Drug Dependence Treatment Research Articles

Prevención y tratamiento en el ámbito penitenciario: las mujeres reclusas drogodependientes en España

The penitentiary drug dependence treatment for women has been traditionally generic (applied for most masculine penitentiary) and with few differentiating empiric studies in an spanish level.Based on a regulatory framework, this research focuses on the study of the main elements of risk and protection implied in the relation between the drug dependant female prisoners and the treatment programs, as well as the recovery processes, in order to propose specific actions.The research has a multimethod approach, inserted within the Project I+D+I named “Mujeres reclusas drogodependientes y su reinserción social. Estudio socioeducativo y propuestas de acción” [EDU2009-13408], with a national sample of second and third degree (Central Government and Community of Catalonia), corresponding to an estimate of 15% of the female prisoners nationally. 538 valid questionnaires, 61 semi-structured interviews has been obtained, in which informatic analytical methods, specific programs for quantitative data (SPSS, V. 15 y 20), and analytical content methods for qualitative data has been applied. The analysis has been developed before and after the internment, including four profiles of female prisioners (AA: Active addicted (8'20%), EX: ex addicted (EX: 67'21%), NA: non addicted (NA: 14.75%) and PMM (9.84%) addicted within methadone maintenance programs ).Among the main results found, it is relevant to mention the elements of risk related to the absence of participation of ex addicted women in relapse prevention programs. In fact, this is a relevant issue since 70% of the women are ex addicted. There is a large number of women not receiving any treatment in prision and not participating in any program due to lack of information, mistrust and overlap with other activities. Aditionally, theres is a perception of gender discrimination towards the access and permanece of women in the programs, compared with men. Also, within the main elements of protection, it has been found that most women access a program motivated by family pressure, and in some cases situations such as motherhood and certain personal health issues were determinant factors for a women to access a program.Finally, a model PROSO –MD (Socio-educational Program for Drug Dependant Women) according to use pattern is proposed to be implemented in a penitentiary field, adapted to the characteristics and realities of the women implied and developing specific a proposal for ex addicted women.

Predictive Capacity of Self-Efficacy in Drug Dependence and Substance Abuse Treatment

Addiction to opiates has increased in recent years. This resurgence in its consumption shows the need to continue to investigate the role of personality in addictive behavior. Variables such as self-efficacy are quite helpful in the treatment of drug addicts. The purpose of this study was to examine and quantify the predictive capacity of self-efficacy in treatment groups (Methadone, Cognitive-Behavioral, Alcohol) and a Control group and in the severity of the substance abuse (quantity and chronicity of use). The sample was composed of 181 participants (97 men and 84 women), who were divided into 4 groups: Methadone, Cognitive-behavioral, Alcohol and Control. Their self-efficacy was measured using the Self-efficacy scale (SE) and the Addictive Behavior Research Interview (EICA). The results showed the self-efficacy is inversely related to the Methadone, Cognitive-behavioral and Alcohol groups and directly related to the Control group. Regarding the severity of the drug use, we found that self-efficacy was inversely related to the quantity of drugs consumed and directly related to chronicity. The study proposes the need to evaluate self-efficacy along with other personality measures, as it is not enough to believe that one is capable of successfully doing something (self-efficacy), but it is also important to show it (coping).

Brief Intervention with Adolescents Having Inhalant Use Disorder: a Case Series

Introduction The prevalence of substance use is among adolescents is on rise. In India, inhalant is one of the common drugs of use and acts as a gateway for illicit substance use. The mainstay of treatment for inhalant use among this population is psychosocial interventions. In India, we largely rely on western models to guide intervention programs, however, there is a need to develop and test the psychosocial interventions which are culturally relevant and effective. Objective The present study aims to highlight the culture specific psychopathological factors associated with inhalant use among adolescents. The paper aims at studying the effectiveness of a psychosocial intervention in reducing the frequency and quantity of inhalant use among adolescent clinic population. Methodology Four adolescents reporting to the Adolescent Clinic at the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi were recruited for the study. A single-case design was adopted. The pre-, and post- intervention assessment were carried out. Results and Discussion There was a significant reduction in frequency and quantity of inhalant use in the cases. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research. The psychpathological factors and challenges to intervention are discussed.

