Addictive Disorders and Their Treatment

Rothe, Eugenio M.; Pumariega, Andres J.; Mihajlovic, Aida S.; May, Catherine; Ruiz, Pedro; Perras, Nicole

doi: 10.1097/ADT.0000000000000164pmid: N/A

In the last 3 years the numbers of forcibly displaced people around the world has reached a record high. Experiences of war, persecution, violence, torture, participating in the killing of others, disruptions of attachments, and emotional losses increase the risk for psychological distress and may contribute to the risk of developing psychiatric and substance abuse disorders. The authors review the existing psychiatric literature on refugees, discuss the sociological reasons that explain the recent crisis, describe the psychiatric consequences, the risk factors and protective factors of the refugee experience, narrate the current conditions in refugee camps located in Greece and discuss the most up-to-date treatment modalities and preventive interventions to treat this patient population.

Carbone, Manuel G.; Pagni, Giovanni; Tagliarini, Claudia; Maremmani, Icro

doi: 10.1097/ADT.0000000000000163pmid: N/A

Gambling disorder is a pathologic condition, resulting from the interaction of multiple risk factors. Among these, dopamine neurotransmission is known for playing a significant role, as seen, for example, in patients using dopamine replacement therapy prescribed for Parkinson disease, in which gambling is considered to be iatrogenic. Considering this, together with the general mechanism of action of antipsychotic drugs, growing attention has recently been dedicated to Aripiprazole and to its partial dopaminergic agonism (reducing D2-receptor hyperactivation in the mesolimbic pathway and improving D2-receptor stimulation in the mesocortical and nigrostriatal pathway). In fact, Aripiprazole has been noticed in several cases to worsen preexisting pathologic gambling and also, in some cases, to precipitate pathologic gambling in those without preexisting pathologic gambling when used at therapeutic doses (10 to 15 mg). Mr F, a bipolar patient under treatment without either personal or family history of gambling, following a low-dose Aripiprazole administration, began displaying gambling behaviors, which immediately ceased after suspension of the drug. Subsequently, after the reintroduction of Aripiprazole, this time at standard dosage, the patient resumed additive behavior of gambling, which in this case also ceased at the time of suspension. It is possible to hypothesize that the dopaminergic agonist activity of low-dose Aripiprazole has influenced the physiological process of salience, leading the patient to give particular attention, through reward circuits, to a specific stimulus, otherwise not relevant. More difficult to explain, on the other hand, is how the standard dosage anti-D2 activity of Aripiprazole, has reactivated gambling behaviors again. According to our hypothesis, it is possible that the administration of standard dose of Aripiprazole has triggered a reward-deficiency syndrome, recalling the gratifying action of the recently experimented gambling to the patient’s memory, bringing him to the relapse.

Toro-Tobón, David; Berbesi-Fernández, Dedsy; Trejos-Castillo, Elizabeth; Arbelaez, Silvia G.

doi: 10.1097/ADT.0000000000000161pmid: N/A

Background:Female who inject drugs are exposed to greater social disapproval, stigmatization, and report a higher risk of unsafe injection practices compared with their male counterparts. Gender differences in injection practices among people who inject drugs (PWID) in Latin America remain understudied.Objectives:This study aimed to examine gender differences in injection practices among PWIDs in Colombia.Materials and Methods:Using respondent-driven sampling, N=1081 participants (14% female; mean age: 26 y) from 5 Colombian cities completed the Pan American Health Organization’s Behaviors of High Risk Drug Consumers Survey. A binary logistic regression model was used to examine first and last injection practices and risk injection behaviors among PWIDs.Results:Female presented high odds of receiving assistance by their sexual partners during the first and last injection episode [adjusted odds ratio (AOR)=8.3, confidence interval (CI)=14.0-16.7; AOR=2.06, CI=1.1-3.7]. Also, female had at least 2 times higher odds of engaging in unsafe injecting practices including sharing drug mix and using drug in a capsule or ready-to-use vial (AOR=2.8, CI=1.4-5.5; AOR=3.4, CI=1.5-7.7) and had lower odds of acquiring the drug to self-inject (AOR=0.4, CI=0.2-0.9) during the last injection episode.Conclusions:High dependence on sexual partner and risky injection behaviors among female who inject drugs were identified. Study findings contextualized with gender vulnerabilities in Colombia are fundamental for prevention/intervention efforts aimed at helping this at-risk population in the country and in Latin America.

Mortazavi, Seyed Mohsen; Nekoei-Moghadam, Mahmoud; Amiresmaili, Mohammadreza; Jafari, Hamid; Bardsiri, Hosein; Heidari, Mohammad

doi: 10.1097/ADT.0000000000000159pmid: N/A

Objective:Methanol poisoning can lead to the loss of vision and even death. The role of the health care system in managing and responding to these types of incidents is significant. This study aimed to identify and discuss the challenges of prehospital and hospital emergency services responding to the widespread methanol poisoning in the city of Rafsanjan.Methods:This qualitative study was carried out using content analysis approach. Data were collected using semistructured interviews. Participants included the matrons of health centers, head of accident and medical emergency center, director of the emergency operation center, ward manager and nursing staffs, and the representative of university’s board of directors. After 15 interviews, data saturation was reached.Results:The findings of this study are based on 4 stages of disaster management cycle, which include: (1) mitigation in disaster with 2 subscales, (2) preparedness with 2 subscales, (3) response to disaster with 4 subscales, and (4) rehabilitation with 3 subscales.Conclusions:Interinstitutional coordination should be promoted through joint meetings, and also training classes on disaster management and its implementation should be held. Moreover, up-to-date clinical protocols must be accessible to personnel, and facilities and resources needed in the disaster should be provided.

