Search

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

The construct of self-regulation is of particular interest to the forensic psychiatric practice due to its associations with both clinical and criminal outcomes, as well as recidivism. However, research on different components of self-regulation within forensic psychiatric practice is rare. The current study aimed to gain knowledge on the construct of self-regulation in a sample of forensic psychiatric patients (N = 94). Firstly, by investigating change of emotional, behavioral and cognitive self-regulation over the course of 12 months in state-mandated care in a treatment facility. Secondly, by looking at the associations between these three elements of self-regulation and childhood trauma, identity dysfunction and personality pathology. Repeated measures ANOVA showed little to no difference in average self-regulation over time (only for behavioral regulation), and rank-order stability was relatively high in most cases. Path analysis showed that: emotion regulation was associated with all outcomes; behavioral regulation with all except childhood trauma and detachment; and cognitive regulation only with antagonism and negative affectivity. Findings suggest short-term changes are unlikely and indicate relative importance of emotional, and to some extent behavioral regulation for clinical practice. However, due to sample size restrictions, interpretations should be made with caution.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work., Denna artikel är en sammanställning av resultat från fyra kartläggningar av systematiska översikter om utredningar respektive insatser i socialt arbete. Syftet var att undersöka det vetenskapliga kunskapsläget, kunskap och kunskapsluckor, inom fyra viktiga områden av praktik och forskning i socialt arbete. Deskriptiva data om sökstrategier i litteraturdatabaser samt definierade domäner hämtades från fyra kartläggningar om socialbidrag, missbruk och beroende, omsorg om äldre personer samt personer med funktionsnedsättning. Översikternas vetenskapliga kvalitet och kunskapsläget bedömdes. Nyckelresultaten sammanfattades genom analys och diskussion av generella och specifika element i kartläggningarna. Sammanställningen har gjorts i nära samarbete mellan forskare från olika ämnesområden och SBU, en svensk kunskapsmyndighet. Såväl kunskap som vetenskapliga kunskapsluckor om effekter och erfarenheter av utredningar och insatser i de fyra områdena identifierades i sammanställningen. En kartläggning ger en omfattande bild av kunskapsläget för socialt arbete och kan därför vara användbart både för forskare och praktiker på vägen mot ett evidensbaserat socialt arbete.

Bakgrund: Smärtupplevelsen är subjektiv och individuell som inte kan uppskattas av storleken på en skada. Sjuksköterskans uppgift är att främja livskvalitet, lindra lidande och reducera komplikationer. Inom sjukvården administreras ofta opioider mot smärta, som har en hög beroendepotential. Personer med ett substansberoende och smärta har lika rätt till en kvalitativ, evidensbaserad och värdig vård. Behandlingen ska präglas av ett personcentrerat förhållningssätt där smärtan respekteras, bekräftas och tros på med hänsyn till olika faktorer som kan påverka smärtupplevelsen. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att behandla smärta hos patienter med ett substansberoende. Metod: En litteraturöversikt som utgick från tio vetenskapliga originalartiklar, hämtade från databaserna PubMed och CINAHL complete. Sökorden i PubMed var följande, "nurs* experienc*", "nurs* attitude*", "Substance-Related Disorders", "Opioid-Related Disorders", "Pain Management", "care management" och "pain". I CINAHL complete var sökorden, "Substance Dependence", "Substance Use Disorders", "Pain Management", "care management", "Pain", "nurs* experienc*" och "nurs* attitude*". Av de utvalda artiklarna var åtta kvalitativa och två kvantitativa som kvalitetsgranskades samt analyserades efter Fribergs metodbeskrivning. Resultat: Resultatet visade att inadekvat vård förekommer i smärtbehandlingen av patienter med substansberoenden. Detta till följd av sjuksköterskors bristande kunskap och kommunikation, stigmatisering, osäkerheter och rädslor samt brister i standardiserade smärtskattningsinstrument och behandlingsriktlinjer. Sammanfattning: Att behandla smärta hos patienter med substansberoenden kräver bred kompetens inom området och berör fysiska, sociala och psykiska behov. Vården behöver integrera ett personcentrerat arbetssätt för att tillgodose detta. Genom att dela med sig av erfarenheter och kunskap kunde man minska stigmatisering och lättare hantera egna känslor. Även o, Background: Pain is a subjective and an individual experience which cannot be judge by the apperance of an injury. The role of a nurse is to improve quality of life, alleviate suffering and reduce the impact of pain. In healthcare, addictive opioids are mainly administered for pain. People with a substance dependence and pain have the same right to a qualitative evidence-based and dignified care. Pain management should be characterized by a person-centred approach in which pain is respected, acknowledged and believed in, considers the various factors that may influence the experience of pain. Aim: The aim was to describe nurses' experiences of managing pain in patients with substance dependence. Method: A general literature review based on ten original scholarly articles, taken from PubMed and CINAHL Complete databases was chosen for the study. The key words in PubMed was “nurs* experienc*”, “nurs* attitude*”, "Substance-Related Disorders", "Opioid-Related Disorders", "Pain Management", "care management" and “pain”. The following key words in Cinahl complete was "Substance Dependence", "Substance Use Disorders", "Pain Management", "care management", “Pain”, “nurs* experienc*” and “nurs* attitude*”. Of the selected articles were eight of qualitative design and two were quantitative. They were all quality reviewed and systematically analyzed according to Friberg's method description. Results: The findings show that inadequate care occurs as a result of nurses' perceived, as well as measurable, experiences of treating pain in patients with substance addictions. Based on lack of knowledge and communication, stigmatization, uncertainties and fears, as well as deficiencies in standardized pain assessment instruments and treatment guidelines. Summary: Managing pain in patients with substance dependence requires broad competence and affects physical, social and psychological needs. The healthcare have to integrate a person-centered way of working to accomplish those needs.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

