The discipline of psychoanalysis was significantly influenced by Freud's experience in neuroanatomy and clinical neurology. Sigmund Freud began his medical career as a neuroanatomist and neurologist before he later established the theories and techniques of psychoanalysis. Freud made several significant contributions to research in neuroanatomy and clinical neurology that were overshadowed by his later accomplishments. As the "Father of Psychoanalysis," Freud was, and his legacy always will be, that of a neurologist.

Austria↗

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Alcohol and drug dependence among the elderly: epidemiology, diagnosis, and treatment.

Alcohol and drug dependence among the elderly is common and yet frequently underdiagnosed. The practice of self-administration of prescribed medications, particularly sedative/hypnotics, benzodiazepines, and nonprescription, over-the-counter (OTC) medications is prevalent, with untoward consequences in the geriatric population. Dementia, depression, and anxiety syndromes are some of the consequences of alcohol and drug dependence, and may mimic other causes of these disorders. The clinician's index of suspicion must be high enough to make the proper diagnosis of these alcohol- and drug-induced syndromes. Unnecessary evaluations, improper diagnosis, and ineffective and costly treatments may be avoided if alcohol and drug dependence is identified and treated. Effective treatment for alcohol and drug dependence does exist for the elderly and may be instituted in a cost-effective manner.

Adolescent↗

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Drug and alcohol dependence and psychiatric populations: the need for diagnosis, intervention, and training.

The comorbidity of psychiatric disorders and alcohol and drug dependence is high. The prevalence rate for each disorder is high as determined by studies in general and patient populations. Moreover, the severity of the course is likely to be greater when the two disorders are combined, prompting the attention of clinicians and researchers. Of importance, the intoxication and withdrawal from alcohol and drugs produce psychiatric symptoms and syndromes that can mimic psychiatric disorders. The prevalence rates for comorbidity of both categories of disorders vary according to the populations studied, methodological approaches used, and duration of longitudinal follow-up postdiagnosis of the disorders. It is evident from a review of the literature that there is a growing urgency for proper diagnosis, improved training programs, and treatment intervention strategies for alcohol and drug dependence in psychiatric populations. Suggestions for broad assessment and specific interventions for alcohol/drug dependence in psychiatric settings are offered, and increased time in psychiatric residency training is recommended.

Ambulatory Care↗

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Cocaine-associated violence and relationship to route of administration.

The relationship between route of cocaine administration, that is, free base/crack smoking (FB), intravenous injection (IV), and nasal insufflation (NS) and level of violence was studied. The authors hypothesized that the route that produced the most intense effects (i.e., FB > IV > NS) would produce the highest level of violence. Over a 12-month period, 194 cocaine users were screened. After excluding polydrug users, 101 patients of both sexes participated in this study for the evaluation of expressions of violence. Evaluations were conducted by a structured questionnaire. The order of level of increased violence matched that of the most "intense" route of administration for some measures only. FB and IV use generally produced the same level of violence for most measurements. Both FB and IV routes produced more violence than NS. Violent actions requiring sustained activity (e.g., rape, burglary, and armed robbery) showed no relationship to route. The difference in levels in violence between males and females varied according to circumstance, not route of administration.

Administration, Intranasal↗

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Clinical diagnosis of substance use disorders in private psychiatric populations.

The clinical diagnoses of comorbid substance use and psychiatric disorders by psychiatrists in a private psychiatric inpatient setting were analyzed. Two hundred patients consecutively discharged from a private university-affiliated psychiatric service by clinical psychiatrists were examined for concomitant substance use and psychiatric disorders according to DSM-III-R criteria for Axis I and Axis II disorders. Fifty-nine patients (30%) were diagnosed with a comorbid substance use and psychiatric disorder on Axis I, supporting findings of previous studies. Comorbid diagnosis patients were more likely to be male (54%, 32) than were psychiatric only (noncomorbid diagnosis) patients (males 37%, 51). There were no differences between comorbid (dual diagnosis) and noncomorbid diagnoses in age, mean length of stay, or discharge type. Of the 59 patients with comorbid disorders, 83% had Axis I diagnoses, and 64% had Axis II diagnoses. Polysubstance use disorder was the most common dual diagnosis, cooccurring with an Axis I diagnosis in 47% of patients with an Axis II diagnosis in 45%. Psychiatrists in clinical psychiatric inpatient settings diagnose substance use disorders in rates similar to public settings despite absence of specific addiction treatment.

Adult↗

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Benzodiazepines: tolerance, dependence, abuse, and addiction.

Many recent studies have clearly documented the development of tolerance, dependence, and addiction to benzodiazepines. In spite of these studies and reviews of the literature, confusion remains regarding the risk and benefits of the use of benzodiazepines in medical practice. The source of the confusion arises in part from the lack of clarity in the definitions of tolerance, dependence, and addiction. The distinctions among these important terms are frequently obscured in research studies and, especially, in clinical practice. In addition, the practice of separating medical from nonmedical populations in reports of benzodiazepine dependence is misleading. The overlap between medical and nonmedical benzodiazepine users is large, so that many of these individuals fall into both categories. These and other points should be considered as serious questions to the safety and freedom from dependence and addiction in any drug-using population.

Animals↗

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The disease model of addiction: a biopsychiatrist's view.

Explore the source record for details and available documents.

Adaptation, Psychological↗

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A neurochemical basis for alcohol and other drug addiction.

