The Need for Psychosocial Interventions to Facilitate the Transition to Extended-Release Naltrexone (XR-NTX) Treatment for Opioid Dependence: A Concise Review of the Literature.

Given the increase of opioid dependence and opioid-related morbidity and mortality, improving treatment options for individuals with opioid dependence warrants increased attention. This article provides a concise review of work in this area. Remission from opioid dependence can be very difficult to sustain, particularly in the absence of opioid replacement or opioid antagonist therapy. For those who wish to transition from opioid use or opioid replacement therapy to opioid antagonist therapy, a significant challenge can be the period of withdrawal symptoms that must be endured prior to the initiation of opioid antagonist therapy. Studies that have incorporated psychosocial interventions into detoxification protocols have found that they can result in improved treatment outcomes. Interventions based on Acceptance and Commitment Therapy have shown promise in the treatment of clinical disorders that present with symptoms similar to those of opioid withdrawal and have been found to positively impact outcomes among those tapering from methadone. However, the use of an Acceptance and Commitment Therapy-based intervention has yet to be studied among opioid-dependent patients transitioning to XR-NTX, and its value to those transitioning to XR-NTX is currently unknown.

Survey of subjective effects of smoking while drinking among college students.

Prevalence of tobacco use among the college-aged population is approximately 30%; a significant percentage of students initiate use or transition to regular use during their college years. This study examined the relationship between drinking and smoking rates, subjective reactivity of concurrent effects of alcohol and tobacco use, and expectations of smoking while under the influence of alcohol in first-year college students. The sample consisted of ever-smokers (n=217), who had smoked at least once in the past year, with a mean age of 19.67 years. Weekly alcohol consumption was 18.53 standard drinks per week, with 2.95 drinking episodes per week. Of the sample, 54% were classified as smokers (smoked more than 100 cigarettes in their lifetime) and 46% were classified as experimenters (smoked less than 100 cigarettes in their lifetime). Results demonstrated that 74% of all smoking episodes occurred while under the influence of alcohol. Smokers had higher levels of alcohol use and reported greater subjective effects from the simultaneous use of alcohol and tobacco. Smokers also were more likely to generate expectancies acknowledging an increase in smoking while drinking and for smoking to enhance reinforcement from alcohol. Experimenters were most likely to report positive reinforcement from smoking while under the influence of alcohol. Overall, smokers experienced stronger subjective effects of concurrent alcohol and tobacco use; however, results suggest that smoking while under the influence of alcohol is a positive experience even for relatively inexperienced smokers.