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PubMed1995

Impact of legislative measures on the sales of analgesics and the subsequent prevalence of analgesic nephropathy: a comparative study in France, Sweden and Belgium.

In a number of European countries (e.g. Belgium), analgesic nephropathy continues to be a highly prevalent renal disease, whereas in other countries (e.g. Sweden) the problem has been resolved after legislative measures were taken. In still other countries, e.g. France, the official prevalence of analgesic nephropathy has always been low. The aim of the present study is to detect whether specific legislation in particular countries has played a role in the prevalence of analgesic nephropathy. Hence, we compared analgesic legislation in Belgium, France and Sweden, and then compared it with the respective sales data of non-narcotic analgesics and with the prevalence data of analgesic nephropathy in the dialysis population. Each investigated country represents a different evolution pattern in the prevalence of analgesic nephropathy. This study indicates that legislation restricting the over-the-counter availability of the majority of analgesic components and resulting in the absence of analgesic mixtures--containing two analgesic substances and one potentially addictive substance--on the market, has effectively resulted in a substantially lower prevalence of analgesic nephropathy. Moreover, it shows that permissive legislation could be associated with very different sales data, depending on the marketing strategy of the pharmaceutical industry and the subsequent purchasing behaviour of the population. These findings indicate that, in order to eradicate analgesic nephropathy, there is a need to elaborate legislation that prohibits the availability of analgesic mixtures containing two analgesic components and at least one potentially addictive substance.

Analgesics↗
PubMed2001

Do you know if your patients, co-workers, friends, family, or you have an addiction?

Substance abuse (chemical dependence) is often a silent, but pervasive problem in today's society. Chemically dependent people come from all components of society, regardless of financial status, ethnicity, or age. They are masters at disguising their addictions. A variety of chemicals, including over-the-counter, prescription, and street drugs are used and abused. Dopamine, a neurotransmitter in the brain, appears to be the major determinant in whether or not a person progresses from casual substance use to substance abuse. This course will discuss commonly abused types of substances, signs of substance use (psychological, physiological, oral manifestations), and the role of dopamine in the addiction process. An outline of successful interventions and preventive strategies will be included. Because health care professionals should be aware of the many aspects of substance abuse, this course is designed to increase understanding of the clinical and social aspects of the problem. It will provide information to help a patient, co-worker, or family member manage this debilitating and complicated problem.

Dopamine↗
PubMed1994

Psychiatric comorbidity in white and African-American cocaine addicts seeking substance abuse treatment.

OBJECTIVE: Few diagnostic studies have reported rates of psychiatric comorbidity among cocaine addicts according to race. This study examines psychiatric comorbidity in African-American and white cocaine addicts. METHODS: Rates of psychiatric comorbidity were assessed in 263 cocaine addicts seeking substance abuse treatment. The sample included 163 non-Hispanic whites and 100 African Americans. Diagnoses were based on patient interviews using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L). The SADS-L was supplemented to include DSM-III-R criteria for substance abuse or dependence and other psychiatric diagnoses and DSM-III criteria for attention deficit disorder. RESULTS: Overall, 55.7 percent of the cocaine addicts met Research Diagnostic Criteria for a current psychiatric diagnosis, and 73.5 percent met criteria for a lifetime psychiatric diagnosis. Whites and African Americans did not differ significantly in overall psychiatric comorbidity. However, whites had significantly higher rates of life-time major depression, alcohol dependence, attention deficit disorder, and conduct disorder. African-American addicts, particularly women, were more likely to meet criteria for a current diagnosis of phobia. CONCLUSIONS: Psychiatric comorbidity is common among cocaine addicts, and the rates for specific disorders vary by race. Differences in current and lifetime rates should be noted. Cocaine addicts seeking treatment should be assessed for comorbid alcohol dependence and other psychiatric disorders, including anxiety, affective, and personality disorders.

Adult↗
PubMed1980

Uncovering drug abuse by alcoholics and alcohol abuse by addicts.

