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CPDD 77Th Annual Meeting • Arizona Biltmore, Phoenix, Arizona

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CPDD 77Th Annual Meeting • Arizona Biltmore, Phoenix, Arizona CPDD 77th Annual Meeting • Arizona Biltmore, Phoenix, Arizona 1 2 EFFECT OF HEMISPHERIC DOMINANT VERSUS NON- SEX, DRUGS, AND VIOLENCE: AN ANALYSIS OF WOMEN IN DOMINANT INSULAR DAMAGE ON SMOKING BEHAVIORS. DRUG COURT. Amir Abdolahi1,2, Geoffrey Williams2, Curtis Benesch2, Henry Wang2, Eric Abenaa Acheampong2, Catherine W Striley3, David O Fakunle1, Linda Cottler3; Spitzer3, Bryan Scott3, Robert Block2, Edwin van Wijngaarden2; 1Philips 1Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Research, Briarcliff Manor, NY, 2University of Rochester, Rochester, NY, MD, 2University of Florida, Gainesville, FL, 3Epidemiology, University of 3Rochester General Health System, Rochester, NY Florida, Gainesville, FL Aims: Recent evidence suggests that damage to the insular cortex (IC), the cere- Aims: This analysis examines exposure to violence and substance use disorders bral cortex beneath the sylvian fissure, disrupts nicotine-induced cravings and is among women in drug court who are: current sex traders (CST), former sex associated with a greater likelihood of cessation relative to non-IC damage. The traders (FST), or women who have never traded sex. role hemispheric dominance may play in regulating these changes, however, has Methods: Data comes from 319 women recruited from a Municipal Drug Court not yet been explored. We hypothesized that current smokers with damage to System in the Midwest. Women were interviewed about sex trading, violence, their dominant IC would experience less withdrawal and cravings and be more and drug use. Women who traded sex in the past 4 months for drugs, alcohol, likely to quit than those with non-dominant IC damage. or other resources were classified as CST, while women who previously traded Methods: A total of 37 smokers with unilateral IC strokes (17 dominant and 20 sex but not in the past 4 months were classified as FST. Multinomial logistic non-dominant) were recruited from 3 acute care hospitals in Rochester, NY. regression determined the association between DSM-IV substance use disorder, Validated questionnaires were administered during admission to assess urge violence, and current sex trading. (Questionnaire on Smoking Urges) before and during admission and 3 months Results: Women were equally divided by trading status: 31% CST, 35% FST, post-stroke, withdrawal intensity (Wisconsin Smoking Withdrawal Scale) during and 34% never traded. Being physically attacked and emotionally abused in the admission, and continuous abstinence at 3 months post-stroke. Bivariate statis- past 4 months were significantly associated with sex trading status-whereas CST tics and multivariable linear regression were used to evaluate differences in urge, reported the highest rates. DSM-IV alcohol, opioid, and cocaine use disorders withdrawal, and cessation between dominant and non-dominant damaged were also significantly associated with sex trading status and greater in CST. In groups, controlling for covariates. an adjusted multinomial model, having at least one instance of violence Results: On average, smokers with dominant IC lesions had a larger decrease in increased the odds of CST (AOR 27.7) and FST (AOR 9.9) compared to those urge from baseline to hospitalization (β = -0.82, 95% CI: -2.08, 0.44) but slight who did not report an instance of violence. Meeting the DSM-IV criteria for increase from baseline to 3-month follow-up (β = 0.55, 95% CI: -0.69, 1.79) alcohol use disorder (CST: AOR 2.60; FST AOR: 2.59) and cocaine use disor- compared to those with non-dominant damage. Dominant IC damage was also der (CST: AOR 22.24; FST: AOR 22.17) also predicted sex trading status. associated with a lower withdrawal score during hospitalization (β = -2.33, 95% Other significant variables were: having less than a high school diploma (CST: CI: -5.48, 0.82) relative to non-dominant damage. Dominance did not seem to AOR 4.54; FST AOR: 2.41), 75+ lifetime sexual partners (CST: AOR 27.70; play a role in continuous abstinence at 3 months post-stroke (OR = 0.87, 95% FST AOR: 9.78), and unstable housing (CST: AOR 4.33; FST AOR: 3.60). CI: 0.18, 4.14). Conclusions: Future interventions should take into account the uneven rates of Conclusions: Although limited by sample size, these results suggest little impact alcohol/drug use and violence in this population. Interventions tailored specifi- of dominant insular adaptations in regulating urge, withdrawal, and cessation. cally to CST and FST are needed. Financial Support: This study was supported in part by the NHLBI Grant # Financial Support: McKnight Doctoral Fellowship, R01NR09180 (PI: Cottler) T32 HL007937 and by CTSI Grant # UL1 RR024160 from the NIH. 3 4 FUNCTIONAL