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Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression. [ABSTRACT FROM AUTHOR]

Gaming Disorder was included as an addictive disorder in the latest version of the International Classification of Diseases (ICD-11), published in 2022. The present study aimed to develop a screening tool for Gaming Disorder, the Gaming Disorder Identification Test (GADIT), based on the four ICD-11 diagnostic criteria: impaired control, increasing priority, continued gaming despite harm, and functional impairment. We reviewed 297 questionnaire items from 48 existing gaming addiction scales and selected 68 items based on content validity. Two datasets were collected: 1) an online panel (N = 803) from Australia, United States, United Kingdom and Canada, split into a development set (N = 589) and a validation dataset (N = 214); and 2) a university sample (N = 408) from Australia. Item response theory and confirmatory factor analyses were conducted to select eight items to form the GADIT. Validity was established by regressing the GADIT against known correlates of Gaming Disorder. Confirmatory factor analyses of the GADIT showed good model fit (RMSEA=<0.001–0.108; CFI = 0.98–1.00), and internal consistency was excellent (Cronbach's alphas = 0.77–0.92). GADIT scores were strongly associated with the Internet Gaming Disorder Test (IGDT-10), and significantly associated with gaming intensity, eye fatigue, hand pain, wrist pain, back or neck pain, and excessive in-game purchases, in both the validation and the university sample datasets. The GADIT has strong psychometric properties in two independent samples from four English-speaking countries collected through different channels, and shown validity against existing scales and variables that are associated with Gaming Disorder. A cut-off of 5 is tentatively recommended for screening for Gaming Disorder. [ABSTRACT FROM AUTHOR]

This paper reports a qualitative survey of experts in problem gaming and/or problem gambling from 19 countries worldwide on the impact of the COVID-19 pandemic on problematic gaming and gambling. Twenty-seven problem gaming experts reported (i) no licensing changes, (ii) few existing or newly introduced policies or regulations, (iii) overall increases in gaming, (iv) adverse health-related outcomes, (v) media coverage of gaming and eSports, (vi) limited health service capacity for treatment and prevention, (vii) difficulty in connecting with patients, and (viii) adaptations including transition to telemedicine. Twenty-eight problem gambling experts reported (i) no changes in policies or regulation, (ii) increased activity of off-shore betting companies, and (iii) increases in online gambling, though (iv) decreased expenditure due to closure of land-based gambling venues, (v) adverse health-related outcomes, (vi) some financial benefits from savings, (vii) few and poorly accessible treatment facilities and (viii) transition to telemedicine. There is a need for: guidelines on the prevention and management of excessive gaming and gambling; studies examining the public health consequences of eSports viewing and participation and closure of land-based gambling venues on other forms of gambling; and longitudinal studies in a number of different areas described herein. [ABSTRACT FROM AUTHOR]

Gaming activities have conferred numerous benefits during the COVID-19 pandemic. However, some individuals may be at greater risk of problem gaming due to disruption to adaptive routines, increased anxiety and/or depression, and social isolation. This paper presents a summary of 2019–2021 service data from specialist addiction centers in Germany, Switzerland, Japan, and the United Kingdom. Treatment demand for gaming disorder has exceeded service capacity during the pandemic, with significant service access issues. These data highlight the need for adaptability of gaming disorder services and greater resources and funding to respond effectively in future public health crises. [ABSTRACT FROM AUTHOR]

When does repeated behaviour constitute behavioural addiction? There has been considerable debate about non-substance-related addictions and how to determine when impaired control over a behaviour is addiction. There are public health benefits to identifying new behavioural addictions if intervention can improve outcomes. However, criteria for establishing new behavioural addictions must guard against diagnostic inflation and the pathologizing of normal problems of living. Criteria should include clinical relevance (Criterion 1), alignment with addiction phenomenology (Criterion 2) and theory (Criterion 3), and taxonomic plausibility (Criterion 4). Against such criteria, evidence does not yet support classification of pornography-use and buying-shopping disorders as addictions. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.04.006 Byline: Jason P. Connor (a), Ross McD. Young (b), Bruce R. Lawford (c), John B. Saunders (d), Terry L. Ritchie (e), Ernest P. Noble (e) Keywords: DRD2 gene; Comorbidity; Alcohol and nicotine dependence Abstract: Cigarette smoking in those who are alcohol dependent is associated with higher morbidity and mortality. The A1 allele of the D.sub.2 dopamine receptor (DRD2) gene has been independently associated with alcohol and nicotine dependence. Whether this polymorphism is associated with nicotine dependence in those who are also alcohol dependent has not been investigated. Subjects were 84 (61 males; 23 females) Caucasian DSM IV diagnosed nicotine- and alcohol-dependent subjects sampled from consecutive admissions to a hospital alcohol detoxification ward. Data were obtained through standardised measures of nicotine and alcohol consumption and dependence severity. A1.sup.+ allelic (A1/A1 or A1/A2 genotype) compared to A1.sup.- allelic (A2/A2 genotype only) patients were characterised by higher levels of alcohol and cigarette consumption. A1.sup.+ allelic patients reported greater alcohol dependence severity, but not nicotine dependence severity. When the combined nicotine and alcohol dose was examined, A1.sup.+ allelic patients consumed significantly more of these drugs than their A1.sup.- allelic counterparts. Author Affiliation: (a) Department of Psychiatry, The University of Queensland, Princess Alexandra Hospital, Brisbane 4102, Australia (b) Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove Carseldine, Brisbane 4034, Australia (c) Hospital Alcohol and Drug Service, Royal Brisbane and Women's Hospital, Brisbane 4029, Australia (d) Department of Psychiatry, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane 4029, Australia (e) Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024-1759, USA

