heroin and Alcoholism

Topics: Alcoholism; Body Mass Index; Bone Diseases, Metabolic; Buprenorphine; Female; Heroin; Humans; Male; Methadone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Risk Factors; Sex Factors; Testosterone

The most important task of clinical and experimental nephrology is to identify risk factors for progression of renal failure with the ultimate goal to counteract the dramatic increase of patients reaching end-stage renal disease. Recently, cigarette smoking has been recognized to be one of the most important remediable renal risk factors. The adverse renal effects of smoking seem to be independent of the underlying renal disease and the current evidence suggests a near doubling of the rate of progression in smokers vs. non-smokers. Cessation of smoking slows the rate of progression. Besides smoking, alcohol abuse has also been implicated as a renal risk factor. The present article reviews the current knowledge about the adverse renal effects of these legal drugs. Furthermore, the acute and chronic renal complications due to illegal recreational drugs is discussed. The impact of these drugs on the risk to reach end-stage renal failure is difficult to assess, which is mainly due to the fact that it is difficult to perform controlled prospective studies in substance abusers. According to estimates, 5-6% of new patients starting end-stage renal disease therapy may have opiate-use-related renal diseases in the USA--a figure which documents the magnitude of the problem. Thus, in any case of unexplained renal functional impairment substance abuse should be considered by the physician.

Topics: Acute Kidney Injury; Adolescent; Adult; Alcoholism; Amphetamines; Anti-Anxiety Agents; Benzodiazepines; Cocaine; Drug-Related Side Effects and Adverse Reactions; Hallucinogens; Heroin; Humans; Illicit Drugs; Kidney; Kidney Diseases; Kidney Failure, Chronic; Male; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Nephrotic Syndrome; Odds Ratio; Risk Factors; Smoking; Smoking Cessation; Substance-Related Disorders; Temazepam

This article includes a summary and critique of methodological limitations of the peer-reviewed studies of developmental outcome during the first 2 years in children prenatally exposed to the most commonly used drugs of abuse: tobacco, alcohol, marijuana, heroin/methadone, and cocaine. Reported effects vary by specific drug or drug combinations and amount and timing of exposure; however, few thresholds have been established. Drug effects also appear to be exacerbated in children with multiple risks, including poverty, and nonoptimal caregiving environments. Although prenatal exposure to any one drug cannot reliably predict the outcome of an individual child, it may be a marker for an array of variables that can impact development. Appropriate intervention strategies require future research that determines which factors place exposed children at risk and which are protective for optimal development.

Topics: Alcoholism; Child Abuse; Child Development; Child, Preschool; Cocaine; Cocaine-Related Disorders; Ethanol; Female; Heroin; Heroin Dependence; Humans; Infant; Infant, Newborn; Marijuana Abuse; Methadone; Nicotine; Poverty; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Factors; Smoking; Substance-Related Disorders

Data on lifetime alcohol and heroin use by 443 White and Chicano addicts of both genders were obtained from a sample of admissions to several Southern California methadone maintenance programs. Patterns of alcohol and heroin use were examined with respect to gender and ethnic differences. Repeated-measures MANOVA established an inverse pattern of alcohol and heroin use for all four groups, confirming and extending the findings of a previous study by the authors. With this additional evidence, the authors propose a compensatory model that explains the obtained inverse pattern of alcohol and heroin use and that may be suitable in examining concurrent or sequential use of other psychoactive substances in addition to alcohol. Significantly higher levels of heavy alcohol use were reported by Chicano than by White addicts. Overall findings indicate that after heroin addiction occurs, there is a convergence in patterns of substance use by both genders, although variations related to ethnicity persist, particularly for alcohol use.

Topics: Adolescent; Adult; Alcoholism; Behavior, Addictive; Ethnicity; Female; Heroin; Hispanic or Latino; Humans; Longitudinal Studies; Male; Retrospective Studies; Sex Factors; Substance-Related Disorders; White People

Topics: Alcoholism; Ambulatory Care; Amphetamines; Aversive Therapy; Barbiturates; Cannabis; Follow-Up Studies; Hallucinogens; Heroin; Heroin Dependence; Humans; Legislation, Drug; Methadone; Smoking; Substance-Related Disorders; United Kingdom

Topics: Alcoholism; Amphetamine; Aversive Therapy; Barbiturates; Heroin; Humans; Lysergic Acid Diethylamide; Methadone; Morphine Dependence; Psychodrama; Psychotherapy; Psychotherapy, Group; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Alcoholism; Amphetamine; Amphetamines; Barbiturates; Cannabis; Child; Epidemiology; Hallucinogens; Heroin; Humans; Inhalant Abuse; Personality; Smoking; Social Conditions; Substance-Related Disorders; Toxicology; United States

For patients hospitalized on inpatient detoxification units, reducing negative symptoms such as withdrawal and craving is a key treatment area. Although lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation, there is a lack of randomized controlled music therapy studies systematically investigating how lyric analysis interventions can affect patients on a detoxification unit.. The purpose of this cluster-randomized effectiveness study was to measure the effects of single-session group lyric analysis interventions on withdrawal and craving with patients on a detoxification unit. A secondary purpose of this study was to determine if relationships existed between treatment effects and participants' familiarity with the song.. Participants (N = 144) were cluster-randomized to experimental (posttest only) or wait-list control (pretest only) conditions to provide treatment to all participants in an inclusive single-session design.. Although participants in the experimental condition had lower withdrawal and craving means than participants in the control condition, these differences were not significant. Familiarity of the song in the lyric analysis was not related to withdrawal or craving.. Group-based lyric analysis interventions may be effective for temporarily relieving withdrawal and craving in patients on a detoxification unit. Familiarity of the song did not affect results. Implications for clinical practice, suggestions for future research, and limitations are provided.

Topics: Adult; Alcoholism; Central Nervous System Depressants; Cocaine; Cocaine-Related Disorders; Craving; Dopamine Uptake Inhibitors; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Music Therapy; Narcotics; Psychotherapy, Group; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome; Young Adult

People with substance use disorder (SUD) may be at increased risk of COVID-19 infection. However, there is little evidence regarding the incidence of and determinants associated with infection in this group. The aims of the study were to determine the cumulative incidence of COVID-19 among people who sought treatment for heroin, cocaine, cannabis, and alcohol use disorder in Catalonia; to identify sociodemographic, substance, and clinical determinants associated with COVID-19 infection among SUD patients; and to compare the cumulative incidence of COVID-19 infection in the population with SUD with that of the general population.. A patient-based retrospective observational study was conducted. The study population comprised people who sought treatment for heroin, cocaine, cannabis, or alcohol use disorder in Catalonia in 2018 and 2019. We analysed cumulative incidence of COVID-19 (confirmed by PCR test) from 25 February to 31 December 2020. Additionally, we used a log-link binomial generalized linear model for COVID-19 infection, using the substance as the exposition, adjusting for sociodemographic and clinical variables.. Of the 23,092 individuals who sought treatment for SUD, 38.15% were considered suspected cases of COVID-19, and 2.60% (95% CI = 2.41-2.82) were confirmed positive for COVID-19 by PCR test during the study period. Those who sought treatment for alcohol use (cumulative incidence of COVID-19 of 3% [95% CI = 2.70-3.34]) had a higher risk ratio than, those who sought treatment for heroin use (cumulative incidence of 1.94% [95% CI = 1.47-2.56]). Being born outside of Spain, living in an institutionalized residence, having HIV, and being in a high morbidity group were associated with higher risk of COVID-19 infection. Meanwhile, the cumulative incidence of COVID-19 in the general population, according to public COVID-19 test data, was 3.86% (95% CI = 3.85-3.87).. This study did not find higher cumulative incidence of COVID-19 infection among people with SUD in Catalonia in 2020, despite the clinical vulnerability of this population and their social disadvantage. However, differences were seen in the cumulative incidence of COVID-19 according to the substance for which treatment was sought. For example, those with alcohol dependence had a higher rate than those dependent on heroin. Further studies are needed to determine the factors contributing to these differences.

Topics: Alcoholism; Cocaine; COVID-19; Heroin; Humans; Incidence; Substance-Related Disorders

The Ottawa Inner City Health's Managed Opioid Program is the first, to our knowledge, to pair injectable opioid agonist hydromorphone treatment with assisted housing for people experiencing homelessness with severe opioid use disorder (OUD) and injection drug use. We aimed to describe this program and evaluate retention, health, and social wellbeing outcomes.. We retrospectively assessed the first cohort of clients enrolled in the Managed Opioid Program between August 2017-2018. The primary outcome was retention at 12 months. Secondary outcomes included injectable and oral opioid dose titration, non-prescribed opioid use, overdoses, connection with behavioural health services, and social well-being. Descriptive statistics were used to summarize baseline demographics and secondary outcomes. Actuarial survival analysis was used to assess retention among participants.. The study sample included 26 participants: median age was 36 years, 14 were female, 22 were White, eight had alcohol use disorders, 25 had stimulant use disorders, and all had a history of concurrent psychiatric illness. Retention at 12 months was 77% (95% CI 62-95). Throughout the first-year participants' opioid treatment doses increased. The median daily dose of injectable hydromorphone was 36 mg [17-54 mg] and 156 mg [108-188 mg] at enrollment and one year respectively. The median daily dose of oral opioid treatment was 120-milligram morphine equivalents [83-180 mg morphine equivalents] and 330-milligram morphine equivalents [285-428 mg morphine equivalents] at enrollment and one year respectively. Over half had no overdoses and there were no deaths among participants who remained enrolled. At one year, 45% stopped non-prescribed opioid use, 96% connected to behavioral health services, 73% reconnected with estranged families, and 31% started work or vocational programs.. Individuals with severe OUD engaged in injectable hydromorphone treatment and housing showed high retention in care and substantive improvements in patient-centered health and social well-being outcomes.

