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PubMed2003

Determining service variations between and within ASAM levels of care.

The American Society of Addiction Medicine (ASAM) Criteria Validity Study at Massachusetts General Hospital and Harvard Medical School randomized patients between programs in two levels of care. It therefore became critical to determine the extent to which programs met ASAM level of care (LOC) descriptions. Quantitative surveys (checklist) and qualitative case studies (field observation, key informant interviews) documented care variation within and between two ASAM LOCs in 12 substance abuse treatment units. These LOCs were: Level II (Intensive Outpatient Treatment) and Level III (Medically Monitored Residential Treatment). The Level II and Level III programs, as a group, met ASAM LOC criteria, but data showed major within-level variation by hours per day and number and type of skilled treatment services. Observational data suggest considerable within-level variation due to managed care and staff training. In multi-site PPC validity studies, it will be crucial to examine within-LOC variation and take into account payment sources and staff training when assessing patient outcomes.

Ambulatory Care↗

PubMed2006

Nicotine and cannabinoids: parallels, contrasts and interactions.

After a brief outline of the nicotinic and cannabinoid systems, we review the interactions between the pharmacological effects of nicotine and cannabis, two of the most widely used drugs of dependence. These drugs are increasingly taken in combination, particularly among the adolescents and young adults. The review focuses on addiction-related processes, gateway and reverse gateway theories of addiction and therapeutic implications. It then reviews studies on the important period of adolescence, an area that is in urgent need of further investigation and in which the importance of sex differences is emerging. Three other areas of research, which might be particularly relevant to the onset and/or maintenance of dependence, are then reviewed. Firstly, the effects of the two drugs on anxiety-related behaviours are discussed and then their effects on food intake and cognition, two areas in which they have contrasting effects. Certain animal studies suggest that reinforcing effects are likely to be enhanced by joint consumption of nicotine and cannabis, as also may be anxiolytic effects. If this was the case in humans, the latter might be viewed as an advantage particularly by adolescent girls, although the increased weight gain associated with cannabis would be a disadvantage. The two drugs also have opposite effects on cognition and the possibility of long-lasting cognitive impairments resulting from adolescent consumption of cannabis is of particular concern.

Animals↗

PubMed2006

Pre/early adolescent onset of gambling and psychosocial problems in treatment-seeking pathological gamblers.

This study examined the association between pre- or early-adolescent onset of gambling and severity of gambling and psychosocial problems in treatment-seeking adult pathological gamblers. A total of 236 pathological gamblers entering outpatient treatment completed the South Oaks Gambling Screen (SOGS) and the Addiction Severity Index (ASI). Using a quartile split procedure, gamblers who began gambling during their pre- or early-adolescent years (mean age of 10.5 years; 1st quartile) were compared to gamblers who began gambling later in life (mean age of 23.0 years; 2nd to 4th quartiles). Compared to later onset gamblers, pre/early adolescent onset gamblers reported increased severity of psychiatric, family/social, and substance abuse problems on the ASI. They were more likely to report cognitive problems (trouble understanding, concentrating, or remembering), suicidal ideation, and a history of inpatient psychiatric treatment, and were less likely to be satisfied with their current living situation. Pre/early adolescent onset gamblers also reported earlier age of initiation of drinking, and were more likely to have received treatment for an alcohol use disorder, and to have used cannabis and cocaine in their lifetimes. Taken together, these data suggest that pre/early adolescent-onset of gambling may be a risk factor for later-life psychiatric, family/social, and substance abuse problems in treatment-seeking pathological gamblers.

Adolescent↗

PubMed2002

CGP 44532, a GABAB receptor agonist, is hedonically neutral and reduces cocaine-induced enhancement of reward.

