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PubMed1996

Rapid assessment of drug abuse in Ethiopia.

A study of drug and substance abuse at Addis Ababa and in 24 towns across Ethiopia was conducted from June to November 1995. Five categories of respondents were selected for the study: street children, commercial sex workers and street vendors; medical, social and public health workers; law enforcement officials; leaders of religious institutions and educational establishments, youth leaders and personnel of non-governmental organizations providing social service to communities; and focus groups comprised of men and women from the various places covered in the study. All categories of respondents agreed that the problem of substance abuse was becoming increasingly serious in Ethiopia; that adolescents and young adults were the most affected group; and that addictive substances were easily obtainable in the country. The study also found that there was a significant increase in the number of Ethiopians chewing khat (Catha edulis). Khat, previously known to grow mainly in the eastern part of Ethiopia, was widely cultivated in all parts of the country. Khat consumption, traditionally confined to a certain segment of the population, had become popular among all segments of the population. Some of the respondents reported that khat-chewing often led to the abuse of illicit substances.

Adolescent↗
PubMed2000

Ultra rapid opiate detoxification as compared to 30-day inpatient detoxification program--a retrospective follow-up study.

PURPOSE: Ultra rapid detoxification (URD) has recently gained significant media attention as a promising treatment for opiate addiction. URD combined with follow-up naltrexone was portrayed as a quick and painless initial detoxification, as well as a long-term cure for the addiction. Following the therapeutic initiation of URD, articles began to emerge in the scientific literature. URD was skeptically viewed by the substance addiction treatment community, skepticism initially based on the theoretical understanding of addiction as a bio-psycho-social problem and the belief that detoxification and medication alone cannot provide long-term abstinence. This initial response was later supported by some scientific studies. URD continues to stir controversy, leading to this study. METHODS: We used available data to conduct a pilot study of URD, comparing it to traditional 30-day inpatient detoxification programs (IDP) used in Israel in achieving long-term abstinence. A sample of 226 men and women, 18 years or older, who entered detoxification in the IDP (N = 87) or in the URD (N = 139) were all clients who received treatment in either of these programs between March and September 1996. Eighty-one (92%) of the IDP subjects and eighty-two (60%) of the URD subjects were successfully interviewed by telephone 12 to 18 months after their participation in these programs. RESULTS: The results provide preliminary evidence that URD may be much less effective and more expensive than traditional treatment. No specific subgroup of clients benefited more from URD, although a prospective study employing random assignment might be more successful in identifying such a group. IMPLICATIONS: This study appears to offer justification for the current longer-term bio-psycho-social treatment alternatives for opiate addiction.

Adult↗
PubMed1997

Disability payments and chemical dependence: conflicting values and uncertain effects.

Receipt of public support payments by people with substance abuse disorders has been a subject of intense controversy in recent years. Observing that such funds are often used to purchase addictive substances, many critics have questioned whether people with chemical dependencies are entitled to such payments and whether they should be allowed to spend these funds unsupervised. This discussion introduces a special section of five data-based papers on the relation of disability payments to chemical dependence. The papers address five questions: Do public support payments worsen substance abuse in vulnerable populations? Does assignment of a representative payee reduce substance abuse among such beneficiaries? What money management procedures are most likely to yield positive outcomes for clients? How can clients who need payees be fairly identified? And how should skilled, responsible payees or guardians be recruited, trained, and retained? In the absence of scientific data, both clinical practice and social policy are vulnerable to the whims of public opinion. These papers shed new light on a heated area of policy debate.

Eligibility Determination↗
PubMed2000

Zyban: an effective treatment for nicotine addiction.

Recent research has identified nicotine as a powerfully addictive substance. This article outlines how the new non-nicotine smoking cessation drug, Zyban, can help people to break the cycle of addiction and stop smoking.

Adolescent↗
PubMed1998

Dual diagnosis: approaches to the treatment of people with dual mental health and drug abuse problems.

People with a dual diagnosis of mental health and drug or alcohol abuse problems may fall between existing specialist services, which tend to focus on treating one or other problem. DAVID MANLEY argues the case for a flexible, individualised approach to treatment which acknowledges the biological and psychosocial features of the co-existent problems and draws on clinical knowledge and skills from both the mental health and substance addiction professions.

Comorbidity↗
PubMed1989

The educational impact of a course about addiction.