Bakgrund: Smärtupplevelsen är subjektiv och individuell som inte kan uppskattas av storleken på en skada. Sjuksköterskans uppgift är att främja livskvalitet, lindra lidande och reducera komplikationer. Inom sjukvården administreras ofta opioider mot smärta, som har en hög beroendepotential. Personer med ett substansberoende och smärta har lika rätt till en kvalitativ, evidensbaserad och värdig vård. Behandlingen ska präglas av ett personcentrerat förhållningssätt där smärtan respekteras, bekräftas och tros på med hänsyn till olika faktorer som kan påverka smärtupplevelsen. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att behandla smärta hos patienter med ett substansberoende. Metod: En litteraturöversikt som utgick från tio vetenskapliga originalartiklar, hämtade från databaserna PubMed och CINAHL complete. Sökorden i PubMed var följande, "nurs* experienc*", "nurs* attitude*", "Substance-Related Disorders", "Opioid-Related Disorders", "Pain Management", "care management" och "pain". I CINAHL complete var sökorden, "Substance Dependence", "Substance Use Disorders", "Pain Management", "care management", "Pain", "nurs* experienc*" och "nurs* attitude*". Av de utvalda artiklarna var åtta kvalitativa och två kvantitativa som kvalitetsgranskades samt analyserades efter Fribergs metodbeskrivning. Resultat: Resultatet visade att inadekvat vård förekommer i smärtbehandlingen av patienter med substansberoenden. Detta till följd av sjuksköterskors bristande kunskap och kommunikation, stigmatisering, osäkerheter och rädslor samt brister i standardiserade smärtskattningsinstrument och behandlingsriktlinjer. Sammanfattning: Att behandla smärta hos patienter med substansberoenden kräver bred kompetens inom området och berör fysiska, sociala och psykiska behov. Vården behöver integrera ett personcentrerat arbetssätt för att tillgodose detta. Genom att dela med sig av erfarenheter och kunskap kunde man minska stigmatisering och lättare hantera egna känslor. Även o, Background: Pain is a subjective and an individual experience which cannot be judge by the apperance of an injury. The role of a nurse is to improve quality of life, alleviate suffering and reduce the impact of pain. In healthcare, addictive opioids are mainly administered for pain. People with a substance dependence and pain have the same right to a qualitative evidence-based and dignified care. Pain management should be characterized by a person-centred approach in which pain is respected, acknowledged and believed in, considers the various factors that may influence the experience of pain. Aim: The aim was to describe nurses' experiences of managing pain in patients with substance dependence. Method: A general literature review based on ten original scholarly articles, taken from PubMed and CINAHL Complete databases was chosen for the study. The key words in PubMed was “nurs* experienc*”, “nurs* attitude*”, "Substance-Related Disorders", "Opioid-Related Disorders", "Pain Management", "care management" and “pain”. The following key words in Cinahl complete was "Substance Dependence", "Substance Use Disorders", "Pain Management", "care management", “Pain”, “nurs* experienc*” and “nurs* attitude*”. Of the selected articles were eight of qualitative design and two were quantitative. They were all quality reviewed and systematically analyzed according to Friberg's method description. Results: The findings show that inadequate care occurs as a result of nurses' perceived, as well as measurable, experiences of treating pain in patients with substance addictions. Based on lack of knowledge and communication, stigmatization, uncertainties and fears, as well as deficiencies in standardized pain assessment instruments and treatment guidelines. Summary: Managing pain in patients with substance dependence requires broad competence and affects physical, social and psychological needs. The healthcare have to integrate a person-centered way of working to accomplish those needs.

This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

The objective was two-fold: to examine possible associations between dopamine-related genetic polymorphisms and (1) substance dependence; and (2) self-reported psychiatric disturbances, behavioral problems, and personality. Genotyping of single nucleotide polymorphisms (SNP: s) in COMT, DAT and DRD4 was conducted in 174 Russian male juvenile inmates (14–18 years of age) subdivided into having a diagnosis of substance dependence or not, as assessed by using K-SADS-PL. The inmates completed several self-reports assessing psychiatric symptoms (CPTS-RI, BDI), behavioral problems (YSR), and personality traits (TCI). Results revealed that juveniles meeting the criteria for substance dependence differed significantly from their counterparts in four polymorphisms, namely COMT rs737865, DAT rs6347, DRD4 C_1611535 and DRD4 exon III; and exact binary regression analysis indicated a highly significant association between the DRD4 C_1611535 GG genotype and substance dependence. One-way ANOVA tests further showed this gene polymorphism variant to be significantly associated with higher levels of posttraumatic stress, thought problems, aggressive behavior, and personality traits indicating antisocial personality disturbances, as compared with the other gene polymorphism variants. In conclusion, the results underscore the role of the DRD4 polymorphism C_1611535 GG genotype for substance dependence, and suggest its associations with different self-reported phenotype characteristics.

Brain asymmetry reflects left-right hemispheric differentiation, which is a quantitative brain phenotype that develops with age and can vary with psychiatric diagnoses. Previous studies have shown that substance dependence is associated with altered brain structure and function. However, it is unknown whether structural brain asymmetries are different in individuals with substance dependence compared with nondependent participants. Here, a mega-analysis was performed using a collection of 22 structural brain MRI datasets from the ENIGMA Addiction Working Group. Structural asymmetries of cortical and subcortical regions were compared between individuals who were dependent on alcohol, nicotine, cocaine, methamphetamine, or cannabis (n = 1,796) and nondependent participants (n = 996). Substance-general and substance-specific effects on structural asymmetry were examined using separate models. We found that substance dependence was significantly associated with differences in volume asymmetry of the nucleus accumbens (NAcc; less rightward; Cohen's d = 0.15). This effect was driven by differences from controls in individuals with alcohol dependence (less rightward; Cohen's d = 0.10) and nicotine dependence (less rightward; Cohen's d = 0.11). These findings suggest that disrupted structural asymmetry in the NAcc may be a characteristic of substance dependence.

[Abstract] Background: Measuring the health-related quality of life is an essential estimation in cost–utility studies. In this research, we provide new evidence about comparing utility scores – in the field of substance dependence. Although the main objective is to compare the EQ-5D-5L and SF-6D with paired gamble, evidence about the SF-6D with standard gamble is also provided. Methods: Ninety-four patients with substance dependence were recruited; the SF-6D and the EQ-5D-5L were administered at the beginning of treatment and 6 months thereafter. Differences in treatment effect were estimated by comparing utility gains. All analyses were reproduced for two subgroups of severity. Results: Both the baseline scores and the treatment effect are sensitive to the instrument used. For severe states, the SF-6D with paired gamble (SF-6D with standard gamble) estimates the lowest (highest) utility. With regard to the impact of treatment, the EQ-5D-5L and SF-6D with paired gamble estimate strongly similar effects for severe states (and both estimate greater effects than does the SF-6D with standard gamble). Conclusions: These findings have implications for cost–utility analyses. The incremental cost-utility ratio of treatments intended for severe states is barely sensitive to the choice of EQ-5D-5L or SF-6D with paired gamble.

