Examining the validity of the addictions neuroclinical assessment domains in a crowdsourced sample of adults with current alcohol use.

Several dimensional frameworks for characterizing heterogeneity in alcohol use disorder (AUD) have been proposed, including the Addictions Neuroclinical Assessment (ANA). The ANA is a framework for assessing individual variability within AUD across three domains corresponding to the proposed stages of the addiction cycle: reward (binge-intoxication stage), negative emotionality (withdrawal-negative affect stage), and cognitive control (preoccupation-anticipation stage). Recent work has evaluated the ANA's three-factor structure and construct validity, primarily in treatment-seekers with AUD. We extended this research by examining the factor structure, bias across alcohol use severity, longitudinal invariance, and concurrent and predictive validity of a novel assessment of the ANA domains in adults with past 12-month regular (10 + alcohol units/week) alcohol use. Participants recruited from Prolific (N = 732), a crowdsourced data collection platform, completed various self-report measures. A test-retest subsample (n = 234) completed these measures 30 days later. Split-half exploratory factor analysis and confirmatory factor analysis supported the three-factor structure of the ANA. The overall factor structure was invariant across 30 days. Concurrently and prospectively, ANA domains demonstrated convergent validity concerning theoretically aligned alcohol-related, psychological, and personality measures. However, there was evidence of poor discriminant validity, and several cognitive control and reward items demonstrated bias across alcohol use severity. Future research is needed to improve the measurement of ANA domains using multimodal indicators, examine longitudinal changes in domains and their relationship with alcohol use severity, characterize phenotypic subgroups based on relative levels of domains, and compare the utility of the ANA with other proposed frameworks for measuring AUD heterogeneity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal measurement invariance of constructs derived from the addiction cycle.

OBJECTIVE: The Alcohol Addiction Research Domain Criteria (AARDoC) is an organizational framework for assessing heterogeneity in addictive disorders organized across the addiction cycle domains of incentive salience, negative emotionality, and executive functioning and may have benefits for precision medicine. Recent work found pretreatment self-report items mapped onto the addiction cycle domains and predicted 1- and 3-year alcohol use disorder treatment outcomes. Given the potential utility of the addiction cycle domains for predicting relevant treatment outcomes, this study sought to evaluate the longitudinal measurement invariance of the domains. METHOD: We conducted a secondary analysis of individuals with alcohol use disorder (n = 1,383, 30.9% female, 76.8% non-Hispanic White, 11.2% Hispanic) who participated in the COMBINE study. Eleven items assessed at pre- and posttreatment were included in exploratory structural equation modeling (ESEM) and longitudinal invariance analyses. RESULTS: The pre- and posttreatment ESEM models had factor loadings consistent with the three addiction cycle domains and fit the data well. The ESEM factor structure was invariant from pre- to posttreatment (representing configural invariance) and metric invariance (factor loadings) was largely supported, but analyses failed to support scalar invariance (item-level thresholds) of the addiction cycle domains. CONCLUSIONS: A three-factor structure representing addiction cycle domains can be modeled using brief self-report measures pre- and posttreatment. Individuals demonstrated a downward shift in the level of item endorsement, indicating improvement with treatment. Although this 11-item measure might be useful at baseline for informing treatment decisions, results indicate the need to exercise caution in comparing the addiction cycle domains pre- to posttreatment within persons. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Return to Sport After Multiligament Knee Injury in Young Athletes.

