Promoting Recovery in an Evolving Policy Context: What Do We Know and What Do We Need to Know About Recovery Support Services?

Promoting recovery in an evolving policy context: What do we know and what do we need to know about recovery support services?

J Subst Abuse Treat. 2013 Mar 15;
Laudet AB, Humphreys K

As both a concept and a movement, “recovery” is increasingly guiding substance use disorder (SUD) services and policy. One sign of this change is the emergence of recovery support services that attempt to help addicted individuals using a comprehensive continuing care model. This paper reviews the policy environment surrounding recovery support services, the needs to which they should respond, and the status of current recovery support models. We conclude that recovery support services (RSS) should be further assessed for effectiveness and cost-effectiveness, that greater efforts must be made to develop the RSS delivery workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive, integrated and patient-centered health care system. As the SUD treatment system undergoes its most important transformation in at least 40years, recovery research and the lived experience of recovery from addiction should be central to reform. HubMed – addiction

 

Positive and negative affect as predictors of urge to smoke: Temporal factors and mediational pathways.

Psychol Addict Behav. 2013 Mar; 27(1): 262-267
Leventhal AM, Greenberg JB, Trujillo MA, Ameringer KJ, Lisha NE, Pang RD, Monterosso J

Elucidating interrelations between prior affective experience, current affective state, and acute urge to smoke could inform affective models of addiction motivation and smoking cessation treatment development. This study tested the hypothesis that prior levels of positive (PA) and negative (NA) affect predict current smoking urge via a mediational pathway involving current state affect. We also explored if tobacco deprivation moderated affect-urge relations and compared the effects of PA and NA on smoking urge to one another. At a baseline session, smokers reported affect experienced over the preceding few weeks. At a subsequent experimental session, participants were randomly assigned to 12-hr tobacco deprived (n = 51) or nondeprived (n = 69) conditions and reported state affect and current urge. Results revealed a mediational pathway whereby prior NA reported at baseline predicted state NA at the experimental session, which in turn predicted current urge. This mediational pathway was found primarily for an urge subtype indicative of urgent need to smoke and desire to smoke for NA relief, was stronger in the deprived (vs. nondeprived) condition, and remained significant after controlling for PA. Prior PA and current state PA were inversely associated with current urge; however, these associations were eliminated after controlling for NA. These results cohere with negative reinforcement models of addiction and with prior research and suggest that: (a) NA plays a stronger role in smoking motivation than PA; (b) state affect is an important mechanism linking prior affective experience to current urge; and (c) affect management interventions may attenuate smoking urge in individuals with a history of affective disturbance. (PsycINFO Database Record (c) 2013 APA, all rights reserved). HubMed – addiction

 

Substance Use Disorders in Adolescents with Attention Deficit Hyperactivity Disorder: A Four-Year Follow-up Study.

Addiction. 2013 Mar 19;
Groenman AP, Oosterlaan J, Rommelse N, Franke B, Roeyers H, Oades RD, Sergeant JA, Buitelaar JK, Faraone SV

AIM: To examine the relationship between a childhood diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) with or without oppositional defiant disorder (ODD)/conduct disorder (CD) and the development of later alcohol/drug use disorder (psychoactive substance use disorder (PSUD)) and nicotine dependence in a large European sample of ADHD probands, their siblings and healthy control subjects. PARTICIPANTS, DESIGNSETTING: Subjects (n=1017) were participants in the Belgian, Dutch and German part of the International Multicenter ADHD Genetics (IMAGE) study. IMAGE families were identified through ADHD probands aged 5-1715 years attending outpatient clinics, and control subjects from the same geographic areas. After a follow-up period (m:4.4 years) this subsample was reassessed at a mean age of 16.4 years. MEASUREMENTS: PSUD and nicotine dependence were assessed using the Diagnostic Interview Schedule for Children, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test, and Fagerström test for Nicotine Dependence. FINDINGS: The ADHD sample was at higher risk of developing PSUD (Hazard Ratio (HR)=1.77, 95%CI= 1.05-3.00) and nicotine dependence (HR=8.61, 95%CI=2.44-30.34) than healthy controls. The rates of these disorders were highest for ADHD youth who also had CD, but could not be accounted for by this comorbidity. We did not find an increased risk of developing PSUD (HR=1.18, 95%CI= .62-2.27) or nicotine dependence (HR=1.89, 95%CI=.46-7.77) among unaffected siblings of ADHD youth. CONCLUSIONS: A childhood diagnosis of Attention-Deficit/Hyperactivity Disorder is a risk factor for psychoactive substance use disorder and nicotine dependence in adolescence, and comorbid Conduct Disorder, but not Oppositional Defiant Disorder, further increases the risk of developing psychoactive substance use disorder and nicotine dependence. HubMed Рaddiction

 

Rat ultrasonic vocalizations demonstrate that the motivation to contextually reinstate cocaine-seeking behavior does not necessarily involve a hedonic response.

Addict Biol. 2013 Mar 18;
Barker DJ, Bercovicz D, Servilio LC, Simmons SJ, Ma S, Root DH, Pawlak AP, West MO

Human self-reports often indicate that changes in mood are a major contributor to drug relapse. Still, arguments have been made that instances of drug-seeking following abstinence in animal models (i.e. relapse/reinstatement) may be outside of hedonic control. Therefore, the present study utilized ultrasonic vocalizations in the rat in order to evaluate affect during cocaine self-administration and contextual reinstatement of cocaine-seeking in a pre-clinical model of drug relapse (abstinence-reinstatement model). Results show that while subjects effectively reinstated drug-seeking (lever pressing) following 30 days of abstinence, and spontaneously recovered/reinstated drug-seeking following 60 days of abstinence, ultrasonic vocalizations did not increase over baseline levels during either reinstatement session. These results are consistent with previous results from our laboratory and current theories of addiction suggesting that cues that are weakly associated with drug consumption can motivate drug-seeking behavior that is outside of hedonic processing. HubMed – addiction