While imaging studies have demonstrated volumetric differences in subcortical structures associated with dependence on various abused substances, findings to date have not been wholly consistent. Moreover, most studies have not compared brain morphology across those dependent on different substances of abuse to identify substance-specific and substance-general dependence effects. By pooling large multinational datasets from 33 imaging sites, this study examined subcortical surface morphology in 1628 nondependent controls and 2277 individuals with dependence on alcohol, nicotine, cocaine, methamphetamine, and/or cannabis. Subcortical structures were defined by FreeSurfer segmentation and converted to a mesh surface to extract two vertex-level metrics-the radial distance (RD) of the structure surface from a medial curve and the log of the Jacobian determinant (JD)-that, respectively, describe local thickness and surface area dilation/contraction. Mega-analyses were performed on measures of RD and JD to test for the main effect of substance dependence, controlling for age, sex, intracranial volume, and imaging site. Widespread differences between dependent users and nondependent controls were found across subcortical structures, driven primarily by users dependent on alcohol. Alcohol dependence was associated with localized lower RD and JD across most structures, with the strongest effects in the hippocampus, thalamus, putamen, and amygdala. Meanwhile, nicotine use was associated with greater RD and JD relative to nonsmokers in multiple regions, with the strongest effects in the bilateral hippocampus and right nucleus accumbens. By demonstrating subcortical morphological differences unique to alcohol and nicotine use, rather than dependence across all substances, results suggest substance-specific relationships with subcortical brain structures.

Hintergrund: Die Substanzabhängigkeit geht mit einer signifikant höheren Komplexitäts-, Komorbiditäts- und Mortalitätsrate einher. Interpersonale und krankheitsbedingte Faktoren dieser Patientinnen und Patienten stellen eine Herausforderung in der Pflegepraxis dar. Pflegefachpersonen sind die Hauptakteure in der Patientinnen- und Patientenversorgung und deren Beziehung nimmt wesentlich Einfluss auf die Behandlungsqualität und den Gesundheitszustand der Patientinnen und Patienten. Ziel: Aufzeigen von Voraussetzungen und evidenzbasierten Strategien für eine professionelle Beziehungsgestaltung mit erwachsenen Patientinnen und Patienten mit einer Substanzabhängigkeit in der Akutsomatik. Methode: Mittels einer systematisierten Literaturrecherche wurden in den pflegerelevanten Datenbanken Medline, CINAHL Complete und Pubpsych sechs geeignete qualitative sowie quantitative Studien gefunden. Ergebnisse: Es wurden überwiegend negativ beeinflussende Faktoren in der Pflegebeziehung identifiziert. Mit Einbezug von Studienergebnissen, welche positive Beziehungserfahrungen aufzeigten, wurde eine differenzierte Bestimmung der Einflussfaktoren auf die Beziehung ermöglicht. Diese Einflussbereiche umfassen Pflegefachperson und Haltung (1), Wissen (2) und Institution (3). Schlussfolgerung: Die Verantwortung einer professionellen Beziehungsgestaltung und deren Potential muss von Institutionen und Pflegefachpersonen erkannt und gestärkt werden. Anhand den Ergebnissen konnten für die einzelnen Bereiche Interventionsempfehlungen formuliert werden. Die Integrierung des Recovery und Caring Konzepts fordert zum Paradigmenwechsel auf und bietet eine Orientierungshilfe in der Beziehungsgestaltung.

While imaging studies have demonstrated volumetric differences in subcortical structures associated with dependence on various abused substances, findings to date have not been wholly consistent. Moreover, most studies have not compared brain morphology across those dependent on different substances of abuse to identify substance-specific and substance-general dependence effects. By pooling large multinational datasets from 33 imaging sites, this study examined subcortical surface morphology in 1628 nondependent controls and 2277 individuals with dependence on alcohol, nicotine, cocaine, methamphetamine, and/or cannabis. Subcortical structures were defined by FreeSurfer segmentation and converted to a mesh surface to extract two vertex-level metrics-the radial distance (RD) of the structure surface from a medial curve and the log of the Jacobian determinant (JD)-that, respectively, describe local thickness and surface area dilation/contraction. Mega-analyses were performed on measures of RD and JD to test for the main effect of substance dependence, controlling for age, sex, intracranial volume, and imaging site. Widespread differences between dependent users and nondependent controls were found across subcortical structures, driven primarily by users dependent on alcohol. Alcohol dependence was associated with localized lower RD and JD across most structures, with the strongest effects in the hippocampus, thalamus, putamen, and amygdala. Meanwhile, nicotine use was associated with greater RD and JD relative to nonsmokers in multiple regions, with the strongest effects in the bilateral hippocampus and right nucleus accumbens. By demonstrating subcortical morphological differences unique to alcohol and nicotine use, rather than dependence across all substances, results suggest substance-specific relationships with subcortical brain structures.

While imaging studies have demonstrated volumetric differences in subcortical structures associated with dependence on various abused substances, findings to date have not been wholly consistent. Moreover, most studies have not compared brain morphology across those dependent on different substances of abuse to identify substance-specific and substance-general dependence effects. By pooling large multinational datasets from 33 imaging sites, this study examined subcortical surface morphology in 1628 nondependent controls and 2277 individuals with dependence on alcohol, nicotine, cocaine, methamphetamine, and/or cannabis. Subcortical structures were defined by FreeSurfer segmentation and converted to a mesh surface to extract two vertex-level metrics-the radial distance (RD) of the structure surface from a medial curve and the log of the Jacobian determinant (JD)-that, respectively, describe local thickness and surface area dilation/contraction. Mega-analyses were performed on measures of RD and JD to test for the main effect of substance dependence, controlling for age, sex, intracranial volume, and imaging site. Widespread differences between dependent users and nondependent controls were found across subcortical structures, driven primarily by users dependent on alcohol. Alcohol dependence was associated with localized lower RD and JD across most structures, with the strongest effects in the hippocampus, thalamus, putamen, and amygdala. Meanwhile, nicotine use was associated with greater RD and JD relative to nonsmokers in multiple regions, with the strongest effects in the bilateral hippocampus and right nucleus accumbens. By demonstrating subcortical morphological differences unique to alcohol and nicotine use, rather than dependence across all substances, results suggest substance-specific relationships with subcortical brain structures.

