Journal of Addiction The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Delayed Ego Strength Development in Opioid Dependent Adolescents and Young Adults Tue, 17 Nov 2015 11:21:39 +0000 Objective. To evaluate ego strengths, in the context of Erikson’s framework, among adolescents and young adults diagnosed with opioid dependence as compared to non-drug using youth. Methods. Opioid dependent () and non-drug using control () youth completed the self-administered Psychosocial Inventory of Ego Strengths (PIES). The PIES assesses development in the framework of Erikson’s ego strength stages. Multivariate linear regression modeling assessed the independent association of the primary covariate (opioid dependent versus control) as well as potential confounding variables (e.g., psychiatric comorbidities, intelligence) with total PIES score. Results. Mean total PIES score was significantly lower in opioid dependent youth ( opioid dependent versus control; ). Evaluation of the PIES subscores found significant () delays in all ego strength areas (hope, will, purpose, competence, fidelity, love, care, and wisdom). When adjusting for potential confounders, opioid dependence remained a significant () independent predictor of total PIES score. Conclusion. Adolescents with opioid dependence demonstrated significant delays in ego strength development. A treatment approach acknowledging this delay may be needed in the counseling and treatment of adolescents with opioid dependence. Benjamin A. Abramoff, Hannah L. H. Lange, Steven C. Matson, Casey B. Cottrill, Jeffrey A. Bridge, Mahmoud Abdel-Rasoul, and Andrea E. Bonny Copyright © 2015 Benjamin A. Abramoff et al. All rights reserved. The Cannabis Dilemma: A Review of Its Associated Risks and Clinical Efficacy Sun, 11 Oct 2015 12:46:37 +0000 Cannabis, also known as marijuana, has 9-tetrahydrocannabinol as the main constituent. There has been strict legislation governing the utilization of cannabis locally and worldwide. However, there has been an increasing push to make cannabis legalized, in view of its potential medical and therapeutic effects, for various medical disorders ranging from development disorders to cancer treatment, and being an adjunctive medication for various neurological conditions. It is the aim of this review paper to explore the evidence base for its proposed therapeutic efficacy and to compare the evidence base supporting its proposed therapeutic efficacy with its known and well-researched medical and psychiatric side effects. Melvyn Weibin Zhang and Roger C. M. Ho Copyright © 2015 Melvyn Weibin Zhang and Roger C. M. Ho. All rights reserved. Risk Factors Associated with Unsafe Injection Practices at the First Injection Episode among Intravenous Drug Users in France: Results from PrimInject, an Internet Survey Sun, 04 Oct 2015 06:04:45 +0000 Background. New drug use patterns may increase the risk of human immunodeficiency virus and hepatitis infections. In France, new injection patterns among youths with diverse social backgrounds have emerged, which may explain the persistently high rates of hepatitis C virus infection. This study explores factors associated with injection risk behaviours at first injection among users who began injecting in the post-2000 era. Methods. A cross-sectional study was conducted on the Internet from October 2010 to March 2011, through an online questionnaire. Multivariate logistic regression identified the independent correlates of needle sharing and equipment (cooker/cotton filter) sharing. Results. Among the 262 respondents (mean age 25 years), 65% were male. Both risk behaviours were positively associated with initiation before 18 years of age (aOR 3.7 CI 95% 1.3–10.6 and aOR 3.0 CI 95% 1.3–7.0) and being injected by another person (aOR 3.1 CI 95% 1.0–9.9 and aOR 3.0 CI 95% 1.3–7.1). Initiation at a party was an independent correlate of equipment sharing (aOR 2.6 95% CI 1.0–6.8). Conclusions. Results suggest a need for innovative harm reduction programmes targeting a variety of settings and populations, including youths and diverse party scenes. Education of current injectors to protect both themselves and those they might initiate into injection is critically important. Anne Guichard, Romain Guignard, France Lert, and Elise Roy Copyright © 2015 Anne Guichard et al. All rights reserved. Improving Consumer Satisfaction with Addiction Treatment: An Analysis of Alumni Preferences Mon, 21 Sep 2015 06:55:11 +0000 Objective. The primary objective