Objective: Dysphoria and depression have been cited as side effects of the opioid antagonist naltrexone. We aimed to assess whether depressive symptoms are a clinically relevant side effect in a [...]

A study involving 380 participants in five heroin detoxification trials whose data were pooled to enable direct comparison of five detoxification trials in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project is detailed. The participants with more previous detoxification attempts were more likely to enter postdetoxification treatment.

Objective: The Temptation and Restraint Inventory (TRI) is commonly used to measure drinking restraint in relation to problem drinking behavior. However, as yet the TRI has not been validated in a clinical group with alcohol dependence. Method: Male (n = 111) and female (n = 57) inpatients with DSM-IV diagnosed alcohol dependence completed the TRI and measures of problem drinking severity, including the Alcohol Dependence Scale and the quantity, frequency and week total of alcohol consumed. Results: The factor structure of the TRI was replicated in the alcohol dependent sample. Cognitive Emotional Preoccupation (CEP), one of the two higher order factors of the TRI, demonstrated sound predictive power toward all dependence severity indices. The other higher order factor, Cognitive Behavioral Control (CBC), was related to frequency of drinking. There was limited support for the CEP/CBC interactional model of drinking restraint. Conclusions: Although the construct validity of the TRI was sound, the measure appears more useful in understanding the development, maintenance and severity of alcohol-related problems in nondependent drinkers. The TRI may show promise in detecting either continuous drinking or heavy episodic type dependent drinkers. (J. Stud. Alcohol 65: 250-254, 2004), DRINKING RESTRAINT has received considerable attention as a potential indicator of problem drinking behavior. Drinking restraint according to Collins (1993) involves a cognitive and behavioral preoccupation with alcohol, demonstrated by [...]

Objective: The potential of general practitioners (GPs) to reduce the prevalence of alcohol-related problems via alcohol intervention contrasts sharply with actual practice. One explanation for GPs' limited involvement in alcohol intervention is that they have had inadequate training or continuing medical education (CME) on alcohol-related issues. This study examined GPs' experience of alcohol-related CME and its possible relationship with attitudes and practice behavior regarding alcohol-related problems. Method: A questionnaire-based survey was returned by 2,139 GPs from 13 countries across Western and Eastern Europe, North America and Australasia. Diagnostic and management skills were assessed by responses to standardized case vignettes. Results: The survey response rate was 54%. Approximately one third of GPs (32%) reported receiving no alcohol-related CME, while 8% could not remember whether or not they had received any such training or education. Of the remaining GPs (n = 1,217), 23% reported less than 4 hours (low levels) and 37% reported 4 or more hours (high levels) of alcohol-related CME. GPs who reported higher levels of alcohol-related CME were more likely to obtain information about alcohol, were more prepared to counsel problem drinkers and managed more patients for alcohol issues than did colleagues reporting lower levels of CME. Those with greater CME experience were also more confident about their ability to alleviate alcohol-related problems and reported more appropriate management strategies than did GPs with less CME experience. Conclusions: Greater exposure to alcohol-related CME appears to result in better diagnosis and more appropriate management of alcohol-related problems by GPs. Whether this is directly due to the CME itself or because GPs with greater interest in alcohol issues seek out such experience cannot be ascertained from the current study and requires further investigation. (J. Stud. Alcohol 62:621-627, 2001), ********** EXCESSIVE ALCOHOL CONSUMPTION is a major cause of health and social problems and loss of economic productivity worldwide (Anderson et al., 1993). Indeed, alcohol-related problems have achieved international prominence [...]

Researchers in Australia conducted a study to measure change in attitudes among staff members working in public methadone programs after the program was changed from abstinence to harm-minimization. The study found that a statistically significant reduction in support for abstinence had occurred. However, no change in punishing illicit drug use or their knowledge of the risks and benefits were found.

The meaning of the word craving varies as illustrated by Kozlowski and Wilkinson's reports of ambiguities in use amongst cigarette smokers. We extended this line of investigation to problem drinkers who sought a goal of controlled drinking versus abstinence, to professionals involved in the addictions area, and to university students. Significant differences in meaning were noted particularly among the problem drinkers (N = 256 between 17 and 60 years of age). Reasons for this are offered.

Background: Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs.Aims: This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined.Method: A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders.Results: The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04-0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results.Conclusions: A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit. [ABSTRACT FROM AUTHOR]