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Annals of Medicine Dec 2021Accurately identifying persons with addiction is critically important for effectively targeting treatment and harm reduction interventions. Misdiagnosis of addictive...
Accurately identifying persons with addiction is critically important for effectively targeting treatment and harm reduction interventions. Misdiagnosis of addictive disorders can lead to a cascade of negative outcomes, including stigma, discontinuation of needed medications, undue scrutiny of both patients and physicians, and even criminal consequences. A recent study raises significant concerns about the accuracy of diagnosis code data, likely rooted in confusingly-worded International Classification of Diseases (ICD)-9 and ICD-10 codes and a general misunderstanding of the difference between addiction and physiologic dependence. It is hardly surprising that physicians frequently mislabel patients when the ICD terms used to code for addiction are themselves misleading. ICD codes have not been updated to reflect current understanding of addiction, unlike those in the DSM-5. To explore this issue further, this commentary briefly discusses new information regarding coding data inaccuracies, how coding inaccuracies can lead to misdiagnosis, and the dangers of conflating "addiction" with "dependence." The commentary concludes with a call for the ICD to update their codes to reflect current understanding of addiction.Key messagesIt is not surprising that physicians frequently conflate patients with "addiction" and "dependence" when the ICD terms used to code for addiction are themselves misleading.ICD codes have not been updated to reflect what we know about the nature of addiction, unlike those in the DSM-5.This commentary calls for the ICD to update their codes to reflect current understanding of addiction.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Drug Overdose; Humans; International Classification of Diseases; Substance-Related Disorders
PubMed: 34751058
DOI: 10.1080/07853890.2021.1995623 -
Trends in Pharmacological Sciences Feb 2016Drug addiction is a major psychiatric disorder with a neurobiological basis that is still insufficiently understood. Initially, non-addicted, controlled drug consumption... (Review)
Review
Drug addiction is a major psychiatric disorder with a neurobiological basis that is still insufficiently understood. Initially, non-addicted, controlled drug consumption and drug instrumentalization are established. They comprise highly systematic behaviours acquired by learning and the establishment of drug memories. Ca(2+)/calmodulin-dependent protein kinases (CaMKs) are important Ca(2+) sensors translating glutamatergic activation into synaptic plasticity during learning and memory formation. Here we review the role of CaMKs in the establishment of drug-related behaviours in animal models and in humans. Converging evidence now shows that CaMKs are a crucial mechanism of how addictive drugs induce synaptic plasticity and establish various types of drug memories. Thereby, CaMKs are not only molecular relays for glutamatergic activity but they also directly control dopaminergic and serotonergic activity in the mesolimbic reward system. They can now be considered as major molecular pathways translating normal memory formation into establishment of drug memories and possibly transition to drug addiction.
Topics: Animals; Calcium-Calmodulin-Dependent Protein Kinases; Humans; Memory; Substance-Related Disorders
PubMed: 26674562
DOI: 10.1016/j.tips.2015.11.001 -
Revista Brasileira de Psiquiatria (Sao... 2013Drug addiction has serious health and social consequences. In the last 50 years, a wide range of techniques have been developed to model specific aspects of drug-taking... (Review)
Review
Drug addiction has serious health and social consequences. In the last 50 years, a wide range of techniques have been developed to model specific aspects of drug-taking behaviors and have greatly contributed to the understanding of the neurobiological basis of drug abuse and addiction. In the last two decades, new models have been proposed in an attempt to capture the more genuine aspects of addiction-like behaviors in laboratory animals. The goal of the present review is to provide an overview of the preclinical procedures used to study drug abuse and dependence and describe recent progress that has been made in studying more specific aspects of addictive behavior in animals.
Topics: Alcohol Drinking; Alcoholism; Animals; Behavior, Addictive; Conditioning, Psychological; Disease Models, Animal; Rats; Substance-Related Disorders
PubMed: 24271226
DOI: 10.1590/1516-4446-2013-1149 -
Addictive Behaviors Mar 2009There is substantial evidence that alcohol, tobacco, and cannabis dependence problems surface more quickly when use of these drugs starts before adulthood, but the... (Review)
Review
There is substantial evidence that alcohol, tobacco, and cannabis dependence problems surface more quickly when use of these drugs starts before adulthood, but the evidence based on other internationally regulated drugs (e.g., cocaine) is meager. With focus on an interval of up to 24 months following first drug use, we examine drug-specific and age-specific variation in profiles of early-emerging clinical features associated with drug dependence. Based upon the United States National Surveys on Drug Use and Health (NSDUH) conducted in 2000-2002, the risk of experiencing drug dependence problems was robustly greater for adolescent recent-onset users of cocaine, psychostimulant drugs other than cocaine, analgesics, anxiolytic medicines, inhalants drugs, and cannabis, as compared to adult recent-onset users (odds ratio=1.5-4.3, p<0.05). This was not the case for the NSDUH hallucinogens group (e.g., LSD). The adolescent onset associated excess risk was not constant across all clinical features. Our evidence suggests promoting earlier detection and interventions, as well as greater parent and peer awareness of drug dependence clinical features that may develop early among young people who have just started using drugs.
