Rethinking Addiction

A path to recovery for overlooked populations and their unique challenges: integrating rehabilitation in palliative care for patients with substance use disorders

Palliative care is a growing medical specialty focusing on providing compassionate and holistic management for those facing life-threatening diseases. These patients frequently present with physical, functional, emotional, and psychosocial problems that require comprehensive interdisciplinary management. However, there is a substantial opportunity to improve care for patients in palliative care who also have a substance use disorder (SUD). These opportunities include direct provision of SUD treatments by specialist palliative care providers and the integration of physical medicine and rehabilitation services. The purpose of this article is to examine the misunderstood and underutilized interaction between palliative care and SUDs, as well as describing the unique opportunities provided by physical medicine and rehabilitation providers to achieve a patient's palliative care goals and optimize overall quality of life. Substance Use Disorder is a chronic, often relapsing, illness that is relevant to palliative care practice due to the potential for significant morbidity and mortality through organ failure, chronic infections, and overdose syndromes. In traditional palliative care practice, it has been observed that past or current SUD diagnoses are often left untreated, resulting in increased distress, and exacerbating an already complex medical situation. Furthermore, many of these patients also experience physical, functional, or psychosocial changes that, when left untreated, will worsen distress and quality of life. To provide more comprehensive and successful palliative care for patients with SUD, the authors recommend an increased emphasis on specialist palliative care training in SUD management, proactive integration of rehabilitation services into the palliative care team, and consistent advocacy for these steps in various arenas. Combined, these actions can improve the care team's ability to provide a holistic, patient-centered approach that can have substantial positive outcomes for patients, health systems, and society.

Working memory-related brain activity in cannabis use disorder: The role of cross-cultural differences in cannabis attitudes

Cannabis legislation and attitudes towards use are changing. Given that evidence from cultural neuroscience research suggests that culture influences the neurobiological mechanisms underlying behaviour, it is of great importance to understand how cannabis legislation and attitudes might affect the brain processes underlying cannabis use disorder. Brain activity of 100 dependent cannabis users and 84 controls was recorded during an N-back working memory (WM) task in participants from the Netherlands (NL; users = 60, controls = 52) and Texas, USA (TX; users = 40, controls = 32). Participants completed a cannabis culture questionnaire as a measure of perceived benefits (positive) and perceived harms (negative) of cannabis from their personal, friends-family's and country-state's perspectives. Amount of cannabis use (grams/week), DSM-5 CUD symptoms and cannabis use-related problems were assessed. Cannabis users self-reported more positive and less negative (personal and friends-family) cannabis attitudes than controls, with this effect being significantly larger in the TX cannabis users. No site difference in country-state attitudes was observed. TX cannabis users, compared with NL cannabis users, and those cannabis users perceiving more positive country-state attitudes showed a more positive association between grams/week and WM-related activity in the superior parietal lobe. NL cannabis users, compared with TX cannabis users, and those cannabis users with less positive personal attitudes showed a more positive association between grams/week and WM-load-related activity in the temporal pole. Both site and cultural attitudes moderated the association of quantity of cannabis use with WM- and WM-load-related activity. Importantly, differences in legislation did not align with perceived cannabis attitudes and appear to be differentially associated with cannabis use-related brain activity.

"They didn't have any idea what drugs were": Pathways to substance use disorders among ultraorthodox Jewish males

BACKGROUND

Substance use disorders (SUDs) are a worldwide phenomenon with very negative consequences, and belonging to a religious community is considered to be a protective factor against them. The pathways to SUDs have been investigated in many studies with the aim of helping us better understand this phenomenon and promoting effective intervention programs to prevent and manage it. However, there is a lack of knowledge regarding SUDs in closed religious communities such as the Ultraorthodox Jewish community.

METHOD

To fill this gap, in the current study we investigated the pathways to SUDs among 14 young men from the Ultraorthodox Jewish community in Israel who were diagnosed as having an SUD in the past and who had been in sustained remission for at least a year. Semi-structured, in-depth interviews consisting of open-ended questions were conducted.

RESULTS

The findings highlighted two main themes: (a) A lack of support and attention from various systems, where participants reported sense of otherness or lack of belonging to family, educational institutions and community; a lack of responsiveness from those systems; a sense of rejection or exclusion; and a longing for belonging, and (b) A light in the darkness - someone who cares, in which the interviewees received some assistance, either in the period before or during drug use.

