Search Results (93)

Cannabis is the most widely consumed illicit substance worldwide, with rising use particularly among adolescents and young adults. Accumulating evidence indicates that chronic cannabis use may negatively impact several domains of cognition, yet findings across studies remain varied and fragmented. This comprehensive review synthesizes current knowledge on the long-term cognitive consequences of cannabis use, focusing on attention, executive functioning, learning, memory, language, motor coordination, and social cognition. Consistent impairments have been observed in domains such as attention, executive function, memory, and learning; however, most evidence derives from studies of acute or residual effects. Evidence of long-lasting deficits after extended abstinence remains more limited and methodologically heterogeneous. Acute motor coordination deficits are well established, but persistent impairments in this domain lack conclusive evidence. Effects on language remain inconclusive, and findings regarding social cognition, though limited, suggest potential deficits in emotion recognition and mental state inference. Early onset and high-frequency use are critical risk factors for more severe and enduring cognitive effects. Some deficits may partially reverse with abstinence, although many persist long after cessation. Overall, cannabis use is associated with widespread and lasting cognitive impairments. These findings underscore the need for targeted prevention strategies, especially among youth, and point to future longitudinal and mechanistic research to better understand the nature, persistence, and potential reversibility of these cognitive effects. Full article

Introduction: Chronic alcohol use is a complex condition influenced by psychological, behavioral, and socio-demographic factors. This study aimed to develop a comprehensive psychosocial profile of individuals with alcohol use disorder (AUD) by examining associations between psychometric variables and relapse risk including repeated psychiatric hospitalizations. Methodology: A cross-sectional observational analytical study was conducted on a sample of 104 patients admitted for alcohol withdrawal management at the “Prof. Dr. Al. Obregia” Psychiatric Clinical Hospital in Bucharest between March 2023 and September 2024. Participants completed a set of validated psychometric tools: the Drinker Inventory of Consequences—Lifetime Version (DrInC), Readiness to Change Questionnaire—Treatment Version (RTCQ), Drinking Expectancy Questionnaire (DEQ), and Drinking Refusal Self-Efficacy Questionnaire (DRSEQ). Additional data were collected on the socio-demographic (education level, socio-professional category), genetic (family history of alcohol use), and behavioral factors (length of abstinence, tobacco use, co-occurring substance use disorders). Results: Higher alcohol-related consequence scores (DrInC) were significantly associated with lower education (p < 0.001, η² = 0.483), disadvantaged socio-professional status (p < 0.001, η² = 0.514), and family history of alcohol use (p < 0.001, η² = 0.226). Self-efficacy (DRSEQ) was significantly lower among individuals with co-occurring substance use (p < 0.001) and nicotine dependence (p < 0.001). Logistic regression showed that the DrInC scores significantly predicted readmission within three months (OR = 1.09, p = 0.001). Conclusions: Psychometric tools are effective in identifying individuals at high risk. Personalized, evidence-based interventions tailored to both psychological and socio-professional profiles, combined with structured post-discharge support, are essential for improving long-term recovery and reducing the readmission rates. Full article

