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[New addictions in the third millennium: anabolic steroids as a substance of abuse].
AIM: The abuse of anabolic steroids is emerging as a psychosocially significant issue. In the last few years the use of the substances has shifted from professional sports to amateur sports and certain occupations (bouncers, models, etc.). In the literature, steroid users are portrayed as multidrug users who engage in dangerous and aggressive behavior towards themselves and others. This study looks into the habits, lifestyles and psychological profiles of a group of subjects who make regular use of sports centres in the city of Palermo, Italy, with the aim of establishing how the abuse of anabolic substances is associated with a specific lifestyle and particular psychosocial behaviour. METHODS: A revision of the American Massachusetts Youth Risk Survey questionnaire (1993), adapted for the Italian context, and a personality assessment scale, The Adjective Check List (1980), were administered to a group of 71 subjects. RESULTS: Fifteen of these subjects admitted taking steroids with differing frequencies. Using Spearman's rho rank correlation, repeated use of anabolic steroids was found to be correlated with abuse of other types of drugs, risk behavior and a distinct personality pattern. Steroid abuse was found to be significantly correlated (r = 0.35, 0.31, 0.30, 0.28, P < 0.01) with illegal drug use (LSD, cocaine and heroin). CONCLUSIONS: It is therefore imperative to develop studies and analyses to investigate more thoroughly the phenomenon and its related psychological and social context in order to lay the foundations for a targeted prevention programme, especially in countries such as Italy where this type of drug abuse is still largely unrecognised and risks degenerating into a new, full-blown social disease.
Recognition, treatment and rehabilitation of narcotic dependent persons (addicts).
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[The case of Heikki (voluntary application for treatment of drug addiction)].
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Rcn Tutor Section winter conference: drugs and addiction.
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Increased central brain-derived neurotrophic factor activity could be a risk factor for substance abuse: Implications for treatment.
Drug addiction is a common psychiatric disorder with complex genetic, psychological and social contributing factors. While the midbrain dopaminergic system is crucial for acute reward and the initiation of addiction, evidence suggests that there are permanent neuronal changes at the cellular and molecular levels that underlie the addictive process. Brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family and the most abundant neurotrophins in the brain, plays a key role in the survival and differentiation of midbrain dopaminergic (DA) neurons. Evidence from animal and clinical studies suggests that increased central BDNF activity may be implicated in the pathogenesis of drug addiction. For example, BDNF infusion into rat midbrain enhances the rewarding effects of cocaine as measured by the condition place preference paradigm. In contrast, cocaine-conditioned place preference was reduced in heterozygous BDNF knockout mice. In humans, the 66Val allele of the BDNF-gene Val66Met polymorphism is associated with higher BDNF secretion in response to neuronal stimulation compared with the 66Met allele. We found higher BDNF 66Val homozygote frequency in people with drug addiction compared with normal controls. Furthermore, plasma BDNF concentrations of methamphetamine users were significantly higher than controls. The increased central BDNF activity hypothesis of drug addiction may provide new insights for improved therapeutic strategies for the prevention and treatment of drug addiction. Several strategies to decrease central BDNF activity that have potential use in the treatment of drug addiction are proposed.
Treatment needs of drug-addicted mothers. Integrated parenting psychotherapy interventions.
Substance abuse among women is associated with several negative maternal as well as child outcomes. This article reviews the theoretical and empirical literature on salient domains of risk and vulnerability among addicted mothers, with a view toward identifying critical components of effective intervention programs.
Feasibility of multidimensional substance abuse treatment matching: automating the ASAM Patient Placement Criteria. American Society of Addiction Medicine.
