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PubMed2002

Drug addiction as drive satisfaction ("antidrive") dysfunction.

Drug addiction is a complex brain disorder, characterized by the loss of control over drug seeking and drug taking behavior, and by the risk of relapse, even after a prolonged period of abstinence. This disorder may have its source in a disturbed balance of drive-related behaviors, which control appetitive reactions aimed at seeking contact with an addictive substance. The act of consumption becomes more and more attractive, and the behavior takes on compulsive character. We suppose that drug addiction may involve a change in the mechanism of satisfaction of drives and states of satiation as well. To understand how the motivational processes are changed with the development of dependence, one must consider the mechanism of drive satisfaction and satiation states that occur in relation to the consumatory reflex. When a given drive is satisfied a state of fulfillment occurs. This state may be a result of a so-called "antidrive" mechanism (Konorski 1967). While a drive activity is characterized by general activation and tension, the drive satisfaction state ("antidrive") is characterized by relaxation and relief. When a particular drive is satisfied, the operation of other drives become possible. Therefore, we postulate that dysfunction of drive satisfaction leads to the sustained activation related to the current drug-related drive, which blocks the operation of other drives. In effect, uncontrolled compulsive appetitive behavior is released, and the operation of other drives is restrained, thus forcing the organism to focus on drug-related drive. The reason for an "antidrive" dysfunction may be related to adaptive changes which develop during a contact with an addictive substance.

Drive↗
PubMed2001

Craving predicts use during treatment for methamphetamine dependence: a prospective, repeated-measures, within-subject analysis.

Clinical lore dictates that craving drives the compulsive use of drugs and alcohol - the core feature of substance dependence. Yet limited research has yielded mixed results, suggesting that craving is neither necessary nor sufficient for continued use or relapse to addictive substances. To investigate the role of craving in compulsive methamphetamine use, 31 men and women in treatment for methamphetamine dependence were asked to indicate, once each week for 12 weeks, the severity of craving that they had experienced during the previous 24 h, using a 100-mm visual analog scale. In a prospective, repeated-measures, within-subject analysis, craving intensity significantly predicted methamphetamine use in the week immediately following each craving report. Craving remained a highly significant predictor in multivariate models controlling for pharmacological intervention, and for methamphetamine use during the prior week. Craving scores that preceded use were 2.7 times higher than scores that preceded abstinence. Risk of subsequent use was 2.5 times greater for scores in the upper half of the scale relative to scores in the lower half. The results obtained demonstrate that, while craving alone may be neither necessary nor sufficient to explain substance addiction, when measured prospectively in a carefully-designed study craving emerges as a salient predictive factor in continued methamphetamine use for patients in treatment for methamphetamine dependence.

Adult↗
PubMedDate not supplied

Drug addiction. Part III. Pharmacotherapy of addiction.

The last decade brought a considerable progress in pharmacotherapy of addiction. Basing on recently gained knowledge of mechanisms of development of addiction and the physiology of the brain reward system, several therapeutic strategies have evolved. The strategies aimed at targeting the basic mechanisms of addiction rely on the premises that addiction is caused by adaptive changes in the central nervous system and that craving, which is the main cause of relapse, depends on dopaminergic mechanisms and requires high general excitability. The pharmacological approach involves drugs that reduce neuronal adaptability by inhibiting the calcium entry to neurons both through voltage-gated channels (e.g. nimodipine) and NMDA receptors (e.g. memantine), and drugs that stimulate the inhibitory GABAergic system (gamma-vinyl-GABA, baclofen), Particular attention is paid to the compounds that may attenuate dopaminergic hyperactivity, without considerable suppression of tonic activity of dopaminergic neurons (e.g. BP 897, a partial dopamine D3 receptor antagonist). Specific strategies are aimed at interference with the action of particular drugs of addiction. An important group includes the agonistic therapies (known also as substitution or maintenance therapies) in which a long-acting agonist is used in order to reduce the action of the drugs of high addictive potential (e.g. methadone against heroin addiction or vanoxerine (GBR 12909) against psychostimulants). Other specific strategies aimed at reduction of the transport of molecules of addictive substances into the brain: the approaches involve preparation of antibodies that form complexes unable to cross blood-brain barrier or enzymes accelerating the metabolism of the compounds in the blood (e.g. variants of butyrylcholinesterase). A considerable progress has been made in combating the abuse of legal addictive substances, alcohol (naltrexone, acamprosate) and tobacco (bupropion). The prospects for developing effective pharmacotherapies against addiction are bright. Unfortunately, ideological and social implications, as well as the conflict of interest with illegal narcotic manufacturers and distributors, may considerably hamper the progress in combating addiction (e.g. difficulties in introduction of methadone).

