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Genome wide association studies (GWASs) have provided insights into the molecular basis of the disorder in different population. This study presents the first GWAS of substance use disorder (SUD) in patients from the United Arab Emirates (UAE). The aim was to identify genetic association(s) that may provide insights into the molecular basis of the disorder. The GWAS discovery cohort consisted of 512 (250 cases and 262 controls) male participants from the UAE. Controls with no prior history of SUD were available from the Emirates family registry. The replication cohort consisted of 520 (415 cases and 105 controls) Australian male Caucasian participants. The GWAS discovery samples were genotyped for 4.6 million single nucleotide polymorphism (SNP). The replication cohort was genotyped using TaqMan assay. The GWAS association analysis identified three potential SNPs rs118129027 (p-value = 6.24 × 10 -8 ), rs74477937 (p-value = 8.56 × 10 -8 ) and rs78707086 (p-value = 8.55 × 10 -8 ) on ch7p14.1, that did not meet the GWAS significance threshold but were highly suggestive. In the replication cohort, the association of the three top SNPs did not reach statistical significance. In a meta-analysis of the discovery and the replication cohorts, there were no strengthen evidence for association of the three SNPs. The top identified rs118129027 overlaps with a regulatory factor (enhancer) region that targets three neighboring genes LOC105375237, LOC105375240, and YAE1D1. The YAE1D1, which represents a potential locus that is involved in regulating translation initiation pathway. Novel associations that require further confirmation were identified, suggesting a new insight to the genetic basis of SUD., (© 2018 Wiley Periodicals, Inc.)

Background: Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents., Methods: We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12-19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models., Results: Those who received the intervention had lower costs ($22 versus $227: z=3.16, p=0.002) and rates (0.03 versus 0.25: z=2.57, p=0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p=0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p=0.924), overall ED presentations ($4266 versus $4150, p=0.916), out-patient mental health services ($4494 versus $7717, p=0.282), or opiate pharmacotherapies ($1013 versus $2054, p=0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z=2.64, p=0.008)., Conclusions: An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Substance use disorder (SUD) is a global problem with no boundaries, which also afflicts individuals from countries of the Arabian Peninsula. Data from this region is limited. In an effort to develop targeted prevention and intervention initiatives in the United Arab Emirates (UAE), it was necessary to identify the nature of substance use by describing the characteristics of those using different substances. Consequently, this study in the UAE was conceived to describe the pattern of SUD in a first-ever cohort that was systematically recruited from the country's National Rehabilitation Centre (NRC) in Abu Dhabi., Methods: Two hundred and fifty male patients were recruited from the NRC. Information on substance use was collected using a questionnaire that was completed at an interview with patients who consented to participate. The questionnaire was based on information that the study was designed to capture. It was reviewed by members of institutional ethics committees and approved prior to use. Two hundred and fifty male subjects from the Emirates Family Registry (EFR) were used as a comparison group., Results: In the cohort studied, SUD correlated with smoking and marital status. Poly-substance users formed the majority of the cohort (84.4 %) with various combinations of substances identified across different age groups. Opioid and alcohol were the most common substances used. The use of pharmaceutical opioids, primarily Tramadol (67.2 % of opioid users), was higher among the youngest age group studied (<30 years old), while older opioid users (≥30 years old) commonly used illicit opioids (Heroin). The use of prescribed medication for non-medical use also included Pregabalin (mean of 8.3 capsules ± 0.5 per day), Procyclidin (6.1 tablets + 0.6 per day) and Carisoprodol (4.2 tablets ± 0.4 per day) and was again highest in the age group below 30 years., Conclusion: This 2015 study highlights the importance of examining the pattern of poly-substance use in a population in order to develop targeted prevention programs to arrest the prevailing trends. It has drawn attention to the rise in use of prescription medication in the UAE, in particular among younger patients (<30 years), and continuing use of illicit opioid amongst males above 30 years. Specific prevention and intervention strategies, targeting differences between these distinct demographic profiles will capture a large subset of sufferers.

Drug dependence is a pattern of repeated self-administration of a drug, which can result in tolerance, withdrawal and compulsive drug-taking behaviour. It has been recently suggested that 5-HTTLPR (LL/LS/SS) variants and rs25531 (A/G) polymorphism in the serotonin transporter gene (SLC6A4) may play a role in drug dependence. The current study aimed to (1) identify allelic, haplotypic and genotypic frequencies of the 5-HTTLPR variants and rs25531 polymorphisms of SLC6A4 gene in drug and nondrug-dependent Jordanian Arab population and (2) determine whether there is an association of these variants in a drug-dependent population from the same area. Jordanian drug male addicts of Arab descent (n = 192) meeting the Diagnostic and Statistical Manual of Mental Disorders - Fourth edition criteria for drug dependence and 230 healthy male controls from an ethnically homogenous Jordanian Arab population were examined. Genotyping was performed using the restriction fragment length polymorphism-polymerase chain reaction-based method to genotype the 5-HTTLPR variants and detect the A/G polymorphism at position rs25531. The biallelic analysis revealed that the frequency of 5-HTTLPR (LL/LS/SS) genotypes was statistically significant different between drug-dependent individuals and controls (χ (2) (2, N = 422), p = 0.04). Drug-dependent subjects had a higher frequency of 'L' allele. However, using the triallelic approach, the estimated frequency of haplotypes (SA , SG , LA and LG ) and phased genotypes (LA /LA , LA /SA , LA /LG , SA /SA and SA /SG) did not show significant association with drug dependence (χ (2) (3, N = 422), p = 0.53 and χ (2) (4, N = 422), p = 0.06, respectively). This study suggests a putative role of the 5-HTTLPR for drug dependence in the Jordanian Nationals of Arab ancestry., (© The Author(s) 2012.)

