Change for the BEST: family changes for parents coping with youth substance abuse

This paper reports family changes for participants in a program for parents coping with youth substance abuse. The Behavioural Exchange Systems Training (BEST) program is a professionally-led, parent training intervention. During 1996 and 1997, six groups of parents participated in the program. High levels of depression were observed at intake and symptoms demonstrated a stable reduction in association with exposure to the program. Parents tended to achieve success in developing common strategies for assertively managing family problems, though couples from more complex blended families found this more difficult. Adolescent improvements were noted during the weeks observed. A two year follow up conducted with a subset of families revealed that parents continued to report that the intervention had helped them cope with youth drug abuse.

Drug overdose: widening the parameters of research and prevention

[A focus on risk environments] helps to overcome the limits of individualism characterising most [drug] prevention interventions as well as to appreciate how drug-related harm intersects with health and vulnerability more generally.

Importance of assessing family dysfunction in conjunction with standardised measures when treating substance abuse

In this thesis, the link between substance abuse and family dysfunction is examined, and an argument is made for the assessment of family dysfunction when treating clients with substance abuse issues. Family dysfunction has been associated with a broad range of problems in children (e.g., low self esteem, increased risk of child abuse) through to adolescence and adulthood (e.g., increased risk of mental disorders such as depressive disorders, substance abuse disorders, and personality disorders) (Kaplan & Sadock, 1998). It is not the purpose of this thesis to suggest that family dysfunction causes substance abuse but rather to highlight that family dysfunction can in some cases place the individual at greater risk of substance abuse. Therefore, in order to understand the reasons why substance abuse developed and how it is maintained in the present requires the assessment of family dysfunction. Further, the importance of assessing the role and impact that family dysfunction may have had on the client, may help to better understand the nature and extent of substance abuse so that relevant and appropriate treatment goals for change may be set, progress monitored, and risk of relapse reduced. Chapter 1 provides a brief introduction to this thesis, and Chapter 2 is a review of the literature on the impact of family dysfunction including poor parental attachment and supervision, neglect, physical and sexual abuse, in adolescence and adulthood. Four case studies are presented to illustrate how family dysfunction and substance abuse may be related, thus highlighting the importance of assessing family dysfunction when treating substance abuse clients. All of the case studies include an individual with a substance abuse disorder (namely heroin) but they are diverse in terms of the types and extent of family dysfunction. The final chapter discusses the case studies in relation to the literature reviewed. Lastly, it gives consideration to the implication of a history of family dysfunction, and how it may impact negatively on treatment and therefore prognosis.

Dancing with death : risk, health promotion and injecting drug users

The thesis investigated ambivalent attitudes towards death in injecting drug users, factors that may lead to such ambivalent attitudes and implications for health promotion campaigns. It was found that this relationship with death was principally attributable to government drug policy in Australia.

Is access to alcohol associated with alcohol/substance abuse among people diagnosed with anxiety/mood disorder?

To investigate the relationship between access to off-license alcohol outlets and areas with dual treatment for alcohol/drug abuse and anxiety/mood disorder compared to areas with anxiety/mood disorder only in an urban setting in New Zealand.

Role of the bed nucleus of the stria terminalis in cardiovascular changes following chronic treatment with cocaine and testosterone: A role beyond drug seeking in addiction?

