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PubMed2005

Ethical issues in the conduct of longitudinal studies of addiction treatment.

Many complex ethical issues arise in the day-to-day conduct of longitudinal studies of addiction treatment. These issues are rooted, in part, in the sustained and potentially ambiguous relationship between research staff and study participants, the frequently changing clinical and legal status of study participants, the assertive methods required to generate high follow-up rates, and the numerous systems of care and control in which participants are involved. To identify common ethical issues that arise in such studies, the authors conducted individual and group interviews with seasoned members (case trackers, field trackers, interviewers, and supervisors) of the research team. The ethical dilemmas identified through these interviews fell into seven broad arenas: (1) informed consent for research participation, (2) confidentiality and information disclosure, (3) relationship boundaries between study participants and research staff, (4) duty to warn/report responsibilities, (5) questions of autonomy and privacy, (6) issues related to compensation for research participation, and (7) data integrity. Case studies that illustrate common ethical dilemmas within each of these seven areas are presented and discussed. Ethical dilemmas in the study of addiction treatment can be effectively managed via ethically informed research protocols, staff training in ethical decision-making, monitoring and supervision, and collective debriefing of critical events.

Adult↗

PubMed2005

Neurobiology of addiction: treatment and public policy ramifications.

In the United States, efforts to treat addiction are hampered by prejudice and a public view that treats it as a disorder of self-control, not a disease. We highlight select advances in addiction research that, if disseminated to the public, could reverse these misconceptions and facilitate changes in policy to improve treatment access and care delivery for this highly prevalent disease.

Behavior, Addictive↗

PubMed2001

Functional magnetic resonance imaging of cocaine craving.

OBJECTIVE: Identification of brain activity associated with craving is important for understanding the neurobiology of addiction. METHOD: Brain activity was measured in cocaine addicts and healthy subjects by functional magnetic resonance imaging (fMRI) while the subjects watched videotapes designed to elicit happy feelings, sad feelings, or the desire to use cocaine. The subjects indicated the onset of drug craving or emotional response, allowing comparison of groups before and after such feelings. RESULTS: Robust activation of the anterior cingulate was evident in patients watching cocaine-cue tapes but not in patients watching happy or sad tapes or in healthy subjects under any condition. Anterior cingulate activation preceded the reported onset of craving and was evident in patients who did not report craving. In contrast, patients showed less activation than healthy subjects during the cocaine-cue tapes in areas of the frontal lobes. After the reported onset of craving, cocaine-dependent subjects showed greater activity than healthy subjects in regions that are more active in healthy subjects when they watch sad tapes than when they watch happy tapes, suggesting a physiologic link between cocaine-cue responses and normal dysphoric states. Dynamic aspects of regional brain activations, but not the location of activations, were abnormal in cocaine-dependent subjects watching sad tapes, suggesting more general affective dysregulation. Patients showed low activation of sensory areas during initial viewing of all videotapes, suggesting generalized alteration in neuroresponsiveness. CONCLUSIONS: Cocaine cues lead to abnormally high cingulate and low frontal lobe activation in cocaine addicts. Addicts also show more general abnormalities in affect-related brain activation.

Adult↗

PubMed2004

Internet use, social skills, and adjustment.

The present study investigated the extent to which inter-personal skills, personality, and emotional intelligence (EI) were related to the extent of usage of the Internet, as measured with the Internet Addiction Scale, on a sample of undergraduates. EI was assessed by performance measures derived from the identification and labeling of emotions as shown in pictures of facial expressions, and as interpreted from descriptions of social episodes. Use of the Internet was related to loneliness and adherence to idiosyncratic values (strong effects), and also to poorer balance between work and leisure and emotional intelligence (weaker effects). Big Five personality dimensions were also included in the study. No link was found between personality and usage of the Internet. Results suggest that frequent users tend to be lonely, to have deviant values, and to some extent to lack the emotional and social skills characteristic of high EI.

Adolescent↗

PubMed2001

Quantitative comparison of ohmefentanyl isomers induced conditioning place preference in mice.