There are major clinical observations in alcohol and other drug addicts and neurochemical studies in animals and humans that support the hypothesis for a common neurochemical basis for alcohol and other drug addiction. The common occurrence of concurrent alcohol and multiple drug dependence in clinical and general populations, family history and genetic studies, and basic and clinical research in the neurochemistry of addictive behavior provide evidence for a common genealogical vulnerability to combined alcohol and other drug addiction. Clinical neurochemical models for addictive behaviors can be derived from neurochemical pathways for the initiation and sustenance of addictive disorders. The role of tolerance and dependence is not specific to addiction but indicates a homeostatic response of the brain to the presence of a foreign substance. Animal and human studies are analyzed for clinical synthesis of a neurochemical basis for addictive disorders.

Alcoholism↗

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Prevalence of depression and alcohol and other drug dependence in addictions treatment populations.

The diagnosis of depression has been viewed as an important factor in the treatment response for those who have alcohol and other drug dependence. The objective of the study was to examine the prevalence of a lifetime history of major depression in inpatients with a substance use disorder in addictions treatment. An evaluation study of 6,355 patients was conducted in inpatient and outpatient addictions treatment programs from 41 sites. Subjects were required to have a substance use disorder and to be evaluated for a lifetime diagnosis of major depression according to DSM-III-R criteria. The rate of a lifetime diagnosis of major depression was 43.7%. The most common diagnosis was alcohol dependence, followed by cocaine dependence, and cannabis dependence). Depression was associated in significantly greater numbers with diagnoses involving drugs other than alcohol, in females greater than in males, with number and frequency of use, and in inpatient programs more than outpatient programs. The rates for continuous abstinence at one year did not differ between those with and without a lifetime history of depression.

Adolescent↗

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Integration of treatment and posttreatment variables in predicting results of abstinence-based outpatient treatment after one year.

A multi-site, longitudinal study of patients undergoing outpatient alcohol and drug dependence treatment was conducted in private outpatient facilities, consisting of 2,029 subjects from 33 independent programs enrolled in a national addiction treatment outcomes registry. Pretreatment demographic and substance variables, treatment utilization variables, and post-treatment continuum of care variables were examined simultaneously in a multivariate prediction context for association with outcome. Upon admission patients provided history information to treatment staff trained in the collection of data for the evaluation efforts. Trained interviewers conducted consecutive structured interviews prospectively for treatment outcome at six- and 12-month follow-up periods. Multivariate analysis with stepwise multiple regression indicated that, relatively speaking, the most powerful predictors of treatment outcome were posttreatment variables: namely, support group attendance and involvement in a continuing care program. Pretreatment and treatment variables contributed proportionately little to the prediction of outcome. Additional sequential-stage analysis showed that the incremental contribution to prediction by posttreatment attendance at Alcoholics Anonymous and involvement in a treatment program following discharge far exceeded the initial predictive validity of the 14 pretreatment and treatment variables examined. Participation in posttreatment continuing care correlated with statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates. Posttreatment more than pretreatment factors may be decisive in influencing risk for relapse.

Adolescent↗

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The integration of pharmacological therapy for comorbid psychiatric and addictive disorders.

The integration of pharmacological therapies for comorbid disorders requires an acceptance of independence and interactions of respective addictive and psychiatric disorders. At the same time, alcohol and other drugs induce psychiatric states that are indistinguishable from psychiatric disorders. On the other hand, while psychiatric disorders do not induce addictive use of alcohol and drugs, they do pose vulnerabilities to the development of addictive disorders. Generally, the treatment of comorbid disorders begins with abstinence and evaluation of the effects of alcohol and other drugs in contributing to the psychiatric picture. In the case of comorbid disorders, stabilization and standard treatments can be employed with certain cautions, namely, to avoid the use of addicting medications such as benzodiazepines and opiates beyond the detoxification stage. High potency neuroleptics and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) can be used to treat continuing psychiatric states after the exclusionary criteria in DSM-IV for substance-related disorders have been applied to the clinical case. If the psychiatric symptoms clear with sustained abstinence, little or no medications may be required. Specific treatment of the addictive disorders will often determine the extent that addictive disorders are responsible for psychiatric symptomatology. Alternatively, treatment of the psychiatric disorder will enhance compliance with addiction treatment.

Anti-Anxiety Agents↗

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Integration of health care economics for addiction treatment in clinic care.

Over the past decade, radical changes have occurred in the availability and funding of treatment services for individuals with addictive disorders. Traditional inpatient and residential treatments have been replaced by outpatient settings. "Standard" addiction treatments, such as 28-day inpatient hospitalizations, are largely a thing of the past. The process of treatment planning has also changed. Treatment decisions now depend on third-party coverage rather than severity of illness. The procedures for determining eligibility and obtaining authorization for treatment are often ponderous and impersonal and determined through administrative procedures that are external to the treatment facility. The criteria used to determine the type of treatment seem arbitrary rather than clinically based.

Alcoholism↗

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Integration in education for addiction medicine.

Addiction to alcohol and other drugs is a serious public health problem that is one of the most common disorders seen in medical practice. Although it is an extremely common disorder, it is poorly diagnosed and treated by physicians. In order to begin to develop an integrated approach to education and addiction, one must define the many roles of the physician working with addicted patients. Training about addictions must begin early in the medical student's career, and continue in a vertically integrated way throughout medical school. The notion of addiction as a disease process must be introduced and integrated into course materials in the preclinical years. Careful attention must be paid to the development of positive views toward working with addicted patients, and students must be indoctrinated early with the idea that physicians have a responsibility to diagnose and manage addicted patients. Students should be given multiple opportunities to learn and use screening interviews for addiction in preclinical interviewing courses, and while on the clerkships. Residency education and continuing medical education in addictions are also important, so that faculty may become good role models for students in this critical area.

Curriculum↗