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PubMedDate not supplied

Integrating skills training and motivational therapies. Implications for the treatment of substance dependence.

Two well-articulated models of substance abuse treatment, skills training and motivational enhancement, have received considerable research attention in recent years. Skills training treatments operate on the underlying rationale of correcting skills deficits, whereas motivational strategies are based on affecting clients' willingness to use skills they already possess. Skills training and motivational enhancement are typically described as distinct treatments and have recently been constructed as different treatments within a large multisite trial in the United States (Project MATCH). This article explores how treatments for substance abuse can draw from and integrate skills training and motivational strategies. Recovery from addictive patterns of behavior often requires learning over time and typically involves slips, relapses, and multiple quit attempts. Therapeutic support for change in addictive behavior, in particular attempting to prevent and minimize relapse, requires assessment and support of both why one might pursue change (motivation) and how one can best be successful (skills).

Adaptation, Psychological↗
PubMedDate not supplied

The role of serotonin in craving: from basic research to human studies.

Increasing evidence suggests that craving may play a central role in the mechanisms of addiction. The experience of craving is largely characterized by obsessional thoughts about drugs, triggering compulsive drug-seeking and drug-taking behaviour. In the present article the possible involvement of brain 5-hydroxytryptamine (5-HT) in the mechanisms of craving and relapse is discussed by integrating the results of basic research with those obtained in human studies. Based on studies suggesting that the brain serotonergic system plays a central role in the regulation of impulse-control mechanisms, it is proposed that 5-HT deficiency may contribute to the loss of control over drug-taking, which is a crucial factor for the maintenance of addictive behaviour.

Animals↗
PubMed1992

Pinball wizard: the case of a pinball machine addict.

This is a description of a young man who is addicted to playing pinball machines. The subject's playing history and playing pathology are outlined using an adapted version of the DSM-III-R criteria for pathological gambling. Such an adaptation of these criteria is proposed as beneficial in monitoring and recording objective measures of all gaming-machine addictions.

Adult↗
PubMed1998

Neural substrates of drug craving and relapse in drug addiction.

Drug addiction is characterized by motivational disturbances such as compulsive drug taking and episodes of intense drug craving. Recent advances using animal models of relapse have shown that drug-seeking behaviour can be triggered by drug-associated cues, by stress and by 'priming' injections of the drugs themselves, events also known to trigger drug craving in human drug addicts. Current evidence suggests that these stimuli all induce relapse, at least in part, by their common ability to activate the mesolimbic dopamine system. Drug-associated cues and stress can activate this system via neural circuits from the prefrontal cortex and amygdala and through activation of the hypothalamic-pituitary-adrenal axis. Our studies suggest that dopamine triggers relapse to drug-seeking behaviour by stimulating D2-dopamine receptors which inhibit the cyclic AMP second messenger pathway in the neurones of the nucleus accumbens. In contrast, compounds which activate D1 receptors prevent relapse to drug-seeking behaviour, possibly through satiation of reward pathways. Chronic neuroadaptations in dopamine receptor signalling pathways in the nucleus accumbens caused by repeated drug use are hypothesized to produce tolerance to the rewarding effects of D1-receptor stimulation, leading to increased drug intake during drug self-administration. Conversely, these same neuroadaptations are hypothesized to enhance drug craving by potentiating D2 receptor-mediated signals during abstinence. These findings identify D1 and D2-dopamine receptor mechanisms as potential targets for developing anticraving compounds to treat drug addiction.

Animals↗
PubMed1997

Changes in HIV-related behaviors among heterosexual alcoholics following addiction treatment.

In order to measure changes in HIV-related behaviors among heterosexual alcoholics following treatment, we conducted a prospective cohort study of 700 self-identified alcoholics recruited from five public alcohol treatment centers, all of which included HIV risk-reduction counseling. Respondents underwent an HIV antibody test and interviewer-administered questionnaire at entry to alcohol treatment and after a mean of 13 months later. Compared to baseline, at follow-up there was an overall 26% reduction in having sex with an injection-drug-using partner (23% versus 32%, P < .001) and a 58% reduction in the use of injection drugs (15% versus 37%, P < .001), along with smaller improvements in other behaviors. Respondents also showed a 77% improvement in consistent condom use with multiple sexual partners (35% versus 20%, P < .01) and a 23% improvement in partner screening (71% versus 57%, P < .001). Respondents who remained abstinent showed substantially greater improvement than those who continued to drink.

Adult↗
PubMed2001

Adolescent addiction and delinquency in the family system.

Drug abuse and delinquent behavior in adolescents have been closely linked in the literature. It is possible that these links are not causal, but rather covariates of the common factor of family. This paper seeks to examine the behaviors of addiction and delinquency within the framework of family systems theory.

