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1.
Psychopharmacology (Berl) ; 237(8): 2233-2255, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32601988

RESUMO

RATIONALE: Agonist-based pharmacologic intervention is an accepted approach in treatment of opioid and tobacco use disorders. OBJECTIVES: We conducted a systematic review and meta-analysis to evaluate usefulness of an agonist approach as treatment of (psycho)stimulant use disorder (PSUD). METHODS: We reviewed PubMed/Medline, LILACS, and ClinicalTrials.gov databases searching for randomized, double-blind, placebo-controlled, parallel-design studies evaluating outcomes of individuals treated for cocaine- or amphetamine-type substance use disorder. We combined results of all trials that included the following prescription psychostimulants (PPs): modafinil, methylphenidate, or amphetamines (mixed amphetamine salts, lisdexamphetamine, and dextroamphetamine). The combined sample consisted of 2889 patients. Outcomes of interest included the following: drug abstinence (defined as 2-3 weeks of sustained abstinence and the average maximum days of consecutive abstinence), percentage of drug-negative urine tests across trial, and retention in treatment. We conducted random-effects meta-analyses and assessed quality of evidence using the GRADE system. RESULTS: Thirty-eight trials were included. Treatment with PPs increases rates of sustained abstinence [risk ratio (RR) = 1.45, 95% confidence interval (CI) = (1.10, 1.92)] and duration of abstinence [mean difference (MD) = 3.34, 95% CI = (1.06, 5.62)] in patients with PSUD, particularly those with cocaine use disorder (very low-quality evidence). Prescription amphetamines were particularly efficacious in promoting sustained abstinence in patients with cocaine use disorder [RR = 2.44, 95% CI = (1.66, 3.58)], and higher doses of PPs were particularly efficacious for treatment of cocaine use disorder [RR = 1.95, 95% CI = (1.38, 2.77)] (moderate-quality evidence). Treatment with prescription amphetamines also yielded more cocaine-negative urines [MD = 8.37%, 95% CI = (3.75, 12.98)]. There was no effect of PPs on the retention in treatment. CONCLUSION: Prescription psychostimulants, particularly prescription amphetamines given in robust doses, have a clinically significant beneficial effect to promote abstinence in the treatment of individuals with PSUD, specifically the population with cocaine use disorder.


Assuntos
Estimulantes do Sistema Nervoso Central/uso terapêutico , Medicamentos sob Prescrição/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Anfetamina/uso terapêutico , Cocaína/uso terapêutico , Método Duplo-Cego , Humanos , Dimesilato de Lisdexanfetamina/uso terapêutico , Metilfenidato/uso terapêutico , Modafinila/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento
4.
JAMA ; 323(22): 2310-2328, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32515820

RESUMO

Importance: Illicit drug use is among the most common causes of preventable morbidity and mortality in the US. Objective: To systematically review the literature on screening and interventions for drug use to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials through September 18, 2018; literature surveillance through September 21, 2019. Study Selection: Test accuracy studies to detect drug misuse and randomized clinical trials of screening and interventions to reduce drug use. Data Extraction and Synthesis: Critical appraisal and data abstraction by 2 reviewers and random-effects meta-analyses. Main Outcomes and Measures: Sensitivity, specificity, drug use and other health, social, and legal outcomes. Results: Ninety-nine studies (N = 84 206) were included. Twenty-eight studies (n = 65 720) addressed drug screening accuracy. Among adults, sensitivity and specificity of screening tools for detecting unhealthy drug use ranged from 0.71 to 0.94 and 0.87 to 0.97, respectively. Interventions to reduce drug use were evaluated in 52 trials (n = 15 659) of psychosocial interventions, 7 trials (n = 1109) of opioid agonist therapy, and 13 trials (n = 1718) of naltrexone. Psychosocial interventions were associated with increased likelihood of drug use abstinence (15 trials, n = 3636; relative risk [RR], 1.60 [95% CI, 1.24 to 2.13]; absolute risk difference [ARD], 9% [95% CI, 5% to 15%]) and reduced number of drug use days (19 trials, n = 5085; mean difference, -0.49 day in the last 7 days [95% CI, -0.85 to -0.13]) vs no psychosocial intervention at 3- to 4-month follow-up. In treatment-seeking populations, opioid agonist therapy and naltrexone were associated with decreased risk of drug use relapse (4 trials, n = 567; RR, 0.75 [95% CI, 0.59 to 0.82]; ARD, -35% [95% CI, -67% to -3%] and 12 trials, n = 1599; RR, 0.73 [95% CI, 0.62 to 0.85]; ARD, -18% [95% CI, -26% to -10%], respectively) vs placebo or no medication. While evidence on harms was limited, it indicated no increased risk of serious adverse events. Conclusions and Relevance: Several screening instruments with acceptable sensitivity and specificity are available to screen for drug use, although there is no direct evidence on the benefits or harms of screening. Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations.


