盐酸二氢埃托啡与丁丙诺啡联合治疗海洛因瘾

５１例海洛因成瘾，男性４６例，女性５例，年龄为２８±ｓ５ａ（１７－４０ａ）。前３ｄ根据近１ｗｋ内海洛因吸注量，用二氢埃托啡４０－１００μｇ于１０％葡萄糖液５００ｍＬ静脉滴注，４－６次／ｄ，ｄ３起加用丁丙诺啡０．３ｍｇ，ｉｍ，ｑ６ｈ共４ｄ。多数戒断症状如攻击行为、威胁、恶心、呕吐、腹泻于ｄ１即消失，７ｄ内所有戒断症状消退，未发现用药成瘾患。     

盐酸二氢埃托啡和美沙酮联合治疗海洛因瘾

年龄，病程近似的海洛因依赖者８０例，随机分为３组，Ａ组２０例，口服美沙酮７－８ｄ，总剂量１３０－１６０ｍｇ。Ｂ组２０例，静脉滴注二氢埃托啡（ＤＨＥ）３ｄ，ｄ４改舌含入，总剂量２．６－３．０ｍｇ。Ｃ组４０例，静脉滴注ＤＨＥ３ｄ，总剂量１．２－１．６ｍｇ，ｄ４口服美沙酮３－５ｄ，总剂量６０－１００ｍｇ。结果Ｃ组优于前２组，戒断症状缓解决，用药量少。     

盐酸二氢埃托啡和美沙酮联合治疗海洛因瘾

年龄、病程近似的海洛因依赖者８０例，随机分为３组。Ａ组２０例，口服美沙酮７－８ｄ，总剂量１３０－１６０ｍｇ。Ｂ组２０例，静脉滴注二氢埃托啡（ＤＨＥ）３ｄ，ｄ４改舌下含入，总剂量２．６－３．０ｍｇ。Ｃ组４０例，静脉滴注ＤＨＥ３ｄ，总剂量１．２－１．６ｍｇ，ｄ４口服美沙酮３－５ｄ，总剂量６０－１００ｍｇ。结果Ｃ组优于前２组，戒断症状缓解快，用药量少。     

比较40例二氢埃托啡成瘾者与40例海洛因成瘾者的戒断综合征

本报告４０例二氢埃托啡（ＤＨＥ）成瘾的戒断症状，并与４０例海洛因成瘾比较。９５％的ＤＨＥ成瘾自身ｉｖ给药，欣快感６±４ｓ，持续时间４５±１７ｍｉｎ，ｉｖ１０－２０次／ｄ，日用量高达２．４±１．５ｍｇ，戒断症状与海洛因（总分２９±５）轻。ＤＨＥ滥用而致成瘾，应引起有关的部门及社会的高度重视，对ＤＨＥ要加强管理。     

牛磺酸治疗小儿上呼吸道感染150例

用牛磺酸治疗小儿上呼吸道感染１５０例（男性９３例，女性５７例，年龄３．７±ｓ２．６ａ）。＜１ａ，０．５袋／次；１－３ａ，１袋／次；４－５ａ，１．５袋／次；６－８ａ，２袋／次；９－１３ａ，３袋／次，均ｔｉｄ，ｐｏ。另７５例用头孢氨苄干糖浆为对照，５０ｍｇ／（ｋｇ·ｄ），分３－４次服。２组均不加任何药物，观察３ｄ．结果：２组疗效无显著差别，但治疗组１ｄ退热，流涕、鼻塞、喷嚏症状改善明显优于对照组（Ｐ＜０．０１）。未发现不良反应。     

比较40例二氢埃托啡成瘾者与40例海洛因成瘾者的戒断综合征

本文报告４０例二氢埃托啡（ＤＨＥ）成瘾者的戒断症状，并与４０例海洛因成瘾者比较。９５％的ＤＨＥ成瘾者自身ｉｖ给药，欣快感６±４ｓ，持续时间４５±１７ｍｉｎ，ｉｖ１０－２０次／ｄ，日用量高达２．４±１．５ｍｇ，戒断症状与海洛因相同，但严重程度ＤＨＥ（总分２１±１０）比海洛因（总分２９±５）轻。ＤＨＥ滥用而致成瘾，应引起有关部门及社会的高度重视。对ＤＨＥ要加强管理。     