While imaging studies have demonstrated volumetric differences in subcortical structures associated with dependence on various abused substances, findings to date have not been wholly consistent. Moreover, most studies have not compared brain morphology across those dependent on different substances of abuse to identify substance-specific and substance-general dependence effects. By pooling large multinational datasets from 33 imaging sites, this study examined subcortical surface morphology in 1628 nondependent controls and 2277 individuals with dependence on alcohol, nicotine, cocaine, methamphetamine, and/or cannabis. Subcortical structures were defined by FreeSurfer segmentation and converted to a mesh surface to extract two vertex-level metrics-the radial distance (RD) of the structure surface from a medial curve and the log of the Jacobian determinant (JD)-that, respectively, describe local thickness and surface area dilation/contraction. Mega-analyses were performed on measures of RD and JD to test for the main effect of substance dependence, controlling for age, sex, intracranial volume, and imaging site. Widespread differences between dependent users and nondependent controls were found across subcortical structures, driven primarily by users dependent on alcohol. Alcohol dependence was associated with localized lower RD and JD across most structures, with the strongest effects in the hippocampus, thalamus, putamen, and amygdala. Meanwhile, nicotine use was associated with greater RD and JD relative to nonsmokers in multiple regions, with the strongest effects in the bilateral hippocampus and right nucleus accumbens. By demonstrating subcortical morphological differences unique to alcohol and nicotine use, rather than dependence across all substances, results suggest substance-specific relationships with subcortical brain structures.

[Abstract] Objective: Drug and/or alcohol dependence (DAD) generates substantial costs to society. One of the main consequences of DAD is its negative impact on health-related quality of life (HRQoL). The main objective of this study is to analyse the impact of using EQ-5D-5L, SF-6DSG (SF-6D using standard-gamble as the preference-eliciting method) and SF-6DPG (SF-6D using a paired-gamble method), to estimate the HRQoL burden, attributable to DAD, within the cost-of-illness framework. Methods: A convenience sample of 109 patients with a diagnosis of substance use disorder was recruited. SF-6D and EQ-5D-5L were administered and then the utility scores were computed. The impact of employing different instruments to estimate the HRQoL burden was assessed by comparing the utility scores of patients and general population after controlling for sex and age through regression analysis. The analysis was reproduced for two subgroups of severity. Results: All instruments detect that DAD significantly affects the HRQoL. However, the estimated impact changes, according to the instrument used, whose pattern varies by severity group. Nonetheless, regardless of severity, SF-6DPG always estimates a higher or equal DAD burden than the other instruments considered. These results are compatible with the presence of the floor effect in SF-6DSG, the ceiling effect in EQ-ED-5L, and a smaller presence of both biases in SF-6DPG. Conclusions: The SF-6DPG instrument emerges as a good candidate to avoid under-estimating intangible costs within the cost-of-illness framework. However, further research is needed to assess the validity of our results in the context of other health problems.

While imaging studies have demonstrated volumetric differences in subcortical structures associated with dependence on various abused substances, findings to date have not been wholly consistent. Moreover, most studies have not compared brain morphology across those dependent on different substances of abuse to identify substance-specific and substance-general dependence effects. By pooling large multinational datasets from 33 imaging sites, this study examined subcortical surface morphology in 1628 nondependent controls and 2277 individuals with dependence on alcohol, nicotine, cocaine, methamphetamine, and/or cannabis. Subcortical structures were defined by FreeSurfer segmentation and converted to a mesh surface to extract two vertex-level metrics—the radial distance (RD) of the structure surface from a medial curve and the log of the Jacobian determinant (JD)—that, respectively, describe local thickness and surface area dilation/contraction. Mega-analyses were performed on measures of RD and JD to test for the main effect of substance dependence, controlling for age, sex, intracranial volume, and imaging site. Widespread differences between dependent users and nondependent controls were found across subcortical structures, driven primarily by users dependent on alcohol. Alcohol dependence was associated with localized lower RD and JD across most structures, with the strongest effects in the hippocampus, thalamus, putamen, and amygdala. Meanwhile, nicotine use was associated with greater RD and JD relative to nonsmokers in multiple regions, with the strongest effects in the bilateral hippocampus and right nucleus accumbens. By demonstrating subcortical morphological differences unique to alcohol and nicotine use, rather than dependence across all substances, results suggest substance-specific relationships with subcortical brain structures.

Hintergrund: Die Substanzabhängigkeit geht mit einer signifikant höheren Komplexitäts-, Komorbiditäts- und Mortalitätsrate einher. Interpersonale und krankheitsbedingte Faktoren dieser Patientinnen und Patienten stellen eine Herausforderung in der Pflegepraxis dar. Pflegefachpersonen sind die Hauptakteure in der Patientinnen- und Patientenversorgung und deren Beziehung nimmt wesentlich Einfluss auf die Behandlungsqualität und den Gesundheitszustand der Patientinnen und Patienten. Ziel: Aufzeigen von Voraussetzungen und evidenzbasierten Strategien für eine professionelle Beziehungsgestaltung mit erwachsenen Patientinnen und Patienten mit einer Substanzabhängigkeit in der Akutsomatik. Methode: Mittels einer systematisierten Literaturrecherche wurden in den pflegerelevanten Datenbanken Medline, CINAHL Complete und Pubpsych sechs geeignete qualitative sowie quantitative Studien gefunden. Ergebnisse: Es wurden überwiegend negativ beeinflussende Faktoren in der Pflegebeziehung identifiziert. Mit Einbezug von Studienergebnissen, welche positive Beziehungserfahrungen aufzeigten, wurde eine differenzierte Bestimmung der Einflussfaktoren auf die Beziehung ermöglicht. Diese Einflussbereiche umfassen Pflegefachperson und Haltung (1), Wissen (2) und Institution (3). Schlussfolgerung: Die Verantwortung einer professionellen Beziehungsgestaltung und deren Potential muss von Institutionen und Pflegefachpersonen erkannt und gestärkt werden. Anhand den Ergebnissen konnten für die einzelnen Bereiche Interventionsempfehlungen formuliert werden. Die Integrierung des Recovery und Caring Konzepts fordert zum Paradigmenwechsel auf und bietet eine Orientierungshilfe in der Beziehungsgestaltung.

