Substance Dependence Syndrome Research Articles

Tertiary care de-addiction centre patients with substance dependence syndrome: A study of sociodemographic profile, sero prevalence of hepatitis B, hepatitis C, human immuno deficiency virus, and psychiatric co-morbidity

Tertiary care de-addiction centre patients with substance dependence syndrome: A study of sociodemographic profile, sero prevalence of hepatitis B, hepatitis C, human immuno deficiency virus, and psychiatric co-morbidity

Review of Factors Affecting Remission in Narcological Patients

INTRODUCTION: Achievement of a sustained remission in patients with substance dependence syndrome is the main criterion of the quality of narcological treatment and a priority treatment task. The article presents a review of factors that influence remission in patients with mental and behavioral disorders resulting from use of psychoactive substances. Studies performed in the recent 15 years, consider the main five groups of factors for development and failure of remission: biological (gender, age, genetic parameters, organic lesions of the brain, etc.), narcological (course of the disease, age at the first use of a drug), personality and pathopsychological (cognitive disorders, comorbid mental disorders, mental trauma, etc.), social (employment, family and social situation, social support, etc.) and therapeutic factors (duration and methods of treatment, therapeutic alliance, etc.)..
 CONCLUSION: There are basic factors of favorable prognosis of the course of narcological diseases that are confirmed from study to study: late onset of the disease, absence of a comorbid dependence syndrome and of a severe mental disorder, involvement in long-term treatment and rehabilitation programs that continue after remission.

Analysis of Protein Markers in Plasma of Patients with Drug Dependence Syndrome: Observational Clinical Study

Background. In drug addiction treatment, the diagnostic process is based on the chemical toxicological determination of the intoxication substrate or its metabolite. Laboratory monitoring and prediction issues that could form the basis of secondary prevention remain unresolved. Specific nervous tissue proteins are considered to be the most promising laboratory markers of drug pathology.Objective — to determine some potential biomarkers of protein-chemical nature in the plasma of patients with drug dependence syndrome.Methods. The study was conducted according to the design of an observational clinical trial at the Narcological Dispensary of Krasnodar Krai in the period from 07.2021 to 07.2022. The main group (group 2) included 31 patients diagnosed with substance dependence syndrome. The control group (group 1, n = 15) consisted of healthy subjects submitted to occupational medical examinations. During the detoxification-stabilization therapy and rehabilitation, 5 proteins were determined in the plasma: brainand glial-derived neurotrophic factors, neuron-specific enolase, alpha-synuclein and calcium-binding protein S100B. Statistical analysis of the data involved the Mann-Whitney test for comparing the values of the control and experimental groups and the Wilcoxon test for comparing the values of one group obtained at different stages of observation. The calculations were carried out using StatPlus version 7 (AnalystSoft Inc., USA).Results. A total of 31 patients were included in the main group, 18 of them were followed up with a diagnosis of opioid dependence syndrome (n = 11) or psychostimulant dependence syndrome (n = 7). Patients dropped out of the study due to their refusal to participate in the study or undergo rehabilitation, or due to relapse of the disease. When admitted to the hospital, patients indicated a 45% decrease in brain-derived neurotrophic factor in the plasma ( p < 0.001), and a 3.9-fold decrease after rehabilitation course ( p < 0.001). Glial-derived neurotrophic factor in the plasma exceeded the controls 1.9 times ( p < 0.001) upon admission to hospital, but rapidly returned to normal values thereafter. Level of neuron-specific enolase in the plasma was also poor, 36% lower than the controls ( p <0.001), but approached the control values by the end of rehabilitation.Conclusion. The study obtained data indicating the changes in neurotrophic factors in the blood plasma of patients with opioid or psychostimulant dependence. The rehabilitation period was marked by a relatively rapid improving level of neurotrophins; however, brain-derived neurotrophic factor remained reduced despite the successful treatment, which may indicate the irreversible changes.

