Molecular Mechanisms of Cannabinoid Addiction.
Molecular mechanisms of cannabinoid addiction.
Curr Opin Neurobiol. 2013 Mar 12;
Fratta W, Fattore L
Cannabis is the world’s most widely used illicit substance, with an estimated number of 119-224 million users worldwide. In recent years we assisted to an increased effort aimed to individuate the brain circuits underlying cannabis addiction and dependence. Similarly to other drugs of abuse, repeated exposure to cannabinoids causes brain neuroadaptations that persist long after drug effects, contribute to the negative affective states during withdrawal, and ultimately facilitate relapse. Recently, considerable progress has been made in understanding the cellular and molecular consequences of prolonged cannabis use, among which is the identification of specific set of transcriptional regulations that develop differently after chronic cannabinoids and in the abstinent brain. HubMed – addiction
Effectiveness of Alcohol Treatment Interventions Integrated into Routine Tuberculosis Care in Tomsk, Russia.
Addiction. 2013 Mar 14;
Shin S, Livchits V, Connery HS, Shields A, Yanov S, Yanova G, Fitzmaurice GM, Nelson AK, Greenfield SF,
AIMS: To test the feasibility and effectiveness of Brief Counseling Intervention (BCI) and Naltrexone integrated into tuberculosis (TB) care in Tomsk, Russia. DESIGN: Using factorial randomized controlled trial design, patients were randomized into: Naltrexone, Brief Behavioral Compliance Enhancement Therapy (BBCET), treatment as usual (TAU); BCI, TAU; Naltrexone, BBCET, BCI, TAU; TAU. SETTING AND PARTICIPANTS: In the Tomsk Oblast, hospitalized TB patients diagnosed with Alcohol Use Disorders (AUDs) by the DSM-IV were referred upon the start of TB treatment. Of the 196 cohort, the mean age was 41 years and 82% were male. Severe TB (84.7% had cavitary disease), and smoking (92.9%) were common. The majority had a diagnosis of an AUD (63.0%). 27.6% reported nearly daily drinking and consumed a median of 16 standard drinks per day. MEASUREMENTS: Primary outcomes were “favorable” TB outcome (cured, completed treatment) and change in mean number of abstinent days in the last month of study compared with baseline. Change in mean number of heavy drinking days, defined as 4 drinks per day and 5 drinks per day for women and men respectively, and TB adherence, measured as percent of doses taken as prescribed under direct observation, were secondary outcomes. Analysis based on “intention to treat” was performed for multivariable analysis. FINDINGS: Primary TB and alcohol endpoints between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly. TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms. Among individuals with a prior quitting attempt (n=111), naltrexone use was associated with an increased likelihood of favorable TB outcomes (92.3% versus 75.9%, P=0.02). CONCLUSIONS: In Tomsk Oblast, Russia, tuberculosis patients with severe Alcohol Use Disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care; however, those patients with past attempts to quit drinking had improved tuberculosis outcomes. HubMed – addiction
Establishing the feasibility of measuring performance in use of addiction pharmacotherapy.
J Subst Abuse Treat. 2013 Mar 11;
Thomas CP, Garnick DW, Horgan CM, Miller K, Harris AH, Rosen MM
This paper presents the rationale and feasibility of standardized performance measures for use of pharmacotherapy in the treatment of substance use disorders (SUD), an evidence-based practice and critical component of treatment that is often underused. These measures have been developed and specified by the Washington Circle, to measure treatment of alcohol and opioid dependence with FDA-approved prescription medications for use in office-based general health and addiction specialty care. Measures were pilot tested in private health plans, the Veterans Health Administration (VHA), and Medicaid. Testing revealed that use of standardized measures using administrative data for overall use and initiation of SUD pharmacotherapy is feasible and practical. Prevalence of diagnoses and use of pharmacotherapy vary widely across health systems. Pharmacotherapy is generally used in a limited portion of those for whom it might be indicated. An important methodological point is that results are sensitive to specifications, so that standardization is critical to measuring performance across systems. HubMed – addiction
Interventions for alcohol and drug problems in outpatient settings: A systematic review.
Drug Alcohol Rev. 2013 Mar 11;
Watson JM, Fayter D, Mdege N, Stirk L, Sowden AJ, Godfrey C
ISSUES: Research evidence indicates a high prevalence of substance abuse among patients presenting in general hospital settings. Such misuse of alcohol and illicit drugs has a major impact on population health and on costs to health services and to society at large. This review aimed to identify the interventions for alcohol or illicit drug misuse problems that have been evaluated for hospital outpatient populations. APPROACH: Thirteen electronic databases including MEDLINE, EMBASE and PsycInfo were searched for published and unpublished studies in any language up to August 2011. Reference lists of included studies and reviews were also hand-searched. We included randomised and controlled clinical trials of any intervention for adult participants identified as having alcohol and/or drug problems presenting to hospital outpatient settings other than addiction or psychiatric units. Participants could be attending hospital for any reason other than treatment for substance abuse. A narrative synthesis was conducted. KEY FINDINGS: There is some evidence to suggest that interventions based on motivational techniques might be effective in treatment of alcohol misuse in oral-maxillofacial clinics but not in general outpatient departments. The evidence is insufficient to allow any conclusions to be derived on the effectiveness of interventions in the treatment of drug misuse and combined alcohol-drug misuse in outpatient settings. CONCLUSIONS: Further research is needed to investigate interventions for alcohol and drug misuse in outpatient settings. Additionally, problems remain in terms of study quality. Procedures to ensure the rigour of a study were often poorly reported. HubMed – addiction
Harold A. Mulford Jr, 1922-2012.
Addiction. 2013 Mar 13;
Roman P
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