Epidemiological studies have shown that there is a high incidence of co-occurring PTSD and substance use disorders (SUDs). Given the numerous legal, social, psychological, and medical consequences associated with these two illnesses, it is important to determine clinical targets for them. Anxiety sensitivity (AS) may serve as such a target, as it is associated with both PTSD and SUDs. Furthermore, little is currently known about how AS and PTSD are associated with polysubstance use, and most of the existing literature focuses on nonclinical samples. The following study aims to address these gaps by examining whether PTSD moderates the relationship between AS and SUDs. 2,617 clients at a residential treatment center completed a clinical intake interview. AS was assessed using the ASI, and current and lifetime SUDs and lifetime PTSD were assessed using the SCID-IV. Two-way ANCOVAs were used to investigate the relationship between SUDs, lifetime PTSD, and AS, after controlling for age, income, and gender. AS was positively associated with both PTSD and SUDs. PTSD strengthened the positive association between AS and SUDs. Participants who met criteria for a greater number of SUDs reported greater AS. These results support the use of anxiety-sensitivity based interventions in treating PTSD and SUDs.

While research suggests that the therapeutic alliance is important in predicting outcomes of psychotherapy, relatively little is known about the development of the alliance or the moment-to-moment components of the relationship and how they combine to create an alliance, which may represent a serious limitation in existing methods of measurement. Language style matching (LSM), or the degree to which unconscious aspects of an interactional partner's language mimic that of the other partner, is a promising, unobtrusive measure of interaction quality that could provide novel insight into the therapist-client alliance. In this article, we present a theoretical argument regarding the trajectory of therapist-client LSM across therapy sessions, as well as potential precursors and consequences of LSM. We then report on a pilot test of our hypotheses that examined how LSM, clients' relational histories, and clients' symptoms were associated within a therapeutic context. Using a small sample of substance dependent mothers (N = 7, 100% Caucasian women) enrolled in a randomized controlled trial of psychodynamic psychotherapy lasting 12 sessions, we examined client and therapist LSM across 4 of the 12 sessions. We found that, on average, LSM decreases over the course of treatment. Furthermore, greater client interpersonal problems prospectively predict lower early LSM in therapist-client dyads, which in turn predicts greater posttreatment psychiatric distress. Results generate questions for future research and support further investigations of LSM as one index of the quality of interactions between therapist and client.

While research suggests that the therapeutic alliance is important in predicting outcomes of psychotherapy, relatively little is known about the development of the alliance or the moment-to-moment components of the relationship and how they combine to create an alliance, which may represent a serious limitation in existing methods of measurement. Language style matching (LSM), or the degree to which unconscious aspects of an interactional partners language mimic that of the other partner, is a promising, unobtrusive measure of interaction quality that could provide novel insight into the therapist-client alliance. In this article, we present a theoretical argument regarding the trajectory of therapist-client LSM across therapy sessions, as well as potential precursors and consequences of LSM. We then report on a pilot test of our hypotheses that examined how LSM, clients relational histories, and clients symptoms were associated within a therapeutic context. Using a small sample of substance dependent mothers (N = 7, 100% Caucasian women) enrolled in a randomized controlled trial of psychodynamic psychotherapy lasting 12 sessions, we examined client and therapist LSM across 4 of the 12 sessions. We found that, on average, LSM decreases over the course of treatment. Furthermore, greater client interpersonal problems prospectively predict lower early LSM in therapist-client dyads, which in turn predicts greater posttreatment psychiatric distress. Results generate questions for future research and support further investigations of LSM as one index of the quality of interactions between therapist and client.

Negative therapeutic reaction was first described by Freud, and theories about this phenomenon have focused on various patient factors, for example, unconscious guilt, narcissistic pride, and overwhelming feelings of shame, as well as devaluation of the therapist as a defense against envy. Different strategies to counteract negative therapeutic reactions in patients with severe personality disorder have been proposed. Bateman and Fonagy suggested that some psychoanalytic techniques are iatrogenic for patients with borderline personality disorder and, thus, the therapeutic method must be modified. One manifestation of negative therapeutic reaction is that patients discontinue therapy prematurely. The aim of this study was to explore the differences in the early therapeutic process between therapy dropouts and therapy completers in mentalization-based treatment (MBT) for patients with concurrent borderline personality disorder (BPD) and substance use disorder (SUD). The first 2 videotaped therapy sessions from 6 MBT therapies were selected—3 therapies that were completed and 3 therapies that were prematurely discontinued by the patient. The therapy process was analyzed using the Psychotherapy Process Q set (PQS). Lists of the most frequent and least frequent PQS items among therapy completers versus dropouts are presented. In comparing the sessions from therapy completers and dropouts, significant differences in frequencies were detected for 13 PQS items. These items included therapist and patient activities, as well as features of the therapeutic interaction. Continuation in therapy seems to be related to therapists’ general skills and adherence to MBT, as well as patients bringing up significant material and not being distant.

Quality of Life (QOL) is increasingly being recognised as an important indicator of recovery from substance use treatment. The current study aimed to determine if there are distinct subclasses of QOL among a broad range of people attending specialist non-government alcohol and other drug treatment services, and how QOL might be associated with substance use, mental health, treatment and demographic characteristics of these individuals. The sample included 9958 individuals attending specialist non-government treatment for alcohol or other substance use in New South Wales, Australia. Cross sectional data on quality of life, drug use, treatment variables, psychological distress and substance dependence severity was collected. Latent class analysis was conducted to identify quality of life classes within the sample. Regression analyses were then performed to identify which individual, treatment and health outcomes were associated with these classes. Three distinct quality of life classes were identified, and termed low (n = 3048), moderate (n = 4211) and high quality of life (n = 2699). Classes differed across individual characteristics, substance use and psychological distress. As hypothesised, greater substance use and higher distress was evident in the lowest quality of life class. Quality of life is an important measure of an individuals’ level of functioning during recovery from substance use. The identification of subgroups of individuals with substance use disorders based on their quality of life classes may help guide interventions to improve their overall global functioning and treatment outcomes.