Background: Both environmental and genetic factors contribute to individual susceptibility to initiation of substance use and vulnerability to addiction. Determining genetic risk factors can make an important contribution to understanding the processes leading to addiction. In order to identify gene(s) and mechanisms associated with substance addiction, a custom platform array search for a genetic association in a case/control of homogenous Jordanian Arab population was undertaken. Patients meeting the DSM-VI criteria for substance dependence (n = 220) and entering eight week treatment program at two Jordanian Drug Rehabilitation Centres were genotyped. In addition, 240 healthy controls were also genotyped. The sequenom MassARRAY system (iPLEX GOLD) was used to genotype 49 single nucleotide polymorphisms (SNPs) within 8 genes (DRD1, DRD2, DRD3, DRD4, DRD5, BDNF, SLC6A3 and COMT)., Results: This study revealed six new associations involving SNPs within DRD2 gene on chromosome 11. These six SNPs within the DRD2 were found to be most strongly associated with substance addiction in the Jordanian Arabic sample. The strongest statistical evidence for these new association signals were from rs1799732 in the C/-C promoter and rs1125394 in A/G intron 1 regions of DRD2, with the overall estimate of effects returning an odds ratio of 3.37 (χ2 (2, N = 460) = 21, p-value = 0.000026) and 1.78 (χ2 (2, N = 460) = 8, p-value = 0.001), respectively. It has been suggested that DRD2, dopamine receptor D2, plays an important role in dopamine secretion and the signal pathways of dopaminergic reward and drug addiction., Conclusion: This study is the first to show a genetic link to substance addiction in a Jordanian population of Arab descent. These findings may contribute to our understanding of drug addiction mechanisms in Middle Eastern populations and how to manage or dictate therapy for individuals. Comparative analysis with different ethnic groups could assist further improving our understanding of these mechanisms.

We evaluated the 12-month outcomes of a brief intervention, enhanced by a consistent support person, which aimed to facilitate referral attendance for substance use treatment following a hospital alcohol or other drug (AOD) presentation. Outcomes were assessed as: attendance for substance use treatment; the number of hospital AOD ED presentations; change in AOD consumption and psychological wellbeing (GHQ-12). We recruited 127 adolescents, with 60 randomised to the intervention and 67 receiving usual care. At 12 months, 87 (69%) were re-interviewed. Significantly more of the intervention than the usual care group (12 versus 4) had attended a treatment agency. Excluding the index presentations, there were 66 AOD hospital presentations post intervention, with the proportion of AOD events falling for the intervention group, whilst no change occurred for the usual care group. Irrespective of randomisation, those who attended for substance use treatment had a greater decline in total self-reported drug use than the remainder. Both intervention and usual care groups had improved GHQ-12 scores by 12 months, with reduction in GHQ scores correlated with reduced drug use. In conclusion, while brief intervention in ED only has limited success in facilitating adolescents to attend for subsequent AOD treatment, it can significantly reduce the number of AOD related ED presentations.

Aims: To examine the prevalence of different substances used by adolescents admitted to hospital emergency departments (ED); to evaluate the impact of an ED based brief intervention (BI) on hospital events; to compare outcomes for those using "alcohol alone", "alcohol plus illicit+/-licit drugs" ("alcohol plus"), or "other drugs" excluding alcohol, and investigate the relationship between hazardous alcohol consumption patterns and hospital events., Design: We used hospital record linkage to follow-up a randomised control trial cohort., Participants: Adolescents (12-19 years) recruited in ED with presentations involving alcohol or other drugs (AOD): 67 received usual care and 60 a BI that facilitated attendance at community drug agencies., Measurements: Drug-use categories were assigned from the substances used at the baseline presentation. Outcomes were assessed as hospital admissions plus ED presentations in the 12-month post-intervention. "Hazardous" alcohol use was categorised via the AUDIT-3., Results: The drug-use categories were "alcohol alone" (n=67, 53%), "alcohol plus" (n=31, 24%) and "other drugs" (n=28, 22%). In the 12-month post-intervention, the randomisation groups had similar numbers of AOD hospital events. A Cox regression showed that in the usual care but not the BI group, for "other drugs" there was a 8-fold increased hazard ("risk") of an AOD hospital event compared with "alcohol alone" and a 10-fold increase compared to 'alcohol plus'. Each pre-recruitment AOD event doubled the hazard of an AOD event. For the BI group, these were not significant predictors. The "other drugs" group had more AOD events than either of the other groups. "Hazardous" (77%) alcohol use was common but was not a predictor of AOD hospital events., Conclusions: BI can be delivered in ED and reduce hospital AOD morbidity associated with the use of drugs other than alcohol. Interventions should focus on those with prior AOD events and "other drugs" presentations.

