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BACKGROUND: Studies have shown that impairments in the ventromedial prefrontal cortex play a crucial role in violent behavior in forensic patients who also abuse cocaine and alcohol. Moreover, interventions that aimed to reduce violence risk in those patients are found not to be optimal. A promising intervention might be to modulate the ventromedial prefrontal cortex by high-definition (HD) transcranial direct current stimulation (tDCS). The current study aimed to examine HD-tDCS as an intervention to increase empathic abilities and reduce violent behavior in forensic substance dependent offenders. In addition, using electroencephalography, we examined the effects on the P3 and the late positive potential of the event-related potentials in reaction to situations that depict victims of aggression.METHODS: Fifty male forensic patients with a substance dependence were tested in a double-blind, placebo-controlled randomized study. The patients received HD-tDCS 2 times a day for 20 minutes for 5 consecutive days. Before and after the intervention, the patients completed self-reports and performed the Point Subtraction Aggression Paradigm, and electroencephalography was recorded while patients performed an empathy task.RESULTS: Results showed a decrease in aggressive responses on the Point Subtraction Aggression Paradigm and in self-reported reactive aggression in the active tDCS group. Additionally, we found a general increase in late positive potential amplitude after active tDCS. No effects on trait empathy and the P3 were found.CONCLUSIONS: Current findings are the first to find positive effects of HD-tDCS in reducing aggression and modulating electrophysiological responses in forensic patients, showing the potential of using tDCS as an intervention to reduce aggression in forensic mental health care.

BackgroundPeople with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may have a different impact on primary care use.AimTo assess the association between multimorbidity clusters and primary care consultations over time.Design and settingA retrospective longitudinal (panel) study design was used. Data comprised electronic primary care health records of 826 166 patients registered at GP practices in an ethnically diverse, urban setting in London between 2005 and 2020.MethodPrimary care consultation rates were modelled using generalised estimating equations. Key controls included the total number of long-term conditions, five multimorbidity clusters, and their interaction effects, ethnic group, and polypharmacy (proxy for disease severity). Models were also calibrated by consultation type and ethnic group.ResultsIndividuals with multimorbidity used two to three times more primary care services than those without multimorbidity (incidence rate ratio 2.30, 95% confidence interval = 2.29 to 2.32). Patients in the alcohol dependence, substance dependence, and HIV cluster (Dependence+) had the highest rate of increase in primary care consultations as additional long-term conditions accumulated, followed by the mental health cluster (anxiety and depression). Differences by ethnic group were observed, with the largest impact in the chronic liver disease and viral hepatitis cluster for individuals of Black or Asian ethnicity.ConclusionThis study identified multimorbidity clusters with the highest primary care demand over time as additional long-term conditions developed, differentiating by consultation type and ethnicity. Targeting clinical practice to prevent multimorbidity progression for these groups may lessen future pressures on primary care demand by improving health outcomes.

Epigenome-wide studies report higher methylation among women than men with decreasing levels with age. Little is known about associations of sex and age with methylation of monoamine oxidase A (MAOA). Methylation of the first exonic and partial first intronic region of MAOA has been shown to strengthen associations of interactions of MAOA-uVNTR genotypes and adversity with aggression and substance misuse. Our study examined associations of sex and age with MAOA first exon and intron methylation levels in 252 women and 157 men aged 14–73 years. Participants included adolescents recruited at a substance misuse clinic, their siblings and parents, and healthy women. Women showed ~ 50% higher levels of exonic, and ~ 15% higher intronic, methylation than men. Methylation levels were similar between younger (M = 22.7 years) and older (M = 46.1 years) participants, and stable across age. Age modified few associations of methylation levels with sex. MAOA genotypes modified few associations of methylation with sex and age. Higher methylation levels among women were not explained by genotype, nor interaction of genotype and sexual abuse. Findings were similar after adjusting for lifetime diagnoses of substance dependence (women = 24.3%; men = 34.2%). Methylation levels were higher among women who experienced sexual abuse than women who did not. Results extend on prior studies by showing that women display higher levels of methylation than men within first intronic/exonic regions of MAOA, which did not decrease with age in either sex. Findings were not conditioned by genotype nor interactions of genotype and trauma, and indicate X-chromosome inactivation.

Loperamide, a popular and inexpensive over-the-counter antidiarrheal medicine, is a potent μ-opioid receptor agonist approved by the U.S. Food and Drug Administration (FDA). It has been on the market since 1976 and is relatively safe with no central nervous system-related side effects when used for a short period of time at the recommended therapeutic dose (2-8 mg/day). In recent years, loperamide has become notoriously known as the "poor man's methadone" for people with substance dependence due to the increase in loperamide overdoses from self-administered medication to treat opioid withdrawal symptoms. As a result, in 2018, the FDA decided to limit the available packaged dose of loperamide to stop prominent abuse. This review provides the synthesis and chemical properties of loperamide as well as the pharmacology and adverse effects of its use and the social effects of such abuse.

Abstract. After decades of stagnation, research on psychedelic substances (such as lysergic acid diethylamide [LSD], psilocybin, or N,N-dimethyltryptamine [DMT]) has experienced a renaissance over the last 10 years, with various major research programs being conducted across Europe and the United States. This research primarily investigates the potential of psychedelics in the treatment of mental health disorders, their short- and long-term effects on recreational users, and the neurological and cognitive processes responsible for their effects. The present review provides a concise summary of the most recent insights gained from this research. We briefly outline the history of psychedelic research, the objective and subjective effects caused by these substances, the prevalence and socio-psychological correlates of their use, as well as their potential for harm. Subsequently, we review empirical research on the beneficial effects of psychedelics in clinical samples, focusing on their efficacy in the treatment of major depression, anxiety, and substance use disorders, and discuss research on the proposed neural and cognitive mechanisms behind these effects. We then review research on their effects on healthy subjects, focusing on psychological well-being as well as changes in personality, nature-relatedness, and creativity. Finally, we review empirical evidence regarding the long-term effects of single experiences with psychedelics and conclude with a summary and outlook.

