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PubMed1994

Platelet monoamine oxidase activity in alcoholics, alcoholics with drug dependence, and cocaine addicts.

The main objective of this investigation was to study the influence of drug dependence on platelet monoamine oxidase (MAO) activity in the presence and absence of alcoholism. One hundred and thirteen admissions to alcohol and drug treatment facilities participated in the study. Twenty-six met the criteria for alcoholism (group I), seventy-eight subjects were alcohol-/cocaine- and cannabis-dependent (group II), and the remaining nine were patients with DSM-III-R diagnosis of cocaine addiction (group III). MAO activity was assayed radiochemically with [14C]tyramine as a substrate (221 microM). The results of this study showed that platelet MAO activity [nmol of product formed x (mg protein)-1 x hr-1] (mean +/- SE) was significantly (p < 0.01) lower in all of these subjects (group I, 5.50 +/- 0.80; group II, 3.90 +/- 0.50; group III, 4.3 +/- 1.60) as compared with controls (14.85 +/- 1.13). Measurements of platelet MAO activity may provide us with a reliable biochemical marker for alcoholism and perhaps addiction to other substances of abuse (i.e., cocaine).

Adolescent↗
PubMed1997

Assessing the quality of life of patients with intestinal failure on home parenteral nutrition.

BACKGROUND: A study was performed to measure the quality of life of patients receiving home parenteral nutrition (HPN). Quality of life is an important determinant of the effectiveness of health technologies, but it has rarely been assessed in patients receiving HPN. AIMS: To measure quality of life and highlight any moderating factors. PATIENTS AND METHODS: Quality of life was measured using two validated instruments (SF 36 and EuroQol) in 51 patients with intestinal failure. All patients had benign disease, the commonest being Crohn's disease (n = 35). RESULTS: HPN patient scores were worse for six of eight SF 36 domains (p < 0.05) compared with standard population scores. Younger patients (< 45) had good scores but older patients (> 55 years) scored significantly less. Patients addicted to narcotic substances had very low scores. EuroQol utility scores confirmed the SF results. Forty one patients reported that they felt too ill to work and only five were in full time work or education. CONCLUSIONS: The health status profile of our young patients on HPN was good compared with the normal population. The poorest scores were in older patients and those dependent on narcotic drugs. This has clinical and economic relevance when considering such patients for HPN.

Adolescent↗
PubMed2000

Hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies.

Hedonistic homeostatic dysregulation is a neuropsychological behavioural disorder associated with substance misuse and addiction. The disorder has been recognised as a consequence of dopamine replacement therapy (DRT) in 15 patients with Parkinson's disease. The syndrome typically develops in male patients with early onset Parkinson's disease, and can occur with orally and subcutaneously administered DRT. These patients take increasing quantities of their DRT, despite increasingly severe drug induced dyskinesias, and may develop a cyclical mood disorder with hypomania or manic psychosis. There is impairment of social and occupational functioning. Tolerance develops to mood elevating effects of DRT and a negative affective withdrawal state occurs if the drugs are withdrawn or doses decreased. The clinical features and guidelines for managing this syndrome are discussed. A set of diagnostic criteria for further investigating this condition is proposed.

Adult↗
PubMed1989

Sequence of onset of different drug use among opiate addicts.

The temporal sequence of drug use should reveal which drugs are precursors to heroin and which drugs are used subsequent to the establishment of heroin addiction as adjunctive drugs. This temporal sequence was examined in an epidemiological study. Out of 249 opiate addicts interviewed in the area of Penang, Malaysia, this sequence of drugs could be obtained in 248 cases. The mean (median) age for first use of nicotine is 15.5 (15) years, alcohol 18.4 (18) years, cannabis 17.8 (17) years, heroin 21.8 (21) years, opium 22.8 (22) years, and benzodiazepines 25.8 (25) years. The age of first use of different drug types is presented in some detail. The patterns of sequence of drug use was analyzed for the five major and most frequently reported drugs, i.e. alcohol, cannabis, heroin, opium and benzodiazepines. Nicotine, used as first drug in almost all cases, was omitted in this analysis. A clear trend to multiple drug abuse emerges from this analysis; the biggest number of cases were users of 4 drugs (81 cases), followed by 3 drugs (59 cases) and 5 drugs (58 cases). Thus, nicotine, alcohol and cannabis are precursors of heroin addiction. Other adjunctive drugs become important only after heroin addiction. Among these substances, opium and benzodiazepines are numerically preponderant.

