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PubMedDate not supplied

Abuse liability in opioid therapy for pain treatment in patients with an addiction history.

Patients may present to physicians with complaints of acute or chronic pain. Some of these patients will have a history of addiction to drugs or alcohol, and a few will have active addiction. Controlled-substance prescriptions, especially opioid pain medications, can be very beneficial for treatment of pain in patients. There are clear differences between physical dependence on medication, active addiction, addiction in remission, and pseudoaddiction. A search of the medical literature revealed different rates of addiction in patients with chronic pain because different criteria were used to define addiction and the types of chronic pain. It appears that rates of addiction in patient populations with chronic pain are no different than rates of addiction in the general population, according to some recent studies. "Drug-seeking behavior" may be seen with either active addiction or pseudoaddiction. A way to distinguish between these conditions is by giving the patient more pain medication and observing the patient's pattern of behavior. Some patients may be at higher risk to abuse prescription opioids, and some types of drug-seeking behavior may be more predictive of active addiction than pseudoaddiction. General guidelines can improve physicians' comfort level in prescribing opioids for patients with chronic pain, even those with a history of addiction. These include using a medication agreement or contract, setting appropriate goals with the patient, giving appropriate amounts of pain medication, monitoring with drug screens and pill counts, and documenting the case carefully. Even patients with a history of addiction can benefit from opioid pain medications if the patients are monitored appropriately.

Behavior, Addictive↗
PubMed2006

Executive dysfunction in substance dependent individuals during drug use and abstinence: an examination of the behavioral, cognitive and emotional correlates of addiction.

Increasing evidence indicates that substance-dependent individuals (SDI) are impaired in executive control tasks relying on different systems within the prefrontal cortex (PFC). Three different functional systems have been described: the dorsolateral prefrontal cortex (DLPC), orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC) circuits. Dysfunction within each PFC system is associated with different behavioral, cognitive, and emotional abnormalities. Few studies have conducted an exhaustive examination of all these different factors in SDI. In this study, SDI (including alcohol, cocaine, and methamphetamine polysubstance users, n=35) were compared with healthy controls (n=36) on a series of behavioral (Frontal Systems Behaviour Scale, FrSBe), cognitive (N-back, Go-No Go, and Wisconsin Card Sorting Tasks), and emotional (International Affective Picture System, IAPS) tasks, each of which was thought to tax a different component of these PFC functional systems. SDI showed greater behavioral problems in the apathy, disinhibition, and executive dysfunction subscales of the FrSBe. Behavioral deficits were significantly associated with several real-life domains in which SDI typically have problems. SDI also showed poorer performance on cognitive tests of working memory, response inhibition and mental flexibility, and abnormal processing of affective images from the IAPS. Cognitive, behavioral, and emotional measures were moderately correlated.

Adult↗
PubMed2006

[A case of tianeptine abuse].

Tianeptine is an antidepressant agent like the selective serotonin reuptake inhibitors (SSRIs). The anxiolytic efficacy of tianeptine is similar to that of tricyclic and tetracyclic antidepressants. Very few cases have been reported in connection with excessive consumption of tianeptine. Although it is not reconciled with results of many studies on excessive consumption of tianeptine, stimulant action has been specifically emphasized on some case reports of tianeptine abuse. These reports indicate that a tolerance is developed, there is a strong mode of feeling, and there are physical withdrawal symptoms if not taken again. Treatment with tianeptine can pose a risk for addicted patients in terms of high doses as well as tolerability. In this article, we report a 24-year-old patient who abused tianeptine for one year. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seeks a psychostimulant effect. The patient had a previous history of addiction to cannabis, opiates and cocaine. We concluded that the effect of tianeptine and its addiction risk at the patient who had a history of addiction to multiple substances, and spontaneously increased dose of tianeptine during the last one year up to 3000 mg per day at present. In the literature, reports of addictions to antidepressants are scarce and most of them involve agents with amphetamine-like properties, including amineptine and tranylcypromine. Other reports involving other antidepressant agents, including amitriptyline, fluoxetine and tianeptine remain exceptional.

