Role of cytosolic calcium balance on cell injury in cultured bovine aortic endothelial cells during hypoxia and reoxygenation]

The integration of pharmacological therapies for comorbid disorders requires an acceptance of independence and interactions of respective addictive and psychiatric disorders. At the same time, alcohol and other drugs induce psychiatric states that are indistinguishable from psychiatric disorders. On the other hand, while psychiatric disorders do not induce addictive use of alcohol and drugs, they do pose vulnerabilities to the development of addictive disorders. Generally, the treatment of comorbid disorders begins with abstinence and evaluation of the effects of alcohol and other drugs in contributing to the psychiatric picture. In the case of comorbid disorders, stabilization and standard treatments can be employed with certain cautions, namely, to avoid the use of addicting medications such as benzodiazepines and opiates beyond the detoxification stage. High potency neuroleptics and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) can be used to treat continuing psychiatric states after the exclusionary criteria in DSM-IV for substance-related disorders have been applied to the clinical case. If the psychiatric symptoms clear with sustained abstinence, little or no medications may be required. Specific treatment of the addictive disorders will often determine the extent that addictive disorders are responsible for psychiatric symptomatology. Alternatively, treatment of the psychiatric disorder will enhance compliance with addiction treatment.     

The neurobiology of craving: Implications for the understanding and treatment of addiction.

Studies of the brain mechanisms of addictive drug actions suggest a two-factor model of addiction. First, all addictive substances are argued to have psychomotor stimulant properties that reflect their activation, at one or more levels, of a common neural mechanism of positive reinforcement. These effects are seen as the biological basis of "psychological" dependence and as the basis for drug cravings that are not rooted in withdrawal symptoms or some other form of distress. Second, at least some addictive substances are thought to activate mechanisms that suppress pain and distress signals, including those associated with the drug's own withdrawal symptoms. These effects represent negative reinforcement effects that, when they occur, can contribute further to the habit-forming impact of a drug and to drug cravings. The brain mechanisms of positive and negative reinforcement are anatomically and functionally distinct, at least in the case of the opiates (on which the concept of physiological dependence is largely modeled). Separate consideration of drug-induced positive and negative reinforcement suggests several new perspectives on the acquisition and extinction of drug habits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Models of addiction: Introduction to the Special Issue.

This Special Issue contains articles that highlight empirical approaches to addiction that have clear theoretical relevance as well as articles that present significant theoretical perspectives on addiction. This collection reflects the implicit assumption that types of addiction are more similar than dissimilar. The characteristics of drug exposure that promote physical dependence, the occurrence of tolerance, the associative elicitation of tolerance, the time course of relapse to drug use, the phenomenology of drug urges or cravings, the precipitants of relapse, the obsessive concern with securing and using drugs are all commonalities among addictive disorders that underscore the fact that addiction is expressed through universal motivational mechanisms and processes. Diverse addictive disorders are phenotypically similar because their motivational bases are similar; if not in particular, then in principle. The selections in this Special Issue reflect a set of assumptions that can be seen as promising areas for future research and theorizing. The first area concerns the application of traditional motivational models and concepts to addictive disorders. The second area for future research and theorizing deals with cognitive or information processing models of addiction. The third area covered in this Special Issue concerns interpersonal/social context. The final area covered in this issue deals with genetics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent developments in the pharmacotherapy of substance abuse

Modern concepts of addictive disorders emphasize the compulsive and relapsing drug-taking behaviors rather than tolerance and physical dependence. As with any chronic disorder, long-term treatment is necessary and medications may aid in the rehabilitative process. Specific medications have been demonstrated to be helpful for psychiatric disorders coexisting with addiction. Medications have also been demonstrated in controlled studies to aid in the rehabilitation of patients dependent on nicotine, alcohol, or opiates. Thus far, no medication has been clearly demonstrated to benefit patients suffering from abuse or dependence on cocaine, cannabinoids, nonalcohol sedatives, or hallucinogens.     

