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Introduction: Dual diagnosis is used in addiction medicine to refer to the co-occurrence of an addiction-related disorder and another psychiatric disorder in the same individual. Adolescence is a key period for the development of both mental disorders and addictions. Objective: The aim of this study is to describe the relationships between psychiatric and addiction-related disorders in patients of the Outpatient Addiction Treatment Clinic for Children and Adolescents at the 1st Faculty of Medicine, Charles University in Prague in 2015–2022. Methods: Data were retrospectively analyzed from the hospital's medical system, which collects basic diagnostic data on patients. Descriptive statistics and cluster analysis were performed to identify relationships between psychiatric and addiction-related disorders. Results: Of the 450 patients, 153 patients (34%) met the criteria for dual diagnosis. The most common addiction-related disorders were mental and behavioural disorders due to the use of cannabinoids (35%) and internet gaming disorder (35%). The most common psychiatric diagnoses were behavioural and emotional disorders with usual onset in childhood and adolescence (64%), with a lower prevalence in girls than in boys. Conclusions: These findings may be important for the diagnosis and treatment of risky behaviours and addictions in children and adolescents. [ABSTRACT FROM AUTHOR]

It has been hypothesized that menthol in cigarettes increases dependence. Several studies suggest that menthol and non-menthol smokers have similar or lower levels of dependence, but those studies are not without limitations. The Heaviness of Smoking Index (HSI) is a widely accepted, validated measure of cigarette dependence. This report aims to provide further evidence regarding dependence among menthol and non-menthol smokers, as indicated by daily smoking and as measured by the HSI. Survey data from 27,131 adult smokers were analyzed to compare the percent of menthol and non-menthol smokers who are daily smokers, and the percentage who are low or high HSI dependence. Logistic regressions were also conducted to determine if menthol use predicts daily smoking, and low or high dependence after controlling for demographic differences. Comparisons among weighted samples of adult smokers demonstrate that menthol smokers were consistently more likely to be non-daily smokers, more likely to be in the low dependence category, and less likely to be in the high dependence category on the HSI as compared to non-menthol smokers. Logistic regression confirmed that when controlling for age, gender, race/ethnicity, and education, relative to non-menthol smokers, menthol smokers had no difference in odds of being in the low dependence HSI category and significantly lower odds of being a daily smoker, and of being in the high dependence category. These analyses support the conclusion that, based on the HSI, menthol smokers are not more cigarette dependent than non-menthol smokers, and may be less dependent. [ABSTRACT FROM AUTHOR]

Background and Aims: Genetic risk can influence disease progression. We measured the impact of genetic risk for substance use disorders (SUDs) on substance use onset and progression of symptoms. Design, Setting, Participants: Using findings from genome‐wide association studies (GWASs) of alcohol use disorder (AUD), opioid use disorder (OUD) and smoking trajectory (SMK) as discovery samples, we calculated polygenic risk scores (PRSs) in a deeply phenotyped independent target sample. Participants in the target sample were recruited from 2000 to 2020 from US inpatient or outpatient settings or through advertisements and comprised 5692 European‐ancestry individuals (EUR) (56.2% male) and 4918 African‐ancestry individuals (AFR) (54.9% male). Measurements: This study measured age of first substance use, regular use, reported problems and dependence diagnosis and progression from regular use to onset of problems and dependence for alcohol, opioids and smoking. We examined the contribution of PRS to each milestone and progression measure. Findings EUR and males reported an earlier onset and shorter progression times than AFR and females, respectively. Among EUR, higher AUD PRS predicted earlier onset and more rapid progression to alcohol‐related milestones (P < 0.001). Although the AUD PRS was a stronger moderator of problem onset among females (P = 0.017), it was more predictive of the progression to problems among males (P = 0.005). OUD and SMK PRS in EUR also predicted earlier onset of the respective milestones (P < 0.001). Among AFR, where power is lower due to the smaller discovery sample, AUD PRS predicted age of regular alcohol use (P = 0.039) and dependence (P = 0.001) and progression from regular use to diagnosis (P = 0.045), while SMK PRS predicted earlier age of initiation (P = 0.036). Conclusions: Genetic risk for SUDs appears to predict substance use milestones and symptom progression among European‐ancestry individuals and, to a lesser extent, African‐ancestry individuals. [ABSTRACT FROM AUTHOR]

INTRODUCTION Khaini is a smokeless tobacco (SLT) product commonly used in the South-Asian region. It is the most common smokeless tobacco product used in India, having a prevalence of 11.2% and is used by 104.1 million adults. No scales exist to assess khaini dependence. Existing scales available to assess dependence on smokeless tobacco products are not ideal as these are adapted from cigarette dependence scales and developed for western populations. This study aimed to develop a khaini dependence scale and assess its reliability and validity. METHODS Recommended methods for scale development were followed for item development, scale development and scale evaluation. Scale development was guided by a theoretical framework, a review of existing scales and in-depth interviews with 21 khaini users recruited from a tertiary care hospital in Mumbai, India. The process involved the identification of domains for dependence and the development of an item pool. Cognitive interviews and pre-testing were conducted with 20 khaini users to assess content validity. A cross-sectional survey with 323 khaini users was conducted, and Exploratory Factor Analysis (EFA) was used to determine the factor structure of the draft scale. The content validity, criterion validity (by cross-referencing with the cotinine level of users), convergent validity and internal consistency of the new scale were assessed. RESULTS The final version of the Khaini SLT Dependence Scale (KSLTDS) had 20 items. EFA indicated an acceptable goodness of fit for a three-factor structure with physical, psychological and sociocultural-behavioral sub-scales. It showed evidence of acceptable criterion validity with cotinine (ρ=0.43, p=0.0002), convergent validity with FTND-ST (ρ=0.51, p<0.0001) and frequency of khaini use (ρ=0.38, p<0.0001). The sub-scales (α=0.87--0.90) showed acceptable internal consistency. CONCLUSIONS The psychometric evaluation of the KSLTDS showed preliminary validity and reliability for assessing dependence on khaini, and therefore, it is appropriate for clinical and research purposes. Re-validation studies are required with various khaini user populations. [ABSTRACT FROM AUTHOR]

Introduction: Denial, or lack of awareness of problems related to substance misuse, is a common feature of drug use disorders and can affect engagement in treatment and recovery. This study tested for association of denial with severity of symptoms used in the diagnosis of Methamphetamine Dependence. Methods: This secondary analysis used data from 69 participants (52.2% male) who met criteria for the diagnosis of Methamphetamine Dependence on the Structured Clinical Interview for DSM-IV (SCID). The association between diagnostic severity, determined from a SCID summary score (8 items), and denial, measured by the University of Rhode Island Change Assessment Scale (URICA) Precontemplation score, was tested by Pearson correlation. In post hoc t -tests, participants who differed on individual SCID items were compared on the Precontemplation score. The additional URICA subscales (Contemplation, Maintenance, Action) were also tested on a secondary basis. Results: SCID summary scores were negatively correlated with URICA Precontemplation scores (P =.003). Post-hoc tests revealed that participants who denied continued methamphetamine use despite persistent or recurrent problems (SCID item 6) had significantly higher Precontemplation scores than those who endorsed these problems (t = 3.066, P =.003). In contrast, positive correlations were observed between diagnostic severity and greater openness/willingness to change on the URICA (eg, Maintenance, r =.26; P =.01). Conclusions: The findings highlight the importance of a patient's insight regarding their addiction in clinical diagnosis. Because minimizing the impact of methamphetamine use may preclude or delay treatment, it is advised that self-report be supplemented to improve accuracy of diagnosis. [ABSTRACT FROM AUTHOR]

