Drug Addiction

For opioid-dependent individuals, recovery efforts begin with a period of withdrawal that typically include discomfort from symptoms, possibly precipitating a return to drug use. The study described here investigated whether the provision of ancillary medications for opioid withdrawal symptoms affects treatment outcomes in 139 participants receiving buprenorphine in a 13-day detoxification trial. Outcome measures include the number of opioid-free urine samples collected and retention in treatment. Ancillary medications were provided to 70% of participants: 59% received medication for insomnia, 45% for anxiety, 40% for bone pain, 35% for nausea, and 28% for diarrhea. Findings indicate no difference in the number of opioid-free urine samples between the group receiving ancillary medication and the group who did not, although tests of specific ancillary medications indicate that those who received diarrhea medication had fewer opioid-free urines than those who did not (p = 0.004). Results also indicate that participants attended fewer days of treatment if they received anxiety, nausea, or diarrhea medication compared to no medication (all p values < .05).

L'alexithymie est un terme inventé par Sifnéos qui se caractérise par l'absence de mots pour exprimer ses émotions (a : privatif ; lexi : mots ; thymie : émotions, humeur). Après avoir passé en revue les différents modèles étiopathogéniques de l'alexithymie et les instruments psychométriques permettant de quantifier cette dimension, nous donnons les premiers résultats du réseau dépendance concernant la prévalence de l'alexithymie chez des patients souffrant de conduites d'addictions (alcoolisme, toxicomanie, anorexie, boulimie) comparativement à une population témoin. Dans le cadre de cette étude multicentrique, 654 patients présentant des conduites de dépendance selon le DSM-IV ont été comparés à 767 témoins appariés sur l'âge, le sexe et le niveau socioprofessionnel ; ces sujets avaient entre 15 et 50 ans. L'alexithymie fut évaluée par la Toronto Alexithymia Scale dans sa version à 20 items. La prévalence de l'alexithymie en population générale était de 20,7 %. Ses relations avec les données sociodémographiques montrent que l'alexithymie dans notre population témoin n'était pas corrélée à l'âge, ni avec le sexe, ni avec le niveau socio-éducatif. En revanche, les sujets appartenant aux couches sociales défavorisées s'avéraient plus alexithymiques que les autres. À l'instar des données de la littérature, la prévalence de l'alexithymie était significativement plus élevée dans le cadre des conduites de dépendance (variant de 63 % chez les patients alcooliques à 41 % chez les patients toxicomanes) comparativement aux sujets témoins. Cette différence était en grande partie liée à la composante émotionnelle de l'alexithymie et non à sa composante cognitive. © 2002 Éditions scientifiques et médicales Elsevier SAS

“Is marijuana a gateway drug?” – Any substance abuse counselor at this point is probably sick of hearing that redundant and often misleading question. The following explanation is time-tested, reasonable and easy to understand for just about everyone. See for yourself:

Η ιδέα της αυτοβοήθειας και αλληλοβοήθειας, που εμφανίστηκε τα τελευταία 150 χρόνια, αρχίζει να συζητείται ευρύτατα τις τελευταίες δεκαετίες τόσο στους ακαδημαϊκούς κύκλους όσο και στους κύκλους των Εθνικών Συστημάτων Υγείας. Στην αύξηση του ενδιαφέροντος της επιστημονικής κοινότητας για την ιδέα της αυτοβοήθειας/αλληλοβοήθειας συνέβαλαν αποφασιστικά δύο γεγονότα. Το πρώτο είναι η αδυναμία αντιμετώπισης των σύγχρονων ψυχοκοινωνικών προβλημάτων από τις παραδοσιακές δομές και τις επαγγελματικές προσεγγίσεις • Albee, 1985• Gartner and Riessman, 1984. Το δεύτερο είναι η μεγάλη ανάπτυξη των ομάδων αυτοβοήθειας στην αντιμετώπιση προβλημάτων ψυχικής και σωματικής Υγείας

This downloadable PDF is designed to give to students or others being trained as counselors. There is a compehensive list of essential knowledge and skills for counselors focused on engagement with challenging clients with substance use and coexisting mental health issues.

