The Changing Role of “Using” Dreams in Addiction Recovery

The Dream Interview Method of dream interpretation can be applied to dreams depicting alcohol and drug use to elucidate the meaning of such dreams in relation to stages of recovery. This paper summarizes the method and demonstrates its application utilizing seven dreams collected from clients in psychotherapy and participants in dream workshops. The incorporation of such interpreted dreams into substance abuse treatment as well as their relationship to other life issues is discussed. Published by Elsevier Science Inc.     

Beyond Narratives: “Free Drawings” as Visual Data in Addiction Research

The study presented here explores the usefulness of visual data when assessing addiction careers from various methodological perspectives. The database consists of 14 “free life-course drawings” produced by seven Swiss and seven Polish male alcohol ex-users, and their life history narratives collected in the context of earlier studies on self-change. The analysis follows the principles of the Barthian visual semiotics approach including the author and the viewer perspective. This is followed by the investigation of the interplay between drawings and narratives in Polish and German.

Compared to the detailed narratives following few sub-storylines at the same time, the drawings provide a more coherent and differentiated overall picture especially of the emotional state over the life course: the relative subjective importance of highs and lows; and clearer visualisation of mixed positive and negative feelings; as well as identity concepts, such as the interplay between Mead's I & me.     

Implementing Evidence-Based Practices in Community Treatment Programs: Initial Feasibility of a Counselor “Toolkit”

ABSTRACT

Community substance abuse treatment programs face many barriers to adopting “evidence-based” therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost all counseling is done in group sessions. The authors adopted an approach widely used in the teaching field—developing a resource “toolkit” for a specific topic, in this case, a Decisional Balance exercise often used in the evidence-based treatment approach of Motivational Interviewing. This trial toolkit was comprised of a DVD (televised during group to illustrate the clinical concept), a laminated counselor guide (to provide guidance and talking points for the counselor during group), and some worksheets and wallet cards for patients to retain key points (see Table 1). A feasibility trial assessed the acceptability, and sustainability of the “Decisional Balance” concept toolkit among 26 counselors and 210 of their patients, from 6 community-based substance abuse treatment programs. The great majority of patients (97%) and all counselors (100%) reported they were satisfied with the toolkit session; 84% of patients said they would like more groups like the toolkit session. Almost all counselors (96%) were still using at least one component of the toolkit 3 months after their initial exposure with no prompting. The toolkit curriculum–based approach may be a viable and attractive way of translating core concepts from sophisticated evidence-based therapies into use by counselors within contemporary, community-based treatment programs with minimal training.     

Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”

Methadone maintenance therapy (MMT), a pharmacological treatment for opioid use disorder for the past 50 years, continues to remain controversial. Despite consistent and overwhelming evidence confirming the effectiveness and safety of MMT, misconceptions and myths persist regarding its legitimacy as a treatment for opioid addiction. This often results in the underutilization and limited availability of this treatment modality. Despite successful outcomes, the controversial nature of MMT, and the stigma experienced by the patients on methadone, has been a particularly difficult obstacle to overcome. We present the history of MMT, review the evidence for its efficacy in the treatment of opioid dependence, and explore the origins of the stigma and misconceptions related to MMT.     

Learning the Language of Abstinence in Addiction Treatment: Some Similarities Between Relapse-Prevention with Disulfiram,Naltrexone, and Other Pharmacological Antagonists and Intensive “Immersion” Methods of Foreign Language Teaching

Relapse-prevention (RP) is an educational process. Learning to abstain from alcohol or opiates after years of dependence involves selectively suppressing old, maladaptive habits of thought and behavior and establishing new, adaptive ones. This process resembles foreign language (FL) learning. Effective FL teaching techniques are relevant to RP. Immersion, the most effective FL teaching method, discourages students from using their first language ab initio, requiring them to use the FL instead, however inexpertly. It resembles exposure and response-prevention for phobic or compulsive disorders. Supervised disulfiram aids RP by discouraging alcoholics from responding to real-life drinking cues in the language of excessive drinking, requiring them, ab initio, to practice new, alcohol-free responses. Supervised or depot naltrexone acts similarly in opiate dependence. We discuss the concept of antagonist-assisted abstinence.     

