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PubMedDate not supplied

Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism.

Eight double-blind placebo-controlled clinical trials in five countries have demonstrated the safety and efficacy of naltrexone as an adjunct in alcoholism treatment. The efficacy depends, however, on how naltrexone is used. Three of the trials tested naltrexone in two ways: (1) with supportive therapy, i.e. support of complete abstinence; (2) with therapy tacitly accepting that relapses may occur and teaching how to cope with them. Although all found benefits from naltrexone with the coping therapy, none of them found any significant benefit of naltrexone over placebo when combined with support for abstinence. These results are consistent with our pre-clinical studies in which naltrexone, naloxone, and nalmefene were effective when paired with drinking but ineffective when given during abstinence. This supported the hypothesis that the primary mechanism involved is extinction (as had been concluded earlier for the effects of naltrexone in opiate addiction treatment), because extinction only weakens responses that are made while reinforcement is blocked. On this basis, it was proposed that: (1) naltrexone should be administered to patients who were still currently drinking; (2) the instructions should be to take naltrexone only when drinking was anticipated; (3) this treatment should continue indefinitely. Subsequently, clinical trials have found that naltrexone used in this manner is safe and effective.

Alcoholism↗

PubMed1999

HIV testing in substance abusers.

HIV testing among substance abusers in the United States is a significant public and individual health issue in need of further examination. We analyzed interview data gathered over 15 months in 1992 and 1993 from 2315 patients on presentation for addiction treatment to determine the frequency of and factors associated with previous HIV testing. Among this group of alcohol, heroin, and cocaine abusers, 53% (1231) reported previous HIV testing. Although in bivariate and multivariable analyses those with identifiable risk factors for HIV were more likely to have been tested, 27% of injection drug users, 38% with multiple sexual partners, and 39% of those with a history of a sexually transmitted disease (STD) had not been HIV tested. Other factors associated with previous HIV testing included having a primary care physician, the primary care physician's awareness of the patient's substance abuse problem, and having received prior addiction care. However, 38% of substance abusers who had previously received addiction treatment beyond detoxification had not been tested. Of those tested, 10% (n = 122) reported a positive test, and 7% (n = 81) had not received the test results. Of those with positive test results, 37% were not injection drug users. Promotion of HIV testing among alcohol and other drug abusers in both medical and substance abuse treatment settings should be a priority.

Adult↗

PubMed2001

Predictors of cigarette smoking by young adults and readiness to change.

A survey on cigarette smoking of a sample of 406 students aged 16/17 years from a Swiss city was carried out in 1995, and the sample was reinvestigated in 1998. Measures were taken of gender, age, school attendance (vocational or other), negative feelings, perception of danger. parental smoking, and reasons for smoking or not smoking at Time 1. Time-2 measures included stages-of-change in smoking cessation and nicotine addiction. Negative feelings at ages 16/17 were predictive of nicotine addiction at ages 19/20, and highly predictive for starting smoking within this period. Frequent smoking and relaxation as a reason for smoking was more likely for sustained smokers than for quitters. The results suggest that if adolescents begin to smoke in order to cope with negative feelings they continue to do so and increase their smoking. Cessation can probably be promoted by advice to reduce the frequency of smoking.

Adolescent↗

PubMed2002

What do citation counts count for in the field of addiction? An empirical evaluation of citation counts and their link with peer ratings of quality.

AIMS: This study investigated the value of citation counts as an index of quality in the field of addiction and examined factors that contribute to papers being cited more or less frequently. DESIGN: The number of times papers published by the journal Addiction in 1995-98 that had been cited up to May 2000 were counted using the Science and the Social Science Citation Indexes. Articles in nine of the monthly issues from 1997 were rated by two independent expert raters for quality. Factors related to citation counts were also examined including: country of origin of the paper, substance type, solicited versus unsolicited papers and methodology used. FINDINGS: A total of 417 unsolicited research reports were included in the citation analysis, of which 79 were also subjected to quality ratings. The experts showed a moderate level of agreement in their ratings (intraclass correlation = 0.39. p < 0.001). However, there was no correlation between number of citations and expert ratings of article quality (R < 0.1). Papers from developing countries received significantly fewer citations than papers from other countries but substance type (e.g. nicotine, opiate, alcohol) and methodology (e.g. survey, treatment trial) were not related to number of citations. CONCLUSIONS: This study involved just one journal but raised an important issue: the number of citations received by papers on addiction appears to reflect the geographical region of study rather than what experts would consider as 'quality'. If these findings are found to generalize they call into question the use of citation-related indices as measures of quality in this field and perhaps in others as well. To our knowledge our methodology has not been used before and could be adapted to study the value of citations more widely.

