Evaluation of a Physical Activity Program for Pathological Gamblers in Treatment

It has been demonstrated that craving for gambling is associated with anxiety and depression in pathological gamblers. Exercise has been shown to reduce anxiety and depression, as well as positively influence abstinence rates in individuals with substance use disorders. In this study, we examined the impact of a physical activity program in 33 pathological gamblers. We also analyzed the association between craving and plasmatic levels of stress hormones (adrenocorticotropic hormone, cortisol, and prolactin). The program involved eight 50-min sessions. Craving was assessed 24 h before, immediately before, and immediately after each session, as well as on a weekly basis. Before and after the program, we evaluated gambling behavior, depressive symptoms, anxiety, and plasma levels of stress hormones. We identified a significant reduction in craving following each session and at the end of the program. There was improvement in anxiety, depressive symptoms, and gambling behavior. The post-session reduction in craving was accompanied by post-program reductions in craving and anxiety but not by a post-program reduction in depressive symptoms. The craving reduction was associated with a variation in prolactin levels but not with variations in levels of cortisol or adrenocorticotropic hormone.     

FDA cracks down on CBD claims

Last week, the Food and Drug Administration (FDA) issued a warning letter to Curaleaf Inc. of Wakefield, Massachusetts, for illegally selling cannabidiol (CBD) with claims that their products treat cancer, Alzheimer's disease, opioid withdrawal, pain and “pet anxiety,” among other conditions and diseases.     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

An individual treatment programme for sexually abused adult males: description and preliminary findings

Growing recognition of male sexual abuse and its potentially debilitating effects has underscored the need to develop effective treatment interventions for this population. The present study describes an individual treatment programme that was developed for adult males who have experienced childhood sexual abuse. The treatment programme focused on three areas related to sexual abuse, specifically feelings of self‐blame, anger and anxiety. The study also presents preliminary findings on treatment effects, using self‐report measures that five participants completed prior to treatment and at various assessments following treatment termination. Overall findings indicated improvements in behavioural self‐blame, anger, state anxiety and trait anxiety. Treatment did not appear to have an effect on characterological self‐blame over the long term. The study's findings are limited by the reliance on self‐report data and the absence of a comparison group. As such, our findings should be viewed as an initial contribution to the currently limited empirical data on treatment effects for sexually abused adult males. Copyright © 2005 John Wiley & Sons, Ltd.     

Attachment Change in the Beginning Stages of Therapy: Examining Change Trajectories for Avoidance and Anxiety

The purpose of this study was to investigate the nature of self‐reported attachment change (avoidance and anxiety) in the context of six sessions of couple therapy designed to emphasize both therapist‐centered and couple‐centered (i.e., enactment‐based) clinical process during the beginning stages of therapy. A total of 48 couples with at least one partner who reported clinically significant relationship dissatisfaction participated in this study. Findings confirmed that some couples experience positive attachment‐related change (anxiety or avoidance), while also identifying a subset of individuals who may not experience optimal levels of attachment‐related change. In addition, findings point toward both differences and similarities between change trajectories for avoidance and anxiety. Finally, there was evidence that socio‐demographic factors may be associated with attachment change.     

A Phenomenological Study of Career Anxiety Among College Students

This study explored the phenomenon of career anxiety through a qualitative investigation of the experiences of 7 traditional‐aged college students who were in various stages of their undergraduate degree programs. Using Moustakas's ( 1994 ) method of transcendental phenomenology, the authors conducted in‐depth interviews to answer the following questions: (a) What are coresearchers’ (participants') experiences with the phenomenon of career anxiety? and (b) In what contexts do the coresearchers experience career anxiety? Seven themes emerged: general symptoms of anxiety, existential concerns, pressure, lack of career guidance, cognitive distortions, social comparisons, and economic/occupational uncertainty. The findings provide a contextual and developmental perspective on career‐related anxiety that can guide counselors in the implementation of interventions for reducing anxiety associated with career choice and development.     

Patients report Vivitrol decreasing in effectiveness by week 3

Patient reports are suggesting that the indication for Vivitrol — one injection of depot naltrexone every four weeks — may be inadequate. They think they feel craving earlier — as early as the second week after the injection. Alkermes, which makes Vivitrol, is not allowed to talk about anything beyond what is on the label, but we tried to find out how patients would experience such craving — or any effects at all — related to a medication that has no effects at all beyond blocking the effects of opioids. If they try to challenge the blockade by taking opioids, and they are able to experience euphoria, that's one thing. It's completely different if they just sense craving.     

