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PubMedDate not supplied

Risk factors for anabolic steroid use in college students and the role of expectancy.

Anabolic steroids are now recognized as a widespread addictive and dangerous substance, no longer exclusively used as an aid to muscle size and strength in world-class athletes. Psychologists have neglected prevention programs for steroid abuse, in part because of a lack of knowledge of the precipitants of abuse. This study examined demographics, personality factors, and steroid expectancies as risk factors for future steroid use. Older subjects, extraversion, global-positive expectancies for steroid use, and identification with peers who advocated health-risk behaviors predicted higher steroid use, whereas specific social-behavioral negative expectancies for steroid use significantly predicted lowered risk of steroid use. These findings are discussed in the context of past research, and implications for preventive intervention are described.

Adult↗

PubMed2005

The influence of partner status, relationship quality and relationship stability on outcomes following intensive substance-use disorder treatment.

OBJECTIVE: Addiction treatment studies examining the influence of patients' partners suggest that partner behaviors affect patients' substance-use outcomes. We examine the influence of having a partner at treatment entry as well as the influence of the general quality of support and substance-using status of the partner, on outcomes following treatment for substance-use disorder. We also examine the influence of relationship stability on treatment outcomes and examine baseline partner behaviors that may predict relationship stability. METHOD: A prospective, intact-group design was utilized with data analyzed using logistic regression. Participants (N = 3,014) from 15 intensive substanceuse disorder treatment programs were assessed at treatment entry and 1-year postdischarge. RESULTS: Although patients with partners possessed a more favorable clinical profile, their outcomes were no better than those of their single counterparts. However, patients whose relationships lasted through the first year posttreatment had better outcomes than patients whose relationships ended. Relationships with more positive partner behaviors and fewer negative partner behaviors at intake were more likely to remain intact over the course of the first year posttreatment. Positive partner behaviors did not enhance patients' outcomes directly, but partner interpersonal stressors and patients' belief that their partner had a substance-use problem had a significant, deleterious impact on patients' substance-use outcomes. CONCLUSIONS: Clinicians should routinely assess the quality of patients' relationships with partners. If deleterious partner behaviors exist, empirically supported interventions (e.g., behavioral couples therapy) could be utilized to reduce these behaviors and ultimately reduce relapse risk.

Adult↗

PubMedDate not supplied

The self-medication hypothesis of substance use disorders: a reconsideration and recent applications.

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

Humans↗

PubMedDate not supplied

Peer, family integration and other determinants of cannabis use among teenagers.

Cannabis consumption is on the rise in the French-speaking Community of Belgium, especially among teenagers. The physical and mental harms related to that drug prompted us to search for factors associated with cannabis consumption. The aim of this paper is thus to identify a series of potential predictors of teenager's cannabis use and particularly the influence of peer and family integration. The data analyzed were taken from the 1998 data bank "Health Behavior in School-Aged Children", an international quantitative cross-national study, which takes place every four years. The variables investigated were peer and family integration and the habit of drug consumption (tobacco, alcohol or a narcotic other than cannabis) as potential determinants of the experimentation, current usage of cannabis (at least once a month) and regular usage (at least once a week). Apart from the socio-demographic variables, these predictors were investigated by univariate and multivariate analysis (logistic regression). The analyses covered 744 students in Catholic high schools. Results showed that 30.2% of students had tried to smoke cannabis and 50% of them continued to smoke it at least during the previous month. Age, number of income in the family, strong peer group integration [OR 7.7; CI 95% (3.5;17.3)] and drug-consumption habit [for example, tobacco use: OR 7.4; CI 95% (4.8;11.32)] were associated with cannabis experimentation. Age, gender, nationality, average family integration [OR 2.13; CI 95% (1.1;4.1)] and other drugs use as addiction to nicotine [OR 9.5; CI 95% (5.6;16.3)] determined the current consumption of the substance. Preventive action should aim at improving the teenager's integration into the family circle in order to prevent the trial and consumption of cannabis. In addition, prevention should include the consumption of (addictive) substances in general.

Adolescent↗

PubMed2003

Can we help addicts become more autonomous? Inside the mind of an addict.

I examine the impact of addiction on autonomy in terms of the standard literature on addiction--referred to also as 'substance dependence.' Then in terms of the criteria for substance dependence, by developing a set of practical strategies to help people with addictions think more clearly, I test the idea of whether addicts can be helped to become more autonomous. Given that unsuccessful attempts to quit constitute part of the criteria of substance dependence, I look at what goes wrong when people try to quit using a substance. The subjective experience of addiction is an important aid in understanding addiction and first person accounts and literary characterisations of addiction provide insight into the addict's mind and assist us in deciding whether addicts can be helped to become more autonomous.

