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Biomedical subjects

N el-Guebaly

Publications and source records attributed to N el-Guebaly.

At least 19 recordsLinked to original sources
PubMed2001

Influence of depression and gender on smoking expectancies and temptations in alcoholics in early recovery.

PURPOSE: Rates of smoking are much higher among persons with alcohol problems and a history of depressive illness than persons without those disorders. Drug use in general may be motivated by outcome expectancies such as negative affective reduction and relaxation. Persons with a history of depression may smoke as a means of mood management. The role of outcome expectancies and major depression in maintaining smoking behavior in a high-risk group of smokers, such as recovering alcoholics, has not been thoroughly examined. METHODS: Using a cross-sectional design, 161 abstinent alcohol-dependent men and women who smoked were administered the Inventory to Diagnose Depression (IDD), a self-report instrument for assessing current and lifetime depression according to DSM-IV criteria, and measures of alcohol dependence, nicotine dependence, smoking motives, and situation-defined temptations to smoke. RESULTS: As expected, smoking motives and temptations were moderated by history of depression. Alcoholics with a history of depression were more likely to smoke with the expectancy of negative affect reduction than those with no prior major depression. Using multiple regression, negative affective reduction, addiction, and severity of past depression were the strongest predictors of current temptations to smoke. IMPLICATIONS: These results suggest that individuals with a combined history of alcoholism and major depression are at a high risk to use smoking as a means of mood enhancement.

Adult↗
PubMed2001

Problem and pathological gambling in North American Aboriginal populations: a review of the empirical literature.

This literature review attempts to: estimate Aboriginal population prevalence rates for problem and pathological gambling and compare these rates to the general population; determine factors associated with the Aboriginal population problem gambling behaviour; and identify other salient findings and issues. Materials used in the review were drawn from available research literature and bibliographies. There were no time restrictions or study design criteria included in the review. Key words used: Aboriginal, Indians, First Nations, Native, lotteries, gambling, casinos, and gaming. Eleven descriptive studies were identified. Gambling appears to be problematic among Aboriginal people. Aboriginal adolescents have higher rates of problem gambling, as do Aboriginal adults for both problem and pathological gambling than their non-Aboriginal counterparts. The odds ratios indicate that the Aboriginal population has a problem gambling behaviour rate 2.2 to 15.69 times higher than the non-Aboriginal population. A number of factors associated with Aboriginal population problem and pathological gambling were identified. Gambling literature specific to the Aboriginal population is limited and there is extensive variation in estimates of their increased risk. Several associated factors were identified but whether these are specific to the Aboriginal population or to all problem and pathological gamblers needs to be determined. More research, particularly qualitative, into these factors is warranted.

Adolescent↗
PubMed2001

Motivational enhancement and self-help treatments for problem gambling.

Two brief treatments for problem gambling were compared with a waiting-list control in a randomized trial. Eighty-four percent of participants (N = 102) reported a significant reduction in gambling over a 12-month follow-up period. Participants who received a motivational enhancement telephone intervention and a self-help workbook in the mail, but not those who received the workbook only, had better outcomes than participants in a 1-month waiting-list control. Participants who received the motivational interview and workbook showed better outcomes than those receiving the workbook only at 3- and 6-month follow-ups. At the 12-month follow-up, the advantage of the motivational interview and workbook condition was found only for participants with less severe gambling problems. Overall, these results support the effectiveness of a brief telephone and mail-based treatment for problem gambling.

Adult↗
PubMed2001

Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practitioners.

OBJECTIVES: To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism. METHODS: A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons. RESULTS: Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication. CONCLUSIONS: Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.

Alcohol Deterrents↗
PubMed2000

Natural and treatment-assisted recovery from gambling problems: a comparison of resolved and active gamblers.

AIM: An exploratory study was conducted to understand the process of recovery from gambling problems. DESIGN: Media recruitment was used to identify a resolved (n = 43) and a comparison group of active pathological gamblers (n = 63). PARTICIPANTS: Participants showed evidence of significant problems related to gambling as well as high rates of co-morbid mood and substance use disorders. The median length of resolution was 14 months with a range of 6 weeks to 20 years. FINDINGS: Resolved gamblers reported a variety of reasons for quitting gambling, related mainly to emotional and financial factors. They did not experience a greater number of precipitating life events compared with active gamblers but did report an increase in positive and a decrease in negative life events in the year after resolution. Both resolved and active gamblers who had relatively more severe problems were more likely to have had treatment or self-help involvement, whereas those with less severe problems, if resolved, were "naturally recovered". CONCLUSIONS: The results support the need for a continuum of treatment options for problem gamblers and provide helpful information about recovery processes.

Adult↗
PubMed2000

Medical education in substance-related disorders: components and outcome.

