Distal and proximal risk factors of problematic cannabis use associated with psychotic-like experiences.

BACKGROUND: Problematic cannabis use is associated with endorsement of psychotic-like experiences (PLEs) in non-clinical samples. However, little is known in regard to predictors of this relationship, which may be relevant to prevention and intervention. In the present research, we investigate impulsivity and cannabis use motives as potential distal and proximal risk factors for PLEs using conditional process analysis. METHODS: Using an online cross-sectional survey of N = 300 students, we assessed endorsement of PLEs using the Community Assessment of Psychic Experiences (CAPE), problematic cannabis use with the Cannabis Use Disorder Identification Test (CUDIT-R), motivations for using cannabis with the Substance Use Motives Measure, and impulsivity using the Urgency and Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behaviour Scale (UPPS-P). RESULTS: All three subscales on the CAPE were associated with significantly higher scores on the CUDIT-R. Before and after covarying for sex, we found that higher CUDIT-R scores mediated the relations between lack of perseverance and negative urgency impulsivity with higher PLE symptoms. Furthermore, the indirect effect of cannabis use on the relationship between lack of perseverance and high negative PLE symptoms was only significant at high and moderate levels of depression-coping, but not at low depression-coping motives. CONCLUSION: Impulsivity and depression-coping motives may be distal and proximal psychological risk factors for negative PLEs in the context of problematic cannabis use. Our findings are in line with the broader substance use and mental health literature and may be informative for cannabis use treatment targets.

Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies.

CLINICAL TRIAL NAME: Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in SchizophreniaURL: www.clinicaltrials.gov; Registration Number: NCT03189810.

Endorsement of psychotic-like experiences and problematic cannabis use associated with worse executive functioning performance in undergraduates.

BACKGROUND: Emerging adults who endorse more positive psychotic-like experiences (PLEs; bizarre experiences, delusional ideations) may experience greater cannabis-related impairments in executive function. Negative and depressive PLEs are also associated with cannabis use, however, less is known about their relation to executive functioning. Here, we hypothesize that high positive PLEs and cannabis use are associated with worse performance on computerized versions of the Iowa Gambling Task (IGT) and the Card Sorting Task (CST); exploratory analyses are conducted with negative and depressive PLEs. METHODS: We recruited university students (N = 543) who completed an online study consisting of self-report measures of problematic cannabis use (Cannabis Use Disorder Identification Test; CUDIT-R) and PLEs (Community Assessment of Psychotic Experiences; CAPE). Of these, n=270 completed the CST and n=251 completed the IGT. RESULTS: Problematic cannabis use and high endorsement of positive PLEs related to significantly worse performance on the IGT and greater perseverative errors on the CST. In addition, people who endorsed high levels of positive PLEs were also significantly more likely to complete the IGT with less money relative to those who endorsed fewer PLEs, regardless of cannabis use. Further analyses based on negative PLEs revealed a similar pattern for perseverative errors on the CST; depressive PLEs were not related to task performance. CONCLUSION: Findings highlight that problematic cannabis use and more frequent and distressing positive PLEs are associated with poorer executive functioning. Thus, executive functioning may have implications for intervention among those high on both attributes, who are at high risk of onset of psychosis.

Stereotype threat contributes to poorer recall performance among undergraduate students with problematic drinking patterns.

Stereotype threat occurs when individuals from stigmatized groups feel they are expected to conform to a negative stereotype associated with their group. Studies show that activating stereotype threat can impair performance on cognitive tasks in various marginalized groups. Individuals with problematic alcohol use are subject to stigmatized views related to cognitive abilities and socialization skills; thus, we examine for the first time whether eliciting stereotype threat impairs performance on a memory and a theory of mind task in undergraduate students with varying drinking patterns. We randomized 205 students to a neutral or a stereotype threat condition, which informed participants that the purpose of the study was to assess memory performance and theory of mind skills in relation to different patterns of alcohol consumption. In the stereotype threat group, individuals with problematic drinking patterns demonstrated significantly worse memory performance than nonproblematic drinkers and nondrinkers. The same was not true in the neutral condition, where memory recall did not differ significantly as a function of drinking status. Experimental group and drinking status failed to reveal significant effects on cognitive and affective theory of mind performance. Problematic alcohol use patterns were only associated with poorer memory when stereotype threat was elicited, which indicates that assessments of neurocognitive profiles may be biased, at least for memory performance, if stereotype threat is inadvertently elicited in substance users. Broader implications support the imperative to avoid stigmatization of problematic substance use in scientific communication and clinical settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Systematic Review of Pharmacological Treatments for Internet Gaming Disorder.

