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PubMed1995

Nutritional assessment of drug addicts.

OBJECTIVE: To discern if factors such as organic pathology, sex, duration and/or intensity of drug addiction, alcohol abuse, hepatitis B infection, anorexia with poor food and drink consumption, or disturbance of social and familial networks, are related to an impaired nutritional status in hospitalized drug addicts. DESIGN: Cross-sectional prospective study. SETTING: Detoxication unit and internal medicine unit of a university hospital. PATIENTS: 140 drug addicts without acute organic pathology and 18 with acute organic pathology related to drug addiction. The immunological study was compared with a control group composed of 50 healthy and well-nourished individuals (26 women and 24 men), age-matched with our patients. RESULTS: Drug addicts without organic pathology were under-nourished: 92.4% weighed under the mean weight for the population and 55.7% had had a weight loss above 5%. The distribution of mid-upper arm circumference (MUAC), triceps skinfold (TSF) measurement and mid-arm muscle area (MAMA) compared with the percentiles for the population showed a shift towards lower values. We found a high percentage of patients with a high lymphocyte count (55%). Despite the high lymphocyte count, delayed hypersensitivity was depressed in our patients. Of our patients, 66.4% exhibited anorexia at admission. The mean calorific intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. However, in most cases, malnutrition (usually marasmus-like malnutrition) was not very severe; only 30% of the drug addicts weighed less than 80% of the mean weight for the population, or admitted to a weight loss above 10%, and by subjective nutritional assessment, only 18% were deeply malnourished. Otherwise, the nutritional status was very poor in drug addicts with acute organic pathology. We also found a worse nutritional status in our patients related to female sex, intensity of drug addiction, anorexia with poor food and drink consumption, and disturbance of the social and familial networks. CONCLUSIONS: Many drug addicts suffer from calorie and protein malnutrition. This mainutrition is related to female sex, intensity of drug addiction, anorexia and poor food and drink consumption, and disturbance of the social and familial links. Acute organic pathology leads to a significant worsening of the nutritional status of drug addicts.

Adult↗
PubMed1986

[Drug addiction, anorexia: what is the connection?].

Drug addictive and anorexic behaviours come from a same desire to reach an eventual autonomy. Drug addicts and anorexic people fight against dependency by instituting a new dependency, the one which ties them up to their behaviours; nevertheless this substitution from one dependency to another one does not happen by chance, it is chosen by these adolescents in order to allow them a possible structuring modification. These latter having difficulties to internalize "the father's law" in a certain way prepare the ground on which the law will become real by setting up a new alienating situation. In a way, drug addictive and anorexic behaviours carry out a "paternal metaphor" that is to say a metaphor which substitutes the "no of the father" to the place first symbolized by the operation of the mother's absence.

Adolescent↗
PubMed1994

[Risk of suicide in young drug addicts].

A high risk of suicide was found in young drug addicts. The risk was especially serious when drug addiction was accompanied by severe personality disorder, depression, or both. Lifetime rates of completed suicide in drug addicts are estimated at 2.5-7.0%, and rates of suicide attempts at 8.0-17.2%. These age-adjusted rates are 5-20 times greater than for the general population. 2 cases of completed suicides by drug addicts in a psychiatric hospital, a man of 32 and a woman of 26, are presented. We recommend increased precaution in handling drug addicts, as for depressed patients with a high suicide risk.

Adult↗
PubMed1993

[Prevalence of antibody to hepatitis C virus in 177 drug addicts].

Antibody to hepatitis C virus (anti-HCV) was measured by enzyme-linked immunosorbent assay (ELISA) in 167 intravenous drug addicts, 10 oral drug addicts, 49 patients without liver disease and 58 blood donors. It was found that the prevalent rate of anti-HCV in these groups were 92.2%, 10%, 2.0% and 1.7%, respectively. It is also noted that the prevalence of anti-HCV for intravenous drug addicts was significantly higher than that for oral drug addicts, patients without liver disease, and blood donors (P < 0.001). There was no significant difference among the later three groups. It is indicated that intravenous drug addicts are high-risk group of HCV infection. Injecting drug with injectors of HCV carrier, injectors and/or solvent not being sterilized may contribute to prevalence of HCV in these groups. It is similar that the distributions of HCV infection in intravenous drug addicts with different trait.