Adolescent↗
PubMed2004

Methadone maintenance reduces heroin- and cocaine-induced relapse without affecting stress-induced relapse in a rodent model of poly-drug use.

Although it is well established that methadone can be an effective treatment for opiate addiction, it is not clear how methadone maintenance affects cocaine use and cravings in individuals who self-administer both opiates and cocaine. In our attempt to explore the effect of methadone maintenance on the effects of cocaine, we first assessed the locomotor stimulatory effects of cocaine in rats maintained on methadone (0, 10, 20, or 30 mg/kg/day, via osmotic minipumps). Chronic methadone elevated baseline locomotion in a dose-dependent manner and did not reduce the direct stimulatory effects of cocaine (5 mg/kg). We then investigated the effects of the highest methadone maintenance dose (30 mg/kg/day) on heroin and cocaine seeking in extinction, and when it was precipitated by exposure to heroin, cocaine, or foot-shock stress in rats trained to self-administer both drugs in the same experimental context (heroin 0.05 mg/kg/inf; cocaine 0.5 mg/kg/inf, eight 3-h sessions each). In tests of reinstatement, rats responded selectively on the appropriate drug-associated lever after priming injections of heroin (0.25 mg/kg) or cocaine (20 mg/kg). Methadone maintenance blocked both cocaine- and heroin-induced reinstatement, but not stress-induced reinstatement, which was not lever selective. These results suggest that although methadone maintenance may not reduce the direct stimulatory effects of cocaine, it has the potential to reduce both spontaneous and cocaine-primed cocaine-seeking behavior.

Analysis of Variance↗
PubMed2006

Toward a model of drug relapse: an assessment of the validity of the reinstatement procedure.

BACKGROUND AND RATIONALE: The reinstatement model is widely used to study relapse to drug addiction. However, the model's validity is open to question. OBJECTIVE: We assess the reinstatement model in terms of criterion and construct validity. RESEARCH HIGHLIGHTS AND CONCLUSIONS: We find that the reinstatement model has adequate criterion validity in the broad sense of the term, as evidenced by the fact that reinstatement in laboratory animals is induced by conditions reported to provoke relapse in humans. The model's criterion validity in the narrower sense, as a medication screen, seems promising for relapse to heroin, nicotine, and alcohol. For relapse to cocaine, criterion validity has not yet been established primarily because clinical studies have examined medication's effects on reductions in cocaine intake rather than relapse during abstinence. The model's construct validity faces more substantial challenges and is yet to be established, but we argue that some of the criticisms of the model in this regard may have been overstated.

Alcoholism↗
PubMed2006

Elevation of glucocorticoids is necessary but not sufficient for the escalation of cocaine self-administration by chronic electric footshock stress in rats.

The examination of cocaine self-administration (SA) by rats under conditions that promote escalating patterns of intake should lead to a better understanding of factors that contribute to cocaine addiction. This study investigated the ability of repeated daily exposure to a stressor, electric footshock (EFS), to escalate cocaine SA. Male Sprague-Dawley rats were trained to self-administer cocaine (0.5 mg/kg/inf, i.v.) by pressing a lever under a FR4 schedule during 2-h sessions comprised of four 30-min SA components. Repeated daily EFS consisting of shock sequences (3 x 0.6 mA, 100-ms duration, 1-s frequency) delivered under a variable time 45-s schedule for 5 min before each of the four SA components across 14 days of SA testing produced a significant escalation of cocaine SA. EFS failed to escalate food-reinforced lever pressing and did not alter cocaine SA when administered either inside or outside of the SA context 4 h after daily SA testing. Surgical adrenalectomy along with diurnal corticosterone (CORT) replacement prevented EFS-induced escalation without altering SA in the absence of EFS, indicating that increases in circulating glucocorticoids were necessary for the escalating effects of EFS. Elevation of CORT through repeated daily CORT injections (3.0 mg/kg, i.p.) failed to reproduce the effects of repeated daily EFS on SA, but restored the escalating effects of EFS in adrenalectomized rats with CORT replacement, suggesting that an elevation of glucocorticoids was necessary but alone was not sufficient for the escalation of cocaine SA by EFS.

Animals↗
PubMed1999

[The prevalence of human immunodeficiency virus infection and the risk behaviors in the heroin addicts of Barcelona, Madrid and Seville: an example of the advantages of centering studies on addicts and not just on intravenous users].

