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PubMed2001

Rural-urban differences in the distribution of parent-reported risk factors for substance use among young adolescents.

PURPOSE: We examined rural-urban differences in cumulative risk for youth substance use. A recent report [National Center on Addiction and Substance Abuse (CASA) 2000] found that the rural-urban distribution of substance use and known risk factors for substance use differed; in many cases rural youth showed higher levels of use, as well as higher levels of risk factors. The current investigation, while not directly examining substance use, further examined rural-urban differences in the distribution of risk factors for youth substance use, based on information from parent reports. METHOD: Study 1 data were collected from a random sample of Midwestern parents (n = 339) with a young adolescent between the ages of 11 and 13 years. Study 2 data were collected from a second sample of Midwestern parents (n = 593). RESULTS: Analyses of rural-urban comparisons demonstrated higher levels of cumulative risk among rural youth. An evaluation of the sensitivity of the analysis to rural-urban classification schemes indicated that the findings were robust, but that there was some minor variation in rural-urban differences by classification scheme. IMPLICATIONS: Results contribute to an explanation of findings from earlier reports of rural-urban differences in substance use, and suggest directions for future research on rural-urban distributions of youth risk factors.

Adolescent↗
PubMedDate not supplied

[Lipid peroxidation and status of the antioxidant system in opiate addiction, chronic alcoholism, or substance abuse caused by inhaling solvent vapors].

Patterns of lipid peroxidation and the state of antioxidant systems were studied in 30 healthy volunteers (control), 18 patients with toxicomania developed as a result of inspiration of organic solvent vapors, 21 patients with chronic alcoholism and in 27 patients with opium narcomania within 4-6 years after withdrawal. The data obtained suggest that activation of lipid peroxidation and decrease in the rate of antioxidant response, which were detected in the patients with narcomania, correlated with severity of the psychopathological failures induced by chronic toxic effect of the narcotics or toxic preparations applied.

Administration, Inhalation↗
PubMed2006

Should addictive disorders include non-substance-related conditions?

AIMS: In anticipation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to consider whether addictive disorders should include non-substance use disorders. METHODS: The author reviewed data and provided perspective to explore whether disorders such as pathological gambling (PG) should be grouped together with substance dependence, given that they share many features. RESULTS: PG and substance dependence currently reside in the DSM, fourth edition, text revision (DSM-IV-TR) within separate categories, with PG classified as an impulse control disorder (ICD) and substance dependence as a substance use disorder (SUD). Arguments can be forwarded to support each categorization, as well as to justify their inclusion together as addictions. CONCLUSIONS: The current state of knowledge suggests that there exist substantial similarities between PG and SUDs. Further research is indicated prior to categorizing PG and other ICDs together with SUDs.

Brain↗
PubMed2005

CANTAB explicit memory is less impaired in addicted schizophrenia patients.

It has been suggested that in order to sustain the lifestyle of substance abuse, addicted schizophrenia patients would have less negative symptoms, better social skills, and less cognitive impairments. Mounting evidence supports the first two assumptions, but data lack regarding cognition in dual diagnosis schizophrenia. Seventy-six schizophrenia outpatients (DSM-IV) were divided into two groups: with (n = 44) and without (n = 32) a substance use disorder. Motor speed and visuo-spatial explicit memory were investigated using CANTAB. As expected, dual diagnosis patients showed a better cognitive performance. Our results suggest either that substance abuse relieves the cognitive deficits of schizophrenia or that the patients with less cognitive deficits are more prone to substance abuse.

Adult↗
PubMed2004

[Psychometric properties and initial validation of the questionnaire on differentiated assessment of addiction].

The "Questionnaire on Differentiated Assessment of Addiction (QDAA)" is a multi-modal, selfrating instrument for the Assessment of addiction and abuse of psychotropic substances. The QDAA provides the diagnosis of addiction as well as an overview of relevant information needed for the treatment of addiction. Several subscales assess variables that contribute to the development and maintenance of addiction such as mood, stress, expectancy of drug effects, self-esteem, life satisfaction and coping ability. In the present study validity and reliability of the QDAA was tested in several dependent and non-dependent samples. A total of 575 non-dependent, alcohol-, heroin- and cannabis-dependent subjects was available for the present study. Six criteria (craving, tolerance, withdrawal, loss of control, addictive behavior, negative consequences), that form the basis of the addiction diagnosis were shown to have high internal consistency and can be reduced to one dimension by factor analysis. The resulting diagnosis of addiction is significantly correlated with the external criterion "dependence syndrome" of the ICD-10 by external experts. The assumed structure of the QDAA-subscales could be confirmed by factor analysis. In addition, the results of the subscale analysis provide empirical evidence for convergent validity. All subscales showed moderate to high internal consistency. The results suggest that the QDAA is a valid and reliable instrument for the differential assessment of substance addiction, abuse as well as relevant information in the context of addiction and its treatment.