Drugs that alter the function of gamma-aminobutyric acid (GABA) neurotransmission seem to reduce cocaine reinforcement, and as such may be useful in pharmacologically treating cocaine addiction. In the present experiment, the anti-cocaine effects of CGP 44532, a phosphinic acid analogue of GABA, and a highly selective GABA(B) receptor agonist were examined in male Sprague-Dawley rats using brain stimulation reward (BSR) paradigm. In this method, the relationship between the rate of bar pressing and the frequency of stimulation pulses was analyzed in two measures: the maximum rate of responding (MAX) and the frequency necessary to sustain half maximal rate of responding known as the locus of rise (LOR). CGP 44532 was found to be hedonically neutral without producing any measurable effects on performance (MAX). It also dose-dependently reduced cocaine-induced BSR enhancement, in the order of 15-31%, as shown by progressive shifts in LOR towards baseline. Thus, in theory, administration of CGP 44532 might reduce cocaine's hedonic effects, while also maintaining patient compliance. Whether this agent would also be effective at curbing craving, a long-term consequence of drug abuse, remains to be determined.

Animals↗

PubMed2006

Demographic, habitual, and socioeconomic determinants of Internet addiction disorder: an empirical study of Korean teenagers.

The objective of this study was to analyze the demographic, socioeconomic, and habitual causes of juvenile Internet addiction. All do not agree that Internet addiction disorder (IAD) is a new type of addiction, but they agree that the IAD phenomenon has widely spread over recent years. This is also true in Korea. For this study, six schools in Korea were selected to collect data: two from Seoul, two from suburban areas, and two from rural areas. Two hundred and forty copies were collected out of some 700 copies distributed. Multiple regression models were employed to explore significant predictors of IAD. This study showed that at least two out of 100 teenagers in Korea are seriously suffering from IAD and that approximately one out of two is exposed to a kind of IAD. The causes of IAD are not only associated with habitual backgrounds for use of the Internet, but also demographic and socioeconomic backgrounds. Therefore, it can be said that the development of IAD is an interactive process between juveniles' habits of using Internet, and their demographic and socioeconomic backgrounds. As IAD progresses, a single type of intervention such as parent interventions or school interventions does not work effectively. Multimodal interventions are required to provide counseling services for individuals suffering from IAD.

Adolescent↗

PubMed2006

Dopamine D4 receptor polymorphism modulates cue-elicited heroin craving in Chinese.

RATIONALE: Subjective craving, which contributes to the continuation of drug use in active abuser and the occurrence of relapse in detoxified abusers, is considered to be a central phenomenon in addiction. Dopamine pathway has been implicated in the mechanism underlying the cue-elicited craving for a variety of addictive substances. OBJECTIVES: The objective of this study was to test the hypothesis that heroin addicts carrying D4 dopamine receptor gene (DRD4) variable number tandem repeat (VNTR) long type allele would have higher craving after exposure to a heroin-related cue. MATERIALS AND METHODS: Craving was induced by a series of exposure to neutral and heroin-related cue and were assessed in a cohort of Chinese heroin abusers (n=420) recruited from the Voluntary Drug Dependence Treatment Center at Shanghai. RESULTS: Significantly stronger cue-elicited heroin craving was found in individuals carrying DRD4 VNTR long type allele than the non-carriers (F=31.040, p<0.001). As for baseline craving and mean change in craving responding to neutral stimuli, no significance was found (1.06+/-0.34 vs 1.07+/-0.36, F=0.067, p=0.797 and 0.42+/-0.34 vs 0.45+/-0.37, F=0.277, p=0.599, respectively). CONCLUSIONS: The results of our study suggest that DRD4 VNTR polymorphism contributes to cue-elicited craving in heroin dependence, indicating DRD4 VNTR represents one of potential genetic risk factors for cue-induced craving.

Adolescent↗

PubMed2005

Exposure to nicotine is probably a major cause of inflammatory diseases among non-smokers.