Successfully engaging difficult and resistant clients in substance abuse treatment is a frequent and prevalent obstacle for counselors particulalry when client's insight and motivation levels may be limited or questionable. Learning to utilize a Change Initiative is a critical guildeline for effectively managing these challenges

The book: Taking the Escalator: An Alternative to the 12 Steps explains the assessment of one's Change Initiative as a simple measure for insight and motivation. The following document explains how to use a Change Initiative measure in greater detail specifically for substance abuse counselors who are attempting to engage difficult clients in treatment

In todays changing world where treatment has become increasingly client-centered and accepting of incremental change, it makes to sense to re-examine how we view addiction, reccovery, abstinence and sobriety and the overall process of postive change

All counselors need to be prepared to appropriately address client setbacks in with engagement in view. The following is a guide for counselors when addressing setbacks with challenging clients, with a view toward maintaining rapport and positive engagement in treatment

The following is published on the www.takingtheescalator.com website but is also being made available on Academia.edu for review. It is designed for groups as an in-depth look at self esteem from a realistic perspective, with substance use issues in mind.

The vast majority of people in this world have heard about the idea of "hitting bottom" when it comes to addiction and making positve changes,  which can be a reality, but often can be a fallacy. "Topping Out" may be a more crucial consideration for young people who find themselves caught up in a lifestyle of drug and alcohol use, abuse and misuse

Buprenorphine is a strong narcotic analgesic. It is also used in the substitution therapy for opium alkaloid addicts. The aim of this paper was to develop and validate a highly sensitive highperformance liquid chromatography-electrospray ionization-mass spectrometry method for simultaneous determination of buprenorphine and norbuprenorphine in human serum. The developed methodology was then applied to real clinical cases in a clinical toxicology setting. Extraction of analytes has been done using solid-phase extraction. Chromatographic separation was achieved on a LiChroCART column with a Purospher RP-18e cartridge, and for detection an LCQ mass spectrometer with an ion trap analyzer was used. Quantitation of buprenorphine and norbuprenorphine was performed in a single ion monitoring mode (m/z 468 buprenorphine, m/z 414 for norbuprenorphine) in order to increase the sensitivity of the method. The standard curves for both compounds were linear over the range of 0.2-10 ng/mL (r 2 > 0.995). The quantitation limit was 0.2 ng/mL for both analytes. The method was used for quantitation of both buprenorphine and norbuprenorphine in the serum of 15 patients undergoing the buprenorphine substitution therapy. Serum concentrations ranged between 0.36 and 4.60 ng/mL for buprenorphine and 0.21 and 2.50 ng/mL for norbuprenorphine, with buprenorphine single dosages from 0.8 to 6.0 rag.

We consider here the applications and limitations of urine testing schedules used in methadone maintenance treatment programs. We show that for patients attending clinic daily, any practical testing schedule will only reliably detect those who are using heroin or other illicit drugs very frequently (e.g., daily). For patients with take-home privileges no testing schedule can effectively detect either skipped doses or use of illicit drugs. Consequently, whether for patients attending clinic daily or for patients with take-home privileges, some programs, as measured by urine test results, may actually be less successful than they appear to be.