Behavior Therapy↗

PubMed1983

Alcohol and drug use by alcohol and drug abusers when incarcerated: clinical and research implications.

Alcohol (n = 24) and drug (n = 60) abusers reported frequent alcohol and/or drug use while incarcerated in hospitals, jails, and residential treatment programs. Although substance use by addicts while incarcerated may be a "well-known" clinical phenomenon, there are virtually no published data regarding the range and frequencies of such behaviors. The clinical and research implications of frequent drug and alcohol use by alcohol and drug abusers when incarcerated are discussed.

Adult↗

PubMed2000

Diagnostic subgroups within a sample of comorbid substance abusers: correlates and characteristics.

Patients seeking treatment at the Addiction Research Foundation for a substance problem but who also reported psychiatric symptomatology were referred to the Mental Health Unit. Following a clinical psychiatric interview, these patients were categorized into one of six diagnostic subgroups based on the presence of DSM-III-R psychiatric disorders: mood, anxiety, psychotic, organic, Axis-II, and adjustment. A control group of patients referred to the Mental Health Unit but not diagnosed with a psychiatric disorder was also included. These groups were compared on several demographic, substance use, and psychiatric variables. Patients assigned a diagnosis of organic (substance-induced) and Axis II disorders were found to have more severe substance use histories, alcohol-related consequences and longer treatment histories. Patients with a diagnosis of adjustment disorder appeared to be functioning relatively better. Implications of studying the heterogeneity of comorbidity are discussed.

Adult↗

PubMed1992

Our society's response to the addictions.

Public health and public policy for our society's response to substance use and abuse and addiction should be the logical extension of our knowledge and information about the drugs and our clinical experience with addicted people. The drugs should be seen along a continuum of addicting potential and physical damage and harm to individuals and to society. There should be no distinction between legal and illegal substances when viewing the impact of drug use. Public policy should reflect the fact that nicotine and alcohol should be viewed as dependence-producing drugs. Addictions are all interrelated; people are addicted. Addiction is a public health problem and should be subjected to the same study and treatment as any other. The remedicalization of our response to addiction is bringing physicians into the field of addiction medicine and is strengthening the place of science and clinical observation in the foundations of our public policy.

Drug and Narcotic Control↗

PubMed2006

Hyperbolic discounting may be reduced to electrical coupling in dopaminergic neural circuits.

Loss of self-control in drug addicts (e.g. cocaine and amphetamine dependent patients) has been associated with hyperbolic discounting of delayed rewards (i.e., inconsistency in intertemporal choice). Neurobiophysical mechanisms underlying hyperbolic discounting are still unknown in spite of recent extensive work in neuroeconomics. Understanding of neuronal mechanisms of hyperbolic discounting is important for establishing neuropharmacological treatment of addiction. At the cognitive level, previous studies have indicated that psychophysics of time-estimation (i.e., Weber-Fechner law and Steven's power law of time-perception) may explain inconsistency in intertemporal choice. Regarding neuronal substrates of time-estimation, drugs of abuse dramatically change time-estimation, indicating that dopaminergic activities may mediate time-estimation. With respect to neuronal changes induced by drugs of abuse, recent studies have revealed that gap junction proteins (e.g., connexin 36) in dopamine neurons are increased by an self-administration of dopaminergic drugs such as cocaine and amphetamine. However, it has been yet to be examined how the enhanced electrical coupling due to substance administration induces addiction. Furthermore, a recent biophysical modelling study has demonstrated that the effect of the psychophysical laws are potentiated by non-synaptic electrical coupling between neurons via gap junctions. Based on these current findings, we hypothesized that hyperbolic discounting may be reduced to biophysical characteristics of dopamine neural circuits, that is, electrical coupling between time-encoding dopaminergic neurons via gap junctions. The present hypothesis states that drugs of abuse may induce addiction by exacerbating subject's impulsivity (a discount rate) and inconsistency (hyperbolicity) in intertemporal choice partly due to enhanced expression of gap junction proteins in dopaminergic neurons. Possible psychopharmacological treatments of impulsivity in drug addicts implied by our present hypothesis, e.g., administration of a gap junction blocker, are discussed.

Brain↗

PubMed2003

Ego depletion and self-regulation failure: a resource model of self-control.

Effective self-regulation is an important key to successful functioning in many spheres, and failed self-regulation may be centrally conducive to substance abuse and addiction. The program of research summarized here indicates that self-regulation operates as a limited resource, akin to strength or energy, especially insofar as it becomes depleted after use-leaving the depleted self subsequently vulnerable to impulsive and undercontrolled behaviors (including increased consumption of alcohol). The self's resources, which are also used for decision-making and active responding, can be replenished by rest and positive emotions.

