Addiction Biology

Cannabis is one of the most widely used psychoactive substances worldwide, and cannabis use disorder (CUD) is increasingly recognized as a major public health concern. Clinical evidence indicates that women may be particularly vulnerable to developing addiction, exhibiting a faster transition from initial drug use to loss of control and increased relapse vulnerability. However, females remain underrepresented in both preclinical and clinical research, limiting our understanding of the neurobiological mechanisms underlying this susceptibility. Here, we investigated sex differences in behavioral and epigenetic susceptibility to cannabinoid addiction using a mouse operant self-administration model with the synthetic cannabinoid agonist WIN 55,212-2. Female mice displayed increased addiction-like behavior, characterized by greater persistence of responding during drug-free periods and enhanced compulsive-like drug seeking compared to males. miRNA profiling in the medial prefrontal cortex (mPFC) identified a female-specific epigenetic signature associated with the addiction-like phenotype, including downregulation of mmu-miR-669j, mmu-miR-7036b-5p, mmu-miR-878-3p, and mmu-miR-7017-3p, together with upregulation of mmu-miR-3092-5p in addicted females. Functional enrichment analyses of predicted target genes revealed pathways related to synaptic organization, axon guidance, neurotransmission, and structural plasticity. Together, these findings demonstrate sex-dependent differences in vulnerability to cannabinoid addiction-like behavior and identify a specific miRNA signature in the mPFC associated with this phenotype, highlighting potential targets for the development of sex-specific therapeutic strategies.

Background: Alcohol use disorder (AUD) is associated with altered gene expression across diverse cell types in reward-related brain regions, including the ventral tegmental area (VTA), which is rich in dopaminergic neurons. The VTA plays a central role in reward processing, learning, and memory; however, cell type-specific gene expression changes within the VTA remain uncharacterized. Methods: We applied single-nucleus RNA sequencing (snRNA-seq) to profile transcriptomic alterations associated with AUD in the VTA. Postmortem VTA samples from four individuals of European ancestry [two with AUD (one male, one female) and two matched controls (one male, one female)] were analyzed using the 10X Genomics Chromium Fixed RNA Profiling protocol. Differentially expressed genes (DEGs) were identified using Seurat, and enriched KEGG pathways was assessed by gene set enrichment analysis. Results: Nuclei were classified into six major cell types: astrocytes, endothelial cells, mature neurons, microglia, oligodendrocytes, and oligodendrocyte precursor cells (OPCs). At thresholds of P < 0.05 and |fold change| > 2.0, we identified 547 DEGs in astrocytes, 727 DEGs in endothelial cells, 715 DEGs in mature neurons, 421 DEGs in microglia, 263 DEGs in oligodendrocytes, and 432 DEGs in OPCs. DEGs across VTA cell types were enriched for pathways related to mitochondrial function, neurodegeneration, and synaptic signaling. Notably, DEGs in mature neurons were enriched for addiction-related pathways. Further subdivision of mature neurons into dopaminergic, GABAergic, glutamatergic, and unclassified subtypes revealed 526, 930, 896, and 569 DEGs, respectively. Neuronal DEGs indicate a convergence on mitochondrial/oxidative phosphorylation and neurodegeneration-related pathways across subtypes, whereas addiction- and synapse-related pathways show dopaminergic neuron-specific enrichment. Conclusions: This study provides the first cell type-resolved transcriptomic profiling of the human VTA, revealing AUD-associated gene expression alterations across neuronal, glial, and endothelial cells. The observed cell type-specific changes in synaptic plasticity and addiction-related genes offer new insights into molecular mechanisms underlying AUD pathophysiology.