Training of residents and medical students in the diagnosis and treatment of dual diagnosis patients

Treatment of dual diagnosis patients requires simultaneous treatment of the addictive and the mental disorders. Available data suggest that this does not happen often. In a survey of several psychiatric services, the unit chiefs reported that dual diagnoses were underreported, no plans were present for combined treatment, families were infrequently involved, and few referrals were made for combined treatment. There is a need for competent, experienced clinician teachers who have had positive experience with the treatment of dual disorders. The training of addiction and mental health professionals must include cooperation, understanding, and respect for each other. Cross-training is needed in chemotherapy, psychotherapy, abstinence from alcohol and other addictive drugs, 12-Step programs, spiritual issues, and milieu therapy. Negative attitudes and ignorance must be overcome for this training to take place. Faculty Fellow training programs have provided a beginning in this direction, but have so far involved few professional schools. Some examples of training with regard to referrals, prescribing, and psychotherapy are given. The importance of supervised clinical experience in treating dual diagnosis patients is emphasized. The provision of this experience provides a challenge to specialists in addiction medicine and addiction psychiatry.     

Jeu de hasard et consommation de substances psychotropes: Prévalence, coexistence et conséquences.

The present article is a critical review of research examining the relationship between pathological gambling and drug/alcohol addiction in adults and adolescents. The authors present diagnostic criteria and prevalence estimates for each population. It is noted that in adults, the prevalence of drug or alcohol dependence is five times greater among pathological gamblers in treatment than it is among the general population. Adults with both disorders exhibit greater levels of impulsiveness and disinhibition than individuals with a single diagnosis. The few studies that have investigated the co-morbidity of pathological gambling and drug/alcohol addiction in adolescents yield results similar to those obtained in adults. Pathological gambling is highly correlated with drug, alcohol and cigarette consumption. Moreover, impulsiveness is greater among adolescents with a co-morbid diagnosis. This review suggests the importance for treatment and prevention programs to take into account the possible co-morbidity among these disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A psychomotor stimulant theory of addiction.

The theory is advanced that the common denominator of a wide range of addictive substances is their ability to cause psychomotor activation. This view is related to the theory that all positive reinforcers activate a common biological mechanism associated with approach behaviors and that this mechanism has as one of its components dopaminergic fibers that project up the medial forebrain bundle from the midbrain to limbic and cortical regions. Evidence is reviewed that links both the reinforcing and locomotor-stimulating effects of both the psychomotor stimulants and the opiates to this brain mechanism. It is suggested that nicotine, caffeine, barbiturates, alcohol, benzodiazepines, cannabis, and phencyclidine—each of which also has psychomotor stimulant actions—may activate the dopaminergic fibers or their output circuitry. The role of physical dependence in addiction is suggested to vary from drug to drug and to be of secondary importance in the understanding of compulsive drug self-administration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol dependence and mood disorders

This article explores the complex relationships between alcohol dependence and mood disorders. Although many alcoholics present with substance-induced depressions, once appropriate methodological controls are used, there does not appear to be a significant relationship between independent unipolar depression and alcohol dependence. However, the data support a small, but significant, relationship between bipolar manic-depressive disease and alcoholism. The literature does not support the relevance of self-medication as a course of alcoholism, unless one includes the use of alcohol to alleviate alcohol-induced psychological and neurochemical perturbations. The clinical importance of distinguishing between substance-induced and independent mood disorders is reviewed.     

Physical and mental comorbidity of substance use disorders in psychiatric consultations. European Consultation-Liaison Workgroup

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.     

Prevalence of DSM-IV substance abuse and dependence disorders among prison inmates

The study examined the 30-day and lifetime prevalence of DSM-IV alcohol and drug disorders among state prison inmates. A sample of 400 inmates consecutively admitted to a state prison reception center were assessed for alcohol and drug disorders using the Structured Clinical Interview for DSM-IV (SCID-IV). Test-retest reliabilities were calculated for the SCID-IV. Lifetime substance abuse or dependence disorders were detected among 74% of inmates, including over half who were dependent on alcohol or drugs. For the 30 days prior to incarceration, over half of the sample were diagnosed as having substance abuse or dependence disorders, including 46% who were dependent on alcohol or drugs. Black inmates were significantly less likely to be diagnosed as alcohol dependent than whites or Hispanics. The high rates of substance use disorders are consistent with previous findings from other studies conducted in correctional settings and reflect the need to expand treatment capacity in prisons.     

The relative roles of bipolar disorder and psychomotor agitation in substance dependence.