CONCLUSION

Findings point to the unique experience of Ultraorthodox young men in their addiction process and shed light on the failure of the abovementioned systems to help these young men cope. Findings are discussed in the context of the theoretical perspectives of social capital theory and exclusion. Implications for intervention and policy are outlined.

Impact of Childhood Onset Psoriasis on Addictive Behaviours, Socioeconomic and Educational Data in Adulthood

Paediatric psoriasis has been associated with school absenteeism, limitation of physical activities, psychiatric disorders and, in the longer term, with sexual dysfunction and addictions. This raises the hypothesis that childhood onset psoriasis may affect patients’ educational development, and further social and professional outcomes. This study evaluated the relationship between childhood onset psoriasis and patients’ educational and socioeconomic characteristics, and the development of addictions in adulthood. This cross-sectional ancillary study captured patients’ characteristics at baseline in the French PSOBIOTEQ registry. Data in adulthood included: educational (baccalaureate) and socioeconomic (working activity) groups, smoking status (self-reporting of being a current smoker vs past smoker or non-smoker), alcohol consumption (defined as at least 1 glass of alcoholic beverage per day), and living conditions (alone/family/social institutions; child at home). A total of 1,960 patients were included, of whom 26.2% had childhood onset psoriasis. In multivariate analyses, childhood onset psoriasis was associated with smoker status (p = 0.02). No association was observed with educational level, working activity, living conditions, or alcohol consumption. This study provides reassuring data overall with regard to the impact of childhood onset psoriasis on major social outcomes. Evidence for some association with addictive behaviours paves the way for larger prospective studies assessing in depth the social and educational impact of this disease.

Analysis of capability, motivation and opportunity to prevent substance abuse in sensation seeking students on the outskirts of a city in Eastern Iran: a qualitative study

Background

Usually, substance abuse begins in adolescence in Iran. Young people who score high on the sensation-seeking trait tend to be more prone to substance abuse and an early experience in using. According to the COM_B model, substance abuse can be observed in situations where a person has the necessary physical and mental abilities, the necessary opportunities, and competing motivations. Therefore the study aimed to deeper understand of capability, motivation, and opportunities of substance abuse behavior to design educational programs.

Methods

This study was conducted based on content analysis approach. Data were collected through a focus group discussion with 18 participants (high school male students) from the outskirts of Birjand, who received a positive score from the Zuckerman Sensation Seeking Questionnaires' summary form. The group discussion was conducted using a guide to semi-structured questions based on COM-B model constructs.

Results

Students' knowledge of substance cognition, side effects, and consequences of addiction were incomplete. Some students believed that substance use was a way to control or vent emotions and that smoking was a sedative, and private spaces and uncrowded public places were physical environments that students cited for engaging in substance use. In the analysis, 24 subcategories and 11 categories were identified for the capability analysis section, 16 subcategories and 7 categories for the motivation section, and 21 subcategories and 6 categories for the opportunity section.

Conclusions

In order to achieve more precise prevention interventions against adolescents' tendency for substance abuse and to have a more significant impact on their behaviors, it is beneficial to study the three identified factors in some of the target individuals before intervention.

A descriptive study of exercise dependence: a short report among Italian and Japanese runners

Background: Exercise dependence is a phenomenon characterized by behavioral, physiological and psychological symptoms similarly to substance use disorders. Although exercise addiction is not classified as a mental health disorder. A descriptive study of exercise dependence in two different countries, Italy and for the first time Japan was performed.Methods: We interviewed 229 Italian and 198 Japanese runners by using the exercise dependence scale-21 (EDS-R), a questionnaire to assess exercise dependence.Results: In Italy, 86.9% of subjects were nondependent symptomatic, 4.4% wxercise-dependent, and 8.7% were nondependent asymptomatic. In Japan, participants were classified as nondependent symptomatic (49%) and nondependent asymptomatic (51%), but none considered as at-risk. Significant differences were found in all the seven EDS-R categories between the two cohorts.Conclusions: Exercise dependence is a complex with many contributing factors such as neuroadaptation to protracted exposure to exercise, runner's features and contextual factors. The role of social and cultural factors of exercise dependence would need further investigations.