Addiction is a chronic and relapsing psychiatric disorder affecting a large number of patients worldwide. Ample evidence from basic and clinical neuroscience has demonstrated that addiction is a brain disease marked by compulsive substance use despite a host of negative consequences. Although extensive preclinical research has elucidated some of the key neurobiological underpinnings of addiction, these findings have yet to be translated into clinical practice. This article provides a review of addiction neurobiology while applying these insights to the understanding of the clinical phenomenology and treatment of this disorder. Recent progress in the fields of psychology and psychiatry suggests that clinical neuroscience will become increasingly important in clinical psychology science and practice. This review provides a framework for integrating neuroscience and clinical psychology while considering its limitations and opportunities.
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The last three decades in psychological research have been marked by interdisciplinary science. Addiction represents a prime example of a disorder marked by a complex interaction among psychosocial and biological factors. This review highlights critical findings in the basic neuroscience of addiction and translates them into clinical language that can inform clinical psychologists in their research, teaching, and practice. From mechanisms of reward processing, learning and memory, allostasis, incentive-sensitization, withdrawal, tolerance, goal-directed decision making, habit learning, genetics, inflammation, and the microbiome, the common theme of this review is to illustrate the clinical utility of basic neuroscience research and to identify opportunities for clinical science. The thoughtful integration of basic and clinical science provides a powerful tool to fulfill the scientific mission of improving health care. Clinical psychologists have a crucial role to play in the translational science of addiction.
Article1 November 1941THE MORPHINE ABSTINENCE SYNDROME, ITS NATURE AND TREATMENTC. K. HIMMELSBACH, M.D.C. K. HIMMELSBACH, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-15-5-829 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDrug addiction is a condition in which an individual has become sufficiently subject to an effect of a drug that he can no longer exert adequate self-control with regard to its continued use. Consequently, a separation of the patient from the drug is essential to successful treatment for drug addiction, no matter whether it has been established to opiates, marijuana, barbiturates, alcohol, tobacco, caffeine, or to any other drug or combination. The various drug addictions differ from one another in the manner and extent to which they confer tolerance, habituation, and physical dependence. Tolerance is the term used to denote...References1. JEWETT SP: Cocain addiction, Tice, Practice of Med., 1935, viii, 53-55. Google Scholar2. DREISBACH RH: Experimental caffeine withdrawal headache, Proc. Am. Soc. Pharm. and Exper. Therap., 1940, lxix, 283. Google Scholar3. ANDREWS HL: Some effects of morphine and morphine addiction on the human electroencephalogram (in press). Google Scholar4. WILLIAMS EG: Blood concentration in morphine addicts, Jr. Pharm. and Exper. Therap., 1939, lxvii, 290. Google Scholar5. MORAT D: Le sang et les sécrétions au corus de la morphinomanie et de la desintoxication, 1911, Thèse de Paris. Google Scholar6. ROWNTREE LG: The effects on mammals of the administration of excessive quantities of water, Jr. Pharm. and Exper. Therap., 1926, xxix, 135. Google Scholar7. GRINKERSEROTA RRH: Studies on corticohypothalamic relations in the cat and man, Jr. Neurophysiol., 1938, i, 573-589. CrossrefGoogle Scholar8. KOLBHIMMELSBACH LCK: Clinical studies of drug addiction. III. A critical review of withdrawal treatments with method of evaluating abstinence syndromes, Am. Jr. Psychiat., 1938, xciv, 759. CrossrefGoogle Scholar9. Report of the Mayor's Committee on Drug Addiction, Am. Jr. Psychiat., 1930, x, 433. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: United States Public Health Service United States Public Health Service Hospital Lexington, Kentucky*Received for publication October 30, 1940.Presented at the Southern Psychiatric Assoc., Jacksonville, Florida, October 22, 1940.The term "morphine" as used throughout this paper includes the phenanthrene derivatives of opium used in the practice of medicine. 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following chronic pentobarbital dosing in catDescriptive Study of Behavior during Transition from Heroin Addict to Methadone PatientHuman sleep and EEG through a cycle of methadone dependenceThe Management of Drug Abuse in Aging Populations: New Orleans FindingsSubjective Experiences Produced by the Withdrawal of OpiatesThe narcotic addict as a medical patientThe Experimental Production of Narcotic Drug Effects and Withdrawal Symptoms Through HypnosisObstetric and gynecologic aspects of heroin addictionTreatment of drug addiction 1 November 1941Volume 15, Issue 5Page: 829-839KeywordsAlcoholsCaffeineDrug addictionDrugsMarijuanaMorphineOpiatesOpium Issue Published: 1 November 1941 PDF downloadLoading ...
