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The Addiction Severity Index medical and psychiatric composite scores measure similar domains as the SF-36 in substance-dependent veterans: concurrent and discriminant validity.
BACKGROUND: Recently attention has focused on the assessment of functional health status in substance-dependent individuals. The addiction severity index (ASI) is a widely used assessment instrument that includes scales to reflect current medical and psychiatric status. This study examines the concurrent validity of these ASI composite scores in relation to the short form 36-item health survey (SF-36), a well-established measure of health-related quality of life/functional health status. METHODS: Veterans (n=674) were assessed at admission to substance dependence treatment. Correlations were performed between ASI composite scores and SF-36 scales and the physical and mental summary components (PSC and MSC, respectively). Areas under receiver operating characteristic (ROC) curves determined the descriminative ability of the ASI composites to ascertain impairment. RESULTS: The ASI medical composite score demonstrated robust correlations with the four SF-36 scales that relate to physical health and with the PCS. The ASI psychiatric composite score had robust correlations with the four SF-36 scales related to mental health and with the mental component summary (MCS). ROC curves indicated that the ASI medical (AUC=0.83) and psychiatric composites (AUC=0.90) accurately detected subjects with impairment. CONCLUSIONS: ASI medical and psychiatric composite scores provide effective initial screening for patients with impaired functional status as measured by the corresponding SF-36 component summary scores.
[Buprenorphine abuse: high dose intravenous administration of buprenorphine].
BACKGROUND: In France, actually, around 70 000 drug addicts are treated with buprenorphine available as sublingual tablets. Clinical studies have demonstrated the clinical efficacity of buprenorphine for opiate addiction. But, it has been reported that some of them injected buprenorphine. Some inquiries have suggested measured with 10% to 40% injectors. To use buprenorphine tablets for injections have had heavy sanitary consequences (4). OBJECTIVES: To know the use buprenorphine context in our population and to analyse the circumstances and outcomes of buprenorphine injection for drug addicts. METHOD: In 1998-1999, we conducted a cross-sectional survey using a structured questionnaire. Information wax collected during a 30-minute face-to-face interview through an 69-item structured questionnaire administered by trained investigators. The questionnaire was composed of questions about social demographic data, the drugs taken before the first use of buprenorphine, the circumstances of the first buprenorphine experiment, the reasons for the first buprenorphine injection into drug addicts, the other substances used in the same time, the risks behaviors, the sensations seeking, the medical consequences. The questionnaire was first tested in a pilot study through ten patients. Drug addicts were followed-up in 8 drug abuse treatment centres among which 2 networks of general practitioners in Paris region, in Strasbourg region and in Nice region. The investigators were general practitioners, psychologists, psychiatrists, educators, nurses. All drugs addict which reported use buprenorphine were seen in treatment centre and were 18 years old or older, were eligible. Drugs addict with severe mental disorders, unable to answer the questions were excluded. Respondents received an assurance of confidentiality and informed consent was obtained. Standard descriptive statistics were used to analyse subjects characteristics: frequency, standard deviation. The study was funded by the Observatoire Français des Drogues et des Toxicomanies (OFDT). RESULTS: Of the 779 consecutive drug addicts interviewed, 770 completed the questionnaire. The study has shown that the majority of subjects were male (77.2%), mean age was 31.3 (SD: 5.98). Most of them were unmarried (67.5%). They had no real employment (56.5%). The mean age at the first use opiate was 19.5 (SD: 4.5). The mean age at the first heroin injection was 20.7 (SD: 4.6). At the time of interview, most of drugs addict used more than two types of drugs (42.6%). Many associations with buprenorphine are described particularly associations to alcohol (41.2%), benzodiazepines (40%), cocaine (12.4%), heroin (7.8%), crack (7.2%); most of these subjects getting buprenorphine without any medical prescription. Most drug addicts had asked themselves for using buprenorphine (61.0%). Near fifty per cent (49.5%) injected buprenorphine. Among them, 39.6% injected this substance the first time they used it. Curiosity (72.8%), need for injection (69.0%), sensation seeking (49.0%) were reasons given by drug addicts for buprenorphine injection. Others reasons were given: an inadequate dosage of sublingual buprenorphine, to find buprenorphine in black market. Buprenorphine injection took place in the secure environment (57.5%). Drug addicts were not alone when