AUD in perspective.

Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.

Feasibility, acceptability and preliminary outcomes of a mindfulness-based relapse prevention program in a naturalistic setting among treatment-seeking patients with alcohol use disorder: a prospective observational study.

OBJECTIVES: Cultural differences between the USA and France led us to examine the feasibility, acceptability and preliminary efficacy data on craving, quality of life and psychological flexibility of the add-on Mindfulness-Based Relapse Prevention (MBRP) programme in alcohol use disorder (AUD) in France. DESIGN: We conducted a prospective observational study with a 6-month follow-up. SETTING: The study was performed in a naturalistic setting with adult outpatients from an addiction department. PARTICIPANTS: We included all patients with a current AUD who participated in the MBRP programme (n=52). There was no non-inclusion criterion. INTERVENTIONS: The intervention was an 8-week MBRP programme, combining elements of traditional relapse prevention cognitive behavioural therapy and mindfulness meditation training. This was an eight-session closed-group programme. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were the number of attended treatment sessions, home practice frequency and dropout rate. Secondary outcomes were changes in craving, quality of life, psychological flexibility, drinking outcomes, depression, anxiety and mindfulness levels. RESULTS: The average number of completed sessions was 6.6 (SD: 1.9). Most participants introduced mindfulness meditation into their everyday lives: 69% and 49% of included patients maintained formal practice at 3 and 6 months, respectively, and 80% and 64% maintained informal practice at 3 and 6 months, respectively. Most participants used mindfulness techniques to face high-risk situations (56% at 6 months). Participants reported a significant reduction in craving, days of alcohol use, depression and anxiety and an increase in mindfulness and psychological flexibility at 6 months. CONCLUSIONS: The MBRP programme showed good acceptability and feasibility. MBRP seemed to improve craving, mindfulness and psychological flexibility. Comparative studies are needed to evaluate the programme's efficacy in AUD. TRIAL REGISTRATION NUMBER: 2200863 v 0.

Mindfulness and Cognitive Training in a CBT-resistant Patient With Gambling Disorder: A Combined Therapy to Enhance Self-control.

: Despite the major health consequences of problem gambling, such as suicide, over-indebtedness, delinquency, or family problems, there is currently no approved drug available for the treatment of problem gambling. The efficacy of cognitive behavioral therapies (CBTs) has been demonstrated repeatedly. However, some people seem resistant to conventional CBT alone. We present the case of a 59-year-old woman with a gambling disorder, who relapsed, despite a CBT-based intervention, and who then received a combined therapy aiming to enhance self-control: a mindfulness-based therapy and cognitive training targeting inhibition.

Spirituality and religion among French prisoners: an effective coping resource?

The aim of this study was to describe the role of spirituality and religiousness (SR) among detainees. Thirty detainees from a French short-stay prison were assessed with the World Health Organization Quality of Life-Spirituality Religion and Personal Beliefs questionnaire (WHOQOL-SRPB) and with open questions about SR. Forty percent of detainees described SR as an important way of coping with incarceration and stressful events, as a means of finding inner peace, showing altruism, and gaining the respect of others. SR involvement was associated with reports of decreased suicide risk and of the prevention of future offences. SR appears to be an important coping mechanism and may help the transition to the community following incarceration. This study endorses the view that SR should be considered when treating this population.

French-language version of the World Health Organization quality of life spirituality, religiousness and personal beliefs instrument.

BACKGROUND: A valid assessment of spirituality and religiousness is necessary for clinical and research purposes. We developed and assessed the validity of a French-language version of the World Health Organization Quality of Life Spirituality, Religiousness and Personal Beliefs Instrument (WHOQOL-SRPB). METHODS: The SRPB was translated into French according to the methods recommended by the WHOQOL group. An Internet survey was conducted in 561 people in 2010, with follow-up 2 weeks later (n = 231, 41%), to assess reliability, factor structure, social desirability bias and construct validity of this scale. Tests were performed based on item-response theory. RESULTS: A modal score of 1 (all answers="not at all") was observed for Faith (in 34% of participants), Connectedness (27%), and Spiritual Strength (14%). All scales had test-retest reliability coefficients ≥0.7. Cronbach's alpha coefficients were high for all subscales (0.74 to 0.98) and very high (>0.9) for three subscales (Connectedness, Spiritual Strength and Faith). Scores of Faith, Connectedness, Spiritual Strength and Meaning of Life were higher for respondents with religious practice than for those who had no religious practice. No association was found between SRPB and age or sex. The Awe subscale had a low information function for all levels of the Awe latent trait and may benefit from inclusion of an additional item. CONCLUSIONS: The French language version of the SRPB retained many properties of the original version. However, the SRPB could be improved by trimming redundant items. The strength of SRPB relies on its multinational development and validation, allowing for cross-cultural comparisons.