Neural plasticity has been observed in the bed nucleus of the stria terminalis (BNST) following exposure to both cocaine and androgenic-anabolic steroids. Here we investigated the involvement of the BNST on changes in cardiovascular function and baroreflex activity following either single or combined administration of cocaine and testosterone for 10 consecutive days in rats. Single administration of testosterone increased values of arterial pressure, evoked rest bradycardia and reduced baroreflex-mediated bradycardia. These effects of testosterone were not affected by BNST inactivation caused by local bilateral microinjections of the nonselective synaptic blocker CoCl2. The single administration of cocaine as well as the combined treatment with testosterone and cocaine increased both bradycardiac and tachycardiac responses of the baroreflex. Cocaine-evoked baroreflex changes were totally reversed after BNST inactivation. However, BNST inhibition in animals subjected to combined treatment with cocaine and testosterone reversed only the increase in reflex tachycardia, whereas facilitation of reflex bradycardia was not affected by local BNST treatment with CoCl2. In conclusion, the present study provides the first direct evidence that the BNST play a role in cardiovascular changes associated with drug abuse. Our findings suggest that alterations in cardiovascular function following subchronic exposure to cocaine are mediated by neural plasticity in the BNST. The single treatment with cocaine and the combined administration of testosterone and cocaine had similar effects on baroreflex activity, however the association with testosterone inhibited cocaine-induced changes in the BNST control of reflex bradycardia. Testosterone-induced cardiovascular changes seem to be independent of the BNST. © 2013 IBRO.

Animal models of alcohol and drug dependence

Drug addiction has serious health and social consequences. In the last 50 years, a wide range of techniques have been developed to model specific aspects of drug-taking behaviors and have greatly contributed to the understanding of the neurobiological basis of drug abuse and addiction. In the last two decades, new models have been proposed in an attempt to capture the more genuine aspects of addiction-like behaviors in laboratory animals. The goal of the present review is to provide an overview of the preclinical procedures used to study drug abuse and dependence and describe recent progress that has been made in studying more specific aspects of addictive behavior in animals.

Stress Abolishes the Effect of Previous Chronic Ethanol Consumption on Drug Place Preference and on the Mesocorticolimbic Brain Pathway

BackgroundConditioned place preference (CPP) to ethanol (EtOH) is an important addiction-related alteration thought to be mediated by changed neurotransmission in the mesocorticolimbic brain pathway. Stress is a factor of major importance for the initiation, maintenance, and reinstatement of drug abuse and modulates the neurochemical outcomes of drugs. Thus, the aim of this study was to investigate the effects of concomitant exposure to chronic EtOH and stress on CPP to this drug and alterations of dopaminergic and serotonergic neurotransmission in mice.MethodsMale Swiss mice were chronically treated with EtOH via a liquid diet and were exposed to forced swimming stress. After treatment, animals were evaluated for conditioning, extinction, and reinstatement of CPP to EtOH. Also, mice exposed to the same treatment protocol had their prefrontal cortex (PFC), nucleus accumbens (NAc), and amygdala dissected for the quantitation of dopamine, serotonin, and their metabolites content.ResultsData showed that previous chronic exposure to EtOH potentiated EtOH conditioning and increased dopaminergic turnover in PFC. Exposure to stress potentiated EtOH conditioning and decreased dopaminergic turnover in the NAc. However, animals exposed to both chronic EtOH and stress did not display alterations of CPP and showed an elevated content of dopamine in amygdala. No treatment yielded serotonergic changes.ConclusionsThe present study indicates that previous EtOH consumption as well as stress exposure induces increased EtOH conditioning, which can be related to dopaminergic alterations in the PFC or NAc. Interestingly, concomitant exposure to both stimuli abolished each other's effect on conditioning and PFC or NAc alterations. This protective outcome can be related to the dopaminergic increase in the amygdala.

Validity of alcohol screening instruments in general population gender studies: an analytical review

The present study is an analytical review of the methodology used in studies of efficacy of screening instruments to detect harmful use/ alcohol dependence according to the gender in population surveys. Systematic review of bibliography was done, using data from Web of Science, Pubmed and PsycInfo. Population studies were included without date range, in English, Spanish or Portuguese languages, with sample of adults, evaluating psychometric characteristics of any alcohol screening instrument, whereas studies in special population or under treatment as well as prevalence of alcohol consumption were excluded. Thirteen studies were selected to be included in the present review. According to the studies, the instruments that presented a better performance among men were AUDIT and its derivatives (6 studies) and CAGE (2 studies), whereas among women, AUDIT and its derivatives (7 studies), followed by CAGE (3 studies). The increase of consumption and problems related to alcohol use and its implications for public health indicate the need and urgency for adequacy of screening instruments to differences of gender in general population. The population surveys in the area are scarce. Furthermore, the found studies present heterogeneous methodology which makes accurate comparisons difficult.