Substance abuse histories from 1,544 men and women receiving treatment at 10 federally funded centers indicated that 80% had abused, either sequentially and/or concurrently, two or more substances at some time during their lives. The equivalent figure for the last 3 months before being interviewed was 56%. These data indicated a preponderance of multiple substance abuse, especially of alcohol and various other drugs, over single substance abuse (SSA). SSA nearly always involved alcohol and was reported mostly by those 40 years or older. Lines of inquiry for diagnosing alcohol abuse by addicts and drug abuse by alcoholics are provided.

Adult↗
PubMed1994

A sibling study of sensation seeking and opiate addiction.

Substance abuse and its correlative personality traits may have familial associations. We assessed the relationship between sensation seeking and drug use in 201 opiate addicts and 133 of their siblings in a cross-sectional family study. Probands and their drug-abusing siblings showed greater sensation seeking than their non-drug-abusing siblings and this diagnosis accounted for the most variance in regression models. Degree of sensation seeking correlated among drug-abusing siblings and with age of first drug use. The results are discussed in terms of substance abuse typologies and for using sensation-seeking assessments for prevention and treatment of substance abuse.

Adolescent↗
PubMed1989

The ethics of statutory coercion in the treatment of chemical substance abuse/dependence (addiction).

Many countries, including the Republic of South Africa, have introduced legislation providing for statutory treatment in cases of chemical substance dependence (addiction). Many more countries, including Canada and the United States of America, have made various attempts at the introduction of similar legislation in the face of an escalating drug abuse problem, only to have such legislation successfully challenged by various civil rights groups protesting about the "infringement of individual rights." This paper will examine some of the practical implications of coercive treatment of chemical addiction against the background of the principles of the rights of the individual. It will examine the feasibility of legal protection for such individual rights with simultaneous insistence on constructive treatment intervention. It will also raise many topics for discussion in terms of the role of the "helping professions", the well-worn tenet of "Am I my brother's keeper?" and the sociological poser of "the benefit of the community."

Behavior Control↗
PubMed2004

Molecular genetic underpinnings of human substance abuse vulnerability: likely contributions to understanding addiction as a mnemonic process.

Classical genetic studies document strong complex genetic contributions to abuse of multiple addictive substances. These genetic influences are more prominent in the later phases of individuals' progressions toward substance dependence. Individual differences in human addiction vulnerability could thus derive, in part, from individual differences in mnemonic systems. These variations could add to allelic variations that could produce effects on addiction vulnerability phenotypes by other routes that could include (1) differences in drug metabolism or biodistribution, (2) differences in drug's rewarding properties, (3) differences in traits manifest by the addict, including personality differences and (4) differences in the addict's psychiatric comorbidities. Data from linkage and association genome scans now identify chromosomal regions that are likely to contain allelic gene variants that contribute to human addiction vulnerability. Converging positive results are found in several different substance-abusing populations studied in several laboratories. This convergence supports the idea that common allelic variants contribute to individual differences in vulnerability to substance dependence. Genomic markers that identify allelic variants that reproducibly alter addiction vulnerability in several populations provide tools for research in addictions, tools to improve addiction treatments, tools to improve addiction prevention, clues to the genetic bases of individual differences in mnemonic processes and clues to the genetic bases of individual differences in the other traits and disorders that co-occur with substance dependencies.

Alleles↗
PubMed2006

The addiction-stroop test: Theoretical considerations and procedural recommendations.

Decisions about using addictive substances are influenced by distractions by addiction-related stimuli, of which the user might be unaware. The addiction-Stroop task is a paradigm used to assess this distraction. The empirical evidence for the addiction-Stroop effect is critically reviewed, and meta-analyses of alcohol-related and smoking-related studies are presented. Studies finding the strongest effects were those in which participants had strong current concerns about an addictive substance or such concerns were highlighted through experimental manipulations, especially those depriving participants of the substance. Theories to account for addiction-related attentional bias are discussed, of which the motivational theory of current concerns appears to provide the most complete account of the phenomenon. Recommendations are made for maximizing the precision of the addiction-Stroop test in future research.