Pharmacological treatments for cocaine dependence: is there something new?

INTRODUCTION: There is no specific and approved treatment, by regulatory authorities, for cocaine dependence. Therefore, developing new medications for the treatment of this disease continues to be a research priority. Recent advances in neurobiology and brain imaging studies have suggested several promising pharmacological approaches. MATERIALS AND METHODS: Literature searches were conducted for the period from January 1990 to February 2011 using PubMed, EMBASE, PsycInfo, the NIDA research monograph index and the reference list of clinicaltrials.gov, which are the main electronic sources of ongoing trials. RESULTS: Recent controlled clinical studies have highlighted some very promising medications, especially glutamatergic (N-Acetylcysteine, modafinil, topiramate) and GABAergic (vigabatrin) agents, agonist replacement therapy (sustained-release methylphenidate, d-amphetamine) and dopamine agents (disulfiram). Additionally, immunotherapy is a new and promising pharmacological approach. CONCLUSION: Promising pharmacological approaches have emerged for the treatment of cocaine dependence, but larger, randomized, placebo-controlled studies are needed for some medications. Preclinical studies suggest new targets of interest in cocaine dependence. The optimal therapeutic platform is the combination of pharmacotherapies with behavioral therapies.

Blocking cannabinoid CB1 receptors for the treatment of nicotine dependence: insights from pre-clinical and clinical studies.

Tobacco use is one of the leading preventable causes of death in developed countries. Since existing medications are only partially effective in treating tobacco smokers, there is a great need for improved medications for smoking cessation. It has been recently proposed that cannabinoid CB(1) receptor antagonists represent a new class of therapeutic agents for drug dependence, and notably, nicotine dependence. Here, we will review current evidence supporting the use of this class of drugs for smoking cessation treatment. Pre-clinical studies indicate that nicotine exposure produces changes in endocannabinoid content in the brain. In experimental animals, N-piperidinyl-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methylpyrazole-3-carboxamide (rimonabant, SR141716) and N-(piperidin-1-yl)-5-(4-iodophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide (AM251), two cannabinoid CB(1) receptor antagonists, block nicotine self-administration behavior, an effect that may be related to the blockade of the dopamine-releasing effects of nicotine in the brain. Rimonabant also seems efficacious in decreasing the influence of nicotine-associated stimuli over behavior, suggesting that it may act on two distinct neuronal pathways, those implicated in drug-taking behavior and those involved in relapse phenomena. The utility of rimonabant has been evaluated in several clinical trials. It seems that rimonabant is an efficacious treatment for smoking cessation, although its efficacy does not exceed that of nicotine-replacement therapy and its use may be limited by emotional side effects (nausea, anxiety and depression, mostly). Rimonabant also appears to decrease relapse rates in smokers. These findings indicate significant, but limited, utility of rimonabant for smoking cessation.

[Behavioral and cognitive therapy to break the smoking habit. Review of the literature]. / Les thérapies comportementales et cognitives dans l'aide à l'arrêt du tabac.

Nicotine addiction is a chronic disease characterized by frequent relapse. Pharmacological and psychological factors are involved and must be specifically addressed in addicts under treatment. Physicians are familiar with pharmacological treatment with nicotine replacement therapy and bupropion, but not with psychological approaches such as behavioral and cognitive therapy. Various techniques have been evaluated during smoking cessation trials: aversive therapy, contracts, social support, stimulus control, relaxation, diet and nicotine fading. Such approaches have been completed with cognitive strategies and therapeutic programs often use motivational interviews, skills training and relapse prevention strategies. This article reviews these techniques and presents the results of a recent meta-analysis evaluating their efficacy. These results confirm the efficacy of behavioral and cognitive therapy in smoking cessation.