Current drug abuse reviews最新文献

The misuse of prescription opioids is a major public health problem in the United States, Canada, Australia and other parts of the developed world. Methods to quantify dimensions of the risk environment in relation to drug usage and law enforcement that are both structural and spatial, draw geography into traditional public health research even though there has been limited attempt to address the prescription opioid misuse problem from a geographic perspective. We discuss how geographic technologies can be utilized to study the landscape of prescription opioids and similar drugs, and target appropriate health services interventions. We use examples drawn from various jurisdictions to present our case and highlight through these examples how a geospatial perspective can help support research on prescription opioid misuse. The prescription drug misuse landscape can be studied through examination of the domains of demand, supply, harms and harm reduction. We discuss how each of these domains can benefit from a local geographic perspective, and subsequent geographic exploration and analyses.

In the the past two decades the medical use of prescription opioids (POs), in particular oxycodone, increased up to 14-fold in the U.S. and Canada. The high consumption of these pain relievers also led to non-medical use and abuse of these substances which in turn resulted in a dramatic increase in the number of PO related fatalities and opioid dependent subjects. In the U.S. POs became the second most prevalent type of abused drug (4.5 million abusers; 1.7% of the population) after marijuana (8 million abusers) with currently 1.9 million (0.7% of the population) people dependent on opioid pain relievers. Pain relief was the leading motive for non-medical use in about 40% of the cases, but about half of non-medical PO users reported non-pain relief motives only, like to get high or to relax. Since 2011, there is a decline in the use and misuse of POs and reduction in painkiller overdose deaths in the U.S. probably due to the introduction of a variety of restrictive regulations. In Europe, the medical use of POs is increasing as well, but at a much slower rate than in the U.S. Moreover, in Europe non-medical use of POs and fatal PO incidents are (still) rare. The paper highlights and discusses the differences between Europe versus U.S. and Canada in an attempt to assess the risk of a PO abuse and overdose epidemic in Europe. It is concluded that the risk in Europe seems to be rather limited but vigilance is needed.

Background: Alcohol misuse is a significant public health issue resulting in substantial morbidity, premature mortality and costs to the healthcare system. Although face-to-face interventions offered by health practitioners have been shown to be effective, they are not routinely offered due to lack of time, training and resources, and potential damage to rapport. Computerbased interventions may help overcome these implementation barriers.

Approach: Suitable research databases were searched and studies were selected if they described digital or computer-based alcohol interventions used by primary care patients. Studies which did not report patient alcohol outcomes were excluded.

Key findings: Fifteen trials were identified, eleven of which trialled brief interventions only while the remaining four trialled both brief and extended interventions. Nine trials were associated with a reduction in alcohol use at followup.

Conclusion: This is the first systematic review of digital or computer-based alcohol intervention programs used by primary care patients. Although the number of trials in this area of research is relatively small, their findings indicate effectiveness in reducing alcohol consumption as well as drinking related consequences. Extended interventions which offer additional opportunities to monitor drinking over time appear no more effective than single occasion brief interventions. These findings suggest that digital and computer-based interventions in primary care may have the potential to increase alcohol intervention activities in the general population at a relatively low cost and low burden on practitioners.

There is a wealth of research about the links between executive functioning (EF) and alcohol use. However, difficulty may arise in interpreting findings because of the variability between studies regarding the specific components of EF measured, as well as the variability of tasks used to examine each EF construct. The current article considers each of these problems within the context of a literature review that focuses on two topics: (1) the efficacy of EF in predicting alcohol use and alcohol-related consequences, and (2) the effect of acute alcohol intoxication on EF task performance. An additional goal was to identify and describe commonly used EF measures with the intention of providing alcohol researchers information on the assessment of different EF domains. Our findings indicate that there is strong evidence supporting a relation between EF difficulties (particularly response inhibition and information updating) and alcohol use, with additional evidence of a significant interaction between EF and implicit associations on alcohol use. In contrast, research supporting a link between set shifting abilities and later alcohol use is scarce. Additionally, this review found evidence of alcohol acutely affecting many EF processes (particularly response inhibition). Overall, there is a need to replicate these findings with commonly used EF tasks (versus developing numerous tasks within individual laboratories) to better advance our understanding of the relation between EF and alcohol use.