Affect↗
PubMedDate not supplied

A strategy for the biological assessment of addiction.

Substances and drugs with powerful psychotropic effects have come into common use during the past decade. Involvement with these substances can range from benign to tragic experiences. Such use may include: experimental, social or recreational use, long-term habituation, toxic reactions, medical-psychologic complications, overdose, and death. Although clinicians tend to analyze and explain many patterns of drug use in terms of various psychodynamic, sociologic and behavioral theories, all of these perspectives begin with the biological and pharmacological effects produced by the various drugs. During the assessment process, the clinician can avoid much confusion by learning to differentiate between the direct pharmacological effects and the diverse psychological and behavioral effects of the drug(s) or substances(s) in question. In order to make these distinctions, a foundation in the "biological basics" is essential. This paper presents a strategy for learning the direct tropic effects produced by various drugs. This approach organizes commonly used drugs into six basic categories reflecting the primary action of each: narcotics and related analgesics; sedative-hypnotics (including barbiturates, non-barbiturate sedatives, minor tranquilizers and alcohol); stimulants (including amphetamines, cocaine, and others); hallucinogens; and others like phencyclidine, cannabis and inhalants, which do not readily fit the other categories.

Amphetamines↗
PubMed2006

Serotonin dysfunction in pathological gamblers: increased prolactin response to oral m-CPP versus placebo.

OBJECTIVE: Acute administration of the partial serotonin (5-HT) agonist meta-chlorophenylpiperazine (m-CPP), that is used also as a street drug, has been reported to induce a "high" and craving response in various impulsive and substance addiction disorders. INTRODUCTION: To clarify altered 5-HT metabolism in pathological gamblers and to explore the specific role of serotonergic system in non-substance addictions, we assessed behavioral ("high" and "craving") and neuroendocrine (prolactin and cortisol) responses to an oral single dose of m-CPP and placebo in pathological gamblers and matched controls. Moreover, the relationship between neuroendocrine outcome and clinical severity has been assessed. METHOD: Twenty-six pathological gamblers and 26 healthy control subjects enter a double-blind, placebo-controlled-crossed administration of orally dose m-CPP 0.5 mg/kg. Outcome measures included prolactin and cortisol levels, gambling severity, mood, craving and "high" scales. RESULTS: Pathological gamblers had significantly increased prolactin response compared to controls at 180 minutes and at 210 minutes post-administration. Greater pathological gamblers severity correlated with increased neuroendocrine responsiveness to m-CCP, suggesting greater 5-HT dysregulation. Pathological gambling patients had a significantly increased "high" sensation after m-CPP administration compared with control. CONCLUSION: These results provide additional evidence for 5-HT disturbance in pathological gamblers and they support the hypotheses that the role of the 5-HT dysfunction related to the experience of "high" might represent the pathway that leads to dyscontrolled behavior in pathological gamblers. Furthermore, the "high" feeling induced by m-CPP in pathological subjects may represent a marker of vulnerability to both behavioral and substance addictions.

Adult↗
PubMed2002

Use of alcohol, illicit drugs, and tobacco among characters on prime-time television.

Previous research of addictive substances suggests that use of alcohol, illicit drugs, and tobacco is overrepresented on prime-time television (TV). These studies, however, have relied on frequency counts of the substance, rather than the prevalence of use among characters. Therefore, the objectives of this study were to compare the prevalence of alcohol, illicit drug, and tobacco users among characters on prime-time TV during 1995 and 1996 with rates of use in the United States. In addition, we determined if the ratio of male to female, young to old, and white to minority addictive substance users on prime-time TV were similar to the equivalent U.S. ratios. Comparing results for prime-time TV characters versus the U.S. population (respectively), 11.0% (99% CI, 9.8-12.1) drank alcohol versus 51.0%; 0.8% (99% CI, 0.5-1.1) used illicit drugs versus 6.1%; and 2.5% (99% CI, 2.0-3.1) smoked tobacco versus 28.9%. In addition, no consistent pattern was evident in our analyses that assessed whether addictive substance users on prime-time TV were more frequently represented as men, young, or minority compared to the similar U.S. ratio. These results indicate that contrary to prevailing beliefs, alcohol, illicit drug, and tobacco users are uncommon on prime-time TV and are less prevalent than in the U.S. population.