Behavior, Addictive↗

PubMed2004

Accuracy and optimism in smokers' beliefs about quitting.

Data collected in two nationwide surveys (N=361 and N=788) provide insight into the extent to which smokers recognize the ease of addiction and the difficulty of quitting. Smokers generally acknowledge that addiction occurs quickly and that smokers have considerable difficulty quitting. Youth smokers, however, generally believe that they would have less difficulty than other smokers and that they are less addicted than the average smoker. Adult smokers tend to say they are not different from other smokers in addiction or ability to quit. Nevertheless, both youth and adult smokers who want to quit greatly overestimate the likelihood that they will succeed in the coming year. Few smokers think about how long they will smoke when they first begin, and the reluctance to believe that they could have serious difficulty quitting may help in the progression from experimental to established smoker.

Adolescent↗

PubMed1998

Reducing the addictiveness of cigarettes. Council on Scientific Affairs, American Medical Association.

OBJECTIVE: To assess the feasibility of reducing tobacco-caused disease by gradually removing nicotine from cigarettes until they would not be effective causes of nicotine addiction. DATA SOURCES: Issues posed by such an approach, and potential solutions, were identified from analysis of literature published by the US Food and Drug Administration (FDA) in its 1996 Tobacco Rule, comments of the tobacco industry and other institutions and individuals on the rule, review of the reference lists of relevant journal articles, other government publications, and presentations made at scientific conferences. DATA SYNTHESIS: The role of nicotine in causing and sustaining tobacco use was evaluated to project the impact of a nicotine reduction strategy on initiation and maintenance of, and relapse to, tobacco use. A range of potential concerns and barriers was addressed, including the technical feasibility of reducing cigarette nicotine content to non-addictive levels, the possibility that compensatory smoking would reduce potential health benefits, and whether such an approach would foster illicit ("black market") tobacco sales. Education, treatment, and research needs to enable a nicotine reduction strategy were also addressed. The Council on Scientific Affairs came to the following conclusions: (a) gradually eliminating nicotine from cigarettes is technically feasible; (b) a nicotine reduction strategy holds great promise in preventing adolescent tobacco addiction and assisting the millions of current cigarette smokers in their efforts to quit using tobacco products; (c) potential problems such as compensatory over-smoking of denicotinised cigarettes and black market sales could be minimised by providing alternate forms of nicotine delivery with less or little risk to health, as part of expanded access to treatment; and (d) such a strategy would need to be accompanied by relevant research and increased efforts to educate consumers and health professionals about tobacco and health. CONCLUSIONS: The council recommends the following: (a) that cessation of tobacco use should be the goal for all tobacco users; (b) that the American Medical Association continue to support FDA authority over tobacco products, and FDA classification of nicotine as a drug and tobacco products as drug-delivery devices; (c) that research be encouraged on cigarette modifications that may result in less addicting cigarettes; (d) that the FDA require that the addictiveness of cigarettes be reduced within 5-10 years; (e) expanded surveillance to monitor trends in the use of tobacco products and other nicotine-containing products; (f) expanded access to smoking cessation treatment, and strengthening of the treatment infrastructure; and (g) more accurate labelling of tobacco products, including a more meaningful and understandable indication of nicotine content.

Behavior, Addictive↗

PubMed2000

Addiction and its reward process through polymorphisms of the D2 dopamine receptor gene: a review.

Since 1990, association studies have amassed strong evidence implicating the D(2) dopamine receptor (DRD2) gene in alcoholism. Specifically, the TaqI A minor (A1) allele of the DRD2 gene has been associated with alcoholism. The DRD2 gene has also been found to be involved in other substance use disorders including cocaine, nicotine and opioid dependence, and obesity. Beyond association studies, pharmacologic studies have shown reduced brain D(2) dopamine receptor numbers in A1(+) allele carriers (A1A1 and A1A2 genotypes) compared to A1(-) allele carriers (A2A2 genotype). Through a number of other approaches, different phenotypes have also been identified in subjects with the A1(+) and A1(-) alleles. These include metabolic, neurophysiological, neuropsychological, personality, stress and treatment studies. It is hypothesized that in an effort to compensate for deficiencies in the dopaminergic system, substance abusers may seek to stimulate the mesocorticolimbic circuits of the brain, long thought to be important in behavioral reward and reinforcement. In effect, one form of the DRD2 gene, the A1 allele, renders the dopaminergic system inefficient and rewards substance abuse that increases brain dopamine levels.

