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PubMed2000

Challenges in the manipulation, assessment and interpretation of craving relevant variables.

The nature of drug craving and its role in the addictive process is a contentious issue in the addiction sciences. There are numerous disputes regarding the definition, assessment, manipulation and interpretation of craving, and progress toward resolving the enigmas of craving confronts numerous conceptual and methodological challenges. Greater attention to certain fundamental principles of measurement and manipulation should generate immediate and substantial improvements in efforts to understand and control alcohol craving. This paper provides suggestions for enhancing the measurement of self-reported alcohol craving and improving the manipulation of alcohol craving under controlled laboratory conditions. With regard to measurement, single-item scales commonly employed in craving research tend to be handicapped by limited reliability and validity. Multi-item craving scales are more likely to provide the accuracy required to accurately discriminate between different levels of craving across individuals or across different settings. Conceptual and practical considerations for the selection of multi-item craving instruments are discussed. With regard to the manipulation of alcohol craving in the laboratory, recent meta-analyses suggest that alcohol craving effects in such research may be relatively weaker than craving effects found in similar research with other addicts. Therefore, laboratory-based investigations into the nature of alcohol craving should utilize procedures and assessments that are particularly sensitive to the detection of alcohol craving. This paper offers methodological recommendations for enhancing the magnitude of alcohol craving effects generated in laboratory research.

Alcohol-Related Disorders↗

PubMed2006

Addiction: a journal and its Invisible College.

UNLABELLED: PROVENANCE: This paper derives from a lecture given before the Society for the Study of Addiction in November 2004, on the author's retirement from the position of Editor-in-Chief of Addiction, one of the Society's journals. AIM: To identify the live processes which have influenced the journal's evolution since its foundation in 1884. CONCLUSIONS: Over the 120-year period a strong, continuing historical thread has been the fluctuating success of the journal's engagement with its 'Invisible College', the community which it seeks to serve. It is argued that the journal's future success will depend on its capacity to explore and nurture further this two-way relationship. Addiction is a journal with an active and clearly articulated, multiple vision of it purpose, and this vision is outlined. It dares to try to influence its future with the authority so to do rooted in its ability to reflect the aspirations and concerns of its readers. It is 'a journal of the second kind'.

Behavior, Addictive↗

PubMed2000

"Computer addiction": a critical consideration.

Problems related to intemperate Internet use are examined within the conceptual framework of addiction. It is argued that empirical support for the construct validity of computer addiction has yet to emerge, that defining the construct as a unique psychiatric disorder is therefore premature, and that, in most cases, excessive computer use may be symptomatic of other, more primary disorders. Greater caution and rigor are urged in investigating and treating problems related to intemperate computer use.

Behavior, Addictive↗

PubMedDate not supplied

[Addictive potential in man: methodological aspects].

Different methods have been developed in clinical abuse liability testing in man. Tolerance, psychic and/or physical dependence must be investigated through clinical studies during drug development of a new substance. Adequate methodology is needed using double-blind, time-blind evaluations, comparisons of different dose levels and duration of treatment for a given drug, abrupt and gradual interruption of treatment, appropriate period of observation after treatment cessation ... The optimal scale to evaluate properly the symptoms occurring after drug discontinuation is still under investigation. These studies will or should permit the differentiation of rebound, withdrawal and recurrence. Methods developed to study reinforcing effects in post-addicts and healthy subjects are self-administration and choice procedures. In addition, the more traditional approach has been through assessing self-reported effects in which standardized questionnaires are used (Addiction Research Center Inventory or A.R.C.I.; Single Dose Questionnaire or S.D.Q.). A third focus of measurement has been discrimination studies performed in individuals with histories of drug abuse as well as healthy subjects. Abuse-liability testing of a new compound needs a multidimensional assessment to optimize the predictivity in defining the relative risk.

Behavior, Addictive↗

PubMed2004

Safeguarding the health of dental professionals.

