History Of Substance Dependence Research Articles

Preparedness for healthy ageing and polysubstance use in long-term cannabis users: a population-representative longitudinal study

SummaryBackgroundCannabis is often characterised as a young person’s drug. However, people who began consuming cannabis in the 1970s and 1980s are no longer young and some have consumed it for many years. This study tested the preregistered hypothesis that long-term cannabis users show accelerated biological ageing in midlife and poorer health preparedness, financial preparedness, and social preparedness for old age.MethodsIn this longitudinal study, participants comprised a population-representative cohort of 1037 individuals born in Dunedin, New Zealand, between April, 1972, and March, 1973, and followed to age 45 years. Cannabis, tobacco, and alcohol use and dependence were assessed at ages 18 years, 21 years, 26 years, 32 years, 38 years, and 45 years. Biological ageing and health, financial, and social preparedness for old age were assessed at age 45 years. Long-term cannabis users were compared using independent samples t tests with five groups: lifelong cannabis non-users, long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. In addition, regression analyses tested dose–response associations for continuously measured persistence of cannabis dependence from age 18 years to 45 years, with associations adjusted for sex, childhood socioeconomic status, childhood IQ, low childhood self-control, family substance dependence history, and persistence of alcohol, tobacco, and other illicit drug dependence.FindingsOf 997 cohort members still alive at age 45 years, 938 (94%) were assessed at age 45 years. Long-term cannabis users showed statistically significant accelerated biological ageing and were less equipped to manage a range of later-life health, financial, and social demands than non-users. Standardised mean differences between long-term cannabis users and non-users were large: 0·70 (95% CI 0·46 to 0·94; p<0·0001) for biological ageing, −0·72 (−0·96 to −0·49, p<0·0001) for health preparedness, −1·08 (−1·31 to −0·85; p<0·0001) for financial preparedness, and −0·59 (−0·84 to −0·34, p<0·0001) for social preparedness. Long-term cannabis users did not fare better than long-term tobacco or alcohol users. Tests of dose–response associations suggested that cannabis associations could not be explained by the socioeconomic origins, childhood IQ, childhood self-control, and family substance-dependence history of long-term cannabis users. Statistical adjustment for long-term tobacco, alcohol, and other illicit drug dependence suggested that long-term cannabis users’ tendency toward polysubstance dependence accounted for their accelerated biological ageing and poor financial and health preparedness, although not for their poor social preparedness (β −0·10, 95% CI −0·18 to −0·02; p=0·017).InterpretationLong-term cannabis users are underprepared for the demands of old age. Although long-term cannabis use appears detrimental, the greatest challenge to healthy ageing is not use of any specific substance, but rather the long-term polysubstance use that characterises many long-term cannabis users. Substance-use interventions should include practical strategies for improving health and building financial and social capital for healthy longevity.

SAVAŞ NEDENİYLE ÜLKELERİNDEN GÖÇEN SURİYELİLERİN YAŞAM KOŞULLARI VE PSİKOSOSYAL DURUMLARI: BURSA ÖRNEĞİ

Amaç: Bu çalışmanın amacı Suriye’de ortaya çıkan savaş sonucu bulundukları yerleri terk etmek zorunda kalan ve Türkiye’de yaşayan Suriyeli göçmenlerin depresyon, anksiyete seviyeleri ve ilişkili sosyal, ekonomik ve kültürel faktörler ve göçmenlerin yaşam koşullarını incelemektir. Yöntem: Gözlemsel bir çalışma olan bu araştırmanın evrenini Bursa ilinin Yıldırım bölgesinde yaşayan 18- 65 yaş arası Yıldırım Göçmen Sağlığı Merkezi’ne başvuran gönüllü ve sağlıklı 254 Suriyeli katılımcı oluşturdu. Araştırmada katılımcılara yüz yüze görüşme yöntemi ile Arapça bilen araştırmacı tarafından gerekli görüldüğünde tercüman desteği ile anket uygulandı. Katılımcılara Göçmen Sağlığı Merkezi (GSM) İzleme ve Değerlendirme Formu, Beck Depresyon Ölçeği (BDÖ), Beck Anksiyete Ölçeği (BAÖ) uygulandı. Bulgular: Katılımcıları depresyon ve anksiyete düzeylerinde yükseklik vardı. Kadınların depresyon ve anksiyete düzeyleri erkeklerden anlamlı olarak yüksekti. Anksiyete ve depresyon düzeyleri ile gebelik sayısı ve düşük sayısı arasında pozitif yönde zayıf ilişki vardı. Madde bağımlılığı olanların depresyon düzeyleri madde bağımlılığı olmayanlara göre anlamlı yüksekti. Sonuç: Mültecilerin psikolojik ve sosyal ihtiyaçlarının giderilmesine yönelik psikososyal destek programlarının geliştirilmesi faydalı olabilir.