CONNECTIVITY IN AN INSULA-BASED LOW THRESHOLD METHADONE PROTECTS AGAINST HIV NETWORK IS ASSOCIATED WITH SMOKING CESSATION INCIDENCE IN A CANADIAN SETTING. OUTCOMES. Keith Ahamad1,2, Kanna Hayashi2, Paul Nguyen2, Sabina Dobrer2, Thomas Merideth Addicott1, Maggie Sweitzer1, Brett Froeliger4, Eric Westman2, Kerr2,1, Julio Montaner2, Evan Wood2,1; 1University of British Columbia, Jed Rose1, Joseph McClernon3; 1Psychiatry and Behavioral Sciences, Duke Vancouver, BC, Canada, 2British Columbia Centre for Excellence in HIV/ University, Durham, NC, 2Duke University Medical Center, Durham NC, NC, AIDS, Vancouver, BC, Canada 3 4 Psychiatry and Behavioral Sciences, Duke University, Durham, NC, Medical Aims: Hypothesis: HIV infection among persons who inject drugs (PWID) is a University of South Carolina, Charleston, SC major international public health concern with the identification of novel pro- Aims: Tobacco addiction is a chronic condition with a high risk of relapse. Little tective factors of utmost importance. We hypothesized that methadone mainte- is known regarding the neurobiological differences between smokers who can nance therapy, when delivered in a low-threshold setting, protects against HIV maintain abstinence compared to those who cannot. Cigarette craving and urges infection among PWID. to smoke are believed to be significant contributors to relapse vulnerability, and Procedure: Observational cohort study with semi-annual HIV testing. evidence supports the role of the insula in connecting interoceptive awareness of Methods: Analysis: Data were derived from a prospective cohort of PWID in craving with cognitive control regions of the brain. We investigated differences Vancouver, Canada where methadone is widely available through family physi- in functional connectivity between smokers who maintained 10 weeks of absti- cian’s offices and dispensed by community pharmacies. We examined the role of nence during a quit attempt versus those who relapsed. methadone maintenance treatment on time to HIV incidence while adjusting for Methods: Smokers (n = 85) underwent a resting-state functional connectivity potential confounders. scan prior to their target quit-date. Participants’ smoking behavior was observed Results: Results: Overall, 1639 HIV-negative individuals were recruited for 10 weeks following the quit-date, and participants were subsequently between May 1996 and May 2013 among whom there were 138 cases of HIV grouped as Abstinent (n = 44) or Relapsed (n = 41) at the end of the observation seroconversion during a median of 75.5 (interquartile range: 33.4 – 115.3) period. The right and left insula, as well as insula subdivisions (posterior, ventro- months of follow up. In multivariate Cox regression analyses, methadone main- anterior, and dorsoanterior) were used as seed regions of interest in the function- tenance therapy (adjusted relative hazard: 0.64 [95% confidence interval: 0.41 al connectivity analysis. – 0.98]) remained independently associated with a reduced hazard of HIV Results: Using the right and left insula as seed regions, the Abstinent Group had infection after adjusting for socio-demographic characteristics and drug use greater functional connectivity than the Relapse Group with the bilateral pre- patterns. and postcentral gyri. This distribution of connectivity was maintained by the left Conclusions: Conclusions: In this setting, where a low threshold program has and right posterior insula, but not by the other insula subdivisions. made methadone widely available through primary care physicians, the use of Conclusions: Our results suggest that relapse vulnerability is associated with methadone was independently associated with a reduced rate of HIV infection. decreased connectivity between the posterior insula and primary sensorimotor These data reinforce the benefits of low threshold methadone on public health cortices. It may be the case that greater connectivity in this network improves the endpoints like reducing the spread of HIV. ability to inhibit a motor response to cigarette cravings when those cravings Financial Support: The study was supported by the US National Institutes of conflict with a goal to remain abstinent. Health (VIDUS: R01DA011591). This research was undertaken, in part, thanks Financial Support: R01 DA025876 (FJM) and K01 DA033347 (MAA). to funding for a Tier 1 Canada Research Chair in Inner City Medicine, which supports Dr. Evan Wood. 1 CPDD 77th Annual Meeting • Arizona Biltmore, Phoenix, Arizona 5 6 HEALTHCALL: TECHNOLOGY USE TO REDUCE NON- IDENTIFYING PREDICTIVE PROFILES OF AMPHETAMINE, INJECTION DRUG USE IN HIV PRIMARY CARE. HEROIN, AND POLYSUBSTANCE DEPENDENCE USING Efrat Aharonovich2, Deborah S Hasin1, Malki Stohl3; 1Epidemiology, Columbia MACHINE LEARNING APPROACHES. University, New York,, NY, 2Psychiatry, Columbia University Medical Center,
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