AIMS: To analyze the process of acquisition by physicians of a body of knowledge and skills in the management of substance abuse. DESIGN: A comprehensive search of English-speaking literature was conducted over 20 years. Articles assessing the outcome of educational strategies in undergraduate, graduate and continuing medical education were examined to determine the targeted sample, the educational strategies involved and the outcomes assessed. FINDINGS: Nine studies in undergraduate education, 11 in graduate and 11 in continuing education met the inclusion criteria. They were generally difficult to compare in design, strategy and outcome analysis. Cognitive knowledge and behavioral skills appear to be easier to obtain compared to more complex attitudinal shifts. CONCLUSIONS: There is growing consensus in the selection of a combined didactic and interactive educational strategy but few empirical data as to the more cost-effective learning interventions. Training must be reinforced at regular intervals. While the expanding panoply of interventions available to physicians should enhance the perceptions of role legitimacy and treatment optimism, cohort studies across levels of education, specialty groups and across-substance and other addictive behaviors are required to determine cost-effective educational strategies.

Education, Medical↗
PubMed1999

Using measures of readiness to change in individuals with schizophrenia.

The literature suggests that substance abuse treatment for schizophrenia patients should consider both the patients' readiness for active treatment and matching phases of intervention with phases of the patient's acceptance of his or her dual problems. This study assessed the suitability of existing measures of "readiness to change" for use with individuals with schizophrenia. Outpatients (n = 39) with a diagnosis of schizophrenia and alcohol and/or drug dependency or abuse were given three measures to assess the stage of readiness to change. Results suggested that there was no agreement between stages defined by the interviewer and stages defined by self-report. This has implications for assessing readiness to change in terms of substance use in a population with schizophrenia.

Alcoholism↗
PubMed1999

Methodological and clinical challenges in evaluating treatment outcome of substance-related disorders and comorbidity.

OBJECTIVE: To review the steps required to develop an outcome evaluation package and to report on the 12-month outcome of an integrated day program. METHOD: Based on the identification of salient outcome predictors, standardized instruments were selected. A cohort of 78 patients was assessed at the time of admission to the program, at discharge, and 3, 6, and 12 months afterward. RESULTS: Improvements were sustained over 1 year in all areas including treatment needs, quality of life, and readiness to change. CONCLUSIONS: The gap between the "cultures" of treatment and research must be narrowed. Following evidence of a program's general effectiveness through outcome monitoring, a randomized control design is optimal for specific interventions. The optimal length of follow-up depends on the perceived confounds.

Adult↗
PubMed1999

Implications of depression on outcome from alcohol dependence: a 3-year prospective follow-up.

The prognostic implications of comorbid depression for outcome from alcohol dependence are unclear. It has been suggested that drinking may represent self-medication of depressive disorders and, alternatively, that the pharmacological properties of alcohol induce episodes of depression. In the present study, these questions were investigated by following 84 alcohol-dependent individuals seeking treatment (34% women) for 3 years in a naturalistic, prospective design. During the follow-up period, depressive and drinking outcomes were significantly related. However, there was no evidence that drinking reliably preceded depressive episodes or that depressive episodes precipitated heavy drinking. Despite their high co-occurrence, this study did not find evidence of a strong, direct causal relationship between these phenomena.

Adolescent↗
PubMed1998

Smoking cessation treatment for patients with schizophrenia.

OBJECTIVE: This study was an uncontrolled trial to assess the efficacy of a smoking cessation group program modified for individuals with schizophrenia. METHOD: Fifty outpatients with schizophrenia were divided into five groups who met separately for seven weekly sessions of a smoking cessation program. The subjects' schizophrenic and extrapyramidal symptoms were assessed before the group sessions began and after they had been completed. Assessments of smoking were made at those times and at 3-month and 6-month follow-ups. RESULTS: Forty-two percent of the subjects had stopped smoking at the end of the group sessions; 16% remained abstinent at 3 months, and 12% at 6 months. These changes were statistically significant. There was no change in the positive or negative symptoms of schizophrenia. CONCLUSIONS: The results suggest that it is possible for individuals with schizophrenia to stop smoking.

Adult↗
PubMed1998

Substance-related cravings and relapses: clinical implications.

OBJECTIVE: To review the implications of current research on clinical practice. METHOD: An examination of the literature over the last 10 years and the data from our own study group. RESULTS: A synopsis of current psychobiological and psychological conceptual underpinnings of the nature and process of cravings and relapses among substance-dependent individuals is presented. The biopsychosocial dimensions of the clinical assessment of craving components, relapse patterns, and predictors, including relevant instruments, are explored. The panoply of management strategies for cravings and relapses encompasses cue exposure treatment techniques, relapse prevention approaches, anticraving and psychotropic medication, family involvement, and twelve-step programs. CONCLUSION: A clinician's familiarity with these strategies should contribute significantly to the transformation of the sense of failure engendered by a patient's relapse into a constructive challenge and opportunity.