Alcoholism↗

PubMed1997

Assessing substance use in multiproblem patients: reliability and validity of the Addiction Severity Index in a mental hospital population.

The Addiction Severity Index (ASI) is the most widely used measure of substance use in the field. Its reputation has been supported by reliability and validity studies. Despite its success, the psychometric properties of the ASI have not been examined in mental hospital populations. Our intent was to replicate prior studies and expand upon the validity of the ASI in a sample of 100 public psychiatric patients selected for a larger study. Findings revealed that a) reliability was acceptable, but there was only moderate agreement on the psychiatric scale severity score; b) the relationship between extent of rater training and reliability requires further study; c) despite some overlap, the scales were largely independent of each other; d) modification of the employment scale was necessary because of low correlations between the composite and severity score; e) raters are more responsive to client subjective ratings in psychiatric settings; f) ASI drug and alcohol scales correlate well with other substance use instruments and with DSM-III-R diagnoses; and g) the ASI can identify meaningful types of patient problems through cluster analysis. These findings, on the whole, support the use of the ASI drug and alcohol scales in public psychiatric hospitals.

Adult↗

PubMedDate not supplied

[Alternating addictions: apropos of 3 cases].

The concept of addiction is now of interest in psychiatry, but is a great subject of controversies. It is now recognized that as different disorders as alcoholism, drug addiction, bulimia, kleptomania, trichotillomania, pathological gambling are to be considered as addictive states. Other pathological behaviours could be included in the addictive spectrum (i.e. suicidal behaviours, compulsive spending). The comorbidity rates of these disorder are elevated in these populations. For example, high comorbidity rates are found between kleptomania and bulimia or drug addiction and pathological gambling. Polyaddictive states are well established. For some subjects, more than one addiction is present in life-time, but not occurring in the same period. We present three patients in whom different addictive states occurred alternately. All the patients had a history of compulsive spending and kleptomania, two of them had a history of bulimia and sexual compulsion. Some clinical characteristics were common: recurrent mood disorder, depression preceeding the addictive state, no psychoactive substance disorder. In all patients, severity of depressive state decreased when addiction appeared. Depressive symptoms varied inversely to addiction severity. The hypothesis about psychopathological links between kleptomania and bulimia on one hand and mood disorders on the other hand has been known for a long time. Kleptomania as other impulsive disorders is, for some authors, understood in the meaning of a "spectrum affective disorder". For these three patients, an antidepressant effect of the behavioural addictions is suggested. In fact, the addictions appeared alternately. The possibility of common psychopathological and/or biological mechanisms for behavioural addiction is supported by these clinical observations, that could contribute to the addiction concept validity.

Adult↗

PubMed2005

Neural systems recruited by drug- and food-related cues: studies of gene activation in corticolimbic regions.

In order to survive, animals must acquire information about the reward value of stimuli in their environment. This process partly depends on the ability of the organism to make associations between the environmental context and the internal representation of value. While this type of learning probably evolved in order to promote behaviors that increase fitness (e.g., ingestive and sexual behavior), neuropsychological research utilizing addictive drugs, which are potent artificial reinforcers, has led to a deeper understanding of reinforcement mechanisms. Through these associations, sensory cues can acquire emotional salience and motivational properties. Exposure to drug-related cues in human addicts results in drug craving and localized activation of central circuits that are known to mediate cue-induced reinstatement of drug-seeking behavior in animal models of relapse. Similar regional activation patterns occur in humans in response to cues associated with foods. Furthermore, drug- and food-related cues not only activate common neuroanatomical regions but also result in similar activity-regulated gene expression programs within these shared areas. Here we discuss recent studies from our laboratory that investigate gene expression patterns elicited by exposure to palatable food- or drug-related cues. These studies suggest that the central nervous system stores and utilizes information about 'natural' and drug reinforcers in similar ways, both neuroanatomically and biochemically. These considerations may have important implications for the pharmacological and cognitive-behavioral treatments of substance use disorders, addiction, eating disorders, and obesity.

Animals↗

PubMed2001

Recent evolution in opiate dependence in France during generalisation of maintenance treatments.