BACKGROUNDThe proliferation of the potent synthetic opioid fentanyl has exacerbated the ongoing crisis of substance use disorder and associated overdose deaths, yet the neurobiological mechanisms that underlie individual vulnerability to addiction and relapse remain poorly understood, particularly in the context of fentanyl use. The prefrontal cortex (PFC) has been identified as a key brain structure important for cognitive functions impacted in addiction, including inhibitory control of behavior and association of drug experience with specific cues, contexts, or actions. Although the heterogenous neuronal composition of the PFC complicates attribution of addiction-related behavioral regulation to specific cortical cell types and circuits, application of cell-type-specific methods in translationally relevant rodent models have begun to elucidate the key neural substrates of opioid addiction. METHODSWe used an intermittent access fentanyl self-administration (IntA SA) model to characterize individual variation and sex differences in addiction vulnerability in male and female rats. Longitudinal wireless fiber photometry recording was used to track calcium activity patterns in intratelencephalic (IT) neurons of the prelimbic cortex across acquisition of self-administration, escalation of fentanyl intake, extinction training, and cue-induced reinstatement of fentanyl seeking. RESULTSWe found that our fentanyl IntA SA paradigm produces distinct low- and high-risk addiction severity phenotypes and that female rats exhibited a greater propensity for high-risk classification, which was characterized by abundant and consistent fentanyl intake, robust responsiveness to conditioned and discriminative fentanyl-associated cues, and high levels of fentanyl-seeking during periods of drug unavailability, extinction training, and a cue-induced reinstatement test. Fiber photometry recordings revealed dynamic encoding of fentanyl-associated stimuli by prelimbic IT neurons across the IntA SA paradigm with event-related calcium transients observed in association with lever presses, fentanyl infusions, and presentation of conditioned and discriminative cues. CONCLUSIONSOur data indicate that fentanyl IntA SA is a translationally relevant paradigm that enables investigation of phenotypic diversity and the role of sex in fentanyl addiction. Longitudinal cell-type-selective calcium recordings revealed dynamic representation of fentanyl-associated stimuli by IT neurons of the prelimbic cortex consistent with a role for this cortical subpopulation in addiction-related behaviors.

Acute COVID-19 outcomes are exacerbated by substance use, however, the impact of substance use on Long-COVID is unknown. Here, we investigated the impact of chronic cocaine administration on spike-induced Long-COVID-like outcomes in the rat. Rats received intermittent chronic cocaine administration and a single intravenous injection of the SARS-CoV-2 spike protein. Two months following spike administration, Long-COVID-like outcomes were assessed. Exposure to spike protein in the presence of cocaine produced a persistent reduction in weight gain as compared with controls or spike protein alone. Further, cocaine-treated rats exposed to spike had lower withdrawal thresholds compared to control animals as well as their own baseline, suggesting increased pain sensitivity. Spike and/or cocaine increased the ratio of interleukin-6 (IL-6) to interleukin-10 (IL-10) levels in the hippocampus, indicating a shift towards a proinflammatory state. Paw withdrawal thresholds were positively correlated with IL-10 levels in the hippocampus and prefrontal cortex. Regarding olfaction, rats exposed to spike spent less time sniffing an odor attractant. Cocaine produced an anxiolytic-like phenotype during the elevated plus maze test. Further analysis of behaviors on the maze revealed that the latency to enter the open arms was shorter in rats exposed to spike or cocaine, suggesting a possible impulsive-like phenotype in these animals. These findings demonstrate the negative impact of cocaine on Long-COVID-like outcomes suggesting a need for increased clinical observations of people with co-occurring Long-COVID and cocaine use disorder. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=59 SRC="FIGDIR/small/729575v1_ufig1.gif" ALT="Figure 1"> View larger version (10K): org.highwire.dtl.DTLVardef@12fdc19org.highwire.dtl.DTLVardef@11b1b0dorg.highwire.dtl.DTLVardef@8d1e21org.highwire.dtl.DTLVardef@b53d20_HPS_FORMAT_FIGEXP M_FIG C_FIG