Adult↗
PubMed2006

Shaping garments of care: tools for maximizing adherence potential.

There is a tendency in health care to treat clients' maladies in accordance with two basic premises: (1) the medical needs of the client (as perceived by the clinician) can be successfully addressed by focusing solely on that aspect of the client's life and (2) if the client is not able or ready, then there will be someone in the client's support system to take responsibility for administering prescribed therapy. In many cases these assumptions hold true, but for certain sub-populations they do not, notably: individuals with substandard/chaotic lives, those with multiple confounding diagnoses (mental health, substance abuse, disability, addiction, domestic violence) who have neither personal adherence ability nor adequate support systems. They are rarely seen in ambulatory care settings, engaging with the health care system only through emergency rooms and hospital admissions. Such a group makes up a large proportion of urban, HIV positive clients. For them, successful adherence can only be accomplished by rethinking what constitutes 'care' and 'tailoring' that care to the individual. In this context adherence requires the interweaving of three sets of needs: (1) needs perceived by the client, (2) client needs as observed by an objective recorder and assessed for impact on the client's ability and willingness to be adherent and (3) medical needs identified by a clinician. Extensive work with this population has led to the creation of a Cluster of Tools (HIVCOT), designed to quantitatively assess the severity of the varied needs (Health Importance Level or HIL), the adherence ability of the client (Adherence Functional Level or AFL) and how difficult it is to adhere to a given treatment (Level of Adherence Difficulty or LAD). Through the application of these tools it becomes possible for the medical providers to make individual adjustments to the design of care so that it closely fits the needs and abilities of the client. In this way the likelihood of adherence is maximized.

Acquired Immunodeficiency Syndrome↗
PubMed2007

[Translation, adaptation, and validation of the Brazilian version of the Marijuana Expectancy Questionnaire].

This study presents the translation and validation of the Marijuana Expectancy Questionnaire (MEQ-Brazilian Adaptation), which evaluates the expectancy of results in marijuana use, important for treatment and prognosis related to addiction to this substance. The sample consisted of 400 subjects, 217 males and 183 females, of whom 147 were marijuana users and 253 were non-users. In the user group, 90 subjects were marijuana-dependent. Semantic validation of the MEQ-Brazilian Adaptation was confirmed after evaluation and suggestions by an expert review panel. In the Brazilian sample, 78 items were applied; however, the decision was made for a statistical analysis using the reduced scale (55 items), with similar psychometric properties. For both scales, an alpha = 0.89 was obtained. Discriminant validation of the reduced scale was statistically significant (p = 0.001). Temporal stability was examined using a 123-subject sample with a one-week interval between test and retest, indicating that the instrument obtains a consistent response pattern over time (r = 0.990). MEQ-Brazilian Adaptation presented good psychometric results and can be used in studies that aim to evaluate expectancy of results related to marijuana use.

Adolescent↗
PubMed1999

Recent progress in the neurotoxicology of natural drugs associated with dependence or addiction, their endogenous agonists and receptors.

Nicotine in tobacco, tetrahydrocannabinol (delta 9-THC) in marijuana and morphine in opium are well known as drugs associated with dependence or addiction. Endogenous active substances that mimic the effects of the natural drugs and their respective receptors have been found in the mammalian central nervous system (CNS). Such active substances and receptors include acetylcholine (ACh) and the nicotinic ACh receptor (nAChR) for nicotine, anandamide and CB1 for delta 9-THC, and endomorphins (1 and 2) and the mu (OP3) opioid receptor for morphine, respectively. Considerable progress has been made in studies on neurotoxicity, in terms of the habituation, dependence and withdrawal phenomena associated with these drugs and with respect to correlations with endogenous active substances and their receptors. In this article we shall review recent findings related to the neurotoxicity of tobacco, marijuana and opium, and their toxic ingredients, nicotine, delta 9-THC and morphine in relation to their respective endogenous agents and receptors in the CNS.

Acetylcholine↗
PubMed1996

Drugs and homicide by women.

In this paper we use data derived from interviews with 215 female homicide offenders incarcerated or on parole in New York to examine their drug use prior to and at the time of the homicide, their victims' drug use, and their perceptions as to the drug-relatedness of the homicides. We found that about 7 out of 10 respondents had been regular users of some drug at some point in their lives prior to their incarceration, while over half had been addicted to a substance. Over one-third of the respondents who were present at the scene were "high" on a drug at the time, while about half of the victims of these homicides used drugs before the homicide. Almost two-thirds of the homicides committed by respondents who were present at the scene were perceived to be drug-related. Alcohol, crack, and powdered cocaine were the drugs most likely to be related to these homicides. The implications of our findings are discussed.

