substance use disorders

This study was designed with the purpose of providing organized instructions on how to improve the psychological, medical, and social circumstances of street children with concurrent substance use disorders. Due to the special vulnerabilities of these children, customized guidelines are required in order to maximize the treatment outcomes. Systemic review of literature was applied on a large number of national and international journal articles available on the phenomenon of substance use among street children. The literature review was followed by a qualitative study using in-depth interviews in order to record and analyze the experience of experts working in this field. The preliminary draft was reviewed by the experts and final modifications were applied. The ultimate guideline presents practical recommendations for different stages of providing service for the target population including case finding, motivational interventions, assessment, care and intervention planning, and follow-ups. Street children face various physical, psychological, and social complications. Substance use disorders can exacerbate their circumstances and add to the complexity of their problems. The current guideline is an initial step to better understanding and treating street children who use drugs. Further research is required to investigate the effectiveness and long term results of this guideline .considering the fact that Iran is one of the many countries dealing with this phenomenon, adjustments should be made for application in different cultures.

Timothy Condon (National Institute on Drug Abuse) emphasized that performance measurement needs to be considered in the context of developments in our under- standing of substance use disorders, of newly emerging standards of care, and of behavioral health more broadly, as well as in the context of general medical care. In- creasingly, common thinking has shifted from consider- ing substance misuse to be a human failing to an understanding that addiction is a treatable disease. Clin- ical research has revealed the role of genetics in vulner- ability to addiction, changes in brain functioning that make voluntary behavior different after addiction than in the absence of addiction, and the role of social/cultural environment in addiction. Thus, the most effective treat- ment strategies will attend to all aspects of addiction, in- cluding biology, behavior and social context. It is key to consider these aspects of the nature of addiction in developing a research agenda on performance measure- ment [5]. There is an emerging consensus that addiction is often a chronic condition akin to other chronic condi- tions in the medical sphere with similar rates of non- adherence to treatment and relapse.

to these communities [12]. In addition, the guidelines of other countries literally do not address the specific needs of Iranian population. The process of developing an opi- oid harm reduction guideline for street children aged 3-18 started with an oversees committee who advised on the development of substance abuse harm reduction guidelines. The committee members included representa- tives from relevant organizations in substance abuse, uni- versity professors, and experts in substance use disorders. A draft of guideline was initially prepared based on the recommendations of Ministry of Health and Medi- cal Education of Iran and UNICEF counseling. The final draft was presented after applying comments of various children service provides, clinicians and social workers. This guideline is presented before any pilot interventions and shall be updated and revised based on the administra- tion results. This is only used as an implementation basis to represent various services in a comprehensive format and the results will be determined after implementation.

Abstract Introduction: The relationship between violent offences, mental disorder and substance-use disorders has been widely analyzed but has produced contradictory results. Studies examining this relationship in prison populations are scarce. Objectives: The aim of the study was to analyze the relationship between violent crime, substance-use disorders and mental disorder. Method: This is a descriptive, cross-sectional, epidemiological study of 707 male prisoners. Socio-demographic, clinical and penal data were collected by trained interviewers. Penal data were confirmed using penitentiary records. The clinical version of the Structured Clinical Interview (SCID 1) for DSM-IV Axis I Disorders was used for diagnosis of Axis I mental disorders (including substance-use disorders). Inmates who have lifetime substance-use disorders were classified by type and number of substances used. We considered violent offences: homicide and attempted homicide, aggravated assault, common assault, robbery, threatening behavior, harassment, arson and any sexual offence. Results: Violent offences in inmates who used drugs (n=370) were more prevalent than in inmates who did not (84.6% vs.15,3%, p<0.0001).The risk of committing a violent crime is double for people using a substance compared to those who do not and those who are not repeat offenders (OR= 2.03 CI 95%: 1.08-3.78). This risk increases when considering repeat offenders and those who use more than one substance (OR= 5.35 CI 95%: 1.26-10.05). The presence of a mental disorder turns out not to be significant (OR= 1.38 CI 95%: 0.98-1.95). Conclusions: In our study, the greatest risk factors for committing a violent offence were being a re-offender and using more than one substance. Mental disorder was not found to be a risk factor for violent offences.