BACKGROUND: The switch from intravenous heroin administration to smoking of heroin might be changed the trends in the prevalence of HIV infection and risk behaviours among Spanish users. SUBJECTS AND METHODS: Cross-sectional study of 909 regular heroin users, recruited within and outside of drug treatment centres. The prevalence of HIV infection and risk behaviours were studied in the whole sample and among injectors. RESULTS: The proportion of heroin users who had ever injected was 86.7% in Barcelona, 71.1% in Madrid and 56.1% in Seville, while the proportion of those who had injected in the last 30 days was 79.7, 35.6 and 29.2%, respectively. The prevalence of HIV infection among users who had ever injected was 46.2% in Barcelona, 39.6% in Madrid and 47.1% in Seville; in the total population of heroin users the prevalence was 40, 31.1 and 28%, respectively. Among current injectors, 10.9% in Barcelona, 13.9% in Madrid and 23.6% in Seville reported they had injected with used syringes in the last 30 days, while the corresponding proportion among the total population of users was 8.7, 4.9 and 6.9%, respectively. Moreover, 19.2% of injectors in Barcelona, 16.7% in Madrid and 16.9% in Seville admitted to injecting drugs which had been diluted in syringes previously used by others in the last 30 days; of this group, over half stated they had not injected with used syringes during that period. CONCLUSIONS: The prevalence of HIV infection and risk behaviours among heroin users differs depending on whether all users or only injectors are considered. This suggests that the transition from injecting to smoking is one of the major factors contributing to the control of the HIV epidemic in Spain. This contribution, which has little to do with regional prevention policies, must be taken into account when comparing their effectiveness.

Adult↗
PubMed2005

Rats maintained chronically on buprenorphine show reduced heroin and cocaine seeking in tests of extinction and drug-induced reinstatement.

Buprenorphine is being introduced as a maintenance therapy in opioid addiction, but it is not clear how buprenorphine will affect co-use of cocaine in opioid users. We examined the effects of chronic buprenorphine (BUP0: 0.0 mg/kg/day; BUP1.5: 1.5 mg/kg/day; BUP3: 3.0 mg/kg/day) on the locomotor activity effects of acute heroin (0.25 mg/kg, subcutaneously (s.c.)) and cocaine (20 mg/kg, intraperitoneally (i.p.)). Buprenorphine had no effect on the stimulatory effect of heroin, but potentiated the locomotor response to cocaine. To investigate further the interactions between buprenorphine (BUP1.5 and BUP3), heroin (0.125, 0.25 and 0.375 mg/kg, s.c.), and cocaine (10, 20 and 30 mg/kg, i.p.), we used in vivo microdialysis and high-performance liquid chromatography to analyze extracellular levels of dopamine (DA) in the nucleus accumbens (NAc). Buprenorphine attenuated the heroin-induced rise in NAc DA, but greatly potentiated the cocaine-induced rise. Finally, we examined the potential of the highest dose of buprenorphine (BUP3) to reduce heroin and cocaine seeking in the presence of drug-associated cues under extinction conditions and in tests for reinstatement induced by heroin (0.25 mg/kg, s.c.), cocaine (20 mg/kg, i.p.), and 15-min footshock stress (0.8 mA, 0.5 s/shock, 40 s mean OFF time) in rats trained to self-administer both drugs. Buprenorphine reduced heroin and cocaine seeking during extinction and following acute heroin and cocaine priming injections, but had no effect on stress-induced reinstatement. These results indicate that the suppression of responding following priming injections of drugs did not result from reduced motor activity, but possibly from a reduction in the salience of drug-associated cues induced by chronic buprenorphine treatment.

Analysis of Variance↗
PubMed2004

Individual differences in the effects of serotonergic anxiolytic drugs on the motivation to self-administer cocaine.

Numerous clinical studies have indicated that lifetime anxiety is highly prevalent in drug addicts. In the treatment of drug abuse, dually diagnosed drug addicts may benefit from pharmacological intervention strategies that alleviate the psychiatric symptomatology. We have previously shown that rats with different coping strategies in a stressful environment show strong differences in the motivation to self-administer cocaine. That is, cocaine self-administration under a progressive ratio (PR) schedule of reinforcement was enhanced in high grooming (HG) rats as compared with low grooming (LG) rats. To identify the pharmacological basis of these differences, we tested the acute effects of several anxiolytic drugs on cocaine self-administration in HG and LG rats under a PR schedule of reinforcement. Chlordiazepoxide increased PR responding in both the HG and LG rats, while the selective corticotrophin releasing hormone 1 receptor antagonist R121919 had no effect on cocaine self-administration under the PR schedule. Interestingly, buspirone and fluoxetine decreased PR responding in HG rats only and thereby abolished the individual differences in PR responding between HG and LG rats. In support of the differential effects of the serotonergic drugs on PR responding in HG and LG rats, we found that the in vitro electrically evoked release of [3H]serotonin from mesocorticolimbic brain slices was reduced in the medial prefrontal cortex, substantia nigra and nucleus accumbens core, and increased in the nucleus accumbens shell of HG rats relative to LG rats. These findings show that serotonergic anxiolytics abolish the pre-existing individual differences in cocaine self-administration between HG and LG rats, which show differences in the reactivity of serotonergic neurons. This suggests that the effectiveness of pharmacological interference may depend on the neurochemical and motivational state of the individual.

