Memory Retrieval and Extinction Reduces Craving For Cigarettes

MedicalResearch.com Interview with:

Michael E. Saladin, Ph.D. Professor, Department of Health Sciences and Research College of Health Professions Medical University of South Carolina Charleston, SC

Dr. Michael Saladin

Michael E. Saladin, Ph.D.
Professor, Department of Health Sciences and Research
College of Health Professions
Medical University of South Carolina
Charleston, SC

MedicalResearch.com: What is the background for this study?

Response: To the extent that learning and memory processes govern all aspects of behavior, they also govern dysregulated or maladaptive behaviors such as addiction and anxiety states. In the former case, stimuli associated with drug administration can acquire the ability to control drug-related motivational states (urges and craving) as well as drug seeking behavior. To illustrate the point, the simple act of observing a person light up a cigarette will cause the typical smoker to desire a cigarette and engage in smoking. A nonsmoker, by contrast, would not be similarly affected because they have no history where stimuli associated with smoking (e.g., sight of a lighter, cigarettes, plumes of smoke) are reliably paired with, or followed by, the rewarding effects of nicotine.

The research we conducted recently was based on neuroscience research showing that retrieved drug-associated memories (prompted with drug-paired cues) can be updated with information that decreases drug craving and/or administration. One such study showed that heroin craving in heroin addicts can be decreased by retrieving memories for heroin use via a brief heroin cue presentation (video of people using heroin) and then, a short time later, presenting an extensive variety of heroin cues (video, pictures and heroin use paraphernalia) over a 1-hour period. The logic of this intervention was that once the heroin memories were prompted into a labile state by the brief video presentation, the extensive heroin cue exposure would serve to update the content of the original memories with new information (i.e., cues are not followed by heroin reward) that is inconsistent with the original cue-drug contingency (i.e., cues are followed with heroin reward). Remarkably, just two sessions of this type of training, which we call retrieval-extinction training, resulted in significant reductions in heroin craving that persisted for six months. This study was done with heroin addicts who were inpatients so there was no way to assess the effects of this treatment on actual heroin use.

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Competitive Athletes At Risk For Addiction

MedicalResearch.com Interview with:
Laurie de Grace

Master’s graduate from the Faculty of Physical Education and Recreation
University of Alberta

MedicalResearch.com: What is the background for this study?

Response: Little is known about the development of substance addiction in the context of sport. There is substantial evidence showing a positive association between sport participation and alcohol use, particularly the binge drinking that is more commonly associated with athletes than non-athletes. However, the connection between sport participation and the use of other substances is not clear. We undertook this study to learn from the perspective of those in recovery from substance addiction, how sport may or may not have played a role in their substance use and subsequent addiction.

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Scientists Block Cocaine Addiction in Mice by Increasing Cadherin “glue” at Synapses

MedicalResearch.com Interview with:

Andrea K. Globa, Ph.D. Candidate Graduate Program in Neuroscience Life Sciences Institute University of British Columbia Vancouver, BC, Canada

Andrea Globa

Andrea K. Globa, Ph.D. Candidate
Graduate Program in Neuroscience
Life Sciences Institute
University of British Columbia
Vancouver, BC, Canada

MedicalResearch.com: What is the background for this study?

Response: Addiction is a complex disease, characterized by continued substance use despite serious negative consequences, increased drug tolerance, and withdrawal. In fact, the statistics show that over 40 million Americans abuse or are addicted to nicotine, alcohol or other drugs. This is a huge public health issue, so naturally, scientists are interested in figuring out why people get addicted, and in particular why certain people are more prone to addiction than others.

Studies examining genetic differences in addicted populations have shown that there are many mutations in genes that are important for brain function. One group of genes affected encode proteins that act as ‘glue’ to hold cells together. These proteins are called cadherins. In the brain, cadherins are important for holding brain cells together at spots where they communicate with one another – and these points where brain cells talk to one another are called synapses.