Association between Metabolic Syndrome and Substance Dependence: A Cross-Sectional Study in Kenya

Metabolic syndrome and its defining components remain an understudied area of human health research in Kenya and Africa. Understanding the relationship between substance dependence and the occurrence of metabolic syndrome is critical in prevention and clinical management of the related complications. This was a cross-sectional study in 6 rehabilitative centers in 3 counties in Kenya with a conveniently selected sample size of 166 participants. A signed informed consent was obtained from each participant following which anthropometric and biochemical measurements were obtained. Descriptive statistics and chi-square test were used to describe the prevalence of metabolic syndrome and the relationship of the defining criteria with the substance of dependence. A quarter of the respondents were overweight and 6% obese. Fasting blood glucose was elevated in 62% of the sampled population with triglycerides having a significant variation with a mean of 216.95mg/ dL and a standard deviation of 151.107. A prevalence rate of 4.8% was established based on the Harmonized Joint Scientific Statement on Metabolic syndrome for the African region. 87.34% of the population showed at least one elevated defining criteria with alcohol as the most prevalent substance of dependence. There was statistical difference of fasting blood glucose and triglycerides with alcohol use. The findings indicate that alcohol use resulted to elevated levels of fasting blood glucose and triglycerides. There is need for emphasis on a multidisciplinary approach to substance dependence and metabolic syndrome management integrating physical activity interventions, dietary modifications and psychotherapeutic approaches.

Substance Dependence and Risk Factors for Suicide Attempt: A Retrospective Study

Introduction: Suicide is closely linked to substance abuse and it is one of the main component of premature death. Aim: To assess the factors that affect the possibility of suicidal behaviour among persons who abuse substance. Materials and Methods: The present study was a retrospective study which was conducted on 101 substance abuse patients who attempted suicide, and 101 substance abusers who have not attempted suicide. Data were collected regarding sociodemographic variables, legal problems (drunken driving/ stealing/perpetrator in domestic violence or physical abuse or sexual abuse or homicide), hereditary and addiction data. The patient was diagnosed with substance dependence syndrome, Anxiety disorders, Depression disorder and Substance-induced psychosis based on The International Classification of Diseases (ICD) 10 criteria. The socio-economic status was assessed using Modified Kuppuswamy Scale. Results: The mean age of the participants who had attempted suicide was 39 years, and those in the other was 43 years. In both the groups all subjects were males. The common abused substance was alcohol. There was a positive association between various demographic variables and attempted suicide, such as socio-economic status, education and place of residence. Early age of onset of substance abuse, abusing more than two substances, co-morbidity of psychiatry illness such as anxiety disorder, depression, and family history of psychiatry illness were the risk factors. In the ‘attempted suicide’ group, 74.2% of the participants abused drugs since more than 10 years, while it was 59.4% in the other group. There was also a positive association between the duration of abuse and attempted suicide. Conclusion: An early age of onset of drug initiation, abusing more than two substances, family history of psychiatry disorders, and co-morbid psychiatric illness increase the risk of suicide. Suicides are preventable, the need to early identification of the risk factors, assess manage and follow-up is the utmost importance of mental health professionals.

Symposium

Nomophobia is a form of behavioural addiction; defined as fear of living without having one’s smartphone. The symptoms include preoccupation with the device, excessive use with loss of control, use in socially inappropriate/dangerous situations, adverse effects on relationships and withdrawal (feelings of anger, tension, sadness when the phone/network is inaccessible, constant worry that battery will drain and craving). As nomophobia being akin to substance dependence syndrome, researchers argue that it’s better to consider Nomophobia as a separate diagnostic entity. Assessment and further intervention as per severity of Nomophobia is important as it is associated with a poorer quality of life and it is going to be a future pandemic. This symposium will discuss current concept about Nomophobia, its diagnostic position and emerging assessment and management protocols. First speaker will talk about behavioural addiction and how nomophobia fits as behavioural addiction. Second speaker will talk about clinical features and epidemiology of nomophobia in current scenario (especially in vulnerable populations: youths, children and adolescents). Third speaker will discuss about Nomophobia as a diagnostic entity. Fourth speaker will talk about assessment of such individuals. Fifth speaker will talk about different management strategies of Nomophobia.

