A Scoping Review of the Literature on Trauma Cue-Induced Drug Craving in Substance Users with Trauma Histories or PTSD

Among trauma-exposed individuals, substances may be used as a means of obtaining symptom relief following exposure to trauma reminders. Repeated pairing of trauma cues with substance use may lead to the development of classically conditioned craving to trauma cues. Conditioned craving following cue exposure can be studied in-lab using the cue-reactivity paradigm. To map cue-reactivity research conducted with trauma-exposed substance users, we aimed to synthesize research which studied our population of interest, used a cue-reactivity paradigm, and measured craving as an outcome. Three databases were searched using relevant keywords. Twenty-eight studies met our criteria. Four key 19 themes are discussed in our review of these scoped studies—(1) craving as an outcome; (2) methodological subtypes across paradigms; (3) affect as an additional outcome or as a mediator of cue-induced craving; and (4) cue-reactivity paradigms as an intervention outcome assessment tool. Overall, there is strong evidence for cue-reactivity paradigms as a useful means of eliciting craving in response to trauma cues. Our scoping review suggests the need for a meta-analysis to determine the magnitude of the trauma cue-induced craving effect in substance users with trauma histories, and to determine significant moderators (e.g., PTSD symptom severity) and mediators of this effect (e.g., negative affect)

Endoscopic treatment (endoscopic balloon dilation/self-expandable metal stent) vs surgical resection for the treatment of de novo stenosis in Crohn's disease (ENDOCIR study): an open-label, multicentre, randomized trial.

Background: Stenosis is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilation (EBD) is the treatment of choice for a short stenosis adjacent to the anastomosis from previous surgery. Self-expandable metal stents (SEMS) may be a suitable treatment option for longer stenoses. To date, however, there is no scientific evidence as to whether endoscopic (EBD/SEMS) or surgical treatment is the best approach for de novo or primary stenoses that are less than 10 cm in length. Methods/design: Exploratory study as "proof-of-concept", multicentre, open-label, randomized trial of the treatment of de novo stenosis in the CD; endoscopic treatment (EBD/SEMS) vs surgical resection (SR). The type of endoscopic treatment will initially be with EDB; if a therapeutic failure occurs, then a SEMS will be placed. We estimate 2 years of recruitment and 1 year of follow-up for the assessment of quality of life, costs, complications, and clinical recurrence. After the end of the study, patients will be followed up for 3 years to re-evaluate the variables over the long term. Forty patients with de novo stenosis in CD will be recruited from 15 hospitals in Spain and will be randomly assigned to the endoscopic or surgical treatment groups. The primary aim will be the evaluation of the patient quality of life at 1 year follow-up (% of patients with an increase of 30 points in the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). The secondary aim will be evaluation of the clinical recurrence rate, complications, and costs of both treatments at 1-year follow-up. Discussion: The ENDOCIR trial has been designed to determine whether an endoscopic or surgical approach is therapeutically superior in the treatment of de novo stenosis in CD