The human fatty acid amide hydrolase (FAAH) missense mutation c.385 C!A, which results in conversion of a conserved proline residue to threonine (P129T), has been associated with street drug use and problem drug abuse. Although a link between the FAAH P129T variant and human drug abuse has been reported, the extent of risk and speciWc types of substance addiction vulnerability remain to be determined. Here, we investigated the relationship of the FAAH P129T variant to a number of linked single nucleotide polymorphisms to establish a haplotyping system, calculate the estimated age and origin of the FAAH 385 C!A mutation and evaluate its association with clinically signiWcant drug addiction in a case control study. The results showed a signiWcant over-representation of the FAAH P129T homozygotes in 249 subjects with documented multiple diVerent drug addictions compared to drug free individuals of the same ethnic backgrounds (P = 0.05) using logistic regression analysis controlling for ethnicity. To increase the logistic regression analysis power by increasing the sample size, the data from our previous study (Sipe et al. in Proc Natl Acad Sci USA 99:8394-8399, 2002) were pooled with the present cohort which increased the signiWcance to P = 0.00003. Investigation of the FAAH chromosomal backgrounds of the P129T variant in both multiple diVerent drug addicted and control subjects revealed a common ancestral haplotype, marked population diVerences in haplotype genetic diversity and an estimated P129T mutation age of 114,425-177,525 years. Collectively, these results show that the P129T mutation is the only common mutation in the FAAH gene and is signiWcantly associated with addictive traits. Moreover, this mutation appears to have arisen early in human evolution and this study validates the previous link between the FAAH P129T variant and vulnerability to addiction of multiple diVerent drugs.

Aims This study compared 5-year treatment outcomes of older adults to thoseof middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome. Design Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline). Measurements Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records. Findings Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model eScholarship provides open access, scholarly publishing services to the University of California and delivers a dynamic research platform to scholars worldwide. included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years: female gender was also significant. Conclusions Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r = .28]; conduct disorder [r = .27]; depression [r = .16]; suicide [r = .14]; anxiety [r = .16]; and posttraumatic stress [r = .09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a high-risk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B = .10], alcohol/drug abuse or dependence [B = .34], depression [B = .20], suicidality [B = .35], anxiety [B = .13], and posttraumatic stress [B = .14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.

The practice of prescribing opioid drugs for opioid dependent patients in the U.S. has been subjected to special government scrutiny for almost 100 years. From 1920 until 1964, doctors who used opioids to treat addicts risked federal and/or state criminal prosecution. Although that period ended when oral methadone maintenance was established as legitimate medical practice, public concern about methadone diversion

The purpose of the study was to determine whether a change in the treatment program at Akeela House Incorporated, a therapeutic community in Anchorage, Alaska, significantly increased the time in treatment for Alaska Native residents. The change in treatment involved implementation of culturally sensitive approaches that incorporated and reinforced Native lifestyles. Data were obtained from the Alaska Management Information System on all treatment admissions from January 1988 to January 1995. Prior to implementation, Alaska Native residents had significantly shorter times in treatment than Black or White residents. After implementation of the change in the treatment program, Alaska Native residents' times in treatment were no longer significantly different from those of Black or White residents, and all three ethnic groups had significantly longer times in treatment than before the intervention.

We review behavioral- and neuroeconomic research that identifies temporal discounting as an important component in the development and maintenance of drug addiction. First we review behavioral economic research that explains and documents the contribution of temporal discounting to addiction. This is followed with recent insights from neuroeconomics that may provide an explanation of why drug dependent individuals discount the future. Specifically, neuroeconomics has identified two competing neural systems that are related to temporal discounting using brain-imaging techniques that examine the relative activation of different brain regions for temporal discounting. According to the competing neural systems account, choices for delayed outcomes are related to the prefrontal cortex (i.e., the “executive system”) and choices for immediate outcomes are related to the limbic brain regions (i.e., the “impulsive system”). Temporal discounting provides a useful framework for future imaging research, and suggests a novel approach to designing effective drug dependence prevention and treatment programs.

Recent studies have implicated the orexin system as a critical regulator of sleep/wake states, feeding behavior, and reward processes. Orexin deficiency results in narcolepsy-cataplexy in humans, dogs, and rodents, suggesting that the orexin system is particularly important for maintenance of wakefulness. Orexin agonists and antagonists are thought to be promising avenues toward the treatment of sleep disorders, eating disorders, and drug addiction. In this chapter, we discuss the current understanding of the physiological roles of orexins in regulation of arousal, sleep/wake states, energy homeostasis, and reward systems.

