Sellman Jd

The relationship between non-acute adolescent cannabis use and cognition

Research indicates that cannabis continues to be a popular illegal drug internationally. Furthermore, adolescent rates of use appear to be significant. Whilst the non-acute effect of cannabis use on adult cognition has been extensively researched, there has been less examination of adolescents. This study aimed to investigate the non-acute relationship between cannabis and cognitive function in a sample of adolescents with a continuum of cannabis use, taking into account additional predictor variables (psychiatric functioning, general functioning, demographics and other drug use). Seventy adolescents were recruited from clinical and community sources as well as through newspaper advertisements. After 12 hours abstinence from cannabis, adolescents completed a two-hour interview covering: demographics; alcohol and drug use history; drug use in the past 28 days; depression; further psychiatric functioning (including ADHD and Conduct Disorder); and cognitive functioning as measured by computerised tasks (CANTAB) and traditional pen and paper tests. Adolescents who were regular cannabis users (more than once a week) had a significantly poorer performance on four measures of cognitive function reflecting attention, spatial working memory and learning. Cannabis use remained an independent predictor of performance on the working memory and strategy measures after additional predictor variables were included in a multivariate regression analysis. The results suggest that aspects of adolescent cognitive function are independently related to the frequency of cannabis use beyond acute intoxication.

Does depression predict relapse in the 6 months following treatment for men with alcohol dependence

Objective: To investigate whether depression measured at the time of treatment predicts relapse of alcohol dependence in the 6 months following treatment of alcohol-dependent men. Method: Ninety-three subjects with moderate-severe alcohol dependence (DSM-Ill-R), recruited from a 3-week, abstinence-focused therapeutic program, were assessed for current and lifetime major depression using the SCID-P and baseline depressive symptoms using the SCL-90, and then followed up for 6 months. Drinking outcomes were based on multiple sources of data. Results: Relapse was not associated with either lifetime major depression, or baseline depressive symptoms; inadequate numbers of subjects with a current major depression precluded statistical analysis of this variable. Conclusions: Neither lifetime major depression, nor the degree of depressive symptoms in alcohol-dependent men at the time of treatment, compromise drinking outcomes in the 6 months following treatment.

What is the cost-effectiveness of hepatitis C treatment for injecting drug users on methadone maintenance in New Zealand?

The cost-effectiveness of hepatitis C virus (HCV) anti-viral therapy for injecting drug users (IDUs) on methadone maintenance is important because the majority have chronic infections that remain untreated. Cost-effectiveness analysis examines the costs of treatment compared with the benefits, which in this study are defined as savings in life. The cost-effectiveness of treatment for HCV infection is investigated for Mäori and non-Mäori IDUs on methadone maintenance therapy (MMT) in New Zealand. Markov models are used to model cohorts of IDUs, changes in their health states and the effects of MMT and anti-viral therapy on morbidity and mortality. Comparisons were made between conventional combination therapy (COT) and combination therapy with pegylated interferon. Sensitivity analysis is used to model cost-effectiveness of treatment under varying assumptions of progression of liver disease and compliance with treatment. The cost-effectiveness of MMT alone was estimated at 25397 dollars per life year saved (LYS) for non-Mäori men and 25035 dollars for non-Mäori women IDUs (costs and benefits discounted at 3%). The incremental effects of providing COT to all eligible patients were to save extra years of life, as well as to involve additional costs of anti-viral therapy. Analysis of both the incremental costs and benefits showed that a policy of providing COT to all patients meeting treatment criteria would have similar cost-effectiveness to MMT alone. Costs per LYS were estimated to be lower for Mäori for both men and women, reflecting ethnic differences in mortality. Cost-effectiveness was found to improve if the average age of stabilizing on MMT could be lowered by 5 years from the current average age of 31 years to age 26. Cost-effectiveness of the new treatment with pegylated interferon and ribavirin was found to be similar to that of COT because the increased LYS were offset by expected higher costs of the new pharmaceuticals. Sensitivity analysis showed that anti-viral treatment remained cost-effective under varying assumptions of the rate of disease progression and compliance with treatment.

A randomized trial of combined citalopram and naltrexone for nonabstinent outpatients with co-occurring alcohol dependence and major depression.

Abstract Despite the high rate of co-occurrence of major depression and alcohol dependence, the role of pharmacotherapy in their treatment remains unclear. In the new era of naltrexone for alcohol dependence, it is notable that only 1 study to date has examined the efficacy of antidepressant medication prescribed concurrently with naltrexone. We aimed to determine whether combining naltrexone with citalopram produced better treatment outcomes than naltrexone alone in patients with co-occurring alcohol dependence and depression, and to investigate whether either sex or depression type (independent or substance-induced depression) moderated treatment response. Participants were 138 depressed alcohol-dependent adults who were not required to be abstinent at the commencement of the trial. They were randomized to 12 weeks of citalopram or placebo, plus naltrexone and clinical case management. Treatment was well attended, and medications were reasonably well tolerated with high adherence rates. Substantial improvements in both mood and drinking occurred in both groups, with no significant differences between groups on any of the mood or drinking outcome measures, whether or not other variables were controlled for. No interaction effect was found for independent/substance-induced depression status, whereas there was a marginal effect found by sex, with greater improvement in 1 drinking outcome measure (percent days abstinent) in women taking citalopram. These findings suggest that citalopram is not a clinically useful addition to naltrexone and clinical case management in this treatment population. Independent/substance-induced depression status did not predict treatment response. Findings for sex were equivocal.