A study on profile of patients using inhalants attending in a tertiary care center of East India

Background: There is a slow but steady increase in inhalant use in India among adolescent age group. There is a very few studies regarding inhalant use disorder in India. No study has been reported from West Bengal. Aims and Objectives: In our study, we aimed to study the sociodemographic and clinical profile of patients using inhalants. Materials and Methods: A cross-sectional clinic-based study conducted in a tertiary care center medical college hospital of West Bengal. All patients attending in the outpatient department with a history of inhalant use were taken in this study irrespective of diagnosis and purpose of visit. Duration of the study was 18 months. Sociodemographic and clinical profiles were obtained using asemi-structured pro forma. Results: We studied 26 patients. All were unmarried male from urban background, middle to lower socioeconomic status. Most of them were from nuclear family. Mean age was 15.2 years. Most of them were studying (69.2%). Inhalant was the preferred substance for all of them. Tobacco was the most common substance used along with inhalants. The most common inhalants substance was glue (Dendrite) 84.6%. Sniffing (80.8%) was the most common form of inhalation. For all of the patients, inhalation was out of curiosity. Only 23.1% had a positive family history of substance dependence. The most common comorbidity found was conduct disorder (30.8%). Motivation for quitting was poor for most of the patients. Conclusion: Inhalant use disorder is an important but still unexplored research area in West Bengal. Although not common, inhalant use disorder is not rare in clinical setting.

Long-Term Cannabis Use and Cognitive Reserves and Hippocampal Volume in Midlife.

Cannabis use is increasing among midlife and older adults. This study tested the hypotheses that long-term cannabis use is associated with cognitive deficits and smaller hippocampal volume in midlife, which is important because midlife cognitive deficits and smaller hippocampal volume are risk factors for dementia. Participants are members of a representative cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972-1973 and followed to age 45, with 94% retention. Cannabis use and dependence were assessed at ages 18, 21, 26, 32, 38, and 45. IQ was assessed at ages 7, 9, 11, and 45. Specific neuropsychological functions and hippocampal volume were assessed at age 45. Long-term cannabis users showed IQ decline from childhood to midlife (mean=-5.5 IQ points), poorer learning and processing speed relative to their childhood IQ, and informant-reported memory and attention problems. These deficits were specific to long-term cannabis users because they were either not present or were smaller among long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. Cognitive deficits among long-term cannabis users could not be explained by persistent tobacco, alcohol, or other illicit drug use, childhood socioeconomic status, low childhood self-control, or family history of substance dependence. Long-term cannabis users showed smaller hippocampal volume, but smaller hippocampal volume did not statistically mediate cannabis-related cognitive deficits. Long-term cannabis users showed cognitive deficits and smaller hippocampal volume in midlife. Research is needed to ascertain whether long-term cannabis users show elevated rates of dementia in later life.

A Cross-sectional Study of the Patterns and Impact of Socio-demographic Factors in Anxious and Depressed Alcohol Dependent Patients

