Neurofeedback for alcohol addiction: Changes in resting state network activity✰.

Alcohol dependence continues to be a major global burden despite significant research progress and treatment development. The aim of this study was to investigate whether neurofeedback training can alter resting state fMRI activity in brain regions that play a crucial role in addiction disorders in patients with alcohol dependence. For this purpose, a total of 52 patients were recruited for the present study, randomized, and divided into an active and a sham group. Patients in the active group received three sessions of neurofeedback training. We compared the resting state data in the active group as part of the NF training on six measurement days. When comparing the results of the active group from neurofeedback day 3 with baseline 1, a significant reduction in activated voxels in the ventral attention network area was seen. This suggests that reduced activity over the course of therapy in subjects may lead to greater independence from external stimuli. Overall, a global decrease in activated voxels within all three analysed networks compared to baseline was observed in the study. The use of resting-state data as potential biomarkers, as activity changes within these networks, may be to help restore cognitive processes and alcohol abuse-related craving and emotions.

Commentary: Similarities and Differences Between Harm-Reduction and Substitute Addiction-- Implications for the Health Professions.

"Substitute addiction" refers to the process of achieving abstinence or resolution of one addictive behavior and subsequently engaging in one or more additional addictive behaviors in its place. Substitute addiction, a concept in the abstinence-based recovery field for decades, is viewed as a cause for concern because resolving one addictive behavior might not fully remove harm or ensure recovery. Conversely, "harm-reduction treatment" refers to a counseling orientation that focuses on helping service users reduce substance-related harm and improve their quality of life without necessarily requiring abstinence or use reduction. Harm-reduction treatment assesses a constellation of addictive behaviors in the larger context of a person's life to holistically reduce harm in that constellation. In this commentary, we define and compare both constructs and point out their implications for addictions treatment.

Effects of different interventions on internet addiction: a systematic review and network meta-analysis.

BACKGROUND: Globally, Internet is a recognized form of leisure, but there are growing apprehensions about the increasing number of individuals developing an addiction to it. Recent research has focused on social issues associated with internet addiction (IA). However, the treatment of IA is currently unclear. This study aimed to explore the relationship between IA treatment outcomes and different intervention strategies through systematic review and data analysis of patients who received different intervention modes. METHODS: A meta-analysis was conducted using RevMan 5.4 and Stata 14.2 on 57 literature research data from five Chinese and English databases, PubMed, Embase, Web of Science, Wanfang and CNKI. RESULT: A total of 57 randomized controlled trials (RCTs) were included in this network meta-analysis involving 3538 IA patients and 13 different interventions. The network meta-analysis results demonstrated that the top four interventions were: rTMS + CBT, drug + others, rTMS, and electro-acupuncture + CBT. CONCLUSION: Our study indicated that comprehensive therapy had an optimal therapeutic effect on IA patients and rTMS + CBT ranked first among all therapeutic indicators of intervention, indicating optimal clinical effectiveness.

Mindfulness interventions for craving reduction in substance use disorders and behavioral addictions: systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: High-quality evidence is still required to affirm the efficacy of mindfulness-based interventions (MBIs) in craving reduction. MBIs may be particularly appropriate for this purpose given the neurobiological mechanisms of addiction with automatic behavior in response to the negative affect. In this systematic review and meta-analysis, we aimed to study the efficacy of MBIs in craving reduction and to synthetize the newly published data. METHODS: We searched four databases and three clinical trial registries for randomized controlled trials (RCTs) up to August 2023, including studies with MBIs in all types of substance use disorders or behavioral addictions. We chose as our outcome of interest the change from the baseline of craving measures at posttreatment. Standardized mean difference was used as an effect size estimator. RESULTS: We included 17 RCTs with 1228 participants. The overall effect size was estimated at -0.70 (95% CI -1.15, -0.26) in favor of MBIs. CONCLUSION: Due to the high inconsistency (I2 = 92%), we were unable to conclude that there is a medium to large effect size. Overall risk of bias was high for most studies, and the GRADE approach detected a low quality of evidence. Previous clinical and fundamental research suggest that MBIs have a promising potential in addiction medicine. However, further investigation of whether MBIs effectively reduce craving is needed, and innovative solutions for resolving methodological limitations in MBI research are warranted. TRIAL REGISTRATION: PROSPERO registration ID CRD42020221141.

Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions.

This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators.

INTRODUCTION: Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care. METHODS: This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12-29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking). RESULTS: A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families' needs are met, barriers are mitigated, and facilitators are enhanced. CONCLUSION: This review provides essential contextual information regarding TAY with MHA concerns and their families' needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population's needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.

An Overview of Mindfulness-Oriented Addiction and Pain Recovery.

ABSTRACT: There is evidence that mindfulness-based interventions are effective as stress-reduction techniques in people with various stressor-related disorders. Research also shows overall improvement in mental health well-being in practitioners of mindfulness. However, there is limited literature probing the potential negative impacts of mindfulness practice. Relapse is a major challenge in substance use disorders (SUDs), particularly for people with chronic pain. There is an overlap between SUDs and chronic pain, which share common pathophysiological pathways that could contribute to poor pain control and mental instability. In this report, we discuss the possible effects of mindfulness on specified aspects of substance craving and chronic pain perception. We propose future directions for research in mindfulness practices to maximize the potential for relapse prevention and pain control.

Development, Content Validation, and Feasibility of Yoga Module for Smartphone Addiction.

Context: Mental health practitioners have postulated that smartphone addiction is a disorder characterized by maladaptive and problematic behavior, and treatment modalities are scarce. Yoga has been found to be a viable tool for addiction treatment and other psychiatric conditions, but no specific validated module is currently available for smartphone addiction. Objective: The study intended: (1) to develop a yoga-based intervention for smartphone addiction, based on the ancient literature of yoga and a modern literature review; (2) to validate the developed module with experts from different schools of yoga; and (3) to test the module's feasibility and efficacy for young adolescents, with the objective of creating biopsychosocial well-being. Design: The research team first conducted a search of traditional and contemporary literature, with the objective of developing the yoga program. That yoga program was then sent to yoga experts for content validation. A pilot study then tested the feasibility of using the developed module for individuals with internet and smartphone addiction. Setting: The study took place in Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University, Bengaluru, India. Participants: For content validity, participants were 15 yoga experts who had >10 years of experience in treating mental health disorders. For feasibility in a pilot study, participants were 22 students from an engineering college in Bengaluru, South India. Outcome Measures: For content validity, the experts' opinions were rated using a content validation ratio (CVR) through Lawshe's formula. For the feasibility study, assessments were performed at baseline and post intervention. Data were collected to evaluate: (1) addiction level using the Smartphone Addiction Scale - Short Version (SAS-SV), (2) impulsiveness using the Barat Impulsive Scale (BIS); (3) sleep problems using the Pittsburgh Sleep Quality Index (PSQI), (4) mindfulness using the Mindful Attention Awareness Scale (MAAS), (4) self-regulation using the Short Self-Regulation Questionnaire (SSRQ); and general health using the General Health Questionnaire (GHQ-12). Results: In the final version of the module, 26 out of 35 items (74.28%) of the practices in the developed program were retained, together with the modifications suggested by the experts. The content validity index for the whole module, an average of all CVRs, was 0.74. The study found significant reductions in the most symptom scores after participants practiced the yoga module for six weeks. Conclusions: A yoga module for smartphone addiction was developed, validated, and checked for feasibility. The content validity of the module was found to be good. The module was found to potentially useful for reducing symptoms in individuals with smartphone addiction. Future studies should test the efficacy of the developed program through a randomized, controlled clinical trial.

Mindfulness and Savoring: A Commentary on Savoring Strategies and Their Implications for Addiction Treatment.

Background: A central facet of the popular understanding of mindfulness practice is the non-judgmental observation of all thoughts and feelings. Savoring is a cognitive practice developed out of economics and positive psychology, which involves the conscious mental engagement with positively-valenced interoceptive and exteroceptive stimuli, which in turn amplifies the derived pleasure experience. Results: When incorporated into mindfulness-based interventions (MBIs), savoring holds promise in improving outcomes related to reward processing, such as positive affect and well-being. The growing body of mindfulness literature also suggests that the inclusion of savoring in MBIs may be key in treating disorders of reward dysregulation, such as addiction. If savoring does indeed reduce craving, this phenomenon offers a point of union for divergent neurobiological theories of addiction. Conclusion: In this commentary, we explore the existing literature on savoring and mindfulness practices as it relates to addictive disorders, posit underlying neurocognitive mechanisms, and present future areas of research.