Differences of analgesia and withdrawal response among ohmefentanyl stereoisomers have been studied. In the present study, Quantitative comparison of reinforcing effects of ohmefentanyl stereoisomers and morphine was performed by using a conditioned place preference design in mice. Results showed that morphine and ohmefentanyl stereoisomers were able to increase significantly the time spent in the drug-paired side with respect to vehicle treated animals. A good linear correlation between doses of drugs and number of mice with place preference was found within a given dose range. On the basis of the dose-response curve analysis, ohmefentanyl stereoisomers displayed a significant difference in place preference ED50. The addictive index (analgesic ED50/place preference ED50) was used to assess the addictive potential of drugs. It was demonstrated that the addictive potential of ohmefentanyl stereoisomers did not exhibit a large difference as addictive index. Among these stereoisomers, the addictive potential of compound F9208 was markedly lower than that of morphine.

Analgesics, Opioid↗

PubMed2000

Disciplining addictions: the bio-politics of methadone and heroin in the United States.

Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the United States. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses: A criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease. Treatment in this context becomes a hostile exercise in disciplining the unruly misuses of pleasure and in controlling economically unproductive bodies. Most of the biomedical and epidemiological research literature on methadone obscures these power dynamics by technocratically debating dosage titrations in a social vacuum. A foucaultian critique of the interplay between power and knowledge might dismiss debates over the Swiss experiments with heroin prescription as merely one more version of biopower disciplining unworthy bodies. Foucault's ill-defined concept of the specific intellectual as someone who confronts power relations on a practical technical level, however, suggests there can be a role for political as well as theoretical engagement with debates in the field of applied substance abuse treatment. Meanwhile, too many heroin addicts who are prescribed methadone in the United States suffer negative side effects that range from an accentuated craving for polydrug abuse to a paralyzing sense of impotence and physical and emotional discomfort.

Adult↗

PubMed2001

Analysis of attitudes toward computer networks and Internet addiction of Taiwanese adolescents.

This study explored the interplay between young people's attitudes toward computer networks and Internet addiction. Ninety possible Internet addicts were selected for examination after analyzing the questionnaire responses of an initial sample of 753 Taiwanese high school adolescents. It was found that the subjects' attitudes toward computer networks could explain many aspects of Internet addiction. However, actual behaviors on Internet usage and perceptions on the usefulness of Internet were more important than affective responses toward computer networks in predicting adolescents' Internet addiction.

Adolescent↗

PubMed2004

Patterns of self-cutting: a preliminary study on differences in clinical implications between wrist- and arm-cutting using a Japanese juvenile detention center sample.

The present study was aimed to clarify the differences in clinical implications between wrist- and arm-cutting. Subjects were 201 delinquent adolescents (178 males and 23 females) who had been admitted to a detention center from February to March 2003. A self-reporting questionnaire and the Adolescent Dissociative Experience Scale (ADES) were given. Traumatic events and other self-injurious behavior were compared among four groups. In total, 33 (16.4%) subjects reported wrist- and/or arm-cutting. Of the females, 60.9% (n = 14) had experienced self cutting behaviors compared to 10.7% of males (n = 19). Subjects were divided into four groups; 'non-cutting' (NC: n = 168, 83.6%), 'wrist-cutting' (WC: n = 5, 2.5%), 'arm-cutting' (AC: n = 19, 9.5%), and 'wrist- and arm-cutting' (WAC: n = 9, 4.5%). WC, AC, and WAC groups reported early separation, bulling in school, and histories of sexual/physical abuse more frequently than NC group. WC and WAC groups reported suicidal ideation and suicide attempts more frequently than NC and AC groups. The ADES scores in AC and WAC groups were significantly higher than in those in NC group (P < 0.001), while the scores in WC were not different from NC groups. WC and WAC groups self-cut due to suicide idea more frequently than the AC group, while AC group self-cut due to anger expression more frequently than WC or WAC groups. Self-cutters experienced early separation, bullying in school, and sexual/physical abuse more frequently than-non-self-cutters. Arm-cutting behavior may predict dissociation, while wrist-cutting may involve with suicidality.