Background: While return to sport (RTS) in young athletes after anterior cruciate ligament (ACL) reconstruction has been well studied, little is known regarding their rate of RTS after multiligament knee injury (MLKI). Purpose: To assess the level of and factors associated with RTS after MLKI in young athletes. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified 116 patients aged ≤23 years who had sustained an injury to ≥2 knee ligaments and undergone operative reconstruction or repair of ≥1 ligament. Our primary outcome was self-reported RTS at the preinjury level or higher. We estimated the likelihood of RTS using binomial logistic regression. Secondary variables included the 2000 International Knee Documentation Committee Subjective Knee Form (IKDC-SF), ACL-Return to Sport after Injury (ACL-RSI), and 12-Item Short Form Health Survey (SF-12) physical and mental health summaries. Results: A total of 30 (25.9%) patients (24 men, 6 women; mean age, 18.1 ± 2.5 years) completed patient-reported outcome surveys at a mean follow-up of 7.8 years (median, 6.6 years [range, 1.1-19.5 years]). A total of 28 patients underwent surgical treatment of ≥2 ligaments. RTS was achieved by 90% of patients, and 43.3% returned to their preinjury level or higher. Patients who had played sports at a higher level before injury were more likely to RTS at their preinjury level or higher (odds ratio [OR], 3.516 [95% CI, 1.034-11.955]; P = .044), while those who played cutting sports were less likely to do so (OR, 0.013 [95% CI, 0.000-0.461; P = .017). Patients who achieved RTS at their preinjury level or higher had significantly higher IKDC-SF and ACL-RSI scores versus patients who did not (P = .001 and P = .002, respectively). The number of ligaments injured, age, mental health diagnosis, and SF-12 scores were not associated with the ability to RTS at the preinjury or higher levels. Conclusion: Most young athletes who sustained MLKI were able to return to play at some level, but a minority returned to their preinjury level. Patients who did return at preinjury or higher levels had higher IKDC-SF and ACL-RSI scores than those who did not. Performance in cutting and/or pivoting sports was negatively associated with RTS.

A clinical science guide for reviewing the cross-cultural rigor of assessments in an alcohol training clinic.

A standard component of service delivery in alcohol treatment clinics is evidence-based assessment (EBA). Although EBA is essential for selecting appropriate treatment modalities for alcohol use and associated problems, there are limitations in existing EBAs concerning evidence of cultural equivalence and utility among individuals seeking alcohol treatment. However, training in EBA, addictions, and clinical applications with diverse populations all are gaps in clinical training in doctoral programs in clinical psychology. The present work used the clinical science model to review the psychometric properties, cross-cultural utility, and measurement invariance of measures in an assessment battery used in an alcohol treatment training clinic. This article describes the results of that review, recommendations for retaining or replacing common assessment measures used in alcohol treatment clinics, and recommendations for alcohol treatment clinics interested in engaging in similar processes. Findings suggested that more research is needed to evaluate the psychometric properties of EBAs utilized in an alcohol treatment assessment battery, particularly among American Indian and Alaska Native people, and to test measurement invariance across race/ethnicity and other identity groups in alcohol treatment-seeking populations. Overall, routine reviews of cultural relevance are needed in clinical settings to stay current with the emerging literature. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Constructs derived from the addiction cycle predict alcohol use disorder treatment outcomes and recovery 3 years following treatment.

OBJECTIVE: The addiction cycle has been proposed as a framework for understanding the progression of alcohol use disorder (AUD) in terms of psychological and biological domains, including reward drinking/incentive salience, relief drinking/negative emotionality, and loss of control/executive functioning impairment. To have utility in clinical practice, self-report measures of these domains that are applicable across sociodemographic groups and associated with clinical outcomes are needed. This study sought to validate domains from self-report measures and to test whether domains are measurement invariant across sociodemographic groups and associated with treatment outcomes. METHOD: Secondary analysis of individuals with AUD (n = 3,092) who participated in two alcohol clinical trials, Project Matching Alcohol Treatment to Client Heterogeneity (MATCH) and COMBINE. Factor analytic methods were used to derive addiction cycle domains at baseline. These domains were then examined as predictors of outcomes. RESULTS: Fifteen self-report items were used as indicators of the addiction cycle domains, with sociodemographic differences in measurement by sex, age, race, education, and AUD symptoms. Relief/negative emotionality and reward/incentive salience were significantly associated with outcomes at 1 and 3 years following treatment, and executive functioning also predicted nonabstinent recovery at 3 years. CONCLUSIONS: The results support the utility of domains relevant to the addiction cycle in predicting AUD treatment outcomes and recovery among individuals who sought treatment for AUD. The addiction cycle domains were more strongly associated with outcomes than other measures clinicians might use to predict outcomes (e.g., AUD symptoms). Future research should continue to develop and refine the items and test whether the addiction cycle domains can inform treatment planning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Transcranial Direct Current Stimulation Provides no Additional Benefit to Improvements in Self-Reported Craving Following Mindfulness-Based Relapse Prevention.