OBJECTIVE: Internet gaming disorder (IGD) is an increasingly common behavioral addiction, with an estimated global prevalence of 3%. A variety of pharmacological treatments have been used to treat IGD, yet no review to date has synthesized clinical trials evaluating their efficacy. This systematic review therefore synthesized the literature reporting on clinical trials of pharmacological treatments for IGD. METHODS: We reviewed articles from MEDLINE, Embase, PubMed Central, CINAHL, and PsycINFO that were published as of March of 2022. A total of 828 articles were retrieved for review and 12 articles were included, reporting on a total of 724 participants. RESULTS: Most participants were male (98.6%), and all were currently living in South Korea. The most common drugs used to treat IGD were bupropion, methylphenidate, and a range of selective serotonin reuptake inhibitors. The Young Internet Addiction Scale was the most frequently used to measure gaming-related outcomes. All studies reported reduced symptoms of IGD from pre- to post-treatment. Across all clinical trials, IGD symptom reductions following the administration of pharmacological treatments ranged from 15.4% to 51.4%. A risk of bias assessment indicated that only four studies had a low risk of bias. CONCLUSION: Preliminary results suggest that a wide array of pharmacological interventions may be efficacious in the treatment of IGD. Future studies using double-blind randomized controlled trial designs, recruiting larger and more representative samples, and controlling for psychiatric comorbidities are needed to better inform understanding of pharmacological treatments for IGD.

Marked Increase in Amphetamine-Related Emergency Department Visits and Inpatient Admissions in Toronto, Canada, 2014-2021.

BACKGROUND: We report emergency department and inpatient amphetamine-related trends focusing on co-occurring substance use and psychiatric diagnoses at the Centre for Addiction and Mental Health, the largest mental health teaching hospital in Canada. METHODS: We describe yearly trends in amphetamine-related Centre for Addiction and Mental Health emergency department visits and inpatient admissions out of all emergency department visits and inpatient admissions between 2014 and 2021, along with proportions of concurrent substance-related admissions and mental/psychotic disorders emergency department visits and inpatient admissions among amphetamine-related contacts; joinpoint regression analyses assessed changes in amphetamine-related emergency department visits and inpatient admissions. RESULTS: Amphetamine-related emergency department visits rose from 1.5% in 2014 to 8.3% in 2021, with a peak of 9.9% in 2020. Amphetamine-related inpatient admissions rose from 2.0% to 8.8% in 2021, with a peak of 8.9% in 2020. Significant increasing trends in the percentage of amphetamine-related emergency department visits happened especially between the second and the fourth quarter of 2014 (quarterly percent change = + 71.4, P <0.01). Similarly, the percentage of amphetamine-related inpatient admissions increased mostly between the second quarter of 2014 and the third quarter of 2015 (quarterly percent change = + 32.6, P <0.01). The proportion of concurrent opioid-related contacts among amphetamine-related emergency department visits and inpatient admission increased markedly between 2014 and 2021; psychotic disorders in amphetamine-related inpatient admissions more than doubled from 2015 to 2021. DISCUSSION: Prevalence of amphetamine use, mostly from methamphetamine, has been increasing in Toronto as have co-occurring psychiatric disorders and opioid use. Our findings highlight the need for increases in accessible efficacious treatments for complex populations with polysubstance use and co-occurring disorders.

A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders.

Background: Integrated and gender-responsive interventions, designed to target co-occurring substance use and psychiatric disorders in women, may be effective in addressing gender-specific challenges.Objectives: This systematic review aims to identify integrated gender-responsive substance use disorder treatments for women, summarize evaluations of these treatments, and address gaps in the literature.Methods: We searched PsycINFO, PubMed, and MEDLINE on September 24, 2021, and March 10, 2022. Included articles were randomized-controlled trials, secondary analyses of naturalistic studies, or open-label studies of integrated and gender-responsive treatments from any year that assessed both substance use and mental health/trauma outcomes.Results: We identified N = 24 studies (participants = 3,396; 100% women) examining Seeking Safety, Helping Women Recover and Beyond Trauma, A Woman's Path to Recovery, Modified Trauma Recovery and Empowerment Model (TREM), Breaking the Cycle, VOICES, Understanding and Overcoming Substance Misuse, Women's Recovery Group, Female Specific Cognitive Behavioral Therapy, and Moment by Moment in Women's Recovery. Across treatments there were significant improvements over time; Seeking Safety, Helping Women Recover, and TREM were associated with significantly better substance use and mental health outcomes relative to the comparison groups.Conclusions: Integrated gender-responsive treatments are a promising approach to treating women with co-occurring substance use and mental health concerns, and broad clinical implementation stands to benefit women. However, there remains a lack of studies evaluating substance use treatments in women with severe mental illness (e.g., psychotic-spectrum disorders) who differ in their needs and capacity.

