|
| ||
|
|
||
Abusers
Kinds of Abusers Selected AbstractsAlcohol abuse in a metropolitan city in China: a study of the prevalence and risk factorsADDICTION, Issue 9 2004Zhang Jiafang ABSTRACT Aims To investigate the prevalence of alcohol abuse in modern China and to explore the risk factors that may be associated with alcohol abuse. Design A face-to-face interview was carried out in a random sample with 2327 respondents. Setting Respondents were selected randomly from Wuhan City, Hubei Province, China, between May and June 2002. Participants Fifteen,65-year-old urban Chinese adults. Measurements Scores for alcohol abuse and related risk factors were the main measures. Findings (1) Nearly 15% of urban Chinese adults aged 15,65 were alcohol abusers. (2) Deviant drinking habits of mother, schoolmates, colleagues or friends all had a negative impact on the respondent's alcohol drinking behaviours, and higher economic status, current smokers, being male and being older were identified as risk factors related to alcohol abuse. In particular, if a drinker's mother used alcohol frequently then this drinker was more likely to become an alcohol abuser than those drinkers whose mothers did not use alcohol frequently (P = 0.0001). Fathers' drinking behaviours do not have a significant impact on the alcohol abusers. Conclusions In addition to common risk factors such as economic status, deviant peers' and fellows' drinking behaviours and negative attitudes to alcohol drinking, maternal alcohol drinking habit influenced significantly the offspring's drinking habits. Therefore, efficient intervention and education of healthy drinking habits in early motherhood is necessary for Chinese women. [source] Naltrexone: report of lack of hepatotoxicity in acute viral hepatitis, with a review of the literatureADDICTION BIOLOGY, Issue 1 2004Colin Brewer Many clinicians appear to be concerned about the potential hepatotoxicity of the opiate antagonist naltrexone (NTX) and this may be one reason why it is not used more widely in treating both heroin and alcohol abusers. Some much-quoted early studies noted abnormalities in liver function tests (LFTs) in very obese patients taking high doses, although there was no evidence of clinically significant liver dysfunction. These concerns may be reinforced by advice in the UK product information sheet to perform LFTs before and during treatment, by high infection rates with hepatitis C virus (HCV) among injecting heroin addicts and by the frequency of abnormal LFTs in alcohol abusers. We describe a heroin abuser in whom clinical and laboratory manifestations of acute hepatitis B and C appeared a few days after the insertion of a subcutaneous naltrexone implant. A decision was made not to remove the implant but the hepatitis resolved completely and uneventfully well within the normal time-scale. A review of the literature indicates that even when given at much higher doses than are needed for treating heroin or alcohol abusers, there is no evidence that NTX causes clinically significant liver disease or exacerbates, even at high doses, serious pre-existing liver disease. During the past decade, NTX has been shown to be safe and effective in the treatment of pruritus associated with severe jaundice caused by severe and sometimes life-threatening cirrhosis and other liver diseases. Its safety, even in these extreme conditions, is particularly reassuring. We suggest that it may be more appropriate and economical to advise patients to report promptly any suspected side effects than to perform regular LFTs, which may be misleading. [source] Injuries to the head, face, mouth and neck in physically abused children in a community settingINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 5 2005A. M. CAIRNS Summary. Objectives. The aims of the present study were to identify the incidence of orofacial injuries found within a cohort of physically abused children, and examine demographic data surrounding the alleged perpetrator, the location in which the alleged assault occurred, the mechanism of injury and the actual orofacial injury incurred. Methods. The research took the form of a retrospective study of clinical case records of children with suspected physical abuse from 1 June 1998 to 31 May 2003. Seven hundred and fifty case records were identified and 390 (46·7%) were available for data extraction. Results. Fifty-nine per cent (n = 230) of children had signs of abuse on the head, face or neck. The alleged perpetrator was the mother in 104 cases (26·7%), the father in 100 (25·6%) and mother's partner in 49 other cases (12·6%). More than half (53·3%) of the alleged abuse occurred in the child's home; in 32·3% of cases, the location was not recorded. Other locations included outside in a public place, school and at the home of the alleged abuser. Some 23·4% (n = 54) had been punched or slapped around the head, neck or face, 17·4% (n = 40) had been struck by an object, and 15·2% (n = 35) had allegedly sustained multiple modes of injury. Bruising to the head, neck or face was seen in 95·2% (n = 219) of children, and 32·6% (n = 75) had abrasions; 65·2% (n = 150) of the bruises and 22·9% (n = 53) of the abrasions were on the face. Conclusions. Fifty-nine per cent of physically abused children in the present cohort had orofacial signs of abuse which would be easily visible to a dental practitioner. The commonest injuries were bruises and abrasions. This concurs with previous reports in the literature and highlights the important role of dental practitioners in the recognition of children who have been abused. [source] Patterns of partners' abusive behaviors as reported by Latina and non-Latina survivorsJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 2 2009Nancy Glass This study builds on the existing knowledge