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PubMed2001

Will healthcare take tobacco addiction seriously? Using policy to drive practice.

Despite being the leading preventable cause of disability, death, and economic burden on society, tobacco-use detection and treatment is yet to be taken as seriously as the prevention and treatment of chronic diseases or other addictive behaviors (eg, hypertension, diabetes, alcohol/substance abuse, and mammography screening). This paper outlines the process of intervening at the policy level to incorporate tobacco-use screening and treatment in health practice. The National Committee for Quality Assurance (NCQA) call for new measures presented a window of opportunity. The NCQA report card (the Health Plan Employer Data Information Set [HEDIS]) is the most widely used and influential performance measure in managed care. Consequently, a 6-month process consisting of an expert panel review of research evidence and consensus building was initiated. Two measures were submitted to NCQA: (1) a primary measure based on chart review of tobacco-use screening and treatment implementation and (2) an adjunctive measure of population prevalence of tobacco use and physician advice to quit, based on a self-report survey of members. HEDIS eventually accepted the second measure. The mixed results, potential impact on societal disease burden and cost savings, and the lessons learned from the process are discussed.

Health Policy↗
PubMed2001

The role of selective serotonin reuptake inhibitors in reducing alcohol consumption.

Preclinical and clinical studies demonstrated an inverse relationship between serotonergic activity and alcohol consumption. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, citalopram, and fluvoxamine have subsequently been examined for their ability to reduce alcohol consumption in alcoholic subjects. Interindividual variability in response to SSRIs is large, with reductions in alcohol consumption ranging from 10% to more than 70%. Several factors, including gender, alcoholic subtype, and extent of drinking, appear to affect the treatment efficacy of the SSRIs. A significant challenge for researchers is to identify the subject variables that predict treatment response, providing a basis for guiding alcohol-dependent individuals to the treatment that is most likely to be effective for them. This article reviews the available clinical studies, discusses possible mechanisms of action for the SSRIs, and describes a model for predicting treatment responses in alcoholic subjects.

Alcohol Drinking↗
PubMed2001

[Persistent injecting practices in subjects on methadone or buprenorphine maintenance therapy. A study of 600 cases].

A descriptive study conducted at the Louis-Harris Institute enrolled 600 patients taking methadone or buprenorphine (Subutex((R))) substitution therapy who were followed by general practitioners or specialists working in specialized clinics. The objective was to look for factors correlated with persistent injecting practices. Several factors were found to be statistically correlated with persistent injecting practices: impulsiveness, depressive state, and relative under-dosing (first daily or globally) in patients on Subutex((R)). Considering these factors, a better psychosocial impact could be achieved by providing sufficient attention to anxious or depressive states aggravating the effects of impulsiveness (co-usage of certain substances, psychotonics, search for certain psychopathological states) and paying special attention to the more impulsive subjects. Optimal coverage with earlier orientation to appropriate psychiatric care requires a team effort including educators, social workers and healthcare professionals. Such measures must be conducted within the framework of good clinical practices to establish a coherent multidisciplinary healthcare scheme which should help eliminate this source of more or less overt somatic complications. Such good clinical practice could also facilitate safe extinction of the conditioning inferred by addicted behavior (persistent injecting practices) which could persist only a few months after the end of the stimulus (cessation of emotional pain).

Adult↗
PubMed2002

Nicotine dependence: the role for antidepressants and anxiolytics.

The addictive nature of cigarette smoking has been appreciated only in the past two decades. Prior to the publication of DSM-III in 1980, excessive tobacco use had not been considered as a psychiatric problem requiring treatment [1]. Smoking has been recognized as a serious medical problem since thefirst Surgeon General's Report on Smoking and Health in 1964. An important development during the 10 to 20 years following this report was the growth of knowledge regarding the physiological effects of regular tobacco use and the importance of nicotine as the main pharmacological ingredient in tobacco. This body of information culminated in the 1988 Surgeon General's Report, which recognized chronic tobacco use as a form of addictive behavior [2]. Nicotine, like other drugs of abuse, has reinforcing psychoactive effects that lead to its repeated self-administration. Nicotine stimulates the release of several neurotransmitters including dopamine, norepinephrine, acetylcholine, 5-hydroxytryptamine, gamma-aminobutyric acid (GABA) and endorphins [3]. Through its effects on the dopaminergic, or 'reward', system, nicotine exerts psychoactive effects such as an increased sense of enjoyment. The norepinephrinergic effects of nicotine may account for increased attentiveness and improved performance in repetitive tasks, while its anxiolytic effects are likely mediated through GABA and the endorphins.

Alcoholism↗
PubMed2002

Pharmacogenomics.