they injected (53.6%). The introducer was an buprenorphine user (57%). The first buprenorphine injection sensation was not pleasant (61%), although injection of buprenorphine is usually performed by 80% of them. However, 93% had been informed that buprenorphine injection was contra-indicated. CONCLUSION: Since six years, many French patients have received a treatment for opiate addiction. High dosage buprenorphine is actually the principal treatment for substitution medication in France. Some misappropriations and wrong uses have been seen, the most frequent and sever being using tablets for injections. The prevalence of buprenorphine injection is high among drug addicts. The results of the study show that the first buprenorphine Injection takes places place a few time after the first buprenorphine use. The codependance to other substances is one of risk markers for intravenous use of buprenorphine tablets and the dangers of polyintoxication were known. Curiosity, need for injection favour buprenorphine injection. But, the sensation seeking brings on the drug addict too. The rather loose frame of prescription, a lack of training among general practitioners, the fragility of the specialises network, the complexities in the care of drug users which not resumed by a substitution must take into consideration. The drug addict's career, the subject's environment and the circumstances of the buprenorphine injection have not been previously described. However their knowledge are of prime necessity to prevent this abnormal use and to find the best treatment for drug addicts.
The oratory of addiction: a 30-year perspective on alcohol and drug misuse.
The annual Leonard Ball Orations illustrate changing perspectives in Australia over 30 years on medical and social effects of misuse of alcohol and other substances. The first oration, in 1968, examined causal factors in the context of 'agent', 'purveyor' and 'host' and provided themes for subsequent orators. In regard to the agent (alcohol), it was proposed that availability (and cost) determined not only overall consumption within the community, but also numbers of users at hazardous levels. This principle seemed applicable to substance misuse and addictive behaviours overall. The influence of purveyors (and advertisers) was discussed with expectedly different perspectives from the liquor industry and social and health-care providers. The role of host was examined in terms of genetic predisposition, foreshadowing current experimental applications of gene transfer and disruption technologies in mice to substance misuse and the promise of the Human Genome Project in clarifying inheritance of substance misuse. Individual successes in harm reduction were described in the context of alcohol and road trauma, smoking prevention and heroin addiction. Government intervention was introduced with the 1987 National Campaign Against Drug Abuse. The focus shifted during the 1980s from alcohol to addictive drugs, in line with community concerns. The 1996 oration on the aborted Canberra trial of supervised heroin administration illustrated the need for, and problems associated with, such studies. The prescience and achievements of the Ball orators provide optimism and direction for efforts in the future.
Precision Genomics: A Reality Having Universal Impact in a New Era of Psychiatry - Lessons Learned, Past and Present.
Addiction neuroscience explores the complex interplay between genetic, neurobiological, environmental, and socio-spiritual factors underlying substance and behavioral addictions. Over the past three decades, research in this domain has identified critical molecular and epigenetic mechanisms-particularly those affecting dopaminergic signaling and reward pathways-that contribute to both vulnerability and resilience to addictive behaviors. Central to this understanding is the concept of reward deficiency syndrome (RDS), first introduced by Kenneth Blum, which posits that hypodopaminergic functioning predisposes individuals to seek maladaptive rewards. Advances in neurogenetics, including the identification of key polymorphisms such as the DRD2 A1 allele, have paved the way for precision tools like the genetic addiction risk severity (GARS®) test. This test, alongside pro-dopaminergic nutraceutical interventions like KB220, demonstrates the potential for early detection and individualized treatment of "pre-addiction" risk states. Despite ongoing reliance on opioids for opioid use disorder (OUD), emerging paradigms advocate for dopamine homeostasis through non-addictive, integrative approaches. Furthermore, the integration of whole genome sequencing data can be used for Genome-Wide Association Studies (GWAS), multi-omics, and machine learning into clinical practice holds promise for advancing personalized medicine in addiction treatment. As the field progresses, addressing health equity and improving genomic representation across populations remain critical goals. This evolving framework underscores the importance of leveraging genomic insights to prevent, predict, and personalize interventions for addiction and mental illness at scale.