of risk factors for lethal intimate partner violence (IPV) and typologies of IPV abusers by exploring patterns of abusive partners' behaviors among known risk factors for intimate partner femicide (i.e., murder of women) and determines if groups of survivors with similar patterns of abusive behaviors exist. The common patterns are then examined for differences among Latina and non-Latina survivors. Face-to-face interviews were conducted with adult English- and Spanish-speaking survivors of past-year physical and/or sexual IPV using a validated risk assessment instrument, the Danger Assessment (DA) Questionnaire. Two-hundred nine IPV survivors participated, 55% Latina. Unique patterns of abusive behaviors perpetrated by an intimate partner or ex-partner across known risk factors for lethal violence were reported. The patterns clustered into five distinct groups: extreme abuser, physical and sexual violence/controlling abuser, forced sex/controlling abuser, threat/controlling abuser, and low-level tactics abuser. Latina and non-Latina survivors reported mean DA scores (13.0 vs. 18.5, respectively) that place them within the "increased danger" and "extreme danger" level, respectively, for lethal violence by an abusive partner. Although both groups were in extreme danger on average, the patterns of abusive behaviors differed. Latina women were more likely to characterize their partner as using forced sex to control the relationship, whereas non-Latina women were more likely to characterize the use of all types of abusive behaviors (i.e., extreme abuser) or threats to kill them (i.e., threat/controlling abuser) to control the relationship. The findings of this study can be used to develop effective individualized safety plans that include culturally and linguistically competent strategies to reduce violence-related morbidity and mortality. © 2009 Wiley Periodicals, Inc. [source] Common Misconceptions in Addressing Domestic Violence in Child Custody DisputesJUVENILE AND FAMILY COURT JOURNAL, Issue 4 2003PETER G. JAFFE ABSTRACT Domestic violence has been recognized as an important factor to consider in determining the best interests of children in custody and visitation disputes. However, there remain many misconceptions about the extent and impact of domestic violence in child custody proceedings. Several misconceptions are identified and juxtaposed with the reality of emerging knowledge in this field, and implications are outlined. These issues are illustrated by the perspectives of 62 women victims and 95 children exposed to domestic violence who had to navigate the justice system after separation from an abuser. Recommendations are offered for enhancing professional education, resource development, and collaboration among courts and community service providers. [source] Oral leishmaniasis in a HIV-positive patient.ORAL DISEASES, Issue 1 2002Report of a case involving the palate Leishmaniasis is a parasitic disease caused by a protozoon (Leishmania), with different clinical forms that are endemic in certain countries. The association of this disease in patients who are seropositive to human immunodeficiency virus (HIV) has recently been described. Leishmaniasis can develop in any stage of HIV infection, although the clinical manifestations , and hence the diagnosis , tend to coincide with the periods of maximum immune depression. We present the case of a HIV-positive, ex-intravenous drug abuser (in stage B2 of the CDC, 1992) with concomitant hepatitis C infection who presented with palatinal pain and bleeding for the past 2 months. Exploration revealed a vegetating tumoration of the hard palate. Hematoxylin-eosin and Giemsa staining of the biopsy confirmed the diagnosis of leishmaniasis. The definitive diagnosis was mucocutaneous leishmaniasis (MCL), for a bone marrow aspirate proved negative, and no further lesions could be established. The patient was treated with meglumine antimoniate (Glucantime), followed by improvement of the lesions. [source] Role of family in alcohol and substance abusePSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2006OMER SAATCIOGLU md Abstract, Abuse is a family disease, which requires joint treatment of family members. Family is an important part of the diagnosis and treatment chain of alcohol and substance abuse. Abuse of alcohol and substance is a response to fluctuations in the family system. In consideration of interactions within the system, it seems an important requirement that the clinician involves, and maintains the presence of, the family in its entirety in the treatment process. A family often needs as much treatment as the family member who is the abuser of alcohol or a substance. In this regard, participation of the family in the treatment process as group members and by assuming a supportive role are assets in terms of preventing relapse, and extending clean time, and also very important for solving conflicts that give rise to abuse of alcohol or substances. Accordingly, it is important to know the family structure and its role in the treatment process. This article covers a review of family systems separately in terms of alcoholism and substance abuse. [source] Marijuana Use Among the Adolescent Children of High-Risk Drug-Abusing FathersTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 2 2002David W. Brook M.D. This study examines marijuana use among children of male drug abusers. Subjects were 83 African-American and European-American male drug abusers, of whom the majority were injection drug users, and their children. Thirty-one of the fathers were HIV-positive and 52 were HIV-negative. Using logistic regression analyses, we explored cross-sectionally the relationship between four psychosocial domains (ie, paternal attributes, adolescent problem