Objectives: Mindfulness-Based Relapse Prevention (MBRP) and transcranial direct current stimulation (tDCS) have each demonstrated efficacy in improving outcomes in those with alcohol use disorder (AUD), however a recent study that combined MBRP with tDCS found tDCS provided no additional benefit to MBRP for AUD. Differences in treatment adherence between active versus sham tDCS groups may have contributed to this result. The current study examined whether treatment adherence interacted with tDCS condition in predicting post-treatment mindfulness and craving. Methods: This study was a secondary data analysis from a randomized sham-controlled trial comparing MBRP paired with tDCS. Linear regression analyses were conducted examining the interaction between tDCS condition and two measures of treatment adherence (i.e., number of groups attended, number of tDCS administrations) on post-treatment mindfulness and craving. Results: There was no effect of treatment adherence by tDCS condition in predicting mindfulness, however the interaction between treatment adherence and tDCS condition significantly predicted post-treatment craving. There was a significant negative association between treatment adherence and post-treatment craving in the sham group, but there was no association in the active tDCS group. Conclusions: MBRP coupled with sham stimulation led to significant reductions in self-reported craving when patients attended more sessions and received a greater number of sham tDCS administrations, while no relationship was observed between treatment adherence and craving among those who received active tDCS. This result provides tentative evidence that, rather than improve the effects of MBRP on craving, this active tDCS protocol provides no additional benefit to MBRP in reducing craving. Pre-registration: This study was registered with clinicaltrials.gov (NCT02861807).

Forgiveness Mediates the Relationship Between Middle Frontal Gyrus Volume and Clinical Symptoms in Adolescents.

Dispositional forgiveness is positively associated with many facets of wellbeing and has protective implications against depression and anxiety in adolescents. However, little work has been done to examine neurobiological aspects of forgiveness as they relate to clinical symptoms. In order to better understand the neural mechanisms supporting the protective role of forgiveness in adolescents, the current study examined the middle frontal gyrus (MFG), which comprises the majority of the dorsolateral prefrontal cortex (DLPFC) and is associated with cognitive regulation, and its relationship to forgiveness and clinical symptoms in a sample of healthy adolescents. In this cross-sectional study (n = 64), larger MFG volume was significantly associated with higher self-reported dispositional forgiveness scores and lower levels of depressive and anxiety symptoms. Forgiveness mediated the relationship between MFG volume and both depressive and anxiety symptom levels. The mediating role of forgiveness in the relationship between MFG volume and clinical symptoms suggests that one way that cognitive regulation strategies supported by this brain region may improve adolescent mental health is via increasing a capacity for forgiveness. The present study highlights the relevance of forgiveness to neurobiology and their relevance to emotional health in adolescents. Future longitudinal studies should focus on the predictive quality of the relationship between forgiveness, brain volume and clinical symptoms and the effects of forgiveness interventions on these relationships.

Clinical Outcomes Following Acute Residential Psychiatric Treatment in Transgender and Gender Diverse Adolescents.

