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Inhalant use is a global problem but in spite of its large prevalence and significant physical and psychological complications, there is inadequate literature on the management of inhalant dependence. Inhalants are also considered a substance of adolescence with most users giving up use in adulthood. There is also limited literature on co-occurring behavioral and substance addictions and the linkage between them. We describe the case of 28-year-old man who had been using toluene in a dependent pattern for 14 years. He also had problem gambling in the past, abstaining from which led to an increase in the daily quantity of use of toluene. The patient was tried on Carbabmazepine but following an adverse event he was prescribed Aripiprazole. He improved over the course of 6 weeks and has been abstaining from inhalants since 3 months. [ABSTRACT FROM AUTHOR]

An exploratory study was conducted on 23 consecutive treatment-seeking adolescent inhalant users at a tertiary drug dependence treatment center in India. Sociodemographic, clinical parameters and neuropsychological functioning were assessed using semi-structured interview, Composite International Diagnostic Interview (CIDI 3.0) for diagnosis, checklist for health damage and withdrawal symptoms, Malin's Intelligence Scale for Indian Children (MISIC), Memory for Design test and Stroop test. Routine biochemical testing and urinary hippuric acid level for recent inhalant use, measured using Gas Liquid Chromatography with Nitrogen Phosphorous Detector (GLC-NPD) was conducted. All participants were urban males (mean age 16 [SD = 1.8] years), who used either ink eraser fluid (87%) or glue (13%). Most participants experienced inhalant withdrawal (80%) and revealed high prevalence of psychiatric co-morbidity (52%), behavioral problems (43.5%), and neuropsychological deficits. Biochemical analysis validated recent (1–3 days) toluene exposure in 69.6% of participants, consistent with self-report. Management plans should take these issues into consideration. [ABSTRACT FROM AUTHOR]

Ketamine was developed in the late 1950s as a potential general anesthetic agent. However, soon it became drug of abuse due to its property of giving “high”. Ever since there have been no systematic studies of ketamine abuse, dependence or withdrawal states in humans, barring some anecdotal case reports. Recently researchers have shown interest in ketamine as a novel agent for the treatment of depression. However, most research does not shed light on its addiction potential. In this paper, we present a case of ketamine dependence with interesting phenomenology, withdrawal symptoms which responded well to naltrexone. Implications of such cases for health professionals particularly psychiatrists and addiction specialists is discussed. [ABSTRACT FROM AUTHOR]

Introduction: A minority of addiction patients receive appropriate treatment directly from trained professionals in addiction medicine. Most countries have not recognized addiction medicine (AM) as a specialty in its own right or within psychiatry/other specialties. Therefore, the effectiveness and organization of AM training around the world need to be improved. Unfortunately, standard instruments are rarely used in most studies to assess training needs. This study aimed to determine international competencies in AM among professionals in as many countries as possible using a standard instrument such as the AM Training Needs Assessment (AM-TNA). Method: We examined competencies in AM with the AM-TNA using an online survey. A General Competency Level in Addiction Medicine (GLOCIAM30) was calculated by dividing the total score by the number of 30 items. This GLOCIAM30 was used to measure the general level of competency in AM and to compare individual competencies. Results: One hundred ninety-nine respondents from 45 countries completed the survey. Ninety-five of the 199 respondents (49.0%) had a GLOCIAM30 higher or equal to 4 (fairly competent). The highest skill level was found for the competency “Assessing substance use problems by taking the patient’s history.” Nine of the 45 countries had 8 or more respondents (n = 129). After post hoc analysis, there was no difference between these countries. Respondents could reasonably estimate whether the competency level in their country was higher or lower than the world average. Conclusions: This study is the first international attempt to examine competencies in AM. Although a much larger study population is needed to establish an overall goal for competencies in AM, our study provided an initial direction for such a gold standard in benchmarking procedures. [ABSTRACT FROM AUTHOR]

Background: Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program "Alcohol e-Health."Objective: We aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial.Methods: This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and a psychoeducation and internet access as usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8).Results: For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, complete case analysis identified higher AUDIT changes in the intervention group (B=-4.18, 95% CI -5.42 to -2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=-9.34, 95% CI -15.90 to -2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (χ21=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results.Conclusions: The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results.Trial Registration: ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475.International Registered Report Identifier (irrid): RR2-10.1111/add.14034. [ABSTRACT FROM AUTHOR]

It is a well-known fact that substance users have used different innovative techniques and routes of administration for consumption of conventional psychoactive substances to get high. However, reports of using unconventional substances to get high are rare and puzzling for addiction specialists. There are hardly any scientific publications on psychoactive properties of such unconventional substances. We present a rare case of opioid-dependent syndrome, who also reported using tail of Indian wall lizard to get high. [ABSTRACT FROM AUTHOR]