In this essay we want to foreground a question: what happens to 'addiction' when we take seriously cultural scripts informing its trajectories? Can this bring us to unthink addiction as problematic notion and move it onto new paradigms that fit better the now acknowledged fluidity and pluralistic episteme of 'addiction' and more broadly of chronic life conditions? Indeed, 'addiction' has become a pivotal concept in the contemporary world. A powerful diagnostic framework in interpreting human behaviour, for some 'addiction' has become the 'new normal' with chronic relations with different things such as food, sex, gambling, and mind-altering substances touching upon the lifestyle of a majority of individuals, making everyone 'addicts in practice'. Perhaps this has something to do with the constituent force that 'habit' – as in 'addiction' – has in defining our present and future. Though 'addiction' goes beyond the question of mind-altering drugs, the politics of 'addiction' is intimately tied to substances such as opioids and opiates, cocaine, cannabis, and psychedelics that have been the object of durable systemic political control and security repression. Contextually the line between licit/illicit substances is softening and blurring, the 'dual' purpose that drugs serve is now recognised in scientific and popular analysis moving the question of 'addiction' beyond the medicine/drug dichotomy. Yet, culture is generally absent in understanding 'addiction.' When it is referred to, this happens in diminutive terms limited to Anglo-American modern culture. Culture matters and it matters with different weights and measures as it moves across the world. There are cultural environments of health informed by practices and epistemologies of well-being that have evolved in lines opposites from or only intersecting with the Anglo-American, and generally Western, world. Exploring these spaces and cultural scripts enables our scholarship on drugs and 'addiction' to move the barycentre of discussion towards novel considerations around the historical trajectories and potential futures of our diagnostic terms and policy interventions. [ABSTRACT FROM AUTHOR]

This clinical case report refers to John, a young individual who has experienced a severe form of sexual and physical abuse in childhood. At the age of sixteen John was introduced to various psychoactive substances. This case study presents information about the client's life, the theoretical application of psychodynamic psychotherapy, the techniques, goals and the therapeutic relationship formed between the therapist and the patient. This article will contribute to a better understanding of treating substance dependency in abused clients. [ABSTRACT FROM AUTHOR]

Objective: Found in plasma, urine, and saliva, cotinine can be used as a biomarker for nicotine in electronic cigarette (e-cig) users. Nicotine is addictive and causes dependence. Thus, it becomes a problem in smoking cessation programs. This study aimed to determine the relationship between urinary cotinine (UCot) and nicotine dependence levels in regular male e-cig users. Materials and Methods: This cross-sectional study consecutively included regular male e-cig users and nonsmokers. All subjects were interviewed and had their UCot levels measured using an enzyme-linked immunosorbent assay method. The regular e-cig users completed the Penn State Nicotine Dependence Index questionnaire. Results: This study recruited 71 males aged 18-45 years divided into e-cig users and non-smokers group. The predominating characteristics in e-cig users are as follows: 23 males (67.6%) aged <30 years, the highest education of senior high school 25 (73.5%) and 25 (73.5%) subjects had occupation. The UCot levels among the e-cig users in the non-dependency group were lower than that of the medium-high dependency group (P = .008). The median value for UCot level in the regular e-cig users was higher than that of the non-smoker group (276.11 [58.01-284.15] ng/mL vs 5.21 [4.65-23.72] ng/mL, P < .001). Factors influencing the UCot levels of the e-cig users were age (P = .041), nicotine level of the e-cig liquid (P = .013), and the flavor of the e-cig liquid (eg, menthol or non-menthol; P = .040). Conclusion: UCot and nicotine dependence levels in the regular male e-cig users were significantly related. Nicotine dependence was found in 76.5% of the regular male e-cig users. The UCot levels in the e-cig users were significantly higher than in the non-smokers. [ABSTRACT FROM AUTHOR]

Objective Low back pain (LBP) is a leading cause of pain and disability. Substance use complicates the management of LBP, and potential risks increase with aging. Despite implications for an aging, diverse U.S. population, substance use and LBP comorbidity remain poorly defined. The objective of this study was to characterize LBP and substance use diagnoses in older U.S. adults by age, gender, and race. Design Cross-sectional study of a random national sample. Subjects Older adults including 1,477,594 U.S. Medicare Part B beneficiaries. Methods Bayesian analysis of 37,634,210 claims, with 10,775,869 administrative and 92,903,649 diagnostic code assignments. Results LBP was diagnosed in 14.8±0.06% of those more than 65 years of age, more in females than in males (15.8±0.08% vs. 13.4±0.09%), and slightly less in those more than 85 years of age (13.3±0.2%). Substance use diagnosis varied by substance: nicotine, 9.6±0.02%; opioid, 2.8±0.01%; and alcohol, 1.3±0.01%. Substance use diagnosis declined with advancing age cohort. Opioid use diagnosis was markedly higher for those in whom LBP was diagnosed (10.5%) than for those not diagnosed with LBP (1.5%). Most older adults (54.9%) with an opioid diagnosis were diagnosed with LBP. Gender differences were modest. Relative rates of substance use diagnoses in LBP were modest for nicotine and alcohol. Conclusions Older adults with LBP have high relative rates of opioid diagnoses, irrespective of gender or age. Most older adults with opioid-related diagnoses have LBP, compared with a minority of those not opioid diagnosed. In caring for older adults with LBP or opioid-related diagnoses, health systems must anticipate complexity and support clinicians, patients, and caregivers in managing pain comorbidities. Older adults may benefit from proactive incorporation of non-opioid pain treatments. Further study is needed. [ABSTRACT FROM AUTHOR]

Currently, measurement tools to assess patient-reported outcomes for drug dependence are limited in their latent trait to adapt to the needs of individual patients while also maintaining comparability of scores across patients. Purpose/Objectives: To develop an item bank for computer adaptive testing (CAT) to measure severity of drug dependence. Methods: There were four phases: (1) review the literature of drug dependence measurement; (2) formulate an item list to be assessed by experts; (3) pretest our item list in two substance dependence treatment centers; and (4) field-test and conduct psychometric performance analysis with the final item bank. Additionally, based on our response data, a CAT simulation was used to validate the item bank, Drug Dependence CAT (DD-CAT). Results: The final drug dependence item bank – with a unidimensional configuration – contained 56 items with good item-fit, high discrimination, no differential item functioning, and covered all symptoms of diagnostic criteria for drug dependence. These results revealed that the final item bank was of good quality. Additionally, the results of a simulation CAT procedure with real response data indicated that the DD-CAT item bank exhibited acceptable and reasonable test reliability, content validity, and criterion-related validity. Conclusions/Importance: The proposed item bank for DD-CAT contained acceptable reliability and validity, and exhibited a shorter but efficient assessment of drug dependence. These psychometric properties can result in shorter test times, less information loss, and a reduction in the testing burden of patients. [ABSTRACT FROM AUTHOR]

Background: Despite research on prescription opioids and dependence being a national priority, little is known about the association between several potential adolescent risk factors and later opioid dependence among those who use opioids non-medically. Objectives: To investigate the association between lifetime opioid dependence and adolescent self-perceived health, health beliefs (thinking there was a pill for everything), health behaviors (onset of alcohol use before 15, onset of prescription opioid use before 15) and parental health practices (having opioids in the family medicine cabinet at age 14, parental suggestions to take pills when sick). Methods: A sample of 343 community members who non-medically used prescription opioids in the past 12 months were recruited for the Prescription Drug Misuse, Abuse, and Dependence Study and retrospectively assessed for adolescent risk factors of lifetime opioid dependence (DSM-IV). Results: Logistic regression revealed the strongest predictor of lifetime opioid dependence was having a prescription opioid in the family medicine cabinet at age 14. Those who grew up believing there was a pill for everything and those who initiated alcohol use before 15 were 1.83 and 1.78 times as likely, respectively, to meet dependence criteria than their counterparts. Demographics and other adolescent predictors were not associated with opioid dependence. Conclusions: Findings suggest several adolescent exposures can be targeted to reduce opioid dependence. Through their behavior, parents can reduce their teens' risk for opioid dependence. [ABSTRACT FROM AUTHOR]

