A World Health Organization perspective on alcohol and illicit drug use and health

COVID-19 pandemic and alcohol consumption: Impacts and interconnections

Alcohol consumption is associated with multiple diseases and might contribute to vulnerability to SARS-CoV-2 infection. It can also catalyze exacerbations of mental and organic illnesses and predispose to behaviors with an increased risk of infection, severity of disease but also independently of sociopathic behavior and violence. Globally, millions of premature deaths from excessive alcohol consumption occur each year. This paper discusses the effects of increased alcohol consumption and the most important consequences on the health of the population during the social isolation and lockdown during current COVID-19 pandemic.

Substance Abuse Profiles of Patients Admitted to the Alcohol and Drug Addiction Research, Treatment, and Education Center in Turkey

Objectives

To determine the substance abuse profiles of patients treated a Drug Addiction Research, Treatment, and Education Center (AMATEM) in association with the percentage of substance use distribution and multiple substance use in their urine samples. For this, we retrospectively evaluated the urine sample analysis reports of 600 male and female patients aged 13 to 65 years who were treated at the AMATEM unit of İstanbul Neuropsychiatry Hospital between January 1^st, 2015, and December 12^th, 2015.

Materials and Methods

The urine samples were sent to Üsküdar University Advanced Toxicology Analysis Laboratory and were analyzed using a UPLC tandem mass spectrometer (UPLC-MS/MS). To determine the substance use profiles of the patients applying to AMATEM, statistical assessment was performed on the analysis reports of the patients.

Results

When the analysis reports of the 600 urine samples were examined, 293 patients were identified to have used addictive substances. The substances most frequently detected in the urine samples were respectively: cannabis, alcohol, morphine, cocaine, synthetic cannabinoids, 3,4-Methylenedioxymethamphetamine, and amphetamine.

Conclusion

The findings in our study resemble the rates of cannabis use by the young population throughout the world. Our results show differences to the literature regarding the consumption of synthetic cannabinoids because the variety of synthetic cannabinoids change rapidly around the world each year.

Reliability and validity of the Spanish version of the substance dependence severity scale

PURPOSE

The purpose of this study was to estimate the reliability and provide evidence for the validity of the Spanish version of the Substance Dependence Severity Scale (SDSS).

METHODS

A total of 211 substance abusers recruited at a public center that provides treatment for substance-related disorders in an outpatient setting were assessed. Reliability was estimated by Cronbach's α and test-retest. Validity evidence was studied by analyzing the relationships with the European Addiction Severity Index (EuropASI) and Health-Related Quality of Life for Drug Abusers (HRQoLDA).

RESULTS

Adequate reliability coefficients were found for the dependence scales of all addressed substances (α = 0.737 to 0.877; test-retest r = 0.796-0.952). Low internal consistency was found for the abuse scales (α = 0.329-0.694), and adequate test-retest coefficients on alcohol, cocaine and heroin (test-retest r = 0.708-0.902). The reliability of the cannabis abuse scales was inadequate. The SDSS scores showed significant relationships with the EuropASI and HRQoLDA dimensions.

CONCLUSIONS

The psychometric analyses validate the use of the severity of dependence scales. The SDSS abuse scales must be used taking the limitations detected into consideration.

Gender differences in alcohol choice among Russians: evidence from a quantitative study

AIMS

Qualitative studies find that men and women in Russia have different preferences for alcoholic beverages, but quantitative evidence for gender differences in beverage type choice remains scarce. The purpose of this article is to test numerically whether and to what extent men and women in Russia differ in terms of preferences for type of drink, such as vodka, wine and beer.

METHODS

Results are based on multinomial logistic regression and ordinary least squares regression analyses of the Russian Longitudinal Monitoring Survey-Higher School of Economics 2008 data.

RESULTS

We observed significant gender differences in preferences for alcoholic beverages. Men have strong preferences for vodka, and they drink it in much larger amounts in comparison with women. Women are more likely to either refrain from drinking or drink mild types of alcoholic beverages, such as wine and beer. Gender differences remain statistically significant even when sociodemographic factors are well accounted for.

CONCLUSIONS

The present study confirms the previous research findings about gender differences in drinking practices among Russians. Our results provide quantitative evidence of the pronounced differences in beverage types consumed by men and women.

The epidemiology of addiction in Sub-Saharan Africa: a synthesis of reports, reviews, and original articles

Use of alcohol and other psychoactive substances is associated with serious social and public health problems, but the extent of the problem in Sub-Saharan Africa is not well known. We set out to review epidemiological publications on alcohol and other psychoactive substances in Sub-Saharan Africa by performing a systematic search of electronic databases and paper records. Ten Sub-Saharan African countries are among the 22 in the world with the highest increase in per capita alcohol consumption. Cannabis, tobacco, and khat are widely used, and use of cocaine, stimulants, and heroin is increasing. More epidemiological research and implementation and evaluation of interventions is needed. Collaboration between African researchers and those in developed countries could help. 

