Addiction-related behaviors, such as loss of control eating (LOC), cigarette smoking and alcohol consumption, have been associated with high body mass index (BMI). This study aimed to assess genetic and environmental contributions to these associations over time. A longitudinal twin study using data from waves 2 and 3 of the Center on Antisocial Drug Dependence study, employing additive genetic (A), shared environmental (C), nonshared environmental (E) influences and cross-lagged models. Colorado, USA. The sample included 764 male and 997 female same-sex twins. BMI was calculated using self-reported height and weight. LOC was self-reported. Cigarettes smoked per day (CPD) and drinks per week (DPW) were assessed during interviews. We conducted three cross-lagged models: LOC and BMI in males, LOC and BMI in females and CPD and BMI in females, after excluding small phenotypic correlations (|r| < 0.10). Trait stability over time was largely attributable to genetic factors, accounting for 62% of the variance in BMI (both sexes), 11% in LOC (males), 18% in LOC (females) and 56% in CPD (females) at wave 3. Residual effects were mostly from nonshared environmental factors, accounting for 38% of the variance in BMI (both sexes), 76% of LOC (females), 71% of LOC (males) and 44% of CPD (females) at wave 3. A small but statistically significant cross-lagged effect occurred from wave 2 BMI to wave 3 LOC, explaining 12% (males) and 3% (females) of the variance in wave 3 LOC, with genetic factors accounting for most of this effect. No cross-lagged effects emerged from LOC or CPD to BMI. Genetic factors contributing to higher body mass index at an earlier age may also increase the risk of developing loss of control eating later in life, highlighting the importance of early weight-related interventions to prevent the onset of disordered eating behaviors.
Steven Hyman, former director of the National Institute of Mental Health (2012), argued that neuroscience research in psychiatry frequently inherits the DSM's assumption that disorders are discrete entities, even though empirical boundaries between conditions are often porous. In response, Hyman and colleagues advanced the Research Domain Criteria (RDoC), which organizes psychopathology around core neurobiological domains that cut across diagnoses. In a conceptually similar direction, Blum (1995) introduced Reward Deficiency Syndrome (RDS) as a transdiagnostic construct intended to unify substance-related and behavioral addictions. To date, PubMed includes more than 1,650 reports referencing "reward deficiency" and 281 specifically referencing RDS. Recent genome-wide association and pharmacogenomic findings in very large cohorts (88.8 million subjects) are interpreted as supporting dopaminergic dysregulation as a key phenotype underlying RDS vulnerability. The Genetic Addiction Risk Severity (GARS®) panel was developed to estimate liability for RDS and "preaddiction." Notably, many conditions listed in DSM-5 share overlapping genetic polymorphisms, with frequent convergence on pathways involved in dopaminergic neurotransmission. Building on this framework, we propose a biphasic prevention and treatment strategy for both substance (e.g., alcohol, nicotine) and non-substance (e.g., highly palatable food/glucose-related) addictive behaviors. In the acute setting, harm-reduction approaches may require targeted modulation of postsynaptic dopamine receptors (D1-D5) within the nucleus accumbens (NAc). Over longer time horizons, however, durable recovery may depend on restoring dopamine signaling-specifically, promoting dopamine activation and release within the NAc to support dopamine homeostasis. Failure to balance short-term and long-term dopaminergic interventions may contribute to affective instability, maladaptive behavior, and, in vulnerable individuals, suicidal ideation. Individuals with serotonergic/dopaminergic receptor deficits and/or high catechol-O-methyltransferase (COMT) activity may be more likely to self-medicate using substances or behaviors that transiently increase dopamine release. A growing body of evidence suggests that increasing D2 receptor expression in genetically vulnerable populations could reduce addictive risk. Although D2 agonists can downregulate receptors in vivo, in vitro work indicates that sustained stimulation may promote receptor proliferation, and gene-transfer studies producing DRD2 overexpression reduce alcohol and cocaine seeking in rodent models. Finally, naturalistic dopaminergic repletion strategies may represent a safer long-term approach to normalize dopaminergic function, support recovery, and improve quality of life across RDS-related behaviors. (WC 286).