山莨菪碱治疗麻醉剂依赖性

阿片成瘾者２５０例（男性２２２例，女性２８例，年龄３０±ｓ５ａ）应用山莨菪碱０．５－２ｍｇ／（ｋｇ·ｄ），分２－３次加入１０％葡萄糖２５０ｍＬ或５％葡萄糖生理盐水５００ｍＬ静脉滴注；东莨菪碱０．０２－０．０３ｍｇ／ｋｇ加入１０％葡萄糖２５０ｍＬ静脉滴注１次，必要时对重患者追加１次，疗程５－７ｄ。结果戒断症状均有改善（Ｐ＜０．０１），２７例需加用羟丁酸钠。不良反应轻，可作为阿片瘾者的脱瘾药物。＊Ｐ＜０．０１。碱确能解除阿片药物戒断症状。其对阿片戒断症状缓解时间在治疗４－５ｄ后，强烈觅药渴求也随之逐渐消失。１５０例（６０％）要求进食，１７５例（７０％）仍需借助安眠药睡眠。另６５例（２６％）戒断症状阵发性发作，每次持续０．５－１ｈ，症状轻重不一，轻者流泪、全身弥漫性疼痛，重者焦躁不安、心中猫抓虫咬样难受，甚至想自残，可配合艾司唑仑３－４ｍｇ／ｄ，ｐｏ或氯硝西泮６－１０ｍｇ／ｄ，ｐｏ；也可用氯硝西泮１－２ｍｇ／次，ｉｍ，每日２－３次；针刺胃俞、脾俞、中脘、足三里、印堂、太阳、百会、内关、合谷、命门、夹脊和肾俞穴位，根据临床症状任选其中３－５个穴位进行治疗或心理治疗能快速减轻患者戒断症状。治程中２７例（１０．８％）重?     

r—福康片对海洛因依赖者脱毒的初步对照研究：——附40例临床疗…

福康片系用于戒毒的纯天然中药片剂，为了验证其疗效，对４０例海洛因依赖者使用福康片脱瘾，２０例以可乐定作对照观察，结果发现脱瘾的头３ｄ治疗，福康片与可乐定均能明显减轻戒断症状，二者比较无显著性差异（Ｐ〉０．０５），但福康片组有８７．５％的病例戒断症状于３－７ｄ内消失，提示有脱瘾效应。治疗过程中，比较安全，不良反应较轻。     

洛非西定撤药后致幻觉妄想1例

患者,女,２４ａ,未婚,无业,初中文化。因烫吸海洛因３ａ,静脉注射海洛因１ａ入院戒毒。吸毒最高量达２．０ｇ·ｄ－１,分３－５次使用,间隙５ｈ。戒断症状主要为：流涕、出汗、发热、腹泻等。入院查体：血压为１０５／７５ｍｍＨｇ除双手臂见多处针扎疤痕外,余无...     

利巴韦林及聚肌胞分别治疗流行性腮腺炎和水痘

流行性腮腺炎７８例（男性３３例，女性４５例；年龄５．７±ｓ２．５ａ）的及水痘２８例（男性１２例，女性１６例；年龄６．３±２．２ａ），用利巴韦林５－７．５ｍｇ／ｋｇ，ｉｍ，ｂｉｄ，治疗３－６ｄ。结果：腮腺消肿时间４．３±１．９ｄ，水痘结痂时间为３．６±１．６。另有流行性腮腺炎３５例（男性１６，女性１９例；年龄５．２±２．３ａ），的水痘２５例（男性１１例，女性１４例；年龄５．７±２．３ａ），用聚肌胞注射液１－２ｍｇ，ｉｍ，ｑｏｄ，成治疗３－６ｄ。结果：腮腺消肿时间为６±３ｄ，水痘结痂时间为５．２±２．０ｄ。利巴韦林组显著优于聚肌胞组（Ｐ＜０．０１及０．０５）。     

Attention-deficit/hyperactivity disorder (ADHD) symptoms, craving to smoke, and tobacco withdrawal symptoms in adult smokers with ADHD

Background

Tobacco withdrawal symptoms may be confounded with attention-deficit/hyperactivity disorder (ADHD) symptoms among smokers with ADHD.