Many neuroscientists believe that addiction is actually a type of “pathological” learning, where there are changes at synapses in a brain circuit involved in reward and motivation. So we decided to examine the molecular mechanisms that are important for the strengthening of synapses in this brain circuit.

To put it very simply, to learn something you have to make your synapses stronger, and this involves adding more cadherin or ‘glue’ to the synapse. We wanted to see if these same rules held true in addiction.

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Brain-Reward Circuit Both Under and Over Responsive in Addiction and Gambling

MedicalResearch.com Interview with:

Guillaume Sescousse, PhD Senior post-doc Donders Centre for Cognitive Neuroimaging The Netherlands

Dr. Guillaume Sescousse

Guillaume Sescousse, PhD
Senior post-doc
Donders Centre for Cognitive Neuroimaging
The Netherlands
with collaborators Maartje Luijten, PhD,
and Arnt Schellekens, MD PhD

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: People with an addiction process rewards in their brain differently from people who are not addicted. However, whether this is associated with “too much” or “too little” brain activity is an open question. Indeed, past research has produced conflicting findings.

In order to get a reliable answer, we have combined 25 studies investigating brain reward sensitivity in more than 1200 individuals with and without addiction to various substances such as alcohol, nicotine or cocaine but also gambling. By analyzing the brain images from these studies, we have discovered an important difference in brain activity between expecting a reward and receiving a reward. Compared with non-addicted individuals, individuals with substance or gambling addiction showed a weaker brain response to anticipating monetary rewards. This weaker response was observed in the striatum, a core region of the brain reward circuit, possibly indicating that individuals with an addiction have relatively low expectations about rewards. In contrast, this same region showed a relatively stronger response to receiving a reward in individuals with substance addiction compared with non-addicted individuals.

This stronger response possibly indicates a stronger surprise to getting the reward, and is consistent with low expectations. This same effect was not found among people addicted to gambling.

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Reasons for Drug Policy Reform: Millions of People are Left with Untreated Pain

MedicalResearch.com Interview with:
Dr. Katherine Irene Pettus, PhD, OSB

Advocacy Officer International Association for Hospice and Palliative Care
Vice Chair, Vienna NGO Committee on Drugs
Secretary NGO Committee on Ageing, Geneva

MedicalResearch.com: What is the background for this study?

Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries.

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Which Patients Stick With Office Based Opioid Treatment with Buprenorphine?

MedicalResearch.com Interview with:

Zoe M. Weinstein MD Assistant Professor of Medicine, Boston University Director, Addiction Consult Service, Boston Medical Center 801 Massachusetts Ave. Crosstown 2 #2039 Boston MA 02118

Dr. Zoe Weinstein

Zoe M. Weinstein MD
Assistant Professor of Medicine, Boston University
Director, Addiction Consult Service
Boston Medical Center
Boston MA 02118

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Like other chronic, life-long medical conditions such as hypertension or diabetes, opioid use disorder (OUD) requires long-term engagement in therapy; however many individuals who participate in Office Based Addiction Treatment are not able to be retained in care long-term.

This observational study followed more than 1,200 patients over 12 years with the goal of identifying patient-specific factors associated with retention in the treatment program for longer than one year. While the study found that older age, female, and co-morbid psychiatric diagnosis were associated with greater odds of treatment retention beyond one year, patients who were black or Hispanic, unemployed, and had evidence of hepatitis C viral infection were associated with decreased odds of treatment retention beyond one year.

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Incidence, Risk factors and Prevention of Hepatitis C Reinfection

MedicalResearch.com Interview with:
Naveed Zafar Janjua, MBBS, MSc, DrPH
Senior Scientist, Clinical Prevention Services
BC Centre for Disease Control
Clinical Associate Professor, School of Population and Public Health
University of British Columbia

MedicalResearch.com: What is the background for this study?

