Abstract: Introduction: Given the rapid population aging taking place in countries like Brazil and in many other countries, understanding patterns of alcohol consumption by older people and the associated factors are important. Methods: The databases MEDLINE, Embase, and LILACS were searched for population-based studies on the prevalence of current alcohol consumption among Brazilians aged over 60. Results: Eight eligible studies were identified. Two studies reported data on binge drinking, with one national study finding a prevalence of 10.3%, while the other (male subjects only) found higher prevalences (27.1% and 13.7% at 2 sites). Heavy drinking was estimated in 4 studies with prevalences varying from 2.9% to 7.3%. Alcohol dependence was estimated in 3 studies, 1 used the DSM-IV diagnosis criteria and found a prevalence of 3.8%, while the other 2 used screening tools and found higher prevalences of 8.2% and 9.2%. Being male and younger were associated with several of the above patterns of alcohol consumption. Higher education was associated with binge and heavy drinking, and low education and socioeconomic status with alcohol dependence. Discussion/Conclusions: These findings show that in Brazil problems related to alcohol use by the elderly remain relatively unknown. There was a high heterogeneity of methodologies in the studies, making it difficult to summarize the findings and produce prevalence estimates for the different patterns of consumption. More homogenous studies using similar definitions of patterns of alcohol consumption are required to allow comparisons to be made between different Brazilian regions and other countries.

Abstract: Introduction:Suicide is a multifactorial phenomenon that is frequently found in comorbidity with mental disorders, such as depression and substance abuse, which can interact in summation to produce any element of the continuum of suicidal behavior: ideation, planning, attempt, and death by suicide.O

Abstract: Objective: To study the relationship between the early consumption of drugs such as alcohol, tobacco, and marijuana in adolescence and the escalation to the use of other illegal drugs as proposed in the gateway hypothesis. Methods: An analysis of the database of the National Study of Psychoactive Substance Consumption in 2013 conducted, calculating adjusted odds ratios using logistic regressions and establishing 95% confidence intervals as indicators of significance of the estimates. Results: There were consistent, significant associations between the consumption of various illegal substances with the early initiation of marijuana use: The odds ratio for any illicit substance in the last year consumption was 1.58; for cocaine use, 1.40; for basuco consumption, 2.15; for heroin, 4.82; and for synthetic drugs, 1.89. Conclusions: The results are in line with the gateway hypothesis, which proposes that early marijuana use increases the probability of using other psychoactive substances, although the origin of the data from a cross-sectional study implies important limitations.

Abstract: Objectives: This study aimed to understand family communication and overall well-being of young adults in the context of familial opioid misuse using the family systems framework. Methods: A cross-sectional, mixed-methods, online survey of young adults aged 18 to 30 years (n=137) was conducted. A cluster analysis was performed based on family organization and structural characteristics. MANCOVA was utilized to compare groups identified using the cluster analysis in terms of (1) family’s belief about opioid misuse, (2) worry regarding opioid misuse, (3) family communication, and (4) overall well-being of young adults. Results: A cluster analysis resulted in three groups (group 1: no familial opioid misuse with high family cohesion; group 2: familial opioid misuse with moderate family cohesion; group 3: those with/without familial opioid misuse and low family cohesion). Group 3 had the lowest family communication compared to group 1 and group 2 (P<0.001 and P=0.001, respectively) and had lower overall well-being compared to group 1 (P=0.008). Group 2 had a higher worry score than group 1 (P<0.001). Qualitative analysis using Labov’s narrative analysis elucidated that having someone misusing opioids with other substances (eg, alcohol) in the family can negatively impact the emotions of family members. Conclusions: Our findings indicated that family cohesion had a greater impact on family communication and overall well-being of young adults even in the presence of familial opioid misuse. This suggests that higher family cohesion may positively influence young adults to cope with issues related to familial opioid misuse.