ADOLESCENCE AND DRUG USE THROUGH THE LENS OF PSYCHOANALYSIS: SUFFERING AND ECSTASY IN THE PASSAGE

ADOLESCENCE AND DRUG USE THROUGH THE LENS OF PSYCHOANALYSIS: SUFFERING AND ECSTASY IN THE PASSAGE The purpose of this study is to reflect upon the psychological factors of adolescent drug addiction according to a psychoanalytic perspective. First we consider adolescence as a social-historical category and then we discuss the psychoanalytic understanding of the adolescent transition. This theoretical path builds the approach that considers drug use as a phenomenon that serves as a passage ritual to contemporary adolescence. This phenomenon is modulated by the drive organization, which determines how the individual will take ownership of the use of psychoactive substances. We conclude that the substance use may function as a buffer-object, activated to deal with the structural fragility of the contemporary affective bonds.

Development of Original Analytical Methods for the Determination of Drugs of Abuse in Biological Samples

Drug abuse is a major global problem which has a strong impact not only on the single individual but also on the entire society. Among the different strategies that can be used to address this issue an important role is played by identification of abusers and proper medical treatment. This kind of therapy should be carefully monitored in order to discourage improper use of the medication and to tailor the dose according to the specific needs of the patient. Hence, reliable analytical methods are needed to reveal drug intake and to support physicians in the pharmacological management of drug dependence. In the present Ph.D. thesis original analytical methods for the determination of drugs with a potential for abuse and of substances used in the pharmacological treatment of drug addiction are presented. In particular, the work has been focused on the analysis of ketamine, naloxone and long-acting opioids (buprenorphine and methadone), oxycodone, disulfiram and bupropion in human plasma and in dried blood spots. The developed methods are based on the use of high performance liquid chromatography (HPLC) coupled to various kinds of detectors (mass spectrometer, coulometric detector, diode array detector). For biological sample pre-treatment different techniques have been exploited, namely solid phase extraction and microextraction by packed sorbent. All the presented methods have been validated according to official guidelines with good results and some of these have been successfully applied to the therapeutic drug monitoring of patients under treatment for drug abuse.

Social network e capitale sociale degli ex-ospiti di Comunita' Liberta': Drug free e ricaduti a confronto

L'indagine condotta, avvalendosi del paradigma della social network analysis, offre una descrizione delle reti di supporto personale e del capitale sociale di un campione di 80 italiani ex post un trattamento terapeutico residenziale di lungo termine per problemi di tossicodipendenza. Dopo aver identificato i profili delle reti di supporto sociale degli intervistati, si è proceduto, in primis, alla misurazione e comparazione delle ego-centered support networks tra soggetti drug free e ricaduti e, successivamente, all'investigazione delle caratteristiche delle reti e delle forme di capitale sociale – closure e brokerage – che contribuiscono al mantenimento dell'astinenza o al rischio di ricaduta nel post-trattamento. Fattori soggettivi, come la discriminazione pubblica percepita e l'attitudine al lavoro, sono stati inoltre esplorati al fine di investigare la loro correlazione con la condotta di reiterazione nell'uso di sostanze. Dai risultati dello studio emerge che un più basso rischio di ricaduta è positivamente associato ad una maggiore attitudine al lavoro, ad una minore percezione di discriminazione da parte della società, all'avere membri di supporto con un più alto status socio-economico e che mobilitano risorse reputazionali e, infine, all'avere reti più eterogenee nell'occupazione e caratterizzate da più elevati livelli di reciprocità. Inoltre, il capitale sociale di tipo brokerage contribuisce al mantenimento dell'astinenza in quanto garantisce l'accesso del soggetto ad informazioni meno omogenee e la sua esposizione a opportunità più numerose e differenziate. I risultati dello studio, pertanto, dimostrano l'importante ruolo delle personal support networks nel prevenire o ridurre il rischio di ricaduta nel post-trattamento, in linea con precedenti ricerche che suggeriscono la loro incorporazione nei programmi terapeutici per tossicodipendenti.