Adult↗
PubMed2003

Accessibility of addiction treatment: results from a national survey of outpatient substance abuse treatment organizations.

OBJECTIVES: This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment. METHODS: Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients. RESULTS: In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR, .65; 95 percent CI, .42 to .99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3). CONCLUSIONS: Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs.

Health Care Surveys↗
PubMed2005

Overcoming barriers to prevention, care, and treatment of hepatitis C in illicit drug users.

Injection drug use accounts for most of the incident infections with hepatitis C virus (HCV) in the United States and other developed countries. HCV infection is a complex and challenging medical condition in injection drug users (IDUs). Elements of care for hepatitis C in illicit drug users include prevention counseling and education; screening for transmission risk behavior; testing for HCV and human immunodeficiency virus infection; vaccination against hepatitis A and B viruses; evaluation for comorbidities; coordination of substance-abuse treatment services, psychiatric care, and social support; evaluation of liver disease; and interferon-based treatment for HCV infection. Caring for patients who use illicit drugs presents challenges to the health-care team that require patience, experience, and an understanding of the dynamics of substance use and addiction. Nonetheless, programs are successfully integrating hepatitis C care for IDUs into health-care settings, including primary care, methadone treatment and other substance-abuse treatment programs, infectious disease clinics, and clinics in correctional facilities.

Alcohol Drinking↗
PubMed1995

Parenting groups for recovering addicts in a day treatment center.

This article describes parenting groups that were conducted at a day treatment center in New York City from 1989 to 1992. The population consisted of parents who were recovering from substance and alcohol addiction with backgrounds of poverty, educational deficits, and intergenerational addiction. The approach combined brief dynamic group therapy with the learning of child development, communication skills, and family management concepts in a psychoeducational model. Empathy and respect for the struggle of the recovering addict characterized the group culture and the stance of the group leader. The methodology included creative writing through group process, role playing, and values clarification activities. The high number of parenting group graduates who also completed the day treatment program suggests that parenting groups were a significant component in the recovery process. Clients in the groups reported feeling better about themselves as parents and were able to express more positive feelings toward their children.

Adolescent↗
PubMed1999

[Knowledge, attitudes and training of family physicians with regard to addiction to illicit drugs].

Substance abuse is one of the most serious problems in Israel. Recent studies show the situation is getting worse. The deleterious outcomes of psychoactive substance abuse include crime, car accidents, physical and mental illness, violence and work injuries. 48 family physicians in the Negev completed a questionnaire which included training, diagnostic and treatment skills, attitudes, knowledge and need for training in this field. 38 family physicians (81%) had had no training, most (96%) indicated the importance of such training. 34 (71%) said that their medical skills could not cope with the problems of addiction, and 29 (64.5%) claimed that the quality of care of addict patients is reduced because of lack of knowledge and diagnostic skills. These findings support the conclusion that efforts should be invested in training family physicians in the field of psychoactive drugs, licit and illicit.

Education, Medical↗
PubMed1975

[Identification in drug addiction].

There is a need to define the field of drug addiction from both the theoretical and the practical point of view, but any attempt to do so encounters difficulties that are inherent in the many types of approach as well as in the polymorphism of drug addiction. The difficulties are also due to the present day consumption of pills which is very high both among members of our "square" society and in the marginal fringes, and occurs in and outside the field of drug addiction proper -- the guide being here the progressive increase of doses. The modes of use are not sufficient to determine the presence of drug addiction: the drug substance must have a psychism-oriented tropism; the increase in the dose of a non-psychotropic product is therefore a matter of hypochondria and not of drug addiction. The means of administering a drug also occupies a privileged place, in so far as the intravenous method suffices alone to label non-medical use as drug addiction. It is the hallucinogens that, despite the absence of physical dependence, most frequently pose the question of the definition of drug addiction, in view of the ritual dimension and the transgressive significance of the absorption of these products, even at relatively moderate doses, and hallucinogens pose this question all the more since their use emerges from a sub-cultural environment that produces typical drug addiction, namely intravenous heroin addiction. The latter does not raise the question of definition, but is used as the basis for a drug addiction referential system.

