Iowa Gambling Task scores predict future drug use in bipolar disorder outpatients with stimulant dependence

Poor decision-making is associated with poor recovery in persons with bipolar disorder and drug relapse in persons with stimulant dependence. Cognitive predictors of stimulant use in those with comorbid bipolar and stimulant dependence are surprisingly absent. Our goal was to determine if a single baseline assessment of decision-making (Iowa Gambling Task, IGT) would predict future drug use in bipolar disorder outpatients with comorbid stimulant dependence. Ninety-four men and women of multiple race/ethnic origins consented to participate in a 20-week study. Data analyses were performed on 63 comorbid bipolar outpatients completing at least four study weeks and 28 cocaine dependent volunteers without a mood disorder who participated as cocaine controls. There were no significant differences in IGT scores between comorbid patients and cocaine controls. In the comorbid group, IGT scores significantly predicted future drug use during the study. Age, sex, race, years of mental illness, or mood state did not significantly influence IGT scores. This is the first longitudinal study to show that IGT scores obtained at a single baseline assessment predicts future objective drug use in comorbid bipolar disorder outpatients with cocaine or methamphetamine dependence. Evaluating decision-making with the IGT may provide clinicians with valuable insight about the trajectory of their patients' risk for future drug use. These data suggest a need to augment existing treatment with cognitive restructuring to prevent slips and relapses in comorbid bipolar patients. The lack of a bipolar control group and a modest sample size may limit data interpretations.     

Munchausen's syndrome: a syndrome of drug dependence

The syndrome of chronic factitious illness is likely more common than has been reported in the literature, and quite probably it is both missed and denied frequently by physicians and surgeons. An attempt has been made to emphasize the drug-dependent nature of this illness with a view toward adopting a more realistic approach to treatment.     

Neurophysiology and neurochemistry of drug dependence: a review

To understand the neurophysiological and neurochemical mechanisms of drug dependence, the functional significance of dopamine, noradrenaline and endogenous opioid peptides in the mediation of natural, self-stimulation and pharmacological reinforcement are discussed. Data on search of system(s), mediator(s) and neurons of reinforcement as well as my own notions on reinforcement as a critical element in organization and regulation of the organism's adaptive activity in variable environments are presented. The role of chronic drug-induced stable modification of central neurochemical systems' functioning as a basis for the alteration of endogenous reinforcement processes and raising drug dependence are examined in detail for main addictive drugs, opiates and psychomotor stimulants.     

Gambling and Gambling Harm in New Zealand: a 28-Year Case Study

It has long been asserted that increased gambling availability leads to increased participation and harm (availability hypothesis). It has also been proposed that over time participation and harm decrease even when availability continues to rise (adaptation hypothesis). New Zealand has national gambling and problem gambling surveys dating from the mid-1980s. They include five-yearly surveys of gambling behaviour and attitudes from 1985 to 2005 and surveys of gambling and problem gambling in 1990 and 1999. The National Gambling Study (NGS) (2012–2015) was in part designed to assess changes in behaviour, attitudes and gambling-related harm since the 1999 and 2005 surveys. Selected NGS data are examined in relation to data from earlier surveys. A national lottery, instant lotteries and electronic gaming machines were introduced during the late 1980s. Since then, gambling availability continued to increase. Participation in most newly introduced gambling forms increased markedly, usually within the first year or two, and then decreased, often substantially. Following an initial rise, contrary to the availability hypothesis, overall participation declined. This was accompanied by a decline in problem gambling prevalence. These findings are consistent with adaptation. Since 2000, while participation continued to fall, problem gambling prevalence plateaued. This finding appears to be at variance with both the availability and adaptation hypotheses. It points to the importance of factors other than gambling availability in determining problem gambling and related harm. Possible reasons for the plateauing of problem gambling in the face of substantial reductions in participation are considered. They have implications for future research and policy.     

Genetics of drug dependence

Drug-dependence disorders (we focus here on cocaine, opioid, and nicotine dependence) are genetically influenced. Risk genes have been located based primarily on genetic linkage studies, and identified primarily based on genetic association studies. In this article we review salient results from linkage, association, and genome-wide association study methodologies, and discuss future prospects for risk allele identification based on these, and on newer, methodologies. Although considerable progress has been made, it is likely that the application of more extensive sequencing than has previously been practical will be required to identify a fuller range of risk variants.     