A multistate analysis found Maine had the second highest average annual increase in maternal opioid use disorder (OUD) at delivery hospitalization during 1999–2012. The objective of our analysis was to estimate the prevalence, maternal characteristics, and geographic distribution of OUD at delivery hospitalization in Maine using recent state-level data. Serially collected cross-sectional population-based data. We used diagnosis and procedure codes to identify deliveries among hospital discharges in Maine, 2009–2018 (n = 120,764), and to categorize deliveries according to the prevalence of maternal OUD and selected conditions. We assessed linear trends in OUD at delivery and calculated prevalence ratios (PR) for co-occurring maternal conditions. The prevalence of maternal OUD per 1000 deliveries in Maine increased from 22.7 in 2009 to 34.9 in 2018 (linear trend P value < 0.01), with a mean annual increase of 1.6 (95% confidence interval [CI]: 0.9 to 2.4). The following conditions were more prevalent among women with OUD at delivery: hepatitis C, PR = 45.8 (95% CI: 38.8 to 54.2); other drug abuse or dependence, PR = 16.8 (13.4 to 20.9); alcohol abuse and dependence, PR = 8.5 (5.8 to 12.5); nicotine use, PR = 6.0 (5.9 to 6.2); cannabis use, PR = 5.2 (4.6 to 5.9); anxiety, PR = 2.7 (2.5 to 3.2); and depression, PR = 2.7 (2.4 to 3.1). Women with OUD at delivery were also more likely to reside in small rural areas (27.3% vs 22.5%) and deliver in a hospital with a level III nursery (50.6% vs 34.9%). Maternal OUD now accounts for 1 in 29 deliveries in Maine and commonly occurs with other medical conditions. Prevention and treatment of OUD among reproductive age women in Maine remains needed. • Maternal opioid use disorder increased among deliveries in Maine during 2009–2018. • Maternal opioid use disorder now accounts for 1 in 29 hospital deliveries. • It co-occurs with other maternal health conditions, such as hepatitis C. • Prevention and treatment of opioid use disorder among women in Maine remains needed. [ABSTRACT FROM AUTHOR]

This study aimed to document the prevalence and factors associated with complete mental health (CMH) among Aboriginal peoples living in Canada. CMH is comprised of three parts: 1) the absence of major depressive episode, anxiety disorders, bipolar disorder, serious suicidal thoughts, and substance dependence in the past year as measured by the World Health Organization (WHO) versions of the Composite International Diagnostic Interview (WHO-CIDI), 2) happiness and/or satisfaction with life in the past month, and 3) psychological and social well-being. The method involved secondary analysis of Statistics Canada's 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Responses from Aboriginal peoples living in Canada off-reserve (n = 965) were examined to determine what percentage were in CMH and what characteristics are associated with being in CMH. Data analysis involved both bivariate and multivariate analytic techniques to examine factors associated with CMH among Aboriginal peoples. Overall, two-thirds of Aboriginal peoples (67.9%) living in Canada were in CMH. Those with a post-secondary degree, who had a confidant, and those who were free of disabling chronic pain were more likely to be in CMH. Additionally, the odds of CMH were higher among those without a history of suicidal ideation, major depression, alcohol dependence, drug dependence, anxiety disorder, or difficulty sleeping. Findings from this study provide indications of substantial resiliency among Aboriginal peoples in Canada. [ABSTRACT FROM AUTHOR]

Objective: Extrapyramidal side-effects (EPSE) are frequent in patients treated with antipsychotics and comorbid substance use disorders (SUDs). Methamphetamine has been shown to act as a dopaminergic neurotoxin. We aimed to determine whether EPSE occur more often in patients with psychotic disorders and co-occurring methamphetamine (MA) use disorders, and we examined the relationship between MA use, antipsychotic type, dose and EPSE. Methods: This study was a secondary analysis of data from three separate primary studies. Across all studies, psychiatric and SUD diagnoses were determined using the SCID-I for DSM-IV. EPSE were determined using the Simpson-Angus Scale (SAS) for Parkinsonism, the Barnes Akathisia Rating scale (BARS), and the Abnormal Involuntary Movement Scale (AIMS) for tardive dyskinesia. Participants were classified as having any EPSE if they scored above the cutoff on any of the EPSE scales (SAS, BARS, AIMS). We analyzed data using multivariable logistic regression analysis. Results: The sample included 102 patients with non-affective or affective psychotic disorders. Of the total sample, 65.7% were male, 54.9% had schizophrenia spectrum disorders, 20.5% bipolar type I disorder with psychotic features, 11.7% schizoaffective disorder and 12.7% had substance-induced psychosis. A diagnosis of a methamphetamine use disorder (abuse or dependence) was present in 25.5% of participants. EPSE occurred in 38.2% of patients and were significantly associated with MA use in the unadjusted and adjusted analysis, ORadj = 4.01, 95% CI [1.07, 14.98], p =.039. Patients with MA dependence and MA use >3 years were significantly more likely to have EPSE. We found a significant interaction effect between MA use disorders and standardized antipsychotic dose on the occurrence of EPSE, ORadj = 1.01, 95% CI [1.00, 1.01], p =.042, with MA users having a disproportionally higher likelihood of having EPSE compared to MA non-users as antipsychotic dosage increased. There were no significant associations of EPSE with comorbid alcohol, cannabis, or methaqualone use disorders. Conclusions: Patients with a MA use disorder were significantly more likely to have EPSE with evidence for a dose-response effect. Clinicians should carefully titrate antipsychotic dosage from lower to higher doses to avoid EPSE in patients with MA use disorders. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine psychiatric disorders after burn trauma and burn-related features in adults. Method: The records of the cases who were hospitalized in the burn center between January 2015 and January 2019 and for whom psychiatric consultation was requested were retrospectively reviewed. Sociodemographic characteristics, burn-related features, psychiatric diagnoses, and treatments of the patients were examined. Results: The mean rate of psychiatric consultations requested in a burn center within a four-year period was 34.05% and 49 (28.5%) of these consulted cases had a work-related accident. Mean hospitalization time was 37.2±24 days and the most common burn type was a fire/flame injury. In the majority of the study sample (63.4%) the total body surface area burnt was more than 20%. Nineteen (11%) cases had a history of psychiatric disorder. The most common psychiatric diagnosis before burn injury was alcohol-drug addiction (n=14, 73.7%). The most common diagnosis after psychiatric consultation was adjustment disorder (31.9%). Among psychotropic drugs the initial treatment was started most frequently treatment with benzodiazepines (30.8%) and antipsychotics (58.1%). In 33 deceased cases, the most common psychiatric diagnosis was delirium with a rate of 42.4%. Conclusion: The incidence of psychiatric disorders before and after burn injury was found to be high in the individuals. Conditions with a high risk of morbidity and mortality, such as delirium, should be diagnosed and treated priorly. Due to the early and long-term effects of burn trauma, a multidisciplinary approach should be developed and psychiatrists should be included in the management of treatment. [ABSTRACT FROM AUTHOR]

Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce. Design: This was a retrospective cohort study. Setting: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016, involving both primary health care and specialized health care. The goals of the project were smoking awareness and preoperative smoking cessation. Subjects: Our study involved 1482 surgical patients operated at Porvoo Hospital between May and December of 2016. Main outcome measures: We studied the recording of smoking status in all patients, and ICD-10 diagnosis of nicotine dependency and the initiation of preoperative smoking cessation in current smokers. Variables were studied from electronic patient records, comparing primary health care referrals and surgical outpatient clinic records. Results: Smoking status was visible in 14.2% of primary health care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n = 275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for initiation of preoperative smoking cessation. The differences between primary health care referrals and outpatient clinic records were statistically significant for all three variables (p ≤.001). Conclusion: In primary health care, very little attention was paid to preoperative smoking cessation. Rates were significantly better at the surgical outpatient clinic, but still low. We could not demonstrate any certain effect of the intervention. Our results call for future research on ways to improve smoking cessation rates. Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce. We found weak smoking awareness and weak smoking cessation intervention numbers among both primary and specialized health care doctors. Our results indicate an urgent need for an efficient preoperative smoking cessation model involving both primary and specialized health care. [ABSTRACT FROM AUTHOR]

Our aim was to examine whether ACEs associate to regular smoking and nicotine dependence (ND) among 508 psychiatric inpatients aged 13–17 years. Adolescents were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children and the European Addiction Severity Index -instruments. ND was measured with the modified Fagerström Tolerance Questionnaire. In girls, all violent ACEs (domestic violence, physical abuse at home, sexual abuse) were related to regular smoking and some family-related ACEs (parental divorce and substance use problems) both to regular smoking and ND. After controlling for covariates, girls with parental substance use had an increased likelihood for being a regular smoker and having ND. Greater number of ACEs in girls indicated higher level of ND. Corresponding associations were not observed in boys. Our findings suggest that girls after experiencing ACEs are more prone to becoming smokers and developing ND already in adolescence compared to boys. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the degree of agreement between the Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) in daily smokers admitted to smoking cessation clinics from National Healthcare System in Spain and Argentine Republic. Material and methods: An observational, longitudinal, multicenter study (prospective cohort) conducted in smoking clinics in daily clinical practice. The patients were consecutively included as they attended the consultations. The statistical analysis was descriptive, and correlation and concordance tests as well as analysis and regression models were used. Results: In total, 308 subjects were included [161 women (52.3%)], with a mean age of 51.4 (10.8) years. We found an absence of agreement and the existence of a proportional difference between both tests [Regression coefficient for global series: 0.55 (0.52–0.59) p <.001]. This difference increased as the value of the FTCD score increased; that is, the higher the value of the FTCD score was, the greater the difference in relation to the value of the HSI score. Likewise, Cohen's kappa concordance coefficient, according to various combinations of categorization of both tests, showed that the agreement between these variables was only good. Approximately 20% of the subjects were not classified with the same degree of dependence by the two tests. Thus, a classification mismatch existed. Conclusions: We found an absence of agreement between both tests. These data imply that we should not substitute one test for the other when we analyze nicotine dependence in a population of smokers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the prevalence and profile of mothers among women who sought treatment for drug addiction, as well as the therapeutic progression of these patients. Design/methodology/approach: A sample of 180 Spanish women with addiction problems was assessed. Information was collected on the patients' socio-demographic characteristics, consumption variables and psychological symptoms. Findings: Of the total sample, 22.2 per cent (n = 40) of the women seeking treatment for substance use disorder were mothers. Compared with women without children, mothers scored significantly higher on several EuropASI and psychological variables. Specifically, mothers presented with more medical problems, worse employment/financial situations, and more severity in alcohol use. Moreover, having a history of lifetime physical and/or sexual abuse was related to belonging to the group of mothers. Regarding therapeutic progression, no statistically significant differences in the retention rate were found between mothers and non-mothers. Originality/value: The results of this study show that mothers generally have more severe problems than non-mothers. Therefore, comprehensive, continuum-based, and client-centred care for mothers is paramount for effective treatment in mothers. The implications of these results for further research and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. Methods: A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. Results: Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. Conclusions: Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood. [ABSTRACT FROM AUTHOR]

Background: Treatment with methadone is effective in reducing heroin use, HIV risk, and death; however, not all patients respond to treatment. Better outcomes may emerge with personalized treatment based on factors that influence treatment courses. Objectives: To investigate psychosocial variables contributing to treatment response, using a comprehensive definition of treatment response. Methods: Seventy participants seeking treatment for heroin and cocaine addiction completed up to 40 weeks of daily methadone. At week 22, we administered a semi-structured interview for DSM-IV symptoms. We defined opioid treatment responders as people still enrolled at 22 weeks, not meeting past 30-day criteria for DSM-IV opioid abuse or dependence or DSM-5 opioid use disorder, and providing ≥75% opioid-negative urine samples in the 30 days prior to week 22. The same criteria were applied to assess cocaine treatment response. Results: Sample was 71% male, 41% White, and averaged 39.4 ± 7.9 years old. Opioid treatment response was more likely in participants who had been employed over the past 3 years (OR: 8.1, 95% CI: 1.2–55) and less likely in those who spent more time on hobbies (OR: 0.45, 95% CI: 0.23–0.88). Cocaine treatment response was more likely in participants who had a good relationship with their father (OR: 5.3, 95% CI: 1.2–24) and less likely if positive for hepatitis C (OR: 0.15, 95% CI: 0.03–0.75). Conclusions: Pretreatment characteristics differentially predict treatment response for heroin and cocaine use. Similar research in diverse patient groups may aid in the development of personalized treatment combining biologic treatment with targeted psychosocial interventions. [ABSTRACT FROM AUTHOR]

Background/Aims: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication‐assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion. Design Cross‐sectional study using inverse‐propensity weights to adjust for differences among insurance groups. Setting: Oregon. Participants: A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014–15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12‐month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses. Measurements Any opioid‐dispensed, chronic (> 90‐days) and high‐dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt. Findings Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3%, 95% confidence interval (CI) = 42.0–42.7%; returning: 49.3%, 95% CI = 48.8–49.7%; continuously: 52.5%, 95% CI = 52.0–53.0%], use opioids chronically (newly: 12.8%, 95% CI = 12.4–13.1%; returning: 11.9%, 95% CI = 11.5–12.3%, continuously: 15.8%, 95% CI = 15.4–16.2%), have OUD diagnoses (newly: 3.6%, 95% CI = 3.4–3.7%; returning: 3.9%, 95% CI = 3.8–4.1%, continuously: 4.7%, 95% CI = 4.5–4.9%) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95% CI = 0.53–0.61; hazard ratio returning: 0.60, 95% CI = 0.56–0.65 (ref: continuously)]. Conclusions: Residents of Oregon, United States who enrolled or re‐enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication‐assisted treatment for opioid use disorder. [ABSTRACT FROM AUTHOR]

Introduction: Addiction is a social phenomenon whose extent of damage and destruction among community members is much greater than other social damage. Aim: The present study was conducted to determine the norms of Rorschach test among drug addicts. The statistical population of the present study, addicted drug addicts in addiction treatment centers in Qorveh city in 1396 were to number 30 people who were examined through Rorschach test. Method: The method of the present research has been Fundamental-Applied in terms of purpose, in terms of strategy, of type descriptive, and in terms of data analysis, was of type content analysis. Results: The findings of the study showed that drug addicts people had a disorder in the defect in compromise and toleration profiles with an average of 5, Perception-Thinking index with an average of 4 and the index of obsessive-compulsive disorder with an average of 4. EA index with mean of 5, es & Adj es an average of 10, D & Adj D with an average of -1 and EBPer with N/A score had a significant difference with other indices. Conclusion: The results indicative the presence of stress, obsession, inhibition of emotions, negative introspection, weak social relationships and poor processing of information in them. These people, due to their inflexible thinking and values, have been mistaken in judging and making decisions and take refuge to fantasy for deny reality and facing the annoying position. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = −0.36; 95% CI: −0.69, −0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = −0.95; 95% CI: −1.44, −0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = −0.87; 95% CI: −1.38, −0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use. [ABSTRACT FROM AUTHOR]