Adolescent↗
PubMedDate not supplied

Animal models of periadolescent substance abuse.

Use of addictive substances by human juveniles and adolescents is common, including use to intoxication and progression from one drug to other drugs. Until quite recently, animal studies have not addressed the periadolescent period as a time of special vulnerability to substance abuse. For ethanol (EtOH), the most studied drug in periadolescent animals, it has become clear that effects of alcohol are similar in some ways, but different in others, compared to the effects seen in adult animals. Sparse data suggest that this conclusion may apply to other drugs as well. Recent work in rats indicates that periadolescent substance use may disrupt normal pubertal development, and may induce stronger effects on systems subserving plasticity and cognition than in adults. Animal data also indicate that some drugs may produce altered subsequent sensitivity to the same or a different drug, changes in adult cognitive capabilities, and even CNS damage. It is now clear that there can be no presumption that all studies of abusable substances carried out in adult animals will generalize readily to periadolescents. Some data suggest that continuing developmental changes in receptor expression may underlie age-related changes in drug effects. However, the biological characteristics of periadolescence which predispose toward consumption to intoxication, and the mechanisms underlying drug progression and persisting drug effects, still remain to be well defined.

Adolescent↗
PubMed2006

The neurobiology of substance and behavioral addictions.

Behavioral addictions, such as pathological gambling, kleptomania, pyromania, compulsive buying, and compulsive sexual behavior, represent significant public health concerns and are associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of these behaviors is still in the early stages, recent advances in the understanding of motivation, reward, and addiction have provided insight into the possible pathophysiology of these disorders. Biochemical, functional neuroimaging, genetic studies, and treatment research have suggested a strong neurobiological link between behavioral addictions and substance use disorders. Given the substantial co-occurrence of these groups of disorders, improved understanding of their relationship has important implications not only for further understanding the neurobiology of both categories of disorders but also for improving prevention and treatment strategies.

Arousal↗
PubMed2006

[New and old addictions: implications for public health].

According to certain authors, any pleasure giving behaviour may become a habit, and depending on the circumstances, an addiction. The objective of this study is to examine the situation of addictions in Spain and the responses generated by health policies. In recent years, both the type and pattern of drug consumption in Spain, has undergone a noticeable change. Studies of the evolution of tobacco consumption suggest that the peak has passed, even though prevalence is still high. Alcohol consumption per capita has fallen by 25% in the last 25 years. During the same period, pattern of consumption has been modified. Sporadic drinking, in episodes of binging and drinking away from meals, is one of the patterns on the rise. According to the European Monitoring Centre for Drugs and Drug Addiction, in Spain, 27.8% of the population between 15- 64 years old has consumed an illegal drug at least once in their lives, with the prevalence rising to 38% among the 15- 34 year olds. Cannabis is the most consumed (29% among 1564 age group), followed by cocaine (5.9%), and ecstasy (4.6%). Spain, comparing with other countries of European Union, is the third in cannabis, ecstasy, and amphetamine and the first in cocaine consumption. With respect to the so-called behavioral addictions, no consensus in the field of psychiatry has been reached. The only psychological addiction with clear diagnostic criteria is gambling. The rest (Internet, sex, etc.), perhaps for their novelty, continue to be the object of controversy. New addictions, as much to addictive substances as to addictive behaviors, run parallel to the development of industrialized societies, leisure, free time, and a new way of life. This is the new challenge for Public Health.

Adolescent↗
PubMed2005

Effects of dopamine D2 receptor (DRD2) and transporter (SLC6A3) polymorphisms on smoking cue-induced cigarette craving among African-American smokers.