Treatment resistance affects 20–60% of patients with psychiatric disorders; and is associated with increased healthcare burden and costs up to ten-fold higher relative to patients in general. Whilst there has been a recent increase in the proportion of psychiatric research focussing on treatment resistance (R2 = 0.71, p

RATIONALE: Prior studies have demonstrated statistically significant but subtle differences in brain function between patients with a history of substance dependence (SD) and control groups. OBJECTIVES: The goal of the present study was to show that variability in brain activation over the trials of a cognitive task is more useful for revealing the putative impact of SD than analyses focusing on the amplitude of activation averaged over trials. The study also tested the additional contribution of antisocial personality disorder (ASPD)—a prevalent comorbidity that promotes both an early onset and more severe course of SD. METHODS: Two hundred eleven adults performed two selective attention tasks while P300 event-related electroencephalo-graphic potentials were recorded. They were assigned to one of 3 mutually exclusive groups: no lifetime history of SD or ASPD (n = 67), a SD history but no ASPD (n = 68), or both SD and ASPD (n = 76). RESULTS: The major finding was a statistically significant elevation of P300 amplitude inter-trial variability (ITV) in the SD plus ASPD group in comparison to the group with neither attribute. The elevation was detected during both selective attention tasks and most prominent at electrodes sites located over the frontal brain. There were no group differences in P300 amplitude averaged over trials. CONCLUSIONS: We conclude from these findings that the ITV of P300 amplitude is an efficient and sensitive biomarker of the maintenance of attention. It is valuable for revealing group differences associated with substance dependence and ASPD. It may ultimately be valuable for detecting improvements resulting from psychostimulant treatment or other interventions, including cognitive remediation.

Objective: This study explores the relationship between income generation, increasing substance dependence, and the risk of relapse among drug treatment inpatients after their primary drug treatmen...

For medical and social reasons, it is important that burn patients attend follow-up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016 to 2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcoxon Rank-Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 [8]% vs 6.5 [11]% median [inter quartile range]), traveled farther (70.2 [111.8] vs 52.5 [76.7] miles), and were more likely to be homeless (22.8% vs 6.9%) and have drug dependence (47.3% vs 27.2%). Patients who had at least one MA were younger (42 [26] vs 46 [28] years) and more likely to be homeless (17.5% vs 2.6%) and have drug dependence (42.5% vs 19.4%). On multivariate analysis, factors associated with never attending an FUA were distance from hospital (odds ratio [OR] 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA: age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and Emergency Department visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

Experiencing pain during the withdrawal period is one of the most significant complications of addiction to opioids. Thus, the main objective of the current study was to investigate the effects of endurance exercise training and methadone on acute and chronic pain responses in morphine-dependent rats going through the withdrawal syndrome. In this study, 48 male Wistar rats (mean age: 9 weeks, mean weight: 295 ± 20 g) were randomly assigned to six subgroups, each with eight rats. The subgroups were control (Ctrl), healthy exercise (CT), control addicts (CTA), addicts treated with exercise (TA), addicts treated with methadone (MA), and addicts treated with methadone plus exercise (TMA). Substance dependence was induced through oral consumption of morphine. The interventional therapy protocol included a combination of methadone and a regular aerobic exercise program. Acute and chronic pain responses were evaluated using the model proposed by Dubuisson and Dennis. The results show significant decreases in the mean scores of acute and chronic pain in (CtA), (MA), and (TA) groups of morphine-dependent rats going through the withdrawal syndrome compared to the control group (Ctrl). Moreover, treatment of morphine-dependent rats with training (TA) alone or with methadone (MA) alone resulted in a significant decrease in the scores of acute and chronic pain compared to the animals receiving both training and methadone (i.e., the TMA group). However, no significant differences were observed among (TMA), (CT), and control groups in terms of the mean scores of acute and chronic pains. It seems that the regular aerobic exercise program and methadone administration in the animal model can serve as useful tools for the modulation of pain in morphine-dependent rats going through the withdrawal syndrome. However, further studies are needed in human samples.

Objective: Substance use and addiction are an increasing problem worldwide. Knowledge of the frequency and features of substance use contribute to ascertaining the addiction trends in a country, re...

This study explored mediating pathways, moderating factors, and moderated mediation effects of a web-based, cognitive behavioral therapy (CBT) intervention for chronic pain patients with aberrant drug-related behavior (ADRB). In a 2-arm RCT, patients with chronic pain who screened positive for ADRB received treatment-as-usual (TAU, n = 55) or TAU plus a 12-week, web-based CBT intervention (n = 55). Assessments were conducted at weeks 4, 8, and 12, and at 1- and 3-months post intervention. Web-CBT significantly reduced pain catastrophizing, which, in turn, reduced pain interference and pain severity via a pathway of pain catastrophizing. Web-CBT also significantly reduced ADRB both directly and indirectly by reducing pain catastrophizing. For pain interference and pain severity, web-CBT was more effective than TAU for younger patients (≤ age 50). For pain severity, web-CBT was more effective for both younger patients (≤ age 50), and those with a lifetime substance use disorder. Findings suggest that web-CBT's positive impact on pain outcomes and ADRB are mediated by its effect on pain catastrophizing, and its treatment effects may be most robust for younger patients and those with histories of substance dependence.

Past research suggests that people with opioid dependence show increased consumption of sweet food, but it is unclear if this is influenced by altered taste preference and/or taste perception. We tested whether people prescribed opioid substitution therapy (OST) exhibited a shift in preference towards sweeter flavours, and altered perception of sweetness, and explored whether these measures of taste preference/perception were associated with measures of opioid use. Three groups of participants (people prescribed OST, n=36; people with past opioid dependence, but now abstinent from all opioids, n=18; and controls with no history of substance dependence other than nicotine, n=29) provided ratings of “sweetness”, “liking”, and “desire” of 4 solutions with varying concentrations of sucrose. We did not find significant differences between groups in the effect of sucrose concentration on “sweetness”, “liking”, or “desire” ratings. However, among those prescribed OST, frequency of recent illicit opioid use was associated with reduced perception of “sweetness” of low sucrose concentrations. Higher methadone dose was associated with a shift towards liking sweeter concentrations. Among those with past opioid dependence, longer duration of abstinence from opioids was associated with a shift towards liking sweeter concentrations. Among people currently dependent on opioids, reduced sensitivity to low levels of sweetness and increased preference for sweeter flavours may be associated with increased dependence on opioids. Among those who have ceased opioid use, the association between preference for sweeter flavours and duration of abstinence is a novel finding that deserves further investigation.