The purpose of this study was to evaluate the impact of a nursing course about addiction on baccalaureate nursing students' attitudes toward addictive substances and on their personal lifestyle behaviors. The course was a three-credit, 15-week offering, focusing on: 1) learning to care for addictive clients, and 2) learning to value responsible attitudes and healthy lifestyle behaviors, as a strategy for primary prevention of addiction in the nursing profession. A non-random treatment group of 46 students enrolled in the course was compared with a control group of 36 students. Data were collected at the beginning and end of the term using Goodstadt's Drug Attitudes Scale and the Healthstyle Self-Test, and analyzed using a two-way analysis of variance with repeated measures over time. The treatment group made significantly greater changes than did the control group when measured by the tobacco subscale and the opiates subscale. Both groups showed a significantly decreased ability to manage stress at the end of the term. In addition, a subgroup of students who indicated a family background of drug or alcohol abuse reported significantly different lifestyle behaviors when compared with a subgroup of students whose families did not use drugs or alcohol.

Adolescent↗
PubMed1996

A study of the dopamine D2 receptor gene in pathological gambling.

Pathological gambling has been termed both the 'pure' and the 'hidden' addiction. 'Pure' because it is not associated with the intake of any addicting substance, and 'hidden' because it is an extension of a common, socially accepted behaviour. The Taq A1 variant of the human DRD2 gene has been associated with drug addiction, some forms of severe alcoholism, and other impulsive, addictive behaviours. We have sought to determine if there is a similar association with pathological gambling. A total of 222 non-Hispanic Caucasian pathological gamblers from multiple sites across the US participated in the study. Of these 171 donated a sample of blood, 127 filled out several questionnaires, and 102 did both. Of the 171 pathological gamblers 50.9% carried the D2A1 allele versus 25.9% of the 714 known non-Hispanic Caucasian controls screened to exclude drug and alcohol abuse, p < 0.00000001, odds ratio (OR) = 2.96. For the 102 gamblers who filled out the questionnaires, 63.8% of those in the upper half of the Pathological Gambling Score (more severe) carried the D2A1 allele (OR versus controls = 5.03), compared to 40.9% in the lower half (less severe). Of those who had no comorbid substance abuse, 44.1% carried the D2A1 allele, compared to 60.5% of those who had comorbid substance abuse. Forty-eight controls and 102 gamblers completed a shorter version of the Pathological Gambling Score. Of the 45 controls with a score of zero, 17.8% carried the D2A1 allele. Of the 99 gamblers with a score of 5 or more, 52.5% carried the D2A1 allele (chi 2 = 15.36, p = 0.00009). These results suggest that genetic variants at the DRD2 gene play a role in pathological gambling, and support the concept that variants of this gene are a risk factor for impulsive and addictive behaviours.

Adult↗
PubMed2006

Pharmacological approaches to smoking cessation.

Smoking, the most prominent nongenetic factor contributing to mortality, remains the major public health problem throughout the world. There are nearly 1.1 billion users of nicotine and tobacco products worldwide while approximately one third to half of them will die from smoking-related disease. The habit of smoking is mainly propelled by nicotine, a strongly addictive substance, to which the vast majority of smokers fall victim. Except for the general and specific support and counseling strategies there are now effective treatments for nicotine addiction. Two types of pharmacological therapies have been approved and are now licensed for smoking cessation. The first therapy consists of nicotine replacement, substituting the nicotine from cigarettes with safer nicotine formulations. The second therapy is bupropion, an antidepressant of the aminoketone class, which has been demonstrated to be effective in smoking cessation. However, although some cigarette smokers are able to quit, many are not, and standard medications to assist smoking cessation are ineffective. Several agents used for other indications (e.g. neurological diseases, depression, alcoholism) might be used to treat this subgroup. In conclusion, new more effective drugs are needed in order to fight the panepidemic of smoking globally.

Bupropion↗
PubMed2006

The development of a research agenda for substance use disorders diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V).

AIMS: This paper describes the background to the establishment of the Substance Use Disorders Workgroup, which was charged with developing the research agenda for the development of the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It summarizes 18 articles that were commissioned to inform that process. METHODS: A preliminary list of research topics, developed at the DSM-V Launch Conference in 2004, led to the identification of subjects that were subject to formal presentations and detailed discussion at the Substance Use Disorders Conference in February 2005. RESULTS: The 18 articles presented in this supplement examine: (1) categorical versus dimensional diagnoses; (2) the neurobiological basis of substance use disorders; (3) social and cultural perspectives; (4) the crosswalk between DSM-IV and the International Classification of Diseases Tenth Revision (ICD-10); (5) comorbidity of substance use disorders and mental health disorders; (6) subtypes of disorders; (7) issues in adolescence; (8) substance-specific criteria; (9) the place of non-substance addictive disorders; and (10) the available research resources. CONCLUSIONS: In the final paper a broadly based research agenda for the development of diagnostic concepts and criteria for substance use disorders is presented.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2000

An ethnographic study of the longitudinal course of substance abuse among people with severe mental illness.