Commentary on Metrebian et al (2015): What is addiction treatment research about? Some comments on the secondary outcomes of the Randomized Injectable Opioid Treatment Trial.

Keywords: Addiction treatment policy; addiction treatment research; heroin assisted treatment; randomized controlled studies; risk factors; cost-effectiveness; treatment objectives

Compulsory drug detention centers in East and Southeast Asia

Over the last three decades in response to a rise in substance use in the region, many countries in East and Southeast Asia responded by establishing laws and policies that allowed for compulsory detention in the name of treatment for people who use drugs. These centers have recently come under international scrutiny with a call for their closure in a Joint Statement from United Nations entities in March 2012. The UN's response was a result of concern for human rights violations, including the lack of consent for treatment and due process protections for compulsory detention, the lack of general healthcare and evidence based drug dependency treatment and in some centers, of forced labor and physical and sexual abuse (United Nations, 2012). A few countries have responded to this call with evidence of an evolving response for community-based voluntary treatment; however progress is likely going to be hampered by existing laws and policies, the lack of skilled human resource and infrastructure to rapidly establish evidence based community treatment centers in place of these detention centers, pervasive stigmatization of people who use drugs and the ongoing tensions between the abstinence-based model of treatment as compared to harm reduction approaches in many of these affected countries.

Nicotinic receptor modulation to treat alcohol and drug dependence.

Alcohol and drug dependence are serious public health problems worldwide. The prevalence of alcohol and drug dependence in the United States and other parts of the world is significant. Given the limitations in the efficacy of current pharmacotherapies to treat these disorders, research in developing alternative pharmacotherapies continues. Preclinical and clinical evidence thus far has indicated that brain nicotinic acetylcholine receptors (nAChRs) are important pharmacological targets for the development of medications to treat alcohol and drug dependence. The nAChRs are a super family of ligand gated ion channels, and are expressed throughout the brain with twelve neuronal nAChR subunits (α2–α10 and β2–β4) identified. Here, we review preclinical and clinical evidence involving a number of nAChR ligands that target different nAChR subtypes in alcohol and nicotine addiction. The important ligands include cytisine, lobeline, mecamylamine, varenicline, sazetidine A and others that target α4β2* nAChR subtypes as small molecule modulators of the brain nicotinic cholinergic system are also discussed. Taken together, both preclinical and clinical data exist that support nAChR–based ligands as promising therapeutic agents for the treatment of alcohol and drug dependence.

Theories and treatment of drug dependency: a neurochemical perspective.

Treatment of chemical dependence ("addiction") requires an understanding of its effects on the brain. To guide research in the area of chemical dependence, several foundational theories have been developed. These include the incentive salience, receptor down-regulation, opponent process, and psychomotor stimulant theories. These have been important both in summarizing and in guiding investigations. However, the extant theories do not provide a single unified framework nor have they yielded all of the guidance necessary for effective chemical dependence treatment. The present paper summarizes and then integrates these theories and suggests some implications for the treatment followed by this integration.

English

This was an exploratory open trial in which young crack-cocaine-users and non-users were clinically examined. The participant’s right dorsolateral prefrontal cortex activity was analysed by an event-related potentials procedure under a cue-reactivity paradigm. The patients group exhibited lower frontal executive scores. Accordingly, they exhibited lower right DLPFC activity for crack cues when compared with neutral cues while healthy subjects exhibited the opposite effect. Considering that the right DLPFC has an important role in executive functions, which is usually impaired in drug addicts, we suggest that any intervention that can improve its activity may have beneficial effects in drug dependence treatment.

