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Drug Dreams in Outpatients With Bipolar Disorder and Cocaine Dependence

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Abstract

Patients with substance abuse or dependence often have dreams about alcohol or drugs during early recovery. However, the literature on drug dreams in rehabilitating patients with drug-related disorders remains limited. No data are available on drug dreams in people with substance-related disorders and other major mental illness. As part of a large study on the use of lamotrigine in patients with bipolar disorder and cocaine dependence, the frequency and nature of drug dreams, triggers for dreams, and response to the dreams during study participation were assessed in 37 outpatients for as long as 36 weeks. Altogether, 74% of participants experienced at least one drug dream during the study. Furthermore, drug dreams rapidly decreased during study participation. The presence of drug dreams at baseline did not predict mood, cocaine craving, or drug use at exit. No clear risk factors for drug dreams were identified. However, drug dreams were related to survival in the study by a negative U-shaped curve relationship in which those participants with the highest and lowest frequency of drug dreams discontinued from the study the earliest. Content of the dreams frequently included drug use or refusing to use the drug. Dreams of drug use tended to occur during the first few weeks of study participation. Most dreams were associated with triggers for drug use. The findings suggest that drug dreams are common in patients with bipolar disorder and cocaine dependence and are similar in nature to those previously reported in people with pure substance abuse.

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... 'Drug dreams' is the term commonly used in the literature to define the dreams of drug-addicted patients that have contents related to their craving for the drugs they are addicted to [10,12,15,21,36,56,59]. These dreams are a well-documented clinical phenomenon in all forms of addiction [10,18,19,36,49,59] and have been investigated in terms of clinical usefulness and prognostic significance in the treatment of addicted patients [4,10,12,29,36,46,57,59,65,72], as well as in their implications from the standpoint of general dream research and theory [15,18,28,14,16,42,45]. ...
... Focusing now on the last drug dream remembered, as a qualitative observation (without statistical significance) it should be noted that more than half of the patients reported that they had not used drugs No answer 4 11.4 ing that particular drug) and other activities related to drug use, that is, seeing/seeking drugs, handling or buying drugs/alcohol. Another frequent content is an "unsuccessful attempt to use drugs" [10,12,13,15,19,37,49,59,72]. Drug dreams presenting an explicit rejection of the drug have been observed more rarely [4,59]. ...
... The above data are in line with previous studies that had found that the onset of drug dreaming is triggered by a condition of abstinence (10,13,15). For example, previous observations have shown that during imprisonment or after admission to hospital, in fact, whenever these patients find difficulty in obtaining drugs -for example, due to lack of money or due to being detained by the police -they report drug dreams [13,15,17,49,72]. Similarly, previous studies show the presence of drug dreams in the initial stage of abstinence from drug use, that is, from one or two weeks to two or three months counting from the start of treatment of drug-addicted patients [10,18,36,57]. ...
Article
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Background. Drug dreams, that is, the dreams of drug-addicted patients with contents related to their craving for the drugs they are addicted to, have been investigated to determine their clinical and prognostic significance, as well as for their implications from the standpoint of general dream research and theory. Recent progress in the neurobiology of drug addiction and drug craving, affective neuroscience, and the neuropsychology of dreaming, provide a background for investigating the possible neurobiological correlates of these dreams, which may deepen our understanding of the close link between drug dreams and the craving for drugs. Aim. This paper investigates the relationship between drug dreams and limbic system activity in drug-addicted patients as measured by means of the Limbic System Check List-33 (LSCL). Methods. 53 heroin-addicted subjects were interviewed about their drug dreams; the interviews made use of the Drug Dreams Questionnaire. Results. The results show that drug-addicted patients reported an LSCL mean score that indicates limbic system irritability. Furthermore, patients whose experience included drug dreams reported a higher, statistically significant LSCL mean score than patients who had not had any drug dreams. Our results are also consistent with previous studies regarding the phenomenological picture of drug dreams and their clinical applications. Discussion and conclusion. We assume that, in the patients who reported drug dreams, the higher LSCL scores may be due to the presence of a stronger drug craving, of which the higher mesolimbic-mesocortical dopamine tone is the neurobiological correlate. The association between the greater limbic DA tone and the occurrence of drug dreams appears to be consistent with the results of clinical-anatomical studies on dreaming with reference to the crucial role of the mesolimbic-mesocortical dopamine system in the instigation of dreams.
... However, recently, emphasis has been placed on the occurrence of one specific type of a dream, the so-called drug dreams (or drug-related dreams) (Colace, 2014a). In these dreams, the drug addicts use or attempt to use their drug of choice (or otherwise seek, handle, or buy drugs) (Christo & Faney, 1996;Colace, 2000Colace, , 2004Colace, , 2014aYee, Perantie, Dhanani, & Brown, 2004;Tanguay, Zadra, Good, & Leri, 2015). Several studies have shown that drug dreams are a well-documented clinical phenomenon in all forms of drug addiction (i.e., alcohol, heroin, cocaine, tobacco, lysergic acid diethylamide [LSD], and benzodiazepine) with comparable frequency, phenomenology, and clinical ORIGINAL RESEARCH www.addicta.com.tr ...