Introduction: Auto-rickshaw driver is exposed to many kinds of risks owing to his profession, such as stressful occupational conditions, environmental pollution, and drug abuse such as smoking, tobacco, and alcohol use. The present study is an attempt to estimate the prevalence of substance abuse and depression among auto-rickshaw drivers and compare these with nonauto-rickshaw drivers. Subjects and Methods: A total of 120 participants were enrolled randomly in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw population. To fulfill the objective, methodology based on the test application of the Beck's Depression Inventory, Hamilton Anxiety Rating Scale, and alcohol, smoking, and substance involvement screening test was used. A predesigned questionnaire was used that included information such as general health status, habits, addictions, and work experience. To establish statistical relationships between two or more random variables, the Pearson correlation coefficient was also calculated. Results: In the present study, significant high prevalence of tobacco and alcohol use was seen among auto drivers, 83.3% and 63.3% as compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). The prevalence of depression in auto-rickshaw drivers was 90% (mild-to-severe range) which was significantly high compared to nonauto-rickshaw drivers (60%). On the Hamilton Anxiety Rating Scale, more than half of the auto-rickshaw drivers, i.e., 60%, had mild-to-moderate anxiety which was higher than nonauto-rickshaw (5%). Driving experience, age, and substance abuse (alcohol and tobacco use) showed a significant association with depression. Conclusion: This study demonstrated a high prevalence of depression, anxiety, and substance abuse in auto-rickshaw drivers. There was a positive correlation of depression with substance abuse (alcohol and tobacco), age, and work experience. This study will assist the psychologist to understand and treat the mental health issues among professional drivers. [ABSTRACT FROM AUTHOR]

Background: The US National Institutes of Mental Health Research Domain Criteria (RDoC) seek to stimulate research into biologically validated neuropsychological dimensions across mental illness symptoms and diagnoses. The RDoC framework comprises 39 functional constructs designed to be revised and refined, with the overall goal of improving diagnostic validity and treatments. This study aimed to reach a consensus among experts in the addiction field on the 'primary' RDoC constructs most relevant to substance and behavioural addictions. Methods: Forty‐four addiction experts were recruited from Australia, Asia, Europe and the Americas. The Delphi technique was used to determine a consensus as to the degree of importance of each construct in understanding the essential dimensions underpinning addictive behaviours. Expert opinions were canvassed online over three rounds (97% completion rate), with each consecutive round offering feedback for experts to review their opinions. Results: Seven constructs were endorsed by ≥ 80% of experts as 'primary' to the understanding of addictive behaviour: five from the Positive Valence System (reward valuation, expectancy, action selection, reward learning, habit); one from the Cognitive Control System (response selection/inhibition); and one expert‐initiated construct (compulsivity). These constructs were rated to be related differentially to stages of the addiction cycle, with some linked more closely to addiction onset and others more to chronicity. Experts agreed that these neuropsychological dimensions apply across a range of addictions. Conclusions: The study offers a novel and neuropsychologically informed theoretical framework, as well as a cogent step forward to test transdiagnostic concepts in addiction research, with direct implications for assessment, diagnosis, staging of disorder, and treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze and compare the profile of dual patients treated in mental health units or drug user services with patients using both. The sample consisted of 170 patients diagnosed with dual pathology, recruited using an accidental sampling technique. Of the sample, 64 were being treated at Addiction Center of Huelva (ADH), 51 at various Community of Mental Health Units (CMHU) in the province of Huelva and 55 were treated with a coordinated use of both resources. The patients were diagnosed using MINI and PID-5. A higher prevalence of patients with a cocaine and heroin dependence profile was observed in the patients treated in ADH (35.9%, as opposed to 2% in CMHU and 16.4% in the coordinated service). For those patients treated in CMHU there was a higher prevalence of profiles related to cannabis dependence (41.2%, as opposed to 9.4% in the ADH and 16.4% in the coordinated service). The odds ratio for hypomanic episodes was 2.879 (p < 0.05) for patients in ADH compared with the other two services. The odds ratio observed for manic episodes was 0.483 (p < .05) in ADH patients, whilst for patients in CMHU there was a higher prevalence of comorbid psychotic disorders in comparison with those using ADH services (66% as opposed to 37.5%). The high prevalence of comorbid disorders-along with the differences in profiles identified between services-suggests the need to consider treating these patients using integrated services. [ABSTRACT FROM AUTHOR]

In this article, M. Rebecca Kilburn and Jill S. Cannon report on First Born, a targeted universal home visiting program operating in over half of New Mexico counties. Created in a small town in response to a lack of support for pregnant women and new parents, First Born adapts features of other home visiting programs, responding to conditions common to high-need, low-resource communities. As its name suggests, First Born enrolls first-time families. A team of home visitors, including a registered nurse or other licensed health care professional and a paraprofessional parent educator, offers 40 weekly home visits during the child's first year; the frequency of visits diminishes during the child's second and third year. The nurse visits the home both before and after the child's birth, and also when medical issues are dre focus of visit. Because nurses are in short supply in many communities, however, most of the home visits are made by parent educators, who coordinate with the nurse visitor. To promote early childhood health and development, First Born educates parents and helps them access community resources, using a three-pronged approach: helping the family to develop life and social skills, such as decision-making, crisis intervention, and knowledge of child development; using screening tools to identify problems (for example, substance dependency or developmental delays) and referring families to the appropriate sources of help; and promoting effective coordination among community resources. Based on First Born's scale-up experience, Kilburn and Cannon outline several lessons for other universal programs, including the pros and cons of universal services, the expectation that universal programs will have population-level impact, and barriers to innovation. [ABSTRACT FROM AUTHOR]

An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION Symptoms of nicotine dependence among adolescents occur at an early stage in smoking onset and can be present even with low exposure to cigarettes. We aim to examine the early occurrence of symptoms of nicotine dependence and how they predict later smoking behavior. METHODS Participants were ninety-four currently smoking 9th-graders attending high school in Targu Mures, Romania. They were followed for 6 months with two assessment points: baseline, and follow-up at 6 months. We assessed the following: 1) the number of smoked cigarettes in the last 30 days, 7 days, and 24 hours using the Minnesota Smoking Index; 2) vulnerability to addiction manifested in cessation difficulties, using the 9-item version of the Hooked On Nicotine Checklist (HONC), 3) loss of autonomy using the endorsement of at least one HONC item, and 4) dependence, using the modified Fagerstrom Tolerance Questionnaire (mFTQ). We performed statistical analysis with SPSS version 19, using paired-sample t-tests for comparing the differences between baseline and follow-up data. We also conducted linear regression analysis to demonstrate the predictive role of the assessed variables, such as the scores of the mFTQ and the HONC in maintaining smoking and reported smoking status. RESULTS Regression models indicated that baseline-measures for symptoms of dependence (β=0.64, p<0.001), vulnerability to addiction (β=0.47, p<0.001), and loss of autonomy (β=0.34, p<0.001) regarding smoking cessation were significant predictors of smoking, explaining 41.7% of the variability of the reported increase in cigarette consumption. At follow-up at 6-months, the three variables were responsible for 14.9% for the variance in cigarette consumption (R2=0.14, F(1,92)=16.05, p<0.01). CONCLUSIONS Nicotine dependence at baseline and at follow-up show significant differences in the control group while in the intervention group the scores remained stable. The findings suggest that participation in the Romanian version of ASPIRE was protective against progression towards nicotine addiction. [ABSTRACT FROM AUTHOR]

