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Drug addiction NeurologySelected video lectures / documentaries relating to drug addiction neurology are followed by extracts of neuroscience research papers with links to the full articles"
Prescription drug abuse and diversion among adolescents in a southeast Michigan school district.
Prescription drug abuse and diversion among adolescents in a southeast Michigan school district. Arch Pediatr Adolesc Med. 2007 Mar;161(3):276-81 Authors: Boyd CJ, McCabe SE, Cranford JA, Young A OBJECTIVES: To determine the prevalence of medical use of 4 classes of prescription medications relative to nonmedical use (illicit use), to examine the relative rates among the 4 drug classes, and to assess whether gender differences exist in the trading, selling, loaning, or giving away of medications. DESIGN: A Web-based survey was administered to 7th- to 12th-grade students residing in 1 ethnically diverse school district; a 68% response rate was achieved. SETTING: During a 3-week period in May 2005, teachers brought students to their schools' computing center where students took the survey using a unique personal identification number to sign on to the survey. PARTICIPANTS: There were 1086 secondary students, including 586 girls, 498 boys, 484 black students, and 565 white students. MAIN OUTCOME MEASURES: Students were asked about their medical and nonmedical use of sleeping, sedative or anxiety, stimulant, and pain medications. Diversion of prescription medication was assessed by determining who asked the student to divert his or her prescription and who received it. RESULTS: Thirty-six percent of students reported having a recent prescription for 1 of the 4 drug classes. A higher percentage of girls reported giving away their medications than boys (27.5% vs 17.4%, respectively; chi(2)(1) = 6.7; P = .01); girls were significantly more likely than boys to divert to female friends (64.0% vs 21.2%, respectively; chi(2)(1) = 17.5; P<.001) whereas boys were more likely than girls to divert to male friends (45.5% vs 25.6%, respectively; chi(2)(1) = 4.4; P = .04). Ten percent diverted their drugs to parents. CONCLUSION: Physicians should discuss the proper use of prescription medications with their patients and their patients' families. PMID: Drug addiction Neurology 17339509 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. Am J Psychiatry. 2007 Jan;164(1):100-7 Authors: Weiss RD, Griffin ML, Kolodziej ME, Greenfield SF, Najavits LM, Daley DC, Doreau HR, Hennen JA OBJECTIVE: Although bipolar disorder and substance use disorder frequently co-occur, there is little information on the effectiveness of behavioral treatment for this population. Integrated group therapy, which addresses the two disorders simultaneously, was compared with group drug counseling, which focuses on substance use. The authors hypothesized that patients receiving integrated group therapy would have fewer days of substance use and fewer weeks ill with bipolar disorder. METHOD: A randomized controlled trial compared 20 weeks of integrated group therapy or group drug counseling with 3 months of posttreatment follow-up. Sixty-two patients with bipolar disorder and current substance dependence, treated with mood stabilizers for >or=2 weeks, were randomly assigned to integrated group therapy (N=31) or group drug counseling (N=31). The primary outcome measure was the number of days of substance use. The primary mood outcome was the number of weeks ill with a mood episode. RESULTS: Intention-to-treat analysis revealed significantly fewer days of substance use for integrated group therapy patients during treatment and follow-up. Groups were similar in the number of weeks ill with bipolar disorder during treatment and follow-up, although integrated group therapy patients had more depressive and manic symptoms. CONCLUSIONS: Integrated group therapy, a new treatment developed specifically for patients with bipolar disorder and substance dependence, appears to be a promising approach to reduce substance use in this population. PMID: Drug addiction Neurology 17202550 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Comments on "prescription drug dependence and evolving beliefs about chronic pain management". Am J Psychiatry. 2006 Dec;163(12):2194; author reply 2194-5 Authors: Fishbain DA, Gallagher RM PMID: Drug addiction Neurology 17151178 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
GMC strikes off expert in drug addiction. BMJ. 2006 Nov 18;333(7577):1035 Authors: Dyer O PMID: Drug addiction Neurology 17110706 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
UN report calls for governments to intensify fight against drug abuse. BMJ. 2006 Jul 1;333(7557):10 Authors: Zarocostas J PMID: Drug addiction Neurology 16809687 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Disorders of sodium balance: hyponatraemia and drug use (and abuse). BMJ. 2006 Apr 8;332(7545):853 Authors: McDade G PMID: Drug addiction Neurology 16601056 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness. Arch Gen Psychiatry. 2006 Apr;63(4):426-32 Authors: Bellack AS, Bennett ME, Gearon JS, Brown CH, Yang Y CONTEXT: Drug abuse by people with severe mental disorder is a significant public health problem for which there is no empirically validated treatment. OBJECTIVE: To evaluate the efficacy of a new behavioral treatment for drug abuse in this population: Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTSAS). DESIGN: Participants were randomly assigned to 6 months of treatment in either BTSAS or a manualized control condition: Supportive Treatment for Addiction Recovery (STAR). SETTING: Treatment was conducted in community-based outpatient clinics and a Veterans Affairs medical center in Baltimore, Md. PARTICIPANTS: Participants were 129 stabilized outpatients meeting DSM criteria for drug dependence (cocaine, heroin, or cannabis) and serious mental illness: 39.5% met DSM-IV criteria for schizophrenia or schizoaffective disorder; 55.8%, for major affective disorders; and the remainder met criteria for severe and persistent mental illness and other Axis I disorders. INTERVENTIONS: Both treatments were administered by trained health care professionals in small groups, twice a week for 6 months. The BTSAS program is a social learning intervention that includes motivational interviewing, a urinalysis contingency, and social skills training. The control condition, STAR, is a supportive group discussion treatment.Main Outcome Measure The primary outcome measure was urinalysis results from twice-weekly treatment sessions. RESULTS: The BTSAS program was significantly more effective than STAR in percentage of clean urine test results, survival in treatment, and attendance at sessions. The BTSAS program also had significant effects on important community-functioning variables, including hospitalization; money available for living expenses; and quality of life. CONCLUSIONS: The BTSAS program is an efficacious treatment. Further work needs to be done to increase the proportion of eligible patients who are able to become engaged in treatment. PMID: Drug addiction Neurology 16585472 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Prescription drug dependence and evolving beliefs about chronic pain management. Am J Psychiatry. 2006 Apr;163(4):594-8 Authors: Streltzer J, Johansen L PMID: Drug addiction Neurology 16585432 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study. Arch Gen Psychiatry. 2006 Feb;63(2):201-8 Authors: Peirce JM, Petry NM, Stitzer ML, Blaine J, Kellogg S, Satterfield F, Schwartz M, Krasnansky J, Pencer E, Silva-Vazquez L, Kirby KC, Royer-Malvestuto C, Roll JM, Cohen A, Copersino ML, Kolodner K, Li R BACKGROUND: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. OBJECTIVE: To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. DESIGN: Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. SETTING: Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. PARTICIPANTS: Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. INTERVENTION: Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. MAIN OUTCOME MEASURES: Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. RESULTS: Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was 120 dollars per participant. CONCLUSION: An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics. PMID: Drug addiction Neurology 16461864 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
NIDA campaign to raise awareness of drug abuse--HIV connection. Am Fam Physician. 2006 Jan 1;73(1):22 Authors: PMID: Drug addiction Neurology 16417060 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Chasing "chasing the dragon" with MRI: leukoencephalopathy in drug abuse. Br J Radiol. 2005 Nov;78(935):997-1004 Authors: Bartlett E, Mikulis DJ Spongiform leukoencephalopathy is a rare complication from inhalation of heated heroin vapour, a practice called "chasing the dragon". The MRI findings are considered pathognomonic, making MRI important for diagnosis. This is especially true in busy urban emergency departments where a variety of patients may present obtunded, unable or unwilling to provide a useful history. Even though the MR pattern of "chasing" toxicity is considered pathognomonic, there are mimickers. We compare the MRI findings of two classic cases of chasing leukoencephalopathy with one case of mimickery from cocaine exposure only. All three cases had diffuse symmetrical white matter changes. MR spectroscopy (MRS) in chasing patients showed increased lactic acid and myo-inositol, decreased N-acetyl aspartate and creatine, normal to slightly decreased choline, and normal lipid peak. MRS in the cocaine exposure patient showed marked increase in lactic acid and lipids. MR perfusion in one chasing patient was normal. In conclusion: (1) All three cases have MR findings suggestive of spongiform leukoencephalopathy. MRS may help differentiate toxicity due to inhaled heroin from other non-heroin related toxicities. (2) Discordance between perfusion and spectroscopy in one chasing patient adds evidence that the disease is due to impaired energy metabolism at the cellular level. (3) MR findings of spongiform leukoencephalopathy secondary to chasing heroin can progress despite apparent abstinence of the drug and during clinical improvement, suggesting the MR changes may represent an evolving injury. PMID: Drug addiction Neurology 16249600 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study. Arch Gen Psychiatry. 2005 Oct;62(10):1148-56 Authors: Petry NM, Peirce JM, Stitzer ML, Blaine J, Roll JM, Cohen A, Obert J, Killeen T, Saladin ME, Cowell M, Kirby KC, Sterling R, Royer-Malvestuto C, Hamilton J, Booth RE, Macdonald M, Liebert M, Rader L, Burns R, DiMaria J, Copersino M, Stabile PQ, Kolodner K, Li R CONTEXT: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings. OBJECTIVE: To evaluate the efficacy of an abstinence-based contingency management intervention as an addition to usual care in community treatment settings. DESIGN: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks. SETTING: Eight community-based outpatient psychosocial drug abuse treatment programs. PARTICIPANTS: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment. INTERVENTION: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent. MAIN OUTCOME MEASURES: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant- and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence. RESULTS: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean +/- SD of 8.0 +/- 4.2 weeks and attended a mean +/- SD of 19.2 +/- 16.8 counseling sessions compared with 6.9 +/- 4.4 weeks and 15.7 +/- 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions. CONCLUSION: The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was efficacious in improving retention and associated abstinence outcomes. PMID: Drug addiction Neurology 16203960 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