4-Aminobutyrate Transaminase↗
PubMed2005

Addicted media: substances on screen.

The depiction of alcohol and drug traffic/usage in films has caused concern since the advent of motion pictures and continues to raise concern with the introduction of new media. This article provides a comprehensive review of much of the existing peer-reviewed published literature about the depiction of substances in the media by focusing on the information obtained in content analyses. This article demonstrates the widespread and overwhelming presence of substances in the media viewed by youth and highlights reviews that discuss the potential impacts of these depictions.

Adolescent↗
PubMed2004

Effects of periadolescent versus adult cocaine exposure on cocaine conditioned place preference and motor sensitization in mice.

RATIONALE: Age of initial exposure to addictive substances is inversely proportional to risk of developing drug dependence. There is debate, however, as to whether intake at a young age causes dependency or whether young people who experiment with addictive substances are predisposed to dependency by other factors. OBJECTIVES. We tested the relationship between cocaine exposure at two different ages in mice and the development of subsequent drug-seeking behavior to test for age-specific exposure effects. METHODS: We performed dose-response analysis of cocaine conditioned place preference (CPP) and locomotor activity in periadolescent and adult C57Bl/6J mice. In addition, we pretreated periadolescent and adult C57Bl/6J mice with cocaine or saline in the home cage or a drug-associated context, and then examined their behavior in a biased CPP procedure in adulthood. RESULTS: Dose-response relationships were similar between the two age groups. In the pretreatment experiments, we observed locomotor sensitization during the pretreatment in periadolescent but not adult mice. We also observed an enhanced aversion to the non-preferred side of the chamber in periadolescent mice compared to adult mice, which was alleviated by cocaine association with that side. Third, we observed that after further conditioning in adulthood, there were no pretreatment-specific effects. CONCLUSIONS: Our results are consistent with a "vulnerable brain" hypothesis for responses to cocaine based on our findings that periadolescent mice exhibit greater locomotor sensitization to cocaine, and greater baseline anxiety responses that are alleviated by cocaine exposure compared to adult mice.

Aging↗
PubMed2004

Substance Use Disorders and Neurologic Illness.

Because of the high rates of substance use disorders among the general and clinical populations, and the abuse potential of many medications commonly used in the treatment of neurologic illnesses, the treating neurologist must deal with drug misuse and abuse in practice. The most important tool neurologists must have in their arsenal is the ability to assess for and recognize substance use disorders in their patients. Any treatment plan developed for such patients must include ongoing management of substance abuse issues. After a substance use disorder is diagnosed, the neurologist must make proper referrals to adjunctive support interventions (Alcoholics Anonymous or Narcotics Anonymous) and chemical dependency specialists, and work closely and in collaboration with these components of the patient's overall treatment. The treating neurologist should be aware of the myriad neurologic sequelae of drug use, because most drugs of abuse, including alcohol, can have neurologic manifestations resulting from acute intoxication, acute withdrawal, or chronic use. Drug use (past and present) should be included in the differential diagnosis for any patient with an atypical constellation of symptoms or with isolated neurologic deficits. If the treatment of a neurologic condition requires the use of a potentially addictive substance, particularly when the patient has a history of substance use disorders, then the clinician must minimize the risk of addiction by giving the least addictive substances and developing a plan to manage the use of the drug throughout the treatment period.

Journal Article↗
PubMed1991

[Pulmonary tuberculosis in patients with mental disorders, drug addiction and substance abuse].