Objective

(1) To assess overlap between ADHD symptoms and tobacco/nicotine withdrawal symptoms and craving; (2) to assess the relationship between craving or withdrawal symptoms and the effect of osmotic-release oral system methylphenidate (OROS-MPH) on ADHD symptoms; (3) to assess the association of ADHD symptoms, craving, and withdrawal symptoms with abstinence.

Methods

Secondary analysis of a randomized, placebo controlled smoking cessation trial assessing the efficacy of OROS-MPH taken in addition to nicotine patch among individuals with ADHD. ADHD symptoms, withdrawal symptoms, and craving were assessed at baseline and 2, 4 and 6 weeks after a target quit day.

Results

Withdrawal symptoms and craving showed limited and modest overlap with ADHD symptoms prior to abstinence but more extensive and stronger correlation after quit day. Compared to placebo, OROS-MPH reduced ADHD symptoms; this effect was attenuated by controlling for withdrawal symptoms, but not by craving. Craving, but not ADHD symptoms and withdrawal symptoms, was associated with abstinence during the trial.

Conclusion

When treating smokers with ADHD (1) craving, rather than tobacco withdrawal symptoms or ADHD symptoms may be the more effective therapeutic smoking cessation targets; (2) careful distinction of craving, withdrawal symptoms, and ADHD symptoms when assessing withdrawal phenomena is needed.     

Alcoholics Anonymous Effectiveness: Faith Meets Science

ABSTRACT

Research on the effectiveness of Alcoholics Anonymous (AA) is controversial and subject to widely divergent interpretations. The goal of this article is to provide a focused review of the literature on AA effectiveness that will allow readers to judge the evidence effectiveness of AA for themselves. The review organizes the research on AA effectiveness according to six criterion required for establishing causation: (1) magnitude of effect; (2) dose response effect; (3) consistent effect; (4) temporally accurate effects; (5) specific effects; (6) plausibility. The evidence for criteria 1- 4 and 6 is strong: rates of abstinence are about twice as high among those who attend AA (criteria 1, magnitude); higher levels of attendance are related to higher rates of abstinence (criteria 2, dose-response); these relationships are found for different samples and follow-up periods (criteria 3, consistency); prior AA attendance is predictive of subsequent abstinence (criteria 4, temporal); and mechanisms of action predicted by theories of behavior change are present in AA (criteria 6, plausibility). However, rigorous experimental evidence establishing the specificity of an effect for AA or Twelve Step Facilitation/TSF (criteria 5) is mixed, with 2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect. Studies addressing specificity using statistical approaches have had two contradictory findings, and two that reported significant effects for AA after adjusting for potential confounders such as motivation to change.     

Evaluation of the mood and physical symptoms scale (MPSS) to assess cigarette withdrawal

Rationale The mood and physical symptoms scale (MPSS) was developed in the early 1980s to assess cigarette withdrawal symptoms, and variants of it have been used for 20 years. To date, no paper has been published on the properties of the scale.Objectives To evaluate psychometric properties of MPSS and the interrelationship between the key tobacco withdrawal symptoms.Methods The core elements of the MPSS involve 5-point ratings of depressed mood, irritability, restlessness, difficulty concentrating and hunger and 6-point ratings of strength of urges to smoke and time spent with these urges. The data set chosen for analysis was well suited to the task in that it involved a relatively large sample, abstinence was defined as not a puff for 24 h biochemically verified, participants were not using any medication that would have reduced withdrawal discomfort (e.g. nicotine patch), the abstinence rate was very high resulting in minimal bias due to attrition, and ratings were provided on three occasions prior to abstinence. The study involved 111 smokers setting a target quit date of whom 106 attempted abstinence and 96 achieved it.Results The MPSS items were stable prior to abstinence and sensitive to abstinence. Post-abstinence increases in mood and physical symptoms demonstrated a high level of internal coherence. Ratings of urges to smoke correlated highly with changes in mood and other symptoms. Ratings of hunger correlated less well with the scale as a whole and may involve some distinct processes.Conclusions The MPSS meets the key requirements of a cigarette withdrawal scale. Although urge to smoke/craving was not included in the list of DSM-IV withdrawal symptoms, it should be regarded as forming part of the withdrawal syndrome.     