A genome-wide search for quantitative trait Loci that influence antisocial drug dependence in adolescence. Arch Gen Psychiatry. 2005 Sep;62(9):1042-51 Authors: Stallings MC, Corley RP, Dennehey B, Hewitt JK, Krauter KS, Lessem JM, Mikulich-Gilbertson SK, Rhee SH, Smolen A, Young SE, Crowley TJ BACKGROUND: Among adolescents, externalizing problem behavior and substance use disorders are often comorbid. Familial influences, including shared genetic risk factors, may account for part of this comorbidity. Previously we reported 2 chromosomal regions (3q24-3q25 and 9q34) likely to contain genes that influence substance dependence vulnerability (DV) in adolescence. OBJECTIVES: To identify quantitative trait loci (QTLs) that influence externalizing problem behavior in adolescence and to determine whether any identified QTL overlap chromosomal regions that influence DV. DESIGN: Regression-based QTL mapping procedures designed for selected sibling pair samples. SETTING: Patient probands were drawn from consecutive admissions to residential and outpatient (milieu-type) treatment facilities for substance abuse and delinquency operated by the University of Colorado; most of these patients were referred for treatment by juvenile justice or social service agencies. PATIENTS: A total of 249 proband-sibling pairs from 191 families were selected for the study. Patient probands were 13 to 19 years of age; siblings of the probands ranged in age from 12 to 25 years. MAIN OUTCOME MEASURES: A community-based sample of 4493 adolescents and young adults was used to define clinically significant, heritable, age- and sex-normed indexes of DV, conduct disorder symptoms (CDS), and a composite index of antisocial substance dependence (DV + CDS). Siblings and parents were genotyped for 374 microsatellite markers distributed across the 22 autosomes (mean intermarker distance, 9.2 centimorgans). RESULTS: For both DV and CDS, there was evidence of linkage to the same region on chromosome 9q34, as well as to 3q24-3q25 for DV, and a novel region on chromosome 17q12 for CDS. Our composite index (DV + CDS) yielded the strongest evidence for linkage (logarithm of odds = 2.65) to the chromosome 9q34 region. CONCLUSION: These results provide the first evidence of a potential molecular genetic basis for the comorbidity between DV and antisocial behavior. PMID: Drug addiction Neurology 16143736 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Behavioral therapies for drug abuse. Am J Psychiatry. 2005 Aug;162(8):1452-60 Authors: Carroll KM, Onken LS The past three decades have been marked by tremendous progress in behavioral therapies for drug abuse and dependence, as well as advances in the conceptualization of approaches to development of behavioral therapies. Cognitive behavior therapy, contingency management, couples and family therapy, and a variety of other types of behavioral treatment have been shown to be potent interventions for several forms of drug addiction, and scientific progress has also been greatly facilitated by the articulation of a systematic approach to the development, evaluation, and dissemination of behavioral therapies. The authors review recent progress in strategies for the development of behavioral therapies for drug and alcohol abuse and dependence and discuss the range of effective behavioral therapies that are currently available. PMID: Drug addiction Neurology 16055766 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
What do we know about drug addiction? Am J Psychiatry. 2005 Aug;162(8):1401-2 Authors: Volkow ND PMID: Drug addiction Neurology 16055760 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Physician suicide and drug abuse. Am J Psychiatry. 2005 Jul;162(7):1390; author reply 1390 Authors: Gold MS, Frost-Pineda K, Melker RJ PMID: Drug addiction Neurology 15994734 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Childhood sexual abuse and age at initiation of injection drug use. Am J Public Health. 2005 Apr;95(4):703-9 Authors: Ompad DC, Ikeda RM, Shah N, Fuller CM, Bailey S, Morse E, Kerndt P, Maslow C, Wu Y, Vlahov D, Garfein R, Strathdee SA OBJECTIVES: We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. METHODS: We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. RESULTS: The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. CONCLUSIONS: Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents. PMID: Drug addiction Neurology 15798133 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Relationship between drug abuse and intimate partner violence: a longitudinal study among women receiving methadone. Am J Public Health. 2005 Mar;95(3):465-70 Authors: El-Bassel N, Gilbert L, Wu E, Go H, Hill J OBJECTIVES: We examined whether frequent drug use increases the likelihood of subsequent sexual or physical intimate partner violence (IPV) and whether IPV increases the likelihood of subsequent frequent drug use. METHODS: A random sample of 416 women on methadone was assessed at baseline (wave 1) and at 6 months (wave 2), and 12 months (wave 3) following the initial assessment. Propensity score matching and multiple logistic regression were employed. RESULTS: Women who reported frequent crack use at wave 2 were more likely than non-drug using women to report IPV at wave 3 (odds ratio [OR]=4.4; 95% confidence interval [CI]=2.1, 9.1; P<.01), and frequent marijuana users at wave 2 were more likely than non-drug users to report IPV at wave 3 (OR=4.5; 95% CI=2.4, 8.4; P<.01). In addition, women who reported IPV at wave 2 were more likely than women who did not report IPV to indicate frequent heroin use at wave 3 (OR=2.7; 95% CI=1.1, 6.5; P=.04). CONCLUSIONS: Our findings suggest that the relationship between frequent drug use and IPV is bidirectional and varies by type of drug. PMID: Drug addiction Neurology 15727978 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Remission from drug dependence symptoms and drug use cessation among women drug users in puerto rico. Arch Gen Psychiatry. 2004 Oct;61(10):1034-41 Authors: Warner LA, Alegría M, Canino G BACKGROUND: Studies of remission from drug dependence have most often been based on treatment samples, with limited generalizability to persons who may benefit from but never seek substance abuse treatment. Little is known about remission patterns among drug users in the community. OBJECTIVE: To identify patterns and predictors of remission in a community sample of drug users followed up prospectively. DESIGN: Three waves of data on a range of individual and interpersonal correlates of drug abuse and health care service use were collected between April 1997 and October 2000. SETTING: Areas of metropolitan San Juan where drug sales were known to occur. PARTICIPANTS: Two hundred seventy-five women aged 18 to 35 who were crack cocaine or injecting drug users. MAIN OUTCOME MEASURES: Self-reported drug use validated with urine screens and drug use dependence criteria based on the DSM-IV. RESULTS: Most (86.9%) of the women were drug dependent at baseline. By wave 3, fewer than half (42.6%) of the women were dependent, 13.8% had subthreshold disorder, and 17.8% used substances but did not endorse any dependence criteria. Cessation of use and decreases in the number of dependence criteria endorsed were significantly less likely for women with depressive symptoms (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.88-0.96; and OR, 0.88; 95% CI, 0.86-0.90; respectively), with a partner who engaged in criminal activities (OR, 0.30; 95% CI, 0.16-0.58; and OR, 0.63; 95% CI, 0.46-0.85; respectively), and who traded sex for money or drugs (OR, 0.12; 95% CI, 0.05-0.29; and OR, 0.26; 95% CI, 0.19-0.35; respectively). CONCLUSIONS: Drug use patterns and rates of dependence fluctuated substantially over time among drug users recruited from the community. Findings regarding the characteristics that impede remission suggest that mental health practitioners have an important role to play in community-based outreach and interventions designed to support women's efforts to stop using drugs. PMID: Drug addiction Neurology 15466677 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Medically eligible women who do not use HAART: the importance of abuse, drug use, and race. Am J Public Health. 2004 Jul;94(7):1147-51 Authors: Cohen MH, Cook JA, Grey D, Young M, Hanau LH, Tien P, Levine AM, Wilson TE OBJECTIVES: We investigated the prevalence and characteristics of HIV-positive women who do not report highly active antiretroviral therapy (HAART) use. METHODS: We analyzed HAART use among 1165 HIV-positive participants in the Women's Interagency HIV Study. RESULTS: Between October 1, 2000, and March 31, 2001, 254 women with clinical indications for HAART reported not using it, 635 reported HAART use, and 276 had no clinical indications. In multivariate analysis, using crack/cocaine/heroin and a history of abuse decreased the likelihood of using HAART, whereas being White increased it. CONCLUSIONS: One of 4 women for whom HAART was indicated reported not using HAART. Childhood sexual abuse prevention, more intensive abuse treatment, and continuing drug treatment may enhance HIV disease treatment of women. PMID: Drug addiction Neurology 15226135 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Treatment of depression in patients with alcohol or other drug dependence: a meta-analysis. JAMA. 2004 Apr 21;291(15):1887-96 Authors: Nunes EV, Levin FR CONTEXT: Depression and substance abuse are common and costly disorders that frequently co-occur, but controversy about effective treatment for patients with both disorders persists. OBJECTIVE: To conduct a systematic review and meta-analysis to quantify the efficacy of antidepressant medications for treatment of combined depression and substance use disorders. DATA SOURCES: PubMed, MEDLINE, and Cochrane database search (1970-2003), using the keywords antidepressant treatment or treatment depressed in conjunction with each of the following alcohol dependence, benzodiazepine dependence, opiate dependence, cocaine dependence, marijuana dependence, and methadone; a search of bibliographies; and consultation with experts in the field. STUDY SELECTION: Among inclusion criteria used for study selection were prospective, parallel group, double-blind, controlled clinical trials with random assignment to an antidepressant medication or placebo for which trial patients met standard diagnostic criteria for current alcohol or other drug use and a current unipolar depressive disorder. Of the more than 300 citations extracted, 44 were placebo-controlled clinical trials, 14 of which were selected for this analysis and included 848 patients: 5 studies of tricyclic antidepressants, 7 of selective serotonin re-uptake inhibitors, and 2 from other classes DATA EXTRACTION: We independently screened the titles and abstracts of each citation, identified placebo-controlled trials of patients with both substance dependence and depression, applied the inclusion criteria, and reached consensus. Data on study methods, sample characteristics, and depression and substance use outcomes were extracted. The principal measure of effect size was the standardized difference between means on the Hamilton Depression Scale (HDS). DATA SYNTHESIS: For the HDS score, the pooled effect size from the random-effects model was 0.38 (95% confidence interval, 0.18-0.58). Heterogeneity of effect on HDS across studies was significant (P <.02), and studies with low placebo response showed larger effects. Moderator analysis suggested that diagnostic methods and concurrent psychosocial interventions influenced outcome. Studies with larger depression effect sizes (>0.5) demonstrated favorable effects of medication on measures of quantity of substance use, but rates of sustained abstinence were low. CONCLUSIONS: Antidepressant medication exerts a modest beneficial effect for patients with combined depressive- and substance-use disorders. It is not a stand-alone treatment, and concurrent therapy directly targeting the addiction is also indicated. More research is needed to understand variations in the strength of the effect, but the data suggest that care be exercised in the diagnosis of depression-either by observing depression to persist during at least a brief period of abstinence or through efforts by clinical history to screen out substance-related depressive symptoms. PMID: Drug addiction Neurology 15100209 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug dependence and addiction, III: Expectation and brain function in drug abuse. Am J Psychiatry. 2004 Apr;161(4):621 Authors: Volkow N PMID: Drug addiction Neurology 15056504 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug dependence and addiction, II: Adult neurogenesis and drug abuse. Am J Psychiatry. 2004 Mar;161(3):426 Authors: Eisch AJ, Mandyam CD PMID: Drug addiction Neurology 14992964 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug dependence and addiction: neural substrates. Am J Psychiatry. 2004 Feb;161(2):223 Authors: Self D PMID: Drug addiction Neurology 14754767 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Medicaid eligibility of former Supplemental Security Income recipients with drug abuse or alcoholism disability. Am J Public Health. 2004 Jan;94(1):46-7 Authors: Hanrahan P, Luchins DJ, Cloninger L, Swartz J PMID: Drug addiction Neurology 14713695 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