Topics: Adult; Alcoholism; Analgesics, Opioid; Canada; Female; Heroin; Housing; Humans; Hydromorphone; Opioid-Related Disorders; Retrospective Studies

Different substance dependences have common effects on reward pathway and molecular adaptations, however little is known regarding their shared genetic factors. We aimed to identify the risk genetic variants that are shared for substance dependence (SD). First, promising genome-wide significant loci were identified from 3296 patients (521 alcoholic/1026 heroin/1749 methamphetamine) vs 2859 healthy controls and independently replicated using 1954 patients vs 1904 controls. Second, the functional effects of promising variants on gene expression, addiction characteristics, brain structure (gray and white matter), and addiction behaviors in addiction animal models (chronic administration and self-administration) were assessed. In addition, we assessed the genetic correlation among the three SDs using LD score regression. We identified and replicated three novel loci that were associated with the common risk of heroin, methamphetamine addiction, and alcoholism: ANKS1B rs2133896 (P

Topics: Alcoholism; Amphetamine-Related Disorders; Animals; Heroin; Heroin Dependence; Humans; Methamphetamine; Rats

Whoonga is a smoked heroin-based street drug that first emerged in South Africa a decade ago. While previous scientific reports suggest that use is growing and youth are particularly vulnerable, trajectories of initiation are not well characterized.. In 2015, 30 men undergoing residential addiction treatment for this smoked heroin drug in KwaZulu-Natal, South Africa participated in semi-structured interviews about their experiences using the drug. Interview data were coded using qualitative content analysis.. Participant trajectories to initiating smoked heroin were "vertical" in the context of marijuana use or "horizontal" in the context of other hard drug use. Participants reporting vertical trajectories began smoking heroin as youth at school or in other settings where people were smoking marijuana. Several participants with horizontal trajectories started smoking heroin to address symptoms of other drug or alcohol addiction. Social influences on initiation emerged as an overarching theme. Members of participants' social networks who were smoking or distributing heroin figured prominently in initiation narratives. Surprisingly, references to injection drug use were absent from initiation narratives. Participants reported people who smoke heroin differ from those who inject heroin by race.. Consistent with theories implicating social and structural influences on substance use initiation, people who started smoking heroin had social contacts who smoked heroin and frequented places where substance use was common. Smoked heroin initiation for several participants with horizontal trajectories may have been averted if they accessed evidence-based treatments for stimulant or alcohol use disorders. With increasing reports of heroin use across Africa, a coordinated approach to address this growing epidemic is needed. However, because smoked heroin and injection heroin use occur in distinct risk environments, interventions tailored to people who use smoked heroin will be needed to prevent smoked heroin use, prevent transition to injection use, and mitigate other social harms.

Topics: Adolescent; Alcoholism; Heroin; Heroin Dependence; Humans; Illicit Drugs; Male; South Africa; Substance Abuse, Intravenous

With the worsening of the opioid epidemic, there has been an increasing number of cases in which patients are "found down" following a drug overdose and develop a crush injury resulting in muscle necrosis, rhabdomyolysis, and elevated compartment pressures in a unique presentation of compartment syndrome. The purpose of the present study is to summarize our experience at a trauma center in a region with a high endemic rate of opiate abuse to provide guidance for the management of patients with "found down" compartment syndrome.. We performed a retrospective review of the records of patients who had been found unconscious as the result of overdose, with findings that were concerning for compartment syndrome, and had been managed with fasciotomy or observation at the discretion of the surgeon. The patients were divided into 3 groups based on presentation (partial deficits, complete deficits, or unexaminable), and the operative findings, hospital course, laboratory values, and functional status were compared between the groups.. Over 12 years, we identified 30 "found down" patients who had an examination that was concerning for compartment syndrome. Twenty-five patients were managed with fasciotomy; this group required an average of 4.2 operations and had a 20% infection rate and a 12% amputation rate. Lactate, creatine phosphokinase, and creatinine levels typically were elevated but did not correspond with muscle viability or return of function. At the time of initial debridement, 56% of patients had muscle that appeared nonviable, although muscle function returned in 28% of the patients who had questionable viability. Four patients had no motor or neurological function on initial examination, and none had meaningful return of function at the time of the latest follow-up. Of the 10 patients who had partial neurological deficits at the time of presentation and underwent fasciotomy, over half (70%) had some improvement in ultimate function.. Patients who are "found down" following an opiate overdose with crush injuries resulting in compartment syndrome have a high surgical complication rate and poor recovery of function. The limited data from the present study suggest that those with absent function at the time of presentation are unlikely to gain function after fasciotomy, and the risk-benefit ratio of fasciotomy in this patient population may be different from that for patients with traumatic compartment syndrome.. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Topics: Adult; Alcoholism; Analgesics, Opioid; Buttocks; Compartment Syndromes; Crush Injuries; Debridement; Drug Overdose; Fasciotomy; Female; Forearm; Heroin; Humans; Leg; Male; Middle Aged; Opioid Epidemic; Time Factors; United States; Young Adult

The Kreek-McHugh-Schluger-Kellogg (KMSK) scales provide a rapid assessment of maximal self-exposure to specific drugs and can be used as a dimensional instrument. This study provides a re-evaluation of the KMSK scales for cannabis, alcohol, cocaine, and heroin in a relatively large multi-ethnic cohort, and also the first systematic comparison of gender-specific profiles of drug exposure with this scale.. This was an observational study of n = 1,133 consecutively ascertained adult volunteers. The main instruments used were the SCID-I interview (DSM-IV criteria) and KMSK scales for cannabis, alcohol, cocaine, and heroin.. Participants were 852 volunteers (297 female) with specific DSM-IV abuse or dependence diagnoses, and 281 volunteers without any drug diagnoses (154 female). Receiver operating characteristic (ROC) curves were calculated for concurrent validity of KMSK scores with the respective DSM-IV dependence diagnoses. The areas under the ROC curves for men and women combined were 99.5% for heroin, 97% for cocaine, 93% for alcohol, and 85% for cannabis. Newly determined optimal KMSK "cutpoint" scores were identical for men and women for cocaine and heroin dependence diagnoses, but were higher in men than in women, for cannabis and alcohol dependence diagnoses.. This study confirms the scales' effectiveness in performing rapid dimensional analyses for cannabis, alcohol, cocaine, and heroin exposure, in a cohort larger than previously reported, with "cutpoints" changed from initial determinations, based on this larger sample. The KMSK scales also detected gender differences in self-exposure to alcohol and cannabis that are associated with the respective dependence diagnoses.

Topics: Adult; Alcoholism; Cannabis; Cocaine; Cohort Studies; Diagnostic and Statistical Manual of Mental Disorders; Female; Heroin; Heroin Dependence; Humans; Male; Marijuana Abuse; Middle Aged; ROC Curve; Sex Characteristics; Substance-Related Disorders; Young Adult

Since 2000, heroin use patterns have shifted within the United States. How this change may relate to polydrug use among local heroin users is unknown. Although polydrug use has been studied, user perceptions of drug use in terms of health risks, arrest risk, availability, cost, liking, and dependence have not been considered.. Data are presented from a brief, face-to-face survey conducted in 2016 of 200 non-in-treatment heroin users from Cleveland, OH. We assessed the use of and attitudes on alcohol, marijuana, methamphetamine, heroin, crack cocaine, powder cocaine, and prescription drugs. We estimated polydrug (concurrent past month) use with cluster analysis and latent profiles. Regression analysis estimated the strength of relationships between attitudes and frequency of use.. We identified five clusters: Cluster 1 used heroin concomitantly with alcohol and occasionally crack; Cluster 2 used heroin and crack cocaine daily; Cluster 3 used heroin daily and almost exclusively; Cluster 4 used heroin and marijuana daily; and Cluster 5 were part-time drug users. Drug use frequency was associated with liking and being anxious when drugs could not be obtained. High perceived availability of heroin and cocaine and low cost facilitated polydrug use.. Understanding polydrug use clusters among heroin users is important for addressing the larger opioid epidemic. Users' perceptions of a drug's availability and cost appeared to facilitate polydrug use and justify more detailed future research on drug access.

Topics: Adult; Alcoholism; Amphetamine-Related Disorders; Analgesics, Opioid; Cocaine-Related Disorders; Crack Cocaine; Drug Users; Female; Heroin; Heroin Dependence; Humans; Male; Marijuana Abuse; Middle Aged; Ohio; Self Report; Substance-Related Disorders

There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients.. This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined.. Overall, 75.5% of the sample used any substance, including alcohol (62.0%), tobacco (44.1%), or illicit drugs/nonmedical medications (27.9%) in the past 12 months (marijuana 20.8%, cocaine 7.3%, opioids 4.8%, sedatives 4.1%, heroin 3.9%). The prevalence of any 12-month SUD was 36.0% (mild disorder 14.2%, moderate/severe disorder 21.8%): tobacco 25.3% (mild 11.5%, moderate/severe 13.8%); alcohol 13.9% (mild 6.9%, moderate/severe 7.0%); and any illicit/nonmedical drug 14.0% (mild 4.0%, moderate/severe 10.0%). Among past 12-month users, a high proportion of tobacco or drug users met criteria for a disorder: tobacco use disorder 57.4% (26.1% mild, 31.3% moderate/severe) and any drug use disorder 50.2% (14.3% mild, 35.8% moderate/severe); a lower proportion of alcohol users (22.4%) met criteria for alcohol use disorder (11.1% mild, 11.3% moderate/severe). Over 80% of adults with opioid/heroin use disorder met criteria for a moderate/severe disorder. Younger ages, male sex, and low education were associated with increased odds of having SUD.. These findings reveal the high prevalence of SUDs in primary care and underscore the need to identify and address them.