behaviors, father-adolescent relations, and environment) and adolescent marijuana use. The father's use of illegal drugs and his failure to cope adaptively predicted adolescent marijuana use, while a close father-child bond predicted less adolescent marijuana use. Adolescent problem behaviors predicted an increased likelihood of marijuana use. Furthermore, hierarchical regression analysis demonstrated that the adolescent's problem behavior mediated the associations between both the father-adolescent relationship and environmental factors with adolescent marijuana use. Reducing the risk factors and enhancing the protective factors within each of the domains could help reduce marijuana use among the adolescent children of drug-abusing fathers. Moreover, if a father is a drug abuser, it is important to help him establish a close bond with his child in order to help attenuate the influence of his drug use on the child's marijuana use. [source] Addressing elder abuse: Western Australian case studyAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2005Duncan Boldy Objective:,To explore the extent of elder abuse in Western Australia and associated aspects, such as the relationship of the abuser to the victim, risk factors and desirable interventions, and current knowledge and use of relevant protocols. Methods:,A mail-out questionnaire was sent to over 1000 organisations and 129 general practitioners (GPs). Recipients were asked to identify any known or suspected cases of elder abuse encountered during the previous 6 months. Results:,The estimated prevalence of elder abuse was 0.58% (in individuals 60+ years). Females and those 75 years and older were more at risk than males or those younger. Financial abuse was the most common, and frequently more than one type of abuse was suffered by the same person. The main abusers were adult children or other relatives. Conclusion:,The importance of education targeted at professionals, the general public and older people themselves was evident. Important direct interventions identified included respite care, advocacy and counselling. [source] Juvenile sexual delinquents: contrasting child abusers with peer abusersCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2004J. Hendriks MA Background There is growing concern regarding juvenile sex offenders, and concomitant interest in a more scientific database which could help direct management and treatment resources. Aims To investigate whether juveniles who sexually offend against children (or those at least five years younger than themselves) differ from those who sexually assault their peers or older victims. Method The study is based on data from psychological screenings conducted for the juvenile courts in the Netherlands. Results As hypothesized, juvenile child molesters scored higher on neuroticism, had experienced more social problems, and had been bullied more often at school than their peers who sexually assaulted same-age or older victims. Child molesters also reported a more negative self-image. When referred for screening, they were younger but had committed more sex offences, more often against males than females. Conclusions The results were suggestive of greater need for psychological interventions in the child molester group, although in both groups substantial minorities had had experience of early childhood deprivation or abuse. Copyright © 2004 Whurr Publishers Ltd. [source] Rhabdomyolysis and brain ischemic stroke in a heroin-dependent male under methadone maintenance therapyACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2009W.-Y. Hsu Objective:, There are several complications associated with heroin abuse, some of which are life-threatening. Methadone may aggravate this problem. Method:, A clinical case description. Results:, A 33-year-old man presented with rhabdomyolysis and cerebral ischemic stroke after intravenous heroin. He had used heroin since age 20, and had used 150 mg methadone daily for 6 months. He was found unconsciousness at home and was sent to our hospital. In the ER, his opiate level was 4497 ng/ml. In the ICU, we found rhabdomyolysis, acute renal failure and acute respiratory failure. After transfer to an internal ward, we noted aphasia and weakness of his left limbs. After MRI, we found cerebral ischemic infarction. Conclusion:, Those using methadone and heroin simultaneously may increase risk of rhabdomyolysis and ischemic stroke. Patients under methadone maintenance therapy should be warned regarding these serious adverse events. Hypotheses of heroin-related rhabdomyolysis and stroke in heroin abusers are discussed. [source] ASIA PACIFIC COLUMN: New challenges and opportunities in managing substance abuse in MalaysiaDRUG AND ALCOHOL REVIEW, Issue 5 2006MAHMUD MAZLAN MD Abstract Until recently, Malaysia has lagged behind in the treatment of drug addiction and related disorders, despite experiencing severe drug problems. By the end of 2004, 234 000 heroin users or heroin-dependent individuals had been registered in the official government registry, but other estimates exceed 500 000 for heroin abusers in the country. Amphetamine-type stimulant abuse is also increasing and of considerable public and government concern. Among the population of drug users, HIV and other infectious diseases rates are very high. In the Western Pacific regions, Malaysia has the second highest HIV prevalence (after Vietnam) among adult populations (0.62%) and the highest proportion of HIV cases resulting from injection drug use (76.3%). Drug use and related disorders exert a heavy burden on the country's health care and legal systems. Historically, drug abusers were rehabilitated involuntarily in correctional, rather than health-care, facilities. This primarily criminal treatment approach had limited effectiveness which