This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

Aims: To examine the psychosocial correlates of substance use among adolescents in six European countries. Design: Cross-sectional school population survey (ESPAD) based on standardized methodological procedures. Setting: High schools in six European countries: ...

This study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a non-specific helix control protocol in a randomized trial. Over a period of 18 months, a 4-week, 14-session auricular acupuncture treatment program was offered in two prisons to 163 men and women with self-reported drug use. Among treatment completers, no differences by method were found in self-reported symptoms of discomfort. Drug use occurred in the NADA group but not in the helix group. In contrast, confidence in the NADA treatment increased over time while it decreased for the helix treatment. No significant negative side effects were observed for either method. Participants in both groups reported reduced symptoms of discomfort and improved nighttime sleep. Future research should compare auricular acupuncture to a non-invasive control in order to attempt to disentangle active effects from placebo.

Objective-One objective was to determine if cocaine-using women who did not maintain infant custody (NMC) would report more psychological distress, domestic violence, negative coping skills, lower social support and more childhood trauma than cocaine-using women who maintained custody (MC) of their infant. A second objective was to evaluate the relative contribution of psychosocial factors to infant placement. Methods-Psychosocial profiles of MC women (n = 144) were compared with NMC (n = 66) cocaine-using women. Subjects were low income, urban, African-American women who delivered an infant at a county teaching hospital. The Brief Symptom Inventory (BSI), an assessment of coping strategies (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), Conflict Tactics Scale (CTS) and Childhood Trauma Questionnaire (CTQ) were administered. The associations of infant placement status to demographic factors, drug use and psychosocial measures were evaluated. Results-The NMC group reported greater overall psychological distress, psychoticism, somatization, anxiety and hostility than the MC group. The NMC group had more childhood neglect and physical abuse and used more negative coping strategies than the MC group. Lack of prenatal care [OR = .83, CI (.75-.91), p < .0001], heavier prenatal cocaine use [OR = 2.55, CI (1.13-4.34), p < .007], greater psychological distress [OR = 2.21, CI (1.13-4.34), p < .02] and a childhood history of emotional neglect [OR = 1.10, CI (1.02-1.19), p < .02] were associated with increased likelihood of loss of infant custody after control for other substance use and demographic variables. Conclusions-NMC women have more negative psychological and behavioral functioning postpartum than MC women. Less prenatal care and greater cocaine use, psychological distress and maternal childhood emotional neglect are associated with the post-partum placement of infants born to cocaine-using women. Practice implications-Results of this study indicate that poor, urban women who use cocaine prenatally display several measurable differences on psychosocial and behavioral risk factors based on child placement status. Among these risk factors heavier cocaine use, lack of prenatal care, more severe psychological symptoms and early childhood experiences of emotional neglect increase the likelihood of loss of infant custody. Routine, objective assessments of psychosocial and behavioral characteristics of women who use cocaine during pregnancy can aid Child Protective Service workers ✩ Supported by National Institutes on Drug Abuse Grant RO1 07957 with a NIDA Underrepresented Minorities Supplement for Undergraduate Students and Underrepresented Minorities Supplement for Graduate Students (R. Humphrey-Wall).