Adult↗
PubMed2004

Current trends in illegal drug use and drug related health problems in Switzerland.

BACKGROUND AND METHOD: As part of the evaluation of the Confederation's measures to reduce drug related problems, a review of available data on drug use and drug related problems in Switzerland has been conducted. Source of data included: population surveys (adults and teenagers), surveys among drug users, health statistics (drug related and AIDS related deaths, HIV case reporting, drug treatments) police statistics (denunciations for consumption). RESULTS: The aims of reducing the number of dependent hard drug users have been achieved where heroin is concerned. In particular, there seems to have been a decrease in the number of people becoming addicted to this substance. For all other illegal substances, especially cannabis, the trend is towards an increased use, as in many European countries. As regards dependent drug users, especially injecting drug users, progress has been made in the area of harm reduction and treatment coverage. CONCLUSION: This epidemiological assessment can be used in the discussions currently engaged about the revision of the Law governing narcotics and will be a baseline for future follow up of the situation.

Adolescent↗
PubMed2004

[Regulation of G protein-coupled receptor kinase 5 mRNA and protein level in rat brain by addictive drugs].

G protein-coupled receptor kinase 5 (GRK5) plays an important role in the regulation of GPCR-transduced signals. Our previous study showed that acute administration of morphine could significantly increase GRK5 mRNA level in the cerebral cortex and hippocampus of the rat brain. The current study investigated the potential effects of acute administration of addictive drugs including morphine, heroine and cocaine on GRK5 mRNA level in the rat brain using in situ hybridization and analyzed the effects of acute and chronic morphine treatments on GRK5 protein level in the rat brain using Western blotting assay. Our results showed that 2 h after the initial morphine (10 mg/kg), cocaine (15 mg/kg) and heroine (1 mg/kg) treatment, the mRNA level of GRK5 in the parietal cortex increased about 110% (P<0.01), 70% (P<0.05) and 100% (P<0.01), respectively. In the temporal cortex, GRK5 mRNA level increased about 90% (P<0.01), 40% (P<0.05) and 80.0% (P<0.01), respectively . In the hippocampus, the mRNA level of GRK5 increased about 60% (P<0.01), 30% (P<0.05) and 80% (P<0.01). However, the mRNA level of GRK5 remained unchanged after acute morphine, cocaine or heroine treatment. In the cerebral cortex of the rat brain, the acute administration of morphine (NS-Mor) increased GRK5 protein level by about 60% while the chronic morphine treatment (Mor-Mor) increased GRK5 protein level even higher [about 130% compared with the control group (chronic saline treatment, NS-NS) group, P<0.01]. In the hippocampus, GRK5 protein level remained unchanged after acute administration of morphine (P>0.1),while the level of GRK5 protein tended to decrease after chronic morphine treatment (P=0.098). In the thalamus, acute morphine treatment caused no change in GRK5 protein level (P>0.1) while after chronic morphine treatment, GRK5 protein level decreased significantly (more than 90%, P<0.01), Taken together, our results indicate that addictive drugs can regulate GRK5 in the rat brain on protein level as well as on mRNA level and suggest that GRK5 may play a role in addiction of psychoactive substances.

Animals↗
PubMed1997

[Diagnosis and therapy of personality disorders].

Approximately 10% of the unselected population are affected with personality disorders, among the patients of psychiatrists and family doctors the quota goes up to 40%. Personality disorders comprise deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. They are stable and lead frequently to subjective distress and/or to impaired social functioning. The division in subgroups is made on the reason of typical patterns of experience and behaviour, but overlapping between different subtypes is frequent. People with personality disorders often come into conflicts with their environment because of their maladaptive behaviour which lead to crises and need of intervention. Psychopharmaca can be given in such situations, but substances with an addictive potential like benzodiazepines should not be prescribed for a longer period. The long-term psychotherapy of personality disordered persons requires an individual planing after a careful analysis of the behaviour pattern and should focus on concretely defined and reachable aims. Personality disordered persons belong to the most difficult patients, their long-term treatment demands appropriate therapeutic skills. In the primary care family doctors therapy and support is important but several basic rules should be followed.

Combined Modality Therapy↗
PubMed1996

Attachment theory as a working model for the therapist transitioning from early to later recovery substance abuse treatment.

