Correlatos neuroanatómicos y neuropsicológicos del comportamiento de adicción a las compras. Una revisión sistemática / Neuroanatomical and neuropsychological correlates of shopping addiction behaviour. A systematic review

Introducción: La incidencia de la compra compulsiva ha aumentado en las últimas dos décadas y supone un impacto negativo sustancial en el funcionamiento general de los consumidores. No obstante, a pesar de su relevancia clínica, todavía se desconocen los mecanismos neuropsicológicos y los correlatos neurales subyacentes a este fenómeno. Asimismo, el comportamiento de compra compulsiva continúa sin reconocerse como una categoría diagnóstica perteneciente a los trastornos adictivos. Objetivo El objetivo del estudio es analizar de forma sistemática la evidencia empírica disponible sobre la compra compulsiva con la finalidad de identificar las variables neuropsicológicas y los correlatos neurales subyacentes. Materiales y métodos Se realizó una búsqueda en PubMed, Scopus y ScienceDirect sobre los mecanismos subyacentes a este fenómeno. Resultados Los resultados muestran únicamente 11 estudios recientes que indagan sobre estos mecanismos. Además, se realizó un registro previo del protocolo de esta revisión sistemática en el registro internacional PROSPERO (número de registro CRD42023427497). Conclusiones Los estudios analizados aluden a una alteración en la función ejecutiva, en la toma de decisiones y en la sensibilidad a la recompensa, y una tendencia a la reactividad de señales relacionadas con las compras. Este patrón conductual parece implicar una pérdida del control del comportamiento vinculado a la desregulación de estructuras como el estriado y las regiones frontales. Se examinan los resultados obtenidos y se analizan las similitudes existentes con los mecanismos subyacentes a otras adicciones. (AU)

INTRODUCTION: The incidence of compulsive buying has increased over the last two decades and it has a substantial negative impact on consumers’ overall functioning. However, despite its clinical relevance, the neuropsychological mechanisms and neural correlates underlying this phenomenon are still unknown. Also, compulsive buying behaviour remains unrecognised as a diagnostic category belonging to addictive disorders. AIM The aim of the study is to systematically analyse the available empirical evidence on compulsive buying in order to identify the underlying neuropsychological variables and neural correlates. MATERIALS AND METHODS PubMed, Scopus and ScienceDirect were searched for the mechanisms behind this phenomenon. RESULTS The results show only 11 recent studies that investigate these mechanisms. In addition, the protocol of this systematic review was pre-registered in the international PROSPERO register (registration number CRD42023427497). CONCLUSIONS The studies reviewed refer to impaired executive functions, decision-making and sensitivity to rewards, and a tendency to reactivity to purchase-related cues. This pattern of behaviour appears to involve a loss of behavioural control linked to dysregulation of structures such as the striatum and frontal regions. The results obtained are examined and similarities with the mechanisms underlying other addictions are discussed. (AU)

How effective are psychological treatments for internet gaming disorder? An umbrella review / ¿Qué eficacia tienen los tratamientos psicológicos para el trastorno de juego por internet? Una revisión de revisiones

Behavioural addictions such as Internet addiction (IA) and, more specifically, Internet gaming disorder (IGD) or video game addiction, have increased their prevalence in recent years in the child and adolescent population. The aim of the present study was to review and synthesise the existingevidence on the effectiveness of psychological treatments for addressing this addiction, as well as to compare them with other types of treatment. Tothis end, an in-depth search for systematic reviews and meta-analyses was carried out across different databases (WOS, Scopus, PubmMed, Cochrane), inclusion and exclusion criteria were set, and guidelines for the search strategy were defined, as well as the study selection method. A totalof 14 reviews and meta-analyses were reviewed. The results showed that cognitive behavioural therapy (CBT) was the most studied psychologicaltreatment, consistently showing effectiveness in reducing the symptoms and severity of IA/IGD. Furthermore, CBT appeared to be more effectivewhen combined with other types of treatment such as pharmacological treatment. It is concluded that there is a need to investigate the effectivenessof psychological treatments for IA/IGD separately in order to provide appropriate interventions to reduce the severity of addiction and improve thequality of life and well-being of children and adolescents. (AU)