BackgroundThe dorsolateral striatum (DLS) is a key site for coordinating the alcohol-induced stimulant response, a behavioral marker predictive of future alcohol use disorder. Although ethanol (EtOH) affects all brain cells, little is known about the contribution of non-neuronal DLS cell types to EtOH-induced stimulation. MethodsWe used ex vivo two photon calcium imaging, in vivo fiber photometry of astrocyte and neuronal GCaMP, and astrocyte-specific manipulations in mice to determine DLS astrocyte contributions to EtOH-induced stimulation and voluntary EtOH drinking behavior. Using fiber photometry of GRAB-ACh sensors and cell-type specific chemogenetics, we also assessed the role of cholinergic signaling in observed astrocyte EtOH effects. ResultsAs expected, intraperitoneal EtOH injections (0.5-2g/kg) evoked a stimulant response, evidenced by increased locomotion compared to saline. In parallel, EtOH dose-dependently decreased astrocyte calcium activity but had minimal effects on direct and indirect pathway neuronal activity. Mimicking this reduction with astrocyte-specific expression of CalEX, a calcium extruding pump, facilitated EtOH stimulation compared to mice expressing a control fluorophore. Hence, EtOH-induced suppression of DLS astrocyte activity contributes to stimulation. Astrocyte calcium signaling is a well-known target of neuromodulation. Fiber photometry recordings of extracellular acetylcholine (ACh) levels via GRAB-ACh imaging showed inhibition of ACh release by acute EtOH. We virally expressed the excitatory chemogenetic actuator hM3Dq in striatal cholinergic interneurons to assess whether artificially increasing ACh release blocks EtOH-induced inhibition of astrocytic calcium activity. Despite facilitating ACh release, this manipulation did not impact astrocyte calcium activity under control (saline) or EtOH conditions. Together, this work identifies DLS astrocytes as key contributors to EtOH-induced stimulation and highlights the importance of considering astrocyte-neuron interactions in evaluating alcohol effects.

Problematic Sexual Behaviour (PSB) is defined as difficult to control recurrent sexual behaviours that continue despite adverse consequences, leading to social and functional impairment. There is debate whether PSB is a disorder of compulsion or addiction; PSB often co-occurs with neuropsychiatric disorders, but further elucidation regarding underlying biology is required. A deficiency in reward neurotransmitter systems (reward deficiency syndrome: RDS) may underlie a shared vulnerability to addiction. We conducted the first case-control genome wide association study (GWAS) of PSB in patients (n=448), and comparison participants with (n=196) and without PSB (n=1488). We used polygenic risk scores (PRS) to test genetic overlap with related psychiatric, behavioural and personality phenotypes. Three models were used: 1) All-PSB (patient + comparison) vs. controls, 2) Patient-PSB vs controls, and 3) RDS (yes/no). Results suggested genetic overlap of PSB with psychiatric conditions, with PRS for major depression, substance use, and others predicting PSB status. PRS for related behavioural phenotypes (e.g., externalizing, age at first sex, number of lifetime sexual partners) and personality traits also predicted PSB. The patient model showed stronger associations than the All-PSB model, and RDS had both shared and distinct genetics with PSB. As expected with the sample size, only suggestive hits were observed with single variant and gene-based tests. PSB may share genetic mechanisms with various conditions. Further research in larger cohorts is needed to better understand the underlying genetics and environmental factors involved, and to improve diagnostic classification, intervention and treatment prospects.

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising treatment across addictive disorders including Cannabis Use Disorder (CUD). Targeting incentive-salience circuitry via the ventromedial prefrontal cortex (vmPFC) and central-executive circuitry via the left dorsolateral prefrontal cortex (LDLPFC) are both promising treatment approaches; however, to date structural targets have predominated whereas functional targeting may allow for more precision. In this pilot trial we adapted a functional Magnetic Resonance Imaging (fMRI) Regulation of Craving (ROC) task to generate fMRI-based rTMS targets in the vmPFC and LDLPFC. Methods: We recruited treatment-seeking participants with moderate or severe CUD as a part of an open-label trial and administered an adapted ROC-task during fMRI following 24-hours of cannabis abstinence. We identified sub-portions of maximal activation of the LDLPFC when participants thought of long-term consequences of cannabis use (Later) and of the vmPFC when participants thought of short-term positive aspects of cannabis use (Now). We hypothesized that our task would generate acceptable rTMS targets in >66% of baseline fMRI scans. Results: A total of 20-participants enrolled in the trial (50%F, age=33.3+9.8) and completed the baseline fMRI. The adapted ROC-task elicited group level activation in the LDLPFC and precuneus in the Later>Now and in the bilateral vmPFC, ACC, and striatum in the Now>Later contrast. Acceptable functional targets resolved in both the vmPFC and LDLPFC in 19 of 20 participants (one participant did not tolerate MRI). Conclusions: The adapted ROC-task elicits activation in incentive salience and central executive circuitry and can feasibly generate rTMS targets when using a cluster selection algorithm.