Obesity is associated with societal pressure to eat "healthy", potentially increasing the risk of orthorexia nervosa (ON), an obsession with healthy eating characterized by food hyperselectivity. This observational study explored ON traits in obesity, focusing on food hyperselectivity and categorization strategies. A total of 114 participants with obesity (91 women, 20 men, 3 gender-diverse; Age = 44.6 ± 10.5; BMI = 39.6 ± 7.4) were assessed through an online food categorization task and questionnaires, including the Eating Habits Questionnaire, Eating Disorders Examination Questionnaire, Yale Food Addiction Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorders-7. Quantitative data were analyzed using correlations and regression models. Participants scored high on eating disorders, addictive-like eating behaviors, anxiety, and depression, but not ON traits. However, those with higher ON traits displayed distinct food categorization strategies compared to those with lower ON traits, avoiding categorizing unhealthy foods as healthy. Participants with addictive-like eating behaviors exhibited similar categorization patterns alongside heightened scores for eating disorders, anxiety, and depression. ON traits correlated with risk-averse food evaluation strategies in obesity, emphasizing caution towards "unhealthy" foods, potentially exacerbating restrictive eating behaviors. Integrating these insights into psychological or nutritional interventions could improve support by addressing maladaptive food evaluation.
Problematic smartphone use (PSU), characterized by addictive behaviors such as neglecting other activities and persisting despite harm, has become increasingly prevalent. Ritualized smartphone use, a habitual, unguided, and purposeless interaction with smartphones, reflects dependence on the device itself rather than on specific content, such as social media or games. Despite its significance, the concept of ritualized PSU lacks a rigorous, quantifiable operational definition, hindering empirical progress. This study proposes to operationalize ritualized PSU based upon the frequency of mind-wandering during smartphone use, a cognitive state reflecting low cognitive demand and drifting attention. We conducted a three-month ecological momentary assessment (EMA), collecting real-time self-reports on participant mind-wandering states in conjunction with smartphone screen on/off logs. Our analysis revealed a U-shaped relationship between PSU severity and the tendency to engage in mind-wandering during smartphone use. This finding provides empirical evidence of the inherent heterogeneity of PSU, and the existence of two distinct states: ritualized and non-ritualized PSU. Additionally, we discuss observed correlations between mind-wandering and social anxiety, providing further insight into psychological mechanisms underlying ritualized smartphone behaviors. These findings help to characterize ritualized PSU and highlight cognitive dimensions of this emerging phenomenon.
Problematic social network use (PSNU) has gained increasing attention as a potential disorder due to addictive behavior. However, evidence regarding underlying cognitive mechanisms remains inconsistent. Implicit cognitive processes, such as implicit associations and approach-avoidance tendencies, have been proposed as relevant factors in substance use disorders and behavioral addictions, but their role in PSNU is still unclear. Given similarities in usage behavior between PSNU and tobacco use disorder (TUD), a direct comparison may help to identify converging and diverging mechanisms. In a laboratory study, a sample of N = 178 participants was classified into four groups using a structured diagnostic interview: individuals with PSNU (n = 53), risky use (n = 61), non-problematic use (n = 48), and TUD (n = 16). Implicit cognitions were assessed using the Implicit Association Test (IAT) and the Approach-Avoidance Task (AAT) with behavior-specific stimuli. Group differences were analyzed using ANOVA and ANCOVA, the latter statistical approach controlling for age and psychopathological symptoms. Significant group differences emerged for the IAT, in individuals with PSNU and risky use showing more positive implicit associations towards behavior-related stimuli than the TUD group but did not remain stable when controlling for age and comorbid psychopathological symptoms. No significant group differences were found for approach-avoidance tendencies across all groups. Our results suggest that implicit cognitions may play a more complex role in PSNU than previously assumed. Implicit associations may already occur in early stages of addictive behaviors and approach-avoidance tendencies may depend on contextual and intraindividual factors. Future research should further address these factors, also by using advanced ecologically valid methods.
