How AIDS affects women and children.
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Acquired Immunodeficiency Syndrome↗
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Prevalence of the improper use of alcohol, tobacco, and drugs in the Ecuadorian population.
An epidemiologic investigation was conducted in 1988 to measure prevalences of the improper use of alcohol, tobacco, and drugs in the Ecuadorian population. This research was based on a structured interview survey of 6,000 individuals representative of the country's entire population between the ages of 10 and 65. The relative frequency of the various common forms of consumption of these substances was also investigated. Overall, the substances used by the highest percentages of study subjects at least once in their lives were alcohol (by 75%) and tobacco (by 54%). Lesser percentages had used medically prescribed psychotropic drugs (for example, 16% reported using tranquilizers at least once). The percentages using the same drugs illegally, without prescription, were lower (for example, 4% in the case of tranquilizers), and the percentages reporting use of outlawed drugs were also small (the respective percentages reporting use of marijuana, inhalants, native plant drugs, cocaine, and cocaine base were 4%, 2%, 1%, 1%, and 1%). The study also found that the prevalences of addiction to substances other than alcohol and tobacco were relatively low, ranging from 0.8% for tranquilizers taken without prescription to 0.01% for cocaine.
Adolescent↗
The outcome and cost of alcohol and drug treatment in an HMO: day hospital versus traditional outpatient regimens.
OBJECTIVE: To compare outcome and cost-effectiveness of the two primary addiction treatment options, day hospitals (DH) and traditional outpatient programs (OP) in a managed care organization, in a population large enough to examine patient subgroups. DATA SOURCES: Interviews with new admissions to a large HMO's chemical dependency program in Sacramento, California between April 1994 and April 1996, with follow-up interviews eight months later. Computerized utilization and cost data were collected from 1993 to 1997. STUDY DESIGN: Design was a randomized control trial of adult patients entering the HMO's alcohol and drug treatment program (N = 668). To examine the generalizability of findings as well as self-selection factors, we also studied patients presenting during the same period who were unable or unwilling to be randomized (N = 405). Baseline interviews characterized type of substance use, addiction severity, psychiatric status, and motivation. Follow-up interviews were conducted at eight months following intake. Breathanalysis and urinalysis were conducted. Program costs were calculated. DATA COLLECTION: Interview data were merged with computerized utilization and cost data. PRINCIPAL FINDINGS: Among randomized subjects, both study arms showed significant improvement in all drug and alcohol measures. There were no differences overall in outcomes between DH and OP, but DH subjects with midlevel psychiatric severity had significantly better outcomes, particularly in regard to alcohol abstinence (OR = 2.4; 95% CI = 1.2, 4.9). The average treatment costs were $1,640 and $895 for DH and OP programs, respectively. In the midlevel psychiatric severity group, the cost of obtaining an additional person abstinent from alcohol in the DH cohort was approximately $5,464. Among the 405 self-selected subjects, DH was related to abstinence (OR = 2.1; 95% CI = 1.3, 3.5). CONCLUSIONS: Although significant benefits of the DH program were not found in the randomized study, DH treatment was associated with better outcomes in the self-selected group. However, for subjects with mid-level psychiatric severity in both the randomized and self-selected samples, the DH program produced higher rates of abstention and was more cost-effective. Self-selection in studies that randomize patients to services requiring very different levels of commitment may be important in interpreting findings for clinical practice.
Adult↗
Treatment outcome of cocaine-alcohol dependent patients.
Cocaine dependent patients (n = 27) with and without concurrent alcohol dependence disorder were compared on measures of substance use, addiction severity (ASI), coping, and psychopathology taken before, during, and after outpatient relapse prevention treatment for cocaine dependence. At pre-treatment, the cocaine-alcohol (CA) group reported more frequent alcohol use, and more severe alcohol and family/social problems compared to the cocaine-only (CO) group. By the end of treatment, both groups reported significantly fewer days of alcohol and cocaine use, with sustained reductions observed at 24 weeks following treatment. On most of the addiction severity and psychiatric symptomatology scales, results indicated overall improvement as a function of time, however scores remained relatively 'worse' in the CA group. Implication of these findings and the need for specific programming in the treatment of dual drug use are explored.
Adaptation, Psychological↗
[List of abuse substances most requested by drug addicts, particularly in reference to the Alexandria province. Notes for the general practitioner].
