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PubMed1996

[Physicians as patients--on the problem of the mentally ill physician].

The phenomenon of mentally ill physicians is hardly noticed in Germany today-a fact that possibly indicates a taboo. This investigation is to reveal the importance of the subject by referring to the findings of several major studies. Epidemiological data turn out to be of little reliability regarding for instance the number of impaired physicians with a range between 0.5-46%. Addiction and substance abuse can be found in 90% of all cases of mental illness. Increased suicide (3-4x), divorce (20x) and addiction rates (according to some authors 30-100x) in comparison with the average population emphasise the necessity of further investigation. These facts imply the question whether doctors are mentally more vulnerable than their patients. Special difficulties in treating doctor-patients deserve attention as only little is known how appropriate "iatrotropic" (psycho-)therapy can be carried out effectively.

Alcoholism↗
PubMed2001

Religiousness and substance use in children of opiate addicts.

PURPOSE: To investigate among children of opiate addicts a potential protective effect of religiousness (broadly defined in the literature to include religious beliefs, practice, and tradition) against onset of substance use. METHODS: Subjects were 161 opiate-addicted biological parents recruited from methadone maintenance programs in the New York metropolitan area, their 279 children, and 63 non-opiate-addicted parents with whom the child had daily contact. Childhood onset of substance use was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS); parental DSM-III-R diagnosis of opiate addiction was assessed using the SADS-Lifetime Version (SADS-L). RESULTS: Religiousness in children of opiate addicts was associated with a substantially decreased likelihood of onset of substance use. Parent-child concordance of religiousness showed additional protective qualities with respect to religious denomination in opiate-addicted parent and with respect to the personal importance of religion and frequent attendance of religious services in non-opiate-addicted parents. CONCLUSION: Religiousness protects against substance use among children of opiate addicts.

Adolescent↗
PubMedDate not supplied

Knowledge and attitudes of registered nurses toward perinatal substance abuse.

OBJECTIVE: To explore the knowledge and attitudes of registered nurses employed in perinatal nursing and to determine the relationships between selected demographic variables and registered nurses' knowledge and attitudes toward perinatal substance abuse. DESIGN: Descriptive, using a convenience sample. SETTING: Perinatal units at 10 hospitals on the west coast of Florida. PARTICIPANTS: 392 registered nurses employed on perinatal units. MAIN OUTCOME MEASURE: Identification of knowledge and attitudes of registered nurses toward perinatal substance abuse, using the 34-item adapted Attitudes About Drug Abuse in Pregnancy (AADAP) questionnaire. RESULTS: Knowledge scores for the sample ranged from 6 to 18 (M = 12.14) out of a possible score of 20. Attitude scores ranged from 16 to 56 (M = 35.81) out of a possible range of 14 to 70. Scores at the lower end of the scale indicate punitive, negative attitudes. Significant relationships were found among several demographic variables and knowledge and attitude scores for the total sample. CONCLUSIONS: Registered nurses demonstrated limited knowledge about substance exposure, addiction, and its effects. They also held attitudes that were more punitive and negative than positive or supportive toward women who abused substances during the perinatal period.

Adult↗
PubMed1991

Clustering of multiple substance use and psychiatric diagnoses in opiate addicts.

Using a standardized psychiatric interview, the prevalence of and interrelationships among various substance use diagnoses and non-substance use psychiatric diagnoses were examined in a population of opiate addicts (n = 66) enrolled in methadone maintenance treatment. Multiple substance use disorders were found in these patients, and more substance use disorders were found in those patients with, versus without, a non-substance use psychiatric diagnosis. Certain substance use disorders were found to cluster. These results suggest that opiate addicts should be evaluated for multiple substance use disorders as well as for non-substance use disorders, and that certain subpopulations may be at increased risk for multiple substance use disorders.

Adult↗
PubMed1996

Reliability and validity of the addiction severity index among homeless substance misusers.

Retrospective self-reports of behavior are widely used in alcohol and drug research. However, assessments of the reliability and validity of such data among certain populations are nonexistent. This study examines the ability of the Addiction Severity Index (ASI), a widely used clinical and research instrument, to provide valid and reliable data within a homeless population of drug misusers. The results support the usefulness of the ASI in producing quality data among homeless substance misusers seeking treatment. Qualitative data gathered from field interviewers are used to highlight strategies for enhancing the quality of ASI data in the future.

Adult↗
PubMed1995

Problems in the application of the Addiction Severity Index (ASI) in rural substance abuse services.