A new anatomical framework for neuropsychiatric disorders and drug abuse. Am J Psychiatry. 2003 Oct;160(10):1726-39 Authors: Heimer L Histotechnological breakthroughs in the late 1960s paved the way for anatomical discoveries that led to the concepts of the ventral striatal-pallidal system and the extended amygdala. These two macro-anatomical systems, together with the basal nucleus of Meynert, represent the main components of the new anatomy of the basal forebrain. The concept of the ventral striatal-pallidal system provided the first indication of the existence of parallel cortical-striatal-pallidal-thalamic-cortical circuits, which in turn led to the theory of segregated cortical-subcortical reentrant circuits as a conceptual framework for the study of neuropsychiatric disorders. The multifarious symptoms of neuropsychiatric disorders, however, cannot be understood unless the extended amygdala, the basal nucleus of Meynert, and the septal-diagonal band system are also included in such deliberations. All of these systems serve as output channels for activities in the greater limbic lobe, which usually is critically involved in neuropsychiatric disorders. Within the context of the new anatomy of the basal forebrain, structures such as the accumbens, the olfactory tubercle, and the amygdala have lost legitimacy as independent functional-anatomical units at the same time as the major components of the last uncharted territory of the human brain, the substantia innominata, have been identified. PMID: Drug addiction Neurology 14514480 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Consumption of coffee during pregnancy: authors should adjust for history of drug abuse. BMJ. 2003 Jun 7;326(7401):1268; author reply 1269 Authors: Sindos M, Pisal N, Michala S PMID: Drug addiction Neurology 12791758 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The role of psychiatric disorders in predicting drug dependence treatment outcomes. Am J Psychiatry. 2003 May;160(5):890-5 Authors: Compton WM, Cottler LB, Jacobs JL, Ben-Abdallah A, Spitznagel EL OBJECTIVE: Previous research has demonstrated that psychiatric disorders are common among people who abuse alcohol and drugs, but few studies have examined the relationship of psychiatric disorders to drug treatment outcome. The authors conducted such an examination. METHOD: They successfully reinterviewed 401 drug-dependent subjects (94% of the baseline in-treatment sample) and determined their drug abuse status at follow-up 12 months later. RESULTS: Analyses indicated that several baseline psychiatric disorders predicted worse outcomes at follow-up. Major depression predicted using a larger number of substances and having more drug dependence diagnoses and symptoms. Alcohol dependence predicted more dependence diagnoses, antisocial personality disorder predicted using a larger number of substances, and generalized anxiety disorder predicted having more dependence diagnoses. Outcomes among men were more closely associated with psychiatric status than outcomes among women, except for phobias, which predicted a better outcome among women. CONCLUSIONS: These results are unique in their assessment of individuals dependent on illicit substances. Overall, the authors found that women with phobias had better outcomes and that men with psychiatric disorders in general, men with major depression, and men with antisocial personality disorder had worse outcomes. PMID: Drug addiction Neurology 12727692 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug supply and drug abuse. CMAJ. 2003 Apr 29;168(9):1113; author reply 1113 Authors: Copeman M PMID: Drug addiction Neurology 12719309 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics. 2003 Mar;111(3):564-72 Authors: Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF OBJECTIVE: Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed. METHODS: We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: <or=14 years, 15 to 18 years, or as an adult (>or=19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use. RESULTS: Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with >or=5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use. CONCLUSIONS: The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice. PMID: Drug addiction Neurology 12612237 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Food and Drug Administration approval of buprenorphine-naloxone for office treatment of addiction. Ann Intern Med. 2003 Feb 18;138(4):360 Authors: Resnick RB PMID: Drug addiction Neurology 12585846 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Annual household survey finds millions of Americans in denial about drug abuse. Public Health Rep. 2002 Jul-Aug;117(4):408 Authors: PMID: Drug addiction Neurology 12552643 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13-year prospective study. Pediatrics. 2003 Jan;111(1):97-109 Authors: Barkley RA, Fischer M, Smallish L, Fletcher K OBJECTIVE: To examine the impact of stimulant treatment during childhood and high school on risk for substance use, dependence, and abuse by young adulthood. METHODS: A total of 147 clinic-referred hyperactive children were followed approximately 13 years into adulthood (mean: 21 years old; range: 19-25). At adolescent (age 15) and adult follow-up, probands were interviewed about their use of various substances and duration of stimulant treatment. RESULTS: Duration of stimulant treatment was not significantly associated with frequency of any form of drug use by young adulthood. Stimulant-treated children had no greater risk of ever trying drugs by adolescence or any significantly greater frequency of drug use by young adulthood. Stimulant treatment in high school also did not influence drug use in adulthood except for greater use of cocaine. This difference was no longer significant after controlling for severity of attention-deficit/hyperactivity disorder and conduct disorder in childhood, adolescence, and adulthood. Stimulant treatment in either childhood or high school was not associated with any greater risk for any formal Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised drug dependence or abuse disorders by adulthood. Treatment with stimulants did not increase the risk of ever having tried most illegal substances by adulthood except for cocaine. Subsequent analyses showed that this elevated risk was primarily mediated by severity of conduct disorder by young adulthood and not by stimulant treatment in childhood. CONCLUSION: This study concurs with 11 previous studies in finding no compelling evidence that stimulant treatment of children with attention-deficit/hyperactivity disorder leads to an increased risk for substance experimentation, use, dependence, or abuse by adulthood. PMID: Drug addiction Neurology 12509561 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Arch Gen Psychiatry. 2002 Nov;59(11):1039-44 Authors: Brook DW, Brook JS, Zhang C, Cohen P, Whiteman M BACKGROUND: The Children in the Community Study is a prospective longitudinal study investigating the association between early drug use (childhood, adolescence, and early 20s) and later psychiatric disorders (in the late 20s). METHODS: Using data from a community-based sample of 736 adults (50% female) from upstate New York, the subjects were interviewed at the mean ages of 14, 16, 22, and 27 years. Psychiatric disorders, measured by age-appropriate versions of the University of Michigan Composite International Diagnostic Interview, and participant's drug use were assessed. RESULTS: Adolescent and young adult tobacco use was significantly associated with an increased risk of alcohol dependence and substance use disorders at a mean age of 27 years, but not with new episodes of major depressive disorder. Earlier alcohol use significantly predicted later major depressive disorder, alcohol dependence, and substance use disorders in the late 20s, as did early marijuana use and other illicit drug use. Except for the effect of tobacco use on major depressive disorder, early drug use was significantly related to later psychiatric disorders, even after statistically controlling for age, sex, parental educational level, family income, and prior episodes of major depressive disorder and substance use disorders. CONCLUSIONS: Our results suggest that early drug use is associated with and predicts later psychiatric disorders. Preventive implications stem from the importance of studying a range of psychiatric disorders in the context of substance use assessed over a wide age range. PMID: Drug addiction Neurology 12418937 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry. 2002 Oct;159(10):1642-52 Authors: Goldstein RZ, Volkow ND OBJECTIVE: Studies of the neurobiological processes underlying drug addiction primarily have focused on limbic subcortical structures. Here the authors evaluated the role of frontal cortical structures in drug addiction. METHOD: An integrated model of drug addiction that encompasses intoxication, bingeing, withdrawal, and craving is proposed. This model and findings from neuroimaging studies on the behavioral, cognitive, and emotional processes that are at the core of drug addiction were used to analyze the involvement of frontal structures in drug addiction. RESULTS: The orbitofrontal cortex and the anterior cingulate gyrus, which are regions neuroanatomically connected with limbic structures, are the frontal cortical areas most frequently implicated in drug addiction. They are activated in addicted subjects during intoxication, craving, and bingeing, and they are deactivated during withdrawal. These regions are also involved in higher-order cognitive and motivational functions, such as the ability to track, update, and modulate the salience of a reinforcer as a function of context and expectation and the ability to control and inhibit prepotent responses. CONCLUSIONS: These results imply that addiction connotes cortically regulated cognitive and emotional processes, which result in the overvaluing of drug reinforcers, the undervaluing of alternative reinforcers, and deficits in inhibitory control for drug responses. These changes in addiction, which the authors call I-RISA (impaired response inhibition and salience attribution), expand the traditional concepts of drug dependence that emphasize limbic-regulated responses to pleasure and reward. PMID: Drug addiction Neurology 12359667 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Health policies on drug dependence must be based on scientific evidence. BMJ. 2002 Jun 1;324(7349):1338 Authors: Davoli M, Ferri M, Perucci CA, Liberati A PMID: Drug addiction Neurology 12039839 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Carisoprodol: an unrecognized drug of abuse. Am J Clin Pathol. 