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PubMed2004

Pharmacologic management of relapse prevention in addictive disorders.

Substance use disorders are an important public health problem associated with significant mortality and morbidity. Effective maintenance pharmacotherapies are available for tobacco, alcohol, and opioid use disorders. For optimum treatment response, these medications should be used in conjunction with behavioral interventions. For other drugs of abuse, especially for cocaine, medication development is an active area of research. Further research is needed to develop new pharmacotherapies for substance use disorders and establish clinical guidelines on how to use these medications most effectively.

Administration, Cutaneous↗
PubMed1993

"Chocolate addiction": a preliminary study of its description and its relationship to problem eating.

Definitions of chocolate addiction and its potential relationship to dieting and problem eating were investigated in 50 individuals who identified themselves as "chocoholics". Respondents were interviewed and completed a battery of questionnaires on food cravings, eating, weight, dieting and depression. On average this sample consumed about 12 (60-g) bars of chocolate per week and craved chocolate about six times per week. Cravings and amount consumed were not significantly related but amount consumed was significantly correlated with disinhibition (r = 0.3). Most (76%) respondents had definitions of chocolate addiction that centred on a lack of control around chocolate and regarded the "addictive" factor in chocolate as orosensory (i.e. taste, smell, texture). Unlike most others, dieters and secret eaters experienced negative affect following consumption of chocolate. Consumers who preferred to eat in secret reported a higher degree of aberrant eating. The extent to which the behaviour of "chocolate addicts" resembles that of eating disordered individuals and other addictions remains to be clarified.

Adolescent↗
PubMed2005

[Addiction--who is not affected?].

Addiction and addiction-related behaviour increased during the past decades. Several substances with psychoactive attributes, like opioids, cocaine or alcohol, can lead to dependence with physical and/or mental symptoms. In addition to substance-related addiction, non-substance-related dependence requires special attention. Increasing numbers of workaholics and patients suffering from internet-addiction, gambling or eating-disorders can be observed. To meet international treatment standards for addiction, diversification of therapy is necessary and, additionally, gender-related aspects in development and treatment of dependence and addiction-related behaviour are essential for state-of-the-art therapy of this patient population.

Behavior, Addictive↗
PubMed2005

Structural changes to electronic gaming machines as effective harm minimization strategies for non-problem and problem gamblers.

This study aimed to evaluate the effectiveness of three proposed modifications to the structural characteristics of electronic gaming machines as harm minimisation strategies for non-problem and probable problem gamblers. Structural changes included reducing the maximum bet size, reducing reel spin and removing large note acceptors. Behavioural patterns of play were observed in 779 participants attending clubs and hotels. Observations were conducted in the gaming venue during regular gaming sessions. Eight experimental machines were designed to represent every combination of the modifications. 210 participants played at least one modified and one unmodified machine. Following play, the South Oaks Gambling Screen (SOGS) was administered. More problem than non-problem gamblers used high denomination bill acceptors and bet over one-dollar per wager. Machines modified to accept the one-dollar maximum bet were played for less time and were associated with smaller losses, fewer individual wagers and lower levels of alcohol consumption and smoking. It was concluded that the reduction of maximum bet levels was the only modification likely to be effective as a harm minimization strategy for problem gamblers.

Adult↗
PubMed2004

Neonatal isolation enhances acquisition of cocaine self-administration and food responding in female rats.

We showed previously that neonatal isolation (ISO) enhances acquisition of cocaine self-administration in adult male rats without altering acquisition of food responding. Female rats show poorer performance in learning tasks and are differentially affected by stress compared to male rats. Thus, we investigated whether ISO alters acquisition of operant responding for cocaine and food in female rats with comparison to male rats. Litters were subjected to ISO or were non-handled (NH). Activity levels were assessed in adult rats. Then, rats were implanted with jugular catheters and allowed to self-administer cocaine under a fixed-ratio 1 (FR1) schedule of reinforcement using an escalating dose presentation procedure. Cocaine intake, discrimination of active versus inactive levers, and ineffective active lever responses were tabulated. Effects of non-contingent cocaine infusions (primes) and increasing FR on responding were then assessed. Other rats were allowed to lever press for food under an FR1 schedule (10 s time-out). ISO enhanced acquisition of operant responding for food and cocaine in female rats. The latter was demonstrated by better lever discrimination, emission of fewer ineffective responses, and superior performance in response to primes. Yet, NH females ingested more cocaine than ISO females during the initial acquisition phase. In male rats, ISO enhanced acquisition of cocaine self-administration but not food responding. Activity levels were unaffected by ISO or gender. These data confirm and extend our previous findings demonstrating the enduring effects of ISO on adult self-administration behavior and emphasize the importance of measuring behavioral patterns versus intake in acquisition studies.