The aim of this research was to test the utility of the Addiction Severity Index (ASI) in a rural community substance abuse outpatient treatment center and to predict future alcohol and drug problems based on ASI information. Substance abuse counselors used the ASI to assess the problems of 89 adult clients at intake, and research staff assessed drug use outcomes 3 months later. There were significant improvements between intake and follow-up on the scores on the alcohol, drug, legal, and family sections of the ASI. Scores on the alcohol abuse, drug abuse, and medical sections of the ASI predicted some of the variance (16%) in drug and alcohol use outcomes, but psychiatric, medical, legal, and employment problems were not significant predictors. There was some difficulty in obtaining adequate reliability in counselors' severity ratings for alcohol problems. The relationship of counselors' severity ratings to the more objective composite scores varied substantially by subsection of the ASI. The improvements in alcohol and drug use indices appeared to be more related to subjective appraisals of problems related to use rather than due to changes in drug-using behavior. Implications of these findings and recommendations for further research using the ASI are discussed.

Adult↗
PubMed1990

The impact of drug abuse and addiction on society.

Over 28 million Americans have admitted to abusing a substance in the last year alone, at a direct purchase price of over 79 billion dollars. Substance abuse and addiction have grave consequences on our existing social systems, effecting crime rates, hospitalizations, child abuse, and child neglect, and are rapidly consuming limited public funds. The intravenous drug abuser represents the fastest growing vector of HIV virus. This report focuses on the social and economic implications of substance abuse and addiction and discusses the merits and limitations of several popular solutions to the problem.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Joy riding: multiple criminal car rides in an intoxicated state in relation to dyssocial personality with addictive tendencies].

Going out from the case report of a young unskilled worker, the author introduces a little known behavioral disorder, named "joy riding". This highly problematic pattern of misbehavior includes the stealing of usually high-powered motorcars in order to take fast and joyful trips without any goal and leaving them anywhere in a more or less damaged state. As our case report shows, this special behavior sometimes develops features of an addiction and thereby similarities to addictive behaviors like pathological gambling, kleptomania, pyromania and others. Rightly, we find in literature several statements denying clearly the nosological independence of all these non-substance-bound addictive behaviors, pointing out the underlying deficiency of impulse control building the common ground to all these addiction-like disorders.

Adult↗
PubMed1991

Strategies for promotion of avoiding harmful substances.

Obviously, avoiding harmful substances and addictions to them and intervening later once the addiction is established are complex tasks. All the aspects of primary, secondary, and tertiary interventions can be used in a given family with addiction, for there may be late-stage, chronic addiction, early addiction that can be interrupted, and youngsters who are prone to addiction. Family patterns accompanying addiction may be intense and well established, more moderate, or in a formative stage. Often addicted persons, no matter what the addiction, may never enter treatment and certainly not often of their own accord. In the select group of faithful AA members, for example, it is said that only 1 of 37 people who ever attend is successful in the program and, of course, many never enter the door. What is our responsibility to the persons who are using harmful substances and their family members? It lies in better case finding, enhanced by a greater awareness of patterns of addiction; in family intervention first, no matter what the stage of addiction or its type; and treatment for the person addicted when that is possible. This is a natural role for nurses, one for which they should take professional and, if need be, personal responsibility. Strengthening families by changing dysfunctional patterns is the ultimate strategy for avoiding the use and abuse for harmful substances.

Alcoholics Anonymous↗
PubMed1999

[Abuse of psychoactive drugs among health professionals].

Health care givers suffer problems of abuse of and addiction to substances at a rate similar to or perhaps higher than that of the general population according to available studies, most of which were done in the United States. Anesthesiologists tend to have the highest incidence of addiction. Among the risk factors identified are self-medication, stress at work and easy access to drugs. After alcohol, opiates and benzodiazepines are the drugs most favored. No data are available for Spain on this problem. One recently opened treatment program exists, implemented by the Department of Health of the autonomous government of Catalonia (Spain) in collaboration with the Official College of Physicians of Barcelona. Although the problem is probably not great in Spain, prevention programs should be put in place to identify and act on known risk factors, by controlling and limiting access to drugs, raising awareness among health-care givers of the risks of self-medication, and improving working conditions. The main obstacle to treating such patients is denial, which makes identification of abusers and their adherence to a program difficult. The therapeutic phases are identification, intervention, treatment, return to work and follow-up. Addicts are chronic patients who require follow-up for many years, given that the risk of relapse is always present.

Anesthesiology↗
PubMed2004

[Relation between characteristics of pregnant adolescents and resistance to drugs use].