Suicide is increasingly being recognized as a global public health concern, but it is still treated as a neglected burden in Nepal. Case-control study on suicide from Nepal is very rare. Thus, a community-based matched case-control study was conducted at Ilam District to identify different stressors associated with Nepalese suicidal victims with appropriate samples of 64 cases which were matched for age group (± 2 years) and area of residence with 128 controls (1:2 ratio). Data was collected through suicide survivors and close neighbors of suicide victims. Intimate partner violence was an independent risk factor for committing suicide (OR (95% CI) = 5.33 (1.41–20.10), P = 0.013). A conditional logistic regression identified two strong stressors of suicide: depression (OR (95% CI) = 10.53 (3.11–35.66), P

Aim: To establish the substance use pattern and psychological distress among the in-coming nursing students of the College with a view towards recommending ways to prevent or reduce complications of substance use disorder in the college. Study design: A cross-sectional design was used. Place and duration: The study took place at the College of Nursing and Midwifery, Jos, Plateau state between the 3rd and 14th of February, 2020. Methodology: The study was carried out during the orientation program of the 206 first-year students of the college. Following approval, a health talk and explanation of the aims and objectives, their consent was obtained in writing. Two-staged sampling with a sociodemographic questionnaire and Hopkins Symptom Checklist-25 followed by urine drug testing was done. The participants were debriefed on the findings while maintaining strict confidentiality. There were 65 males and 141 females. Results: Lifetime prevalence rate of any substance use was 21.8%. More females 33 (23.4%) than males 12 (18.5%) used substances. Only 9 (4.5%) volunteered their substance use, the rest was revealed by the urine testing. Prevalence of alcohol was 23 (11.2%), ketamine 13 (6.3%), nicotine 3 (1.5%), benzodiazepines 3 (1.5%), cannabis 2 (1.0%) and opiods 1 (0.5%). Symptoms of psychological distress were high as 118 (57.3%) and 82 (38.8%) were symptomatic for anxiety and depression respectively. Alcohol use was significantly related with having symptomatic anxiety (P = 0.02) and depression (P = 0.00) in the study. Conclusion: Considering the high prevalence of substance use among the participants, educational intervention and policies should be designed to prevent substance dependence with its complications within the students.

Contains fulltext : 219494.pdf (Publisher’s version ) (Closed access) 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. 15 p.

This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored. Funding Agencies|Linkoping University

To determine the prevalence of substance use disorders (SUDs) in patients with schizophrenia in a sample from South Africa and compare the clinical and demographic correlates in those with and without co-occurring SUDs. Patients with schizophrenia were interviewed using the Xhosa version SCID-I for DSM-IV. We used logistic regression to determine the predictors of SUDs. In the total sample of 1420 participants, SUDs occurred in 47.8%, with the most prevalent SUD being cannabis use disorders (39.6%), followed by alcohol (20.5%), methaqualone (6.2%), methamphetamine (4.8%) and other SUDs (cocaine, ecstasy, opioids, 0.6%). Polydrug use occurred in 40%, abuse occurred in 13.5%, and 39.6% had at least one substance dependence diagnosis. Significant predictors of any SUD were younger age (41–55 vs. 21–30: OR = 0.7, 95% CI = 0.5–0.9), male sex (OR = 8.6, 95% CI = 5.1–14.6), inpatient status (OR = 1.7, 95% CI = 1.3–2.1), post-traumatic stress symptoms (OR = 4.6, 95% CI = 1.6–13.3), legal (OR = 3.4, 95% CI = 2.0–5.5) and economic problems (OR = 1.4, 95% CI = 1.0–2.0). Methamphetamine use disorders occurred significantly less often in the Eastern compared to the Western Cape provinces. Inpatient status and higher levels of prior admissions were significantly associated with cannabis and methamphetamine use disorders. Post-traumatic stress symptoms were significantly associated with alcohol use disorders. Anxiety disorders were associated with other SUDs. SUDs occurred in almost half of the sample. It is important for clinicians to identify the presence of SUDs as their presence is associated with characteristics, such as male sex, younger age, inpatient status, more prior hospitalisations, legal and economic problems, PTSD symptoms and anxiety.

Background: This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. Methods: The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence.Results: Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). Conclusions: Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.

People with psychotic disorders have a high prevalence of comorbid mental disorders, especially if severe mental illness (SMI) criteria are fulfilled. Substance Use Disorders (SUD) are the most common comorbidity. The aim of the study is to investigate whether SMI patients with and without comorbid SUD have a comparable course, remission and recovery rates within evidence-based care.ACCESS is an integrated care model for patients with severe nonaffective and affective psychotic disorders. Treatment trajectories of patients, who have been in ACCESS care for at least 4 years, with and without SUD were compared with regard to the course of illness using Mixed Model Repeated Measures (MMRM) as well as recovery rates and its predictors.187 of 312 patients (60%) were at least 4 years in ACCESS. Of these, 126 (67.4%) had a comorbid SUD at admission. Patients had on average 2.96 SUD, 87 (69%) had a dependence. Both groups improved significantly over 4 years in all outcome parameters. However, patients with substance dependence showed significantly worse outcomes in psychopathology (p 0.001), functioning (p = 0.006) and quality of life (p = 0.026). Using LOCF, 44 patients (23.5%) fulfilled recovery criteria at endpoint. Comorbid substance use dependence was the only significant predictor for non-recovery (OR = 0.462, p = 0.048).SUD and especially substance dependence are common in psychotic disorders with SMI. Evidence-based integrated care also leads to long-term improvement in these patients, but to a lesser extent than in patients without SUD. In particular, the "optimal" outcome recovery is made more difficult by SUD dependence.