“She encourages people to drink”: A qualitative study of the use of females to promote beer in Nigerian institutions of learning

Background: University students engage in heavy alcohol consumption and one factor that facilitates their alcohol use is alcohol marketing. Diverse sophisticated sales promotion strategies are used by multinational alcohol industries in Nigeria, and no policies to regulate alcohol promotion exist. This study explores the marketing strategy of using female students to promote beer in bars, nightclubs and hotels and how it facilitates alcohol use amongst students. Methods: Thirty-one in-depth interviews were conducted with university students (aged 19–23 years). The data were analysed to generate themes with the aid of NVivo 10 software (QSR International Pty Limited, Doncaster, Victoria, Australia). Results: The results show that female students identified as “beautiful” are strategically employed to promote beer brands in bars, nightclubs and other drinking sites. Beer promotion involves socialising in bars and persuading customers to buy more alcohol. Women agree to promote beer due to the commission that they are paid within a short time period. However, promoting beer creates different levels of risk for beer promoters. Beer promoters may be pressured into unwanted relationships because purchasing beer, for some men, constitutes the first step towards initiating a relationship with them. Their male customers are also at risk because they may drink large quantities of alcohol, either to gain the approval of a beer promoter in the hope of a relationship or to win prizes, such as free drinks and other branded paraphernalia that accompany beer promotion. Conclusions: The findings suggest that using women to promote beer facilitates their exploitation and also contributes to the growing alcohol-related problems in Nigeria. Effective written national alcohol control policies that regulate alcohol promotion should be formulated and implemented in Nigeria.     

“First-dose” response to mianserin: effects of age

The effects of single 10 mg oral doses of the antidepressant mianserin on psychomotor performance, subjective sedation and supine and standing blood pressure were compared in ten young and nine elderly healthy volunteers. Immediate and residual sedation following this subtherapeutic dose was readily detected in both groups. In contrast to previous studies with benzodiazepines, the sedation effect was not accentuated in the older subjects. Subjective awareness of sedation was significant in the young but not, however, in the elderly. First-dose postural hypotension, presumably due to post-synaptic alpha-blockade also occurred in young subjects only. Caution may be needed on initial dosage of mianserin in young individuals who drive or undertake skilled tasks and in the elderly who may be unaware of psychomotor impairment. The reported alpha₂ receptor selectivity of mianserin might explain the lack of postural effects in the elderly, and might constitute a potentially useful characteristic in the development of new compounds.     

Internal Medicine Residents’ Training in Substance Use Disorders: A Survey of the Quality of Instruction and Residents’ Self-Perceived Preparedness to Diagnose and Treat Addiction

ABSTRACT

Background: Resident physicians are the direct care providers for many patients with addiction. This study assesses residents’ self-perceived preparedness to diagnose and treat addiction, measures residents’ perceptions of the quality of addictions instruction, and evaluates basic knowledge of addictions. Methods: A survey was e-mailed to 184 internal medicine residents at Massachusetts General Hospital in May 2012. Results: Responses were obtained from 55% of residents. Residents estimated that 26% of inpatients they cared for met criteria for a substance use disorder (SUD). Twenty-five percent of residents felt unprepared to diagnose and 62% felt unprepared to treat addiction. Only 13% felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across postgraduate year (PGY) level. Fifty-five percent rated the overall instruction in addictions as poor or fair. Seventy-two percent of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56% in the inpatient setting. No resident answered all 6 knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19% correctly answered a question about naltrexone. Nine percent of residents responded that someone had expressed concern about the respondent's substance use. Conclusions: Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUDs. More than half rate the quality of addictions instruction as fair or poor. Structured and comprehensive addictions curriculum and faculty development are needed to address the deficiencies of the current training system.     

Avoidance of “First-Pass” Elimination of Rectally Administered Propranolol in Relation to the Site of Absorption in Rats

The extent of first-pass elimination of racemic propranolol and dextropropranolol in doses of 0.25 or 0.50 mg was investigated in relation to the site of drug administration in the rectum of rats. The compounds were given orally, i.v., and rectally at distances of 2 and 1 cm from and directly at the anus by low volume zero-order 30 min infusion. Unchanged propranolol was determined in blood, and propranolol and three metabolites were measured in urine. The systemic availability of propranolol after oral administration was approximately 6 %. Rectal administration at 2 cm, at 1 cm and directly at the anus (0.2 cm) gave two, three and six times higher values, respectively. The more distal application site produced urinary metabolite profiles that were comparable to those observed after oral administration, while application directly at the anus was similar to i.v. dosing. In all experiments log-linear elimination phases with comparable elimination half-lives (range 12–18 min) were found, except with the 0.50 mg dose after i.v. and rectal administration close to the anus which showed a non-linear profile. The mean systemic availability after rectal administration of 0.25 mg dextro-propranolol close to the anus was 50 and 64 % as compared to a 0.25 and 0.125 mg i.v. dose, respectively. The rectal route may be used for propranolol to partially prevent hepatic first-pass metabolism. However, avoidance of presys-temic elimination is maximal only in the immediate vicinity of the anus as the venous blood supply of the upper part of the rectum of rats appears to be connected to the portal system and the lower part to the general circulation.     