Topics: Adult; Alcoholism; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Heroin; Humans; Hypnotics and Sedatives; Illicit Drugs; Opioid-Related Disorders; Prevalence; Primary Health Care; Substance-Related Disorders; Tobacco Use Disorder

To date, it has been difficult to address the issue of sexual functioning and drug use, and many approaches to it have basic problems and methodological errors.. The present cross-sectional study compared the sexual functioning scores of a group of drug users with those of a group of nondrug users. It explored the relationship between drug abstinence and sexual functioning.. A sample of 905 males participated in this study (549 met the substance dependence criteria and 356 were controls). All of them were assessed with the Changes in Sexual Functioning Questionnaire-Drugs version.. The assessment was conducted from September 2009 to January 2011. The clinical sample was evaluated in nine different substance abuse treatment facilities.. Results show that, overall, all dimensions (pleasure, desire, arousal, and orgasm) were moderately impaired. Yet, differences regarding preferred substance were observed. Pleasure and orgasm were the two areas most significantly impaired. In these areas, all drugs seemed to negatively affect sexual functioning. However, desire and arousal were not affected by all the substances. In addition, at least after 2 weeks of drug abstinence, no relationship was found between drug abstinence and improvement in sexual functioning. The sample studied had an average of 1 year of drug abstinence and was found to have poorer sexual functioning than the control group.. Therefore, these results seem to contradict those that argue that drug use only impairs sexual functioning temporarily. Moreover, they suggest that sexual functioning does not improve just by stopping drug use.

Topics: Adult; Alcoholism; Arousal; Cocaine; Drug Synergism; Ethanol; Follow-Up Studies; Heroin; Humans; Illicit Drugs; Libido; Male; Middle Aged; Orgasm; Pleasure; Sexual Dysfunction, Physiological; Sexuality; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Substance Withdrawal Syndrome; Substance-Related Disorders

Alprazolam is a benzodiazepine anxiolytic widely prescribed for treatment of panic-disorder and social phobias, although this medication is also subject to abuse. In this paper, the concentrations of alprazolam in venous blood samples from impaired drivers were compared with femoral blood samples from forensic autopsies classified as intoxication or other causes of death (e.g. natural, trauma). After liquid-liquid extraction (n-butyl acetate) alprazolam was determined in blood by capillary gas chromatography with a nitrogen-phosphorous detector. The mean (median) and range of alprazolam concentrations in blood from impaired drivers (n = 773) were 0.08 mg/L (0.05 mg/L) and 0.02-3.9 mg/L, respectively. Many traffic offenders had co-ingested ethanol (13%), amphetamine (46%), cannabis (32%), or heroin (14%), as well as other drugs. In deaths attributed to drug intoxication, the mean (median) and range of alprazolam concentrations in blood (n = 438) were 0.10 mg/L (0.06 mg/L) and 0.02-1.6 mg/L, respectively, which were not much different from other causes of death (n = 278); 0.08 mg/L (0.05 mg/L) and 0.02-0.9 mg/L. Median concentrations of alprazolam in blood from living and deceased persons did not seem to depend on the number of co-ingested substances. The result of this pharmacoepidemiological study suggests that alprazolam is a fairly innocent drug when used as monotherapy, but toxicity problems arise when co-ingested with illicit drugs and/or psychoactive medication.

Topics: Age Factors; Alcoholism; Alprazolam; Amphetamine; Anti-Anxiety Agents; Automobile Driving; Crime; Databases, Factual; Female; Forensic Toxicology; Heroin; Humans; Illicit Drugs; Male; Marijuana Abuse; Psychotropic Drugs; Substance Abuse Detection; Substance-Related Disorders; Sweden; Wounds and Injuries

Objective. Acute or chronic heroin abuse has been associated with various central neurologic pathologies and, occasionally, with peripheral nervous system damage. The effect of heroin on hearing has not been adequately documented, although several cases with sudden hearing loss owed to heroin abuse have been reported. We present a young male with bilateral sudden sensorineural hearing loss, following heroin sniffing and alcohol consumption. Methods. Our patient underwent a detailed clinical and audiological evaluation, including auditory brainstem responses and otoacoustic emission. Routine laboratory blood tests and imaging studies were performed. Results. The patient was treated with corticosteroids and magnesium, resulting in complete restoration of hearing after one month. Conclusion. Sudden hearing loss owed to heroin abuse is usually curable, following adequate treatment.

Topics: Adult; Alcoholism; Audiometry; Central Nervous System Depressants; Ethanol; Evoked Potentials, Auditory, Brain Stem; Hearing Loss, Bilateral; Hearing Loss, Sudden; Heroin; Heroin Dependence; Humans; Male; Otoacoustic Emissions, Spontaneous

Animal models of drug dependence have described both reductions in brain reward processes and potentiation of stress-like (or anti-reward) mechanisms, including a recruitment of corticotropin-releasing factor (CRF) signaling. Accordingly, chronic exposure to opiates often leads to the development of mechanical hypersensitivity. We measured paw withdrawal thresholds (PWTs) in male Wistar rats allowed limited (short access group: ShA) or extended (long access group: LgA) access to heroin or cocaine self-administration, or in rats made dependent on ethanol via ethanol vapor exposure (ethanol-dependent group). In heroin self-administering animals, after transition to LgA conditions, thresholds were reduced to around 50% of levels observed at baseline, and were also significantly lower than thresholds measured in animals remaining on the ShA schedule. In contrast, thresholds in animals self-administering cocaine under either ShA (1 h) or LgA (6 h) conditions were unaltered. Similar to heroin LgA rats, ethanol-dependent rats also developed mechanical hypersensitivity after eight weeks of ethanol vapor exposure compared to non-dependent animals. Systemic administration of the CRF1R antagonist MPZP significantly alleviated the hypersensitivity observed in rats dependent on heroin or ethanol. The emergence of mechanical hypersensitivity with heroin and ethanol dependence may thus represent one critical drug-associated negative emotional state driving dependence on these substances. These results also suggest a recruitment of CRF-regulated nociceptive pathways associated with escalation of intake and dependence. A greater understanding of relationships between chronic drug exposure and pain-related states may provide insight into mechanisms underlying the transition to drug addiction, as well as reveal new treatment opportunities. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

Topics: Alcoholism; Animals; Cocaine; Cocaine-Related Disorders; Heroin; Heroin Dependence; Hyperalgesia; Male; Pain Perception; Pain Threshold; Physical Stimulation; Pyrimidines; Rats; Rats, Wistar; Receptors, Corticotropin-Releasing Hormone; Reward; Self Administration

Once dependent on alcohol or opioids, negative affect may accompany withdrawal. Dependent individuals are hypothesized to "self-medicate" in order to cope with withdrawal, which promotes escalated alcohol and drug use.. The current study aimed to develop a reliable animal model to assess symptoms that occur during spontaneous alcohol and opioid withdrawal.. Dependence was induced using intermittent alcohol exposure or pulsatile heroin delivery and assessed for the presence of withdrawal symptoms during acute withdrawal by measuring somatic signs, behavior in the forced swim test (FST), and air-puff-induced 22-kHz ultrasonic vocalizations (USVs). Additional animals subjected to 8 weeks of alcohol vapor exposure were evaluated for altered somatic signs, operant alcohol self-administration, and 22-kHz USV production, as well as performance in the elevated plus maze (EPM).. During spontaneous withdrawal from pulsatile heroin or intermittent alcohol vapor, animals displayed increased somatic withdrawal signs, FST immobility, and 22-kHz USV production but did not show any behavioral change in the EPM unless the duration of alcohol exposure was extended to 4 weeks. Following 8 weeks of alcohol vapor exposure, animals displayed somatic withdrawal signs, escalated alcohol self-administration, and increased 22-kHz USVs.. These paradigms provide consistent methods to evaluate the behavioral ramifications, and neurobiological substrates, of alcohol and opioid dependence during spontaneous withdrawal. As immobility in the FST and percent open-arm time in the EPM were dissociable, with 22-kHz USVs paralleling immobility in the FST, assessment of air-puff-induced 22-kHz USVs could provide an ethologically valid alternative to the FST.

Topics: Affect; Alcoholism; Animals; Conditioning, Operant; Disease Models, Animal; Ethanol; Heroin; Heroin Dependence; Male; Maze Learning; Rats; Rats, Wistar; Self Administration; Substance Withdrawal Syndrome; Swimming; Time Factors; Vocalization, Animal

The aim of the study was to investigate predictors of offending among prisoners from official records after controlling for age at first conviction and antisocial personality disorder. The participants were 198 Scottish prisoners, who had completed Diagnostic Statistical Manual IV screens for child and adult attention-deficit hyperactivity disorder (ADHD) symptoms and the Millon Clinical Multiaxial Inventory III for Axis I and Axis II disorders. The ADHD symptomatic group had significantly higher rates of total, acquisitive and violent offending than other prisoners, as well as greater regular heroin use. Hierarchical multiple regressions, using child and adult symptoms as dimensions, showed that frequent use of heroin in the year prior to imprisonment was the single most powerful predictor of the extent of total offending, with ADHD symptoms also adding independently to the variance in offending. In contrast, for violent offending, ADHD symptoms were the strongest predictor followed by alcohol dependence. The findings demonstrate the importance of heroin use and ADHD symptoms in the persistence of offending. There is an urgent need to treat drug addiction and ADHD symptoms in order to reduce offending among the most persistent offenders. Recently, treatment programmes have been developed for adults with ADHD, heroin and crack cocaine addiction which can be applied to this population.