A two-year ethnography conducted among 16 dually diagnosed clients yielded two longitudinal findings. First, four "positive quality of life" factors were strongly correlated with clients' efforts to cease using addictive substances: (1) regular engagement in an enjoyable activity; (2) decent, stable housing; (3) a loving relationship with someone sober who accepts the person's mental illness; and (4) a positive, valued relationship with a mental health professional. Second, the study revealed that five "negative background factors" in participants' childhood homes were predictive of long-term continuation of substance use: (1) substance abuse in childhood home, (2) childhood household in dire poverty, (3) "non-functional" household members, (4) reporting of abuse imputed to care-givers, and (5) serious mental illness in household. The implications of these findings for treatment are discussed.

Anthropology, Cultural↗
PubMed1996

Electrostimulation: addiction treatment for the coming millennium.

At a period of fundamental review of the health care system, it is timely to re-assess one of medicine's most intractable problems--the treatment of addictions. The apparently insoluble dilemmas posed by the acute and chronic withdrawal syndromes underlie universally high drop-out and relapse rates. In a decade of HIV and AIDS infection, poly-substance addiction, potent street drugs, and ossified treatment strategies, it is urgent that policy formulators investigate seriously a flexible system of non-pharmacological transcranial electrostimulation treatment, based on its record of rapid, safe, and cost-effective detoxification in several countries, as one innovative contribution to the challenges presented by addiction in the 1990s. This is a brief report of the introduction of NeuroElectric Therapy (NET) into Germany, describing the responses of the first 22 cases. The daily progress of a heroin addict and a methadone addict are detailed: both were treated as outpatients for 8 hours daily, for 7 and 10 days respectively.

Electric Stimulation Therapy↗
PubMedDate not supplied

Nicotine dependence in women.

Cigarette smoking is the most preventable cause of death in the United States, accounting for the deaths of approximately 140,000 women annually. Despite the known health risks, women continue to begin and continue smoking at high rates. Like other addictive drugs, nicotine becomes reinforcing with repeated use, induces euphoric sensations, and is self-administered. Tolerance to nicotine's effects develops rapidly and leads to increased use. Reducing or suppressing tobacco consumption produces a withdrawal syndrome characterized by irritability, difficulty concentrating, cognitive impairments, and weight gain. These withdrawal symptoms, along with other factors, lead to relapse rates comparable to those following cessation from other addictive drugs. This review article discusses the pathogenesis of nicotine addiction compared to other addictive substances such as cocaine and heroin with an effort to provide comparative data for men and women.

Adolescent↗
PubMed1986

16PF items discriminating recidivists and long-term recovered polyaddicts.

Responses to 65 of the 187 items on Cattell's 16PF test were skewed by 83 members of Alcoholics Anonymous. Seventeen of those items had significantly different distributions when the 18 recidivists were compared to the 8 who had remained clean of all addictive substances and compulsive behaviors during the 2-year period studied. Another 14 items had significantly different distributions when the recidivists were compared to all the others. Comparisons with non-drug-disadvantaged groups and non-AA recovering addicts are suggested in order to isolate empirical predictor items for "addictive" versus "cured" scales.

Alcoholics Anonymous↗
PubMed1992

Addiction as a form of perversion.

Psychoanalytic treatment of addiction is often ineffective because therapists fail to recognize addiction as a discrete disorder. The author reviews psychoanalytic theories of addiction and presents an alternative concept comprising biological, behavioral, and psychological characteristics. She compares the structural similarities between addiction and perversion and describes the use of the addictive substance as a fetish object. Finally, she discusses the implications of psychoanalytically oriented treatment and advocates a multimodal treatment approach.

Behavior, Addictive↗
PubMed2006

The fatty acid amide hydrolase 385 A/A (P129T) variant: haplotype analysis of an ancient missense mutation and validation of risk for drug addiction.