Abstract: Objectives: The main objectives of this study were to compare the risk of suicide, sociodemographic and clinical characteristics in 3 designated groups: dual diagnosis (DD), substance-related disorder without other comorbid mental disorder, and any mental disorder without the presence of co-occurring substance-related disorders. Materials and Methods: This was a cross-sectional study with secondary information source from a population study. Adults of both sexes between 19 and 65 years of age were included and were screened for 23 mental disorders, the data collection tool used was the Compositum International Diagnosis Interview (CIDI 3.0), which uses DSM IV diagnostic criteria. Suicide risk in individuals with DD and other mental disorders was compared. Results: In total, 303 adults between 19 and 65 years of age were included. In all, 63% were women. The median age was 41 and the interquartile range 21. The prevalence of DD was 2.0% in the last 12 months and the prevalence of suicidal behavior was 7.6%, any substance abuse disorder 4.8%, any mental disorder without substance abuse 17.4%. An association of suicidal behavior with DD was found [odds ratio (OR), 13.85; 95% confidence interval (CI), 2.62-73.09) with grouped substance-related disorder (OR, 9.61; 95% CI, 2.49-37.00) and grouped mental disorders (OR, 4.97; 95% CI, 2.07-11.92). Conclusions: A higher risk of suicide was found in DD compared with noncomorbid mental disorders or substance-related disorder.

Abstract: Background: Female who inject drugs are exposed to greater social disapproval, stigmatization, and report a higher risk of unsafe injection practices compared with their male counterparts. Gender differences in injection practices among people who inject drugs (PWID) in Latin America remain understudied. Objectives: This study aimed to examine gender differences in injection practices among PWIDs in Colombia. Materials and Methods: Using respondent-driven sampling, N=1081 participants (14% female; mean age: 26 y) from 5 Colombian cities completed the Pan American Health Organization’s Behaviors of High Risk Drug Consumers Survey. A binary logistic regression model was used to examine first and last injection practices and risk injection behaviors among PWIDs. Results: Female presented high odds of receiving assistance by their sexual partners during the first and last injection episode [adjusted odds ratio (AOR)=8.3, confidence interval (CI)=14.0-16.7; AOR=2.06, CI=1.1-3.7]. Also, female had at least 2 times higher odds of engaging in unsafe injecting practices including sharing drug mix and using drug in a capsule or ready-to-use vial (AOR=2.8, CI=1.4-5.5; AOR=3.4, CI=1.5-7.7) and had lower odds of acquiring the drug to self-inject (AOR=0.4, CI=0.2-0.9) during the last injection episode. Conclusions: High dependence on sexual partner and risky injection behaviors among female who inject drugs were identified. Study findings contextualized with gender vulnerabilities in Colombia are fundamental for prevention/intervention efforts aimed at helping this at-risk population in the country and in Latin America.

Abstract: Background: Hypnotherapy has proved to be effective for the treatment of several medical and psychiatric conditions. It has been used in the treatment of alcohol use disorder (AUD), but only 2 randomized controlled trials have been conducted for this disorder. Methods: This study was carried out at an inpatient clinic in Norway. A 6-week long treatment program included intensive group therapy, but also 5 hours of individual therapy, given as motivational interviewing (MI). Thirty-one patients were randomized either to receive 5 individual sessions of hypnotherapy instead of MI (N=16) or to be in the control group (N=15). The treatment method for the hypnotherapy group was Erickson (permissive) hypnosis. At baseline all the participants were diagnosed using a psychiatric interview and filled in the Alcohol Use Identification Test (AUDIT), Timeline FollowBack (TLFB) for alcohol use, Hopkins Symptoms Check List (HSCL-25) for monitoring mental distress and Traumatic Life Events Questionnaire. AUDIT, TLFB, and HSCL-25 were readministered at follow-up after 1 year. Results: There were no differences between groups at baseline. One year later more women were lost to follow-up in the MI group. Both the intervention and control groups had reduced their alcohol consumption significantly. The change in AUDIT score was, however, largest for the hypnotherapy group, albeit only on a trend level (P=0.088). Conclusions: Those receiving hypnotherapy did marginally better concerning alcohol use at 1-year follow-up. This small advantage for hypnotherapy could indicate an effect, rendered nonsignificant by an underpowered study. It could also be that neither MI nor hypnotherapy gave an additional effect on top of the substantial group therapy. Lastly the findings could indicate that hypnotherapy is at least as effective as MI.