Context: Tobacco will cause one billion deaths in the 21st century. The use of tobacco causes dependence both psychological and physical. Aims: To find out the level of nicotine dependence and it correlates among adolescents. Settings and Design: A community-based, cross-sectional, observational study was conducted in the Burdwan town, West Bengal, among 1354 adolescent tobacco users. Materials and Methods: Data were collected by direct interview using a pretested, predesigned, semistructured schedule containing the Fagerström Test for Nicotine Dependence (FTND) questionnaire. Statistical Analysis: Pearson's Chi-square test, Student's unpaired t-test, one-way analysis of variance, Pearson's product-moment correlation coefficient, and multivariable linear regression were used. All the statistical analyses were performed using SPSS version 19.0. Results: The mean FTND score was significantly higher among adolescents aged >15 years, males, Hindu, tobacco users from joint family, who belonged to lower socioeconomic status, who started using tobacco at the age of 10-12 years, using tobacco for ≥5 years, who were not married, were illiterate, working, and not aware of the injurious effect of tobacco to health. Conclusions: A suitable individualized approach should be used for those who want to quit tobacco depending on their FTND score. [ABSTRACT FROM AUTHOR]

Background: Diagnostic and treatment gaps exist for those with substance use disorders (SUD). SUD diagnostics in treatment have been critically under-investigated. We investigated known diagnoses in US addiction treatment centres receiving state or federal funding.Methods: Cross-sectional risk factor analysis of variables associated with known diagnoses in US inpatient and outpatient treatment facilities receiving public funding from 2000 to 2014 (N = 8,692,362).Results: Of all clients, 59.68% had unknown diagnoses. However, 14 states reported zero diagnostic data, representing the majority of unknown diagnoses. Of the reporting states (n = 4,161,021), 16.05% had unknown diagnoses. Those with known diagnoses were represented by four subcategories of SUD (73.22%), No Diagnosis (0.81%), Alcohol Intoxication (1.36%), and Mental Health (8.57%). Uninsured status was one meaningful association and was less likely to have a known diagnosis. Insurance status, referral source, service setting, and wait to admission significantly predicted known diagnosis (p <  0.0001).Conclusions: A large proportion of admissions are missing diagnoses. Many states do not report any diagnostics. Variables predictive of a known diagnosis highlight administrative inconsistencies. Policies requiring SUD diagnosis documentation can improve assessment of treatment appropriateness and level of care, programme evaluation, and inform the funding allocation for relevant treatment efforts. [ABSTRACT FROM AUTHOR]

Abstract Objectives To examine whether the (a) childhood neighborhood context predicts alcohol use disorder, nicotine dependence, and cannabis use disorder symptoms at the age of 39 years; and (b) socio-economic status during young adulthood mediates these relationships. Gender differences were also examined. Study design The Seattle Social Development Project is a prospective longitudinal study of 808 individuals followed up from ages 10 to 39 years in Seattle, Washington, United States. The sample was gender balanced (51% were men). Methods Alcohol, nicotine, and cannabis use disorder symptoms were assessed using the Diagnostic and Statistical Manual of Mental Disorders IV–based Diagnostic Interview Schedule. Childhood neighborhood data consisted of 10 neighborhood-level variables from the 1990 national census, which were consolidated using principal component analyses. Two components with eigenvalues greater than 1 were extracted—neighborhood disadvantage and neighborhood stability. Educational attainment and employment status represented socio-economic status during young adulthood. Covariates included baseline symptoms of psychopathology, baseline substance use, gender, ethnicity, and childhood socio-economic status at the family level. Negative binomial regression was used as the primary modeling strategy. Six models for each outcome measure were estimated. The first three models examined associations between two neighborhood components and each substance use outcome measure. Next, we tested the second research question by adding unemployment and college graduate indicators at the age of 30 years as potential mediators underlying the link between the childhood neighborhood context and three substance use measures. Results Study findings revealed that childhood neighborhood stability significantly reduced alcohol and cannabis use disorder symptoms nearly 3 decades later. Path analyses suggested that socio-economic status during the transition to adulthood did not influence these relationships but rather had independent effects on problematic nicotine and cannabis use. Furthermore, the effects of childhood neighborhood factors on problematic nicotine use were stronger for men. Conclusions Neighborhood characteristics during childhood may be important factors for alcohol and cannabis use disorder symptoms among adults and nicotine dependence disorder symptoms among men. Prevention efforts that address community stability and disadvantage can and should start in childhood, with a focus on intervention targets that might gain salience later in life to discourage the development and persistence of problematic substance use in adulthood. Highlights • Childhood neighborhood stability significantly reduced problematic alcohol and cannabis use nearly 3 decades later. • Socio-economic status in young adulthood affects adulthood problematic substance use, particularly nicotine and cannabis. • The effects of childhood neighborhood factors on problematic nicotine use were stronger for men. [ABSTRACT FROM AUTHOR]

Objective: The study of the features of the higher mental functions of the brain in patients suffering from addiction to psychoactive substances is very important for narcology. It is necessary not only to uncover the mechanisms of addiction, a complete understanding of the neurophysiological processes that determine the nature of the development and severity of the disease, but also to solve practical problems related to the development of treatment methods and the implementation of preventive measures. Method: In the study of patients, a specially designed map was used containing information on the hereditary and demographic characteristics, on the course of the disease, as well as on the socio-cultural status of patients. To determine the functional state of cortical activity in the process of perception of unconscious signals, a special technique was used. The obtained results were subjected to dispersive analysis and the significance of differences was calculated according to Student's t-criterion. Results: An analysis of premorbid personality traits made it possible to establish the prevalence of instability, pathological conformity, and hysteroidal features in patients. It should be noted that a large percentage of the surveyed had a hereditary burden of alcoholism, mainly in the line of the father. Curiosity, passive submission, imitation of friends were among the motives of the first drug use. All patients in the process of addiction formed the following features: increased excitability, increasing effective disorders (depression, dysphoria), aggravated by exacerbation of craving for the drug, a decline in morals and ethics (egoism, deceit, indifference to one's fate, hedonism, loss of sense of duty), disorders of the emotional-volitional sphere (emotional instability, hypersensitivity, vulnerability). Conclusion: The analysis of the duration of latent periods and magnitude of the amplitudes of the late positive R3OO wave in patients with heroin addiction revealed clear differences between the data obtained upon presentation of an unconscious neutral and motivationally significant word. Patients who use psychoactive substances, using the method of recording induced potentials of the brain, which is a sensitive indicator of the activity of brain structures in relation to the substance used, revealed a clear diffuse activation of the cerebral cortex in response to an unconscious verbal stimulus related to the motivation prevailing in patients, in particular to "heroin". Such activation, as well as the difficult dying out of the developed reactions to an unconscious stimulus, indicate certain neurophysiological foundations of the mechanism underlying the changes in the motivational sphere and the stability of the pathological craving for the psychoactive substance. [ABSTRACT FROM AUTHOR]

