Integration of generalized vulnerability to drug and alcohol addiction

Summary

The vulnerability to develop addiction to alcohol has been well established in familial and genetic studies. Similar familial and genetic studies have supported a vulnerability to drug addiction. The co‐occurrence of alcohol and drug addiction in the same individuals is highly prevalent in clinical populations. Common putative neurochemical mechanisms underlie addiction to both alcohol and drugs, namely, in the mesolimbic pathway and the locus ceruleus in the brain. Treatment strategies are directed at both alcohol and multiple drug addictions in patient populations. The formulation of a generalized vulnerability that extends to both alcohol and drug addiction is not only possible but necessary to explain the substantial numbers of individuals who develop both alcohol and drug addictions. Future research that is pertinent and relevant may depend on the understanding of a generalized vulnerability to develop alcohol and drug addiction and its application in diagnostic strategies and treatment models.     

Effectiveness of coerced addiction treatment (alternative consequences): a review of the clinical research

Of central importance is that our clinical experience and treatment outcome studies to date strongly suggest that coercion is fundamental to addiction treatment and favorable outcomes from therapeutic interventions. Often the alcoholic/drug abuser must be given an opportunity to feel, face, or experience the "consequences" of their alcohol and drug addiction before the denial of their illness can be penetrated and motivation for treatment to recover from addictive illness can be developed. Continued use of alcohol and drugs is an unhealthy and dangerous state for those who are addicted and for others who are affected by their addictive illnesses. Effective therapeutic interventions and long-term recovery are more likely to succeed if avoiding "alternative consequences" are contingent on continued compliance with addiction treatment by those who suffer from addictive illnesses.     

Novelty Seeking and Drug Addiction in Humans and Animals: From Behavior to Molecules

Global treatment of drug addiction costs society billions of dollars annually, but current psychopharmacological therapies have not been successful at desired rates. The increasing number of individuals suffering from substance abuse has turned attention to what makes some people more vulnerable to drug addiction than others. One personality trait that stands out as a contributing factor is novelty seeking. Novelty seeking, affected by both genetic and environmental factors, is defined as the tendency to desire novel stimuli and environments. It can be measured in humans through questionnaires and in rodents using behavioral tasks. On the behavioral level, both human and rodent studies demonstrate that high novelty seeking can predict the initiation of drug use and a transition to compulsive drug use and create a propensity to relapse. These predictions are valid for several drugs of abuse, such as alcohol, nicotine, cocaine, amphetamine, and opiates. On the molecular level, both novelty seeking and addiction are modulated by the central reward system in the brain. Dopamine is the primary neurotransmitter involved in the overlapping neural substrates of both parameters. In sum, the novelty-seeking trait can be valuable for predicting individual vulnerability to drug addiction and for generating successful treatment for patients with substance abuse disorders.     

The Diagnosis of Alcohol and Cannabis Dependence (Addiction) in Cocaine Dependence (Addiction)

In two separate studies in 263 inpatients using DSM-III-R criteria for alcohol and drug dependence (addiction) we confirm the clinical experience that cocaine addicts are dependent on other drugs including alcohol. Our study finds a high prevalence of alcohol dependence and cannabis dependence in patients with cocaine dependence. As many as 89% of cocaine addicts diagnosed by DSM-III-R criteria for cocaine dependence (addiction) qualify for other alcohol and drug dependence diagnoses. Previous reports regarding alcohol and other drug use among cocaine addicts are few and inconclusive. The diagnosis of other alcohol and drug dependence in cocaine dependence has important impact on etiology, prognosis, and treatment.     

In search of a new pharmacological treatment for drug and alcohol addiction: N-methyl-D-aspartate (NMDA) antagonists

The most challenging aspect of treating alcohol and drug addiction is the relapsing course of these disorders. Although substitution therapies for nicotine and opioid dependence have proven to be relatively effective, there is a need for new pharmacotherapies designed to decrease the frequency and severity of relapse. The aim of this paper is to provide an overview of the potential utility of N-methyl-D-aspartate (NMDA) receptor antagonists as treatments for substance abuse as shown in preclinical models and preliminary clinical trials. It is hypothesized that NMDA receptors mediate the common adaptive processes that are involved the development, maintenance, and expression of drug and alcohol addiction. Modulation of glutamatergic neurotransmission with NMDA receptor antagonists offers a novel treatment approach. It is proposed that NMDA antagonists may have multiple functions in treating addictions, including an attenuation of withdrawal effects, normalization of the affective changes following initiation of abstinence which arise from neurochemical changes resulting from chronic addiction, and an attenuation of conditioned responses arising from drug-related stimuli.     