Previous studies have shown that both bipolar disorder (BPD) and psychomotor agitation (PMA) are associated with substance dependence. These two findings have yet to be integrated, despite evidence that PMA is closely linked with the bipolar spectrum. Accordingly, the current study examined whether BPD and PMA had unique or overlapping associations with substance dependence disorders. Participants were 2,300 individuals seeking outpatient psychiatric treatment. Before treatment, participants were assessed using structured clinical interviews, which yielded DSM-IV psychiatric diagnoses and clinical ratings of mood symptoms. Current PMA and lifetime BPD were present in 483 and 172 (bipolar I, n = 71; bipolar II, n = 101) participants, respectively. Current PMA and lifetime BPD each were associated with increased prevalence of lifetime nicotine, alcohol, and drug dependence (ORs ≥ 1.52, ps ≤ .0004). These associations remained significant when controlling for demographic characteristics and comorbid psychiatric disorders, except the link between agitation and alcohol dependence, which was reduced to a trend (p = .058). Although BPD and PMA were associated with each other, these two factors demonstrated unique, nonoverlapping relationships to nicotine, alcohol, and drug dependence. Individuals with both PMA and BPD exhibited especially high rates of comorbid substance dependence. The present results replicate and extend previous findings documenting the relations of BPD and PMA to substance dependence. BPD and PMA may represent independent psychopathological correlates of substance dependence. Future research should explore the theoretical and clinical significance of these potentially distinct relations to substance dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychodynamic approach to the addictive personality structure specific for alcohol and hard drugs

The overconsumption of psychotropic substances is a major problem for contemporary societies. In the USA, 14.1% of the population between the age 15 and 54 have experienced addiction problems to alcohol during their lives while as 7.5% are addicted for life to other drugs (cannabis, cocaine, stimulants, etc). Many studies report that excessive consumption of alcohol, with or without illegal drug use, is associated to social conditions favoring the development of psychological distress and isolation. Although there are many studies on the differences between personality traits of alcoholics and drug users, few authors have examined the possibility to bring to the fore a specificity between the personality structures of the alcoholic and the drug user from a psychodynamic approach. This exploratory review of literature, first presents studies already conducted in order to identify common or distinct personality features for these types of addition. This article then reviews psychodynamic writings examining the possibility of a structural organization that is specific to addiction. Finally, the authors propose a few thoughts allowing to postulate on the existence of a structural organization specific to these two types of addiction.     

Spouse similarity for lifetime psychiatric history in the general population

BACKGROUND: Most studies of spouse similarity for psychiatric disorders have focused on clinical samples and are thus limited by selection bias. This study is, to our knowledge, the first comprehensive investigation of spouse similarity for lifetime psychiatric history in a general population sample using standardized diagnostic criteria. METHODS: We studied 519 pairs of spouses residing in Edmonton, Canada who completed the Diagnostic Interview Schedule psychiatric interview. In each pair, one spouse belonged to a random subsample of persons who had participated in a large population survey and was re-interviewed. Association between spouses for lifetime DSM-III psychiatric disorders was analysed with bivariate and multivariate logistic regression analyses. RESULTS: We observed significant spousal association for lifetime presence of affective disorders and for the spectrum of antisocial personality and addiction disorders. Antisocial personality in one spouse was also associated with anxiety disorders in the other spouse, namely post-traumatic stress disorder in wives and phobia in husbands; similarly, drug abuse/dependence in wives was associated with generalized anxiety in husbands and male drug abuse/dependence was associated with female post-traumatic stress disorder. Dysthymia in wives was associated with generalized anxiety and post-traumatic stress disorder in husbands. CONCLUSIONS: The existence of associations between spouses for the presence of psychiatric disorders, either similar or different, has significant implications for both clinicians and researchers. Future research should aim at exploring the aetiological mechanisms of these associations.     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.     