This article assesses the hypothesis that most inflammatory diseases are conditioned responses caused by the psychoactive action of nicotine. Even in very 'light' passive smokers, the repeated nicotinic stimulation of the reward system can produce, through classical and subsequent operant conditioning, unconscious addiction to most relevant perceptions occurring simultaneously, including the artificial, non-localised sensation of pain or sickness caused by the action of nicotine on the nociceptive 'cholinergic anti-inflammatory pathway'. During nicotine abstinence and especially under stress, the brain previously addicted to this pain is compelled to reproduce it by the only method available without nicotine: causing lesions or cellular stress in one's organism, for example, by triggering intense inflammations. The author's observations and two independent studies have confirmed that nicotine withdrawal causes inflammatory crises. Furthermore, there is evidence that severe inflammations can be triggered even by almost unnoticeable exposures to nicotine, for example, by staying several minutes outdoors at a few metres from smokers. This has been clearly observed by one patient and can be deduced from theoretical considerations (sensitivity of neural pathways and cumulativeness of conditioning processes) and an animal experimental reference, and is confirmed by the fact that most inflammatory diseases affect similarly all non-smokers regardless of their apparent exposure to nicotine, despite the proven relation between nicotine withdrawal and inflammation. This sensitivity implies that the outdoors atmosphere of most densely populated urban areas represents now a serious health hazard, probably requiring the prohibition of all smokable forms of nicotine. The usual anti-smoking measures focused on closed spaces are inefficient against this danger.

Acetylcholine↗

PubMed2005

Addiction and pain medicine.

The adequate cotreatment of chronic pain and addiction disorders is a complex and challenging problem for health care professionals. There is great potential for cannabinoids in the treatment of pain; however, the increasing prevalence of recreational cannabis use has led to a considerable increase in the number of people seeking treatment for cannabis use disorders. Evidence that cannabis abuse liability is higher than previously thought suggests that individuals with a history of substance abuse may be at an increased risk after taking cannabinoids, even for medicinal purposes. Smoked cannabis is significantly more reinforcing than other cannabinoid administration methods. In addition, it is clear that the smoked route of cannabis delivery is associated with a number of adverse health consequences. Thus, there is a need for pharmaceutical-grade products of known purity and concentration using delivery systems optimized for safety. Another factor that needs to be considered when assessing the practicality of prescribing medicinal cannabinoids is the difficulty in differentiating illicit from prescribed cannabinoids in urine drug testing. Overall, a thorough assessment of the risk/benefit profile of cannabinoids as they relate to a patient's substance abuse history is suggested.

Analgesics↗

PubMed2003

Effects of naltrexone and isradipine, alone or in combination, on cocaine responses in humans.

Preclinical studies suggested that combination of naltrexone and isradipine may be useful for the treatment of cocaine addiction. This study examined whether naltrexone and isradipine, alone or in combination, would attenuate the subjective and physiological effects of cocaine in humans. Seven cocaine users participated in a randomized, double-blind, placebo-controlled inpatient study. Before each of the seven experimental sessions, subjects were treated orally with naltrexone (50 mg or placebo), isradipine (10 mg or placebo), or naltrexone plus isradipine. Subjects then received a single dose of intranasal cocaine (4 mg or 100 mg/70 kg). Isradipine alone attenuated the systolic blood pressure response to cocaine. In contrast, isradipine plus naltrexone treatment attenuated both the systolic and diastolic blood pressure responses. Naltrexone alone did not affect the blood pressure response to cocaine. For subjective response to cocaine, isradipine, alone or in combination with naltrexone, did not have significant effects. Naltrexone treatment alone attenuated the rating of "good effects" from cocaine without affecting other subjective responses. These results suggest that isradipine alone or in combination with naltrexone attenuates some of the physiological effects of cocaine.

Adult↗

PubMed2004

What can dependence theories tell us about assessing the emergence of tobacco dependence?

