Former heroin-dependent alcohol use disorder patients. prevalence, addiction history and clinical features

Aims: To examine the prevalence of former heroin dependence (FHA) in Alcohol Use Disorder (AUD) patients; to compare the clinical characteristics of FHA-AUD patients versus AUD patients without any past use of heroin at alcohol treatment entry; to document the heroin dependence history of FHA-AUD patients, and review treatment strategies for this group. Methods: Retrospective case review of 448 consecutive AUD patients. Results: The annual entry of FHA-AUD showed stability over the study period of 3 years overall 60/ 448 (13.3%). FHA-AUD patients showed higher concomitant use of cocaine, benzodiazepines, cannabis and hallucinogens than other heroin addicts. They consumed higher amounts of alcohol at the beginning of their alcohol dependence history, and reached a high maximum level of alcohol consumption, than other AUD patients, and tended to have more physical disorders. The most important signals of FHA-AUD were polyabuse and older age at the time of presentation. FHA-AUD patients tended to have had a severe pattern of heroin dependence associated with inadequate agonist opiate treatment. Conclusions: The prevalence of FHA-AUD patients is not negligible. This may relate to previous inadequate treatment of heroin addiction contributing to the development of severe AUD. For these patients we propose a reconsideration of ‘soft’ (low dose) agonist opiate treatment

Can Ropinirole Modulate Reinforcing Subjective Effects of Cocaine in Humans?

In this study we evaluated, by means of the “cocaine rush visual analog scale,” the impact of ropinirole on the expected rush induced by cocaine in a group of heroin addicts abusing cocaine; the self-reported reaction to the rush blockade (if any) on cocaine consumption, and the correlations between this self-reported reaction and individual, clinical, and therapeutic parameters. Nineteen cocaine abuser heroin-dependent patients entered the study. Their experienced cocaine rush was 61.31 ± 32.1% of the maximum effect previously experienced. Compared with their previous rush intensity 16 patients experienced significantly lower intensity, 3 the same intensity, and none a higher intensity. In particular, two patients experienced a complete blockade of rush and reported a reduced use of cocaine. Fourteen patients experienced a partial blockade of cocaine rush; of these, nine reported they had reduced their use of cocaine. Ropinirole does diminish the subjective intensity of an expected cocaine rush, so interfering with the dynamics of reward, while supporting its possible use in the treatment of cocaine dependence

The newer opioid agonist treatment with lower substitutive opiate doses is associated with better toxicology outcome than the older harm reduction treatment

Background: Charge-free heroin use disorder treatment in Italy follows two main approaches, i.e., harm reduction treatment (HRT) strategy in community low-threshold facilities for drug addiction and opioid agonist treatment (OAT) in high-threshold facilities for opioid addiction, focusing on pharmacological maintenance according to the Dole and Nyswander strategy. We aimed to compare the impact of HRT and OAT on patient outcome, as assessed through negativity for drugs on about 1-year urinalyses. Methods: We examined retrospectively the urinalyses of HRT and OAT patients for which at least four randomly sampled urinalyses per month were available for about 1 year, during which patients were undergoing methadone or buprenorphine maintenance; urinalyses focused on heroin, cocaine, cannabinoids, and their metabolites. Results: Included were 189 HRT and 58 OAT patients. The latter were observed for a significantly longer period. There was a higher proportion of heroin- and cocaine-clean urinalyses in OAT patients, with cocaine-clean urinalyses discriminating best between the two groups. OAT patients were older, with longer dependence duration, more severe addiction history, and received lower methadone doses. Buprenorphine maintenance was more often associated with heroin-clean urinalyses. The higher the methadone doses, the lower were the percentage of heroin-clean urinalyses in HRT patients (negative correlation). Conclusions: The OAT approach was related to higher recovery and polyabuse abstinence rates compared to the HRT approach, despite greater severity of substance use, psychiatric and physical comorbidities. Our results are consistent with the possibility to use lower maintenance opiate doses (after induction and stabilization in methadone treatment according to Dole and Nyswander methodology) in treating heroin addiction. This seemed to be impossible adopting the currently accepted HRT model

Do Akiskal & Mallya's affective temperaments belong to the domain of pathology or to that of normality?