Cannabis and alcohol use in young adults: Connections

People with HIV, as well as those who are uninfected, do well on long‐term treatment with opioids (methadone or buprenorphine), researchers have found. There is a strong dose‐response relationship between mortality (all causes), unnatural death and overdose, with the higher morphine equivalent daily doses having the best outcomes, according to the study, by Ajay Manhapra, M.D., and colleagues and published online Sept. 16 in the Journal of Drug and Alcohol Dependence. “Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all‐cause mortality in addition to unnatural and overdose fatalities,” the researchers conclude in the abstract. For the study, there were 22,996 patients on long‐term treatment, 6,578 (29%) with HIV and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. The study, “All‐cause mortality among males living with and without HIV initiating long‐term opioid therapy, and its association with opioid dose, opioid interruption and other factors,” also found that benzodiazepine use was associated with overdose.     

Infant Sex Moderates the Effects of Maternal Pre‐ and Postnatal Stress on Executive Functioning at 8 Months of Age

Previous studies report that early life stress, including maternal pre‐ and postnatal stress, has adverse effects on cognitive development and that these associations might be sex‐specific. However, no studies exist on early life stress and infant executive functioning (EF). The aim of this study was to examine the relationship between maternal pre‐ and postnatal stress and infant EF, and whether these associations are moderated by infant sex. Maternal prenatal depressive, general anxiety, and pregnancy‐specific anxiety symptoms were measured three times, and postnatal depressive and general anxiety symptoms were measured 6 months postpartum. Infant EF was assessed with a modified A‐not‐B task 8 months postpartum (N = 214). Maternal postnatal general anxiety predicted poorer EF in girls in comparison with boys. Moreover, there was a trend toward an interaction between prenatal anxiety and infant sex such that prenatal anxiety predicted infant EF differently in girls and in boys. No association was found between depressive symptoms or pregnancy‐specific anxiety symptoms and infant EF. These findings suggest that maternal anxiety may have sex‐specific effects on early EF and that pre‐ and postnatal stress may differently affect infant EF/cognitive development. The implications of these findings and important future directions are discussed.     

Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center,Randomized, Double-Blind Clinical Trial

Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.     

Delivery Pain and the Development of Mother—Infant Interaction

This study examined delivery pain as a possible risk factor for the development of mother‐infant interaction. Eighty‐one mothers completed the Pain Catastrophizing Scale, the State‐Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. A retrospective evaluation of labor pain was performed using the Visual Analog Scale at 2 days postpartum. Six weeks after birth the mothers were visited at home, completed measures of anxiety and depression, and were observed during a free play session with the infant. The mother's tendency to catastrophize pain predicted lower levels of mother‐infant reciprocity at 6 weeks, controlling for maternal age, education, parity, epidural analgesia, pain perception, anxiety, and depression. Trait anxiety was related to lower maternal sensitivity. The mother's tendency to catastrophize pain was discussed in relation to the personality trait of exaggerated emotional perception of pain and its potential interference with the formation of the mother‐infant relationship.     

Methadone and buprenorphine superior to all other treatments

A very important insurance‐based retrospective study shows clearly what the clinical trials have already shown: Agonist treatment for opioid use disorder (OUD) is better than abstinence‐based or antagonist‐based treatment in terms of reducing overdose and opioid‐related morbidity. (Buprenorphine and methadone are opioid agonists, naltrexone/Vivitrol is an antagonist.)     

EFFECTS OF WELFARE REFORM ON ILLICIT DRUG USE OF ADULT WOMEN

Exploiting changes in welfare policy across states and over time and comparing relevant population subgroups within an econometric difference‐in‐differences framework, we estimate the effects of welfare reform on adult women's illicit drug use from 1992 to 2002, the period during which welfare reform unfolded in the United States. The analyses are based on all available and appropriate national data sets, each offering unique strengths and measuring a different drug‐related outcome. We investigate self‐reported illicit drug use (from the National Household Surveys on Drug Abuse and National Surveys on Drug Use and Health), drug‐related prison admissions (from the National Corrections Reporting Program), drug‐related arrests (from Federal Bureau of Investigation Uniform Crime Reports), and drug‐related emergency department episodes (from the Drug Abuse Warning Network). We find robust evidence that welfare reform led to a 10%–21% decline in illicit drug use among women at risk of relying on welfare, as well as associated declines in drug‐related arrests (6%–7%), drug‐related hospital emergency department episodes (7%–11%), and possibly drug‐related prison admissions (11%–19%). The findings indicate that an appropriately designed welfare system with sufficient job opportunities for those who are able to work can result in both increases in employment and decreases in drug use. (JEL I38, K42, J21)     

Maternal Depression and the Ability to Facilitate Joint Attention With 18‐Month‐Olds

Maternal depression has been associated with the mother‐child dyad's ability to engage in joint attention. This study of 69 depressed and 63 control mothers and their 18‐month‐olds addresses how aspects of maternal psychopathology are related to joint attention during a snack interaction. Although nondepressed‐mother dyads appeared better at joint attention than depressed‐mother dyads, this difference was not statistically significant. Among the depressed‐mother dyads, joint attention was related to presence of a comorbid Axis I diagnosis (usually an anxiety disorder) versus a diagnosis of major depressive disorder (MDD) only. Surprisingly, dyads with mothers who met criteria for a comorbid diagnosis were better at joint attention than those with MDD only, despite the fact that those mothers were likely to have longer and more severe depressive histories. The relationship between comorbid status and joint attention was mediated by the mother's affect. Rationale for the paradoxical finding that the “more pathological” mothers had greater success in engaging in joint attention is discussed.     

Substance use behaviors by parents and the decision to substantiate child physical abuse and neglect by caseworkers

The changing policy landscape with regards to marijuana and a growing epidemic related to opioid misuse may affect caseworkers' decisions to substantiate maltreatment involving use of those two substances. This study examined whether caseworkers factor marijuana and opioid use, including whether or not the drug was medically prescribed, into substantiation decisions. In this study, each respondent (n = 467) was given two vignettes (one for neglect and one for physical abuse) with one of five drug use conditions. Logistic regression models showed that any drug use was related to higher odds of substantiating neglect. Only illicit opioid or marijuana use was positively related to substantiating physical abuse. Any substance use may impair a parent's functioning and be interpreted as placing a child in greater risk for potential harm from neglect. For physical abuse, caseworkers may view illicit substance use as participating in a deviant behavior making physical abuse seem more likely.     

Predictors of sexual risk‐taking among new drug users

We studied predictors of HIV‐related sexual risk‐taking among individuals who initiated the use of heroin or metham‐phetamine during the past 5 years. Many studies have linked drug use to HIV risk, but most research has been based on samples of users with long‐established drug careers. We conducted face‐to‐face interviews with 153 adult new drug users in Atlanta, GA. Drug use was not a statistically significant predictor of sexual risk, but gender, age, race, homelessness status, childhood neglect, level of paranoia, and level of (dys)functionality in handling disagreements were associated with frequency of sexual risk‐taking. We discuss the need to incorporate new drug users in HIV/AIDS and other health‐related prevention and intervention programs.     

Briefly Noted

We asked Jerry Rhodes, former top executive at CRC (now Acadia) and a leader in opioid treatment program management, what he thinks of methadone as a medication to be used in primary care to treat opioid use disorder (OUD), as some people — including former Office of National Drug Control Policy Director Michael Botticelli — recommended last year (see ADAW, July 16, 2018). “I take issue with that,” said Rhodes. “Methadone is a dangerous drug in an unregulated environment,” he told ADAW. Buprenorphine is prescribed this way, but “buprenorphine is a relatively safe drug, and methadone isn't,” he said. A veteran of many battles over methadone, including the near‐elimination of opioid treatment programs, Rhodes told ADAW that “you don't give unfettered access to methadone” to patients with OUD. “Be careful what you wish for” is his advice. This has the potential to cause harm, he said. “Only people who don't understand the history of its utilization would recommend this.”     

Yoga,quality of life,anxiety, and trauma in low-income adults with mental illness: A mixed-methods study

We used a mixed-methods convergent parallel design to explore the effect of yoga on quality of life, trauma, and anxiety in low-income adults with mental illness. Participants included a convenience sample (N = 18) of parents at a community mental health agency who participated in a six-week yoga intervention. Participants completed standardized measures of quality of life, anxiety, and post-traumatic stress disorder (PTSD) pre- and post-intervention. Focus groups were conducted to further explore barriers to and the effects of participation in the yoga intervention. Wilcoxon Signed Ranks Tests indicated a statistically significant decrease in anxiety and PTSD after the yoga intervention, but no significant changes in quality of life or trait anxiety. Qualitative results reveal five themes related to participation in yoga classes, including barriers to participation and ways to improve the class. Qualitative results corroborate quantitative findings, suggesting improved relaxation and anger management for participants who strongly endorsed the benefits they experienced.     

Contagion of Anxiety Symptoms Among Adolescent Siblings: A Twin Study

This study examined whether social contagion of anxiety symptoms is present between siblings during early adolescence and whether this process is moderated by sex, relationship quality, and zygosity. Based on 634 monozygotic and dizygotic twins (336 females) assessed in Grades 6 and 7, anxiety symptoms and sibling relationship quality were measured with self‐report questionnaires. The predictive association of the co‐twin's level of anxiety with adolescents' own increased anxiety 1 year later was only observed in same‐sex twin dyads (monozygotic and dizygotic) and was higher for those who perceived a higher level of relationship quality with their co‐twin. Raising awareness of a possible sibling contagion of anxiety may be useful for preventing the development of anxiety symptoms in youth.