[Substance dependence in the elderly. Gentle treatment of addiction].
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A critical perspective on cross-cultural contexts for addiction and multiculturalism: their meanings and implications in the substance use field.
Despite evidence of the antiquity and ubiquity of psychoactive substance use, much of the literature is devoted to addiction in minority ethnocultural subgroups. When researchers study drug use in isolated "primitive" communities, they consider drug use to serve as a mechanism of social integration; when they study drug use in ethnocultural subgroups in contact with mainstream society, they consider drug use as a marker, or sometimes as a cause of social disorganization. The implicit assumption appears to be that addiction and race, ethnicity, or other minority ethnocultural subgroup membership are linked, and more prevalent and/or more problematic in minorities, further problematizing the status of minorities. Empirical studies identified through ETOH, the U.S. National Institute of Alcohol and Alcoholism (NIAAA)'s Internet-accessible computerized database, were subjected to content analysis of their abstracts (n(abs) = 44) as well as actual reports (n(rep) = 40). It was found that the content of neither abstracts nor actual reports supported the contention that there was a greater prevalence of drug use, drug-use-associated problems, or drug-use-enhancing attitudes in minority ethnocultural subgroups when compared to mainstream society (chi2(abs) = 2.16, d.f. = 3, n.s., and chi2(rep) = 3.52, d.f. = 2, n.s. respectively). Researchers need to be aware of possible implicit assumptions about the relation between ethnicity and addiction.
Addiction and sexually transmitted disease (STD), human immunodeficiency virus, (HIV), and acquired immune deficiency syndrome (AIDS): their mutual interactions.
We explore the links between substance use, misuse, addiction, and dependency1 and sexuality, sexually transmitted diseases (STD), human immunodeficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) to increase our awareness of their interdependence and to identify new ways to perceive, judge, and intervene (or not to) with associated problems. We consider the sociocultural and economic context in which these behaviors occur; the impact these behaviors have on one another; the personal opinions and attitudes; the religious, moral, or political beliefs and agendas; the physiological and fiscal constraints; and theories of rational decision-making and psychological motivation that act to increase or reduce the incidence of these behaviors and their sequellae, while hindering or facilitating prevention, harm reduction, and treatment interventions. Mechanisms of epidemic spread of STDS/HIV/AIDS are presented in the Appendix. Each of these terms are loaded "container concepts" that are culture-bound and stakeholder-driven and whose dimensions are less than consensus-based. They represent a range of meanings, uses, and misuses in an ongoing politicalized area of human and systemic functioning and adaptations.
[The dopaminergic system and addictions].
AIM: All psychoactive substances with a high abuse potential are characterized by altering the mesocorticolimbic dopaminergic neurotransmission system. In this article it is proposed to review the neurobiological mechanisms that comprise the foundation of the development of addiction. DEVELOPMENT: The acute drug intake provokes an increase in extracellular dopamine which, in vulnerable individuals, could be the start of the addictive process. Chronic drug use is accompanied by a reduction in the dopaminergic function with the development of neuroadaptive changes in the mesolimbic and mesocortical pathways. In the prefrontal cortex, the changes in dopaminergic function produce an inbalance between receptors D1 and D2, which leads to a predominance of inhibitatory function. Dopaminergic innervation in the amygdala and its interaction with the nucleus accumbens plays an essential role in the conditioning of environmental stimuli, and can trigger the craving and relapse. In drug dependent patients, dopaminergic changes extend from the limbic regions to the associative and sensorimotor striatum, and affect the cortico-striatico-cortical circuits. CONCLUSION: The involvement of the dopaminergic systems is crucial in the development of addiction, from the early phases in which drug use begins as an object-directed instrumental behavior, to the consolidation of the addiction as a compulsive habit, controlled by stimulus-response mechanisms, which progressively invade all aspects of the life of an individual.
Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes.
More than half of substance abusers entering addiction treatment report a history of physical or sexual abuse. It is unclear if such a history impacts treatment outcomes. This one-year follow-up study of 700 substance abusers sought to clarify the relationship between lifetime physical and/or sexual abuse and addiction treatment outcome to help address the specific needs of this population. To achieve this goal, baseline characteristics, no-show for treatment status, post-treatment clinical outcomes, and treatment history were studied for subjects with lifetime history of abuse (47.3%) versus without. Abused subjects, predominantly women, were significantly more impaired at baseline on clinical dimensions including family/social severity and psychiatric severity as measured by the Addiction Severity Index (ASI), and general level of functioning. The two groups endorsed different drugs as primary, with the abused group less frequently endorsing heroin and cocaine in favor of alcohol and polydrug use. Abused subjects reported more prior medical and psychiatric treatments. Abuse history was not a predictor of no-show for treatment. Over the 1-year follow-up, lifetime physical and/or sexual abuse was significantly associated with worse psychiatric status and more psychiatric hospitalizations and outpatient treatment despite receiving similar intensive addiction treatment.
Evaluation of patients treated for pathological gambling in a combined alcohol, substance abuse and pathological gambling treatment unit using the Addiction Severity Index.
Seventy-two pathological gambling patients were followed-up after treatment in a combined alcohol, substance abuse and compulsive gambling treatment program. The Addiction Severity Index (modified for use with pathological gamblers) was used to evaluate the effectiveness of treatment. Patients reduced their intake of alcohol, other drugs and their gambling as well as improved in legal, family/social, and psychological functioning. There was a trend for improvement in medical condition and no net change in employment functioning. The study supports the idea that combined treatment is an effective way of dealing with patients whose gambling problems are discovered when they enter treatment for another addiction, as well as for patients whose initial complaints include pathological gambling, with or without additional problems.
[Addictions in young people with different backgrounds].
The research, carried out among young people of selected groups from different environments estimated the occurrence of addictions, the degree of danger of nicotine addiction, alcoholism and pharmacomania. A questionnaire of the interview standardized into smokers and non-smokers was used among students. Evaluation of addiction to alcohol, drugs and nicotine among young people treated at the Toxicology Ward was done on the basis of clinical material of toxemias. Addiction to psychoactive substances among students amounts to on average of 30%. Most of the smokers would like to drop the habit. Frequency of addictions among young people hospitalized in the clinic is much higher in comparison with the group occupationally passive or working, especially in big cities. Acute toxemias among addicts, especially in the group of alcohols, drugs and psychotropic drugs were quite serious. Toxic coma accompanying toxemia is a danger to health and life.
[Types of hearing disorders in drug addicts and individuals drinking non-consumable alcohols].
All over the world an increase in the number of subjects addicted to various chemical substances has been observed. The studies of their toxic effect on the hearing have been so far most frequently limited to acute intoxication or direct effect: there are no data concerning distant and persistent effects. The aim of the study was to determine the type of hearing loss in drug addicts and individuals drinking non-consumable alcohols, examined during the period of abstinence. A group of 210 subjects addicted to various substances was examined using acumetry test and tuning forks, as well as threshold, suprathreshold and speech audiometry. Taking into consideration the threshold results for particular subjects, the percentage of hearing loss for both ears was calculated using CPT index. Most frequent complaints connected with the organ of hearing, such as tinnitus and hearing impairment were reported by alcoholics and opioid addicts. In the age adjusted threshold audiometry, perceptive hearing loss was diagnosed in nearly 50% of the subjects. The percentage of hearing loss calculated for both ears, using CPT index, demonstrated the highest values in the group of subjects drinking non-consumable alcohols and addicted to volatile organic substances.