Patterns of comorbidity between depressive symptoms and substance use were examined simultaneously in community and clinical-based samples of 5268 Costa Rican adolescents, ages 12-20, through a series of descriptive, ANCOVA and logistic regression analyses. Groups surveyed included high school students, street youth, and youth in treatment for substance abuse problems. Results revealed significant group differences in substance use and significant correlations between depressive symptoms and problems with alcohol and drugs. The association between depressive symptoms and overall substance use involvement was significant for all youth, but strongest for female street youth. Logistic regression analyses revealed that depressive symptoms were associated with increased odds of specific substance use for all three groups, though in the case of street youth and youth in treatment, these associations only were observed in males. Analyses of covariance indicated that problems with drugs and alcohol differed across group and sex. Youth in treatment had more problems with drugs and alcohol than other groups. Among street youth, males had more problems with drugs than females. This study provides a unique cross-cultural perspective on the comorbidity of depression and substance use among youth, and allows for comparative analyses between community and clinical-based participants.

contributed to writing the review of literature and introduction. Adeline Nyamathi, and Mary Marfisee contributed to the methods and discussion. Allan Cohen, Kamala Nyamathi, Viviane de Castro and Daniel George contributed to the editing and final review of the manuscript. Barbara Leake provided the statistical analysis. All authors approved the final paper.

MRL/MpJ-Fas lpr (MRL/lpr) mice are an accepted animal model to study human systemic lupus erythematosus. We tested if a commonly used analgesic (buprenorphine hydrochloride) would reduce pain and distress in these mice without impacting the progression of autoimmune disease. Female MRL/lpr mice were randomly separated into four groups. Experimental groups received cyclophosphamide (25 mg/kg i.p. weekly), buprenorphine (0.09 mg/kg/mouse/day via drinking water), or cyclophosphamide + buprenorphine from 11 to 21 weeks of age. Controls received no treatments. Mice were monitored daily by a licensed veterinarian (blinded observer) and assigned a score weekly on parameters associated with pain and distress as well as progression of disease. Proteinuria was measured weekly, and serum anti-dsDNA antibody levels were determined at 11, 15, and 18 weeks of age. At 21 weeks of age, the animals were euthanized and the kidneys and spleens were removed for evaluation. Regardless of the parameter observed, buprenorphine did not significantly decrease distress when compared to the controls. Buprenorphine did not alter the progression of autoimmune disease, based on characteristics of splenic architecture and splenocyte cell profiles, development of lymphadenopathy, or kidney histology as compared to controls. This study indicates that buprenorphine at this dose and route of administration was ineffective in reducing distress associated with disease progression in the MRL/lpr strain. More studies are needed to determine if, at a different dose or route, buprenorphine would be useful as adjunctive therapy in reducing distress in MRL/lpr mice.

Active drug users with HIV infection suffer from both low utilization of, and adherence to, primary care. Combining drug treatment and primary care on-site reduces these problems significantly because it creates a social support structure; treatment program staffs can monitor patients' adherence and provide ongoing encouragement. But in the United States, only a very small minority of HIV+ drug users receive this demonstrably effective form of care. We report the results from a feasibility study of an alternative support structure, termed a ''peer-driven intervention'', that serves as a functional equivalent to drug treatment for increasing drug users' adherence to HIV therapeutics. The sixmonth study included 14 adult active drug users receiving medical care for HIV disease in New Haven, Connecticut. As a health advocate, each subject was assigned and asked to meet with another subject once a week at the project's storefront to provide peer support and counseling. As a peer, each subject was assigned and asked to meet with another health advocate once a week to receive support in keeping up his or her medical care. No two subjects played both roles for one another. Advocates earned nominal monetary rewards for eliciting positive responses from their peers in keeping clinical appointments, responding to physicians' referrals, picking up prescriptions on time and attending weekly meetings with the advocate. The results of the study suggest that an alternative social support structure to drug treatment is feasible for increasing active drug users' adherence to medical care. Innovative mechanisms that harness drug users' peer pressure to promote positive behavioral changes deserve greater study. r