BACKGROUND: A healthy dentist is one of the most important ingredients in a successful dental practice, an ingredient not to be taken for granted. Professionals, dentists included, can and do experience illnesses and problems that can disrupt or impair a practice. CONCLUSIONS: In addition to the vulnerabilities of the human condition--addictive disorders, psychiatric illnesses, infectious disease, family and relationship problems, or the many varieties of human misery--dentists have undergone a powerful process of socialization into their professional role that makes it difficult to seek help for themselves. Stigma about addictive and psychiatric illnesses continues to be a problem despite significant advances in scientific understanding of these disorders. Many people, especially those in positions of community visibility as dentists are, still struggle with shame when they associate problems with personal failure. Dental societies are in an ideal position to provide resources and support, should they choose to take this opportunity, and the ADA has the information and expertise to help them do this. PRACTICE IMPLICATIONS: Dentists can become more aware of their own vulnerabilities and enhance their personal and professional effectiveness, as well as evaluate ways they may support their staff and colleagues.

Adult↗

PubMed1996

Heterogeneity of person and place: assessing co-occurring addictive and mental disorders.

Provision of appropriate treatment for clients with co-occurring addictive and mental disorders is hampered by difficulties in diagnosing this diverse population and in identifying and delivering necessary services via agencies that typically focus on only a portion of these clients' problems. This paper considers common pitfalls in assessment across settings and suggests approaches to identifying and meeting the needs of clients with multiple problems.

Behavior, Addictive↗

PubMed2003

Are scratchcards addictive? The prevalence of pathological scratchcard gambling among adult scratchcard buyers in the Netherlands.

AIMS: To determine the prevalence of regular, potential problematic and pathological scratchcard gambling (PSG) 5 years after the introduction of scratchcards in the Netherlands. DESIGN AND PARTICIPANTS: A non-proportional stratified random sample of 12,222 scratchcard buyers was approached. Regular scratchcard buyers (n = 3342) were asked to fill out the South Oaks Gambling Screen (SOGS). Those with a SOGS score of 3 or more (n = 340) were interviewed with the gambling section of the DSM-IV Diagnostic Interview Schedule (DIS-T). Weighted data were used to obtain unbiased prevalence estimates. FINDINGS: The estimated prevalence of regular and potential problematic scratchcard gambling were 28.4% and 2.68%, respectively. Only 0.24% met DSM-IV criteria for PSG. Of those, only 0.09% were addicted uniquely to scratchcards. The remaining 0.15% were also addicted to other games of chance. Demographic and gambling characteristics of these 'combined' PSG (young men, mainly slot-machine players) resembled characteristics of pathological gamblers in general. In contrast to these 'combined' PSG, 'unique' PSG were mainly women between 25 and 34 years who spent relatively small amounts of money on scratchcards (equivalent to one scratchcard a day). CONCLUSION: Scratchcards have a very low addiction potential among adults in the Netherlands. Given the specific characteristics of the unique PSG and the relatively small amount of money they spent, the appropriateness of DSM criteria for this particular form of gambling can be questioned.

Adolescent↗

PubMed2006

Impact of health literacy on depressive symptoms and mental health-related: quality of life among adults with addiction.

BACKGROUND: Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse. OBJECTIVE: We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive symptoms, and worse mental health functioning compared with those with higher literacy in adults with alcohol and drug dependence. METHODS: The association of literacy with multiple mental health outcomes was assessed using multivariable analyses. Measurement instruments included the Rapid Estimate of Adult Literacy in Medicine (REALM), the Center for Epidemiologic Studies-Depression (CES-D) scale, the Mental Component Summary scale of the Short Form Health Survey, and the Addiction Severity Index for drug and alcohol addiction. Subjects included 380 adults recruited during detoxification treatment and followed prospectively at 6-month intervals for 2 years. Based on the REALM, subjects were classified as having either low (< or = 8th grade) or higher (> or = 9th grade) literacy levels. RESULTS: In longitudinal analyses, low literacy was associated with more depressive symptoms. The adjusted mean difference in CES-D scores between low and high literacy levels was 4 (P<.01). Literacy was not significantly associated with mental health-related quality of life or addiction severity. CONCLUSIONS: In people with alcohol and drug dependence, low literacy is associated with worse depressive symptoms. The mechanisms underlying the relationship between literacy and mental health outcomes should be explored to inform future intervention efforts.