Alcoholism↗

PubMed1989

Use of milieu as a problem-solving strategy in addiction treatment.

Addicted clients begin their recovery through detoxification and treatment in a structured inpatient unit. The focus of treatment is most appropriately on learning new, more constructive ways for solving problems. Everyday living skills can best be learned in a therapeutic milieu where interactions in the here-and-now are examined and opportunities are present for practicing problem-solving skills. A therapeutic milieu can be designed and initiated through efforts of the nursing staff and members of other disciplines. It is a group treatment approach emphasizing active participation in structured activities, decision-making by consensus involving all members of the community, and a reward and restriction system based on the appropriateness of client behaviors. Certain problem behaviors of addicted clients can be addressed through confrontation and group pressure; to be expected are problems with manipulation, avoidance, aggression, impulsiveness, and grandiose denial. Staff members who work in a therapeutic milieu approach to treatment of addicted clients share certain concerns. Strategies need to be developed for dealing with manipulative attempts at splitting the staff into opposing forces, clarifying roles, enforcing unit policies, and lessening feelings of hopelessness when clients fail to achieve sobriety. A cohesive staff who work at trusting each other in an atmosphere of open communication and equitable conflict resolution are best able to support each other while addressing common concerns. While treatment in a therapeutic milieu is an effective beginning in the process of recovery, it must be remembered that it is only a beginning in the long, slow process of rehabilitation. And during that process, there are likely to be relapses, which can be used as learning tools in the development of improved problem-solving skills.

Adult↗

PubMed2005

Psychological predictors of problem mobile phone use.

Mobile phone use is banned or illegal under certain circumstances and in some jurisdictions. Nevertheless, some people still use their mobile phones despite recognized safety concerns, legislation, and informal bans. Drawing potential predictors from the addiction literature, this study sought to predict usage and, specifically, problematic mobile phone use from extraversion, self-esteem, neuroticism, gender, and age. To measure problem use, the Mobile Phone Problem Use Scale was devised and validated as a reliable self-report instrument, against the Addiction Potential Scale and overall mobile phone usage levels. Problem use was a function of age, extraversion, and low self-esteem, but not neuroticism. As extraverts are more likely to take risks, and young drivers feature prominently in automobile accidents, this study supports community concerns about mobile phone use, and identifies groups that should be targeted in any intervention campaigns.

Accidents, Traffic↗

PubMed2001

Social context and "natural recovery": the role of social capital in the resolution of drug-associated problems.

This paper explores the social context of "natural recovery" from problems associated with the misuse of intoxicants. Using data collected from in-depth interviews with 46 former alcohol- and drug-dependent persons, this paper examines how the social capital that these respondents had accumulated prior to their addiction and maintained during it aided in their recovery without treatment. We specifically explore how the relations within their lives and the actual and virtual resources available to subjects through their social capital aided in our respondents' "natural recovery" from drug-use related problems. We conclude with a discussion of the implications an analysis of social capital has for the treatment of drug-associated problems as well as for drug policy.

Adult↗

PubMed1997

Integration of research in pharmacotherapy for addictive disease: where are we? Where are we going?

Systematic efforts by NIDA and NIAAA to develop new medications for drug and alcohol dependence have resulted in recent FDA approval of LAAM for opiate dependence, naltrexone for alcohol dependence and, more recently, a nasal spray for nicotine dependence. This article reviews the current strategies that guide these development efforts, including further examination of the interactions between potential pharmacotherapeutic agents and the drugs of abuse, the enhancement of pharmacotherapeutic efficacy with nonpharmacological interventions, and the development of more precise and meaningful measures of research outcome.

Behavior, Addictive↗

PubMed1976

Behavioural concomitants of prenatal addiction to narcotics.