Two maintenance drugs had been used in France since 1996, methadone and high-dosage buprenorphine. This study aimed to examine changes in drug use from observations gathered between 1995 and 1997, within the framework of the French program for the monitoring of drug dependence (OPPIDUM). This annual survey studies psychoactive substances consumed by drug addicts attending specialised drug care centres. During the last three surveys, 16 centres collected a total of 1597 patient-files. This study shows an increase in the number of patients undergoing maintenance treatment (from 14 to 69%), a reduction in the number of intravenous drug users (from 55 to 22%) and a reduction in consumption of psychoactive substances. However, poly-drug addiction behaviour continues and high-dose buprenorphine subjects frequently use the substance intravenously and in association with benzodiazepines.

Adult↗

PubMed2006

The role of sexual dysfunctions in inducing the use of drug in young males.

INTRODUCTION: Adolescence is one of the periods in which the risk of the initial use of drugs is high. Among the risk factors of first drug use, sexual disorders have been considered one of the possible reasons leading young males to substance abuse and addiction. AIM: To provide data supporting the "La Pera hypothesis", according to which, a very large percentage of young males begin to use drugs due to sexual problems. METHODS: A total of 86 subjects, recruited from 5 drug rehabilitation centers were invited to fill in a questionnaire with their personal data, toxicological history, sexual experiences as well as quality of performances. RESULTS: Approximately 50% of the entire sample used psychotropic drugs to improve their sexual performance with 30 subjects (34.1%) stating that their sexual disorder had influenced their decision to start taking drugs. Of these 30 subjects, 18 (60%) stated their sexual problem had influenced them a little, while in 8 (26.7%), it had influenced them a lot and in 4 (13.3%) it had been a decisive factor. The prevalence of sexual dysfunction prior to first drug use was greater among subjects whose sexual problems influenced their initial use of drugs compared to the remainder of the sample, the difference being statistically significant. CONCLUSIONS: These data are in accordance with the "La Pera hypothesis" based on the cause/effect relationship between sexual dysfunctions and initial use of drugs. It is urgent to demonstrate that sexual disorders lead to first drug use since sex education and early treatment of sexual dysfunctions could provide an effective tool for the primary prevention of substance abuse in young males.

Adult↗

PubMed2003

Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program.

OBJECTIVE: This study examined how well older chemical dependency patients succeed in treatment relative to middle-aged and younger patients in a mixed-age private HMO outpatient program. To predict successful outcome, we tested a model incorporating age group differences in individual, treatment and extratreatment factors. METHOD: The sample included 89 patients aged 55 and over, 379 patients aged 40 to 54, and 736 patients aged 18-39 (N = 1,204). Baseline measures included DSM-IV substance misuse diagnoses, Addiction Severity Index (ASI), psychiatric symptom checklist, sources of suggestion to enter treatment, treatment history and motivation. Outcome measures were abstinence rates and ASI score 6 months posttreatment. RESULTS: At baseline, older adults showed higher levels of alcohol dependence, lower rates of drug dependence and lower psychiatric symptoms relative to younger individuals. Source of suggestions to enter treatment differed by age. Older and middle-aged patients were more likely to have an abstinence goal and to stay in treatment longer than younger adults. At 6 months posttreatment, 55% of older adults reported abstinence in the preceding 30 days, versus 59% of middle-aged adults and 50% of younger adults (p = .035). CONCLUSIONS: Lower rates of dependence and hostility, and greater abstinence motivation and length of stay in treatment--all of which were associated with greater age--positively affect prognosis of older adults in treatment.

Adolescent↗

PubMed1979

A heroin addiction scale for the MMPI: effectiveness in differential diagnosis in a psychiatric setting.

This study examined the discriminative utility of the Cavior Heroin Addiction Scale (HE) in separating samples of male heroin addict, alcoholic, and polydrug abuser samples from psychiatric control samples matched on sex, age, race, and education level. Heroin addicts were the only substance abuser samples that did not differentiate from its control sample. Heroin addicts obtained higher mean HE values than did the alcoholics although the polydrug abusers obtained higher mean HE values than both alcoholics and heroin addicts. HE was found to be less successful in separating these samples than was the MacAndrew Alcoholism Scale. This poorer performance is related to HE's confounding systematic relation to subject age and race, or to differences in scale construction methodology.

Adult↗

PubMedDate not supplied

Preventing child placement in substance-abusing families: research-informed practice.

The authors present finding from their study of a placement prevention program designed to facilitate addiction treatment for substance-abusing mothers and other primary caregivers reported for child maltreatment. Relationships between involvement in the program, the status of addiction treatment, and the variety of outcomes for caregivers and their children were tested. Findings indicate that nearly half of the participants were able to complete addiction treatment and achieve sobriety. Those who used the program's child day care component were three times more likely to complete treatment. Implications for confronting the problem of substance-abusing caregivers in the child welfare system are drawn.

Adult↗