Effects of auriculotherapy on addiction: a systematic review.

Auriculotherapy has been used to reduce withdrawal symptoms during drug detoxication. The purpose of this study was to review the results of the randomized controlled trials (RCTs) that examined the impact of auriculotherapy on addiction. This study aimed to find an effective protocol involving auricular acupuncture points, intervention duration and frequency, and stimulating methods. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Medline for articles published between January 1, 1994, and March 31, 2021. The keywords used were auricular, acupuncture, addiction, substance misuse, smoking, randomized controlled trial, clinical trial, and human. Each RCT was evaluated for quality applying the risk of bias tool by the Cochrane group. Effect size (Hedges's g) was calculated using the mean values and standard deviation of the experimental and control groups. The risk for bias of these studies was moderate to high and only four studies (11.1%) earned scores of 6, indicating the lowest risk of bias and highest quality RCT. Out of 36 studies, 23 (64%) reported that auriculotherapy was effective for treating addiction such as opioids, cocaine, alcohol, heroin, nicotine, and gambling. The most commonly used combination of acupuncture points (four of 36 studies) was shenmen, sympathetic, liver, lung, and kidney, which are called NADA protocol. The following most frequently used combination of acupressure points (four out of 36 studies) was shenmen, subcortex, heart, lung, and liver. Acupressure could be considered to be used for the treatment of addiction.

Neuronal adaptations in the lateral habenula during drug withdrawal: Preclinical evidence for addiction therapy.

The epithalamic lateral habenula (LHb) regulates monoaminergic systems and contributes to the expression of both appetitive and aversive behaviours. Over the past years, the LHb has emerged as a vulnerable brain structure in mental illnesses including addiction. Behavioural and functional evidence in humans and rodents provide substantial support for a role of LHb in the negative affective symptoms emerging during withdrawal from addictive substances. Multiple forms of cellular and synaptic adaptations that take hold during drug withdrawal within the LHb are causally linked with the emergence of negative affective symptoms. These results indicate that targeting drug withdrawal-driven adaptations in the LHb may represent a potential strategy to normalize drug-related behavioural adaptations. In the current review we describe the mechanisms leading to functional alterations in the LHb, as well as the existing interventions used to counteract addictive behaviours. Finally, closing this loop we discuss and propose new avenues to potentially target the LHb in humans in light of the mechanistic understanding stemming from pre-clinical studies. Altogether, we provide an overview on how to leverage cellular-level understanding to envision clinically-relevant approaches for the treatment of specific aspects in drug addiction.

Digital gaming interventions: a novel paradigm in mental health? Perspectives from India.

The mental health gap has been a persistent concern globally, especially in low and middle-income countries (LMIC). In an attempt to mitigate resource limitations, the psychiatric practice has been undergoing a paradigm shift into digitalized mental health interventions. One such innovation involves digital gaming utilizing the principles of 'gamification' to incorporate both the playfulness component of online gaming as well as the domain-targeted design of gaming elements. Digital gaming-based interventions have been to deliver psychotherapy, biofeedback, cognitive training and rehabilitation, as well as behavioural modification and social skills training. Research shows their utility in autism spectrum disorders, attention deficit disorders, schizophrenia, depression, anxiety disorders, post-traumatic stress, eating disorders, neurocognitive disorders and also to promote healthy aging. Though promising in scope, these interventions face pragmatic challenges for implementation in developing countries. Even though increased use of technology, internet penetration and growing digital literacy have enhanced their accessibility and feasibility, various factors like socio-cultural diversity, lack of standardization, poor infrastructural support, bandwidth issues and lack of practice can impair their use and acceptability. Keeping this in the background, this commentary critically discusses the scope, applications and challenges of digital gaming in mental healthcare delivery in one of the rapidly globalizing LMIC nations, India.

