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The objectives were, firstly, to describe the frequency and type of hospital emergency department (ED) admissions in a small number of alcohol and other drug (AOD) using adolescents who accounted for a high number of ED and other hospital presentations. Secondly, to identify interventions that impacted on these repeat ED presentations. An earlier 12-month review of hospital presentations identified a cohort of 55 AOD using adolescents with 236 repeat presentations. Six adolescents accounted for 47% (n = 112) of these presentations. A case review of these six adolescents was conducted over 24-months across the four major public hospitals in Perth. AOD treatment during this period was identified from hospital case notes and patient notes at the major opiate treatment service. There were 172 hospital presentations of which 98 were overdoses (ODs) (75% opiate). There were 24 other AOD related and 50 non-AOD presentations. ED treatment focused on acute care. Four adolescents were referred to an external treatment agency and two, a residential psychiatric hospital. Five of the six attended a specialist opiate treatment centre. Of these, one opted for unsupervised home detoxification and continued to represent to ED, primarily with opiate ODs. Four underwent rapid opiate detoxification (ROD), with three commencing oral naltrexone maintenance. Three cases with continuing ODs were further treated with slow-release naltrexone implants. In 91 weeks post implant follow-up (range 8-42) there were no opiate or non-opiate OD presentations compared with 14 in the corresponding pre-implant period. The sixth adolescent had representations primarily related to psychiatric problems. ED based interventions, including intensive case management had little impact on repeat ED presentation in these "high-risk" adolescents. Preliminary results however, suggest that treatment with naltrexone implants dramatically reduces repeat OD presentations.

Abstract 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.