Little is known about the processes that underlie changes in smoking that occur between the first use of a cigarette, subsequent regular use and eventual addictive use. At present, assessments of those critical processes are poorly developed and not strongly informed by contemporary models of drug dependence. The preceding three papers in this special issue address explicitly how modern drug-dependence theories describe the emergence of drug dependence and the implications of those theories for assessment. The papers covered three domains of theories: negative reinforcement, positive reinforcement, and cognitive and social learning. In this paper, we summarize these reviews and extract general themes and issues that emerge across all the articles. These include: (1) the importance of learning processes; (2) limitations of self-report measures; (3) the view of dependence as a process and not a state; (4) the conception of dependence on a continuum in contrast to the conventional perspective of tobacco dependence as a natural category; (5) the ontological status of the dependence concept; (6) limitations of backward extrapolations from adult assessments; (7) the possibility of multiple dimensions or forms of dependence; and (8) the value of a transdisciplinary approach when studying the emergence of tobacco dependence.

Behavior, Addictive↗

PubMed2006

Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls.

AIMS: Neurocognitive functions in pathological gambling have relevance for the aetiology and treatment of this disorder, yet are poorly understood. This study therefore investigated neurocognitive impairments of executive functions in a group of carefully screened Diagnostic and Statistical Manual version IV (DSM-IV-TR) pathological gamblers. Performance was compared to a group of normal control participants. To study the specificity of these neurocognitive deficits, a substance dependence group (alcohol dependence) and an impulse control disorder group (Tourette syndrome) were included. DESIGN: Cross-sectional study. SETTING: Addiction and general mental health treatment centres. PARTICIPANTS: Forty-nine pathological gamblers, 48 abstinent alcohol-dependent patients, 46 participants with Tourette syndrome and 49 normal control participants. MEASUREMENTS: A comprehensive neuropsychological battery measuring executive functions as well as basic cognitive functions. FINDINGS: Both the pathological gambling and the alcohol dependent groups were characterized by diminished performance on inhibition, time estimation, cognitive flexibility and planning tasks. The Tourette syndrome group showed deficits only on inhibition tasks. Basic cognitive functions were intact in all clinical groups. Comorbid attention deficit hyperactivity disorder, antisocial personality disorder and nicotine dependence influenced the impaired functions of the clinical groups only minimally. CONCLUSIONS: Carefully screened groups of pathological gamblers and alcohol dependents were characterized by diminished executive functioning, suggesting a dysfunction of frontal lobe circuitry in these disorders. The resemblance between the pathological gambling group and the alcohol dependence group suggests a common neurocognitive aetiology for these disorders. Psychosocial treatment of these disorders could benefit from assessing and targeting deficits in executive functions, as they probably influence the course of these disorders negatively.

Adult↗

PubMed2006

18-Methoxycoronaridine acts in the medial habenula and/or interpeduncular nucleus to decrease morphine self-administration in rats.

The novel iboga alkaloid congener 18-methoxycoronaridine (18-MC) is a putative anti-addictive agent that has been shown, in rats, to decrease the self-administration of morphine and other drugs of abuse. Previous work has established that 18-MC is a potent antagonist at alpha3beta4 nicotinic receptors. Because alpha3beta4 nicotinic receptors in the brain are preferentially located in the medial habenula and the interpeduncular nucleus, the present study was conducted to determine if 18-MC could act in these brain areas to modulate morphine self-administration in rats. Local administration of 18-MC into either the medial habenula or the interpeduncular area decreased morphine self-administration while having no effect on responding for a non-drug reinforcer (sucrose). Similar results were produced by local administration into the same brain areas of two other alpha3beta4 nicotinic antagonists, mecamylamine and alpha-conotoxin AuIB. Local administration of 18-MC into the ventral tegmental area had no effect on morphine self-administration. These and other data are consistent with the hypothesis that 18-MC decreases morphine self-administration by blocking alpha3beta4 nicotinic receptors in the habenulo-interpeduncular pathway.

Animals↗

PubMedDate not supplied

Improving general medical care for persons with mental and addictive disorders: systematic review.

