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PubMed1989

A hierarchical model of opiate addiction. Failures of self-regulation as a central aspect of substance abuse.

In this paper, we first examine and recast the research literature on opiate addiction in the light of a hierarchical model of self-organization. The hierarchical model consists of five modes of psychological and psychobiological functioning defined epigenetically. Research and theories of opiate addiction are classified as to their primary modal emphases. We then describe failures of self-regulation as particular vulnerabilities along the first three modes of the hierarchy. A measure of this construct, the Scale for Failures in Self-Regulation (SFSR), a projective measure that utilizes Thematic Apperception Test responses, is introduced for the study of opiate addicts. The SFSR was administered to normal and opiate-addicted subjects in order to examine the predictive and explanatory power of the hierarchial model. A multivariate analysis of variance showed the addicts to have greater difficulties in self-regulatory functioning than normal subjects. In terms of the hierarchical model, the implications of these findings for the questions of severity of illness, psychotherapy technique, and future research are discussed.

Adult↗
PubMed1998

Psychological assessment (MMPI-2) of male African-American substance-abusing patients with and without histories of childhood physical abuse.

Twenty-nine drug addicted patients in a VA substance abuse program with a history of childhood physical abuse were compared to 29 drug addicted patients without a history of childhood abuse, using the MMPI-2 as a measure of personality traits and functioning. Drug addicted patients with an abuse history showed psychological maladjustment on almost all measures and at greater levels of intensity and severity than the nonabused group. We conclude that drug addicted patients who have been abused represent a unique subset of the drug addicted population and may require targeted psychological treatment for residual problems associated with childhood abuse. This may then also improve the efficacy of substance abuse treatment as well.

Adaptation, Psychological↗
PubMed2006

Clinical considerations in the treatment of chronic pain with opiates.

This article considers assessment and treatment issues for mental health practitioners working with patients using opiate medications to treat chronic pain with a particular emphasis on their potential relationship to substance abuse. We review general opiate medications, including a discussion of medications with increased addiction potential. Practice guidance is offered regarding long-term opiate treatment, including definitions of addiction, initial assessments, ongoing substance misuse monitoring, use of psychological assessment instruments, and managing medication misuse problems. Additionally, we examine the role of the mental health professional within this area and examine the incorporation of psychological interventions for patients using opiates. A case illustration includes several of these complicated issues of managing chronic pain with opiate medications.

Accidents, Traffic↗
PubMed2006

Life stress, coping and comorbid youth: an examination of the stress-vulnerability model for substance relapse.

The stress-vulnerability model of addiction relapse states that the impact of life stress on alcohol and other drug use is influenced by several types of psychosocial risk and protective factors. Coping skills have been shown to be protective against alcohol or other drug use in adolescents and adults. To date, the influence of life stress and coping on addiction relapse has not been investigated among substance use disordered youth with comorbid Axis I psychopathology. In the present study, 80 adolescents, ages 13 to 17, were followed six months after treatment for substance use and Axis I disorders. Participants completed measures of psychopathology, substance use, life stressors and coping during treatment and at three and six months following treatment. Coping ability best predicted youth substance use at six months. Negative life events moderated the relation between coping and frequency of substance use. These results suggest that coping is a protective factor for return to substance involvement post-treatment, particularly for comorbid youth who have experienced high levels of life stress.

Adaptation, Psychological↗
PubMedDate not supplied

The semantics of addiction: moving beyond expert models to lay understandings.

Five expert discourses on addiction purport to explain the phenomenon of the semantics of addiction. An assessment of the burgeoning use of this term by the lay public, however, reveals a plethora of socially contextualized and culturally mediated meanings related to addiction that are generally not considered by expert models. Addiction has meanings that index the loss of self-control and individual responsibility, as well political and moral meanings and meanings that index social modes of consumption, the range and limits of normative behavior, and the constitution of deviance. The category of addition interacts with other socially produced categories, including "drugs" and "desires," and implies an unfolding history linked to specific cultural conventions of what is proper. This paper briefly reviews expert debates over the meanings of addiction and explores the semantics of how this term is used in both popular discourse and among those who use substances associated with physical addiction. In addition, some of the more interesting theoretical issues this discussion brings to light are highlighted, with the intent to identify issues warranting future research that will broaden the study of addiction.

