Drug and alcohol services in middle-income countries

PURPOSE OF REVIEW: The present review summarizes current research in middle-income countries on drug and alcohol services for prevention, screening, treatment, care and rehabilitation between June 2006 and December 2007. RECENT FINDINGS: There is a dearth of scientific literature on prevention, treatment and rehabilitation in middle-income countries and no novel effective approaches reported during the review period. The Lancet Series on Global Mental Health showed only 0.7% of all papers reviewed were on low-income and middle-income countries. Several studies in these countries confirmed the effectiveness of brief interventions in treating alcohol use disorders at a primary care level. One study on alcohol screening in Brazil produced a promising screening tool. Other studies reported the availability of pharmacological and nonpharmacological treatments for alcohol and drug use disorders. Overall, poor accessibility to services and delayed onset of treatment persist. Political and cultural environments play a crucial role in providing services to fulfill treatment needs. SUMMARY: During the review period, reports from middle-income countries on alcohol and drug services were very limited. A few studies in some countries confirm the effectiveness of brief interventions in primary care settings. There is an obvious need for more research on alcohol and drug treatment services in middle-income countries.     

Designing new substance abuse treatment services for a competitive environment.

A multivariate analysis of the relationships between service attributes and physician perceptions was conducted as an approach to marketing substance abuse treatment services. The results of this attribute-perceptive-preference study indicate: the physician(s) on staff attribute makes the greatest contribution to perceived quality and efficiency; easy referral admission makes the largest contribution to accessibility perceptions; and providing feedback produces the greatest contribution to perceived continuity. The JCAH attributes neither adds to nor subtracts from the perceptions of any of the four perceptual attributes. Other findings indicate that perceived efficiency produces the greatest contribution to overall consumer preference. Quality perceptions make the second largest contribution to overall preference, followed by continuity and accessibility perceptions.     

Drug and alcohol abuse by bulimic women and their families

The author studied patterns of drug and alcohol abuse in 35 bulimic women, 35 healthy control subjects, and their first- and second-degree relatives. The bulimic women and their families had significantly higher rates of substance abuse disorders.     

Management of methamphetamine abuse and dependence

Preliminary implications for evidence-based treatments and future practice may be drawn from new research findings that inspire a fresh view of methamphetamine dependence and associated medical consequences. Current user populations include increasingly impacted subgroups (ie, youths, women, men who have sex with men, and rural residents); complex consequences of methamphetamine abuse among these subgroups require additional efforts involving contextual understanding of characteristics and needs to develop effective treatments. The neurobiological data on cellular activity of methamphetamine taken with findings from neuroimaging studies indicate potential targets for pharmacologic interventions. In early trials, several candidate medications—bupropion, modafinil, and, to a lesser extent, baclofen—have shown promise in treating aspects of methamphetamine dependence, including aiding memory function necessary to more effectively participate in and benefit from behavioral therapies. Clinicians and researchers must interact to efficiently address the problems of methamphetamine dependence, a major drug problem in the United States and the world.     

Huntington's disease and alcohol abuse.

The dopamine, glutamate and GABA systems are known to mediate the effects of alcohol on the movement disorders, though their exact roles are not clear. Thus, use of alcohol has implications for pathogenesis as well as management of the movement disorders. These implications are discussed citing a patient who had a strong family history of Huntington's disease and in whom movement disorder and behavioral problems were manifest under alcohol use and withdrawal, but not while being abstinent.     

Neurocognitive assessment in alcohol abuse and dependence: implications for treatment

The aim of the Neuropsychology applied to the Alcohol Dependence field is the comprehension of the effects of brain dysfunction on cognition and human behavior. It investigates neurocognitive impairments and associates them to structural and functional neuroimaging findings (CT, MRI, PET and SPECT). Acute use of alcohol impairs attention, memory, executive functions and visuospatial skills, while chronic abuse causes neurocognitive deficits in memory, learning, visuospatial functions, psychomotor speed processing, executive functions and decision-making, and may lead to persistent amnesic disorder and alcoholic dementia. Executive Dysfunction related to frontal lobe has direct implications on treatment, by the choosing of strategies and for prognostic evaluation. It is presented an easy tool to screen cognitive impairments, the Frontal Assessment Battery--FAB.15. Neuropsychological Assessment is useful for early detection of impairments and evaluation of their evolution and Cognitive Rehabilitation has a significant role on deficits recovery and psychosocial adjustment of these patients.     

A new measure of substance abuse treatment. Initial studies of the treatment services review.

This paper describes the development and initial testing of the Treatment Services Review (TSR). The TSR is a 5-minute, technician-administered interview that provides a quantitative profile of the number and types of treatment services received by patients during alcohol and drug abuse rehabilitation. Test-retest studies indicated satisfactory reliability administered either in person or over the phone. Tests of concurrent validity showed the ability to discriminate different levels of treatment services and good correspondence with independent measures of treatment provided. While additional studies are still needed with this instrument, the data collected thus far suggest that the TSR may serve two types of needs. First, at the programmatic level, the TSR may prove useful in describing and comparing programs in terms of the nature and number of services actually delivered to patients. At the individual patient level, the TSR may offer a means of evaluating the "match" between a patient's needs and the services actually provided.     

Meditation and the prevention of alcohol abuse.

The authors surveyed the frequency of alcohol use in individuals identified as practitioners of Transcendental Meditation (N equals 126) and a matched control group (N equals 90). No control subjects reported discontinuation of beer and wine use; 40 percent of subjects who had meditated for more than 2 years reported discontinuation within the first 6 months. After 25-39 months of meditation, this figure increased to 60 percent. In addition, 54 percent of this group, versus 1 percent of the control group, had stopped drinking hard liquor. The authors suggest that meditation could be an effective preventive tool in the area of alcohol abuse.     

Providing effective substance abuse treatment for young-offender populations: what works!

Previous research has documented a strong linkage between substance abuse and criminal activity among young offenders. Consequently, the provision of effective substance-abuse interventions for this population is of paramount importance to the criminal justice system. This article explores the literature on the treatment of substance abuse in offender and nonoffender populations. It reviews three major areas: pretreatment variables (eg, gender and psychopathology), in-treatment variables (eg, program targets, program setting, client-treatment matching), and posttreatment variables (eg, aftercare). The article concludes with a list of empirically derived guidelines for the effective development and implementation of substance-abuse treatment programs for adolescents.