Sleep disturbances are sometimes reported in clinical settings among individuals with opioid use disorder (OUD) receiving methadone maintenance treatment (MMT). Although numerous studies have explored this issue, a systematic assessment of the prevalence of these disturbances is lacking. We searched for trials reporting the prevalence of sleep disturbances in patients with OUD receiving MMT. Studies assessing sleep-related symptoms using a standardized scale were included in a prevalence meta-analysis. All other studies were synthesized narratively and in tabular form. Thirty-eight articles were included. Thirteen studies assessed the prevalence of poor sleep quality using a Pittsburgh Sleep Quality Index (PSQI) score > 5. Given the high level of heterogeneity among included studies, a prediction interval was calculated, suggesting that the prevalence of poor sleepers in future trials will likely range from 50

BACKGROUND AND AIMS:Current treatment options for alcohol use disorder are limited. Transcranial direct current stimulation has been proposed as a therapeutic approach, but evidence remains scarce. This study aimed to compare active vs. sham transcranial direct current stimulation to evaluate its efficacy and safety in reducing alcohol consumption in a large sample of individuals with alcohol use disorder. DESIGN:REDSTIM is a triple-blind, randomized, sham-controlled trial that was conducted from October 2015 to January 2022. Participants were followed up every 4 weeks for 24 weeks. SETTING:Fourteen sites in France and Monaco. PARTICIPANTS:356 adult outpatients with alcohol use disorder were assessed for eligibility, and 337 were enrolled and randomly assigned (1:1) to receive active or sham stimulation. At baseline, the randomized participants were primarily male (60.5%) with an average age of 51.3 ± 11.3 years. INTERVENTION AND COMPARATOR:Two daily stimulation sessions (anode F4, cathode F3, 2 mA) delivered over five consecutive days vs. sham stimulation. Direct currents were applied via a pair of 0.9% NaCl-soaked surface sponge electrodes (25 cm2). In the sham stimulation group, the initial ramp-up time of 15 s (also up to 2 mA) was immediately followed by a ramp down phase of 30 seconds. MEASUREMENTS:The co-primary outcomes were the change in the number of heavy drinking days (HDD) and total alcohol consumption (TAC) over the follow-up period. Exploratory secondary outcomes included alcohol craving, clinical and biological improvements, quality-of-life, mood, cognitive and safety assessments. FINDINGS:Over 24 weeks of follow-up, vs. sham, the active stimulation group reported statistically significant reductions in the number of HDD [-2.45 HDD/4 weeks, 97.5% confidence interval (CI) = -4.86 to -0.05, P = 0.022]. The reduction in TAC was not statistically significant (-5.96 g/day, 97.5% CI = -15.18 to 3.26, P = 0.147). The interpretation of these findings should take into account the proportion of missing data related to alcohol diary completeness and losses to follow-up. For secondary outcomes at 24 weeks, vs. sham, craving assessments were lower in the stimulation group (-0.36 95% CI = -0.65 to -0.07, P = 0.016), as were carbohydrate deficient transferrin levels (-0.33 95% CI = -0.65 to -0.01, P = 0.045). In the active vs. sham stimulation group, 69 (41.1%) and 62 participants (36.7%) experienced one or more adverse effects, resulting in 6 dropouts. CONCLUSIONS:Among adult outpatients with alcohol use disorder, active transcranial direct current stimulation resulted in a modest but sustained reduction in heavy drinking days over 24 weeks, while no statistically significant effect was observed for total alcohol consumption. The intervention was well tolerated.

INTRODUCTION:Innovative interventions such as repetitive transcranial magnetic stimulation (rTMS) may hold promise for individuals seeking smoking cessation support. In this Phase II pilot trial, we explored the potential of low-frequency rTMS (1 Hz) combined with nicotine replacement therapy to contribute to sustained tobacco abstinence. METHODS:A non-comparative single-step Fleming-type Phase II randomized, double-blind, sham-controlled design was used to test the eligibility of active rTMS for a Phase III trial. The primary outcome was biochemically confirmed Continuous Abstinence Rate (CAR) at six weeks post-randomization in the active rTMS group. Secondary outcomes included 12-week and 12-month CAR, craving, mood and safety evaluations in both groups. RESULTS:78 participants were randomized to the active (n=39) or sham rTMS group (n=39). All participants received nicotine replacement therapy. In the active rTMS group, at 6-week follow-up, 16 patients (41%) were abstinent versus 18 patients (46%) in the sham rTMS group. At the 12-week and 12-month follow-up assessments, abstinence rates declined in both groups, with 26% and 15% of participants maintaining abstinence in the active rTMS group, compared with 15% and 10% in the sham group, respectively. Craving scores decreased in both groups, and mood scores were equally distributed. Eleven mild-to-moderate adverse events were reported in the active group versus twenty-three in the sham group. CONCLUSION:Given our definition of treatment efficacy, active low-frequency rTMS can be considered effective and eligible for a phase III trial. However, this result requires careful consideration since the sham rTMS group exhibited similar outcomes. The remaining uncertainty suggests a need for further research, particularly to assess nicotine's influence on cortical excitability.