Aboriginal Gambling and Problem Gambling: A Review

The prevention of gambling-related problems amongst Aboriginal communities has been neglected by most public health strategies which concentrate on mainstream populations. Research indicates that rates of problem gambling are higher for Aboriginal groups than the general population. Specific cultural, familial, and social patterns influence gambling by Aboriginal groups, which are individually different, making it difficult to implement a cohesive strategy to address gambling-related harms. Because of this complexity, a thorough literature review is necessary to identify gaps in policy and research. This paper uses a public health framework to consider multi-dimensional influences (personal, environmental, economic, cultural and social) that affect gambling uptake. Such analysis is also important for identifying risk factors which facilitate the development and maintenance of problem gambling and potentially for underpinning protection, prevention and treatment programs. It is advised that strategies be developed in consultation with Aboriginal peoples to guide public health policy and research to minimise any gambling-related harms.     

Epidemiologic differences in drug dependence

Background: Published epidemiologic survey statistics do not allow direct cross-national comparison of drug dependence in the US and the UK, primarily because of a lack of uniformity across case definitions and methods of case ascertainment. Aims: The current study sought to re-estimate these prevalence values after calibration of case definitions (i. e., imposing methodological constraints to unify case definitions), to identify suspected determinants, and also to investigate symptom profiles among active cases. Method: Analyses of data from the US National Household Survey on Drug Abuse and the UK Survey of Psychiatric Morbidity were conducted. Prevalence of active drug dependence symptoms was estimated. Logistic regression analysis was used to estimate the magnitude of the association between suspected socio-demographic variables and drug dependence. Results: The prevalence of drug dependence was an estimated 1.4 % in the US and 0.5 % in the UK. This difference was somewhat attenuated when the effect of living in an urban setting was controlled. Symptom profiles among active cases were very similar. In both countries, being male, non-married, of a low socio-economic status (SES), and living in an urban setting were associated with an increased occurrence of drug dependence. Conclusion: There are US–UK differences in prevalence of active drug dependence beyond what available statistics imply and some of this difference can be explained by variations associated with living in urban and rural conditions. Accepted: 27 September 2002 Correspondence to James C. Anthony, Ph. D.     

The Risk of Online Gambling: a Study of Gambling Disorder Prevalence Rates in Spain

Since the 1990s, gambling has been considered a public health concern. The characteristics of games and the environments in which gambling is carried out are major causes of gambling disorder. Information and communication technologies (e.g., Internet, mobile phones) have been adapted for gambling, and new forms of online gambling have appeared.

Online gambling is currently legal in many countries worldwide, and it is continuing to expand globally. In Spain, online gambling has been legal since 2012, when the government authorized companies to operate in this space. Many other countries have been through a similar process of legalization and the promotion of online gambling.

In this study, we analyzed the prevalence of gambling disorder in Spain, as well as differences between online and traditional gambling, according to sex and age group. Prevalence indicators of gambling disorder were higher than expected, and this result was especially evident with regard to online gambling.

     

立体定向手术治疗药物依赖24例临床分析

目的探讨立体定向手术治疗药物依赖的方法。方法对24例药物依赖病人行立体定向脑深部核团毁损术治疗,靶点为双侧伏隔核各1点,双侧扣带回前部、中部、前部与中部中间各1点。结果病人出院时均符合戒断标准。随访1~6个月,2例复吸,22例正常生活。结论采用立体定向手术治疗药物依赖病人,近期效果肯定,相对安全,长期疗效有待观察。     

Problem Gambling in Early Adulthood: a Population-Based Study

The aims of this study were to investigate stability of problem gambling between 20 and 24 years of age, and the antecedents and consequences of problem gambling at age 20 years. Young adult participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) completed computer-administered gambling surveys on paper, or online. Responses to the Problem Gambling Severity Index (PGSI) were complete for 2624 participants at 20 years, and 1921 participants at 24 years. Responses were categorized into ‘non-problem’ (71–78%), ‘low-risk gambling’ (16–21%), ‘moderate-risk gambling’ (4–5.5%), and ‘problem gambling’ (1–1.5%). The overall frequency of moderate-risk/problem gambling varied little between age 20 and 24 years, and scratch cards, online betting and gambling were the most frequent activities. Problem gamblers at age 20 years had a history of hyperactivity and conduct problems in adolescence, high sensation seeking, and an external locus of control. They were more likely to have mothers who had problems with gambling, reported less parental supervision, and higher social media usage. Moderate-risk/problem gambling at age 20 years was associated with regular cigarette smoking, high levels of illicit drug use, and problematic use of alcohol at age 24 years. A significant minority of young adults (mainly males) showed problem gambling behaviours which appeared to be established by the age of 20 years and were associated with other potentially addictive behaviours.