针灸治疗药物依赖者稽延期抑郁症的选穴规律研究

目的　分析针灸治疗药物依赖者稽延期抑郁症的用穴规律。方法　通过检索中英文数据库收集有关针灸治疗药物依赖者稽延期抑郁症的临床文献，建立其处方数据库，采用SPSS 22.0对其进行描述性分析和聚类分析，采用SPSS Modeler 18.0对其进行关联规则分析，探究针灸治疗药物依赖者稽延期抑郁症的腧穴运用特点及其规律。结果　对纳入的28篇文献进行分析，结果显示，针灸治疗药物依赖者稽延期抑郁症最常用的腧穴配伍存在固定搭配，经穴置信度最高的关联群为内关-三阴交-神门和足三里-三阴交-神门；通过聚类分析可得到2个聚类群。结论　通过数据挖掘技术发现针灸治疗药物依赖者稽延期抑郁症存在一定规律，内关、足三里、神门、三阴交为针灸治疗药物依赖者稽延期抑郁症的主要腧穴。     

Evaluation and Acute Management of Psychotic Symptomatology in Alcohol and Drug Addictions

The practical clinical evaluation of patients manifesting psychotic symptomatology and addictive illness is approached in diverse and contradictory ways. While addiction specialists may not recognize the existence of Axis I disorders that prevent the utilization of treatment in the system, trained mental health professionals are traditionally prone to deny or minimize the addictive process and its capacity to produce psychiatric symptoms. This may result in premature diagnosis, and in a poor response to psychiatric treatment. The purpose of this paper is to describe a pragmatic model, based on clinically observable conditions, for the evaluation and acute management of major psychiatric symptomatology associated with diagnosed drug and alcohol addiction. Before describing the model, psychotic illness and symptoms in the general population versus the drug and alcohol addicted will be examined. The model will be applied to a few discrete syndromes based on common clinical presentations.     

The diagnosis of alcohol, cocaine, and other drug dependence in an inpatient treatment population

The diagnosis of alcohol, cocaine, and other drug dependence in inpatient treatment populations is important to identify for clinical prognosis, treatment, and genetic research. The use of alcohol by cocaine addicts is a common cause for relapse to cocaine. The treatment of cocaine addiction is simplified if alcohol dependence is also present because the same methods can be used for both. In this study, 94% of those patients who qualified for the diagnosis of cocaine dependence were also diagnosed as having alcohol and other drug dependence. The demographic characteristics of these cocaine addicts (n = 413) compared to those patients with the diagnosis of alcohol dependence only (n = 677) and alcohol dependence and drug dependence other than cocaine (n = 453).     

Life stress, coping and comorbid youth: an examination of the stress-vulnerability model for substance relapse

The stress-vulnerability model of addiction relapse states that the impact of life stress on alcohol and other drug use is influenced by several types of psychosocial risk and protective factors. Coping skills have been shown to be protective against alcohol or other drug use in adolescents and adults. To date, the influence of life stress and coping on addiction relapse has not been investigated among substance use disordered youth with comorbid Axis I psychopathology. In the present study, 80 adolescents, ages 13 to 17, were followed six months after treatment for substance use and Axis I disorders. Participants completed measures of psychopathology, substance use, life stressors and coping during treatment and at three and six months following treatment. Coping ability best predicted youth substance use at six months. Negative life events moderated the relation between coping and frequency of substance use. These results suggest that coping is a protective factor for return to substance involvement post-treatment, particularly for comorbid youth who have experienced high levels of life stress.     

Drug injection cessation among HIV-infected injecting drug users

This article reports findings from a cohort study that investigated drug injection cessation over an 18-month period among HIV-infected injecting drug users followed up in a clinical setting. At 18th month visit, individuals reporting persistent injection practices were compared with individuals who reported drug injection cessation for at least 12 months. Crude and adjusted odds ratios were used to assess the impact of change in addictive and sexual behaviors, contacts with the drug network, depression, negative life events, clinical status, HIV therapy, and drug maintenance treatment (DMT) on drug injection cessation. After multiple adjustment, a general decrease of addiction practices (alcohol and cannabis) and of unsafe sexual behaviors significantly accompanied injection cessation. Individuals with higher education level, still in contact with the drug network, and not yet treated for their HIV disease were significantly more likely to persist injecting behaviors. These results underscore the importance and the need of monitoring addiction practices and unsafe sexual behaviors among HIV-positive individuals to properly address primary and secondary prevention in the era of highly active antiretroviral treatments (HAART).     