Physical exercise may affect drug use by balancing neurohormonal system mechanisms. Cortisol and β-endorphin, associated with stress, mood, and pleasure feelings, can be affected by exercise and act as regulators of withdrawal symptoms associated with drug use during short-term abstinence. The present study investigated the effect of a supervised, two-month moderate-intensity aerobic exercise program on salivary cortisol and β-endorphin levels in patients with an opioid use disorder (OUD) and on a substitution treatment during a short-term, 24–36 h withdrawal phase from methadone/buprenorphine medication. Ninety opioid users (41 females) in methadone and buprenorphine substitution treatment were randomly divided into four groups: (a) buprenorphine exercise (BEX) (n = 26; age (mean ± SD): 41.9 ± 6.1 yrs), (b) buprenorphine control (BCON) (n = 25; age: 41.9 ± 5.6 yrs), (c) methadone exercise (MEX) (n = 20; age: 46.7 ± 6.6 yrs), and (d) methadone control (MCON) (n = 19; age: 46.1 ± 7.5 yrs). The exercise intervention groups (BEX and MEX) followed a training program on a treadmill for 20 min at 70% HRmax, 3 days/week for 8 weeks. The responses of cortisol and β-endorphin were measured before (t0) and immediately after an exercise session (t20) on different days (i.e., the 1st, 12th, and 24th session) corresponding to the beginning, middle, and end of the training program. A significant increase in β-endorphin levels was observed after the completion of the training intervention (24th exercise session) in both exercise groups (BEX before: 63.8 ± 33; BEX after: 185.6 ± 182.8 pg/mL; MEX before: 115 ± 211; MEX after: 262.3 ± 505.7 pg/mL), whereas β-endorphin was decreased in the control groups (BCON before: 34.7 ± 20.1; BCON after: 24.2 ± 8.8 pg/mL; MCON before: 129.7 ± 185.7; MCON after: 84.9 ± 104.3 pg/mL) (p < 0.05). Inversely, cortisol decreased in both exercise groups post-intervention (BEX before: 9.5 ± 5.9; BEX after: 2.8 ± 1.5 ng/mL; MEX before: 9.3 ± 6.6; MEX after: 3.1 ± 1.5 ng/mL) and increased in control groups (BCON before: 6.3 ± 2.5; BCON after: 10.1 ± 5.4 ng/mL; MCON before: 7.5 ± 3.2; MCON after: 12.5 ± 4.3 ng/mL) (p < 0.05). Moderate-intensity aerobic exercise can beneficially influence β-endorphin and cortisol levels in individuals undergoing treatment for OUD. By increasing endogenous opioid levels and reducing stress hormones, exercise emerges as a promising adjunctive strategy for alleviating withdrawal symptoms, enhancing emotional regulation, and potentially reducing the risk of relapse. The inverse relationship between β-endorphin and cortisol highlights the role of physical activity as a long-term modulator of neuroendocrine function in the context of substance use recovery. Future research should prioritize longitudinal studies extending beyond two months and involving larger, more diverse populations. Additionally, investigating the integration of exercise with non-pharmacological interventions—and its effects on relapse rates, mental health outcomes, and overall quality of life—would provide further insight into its therapeutic value in addiction recovery. Full article

Background: Alcohol Use Disorder (AUD) is highly prevalent among substance use disorders worldwide and is characterized by a multifactorial pathophysiology. AUD treatment is mostly based on combined pharmacotherapy and multidisciplinary clinical approaches. Nonetheless, meta-analytical studies assessing the efficacy of combination therapy are scarcely available. Methods: We searched for randomized clinical trials through PubMed, ClinicalTrials.gov, Cochrane Library, SciELO, Biblioteca Virtual em Saúde, and Google Scholar databases. Original clinical trials published in English and Portuguese were selected. Data collection followed the PRISMA and MOOSE guidelines and was assessed using the Risk of Bias Tool (RoB 2). Heterogeneity was assessed using the Q test. Meta-regression was conducted using Egger’s regression method. Twelve articles were finally included in the analysis, and random-effects models were applied on aggregate trial results. Results: The meta-analysis found that combination therapies led to an average 4.045% increase in abstinence rates (95% CI: 0.415% to 7.675%) compared to monotherapies. Meta-regression showed a strong positive association between the use of naltrexone, acamprosate, and sertraline—either alone or in combination—and treatment success in AUD. The meta-regression also highlighted the impact of patients’ variables, such as gender, age, country, and psychiatric comorbidities, on their treatment outcomes. These findings may identify a potential therapeutic pathway promoting alcohol abstinence, further supported by a Number Needed to Treat (NNT) of 25, as an acceptable value for substance use disorder treatments. Conclusions: Combined pharmacotherapies are more effective than monotherapy in enhancing abstinence rates in AUD treatment, with naltrexone, acamprosate, and sertraline emerging as key adjunctive agents promoting these outcomes. These findings underscore the complexity of AUD as a multifactorial psychiatric condition and highlight the potential of combined pharmacotherapy as a promising strategy for achieving better treatment outcomes, particularly in terms of abstinence rates. Full article