Alcohol use disorder (AUD) is a significant public health concern. In Canada, about 18% of individuals aged 15 or older will meet the clinical criteria for AUD at some point in their lives (CAMH, 2023). Treatment options for AUD are limited, and the high relapse rates highlight the urgent need for innovative methods to study and address AUD. Zebrafish (Danio rerio) is an emerging model for exploring the neurobiological impacts of alcohol. Previous studies have demonstrated that zebrafish respond to the rewarding effects of alcohol, but most research methods rely on passive administration, such as immersion, which does not reflect the typical routes of alcohol intake in humans. We previously showed that zebrafish can learn to self-administer drugs of abuse in small groups and conditioned animals are displaying key features of substance abuse disorders. However, group-based conditioning limits our understanding of individual drug preference and intake profile. In this study, we improved upon our previous design by establishing an individual self-administration protocol to measure voluntary alcohol intake and model alcohol use disorder. In this novel assay, individual adult fish learn to discriminate between two zones to self-administer a 5% ethanol solution. Moreover, animals conditioned in this assay can perform progressive ratio and display signs of withdrawal upon cessation of ethanol intake. These results suggest zebrafish can develop ethanol abuse-like behaviour, providing a powerful platform to study genetic predisposition and screen for therapeutic compounds.

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising treatment across addictive disorders including Cannabis Use Disorder (CUD). Stimulation of two rTMS-targets, the ventromedial prefrontal cortex (vmPFC) and the left dorsolateral prefrontal cortex (LDLPFC), limbic and executive control network hubs respectively, may yield differential effects. In this pilot trial, we explored the differential effects of 36-sessions of rTMS applied to either the vmPFC or LDLPFC. Methods: Treatment-seeking participants with moderate or severe CUD (n=20, 10F, age=33.3+9.8SD) were randomized to 36-sessions of open-label rTMS (two sessions-per-visit, two or three visits-per-week) to either the LDLPFC (3000-pulses; 10Hz) or vmPFC (900-pulses; 1Hz) using personalized functional Magnetic Resonance Imaging (fMRI) targets along with three-sessions of Motivational Enhancement Therapy. At baseline and following rTMS, the Time-Line Follow-Back was used to measure Days-per-week of cannabis use and the fMRI Regulation of Craving (ROC) task was used to measure network activation to cues associated with long-term negative ('Later') and short-term positive ('Now') consequences of cannabis use. Results: Eighty percent of participants completed study-rTMS. There was a significant decrease in days-per-week of cannabis use in both groups (vmPFC: d=7.9; DLPFC, d=3.1) between the four-weeks of baseline and seven-weeks of follow-up. LDPFC-rTMS reduced fMRI BOLD signal magnitude and increased LDLPFC functional connectivity in response to cues, while vmPFC-TMS reduced functional connectivity. Conclusions: Treatment-seeking participants with CUD reduced the number of days-per-week they used cannabis when receiving rTMS applied to either the LDPFC or vmPFC, while fMRI effects differed by treatment target. Future larger sham-controlled trials are needed for efficacy and biomarker determination.

Background/ObjectivesPersistent cognitive impairments are prevalent in methamphetamine (meth) use disorder and contribute to maladaptive decision-making and increased relapse vulnerability. There are currently no effective treatments for meth-associative cognitive deficits, and their neurobiological underpinnings remain incompletely understood. This study investigated the effects of chronic meth self-administration on episodic-like recognition memory and evaluated whether pharmacological potentiation of metabotropic glutamate receptor subtype 2 (mGlu2) could rescue these deficits. MethodsAdult male Sprague-Dawley rats underwent 7 days of limited- (1h/day) followed by 14 days of extended-access (6h/day) meth self-administration, followed by 30 days of abstinence. Recognition memory was assessed using the object-in-place (OIP) task. A positive allosteric modulator of mGlu2 receptors, LY-487379 (25 mg/kg, s.c.), was administered prior to the memory test. In parallel, changes in total and surface mGlu2/3 protein levels in the prelimbic and perirhinal cortices were evaluated. ResultsRats with extended access to meth self-administration exhibited escalated drug intake and persistent deficits in OIP memory. Administration of LY-487379 reversed this deficit. Total mGlu2/3 protein levels were unaltered; however, meth exposure was associated with a significant increase in surface mGlu2/3 receptor expression in both cortical regions examined. ConclusionsThese results demonstrate that chronic meth produces persistent cognitive dysfunction that can be rescued by mGlu2 receptor potentiation. The observed increase in surface mGlu2/3 expression may represent a compensatory response to chronic glutamatergic dysregulation, but it appears to be insufficient to restore cognitive function alone, without pharmacological enhancement. The current data encourage further exploration of mGlu2 role in stimulant-associated cognitive dysfunction. HighlightsChronic methamphetamine self-administration produced persistent deficits in episodic-like recognition memory in male rats and dysregulation of mGlu2/3 receptors in the prelimbic and perirhinal cortices. Systemic pharmacological potentiation of mGlu2 receptors rescued meth-associated memory deficits. mGlu2 receptor potentiation may represent a promising therapeutic strategy for treating stimulant-associated cognitive dysfunction. Increased surface mGlu2/3 expression may represent a compensatory adaptation to post-methamphetamine glutamatergic dysfunction, but it is not sufficient to restore cognition alone, without pharmacological enhancement.