Methylene tetra hydrofolate Reductase C677T Gene Polymorphism in Heroin Dependence

Dependence to opiates is a chronic relapsing brain disease that can cause major health, social and economic problems [1]. Dependence vulnerability is affected by environmental factors, drug-induced factors and hereditary factors, which represent approximately 40–60% of the risk of developing dependence [2]. Illicit drug use could lead to epigenetic changes in DNA methylation which may play an important role in the development of chronic substance abuse by enhancement of drug reward, craving and relapse use [3,4]. Epigenetic factors could be also responsible for vulnerability to drug response, dependence and addiction treatment response [5].

웰니스를 위한 빅데이터 분석과 의료 질 관리

의학기술의 발전과 소득수준의 증가로 "건강하게 오래살기"에 관심이 높아지면서 적극적으로 건강을 증진하고 유지하는 웰니스가 확대되고 있다. 또한 맞춤형 의료서비스에 대한 수요가 증가하고 방대한 의료 빅 데이터를 이용한 질병 예방의 움직임도 나타나고 있다. 이 논문에서는, 의료 시장에서 주요 관심분야로 부각되고 있는 웰니스를 지원하기위해 빅 데이터 기반의 의료 질 향상을 통한 환자중심의 의료서비스를 목적으로 한다. 환자를 약물에 의존적으로 치료만 하는 것이 아니라 식생활 개선을 기반으로 질병예방과 치료를 위해 빅데이터를 분석한다. 개인 트윗터를 분석해서 일상생활정보를 획득하고 웰니스 사전을 기반으로 질병예방과 치료를 목적으로 한다. 효율적인 빅데이터 분석을 위해 하둡노드를 증가하면서 데이터 처리시간을 실험하였다. 실험결과 저장시간의 경우 63%, 데이터 통합의 경우 18%, 전체 테스트 시간을 기준으로 26%로 하나의 노드로 처리하는 경우보다 세 개의 노드로 처리하는 것이 효율적임을 실험을 통해 확인하였다. Medical technology development and increase the income level of a "Long and healthy Life=Wellness," with the growing interest in actively promoting and maintaining health and wellness has become enlarged. In addition, the demand for personalized health care services is growing and extensive medical moves of big data, disease prevention, too. In this paper, the main interest in the market, highlighting wellness in order to support big data-driven healthcare quality through patient-centered medical services purposes. Patients with drug dependence treatment is not to diet but to improve disease prevention and treatment based on analysis of big data. Analysing your Tweets-daily information and wellness disease prevention and treatment, based on the purpose of the dictionary. Efficient big data analysis for node while increasing processing time experiment. Test result case of total access time efficient 26% of one node to three nodes and case of data storage is 63%, case of data aggregate is 18% efficient of one node to three nodes.

UNODC-WHO program on drug dependence treatment and care: Building treatment capacity in low and middle income countries

UNODC-WHO program on drug dependence treatment and care: Building treatment capacity in low and middle income countries

Troubles affectifs et comorbidités addictives en dehors de l’alcool

Mood and substance use disorders commonly co-occur, yet there is little evidence-based research to guide the pharmacologic management of these comorbid disorders. The authors review the existing empirical findings including current clinical pharmacotherapy practices for treating co-occurring mood and substance use disorders and call into question current clinical practices. The specific mood disorders reviewed are bipolar and major depressive disorders (either one co-occurring with a substance use disorder). The authors also highlight knowledge gaps that may serve as a basis for future research. Findings from the relatively small amount of available data indicate that pharmacotherapy for managing mood symptoms might be effective in patients with substance dependence, although results have not been consistent across all studies. In most studies, medications for managing mood symptoms did not appear to have an impact on the substance use disorder. Research has only begun to address optimal pharmacologic management of co-occurring disorders. In addition, current clinical treatment for drug dependence often exclude new pharmacotherapies approved by the French Haute Autorité de Santé for treating certain types of addiction. With new data becoming available, it appears that we need to revisit current practice in the pharmacological management of co-occurring mood and substance use disorders.