led to widespread public dissatisfaction and the recent introduction of medical treatments for addiction. Naltrexone was introduced in 1999; buprenorphine was introduced in 2001 and methadone in 2003. Agonist maintenance programmes were embraced rapidly by the medical community in Malaysia. Currently, over 30 000 opiate-dependent patients are treated with agonist maintenance treatments by more than 500 medical practitioners in Malaysia. Despite these recent advances, treatments for amphetamine-type stimulant abuse or dependence are underdeveloped, and diversion of agonist medications is an emerging concern. [source] Rumination as a predictor of drinking behaviour in alcohol abusers: a prospective studyADDICTION, Issue 6 2010Gabriele Caselli ABSTRACT Aims To investigate the role of depression and rumination in predicting drinking status (absence or presence of alcohol use) and level of alcohol use at 3, 6 and 12 months following a brief course of cognitive,behavioural therapy for alcohol abuse. Methods A total of 80 out-patients with a diagnosis of alcohol abuse completed measures of depression (Beck Depression Inventory), rumination (Ruminative Responses Scale) and alcohol use (Quantity,Frequency Scale). Results These indicated that rumination predicted drinking status and level of alcohol use at 3-, 6- and 12-month follow-up. The contribution of rumination was independent of depression and initial level of alcohol use. Conclusions The results confirm that rumination is an important prospective predictor of drinking status and level of alcohol use in alcohol abusers and highlight the potential relevance of targeting rumination in the treatment of alcohol abuse. [source] Emergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2004Larry Brannam MD Objectives: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)-guided peripheral IVs are used and evaluate the success rates for such lines by ENs. Methods: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US-guided IV line placement on difficult-to-stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45-minute lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. Results: A total of 321 surveys were collected in a five-month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty-eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. Conclusions: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult-access patients. [source] Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine-maintained intravenous heroin abusersADDICTION, Issue 4 2010Sandra D. Comer ABSTRACT Background Sublingual buprenorphine is an effective maintenance treatment for opioid dependence, yet intravenous buprenorphine misuse occurs. A buprenorphine/naloxone formulation was developed to mitigate this misuse risk. This randomized, double-blind, cross-over study was conducted to assess the intravenous abuse potential of buprenorphine/naloxone compared with buprenorphine in buprenorphine-maintained injection drug users (IDUs). Methods Intravenous heroin users (n = 12) lived in the hospital for 8,9 weeks and were maintained on each of three different sublingual buprenorphine doses (2 mg, 8 mg, 24 mg). Under each maintenance dose, participants completed laboratory sessions during which the reinforcing and subjective effects of intravenous placebo, naloxone, heroin and low and high doses of buprenorphine and buprenorphine/naloxone were examined. Every participant received each test dose under the three buprenorphine maintenance dose conditions. Results Intravenous buprenorphine/naloxone was self-administered less frequently than buprenorphine or heroin (P < 0.0005). Participants were most likely to self-administer drug intravenously when maintained on the lowest sublingual buprenorphine dose. Subjective ratings of ,drug liking' and ,desire to take the drug again' were lower for buprenorphine/naloxone than for buprenorphine or heroin (P = 0.0001). Participants reported that they would pay significantly less money for buprenorphine/naloxone than for buprenorphine or heroin (P < 0.05). Seven adverse events were reported; most were mild and transient. Conclusions These data suggest that although the buprenorphine/naloxone combination has intravenous abuse potential, that potential is lower than it is for buprenorphine alone, particularly when participants received higher maintenance doses and lower buprenorphine/naloxone challenge doses. Buprenorphine/naloxone may be a reasonable option for managing the risk for buprenorphine misuse during opioid dependence treatment. [source] A randomized controlled trial of an internet-based intervention for alcohol abusersADDICTION, Issue 12 2009John A. Cunningham ABSTRACT Objective Misuse of alcohol imposes a major public health cost, yet few problem drinkers are willing to access in-person services for alcohol abuse. The development of brief, easily accessible ways to help problem drinkers who are unwilling or unable to seek traditional treatment services could therefore have significant public health benefit. The objective of this project is to conduct a randomized controlled evaluation of the internet-based Check Your Drinking (CYD) screener ( http://www.CheckYourDrinking.net). Method Participants (n = 185) recruited through a general telephone population survey were assigned randomly to receive access to the CYD, or to a no-intervention control group. Results Follow-up rates were excellent (92%). Problem drinkers provided access to the CYD displayed a six to seven drinks reduction in their weekly alcohol consumption (a 30% reduction in typical weekly drinking) at both the 3- and 6-month follow-ups compared to a one drink per week reduction among control group respondents. Conclusions The CYD is one of a growing number of internet-based interventions with research