1800 articles - 08.09.10
1: Drug Alcohol Depend. 2010 Aug 10; [Epub ahead of print]
Azar MM, Springer SA, Meyer JP, Altice FL.
Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven 06511, CT, USA.
BACKGROUND: Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals. OBJECTIVES: To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA). DATA SOURCES: Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined. REVIEW METHODS: Selection criteria included: (1) AUD and adherence (N=20); (2) AUD and health services utilization (N=11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N=10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV- status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized. DATA SYNTHESIS AND CONCLUSIONS: Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20705402&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20705402 [PubMed - as supplied by publisher]2: Alcohol Clin Exp Res. 2010 Jul 21; [Epub ahead of print]
Garbutt JC, Kampov-Polevoy AB, Gallop R, Kalka-Juhl L, Flannery BA.
From the Department of Psychiatry and the Bowles Center for Alcohol Studies (JCG, ABKP, LKJ, BAF), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Research Triangle International (BAF), Baltimore, Maryland; and West Chester University (RG), West Chester, Pennsylvania.
Background: Recent clinical trials and case-reports indicate that baclofen, a GABA(B) agonist, may have efficacy for alcohol dependence. Baclofen has been shown to enhance abstinence, to reduce drinking quantity, to reduce craving, and to reduce anxiety in alcohol-dependent individuals in 2 placebo-controlled trials in Italy. However, the clinical trial data with baclofen is limited. The purpose of the present study was to test the efficacy and tolerability of baclofen in alcohol dependence in the United States. Methods: The study was a double-blind, placebo-controlled, randomized study comparing 30 mg/d of baclofen to placebo over 12 weeks of treatment and utilizing 8 sessions of BRENDA, a low-intensity psychosocial intervention. One hundred and twenty-one subjects were screened to yield 80 randomized subjects (44 men) with randomization balanced for gender. Percent heavy drinking days was the primary outcome measure with other drinking outcomes, anxiety levels, and craving as secondary outcomes. Tolerability was examined. Results: Seventy-six percent of subjects completed the study. No difference by drug condition was seen in percentage of heavy drinking days where on-average rates were 25.5% (+/-23.6%) for placebo and 25.9% (+/-23.2%) for baclofen during treatment (t(73) = 0.59, p = 0.56). Similarly, no differences were seen by drug condition in percentage of days abstinent, time to first drink, or time to relapse to heavy drinking. Baclofen was associated with a significant reduction in state anxiety (F(1,73) = 5.39, p = 0.02). Baclofen was well tolerated with only 2 individuals stopping baclofen because of adverse events. There were no serious adverse events. Conclusions: Baclofen, a GABA(B) agonist, represents a possible new pharmacotherapeutic approach to alcohol dependence. Despite encouraging preclinical data and prior positive clinical trials with baclofen in Italy, the current trial did not find evidence that baclofen is superior to placebo in the treatment of alcohol dependence. Additional clinical trial work is necessary to establish whether baclofen does or does not have therapeutic efficacy in alcohol dependence and, if it does, what factors are predictive of response.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20662805&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20662805 [PubMed - as supplied by publisher]3: Alcohol Clin Exp Res. 2010 Jul 21; [Epub ahead of print]
Samokhvalov AV, Popova S, Room R, Ramonas M, Rehm J.
From the Public Health and Regulatory Policies (AVS, SP, MR, JR), Centre for Addiction and Mental Health; Department of Psychiatry (AVS, JR), University of Toronto; Dalla Lana School of Public Health (SP, JR), University of Toronto; Factor-Inwentash Faculty of Social Work (SP, JR), University of Toronto, Toronto, ON, Canada; AER Centre for Alcohol Policy Research (RR), Turning Point Alcohol and Drug Centre; School of Population Health (RR), University of Melbourne, Melbourne, Vic., Australia; and Epidemiological Research Unit (JR), Klinische Psychologie and Psychotherapie, Technische Universitat Dresden, Dresden, Germany.