... Several studies have shown that drug dreams are a well-documented clinical phenomenon in all forms of drug addiction (i.e., alcohol, heroin, cocaine, tobacco, lysergic acid diethylamide [LSD], and benzodiazepine) with comparable frequency, phenomenology, and clinical ORIGINAL RESEARCH www.addicta.com.tr usefulness (Sòrio, Schiefelbein, Balbinot, Santos, & Araujo, 2016;Silva & Nappo, 2019;Choi, 1973;Christo & Faney, 1996;Colace, 2004;2006;2014a;Hajek & Belcher 1991;Parker & Alford, 2009;Steinig, Foraita, Happe, & Heinze, 2011;Yee, Perantie, Dhanani, & Brown, 2004;Frías Ortiz, León Alegria, Fernández Guerra, Ali Al Shaban, Fernández Miranda, & Gonzalez Fernández, 2016). Drug dreams are often short, with simple and clear content that refers directly to daytime experiences and do not require interpretation to understand their meaning. ...
... The presence of drug craving is considered one of the distinguishing signs of drug dependence, and most studies suggest a close relationship between drug craving and the appearance and/or increased frequency of drug dreams (Araujo, Oliveira, Piccoloto & Szupszynski, 2004;Choi, 1973;Christo & Franey, 1996;Fiss, 1980;Persico, 1992;Tanguay et al. 2015;Colace, 2004;2014a;Silva & Nappo, 2019). Furthermore, it has been shown that drug craving increments obtained by means of active stimulation (in nature or experimentally induced) might favor the appearance of drug dreams (Christensen, 2009;Looney, 1972;Yee et al., 2004;Ziegler, 2005). ...
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Abstract Drug dreams, i.e., dreams in which drug-addicted patients use or attempt to use drugs, are a well-documented clinical phenomenon in drug addiction. These dreams offer a useful way to understand the vicissitudes of drug craving in patients who are drug addicts as well as their ability to cope with it. Authors consider drug dreams as a valuable clinical tool in the treatment of drug addiction. Although pathological gambling disorder is a form of behavioral addiction that has several aspects in common with substance addiction, gambling dreams (i.e., dreams about gambling) are seldom described in scientific literature. This study aimed to provide the first systematic investigation on the presence of “gambling dreams” among abstinent pathological gamblers. A total of 10 individuals who arrived consecutively for outpatient treatment at the Centre for Drug Addiction were evaluated on the basis of South Oaks Gambling Scale. They also completed a questionnaire on gambling dreams. The results showed that most pathological gamblers report gambling dreams. These dreams can be considered in terms of frequency, content, and relationship with craving in the same way as drug dreams for drug addiction. Further studies might also shed light on the clinical utility of gambling dreams for treatment of pathological gamblers. Keywords: Gambling disorder, gambling dreams, drug dreams, drug craving, addiction. Main Points • This study shows for the first time the presence of gambling dreams, i.e. dreams about the craving to gamble, in a group of pathological gambler outpatients, offering some insight on the vicissitudes of the patients’ craving and their propensity to cope with it. • The gambling dreams reported here are absolutely comparable, also in terms of contents, with drug dreams in drug addictions. These dreams have the craving to gamble as their main theme, just as drug dreams focus on craving for drug. • These initial observations apparently support the hypothesis that gambling dreams can be considered, in terms of appearance / frequency, content, and relationship with craving, in the same way as drug dreams in other forms of addiction. • The same type of clinical and prognostic usefulness would seem to arise for gambling dreams, as it does for drug dreams in the treatment of drug-addicted patients.
... Naloxone has a 60-90 minute half-life, and its most widespread use is the treatment of respiratory depression in the context of an opiate overdose. It also has an antagonist action, though with a lower affinity, at the sites of κand δ-opioid receptors [72,104,126,164]. ...
... 'Drug dreams' is the term commonly used in the literature to define the dreams of drug-addicted patients that have contents related to their craving for the drugs they are addicted to [10,12,15,21,36,56,59]. These dreams are a well-documented clinical phenomenon in all forms of addiction [10,18,19,36,49,59] and have been investigated in terms of clinical usefulness and prognostic significance in the treatment of addicted patients [4,10,12,29,36,46,57,59,65,72], as well as in their implications from the standpoint of general dream research and theory [15,18,28,14,16,42,45]. ...
... Focusing now on the last drug dream remembered, as a qualitative observation (without statistical significance) it should be noted that more than half of the patients reported that they had not used drugs No answer 4 11.4 ing that particular drug) and other activities related to drug use, that is, seeing/seeking drugs, handling or buying drugs/alcohol. Another frequent content is an "unsuccessful attempt to use drugs" [10,12,13,15,19,37,49,59,72]. Drug dreams presenting an explicit rejection of the drug have been observed more rarely [4,59]. ...
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Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been conducted nationwide; the purpose of this study was, therefore, to determine whether such a pattern could be identified. Methods. A total number of 577 analyses were performed during a three-year period on people suspected of non-lethal substance abuse, in more than two-thirds of the counties in Romania. Preliminary tests were conducted using immunoassay tests (blood or urine) and confirmatory tests were carried out using either GC-MS or HPLC. Results. 240 cases (41.6%) were negative while 327 cases (58.4%) tested positive for illegal drugs, central nervous system medication or both. Men represented 89.5% of all cases, while women accounted for only 10.5%. The pattern of substance abuse varied significantly, depending on the geographical area. In most cases, the identified drugs of abuse were cannabinoids and opiates, with a significantly different distribution of cases, depending on the geographical area. The highest number of positive cases was identified in the month of October, whereas the smallest numbers were identified in July and December. The annual trend of consumption revealed a significant decrease in the analysed substances in 2011. Conclusions. Our study has determined the presence of a specific pattern of consumption in different geographical areas - a result that suggests the need for more targeted prevention programmes, addressing local particularities in consumption behaviours. A significant decrease in the identification of drugs of abuse in the third year of our study, combined with data attesting the significant increase in the consumption of legal highs suggests that the forensic toxicology laboratories need to be equipped with apparatus able to detect these newer substances of abuse more efficiently.
