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BMC Geriatrics Jun 2019In older patients, timely recognition and treatment of medication misuse and dependence are crucial to secure medication safety and to avoid increasing health...
BACKGROUND
In older patients, timely recognition and treatment of medication misuse and dependence are crucial to secure medication safety and to avoid increasing health expenditure. Nonetheless, the detection of this condition remains challenging due to the paucity of screening instruments validated for older people. This study assesses diagnostic accuracy, reliability, validity and the factor structure of the Severity of Dependence Scale (SDS) in detecting medication misuse and dependence among hospitalized older patients, focusing on prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.
METHODS
246 adults aged 65-90 were recruited consecutively from somatic departments of the Akershus University Hospital, Norway. Among these, 100 patients were identified as prolonged users of CNSDs. Diagnostic accuracy and validity of the SDS were assessed using DSM-IV criteria for substance abuse and dependence as the reference standard. We also performed an exploratory factor analysis and assessment of internal consistency using Cronbach's alpha.
RESULTS
The area under the ROC curve was 0.86 (95%CI = 0.79-0.93; p < 0.001). A score of 5.5 was determined as the optimal cutoff for detecting CNSD misuse and dependence among older patients. Cronbach's alpha obtained was satisfactory (α = 0.73). There was a significant positive correlation between the SDS score and DSM-IV criteria for substance abuse and dependence (Pearson's correlation coefficient = 0.61, p < 0.001). The uni-dimensionality of the SDS was documented.
CONCLUSIONS
The SDS is reliable, valid and capable of detecting medication misuse and dependence among hospitalized older patients, with good diagnostic performance. The scale thus holds promise for use in both clinical and research contexts.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03162081 . Registered 3 May 2017.
Topics: Aged; Aged, 80 and over; Diagnostic and Statistical Manual of Mental Disorders; Female; Hospitalization; Humans; Male; Mass Screening; Norway; Prescription Drug Misuse; Reproducibility of Results; Severity of Illness Index; Substance-Related Disorders
PubMed: 31234786
DOI: 10.1186/s12877-019-1182-3 -
American Family Physician Jul 2013Substance misuse is common among patients in primary care settings. Although it has a substantial health impact, physicians report low levels of preparedness to identify... (Review)
Review
Substance misuse is common among patients in primary care settings. Although it has a substantial health impact, physicians report low levels of preparedness to identify and assist patients with substance use disorders. An effective approach to office-based treatment includes a coherent framework for identifying and managing substance use disorders and specific strategies to promote behavior change. Brief validated screening tools allow rapid and efficient identification of problematic drug use, including prescription medication misuse. After a positive screening, a brief assessment should be performed to stratify patients into three categories: hazardous use, substance abuse, or substance dependence. Patients with hazardous use benefit from brief counseling by a physician. For patients with substance abuse, brief counseling is also indicated, with the addition of more intensive ongoing follow-up and reevaluation. In patients with substance dependence, best practices include a combination of counseling, referral to specialty treatment, and pharmacotherapy (e.g., drug tapering, naltrexone, buprenorphine, methadone). Comorbid mental illness and intimate partner violence are common in patients with substance use disorders. The use of a motivational rather than a confrontational communication style during screening, counseling, and treatment is important to improve patient outcomes.
Topics: Directive Counseling; Domestic Violence; Female; Humans; Male; Opiate Substitution Treatment; Primary Health Care; Substance-Related Disorders
PubMed: 23939642
DOI: No ID Found -
Adicciones 2013Mexico is a country affected by drugs in every aspect: it is a drug producing country of heroin, marihuana and methamphetamines, mainly for external markets but also for...
Mexico is a country affected by drugs in every aspect: it is a drug producing country of heroin, marihuana and methamphetamines, mainly for external markets but also for the growing internal demand; it is a transit country for cocaine that has found its way through the Central American and Mexican corridor on its way to external markets and for the internal supply. As a result of the increasing availability of substances and a favorable social environment, it has become a consuming country; drug experimentation use and dependence of illegal drugs, although still low, have increased. The abuse/dependence of legal substances such as alcohol and tobacco are the main substance abuse problems; only the abuse of pharmaceuticals remains low and relatively stable, mainly as a result of low availability for medical purposes and therefore limited scope for deviation. Social costs are considerable, as happens in other countries in the region, violence being the most prevailing characteristic of the drug scene, increasing from 2008 onwards. Within these important challenges for health and security, it is also true that significant, continuous efforts have been made by demand reduction programs at the national level since 1972 and adapted to the changing circumstances. This editorial seeks to tell the story of drug transitions in Mexico and the programs that have been implemented and discusses areas of opportunity for a new approach.