Psychotherapy with addicted individuals often involves a shift in therapeutic techniques during the transition from early to later recovery treatment. A conceptual model based in attachment theory can provide a rationale and framework for this shift in the treatment of some addicted persons. Techniques and case material are presented to illustrate how a therapist first "establishes a secure base" and then transitions to "facilitating exploration." An active, directive, supportive, and educative therapeutic approach that deemphasizes exploratory work in early recovery helps the patient achieve abstinence and develop a sense of security and attachment with the therapist. This sense of therapeutic security combined with ongoing abstinence permits a shift to a more nondirective, expressive therapeutic stance that facilitates the exploratory work of later recovery. Working through these issues in the therapeutic transition provides an excellent opportunity to examine the interpersonal and emotional difficulties of addicted patients. Two cases are presented to illustrate a successful and unsuccessful attempt to establish a secure base and facilitate exploration in substance abuse psychotherapy.

Emotions↗
PubMed1997

The most important unresolved issue in the addictions: conceptual chaos.

This article suggests that the field of addiction study and treatment remains in a state of conceptual chaos. The addictions is an emerging scientific field that lacks conceptual clarity. To develop the precision necessary for scientific advance, we must begin by developing improved definitions of substance use, abuse, dependence, and addiction. Complicating matters, psychoactive substance use is not a necessary and sufficient cause of addiction. For example, pathological gamblers experience addiction, including tolerance and withdrawal, often in the absence of any drug use. The neurobiology of subjective experience may be a more important factor in helping to explain addictive behaviors. Consequently, this article concludes that it is improper to consider drugs as the necessary precondition for addiction. Better operational definitions will advance addictions research.

Behavior, Addictive↗
PubMed1990

The nosology of abuse and dependence.

Physicians who prescribe benzodiazepines often are asked by their patients if these drugs might be addicting or have potential for abuse. Clarifying these concepts is difficult because of numerous "gray areas" of drug use and confusion over medical criteria for such terms as "addiction", "dependence", and "tolerance". Many of the efforts to clarify the terminology regarding substance habituation, abuse, and addiction have resulted in additional confusion. They have resulted in overlapping definitions of abuse and dependence, the injection of moral judgments into scientific terms, and difficulty separating the diagnoses of the physical dependence (caused by prolonged use of a wide variety of drugs, many of which are never abused) from that of physical dependence secondary to an abusive pattern of use. This article will trace the history of the various definitions currently in use, and will suggest newer terminology to replace misleading or erroneous terms.

Anti-Anxiety Agents↗
PubMed2002

Measuring problem video game playing in adolescents.

AIMS: Some researchers suggest that for some people, video game playing is an addictive behaviour similar to substance dependence. Our aim was to design and validate a scale to measure the problems associated with the apparently addictive use of all types of video games and video game systems, because there is no instrument at the present time that can be used for this purpose. DESIGN: We reviewed the DSM-IV criteria for substance dependence and for pathological gambling, as well as the literature on the addictions in order to design a short scale (PVP; problem video game playing) that is quick and easy to apply. PARTICIPANTS: The scale was administered to 223 Spanish adolescents aged between 13 and 18 years. The study was carried out in Granada and Algeciras, Spain. FINDINGS: Psychometric analyses show that the PVP seems to be unidimensional and has acceptable internal consistency (Cronbach's alpha) at 0.69. The pattern of associations between the scale scores and alternative measures of problem play supports its construct validity (higher total scores in the scale were associated with higher frequency of play, mean and longest times per session, self and parents' perception of playing to excess, and scores in the Severity of Dependence Scale). CONCLUSIONS: Our results confirm that the excessive use of video games is associated with a number of problems which resemble a dependence syndrome, and the PVP appears as a useful instrument for the measurement of such problems.

Adolescent↗
PubMed1993

[Comments on the definition of so-called "new addictions"].

To apply the term "addiction" to non-substantial addiction-like behavior is both problematic and useful. It is problematic because the uncritical application of the term has led to an inflation of addictions. If everything is called addiction the term is losing its predicative power and is getting meaningless. In the field of non-substantial addicted behavior we have been given the chance to study the phenomenon addiction in "pure" form without disturbing influences of any substance. To apply the term "addiction" to non-substantial addicted behavior is possible in principle. Von Gebsattel 1954 and Giese 1962 have already referred to this. However, it requires well-defined criterias. A strictly composition of the term would be recommendable.

Behavior, Addictive↗