... Naloxone has a 60-90 minute half-life, and its most widespread use is the treatment of respiratory depression in the context of an opiate overdose. It also has an antagonist action, though with a lower affinity, at the sites of κand δ-opioid receptors [72,104,126,164]. ...
... 'Drug dreams' is the term commonly used in the literature to define the dreams of drug-addicted patients that have contents related to their craving for the drugs they are addicted to [10,12,15,21,36,56,59]. These dreams are a well-documented clinical phenomenon in all forms of addiction [10,18,19,36,49,59] and have been investigated in terms of clinical usefulness and prognostic significance in the treatment of addicted patients [4,10,12,29,36,46,57,59,65,72], as well as in their implications from the standpoint of general dream research and theory [15,18,28,14,16,42,45]. ...
... Focusing now on the last drug dream remembered, as a qualitative observation (without statistical significance) it should be noted that more than half of the patients reported that they had not used drugs No answer 4 11.4 ing that particular drug) and other activities related to drug use, that is, seeing/seeking drugs, handling or buying drugs/alcohol. Another frequent content is an "unsuccessful attempt to use drugs" [10,12,13,15,19,37,49,59,72]. Drug dreams presenting an explicit rejection of the drug have been observed more rarely [4,59]. ...
Article
Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been conducted nationwide; the purpose of this study was, therefore, to determine whether such a pattern could be identified. Methods. A total number of 577 analyses were performed during a three-year period on people suspected of non-lethal substance abuse, in more than two-thirds of the counties in Romania. Preliminary tests were conducted using immunoassay tests (blood or urine) and confirmatory tests were carried out using either GC-MS or HPLC. Results. 240 cases (41.6%) were negative while 327 cases (58.4%) tested positive for illegal drugs, central nervous system medication or both. Men represented 89.5% of all cases, while women accounted for only 10.5%. The pattern of substance abuse varied significantly, depending on the geographical area. In most cases, the identified drugs of abuse were cannabinoids and opiates, with a significantly different distribution of cases, depending on the geographical area. The highest number of positive cases was identified in the month of October, whereas the smallest numbers were identified in July and December. The annual trend of consumption revealed a significant decrease in the analysed substances in 2011. Conclusions. Our study has determined the presence of a specific pattern of consumption in different geographical areas - a result that suggests the need for more targeted prevention programmes, addressing local particularities in consumption behaviours. A significant decrease in the identification of drugs of abuse in the third year of our study, combined with data attesting the significant increase in the consumption of legal highs suggests that the forensic toxicology laboratories need to be equipped with apparatus able to detect these newer substances of abuse more efficiently.
... Several authors have noticed that drug-addicted patients (addicted, for example, to alcohol, cocaine, or heroin) frequently report dreams the contents of which are related to their abnormal urge to use the drug they are addicted to (i.e., drug craving). These authors have investigated the usefulness of these dreams from the point of view of the treatment of addicted patients (e.g., Christo & Franey, 1996;Reid & Simeon, 2001;Yee, Perantie, Dhanani, & Brown, 2004). ...
... 1. Drug dreaming is a widespread phenomenon in several other forms of addiction and occurs frequently among a. abstinent polydrug-addicted patients (heroin, cocaine, alcohol, and benzodiazepine) (Christo & Franey, 1996;Johnson, 2001) b. abstinent tobacco smokers (dreams about smoking) (Hajeck & Belcher, 1991;Persico, 1992;Sharpe, 1985) c. abstinent alcoholic patients (dreams about drinking) (Alcoholics Anonymous study as quoted in Christo & Franey, 1996;Beaman, 2002;Choi, 1973;Denzin, 1988;Fiss, 1980 (Beaman, 2002) e. abstinent cocaine-addicted patients (dreams about cocaine) (Colace, 2004a;Reid & Simeon, 2001;Yee et al., 2004). 2. Drug dreams occur more frequently among abstaining patients than in those who still use drugs (Choi, 1973;Hajek & Belcher, 1991;Persico, 1992). ...
Article
The study of dreams in drug-addicted subjects who typically show an abnormal desire to use drugs (i.e., drug craving) represents a new clinical contribution to the investigation of the role of motivations in dreaming processes. This paper reports two studies on the dreaming of heroin-addicted patients. These studies show that: (a) patients frequently dream about heroin (“using heroin” or “seeking and attempting to use heroin”) during abstinence (i.e., drug-craving frustration); and (b) dreams about heroin occur only in abstinent subjects and not in those who regularly use heroin. These results are largely compatible with the previous literature on dreaming in other forms of addiction. Drug dreams undoubtedly show that a clear specific motivational state (drug craving) is strongly involved in the occurrence of dreams clearly related to it. The implications of these data for dream research and theory are discussed.
... Diversi studi hanno mostrato come i pazienti tossicodipendenti riportano frequentemente sogni nei quali usano o tentano di usare la droga dai quali dipendono (Choi 1973, Christo e Franey 1996, Colace 2000, 2004a, 2006, 2010, Yee et al. 2004. ...