Исследование ассоциации полиморфизма гена серотонинового рецептора HTR2C rs6318 (C23S) с синдромом зависимости от психоактивных веществ

Серотониновые рецепторы участвуют в регуляции настроения, аппетита и различных аспектов поведения. Рецепторы 5-HT2C регулируют высвобождение дофамина в полосатом теле, префронтальной коре, прилежащем ядре, гиппокампе, гипоталамусе, миндалине и некоторых других структурах мозга. Целью исследования было изучение связи полиморфизма гена HTR2C c синдромом зависимости от психоактивных веществ. В исследование было включено 1097 человек, из которых 773 человека были здоровы в отношении наркологических заболеваний, 324 были пациентами, госпитализированными с диагнозом синдром отмены, вызванным употреблением психоактивных веществ. Когорта здоровых была представлена 473 женщинами и 300 мужчинами, в то время как больных - 220 мужчинами и 104 женщинами. Частоты аллелей локуса rs6318 у женщин распределились следующим образом: у больных fG= 0,861 fC = 0,139, у здоровых fG= 0,865 fC = 0,135. ORС = 1,04 (CI=0,95: 0,67-1,60). Частоты аллелей локуса rs6318 у мужчин распределились следующим образом: у больных fG= 0,841 fC = 0,159, у здоровых fG= 0,87 fC = 0,13. ORС = 1,27 (CI=0,95: 0,77-2,07). Serotonin receptors are involved in regulation of mood, appetite and different aspects of behavior. 5-HT2C receptors modulate dopamine release in the striatum, prefrontal cortex, nucleus accumbens, hippocampus, amygdala, hypothalamus and some other brain structures. HTR2C genetic polymorphism rs6318 is known to lead to a substitution of serine for cysteine at codon 23 (Cys23Ser). There is some evidence that the Ser23 C allele is supposed to be more active than the Cys23 G allele. Despite of numerous articles about this polymorphism, the data on its contribution to substance dependence syndrome is missing. The aim of this study was to assess possible association between HTR2C rs6318 polymorphism and substance dependence syndrome. The study included 1087 participants: 773 controls and 324 patients, diagnosed with psychoactive substance dependence with withdrawal. The allele frequencies of rs6318 polymorphism were: fG= 0.861 fC = 0.139 in female patients, fG= 0.865 fC = 0.135 in female controls, in male patients fG= 0.841 fC = 0.159, and in male controls fG= 0.87 fC = 0.13.

Differences between Female and Male Inmates in Animal Assisted Therapy (AAT) in Austria: Do We Need Treatment Programs Specific to the Needs of Females in AAT?

Simple SummarySo far, many studies in the field of animal assisted therapies (AAT) show promising results in several areas for male and female participants. A newer study has found auspicious results for the target group of female inmates in 2013, which prompted our literature research and an additional gender and sex related evaluation of especially selected intervention data collected over a time period of ten years in specialized institutions with criminal offenders suffering from substance dependence syndrome. We found in our analysis that although male and female participants benefit both from the dog assisted group therapy (MTI), female drug dependent criminal offenders benefit less, especially regarding skills connected with emotions. Although practice and research in the area of AAT is booming and most studies promise positive results for a large variety of people, research has to focus on who benefits from which kind of intervention, what intensities and numbers of sessions are needed, and what prerequisites need to be met to allow benefits for all beings involved.With the growth of female inmates worldwide, research regarding specific treatment of these has become more important. Although new programs have been started, the lack of scientific results is startling. The goal of the current study was to identify differences between participants from the men’s and women’s section in a specialized prison for criminal offenders suffering from substance dependence syndrome regarding the effects of dog-assisted group therapy. Therefore, 81 incarcerated participants (50 male, 31 female) took part in a dog-assisted group therapy targeting socio-emotional competencies. Self-report questionnaires to measure self-concept (SDQ-III), emotional status (EMI-B) and emotional competencies (SEE) were employed. Statistical analysis included General Linear Model (GLM) procedures and η2 as concurrent effect size measure. Results demonstrate that participants from the women’s ward tend to benefit significantly less from the dog-assisted group therapy in most measured areas than men, especially in terms of their emotional status (e.g., aggressiveness) and emotional competencies (e.g., emotion regulation). Treatment programs specific to the needs of women might be a future challenge for practitioners and researchers in AAT.

