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Current Opinion in Psychiatry Jul 2016Alcohol and other drug use are major contributors to the global burden of disease. Prevention is critical and evidence is beginning to support the use of online mediums... (Review)
Review
PURPOSE OF REVIEW
Alcohol and other drug use are major contributors to the global burden of disease. Prevention is critical and evidence is beginning to support the use of online mediums to prevent alcohol and other drug use and harms among adolescents. This study aims to expand the evidence base by conducting a systematic review of recent universal prevention programs delivered by computers and the Internet.
RECENT FINDINGS
A total of 12 papers reporting outcomes from trials of nine universal online prevention programs were identified. Of the identified interventions, five targeted multiple substances, two focused solely on alcohol, one targeted only cannabis and one primarily addressed smoking. The majority of programs were delivered at school; however one was implemented in a primary care setting. Six programs demonstrated significant, but modest, effects for alcohol and/or other drug use outcomes.
SUMMARY
Evidence to support the efficacy of computer and Internet-based prevention programs for alcohol and other drug use and related harms among adolescents is rapidly emerging, demonstrating that online prevention is an area of increasing promise. Further replication work, longer-term trials and attempts to increase the impact are required.
Topics: Alcohol-Related Disorders; Humans; Internet; Outcome and Process Assessment, Health Care; Substance-Related Disorders
PubMed: 27153124
DOI: 10.1097/YCO.0000000000000258 -
The International Journal on Drug Policy Aug 2021Over the past decades gamma-hydroxybutyrate (GHB) has emerged as a popular drug with high potential of (ab)use due to its euphoric and relaxing effects. An overview of... (Review)
Review
BACKGROUND
Over the past decades gamma-hydroxybutyrate (GHB) has emerged as a popular drug with high potential of (ab)use due to its euphoric and relaxing effects. An overview of different populations using GHB is urgently needed, since this would enable development of adequate prevention and treatment policies to diminish the risks associated with GHB use. We systematically reviewed literature on different GHB using populations, comparing demographic characteristics, GHB use patterns, psychosocial aspects and psychiatric comorbidity.
METHODS
We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Rayyan software. Original studies published from January 1997 up to October 2019 on GHB use were included. Out of 80 full-text articles, 60 articles of 51 unique studies were included. Most studies included people using GHB 1) presenting at emergency departments (n = 22), 2) recruited from the general population (n = 11), or 3) presenting at addiction care (n = 8).
RESULTS
Three main sub-populations of people using GHB are described in the literature: people using GHB recreationally without adverse effects; people using GHB recreationally with adverse effects, and people with dependence on GHB. These groups show considerable overlap in gender, age range, and comorbid substance use, as well as amount of GHB use per occasion. Differences are related to frequency and function of GHB use, the number of comas experienced, as well as work status, and psychiatric comorbidity.
CONCLUSION
Policy interventions should aim at preventing the transition from recreational substance use to GHB use, as most users are experienced recreational substance users prior to starting GHB use. When people use GHB regularly, interventions should aim at reducing the level of GHB use and preventing GHB use-related harm. Longitudinal studies and population-based probability sampling are required for more insight in the dynamics of GHB use in different sub-populations, and the transition from one group to the other, ultimately leading to dependence on GHB.
Topics: Coma; Drug Users; Humans; Sodium Oxybate; Substance-Related Disorders
PubMed: 33892279
DOI: 10.1016/j.drugpo.2021.103230 -
Addiction (Abingdon, England) Oct 2022Several studies have indicated an association between maternal prenatal substance use and offspring externalizing disorders; however, it is uncertain whether this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Several studies have indicated an association between maternal prenatal substance use and offspring externalizing disorders; however, it is uncertain whether this relationship is causal. We conducted a systematic review to determine: (1) if the literature supports a causal role of maternal prenatal substance use on offspring externalizing disorders diagnosis and (2) whether these associations differ across externalizing disorders.
METHODS
We searched Web of Science, Embase, PsycINFO and Medline databases. Risk of bias assessment was conducted using the Newcastle-Ottawa Scale (NOS), and where possible meta-analysis was conducted for studies classed as low risk of bias. We included studies of any design that examined prenatal smoking, alcohol or caffeine use. Studies in non-English language, fetal alcohol syndrome and comorbid autism spectrum disorders were excluded. Participants in the included studies were mothers and their offspring. Measurements included prenatal smoking, alcohol or caffeine use as an exposure, and diagnosis of attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD) in offspring as an outcome.
RESULTS
We included 63 studies, 46 of which investigated smoking and ADHD. All studies were narratively synthesized, and seven studies on smoking and ADHD were meta-analysed. The largest meta-analysis based on genetically sensitive design included 1 011 546 participants and did not find evidence for an association [odds ratio (OR) = 0.90, 95% confidence interval (CI) = 0.83-1.11; OR = 1.04, 95% CI = 0.79-1.36). Studies on alcohol exposure in all the outcomes reported inconsistent findings and no strong conclusions on causality can be made. Studies on caffeine exposure were mainly limited to ADHD and these studies do not support a causal effect.