Substance use disorders in physicians is a serious problem of the medical community and public health. The prevalence of substance use disorders depends on gender, age and medical specialty. The substance abuse impairs physical and mental health of physicians and affects the quality of patient care. Treatment of chemically addicted physicians involves the use of conventional therapeutic approaches adopted in addiction medicine, but requires compliance with certain special principles.

Objective The present investigation tested the association of a novel measure of brain activation recorded during a simple motor inhibition task with a GRM8 genetic locus implicated in risk for substance dependence. Methods 122 European-American adults were genotyped at rs1361995 and evaluated against DSM-IV criteria for Alcohol Dependence, Cocaine Dependence, Conduct Disorder, and Antisocial Personality Disorder. Also, their brain activity was recorded in response to rare, so-called “No-Go” stimuli presented during a continuous performance test. Brain activity was quantified with two indices: (1) the amplitude of the No-Go P300 electroencephalographic response averaged across trials; and (2) the inter-trial variability of the response. Results The absence of the minor allele at the candidate locus was associated with all of the evaluated diagnoses. In comparison to minor allele carriers, major allele homozygotes also demonstrated increased inter-trial variability in No-Go P300 response amplitude but no difference in average amplitude. Conclusions GRM8 genotype is associated with Alcohol and Cocaine Dependence as well as personality risk factors for dependence. The association may be mediated through an inherited instability in brain function that affects cognitive control. Significance The present study focuses on a metric and brain mechanism not typically considered or theorized in studies of patients with substance use disorders.

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. 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. 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. 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.

BACKGROUND AND OBJECTIVES Alcohol use is often overlooked and underestimated among patients recovered from substance dependence. The prevalence and correlates of alcohol use disorder (AUD) among adults recovered from substance use disorders (SUDs) are estimated in this study. METHODS A nationally representative cross-sectional analysis of the National Epidemiological Survey on Alcohol and Related Conditions Wave-III was used in this study. Survey respondents, aged 18 or older, who recovered from SUDs, based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria (n = 2061 unweighted), were included. A total of three comparison groups were identified using DSM-5 criteria (1) current AUD, (2) former AUD, and (3) never had AUD. The prevalence of these groups was estimated; medical and psychiatric comorbidities and health-related quality of life were compared; and factors associated with having a current AUD when compared with those with former AUD and those who never had AUD were examined, controlling for other covariates. RESULTS About 5.7% of US adults, nationally representative of 14.2 million, have been reported to have recovered from past SUDs. Of these, 28.9% met criteria for current AUD and 48.4% had former AUD. When compared with those who never had AUD, factors associated with having a current AUD included the following: living in urban areas (P = .019), having a bipolar 1 disorder (P

Background Although unhealthy alcohol use and low bone density are prevalent among people living with HIV (PLWH), it is not clear whether alcohol use is associated with bone turnover markers (BTMs), and if so, at what quantity and frequency. The study objective was to examine the association between alcohol and BTMs in PLWH with substance use disorder. Methods We studied a prospective cohort recruited from 2 HIV clinics who met criteria for DSM‐IV substance dependence or reported ever injection drug use. Outcomes were BTM of (i) bone formation (serum procollagen type 1 N‐terminal propeptide [P1NP]) and (ii) bone resorption (serum C‐telopeptide type 1 collagen [CTx]). Alcohol consumption measures included (i) mean number of drinks/d (Timeline Follow‐Back [TLFB]) (primary predictor), (ii) any alcohol use on ≥20 of the past 30 days, and phosphatidylethanol (PEth), a biomarker of recent alcohol consumption. Linear regression analysis examined associations between (i) each alcohol measure and each BTM and (ii) change in alcohol and change in BTM over 12 months. Results Among 198 participants, baseline characteristics were as follows: The median age was 50 years; 38% were female; 93% were prescribed antiretroviral medications; 13% had ≥20 drinking days/month; mean drinks/day was 1.93 (SD 3.89); change in mean drinks/day was −0.42 (SD 4.18); mean P1NP was 73.1 ng/ml (SD 34.5); and mean CTx was 0.36 ng/ml (SD 0.34). Higher drinks/day was significantly associated with lower P1NP (slope −1.09 ng/ml; 95% confidence interval [CI] −1.94, −0.23, per each additional drink). On average, those who drank on ≥ 20 days/month had lower P1NP (−15.45 ng/ml; 95% CI: −26.23, −4.67) than those who did not. Similarly, PEth level ≥ 8ng/ml was associated with lower P1NP. An increase in drinks/d was associated with a decrease in P1NP nonsignificantly (−1.14; 95% CI: −2.40, +0.12; p = 0.08, per each additional drink). No significant associations were detected between either alcohol measure and CTx. Conclusions In this sample of PLWH with substance use disorder, greater alcohol consumption was associated with lower serum levels of bone formation markers., We examined whether alcohol consumption was associated with serum bone turnover markers in a sample of adults with HIV infection and a substance use disorder. Alcohol exposure was examined with three self‐report measures of past month alcohol quantity/frequency as well as phosphatidylethanol (PEth) level, a biomarker of recent alcohol consumption. All alcohol consumption measures were associated with lower levels of a bone formation marker (P!NP) but not with C‐telopeptide, a marker of bone resorption. Vitamin D deficiency was not a mediator in these associations.

