Amandine Luquiens

Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice.

Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second‐line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.

The Effects of as-Needed Nalmefene on Patient-Reported Outcomes and Quality of Life in Relation to a Reduction in Alcohol Consumption in Alcohol-Dependent Patients

Background The objective of this article was to investigate the effect of as-needed nalmefene on health-related quality of life (HRQoL) in patients with alcohol dependence, and to relate changes in drinking behavior and status to HRQoL outcomes. Methods This post hoc analysis was conducted on a pooled subgroup of patients with at least a high drinking risk level (men: >60 g/day; women: >40 g/day) who participated in one of two randomized controlled 6-month studies, ESENSE 1 and ESENSE 2. Patients received nalmefene 18 mg or placebo on an as-needed basis, in addition to a motivational and adherence-enhancing intervention (BRENDA). At baseline and after 12 and 24 weeks questionnaires for the Medical Outcomes Study (MOS) 36-item Short-Form Health Survey (SF-36), European Quality of life-5 Dimensions (EQ-5D) and the Drinker Inventory of Consequences (DrInC-2R) were completed. Results The pooled population consisted of 667 patients (nalmefene: 335; placebo: 332), with no notable between-group differences in baseline patient demographics/characteristics. At week 24, nalmefene had a superior effect compared to placebo in improving SF-36 mental component summary scores (mean difference [95% CI], p-value: 3.09 [1.29, 4.89]; p=0.0008), SF-36 physical component summary scores (1.23 [0.15, 2.31]; p=0.026), EQ-5D utility index scores (0.03 [0.00, 0.06]; p=0.045), EQ-5D health state scores (3.46 [0.75, 6.17]; p=0.012), and DrInC-2R scores (-3.22 [-6.12, 0.33]; p=0.029). The improvements in SF-36 mental component summary scores at week 24, and the DrInC-2R total score change from baseline to week 24, were significantly correlated to reductions in heavy drinking days and total alcohol consumption at week 24. Conclusions As-needed nalmefene significantly improved almost all patient-reported HRQoL measures included in SF-36 and EQ-5D compared with placebo. These HRQoL gains were significantly correlated to reduced drinking behavior, as determined by reductions in heavy drinking days and total alcohol consumption.

Tracking online poker problem gamblers with player account-based gambling data only

The aim was to develop and validate an instrument to track online problem poker gamblers with player account‐based gambling data (PABGD). We emailed an invitation to all active poker gamblers on the online gambling service provider Winamax. The 14,261 participants completed the Problem Gambling Severity Index (PGSI). PGSI served as a gold standard to track problem gamblers (i.e., PGSI ≥ 5). We used a stepwise logistic regression to build a predictive model of problem gambling with PABGD, and validated it. Of the sample 18% was composed of online poker problem gamblers. The risk factors of problem gambling included in the predictive model were being male, compulsive, younger than 28 years, making a total deposit > 0 euros, having a mean loss per gambling session > 1.7 euros, losing a total of > 45 euros in the last 30 days, having a total stake > 298 euros, having > 60 gambling sessions in the last 30 days, and multi‐tabling. The tracking instrument had a sensitivity of 80%, and a specificity of 50%. The quality of the instrument was good. This study illustrates the feasibility of a method to develop and validate instruments to track online problem gamblers with PABGD only. Copyright

Quantitative damage-benefit evaluation of drug effects: major discrepancies between the general population, users and experts

Aims: This study sought to quantify the perceptions of damage and benefit, for users and society, associated with five addictive substances (alcohol, tobacco, cannabis, cocaine and heroin) and one addictive behavior (gambling), in a large sample representative of the French population. We compared with expert assessments and investigated the effects of substance consumption on these perceptions. Findings: The ranking of substances by the lay public is very divergent from that of experts. The public overestimates damage to users and to society and underestimates the benefit, in comparison with experts, for all substances. Alcohol is the only exception, with damage and benefit perceptions similar to those of experts. Heroin and cocaine are perceived as the two most dangerous substances. The damage of cannabis and alcohol are judged to be equivalent. The three legal substances are associated with the highest overall benefit, although cannabis has the highest perceived benefit for users. Substances with the highest perceived benefit tend to be associated with perception of lower levels of damage. Individuals with an history of substance use have a perception of the damage and the benefit for that substance which is more congruent with experts, including a similar ranking of substances. Conclusions: Prevention campaigns focused on perceptions of damage alone have reached their limits. The perception of benefit should be taken into account in early interventions with illegal substance users.

EPA-0464 – Tracking and treatment of online problem and pathologic poker gamblers: cross-sectional assessment followed by an internet-based randomized controlled trial of brief-interventions protocol presentation

Introduction Internet-based randomized controlled-trial is an emergent design that could be particularly pertinent in problem and pathologic online gamblers. Aim The proposed design of this first online randomized controlled trial among moderate risk problem and pathologic online poker gamblers with a naturalistic recruitment on the online poker operator website Winamax. Objectives The first part of the study is a cross sectional phase, aiming to identify a screening tool of moderate risk problem and pathologic gambling among routine registered-by- operator data by comparison to the clinical diagnosis tool ‘Canadian Pathological Gambling Index’ (CPGI). The second part is an interventional phase, aiming to assess efficacy of 3 internet-based brief interventions on problem gamblers at 6 and 12 weeks compared. Methods The cross sectional phase will be proposed systematically to all online problem poker gamblers. The interventional phase will be proposed to all online problem poker gamblers with a CPGI score ≥ 5. Subjects will be randomized in 4 groups: 1. Control= waiting list; 2. email with personal normative information ; 3. self-help program to be downloaded (based on Cognitive Behavioral Therapy and Motivational Interview) ; 4. Same program provided by weekly email contacts with a psychologist. The first judgment criterion will be the decrease in CPGI at six weeks. Conclusion The perspectives of this study are to enhance problem and pathologic online gamblers profiling by operators by proposing a surrogate endpoint of problem and pathologic gambling and to propose an easy, acceptable, minimal-efficient online behavioral intervention to problem and pathologic gamblers.