Routines and rituals: a grounded theory of the pain management of drug users in acute care settings

AIM

This study reviewed the perceptions and strategies of drug users and nurses with regard to pain management in acute care settings.

BACKGROUND

Drug users present unique challenges in acute care settings with pain management noted to be at best suboptimal, at worst non-existent. Little is known about why and specifically how therapeutic effectiveness is compromised.

DESIGN

Qualitative: constructivist grounded theory.

METHOD

A constructivist grounded theory approach incorporating a constant comparative method of data collection and analysis was applied. The data corpus comprised interviews with drug users (n = 11) and five focus groups (n = 22) of nurses and recovering drug users.

RESULTS

Moral relativism as the core category both represents the phenomenon and explains the basic social process. Nurses and drug users struggle with moral relativism when addressing the issue of pain management in the acute care setting. Drug users lay claim to expectations of compassionate care and moralise via narration. Paradoxically, nurses report that the caring ideal and mutuality of caring are diminished. Drug users' individual sensitivities, anxieties and felt stigma in conjunction with opioid-induced hyperalgesia complicate the processes. Nurses' and hospitals' organisational routines challenge drug user rituals and vice versa leading both protagonists to become disaffected. Consequently, key clinical issues such as preventing withdrawal and managing pain are left unaddressed and therapeutic effectiveness is compromised.

CONCLUSION

This study provides a robust account of nurses' and drug users' struggle with pain management in the acute care setting. Quick technological fixes such as urine screens, checklists or the transient effects of (cognitive-based) education (or training) are not the answer. This study highlights the need for nurses to engage meaningfully with this perceptibly 'difficult' group of patients.

RELEVANCE TO CLINICAL PRACTICE

The key aspects likely to contribute to problematic interactions with this patient cohort are outlined so that they can be prevented and, or addressed.

Antipsychotic agents for the treatment of substance use disorders in patients with and without comorbid psychosis

Substance dependence has serious negative consequences upon society such as increased health care costs, loss of productivity, and rising crime rates. Although there is some preliminary evidence that atypical antipsychotic agents may be effective in treating substance dependence, results have been mixed, with some studies demonstrating positive and others negative or no effect. The present study was aimed at determining whether this disparity originates from that reviewers separately discussed trials in patients with (DD) and without (SD) comorbid psychosis. Using electronic databases, we screened the relevant literature, leaving only studies that used a randomized, double-blind, placebo-controlled or case-control design that had a duration of 4 weeks or longer. A total of 43 studies were identified; of these, 23 fell into the category of DD and 20 into the category of SD. Studies in the DD category suggest that atypical antipsychotic agents, especially clozapine, may decrease substance use in individuals with alcohol and drug (mostly cannabis) use disorders. Studies in the SD category suggest that atypical antipsychotic agents may be beneficial for the treatment of alcohol dependence, at least in some subpopulations of alcoholics. They also suggest that these agents are not effective at treating stimulant dependence and may aggravate the condition in some cases.

A multivariate approach to a meta-analytic review of the effectiveness of the D.A.R.E. program

The Drug Abuse Resistance Education (D.A.R.E.) program is a widespread but controversial school-based drug prevention program in the United States as well as in many other countries. The present multivariate meta-analysis reviewed 20 studies that assessed the effectiveness of the D.A.R.E. program in the United States. The results showed that the effects of the D.A.R.E. program on drug use did not vary across the studies with a less than small overall effect while the effects on psychosocial behavior varied with still a less than small overall effect. In addition, the characteristics of the studies significantly explained the variation of the heterogeneous effects on psychosocial behavior, which provides empirical evidence for improving the school-based drug prevention program.

Two generations of Slovenian suicidal adolescent inpatients

BACKGROUND

The political and socio-economic situation in Slovenia, a former Yugoslav republic, a country in transition and a country with a high suicide rate, which joined the European Union in 2004, has changed steadily since the beginning of the 1970s. Literature shows constancy in suicide statistics in Slovenia during these times.

AIM

The present study examines whether the suicidal adolescent inpatient population in Slovenia reflects recent social changes and upheavals.

METHOD

Data on two groups of patients admitted to a specialized adolescent psychiatry department after attempting suicide were collected. The first group (n = 74) were patients admitted from 1975 to 1977, the second group (n = 73) from 2002 to 2004. They were compared on general characteristics, family and living circumstances, risk behaviors, suicide attempts and diagnoses.

RESULTS

The comparison revealed statistically significant differences between groups on educational level, number of siblings, frequency of smoking and psychoactive medication misuse as well as number of previous suicide attempts. No differences were found in other family and living circumstances, methods used in the index suicide attempt, other risk behaviors or diagnoses.

CONCLUSIONS

The post-independence suicidal inpatient population in Slovenia shows a tendency towards higher morbidity, but has changed less than expected considering the vast changes in the society. These results suggest a certain constancy in adolescent suicidal behavior.