Addiction is a growing public health crisis, yet comparatively very few health services psychology programs include formal training in addiction science (Dimoff, Sayette, Norcross, 2017). Health services psychologists (i.e., psychologists who integrate psychological science and practice to understand development and functioning; APA, 2015) are well-suited to study and treat addiction, and doctoral level training is an ideal time to prepare future health services psychologists to do so. One possible barrier to incorporating addiction science training is the necessity of a multidisciplinary approach to study and treat addiction and related health behaviors. We focus primarily on clinical science training and argue for a multi-faceted approach to doctoral training in addiction science that would prepare trainees for research careers. The proposed training model emphasizes the importance of mentorship, coursework, grant preparation, responsible conduct of research, prevention, intervention, and treatment, and invited speakers and conference attendance. Each of these components is discussed with an emphasis on addiction science. We offer suggestions for incorporating portions of this training model for programs with few addiction science related resources. We also discuss the importance of enhancing diversity and inclusion in addiction training and offer brief recommendations on this topic.
Addiction has emerged as a serious public health crisis. Clinical psychology as a hub science has a long-standing interest in addiction and is particularly well suited to offer multifaceted treatment to those struggling with substance use disorders. To examine how well clinical psychology training is addressing this proliferation of addiction-related problems, we surveyed the directors of clinical training at all APA-accredited U.S. clinical psychology doctoral programs on 7 occasions between 1999 and 2013. The number of clinical programs rose from 181 to 237 programs across the years, with at least 95% response at each wave of data collection. Results indicated that less than 40% of programs had even 1 faculty member studying addiction, and less than 1 third offered any specialty clinical training in addiction. Results also revealed that both the percentage of programs reporting any faculty studying addiction and the percentage of programs offering specialty clinics in addiction have not increased over the 14-year period. We argue that clinical psychology training must bolster its focus on addiction research and practice. (PsycINFO Database Record
Dr. Dilip Jeste, the then President of the American Psychiatric Association, released the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5)[1] on May 18, 2013 at the 166th Annual Meeting of the APA at San Francisco. This was a landmark achievement for the APA. Indian psychiatrists should take additional pride in the fact that Dr. Dilip V. Jeste is actually one of us. He used to be an Overseas Member of the Indian Psychiatric Society (IPS). HISTORY OF THE DSM Earliest documented efforts to gather epidemiological data on mental illness commenced in the USA in the year 1840. Mental illnesses were then classified under a single category of idiocy/insanity. Inaccurately defined categories of mental illness like mania, melancholia, monomania, general paralysis of the insane, dementia, and dipsomania were included in the US Census of 1880. In 1918, the American Medico-Psychological Association published a manual of classification of mental illnesses that listed 22 categories. The manual was designed for the use of Institutions for the Insane. The American Medico-Psychological Association was later renamed APA in 1921. During World War II, the US army prepared a manual of medical illnesses called the ‘Medical 203’. The US Navy revised the Medical 203 to formulate the “Standard Classified Nomenclature of Disease” or the “Standard”. Office of the US Surgeon General adopted the Standard to classify illnesses on the battle grounds and among veterans returning from the war. The Veterans Administration adopted the Standard with few modifications. After the war, psychiatrist with experience of using the Standard during the Second World War continued to use it in civilian practice. The World Health Organization (WHO) included a chapter on Mental Disorders in its International classification of Diseases (ICD) 6 (1949). It resembled the Standard. In the year 1950, the APA set up a committee on nomenclature and statistics. This committee published the first DSM in the year 1952.[23456] The first edition of DSM (1952) was titled ‘Diagnostic and Statistical Manual of Mental Disorders’. It did not carry any number attached to its title. Authors of the manual had perhaps not envisaged that the manual would be revised periodically. The second edition (1968) was titled Diagnostic and Statistical Manual of Mental Disorders, Second Edition. The trend of fixing a roman suffix to the newer editions of the DSM commenced with the third edition which was titled DSM III (1980). DSM III also pioneered the multiaxial system of evaluation and classification of mental disorders. A revised version was christened DSM III R (1987). The trend continued while publishing the DSM IV (1994) and its text revised edition the DSM IV TR (2000).