Consultation Liaison Psychiatry: A Study at GMC

Introduction: Consultation Liaison Psychiatry is the fusion of Psychiatry and general medicine. The presence of mental disorders in physically ill people is often associated with poor medication compliance, slower or incomplete recovery, poor participation in the rehabilitation program, increased mortality and the high psychiatric comorbidity to other medical disorders in hospitalized patients significantly increases their length of hospital stay. Therefore, mental health professionals have important role to provide holistic care to people with various physical illnesses. 
 Material and Method: This is a hospital- based, cross- sectional, descriptive study conducted for the period of six months, from 1st Baisakh, 2076 (14th April, 2019) to 30th Asoj, 2076 (17th October, 2019) at the department of Psychiatry at Gandaki Medical College, Pokhara, Nepal. This study was conducted to diagnose the various psychiatric disorders among the in-patients suffering from other physical illness, which were referred from other medical specialties. The psychiatric evaluation and the diagnosis were made by the consultant psychiatrists. 
 Results: The total number of cases enrolled were163, out of which male were 96 (58.8%) and female were 67 (41.2%) in numbers. The age of the patients ranged from 6 years to 90 years with the mean age of 41.17 ± 18.57 years. Majority of the in- patient cases referred for psychiatric assessment were from the Internal medicine (42.3%), followed by ICU (23.3%), Surgery (12.8%), Orthopedics (9.8%) and Gynecology and Obstetrics (7.3%) specialty. Among the in- patient referral cases, the most common psychiatric diagnosis was substance dependence syndrome (39.2%), followed by anxiety disorder (17.1%), delirium due to general medical condition (12.2%), depression (6.7%), seizure disorder (6.7%) and intentional self harm (5.5%). 
 Conclusion: Under Consultation Liaison Psychiatry, the most common diagnoses to look for are the substance dependence syndrome, anxiety disorder, delirium, depression, seizure disorder, self harm etc.

History of the Concept of Addiction.

Our distant forebears wrestled with concepts of alcohol addiction not unlike those of today: Is addiction a sin or a disease? Is addiction caused by the gods, the substance, the individual's vulnerability, or psychological or social factors? Luther, Calvin, and Catholic Church leaders viewed moderate alcohol use as God's gift; used intemperately, it was a moral transgression. The founders of modern scientific psychiatry rejected moral explanations for addiction in favor of an early biological model. The first two versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and DSM-II) stigmatized addiction by listing it with other societally disapproved disorders stemming from personality disorder. DSM-III espoused atheoretical, descriptive diagnoses but required tolerance or withdrawal to diagnose dependence. Substance dependence in DSM-III-R included physiological and behavioral symptoms and reflected the substance dependence syndrome. DSM-IV's emphasis on biology in its concept of dependence was unchanged from its immediate predecessors. DSM-5 declared that all drugs taken in excess have in common the direct activation of the brain reward system. This article examines evolving concepts of alcohol addiction through 12,000 years of recorded human history, from the first mention of alcohol consumption in China more than 12,000 years ago to alcohol use and abuse in the DSM era, 1952 to the present.