... Tali sogni, descritti in letteratura con i termini drug dreams o drug-related dreams, sono tipicamente presenti in tutti i tipi di tossicodipendenza (eroina, cocaina, alcohol, LSD, tabacco, etc.) (Choi 1973, Christo e Franey 1996, Colace 2004a, 2010, Yee et al. 2004) e rappresentano un fenomeno esclusivo di tale patologia, infatti non si osservano nè nei consumatori occasionali di droghe, nè nelle persone che non le utilizzano affatto , Johnson 2011, Keeley 2004, Parker e Alford 2009. ...
Article
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Drug dreams, that is, the dreams in which drug-addict patients typically use or attempt to use the drugs they are addicted to, are a well-known clinical expression of drug craving in drug addiction. Several authors have highlighted the clinical, therapeutic and prognostic usefulness of drug dreams. The case report presented here provides an indication of how these dreams may act as "alert signals" of a recrudescence of drug craving, even after a prolonged drug-free period of time, that might expose patients to a potential risk of relapse. In agreement with the existing literature, this case report suggests that including the collection of drug dreams in the clinical practice may be useful for the purpose of monitoring drug craving and the ability to cope with it.
... Johnson, 2001B. Johnson, , 2008R. A. Johnson, 2000;Stewart, 1999;Yee, Perantie, Dhanani, & Brown, 2004). Generally, in these "drug dreams" subjects seek for and use the drug, or attempt to use it. ...
Article
Several studies have noticed that drug-addicted subjects frequently report dreams the contents of which are related to their abnormal urge to use the drug to which they are addicted (i.e., drug craving). In B. Johnson’s hypothesis, the mesolimbic-mesocortical dopaminergic system, identified by Solms as essential in the generation of dreaming, is exactly the one that, when upregulated by addictive drugs exposure, is responsible for drug craving and related drug dreams. These dopaminergic circuits arise from the ventral tegmentum and have substantial projections in limbic structures. The aim of this study is to investigate the limbic activity, assessed by means of the Limbic System Checklist, LSCL-33, of drug-addicted subjects in relation to their drug dreaming. Consistent with Johnson’s hypothesis, results show that drug-addicted subjects who reported drug dreams had significantly higher LSCL-33 scores than did the control group, which did not have drug dreams. The LSCL-33 scores of drug-addicted subjects are similar to those obtained from temporal-lobe epilepsy subjects. The results of the study provide a clinical exemplification of the neuropsychoanalytic model and are consistent with previous literature that found a correlation between limbic hyperactivity and dreams with a strong emotional/motivational connotation. From the neurobiological background of the drug dreams observed in this study and in previous literature, an account of drug-dream onset is proposed.
... In this study, occurrence of DD did not decrease significantly over the 5 weeks of treatment. However, it has been observed that frequency of DD significantly abates over longer periods of time (ie, months following treatment; Christo and Franey, 1996;Reid and Simeon, 2001;Yee et al., 2004). Hence, because almost half of the participants stopped using drugs only a few days before recruitment in this study, it seems that DD may be particularly common during early withdrawal from drugs. ...
Article
To explore the relationship between occurrence of drug dreams (DDs) and daytime negative affect and drug craving during the course of a 5-week treatment program for substance dependence. Using the dream journal methodology, 86 participants reported occurrence of dreams, dream content, and ratings of affect and drug craving. The relationships between the experience of DD, dream content ("active" vs "passive"), and affect and craving were analyzed using mixed model methods. The experience of DD was associated with higher levels of negative affect (P < 0.001) and craving (P < 0.001). The occurrence of DD did not decrease significantly over the 5 weeks of the study. Cocaine/crack users reported a higher occurrence of DD (P < 0.05) than the other drug groups (opiates and alcohol), and DD involving "active" drug use was associated with larger (P < 0.05) changes in negative affect. These results are consistent with the hypothesis that DD can act as drug-conditioned stimuli to elevate negative affect and craving in abstaining individuals. Although correlational, such findings support the implementation of psychological and pharmacological interventions aimed at minimizing the impact of DD on individuals in recovery from drug addiction.
... Then there There are many reports suggesting that dreaming about alcohol and drugs is an important aspect of both addiction and recovery. The presence of dreams about specific drugs of addiction has been repeatedly documented; alcohol (43)(44)(45)(46)(47)(48), nicotine (43,49,50), cocaine (43,(51)(52)(53)(54), opiates (43,(55)(56)(57)(58), benzodiazepines (41,43), and marijuana (59). Reports of multiple drugs appearing in multiple dreams come from Christo and Franey (60) and Johnson (43). ...
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Attempting to treat patients who are actively using addictive drugs is unlikely to be helpful and is potentially harmful. Actively using patients should be referred for detoxification before treatment for insomnia is implemented. All drugs of abuse cause insomnia. Although insomnia is most severe during withdrawal, it may be a long-lasting complication of addiction. Cocaine has been shown to provoke “occult” insomnia: degraded sleep accompanied by deteriorated cognitive functioning without the sensation of lack of sleep. This is thought to be caused by a decreased drive for sleep. Insomnia during methadone maintenance is the rule. Because of methadone-provoked central sleep apnea and because of the common lethality of benzodiazepines added to methadone, benzodiazepines are contraindicated during methadone maintenance. Physicians should be sure to include non-medication approaches for insomnia such as sleep hygiene, and if available, acupuncture. If medications are indicated for insomnia, trazodone, low-dose mirtazapine, quetiapine, clonidine, and valproic acid are good choices. Drug dreams are probably provoked by the same mechanism as drug craving: up-regulation of the ventral tegmental dopaminergic seeking system. Attention to drug-seeking during dreams may facilitate recovery.