Humans↗
PubMed1988

Addiction in anesthesiologists: drug access and patterns of substance abuse.

Impaired anesthesiologists (IAs) seen by the Medical Association of Georgia Impaired Physicians Program were compared to all other impaired physicians seen by the program. Anesthesiologists were the specialists most overrepresented in the program. When each IA was matched to a control with respect to age, sex, race, professional activity status, and year of admission to the program, the IAs were found to be more likely to abuse drugs than alcohol, to abuse narcotics, and to abuse drugs intravenously. The authors recommend tighter control of narcotics and surveillance of all anesthesia personnel in order to reduce the risks to patients associated with chemical dependence.

Adult↗
PubMed2006

Fentanyl abuse and dependence: further evidence for second hand exposure hypothesis.

We have proposed a novel hypothesis regarding the potential role of occupational or second-hand exposure in physician substance use, abuse, and addiction. While only 5.6% of licensed physicians in Florida are anesthesiologists, nearly 25% of physicians followed for substance abuse/dependence are anesthesiologists. When we sort by drug of choice, anesthesiologists have more opioid abuse and dependence than other physicians and appropriate controls. Abuse of one opioid, fentanyl, appears to be increasing and has been noted among the State of Florida's causes of opioid deaths. Fentanyl and sufentanyl are commonly administered highly potent opioid analgesics, as much as 80-800 times as potent as morphine. We have recent data from the State of Florida impaired physicians database, which has allowed us to categorize all fentanyl abusing and/ or dependent physicians. Just knowing that a physician abuses fentanyl gives you a good clue as to their specialty; 75% are anesthesiologists! While drug abuse researchers, oncologists and others who handle drugs of abuse everyday, have no greater incidence of opioid abuse or dependence, anesthesiologists are at the top of every list. Can this be due to just access and stress? We have proposed an alternative hypothesis of second hand exposure. To test this hypothesis, we developed a sensitive LC/MS/MS assay to measure the intravenous anesthetic and analgesic agents, propofol and fentanyl in air. Not only did we detect propofol and fentanyl in cardiovascular surgery operating room air, we also found the highest concentrations were close to the patient's mouth where anesthesiologists work for hours. Like tobacco, second hand opioid exposure can sensitize and change the brain making abuse, dependence and behavioral disorders more likely. Thus environmental exposure and sensitization may be an important risk factor in physician addiction. Second hand exposure may affect treatment outcome and explain anesthesiologist's inability to return to work in the operating room. We are developing an animal model for second hand exposure and additional studies of the operating room and cardiac anesthesiologists are underway.

Analgesics, Opioid↗
PubMed2002

Work rehabilitation and patterns of substance use among persons with schizophrenia.

OBJECTIVE: The aim of this study was to identify patterns of substance use among participants in work rehabilitation, to identify symptom patterns associated with substance use, and to assess the impact of substance use on work rehabilitation outcomes. METHODS: Addiction Severity Index interviews were conducted and Positive and Negative Syndrome Scale ratings were obtained at the start of the study and again five months and 12 months later for 220 patients with schizophrenia or schizoaffective disorder who were already enrolled in a study of work rehabilitation. RESULTS: Eighty percent of the participants met Addiction Severity Index criteria for lifetime substance use, but 75 percent were abstinent at intake. During the 12-month follow-up period, abstinence rates remained above 66 percent. Participants with a lifetime history of cocaine use were more likely to return to substance use. The type of substance used was also related to distinct symptom patterns. Participants with past cocaine use had more severe hostility symptoms and less severe negative symptoms. No significant relationships were found between lifetime or current substance use and participation in the work rehabilitation program. CONCLUSIONS: Even though a high rate of lifetime substance use was observed in this sample, most participants were in stable remission of substance use throughout the one-year study. Substance use and work participation appeared to be semiautonomous: substance use did not directly affect work participation, and work participation did not directly affect substance use.

Adult↗
PubMed2003

Risky business: emotion, decision-making, and addiction.