Quality of life in substance dependence syndrome

Euphoriant or consciousness altering substance is detrimental to the quality of life of the users. However, due to paucity of studies it is difficult to draw an overall picture of the connection between substance use and quality of life. Fishtail Hospital and Research Centre Pvt. Ltd is located at Pokhara. It is a well-known region in Nepal which has high prevalence of the substance dependence and thus warrants certain effective strategies to address this public health problem. This is a cross- sectional, descriptive hospital based study. After informed consent by administering a semi-structured clinico-socio- demographic performa 60 subjects were included. ICD-10 criteria were used for the diagnosis. The Nepali version of WHOQOL-BREF was administered to assess the quality of life10. Data were analysed by using appropriate tools like Chi-square and Fisher exact tests for association between the continuous variable. The relevant socio-demographic and clinical profiles were also incorporated. The subjects made two groups 30 with alcohol dependence (ADS) and 30 with injecting drug use (IDU). QOL in all spheres was low in all the subjects but with IDU it was even poorer. Among the domain score of both the group of subjects the most affected areas were the psychological health followed by physical health while social and environmental health were relatively less affected.QOL in all spheres was low in all the subjects but with IDU it was even poorer. The most affected areas were the psychological health and physical health.

Khat dependence syndrome: A cross sectional preliminary evaluation amongst UK-resident Yemeni khat chewers

Ethnopharmacological relevanceKhat is a natural psychostimulant that has pharmacological effects similar to that of amphetamine. The behaviour of khat chewing is embedded within a cultural context. Meanwhile khat chewing is associated with psychological and physiologically burden, as a ‘dependence producing' substance. Aims of the studyTo assess the applicability of the construct of substance dependence syndrome (DSM-IV, 1994) to khat chewing and to examine psychosocial and behavioural correlates of this syndrome including tobacco use. Materials and methodsA sample of 204 khat chewers was recruited during random visits to khat sale outlets. A face to face interview that assessed socio-demographic, psychosocial dependence, substance dependence syndrome and behavioural characteristics was conducted. Descriptive, exploratory psychometric and multivariate analyses were employed. ResultsApproximately a third (31%) of khat chewers reported symptoms consistent with dependence syndrome including increased khat chewing (13%) and cessation attempts (19%) while 17% reported withdrawal symptoms including depression (61%), increase in appetite (74%) and interrupted sleep (58%). Thirty-eight percent reported continued khat chewing despite impacts on their health. Psychometric assessment of the DSM-IV criteria for khat chewing dependence identified two factors; factor 1 consisted of bio-behavioural items and factor 2 withdrawal items, accounting for 67% of the variance and Cronbach's alpha coefficient at 0.78. In multivariate logistic regression modelling, there was an association between intensity of psychological khat dependence (SDS-Khat) and nicotine dependence with the likelihood of exhibiting khat chewing dependence syndrome (p=0.0005, OR=1.51, 95%CI=1.33–1.71; p=0.043, OR=2.87, 95%CI=1.03–7.98, respectively). ConclusionsThe substance dependence syndrome criteria are applicable to khat chewing and associated with increased intensity of nicotine and psychological khat dependence. The applicability of khat dependence syndrome and exploration of its dimensions and associated factors should be extended in future research. Concurrent validation of these findings using specific objective measures for self-report khat chewing is also recommended.

Deliberate Self-harm in Nondepressed Substance-dependent Patients

The lifetime diagnosis of substance dependence syndrome is a major risk factor for attempting suicide. The systematic study of various risk factors of suicide in substance-dependent patients in Indian population will have far-reaching implications about the understanding of disorder. The objective was to study the sociodemographic and clinical factors associated with deliberate self-harm (DSH) in nondepressed substance-dependent patients. Participants included 60 male inpatients (30 patients with DSH and 30 without DSH) fulfilling International Classification of Diseases, Tenth Revision Diagnostic Criteria for Research for substance dependence syndrome, aged between 18 and 60 years, with Hamilton Depression Rating Scale score fewer than 7. They were assessed using Addiction Severity Index, Presumptive Stressful Life Event Scale, State-Trait Anger Expression Inventory, Lubben Social Network Scale, International Personality Disorder Examination, Risk Rescue Rating Scale, and Global Assessment of Functioning. Patients with DSH had significantly higher rates of opioid dependence (P < .05), risk of isolation (P < 0.001), the number of life events (P < 0.001), anger trait and anger expression (P < 0.001), personality disorder (P < 0.05), the number of substance use problems and lower social functioning (P < 0.001), as compared with those without DSH (P < 0.001). There was no significant correlation between Risk Rescue Rating Scale with sociodemographic and clinical variables. The study demonstrated that patients with opioid dependence, high risk of isolation, the greater number of life events, higher anger trait and anger expression, personality disorder, low social functioning, and greater number of substance use problems have risk for DSH.