Objective: The present study investigated the association between food addiction (FA) and other addictive behaviours in 216 bariatric surgery candidates (91.7% class 3 obesity; 80.1% women; age Mdn = 44.00 years, range 18–73). Method: Assessment included the Yale Food Addiction Scale 2.0 (YFAS 2.0) and standardized self‐report questionnaires to measure symptoms of disorders related to substance use (alcohol and nicotine) and behavioural addictions (gambling, Internet‐use, buying, hypersexual disorders, and exercise dependence). Results: Bivariate correlations indicated a moderate relationship of YFAS 2.0 FA symptoms with buying disorder symptoms and a weak association with Internet‐use disorder symptoms. Fifty‐nine patients (27.3%) met the YFAS 2.0 threshold for FA, 1.9% for alcohol use disorder, 6.0% for nicotine use disorder, 17.3% for buying disorder, 2.3% for Internet‐use disorder, and 1.4% for hypersexual disorder. None of the patients scored above the respective questionnaire thresholds for gambling disorder or exercise dependence. Patients with versus without YFAS 2.0 FA diagnosis did not differ with regard to prevalence estimates of addictive behaviours. Conclusions: Clinical implications and potential limitations of the findings are discussed. Future studies should address the potential risk of postoperative addiction transfer using long‐term follow‐ups and controlled study designs. [ABSTRACT FROM AUTHOR]

Background: Tolerance and dependence of centrally acting muscle relaxants have been reported in the medical literature for nearly 50 years. Meprobamate, which is one of the best-known examples, had been a controlled substance after studies indicating its addictive effects, shortly after its introduction in the 1950 s. Phenprobamate, which has been reported to be similar to meprobamate in terms of effects, side effects, and toxicity, is not a controlled substance and is frequently prescribed as a centrally acting 10 muscle relaxant. To our knowledge, there is only one case report regarding phenprobamate dependence, which is known for its similar mechanism of action to meprobamate. Methods and Results: Here a case study, who is taking 12 grams a day (30 tablets/day), is presented about phenprobamate, which could have an addictive effect similar to some centrally acting muscle relaxants that were reported in the literature. Conclusions: Physicians should investigate non-phenprobamate muscle relaxant options in those with a history of 15 alcohol and substance use disorders, and health policy should prevent over-the-counter drug sales and prevent possible addictions. [ABSTRACT FROM AUTHOR]

Mephentermine is an α-adrenergic agonist, indicated for treatment of hypotensive states. It is not a common drug used for recreational purposes; rather for its performance enhancing properties. However, there are few case reports which highlight its dependence potential or its effect on induction of psychotic symptoms. In this case series, we intend to present cases of two individuals who used mephentermine as performance enhancer. Both showed significant improvement in short span of time on remaining abstinent from it. This highlights the common context of usage of mephentermine as performance enhancer leading to dependence and its effect on induction of psychosis in individuals with low genetic vulnerability. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate the psychometric properties of the Bahasa Melayu version of the Taqwa (piety) questionnaire, used for the measurement of behaviour of Drug Dependency Syndrome (DDS), in Malay patients. A sample of 98 males with a psychiatric diagnosis (DSM-IV-R) as the DDS was randomly selected from Kajang Khafidz Polyclinic Kuala Lumpur, Malaysia. After receiving their agreement to attend the study, they completed the Taqwa (piety) questionnaire. The reliability was assessed by determining the Cronbach’s α to measure the consistency of related questions for all four dimensions (subscales), including individual, social, cognitional, and emotional Taqwa behaviour. In the next step to evaluate the composite reliability, convergent, and discrimination validity, a measurement model was determined via Conformity Factor Analysis (CFA) based on Partial List Square method (Smart- PLS Ver: 2M3). The reliability of four dimensions of the questionnaire was acceptable (α1=0.881,α2-0.862,α3=0.86,andα4=0.90)and correlated to each other. However, according to the CFA method, the items with low loading factor (<0.5) were excluded from each dimension. Item 24 and 35 that were related to individual Taqwa, and item 35 that belonged to emotional Taqwa were excluded from the analysis. The composite reliability and convergent, and discrimination validity were satisfied in all conformity factor loading that exceeded 0/05. The psychometric properties of the Taqwa questionnaire are acceptable, and the scale is a good instrument for assessing the Islamic attitude, beliefs, and behaviour of the Bahasa Melayu DDS patients. [ABSTRACT FROM AUTHOR]

Objective: Nasal mucociliary activity, which is a good indicator of nasal mucosal function, is one of the most important defense mechanisms of the body. The aim of the present study is to investigate the effect of smoking and cigarette consumption on nasal mucociliary activity per se by singling out other factors affecting nasal mucociliary activity. Methods: One hundred ninety seven patients aged 18-55 years, one hundred twenty three smokers (case group) and seventy four non-smokers (control group), were included in the present study. Saccharin transfer time (STT) test, CO measurement, Fagerstrom Test for Nicotine Dependence, and a questionnaire including smoking characteristics were applied to all participants. Results: No statistically significant difference was determined between the case and control group in terms of age and body mass index parameters affecting mucociliary activity. In the present study, a statistically significant difference was determined in the mucociliary transfer time between the case and the control group. Moreover, a positive correlation between saccharin transfer time (STT) and number of cigarettes smoked per day, STT and package-year, STT and total smoking years was also determined. Conclusions: In conclusion, smoking has been in the present study determined to deteriorate nasal mucociliary system with a direct proportion to the amount and total duration of smoking. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: There is currently no well‐validated measure that assesses a broad spectrum of substance‐related and behavioural addictions in general populations. This study aimed to develop a brief self‐attribution Screener for Substance and Behavioural Addictions (SSBA) to screen for four substances and six behaviours, and to compare its performance with established individual‐behaviour screening instruments. Design: A small, psychometrically optimal set of items to assess self‐attributed indicators of addiction across alcohol, tobacco, cannabis, cocaine, gambling, shopping, videogaming, overeating, sexual activity and overworking were identified from a broader pool that was developed using a lay epidemiology qualitative approach. The suitability of the four‐item single‐factor solution was tested for each behaviour and scores were compared with those obtained from the sample using individual‐behaviour screening instruments. Setting and Participants: Participants (n = 6000), broadly representative of the Canadian English‐speaking adult population, were recruited through the Ipsos Reid Canadian Online Panel. Measurements: Participants completed an item pool of 15 indicators of addiction for each target behaviour and a validation instrument for one randomly assigned behaviour. Findings: A set of four items identified using principal component and confirmatory factor analyses demonstrated good fit and excellent internal consistency (α = 0.87–0.95) across behaviours, and good convergent validity (rs = 0.44–0.8) with extant instruments measuring similar constructs, with only one exception (r = 0.26). Conclusions: The proposed Screener for Substance and Behavioural Addiction is a reliable and valid measure assessing the lay public's self‐attributed indicators of addiction across 10 substances and behaviours. [ABSTRACT FROM AUTHOR]

Background: The need for effective and accepted method for opioid detoxification is ever increasing. Sublingual buprenorphine and oral clonidine have been effective in opioid detoxification. As often, there is a great variation in the dosage of buprenorphine and clonidine prescribed by the clinicians; hence, there is a felt need to find an effective dosage for a favorable outcome of opioid detoxification. Objective: The objective of this study was to compare the effectiveness of different doses of sublingual buprenorphine and clonidine in opioid detoxification. Materials and Methods: A total of 100 patients with the diagnosis of opioid dependence as per the international classification of diseases-10 criteria were recruited for this study. Participants were assigned randomly into four groups – low-dose clonidine, high-dose clonidine, low-dose sublingual buprenorphine, and high sublingual dose buprenorphine using a computer-generated random number table, resulting in 25, 26, 23, and 26 patients in each group, respectively. Results: The four groups had comparable scores on all the items of “stages of change readiness and treatment eagerness scale” for the assessment of motivation at baseline. Progressive decrease in withdrawal score was seen in all the groups on “clinical opiate withdrawal scale” and “subjective opiate withdrawal scale.” Conclusion: From the current study, we can infer that both low and high doses of buprenorphine and clonidine are comparable regarding controlling withdrawal. [ABSTRACT FROM AUTHOR]