Abstract: Introduction: The survey of drug and psychedelic abuse-related deaths in elderly people provides information on the most severe social and psychological consequences of drug abuse and its impact on community health. In contrast, with regard to the ageing population of Iran, along with all age groups who might misuse drugs, elderly people cannot be ignored. Therefore, the present study aims to investigate the number of deceased elders whose deaths were caused by complications related to narcotic or psychedelic drug abuse as described by the legal medicine organization of Tehran, Iran, 2013 to 2014. Methods: In this descriptive study, the forensic files of all elderly people (age, 60 y or older) who died because of narcotic or psychedelic drug abuse and were referred to the legal medicine center of Tehran in 2013 and 2014 were investigated. Elders who died because of reasons other than narcotic or psychedelic drug abuse or because of underlying illness were excluded from the study. Data were recorded in a questionnaire containing questions related to demographic status, family status, social status, examinations, autopsy, and laboratory data, of elders. The data were analyzed using SPSS 16 software. Findings: According to inclusion and exclusion criteria, 227 (n=203, 89.4% male) deaths of elderly people because of narcotic or psychedelic drug abuse were investigated. The incidence of drug-related deaths among elderly people was 2.2012 and 1.912 per 100,000 people, during 2013 and 2014, respectively. The incidence of drug-related deaths among elderly women during the years 2013 and 2014 was .3598 and .5179 1.22, respectively. In addition, the incidence of drug-related deaths among elderly men during the years 2013 and 2014 was 4.5096 and 3.3517, respectively. The most common drug used by the elders (126, 55.5%) was opium. The mean age of the elders was 66.9±7.3 years (60 to 90 y old) and the mean age of onset (first intake) was 40.3±12.9 years (14 to 85 y old). Most of the deceased elders were from the Tehran (38%), Khorasan Razavi (11%), and Hamedan (9%) provinces of Iran. Half of the deceased elders had their own home (52.9%), and most were married (55%). Few (n=15, 6.6%) of the deceased elders had a history of hospitalization because of mental illness. The highest rate of death was observed in free-occupation (26.9%), retired (14.5%), and unemployed (11%) elders, respectively. Many deceased elders had an education level below the diploma (78, 34.4%) or were illiterate (63, 27.7%). Few (5, 2.2%) of the deceased elders had a history of suicide attempts. More than half (61.7%) of the elderly deceased were autopsied. In 113 (49.8%), poison sampling and in 54 (23.8%), pathology test was performed. Conclusions: It can be argued that factors such as low level of education, male gender, habitation in a big city, free occupation, retirement or unemployment can contribute to an individual’s inclination to become addicted to narcotic or psychedelic drug abuse in aging (in the elderly), and these factors may be used to identify the elderly people at risk of drug addiction. Low prices and the fast availability of opium in Iran and some misconceptions about opium among Iranian people, may lead to its prevalent consumption among the elders. Increasing awareness in the elderly about the adverse effects of narcotic or psychedelic drug abuse can reduce their willingness to consuming drugs. Family support and psychological services, as well as medical and rehabilitation services for the elderly, can also be helpful in this regard.

Abstract: In the last 3 years the numbers of forcibly displaced people around the world has reached a record high. Experiences of war, persecution, violence, torture, participating in the killing of others, disruptions of attachments, and emotional losses increase the risk for psychological distress andmay contribute to the risk of developing psychiatric and substance abuse disorders. The authors review the existing psychiatric literature on refugees, discuss the sociological reasons that explain the recent crisis, describe the psychiatric consequences, the risk factors and protective factors of the refugee experience, narrate the current conditions in refugee camps located inGreeceand discuss the most up-to-date treatment modalities and preventive interventions to treat this patient population.

Abstract: Objectives: This study is aimed to translate the game addiction scale for adolescents into Arabic language and to test reliability and validity of the Arabic version. The game addiction scale for adolescents was developed to measure computer and video game addiction based on the criteria of pathological gambling in DSM-IV. Methods: The scale has been translated into Arabic. The English and Arabic versions were compared by psychiatry experts to ensure consistency and then they were administered to bilingual individuals who played computer and video games. Finally, the Arabic version was distributed among 50 school students, aged 10 to 19 years, who played computer and video games. Results and Conclusions: The data were collected from school students. The statistical analysis of the Arabic version of game addiction scale for adolescents showed that the Arabic/English validity was satisfactory, with proper internal consistency and reliability.