Background: Cannabis use is highly prevalent among emerging adults (18-25 years), a developmental period marked by ongoing neurodevelopment and heightened risk for cannabis use disorder (CUD). Structural alterations in the orbitofrontal cortex (OFC) and medial prefrontal/anterior cingulate cortex (mPFC/ACC) have been linked to cannabis use, though findings remain inconsistent in directionality. To address this, we examined cortical thickness and surface area of the OFC and mPFC/ACC subregions using the high-resolution Glasser atlas, allowing for more granular characterization of associations with CUD severity. Method: One hundred eleven emerging adults (41% male, aged=20.6{+/-}1.1 years) reporting significant alcohol and/or cannabis use completed clinical assessments and structural MRI. The OFC and mPFC/ACC were segmented into seven and six subregions per hemisphere, respectively. Multiple linear regressions tested associations between cortical thickness or surface area and DSM-5 CUD symptom count, controlling for alcohol use and intracranial volume. Subregions surviving false discovery rate correction were examined in relation to depression, trauma-related symptoms, impulsivity, and cannabis use motives. Results: Greater CUD severity was associated with lower cortical surface area and greater cortical thickness in OFC and mPFC/ACC subregions. Lower OFC surface area was correlated with coping- and enhancement-related cannabis use motives. Lower mPFC/ACC surface area and greater thickness were associated with more severe depression, trauma-related symptoms, and impulsivity. Conclusion: In high-risk emerging adults, greater CUD symptom burden is associated with lower surface area and greater thickness in OFC and mPFC/ACC subregions. Using the high-resolution Glasser atlas, these findings provide a more precise characterization of structural correlates of CUD and highlight potential neurobiological markers linked to affective and motivational processes underlying cannabis use.

In a single-blind randomized controlled trial, we investigated the effectiveness of real-time fMRI neurofeedback delivered in 7 runs over three sessions across two weeks in N = 65 patients with alcohol use disorder. The intervention targeted modulation of ventral striatal cue reactivity to alcohol-related cues as well as enhancement of prefrontal control mechanisms in the right inferior frontal gyrus. The study design incorporate three experimental groups that either were instructed to downregulate a ventral striatum signal, upregulate the right inferior frontal gyrus, or upregulate negative functional connectivity between these two structures. In two active control groups participants were instructed to either up- or downregulate the primary auditory cortex. We did not find an effect of ventral striatal downregulation or negative connectivity feedback, and a reduced striatal activation in the right inferior frontal gyrus upregulation group was accompanied by concurrent lower activation in the target structure, suggesting that our intended modulation approaches were not effective. Identified problems that might have contributed to this unexpected outcome might have been the use of continuous feedback presentation that potentially confuses regulation target and reward processing in the ventral striatum, counterintuitive regulation directions, a lack of explicit strategy guidance and transparency about the targeted process, and generally the difficulty to recruit a sufficient number of eligible voluntary participants for a well-powered study with a complex design. These insights emphasize the complex challenges of real-time fMRI neurofeedback interventions for the treatment of substance use disorders and could provide guidance for the development of more effective future approaches.