OBJECTIVE: To conduct a systematic review of studies of interventions designed to improve general medical care in persons with mental and addictive disorders. METHODS: Following Cochrane Collaboration guidelines, a comprehensive search through October 2005 was conducted in multiple bibliometric indexes using search terms related to primary medical care and mental health/addictive disorders. Two assessors independently extracted information on linkage, quality, outcomes and costs of care. RESULTS: Six randomized trials met the preestablished search criteria. The interventions spanned a continuum of approaches for improving treatment, ranging from on-site medical consultation, through team-based approaches, to models involving facilitated referrals to primary care. The studies demonstrated a substantial positive impact on linkage to and quality of medical care; there was evidence of health improvement and improved abstinence rates in patients with greater medical comorbidity. The three studies that assessed expenditures found the programs to be cost-neutral from a health-plan perspective. CONCLUSION: A small but growing body of research suggests that a range of models may hold potential for improving these patients' health and health care, at a relatively modest cost. Future work should continue to develop and test approaches to this problem that can be tailored to local system needs and capacities.

Behavior, Addictive↗

PubMed2000

Neural responses associated with cue evoked emotional states and heroin in opiate addicts.

Ten male opiate addicts, who were current heroin injectors, underwent positron emission tomographic (PET) scanning during exposure to a sequence of six alternating drug related and neutral video cues, on two occasions. After the second scan, each subject received heroin or placebo using a randomised single-blind procedure. This design allowed the investigation of patterns of brain activity during a range of self-reported cue evoked emotional states, both in the presence and absence of heroin. Self-reports of 'urge to use' correlated strongly with increased regional blood flow (rCBF) in the inferior frontal and orbitofrontal cortex target regions of the mesolimbic dopaminergic system, implicated in conditioning and reward. 'Urge to use' was also associated with highly significant increased rCBF in the right pre-cuneus, an area associated with episodic memory retrieval, and in the left insula, implicated in the processing of the emotional components of stimuli. Self-reports of feeling 'high' correlated with rCBF activation in the hippocampus, an area relevant to the acquisition of stimulus-associated reinforcement.

Adult↗

PubMed2003

Validity of a gambling scale for the addiction severity index.

This study assessed the validity of an adaptation of the Addiction Severity Index (ASI) for evaluating severity of gambling problems. Participants (N = 597) from four different populations (pathological gamblers enrolled in a treatment study, pathological gamblers initiating outpatient treatment at a community-based program, frequent gamblers recruited from advertisement, and substance abusers) completed the ASI, along with a supplemental gambling subscale (ASI-G). Internal consistency of the ASI-G was good (alpha =.90), and a principal components analysis indicated a single factor explained 73% of the variance in responses. ASI-G scores demonstrated excellent convergent validity with other measures of gambling and convergent validity with external sources, including collateral informant and clinician-rated reports. ASI-G scores discriminated among the samples tested. Temporal stability of ASI-G scores was high during a 1-month period for patients with substance abuse disorder who were not seeking gambling treatment. For treatment-seeking gamblers, the number of treatment sessions attended was significantly associated with reductions in ASI-G scores. Together, these data suggest that the ASI-G subscale may be a useful tool for assessing severity of gambling problems in a variety of populations.

Adult↗

PubMed1997

Automaticity of cognitive biases in addictive behaviours: further evidence with gamblers.