Assuntos
Programas de Rastreamento/normas , Antagonistas de Entorpecentes/uso terapêutico , Psicoterapia , Detecção do Abuso de Substâncias/normas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Naloxona/efeitos adversos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/efeitos adversos , Guias de Prática Clínica como Assunto , Gravidez , Sensibilidade e Especificidade , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários
5.
JAMA ; 323(22): 2301-2309, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32515821

RESUMO

Importance: An estimated 12% of adults 18 years or older and 8% of adolescents aged 12 to 17 years report unhealthy use of prescription or illegal drugs in the US. Objective: To update its 2008 recommendation, the USPSTF commissioned reviews of the evidence on screening by asking questions about drug use and interventions for unhealthy drug use in adults and adolescents. Population: This recommendation statement applies to adults 18 years or older, including pregnant and postpartum persons, and adolescents aged 12 to 17 years in primary care settings. This statement does not apply to adolescents or adults who have a currently diagnosed drug use disorder or are currently undergoing or have been referred for drug use treatment. This statement applies to settings and populations for which services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. Evidence Assessment: In adults, the USPSTF concludes with moderate certainty that screening by asking questions about unhealthy drug use has moderate net benefit when services for accurate diagnosis of unhealthy drug use or drug use disorders, effective treatment, and appropriate care can be offered or referred. In adolescents, because of the lack of evidence, the USPSTF concludes that the benefits and harms of screening for unhealthy drug use are uncertain and that the balance of benefits and harms cannot be determined. Recommendation: The USPSTF recommends screening by asking questions about unhealthy drug use in adults 18 years or older. Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.) (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for unhealthy drug use in adolescents. (I statement).


Assuntos
Programas de Rastreamento/normas , Antagonistas de Entorpecentes/uso terapêutico , Psicoterapia , Detecção do Abuso de Substâncias/normas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Humanos , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Antagonistas de Entorpecentes/efeitos adversos , Sensibilidade e Especificidade , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários
6.
PLoS One ; 15(6): e0234809, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555667

RESUMO

AIMS: Stimulant use disorder contributes to a substantial worldwide burden of disease, although evidence-based treatment options are limited. This systematic review of reviews aims to: (i) synthesize the available evidence on both psychosocial and pharmacological interventions for the treatment of stimulant use disorder; (ii) identify the most effective therapies to guide clinical practice, and (iii) highlight gaps for future study. METHODS: A systematic database search was conducted to identify systematic reviews and meta-analyses. Eligible studies were those that followed standard systematic review methodology and assessed randomized controlled trials focused on the efficacy of interventions for stimulant use disorder. Articles were critically appraised using an assessment tool adapted from Palmeteer et al. and categorized for quality as 'core' or 'supplementary' reviews. Evidence from the included reviews were further synthesized according to pharmacological or non-pharmacological management themes. RESULTS: Of 476 identified records, 29 systematic reviews examining eleven intervention modalities were included. The interventions identified include: contingency management, cognitive behavioural therapy, acupuncture, antidepressants, dopamine agonists, antipsychotics, anticonvulsants, disulfiram, opioid agonists, N-Acetylcysteine, and psychostimulants. There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder. Psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence to support or discount their use. Results of this review do not support the use of all other treatment options. CONCLUSIONS: The results of this review supports the use of contingency management interventions for the treatment of stimulant use disorder. Although evidence to date is insufficient to support the clinical use of psychostimulants, our results demonstrate potential for future research in this area. Given the urgent need for effective pharmacological treatments for stimulant use disorder, high-quality primary research focused on the role of psychostimulant medications for the treatment of stimulant use disorder is needed.