Objective: Individuals with substance use disorder are not homogeneous as we might regard. Thus, this study was conducted to present a novel classification of substance use disorder based on temperament, addiction severity, and negative emotions. Method: In this correlation study, Temperament and Character Inventory, Addiction Severity Index, Aggression Subscale of MMPI-2, Depression, Anxiety, Stress Scale, Emotional Schema Questionnaire, and Psychosocial Checklist were used for data collection. Results: The cluster analysis of 324 individuals with substance use disorder explored 4 subtypes. Subgroups were named based on the main features as emotionally distressed, constitutional, nonconformist, and impulsive. Significant differences were found among groups in emotional schemas, history of mental disorder in the family, rate of relapse, and history of imprisonment. Conclusion: It seemed that temperament dimensions, addiction severity, and negative emotional states were valid components in classifying individuals with substance use disorder. [ABSTRACT FROM AUTHOR]

Abstract: The Cannabis Abuse Screening Test (CAST) aims at screening the problematic use of cannabis. It has never been validated against the Diagnostic and Statistical Manual of Mental Disorders (DSM)‐5 and its relationships with this latter have never been studied. We used a probabilistic telephone survey collected in 2014 (1351 past‐year cannabis users aged 15–64) implementing the CAST and a DSM‐5 adaptation of the Munich Composite International Diagnostic Interview assessing cannabis use disorders. Data were weighted, and CAST items were considered categorical. Factorial structures were assessed with confirmatory factor analyses; the relationships between the instruments were studied with multiple factor analysis (MFA). One factor for the DSM‐5 and two correlated factors for the CAST were the best confirmatory factor analyses solutions. The CAST thresholds for screening moderate/severe and severe cannabis use disorders were 5 (sensitivity = 78.2% and specificity = 79.6%) and 8 (sensitivity = 86.0% and specificity = 86.7%), respectively. The MFA identified two orthogonal dimensions: The first was equally shared by both instruments; the second was the second CAST dimension (extreme frequencies of use before midday and alone, memory problems, and reproaches from friends/family). The CAST structure and screening properties were confirmed. The MFA explains its screening performances by its first dimension and identified the problematic patterns (the second dimension) that are not captured by the DSM‐5. [ABSTRACT FROM AUTHOR]

Background: Benzodiazepines (BZDs) are widely prescribed during psychiatric treatment. Unfortunately, their misuse has led to recent surges in overdose emergency visits and drug-related deaths.Methods: Electronic health record data from a large healthcare system were used to describe racial/ethnic, sex, and age differences in BZD use and dependence. Among patients with a BZD prescription, we assessed differences in the likelihood of subsequently receiving a BZD dependence diagnosis, number of BZD prescriptions, receiving only one BZD prescription, and receiving 18 or more BZD prescriptions. We also estimated multivariate hazard models and generalized linear models, assessing racial/ethnic differences after adjustment for covariates.Results: In both unadjusted and adjusted analyses, Whites were more likely than Blacks, Hispanics, and Asians to have a BZD dependence diagnosis and to receive a BZD prescription. Racial/ethnic minority groups received fewer BZD prescriptions, were more likely to have only one BZD prescription, and were less likely to have 18 or more BZD prescriptions. We identified greater BZD misuse among older patients but no sex differences.Conclusions: Findings from this study add to the emerging evidence of high relative rates of prescription drug abuse among Whites. There is a concern, given their greater likelihood of having only one BZD prescription, that Blacks, Hispanics, and Asians may be discontinuing BZDs before their clinical need is resolved. Research is needed on provider readiness to offer racial/ethnic minorities BZDs when indicated, patient preferences for BZDs, and whether lower prescription rates among racial/ethnic minorities offer protection against the progression from prescription to addiction. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug‐related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. Objectives: The objective was to evaluate a relationship between PDMP opioid prescription records and self‐reported nonmedical opioid use of prescription opioids in a cohort of opioid‐dependent ED patients enrolled in a treatment trial. Methods: PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross‐tabulated with data on 30‐day nonmedical prescription opioid use self‐report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. Results: During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1–51) in our states’ PDMP. Patients who reported ≥15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p < 0.05 for both). Conclusion: PDMPs may be helpful in identifying patients with certain aberrant drug‐related behavior, but are unable to detect many patients with opioid use disorder. The majority of ED patients with opioid use disorder were not captured by the PDMP, highlighting the importance of using additional methods such as screening and clinical history to identify opioid use disorders in ED patients and the limitations of PDMPs to detect opioid use disorders. [ABSTRACT FROM AUTHOR]

Drug abuse is a public health and social problem. A number of studies have reported that drug addiction is associated with microRNAs (miRNAs). By comparing the expression of miRNAs in the serum exosomes of methamphetamine‑dependent and ketamine‑dependent rats, the aim of the present study was to provide insights into the miRNA‑mediated associations between the two groups. Published results on conditioned place preference (CPP) in rats conditioned by methamphetamine and ketamine were replicated. The expression of miRNAs in serum exosomes were determined by gene‑chip sequencing. The potential target genes of differentially expressed (DE) co‑miRNAs were predicted in the methamphetamine and ketamine rats, then functional analysis of their target genes was performed. Methamphetamine and ketamine reward greatly increased the activity time and distance in the intrinsically non‑preferred side of the behavioral apparatus when compared with controlled rats (P<0.01). In addition, methamphetamine upregulated the expression of 276 miRNAs and downregulated 25 miRNAs, while ketamine only downregulated the expression of 267 miRNAs. Ten DE co‑miRNAs in the two model groups were identified. Functional analysis revealed that DE co‑miRNAs are involved in the development of addiction at different stages, and their target genes were enriched in ‘vesicular transport’, ‘amphetamine addiction’, ‘dopaminergic synapse’ and ‘GABAergic synapse’. Therefore, it was suggested that these co‑miRNAs may have a strong association with drug addiction, and they may be involved in the different addiction processes, which partly explains methamphetamine and ketamine addiction. [ABSTRACT FROM AUTHOR]

Psychoactive drug use is a common behavior in many societies worldwide, frequently associated with drug instrumentalization. Regular use may develop into drug addiction, which is a severe psychiatric disorder with multiple pathological effects to virtually all organ systems. Treatment strategies for addiction are often insufficient with no broadly working pharmaco-treatment available. Recently, lipids, and particularly sphingolipids, have been considered as new mediators in the pathogenic pathways and as possible therapeutic targets for the treatment of addictive states. In our review, we discuss the contribution of sphingolipids in the development of addictive states including alcohol consumption, nicotine, amphetamine, morphine, and cocaine dependencies. Recent data show that the involvement of various classes of sphingolipids, such as sphingomyelins, ceramides, globosides, sulfatides, and cerebrosides, might explain the development of some specific features of addictive states, for example, apoptotic neurodegeneration induced by psychoactive substances. On the other hand, protective effects of sphingolipids are discussed. Sphingolipids might be a key mechanism in the development of beneficial effects of moderate alcohol consumption. Therefore, sphingolipid systems emerge as possible new pathways involved in the development of addiction and its pathophysiological consequences. However, further analysis is still needed to investigate the exact mechanisms of sphingolipid contribution and possibility of using of sphingolipids as new therapeutic targets. [ABSTRACT FROM AUTHOR]