[23456] The most recent edition of the DSM was initially labeled DSM V. As the process of developing the manual progressed, the Roman numerical ‘V’ was replaced by the alpha numerical ‘5’. This would facilitate subsequent revisions being numbered as 5.1, 5.2 and so forth. While facilitating the numbering, it is also a tacit acceptance that the DSM 5 is not the ultimate manual of classification of mental disorders. It is a document that reflects current consensus of the leading academicians, clinicians, and researchers in the field of mental health.[567] METHODOLOGY By the year 1999, even as the DSM IV TR was being published, clinicians and researchers had noticed several flaws in the DSM IV. The DSM IV TR (2000) did not propose any substantial modifications to the doctrine of DSM IV (1994). The diagnostic criteria continued to result in rather frequent diagnosis of comorbidity. Heterogeneity within the diagnostic groups was unacceptable to the researchers and it contaminated treatment outcome. The erratic thresholds for inclusion and exclusion could not differentiate the normal from abnormal or syndromal from subsyndromal disorders. Clinicians would then resort to the not otherwise specified (NOS) diagnoses. The DSM IV did not consider emerging clinical conditions like addiction to the internet or the so called nocturnal refrigerator raids. Some authors had noticed that the number of psychiatric classification had “swollen to kaleidoscope of putative disorders”.[2389101112] These are some of the salient features that prompted leaders in the field led by Dr. Steven M. Mirin, the then Medical Director of the APA; Dr. Steven Hyman the then Director of National Institute of Mental Health (NIMH); and Dr. David Kupfer, the then Chairman of the APA's Committee on Psychiatric Diagnosis and Assessment, to take cognizance of the scope for the APA and NIMH to work together and explore scientific basis for diagnosis and classification of mental disorders. It reflects the need for urgency and prominence of mental disorders. An important component of mental disorders is that unlike physical illnesses that incorporate a socially acceptable sick role, mental disorders could stigmatize personal sense of identity.[1213] The first DSM 5 Research Planning Conference of 1999 was attended by invited participants. The planning conference included experts in family and twin studies, molecular genetics, basic and clinical neurosciences, cognitive and behavioral sciences, and covered issues in development throughout the lifespan and disability. The conference focused on issues like lacunae in the DSM IV system of classification, disability and impairment, newer insights from the research in neuroscience, need for improved nomenclature, and the impact of cross cultural issues. The thrust at the planning stage itself was to look beyond the DSM IV. Participants closely involved in the process of developing DSM IV were not invited to participate in the process of developing the DSM 5. By the year 2008, Dr. Darrel A. Reiger then the Executive Director of the American Psychiatric Institute for Research and Education (APIRE), leaders from the WHO and the World Psychiatric Association (WPA) and 397 participants nearly half of them from outside of the US, were involved in the process of developing the DSM 5. All the working group members were reviewed for potential conflict of interest and approved by the APA Board of Trustees.[1314] DSM 5 is essentially a joint effort of APA, the National Institutes of Health USA viz the NIMH, National Institute of Drug Abuse, and the National Institute of Alcoholism and Alcohol abuse; the WHO and the WPA. Dr. David Kupfer, MD and Dr. Darrel A. Reiger led the team of more than 397 participants working in 13 work groups, six study groups, and a task force of advocates, clinicians, and researchers since the year 2008. Each committee had co-chairs from both the US and another country. The entire process maintained transparency by publishing minutes of every meeting and monographs of their proceedings on the APA website, presentations at scientific conferences with question-and-answer opportunity at countless national and international conferences, they held grand rounds at leading university medical center, and presented posters as well as papers at the annual meetings of the APA.[1314] The years of relentless efforts include evidence based planning; field trials; revising; seeking; and incorporating feedback, suggestions, and objections from the stake holders, public, patient, and other interested groups worldwide; revising again; and obtaining approval of the Board of Trustees of the APA. The process finally concluded with the publication of DSM 5 on the morning of May 18, 2013 at the 166th Annual Meeting of the APA at San Francisco. THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS 5 DSM 5 does not claim to be the ultimate or the final word in classification of mental disorders. It is a manual that reflects current state of knowledge and consensus among leaders in the field.