Adolescent↗

PubMed1992

Drug abuse and eating disorders: prevention implications.

This article explores the relationship between drug and alcohol abuse and eating disorders in a sample of adolescent females using a self-report methodology. An Eating Disorders Risk (EDR) Scale is adopted and correlated with drug and alcohol use, other forms of deviance, family and peer relationships, and depression. The findings support the concept of a generalized theory of addictions based on psychosocial, family, and peer factors. Family and peer prevention applications and a need for further research on the correlates of depression are discussed.

Adolescent↗

PubMed1993

Alcohol and heroin use patterns of narcotics addicts: gender and ethnic differences.

Data on lifetime alcohol and heroin use by 443 White and Chicano addicts of both genders were obtained from a sample of admissions to several Southern California methadone maintenance programs. Patterns of alcohol and heroin use were examined with respect to gender and ethnic differences. Repeated-measures MANOVA established an inverse pattern of alcohol and heroin use for all four groups, confirming and extending the findings of a previous study by the authors. With this additional evidence, the authors propose a compensatory model that explains the obtained inverse pattern of alcohol and heroin use and that may be suitable in examining concurrent or sequential use of other psychoactive substances in addition to alcohol. Significantly higher levels of heavy alcohol use were reported by Chicano than by White addicts. Overall findings indicate that after heroin addiction occurs, there is a convergence in patterns of substance use by both genders, although variations related to ethnicity persist, particularly for alcohol use.

Adolescent↗

PubMed1999

[Interdisciplinary therapeutic approaches with substance abusers taking into consideration gender differences].

Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction includes behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral and social-context components. Whereas the basic treatment approach in substance dependence involves the medical field, psychosocial support is the second main area which has to be included in order to gain a successful treatment outcome. In addition, psychotherapy presents a third useful area in the field of the treatment of drug addiction, but only under the consideration that the addict shows a continuing motivation to change. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impinge on society's overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction. Treatment of substance dependence in men differs from treatment of substance dependence in women; drug addiction in females requires special attention when the woman is pregnant.

Adult↗

PubMed2002

The prevention of gambling problems in youth: a conceptual framework.

Despite increased awareness of the need to begin educating young children about the potential dangers of gambling, empirical knowledge of the prevention of adolescent problem gambling and its translation into science-based prevention initiatives is scarce. This paper poses the question of whether or not the common elements of tobacco, alcohol, and illicit drug abuse prevention programs can be applied to gambling prevention. Common risk and protective factors across addictions, including gambling, appear to point to the need to develop a general model of primary, secondary, and tertiary prevention. The authors present the need for science-based prevention initiatives and describe a general adolescent risk-taking model as a basis for science-based prevention of adolescent problem gambling and other risk behaviors.

Adolescent↗

PubMed1997

The challenge of sobriety: natural recovery without treatment and self-help groups.

Natural recovery is a phenomenon that is not understood and largely challenged by self-help group members and professionals working in the field of substance abuse. So strong is the supposition of the process of recovering as a life-long condition that requires treatment and/or a self-help group for on-going support and rehabilitation that recovery on one's own is given little credence. Yet there is growing empirical evidence that natural recovery not only exists, but may be more prominent than is currently recognized. This article presents a study of natural recoverers from alcoholism and problem drinking, reporting their subjective motivating factors and strategies of recovery, while examining an issue of which there is still limited data--the perceived changes since abstaining, i.e., how their lives have been altered by pursuing abstinence on their own. It concentrates on rich narrative data to explore the meaning of the change experience that can be applied to various addictions, for the purpose of illuminating novel approaches that have the potential for expanding practice techniques and forums, thereby enhancing its effectiveness.

Adaptation, Psychological↗

PubMed2000

Research perspectives on alcohol craving: an overview.