Assuntos
Transtornos Relacionados ao Uso de Substâncias/terapia , Acupuntura , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Terapia Cognitivo-Comportamental , Agonistas de Dopamina/uso terapêutico , Humanos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/patologia
7.
Adv Pharmacol ; 88: 233-275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32416869

RESUMO

Alcohol and substance use disorders are chronic relapsing disorders, characterized by a compulsion to take drugs and loss of control in limiting intake. The impact of alcohol and substance abuse on morbidity and mortality is very high worldwide, and treatment options are inadequate at a population level. There is a need for the discovery and development of novel pharmacotherapies to treat alcohol and substance use disorders. The recent development of subtype selective muscarinic acetylcholine receptor (mAChR) allosteric modulators, is rapidly increasing our understanding of this system and revealing great promise for disease treatment. In this chapter, we will present and integrate the current literature regarding the role of mAChRs in drug and alcohol abuse with emerging evidence using novel allosteric modulators targeting specific mAChR subtypes. We will focus on the potential of M1, M4 and M5 mAChRs in the treatment of alcohol, psychostimulant and opioid dependence, using evidence from preclinical studies to predict their utility in treating different stages of the addiction cycle. Overall, preclinical evidence suggests allosteric modulation of mAChRs may provide promise as potential treatment options for alcohol and substance abuse in reducing consumption, facilitating abstinence and preventing relapse.


Assuntos
Alcoolismo/tratamento farmacológico , Receptores Muscarínicos/metabolismo , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Regulação Alostérica , Animais , Modelos Animais de Doenças , Humanos , Terapia de Alvo Molecular
8.
Epidemiol Psychiatr Sci ; 29: e125, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32370818

RESUMO

AIMS: More than one-half of betel-quid (BQ) chewers have betel-quid use disorder (BUD). However, no medication has been approved. We performed a randomised clinical trial to test the efficacy of taking escitalopram and moclobemide antidepressants on betel-quid chewing cessation (BQ-CC) treatment. METHODS: We enrolled 111 eligible male BUD patients. They were double-blinded, placebo-controlled and randomised into three treatment groups: escitalopram 10 mg/tab daily, moclobemide 150 mg/tab daily and placebo. Patients were followed-up every 2 weeks and the length of the trial was 8 weeks. The primary outcome was BQ-CC, defined as BUD patients who continuously stopped BQ use for ⩾6 weeks. The secondary outcomes were the frequency and amount of BQ intake, and two psychological rating scales. Several clinical adverse effects were measured during the 8-week treatment. RESULTS: Intention-to-treat analysis shows that after 8 weeks, two (5.4%), 13 (34.2%) and 12 (33.3%) of BUD patients continuously quit BQ chewing for ⩾6 weeks among placebo, escitalopram, moclobemide groups, respectively. The adjusted proportion ratio of BQ-CC was 6.3 (95% CI 1.5-26.1) and 6.8 (95% CI 1.6-28.0) for BUD patients who used escitalopram and moclobemide, respectively, as compared with those who used placebo. BUD patients with escitalopram and moclobemide treatments both exhibited a significantly lower frequency and amount of BQ intake at the 8th week than those with placebo. CONCLUSIONS: Prescribing a fixed dose of moclobemide and escitalopram to BUD patients over 8 weeks demonstrated treatment benefits to BQ-CC. Given a relatively small sample, this study provides preliminary evidence and requires replication in larger trials.


Assuntos
Antidepressivos/uso terapêutico , Areca , Citalopram/uso terapêutico , Mastigação , Moclobemida/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adolescente , Adulto , Idoso , Areca/efeitos adversos , Grupo com Ancestrais do Continente Asiático , Método Duplo-Cego , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento
9.
Nihon Yakurigaku Zasshi ; 155(3): 130-134, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32378628

