The playful as a psycho-pedagogic method: one experience in preventing youth drug dependence

This participatory action research was based on a experience of educational intervention on La Cruz and Bello Oriente (Manrique-Medellin), a marginal zone in the northeastern part of the Commune 3 in Medellin,. Colombia. In this marginal sector, psychosocial problems seem to be associated to limited educational and employment opportunities, domestic violence, illegal armed forces, sexual abuse, social discrimination, and lack of adequate public services, among others.  All these are also considered as risk factors for drug dependency.  We used a structured interview designed to identify leisure tendencies, use of free time, and tendencies in recreational activities. Data from the interview were triangulated with information collected by observation and in field work and used to build a psycho-pedagogic method based on play and leisure activities. The effects of the use of this educational intervention on the satisfaction of human needs were analyzed in light of the theory of Manfred Max-Neef. Results point out the need for new educational strategies aimed to promote creativity, solidarity, mental, physical and social health, more enthusiasm and motivation and in general, positive attitudes that help prevent drug dependence.

Drug dependence, mental impairment and education

This study aimed to evaluate the mental conditions of cocaine-dependent individuals and school commitment/attachment. We evaluated 50 patients referred to the psychiatry emergency room due to mental disorders from chemical dependence. After clinical diagnosis, clinical interview, Hospital Anxiety and Depression Scale, Hamilton Scale for Depression and Brief Psychiatric Rating Scale were applied. The Spearman and Mann-Whitney nonparametric tests, as well as the t-Student test were utilized for statistical analysis.. The accepted significance value was 0.05. All subjects had used cocaine or crack and other substances. Only 13 (26%) did not drop out of school (group 1). Regarding the other 37 (74%), irregular class attendance , successive failures and definitive school drop out rates (group 2) were verified. These subjects presented an early substance use when compared with those which did not drop out of school (p=0.0001). Patients with an early substance use presented higher school dropout rates than those with a later initiation to substance use. Psychopathological phenomena were frequent in both groups.

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.

Aggression, impulsivity and serotonin in drug dependence

Aggression, impulsivity, and central serotonergic function were evaluated in two groups of human volunteers; one group having a history of substance dependence (DRUG+) and another group with no drug use history (DRUG$-$). The hypothesis was that DRUG+ subjects would be more aggressive, more impulsive, and have attenuated serotonergic function. Results showed that DRUG+ subjects behaved more aggressively in a computer paradigm of aggression and also reported more aggression on questionnaires than DRUG$-$ subjects. In a computer paradigm of impulsivity, the DRUG+ group showed a lesser ability to delay gratification than the DRUG$-$ group in the last session of testing. The DRUG+ subjects also reported more venturesomeness and problems associated with low impulse control on questionnaires. Serotonergic function was measured through the neuroendocrine and hypothermic response to an orally administered serotonin (5-HT) agonist specific to the 5-HT$\rm\sb{1A}$ receptor subtype (ipsapirone). The neuroendocrine responses did not differ between DRUG$\pm$ groups, indicating no difference in the sensitivity of the presynaptic or postsynaptic 5-HT$\rm\sb{1A}$ receptors. An unexpected result was that the indicator hormone, cortisol, was at a lower baseline level in the DRUG+ group than the DRUG$-$ group. Lowered cortisol levels have been previously noted in children at high risk foul antisociality and future drug use. A principal components analysis including impulsivity, aggression, and serotonergic function measures produced three unique factors. The factors, Antisocial Tendency and Self-Control and Serotonergic Function combined to produce a significant regression equation explaining 36% of variability in the DRUG$\pm$ groups. These factors included measures of aggression, impulsivity, mood, and educational attainment. These results suggest that the current measures of aggression and impulsivity were predictive of a drug dependence disorder but that neuroendocrine function is not yet a useful indicator of drug dependence status. ^

Drug dependence

Each number also called Experimental issue

Behavioral pharmacology of human drug dependence /

Mode of access: Internet.

