Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention

World Psychiatry, Journal Year: 2023, Volume and Issue: 22(2), P. 203 - 229

Published: May 9, 2023

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well‐being, social functioning. Long‐lasting changes in brain networks involved reward, executive function, stress reactivity, mood, self‐awareness underlie the intense drive to consume substances inability control this urge person who suffers from addiction (moderate or severe SUD). Biological (including genetics developmental life stages) adverse childhood experiences) determinants of health recognized factors that contribute vulnerability for resilience against developing SUD. Consequently, prevention strategies target risk can improve outcomes and, when deployed adolescence, decrease these disorders. SUDs treatable, evidence clinically significant benefit exists medications (in opioid, nicotine alcohol disorders), behavioral therapies all SUDs), neuromodulation disorder). Treatment should be considered within context Chronic Care Model, with intensity intervention adjusted severity disorder concomitant treatment comorbid psychiatric physical conditions. Involvement care providers detection management SUDs, including referral cases specialized care, offers sustainable models further expanded telehealth. Despite advances our understanding individuals conditions continue stigmatized some countries, incarcerated, highlighting need dismantle policies perpetuate their criminalization instead develop ensure support access treatment.

Language: Английский

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Functional and structural brain abnormalities in substance use disorder: A multimodal meta‐analysis of neuroimaging studies

Acta Psychiatrica Scandinavica, Journal Year: 2023, Volume and Issue: 147(4), P. 345 - 359

Published: Feb. 21, 2023

Abstract Introduction Numerous neuroimaging studies of resting‐state functional imaging and voxel‐based morphometry (VBM) have revealed that patients with substance use disorder (SUD) may present brain abnormalities, but their results were inconsistent. This multimodal meta‐analysis aimed to estimate common specific alterations in SUD by combining information from all available spontaneous activity gray matter volume (GMV). Methods A whole‐brain on VBM was conducted using the Seed‐based d Mapping Permutation Subject Images (SDM‐PSI) software, followed overlapping comprehensively investigate function structure SUD. Results In this meta‐analysis, 39 independent 47 datasets related (1444 patients; 1446 healthy controls [HCs]) included, as well 77 89 for GMV (3457 3774 HCs). Patients showed decreased bilateral anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC). For reduced ACC/mPFC, insula, thalamus extending striatum, left sensorimotor cortex. Conclusions exhibited shows impairment both suggesting deficits structural domains could be correlated together. addition, a few regions only SUD, including thalamus, areas.

Language: Английский

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Incubation of methamphetamine craving in punishment-resistant individuals is associated with activation of specific gene networks in the rat dorsal striatum

Molecular Psychiatry, Journal Year: 2024, Volume and Issue: 29(7), P. 1990 - 2000

Published: Feb. 14, 2024

Methamphetamine use disorder (MUD) is characterized by loss of control over compulsive drug use. Here, we used a self-administration (SA) model to investigate transcriptional changes associated with the development early and late compulsivity during contingent footshocks. Punishment initially separated methamphetamine taking rats into always shock-resistant (ASR) that continued active lever pressing shock-sensitive (SS) reduced their pressing. At end punishment phase, underwent 15 days forced abstinence at which they were re-introduced SA paradigm followed plus shocks. Interestingly, 36 percent initial SS developed delayed shock-resistance (DSR). Of translational relevance, ASR showed more incubation craving than DSR sensitive (AS) rats. RNA sequencing revealed increased striatal Rab37 Dipk2b mRNA levels correlated craving. Bdnf HDAC2-dependent decreased expression in AS The present should help elucidate molecular substrates addiction-like behaviors.