To determine the comparative levels of violent offending and victimization among regular methamphetamine and heroin users. Design Cross-sectional Setting Sydney, Australia. Participants A total of 400 regular methamphetamine (METH) and heroin (HER) users (118 methamphetamine users: METH; 161 regular heroin users: HER; 121 regular users of both: BOTH). Findings Eighty-two per cent reported a life-time history of committing violent crime, 41% in the past 12 months. There were no group differences in life-time violence, but the METH group were significantly more likely than the HER group to have committed violence in the past 12 months (odds ratio 1.94). Nearly all (95%) reported that they had been a victim of violent crime, 46% in the preceding 12 months, with no group differences. Those who had committed a violent crime in the past 12 months were 13.23 times more likely to have been a victim in that period. The majority believed it unlikely that they would be a victim of (78%), or commit (87%), a violent crime in the next 12 months. Conclusions Regular methamphetamine use appears to be associated with an increased risk of violent offending, but not victimization, compared with heroin use.

This prospective study (n = 190) examined correlates of alcohol use from baseline data of a longitudinal trial conducted among moderate and heavy alcohol users receiving methadone maintenance therapy (MMT). The sample included MMT clients who were 18-55 years of age, and were receiving MMT from five large methadone maintenance clinics in the Los Angeles area. Half of the sample was heavy drinkers and nearly half (46%) reported heroin use. Using a structured questionnaire, correlates of heavy alcohol use included White and Hispanic ethnicity, and fair or poor physical health combined with older age (≥50 years). We also found that MMT clients who were younger than 50 years, regardless of health status, were more likely to be heavy drinkers. Compared with moderate alcohol consumers, a greater number of heavy alcohol users also experienced recent victimization. To optimize MMT, alcohol screening should be part of routine assessment and alcohol treatment should be made available within MMT programs. Moreover, special consideration should be provided to the most vulnerable clients, such as the younger user, those with a long-term and current history of heavy drug use, and those victimized and reporting fair or poor health. In addition, promoting attention to general physical and mental health problems within MMT programs may be beneficial in enhancing health outcomes of this population.

To examine predictors of cannabis use initiation, continuity and progression to daily use in adolescents. Design. Population-based cohort study over 3 years with 6 waves of data collection. Participants. 2032 students, initially aged 14-15 years, from 44 secondary schools in the state of Victoria, Australia. Measurements. Self-report cannabis use was categorized on four levels (none, any, weekly, daily) and summarized as mid-school (waves 2/3) and late-school (waves 4/5/6) use. Background, school environment, mid-school peer use and individual characteristics were assessed. Findings. Peer cannabis use, daily smoking, alcohol use, antisocial behaviour and high rates of school-level cannabis use were associated with mid-school cannabis use and independently predicted late-school uptake. Cannabis use persisted into late-school use in 80% of all mid-school users. Persisting cannabis use from mid-to late-school was more likely in regular users (odds ratio (OR) 3.4), cigarette smokers (OR any smoking: 2.0, daily smoking: 3.3) and those reporting peer use (OR 2.1). Mid-school peer use independently predicted incident late-school daily use in males (OR 6.5) while high-dose alcohol use (OR 6.1) and antisocial behaviour (OR 6.6) predicted incident late-school daily use in females. Conclusions. Most cannabis use remained occasional during adolescence but escalation to potentially harmful daily use in the late-school period occurred in 12% of early users. Transition was more likely in males, for whom availability and peer use were determinants. In contrast, females with multiple extreme behaviours were more likely to become daily users. Cigarette smoking was an important predictor of both initiation and persisting cannabis use.

Substance abuse among homeless mothers has negative consequences for both the mother and her child. Few researchers have examined the needs of these mothers in order to effectively intervene in their lives. This study uses a qualitative focus group research method to examine the needs of substance abusing homeless mothers recruited from a homeless families' shelter. Twenty eight women were engaged in three focus groups to identify their needs and acceptable intervention components. Content analysis of data revealed five major categories of needs: subsistence, employment, education and information, service, and counseling and connectedness needs. Findings of this study call for a multifaceted intervention approach that targets several areas of need in a coordinated manner.