Adolescent↗
PubMed1982

The addictive process.

In order to understand and treat addictions one must go beyond the specific agent and practice, one must understand the addictive process. The author bases his conceptualization of an addictive process on twenty-five years of naturalistic observation, individual and group psychoanalytic psychotherapeutic treatment and therapeutic trials of one hundred and thirty-three single and poly substance and behavior addicted patients. No single addictive personality (addict) exists. People become addictive because specific etiological and constitutional factors contribute to their vulnerability to the addictive process. This process can be defined and diagnosed. It involved common inter/intrapersonal psychodynamics. One must look for the addictive complement and trigger mechanisms which can initiate and perpetuate the process. The process has a life history and stages, which can be cyclic, periodic, or sporadic. The individual can shift from one addiction to another or sustain multiple addictions at different times. Understanding the above factors is essential to making an accurate diagnosis and to treatment.

Ego↗
PubMed2006

Altered adaptive but not veridical decision-making in substance dependent individuals.

Drug addiction is associated with impaired judgment in unstructured situations in which success depends on self-regulation of behavior according to internal goals (adaptive decision-making). However most executive measures are aimed at assessing decision-making in structured scenarios, in which success is determined by external criteria inherent to the situation (veridical decision-making). The aim of this study was to examine the performance of Substance Abusers (SA, n = 97) and Healthy Comparison participants (HC, n = 81) in two behavioral tasks that mimic the uncertainty inherent in real-life decision-making: the Cognitive Bias Task (CB) and the Iowa Gambling Task (IGT) (administered only to SA). A related goal was to study the interdependence between performances on both tasks. We conducted univariate analyses of variance (ANOVAs) to contrast the decision-making performance of both groups; and used correlation analyses to study the relationship between both tasks. SA showed a marked context-independent decision-making strategy on the CB's adaptive condition, but no differences were found on the veridical conditions in a subsample of SA (n = 34) and HC (n = 22). A high percentage of SA (75%) also showed impaired performance on the IGT. Both tasks were only correlated when no impaired participants were selected. Results indicate that SA show abnormal decision-making performance in unstructured situations, but not in veridical situations.

Adaptation, Psychological↗
PubMed1993

Assessment of binge eating in obese patients.

Obese patients entering a weight control program were classified as binge eaters if they reported uncontrolled consumption of what others would regard as an unusually large amount of food at least once a week for the previous month. Binge eaters differed significantly from nonbingers across a broad range of eating and weight-related characteristics assessed using a self-report version of the Eating Disorder Examination. Attitudinal differences were marked. The results provided no support for the view that obese binge eaters have a pattern of general "addictiveness" to psychoactive substances or other activities.

Adult↗
PubMed1999

Clinicians' perceptions of barriers to pain management in AIDS.

A growing body of literature has demonstrated the widespread undertreatment of pain in patients with AIDS. While clinician-related barriers to cancer pain management have been studied, to date there has been no systematic attempt to survey clinician-related barriers to the management of pain in patients with AIDS. We surveyed AIDS health care providers' attitudes towards pain management, as well as their perception of the barriers to adequate pain management in patients with HIV disease. Subjects were 492 AIDS care providers attending continuing education symposia on the clinical management of pain in patients with AIDS in 5 major U.S. cities (New York, Philadelphia, San Francisco, Los Angeles, and Miami). Results indicated that the most frequently endorsed barriers to pain management were those regarding lack of knowledge about pain management or access to pain management experts, and concerns regarding potential substance abuse or addiction. Experience in the management of pain in patients with AIDS was inversely correlated with endorsement of barriers related to pain management expertise and concern regarding potential substance abuse. More experienced clinicians were significantly less likely to cite these factors as barriers to pain management. More knowledgeable respondents were significantly more likely to identify barriers to pain management and individuals with more conservative attitudes towards pain management were significantly more likely to cite substance abuse issues or medical concerns as barriers to pain management.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Addiction and paranoid process: psychoanalytic perspectives.