2002 Mar;117(3):396-400 Authors: Bailey DN, Briggs JR During a 6-month monitoring period, carisoprodol was detected in the urine specimens of 19 patients for whom drug screening had been ordered for purposes of patient care. The clinical history suggested that in 7 cases the drug was abused or implicated in a suicide attempt or gesture. In another 7 cases, the drug was used primarily for medical purposes, and in 5 cases the reason for use could not be determined. One patient ingested homemade tablets that were found to contain carisoprodol. In an additional case, the drug was detected in breast milk. Physical findings, clinical history, and treatment are described, and the profile of a typical carisoprodol user is discussed. It seems that carisoprodol has become an unrecognized drug of abuse, at least in our community. This drug and its metabolite, meprobamate, should be included in comprehensive drug screening. PMID: Drug addiction Neurology 11888078 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatry. 2001 Dec;158(12):2027-32 Authors: Wells K, Klap R, Koike A, Sherbourne C OBJECTIVE: Recent policy has focused on documenting and reducing ethnic disparities in availability and quality of health care. The authors examined differences by ethnic status in unmet need for alcoholism, drug abuse, and mental health treatment. METHOD: Data were from a follow-up survey of adult respondents to a 1996-1997 national survey. Non-Hispanic whites, African Americans, and Hispanics were compared in access to alcoholism and drug abuse treatment and mental health care (primary or specialty), unmet need for care, satisfaction with care, and use of active treatment for alcoholism, drug abuse, and mental health problems in the prior 12 months. RESULTS: A total of 31.9% of whites, 28.1% of African Americans, and 30.1% of Hispanics had some alcoholism, drug abuse, and mental health care, mostly in primary care. Among those with perceived need, compared to whites, African Americans were more likely to have no access to alcoholism, drug abuse, or mental health care (25.4% versus 12.5%), and Hispanics were more likely to have less care than needed or delayed care (22.7% versus 10.7%). Among those with need, whites were more likely than Hispanics or African Americans to be receiving active alcoholism, drug abuse, or mental health treatment (37.6% versus 22.4%-25.0%). CONCLUSIONS: The authors document greater unmet need for alcoholism and drug abuse treatment and mental health care among African American and Hispanics relative to whites. New policies are needed to improve access to and quality of alcoholism, drug abuse, and mental health treatment across diverse populations. PMID: Drug addiction Neurology 11729020 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Lack of association between parental alcohol or drug addiction and behavioral inhibition in children. Am J Psychiatry. 2001 Oct;158(10):1731-3 Authors: Biederman J, Hirshfeld-Becker DR, Rosenbaum JF, Perenick SG, Wood J, Faraone SV OBJECTIVE: "Behavioral inhibition to the unfamiliar" has been proposed as a precursor to anxiety. A recent study proposed that it may also be a precursor to alcoholism. The authors sought to replicate the latter finding through a secondary analysis of data from a large study of young children (age 2-6 years)-offspring of parents with panic and depressive disorders-who had been assessed for behavioral inhibition through laboratory-based observations. METHOD: The offspring were stratified on the basis of presence or absence of parental lifetime history of DSM-III-R alcohol dependence (N=115 versus N=166, respectively) or drug dependence (N=78 versus N=203). The rates of behavioral inhibition were then compared between groups. RESULTS: Despite adequate power to detect associations, neither parental alcohol dependence nor drug dependence was associated with a higher risk for behavioral inhibition in the offspring. CONCLUSIONS: These results are not consistent with the hypothesis linking behavioral inhibition to addictions. PMID: Drug addiction Neurology 11579013 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug abuse and mental illness: progress in understanding comorbidity. Am J Psychiatry. 2001 Aug;158(8):1181-3 Authors: Volkow ND PMID: Drug addiction Neurology 11481146 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Remission from drug abuse over a 25-year period: patterns of remission and treatment use. Am J Public Health. 2001 Jul;91(7):1107-13 Authors: Price RK, Risk NK, Spitznagel EL OBJECTIVES: Using an epidemiologically obtained sample, we examined patterns of illicit drug use, abuse, and remission over a 25-year period and recent treatment use. METHODS: The surviving members of the cohort (n = 841), previously surveyed in 1972 and 1974, comprised 3 subsamples of Vietnam War enlisted men and civilian controls. Retrospectively obtained year-to-year measures from the 1996-1997 survey included use and remission of sedatives, stimulants, marijuana, cocaine, and opiates, as well as substance abuse and psychiatric treatment use. RESULTS: Relatively stable patterns of frequent use in adulthood were found, with the mean duration from initiation to the last remission ranging from 9 to 14 years. A majority attempted to quit; however, most did not use traditional drug treatment in their last attempts. Fewer than 9% of the then-current drug users were treated in inpatient or outpatient settings at the time of data collection. CONCLUSIONS: Most drug abusers who had started using drugs by their early 20s appeared to gradually achieve remission. Spontaneous remission was the rule rather than the exception. Nonetheless, considerable unmet needs existed for those who had continued use into middle age. PMID: Drug addiction Neurology 11441739 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
From the Centers for Disease Control and Prevention. Trends in injection drug use among persons entering addiction treatment--New Jersey, 1992-1999. JAMA. 2001 Jun 6;285(21):2706-7 Authors: PMID: Drug addiction Neurology 11419420 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
D is for drug addiction--and disability. CMAJ. 2001 May 29;164(11):1565-6 Authors: Berger PB PMID: Drug addiction Neurology 11402793 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The patient recovering from alcohol or drug addiction: special issues for the anesthesiologist. Anesth Analg. 2001 Jun;92(6):1601-8 Authors: May JA, White HC, Leonard-White A, Warltier DC, Pagel PS PMID: Drug addiction Neurology 11375854 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs. JAMA. 2001 May 9;285(18):2355-62 Authors: Laine C, Hauck WW, Gourevitch MN, Rothman J, Cohen A, Turner BJ CONTEXT: Patients and the public could benefit from identification of factors that prevent drug users' heavy reliance on inpatient care; however, optimal health care delivery models for illicit drug users remain ill-defined. OBJECTIVE: To evaluate associations of outpatient medical and drug abuse care with drug users' subsequent hospitalization rates. DESIGN AND SETTING: Retrospective cohort study of data from longitudinally linked claims for all ambulatory physician/clinic services and drug abuse services covered by the New York State Medicaid program. SUBJECTS: A total of 11 556 human immunodeficiency virus (HIV)-positive and 46 687 HIV-negative drug users. MAIN OUTCOME MEASURES: Hospitalization in federal fiscal year (FFY) 1997 compared by 4 patterns of care in FFY 1996: regular drug abuse care (>/=6 months in 1 program), regular medical care (>35% of care from 1 clinic, group practice, or individual physician), both, or neither. RESULTS: Hospitalization occurred in 55.6% of HIV-positive and 37.5% of HIV-negative drug users, with a mean of 27.5 and 24.5 inpatient days, respectively. In HIV-positive drug users, the adjusted odds ratio (AOR) for hospitalization was lowest among those with both regular medical and drug abuse care (AOR, 0.76; 95% confidence interval [CI], 0.67-0.85) followed by those with regular medical care alone (AOR, 0.82; 95% CI, 0.74-0.91) and regular drug abuse care alone (AOR, 0.85; 95% CI, 0.76-0.96) vs those with neither. In HIV-negative drug users, the AOR of hospitalization was lower for those with regular medical and drug abuse care (AOR, 0.73; 95% CI, 0.68-0.79), regular drug abuse care alone (AOR, 0.71; 95% CI, 0.66-0.76), and regular medical care (AOR, 0.91; 95% CI, 0.86-0.95) vs those with neither. Both types of care showed favorable effects for all but drug abuse-related hospitalizations. CONCLUSION: Our data indicate that regular drug abuse care with regular medical care for drug users is associated with less subsequent hospitalization. PMID: Drug addiction Neurology 11343483 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Neural activity related to drug craving in cocaine addiction. Arch Gen Psychiatry. 2001 Apr;58(4):334-41 Authors: Kilts CD, Schweitzer JB, Quinn CK, Gross RE, Faber TL, Muhammad F, Ely TD, Hoffman JM, Drexler KP BACKGROUND: Crack cocaine dependence and addiction is typically associated with frequent and intense drug wanting or craving triggered by internal or environmental cues associated with past drug use. METHODS: Water O 15 positron emission tomography (PET) studies were used to localize alterations in synaptic activity related to cue-induced drug craving in 8 crack cocaine-dependent African American men. In a novel approach, script-guided imagery of autobiographical memories were used as individualized cues to internally generate a cocaine craving state and 2 control (ie, anger and neutral episodic memory recall) states during PET image acquisition. RESULTS: The mental imagery of personalized drug use and anger-related scripts was associated with self-ratings of robust drug craving or anger, and comparable alterations in heart rate. Compared with the neutral imagery control condition, imagery-induced drug craving was associated with bilateral (right hemisphere amygdala activation greater than left) activation of the amygdala, the left insula and anterior cingulate gyrus, and the right subcallosal gyrus and nucleus accumbens area. Compared with the anger control condition, internally generated drug craving was associated with bilateral activation of the insula and subcallosal cortex, left hippocampus, and anterior cingulate cortex and brainstem. A brain-wide pixel-by-pixel search indicated significant positive and negative correlations between imagery-induced cocaine craving and regional cerebral blood flow (rCBF) in distributed sites. CONCLUSIONS: The collected findings suggest the craving-related activation of a network of limbic, paralimbic, and striatal brain regions, including structures involved in stimulus-reward association (amygdala), incentive motivation (subcallosal gyrus/nucleus accumbens), and anticipation (anterior cingulate cortex). PMID: Drug addiction Neurology 11296093 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Addiction and the brain: the role of neurotransmitters in the cause and treatment of drug dependence. CMAJ. 2001 Mar 20;164(6):817-21 Authors: Tomkins DM, Sellers EM Recent scientific advances have led to a greater understanding of the neurobiological processes that underlie drug abuse and addiction. These suggest that multiple neurotransmitter systems may play a key role in the development and expression of drug dependence. These advances in our knowledge promise not only to help us identify the underlying cause of drug abuse and dependence, but also to aid the development of effective treatment strategies. PMID: Drug addiction Neurology 11276551 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Addressing drug abuse: policy deliberations in the great south land. Public Health Rep. 2000 Sep-Oct;115(5):476-9 Authors: Samet JH PMID: Drug addiction Neurology 11236020 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug addiction: to the cortex.and beyond! Am J Psychiatry. 2001 Mar;158(3):349-50 Authors: Kalivas PW PMID: Drug addiction Neurology 11229971 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Screening and intervention for illicit drug abuse: a national survey of primary care physicians and psychiatrists. Arch Intern Med. 2001 Jan 22;161(2):248-51 Authors: Friedmann PD, McCullough D, Saitz R BACKGROUND: Illicit drug abuse causes much morbidity and mortality, yet little is known about physicians' screening and intervention practices regarding illicit drug abuse. METHODS: We mailed a survey to a national sample of 2000 practicing general internists, family physicians, obstetricians and gynecologists, and psychiatrists to assess their screening and intervention practices for illicit drug abuse. RESULTS: Of 1082 respondents (adjusted response rate, 57%), 68% reported that they regularly ask new outpatients about drug use. For diagnosed illicit drug abuse, 55% reported that they routinely offer formal treatment referral, but 15% reported that they do not intervene. In multivariate logistic regression models, more optimal screening and intervention practices were associated with psychiatry specialty, confidence in obtaining the history of drug use, optimism about the effectiveness of therapy, less concern that patients will object, and fewer perceived time constraints. CONCLUSIONS: Most physicians reported that they ask patients about illicit drug use, but a substantial minority inadequately intervene in diagnosed drug abuse. Initiatives to promote physician involvement in illicit drug abuse should include strategies to increase physicians' confidence in managing drug problems, engender optimism about the benefits of treatment, dispel concerns about patients' sensitivity regarding substance use, and address perceived time limitations. PMID: Drug addiction Neurology 11176739 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Gamma-hydroxybutyrate (GHB): a newer drug of abuse. Am Fam Physician. 