... The study of "drug dreams," or the dreams in which drug-addicted patients typically use (or attempt to use) the drugs to which they are Downloaded by [109.113.83.60] at 00:43 18 April 2016 addicted (e.g., Christo & Franey, 1996;Hajek & Belcher, 1991;Johnson, 2001;Yee, Perantie, Dhanani, & Brown, 2004;Persico, 1992;Reid & Simeon, 2001;Steinig, Foraita, Happe, & Heinze, 2011), further show that these dreams are frequently a clear wish-fulfillment or wish-fulfillment attempt (Choi, 1973;Colace, 2000Colace, , 2004aColace, , 2014Colace et al., 2010;Colace, Belsanti, et al., 2014;Denzin, 1988, Fiss, 1980Peters, 2000). Drug dreams suggest an important role of dreams in the regulation of the appetitive and libidinal drives, such as the craving for drugs, in drug addicted patients. ...
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This article replies directly to the two cornerstones of Hobson’s legendary transposition of Freud’s dream theory, that is, the theory’s presumed empirical untestability and its scientific obsolescence or replaceability in the scientific arena. After an outline of Freudian dream theory, empirical data coming from two research paradigms (“children’s dreams” and “drug dreams”) are reported. From a theoretical-epistemological point of view, the studies show that Freud’s dream theory includes clear “potential falsifiers,” that is, in Popper’s terms, certain events, which if found to be true, would unequivocally show Freud to be wrong. This challenges Hobson’s accusation concerning the empirical untestability of Freud dream theory. From an empirical viewpoint, these studies show that Freudian dream theory is not even remotely scientifically outdated and obsolete. The results of these studies are consistent with the cornerstones of Freudian dream theory (e.g., the hypothesis of dreams as wish-fulfillment, the disguise-censorship model) and suggest the viability and worth of further investigation in this arena. Indeed, Freud’s dream theory is alive and useful in explaining the phenomenon of dreams in various fields of application. These authors believe that J. A. Hobson’s dismissal of Freudian dream theory is thus misguided and premature because, to date, the findings indicate that Freud was essentially correct.
... Lamotrigine has been suggested as effective in the treatment of comorbid bipolar and borderline personality disorder (Preston et al 2004), comorbid bipolar disorder and alcohol dependence (Rubio et al 2006 ), and comorbid bipolar disorder and cocaine dependence (Brown et al 2003; Brown E et al 2006 ). However, these studies all have limited methodological rigor that impact on the validity of their fi ndings. ...
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Lamotrigine has emerged with a distinct place in the pharmacological treatment of bipolar disorder, with the potential to treat and prevent bipolar depression, which is the dominant and arguably most disabling and under-treated phase of the illness. This review examines the published clinical trials of lamotrigine in bipolar treatment. While the data supports its tolerability and safety, the strongest evidence for its efficacy lies in the prevention of bipolar depression, with weaker evidence for the treatment of acute bipolar depression, refractory unipolar and bipolar depression, and rapid cycling bipolar disorder. The total number of published well designed trials is small, even the maintenance evidence is derived from two studies. However, this relative inadequacy compares favorably with the alternative treatment options for bipolar depression, which are marked by poor efficacy or risk of polarity switch. The designation of lamotrigine as first-line treatment for bipolar depression prophylaxis should be done in cognizance of this context, and it would seem prudent to await greater evidence of efficacy before designating lamotrigine as first-line treatment for other bipolar indications. Further randomized controlled trials are required to consolidate the available findings and to explore the boundaries of lamotrigine's efficacy, which may encompass the soft spectral disorders.
... In Substance Use Related Disorders (SUD), there are some studies about the study of dreams, suggesting that they may be indicative of craving and demonstrating its utility in the therapy of the patients as a tool for evaluating risk situations for relapses (Colace, 2014;Araujo et.al., 2008;Beck, Wright, Newman, & Liese, 1999;Johnson, 2001;Reid & Simeon, 2001;Yee, Perantie, Dhanani, & Brown, 2004;Gillispie, n.d.;Christo & Franey, 1996). Christo and Franey (1996) found that 84% of 101 patients users of psychoactive substances dreamt about the drug, especially during abstinence. ...
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Background: There are some studies about of dreams suggesting an indicative of craving from dreams and demonstrating as a tool for evaluating risk situations for relapses. Objective: To verify, in patients addicted to crack/cocaine, the association between the presence of the crack content in dreams and craving increase. Methods: It is a clinical study, analytical, transversal type. We evaluated 51 patients who were admitted to Unit Detoxification. Results: We verified that 21 patients reported dreams with the crack, when 19.6% reported not awakening the craving after dreaming about crack, against 21.4% who woke up with this urge. Regarding the perception on the night before the dream of the crack, 17.5% thought they had presented craving for crack. No association was found between dream the crack and the craving (p=0.34). Discussion/Conclusion: Dreaming of the crack is not associated with an increase in craving in patients admitted for detoxification.
... Esses sonhos já foram descritos por outros autores que tiveram como foco outras drogas (álcool, heroína, cocaína, etc.) 14,15,[26][27][28][29] . Porém, pouca literatura se encontra a respeito de sonhos com crack o que reforça o objetivo deste trabalho. ...
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Resumo O objetivo deste artigo é descrever os conteúdos dos sonhos dos usuários de crack, de acordo com sua visão, e analisar a interferência que produzem no processo de abstinência. Pesquisa qualitativa com 21 usuários de crack. Consumir a droga durante o sonho significou o fracasso ou uma forma compensatória de prazer ou de alerta a potenciais recaídas; não consumir a droga significou sintomas de abstinência ou o sucesso em ter vencido a dependência. A interpretação dada aos sonhos pode levar os usuários de crack à fissura e recaída. Os resultados podem contribuir para intervenções terapêuticas eficazes.
... Another line of evidence which associates SEEKING with SUD is based on research focused on the so called "drug dreams" phenomenon found in SUD patients (103). With regard to Solm's (104, 105) neuropsychoanalytic dream theory-identifying the SEEKING system as essential for the generation of dreamsseveral studies observed that SUD patients frequently report dreams related to their craving of the drug they are addicted to (106)(107)(108)(109)(110). Usually, these dreams contain episodes in which subjects seek for drugs, and either use them or attempt to use them. ...
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Background While traditional psychoanalysis has been criticized as insufficient for the treatment of substance use disorder (SUD), recent progress in the field of neuropsychoanalysis has generated new and promising hypotheses regarding its etiology. However, empirical research applying this framework has been sparse.Aim and ScopeThe present overview aims at developing and empirically validating a neuroscientifically informed psychodynamic framework regarding the etiology of SUD. For this purpose, this review provides a concise overview of the most relevant historical and contemporary psychoanalytic theories on SUD etiology. Furthermore, the original research summarized in this paper consists of three studies investigating connections between childhood trauma, primary emotions, personality structure and attachment, as well as their relation to SUD development and treatment.Conclusions The results highlight the empirical validity of the neuropsychoanalytic approach towards SUD etiology. In particular, the findings underscore the conceptualization of SUD as a disorder related to dysfunctional attachment and affect regulation abilities especially linked to increased SADNESS and ANGER dispositions, which mediated the relationship between SUD and traumatic childhood relationships. Based on these findings, a refined model of SUD etiology is proposed, which should be tested in future studies.
... The frequency of drug dreams showed an important decrease from 3 to 36 weeks into the study. 27 In another case report by Colace, he documented the case of an 18-year-old woman who had been using cocaine for 1 year. During the first month of psychological treatment, the patient presented vivid dreams, in which large amounts of cocaine were administered intravenously, which she reported as generating intense feelings of pleasure during the dream, but a strong feeling of sadness upon awaking. ...
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Parasomnias are involuntary behaviors or subjective experiences during sleep. Our objective was to review existing information on the presence of parasomnias in patients with addictions or during treatment for addictions. Information about parasomnias related to rapid-eye-movement (REM) and non-REM sleep in patients with addictions, while using substances or in abstinence, was reviewed. A systematic search of published articles reporting parasomnias as a consequence of drug use or abuse was conducted in the PubMed and SciELO databases. The search for the studies was performed in three phases: (1) by title, (2) by abstract, and (3) by complete text. The search was performed independently by two researchers, who then compared their results from each screening phase. Seventeen articles were found. The consumption of alcohol was reported in association with arousal disorders, such as sexsomnia and sleep-related eating disorder; and REM sleep behavior disorder was reported during alcohol withdrawal. Cocaine abuse was associated with REM sleep behavior disorder with drug consumption dream content. Overall, we found that several types of parasomnias were very frequent in patients with addictions. To avoid accidents in bedroom, legal problems, and improve evolution and prognosis; must be mandatory to include security measures related to sleep period; avoid pharmacological therapy described as potential trigger factor; improve sleep hygiene; and give pharmacological and behavioral treatments for patients with these comorbid sleep disorders.
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Measures of subjective drug craving - often defined as the experience of an intense or compelling urge or desire - may be used to predict relapse, evaluate psychological and pharmacological treatments, and test theories of addiction and craving. This review summarizes both direct self-report questionnaires and indirect behavioral, physiological and reaction time measures designed to assess craving for alcohol, amphetamines, cocaine, heroin, marijuana, and tobacco. Multi-item questionnaires have typically been based on one of four underlying conceptualizations of addiction or craving (obsessive-compulsive, approach-avoidance, multi-dimensional, intensity-frequency-duration). Most multi-item self-report questionnaires have high internal consistency, correlate significantly with single-item craving ratings, and demonstrate several aspects of construct validity. Proposed indirect or proxy measures of craving include drug dreams, speed of drug consumption, willingness to work for drug access, selection of monetary rewards over drug access, psychophysiological reactivity, and attentional bias to drug cues. These proxy measures of craving are presumed to obviate self-report biases, to be less subject to conscious self-control, and to reflect craving which the person may not be able to articulate; however, there have been too few demonstrations of their validity and they have too many practical limitations to supplant self-report measures of craving at this time.
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Drug dreams, that is, dreams in which patients addicted to drugs typically use or make an attempt to use the drugs they are addicted to, are a well-documented clinical phenomenon in various forms of addiction. One clinical function of these dreams is their ability to signal the latent recrudescence of drug craving even long after the patients have resolved their addictive behaviours. The following case is an example of how drug dreams reveal the extraordinary persistence in time of drug craving and the patient's risk of potential relapse, even after as many as 10 years of living in a drug-free state.