Fronto-Temporal Dementia (FTD) is a cluster of syndromes, characterized by progressive deterioration of cognition, language and/or behavioural changes associated with degeneration of the frontal and temporal lobes. A 53-year-old man was admitted with a history of gradually progressive behavioural disturbances, disinhibition, unprovoked anger outbursts, apathy, disorganised behaviour and impaired self-care. A clinical diagnosis of Fronto temporal Dementia (behavioural variant) was made. Extensive investigations found no abnormality except in FDG-PET scan of the brain which revealed hypo metabolism in bilateral anterior insular region. Insula is an important brain area implicated in emotional awareness and behaviour control. Hypo metabolism in insular region in the absence of any structural neuroimaging findings, in a case of behavioural variant of Fronto-temporal dementia suggest that, it might be one of the earliest neurobiological changes occurring in this disorder. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 11-year-old boy with catatonia.

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and professionals globally. The dynamic nature of drug addiction at the global level has resulted in a crucial need for developing an international collaborative network of addiction societies, treatment programs and experts to monitor emerging national, regional, and global concerns. This protocol paper presents methodological details of running longitudinal surveys at national, regional, and global levels through the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN). The initial formation of the network with a recruitment phase and a round of snowball sampling provided 354 experts from 78 countries across the globe. In addition, 43 national/regional addiction societies/associations are also included in the database. The surveys will be developed by global experts in addiction medicine on treatment services, service coverage, co-occurring disorders, treatment standards and barriers, emerging addictions and/or dynamic changes in treatment needs worldwide. Survey participants in categories of (1) addiction societies/associations, (2) addiction treatment programs, (3) addiction experts/clinicians and (4) related stakeholders will respond to these global longitudinal surveys. The results will be analyzed and cross-examined with available data and peer-reviewed for publication., Competing Interests: 2.10.6All the investigators involved in designing the surveys, analyzing the data, interpreting the results and publishing the reports will need to report any potential conflict of interest in advance and inform the principal investigators if there is any update in their conflict of interest within 3 months.Dr. MP has consulted for Opiant Therapeutics, Game Day Data, Baria-Tek, the Addiction Policy Forum, AXA, and Idorsia Pharmaceuticals; been involved in a patent application with Yale University and Novartis; received research support from Mohegan Sun Casino, Children and Screens and the Connecticut Council on Problem Gambling; is on the Boards of multiple organizations including the International Society of Addiction Medicine and the Addiction Policy Forum; been a principal investigator on a grant supporting the annual conference of the International Society of Addiction Medicine; participated in surveys, mailings, or telephone consultations related to drug addictions, internet use, impulse-control disorders, and other health topics; consulted for or advised gambling, non-profit and legal entities on issues related to internet use, impulse-control and/addictive disorders; and given academic lectures in grand rounds, continuing medical education events, and other clinical or scientific venues. Dr. AMB has no conflicts of interest with regard to the current work. However unrelated to this project he has received unrestricted educational grants from Schering Plough, Merck Serono, Reckitt Benckiser, CAMURUS and Indivior. The remaining authors declare that the research was conducted in the absence of commercial or financial relationships constituting conflicts of interest., (Copyright © 2024 Ekhtiari, Khojasteh Zonoozi, Rafei, Abolghasemi, Pemstein, Abdelgawad, Achab, Ghafri, Al’Absi, Bisch, Conti, Ambekar, Arunogiri, Bhad, Bilici, Brady, Bunt, Busse, Butner, Danesh, El-Khoury, Omari, Jokūbonis, Jong, Dom, Ebrahimi, Fathi Jouzdani, Ferri, Galea-Singer, Parker, Higuchi, Kathiresan, Khelifa, Kouimtsidis, Krupitsky, Long, Maremmani, McGovern, Mohaddes Ardabili, Rahimi-Movaghar, Rataemane, Sangchooli, Sibeko, Vella, Vista, Zare-Bidoky, Zhao, Javed, Potenza and Baldacchino.)

Somatization disorder is a common cause of chronic non-cancer pain. The use of opioids in such conditions carries a risk of their potential abuse. Lax regulations coupled with sub-optimal medical training in India lead to the rampant use of prescription opioids. We present a case of somatization disorder along with injection pentazocine dependence in a woman, in whom use of pentazocine was initiated by a registered medical practitioner for somatoform pain management, followed by self-injection because of its easy availability in local pharmacy shops. We highlight the need for education of medical practitioners on appropriate use of pharmaceutical opioids, need for regulation of local pharmacy shops, and development of guidelines for use of opioids in chronic non-cancer pain., (Copyright 2015, NMJI.)

Irritable bowel syndrome is a common gastrointestinal condition with underlying psychological factors. Its management can be challenging, sometimes necessitating a multidisciplinary team of gastroenterologists, psychiatrists and clinical psychologists. Non-pharmacological interventions are gaining attention for the management of chronic irritable bowel syndrome. We present a difficult-to-treat case of chronic irritable bowel syndrome, which was managed successfully with psychological interventions., (Copyright 2015, NMJI.)