Background: Psychological parameters related to alcohol dependence (AD) affect patients’ behavioral and cognitive control, decision making, impulsivity and inhibitory control. People with AD often have a chronic course with a relapse to dependent substance use even after extensive treatment. This study investigated whether the psychological parameters of patients with AD predict (a) premature termination of treatment, and/or (b) relapse into consumption of alcohol from admission until 6 weeks after discharge from an inpatient rehabilitation treatment. Methods: Participants: Alcohol-dependent patients consecutively admitted for a duration of about three months to inpatient rehabilitation treatment in a hospital specialized in substance use disorders. Craving (OCDS-G) and impulsivity (BIS-11; UPPS) were assessed with computerized questionnaires. Attentional bias and inhibitory control were measured with two computer-based experiments (dot-probe task; stop-signal task (SST)). Investigations were conducted at entry (T1); after 6 weeks (T2); and during the last two weeks of the inpatient treatment (T3). Some N = 128 patients finished the first, N = 102 the second and N = 83 the third assessments. Outcome variables were discontinuation of treatment and abstinence or relapse until follow-up 6 weeks after discharge; participants were contacted via telephone. Results: None of the variables are associated with discontinuation of treatment. Poor inhibitory control (SST) and high craving (OCDS-5) levels, measured at T1, are significantly associated with relapse. Higher impulsivity (UPPS) measured at T2 and T3 is significantly associated with relapse. Exploratory analyses showed that older age, longer inpatient treatment duration and time spent in abstinence before rehabilitation treatment were significantly associated with a reduced risk of relapse. Conclusions: Psychological parameters, craving and impulsivity levels did not predict relapse to a high degree. It is assumed that discontinuation of treatment and relapse may be associated with different issues, such as social context, and individual motivation levels. In contrast, the length of both abstinence before admission and of inpatient treatment were significantly associated with abstinence; it is here suggested that recovery time duration may be an underestimated influencing factor regarding relapse in AD patients. Full article

Introduction: Various models of nicotine vaccines have been evaluated. In humans, antibody levels are low and variable. In this sense, it is necessary to improve or optimize the nicotine vaccines already evaluated. We reported the efficacy of the M₆-TT vaccine. Recently, we reported the efficacy of the COC-TT vaccine, which was developed from the M₆-TT vaccine. Both vaccines generate high titers of antibodies and attenuate heroin- or cocaine-induced behavioral effects in rodents. Aims and Methods: The objective of this study was to determine whether the antibodies generated by a tetanus toxoid-conjugated nicotine vaccine (NIC₆-TT) can produce anti-nicotine antibodies and decrease the nicotine-induced reinforcing and psychomotor effects. Male Wistar rats were immunized with the NIC₆-TT. A solid-phase antibody-capture ELISA was used to monitor antibody titer responses after each booster dose in vaccinated animals. The study used nicotine self-administration and nicotine locomotor sensitization testing to evaluate the nicotine-reinforcing and psychomotor effects. Results: The NIC₆-TT vaccine could generate high and sustained levels of anti-nicotine antibodies. The antibodies reduced the nicotine self-administration and expression of nicotine locomotor sensitization. Conclusions: These findings suggest that the NIC₆-TT vaccine generates a robust immunogenic response capable of reducing the reinforcing and psychomotor effects of nicotine, which supports its possible future use in clinical trials for the treatment of smokers. Implications: Smoking is the second most used psychoactive substance in the world, which is associated with millions of preventable deaths. An effective treatment is required. Nicotine vaccines must generate high levels of anti-nicotine antibodies, but above all, the decay curve of the antibodies must be very slow, so that they can provide long-term protection and support long-term smoking abstinence. The NIC₆-TT vaccine meets these properties. Full article