Adolescent↗
PubMed1992

[Drug addiction in Lebanon].

This paper studies the expansion of drug addiction in Lebanon during the years of civil war (1973-1990). A social and historical review of the problem of drugs in Lebanon is presented as an introduction. The profile of the lebanese drug addict is studied in its various components: 1) The average age at hospitalization is around 30 years; the first intake of drugs between 13 and 35 years (mean 20). 2) The sex ratio is 8:2 male to female. The war has especially affected men in their encounter with drugs. 3) Heroin is the most widely used product (80.5%), often in combination with other drugs like hashish or cocaine. Only 17% use it intravenously, the rest by inhalation. 4) There is a certain "democratization" of the phenomenon of drug addiction (23% from the lower socioeconomic class). 5) A preponderance of drug addicts in the big cities like Beirut and Tripoli. 6) Only 20% have an underlying psychopathology responsible for the intake of drugs (psychosis, neurosis). The war has been found conducive to the eclosion of drug addiction by increasing the prevalence of the products, the psychological fragility of the lebanese people, the economic crisis and the more permissive sociocultural context.

Adolescent↗
PubMed1975

Conditioned avoidance behavior in pretrained rats intermittently treated with addictive drugs.

Rats pretrained in a conditioned avoidance (CAR) paradigm were put on eight potentially addictive drugs in drinking water at two dose levels each. Fluid intake and body weight, monitored during the drugged (addiction) and nondrugged (withdrawal) states, showed drug/dose-dependent fluctuations in most groups. Extinction and relearning trials were spread over both drug and nondrug phases. CAR-performance generally deteriorated in the early drug phase but improved to near normalcy during the late drug and withdrawal phases in all groups except for alcohol and barbiturate-treated one. Excluding amphetamine, low-dose morphine and phenobarbital groups, substantial extinction of CAR occurred during the drug phase only; these three groups, as well as the high-dose alcohol, barbiturates and medazepam ones, showed extinction during the nondrug phase also. The rate and extent of a second-order relearning neither differed significantly between the groups nor was truly contingent upon prior extinction. These results are discussed in the light of state-dependent learning, comparing them with those from another series of rats primarily trained under the influence of these addictive drugs.

Amphetamine↗
PubMed2001

Drug addiction: functional neurotoxicity of the brain reward systems.

Drug addiction is a chronic relapsing brain disorder characterized by a compulsion to take a drug with loss of control over drug intake. The hypothesis under discussion here is that chronic drug use produces long-lasting dysfunctions in neurons associated with the brain reward circuitry, and this "functional neurotoxicity" of drugs of abuse leads to vulnerability to relapse and continued drug dependence. Several sources of reinforcement are associated with various components of the drug addiction cycle and much progress has been made in identifying the midbrain-basal forebrain neural elements involved in the positive reinforcing effects of drugs of abuse and more recently in the neural elements involved in the negative reinforcement associated with drug addiction. Key elements for the acute reinforcing effects of drugs of abuse include a macrostructure in the basal forebrain called the extended amygdala that contains parts of the nucleus accumbens and amygdala and involves key neurotransmitters such as dopamine, opioid peptides, serotonin, GABA, and glutamate. Withdrawal from drugs of abuse is associated with subjective symptoms of negative affect and dysregulation of brain reward systems involving some of the same neurochemical systems implicated in the acute reinforcing effects of drugs of abuse. In addition, the functional toxicity of acute withdrawal is accompanied by recruitment of the brain stress neurotransmitter system corticotrophin-releasing factor. During more prolonged abstinence, post-acute withdrawal, evidence is accumulating of continued dysregulation of the neural systems associated with drug reinforcement and stress, regulation that may represent more subtle but persistent functional neurotoxic effects of chronic drug use and could be responsible for long-lasting vulnerability to relapse. Such functional neurotoxicity could be hypothesized to lead to a change in set point for drug reward that may represent an allostatic state contributing to vulnerability to relapse and re-entry into the addiction cycle. Elucidation of the specific neuropharmacological changes contributing to this prolonged functional neurotoxicity will be the challenge of future research on the neurobiology of drug addiction.