Importance: Transgender and gender diverse (TGD) individuals, who have a gender identity that differs from their sex assigned at birth, are at increased risk of mental health problems, including depression, anxiety, self-injurious behavior, and suicidality, relative to cisgender peers. Objective: To examine mental health outcomes among TGD vs cisgender adolescents in residential treatment. Design, Setting, and Participants: This cohort study's longitudinal design was used to compare groups at treatment entry and discharge, and 1-month postdischarge follow-up. The setting was an adolescent acute residential treatment program for psychiatric disorders. Participants were TGD or cisgender adolescents enrolled in the treatment program. Statistical analysis was performed October 2019 to March 2021. Exposure: Adolescents participated in a 2-week acute residential treatment program for psychiatric disorders. Main Outcomes and Measures: Primary outcomes were depressive (the Center for Epidemiologic Studies Depression Scale [CES-D]) and anxiety (the Multidimensional Anxiety Scale for Children [MASC]) symptoms, and emotional dysregulation (the Difficulties in Emotion Regulation Scale [DERS]), measured at treatment entry and discharge, and postdischarge follow-up. Age of depression onset, suicidality, self-injury, and childhood trauma also were assessed at treatment entry. Results: Of 200 adolescent participants who completed treatment entry and discharge assessments, the mean (SD) age was 16.2 (1.5) years; 109 reported being assigned female at birth (54.5%), 35 were TGD (17.5%), and 66 (49.3%) completed 1-month follow-up. TGD participants had an earlier mean (SD) age of depression onset (TGD: 10.8 [2.4] years vs cisgender: 11.9 [2.3] years; difference: 1.07 years; 95% CI, 0.14-2.01 years; P = .02), higher mean (SD) suicidality scores (TGD: 44.4 [23.1] vs cisgender: 28.5 [25.4]; difference: 16.0; 95% CI, 6.4-25.5; P = .001), more self-injurious behavior (mean [SD] RBQ-A score for TGD: 3.1 [2.5] vs cisgender: 1.7 [1.9]; difference: 1.42; 95% CI, 0.69-2.21; P = .001) and more childhood trauma (eg, mean [SD] CTQ-SF score for emotional abuse in TGD: 12.7 [5.4] vs cisgender: 9.8 [4.7]; difference: 2.85; 95% CI, 1.06-4.64; P = .002). The TGD group also had higher symptom scores (CES-D mean difference: 7.69; 95% CI, 3.30 to 12.08; P < .001; MASC mean difference: 7.56; 95% CI, 0.46 to 14.66; P = .04; and DERS mean difference: 18.43; 95% CI, 8.39 to 28.47; P < .001). Symptom scores were significantly higher at entry vs discharge (CES-D mean difference, -12.16; 95% CI, -14.50 to -9.80; P < .001; MASC mean difference: -3.79; 95% CI, -6.16 to -1.42; P = .02; and DERS mean difference: -6.37; 95% CI, -10.80 to -1.94; P = .05) and follow-up (CES-D mean difference: -9.69; 95% CI, -13.0 to -6.42; P < .001; MASC mean difference: -6.92; 95% CI, -10.25 to -3.59; P < .001; and DERS mean difference: -12.47; 95% CI, -18.68 to -6.26; P < .001). Conclusions and Relevance: This cohort study found mental health disparities in TGD youth relative to cisgender youth, with worse scores observed across assessment time points. For all participants, primary clinical outcome measures were significantly lower at treatment discharge than at entry, with no significant differences between discharge and 1-month follow-up. Given the substantial degree of mental health disparities reported in TGD individuals, these findings warrant focused clinical attention to optimize treatment outcomes in gender minority populations.

A Longitudinal Mediation Model of Negative Emotionality, Coping Motives and Drinking Intensity Among Individuals Receiving Community Treatment for Alcohol Use Disorder.

AIMS: Negative emotionality is a key domain in frameworks measuring heterogeneity in alcohol use disorder (AUD), such as the Addictions Neuroclinical Assessment (ANA). Recent research has examined the construct validity of the ANA negative emotionality domain, but has not examined whether this domain demonstrates predictive validity for drinking outcomes. In this study, we examined the association between self-reported negative emotionality at baseline and drinking intensity 1 year following AUD treatment initiation. We also assessed whether coping motives for alcohol use at 6 months following treatment initiation and changes in coping motives mediated this association. METHODS: This was a secondary data analysis of a multisite prospective study of individuals entering AUD treatment (n = 263; 61.6% male; mean age = 33.8). Measures of coping motives and drinking intensity captured those who experienced a lapse to drinking. The associations between the ANA negative emotionality domain, coping motives and drinking intensity over time were assessed using a latent growth curve mediation model. RESULTS: The ANA negative emotionality domain at baseline was indirectly associated with greater 7-12-month drinking intensity through higher coping motives at 6 months. Negative emotionality was not related to change in coping motives over the assessment period and change in coping motives was not related to 7-12-month drinking intensity. CONCLUSIONS: This analysis provides evidence for the predictive validity of the ANA negative emotionality domain for coping motives and drinking intensity among treatment seekers who experienced a lapse to drinking. Coping motives may be an important target in AUD treatment among those high in negative emotionality.