RESUMO

Recently, topics related to substance dependence and behavioral addiction have been reported through the media. Therapeutic treatment for substance dependence and behavioral addiction is one of the challenges in a clinical practice. This is because there is no therapeutic treatment for a complete cure, and reuses and repetitive hospitalization occur in patients. Therefore, it is an urgent need to develop new treatments for substance dependence and behavioral addiction. In the present review, we outline associations between dependence and G-protein-activated inwardly rectifying potassium (GIRK) channels which we focus on as therapeutic targets, and introduce ongoing clinical study using an inhibitor of GIRK channels. Previous studies including animals and patients have accumulated the results that GIRK channels have a key role for mediating signals from addictive substances. GIRK channels are expressed in various rodent brain regions including the reward system. The activation of G protein-coupled receptors (GPCRs) that activates GIRK channels through G-protein ßγ subunits and activated GIRK channels contribute to control of neuronal excitability. Pretreatment with ifenprodil that is one of the GIRK channel blockers suppressed addictive substance-induced behaviors in animals. Ifenprodil is safe and broadly used as a cerebral circulation/metabolism ameliorator that is covered by medical insurance in Japan. The authors reported that ifenprodil treatment for 3 months decreased alcohol use scores in patients with alcohol dependence compared with patients who received the control medication. We currently conduct a clinical trial to investigate the outcomes of ifenprodil treatment for methamphetamine dependence. In the future, we will expand clinical studies using ifenprodil for patients with other substance dependence and behavioral addiction.


Assuntos
Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/antagonistas & inibidores , Piperidinas/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Anfetaminas/tratamento farmacológico , Animais , Ensaios Clínicos como Assunto , Humanos , Japão , Metanfetamina , Neurônios , Recompensa
11.
Neurology ; 94(20): e2099-e2108, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32327491

RESUMO

OBJECTIVE: To evaluate the risk of death in relation to incident antiepileptic drug (AED) use compared with nonuse in people with Alzheimer disease (AD) through the assessment in terms of duration of use, specific drugs, and main causes of death. METHODS: The MEDALZ (Medication Use and Alzheimer Disease) cohort study includes all Finnish persons who received a clinically verified AD diagnosis (n = 70,718) in 2005-2011. Incident AED users were identified with 1-year washout period. For each incident AED user (n = 5,638), 1 nonuser was matched according to sex, age, and time since AD diagnosis. Analyses were conducted with Cox proportional regression models and inverse probability of treatment weighting (IPTW). RESULTS: Nearly 50% discontinued AEDs within 6 months. Compared with nonusers, AED users had an increased relative risk of death (IPTW hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.12-1.36). This was mainly due to deaths from dementia (IPTW HR, 1.62; 95% CI, 1.42-1.86). There was no difference in cardiovascular and cerebrovascular deaths (IPTW HR, 0.98; 95% CI, 0.67-1.44). The overall mortality was highest during the first 90 days of AED use (IPTW HR, 2.40; 95% CI, 1.91-3.03). Among users of older AEDs, relative risk of death was greater compared to users of newer AEDs (IPTW HR, 1.79; 95% CI, 1.52-2.16). CONCLUSION: In older vulnerable patients with a cognitive disorder, careful consideration of AED initiation and close adverse events monitoring are needed.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/mortalidade , Anticonvulsivantes/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Idoso , Cognição/efeitos dos fármacos , Cognição/fisiologia , Feminino , Humanos , Vida Independente/psicologia , Masculino , Fatores de Risco
12.
Pesqui. prát. psicossociais ; 15(1): 1-16, jan.-abr. 2020. tab
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1098431

RESUMO

A literatura considera que existe um conjunto de valores, crenças e práticas familiares que constituem o referencial cultural da família e que interfere na participação dos familiares no tratamento dos consumidores de crack e outras drogas. O objetivo deste estudo foi investigar as crenças familiares sobre consumo de crack e sua relação com a participação familiar no tratamento de seus membros. Participaram desta pesquisa qualitativa 10 familiares de consumidores de crack que estavam em tratamento em uma Comunidade Terapêutica (CT) e um representante da instituição. Foram aplicados os seguintes instrumentos: uma escala para avaliar o nível socioeconômico; uma versão resumida do questionário Cebrid/Samsha, para avaliar a percepção de risco sobre o consumo de substâncias psicoativas; e dois roteiros de entrevista semiestruturada - versões família e representante da CT. Na avaliação de risco, os familiares consideraram que o consumo de crack, desde a primeira vez na vida, já apresentava um risco grave, em comparação com as outras substâncias. Foram investigadas crenças relacionadas ao consumo do crack, principalmente com relação à influência dos amigos, dependência química, influência do consumidor com o tráfico, entre outras. Os familiares acreditam na importância da participação familiar e consideram que contribuem nesse sentido. Os resultados puderam fornecer subsídios para uma melhor compreensão das crenças familiares sobre o consumo de crack, contribuindo para fomentar uma intervenção que favoreça a participação familiar no tratamento.


