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PubMed1996

The resurrection and the life.

This first-person account of a woman undergoing manic-depression concurrent with alcohol and drug problems highlights the difficulties of attaining help from a system geared toward treating one or the other but not both, and hints at the positive outcomes possible when an integrated approach to co-occurring addictive and mental disorders--one that incorporates the knowledge and perspectives of the client and the family as well as the professional--is available.

Alcoholism↗
PubMed2000

CYP2D6 ultrarapid metabolizer genotype as a potential modifier of smoking behaviour.

Some 3-10% of Caucasians are deficient in CYP2D6 metabolism (poor metabolizers), due to inheritance of two defective alleles, whereas amplification of the CYP2D6 gene results in ultrarapid metabolism in 1-2% of Caucasian populations. To examine the possible association between CYP2D6 polymorphism and individual smoking behaviour, we analysed the prevalence of CYP2D6 genotypes among 292 long-term heavy smokers, 382 individuals with more variable smoking histories, and 302 never-smokers. The prevalence of ultrarapid metabolizers in heavy smokers (7.9%) was twofold compared to individuals with variable smoking habits (3.7%; odds ratio 2.3, 95% confidence interval 1.2-4.4), and fourfold compared with never-smokers (2.0%) (odds ratio 4.2, 95% confidence interval 1.8-9.8). The frequency of poor metabolizer genotype was approximately 2%, in each smoker group. However, when men and women were studied separately, the prevalence of poor metabolizer genotype was higher in male never-smokers (3.6%) than in variable smokers (2.7%) and heavy smokers (2.2%). Moreover, a trend test, adjusted by age, gender and cancer status, revealed a significant trend for the increased tobacco usage with increased metabolic capacity. Our results are in agreement with the assumption that increased CYP2D6 activity may contribute to the probability of being addicted to smoking.

Age Distribution↗
PubMed2005

Electronic gaming machines: are they the 'crack-cocaine' of gambling?

BACKGROUND: There is a general view that electronic gaming is the most 'addictive' form of gambling, in that it contributes more to causing problem gambling than any other gambling activity. As such, electronic gaming machines have been referred to as the 'crack-cocaine' of gambling. While this analogy has popular appeal, it is only recently that the scientific community has begun to investigate its validity. In line with the belief that electronic gambling has a higher 'addictive' potential than other forms of gambling, research has also begun to focus on identifying the characteristics of gaming machines that may be associated with problem gambling behaviour. AIMS AND METHODS: This paper will review the different types of modern electronic gaming machines, and will use the introduction of gaming machines to Australia to examine the association between electronic gaming and problem gambling, with particular reference to the characteristics of modern electronic gaming machines. FINDINGS AND CONCLUSIONS: Despite overwhelming acceptance that gaming machines are associated with the highest level of problem gambling, the empirical literature provides inconclusive evidence to support the analogy linking electronic gaming to 'crack-cocaine'. Rigorous and systematic evaluation is required to establish definitively the absolute 'addictive' potential of gaming machines and the degree to which machine characteristics influence the development and maintenance of problem gambling behaviour.

Australia↗
PubMed1996

Self-mutilation in adolescence as addictive behaviour.

Self-mutilation as addictive behaviour has been mentioned in a few studies in recent years. We present the case of a girl with narcissistic borderline personality disorder (DSM III-R: 301.83, 301.81), who undertook multiple, repetitive self-mutilating acts. Self-mutilation is discussed as addictive behaviour in this case. We emphasize the evaluation of repetitive self-mutilating acts by applying criteria for addictive and dependence disorders, in order to achieve additional adequate strategies for treating patients showing this behaviour.

Adolescent↗
PubMed1993

Self-damaging and addictive behaviour in bulimia nervosa. A catchment area study.

This study examines the prevalence of self-damaging and addictive behaviour in a consecutive series of 112 normal-weight bulimic women all stemming from the same urban catchment area. A quarter reported consuming over 36 units of alcohol a week, and nine drank over 50 units. Twenty-eight per cent abused drugs, 21% repeatedly stole, 18% repeatedly overdosed, and 8% regularly cut themselves. In all, 40% reported self-damaging and addictive behaviour, 80% of whom gave a history of three or more behaviours together. Alcohol abuse was significantly associated with drug abuse and repeated overdosing; repeated cutting was significantly associated with drug abuse. Repeated stealing and overdosing were markers of severity and did not occur in isolation. A core group, termed and defined by the author as 'multi-impulsive bulimics', were older, less likely to be employed, married, or in a stable union, but were more likely to have an alcohol-abusing partner or to come from a family with a history of alcohol abuse. They were also more likely to give a history of sexual abuse.