Las adicciones conductualescomo la adicción a internet (IA) y, concretamente, el trastorno de juego por internet (IGD) o adicción a videojuegos, han aumentado su prevalenciaen los últimos años en población infanto-juvenil. El objetivo del presente estudio fue realizar una revisión de revisiones para agrupar y sintetizar laevidencia existente acerca de la efectividad de los tratamientos psicológicos para abordar este tipo de adición, así como compararlos con otrostipos de tratamiento. Para ello, se realizó una búsqueda exhaustiva de revisiones sistemáticas y/o meta-análisis en diferentes bases de datos (WOS,Scopus, PubmMed, Cochrane), se establecieron los criterios de inclusión y exclusión, y se definió la estrategia de búsqueda, así como el método deselección de los estudios. En total se revisaron 14 revisiones y meta-análisis. Los resultaron evidenciaron que la terapia cognitivo-conductual (TCC)fue el tratamiento psicológico más estudiado, mostrando consistentemente efectividad para reducir los síntomas y la severidad de IA/IGD. Además,la TCC parece ser más efectiva cuando se combinaba con otros tipos de tratamiento como el farmacológico. Se concluye la necesidad de investigarla efectividad de los tratamientos psicológicos para IA/IGD de manera diferenciada con el objetivo de establecer intervenciones adecuadas quepermitan reducir la gravedad de la adicción y mejorar el bienestar y la calidad de vida de los niños y adolescentes. (AU)

Tendencias en la hospitalización psiquiátrica por alcoholy drogas en Castilla y León entre 2005 y 2015 / Trends in psychiatric hospitalization for alcohol and drugs in Castilla y León between 2005 and 2015

A nivel mundial, se ha estimado que el alcohol, el tabaco y las drogashan sido responsables de más de 10 millones de muertes en 2016, yque existe mucho margen para reducir la mortalidad. Se han realizadoavances en la extracción de información de bases de datos administrativas con el fin de analizar grandes volúmenes de datos sanitarios. Hemosestudiado las tendencias en las tasas de hospitalización con diagnóstico de adicción a alcohol y drogas durante once años con el softwareJoinpoint Trend Analysis. Se trata de un estudio descriptivo de asociación cruzada de 3.758 ingresos hospitalarios de pacientes con diagnóstico principal de abuso o dependencia de alcohol y drogas en unidadesde Psiquiatría de centros públicos de Castilla y León entre 2005 y 2015.Las tendencias en la hospitalización por adicción al alcohol y/o drogasdisminuyeron a lo largo de los once años. Además de una reducciónestadísticamente significativa de los ingresos por alcohol y cocaína, seapreció una fuerte tendencia al alza en los ingresos por cannabis entre2013 y 2015. El alcohol fue durante todo el periodo de estudio la principal causa de ingreso y el que más días de hospitalización ha generado.No obstante, en los 11 años se observó una reducción progresiva y constante en los ingresos por todas las sustancias a excepción del cannabis.La metodología utilizada ya ha demostrado ser muy útil para identificarcambios de tendencias en diferentes patologías. (AU)

It has been estimated that alcohol, tobacco, and illicit drugs were responsible for more than 10 million deaths worldwide in 2016, andthere are many opportunities for improvement. Regarding innovativedata analysis, advances have been made in the extraction of information from administrative databases for analytics purposes. We studiedtrends in hospitalization rates for alcohol and drug abuse over elevenyears with Joinpoint Trend Analysis software. This is a descriptive studyof cross-associations in 3,758 hospital admissions of patients admittedwith a main diagnosis of alcohol and drug abuse or dependence inpsychiatry units of public health centres of Castilla y León (Spain)between 2005 and 2015. Hospitalization trends for alcohol and drugrelated conditions declined over the eleven-year period. Separately,there was a statistically significant decrease in alcohol and cocainerelated conditions, but a strong upward trend in cannabis relatedconditions between 2013 and 2015. Alcohol was the main cause ofadmission to psychiatric units with a diagnosis of addiction. In the11 years researched, there was a progressive and constant reductionin admissions for substance use except for cannabis. The innovativestatistical methodology has already proven to be useful for identifyingtrends and changes in different pathologies over time. (AU)

El modelo UPPS de impulsividad en el abuso de lasTecnologías de la Información y la Comunicación (TIC) / The UPPS model of impulsivity in the abuse of Information and Communication Technologies (ICT)