[15] It is a 947 page manual, divided into three sections and an appendix. Section I is the basics which includes introduction, instruction on how to use the manual, and a chapter on cautionary statement for forensic use of DSM 5. Section II of the manual lists diagnostic criteria and codes of 22 diagnostic categories. DSM 5 has a single axis format and considers the relevance of age, gender, and culture. The manual lists ICD 9 Clinical Modification (CM) and ICD 10 CM codes for each diagnostic category. The APA is scheduled to switch over to ICD 10 CM codes from October 01, 2014. Section III is on the emerging measures and models. It covers self-rated cross-cutting symptom measures for adults, children, and adolescents between age 6 and 17 years; WHO Disability Assessment Schedule 2, an alternative DSM 5 model for personality disorders; and a list of conditions for further study. Cultural Formulation Interview with guide for the interviewer.[1] Dr. Dilip Jeste[15] had clearly stated at the release of the DSM 5 that goal of DSM 5 is to help clinicians make more accurate diagnoses and improve patient outcomes. When viewed in totality, DSM 5 is not very much different from DSM IV. All major categories of mental disorders in Section II of the DSM 5 have listed specifiers and precise instructions about coding the severity of the disorder on a five point scale, where applicable. The new approach combines the former axes I, II, and III into a single axis. Psychosocial and contextual factors (formerly axis IV) and disability (formerly axis V) have to be rated separately. The DSM 5 specifies that psychosocial and contextual factors be rated on the Z code of ICD 10 CM or V codes of ICD 9 CM. It has replaced the GAF with the World Health Organization's Disability Assessment Schedule 2 (WHODAS 2). Section III DSM 5 has 36 item self-administered version of the WHODAS 2. A set of flash cards to administer the WHODAS 2 may be downloaded online from www.who.int/classifications/icf/whodasii/en.[16] There is a provision in DSM 5 to obtain better understanding of the patient's perception of the dynamics of the mental disorder with the help of prompt driven Cultural Formulation Interview (CFI) included in Section III of the DSM 5.[116] DIMENSIONS OF MENTAL DISORDERS Clinicians frequently encounter depressed patients experiencing panic or patients of schizophrenia with varying degrees of impairment or a patient exhibiting symptoms of anxiety that could not be clearly labeled as abnormal. DSM IV did not provide clear guidelines to categorize such cases. Panic attacks in a patient of depression invited two comorbid diagnoses. The longitudinal course specifiers of schizophrenia in DSM IV or DSM IV TR did not clearly differentiate symptom free patient of schizophrenia from a patient experiencing florid symptoms. An anxious adolescent was often a diagnostic dilemma. The dimensional approach of DSM 5 rates magnitude of individual symptoms. The dimensional model helps to grade and chart the course of the disorder. It thus differentiates normal from the abnormal. It can be used as an apparatus to screen for mental disorders in general population or be used as an instrument to conduct study of prevalence of mental disorders in a given community.[16] Many of the procedures that were adopted while developing the DSM 5 are improvised versions of those of the previous editions of DSM.[1] Yet the DSM 5 is a indeed a unique manual. It includes published American and global information on mental disorders. Where needed, the DSM committees planned and conducted specifically designed studies in academic institutions and in clinical practice. The new knowledge thus gained during the planning of the manual from clinical practice within and outside the US was integrated in the text of the DSM 5. It also amalgamates manuals like the ICD and the Disability Assessment Schedules, while providing an avenue for the individual clinician to study cultural components of mental illness, worldwide. Critics of the DSM 5 feel that the state of current knowledge does not justify a new classification. They doubt whether the current understanding of psychopathology or the phenomenology augment clinician's competence to make a clinical diagnoses by objective parameters or measurable criteria. Dr. Thomas Insel voiced that Research Domain Criteria (RDoC) would be a better diagnostic tool. Later, the then APA President elect Dr. Jeffrey Liebermann, and Dr. Thomas Insel issued a joint statement as they noted that criteria that are important for clinical practice may not be sufficient for researchers. In a joint statement they said “…Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior”.[17] CONCLUSION DSM 5 indeed is a manual of the state of knowledge of the mental disorders, by experts in the field of mental health and related professions, for the betterment of those involved with mental disorders including patients, clinicians, researchers, administrators, insurance companies, and other stakeholders. It has retained the categorical model of DSM IV in large proportion. Some clinical conditions have been recategorized. Dimensions of individual clinical condition are added. We will have to understand and apply them in our clinical practice ahead of meaningful debates on their relevance. At this moment, one would readily concur with Dr. Jeffrey Liebermann and Dr. Thomas Insel that “….along with the International Classification of Diseases, the DSM (5) represents the best information currently available for clinical diagnosis of mental disorders” and that the two publications “remain the contemporary consensus standard to how mental disorders are diagnosed and treated”.[17]