According to the literature, there is a set of values, beliefs, and family practices that form a family's cultural frame of reference and may even interfere in the participation of the family in the treatment of crack users - and users of other types of substances. The goal study is to explore family beliefs regarding the use of crack and its correlation with the family's involvement in the treatment of its members. Ten family members of crack users, all of whom were receiving treatment at one of the recovery centers known as Therapeutic Communities, and a representative of this institution took part in the study. The following tools were used: a scale to evaluate the socioeconomic status, a shortened version of the questionnaire developed by Cebrid (the "Brazilian Center of Information on Psychotropic Drugs") and Samsha (the Substance Abuse and Mental Health Services Administration), in order to evaluate the perception of the risks involved in the use of psychoactive substances, and two semi-structured interview scripts. Two versions of the script were elaborated: one for the family and another for the Therapeutic Community representative. The family members stated that using crack is dangerous from the very beginning, particularly when compared to using other substances. Beliefs related to the use of the drug were analyzed, especially concerning the influence of friends, substance abuse, the relationship between the drug user and the traffic, and other factors. The family members believe in the importance of their participation. The results provided a better understanding of family beliefs regarding the use of crack, which helped to create an intervention that may emphasize more the family's participation in the treatment.


La literatura tiene en cuenta que hay un conjunto de valores, creencias y prácticas familiares que constituyen el referencial cultural de la familia y que interfieren en su participación en el tratamiento de los consumidores del crack y de otras drogas. Esta investigación tuvo el objetivo de buscar las creencias familiares acerca del consumo del crack y su relación con la participación de la familia en tratamiento de sus miembros. Participaron de esta investigación cualitativa 10 familiares de consumidores del crack que recibían tratamiento en uno de los centros de recuperación conocidos como Comunidades Terapéuticas y un representante de la institución. Las siguientes herramientas fueron utilizadas: una escala para que se evaluara el nivel socioeconómico, una versión resumida del cuestionario desarrollado por Cebrid (el "Centro Brasileño de Informaciones sobre Drogas Psicotrópicas") y Samsha (la "Administración de Salud Mental y de Abuso de Sustancias", en los EE.UU.), para que se evaluara la percepción de riesgo acerca del consumo de sustancias psicoactivas, y dos guiones de entrevistas semiestructuradas - en las versiones "familia" y "representante de la Comunidad Terapéutica". En la evaluación de riesgos, los miembros de la familia afirmaron que el consumo del crack, desde el principio, representa un grave riesgo en comparación con otras sustancias. Se investigaron las creencias relacionadas al consumo del crack, sobre todo con respecto a la influencia de los amigos, a la dependencia química, a la relación del consumidor con el tráfico y otros factores. La familia cree en la importancia de su participación y en su contribución. Los resultados colaboraron con una mejor comprensión de las creencias de la familia acerca del consumo del crack, lo que ayudó a desarrollar un tipo de intervención que favoreciera la participación de la familia en el tratamiento.


Assuntos
Cocaína Crack , Usuários de Drogas , Psicotrópicos , Família , Medição de Risco , Transtornos Relacionados ao Uso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Serviços de Saúde Mental
13.
Handb Exp Pharmacol ; 258: 299-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32193666

RESUMO

In recent years, use of cocaine and amphetamines and deaths associated with stimulants have been on the rise, and there are still no FDA-approved medications for stimulant use disorders. One contributing factor may involve heterogeneity. At the neurobiological level, dual dopamine dysfunction may be undermining medication efficacy, suggesting a need for combination pharmacotherapies. At the population level, individual variability is expressed in a number of ways and, if left unaddressed, may interfere with medication efficacy. This chapter reviews studies investigating medications to address dopamine dysfunction, and it also identifies several prominent heterogeneities associated with stimulant (and other substance) use disorders. The chapter has implications for improving interventions to treat stimulant use disorders, and the theme of individual heterogeneity may have broader application across substance use disorders.