Vape use in Australian young adults (18-24 years) is the highest of all age groups. With long-term health behaviors established during young adulthood, vaping addiction is concerning, as is establishing appropriate cessation supports for this group. Our qualitative study explored the perspectives and experiences of vaping-related addiction and cessation among Australian young adults. This study was a qualitative study using data from the Generation Vape research study. Twenty semi-structured focus groups were conducted online in February 2023. The Framework Method was used to thematically analyze for key themes and sub-themes. Participants (n=114) were, on average, 21 years old, approximately half were female (51.8%), and most had vaped (78.9%). Our analysis identified three themes: 1) factors facilitating regular vaping; 2) perceptions of vaping addiction; and 3) vaping cessation behaviors. Themes appeared to influence each other and highlighted the nuanced ways young adults understand addiction and reflect on their use. While young adults agreed that vapes were addictive, addiction itself was categorized as habitual (i.e. embedded in daily routine) or compulsive (i.e. an uncontrollable urge) - with varying levels of acceptability. Young adults experiencing addiction to vaping highlighted that this was an unintended outcome, describing cessation challenges of nicotine withdrawal and social temptation. Those not considering cessation felt in control of their use and would avoid addiction, viewing vaping as a transient life-phase. Our findings are timely considering the recent policy changes in Australia. Vaping attitudes and potential misconceptions need to be challenged in young adults who may underestimate addiction. Given that vaping is a socially embedded practice among young adults, support tailored specifically to this group is needed to effectively promote cessation.
Glucagon-like peptide-1 receptor agonists (GLP1RAs) have demonstrated substantial efficacy for obesity and metabolic disease treatment, with emerging evidence suggesting effects on reward-processing pathways and motivated behaviors. Although reductions in food craving and addictive behaviors may be beneficial, some patients anecdotally report diminished motivation and anhedonia-like symptoms during high-dose therapy. This case series highlights a potentially underrecognized neurobehavioral effect associated with high-dose tirzepatide and explores clinical management strategies. Three female patients with obesity treated with high-dose tirzepatide (15 mg·week-1) reported reduced motivation, emotional "flatness," or loss of interest in exercise and previously enjoyable activities despite successful weight loss. Two patients had no prior history of mood disorders, while one patient had a history of depression and anxiety. Symptoms were described as distinct from depressive episodes and emerged after prolonged treatment at or near maximal dosing. One patient independently noted symptom improvement after temporary discontinuation and dose reduction surrounding a medical procedure. All patients underwent tirzepatide dose reduction to 10 mg·week-1 or lower. Two patients experienced marked improvement in motivation and enjoyment of daily activities after dose reduction alone. One patient required adjunctive bupropion therapy, which produced additional symptomatic improvement. Re-escalation of the tirzepatide dose in one patient resulted in recurrence of symptoms without additional weight loss benefit, whereas subsequent dose reduction restored motivation while maintaining weight-loss outcomes. Across all cases, symptom improvement occurred alongside continued weight maintenance or further weight reduction. This case series suggests that anhedonia-like symptoms may occur in a subset of patients receiving high-dose tirzepatide, potentially related to GLP1RA-mediated modulation of mesolimbic dopaminergic pathways. Clinicians should consider monitoring for changes in motivation and reward perception during treatment, particularly at higher doses. Dose reduction, with or without adjunctive dopaminergic therapy such as bupropion, may alleviate symptoms while preserving therapeutic benefits.
Problematic smartphone use (PSU) poses increasing risks to young adults' psychological well-being and daily functioning. While offline social exclusion has been linked to maladaptive behaviors, the effects of cyberostracism-online forms of exclusion-and the mediating role of parental behaviors remain underexplored. Guided by the Need-Threat Model of Ostracism and the Rejection Sensitivity Model, the present study examined whether perceived parental phubbing mediates the relationship between distinct forms of cyberostracism and PSU among Iranian young adults. A total of 428 participants (303 females, 125 males; mean age = 28.03 years, SD = 8.67) completed validated self-report measures assessing cyberostracism (direct, indirect, and ignored), perceived parental phubbing, and PSU. Structural equation modeling was used to test direct and indirect pathways. Results indicated that cyber indirect exclusion was directly associated with higher PSU, whereas the association between direct exclusion and PSU was mediated by increased perceptions of parental phubbing. Cyber-ignoring was not significantly associated with PSU. These findings suggest that the psychological correlates of social media-based exclusion on smartphone use vary according to the type of exclusion, with perceived parental phubbing serving as a key process through which explicit online exclusion is associated with maladaptive smartphone engagement. Overall, these findings underscore the importance of integrating social media exclusion experiences with family-level digital behaviors into theoretical models and targeted interventions aimed at reducing PSU.