Topics: Adolescent; Adult; Aged; Child; Drug Trafficking; Female; Humans; Male; Mexico; Middle Aged; Substance-Related Disorders; Young Adult
PubMed: 24217498
DOI: 10.20882/adicciones.29 -
Genes, Brain, and Behavior Jul 2019Genetic influences on alcohol and drug dependence partially overlap, however, specific loci underlying this overlap remain unclear. We conducted a genome-wide...
Genome-wide association study identifies loci associated with liability to alcohol and drug dependence that is associated with variability in reward-related ventral striatum activity in African- and European-Americans.
Genetic influences on alcohol and drug dependence partially overlap, however, specific loci underlying this overlap remain unclear. We conducted a genome-wide association study (GWAS) of a phenotype representing alcohol or illicit drug dependence (ANYDEP) among 7291 European-Americans (EA; 2927 cases) and 3132 African-Americans (AA: 1315 cases) participating in the family-based Collaborative Study on the Genetics of Alcoholism. ANYDEP was heritable (h in EA = 0.60, AA = 0.37). The AA GWAS identified three regions with genome-wide significant (GWS; P < 5E-08) single nucleotide polymorphisms (SNPs) on chromosomes 3 (rs34066662, rs58801820) and 13 (rs75168521, rs78886294), and an insertion-deletion on chromosome 5 (chr5:141988181). No polymorphisms reached GWS in the EA. One GWS region (chromosome 1: rs1890881) emerged from a trans-ancestral meta-analysis (EA + AA) of ANYDEP, and was attributable to alcohol dependence in both samples. Four genes (AA: CRKL, DZIP3, SBK3; EA: P2RX6) and four sets of genes were significantly enriched within biological pathways for hemostasis and signal transduction. GWS signals did not replicate in two independent samples but there was weak evidence for association between rs1890881 and alcohol intake in the UK Biobank. Among 118 AA and 481 EA individuals from the Duke Neurogenetics Study, rs75168521 and rs1890881 genotypes were associated with variability in reward-related ventral striatum activation. This study identified novel loci for substance dependence and provides preliminary evidence that these variants are also associated with individual differences in neural reward reactivity. Gene discovery efforts in non-European samples with distinct patterns of substance use may lead to the identification of novel ancestry-specific genetic markers of risk.
Topics: Black or African American; Chromosomes, Human, Pair 13; Chromosomes, Human, Pair 3; Genetic Loci; Humans; Phenotype; Polymorphism, Single Nucleotide; Reward; Substance-Related Disorders; Ventral Striatum; White People
PubMed: 31099175
DOI: 10.1111/gbb.12580 -
Nature Reviews. Genetics Nov 2021Substance use disorders (SUDs) are conditions in which the use of legal or illegal substances, such as nicotine, alcohol or opioids, results in clinical and functional... (Review)
Review
Substance use disorders (SUDs) are conditions in which the use of legal or illegal substances, such as nicotine, alcohol or opioids, results in clinical and functional impairment. SUDs and, more generally, substance use are genetically complex traits that are enormously costly on an individual and societal basis. The past few years have seen remarkable progress in our understanding of the genetics, and therefore the biology, of substance use and abuse. Various studies - including of well-defined phenotypes in deeply phenotyped samples, as well as broadly defined phenotypes in meta-analysis and biobank samples - have revealed multiple risk loci for these common traits. A key emerging insight from this work establishes a biological and genetic distinction between quantity and/or frequency measures of substance use (which may involve low levels of use without dependence), versus symptoms related to physical dependence.