Adult↗

PubMed2004

Allostasis and dysregulation of corticotropin-releasing factor and neuropeptide Y systems: implications for the development of alcoholism.

Alcoholism is a chronic relapsing disorder, accompanied by alterations in psychological and physiological functioning, which reaches an addictive state where an individual demonstrates uncontrollable compulsive alcohol drinking and impairment in social and occupational functioning. Withdrawal is one of the defining characteristics of dependence, characterized by impaired physiological function and enhanced negative affect, and is thought to be a major contributing factor to relapse. The negative emotional aspects of withdrawal appear to be more involved in continued alcohol craving because physical withdrawal symptoms are not highly correlated with relapse in alcoholics. Allostasis describes maintaining stability outside the homeostatic range by varying the internal milieu to match environmental demands. This concept has been applied to neurobiological models of drug addiction and is thought to contribute to the vulnerability of drug addicts to relapse, as addicts continue to use drugs in order to maintain their psychological state within a homeostatic range. With regard to alcohol, two neuropeptides appear to be involved in the regulation of alcohol-related stress, corticotropin-releasing factor (CRF), which is associated with an increased stress response and negative affect, and neuropeptide Y (NPY), a neuropeptide with anxiolytic properties. The hypothesis to be developed in the present review is that a dysregulation of the CRF and NPY systems significantly contributes to the motivational basis of continued alcohol-seeking behavior during alcohol dependence. It appears that increases in CRF contribute to the negative affective state that is strongly associated with alcohol withdrawal, and NPY provides a motivational basis to consume alcohol because the anxiolytic effects of alcohol, which are strongly associated with relapse, appear to be regulated in part by this neuropeptide.

Alcoholism↗

PubMed2006

Substance abuse and dependence in anaesthetists.

The incidence of substance abuse amongst anaesthetists in the United Kingdom is unknown. In the interests of patient safety, it is essential that the dependent doctor is identified and entered into a treatment regime. No national strategy is in place to treat and, where possible, return the anaesthetist in recovery to work. It is important therefore, that individual employers have a standing operating procedure to deal with the addicted doctor. It is essential that the initial approach is made by a competent panel, each of whom has experience of dealing with dependent doctors. This is an extremely stressful time for the doctor involved; it is therefore essential that active support is given. It is not always necessary to suspend the doctor from work whilst treatment is undertaken. In the dependent doctor sudden withdrawal of the substance of addiction can be life-threatening. It is therefore essential that the supervising physician has specialist knowledge of the treatment of addiction. Residential care probably provides the greatest hope of success. In the United States, Canada, Australia and New Zealand 'impaired physician' programmes are in place which allow some doctors to return to work, initially under strict supervision. Registration with a self-help organisation is essential; a list of such groups in the United Kingdom is appended.

Anesthesiology↗

PubMed2002

Addictive and nonaddictive smoking as related to responsivity to neurotransmitter systems.

In a double-blind crossover design on 36 male smokers, differences in hormone responses to a serotonergic (citalopram) and dopaminergic (bromocriptine) challenge were tested, to compare transmitter responsivities in addicted and pleasure-motivated smokers with respective controls. A general score of smoking addiction, according to DSM IV criteria, was associated with a blunted prolactin decrease to bromocriptine, indicating a possible nicotine-induced desensitization of DA receptors. The single questionnaire-based symptom of tolerance was associated with a blunted cortisol response to citalopram, indicating a particular desensitization of serotonin receptors. Nontolerant but addicted subjects exhibited increased serotonergic responsivity, interpreted as resulting from low serotonin levels associated with lack of impulse control. The questionnaire-based score of pleasure-motivated (='indulgent') smoking was associated with high dopaminergic activity (pronounced prolactin responses), confirming findings obtained in subjects exhibiting reward-related personality factors.