Journal Article↗
PubMed1991

Dual diagnoses: psychiatric syndromes in alcoholism and drug addiction.

Concomitant psychiatric illness and alcohol or drug addiction are difficult to diagnose and treat. Alcohol and drug problems are significantly underdiagnosed in medical and psychiatric populations, while psychiatric disorders may be underdiagnosed in alcohol- and drug-addicted patients. An understanding of addiction and psychiatric disorders is essential for successful treatment of the comorbidity of these disorders. Alcohol or drug addiction frequently produces significant psychiatric syndromes, which may resolve during periods of sobriety. The combination of addiction and established psychiatric disorders is less common.

Alcoholism↗
PubMed1992

[Drug addiction and pregnancy].

In drug-addicted women pregnancy is always at risk and difficult to supervise owing to the social and psycological profiles of these women. At the moment, we are dealing in France mainly with pregnancies that occur in heroin addicts and frequently have the following complications: lack of follow-up, prematurity, short child stature, infections (notably HIV infection) and weaning syndrome in the newborn. Due to improvements in the management of these patients, the neonatal mortality has been considerably reduced and has become exceptional. In the USA the number of pregnancies occurring in cocaine addicts has increased, and complications similar to those of heroin addicts have been observed, particularly with crack. It is not impossible that we might soon be confronted with this type of drug addiction.

Female↗
PubMed1980

[Adolescents and drug-addiction (author's transl)].

Drug-addiction is one of the most common psychopathologic behavior in adolescents. Three questions were considered in this study: how does the adolescent meet drug? What does drug-addiction mean? Which practical attitudes could be proposed? An answer to these three fundamental questions is drawn through three cases.

Adolescent↗
PubMed2002

Role of dopamine, the frontal cortex and memory circuits in drug addiction: insight from imaging studies.

Drug addiction is characterized by a set of recurring processes (intoxication, withdrawal, craving) that lead to the relapsing nature of the disorder. We have used positron emission tomography to investigate in humans the role of dopamine (DA) and the brain circuits it regulates in these processes. We have shown that increases in DA are associated with the subjective reports of drug reinforcement corroborating the relevance of drug-induced DA increases in the rewarding effects of drugs in humans. During withdrawal we have shown in drug abusers significant reductions in DA D2 receptors and in DA release. We postulate that this hypodopaminergic state would result in a decreased sensitivity to natural reinforcers perpetuating the use of the drug as a means to compensate for this deficit and contributing to the anhedonia and dysphoria seen during withdrawal. Because the D2 reductions are associated with decreased activity in the anterior cingulate gyrus and in the orbitofrontal cortex we postulate that this is one of the mechanisms by which DA disruption leads to compulsive drug administration and the lack of control over drug intake in the drug-addicted individual. This is supported by studies showing that during craving these frontal regions become hyperactive in proportion to the intensity of the craving. Craving is also associated with activation of memory circuits including the amygdala (implicated in conditioned learning), hippocampus (implicated in declarative learning), and dorsal striatum (implicated in habit learning) all of which receive DA innervation. We therefore postulate that dopamine contributes to addiction by disrupting the frontal cortical circuits that regulate motivation, drive, and self-control and by memory circuits that increase the motivational salience of the drug and drug-associated stimuli.

Amygdala↗
PubMed1989

Prevalence of hepatitis B virus, delta agent and human immunodeficiency virus infections in drug addicts.