Abstract: Objective: The objective of this narrative review was to investigate the advances that have been made in research on the model of executive functioning for rehabilitation in addictions. Materials and Methods: This study presents a narrative review of studies that have focused on the neuropsychological model in the rehabilitation of addictions. For this, a total of 49 studies were analyzed, published in a period from 1982 to 2017. Results: The results showed that addictions constitute a brain damage agent, their main sequel is related to executive functioning and attentional capacity. Conclusions: Research on cognitive rehabilitation performed with patients with multiple brain pathologies, have shown their effectiveness in treatment, generating a line of study in addictions, which shows improvements in treatment retention rates and decrease in relapse rates.

Abstract: The results of the last 20 years of research on addictions in Centros de Integración Juvenil (CIJ) and their application in the development of care strategies will be presented. The review gathers the results of works developed in 4 main research lines: Epidemiological, psychosocial, clinical, and evaluative as well as community diagnostic studies carried out for the planning of the care services. This journey shows, in someway, the evolution of the phenomenon of addictions in a certain population sector that is the focus of CIJ’s care programs—basically made up of students and applicants for treatment—of its magnitude and impact of the factors and disorders associated with it, the characteristics of the demand for treatment, the needs for preventive care, etc.; and at the same time it is a sample of the different views from which the study of this problem has been addressed over time. From exploratory, correlational studies, to prospective, and multivariate studies and from the incorporation of qualitative research methods and the introduction of priority thematic axes such as the sex perspective, violence, migration and dual disorders, among others.

Abstract: Objective: To present a case of pedophilic disorder associated to intellectual disability and substance-use disorder (SUD). Background: Pedophilic disorders often appear in comorbidity with other mental disorders. Case description: A 21-year-old man is hospitalized in an addictive behavior unit, with a history of SUD, an exclusive sexual preference for boys aged 12 or under, associated to interpersonal problems with borderline Intelligence Quotient score, and failure in global functioning. Discussion: The article analyses the criteria related to pedophilic disorder, the difficulties in its diagnosis, the clinical implications of the comorbidity with intellectual disability and SUD. Conclusions: It is important to differentiate between pedophilic disorder, SUD, and intellectual disability. An active search for deviant sexual behavior is recommended in patients with dual diagnosis.

Abstract: Objectives: So far, no specific medication has been approved by international drug regulatory agencies for the treatment of cocaine use disorder (CoUD). The reward deficiency syndrome (dysphoric-depressive) was originally described as an outcome after detoxification; it is now considered to be one of the possible routes to relapsing behavior. Materials and Methods: We describe the case of 9 consecutive patients affected by mono CoUD. They voluntarily stopped cocaine use for almost 2 weeks, after daily use for almost 2 months, entering into a dysphoric-depressive syndrome and experiencing a high level of craving for cocaine. All patients received trazodone contramid once a day, at bedtime, at an initial dose of 150 mg the first week, upgraded to 300 mg starting with the second week of treatment; they were followed up for 6 months. Results: Only 1 patient failed to complete 6-month follow-up, relapsing many times into cocaine use during the observational period. Another patient completed the follow-up while improving his psychiatric symptoms but relapsing 3 times into cocaine use. In total, 7/9 patients (77.8%) improved their psychiatric symptoms and, 6 months after starting therapy, remained cocaine-detoxified. Conclusions: The present case series shows that trittico contramid is probably able to positively modify psychopathologic symptomatology and cocaine craving in CoUD patients who voluntarily stopped cocaine use but were at high risk of early relapse. The current need is for controlled clinical trials to confirm the safety and efficacy of trittico contramid in avoiding early relapse in cocaine self-detoxified patients.

Abstract: Objectives All 50 states have implemented a Prescription Drug Monitoring Program (PDMP) in efforts to control prescription drug abuse. Many now mandate PDMP checks before clinicians prescribe controlled substances. The aim of this study was to characterize the associations between patient characteristics, red flags found on PDMP reports, and prescriber behavior at community mental health agencies. Methods Prescribers at 9 practice sites, in five regional community mental health centers, were recruited by a practice-based research network (PBRN) to participate in a Card Study. Prescribers completed a PDMP attitudes survey, and cards were completed for patients who had PDMP reports checked. Data were analyzed using descriptive and inferential statistics. Results Thirty nine providers completed cards for n=249 unique patient encounters. Over 1/3 of all patients reported an addiction disorder (38%) or a diagnosis of chronic pain (34%). Twenty percent of PDMP reports were found to have red flags, most commonly multiple prescribers or multiple pharmacies. Red flags were associated with race (p<.0.05), presence of chronic pain (p<0.01), presence of an addiction diagnosis (p<0.05), use of opioids (p<0.001), and non-adherence with treatment (p<0.006). Among prescribers, red flags were associated with lower prescribing rates (p<0.01), and decisions to decrease dosage (p<0.002). Conclusions Red flags were commonly found on PDMP reports done in community mental health settings, and were associated with important patient characteristics and diagnostic factors. PBRN research methods can be leveraged to obtain real-time observational data about psychiatric prescribers' use of PDMP reports in clinical decision-making in different settings.