Topics: Alcoholism; Antisocial Personality Disorder; Attention Deficit Disorder with Hyperactivity; Criminals; Heroin; Heroin Dependence; Humans; Male; Prisoners; Scotland; Substance-Related Disorders; Surveys and Questionnaires; Violence

HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users.. A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4+ cell count, and viral load were performed every 6 months.. Crack-cocaine users were 2.14 times [95% confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to

Topics: Adult; Alcoholism; Antiretroviral Therapy, Highly Active; Cannabis; CD4 Lymphocyte Count; Cocaine-Related Disorders; Cohort Studies; Crack Cocaine; Disease Progression; Female; Heroin; HIV Infections; Humans; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Substance-Related Disorders; Viral Load

The aim of this study was to determine predictors of non-fatal overdose (OD) among a cohort of 470 adults after detoxification from heroin, cocaine or alcohol.. We examined factors associated with time to OD during 2 years after discharge from an urban detoxification unit in Boston, MA, USA using multivariable regression analyses. Separate analyses were performed for both the total sample and a subgroup with problem opioid use.. Lifetime prevalence for any OD was 30.9% (145/470) in the total sample and 42.3% (85/201) in patients with opioid problems. During the 2-year follow-up, OD was estimated to occur in 16.9% of the total sample and 26.7% of the opioid problem subgroup, with new-onset (incidence) OD estimated at 5.7% and 11.0%, respectively. Factors associated with an increased hazard of OD in both samples included white race, more depressive symptoms, and prior OD regardless of intent. Prior suicidal ideation or attempt was not associated with future OD.. Findings underscore both the high prevalence of non-fatal OD among detoxification patients especially opioid users, and the potency of prior OD as a risk factor for future OD. Depressive symptoms, a modifiable risk factor, may represent a potential intervention target to prevent OD, including some "unintentional" ODs.

Topics: Adult; Alcoholism; Boston; Cocaine; Cocaine-Related Disorders; Comorbidity; Cross-Sectional Studies; Depression; Drug Overdose; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Proportional Hazards Models; Prospective Studies; Risk Factors; Urban Population

HIV-infected substance users have poorer health outcomes than other HIV risk groups. Few studies have examined the impact of specific types of substance use on health care. This study investigated the associations between specific types of substances of abuse and access to health care. HIV-infected individuals living in eight different single room occupancy hotels in the Bronx, New York, were interviewed between August 1999 and February 2001 regarding demographics, health care access and utilization, and drug and alcohol use. Of the 238 participants, the majority were male (59%), black or Hispanic (93%), and active drug users (61%). Individuals reporting any drug or crack/cocaine use were less likely to have a regular provider than those reporting no drug or no crack/cocaine use (adjusted odds ratio [AOR] = 0.50, p = 0.05; AOR =0.35, p = 0.004, respectively), while those with binge alcohol use were more likely to have a regular doctor than those without binge alcohol use (AOR = 2.61, p = 0.05). Individuals reporting any drug or crack/cocaine use were also less likely to perceive quality of health care positively (AOR = 0.50, p = 0.02; AOR = 0.37, p = 0.002, respectively). Heroin use, and injection drug use were not associated with these outcomes. When the sample was limited to recent drug users, similar patterns were found. Although drug use in general is associated with negative health outcomes, in this study, poorer measures of access to health care among substance users was associated predominantly with crack/cocaine use. It is important that clinicians and researchers working with substance-using populations understand how specific types of substance use differentially impact on health care.

Topics: Adult; Alcoholism; Cocaine; Female; Health Services Accessibility; Heroin; HIV; HIV Infections; Humans; Male; Middle Aged; New York City; Substance-Related Disorders

Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services.. This study compared the sociodemographic, clinical, and health care utilization characteristics of a multisite sample of HIV-positive persons who were hard to reach with a nationally representative cohort of persons with HIV infection who were receiving care from known HIV providers in the United States and examined whether the independent correlates of low ambulatory utilization differed between the 2 samples.. We compared sociodemographic, clinical, and health care utilization characteristics in 2 samples of adults with HIV infection: 1286 persons from 16 sites across the United States interviewed in 2001-2002 for the Targeted HIV Outreach and Intervention Initiative (Outreach), a study of underserved persons targeted for supportive outreach services; and 2267 persons from the HIV Costs and Services Utilization Study (HCSUS), a probability sample of persons receiving care who were interviewed in 1998. We conducted logistic regression analyses to identify differences between the 2 samples in sociodemographic and clinical associations with ambulatory medical visits.. Compared with the HCSUS sample, the Outreach sample had notably greater proportions of black respondents (59% vs. 32%, P = 0.0001), Hispanics (20% vs. 16%), Spanish-speakers (9% vs. 2%, P = 0.02), those with low socioeconomic status (annual income < Dollars 10,000 75% vs. 45%, P = 0.0001), the unemployed, and persons with homelessness, no insurance, and heroin or cocaine use (58% vs. 47%, P = 0.05). They also were more likely to have fewer than 2 ambulatory visits (26% vs. 16%, P = 0.0001), more likely to have emergency room visits or hospitalizations in the prior 6 months, and less likely to be on antiretroviral treatment (82% vs. 58%, P = 0.0001). Nearly all these differences persisted after stratifying for level of ambulatory utilization (fewer than 2 vs. 2 or more in the last 6 months). In multivariate analysis, several variables showed significantly different associations in the 2 samples (interacted) with low ambulatory care utilization. The variables with significant interactions (P values for interaction shown below) had very different adjusted odds ratios (and 95% confidence intervals) for low ambulatory care utilization: age greater than 50 (Outreach 0.55 [0.35-0.88], HCSUS 1.17 [0.65-2.11)], P = 0.05), Hispanic ethnicity (Outreach 0.81 [0.39-1.69], HCSUS 2.34 [1.56-3.52], P = 0.02), low income (Outreach 0.73 [0.56-0.96], HCSUS 1.35 [1.04-1.75], P = 0.002), and heavy alcohol use (Outreach 1.74 [1.23-2.45], HCSUS 1.00 [0.73-1.37], P = 0.02). Having CD4 count less than 50 was associated with elevated odds of low ambulatory medical visits in the Outreach sample (1.53 [1.00-2.36], P = 0.05).. Compared with HCSUS, the Outreach sample had far greater proportions of traditionally vulnerable groups, and were less likely to be in care if they had low CD4 counts. Furthermore, heavy alcohol use was only associated with low ambulatory utilization in Outreach. Generalizing from in care populations may not be warranted, while addressing heavy alcohol use may be effective at improving utilization of care for hard-to-reach HIV-positive populations.

Topics: Adolescent; Adult; Age Factors; Alcoholism; Ambulatory Care; Anti-Retroviral Agents; CD4 Lymphocyte Count; Cocaine; Cohort Studies; Community-Institutional Relations; Confidence Intervals; Emergency Service, Hospital; Ethnicity; Female; Health Services; Health Services Accessibility; Health Status; Heroin; HIV Infections; Humans; Ill-Housed Persons; Insurance, Health; Logistic Models; Male; Medically Uninsured; Middle Aged; Multivariate Analysis; Odds Ratio; Socioeconomic Factors; Time Factors; United States

2015 subjects were interviewed at musical events and raves in Northern Italy: average age 25.1, 42% female, 67% work, 42% study, 61% have higher certificate of education. 3.8% used drugs for the first time in the last year, and 60% have been using drugs for over 5 years, age of first use 16.3. In the last year, 26% have tried a mix of drugs, 52% alcohol and drugs, 48% have driven after drinking; drug consumption was: marijuana 58%, hashish 55%, cocaine 24%, popper 12%, hallucinogenic mushrooms 13%, ecstasy 13%, amphetamines 13%, Salvia divinorum 11%, LSD 9%, opium 9%, ketamine 7%, heroin 5%. In the last year, 27% subjects had depression, 25.7% anxiety, 23.7% sleep disorders, 15% financial problems, 13% road accidents, 9% addiction, 6% judicial problems. All problems were correlated to CAGE (Cut, Annoyed, Guilty, Eye-opener) test, drug use and mix drug use; psychological problems were higher for females: anxiety for cocaine, memory and psychosomatic for opium, sleeping disorders for crack, anxiety for popper, hallucinations for LSD and hallucinogenic mushrooms.

Topics: Accidents, Traffic; Adult; Alcoholism; Amphetamines; Anxiety; Crack Cocaine; Depression; Female; Hallucinogens; Heroin; Humans; Italy; Ketamine; Male; Marijuana Abuse; Nicotine; Opium; Sleep Wake Disorders; Substance-Related Disorders; Surveys and Questionnaires

The purpose of this study was to explore to what extent alcohol is a factor in non-fatal overdoses on the basis of records of ambulance emergencies, and to what extent this varies across gender and age. Furthermore, we wanted to investigate whether alcohol intake, in relation to an overdose, is associated with the risk of recurrent overdoses, and if so, whether such an association varies across gender and age. To investigate the role of alcohol intake in non-fatal overdoses, analyses were conducted both at the event level and at the individual level. Bivariate associations were explored in table analyses and by comparisons of means. To determine whether alcohol intake was associated with experiencing recurrent overdoses, survival analyses were conducted applying Kaplan-Meier estimation and Cox regression models. Furthermore, a linear regression model was estimated to assess the impact of gender age and number of overdoses on the proportion of overdoses in which alcohol was involved. Between groups of clients who had overdosed once, several times or many times, we found that there was a U-shaped relationship. The proportion of overdoses with alcohol involved was highest among those who had overdosed once and those who had overdosed more than ten times. The probability for a recurrent overdose was higher among those who were reported with no alcohol intake in the first overdose. Being female and having alcohol involved in the first overdose registered during our observation period reduced the risk for a recurrent overdose. However, age seemed to be a gradient with respect to alcohol's association with recurrent overdoses. While alcohol was associated with a significantly lower risk for recurrence in the two youngest age groups, this is not the case in the oldest age group. A possible explanation might be that it is a change in the pattern of drug use as an effect of aging where infrequent heroin use in combination with frequent alcohol intake increases with increasing age. For this type of drug users the individual's risk of recurrent overdoses may be lower due to fewer events of heroin intake.

Topics: Adult; Age Factors; Alcoholism; Coma; Comorbidity; Drug Overdose; Emergencies; Ethanol; Female; Heroin; Humans; Illicit Drugs; Male; Middle Aged; Norway; Recurrence; Regression Analysis; Respiratory Insufficiency; Risk; Sex Factors

We describe the first case of paroxysmal nonkinesogenic dyskinesia secondary to pallidal ischaemia, which is uniquely and specifically triggered by alcohol.