[Weakness of will].
Addictive behaviours raise the issue how it is possible that a free agent is not able to act according to his own will. Indeed an agent can be defined as "addicted", to a substance or a behaviour, only when he does not succeed in discontinuing despite his will. Namely in the very idea of addiction it is involved the idea of weakness of will. The problem of weakness of will is one of the most intriguing problems posed by human spirit. This paper intends to show some of its manifestations.
Genetic vulnerability to drug abuse.
Addiction to various substances, including drugs and alcohol, probably arises from a combination of environmental and genetic factors. The genetic vulnerability to drug addiction is supported by several familial, adoption and twin studies. However, as in other mental disorders, the genetic vulnerability to drug addiction appears complex: these disorders do not follow the rules of Mendelian inheritance. Instead, they are probably influenced by multiple susceptibility genes, each of which contributes to the disorder. The more genes necessary for a disorder, the harder it is to detect any of them. This difficulty is magnified by the role of environmental factors. Association studies using the candidate gene approach can identify susceptibility genes for drug abuse supported by the pathophysiological hypothesis of the illness. This review will focus on the clinical and molecular genetic studies in drug abuse.
Reducing substance abuse during pregnancy. Discriminating among levels of response in a prenatal setting.
Providers in prenatal care settings are well-positioned to help pregnant women with substance abuse problems take the first steps toward recovery. This study reports the results of the ANGELS Program, a program of enhanced prenatal care designed to reduce substance use among pregnant women. In a suburban office serving a broad range of pregnant women, certified nurse-midwives (CNMs) and on-site addictions counselors addressed substance abuse during prenatal care. This paper describes a cohort of 77 pregnant women who were identified as abusers of alcohol and/or other drugs at the start of pregnancy. According to a level of change rating assigned by the CNM at delivery, 51% of women were able to be largely abstinent during their pregnancy, 35% had reduced their use somewhat, and 14% had shown no change in use. Discriminant analysis techniques were used to learn what characteristics differentiated women in these three level of change groups. Baseline variables that differentiated the groups included severity of cocaine and cannabis use, psychosocial stressors, and initiation of prenatal care. Significant process variables included number of prenatal visits and contact with the addictions counselors. Clinical vignettes illustrate the differences among women in the three level of change groups. Implications of the results are discussed.
Opioid receptor and peptide gene polymorphisms: potential implications for addictions.
Addictions to drugs of abuse and alcohol have been shown by studies of genetic epidemiology to have both a heritable and an environmental basis, with these factors influencing addiction to different substances to a different extent. In the search for specific alleles of specific genes that may contribute to the development of the addictions, many researchers have focused on the endogenous opioid system, which mediates a diverse array of neurological, physiological, and behavioral functions. The endogenous opioid system is also centrally important in mediating the effects of drugs of abuse and alcohol. Polymorphisms, including single nucleotide polymorphisms, have been identified in genes of the endogenous opioid receptors and peptides. A number of recent genetic association studies and a few studies of potential function provide clues as to which genes and which alleles may have implications for human physiology and pathophysiology, including the addictions.
Stereotyping as a negative factor in substance abuse treatment.
Sixty addicts, health professionals, and counseling students were administered the Internal-External Locus of Control Test and the Multiple Affect Adjective Check List to determine if stereotypes exist between the subject groups, the nature of the stereotypes, and if educational level alters the stereotypes. The findings demonstrated gross misperception of addict clients by the health professionals and students, particularly toward psychotic and hostile dimensions. Educational level was found to improve the accuracy of the nonaddict perceptions. The study concludes with a discussion of the findings as they pertain to development of the counselor-client relationship, recidivism, and treatment of substance abuse clients.