Abstract: Objective: The purpose of this study was to compare the characteristics of treatment-seeking crack cocaine users in Brazil in 1996/1997 and 2012/2013. Methods: We analyzed data from 2 cross-sectional studies conducted 16 years apart. The first study (performed 1996-1997) included 133 crack users. The second study (performed 2012-2013) included 577 crack users. An interview based on the Intake Questionnaire and the Maudsley Addiction Profile was performed to examine sociodemographic characteristics and patterns of drug use. In both surveys, criminal and treatment history were collected. Results: The mean age of users increased from 27.3 years (SD=7.9) in 1997 to 30.8 years in 2013 (SD=7.7). The number of individuals with a high school diploma was >3 times higher in 2013, (11.7% vs. 38.9%). The mean time elapsed since first use was 3.9 years (SD=2.8) in 1997 versus 9.3 years (SD=5.8) in 2013. Other differences included higher unemployment and incarceration rates in the 1997 study. Conclusions: A change was detected in the profile of treatment-seeking crack cocaine users over the past 2 decades. Current patients appear to be older and use the drug more chronically, in addition to having a higher level of schooling and lower unemployment rates when compared with 1997 users.

Abstract: Objectives: For patients with opioid addiction seeking treatment, an effective option is Medication-assisted Treatment (MAT). In Albuquerque, the city with the greatest number of people who use opioids in New Mexico, the demand for MAT exceeds the number of patients receiving treatment. The authors hypothesized that a primary factor in patients’ ability to access treatment is clinic payment options, rather than the traditionally cited availability of providers. Methods: The authors conducted a survey assessing payment methods and corresponding availability in MAT programs for 53 of Albuquerque’s ~70 providers. Results: The authors found a statistically significant (P<0.01) imbalance in treatment availability between insurance-accepting clinics (10.1% had ≥1 openings) and cash clinics (100% had ≥1 openings). Conclusions: These findings suggest that a lack of clinics accepting Medicaid and third party insurance may pose a significant treatment barrier. The authors thus conclude that more focus should be placed on increasing the number of clinicians and clinics accepting insurance.

Abstract: Objective: The use of vaporizers for nicotine and other illicit substances is increasing among adolescents. Our study aims to identify the risk factors for vaping illicit drugs in adolescents. Methods: Cross-sectional data were collected from 692 patients, aged 13 to 17, admitted to the Children's Recovery Center, Norman, Oklahoma, between August 11, 2014 and March 30, 2016. Descriptive statistics were computed to evaluate the study population and identify the rate of nicotine and other substance abuse in the adolescents. Logistic regression and adjusted odds ratio were performed to identify the risk factors for vaping illicit drugs. Results: Of 692 adolescents, 70.6% (n=489) reported using nicotine at least once in their lifetime. Among them, 56.4% (n=276) were daily tobacco users and 82.4% (n=403) described smoking by means of a vaporizer/electronic cigarette (e-cigarette). Among the study population, 67.4% (n=467) stated using illicit substances at least once, out of which, 18.4% (n=86) reported consuming illicit drugs through a vaporizer/e-cigarette. Male sex, history of nicotine use with a vaporizer/e-cigarette, and previous drug abuse are evidenced as risk factors for vaping illicit substances in adolescents (P<0.05). Conclusions: Our study results indicate that nicotine use by means of a vaporizer/e-cigarette, history of illicit drug abuse increase the likelihood of vaping illicit substances among adolescents. With increasing popularity in battery-powered smoking devices, it is necessary to understand the potential dangers and consequences that might occur with vaping illegal drugs.