Topics: Adult; Alcohol-Induced Disorders, Nervous System; Alcoholic Intoxication; Alcoholism; Basal Ganglia Diseases; Chorea; Drug Overdose; Dyskinesia, Drug-Induced; Globus Pallidus; Heroin; Humans; Hypoxia-Ischemia, Brain; Illicit Drugs; Magnetic Resonance Imaging; Male; Neurologic Examination; Risk Factors; Substance-Related Disorders

The present paper describes the type and prevalence of co-morbid psychiatric disorders in a group of opioid dependent addicts.. In 17 Swiss centres for heroin-assisted treatment 85 opiate addicts were assessed at entry using the SKID interview.. Lifetime prevalence of co-morbid Axis I or Axis II disorders was 86 %. Most frequently patients were diagnosed with a personality disorder (58 %). Second frequently were mood disorders with a prevalence of 55 %, followed by anxiety disorders with a prevalence of 26 %.. The high prevalence of co-morbid psychiatric disorders indicate the urgent necessity to further develop and adapt health services for opioid addicts.

Topics: Adult; Alcoholism; Cocaine-Related Disorders; Comorbidity; Cross-Sectional Studies; Diagnosis, Dual (Psychiatry); Female; Heroin; Heroin Dependence; Humans; Male; Mental Disorders; Opioid-Related Disorders; Psychiatric Status Rating Scales; Rehabilitation Centers; Substance-Related Disorders; Switzerland

(i) To describe illegal drug use patterns in an adolescent normal population sample with special emphasis on MDMA, ecstasy; (ii) to investigate where ecstasy is introduced in a hypothesized drug use sequence, and (iii) to contrast the predictors of ecstasy use with those of other illegal substances. Special attention was given to the relationship to subcultural music preferences and house-party-going.. A school-based survey of the total cohort of adolescents enrolled in the school system in a city.. 10,812 adolescents, age 14-17 years, response rate 94.3%.. Oslo, the capital and only metropolitan town in Norway.. Social class was measured by the occupation standard ISCO 88, questions were posed as regards frequency of alcohol use and alcohol intoxication, cigarette smoking and use of cannabis, amphetamines, ecstasy and heroin. Alcohol problems were measured by a shortened version of Rutgers Alcohol Problem Index (RAPI), conduct problems were measured according to the four categories of acts forming the basis of the diagnosis conduct disorder in DSM-IV, internalizing mental health problems were measured using items from Hopkins Symptoms Checklist (HCL). A number of questions were asked as regards subcultural music preferences and house-party-going. STATISTICAL MODELS: A hypothesized cumulative sequence in drug use was investigated by means of latent class analysis, and the predictors of the various patterns of drug use were estimated and compared by means of multinominal logistic regression analysis.. The use of ecstasy was often intermingled with the use of cannabis, amphetamines and heroin, in a pattern of polydrug use. The latent class analysis revealed the following drug use sequence: (1) alcohol, (2) cigarettes, (3) cannabis, (4) amphetamines, (5) ecstasy and (6) heroin. There was no significant association between ecstasy use and parental social class or residential area of the town. All patterns of illegal drug use were highly associated with cigarette smoking, alcohol use, alcohol problems and conduct problems, whereas the associations with internalizing mental health problems were of less magnitude. Multinominal logistic regression analysis revealed that the use of ecstasy (E) was significantly more weakly associated with cigarette smoking than were the use of cannabis only (C), amphetamines (A) and the combination of ecstasy and amphetamines (A + E). The association between E and conduct problems (CP) was weaker than the association between CP and A and A + E. Finally, there were associations between E and A + E and House/Techno preferences and house-party-going, which were not found for C and A.. Ecstasy is used by adolescents who use other legal and illegal substances in a polydrug-use pattern. The substance is introduced late in a hypothesized drug use sequence. Even so, ecstasy use seems to differ from the use of, e.g. amphetamines, in that the association with smoking and conduct problems is weaker and that the associations with subcultural music preferences and house-party-going are much stronger.

Topics: Adolescent; Alcoholism; Amphetamines; Cannabis; Cohort Studies; Female; Hallucinogens; Heroin; Humans; Logistic Models; Male; N-Methyl-3,4-methylenedioxyamphetamine; Norway; Prevalence; Smoking; Social Behavior; Substance-Related Disorders

Drug use histories and treatment outcomes were compared for age, race and gender-matched samples of intravenous (IV; n = 28) versus intranasal (IN; n = 28) opiate abusers entering a 3-day inpatient detoxification unit. Data were derived from the Addiction Severity Index (ASI) interview. Both groups reported daily heroin use prior to detoxification, but IV users reported more days of alcohol and multiple drug use during the past 30 days. Despite age matching, IV users also started using alcohol at an earlier age and accumulated more lifetime months of regular alcohol, cocaine and multidrug use. IV users were more likely to enter treatment following the detox, but no significant outcome differences were noted at 1 and 3 months post-detoxification. The results show that intravenous, as compared to intranasal, opiate users have both a more severe pattern and a more extensive history of the use of non-opiate drugs.

Topics: Administration, Intranasal; Adult; Alcoholism; Cocaine-Related Disorders; Comorbidity; Female; Heroin; Heroin Dependence; Humans; Male; Substance Abuse Detection; Substance Abuse, Intravenous; Treatment Outcome

The receptors for tetrahydrocannabinol, the active ingredient of marijuana, have been identified. A microsatellite polymorphism (AAT)n at the cannabinoid CB1 (brain) receptor gene (CNR1) consists of 9 alleles. Since the cannabinoid system is part of the reward pathway we examined the hypothesis that genetic variants of the CNR1 gene might be associated with susceptibility to alcohol or drug dependence. The study consisted of 92 subjects on an Addiction Treatment Unit (ATU) and 114 controls. All were non-Hispanic Caucasians. The ATU subjects were screened for all types of substance dependence using the Diagnostic Interview Schedule (DIS), and for a variety of substance abuse symptoms using the Addiction Severity Index (ASI). Since inspection of the distribution of alleles in controls vs i.v. drug use showed a decrease in the frequency of the 4 allele, and the < 4 alleles were rare, the alleles were divided into two groups, < 5 and < or = 5, and three genotypes < 5/< 5, heterozygotes, and > or =/> or = 5. When all variables were subjected to factor analysis, factor 1 showed a clustering of drug dependence variables and factor 2 of alcohol dependence variables. By ANOVA only factor 1 showed significant differences by genotype consistent with a model where homozygosity for the > or = 5 repeat alleles showed the greatest effect. The number of i.v. drugs used was significantly greater for those carrying the > or =/> or = 5 genotype than for other genotypes (P = 0.005). The association with specific types of drug dependence was greatest for cocaine, amphetamine, and cannabis dependence. The results are consistent with a role of cannabinoid receptors in the modulation of dopamine and cannabinoid reward pathways. Independent studies should be designed to further confirm the hypothesis that cannabinoid receptors may contribute to the susceptibility to drug abuse.

Topics: Administration, Inhalation; Administration, Oral; Adult; Alcoholism; Alleles; Amphetamines; Cocaine; Comorbidity; Disease Susceptibility; Evoked Potentials; Female; Gene Frequency; Genotype; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Middle Aged; Receptors, Cannabinoid; Receptors, Drug; Reward; Risk Factors; Smoking; Substance Abuse, Intravenous; Substance-Related Disorders; Trinucleotide Repeats

The test-retest reliability of lifetime substance abuse and dependence diagnoses obtained by telephone interviewers was investigated. Trained personnel administered two identical interviews based on a modified Diagnostic Interview Schedule-Substance Abuse Module (DISSAM) approximately a week apart for 100 respondents, of whom 55 were receiving alcohol or other drug treatment and 45 and randomly selected from residential households in one Michigan county. The uncorrected agreement for all lifetime dependence diagnoses exceeded 93% for all six categories assessed and the more conservative chance corrected agreement (Cohen's Kappa coefficient kappa) was .92 (alcohol),.76 (marijuana),.87 (cocaine), and .71 (other opiates). Kappa coefficients for hallucinogens and heroin dependence could not be calculated due to low (i.e., 5% or less) base rates. Likewise, kappa was calculated only for a single abuse diagnosis, alcohol, with kappa = .42 and 95% agreement. In the interpretation of kappa, the standard applied was: kappa ranging from .41 to .60 represented moderate agreement, kappa ranging from .61 to .80 represented substantial agreement, and kappa ranging from .81 to 1.00 represented excellent agreement. Thus, test-retest reliability was excellent for lifetime alcohol and cocaine dependence and was substantial for lifetime marijuana and other opiates dependence. These results indicate that lifetime psychoactive substance abuse diagnoses can be obtained fairly reliably over the telephone using trained lay interviewers.

Topics: Adolescent; Adult; Aged; Alcoholism; Cocaine; Data Collection; Evaluation Studies as Topic; Female; Heroin; Humans; Interviews as Topic; Male; Marijuana Abuse; Middle Aged; Narcotics; Psychotropic Drugs; Reproducibility of Results; Sensitivity and Specificity; Substance-Related Disorders

Blood toxicology results for deaths attributed to heroin overdose during 1995 in the South Western Sydney (SWS) region (n = 39) were compared with those of a sample of 100 current SWS heroin users who had injected within the preceding 24 h. Heroin-related deaths had a higher median concentration of morphine than current heroin users (0.35 versus 0.09 mg/l). However, there was substantial overlap between the blood morphine concentrations of the two groups, ranging from 0.08-1.45 mg/l. This range incorporated 90% of heroin-related deaths. A third of current users had morphine concentrations over twice the toxic blood morphine concentration employed by the analytical laboratories, and 7% had morphine levels higher than the median recorded for fatal cases. Alcohol was detected in 51% of fatal cases (median = 0.10 g/100 ml) compared with 1% of current heroin user. There was a significant negative correlation among fatal cases between blood morphine and blood alcohol concentrations (r2 = -0.41). There was no significant difference between groups in the proportions of subjects positive for blood benzodiazepines. The results raise questions about the mechanisms of death in what are termed overdoses, and about the role of alcohol in these fatalities.