Excessive engagement in online gaming and gambling is increasingly prevalent among young individuals, particularly first-year university students, and is associated with significant psychosocial damage. The aim of the present study was to identify empirical clusters among university students reporting problematic online gaming and gambling behaviors and to examine the extent to which these clusters differ from a control group of students without gaming- and gambling-related problems. The sample included 273 first-year university students (180 women and 93 men, aged 18-25 years). Participants were first classified into a subgroup with problematic online gaming or gambling (n = 100) and a non-problematic (control) group (n = 173), based on DSM-5 criteria. A two-step cluster analysis was then conducted exclusively within the problematic subgroup to identify latent profiles, using indicators of addictive behavior severity, engagement with social networks and the internet, impulsivity, emotion dysregulation, gambling-related cognitive distortions, and psychological distress. Subsequently, the identified clusters were compared with each other and with the control group across a broad range of psychological and behavioral indicators. Two clusters were identified, primarily differentiated by the severity of gaming-gambling involvement and associated psychological vulnerabilities. Cluster profiles revealed distinct patterns of impulsivity, emotional deficit, and cognitive biases. Both clusters significantly differed from the control group, with higher scores on all clinical and cognitive measures except for the social internet use and sensation seeking. The findings provide empirical support for the heterogeneity of problematic gaming and gambling among young university students. The identification of discrete subgroups underscores the relevance of individualized prevention and intervention strategies, tailored to the severity and psychological correlates of the addictive behavior(s). These results also highlight the need to refine screening and diagnostic tools within this target population.
The growing popularity of various gambling platforms, the dispositional greed to indulging in it, and the emotional attachment associated with it have led to an unusually alarming attractiveness to gambling behaviors in most young males. This study established a mechanism and adopted Ryan and Deci (2017) self-determination theory(STD) to explain problem gambling through dispositional greed and emotional regulation. A total of 1123 Southeastern Nigerian male sample whose ages ranged from 18 to 30 years (mean age = 24 years, SD = 3.80) participated in the study.The study adopted a cross-sectional design, and participants responded to Problem Gambling Severity of Index (PGSI), Emotion Regulation Questionnaire (ERQ), and Greed Scale. Results of the correlation analysis and Hayes Process Macro showed that emotion regulation was not associated with problem gambling. However, the expressive suppression dimension became positively associated with problem gambling after being enhanced by dispositional greed, which positively associated with problem gambling and further mediated its relationships with both dimensions of emotion regulation. Interventions targeting emotional regulations and dispositional greed may be effective in reducing problem gambling behaviors.
Tobacco use and the screening of nicotine dependence using the Fagerström test among adults with intellectual disabilities (ID) is an understudied public health issue. Despite lower reported prevalence relative to the general population, methodological challenges - particularly the suitability of self-reported tools - limit reliable measurement. This study assesses the convergent validity of the Fagerström test for nicotine dependence (FTND) by comparing it with exhaled carbon monoxide (CO), an objective biomarker of recent smoking, in a sample of adults with ID. Data were collected from an observational cross-sectional validation study during 2024, which investigates addictive behaviors, health indicators, and physical activity among adults with ID in northern France. Nurses administered a standardized questionnaire, including the FTND, and measured exhaled CO using a portable analyzer. Associations were examined using correlation analyses and univariable and multivariable linear regressions controlling for sociodemographic and health variables. Among 35 people who smoke, FTND scores were positively and strongly correlated with exhaled CO (r=0.540, p<0.001). In adjusted regression models, FTND remained a significantly associated factor of CO levels (0.60; 95% CI: 0.17-1.02), alongside age (0.065; 95% CI: 0.00-0.13), employment in sheltered workshops (1.86; 95% CI: -0.07-3.78), and cognitive support needs (-1.62; 95% CI: -3.51-0.26). Analyses conducted on the full sample, including 68 people who do not smoke, yielded consistent results, with FTND remaining the strongest predictor of exhaled CO. The results suggest evidence of validity of the FTND in adults with ID, suggesting that self-report instruments can reliably estimate nicotine dependence when administered with appropriate support. Nevertheless, the interpretation of CO levels in adults with ID should account for age, cognitive support needs, and contextual factors.