Response: Hepatitis C is a viral infection that affects the liver. About quarter of people infected with hepatitis C clear their infection spontaneously rest develop chronic infection. Left untreated, hepatitis C could results in scarring of liver (liver cirrhosis), liver cancer or death. New anti-viral drugs are highly effective in curing hepatitis C, about than 95 per cent of those treated can be cured. However, people who engage in high risk activities such as people who inject drugs (PWID) remain at risk of reinfection. As the cost of treatment is very high, re-infection is a concern among physicians and policy makers in Canada and around the world.

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Opioid Emergencies Increased Almost 100% in Some States

MedicalResearch.com Interview with:
Claudia Steiner, M.D., MPH.

Agency for Healthcare Research and Quality (AHRQ)
Rockville, MD

MedicalResearch.com: What is the background for this study?

Response: The Agency for Healthcare Research and Quality (AHRQ) has a longstanding project and partnership, The Healthcare Cost and Utilization Project (HCUP, pronounced “H-Cup”). HCUP is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership. HCUP databases bring together the data collection efforts of State data organizations, hospital associations, and private data organizations (HCUP Partners) and the Federal government to create a national information resource of encounter-level health care data. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels.

The HCUP Partners recognized the urgency of providing descriptive statistics to help inform the growing opioid epidemic in the U.S., and therefore agreed to supporting this statistical brief as well as the Opioid-Related Hospital Use path on Fast Stats: http://www.hcup-us.ahrq.gov/faststats/landing.jsp

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Rural Babies Increasingly Affected By Opioid Epidemic

MedicalResearch.com Interview with:
Nicole Villapiano, MD, MSc

Robert Wood Johnson Clinical Scholar
Internal Medicine/Pediatrics
Institute for Healthcare Policy & Innovation
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over the past few years, research has highlighted that the opioid epidemic is accelerating at a rapid pace across the United States, including in rural areas. What we don’t know is how the opioid crisis is affecting rural moms and their infants.
As a doctor that takes care of kids, I was concerned about this. So our team took on this study to explore the differences in rates of maternal opioid use and neonatal abstinence syndrome in rural and urban areas of the US from 2004-2013.

Neonatal abstinence syndrome is what happens to babies who are exposed to opioids in their mothers’ womb. When these babies are born and no longer have opioid exposure from mom, they go through a period of opioid withdrawal. These babies can have symptoms that range from difficulty taking a bottle, jitteriness, difficulty sleeping, irritability, and discomfort to more serious problems like prematurity, difficulty breathing, and seizures. Symptoms can last several days to many weeks. Babies with neonatal abstinence syndrome are in the hospital longer than the average newborn, and sometimes require special treatment to help control their symptoms.

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Drug Positivity in U.S. Workforce Rises to Highest Level in a Decade

MedicalResearch.com Interview with:

Dr. Barry Sample PhD Senior director, science and technology Quest Diagnostics Employer Solutions A business of Quest Diagnostics

Dr. Barry Sample

Dr. Barry Sample PhD
Senior director, science and technology
Quest Diagnostics Employer Solutions
A business of Quest Diagnostics

MedicalResearch.com: What is the background for this study of drug testing of the U.S. workforce?

Response: As a leader in the drug testing industry, our primary goal at Quest Diagnostics Employer Solutions is to help employers maintain drug-free workplaces and combat the impacts of substance abuse such as higher absenteeism, increased risk of injury and lower productivity and performance.

One way we support these efforts is to offer analysis and information from resources like the Quest Diagnostics Drug Testing Index™, which we publish as a public service for government, media, and industry. We’ve published the Drug Testing Index since 1988, which is also the year that Congress passed the Drug-Free Workplace Act.
The Drug Testing Index examines positivity rates – the proportion of positive drug test results – among three major testing populations: federally-mandated, safety-sensitive workers; the general (private sector) U.S. workforce; and the combined U.S. workforce. Thresholds for positivity are determined by cutoff levels as established by the administrating authority; these cutoff levels determine the threshold for positivity for a specific substance. Should a metabolite appear at or above the level of the cutoff, a test is determined to be positive.