Aim-To determine whether depression and family history of alcoholism are associated with heightened sweet preferences in children, before they have experienced alcohol or tobacco and at a time during the lifespan when sweets are particularly salient. Design-Betweenand within-subject experimental study. Participants-Children, 5-12 years old (n = 300), formed four groups based on family history of alcohol dependence up to second-degree relatives [positive (FHP) versus negative (FHN)] and depressive symptoms as determined by the Pictorial Depression Scale [depressed (PDEP) versus non-depressed (NDEP)]. Measurements-Children were tested individually to measure sucrose preferences, sweet food liking and, for a subset of the children, the analgesic properties of sucrose versus water during the cold pressor test. Findings-The co-occurrence of having a family history of alcoholism and self-reports of depressive symptomatology was associated significantly with a preference for a more concentrated sucrose solution, while depressive symptomatology alone was associated with greater liking for sweet-tasting foods and candies and increased pain sensitivity. Depression antagonized the analgesic properties of sucrose. Conclusions-While children as a group innately like sweets and feel better after eating them, the present study reveals significant contributions of family history of alcoholism and depression to this effect. Whether the heightened sweet preference and the use of sweets to alleviate depression are markers for developing alcohol-related problems or responses that are protective are important areas for future research.

Aims A brief intervention called the Marijuana Checkup (MCU) was designed to attract adult marijuana users who were experiencing adverse consequences, but who were ambivalent about change and would be unlikely to seek treatment. Our objective was to determine whether the MCU would reach the target population. Design Comparisons were made between those who enrolled in the MCU versus those who were screened but failed to follow through with enrollment on demographic, drug use and stage of change variables. Comparisons were also made between participants in the MCU and participants in a concurrently offered treatment project that targeted marijuana users who wanted to quit. Setting The study took place at the University of Washington in Seattle. Participants Participants were adult marijuana users who telephoned and expressed interest in the MCU (n = 587). Measurement Study variables included stage of change, frequency and duration of drug use, DSM-IV cannabis dependence and abuse diagnoses and negative consequences of marijuana use assessed via interviews and questionnaires. Findings Callers to the MCU were near-daily marijuana users, two-thirds of whom were in the pre-contemplation or contemplation stage of change. Participants who enrolled in the MCU reported fewer problems related to marijuana use and less readiness to make changes compared to those enrolled in the treatment study, despite similar levels of drug use. Conclusions The MCU attracted and enrolled near-daily users of marijuana who experienced negative consequences but were ambivalent about making changes. The MCU potentially has a role in the continuum of care for substance abuse problems.

E stimates of co-occurring alcohol and drug use disorders among people with mental illness range from 41% to 70% (1,2). Risk factors for this population include poverty, homelessness, incarceration, and unemployment (3). Approximately 800,000 persons with mental illnesses enter jails and prisons each year (4), and 70% have a cooccurring alcohol or substance use disorder (5). Nationally, efforts are under way to improve the lives and conditions of persons with co-occurring disorders and a criminal justice history (1,2,4). Programs developed to address the needs of individuals with co-occurring disorders include integrated treatment, dual recovery therapy, cognitive-behavioral therapy, case management, Alcoholics Anonymous (AA) 12step integration, motivational interviewing, outreach and engagement, assertive community treatment, "staged" or "readiness" approaches, and community reinforcement (6,7). Most of these programs use a combination of approaches from the alcohol and drug abuse treatment and mental health fields. In Drake and colleagues' (6) review of 26 dual-disorder programs, the outcomes for recovery, reduced alcohol use, and hospitalizations improved as the degree of program integration increased.

This tool has been edited to correct some formatting errors

This tool is free for download and use. If you or your agency is going to use this tool, please email takingtheescalator@gmail.com just to notify

In spite of the extent of the substance use problem in many parts of the world, the number of available comprehensive substance use assessment tools is limited. Some of the tools that are available are extremely outdated. The E13 Comprehensive Integrated Substance Use Assessment is modern and inclusive as it considers aspects of motivation, insight,  MAT and Harm Reduction as well as including ASAM criteria and DSM 5 diagnosis components. In addition the assessment fully integrates coexisting mental health, medical and behavioral issues as well as multiple other relevant life area assessments.