A Review of: “Statistics: A Guide to the Unknown”

The two-period repeated measurements crossover design is often used in clinical trials. In this article we give a formula for sample size determination for testing treatment effect in two-period repeated measurements crossover design by taking an analysis of variance approach to the repeated measurements analysis. A balanced situation is considered: two treatment sequences that have the same number of patients, and the time points of measurements on each subject within each treatment period equal in number. The formula reveals the relationship between the required number of patients for each treatment sequence the number of repeated measurements within each treatment period the detectable treatment difference with respect to a primary response variable and the power for testing the treatment difference. A clinical trial example is given to illustrate the use of the formula.     

Assessment of Early Acute Lung Injury in Rats Exposed to Aerosols of Consumer Products: Attempt to Disentangle the “Magic Nano” Conundrum

In Germany in 2006 a series of rapidly developing and sometimes severe cases of pulmonary health impairment were observed after normal use of the “Magic Nano Glass & Ceramic” spray and “Magic Nano Bath” spray. In contrast, the previously marketed “Magic Nano” pump spray product (handheld trigger device without propellants) was unobtrusive. Analysis of particles discharged from these products did not reveal stable (solid) nano-sized particles. The precipitous increase of pulmonary health impairment in humans caused by “Magic Nano Sprays” triggered a comparative assessment of the acute inhalation toxicity of “Magic Nano Glass & Ceramic” spray, “Magic Nano Bath” spray, and “Magic Nano” pump spray in rats. The first two test specimens were examined as spray-can aerosols using an intermittent generation principle, whereas the undiluted liquid content of the pump spray was continuously aerosolized. Groups of Wistar rats were nose-only exposed for 4 h. However, due to mortality occurring already during exposure following exposure to Glass & Ceramic spray, the exposure duration was reduced to ～ 2 h in some groups. In addition to endpoints called for by contemporary testing guidelines, respiratory tract injury was also probed by respiratory function measurements during exposure supplemented by analyses in bronchoalveolar lavage (BAL) fluid on the first postexposure day, including lung histopathology in rats exposed to Glass & Ceramic spray. The Glass & Ceramic spray caused mortality at 2269 mg/m³ and above, the pump spray was in the beginning lethal range at 81222 mg/m³, while the bath spray was tolerated without mortality up to the maximum tested nominal concentrations of 28100 mg/m³. The time-adjusted 4-h LC₅₀ of Glass & Ceramic spray was 5098 mg/m³. The analysis of respiratory patterns revealed changes indicative of both upper and lower respiratory tract sensory irritation. In addition to clinical signs suggestive of marked lung irritation, especially in the rats exposed to the Glass & Ceramic spray, histopathology revealed lung inflammation, hemorrhages, edema, and focal septal thickening. Lung weights and BAL endpoints (lactate dehydrogenase [LDH], protein, γ -glutamyltransaminase, and neutrophilic granulocytes) were markedly increased. In summary, this comparative study demonstrates that the conventional OECD 403 protocol is suitable to comparatively assess the potential and potency of these types of consumer products in their end-use configuration. Measurements in BAL were most suitable for the identification of acute lung injury. By contrast, lung function measurements during exposure did not demonstrate any conclusive association with lung injury. It does not appear that the particle size per se is a key determinant in the toxicity of “Magic Nano Glass & Ceramic” spray (approximately 100% mortality occurred at a MMAD of ～ 7 μ m; GSD ≈ 3). This might suggest that more volatile substances or substances contained in the test articles that co-evaporate with solvents or water may be causative for the findings observed. Hence, the findings of this study support the notion that the assessment of the acute inhalation toxicity of complex end-use products is methodologically challenging and cannot be readily anticipated based on compositional or physical (particle size) data. Accordingly, in the absence of predictive and validated in vitro assays, in vivo inhalation testing of potentially toxic commercialized spray products appears to be indispensable for consumer safety. In order to prevent indiscriminant testing of such products in bioassays, the development of standardized in vitro alternatives should be considered with high priority.     

Determination of “safe” and “critical” nanoparticles exposure to welders in a workshop

ABSTRACT

The present study examined consequences of “safe” versus “critical” exposure to nanoparticles (NP) released during welding operations. With this aim in mind, a set of measurements regarding NP emissions was undertaken in a workshop during welding by metal active gas of carbon steel using different mixtures of argon (Ar) and carbon dioxide (CO₂) as well as different process parameters which might influence emission of (NP). If these measurements were conducted in several locations away from the welding sources, the graphical representation of the obtained observations with time enabled definition of “safe” and “critical” regions within a welding workshop in terms of welder’s exposure. This information may be combined with the results of risk analysis derived by control banding and helps to categorize the sites where regulatory measures such as operation containment or dedicated exhaust ventilation need to be implemented.