Addiction Practice Research Articles

Coexisting addiction and mental health practices of a national addiction workforce

While coexisting mental health problems (CEP) are recognised as the norm among people seeking addiction treatment, little is known about the capability of the addiction workforce to address CEP with clients during their treatment. The aim of this study was to investigate the mental health assessment and treatment practices of addiction-treatment workers in New Zealand. Phone interviews were conducted with a representative national sample of New Zealand addiction-treatment workers (n = 232), and of these, 86 workers had recently completed a comprehensive assessment. Only 27 of this latter group reported inquiring about all five commonly experienced coexisting mental health disorders. This result differed significantly from workers’ perceived optimal assessment practice. One hundred and forty-nine from the total sample of 232 workers reported routinely addressing CEP with clients all or most of the time. The majority of workers endorsed a need for further education relating to mental health practice. Taken ...

The Exclusion of Nicotine: Closing the Gap in Addiction Policy and Practice

Addiction is a complex brain disease with frequently overlapping expressions involving nicotine, alcohol, and other drugs. Yet current health care practices, public policies, and national treatment data too often exclude nicotine or address its use as completely separate from other forms of substance use and addiction, compromising patients' health and incurring unnecessary health care costs. Effective prevention and treatment requires the inclusion of nicotine in a comprehensive approach addressing all manifestations of addiction within health care policy and practice.

Pratiques addictives dans la vieillesse

Addictive behavior still persists among the elderly, mainly concerning substance abuse, such as alcohol, tobacco or psychotropic drugs and addictive practices such as gambling. Illegal substances or cyber-addictions appear much less often. The environment (place of residence or care) and/or economic factors may influence behavior and practices. The incidence of somatic illness or psychiatric disorders, such as cognitive impairment among the elderly patients, complicates even further the presentation of addictive disorders and their treatment. The age factor does not seem to lessen the suffering felt by the patient and care is required in an equal manner for all ages. Prevention (maintenance of personal autonomy and quality of life throughout the ageing process) plays an essential role along with the offer of care. The lack of scientific data such as the absence of validation for adult care among the elderly, leave wide scope for epidemiological, clinical and theoretical research.

Association of Betel Nut with Carcinogenesis: Revisit with a Clinical Perspective

Betel nut (BN), betel quid (BQ) and products derived from them are widely used as a socially endorsed masticatory product. The addictive nature of BN/BQ has resulted in its widespread usage making it the fourth most abused substance by humans. Progressively, several additives, including chewing tobacco, got added to simple BN preparations. This addictive practice has been shown to have strong etiological correlation with human susceptibility to cancer, particularly oral and oropharyngeal cancers.The PUBMED database was searched to retrieve all relevant published studies in English on BN and BQ, and its association with oral and oropharyngeal cancers. Only complete studies directly dealing with BN/BQ induced carcinogenesis using statistically valid and acceptable sample size were analyzed. Additional relevant information available from other sources was also considered.This systematic review attempts to put in perspective the consequences of this widespread habit of BN/BQ mastication, practiced by approximately 10% of the world population, on oral cancer with a clinical perspective. BN/BQ mastication seems to be significantly associated with susceptibility to oral and oropharyngeal cancers. Addition of tobacco to BN has been found to only marginally increase the cancer risk. Despite the widespread usage of BN/BQ and its strong association with human susceptibility to cancer, no serious strategy seems to exist to control this habit. The review, therefore, also looks at various preventive efforts being made by governments and highlights the multifaceted intervention strategies required to mitigate and/or control the habit of BN/BQ mastication.

Mucocutaneous complications of smoking cessation therapies

Despite widespread knowledge of the morbidity and mortality associated with smoking, this addictive practice continues to be quite prevalent throughout the United States, as about one-fifth of the population smokes cigarettes. Because of the financial burden, and the significant psychosocial and health implications of smoking, many individuals are now attempting to quit, and often using some type of pharmacotherapy for assistance. Given that dermatologists will likely encounter patients using smoking cessation aids, it is important to be aware of their potential mucocutaneous adverse effects. We present a brief review of the dermatologic complications associated with smoking cessation therapies. Hopefully, this article will alsoremind dermatologists to encourage smoking cessation at every visit.

Preferences for evidence-based practice dissemination in addiction agencies serving women: a discrete-choice conjoint experiment.