Validity and measurement invariance of the Addictions Neuroclinical Assessment incentive salience domain among treatment-seekers with alcohol use disorder.

Incentive salience, or the attribution of motivational value to stimuli, is a biopsychological process that is disrupted in alcohol use disorder (AUD). The Addictions Neuroclinical Assessment (ANA) is a framework to characterize heterogeneity in addiction and establish a common assessment battery for research and clinical use. The ANA framework hypothesizes three constructs that correspond to processes in the etiology, course, and treatment of addiction: incentive salience, negative emotionality, and executive function. The current study extends prior findings on the ANA by validating the incentive salience construct among participants (n = 563) in a multisite prospective study of individuals entering treatment for AUD. We used confirmatory factor analysis to test a one-factor model of incentive salience. Indicators included items assessing perception of urges to drink from the Alcohol Dependence Scale, Impaired Control Scale, and Marlatt Relapse Interview. Results indicated the one-factor model fit the data well (χ2 (12) = 19.42, p = .08; RMSEA = 0.034 [90% CI: 0.000, 0.060], CFI = 0.992) and was measurement invariant across sex. Incentive salience was associated with drinking patterns (e.g., drinks per day, r = 0.447 [95% CI: 0.379, 0.514]); reasons for drinking (urges/temptation r = 0.529 [95% CI: 0.460, 0.599]); testing personal control, r = 0.384 (95% CI: 0.308, 0.461); social pressure, r = 0.549 (95% CI: 0.481, 0.617); and family history of AUD, r = 0.134. The incentive salience factor demonstrated greater predictive validity for drinking outcomes compared to alternative preexisting scales. Overall, this study provides support for the construct validity and measurement invariance of the ANA incentive salience construct in a sample of individuals seeking AUD treatment.

Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment.

OBJECTIVE: Four decades ago, the "controlled drinking" controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment. METHODS: Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n  = 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at https://osf.io/3hbxr. RESULTS: Four latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years. CONCLUSIONS: Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.

Can Alcohol Use Disorder Recovery Include Some Heavy Drinking? A Replication and Extension up to 9 Years Following Treatment.

BACKGROUND: Recent research indicates some individuals who engage in heavy drinking following treatment for alcohol use disorder fare as well as those who abstain with respect to psychosocial functioning, employment, life satisfaction, and mental health. The current study evaluated whether these findings replicated in an independent sample and examined associations between recovery profiles and functioning up to 6 years later. METHODS: Data were from the 3-year and 7- to 9-year follow-ups of subsamples initially recruited for the COMBINE study (3-year follow-up: n = 694; 30.1% female, 21.0% non-White; 7- to 9-year follow-up: n = 127; 38.9% female, 27.8% non-White). Recovery at 3 years was defined by latent profile analyses including measures of health functioning, quality of life, employment, alcohol consumption, and cannabis and other drug use. Functioning at the 7- to 9-year follow-up was assessed using single items of self-rated general health, hospitalizations, and alcohol consumption. RESULTS: We identified 4 profiles at the 3-year follow-up: (i) low-functioning frequent heavy drinkers (13.9%), (ii) low-functioning infrequent heavy drinkers (15.8%), (iii) high-functioning heavy drinkers (19.4%), and (iv) high-functioning infrequent drinkers (50.9%). At the 7- to 9-year follow-up, the 2 high-functioning profiles had the best self-rated health, and the high-functioning heavy drinking profile had significantly fewer hospitalizations than the low-functioning frequent heavy drinking profile. CONCLUSIONS: Previous findings showing heterogeneity in recovery outcomes were replicated. Most treatment recipients functioned well for years after treatment, and a subset who achieved stable recovery engaged in heavy drinking and reported good health outcomes up to 9 years after treatment. Results question the long-standing emphasis on drinking practices as a primary outcome, as well as abstinence as a recovery criterion in epidemiologic and treatment outcome research and among stakeholder groups and funding/regulatory agencies. Findings support an expanded recovery research agenda that considers drinking patterns, health, life satisfaction, and functioning.

The Role of Affect in Psychosocial Treatments for Substance Use Disorders.