of this investigation is to determine which individual and aggregate factors of residential addiction treatment centers are most significant influencers of alumni satisfaction. Design. Survey targeted alumni of residential addiction treatment facilities. Alumni were queried through a survey, which utilized Likert-scale matrices and binary response options: 379 respondents met the completion threshold. Alumni rated amenities and individual and group counseling factors; additionally, respondents provided feedback on two satisfaction proxies: cost worthiness and future recommendations. Descriptive and relational analyses were conducted, with the latter utilizing logistic regression models. Results. Individual factors’ scores of group counseling, and overall aggregate group counseling score, are most enthusiastically positive. Group counseling is also the most significant influencer of satisfaction. Other significant influencers of satisfaction are met expectations for individual counseling and psychiatric care offerings. Conclusions. While individual counseling and facility amenities should not be ignored, group counseling may be the most significant influencer of alumni satisfaction. Long-term outcomes are not single-faceted; however, treatment providers should be encouraged to invest in high-quality group counseling offerings in order to best satisfy, and thereby empower, clients. Ruchi M. Sanghani and Alexander K. Moler Copyright © 2015 Ruchi M. Sanghani and Alexander K. Moler. All rights reserved. Psychopathology in Substance Use Disorder Patients with and without Substance-Induced Psychosis Mon, 31 Aug 2015 13:04:13 +0000 Background. Substance-induced psychotic disorder (SIPD) is a diagnosis constructed to distinguish substance-induced psychotic states from primary psychotic disorders. A number of studies have compared SIPD persons with primary psychotic patients, but there is little data on what differentiates substance use disorder (SUD) individuals with and without SIPD. Here, we compared psychopathology, sociodemographic variables, and substance use characteristics between SUD patients with and without SIPD. Methods. A retrospective chart review was conducted on newly admitted patients at a rehabilitation centre between 2007 and 2012. Results. Of the 379 patients included in the study, 5% were diagnosed with SIPD and 95% were diagnosed with SUDs without SIPD . More SIPD patients reported using cannabis and psychostimulants, and fewer SIPD patients reported using alcohol than SUDs patients without SIPD. SIPD patients scored higher on the “schizophrenia nuclear symptoms” dimension of the SCL-90R psychoticism scale and exhibited more ClusterB personality traits than SUD patients without SIPD. Discussion. These data are consistent with previous studies suggesting that psychopathology, substance type, and sociodemographic variables play important role in the development of SIPD. More importantly, the results highlight the need for paying greater attention to the types of self-reported psychotic symptoms during the assessment of psychotomimetic effects associated with psychoactive substances. Simon Zhornitsky, Andràs Tikàsz, Élie Rizkallah, Jean-Pierre Chiasson, and Stéphane Potvin Copyright © 2015 Simon Zhornitsky et al. All rights reserved. Psychometric Properties and Validation of the Arabic Social Media Addiction Scale Tue, 11 Aug 2015 08:02:25 +0000 This study investigated the psychometric properties of the Arabic version of the SMAS. SMAS is a variant of IAT customized to measure addiction to social media instead of the Internet as a whole. Using a self-report instrument on a cross-sectional sample of undergraduate students, the results revealed the following. First, the exploratory factor analysis showed that a three-factor model fits the data well. Second, concurrent validity analysis showed the SMAS to be a valid measure of social media addiction. However, further studies and data should verify the hypothesized model. Finally, this study showed that the Arabic version of the SMAS is a valid and reliable instrument for use in measuring social media addiction in the Arab world. Jamal Al-Menayes Copyright © 2015 Jamal Al-Menayes. All rights reserved. Alcohol and Substance Use in the Jewish Community: A Pilot Study Tue, 16 Jun 2015 12:44:04 +0000 Awareness of addictions in the Jewish community is becoming increasingly prevalent, and yet, a gap exists in the literature regarding addictions in this community. Knowledge