Introduction: Socio-demographic factors may play a pivotal role in anxious and depressed alcohol dependent patients. Identifying the patterns and impact of these factors may be important in the successful management of Alcohol Use Disorders (AUDs). Aim: To assess the patterns and impact of socio-demographic factors in anxious and depressed alcohol dependent patients. Materials and Methods: This cross-sectional study was conducted at Rama Medical College Hospital and Research Center Hapur, Uttar Pradesh, India, from August 2018 to January 2020. Patients with history of substance dependence, gross brain damage, severe medical complications, or evidence of drinking during the hospital stay were excluded. Severity of Alcohol Dependence Questionnaire (SADQ) was used to rate the extent of alcohol dependence and Hamilton Depression Rating Scale (HAM-D or HDRS) to rate depression. Sociodemographic data was recorded in each patient which included age, gender, background, education level, employment status, occupation, marital status, and family type. The severity of anxiety symptoms was measured on Hamilton Anxiety Rating Scale (HAM-A). Independent t-tests, Chi-square tests, oneway Analysis of Variance (ANOVA) and Pearson’s correlation analysis were used for statistical analysis. A p-value &lt;0.05 was considered statistically significant. Results: The total of 90 alcohol dependent patients with mean age of 37.6±9.3 years and mean HDRS score was 8.5±4.3. The overall prevalence of depression cohort was. Out of these 30 (33.3%) had mild and 6 (6.7%) had moderate depression, respectively. The mean Hamilton anxiety scale score was 18.6±5.2. Patients who had a lower Socio-economic Status (SES) (p-value= 0.049 and 0.004), were martially separated (p-value&lt;0.001 and 0.027), living in a nuclear family (p-value=0.005 and &lt;0.001) and were unemployed (p-value&lt;0.001 and p-value&lt;0.001) had significantly higher depression and anxiety scores, respectively. Conclusion: In anxious and depressed alcohol dependent patients, lower SES, martial separation, living as a single family and unemployment significantly influenced depression and anxiety

Temporal instability in brain activation: a novel paradigm for evaluating the maintenance of attention among substance dependent patients.

Prior studies have demonstrated statistically significant but subtle differences in brain function between patients with a history of substance dependence (SD) and control groups. The goal of the present study was to show that variability in brain activation over the trials of a cognitive task is more useful for revealing the putative impact of SD than analyses focusing on the amplitude of activation averaged over trials. The study also tested the additional contribution of antisocial personality disorder (ASPD)-a prevalent comorbidity that promotes both an early onset and more severe course of SD. Two hundred eleven adults performed two selective attention tasks while P300 event-related electroencephalographic potentials were recorded. They were assigned to one of 3 mutually exclusive groups: no lifetime history of SD or ASPD (n = 67), a SD history but no ASPD (n = 68), or both SD and ASPD (n = 76). The major finding was a statistically significant elevation of P300 amplitude inter-trial variability (ITV) in the SD plus ASPD group in comparison to the group with neither attribute. The elevation was detected during both selective attention tasks and most prominent at electrodes sites located over the frontal brain. There were no group differences in P300 amplitude averaged over trials. We conclude from these findings that the ITV of P300 amplitude is an efficient and sensitive biomarker of the maintenance of attention. It is valuable for revealing group differences associated with substance dependence and ASPD. It may ultimately be valuable for detecting improvements resulting from psychostimulant treatment or other interventions, including cognitive remediation.

Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history.

BackgroundThis study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. MethodsThe study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence.ResultsInadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). ConclusionsInadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.

Validation of the Substance Use Risk Profile Scale (SURPS) With Bulgarian Substance Dependent Individuals.

Background: The Substance Use Risk Profile Scale (SURPS) is a 23-item self-report questionnaire that assesses four well-validated personality risk factors for substance misuse (Impulsivity, Sensation Seeking, Anxiety Sensitivity, and Hopelessness). While the SURPS has been used extensively with adolescents at risk for substance dependence, its properties with adult substance-dependent populations have been understudied. Further, the validity of the Bulgarian version of the SURPS has not been evaluated. The aims of the present study were to examine the factor structure of the Bulgarian version of the SURPS, its psychometric properties, and its ability to distinguish individuals with substance dependence from healthy controls.Methods: Participants included 238 individuals ages 18 to 50 (45% female): 36 “pure” (i.e., mono-substance dependent) heroin users, 34 “pure” amphetamine users, 32 polysubstance users, 64 controls with no history of substance dependence, 43 unaffected siblings of heroin users, and 29 unaffected siblings of amphetamine users. We explored the factor structure of the Bulgarian version of the SURPS with confirmatory factor analyses, examined its reliability and validity, and tested for group differences between substance dependent and non-dependent groups.Results: Confirmatory factor analyses (CFA) replicated the original four-factor model of the SURPS. The four subscales of the SURPS demonstrated good internal consistency (Cronbach's alphas ranged from 0.71 to 0.85) and adequate concurrent validity. Significant group differences were found on the Impulsivity and Sensation Seeking subscales, with the three substance dependent groups scoring higher than controls.Conclusions: The SURPS is a valid instrument for measuring personality risk for substance use disorders in the Bulgarian population. The Bulgarian version of the SURPS demonstrates adequate to good reliability, concurrent validity, and predictive validity. Its ability to distinguish between groups with and without a history of substance dependence was specific to externalizing traits such as Impulsivity and Sensation Seeking, on which opiate, stimulant, and polysubstance dependent individuals scored higher than non-dependent controls.