For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person (e.g., [1–4]). Previously, we documented the extent of this co-occurrence and offered a number of methodological and theoretical explanations for the co-occurrence [4]. In this article, we provide an update on this co-occurrence by reviewing studies published be- tween 2000 and 2017, inclusive, and we compare the co-occurrence rates between BPD and SUDs with our previous review. First, we briefly introduce the distinc- tion between co-occurrence and comorbidity. Next, we provide some background and context on BPD symp- toms and we highlight the conceptual and potential etio- logical overlap of SUDs and BPD. Third, we review and compare the data on the rates of co-occurrence between BPD and SUDs from the present and a previous review [4]. Finally, we discuss the conceptual and clinical impli- cations of this co-occurrence to facilitate future research and treatment.

Abstract: In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling disorder was recategorized from the “Impulse Control Disorder” section to the newly expanded “Substance-related and Addictive Disorders” section. With this move, gambling disorder has become the first recognized nonsubstance behavioral addiction, imply- ing many shared features between gambling disorder and substance use disorders. This review examines these similarities, as well as differences, between gambling and substance-related disorders. Diagnostic criteria, comorbidity, genetic and physiological underpinnings, and treat- ment approaches are discussed.

There are limitations to the study. The sample was purposively selected to provide as wide a range of views as possible; this included seeking some extreme cases in a range of demographic and clinical factors. Employing a theoretical, rather than statistical approach to sampling means we did not intend to recruit a representative or typical sample of patients. A number of steps were taken to ensure the trustworthiness of the analysis including a comprehensive sampling strategy, seeking deviant cases to test emerging patterns in the data, use of researchers from different disciplinary background (Henwood and Pidgeon 1992). Nevertheless, findings from this grounded theory study need to be complemented by quantitative research to determine the correlates of these themes in representative clinical samples. It is not possible to say from our data how common these themes are in a population of patients with both bipolar disorder and substance use disorders. The findings cannot be extrapolated to the use of alcohol and drugs in bipolar disorder patients without substance misuse disorders. We included only patients with bipolar 1 disorder so the findings do not necessarily generalise to patients with bipolar 2 or atypical bipolar disorders. Care should be taken also in extrapolating our data to populations where there are quite different cultural and religious taboos on alcohol and drug use such as in some Muslim countries (Ustun and Sartorius, 1995). Another limitation is that the data collection is based entirely on patient self report and was not verified against relative reports or case notes in relation to their consumption of alcohol and drugs, nor to verify their consequences. There is the possibility that subjects who were willing to talk to us were patients who were more adherent to treatment and accepted that

The demographic characteristics of participants in study 1 and 2 with and without SUD are shown in Table I. Lifetime SUD was significantly associ- ated with male gender in study 1, but not in study 2. Marital status, educational level and occupa- tion were unrelated with lifetime SUD in both studies. Only in study 1 patients with SUD had a shorter duration of illness compared to those with- out SUD. The frequency of the individual lifetime substance use disorders in the two study groups is provided in Table II. Alcohol and cannabis use disorders were the most frequent diagnoses in both samples. Overall, patients in study 2 had a higher lifetime prevalence of comorbid SUD compared to participants in study 1.

Abstract: Substance use disorders (SUDs) are a significant problem among our nation’s military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed.

Once their babies are born, significant changes can occur in the lives of women who abused alcohol or drugs during pregnancy. In the case of babies who test positive for substances at birth, the mothers may experience remorse and sadness over the actual or potential consequences of their substance use, which also can be a motivating factor to seek treatment. If CPS is involved, mothers may admit to enough drug use to explain the positive drug test, but not to an addiction, due to the fear of losing custody of their children. They may comply with treatment requirements in order to compensate for the problems their SUD may have caused their children. Nevertheless, new difficulties may begin when CPS closes the case and the pressure is off the mothers to stay clean. For instance, they may be tempted to use drugs and alcohol again. (For more information on treatment issues, see Chapter 5, Treating Substance Use Disorders.)

Lobbana and colleagues conducted a qualitative study in which they asked young adults who were engaged in first-episode psychosis services and had used substances prior to treatment about factors that influenced their substance use. One theme that emerged was that changes in life goals a ected substance use. Many young adults in the sample reported that values such as health, income, and family increased in importance over time and were key reasons for reducing or stopping substance use. n synthesizing the findings of their review, isdom and colleagues speculate that many influences are likely at work: E perience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis.