PURPOSE OF REVIEW: This paper provides a narrative review of studies published over the past five years that have examined the role of affect, including both affective symptoms and affective disorders, in psychosocial treatments for substance use disorder. RECENT FINDINGS: A growing body of literature suggests that affective symptoms and affective disorders may moderate substance use disorder treatment efficacy, mediate the effects of treatment on substance use outcomes, and may be directly changed by substance use disorder treatment. SUMMARY: Substance use disorders and affective disorders commonly co-occur, and both affect and affective disorders are associated with substance use disorder treatment outcomes. Future research should continue to examine affect as a moderator, mediator, and outcome of substance use disorder treatments. In particular, new studies that are designed to test precision medicine hypotheses would greatly expand our understanding of the role of affective symptoms and disorders in substance use disorder treatment.

Decreases in the Late Positive Potential to Alcohol Images Among Alcohol Treatment Seekers Following Mindfulness-Based Relapse Prevention.

AIM: Heightened craving among individuals with alcohol use disorder (AUD) has been attributed to a hypersensitivity to alcohol cues in attentional brain networks. Active mindfulness training has been shown to help improve attentional control. Here, we examined alcohol cue-related hypersensitivity among individuals with AUD who received rolling group mindfulness-based relapse prevention (MBRP) in combination with transcranial direct current stimulation (tDCS), over right inferior frontal gyrus. METHODS: Participants (n = 68) viewed a series of emotionally negative, emotionally neutral and alcohol-related images. Following image presentation, participants were asked to rate their level of craving for the alcohol cues, and their level of negative affect evoked by neutral and negative cues. During the task, electroencephalogram (EEG) was recorded to capture an event-related component shown to relate to emotionally salient stimuli: the late positive potential (LPP). Participants who completed a follow-up EEG (n = 37) performed the task a second time after up to eight sessions of MBRP coupled with active or sham tDCS. RESULTS: We found that both craving ratings and the LPP significantly decreased in response to alcohol cues from pre- to post-treatment, but not for other image cues. The magnitude of alcohol image craving reductions was associated with the number of MBRP group sessions attended. Active tDCS was not associated with craving ratings, but it was associated with greater LPP amplitudes across image types. CONCLUSIONS: Taken together, these results suggest that disruption of alcohol-cue hypersensitivity in people with AUD may be a target mechanism of MBRP.

Mindfulness-Based Relapse Prevention and Transcranial Direct Current Stimulation to Reduce Heavy Drinking: A Double-Blind Sham-Controlled Randomized Trial.

BACKGROUND: Mindfulness-based relapse prevention (MBRP) and transcranial direct current stimulation (tDCS) have independently shown benefits for treating alcohol use disorder (AUD). Recent work suggests tDCS may enhance mindfulness. The combination of MBRP and tDCS may provide synergistic benefits and may target both behavioral and neurobiological dysfunctions in AUD. The goal of this double-blind sham-controlled randomized trial was to examine the efficacy of a rolling group MBRP treatment combined with tDCS among individuals interested in reducing their drinking. METHODS: Individuals who were interested in reducing their alcohol use (n = 84; 40.5% female; mean age = 52.3; 98.9% with current AUD) were randomized to receive active (2.0 milliamps) or sham (0.0 milliamps) anodal tDCS (5 cm × 3 cm electrode) of the right inferior frontal gyrus with the 5 cm × 3 cm cathodal electrode applied to the left upper arm, combined with 8 weeks of outpatient MBRP rolling group treatment. Assessments were conducted at baseline, posttreatment, and 2 months following treatment. The primary outcome was drinks per drinking day, and secondary outcomes were percent heavy drinking days, self-reported craving, alcohol cue reactivity in an alcohol cue task, and response inhibition in a stop signal reaction time task. RESULTS: Results indicated significant reductions in drinks per drinking day over time, B(SE) = -0.535 (0.16), p = 0.001, and a significant dose effect for number of groups attended, B(SE) = -0.259 (0.11), p = 0.01. There were also significant effects of time and dose for number of groups attended on secondary outcomes of percent heavy drinking days and alcohol cue reactivity. There were no effects of active versus sham tDCS on primary or secondary outcomes. CONCLUSIONS: Findings from the current study provide initial support for the effectiveness of rolling group MBRP as an outpatient treatment for drinking reduction. The current study did not find additive effects of this tDCS protocol in enhancing MBRP among individuals with drinking reduction goals.