This study sought to replicate and extend findings regarding change in the number of endorsed Diagnostic and Statistical Manual (DSM) criteria for substance use disorders as a meaningful outcome for clinical trials with Spanish-speakers. A secondary analysis was conducted of data from 83 treatment-seeking individuals with current DSM-IV substance dependence participating in a randomized controlled trial evaluating a culturally-adapted version of a computer-based cognitive behavioral therapy program (CBT4CBT) for Spanish-speakers. Participants were randomized to either weekly standard outpatient counseling (treatment as usual – TAU), or TAU plus access to CBT4CBT (TAU+CBT4CBT). The Structured Clinical Interview for DSM-IV (SCID-IV) was administered at baseline and at the end of the 8-week treatment period to measure change in diagnostic status and total criteria count. Frequency of substance use during treatment and throughout a 6-month follow-up period was measured by self-report using a calendar-based Timeline FollowBack method, with abstinence verified through instant urine toxicology, and problem severity was measured with the Addiction Severity Index (ASI). Results of a generalized linear model with Poisson’s distribution indicated significant reduction in the total count of DSM-IV dependence criteria during treatment (Wald X(2) = 136.20; p

Introduction: Substance abuse refers to the harmful or hazardous use of any psychoactive substance including licit and illicit drugs, other than when medically indicated. According to a UN report, 1 million heroin addicts are registered in India, and unofficially, there are as many as 5 million. Among all the states Punjab stood third in substance abuse and also injectable drug use. The present study was thus conducted to assess the sociodemographic profile and pattern of substance abuse among patients attending a Drug de-addiction centre. Material and Methods: A record-based analysis from March 2015 to March 2019 was done. Substance dependence was diagnosed post detailed clinical interview by a consultant psychiatrist at the center using DSM -10. For the 966 registered patients admitted in the last four years, the record was checked for completeness of data and relevant information on socio-demographic profile, substance abused, duration of hospital stays, drop out and relapse rates was extracted. Results: Of the total admitted patients (n= 966) 100% addicts were of male gender and natives of Punjab. 514 (53.21%) were married followed by 434(44.93%) never married. Maximum patients 456(47.20%) were self-employed. Heroin was the most abused drug. The injecting route of drug abuse was used by most of the abusers i.e. 51.66%. Only 173 (17.90%) patients dropped out of the treatment followed by relapse in 192 (19.88%). Conclusion: In this paper we demonstrated the vulnerability of young population towards drug addiction. Easy accessibility of drugs, peer pressure and difficult family circumstances raises the fragility to restore for substance use. However, community-based studies are imperative in order to estimate how big is the problem at the bottom.

Recently, topics related to substance dependence and behavioral addiction have been reported through the media. Therapeutic treatment for substance dependence and behavioral addiction is one of the challenges in a clinical practice. This is because there is no therapeutic treatment for a complete cure, and reuses and repetitive hospitalization occur in patients. Therefore, it is an urgent need to develop new treatments for substance dependence and behavioral addiction. In the present review, we outline associations between dependence and G-protein-activated inwardly rectifying potassium (GIRK) channels which we focus on as therapeutic targets, and introduce ongoing clinical study using an inhibitor of GIRK channels. Previous studies including animals and patients have accumulated the results that GIRK channels have a key role for mediating signals from addictive substances. GIRK channels are expressed in various rodent brain regions including the reward system. The activation of G protein-coupled receptors (GPCRs) that activates GIRK channels through G-protein βγ subunits and activated GIRK channels contribute to control of neuronal excitability. Pretreatment with ifenprodil that is one of the GIRK channel blockers suppressed addictive substance-induced behaviors in animals. Ifenprodil is safe and broadly used as a cerebral circulation/metabolism ameliorator that is covered by medical insurance in Japan. The authors reported that ifenprodil treatment for 3 months decreased alcohol use scores in patients with alcohol dependence compared with patients who received the control medication. We currently conduct a clinical trial to investigate the outcomes of ifenprodil treatment for methamphetamine dependence. In the future, we will expand clinical studies using ifenprodil for patients with other substance dependence and behavioral addiction.

BACKGROUND In December 2019, the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China, and now, it has spread all over the world. Pregnant women are a susceptible population, but there is scant information about COVID-19 in this population. Here, we report a case of a mother with substance use disorders who was infected with COVID-19 in her pregnancy. CASE The patient was a 29-year-old, primigravida mother at the 37th gestational week who was referred to our center because of vaginal bleeding and severe uterine contractions. The patient was abusing opioids. With the suspicion of placental abruption, she was admitted for cesarean section. One day after delivery, she developed dyspnea, rhinorrhea, and vomiting. These were thought of as withdrawal signs. Despite methadone administration, these signs persisted. After ruling out deprivation syndrome and possible obstetric causes, a SARS-CoV-2 Polymerase chain reaction (PCR) test was ordered; the result was positive. CONCLUSION In this case, because of the flu-like symptoms of substance withdrawal and postpartum causes of shortness of breath, the medical team's attention was drawn to these causes. SARS-CoV-2 infection should be considered as a differential diagnosis for these patients.

ImportanceHomeless or precariously housed individuals live with poor health and experience premature mortality compared to the general population. With an increasing average age among this demographic, syndromes associated with neurogenerative disease are also increasing. Quantitative MRI measures may help define the roles of age and risk factors for poor brain health among these individuals.ObjectiveTo evaluate whether MRI measures of brain structure are differentially associated with age and selected risk factors among individuals who are homeless or precariously housed compared to a general population sample.Design, setting, and participantsCross sectional comparison of baseline data from 312 community-based, precariously housed participants with a publicly available dataset of 382 participants recruited from the general population.Exposure(s)The primary exposure was housing status (precariously housed vs general population). Risk factors in the precariously housed sample included mental illness, substance dependence, intravenous drug use, HIV, and history of traumatic brain injury.Main outcome(s) and measure(s)The main outcomes were MRI measures of whole-brain tissue- to-intracranial volume ratio, fractional anisotropy, and mean diffusivity. Multiple linear regression and piecewise regression were used to evaluate differences in associations between MRI measures and age between the samples, and to explore associations with risk factors in the precariously housed sample.ResultsCompared to the general population sample, older age in the precariously housed sample was associated with more whole-brain atrophy (β=-0.20, p=0.0029), lower whole-brain FA (β=-0.32, pβ=0.69, pConclusions and relevanceOlder age is associated with adverse MRI measures of brain structure among homeless and precariously housed individuals compared to the general population. Education, improvements in care provision and policy may help to reduce the health disparities experienced by these individuals.