AIMS: Amazon Mechanical Turk (MTurk) provides a crowdsourcing platform for the engagement of potential research participants with data collection instruments. This review (1) provides an introduction to the mechanics and validity of MTurk research; (2) gives examples of MTurk research; and (3) discusses current limitations and best practices in MTurk research. METHODS: We review four use cases of MTurk for research relevant to addictions: (1) the development of novel measures, (2) testing interventions, (3) the collection of longitudinal use data to determine the feasibility of longer-term studies of substance use and (4) the completion of large batteries of assessments to characterize the relationships between measured constructs. We review concerns with the platform, ways of mitigating these and important information to include when presenting findings. RESULTS: MTurk has proved to be a useful source of data for behavioral science more broadly, with specific applications to addiction science. However, it is still not appropriate for all use cases, such as population-level inference. To live up to the potential of highly transparent, reproducible science from MTurk, researchers should clearly report inclusion/exclusion criteria, data quality checks and reasons for excluding collected data, how and when data were collected and both targeted and actual participant compensation. CONCLUSIONS: Although on-line survey research is not a substitute for random sampling or clinical recruitment, the Mechanical Turk community of both participants and researchers has developed multiple tools to promote data quality, fairness and rigor. Overall, Mechanical Turk has provided a useful source of convenience samples despite its limitations and has demonstrated utility in the engagement of relevant groups for addiction science.
BACKGROUND: Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships. METHODS: We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul's Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software. RESULTS: We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training. CONCLUSIONS: Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.
In the last decade, Internet usage has grown tremendously on a global scale. The increasing popularity and frequency of Internet use has led to an increasing number of reports highlighting the potential negative consequences of overuse. Over the last decade, research into Internet addiction has proliferated. This paper reviews the existing 68 epidemiological studies of Internet addiction that (i) contain quantitative empirical data, (ii) have been published after 2000, (iii) include an analysis relating to Internet addiction, (iv) include a minimum of 1000 participants, and (v) provide a full-text article published in English using the database Web of Science. Assessment tools and conceptualisations, prevalence, and associated factors in adolescents and adults are scrutinised. The results reveal the following. First, no gold standard of Internet addiction classification exists as 21 different assessment instruments have been identified. They adopt official criteria for substance use disorders or pathological gambling, no or few criteria relevant for an addiction diagnosis, time spent online, or resulting problems. Second, reported prevalence rates differ as a consequence of different assessment tools and cut-offs, ranging from 0.8% in Italy to 26.7% in Hong Kong. Third, Internet addiction is associated with a number of sociodemographic, Internet use, and psychosocial factors, as well as comorbid symptoms and disorder in adolescents and adults. The results indicate that a number of core symptoms (i.e., compulsive use, negative outcomes and salience) appear relevant for diagnosis, which assimilates Internet addiction and other addictive disorders and also differentiates them, implying a conceptualisation as syndrome with similar etiology and components, but different expressions of addictions. Limitations include the exclusion of studies with smaller sample sizes and studies focusing on specific online behaviours. Conclusively, there is a need for nosological precision so that ultimately those in need can be helped by translating the scientific evidence established in the context of Internet addiction into actual clinical practice.
