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Drug addiction.

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Humans↗

Vulnerability to substance abuse and psychopathology among siblings of opioid abusers.

Vulnerability to drug abuse and psychopathology was explored among siblings of 201 opioid-addicted probands. Disorders were evaluated based on family histories among 476 siblings; a subset of 133 siblings was also directly interviewed. Results indicated that a) siblings of opiate addicts had substantially higher rates of several disorders in comparison with rates in the community; b) as compared with parents of addicts, siblings had elevated rates of substance abuse and antisocial personality; c) the presence of a major psychiatric disorder significantly increased the risk of developing substance abuse among siblings; and d) psychopathology appeared to precede drug abuse in terms of age of onset in this group. Results obtained with the interviewed sample of siblings were replicated in the overall group. Findings of the study are discussed in terms of implications for the classification and treatment of substance abuse.

Adult↗

Stress-coping and temptation-coping as predictors of adolescent substance use.

The stress-coping model of addiction posits that stress-coping and temptation-coping skills each make an independent contribution to the likelihood of substance use. Despite the popularity of this model, this proposition has never been examined empirically. The current study tested this proposition using a sample of public high school students (n = 332). Results supported the model, as stress-coping and temptation-coping each accounted for statistically unique and significant variance in teenagers' substance use. In addition, substance-abusing adolescents reported engaging in significantly more avoidance stress-coping and significantly less temptation-coping than demographically-matched nonsubstance-abusing adolescents. Our results replicate and expand previous findings from the stress-coping literature and have implications for future research and intervention efforts in the adolescent substance abuse field.

Adaptation, Psychological↗

When acute-stage psychosis and substance use co-occur: differentiating substance-induced and primary psychotic disorders.

Substances such as alcohol, cocaine, amphetamine, and cannabis can produce psychotic reactions in individuals who are otherwise free of serious mental illness. However, persons with primary psychotic disorders, such as schizophrenia and bipolar disorder, who use these substances often present for treatment with signs and symptoms similar to those whose psychosis resulted from the use of drugs alone. While it is often difficult to distinguish substance-induced from primary psychoses, especially early in the course of treatment, this differential diagnosis has important implications for treatment planning. To help clinicians distinguish these two types of presentations, the authors first review the types of psychotic symptoms that can co-occur with substance use. They discuss the prevalence and patterns of substance use that have been found in patients with schizophrenia and other primary psychotic disorders and review the negative outcomes associated with substance use in this population. The prevalence of and types of symptoms and problems associated with psychotic symptoms that occur as a result of substance use alone are also reviewed. The authors describe assessment procedures for differentiating substance-induced and primary psychotic disorders. They stress the importance of accurately establishing the temporal relationship between the substance use and the onset and continuation of psychotic symptoms in making a differential diagnosis, as well as the importance of being familiar with the types of psychological symptoms that can occur with specific substances. The authors review the utility and limitations of a number of diagnostic instruments for assessing patients with co-occurring psychosis and substance use problems, including The Addiction Severity Index, The Michigan Alcohol Screening Test, and diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia and the Structured Clinical Interview for DSM. They then discuss the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), an instrument that has been developed to address the lack of a diagnostic interview that is suitable for assessing the comorbidity of substance use and psychiatric disorders. The article concludes with a discussion of the importance of an appropriate match between diagnosis and treatment and the current state of our knowledge concerning the most appropriate types of treatment interventions for patients with substance-induced psychosis and those with dual diagnoses.

Journal Article↗

History of addiction: a UK perspective.

The level of substance misuse in Britain has fluctuated over recent centuries, reaching its nadir in the early twentieth century. Since then, the trends for alcohol and drug abuse (though not for tobacco consumption) have risen steadily. British physicians have played a major role in the emergence of the addiction concept, from the initial challenge to Galen's theories to the now widely adopted Alcohol Dependence Syndrome. While treatment has been influenced by contemporary attitudes, it has been generally underpinned by pragmatism and has avoided the punitive responses seen in other parts of the world.

Alcohol-Related Disorders↗

Childhood trauma and posttraumatic stress disorder in substance abuse inpatients.