Aims: To evaluate the effectiveness of a brief intervention enhanced by a consistent support person in facilitating attendance for substance use treatment following a hospital alcohol or other drug (AOD) presentation., Participants: We recruited 127 adolescents (aged 12-19 years) from hospital emergency departments, 57 were female. Sixty were randomly assigned to receive the intervention and 67 to receive standard hospital care. For the purpose of comparison, normative data were also collected (at baseline) from 122 non-AOD presenting adolescents., Intervention: The brief intervention involved identifying impediments to treatment service attendance and facilitating attendance via a consistent support person., Results: At 4 months, a significantly greater proportion of the intervention group, both daily and "occasional" drug users, had attended treatment than the usual care group. Regardless of attendance at the treatment service the intervention group showed a greater improvement in GHQ-12 scores than the usual care group. Across groups, a greater proportion of those who attended treatment moved to "safer" drug use behaviour (non-hazardous alcohol consumption and/or non-injecting drug use (IDU)), and showed a greater decline on a composite total drug use score., Conclusions: Adolescent attendance for treatment can be improved by brief intervention with harmful substance use behaviours reduced for both "occasional" and daily users. Improvements in psychosocial well-being is observed regardless of attendance at a treatment service.

The aim of this paper is to evaluate the effectiveness of brief interventions (BI) with adolescents (mean age <20) in reducing alcohol, tobacco or other drug (ATOD) use by means of a systematic review of BI for adolescent substance use in the English language literature up to 2002. We identified 11 studies involving 3734 adolescents. Follow-up ranged from 6 weeks to 24 months. Motivational interviewing was the predominant approach, underpinning eight studies: the remaining three provided personalized health information. Seven papers reported outcomes for alcohol interventions and four involved other substances (including one with separate alcohol outcomes). The overall effect size was d=0.126 with borderline homogeneity (Q=14.9, df=9, p=0.09). The effect size from the eight alcohol interventions (n=1,075) was classified as significant but "small" (d=0.275). The remaining non-alcohol studies were considered separately as interventions involving tobacco or multiple substance use. The two interventions with tobacco involved a substantial sample (n=2,626) but had a very small effect (d=0.037), while the two interventions addressing multiple substances involved few participants (n=110) but had a medium-large effect (d=0.78). Across a diverse range of settings (dental clinic, schools, universities, substance treatment centres) and, therefore, probably diverse clients, BI conferred benefits to adolescent substance users. BI had a small effect on alcohol consumption and related measures. The data for tobacco interventions suggested a very small reduction, particularly with general community interventions. The effect of BI with multiple substances appears substantial but the small sample cautions against expansive generalization.

Aims: To investigate 'all cause' and the subset of 'alcohol or other drug' (AOD) related hospital emergency department (ED) presentations over 12 months by adolescents with a previously identified AOD ED presentation., Design and Setting: A retrospective review of medical records in four metropolitan hospitals in Perth, Australia., Participants: One hundred and fifty-two adolescents (13-19 years) identified during a previous 4-week study. The median age was 17.5 (interquartile range (IQR) 16-19); 61 (40%) were female., Method: Medical records were reviewed for the 6 months either side of a previously identified index AOD presentation. Hospital events in this period were collapsed as 'all cause' morbidity with a subclassification of AOD related., Findings: Over half (n=87, 57%) had no additional hospital events and 10 (7%) had only 'follow-up' treatment for their index event. The drug identified for both these groups was primarily alcohol or alcohol plus other drugs compared with mainly heroin or prescription drugs for those with multiple presentations. There were 55 (36%) adolescents who had 236 presentations, including 39 with 147 AOD presentations: six polydrug users accounted for 47% of multiple presentations. Polydrug users had more 'all cause' and AOD presentations (Mann-Whitney U=168.5, P < 0.001) than single drug users, as did 'heroin users' compared with other AOD users (U=177.5, P < 0.001). There were no significant gender differences in the total number of 'all cause' or AOD presentations., Conclusions: Alcohol users were the largest group at index presentation, but accounted for few of the presentations over 12 months. Polydrug users typically had multiple presentations and may benefit from additional non-medical hospital support. A more labour-intensive and structured approach might help the small number of polydrug users who accounted for a large proportion of repeat presentations over the 12-month period.