Intact responses to non-drug rewards in long-term opioid maintenance treatment

Background. Drug dependence is associated with disrupted reward processing and anhedonia across drug use disorders. It remains unclear whether chronic drug use disrupts reward processing. Alternative causes could be psychosocial vulnerability factors or stress from recurring relapse to drug use. Methods. We measured subjective and objective reward responsiveness in 26 previously heroin-addicted mothers with a minimum of seven years stable opioid maintenance treatment (OMT) and 30 healthy age-matched mothers (COMP). Objective reward responsiveness was assessed in a 300-trial two-alternative forced-choice task with skewed rewards. Results were also compared to performance from an additional 968 healthy volunteers (meta-analytic approach). Finally, we compared subprocesses of reward-based decisions across groups using computational modelling with a Bayesian drift diffusion model of decision making (DDM). Results. Self-reported reward responsiveness was comparable for the OMT and comparison groups (means: OMT=6.59, COMP=6.67, p=.84, BF10=0.29), yielding moderate evidence against subjective anhedonia in this OMT group. Importantly, the mothers in OMT also displayed intact reward responsiveness in the objective behavioral task. Indeed, their performance did not significantly differ from that of the local comparison group (means OMT=0.12, COMP=0.12, p=.96, BF10=0.18) and was comparable to data from 968 healthy controls previously tested. Objective reward responsiveness was comparable even at the level of decision sub-processes, as estimated by computational modelling. Conclusions. Mothers in stable long-term opioid maintenance treatment displayed intact reward responsiveness as measured by reward behavior and self-report. Hence, reduced sensitivity to rewards and anhedonia are not necessary consequences of prolonged opioid use

State of the science in women's cardiovascular disease : a Canadian perspective on the influence of sex and gender

Cardiovascular disease (CVD) is the leading cause of premature death for women in Canada.1 Although it has long been recognized that estrogen impacts vascular responses in women, there is emerging evidence that physiologic and pathophysiologic cardiovascular responses are uniquely affected across the spectrum of a woman's life. Despite a global understanding that manifestations and outcomes of CVD are known to differ between men and women, uptake of the recognition of sex and gender influences on the clinical care of women has been slow or absent.2 To highlight the need for better research, diagnosis, treatment, awareness, and support of women with CVD in Canada, the Canadian Women's Heart Health Alliance (CWHHA), supported by the University of Ottawa Heart Institute, and in collaboration with the Heart and Stroke Foundation of Canada (HSFC), undertook a comprehensive review of the evidence on sex‐ and gender‐specific differences in comorbidities, risk factors, disease awareness, presentation, diagnosis, and treatment across the entire spectrum of CVD. The intent of this review was not to directly compare women and men on epidemiological and outcome measures of CVD, but to synthesize the state of the evidence for CVD in women and identify significant knowledge gaps that hinder the transformation to clinical practice and care that is truly tailored for women, a significant health challenge that has only been recognized in Canada relatively recently. This review highlights the scarcity of Canadian data on CVD in women as part of the ongoing struggle to increase awareness of and improve outcomes for women with CVD. Because of a paucity of published Canada‐specific evidence, the purpose of this review is to provide an infrastructure to summarize world‐wide published evidence, including knowledge gaps that must be understood to then make effective recommendations to alleviate the glaring “unders” of CVD for women in Canada: under‐aware, under‐diagnosed and under‐treated, under‐researched, and under‐support

The Canadian Women’s Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations

This final chapter of the Canadian Women’s Heart Health Alliance “ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women” presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women’s cardiovascular care, with the goal to improve outcomes for women in Canada. Résumé: Dans ce chapitre final de l’ATLAS sur l’épidémiologie, le diagnostic et la prise en charge de la maladie cardiovasculaire chez les femmes de l’Alliance canadienne de santé cardiaque pour les femmes, nous présentons les points saillants de l’ATLAS au sujet de l’état actuel des soins cardiovasculaires offerts aux femmes, ainsi que des défis et des occasions dans ce domaine. Nous concluons par 12 recommandations concrètes sur les prochaines étapes à entreprendre pour donner suite aux progrès déjà réalisés afin de combler les lacunes dans les connaissances, en s’attaquant aux disparités qui subsistent dans les soins cardiovasculaires prodigués aux femmes, dans le but d’améliorer les résultats de santé des femmes au Canada