2000 Dec 1;62(11):2478-83 Authors: O'Connell T, Kaye L, Plosay JJ Gamma-hydroxybutyrate (GHB) is an illicitly marketed substance that has recently gained popularity among body builders and party attendees as a drug of abuse. GHB is a depressant that acts on the central nervous system. It is purported as a strength enhancer, euphoriant and aphrodisiac and is one of several agents reported as being used as a "date rape" drug. Because of its central nervous system depressant effects, GHB can be lethal when combined with alcohol or other depressants. Currently, there is no accepted medical use for GHB, and the U.S. Food and Drug Administration has prohibited its manufacture and sale. Clinicians should be familiar with the typical clinical presentation of GHB and its adverse effects. In addition, patients should be warned of its potential toxicity and be cautioned to avoid the use of GHB. PMID: Drug addiction Neurology 11130233 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Testosterone--fountain of youth or drug of abuse? J Clin Endocrinol Metab. 2000 Sep;85(9):3020-3 Authors: Hayes FJ PMID: Drug addiction Neurology 10999779 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Severe mental illness and substance use disorders among former Supplemental Security Income beneficiaries for drug addiction and alcoholism. Arch Gen Psychiatry. 2000 Jul;57(7):701-7 Authors: Swartz JA, Lurigio AJ, Goldstein P BACKGROUND: Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DA&A) may be creating a residual population that is too seriously impaired to work owing to psychiatric and substance use disorders. METHOD: Data in this report were derived from 1-year follow-up interviews of 204 randomly selected DA&A beneficiaries in Chicago who were initially interviewed between January 1997 and March 1997, immediately following their termination in the Supplemental Security Income DA&A program. Information on subjects' work and benefits status were collected along with DSM-III-R psychiatric and substance use disorder diagnostic information. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, phencyclidine, amphetamines, and methadone. RESULTS: Twenty-six percent had a past-year severe mental illness while 34% met the DSM-III-R criteria for drug dependence. Illegal drug use was also prevalent with about 50% of the sample testing positive for marijuana, cocaine, or opiates. Compared with those working and earning at least $500 a month, unemployed or underemployed subjects who had lost all federal benefits had a much greater likelihood of being dependent on drugs (odds ratio, 5.0; P<.005; 95% confidence interval, 1.6-15.7) and of having 2 or more comorbid psychiatric disorders (odds ratio, 6.9; P<.005; 95% confidence interval, 1.9-24.7). CONCLUSIONS: Those who have lost DA&A disability benefits and who continue to be unemployed or underemployed have elevated rates of drug dependence and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult. PMID: Drug addiction Neurology 10891041 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
An approach to drug abuse, intoxication and withdrawal. Am Fam Physician. 2000 May 1;61(9):2763-74 Authors: Giannini AJ The symptomatic effects of drug abuse are a result of alterations in the functioning of the following neurotransmitters or their receptors: acetylcholine, dopamine, gamma-aminobutyric acid, norepinephrine, opioids and serotonin. Anticholinergic drugs antagonize acetylcholine receptors. Dissociative drugs affect all transmitter sites. Opiates act on both opioid and adrenergic receptor sites. Psychedelic drugs stimulate serotonin release, and sedative-hypnotic drugs potentiate the gamma-aminobutyric acid receptor. Specific signs and symptoms are associated with the neurotransmitters and receptors affected by each drug class. By recognizing symptomatic changes related to particular neurotransmitters and their receptors, family physicians can accurately determine the drug class and intervene appropriately to counteract drug-induced effects. PMID: Drug addiction Neurology 10821156 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Addiction: part II. Identification and management of the drug-seeking patient. Am Fam Physician. 2000 Apr 15;61(8):2401-8 Authors: Longo LP, Parran T, Johnson B, Kinsey W The medications most often implicated in prescription drug abuse are opioid analgesics, sedative-hypnotics and stimulants. Patients with acute or chronic pain, anxiety disorders and attention-deficit disorder are at increased risk of addiction comorbidity. It is important to ask patients about their substance-use history, including alcohol, illicit drugs and prescription drugs. Patients who abuse prescription drugs may exhibit certain patterns, such as escalating use, drug-seeking behavior and doctor shopping. A basic clinical survival skill in situations in which patients exert pressure on the physician to obtain a prescription drug is to say "no" and stick with it. Physicians who overprescribe can be characterized by the four "Ds"-dated, duped, dishonest and disabled. Maintaining a current knowledge base, documenting the decisions that guide the treatment process and seeking consultation are important risk-management strategies that improve clinical care and outcomes. PMID: Drug addiction Neurology 10794581 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
JAMA Patient Page: drug abuse. JAMA. 2000 Mar 8;283(10):1378 Authors: PMID: Drug addiction Neurology 10714739 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Trends in funding and use of alcohol and drug abuse treatment at specialty facilities, 1990-1994. Am J Public Health. 2000 Jan;90(1):109-11 Authors: Dayhoff DA, Urato CJ, Pope GC OBJECTIVES: This study examined trends in funding and use of alcohol and drug abuse treatment at specialty facilities between 1990 and 1994. METHODS: The 1990 and 1994 National Drug and Alcohol Treatment Unit Surveys were used to estimate annual funding and number of clients in treatment. RESULTS: Public funding increased by 5%, whereas private funding decreased by 28% in real terms between 1990 and 1994. The number of publicly and privately funded clients decreased slightly. CONCLUSIONS: The rapid growth in private and public sector substance abuse funding during the 1980s has not continued into the 1990's. PMID: Drug addiction Neurology 10630146 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug treatment beats prison for cutting crime and addiction rates. BMJ. 1999 Aug 21;319(7208):470 Authors: Jones J PMID: Drug addiction Neurology 10454396 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Arch Gen Psychiatry. 1999 Jun;56(6):493-502 Authors: Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken LS, Muenz LR, Thase ME, Weiss RD, Gastfriend DR, Woody GE, Barber JP, Butler SF, Daley D, Salloum I, Bishop S, Najavits LM, Lis J, Mercer D, Griffin ML, Moras K, Beck AT BACKGROUND: This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients. METHODS: Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Patients were assessed monthly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index-Drug Use Composite score and the number of days of cocaine use in the past month. RESULTS: Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index-Drug Use Composite score. Individual group counseling plus GDC was also superior to the 2 psychotherapies on the number of days of cocaine use in the past month. Hypotheses regarding the superiority of psychotherapy to GDC for patients with greater psychiatric severity and the superiority of cognitive therapy plus GDC compared with supportive-expressive therapy plus GDC for patients with antisocial personality traits or external coping style were not confirmed. CONCLUSION: Compared with professional psychotherapy, a manual-guided combination of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence. PMID: Drug addiction Neurology 10359461 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug abuse treatment success among needle exchange participants. Public Health Rep. 1998 Jun;113 Suppl 1:129-39 Authors: Brooner R, Kidorf M, King V, Beilenson P, Svikis D, Vlahov D OBJECTIVE: Although lowering incidence rates of human immunodeficiency virus (HIV) transmission is the primary goal of needle exchange programs (NEPs), other desirable outcomes are possible. Referring exchange participants to more comprehensive drug abuse treatment programs has the potential to reduce or eliminate the use of drugs. This possibility was evaluated by comparing the treatment responses of new admissions with an outpatient opioid agonist treatment program in Baltimore, Maryland. METHODS: New admissions (1994 - 1997) to an opioid agonist treatment program were first grouped by referral source (needle exchange, n = 82 vs. standard referrals, n = 243) and then compared on admission demographic and clinical variables and response to treatment during the first three months. Outcome measures included retention rates, self-reported drug use and injecting frequencies, self-reported illegal activities for profit, and results from weekly urinalysis testing for opioids and cocaine. RESULTS: Patients from the NEP were significantly older and more likely to be male, African American, and unemployed than standard referral patients. Needle exchange patients also had a greater baseline severity of drug use than patients in the standard referral group. Despite these baseline differences, both groups achieved comparably good short-term treatment outcomes (including reduced drug use and criminal activity for profit); treatment retention was also good, although slightly better in the standard referral group (88% vs. 76%). CONCLUSION: These data demonstrate the feasibility and merits of creating strong linkages between NEPs and more comprehensive drug abuse treatment clinics. PMID: Drug addiction Neurology 9722818 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug abuse treatment as AIDS prevention. Public Health Rep. 1998 Jun;113 Suppl 1:97-106 Authors: Metzger DS, Navaline H, Woody GE OBJECTIVE: As the acquired immunodeficiency syndrome (AIDS) epidemic among drug users enters its third decade in the United States, it is important to consider the role playing by substance abuse treatment in the prevention of human immunodeficiency virus (HIV) infection. METHODS: The authors review the research literature, examining findings from studies with behavioral and serologic measures on the association among treatment participation, HIV risk reduction, and HIV infection. RESULTS: Numerous studies have now documented that significantly lower rates of drug use and related risk behaviors are practiced by injecting drug users (IDUs) who are in treatment. Importantly, these behavioral differences, based primarily on self-report, are consistent with studies that have examined HIV seroprevalence and seroincidence among drug users. CONCLUSION: The underlying mechanism of action suggested by the collective findings of the available literature is rather simple-- individuals who enter and remain in treatment reduce their drug use, when leads to fewer instances of drug-related risk behavior. This lower rate of exposure results in fewer infections with HIV. The protective effects of treatment, however, can only be achieved when programs are accessible and responsive to the changing needs of drug users. Future research needs to be directed at developing a better understanding of the factors that enhance treatment entry and retention. PMID: Drug addiction Neurology 9722815 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Deadliness of declining drug abuse. Public Health Rep. 1998 May-Jun;113(3):234-5 Authors: Woodward A PMID: Drug addiction Neurology 9696674 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Co-occurrence of abuse of different drugs in men: the role of drug-specific and shared vulnerabilities. Arch Gen Psychiatry. 