Pharmacogenomics, a revolutionary chapter in the history of pharmacology, has received new impetus from the development and accessibility of molecular biotechnologies, notably DNA chips. The longstanding notion of responders/non-responders has given way to a more organic approach, where idiosyncrasy becomes an obsolete concept. This is a major step towards predictive, individualized medicine. In this review, several applications of pharmacogenomics are considered. Genetic polymorphisms of metabolization reactions, mainly with cytochrome P450, explain most of the cases described today. More fundamental and innovative studies have tried to link the structure of receptors or transporters and drug response. A leading topic in neuropsychopharmacology is the relation between the polymorphism of dopaminergic receptors and the efficacy of, or adverse reaction to, neuroleptics. In asthma, the structure of the beta2-adrenergic receptor has been associated with response to treatment. Intrinsic genetic predisposition also plays an important role in cardiovascular diseases, and the role of ion channel mutations will be discussed. Research in oncological molecular epidemiology has explored the connection between the predisposition to certain cancers and specific enzymatic equipment hindering the detoxification of potentially carcinogenic exogenous compounds, or, on the contrary, promoting metabolic activation implicated in the formation of reactive compounds. The search for determinants of addictive behavior is another vast field of pharmacogenomics. Finally, we consider the impact of pharmacogenomics on the methodology of drug development in preclinical and clinical trials. Progress in methods of phenotyping/genotyping should promote diagnosis, guide the choice of drug for an individual (benefit/risk ratio), and determine dosage and regimen.

Cardiovascular Physiological Phenomena↗
PubMed2002

[Study of mortality due to myocardial infarction and alcoholism on the basis of the WHO MONICA and Acute Myocardial Infarction Registry programs].

AIM: To study trends of mortality due to alcoholism (A) and cardiovascular diseases (CVD) in Novosibirsk in 1981 to 1998. MATERIALS AND METHODS: The WHO MONICA and Acute Myocardial Infarction Register programmes were used to survey the population of 3 Novosibirsk districts. There were notified 9016 cases of nonviolent death, by exclusing another pathology, with the exception of CVD and alcoholic intoxication. RESULTS: Mortality rates due to myocardial infarction (MI) were relatively stable throughout the observation period, except for 1988, 1994, and 1998 (a significant increase). Those due to A showed the following trend: stabilization in 1981-1982, a significant increase in 1983-1987, stabilization in 1988-1991, a significant increase in 1992-1994, and a decrease in 1995-1998. Mortality rate from MI were 2-3 times greater than that from A, with the exception of 1994-1995 when they were equal, i.e. the trends of mortality from MI and A did not coincide. Social stress is a factor that greatly influences MI death rates, mainly due to prehospital mortality. As social stress increases, younger age groups, both males and females, are afflicted, which is extremely hazardous for the population. By taking into account the mortality trends, it may be stated that A hardly affects death rates from MI. In the pattern of mortality from CVD, death rates from MI and A were 50-70% in males and 35-60% and females; those from MI were 35-55 and 30-45%, respectively. The increase in alcoholism mortality is associated with the population's addictive behavior in the period of social upheavals in the community. CONCLUSION: According to official statistics, the mortality trends do not reflect the actual state of things. This may be done only by stringently standardized programmes with their schemes of data collection and diagnosis verification. The WHO MONICA and Acute Myocardial Infarction programmes belong to such programmes.

Adult↗
PubMed2003

Cooperative activation of dopamine D1 and D2 receptors increases spike firing of nucleus accumbens neurons via G-protein betagamma subunits.

Dopamine in the nucleus accumbens modulates both motivational and addictive behaviors. Dopamine D1 and D2 receptors are generally considered to exert opposite effects at the cellular level, but many behavioral studies find an apparent cooperative effect of D1 and D2 receptors in the nucleus accumbens. Here, we show that a dopamine-induced enhancement of spike firing in nucleus accumbens neurons in brain slices required both D1 and D2 receptors. One intracellular mechanism that might underlie cooperativity of D1 and D2 receptors is activation of specific subtypes of adenylyl cyclases by G-protein betagamma subunits (Gbetagamma) released from the Gi/o-linked D2 receptor in combination with Galpha(s)-like subunits from the D1 receptor. In this regard, dopaminergic enhancement of spike firing was prevented by inhibitors of protein kinase A or Gbetagamma. Furthermore, intracellular perfusion with Gbetagamma enabled D1 receptor activation but not D2 receptor activation to enhance spike firing. Finally, our data suggest that these pathways may increase spike firing by inhibition of a slow A-type potassium current. These results provide evidence for a novel cellular mechanism through which cooperative action of D1 and D2 receptors in the nucleus accumbens could mediate dopamine-dependent behaviors.

Action Potentials↗
PubMed2003

Eating disorders and substance use: be aware of this dual diagnosis.