BACKGROUND: Street-based heroin injectors represent an especially vulnerable population group subject to negative health outcomes and social stigma. Effective clinical treatment and public health intervention for this population requires an understanding of their cultural environment and experiences. Social science theory and methods offer tools to understand the reasons for economic and ethnic disparities that cause individual suffering and stress at the institutional level. METHODS AND FINDINGS: We used a cross-methodological approach that incorporated quantitative, clinical, and ethnographic data collected by two contemporaneous long-term San Francisco studies, one epidemiological and one ethnographic, to explore the impact of ethnicity on street-based heroin-injecting men 45 years of age or older who were self-identified as either African American or white. We triangulated our ethnographic findings by statistically examining 14 relevant epidemiological variables stratified by median age and ethnicity. We observed significant differences in social practices between self-identified African Americans and whites in our ethnographic social network sample with respect to patterns of (1) drug consumption; (2) income generation; (3) social and institutional relationships; and (4) personal health and hygiene. African Americans and whites tended to experience different structural relationships to their shared condition of addiction and poverty. Specifically, this generation of San Francisco injectors grew up as the children of poor rural to urban immigrants in an era (the late 1960s through 1970s) when industrial jobs disappeared and heroin became fashionable. This was also when violent segregated inner city youth gangs proliferated and the federal government initiated its "War on Drugs." African Americans had earlier and more negative contact with law enforcement but maintained long-term ties with their extended families. Most of the whites were expelled from their families when they began engaging in drug-related crime. These historical-structural conditions generated distinct presentations of self. Whites styled themselves as outcasts, defeated by addiction. They professed to be injecting heroin to stave off "dopesickness" rather than to seek pleasure. African Americans, in contrast, cast their physical addiction as an oppositional pursuit of autonomy and pleasure. They considered themselves to be professional outlaws and rejected any appearance of abjection. Many, but not all, of these ethnographic findings were corroborated by our epidemiological data, highlighting the variability of behaviors within ethnic categories. CONCLUSIONS: Bringing quantitative and qualitative methodologies and perspectives into a collaborative dialog among cross-disciplinary researchers highlights the fact that clinical practice must go beyond simple racial or cultural categories. A clinical social science approach provides insights into how sociocultural processes are mediated by historically rooted and institutionally enforced power relations. Recognizing the logical underpinnings of ethnically specific behavioral patterns of street-based injectors is the foundation for cultural competence and for successful clinical relationships. It reduces the risk of suboptimal medical care for an exceptionally vulnerable and challenging patient population. Social science approaches can also help explain larger-scale patterns of health disparities; inform new approaches to structural and institutional-level public health initiatives; and enable clinicians to take more leadership in changing public policies that have negative health consequences.