evidence supporting its efficacy to reduce alcohol consumption. The internet could increase the range of help-seeking options available because it takes treatment to the problem drinker rather than making the problem drinker come to treatment. [source] Associations of cohort and socio-demographic correlates with transitions from alcohol use to disorders and remission in metropolitan ChinaADDICTION, Issue 8 2009Sing Lee ABSTRACT Aims To examine socio-demographic associations of transitions from alcohol use to disorders and of remission from disorders in metropolitan China. Design and setting Face-to-face interviewing by trained lay-interviewers on a multi-staged, clustered sample from the general population of Beijing and Shanghai, China. Participants A total of 5201 adults aged 18,70 years and with household registration. Measurements World Mental Health version of Composite International Diagnostic Interview. Findings Lifetime prevalence estimates for alcohol use, regular use (at least 12 drinks in a year), DSM-IV abuse and dependence with abuse were 65.4%, 39.5% (60.4% of ever-drinkers), 4.6% (11.6% of regular users) and 0.9% (20.4% of lifetime alcohol abusers), respectively. These estimates were higher among respondents from the recent cohort; 64.3% and 36.9% respondents with a history of lifetime abuse and dependence respectively had remitted. The number of socio-demographic associations for the onset of each transitional stage decreased from alcohol use to alcohol dependence. Onset of ever-use was more common in respondents who were male, 18,50 years of age, with middle education level and never married, but less common among the previously married and students. First onset of regular use among those with ever-use was more common in respondents who were male, less than 50 years of age and never married, but less common in students. Being male and less than 50 years of age was associated with more alcohol abusers among regular users. Conclusion This study was the first to reveal in a Chinese population that qualitatively different risk factors might operate during the different stages of progression from alcohol use to disorders. Further research is needed to clarify the mechanisms underlying these differences in order to guide prevention programmes. [source] Effects of lactate and acetate on the determination of serum ethyl glucuronide by CZEELECTROPHORESIS, Issue 23 2006Michaela Mrázková Abstract The analysis of ethyl glucuronide,(EtG), a marker of recent alcohol consumption, in serum with an optimized CZE assay is reported. The method uses a 0.1-mm,id fused-silica capillary of 50,cm effective length that is coated with linear polyacrylamide, a pH,4.4 nicotinic acid/,-aminocaproic acid (EACA) BGE, reversed polarity and indirect analyte detection. The assay is based on a 1:1 dilution of serum with deionized water and has LODs for EtG, lactate and acetate of 3.8×10,7,M, 2.60×10,6,M and 2.18×10,6,M, respectively. Separation of EtG from endogenous macro- and microcomponents (anionic serum components of high and low concentration, respectively) and its quantification are shown to be possible for a wide range of lactate (stacker) and acetate (destacker) concentrations, macrocomponents that have an impact on the CZE behavior of EtG and that change after intake of ethanol. The assay has been successfully applied to the analysis of EtG, lactate and acetate in (i),sera of volunteers that ingested known amounts of alcohol and (ii),samples of patients that were classified (teetotalers and social drinkers vs. alcohol abusers) via analysis of carbohydrate-deficient transferrin. [source] Genetic toxicity of methamphetamine in vitro and in human abusersENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 4 2003Jih-Heng Li Abstract Methamphetamine (METH) is a widely abused psychomotor stimulant. Although numerous studies have examined METH-induced neurotoxicity, its ability to produce genotoxic effects has not been evaluated. In this article, we report on the genotoxicity of METH in vitro and in human METH abusers. METH induced his+ revertants in Salmonella typhimurium strains TA98 and TA100, and increased the frequency of hprt mutants, micronuclei, and sister chromatid exchange (SCE) in cultured Chinese hamster ovary K1 (CHO-K1) cells. These METH-induced genotoxic effects were eliminated if METH exposure was conducted in the presence of rat liver S9, indicating that the genotoxicity was caused by METH, and not by metabolites of METH. In addition, reactive oxygen species (ROS) scavengers inhibited the METH-induced micronuclei in CHO-K1 cells. Further investigation with 76 human long-term METH abusers and 98 unexposed controls demonstrated that total METH exposure correlated with micronucleus and SCE frequencies in cultured lymphocytes. The results of this study indicate that METH is a genotoxic agent and that ROS may play a role in METH-induced genotoxicity. Environ. Mol. Mutagen. 