Background: More than one-third of justice-involved individuals meet the criteria for substance use disorder (SUD). Many studies show that treatment expectancy predicts longitudinal SUD outcomes; h...

Objectives We describe retention in care, medication for opioid use disorder (MOUD) prescribing, and urine toxicology outcomes of a comprehensive perinatal shared medical appointment model that combined medication, group-based counseling, and recovery supports. Methods We conducted a retrospective study of program retention between 11/1/16 and 3/31/20 in pregnant and postpartum women with substance dependence or use disorder. Disengagement reasons, MOUD prescribing, and urine toxicology were abstracted from medical records. A Cox proportional hazards model was used to evaluate risk factors for program disengagement. Results Approximately 87% of patients had OUD and 80% were pregnant at the initial visit (N = 140). Retention at 3 months, 6 months, 1 year, and 2 years was approximately 86%, 78%, 66%, and 48%, respectively. Over 97% of patients were prescribed MOUD and 88% of all urine toxicology results were negative for non-prescribed opioids. Patients enrolled after initiation of wraparound services (HR 0.52, 95% CI 0.28-0.96) and those attending more shared medical appointments (HR 0.90, 95% CI 0.87-0.93) had a lower hazard of disengagement after controlling for other covariates. Loss to follow-up was the most common disengagement reason. Conclusions A low-threshold, comprehensive perinatal shared medical appointment program had high retention rates, increased access to evidence-based MOUD, and high rates of opioid-negative urine toxicology. Participants enrolled after wraparound services began had a lower hazard of disengagement. Future research in perinatal substance use should evaluate the most optimal and cost-effective components of comprehensive programs to inform standard of care.

BACKGROUND: Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning.AUTHORS' CONCLUSIONS: PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.

Betel quid (BQ) is one of the most popular addictive substances in the world. However, the neurophysiological mechanism underlying BQ addiction remains unclear. This study aimed to investigate whether and how BQ chewing would affect brain function in the framework of a dynamic brain network model. Resting-state functional magnetic resonance imaging scans were collected from 24 male BQ-dependent individuals and 26 male non-addictive healthy individuals before and promptly after chewing BQ. Switching rate, a measure of temporal stability of functional brain networks, was calculated at both global and local levels for each scan. The results showed that BQ-dependent and healthy groups did not significantly differ on switching rate before BQ chewing (F = 0.784, p = 0.381, analysis of covariance controlling for age, education, and head motion). After chewing BQ, both BQ-dependent (t = 2.674, p = 0.014, paired t-test) and healthy (t = 2.313, p = 0.029, paired t-test) individuals showed a significantly increased global switching rate compared to those before chewing BQ. Significant corresponding local-level effects were observed within the occipital areas for both groups, and within the cingulo-opercular, fronto-parietal, and cerebellum regions for BQ-dependent individuals. Moreover, in BQ-dependent individuals, switching rate was significantly correlated with the severity of BQ addiction assessed by the Betel Quid Dependence Scale scores (Spearman's rho = 0.471, p = 0.020) before BQ chewing. Our study provides preliminary evidence for the acute effects of BQ chewing on brain functional dynamism. These findings may provide insights into the neural mechanisms of substance addictions.

Background: Patients with acute poisoning sometimes require hospitalization in the Intensive Care Unit (ICU). The correct admission of these patients has resulted to lower mortality. This study compared the characteristics of adult patients with acute poisoning who were admitted to the poisoning ward and the ICU. We also determined the relevant outcome predictive factors. Methods: This cross-sectional study was conducted on adult acutely poisoned patients who were admitted to the emergency room of Khorshid Hospital affiliated with Isfahan University of Medical Sciences from October 2018 to 2019. The clinico-epidemiological variables and outcomes were compared between adult patients hospitalized in the ward (n=100) and ICU (n=100). Binary logistic regression was used for predicting the outcome factors. Results: The Mean±SE age of the study patients in the ICU and ward were 36.6±1.62 (median: 34) and 34.20±1.19 years, (median: 33, P=0.23), respectively. There was no significant difference between the study groups respecting substance dependence, alcohol and drug abuse, disease history, and the type of exposure (P>0.05). However, self-mutilation, the kind of substance, the vital signs and level of consciousness at admission, and outcomes were significantly different between the research groups (P

Background: Poisoning is among the leading causes of childhood injuries. With the increasing prevalence of substance dependence in the community, there is a rise in the frequency of children admitted to hospitals with drug intoxication. Therefore, we investigated the prevalence of acute opioids poisoning in children. Methods: The present cross-sectional study was performed on children under 17 years of age who were admitted to Sabzevar hospitals with a diagnosis of opioids poisoning. A researcher-made checklist was used for data collection, including the patient’s age, gender, intoxication agent, drug consumption route and form, hospitalization length and outcome, family’s educational level, occupational status, and living area. Besides, descriptive tests were used in SPSS to analyze the obtained data. Results: In total, 129 cases of opioids poisoning were reported during the study period. The mean±SD age of the studied children was 2.74±3.05 years. The minimum and maximum ages of poisoned children were 1 and 16 years, respectively. The liquid-soluble form was the most common form of opioids used (38.3%). Opium was also the most commonly used substance (68.45%). In 85 (65.89%) children, a decrease in Glasgow Coma Scale (GCS) was observed at baseline. Moreover, 7 of the explored children have died. Besides, 90.7% of their fathers and 95.3% of their mothers had an educational level of a diploma or below. The most common factor associated with opium poisoning was the family’s substance dependence in 120 (93%) cases. Substance dependence in children was mostly observed in those aged 3-5 years. Conclusion: Poisoning with opium is the most common type of children’s opioid poisoning in Sabzevar. A decreased level of consciousness is the most frequent manifestations in these patients. Therefore, in all children, by observing a sudden decrease in the level of consciousness without apparent reasons, especially along with other symptoms, such as acute diarrhea, restlessness, etc., it is recommended to consider opioids poisoning.