Reward learning can contribute to addictive behaviors by shaping attention and action selection. While reward-associated stimuli are known to capture attention, it remains unclear whether such learning can also guide behavior without stimulus-outcome contingency awareness. This study examined whether implicitly learned reward associations influence both attention and action selection, and how these effects relate to risky alcohol use. Eighty university students (40 low-risk and 40 high-risk drinkers) completed a Pavlovian-to-instrumental transfer task combined with an emotional attentional blink paradigm. During learning, conditioned stimuli and responses were probabilistically paired with monetary rewards. Awareness of stimulus-outcome contingencies was assessed at the individual level, using the Bayesian Awareness Categorization Technique. Reward-related influences on attention and response selection were then tested in a transfer phase. We observe no evidence of Pavlovian-to-instrumental transfer in either participants aware or unaware of reward contingencies. Similarly, reward associations did not modulate attention. The absence of effects in both aware and unaware participants makes it difficult to determine whether Pavlovian influences on attention and behavior are truly absent or simply not detectable under the current task conditions. However, exploratory analyses show that high-risk drinkers present greater preference for high-probability, low-value responses in the transfer phase. The observed preference for high-probability rewards in high-risk drinkers may reflect altered reward sensitivity. Together, these findings underscore the importance of evaluating reward-driven attentional and behavioral biases under well-controlled conditions and highlight the value of publishing null results to refine theoretical models of Pavlovian influences in addiction.
Problematic Use of Licit Substances is an increasing public health concern in Lebanon, where political and economic instability, alongside cultural and religious diversity, may intensify risk behaviors, while social desirability and conformity can influence their reporting. This study aims to assess the profiles of participants related to social desirability and conformity pressures and their association with licit substance use and problematic use. A cross-sectional online survey was conducted among 460 adults in Lebanon (February-March 2025). Data on cigarette, waterpipe, and alcohol use were collected alongside validated measures of social desirability and conformity. A two-step cluster analysis was first conducted to determine the optimal number of clusters, followed by K-means clustering to classify participants based on their social desirability and conformity scores, with subsequent regression analyses examining sociodemographic and cluster membership correlation with substance use behaviors. Three clusters emerged: Norm Internalizing Perfectionists (N = 127 (29.2%)); Detached Autonomists (N = 143 (32.9%)); and Strategic Conformists (N = 165 (37.9%)). The risk of problematic substance use was higher in the detached/autonomous phenotype and increased with age and among male gender participants, while religious prohibition appeared strongly protective. Differential results were found for waterpipe and alcohol, in comparison with problematic cigarette use. Considering social desirability and conformity allows for more precise identification of problematic substance use clusters, guiding targeted prevention and intervention. This complex interplay of personality traits, cultural values, age, gender, and education highlights the need for culturally sensitive, gender-specific, and cluster-tailored public health and psychosocial interventions rather than universal approaches.
Research on young adult alcohol use often overlooks the influence of specific social network members on daily alcohol use. This pilot study combined egocentric social network methods with a daily diary design to examine how network members influence drinking at the day level. Participants (N = 21) identified six social network members they frequently drank with and saw in person and then reported on these individuals in a 21-day study. Daily reports captured self-reported alcohol use and social network members presence and alcohol use from the previous day. Across 417 morning reports, participants drank on 77 days (18.5%), consuming an average of 2.36 drinks (SD = 1.70) on those days. Linear mixed-effects models showed that being with a given network member who was drinking was associated with consuming 1.75 more drinks than the participant's average. Network members who contributed to higher alcohol use were more likely to be people the participant intended to drink with in the future and who had frequently consumed alcohol in the past month, regardless of whether it was with the participant. The findings from this pilot study provide preliminary evidence that the drinking of and anticipating future drinking with certain network members contributes to greater alcohol use and suggests that interventions could use personalized feedback to help individuals recognize the network members who facilitate heavier drinking.