Topics: Alcoholism; Animals; Brain; Epigenomics; Genome-Wide Association Study; Humans; Illicit Drugs; Nicotine; Substance-Related Disorders
PubMed: 34211176
DOI: 10.1038/s41576-021-00377-1 -
Addiction Biology Jan 2009A challenging question that continues unanswered in the field of addiction is why some individuals are more vulnerable to substance use disorders than others. Numerous... (Review)
Review
A challenging question that continues unanswered in the field of addiction is why some individuals are more vulnerable to substance use disorders than others. Numerous risk factors for alcohol and other drugs of abuse, including exposure to various forms of stress, have been identified in clinical studies. However, the neurobiological mechanisms that underlie this relationship remain unclear. Critical neurotransmitters, hormones and neurobiological sites have been recognized, which may provide the substrates that convey individual differences in vulnerability to addiction. With the advent of more sophisticated measures of brain function in humans, such as functional imaging technology, the mechanisms and neural pathways involved in the interactions between drugs of abuse, the mesocorticolimbic dopamine system and stress systems are beginning to be characterized. This review provides a neuroadaptive perspective regarding the role of the hormonal and brain stress systems in drug addiction with a focus on the changes that occur during the transition from occasional drug use to drug dependence. We also review factors that contribute to different levels of hormonal/brain stress activation, which has implications for understanding individual vulnerability to drug dependence. Ultimately, these efforts may improve our chances of designing treatment strategies that target addiction at the core of the disorder.
Topics: Alcoholism; Allostasis; Animals; Arousal; Brain; Corticotropin-Releasing Hormone; Cues; Dopamine; Glucocorticoids; Humans; Hypothalamo-Hypophyseal System; Illicit Drugs; Macaca mulatta; Mice; Neural Pathways; Pituitary-Adrenal System; Polymorphism, Genetic; Rats; Reward; Self Medication; Stress, Psychological; Substance-Related Disorders; gamma-Aminobutyric Acid
PubMed: 18855803
DOI: 10.1111/j.1369-1600.2008.00131.x -
Drug and Alcohol Dependence May 2008The purpose of this study was to examine substance use and dependence among cocaine dependent subjects and their siblings compared to individuals recruited from the same...
BACKGROUND
The purpose of this study was to examine substance use and dependence among cocaine dependent subjects and their siblings compared to individuals recruited from the same neighborhood and their siblings in order to better understand family and neighborhood contributions to the development of dependence.
METHODS
Cocaine dependent subjects were recruited through treatment centers. Community-based subjects were matched to cocaine dependent index cases on age, ethnicity, gender, and zip code. One full sibling for each case and community-based subject participated.
RESULTS
Cocaine dependent subjects were significantly more likely than community-based subjects to use all substances studied and were 2-10 times more likely to be dependent on alcohol and other illicit drugs. Dependence only on cocaine was uncommon (<10%). The siblings of cocaine dependent subjects had higher rates of substance use and were 1.3-3 times more likely to have a diagnosis of substance dependence compared siblings of community-based subjects. However, when analyses focused only on those who ever used a specific substance, the siblings of cocaine dependent cases were at a similar or modestly elevated risk (1.5 times) of developing dependence.
CONCLUSIONS
Cocaine dependence is characterized by polysubstance use and dependence. In addition, the prevalence of substance dependence in the community subjects was higher than reported for the general population, indicating that cocaine dependent cases live in high-risk communities with elevated prevalence of substance dependence. A potential intervention to decrease the family clustering of dependence is to reduce the initiation of drug use in relatives at risk.
Topics: Adult; Alcoholism; Cluster Analysis; Cocaine-Related Disorders; Comorbidity; Cross-Sectional Studies; Female; Genetic Predisposition to Disease; Health Surveys; Humans; Illicit Drugs; Male; Marijuana Abuse; Matched-Pair Analysis; Middle Aged; Missouri; Opioid-Related Disorders; Residence Characteristics; Risk Factors; Siblings; Smoking; Social Environment; Substance Abuse Detection; Substance Abuse, Intravenous; Substance-Related Disorders
PubMed: 18243582
DOI: 10.1016/j.drugalcdep.2007.11.023 -
British Medical Journal Mar 1974Eight cases of chlorodyne dependence seen in a London drug clinic are described. These cases and the results of an inquiry among pharmacies in central and south London...