Redefining Pain and Addiction: Creation of a Statewide Curriculum.

OBJECTIVES: In response to a declared statewide public health emergency due to opioid-related overdose deaths, the Arizona Department of Health Services guided the creation of a modern, statewide, evidence-based curriculum on pain and addiction that would be relevant for all health care provider types. METHODS: The Arizona Department of Health Services convened and facilitated 4 meetings during 4 months with a workgroup comprising the deans and curriculum representatives of all 18 medical, osteopathic, physician assistant, nurse practitioner, dental, podiatry, and naturopathic programs in Arizona. During this collaborative and iterative process, the workgroup reviewed existing curricula, established a philosophical framework, and developed a flexible and practical structure for a curriculum that would suit the needs of all program types. RESULTS: The Arizona Pain and Addiction Curriculum was finalized in June 2018. The curriculum aims to redefine pain and addiction as multidimensional public health issues and is structured as 10 core components, each supported by a detailed set of evidence-based objectives. The curriculum includes a set of annual metrics to collect from both programs (focused on implementation progress and barriers) and learners (focused on knowledge, attitudes, and practice plans). CONCLUSIONS: To our knowledge, this is the first example of a statewide collaboration among diverse health professional education programs to create a single, standard curriculum. This collaborative process and the nonproprietary Arizona Pain and Addiction Curriculum may serve as a useful template for other states to enhance pain and addiction education.

[Body-mind therapies in addictology: contributions of psychomotricity]. / Thérapies corps-esprit en addictologie : apports de la psychomotricité.

Addictive disorders restrict addicts' physical activity. On a neurobiological level, the reward system is disrupted. Pleasure is transformed into a constraint and patients lose control of themselves. Differing from a physical activity technique, psychomotor therapy, by drawing on the body's experience, in relation to the environment, can form part of the care plan. It is based on sensation, tonus, posture and tonico-emotional engagement.

[Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind]. / Achtsamkeit in der entwicklungsorientierten Suchtprävention und -therapie: Rational, Design und Ziele des Forschungsverbundes IMAC-Mind.

Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind Substance use disorders (SUD) are a major contributor to morbidity and mortality. They are typically initiated during adolescence and can have fatal implications for healthy development. Despite substantial scientific advances, there remains a need to prioritize research directed at reducing risks for SUD, particularly in vulnerable periods and populations from a developmental perspective. Research indicates that reward sensitivity, impulsivity, deficient self-regulation, and stress reactivity develop markedly in childhood and adolescence and play an important role in the initiation and maintenance of SUD. A growing number of research results suggest that these factors can be favorably influenced by mindfulness-based interventions and that mindfulness-based exercises can be successfully integrated into established prevention and treatment programs. In this paper we summarize the conceptual relationships between the development and maintenance of addiction disorders and mindfulness, discuss existing empirical findings with regard to childhood and adolescence, and present the aims, study designs and intervention models of the subprojects from the ongoing research network "IMAC-Mind: Improving Mental Health and Reducing Addiction in Childhood and Adolescence through Mindfulness: Mechanisms, Prevention and Treatment".

Third wave cognitive and behavioral processes and therapies for addictive behaviors: An introduction to the Special Issue.

Third wave cognitive and behavioral therapies have garnered significant attention in the study and treatment of addiction. Such treatments employ a process-oriented, transdiagnostic approach to mitigate problematic thought and behavioral patterns and consequences associated with substance use. Although initial evidence is promising, much remains unknown regarding the impact of third wave processes on substance use behavior and treatment outcomes. Additionally, more work is needed to elucidate the potential of novel third wave treatments on substance use outcomes. If proven successful, third wave processes and therapies may hold the key to disrupt the huge financial, societal, and personal burden associated with addiction. This Special Issue highlights recent, scientifically rigorous, clinically applicable advances in current understanding of third wave cognitive and behavioral processes and therapies for substance use. Research presented in this Special Issue covers topics ranging from the role and application of mindfulness in the etiology of substance use behavior, treatment outcomes, and familial support; the potential of transdiagnostic factors as important considerations for vulnerable groups; and the development and refinement of novel technological and integrated interventions. This Special Issue is organized into three parts classified as third wave processes and substance use behavior; third wave processes in traditional substance use treatment and their malleability; and third wave treatments for substance use among special populations. It is hoped that this issue will alert readers to the significance of this work, illustrate the many domains currently being explored via process-oriented, transdiagnostic treatment, and identify promising and impactful areas for research.