BACKGROUND: The relative paucity of research on Addiction-Affected Families' (AAF) issues and the lack of attention given to their difficulties and treatment in interventions and clinical practices indicate that the primary focus consistently revolves around individuals with addictive disorders, even when the treatment process involves their families. However, it is believed that family members endure significant pressures that result in extensive negative consequences on the personal, familial, and social aspects of their lives. Aiming for a better understanding of the challenges and issues that AAF's experience, this systematic review explored qualitative studies with a focus on the impact of addiction on different aspects of families. METHODS: We searched Research Gate, Scopus, Web of Science, ProQuest, Elsevier, and Google Scholar Databases. We included studies of qualitative design which have investigated the effects of addiction on families. Non-English language studies, medical views, and quantitative approaches were excluded. Participants in the selected studies included parents, children, couples, sisters/brothers, relatives, drug users and specialists. The data from the selected studies were extracted using a standard format for the systematic review of qualitative research (the National Institute of Health and Care Excellence [NICE] 2102a). RESULTS: A thematic analysis of the findings of the studies identified 5 main themes: 1) initial shock (family encounter, searching for why), 2) family in the fog (social isolation, stigma and label), 3) sequence of disorders (emotional decline, negative behavioral experiences, mental disturbance, physical degeneration, family burden), 4) internal family chaos (instability of relationships, shadow people, erosive confrontation with the drug-using member, a newly emerging member, collapsing system, financial collapse), and 5) self-protection (attracting information, support, and protective sources, coping and adjusting the effects, the emergence of spirituality). CONCLUSION: This systematic review of qualitative research highlights the various and complex issues which addiction-affected families go through in terms of financial, social, cultural, mental and physical health problems, as a result of which experts of the field are needed to investigate and take measures. The findings can inform policy and practice and the development of interventions aimed to lighten the burdens which addiction-affected families carry.
The intersection of pharmacological, psychological, and economic theory within behavioral economics has helped advance an understanding of substance use disorder. A notable contribution of this approach is the conceptualization of reinforcement from a behavioral economic demand perspective. Demand analyses provide a multidimensional view of reinforcement in which distinct behavioral mechanisms are measured that impact decision making and drug consumption. This review describes the state of research on behavioral economic demand as a common language for addiction science researchers across varied model systems and stages of a translational continuum. We first provide an overview of the theoretical concepts and procedures used to evaluate demand in animal and human models. The potential for demand to serve as a common language for diverse research groups in psychopharmacology and addiction science (e.g., those evaluating neurobehavioral outcomes, medications development, clinical practice) is then described. An overview is also provided of existing empirical studies that, while small in number, suggest good linguistic and conceptual overlap between animal and human demand models when studying biological, environmental, and pharmacological individual difference vulnerabilities underlying drug-taking behavior. Refinement of methodological procedures and incorporation of more nuanced environmental features should help improve correspondence between animal and human demand studies as well as clinical translation of such findings. Our hope is that this review and commentary ultimately serves as inspiration for new collaborative efforts involving behavioral economic demand between animal and human researchers who share a common goal of improving substance use treatment outcomes and broader psychological wellbeing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Substance and alcohol use disorders cause an enormous amount of human suffering, loss of productivity, costs to our medical care system, and costs to the economy. This chapter provides a heuristic conceptual framework for alcohol and other substance use disorders, in which we integrate preclinical and clinical advances in the neuroscience of addiction that are pertinent to the prevention and management of these disorders. Conceptualization of addiction as a three-component cycle consisting of a binge/intoxication stage, a withdrawal/negative affect stage, and a preoccupation/anticipation (craving) stage has allowed identification of key neurocircuits that underlie addiction to alcohol and many other drugs. Each stage of the addiction cycle is hypothesized to represent a different domain of dysfunction that is mediated by a different neurobiological circuit. The binge/intoxication stage involves recruitment of reward neurotransmission in the basal ganglia to drive incentive salience and pathological habits. The withdrawal/negative affect stage involves loss of reward neurotransmission and gain of stress neurotransmission in the extended amygdala to drive the negative emotional state of withdrawal. The preoccupation/anticipation stage involves dysregulation of the prefrontal cortex to drive abnormal executive function and craving. Molecular genetic mediation and epigenetic loads on these same three major neurocircuits are hypothesized to confer environment-dependent and environment-independent vulnerabilities to addiction and thus represent promising targets for the development of novel approaches to strengthen resilience and prevent relapse. Accumulating data show how existing treatments for addiction work on these neurocircuits, and the growing knowledge base on the neurocircuitry of addiction provides evidence-supported information for the development of novel, science-based approaches to diagnosis, prevention, and treatment. Such advances will facilitate implementation of evidence-based practices in primary care, mental health care, and other health care settings.