The human fatty acid amide hydrolase (FAAH) missense mutation c.385 C-->A, which results in conversion of a conserved proline residue to threonine (P129T), has been associated with street drug use and problem drug abuse. Although a link between the FAAH P129T variant and human drug abuse has been reported, the extent of risk and specific types of substance addiction vulnerability remain to be determined. Here, we investigated the relationship of the FAAH P129T variant to a number of linked single nucleotide polymorphisms to establish a haplotyping system, calculate the estimated age and origin of the FAAH 385 C-->A mutation and evaluate its association with clinically significant drug addiction in a case control study. The results showed a significant over-representation of the FAAH P129T homozygotes in 249 subjects with documented multiple different drug addictions compared to drug free individuals of the same ethnic backgrounds (P = 0.05) using logistic regression analysis controlling for ethnicity. To increase the logistic regression analysis power by increasing the sample size, the data from our previous study (Sipe et al. in Proc Natl Acad Sci USA 99:8394-8399, 2002) were pooled with the present cohort which increased the significance to P = 0.00003. Investigation of the FAAH chromosomal backgrounds of the P129T variant in both multiple different drug addicted and control subjects revealed a common ancestral haplotype, marked population differences in haplotype genetic diversity and an estimated P129T mutation age of 114,425-177,525 years. Collectively, these results show that the P129T mutation is the only common mutation in the FAAH gene and is significantly associated with addictive traits. Moreover, this mutation appears to have arisen early in human evolution and this study validates the previous link between the FAAH P129T variant and vulnerability to addiction of multiple different drugs.

Black or African American↗
PubMed1995

Medicalizing the war on drugs.

Most medical colleges, teaching hospitals, and other health education and treatment institutions are already expanding their horizons to include attention to the public health needs of their communities. But one pressing public health problem--substance abuse--that should be treated as a disease and handled by doctors and nurses is at present entrusted primarily to law enforcement. The author believes that this is the wrong approach: the War on Drugs is not working, and drug laws are inconsistent and illogical. Changes in national drug policies must be changed. The author has called for a national commission to study how all drugs--legal and illegal--should be regulated. He advocates a health-regulatory strategy, sometimes called "medicalization," whereby the government would set up a regime to pull addicts into the public health system and would control the price, distribution, purity, and access to addictive substances, just as it now does with prescription drugs. This would take the profit out of drug trafficking. Addicts would be treated and if necessary maintained under medical auspices. Baltimore began its own version of medicalization in the summer of 1994 with a needle-exchange program, an approach that has elsewhere led to dramatic drops in AIDS infection and drug-related crime. Baltimore also has a mobile van for methadone treatment and is getting help from public and private sources for increased drug treatment and prevention programs. In the medicalization of the War on Drugs, the nation's medical colleges, schools of public health, teaching hospitals, and nursing schools all have roles to play.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug and Narcotic Control↗
PubMed2001

Do treatments and other interventions work? Some critical issues.

A variety of interventions, both therapeutic and preventive, have been used to control, reduce or eliminate substance use and misuse and their attendant problems. Yet, despite years of ever more sophisticated and expensive ways of responding to the use and misuse of a variety of legal and illegal substances, addiction continues to be experienced as a major social problem that plagues users, their families and communities, therapists and clinicians, policymakers, and the public. In view of a recidivist treatment population and finite resources, this paper considers whether and to what extent treatments and other interventions used for planned interventions with alcohol- and drug-use related problems work. It examines both clinical treatment outcomes and broad-based population prevention interventions, and reviews their underlying rationales. Finally, it identifies a number of areas that must be addressed if we are to improve the situation. These areas include a lack of agreement on what is meant by the problem of "addictions," how successful interventions are to be defined and measured so that better interventions can be applied in the future, as well as integrating the processes of quality and appropriateness into the planning, implementation and assessment of effective, needed substance use intervention.

Alcoholism↗
PubMed1996

[Possibilities and limits of drug substitution treatment in ambulatory practice].

The controversial discussion about the use of methadone in the treatment of drug addicts has occupied specialists in West Germany for decades. Owing to the political pressure to find a solution to the drug problem, methadone has been an established place in the classical drug treatment system for a long time. Therefore, there has been a supplement (in 1991) to the guidelines of the N.U.B. that under special conditions, it is now possible, for a physician working in a practice or outpatient clinic to use methadone substitution as a routine procedure. The psychosocial care of the patient ist also very important in addition to the purely medical provision of a substitute drug which blocks the heroin hunger and helps prevent criminal activity. The profound dependence of a drug addict is not created primarily by the consumption of addictive substances but must be seen as the result of a severely disturbed personality development and treated accordingly. The individual context of the particular drug scene, scene behavior and jargon should also be taken into account. It is not sufficient to explain addiction and dependence by means of chemical formula or physiological processes. Thus, a substitution treatment always includes two crucial aspects: the soothing and protecting aspect of the medicine administered and the conflict and insight orientated aspect of the therapeutic commitment. The physician, the clinic employees and the social worker should be comprehensively and thoroughly qualified in order to deal with the equally wide-ranging demands of substitutions therapy.

Ambulatory Care↗