Infections with the hepatitis B (HBV) and delta (HDV) viruses and with the human immunodeficiency virus (HIV) are very common among intravenous drug addicts. The serum of 80 percent of drug addicts contains one of the HBV markers, and 15 percent of them carry an anti-D antibody. Infections with the hepatitis A and non A-non B viruses are also very common among drug abusers. Some of them may harbour several of these pathogens. This can explain the frequency of liver disease (biological anomalies and histological lesions) observed in drug addicts, as does alcohol consumption associated with drug abuse. Fifty to 60 per cent of intravenous drug addicts are seropositive for HIV. This prevalence varies across studies and countries. The high prevalence of infection by HIV in drug addicts may be explained by the use of a shared syringe. This prevalence exposes drug addicts to an increase in AIDS cases in the near future. The high prevalence of infections by HBV, HDV and HIV in drug addicts represents a risk factor for the spread of HBV, HDV and HIV infections among the general population. Preventing the rapid spread of these viruses among drug addicts is of utmost importance for the future.

Acquired Immunodeficiency Syndrome↗
PubMed1983

[Problems of pulmonary pathology in drug addicts].

The hospitalisation of a group of drug addicts with pulmonary diseases leads to an examination of the relationship between drug addiction and bronchopneumopathies in the light of experience and reported data. After a brief examination of cases, the most frequently observed forms of bronchopulmonary disease are reviewed together with differences in the clinical course of the diseases in drug-addicted and other patients.

Adolescent↗
PubMed1996

[Rates of human immunodeficiency virus (HIV) infection in intravenous drug addicts from the Barcelona area, according to sex and age of drug consumption onset].

BACKGROUND: The differences in the rates of HIV infection in intravenous drug addicts according to the age of onset of drug consumption, sex and length of intake were evaluated. METHODS: The study sample was made up of 650 intravenous drug addicts (535 males and 115 females) admitted to a Hospital Detoxication Unit over 7 years (1987-1993). Of all these patients HIV serology and a questionnaire related to sociodemographic variables and drug consumption (age, sex, year of onset of intravenous drug intake, length of addiction and year of admission) were obtained. RESULTS: The rate of HIV infection for any length of addiction was higher in females than in males with this difference being significant for a length of addiction of less than 24 months (p = 0.03). The greater the age of onset in the use of intravenous drugs the lower the rate of HIV infection (p < 0.0001). In addiction times of less than 24 months the subjects who began drug consumption at an earlier age than the mean (19 years) presented significantly higher HIV infection rates (p = 0.04). CONCLUSIONS: Among the intravenous drug consumers in the area of Barcelona, Spain subgroups may be found: those who enter the consumption of intravenous drugs early and women, demonstrating high rates of HIV seroprevalence from the onset of their addiction.

Adult↗
PubMedDate not supplied

[Alexithymia, depression and drug addiction].