Assuntos
Estimulantes do Sistema Nervoso Central/efeitos adversos , Dopamina/fisiologia , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Anfetaminas/efeitos adversos , Ensaios Clínicos como Assunto , Cocaína , Transtornos Relacionados ao Uso de Cocaína , Humanos
14.
Psychiatr Hung ; 35(2): 182-210, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-32191222

RESUMO

A recent paradigm shift in medicine resulted in the emergence of so-called evolutionary medicine, which studies the interactions between the environment and biological phenomena in a timeline to understand diseases and develop new treatments. In the course of evolutionary discussion of chemical substance abuse, the issue was approached through five steps. The biological level helps to understand the interference and coevolution of chemical agents and biochemical mechanisms, thus demonstrating the vulnerability toward chemical agents. The psychological level approaches behavior and its change, taking into account the consequences of the substance-induced false feelings. The social, cultural and civilization levels take into account the effects of the non-physical environment by discussing the interactions among individuals, the benefits of communication and group formation, and the subsequently emerging conflicts. The integration at individual level is implemented by the Zinberg three-pillar model, while for the integration at the level of population the phenomenon of run-away is recommended in the literature. The paper disputes the latter and suggests the concept of civilization disease to describe the phenomenon. To explain the epidemic of chemical substance abuse in our age, two additional, interrelated reasons are listed: the change in the relation to time and spirituality. And also, the question whether the appearance of epigenetics in medical thinking means the renaissance of degenerationism is raised in the article. The author has finally arrived at the conclusion that the reasons for the increase of chemical substance use in the postmodern era are basically the consequences of the strengthened psycho-social mismatch such as the rate of environmental change, changes in social control, social insecurity and anxiety, and the secularization of drug use. Therefore, the clue to solve the problem is the rethinking of the opportunities provided by the development of technology and the role of human being therein. With other words a further paradigm changing is needed.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Ansiedade , Humanos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/psicologia
17.
Psychopharmacology (Berl) ; 237(5): 1521-1532, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32043165

RESUMO

RATIONALE: The regular consumption of very small doses of psychedelic drugs (known as microdosing) has been a source of growing media and community attention in recent years. However, there is currently limited clinical and social research evidence on the potential role of microdosing as therapies for mental and substance use disorders. OBJECTIVES: This paper examined subjective experiences of microdosing psychedelics to improve mental health or to cease or reduce substance use, and examined sociodemographic and other covariates of perceived improvements in mental health that individuals attributed to microdosing. METHODS: An international online survey was conducted in 2018 and examined people's experiences of using psychedelics for self-reported therapeutic or enhancement purposes. This paper focuses on 1102 respondents who reported current or past experience of psychedelic microdosing. RESULTS: Twenty-one percent of respondents reported primarily microdosing as a therapy for depression, 7% for anxiety, 9% for other mental disorders and 2% for substance use cessation or reduction. Forty-four percent of respondents perceived that their mental health was "much better" as a consequence of microdosing. In a multivariate analysis, perceived improvements in mental health from microdosing were associated with a range of variables including gender, education, microdosing duration and motivations, and recent use of larger psychedelic doses. CONCLUSIONS: Given the promising findings of clinical trials of standard psychedelic doses as mental health therapies, clinical microdosing research is needed to determine its potential role in psychiatric treatment, and ongoing social research to better understand the use of microdosing as self-managed mental health and substance use therapies.


Assuntos
Alucinógenos/administração & dosagem , Transtornos Mentais/tratamento farmacológico , Saúde Mental , Percepção/efeitos dos fármacos , Autogestão/métodos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adulto , Atenção/efeitos dos fármacos , Atenção/fisiologia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/psicologia , Saúde Mental/tendências , Motivação/efeitos dos fármacos , Motivação/fisiologia , Percepção/fisiologia , Autogestão/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
18.
Expert Opin Pharmacother ; 21(3): 287-296, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31928246

RESUMO

Introduction: Gambling disorder is classified as an addictive disorder and is associated with significant distress and impairment in personal, social, occupational or other important areas of functioning. Although no pharmacotherapy has a formal indication for gambling disorder, data suggest potential benefits of specific medications.Area covered: This systematic review evaluated findings from 19 randomized controlled trials testing pharmacotherapies for the treatment of gambling disorder.Expert opinion: Few randomized controlled trials have studied pharmacotherapies for gambling disorder. Though results are limited, opioid antagonists like naltrexone showed promise in the pharmacological treatment of gambling disorder. Pharmacotherapy combined with psychotherapy treatments for gambling disorder may provide better rates of patient retention in comparison to pharmacology-only treatments, though further research is needed in this area. Future studies should address gaps relating to considerations of racial, ethnic, gender and other individual differences in clinical studies. Because gambling disorder often co-occurs with other psychiatric disorders, additional research is needed to test treatments for dually diagnosed patients.