RationaleThe progression of psychostimulant abuse is associated with a shift from recreational to habitual use (R2H-shift). Because this R2H-shift can be modeled using behavioral economics, we developed a novel Behavioral Economic model for the Analysis of Self-administration Time-curve (BEAST) to obtain R2H-shift variable(s). The relationship(s) between R2H-shift variables and drug intake (under normal and/or punishment conditions) is/are unknown. Our goal was to determine if the R2H-shift variable and intake variables obtained during the initial self-administration training phase were related to 1) drug intake at that time, and subsequent drug intake under 2) normal, 3) punishment, 4) post-punishment, and 5) price-constrained conditions. MethodLong Evans rats self-administered methamphetamine (METH, males n = 16, females n = 14), sucrose (males n = 22, females n = 22) and/or saline (males n = 3, females n = 10) under FR1 for 6 h per day for 20 days to obtain 1) followed by the assessment of subsequent drug intake under different conditions (2-5 above). We obtained all variables referenced above. We determined the relationships between all variables (multivariate analysis). ResultsThere were no sex differences detected in the METH and sucrose studies. For METH and sucrose, prior drug intake levels could predict drug intake under normal/punishment but not under price-constrained conditions. The R2H-shift variable could predict drug intake under a consumption-price curve but could not predict intake under normal/punishment conditions. ConclusionsWhile related to economic demand, the recreational-to-habitual shift rate was unrelated to drug intake levels (under normal and punishment conditions).

The addictive properties of opioids are due in part to these drugs ability to alter ventral tegmental area (VTA) activity via activation of mu opioid receptors (MORs) on local and distal inputs. Prior studies have identified numerous opioid-modulated afferents to the VTA, some of which show differing levels of functional modulation by opioids, but the degree to which this parallels differences in receptor expression is not known. Hence, we used retrograde labeling combined with RNAscope to examine oprm1 mRNA expression in VTA-projecting afferents arising from a variety of distal brain regions. Because opioids are thought to be particularly influential on GABAergic afferents to the VTA, we also examined colocalization of oprm1 with GABAergic markers in VTA-projecting neurons. Interestingly, we found that oprm1 mRNA is present in both GABAergic and non-GABAergic VTA-projecting neurons. However, many (though not all) GABAergic afferents expressed higher levels of oprm1 compared to most non-GABAergic afferents (especially those arising from the cortex). These results complement previous anatomical studies that had examined oprm1 expression in these regions but in a non-quantitative way and without regard to their efferent targets. Our findings encourage future work to examine the functional implications of MOR sensitivity within these afferent pathways.

RationalePrenatal alcohol exposure (PAE) can result in Fetal Alcohol Spectrum Disorder (FASD), which consists of a group of diagnosable medical conditions that can include an increased risk for anxiety disorders and/or alcohol misuse, and sensory issues, such as increased mechanical sensitivity. ObjectiveThis study investigated how a single moderate PAE on gestational day 12 (G12) alters anxiety-like behavior, ethanol (EtOH) intake, and mechanical sensitivity across the lifespan of Sprague Dawley rats. MethodsPregnant dams were exposed to vaporized EtOH or room air (control) for 6 hours (BECs [~]108 mg/dL). Testing in male and female offspring began at three different ages: juveniles ([~]postnatal day (P) 25), adolescents ([~]P45) and adults ([~]P80). ResultsThe greatest PAE effects were observed in adolescent animals, with alterations in anxiety-like behaviors demonstrated in the light-dark box and elevated plus maze. Additionally, adolescent female animals consumed more sweetened EtOH compared to males. However, PAE adolescent animals consuming less sweetened EtOH compared to their counterparts, which was also observed in adult PAE females. Interestingly, this effect is reversed in juvenile and adolescent males when tested with unsweetened EtOH, with juvenile females consuming more EtOH also. Finally, PAE and air animals exhibited increased mechanical sensitivity following post-natal EtOH consumption across all ages. ConclusionThese data demonstrate that there are age- and sex-specific effects of PAE on anxiety-like behaviors, EtOH intake, and mechanical sensitivity that are more distinct in adolescent animals.

