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substance related disorder [keywords]
- Sy20-3promising pharmacological agents for internet addiction. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i19.
Since the Internet appeared, it has, in turn, led to the emergence of psychopathological features of addiction linked to its use. To date, however, there is no standard clinical treatment protocols or approved medications. There have been many reports suggesting Internet addiction has a high comorbidity with various psychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD), depression, social phobia, and so on. The use of an opioid receptor antagonist could be considered for patients with high levels of discomfort and craving, and substance use disorders. For patients with depression or anxiety disorders, selective serotonin reuptake inhibitors could be helpful. Bupropion could be also helpful to patients with major depressive disorder. If the patients have manic, hypomanic, or excitement symptoms, the clinicians could consider the use of mood stabilizers. Psychostimulants and atypical antipsychotics could benefit Internet-addicted patients aiming to impulsivity/compulsivity and ADHD symptoms respectively. Although a clinically significant beneficial effect is easily observed, it is difficult to determine to what extent pharmacological treatment of concurrent mental disorders may affect the psychopathology related to Internet addiction. Further randomized controlled trials with long-term follow-up will be required to evaluate the treatment effects in large samples of Internet addiction.
- Sy21-1are there any benefits from reducing alcohol consumption? [Journal Article]
- Alcohol Alcohol 2014 Sep.:i19-i20.
Alcohol contributes substantially to the global burden of disease and is the fifth leading disorder of DALYs in 2010 (GBD 2010 study) worldwide, and thus is one of the largest avoidable risk factors. Any reduction in dose of alcohol consumed, as well as in frequency of drinking occasions and the amount drunk on a single occasion will have an immediate impact in reducing alcohol-related injuries, the cardiovascular events and mortality related to heavy episodic drinking. Several examples demonstrate that total alcohol consumption has a significant impact on chronic consequences of excessive drinking. However, many treatment programs promote abstinence as the only/main acceptable treatment goal. Thus, many problem drinkers decline treatment programs aimed at abstinence. Offering both abstinence and no abstinence treatment goals to clients, permits a client-centered approach that contributes to alleviate client's resistance to change. The new DSM-5 introduces a diagnostic shift from the binary diagnostic criteria of alcohol dependence and alcohol abuse, to a single continuum of alcohol use disorders introducing a clear measure of severity such that treatment goals can be modified individually. In conclusion, reduction strategies offer an opportunity to address patient heterogeneity and lower the treatment threshold by bringing new patients into the treatment.
- Sy17-2health associations with problem-gambling severity: insights from a longitudinal representative us sample. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i16-i17.
In the general population, problem-gambling severity lies across a spectrum, ranging from non-gambling through recreational gambling to problematic gambling. Cross-sectional data indicate that subsyndromal levels of gambling (i.e., not meeting the threshold for pathological gambling or in DSM-5 gambling disorder) are associated to varying degrees with poor health, particularly psychopathology. However, few studies have investigated incident psychiatric or general medical conditions with respect to problem-gambling severity.Secondary analysis of data from waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions was conducted. The 2 waves (collected from 2001-2002 and 2004-2005, respectively) included at wave 1 measures of problem-gambling severity (operationalized using inclusionary criteria for pathological gambling with individuals acknowledging one or more criteria categorized as having at-risk/problematic gambling - ARPG) and at waves 1 and 2 measures of psychiatric and medical conditions. Logistic regression analyses were conducted to examine the extent to which ARPG prospectively related to new (incident) psychiatric and general medical conditions.Relative to non-ARPG, ARPG was prospectively associated with: 1) incident nicotine dependence among adult women; 2) incident alcohol use disorders among adult men; 3) incident anxiety disorders and substance use disorders among older adults; and 4) incident cardiovascular conditions among older adults.The findings of incident psychiatric disorders and cardiovascular conditions in relation to ARPG suggest that public health policies and initiatives should incorporate considerations relating to problem-gambling severity.
- Pl5mechanisms and treatment of behavioral addictions with special emphasis on internet and food addictions. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i1-i2.
The extent to which excessive engagement in non-substance-related behaviors may constitute addictions has been debated. The recent classification of gambling disorder together with substance-use disorders in DSM-5 was based on similarities between the disorders and lends additional credence to the concept of non-substance or behavioral addictions.Data will be presented from studies into the biological underpinnings of substance-use and non-substance-use disorders involving excessive patterns of gambling, eating, Internet use, sex and other behaviors. Data from randomized clinical trials will be presented.Gambling disorder is arguably the best studied of the behavioral addictions to date. Data indicate multiple similarities, as well as differences, between gambling disorder and substance-use disorders. Considerable debate exists as to whether obesity of other eating-related disorders might be best considered within an addiction framework, with data suggesting particular similarities between gambling, substance-use and binge-eating disorders. Although less data exist for excessive engagement in other behaviors (Internet use, sex), emerging data suggest similarities with substance-use disorders. Given biological similarities, a question arises as to whether behavioral and pharmacological treatments efficacious in the treatment of substance addictions might prove helpful in the treatment of behavioral addictions, with data providing support for cognitive-behavioral therapies and opioidergic and glutamatergic agents.An improved understanding of the biological factors underlying behavioral addictions is developing, and this understanding should lead to the greater availability of validated therapies.