The clinical manifestations, course and outcomes of pulmonary tuberculosis were studied in 215 patients with concurrent severe mental diseases (112 had schizophrenia and 103 other organic diseases of the central nervous system). The patients had mainly disseminated pulmonary tuberculosis with copious bacilli excretion and destruction. Their clinical manifestations and the course of a specific process were mainly progressive. Fatal outcomes were most common in tuberculosis patients with concurrent drug addiction and toxicomania. It is recommended that patients with mental diseases, narcomania and toxicomania should undergo a prophylactic fluorographic screening twice a year. Treatment of patients with tuberculosis and concurrent mental diseases should be combined and carried out by a psychiatrist (narcologist) jointly with a phthisiatrist.

Adult↗
PubMed2003

A national survey of the oral health status of homeless veterans.

OBJECTIVES: This study reports results from a survey designed to (1) assess the oral health needs of a national sample of homeless veterans and (2) compare the dental needs of homeless veterans participating in VA-sponsored rehabilitation programs with domiciled veterans in VA substance addiction programs. METHODS: Homeless veterans enrolled in a nationwide rehabilitation program (n = 1,152) completed a survey including questions concerning patients' perceptions of their oral health, dental service needs and use, and alcohol and tobacco use. A sample of these veterans (n = 281) subsequently received dental exams. A comparison group of domiciled veterans enrolled in VA substance abuse programs (n = 339) completed a similar survey. A sample of these veterans (n = 150) also received dental exams. RESULTS: Sociodemographic variables, patient-reported oral health information and risk behaviors, and findings from dental exams described two remarkably similar populations. CONCLUSIONS: As expected, the homeless veterans exhibited poor oral health, but it was not different from domiciled veterans enrolled in substance addiction programs. Lifestyle choices, such as heavy drinking and smoking, may contribute more to poor oral health than living conditions.

Adult↗
PubMedDate not supplied

[Individual susceptibility to addiction. Contribution of animal models].

Whereas the main clinical problem in drug addiction lies in individual vulnerability to toxicomania, experimental models of drug abuse usually focus on the brain targets involved in the reinforcing properties of drugs. In this short review, we describe the two main procedures of animal drug self-administration--retention and acquisition paradigms--designed to investigate the neural substrate of drug abuse and the individual susceptibility to toxicomania. Retention procedures have been widely employed since Weeks (1962) to study the reinforcing properties of various addictive substances in experimental animals, particularly opiates and psychostimulants. If the meso-accumbens dopaminergic pathway actually seems to underlie the reinforcing properties of psychostimulants, the question remains unsolved regarding opiates and other drugs of abuse such as benzodiazepines, nicotine or alcohol. Rather than a final common pathway for the reinforcing properties of drugs, the dopaminergic system could be considered as a modulator which enables the expression of addictive properties, supported by the interaction of drugs with other brain structures. Therefore, the neural substrate of drug reinforcement appears redundant and widespread rather than convergent and anatomically circumscribed. On the other hand, acquisition procedures deal with factors that influence the individual vulnerability to drug addiction in animals. This procedure measures the ability of animals to become dependent of low doses of addictive substances. Under various conditions such as stress, food deprivation or isolated housing, it is possible to detect changes in the vulnerability to drug consumption. Moreover, it is possible to detect behavioral characteristics that predict the vulnerability of animals to the spontaneous self-administration of psychostimulants.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1998

[Analgesic nephropathy].

Analgesic nephropathy is a slowly progressive disease caused by the chronic abuse of analgesic mixtures containing two analgesic components combined with potentially addictive substances (coffeine and/or codeine). Pathologically, the nephropathy is characterized by renal papillary necrosis with calcification and chronic interstitial nephritis sometimes in association with transitional-cell carcinoma of the uroepithelium. In the early stage, the clinical characteristics are polyuria, sterile pyuria, sometimes renal colic and haematuria. With further progression of the disease, there are the nonspecific symptoms of advanced renal failure. The incidence of classic analgesic nephropathy among Hungarian patients on chronic renal replacement therapy has proven. There is an urgent need for the estimation of analgesic nephropathy among patients with chronic renal disease and among patients with chronic pain presumably regularly taking analgesics in Hungary. As long as analgesic mixtures containing phenacetin or paracetamol and/or nonsteroidal antiinflammatory drugs and addictive substances are available "over-the-counter", analgesic nephropathy will continue to be a problem also in our country.