Adolescent↗
PubMed2001

[Internet addiction: a different kind of addiction?].

The concept of Internet addiction, also called Internet addictive disorder or pathological Internet use, entered the medical dictionary in 1995. More and more authors have been preoccupied with it lately, and the majority conclude that this condition, on which some people cast doubt a few years ago, well and truly exists. Several forms of Internet addiction appear to exist, categorised according to the type of misuse it is subjected to: "cybersex", "chat rooms", "net gaming", the pathological search for information or video games being the most frequent. Psychiatric disorders most usually associated with Internet addiction seem to be bipolar disorders. As a consequence, efficient drugs would be those that act as thymo-stabilisers, undoubtedly because they are also effective against those bipolar disorders. Psychotherapeutic treatments as discussion groups on the Internet or group therapies have not yet been evaluated.

Antipsychotic Agents↗
PubMed1978

Biofeedback application to drug addiction in the University of Colorado drug rehabilitation program.

Biofeedback was used as a means to relieve stress and anxiety for methadone patients. The hypothesis was that biofeedback could substitute for the use of drugs that were previously used to relieve stress and anxiety. Biofeedback was found to be an effective substitute for opiates and also a tool for insight into behavior. The addict learned to use his own abilities to improve his well-being and control over his life situations. The goal of maintaining a drug-free life with the help of biofeedback techniques was supported in this study.

Anxiety↗
PubMed2004

Psychiatric correlates of gambling in adolescents and young adults grouped by age at gambling onset.

BACKGROUND: Gambling is a prevalent behavior, yet few studies have investigated its mental health correlates. Although early-onset engagement in behaviors with addictive potential has generally been associated with more severe problems, direct investigation of a nationally representative sample of gamblers grouped by age at onset of gambling has not been performed. OBJECTIVE: To identify differences in psychiatric correlates of gambling and gambling-related attitudes and behaviors in adolescents (aged 16-17 years) and in young adults (aged 18-29 years) with early-onset (before age 18 years) and adult-onset gambling. DESIGN: Logistic regression analysis. SETTING: Public access data set derived from random-digit-dialing telephone surveys. PATIENTS: The study analyzed data from adolescent (n = 235), early-onset adult (n = 151), and adult-onset (n = 204) past-year gamblers and adolescent (n = 299) and adult (n = 187) nongamblers in the Gambling Impact and Behavior Study. MAIN OUTCOME MEASURES: Gamblers and nongamblers were compared within each group on measures of sociodemographics and psychiatric health. Adolescent, early-onset adult, and adult-onset past-year gamblers were compared on measures of gambling attitudes and behaviors. RESULTS: Adolescent gamblers were more likely than adolescent nongamblers to report alcohol and drug use and abuse/dependence and depression. Elevated rates of alcohol and drug use and abuse/dependence were observed in early-onset adult gamblers vs adult nongamblers, and only elevated rates of alcohol use were observed in adult-onset gamblers vs adult nongamblers. Substantial differences in reasons for and patterns of gambling were observed among the 3 groups of gamblers. CONCLUSIONS: Adolescent-onset gambling is associated with more severe psychiatric problems, particularly substance use disorders, in adolescents and young adults. More research is needed to investigate the relationships and inform prevention and treatment strategies.

Adolescent↗
PubMed2003

The Shorter PROMIS Questionnaire: further validation of a tool for simultaneous assessment of multiple addictive behaviours.

There is both a theoretical and clinical need to develop a questionnaire that assesses a range of addictive behaviours. The Shorter PROMIS Questionnaire (SPQ) is a 16-scale self-report instrument assessing the use of nicotine, recreational drugs, prescription drugs, gambling, sex, caffeine, food bingeing, food starving, exercise, shopping, work, relationships dominant and submissive, and compulsive helping dominant and submissive. Clinical cut-off scores using the 90th percentile were derived from a normative group of 508 individuals. These cut-offs correctly identified 78-100% of cases within clinical criterion groups of specific disorders. The clinical sample also completed other validated scales assessing gambling, eating, alcohol, and drug use. Correlations were typically.7 with relevant SPQ scales. The SPQ food, drug, and alcohol scales were at least equivalent to validated comparison scales in the strength of their relationship to relevant clinical criterion groups. Internal consistency was high for all scales, and test-retest reliability was generally good. This clinically useful instrument provides a broad assessment of addictive problems, thereby benefiting both the treatment provider and the client.