Background. Sleep disturbances are frequent in patients with substance use disorders (SUDs) and are associated with craving and addiction relapses, leading to increased clinical severity and detrimental outcomes. Daridorexant, a selective dual orexin receptor antagonist, has been approved for persistent insomnia disorder (ID), but specific insights on patients with SUDs are lacking. Methods. This observational, retrospective study investigated the effects of a three-month treatment with daridorexant (50 mg/day) in 41 outpatients with comorbid IDs and SUDs. Improvement in subjective sleep measures, assessed with the Insomnia Severity Index (ISI) and subjective total sleep time, was the primary outcome measure. Changes in anxiety and depression symptoms, quality of life, clinical global severity, and craving were also investigated through the following: Hamilton Anxiety and Depression Rating Scale; Five-item World Health Organization Well-Being Index; Clinical Global Impression Severity Scale; Visual Analog Scale for Craving. Results. All sleep outcomes significantly improved throughout treatment, which was generally safe and well tolerated, with mild and transient drowsiness and sluggishness reported in 21.1% of patients. Similar improvements were observed in psychopathology, quality of life, and craving, and positive correlations were found among ISI scores and anxiety/depression symptoms and craving. An abstinence rate (i.e., absence of any substance use, regardless of the amount, throughout treatment) of 65.8% was also detected at the endpoint. Conclusions. These preliminary findings suggest that daridorexant might represent a promising tool for treating insomnia in patients with SUDs. Identifying interventions effectively targeting insomnia with a good safety/tolerability profile in SUDs is crucial to achieve remission and full functional recovery. Full article

Background: Substance Use Disorders (SUDs) are chronic conditions characterized by high relapse rates and significant psychological, physical, and social complications. Despite the availability of traditional pharmacological and psychotherapeutic interventions, many individuals struggle to maintain abstinence. Recently, physical activity (PA) has emerged as a promising complementary intervention. This review aims to examine the existing evidence on the effects of PA in individuals with SUDs, with a particular focus on neurobiological mechanisms. Methods: A narrative review was conducted on 30 September 2024, searching relevant keywords on PubMed, Web of Science, Google Scholar, and Scopus. Randomized clinical trials, cohort studies, reviews, and meta-analyses published between 1988 and 2024 were considered. Results: Fifty studies were included. Key themes included the role of PA in inducing neuroadaptation in individuals with SUDs, which is crucial for relapse prevention and impulse control, and the effects of PA depending on the type of PA and the specific SUD. Neurobiological modifications related to PA are of particular interest in the search for potential biomarkers. Additionally, studies explored the effects of PA on cravings, mental health, and quality of life. The review overall discusses the psychological changes induced by PA during SUD rehabilitation, identifies barriers to participation in PA programs, and suggests clinical and organizational strategies to enhance adherence. Conclusions: Physical activity is a promising adjunctive therapy for the management of Substance Use Disorders. Long-time longitudinal studies and meta-analyses are needed to sustain scientific evidence of efficacy. The success of PA programs moreover depends on overcoming barriers to adherence, including physical, psychological, and logistical challenges. Full article

Background and Objectives: Substance use disorders (SUDs) affect millions worldwide. Despite increasing drug use, treatment options remain limited. Psychedelic-assisted therapy (PAT), integrating psychedelic substances with psychotherapy, offers a promising alternative by addressing underlying neural mechanisms. Materials and Methods: This review’s purpose is to investigate the current understanding of psychedelic therapy for treating SUDs, including tobacco, alcohol, and drug addiction. The systematic review approach focused on clinical trials and randomized controlled trials conducted from 2013 to 2023. The search was performed using PubMed, Google Scholar, and Consensus AI, following PRISMA guidelines. Studies involving psychedelics like LSD, psilocybin, ibogaine, and ayahuasca for treating various addictions were included, excluding naturalistic studies and reviews. Results: Our results highlight the key findings from 16 clinical trials investigating psychedelic therapy for SUDs. Psychedelics like psilocybin and ayahuasca showed promise in reducing alcohol and tobacco dependence, with psilocybin being particularly effective in decreasing cravings and promoting long-term abstinence. The studies revealed significant improvements in substance use reduction, especially when combined with psychotherapy. However, the variability in dosages and study design calls for more standardized approaches. These findings emphasize the potential of psychedelics in SUD treatment, though further large-scale research is needed to validate these results and develop consistent protocols. Conclusions: This research reviewed the past decade’s international experience, emphasizing the growing potential of psychedelic therapy in treating SUDs pertaining to alcohol, tobacco, and cocaine dependence. Psychedelics such as psilocybin and ketamine can reduce cravings and promote psychological well-being, especially when combined with psychotherapy. However, regulatory barriers and specialized clinical training are necessary to integrate these therapies into mainstream addiction treatment safely. Psychedelics offer a promising alternative for those unresponsive to conventional methods. Full article

