Lead Story: Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition

Show Notes:

 

Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition 

The American Journal of Psychiatry 

The authors present a newly developed National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from the DSM-5 diagnosis of alcohol use disorder (AUD). This definition views recovery as a process of behavioral change and an outcome, incorporating two key components of recovery: remission from DSM-5 AUD and cessation from heavy drinking, a non-abstinent recovery outcome. It also emphasizes the importance of biopsychosocial functioning and quality of life in enhancing outcomes. By adopting a uniform definition, researchers and health care professionals can more precisely operationalize and measure recovery-related processes.  

 

Benzodiazepine-Involved Overdose Deaths in the USA: 2000–2019 

Journal of General Internal Medicine 

Overdose deaths involving benzodiazepines and opioids are well studied and characterized. In this study, the authors examine all benzodiazepine-involved overdose deaths to better understand the pattern of use and overdoses between 2010 and 2019. While opioids were involved in 83.5% of all benzodiazepine related overdoses, antidepressants (18.8%), alcohol (16.3%), cocaine (13.4%) and psychostimulants (7.3%) were also frequently involved. Only 9% of benzodiazepine overdose deaths did not co-involve another substance. In addition, a larger proportion of deaths with benzodiazepine alone were due to suicide (36.2%) compared to those involving opioids (8.5%). Any interventions to reduce overdose deaths involving benzodiazepines need to consider co-involved substances and the role of suicide. 
  

Differences in clinical features associated with cannabis intoxication in presentations to European emergency departments according to patient age and sex 

Clinical Toxicology 

Using presentations in the Euro-DEN Plus dataset from 2014 to 2019, this study investigated whether clinical features associated with acute cannabis intoxication in patients presenting to Emergency Departments for medical assistance differ according to patient age and sex. The most frequent clinical features in patients younger than 20 years were vomiting, reduced consciousness, and headache; and less frequently acute psychosis. Patients older than 49 years more often had hypotension and less frequently vomiting, anxiety, agitation, and reduced consciousness. Males more frequently presented with hypertension, psychosis, chest pain, and seizures. 

  

Increased global integration in the brain after psilocybin therapy for depression 

Nature Medicine 

Two clinical trials assessed the subacute impact of psilocybin on brain function in treatment resistant depression. In both trials, the antidepressant response to psilocybin was rapid, sustained, and correlated with decreases in fMRI brain network modularity, implying that psilocybin’s antidepressant action may depend on a global increase in brain network integration. Network cartography analyses indicated that 5-HT2A receptor-rich higher-order functional networks became more functionally interconnected and flexible after psilocybin treatment. Consistent efficacy-related brain changes, correlating with robust antidepressant effects across two studies, suggest an antidepressant mechanism for psilocybin therapy: global increases in brain network integration. 

 

Non–prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder 

Journal of Substance Abuse Treatment 

In this study, data were obtained from a large, multi-site, multi-state office-based opioid treatment (OBOT) network. Individuals (n=971) were randomly selected from a pool of 18,513 initiating buprenorphine care. At treatment entry, 60% tested positive for buprenorphine (TPB), and 73% of these were taking non-prescribed buprenorphine. The TPB group was less likely to test positive for opiates at treatment entry (25% vs. 53%) and continued to be less likely to test positive for opiates during the first several months of treatment. The TPB group was less likely to discontinue treatment (hazard ratio 0.52). There were no significant differences comparing those prescribed with non-prescribed use, in the TPB group. They suggest that use of “diverted” buprenorphine is a marker of patient motivation for treatment and conclude that “concerns regarding buprenorphine diversion due to misuse may be misplaced.”  

  

What are the implications of the steady 40 year rise in US fatal overdoses?: Introduction to a special section 

International Journal of Drug Policy 

While overdose deaths due to opioids is understood to be the driver of current increase in overdose deaths and a well-recognized epidemic, in a series of recent studies it was demonstrated that overdose deaths have been steadily increasing over the last 40 years.  In this editorial, the authors discuss various commentaries responding to these studies and highlight various perspectives on these data. While much of the focus in recent years has been on opioid overdose deaths and access to medication assisted treatment, interventions may be needed to address broader factors associated with substance use, including both supply and demand side factors. In addition, data at more local levels may be useful in predicting substance use epidemics at more local levels for intervention. 

  

The Effectiveness of Exercise as an Adjunct Intervention to Improve Quality of Life and Mood in Substance Use Disorder: A Systematic Review 

Substance Use and Misuse 

This review examined 42 papers (2531 individuals) regarding the effect of exercise on quality of life, depression, and anxiety during treatment of substance use disorder. The majority, 22 studies, took place in an inpatient rehabilitation setting. They examined a broad range of exercise modalities: aerobic, resistance, flexibility, tai chi, yoga, high intensity interval training, and increasing step count. The results support a beneficial impact of exercise on quality of life, depression, and anxiety. There was a dose response effect with greater benefit with increased number of sessions per week and over 12 weeks of program duration, however, some improvement was seen following a single session. The modality of exercise was less important and simply increasing daily step count was beneficial.   

 

Addressing the substance use treatment gap in Africa using digital screening and brief interventions 

The Lancet Psychiatry 

Services and staffing for substance use treatment and prevention are scarce throughout many parts of Africa. One treatment option is a self-administered digital substance use screening and brief intervention (SBI). This literature search noted a paucity of research investigating the feasibility of SBIs in Africa. Such an SBI has the potential to increase access to care and decrease intervention delivery costs. Given the rapid increase in internet penetration rates, and smartphone usage across the continent, as well as limited access to treatment, there is an urgent need to explore the utility of this treatment tool across the continent.