The impact of a reduction in drug supply on demand for and compliance with treatment for drug dependence

Background: In early 2001, Australia experienced a sudden, dramatic and;sustained decrease in heroin availability that was accompanied by sharp increases in price and decreases in street level purity-the so-called heroin shortage. These unprecedented changes occurred in a context of widespread treatment availability, which made it possible for the first time to examine the impact of a sharp reduction in heroin supply in New South Wales (NSW) on entry to and adherence with treatment for heroin dependence. Given the evidence of drug substitution by some users. the current paper also examines the effects of the shortage on entry to treatment for other forms of drug dependence. Methods: Interrupted time-series analysis of the number of persons entering opioid pharmacotherapy and other treatment modalities in NSW for heroin dependence and for the treatment for other types of drug dependence. Findings: The heroin shortage was associated with a reduction in the number of younger persons entering opioid pharmacotherapy. There was a dramatic decrease in the number of persons entering heroin withdrawal or assessment only treatment episodes. There appear to have been small improvements in adherence to and retention in heroin treatment after the reduction in heroin supply. Relatively small increases were observed in numbers being treated for cocaine dependence. Conclusions: In the context of good treatment provision, a reduction in heroin supply appeared to produce modest improvements in intermediate outcomes. Supply and demand reduction measures, when both are implemented successfully, may be complementary. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: results from the GBD 2010 study

Aim Estimate the prevalence of cannabis dependence and its contribution to the global burden of disease. Methods Systematic reviews of epidemiological data on cannabis dependence (1990-2008) were conducted in line with PRISMA and meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Culling and data extraction followed protocols, with cross-checking and consistency checks. DisMod-MR, the latest version of generic disease modelling system, redesigned as a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. The disability weight associated with cannabis dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs) and disability-adjusted life years (DALYs). YLDs and DALYs attributed to regular cannabis use as a risk factor for schizophrenia were also estimated. Results There were an estimated 13.1 million cannabis dependent people globally in 2010 (point prevalence0.19% (95% uncertainty: 0.17-0.21%)). Prevalence peaked between 20-24 yrs, was higher in males (0.23% (0.2-0.27%)) than females (0.14% (0.12-0.16%)) and in high income regions. Cannabis dependence accounted for 2 million DALYs globally (0.08%; 0.05-0.12%) in 2010; a 22% increase in crude DALYs since 1990 largely due to population growth. Countries with statistically higher age-standardised DALY rates included the United States, Canada, Australia, New Zealand and Western European countries such as the United Kingdom; those with lower DALY rates were from Sub-Saharan Africa-West and Latin America. Regular cannabis use as a risk factor for schizophrenia accounted for an estimated 7,000 DALYs globally. Conclusion Cannabis dependence is a disorder primarily experienced by young adults, especially in higher income countries. It has not been shown to increase mortality as opioid and other forms of illicit drug dependence do. Our estimates suggest that cannabis use as a risk factor for schizophrenia is not a major contributor to population-level disease burden.

Stage of change of cigarette smoking in drug dependent patients.

Nicotine cessation programmes in Switzerland, which are commonly based on the stage of change model of Prochaska and DiClemente (1983), are rarely offered to patients with illicit drug dependence. This stands in contrast to the high smoking rates and the heavy burden of tobacco-related problems in these patients. The stage of change was therefore assessed by self-administered questionnaire in 100 inpatients attending an illegal drug withdrawal programme. Only 15% of the patients were in the contemplation or decision stage. 93% considered smoking cessation to be difficult or very difficult. These data show a discrepancy between the motivation to change illegal drug consumption habits and the motivation for smoking cessation. The high proportion of patients remaining in the precontemplation stage for smoking cessation, in spite of their motivation for illicit drug detoxification, may be due to the perception that cessation of smoking is more difficult than illicit drug abuse cessation.