The drugs in Italy most requested by addicts, who use them in their constant search for perceptive distortion are listed. The list refers principally to the figures collected in the province of Alessandria. The list is aimed at the general practitioner who usually receives the highest number of requests for prescriptions for such drugs. It is recommended how to behave so as to avoid errors punishable by law.
Drug Overdose↗
Racism and perinatal addiction.
Recent publicity and policy have targeted drug use by non-white women, particularly during pregnancy and parenthood. This emphasis on women of color is discordant with the population demographics of substance use and addiction, although morbidity and mortality related to drugs is often greater among nonwhites. Women with addictive disorders that are exacerbated by their social environments are blamed for their behavior. Meanwhile, drug treatment and primary health care services for these women are woefully inadequate. Among newborns testing positive for cocaine, those with black mothers are more likely to be discharged to non-maternal care, which may perpetuate family disruption. There are multiple reasons for true and perceived ethnic differences in substance use, addiction, and related social and medical harm. Such harm may be worsened by the racism inherent in U.S. drug policy. The scapegoating of non-white drug-using women and the paucity of treatment for them may be related to political and economic imperatives of society in maintaining and pacifying exploited groups.
Black or African American↗
Is social attachment an addictive disorder?
There is a considerable literature on the neurobiology of reward, based largely on studies of addiction or substance abuse. This review considers the possibility that the neural circuits that mediate reward evolved for ethologically relevant cues, such as social attachment. Specifically, mesocorticolimbic dopamine appears important for maternal behavior in rats and pair bonding in monogamous voles. It is not yet clear that dopamine in this pathway mediates the hedonic properties of social bond formation or whether dopamine's role is more relevant to developing associative networks or assigning salience to social stimuli. The neuropeptides oxytocin (OT) and vasopressin (AVP) appear to be critical for linking social signals to the mesocorticolimbic circuit.
Animals↗
[Prevention of AIDS transmission by syringes and needles in France and Africa].
A study made among drug addicts in the Northern suburbs of Paris enables establishing a stabilisation of positive H.I.V. serology prevalence among them, a fact related to the free sale of syringes and needles. In Africa, the nosocomial transmission of H.I.V. by non-sterilisable but reused needles and syringes is demonstrated, and two cases are described. Its importance is certain but must be precise. The prevention of this epidemiological modality must be done by systematic use of reusable and sterilisable injectable material.
Acquired Immunodeficiency Syndrome↗
Caffeine intake, tolerance, and withdrawal in women: a population-based twin study.
OBJECTIVE: Caffeine is by far the most commonly consumed psychoactive substance. The use and abuse of most other licit and illicit psychoactive drugs have been shown to be substantially heritable. However, the impact of genetic factors on caffeine consumption, heavy use, intoxication, tolerance, and withdrawal is largely unknown. METHOD: Caffeine consumption, in the form of brewed coffee, instant coffee, tea, and caffeinated soft drinks, as well as caffeine intoxication, tolerance, and withdrawal, were assessed by personal interviews of 1,934 individual twins from female-female pairs ascertained from the population-based Virginia Twin Registry. The sample included both members of 486 monozygotic and 335 dizygotic pairs. Twin resemblance was assessed by probandwise concordance, odds ratios, and tetrachoric correlations. Biometrical model fitting was also performed. RESULTS: The resemblance in twin pairs for total caffeine consumption, heavy caffeine use, caffeine intoxication, caffeine tolerance, and caffeine withdrawal was substantially greater in monozygotic than in dizygotic twin pairs. Model fitting suggested that twin resemblance for these measures could be ascribed solely to genetic factors, with estimated broad heritabilities of between 35% and 77%. CONCLUSIONS: Caffeine is an addictive psychoactive substance. Similar to previous findings with other licit and illicit psychoactive drugs, individual differences in caffeine use, intoxication, tolerance, and withdrawal are substantially influenced by genetic factors.
Adult↗
Demographic characteristics, life context, and patterns of substance use among alcohol-dependent treatment clients in a health maintenance organization.
BACKGROUND: Although individuals dependent only on alcohol and those dependent on both alcohol and drugs typically are not studied together in clinical trials, they are treated together in most treatment programs. In this study we compared epidemiological characteristics of the alcohol-only and alcohol-and-drug dependents in a treatment sample to assess differential treatment needs. METHOD: Patients admitted to treatment at a health maintenance organization's chemical dependency program were sampled and interviewed by using a structured questionnaire. The sample included 491 alcohol-only and 217 alcohol-and-drug dependents. Demographic characteristics, lifetime and current substance use, Addiction Severity Index composite scores, and DSM-IV criteria for alcohol and drug dependence were assessed at admission. RESULTS: The odds of alcohol-and-drug dependence were higher among males, African Americans (when compared with whites), those who were younger, and those with less than college education. The risk was also higher among those who initiated heavy drinking or drug use before the age of 18. Increased psychiatric and family/social problems also were associated with combined dependence. CONCLUSIONS: Even in this relatively homogeneous socioeconomic status population, demographic characteristics were important predictors of type of dependence. Treatment programs which provide services that address prevention and psychosocial problems should pay attention to age of initiation as well as psychiatric and social problems.