Abstract: Introduction: This study aims to further differentiate the profiles of drug users based on sociodemographic factors associated with displacement and mental health disorders, which, within the context of this research, appear to be relevant when considering substance use. Objectives: To classify a sample of the population of victims of armed displacement in Colombia into homogenous groups through an interdependent multivariate cluster analysis, taking into account substance use in the last year. Methods: The data are taken from a study involving 1026 people between the ages of 13 and 65 that was designed to investigate the mental health and drug use patterns of populations displaced by the armed conflict in Colombia in 3 cities: Bogotá, Medellín, and Buenaventura. This study selected 540 cases presenting with at least 1 instance of alcohol, tobacco, or illicit substance use in the last year. Results: Cluster analysis identified 5 alcohol, 5 tobacco, and 4 illicit substance use groups. Age, sex, occupation, and some variables related to displacement were associated with the use of these substances. Considering illicit substances, cluster 2 is the group with the most characteristics in common; as such, interventions for this group should be prioritized in public health policies aimed at this population. Conclusions: There are specific groups of substance users in populations that have been the victim of forced displacement in Colombia

Abstract: Background: Substance abuse is a multifactorial disorder. Scientists have found that an individual’s inherited traits or temperament contributes to the disorder by shaping a personality strongly linked with the risk of substance abuse. DRD2/ANKK1 TaqIA polymorphism is believed to be associated with impulsive behaviors that lead to substance abuse. Methods: We assessed 80 opioid dependent patients using Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) and the Urgency—lack of Perseverance—lack of premeditation—Sensation seeking (UPPS) Impulsive Behavior Scale. We extracted DNA from the subjects’ whole blood and genotyped it for DRD2 allelic variants. Results: Genotype analysis showed that 33.8% of the subjects had TaqIA polymorphism versus 66.3% had normal genotype. The mean value of Urgency subscale of the UPPS in patients with normal genotype is (35.8±9.0) versus (40±8.4) in patients with polymorphism. Conclusions: Patients with TaqIA polymorphism shows statistically significant higher levels of urgency on UPPS than patients with wild genotype.

Abstract: Objectives: The combination of substance dependence and anxiety disorders is recognized to be increasingly common. The aim of this study was to assess the presence of anxiety disorders in recovered patients with substance dependence and to determine the prevailing types of anxiety disorders among these patients. Materials and Methods: Subjects diagnosed with substance dependence were recruited from the outpatient clinic of the Psychiatry and Addiction Prevention Hospital in Kasr Al Ainy. Patients were diagnosed by the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) for Anxiety Disorders and Substance Dependence Disorders. Urine screening test was performed for all participants. Baseline assessment was carried out after 1 month of quitting the substance intake; thereafter, the same assessment was repeated after 6 months. Results: There was a high prevalence (94%) of anxiety disorders in recovered patients with ≥6 months abstinence from substance dependence. Specific phobic disorder was the most prevalent type in recovered patients (20%), followed by social anxiety disorder (18%). There was a statistically significant relation between the main type of substance used and generalized anxiety disorder. Conclusions: Anxiety disorders are common in recovered patients with substance dependence. Specific phobic disorder was the most commonly diagnosed anxiety disorder in these patients.

Abstract: Background and Aim: Controlling the symptoms of opioid withdrawal syndrome is important for the treatment of opioid addiction. There is very limited evidence on the effectiveness of pregabalin on opioid withdrawal syndrome. The present study examines the effectiveness of pregabalin in reducing opioid withdrawal symptoms. Methods: This double-blind clinical-trial was conducted on noninjecting opioid users diagnosed with opioid dependence and referred to the Addiction Treatment Center of Khorshid Hospital in Isfahan, Iran, in 2015 and 2016. The patients were divided into intervention and control groups, and both groups received Buprenorphine for the routine management of opioid withdrawal syndrome. The intervention group additionally received 450 mg/d of pregabalin while the control group received placebos. Opioid withdrawal symptoms were evaluated using the Short Opioid Withdrawal Scale (SOWS). Data were analyzed in SPSS-20. Descriptive data were reported as mean±SD. The analytic data were analyzed using the repeated-measures ANOVA. The level of statistical significance was set at P-value<0.05. Results: The mean age was 41.58±10.09 in the intervention group and 44±8.87 years in the control group (P=0.47). None of the assessed signs and symptoms differed significantly between the 2 groups. Conclusions: The results did not show the superiority of the 450-mg/day pregabalin regimen versus the placebo for controlling the symptoms of opioid withdrawal syndrome. Further studies administering higher doses of pregabalin are recommended.

