Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder.
Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder.
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DOI：
10.3389/fpsyt.2023.1103739
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发表时间：
2023
影响因子：
4.7
通讯作者：
Roehrs, Timothy A. A.
中科院分区：
文献类型：
--
作者：
Greenwald, Mark K. K.;Moses, Tabitha E. H.;Lundahl, Leslie H. H.;Roehrs, Timothy A. A.
苯二氮卓类药物（BZD）滥用是一个重大的公共卫生问题，特别是与阿片类药物一起使用时，由于过量和死亡的风险增加。BZD滥用的一个假定机制是情感失调，通过夸大的负面影响（例如，焦虑、抑郁、压力反应性）和/或受损的积极情感（快感缺乏）。与其他滥用物质类似，BZD消费对价格和个体差异敏感。虽然购买任务和需求曲线分析可以揭示物质使用的决定因素，但很少有研究探讨BZD需求，也没有与需求相关的因素。这项正在进行的研究正在检查阿普唑仑的模拟经济需求（基于自我报告和DSM-5诊断的BZD终身滥用者中;共n = 23; 14例男性，9例女性）以及使用临床不稳定的阿片类药物使用障碍患者（共n = 59; 38例男性，21例女性）的假设购买任务的每位参与者的首选阿片类药物/途径，即，定义为治疗早期或治疗时间较长但最近使用过药物。目的是确定：（1）BZD滥用者与从未滥用者在首选阿片类药物经济需求、情感失调（使用问卷和性能指标）、失眠/行为警觉性、精神病诊断或药物或尿分析结果方面存在差异;（2）BZD滥用者中阿普唑仑需求与情感失调或其他指标相关。终生BZD滥用与当前重度抑郁症诊断、阿片类药物阴性和美沙酮阴性尿液分析、较高的特质焦虑、较高的自我报告情感失调和较年轻的年龄显着相关（p < 0.05），但与首选阿片类药物需求或失眠/行为警觉性无关。阿普唑仑和阿片类药物需求均与较高的快感缺失显著正相关，在较小程度上与抑郁症状显著正相关，但与其他负性情感失调指标、精神疾病或药物（包括阿片类药物激动剂治疗或住院/门诊治疗方式）或睡眠相关问题无关。快感缺失（积极情感缺陷）有力地预测了BZD和阿片类药物需求的增加;这些因素可以调节治疗反应。对同时存在阿片类药物和镇静剂使用障碍的人群进行常规评估和有效治疗可能会改善治疗结果。https：//clinicaltrials.gov/ct2/show/NCT03696017，标识符NCT 03696017。
Benzodiazepine (BZD) misuse is a significant public health problem, particularly in conjunction with opioid use, due to increased risks of overdose and death. One putative mechanism underlying BZD misuse is affective dysregulation, via exaggerated negative affect (e.g., anxiety, depression, stress-reactivity) and/or impaired positive affect (anhedonia). Similar to other misused substances, BZD consumption is sensitive to price and individual differences. Although purchase tasks and demand curve analysis can shed light on determinants of substance use, few studies have examined BZD demand, nor factors related to demand. This ongoing study is examining simulated economic demand for alprazolam (among BZD lifetime misusers based on self-report and DSM-5 diagnosis; n = 23 total; 14 male, 9 female) and each participant’s preferred-opioid/route using hypothetical purchase tasks among patients with opioid use disorder (n = 59 total; 38 male, 21 female) who are not clinically stable, i.e., defined as being early in treatment or in treatment longer but with recent substance use. Aims are to determine whether: (1) BZD misusers differ from never-misusers on preferred-opioid economic demand, affective dysregulation (using questionnaire and performance measures), insomnia/behavioral alertness, psychiatric diagnoses or medications, or urinalysis results; and (2) alprazolam demand among BZD misusers is related to affective dysregulation or other measures. Lifetime BZD misuse is significantly (p < 0.05) related to current major depressive disorder diagnosis, opioid-negative and methadone-negative urinalysis, higher trait anxiety, greater self-reported affective dysregulation, and younger age, but not preferred-opioid demand or insomnia/behavioral alertness. Alprazolam and opioid demand are each significantly positively related to higher anhedonia and, to a lesser extent, depression symptoms but no other measures of negative-affective dysregulation, psychiatric conditions or medications (including opioid agonist therapy or inpatient/outpatient treatment modality), or sleep-related problems. Anhedonia (positive-affective deficit) robustly predicted increased BZD and opioid demand; these factors could modulate treatment response. Routine assessment and effective treatment of anhedonia in populations with concurrent opioid and sedative use disorder may improve treatment outcomes. https://clinicaltrials.gov/ct2/show/NCT03696017, identifier NCT03696017.
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