Reward-Based Learning as a Function of Severity of Substance Abuse Risk in Drug-Naïve Youth with ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is associated with elevated risk for later development of substance use disorders (SUD), specifically because youth with ADHD, similar to individuals with SUD, exhibit deficits in learning abilities and reward processing. Another known risk factor for SUD is familial history of substance dependence. Youth with familial SUD history show reward processing deficits, higher prevalence of externalizing disorders, and higher impulsivity scores. Thus, the main objective of this proof-of-concept study is to investigate whether risk loading (ADHD and parental substance use) for developing SUD in drug-naïve youth impacts reward-related learning. Forty-one drug-naïve youth, stratified into three groups: Healthy Controls (HC, n = 13; neither ADHD nor parental SUD), Low Risk (LR, n = 13; ADHD only), and High Risk (HR, n = 15; ADHD and parental SUD), performed a novel Anticipation, Conflict, and Reward (ACR) task. In addition to conventional reaction time (RT) and accuracy analyses, we analyzed computational variables including learning rates and assessed the influence of learned predictions of reward probability and stimulus congruency on RT. The multivariate ANOVA on learning rate, congruence, and prediction revealed a significant main Group effect across these variables [F(3, 37) = 3.79, p = 0.018]. There were significant linear effects for learning rate (Contrast Estimate = 0.181, p = 0.038) and the influence of stimulus congruency on RTs (Contrast Estimate = 1.16, p = 0.017). Post hoc comparisons revealed that HR youth showed the most significant deficits in accuracy and learning rates, while stimulus congruency had a lower impact on RTs in this group. LR youth showed scores between those of the HC and HR youth. These preliminary results suggest that deficits in learning and in adjusting to task difficulty are a function of increasing risk loading for SUD in drug-naïve youth. These results also highlight the importance of developing and applying computational models to study intricate details in behavior that typical analytic methodology may not be sensitive to.

Decision-Making Under Risk, but Not Under Ambiguity, Predicts Pathological Gambling in Discrete Types of Abstinent Substance Users.

This study explored how different forms of reward-based decision-making are associated with pathological gambling (PG) among abstinent individuals with prior dependence on different classes of drugs. Participants had lifetime histories of either “pure” heroin dependence (n = 64), “pure” amphetamine dependence (n = 51), or polysubstance dependence (n = 89), or had no history of substance dependence (n = 133). Decision-making was assessed via two neurocognitive tasks: (1) the Iowa Gambling Task (IGT), a measure of decision-making under ambiguity (i.e., uncertain risk contingencies); and (2) the Cambridge Gambling task (CGT), a measure of decision-making under risk (i.e., explicit risk contingencies). The main effects of neurocognitive performance and drug class on PG (defined as ≥3 DSM-IV PG symptoms) as well as their interactional effects were assessed via multiple linear regression. Two CGT indices of decision-making under risk demonstrated positive main effects on PG. Interaction effects indicated that the effects of decision-making under risk on PG were largely consistent across participant groups. Notably, a linear relationship between greater CGT Risk-Taking and PG symptoms was not observed among amphetamine users, whereas IGT performance was selectively and positively associated with PG in polysubstance users. Overall, results indicate that reward-based decision-making under risk may represent a risk factor for PG across substance users, with some variations in these relationships influenced by specific class of substance of abuse.

