Methadone maintenance treatment is more effective than compulsory detoxification in addressing gut microbiota dysbiosis caused by heroin abuse.

Introduction: Heroin use disorder (HUD) is commonly accompanied by gut dysbiosis, but the roles of gut microbiota in HUD treatment, such as compulsory detoxification and methadone maintenance treatment (MMT), remain poorly understood. Methods: In this study, we performed 16 s rDNA and whole metagenome sequencing to analyze the gut microbial profiles of HUD patients undergoing heroin addiction, heroin withdrawal (compulsory detoxification), and MMT. Results: Our findings revealed that, compared to healthy controls, microbial diversity was significantly decreased in HUD patients who were in a state of heroin addiction and withdrawal, but not in those receiving MMT. We observed significant alterations in 10 bacterial phyla and 20 bacterial families in HUD patients, while MMT partially restored these changes. Whole metagenome sequencing indicated gut microbiota functions were significantly disrupted in HUD patients experiencing heroin addiction and withdrawal, but MMT was found to almost reverse these dysfunctions. In addition, we identified 24 featured bacteria at the genus level that could be used to effectively distinguish between healthy individuals and those with heroin addiction, heroin withdrawal, or receiving MMT. Furthermore, we found the relative abundance of Actinomyces, Turicibacter and Weissella were positively associated with the Hamilton Depression Scale score in different states of HUD patients. Discussion: This study provides evidence from the gut microbiota perspective that MMT is a more effective approach than compulsory detoxification for HUD treatment.

The motivation against change in male methamphetamine users in the compulsory detoxification setting.

Aims: The study was designed to develop a measurement for the motivation for and against change in methamphetamine users in the compulsory detoxification setting. Design: This is a cross-sectional study. Setting: The study was carried out in a compulsory detoxification center for male drug users in China. Participants: A total of 228 male methamphetamine users who had undergone the program for at least 30 days. Measurements: The motivation for/against change relating to compulsory detoxification was carried out using the Likert scale. A series of questionnaires were filled out by the participants, including the Egna Minnen Beträffande Uppfostran for rearing style, the Barratt Impulsiveness Scale-11, the adult ADHD self-report scale, and the Pittsburgh sleep quality index. Participants were also asked to recall the withdrawal symptoms before the program and to rate their current craving levels. Findings: Motivations were grouped into three factors, namely, the expectation to use drugs upon the completion of the program (factor 1), the disagreement with the compulsory setting (factor 2), and the motivation to quit drug use (factor 3). Cronbach's alpha values were 0.8037, 0.8049, and 0.6292, respectively. The structural equation model showed that the overall motivation was characterized by motivation against change rather than that for change. The overall motivation was also directly affected by the current craving level and indirectly affected by the severity of addiction, paternal authoritarian upbringing style, and ADHD traits. Conclusion: This study provided a measurement of motivation for and against change in subjects with drug misconduct and suggested that the motivation against change may disclose more psychological barriers than the motivation for change.

Association Between Alexithymia, Social Support, and Duration of Methamphetamine Use Among Male Methamphetamine-Dependent Patients.

Introduction: China has 1.18 million methamphetamine abusers. Among the illegal drugs in China, methamphetamine has the highest abuse rate. Although previous studies have indicated a positive relationship between alexithymia and declining social support, the incidence of alexithymia, the total duration of methamphetamine dependence, social support, and the relationships between them among methamphetamine-dependent patients in the Chinese population have been rarely reported. Methods: A total of 113 methamphetamine-dependent patients (all male, mean age 30.45 ± 3.81 years) were enrolled in this cross-sectional study. General demographic data were collected. Alexithymia and social support were measured by Toronto Alexithymia Scale and Social Support Rating Scale. Results: Duration of methamphetamine use among Chinese male methamphetamine-dependent patients in compulsory detoxification was 8.01 ± 3.80 years on average, 23% (26/113) methamphetamine-dependent patients were considered to have alexithymia personality traits. Compared with short-duration methamphetamine-dependent patients (≤8 years), long-duration methamphetamine-dependent patients (> 8 years) were characterized by older age, higher incidence of alexithymia, less subjective social support and support availability, and greater difficulty in identifying feelings. The results of correlation analysis and multiple linear regression analysis indicated that the total duration of methamphetamine use was positively correlated with difficulty in identifying feelings, but negatively correlated with subjective social support. Conclusions: This study provides support for an association between the duration of methamphetamine use and difficulty in identifying feelings or subjective social support. Although the causality is still unclear, this finding should be considered in the psychotherapy of methamphetamine rehabilitation.

A Multi-Site Cross-Sectional Study of Anxiety Symptoms and the Associated Factors Among Chinese Drug Users Undergoing Compulsory Detoxification Treatment.

