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PubMed2006

Choosing Health and the inner citadel.

It is argued in this paper that the latest UK government white paper on public health, Choosing Health, is vulnerable to a charge of paternalism. For some years libertarians have levelled this charge at public health policies. The white paper tries to avoid it by constant reference to informed choice and choice related terms. The implication is that the government aims only to inform the public of health issues; how they respond is up to them. It is argued here, however, that underlying the notion of informed choice is a Kantian, "inner citadel" view of autonomy. According to this view, each of us acts autonomously only when we act in accord with reason. On such a view it is possible to justify coercing, cajoling, and conning people on the basis that their current behaviour is not autonomous because it is subject to forces that cause irrational choice, such as addiction. "Informed choice" in this sense is compatible with paternalism. This paternalism can be seen in public health policies such as deceptive advertising and the treatment of "bad habits" as addictions. Libertarians are bound to object to this. In the concluding section, however, it is suggested that public health can, nonetheless, find ethical succour from alternative approaches.

Attitude to Health↗
PubMed2003

The relationship between cocaine craving, psychosocial treatment, and subsequent cocaine use.

OBJECTIVE: Regular measurement of craving during treatment for cocaine dependence can monitor patients' clinical status and potentially assess their risk for drug use in the near future. Effective treatment can reduce the correlation between craving and subsequent drug use by helping patients abstain despite high craving. This study examined the relationship between cocaine craving, psychosocial treatment, and cocaine use in the ensuing week. METHOD: In the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, which compared four psychosocial treatments for cocaine dependence, a three-item craving questionnaire was administered weekly to 449 patients to see whether it predicted cocaine use in the ensuing week. Cocaine use was assessed with self-reports and urine screening. RESULTS: With control for the previous week's cocaine use, a higher composite score on the craving questionnaire was associated with greater likelihood of cocaine use in the subsequent week; each 1-point increase on the composite score of the craving questionnaire increased the likelihood of cocaine use in the ensuing week by 10%. However, among patients who received individual plus group drug counseling, the treatment condition with the best overall cocaine use outcome, increased craving scores were not associated with greater likelihood of cocaine use in the subsequent week. CONCLUSIONS: A three-item cocaine craving questionnaire predicted the relative likelihood of cocaine use during the subsequent week. Moreover, the relationship between craving and subsequent cocaine use varied by treatment condition, suggesting that the most effective treatment in the study might have weakened the link between craving and subsequent use.

Adult↗
PubMed1992

[Pathological gambling: literature revue].

This paper summarizes the current literature on pathological gambling. Interest in gambling has been present in every society but treated as an object of sociopolitical or literary interest. It is only from the beginning of this century that psychiatry began to look at pathological gambling, first with Freud and his writing on Dostoïevsky then with other theories like the learning theory, studies on substance dependence, the links with affective syndromes and the psychobiological studies. These studies are presented and discussed. Finally, the authors offer some guidelines for an approach to a pathological gambler.

Behavior, Addictive↗
PubMed1998

Role of the limbic system in dependence on drugs.

The limbic system is a group of structurally and functionally related areas of the brain that provides the anatomical substrate for emotions and motivated behaviour, including the circuitry for the stress response and reward-related events. This system is strongly implicated in drug abuse from the pleasure and/or positive side associated with acute exposure to the dysphoria and craving associated with withdrawal. The contribution of the main cortical and subcortical elements of the limbic system to drug dependence is briefly reviewed in the present work with a focus on the role of the extended amygdala and its connections as well as on the peripheral feedback signals mediated by adrenal glucocorticoids. The elucidation of the neuroadaptive responses of the limbic system to chronic drug exposure will undoubtedly help to design rational strategies for the treatment of addiction.

Animals↗
PubMedDate not supplied

An "economic" theory of addiction, hypomania, and sensation seeking.

Research into the relationship between mania, sensation seeking, and substance abuse has shown that hypomanics and sensation seekers use substances frequently and often for the purpose of adjusting their moods. This essay develops an "economic" theory of addiction that attempts to account for those phenomena. The theory also supports the notion that sensation-seeking behavior and variants of manic behavior share many of the characteristics of the addictive behaviors. Implications for the treatment of addictive behaviors are discussed. Data from drug users in the military (Navy) are presented to support the theory, and suggestions for future research are outlined.

Adolescent↗
PubMed2002

[Clinical and dynamic features of pathological craving for narcotics in patients with opioid (heroin) addiction].

Particular features have been studied of the clinical picture and time-related course of an abnormal urge to consume narcotics in patients with opiumism. The time-related characteristics of the pathological urge undergo qualitative changes with progression of the illness from the discrete character of actualization to a continuous maintenance of the addiction in the active state. Variants of the pathological urge to opiates dynamics, characteristic of different stages of opium addiction are highlighted.

Adolescent↗
PubMed2003

Assessment and treatment of compulsive sexual behavior.

The hallmarks of compulsive sexual behavior (CSB) are recurrent and intense sexually arousing fantasies, sexual urges, and behaviors that cause individuals distress in daily functioning. Clinical signs of CSB can include anxiety, depression, somatic complaints, alcohol or drug use or dependency, relationship problems, or signs of abuse. This article describes the symptoms of paraphilic and nonparaphilic CSB and discusses their epidemiology, etiology, as well as comorbid psychiatric conditions. It also presents screening questions that clinicians can use with patients suspected of having CSB and outlines medical and psychiatric treatment for the condition. When CSB is suspected, referral to a clinician experienced in treating sexual disorders is recommended.

Behavior, Addictive↗