- Satisfaction with substance use treatment and 12-step groups predicts outcomes. [JOURNAL ARTICLE]
- Addict Behav 2014 Aug 21.:27-32.
Satisfaction is a critical component of patient-centered care, yet little is known about the degree to which patient satisfaction is linked to subsequent outcomes, especially in substance use disorder (SUD) treatments and 12-step groups. The current study assessed the degree to which satisfaction with Department of Veterans Affairs (VA) outpatient SUD treatment and with 12-step groups, both measured at 6 months after treatment initiation, was associated with additional treatment utilization and better substance-related outcomes during the next 6 months, that is, up to 1 year after treatment initiation.Participants were 345 patients entering the VA SUD treatment program.More satisfaction with treatment and with 12-step groups at 6 months was associated with less alcohol use severity and more abstinence at 1 year. More treatment satisfaction was related to less subsequent medical severity, whereas more 12-step group satisfaction was related to less subsequent psychiatric severity. More 12-step group satisfaction was related to subsequent increases in 12-step group attendance and involvement. A single item assessing overall satisfaction appeared best related to subsequent outcomes.Satisfied SUD treatment patients and 12-step mutual help members appeared to have better subsequent service utilization patterns and treatment outcomes. SUD treatments can improve outcomes by monitoring and enhancing patient satisfaction.
- Approach to cannabis use disorder in primary care: Focus on youth and other high-risk users. [REVIEW]
- Can Fam Physician 2014 Sep; 60(9):801-808.
To review the clinical features and complications of at-risk cannabis use and cannabis use disorder, and to outline an office-based protocol for screening, identifying, and managing this disorder.PubMed was searched for controlled trials, observational studies, and reviews on cannabis use among adolescents and young adults; cannabis-related medical and psychiatric harms; cannabis use disorder and its treatment; and lower-risk cannabis use guidelines.Physicians should ask all patients about cannabis use. They should ask adolescents and young adults and those at highest risk of cannabis-related harms (those with concurrent psychiatric or substance use disorders) more frequently. Physicians should also ask about cannabis use in patients who have problems that could be caused by cannabis, such as mood disorders, psychosis, and respiratory symptoms. In patients who report cannabis use, physicians should inquire about frequency and amount, tolerance and withdrawal symptoms, attempts to reduce use, and cannabis-related harms. Lower-risk cannabis users smoke, inhale, or ingest cannabis occasionally without evidence of school, work, or social dysfunction; those with problematic use often use cannabis daily or almost daily, have difficulty reducing their use, and have impaired school, work, or social functioning. Physicians should offer all patients with problematic use brief advice and counseling, focusing on the health effects of cannabis and setting a goal of abstinence (some higher-risk groups should not use cannabis at all) or reduced use, and they should provide practical strategies to reduce cannabis use. Physicians should incorporate simple motivational interviewing techniques into the counseling sessions. They should refer those patients who are unable to reduce use or who are experiencing harms from cannabis use to specialized care, while ensuring those patients remain connected to primary care. As well, physicians should give information on lower-risk cannabis use to all cannabis users.Physicians should screen all patients in their practices at least once for cannabis use, especially those who have problems that might be caused by cannabis. Physicians should screen those at higher risk more often, at least annually. Lower-risk cannabis use should be distinguished from problematic use. Brief counseling should be provided to those with problematic use; these patients should be referred to specialists if they are unable to reduce or cease use.
- Anxiety and compulsion patterns in the maintenance of bingeing/purging behaviours by individuals with bulimia nervosa. [JOURNAL ARTICLE]
- J Psychiatr Ment Health Nurs 2014 Sep 12.