食欲素在酒精依赖及复发中的研究进展

酒精依赖是长期过度饮酒导致中枢神经系统紊乱的一种慢性、复发性脑疾病,该疾病已给全球造成了巨大的社会和经济负担.但目前为止,酒精依赖形成的机制仍不明确,且缺乏相对有效的治疗手段,戒酒后的高复发率严重影响着酒依赖患者的身心健康.近年来研究发现,由下丘脑产生的食欲素除了参与调节机体的食物摄入、睡眠-觉醒和能量平衡外,在物质成...     

General Practitioners' views of home detoxification

There is a growing movement towards community-based health care for the treatment and management of alcohol and drug problems across Australia. In spite of substantial evidence to support the clinical efficacy, cost-effectiveness, and the utility of home detoxification, it is not an activity that has been readily embraced by Australian General Practitioners (GPs). Thus, GPs' views on this issue are vital if there is to be any form of viable home detoxification programme for alcohol and/or other drugs. A qualitative study was undertaken to determine General Practitioners' views in regard to alcohol and drug home detoxification. A qualitative data collection method, focus groups, was used. Focus group participants were obtained from a maximum variation sampling technique. Twelve focus groups were conducted in rural and metropolitan Queensland Australia, over a fourmonth period. Fifty-two participants (43 general practitioners and 9 other health professionals, 20 females and 32 males). Mean age was 40.5 years (age range 19-70). Views about home detoxification were dependent on level of experience with substance abuse treatment. Overwhelmingly, GPs argued that for home detoxification to become viable, there would need to be a more responsive infrastructure, clear policy guidelines, training and more reasonable remuneration than currently exists. GPs require improved training in addiction and drug and alcohol problems. Revised remuneration schemes will facilitate better GP management of complex chronic problems such as addiction. Even though GPs' held quite negative views about alcohol and drug dependent patients there was a high level of willingness to become involved in their treatment and support. Although the clinical efficacy of home detox has been demonstrated GPs have understandably mixed views about their potential involvement. Improved training, support and resourcing is needed to substantially facilitate the expansion of GPs' role into this growing area of care.     

Comparative profiles of addicted adult populations in rehabilitation and correctional services

For many years, clinicians, especially those working in rehabilitation centers for alcohol and drug users, have been preoccupied with clients presenting with dual diagnosis: substance abuse and legal problems. Comparative analyses of three groups of addicted men, 553 offenders and 499 nonoffenders in treatment for addiction problems and 103 addicted inmates were made to ascertain the biopsychosocial profile of these persons. Results showed that dual-diagnosis clients experienced more severe biopsychosocial problems than the nonoffending group of subjects. Offenders in prison experienced more social maladjustment than offenders in drug addiction treatment, they were less preoccupied by their drug consumption, and less motivated to change. Implications for treatment are discussed.     

Applications of stable isotopes in clinical pharmacology

This review aims to present an overview of the application of stable isotope technology in clinical pharmacology. Three main categories of stable isotope technology can be distinguished in clinical pharmacology. Firstly, it is applied in the assessment of drug pharmacology to determine the pharmacokinetic profile or mode of action of a drug substance. Secondly, stable isotopes may be used for the assessment of drug products or drug delivery systems by determination of parameters such as the bioavailability or the release profile. Thirdly, patients may be assessed in relation to patient-specific drug treatment; this concept is often called personalized medicine. In this article, the application of stable isotope technology in the aforementioned three areas is reviewed, with emphasis on developments over the past 25 years. The applications are illustrated with examples from clinical studies in humans.     

Assessment of a proposed “three-criteria” cocaine addiction model for use in reinstatement studies with rats

Rationale

Relapse is a primary obstacle in the treatment of addiction disorders, and as such, understanding this phenomenon is a major effort of clinical and preclinical studies of cocaine addiction.

Objective

A recently developed protocol uses laboratory rats to model cocaine addiction by examining three criteria of addiction-like behaviors (persistent seeking in the absence of drug, high motivation for drug, and resistance to punishment during drug seeking) to detect subjects that possess an addiction phenotype. We closely followed this protocol in order to detect rats possessing this addiction phenotype, with the goal of utilizing this model in future studies investigating potential therapies for relapse in human cocaine addicts.

Results

The majority of the rats used in this study exhibited multiple characteristics thought to be associated with addiction-like behavior in rats, including robust reinstatement to multiple stimuli and high motivation to obtain cocaine. However, no rats displayed the complete addiction phenotype as previously described, due to a complete lack of addiction-like behavior in all subjects on two of the three addiction criteria (drug seeking in the absence of drug and resistance to punishment).