Adolescent↗
PubMedDate not supplied

The eating disorders as addiction: a psychobiological perspective.

A number of theories have been proposed to explain the substantial comorbidity between the eating disorders and the substance-related disorders. Among them is the claim that self-starvation--exacerbated by excessive exercising--is itself an addiction to the body's endogenous opioids. While efforts have also been made to identify an "addictive personality," attempts to establish whether eating-disordered patients share these characteristics have met with mixed success. The present study was designed to determine the degree to which anorexic and bulimic patients display addictive personality characteristics, and whether these traits are useful in predicting the severity of the patient's weight preoccupation and their degree of excessive exercising. Results confirmed that both anorexic and bulimic patients had high scores on the Addiction Scale of the Eysenck Personality Questionnaire, and that addictiveness and obsessive-compulsiveness were related simultaneously to weight preoccupation and excessive exercising in both patient groups. Findings are discussed within the framework of the auto-addiction opioid theory, and they highlight the similarities and differences in the personality structure of the eating-disorder subtypes.

Adaptation, Psychological↗
PubMed2004

Addiction and disability: moral and policy issues.

This article discusses the conceptual, ethical, and policy issues raised by the legal classification of drug addiction as an impairment, and of some nonusing drug addicts as people with disabilities. It focuses on the questions of (1) what moral judgments, if any, underlie the classification of addiction as an impairment; (2) whether it makes sense to apportion the burdens of drug addiction between chemical, biological, social, political, and other causes; (3) how considerations of distributive justice may compel or constrain measures to ease the burdens of drug addiction; and (4) whether it is justifiable to deny the current users of illegal substances legal protections available to the current users of legal substances.

Attitude to Health↗
PubMed2004

Drug addiction and responsibility for the health care of drug addicts.

Taking care of those who are in need of health care is something that we, as a society, feel ourselves committed to insofar as public funds make that possible. Is this commitment in any way qualified by the fact that a person's medical maladies are the result of that person having voluntarily embarked on activities whose deleterious consequences for health were known and appreciated by that person beforehand? Specifically, is society's obligation to provide healthcare services to those who have addicted themselves to illicit drugs attenuated by the fact of that addiction? Some argue that it is, whereas others consider this position morally untenable. This essay explores the question of who is right on this matter and why.

Attitude to Health↗
PubMed2006

Preventing and treating nicotine addiction: a review with emphasis on adolescent health.

This article is the fourth in a series of four providing current, state-of-the-art information about the tobacco problem and how physicians can effectively intervene. The articles review the health effects of second-hand smoke, current treatment strategies for nicotine addiction and the implementation of best practices, such as the "5 As," to effectively intervene with families with smokers. Three of the articles are accredited for free continuing medical education (CME) credit for physicians. To obtain AMA PRA Category 1 Credit(s)TM for this article, please go online to www.PedsEducation.org, your source for free continuing medical education from Nemours. Choose "Online Education" and the article, and complete the post-test as directed. CME accreditation for this educational presentation is provided at no cost as a service of Nemours, one of the nation's largest children's health systems. Nemours is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Nemours designates this educational activity for a maximum of .5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This article will focus on the prevention of adolescent smoking and discuss a global approach to the tobacco problem among youth. It also reviews the rationale for and pharmacology of treating nicotine addiction to empower physicians to assist smokers with quitting. By reading the article and completing the post-test, it is anticipated that the following learning objectives will be met: Physicians will become familiar with: 1) Options for treating nicotine addiction, 2) The unique aspects of the tobacco problem in adolescence, 3) The risk factors for teen smoking initiation.

Adolescent↗
PubMed2006

Characteristics of older adult problem gamblers calling a gambling helpline.