Disrupted resting brain graph measures in individuals at high risk for alcoholism

Familial susceptibility to alcoholism is likely to be linked to the externalizing diathesis seen in high-risk offspring from high-density alcohol use disorder (AUD) families. The present study aimed at comparing resting brain functional connectivity and their association with externalizing symptoms and alcoholism familial density in 40 substance-naive high-risk (HR) male offspring from high-density AUD families and 30 matched healthy low-risk (LR) males without a family history of substance dependence using graph theory-based network analysis. The HR subjects from high-density AUD families compared with LR, showed significantly reduced clustering, small-worldness, and local network efficiency. The frontoparietal, cingulo-opercular, sensorimotor and cerebellar networks exhibited significantly reduced functional segregation. These disruptions exhibited independent incremental value in predicting the externalizing symptoms over and above the demographic variables. The reduction of functional segregation in HR subjects was significant across both the younger and older age groups and was proportional to the family loading of AUDs. Detection and estimation of these developmentally relevant disruptions in small-world architecture at critical brain regions sub-serving cognitive, affective, and sensorimotor processes are vital for understanding the familial risk for early onset alcoholism as well as for understanding the pathophysiological mechanism of externalizing behaviors.

Psychosocial Factors Associated with Relapse in Patients with Alcohol Dependence.

Introduction:Despite the recent developments in the biology of addiction, a significant part of relapse and its management is still influenced by psychosocial factors and the interplay between them. This study aims at finding the extent of association of various psychosocial factors with relapse in patients of alcohol dependence.Materials and Methods:It is a cross-sectional study of two groups of alcohol dependence patients: abstinence (n = 31) and relapse (n = 35). Demographic, clinical, and psychosocial variables were compared between the two groups. Statistical analyses were aimed at finding the extent of association between various factors and relapse.Results:Demographic variables such as family history of substance dependence (odds ratio [OR] =2.09; confidence interval [CI] =0.74–5.90) and past history of ≥2 relapses (OR = 2.71; CI = 0.83–8.87) were associated with relapse in alcohol dependence. Clinical variables such as younger age of onset of dependence (Mean difference = −3.93; 95% CI = −7.66 - −0.21; P = 0.038) and shorter time to develop dependence (Mean difference = −3.08; 95% CI = −5.53 -−0.63; P = 0.014) were significantly associated with relapse. Of the psychosocial variables, coping behavior (OR = 6.54; CI = 1.17–36.74) had the highest association with relapse followed by relapse precipitants (OR = 1.42; CI = 1.16–1.74).Conclusion:Coping behaviors to adverse situations have greater association with relapse among psychosocial variables than the number of high-risk situations a patient experiences. Interventions targeted at improving coping skills can help patients stay abstinent.

Plasma Inflammatory Factors Are Associated with Anxiety, Depression, and Cognitive Problems in Adults with and without Methamphetamine Dependence: An Exploratory Protein Array Study.

It is hypothesized that immune factors influence addictive behaviors and contribute to relapse. The primary study objectives were to (1) compare neuropsychiatric symptoms across adults with active methamphetamine (MA) dependence, in early remission from MA dependence, and with no history of substance dependence, (2) determine whether active or recent MA dependence affects the expression of immune factors, and (3) evaluate the association between immune factor levels and neuropsychiatric symptoms. A cross-sectional study was conducted using between group comparisons and regression analyses to investigate associations among variables. Eighty-four adults were recruited into control (CTL) (n = 31), MA-active (n = 17), or MA-remission (n = 36) groups. Participants completed self-report measures of anxiety, depression, and memory complaints and objective tests of attention and executive function. Blood samples were collected, and a panel of immune factors was measured using multiplex technology. Relative to CTLs, MA-dependent adults evidenced greater anxiety and depression during active use (p < 0.001) and remission (p < 0.007), and more attention, memory, and executive problems during remission (p < 0.01) but not active dependence. Regression analyses identified 10 immune factors (putatively associated with cytokine-cytokine receptor interactions) associated with anxiety, depression, and memory problems. While psychiatric symptoms are present during active MA dependence and remission, at least some cognitive difficulties emerge only during remission. Altered expression of a network of immune factors contributes to neuropsychiatric symptom severity.

Which adolescents develop persistent substance dependence in adulthood? Using population-representative longitudinal data to inform universal risk assessment.

