Virtual reality cue-exposure therapy in reducing cocaine craving: the Promoting Innovative COgnitive behavioral therapy for Cocaine use disorder (PICOC) study protocol for a randomized controlled trial.

BACKGROUND: Cocaine craving is a central symptom of cocaine use disorders (CUD). Virtual reality cue-exposure therapy for craving (VRCET) allows more immersive, realistic, and controllable exposure than traditional non-VR cue-exposure therapy (CET), whose efficacy is limited in treating substance use disorders. The purpose of this study is to evaluate the efficacy and acceptability of VRCET, as a stand-alone and add-on intervention (i.e., combined with cognitive therapy), compared to a picture-based CET (PCET), in reducing self-reported cocaine craving in inpatients hospitalized for CUD. METHODS: Fifty-four inpatients hospitalized for CUD will be randomized in one of two intensive 3-week treatment arms: 10 meetings/2-week treatment of VRCET plus 5 meetings/1-week treatment of memory-focused cognitive therapy (MFCT; experimental arm), or 15 meetings/3-week treatment of PCET (active control arm). The Craving Experience Questionnaire (CEQ - F & S) will be used to assess the primary outcome, i.e., the post-treatment decrease of self-reported cocaine craving frequency (within the past 2 weeks) and intensity scores (in VR exposure to cocaine cues). Secondary endpoints include urinary, physiological, and self-reported cocaine use-related measures. Assessments are scheduled at pretreatment, after 2 weeks of treatment (i.e., VRCET vs. PCET), post-treatment (3 weeks, i.e., VRCET + MFCT vs. PCET), and at 1-month follow-up. Acceptability will be evaluated via (i) the Spatial Presence for Immersive Environments - Cybersickness along VRCET and (ii) the Client Satisfaction Questionnaires after 2 weeks of treatment and post-treatment. DISCUSSION: This study will be the first to evaluate the acceptability and efficacy of VRCET for CUD, as a psychotherapeutic add-on, to reduce both cocaine craving frequency and intensity. Additionally, this study will provide evidence about the specific interest of VRCET, compared to a non-VR-based CET, as a cue reactivity and exposure paradigm for treating substance use disorders. TRIAL REGISTRATION: NCT05833529 [clinicaltrials.gov]. Prospectively registered on April 17, 2023.

[French shift workers seen at health centres have an increased risk of lipid disorders]. / Perturbation du métabolisme lipidique chez des travailleurs postés consultants de centres d'examens de santé.

AIMS: To describe cardiovascular risk factors and metabolic disturbances in a French population including shift workers and study whether possible changes were noticeable after non-shift to shift work transition within the last five years. METHODS: The study population included 4764 attendees of two health examinations (5 years apart), between January 1996 and October 2008, in 11 health examination centres. Clinical, biological and metabolic factors together with their changes over a five-year period were compared between attendees who kept a non-shift daytime job, those who kept working shift and those who switched from non-shift daytime to shift work over the last 5 years. RESULTS: At baseline, working shift was, independently of lifestyle or BMI, significantly related to more elevated plasma triglycerides (ß=0.04, P=0.05) and rate of hypertriglyceridemia (ß=0.27, P=0.01), lower plasma HDL-C levels (ß=-2.03, P=0.006) and less hypertension (ß=-0.25, P=0.01) compared to non-shift daytime work. In men, a slightly more elevated yet non significant proportion of hypertriglyceridemia was observed with the transition from non-shift daytime to shift work within the last 5 years in comparison to men who kept a non-shift daytime job (13.9% vs. 11.0% P=0.17). CONCLUSION: Our results are in agreement with previous studies showing a deleterious effect of shift work on lipid metabolism. In our population, triglycerides and HDL-C levels were the main parameters negatively influenced by shift work. Consequently, a regular biological monitoring together with the promotion of healthy behaviours should be provided to shift workers before negative consequences of working shift become noticeable.

[Community-based screening: a motivating experience for drug users]. / Dépister hors les murs d’un centre de dépistage?: une expérience mobilisatrice pour des usagers de drogues.

OBJECTIVES: Hepatitis C virus infection (HCV) is a major public health problem among drug users. Screening for hepatitis C virus in this population is complicated. The aim of the study was to describe a community-based screening experience conducted by the Tours university hospital addiction medicine team. METHODS: Between 2008 and 2010, a free 14-day HCV, hepatitis B virus (HBV) and HIV community-based screening programme was conducted by the addiction medicine and prevention team. A questionnaire collected the main risk factors for transmission of these viruses and the subject's viral serology status. RESULTS: 76% of the 219 screened subjects reported being drug users. HCV prevalence was 20%. Risk factors for HCV infection were exclusive intravenous use and the use of several routes of administration. Among the 30 HCV patients with positive RNA, 83% were followed up. CONCLUSIONS: The prevalence of HCV infection was similar to that reported in the literature for drug users, whereas the number of patients treated and followed up was higher than in the literature. A community-based screening experience facilitated initiation and follow-up of medical care.