OBJECTIVES: The hypotheses that automatic, non-volitional, attentional and memory biases for addiction-related constructs exist is tested with compulsive gamblers. DESIGN: An independent groups design was employed. Processing of gambling, compared to neutral and drug-related information was examined in 15 gamblers recruited from new members of Gamblers Anonymous. Comparisons were made with the performance of their spouses (N = 15) to help distinguish addiction mechanisms from more non-specific emotional experiences with gambling, and an independent control group (N = 15), recruited from the staff and students of a university department. METHODS: A modified Stroop procedure was first employed. Automative cognitive interference was assessed relatively, by comparing colour-naming times on the gambling, drug and neutral Stroops. A subsequent word-stem completion task of implicit memory was then used to assess selective and automatic priming of the gambling constructs in memory. RESULTS: Only the gamblers showed selective and automatic interference for gambling-related constructs on the Stroop task. Spouses behaved like the control group on this task. An implicit memory bias for gambling-related words was statistically detected only in the gamblers compared to the control group, although the trend was similar in the comparison with spouses. Further evidence for the specificity of these effects was obtained in subgroup comparisons involving fruit-machine with racing gamblers. CONCLUSIONS: Results are generally consistent with an automaticity in the cognitive biases gamblers show for gambling-related information. Implications for cognitive understanding and treatments are highlighted.

Adult↗

PubMed2005

Human nicotine conditioning requires explicit contingency knowledge: is addictive behaviour cognitively mediated?

RATIONALE: Two seemingly contrary theories describe the learning mechanisms that mediate human addictive behaviour. According to the classical incentive theories of addiction, addictive behaviour is motivated by a Pavlovian conditioned appetitive emotional response elicited by drug-paired stimuli. Expectancy theory, on the other hand, argues that addictive behaviour is mediated by an expectancy of the drug imparted by cognitive knowledge of the Pavlovian (predictive) contingency between stimuli (S+) and the drug and of the instrumental (causal) contingency between instrumental behaviour and the drug. AIMS AND METHOD: The present paper reviewed human-nicotine-conditioning studies to assess the role of appetitive emotional conditioning and explicit contingency knowledge in mediating addictive behaviour. RESULTS: The studies reviewed here provided evidence for both the emotional conditioning and the expectancy accounts. The first source of evidence is that nicotine-paired S+ elicit an appetitive emotional conditioned response (CR), albeit only in participants who expect nicotine. Furthermore, the magnitude of this emotional state is modulated by nicotine deprivation/satiation. However, the causal status of the emotional response in driving other forms of conditioned behaviour remains undemonstrated. The second source of evidence is that other nicotine CRs, including physiological responses, self-administration, attentional bias and subjective craving, are also dependent on participants possessing explicit knowledge of the Pavlovian contingencies arranged in the experiment. In addition, several of the nicotine CRs can be brought about or modified by instructed contingency knowledge, demonstrating the causal status of this knowledge. CONCLUSIONS: Collectively, these data suggest that human nicotine conditioned effects are mediated by an explicit expectancy of the drug coupled with an appetitive emotional response that reflects the positive biological value of the drug. The implication of this conclusion is that treatments designed to modify the expected value of the drug may prove effective.

Animals↗

PubMed2006

Cotinine concentration in smokers from different countries: relationship with amount smoked and cigarette type.

This four-country study examined salivary cotinine as a marker for nicotine intake and addiction among smokers in relation to numbers and types of cigarettes smoked. Smoking characteristics of cigarette smokers in Brazil, China, Mexico, and Poland were identified using a standard questionnaire. Cotinine concentration was measured using a saliva sample from each participant; its relationship with numbers and types of cigarettes smoked was quantified by applying regression techniques. The main outcome measure was salivary cotinine level measured by gas chromatography. In all four countries, cotinine concentration increased linearly with cigarettes smoked up to 20 per day [11.3 ng/mL (95% confidence interval, 10.5-12.2)] and then stabilized as the number of cigarettes exceeded 20 [6.8 ng/mL per cigarette (95% confidence interval, 6.3-7.4) for up to 40 cigarettes]. On average, smokers of regular cigarettes consumed more cigarettes and had higher cotinine levels than light cigarette smokers. Cotinine concentration per cigarette smoked did not differ between regular and light cigarette smokers. Results suggest a saturation point for daily nicotine intake and minimal or no reduction in nicotine intake by smoking light cigarettes.

Adolescent↗