Background: Alcohol use disorders (AUD), i.e., alcohol dependence and abuse, are major contributors to burden of disease. A large part of this burden is because of disability. However, there is still controversy about the best disability weighting for AUD. The objective of this study was to provide an overview of alcohol-related disabilities. Methods: Systematic literature review and expert interviews. Results: There is heterogeneity in experts' descriptions of disabilities related to AUD. The major core attributes of disability related to AUD are changes of emotional state, social relationships, memory and thinking. The most important supplementary attributes are anxiety, impairments of speech and hearing. Conclusions: This review identified the main patterns of disability associated with AUD. However, there was considerable variability, and data on less prominent patterns were fragmented. Further and systematic research is required for increasing the knowledge on disability related to AUD and for application of interventions for reducing the associated burden.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20662803&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20662803 [PubMed - as supplied by publisher]4: Alcohol Clin Exp Res. 2010 Jul 23; [Epub ahead of print]
Cherpitel CJ, Korcha RA, Moskalewicz J, Swiatkiewicz G, Ye Y, Bond J.
From the Alcohol Research Group (CJC, RAK, YY, JB), 6475 Christie Avenue, Suite 400, Emeryville, California; and Institute of Psychiatry and Neurology (JM, GS), Sobieskiego 9, 02-957 Warsaw, Poland.
Background: A randomized controlled trial of screening, brief intervention, and referral to treatment (SBIRT) among at-risk (based on average number of drinks per week and drinks per drinking day) and dependent drinkers was conducted in an emergency department (ED) among 446 patients 18 and older in Sosnowiec, Poland. Methods: Patients were recruited over a 23-week period (4:00 pm to 12:00 midnight) and randomized to 1 of 3 conditions: screened-only (n = 147), assessed (n = 152), and intervention (n = 147). Patients in the assessed and intervention conditions were blindly reassessed via a telephone interview at 3 months, and all 3 groups were assessed at 12 months (screened-only = 92, assessed = 99, and intervention = 87). Results: No difference was found across the 3 conditions in at-risk drinking at 12 months, as the primary outcome variable, or in decrease in the number of drinks per drinking day, with all 3 groups showing a significant reduction in both. Significant declines between baseline and 12 months in secondary outcomes of the RAPS4, number of drinking days per week, and the maximum number of drinks on an occasion were seen only for the intervention condition, and in negative consequences for both the assessment and intervention conditions. Conclusions: Data suggest that improvements in drinking outcomes found in the assessment condition were not because of assessment reactivity, with both the screened and intervention conditions demonstrating greater (although nonsignificant) improvement than the assessed condition. Only those in the intervention condition showed significant improvement in all outcome variables from baseline to 12-month follow-up. Although group by time interaction effects were not found to be significant, these findings suggest that declines in drinking measures for those receiving a brief intervention can be maintained at long-term follow-up.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20659072&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20659072 [PubMed - as supplied by publisher]5: Addiction. 2010 Jun;105(6):991-1002.
Marshall BD, Werb D.
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. bmarshall@cfenet.ubc.ca
OBJECTIVES: Methamphetamine (MA) use among young people is of significant social, economic and public health concern to affected communities and policy makers. While responses have focused upon various perceived severe harms of MA use, effective public health interventions require a strong scientific evidence base. METHODS: We conducted a systematic review to identify scientific studies investigating health outcomes associated with MA use among young people aged 10-24 years. The International Classification of Diseases (ICD-10) was used to categorize outcomes and determine the level of evidence for each series of harms. RESULTS: We identified 47 eligible studies for review. Consistent associations were observed between MA use and several mental health outcomes, including depression, suicidal ideation and psychosis. Suicide and overdose appear to be significant sources of morbidity and mortality among young MA users. Evidence for a strong association between MA use and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections is equivocal. Finally, we identified only weak evidence of an association between MA use and dental diseases among young people. CONCLUSIONS: Available evidence indicates a consistent relationship between MA use and mental health outcomes (e.g. depression, psychosis) and an increased risk of mortality due to suicide and overdose. We found insufficient evidence of an association between MA use and other previously cited harms, including infectious diseases and dental outcomes. As such, future research of higher methodological quality is required to further investigate possible associations. Current interventions should focus attention upon MA-related health outcomes for which sound scientific evidence is available.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20659059&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20659059 [PubMed - in process]6: Addiction. 2010 Aug;105(8):1362-80.