This is a qualitative study. We interviewed 20 pregnant adolescents, who agreed to participate in this research about the relation between the characteristics of pregnant adolescents and resistance to drugs use. We observed that they had contact will legal and illegal drugs, as well as their decision to reject them, give up or decrease substance use; we also identified a lack of knowledge about reproductive health and body changes. It is important for this population to be able to count on their partner and child, as a support not using addictive toxic substances.

Adolescent↗
PubMed2000

Family interventions to prevent substance abuse: children and adolescents.

Substance abuse often begins in adolescence and is a major factor determining health outcomes for adolescents and adults; thus, it is an important focus for prevention strategies. The use of drugs, especially alcohol, can lead to chronic addiction to substances as well as contribute to a number of common chronic conditions. These conditions include cancer, cardiovascular disease, disability from accidents or violence, and unplanned pregnancy and are major causes of morbidity and mortality among adolescents and adults. As the major social unit responsible for socialization of children and stabilization of adult personalities, the family has been the target of prevention efforts. In this chapter the empirical literature on family interventions to prevent substance use in adolescents is critically reviewed, generalizations and implications for practice identified, and directions for future research projected.

Adolescent↗
PubMed2000

Race, age, and back pain as factors in completion of residential substance abuse treatment by veterans.

OBJECTIVE: Variables associated with successful completion of residential substance abuse treatment were identified. METHODS: The records of 340 veterans admitted to a 120-day substance abuse treatment program were retrospectively analyzed. The likelihood of successful treatment completion was calculated as a function of race, age, gender, psychiatric diagnosis, past suicide attempts, homelessness, legal history, childhood physical or sexual abuse, parental history of addiction, multiple substance dependence, medical problems, and the race of the therapist. Univariate analysis and logistic regression analysis were used to identify variables that were significant predictors of treatment completion. RESULTS: Overall, 66 percent of veterans completed the program. Eighty-two percent of the veterans admitted to the program were black, and 16 percent were white. The completion rate of black veterans (71 percent) was significantly higher than that of white veterans (49 percent). Veterans completing treatment were significantly more likely to be older, by an average of two years, than those who did not complete treatment. The association between younger age and failure to complete the program was largely accounted for by younger black veterans. Veterans with back pain were significantly less likely to complete treatment than those without back pain. Completion rates did not vary by the other variables examined. In the regression analysis that included age, race, and back pain, each variable, when adjusted by the other variables, was a significant predictor of completion. CONCLUSIONS: White patients were less likely to complete residential substance abuse treatment in a program in which the majority of both therapists and patients were black. Younger black veterans and those with back pain were also less likely to complete treatment.

Adult↗
PubMed1989

Smokeless tobacco use by youth in the U.S.

Oral snuff and chewing tobacco, commonly referred to as smokeless tobacco, are being used by many adolescent and young adult males, and no indication exists that use by this group is declining. Users are at risk for oral cancer, noncancerous oral pathology such as leukoplakias, and addiction. Information about patterns of smokeless tobacco use and motivations of users may help planners develop and implement interventions. Variables include the importance of peer and family influences, social image, knowledge of harmful effects, regional differences, use of other substances, and addiction. Due to the addictive nature of smokeless tobacco, older youth may need cessation programs. Health educators are encouraged to include smokeless tobacco in their tobacco use prevention programs and to develop and implement comprehensive tobacco interventions appropriate for their youth population.

Adolescent↗
PubMed1998

Substance dependence as a compulsive behavior.

A compulsion to take a drug combined with a loss of control in limiting intake is the defining feature of substance dependence or addiction, and is the conceptual framework for the criteria of substance dependence or addiction outlined by the World Health Organization and the American Psychiatric Association. However, defining exactly what constitutes loss of control and compulsive drug taking at the level of animal models is a daunting task, and it is clear that no validated animal model exists for the whole syndrome of addiction. The present discussion redefines loss of control as a narrowing of the behavioral repertoire toward drug-seeking behavior and suggests that there are many sources of reinforcement that contribute to this behavioral focus on drug seeking. Evidence is presented demonstrating separate animal models for many of these sources of reinforcement as well as for most of the criteria for substance dependence. Evidence is also presented showing that the brain neurochemical systems involved in processing drug reward are altered by chronic drug exposure to contribute additional sources of reinforcement. Challenges for the future involve not only elucidation of the neurobiological substrates of the different behavioral components of addiction, but better animal models of these components with which to effect such studies.

Animals↗
PubMed1995

HIV-1 prevalence and risk factors among sexually transmitted disease clinic attenders in Trinidad.