In summary, dual-diagnosis patients are challenging; their symptoms interact and may lead to dangerous medical sequelae. Their addiction and addiction-like behaviors are therefore best addressed in settings equipped to offer a parallel and simultaneous treatment course for both ED and SUD.

Behavior, Addictive↗
PubMedDate not supplied

The endocannabinoid-CB receptor system: Importance for development and in pediatric disease.

Endogenous cannabinoids (endocannabinoids) and their cannabinoid CB1 and CB2 receptors, are present from the early stages of gestation and play a number of vital roles for the developing organism. Although most of these data are collected from animal studies, a role for cannabinoid receptors in the developing human brain has been suggested, based on the detection of "atypically" distributed CB1 receptors in several neural pathways of the fetal brain. In addition, a role for the endocannabinoid system for the human infant is likely, since the endocannabinoid 2-arachidonoyl glycerol has been detected in human milk. Animal research indicates that the Endocannabinoid-CB1 Receptor ('ECBR') system fulfills a number of roles in the developing organism: 1. embryonal implantation (requires a temporary and localized reduction in anandamide); 2. in neural development (by the transient presence of CB1 receptors in white matter areas of the nervous system); 3. as a neuroprotectant (anandamide protects the developing brain from trauma-induced neuronal loss); 4. in the initiation of suckling in the newborn (where activation of the CB1 receptors in the neonatal brain is critical for survival). 5. In addition, subtle but definite deficiencies have been described in memory, motor and addictive behaviors and in higher cognitive ('executive') function in the human offspring as result of prenatal exposure to marihuana. Therefore, the endocanabinoid-CB1 receptor system may play a role in the development of structures which control these functions, including the nigrostriatal pathway and the prefrontal cortex. From the multitude of roles of the endocannabinoids and their receptors in the developing organism, there are two distinct stages of development, during which proper functioning of the endocannabinoid system seems to be critical for survival: embryonal implantation and neonatal milk sucking. We propose that a dysfunctional Endocannabinoid-CB1 Receptor system in infants with growth failure resulting from an inability to ingest food, may resolve the enigma of "non-organic failure-to-thrive" (NOFTT). Developmental observations suggest further that CB1 receptors develop only gradually during the postnatal period, which correlates with an insensitivity to the psychoactive effects of cannabinoid treatment in the young organism. Therefore, it is suggested that children may respond positively to medicinal applications of cannabinoids without undesirable central effects. Excellent clinical results have previously been reported in pediatric oncology and in case studies of children with severe neurological disease or brain trauma. We suggest cannabinoid treatment for children or young adults with cystic fibrosis in order to achieve an improvement of their health condition including improved food intake and reduced inflammatory exacerbations.

Adolescent↗
PubMed2005

[Age dynamics of mental disorders in neglected minors].

Three hundred and sixty socially maladapted 7-18 year old children have been studied. Their mental state was evaluated in 3 age groups: 7-10 years (60 subjects); 11-14 years (202) and 15-18 years (98). The ICD-10 diagnosis of addictive behavior was established in 228 cases, mild cognitive disorders in 92; adaptation disorders in 61 and socialized and unsocialized disturbances of behavior--86 and 66 cases, respectively. As a rule, these disorders combined with neurotic ones. With age, social and school maladaptation advances, pathological drives and asocial behavior progress. Family history of mental diseases, social impacts such as lack of parent's or formal caregiver's control, and high frequency of mental disorders in children are risk factors for neglect.

Adaptation, Psychological↗
PubMedDate not supplied

[Panic disorder and alcoholism].

Relationships between alcoholism and anxiety disorder are well known by clinicians. Studies have recently shown that the prevalence of alcohol abuse or dependence is very high in patients with panic disorder with or without agoraphobia (Thyer et al., 1986; Bibb and Chambless, 1986). The aims of this study were to determine the prevalence and comorbidity of alcohol abuse and dependence in a population of panic outpatients who were consecutive referrals for treatment of panic disorder (PD) in an anxiety clinic. Patients were interviewed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version Modified for the study of anxiety disorders (SADS-LA) which is a standardized and semi-structured interview allowing to make diagnoses according to RDC, DSM III and DSM III-R criteria. One hundred and three panic patients (39 males and 64 females) were included in the study. Their mean age was 38.5 years (SD: 11.6). In this sample, 24.3% met the DSM III-R criteria for alcohol abuse and 8.7% those for alcohol dependence. Among these patients, 26.2%, abused of benzodiazepines and 16.5% of them of other substances. We found a high comorbidity rate. In fact, 6.8% of the patients met diagnostic criteria for PD alone, 31.0% for one more diagnosis, 29.1% for two more and 33.0% for three or more besides PD. In this study, we found an association between alcohol abuse and the presence of a lifetime diagnosis of major depressive episode and/or other addictive behaviors. Otherwise, alcohol abuse did not occur more often in patients suffering from panic disorder associated with agoraphobia and/or social phobia.