Agboola S, McNeill A, Coleman T, Leonardi Bee J.
Division of Epidemiology and Public Health, UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK. shade.agboola@nottingham.ac.uk
AIMS: To carry out a systematic review of the effectiveness of relapse prevention interventions (RPIs) among abstinent smokers who had completed an initial course of treatment or who had abstained unassisted, pooling only outcome data from similar follow-up time points. METHODS: We used the same search strategy as was used in Cochrane reviews of RPIs to identify randomized trials of behavioural and pharmacological studies of smoking RPIs published up to July 2008. Abstinence from smoking was defined as either continuous abstinence or point prevalence abstinence, measured at three follow-up time points: short term (1-3 months post randomization), medium term (6-9 months) and long term (12-18 months). Abstinence among pregnant/postpartum women was also measured at delivery or the last follow-up prior to delivery. Random effect meta-analysis was used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Thirty-six studies randomizing abstainers were included. Self-help materials appeared to be effective in preventing relapse at long-term follow up in initially unaided quitters (pooled OR 1.52; 95% CI 1.15 to 2.01, I2 = 0%, NNT = 11, 3 studies). Other behavioural interventions for relapse prevention appeared effective in the short term only. There were positive results for the use of pharmacotherapies for relapse prevention. Bupropion was effective at long-term follow-up (pooled OR 1.49; 95% CI 1.10 to 2.01; I2 = 0%; NNT = 11; 4 studies). Nicotine replacement therapy (NRT) was effective at medium-term (pooled OR 1.56; 95% CI 1.16 to 2.11; I2 = 37%; NNT = 14; 4 trials) and long-term follow-ups (pooled OR 1.33; 95% CI 1.08 to 1.63; I2 = 0%; NNT = 20; 4 trials). Single trials of extended treatment of Varenicline and rimonabant were also found to be effective at short-term and medium-term follow-ups. CONCLUSIONS: Self-help materials appear to prevent relapse in initially unaided quitters. Use of NRT, bupropion and varenicline appears to be effective in preventing relapse following an initial period of abstinence or an acute treatment episode. There is currently no good evidence that behavioural support prevents relapse after initial unaided abstinence or following an acute treatment period.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20653619&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20653619 [PubMed - in process]7: Addiction. 2010 Aug;105(8):1340-5.
Parry CD.
Alcohol and Drug Abuse Research Unit, Medical Research Council and Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa.
BACKGROUND: Implementation of effective policies to reduce harmful alcohol consumption requires both a good understanding of the policy development process and which strategies are likely to work. AIMS: To contribute to this understanding by reviewing four specific policy development initiatives that have taken place in South Africa between 1994 and 2009: restrictions on alcohol advertising and counter-advertising, regulation of retail sales of alcohol, alcohol taxation and controls on alcohol packaging. METHODS: Material was drawn from a record of meetings and conferences held between 1994 and 2009 and a database of reports, newspaper clippings and policy documentation. FINDINGS: When the policy process resulted in a concrete outcome there was always a clear recognition of the problem and policy alternatives, but success was more likely if there was an alignment of 'political' forces and/or when there was a determined bureaucracy. The impact of the other factors such as the media, community mobilization, non-governmental organizations (NGOs), the liquor industry and research are also discussed. Future avenues for policy research are identified, including the need for more systematic studies that give greater consideration to economic factors. CONCLUSIONS: Alcohol policy development in South Africa takes place in a piecemeal fashion and is the product of various competing influences. Having a comprehensive national alcohol strategy cutting across different sectors may be a better way for other developing countries to proceed.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20653617&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20653617 [PubMed - in process]8: Drug Alcohol Depend. 2010 Jun 1; [Epub ahead of print]
Thurstone C, Salomensen-Sautel S, Riggs PD.
