heroin and Alcohol-Related-Disorders

Despite the availability of effective medications and psychosocial interventions for the management of a substance use disorder, some individuals repeatedly fail the most aggressive treatment regimens. For such individuals, alternative treatment options exist seeking to mitigate the negative consequences of the use of harmful substances. Participation in a managed alcohol program, or the use of sustained-release oral morphine or injectable opioid agonist treatment or the creation of safe injecting facilities, are examples of such nonstandard approaches. This article reviews the available evidence of these treatment modalities.

Topics: Alcohol-Related Disorders; Analgesics, Opioid; Delayed-Action Preparations; Heroin; Humans; Morphine; Opioid-Related Disorders; Public Housing; Randomized Controlled Trials as Topic; Severity of Illness Index

To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco).. The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded.. Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01).. Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.

Topics: Alcohol-Related Disorders; Analgesics, Opioid; Attitude; Attitude of Health Personnel; Cross-Sectional Studies; Education, Continuing; Ethanol; Heroin; Humans; Nicotiana; Pharmacists; Substance-Related Disorders

Research on the neurocognitive characteristics of heroin addiction is sparse and studies that do exist include polydrug abusers; thus, they are unable to distinguish neurocognitive effects of heroin from those of other drugs. To identify neurocognitive correlates specific to heroin addiction, the present study was conducted in St. Petersburg, Russia where individuals typically abuse and/or become addicted to only one substance, generally alcohol or heroin. Heroin addicts were recruited from an inpatient treatment facility in St. Petersburg. Three comparison groups included alcoholics, addicts who used both alcohol and heroin, and non-abusers. Psychiatric, background, and drug history evaluations were administered after detoxification to screen for exclusion criteria and characterize the sample. Executive Cognitive Functions (ECF) that largely activate areas of the prefrontal cortex and its circuitry measured include complex visual pattern recognition (Paired Associates Learning), working memory (Delayed Matching to Sample), problem solving (Stockings of Cambridge), executive decision making (Cambridge Decision Making Task), cognitive flexibility (Stroop Color-Word Task) and response shifting (Stop Change Task). In many respects, the heroin addicts were similar to alcohol and alcohol+heroin dependent groups in neurocognitive deficits relative to controls. The primary finding was that heroin addicts exhibited significantly more disadvantageous decision making and longer deliberation times while making risky decisions than the other groups. Because the nature and degree of recovery from drug abuse are likely a function of the type or pattern of neurocognitive impairment, differential drug effects must be considered.

Topics: Adolescent; Adult; Alcohol-Related Disorders; Alcoholic Beverages; Brain; Comorbidity; Cross-Sectional Studies; Decision Making; Female; Heroin; Heroin Dependence; Humans; Male; Neuropsychological Tests; Neurotoxicity Syndromes; Problem Solving; Russia; Substance Abuse Treatment Centers

To examine the relationship between key patient variables and variation in naloxone dose (from the standard dose of 1.6 mg IMI) administered by ambulance paramedics in the prehospital management of heroin overdose.. A retrospective analysis of 7985 ambulance patient care records of non-fatal heroin overdose cases collected in greater metropolitan Melbourne. The main outcome measure was the dose of intramuscular naloxone required to increase the level of consciousness and the respiratory rate in patients presenting with suspected heroin overdose. Key patient variables influencing the dose that were recorded included: age, sex, initial patient presentation and reported concurrent alcohol use.. Multinomial logistic regression revealed that patients with higher levels of consciousness and respiratory rates on arrival of the paramedic crew were more likely to receive a less than standard dose of naloxone. Conversely, patients with lower levels of consciousness and low respiratory rates received greater than standard doses of naloxone for resuscitation. Patients who received greater than the standard dose of naloxone were 2.25 (95% CI, 1.83-2.77) times more likely to have been under the influence of alcohol when consuming the heroin that resulted in overdose.. The concurrent use of alcohol with heroin resulted in the use of greater than standard doses of naloxone by paramedics in resuscitating overdose patients. It is possible that the higher dose of naloxone is required to reverse the combined effects of alcohol and heroin. There was also a link between initial patient presentation and the dose of naloxone required for resuscitation. In light of these findings, it would appear that initial patient presentation and evidence of alcohol use might be useful guides as to providing the most effective dose of naloxone in the prehospital setting.

Topics: Adolescent; Adult; Aged; Alcohol-Related Disorders; Dose-Response Relationship, Drug; Drug Overdose; Emergency Medical Services; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Naloxone; Narcotic Antagonists; Retrospective Studies

The present study examined differences in neuropsychological performance among chronic cocaine, alcohol, and polysubstance abusers. A comprehensive neuropsychological battery was completed by 355 incarcerated adult male felons who were classified by DSM-IV criteria into four subgroups: (1) alcohol dependence or abuse (ETOH) (n = 101), (2) cocaine dependence or abuse (COC) (n = 60), (3) polysubstance dependence or abuse (POLY (n = 56), and (4) a group of age and education matched adult male felons with no history of drug abuse (n = 138). Results showed no significant differences in neuropsychological performance between COC and control subjects. However, both the POLY and ETOH groups were found to perform significantly worse on nearly all measures compared to the COC and control groups. Further, analysis of neuropsychological domains showed the POLY group to perform significantly worse compared to the other groups in the areas of short-term memory, long-term memory and visual motor ability. Correlations between neuropsychological performance and length of abstinence from drug use showed the ETOH group to have made the greatest amount of improvement on individual measures and domains. The COC group showed the least amount of improvement, but their performance was not significantly different from controls. Results provide further support for the differential effects of drug use on neuropsychological functioning.

Topics: Adult; Alcohol Drinking; Alcohol-Related Disorders; Amphetamines; Chi-Square Distribution; Cocaine; Cocaine-Related Disorders; Cognition Disorders; Cross-Sectional Studies; Drug Interactions; Forensic Psychiatry; Heroin; Humans; Male; Multivariate Analysis; Neuropsychological Tests; Prisoners; Substance-Related Disorders; Time Factors

Smooth pursuit eye movements were evaluated in 21 healthy volunteers and 126 patients meeting criteria for one of the following DSM-III-R dependence diagnoses: alcohol (n = 10), cocaine (n = 44), heroin (n = 34), or dual alcohol and cocaine (n = 38). A significant reduction in tracking accuracy was found in the heroin and the dually dependent groups relative to controls. Interestingly, the eye movement dysfunction in the drug-dependent groups was no longer detectable when the effects of antisocial personality disorder were statistically removed. The magnitude of the dysfunction also correlated with several antisocial personality-related features, including an increased number of criminal charges and months of incarceration, increased problems associated with drug abuse, and lower intellectual functioning. The relationship demonstrated presently between antisocial personality disorder and eye movement dysfunction may have implications beyond studies of substance dependence.

Topics: Adult; Alcohol-Related Disorders; Antisocial Personality Disorder; Cocaine; Cocaine-Related Disorders; Comorbidity; Diagnosis, Dual (Psychiatry); Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Ocular Motility Disorders; Pursuit, Smooth; Reaction Time; Risk Factors