Drug-Use Amongst Teenagers in Romania and the Republic of Moldavia"

Drug-use among teenagers in two ex-communist countries, Romania and the Republic of Moldova, was studied both in isolation and on a comparative basis. The group carried out a psycho-social study, gaining data from two representative samples of teenagers (N=713 in Romania and N=760 in Moldova). Teachers, parents and experts were also interviewed, using focus groups, questionnaires and 3 individual interviews. Aspects of the phenomenon investigated were the extent of drug use (frequency of consumption, kinds of drugs used, and categories of teenage consumers, by age, gender, residential areas, occupational status, marketplaces and traffickers); internal and external stimulating and inhibiting factors, the attitude of all four categories of subjects to drug abuse in teenagers, and strategies for combating this and other such problems.

Patterns of alcohol and illicit substance use in the United States and Mexico. Substantive and methodologic issues in the cross-national analysis of alcohol and drug use data

This research examines prevalence of alcohol and illicit substance use in the United States and Mexico and associated socio-demographic characteristics. The sources of data for this study are public domain data from the U.S. National Household Survey of Drug Abuse, 1988 (n = 8814), and the Mexican National Survey of Addictions, 1988 (n = 12,579). In addition, this study discusses methodologic issues in cross-cultural and cross-national comparison of behavioral and epidemiologic data from population-based samples. The extent to which patterns of substance abuse vary among subgroups of the U.S. and Mexican populations is assessed, as well as the comparability and equivalence of measures of alcohol and drug use in these national samples.^ The prevalence of alcohol use was somewhat similar in the two countries for all three measures of use: lifetime, past year and past year heavy use, (85.0%, 68.1%, 39.6% and 72.6%, 47.7% and 45.8% for the U.S. and Mexico respectively). The use of illegal substances varied widely between countries, with U.S. respondents reporting significantly higher levels of use than their Mexican counterparts. For example, reported use of any illicit substance in lifetime and past year was 34.2%, 11.6 for the U.S., and 3.3% and 0.6% for Mexico. Despite these differences in prevalence, two demographic characteristics, gender and age, were important correlates of use in both countries. Men in both countries were more likely to report use of alcohol and illicit substances than women. Generally speaking, a greater proportion of respondents in both countries 18 years of age or older reported use of alcohol for all three measures than younger respondents; and a greater proportion of respondents between the ages of 18 and 34 years reported use of illicit substances during lifetime and past year than any other age group.^ Additional substantive research investigating population-based samples and at-risk subgroups is needed to understand the underlying mechanisms of these associations. Further development of cross-culturally meaningful survey methods is warranted to validate comparisons of substance use across countries and societies. ^

The role of drug use in welfare to work: Evidence from Houston, Texas

The purpose of this study is to examine the prevalence of drug abuse among welfare recipients in Houston, TX and compare the work activities and employment barriers of drug abusers in order to better understand the potential effects of welfare reform for this population. Four hypotheses were tested comparing the work activities and employment barriers of drug abusers to others on welfare and the relative importance of drug abuse and employment barriers in predicting work activity. ^ This cross-sectional study examined the characteristics and work activities of 447 welfare recipients (81 drug abusers and 366 non-abusers) who were surveyed between October 1998 and April 1999 in Houston, TX. Subjects were introduced and recruited to participate in the study through a flyer, door to door visits, and peer driven recruitment/referral. ^ About 18% were found to be drug abusers, which is consistent with the national average (10–33%) among welfare recipients. Compared to others on welfare, drug abusers were less involved in work activities, and had more employment barriers. Employment barriers were found to be more predictive of welfare to work activities than drug abuse. The results suggest that alleviating employment barriers should be stressed in programs aimed at welfare recipients with drug abuse problems. ^