Over the last few decades, testing policies have evolved to serve a dual purpose of protecting the health, safety, and welfare of both employees and the general public. That’s especially important in certain industries, such as transportation, where an impaired driver, pilot, or operator can create substantial public risk. The positivity rate in 1998, the year of the first Drug Testing Index, was 13.6 percent. Over the last 25 years, as we have tracked the overall positivity rate, we have noted other significant trends in the American workforce based on workplace drug tests. For example, our 2003 analysis revealed that amphetamine positivity had grown by 70 percent over the previous five years. The 2011 Drug Testing Index found that hydrocodone and oxycodone led U.S. general workforce positives. In both 2010 and 2011, the overall drug positivity rate was 3.5 percent, the lowest rate since we began publishing the Drug Testing Index. This year, we found positivity is at a ten-year high.

What that tells us is that trends come and go, and that we cannot rely on assumptions about drug use.

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Childhood Trauma Associated With Greater Risk of Adult Drug Abuse

MedicalResearch.com Interview with:

Kelly Quinn, PhD, MPH Assistant Professor Department of Population Health NYU Langone Medical Center New York, NY 10016-6481

Dr. Kelly Quinn

Kelly Quinn, PhD, MPH
Assistant Professor
Department of Population Health
NYU Langone Medical Center
New York, NY 10016-6481

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prescription pain reliever misuse epidemic in the United States has contributed to a dramatic increase in overdoses and overdose mortality and is linked to injection drug use. Identification of upstream drivers of drug misuse is crucial for prevention strategies. We aimed to further the knowledge of the association between traumatic experiences in childhood and drug misuse in adulthood.

Using nationally-representative data from The National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined the associations of nine childhood traumas (neglect; emotional, physical, and sexual abuse; parent binge drinking and incarceration; and witnessing, being threatened with, and experiencing violence) with prescription pain reliever misuse and injection drug use in emerging adulthood and adulthood. Some, but not all, traumas independently predicted drug misuse. However, this analysis found that the cumulative number of traumas predicted drug misuse in a dose-response fashion. That is, relative to children reporting no trauma, increasing number of traumas in childhood was associated with higher odds of initiating drug misuse later in life.

MedicalResearch.com: What should readers take away from your report?

Response: These findings add to evidence that the trauma load during stress-sensitive childhood has negative health consequences throughout the life course and have immediate public health significance. Prescribing patterns for prescription pain relievers must be carefully monitored in order to prevent misuse, addiction, and escalation to heroin use and drug injection. Screening for and addressing childhood trauma may be an important strategy to prevent initiation of drug use, and for drug users, trauma-informed interventions throughout the life course are important for treatment and mitigation of relapse.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future research is needed to elucidate causal mechanisms, to better understand the influence of age at childhood trauma, and to clarify escalation from misusing prescription pain relievers to injecting drugs.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

APHA 2016 abstract and publication

Associations between Childhood Traumatic Events and Adulthood Prescription Pain Pill Misuse and Injection Drug Use in the United States
Quinn, Kelly et al.
Drug & Alcohol Dependence , Volume 0 , Issue 0
Published online: October 04, 2016

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Rapid Rise in Opioid Poisonings and Hospitalizations Among Children and Adolescents

MedicalResearch.com Interview with:

Julie R Gaither, PhD, MPH, RN Postdoctoral Fellow in Biostatistics Yale School of Medicine

Dr. Julie R Gaither

Julie R Gaither, PhD, MPH, RN
Postdoctoral Fellow in Biostatistics
Yale School of Medicine

MedicalResearch.com: What is the background for this study?

Response: In light of the prescription opioid epidemic that has affected the adult US population in recent years, our objective with this study was to examine how hospitalization rates for prescription opioid poisonings have changed over time in the pediatric population.

In addition, because prescription opioids are thought to be a precursor to illicit opioid use, we examined in older adolescents hospitalization rates for heroin overdose.

In all children, we determined whether the poisoning was of an accidental nature or could be attributed to suicidal intent.

To address these questions, we used the Kids’ Inpatient Database, a nationally representatives sample of pediatric hospital records released every three years, starting in 1997.

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