Topics: Adolescent; Age Factors; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Risk Factors; Substance-Related Disorders; Young Adult
PubMed: 19022584
DOI: 10.1016/j.addbeh.2008.10.021 -
Magnesium Research Mar 2008Magnesium decreases the intensity of some drug-induced dependences (e.g. opiates, nicotine, cocaine, amphetamine, ethanol, etc.). The main mechanism involved is a... (Review)
Review
Magnesium decreases the intensity of some drug-induced dependences (e.g. opiates, nicotine, cocaine, amphetamine, ethanol, etc.). The main mechanism involved is a decreasing activity of central glutamatergic synapses, especially those involved in the reward system. There are many particularities of action for each drug dependence. Apart from the effects during emerging dependence, magnesium ions administered only during the withdrawal syndrome decrease the intensity of clinical symptoms. In some cases, Mg2+ decreased the relapse and reinstatement of cocaine and amphetamine intake. Administered alone, in the absence of any abused drug, Mg2+ has moderate stimulatory effects on the reward system and reinforcement, without inducing dependence. The existent data stress a modulatory role of Mg2+ in some drug-induced dependences. Therapeutic administration of magnesium decreases nicotine dependence and cocaine/amphetamine self-administration.
Topics: Amphetamine; Animals; Behavior, Addictive; Cocaine; Cocaine-Related Disorders; Magnesium; Models, Biological; Nicotine; Substance-Related Disorders; Tobacco Use Disorder
PubMed: 18557129
DOI: No ID Found -
Alcohol Research & Health : the Journal... 2008Alcohol dependence and dependence on other drugs frequently co-occur, and strong evidence suggests that both disorders are, at least in part, influenced by genetic... (Review)
Review
Alcohol dependence and dependence on other drugs frequently co-occur, and strong evidence suggests that both disorders are, at least in part, influenced by genetic factors. Indeed, studies using twins suggest that the overlap between dependence on alcohol and on other drugs largely results from shared genetic factors. This common genetic liability, which also extends to antisocial behavior, has been conceptualized as a general predisposition toward a variety of forms of psychopathology characterized by disinhibited behavior (i.e., externalizing psychopathology). Accordingly, many of the genetic factors affecting risk for dependence on alcohol or other drugs appear to act through a general externalizing factor; however, other genetic factors appear to be specific to a certain disorder. In recent years, researchers have identified numerous genes as affecting risk for dependence on alcohol and other drugs. These include genes involved in alcohol metabolism as well as in the transmission of nerve cell signals and modulation of nerve cell activity (i.e., γ-aminobutyric acid [GABA] and acetylcholinergic neurotransmission and the endogenous opioid and cannabinoid systems).
Topics: Alcoholism; Animals; Genetic Predisposition to Disease; Humans; Mental Disorders; Substance-Related Disorders
PubMed: 23584813
DOI: No ID Found -
The Primary Care Companion For CNS... Feb 2017To examine the clinical characteristics and course of benzodiazepine and �Z-drug� dependence in patients presenting to a tertiary deaddiction center in southern India.
OBJECTIVE
To examine the clinical characteristics and course of benzodiazepine and �Z-drug� dependence in patients presenting to a tertiary deaddiction center in southern India.
METHODS
Case files of 950 inpatients admitted between January 2007 and January 2014 who reported benzodiazepine or Z-drug use were reviewed. Patients (n = 170) with an ICD-10 diagnosis of mental and behavioral disorders due to the use of sedatives or hypnotics-dependence syndrome currently using substance (F13.24) were included in this study.
RESULTS
Alprazolam (n = 86, 50.6%), nitrazepam (n = 40, 23.5%), and zolpidem (n = 19, 11.2%) were the most commonly reported drugs of abuse. Alcohol dependence was present in 37 subjects (21.8%) and opioid dependence in 41 subjects (24.1%). Comorbid psychiatric illness was diagnosed in 67 patients (39.0%). Only 28 patients (16.5%) had sedative dependence with no other substance use disorder.
CONCLUSION
High comorbidity occurs in this group of patients. Outcome varies significantly (P < .05) between sedative-dependent only and multiple-substance�dependent patients. High attrition should be addressed through follow-up and tracking mechanisms.