1998 Nov;55(11):967-72 Authors: Tsuang MT, Lyons MJ, Meyer JM, Doyle T, Eisen SA, Goldberg J, True W, Lin N, Toomey R, Eaves L BACKGROUND: Previous research has demonstrated genetic and environmental influences on abuse of individual substances, but there is less known about how these factors may influence the co-occurrence of abuse of different illicit drugs. METHODS: We studied 3372 male twin pairs from the Vietnam Era Twin Registry. They were interviewed using the Diagnostic Interview Schedule, Version III, Revised to investigate the extent to which the abuse of different categories of drugs occurs together within an individual, as well as the possibility that genetic and environmental factors are responsible for observed co-occurrence. Co-occurrence was quantified using odds ratios and conditional probabilities. Multivariate biometrical modeling analyses were used to assess genetic and environmental influences on co-occurrence. RESULTS: Abusing any category of drug was associated with a marked increase in the probability of abusing every other category of drugs. We found evidence for a shared or common vulnerability factor that underlies the abuse of marijuana, sedatives, stimulants, heroin or opiates, and psychedelics. This shared vulnerability is influenced by genetic, family environmental, and nonfamily environmental factors, but not every drug is influenced to the same extent by the shared vulnerability factor. Marijuana, more than other drugs, was influenced by family environmental factors. Each category of drug, except psychedelics, had genetic influences unique to itself (ie, not shared with other drug categories). Heroin had larger genetic influences unique to itself than did any other drug. CONCLUSION: There are genetically and environmentally determined characteristics that comprise a shared or common vulnerability to abuse a range of illicit drugs. PMID: Drug addiction Neurology 9819064 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Management of withdrawal syndromes and relapse prevention in drug and alcohol dependence. Am Fam Physician. 1998 Jul;58(1):139-46 Authors: Miller NS, Gold MS The primary care physician is in a good position to diagnose, manage and intervene with patients who are undergoing the process of treatment and recovery from alcohol and drug disorders. Medications such as benzodiazepines are effective in the treatment of withdrawal syndromes, and naltrexone and disulfiram can be used to augment relapse prevention. Patients may also participate in psychosocial methods of addiction treatment that can reduce the risk of relapse and improve their psychosocial, health, legal and employment status. PMID: Drug addiction Neurology 9672434 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Physical dependence on zopiclone. Prescribing this drug to addicts may give rise to iatrogenic drug misuse. BMJ. 1998 Jul 11;317(7151):146 Authors: Sikdar S PMID: Drug addiction Neurology 9657802 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Cocaine dependence with and without PTSD among subjects in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Am J Psychiatry. 1998 Feb;155(2):214-9 Authors: Najavits LM, Gastfriend DR, Barber JP, Reif S, Muenz LR, Blaine J, Frank A, Crits-Christoph P, Thase M, Weiss RD OBJECTIVE: This study examined the prevalence of lifetime traumatic events and current symptoms of posttraumatic stress disorder (PTSD) among treatment-seeking cocaine-dependent outpatients and compared patients with and without PTSD on current substance use, psychopathology, and sociodemographic characteristics. METHOD: The subjects were 122 adult cocaine-dependent outpatients participating in a treatment outcome study of psychosocial therapy. In addition to standard self-report and interview measures of psychopathology and substance use, the subjects completed the Trauma History Questionnaire and the PTSD Checklist before entering treatment. RESULTS: These patients experienced a large number of lifetime traumatic events (mean = 5.7); men experienced more general disasters and crime-related traumas than women, and women experienced more physical and sexual abuse than men. According to self-report measures, 20.5% of the subjects currently met the DSM-III-R criteria for PTSD; the rate of PTSD was 30.2% among women and 15.2% among men. Patients with PTSD had significantly higher rates of co-occurring axis I and axis II disorders, interpersonal problems, medical problems, resistance to treatment, and psychopathology symptoms than patients without PTSD. Psychopathology symptoms represented the most consistent difference between the two groups and provided the best prediction of PTSD status in a logistic regression. However, the groups did not differ significantly in current substance use or sociodemographic characteristics. CONCLUSIONS: These findings underscore the value of screening substance abusers for PTSD, because it can identify a small but substantial number who might require additional treatment. Further studies of the relationship between PTSD and substance abuse appear warranted. PMID: Drug addiction Neurology 9464200 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Treating alcohol dependence. Acamprostate is another drug to help maintain abstinence. BMJ. 1997 Nov 29;315(7120):1466 Authors: Haddad P, Daly C PMID: Drug addiction Neurology 9432251 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior. Am J Public Health. 1997 Oct;87(10):1637-44 Authors: McCusker J, Bigelow C, Frost R, Garfield F, Hindin R, Vickers-Lahti M, Lewis B OBJECTIVE: This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors. METHODS: Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors. RESULTS: Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6-month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74; 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program. CONCLUSIONS: No overall benefit of extending treatment beyond 6 months was found. PMID: Drug addiction Neurology 9357345 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug abuse control under FDA, 1938-1968. Public Health Rep. 1997 Jan-Feb;112(1):83-6 Authors: Swann JP PMID: Drug addiction Neurology 9018295 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The Trading Cards Program--using high school role models for drug abuse prevention. Public Health Rep. 1996 Nov-Dec;111(6):547-8 Authors: Harris JL PMID: Drug addiction Neurology 8955705 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Illicit drug use by persons with disabilities: insights from the National Household Survey on Drug Abuse. Am J Public Health. 1996 Nov;86(11):1613-5 Authors: Gilson SF, Chilcoat HD, Stapleton JM OBJECTIVES: This study sought to evaluate the association of drug use with disability in a representative sample of the US household population. METHODS: The use of illicit drugs and alcohol reported by respondents in the 1991 National Household Survey on Drug Abuse who identified themselves as "disabled, unable to work" was compared with respondents without disabilities. RESULTS: Among younger adults (18-24 years), persons with disabilities were more likely than those without disabilities to report that they had used heroin (adjusted odds ratio [OR] = 6.89; 95% confidence interval [CI] = 1.35, 35.1) or crack cocaine (OR = 6.38; 95% CI = 1.05, 38.6). Among older adults (35 years and older), persons with disabilities were more likely to report the use of sedatives (OR = 2.46; 95% CI = 1.21, 4.94) or tranquilizers (OR = 2.18: 95% CI = 1.08; 4.42) not medically prescribed. CONCLUSIONS: These results suggest that use of illicit drugs is a potentially serious problem among persons with disabilities and requires both research and clinical attention. PMID: Drug addiction Neurology 8916529 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Alcohol and drug use, abuse, and dependence among welfare recipients. Am J Public Health. 1996 Oct;86(10):1450-4 Authors: Grant BF, Dawson DA OBJECTIVES: This paper presents national estimates of heavy drinking, drug use, and alcohol and drug abuse and/or dependence among recipients of selected welfare programs. METHODS: Data from the 1992 National Longitudinal Alcohol Epidemiologic Survey were analyzed. RESULTS: The percentages of welfare recipients using, abusing, or dependent on alcohol or drugs were relatively small and consistent with the general US population and those not receiving welfare benefits. CONCLUSIONS: Although a minority of welfare recipients have alcohol or drug problems, substance abuse prevention and treatment services are needed among high-risk subgroups. PMID: Drug addiction Neurology 8876518 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Harm-reduction strategies weapon of choice in BC's battle with drug addiction. CMAJ. 1996 Sep 1;155(5):571-3 Authors: Kent H British Columbia, which holds the dubious distinction of being the country's heroin capital, has introduced a number of programs in an attempt to reduce the number of drug-overdose deaths. A BC coroner who headed a provincial government task force into overdose fatalities in 1994 has recommended a number of harm-reduction strategies such as needle exchanges to reduce the negative consequences associated with illicit drug use. In addition, the College of Physicians and Surgeons of British Columbia is a world leader in methadone maintenance, with 1800 patients and 250 physicians registered in the program. PMID: Drug addiction Neurology 8804264 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Extracellular potassium modulation of drug block of IKr. Implications for torsade de pointes and reverse use-dependence. Circulation. 1996 Feb 1;93(3):407-11 Authors: Yang T, Roden DM BACKGROUND: Torsade de pointes often occurs with underlying hypokalemia and bradycardia. A common effect of many drugs producing torsade de pointes is block of the rapidly activating component of the cardiac delayed rectifier (IKr). In this study, we evaluated the effect of changing extracellular potassium ([K+]o) on IKr block by the nonspecific agent quinidine and by the specific IKr blocker dofetilide. METHODS AND RESULTS: IKr was measured in AT-1 cells, where contaminating outward currents are absent. The drug concentration producing 50% inhibition of IKr tails (IC50) was strikingly [K+]o-dependent. Elevating [K+]o from 1 to 8 mmol/L increased the IC50 for dofetilide block from 2.7 +/- 0.9 to 79 +/- 32 nmol/L and for quinidine block from 0.4 +/- 0.1 to 3.8 +/- 1.2 mumol/L. CONCLUSIONS: (1) The increase in drug block with low [K+]o provides a mechanism to explain the link between hypokalemia and torsade de pointes. (2) Elevations in [K+]o occur with myocardial ischemia and with rapid pacing. Possible consequences of blunted drug block with high [K+]o include loss of drug efficacy with ischemia and with rapid pacing; the latter may contribute to "reverse use-dependent" action potential prolongation. Extracellular potassium is a critical determinant of drug block of IKr, with substantial clinical implications. PMID: Drug addiction Neurology 8565156 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The effectiveness of alternative planned durations of residential drug abuse treatment. Am J Public Health. 1995 Oct;85(10):1426-9 Authors: McCusker J, Vickers-Lahti M, Stoddard A, Hindin R, Bigelow C, Zorn M, Garfield F, Frost R, Love C, Lewis B Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit. PMID: Drug addiction Neurology 7573630 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Correlates of drug abuse among homeless and transient people in the Washington, DC, metropolitan area in 1991. Public Health Rep. 1995 Jul-Aug;110(4):455-61 Authors: Lambert EY, Caces MF Sociodemographic correlates of drug use among the general household population may have less accuracy and utility for describing risk factors for drug use among nonhousehold populations like the homeless and transient. This analysis examines correlates of past year use of marijuana, cocaine, and needles among homeless and transient people in the Washington, DC, metropolitan statistical area (DC MSA) and discusses them vis-a-vis traditional indicators of drug use among the general household population. Data are from a study conducted in the DC MSA in 1991 that used a multistage sampling design and surveyed a random sample of 908 homeless and transient people ages 12 years and older. The analysis uses multiple logistic regression to assess the independent effect of demographic and other predictors on selected drug use measures among this population. Three key socioeconomic correlates of drug use among the general household population (educational attainment, employment status, and marital status) were nonsignificant predictors of drug use among the homeless. However, other factors were significant, including past year institutionalization, location within the DC MSA, and stage of homelessness. The age group at greatest risk for use of marijuana and cocaine in the past year were the homeless ages 26 to 34, but the oldest group (35 years and older) had the highest risk of needle use. Although men were more likely to have used marijuana and cocaine in the past year, there were no sex differences in the use of needles in the past year. Only past year use of cocaine differed significantly by race or ethnicity, with a greater likelihood among homeless blacks than among homeless whites.