Adolescent↗

PubMed1998

Truthful self-nurturing: a grounded formal theory of women's addiction recovery.

This grounded formal theory study was designed to develop a midrange theory of women's addiction recovery from multiple substantive reports. Ten research reports from diverse contexts were analyzed using theoretical sampling and constant comparison. The basic problem of addiction was found to be self-destructive self-nurturing. The basic process of recovery was truthful self-nurturing, which required a painful awareness shift in which addiction gained meaning as a problem. Subsequent recovery involved three areas of social-psychological change: abstinence work, self-work, and connection work. Consequences were enjoying simple pleasures, growing self-understanding, self-acceptance, and sense of belonging, and empowered connectedness. The theory was supported by findings of other qualitative studies of the same phenomenon.

Adult↗

PubMed2000

Addicts' narratives of recovery from drug use: constructing a non-addict identity.

Sociological accounts of the process of recovery from dependent drug use have emphasised the importance of the individual constructing a non-addict identity for themselves. Following Giddens we identify the process of providing a narrative of their recovery as one of the mechanisms by which addicts may seek to achieve this. The narratives of recovery which are the subject of this paper were elicited in the course of semi-structured interviews with a sample of 70 recovering addicts. There were three key areas in which the addicts' narratives of recovery could be seen to be constructing a non-addict identity for the individual; firstly, in relation to the reinterpretation of aspects of their drug using lifestyle; secondly, in relation to the reconstruction of their sense of self and thirdly, in relation to the provision of convincing explanations for their recovery. In certain respects, the addicts' narratives of recovery are similar to the accounts of recovery provided by drug workers and addictions researchers. The paper argues that the correspondence between addicts' own accounts of their recovery and those of professional drug workers may be not so much the result of the intrinsic nature of the recovery process as a product of the socially constructed nature of the narratives and the fact that the latter may have been developed in conjunction with those working in the drug treatment industry.

Adult↗

PubMed2006

Trends in gambling studies research: quantifying, categorizing, and describing citations.

As opportunities to gamble have increased during the 20th century, so has gambling research. This study used new strategies, methods, and technology to examine citation trends and the growth of knowledge in the field of gambling studies. The sample included 2,246 citations that were published between 1903 and 2003. By using multiple keywords to classify each citation into distinct topic areas, this study yielded a more comprehensive analysis than was previously available. The results reveal that gambling-related research has grown at an exponential rate. The most prevalent topics explored within gambling studies citations have been pathology, risk-taking, decision-making and addiction. Between 1999 and 2003, studies addressing epidemiology, drug abuse, comorbidity and neuroscience have become increasingly prevalent. Based on these trends and their implications, this paper provides several recommendations for both future areas of inquiry within the field of gambling studies and better classification techniques for citations within all fields of psychology.

Abstracting and Indexing↗

PubMed2004

Pathological gambling: a comprehensive review of biobehavioral findings.

In this review, findings of biobehavioral research into pathological gambling (PG) are discussed, focusing on neuropsychological, psychophysiological, neuroimaging, neurochemical and genetic studies. Neuropsychological studies indicate deficiencies in certain executive functions. Psychophysiological studies indicate that arousal in PG is of importance when reward is present. Neuroimaging studies point to abnormalities in brain functioning. Recent research into the neurochemistry of PG indicates that abnormalities exist in different neurotransmitter systems. Finally, genetic studies indicate the existence of abnormal dopamine receptor genes in PG. Methodological and theoretical factors that may explain discrepancies between studies include differences in screening and assessment, heterogeneity of gambling problems and different underlying cognitive or motivational mechanisms. Results from the PG studies fit in with recent theoretical models of addiction and PG, which stress the involvement of brain reward pathways, neurotransmitter abnormalities, the frontal cortex and the psychophysiological stress system. A framework for future studies is suggested, indicating the need for studies that integrate knowledge from different research areas, and that employ stricter diagnostic screening methods and inclusion of clinical control groups.