The Effect of Mind Subtraction Meditation Intervention on Smartphone Addiction and the Psychological Wellbeing among Adolescents.

As the smartphone has become an indispensable device in modern lives, consequential psychosocial problems such as smartphone addiction have been getting attention worldwide, especially regarding adolescents. Based on its positive effect on young individuals' mental health, mind subtraction meditation has been widely applied to many school-based programs in South Korea. This study aims to identify the effects of a school program based on mind subtraction on the smartphone addiction of adolescents. A total of 49 high school sophomores, 24 from the experimental group (mean age = 16), and 25 from the control group (mean age = 16) are included in this case-control study. The experimental group is given the meditation program sessions in the morning, two times a week for 20 min per session, for a total of 12 weeks. The experimental group shows improvements regarding the 'smartphone addiction' section (p < 0.001), for instant satisfaction (p < 0.001) and long-term satisfaction (p < 0.001). Concerning the 'self-control' section and decreasing stress (p < 0.001), problem focusing (p < 0.001), and social support navigation (p = 0.018), there are improvements in these 'stress coping strategies' sections. This study directly shows the positive effect of mind subtraction meditation on smartphone addiction in adolescents and, thus, provides guidance to the future development of smartphone addiction prevention programs for young individuals.

Co-occurring Substance Use Disorders in Youth With Chronic Medical Conditions: The Need for Integration of Addiction Treatment into Mainstream Medical Facilities.

: Approximately 5% of adolescents in the US meet criteria for a substance use disorder (SUD), and many of them benefit from residential treatment programs at points in the course of the disorder to achieve early sobriety and stabilization. Youth with chronic medical conditions use alcohol, marijuana, and other substances at levels similar to peers, but are at greater risk of progression to heavy or problem use of alcohol, marijuana, and tobacco by young adulthood and often encounter unique treatment barriers that limit access to an appropriate level of care. We describe 2 such adolescents; a 15-year-old boy with type 1 diabetes who experienced interruptions in substance use treatment because of concerns regarding routine glycemic management and a 17-year-old boy with inflammatory bowel disease, who experienced treatment delays in the context of increasing alcohol and marijuana use because of digestive symptoms. For both of these adolescents, lack of access to professionals who could manage chronic medical conditions prevented delivery of substance use treatment and resulted in an increase in substance use behaviors. These cases illustrate the need for integrated substance use care within medical specialty settings. We propose opportunities for improvement, such as providing cross-training for medical and addiction treatment teams and integration of substance use treatment within traditional medical facilities.

Does establishing local treatment institutions lead to different populations seeking treatment among Greenlandic Inuit?

Introduction: In 2016, a new addiction treatment service was established in Greenland to tackle the addiction problems with alcohol, cannabis and gambling among the population. The new service has established a treatment center in each of the five municipalities and works in partnership with a central private provider of treatment for those who reside in areas without a local treatment center.Methods: The national addiction database provided us with data from the Alcohol Use Disorder Identification Test, Alcohol Severity Index and questions on cannabis use and gambling behavior received at referral to, and at initiation of treatment. The data were analyzed for differences between the population in local or central treatment using SPSS version 25 (SPSS Inc., Chicago, IL).Results: Significant differences between the individuals in local and central treatment were revealed. Individuals in local treatment are more often women with minor children and a job, and their alcohol use is concentrated on weekends/holidays. Individuals in central treatment are more equal in both genders, few have minor children living at home, heavy drinking is more pronounced, and cannabis is used more frequently as well.Discussion: The findings support our expectations of local treatment being more attractive to individuals with obligations at home. The differences in the populations are worth considering when planning the treatment service, as the needs of the populations might differ. The findings are limited by many missing in the analyses, which we believe is caused by the establishing process of the new service.