Moving on in my recovery (MOIMR) is a new, acceptance and commitment therapy (ACT) based group intervention to support recovery from substance use disorder. It was co-developed by, and is co-facilitated with, people in recovery. This study used a grounded theory model to understand the process of change experienced by individuals who completed the group programme. Ten individuals who were abstinent from substances following their participation in MOIMR were interviewed. The model that emerged depicted a chronological series of processes that centred around a core category of gains derived from approaching their emotional vulnerability by leaning in to discomfort (e.g., difficult internal experiences like thoughts, emotions, and physical sensations) whilst pursuing activities that aligned to what mattered to them. Initial key processes indicated that participants experienced a degree of suffering from substance use prior to engagement. Group safety was a key element in fostering connection, normalisation, and cohesion, combined with psychological understanding being significantly derived from those with a lived experience of substance misuse and addiction. Later processes reflecting core ACT mechanisms such as letting go, value-guided action, and acceptance of difficult internal experiences took time to develop; many participants reported completing MOIMR more than once as a means of understanding these components. Limitations, along with implications for clinical practice and future research are discussed. Full article

Background: Substance use disorders (SUDs) remain a growing public health issue, with drug- and alcohol-related deaths continuing to increase. A myriad of barriers prevent many with SUDs from seeking care. Telehealth interventions are well-positioned to reduce barriers and increase engagement in SUD treatment. The SUD intensive outpatient program (IOP) is specifically designed for telehealth and offers evidenced-based care delivered by SUD professionals as well as asynchronous assignments to enhance treatment. This study explores the feasibility of providing a telehealth IOP. Methods: participant engagement, reasons for disengagement, and days of abstinence were examined using existing records from a cohort of participants between 2021 and 2023 (n = 4724). Results: Nearly 80% of participants remained engaged in the program for 30 days, and 91% attained at least 30 consecutive days of abstinence over the course of treatment. Nearly 45% demonstrated a successful response to care and no longer required IOP treatment. Those who finished the IOP completed over 70% of the asynchronous assignments. Conclusions: Results support the feasibility and effectiveness of delivering a telehealth IOP for SUDs. Full article

Introduction: Third-generation therapies (TGTs) have been shown to be effective in the treatment of substance use behaviors in college-aged adolescents. These therapies are based on acceptance, mindfulness and psychological flexibility, which enable young people to change their Psychoactive Substance Use (PSU)-related behaviours, develop coping skills to manage difficult emotions and thoughts, reduce experiential avoidance and maintain long-term abstinence. Objective: To explore the implementation and potential benefits of third-generation therapies, Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT) and Mindfulness, for the treatment of PSU in college youth. This review includes articles within a 5-year window. Method: A scoping, observational and retrospective review was conducted using the PRISMA method in SCOPUS, PUBMED and Web of Science. Results: eight studies were found, six based on mindfulness, one on dialectical behaviour therapy and one on acceptance and commitment therapy. The results of the studies are promising and emerging for the intervention of the problem. Conclusion: The interventions used show evidence of reducing PSU and other mental health problems such as anxiety, depression and post-traumatic stress. In addition, they allowed patients to increase their well-being and mindfulness. Full article