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: Drug addiction Neurology 7638333 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Methadone maintenance treatment. Britain has been overcommitted to psychological theories of drug dependence. BMJ. 1995 Feb 18;310(6977):463 Authors: Caplehorn J PMID: Drug addiction Neurology 7873957 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug abuse treatment experience and HIV risk behaviors among active drug injectors in Ohio. Am J Public Health. 1995 Jan;85(1):105-8 Authors: Siegal HA, Carlson RG, Falck RS, Wang J This study compares the sociodemographic characteristics and human immunodeficiency virus (HIV) risk behaviors of injection drug users who had received drug abuse treatment in the previous 5 years and those who had not received treatment. The National AIDS Demonstration Research Program database provided 2001 structured interviews, representing Cleveland, Columbus, Cincinnati, and Dayton, Ohio. About 43% of the subjects reported having received treatment in the previous 5 years. Length of involvement with drugs, more frequent injection, more legal problems, and higher levels of HIV risk behaviors were associated with a history of treatment. Incorporating HIV risk reduction education in drug abuse treatment is an urgent priority. PMID: Drug addiction Neurology 7832244 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Social and legal factors related to drug abuse in the United States and Japan. Public Health Rep. 1994 Nov-Dec;109(6):731-7 Authors: Greberman SB, Wada K This article is an overview of social and legal differences in the United States and in Japan that are related to patterns of current drug abuse epidemics in these countries. These two nations have drug abuse problems with different histories and take different approaches currently to handling illicit drug marketing and use. Histories of opiate and cocaine abuse in the United States and of stimulant and inhalant abuse in Japan are discussed. The United States has experienced three heroin epidemics in the last three decades; cocaine addiction began to merit national concern by the end of the 1980s. In Japan, the first methamphetamine epidemic began after World War II; it was controlled in the 1950s. The current inhalant epidemic began in the late 1960s and was followed by the second methamphetamine epidemic that began in 1970; both are continuing to the present. The criminal justice system is always given first consideration when assessing societal measures employed to reduce drug use. Legal penalties for illicit drug offenses reflect the societal differences of these two nations with respect to the seriousness of particular types of crimes. Characteristics of the health care system of a nation may also influence patterns of drug abuse, particularly where functions of criminal justice and health care systems overlap. Health care systems in the United States and in Japan are based on different treatment philosophies and patients' expectations; these differences are discussed along with explanations of their potential influence on the epidemiology of drug abuse. PMID: Drug addiction Neurology 7800780 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. Am J Public Health. 1994 Sep;84(9):1394-401 Authors: Ennett ST, Tobler NS, Ringwalt CL, Flewelling RL OBJECTIVES. Project DARE (Drug Abuse Resistance Education) is the most widely used school-based drug use prevention program in the United States, but the findings of rigorous evaluations of its effectiveness have not been considered collectively. METHODS. We used meta-analytic techniques to review eight methodologically rigorous DARE evaluations. Weighted effect size means for several short-term outcomes also were compared with means reported for other drug use prevention programs. RESULTS. The DARE effect size for drug use behavior ranged from .00 to .11 across the eight studies; the weighted mean for drug use across studies was .06. For all outcomes considered, the DARE effect size means were substantially smaller than those of programs emphasizing social and general competencies and using interactive teaching strategies. CONCLUSIONS. DARE's short-term effectiveness for reducing or preventing drug use behavior is small and is less than for interactive prevention programs. PMID: Drug addiction Neurology 8092361 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Admissions of injection drug users to drug abuse treatment following HIV counseling and testing. Public Health Rep. 1994 Mar-Apr;109(2):212-8 Authors: McCusker J, Willis G, McDonald M, Lewis BF, Sereti SM, Feldman ZT The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently. PMID: Drug addiction Neurology 8153272 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug and alcohol referrals: are elderly substance abuse diagnoses and referrals being missed? BMJ. 1994 Feb 12;308(6926):444-6 Authors: McInnes E, Powell J OBJECTIVE--To examine the diagnosis of problem substance use in hospital inpatients aged 65 years and over and their referral to drug and alcohol services by medical staff. DESIGN--Questionnaire to registrars or house officers caring for patients 65 years of age and over with problem substance use. SETTING--3 hospitals in New South Wales, Australia. SUBJECTS--Medical staff caring for 263 inpatients. RESULTS--Medical staff did not recognise substance misuse in older hospital patients and did not seem to be aware of current recommendations of the National Health and Medical Research Council recommendations for safe use of alcohol and benzodiazepines. Three out of 88 problem users of benzodiazepines, 29 out of 76 smokers, and 33 out of 99 problem drinkers were identified by medical staff. Of those identified with problems, 2 benzodiazepine users, 6 smokers, and 19 drinkers were considered for referral to drug and alcohol services. CONCLUSIONS--Greater awareness of recommendations for dealing with problem use of benzodiazepines and alcohol needs to be promoted among medical staff, along with an increased emphasis in medical education on substance use as a potentially important problem for older people. Drug and alcohol services also need to promote a broader role, particularly in regard to early intervention in a hospital setting for older patients. PMID: Drug addiction Neurology 8124174 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Clinical freedom and drug dependence. Treatment of American was legitimate. BMJ. 1993 Dec 11;307(6918):1565 Authors: Marks J PMID: Drug addiction Neurology 8274943 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Clinical freedom and drug dependence. No rationale for prescribing cocaine to addicts. BMJ. 1993 Dec 11;307(6918):1565 Authors: Johns A PMID: Drug addiction Neurology 8123150 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later. Ann Intern Med. 1993 Nov 15;119(10):1017-28 Authors: Cherubin CE, Sapira JD PURPOSE: To review changes in the medical complications of drug abuse that have occurred since the authors reviewed them 25 years ago. DATA SOURCE: Manual search of the internal medicine and subspecialty literature of the past three decades that was selected by the authors. STUDY SELECTION: Selected studies were of three types--baseline studies for the period ending in 1968, studies after 1968 that emphasized changes from baseline, and studies after 1968 that emphasized change (or the absence of change) and the manner in which clinicians conceptualized problems. DATA EXTRACTION: We extracted data that showed changes in the diseases, the appearance of new diseases, or the disappearance of formerly common diseases. RESULTS OF DATA SYNTHESIS: The diseases complicating drug abuse are now more widely disseminated than they were in the last 25 years. Some former "diseases of addiction" such as tetanus and malaria are now rare. Diseases (such as human immunodeficiency virus infection) not known to exist or rare 25 years ago now occur frequently. The drugs of abuse have also changed; for example, cocaine is now much more common. CONCLUSIONS: Treating the acute medical problems (mostly infectious diseases) in poor, undereducated, and often noncompliant intravenous drug users is far more complex than previously described. Although some features have remained constant, the emergence of human immunodeficiency virus infection and changes in patterns of drug use have radically altered patient management. PMID: Drug addiction Neurology 8214979 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The taking of free condoms in a drug abuse treatment clinic: the effects of location and posters. Am J Public Health. 1993 Oct;83(10):1466-8 Authors: Amass L, Bickel WK, Higgins ST, Budney AJ, Foerg FE Drug abuse treatment programs can help reduce high-risk sexual behavior in drug users by promoting condom use. This study examined the influence of distribution location and poster prompts on the taking of free condoms in a drug abuse treatment clinic. Over 6 months, condoms were available alternately, with and without poster prompts, in the clinic's private restroom or public waiting area. Overall, 381% more condoms were taken from the restroom. The presence of poster prompts did not affect condom taking. These results suggest that distribution location is a critical factor in promoting condom taking in public clinic. PMID: Drug addiction Neurology 8214242 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The underreporting of cocaine-related trauma: drug abuse warning network reports vs hospital toxicology tests. Am J Public Health. 1993 Mar;83(3):369-71 Authors: Brookoff D, Campbell EA, Shaw LM OBJECTIVE. The purpose of this study was to assess whether cocaine-related trauma is underreported to the US Federal Drug Abuse Warning Network (DAWN). METHODS. We compared DAWN reports filed by an urban emergency department with the department's toxicology results for patients treated for major trauma. DAWN regulations in effect during the study period required the reporting of all patients treated for injury who used drugs or who tested positive for drugs of abuse. RESULTS. Of 520 patients treated for major trauma, 217 (42%) were tested for a variety of drugs. Of these, 82 (38%) tested positive for cocaine. Of the 102 patients injured in motor vehicle accidents, 20 (20%) tested positive for cocaine. Of the 59 patients injured in motor vehicle accidents who were under age 40, 18 (30%) tested positive for cocaine. Of 100 victims of violent assault, 57 tested positive for cocaine. During the time period studied, DAWN recorded 48 hospital visits associated with cocaine, none involving trauma or injury. CONCLUSIONS. Cocaine-related trauma was unreported to DAWN despite the hospital's compliance with the system's guidelines. The pattern of DAWN reports from other institutions suggests that underreporting of cocaine-related injury is widespread. PMID: Drug addiction Neurology 8438974 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug abuse and illicit drug use in Puerto Rico. Am J Public Health. 1993 Feb;83(2):194-200 Authors: Canino G, Anthony JC, Freeman DH, Shrout P, Rubio-Stipec M OBJECTIVES. Based on an epidemiologic field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the United States mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. METHODS. Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents aged 17 to 68 years who were selected by multistage probability sampling of island households. RESULTS. An estimated 8.2% of the population had a history of illicit drug use and 1.2% qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4% of the male drug users and 7.7% of the female drug users met criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. CONCLUSIONS. The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables. PMID: Drug addiction Neurology 8427322 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Risk reduction in sexual behavior: a condom giveaway program in a drug abuse treatment clinic. Am J Public Health. 1992 Nov;82(11):1536-8 Authors: Calsyn DA, Meinecke C, Saxon AJ, Stanton V Just before and 4 months after initiation of a condom giveaway program, a questionnaire regarding sexual behavior and condom acquisition was administered to 103 men attending an outpatient drug abuse treatment clinic. Jars filled with a variety of condoms were placed in every clinic room. Condom taking varied as a function of room. Sixty percent of the subjects reported taking condoms. At follow-up, clients reported increases in condom possession and in use of condoms for vaginal intercourse. PMID: Drug addiction Neurology 1332520 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