Future of God in recovery from drug addiction

The purpose of the present paper was to explore the concept and experience of God in relation to recovery from drug addiction from a scientific perspective. Examination of a diverse literature was undertaken, including five key threads: the universality of the experience of God; the induction of spiritual experiences of God through hallucinogenic drugs; the nature of drug addiction from an evolutionary neurobiological perspective; the 12 Step movement as the prototype for the place of God in recovery from drug addiction; and identified ingredients for successful recovery from addiction. The diverse threads of literature examined can be integrated around the concept of higher power as an important factor in recovery from drug addiction. Higher power can be manifested in individuals in diverse ways: religious, ethnic, spiritual including the use of entheogens, as well as cognitive behavioural development, but a common final pathway for all is the strengthening of executive functions (the brains ‘higher power’). Practical implications for assisting people with drug addiction to achieve recovery through their own experience of God/development of higher power are outlined.

CLINICIAN BELIEFS AND PRACTICES RELATED TO INCREASING RESPONSIVITY TO THE NEEDS OF MAORI WITH ALCOHOL AND DRUG PROBLEMS

Culturally responsive treatments are often cited as essential for successfully addressing substance use-associated problems in indigenous and other ethnicgroups. However, there has been little investigation of the support for this assertion among alcohol and drug-user treatment workers, or how it might translate into clinical practice. The current paper reports on the results of a survey of the New Zealand alcohol and drug-user treatment field, which canvassed these issues. Eighty-six percent of respondents advocated adjustment of clinical practice when working with Maori. Two key strategies were referral to specialist Maori groups or individuals and/or contacting/meeting with whanau (family). Comparisons were made between respondents who referred clients on and those who provided intervention themselves. Implications of results, limitations and future research are discussed.

Antidepressant therapy for depressed patients with an alcohol use disorder.

Depression and alcohol use disorder are major causes of disability worldwide, and they commonly co-occur. Patients experiencing both conditions have worse outcomes in a range of areas, including healthcare utilisation, suicide risk and relapse of depression or drinking. Finding an effective approach to treating depression in people with an alcohol use disorder is, therefore, an important clinical problem. Antidepressant therapy is a cornerstone of treatment for severe unipolar depression, but its effectiveness in people with a co-existing alcohol use disorder is less established. Despite this, recent Australian data showed that heavy alcohol consumption is an independent predictor of current antidepressant use (Paige et al., 2015), suggesting antidepressants are commonly prescribed for individuals who are drinking heavily. Until the mid-1990s, it was generally accepted that antidepressant therapy was not indicated in individuals with active alcoholism and depressive symptoms since depressive symptoms typically dissipate with abstinence (Nunes and Levin, 2004). Nonetheless, a series of small randomised placebocontrolled antidepressant trials from the 1990s onwards began to challenge this dogma. These trials were summarised in a 2004 meta-analysis of antidepressant therapy for depressive comorbidity in substance use disorders more generally (Nunes and Levin, 2004). In this review, Nunes and Levin found modest support for antidepressant therapy, particularly among studies with lower levels of placebo response. The authors stressed the importance of actively treating depression in patients with substance use comorbidity, although they cautioned ‘at least a brief period of abstinence’ was warranted before treatment commenced. In contrast, three further randomised trials in the past decade failed to show any effect of antidepressant monotherapy in depressed alcohol-dependent patients, although one of these studies reported that combining sertraline with the anticraving drug naltrexone led to better depression outcomes than either drug alone. These newer findings were incorporated into a recent meta-analysis, suggesting the pooled effect of antidepressant therapy in patients with an alcohol use disorder is close to zero (Foulds et al., 2015). One explanation for the underwhelming findings for antidepressant therapy is patient selection. Among depressed patients without comorbidity, the robust effect of antidepressants is mainly confined to those with severe depression. In contrast, most of the trials on comorbid samples have been in patients with mild to moderate depression (Foulds et al., 2015). There are two main reasons studies typically select individuals with relatively mild depression. First, it is difficult to recruit patients for a study in which two disorders need to be present simultaneously; therefore, severity thresholds for including patients tend to be low. Second, depressive symptoms improve rapidly in alcohol treatment settings, so they are often mild by the time baseline measures are taken and randomisation occurs. Determining whether a patient’s depression is independent or alcoholinduced has also been promoted as a key determinant of prognosis and antidepressant response (Schuckit, 1994). This categorisation is made by assessing whether there is a history of depression prior to the first onset of heavy drinking or during a period of abstinence lasting at least several weeks. However, the predictive value of this typology in clinical settings has not been validated. Patients with independent depression experience improved mood if they stop drinking, and those with apparent alcohol-induced depression are at high risk of developing independent depression in the next 12 months. Notwithstanding these limitations, the evidence for antidepressant therapy does appear somewhat more consistent for independent depression, although even in this group, the standardised mean difference in depression Antidepressant therapy for depressed patients with an alcohol use disorder

