Latest
TACTIC: Tuberculosis Active Case Tracking via Interpersonal Connections
PROJECT SUMMARY/ABSTRACT Tuberculosis (TB) remains the leading infectious cause of death worldwide. Interruption of transmission is the most effective strategy to reduce incident infections, yet current approaches often fail to reach individuals for timely testing and treatment. This study addresses that gap by leveraging social networks to identify individuals at highest risk of transmitting TB, specifically, people who use drugs (PWUD). We will evaluate respondent-driven sampling (RDS), a peer7 based community recruitment strategy, to identify TB cases among PWUD and the household contacts (HHCs) of those with TB disease (RDS-TB) in Kampala, Uganda. Conducting this work in a high-prevalence setting such as Kampala where our team has established expertise allows us to overcome recruitment challenges common in settings in the United States while generating findings that are directly translatable. This is particularly relevant given that higher TB prevalence and larger outbreaks in the United States have been associated with the use of methamphetamine, heroin, and crack/cocaine, drugs that we will study. In Aim 1, we will compare the effectiveness and reach of RDS-TB with a traditional clinic-based index case HHC approach for TB case finding. We will screen 2,000 PWUD and their HHCs, estimate the number needed to screen to identify one case of TB disease, and compare the demographic and network characteristics of RDS-TB recruits with clinic-based HHCs. Whole genome sequencing will be used to characterize transmission dynamics. In Aim 2, we will compare the yield of individual and combined TB diagnostic strategies for community-based active case finding. Participants will undergo chest radiography with computer-aided detection, tongue swab testing for TB nucleic acid amplification tests (NAAT), and sputum testing for NAAT and mycobacterial culture. We will identify the minimal combination of tests needed to meet World Health Organization target product profile thresholds for screening. In Aim 3, we will define the conditions under which RDS-based screening can effectively interrupt TB transmission. We will develop an agent-based model informed by social network data from individuals with and without TB, incorporating drug use patterns and demographic characteristics. This project will generate a practical, scalable roadmap for social network–based TB active case finding in high28 risk communities. The approach will be readily adaptable to settings in the United States and will inform strategies to interrupt transmission and advance progress toward TB elimination, in alignment with the NIH Strategic Plan for TB Research.
Apathy and Anhedonia in Adult and Adolescent Cannabis Users and Controls Before and During the COVID-19 Pandemic Lockdown
COVID-19 lockdown measures have caused severe disruptions to work and education and prevented people from engaging in many rewarding activities. Cannabis users may be especially vulnerable, having been previously shown to have higher levels of apathy and anhedonia than non-users. In this survey study, we measured apathy and anhedonia, before and after lockdown measures were implemented, in n = 256 adult and n = 200 adolescent cannabis users and n = 170 adult and n = 172 adolescent controls. Scores on the Apathy Evaluation Scale (AES) and Snaith-Hamilton Pleasure Scale (SHAPS) were investigated with mixed-measures ANCOVA, with factors user group, age group, and time, controlling for depression, anxiety, and other drug use. Adolescent cannabis users had significantly higher SHAPS scores before lockdown, indicative of greater anhedonia, compared with adolescent controls (P = .03, η p2 = .013). Contrastingly, adult users had significantly lower scores on both the SHAPS (P < .001, η p2 = .030) and AES (P < .001, η p2 = .048) after lockdown compared with adult controls. Scores on both scales increased during lockdown across groups, and this increase was significantly smaller for cannabis users (AES: P = .001, η p2 = .014; SHAPS: P = .01, η p2 = .008). Exploratory analyses revealed that dependent cannabis users had significantly higher scores overall (AES: P < .001, η p2 = .037; SHAPS: P < .001, η p2 = .029) and a larger increase in scores (AES: P = .04, η p2 =.010; SHAPS: P = .04, η p2 = .010), compared with non-dependent users. Our results suggest that adolescents and adults have differential associations between cannabis use as well as apathy and anhedonia. Within users, dependence may be associated with higher levels of apathy and anhedonia regardless of age and a greater increase in levels during the COVID-19 lockdown.
Schizophrenia and Substance Use Disorders: Cracking the Chicken-or-Egg Question
Although substance use disorders (SUDs) occur commonly in patients with schizophrenia and significantly worsen their clinical course, the neurobiological basis of SUDs in schizophrenia is not well understood. Therefore, there is a critical need to understand the mechanisms underlying SUDs in schizophrenia in order to identify potential targets for therapeutic intervention. Since drug use usually begins in adolescence, it is also important to understand the long-term effects of adolescent drug exposure on schizophrenia- and reward- related behaviors and circuitry. This talk will combine pharmacological, behavioral, electrophysiologic (local field potential recordings) and pre-clinical magnetic resonance imaging (resting-state functional connectivity and magnetic resonance spectroscopy) approaches to study these topics with an eye toward developing better treatment approaches.
Neuronal encoding of drug choices and preference in the orbitofrontal cortex
Human neuroimaging research has consistently shown that drug addiction is associated with structural and functional changes within the orbitofrontal cortex (OFC). In view of the important role of the OFC in value-based decision-making, these changes have been hypothesised to bias choice towards drug use despite and at the expense of other competing pursuits, thereby explaining drug addiction. Here I will present in vivo recording data in the OFC supporting this hypothesis in a choice-based model of addiction where rats could choose between two actions, one rewarded by a drug (cocaine or heroin), the other by a nondrug alternative (saccharin).
Social deprivation, coping and drugs: a bad cocktail in the COVID-19 era: evidence from preclinical studies
The factors that underlie an individual’s vulnerability to switch from controlled, recreational drug use to addiction are not well understood. I will discuss the evidence in rats that in individuals housed in enriched conditions, the experience of drugs in the relative social and sensory impoverishment of the drug taking context, and the associated change in behavioural traits of resilience to addiction, exacerbate the vulnerability to develop compulsive drug intake. I will further discuss the importance of the acquisition of alcohol drinking as a mechanism to cope with distress as a factor of exacerbated vulnerability to develop compulsive alcohol intake. Together these results demonstrate that experiential factors in the drug taking context, which can be substantially driven by social isolation, shape the vulnerability to addiction.
Neuroimaging in human drug addiction: an eye towards intervention development
Drug addiction is a chronically relapsing disorder characterized by compulsive drug use despite catastrophic personal consequences (e.g., loss of family, job) and even when the substance is no longer perceived as pleasurable. In this talk, I will present results of human neuroimaging studies, utilizing a multimodal approach (neuropsychology, functional magnetic resonance imaging, event-related potentials recordings), to explore the neurobiology underlying the core psychological impairments in drug addiction (impulsivity, drive/motivation, insight/awareness) as associated with its clinical symptomatology (intoxication, craving, bingeing, withdrawal). The focus of this talk is on understanding the role of the dopaminergic mesocorticolimbic circuit, and especially the prefrontal cortex, in higher-order executive dysfunction (e.g., disadvantageous decision-making such as trading a car for a couple of cocaine hits) in drug addicted individuals. The theoretical model that guides the presented research is called iRISA (Impaired Response Inhibition and Salience Attribution), postulating that abnormalities in the orbitofrontal cortex and anterior cingulate cortex, as related to dopaminergic dysfunction, contribute to the core clinical symptoms in drug addiction. Specifically, our multi-modality program of research is guided by the underlying working hypothesis that drug addicted individuals disproportionately attribute reward value to their drug of choice at the expense of other potentially but no-longer-rewarding stimuli, with a concomitant decrease in the ability to inhibit maladaptive drug use. In this talk I will also explore whether treatment (as usual) and 6-month abstinence enhance recovery in these brain-behavior compromises in treatment seeking cocaine addicted individuals. Promising neuroimaging studies, which combine pharmacological (i.e., oral methylphenidate, or RitalinTM) and salient cognitive tasks or functional connectivity during resting-state, will be discussed as examples for using neuroimaging for empirically guiding the development of effective neurorehabilitation strategies (encompassing cognitive reappraisal and transcranial direct current stimulation) in drug addiction.
drug use coverage
6 items
Add content
Have a seminar, talk, or paper on drug use? Post it so others working in this area can find it.
Post content