Assuntos
Comportamento Aditivo/tratamento farmacológico , Jogo de Azar/tratamento farmacológico , Diagnóstico Duplo (Psiquiatria) , Humanos , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Psicoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico
19.
Curr Pharm Des ; 26(4): 466-484, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939725

RESUMO

Substance-use disorder represents a frequently hidden non-communicable chronic disease. Patients with intravenous drug addiction are at high risk of direct exposure to a variety of viral infections and are considered to be the largest subpopulation infected with the hepatitis C virus. Ribavirin is a synthetic nucleoside analog that has been used as an integral component of hepatitis C therapy. However, ribavirin medication is quite often associated with pronounced psychiatric adverse effects. It is not well understood to what extent ribavirin per se contributes to changes in drug-related neurobehavioral disturbances, especially in the case of psychostimulant drugs, such as amphetamine. It is now well-known that repeated amphetamine usage produces psychosis in humans and behavioral sensitization in animals. On the other hand, ribavirin has an affinity for adenosine A1 receptors that antagonistically modulate the activity of dopamine D1 receptors, which play a critical role in the development of behavioral sensitization. This review will focus on the current knowledge of neurochemical/ neurobiological changes that exist in the psychostimulant drug-addicted brain itself and the antipsychotic-like efficiency of adenosine agonists. Particular attention will be paid to the potential side effects of ribavirin therapy, and the opportunities and challenges related to its application in already existing psychostimulant-use disorder.


Assuntos
Encéfalo/efeitos dos fármacos , Estimulantes do Sistema Nervoso Central , Ribavirina , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adenosina/agonistas , Anfetamina/efeitos adversos , Animais , Química Encefálica , Estimulantes do Sistema Nervoso Central/efeitos adversos , Humanos , Receptores de Dopamina D1 , Ribavirina/efeitos adversos , Ribavirina/uso terapêutico
20.
PLoS One ; 15(1): e0228394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999764

RESUMO

BACKGROUND: Effective treatment strategies exist for substance use disorder (SUD), however severe hurdles remain in ensuring adequacy of the SUD treatment (SUDT) workforce as well as improving SUDT affordability, access and stigma. Although evidence shows recent increases in SUD medication access from expanding Medicaid availability under the Affordable Care Act, it is yet unknown whether these policies also led to a growth in hiring in the SUDT related workforce, partly due to poor data availability. Our study uses novel data to shed light on recent trends in a fast-evolving and policy-relevant labor market, and contributes to understanding data sources to track the SUDT related workforce and the effect of recent state healthcare policies on the supply side of this sector. METHODS AND DATA: We examine hiring attempts in the SUDT and related behavioral health sector over 2010-2018 to estimate the causal effect of the 2014-and-beyond state Medicaid expansions on these outcomes through "difference-in-difference" econometric models. We use Burning Glass Technologies (BGT) data covering virtually all U.S. job postings by employers. FINDINGS: Nationally, we find little growth in the sector's hiring attempts in 2010-2018 relative to the rest of the economy or to health care as a whole. However, this masks heterogeneity in the bimodal trend in SUDT job postings, with some increases in most years but a decrease in 2014 and in 2017, as well as a shift in emphasis between different occupational categories. Medicaid expansion, however, is not associated with any statistically significant change in overall hiring attempts in the SUDT related sector during this time period, although there is moderate evidence of increases among primary care physicians. CONCLUSIONS: Although hiring attempts in the SUDT related sector as measured by the number of job advertisements have not grown substantially over time, there was a shift in the hiring landscape. Many national factors including reimbursement policy may play a role in incentivizing demand for the SUDT related workforce, but our research does not show that recent state Medicaid expansion was one such statistically detectable factor. Future research is needed to understand how aggregate labor demand signals translate into actual increases in SUDT workforce and availability.


Assuntos
Acesso aos Serviços de Saúde/legislação & jurisprudência , Mão de Obra em Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Humanos , Medicaid , Modelos Econométricos , Patient Protection and Affordable Care Act , Estigma Social , Estados Unidos
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