Background and Aims: Synthetic opioids cause tens of thousands of deaths each year in North America, and there are indications that synthetic opioids are also becoming increasingly prevalent in the European drug market. This study aimed to examine high-risk substance use in the German drug-using community with a particular focus on the synthetic opioids fentanyl and nitazenes and related awareness, concerns, overdose experiences, and harm-reduction behavior. Design: Cross-sectional, observational online survey. Setting: Open drug-use scenes, addiction clinics, and substitution practices at numerous geographic locations throughout Germany, August to September 2025. Participants: 235 individuals aged 14+ from the drug using community (mean age 43.4 years; 57.9% male), 79.6% recruited by peers in open drug-use scenes. Measurements: The primary outcome was substances used within the past 12 months. In addition, sources, forms, routes of administration, and perceived changes in availability and price of (synthetic) opioids were assessed as well as risk perceptions, fears, harm-reduction behavior, and overdose-related experiences. Findings: 227 respondents reported substance use with an average of 6.2 substances, and 73.1% (95% confidence interval [CI] = 67.0-78.5%) had used at least one opioid in the past year. Synthetic opioids were consumed in many parts of Germany and across all age and gender groups. Among participants who experienced a shortage of their primary opioid in the past year, 25% (95% CI = 15.8-37.2%) reported having used fentanyl instead. 56.5% (95% CI = 36.8-74.3%) of individuals using synthetic opioids reported having experienced an overdose in the past twelve months. Most of the respondents perceived synthetic opioids as posing a high risk, and a substantial proportion expressed fear that they could be mixed into their own substances. However, only 9.9% (95% CI = 6.6-14.7%) use drug checking, although the vast majority stated they would use it if it were available to them. Conclusions: Synthetic opioids, including fentanyl and nitazenes, have entered the German drug scene, with users reporting high rates of overdose and limited access to harm reduction measures. Germany may be in an early phase of a synthetic opioid transition, warranting urgent expansion of surveillance, naloxone distribution, and drug checking services.

BackgroundChronic alcohol use disorder (AUD) is associated with profound dysregulation of immune function, neuroinflammation, and systemic stress responses, which contribute to both the maintenance of addiction and alcohol-related organ damage. While brain transcriptomic studies have established neuroimmune signaling and synaptic remodeling as central features of AUD, peripheral blood signatures during early withdrawal and recovery remain underexplored. Understanding the dynamic transcriptional changes in peripheral blood accompanying supervised withdrawal therapy is critical for identifying reversible molecular processes versus persistent trait-like alterations. MethodsRNA sequencing (RNA-seq) was performed on peripheral blood from individuals with alcohol use disorder (AUD, n = 100) and healthy controls (n = 74) at baseline and after three weeks of supervised withdrawal therapy. Differentially expressed genes (DEGs) were identified using linear mixed models assessing main effects of group, time, and their interaction. Functional enrichment and co-expression network analyses were performed to identify coordinated biological processes. ResultsAt baseline, more than 1,000 genes were differentially expressed between AUD and control participants, showing robust dysregulation of immune-related pathways. After three weeks of withdrawal, the number of DEGs decreased markedly to 141, indicating partial transcriptomic normalization. Nevertheless, immune dysregulation persisted despite treatment, particularly linked to B cell activation and cell-cell junctions. Interaction analyses (group x time) identified 16 genes whose expression dynamically changed with therapy, highlighting strong enrichment for fatty acid pathways. Co-expression network analysis revealed that baseline modules were enriched for genes associated with secretory granules and immune signaling, while therapy-related co-expression shifts involved coagulation and platelet activation processes. ConclusionsAUD is associated with widespread but partly reversible transcriptomic dysregulation in peripheral blood. These findings support a system-level view of AUD as a disorder of intertwined immune, metabolic, and coagulation biology and suggest that longitudinal blood transcriptomics may help identify both rapidly therapy-responsive and more stable molecular targets for relapse prevention.