Topics: Adolescent; Adult; Alcoholism; Autopsy; Cause of Death; Dose-Response Relationship, Drug; Drug Overdose; Drug Synergism; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Morphine; New South Wales; Substance Abuse, Intravenous

Numerous studies reported in recent years have shown that withdrawal from chronic consumption of drugs induces high levels of anxiety, both in humans and in animal models. In the present study, we demonstrated that withdrawal from chronic consumption of either ethanol or heroin causes a significant increase in plasma nerve growth factor, suggesting that the resulting anxiety condition triggers the release of this molecule. Although the functional significance of this phenomenon needs to be better defined, it is hypothesized that the increased levels of circulating nerve growth factor might be involved in homeostatic adaptive and/or reparative mechanisms.

Topics: Adult; Aged; Alcohol Withdrawal Delirium; Alcoholism; Animals; Anxiety; Arousal; Corticotropin-Releasing Hormone; Female; Heroin; Heroin Dependence; Homeostasis; Humans; Male; Middle Aged; Nerve Growth Factors; Rats; Rats, Sprague-Dawley; Substance Withdrawal Syndrome

Twenty-three methadone-maintained individuals seeking admission into a cocaine study were interviewed using the Pattern-of-Drug-Use assessment. Sample characteristics included: 96% male, 91% Caucasian, and 36 +/- 5 mean years of age. Mean methadone dose was 81 +/- 20 mg. On average, subjects reported using greater than $200 or 5 grams of cocaine per week. "Binge/crash" cocaine use did not appear to be the typical pattern of use. However, during daily periods of cocaine use, repeated injections of large amounts of cocaine were taken, which may place patients at risk for medical complications. These findings emphasize the importance of developing novel treatment strategies to treat these dually-addicted individuals.

Topics: Adult; Alcoholism; Cannabis; Cocaine; Female; Heroin; Humans; Male; Methadone; Narcotics; Substance-Related Disorders; Time Factors

The purpose of this review of all appropriate, available medical examiner (ME) studies is to provide information on cases with positive toxicologies for cocaine, morphine (the heroin metabolite) and methadone that have positive blood or brain alcohol concentrations (BACs).. Criteria for inclusion of U.S. ME studies in this review are (1) at least 20 cases with a positive toxicology for cocaine, morphine or methadone and (2) BAC test findings according to specific drug positivity. Only 19 studies conducted from 1969 to 1992 met these criteria; most studies reviewed were not included primarily because of their failure to present or link available BAC test findings with positive toxicologies for these other drugs.. The BAC-positive ranges were similar for cocaine and heroin. In reports on both heroin and methadone or on all three drugs, heroin-positive cases had the highest proportions and methadone-positive cases had the lowest proportions with positive BACs.. Published data confirm the substantial presence of alcohol in combination with cocaine, heroin and methadone among ME cases. Future ME studies should endeavor to link BAC and toxicology findings for other drugs according to drug-induced or drug-related manner of death. These data would advance our knowledge about the role of alcohol in drug deaths and provide additional information on substance abuse trends.

Topics: Adolescent; Adult; Aged; Alcoholism; Cause of Death; Child; Cocaine; Comorbidity; Coroners and Medical Examiners; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Substance-Related Disorders; United States

In the period 1987-1991 a total of 739 fatalities among drug addicts was investigated at the three University Institutes of Forensic Medicine in Denmark. The annual number rose from 130-140 in the first 4 years to 192 in 1991, and 80% were males. The mean and median age for both males and females increased by 1 year in the period. The main drug of abuse was heroin, in most cases supplemented by various other drugs, and in almost all cases taken intravenously. In about one-third of the cases each year there was information of abuse of alcohol in addition. In the poisoning cases, the main drug of poisoning was morphine/heroin, constituting 35-55% of the cases each year. As regards methadone-poisoning cases, the number increased significantly in 1991 compared to the first 4 years. Furthermore, the number and proportion of addicts dying while in methadone treatment increased during the 5-year period. In about half of the methadone poisoning cases, there was information of methadone treatment at the time of death. The other half obviously obtained the methadone completely illegally. Ketobemidone was the third most frequent drug of poisoning, while propoxyphene and barbituric acid only were found in a very few cases each. The results are compared to those from an earlier investigation concerning drug deaths in Denmark in 1968-1986. The importance of registering drug deaths is emphasized.

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Analgesics, Opioid; Barbiturates; Cannabis; Cause of Death; Denmark; Dextropropoxyphene; Female; Heroin; Humans; Male; Meperidine; Methadone; Morphine; Substance-Related Disorders; Suicide; Survival Rate

Gluteal compartment syndrome is a rare disorder that most often occurs in conjunction with prolonged immobility after a sedative overdose but also may result from direct trauma. Patients present with localized tenderness, induration, and pain with passive flexion of the gluteal muscles. Signs of sciatic nerve compression occur frequently, and rhabdomyolysis may be associated with the syndrome. If the diagnosis of gluteal compartment syndrome is suspected, intracompartmental pressures should be measured. If pressures are high or if sufficient clinical suspicion remains, the patient should undergo prompt fasciotomy.

Topics: Adult; Alcoholism; Buttocks; Compartment Syndromes; Emergencies; Heroin; Humans; Male; Pressure; Rhabdomyolysis; Substance-Related Disorders

Complete toxicology screens were performed on Bexar County homicide victims in four recent representative years (1985, 1986, 1990, and 1991). A high positivity rate for drugs and/or alcohol, ranging from 66 to 73%, was found for each year. Alcohol was present in more than half of the cases, ranging from 54.2 to 60.3%. Detection of cocaine or cocaine metabolites increased drastically during this study period, from 1.6% of cases in 1985 to 18.7% in 1991. Heroin metabolites, indicative of recent heroin use, were detected in only 2-5% of the cases in each of the years studied. Drugs other than alcohol, cocaine, or heroin were detected in 7-25% of the cases.

Topics: Adolescent; Adult; Alcoholism; Cocaine; Heroin; Homicide; Humans; Illicit Drugs; Prevalence; Substance-Related Disorders; Texas

A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self-report data on needle-sharing and sexual practices were collected from 91 heroin users entering a residential, drug-free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin-dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle-sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle-sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner-city suburbs.

Topics: Acquired Immunodeficiency Syndrome; Alcoholism; Benzodiazepines; Female; Heroin; Humans; Male; Needle Sharing; New South Wales; Risk-Taking; Sexual Behavior; Substance Abuse, Intravenous; Substance-Related Disorders

Topics: Adult; Alcoholism; Cholesterol; Cocaine; Heroin; Humans; Substance-Related Disorders

This paper describes patterns of drug use such as choice of drug, other substances abused, and route of administration in 174 women who reported methamphetamine, cocaine, heroin, or "Ts and blues" abuse during pregnancy. Seventy-five percent (130/174) reported using more than one drug. Other than tobacco, alcohol and cocaine were the drugs most frequently used in combination with other drugs (7% to 53% and 12% to 54% of the time, respectively). The extent of polydrug use observed in this study emphasizes (1) the difficulty in ascribing adverse maternal or fetal health effects to single substances, and (2) the potential for interaction effects due to multiple substance abuse.

Topics: Adolescent; Adult; Age Factors; Alcoholism; Cocaine; Female; Fetal Diseases; Heroin; Humans; Marijuana Abuse; Methadone; Methamphetamine; Odds Ratio; Pentazocine; Pregnancy; Pregnancy Complications; Smoking; Substance-Related Disorders; Tripelennamine

This article examines the commonly used laboratory indicators of heavy alcohol use (elevated MCV, GGTP and AST values) in subgroups of drug-using and non-drug-using alcoholic men admitted to an inpatient alcoholism treatment program. A total of 380 consecutive admissions meeting DSM-III diagnostic criteria for alcohol use or dependence were studied. Of these subjects, 75% used both alcohol and drugs. The most frequently used drugs were marijuana, cocaine, amphetamines and tranquilizers. Overall, subjects who used drugs with alcohol had significantly lower MCV and GGTP values than subjects who used alcohol alone. More specifically, cocaine use was associated with lower MCV values, marijuana use with lower AST values and heroin use with higher AST and GGTP values. These differences between drug-using and non-drug-using alcoholics were significant even after controlling for variables that affect the laboratory values such as age, quantity, frequency and duration of alcohol consumption. These findings indicate that any study of laboratory markers of alcoholism needs to consider concomitant illicit drug use patterns.

Topics: Adult; Aged; Alcoholism; Amphetamines; Analysis of Variance; Barbiturates; Biomarkers; Cannabis; Cocaine; Hallucinogens; Heroin; Humans; Male; Middle Aged; Narcotics; Substance-Related Disorders

A total of 51 (34 men and 17 women) heterosexual alcoholic inpatients were assessed with respect to their engagement in high-risk behaviors for HIV infection and AIDS. Results indicated that a subset of the subjects engaged in frequent and diverse high-risk sexual activities, often had several different sexual partners over a 6-month period, frequently used drugs during sexual activities and sometimes used drugs intravenously. The frequency of high risk behaviors was similar for men and women, but minority subjects engaged in higher levels of high-risk behaviors than did whites. Both age and educational level were inversely related to behavioral risk for HIV infection. Although the current findings are limited due to sample size and representativeness, the results indicate that future research needs to focus on high-risk behaviors for HIV infection among alcoholics, with more attention directed toward prevention and intervention strategies.