Analgesics↗
PubMed1991

[A study of high school students with alcoholic parents].

This is the first study in Japan which estimates the frequency of children with alcoholic parents in the general population and investigates the addictive substances abused by these children. In order to determine which children have alcoholic parents, a 10-item set of questions concerning the alcohol problems of parents known as CAST-J (Children of Alcoholics Screening Test-Japan) was prepared using CAST (Children of Alcoholics Screening Test) as a reference. In a preliminary survey, CAST-J and CAST were performed on 20 cases diagnosed as children of parents with alcohol-related problems by psychiatrists and 112 students of medically-related school. From these results, it was decided that those who had answered affirmatively to at least three of the 10 questions in CAST-J were children of alcoholic parents (parents with alcohol-related problems). The present survey was performed on 1,754 high school students who underwent the CAST-J and AAIS (Adolescent Alcohol Involvement Scale). The information on the experience of smoking and thinner inhalation was also obtained. Among these high school students, 11.6% of the total (8.4% of males and 15.2% of females) had alcoholic parents. Among the high school students with alcoholic parents, 21.7% were found to be alcohol misusers or alcoholic-like drinkers in the AAIS, which was significantly more than the 10.6% of students without alcoholic parents. This significant difference was seen for both males and females. It was also found that significantly more high school students with alcoholic parents had experienced smoking and thinner inhalation than those without such parents. In conclusion, it appeared that more than 10% of Japanese high school students have alcoholic parents, and they also often misuse addictive substances such as alcohol, tobacco and thinner.

Adolescent↗
PubMed1994

Analgesic nephropathy in Belgium is related to the sales of particular analgesic mixtures.

Analgesic nephropathy, a chronic progressive renal disease induced by the abuse of drugs containing analgesics and potentially addictive substances (e.g. caffeine, codeine), continues to be a serious problem in Belgium. A recent investigation (1990) of Belgian dialysis patients, including 54 of the 55 dialysis centres, established that 15.6% of the patients had analgesic nephropathy, showing a small decrease in prevalence compared to the 1979 and 1984 estimates. Considerable changes were observed in the sales figures of analgesic during the period 1983-1991. Phenacetin completely disappeared from the market and single analgesics, particularly paracetamol, gained large market shares. The total sales of single analgesics slowly increased, whereas the sales of analgesic mixtures decreased from 12.5 million to 8 million packages per year. In recent years the composition of most analgesic mixtures has been reduced to a single analgesic component in combination with caffeine and/or codeine. In comparing the geographical distribution of the sales of different analgesic products (1983) with the prevalence of analgesic nephropathy (1990), a strong correlation could be observed with particular analgesic mixtures, whereas this was not the case with single analgesics. This observation suggests that a careful analysis of sales data showing a high volume of analgesic mixtures sold, containing two analgesic substances combined with potentially addictive components, is a pharmacoepidemiological indicator for the presence of analgesic nephropathy in a given population.

Adult↗
PubMed2002

Aspects of guilt and self-reported substance use in adolescence.

The use of addictive substances is undergoing moralization in American society-behaviors once viewed as personal preferences now carry moral significance. Research has shown that sociomoral emotions like guilt, thought to be reflective of one's internalized standards and societal mores, can be an important influence on behavior. The present study explored the relationship between college students' self-reports of adolescent substance use (cigarettes, alcohol, and marijuana) and scores on indices tapping different aspects of guilt (Standards, Situational, and Chronic Guilt). Participants were 230 undergraduate students (mean age = 19; 55 percent female; 69 percent White). Substance users had lower scores on Standards and Situational Guilt than non-users, but no difference was observed in Chronic Guilt. The present results suggest that a stronger internalization of societal standards, as reflected by higher scores on Standards and Situational Guilt, may prove a useful tool in the prevention of substance use.

Adolescent↗