Abstract: Background: The co-occurrence of psychiatric and substance use disorder increases the duration of illness, hospitalization rates, and causes more functional impairment and legal problems, which may increase the burden of illness. Hence, identifying the risk factors of such comorbidity may help in mitigating such problems. Objective: This study examined the risk factors associated with comorbid Axis I and Axis II disorders in a sample of male Egyptian patients with substance abuse. Patients and Methods: A total of 158 male inpatients diagnosed with substance use disorder according to diagnostic and statistical manua-IV diagnostic criteria answered the Structured Clinical Interview for Axis I and Axis II disorders (SCID-I and SCID-II). They were also evaluated by the Addiction Severity Index scale and the Global Assessment of Functioning. Results: An overall 60% were diagnosed with another Axis I or Axis II disorder. An overall 26% of them had psychosis, and 21% had borderline personality disorder. Unemployment, history of child abuse, high cannabis, opioid and tramadol abuse, frequent overdosing, longer hospitalization, aggressive behavior, family dysfunction, and occupational and legal problems were significantly more in patients with comorbidity. Moreover, 62% of them had severe problems on the Addiction Severity Index scale. The predictive risk factors for comorbidity were familial problems, aggressive symptoms, cluster B personality traits, past history of psychiatric disorders, longer time of hospitalization, and lower Global Assessment of Functioning scores. Conclusions: Identifying the risk factors for psychiatric comorbidity in patients with substance dependence highlights the importance of developing a dual diagnosis service to meet the needs of this population.

Abstract: Introduction: Chronic use of psychoactive substances has been associated with various cognitive impairments. Also, it has been described that an associated cognitive impairment is one of the long-term consequences of having a mental illness. The coexistence of an addiction with at least one other mental illness is quite frequent. Little has been published about cognitive impairments in dual diagnosis patients in Colombia. Methods: A cross-sectional descriptive study with primary data was carried out in 31 patients with a dual diagnosis who were admitted to the Centro de Atención de Patología Dual (Dual Diagnosis Care Center) of the Clínica del Oriente between June and December 2017. The psychiatric diagnostic criteria of DSM-IV-TR and neuropsychological tests were used. Results: It was found that 90.9% of the patients had alterations in the medial orbital cortex; 54.5% in the anterior prefrontal cortex; and 45.5% in the dorsolateral cortex; 72.7% had alterations in sustained attention; 59.1% in alternating attention; and 81.8% in executive functions. Conclusions: 100% of patients with dual pathology suffer from cognitive impairments, which pose significant challenges in their rehabilitation process. For this reason, the inclusion of neuropsychological therapies should be considered in addition to comprehensive management.

Abstract: Objectives: The aim of this work was to study the association between different dimensions of impulsive behavior from one side and addiction-related problems and diurnal salivary cortisol levels from the other side. Methods: A cross sectional case/control study with 50 subjects consisting 2 equal groups. Subjects were recruited consecutively from Kasr Al-Ainy Psychiatry and Addiction Hospital, Cairo University and were matched for age, sex, and socioeconomic status. Both groups were subjected to Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I), Arabic version; UPPS Impulsive Behavior Scale. Patients with substance dependence completed the Addiction Severity Index, Arabic version. Diurnal salivary cortisol level was measured in both groups to reflect baseline activity of the hypothalamo-pituitary-adrenal (HPA) axis. Results: Patients with substance dependence had statistically significant higher scores on urgency (P=0.000), lack of premeditation (P=0.006), and lack of perseverance (P=0.018) subscales. About 76% had no problem, (20%) had mild problems and (4%) had severe alcohol use problems. Difference between the 2 groups in terms of salivary cortisol levels was not statistically significant (P=0.806). Conclusions: Substance-dependent subjects scored significantly higher than control subjects on lack of premeditation, urgency, and lack of perseverance traits. There was no relation between diurnal salivary cortisol levels and impulsivity.