about the prevalence of addictions within Jewish communities is limited; some believe that Jews cannot be affected by addictions. To address this gap, a pilot study was conducted to gather preliminary evidence relating to addictions and substance use in the Jewish community. Results indicate that a significant portion of the Jewish community knows someone affected by an addiction and that over 20% have a family history of addiction. Future research needs are discussed. Melanie Baruch, Abraham Benarroch, and Gary E. Rockman Copyright © 2015 Melanie Baruch et al. All rights reserved. National Helpline for Problem Gambling: A Profile of Its Users’ Characteristics Sun, 03 May 2015 14:13:51 +0000 Gambling has seen a significant increase in Italy in the last 10 years and has rapidly become a public health issue, and for these reasons the first National Helpline for Problem Gambling (GR-Helpline) has been established. The aims of this study are to describe the GR-Helpline users’ characteristics and to compare the prevalence rates of the users with those of moderate-risk/problematic gamblers obtained from the national survey (IPSAD 2010-2011). Statistical analysis was performed on data obtained from the counselling sessions (phone/e-mail/chat) carried out on 5,805 users (57.5% gamblers; 42.5% families/friends). This confirms that the problems related to gambling concern not only the gamblers but also their families and friends. Significant differences were found between gamblers and families/friends involving gender (74% of gamblers were male; 76.9% of families/friends were female), as well as age-classes and geographical area. Female gamblers had a higher mean age (47.3 versus 40.2 years) and preferred nonstrategy-based games. Prevalence rates of GR-Helpline users and of moderate risk/problematic gamblers were correlated (Rho = 0.58; ). The results highlight the fact that remote access to counselling can be an effective means of promoting treatment for problem gamblers who do not otherwise appeal directly for services. Luca Bastiani, Maurizio Fea, Roberta Potente, Claudia Luppi, Fabio Lucchini, and Sabrina Molinaro Copyright © 2015 Luca Bastiani et al. All rights reserved. Comorbid Psychopathology and Alcohol Use Patterns among Methadone Maintenance Treatment Patients Mon, 23 Mar 2015 08:24:50 +0000 130 patients from a methadone maintenance treatment program agreed to complete Symptoms Checklist 90-Revised (SCL-90R) and Alcohol Use Disorders Identification Test (AUDIT) self-report scales. Scores higher than the proposed cut-score on SCL-90R scale were observed on depression, obsessions-compulsions, paranoid ideation, anxiety, anger-hostility, somatization, interpersonal sensitivity, and psychoticism subscales. In sum, 42.9% of our sample exhibited depressive symptomatology, 34.9% obsessive-compulsive symptoms, 29.1% somatization, 27.2% anxiety symptoms, 22.2% paranoid ideation, 19% phobic anxiety, 15.1% psychoticism, and 15.1% hostility and 11.9% presented with symptoms of interpersonal sensitivity. Mean score on AUDIT scale was . 63.0% of our participants scored below cut-off and were classified as having a low level of alcohol-related problems; 24.4% scored in the range of 8–15 which is an indication of alcohol abuse whereas 12.6% scored 16 and above indicative of serious abuse/addiction. Scores on AUDIT scale were positively correlated with length of time on methadone treatment, but not with length of time on drug use or age of our participants. Positive correlations were observed among AUDIT and SCL-90R scores, namely, with global severity index score, positive symptom distress index, positive symptom total, and all primary symptom dimensions subscales except phobic anxiety. Georgios Moussas, Irene Fanouraki, Argiro Pachi, Arezina Asomatou, Olga Drylli, Georgios Paschalakis, Athanasios Tselebis, Konstantinos Giotakis, Dionisios Bratis, Georgios Dermatis, and Meni Malliori Copyright © 2015 Georgios Moussas et al. All rights reserved. Predictors of Intention to Quit Waterpipe Smoking: A Survey of Arab Americans in Houston, Texas Wed, 04 Mar 2015 10:02:53 +0000 Waterpipe smoking has been described as “the second global tobacco epidemic since the cigarette.” Both Middle Eastern ethnicity and having a friend of Middle Eastern ethnicity have been reported as significant predictors of waterpipe smoking. Addressing waterpipe smoking in this ethnic minority is essential to controlling this growing epidemic in the US. We investigated the predictors of an intention to quit waterpipe smoking by surveying 340 Arab American adults in the Houston area. Primary analyses were conducted using stepwise logistic regression. Only 27% of participants reported having an intention to quit waterpipe smoking. Intention to quit waterpipe smoking was significantly higher with history of cigar use, a prior attempt to quit, and not smoking when seriously ill and significantly lower with increasing age, medium cultural acceptability of using waterpipe among family, high cultural acceptability of using waterpipe among friends, longer duration of smoking sessions, and perceiving waterpipe smoking as less harmful than cigarettes. Educational programs that target Arab Americans in general, and specifically older adults, those who smoke waterpipe for more than 60 minutes, those whose family and friends approve waterpipe smoking, and those with no former attempts to quit, may be necessary to increase the intention to quit waterpipe smoking. Liqa Athamneh, Sujit S. Sansgiry, E. James Essien, and Susan Abughosh Copyright © 2015 Liqa Athamneh et al. All rights reserved. Evolution of Metabolic Abnormalities in Alcoholic Patients during Withdrawal Tue, 24 Feb 2015 14:15:17 +0000 Chronic alcohol intoxication is accompanied by metabolic abnormalities. Evolution during the early withdrawal period has been poorly investigated. The aim of this study was to determine the evolution of metabolic parameters during alcohol withdrawal. Patients and Methods. Thirty-three patients admitted in our department for alcohol withdrawal were prospectively included. Results. Baseline hypophosphatemia was found in 24% of cases. FEPO4 was reduced from 14.2 ± 9% at baseline to 7.3 ± 4.2% at day 3 (). FEPO4 inversely correlated with albuminemia (rs = −0.41, P = 0.01). CPK level was 124 ± 104 IU/L in men and 145 ± 85 IU/L in women ( and <192 IU/L, resp.), 7% and 28% of patients having a CPK level >nl, respectively. No correlation was found between the sodium and CPK levels () nor between the CPK level and the amount of alcohol ingested (rs = 0.084, ). Baseline urate level was elevated and returned to normal after three days. Baseline magnesium concentration was normal and stable over time. Conclusion. Chronic alcohol intoxication was accompanied by phosphaturia, rapidly reversible after alcohol withdrawal and inversely correlated with albuminemia, slight hyponatremia, low levels of 25 hydroxy vitamin D, elevated CPK level in about 30% of women, and hyperuricemia with rapid normalization. X. Vandemergel and F. Simon Copyright © 2015 X. Vandemergel and F. Simon. All rights reserved. Neighborhood Characteristics Associated with the Availability of Alcohol Outlets in Quebec, Canada Tue, 24 Feb 2015 06:26:34 +0000 Objectives. The objectives of this study were to examine the spatial accessibility to alcohol outlets in Quebec and to assess the association between neighborhood level characteristics and availability of alcohol outlets. Methods. The Tobit Model was used to assess the association between neighborhood level characteristics and the availability of alcohol outlets within 500, 1000, 2000, and 3000 metres, respectively. Results. Alcohol outlets were found to be most available in the two largest metropolitan areas of the province of Quebec (Montréal and Québec City). Within 1000 metres, alcohol outlets are more available in neighbourhoods with the following characteristics: highest concentration of men, least materially deprived highest concentration of persons aged 20 years or more, and location either in a metropolitan area or in a small town. Finally, the number of bars with video lottery terminals increases with the level of social and material deprivation. Conclusion. In Québec, there is no rule governing the location of alcohol outlets. Thus, there is an abundant literature indicating that the regulation of alcohol outlet density could be an effective means of controlling risk attributable to alcohol consumption. André Ngamini Ngui, Philippe Apparicio, Mathieu Philibert, and Marie-Josée Fleury Copyright © 2015 André Ngamini Ngui et al. All rights reserved. Women, Drug Dependency and Consequences: A Study from a Developing Country Mon, 23 Feb 2015 07:44:34 +0000 Introduction. Addiction in women can expose them to malnutrition, high blood pressure, cancer, and some other dangerous diseases like hepatitis, AIDS, or other sexual transmitted diseases. The aim of this study was to assess illegal sexual relations in three groups of women. Methods. This is a cross-sectional study that was done on 236 girls and young women aged 16–25 years in 2012 in three groups: vulnerable women who have substance dependency (crimes that had made women incarcerated were considered as vulnerability in this study), invulnerable women who have substance dependency (substance dependent women without a history of incarceration), and a control group (women with no history of substance dependency or being in prison). Results. 