The purpose of this article is to understand how people with substance dependence problems employ testimonies of spiritual transformation to develop, cope and sustain a sense of personal identity and create meaning from conflicting (traumatic) life experiences. The quest to undo the struggling with substance dependence is seen as a spiritual attempt to reconfigure the person's 'spoiled identity'. Drawing on 31 autobiographies of people who recovered from substance dependence problems I analyzed their conversion testimonies in two European contexts (Serbia and the Netherlands, including a sample of immigrants). It draws on the observation that substance dependence often (though certainly not always) develops in response to life crises or trauma and identity confusion, while spiritual transformation, including religious conversion, can foster recovery. The study focuses specifically of the role of testimony in reconstructing a viable narrative of the self, accounting for trauma, substance dependence experience, and conversion and embedding in different social, cultural, and spiritual contexts. Finally, suggestions for the helping professions and care providers of substance dependence service will be offered.

Background: Women with comorbid substance use disorders are an extremely vulnerable group having an increased relative risk of negative outcomes such as incarceration, morbidity and mortality. In Sweden, women with comorbid substance use disorders may be placed in compulsory care for substance abuse treatment. Clinical intake assessment procedures are a distinct aspect of clinical practice and are a foundation upon which client motivation and continued treatment occurs. Method: The current study is a naturalistic quasi-experiment and aims to assess the five-year costs and benefits of a standard intake interview versus an extended psychological and psychiatric assessment for a group of chronic substance abusing women placed in compulsory care in Sweden between 1997 and 2000. Official register data on criminal activity, healthcare use, compulsory care stays and other services was retrieved and all resources used by study participants from date of index care episode was valued. In addition, the cost of providing the intake assessment was estimated. Results: Results show that the extended assessment resulted in higher net costs over five years of between 256,000 and 557,000 SEK per person for women placed in care via the Law on Compulsory Care for Substance Abusers (LVM). Higher assessment costs made up a portion of this cost. The majority of this cost (47-57%) falls on the local municipality (social welfare) and 11.6-13.7% falls on the individual patient. Conclusions: Solid evidence supporting the clinical utility or incremental validity of assessment for improving treatment outcomes in this setting was not confirmed.

Background: Substance dependence is associated with deficits in several areas of executive functioning, such as planning and multitasking. Traditional tests of executive functioning have been criticized for their low ecological validity. Shallice and Burgess (1991) developed the Multiple Errands Test (MET), where participants are required to perform multiple tasks in a real-world setting. In this study, we aimed to adapt the MET for use in populations with substance dependence. Objectives: This study aimed to: (1) examine the applicability of a contextualized version of the Multiple Errands Test, namely, the Multiple Errands Test-Contextualized Version (MET-CV); (2) study the testing context reliability and convergent validity of MET-CV scores; (3) compare the performance of people with substance dependence to a control group. Methods: Data were collected from 60 participants with substance dependence and 30 healthy controls. Both groups performed a neuropsychological assessment, which consisted of the MET-CV and traditional neuropsychological tests (Letter Number Sequencing, Zoo Map Test, Revised Strategy Application Test, Information Sampling Test, Stockings of Cambridge). Results: The MET-CV has adequate testing context reliability and moderate convergent validity relative to traditional planning measures. People with substance dependence (PWSD) showed significant deficits in executive function tests compared to healthy controls, most notably on the MET-CV rather than on traditional neuropsychological tests. Conclusions: The MET-CV can be feasibly applied in the context of therapeutic communities treatment in PWSD. The MET-CV showed adequate reliability and validity, and detected planning deficits in PWSD., SCOPUS: ar.j, info:eu-repo/semantics/published

Background and Aims: Our understanding of patient pathways through specialist Alcohol and Other Drug treatment and broader health/welfare systems in Australia remains limited. This study examines how treatment outcomes are influenced by continuity in specialist Alcohol and Other Drug treatment, engagement with community services and mutual aid, and explores differences between clients who present with a primary alcohol problem relative to those presenting with a primary drug issue. Method: In a prospective, multi-site treatment outcome study, 796 clients from 21 Alcohol and Other Drug services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. A total of 555 (70%) completed a follow-up assessment of subsequent service use and Alcohol and Other Drug use outcomes 12-months later. Results: Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients with meth/amphetamine (66%) as their primary drug of concern and lowest among clients with alcohol as their primary drug of concern (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist Alcohol and Other Drug care was associated with higher rates of abstinence than fragmented Alcohol and Other Drug care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance (odds ratio=2.5) and community service engagement (odds ratio=2.0) for clients with alcohol as the primary drug of concern, and completion of the index treatment (odds ratio=2.8) and continuity in Alcohol and Other Drug care (odds ratio=1.8) when drugs were the primary drugs of concern. Conclusion: This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in Alcohol and Other Drug service

We discuss the concepts of harm reduction in the context of the use and abuse of psychoactive substances through street approach’s therapeutic practices in the urban territory, called the “Consultório de Rua” project. It is an empirical study with qualitative and exploratory nature, in the city of Fortaleza-CE. Knowledge’s systematization deployed in a critical-analytical perspective of social phenomenon analysis and its relationship with the field of mental health, by the social praxis, through structured interviews and literature review. Through content analysis the following categories were considered: Care, Accessibility, Territoriality, Strategy and Politics. Harm reduction policy was presented as a transversal strategy in therapeutic practices to street approach and public health., Discutem-se as concepções da Redução de Danos no âmbito do uso e abuso das substâncias psicoativas através das práticas terapêuticas da abordagem de rua em território urbano, no Projeto Consultório de Rua. Trata-se de um estudo empírico, com natureza qualitativa e exploratória, no município de Fortaleza-CE. A sistematização do conhecimento desdobrou-se na perspectiva crítico-analítica de análise do fenômeno social e de suas relações com o campo da saúde mental, pela práxis social, através de pesquisa de campo, por meio do diário de campo e entrevista semiestruturada, e revisão de literatura especializada. Por meio da análise de conteúdo consideraram-se as categorias Cuidado, Acessibilidade, Territorialidade, Estratégia, Política e Escuta. Foi discutida a Política de Redução de Danos enquanto estratégia transversal nas práticas terapêuticas da abordagem de rua na saúde pública., Se discuten las concepciones de Reducción de Daños en el contexto del uso y abuso de sustancias psicoactivas a través de prácticas terapéuticas de abordage en la calle en territorio urbano, en el Proyecto Consultorio de Calle. Es un estudio empírico de naturaleza cualitativa y exploratoria, en la ciudad de Fortaleza, estado de Ceará. La sistematización del conocimiento se desarrolló por la la perspectiva crítica analítica del análisis del fenómeno social y su relación con el campo de la salud mental, la praxis social, a través de entrevistas estructuradas y revisión de la literatura. A través del análisis de contenido, son consideradas las categorías de Cuidado, Accesibilidad, Territorialidad, Estrategia, Política y Escucha. Se debatió la Política de Reducción de Daños como estrategia transversal en las prácticas terapéuticas de abordage en la calle, en salud pública.