CONCLUSIONS
There appears to be no clear evidence to support a causal relationship between maternal prenatal smoking and offspring attention-deficit hyperactivity disorder. Findings with alcohol and caffeine exposures and conduct disorder and oppositional-defiant disorder need more research, using more genetically sensitive designs.
Topics: Attention Deficit Disorder with Hyperactivity; Caffeine; Conduct Disorder; Ethanol; Female; Humans; Pregnancy; Prenatal Exposure Delayed Effects; Smoking; Substance-Related Disorders
PubMed: 35385887
DOI: 10.1111/add.15858 -
The International Journal on Drug Policy Feb 2016Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the... (Review)
Review
BACKGROUND
Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment.
METHODS
We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism.
RESULTS
Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use.
CONCLUSION
There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.
Topics: Humans; Mandatory Programs; Program Evaluation; Substance-Related Disorders; Treatment Outcome
PubMed: 26790691
DOI: 10.1016/j.drugpo.2015.12.005 -
Addiction (Abingdon, England) Sep 2023Studies often rely upon self-report and biological testing methods for measuring illicit drug use, although evidence for their agreement is limited to specific... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Studies often rely upon self-report and biological testing methods for measuring illicit drug use, although evidence for their agreement is limited to specific populations and self-report instruments. We aimed to examine comprehensively the evidence for agreement between self-reported and biologically measured illicit drug use among all major illicit drug classes, biological indicators, populations and settings.
METHODS
We systematically searched peer-reviewed databases (Medline, Embase and PsycINFO) and grey literature. Included studies reported 2 × 2 table counts or agreement estimates comparing self-reported and biologically measured use published up to March 2022. With biological results considered to be the reference standard and use of random-effect regression models, we evaluated pooled estimates for overall agreement (primary outcome), sensitivity, specificity, false omission rates (proportion reporting no use that test positive) and false discovery rates (proportion reporting use that test negative) by drug class, potential consequences attached to self-report (i.e. work, legal or treatment impacts) and time-frame of use. Heterogeneity was assessed by inspecting forest plots.
RESULTS
From 7924 studies, we extracted data from 207 eligible studies. Overall agreement ranged from good to excellent (> 0.79). False omission rates were generally low, while false discovery rates varied by setting. Specificity was generally high but sensitivity varied by drug, sample type and setting. Self-report in clinical trials and situations of no consequences was generally reliable. For urine, recent (i.e. past 1-4 days) self-report produced lower sensitivity and false discovery rates than past month. Agreement was higher in studies that informed participants biological testing would occur (diagnostic odds ratio = 2.91, 95% confidence interval = 1.25-6.78). The main source of bias was biological assessments (51% studies).
CONCLUSIONS
While there are limitations associated with self-report and biological testing to measure illicit drug use, overall agreement between the two methods is high, suggesting both provide good measures of illicit drug use. Recommended methods of biological testing are more likely to provide reliable measures of recent use if there are problems with self-disclosure.
Topics: Humans; Self Report; Substance-Related Disorders; Illicit Drugs; Sensitivity and Specificity
PubMed: 37005867
DOI: 10.1111/add.16200 -
Archives of Disease in Childhood. Fetal... Sep 2018To determine whether prenatal and perinatal maternal consumption of alcohol, tobacco and/or illicit drugs is associated with risk of neuroblastoma. (Review)
Review
OBJECTIVE
To determine whether prenatal and perinatal maternal consumption of alcohol, tobacco and/or illicit drugs is associated with risk of neuroblastoma.
DATA SOURCES
Medline and Embase (both from inception to February 2017), and reference lists of included studies.
STUDY SELECTION
To be eligible, a study had to be an original report including data on intake of alcohol, tobacco smoking and/or consumption of illicit drugs during pregnancy and risk of neuroblastoma in the child.
DATA EXTRACTION
From eligible studies, data study characteristics as well as effect measures and confounders were extracted. We assessed unadjusted and confounder-adjusted estimates, performed risk of bias analysis, constructed random-effects models and assessed heterogeneity.
RESULTS
We identified 14 case-control studies (1987-2016) involving a total of 3114 children with neuroblastoma. Meta-analysis of unadjusted estimates showed an association between alcohol (OR 1.26; 95% CI 1.07 to 1.49), tobacco (OR 1.22; 95% CI 1.04 to 1.44) and illicit drug consumption during pregnancy and risk of neuroblastoma during childhood, with illicit drug consumption showing the strongest association (OR 3.26; 95% CI 1.36 to 7.86). However, adjusted estimates were highly heterogeneous.
