Circadian Rhythmic Characteristics in Men With Substance Use Disorder Under Treatment. Influence of Age of Onset of Substance Use and Duration of Abstinence

Abstract

There is evidence of the reciprocal influence between the alteration of circadian rhythms and Substance Use Disorders (SUD), and part of the success of the SUD treatment lays in the patient's rhythmic recovery. We aim to elucidate the effect of the SUD treatment in circadian rhythmicity considering, for the first time, the age of onset of substance use (OSU) and duration of abstinence. We registered the sleep-wake schedules, the chronotype and the distal skin temperature of 114 SUD patients with at least 3 months of abstinence, considering whether they had begun consumption at age 16 or earlier (OSU ≤ 16, n = 56) or at 17 or later (OSU ≥ 17, n = 58), and duration of abstinence as short (SA: 3 to 5 months, n = 38), medium (MA: 6 to 9 months, n = 35) or long (LA: more than 9 months, n = 41). Moreover, we compared the patients' distal skin temperature pattern with a similar sample of healthy controls (HC, n = 103). SUD patients showed a morningness tendency and higher night values, amplitude and stability, a better adjustment to the cosine model and lower minimum temperature and circadianity index in the distal skin temperature rhythm, in contrast to the HC group. The OSU ≥ 17 and LA groups showed a more robust distal skin temperature pattern, as well as milder clinical characteristics when compared to the OSU ≤ 16 and SA groups, respectively. The circadian disturbances associated to substance consumption seem to improve with treatment, although the age of OSU and the duration of abstinence are modulating variables. Our results highlight the need to include chronobiological strategies that boost circadian rhythmicity both in SUD prevention and rehabilitation programs. The measurement of distal skin temperature rhythm, a simple and reliable procedure, could be considered an indicator of response to treatment in SUD patients.

Circadian Functioning and Quality of Life in Substance Use Disorder Patients With and Without Comorbid Major Depressive Disorder

“…We observed that in the SUD patients, the intermediate type was more prevalent, although it was lower in relation to population norms (53). By contrast, a study with SUD patients under treatment showed that the predisposition was toward the morning type (74), whereas other studies indicated that the SUD patients were more prone to the evening type (20,75,76).…”

Personality Profile and Clinical Correlates of Patients With Substance Use Disorder With and Without Comorbid Depression Under Treatment

“…In this sense, those patients with an older age of SUD onset showed a higher preference for being active, which it could be possible explained by substance use limiting the span of activities done as a result of prioritizing addiction related behaviors (15). On the other hand, the activity scale of ZKPQ questionnaire appears to be sensitive to circadian typology (45, 46), and the SUD treatment imposes a morning circadian functioning (39, 47) which could influence energy levels of patients during treatment. Future studies should analyze the role of this individual difference in addict and dual disorder patients with measures before, during, and after treatment.…”

Circadian Characteristics in Patients under Treatment for Substance Use Disorders and Severe Mental Illness (Schizophrenia, Major Depression and Bipolar Disorder)

“…Moreover, sleep disturbances have been associated with a higher risk of drug use and relapses [ 12 , 13 ], while the magnitude of the phase delay with the degree of dependence [ 14 ]. Thus, the exploration of the affectation and recovery of circadian rhythmicity seems to be of special relevance in patients under treatment for SUD [ 7 , 15 ]. In relation to the circadian typology, there seem to be rhythmic differences depending on the chronotype.…”

“…Studies in patients with SUD who have completed a detoxification phase indicated they have a higher prevalence of the morning and intermediate typologies, compared with those who have not initiated treatment, which seems to be a positive characteristic linked to better adherence to treatment [ 7 , 15 ]. Likewise, these patients exhibited a more robust circadian pattern of distal skin temperature (DST) than healthy controls, which is associated with longer abstinence periods and related to some of the treatment strategies used in therapeutic communities (e.g., strong daytime activity and morning habits).…”

“…Different studies have shown that addictive behavior has negative effects on circadian rhythmic expression [5,6] which can persist weeks or months after starting substance withdrawal [7,8] and they do not always respond to treatment with medication [9,10] Rhythmic alterations commonly observed in patients with SUD are amplitude reduction and phase delay, which in severe cases can lead to chronodisruption or disappearance of rhythmicity [8]. This affectation is related both to the type of substance used and to the person's metabolism and tolerance (i.e., sensitivity to reward) [11].…”