AIMS: The clinical practice and science of addiction are increasingly active fields, which are attracting professionals from diverse disciplines such as psychology and neurobiology. Our scientific knowledge of the pathophysiology of addiction is rapidly growing, along with the variety of effective treatments available to clinicians. Yet, we believe that the medical specialties of addiction medicine/psychiatry are not attracting the interest and enthusiasm of young physicians. What can be done? METHODS: We offer the opinions of two experience addiction psychiatrists. RESULTS: In the US, there has been a decline in the number of psychiatrists seeking training or board certification in addiction psychiatry; about one-third of graduates with such training are not practicing in an addiction psychiatry setting. There is widespread neglect of addiction medicine/psychiatry among the medical profession, academia and national health authorities. This neglect is unfortunate, given the enormous societal costs of addiction (3-5% of the gross domestic product in some developed countries), the substantial unmet need for addiction treatment, and the highly favourable benefit to cost yield (at least 7:1) from treatment. CONCLUSIONS: We believe that addiction medicine/psychiatry can be made more attractive for young physicians. Helpful steps include widening acceptance as a medical specialty or subspecialty, reducing the social stigma against people with substance use disorders, expanding insurance coverage and increasing the low rates of reimbursement for physicians. These steps would be easier to take with broader societal (and political) recognition of substance use disorders as a major cause of premature death, morbidity and economic burden.
Dante’s Inferno may have been far more than a religious epic。 New research argues that the 14th-century poet essentially imagined a catastrophic asteroid impact centuries before modern science understood meteors。 In this interpretation, Satan crashes into Earth like a giant cosmic object, blasting through the Southern Hemisphere and reshaping the p
BACKGROUND: Information technology can be used to advance addiction science and clinical practice. MAIN BODY: This special issue, "Information technology (IT) interventions to advance treatment for opioid and other addictions" presents studies that expand our understanding of IT intervention efficacy, patients' perspectives, and how IT can be used to improve substance use health care and research. This editorial introduces the topics addressed in the special issue and focuses on some of the challenges that the field is currently facing, such as attrition and treatment retention, transferability of intervention paradigms, and the challenge to keep pace with rapidly changing technologies. CONCLUSIONS: Increasing treatment reach is particularly crucial in the addiction field. IT empowers researchers and clinicians to reach large portions of the population who might not otherwise access standard treatment modalities, because of geographical limitations, logistical constraints, stigma, or other reasons. The use of information technology may help reduce the substance use treatment gap and contribute to public health efforts to diminish the impact of substance use and other addictive behaviors on population health.
: A Focused Update of the ASAM National Practice Guideline for the Treatment of Opioid Use Disorder is published in the current issue of the Journal of Addiction Medicine. The focused update included a search of Medline's PubMed database from January 1, 2014 to September 27, 2018, as well as a search of the grey literature (archives of the Clinical Guideline Clearinghouse, and key agency and society websites) for new practice guidelines and relevant systematic reviews addressing the use of medications and psychosocial treatments in the treatment of opioid use disorder, including within special populations. The search identified 11 practice guidelines and 35 systematic reviews that informed the subsequent RAND/UCLA Appropriateness Method (RAM) process employed to facilitate the focused update by a National Guideline Committee of addiction experts. New and updated recommendations were included if they were considered: (a) clinically meaningful and applicable to a broad range of clinicians treating addiction involving opioid use; and (b) urgently needed to ensure the Practice Guideline reflects the current state of the science for the existing recommendations, aligns with other relevant practice guidelines, and reflects newly approved medications and formulations.
Penn researchers have developed a smarter AI method for solving notoriously difficult inverse equations, which help scientists uncover hidden causes behind observable effects。 By introducing “mollifier layers” that smooth noisy data, they’ve made these calculations more stable and far less computationally demanding。 This could transform fields like