43.8% of vulnerable women who have substance dependency had extramarital sexual relations; this percentage was 55.8% in invulnerable women who have substance dependency and 1.4% in the control group. Crystal and methamphetamine abuse was higher in addicts who had extramarital sexual relations and alcohol abuse was correlated with unsafe sexual intercourse (, ). There was a statistically significant difference in extramarital sexual relation based on marital status (). Conclusions. Poverty, drug dependency, divorce, and alcohol consumption make women prone to other high risk behaviors that need more attention. Mohammad Khajedaluee, Maliheh Dadgarmoghaddam, Majidreza Erfanian, Arash Alipourtabrizi, and Majid Khadem-Rezaiyan Copyright © 2015 Mohammad Khajedaluee et al. All rights reserved. Injecting Drug Users and Their Health Seeking Behavior: A Cross-Sectional Study in Dhaka, Bangladesh Tue, 27 Jan 2015 08:55:25 +0000 Introduction and Aim. Injecting drug users (IDUs) are amongst the most vulnerable people to acquisition of HIV/AIDS. This study aims to collect information on IDUs and their health seeking behavior in Bangladesh. Design and Methods. A cross-sectional study was conducted among 120 IDUs attending a drug rehabilitation center in Dhaka, Bangladesh. Data were collected on sociodemographics, drug use, health seeking behavior, knowledge of injecting drugs, and sexual behavior. Results. The mean ± SD and median (IQR) age of the participants were and 33 (27–38) years, respectively, with only 9.2% females. Injection buprenorphine was the drug of choice for 40% of participants, and 58% of the participants first started drug use with smoking cannabis. 73.3% of participants shared needles sometimes and 57.5% were willing to use the needle exchange programs. 60% of the participants had no knowledge about the diseases spread by injection. Condom use during the last intercourse with regular partners was 11.7% and with any partners 15.8%. Conclusion. IDUs in Bangladesh are a high-risk group for HIV/AIDS due to lack of knowledge and risky behaviors. Education and interventions specifically aimed at IDUs are needed, because traditional education may not reach IDUs or influence their behavior. Sheikh Mohammed Shariful Islam, Tuhin Biswas, Faiz Ahmed Bhuiyan, Md. Serajul Islam, Mohammad Mizanur Rahman, and Hurun Nessa Copyright © 2015 Sheikh Mohammed Shariful Islam et al. All rights reserved. Functional Activation and Effective Connectivity Differences in Adolescent Marijuana Users Performing a Simulated Gambling Task Mon, 26 Jan 2015 06:40:48 +0000 Background. Adolescent marijuana use is associated with structural and functional differences in forebrain regions while performing memory and attention tasks. In the present study, we investigated neural processing in adolescent marijuana users experiencing rewards and losses. Fourteen adolescents with frequent marijuana use (>5 uses per week) and 14 nonuser controls performed a computer task where they were required to guess the outcome of a simulated coin flip while undergoing magnetic resonance imaging. Results. Across all participants, “Wins” and “Losses” were associated with activations including cingulate, middle frontal, superior frontal, and inferior frontal gyri and declive activations. Relative to controls, users had greater activity in the middle and inferior frontal gyri, caudate, and claustrum during “Wins” and greater activity in the anterior and posterior cingulate, middle frontal gyrus, insula, claustrum, and declive during “Losses.” Effective connectivity analyses revealed similar overall network interactions among these regions for users and controls during both “Wins” and “Losses.” However, users and controls had significantly different causal interactions for 10 out of 28 individual paths during the “Losses” condition. Conclusions. Collectively, these results indicate adolescent marijuana users have enhanced neural responses to simulated monetary rewards and losses and relatively subtle differences in effective connectivity. Ashley Acheson, Kimberly L. Ray, Christina S. Hines, Karl Li, Michael A. Dawes, Charles W. Mathias, Donald M. Dougherty, and Angela R. Laird Copyright © 2015 Ashley Acheson et al. All rights reserved. Correlates and Consequences of Opioid Misuse among High-Risk Young Adults Mon, 24 Nov 2014 08:57:34 +0000 Background. Prescription opioids are the most frequently misused class of prescription drug among young adults aged 18–25, yet trajectories of opioid misuse and escalation are understudied. We sought to model opioid misuse patterns and relationships between opioid misuse, sociodemographic factors, and other substance uses. Methods. Participants were 575 young adults age 16–25 who had misused opioids in the last 90 days. Latent class analysis was performed with models based on years of misuse, recency of misuse, and alternate modes of administration within the past 12 months, 3 months, and 30 days. Results. Four latent classes emerged that were differentially associated with heroin, cocaine, and methamphetamine use, tranquilizer misuse, daily opioid misuse, and opioid withdrawal. Alternate modes of administering opioids were associated with increased risk for these outcomes. Sociodemographic factors, homelessness, prescription history, and history of parental drug use were significantly associated with riskier opioid misuse trajectories. Conclusion. Young adults who reported more debilitating experiences as children and adolescents misused opioids longer and engaged in higher risk alternate modes of administering opioids. Data on decisions both to use and to alter a drug’s form can be combined to describe patterns of misuse over time and predict important risk behaviors. Sheree M. Schrager, Aleksandar Kecojevic, Karol Silva, Jennifer Jackson Bloom, Ellen Iverson, and Stephen E. Lankenau Copyright © 2014 Sheree M. Schrager et al. All rights reserved. Experiences from a Community Based Substance Use Treatment Centre in an Urban Resettlement Colony in India Sun, 09 Nov 2014 12:03:12 +0000 Background. There are limited community based treatment services for drug dependence in India. Rural areas and urban resettlement colonies are in particular deficient in such services. Aims. The current study aimed at preliminary assessment of substance use disorder management services at a community based substance use treatment clinic in an urban resettlement colony. Methods. The study was carried out at community based substance use treatment centre in a resettlement colony in India. The records of the centre were chart reviewed. Results. A total of 754 patients were registered at the clinic during the study period. Heroin was the primary drug of abuse for 63% of the patients. The mean duration of follow-up for the patients with opioid and alcohol dependence was 13.47 (; range 0–39) months. A total of 220 patients of opioid dependence were prescribed substation or abstinence directed therapy. Buprenorphine (87), slow release oral morphine (SROM) (16), and dextropropoxyphene (98) were used for opioid substitution. Conclusion. It is possible to deliver substance use disorder treatment services in community setting. There is a need to develop area specific community based treatment services for substance abuse in socially disadvantaged populations such as urban resettlement colonies. Yatan Pal Singh Balhara, Rajeev Ranjan, Anju Dhawan, and Deepak Yadav Copyright © 2014 Yatan Pal Singh Balhara et al. All rights reserved. Psychosocial Determinants of Tobacco Use among School Going Adolescents in Delhi, India Thu, 06 Nov 2014 09:29:22 +0000 Background. Tobacco use is one of the major preventable causes of premature death and disease in the world. Many psychosocial factors were found to influence tobacco use. Therefore the present study was designed to determine the role of psychosocial factors associated with tobacco use among school going adolescents in Delhi, India. Methods. Cross-sectional study was conducted from February 2013 to September 2013 in four government schools in South district of Delhi, India. The questionnaire contains questions adapted from GYTS (Global Youth Tobacco Survey) to find the prevalence and pattern of tobacco use among adolescents. Data were analyzed using SPSS version 21. Results. The prevalence of ever and current tobacco use was found in 16.4% and 13.1%. Current smoking and current tobacco chewing were found in 10.2% and 9.4% students, respectively. The risk of current tobacco use was found to be higher among males ( value = 0.000) and in those who got higher pocket money ( value = 0.000). Psychosocial factors like lower general self-efficacy and maladjustments with peers, teachers, and schools were also found to be significant predictors of current tobacco use. Conclusion. The study has revealed higher prevalence of ever and current tobacco use among adolescent students in Delhi, India. Varun Kumar, Richa Talwar, Neelam Roy, Deepak Raut, and Saudan Singh Copyright © 2014 Varun Kumar et al. All rights reserved. Predictors of Dropout from Inpatient Opioid Detoxification with Buprenorphine: A Chart Review Thu, 30 Oct 2014 07:32:46 +0000 Inpatient withdrawal treatment (detoxification) is common in opioid dependence, although dropout against medical advice often limits its outcome. This study aimed to assess baseline predictors of dropout from inpatient opioid detoxification with buprenorphine, including age, gender, current substance use, and type of postdetoxification planning. A retrospective hospital chart review was carried out for inpatient standard opioid detoxifications using buprenorphine taper, in a detoxification ward in Malmö, Sweden . Thirty-four percent of patients dropped out against medical advice. In multivariate logistic regression, dropout was significantly associated with younger age (OR 0.93 [0.89–0.97]) and negatively predicted by inpatient postdetoxification plan (OR 0.41 [0.18–0.94]), thus favouring an inpatient plan as opposed to outpatient treatment while residing at home. Dropout was unrelated to baseline urine toxicology. In opioid detoxification, patients may benefit from a higher degree of postdetoxification planning, including transition to residential treatment, in order to increase the likelihood of a successful detoxification and treatment entry. Young opioid-dependent patients may need particular attention in the planning of detoxification. Anders Hakansson and Emma Hallén Copyright © 2014 Anders Hakansson and Emma Hallén. All rights reserved. Unraveling Exercise Addiction: The Role of Narcissism and Self-Esteem Tue, 28 Oct 2014 00:00:00 +0000 The aim of this study was to assess the risk of exercise addiction (EA) in fitness clubs and to identify possible factors in the development of the disorder. The Exercise Addiction Inventory (EAI), the Narcissistic Personality Inventory (NPI), and the Coopersmith Self-Esteem Inventory (SEI) were administered to a sample of 150 consecutive gym attenders recruited in fitness centers. Based on EAI total score, high EA risk group (HEA ) and a low EA risk group (LEA ) were identified. HEA reported significantly higher total score (mean = 20.2 versus 14.6) on the NPI scale and lower total score (mean = 32.2 versus 36.4) on the SEI scale than LEA. A stepwise regression analysis indicated that only narcissism and self-esteem total scores ( were good predictors of days per week exercise. The present study confirms the direct and combined role of both labile self-esteem and high narcissism in the development of exercise addiction as predictive factors towards the risk of addiction. Multidisciplinary trained health care providers (physiatrists, psychologists, and psychiatrists) should carefully identify potential overexercise conditions in order to prevent the potential risk of exercise addiction. Antonio Bruno, Diego Quattrone, Giuseppe Scimeca, Claudio Cicciarelli, Vincenzo Maria Romeo, Gianluca Pandolfo, Rocco Antonio Zoccali, and Maria Rosaria Anna Muscatello Copyright © 2014 Antonio Bruno et al. All rights reserved. Process and Product in Cross-Cultural Treatment Research: Development of a Culturally Sensitive Women-Centered Substance Use Intervention in Georgia Mon, 22 Sep 2014 09:14:04 +0000 Women who inject drugs (WID) are highly marginalized and stigmatized and experience ongoing discrimination in Georgia. Few opportunities exist for WID to receive publicly funded treatment for substance use disorders. The IMEDI (Investigating Methods for Enhancing Development in Individuals) project was developed in response to the need for women-specific and women-centered treatment services. This paper described our approach to understanding the Georgian culture—and WID within that culture—so that we could integrate two interventions for substance use found effective in other Western and non-Western cultures and to outline how we refined and adapted our integrated intervention to yield a comprehensive women-centered intervention