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Bu çalışmada madde kullanıcılarının rüyalarında maddenin görünümünü ortaya çıkarmak, madde bağlantılı rüyaların etkilerini ortaya koymak ve madde kullanım isteği ile madde bağlantılı rüyalar arasındaki ilişkiyi incelemek amaçlanmaktadır. Araştırma nitel araştırma desenine göre kurgulanmıştır. Veri toplama tekniği olarak yarı yapılandırılmış mülakat formu kullanılmış ve 11 katılımcıyla görüşme gerçekleştirilmiştir. Elde edilen veriler betimsel analiz yöntemine ile analiz edilmiş ve yorumlanmıştır. Katılımcılardan elde edilen veriler ışığında; uyku düzeni, rüyaların ilk başladığı dönem, rüyaların görüldüğü zamanlar/dönemler, rüya sonrası davranışlar, rüya içerikleri ve rüyada doyum yaşamak olmak üzere 6 tema oluşturulmuştur. Yoğun kullanım isteğinin ve yoksunluğun rüyaların ortaya çıkmasını tetikleyebildiği, genellikle kullanıcıların temiz kaldığı ilk dönemlerde rüyaların görülebildiği, rüyaların kişilerde kullanım isteğini uyandırabildiği ve madde kullanımına yöneltebildiği, rüyaların şiddet/korku veya keyif içerikli olduğu, kullanıcıların rüyalarında madde kullanmaları durumunda rüyada doyum yaşayabildikleri öne çıkan bulgulardır. Madde bağlantılı rüyalar görmek ve madde kullanımı arasında güçlü bir ilişki bulunmaktadır. Buna göre madde bağlantılı rüya görmek bireylerin madde kullanım sıklığını ve yoğunluğunu etkilemektedir. Rüyadaki madde kullanımın gerçek deneyime yakın etkiler oluşturması, rüyaların bu etkisini arttırıcı bir zemin oluşturabilir. Yine tedavi sürecinde bulunan bağımlılar için, rüya görme deneyimlerinin takip edilmesi, tedavinin etkinliği ve seyri açısından takip edilebilir. Madde bağlantılı rüyalar kişilerin kayma davranışlarına ilişkin bir öncül olarak kabul edilebilir.
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Craving is a concept with good face validity and poor construct validity. The difficulties measuring craving includes that it varies by time, by environment, by the amount of stress, by one's state of mood, that it may be partially unconscious and that there is no clearly established concept of what exactly is being measured. Neural mechanisms of drug craving are reviewed. The ventral tegmentum is central to craving. It is connected to limbic and cortical structures that help the organism learn to find alcohol and drugs via the establishment of drug cues that intensify craving. The dream on mechanism and the subcortical pathways of addiction are identical (Solms, Behav Brain Sci 23:843-850, 2000). Specimen drinking/drug dreams are provided. A possible neural mechanism of transition from heavy drinking of alcohol to physical addiction is described and tied to the onset of drinking dreams. Therefore, drinking dreams would represent a biological marker of the transition from psychological to physical addiction. With more empirical work, it is possible that drug dreams would be established as the psychological readout of the switch mechanism to physical addiction and persistent craving for alcohol or drugs. Drug dreams might then represent the gold standard for craving research because they are a direct readout of midbrain function, and become the basis of construction of scales to capture the phenomenon of craving. Drinking and drug dreams represent a biological manifestation of addiction that can be used in psychotherapy to help the patient to be conscious of their persistent urge to relapse and to understand that their brain has been permanently captured by the addictive drug; whether they use or not. Nightmares are a subset of dreams defined by the presence of alarm on awakening. Nightmares are common in the addicted population because of an increased incidence of childhood abuse and posttraumatic stress disorder. Despite the wishes of some patients to avoid using nightmares in their psychotherapy, addressing the issues raised by the nightmare is essential as part of helping the patient remain abstinent. © 2012 Springer Science+Business Media, LLC. All rights reserved.
Chapter
The devastating impact of substance use disorders (SUDs) among older adults has only recently attracted the attention of researchers, clinicians, and the general public. Despite the evidence that alcohol and other SUDs affect nearly 1 in 5 older adults, there has been limited examination of these areas in the substance abuse or gerontology literature. Bearing in mind the paucity of research on the screening, assessment, and treatment protocols for older adults with bipolar disorder and coexisting SUD, in this chapter, we outline the state of current knowledge and where possible, make clinical recommendations on the assessment and management of SUDs among older adults with bipolar disorder. Adults with bipolar disorder (compared to other psychiatric disorders) have the highest rate of alcohol use disorder [3]. With the predicted dramatic growth of the aging population, as well as more geriatric patients in outpatient opioid maintenance programs both due to the aging of patients first enrolled in the 1990s and due to patients with prescription opioid misuse in later life, the need and demand for effective, comprehensive mental health services for older adults with psychiatric illness and substance use disorders will continue to grow. Other disorders, such as benzodiazepines, cannabis, and psychostimulants are also described, with future directions for research outlined.