Topics: Acetamides; Adult; Azabicyclo Compounds; Bacterial Proteins; Benzodiazepines; Female; Humans; Hypnotics and Sedatives; India; Male; Mental Disorders; Piperazines; Prescription Drug Misuse; Pyridines; Pyrimidines; Substance-Related Disorders; Tertiary Care Centers; Unemployment; Zolpidem
PubMed: 28207998
DOI: 10.4088/PCC.16br02025 -
Canadian Journal of Psychiatry. Revue... Apr 2014Our study sought to identify sociodemographic, clinical, life perception, and service use characteristics that distinguish new cases of people dependent on substances...
OBJECTIVE
Our study sought to identify sociodemographic, clinical, life perception, and service use characteristics that distinguish new cases of people dependent on substances from the general population; and to determine predictors of substance dependence over a 2-year period. Variables that differentiate people dependent on substances according to sex and age were also assessed.
METHODS
Among 2434 people who took part in an epidemiologic catchment area health survey at baseline, 2.2% were identified with substance dependence at the second measurement time only. Using a comprehensive framework, various aspects were considered as predictors for multivariate statistics.
RESULTS
Participants with substance dependence at time 2 only showed worse clinical conditions, life events, life and health perception, and neighbourhood characteristics than other participants, but only 2.5% used health care services. Male sex, younger age, stigmatization, and impulsiveness were predictors of substance dependence. Regarding sex, females with dependence were only more likely to suffer from social phobia than males. In terms of age categories, participants over 50 with substance dependence were more likely to have a lower household income and less social support than younger people.
CONCLUSION
Stigmatization was the strongest predictor of substance dependence. Our study also confirmed that males and younger people were more likely to have substance dependence. Anti-stigmatization, prevention, and outreach programs are needed to overcome the reluctance of this clientele to use health care services. Health professionals should also pay more attention to life and health perception and neighbourhood characteristics of newly identified drug users.
Topics: Adult; Age Factors; Alcoholism; Attitude to Health; Canada; Demography; Female; Health Surveys; Humans; Life Change Events; Male; Middle Aged; Needs Assessment; Preventive Health Services; Preventive Psychiatry; Prognosis; Risk Factors; Sense of Coherence; Sex Factors; Socioeconomic Factors; Stereotyping; Substance-Related Disorders
PubMed: 25007113
DOI: 10.1177/070674371405900405 -
Trends in Cognitive Sciences Jul 2015Brain lesions that damage the insular cortex (IC) interrupt addictive behaviors, suggesting that drug addiction sensitizes the insula. However, neuroimaging studies seem... (Review)
Review
Brain lesions that damage the insular cortex (IC) interrupt addictive behaviors, suggesting that drug addiction sensitizes the insula. However, neuroimaging studies seem to lead to an opposite picture: structural neuroimaging studies show reduced gray matter volume of the IC of drug users, and functional neuroimaging studies show reduced IC activity when drug users perform decision-making tasks. These results have been interpreted as indicating that addictive behaviors are associated with reduced interoceptive signaling within the IC. Here, we use this apparent contradiction to examine the possible roles of the insula in addiction, identify open questions, and explore ways to address them.
Topics: Animals; Cerebral Cortex; Humans; Neuroimaging; Substance-Related Disorders
PubMed: 26066588
DOI: 10.1016/j.tics.2015.05.005 -
British Journal of Pharmacology May 2008Drug addiction presents as a chronic relapsing disorder characterized by persistent drug-seeking and drug-taking behaviours. Given the significant detrimental effects of... (Review)
Review
Drug addiction presents as a chronic relapsing disorder characterized by persistent drug-seeking and drug-taking behaviours. Given the significant detrimental effects of this disease both socially and economically, a considerable amount of research has been dedicated to understanding a number of issues in addiction, including behavioural and neuropharmacological factors that contribute to the development, loss of control and persistence of compulsive addictive behaviours. In this review, we will give a broad overview of various theories of addiction, animal models of addiction and relapse, drugs of abuse, and the neurobiology of drug dependence and relapse. Although drugs of abuse possess diverse neuropharmacological profiles, activation of the mesocorticolimbic system, particularly the ventral tegmental area, nucleus accumbens, amygdala and prefrontal cortex via dopaminergic and glutamatergic pathways, constitutes a common pathway by which various drugs of abuse mediate their acute reinforcing effects. However, long-term neuroadaptations in this circuitry likely underlie the transition to drug dependence and cycles of relapse. As further elucidated in more comprehensive reviews of various subtopics on addiction in later sections of this special issue, it is anticipated that continued basic neuroscience research will aid in the development of effective therapeutic interventions for the long-term treatment of drug-dependent individuals.
Topics: Animals; Behavior, Addictive; Behavior, Animal; Central Nervous System Agents; Dopamine; Glutamic Acid; Humans; Limbic System; Models, Animal; Models, Psychological; Neural Pathways; Neurotransmitter Agents; Recurrence; Substance Withdrawal Syndrome; Substance-Related Disorders
PubMed: 18311189
DOI: 10.1038/bjp.2008.51