42:233,242, 2003. © 2003 Wiley-Liss, Inc. [source] Corticolimbic dysregulation and chronic methamphetamine abuseADDICTION, Issue 2007Kate Baicy ABSTRACT Aims This review aims to present and interpret evidence that methamphetamine dependence is associated with disorder of brain function that is required for top-down control of behavior. Approach Presented here are findings from brain imaging studies of human research participants with histories of chronic methamphetamine abuse in the context of functional consequences and implications for treatment of their dependence on methamphetamine. Findings Brain imaging studies have revealed differences in the brains of research participants who have used methamphetamine chronically and then abstained from taking the drug, compared with healthy control subjects. These abnormalities are prominent in cortical and limbic systems, and include deficits in markers of dopaminergic and serotonergic neurotransmitter systems, differences in glucose metabolism and deficits in gray matter. These abnormalities accompany cognitive deficits, including evidence of impaired inhibitory control. Conclusion Cortical deficits in abstinent methamphetamine abusers can affect a wide range of functions that can be important for success in maintaining drug abstinence. These include but are not limited to modulation of responses to environmental stimuli as well as internal triggers that can lead to craving and relapse. Potential therapies may combine behavioral approaches with medications that can improve cognitive control. [source] Approaches to the development of medications for the treatment of methamphetamine dependenceADDICTION, Issue 2007Frank J. Vocci ABSTRACT Background Methamphetamine abuse has become an increasing problem in both the United States and globally with concomitant increases in adverse medical, social and environmental sequelae. Behavioral therapies have been used with some success to treat methamphetamine abusers and dependent individuals, but are not universally efficacious. Methamphetamine has a rich pharmacology that theoretically provides many opportunities for potential pharmacotherapeutic intervention. Nevertheless, there are no approved medications with an indication for treating methamphetamine abusers or addicts at this time. Aim To describe briefly how methamphetamine functions and affects function in brain and report how basic researchers and clinicians are attempting to exploit and exploiting this knowledge to discover and develop effective pharmacotherapies. Results Scientifically based approaches to medications development by evaluating medications that limit brain exposure to methamphetamine; modulate methamphetamine effects at vesicular monoamine transporter-2 (VMAT-2); or affect dopaminergic, serotonergic, GABAergic, and/or glutamatergic brain pathways that participate in methamphetamine's reinforcing effects are presented. Conclusion The evidence supports the rationale that pharmacotherapies to decrease methamphetamine use, or reduce craving during abstinence may be developed from altering the pharmacokinetics and pharmacodynamics of methamphetamine or its effects on appetitive systems in the brain. [source] Widespread axonal damage in the brain of drug abusers as evidenced by accumulation of ,-amyloid precursor protein (,-APP): an immunohistochemical investigationADDICTION, Issue 9 2006Andreas Büttner ABSTRACT Background In drug abusers, white matter changes have been described by neuroimaging analyses in different brain regions. A specific pattern of involvement or a predominance of a specific brain region could not be drawn. Aims To examine alterations of the white matter as a possible morphological substrate of the neuroimaging findings. Methods Brain specimens of 30 polydrug abusers and 20 controls were obtained at autopsy. The white matter from 11 different brain regions was analysed by means of immunohistochemistry for ,-amyloid precursor protein (,-APP), a marker of axonal damage. Findings In the white matter of polydrug abusers, ,-APP-immunopositive accumulations were increased significantly compared to controls. They were more prominent in the brains of younger drug abusers than in those of the elderly. With the exception of five cases (four polydrug abusers and one control case), there were no significant white matter changes seen on myelin-stained sections, but there was a concomitant microglial activation. Conclusions Our results show a significant axonal damage in the brains of polydrug abusers, which might represent the morphological substrate of a chronic-progressive drug-induced toxic-metabolic process. It is yet to be established if the observed changes are responsible for the alterations seen in different neuroimaging analyses and which drugs of abuse might be of major pathogenetic significance. [source] The impact of a social network intervention on retention in Belgian therapeutic communities: a quasi-experimental studyADDICTION, Issue 7 2006Veerle Soyez ABSTRACT Background Although numerous studies recognize the importance of social network support in engaging substance abusers into treatment, there is only limited knowledge of the impact of network involvement and support during treatment. The primary objective of this research was to enhance retention in Therapeutic Community treatment utilizing a social network intervention. Aims The specific goals of this study were (1) to determine whether different pre-treatment factors predicted treatment retention in a Therapeutic Community; and (2) to determine whether participation of significant others in a social network intervention predicted treatment retention. Design, setting and participants Consecutive admissions to four long-term residential Therapeutic Communities were assessed at intake (n = 207); the study comprised a mainly male (84.9%) sample of polydrug (41.1%) and opiate (20.8%) abusers, of whom 64.4% had ever injected drugs. Assessment involved the European version of the Addiction Severity Index (EuropASI), the Circumstances, Motivation, Readiness scales (CMR), the Dutch version of the family environment scale (GKS/FES) and an in-depth interview on social network structure and perceived social support. Network members of different cohorts were assigned to a social network intervention, which consisted of three elements (a video, participation at an induction day and participation in a discussion session). Findings Hierarchical regression analyses showed that client-perceived social support (F1,198 = 10.9, P = 0.001) and treatment motivation and readiness (F1,198 = 8.8; P = 0.003) explained a significant proportion of the variance