Conclusions

Our data highlight the independence of behavioral aspects of a rat addiction-like phenotype and suggest that some of these behavioral criteria may be altogether absent in some rat populations. Furthermore, our results suggest a closer review and analysis of some parameters used in this protocol and its global utility.     

Holding ‘new recovery’ together: Organising relations and forms of coordination in professional sociomaterial practices of addiction recovery

Questions about what addiction recovery is and the mechanisms by which people ‘recover’ have long animated alcohol and other drug research and policy. These debates became even more intense following the advent, and increasing influence in some quarters, of the ‘new recovery’. Starting from the position that recovery is ontologically multiple (Mol & Law, 2002), we trace how alcohol and other drug professionals attempted to make sense of ‘new recovery’ as a concept and set of professional practices during a period of Australian drug treatment system reform. Drawing on Annemarie Mol's (2002) account of organising relations and forms of coordination (addition, translation and distribution), we explore how the new recovery was enacted and coordinated in alcohol and other drug professionals’ sociomaterial practices, and highlight the ontological work involved in holding such an unstable object together. First, we argue that the addition of multiple enactments of addiction and recovery contributed to the formation of a singular and serviceable problem (that was simultaneously heterogeneous and complex), making the ‘disease-to-be-treated’ amenable to diverse treatment approaches, including new recovery. Second, we analyse the role of metaphor in translating authoritative logics and obligations into an enactment of new recovery suitable for application in clinical settings. Lastly, we track how incompatible enactments of recovery, both new and old, were kept apart through distribution. Although new recovery ultimately failed to gain policy traction in the Australian context, we focus on the ontological work undertaken by professionals in response to its introduction as such case studies can be useful for analysing other powerfully governing policy objects and their operations.     

Only one in three people with alcohol abuse or dependence ever seek treatment

The proportion of respondents who had a lifetime diagnosis of alcohol abuse or dependence who ever attended addiction treatment was determined using data from a Canadian population survey. Only one in three of these respondents had ever attended treatment for their alcohol concerns. Respondents' age and severity of alcohol problem (alcohol abuse versus dependence) were significantly associated with addiction treatment attendance.     

Measuring Confrontation During Recovery From Addiction

The effect of confrontation on recovery from addiction continues to be a topic of considerable debate. Although many residential treatment programs view some form of confrontation as an integral part of recovery, a number of studies have found confrontation from professional treatment staff to be counterproductive. One of the problems inherent in the current debates about confrontation is the lack of a comprehensive measure of confrontation that assesses different dimensions. This study describes the development of the “Alcohol and Drug Confrontation Subscale” (ADCS), a 72-item instrument designed to measure the quantity and frequency of confrontation that individuals receive about drug or alcohol use–related problems. Confrontation is defined as an individual being told “bad things” might happen to them if they do not make changes to address a drug or alcohol use–related problem or make changes to maintain sobriety. The instrument also measures the respondents' perceptions about their relationships with confronters (three-item alpha =. 79) and perceptions about the confrontational statements (three-item alpha =. 63). The sample included 108 individuals entering three sober living housing organizations in Northern California between 2003 and 2005. They indicated that receiving confrontational statements about alcohol or drug use–related problems was common, especially from spouses/significant others (56% of those with significant others) and family members (60%). Participants who reported receiving more confrontation reported having more positive views about their relationships with confronters and about confrontational statements than those who received less confrontation. Additional studies are necessary to establish validity, generalize results to more diverse populations, and assess confrontation at different time points during recovery.     

Attitudes, knowledge, and perceptions of Chinese doctors toward drug abuse

We assessed the attitudes, knowledge, and perceptions of Chinese doctors who worked with drug abusers to provide direction for planned drug and alcohol education and training. A 34-item questionnaire was developed; 523 copies were distributed and 446 (84.5%) validated copies were collected. Half of the respondents (50.0%) had no formal training before they started treating drug abusers. Among them, only 16.6% were psychiatrists. Less than half of the respondents agreed that drug abuse (addiction) is a brain disorder. Male and female doctors and doctors from different facilities tended to have different opinions on reasons for relapse, efficacy of treatments, and awareness of treatment modalities, among others. Doctors from involuntary facilities were more likely to disagree with the idea that drug addiction is a brain disorder and favored compulsory treatment. Doctors involved in drug abuse treatment in China are not well prepared or experienced in drug abuse treatment and have negative attitudes toward drug abuse and abusers.