Background Minor physical anomalies (MPA) are markers of impaired neurodevelopment during the prenatal stage. Assessing MPA across psychiatric disorders may help understand their shared nature. In addition, MPA in family members would indicate a shared liability and endophenotype potential. We examined familial aggregation of MPA and their role as transdiagnostic and disorder-specific markers of 5 major psychiatric/neuropsychiatric conditions (schizophrenia, bipolar disorder, substance dependence, obsessive-compulsive disorder, and Alzheimer's dementia). Methods Modified Waldrop's MPA scale was applied on 1321 individuals from 439 transdiagnostic multiplex families and 125 healthy population controls (HC). Stage of fetal development (morphogenetic/phenogenetic)- and anatomical location (craniofacial/peripheral)-based sub-scores were calculated. Familiality and endophenotypic potential of MPA were analyzed with serial negative binomial mixed-effect regression. Cross-diagnostic differences and the effect of family history density (FHD) of each diagnosis on MPA were assessed. Mixed-effects Cox models estimated the influence of MPA on age-at-onset of illness (AAO). Results MPA were found to be heritable in families with psychiatric disorders, with a familiality of 0.52. MPA were higher in psychotic disorders after controlling for effects of sex and intrafamilial correlation. Morphogenetic variant MPA was noted to be lower in dementia in comparison to HC. FHD of schizophrenia and bipolar disorder predicted higher, and that of dementia and substance dependence predicted lower MPA. MPA brought forward the AAO [HR:1.07 (1.03–1.11)], and this was more apparent in psychotic disorders. Conclusion MPA are transmissible in families, are specifically related to the risk of developing psychoses, and predict an earlier age at onset. Neurodevelopmentally informed classification of MPA has the potential to enhance the etiopathogenic and translational understanding of psychiatric disorders.

INTRODUCTION: Prohibited substances issue and their abuse have become a scourge for people in Indonesia. This situation creates concern for every level of society since this is very influential to damage and can even eliminate generations at a later time. AIM: This study aims to determine the characteristics of age, education, psychological and social problems related to substance dependence experienced by individuals with substance disorders who undergo rehabilitation in Medan, Indonesia. METHODS: This study is a cross-sectional analytic, in which the sample of this study was individuals who underwent rehabilitation in the Rehabilitation Center in Medan City who fulfilled the inclusion and exclusion criteria. A structured interview was carried out with the MINI ICD-10 on part M. disorders related to psychoactive substances. Furthermore, to see the level of dependence, WHO ASSIST questionnaire (The Alcohol, Smoking and Substance Involvement Screening Test) was used. RESULTS: This study discovered that subjects with age above 21 years were the most dominant of the prohibited substance users group as many as 87 people (69%), Batak tribe with 73 people (57.9%), residence originating from outside the city with 70 people (55.6%), Unmarried with 87 people (70.2%), education level is medium (junior high school) with 117 people (92.9%) and work as many as 77 people (61.1%). The study also found that the most dominant number of prohibited substances users were single users of methamphetamine and a combination of two substances, each of which was 49 people (38.9%). There is no relationship between social factors and patterns of prohibited substance use. Also, the most dominant users of prohibited substances who undergo rehabilitation are those based on family and police (involuntary admission). Finally, as many as 70 people used methamphetamine require intensive intervention. CONCLUSION: This study shows that social and demographic factors are not related to the pattern of prohibited substance use.

Similarities have been observed between substance dependence and overconsumption of food, leading to the development of the food addiction (FA) concept. While psychological markers of FA have often been documented, data on physiological markers remains scarce. This study aimed to investigate HPA-axis functioning through cortisol awakening response (CAR) in relation to FA among bariatric candidates. We hypothesized that participants presenting high FA symptomatology would present a blunted CAR when compared to participants presenting low FA symptomatology and that significant associations between CAR and eating behaviors would be observed within both groups. The final sample comprised 40 participants, who were invited to complete questionnaires and provide saliva samples upon awakening (T0, T15, and T30). Results from the two-way ANOVA with repeated measures showed a non-significant “time x group” interaction, indicating that CAR did not differ between groups. Moreover, results from correlational analyses showed different patterns of associations between CAR and eating behaviors within each group; further analyses showed that the relationship between CAR and food cravings triggered by cues in the environment was significantly moderated by FA symptomatology, as higher CAR was related to lower cue-triggered food cravings only in individuals presenting low FA symptomatology. While these findings do not support the presence of HPA-axis functioning differences in relation to FA, they suggest that the association of CAR with eating behaviors may depend on whether or not addictive tendencies are present. Further investigation of the association between CAR and eating behaviors in the context of FA will thus be essential.

Background There is much focus on the dearth of resources within healthcare systems, with a focus on health services. In 2018, we held a speed networking event for two local areas of a HSE Community Healthcare Organisation. This highlighted the vast array of supports available to assist older people to live well. This, alongside a Listening to Older Person’s Workshop, highlighted the need for a local directory of services. Methods In considering potential networking attendees, a social determinants of health approach (Dahlgren and Whitehead, 1991) was adopted to scope all supports available across community, acute, voluntary and statutory health and social care services within the area. This was expanded on further to develop the directory. Results The directory provides details of 358 organisations, individuals and groups available to support older persons within a catchment area with a population of 13,833 older persons (CSO Census, 2016). Hospital services comprised 27 of these while community HSE and GP health services made up 130. The remaining 201 were local and national NGOs and community groups ranging in service provision, a sample of which as follows: 39 provided some level of social/education engagement, three befriending, 18 counselling, five housing specific, 11 substance dependency, 12 provided supports to persons impacted by abuse. A further 20 national NGOs provided a local service or helpline with a focus on a particular health diagnosis. Conclusion This exercise shows the vast number of services available within just one small region, to support older persons to live well at home. The directory has been approved as a template for other networks in the CHO. It is being adapted into an online version by an interagency group. Using this template nationally has the potential to overcome gaps in health service resources, and support true integration, in line with the ICPOP (2016) 10 step framework.