Adolescent↗
HIV infection and STD in drug addicted prostitutes in Amsterdam: potential for heterosexual HIV transmission.
To assess the potential role of drug using prostitutes in the heterosexual transmission of human immunodeficiency virus (HIV), 117 prostitutes, recruited from December 1985 to November 1987 at a weekly evening sexually transmitted diseases (STD) clinic for drug using prostitutes only, were studied for the prevalence of HIV and STD. Intravenous drug use was reported by 96 (82%) of the women. Antibody to HIV was found in 35/117 (30%) women, all but one of whom had been using drugs intravenously. Most (73, 62%) of the prostitutes reported having had more than 2000 clients each in the preceding five years. In the six months preceding enrollment to the study they had practised mainly vaginal (106/117) and orogenital (82/117) intercourse; 90% (105/117) reported frequent use of condoms in vaginal intercourse and 65% (68/105) in orogenital intercourse. Despite frequent condom use, 81% (84/104) contracted one or more STD in this period. Considering the high incidence of HIV and STD and the finding by others that the presence of STD may facilitate transmission of HIV, we conclude that the potential for HIV transmission from these prostitutes to their clients (and vice versa) was clearly present.
Acquired Immunodeficiency Syndrome↗
The application of mindfulness-based cognitive interventions in the treatment of co-occurring addictive and mood disorders.
This article reviews the theory, clinical application, and empirical findings on mindfulness-based cognitive therapy (MBCT) for mental health and addictive disorders. Expanding upon the research demonstrating the efficacy of cognitive-behavioral therapy (CBT) for addiction, this article develops and explores the rationale for combining mindfulness-based interventions with evidence-based CBTs in treating addictive disorders, with an emphasis on substance use disorders with co-occurring mood disorders. This article proposes that deficits in affect--regulation related to the behavioral and emotional effects of neurobiological changes that occur with long-term substance abuse--pose a unique set of challenges in early recovery. Prolonged use of addictive substances impairs the brain pathways that mediate certain affect regulation functions. These functions involve attention and inhibitory control, the saliency of and response to addictive versus natural reward stimuli, and the ability to detach or maintain perspective in response to strong emotional states. In treating this affective dysregulation, which can contribute to the vulnerability to relapse in the early stages of recovery, the affect-regulation-specific focus of MBCT adds a valuable element to augment CBT for addiction. Summarizing magnetic resonance imaging and positron emission tomography findings on the effects of MBCT and the neurobiology of drug addiction, this article outlines directions for further research on potential benefits of MBCT for the recovering individual. Finally, this article describes a structured protocol, developed at the Mount Sinai School of Medicine in New York City, which combines CBT with mindfulness-based intervention, for the treatment of affect-regulation issues specific to co-occurring addictive and mood disorders.
Affect↗
Transmission of human immunodeficiency virus to sexual partners of hemophiliacs.
To examine the variables associated with heterosexual transmission of human immunodeficiency virus (HIV), we studied 32 couples in our hemophilia center who had steady sexual relationships for periods more than 1 year. Of the 32 sexual partners of the hemophiliacs, five (15.6%) were HIV seropositive. All five hemophiliacs with HIV transmission to their sexual partners had measurable immunologic deficiencies, as shown by their lower median T-helper (CD-4+) lymphocyte count of 172 cells/mm3. The hemophiliacs without transmission had a slightly higher median CD-4+ count of 297 cells/mm3 (P = .26). To determine if factors other than the degree of immunologic deficiency in the hemophiliac might contribute to HIV transmission, 18 of the 32 couples were studied more intensively by confidential, coded questionnaires. Regular condom use was reported by nine couples (50%). Two of nine women (22%) without condom usage acquired HIV. One of nine women (11%) using condoms was seropositive; she also reported eight needlestick injuries while assisting her spouse with clotting factor treatments. Intravenous drug abuse was reported in two of the five couples with HIV transmission. Thus, hemophiliacs are at risk for transmitting HIV parenterally as well as venereally. Despite various risk behaviours associated with HIV transmission, the prevalence of infection in our cohort of hemophiliacs' sexual partners is low and within the range (6.8-22%) reported by others. This study underscores the need for comprehensive education and counseling in what previously appeared to be a homogeneous clinic population at risk for transmitting HIV to others.