Although metabolic abnormalities in the orbitofrontal cortex have been observed in substance dependent individuals (SDI) for several years, very little attention was paid to the role of this brain region in addiction. However, patients with damage to the ventromedial (VM) sector of the prefrontal cortex and SDI show similar behaviors. (1) They often deny, or they are not aware, that they have a problem. (2) When faced with a choice to pursue a course of action that brings an immediate reward at the risk of incurring future negative consequences, they choose the immediate reward and ignore the future consequences. Studies of patients with bilateral lesions of the VM prefrontal cortex support the view that the process of decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion, and feeling. Parallel lines of study have revealed that VM cortex dysfunction is also evident in subgroups of individuals who are addicted to substances. Thus, understanding the neural mechanisms of decision-making has direct implications for understanding disorders of addiction and pathological gambling, and the switch from a controlled to uncontrolled and compulsive behavior. On the clinical front, the approach to treat addictive disorders has been dominated by a diagnostic system that focuses on behaviors, physical symptoms, or choice of drugs. The article emphasizes the concept of using neurocognitive criteria for subtyping addictive disorders. This is a significant paradigm shift with significant implications for guiding diagnosis and treatment. Using neurocognitive criteria could lead to more accurate subtyping of addictive disorders, and perhaps serve as a guide for more specific, and potentially more successful, behavioral and pharmacological interventions.

Behavior, Addictive↗
PubMedDate not supplied

Stress among males recovering from substance abuse.

The Stress Audit self-report inventory was used to measure the magnitude and types of stress experience as well as relative vulnerability of recovering male drug addicts in an urban substance abuse program. The means for the Stress Situations scale and each of the situations subscales showed significant elevations relative to the normative sample and control group of nonaddicted, nonalcoholic males. The mean for the Stress Symptoms scale and the means for all symptoms subscales were also significantly higher for the recovering drug addicts, with the highest values for cognitive and muscular symptoms. The Vulnerability scale was the only measure for which recovering drug addicts had a mean similar to published norms, with no significant elevation. This profile of substantially greater stress situations and symptoms despite normal vulnerability indicates that, whether stress is a cause or consequence of drug addiction, stress-management techniques should be a component of drug rehabilitation programs.

Adaptation, Psychological↗
PubMed2000

Sexual life style, drug habit and socio-demographic status of drug addicts in Bangladesh.

The sexual life style, drug habit and socio-demographic status of 253 male hospitalized drug addicts were investigated. This study was conducted during the period June 1997 to July 1998, and each case was selected by the random sampling method. The research instrument was an interviewer-administered questionnaire, the sexual habits, number and quality of sex partners, use of condoms, sexually transmitted diseases, etc., were considered as indicators of the sexual life style of the drug addicts. Eighty-eight percent (n=233) of the addicts were heterosexual. Bisexuality was found only in 7% (n=18) of the addicts. Eighty-seven percent (n=240) of the addicts have multiple sex partners of either commercial or residential category. Most of the drug addicts (72%,n=181) did not use condoms. Fifty-seven percent (n=145) of the addicts were observed to have sexual diseases. As indicators of a drug habit, starting drug, choice of drug, period of addiction, sharing of needles, etc., were included. Cannabis was the starting substance for 59% (n=149) of the addicts. Heroin was the drug of choice for 60% (n=157) addicts. A single drug was taken only by 8% (n=20) of the addicts and the remaining 92% (n=233) took multiple drugs. The drug addicts (n=97) who used mostly injection (87%,n=84) shared needles. Education, occupation, income, age, marital status, influencing factors for addiction were considered as socio-demographic characteristics. Young adults (79%,n=199), secondary educated (46%,n=116), low-mid income (60%,n=150), businessmen (46%,n=150) and married (60%,n=151) people were found highly involved in addiction. Self-curiosity and a friend's incitement were revealed as the most important influencing factors for taking drugs.

Adolescent↗
PubMed2000

Psychiatric symptoms in problem gambling and non-problem gambling substance abusers.

This study compared demographic characteristics, Addiction Severity Index (ASI) ratings, and psychiatric symptoms in 103 substance abusers with and without gambling problems. Thirty-one of the substance abusers were identified as probable pathological gamblers on the South Oaks Gambling Screen. Although no differences in demographic characteristics or ASI ratings were noted between the groups, subjects with a gambling problem consistently reported more psychiatric distress than substance abusers without a gambling problem. Specifically, they had increased ratings on somatization, obsessive-compulsive, interpersonal sensitivity, hostility, and paranoia scales. These results are discussed in terms of the need to identify and treat gambling problems among substance abusers.