Alexithymia is a multidimensional concept associating an emotional component focused on the difficulty in identifying and describing feelings and a cognitive one centred on the use of a concrete and poorly introspective way of thinking. Alexithymia can be assessed by self-assessment instruments and in particular by the 20 items version of the Toronto Alexithymia Scale (TAS-20). Depressive disorders have complex relationships with the construct of alexithymia and there exist few experimental works on the subject. Epidemiological studies frequently raise an overlap between alexithymia and depression, in particular in the context of addiction. The main aim of this study was to confirm the high prevalence of alexithymia among drug addicted patients taking into account socio-demographic variables (sex, age, social and economic categories). The second aim of the study was to investigate the relationships between alexithymia and depression among drug addicted patients. A sample of 128 drug addicted patients answering DSM IV criteria of dependence to a psycho-active substance (alcohol excluded) was paired according to socio-demographic variables to a control sample of 128 normal subjects. Diagnostic assessment was made using the Mini International Neuropsychiatric Interview (MINI). Alexithymia and depression were assessed with the TAS-20 and with the short version of the Beck Depression Inventory (BDI-13). The results confirm the high prevalence of alexithymia among drug addicted patients (43.5%) compared to controls (24.6%). This difference is based namely on the emotional component of alexithymia, the cognitive component failing to show any difference between the two samples. Moreover, alexithymia appears to be independent from socio-demographic variables in our sample of drug addicted patients; 66.4% of drug addicted patients presents a depressive symptomatology (which is significantly more important in female patients), compared to 26% of the controls. Studies using the TAS and the BDI with 21 items have shown that from 10 to 20% of the variance of alexithymia is explained by depression. Our own results show a shared variance of 20% between the TAS-20 and the BDI, going in the direction of a moderated correlation between alexithymia and depressive symptomatology. Moreover, when we retain only subjects without depressive symptomatology at BDI, drug addicted (n=42) are not any more alexithymic than controls (n=114). Our results plead for a positive association between depression and alexithymia in drug addicted, depressed or healthy subjects. Alexithymia and depression would be two associated dimensions, the emotional component explaining alone this association. The emotional component of the alexithymia would be thymo-dependent, whereas the cognitive component (externally oriented thought) would be independent and constitute a stable clinical feature. These results are concordant with other studies in the literature suggesting that alexithymia in its emotional component is supported by depression. Alexithymia thus did not appear as an autonomous dimension which would discriminate between drug addicted and controls, independently of the absence of a depressive state. The Authors discuss the complexity of the relationships between alexithymia and depression and the correlations between TAS and BDI scales especially for the factor Difficulty Identifying Feelings. These results deserve further studies. The cross-sectional nature of this study do not allow to establish if alexithymia is a subjacent and preexistent in the form of a psychopathological dimension in addictive behaviours, so supporting its emergence, and/or if it develops once the dependence is installed and chronicized. Longitudinal studies remain to be realised.

Adult↗
PubMedDate not supplied

[Clinical and X-ray features of pneumonia in drug addicts].

The authors observed 68 drug addict in-patients, who received treatment for the pneumonia at the Primorski Regional Clinical Hospital and Vladivostok Municipal Clinical Hospital No. 1. The article details the specific features of the pneumonia of these in-patients. It was distinguished the 3 groups of hospital patients with the following characteristic features: patients with the respiratory distress syndrome of the adults; patients with the primary infective endocarditis mainly with the damage of respiratory (right) heart; patients with non-specific pneumonia. The peculiarities of the clinical process with the X-Ray pictures of the disease were also presented. The article identifies the acute beginning of the disease; the strongly pronounced intoxication syndrome; the usual cases of the late going to hospital of those patients; the extensiveness of the damage; the occurrence of the following complications at the early stage: pulmonary destruction, exudative pleurisy, empyema; the long period of the disease process; the development of the extensive pulmonary fibrosis. It was identified the 33.7% lethality for these groups of in-patients, while the average lethality of the in patients treated for pneumonia was 3.3% for the same period of time. The complicated pneumonia process of young patients with the infective endocarditis with damages of respiratory (right) hearts let us suppose their drug addiction.

Adolescent↗
PubMedDate not supplied

[Drug addiction and working].

The majority of subjects with drugs addiction is actively working. Therefore, the possible consequences of drug addiction in the workplace are presented in this paper. They entail reduction of work performance, increase of accidents and absenteism. The role of the occupational physician is also discussed in terms of drug addiction diagnosis and job fitness evaluation. The opportunity to use drug testing in the workplace is also considered, for those cases of occasional drugs abuse.

Absenteeism↗
PubMedDate not supplied

[Structural changes in the brain in HIV infection complicated by drug addiction].

Comparative analysis of brain alterations in drug addicts who were HIV-seropositive and died of sepsis and HIV-seronegative addicts showed similarity of these changes which manifested with ganglion cell rarefaction and losses, changed neuron content of main structural-functional types; massive satellitosis and neuronophagia, massive glycosis and leucodystrophy. These changes were diffuse in seropositive patients and rather focal in seronegative patients. The authors, on the basis of these findings, suggest a wider spread of HIV infection in drug addicts; they express doubts in the secondary nature of HIV-encephalopathy and believe that drug addiction should be considered as factor promoting HIV-infection development.

Brain↗