Does the Excessive use of Mobile Phones in Young Adults Reflect an Emerging Behavioral Addiction?

ABSTRACT Background and objective Mobile phones have become an essential part and parcel of modern life. Some of the studies have shown potentially adverse consequences of excessive mobile phone use. Aim of this study was to explore the pattern of mobile phone use among young adults and evaluate the mobile phone use pattern on the substance dependence criteria and assess the adverse consequences of mobile phone use. Materials and methods A 46-item questionnaire based on the ICD-10 substance dependence syndrome criteria, CAGE questionnaire and keeping the possible adverse consequences of excessive use in mind was given to the participants. Results A total of 212 young adults with a mean age of 21.6 years participated in the study. About one-third of the participants met three or more of the ICD-10 diagnostic criteria for substance dependence and more than half (57.1%) fulfilled two or more items on the CAGE questionnaire. Those who fulfilled the dependence criteria spent more time per day on the mobile phone and more frequently had harmful consequences on various aspects of life. Conclusion Excessive mobile phone use is associated with adverse consequences in different spheres of life and some subjects use it in dependent pattern. How to cite this article Nehra R, Kate N, Grover S, Khehra N, Basu D. Does the Excessive use of Mobile Phones in Young Adults Reflect an Emerging Behavioral Addiction? J Postgrad Med Edu Res 2012;46(4):177-182.

Inhibitory control and psychopathology: A meta-analysis of studies using the stop signal task

The Stop Signal Task (SST) is a measure that has been used widely to assess response inhibition. We conducted a meta-analysis of studies that examined SST performance in patients with various psychiatric disorders to determine the magnitude and generality of deficient inhibition. A five-item instrument was used to assess the methodological quality of studies. We found medium deficits in stop signal reaction time (SSRT), reflecting the speed of the inhibitory process, for attention-deficit hyperactivity disorder (ADHD) (g = 0.62), obsessive compulsive disorder (OCD) (g = 0.77) and schizophrenia (SCZ) (g = 0.69). SSRT was less impaired or normal for anxiety disorder (ANX), autism, major depressive disorder (MDD), oppositional defiant disorder/conduct disorder (ODD/CD), pathological gambling, reading disability (RD), substance dependence, and Tourette syndrome. We observed a large SSRT deficit for comorbid ADHD + RD (g = 0.82). SSRT was less than moderately impaired for ADHD + ANX and ADHD + ODD/CD. Study quality did not significantly affect SSRT across ADHD studies. This confirms an inhibition deficit in ADHD, and suggests that comorbid ADHD has different effects on inhibition in patients with ANX, ODD/CD, and RD. Further studies are needed to firmly establish an inhibition deficit in OCD and SCZ.

Atención y craving o ganas compulsivas. Avances en su conceptualización y su implicación en la prevención de recaídas

Irresistible compulsion to use, or craving, is one of the key symptoms of substance dependence syndrome, and of major relevance with regard to relapse in the abuse of alcohol or other drugs. In the present paper, the relationship between attention, attentional processes and the craving phenomenon is reviewed. The paper also explores the different elements of attention, and particularly the relevance of selective attention in craving and the initial stages of relapse. Those psychological strategies that have emerged as effective in the management of craving for substances are also reviewed, with particular emphasis on the cognitive-behavioral model of relapse and on relapse-prevention therapy. Finally, we discuss the characteristics of so-called attentional therapy, based on mindfulness, and its potential effectiveness in the management of addictive disorders in general and of craving in particular.