BACKGROUND Central pontine myelinolysis (CPM) is an osmotic demyelination syndrome most commonly observed in patients with chronic hyponatremia who undergo rapid serum sodium correction. Risk factors for CPM include malnutrition, hypokalemia, advanced liver disease, hyperemesis gravidarum, and alcohol use disorder. In this case report, we present an unusual case of CPM in a 30-year-old man with alcohol use disorder who did not have hyponatremia during hospitalization and had no history of chronic hyponatremia. CASE REPORT A 30-year-old man was admitted to the hospital for alcohol detoxification. He presented with symptoms of alcohol withdrawal and distal lower-limb pain, accompanied by bilateral edema. After his withdrawal symptoms were controlled, persistent neurological abnormalities prompted an MRI, which revealed lesions suggestive of central pontine myelinolysis (CPM). The patient did not exhibit hyponatremia during his hospital stay. However, he had multiple previously identified risk factors for CPM, including significant alcohol consumption leading to malnutrition and refeeding syndrome-associated hypokalemia. The neurological exam performed 1 month after the onset of symptoms showed a favorable outcome without signs of dystonia or cerebellar syndrome, but with persistent left-wrist extrapyramidal rigidity. CONCLUSIONS This case report highlights the importance of a thorough neurological examination in patients with alcohol use disorder, to prevent falsely attributing neurological symptoms to alcohol intoxication. Clinicians should remain vigilant about the risk of CPM in patients with alcohol use disorder, even in the absence of hyponatremia, considering that other metabolic disturbances can contribute to its pathogenesis.

BACKGROUND:Alcohol use disorder (AUD) is a chronic condition linked to allostatic neuroadaptations in the brain's reward circuitry, leading to compulsive and automatized alcohol use in response to craving or negative affect. There are only a few treatment options for AUD, and their efficacy and tolerance profiles remain suboptimal. New AUD management strategies are actively being investigated, and among these, non-invasive brain stimulation (NIBS) interventions. We are planning to conduct a systematic review and network meta-analysis to simultaneously compare different NIBS strategies for AUD, and the present protocol aims to document our methodological approaches and a priori decisions. METHODS AND ANALYSIS:We will include only randomized controlled trials involving adults with AUD, alcohol dependence, or alcohol abuse. The primary interest outcomes of our review will concern alcohol consumption in AUD population. In trials investigating NIBS as a strategy for alcohol use reduction, we will explore the effect of NIBS on the reduction in total alcohol consumption and the number of heavy drinking days among participants. In trials in recently detoxified AUD patients where the potential of NIBS to prevent relapse is explored, the primary outcome will concern the rate of relapse. Data on craving and safety parameters will be gathered as secondary interest outcomes. At the time of submitting this protocol, four electronic databases (EMBASE, PubMed, PsycINFO, and The Cochrane Library) and three clinical trial registries (Clinical Trials, EU Trials, WHO ICTRP) were searched. The results of the searches were screened in a blinded manner by two authors using titles and abstracts, with conflicts adjudicated by a third author. The second round of selection based on full texts will be performed after the protocol submission. Data will then be extracted independently by two authors using a predefined extraction form. Risk of bias evaluation for each trial will be performed independently by two authors using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). We will quantitatively synthesize the extracted results using mean differences and risk ratios as effect measures. Initially, a random-effects pairwise meta-analysis will be performed to compare treatment and control arms across different trials. A network meta-analysis will then be conducted. The results of the network meta-analysis will be presented as a network graph representing treatment nodes and direct comparisons, a league table with both direct and network meta-analysis (indirect or mixed) estimates, a net heat plot for inconsistency evaluation, and CINeMA evaluation of the confidence in our results. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration number CRD42024504362.

