Psychological Impact of the Acute COVID-19 Period on Patients With Substance Use Disorders: We are all in this Together.

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) results from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). it is now a pandemic that affects us all. For patients referring to the addiction care systems, this pandemic can create additional vulnerabilities. A great deal of effort has made to re-organize the care systems for patients with addiction. Our study focuses on the voice of our patients, on clues to adapt treatment, and on the impact of the pandemic on the therapeutic alliance. METHODS: A qualitative design was used to develop a description and understanding of general and clinically relevant aspects of the impact of the COVID-19 pandemic. Fifteen addicted patients (11 under treatment and 4 in recovery) were interviewed by 4 interviewers according to the COREQ (consolidated criteria for reporting qualitative research). RESULTS: COVID-19 has had a serious impact on thoughts, feelings, and behaviors. Interviewees shared their anxieties about their health and the health of their relatives. Frightening thoughts were associated with a range of negative feelings and behaviors, such as stress, anger, avoidance, and isolation. The use of psychoactive substances differed between the patients in treatment with those who are in stable recovery. In the former, all succeeded in staying abstinent. They have experienced that solidarity and connectedness were essential in sustaining their recovery. Those still in treatment were fighting against the temptation to start using again; they felt emotionally isolated and sometimes patronized by health care workers. CONCLUSION: The elaboration of the interviewees on the therapeutic relationship provides promising clues to optimize that relationship. Remembering this common expression, "we are all in this together", shared decision making could very well be used to shape effective and receptive treatment interventions during the different challenges faced at different stages of the COVID-19 epidemic.

Gammahydroxybutyrate in hair of non-GHB and repeated GHB users: A new and optimized method.

Gamma-hydroxybutyric acid (GHB) is a short-chain fatty acid used recreationally as a drug of abuse due its strong suppressive effect on the central nervous system. The detection window of GHB in blood and urine is very narrow (t1/2=30min) but can be substantially prolonged using alternative matrices such as hair. We here present a newly developed and limited validated method with a solid phase extraction (SPE) using GC-MS/MS to determine concentrations of GHB in hair samples. The soft extraction technique (water and 90min ultrasonic bath) preserves GHB with a high yield and clean extracts. In addition, endogenous GHB can be detected in hair of non-GHB users. However, little is known about GHB concentrations in hair of abstinent, frequent and chronic GHB users. Therefore, we present data from hair samples of healthy volunteers to evaluate the proposed endogenous GHB ranges, and from GHB-dependent patients to address GHB concentrations in hair with GHB intake. In 20 non-GHB users, a mean endogenous concentration of 1.1±0.6ng/mg hair (range of 0.3-2ng/mg) was found. In GHB-dependent patients, concentrations between 6.3-239.6ng/mg hair were found, with no correlation between concentrations in hair and dose of GHB intake. In summary, we present a new and limited validated method, adequately sensitive for the detection of GHB in hair, as well as first-time measurements of GHB concentrations in dependent patients in order to better understand the relationship between the frequency of use/dose and concentrations observed in hair samples.

A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders.

AIMS: Attention deficit/hyperactivity disorder (ADHD) is common among adult patients with substance use disorders. The benefits of treating ADHD in these patients are uncertain and the prescription of psychostimulants is disputed, because of the risk of abuse. This study examined the short-term effectiveness of methylphenidate treatment for ADHD in adults with substance use disorders. DESIGN: Double-blind, placebo-controlled, multiple cross-over (A-B-A-B design) comparative trial of methylphenidate versus placebo. SETTING: In-patient addiction treatment facility. PARTICIPANTS: Twenty-five patients with ADHD who were receiving in-patient treatment for various substance use disorders. INTERVENTION: During the course of 8 weeks, each participant completed two phases of placebo and two phases of active medication treatment, in a fixed low-dosage schedule (up to 0.6 mg/kg/day). Abstinence was maintained during the study. MEASUREMENTS: The outcome measure was ADHD symptomatology, as measured with the ADHD rating scale-IV. The results were compared using MANOVA repeated measures. FINDINGS: Nineteen of the 25 patients completed the trial. A significant reduction in ADHD symptoms was observed in the first week in both conditions. The positive response to active treatment (nine patients; 36%) was not significantly higher than that to placebo (five patients; 20%). CONCLUSIONS: In this small pilot study, the effect of low-dose methylphenidate in adult ADHD patients with concomitant substance use disorders is limited. ADHD symptoms in adults were susceptible to a distinct short-term placebo response.