BACKGROUND: Few investigations have characterized groups of older adults with gambling problems, and published reports are currently limited by small samples of older adult problem gamblers. Gambling helplines represent a widespread mechanism for assisting problem gamblers to move into treatment settings. Given data from older adult problem gamblers in treatment, we hypothesized that older as compared with younger adult problem gamblers calling a gambling helpline would be less likely to report gambling-related problems. DESIGN AND METHODS: Logistic regression analyses were performed on data obtained from January 1, 2000 to December 31, 2001, inclusive, from callers with gambling problems (N = 1,084) contacting the Connecticut Council on Problem Gambling Helpline. RESULTS: Of the 1,018 phone calls used in the logistic regression analyses, 168 (16.5%) were from older adults and 850 (83.5%) from younger adults. Age-related differences were observed in demographic features, types and patterns of gambling reported as problematic, gambling-related problems and psychiatric symptoms, substance use problems, patterns of indebtedness, and family histories of addictive disorders. Older as compared with younger adult problem gamblers were more likely to report having lower incomes, longer durations of gambling, fewer types of problematic gambling, and problems with casino slot machine gambling and less likely to report gambling-related anxiety, family problems, illegal behaviors and arrests, drug problems, indebtedness to bookies or acquaintances, family histories of drug abuse, and problems with casino table gambling. CONCLUSIONS: Older as compared with younger adult problem gamblers calling a gambling helpline differ on many clinically relevant features. The findings suggest the need for improved and unique prevention and treatment strategies for older adults with gambling problems.

Adult↗
PubMedDate not supplied

Craving patterns in methadone maintenance treatment with dextromoramide as adjuvant.

A study was performed to establish the effect on opiate craving among six long-term opiate-dependent subjects in methadone maintenance treatment. Subjects currently stabilised on methadone, received 5 or 10 mg dextromoramide besides methadone. During the study the usual methadone dose was diminished according to the individual subject's expectation of the effect of dextromoramide addition. A clear drug-effect relationship between the increment of dextromoramide plasma concentration and decrement of opiate craving could be seen. A craving increase before drug administration was seen in three cases. The results could imply beneficial effects of a short-acting opiate on diminishing craving in opiate addicts who are difficult to stabilise with methadone maintenance treatment.

Adult↗
PubMed2006

Helping smokers to decide on the use of efficacious smoking cessation methods: a randomized controlled trial of a decision aid.

AIMS: Most smokers attempt to stop smoking without using help. We evaluated the efficacy of a decision aid to motivate quitters to use efficacious treatment. SETTING AND PARTICIPANTS, A total of 1,014 were recruited from a convenience sample of 3,391 smokers who intended to quit smoking within 6 months. DESIGN AND Smokers were assigned randomly to either receive the decision aid or no intervention. The decision aid was expected to motivate quitters to use efficacious cessation methods and contained neutral information on treatment methods, distinguishing between efficacious and non-efficacious treatments. MEASUREMENTS Baseline questionnaire and follow-ups were used 2 weeks and 6 months after the start of the intervention. FINDINGS: The decision aid increased knowledge of cessation methods and induced a more positive attitude towards these methods. Furthermore, 45% reported increased confidence about being able to quit and 43% said it helped them to choose between treatments. However, no clear effect on usage of treatment aids was found, but the intervention group had more quit attempts (OR=1.52, 95% CI 1.14-2.02) and higher point prevalence abstinence at 6-month follow-up (20.2% versus 13.6%; OR=1.51, 95% CI=1.07-2.11). CONCLUSIONS An aid to help smokers decide to use efficacious treatment when attempting to quit smoking had a positive effect on smoking cessation, while failing to increase the usage of efficacious treatment. This finding lends support to the notion that the mere promotion of efficacious treatments for tobacco addiction might increase the number of quit attempts, irrespective of the actual usage of treatment.

Adolescent↗
PubMed2000

[Drug use: a life choice or health threat].

The term "enjoyment" is used to denote a pleasurable, utility-creating activity or an act of consumption, which, however, may often be accompanied by subsequent risks, health-care costs or reduction in the quality of life. If viewed from the vantage point of health policy, we may quote several examples of consumer behaviour of this type, ranging first and foremost from the consumption of alcohol and nicotine to the use of "hard" drugs. But certain sports activities or sexual behaviour that may prove damaging to other persons must also be mentioned in this context. All these forms of consumption often lead to direct or indirect consequences to health and thereby result in increased health spending amounting to several thousand million DM. The decline in quality of life resulting from the above-mentioned forms of behaviour could be avoided through health promotion and prevention or, at the very least, through measures of rehabilitation, above all, information, counselling, and education, which represent medium- or long-term measures to that effect. Financial incentives or disincentives, for example, via an increase in co-payment in case of illness caused by risky behaviour, have not been as effective as had been expected by many proponents. Product-specific levies, risk-related payments and other financial incentives and disincentives are generally also not as effective as desired. Health policy measures aimed at influencing behaviour via financial measures are particularly ineffective in case of persons addicted to particular types of consumables, especially to drugs: Information, counselling and education represent non-financial forms of influencing and guiding behaviour with a greater scope for success.

Behavior, Addictive↗