Adult↗
PubMed2006

Severity profiles of substance-abusing patients in Italian community addiction facilities: influence of psychiatric concurrent disorders.

Mental health and addiction services have traditionally evolved separately in many European countries, with policy reflecting this. Differences in severity profiles between users of the community addiction services with comorbidities of mental illness and substance misuse and those with substance misuse only were studied using a matched case-control study design, with regard to the main substance (opiates or cocaine) patients were dependent on. Patterns of substance abuse and diagnostic features were evaluated according to the Addiction Severity Index (ASI) and DSM-IV. Mentally ill substance abusers are significantly more likely to have used amphetamines, inhalants and having been polydrug users. They are particularly impaired in medical and family/social relationships ASI composite scores, but less in drug use. Severity profiles and needs of dually diagnosed patients require assessment and treatment skills that should be provided through adequate links with mental health system.

Adult↗
PubMed1987

Can demand for illicit drugs be reduced?

Given the technological advances in communications and logistics systems, as well as the enormous profits derived from illicit drug trafficking, it is most probable that traffickers will in the future attempt to increase both the illicit supply of and demand for drugs. It is also expected that traffickers will manage to produce new addiction-producing substances for the illicit market. In these circumstances, and given the fact that addicts have formed deeply rooted drug-using habits, it appears that the reduction of the illicit demand for drugs can only be achieved by concurrent implementation of both stringent drug law enforcement measures and effective programmes for the prevention of drug abuse and for the treatment, rehabilitation and social reintegration of drug-addicted persons.

Education↗
PubMed2006

Salt addiction: a different kind of drug addiction.

Under the headline "drug addiction" the medical world has exclusively been interested in psychoactive drugs. For diagnosis of substance dependence (addiction), DSM-IV-TR has determined seven criteria, and fulfilling at least three of them signifies addiction. When studied salt intake according to these criteria it is seen that most of them are fulfilled, showing that sodium chloride, which is not classified under the psychoactive drugs, is capable of producing addiction. Namely: at the beginning of salt abstinence, anorexia and slight nausea during meal time (withdrawal symptoms); about 1000-fold difference of per capita salt consumption between several human societies, and life-long continuation of discretional salt intake behaviour (high dose and very long duration of use); difficulty of restriction of salt intake (unsuccessful efforts to cut down or control); lack of success of salt restriction campaigns in hypertensive patients (substance use despite health problem). Additionally, the decrease of salt preferences of individuals whose salt intake are restricted for some time, and vice versa, signifies tolerance. On the other hand, it is evident that as the main culprit of developing systemic hypertension and as producing or promoting some other important health problems, salt intake causes millions of deaths in the world yearly. The recognition of addicting property of salt will facilitate combating these health problems.

Asthma↗
PubMed2006

Controlled prescription drug abuse at epidemic level.

In July 2005, The National Center on Addiction and Substance Abuse (CASA) at Columbia University announced the results of a study indicating that the number of Americans who abuse controlled prescription drugs has nearly doubled from 7.8 million to 15.1 million from 1992 to 2003 and abuse among teens has more than tripled during that time. A summary of that study and information about the full report are presented.

Adolescent↗
PubMed2005

Stress-induced hypocortisolemia diagnosed as psychiatric disorders responsive to hydrocortisone replacement.

In patients of all ages, many disorders labeled as psychiatric may actually be due to hormonal insufficiencies. For example, cortisol deficiency is rarely taken into account in a medical or psychiatric work-up, so persons with mild to moderate cortisol insufficiency are for the most part relegated to receiving a psychiatric diagnosis when, in fact, the same disorder is represented. However, the symptoms of cortisol insufficiency appear to closely parallel such psychiatric disorders as post traumatic stress disorder (PTSD) and addictions. There has been some question of whether substance abuse causes a hypocortisolemic state. In reviewing the literature and obtaining detailed histories of addicted patients, it appears that childhood trauma, also known as "early life stress" (ELS), instead may elicit a hypocortisolemic state. This leads some to self-medicate with an addictive substance to quell the pain of a cortisol insufficiency, both physical and emotional. In fact, the literature supports the concept that addictive substances increase cortisol in predisposed patients. Patients with a variety of psychiatric disorders including addictions were found to have signs and symptoms of mild or moderate hypocortisolemia. Generally, an appropriate comprehensive examination supported a diagnosis of cortisol insufficiency. For the most part, these patients were successfully treated with physiologic doses of bio-equivalent hydrocortisone, along with replacement of any other deficient hormone. By correcting underlying hormonal insufficiencies, many patients improved, with some patients having a total reversal of psychiatric symptoms. It is therefore reasonable to evaluate and treat hormonal insufficiencies with hormones prior to using psychotropic medication.