Traumas and other adverse life events in adolescents with alcohol abuse and dependence

OBJECTIVE: Clinical observation suggests that adolescents with alcohol use disorders often have complex histories that include childhood maltreatment and other traumas. The aim of this study was to determine the relationships among adolescent alcohol use disorders and a broad range of traumas and adverse life events. METHOD: The subjects were 132 adolescents with alcohol dependence, 51 adolescents with alcohol abuse, and 73 adolescents recruited from the community as a control group. Trauma history was assessed by a semistructured interview and other adverse life events by questionnaire. RESULTS: Traumatic events reflecting interpersonal violence had occurred in many of the adolescents with alcohol dependence and abuse and few of the control adolescents. Adolescents with alcohol abuse or dependence, compared with control subjects, were 6 to 12 times more likely to have a physical abuse history and 18 to 21 times more likely to have a sexual abuse history. Sexual abuse was more common in females, and victimization by other violent acts was more common in males. Many other adverse life events were also significantly more common in the alcohol use disorder groups than in the control group, including having a close friend die, arguments within the family, and legal difficulties. CONCLUSIONS: These results demonstrate that trauma and other adverse life events are strongly associated with alcohol use disorders in adolescents. Clinical screening of adolescents with alcohol use disorders for a range of traumatic events is recommended.     

Effect of chronic hemodialysis on thyroid function tests in patients with end-stage renal disease

The Maryland Dentist's Well-Being Committee was formed in 1980 as a standing committee of the Maryland State Dental Association. The committee has assisted many dentists over the years with problems such as stress, alcoholism, drug dependence, psychiatric disorders, medical problems, HIV (human immunodeficiency virus) disease, neurological disorders, and other illnesses that cause impairment. Key elements of the committee include confidentiality, a good working relationship with the Maryland State Board of Dental Examiners, advocacy efforts, and a paid clinical coordinator with special expertise in mental health and addiction treatment.     

Psychiatric comorbidity with problematic alcohol use in high school students

OBJECTIVE: To delineate the degree to which various levels of problematic alcohol use are associated with psychiatric disorders in adolescents. METHOD: The lifetime occurrence of psychiatric disorders was examined in a community sample of 1,507 older adolescents (aged 14 through 18 years) who were categorized according to their alcohol use (i.e., abstainers, experimenters, social drinkers, problem drinkers, and abuse/dependence group). RESULTS: Increased alcohol use was associated with the increased lifetime occurrence of depressive disorders, disruptive behavior disorders, drug use disorders, and daily tobacco use. There was a trend for increased alcohol use in girls to be associated with anxiety disorders. More than 80% of adolescents with alcohol abuse/dependence had some other form of psychopathology. Alcohol disorders, in general, followed rather than preceded the onset of other psychiatric disorders. Comorbidity was associated with an earlier age of alcohol disorder onset and with greater likelihood of mental health treatment utilization. CONCLUSIONS: Rates of psychiatric comorbidity with problematic alcohol use in adolescents are striking and represent an important therapeutic challenge.     

The self-medication hypothesis of substance use disorders: a reconsideration and recent applications

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.     

Molecular and cellular basis of addiction

Drug addiction results from adaptations in specific brain neurons caused by repeated exposure to a drug of abuse. These adaptations combine to produce the complex behaviors that define an addicted state. Progress is being made in identifying such time-dependent, drug-induced adaptations and relating them to specific behavioral features of addiction. Current research needs to understand the types of adaptations that underlie the particularly long-lived aspects of addiction, such as drug craving and relapse, and to identify specific genes that contribute to individual differences in vulnerability to addiction. Understanding the molecular and cellular basis of addictive states will lead to major changes in how addiction is viewed and ultimately treated.     

Issues in personality conceptualizations of addictive behaviors.

This article describes the issues and implications associated with personality conceptualizations of addictive behaviors. Attention is directed toward characterizing the sociopolitical climate as it affects the identification, evaluation, and management of substance-abuse disorders. Arguments spawned by unnecessarily simplistic formulations of addiction-proneness hypotheses and by their behavioral antitheses are also reviewed within a historical perspective. In this discussion, the sometimes myopic focus of both personality and behavioral researchers is underscored. Overall, alcohol and drug use phenomena are explored in a conceptual schemata that encompasses multifactorial, reciprocal, and integrative explanations of the etiology, natural history, and progression of addictive disorders and their comorbidities. The methodological limitations of research in the areas are examined, and multidisciplinary, longitudinal research sufficiently comprehensive to target a range of drug and alcohol use types and use frequencies is encouraged. Emphasis is directed toward the understanding of possible commonalities among seemingly excessive behaviors and the implementation of treatment strategies consonant with practical endorsement of multivariate theoretical models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)