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Despite the minimal attention that physicians typically pay to dreams, their assessment can be of diagnostic interest and have management implications. This chapter reviews the world literature on dream abnormalities of clinical neurological significance, starting with the classical concept of Charcot–Wilbrand syndrome. This and the other recognised disorders are broadly classified here under headings of ‘deficits’ and ‘excesses’ of dreaming. Also reviewed here are major trends in the neuro-imaging and pharmacological literature regarding dreams. In addition, the chapter reviews some current theoretical issues regarding the brain mechanisms of dreaming.
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The dream has always been of interest to psychiatrists. It can assist with the diagnosis and treatment of psychiatric disorders. To find out whether the dream is regarded as meaningful in modern psychiatry and to discover how dreams can be used by psychiatrists in clinical practice. Initially, psychoanalytic monographs on the subject of dreams were read thoroughly. This is followed by a literature search in PubMed and PEPWeb on the basis of the search terms 'dream', 'dreams' and 'dreaming'. results There has been considerable interest in dreams in the psychiatric literature published in the last few decades. Neuroscientific data seem to confirm Freud's wish-fulfilling theory. The dream plays a role in the consolidation of memory. It seems reasonable that psychopathological diagnosis should take the content of dreams into account. Not only is the dream a fascinating subject for research, it is also useful in the diagnosis and treatment of a number of psychiatric disorders.
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Two versions of a 45-item questionnaire on cocaine craving were administered to 225 cocaine users. The Now version asked about current craving for cocaine, and the General version asked about average craving over the preceding week. Factor analyses showed that a four-factor solution best described the item structure for both versions of the questionnaire. Higher-order analyses indicated that each version was permeated by a single second-order factor. Factor scales derived for each primary and second-order factor had moderate to high reliabilities. Examination of item content, correlations of factors across versions, and external correlates of the factors suggested that both versions were represented by the same hierarchical factor structure. The theoretical and clinical implications of the results from these craving instruments are discussed.
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The purpose of the present study was to revise the Barratt Impulsiveness Scale Version 10 (BIS-10), identify the factor structure of the items among normals, and compare their scores on the revised form (BIS-11) with psychiatric inpatients and prison inmates. The scale was administered to 412 college undergraduates, 248 psychiatric inpatients, and 73 male prison inmates. Exploratory principal components analysis of the items identified six primary factors and three second-order factors. The three second-order factors were labeled Attentional Impulsiveness, Motor Impulsiveness, and Nonplanning Impulsiveness. Two of the three second-order factors identified in the BIS-11 were consistent with those proposed by Barratt (1985), but no cognitive impulsiveness component was identified per se. The results of the present study suggest that the total score of the BIS-11 is an internally consistent measure of impulsiveness and has potential clinical utility for measuring impulsiveness among selected patient and inmate populations.
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An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.
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This study tested the hypothesis that differences in both length of abstinence and demographic characteristics would be found between alcoholics who have dreams about drinking (DD group) and those who do not have such dreams (NDD group). The DD group was abstinent for longer periods of time; these parients were more often white, married, and taking disulfiram than were NDD patients. The author concluded that in outpatient treatment of alcoholics, dreaming about drinking is a good prognostic sign.
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The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
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This study tested the hypotheses that a) the dream content of crack cocaine abusers in Trinidad and Tobago changes during abstinence, and b) the change in dream content can be used to predict treatment outcome. The sample comprised 46 consecutive patients who completed a 3-month residential treatment program and were followed up after 6 months. Dreams and associated emotions were recorded during the first month of inpatient treatment and at 6 months follow-up. Forty-one (89.1%) patients reported drug dreams during the first month, mainly of using the drug. Twenty-eight (60.9%) had drug dreams at 6 months follow-up, mainly of using or refusing the drug. There was an abstinence rate of 56.5% at 6 months. A better treatment outcome was associated with having drug dreams at 6 months follow-up (p < .05) and dreams of refusing the drug (p < .05). Findings support the need to further explore the progression of dreams during treatment as a predictive tool.
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Bipolar disorder is associated with the highest substance abuse rates of any psychiatric illness. Therefore, treatments that stabilize mood and decrease drug use or cravings are of great interest. Open-label lamotrigine was examined in 30 outpatients with DSM-IV bipolar disorder and cocaine dependence. Lamotrigine was either added to existing medication regimens or used as monotherapy. Lamotrigine was started at a dose of 25 mg/day (12.5 mg/day in those taking valproic acid) and titrated to a maximum dose of 300 mg/day. Subjects received a baseline evaluation including a structured clinical interview and weekly assessments for 12 weeks with the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), and Cocaine Craving Questionnaire (CCQ). At each appointment, a urine sample was obtained, and participants reported drug use during the previous week. The subjects consisted of 13 men and 17 women with cocaine dependence and bipolar I disorder (N = 22), bipolar II disorder (N = 7), or bipolar disorder not otherwise specified (N = 1), with a mean +/- SD age of 35.4 +/- 7.2 years. Data were analyzed using the last observation carried forward on all subjects who completed the baseline evaluation and at least 1 postbaseline assessment. Significant improvement was observed in HAM-D, YMRS, and BPRS scores (p < or =.02). Cravings also significantly decreased as measured by the CCQ (p <.001). Dollar amount spent on drugs decreased nonsignificantly. Lamotrigine was well tolerated, with no subjects discontinuing due to side effects. Lamotrigine treatment was well tolerated in this sample and associated with statistically significant improvement in mood and drug cravings but not drug use. The findings suggest that larger controlled trials of lamotrigine are needed in this population.
Factor structure of the Barratt impulsiveness scale.
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