Denver Health and Hospital Authority, University of Denver, 1155 Cherokee Street, MC 3440, Denver, CO 80204, USA.
There is concern that research reimbursements to adolescents may increase substance use. However, these concerns have not been examined empirically. Participants were 70 adolescents (13-19 years) with at least one non-nicotine substance use disorder (SUD) enrolled in a 12-week clinical trial of atomoxetine/placebo for attention/deficit-hyperactivity disorder (ADHD). Adolescent participants received cash reimbursement after each study visit (maximum possible=$425 over 12 weeks). Participants reported each week how they spent the previous reimbursement. Results were tallied, and correlates of spending a payment on substances were examined. Results showed that 26 of 70 subjects reported spending at least one research payment on alcohol or drugs, and 25 of 70 subjects reported spending at least one payment on tobacco. Comparing those who did and did not spend a research payment on alcohol/drugs, those who did had more frequent baseline alcohol/drug use but did not differ in demographics (age, gender) or other clinical characteristics (ADHD severity, diagnosis of conduct disorder, number of SUD diagnoses, number of treatment sessions attended, or pre/post-change in number of days used substances in the past 28 days). Comparing those who did and did not spend a payment on tobacco, those who did were slightly older and had more frequent baseline tobacco use. In conclusion, a significant proportion of subjects used at least a portion of one research payment to buy alcohol, drugs or tobacco. However, there was little indication that research payments increased substance use. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20627618&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20627618 [PubMed - as supplied by publisher]9: Addiction. 2010 Sep;105(9):1616-24. Epub 2010 Jul 12.
Polsky D, Glick HA, Yang J, Subramaniam GA, Poole SA, Woody GE.
PENN Medicine and the Wharton School, University of Pennsylvania, Blockley Hall, Philadelphia, PA 19104, USA. polsky@mail.med.upenn.edu
AIMS: The objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine-naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth. DESIGN: Economic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling. PARTICIPANTS: 152 patients aged 15-21 years. MEASUREMENTS: Data were collected prospectively during the 12-week treatment and at follow-up interviews at months 6, 9 and 12. FINDINGS: The 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25,049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100,000 per QALY. CONCLUSIONS: Extended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth.
Publication Types: Research Support, N.I.H., Extramural
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20626379&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20626379 [PubMed - in process]10: Addiction. 2010 Sep;105(9):1557-67. Epub 2010 Jul 12.
Miller PG, Sonderlund AL.
School of Psychology, Deakin University, Australia. petermiller.mail@gmail.com
AIMS: To review the current research of hidden populations of illicit drugs users using web-based methods and discuss major advantages and disadvantages. METHODS: Systematic review of 16 databases, including PubMed, PsycINFO (EBSCOhost), CSA Sociological Abstracts, Expanded Academic ASAP and Google Scholar. FINDINGS: Substances researched were most commonly 'party/club drugs' (such as ecstasy) and cannabis. All of the studies reviewed concluded that the internet is a useful tool for reaching hidden populations, but is likely to impose some bias in samples. Advantages include: access to previously under-researched target groups; speed; international applications; increased ease of data entry; and improved confidentiality for respondents. The major disadvantage is a lack of representativeness of samples. CONCLUSIONS: Internet research is successful at accessing hidden populations of illicit drugs users, when appropriately targeted and provides unprecedented opportunities for research across a wide range of topics within the addictions field. Findings are unlikely to be generalisable to the general public, but appropriate for describing target populations.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20626378&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20626378 [PubMed - in process]11: Addiction. 2010 Jul 12; [Epub ahead of print]
Roozen HG, de Waart R, van der Kroft P.