Eight cases of chlorodyne dependence seen in a London drug clinic are described. These cases and the results of an inquiry among pharmacies in central and south London suggest that this form of drug dependence is commoner among younger people than has been supposed and that the total number of chlorodyne-dependent people in Greater London may exceed 1,000. The prognosis for cure is poor. We recommend that the supply of chlorodyne, now available without prescription to the public, should be restricted.
Topics: Adult; Capsicum; Chloroform; Drug Combinations; Ethanol; Female; Humans; London; Male; Methadone; Middle Aged; Morphine Dependence; Nonprescription Drugs; Opium; Plants, Medicinal; Prognosis; Substance Withdrawal Syndrome; Substance-Related Disorders
PubMed: 4816855
DOI: 10.1136/bmj.1.5905.427 -
The American Journal of Psychiatry Jan 2013Mood and substance use disorders commonly co-occur, yet there is little evidence-based research to guide the pharmacologic management of these comorbid disorders. The... (Review)
Review
Mood and substance use disorders commonly co-occur, yet there is little evidence-based research to guide the pharmacologic management of these comorbid disorders. The authors review the existing empirical findings, some of which may call into question current clinical pharmacotherapy practices for treating co-occurring mood and substance use disorders. The authors also highlight knowledge gaps that can serve as a basis for future research. The specific mood disorders reviewed are bipolar and major depressive disorders (either one co-occurring with a substance use disorder). Overall, findings from the relatively small amount of available data indicate that pharmacotherapy for managing mood symptoms can be effective in patients with substance dependence, although results have not been consistent across all studies. Also, in most studies, medications for managing mood symptoms did not appear to have an impact on the substance use disorder. In a recent trial for comorbid major depression and alcohol dependence, combination treatment with a medication for depression and another for alcohol dependence was found to reduce depressive symptoms and excessive drinking simultaneously. However, research has only begun to address optimal pharmacologic management of co-occurring disorders. In addition, current clinical treatment for alcohol and drug dependence often excludes new pharmacotherapies approved by the U.S. Food and Drug Administration for treating certain types of addiction. With new data becoming available, it appears that we need to revisit current practice in the pharmacological management of co-occurring mood and substance use disorders.
Topics: Alcoholism; Antidepressive Agents; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Cognitive Behavioral Therapy; Combined Modality Therapy; Comorbidity; Controlled Clinical Trials as Topic; Depressive Disorder, Major; Diagnosis, Dual (Psychiatry); Double-Blind Method; Drug Therapy, Combination; Humans; Mood Disorders; Naltrexone; Narcotic Antagonists; Psychotropic Drugs; Sertraline; Substance-Related Disorders
PubMed: 23223834
DOI: 10.1176/appi.ajp.2012.12010112 -
Differences in Drug Use among Persons Experiencing Homelessness According to Gender and Nationality.International Journal of Environmental... Feb 2023The main aims of this article are to update the data related to drug and alcohol use in persons experiencing homelessness (PEH) who use shelters, and to see if there are...
The main aims of this article are to update the data related to drug and alcohol use in persons experiencing homelessness (PEH) who use shelters, and to see if there are significant differences in their drug use depending on their gender and nationality. The article presents an analysis of the interconnections between the results of drug dependence detection tools (Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST-10), Severity of Dependence Scale (SDS)) according to gender and nationality with the intention of identifying specific needs that lead to new lines of research into better approaches to homelessness. A cross-sectional, observational and analytical method was used to analyse the experiences of persons experiencing homelessness who use various shelters in the cities of Madrid, Girona, and Guadalajara (Spain). The results show that there are no gender differences in the risks of using drugs and drug addiction, but there are differences in terms of nationality for drug addiction, with Spanish nationals showing a greater tendency to develop drug addiction. These findings have significant implications, as they highlight socio-cultural and socio-educational influence as risk factors in drug addiction behaviours.
Topics: Humans; Alcoholism; Ethnicity; Cross-Sectional Studies; Ill-Housed Persons; Substance-Related Disorders
PubMed: 36901020
DOI: 10.3390/ijerph20054007