We discuss the concepts of harm reduction in the context of the use and abuse of psychoactive substances through street approach’s therapeutic practices in the urban territory, called the “Consultório de Rua” project. It is an empirical study with qualitative and exploratory nature, in the city of Fortaleza-CE. Knowledge’s systematization deployed in a critical-analytical perspective of social phenomenon analysis and its relationship with the field of mental health, by the social praxis, through structured interviews and literature review. Through content analysis the following categories were considered: Care, Accessibility, Territoriality, Strategy and Politics. Harm reduction policy was presented as a transversal strategy in therapeutic practices to street approach and public health., Discutem-se as concepções da Redução de Danos no âmbito do uso e abuso das substâncias psicoativas através das práticas terapêuticas da abordagem de rua em território urbano, no Projeto Consultório de Rua. Trata-se de um estudo empírico, com natureza qualitativa e exploratória, no município de Fortaleza-CE. A sistematização do conhecimento desdobrou-se na perspectiva crítico-analítica de análise do fenômeno social e de suas relações com o campo da saúde mental, pela práxis social, através de pesquisa de campo, por meio do diário de campo e entrevista semiestruturada, e revisão de literatura especializada. Por meio da análise de conteúdo consideraram-se as categorias Cuidado, Acessibilidade, Territorialidade, Estratégia, Política e Escuta. Foi discutida a Política de Redução de Danos enquanto estratégia transversal nas práticas terapêuticas da abordagem de rua na saúde pública., Se discuten las concepciones de Reducción de Daños en el contexto del uso y abuso de sustancias psicoactivas a través de prácticas terapéuticas de abordage en la calle en territorio urbano, en el Proyecto Consultorio de Calle. Es un estudio empírico de naturaleza cualitativa y exploratoria, en la ciudad de Fortaleza, estado de Ceará. La sistematización del conocimiento se desarrolló por la la perspectiva crítica analítica del análisis del fenómeno social y su relación con el campo de la salud mental, la praxis social, a través de entrevistas estructuradas y revisión de la literatura. A través del análisis de contenido, son consideradas las categorías de Cuidado, Accesibilidad, Territorialidad, Estrategia, Política y Escucha. Se debatió la Política de Reducción de Daños como estrategia transversal en las prácticas terapéuticas de abordage en la calle, en salud pública.

Objectives: To explore whether facial emotion recognition (FER), impaired in both schizophrenia and alcohol and substance use disorders (AUDs/SUDs), is additionally compromised among comorbid subjects, also considering the role of catechol‐O‐methyltransferase (COMT) Val158Met. Methods: We conducted a cross‐sectional study, randomly recruiting 67 subjects with a DSM‐IV‐TR diagnosis of schizophrenia, and rigorously assessing AUDs/SUDs and COMT Val158Met polymorphism. FER was assessed using the Ekman 60 Faces Test‐ EK‐60F. Results: As a whole, the sample scored significantly lower than normative data on EK‐60F. However, subjects with comorbid AUDs/SUDs did not perform worse on EK‐60F than those without, who had a better performance on EK‐60F if they carried the COMT Val/Met variant. Conclusions: This study is the first to date examining the impact of AUDs/SUDs and COMT variants on FER in an epidemiologically representative sample of subjects with schizophrenia. Our findings do not suggest an additional impairment from comorbid AUDs/SUDs on FER among subjects with schizophrenia, whilst COMT Val158Met, though based on a limited sample, might have a role just among those without AUDs/SUDs. Based on our results, additional research is needed also exploring differential roles of various substances.

Background: A functional polymorphism in the catechol-O-methyltransferase (COMT) gene (Val158Met) appears to influence cognition in people with alcohol/substance use disorders (AUD/SUD) and in those with psychosis. Methods: To explore the potential moderating effect of these factors, a cross-sectional study was conducted, randomly recruiting subjects with DSM-IV diagnosis of schizophrenia. AUD/SUD was rigorously assessed, as well as COMT Val158Met polymorphism. Executive control functioning was measured using the Intra-Extra Dimensional Set Shift (IED). The effect of a possible interaction between comorbid AUD/SUD and COMT Val158Met polymorphism on IED scores was explored. Results: Subjects with schizophrenia, comorbid AUD/SUD, and MetMet carriers for SNP rs4680 of the COMT gene showed worse performance on IED completed stages scores, as compared with individuals with ValVal genotype. However, among subjects without AUD/SUD, those with the MetMet variant performed better than people carrying ValVal genotype. Conclusions: This study is the first to date examining the impact of COMT on cognition in a highly representative sample of people with schizophrenia and comorbid AUD/SUD. Differential moderating effects of COMT Val/Met genotype variations may similarly influence executive functions in people with schizophrenia and comorbid AUD/SUD.

The mu1 opioid receptor gene, OPRM1, has long been a high-priority candidate for human genetic studies of addiction. Because of its potential functional significance, the non-synonymous variant rs1799971 (A118G, Asn40Asp) in OPRM1 has been extensively studied, yet its role in addiction has remained unclear, with conflicting association findings. To resolve the question of what effect, if any, rs1799971 has on substance dependence risk, we conducted collaborative meta-analyses of 25 datasets with over 28,000 European-ancestry subjects. We investigated non-specific risk for "general" substance dependence, comparing cases dependent on any substance to controls who were non-dependent on all assessed substances. We also examined five specific substance dependence diagnoses: DSM-IV alcohol, opioid, cannabis, and cocaine dependence, and nicotine dependence defined by the proxy of heavy/light smoking (cigarettes-per-day >20 vs. ≤ 10). The G allele showed a modest protective effect on general substance dependence (OR = 0.90, 95% C.I. [0.83-0.97], p value = 0.0095, N = 16,908). We observed similar effects for each individual substance, although these were not statistically significant, likely because of reduced sample sizes. We conclude that rs1799971 contributes to mechanisms of addiction liability that are shared across different addictive substances. This project highlights the benefits of examining addictive behaviors collectively and the power of collaborative data sharing and meta-analyses.