Erasmus University Medical Centre, Department of Forensic Psychiatry, Rotterdam, the Netherlands.
ABSTRACT Aims Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs. Methods The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model. Results CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon [relative risk (RR) 3.25, 95% confidence interval (CI) 2.11-5.02, P < 0.0001; numbers needed to treat (NNT) = 2] and twice the engagement of the Johnson Institute intervention (RR 2.15, 95% CI 1.28-3.62, P = 0.004; NNT = 3). Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically for four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window. Conclusion CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20626372&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20626372 [PubMed - as supplied by publisher]12: Addiction. 2010 Sep;105(9):1545-54. Epub 2010 Jun 23.
Merrall EL, Kariminia A, Binswanger IA, Hobbs MS, Farrell M, Marsden J, Hutchinson SJ, Bird SM.
MRC Biostatistics Unit, Cambridge, UK.
AIMS: The transition from prison back into the community is particularly hazardous for drug-using offenders whose tolerance for heroin has been reduced by imprisonment. Studies have indicated an increased risk of drug-related death soon after release from prison, particularly in the first 2 weeks. For precise, up-to-date understanding of these risks, a meta-analysis was conducted on the risk of drug-related death in weeks 1 + 2 and 3 + 4 compared with later 2-week periods in the first 12 weeks after release from prison. METHODS: English-language studies were identified that followed up adult prisoners for mortality from time of index release for at least 12 weeks. Six studies from six prison systems met the inclusion criteria and relevant data were extracted independently. RESULTS: These studies contributed a total of 69 093 person-years and 1033 deaths in the first 12 weeks after release, of which 612 were drug-related. A three- to eightfold increased risk of drug-related death was found when comparing weeks 1 + 2 with weeks 3-12, with notable heterogeneity between countries: United Kingdom, 7.5 (95% CI: 5.7-9.9); Australia, 4.0 (95% CI: 3.4-4.8); Washington State, USA, 8.4 (95% CI: 5.0-14.2) and New Mexico State, USA, 3.1 (95% CI: 1.3-7.1). Comparing weeks 3 + 4 with weeks 5-12, the pooled relative risk was: 1.7 (95% CI: 1.3-2.2). CONCLUSIONS: These findings confirm that there is an increased risk of drug-related death during the first 2 weeks after release from prison and that the risk remains elevated up to at least the fourth week.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20579009&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20579009 [PubMed - in process]13: Drug Alcohol Depend. 2010 Jun 17; [Epub ahead of print]
Epperson CN, Toll B, Wu R, Amin Z, Czarkowski KA, Jatlow P, Mazure CM, O'Malley SS.
University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA 19104, USA; University of Pennsylvania School of Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA 19104, USA.
In a series of exploratory analyses, we examined the roles of gender, reproductive status and negative affect on smoking abstinence in subjects participating in a large (n=385) 6-week randomized clinical trial (RCT) of nicotine patch therapy, with varying doses of oral naltrexone (0mg, 25mg, 50mg, 100mg) treatment. Negative affect was assessed daily during the first post-quit week via telephone interactive voice response (IVR). Weight and adverse events were recorded weekly. In the intent to treat sample, the effects of dose on continuous abstinence were non-significant in the overall model for men and women. In the 295 study completers, there was a significant effect of dose on continuous abstinence in women only (F=8.53, p=0.04). In the 100mg group, 71% of women were continuously abstinent compared to 41% in the placebo group (p<0.05). Women in the active naltrexone groups gained less weight (F=2.91, df=3, p=0.04). Women in the 100mg vs. placebo group were less adherent with medication (F=3.19, p<0.05). These effects were not significant in men. Naltrexone treatment condition (100mg vs. placebo, p=0.02, odds ratio (OR)=0.28), gender (OR=0.55 p=0.09), and IVR ratings of negative affect (OR 1.02, p=0.04) predicted abstinence at Week 1 in study completers. Menstrual cycle status on quit day had a modest affect on abstinence. These data suggest that naltrexone dose, gender, and negative affect play a role in smoking abstinence, particularly in the early stages of treatment. When used in conjunction with nicotine replacement therapy, naltrexone dose may be important in women. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20561758&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20561758 [PubMed - as supplied by publisher]14: Drug Alcohol Depend. 2010 Sep 1;111(1-2):97-104. Epub 2010 May 26.