in treatment retention (model fit: F7,197 = 4.4; P = 0.000). By including the variable ,significant others' participation in network intervention' (network involvement) in the model, the fit clearly improved (F1,197 = 6.2; P = 0.013). At the same time, the impact of perceived social support decreased (F1,197 = 2.9; P = 0.091). Conclusions Participation in the social network intervention was associated with improved treatment retention controlling for other client characteristics. This suggests that the intervention may be of benefit in the treatment of addicted individuals. [source] Alcohol abuse in a metropolitan city in China: a study of the prevalence and risk factorsADDICTION, Issue 9 2004Zhang Jiafang ABSTRACT Aims To investigate the prevalence of alcohol abuse in modern China and to explore the risk factors that may be associated with alcohol abuse. Design A face-to-face interview was carried out in a random sample with 2327 respondents. Setting Respondents were selected randomly from Wuhan City, Hubei Province, China, between May and June 2002. Participants Fifteen,65-year-old urban Chinese adults. Measurements Scores for alcohol abuse and related risk factors were the main measures. Findings (1) Nearly 15% of urban Chinese adults aged 15,65 were alcohol abusers. (2) Deviant drinking habits of mother, schoolmates, colleagues or friends all had a negative impact on the respondent's alcohol drinking behaviours, and higher economic status, current smokers, being male and being older were identified as risk factors related to alcohol abuse. In particular, if a drinker's mother used alcohol frequently then this drinker was more likely to become an alcohol abuser than those drinkers whose mothers did not use alcohol frequently (P = 0.0001). Fathers' drinking behaviours do not have a significant impact on the alcohol abusers. Conclusions In addition to common risk factors such as economic status, deviant peers' and fellows' drinking behaviours and negative attitudes to alcohol drinking, maternal alcohol drinking habit influenced significantly the offspring's drinking habits. Therefore, efficient intervention and education of healthy drinking habits in early motherhood is necessary for Chinese women. [source] Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomesADDICTION, Issue 7 2004Damaris J. Rohsenow Abstract Aims This clinical trial investigated effects of motivational enhancement treatment (MET) and group coping-skills training (CST) tailored for cocaine dependence. Effects of MET were hypothesized to be greater with CST and for less motivated patients. Design and interventions A 2 × 2 design investigated two individual sessions of MET compared to meditation,relaxation (MRT), followed by four group sessions of CST versus drug education (ED), as daily adjuncts to intensive treatment. Setting The substance abuse program provided full-day treatment with a learning-theory and 12-Step orientation. Participants Cocaine-dependent patients were recruited. Measurements Assessment included treatment retention; change in cocaine-related urge, self-efficacy, pros and cons, and motivation; substance use and problems during 12-month follow-up. Findings Of 165 patients, follow-up status is known for 90% (n = 149). Patients in MET with low initial motivation to change reported less cocaine and alcohol relapse and use days and fewer alcohol problems than MET patients with higher initial motivation. MET produced more employment improvement than MRT, with no other significant benefit for MET. Patients with higher motivation had more cocaine use and alcohol problems after MET than MRT. Group CST reduced cocaine and alcohol use during follow-up for women only and reduced alcohol relapse for men and women. Conclusions MET is more beneficial for patients with lower initial motivation than for patients with high initial motivation. CST reduced cocaine and alcohol use for women only and reduced alcohol relapses, in contrast to results with lengthier individual CST. [source] Alcoholic macrocytosis,is there a role for acetaldehyde and adducts?ADDICTION BIOLOGY, Issue 1 2004Onni Niemelä Although alcohol abuse is known to cause a wide array of adverse effects on blood cell formation, the molecular mechanisms by which alcohol exerts its toxic actions have remained poorly defined. Elevated mean corpuscular volume (MCV), macrocytosis, is the most typical morphological abnormality induced by excessive ethanol consumption. This paper reviews recent data indicating that acetaldehyde, the first metabolite of ethanol, may play a role in the haematological derangements in peripheral blood cells and in bone marrow of alcoholic patients. Studies in experimental animals and in human alcoholics have shown that acetaldehyde can bind to proteins and cellular constituents forming stable adducts. Elevated adduct levels have been found from the erythrocytes of alcohol abusers, which may also be associated with ethanol-induced effects in haematopoiesis and adverse consequences in cellular functions. [source] Naltrexone: report of lack of hepatotoxicity in acute viral hepatitis, with a review of the literatureADDICTION BIOLOGY, Issue 1 2004Colin Brewer Many clinicians appear to be concerned about the potential hepatotoxicity of the opiate antagonist naltrexone (NTX) and this may be one reason why it is not used more widely in treating both heroin and alcohol abusers. Some much-quoted early studies noted abnormalities in liver function tests (LFTs) in very obese patients taking high doses, although there was no evidence of clinically significant liver dysfunction. These concerns may be reinforced by advice in the UK product information sheet to perform LFTs before and during treatment, by high infection rates with hepatitis C virus (HCV) among injecting heroin