El modelo UPPS de impulsividad se ha propuesto recientemente, hasido ampliamente aplicado al abuso de sustancias y es uno de los recomendados en el contexto de investigación Research Domain Criteria,RDoC. Sin embargo, su aplicación al abuso de tecnologías de la información y la comunicación (TIC) ha sido muy limitado. En el presentetrabajo se reclutó a través de Internet una muestra de n=748 (67%mujeres) y se administró la versión reducida de la UPPS-P, además delMULTICAGE-TIC y el Inventario de Síntomas Prefrontales (ISP-20).Las propiedades psicométricas de la UPPS-P resultaron satisfactoriasen consistencia interna (0,87>ω>0,75) y validez estructural. La impulsividad medida por la UPPS-P correlacionó con todas las escalas delMULTICAGE-TIC, aunque con un tamaño del efecto muy pequeño,y con mayor magnitud con las de síntomas de mal funcionamientoprefrontal. Las dimensiones de impulsividad más relacionadas con elabuso de las TIC fueron las de Urgencia (0,3>r>0,2). Se realizó unanálisis estructural de todas las variables apareciendo la impulsividadcomo un producto del mal funcionamiento prefrontal que predecía,a través de la Urgencia Positiva, el abuso de las TIC. La impulsividadno parece ser el núcleo central del abuso de las TIC, sino los fallos enel control superior de la conducta, de los que la impulsividad seríauna consecuencia, pero no la más importante. Ello hace recomendable el diseño de intervenciones de rehabilitación cognitiva que mejoren el funcionamiento de los mecanismos de control superior de laconducta en la prevención y tratamiento del abuso de las TIC. (AU)

The UPPS model of impulsivity has recently been proposed, has beenwidely applied to substance abuse and is one of those recommendedin the context of Research Domain Criteria, RDoC. However, its application to the abuse of information and communication technologies (ICTs) has been very limited. In the present work, a sample ofn=748 (67% females) was recruited through the Internet, and thereduced version of the UPPS-P was administered, in addition to theMULTICAGE-TIC and the Prefrontal Symptoms Inventory (PSI-20).The psychometric properties of UPPS-P were satisfactory in terms ofinternal consistency (0.87 > ω > 0.75) and structural validity. Impulsivity measured by UPPS-P correlated with all MULTICAGE-TIC scales,although with a very small effect size, and with greater magnitudewith prefrontal dysfunction symptoms. The impulsivity dimensionmost related to ICT abuse was Urgency (0.3 > r > 0.2). A structuralanalysis of all the variables was carried out, with impulsivity appearingas a product of the prefrontal malfunction that predicted, throughPositive Urgency, the abuse of ICTs. Impulsivity does not seem to bethe central nucleus of ICT abuse, but rather failures in the superiorcontrol of behavior, of which impulsivity would be a consequence, butnot the most important. This makes it advisable to design cognitiverehabilitation interventions that improve the functioning of superiorbehavior control mechanisms in the prevention and treatment of ICTabuse. (AU)

Addiction medicine in the time of COVID-19: An overview of the 2020 Joint Scientific Annual Conference of the International Society of Addiction Medicine and Canadian Society of Addiction Medicine.

For years, Substance Abuse has annually published a communication regarding the annual conference of the International Society of Addiction Medicine (ISAM). These pieces have highlighted the important events of the conference and the work of the organization, as reflected in part by selected abstracts from the conference. This editorial communicates the events of the 2020 conference, the third to be held in conjunction with the Canadian Society of Addiction Medicine (CSAM) and the first virtual conference. The conference was attended by over 800 participants and covered a wide range of topics, including addiction medicine during the COVID-19 pandemic. Despite the challenges of not being able to meet physically in Victoria, British Columbia as had been planned, the virtual event provided an opportunity to share current information in order to help advance prevention, treatment, policy and public helath efforts relating to addressing addictions and helping those impacted by these often devastating conditions.

Understanding addiction: The shift from epistemology to ontology.

This essay contrasts a late modernist epistemological paradigm with an ontology-oriented Anthropocene-conscious Approach (ACA) as frameworks for understanding the coming into being and the making of addiction. Operationalizable theories and concepts of addiction have been crucial in an era with a great demand for compartmentalizing and systemically defining psychological struggles and social problems. In the modernistic progress story, the addiction phenomenon materializes through the conceptual division between capacity and non-capacity, with those capable of mastering their urges on one side and those incapable of doing so on the other. The ACA strives actively to move beyond artificial divides between agency/structure, culture/nature, mind/matter and instead explore phenomena ecologically across these continuums. This entails a conscious re-focus away from authoritative human-made assumptions towards new types of knowledge and knowing. In the ACA assemblage-like ontology, different elements are brought together in their capacities to affect each other into entities. Due to its claims of practical uses, I predict that the ACA will become as influential as Foucauldian genealogy in the field of addiction studies.

Advances and Future Directions in the Clinical Utility of Food Addiction.

The body of research examining the validity of food addiction and eating addiction far exceeds the research examining their clinical utility [...].

[What's new in addiction medicine]. / Addictions.