OBJECTIVES: To study trends in prevalence and to ascertain risk factors for HIV-1 among sexually transmitted disease (STD) clinic attenders in Trinidad. DESIGN AND METHODS: Serial cross-sectional studies were conducted in 1987-1988 and 1990-1991 at a centralized STD clinic in Port of Spain. A case-control study was carried out to examine in greater detail the demographic and behavioral risk factors for HIV-1 among self-declared heterosexuals in this population. RESULTS: HIV-1 prevalence increased from 3.0% [95% confidence interval (CI), 2.3-3.9] in 1987-1988 to 13.6% (95% CI, 11.8-15.6) in 1990-1991. Age > or = 40 years [odds ratio (OR), 2.0; 95% CI, 1.4-2.8], urban residence (OR, 2.2; 95% CI, 1.6-3.0), and human T-lymphotropic virus-I seropositivity (OR, 3.1; 95% CI, 1.6-6.0) were significant risk factors for HIV-1 in 1990-1991. In the case-control analysis, significant independent risk factors for men included current genital ulcer disease (OR, 5.2; 95% CI, 2.2-12.5), current genital warts (OR, 3.9; 95% CI, 1.2-12.0), having ever had syphilis (OR, 3.2; 95% CI 1.6-6.1), and use of crack cocaine in the preceding 6 months (OR, 6.2; 95% CI, 2.7-14.2). Corresponding risk factors for women were commercial sex work (OR, 5.7; 95% CI, 1.3-25.7), initiation of sexual activity before age 14 years (OR, 4.8; 95% CI, 1.5-16.0), and past non-gonococcal cervicitis (OR, 4.1; 95% CI, 1.3-13.1). CONCLUSIONS: HIV-1 in this setting is primarily heterosexually transmitted in a milieu of unprotected sexual activity fuelled by a crack cocaine epidemic. Targeted interventions to prevent, detect and treat STD and crack cocaine addiction, as well as disrupt their adverse synergism, may substantially reduce HIV-1 transmission in this population.

Adult↗
PubMed2006

Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse.

This study assessed the knowledge, attitudes, and professional practices of pharmacists regarding addiction and patient use of controlled medications. This research project explored the relationship between pharmacy education, perceived and actual knowledge, and professional interactions as it pertains to problems surrounding dependency and addiction. A questionnaire of 25 items was administered at three separate continuing education programs in Florida in 2005. A total of 484 surveys were completed. Pharmacists (67.5%) reported participating in two hours or less of addiction/substance abuse education in pharmacy school. Of particular concern was that 29.2% reported having received no addiction education. Pharmacists who had greater amounts of addiction-specific education had a higher likelihood of correctly answering questions relating to the science of addiction and substance abuse counseling. In addition, pharmacists who reported more education counseled patients more frequently and felt more confident about counseling. A majority of respondents (53.7%) reported that they had never referred a patient to drug treatment in their career. These findings suggest that the neurobiological basis for addictive diseases, standards of care, and pain management guidelines were not widely understood by the sample. More research should be undertaken to determine the educational needs of practicing pharmacists to enable them to assume a leadership role in detecting, preventing, and treating prescription drug abuse.

Adult↗
PubMed2006

Further investigation of psychological and environmental correlates of substance use in adolescence in six European countries.

AIM: To study the multifactorial correlates of adolescents' use of legal and illegal substances in six European countries and to assess whether a common pattern of factors exists irrespective of the countries' different sociocultural backgrounds. DESIGN: Cross-sectional European school population survey (ESPAD) following standardized methodology. PARTICIPANTS: National probability samples of 16-year-old high school students from Bulgaria, Croatia, Greece, Romania, Slovenia and the UK. Total sample 16,445. MEASUREMENTS: Anonymous questionnaire self-administered in the classroom. Self-reported use of tobacco, alcohol, marijuana and other illegal drugs. Correlates examined: environmental, such as peer culture and family-related; behavior-related such as antisocial behavior, truancy and anomie; and psychological factors such as self-esteem and depressive mood. FINDINGS: Separate logistic regressions for the two genders produced a set of psychosocial correlates common to the use of all legal and illegal substances. The strongest were peer and older sibling models of use, and peer-oriented lifestyle, followed by patterns of antisocial behavior and truancy. Family-related variables such as not living with both parents, parental monitoring and relationships with parents were less significant. Self-esteem and depressive mood were not significant. Girls' use of substances, especially illegal ones, showed stronger associations than boys' with a deviant behavior pattern. Few interactions between country and other correlates were significant. CONCLUSIONS: Common correlates can be identified across countries. Older siblings' and peers' substance have a strong impact on adolescents' use. Preventive interventions should include all substances with addictive potential.

Adolescent↗