Substance dependence and non‐dependence in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD): can an identical conceptualization be achieved?

This review summarizes the history of the development of diagnostic constructs that apply to repetitive substance use, and compares and contrasts the nature, psychometric performance and utility of the major diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) diagnostic systems. The available literature was reviewed with a particular focus on diagnostic concepts that are relevant for clinical and epidemiological practice, and so that research questions could be generated that might inform the development of the next generation of DSM and ICD diagnoses. The substance dependence syndrome is a psychometrically robust and clinically useful construct, which applies to a range of psychoactive substances. The differences between the DSM fourth edition (DSM-IV) and the ICD tenth edition (ICD-10) versions are minimal and could be resolved. DSM-IV substance abuse performs moderately well but, being defined essentially by social criteria, may be culture-dependent. ICD-10 harmful substance use performs poorly as a diagnostic entity. There are good prospects for resolving many of the differences between the DSM and ICD systems. A new non-dependence diagnosis is required. There would also be advantages in a subthreshold diagnosis of hazardous or risky substance use being incorporated into the two systems. Biomedical research can be drawn upon to define a psychophysiological 'driving force' which could underpin a broad spectrum of substance use disorders.

What's Wrong With Addiction?

Back to table of contents Previous article Next article Book ReviewsFull AccessWhat's Wrong With Addiction?Timothy Fong, M.D.Timothy FongSearch for more papers by this author, M.D.Published Online:1 Jan 2006https://doi.org/10.1176/appi.ps.57.1.149-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The most common questions I receive as an addiction psychiatrist are, "How do you know when someone is addicted?"; "Can't anything be considered addictive?"; and "How can you stand to work with addicts?" Interestingly, the answers to these questions are not simple. A number of theories have tried to explain the concept of addiction, often standing in stark contrast to one another. These theories range from the medical model (addiction as a neurobiological disease) to models of morality (addiction as conscious self-destruction).These are the primary issues that Helen Keane, Ph.D., takes on in her book What's Wrong With Addiction. The book is an extended analysis of the ambiguities of addiction. Keane is a research fellow at the National Centre in HIV Social Research at the University of New South Wales in Australia. Her principal theme is that discourse on addiction can have a powerful impact on society by influencing those who are involved in the decision-making process. Popular culture, politics, and the medical fields have portrayed addiction as a disease. As a result, addicts are considered to be without free will, "compelled" to stay with the addiction. As a result, freedom is lost, resulting in further stigmatization.Keane describes why it is considered "bad" to be labeled an addict and also explains how concepts of addiction are shaped through discourse surrounding its own definition, societal portrayal, political regulation, and scientific research. Addiction, for Keane, is not so much about lack of self-control as it is about perverse desire: "Addiction is a state marked by caring too much about the wrong things, and not enough about the right things."The book is divided into three sections. The first three chapters frame addiction as a disease of the individual by describing a pharmacologic understanding of how drugs lead to addiction, exploring the substance dependence syndrome, and discussing the impact of self-help literature on addiction. The middle chapters describe concepts of addiction to behaviors and substances other than drugs or alcohol—namely, nicotine, food, and sex. Conspicuously absent is an analysis of gambling with reference to concepts of addiction, which is surprising given the recent increase in the popularity of gambling as an activity and as an area of academic study.The book concludes with an analysis of the recovery process and how concepts of health, habit, and conduct are involved. Keane ends by describing addiction as a habit, not a disease. This conceptualization would in turn, she argues, remove the need for labeling patients with addictions as good versus bad or as motivated versus unmotivated and would instead focus on modifying habits that are already in place.Overall, What's Wrong With Addiction is written in a scholarly fashion and is designed primarily for anyone who has struggled to understand what it means to be addicted. Keane's work is thoughtful and thought provoking and incorporates elements of medical history and philosophy. The arguments are compelling, but the highly intellectualized writing and the abstract concepts presented make reading this book an investment of time and energy. It is not a clinically useful book, nor will it immediately help patients and families who are struggling to manage the direct consequences of addiction. Rather, this book's strength is in its delivery of an important reminder to all stakeholders who work with addiction to critically rethink current concepts of mental and medical health.Dr. Fong is assistant clinical professor at the Neuropsychiatric Institute and Hospital and director of the gambling studies program at the University of California, Los Angeles.by Helen Keane, Ph.D.; New York, New York University Press, 2002, 228 pages, $20 FiguresReferencesCited byDetailsCited byNone Volume 57Issue 1 January 2006Pages 149-a-150 Metrics History Published online 1 January 2006 Published in print 1 January 2006