The mu1 opioid receptor gene, OPRM1, has long been a high-priority candidate for human genetic studies of addiction. Because of its potential functional significance, the non-synonymous variant rs1799971 (A118G, Asn40Asp) in OPRM1 has been extensively studied, yet its role in addiction has remained unclear, with conflicting association findings. To resolve the question of what effect, if any, rs1799971 has on substance dependence risk, we conducted collaborative meta-analyses of 25 datasets with over 28,000 European-ancestry subjects. We investigated non-specific risk for "general" substance dependence, comparing cases dependent on any substance to controls who were non-dependent on all assessed substances. We also examined five specific substance dependence diagnoses: DSM-IV alcohol, opioid, cannabis, and cocaine dependence, and nicotine dependence defined by the proxy of heavy/light smoking (cigarettes-per-day >20 vs. ≤ 10). The G allele showed a modest protective effect on general substance dependence (OR = 0.90, 95% C.I. [0.83-0.97], p value = 0.0095, N = 16,908). We observed similar effects for each individual substance, although these were not statistically significant, likely because of reduced sample sizes. We conclude that rs1799971 contributes to mechanisms of addiction liability that are shared across different addictive substances. This project highlights the benefits of examining addictive behaviors collectively and the power of collaborative data sharing and meta-analyses.

Background Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Methods Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. Results There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. Conclusion The study raises questions concerning whether various European CCC laws in relation to substan

Background Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Methods Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. Results There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. Conclusion The study raises questions concerning whether various European CCC laws in relation to substan

Background Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Methods Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. Results There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. Conclusion The study raises questions concerning whether various European CCC laws in relation to substan

Background Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Methods Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. Results There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. Conclusion The study raises questions concerning whether various European CCC laws in relation to substan

Aims: To understand the role of ancestral genomic background in substance dependence (SD) genome-wide association studies (GWAS), we analyzed population diversity at genetic loci associated with SD traits and evaluated its effect on GWAS outcomes. Materials & methods: We investigated 24 genes with variants associated with SD by GWAS; and 82 loci with putative subordinate roles with respect to SD-associated genes. Results: We observed high ancestry-related frequency differences in common functional alleles in GWAS relevant genes and their interactive partners. Common functional alleles with high frequency differences demonstrated significant effects on the GWAS outcomes. Conclusion: Population differences in SD GWAS outcomes seem not to be influenced by general variation across the genome, but by ancestry-related local haplotype structures at SD-associated loci.

Aims: To understand the role of ancestral genomic background in substance dependence (SD) genome-wide association studies (GWAS), we analyzed population diversity at genetic loci associated with SD traits and evaluated its effect on GWAS outcomes. Materials & methods: We investigated 24 genes with variants associated with SD by GWAS; and 82 loci with putative subordinate roles with respect to SD-associated genes. Results: We observed high ancestry-related frequency differences in common functional alleles in GWAS relevant genes and their interactive partners. Common functional alleles with high frequency differences demonstrated significant effects on the GWAS outcomes. Conclusion: Population differences in SD GWAS outcomes seem not to be influenced by general variation across the genome, but by ancestry-related local haplotype structures at SD-associated loci.

Background Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Methods Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. Results There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. Conclusion The study raises questions concerning whether various European CCC laws in relation to substan

Since the recognition of addiction as a mental illness, studies concerning treatment and therapeutic models have tended to focus on its psychiatric and psychological dimensions. The aim of this article is to highlight the centrality of the social dimension, not only as potential trigger of addictive behaviors and of stigma regarding these behaviors, but also as a variable that permeates diagnosis and treatment. The reflections are based on fieldwork carried out in rehabilitation centers for drug-consuming women in the border city of Tijuana, northwestern Mexico. The results show that the predominant therapeutic models in the city are based in and reproduce the traditional role of women. The social implications of this finding are analyzed, and it is suggested that these centers could be better utilized in the process of building a society with greater gender equality., Desde que la adicción adquirió reconocimiento como enfermedad mental, los estudios relativos al tratamiento y modelos terapéuticos han tendido a centrarse en sus dimensiones psiquiátricas y psicológicas. El objetivo de este artículo es destacar la centralidad de la dimensión social, no solo como potencial detonante de comportamientos adictivos y estigmas sobre ellos, sino como variable que permea también su diagnóstico y tratamiento. Las reflexiones parten del trabajo de campo realizado en centros de rehabilitación para mujeres consumidoras de drogas, en la ciudad fronteriza de Tijuana, al noroeste de México. Los resultados arrojan que los modelos terapéuticos predominantes en la ciudad se basan en el rol tradicional de la mujer y lo reproducen. Se analizan las implicaciones sociales de este hecho, y finalmente se sugiere que esos centros podrían ser igualmente aprovechados en el proceso de construcción de una sociedad con mayor equidad de género.

Background Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Methods Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. Results There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. Conclusion The study raises questions concerning whether various European CCC laws in relation to substan

Aims: To understand the role of ancestral genomic background in substance dependence (SD) genome-wide association studies (GWAS), we analyzed population diversity at genetic loci associated with SD traits and evaluated its effect on GWAS outcomes. Materials & methods: We investigated 24 genes with variants associated with SD by GWAS; and 82 loci with putative subordinate roles with respect to SD-associated genes. Results: We observed high ancestry-related frequency differences in common functional alleles in GWAS relevant genes and their interactive partners. Common functional alleles with high frequency differences demonstrated significant effects on the GWAS outcomes. Conclusion: Population differences in SD GWAS outcomes seem not to be influenced by general variation across the genome, but by ancestry-related local haplotype structures at SD-associated loci.

Background: Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether threelegal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Methods: Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. Results: There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. Conclusion: The study raises questions concerning whether various European CCC laws in relation to subs