Addressing unmet addiction need in an urban hospital

Addressing unmet addiction need in an urban hospital

Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226 .423; MJ: AOR .28), 4 + arrests (CC + MJ: AOR 3.80; CC: AOR 2.33), and Gain revealed hypo...

60KB Sizes 88 Downloads 149 Views

Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226

.423; MJ: AOR .28), 4 + arrests (CC + MJ: AOR 3.80; CC: AOR 2.33), and <30 years of age (CC + MJ: AOR .41; CC: AOR .17; MJ: AOR 2.87). Conclusions: Future drug prevention and interventions should consider the potential protective effects of religion/spirituality on substance use. Financial Support: McKnight Doctoral Fellowship (Acheampong), R01DA2079 (PI: Cottler). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.023 The interaction between cocaine dependence and HIV infection on risky decision making and its neural substrates Merideth Addicott ∗ , Andrea L. Hobkirk, Daniella Cordero, Christina S. Meade Psychiatry & Behavioral Sciences, Duke University, Durham, NC, United States Aims: Stimulant drug abuse is a major driver of HIV infections since stimulant abusers engage in high rates of risky sexual behaviors. Both stimulants and HIV alter brain function, which may contribute to risky decision making. Cocaine abuse affects dopamine function, and cocaine users display impaired executive function related to inhibitory control and risk-taking propensity. HIV infection is also associated with deficits in executive function, such as impaired inhibition and risky decision making. However, how the interaction between cocaine dependence and HIV infection affects decision-making processes is unknown. Methods: In this case-control study, four groups of participants (cocaine dependent/HIV+, n = 15; cocaine dependent/HIV−, n = 17; non-drug user/HIV+, n = 17; non-drug user/HIV−, n = 20) completed a loss aversion task while undergoing functional MRI. In this task, participants accepted or rejected gambles with an equal probability of winning or losing. Gambles were drawn randomly from a gain/loss matrix that ranged from $0 to $40 and from $0 to −$20. Results: Behaviorally, there was a step-wise decrease in loss aversion across the four groups (p < .05), with cocaine dependent/HIV+ participants demonstrating the least loss aversion. The BOLD signal was modeled using regressors for gain values and loss values, separately. Group-level tests on the contrast Loss > Gain revealed hypoactivation among cocaine dependent participants compared to non-drug users in the bilateral caudate/putamen; hypoactivation among HIV+ compared to HIV− participants in the bilateral frontal poles, inferior temporal lobes, and superior parietal lobules; and an interaction effect in the right insula (cluster corrected, p < 0.05). Conclusions: These results suggest that cocaine dependence and HIV infection have unique, yet additive, effects on rewardbased decision making, which may help to explain engagement in risky behaviors. Financial Support: This research was supported by R21 DA036450 (CSM), K23 DA028660 (CSM), and K01 DA033347 (MAA). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.024

e3

Effects of electronic vs. combustible cigarette administration on smoking withdrawal suppression Claudia G. Aguirre ∗ , Adam Leventhal, Matthew Kirkpatrick, Nicholas Goldenson, Jimi Huh Preventive Medicine, University of Southern California, Los Angeles, CA, United States Aims: Concurrent use of electronic cigarettes (ECs) and combustible cigarettes (CCs) (“dual use”) is becoming increasingly common. Dual users may use ECs as a smoking substitute to provide acute satiation of key withdrawal symptoms (i.e., negative affect and urge to smoke) during brief periods of CC abstinence. We tested whether ECs effectively substitute for CCs by comparing the effects of CC and EC administration on suppression of withdrawal symptoms in dual users in a lab study. Methods: Dual users (aged 18–58; n = 25) completed four lab visits each after 16 h of nicotine deprivation. At each visit, subjects completed (in randomized order) one of four experimental conditions as part of a 2 [Nicotine Administration: administration of EC or CC vs. matched continued deprivation control] × 2 [Cigarette Type: EC vs. CC administration/matched control] factorial withinsubject design. Participants used their preferred CC brand and EC device during the 8-minute nicotine administration procedure to maximize external validity. Subjective measures were administered before and after EC or CC ad-lib administration (or continued deprivation for the matched control conditions). Results: There was a Nicotine Administration x Cigarette Type interaction for urge to smoke [F(1, 100) = 6.15, p = .02]. Both ECs and CCs significantly suppressed smoking urge, but the magnitude of suppression (relative to continued deprivation) was weaker from ECs [F(1,47) = 11.21, p < .01] than CCs [F(1,47) = 82.58, p < .0001]. Both EC and CC administration significantly suppressed urge to vape and negative affect; the magnitude of suppression did not differ. Conclusions: Use of preferred EC device provides satiating effects on negative affect and urge in dual users, though the magnitude of suppression of smoking urge may not be as robust as CC-induced urge suppression. Future research on dimensions of EC product diversity that maximize smoking withdrawal suppression is warranted to inform possible harm reduction efforts. Financial Support: USC TCORS HS-CG-13-00019. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.025 Addressing unmet addiction need in an urban hospital Keith Ahamad 2,∗ , Seonaid Nolan 3 , Evan Wood 1 1

Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada 2 University of British Columbia, Vancouver, BC, Canada 3 Department of Medicine, University of British Columbia, Vancouver, BC, Canada Aims: Patients with substance use disorders are heavy users of inpatient hospital care. Significant barriers exist in accessing evidenced based addiction care. Much of the issue is the lack of medical education and availability of specialty consultation with linkage to primary care follow-up. We aim to assess the impact of the creation of an academic teaching service on medical education and specialty consultation for addiction related hospitalizations in Vancouver, BC.