Hormone Replacement Therapy↗
PubMed2004

Opioid therapy in patients with a history of substance abuse.

A range of aberrant drug-taking behaviours can occur in patients who are undergoing treatment for chronic pain, especially if opioid therapy is involved. Assessing and understanding these behaviours, and their relationship to addiction (or substance use disorder), can be difficult but it is necessary for assuring quality pain management. Aberrant drug-taking behaviour may be evident, for example, when a patient with pain is unilaterally escalating doses of opioids or using the medications to treat other symptoms or when prescriptions are being mishandled. In patients with a history of substance abuse, these are often serious developments to which a clinician must know how to react. These complex behaviours may be indicative of addiction or may be simply a reaction to under-medicated pain. The clinician therefore is challenged to understand such behaviours and plan interventions accordingly. Although it is becoming increasingly common to avoid opioid therapy in patients demonstrating such challenging behaviours for fear of regulatory scrutiny, clinical management can be tailored to address the many possibilities that might be giving rise to such behaviours. In addition, control over prescriptions can be accomplished without necessarily terminating the prescribing of controlled substances entirely. Optimal medical management of chronic pain in those patients with addiction problems or engaging in problematic behaviours involves careful, ongoing assessment by the clinician as well as a tailored management approach. This approach should use multiple structures including strict contracts, prudent drug selection and frequent follow-ups to pain and addiction treatments, including the use of urine toxicology screening, to maximise the likelihood of a good outcome.

Chronic Disease↗
PubMed1986

[Dependence on gambling].

The indicated symptomatology of pathological gambling makes clear that a reduction of the problematic nature of addiction to substance dependence - alcohol, illegal drugs and medicaments - is not valid. Beside the consumption of substance, gambling as well can produce the desired effect, cause pleasant sensations or avoid aversion and addictive behavior can develop. Biological, psychological and sociological theories of pathological gambling are presented, each of which does not serve as a convincing frame of arguments. On the contrary considerations have to be based on an interaction between individual, gambling and social surrounding field to do justice to complex reality. As a matter of fact the actual state of research leaves many questions unanswered. A completion or alternative to the professional methods of treatment consists in the self-help groups which have been founded by dependent gamblers in many cities during the last few years.

Gambling↗
PubMed1984

MMPI substance abuse scales on drug addicts with and without concurrent alcoholism.

The range and utility of the MMPI-derived MacAndrew Alcoholism Scale (MAC) and the Heroin Addiction Scale (He) was assessed with a large sample of drug addicts with and without concurrent alcoholism. Results indicated that addicts with a co-existing alcohol problem obtained higher MAC scores than addicts without a current alcohol problem. Opiate abusers scored higher on the MAC than non-opiate abusers. No such effects were observed with the He scale. The MAC is a particularly robust scale that taps generic substance abuse and may even be sensitive enough to detect alcoholism in drug addicts.

Adult↗
PubMed2005

Training psychiatrists to diagnose and treat substance abuse disorders.

Addiction training in psychiatric residency programs needs expansion. Epidemiology research has shown that patients with substance use disorders and co-occurring mental health disorders are the norm in nearly all clinical settings. Unfortunately, traditional training approaches built around brief rotations on detoxification or intensive substance abuse rehabilitation units do not adequately train psychiatrists in long-term management skills, and may reinforce misperceptions that these patients do not respond to treatment. An enhanced addiction curriculum coupled with an extended outpatient clinic rotation is an ideal model for teaching the skills needed to successfully care for these patients. Training must include an adequate knowledge base, an opportunity to cultivate positive attitudes toward these patients, and recognition that psychiatrists must take responsibility for treating the addiction problem and any co-occurring psychiatric disorders. The program developed at Boston University Medical Center successfully integrates expanded addiction psychiatry training into the general psychiatry residency.

Curriculum↗
PubMed2000

Mother-bingo bonding: screening for gambling addiction in the neonatal intensive care unit.

As the prevalence of gambling increases in society, problem or pathologic gambling in new mothers may interfere with the bonding process as well as with infant and child care. Although neonatal nurses routinely screen for maternal addictions to substances such as alcohol, cocaine, and heroin, they are less likely to be alerted to signs of gambling addiction in new parents. This article presents a case study of a mother with a bingo preoccupation, provides neonatal nurses with an overview of problem and pathologic gambling, presents brief interview questions and a standardized screening tool for assessing gambling problems in parents, and suggests areas for intervention.

Female↗