Chronic morphine drinking establishes morphine tolerance, but not addiction in Wistar rats

OBJECTIVE

Some animal models apply morphine in the drinking water to generate addiction, but related reports are not free of conflicting results. Accordingly, this study aimed to figure out if chronic consumption of morphine in the drinking water can induce morphine addiction in Wistar rats.

METHODS

For 3 weeks, the animals received a daily morphine dose of 35 mg/kg by offering a calculated volume of sugar water (5% sucrose) with morphine (0.1 mg/ml) to each rat; animals receiving just sugar water served as controls. Immediately after the treatment phase, the tail immersion test was used to check for morphine tolerance, and all animals were then kept on tap water for one week (withdrawal phase). Afterwards, all rats were allowed to choose their drinking source by offering two bottles, containing sugar water without and with morphine, simultaneously for two days (preference phase).

RESULTS

While the chronic consumption of morphine led to a reduction in body weight and to morphine tolerance, the morphine-treated Wistar rats did not show any preference for the opiate-containing sugar water.

CONCLUSION

Body weight loss and tolerance do not reveal a condition of drug craving, and current animal models should be re-evaluated regarding their potential to establish morphine addicted animals.

Tobacco consumption and its association with illicit drug use among men in Bangladesh

AIMS

This study examined the association of tobacco consumption (smoking and chewing) with illicit drug use among Bangladesh males.

DESIGN

Cross-sectional survey data from the Bangladesh Demographic and Health Survey 2004 were used.

SETTING

Bangladesh.

PARTICIPANTS

A total of 4297 males aged 15-54 years.

MEASUREMENTS

Age, education, religion, marital status, place of residence; tobacco consumption such as cigarette and bidi smoking, chewing sada, pata, tobacco leaves, gul, betel quid with zarda; taking illicit drugs such as ganja, charas, heroin, pethedine, phensidyl; having sexually transmitted diseases (STDs).

FINDINGS

Overall prevalence of tobacco consumption was 59%. Bidi smoking (29.6%), cigarette smoking (27.8%) and chewing betel quid with tobacco/zarda (17.5%) were predominant. Overall prevalence of illicit drug use was 4%. Ganja was the main drug (3%), followed by phensidyl (0.8%), heroin (0.3%) and charas (0.3%). Age, education, place of residence, marital status, having STDs, premarital and extra-marital sex were associated significantly with tobacco smoking. Almost all variables were also associated significantly with illicit drug use. Smoking cigarettes and bidi and eating tobacco leaves/shada pata/gul showed significantly positive associations with illicit drug use when adjusted for other variables.

CONCLUSIONS

Tobacco consumption is common and associated positively with the illicit drug use among males in Bangladesh.

Association between Opium Abuse and Comorbidity in Diabetic Men

The aims of this study were to determine the prevalence of opium abuse in diabetic men and to investigate its association with comorbidity. The study population was comprised of 312 consecutive diabetic men aged 20 years or older residing in the study area in 2005. The prevalence of self-reported opium abuse was 11.2%. Opium use was associated with low socioeconomic status, smoking, tea consumption, and a higher prevalence of erectile dysfunction (ED) and severe depression. The prevalence of severe depression was 22.8% among 35 men who used opium and 13.4% among 277 who did not use it. The prevalence of moderate or severe ED was 85.7% among opium users and 66.1% among non-users. The risk of ED was two times (95% CI 1.0-7.4) higher in opium users compared with nonusers.

Oral health sensations associated with illicit drug abuse

OBJECTIVES

To investigate oral health sensations (short term oral health effects) associated with illicit drug abuse. In addition, to identify variations in oral health sensations produced by different illicit drugs.

SUBJECT

Young adults in a drug rehabilitation programme in Hong Kong, China.

METHOD

Self-completed questionnaire about their previous pattern of drug abuse and oral health sensations experienced (recalled).

RESULTS

All (119) subjects were poly-drug abusers (abused one or more illicit drugs in the past). Amphetamine-based drugs such as methamphetamine ('speed') and methylenedioxymethamphetine ('ecstasy') were commonly abused. A wide range of oral health sensations were reported on recall of their abuse of illicit drugs; most frequently dry mouth (95%, 113). Types of illicit drugs abused were associated with oral health sensations reported (P < 0.001). 'Ecstasy' abusers more frequently reported chewing (P < 0.001), grinding (P < 0.001), and TMJ tenderness (P < 0.001) compared to non-'ecstasy' abusers.

CONCLUSION

Illicit drug abuse produces many oral health sensations. Types of drugs abused were associated with oral sensations produced. and behavioural effects that may manifest as depression, anxiety, memory loss and various neuropsychotic disorders.(8),(9) In some cases drug abuse can result in death by various means: malignant hyperthermia, internal bleeding, fatal overdosing and through allergic reactions.(10),(11) Likewise, there have been reports on the long term clinical effects of illicit drug abused on oral health.