Etablierung und Optimierung von Therapeutischem Drug Monitoring für die Psychopharmakotherapie von Patienten mit Substanzabhängigkeit

Therapeutisches Drug Monitoring (TDM) findet Anwendung in der Therapie mit Immunosuppressiva, Antibiotika, antiretroviraler Medikation, Antikonvulsiva, Antidepressiva und auch Antipsychotika, um die Effizienz zu steigern und das Risiko von Intoxikationen zu reduzieren. Jedoch ist die Anwendung von TDM für Substanzen, die Einsatz finden in der Rückfallprophylaxe, der Substitution oder dem Entzug von Abhängigkeitserkrankungen nicht etabliert. Für diese Arbeit wurde im ersten Schritt eine sensitive Rating-Skala mit 22 Items entwickelt, mit Hilfe derer der theoretische Nutzen von TDM in der Pharmakotherapie von substanzbezogenen Abhängigkeitserkrankungen auf der Basis von pharmakologischen Eigenschaften der Medikamente und von Patientencharakteristika evaluiert wurde. Die vorgenommene Einschätzung zeigte für Bupropion, Buprenorphin, Disulfiram (oder einen Metaboliten), Methadon (chirale Bestimmung wenn möglich) und Naltrexon einen potentiellen Nutzen von TDM.rnFür die meisten Medikamente, die zur Behandlung von Abhängigkeitserkrankungen zugelassen sind, fehlen valide Messverfahren für TDM. Im Alltag werden überwiegend Drogen Screening-Tests in Form immunologischer Schnelltests angewendet. Für die Anwendung von TDM wurden in dieser Arbeit chromatographische Verfahren für die Bestimmung von Naltrexon und 6β-Naltrexol, Bupropion und Hydroxybupropion sowie R,S-Methadon und R,S-2-Ethyliden-1,5-dimethyl-3,3-diphenylpyrrolidin entwickelt, optimiert und validiert. Es handelt sich dabei HPLC-UV-Methoden mit Säulenschaltung sowie zur Bestimmung von Naltrexon und 6β-Naltrexol zusätzlich eine LC-MS/MS-Methode. Voraussetzung für die Interpretation der Plasmaspiegel ist im Wesentlichen die Kenntnis eines therapeutischen Bereichs. Für Naltrexon und seinen aktiven Metaboliten 6β-Naltrexol konnte eine signifikante Korrelation zwischen dem auftretenden Craving und der Summenkonzentration gefunden werden. Mittels Receiver-Operation-Characteristics-Kurven-Analyse wurde ein Schwellenwert von 16,6 ng/ml ermittelt, oberhalb dessen mit einem erhöhten Ansprechen gerechnet werden kann. Für Levomethadon wurde bezüglich der Detoxifikationsbehandlung ein Zusammenhang in der prozentualen Reduktion des Plasmaspiegels und den objektiven und subjektiven Entzugssymptomen gefunden. rnDoch nicht nur die Wirkstoffe, sondern auch das Patientenmerkmal substanzbezogene Abhängigkeit wurde charakterisiert, zum einen bezüglich pharmakokinetischer Besonderheiten, zum anderen in Hinsicht auf die Therapietreue (Adhärenz). Für Patienten mit komorbider Substanzabhängigkeit konnte eine verminderte Adhärenz unabhängig von der Hauptdiagnose gezeigt werden. Die Betrachtung des Einflusses von veränderten Leberwerten zeigt für komorbide Patienten eine hohe Korrelation mit dem Metabolisiererstatus, nicht aber für Patienten ohne Substanzabhängigkeit.rnÜbergeordnetes Ziel von TDM ist die Erhöhung der Therapiesicherheit und die Steigerung der Therapieeffizienz. Dies ist jedoch nur möglich, wenn TDM im klinischen Alltag integriert ist und korrekt eingesetzt wird. Obwohl es klare Evidenz für TDM von psychiatrischer Medikation gibt, ist die Diskrepanz zwischen Laborempfehlung und der klinischen Umsetzung hoch. Durch Intensivierung der interdisziplinären Zusammenarbeit zwischen Ärzten und Labor, der Entwicklung von interaktivem TDM (iTDM), konnte die Qualität der Anwendung von TDM verbessert und das Risiko von unerwünschten Arzneimittelwirkungen vermindert werden. rnInsgesamt konnte durch die eigenen Untersuchungen gezeigt werden, dass TDM für die medikamentöse Einstellung von Patienten mit Abhängigkeitserkrankung sinnvoll ist und dass optimales TDM eine interdisziplinäre Zusammenarbeit erfordert.rn

Testing drugs for physical dependence potential and abuse liability /

Mode of access: Internet.