Predictors of loss to follow-up among children registered in an HIV prevention mother-to-child transmission cohort study in Pernambuco, Brazil.

BackgroundMother-to-child transmission of HIV (MTCT) is the major form of acquiring the disease among children. The loss to follow-up (LTF) of mothers and their children is a problem that affects the effectiveness of programs for the prevention of mother-to-child transmission (PMTCT). The aim of this study is to identify risk factors associated with the LTF of HIV-exposed children in the state of Pernambuco, Brazil.MethodsA retrospective cohort study was carried out with 1200 HIV-exposed children born between 2000 and 2009, registered up to the age of 2 months in a public health PMTCT program. Children were considered LTF if they did not return for scheduled visits to monitor infection status. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for LTF.ResultsA total of 185 children (15.4%; CI: 95%: 13.4 - 17.4%) met the case definition of LTF before the determination of serological HIV status. Risk factors independently associated with LTF were mother-child pairs who reside in rural and remote areas (OR 1.86; 95% CI: 1.30-2.66) and mothers who use illicit drugs (OR 1.8; 95% CI: 1.08-3.0). Initiation of the PMTCT during pregnancy was a protective factor for LTF (OR 0.69; 95% CI: 0.49-0.96).ConclusionsThe decentralization of support services for HIV-exposed children to other cities in the state seems to be crucial for the accurate monitoring of outcomes. It is also important to introduce additional measures addressing mothers who are drug users so that they remain in the program: an intensive follow-up program that actively searches for absentee mother-child pairs, support from social services and treatment for drug-dependency. The findings of this study highlight the importance of diagnosing mothers as early as possible in order to conduct a more complete follow-up period of the children. Solving the above-mentioned problems is a challenge, which must be overcome so as to improve the quality of PMTCT.

Current practices and attitudes of family physicians toward substance use disorders in the Emirate of Abu Dhabi: a cross-sectional survey in primary care

Background: Primary care clinics are the ideal setting to treat individuals with Substance Use Disorders (SUD). However, in most societies including the United Arab Emirates(UAE), the level and type of treatment provided by physicians in primary care is unknown. This study aims to assess the attitudes and beliefs of primary care physicians towards the treatment of patients with SUD. Methods: A cross-sectional electronic survey was distributed to 231 physicians across 35 primary healthcare clinics in the Emirate of Abu Dhabi. The survey questionnaire captured data on four main areas including demographic and practice characteristics of the physicians, practice patterns of the physicians, training, and attitudes towards drug dependency treatment. Results: The response rate was 46%. There were more females (59%) and the mean (standard deviation) age of participants was 46.4 (9.5) years. Only 8.7% of physicians treated people with SUDs. Most of the physicians (93.2%) did not have specialised training in treating SUDs. A total 66% of physicians were interested in obtaining further training in screening and management of SUDs. Conclusion: This study identifies the need to implement training for physicians in diagnosing and further managing patients with addiction. DOI: http://dx.doi.org/10.4038/ijptsud.v1i2.7702 International Journal of Prevention and Treatment of Substance Use Disorders 2014;1(2):84-97

Considerations on the role of buprenorphine in recovery from heroin addiction from a UK perspective.

The United Kingdom Drug Strategy emphasises recovery as a key focus in the treatment of drug dependence. A framework for recovery is defined in the Recovery-Orientated Drug Treatment report, written by an expert working group, and comprises four key phases: engagement and stabilisation, including the establishment of treatment goals; preparation for change, involving engagement in psychosocial and pharmacological interventions; active change, including detoxification and medical withdrawal; and completion, including interventions that strengthen community integration. A body of evidence supports the benefits of buprenorphine, a partial agonist at mu opioid receptors, in supporting individualised recovery based on this framework, specifically in relation to the potential for rapid stabilisation, flexibility to transition to other treatment options or achieve abstinence, effective blocking of on-top use of illicit drugs, the treatment of comorbidities through the minimisation of drug-drug interactions, and a good safety profile. In addition, the newer abuse-deterrent formulation of buprenorphine combined with the opioid antagonist naloxone is likely to strengthen recovery-orientated systems of care due to its potential to reduce misuse and diversion. Progress through the recovery journey and the ability to sustain recovery will depend on individual needs and goals and on the amount of recovery capital that individuals have developed.