Behavior, Addictive↗

PubMed2006

Recent trends in adolescent substance use, primary care screening, and updates in treatment options.

PURPOSE OF REVIEW: To provide a brief overview on trends in common substances of abuse in adolescents, a summary of tools to evaluate adolescent substance abuse in an outpatient setting, and an update of outpatient and inpatient treatment options. RECENT FINDINGS: Recent national data suggest an overall slight decline in the use of tobacco, crystal methamphetamine, heroin, and club drugs. No significant change was noted in the use of alcohol, marijuana, and cocaine. Yearly screening of all adolescents for substance use is recommended. This can be accomplished in an office setting using mnemonics, structured interview techniques, and brief screens for substance abuse. If a problem is identified, various outpatient and inpatient treatments are available. Individual, family, and group therapy methods are available. Other options include acute detoxification programs, partial hospitalization, acute residential treatment, residential treatment centers and wilderness programs. Pharmacological treatments are available for nicotine, alcohol, and opioid addiction. SUMMARY: Tobacco, alcohol, marijuana, and other drugs remain a significant problem among adolescents in the United States. Pediatricians should screen and assess all adolescents on a yearly basis. If a problem is identified, there are many options for treatment, including pharmacologic treatment as well as individual, family, or group therapy in an inpatient or outpatient setting.

Adolescent↗

PubMed2005

Activation of orbital and medial prefrontal cortex by methylphenidate in cocaine-addicted subjects but not in controls: relevance to addiction.

Drugs of abuse are rewarding to addicted and nonaddicted subjects, but they trigger craving and compulsive intake only in addicted subjects. Here, we used positron emission tomography (PET) and [18F] deoxyglucose to compare the brain metabolic responses (marker of brain function) of cocaine-addicted subjects (n = 21) and controls (n = 15) to identify brain regions that are uniquely activated in addicted subjects by intravenous methylphenidate (a drug that cocaine-addicted subjects report to be similar to cocaine). In parallel, we also measured the changes in dopamine (DA) induced by intravenous methylphenidate (using PET and [11C] raclopride) in the striatum and in the thalamus. Metabolic responses between groups differed significantly only in the right medial orbital prefrontal cortex [Brodmann's area (BA) 25 and medial BA 11], where methylphenidate increased metabolism in addicted subjects but decreased metabolism in controls. These changes were associated in all subjects with increased "desire for methylphenidate" and in the addicted subjects with "cocaine craving." In addicted subjects, increases in BA 25 were also associated with mood elevation. Methylphenidate-induced increases in metabolism in the medial orbital prefrontal cortex were associated with its increase of DA in the thalamus but not in the striatum. These findings provide evidence that enhanced sensitivity of BA 25 (region involved with emotional reactivity) and BA 11 (region involved with salience attribution and motivation) in cocaine-addicted subjects may underlie the strong emotional response to the drug and the intense desire to procure it that results in craving and compulsive drug intake. It also suggests that the mesothalamic DA pathway may contribute to these processes.

Adult↗

PubMed2004

Neurobiological mechanisms in the transition from drug use to drug dependence.

Drug addiction is a chronic relapsing disorder characterized by compulsive drug intake, loss of control over intake, and impairment in social and occupational function. Animal models have been developed for various stages of the addiction cycle with a focus in our work on the motivational effects of drug dependence. A conceptual framework focused on allostatic changes in reward function that lead to excessive drug intake provides a heuristic framework with which to identify the neurobiologic mechanisms involved in the development of drug addiction. Neuropharmacologic studies in animal models have provided evidence for the dysregulation of specific neurochemical mechanisms in specific brain reward and stress circuits that provide the negative motivational state that drives addiction. The allostatic model integrates molecular, cellular and circuitry neuroadaptations in brain motivational systems produced by chronic drug ingestion with genetic vulnerability, and provides a new opportunity to translate advances in animal studies to the human condition.

Adaptation, Physiological↗