The feasibility of collecting drug abuse data by telephone. Public Health Rep. 1991 Jul-Aug;106(4):384-93 Authors: Gfroerer JC, Hughes AL An evaluation was made of the use of telephone survey methods to collect illicit drug use data. Using data from a national survey that collects data by personal interviews, marijuana and cocaine use prevalence rates among households with telephones and those without were compared in order to assess coverage errors in telephone surveys. Drug use rates were substantially higher among households without telephones, with 24.9 percent of those living in households without telephones reporting use of marijuana in the past year, compared with only 9.4 percent of persons living in households with telephones. Trends in drug use were divergent, with substantial decreases in use occurring between 1985 and 1988 in households with telephones, but not in those without. National prevalence patterns and trends among households with telephone appear to be consistent with national patterns and trends in the total household population, because about 93 percent of the population lives in households with telephones. However, surveys conducted by telephone were found to produce underestimates of illicit drug use prevalence. In a 1988 national telephone survey, estimated rates of past year use were 5.2 percent for marijuana and 1.4 percent for cocaine. Comparable data from a personal visit survey (including only households with telephones and reedited and reweighted to control for differences in data collection protocols) were 8.0 percent for marijuana and 3.1 percent for cocaine use. Comparisons with several other telephone surveys collecting illicit drug use data showed similar results. Based on these results, researchers are advised to use caution in using telephone surveys to produce drug use prevalence estimates. PMID: Drug addiction Neurology 1908589 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Rep. 1991 May-Jun;106(3):280-92 Authors: Rice DP, Kelman S, Miller LS The high prevalence of alcohol and drug abuse and mental illness imposes a substantial financial burden on those affected and on society. The authors present estimates of the economic costs from these causes for 1985 and 1988, based on current and reliable data available from national surveys and the use of new costing methodology. The total losses to the economy related to alcohol and drug abuse and mental illness for 1988 are estimated at $273.3 billion. The estimate includes $85.8 billion for alcohol abuse, $58.3 billion for drug abuse, and $129.3 billion for mental illness. The total estimated costs for 1985, $218.1 billion, include $51.4 billion for direct treatment and support costs; $80.8 billion for morbidity costs, the value of reduced or lost productivity; $35.8 billion for mortality costs, the value of foregone future productivity for the 140,593 premature deaths associated with these disorders, based on a 6 percent discount rate and including an imputed value for housekeeping services; and $47.5 billion in other related costs, including the costs of crime, motor vehicle crashes, fire destruction, and the value of productivity losses for victims of crime, incarceration, crime careers, and caregiver services. The cost of acquired immunodeficiency syndrome associated with drug abuse is estimated at $1 billion, and the cost of fetal alcohol syndrome is estimated at $1.6 billion. The estimates may be considered lower limits of the true costs to society of alcohol and drug abuse and mental illness in the United States. PMID: Drug addiction Neurology 1905049 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Effect of scheduling of buprenorphine (Temgesic) on drug abuse patterns in Glasgow. BMJ. 1991 Apr 20;302(6782):969 Authors: Stewart MJ PMID: Drug addiction Neurology 2032058 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug dependence in prisoners. BMJ. 1991 Apr 13;302(6781):880 Authors: Maden A, Swinton M, Gunn J PMID: Drug addiction Neurology 2025727 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Trends in cocaine abuse reflected in emergency room episodes reported to DAWN. Drug Abuse Warning Network. Public Health Rep. 1991 Jan-Feb;106(1):59-68 Authors: Colliver JD, Kopstein AN The National Institute on Drug Abuse supports the Drug Abuse Warning Network (DAWN), a voluntary data collection system through which hospital emergency room (ER) and medical examiner facilities report information on medical crises and deaths related to the use of drugs. This study is based on cocaine-related episodes seen at 453 consistently reporting hospital emergency rooms located primarily in 21 U.S. metropolitan areas. Cocaine-related medical emergencies reported to DAWN increased from 16,033 in the first half of 1987 to 25,607 in the first half of 1989; they decreased to 22,796 in the second half of 1989. In the Boston, Buffalo, Dallas, Detroit, Minneapolis, New York, Newark, Phoenix, and Washington, DC, areas cocaine-related ER episodes decreased for at least the last two consecutive semiannual periods. Consistent with the prevalence of crack, smoking was the most frequently reported route of administering cocaine. Patients who had smoked the drug generally were younger and less likely to use other drugs in combination than were those who took cocaine by other routes. The proportion of black patients increased from 57 to 63 percent in cocaine-related ER episodes overall, and from 74 to 77 percent in episodes where the drug was smoked. Heroin used in combination with cocaine was reported in 12 to 15 percent of cocaine episodes, and both drugs were injected in 75 to 78 percent of the cases where both were involved, suggesting so-called speedballing. Patients who combined heroin with cocaine were generally older than patients in cocaine episodes overall. PMID: Drug addiction Neurology 1847529 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Medical education for alcohol and other drug abuse in the United States. CMAJ. 1990 Nov 15;143(10):1091-6 Authors: Lewis DC Initiatives by individuals, private foundations and government have led to improvements in the United States in medical education dealing with alcohol and drug-related problems. Progress has been made, particularly in the past 5 years, in developing new medical school curricula and in faculty development. Greater activity by national professional organizations has helped raise the priority of training in alcohol- and drug-related areas for undergraduate and postgraduate medical education. As an example, Project ADEPT (Alcohol and Drug Education for Physician Training in primary care) at Brown University in Providence, Rhode Island, is described. The importance of positive and motivated faculty role models and of skills training is emphasized. PMID: Drug addiction Neurology 2224678 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Prescription drug abuse. Patient, physician, and cultural responsibilities. West J Med. 1990 May;152(5):613-6 Authors: Wesson DR, Smith DE The abuse of prescription drugs is one facet of America's drug problem that is particularly complex because access to prescription drugs must be maintained for some purposes and contained for others. The American Medical Association has sponsored two national conferences to grapple with the confluence of the medical access to prescription drugs and a national drug abuse control policy. One result has been a classification of misprescribing physicians that blames physicians for prescription drug abuse. The conceptualization and public policy response to prescription drug abuse have been largely shaped by the emotional response to the epidemic of crack cocaine and other nonprescription drug abuse. A new perspective is needed--one that accommodates the evolving role of physicians in society, the life-style choices that physicians enable in their patients, and the respective responsibilities of both physicians and patients in physician-patient transactions. PMID: Drug addiction Neurology 2349802 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug abuse, psychiatric disorders, and AIDS. Dual and triple diagnosis. West J Med. 1990 May;152(5):547-52 Authors: Batki SL Substance abuse and psychiatric disorders commonly occur together. This form of dual diagnosis is notable because it complicates assessment and makes treatment more difficult for both psychiatric and drug abuse problems. Drugs can cause psychiatric disorders and can also be used as an attempt to "cure" them by self-medication. The spread of the human immunodeficiency virus (HIV) among drug users has added a third potential clinical problem, that of the acquired immunodeficiency syndrome, to the difficulties already presented by drug abuse and psychiatric disorders. Patients with this triple diagnosis pose challenges to primary care physicians as well as addiction medicine specialists or psychiatrists. Assessment should include a drug abuse history, preferably corroborated by others, evaluation of the mental state, and examination focusing on signs of drug abuse and HIV infection. Treatment should include the management of HIV disease, abstinence from drug abuse, and access to psychiatric care. New systems of health care service, including interdisciplinary case management, may be needed to manage patients with a triple diagnosis. PMID: Drug addiction Neurology 2190423 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Drug addiction and pregnancy: policy crossroads. Am J Public Health. 1990 Apr;80(4):483-7 Authors: Chavkin W PMID: Drug addiction Neurology 2180329 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Alloimmunization and intravenous drug abuse. CMAJ. 1990 Mar 1;142(5):439 Authors: Bowman JM, Manning FA, Harman CR PMID: Drug addiction Neurology 2105830 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
Knowledge and experience of young people regarding drug abuse, 1969-89. BMJ. 1990 Jan 13;300(6717):99-103 Authors: Wright JD, Pearl L OBJECTIVE--To establish a baseline of knowledge to plan an effective health education programme in schools. The survey was repeated at five year intervals from 1969 to 1989. DESIGN--To preserve consistency, the same anonymous questionnaire, which was confidential to the research workers, was used throughout. SETTING--Three secondary schools in Wolverhampton in different parts of the town and representing different social groups. SUBJECTS--Sample sizes ranged from 471 fourth year pupils (aged 14 to 15) in 1969 to 540 in 1984 and 380 in 1989, the decrease being due mainly to the falling birth rate. There were slightly more girls than boys, and the pupils covered the whole range of academic ability. RESULTS--Over the 20 years the proportion of pupils who knew someone taking drugs more than doubled from 15% (71) to 31% (117) and the proportion who had been offered drugs almost quadrupled from 5% (24) to 19% (72). The changes taking place over the past five years were characterised by an increased knowledge about drugs and the first mention of "crack," a purified form of cocaine, and "ecstasy" (methylenedioxymethamphetamine). Peer influence continued to be given as the prime reason for taking drugs. Over the 20 years, though less often mentioned in 1989, television and newspapers remained the most common source of information. CONCLUSIONS--These results suggest the need for responsible coverage by the mass media and for more effective health and social education programmes to prevent the spread of drug misuse. PMID: Drug addiction Neurology 2105785 [PubMed - indexed for MEDLINE ( Drug addiction Neurology) ]
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