Language: Английский

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What Chemsex does to the brain - neural correlates (ERP) regarding decision making, impulsivity and hypersexuality

European Archives of Psychiatry and Clinical Neuroscience, Journal Year: 2024, Volume and Issue: unknown

Published: July 6, 2024

Abstract Chemsex describes the use of specific substances (methamphetamine, GHB/GBL, mephedrone, ketamine) which initiate or enhance sexual experiences and is mainly prevalent among men who have sex with men. Many users experience somatic complications (for example sexually transmitted diseases) sometimes adverse sociological, psychological, neurological symptoms, such as depression, impulse control disorders hypersexuality. Changes in impulsivity deficits executive functions demonstrated to be associated addiction well frontal brain dysfunction behavioral deficits. This study aims explore effects neurophysiological correlates inhibition decision making an EEG paradigm using event-related potentials (N2, P3). 15 14 matched subjects, all them man, participated auditory Go/NoGo/Voluntary Selection paradigm. In addition, clinical data (e.g. regarding depression), demographic information measures well-being behavior were collected. The results that hypersexuality, risk more pronounced compared non-users. P3 amplitudes did not differ significantly between groups. However, showed decreased electrophysiological N2 responses fronto-central regions during decision-making, indicating compromised function inhibitory control. observed impairments may lead increased drug abuse Understanding neurobiological mechanisms can contribute targeted interventions order mitigate negative consequences engaging improve general well-being.

Language: Английский

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Predictors of Readmission in Young Adults with First-Episode Psychosis: A Multicentric Retrospective Study with a 12-Month Follow-Up

Clinics and Practice, Journal Year: 2024, Volume and Issue: 14(4), P. 1234 - 1244

Published: June 24, 2024

Background: A significant number of young individuals are readmitted one or more times shortly after their first episode psychosis. Readmission may represent a marker psychopathological vulnerability. Our primary aim was to evaluate the impact clinical and socio-demographic variables on readmission at 12-month follow-up. Secondly, our goal determine whether use Long-Acting Injection (LAI) antipsychotics provides notable benefits compared oral medications in preventing subsequent readmissions. Subjects methods: 80 patients hospitalised for time with diagnosis psychotic disorder (ICD-10 criteria) were retrospectively assessed through records. The mean age 21.7 years. Patients predominantly male (n = 62, 77.5%), 55 subjects had least 8 years education. 50% sample “NEET” (not education, employment, training). Results: 35 (43.8%) discharged LAI antipsychotic, while 45 (56.2%) recieved antipsychotic therapy. Substance (p 0.04) discharge 0.003) significantly associated 1 year. We did not find any predictors being Conclusion: findings underlined importance identifying risk order prevent future rehospitalization promote appropriate prevention strategies. LAIs should be considered as first-choice treatment FEP since they proved effective relapse.

Language: Английский

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Addictive and other mental disorders: a call for a standardized definition of dual disorders

Translational Psychiatry, Journal Year: 2022, Volume and Issue: 12(1)

Published: Oct. 13, 2022

Abstract The persistent difficulty in conceptualizing the relationship between addictive and other mental disorders stands out among many challenges faced by field of Psychiatry. different philosophies schools thought about, sheer complexity these highly prevalent clinical conditions make progress inherently difficult, not to mention profusion competing sometimes contradictory terms that unnecessarily exacerbate challenge. lack a standardized term adds confusion, fuels stigma, contributes “wrong door syndrome” captures only diagnosing but also treating an integrated manner. World Association on Dual Disorders (WADD) proposes adoption “Dual Disorder” which, while still arbitrary, would help harmonize various research efforts rallying around single, more accurate, less stigmatizing designation.

Language: Английский

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Updated Perspectives on the Neurobiology of Substance Use Disorders Using Neuroimaging

Substance Abuse and Rehabilitation, Journal Year: 2023, Volume and Issue: Volume 14, P. 99 - 111

Published: Aug. 1, 2023

Abstract: Substance use problems impair social functioning, academic achievement, and employability. Psychological, biological, social, environmental factors can contribute to substance disorders. In recent years, neuroimaging breakthroughs have helped elucidate the mechanisms of misuse its effects on brain. Functional magnetic resonance imaging (MRI), positron emission tomography (PET), single-photon computed (SPECT), spectroscopy (MRS) are all examples. Neuroimaging studies suggest affects executive function, reward, memory, stress systems. Recent research attempts provided clinicians with improved tools diagnose patients who substances, comprehend complicated neuroanatomy neurobiology involved, devise individually tailored monitorable treatment regimens for individuals This review describes most developments in drug neuroimaging, including disorders, established techniques, techniques emerging clinical technology. Keywords: MRI, neurobiology, misuse, addiction, AI, PET, fMRI, SPECT