BACKGROUND: Kraepelin and Kretschmer hypothesized a continuum between full-blown affective pathology and premorbid temperaments. More recently Akiskal proposed a putative adaptive role for the four fundamental temperaments: the hyperthymic one characterized by emotional intensity, the cyclothymic one by emotional instability, the depressive one by a low energy level, and the irritable one by an excessive response to stimuli. Today it is widely debated whether affective temperaments belong to the domain of pathology or to that of normality. PURPOSE: To make clear, by applying an integrated model, the position of affective temperaments within the continuum between normality and pathology. METHODS: We reviewed several papers that explore the distribution of affective temperaments among the general population, and their involvement both in pathological conditions (somatic and psychiatric) and in human activities (professions and other occupations). RESULTS: Far from being intrinsically pathological conditions, affective temperaments seem to represent adaptive dispositions whose dysregulation can lead to full-blown affective pathology. All the temperamental types display some impact on people's lives by influencing personal skills and professional choices over a wide field of human activities. CONCLUSIONS: Affective temperaments are not problematic when they appear in a mild form, but when they occur in extreme form we have observed a gap between the hyperthymic temperament, which represents the most functional and desirable, and the cyclothymic, depressive, irritable and phobic anxious ones, which are closer to mood, anxiety, and substance use disorders, and imply a component of somatic diseases and life stressors

Do methadone and buprenorphine have the same impact on psychopathological symptoms of heroin addicts?

<p>Abstract</p> <p>Background</p> <p>The idea that the impact of opioid agonist treatment is influenced by the psychopathological profile of heroin addicts has not yet been investigated, and is based on the concept of a specific therapeutic action displayed by opioid agents on psychopathological symptoms. In the present report we compared the effects of buprenorphine and methadone on the psychopathological symptoms of 213 patients (106 on buprenorphine and 107 on methadone) in a follow-up study lasting 12 months.</p> <p>Methods</p> <p>Drug addiction history was collected by means of the Drug Addiction History Rating Scale (DAH-RS) and psychopathological features were collected by means of the Symptom Checklist-90 (SCL-90), using a special five-factor solution. Toxicological urinalyses were carried out for each patient during the treatment period.</p> <p>Results</p> <p>No statistically significant differences were detected in psychopathological symptoms, including 'worthlessness-being trapped', 'somatization', and 'panic-anxiety'. Methadone proved to be more effective on patients characterized by 'sensitivity-psychoticism', whereas buprenorphine was more effective on patients displaying a 'violence-suicide' symptomatology.</p> <p>Conclusions</p> <p>Heroin-dependent patients with psychiatric comorbidities may benefit from opioid agonist treatment not only because it targets their addictive problem, but also, precisely due to this, because it is effective against their mental disorder too.</p

Clonazepam as Agonist Substitution Treatment for Benzodiazepine Dependence: A Case Report

Nowadays, the misuse of benzodiazepines (BZDs) is a cause for a serious concern among pharmacologically inexperienced patients, whether treated or untreated, that could lead to significant complications, including tolerance, dependence, and addiction. We present a case report in which an Italian patient affected by anxiety disorder and treated with BZDs presented a severe case of dependence on BZDs. We treated him according to an agonist substitution approach, switching from the abused BZD to a slowonset, long-acting, high potency agonist (clonazepam), and looking at the methadone treatment model as paradigm. We decided to use clonazepam for its pharmacokinetic properties. The advantage of choosing a slow-onset, long-lasting BZD for the treatment of our patient was that it led us to a remarkable improvement in the clinical situation, including the cessation of craving, absence of withdrawal symptoms, reduced anxiety, improvements in social functioning, and a better cognition level

Item Reduction, Psychometric and Biometric Properties of the Italian Version of the Body Perception Questionnaire-Short Form (BPQ-SF): The BPQ-22

Body awareness disorders and reactivity are mentioned across a range of clinical problems. Constitutional differences in the control of the bodily state are thought to generate a vulnerability to psychological symptoms. Autonomic nervous system dysfunctions have been associated with anxiety, depression, and post-traumatic stress. Though interoception may be a transdiagnostic mechanism promoting the improvement of clinical symptomatology, few psychometrically sound, symptom-independent, self-report measures, informed by brain-body circuits, are available for research and clinical use. We validated the Italian version of the body perception questionnaire (BPQ)-short form and found that response categories could be collapsed from five to three and that the questionnaire retained a three-factor structure with items reduced from 46 to 22 (BPQ-22). The first factor was loaded by body awareness items; the second factor comprised some items from the body awareness scale and some from the subdiaphragmatic reactivity scale (but all related to bloating and digestive issues), and the third factor by supradiaphragmatic reactivity items. The BPQ-22 had sound psychometric properties, good convergent and discriminant validity and test-retest reliability and could be used in clinical and research settings in which the body perception assessment is of interest. Psychometric findings in light of the polyvagal theory are discussed

Verso una psicopatologia specifica dell'addiction. Rapporti con le covariate comportamentali del craving nel disturbo da uso di eroina