To model variables influencing the dissemination of evidence-based practices to addiction service providers and administrators. A discrete-choice conjoint experiment. We systematically varied combinations of 16 dissemination variables that might influence the adoption of evidence-based practices. Participants chose between sets of variables. Canadian agencies (n = 333) providing addiction services to women. Service providers and administrators (n = 1379). We estimated the relative importance and optimal level of each dissemination variable. We used latent class analysis to identify subsets of participants with different preferences and simulated the conditions under which participants would use more demanding professional development options. Three subsets of participants were identified: outcome-sensitive (52%), process-sensitive (29.6%) and demand-sensitive (18.2%). Across all participants, the number of clients who were expected to benefit from an evidence-based practice exerted the most influence on dissemination choices. If a practice was seen as feasible, co-worker and administrative support influenced decisions. Client benefits were most important to outcome-sensitive participants; type of dissemination process (e.g. active versus passive learning) was more important to process-sensitive participants. Brief options with little follow-up were preferred by demand-sensitive participants. Simulations predicted that initiatives selected and endorsed by government funders would reduce participation. Clinicians and administrators are more likely to adopt evidence-based addiction practices if the practice is seen as helpful to clients, and if it is supported by co-workers and program administration.

Tabac et cannabis chez l’adolescent scolarisé de Nouméa

New Caledonia is situated in the western South Pacific 20000 km from France. In this Overseas Territory (pays d'outre-mer [POM]) the prevalence of tobacco smoking is very high and estimated at 30% among men and 34% among women. Experimenting with cannabis is also very widespread. The incidence of chronic respiratory illness and lung cancer remains high in the Territory. Modern laws protecting non-smokers still do not exist. This study aims at describing the behaviour of young people from 14 to 18 years old, at school in the public sector of Noumea, with respect to tobacco and marijuana consumption. This survey examines the way this behaviour varies according to age, sex, community, place of residence and socioeconomic conditions, in order to identify the most exposed groups. Finally, we study the effect of this consumption on the respiratory health of young school people. The enquiry was undertaken from May 4th to 15th 2009 in 16 classes drawn randomly from the colleges and secondary schools of Noumea (439 pupils). The survey consisted of an anonymous questionnaire containing 48 questions grouped into five subjects: a sociodemographic description of the subject and his/her family, the family lifestyle, tobacco consumption, marijuana consumption and a respiratory questionnaire. The completion of the questionnaires took, on average, 25 minutes and took place in class in the presence of the doctor undertaking the survey. The data were analysed with Ethnos-4 software. The analysis was made in two stages: a descriptive study after uni- and bivariate analysis and an analytical study to identify the risk factors of the addictive practices. The statistical tests used were Pearson's chi(2) test and the Hosmer-Lemeshow test for calculation of odds ratio. The participation rate was 95.2% (n = 415). The sample was predominantly female (56.6%) and 31% of the pupils were less than 16 years old. The number of tobacco smokers was considerable at 41.1%, 27.3% were regular daily smokers including 38.5% who smoked more than six cigarettes a day. The results were dependent on sex (female predominence) but independent of ethnic origin and socioeconomic factors. The number of cannabis smokers was 48% among whom 32% were regular consumers. The daily smokers were uniquely boys and the custom was more frequent among the Melanesian population. Only 11% of the pupils were worried about their consumption and, among them, only the regular smokers were more at risk of bronchial infection. In New Caledonia, tobacco consumption levels are higher than those in developed countries. We did not find a falling trend compared with previous data. The use of cannabis remains very widespread at an early age, with a male predominance for daily consumption. For both, these addictions the perception of the risk and the desire to stop are weak. The population studied is representative of teenagers in the public sector schools in Grand-Noumea but probably does not reflect the situation on the whole territory. The results obtained suggest the value of a study of the whole of New Caledonia, the eventual purpose being to guide the public health authorities towards policies that help the young people of the country.

Étude comparative de l’attirance, la fréquence et l’intensité des conduites addictives chez les étudiants et les étudiantes

Objectives When facing to the stressful conditions of the academic living style, students seem to develop various addictive behaviours. These behaviours sometimes correspond to the use of a substance, sometimes to an addictive practice without any substance. Addictive behaviours are identified as a major public health problem and may occur for every student. However, differences are observed according to their gender. These differences mainly concern the prevalence, the reasons of use, and the psychological comorbidities, etc. Consequently, the aim of this study was to assess the male and female students’ addictive behaviour referring to three additional criteria: the attraction with the addictive behaviour, the incidence and the intensity of addictive behaviours with and without substances. These criteria have been estimated for three addictive behaviours related to substance use (alcohol, tobacco and cannabis) and three addictive behaviours without any substance (sport practice, the Internet use, and eating behaviours). These addictive behaviours are considered as the most frequently reported for the students. Procedure and participants The attraction, incidence and intensity of the seven addictive behaviours have been estimated with the different specific versions of the Intensity of Addictive Behaviours Assessment Questionnaire (Décamps, Battaglia et Idier, sous presse [11]). The seven specific versions of the questionnaire was administered to a 354-students sample, composed with 281 girls (79,4 %) and 73 boys (20,6 %). The order of the seven questionnaires was randomised. Results The comparison between male and female students revealed that the use of tobacco failed to reach statistical significance for the attraction, incidence and intensity score. This addictive behaviour is the only one that appears indistinctly between the two groups of students. The main results stated that most of the other forms of addiction seem to be more specific of either the male students or the female. The male students generally reported higher scores for alcohol use, cannabis use and sport practice than the female. Contrarily, addictive eating behaviours are more frequently reported for the female students. Conclusion According to the differences observed between male and female students’ addictive behaviours, the results emphasise the importance of gender-specific actions of prevention and specific care for the consequences of such any addictions.