Combined Modality Therapy↗
PubMed1998

Nicotine and endogenous opioids: toward specific pharmacotherapy.

OBJECTIVE: To address the theoretical framework behind opioid receptor antagonism for the treatment of nicotine abuse. The current literature is reviewed with a focus on opioid-nicotine interactions in animals and humans. Furthermore, previous studies addressing the effect of opioid antagonism on smoking behaviour are reviewed critically with a focus on suggestions and implications for future trials. METHOD: Computerized data bases and reference lists of existing articles were searched for prior publications in 3 areas: 1) the association between nicotine and endogenous opioids, 2) nicotine and reward, and 3) opioid antagonism in the treatment of nicotine use. RESULTS: Nicotine affects the mesolimbic reward pathway postsynaptically via nicotinic cholinergic receptors and presynaptically via the central nervous system's (CNS) neurohumoral pathways. Thus nicotine results in the release of endogenous opioids that bind to mu receptors, which increases the release of dopamine along this pathway. Studies to date have shown mixed results on the effect of opioid antagonism on smoking behaviour. CONCLUSIONS: The role of opioid antagonism on smoking behaviour is unclear, despite the publication of 5 trials on the subject. Further trials of longer duration should be undertaken and use both longer-acting medications and those more specific to the mu receptor to further focus on the rewarding aspects of nicotine ingestion, thus addressing the craving for this drug. The development of adequate compounds has just begun, and psychiatrists can hope to have a more specific pharmacotherapy to address the cravings and short-term rewards of nicotine use.

Animals↗
PubMed1998

Psychiatric comorbidity in pathological gambling: a critical review.

OBJECTIVE: To critically review the current literature on pathological gambling as regards the significant psychiatric comorbidities associated with it. METHOD: The authors synthesized information found via electronic searches (MEDLINE) and bibliographic-directed searches in over 60 publications. RESULTS: Pathological gamblers frequently have comorbid substance use disorders. In addition, a subset appear to have comorbid antisocial personality disorder, but they represent a minority when compared with those people who have acquired their antisocial traits as a consequence of their gambling behaviour. A comorbidity with the mood disorders is probable, but methodological concerns and inconsistencies with the data prevent further delineation of this. Emerging research for other disorders possibly associated with pathological gambling is also reviewed. CONCLUSION: Pathological gambling is associated with significant psychiatric comorbidity. Recommendations for future research are described.

Antisocial Personality Disorder↗
PubMed1998

Group treatment for substance abuse in schizophrenia.

OBJECTIVES: A review of the relevant research suggests a need to develop an appropriate, effective, and replicable treatment to help individuals with schizophrenia and substance abuse problems. This pilot study describes a biweekly group specifically designed to help the individual with both schizophrenia and substance abuse. The components of the group were support, psychoeducation, and skills training. Attention was also paid to the stage of recovery. METHOD: Eighteen subjects attended the group and were assessed pregroup. Thirteen subjects completed a 1-year follow-up, and 5 subjects were assessed between 3 and 6 months. RESULTS: At the follow-up assessment, 8 subjects (44%) were abstinent. CONCLUSIONS: This type of treatment appears to be effective for reducing substance abuse in this population.

Adult↗
PubMed1998

Substance abuse and the emergency room: programmatic implications.

A literature review (1984 to 1995) was conducted to identify cost effective policy implications regarding substance use in the emergency room (ER) and trauma unit. Prevalence rates, ranging from 9% to 47%, vary according to where, when and who is tested. Other drugs, most commonly marijuana, benzodiazepines and cocaine, follow a similar pattern to alcohol. The optimal method of measuring substance use depends on the goal of the assessment and a combination of clinical, self-report and biochemical markers is recommended. Simple screening questions such as the TWEAK or AUDIT should be routinely used with all attendants and further assessment provided only when high risk factors have been identified. These include: males, younger patients, metropolitan centres, after midnight and on weekends, injury from violence, accidents including MVAs, high acuity and psychiatric morbidity. Further, this screening should be complimented by an intervention, referral and treatment resource for those in need.

Benzodiazepines↗
PubMed1997

Readiness to stop smoking in schizophrenia.

OBJECTIVE: To assess the motivation and readiness to change of individuals with schizophrenia prior to developing a smoking cessation program. METHOD: Smoking history, nicotine dependence, readiness to stop smoking, and interest in a smoking cessation group were assessed in 60 schizophrenia outpatients who smoked. RESULTS: The majority were interested in attending a smoking cessation group and appeared to be appropriately motivated. CONCLUSIONS: Smoking cessation groups for a schizophrenia population may be a worthwhile endeavour. Current measures of motivation and readiness to change may be useful to identify those who are most likely to succeed.

Adult↗