Substance use disorders are comparable to chronic medical illnesses and have a chronic relapsing course. Despite being significant contributors to morbidity and mortality, limited treatment options exist. The current narrative review was aimed at providing an overview of yoga therapy in substance‑use disorders and discuss the relevant methodological issues. Articles published in English language till May 2017 indexed with PubMed, PubMed central, and Google Scholar were searched using search terms “Yoga,” “Substance use,” “Drug dependence,” “Nicotine,” ”Tobacco,” “Alcohol,” “Opioids,” “Cannabis,” “Cocaine,” “Stimulants,” “Sedative hypnotics,” “Inhalants,” and “Hallucinogens” for inclusion in the review. A total of 314 studies were found fulfilling the stated criteria. Out of which, 16 studies were found to fulfill the inclusion and exclusion criteria and 12 were randomized control trials. The majority of studies were available on the role of yoga in management of nicotine dependence. Sample size of these studies ranged from 18 to 624. The majority of studies suggested the role of yoga in reducing substance use as well as substance‑related craving (especially in nicotine‑use disorders) in short term. However, more studies are required for demonstrating the long‑term effects of yoga therapy in substance‑use disorder.

design of this study offers a real world perspective on the course of anxiety illness in clinical populations. In addi- tion, HARP examines the prevalence of anxiety disorders in general and not specifically regarding family history of substance use disorders. Therefore, the results of the cur- rent investigation may be less likely to be influenced by false positives of parental substance use disorders. This study does have some limitations that need to be considered. First, the study uses a clinical sample that was treatment-seeking when originally recruited. As such, the results may not be generalizable to non-clinical and/or non-treatment-seeking populations of anxiety patients. Second, our assessments were also limited by a lack of direct assessment of the status of parental substance use disorders, relying instead on patient self-report of their parents' behaviors. Given the tendency for children of alcoholics/addicts to underreport parental SU, the find- ings observed may be conservative. Third, although approximately one-third of parents with SU had drug use disorders, the limited number of SU parents with only drug use disorders precluded examination of the inde- pendent effects of parental drug use disorders. Fourth, the number of events (remissions or relapses) limited the number of apriori predictor variables to be tested with adequate power in cox regression models. Future investi- gations are warranted that examine important environ- mental and personal characteristics that may negate or exacerbate the effects of parental SU. Finally, the sample was primarily Caucasian and thus generalizing our results to non-Caucasian populations is not advisable.

Some of the pertinent questions in the treatment of co- morbid EDs and SUDs include how to ascertain the presence of a co-morbid disorder, whether to treat the disorders concurrently, and if not, which disorder to ad- dress first [12,76]. One difficulty is that treatment stud- ies for EDs and SUDs often exclude patients with dual diagnoses making research evidence on effective man- agement strategies for this population extremely scarce [12,85]. Nevertheless, there are a number of important considerations. Firstly, sequential treatment may lead to an increase/relapse of symptoms of one of the disorders as symptoms of the other disorder improve [4,8,86]. Sec- ondly, symptoms of the disorder not being treated may interfere with recovery from the disorder for which treatment is underway [87,88]. Thirdly, inadequate man- agement of both disorders can also increase relapse rates in symptoms of one or both [8,86]. An additional con- sideration is the presence of other co-morbid psychiatric diagnoses such as anxiety and depression which may need to be simultaneously managed in these patients [4]. Despite the paucity of treatment outcome studies, some researchers suggest that treatments which target aetiological factors common to both disorders are effect- ive, for example addressing difficulties with emotional regulation in concurrent binge eating and substance use disorders [89]. Woodside and Staab (2006) recommend that when there is a current SUD, patients should undergo detoxification prior to ED treatment, and where possible this should be combined with ED treatment, for example in a residential treatment facility [90]. Overall, the literature indicates that the ED and SUD should be addressed simultaneously [4,76,86]. CASA (2003) rec- ommend programmes which include treatments focused on substance abuse and EDs specifically, as well as indi- vidually tailored combinations of personal, group and family therapy provided by a multi-disciplinary team [8]. General treatment principles for eating disorders such as establishing a trusting, collaborative therapeutic relation- ship and avoiding power struggles should be followed [91]. Several treatment modalities are considered below.