LIMITATIONS
All studies were at high risk of bias.
CONCLUSIONS
Smoking, alcohol or illicit drugs during pregnancy might play a role in the development of neuroblastoma. However, well-designed studies are needed to assess whether these exposures are causal and whether time period during pregnancy, dose or co-consumption of substances is critical.
TRIAL REGISTRATION NUMBER
Registration number CRD42016036165.
Topics: Female; Humans; Neuroblastoma; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Factors; Substance-Related Disorders
PubMed: 29162685
DOI: 10.1136/archdischild-2017-313615 -
Scandinavian Journal of Psychology Oct 2022Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim... (Meta-Analysis)
Meta-Analysis Review
Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim of this meta-analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale-20 scale. Random effects meta-analysis was used to evaluate the overall and sub-group associations. Of the studies, 50 were cross-sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen's d = 0.62, 95% confidence interval [CI] 0.49-0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension "Difficulty in Identifying Feelings" (d = 0.64, 95% CI = 0.47-0.81) and "Difficulty in Describing Feelings" (d = 0.44, 95% CI = 0.32-0.55) than for "Externally Oriented Thinking" (d = 0.19, 95% CI = 0.09-0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62-1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion-related dimensions than with the cognition-related dimension of alexithymia. As nearly all the studies were cross-sectional, more longitudinal studies are needed.
Topics: Affective Symptoms; Emotions; Female; Humans; Illicit Drugs; Male; Students; Substance-Related Disorders
PubMed: 35436351
DOI: 10.1111/sjop.12821 -
Forensic Science International Aug 2016Gender differences in substance use/abuse have been the focus of research in the last 15 years. Initiation, use patterns, acceleration of disease course, and... (Review)
Review
Gender differences in substance use/abuse have been the focus of research in the last 15 years. Initiation, use patterns, acceleration of disease course, and help-seeking patterns are known to be influenced by gender differences with regard to biological, psychological, cultural and socioeconomic factors. This paper presents a systematic review of published data on gender differences in the use/abuse of psychoactive and psychotic drugs, focusing on the importance of a multidisciplinary approach. The basis for this paper was obtained by Medline searches using the search terms "human" and "gender", combined with individual drug names or "drugs of abuse". The reference lists of these papers were further checked for other relevant studies. The gender difference in drug abuse is more evident in adults than in adolescents (13-19 years): adult men are 2-3 times more likely than women to develop drug abuse/dependence disorders and approximately 4 times as likely to have an alcohol use disorder. Such prevalence rates have not been observed in adolescents. Differences between men and women involve: (i) the biological response to the drug, (ii) the progression to drug dependence, and (iii) the comorbid psychiatric diagnoses, which may be due to both sociocultural factors and innate biological differences. A crucial role played by ovarian hormones (oestrogens and progesterone) has been documented in both human and animal model studies. Epidemiological data on how particular psychobiological and physiological characteristics in females influence vulnerability to both drug addiction and toxicological consequences of drugs are still in their infancy. Significant gaps remain in our knowledge, which are primarily attributable to the lack of empirical data that only a systematic and multidisciplinary approach to the topic can generate. The introduction of gender into forensic toxicological evaluations may help elucidate the relationship between the body's absorption of abused drugs (alone or in combination) and the onset of intoxications, both lethal and none.
Topics: Female; Forensic Toxicology; Gender Identity; Humans; Male; Substance-Related Disorders
PubMed: 26836148
DOI: 10.1016/j.forsciint.2016.01.014 -
American Journal of Public Health Nov 2015Drug overdose is an important, yet an inadequately understood, public health problem. Global attention to unintentional drug overdose has been limited by comparison with... (Review)
Review
BACKGROUND
Drug overdose is an important, yet an inadequately understood, public health problem. Global attention to unintentional drug overdose has been limited by comparison with the scope of the problem. There has been a substantial increase in drug overdose incidence and prevalence in several countries worldwide over the past decade, contributing to both increased costs and mortality.
OBJECTIVES
The aim of this study was to systematically synthesize the peer-reviewed literature to document the global epidemiological profile of unintentional drug overdoses and the prevalence, time trends, mortality rates, and correlates of drug overdoses. We searched different combinations of Medical Subject Headings (MeSH) terms in PubMed for articles published from 1980 until July 2013, and we organized these results in tabular spreadsheets and compared them. We restricted the search to English-language articles that deal with unintentional overdose, focusing on 1 or more of the following key constructs: prevalence, time trends, mortality rates, and correlates. The term "overdose" as a MeSH major topic yielded 1076 publications. In addition, we searched the following combinations of nonmajor MeSH terms: "street drugs" and "overdose" yielded 180, "death" and "overdose" yielded 114, and "poisoning" and "drug users" yielded 17. There was some overlap among the searches. Based on the search and inclusion and exclusion criteria, we selected a total of 169 relevant articles for this article based on a close review of abstracts.