Compulsory drug detoxification treatment (CDT) is currently the major drug rehabilitation modality in China, and drug users often suffer from extraordinary levels of stress during CDT, leading to a high prevalence of anxiety symptoms. This study assesses anxiety symptoms of the drug users undergoing CDT and explores the associated factors. A cross-sectional study with cluster sampling was conducted in three cities in Liaoning Province of Northeast China. Nine hundred CDT drug users were interviewed face-to-face with Chinese questionnaires. Hierarchical multiple regression (HMR) analysis was conducted to explore the factors associated with anxiety symptoms. The prevalence of anxiety symptoms among the CDT drug users was substantially high (33.2%). HMR analysis indicated perceived stress and characteristics of drug use such as types of drugs, were the most important contributors to anxiety symptoms. Optimism (LOT-R) played a protective role in reducing anxiety symptoms in this population. Anxiety symptoms of drug users undergoing CDT were present in a significant proportion of the CDT population. Optimism is a protective factor which could attenuate the detrimental effects of perceived stress on anxiety symptoms and potentially improve treatment outcomes.

Tracking Study on the Relapse and Aftercare Effect of Drug Patients Released From a Compulsory Isolated Detoxification Center.

BACKGROUND AND AIMS: There are no accurate statistical data on the relapse rate of drug abstainers after compulsory detoxification in China. This study aimed to collect relapse data for drug abstainers through follow-up visits, verify the effectiveness of professional social worker services and explore significant factors affecting relapse. DESIGN AND SETTING: The drug abstainers released from Guangzhou T Compulsory Isolated Detoxification Center were randomly divided into two groups. The difference between the experimental group and the control group is that assistance services were provided by social workers to the former. PARTICIPANTS: The study included 510 drug abstainers released from T Center, including 153 in the experimental group and 357 in the control group. MEASUREMENTS: Demographic information, history of drug abuse, and motivation for drug rehabilitation (SOCRATES) were collected 1 month prior to drug abstainer release from compulsory detoxification. Then, the relapse situation after their release was tracked according to fixed time points. FINDINGS: The overall relapse rate of 510 drug abstainers after their release from compulsory detoxification was 47.6%. The average survival time to relapse based on survival analysis was 220 days (N = 486), as calculated with Bayesian estimation by the MCMC method. The average survival times to relapse of the experimental group and control group were 393 and 175 days, respectively. By taking the specific survival time as the dependent variable and the group as the control variable (OR = 25.362), logistic regression analysis showed that marital status (OR = 2.666), previous compulsory detoxification experience (OR = 2.329) and location of household registration (OR = 1.557) had a significant impact on the survival time to relapse. CONCLUSIONS: The occurrence of relapse among drug patients released from compulsory detoxification can be delayed effectively through the intervention of professional social worker services. Regardless of whether patients receive aftercare after compulsory detoxification, drug-using patients who are single, have multiple detoxification experiences and whose households are registered in other provinces deserve special attention. Relevant suggestions to avoid relapse are provided.

"In their perception we are addicts": social vulnerabilities and sources of support for men released from drug treatment centers in Vietnam.

BACKGROUND: Amid the global transition to treat opioid addiction as an illness, many people who inject drugs (PWID) face heterogeneous legal environments that include both punitive and harm reduction measures. In Vietnam, many PWID, who have a high burden of HIV, are sent to drug treatment centers, or "06 centers", for compulsory detoxification, vocational training, and labor for up to four years. This study investigates the challenges and facilitators of reentry into community and family life among men who are released from "06 centers" and provides insights and recommendations for developing policies and interventions that address special needs of this vulnerable population. METHODS: In-depth interviews were conducted in 2011 by trained interviewers among a sample of 43 male PWID released within the past 2 years from "06 centers" in Hanoi, Vietnam to investigate the above issues and to recommend potential interventions. Participants were recruited from outpatient HIV clinics that serve PWID (n=22) and through peer referral from self-help groups for PWID (n=21). Interviews were audiotaped, transcribed, translated, entered into Atlas.TI qualitative data analysis software and analyzed for key themes. RESULTS: The interviews revealed persistent drug-related stigmatization, frequently paired with HIV-related stigmatization and discrimination, which hindered employment, increased participants' social isolation and exacerbated their struggles with addiction. Families were participants' primary source of financial, employment, and emotional support, but addiction-related family tensions also had negative psychological effects. Participants identified methadone maintenance treatment as an effective means of overcoming addiction, yet few could fully benefit from this treatment due to its limited availability. CONCLUSION: Our study suggests that PWID released from "06 centers" would greatly benefit from the scale-up of community-based harm reduction measures that include addiction and HIV treatment, coupled with employment-support and family centered mental health services.

New Drug Prohibiting Law and Its Implications for Harm Reduction Policy in China / 中国医学伦理学

By comparing the differences of " Decision of the Standing Committee of the National People's Congress on the prohibition against narcotic drugs " and "Law of the People's Republic of China on Narcotics Control " and their implications for harm reduction,the article analyzed the ethical issues existing in applying harm reduction policy in HIV/AIDS prevention and control,and held that the new policy to promote the methadone use would play a major role for control of drug abuse and AIDS.