UNLABELLED: The Patient Placement Criteria published by the American Society of Addiction Medicine (ASAM Criteria) established a non-proprietary standard for matching substance use disorder patients to treatment settings. METHODS: Data from 593 substance dependent adults who were assessed using the first computerized implementation of the ASAM Criteria were analyzed to determine whether the level of care assignments showed significant differences on a variety of clinical measures. RESULTS: The algorithm showed acceptable discrimination between each of three ASAM Levels of Care across numerous clinical subscales. CONCLUSIONS: It is feasible to implement complex, multidimensional criteria for substance abuse treatment that may improve reliability and facilitate validity studies.
Pregnancy and addiction. A comprehensive care model.
The problem of substance abuse in pregnancy is a major public health dilemma. Effective comprehensive care of drug addicted women has been shown to improve maternal and neonatal outcomes. The Center for Addiction and Pregnancy (CAP) combines the disciplines of pediatrics, substance abuse treatment, obstetrics/gynecology, and family planning in an effort to reduce the barriers to care often presenting in this subpopulation. For the first 100 CAP births, 82% were delivered vaginally, with a mean gestational age of 38 weeks. The Neonatal Intensive Care Unit admission rate was 10%, and the Bayley Scales of Infant Development performed at 6 and 12 months revealed mean developmental indices within the normal range. In a comparison study, a group of CAP participants had nearly $5,000 savings in costs when compared to a matched cohort. The CAP model of care appears to be an effective mode of treatment for substance abusing pregnant women.
Severe mental illness and substance use disorders among former Supplemental Security Income beneficiaries for drug addiction and alcoholism.
BACKGROUND: Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DA&A) may be creating a residual population that is too seriously impaired to work owing to psychiatric and substance use disorders. METHOD: Data in this report were derived from 1-year follow-up interviews of 204 randomly selected DA&A beneficiaries in Chicago who were initially interviewed between January 1997 and March 1997, immediately following their termination in the Supplemental Security Income DA&A program. Information on subjects' work and benefits status were collected along with DSM-III-R psychiatric and substance use disorder diagnostic information. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, phencyclidine, amphetamines, and methadone. RESULTS: Twenty-six percent had a past-year severe mental illness while 34% met the DSM-III-R criteria for drug dependence. Illegal drug use was also prevalent with about 50% of the sample testing positive for marijuana, cocaine, or opiates. Compared with those working and earning at least $500 a month, unemployed or underemployed subjects who had lost all federal benefits had a much greater likelihood of being dependent on drugs (odds ratio, 5.0; P<.005; 95% confidence interval, 1.6-15.7) and of having 2 or more comorbid psychiatric disorders (odds ratio, 6.9; P<.005; 95% confidence interval, 1.9-24.7). CONCLUSIONS: Those who have lost DA&A disability benefits and who continue to be unemployed or underemployed have elevated rates of drug dependence and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult.
Ethical considerations in caring for women with substance use disorders.
People living with addiction endure many hardships, and this may be especially true for women who face distinct clinical and significant psychologic and socioeconomic repercussions of addictive disorders and their companion stresses. Clinicians who work with women with addictions are confronted by many challenges, particularly in the care of pregnant and parenting women. The dilemmas faced by patients with addictions and their providers often arise directly from tensions among core ethical principles, from inconsistencies in the way these principles are applied, and from the pervasive effects of stigma. Although difficult issues are to be expected in the arena of substance abuse treatment, consideration of principles of voluntarism, beneficence, respect for persons and justice, confidentiality and truth-telling, and informed consent are invaluable in shaping clinical ethical decision making. Furthermore, proactive steps can be taken to enhance the ethical caliber of care. These steps involve policy-level and systemic actions, such as the development and expansion of programs serving women's unique needs, empiric research into the most effective treatments for women with various disorders, and reexamination of legal and societal stances toward pregnant and parenting women who have addictions. In addition, local and individual steps are needed, including addressing gaps or inherent biases in programs, training counselors and clinicians in effective strategies or counseling styles, and developing awareness of one's own attitudes when dealing with difficult patients and challenging disorders. Such efforts will help ensure that women who have addictions will be cared for in a manner that is respectful, beneficent, compassionate, honest, and just.