Bisaga A, Aharonovich E, Cheng WY, Levin FR, Mariani JJ, Raby WN, Nunes EV.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. bisagaa@pi.cpmc.columbia.edu
Preclinical findings suggest that the inhibition of NMDA glutamatergic neurotransmission may have beneficial effects in the treatment of cocaine dependence. We hypothesized that memantine, a low potency, uncompetitive NMDA receptor antagonist, would be safe and effective in the treatment of cocaine dependence, particularly in preventing relapse to cocaine use in abstinent individuals. Cocaine dependent patients (N=112) were enrolled. The trial began with a 2-week placebo lead-in period during which patients received high-value voucher contingency management to induce abstinence. Participants were then randomized to receive either memantine 20mg bid (N=39) or placebo (N=42) for 12-weeks in combination with individual relapse-prevention therapy. The randomization was stratified by abstinence status during the lead-in period. The primary outcome was the weekly proportion of days of cocaine use. There were no significant differences in cocaine use outcome between the groups treated with memantine versus placebo. Thus, the efficacy of memantine 40 mg/d for the treatment of cocaine dependence was not supported. Urine-confirmed abstinence during the lead-in period was achieved by 44% of participants, and was a strong predictor of subsequent cocaine abstinence during the trial. This suggests that this clinical trial design, an intensive behavioral intervention during a lead-in period, resolves cocaine dependent patients into two subgroups, one that rapidly achieves sustained abstinence and may not need a medication, and another that displays persistent cocaine use and would most likely benefit from a medication to help induce abstinence. Targeting the latter subgroup may advance medication development efforts. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
Publication Types: Research Support, N.I.H., Extramural
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20537812&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20537812 [PubMed - as supplied by publisher]15: Addiction. 2010 Aug;105(8):1474-83. Epub 2010 Jun 7.
Bullen C, Howe C, Lin RB, Grigg M, Laugesen M, McRobbie H, Glover M, Walker N, Wallace-Bell M, Whittaker R, Rodgers A.
Clinical Trials Research Unit, School of Population Health, The University of Auckland, Auckland, New Zealand. c.bullen@ctru.auckland.ac.nz
AIMS: To determine the effectiveness of 2 weeks' pre-cessation nicotine patches and/or gum on smoking abstinence at 6 months. DESIGN: Pragmatic randomized controlled trial. SETTING: New Zealand. PARTICIPANTS: Eleven hundred adult, dependent smokers who called the New Zealand Quitline between March 2006 and May 2007 for support to stop smoking were randomized to 2 weeks of nicotine patches and/or gum prior to their target quit day followed by usual care (8 weeks of patches and/or gum plus support calls from a Quitline adviser), or to usual care alone. MEASUREMENTS: The primary outcome was self-reported 7-day point prevalence smoking abstinence 6 months after quit day. Secondary outcomes included continuous abstinence, cotinine-verified abstinence, daily cigarette consumption, withdrawal symptoms and adverse events. FINDINGS: Six months after quit day 125 (22.7%) participants in the pre-cessation group and 116 (21.0%) in the control group reported 7-day point prevalence abstinence (relative risk 1.08 95% CI: 0.86, 1.35, P = 0.4, risk difference 1.7%, 95% CI: -3.2%, 6.6%). However, when pooled in a meta-analysis with other pre-cessation trials a moderate benefit of about a one-quarter increase in cessation rates was evident. There was no difference in adverse events between groups. CONCLUSIONS: In this, the largest pre-cessation NRT trial to date, using NRT 2 weeks before the target quit day was safe and well tolerated but offered no benefit over usual care. However, in conjunction with previous pre-cessation trials there appears to be a moderate benefit, but not as large as that seen in most smaller trials.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20528810&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20528810 [PubMed - in process]16: Addiction. 2010 May 28; [Epub ahead of print]
Mann K.
Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany.
ABSTRACT Addictive behaviour is as prevalent in Germany as in other western countries, but in contrast to some European countries and the United States, very little money was given to this research field. Change came in the early 1990s, when the German government started to launch specific grants for addiction research. The first chair in addiction research was created in 1999 (Karl Mann) at the Central Institute of Mental Health Mannheim (CIMH; University of Heidelberg). The recruitment of a pre-clinical alcohol researcher as head of the department of psychopharmacology followed (Rainer Spanagel). This 'addiction research cluster' collaborates with several research groups at the CIMH (such as genetics). We inaugurated a clinical trial network which now comprises up to 20 treatment centres throughout Germany. Like most authors, we found effect sizes of different treatment modalities more in the low to moderate range, perhaps because of the heterogeneity of large patient samples. Therefore, we concentrated upon the biological basis of addiction in order to define more homogeneous 'subtypes' of patients for a better match with existing treatments. Results concerning genetics and neuroimaging (both animal and human) are promising, and could move our field towards a more personalized treatment approach. Our funding has been extended over the years, including involvement in several large European grants. We are studying substance-related problems as well as so-called 'behavioural addictions'. As a natural consequence of this development, we are deeply involved both in informing the general public on addiction issues as well as in counselling policy makers in Germany.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20528807&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20528807 [PubMed - as supplied by publisher]17: Addiction. 2010 Aug;105(8):1381-90. Epub 2010 May 28.
Rooke S, Thorsteinsson E, Karpin A, Copeland J, Allsop D.
National Cannabis Prevention and Information Centre, University of New South Wales, Randwick, NSW 2031, Australia. s.rooke@unsw.edu.au
AIMS: To quantify the overall effectiveness of computer-delivered interventions for alcohol and tobacco use. METHODS: Meta-analysis of 42 effect sizes from randomized controlled trials, based on the responses of 10 632 individuals. RESULTS: The weighted average effect size (d) was 0.20, P < 0.001. While lower effect sizes were associated with studies addressing tobacco use (d = 0.14) this may well reflect differences in the types of outcome measure used. Effect sizes did not vary significantly as a function of treatment location, inclusion of entertaining elements, provision of normative feedback, availability of a discussion feature, number of treatment sessions, emphasis on relapse prevention, level of therapist involvement or follow-up period. CONCLUSION: Findings of the meta-analysis suggest that minimal contact computer-delivered treatments that can be accessed via the internet may represent a cost-effective means of treating uncomplicated substance use and related problems.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20528806&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20528806 [PubMed - in process]18: Alcohol Clin Exp Res. 2010 Aug;34(8):1334-45. Epub 2010 May 14.
Lejuez CW, Magidson JF, Mitchell SH, Sinha R, Stevens MC, de Wit H.
Department of Psychology, University of Maryland, Center for Addictions, Personality and Emotion Research, Maryland 20742, USA. clejuez@psyc.umd.edu
Alcohol use disorders (AUDs) are a devastating public health problem. The construct of impulsivity is biologically based and heritable, and its various dimensions are relevant for understanding alcohol use. The goal of the current manuscript is to review recent behavioral and biological research examining various dimensions of impulsivity and their relation to AUDs from risk for initial use through dependence and relapse. Moreover, we also highlight key psychological variables including affective processes as they relate to current use and early indications of alcohol problems, as well as psychopathology, violence, and aggression in relation to AUDs. Each section includes a critical summary and we conclude the review with future directions focused on issues relevant to measurement, causality, and intervention. Throughout the review, we attempt to be as specific as possible about the dimensions of impulsivity being referenced, while attempting to draw parallels and highlighting differences as the existing literature allows.