RESULTS
We found wide variability in lifetime prevalence of experiencing a nonfatal overdose or witnessing an overdose, and in mortality rates attributable to overdose. Lifetime prevalence of witnessed overdose among drug users (n = 17 samples) ranged from 50% to 96%, with a mean of 73.3%, a median of 70%, and a standard deviation of 14.1%. Lifetime prevalence of drug users personally experiencing a nonfatal overdose (n = 27 samples), ranged from 16.6% to 68.0% with a mean of 45.4%, a median of 47%, and a standard deviation of 14.4%. Population-based crude overdose mortality rates (n = 28 samples) ranged from 0.04 to 46.6 per 100 000 person-years. This range is likely attributable to the diversity in regions, time periods, and samples. Most studies on longitudinal trends of overdose death rates or overdose-related hospitalization rates showed increases in overdose death rates and in overdose-related hospitalization rates across time, which have led to peaks in these rates at the present time. An overall trend of increasing deaths from prescription opioid use and decreasing deaths from illicit drug use in the past several years has been noted across most of the literature. With the increase in prescription opioid overdose deaths, drug overdose is not just an urban problem: rural areas have seen an important increase in overdose deaths. Lastly, cocaine, prescription opioids, and heroin are the drugs most commonly associated with unintentional drug overdoses worldwide and the demographic and psychiatric correlates associated with unintentional drug overdoses are similar globally.
CONCLUSIONS
There is a need to invest in research to understand the distinct determinants of prescription drug overdose worldwide. Several other countries need to collect in a systematic and continuous fashion such data on sales of prescription opioids and other prescription drugs, nonmedical use of prescription drugs, and hospitalization secondary to overdoses on prescription drugs. The sparse evidence on the environmental determinants of overdose suggests a need for research that will inform the types of environmental interventions we can use to prevent drug overdose. Methodological issues for future studies include enhancing data collection methods on unintentional fatal and nonfatal overdoses, and collecting more detailed information on drug use history, source of drug use (for prescription drugs), and demographic and psychiatric history characteristics of the individual who overdosed.
Topics: Accidents; Analgesics, Opioid; Drug Overdose; Epidemics; Global Health; Humans; Illicit Drugs; Prescription Drugs; Prevalence; Public Health; Risk Factors; Socioeconomic Factors; Substance-Related Disorders
PubMed: 26451760
DOI: 10.2105/AJPH.2015.302843 -
Drugs Mar 2017Gabapentinoid (pregabalin and gabapentin) abuse is increasingly being reported. (Review)
Review
BACKGROUND
Gabapentinoid (pregabalin and gabapentin) abuse is increasingly being reported.
OBJECTIVE
To assess the extent of gabapentinoid abuse, characteristics of typical abusers, patterns of abuse, and potential harms in order to bring this trend to providers' attention.
METHODS
A systematic review of MEDLINE, Cochrane Library, ClinicalTrials.gov, and US FDA data, indexed through 28 July 2016, utilizing the following searches: pregabalin OR gabapentin OR gabapentinoid AND one of the following: abuse, misuse, overdose, or substance-related disorders[MESH], was conducted. Additional studies were identified through review of references. English-language epidemiological studies, clinical studies, and case reports/series of gabapentinoid abuse/misuse/overdose were included. The authors reached consensus regarding study inclusion after full-text review. The body of literature was assessed for bias qualitatively.
RESULTS
Fifty-nine studies were included in this systematic review (24 epidemiological, three clinical abuse liability, 16 abuse/misuse/dependence case reports/series, 17 acute overdose case reports/series-one included both an epidemiological study and case series and was included in both counts). Analysis of these studies indicates increasing numbers of patients are self-administering higher than recommended doses to achieve euphoric highs. In the general population, a 1.6% prevalence of gabapentinoid abuse was observed, whereas prevalence ranged from 3% to 68% among opioid abusers. An international adverse event database identified 11,940 reports of gabapentinoid abuse from 2004-2015, with >75% reported since 2012. Risk factors include a history of substance abuse, particularly opioids, and psychiatric co-morbidities. While effects of excessively high doses are generally non-lethal, gabapentinoids are increasingly being identified in post-mortem toxicology analyses.
CONCLUSION
Evidence suggests gabapentinoids possess potential for abuse, particularly in individuals with a history of opioid abuse, and reports of such abuse are increasingly being documented. Prescribers should be aware of high-risk populations and monitor for signs of abuse.
Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Drug Overdose; Gabapentin; Humans; Pregabalin; Substance-Related Disorders; gamma-Aminobutyric Acid
PubMed: 28144823
DOI: 10.1007/s40265-017-0700-x