Free for download and use.  If you plan on using the E13 Assessment in your clinical practice or agency, please simply email takingtheescalator@gmail.com to inform. Modifications can be made in the assessment tool for your specialized needs

We conducted a qualitative evaluation of a semi-structured, client-led support group that addressed drug use recovery issues and was assisted by a psychological consultant. Seven regular group members and their counselors were interviewed about the effect of the assisted self-help group on drug use and the clients' quality of life, and these interviews were content analyzed. In addition, the psychological consultant made group process observations for each session of the first three months. Clients reported group strengths as: Feeling supported and understood, being able to speak freely without fear of staff reprisals, obtaining information/feedback, improved mood, and decreased drug use. With the provision of professional support and guidance, this group shows promise as an adjunct to standard outpatient drug abuse treatment by allowing for some degree of client independence and extending the scarce resource of professional counseling.

The limited number of systematic, controlled studies that assess the safety and efficacy of psychotropic medications for children reinforce the hesitation and reluctance of parents to administer such medications. The aim of this study was to investigate the attitudes of parents of children with psychiatric disorders, towards psychotropic medication.

Objective-Efforts to understand specific effects of prenatal methamphetamine exposure on cognitive processing are hampered by high rates of concomitant alcohol use during pregnancy. We examined whether neurocognitive systems differed among children with differing prenatal teratogenic exposures when they engaged in a verbal memory task.

Post-training administration of cocaine (1-10 mg/kg) or nomifensine (1-10 mg/kg) dose-dependently improves retention of an inhibitory avoidance response in C57BL16 mice, while impairing it in the DBA/ 2 strain. The effects on retention performance induced by the psychostimulant and the dopamine (DA) reuptake blocker in C57BL/6 and DBA/2 mice appear to be due to an effect on memory consolidation. In fact, they were observed when drugs were given at short, but not long, periods of time after training, i.e. when the memory trace is susceptible to modulation. Moreover, these effects are not to be ascribed to an aversive or a rewarding or nonspecific action of the drugs on retention performance, as the latencies during the retention test of those mice that had not received a footshock during the training were not affected by the post-training drug administration. The strain-dependent effects of an intermediate dose (5 mg/ kg) of both cocaine and nomifensine were reversed by pretreatment with either selective Dt or D 2 DA receptor antagonists SCH 23390 and (-)-sutpiride administered at per se non-effective doses (0.025 and 6 mg/kg, respectively), thus suggesting that D1 and D 2 receptor types are similarly involved in modulating memory processes. These results show that the effects of cocaine on memory consolidation are related to its dopaminergic action, since they are similar to those produced by nomifensine and, what is more important, are antagonized by pretreatment with DA receptor antagonists. Moreover, they point to possible genotype-dependent factors in DA mediated effects of cocaine on memory consolidation, indicating inbred mice as an experimental tool to investigate neural mechanisms underlying interindividual susceptibility to drug addiction.

To review the characteristics of psychiatric screening tools currently available in addiction treatment services for rapid assessment of comorbid pathology and to introduce the Centre for Addictions and Mental Health Concurrent Disorders Screener (CAMH-CDS), a computer-administered questionnaire that screens for the occurrence of 11 Axis I disorders plus all substance use disorders, as well as for a history of conduct disorder. We describe the structure, contents, and application of the CAMH-CDS. We undertook a sensitivity and specificity trial involving 171 subjects, a test-retest reliability study with 301 participants, and an open-label concordance study with 656 respondents. All subjects were regular clients of a major addiction treatment facility. The CAMH-CDS was easily and effectively used by addiction counsellors with limited or no mental health training. It has a low rate of false-negative responses, and it yields excellent test-retest reliability figures. It is highly sens...