The lifetime prevalence of alcohol abuse and drug abuse in people with bipolar disorder are known to be three to nine times that of the general population (Regier et al, 1990; ten Have et al, 2002; Merikangas et al, 2007). Among patients hospitalised for mania or mixed affective episodes, nearly 60 per cent had a lifetime diagnosis of substance use disorder (Cassidy et al, 2001). Negative outcomes have been reported in patients with bipolar disorder and comorbid substance use disorders including suicide (Isometsa, 2005), suicide attempts (Hawton et al, 2005; Simon et al, 2007), poor insight and denial of illness (Salloum and Thase, 2000), and treatment non-adherence (Keck et al, 1998). Therefore patients with dual diagnosis bipolar disorder and

The age of onset of substance use was significantly associ- ated with psychosocial problems. The respondents who self reported initiating substance use before 18 years had signifi- cantly higher problems on overall and all the domains of DUSI-R such as Substance use disorder, Behavior pattern, Psychiatric disorder, Health status, Social competence, Family system, Peer relationship, Leisure/Recreation, School performance and Work adjustment domains. When demographic and substance use related characteristics such as age, gender, occupation, types of substance use, fre- quency of substance use, mode of substance use and relapse history were entered as covariates, the overall model still suggested differences in psychosocial problems among early and late onset of substance user. However, in the follow up ANCOVA, previously observed statistically significant group differences in psychosocial problem scores (DUSI-R domains), were not observed in some domains such as Substance use disorders, Health status, Social competence and School performance. The group differences in those domains were apparently not due to the effects of age of Table 3 Age of onset of substance use (early vs late) differences

Abstract: This commentary discusses the need for developing patient registries of substance use disorders (SUD) in general medical settings. A patient registry is a tool that documents the natural history of target diseases. Clinicians and researchers use registries to monitor patient comorbidities, care procedures and processes, and treatment effectiveness for the purpose of improving care quality. Enactments of the Affordable Care Act 2010 and the Mental Health Parity and Addiction Equity Act 2008 open opportunities for many substance users to receive treatment services in general medical settings. An increased number of patients with a wide spectrum of SUD will initially receive services with a chronic disease management approach in primary care. The establishment of computer-based SUD patient registries can be assisted by wide adoption of electronic health record systems. The linkage of SUD patient registries with electronic health record systems can facilitate the advancement of SUD treatment research efforts and improve patient care.

Substance use has unwanted consequences, one of which is transmission of diseases through needle sharing or promiscuous sexual behavior. The majority of Saudis who inject drugs are young (< 50 years old), and are therefore able to spread infections to their sexual part- ners and to other PWUDs with whom they share needles [36]. Consequently, data show that Saudis who inject drugs have a high prevalence of blood borne infections including HIV, HCV, and HBV [36–40, 51]. In order to reduce harm, many western societies have adopted vari- ous harm reduction policies, such as needle and syringe exchange programs (NSPs), opioids stimulation therapy (OST), peer distribution of naloxone, overdose response and drug consumption rooms (DCRs), supervised injec- tion facilities, and outreach services for injecting drug users [11, 12]. Saudi Arabia does not have such harm re- duction programs in place although it has policies and government-funded programs for treatment and re- habilitation for people with SUD [11].

The strengths of this study lie in the sample collection and assessment methods. The catchment-area-based ser- vices made it possible to identify all patients who met the study criteria. Other specialized addiction or psychi- atric services, which received patients from the catch- ment area, cooperated by identifying eligible patients and referring them to the study. In contrast to earlier studies, the PDs in our sample were assessed at a rela- tively early stage. By selecting a sample of patients at their first admission, we avoided an overrepresentation of the chronically ill, and we reduced recall bias. Fur- thermore, we obtained reliable assessment of all com- mon SUDs, Axis I, and Axis II disorders, by using reliability-tested diagnostic interviews performed by a psychiatrist. The SCID-II was chosen for its good criter- ion validity and reliability in diagnosing PDs. The PRISM is the best-documented diagnostic interview for diagnos- ing a wide range of Axis I disorders in heavy substance users. The use of different methods to assess some of the same symptom areas showed consistent results. This strengthens the findings. SUD patients are at high risk of noncompliance. Even so, we had a low dropout rate of four out of 78 (5%), which was achieved by the personal follow-up of each patient.

An ED visit for an acute change in health, whether from SUD related injury, pneumonia, soft tissue infec- tion or overdose, provides an opportunity for physicians to actively engage patients in discussion and reflection, to help them to make the connection between substance use and their acute medical condition, which may help provide motivation for behavior change. Sometimes this connection is evident to patients, but often it is not, and concepts derived from motivational interviewing (MI) have been adapted to brief interventions used in ED settings to engage individuals in the process of mak- ing positive behavior changes through a 4 step process of engaging, focusing, evoking and planning [14, 15]. These interventions help guide the participant towards