Problematic Internet use (PIU) is a public health concern in children and adolescents and is associated with physical (e.g., musculoskeletal pain, headache) and mental health problems (e.g., depression, emotional instability). Kagawa Prefecture in Japan introduced a residential treatment camp for adolescent PIU in 2022; however, previous studies on its effectiveness lacked control groups and longitudinal follow-ups. This study evaluated the short-term effects of the treatment camp on Internet addiction severity and mental health indicators using a non-randomized controlled design. This pilot non-randomized controlled study was conducted between July and November 2024, with grade 5-9 students and their parents. The intervention group (n = 22) attended a 7-day residential camp, whereas the control group (n = 106) did not. Baseline assessments were conducted in July or August, and follow-up surveys three months post intervention. Students' Internet addiction, attachment style, mental health, self-efficacy, and lifestyle habits were measured. Parents' mental health and parenting styles were also measured. Intervention-group students had higher Internet addiction and mental health scores than control-group students at baseline. Post-intervention, intervention-group students showed greater improvements in Internet addiction (Δmedian =  - 9.5 vs. - 2.0) and mental health (Δmedian =  - 4 vs. 0), while intervention-group parents demonstrated a greater reduction in negative parenting behaviors (Δmedian =  - 6 vs. 0). This pilot non-randomized controlled study suggests short-term improvements in camp attendees' IAT scores and depressive symptoms at 3-month follow-up. A 12-month follow-up is planned to evaluate the longer-term sustainability of these findings.
Social networks (SN) are used for different reasons in everyday life, often resulting in higher usage time and sometimes in a problematic use of social networks (PSNU). The I-PACE model outlines that specific predisposing variables (e.g., usage motives, personality traits, stress-appraisal, coping strategies) and affective and cognitive mechanisms (e.g., use expectancies, gratification, compensation) as well as their interactions contribute to the development and maintenance of PSNU. Our aim was to test a structural equation model with two different paths of reinforcement mechanisms: pleasure-seeking for achieving specific emotional experiences and compensation-seeking to avoid or reduce negative states. Both pathways are assumed to lead to higher symptom severity of PSNU and usage time of SN. In a pre-registered, multi-center study (DFG-funded research unit) with a mixed-method, cross-sectional, between-subject design in Germany, 306 (81% female; Age: M = 26.41 years; SD = 07.76, Range: 16-64 years) participants underwent the study procedure, including a diagnostic interview based on DSM-5 criteria for gaming disorder (modified for PSNU), thereby identifying individuals with problematic use of SN. Additional constructs were assessed by self-reports. The structural equation model provided an acceptable fit with the data. It showed that positive reinforcement mediates the effect of usage motives on SN usage time. Negative reinforcement mediates the effect of stress-appraisal and coping on PSNU and the effect of usage motives on PSNU. The pleasure-seeking pathway significantly leads to higher usage time of SN while the compensation-seeking pathway results in higher symptom severity. The results emphasize the relevance of different predisposing factors and reinforcement processes, and expands existing theoretical models.
Alcohol use disorder (AUD) is a chronic relapsing disorder with high early rehospitalization rates. Valid instruments assessing dependence severity, craving, and relapse risk are fundamental for follow-up. The aim of this study was to examine the psychometric properties of the Hungarian Severity of Alcohol Dependence Questionnaire (SADQ), Multidimensional Alcohol Craving Scale (MACS), Penn Alcohol Craving Scale (PACS) and Alcohol Relapse Risk Scale (ARRS), and test their utility in predicting relapse risk and rehospitalization. Ninety-three AUD inpatients were assessed on hospitalization day 8 with SADQ, AUDIT, MACS, PACS, visual analogue scale (VAS) of craving and ARRS, and followed for 3 months. Internal consistency and concurrent validity were evaluated. We tested whether SADQ and ARRS predicted 3-month rehospitalization (logistic regressions), whether MACS and PACS predicted relapse risk (linear regression). The 3-month rehospitalization rate was 21.5%. All scales showed high internal consistency (α = 0.86-0.94) and concurrent validity. After item reduction based on item-total correlations, the 27-item ARRS (ARRS-27) showed higher internal consistency, and predicted rehospitalization (OR = 1.12, 95% CI: 1.05-1.18; p < 0.001). Higher SADQ scores predicted rehospitalization (OR = 1.05, 95% CI: 1.02-1.09; p = 0.007). MACS (p < 0.001) and PACS (p = 0.046) scores predicted ARRS scores (R2 = 0.53), with MACS showing the stronger effect. Based on our preliminary results, the Hungarian SADQ, MACS, PACS, and ARRS-27 are reliable instruments with predictive value for relapse risk and rehospitalization in AUD. Their combined use might support a treatment and relapse-prevention algorithm, improving clinical care and guiding future research.