The gut microbiome has been implicated in alcohol use disorder (AUD), but its relationship to drinking intensity and treatment response remains poorly understood. We conducted a longitudinal multi-omics analysis of stool samples collected at baseline and endpoint (after 12 weeks) from 122 participants enrolled in a double-blind, placebo-controlled trial of dutasteride for AUD. Gut microbiome composition was characterized using 16S rRNA gene sequencing, and fecal metabolites were measured by LC-MS-based metabolomics. At baseline, drinking intensity was associated with increasingly lower microbial richness. Genera in the class Clostridia emerged as key microbial hubs associated with drinking intensity in an age- and sex-dependent manner. Drinking intensity promoted co-enrichment of [Ruminococcus] gnavus group and [Clostridium] inocuum group with amino acid catabolites, as well as the co-depletion of diverse Clostridia taxa and lipid metabolites. Dutasteride treatment and drinking reduction had minimal impact on gut microbiome composition. Random forest models integrating baseline clinical, microbiome, and metabolome data improved the classification of clinically meaningful drinking reduction compared to models using clinical data alone. These findings show that a coupled baseline gut microbiome-metabolome signature is associated with drinking intensity and future treatment response in AUD, highlighting the potential for multi-omics integration to inform precision treatment approaches.

Relapse-prevention strategies aimed at reducing relapse following abstinence, primarily focus on reducing cravings that lead to drug-seeking triggered by stress, drug-related cues, or re-exposure to the drug. Because addictive drugs form persistent associative contextual memories, we investigated how reactivation of cocaine-related hippocampal memories influences subsequent drug-seeking. Here, we tagged dorsal dentate gyrus (dDG) memory ensembles involved in encoding either a first or fourth cocaine exposure (15mg/kg, i.p) in male and female c57BL/6 mice using a TetTag approach. Mice underwent cocaine conditioned place preference (CPP), extinction, and reinstatement. We assessed whether optical reactivation of tagged cocaine-related ensembles could substitute for a cocaine priming injection to reinstate CPP, whether reactivation altered cocaine-induced reinstatement, and if these effects differed depending on stage of drug exposure. We also compared these effects to reactivation of saline-associated ensembles. Cocaine produced robust locomotor activation during conditioning, and sensitization developed across repeated drug exposures. Reactivation of a cocaine-related engram alone did not reinstate CPP. However, reactivation of the first cocaine exposure engram attenuated cocaine-induced reinstatement. In contrast, reactivation of the fourth exposure engram did not confer this protective effect. Interestingly, reactivation of saline-associated ensembles also reduced cocaine-induced reinstatement specifically in females, suggesting dDG ensemble reactivation may modulate relapse-related behavior through interference or neuromodulatory disruption of cocaine-associated representations, consistent with our prior work. These findings raise the possibility that early contextual experiences form competing or destabilizing representations that interfere with later cocaine-seeking when reactivated. Females also displayed greater sensitivity to locomotor-inducing effects of cocaine memory reactivation, although this was dissociated from CPP. Together, these findings show that cocaine memories are distinct across drug experience and selective reactivation of dDG engrams can differentially influence drug-seeking.

Dopamine (DA) is important in many fundamental behaviors, including positive and negative reinforcement, incentive salience, and decision-making. This behavioral diversity is now known to be due, in part, to neurotransmitter diversity, based on rodent models. To address DA neuron transmitter properties in higher species, we examined the ventral midbrain in 5 young macaques (3 male, 2 females, 3-6 years) using RNAscope in situ hybridization for tyrosine hydroxylase (TH), vesicular glutamate transporter 2 (VGluT2) and glutamic acid dehydroxylase 1 (GAD1) across the A10 (VTA; midline VTA nuclei and parabrachial nucleus; PBP), the A9 (substantia nigra, pars compact, SNc) and the A8 (retrorubral field, RRF) subregions. We followed up with immunocytochemical studies in the same cohort to infer extent of mRNA and protein matches. There were 7 mRNA phenotypes, with TH-mRNA containing cells forming the largest proportions of all neurons, as expected. Surprisingly, multiplexed TH+ neurons were much more frequent than TH-single labeled neurons overall (TH-VGluT2, 22% and TH-VGluT2-GAD1, 23% compared to TH-single labeled neurons, 19%). GAD1 mRNA co-expression mainly occurred in triple labeled cells, i.e. those with VGluT2- and TH mRNA expression. VGluT2 mRNA single-labeled neurons represented only 8%, and GAD1 mRNA single-labeled neurons comprised 20%, of the total population. Proportions of cellular phenotypes were similar across the A10-A9-A8 subregions. Most DA neurons in the young macaque contain multiple transmitters, indicating an important role for fast synaptic transmission alongside dopaminergic transmission in all subregions. We discuss the developmental and circuit implications of these findings in higher primates.