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\"Addiction might be an age-old affliction but we still only have a modest understanding of how and why addiction treatment works. This book uses an innovative translational approach to weave together basic biological (brain) mechanisms with human behaviour in order to provide a critical insight into why people do (and do not) change in the context of addiction treatment. With sections focusing on both adults and adolescents, this book bridges the gap between experimental scientists and clinical practitioners to provide an overview of the influence of basic brain functions. \"-- Provided by publisher.

Alcohol-related harm, a major cause of disease burden globally, affects people along a spectrum of use. When a harmful pattern of drinking is present in the absence of significant behavioral pathology, low-intensity brief interventions that provide information about health consequences of continued use provide large health benefits. At the other end of the spectrum, profound behavioral pathology, including continued use despite knowledge of potentially fatal consequences, warrants a medical diagnosis, and treatment is strongly indicated. Available behavioral and pharmacological treatments are supported by scientific evidence but are vastly underutilized. Discovery of additional medications, with a favorable balance of efficacy versus safety and tolerability can improve clinical uptake of treatment, allow personalized treatment, and improve outcomes. Here, we delineate the clinical conditions when pharmacotherapy should be considered in relation to the main diagnostic systems in use and discuss clinical endpoints that represent meaningful clinical benefits. We then review specific developments in three categories of targets that show promise for expanding the treatment toolkit. GPCRs remain the largest category of successful drug targets across contemporary medicine, and several GPCR targets are currently pursued for alcohol-related indications. Endocrine systems are another established category, and several promising targets have emerged for alcohol indications. Finally, immune modulators have revolutionized treatment of multiple medical conditions, and they may also hold potential to produce benefits in patients with alcohol problems.

Background Substance use disorders are prevalent and returning to substance use (i.e., relapse) following treatment is common, underscoring the need for effective treatments that will help individuals maintain long-term reductions in substance use. Mindfulness-based interventions (MBIs) have been increasingly developed and evaluated for the treatment of substance use disorders. The aim of this article was to update a systematic review conducted by Li et al. in 2017 on the outcomes of randomized control trials of MBIs for substance use disorders. In addition, we provided a session-by-session examination of the most widely used MBI protocols. Methods We conducted a comprehensive literature search of the PubMed, PsycINFO, and Web of Science databases from January of 2016 through April of 2020. Studies were included based on the following criteria: 1) examined the effects of an MBI, 2) employed a randomized controlled trial design with repeated measures, including secondary data analyses of randomized controlled trials, and 3) enrolled participants seeking treatment for substance use disorders. Results The search identified 902 publications and 30 studies were eligible for inclusion and data extraction. MBIs appear to be as effective as existing evidence-based treatments for substance use disorders at reducing the frequency and quantity of alcohol and drug use, substance-related problems, craving for substance use, and at increasing the rate of abstinence. Conclusions Future directions include additional large scale randomized controlled trials, investigation of the most suitable settings and protocols, examination of patient populations that may benefit most from MBIs, and dissemination and implementation research.

BackgroundThe World Health Organization (WHO) categorizes alcohol consumption according to grams consumed into low-, medium-, high-, and very-high-risk drinking levels (RDLs). Although abstinence has been considered the ideal outcome of alcohol treatment, reductions in WHO RDLs have been proposed as primary outcomes for alcohol use disorder (AUD) trials.ObjectiveThe current study examines the stability of WHO RDL reductions and the association between RDL reductions and long-term functioning for up to 3 years following treatment.Design and ParticipantsSecondary data analysis of patients with AUD enrolled in the COMBINE Study and Project MATCH, two multi-site, randomized AUD clinical trials, who were followed for up to 3 years post-treatment (COMBINE: n = 694; MATCH: n = 806).MeasuresAlcohol use was measured via calendar-based methods. We estimated all models in the total sample and among participants who did not achieve abstinence during treatment.Key ResultsOne-level RDL reductions were achieved by 84% of patients at the end of treatment, with 84.9% of those individuals maintaining that reduction at a 3-year follow-up. Two-level RDL reductions were achieved by 68% of patients at the end of treatment, with 77.7% of those individuals maintaining that reduction at a 3-year follow-up. One- and two-level RDL reductions at the end of treatment were associated with significantly better mental health, quality of life (including physical quality of life), and fewer drinking consequences 3 years after treatment (p < 0.05), as compared to no change or increased drinking.ConclusionAUD patients can maintain WHO RDL reductions for up to 3 years after treatment. Patients who had WHO RDL reductions functioned significantly better than those who did not reduce their drinking. These findings are consistent with prior reports suggesting that drinking reductions, short of abstinence, yield meaningful improvements in patient health, well-being, and functioning.

Cue reactivity is one of the most frequently used paradigms in functional magnetic resonance imaging (fMRI) studies of substance use disorders (SUDs). Although there have been promising results elucidating the neurocognitive mechanisms of SUDs and SUD treatments, the interpretability and reproducibility of these studies is limited by incomplete reporting of participants’ characteristics, task design, craving assessment, scanning preparation and analysis decisions in fMRI drug cue reactivity (FDCR) experiments. This hampers clinical translation, not least because systematic review and meta-analysis of published work are difficult. This consensus paper and Delphi study aims to outline the important methodological aspects of FDCR research, present structured recommendations for more comprehensive methods reporting and review the FDCR literature to assess the reporting of items that are deemed important. Forty-five FDCR scientists from around the world participated in this study. First, an initial checklist of items deemed important in FDCR studies was developed by several members of the Enhanced NeuroImaging Genetics through Meta-Analyses (ENIGMA) Addiction working group on the basis of a systematic review. Using a modified Delphi consensus method, all experts were asked to comment on, revise or add items to the initial checklist, and then to rate the importance of each item in subsequent rounds. The reporting status of the items in the final checklist was investigated in 108 recently published FDCR studies identified through a systematic review. By the final round, 38 items reached the consensus threshold and were classified under seven major categories: ‘Participants’ Characteristics’, ‘General fMRI Information’, ‘General Task Information’, ‘Cue Information’, ‘Craving Assessment Inside Scanner’, ‘Craving Assessment Outside Scanner’ and ‘Pre- and Post-Scanning Considerations’. The review of the 108 FDCR papers revealed significant gaps in the reporting of the items considered important by the experts. For instance, whereas items in the ‘General fMRI Information’ category were reported in 90.5% of the reviewed papers, items in the ‘Pre- and Post-Scanning Considerations’ category were reported by only 44.7% of reviewed FDCR studies. Considering the notable and sometimes unexpected gaps in the reporting of items deemed to be important by experts in any FDCR study, the protocols could benefit from the adoption of reporting standards. This checklist, a living document to be updated as the field and its methods advance, can help improve experimental design, reporting and the widespread understanding of the FDCR protocols. This checklist can also provide a sample for developing consensus statements for protocols in other areas of task-based fMRI.Cue reactivity measured by functional magnetic resonance imaging is used in studies of substance-use disorders. This Consensus Statement is the result of a Delphi process to arrive at parameters that should be reported in describing these studies.

Background Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk for aggression and excessive use of force, as well as mental health consequences, including post-traumatic stress disorder, burnout, alcohol misuse, depression, and suicide. Mindfulness training is a promising approach with high-stress populations that has been shown effective for increasing resilience and improving negative mental health outcomes common among LEOs. Method Implemented at two sites, the proposed study is designed to establish optimal protocols and procedures for a future full-scale, multisite trial assessing effects of mindfulness-based resilience training versus an attention control (stress management education) and a no-intervention control on physiological, behavioral, and psychological outcomes. To prepare for this future clinical trial, the current study is designed to: enhance efficiency of recruitment, engagement, and retention; optimize laboratory, assessment, and data management procedures; optimize intervention training and ensure fidelity to intervention protocols; and assess participant experience and optimize outcome measures across two sites. Herein, we describe the protocol and methodology of this multisite, randomized, single-blind clinical feasibility trial. Discussion The long-term objective of this line of research is to develop an intervention that will reduce violence and increase resilience and mental health among LEOs, as well as yield significant benefits for the communities and residents they serve. Trial registration ClinicalTrials.gov, NCT03784846 . Registered on 24 December 2018.

The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.

IntroductionSexual minority women represent one of the highest-risk groups for hazardous drinking and comorbid mental health problems (eg, depression, anxiety). Research has identified cognitive (eg, expectations of rejection), affective (eg, emotion dysregulation) and behavioural (eg, avoidant coping) pathways through which minority stress (eg, stigma) places sexual minority women at disproportionate risk of hazardous drinking and comorbid depression/anxiety; yet no evidence-based interventions have been tested to address these pathways in this population. This article describes the design of Project EQuIP (Empowering Queer Identities in Psychotherapy), a randomised controlled trial of a transdiagnostic lesbian, gay, bisexual, transgender, queer (LGBTQ)-affirmative cognitive-behavioural therapy intervention (CBT) designed to improve minority stress coping and reduce sexual minority women’s hazardous drinking and mental health comorbidities.Methods and analysisThis two-arm randomised controlled trial, funded by the National Institute on Alcohol Abuse and Alcoholism, has two objectives: (1) test the efficacy of 10 sessions of LGBTQ-affirmative CBT compared with 10 sessions of supportive counselling for sexual minority women in the community (anticipated n=450) who report hazardous alcohol use and meet criteria for a Diagnostic and Statistical Manual of Mental Disorders - 5 diagnosis of a depression or anxiety disorder and (2) examine psychosocial mechanisms and demographic factors as potential mediators and moderators, respectively, of the treatment-outcome relationship. This study’s primary outcome is change in the proportion of heavy drinking days. Secondary outcomes are changes in depressive and anxious symptoms.Ethics and disseminationThe Yale University Human Subjects Committee reviewed and approved the research protocol. Results of this study will be disseminated to researchers and practitioners through peer-review publications and conference presentations, and directly to study participants.Trial registration numberRegistered on 17 August 2022 (ClinicalTrials.gov identifier: NCT05509166).

•Examining sex in alcohol research is critical.•Findings across animals and humans are complex.•More research is needed to further clarify and understand this complexity.

Objectives Elucidating the active ingredients of psychological treatments is an important step in the scientific validation of these interventions. Component studies are one way to test which aspects of psychological treatments impact outcomes or, in other words, are the active ingredients of treatment. As research and popular interest in mindfulness-based programs grows, it is important to evaluate the active ingredients of these programs and to continually refine theorized models of the mechanisms of mindfulness. Studying active ingredients may help clarify which elements of mindfulness-based programs are most important for dissemination. Methods We conducted a systematic review of component studies of mindfulness-based programs for adults with psychological conditions. PRISMA guidelines for systematic reviews were followed. Results Eight component studies were identified. These studies dismantled mindfulness-based stress reduction, mindfulness-based cognitive therapy, unified mindfulness, and core mindfulness processes. The eight studies differed with respect to types of programs and populations studied, yet similarities emerged. Notably, acceptance coupled with awareness and mindfulness meditation training may be two promising active ingredients of these different programs. Conclusions Future studies examining mindfulness-based programs should continue to attempt to dismantle active ingredients of treatment and use the findings to update theoretical models of mindfulness.