To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood. Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years. A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80). A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.

Venlafaxine extended-release for depression following spinal cord injury: a randomized clinical trial.

Depression is prevalent and associated with negative outcomes in individuals with spinal cord injury (SCI). Antidepressants are used routinely to treat depression, yet no placebo-controlled trials have been published in this population to our knowledge. To determine the efficacy and tolerability of venlafaxine hydrochloride extended-release (XR) for major depressive disorder (MDD) or dysthymic disorder in persons with chronic SCI. Multisite, randomized (1:1), double-blind, placebo-controlled Project to Improve Symptoms and Mood After SCI (PRISMS) trial. All research staff conducting screening, intervention, and outcome procedures were blinded to randomization status. We screened 2536 patients from outpatient clinics at 6 SCI treatment centers in the United States and randomized 133 participants into the trial. Participants were 18 to 64 years old and at least 1 month after SCI, with MDD or dysthymic disorder. Seventy-four percent of participants were male, and participants were on average 40 years old and 11 years after SCI. Forty-seven percent had cervical injuries, 53.4% had American Spinal Injury Association injury severity A (complete injury) SCI, 24.1% had at least 2 prior MDD episodes, and 99.2% had current MDD. Common comorbidities included chronic pain (93.9%), significant anxiety (57.1%), and history of substance dependence (44.4%). Twelve-week trial of venlafaxine XR vs placebo using a flexible-dose algorithm. The Hamilton Depression Rating Scale (HAM-D 17-item version and Maier subscale, which focuses on core depression symptoms and excludes somatic symptoms) over 12 weeks. Mixed-effects models revealed a significant difference between the venlafaxine XR and placebo groups in improvement on the Maier subscale from baseline to 12 weeks (treatment effect, 1.6; 95% CI, 0.3-2.9; P = .02) but not on the HAM-D 17-item version (treatment effect, 1.0; 95% CI, -1.4 to 3.4; P = .42). Participants receiving venlafaxine XR reported significantly less SCI-related disability on the Sheehan Disability Scale at 12 weeks compared with placebo (treatment effect, 4.7; 95% CI, 1.5-7.8; P = .005). Blurred vision was the only significantly more common new or worsening adverse effect in the venlafaxine XR group compared with the placebo group over 12 weeks. Venlafaxine XR was well tolerated by most patients and an effective antidepressant for decreasing core symptoms of depression and improving SCI-related disability. Further research is needed to determine the optimal treatment and measurement approaches for depression in chronic SCI. clinicaltrials.gov Identifier: NCT00592384.

Drug use, abuse, and dependence and the persistence of nicotine dependence.

Illicit drug use and nicotine dependence (ND) frequently co-occur. Yet, to date very few studies have examined the role of alcohol and illicit drug use in ND persistence. The objectives of this study were to investigate the relationships between specific classes of drug use, abuse, and dependence and the persistence of ND over time among adults in the United States. Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a national survey of 34,653U.S. adults interviewed between 2001-2002 and reinterviewed 3 years later. Logistic regression analyses were used to investigate the relationships between various classes of drug use, abuse, and dependence among adults with ND at Wave 1 and the odds for persistent ND at Wave 2. Analyses were adjusted for differences in demographic characteristics, mood/anxiety disorders, alcohol use disorders, and other substance use disorders. Lifetime drug use was not associated with significantly increased likelihood for persistent ND. Sedative abuse was associated with increased odds for nicotine persistence, but no other types of drug abuse were predictive of ND persistence, after adjusting for demographics, mood/anxiety, and alcohol use disorders. All types of drug dependence were associated with persistence of ND; the strongest associations emerged between opioid and tranquilizer dependence and persistent ND, while the associations between cannabis and cocaine dependence were no longer significant after adjusting for mood/anxiety disorders. Clinicians should take care to evaluate the presence and/or history of drug dependence among patients seeking treatment for smoking cessation. These data suggest that a history of substance dependence predicts increased vulnerability to persistent ND.

Experiences of mothers with substance dependence: Informing the development of parenting support.