e4

Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226

Methods: Following the creation of and Addiction Medicine Fellowship program in Vancouver, BC an existing addiction consultative service was expanded to include medical students, residents and fellows. Data for trainees working on the service were tracked using administrative records between August, 2013 and June, 2016. Data for patient consultations were tracked using the hospital’s Patient Care Information System between January, 2009 and December, 2015. Results: Overall, between July 2013 and June 2016 medical trainees increased from 33 in 2013–14 (4 follows, 2 practicing GPs, 12 residents, 1 nurse, 12 medical students), 73 in 2014–15 (4 fellows, 5 practicing GPs, 43 residents, 1 nurse, 20 medical students), and 98 in 2015–16 (6 fellows, 5 practicing GPs, 47 residents, 2 nurses, 37 medical students). Patient consultations were tacked pre and post expansion. Pre-expansion consults between January, 2009 and December, 2012 averaged 940.25 per year. Post-expansion consults increased in 2013, 2014, and 2015 to 1144, 1623, and 1946, respectively. Conclusions: In this setting, creation of an academic addiction training service has resulted in substantial increases in medical trainees and doubled the number of patients seen in consultation. Further study is needed to assess long-term patient outcomes. Financial Support: Providence Health Care. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.026 Healthcall on smartphone: A brief intervention to reduce concurrent drug and alcohol use Efrat Aharonovich 1,2,∗ , Eliana Greenstein 2 , Aline Le 2 , Deborah S. Hasin 1,2 1 Psychiatry, Columbia University Medical Center, New York, NY, United States 2 NYSPI, New York, NY, United States

Aims: Alcohol and drug abuse are often not addressed in primary care settings, where staff are busy and resources scarce, so we developed HealthCall to enhance brief intervention using interactive voice response. Recently, as part of the NIH Collaborative Research on Addiction initiative (CRAN), we migrated HealthCall to smartphone technology, and adapted it to have an integrated focus on both alcohol and drugs (“HealthCall-A/D”), for use in enhancing brief behavioral intervention in HIV+ individuals. Due to the innovations in HealthCall-A/D, feasibility information and patient engagement by end-of-treatment (60 days) was needed. Methods: Participants were 41 HIV+ non-injection drug users who were concurrent binge drinkers recruited via ads in local NYC newspapers. Mean age was 50 (s.d., 8.2), 78% were male, 88% African-American, 71% had HS grad/GED. At baseline, mean days of drug use in the past 30 days was 14 (s.d. 6.2), mean drinks per drinking days was 6.4 (s.d. 3.4); mean drinks per day was 3.0 (s.d.2.3) and mean percent days abstinent (PDA) was 53.5 (s.d. 22.7). Study is ongoing; here we present preliminary results. Results: By end of treatment, reduction in mean days of drug use was significant (p < .0001), as was reduction in mean drinks per day (p < .0001) and mean PDA (p < .0001), while reduction in mean drinks per drinking day trended towards significance (p = 0.08). Retention to date is very good, with 100% of participants due for their final visit attending. Engagement is very high; participants have used HealthCall-AD 90.85% of possible days (i.e., nearly daily). Conclusions: Significant drug and alcohol use reductions occurred by the end of treatment in this sample of low SES HIV+ individuals. HealthCall-A/D use (∼91% of possible days) was substantially higher than in our previous HealthCall work in HIV+ drug abusers using interactive voice response (∼65%). These preliminary

results are promising as they show HealthCall-A/D to be highly feasible and engaging for HIV+ individuals abusing both alcohol and drugs. Financial Support: R01DA024606, New York State Psychiatric Institute. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.027 Taurine’s effects on cocaine reward in adolescent male and female rats Ugochukwu Akpara ∗ , Rina Liang, Avery Villa-Gonzalez, Denzel Harrris, Adel Elzanie, Kirtan Chauhan, Cladimar Vasquez, Tianna Irving, Ayana Cole, Kaliris Yimar Salas-Ramirez Department of Physiology, Pharmacology and Neuroscience, CUNY School of Medicine, New York, NY, Brooklyn, NY, United States Aims: According to the 2013 National Survey on Drug Use and Health (NSDUH), approximately 4.2 million United States residents are estimated to use cocaine in a year. The survey showed that approximately 3% of current users in the US are adolescents. Females begin using illicit drugs, like cocaine, at lower doses when compared to males; however, their uses escalate very rapidly into addiction. Women also relapse more often and have a tougher time in rehab, therefore, when considering pharmacological interventions for cocaine addiction, one must consider sex and age of exposure. Previous studies from our laboratory determined sex specific effects of taurine on cocaine reward, males benefitting from taurine pre-treatment. Although it also decreased cocaine reward in females, it was dependent on time of exposure and gonadal hormones. The objective of this study was to test whether taurine would have a differential effect on adolescent rats. Methods: Thirty-six male adolescent rats (P30) were treated with either taurine (100 mg/kg) or saline and tested for cocaine (10 mg/kg) reward using a conditioned place preference paradigm. Results: Adolescent male rats showed a strong preference towards the cocaine paired chamber, independent of taurine pretreatment. Surprisingly, they also acquired a preference to taurine. Conclusions: This was not observed in intact or gonadectomized adult males. The preference to cocaine in females is hormone dependent, so we hypothesized that taurine may exacerbate cocaine reward in adolescent females. These findings have strong implications for the relationship between compounds found in energy drinks and stimulant use and abuse. We will further investigate sex differences within this paradigm to determine whether these effects are sex-specific. Financial Support: 5G12RR003060-26 from the NCRR and 8G12MD7603-27 from the NIMHD (EF, KSR). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.028