Analysis of Variance↗
PubMed2004

Medical comorbidity in addictive disorders.

Greater risks exist for medical comorbidities in persons with addictive disorders. Clinicians should screen for early comorbidities such as hepatitis C and HIV. During acute intoxications and overdoses, patients are at greater risk for major respiratory and cardiac events. Long-term management of persons with addictions and medical disorders requires integrative care programs involving comprehensive primary and psychiatric care.

Behavior, Addictive↗
PubMed2004

Covariation in addictive behaviours: a study of addictive orientations using the Shorter PROMIS Questionnaire.

Previous research has suggested that different addictive behaviours are linked, such that decreases in one may lead to compensatory increases in another, or even that one addiction may lead to another. Such views on "cross addiction" are encouraged by the prevailing tendency amongst researchers from very different theoretical backgrounds to view different addictions as serving a common function, such as mood alteration, or the "management of hedonic tone." Previous studies have suggested that different addictions may usefully be grouped according to how they covary. The present study, using factor and cluster analyses, confirms the importance of a division between "hedonistic" and "nurturant" addictions, but with the need for further subdivisions within those categories. Hedonism comprises a "drug use" factor and an "interpersonal dominance" factor. Nurturance comprises both "self-regarding" and "other-regarding" factors. Theoretically, the results suggest that different addictions illustrate contrasting techniques of interpersonal manipulation. Clinically, the results indicate the drawbacks of addressing addictive behaviours singly, and the potential importance of addictive orientations in treatment, and relapse prevention.

Adolescent↗
PubMed1998

Effects of buprenorphine and naloxone in morphine-stabilized opioid addicts.

The present study, conducted as part of the development of a buprenorphine/naloxone combination product, was designed to evaluate the individual and combined effects of intravenously administered buprenorphine and naloxone. This in-patient trial used a randomized, double-blind, crossover design. Ten opioid-dependent male subjects were stabilized and maintained on morphine, 15 mg given intramuscularly four times daily. Then, at 48- to 72-h intervals, subjects received one of the following by intravenous injection: (1) placebo, (2) morphine 15 mg, (3) buprenorphine 2 mg, (4) buprenorphine 2 mg/naloxone 0.5 mg, and (5) naloxone 0.5 mg. Both naloxone and buprenorphine/naloxone produced significant (P < 0.005) opioid withdrawal effects compared to placebo as assessed with the CINA scale, an instrument which utilizes subject- and observer-reported, as well as physiological parameters. The combination of buprenorphine with naloxone in a 4:1 ratio produced opioid antagonist-like effects which should limit its potential for intravenous abuse by opioid addicts.

Adult↗
PubMed2000

Addiction and schizophrenia.

Epidemiologic studies in the general population and those based on the clinical assessment of schizophrenic populations have revealed a high degree of overlap between schizophrenia and addictive disorders. The abuse of psychoactive substances (including alcohol) throughout life is so frequent (50%) that the possibility of a specific link inevitably arises. Various hypotheses have been suggested to explain the high co-morbidity between schizophrenia and addiction: 1) The social-environmental hypothesis has been developed but studies have provided poor evidence to validate it. 2) The possible shared biological vulnerability between schizophrenia and addictions led researchers to explore common genetic determinants and study the involvement of the dopaminergic and opioid systems in the aetiology of both schizophrenia and the abuse of and dependence on psychoactive drugs. 3) Finally, the theory of self-medication suggests that schizophrenics may be attempting to counter the deficit linked to their disorders by using the substances they take or their dependency-type behaviour to cope with their emotional problems. The clinical profile of schizophrenic addicts does seem to display some distinctive features, such as the high level of depressive co-morbidity, very high nicotine and alcohol dependence, with a very poor prognosis. These patients are difficult to manage; the possibility of pharmacologic interactions between the substances they are taking and neuroleptic medication calls for prudence, and their compliance is also poor. Addictive disorders in schizophrenics are currently a topic of active research intended to lead to identifying specific treatments. The early identification of addictive disorders in schizophrenics should make it possible to limit their development and improve the prognosis.

Adaptation, Psychological↗
PubMed2001

Molecular basis of long-term plasticity underlying addiction.