Treating drug dependence with the aid of ibogaine: a retrospective study.

Ibogaine is an alkaloid purported to be an effective drug dependence treatment. However, its efficacy has been hard to evaluate, partly because it is illegal in some countries. In such places, treatments are conducted in underground settings where fatalities have occurred. In Brazil ibogaine is unregulated and a combined approach of psychotherapy and ibogaine is being practiced to treat addiction. To evaluate the safety and efficacy of ibogaine, we conducted a retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users (72% poly-drug users). We observed no serious adverse reactions or fatalities, and found 61% of participants abstinent. Participants treated with ibogaine only once reported abstinence for a median of 5.5 months and those treated multiple times for a median of 8.4 months. This increase was statistically significant (p < 0.001), and both single or multiple treatments led to longer abstinence periods than before the first ibogaine session (p < 0.001). These results suggest that the use of ibogaine supervised by a physician and accompanied by psychotherapy can facilitate prolonged periods of abstinence, without the occurrence of fatalities or complications. These results suggest that ibogaine can be a safe and effective treatment for dependence on stimulant and other non-opiate drugs.

A perspective from drug user organisations on 'ECDC and EMCDDA guidance: prevention and control of infectious diseases among people who inject drugs'.

A perspective from drug user organisations on 'ECDC and EMCDDA guidance: prevention and control of infectious diseases among people who inject drugs'.

Hepatitis - a devastating epidemic in Europe.

With hepatitis B and C, the European region is confronting a devastating epidemic that seemingly has emerged in silence. The major driver of hepatitis B and C in Europe is now injecting drug use. Yet it would be a mistake to think of these diseases as a problem primarily for people who inject drugs (PWID). They are a problem for governments, health systems, communities, families and all who care about the rights and dignity of the most marginalised members of our society. The first European Conference on Hepatitis C and Drug Use, slated for 23-24 October 2014, may well be seen in retrospect as a landmark event spurring the emergence of the broad-based movement that is needed to alter the course of the region’s hepatitis epidemic. The conference’s international organising partner, the Correlation Network’s Hepatitis C Initiative, has utilised financial support from the Drug Prevention and Information Programme of the European Union to publish a journal supplement in conjunction with the conference. We, the editors of the supplement, are proud to have had this opportunity to bring together information and viewpoints about some of the most important issues on the conference agenda. We trust that the publication will both inform the current dialogue around key issues and also find a place as a core resource for the many additional people who will surely be drawn to this work in the years to come. The European Conference on Hepatitis C and Drug Use takes place at a pivotal time. The first-ever World Health Assembly resolution on viral hepatitis in 2010 [1] generated momentum in relation to key strategy and policy issues at the global level, as reflected in the viral hepatitis strategic framework announced by the World Health Organization (WHO) in 2012 [2]. In 2013, WHO followed up by asking Member States to report on existing national policies and practices in relation to the four axes of the strategic framework. The resulting Global Policy Report on the Prevention and Control of Viral Hepatitis in WHO Member States [3] provides a benchmark for measuring progress on a number of critical issues. In the spring of 2014, WHO’s hepatitis programme convened its first-ever “global partners meeting,” and the resulting “Call to Action to Scale Up Global Hepatitis Response” captured the major concerns of the many civil society organisations that attended the meeting [4]. Not long afterwards, strong civil society engagement helped to ensure passage of a new World Health Assembly resolution [5] that obligates governments to take more concrete measures in response to viral hepatitis. Civil society again came together to contribute to the first Global Community Hepatitis Policy Report, released by the World Hepatitis Alliance on World Hepatitis Day 2014 [6]. The importance of addressing the viral hepatitis prevention and treatment needs of people who inject drugs has been a strand running through all of these developments. Indeed, one of the key advocacy victories associated with the new World Health Assembly resolution is the inclusion of commitments relating to people who inject drugs. The resolution calls on WHO Member States to “implement comprehensive hepatitis prevention, diagnosis and treatment programmes for people who inject drugs.” Footnoted text names nine key interventions, including needle and syringe programmes; opioid substitution therapy and other drug dependence treatment; and targeted information, education and communication for people who inject drugs and their sexual partners [5]. In short, this is an opportune time to bring PWID issues to the forefront in discussions about how to rein in hepatitis B and C in Europe and globally. The discussions underway in policy, advocacy and research circles are by necessity very broadly focused. Viral hepatitis prevention efforts must overcome immense obstacles associated with low public awareness and misconceptions about the nature of the threat. The same factors hinder health systems from identifying a vast number of infected but currently asymptomatic and undiagnosed people who might benefit from treatment. * Correspondence: jeffrey.lazarus@regionh.dk CHIP, Centre for Health and Infectious Disease Research and WHO Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Full list of author information is available at the end of the article Lazarus and Fenton BMC Infectious Diseases 2014, 14(Suppl 6):S1 http://www.biomedcentral.com/1471-2334/14/S6/S1