Cue-induced craving for addictive substances has long been known to contribute to the problem of persistent addiction in humans. Research in animals over the past decade has solidly established the central role of dopamine in cue-induced craving for addictive substances, including nicotine. Analogous studies in humans, however, are lacking, especially among African-American smokers, who have lower quit rates than Caucasian smokers. Based on the animal literature, the study's objective was to test the hypothesis that smokers carrying specific variants in dopamine-related genes previously associated with risk for addictive behaviors would exhibit heightened levels of cigarette craving following laboratory exposure to cues. To this end, cigarette craving was induced in healthy African-American smokers (n=88) through laboratory exposure to smoking cues. Smokers carrying either the DRD2 (D2 dopamine receptor gene) TaqI A1 RFLP or the SLC6A3 (dopamine transporter gene) 9-repeat VNTR polymorphisms had stronger cue-induced cravings than noncarriers (Ps <0.05 and 0.01, respectively). Consistent with the separate biological pathways involved (receptor, transporter), carriers of both polymorphisms had markedly higher craving responses compared to those with neither (P<0.0006), reflecting additive effects. Findings provide support for the role of dopamine in cue-induced craving in humans, and suggest a possible genetic risk factor for persistent smoking behavior in African-American smokers.

Adult↗
PubMed2004

Modulation of simian immunodeficiency virus neuropathology by dopaminergic drugs.

Drug abuse and human immunodeficiency virus (HIV) infection seem to cause cumulative damage in the central nervous system (CNS). Elevated extracellular dopamine is thought to be a prime mediator of the reinforcing effects of addictive substances. To investigate the possible role of increased dopamine availability in the pathogenesis of HIV dementia, simian immunodeficiency virus (SIV)-infected monkeys were treated with dopaminergic drugs (selegiline or L-DOPA). Both substances increased intracerebral SIV expression, combined with aggravation of infection-related neuropathology and ultrastructural alterations of dendrites in dopaminergic areas (spongiform polioencephalopathy) in asymptomatic animals. Moreover, this treatment resulted in enhanced TNF-alpha expression in the brains of SIV-infected animals. These findings indicate a synergistic interaction between dopamine and SIV infection on microglia activation, leading to increased viral replication and production of neurotoxic substances. Our results suggest that increased dopamine availability through dopaminergic medication or addictive substances may potentiate HIV dementia.

Animals↗
PubMed2002

Substance abuse vulnerability loci: converging genome scanning data.

Classical genetic studies suggest strong complex genetic contributions to a predisposition to abuse multiple addictive substances. Until recently, there were no reproducible genome scanning data identifying chromosomal positions likely to contain allelic variants that predispose the carrier to illegal substance addiction. Nominal results of linkage-based genome scanning studies for ethanol and nicotine addictions failed to display much agreement. Our recent data from association-based genome scans for illegal addictions, and reanalyses of previous results now provide a substantial body of converging results. The 15 reproducible chromosomal loci identified here are good candidates to harbor allelic variants that alter human substance abuse vulnerabilities. We discuss several approaches to identifying the specific gene variants that underlie these convergent association and linkage observations, and the impact that these convergent observations should have on understanding important human addictive disorders.

Chromosome Mapping↗
PubMed2001

Ego atrophy in substance abuse: addiction from a socio-cultural perspective.

The use of intoxicants is indexed in American history adopting a social perspective of the role of alcoholism in traditional American society. Appealing to societal patterns, the elaboration of substance abuse as a disease is explored with a diagnostic focus on intervention as it relates to pathogenesis. Using clinical vignettes, the ego is proposed as the focus of pathology in the addiction process, featuring a regression to the defenses of projection and denial. Following the model proposed in Zinberg's seminal paper on addiction and ego function, various deficits are annotated that typify such regression. The ultimate clinical picture is one of ego atrophy, where basic interests and object relations are usurped by the all-consuming preoccupation with the substance of abuse.

Behavior, Addictive↗