Adult↗
PubMed2002

Physical and sexual abuse history and addiction treatment outcomes.

OBJECTIVE: Prior research on patients with substance use disorders has shown that lifetime physical or sexual abuse is associated with more impaired functioning at treatment intake. The present study sought to determine whether physical or sexual abuse also predicted treatment response (posttreatment outcomes) of individuals with substance use disorders. METHOD: Male (n = 19,989) and female (n = 622) veterans with substance use disorders were assessed with the Addiction Severity Index (ASI) early in treatment and reassessed an average of 12 months later. Treatment outcomes were compared for patients who did and did not report prior physical or sexual abuse in the initial ASI interview. RESULTS: Lifetime physical or sexual abuse predicted worse outcomes in six of seven domains of functioning, after controlling for baseline functioning, psychiatric diagnoses and demographic variables. Although women were more likely than men to report being abused, the effect of abuse on treatment outcomes was similar for both genders. Psychiatric problems at baseline mediated the effect of abuse history on outcomes. Abuse history moderated the effect of treatment intensity (contacts per month) on outcomes: More frequent treatment contacts were more beneficial for abused patients than for nonabused patients. CONCLUSIONS: Individuals with substance use disorders who have a history of physical or sexual abuse may have higher risk for problematic treatment outcomes as a result of greater psychiatric problems, deficits in social support and possible difficulties in establishing treatment alliance. Clinicians may consider increasing the duration and intensity of treatment to temper the negative effects of abuse on later functioning.

Domestic Violence↗
PubMed2005

Future of anti-addiction vaccines.

The medical rational for using anti-drug antibodies in the serum as a treatment is to reduce drug levels in the brain and to bind drug before it enters the brain. Drugs of abuse are small molecules that can readily cross the blood brain barrier, while antibodies are larger molecules that cannot get into the brain. Thus, any drug that is bound to antibody also cannot cross the blood brain barrier and cannot enter the brain. Active anti-drug vaccines stimulate the body to makes its own antibodies, but the small size of abused drugs prevents them from stimulating an immune response. Thus, individuals do not ordinarily produce antibodies to abused drugs, and vaccines to stimulate antibodies are made by chemically linking these abused drugs to toxins such as cholera toxin. Alternatively, passive immunotherapy uses monoclonal antibodies that are generated in a laboratory and then administered via intravenous injection. Antibodies can be used to treat drug overdose; to reduce drug use relapse; or to protect certain at risk populations who have not yet become drug dependent. The advantages of anti-addiction vaccines are that antibodies target the drug, not the drug's sites of action in the brain and antibody binding inactivates the drug. These vaccines can complement behavioral and other medical therapies with minimal side effects and are not addictive like some chemical agonists. Technology advances in manufacturing and delivery systems will improve future anti-addiction vaccines, but social acceptance of anti-addiction vaccines will depend on substance abuse program staff and the families of substance abusers, who have some values that oppose medical solutions to addictive diseases and view addictions as moral problems.

Drug Delivery Systems↗
PubMed2005

[Prevalence and risk factors for substance abuse and dependence among anaesthetists: a national survey].

OBJECTIVE: Addiction behaviours in the anaesthetist population have been recognized as a significant health-related issue and its scope is a matter of concern. METHODS: A national survey conducted among French anaesthetists consisted of a questionnaire designed to elicit information related to demographics, and work conditions, as well as substance consumption status. The study investigated the following: tobacco, alcohol, tranquillizers-hypnotics, and other agents such as cannabis, cocaine, opiates and anaesthetic agents. Respondents were classified in two categories: (no use and use)-(abuse and dependence). An univariate and multivariate analysis were performed to determine risk factors associated with drug abuse and dependence. RESULTS: 3,476 physicians responded to the questionnaire (38.0% response rate); 22.7% were daily tobacco smokers; 10.9% were abuser or dependent to one or more substances other than tobacco i.e. alcohol (59.0%), tranquillizers and hypnotics (41.0%), cannabis (6.3%), opiates (5.5%), and stimulants (1.9%). Sleep disturbances and negative perception of work environment were more frequently reported among addicted anaesthetists. CONCLUSION: In French anaesthetists, addiction is mainly related to alcohol consumption but includes a broad spectrum of substances. Addicted subjects report issues around work environment that may have contributed to the development of their pathology.

Adult↗