This overview of the Addiction supplement on 'Research Perspectives on Alcohol Craving' has three objectives. The first is to familiarize readers with the variety of theoretical models relevant to craving and the definitions of craving generated by them that are discussed in the supplement. These include phenomenological models, classical and operant conditioning models, the incentive-sensitization theory, a tonic-phasic model of dopamine system regulation, cognitive social learning theory and the cognitive processing theory of craving. The second objective is to provide a brief summary of the methodological articles which focus as a whole more on what can be done than on what has been done in alcohol craving research. The final objective is to emphasize the potential importance of transdisciplinary research--research that integrates components of different theoretical models--for delineating the role of alcohol and drug craving in the complex biobehavioral process known as addiction. It is the hope of the guest editors (the authors of this overview) that the Addiction supplement and this introduction to it will contribute to development of a framework for future transdisciplinary research on alcohol craving.

Alcohol-Related Disorders↗

PubMed2003

Neuropsychiatric consequences (atypical psychosis and complex-partial seizures) of ecstasy use: possible evidence for toxicity-vulnerability predictors and implications for preventative and clinical care.

Two case reports of ecstasy abuse and its serious neuropsychiatric complications are presented. The first patient developed a florid paranoid psychosis resembling schizophrenia after repeated long-term recreational ecstasy abuse, and significant alterations with intermittent paroxysmal discharges were found in his electroencephalogram. The second patient showed an atypical paranoid psychosis with Fregoli syndrome and a series of complex-partial epileptic seizures with secondary generalization after a first single ecstasy dose. Both subjects presented considerable vulnerability; the first a minimal brain dysfunction after perinatal asphyxia and a persisting attention deficit/hyperactivity disorder, the second a long-lasting opioid addiction. In vulnerable individuals, dose-independent ecstasy abuse can lead to unpredictable and potentially dangerous neuropsychiatric sequelae which require proper initial assessment and adequate treatment.

Adult↗

PubMed1995

Eating disorders, addictions, and unconscious fantasy.

Using concepts from object relations theory, the author extends the theories of eating disorders advanced by Freud and Bruch. Ogden's sensation-based autistic-contiguous position, Tustin's related concepts of autistic shapes and objects, and Fairbairn's theory of object relations are related to the addictive nature of eating disorders. A clinical illustration demonstrates how these recent theoretical concepts can help explain the unique qualities of the transference and countertransference that develop when working with eating disorder patients.

Adult↗

PubMed2005

Euphoria, ecstacy, inebriation, abuse, dependence, and addiction: a conceptual analysis.

A conceptual analysis of basic notions of addictiology, i.e., Euphoria, Ecstasy, Inebriation, Abuse, Dependence, and Addiction was presented. Three different forms of dependence were distinguished: purely psychic, psycho-physiological, and purely somatic dependence. Two kinds of addiction were differentiated, i.e. appetitive and deprivative addiction. The conceptual requirements of addiction were discussed. Keeping these in mind some ethical problems of drug therapy and psychotherapy were explained. Criteria for the assessment of therapeutic approaches are suggested: effectiveness, side effects, economic, ethic, and esthetic valuation.

Behavior, Addictive↗

PubMed2006

Predictors of course satisfaction and perceived course impact of addiction nurses undertaking a postgraduate diploma in addictive behaviour.

The effectiveness and impact of continuing education for specialist nurses working with drug and alcohol had been poorly documented and the purpose of this study was to enhance our understanding of this process. The aims of the study were to identify predictors of course satisfaction and perceived course impact and to examine students' satisfaction with modules' learning outcomes and their applications to practice. This study was a cross-sectional survey of 46 part-time students enrolled a Postgraduate Diploma in Addictive Behaviour. Three instruments were used to measure modules' satisfaction, post-course satisfaction (PCSQ-18) and on-the-job impact (CIQ-17). The findings provided some support on the effect and impact of an educational programme on the practice development of addiction nurses. Within the multilayered hypothesis, the results indicate that expectations on the Health Education and Prevention Module were the only significant predictor of course satisfaction and Expectation of the Special Population Module was the only significant predictor of course impact on professional practice. Clinical placements have had a significant impact on professional practice of addiction nurses. Further evaluative studies need to be undertaken to examine the impact of educational programmes on its applications to clinical practice and the quality of care provided.

Adult↗