ABSTRACT
It started with a simple question on social media, "How is everybody doing?" (Elmo [@elmo], 2024). With this basic check-in from one of our most beloved Sesame Street characters, Elmo was able to reach millions of people and elicit responses that gave words to the feelings that the authors have been personally experiencing and noticing within my behavioral health (BH) colleagues and patients for some time now. Quite simply, we are struggling. Responses to Elmo's collective check-in demonstrated the depths of the current human experience, ranging from individual sadness, trauma, existential crises, despondence, mere survival, disbelief, and societal despair. Resilience for BH providers is possible if we return to the basics, what we are foundationally trained to do, and what Elmo reminded us works so well: facilitate human connection within ourselves, with our colleagues, with our patients, and to continue to advocate for this connection at a systemic level. Exploring fundamental questions about our well-being, showing empathy for each other's pain, and openly acknowledging our shared struggles allows for a way through this, together. As we practice these efforts at the individual level, broader policies to support the BH system must follow to offer an effective, resilient, and enduring BH system necessary for the world we live in. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Subject(s)
Social Media , Humans , Social Media/trends , Social Media/instrumentationABSTRACT
OBJECTIVE: Supratherapeutic doses of methylphenidate activate µ-opioid receptors, which are linked to euphoria. This study assessed whether naltrexone, a mixed µ-opioid antagonist, may attenuate the euphoric effects of stimulants, thereby minimizing their abuse potential in subjects with attention-deficit/hyperactivity disorder (ADHD). METHODS: We conducted a 6-week, double-blind, placebo-controlled, randomized clinical trial of naltrexone in adults with DSM-IV ADHD receiving open treatment with a long-acting formulation of methylphenidate (January 2013 to June 2015). Spheroidal Oral Drug Absorption System methylphenidate (SODAS-MPH) was administered twice daily, was titrated to ~1 mg/kg/d over 3 weeks, and was continued for 3 additional weeks depending on response and adverse effects. Subjects were adults with ADHD preselected for having experienced euphoria with an oral test dose of 60 mg of immediate-release methylphenidate (IR-MPH). The primary outcome measure was Question 2 (Liking a Drug Effect) on the Drug Rating Questionnaire, Subject version, which was assessed after oral test doses of 60 mg of IR-MPH were administered after the third and sixth weeks of treatment with SODAS-MPH. RESULTS: Thirty-seven subjects who experienced stimulant-induced (mild) euphoria at a baseline visit were started in the open trial of SODAS-MPH and randomized to naltrexone 50 mg/d or placebo. Thirty-one subjects completed through week 3, and 25 completed through week 6. Naltrexone significantly diminished the euphoric effect of IR-MPH during the heightened-risk titration phase (primary outcome; first 3 weeks) (χ² = 5.07, P = .02) but not the maintenance phase (weeks 4-6) (χ² = 0.22, P = .64) of SODAS-MPH treatment. CONCLUSIONS: Preclinical findings are extended to humans showing that naltrexone may mitigate stimulant-associated euphoria. Our findings provide support for further studies combining opioid receptor antagonists with stimulants to reduce abuse potential. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01673594.