The development of research, clinical practice and prevention in addiction medicine is, compared to other disciplines, more influenced by socio-political factors. Research on psychedelics has thus long been hampered by prohibitive policy but has recently been revived thanks to the relaxation of these political positions. The extensive prescription of baclofen for alcohol addiction is mainly the consequence of popular support and has so far not been clearly supported by specific research. The aim of the new Gambling Act was to harmonize the regulatory provisions for lotteries and betting on the one hand and casino gambling on the other, while at the same time opening up the market for online gambling.

Le développement de la recherche, de la pratique clinique et de la prévention en addictologie est davantage influencé par les circonstances sociopolitiques que dans de nombreuses autres disciplines. La recherche sur les psychédéliques a ainsi longtemps été entravée par une politique prohibitive mais a été relancée récemment grâce à l'assouplissement de ces positions politiques. La prescription importante du baclofène pour traiter l'addiction à l'alcool est principalement la conséquence d'un soutien populaire et n'est jusqu'à présent pas clairement appuyée par la recherche spécifique. Le but de la nouvelle loi sur les jeux d'argent était d'harmoniser les dispositifs de régulation concernant les loteries et paris d'une part et les jeux de casinos d'autre part, tout en ouvrant le marché des jeux en ligne.

Guidelines for the assessment and management of addiction in the hospitalized patient with opioid use disorder: a twenty-first century update.

While there have been many articles published on managing the medical sequelae of opioid use disorder in specific patient populations or settings, there is a dearth of literature on assessing and managing opioid use disorder in the acute hospital setting. In 1975, Fultz and Senay published proposed guidelines on the management of what they called the "hospitalized narcotic addict" Fultz and Senay (Ann Intern Med 82(6):815-818, 1975). Since then, many new developments in the treatment of opioid use disorder have occurred. In our experience, services in the acute inpatient hospital turn to psychiatric consultation teams for recommendations on how to manage these complicated and, sometimes, difficult patients. This article serves to provide the internal medicine physician a foundation of understanding how to address the main issues in hospitalized patients with opioid use disorder on a general medical or surgical floor.

Addressing a rapidly changing service landscape during the COVID-19 pandemic: Creation of the Oregon substance use disorder resource collaborative.

Following the rising crisis of COVID-19 and the Oregon governor's stay-at-home orders, members of the Oregon Health and Science University (OHSU) inpatient addiction consult service recognized that local addiction treatment and recovery organizations were operating at limited capacity. As a result, discharge planning, patient access to local community-based treatment, and safety-net programming were affected. Given structural and intersectional risk vulnerabilities of people with substance use disorders (SUDs), the OHSU members felt that COVID-19 would disproportionately impact chronically marginalized members of our community. These inequities inspired the formation of the Oregon substance use disorder resources collaborative (ORSUD) led by four medical students. ORSUD's mission is to support the efforts of local safety-net organizations that and front-line providers who serve chronically marginalized community members in the midst of the global pandemic. We operationalized our mission through: 1) collecting and disseminating operational and capacity changes in local addiction and harm reduction services to the broader treatment community, and 2) identifying and addressing immediate resource needs for local safety-net programs. Our program uses a real-time public-facing document to collate local programmatic updates and general community resources. COVID-19 disproportionately burdens people with SUDs; thus, ORSUD exists to support programs serving people with SUDs and will continue to evolve to meet their needs and the needs of those who serve them.

The Science of Addiction Through the Lens of Opioid Treatment for Chronic Noncancer Pain.

Addiction is a chronic, relapsing brain disease. It is not the same as physical dependence (i.e., withdrawal) and tolerance, but is characterized by loss of control over the use of the substance, continued use despite consequences, compulsive use, and cravings. Addiction involves functional changes to brain pathways involved in reward, stress and learning, and these changes can last a long time after the addictive substance is no longer used. Repeated interruption of normal brain function from repetitive use of addictive substances can hijack normal reward mechanisms resulting in fundamental alterations in brain structure and function. Over time, addictive substances can bring about a false fixed prediction error that cannot be rectified during learning. And, for individuals who develop an addiction, initial impulsive drug use progresses to compulsive drug use and this progression also has neurobiological underpinnings. Drug addiction is partly heritable, although there is no single gene coding specifically for the disease of addiction. Genetic factors contribute to a vulnerability to develop both addiction and addiction comorbidities, and play an appreciable role in responses to and metabolism of addictive substances, and most likely, the experience of rewarding effects. Patients with pain who are addicted to opioids have, in addition to the pain disorder, a chronic relapsing brain disease that can be life-threatening. Addiction can be treated and controlled, but not cured. Treatment of pain in individuals with addiction is a complex clinical challenge. Holistic assessment, interprofessional approaches, use of established guidelines, and non-pharmacological complementary modalities are needed.

Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis.

BACKGROUND: Hospitalizations due to medical and surgical complications of substance use disorder (SUD) are rising. Most hospitals lack systems to treat SUD, and most people with SUD do not engage in treatment after discharge. OBJECTIVE: Determine the effect of a hospital-based addiction medicine consult service, the Improving Addiction Care Team (IMPACT), on post-hospital SUD treatment engagement. DESIGN: Cohort study using multivariable analysis of Oregon Medicaid claims comparing IMPACT patients with propensity-matched controls. PARTICIPANTS: 18-64-year-old Oregon Medicaid beneficiaries with SUD, hospitalized at an Oregon hospital between July 1, 2015, and September 30, 2016. IMPACT patients (n = 208) were matched to controls (n = 416) using a propensity score that accounted for SUD, gender, age, race, residence region, and diagnoses. INTERVENTIONS: IMPACT included hospital-based consultation care from an interdisciplinary team of addiction medicine physicians, social workers, and peers with lived experience in recovery. IMPACT met patients during hospitalization; offered pharmacotherapy, behavioral treatments, and harm reduction services; and supported linkages to SUD treatment after discharge. OUTCOMES: Healthcare Effectiveness Data and Information Set (HEDIS) measure of SUD treatment engagement, defined as two or more claims on two separate days for SUD care within 34 days of discharge. RESULTS: Only 17.2% of all patients were engaged in SUD treatment before hospitalization. IMPACT patients engaged in SUD treatment following discharge more frequently than controls (38.9% vs. 23.3%, p < 0.01; aOR 2.15, 95% confidence interval [CI] 1.29-3.58). IMPACT participation remained associated with SUD treatment engagement when limiting the sample to people who were not engaged in treatment prior to hospitalization (aOR 2.63; 95% CI 1.46-4.72). CONCLUSIONS: Hospital-based addiction medicine consultation can improve SUD treatment engagement, which is associated with reduced substance use, mortality, and other important clinical outcomes. National expansion of such models represents an opportunity to address an enduring gap in the SUD treatment continuum.

Addiction disorders: a need for change. Proposal for a new management. Position paper of SIA, Italian Society on Alcohol.

Various epidemiological and biological evaluations and the recent publication of the DSM-V (diagnostic and statistical manual of mental disorders) has imposed on the scientific community a period of reflection on the diagnosis and treatment of what in the DSM-IV was defined as "addiction". To date, the term "addiction" has been replaced by the DSM-5, because there is no global scientific consensus that has unequivocally characterized its clinical characteristics. This, we will talk about substance/alcohol use disorders (SUDs/AUDs) and disorders related to behavioral alterations (DBA) that can generate organic diseases, mental disorders, and social problems. In the first psychotic episode 40-70% of subjects meet the criteria of a SUDs/AUDs, excluding tobacco dependence. Substances can not only be the cause of a psychotic onset, but they can also disrupt a psychotic picture or interfere with drug therapy. The pharmacodynamic profiles of many substances are able to provoke the phenomenology of the main psychotic symptoms in a way that can be superimposed onto those presented by psychotic subjects without a history of SUDs/AUDs. The Department of Addictions (DAs) must not be absorbed by or incorporated into the Departments of Mental Health (DMH), with which, however, precise operational cooperation protocols will have to be defined and maintained, but it will have to maintain its own autonomy and independent connotation. Addiction Medicine is a discipline that brings together elements of public health, prevention, internal medicine, clinical pharmacology, neurology, and even psychiatry. The inclusion of the DAs in those of DMH refers purely to a problem of pathology that has to do with lifestyle, choices, and behaviors. These, over time, show their dysfunctionality and only then do related problems emerge. Moreover, epidemiological, social, and clinical motivations impose the creation of alcohological teams dedicated to alcohol-related activities. The collaboration with self-help-groups (SHGs) is mandatory. The action of SHGs is accredited in numerous international recommendations both on the basis of consensus and evidence in the literature.

[Day clinic, a gateway towards risk reduction]. / Hôpital de jour, une passerelle vers la réduction des risques.

The addictology day clinic at Fernand-Widal hospital in Paris caters mainly for patients suffering from alcohol dependence. The aim is to consolidate the withdrawal which has taken place, to help reduce risks and harm and to support people waiting for follow-up care.