Beliefs About and Attitudes Toward Gambling in French-Speaking Switzerland

The present study aims to analyze attitudes and beliefs of the French-speaking general Swiss population (n=2500; female n=1280; mean age=43years) as regards gambling, which are to date almost exclusively studied in the North American and Australian contexts. Beliefs related to gambling include the perception of the effectiveness of preventive measures toward gambling, the comparative risk assessment of different addictive behaviors, the perceived risks of different types of gambling and attitudes are related to the gambler's personality. The general population perceived gambling rather negatively and was conscious of the potential risks of gambling; indeed, 59.0% of the sample identified gambling as an addictive practice. Slot machines were estimated to bear the highest risk. Compared with women and older people, men and young people indicated more positive beliefs about gambling; they perceived gambling as less addictive, supported structural preventive measures less often, and perceived gambling as a less serious problem for society. Gamblers were more likely to put their practices into perspective, perceiving gambling more positively than non-gamblers. General population surveys on such beliefs can deliver insights into preventive actions that should be targeted to young men who showed more favorable views of gambling, which have been shown to be associated with increased risk for problematic gambling.

News and Notes

News and Notes

Reliability and Validity of Measurement Tools Used in Addictions Research and Practice

Based on the degree of reliability and validity, a clinician or researcher can make an informed decision on using a measurement tool on a desired population. It is very important to know the develo...

P.459 Replacement of hepatitis C virus genotype 1b by genotype 2 over a 10 year period in Venezuela

Sharing of contaminated injection equipment accounts for the rapid spread of the humanimmunodeficiency virus (HIV) among injecting drug users (IDUs). The profile of drug addiction practice among inmates of the Shek Kwu Chan Drug Rehabilitation Centre in Hong Kong was studied. Registers on all the new admissions to the Centre during a two-year period between 1990 and 1992 were reviewed. Of the 3129 drug users studied, 68.7% were aged between 21 and 40; 84.8% were IDUs and heroin was the commonest drug of addiction. Nearly 70% of the IDUs had never shared injection equipment with others. There were significantly more young addicts (⩽ 30 years old) who had shared needles compared with the older ones (31.2% vs 26.8%, P < 0.05). Those with addiction time > 6 months were more likely to have shared needles than the new ones. Only 19% of the drug users accepted HIV testing at their first admission. Factors speculated for the low needle-sharing rates among IDUs in Hong Kong and the low HIV prevalence in the IDU population are discussed. It is of utmost importance to monitor continuously such a high-risk behaviour pattern so as to design appropriate intervention strategies to stop the transmission of HIV.

The Future of Social Work Practice in Addictions

Few social workers specialize in addictions practice. That number may grow in the years ahead due to demographic changes in the population, an expanding definition of addiction, and other factors. Social workers in all areas of practice see clients with addictions and their family members, but there is a large gap in the numbers who need treatment and receive it. The social work workforce of the future must be better equipped to develop and identify prevention and treatment services that are both appealing to clients and effective. These services may need to be offered in other setting where clients are seen. There is also much work to be done in the years ahead in the political environment to make treatment available and to see that individuals with addictions are treated fairly. Substantial research is being conducted on genetics and the brain chemistry of addiction. Psychosocial factors are also believed to play a substantial role in the development of addictions, thus ensuring social workers place in the addictions field in the years ahead.

Drug injection cessation among HIV-infected injecting drug users

This article reports findings from a cohort study that investigated drug injection cessation over an 18-month period among HIV-infected injecting drug users followed up in a clinical setting. At 18th month visit, individuals reporting persistent injection practices were compared with individuals who reported drug injection cessation for at least 12 months. Crude and adjusted odds ratios were used to assess the impact of change in addictive and sexual behaviors, contacts with the drug network, depression, negative life events, clinical status, HIV therapy, and drug maintenance treatment (DMT) on drug injection cessation. After multiple adjustment, a general decrease of addiction practices (alcohol and cannabis) and of unsafe sexual behaviors significantly accompanied injection cessation. Individuals with higher education level, still in contact with the drug network, and not yet treated for their HIV disease were significantly more likely to persist injecting behaviors. These results underscore the importance and the need of monitoring addiction practices and unsafe sexual behaviors among HIV-positive individuals to properly address primary and secondary prevention in the era of highly active antiretroviral treatments (HAART).