Publication Types: Research Support, N.I.H., Extramural
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20491733&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20491733 [PubMed - in process]19: Addiction. 2010 Jul;105(7):1176-89. Epub 2010 May 11.
Banham L, Gilbody S.
South London and the Maudsley Mental Health Trust, Beckenham, Kent, UK. lindsay.banham@slam.nhs.uk
AIMS: The physical health of people with severe mental illness (SMI) is poor. Smoking-related illnesses are a major contributor to excess mortality and morbidity. An up-to-date review of the evidence for smoking cessation interventions in SMI is needed to inform clinical guidelines. METHODS: We searched bibliographic databases for relevant studies and independently extracted data. Included studies were randomized controlled trials (RCTs) of smoking cessation or reduction conducted in adult smokers with SMI. Interventions were compared to usual care or placebo. The primary outcome was smoking cessation and secondary outcomes were smoking reduction, change in weight, change in psychiatric symptoms and adverse events. RESULTS: We included eight RCTs of pharmacological and/or psychological interventions. Most cessation interventions showed moderate positive results, some reaching statistical significance. One study compared behavioural support and nicotine replacement therapy (NRT) to usual care and showed a risk ratio (RR) of 2.74 (95% CI 1.10-6.81) for short-term smoking cessation, which was not significant at longer follow-up. We pooled five trials that effectively compared bupropion to placebo giving an RR of 2.77 (95% CI 1.48-5.16), which was comparable to Hughes et al.'s 2009 figures for general population data; RR = 1.69 (95% CI 1.53-1.85). Smoking reduction data were too heterogeneous for meta-analysis, but results were generally positive. Trials suggest few adverse events. All trials recorded psychiatric symptoms and the most significant changes favoured the intervention groups over the control groups. CONCLUSIONS: Treating tobacco dependence is effective in patients with SMI. Treatments that work in the general population work for those with severe mental illness and appear approximately equally effective. Treating tobacco dependence in patients with stable psychiatric conditions does not worsen mental state.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20491721&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20491721 [PubMed - in process]20: Alcohol Clin Exp Res. 2010 Jul;34(7):1282-90. Epub 2010 May 4.
Voas RB, Tippetts AS, McKnight AS.
Pacific Institute for Research and Evaluation, Calverton, Maryland 20705-3111, USA. voas@pire.org
BACKGROUND: We examined the extent to which driving under the influence (DUI) offenders delay reinstatement, the reasons for that delay, and the relationship of the delay to recidivism. Analyzed were the driving records of 40 million drivers (3 million convicted of DUI) from 7 of the largest states spanning 7 to 14 years. License suspension effectively reduces, but does not eliminate, impaired driving. Apparently, many feel they can avoid apprehension for unlicensed driving; the limited research to date suggests that up to 75% of convicted offenders continue to drive and up to 84% delay reinstatement for 3 or more years. METHODS: ANOVA and regression procedures were used to determine the relationship of prior driving record and sentence length to the DUI offender's delay in reinstatement. Meta-analysis was used to summarize results across the 7 states and survival analysis to determine the effect of the delay on recidivism. RESULTS: Forty-two percent of first offenders and 55% of multiple offenders convicted for DUI delay reinstatement for more than a year. For a third of the offenders, there were no records of their having reinstated within 5 years of becoming eligible. Both factors-more than one prior offense and the length of suspension imposed-were related to delay in reinstatement. Offenders who delayed reinstatement were more likely to recidivate both while they delayed before reinstating and after they reinstated. CONCLUSIONS: DUI offenders who delay reinstatement after they become eligible are high-risk drivers. Offenders who reinstate, however, have lower recidivism rates than those who do not. This suggests that encouraging reinstatement but with continued controls, as some states have provided through laws requiring interlocks as a condition of reinstatement, may be effective if they do not motivate extended delays.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20477763&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20477763 [PubMed - in process]