The International journal of the addictions最新文献

This article reviews epidemiological, neurological, cognitive, and imaging data on alcohol-induced dementia. Recent studies indicate that "heavy alcohol use" (variously defined) is a contributing factor in 21-24% of cases of dementia. Research difficulties include lack of positive diagnostic criteria, few post-mortem studies, and no accepted pathological mechanism. Sulcal widening and ventricular enlargement (occasionally reversible) are the strongest findings in patients with alcohol-induced dementia. There is evidence for peripheral neuropathy, ataxia, sparing of language, and improved prognosis when patients with alcohol-induced dementia are compared to other dements. Case examples, etiologic theories, and recommendations for research, training, and clinical practice are included.

The elderly person is at risk of drug misuse and related problems because of frequent use of prescription drugs, biologic factors, and social circumstances associated with aging. Confusion, falls, and aggravation of untoward emotional states are examples of the adverse consequences. Diagnosis of drug dependency states is difficult because of the overlap of general medical disorders and mental disorders and a lack of suitable diagnostic criteria for the aged. Two case examples of drug misuse are given, and the management of drug misuse and the treatment of drug dependence on an inpatient and outpatient basis are discussed. Future research directions are suggested.

This paper reports a study of alcohol- and drug-use by older clients in relation to their health and well-being. The sample of 349 persons was drawn from adults aged 60 and over living in senior citizens apartments in Toronto. Interviews were done in several languages. The results indicated that males and those aged 60 to 65 were less happy and healthy, had fewer social supports, and more alcohol-related problems. Drug-related problems were less numerous but occurred equally for both sexes. These results indicate that new alcohol programs are needed for the elderly, and these should focus on males, especially the younger elderly in transition from work to retirement.

More than 75% of people age 65 and older use medications. Of the drugs most commonly used by older people, many have potential to interact adversely with alcohol. The absorption, distribution, metabolism, and effects of drugs or alcohol may be affected. The major adverse clinical outcomes of drug-alcohol interactions are altered blood levels of the medication or of alcohol, liver toxicity, gastrointestinal inflammation and bleeding, sedation and delirium, disulfiram-like reactions, and interference with the desired effect of medications. Since alcohol is commonly used by elderly people, educating patients about the potential for these interactions should be a routine part of health care visits.

With increased knowledge of effective prevention of adolescent smoking, there is a concomitant lack of research on effective adolescent smoking cessation. This study surveyed 77 adolescents (mean age 15.8 years) at a youth detention center in Seattle, Washington, about smoking patterns, cessation attempts, and motivations as well as withdrawal symptoms from nicotine. The results revealed that the majority of smokers had previously attempted smoking cessation (72%). The most common reasons for wanting to quit were for health concerns. Only 30.8% abstained for more than 1 month, and 35.9% abstained for less than 3 days. Nicotine craving was the most severe and most commonly reported withdrawal symptom.

Recent longitudinal studies have demonstrated that smoking cessation leads to reduced feelings of stress. This finding is not predicted by either of the two main models for smoking behavior. The nicotine resource model (Warburton) states that nicotine is used to cope with external stressors, and predicts that smokers will suffer from increased stress when they quit smoking. The deprivation reversal model (Schachter), suggests that smoking reverses the deleterious effects of deprivation; cessation will then lead to a period of increased stress, followed by a return to baseline. Although the stress/cessation data agree with neither model, they are consistent with a third explanation, namely that smoking causes stress. This model states that acute nicotine deprivation (i.e., between cigarettes) leads to increased stress. Smokers then use cigarettes to reverse these withdrawal effects and "normalize" their mood. This model explains some paradoxical aspects of the smoking/mood relationship. First, why smokers are calmed by smoking, yet report high average levels of stress. Second, why stress levels become reduced after smoking cessation; this is because the former smoker no longer suffers from the adverse mood effects of acute nicotine depletion.

We report the results of a study of the predictors of recidivism to a Juvenile Assessment Center in Hillsborough County, Florida, involving over 2,000 youths processed at the center during its first 8 months of operation. Consistent with previous research, younger aged youths, youths with abuse or neglect histories, with previous arrests for property, violence, or drug offenses, with potential vocational, leisure-recreation, and family problems, or who were arrested on property felony charges were likely to recidivate. The program activity and policy implications of these results are discussed.

The socializing impact of the family is compared to that of peers during adolescent progressive involvement with drugs. This longitudinal study replicates in the school population of Madrid the work of Kandel and associates in the state of New York in an attempt to verify the "stepping-stone" hypothesis. Although the Madrid study detected a sequence of drug use similar to that in the New York study, the Spanish study hypothesized tobacco use to be the first stage and alcohol use the second. Cultural traits explain the different findings of these studies, especially those concerning the preventive role of the mother-child bond among Spanish adolescents.

A social control drug progression model was delineated and tested using a sample of 2,626 high school students from the southwestern United States. Along with the social control constructs of parental attachment, educational attachment, religious attachment, and conventional values, we incorporated alcohol, cigarette, and marijuana use into the model as intervening variables. The model explains 39% of the variation in the self-reported amphetamine use and 24% of the variation in "hard drug" use (cocaine, heroin, LSD, and PCP). The findings suggest that the integration of social control theory and drug progression improves the predictive power of the model of adolescent drug use.