Adult↗
PubMed1990

[Drug abuse among residents of Beijing: an epidemiologic survey of 1,822 households].

An epidemiological survey was conducted in the residential areas of 6 neighbourhood committees of Chao Yang District of Beijing in search of the prevalent status and related factors of drug abuse among 1,822 households out of 6,114 population. The result of present study reveals that the prevalence rate of limit daily-used drug abuse is 3.09% among a sample of 5,509 people over the age of fifteen. However, the extent of drug abuse seems neither great nor epidemic and all 17 dependents living in scattered geographical sites. In exploring the causation of drug abuse, the authors found that family structure, economic status, individual social function or stressful life events are not correlated and the use of drug is not a coping method to environmental maladaptation. On the contrary, most of the drug dependent are attributable to some iatrogenic reasons lacking of certain drug monitoring measures in their long-term medication. In a word, the misuse of drug facilitated addictive behaviors. No social problem emerged among all cases of study as measured with SDSS, but it is still a potential hazard to the psychosomatic health condition in the long run.

Adult↗
PubMed1990

Efficacy expectations among alcohol-dependent patients--a Swedish version of the Situational Confidence Questionnaire.

The Situational Confidence Questionnaire (SCQ) developed by Annis (1986 A relapse prevention model for treatment of alcoholics. In Treating Addictive Behaviors. Processes of Change, Miller W. R. and Heather, N. eds, pp. 407-435. Plenum Press, New York) is an important assessment instrument for use in the treatment of alcoholism and particularly in relapse prevention. The SCQ was translated into Swedish and tested on 91 alcohol-dependent patients. A principal component analysis of the item responses resulted in a shortened 35-item version of the SCQ with satisfactory test-retest reliability, internal consistency and scale specificity. Instead of eight relapse situation categories the analysis resulted in four categories with lower intercorrelations than in the original SCQ. The components were: (1) unpleasant emotions; (2) social pressure; (3) testing personal control; and (4) positive emotional states. In a one-way ANOVA only the Social Pressure scale had a significant relationship with severity of alcohol problems.

Alcoholism↗
PubMed1989

A bridge to treatment: the needle exchange pilot program in New York City.

The needle exchange pilot program in New York City is one element in a spectrum of drug prevention and treatment modalities under way to slow the spread of the human immunodeficiency virus. The program's aim is to help us learn about the addict behaviors that spread the AIDS virus, including whether needle exchange can help reduce the frequency or eliminate those behaviors. Thus far, its primary value for clients lies in drug counseling and referral to treatment. Where an active IV drug user has taken the first step in changing the direction of his or her life by seeking treatment, needle exchange has been a significant means of helping keep that change in focus. Because of its value in helping change, and save, the lives of intravenous drug users and their sex partners and children, it should be expanded, and should be considered for adaption by other communities according to their needs as one relatively small element in a comprehensive AIDS prevention program.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Identifications in several young alcoholics].

For this article we used personality tests (Rorschach, TAT), in particular, to study the problems of identification and identity among 16 young problem drinkers. Certain problems are analyzed in greater detail, for example absence or failure of identifications, identifications with collective ideals, incorporation fantasies, and some identification problems specific to adolescence. The author concludes that these young problem drinkers use their addictive behavior to transform identity problems in social conflicts. This transformation complicates for them all personal relationship that could include an authentic and individual expression of their problems.

Adult↗
PubMedDate not supplied

Nurses' perceptions of their pain assessment skills, pain management practices, and attitudes toward pain.

Nursing pain assessments are influenced by the length of available tools, patient characteristics, patient pathology, concern about addictive behavior, and characteristics of the nurse. The relationship among these variables was explored in a sample of community hospital nurses (N = 59) and ONS members (N = 19). Although a number of interesting similarities were found in the two groups, age, professional and continuing education, and care setting appear to be related to differences in pain assessment practices. Implications for practice, research, and education include teaching nurses to: assess factors related to quality of life in the pain experience, assess and validate data from families, assess coping skills, and teach patients to use behavioral pain management strategies. The findings also suggest that further study is needed concerning the relationship between personal beliefs and experiences and the assessment and management of pain. Membership in professional organizations appears to be associated with comprehensive approaches to the assessment and management of cancer pain and should be addressed in further research.

Adult↗
PubMed1988

Adolescents who apparently are invulnerable to drug, alcohol, and nicotine use.

As part of a large survey of addictive behavior in high school students, a group of 43 girls and 34 boys was identified who denied any use of drugs, alcohol, or tobacco. These apparently invulnerable adolescents were compared to the rest of the "user" sample on the remaining items of the questionnaire. The invulnerable students reported generally better physical and mental health and academic achievement. They also indicated a significantly lower rate of similar problems in their parents.

Achievement↗