Khalil, Afaf H.; Omar, Abdel N.M.; Ali, Ramy R.; Mahmoud, Dalia A.M.; Naoum, Dina O.; Khumisi, Abdallah A.; El Missiry, Ahmed A.

doi: 10.1097/ADT.0000000000000158pmid: N/A

Background:The co-occurrence of psychiatric and substance use disorder increases the duration of illness, hospitalization rates, and causes more functional impairment and legal problems, which may increase the burden of illness. Hence, identifying the risk factors of such comorbidity may help in mitigating such problems.Objective:This study examined the risk factors associated with comorbid Axis I and Axis II disorders in a sample of male Egyptian patients with substance abuse.Patients and Methods:A total of 158 male inpatients diagnosed with substance use disorder according to diagnostic and statistical manua-IV diagnostic criteria answered the Structured Clinical Interview for Axis I and Axis II disorders (SCID-I and SCID-II). They were also evaluated by the Addiction Severity Index scale and the Global Assessment of Functioning.Results:An overall 60% were diagnosed with another Axis I or Axis II disorder. An overall 26% of them had psychosis, and 21% had borderline personality disorder. Unemployment, history of child abuse, high cannabis, opioid and tramadol abuse, frequent overdosing, longer hospitalization, aggressive behavior, family dysfunction, and occupational and legal problems were significantly more in patients with comorbidity. Moreover, 62% of them had severe problems on the Addiction Severity Index scale. The predictive risk factors for comorbidity were familial problems, aggressive symptoms, cluster B personality traits, past history of psychiatric disorders, longer time of hospitalization, and lower Global Assessment of Functioning scores.Conclusions:Identifying the risk factors for psychiatric comorbidity in patients with substance dependence highlights the importance of developing a dual diagnosis service to meet the needs of this population.

Shestopal, Irene; Bramness, Jørgen G.

doi: 10.1097/ADT.0000000000000170pmid: N/A

Background:Hypnotherapy has proved to be effective for the treatment of several medical and psychiatric conditions. It has been used in the treatment of alcohol use disorder (AUD), but only 2 randomized controlled trials have been conducted for this disorder.Methods:This study was carried out at an inpatient clinic in Norway. A 6-week long treatment program included intensive group therapy, but also 5 hours of individual therapy, given as motivational interviewing (MI). Thirty-one patients were randomized either to receive 5 individual sessions of hypnotherapy instead of MI (N=16) or to be in the control group (N=15). The treatment method for the hypnotherapy group was Erickson (permissive) hypnosis. At baseline all the participants were diagnosed using a psychiatric interview and filled in the Alcohol Use Identification Test (AUDIT), Timeline FollowBack (TLFB) for alcohol use, Hopkins Symptoms Check List (HSCL-25) for monitoring mental distress and Traumatic Life Events Questionnaire. AUDIT, TLFB, and HSCL-25 were readministered at follow-up after 1 year.Results:There were no differences between groups at baseline. One year later more women were lost to follow-up in the MI group. Both the intervention and control groups had reduced their alcohol consumption significantly. The change in AUDIT score was, however, largest for the hypnotherapy group, albeit only on a trend level (P=0.088).Conclusions:Those receiving hypnotherapy did marginally better concerning alcohol use at 1-year follow-up. This small advantage for hypnotherapy could indicate an effect, rendered nonsignificant by an underpowered study. It could also be that neither MI nor hypnotherapy gave an additional effect on top of the substantial group therapy. Lastly the findings could indicate that hypnotherapy is at least as effective as MI.

Dişsiz, Melike

doi: 10.1097/ADT.0000000000000172pmid: N/A

Background:The available data suggest that most illicit drugs have adverse effects on erection, sexual desire, and ejaculation latency in male individuals.Objective:This study was conducted for the evaluation of the sexual functions of substance abuse men.Methods:This descriptive study was conducted at the Alcohol and Substance Research Treatment and Education Center. Male individuals diagnosed as having substance use disorder according to DSM-V (n=106) were included as the patient group. A 30-item sociodemographic and reproductive health interview form developed by researchers and the 15-item International Erectile Function Index were administered to all the participants.Results:It was determined that the most prevalent addiction was cannabis addiction (39.6%) in the substance abuser group, and this was followed by heroin (35.8%) and cocaine addiction (24.6%). It was observed that the substance used by participants at the earliest age (15.81±4.19) was cocaine, and the longest duration in substance use (13.11±9.11) was in the cannabis group. An overall 41.5% of participants stated that they had a sexual problem, and 31.1% of them said they were not satisfied with their sexual life. It was detected that most of the substance abuser men (77.4%) have mild erectile dysfunction (ED) at the rate of 12.3% and moderate ED in 65.1% of them, and the cannabis user group had the most ED (83.3%).Conclusions:Substance abuse affects male sexual functions negatively. There are limited studies about the effects of substance abuse on male sexual functions in our country. For this reason, there is a need for more extensive prospective studies.