BACKGROUND:Tobacco use is one of the leading causes of preventable disease and death worldwide. Despite the availability of evidence-based pharmacological treatments, only a small number of individuals with tobacco use disorder achieve long-term abstinence after smoking cessation. This highlights the need to enhance existing interventions. In this protocol, we describe our single-center mixed-method trial, HowToMind, conducted in Dijon, France. This trial aims to investigate the usability and acceptability of a digital mindfulness-based intervention designed to complement standard smoking cessation treatment to potentiate its effects. METHODS:We will include 60 adults seeking treatment for tobacco use disorder, as defined by DSM-5 criteria, who wish to quit smoking and own a smartphone. All participants will receive a combination of transdermal and oral nicotine replacement therapy and will be introduced to an eHealth app that provides a digital equivalent of an 8-week mindfulness training program. The acceptability of the initial version of our app will be assessed based on usage frequency, and usability will be evaluated using the Mobile App Rating Scale (French version). A participatory approach will be employed through focus groups conducted at the end of the 8 weeks of app use, aimed at co-constructing the final version of the app based on participant feedback. DISCUSSION:Our pilot mixed-method trial seeks to explore the usability and acceptability of our app, making necessary adjustments to its content and functionality based on participant feedback before its implementation in a large randomized controlled trial assessing the app's potential to enhance the effects of standard treatment. TRIAL REGISTRATION:ClinicalTrials.gov, NCT06500117.

In this article we aimed synthesize all available evidence regarding the effects of non-invasive brain stimulation (NIBS) techniques combined with mindfulness-based interventions (MBIs) on mental health indicators. We performed a systematic review of randomized controlled trials evaluating NIBS/MBIs combinations in clinical populations and a random effects pairwise meta-analysis of studies evaluating anxiety and depression symptoms. After independent trial selection by two authors based on titles/abstracts, and then on full texts, twelve trials were retrieved. There was a large effect size favoring the NIBS/MBIs over the control intervention for anxiety symptoms (Cohen’s d = − 0.82 (− 1.35, − 0.30), I2 = 55

BackgroundMindfulness training programs and non-invasive brain stimulation are both evidence-based interventions that have applications in mental health disorders. While both have showed promising results on a range of symptoms related to mental health, their combination has more recently grabbed the attention of researchers. There is a theoretical framework for their synergistic effects, and these effects can be tested through a variety of neurophysiological and clinical outcomes. This emerging field of research, which is regularly extended with new trials, has not yet been systematically reviewed. This systematic review protocol aims to present a rationale for combining these two interventions and to document the methodical approach to our systematic review before data extraction.Methods and analysisFour electronic databases (Medline, EMBASE, CENTRAL, PsycINFO) and three clinical trial registries (Clinical Trials, EU Trials, WHO ICTRP) were searched. All randomized controlled trials testing the combination of mindfulness-based interventions and non-invasive brain stimulation in humans will be included. As primary outcome, data on change in anxiety and depression symptoms from baseline, and, as secondary outcomes, other mental health outcomes data will be gathered. Data will be extracted independently by two authors using a predefined extraction form. Depending on the clinical heterogeneity of the included studies, the research team will decide whether a quantitative synthesis is appropriate for each of the predefined outcomes. If there is considerable statistical heterogeneity, subgroup analyses and meta-regression will be performed. Bias will be assessed using a revised Cochrane risk-of-bias tool for randomized trials and the strength of evidence in our review will be assessed using the GRADE form in GRADEPro. We started our scoping searches in November 2022. This systematic review and meta-analysis protocol was finished and submitted before the end of the independent full-text selection process by two members of the team.Ethics and disseminationEthics approval and consent to participate were not applicable to our systematic review. Our dissemination plan includes the publication of our systematic review and meta-analysis in an international peer-reviewed journal as well as international communication of our results.Trial registrationPROSPERO registration number CRD42022353971.