Animals↗
PubMed2004

The neurobiology of pleasure, reward processes, addiction and their health implications.

Modern science begins to understand pleasure as a potential component of salutogenesis. Thereby, pleasure is described as a state or feeling of happiness and satisfaction resulting from an experience that one enjoys. We examine the neurobiological factors underlying reward processes and pleasure phenomena. Further, health implications related to pleasurable activities are analyzed. With regard to possible negative effects of pleasure, we focus on addiction and motivational toxicity. Pleasure can serve cognition, productivity and health, but simultaneously promotes addiction and other negative behaviors, i.e., motivational toxicity. It is a complex neurobiological phenomenon, relying on reward circuitry or limbic activity. These processes involve dopaminergic signaling. Moreover, endorphin and endogenous morphinergic mechanisms may play a role. Natural rewarding activities are necessary for survival and appetitive motivation, usually governing beneficial biological behaviors like eating, sex and reproduction. Social contacts can further facilitate the positive effects exerted by pleasurable experiences. However, artificial stimulants can be detrimental, since flexibility and normal control of behavior are deteriorated. Additionally, addictive drugs are capable of directly acting on reward pathways. Thus, the concrete outcome of pleasant experiences may be a question of dose. Moderate pleasurable experiences are able to enhance biological flexibility and health. Hence, pleasure can be a resistance resource or may serve salutogenesis. Natural rewards are mediated by sensory organ stimulation, thereby exhibiting a potential association with complementary medical approaches. Trust and belief can be part of a self-healing potential connected with rewarding stimuli. Further, the placebo response physiologically resembles pleasure phenomena, since both involve brain's reward circuitry stimulation and subjective feelings of well-being. Pleasurable activities can stimulate personal growth and may help to induce healthy behavioral changes, including stress management. However, more research is needed to better understand the nature, neurobiology and maybe dangerous aspects of pleasure. Also, a possible involvement of endogenous morphinergic signaling has to be studied further.

Behavior, Addictive↗
PubMedDate not supplied

Taking a gamble.

A new law intended to make access to gambling easier could put more people at risk of gambling addiction. Currently there is little mental healthcare provision for people who get into difficulties. Gambling is being promoted as a leisure activity. Casinos can now sign up members without the need for a 24-hour cooling-off period. People addicted to gambling experience physical symptoms if they fail to get their 'fix'. Some gambling addicts have dual addictions as they are also addicted to drugs or alcohol.

Behavior, Addictive↗
PubMed2004

Attentional biases for alcohol cues in heavy and light social drinkers: the roles of initial orienting and maintained attention.

RATIONALE: There has been considerable theoretical interest in attentional biases for drug-related cues. However, there is little research on the component processes of such attentional biases. OBJECTIVES: We examined initial orienting to, and the maintenance of attention on, alcohol-related cues in heavy and light social drinkers. METHODS: The present study used a visual probe task to investigate biases in visual orienting to alcohol-related cues. We varied the presentation duration of alcohol-related pictures (200, 500 or 2000 ms) to investigate whether attentional biases operated in initial orienting or the maintenance of attention. RESULTS: In comparison with light social drinkers, heavy social drinkers had an attentional bias for alcohol pictures which were presented at the longer exposure durations (500 and 2000 ms), but not at the shorter duration of 200 ms. Subjective alcohol craving was correlated with the attentional bias index for alcohol pictures presented for 2000 ms. CONCLUSIONS: These results suggest that biases in visual orienting to alcohol-related cues in heavy social drinkers operate mainly in the processes involved in the maintenance of attention.

Adult↗
PubMed2004

The relationship of ecological and geographic factors to gambling behavior and pathology.

The current study examined the effect of neighborhood disadvantage and gambling availability on gambling participation and pathology. A national telephone survey included 2631 US adults. Census data was used to characterize the respondent's neighborhood, and the distance from the respondent's home to gambling facilities was calculated. Logistic and linear regressions were performed to predict gambling participation and pathology. Results showed that the neighborhood disadvantage was positively related to frequency of gambling and problem/pathological gambling. The presence of a casino within 10 miles of the respondent's home was positively related to problem/pathological gambling. The permissiveness of gambling laws was positively related to any gambling in the past year, as well as frequent gambling. These results were interpreted to mean that the ecology of disadvantaged neighborhoods promotes gambling pathology, and that availability of gambling opportunities promotes gambling participation and pathology.

Adult↗