Topics: Acquired Immunodeficiency Syndrome; Alcoholism; Cocaine; Heroin; Humans; Pilot Projects; Risk Factors; Sexual Behavior; Substance Abuse, Intravenous

Urine surveillance of patients is a universal procedure in drug treatment programs for monitoring frequency and type of illicit drug use. The method is also being increasingly utilized by employers to screen employees for drug use. The presence of a prescribed substance in a subject's urine is considered objective evidence of illicit drug use, and is used to confront subjects. However, studies have demonstrated that urine surveillance is not infallible. The presence of inaccuracy in urine surveillance has definite negative consequences of both individuals and the testers. In this paper, we report that a positive urine test for quinine, which may be evidence of illicit drug use, results from the consumption of the amount of tonic water present in a mixed drink. The implications of this finding are discussed.

Topics: Adult; Alcoholism; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Mineral Waters; Naltrexone; Patient Compliance; Quinine

Laos in the period 1965-1975 provided an opportunity to study sex differences in drug and alcohol use, as influenced by ethnicity. Several psychoactive substances were locally consumed, including opium, heroin, alcohol, tobacco, betel-areca, and cannabis. Much diversity occurred among the various ethnic groups with regard to male-female use of drugs and alcohol. Trends in these use patterns suggested the existence of certain principles which govern the male-female dimension of drug use. Social changes going on in the society were reflected in choice of substance forms by younger people as compared to their elders (e.g., cigarettes vs pipes or cigars, heroin vs opium, manufactured vs village-produced alcohol). Ecological factors, which contributed to drug availability, also were powerful in determining type of drugs and patterns of use.

Topics: Adult; Alcohol Drinking; Alcoholism; Areca; Ethnicity; Female; Heroin; Humans; Laos; Male; Middle Aged; Opium; Plants, Medicinal; Sex Factors; Smoking; Substance-Related Disorders

Topics: Alcoholism; Anxiety; Clonidine; Dextropropoxyphene; Heroin; Humans; Inactivation, Metabolic; Kinetics; Methadone; Mood Disorders; Naltrexone; Narcotic Antagonists; Opioid-Related Disorders

The acceptability of nonmedical use for a particular drug is a function of diverse social needs. Drug dependence is due less to intrinsic effects than to the situation in which drug taking occurs. An addictive level of drug self-administration is a symptom of behavioral troubles rather than a definition of the trouble itself. The intrinsic effects of drugs do not in themselves produce either misuse or evoke specific kinds of behavior such as sexual or aggressive activities. Drugs can, however, come to function as discriminative stimuli for socially sanctioned behavior that would not under other circumstances be tolerated. The intrinsic reinforcing potential of an agent evolves in and dominates situations in which other reinforcing opportunities are either absent or remain unavailable to an individual who is unprepared to exploit them. While certain intrinsic properties of a drug contribute to its potential as a reinforcer (e.g., rapid onset and brief duration of action), reinforcing efficacy is notoriously malleable. It is a function of historic and currently-acting factors, particularly social reinforcers. The importance of physical dependence in the maintenance of drug seeking and taking is mainly unproven and probably overrated. Situations under which important reinforcers are available only in small portions intermittently can induce various excessive activities, including an untoward concern with obtaining and using drugs. Drug dependence prevention as a species of environmental dependence can be best effected by either alterations in the intermittent reinforcement situations inducing excessive behavior or by providing opportunities and training with respect to reinforcing alternatives other than drugs.

Topics: Aggression; Alcoholism; Animals; Attitude to Health; Environment; Ethanol; Heroin; Humans; Indians, North American; Phencyclidine; Rats; Reinforcement Schedule; Reinforcement, Social; Sexual Behavior; Social Problems; Substance-Related Disorders; Violence

Prisoners deserve to be taken seriously and treated with respect by the physician, as does any person seeking medical care. Treatment should include an adequate history and physical examination as well as indicated laboratory tests. Anxiety is a ubiquitous problem in prison life and can adversely affect any medical condition. The diagnosis of malingering is and should be one of exclusion, and the physician should keep in mind that a seemingly healthy prisoner might have several other reasons for seeking medical help. The physician needs to be confident of the diagnosis before returning the person to the cell block, as prisoners do not have freedom of access to medical care. New standards, programs, literature, journals, and conferences have drawn attention to the jail as a place where the physician can intervene in a positive way to decrease the recycling of crime and illness. It is not enough to be able to practice good medicine in a jail. Such practice must recognize the special needs of prisoners and the special problems inherent in the jail environment.

Topics: Adult; Alcoholism; Cannabis; Diazepam; Ethics, Medical; Female; Health Services; Heroin; Humans; Male; Mental Disorders; Physician-Patient Relations; Prisoners; Prisons; Seizures; Substance-Related Disorders; Tuberculosis; United States

This study examines sequential use of various drugs and alcohol among 1544 subjects being treated for substance abuse in 10 treatment centers. Several models were developed to examine drug usage with respect to specific lags dealing with the number of years between periods of beginning use of different types of drugs. The models also assessed the relationships between the lags from first to regular use of specific drugs. Length of use and amount of the drug used first in a sequence are associated with the lag from regular use of that drug to regular use of another drug--especially when the initial drug is marijuana. Contrary to expectation, shorter lags from first to regular alcohol use point toward longer lags from regular alcohol use to use of other drugs. However, the lag from first to regular alcohol use is positively related to the lag from first to regular marijuana use.

Topics: Alcoholism; Analysis of Variance; Heroin; Heroin Dependence; Humans; Illicit Drugs; Marijuana Abuse; Pharmaceutical Preparations; Time Factors

Topics: Alcoholism; Drug and Narcotic Control; Heroin; Humans; Substance-Related Disorders; United Kingdom

This paper reviews the part which prior consumption of alcohol played in motor vehicular fatalities in Geelong and district between January, 1967, and June, 1978. There were 344 deaths of persons aged 17 years and older within four hours after the accident. Of 147 such victims who were aged 17 to 50 years and who were drivers of motor vehicles. 54% had a blood alcohol concentration (BAC) greater than 0.1 g/100 mL (22 mmol/L) at autopsy. Of 35 male pedestrians, 60% had a BAC greater than 0.15 g/100 mL (33 mmol/L) at autopsy, and 80% of such accidents occurred between 6 p.m. and 10 p.m. A high degree of sobriety was noted among all female road traffic victims. The increasing road toll related to motorcycle accidents and the problem of legal and illegal drug use are also briefly discussed.

Topics: Accidents, Traffic; Adolescent; Adult; Aged; Alcohol Drinking; Alcoholism; Australia; Automobile Driving; Diphenhydramine; Ethanol; Female; Heroin; Humans; Male; Methaqualone; Middle Aged; Risk; Safety; Substance-Related Disorders

Topics: Adult; Alcoholism; Amphetamine; Barbiturates; Depression; Hallucinogens; Heroin; Humans; Male; Mental Disorders; Schizophrenia; Schizophrenia, Paranoid; Substance-Related Disorders

Topics: Adolescent; Alcoholism; Attitude; Caffeine; Cannabis; Female; Heroin; Homosexuality; Humans; Lysergic Acid Diethylamide; Male; Nicotine; Sex; Sex Education; Sexual Behavior; Substance-Related Disorders

Samples of six specific groups (both students and adults) were intensively surveyed on their differential attitudes toward the use and sale of eight drug types. Resulting comparisons between groups, drugs, and attitudes provide a relative picture of the attitudes on drug sale and use held by those surveyed.

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Attitude; Barbiturates; Cannabis; Cocaine; Drug and Narcotic Control; Faculty; Female; Hallucinogens; Heroin; Heroin Dependence; Humans; Legislation, Drug; Male; Parents; Smoking; Students; Substance-Related Disorders; United States

Topics: Alcoholism; Animals; Cannabis; Genitalia, Male; Heroin; Heroin Dependence; Humans; Male; Methadone; Spermatogenesis; Substance-Related Disorders; Testosterone

Topics: Adolescent; Adult; Age Factors; Alcohol Drinking; Alcoholism; Amphetamine; Attitude; Attitude of Health Personnel; Attitude to Health; Barbiturates; Cannabis; Communication; Drug and Narcotic Control; Faculty; Health Education; Heroin; Humans; Illinois; Lysergic Acid Diethylamide; Middle Aged; Smoking; Social Control, Informal; Students; Substance-Related Disorders

Topics: Adolescent; Adult; Aggression; Alcoholism; Amphetamine; Barbiturates; California; Cannabis; Cocaine; Criminal Psychology; Ethanol; Ethnicity; Heroin; Humans; Male; Prisoners; Psychotropic Drugs; Secobarbital; Sex Offenses; Social Class; Substance-Related Disorders; Violence

Topics: Adolescent; Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; Heroin; Humans; Lysergic Acid Diethylamide; New York City; Smoking; Students; Substance-Related Disorders; Tranquilizing Agents

Complications resulting from drug abuse more frequently affect the lung than any other organ. The spectrum of pulmonary complications associated with drug abuse is wide. The current practice of using mixtures of drugs is mainly responsible for the increase in pulmonary complications. The chief complications observed in a series of 241 drug abuse patients were aspiration pneumonitis (12.9 percent), pulmonary edema (10.0 percent), and pneumonia (7.5 percent).