Adolescent alcohol and drug use disorders pose significant risks to adolescents' future functioning. Unfortunately, relapse rates following treatment for these disorders are high. The newest generation of interventions, designed in part to address this problem, place greater focus on the developmental needs of adolescents. In this review, we highlight the importance and promise of this progress in the field. We also argue for a further, more complete, integration of development and treatment: Instead of a focus on developmental issues as part of the process of substance use treatment, we argue for an approach in which healthy development is an outcome of equal importance to changes in substance use and risk behaviors. From this perspective, treatment should address the skills necessary for social, emotional, achievement, and identity development, with substance abuse understood as one example of dysfunctional development. We argue that this approach holds the greatest promise for providing adolescents in treatment with the skills they need to maintain successful post-treatment trajectories. In this paper, we offer theory underlying this perspective, a definition of the outcomes of healthy development that can guide researchers and clinicians, as well as proposals for both researchers and clinicians to continue to push the developmental sensitivity of adolescent substance use treatment forward.

We reviewed the cognitive and neurobiological commonalities between chemical and behavioral addictions. Poor impulse control, limited executive function and abnormalities in reward processing are seen in both group of entities. Brain imaging shows consistent abnormalities in frontoparietal regions and the limbic system. In drug addiction, exaggerated risk taking behavior and temporal discounting may reflect an imbalance between a hyperactive mesolimbic and hypoactive executive systems. Several cognitive distortions are found in pathological gambling that seems to harness the brain reward system that has evolved to face situations related to skill, not random chance. Abnormalities in risk assessment and impulsivity are found in variety of eating disorders, in particularly related to eating behavior. Corresponding findings in eating disorder patients include abnormalities in the limbic system, i.e. orbitofrontal cortex (OFC), striatum and insula. Similarly, internet addiction disorder is associated with risky decision making and increased choice impulsivity with corresponding discrepant activation in the dorsolateral prefrontal cortex, OFC, anterior cingulate cortex, caudate and insula. Sexual addictions are in turn associated with exaggerated impulsive choice and suggestive evidence of abnormalities in reward processing. In sum, exploration of executive function and decision making abnormalities in chemical and behavioral addictions may increase understanding in their psychopathology and yield valuable targets for therapeutic interventions.

Neuropyschological dysfunction, ranging from mild cerebral indicators to dementia has been a consistent part of the medical picture of HIV/AIDS. However, advances in medical supervision, particularly as a result of antiretroviral (ARV) treatment, have resulted in some mitigation of the neuropsychological effects of HIV and necessitate re-evaluation of the pattern and nature of HIV-related cognitive or mental deficits. The associated enhancements in morbidity and mortality that have occurred as a result of ARV medication have led to a need for interventions and programs that maintain behaviors that are healthy and stop the resurgence of the risk of HIV transmission. Risk factors such as mental illness and substance use that may have contributed to the initial infection with HIV still need consideration. These risk factors may also increase neuropsychological dysfunction and impact observance of prevention for treatment and recommendations. Explicitly, a better comprehension of the role of substance use on the progression of HIV-related mental decline can enlighten management and evaluation of persons living with HIV with concurrent disorders of substance use. This review provides a summary of the neurophyschology of substance use and HIV and the existing research that has looked at the effects of both substance use and HIV disease on neurophyscological function and suggestions for future research and treatment.

Ecstasy or 3,4-methylenedioxymethamphetamine (MDMA) is a popular drug of abuse. In the animal studies MDMA has been shown to have deleterious effects on the serotonergic neurotransmitter system. Understanding the adverse effects of MDMA on human brain function is of considerable importance owing to the rising number of MDMA users. Various neuroimaging studies have investigated the structural, chemical and functional differences in the brain integrity of chronic MDMA users. Various neurocognitive domains like working memory, episodic memory, semantic memory, visual stimulation, motor function and impulsivity have been compared between chronic MDMA users and nonusers using fMRI. The fMRI studies remain much more sensitive in studying the neurological deficits associated with chronic MDMA use as compared to the cognitive studies alone and therefore they serve as a prelude in our understanding of MDMA induced neurotoxicity. However they still face certain limitations contributing to inconsistency in the results and further research is needed before we can draw definitive conclusions regarding the neurotoxic effects of MDMA.