Multiple aspects of the problem of drug abuse and addiction are formulated in terms of the dynamics of the paranoid process, specifically emphasizing the complex interactions of introjection, projection, and the paranoid construction. The effect of projection is to modify the experience of the drug substance so qualities and capacities, often powerful and magical, are attributed to it, allowing it to serve as an external agency contributing to the maintenance of internal introjective configurations and correspondingly to the preservation of an inner sense of self-cohesion. The projective dynamics deal primarily with the vicissitudes of aggression and narcissism, and are given a sense of organization and meaningful integration by the cognitive elaboration of the paranoid construction. They also serve to locate the drug-taking behavior in a larger matrix of familial, social, and other environmental influences, which tend to give support to the projective system. The interaction of these projective psychological dynamics with the pharmacological action of drug substances completes the drug equation and helps to shed further light on the selection of specific drug substances as having addictive potential.

Adult↗
PubMed2001

Neuropsychological functioning in substance-dependent patients.

The present study examined neurocognitive functioning in groups of individuals addicted to various psychoactive substances. One hundred ten patients admitted to treatment for substance misuse were assessed using a semistructured clinical interview, the Beck Depression Inventory, the Symptom CheckList-90, the Trail Making A and B tests, and the Shipley Institute of Living Scale. Results revealed that at intake, alcohol- and benzodiazepine-addicted clients exhibited higher levels of cognitive impairment and psychological distress than patients dependent on other drugs. Regression analysis showed that the Shipley vocabulary raw score was a significant predictor of length of stay in treatment.

Adult↗
PubMed2000

The impact of managed care on substance abuse treatment: a report of the American Society of Addiction Medicine.

This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.

Cost-Benefit Analysis↗
PubMed2002

Substance abuse integration in nursing education: an innovative collaborative model.

This paper reports the outcomes of a 3-year faculty development project, the Nursing School Education Collaborative (NSEC), implemented in four baccalaureate schools of nursing. The focus of the NSEC was to strengthen educational programs through faculty development and curriculum integration in the area of substance abuse and addictions education. A comprehensive needs assessment process is outlined, and faculty development and curriculum integration activities are detailed. Faculty development has resulted in significant improvements in each school's substance abuse curriculum. Outcomes at each participating school have included continuing education activities, acquisition of additional teaching resources, the development of an integration model, and increased curriculum and clinical contact hours. With the increasing recognition of substance abuse as a number one public health problem and nursing as a major health workforce, this project serves as a model for replication.

Adult↗
PubMed2006

Neurorobiology and evidence-based biological treatments for substance abuse disorders.

Behavioral patterns of addiction include compulsive drug-seeking, persistent abuse of substances despite the often dire consequences on social functioning and physical health, and the high probability of relapse even after prolonged drug-free periods. The recent focus on the biological basis of addiction has provided evidence to support the hypothesis that behavioral manifestations for addiction are influenced by biological factors, and biological factors often produce behavioral changes that can further increase risk. The current understanding of the role of the dopaminergic, glutamatergic, Upsilon-aminobutyric acidergic, and opioid receptor systems in the pathophysiology of addiction as well as the clinical implications of these systems for new and emerging treatments will be discussed. This article will also review the pharmacologic agents used in the treatment of substance abuse disorders and presents evidence-based data for their safety, efficacy, and feasibility of use in different patient populations.

Brain↗
PubMedDate not supplied

When to begin smoking cessation in substance abusers.

During the past several years, there has been an increasing recognition and acceptance that the use of tobacco products often produces nicotine dependence and nicotine addiction. Despite this, the substance abuse treatment community has been slow to promote smoking cessation for patients who are in substance abuse treatment for another addiction. Dogma, although starting to change, persists that cigarette smoking pales in comparison to other addictions and should not be addressed at the time of initial treatment for another addiction. The limited research to date, which will be reviewed in this article, does not support this dogma. In addition, patients presenting for substance abuse treatment report high interest in stopping smoking, including interest in stopping when they initially present for substance abuse treatment.

Alcoholism↗