Bulimia nervosa, if not treated or if treated unsuccessfully, can develop into a severe and enduring eating disorder. Analysis of self-management of Seed-BN indicates that individuals frequently experience significant negative mental health issues and a complex relationship with medication management. Two discrete patterns of coping strategies to prevent deterioration in distressing symptoms were in evidence, controlled vomiting, which was related to the management of anxiety, and uncontrolled vomiting due to more dominant self-management of compulsive acts. The implications for nursing revolve around accurate assessment of vomiting and subsequent engagement by the individual with their coping strategies in relation to perceived deterioration in distressing symptoms.This paper reports on the results of a study into the self-reported coping strategies employed by a small sample (n = 12) of individuals diagnosed with bulimia nervosa purging sub-type, severe and enduring eating disorder (Seed-BN), referred to an outpatient clinic for psychotherapy. Data collection focused on the vomiting activities of participants through analysis of their self-management from diary extracts, which recorded vomiting patterns. Participants all experienced significant mental health issues, had complex histories of BN over a prolonged period, difficulties maintaining relationships, and many had an additional history of substance misuse including dependence on prescription drugs. The study findings indicated two different self-management strategies, anxiety containment and compulsion maintenance. There was a clear association between anxiety and controlled weekly vomiting patterns compared with compulsion and daily vomiting patterns. The implications for nursing practice relate to the potential for assessment of differences in vomiting patterns to indicate self-management status and subsequent interventions focusing on either anxiety or compulsive patterns.
- Impact of Public Housing Relocations: Are Changes in Neighborhood Conditions Related to STIs Among Relocaters? [Journal Article]
- Sex Transm Dis 2014 Oct; 41(10):573-9.
Cross-sectional and ecologic studies suggest that place characteristics influence sexual behaviors and sexually transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater postrelocation improvements in neighborhood conditions (i.e., socioeconomic disadvantage, social disorder, STI prevalence, and male/female sex ratios) would have reduced the odds of testing positive for an STI over time.Baseline data were collected in 2009 from 172 public housing residents before relocations occurred; 3 waves of postrelocation data were collected every 9 months thereafter. Polymerase chain reaction methods were used to test participants' urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Individual-level characteristics were assessed via survey. Administrative data described the census tracts where participants lived at each wave (e.g., sex ratios, violent crime rates, and poverty rates). Hypotheses were tested using multilevel models.Participants experienced improvements in all tract-level conditions studied and reductions in STIs over time (baseline: 29% tested STI positive; wave 4: 16% tested positive). Analyses identified a borderline statistically significant relationship between moving to tracts with more equitable sex ratios and reduced odds of testing positive for an STI (odds ratio, 0.16; 95% confidence interval, 0.02-1.01). Changes in other neighborhood conditions were not associated with this outcome.Consonant with past research, our findings suggest that moving to areas with more equitable sex ratios reduces the risk of STI infection. Future research should study the extent to which this relationship is mediated by changes in sexual network dynamics.
- Motivation for treatment in patients with substance use disorder: personal volunteering versus legal/familial enforcement. [Journal Article]
- Neuropsychiatr Dis Treat 2014.:1599-604.
Motivation for treatment on the part of patients with addictive disorders is known to affect their prognosis, and lack thereof is reported to be among the most common reasons for failed treatment adherence and relapse after treatment. This study evaluated the relationship between volunteering, personality, demographic factors, and motivation for treatment.The study was conducted at a substance dependence center in the eastern part of Turkey. Forty-five patients (mean age 37.9±11.2 years) with a substance use disorder were included. They were assessed using the Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders) Axis II disorders. Depression and anxiety were evaluated using the Beck depression and anxiety inventories, and motivation for treatment was measured using the Turkish version of the Texas Christian University Motivation for Treatment scale.All patients had been using substances daily and 41 (88.9%) had been using multiple drugs. The most commonly used substance was heroin (n=18, 40%). Voluntary admission was a predictor of motivation for treatment (P<0.05). Having a personality disorder and higher depression scores were related to less motivation for treatment.Motivation for treatment is affected by external factors such as type of admission and internal factors such as personality disorder and depression. Investigation of ways to encourage voluntary admission for treatment instead of enforced strategies may be helpful for achieving higher levels of motivation for treatment in substance users.
- Prevalence and Factors Associated with Methamphetamine Use among Adult Substance Abusers. [Journal Article]
- J Res Health Sci 2014; 14(3):221-6.
The use of methamphetamine and other drugs among young adults has been a theme of growing interest and concern on the part of researchers and health associations. This paper reports recent use of methamphetamine and its relation with some demographic variables among substance users in west of Iran.This cross-sectional study was carried out on 559 substance users of Hamadan, western Iran recruited through a snowball sampling method in 2012. The participants received a self-administered questionnaire contained questions regarding substance use, reasons of drug abuse and pattern of MA use. Data were analyzed using SPSS software using Chi-square, Fisher's exact tests and logistic regression methods.A number of 248 (44.4%) people reported a history of having ever used methamphetamine and the mean drug abuse initiation age was 17.8 (SD= 3.9). According to the history, reducing effect of previous drug and resurfacing of new drug were common reasons associated with the changes in previous drug to use of methamphetamine. In multivariate analysis, 'being single' and higher school were obtained as independent predictors of methamphetamine use (P<0.001).Methamphetamine use is common among adult substance abusers in Iran. Demographic, behavioral and psychosocial correlates of methamphetamine use identified in this research may be helpful for the development of preventive interventions.