This study tested whether Surrender to God (StG), assessed explicitly (self-report) and implicitly (implicit association task), was a predictor of recovery characterized by reduced risk of relapse, reduced Substance Use Disorder (SUD) symptoms, and increased meaning in life. Longitudinal data (N = 177) were collected during treatment at a Christian inpatient SUD treatment facility, with follow-ups at one, six, and twelve months after treatment discharge. We used generalized estimating equations (GEE) analyses with the binary outcome relapse to estimate predictive relationships of explicit and implicit StG after treatment. Additionally, linear mixed model analyses (LMM) were conducted concerning SUD symptoms and meaning in life, with either implicit or explicit StG scores as predictors. The analyses were controlled for baseline scores of SUD symptoms and meaning in life including Bonferroni-Holm correction. Implicit StG predicted decreased odds of relapse (Odds ratio = 0.371, p = 0.001) over the course of one year but not at the one-month follow-up assessment. The reversed pattern was found for explicit StG, which predicted lower chances of relapse up to one month after treatment (Odds ratio = 0.962, p = 0.011) but not at 6 or 12-months assessments. Neither implicit nor explicit StG predicted follow-up SUD symptoms or meaning in life. These results suggest that explicit StG may be useful in predicting short-term relapse, and implicit StG may be useful in predicting longer-term relapse. In the context of religion-based recovery, theory and clinical practice may benefit from including explicit and implicit measures concerning religion and spirituality, such as StG.
Patients with opioid use disorder often have undertreated withdrawal while in hospital, leading to high rates of premature discharges. Short-acting, full agonist opioids (SAFAOs) have been proposed to alleviate withdrawal symptoms when provided as adjuncts to opioid agonist therapy (OAT). We aimed to synthesize evidence on the safety and efficacy of SAFAOs. We searched the scientific databases MEDLINE, Embase, CINAHL, PsycInfo, Web of Science Core Collection, and the Cochrane Library for studies with adults whose opioid withdrawal symptoms were treated with SAFAOs. Results were narratively synthesized. Our search yielded 5,616 papers screened and 15 studies included. Information was gathered mostly from patient charts, followed by cohort studies, a cross-sectional study, and a clinical trial. Hydromorphone, tramadol, fentanyl, and oxycodone were described individually or as groupings to reduce withdrawal from heroin or fentanyl, initiate OAT, or as a bridge to transition between medications. Most studies observed reduced withdrawal scores and fewer occurrences of premature discharges in those who received these medications. Oversedation was observed as an adverse event in patients with ongoing opioid use. This systematic review provides an up-to-date synthesis on the use of SAFAOs to treat withdrawal. Our results suggest that in-hospital use of SAFAOs can reduce patient suffering and potentially the following risk for premature discharges. More clinical studies are needed to further investigate the clinical utility of SAFAO as a combination treatment with OAT.
Internet gaming disorder (IGD) has become a worldwide concern, but there are still no approved medications or treatments for IGD. The present study systematically meta-analyzed the available research regarding off-label medications and non-invasive brain stimulation (NIBS) as neurobiological treatments for IGD. A total of 18 studies met the inclusion criteria (n = 687; age range = 9 to 26 years) following PRISMA guidelines, and data from 15 studies were included in the meta-analysis. In some of the studies, IGD was a comorbid condition with major depression, alcohol use disorder, attention deficits, and/or hyperactivity disorder. The findings indicated that: (i) treatment using non-invasive neuromodulation (tDCS targeting dorsolateral prefrontal cortex [DLPFC]), bupropion, selective serotonin reuptake inhibitors (SSRIs), and methylphenidate were significant in reducing IGD; (ii) pharmacotherapy was much more effective than tDCS; (iii) there were no significant differences between tDCS, SSRIs, and methylphenidate, and all except SSRIs were outperformed by bupropion; (iv) the effect of tDCS, bupropion, and SSRIs were independent of IGD severity; (v) the effect of bupropion was independent of treatment duration, gaming level, or comorbidity with depression; (vi) the effect of bupropion remained stable after 12 weeks follow-up; (vii) the effect of methylphenidate was independent of treatment duration; and (viii) the effect of SSRIs was independent of IGD severity and treatment duration. However, this initial evidence is limited in its generalizability due to high risk of bias, overrepresentation of males, small sample sizes, lack of clinical interviews, lack of consideration of comorbidities, lack of monitoring for side effects, and insufficient details for exact replication.