To understand the experiences of women with a history of substance dependence when they attempted to gain parenting support. Becoming a mother provides a window of opportunity to support women with a substance dependence make changes to their lives and the way they will parent their infants and young children. Yet there are many barriers and a constant fear of the removal of their children from their care. Focus groups were conducted using a qualitative interpretive descriptive approach to enable exploration of the women's experiences as mothers with infants and young children. A series of three focus groups were facilitated with three to six women per group. Thirteen women who were substance dependent participated in this study. Semi-structured interviews guided the collection of data. Thematic content analysis was used to work with the data. Four themes were identified: (1) feelings of guilt, (2) judged by others, (3) normalising and (4) support and learning to be a mother. The mothers expressed alienation from mainstream health services. Providing parenting and child health services, which avoid mothers feeling judged by the staff and other mothers, is an important step to enabling these women to appropriately and sensitively care for their infants and young children. Midwives and nurses working with mothers and their infants and young children are well positioned to support women who are or have experienced substance dependence. Working with this group of mothers requires the development of a therapeutic relationship to provide optimum support, education and, if necessary, intervention.

Psychopathy in Bulgaria: The cross-cultural generalizability of the Hare Psychopathy Checklist.

The generalizability of the psychopathy construct to Eastern European cultures has not been well-studied, and no prior studies have evaluated psychopathy in non-offender samples from this population. The current validation study examines the factor structure, internal consistency, and external validity of the Bulgarian translation of the Hare Psychopathy Checklist: Screening Version. Two hundred sixty-two Bulgarian adults from the general community were assessed, of which 185 had a history of substance dependence. Confirmatory factor analysis indicated good fit for the two-, three-, and four-factor models of psychopathy. Zero-order and partial correlation analyses were conducted between the two factors of psychopathy and criterion measures of antisocial behavior, internalizing and externalizing psychopathology, personality traits, addictive disorders and demographic characteristics. Relationships to external variables provided evidence for the convergent and discriminant validity of the psychopathy construct in a Bulgarian community sample.

Substance use disorders in men presenting to a psychosexual clinic.

Introduction. Substance use disorders (SUDs) are commonly associated with a variety of psychiatric disorders. Community-based studies have found a significant association between SUDs and sexual dysfunction in men, with a possible causal relation in the case of nicotine. Methods. The case records of 105 men presenting to a clinic for patients with psychosexual disorders were reviewed. Men with and without comorbid SUDs were compared in terms of demographic, clinical, and familial variables. Results. 25 of the 105 men (23.8%) had a lifetime diagnosis of SUD, and 19 (18.1%) had a current SUD. The commonest substances involved were nicotine (n = 21, 20%) and alcohol (n = 9, 9.5%). Men with comorbid SUDs were more likely to report a family history of substance dependence, particularly alcoholism. Single men with SUDs were more likely to have a comorbid mood disorder. Conclusion. SUDs, particularly nicotine and alcohol use disorders, are common comorbidities in patients with psychosexual disorders. Identifying and treating these disorders in this population are important aspects of management.

Offenders as victims: post-traumatic stress disorder and substance use disorder among male prisoners

Background: Comorbid substance use disorder(s) and post-traumatic stress disorder (SUD-PTSD) is common among prisoners and linked to an increased risk of criminal recidivism; however, little is known about the characteristics of prisoners with this comorbidity. Aim: This study provides a preliminary examination of the clinical and criminal profile of male inmates with symptoms of SUD-PTSD, and examines whether this profile differs according to whether a person has experienced a trauma while in prison. Methods: Thirty male inmates from two correctional centres in Sydney, Australia, were recruited and assessed using a structured interview. Results: The sample reported extensive criminal, substance use and trauma histories. A history of substance dependence was almost universal (90%) and 56.7% met diagnostic criteria for PTSD with the remainder experiencing sub-threshold symptoms. Forty-three per cent reported a traumatic event while in prison. Those who had experienced trauma in prison, compared to those who had not, were more likely to nominate heroin as their main drug of concern and to be receiving drug treatment in prison. There was also a trend toward inmates who had experienced a trauma in prison being more likely than inmates who had no prison trauma to have experienced a physical assault. Conclusion: Male prisoners with SUD-PTSD are a high-needs group yet treatment responses are poor. Further research examining treatment options for this comorbidity may improve prisoner well-being and reduce recidivism.