literature describing kratom use as a drug substitute, or as a nonmedical “self-treatment” for attenuating dependence or SUD symptoms. Recent Findings Kratom products have been documented as being used as a licit and illicit opioid substitute. Use to reduce alcohol or stimulant consumption is less well documented. Although prior and current polydrug use appear common among a some kratom users, it is unclear if co-use is contemporaneous or concomitant. Temporal order of use initiation is typically undocumented. Use for energy and recreation are also increasingly reported. Summary Data on kratom consumption come primarily from self-report with significant limitations. Until controlled human laboratory studies have been conducted, we can presently only describe what is known about human kratom use based on self-report. Such data describe real-world kratom use, leaving unaddressed human abuse liability or therapeutic potential of kratom alkaloids. Clinicians should be mindful of use motivations among people with SUD histories, sensitively assessing use. The paucity of data highlights the urgent need to increase funding and research for understanding kratom’s effects in humans. PubDate: 2023-04-18
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