Review of third-wave therapies for substance use disorders in people of color and collectivist cultures: Current evidence and future directions.

OBJECTIVE: In people of color (POC) and from collectivist cultures, third-wave therapies utilizing mindfulness may be a more sensitive approach to substance use disorder (SUD) treatment, than cognitive behavioral therapy (CBT). This systematic review examined this hypothesis. METHOD: We searched PsycINFO, Pubmed, and MEDLINE on December 23, 2021. Articles were included if they compared efficacy of third-wave therapies to therapies with only CBT elements and reported treatment outcomes for POC/people from collectivist cultures. RESULTS: We included eleven studies conducted in the United States (n = 5), Spain (n = 2), Brazil (n = 2), Hong Kong (n = 1), and Iran (n = 1). Third-wave therapies included mindfulness-based relapse prevention (n = 4), acceptance and commitment therapy (n = 3), yoga and breathing strategies (n = 2), and mindfulness/emotion regulation training (n = 2). The substance use outcomes measured included nicotine use (n = 6), opioid use (n = 1), and general SUDs (n = 4) using biological measures (n = 7), Timeline Followback (n = 4), and the Addiction Severity Index (ASI; n = 2) to measure substance use. Overall, eight studies reported greater improvements in the third-wave therapy group relative to the CBT group in POC, on at least one substance use outcome. CONCLUSIONS: Findings suggest that relative to CBT, third-wave therapies are a promising modality in the treatment SUDs in POC and people and from collectivist cultures. However, studies are relatively sparse and carry a number of methodological problems. As such, there remains a need for further research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Binge drinking indirectly predicts a negative emotional memory bias through coping motivations and depressive symptoms: The role of sex/gender.

Background: In this three-part study, we investigate whether the associations between binge and problematic drinking patterns with a negative emotional memory bias (NMB) are indirectly related through coping motivations and depressive symptoms. We also address potential sex differences in these relations. Methods: Participants (N = 293) completed the Timeline Followback to assess binge drinking, the Alcohol Use Disorder Identification Test (AUDIT) to assess problematic alcohol use, the Drinking Motives Questionnaire-Revised to assess coping motivations, and the Depression, Anxiety, and Stress Scales-21 to assess depression. Participants were asked to identify whether 30 emotional sentences were self-referent or not in an incidental encoding task; 24 h later they were asked to recall as many sentences as possible and a negative memory bias score was calculated. Results: Across all three studies, we found significant bivariate relations between AUDIT scores, coping, depression, and an NMB, particularly for sentences participants deemed self-referent. In two undergraduate samples, there were significant indirect effects through coping motivations and depressive symptoms between binge drinking and an NMB in females as well as between AUDIT scores and an NMB in females only. In the community sample, there was only an indirect effect through coping motives, but this was observed in both females and males. Conclusion: These findings support a relation between binge drinking as well as problematic alcohol use and a self-referent NMB in the context of coping motivations for alcohol use and depressive symptoms. Moreover, the pattern of findings suggests this model primarily holds for females, yet may also apply to males at higher levels of problematic alcohol use.

Neurocognitive moderation of repetitive transcranial magnetic stimulation (rTMS) effects on cannabis use in schizophrenia: a preliminary analysis.

Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment for cannabis use disorder in schizophrenia; however, gaps in the literature remain as to the potential role of neurocognitive functioning in treatment response. We evaluated the moderating role of select cognitive functions including baseline executive functioning, verbal memory, and sustained attention, and we explore the mediating role of changes in task performance on changes in cannabis use in both active and sham rTMS groups. Participants underwent high-frequency (20 Hz) rTMS applied to the bilateral dorsolateral prefrontal cortex 5x/week for 4 weeks. Weekly self-report of cannabis use and semi-quantitative urinary carboxy-tetrahydrocannabinol levels were recorded. A neurocognitive battery assessing verbal memory, visuospatial working memory, verbal working memory, sustained attention, delayed discounting, and complex planning was administered pre- and post-treatment. Better baseline performance on tasks assessing sustained attention, delayed discounting, and complex planning moderated the extent to which participants in the active group reduced cannabis use. There were no significant indirect pathways between treatment, changes in neuropsychological performance, and changes in cannabis use; however, active rTMS improved complex planning and sustained attention. These preliminary findings suggest that there is a moderating role of sustained attention, delayed discounting, and complex planning on the effects of rTMS on cannabis use. Further, mediation models suggest rTMS may exert direct effects on cannabis use independent of its effects on cognitive functioning in people with SCZ. Trial Registration: clinicaltrials.gov: NCT03189810.

Does cannabis use predict aggressive or violent behavior in psychiatric populations? A systematic review.