Background:Substantial substance use disorders and related health conditions emerged during the mid-20th century and continue to represent a remarkable 21st century global burden of disease. This burden is largely driven by the substance-dependence process, which is a complex process and is influenced by both genetic and environmental factors. During the past few decades, a great deal of progress has been made in identifying genetic variants associated with Substance Use and Dependence (SUD) through linkage, candidate gene association, genome-wide association and sequencing studies.Methods:Various statistical methods and software have been employed in different types of SUD genetic studies, facilitating the identification of new SUD-related variants.Conclusion:In this article, we review statistical methods and software that are currently available for SUD genetic studies, and discuss their strengths and limitations.

Behavioral health problems affect at least 15% of mothers, but few studies have examined how different problems cluster together. Characterizing symptom profiles and their correlates early in the family life cycle can extend existing understanding beyond that provided by studies based on single problems. Mothers in the Fragile Families and Child Wellbeing study, a national birth cohort of racially diverse and mostly unmarried mothers (N = 4205), reported depression, anxiety, and substance dependence symptoms. Latent class analysis (LCA) identified mothers' symptom profiles in their children's third year. We explored associations between symptom profiles and demographics, reproductive health outcomes, functional limitations, and postpartum behavioral health. LCA identified five profiles: (1) Depression only (14.5% of sample), (2) Severe depression and anxiety (5.3%), (3) Anxiety only (2.2%), (4) Depression and substance use (1.4%), and (5) Currently symptom free (76.6%). Depressive symptoms were more moderate when co-occurring with substance dependence and more severe when co-occurring with anxiety. Postpartum depression, postpartum anxiety, and smoking during pregnancy were the most robust correlates of being symptomatic in year 3. Mothers in the "Severe depression and anxiety" group were more likely to be in that profile if they reported functional impairment and/or relationship dissolution. Mothers in the "Depression only" profile were more likely to have higher parity and/or functional impairment. A quarter of mothers of young children had significant behavioral health symptoms, with most reporting depression symptoms. Psychosocial and physical health factors in the pregnancy and postpartum periods were associated with future symptoms, warranting obstetrician and pediatrician attention.

Objective: The authors used a decision tree classifier to reduce neuropsychological, behavioral and laboratory measures to a subset of measures that best predicted whether an individual with alcohol use disorder (AUD) seeks treatment. Method: Clinical measures (N = 178) from 778 individuals with AUD were used to construct an alternating decision tree (ADT) with 10 measures that best classified individuals as treatment or not treatment-seeking for AUD. ADT's were validated by two methods: using cross-validation and an independent dataset (N = 236). For comparison, two other machine learning techniques were used as well as two linear models. Results: The 10 measures in the ADT classifier were drinking behavior, depression and drinking-related psychological problems, as well as substance dependence. With cross-validation, the ADT classified 86% of individuals correctly. The ADT classified 78% of the independent dataset correctly. Only the simple logistic model was similar in accuracy; however, this model needed more than twice as many measures as ADT to classify at comparable accuracy. Interpretation: While there has been emphasis on understanding differences between those with AUD and controls, it is also important to understand, within those with AUD, the features associated with clinically important outcomes. Since the majority of individuals with AUD do not receive treatment, it is important to understand the clinical features associated with treatment utilization; the ADT reported here correctly classified the majority of individuals with AUD with 10 clinically relevant measures, misclassifying

Purpose Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of these rehabilitative trajectories are subject to “drop-out”. In addition, “drop-out” is a significant risk factor for relapse. There is an urgent demand for effective treatment, which would enable patients to reduce abuse and prevent relapse. Takiwasi is an addiction treatment centre that combines traditional Amazonian plant medicine with conventional western medicine and psychotherapy. The purpose of this paper is to explore whether socio-demographics factors, such as education level and occupation, psychiatric comorbidities and primary drug use, are associated with treatment non-completion of Ayahuasca (AYA)-assisted addiction therapy. Design/methodology/approach Data on the first treatment episode of 121 patients were collected from the patient database from the years 2012 to 2017. To determine whether there is an association between the variables of interest and treatment non-completion, a χ2 analysis and a logistic regression analysis were performed. Findings Of the 121 patients analysed, 48.2 per cent completed their treatment, whilst 51.8 per cent did not. Students compared to those who are employed showed significantly higher odds for treatment non-completion (p=0.006; OR=3.7; 95% CI=1.5–9.6). Other variables in the multivariable analysis showed no significant relationship with treatment non-completion. While several limitations restricted the study, the findings suggest that the AYA-assisted treatment in Takiwasi may benefit from additional support for patients who are students. Moreover, it is advised to conduct more long-term follow-up of patients in order to gain better insight into the outcome of treatment at an AYA-assisted treatment centre. Originality/value It appears that AYA-assisted therapy in a therapeutic community is a feasible type of treatment for addiction, for which further studies should elucidate the role of motivation in relation to socio-demographic factors and type of addiction in the risk of treatment non-completion.

Hypnosis has a therapeutic effect on substance dependence. However, its neural basis remains unclear, which impedes its further clinical applications. This study investigated the mechanisms of smoking treatment based on hypnosis from two perspectives: immediate and follow-up effects. Twenty-four smokers screened from 132 volunteers underwent hypnosis suggestion and performed a smoking-related cue task twice during functional magnetic resonance imaging (fMRI) scanning (in normal and hypnotic states). The number of cigarettes smoked per day was recorded at follow-up visits. The smokers reported decreased craving after hypnosis. The activations in the right dorsal lateral prefrontal cortex (rDLPFC), the left insula and the right middle frontal gyrus (rMFG), and the functional connectivity between the rDLPFC and the left insula were increased in the hypnotic state. The reduced craving was related to the DLPFC-insula network, which reflected the immediate mechanism of hypnosis on smoking. The number of cigarette use at the 1-week and 1 month follow-up was correlated with the rMFG activation which reflecting hypnotic depth, suggesting the follow-up effect of hypnosis on smoking depended on the trait of smokers. We identified two different mechanisms of hypnosis effect on smoking, which have important implications for design and optimization of hypnotic treatments on mental disorders.