Rapid and Ultrarapid Opioid Detoxification Techniques

To review the scientific literature on the effectiveness of rapid opioid detoxification (RD) (opioid withdrawal precipitated by naloxone hydrochloride or naltrexone) and ultrarapid opioid detoxification (URD) (opioid withdrawal precipitated by naloxone or naltrexone under anesthesia or heavy sedation) techniques. The MEDLINE database was searched from 1966 through 1997 using the indexing terms naloxone, naltrexone, substance dependence, and substance withdrawal syndrome. Additional data sources included bibliographies of papers identified on MEDLINE and bibliographies in textbooks on substance abuse. Inclusion criteria were studies of RD or URD, pharmacologic protocols specified, and clinical outcomes specified and reported. Exclusion criteria were unpublished data, data not in peer-reviewed journals, abstract-only publications, and review articles. The methodologic characteristics of studies were extracted by the authors and summarized according to key components of research design concerning subject characteristics, therapy allocation, and outcomes assessed. A qualitative analysis was performed on the 12 studies of RD and the 9 studies of URD identified in our search. The RD studies enrolled 641 subjects (range for individual studies, 1-162): 7 were inpatient studies, and the protocols varied considerably, as did the outcomes assessed. Three RD studies included a control group, 2 used a randomized design, and 3 reported outcomes beyond 12 days. The URD studies enrolled 424 subjects (range for individual studies, 6-300): all were inpatient studies, the detoxification and anesthesia protocols varied, 3 included a control group, 2 used a randomized design, and 2 reported outcomes for URD beyond 7 days. The existing literature on RD and URD is limited in terms of the number of subjects evaluated, the variation in protocols studied, lack of randomized design and use of control groups, and the short-term nature of the outcomes reported. Further research is needed using more rigorous research methods, longer-term outcomes, and comparisons with other methods of treatment for opioid dependence.

Caffeine Dependence Syndrome

The extent to which daily caffeine use is associated with a substance dependence syndrome similar to that associated with other psychoactive drugs is unknown. The purpose of this study was to assess volunteers who reported problems with their use of caffeine for evidence suggesting a diagnosis of caffeine dependence based on the generic criteria for substance dependence from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Case-series evaluations. An academic research center. Self-identified adults who believed they were psychologically or physically dependent on caffeine. Diagnoses made by a psychiatrist using a structured clinical interview that included a section on caffeine dependence based on genetic criteria for DSM-IV substance dependence. Double-blind caffeine-withdrawal evaluation. Ninety-nine subjects were screened for the study, and 16 were identified as having a diagnosis of caffeine dependence. Median daily caffeine intake was 357 mg, and 19% of subjects consumed less than the national (US) daily average of caffeine. Criteria used for making diagnoses (and rates of their prevalence) were as follows: withdrawal (94%), use continued despite knowledge of a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by caffeine use (94%), persistent desire or unsuccessful efforts to cut down or control use (81%), and tolerance (75%). Eleven subjects underwent the double-blind caffeine-withdrawal evaluation portion of the study, and nine (82%) of the 11 showed objective evidence of caffeine withdrawal, including eight of 11 with functional impairment. These results, together with other experimental evidence, suggest that caffeine exhibits the features of a typical psychoactive substance of dependence. It is valuable to recognize caffeine dependence as a clinical syndrome, since some people feel compelled to continue caffeine use despite desires and recommendations to the contrary.