OR06-3 * RISK OF HCV INFECTION AMONG HEROIN AND METHAMPHETAMINE USERS

Aims. The objective of the study was to find out, if there is a difference in the prevalence of HCV infection between opiate and methamphetamine users. Patients and Methods. There were 222 patients in the study with the average age 23 years (SD 4.3), males 75%, females 25%. Comparative study was conducted among the patients who requested treatment for drug dependence on opiates (101 patients) and methamphetamines (121). Results. 65% of heroin users and 12% of methamphetamine users were infected with HCV, the prevalence among those who injected drugs was 70% and 28%, respectively. 93% of opiate users and 35% of methamphetamine users were injecting drug some time in their life. The risk of HCV infection was significantly higher among the opiate users (OR 13.4). Conclusions. The prevalence of injecting behavior and the risk of the HCV infection is lower among the methamphetamine in comparison with the opiate users. Still, this is much higher than in the general population. Because no substitution treatment is available for methamphetamine users, the detoxification followed by drug-free treatment is the important part of the risk reduction of the transmission of drug-related infectious diseases in general, and HCV in particular.

SY03-2-4 * WHO-ISAM FELLOWSHIP BARRIERS OF TOBACCO CESSATION AMONG INDIAN BUPRENORPHINE-NALOXONE MAINTAINED PATIENTS

Introduction. Prevalence of smoking in opioid agonist treatment programme, leading to significant health hazards and high mortality. This study aims to examine the readiness to quit, perceived personal health and risk susceptibility associated with tobacco use and importance of intervention, among patients on opioid agonist treatment with buprenorphine-naloxone. Methods. Fifty-five males on buprenorphine-naloxone treatment at National Drug Dependence Treatment Centre, India, were assessed using Tobacco Use Characteristics, Fagerstrom test for nicotine dependence (smoker and smokeless tobacco user), Readiness to Change questionnaire (RCQ), Smoker's Perceived Health Risk Evaluation (SPHERE), Importance of Intervention scale and a semi-structured questionnaire. Results. 65.4% of the subjects were smokers, 9% were using smokeless tobacco only whereas 25.6% were using both. Mean FTND score of 5 ± 1.70 among smokers, denotes medium dependence. Only one-fifth of them reported prior quit attempts for tobacco. None of the attempts involved any assistance. 38.8% did not plan to quit in next 6 month. Perceived personal health and risk were poor. Only 61.62% considered intervention for smoking cessation important. Most common choice of intervention was advice and guidance only (49%). Conclusions. Higher severity of nicotine dependence, Poor willingness to quit highlights the need for on-site motivational treatment.