Abstract: Gambling disorder is a pathologic condition, resulting from the interaction of multiple risk factors. Among these, dopamine neurotransmission is known for playing a significant role, as seen, for example, in patients using dopamine replacement therapy prescribed for Parkinson disease, in which gambling is considered to be iatrogenic. Considering this, together with the general mechanism of action of antipsychotic drugs, growing attention has recently been dedicated to Aripiprazole and to its partial dopaminergic agonism (reducing D2-receptor hyperactivation in the mesolimbic pathway and improving D2-receptor stimulation in the mesocortical and nigrostriatal pathway). In fact, Aripiprazole has been noticed in several cases to worsen preexisting pathologic gambling and also, in some cases, to precipitate pathologic gambling in those without preexisting pathologic gambling when used at therapeutic doses (10 to 15 mg). Mr F, a bipolar patient under treatment without either personal or family history of gambling, following a low-dose Aripiprazole administration, began displaying gambling behaviors, which immediately ceased after suspension of the drug. Subsequently, after the reintroduction of Aripiprazole, this time at standard dosage, the patient resumed additive behavior of gambling, which in this case also ceased at the time of suspension. It is possible to hypothesize that the dopaminergic agonist activity of low-dose Aripiprazole has influenced the physiological process of salience, leading the patient to give particular attention, through reward circuits, to a specific stimulus, otherwise not relevant. More difficult to explain, on the other hand, is how the standard dosage anti-D2 activity of Aripiprazole, has reactivated gambling behaviors again. According to our hypothesis, it is possible that the administration of standard dose of Aripiprazole has triggered a reward-deficiency syndrome, recalling the gratifying action of the recently experimented gambling to the patient’s memory, bringing him to the relapse.

Abstract: Objectives: There is no epidemiological information available about the use of new psychoactive substances (NPS) among the Mexican clinical population. For this reason, we examined NPS use among patients in a treatment institution, on the basis of clinicians’ report. Materials and Methods: This was an exploratory study carried out during 2017 and conducted by means of a survey, to consult clinicians about which NPS were used by patients in the previous year. Results: It was found that all groups of NPS were present in practically all of the treatment units in the country. The groups of NPS most reported were that of ketamine and phencyclidine. Conclusions: The results show the need to evaluate NPS use through an epidemiological perspective among both the clinical and the general populations.

Abstract: Background: The available data suggest that most illicit drugs have adverse effects on erection, sexual desire, and ejaculation latency in male individuals. Objective: This study was conducted for the evaluation of the sexual functions of substance abuse men. Methods: This descriptive study was conducted at the Alcohol and Substance Research Treatment and Education Center. Male individuals diagnosed as having substance use disorder according to DSM-V (n=106) were included as the patient group. A 30-item sociodemographic and reproductive health interview form developed by researchers and the 15-item International Erectile Function Index were administered to all the participants. Results: It was determined that the most prevalent addiction was cannabis addiction (39.6%) in the substance abuser group, and this was followed by heroin (35.8%) and cocaine addiction (24.6%). It was observed that the substance used by participants at the earliest age (15.81±4.19) was cocaine, and the longest duration in substance use (13.11±9.11) was in the cannabis group. An overall 41.5% of participants stated that they had a sexual problem, and 31.1% of them said they were not satisfied with their sexual life. It was detected that most of the substance abuser men (77.4%) have mild erectile dysfunction (ED) at the rate of 12.3% and moderate ED in 65.1% of them, and the cannabis user group had the most ED (83.3%). Conclusions: Substance abuse affects male sexual functions negatively. There are limited studies about the effects of substance abuse on male sexual functions in our country. For this reason, there is a need for more extensive prospective studies.

Abstract: Objective: Methanol poisoning can lead to the loss of vision and even death. The role of the health care system in managing and responding to these types of incidents is significant. This study aimed to identify and discuss the challenges of prehospital and hospital emergency services responding to the widespread methanol poisoning in the city of Rafsanjan. Methods: This qualitative study was carried out using content analysis approach. Data were collected using semistructured interviews. Participants included the matrons of health centers, head of accident and medical emergency center, director of the emergency operation center, ward manager and nursing staffs, and the representative of university's board of directors. After 15 interviews, data saturation was reached. Results: The findings of this study are based on 4 stages of disaster management cycle, which include: (1) mitigation in disaster with 2 subscales, (2) preparedness with 2 subscales, (3) response to disaster with 4 subscales, and (4) rehabilitation with 3 subscales. Conclusions: Interinstitutional coordination should be promoted through joint meetings, and also training classes on disaster management and its implementation should be held. Moreover, up-to-date clinical protocols must be accessible to personnel, and facilities and resources needed in the disaster should be provided. Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited.