Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder

Abstract

BackgroundBenzodiazepine (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.MethodsThis 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.ResultsLifetime 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.ConclusionAnhedonia (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.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03696017, identifier NCT03696017.

A pilot study of virtual reality for inpatients with opioid use disorder

“…The interventions in this case incorporated aspects related to MBCT such as the value of distinguishing thoughts from statements of fact, developing awareness of the present moment, mitigating physiological stress responses, and identifying feelings without changing or avoiding them 29 . In addition, the intervention addressed factors derived from Psychological Systems Theory, 19,28 including emotionally supportive comments from a calming voice that were intended to bolster their self‐esteem, confidence, and motivation.…”

“…The interventions in this case incorporated aspects related to MBCT such as the value of distinguishing thoughts from statements of fact, developing awareness of the present moment, mitigating physiological stress responses, and identifying feelings without changing or avoiding them. 29 In addition, the intervention addressed factors derived from Psychological Systems Theory, 19,28 including emotionally supportive comments from a calming voice that were intended to bolster their self-esteem, confidence, and motivation. This intervention was delivered as a three-dimensional (3D), multisensory experience through the Meta Quest 2.0, a commercially available VR headset while the user was engaged in activities such as interactive 3D art, first-person challenges, problem-solving, and educational/confidence-building games, guided by a calming voice.…”

“…To this end, we sought to evaluate the feasibility of a version of VR, 3D Therapy Thrive (3DTT), which leverages a Mindfulness‐Based Cognitive Therapy (MBCT) approach focused to increase OUD withdrawal management retention by targeting patients' mood, anxiety, and cravings coupled with enhancement of other psychological deficits in this group such as self‐esteem and competence 28 . We hypothesized that this combination of VR and psychologically based interventions would be well tolerated, improve mood and tension, reduce cravings, and improve retention in treatment compared to TAU.…”