Non-invasive brain stimulation in substance use disorders: implications for dissemination to clinical settings.

With expanding knowledge of how neural circuitry is disrupted in substance use disorders (SUD), non-invasive brain stimulation (NIBS) techniques have emerged as potential strategies to directly modulate those neural circuits. There is some evidence supporting the two most common forms of NIBS, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), in the treatment of SUD. Yet results of recent studies have been mixed and critical methodological issues must be addressed before strong conclusions can be drawn. This review highlights recent evidence of NIBS for SUD, addressing the impact of stimulation on relevant clinical and cognitive outcomes in substance-using populations. Additionally, we aim to bring a clinical perspective to the opportunities and challenges of implementing neuromodulation in SUD treatment.

Adolescent Hippocampal and Prefrontal Brain Activation During Performance of the Virtual Morris Water Task.

The frontal cortex undergoes substantial structural and functional changes during adolescence and significant developmental changes also occur in the hippocampus. Both of these regions are notably vulnerable to alcohol and other substance use, which is typically initiated during adolescence. Identifying measures of brain function during adolescence, particularly before initiation of drug or alcohol use, is critical to understanding how such behaviors may affect brain development, especially in these vulnerable brain regions. While there is a substantial developmental literature on adolescent working memory, less is known about spatial memory. Thus, a virtual Morris water task (vMWT) was applied to probe function of the adolescent hippocampus. Multiband blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) data were acquired at 3T during task performance. Participants included 32 healthy, alcohol- and drug-naïve adolescents, 13-14 years old, examined at baseline of a 3-year longitudinal MRI study. Significantly greater BOLD activation was observed in the hippocampus and surrounding areas, and in prefrontal regions involved in executive function, during retrieval relative to motor performance. In contrast, significantly greater BOLD activation was observed in components of the default mode network, including frontal medial cortex, during the motor condition (when task demands were minimal) relative to the retrieval condition. Worse performance (longer path length) during retrieval was associated with greater activation of angular gyrus/supramarginal gyrus, whereas worse performance (longer path length/latency) during motor control was associated with less activation of frontal pole. Furthermore, while latency (time to complete task) was greater in females than in males, there were no sex differences in path length (accuracy), suggesting that females required more time to navigate the virtual environment, but did so as effectively as males. These findings demonstrate that performance of the vMWT elicits hippocampal and prefrontal activation patterns in early adolescence, similar to activation observed during spatial memory retrieval in adults. Given that this task is sensitive to hippocampal function, and that the adolescent hippocampus is notably vulnerable to the effects of alcohol and other substances, data acquired using this task during healthy adolescent development may provide a framework for understanding neurobiological impact of later initiation of use.

Mindfulness-based interventions for addictive behaviors: Implementation issues on the road ahead.

Over the past 35 years, mindfulness meditation practices have increasingly been integrated into Western medical settings. Research into the benefits of mindfulness-based interventions (MBIs) continues to expand, such that there are currently more than a dozen different protocolled MBIs for patients suffering from a variety of physical and psychological disorders. In the last decade, a number of MBIs specifically designed to treat addictive behaviors have been developed and tested. This review first provides a brief overview of the current state of the science with respect to the efficacy of MBIs for addictive behaviors, and some of the proposed mechanisms underlying the efficacy of MBIs. Second, the review highlights unresolved implementation issues and provides suggestions for how future research can address the implementation challenges to advance the delivery of MBIs. Specifically, this review focuses on the lack of clear empirical guidelines in the following areas: (a) effective training for MBI treatment providers; (b) adaptations of the traditional 2-hr closed-cohort group format; (c) delivery of MBIs in 1-on-1 treatment contexts; (d) delivery of MBIs at different points in the change process; (e) delivery of MBIs via technology-based platforms; and (f) facilitation of precision medicine in the delivery of MBIs. Specific research directions are suggested with an eye toward a meaningful increase in access to MBIs for front-line clinicians and clients. (PsycINFO Database Record