Studies of human addicts and behavioural studies in rodent models of addiction indicate that key behavioural abnormalities associated with addiction are extremely long lived. So, chronic drug exposure causes stable changes in the brain at the molecular and cellular levels that underlie these behavioural abnormalities. There has been considerable progress in identifying the mechanisms that contribute to long-lived neural and behavioural plasticity related to addiction, including drug-induced changes in gene transcription, in RNA and protein processing, and in synaptic structure. Although the specific changes identified so far are not sufficiently long lasting to account for the nearly permanent changes in behaviour associated with addiction, recent work has pointed to the types of mechanism that could be involved.

Animals↗
PubMedDate not supplied

Stigma or legitimation? A historical examination of the social potentials of addiction disease models.

This article presents a historical discussion of disease models of opiate addiction in the United States in the twentieth century. First, several approaches to defining disease are discussed. Then, the shifts in formulations of opiate addiction as a disease in the twentieth century in the U.S. are analysed in light of the preceding theoretical discussion. The period before 1920 is described as heterodox, as researchers attempted to develop scientific models of opiate addiction, while various medically legitimate and quasi-legitimate treatment approaches flourished in an unregulated marketplace. After 1920, a stigmatizing disease model of opiate addiction was based on a psychiatric formulation that linked chronic addiction with psychoneurotic deficits in certain individuals. After 1940, this model dominated medical and scientific thinking about opiate addiction for several decades. After 1970, enormous changes in the demographics of drug use forced changes to the prevailing model of addiction. A new focus on behavioral aspects of addiction allowed the creation of a nonstigmatizing Parsonian disease model.

History, 20th Century↗
PubMed2006

Time distortion for expert and novice online game players.

Online game addiction is a new mental disorder. This disorder is difficult to describe because of its comprehensive nature. Many online game players have problems controlling their playing time. They cannot stop playing a game that they enjoy. This research surveyed the past literature on "flow" and time disorder theory. A time distortion experiment was conducted. This research invited 64 children, teenagers, and young adults to investigate player skill and playing time effects on online game break-off. The playing experience and degree of time distortion were measured and analyzed. The results showed that both novice and expert online game players were subject to time distortion. The participants had difficulty breaking off from the game without intrusion by others in the real world. This research also suggests eight questions for self-evaluation for online game addiction.

Adolescent↗
PubMed1992

The paraphilias: a multiplicity of deviant behaviours.

The DSM-II and DSM-III both allow for multiple diagnoses. The DSM-III acknowledges that a patient may have multiple paraphilias but the true nature and extent of the multiplicity has only been documented recently. In order to study the degree of crossover between the various paraphiliac acts, a study of men who admitted to at least one paraphilia was conducted. A proportional index of multiple deviation was obtained. In addition, the mean number of admitted sexually deviant incidents per paraphilic category was computed as an estimate of the extent of deviant acts committed by this population. The results indicated that paraphiliacs tend to have multiple types of sexual aberrations as well as a high frequency of deviant acts per individual.

Adult↗
PubMed2001

Gambling as an addictive disorder among athletes: clinical issues in sports medicine.

This article examines the role of gambling as an addictive disorder experienced by athletes, both college and professional. Gambling may often be seen as a comorbid factor with other addictions and with depression among athletes. The focus on addictions among athletes has gained considerable attention among sports medicine clinicians. Diagnostic indicators, risk and protective factors, and a stage model of addiction among athletes are addressed. An algorithm and pathway of care for athletes with an addictive disorder is offered as are recommendations that sports physicians, sports medicine specialists, coaches and counsellors need to address athletes who have an addictive disorder.

Behavior, Addictive↗
PubMed1999

[Clinical features of cocnar addiction].

Some peculiarities of clinical manifestations of cocnar addiction were studied in 172 patients of Shimkent narcologic outpatient clinic (South Kazakhstan). A comparison of cocnar addiction with one caused by administration of chemically processed raw opium was made in 302 patients. It was established that cocnar addiction is characterised by slow development, slow progression of the disease. The age of most of such patients was more than 70 years (in group which abused raw opium--less than 40). Cocnar addiction was characterised by longer duration of the disease (up to 33 years), while in case of raw opium abuse its duration was mainly till 5 years. Compared to raw opium abuse stage III of the disease was less frequent, (9.8 and 29.8% respectively). Working capacity was preserved longer in cocnar addiction, and such patients were less inclined to commit criminal actions. The attention is paid to possibility of both "rejuvenation" and increase of the progredient course of cocnar addiction in conditions of its spreading.

Adult↗