Acquired Immunodeficiency Syndrome↗
Seroepidemiology of hepatitis B virus, hepatitis D virus, and human immunodeficiency virus infections among parenteral drug abusers in southern Taiwan.
A total of 390 parenteral drug abusers (PDAs) at the Kaohsiung Municipal Narcotics Abstention Institute were examined for markers of hepatitis B virus (HBV), hepatitis D virus (HDV), and human immunodeficiency virus (HIV). All sera were tested for hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs), and core antibody (anti-HBc) by radioimmunoassay (RIA) and for antibody to HIV (anti-HIV) by enzyme-linked immunosorbent assay (ELISA). Hepatitis B e antigen (HBeAg) and antibody to HDV (anti-HDV) were also tested for HBsAg-positive serum samples. Although the HBsAg-positive rate (22.1%) among PDAs was similar to that of the general population in southern Taiwan, the HBV infection rate (99.2%) and the anti-HDV-positive rate (78.5%) among HBsAg-positive subjects were significantly higher than those of the general population in southern Taiwan (P less than 0.0001). None of the PDAs studied were positive for anti-HIV. The levels of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) among PDAs were significantly higher than those of the general population in southern Taiwan (P less than 0.0001). The more frequent the institutionalisation, the higher the infection rates with HBV and HDV and elevated levels of SGOT and SGPT. Horizontal transmission through parenteral drug abuse may be considered a possible reason for the significantly higher rates of HBV and HDV among parenteral drug abusers.
Acquired Immunodeficiency Syndrome↗
Transmission of human immunodeficiency virus (HIV/HTLV-III/LAV): a review.
The literature on the transmission of human immunodeficiency virus (HIV/HTLV-III/LAV) is reviewed. HIV spreads by vertical transmission and by iatrogenic transmission (transfer of blood or blood-containing products), by infected needles among i.v. drug users and, more rarely, among health care workers, but mainly by sexual contact. In Western countries the virus is mainly spread by passive anal intercourse among homosexuals and seldom by heterosexual intercourse. In African countries, however, the virus is mainly spread by heterosexual intercourse, probably because of other, concurring sexually transmitted diseases. Some preventive measures are discussed.
Acquired Immunodeficiency Syndrome↗
[Excessive computer usage in adolescents--results of a psychometric evaluation].
Excessive computer and video game playing among children is being critically discussed from a pedagogic and public health point of view. To date, no reliable data for this phenomenon in Germany exists. In the present study, the excessive usage of computer and video games is seen as a rewarding behavior which can, due to learning mechanisms, become a prominent and inadequate strategy for children to cope with negative emotions like frustration, uneasiness and fears. In the survey, 323 children ranging in age from 11 to 14 years were asked about their video game playing behavior. Criteria for excessive computer and video game playing were developed in accordance with the criteria for dependency and pathological gambling (DSM-IV, ICD-10). Data show that 9.3% (N = 30) of the children fulfill all criteria for excessive computer and video game playing. Furthermore, these children differ from their class mates with respect to watching television, communication patterns, the ability to concentrate in school lectures and the preferred strategies coping with negative emotions. In accordance with findings in studies about substance-related addiction, data suggest that excessive computer and video game players use their excessive rewarding behavior specifically as an inadequate stress coping strategy.
Adolescent↗
Thailand: AIDS crisis looms.
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Acquired Immunodeficiency Syndrome↗
Problems and help seeking in high-risk adolescent patients of health clinics.
In this study, 2787 adolescents between the ages of 13 and 18 years living in inner-city communities were interviewed about their mental and physical health and their clinic use. The patients used consolidated mental and physical health clinics located in neighborhoods, hospitals, or schools; or traditional neighborhood or hospital health clinics. Analyses of selected patient problems reveal that less than one third of adolescent patients with suicide ideation, conduct disorder, and substance abuse or dependency sought or received care for those problems. Only half of the adolescents with major depression sought or received care for depression, and only two thirds of the sexually active females sought or received help with birth control. A special effort needs to be made to attract troubled youth to clinics and to identify and treat their problems, particularly when those problems involve mental health concerns.
Adolescent↗