Background High-quality evidence is still required to affirm the efficacy of mindfulness-based interventions (MBIs) in craving reduction. MBIs may be particularly appropriate for this purpose given the neurobiological mechanisms of addiction with automatic behavior in response to the negative affect. In this systematic review and meta-analysis, we aimed to study the efficacy of MBIs in craving reduction and to synthetize the newly published data. Methods We searched four databases and three clinical trial registries for randomized controlled trials (RCTs) up to August 2023, including studies with MBIs in all types of substance use disorders or behavioral addictions. We chose as our outcome of interest the change from the baseline of craving measures at posttreatment. Standardized mean difference was used as an effect size estimator. Results We included 17 RCTs with 1228 participants. The overall effect size was estimated at -0.70 (95% CI -1.15, -0.26) in favor of MBIs. Conclusion Due to the high inconsistency ( I 2 = 92%), we were unable to conclude that there is a medium to large effect size. Overall risk of bias was high for most studies, and the GRADE approach detected a low quality of evidence. Previous clinical and fundamental research suggest that MBIs have a promising potential in addiction medicine. However, further investigation of whether MBIs effectively reduce craving is needed, and innovative solutions for resolving methodological limitations in MBI research are warranted. Trial registration PROSPERO registration ID CRD42020221141.

BACKGROUND AND AIMS:Non-invasive brain stimulation (NIBS) methods have showed promising results for the treatment of tobacco use disorder, but little is known about the efficacy of NIBS on sustained tobacco abstinence. We aimed to assess its effectiveness for long-term smoking cessation.METHODS:Systematic review and meta-analysis of randomized controlled trials (RCT). PubMed, Cochrane library, Embase, PsycINFO and clinical trials registries were systematically searched for relevant studies up to May 2021. Relevant studies included adult smokers seeking smoking cessation, included in an RCT using NIBS [specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)], and with follow-up of more than 4 weeks. There were no restrictions on location. Abstinence rates in the active NIBS groups were compared with abstinence rates in sham NIBS or in usual treatment groups, from 4 weeks to 12 months following the quit attempt. Smoking abstinence was measured on an intention-to-treat basis and we used risk ratios (RRs) as measures of effect size.RESULTS:Seven studies were included (n = 699 patients). In all included studies, the control groups were receiving sham NIBS and only data from 3 to 6 months were analysable. By pooling the seven included studies, the RR of sustained abstinence of any form of NIBS relative to sham NIBS was 2.39 [95% confidence interval (CI) = 1.26-4.55; I2  = 40%]. Subgroup analyses found that the RR was even higher when excitatory rTMS was used on the left dorsolateral prefrontal cortex (RR = 4.34; 95% CI = 1.69-11.18; I2  = 0%) or when using deep rTMS targeting the lateral prefrontal cortex and insula bilaterally (RR = 4.64; 95% CI = 1.61-13.39; I2  = 0%). A high risk of bias was found in four included studies. We also determined, using grades of recommendation, assessment, development and evaluation, that overall there was a low level of confidence in the results.CONCLUSION:Non-invasive brain stimulation (NIBS) may improve smoking abstinence rates from 3 to 6 months after quitting smoking, compared with sham NIBS or usual treatment.

Abstract Background and aim In the last two decades, the proportion of internet users has greatly increased worldwide. Data regarding internet addiction (IA) are lacking in Africa compared to other continents. This systematic review and meta-analysis aimed to estimate the pooled prevalence of IA in African countries. Methods We systematically sought relevant articles in PubMed/MEDLINE, EMBASE, PsycINFO and Cochrane database published before September 25, 2021. The risk of bias was assessed using the Joanna Briggs Institute tool, and we estimated the pooled prevalence of IA using a random-effects meta-analytic model. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results We included 22 studies (13,365 participants), and collected data from Egypt, Ethiopia, Morocco, Nigeria, South Africa, Tanzania and Tunisia between 2013 and 2021. The mean age of participants ranged from 14.8 to 26.1 years, and the most used tool for IA screening was the Young's 20-item Internet Addiction Test. The pooled prevalence rate of IA was 40.3% (95% CI: 32.2%–48.7%), with substantial heterogeneity. The pooled prevalence for Northern Africa was 44.6% (95% CI: 32.9%–56.7%), significantly higher than the prevalence in sub-Saharan Africa, which was 31.0% (95% CI: 25.2%–37.1%). The risk of bias was moderate for most studies, the certainty was very low, and we found no publication bias. Discussion and conclusions Four in every ten individuals was considered to have IA in Africa. Further research with methodological optimization seems needed, especially for IA screening tools and the representativity of some subregions.