Language: Английский

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The potential of 5‐methoxy‐N,N‐dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action

Addiction Biology, Journal Year: 2024, Volume and Issue: 29(4)

Published: April 1, 2024

Abstract Alcohol use disorder (AUD) remains one of the most prevalent psychiatric disorders worldwide with high economic costs. Current treatment options show modest efficacy and relapse rates are high. Furthermore, there increases in gap few new medications have been approved past 20 years. Recently, psychedelic‐assisted therapy psilocybin lysergic acid diethylamide has garnered significant attention AUD. Yet, they require amounts therapist input due to prolonged subjective effects (~4–12 h) leading costs impeding implementation. Accordingly, is an increasing interest rapid short‐acting psychedelic 5‐methoxy‐ N,N ‐dimethyltryptamine (5‐MeO‐DMT). This paper offers a first look at potential therapeutic mechanisms for AUD by reviewing current literature on 5‐MeO‐DMT. Primarily, 5‐MeO‐DMT able induce mystical experiences ego‐dissolution together psychological flexibility mindfulness. could decrease symptoms through alleviation mood‐related comorbidities consistent negative reinforcement self‐medication paradigms. In addition, preliminary evidence indicates that modulates neural oscillations might subserve (increases gamma ), mindfulness theta reorganization executive control networks coherence across frequencies) improve emotion regulation inhibition. Finally, animal studies characterized neuroplasticity, anti‐inflammation, 5‐HT 2A receptor agonism, downregulation metabotropic glutamate 5 clinical implications comorbidities. The concludes several recommendations future research establish purported action.

Language: Английский

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Whole-brain white matter abnormalities in human cocaine and heroin use disorders: association with craving, recency, and cumulative use

Molecular Psychiatry, Journal Year: 2022, Volume and Issue: 28(2), P. 780 - 791

Published: Nov. 11, 2022

Language: Английский

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The Neural Signature of Impaired Inhibitory Control in Individuals with Heroin Use Disorder

Journal of Neuroscience, Journal Year: 2022, Volume and Issue: 43(1), P. 173 - 182

Published: Nov. 17, 2022

Heroin addiction imposes a devastating toll on society, with little known about its neurobiology. Excessive salience attribution to drug over nondrug cues/reinforcers, concomitant inhibitory control decreases, are common mechanisms underlying addiction. Although alterations generally culminate in prefrontal cortex (PFC) hypoactivations across drugs of abuse, patterns individuals heroin (iHUDs) remain unknown. We used stop-signal fMRI task designed meet recent consensus guidelines mapping 41 iHUDs and 24 age- sex-matched healthy controls (HCs). Despite group similarities the response time (SSRT; classic measure), compared HCs, exhibited impaired target detection sensitivity (proportion hits go vs false alarms stop trials; p = 0.003). Additionally, lower right anterior PFC (aPFC) dorsolateral (dlPFC) activity during successful versus failed stops (the hallmark contrast). Lower left dlPFC/supplementary motor area (SMA) was associated slower SSRT specifically aPFC worse all participants ( < 0.05 corrected). Importantly, iHUDs, SMA shorter since last use higher severity dependence, respectively Together, results revealed perceptual cognitive regions (e.g., aPFC, dlPFC, SMA) as performance measures iHUDs. Such neurobehavioral deficits may contribute self-control lapses addiction, constituting targets for prevention intervention efforts enhance recovery. SIGNIFICANCE STATEMENT continues deadly impact, neurobiology this disorder. behavioral cortical impairments characterize these underexplored Here, we illustrate significant impairment discrimination matched controls. further show engagement (key that regulate control) stopping, discrimination, measures. Mapping first time, identify potential treatment inclusive cortex-mediated amenable neuromodulation en route

Language: Английский

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