addicts and by the frequency of abnormal LFTs in alcohol abusers. We describe a heroin abuser in whom clinical and laboratory manifestations of acute hepatitis B and C appeared a few days after the insertion of a subcutaneous naltrexone implant. A decision was made not to remove the implant but the hepatitis resolved completely and uneventfully well within the normal time-scale. A review of the literature indicates that even when given at much higher doses than are needed for treating heroin or alcohol abusers, there is no evidence that NTX causes clinically significant liver disease or exacerbates, even at high doses, serious pre-existing liver disease. During the past decade, NTX has been shown to be safe and effective in the treatment of pruritus associated with severe jaundice caused by severe and sometimes life-threatening cirrhosis and other liver diseases. Its safety, even in these extreme conditions, is particularly reassuring. We suggest that it may be more appropriate and economical to advise patients to report promptly any suspected side effects than to perform regular LFTs, which may be misleading. [source] Changes in mu opioid receptors and rheological properties of erythrocytes among opioid abusersADDICTION BIOLOGY, Issue 2 2002ALLEN R. ZEIGER The high prevalence of anemia among chronic opioid users leads us to propose that chronic opiate use results in elevated mu opioid receptor levels on human erythrocytes and that these receptor changes may affect erythrocyte membrane properties. Blood samples from 17 opioid-dependent subjects (based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or DSM-IV) and 15 drug-free controls were assayed for mu opioid receptors on erythrocytes using a flow cytometry immunoassay. Deformability and the hydration status of erythrocytes were studied by ektacytometry. Data were analyzed by independent t-tests, tests of correlation, chi square and cluster analyses. As expected, the percentage of erythrocytes from opioiddependent subjects with opioid receptors (opioid receptor levels) was significantly higher (47.4 ± 38.3%) than controls (22.8 ± 30.1%) (t = 2.01, df = 30, p < 0.05). Also, the opioid-dependent patients showed a wide variation in the percentage of erythrocytes bearing opioid receptors and data analyses of these patients showed two strongly defined clusters. One subgroup consisted of nine individuals with very high receptor levels (mean = 81.5%) while the other had eight patients with low receptor levels (mean = 9.1%) that were not significantly different than the receptor levels of controls. Ektacytometry of opioid dependent patients with high opioid receptor levels showed changes in rheological parameters of erythrocytes, such as deformability index and cellular hydration. For example, a positive correlation was observed between opioid receptor levels and deformability indices among opioid-dependent patients (r = 0.74, p < 0.005). Our findings indicate that the mu opioid receptor is present on human erythrocytes, although with considerable variation in receptor levels, and that the levels of this receptor are significantly elevated with chronic opioid exposure. Moreover, erythrocytes with high opioid receptor levels from chronic opiate users seem to have high deformability. This study may offer clues to the biological properties of peripheral blood cells that may be mediated by mu opioid receptors and lead to a better understanding of some of the clinical effects of opioid use. [source] Acute isolated cerebral mucormycosis in a patient with high grade non-Hodgkins lymphomaEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2000M. Zarei A 57-year-old female in complete remission of grade IV non-Hodgkin lymphoma whilst on intensive chemotherapy, suddenly developed unilateral hemispheric stroke with a fatal outcome in 3 days. She was apyrexial and had received antifungal prophylaxis during her treatment. Post-mortem examination showed complete thrombosis of the internal carotid artery leading to infarction in the territory of the middle and anterior cerebral arteries. Microscopic examination of the brain showed involvement of intra-cranial vessel walls and brain parenchyma by mucormyces, with no evidence of systemic mucormycosis. Isolated cerebral mucormycosis is a rare occurrence, more commonly found in intravenous drug abusers, but can occur in patients with haematological malignancy. [source] Validation of the UPPS impulsive behaviour scale: a four-factor model of impulsivityEUROPEAN JOURNAL OF PERSONALITY, Issue 7 2005Stephen P. Whiteside The current study attempts to clarify the multi-faceted nature of impulsivity through the use of the four-factor UPPS Impulsive Behaviour scale. In order to build the nomological network surrounding this scale, the UPPS was administered to individuals with borderline personality disorder (BPD), pathological gamblers (PG), alcohol abusers (divided into two groups based on the presence of antisocial features), and a control group. Several of the UPPS scales (e.g. Urgency, lack of Premeditation, and Sensation Seeking) differentiated the BPD, PG, and alcohol abusers with antisocial features from a group of non-antisocial alcohol abusers and a control group. Overall, the UPPS scales accounted for between 7% (pathological gambling) and 64% (borderline personality disorder features) of the overall variance in the psychopathology measures. Individual UPPS scales also made unique contributions to several of these disorders, which may provide insight into which of these personality traits may predispose individuals to behave in maladaptive or problematic ways. The results provide support for the differentiation of impulsivity-related constructs into the current four-factor model. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||