Behavioral characteristics of infants of methadone-treated and nonaddicted women were studied during the neonatal period and at three, six, and 12 months of age. Several Brazelton Neonatal Behavioral Assment Scale measures differentiated between groups. Major differences occurred in irritability of the central nervous system, and these measures appeared able to predict severity of withdrawal. The increased tremulousness of addicted infants remained through at least the first month of life. Mental and motor development was within normal limits in both groups throughout the year. However, the addicted infants showed a progressive decline in psychomotor performance whereas nonaddicted infants' scores remained stable.

Child Development↗

PubMed2005

Addicted media: substances on screen.

The depiction of alcohol and drug traffic/usage in films has caused concern since the advent of motion pictures and continues to raise concern with the introduction of new media. This article provides a comprehensive review of much of the existing peer-reviewed published literature about the depiction of substances in the media by focusing on the information obtained in content analyses. This article demonstrates the widespread and overwhelming presence of substances in the media viewed by youth and highlights reviews that discuss the potential impacts of these depictions.

Adolescent↗

PubMed2006

A highly selective kappa-opioid receptor agonist with low addictive potential and dependence liability.

Buprenorphine analogs have been synthesized. In the studies of analgesic and addictive effects in mice and [(35)S]GTPgammaS binding assay in human brain tissue, an analog of buprenorphine where the tert-butyl is replaced by a cyclobutyl moiety (16) has been identified as a selective kappa-partial agonist which gives antinociceptive effects, but has low abuse potential. The results may lead to lower degrees of dysphoria than full kappa-agonists.

Animals↗

PubMed1999

[Biological hallucinogens. New patterns of substance abuse in young addicts?].

Among young patients with multiple substance abuse, a high level of abuse of natural products was noticed. In a rehabilitation clinic for young addicts 180 patients filled out a questionnaire regarding drugs they regularly consumed. It was discovered that the patients consumed high levels of Psilocybe, Amanita and Datura. The natural drugs of the 70's, Ayahuasco and Cactus, are now rarely seen. The toxicological basis of the frequently used biological drugs is discussed. The results imply that a specific exploration of patients with multiple substance abuse in regard to the use of biological drugs is necessary.

Adolescent↗

PubMed2006

c-Fos facilitates the acquisition and extinction of cocaine-induced persistent changes.

Development of drug addiction involves persistent neurobiological changes. The dopamine D1 receptor is involved in mediating cocaine-induced neuroadaptation, yet the underlying intracellular mechanisms remain unclear. We examined a potential role of the immediate early gene Fos, which is robustly and rapidly induced by cocaine via D1 receptors, in mediating cocaine-induced persistent neurobiological changes by creating and analyzing a mouse in which Fos is primarily disrupted in D1 receptor-expressing neurons in the brain. We show that the expression levels of several transcription factors, neurotransmitter receptors, and intracellular signaling molecules induced by repeated cocaine administration are altered in Fos-deficient brains. Dendritic remodeling of medium spiny neurons induced by repeated exposure to cocaine is blunted in the mutant mice. The mutant mice exhibit attenuated behavioral sensitization after repeated exposure to cocaine and more persistent memory of cocaine-induced conditioned place preference. Our findings indicate that c-Fos produced in D1 receptor-expressing neurons integrates mechanisms to facilitate both the acquisition and extinction of cocaine-induced persistent changes.

Animals↗

PubMed2006

Addiction and arousal: alternative roles of hypothalamic peptides.

The importance of the lateral hypothalamus in the regulation of reward and motivation has long been recognized. However, the neuronal network involved in such a hypothalamic regulation of reward remains essentially unknown. Recently, hypocretin-containing neurons, a group of hypothalamic neurons known to be associated with the stability of arousal, have emerged as important structures in the control of brain reward function. This review summarizes a Mini-Symposium presented at the 2006 Annual Meeting of the Society for Neuroscience.

Animals↗

PubMed2004

Addictive disorders.

In conclusion, complex medical and psychiatric comorbidity is com-mon in individuals with substance use disorders. It is important to assess comorbidity because of the implications for prevention and treatment. Studies of the neurobiology of substance use and psychiatric disorders are accumulating rapidly and informing treatment development. Information about the prevention and treatment of infectious diseases and other medical conditions associated with substance use disorders also is growing, and it is important that patients are able to benefit from this. The articles in this issue provide state-of-the-art information about several issues related to comorbidity in substance use disorders.

Behavior, Addictive↗