La tossicodipendenza da eroina è una malattia cronica del cervello che, ad oggi, sembra non possedere una propria psicopatologia specifica. Pertanto ogni aspetto legato alle dimensioni di pensiero, affettività e impulsività, è inquadrato come indotto dalla sostanza o dalla comorbidità psichiatrica. L’analisi fattoriale dell’SCL-90 in un campione di eroinomani all’ingresso in trattamento con agonisti oppiacei ha permesso di identificare 5 nuove dimensioni, specifiche del disturbo da uso di eroina: 1-“perdita di speranza-sentirsi in trappola”, 2-“sintomi somatici”, 3-“ansia panica”, 4-“sensitività-psicoticismo” e 5-“violenza suicidio”. Queste stesse dimensioni sono state successivamente confermate in eroinomani all’ingresso in comunità terapeutica. In quest’ultimo campione le dimensioni rimangono inalterate indipendentemente dall’uso attivo di eroina e dalla presenza di sintomatologia psichiatrica. Con la pubblicazione dell’ultima versione del DSM, il craving è entrato a far parte della lista dei criteri necessari per la diagnosi di disturbo da uso di sostanze. Benché la sua importanza sia centrale nella clinica e nella ricerca, il craving viene studiato attraverso scale quantitative, mentre non viene indagata la sua corrispondenza a livello comportamentale. Per questo abbiamo creazione una scala di valutazione CRAV-HERO© che indaga il comportamento tossicomanico tramite la presentazione di 13 domande/scenario. La somministrazione a un gruppo di “typical responders” ha evidenziato la validità della scala. Nello specifico, gli items proposti mostrano tutti lo stesso peso nell’identificazione delle covariate comportamentali di craving, evidenziando un’unica dimensione costituita dalla presenza di tutti gli items. CRAV-HERO© permette inoltre di identificare quali comportamenti gli eroinomani stessi ritengano maggiormente caratterizzanti il craving e quali siano associati al più elevato grado di craving. Alla luce dei risultati precedenti, per la prima volta, abbiamo analizzato i rapporti tra psicopatologia specifica dell’eroinopatia e covariate comportamentali di craving. Esiste una correlazione tra gravità dei comportamentali da craving e sintomi di psicopatologia sia come punteggi totali sia come 5 dimensioni specifiche. Inoltre, i disturbi dell’umore (depressione ricorrente e spettro bipolare) sono in relazione con specifici comportamenti di craving

Toward the identification of a specific psychopathology of heroin use disorder: biochemical and clinical correlations

Proteomic can undoubtedly offer valuable new insight into the study of drug addiction, in particular into the identification of potential biomarkers to assist in diagnosis and prognosis. Identifying abnormal levels of proteins or metabolites in body fluids can directly help clinicians to identify certain drug users from others or distinct the addiction stages during drug use. This study was a cohort, non interventional pilot study, with treatment of usual procedure consistent with the real world practice. The main aim of the study was to look for potential biomarkers of heroin addiction. To do this, proteomic profiles of human saliva were analysed in heroin use disorder individuals at treatment entry (individuals using daily street heroin); the procedure was then repeated in the same subjects after treatment stabilization with methadone. Correlations between serum level of methadone and clinical variables was also performed. Particularly, psychopathological domains (the heroin use disorder 5 specific psychopathological factors), behavioural covariates of craving, and stress-reaction have been compared in the same individuals at treatment entry and after pharmacological stabilization. The results showed a few variations into proteomic profile of heroin use disorder (HUD) individuals entering methadone treatment and after 6 months of continuous methadone treatment. Opposite than at T0, proteomic profiles showed greater dishomogeneity among individuals after 6 months of pharmacological intervention. The proteins, which showed variations, were those belonging to the immune response, thioredoxin, albumin, prolactin-inducing protein and cystatins. Interestingly amylases showed an apparent correlation with the 5 specific psychopathological domains. From a clinical perspective, all HUD individuals improved after treatment. The 5 main domains of psychopathology showed a significant reduction in severity, but the typology was stable from a qualitative point a view even after methadone treatment. Addictive behaviours and sensitivity to stress exhibited a great improvement. Regarding to methadone dosage, no correlation was found between dosage taken orally and blood level concentration. A positive correlation between methadone dosage and severity of cue induced/environmental addicted behaviour was found while there was a negative correlation between methadone blood concentration and maladaptive coping and arousal symptoms. In conclusions this study suggests that even in the field of substance use disorder it is possible to use correlations between patient clinical and biochemical characteristics for a better personalization of diagnostic and therapeutic interventions