     

Psychopathology in offspring from multiplex alcohol dependence families with and without parental alcohol dependence: a prospective study during childhood and adolescence

Multiplex families ascertained through multiple alcohol dependent individuals appear to transmit alcohol and drug use disorders at higher rates than randomly selected families of alcoholics. Our goal was to investigate the risk of developing specific psychiatric diagnoses during childhood or adolescence in association with familial risk status (high-risk [HR] or low-risk [LR]) and parental diagnosis. Using a prospective longitudinal design, HR offspring from three generation multiplex alcohol dependence families and LR control families were followed yearly. Data analysis was based on consensus diagnoses from 1738 yearly evaluations conducted with the offspring and a parent using the K-SADS, and separately modeled the effects of familial susceptibility and exposure to parental alcohol dependence. Multiplex family membership and parental alcohol and drug dependence significantly increased the odds that offspring would experience some form of psychopathology during childhood or adolescence, particularly externalizing disorders. Additionally, parental alcohol dependence increased the odds that adolescent offspring would have major depressive disorder (MDD). While it is well known that parental substance dependence is associated with externalizing psychopathology, the increased risk for MDD seen during adolescence in the present study suggests the need for greater vigilance of these children.     

Illicit drug use and dependence in a New Zealand birth cohort

OBJECTIVE: To describe the patterns of illicit drug use in a birth cohort studied to the age of 25 years. METHOD: The data were gathered during the Christchurch Health and Development Study. In this study a cohort of 1265 children born in the Christchurch, New Zealand urban region in mid-1977 have been studied to the age of 25 years. Information was gathered on patterns of illicit drug use and dependence during the period 15-25 years. RESULTS: By age 25 years, 76.7% of the cohort had used cannabis, while 43.5% had used other illicit drugs on at least one occasion. In addition, 12.5% of the cohort met DSM-IV criteria for dependence on cannabis, and 3.6% of the cohort met criteria for dependence on other illicit drugs at some time by age 25. There was also evidence of substantial poly-drug use among the cohort, with hallucinogens and amphetamines being the most commonly used illicit drugs (excluding cannabis). Illicit drug use and dependence was higher in males, in Māori, and in those leaving school without qualifications. Key risk factors for illicit drug use and dependence included adolescent risk-taking behaviours including cigarette smoking and alcohol consumption, affiliation with substance-using peers, novelty-seeking, and conduct problems in adolescence. Other key risk factors included parental history of illicit drug use and childhood sexual abuse. CONCLUSIONS: Levels of cumulative illicit drug use in this cohort were relatively high, with the majority of respondents having tried illicit drugs by age 25. For the majority of illicit drug users, drug use did not lead to problems of dependence. Nonetheless, nearly 15% of the cohort showed symptoms of illicit drug dependence by the age of 25 years, with cannabis dependence accounting for the majority of illicit drug dependence.     

Pathological Gambling: Psychiatric Models

Three psychiatric conceptual models: addictive, obsessive-compulsive spectrum and mood spectrum disorder have been proposed for pathological gambling. The objectives of this paper are to (1) evaluate the evidence base from the most recent reviews of each model, (2) update the evidence through 2007 and (3) summarize the status of the evidence for the three models. Structured literature review and evidence grading. The evidence base supporting all three models is limited. The majority of the evidence is controlled, but not randomized studies that provide evidence of association. The addiction model satisfies several of the criteria formulated for the evaluation of associational evidence, but no model coherently explains all of the associational evidence. Heterogeneity among pathological gamblers or confounding could be the factors contributing to failures of the current conceptual models. New models such as multi-component or subtype models may be needed.