Topics: Adult; Alcoholism; Barbiturates; Cannabis; Cocaine; Coma; Female; Heroin; Humans; Lung Abscess; Lung Diseases; Male; Pneumonia; Pneumonia, Aspiration; Pulmonary Atelectasis; Pulmonary Edema; Pulmonary Embolism; Pulmonary Fibrosis; Substance-Related Disorders

Topics: Alcoholism; Angina Pectoris; Aortic Aneurysm; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Hemodynamics; Heroin; Humans; Hypertension; Hyperthyroidism; Migraine Disorders; Myocardial Infarction; Pacemaker, Artificial; Pheochromocytoma; Propranolol; Substance-Related Disorders; Tachycardia, Paroxysmal; Tetralogy of Fallot; Tremor; Wolff-Parkinson-White Syndrome

Topics: Alcohol Drinking; Alcoholism; Disulfiram; Heroin; Heroin Dependence; Hospitalization; Humans; Methadone; Reinforcement, Psychology; Social Adjustment; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Alcoholism; Child; Female; Hepatitis A; Heroin; Humans; Liver Cirrhosis; Liver Diseases; Lung Diseases; Male; Middle Aged; Oxygen Inhalation Therapy; Pneumonia; Respiratory Insufficiency; Syndrome

Topics: Alcohol Drinking; Alcoholic Beverages; Alcoholism; Counseling; Female; Heroin; Heroin Dependence; Humans; Male; Sex Factors; Social Adjustment; Social Behavior; Social Control, Formal; Substance-Related Disorders

Topics: Adolescent; Adult; Age Factors; Alcoholism; Amphetamine; Cannabis; Child; Drug and Narcotic Control; Female; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Lysergic Acid Diethylamide; Male; Solvents; Substance-Related Disorders; Tranquilizing Agents; United States

Topics: Adolescent; Adult; Alcoholism; Child; Criminal Psychology; Ethnicity; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Life Style; Male; Methadone; Middle Aged; New Mexico; Prisons; Social Adjustment; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Alcoholism; Chemical and Drug Induced Liver Injury; Hepatitis A; Hepatitis B; Heroin; Heroin Dependence; Humans; Liver Diseases; Substance-Related Disorders

Topics: Adolescent; Adult; Alcoholism; Barbiturates; Bradycardia; Cocaine; Death, Sudden; Electrocardiography; Female; Heart; Heart Rate; Heroin; Humans; Male; Methadone; Middle Aged; Morphine; Quinine; Substance-Related Disorders

Topics: Adolescent; Age Factors; Alcoholism; Amphetamine; Arizona; Cannabis; Child; Ethanol; Female; Heroin; Humans; Internal-External Control; Juvenile Delinquency; Lysergic Acid Diethylamide; Male; Prisoners; Psychological Tests; Self Concept; Substance-Related Disorders

Topics: Adolescent; Alcoholism; Amphetamine; California; Cannabis; Child; Community Health Services; Emergencies; Heart Massage; Heroin; Heroin Dependence; Humans; Interpersonal Relations; Lysergic Acid Diethylamide; Narcotic Antagonists; Respiration, Artificial; Scopolamine; Social Conformity; Substance-Related Disorders

Topics: Alcoholism; Heroin; Heroin Dependence; Humans; Male; Methods; MMPI; Psychometrics; Statistics as Topic; Substance-Related Disorders

Topics: Adult; Aged; Alcoholism; Diagnosis, Differential; Heroin; Humans; Male; Middle Aged; MMPI; Substance-Related Disorders

Topics: Alcoholism; Attitude of Health Personnel; Attitude to Health; Heroin; Humans; Professional-Patient Relations; Substance-Related Disorders

Topics: Adult; Alcoholic Beverages; Alcoholism; Antibodies, Viral; Antigens, Viral; Blood Proteins; Ethanol; Hemagglutination Inhibition Tests; Hepatitis; Heroin; Humans; Immunodiffusion; Immunoelectrophoresis; Immunoglobulins; Liver; Liver Function Tests; Long-Term Care; Methadone; Prospective Studies; Radioimmunoassay; Substance-Related Disorders; Time Factors

Topics: Adult; Alcoholism; Behavior Therapy; Disulfiram; Heroin; Heroin Dependence; Humans; Male; Methadone; Substance-Related Disorders

Topics: Adolescent; Adult; Alcoholism; Female; Geography; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Nutritional Physiological Phenomena; Substance Withdrawal Syndrome; Substance-Related Disorders; Weather

Topics: Adult; Age Factors; Alcoholism; Black or African American; Community Mental Health Services; Educational Status; Evaluation Studies as Topic; Female; Heroin; Hospitalization; Humans; Length of Stay; Male; Massachusetts; Methadone; Methods; Religion; Substance Withdrawal Syndrome; Substance-Related Disorders; White People

Topics: Alcohol Drinking; Alcoholism; Cannabis; Delayed-Action Preparations; Disulfiram; Heroin; Humans; Methadone; Morphine Dependence; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Alcoholism; Amphetamine; Attitude to Health; Barbiturates; Cannabis; Demography; Hallucinogens; Health Education; Heroin; Humans; Male; Military Medicine; Substance-Related Disorders; Surveys and Questionnaires; United States

Topics: Alcohol Drinking; Alcoholism; Automatism; Habits; Heroin; Humans; Morphine Dependence; Recurrence; Reinforcement, Psychology; Smoking; Statistics as Topic; Substance-Related Disorders

Topics: Adolescent; Alcoholism; Cannabis; Drug and Narcotic Control; Heroin; Humans; Jurisprudence; Lysergic Acid Diethylamide; Physician-Patient Relations; Social Problems; Substance-Related Disorders; United States

Topics: Adolescent; Adult; Affective Symptoms; Age Factors; Aggression; Alcoholism; Cannabis; Europe; Exploratory Behavior; Family; Frustration; Heroin; Humans; Lysergic Acid Diethylamide; Middle Aged; Opium; Physical Therapy Modalities; Puberty, Precocious; Social Conditions; Substance-Related Disorders

Topics: Alcoholism; Cannabis; Heroin; Humans; Methadone; Phytotherapy; Substance-Related Disorders

Topics: Adult; Age Factors; Alcoholism; Barbiturates; Community Mental Health Services; Crime; Educational Status; Female; Heroin; Humans; Male; Methadone; Morphine Dependence; Occupations; Sex Factors; Social Behavior Disorders; Substance-Related Disorders; Unemployment

Topics: Alcoholism; Economics, Medical; Female; Health Facility Planning; Health Workforce; Heroin; Humans; Male; Research; Social Conditions; Substance-Related Disorders; United Kingdom; United States

Topics: Adolescent; Adult; Alcoholism; Drug and Narcotic Control; Female; Heroin; Humans; Male; Social Problems; Substance-Related Disorders; United States

Topics: Adult; Alcoholism; Amphetamine; Barbiturates; Child, Preschool; Community Health Services; Evaluation Studies as Topic; Female; Forensic Medicine; Heroin; Homicide; Humans; Male; Methadone; Middle Aged; Morphine Dependence; Narcotics; New York City; Substance-Related Disorders; Suicide

Topics: Adolescent; Adult; Age Factors; Alcoholism; Community Mental Health Services; Drug and Narcotic Control; Educational Status; Employment; Ethnicity; Evaluation Studies as Topic; Female; Heroin; Humans; Male; Methadone; Middle Aged; Morphine Dependence; New York City; Recurrence; Social Behavior; Substance-Related Disorders

Topics: Alcoholism; Community Health Services; Heroin; Hospitals, Teaching; Humans; Morphine Dependence; Neurology; Substance-Related Disorders

Topics: Adolescent; Alcohol Drinking; Alcoholism; Amphetamine; Barbiturates; Black or African American; Cannabis; Crime; Educational Status; Follow-Up Studies; Heroin; Humans; Male; Occupations; Opium; Sexual Behavior; Substance-Related Disorders; Violence

Topics: Adolescent; Adolescent Psychiatry; Adult; Alcoholism; Amphetamine; Cannabis; Ego; Female; Heroin; Homosexuality; Humans; Lysergic Acid Diethylamide; Male; Opium; Personality Development; Psychoanalytic Therapy; Psychotic Disorders; Substance-Related Disorders

Topics: Adolescent; Adult; Aged; Alcoholism; Amphetamine; Analgesics; Barbiturates; Cannabis; Cocaine; Female; Hallucinogens; Heroin; Humans; Hypnotics and Sedatives; Male; Middle Aged; Morphinans; Opium; Phytotherapy; Prognosis; Substance-Related Disorders; Tranquilizing Agents

Topics: Alcoholism; Antisocial Personality Disorder; Crime; Heroin; Humans; Medicine; Methadone; Morphine Dependence; Motivation; Social Behavior; Social Behavior Disorders; Social Problems; Social Welfare; Substance-Related Disorders

Dr T H Bewley discusses recent increases in the incidence of all types of drug dependence in Great Britain.Dr P H Connell considers the problem of amphetamine dependence historically and in different age groups and draws attention to the sociocultural patterns of behaviour which have sprung up amongst the adolescent and young adult population. Treatment is discussed.Dr R H V Ollendorff outlines a theory of drug addiction based upon seven aetiological factors, and stresses the importance of the general practitioner in treating the addict.

Topics: Adult; Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; Female; Hallucinogens; Heroin; Humans; Lysergic Acid Diethylamide; Middle Aged; Morphine Dependence; Substance-Related Disorders; United Kingdom

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; Hepatitis A; Hepatitis B; Heroin; Humans; Lysergic Acid Diethylamide; Male; Middle Aged; Opium; Phenothiazines; Prisons; Psychotic Disorders; Sepsis; Smoking; Substance-Related Disorders; United Kingdom

Topics: Alcohol Drinking; Alcoholism; Character; Child Rearing; Heroin; Humans; Lysergic Acid Diethylamide; Male; Mother-Child Relations; Personality Assessment; Psychopathology; Substance-Related Disorders

Topics: Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; England; Hallucinogens; Heroin; Humans; Morphine; Opium; Social Problems; Substance-Related Disorders; World Health Organization

Topics: Adolescent; Adult; Alcoholism; Cocaine; Heroin; Hospitals, Psychiatric; Humans; Male; Middle Aged; Morphine Dependence; Psychiatry; Psychotherapy; Psychotherapy, Group; Rehabilitation

Topics: Adolescent; Alcoholism; Barbiturates; Black People; Connecticut; Depression; Depressive Disorder; Geriatrics; Heroin; Meperidine; Morphine Dependence; Neurotic Disorders; Social Conditions; Statistics as Topic; Substance-Related Disorders

Topics: Alcoholism; Amphetamine; Amphetamines; Chlorpromazine; Disulfiram; Heroin; Humans; Japan; Methamphetamine; Opium; Rehabilitation; Statistics as Topic; Substance-Related Disorders; Toxicology