Evaluation of buprenorphine maintenance treatment in a French cohort of HIV-infected injecting drug users

Background: Buprenorphine was approved in France for treating opiate dependence in July 1995 and can be prescribed by general practitioners (GPs). Most studies assessing buprenorphine maintenance treatment (BMT) outcomes have taken place in GP settings. An evaluation of BMT outcomes in patients already followed for their HIV-infection could supply additional information about the changes in addictive practices in a non-GP setting. Methods: We assessed BMT discontinuations and the course of self-reported addictive behaviours and characteristics associated with buprenorphine-injection misuse in 114 HIV-infected patients on BMT who were followed in a hospital-based outpatient department. Results: The continuous series of follow-up visits at which these 114 patients reported regular buprenorphine prescriptions accounted for 237.5 person-years of observation, i.e. 475 follow-up visits. Of the 114 patients on BMT, 43% continued BMT throughout the follow-up, 40% stopped it, and results for 17% were not available either because they did not answer the self-administered questionnaire (5%) or because they were lost to follow-up (12%). Addictive behaviours declined but buprenorphine injection misuse remained stable. Depression measured by the CESD score (RR=1.04 95%CI [1.01–1.06]), cocaine use (RR=2.48 95%CI [1.31–4.68]) and alcohol consumption exceeding 4 alcohol units (AU) per day (RR=2.29, 95%CI [1.17–4.46]) were independently associated with buprenorphine injection misuse among stabilised BMT patients. Conclusions: Despite the reduction in drug injection after starting BMT, buprenorphine injection misuse mainly involves patients with characteristics of severe addiction. Better monitoring of the illicit drug use patterns of patients on BMT may suggest new medical strategies for GPs to improve BMT outcomes.

Teaching Evidence-Based Addiction Practice: Project MATCH Comes to the Classroom

ABSTRACT This article describes a teaching model used in two sites (Dublin, Ireland, and San Diego) to train students in different methods of substance abuse treatment. Addiction Studies students and graduate social work students received treatment manuals that were used in Project MATCH, a large federally funded clinical trial of alcoholism treatments. For the Project MATCH study, three methods of treatment were used: Cognitive-Behavioral, Motivational Enhancement, and Twelve-Step Facilitation. The manuals describe each intervention, which the students adapted to a group setting. Students presented and then role-played each method, demonstrating the various elements of each model. Results of Project MATCH were then discussed. Students reported surprise at the level of sophistication in substance abuse treatment, increased comfort in group work skills, willingness to examine other models of treatment, and a recognition of the connection between research and practice.

The Search for Evidence-Based Addiction Practice in the United Kingdom

ABSTRACT This paper examines the case for evidence-based practice and its application to social work. Developments in evidence-based practice in the field of substance misuse treatment that are of particular interest to social workers, such as Motivational Enhancement Therapy (MET), Community Reinforcement Approach (CRA), and Social Be havior and Network Therapy (SBNT) are described.

Cycle of Change: ideas, issues and implications

The cycle of change model has been influential in our understanding of addictive behaviour since it was first developed in the early 1980s. It has been widely accepted and has guided practice in addictions particularly and in health psychology more generally. This is in spite of a number of significant problems in terms of its construct and predictive validity. This article summarizes the key contemporary criticisms of the cycle of change model and poses the question of why, in the face of these criticisms, does it remain so popular among researchers and clinicians alike.

Treatment of Methamphetamine Cravings With Bupropion

Treatment of Methamphetamine Cravings With Bupropion

Development, Preliminary Testing and use of the Parenting Tracking form in Perinatal Addiction Treatment

An instrument for assessing the parent-child relationship over time was developed and tested for clinical application, using a transactional development framework. It was used each month by the primary therapist for each of 18 mother-child dyads for a period of 14 months, resulting in 128 incidences of use of the tool. Items are related to the Mental Development Index (MDI) subscale of the Bayley Scale for Infant Development (BSID). Exploratory factor analysis to test construct validity yielded three factors that accounted for 84.8% of the variance, with factor loadings of. 52143 to.78355. Results describe the nature of the parenting relationship during addiction recovery for this sample, and indicate the usefulness of this instrument for assessing the nature of the parenting relationship during addiction recovery. Implications for perinatal addiction research and practice include encouraging healthy parent-child interactions that support the continuing development of the child.