This pilot study examined: the prevalence of childhood trauma in a sample of male veteran substance abuse inpatients, and the relationship of childhood trauma to substance abuse in this sample, controlling for posttraumatic stress disorder (PTSD). Forty-six subjects were interviewed using the Traumatic Antecedents Questionnaire, Structured Clinical Interview for DSM-III-R (SCID)-P Psychoactive Substance Use Disorders module, the Addiction Severity Index, and the SCID-NP-V PTSD module. Seventy-seven percent of subjects had been exposed to severe childhood trauma. Fifty-eight percent had lifetime PTSD. The total number of lifetime substance dependence disorders was strongly positively associated with total childhood trauma exposure. This relationship remained significant after controlling for demographics, family history of alcohol problems, combat exposure, and lifetime PTSD, including combat-related PTSD. A substantial number of these subjects reported exposure to childhood trauma, which in turn was related to multiple substance dependence. This has important implications for the natural history and prevention of multiple substance dependence disorders.

Adolescent↗

[Sporting activities and psychoactive substance use. Data abstracted from the French part of the European School Survey on Alcohol and other Drugs (ESPAD 99)].

Few studies have analyzed in the general population psychoactive substance use among athletes, especially among females. In fact, sporting activity is often promoted in prevention actions, as an alternative to addiction or alcohol, tobacco or other substance misuse. So, we propose an analysis of the ESPAD 1999 sample among students (16-18 years old), focused on the relationship between sporting activities and substance use. Boys play sport more frequently than girls (71.5% versus 49.5%) and report 8 hours and more a week 4 more times than girls (14% versus 3.5%). Sixty-eight percent of boys and 36% of girls have already participated in sport competitions, more often at a local, departmental or regional level; a minority of them (26% of boys and 20% of girls) have already participated in sport competitions at a national or international level. Sporting activity is decreasing with age among girls, students from general lycée play sport more frequently than others do (vocational lycée); the higher the father's education level, the more frequently the students play sport. Moderate sporting activity (1-8 hours a week) is a protective factor against regular smoking (OR=0.54 in boys and OR=0.60 in girls) and against regular cannabis use among boys (OR=0.64). Intensive sporting activity (>8 hours a week) is a risk factor for illicit drugs (except cannabis) use (OR=2.74) and sleeping drugs/tranquillizers (OR=1.82) only among girls. Competition level is the most important risk factor for substance misuse as well in boys (except sleeping drugs/tranquillizers) as in girls. Practical implications are: adjusting health policy concerning the beneficial effects of sporting activity, raising sports associations abilities and avoiding doping and addiction in high-level sporting activities.

Adolescent↗

Substance abuse as a symptom of childhood sexual abuse.

The recovery process of a 37-year-old woman with adult onset posttraumatic stress disorder (PTSD) is presented. The patient had suffered childhood sexual abuse and had self-medicated for many years with drugs and alcohol to maintain the dissociation of memories of abuse and to facilitate interpersonal functioning. Upon onset of PTSD, the patient's substance abuse became a full-blown addiction that was highly resistant to treatment. It became evident that her substance abuse symbolically repeated her traumatization. In reexperiencing the affects associated with her earlier trauma (despair, denial, shame, and helplessness) as part of her substance abuse and in the transference, the patient was able to gain mastery over these affects and, subsequently, was able to achieve a stable recovery from both illnesses.

Adult↗

Naloxone challenge as a biological predictor of treatment outcome in opiate addicts.

Thirty seven consecutive applicants to methadone maintenance were assessed for depression and for level of opiate dependence using a 0.8-mg naloxone challenge. Nineteen of the applicants met DSM-III-R criteria for current major depression. At 3-month follow-up, high naloxone challenge test (NCT) scores at intake (high levels of opiate addiction) were found to predict poor program retention and elevated symptoms of depression at follow-up. Reports of heavy current drug use at intake were also associated with poor program retention and with high frequencies of positive urine screens for illicit substances during treatment. Level of addiction and reported amount of drug use at intake independently predicted program retention with a multiple correlation of 0.46 (P less than .01). Although NCT predicted depression at follow-up, depression at intake did not significantly predict treatment outcome, and NCT score predicted outcome independently of psychopathology.

Arousal↗