Background: Despite an increase in information evaluating the therapeutic and adverse effects of cannabinoids, many potentially important clinical correlates, including violence or aggression, have not been adequately investigated.Objectives: In this systematic review, we examine the published evidence for the relationship between cannabis and aggression or violence in individuals with psychiatric disorders.Methods: Following PRISMA guidelines, articles in English were searched on PubMed, Google Scholar, MEDLINE, and PsycINFO from database inception to January 2022. Data for aggression and violence in people with psychiatric diagnoses were identified during the searches.Results: Of 391 papers identified within the initial search, 15 studies met inclusion criteria. Cross-sectional associations between cannabis use and aggression or violence in samples with post-traumatic stress disorder (PTSD) were found. Moreover, a longitudinal association between cannabis use and violence and aggression was observed in psychotic-spectrum disorders. However, the presence of uncontrolled confounding factors in the majority of included studies precludes any causal conclusions.Conclusion: Although cannabis use is associated with aggression or violence in individuals with PTSD or psychotic-spectrum disorders, causal conclusions cannot be drawn due to methodological limitations observed in the current literature. Well-controlled, longitudinal studies are needed to ascertain whether cannabis plays a causal role on subsequent violence or aggression in mental health disorders.

Dose-dependent effects of Varenicline on tobacco craving and withdrawal in tobacco smokers with and without schizophrenia.

BACKGROUND: People with schizophrenia (SCZ) have significantly higher tobacco smoking rates and lower quit rates than the general population. Varenicline, a partial agonist at α4ß2 nicotinic acetylcholine receptors (nAChRs) is an effective smoking cessation pharmacotherapy, however, investigation into its effects in SCZ are less well-studied and mechanisms may differ from non-psychiatric controls due to dysregulation in nAChR neurotransmission associated with SCZ. Here, we investigate whether Varenicline attenuates acute abstinence-induced increases in craving and withdrawal in participants with and without SCZ. METHODS: Following biochemically-verified overnight abstinence and subsequent smoking reinstatement, individuals with nicotine-dependence (n = 13 SCZ or schizoaffective; n = 12 controls) were assessed on the Minnesota Nicotine Withdrawal Scale (MNWS) and Tiffany Questionnaire for Smoking Urges (TQSU). Participants were pretreated in a double-blind, counterbalanced manner with Varenicline (0, 1 or 2 mg/day x 3 days) over three separate weeks. Data were analyzed using linear mixed-effects modelling and estimated marginal means. RESULTS: Robust effects of smoking abstinence were observed on TQSU and MNWS scores in SCZ and control participants. Relative to 1 mg, 2 mg/day of Varenicline attenuated abstinence-induced increases in craving (TQSU Factor 1 d=-0.47, p = .006; TQSU Factor 2 d=-0.42, p = .008) and withdrawal (MNWS d=-0.35, p = .03) in both groups. CONCLUSION: Our preliminary findings suggest that subacute Varenicline treatment reduces abstinence-induced craving and withdrawal in participants with and without SCZ. The efficacy of Varenicline on tobacco withdrawal and craving requires further study.

Neuromodulation to Treat Substance Use Disorders in People With Schizophrenia and Other Psychoses: A Systematic Review.

BACKGROUND: Substance use disorders (SUDs) are a common yet poorly studied comorbidity in individuals with psychotic disorders. The co-occurrence of the two complicates recovery and interferes with pharmacological and behavioral treatment response and adherence. Recently, researchers have been exploring both invasive and non-invasive neuromodulation techniques as potential treatment methods for SUDs. We review the evidence that neuromodulation may reduce substance craving and consumption in individuals with schizophrenia. METHODS: A comprehensive literature search of PubMed, MEDLINE, and PsycINFO databases was conducted (N = 1,432). Of these, we identified seven studies examining the effects of repetitive transcranial magnetic stimulation (rTMS) and two studies using transcranial direct current stimulation (tDCS) on drug consumption and craving in schizophrenia or schizoaffective disorders. RESULTS: Despite the limited number of studies in this area, the evidence suggests that rTMS to the dorsolateral prefrontal cortex (DLPFC) may reduce cannabis and tobacco use in patients with schizophrenia and schizoaffective disorder. Findings with tDCS, however, were inconclusive. DISCUSSION: Our systematic review suggests that rTMS applied to DLPFC is a safe and promising therapeutic technique for the management of comorbid schizophrenia and SUDs, with the majority of the evidence in tobacco use disorder. However, there was substantial heterogeneity in study methods, underscoring the need to optimize stimulation parameters (e.g., frequency, duration, and target regions). Larger clinical trials are needed to establish the efficacy of rTMS in reducing drug consumption and craving in psychotic patients, ideally in comparison to existing pharmacological and behavioral interventions.