Background: Alcohol dependence is associated with several neuropsychological abnormalities, such as increased impulsivity or attentional bias towards drug-related stimuli. However, it is debated whether these abnormalities are on the decline after long-term abstinence from alcohol. Inpatient rehabilitation treatment enables the longitudinal investigation of such variables during a long, largely secured, period of abstinence. Methods: This study involved alcohol-dependent patients consecutively admitted for a duration of 14–26 weeks to an inpatient rehabilitation treatment center located in a hospital specializing in substance use disorders. Craving and impulsivity were assessed with the means of two questionnaires (e.g., OCDS-G and BIS-11); conversely, attentional bias and problems with inhibition were measured with the help of two computer-based experiments (e.g., dot–probe task and stop–signal–reaction task). Investigations were conducted at entry, after 6 weeks, and during the last two weeks of the inpatient treatment. Results: A total of 130 patients with alcohol dependence (mean age 43.3 years; 78.5% male) completed the first, N = 102 the second, and N = 83 the final assessment. Over the whole period of inpatient treatment, there was a significant decrease in patients’ scores for both craving (t(83) = 7.8, p < 0.001) and impulsivity (t(82) = −3.75, p < 0.001, t(82) = 4.4, p < 0.001). However, there were no significant changes regarding attentional bias (t(82) = 0.16, p = 0.494) and inhibitory control (t(76) = 0.04, p = 0.482) scores. Conclusions: Neuropsychological abnormalities associated with alcohol dependence might persist even after a long abstinence period. The decrease in both craving and impulsivity levels may be explained by the protected, alcohol-free, hospital environment; however, patients’ risk of post-discharge relapse may remain high, as the basic neurobiological mechanisms of alcohol dependence may persist for long periods, and possibly for more than 3–6 months. Full article

Background/Objectives: Major depressive disorder (MDD) frequently co-occurs with substance use disorders such as alcohol and nicotine use disorders. Comorbid substance use disorders worsen the clinical symptoms of MDD and exacerbate addictive behaviors and presentations. However, the relationship between MDD and betel quid use disorder (BUD) in Taiwan has not been extensively investigated. Methods: We performed this cross-sectional study investigated associations between betel quid use, BUD, and MDD specifically in the Taiwanese population. Long-term betel quid use is a major public health concern, contributing significantly to the high incidence of oral cancers, which rank fifth among the top ten most common cancers in Taiwan. Results: Among patients with MDD, the current BUD prevalence rate was 7.32%, and the lifetime BUD prevalence rate was 15.45%. Patients with comorbid BUD were more likely to have severe alcohol and nicotine dependence disorders and required longer antidepressant treatment. Conclusions: Notably, 16.98% of patients with comorbid BUD who received selective serotonin reuptake inhibitor treatment achieved abstinence. BUD has a detrimental effect on health outcomes in patients with MDD, and selective serotonin reuptake inhibitor treatment may be required to be prolonged for betel quid abstinence therapy to be effective. Additional studies should investigate medication therapies for betel quid addiction disorders. Full article

The mesolimbic reward system originating from dopamine neurons in the ventral tegmental area (VTA) of the midbrain shows a profound reduction in function during cannabinoid withdrawal. This condition may underlie aversive states that lead to compulsive drug seeking and relapse. The lateral habenula (LHb) exerts negative control over the VTA via the GABA rostromedial tegmental nucleus (RMTg), representing a potential convergence point for drug-induced opponent processes. We hypothesized that the LHb–RMTg pathway might be causally involved in the hypodopaminergic state during cannabinoid withdrawal. To induce Δ⁹-tetrahydrocannabinol (THC) dependence, adult male Sprague–Dawley rats were treated with THC (15 mg/kg, i.p.) twice daily for 6.5–7 days. Administration of the cannabinoid antagonist rimonabant (5 mg/kg, i.p.) precipitated a robust behavioral withdrawal syndrome, while abrupt THC suspension caused milder signs of abstinence. Extracellular single unit recordings confirmed a marked decrease in the discharge frequency and burst firing of VTA dopamine neurons during THC withdrawal. The duration of RMTg-evoked inhibition was longer in THC withdrawn rats. Additionally, the spontaneous activity of RMTg neurons and of LHb neurons was strongly depressed during cannabinoid withdrawal. These findings support the hypothesis that functional changes in the habenulo–mesencephalic circuit are implicated in the mechanisms underlying substance use disorders. Full article