Studies on Acute Tolerance to Ethanol in the Abstinence Period after Long-term Barbital Treatment in the rat

Abstract Male rats were treated with sodium barbital in the drinking water for 18 weeks. The average weekly dosage was around 215 mg/kg in groups 1, 3 and 5. Groups 2, 4 and 6 were controls. Every week in the abstinence period after the barbital treatment the sensitivity to hexobarbital was tested with a threshold method after three different pretreatments. These pretreatments consisted of saline (groups 1 and 2) and ethanol (2.0 g/kg intraperitoneally) given either 0.25 hr (groups 3 and 4) or 2.5-3 hrs (group 5 and 6) prior to the hexobarbital test. Tolerance seen as a difference in the sensitivity to hexobarbital between groups 1 and 2 (saline pretreatment) were found on day 1, 8, 22 and 36 in the abstinence period. In groups 3 and 4 (tested 0.25 hr after ethanol) a tolerance was found on day 1 and 15. In groups 5 and 6 (tested 2.5-3 hrs after ethanol) a tolerance was only found on day 1. An acute tolerance to ethanol in the controls (seen as a difference between groups 4 and 6) was always recorded. Since tolerance in group 1 was not always accompanied by a tolerance in group 3, an acute tolerance to ethanol is unlikely as an unitary explanation to the tolerance induced by the barbital treatment, which instead seem to be part of much more complex changes. The acute tolerance to ethanol was influenced by the weekly administrations of ethanol used in the tests of the controls (groups 4 and 6) which means that acute tolerance could be one participant in these more complex changes.     

Course of Psychiatric Symptoms and Abstinence among Methamphetamine-Dependent Persons in Sober Living Recovery Homes

Background: Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). Methods: Residents entering SLHs (N = 243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past-year drug and alcohol dependence, and abstinence over six-month time periods. Results: Overall, severity of psychiatric symptoms on the BSI was similar among MA-dependent and other dependent residents. Global psychiatric severity, depression, and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA-dependent residents but not for those dependent on other substances. Conclusion: The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA-dependent residents but not those dependent on other substances.     

Randomised controlled trial of ondansetron in smoking cessation

A double-blind, placebo controlled trial was undertaken to examine the effect of the 5-HT₃ antagonist, ondansetron .25 mg bd on cigarette withdrawal symptoms and on proportion of individuals maintaining continuous abstinence for 4 weeks in a smoking treatment programme. A total of 111 smokers were allocated to active or placebo conditions and began taking their study medication 2 weeks before the quit date. They attended the smokers clinic for weekly group treatment sessions. The results showed no evidence for less severe withdrawal symptoms or improved abstinence rates in the active medication group. They suggest that inhibiting 5-HT₃ activity is not an effective method of controlling nicotine withdrawal or helping smokers to stop.     

Buprenorphine: bell-shaped dose-response curve for its antagonist effects

1. Doses of buprenorphine (0.01, 0.1, 0.5, 1, 5, 10 and 50 mg/kg) were administered to determine buprenorphine's ability to precipitate abstinence symptoms in morphine-dependent mice. 2. When buprenorphine was administered in the fourth day of morphine addiction, the results demonstrate that the administration of the partial agonist opioid produce a bell-shaped dose-response curve. 3. The highest dose (50 mg/kg) was partially inactive while lower doses causing similar percentage than group treated with naloxone with respect to the appearance of the most of the symptoms of abstinence studied (diarrhoea, tremor, shaking-"wet dog shakes"-, jumping and weight loss). 4. Our findings demonstrate the bell-shaped response curve of the antagonist effects of buprenorphine.