Potential risk for fatal drug overdose perceived by people using opioid drugs: Perceptions of risk of fatal opioid overdose

Introduction and Aims. Combinations of drugs can increase the risk of overdose. Our aim was to examine perceptions of people dependent on opioid drugs on the potential risk of overdose from taking a prescribed dose of methadone in combination with various other recreational substances. Design and Methods. A peer-interviewer survey was conducted in three New Zealand regions. Recruitment was via snowballing initiated at needle exchange and opioid substitution treatment (OST) services. Results. Participants were 56% male, with a mean age of 37.5 years, 75% were New Zealand European, 24% M aori and 51% were receiving OST. Methadone and alcohol or benzodiazepine combinations were perceived as being of higher potential risk than methadone and stimulant or cannabis combinations. However, methadone taken in combination with alcohol or benzodiazepines was perceived as low risk by over half (55%) the participants. Factors associated with higher risk potential were area of residence, use of methadone in the previous month and a non-opioid drug injecting preference. Discussion and Conclusions. People who use opioid drugs continue to perceive taking opioids in combination with alcohol and benzodiazepines as low risk. Prevention efforts could be informed by greater exploration of barriers to understanding potential overdose risk and changing high-risk behaviours, and accessible and relevant opioid-related fatality data. OST must be able to attract and retain people who are dependent on opioid drugs. [Deering DEA, Adamson SJ, Sellman JD, Henderson C, Sheridan J, Pooley S, Robertson RM, Noller G, Frampton CMA. Potential risk for fatal drug overdose perceived by people using opioid drugs. Drug Alcohol Rev 2018;37:S309–S313]

Measuring Eating Compulsivity in the Wider Clinical Context

compulsive eating behaviors is, of course not true. On the other hand, obese people are one of the high risk populations for compulsive eating and I agree that Schroder et al.s study to develop and validate MEC is consisted of subjects with a BMI greater than 30. However, the clinicians and researchers working with obese people should keep in mind that they very likely have high insulin resistance and frequent reactive hypoglycemic episodes which is also known as postprandial hypoglycemia after consuming a diet with a high glycemic index. The sudden drops in blood glucose level are usually recurrent and occur within four hours after eating the simple-carbohydrate rich foods. As all physicians are well aware, if one has hypoglycemia, this means that he/she might have food cravings, urge to eat with irritability, very little control over eating and cannot be able to control how much he/ she eats till the blood glucose level approaches to normal. Episodes of reactive hypoglycemia may easily be misdiagnosed as excessive hunger or polyphagia and the obese patient may be stigmatized as a gluttonous person. The blaming of being weak willed for weight lose by others may end up with self-accusation and decreased self-respect. It is very important not to diagnose an obese patient with reactive hypoglycemic episodes as having eating compulsivity since the clinical approach and the treatment of the patients with hypoglycemia or the eating compulsivity are totally different. The one with postprandial hypoglycemia needs to avoid simple sugars in the diet, increase the frequency and reduce the size of the meals in order to increase the compliance to nutritional rehabilitation and weight lose which in turn help to decrease the insulin resistance. However, the patient with proposed compulsive eating will not benefit from the medical approach and will need a comprehensive psychopathological evaluation not only focusing on eating. In conclusion, I agree with the authors that this brief measure is likely to have utility in clinical and research settings as a screening tool but reactive hypoglycemia in obese people should also be considered depending on the clinical symptomatology.

Development and Validation of a Brief Measure of Eating Compulsivity (MEC)

ABSTRACT Food addiction is increasingly being recognised as a contributory factor in overweight and obesity. Management of eating compulsivity, a key component of food addiction, may assist greatly in the successful treatment of obesity. Measurement of food addiction and its core characteristic of eating compulsivity is fundamental to increasing understandings of the concept of food addiction, its prevalence among people with and without obesity and its utility within a treatment context. The current study describes the development and initial validation of a brief measure of eating compulsivity that can be used within clinical and research settings to establish a persons level of eating compulsivity. Sixty five participants with a BMI ≥30 (mean BMI 38.1) were recruited from a general population sample within Christchurch, New Zealand. Participants completed the test version of the Measure of Eating Compulsivity (MEC) and the Yale Food Addiction Scale (YFAS) as well as providing self-reported measures of height and weight. The 10-item MEC was developed. This measure was shown to have excellent internal consistency (Cronbachs alpha =.946), based on a single factor accounting for 67.4% of the variance and excellent test-retest reliability (r =.923). MEC10 score was strongly predictive of being categorised as having food addiction based on the YFAS, although not associated with BMI. This brief tool is likely to have high utility in clinical and research settings and requires further validation with a range of populations including those with and without obesity, binge eating disorder and other eating disorders.