Showing papers in "Current Addiction Reports in 2021"
TL;DR: In this paper, the authors present an overview of how sex and gender may influence epidemiology, clinical manifestations, social impact, and the neurobiological basis of these differences of women with substance use disorders, based on human research.
Abstract: Substance use disorders (SUD) affect differentially women and men. Although the prevalence has been reported higher in men, those women with addictive disorders present a more vulnerable profile and are less likely to enter treatment than men. The aim of this paper is to present an overview of how sex and gender may influence epidemiology, clinical manifestations, social impact, and the neurobiological basis of these differences of women with SUD, based on human research. The differences in prevalence rates between genders are getting narrower; also, women tend to increase the amount of consumption more rapidly than men, showing an accelerated onset of the SUD (telescoping effect). In respect to clinical features, the most important differences are related to the risk of experience psychiatric comorbidity, the exposure to intimate partner violence, and the associated high risks in sexual and reproductive health; and those who are mothers and addicted to substances are at risk of losing the custody of children accumulating more adverse life events. Some of these differences can be based on neurobiological differences: pharmacokinetic response to substances, sensitivity to gonadal hormones, differences in neurobiological systems as glutamate, endocannabinoids, and genetic differences. Specific research in women who use drugs is very scarce and treatments are not gender-sensitive oriented. For these reasons, it is important to guarantee access to the appropriate treatment of women who use drugs and a need for a gender perspective in the treatment and research of substance use disorders.
30 citations
TL;DR: The use of e-cigarettes by healthy adults has been shown to increase blood pressure, heart rate, and arterial stiffness, as well as resistance to air flow in lungs as discussed by the authors.
Abstract: Although e-cigarettes have become popular, especially among youth, the health effects associated with e-cigarette use remain unclear. This review discusses current evidence relating to the cardiovascular, pulmonary, and immunological effects of e-cigarettes. The use of e-cigarettes by healthy adults has been shown to increase blood pressure, heart rate, and arterial stiffness, as well as resistance to air flow in lungs. Inhalation of e-cigarette aerosol has been shown to elicit immune responses and increase the production of immunomodulatory cytokines in young tobacco-naive individuals. In animal models, long-term exposure to e-cigarettes leads to marked changes in lung architecture, dysregulation of immune genes, and low-grade inflammation. Exposure to e-cigarette aerosols in mice has been shown to induce DNA damage, inhibit DNA repair, and promote carcinogenesis. Chronic exposure to e-cigarettes has also been reported to result in the accumulation of lipid-laden macrophages in the lung and dysregulation of lipid metabolism and transport in mice. Although, the genotoxic and inflammatory effects of e-cigarettes are milder than those of combustible cigarettes, some of the cardiorespiratory effects of the two insults are comparable. The toxicity of e-cigarettes has been variably linked to nicotine, as well as other e-cigarette constituents, operating conditions, and use patterns. The use of e-cigarettes in humans is associated with significant adverse cardiorespiratory and immunological changes. Data from animal models and in vitro studies support the notion that long-term use of e-cigarettes may pose significant health risks.
29 citations
TL;DR: This article examined how adolescents are influenced by junk food marketing; inform proposed policies to expand food marketing restrictions to protect children up to age 17, and found that adolescents may be even more vulnerable to junkfood marketing appeals than younger children.
Abstract: Examine current research on how adolescents are influenced by junk food marketing; inform proposed policies to expand food marketing restrictions to protect children up to age 17. Previous food marketing effects research focused primarily on TV advertising to younger children. However, recent research with adolescents demonstrates the following: (a) unique effects of food marketing on adolescents; (b) extensive exposure to social media and other digital marketing “disguised” as entertainment and messages from peers; (c) adolescents’ still-developing and hypersensitive reward responsivity to appetitive cues; and (d) disproportionate appeals to Black and Hispanic youth, likely exacerbating health disparities affecting their communities. Adolescents may be even more vulnerable to junk food marketing appeals than younger children. Additional research on how food marketing uniquely affects adolescents and efficacy of potential solutions to protect them from harm are critical to support stronger restrictions on junk food marketing to all children.
26 citations
TL;DR: In this article, the authors provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors, and also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD and co-occurring suicidal ideation and behavior.
Abstract: Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior. Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior. Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
26 citations
TL;DR: In this paper, the efficacy and possible underlying mechanisms of mindfulness-based interventions (MBI) in addictive disorders are summarized, and the authors conclude that MBI holds promise in treating addictive disorders while larger randomized controlled trials with longitudinal study designs are needed to confirm their utility.
Abstract: While the treatment of addictive disorders proves to be challenging, new treatment approaches that evolved around the concepts of mindfulness and acceptance have been utilized and investigated in recent years. Our goal is to summarize the efficacy and possible underlying mechanisms of mindfulness-based interventions (MBI) in addictive disorders. Various meta-analyses have suggested that MBIs show clinical efficacy in the treatment of addictive disorders. Considering the factors that impact addictive disorders, MBIs have been indicated to augment responsiveness to natural rewards in contrast to addiction-related cues as well as to increase top-down cognitive control, decrease subjective and physiological stress perception, and enhance positive affect. In summary, MBIs hold promise in treating addictive disorders while larger randomized controlled trials with longitudinal study designs are needed to confirm their utility. Newest clinical endeavors strive to enhance the clinical utility of MBIs by augmentation or personalization.
16 citations
TL;DR: In this paper, a narrative review aims at reflecting the discussions on overlaps of problematic online buying-shopping with both offline CBSD and specific internet-use disorders (e.g., gaming disorder, pornography-use disorder, or social-network use disorder).
Abstract: Problematic online buying-shopping became a recent research topic, and the question arises as to whether it would be useful to differentiate between a “predominantly online” and a “predominantly offline” compulsive buying-shopping disorder (CBSD) subtype by analogy with gaming disorder and gambling disorder in the ICD-11. This narrative review aims at reflecting the discussions on overlaps of problematic online buying-shopping with both offline CBSD and specific internet-use disorders. Preliminary data suggest that problematic online buying-shopping shares many commonalities with both offline CBSD and potential specific internet-use disorders (e.g., gaming disorder, pornography-use disorder, or social-network–use disorder). However, there is a lack of research addressing the etiology, underlying affective and cognitive mechanisms, psychosocial correlates, comorbidity profiles, and treatment of problematic online buying-shopping. The question of whether online CBSD can develop independently from offline CBSD or only as medial transformation of offline CBSD still remains unanswered due to limited research on problematic online buying-shopping. Both perspectives are conceivable: that online CBSD represents a standalone specific internet-use disorder or the online subtype of CBSD. Future studies should examine which approach has clinical utility and indicates specific treatment options and better outcomes.
15 citations
TL;DR: The role of the mu-opioid receptor (MOR) system in the processing of threat and reward has been examined in this article, and it is possible that disruption of these processes by chronic opioid use might alter emotional learning and reward responsiveness.
Abstract: Opioid receptors are widely expressed in the human brain. A number of features commonly associated with drug use disorder, such as difficulties in emotional learning, emotion regulation and anhedonia, have been linked to endogenous opioid signalling. Whereas chronic substance use and misuse are thought to alter the function of the mu-opioid system, the specific mechanisms are not well understood. We argue that understanding exogenous and endogenous opioid effects in the healthy human brain is an essential foundation for bridging preclinical and clinical findings related to opioid misuse. Here, we will examine psychopharmacological evidence to outline the role of the mu-opioid receptor (MOR) system in the processing of threat and reward, and discuss how disruption of these processes by chronic opioid use might alter emotional learning and reward responsiveness. In healthy people, studies using opioid antagonist drugs indicate that the brain’s endogenous opioids downregulate fear reactivity and upregulate learning from safety. At the same time, endogenous opioids increase the liking of and motivation to engage with high reward value cues. Studies of acute opioid agonist effects indicate that with non-sedative doses, drugs such as morphine and buprenorphine can mimic endogenous opioid effects on liking and wanting. Disruption of endogenous opioid signalling due to prolonged opioid exposure is associated with some degree of anhedonia to non-drug rewards; however, new results leave open the possibility that this is not directly opioid-mediated. The available human psychopharmacological evidence indicates that the healthy mu-opioid system contributes to the regulation of reward and threat processing. Overall, endogenous opioids can subtly increase liking and wanting responses to a wide variety of rewards, from sweet tastes to feelings of being connected to close others. For threat-related processing, human evidence suggests that endogenous opioids inhibit fear conditioning and reduce the sensitivity to aversive stimuli, although inconsistencies remain. The size of effects reported in healthy humans are however modest, clearly indicating that MORs play out their role in close concert with other neurotransmitter systems. Relevant candidate systems for future research include dopamine, serotonin and endocannabinoid signalling. Nevertheless, it is possible that endogenous opioid fine-tuning of reward and threat processing, when unbalanced by e.g. opioid misuse, could over time develop into symptoms associated with opioid use disorder, such as anhedonia and depression/anxiety.
15 citations
TL;DR: Longitudinal approaches with reliable and ecologically valid paradigms of Pavlovian and instrumental processes, including alcohol-related cues and outcomes, are warranted and should be combined with state-of-the-art imaging techniques, computational approaches, and ecological momentary assessment methods.
Abstract: Current theories of alcohol use disorders (AUD) highlight the importance of Pavlovian and instrumental learning processes mainly based on preclinical animal studies. Here, we summarize available evidence for alterations of those processes in human participants with AUD with a focus on habitual versus goal-directed instrumental learning, Pavlovian conditioning, and Pavlovian-to-instrumental transfer (PIT) paradigms. The balance between habitual and goal-directed control in AUD participants has been studied using outcome devaluation or sequential decision-making procedures, which have found some evidence of reduced goal-directed/model-based control, but little evidence for stronger habitual responding. The employed Pavlovian learning and PIT paradigms have shown considerable differences regarding experimental procedures, e.g., alcohol-related or conventional reinforcers or stimuli. While studies of basic learning processes in human participants with AUD support a role of Pavlovian and instrumental learning mechanisms in the development and maintenance of drug addiction, current studies are characterized by large variability regarding methodology, sample characteristics, and results, and translation from animal paradigms to human research remains challenging. Longitudinal approaches with reliable and ecologically valid paradigms of Pavlovian and instrumental processes, including alcohol-related cues and outcomes, are warranted and should be combined with state-of-the-art imaging techniques, computational approaches, and ecological momentary assessment methods.
15 citations
TL;DR: This article defined compulsive sexual behavior disorder as a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviors that cause marked distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning.
Abstract: Compulsive sexual behavior disorder is defined as a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviors that cause marked distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning. Although compulsive sexual behavior has been identified in the literature for a considerable period of time, it remains a controversial and understudied condition. For the past several decades, compulsive sexual behavior has been labeled and classified in numerous ways. Research on minoritized racial, ethnic, and sexual groups, older adults, individuals with disabilities, and the impact of religious beliefs remains limited in the literature of compulsive sexual behavior. Several psychiatric comorbidities with compulsive sexual behavior have been identified; however, treatment options, neuroscience, proper medication, and assessment measures are insufficient to draw strong conclusions. Recommendations for future classification, research, treatment, and assessment are suggested to aid in filling these gaps. Specifically, additional focus should be given to diverse populations (e.g., LGBTQ + , older adults, Black, Indigenous, and People of Color, individuals with intellectual and physical disabilities) in future research to better understand the etiology, prevalence, assessment, and best clinical practices for treatment-seeking clients.
14 citations
TL;DR: In this paper, the potential of digital phenotyping and mobile sensing not only shedding light on the nature of Internet Use Disorders (IUD), but also to provide new ideas on how to improve psycho-diagnostics of mental processes linked to IUD.
Abstract: The present paper provides an accessible overview on the potential of digital phenotyping and mobile sensing not only shedding light on the nature of Internet Use Disorders (IUD), but also to provide new ideas on how to improve psycho-diagnostics of mental processes linked to IUD. In detail, the psycho-diagnostic areas of prevention, treatment, and aftercare in the realm of IUDs are focused upon in this work. Before each of these areas is presented in more specificity, the terms digital phenotyping and mobile sensing are introduced against the background of an interdisciplinary research endeavor called Psychoinformatics. Obstacles to overcome problems in this emerging research endeavor—sensing psychological traits/states from digital footprints—are discussed together with risks and chances, which arise from the administration of online-tracking technologies in the field of IUDs. Given the limited validity and reliability of traditional assessment via questionnaires or diagnostic interviews with respect to recall bias and tendencies to answer towards social desirability, digital phenotyping and mobile sensing offer a novel approach overcoming recall bias and other limitations of usual assessment approaches. This will not only set new standards in precisely mapping behavior, but it will also offer scientists and practitioners opportunities to detect risky Internet use patterns in a timely manner and to establish tailored feedback as a means of intervention.
14 citations
TL;DR: In this article, a systematic review summarizes the literature that examines the association between video game genres and structural characteristics and GD symptoms, and suggests that some game types containing certain structural game characteristics are positively related to problem gaming.
Abstract: With its inclusion in the International Statistical Classification of Diseases and Related Health Problems, 11th Revision, gaming disorder (GD) has been officially recognized as a behavioral addiction. Etiological models of GD refer to the interaction of personal, environmental, and game-related risk factors. However, the role of video game characteristics in the development of problem gaming and GD is not well understood. This systematic review summarizes the literature that examines the association between video game genres and structural characteristics and GD symptoms. Recent studies report that playing massively multiplayer online role-playing games, first-person shooters, and real-time strategy games/Multiplayer Online Battle Arena (MOBA) is associated with more time spent gaming and higher endorsement of GD symptoms. Reward and punishment features (reinforcement), social features, and monetization features have been associated with more frequent gaming and higher scores on self-report measures of GD. The literature is limited due to inconsistencies in measurement of game features, as well as other methodological weaknesses, demonstrating the need for higher quality studies, including studies of individuals with verified gaming disorders to understand their use of specific games. Current research suggests that some game types containing certain structural game characteristics are positively related to problem gaming. We propose that future studies are guided by theory-based taxonomies of structural game characteristics and examine game influences using experimental designs. For this purpose, a measurement tool to aid the investigation of diverse elements of video game characteristics would be valuable.
TL;DR: In this article, the authors provide a systematic review of the existing literature that has explicitly analyzed the association between problematic smartphone use and problematic social media use (PSMU) in order to examine study characteristics in terms of samples analysed and effect sizes of the associations reported.
Abstract: Over the last decade, problematic smartphone use (PSU) and problematic social media use (PSMU) have emerged as new potential problematic behaviours. Several studies have suggested that smartphones are predominantly used for social purposes (i.e., using messaging apps and social networking sites). The aim of the current article is to provide a systematic review of the extant literature that has explicitly analysed the association between PSU and PSMU in order to examine study characteristics in terms of samples analysed and effect sizes of the associations reported. This systematic review is based on the ongoing debate about whether the smartphone can be considered as the medium of one or more problematic activities, including PSMU. Existing evidence suggests that the effect sizes of the associations between PSU and PSMU are medium to large and large across the 13 studies included, with the largest correlations observed between PSU and problematic WhatsApp use or general PSMU. Overall, reviewed results suggest a partial overlap between the two problematic behaviours. PSU and PSMU are overlapped mostly because the smartphone is a common medium to use social media, especially concerning instant messaging apps like WhatsApp. Moreover, PSU should be preferentially studied with a focus on specific types of apps used rather than a more holistic phenomenon.
TL;DR: In this paper, a systematic literature review was conducted to examine relationships between exercise addiction and perfectionism while also considering the subdimensions of perfectionism in different groups, and the findings substantiate that perfectionism and its dimensions are weakly or moderately related to exercise addiction.
Abstract: Exercise addiction may be conceptualized as a behavioral addiction in which a person develops an unhealthy obsession with exercise and physical activity While exercise addiction is not a formally recognized disorder in the Diagnostic and Statistical Manual or the International Classification of Diseases, it has been studied and connected to both personal and situational factors Perfectionism is a feature that has been strongly linked to exercise addiction The objective of this systematic literature review, performed by following the PRISMA protocol, was to examine relationships between exercise addiction and perfectionism while also considering the subdimensions of perfectionism in different groups Three databases (PsycINFO, PubMed/Medline, and SPORTDiscus) were examined Sixty relevant articles were identified, of which 22 met inclusion criteria The findings substantiate that perfectionism and its dimensions are weakly or moderately related to exercise addiction This relationship has been observed in adults, adolescents, athletes, and patients with eating disorders Of the 22 studies examined, only one did not identify an association between perfectionism or its subdomain(s) and exercise addiction However, in most studies, the common variance between perfectionism and exercise addiction is relatively small, raising questions regarding the clinical relevance of the relationship Perfectionism is related to exercise addiction, but the strength of the relationship varies in different circumstances, which should be examined in future research
TL;DR: The authors conducted a systematic review to identify the characteristics of people who purchase loot boxes with real money, focusing on the relationships (a) between loot boxes and gaming, (b) between looting boxes and gambling, and (c) between Loot boxes and other variables, such as mood, gender, physiological state, motivation and loot box engagement.
Abstract: Research has indicated that loot boxes are risky gaming components that could exacerbate Internet gaming disorder due to a link between loot box purchasing and gambling. We conducted a systematic review to identify the characteristics of people who purchase loot boxes with real money, focusing on the relationships (a) between loot boxes and gaming, (b) between loot boxes and gambling, and (c) between loot boxes and other variables. Of the 201 studies examined for eligibility, we reviewed 20 studies that met the predefined criteria, which were extracted by searching electronic databases (PsycINFO, PubMed, Ovid, EBSCO, and Web of Science) and the reference lists of included studies, and that were published up to March 27, 2021. Overall, this review identified positive relationships among Internet gaming disorder–related symptoms, disordered gambling symptoms, and engagement with, or investment in, loot boxes. In addition to gaming and gambling, the relationships among some variables, such as mood, gender, physiological state, motivation, and loot box engagement, were examined. The present review clarified relationships between loot box engagement, gaming, gambling, and other variables, such as mood, gender, physiological state, and motivation, and partially identified the characteristics of people who purchase loot boxes using real money. Specifically, those who spend more money in-game on loot boxes exhibit Internet gaming–related and/or disordered gambling symptoms and behaviors. Finally, we discussed future directions for clinical psychological studies on loot boxes.
TL;DR: This article proposed an integration of desire thinking into the interaction of Person-Affect-Cognition-Execution (I-PACE) model based on theoretical considerations within the ELaborated Intrusion Theory of Desire and Self-Regulatory Execution Function model and empirical evidence from the field of internet-use disorders.
Abstract: This manuscript aims to propose an integration of desire thinking into the Interaction of Person-Affect-Cognition-Execution (I-PACE) model based on theoretical considerations within the Elaborated Intrusion Theory of Desire and Self-Regulatory Execution Function model and empirical evidence from the field of internet-use disorders. Theory and research on desire thinking in the context of internet-use disorders suggest considerable relations to craving, metacognitive beliefs, and emphasizes its nature when initiated as a reaction towards unpleasant triggers. Accordingly, we postulate that desire thinking may be located at the position for affective and cognitive reactions towards triggers within the I-PACE model. The suggested integration of desire thinking into the I-PACE model specifically implies the assumption of a relief-oriented and pleasure-oriented entry pathway into desire thinking and a feedback loop between desire thinking and the experience of gratification and compensation. The model pathways proposed here may serve as a theoretical basis for future research and need further empirical verification.
TL;DR: In this paper, the authors synthesize EMA findings from their research group, which has studied several hundred outpatients during treatment for opioid-use disorder (OUD) during treatment, concluding that Craving and some negatively valenced mood states are concurrently and prospectively associated with lapses to opioid use during treatment.
Abstract: Addiction scientists have begun using ambulatory assessment methods—including ecological momentary assessment (EMA), experience sampling, and daily diaries—to collect real-time or near-real-time reports of participants’ internal states in their natural environments. The goal of this short review is to synthesize EMA findings from our research group, which has studied several hundred outpatients during treatment for opioid-use disorder (OUD). (We cite pertinent findings from other groups, but have not tried to be comprehensive.) One of our main goals in using EMA is to examine momentary changes in internal states that proximally predict, or concurrently mark, events such as lapses to opioid use. We summarize findings evaluating several classes of momentary markers or predictors (craving, stress, negative and positive moods, and physical pain/discomfort) of lapses and other states/behaviors. Craving and some negatively valenced mood states are concurrently and prospectively associated with lapses to opioid use during treatment. Craving is also concurrently and prospectively associated with momentary changes in stress and mood. Convincing evidence has not yet emerged for stress as a robust redictor of lapse to opioid use; it appears to be contributory, but neither necessary nor sufficient. Ambulatory assessment can capture changes in internal states and drug-related behaviors in situ and at high temporal resolution. We recommend research strategies that may increase the clinical and prognostic utility of ambulatory assessment, including denser sampling (i.e., more assessments per day) and more attention to heterogeneity across people and across populations.
TL;DR: In this paper, a review highlights how children are affected by food promotions, why companies even target children with their promotional efforts, and what makes children so susceptible to promotion of unhealthy food.
Abstract: Childhood obesity is a global health concern. And a number of studies have indicated that food promotions affect children’s food attitudes, preferences, and food choices for foods high in fat and sugar, which potentially impacts children’s body weight development. This review showcases how children are affected by food promotions, why companies even target children with their promotional efforts, and what makes children so susceptible to promotion of unhealthy food. In addition, this review discusses how regulations, parental styles, and individual media literacy skills can help to contain the potential detrimental effects of food promotions on children’s health. The recent findings indicate that children are affected by food promotions in their preference for unhealthy food and beverages in selection tasks shortly conducted after exposure. Furthermore, results indicate significant effects of food marketing, including enhanced attitudes, preferences, and increased consumption of marketed (predominantly unhealthy) foods connected with a wide range of marketing strategies. Children are particularly vulnerable to promotional efforts and react to it strongly due to their still developing cognitive and social skills as well as their lack in inhibitory control. This review proposes an applied focus that discusses pathways for regulators, parents, and educators. In the light of the discussed results, a large number of studies on food promotion indicate that there is need to react. In all these measures, however, it is of relevance to consider children’s developmental stages to effectively counteract and respond to the potential detrimental effects of food promotions on children’s long-term weight development.
TL;DR: A review of recent computational modelling studies of substance use disorders (SUDs), with a focus on work published within the last 5 years, can be found in this paper, where Bayesian approaches offer a complementary perspective, suggesting that drug induced overconfidence in prior expectations prevents substance users from appropriately updating their beliefs in the face of negative outcomes.
Abstract: In this article, we provide a brief review of recent computational modelling studies of substance use disorders (SUDs), with a focus on work published within the last 5 years. While reinforcement learning (RL) approaches are most prominent in recent studies, we also review work from other perspectives that focus on Bayesian (active) inference and perceptual processing. Recent work in RL shows evidence that goal-directed (model-based) planning processes are impaired in SUDs, leading to impulsive, habitual decision processes focused on short-term reward despite long-term negative consequences. Bayesian approaches offer a complementary perspective, suggesting that drug-induced overconfidence in prior expectations prevents substance users from appropriately updating their beliefs in the face of negative outcomes. Recent neurocomputational studies have shown promise in differentiating those who will and will not relapse. Computational modelling has made progress in identifying specific prospective decision-making processes that are impaired in SUDs, but further research is necessary before these approaches can directly inform medical practice on an individualized level.
TL;DR: In this article, a systematic review of pornography use and online sexual behaviors on sexual wellbeing was conducted, with a particular focus on the effects of pornography on sexual functioning and sexual satisfaction.
Abstract: Pornography use is a common recreational activity in most developed nations with unrestricted internet access. As public awareness of pornography’s popularity has grown, so have concerns about potentially deleterious effects of pornography. One domain of particular concern has been the impact of pornography use and online sexual behaviors on sexual wellbeing. Over recent years, a number of studies have examined how pornography use relates to sexual wellbeing. The present work seeks to review such literature, with a particular focus on the effects of pornography on sexual functioning and sexual satisfaction. To this end, a systematic review of recent research (within the past 5 years) was conducted. A total of 44 articles were included in the systematic review. In some situations, pornography use is associated with greater sexual functioning and greater sexual satisfaction, and in other cases it seems to be associated with lower sexual functioning and lower sexual satisfaction. Specifically, mere pornography use itself was most often not associated with sexual functioning in either direction, but self-reported problematic use of pornography was consistently associated with more sexual functioning problems. Collectively, results suggest a nuanced understanding of the effects of pornography on sexual wellbeing, with the context of and perceptions about pornography use being extremely important in predicting whether or not pornography has negative effects.
TL;DR: In this article, the authors address current discussions relating to potential subtypes of compulsive sexual behavior disorder, the aspect of compulsivity in CSBD, and the aspects of moral incongruence and CSBD including multiple specific sexual behaviors that might be related to specific psychological processes.
Abstract: There are ongoing debates about specific features of compulsive sexual behavior disorder (CSBD) relating to classification and diagnoses. We aim to address current discussions relating to potential subtypes of CSBD, the aspect of compulsivity in CSBD, and the aspect of moral incongruence and CSBD. CSBD includes multiple specific sexual behaviors that might be related to specific psychological processes. Problematic pornography use may be considered a subtype of CSBD, which may have multiple parallels with addictive behaviors. The feature of compulsivity in CSBD may be different from compulsivity in other disorders and may be differently involved in early versus later stages of CSBD. Moral incongruence is important to consider in the context of CSBD, although moral disapproval is not a general exclusion criterion for diagnosing CSBD. Considering the current debates of specific features of CSBD, future research and clinical practice may benefit from a trans-diagnostic approach to contribute to a more fine-grained understanding of the multiple facets of CSBD.
TL;DR: In this article, a review of VR-based approaches for substance use disorders is presented, focusing on different substances of abuse and incorporating VR in craving induction/assessment as well as therapy, showing consistent results in eliciting and reducing craving across different substances.
Abstract: Substance use disorders (SUD) are burdening chronic conditions characterized by high relapse rates despite severe negative consequences. Substance-related cues that elicit craving by means of automatic physiological and behavioural responses have long been suggested to predict relapse. One major mechanism contributing to relapse behaviour are cue-induced behavioural approach tendencies towards the addictive agent. Recently, there has been an emerging interest in virtual reality (VR)-based approaches to assess and modify craving and its related responses. This review aims at elucidating (1) VR techniques applied in the field of SUD, (2) VR as an induction/assessment tool for biopsychological correlates of craving and (3) VR-based therapeutic approaches. There is an emerging number of studies focusing on different substances of abuse incorporating VR in craving induction/assessment as well as therapy. Despite some limitations as missing of randomized controlled clinical trials with large samples and missing data on the long-term effects of VR treatment, the VR approach showed consistent results in eliciting and reducing craving across different substances. This review suggests virtual reality as a promising tool for the assessment and treatment of craving among individuals with substance use disorders. Because of its ecological validity, VR unifies the benefits of a laboratory setting with the advantages of a realistic environment. Further studies with large samples and randomized controlled clinical trials using more homogenous VR techniques as well as assessment of objective biophysiological craving markers are required.
TL;DR: In this paper, a review focused on bidirectional pathways between the brain and cardiovascular system that are well-documented and provide innovative, malleable targets to bolster recovery and alter substance use behaviors.
Abstract: Addiction and excessive substance use contribute to poor mental and physical health. Much research focuses tightly on neural underpinnings and centrally acting interventions. To broaden this perspective, this review focuses on bidirectional pathways between the brain and cardiovascular system that are well-documented and provide innovative, malleable targets to bolster recovery and alter substance use behaviors. Cardiovascular signals are integrated via afferent pathways in networks of distributed brain regions that contribute to cognition, as well as emotion and behavior regulation, and are key antecedents and drivers of substance use behaviors. Heart rate variability (HRV), a biomarker of efficient neurocardiac regulatory control, is diminished by heavy substance use and substance use disorders. Promising evidence-based adjunctive interventions that enhance neurocardiac regulation include HRV biofeedback, resonance paced breathing, and some addiction medications. Cardiovascular communication with the brain through bidirectional pathways contributes to cognitive and emotional processing but is rarely discussed in addiction treatment. New evidence supports cardiovascular-focused adjunctive interventions for problematic substance use and addiction.
TL;DR: The authors of as discussed by the authors summarized the translational progression of three potential medications for OUD, which had varying levels of success in preclinical studies, including Memantine, lorcaserin, and lofexidine.
Abstract: Pharmacotherapies are the most effective means of reducing the harms associated with opioid use disorder (OUD). Translational research seeking to develop novel medications to treat OUD has been challenging due to the complex etiology of addiction. Preclinical outcome measures are often behavioral, and it is difficult, if not impossible, to fully mirror the various emotional and cognitive processes that motivate opioid use in humans. The goal of the current narrative review was to summarize the translational progression of three potential medications for OUD, which had varying levels of success. Memantine, lorcaserin, and lofexidine all showed promise in preclinical studies; however, only lofexidine was able to consistently replicate these findings in human subjects, and receive FDA approval. It was the authors’ objective to use this review to identify areas of needed improvement in translational research for OUD. Preclinical studies vary significantly in their ability to forecast effectiveness in clinical trials. Among the various preclinical models, suppression of opioid self-administration appears to have the best predictive validity. As they model a mostly physiological phenomenon, preclinical assessments of opioid withdrawal also appear to have high predictive validity. In our review of the literature, the authors noted numerous examples of clinical trials that were underpowered, lack precision, and proper outcomes. Better-validated preclinical targets and improved design of proof-of-concept human studies should allow investigators to more efficiently develop and test medications for OUD.
TL;DR: In this paper, the authors provide an overview of the still limited, but growing research literature on the relevance of EI and related constructs to addictions and suggest that EI is an important risk factor for the development of addictions.
Abstract: Emotional intelligence (EI) is widely regarded as an important predictor of a diverse set of health and life success outcomes. There is growing evidence to demonstrate the role that EI plays in the development of both substance use and behavioral addictions. The aim of this article is to provide an overview of the still limited, but growing research literature on the relevance of EI and related constructs to addictions. There is substantial empirical evidence to suggest that EI is an important risk factor for the development of addictions. This points to a need for greater research attention into the specific mechanisms linking EI to addictions, as well as the potential utility of EI training in the treatment of addictions. Future research should examine the specific components of EI and mediator variables that underlie the relationship between EI and addictions, as well as develop and evaluate EI training programs for use in treatment.
TL;DR: The authors found that having a financially focused self-concept is an etiological factor that is common to the different gambling disorder subtypes outlined in the Pathways Model, which is the leading biopsychosocial model of gambling addiction and gambling harm.
Abstract: People can place preponderant importance on a single life domain (e.g., relationships, appearance, financial success). The result is that success (or failure) in that domain has significant influence on the self-concept and thus judgments of self-worth. A focused self-concept has also been shown to be a core feature of various psychiatric disorders, including depression, body image disorders, and obsessive-compulsive and related disorders. Herein, we summarize mounting evidence indicating that a self-concept focused on financial success is important for understanding the etiology and maintenance of disordered gambling. The review indicates that a financially focused self-concept is moderately and positively associated with disordered gambling severity. Specifically, we outline research that has examined how and why financially focused self-concept proliferates and maintains disordered gambling. Based on this research, we put forth the idea that having a financially focused self-concept is an etiological factor that is common to the different gambling disorder subtypes outlined in the Pathways Model—arguably the leading biopsychosocial model of gambling addiction and gambling harm. More research is needed that assesses the antecedents and consequences of possessing a financially focused self-concept. We call on researchers to assess sociocultural, psychological, and environmental factors that may cultivate a financially focused self-concept as well as factors that may help people expand their domains of self-worth. The recovery process from any psychiatric disorder that includes a financial focus as an etiological factor should be aided by an expansion of the life domains from which self-worth is garnered.
TL;DR: In this paper, the authors provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses and the relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches.
Abstract: This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches. Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce. Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.
TL;DR: An overview of the literature on the role of anxiety in opioid misuse is provided in this article, where anxiety is among the most common symptoms and disorders in people with opioid use disorder, and anxiety-focused treatment may be a promising approach for the prevention and treatment of opioid use disorders.
Abstract: Anxiety is among the most common symptoms and disorders in people with opioid use disorder. Although anxiety disorders have been understudied in opioid use disorder, research supports an important role of anxious responding to distress (e.g., distress intolerance) in problem opioid use. In this review, we provide an overview of the literature on the role of anxious responding to distress in opioid misuse. Anxious responding to distress is elevated in people with problem opioid use, is associated with severity of misuse, and appears to amplify risk via an increase in motivation for seeking relief. Preliminary studies have suggested that these vulnerabilities can be reduced with treatment in people with opioid use disorder. Anxious responding to distress is associated with opioid misuse across the spectrum of severity. Anxiety-focused treatment may be a promising approach for the prevention and treatment of opioid use disorder.
TL;DR: In this article, an evidence-based parenting intervention called "mothering from the inside out" (MIO) was proposed for mothers with addictions, which addressed addiction, adversity, and attachment simultaneously.
Abstract: Purpose of review Mothers with substance use disorders are often referred for parenting support, though commonly available programs may miss the mark for families impacted by addiction. This may be related to a lack of attention to children's emotional needs, mothers' histories of adversity, and the neurobiological differences seen in mothers with addictions. We review the implications of addiction, adversity, and attachment for parenting interventions. We then describe Mothering from the Inside Out (MIO), an evidence-based parenting intervention designed specifically for mothers with addictions. Recent findings Evidence from clinical trials suggests that MIO improves outcomes for two generations: both mothers with addictions and their children. Recent trials demonstrate that MIO may be delivered effectively by community-based clinicians and may be beneficial for parents with other chronic stressors. Summary Addressing addiction, adversity, and attachment simultaneously may have a positive synergistic effect. Future research should study the implementation of MIO in real-world settings and examine the impact of MIO on maternal neurobiology.
TL;DR: In this article, the current state of social scientific knowledge on this key variant of digitized sexual violence and suggests new directions in empirical work, including mental health and sexual wellness awareness campaigns that include ethical behaviors in a digital space.
Abstract: Widely referred to as either “revenge porn” or “nonconsensual sharing of sexual imagery,” image-based sexual abuse targets millions of people around the world and causes much harm. This article covers the current state of social scientific knowledge on this key variant of digitized sexual violence and suggests new directions in empirical work. A rapidly growing body of research shows that image-based sexual abuse is committed mainly by men against women and it often co-occurs with offline forms of male-to-female assaults like rape, stalking, and beatings. Additionally, to further understand the scope of factors that contribute to the problems of online image-based sexual abuse online, researchers should examine the relationship between image-based sexual abuse and pornography consumption. Future studies should be specially designed to test theories that prioritize the concepts of gender, power, control, and patriarchy. Further, despite the creation of new legislation aimed at curbing image-based sexual abuse, the criminal justice system’s response has, thus far, been woefully inadequate. Hence, additional means of prevention and control are necessary. A multidisciplinary approach may involve mental health and sexual wellness awareness campaigns that include ethical behaviors in a digital space. Also, clinical assessment and treatment may be part of creating long-term changes at individual, interpersonal, and societal levels with psychosexual education that investigates core beliefs and harmful operating systems that facilitate image-based sexual abuse. Moreover, testing and providing empirically validated treatments for those who experienced sexual trauma and those who perpetrated and consumed digitized sexual abuse are warranted.
TL;DR: In this article, a review examines the current state of the research literature on the co-occurrence of cannabis and gambling and concludes that there is a link between gambling and cannabis, whereby engaging in any form of gambling is linked with cannabis use; moreover, increasing problem gambling severity is associated with increased cannabis use.
Abstract: Given recent changes in cannabis legalization across North America, understanding cannabis-gambling relationships is of increasing interest. This review examines the current state of the research literature on the co-occurrence of cannabis and gambling. Specifically, the relationship between cannabis and gambling is examined in youth, adults, treatment-seeking individuals, as well as in specific populations. Literature search findings show that the majority of studies to date examining gambling and cannabis are epidemiological investigations conducted in youth. Overall, studies suggest a link between cannabis and gambling, whereby engaging in any form of gambling is linked with cannabis use; moreover, increasing problem gambling severity is associated with cannabis use. The literature search revealed no studies that systematically investigate simultaneous cannabis use during gambling in gambling populations. Findings from the current review demonstrate high rates of co-occurrence between cannabis use and gambling, albeit less information on simultaneous use exists. An important research priority for informing policy, therefore, is a better understanding of cannabis’ effects on decision-making and risky behaviours. Findings from the current review highlight that these behaviours begin in youth even before reaching high school. Longitudinal studies are needed to clarify the epidemiology of gambling-cannabis relationships, nevertheless, initial findings suggest that early gambling behaviour may serve as an important behavioural marker. Altogether, the findings demonstrate that regulatory frameworks should not only consider cannabis co-use with other substances but also a need to include other addictive behaviours, such as gambling.