for substance use. Reinforcement Based Treatment (RBT) and the Women’s CoOp (WC) were adapted and refined based on in-depth interviews with WID () and providers of health services () to such women and focus groups [2 with WID () and 2 with health service providers ()]. The resulting comprehensive women-centered intervention, RBT+WC, was then pretested and further refined in a sample of 20 WID. Results indicated positive pre-post changes in urine screening results and perceived needs for both RBT+WC and a case management control condition. The approach to treatment adaptation and the revised elements of RBT+WC are presented and discussed. Hendrée E. Jones, Irma Kirtadze, David Otiashvili, Kevin E. O’Grady, Keryn Murphy, William Zule, Evgeny Krupitsky, and Wendee M. Wechsberg Copyright © 2014 Hendrée E. Jones et al. All rights reserved. Links between Psychotropic Substance Use and Sensation Seeking in a Prevalence Study: The Role of Some Features of Parenting Style in a Large Sample of Adolescents Sun, 21 Sep 2014 06:11:41 +0000 Aims. The objectives of the study were to (a) investigate the prevalence risk of current drug users and (b) explore the association between parental monitoring, adolescent-parent relationship, family structure, financial status, and sensation-seeking and psychotropic substance use. Methods. Data were drawn from the 2002 Italian student population survey of the European School Survey Project on Alcohol and Other Drugs. The sample size was 10,790 adolescents, aged 15–19 years. Multivariate logistic analyses were performed. Findings. The prevalence of users was 27.3% (34.2% males; 21.6% females). Single-parent and reconstructed families were related to the greatest likelihood of substance use. A medium financial status and, for females, a satisfying relationship with father were protective factors. Probability of engaging in risk-taking behavior increased when parental knowledge decreased. Exploring deeper how parental monitoring could modify the relation between different traits of sensation seeking and substances use revealed the following: “thrill and adventure seeking,” within the case of a good monitoring, can help against the use of substances; “boredom susceptibility” is not associated with drug use, except when parental monitoring is weak. Conclusions. Specific subdimensions, associated with substance use, may be more amenable to prevention than general interventions on sensation-seeking personality. Family is the context that could promote health education. Marco Scalese, Olivia Curzio, Valentina Cutrupi, Luca Bastiani, Mercedes Gori, Francesca Denoth, and Sabrina Molinaro Copyright © 2014 Marco Scalese et al. All rights reserved. The Great Recession and Drinking Outcomes: Protective Effects of Politically Oriented Coping Sun, 14 Sep 2014 09:31:31 +0000 Research derived from the stress paradigm suggests that certain types of coping (e.g., problem-focused coping instead of behavioral disengagement) are protective against problem-related drinking to deal with social stressors. Going beyond the typical focus in the coping literature, we hypothesize that stressors engendered by macrolevel social forces may require coping actions within the political realm in contrast to modes of coping focused outside of the political realm. A United States sample of 663 respondents completed a mail survey in 2010, including measures of stressful consequences of the Great Recession, drinking patterns and problems, modes of coping encompassed in the Brief COPE instrument, and politically oriented coping. Structural equation modeling examined whether modes of coping mediated the links between stressors and drinking outcomes. A substantial portion of the associations between stressors and drinking was explained by modes of coping. Politically oriented coping was protective against problem drinking for both genders. Future studies should further explore politically oriented coping in addition to modes of coping outside of the political realm when studying the relationships between macrolevel social stressors and deleterious drinking outcomes. Judith A. Richman, Robyn Lewis Brown, and Kathleen M. Rospenda Copyright © 2014 Judith A. Richman et al. All rights reserved. Etiology of Drug Abuse: A Narrative Analysis Tue, 26 Aug 2014 13:16:21 +0000 Introduction and Aim. Further gains in the prevention of drug abuse disorders require in-depth and holistic understanding of the risk factors of addiction from different perspectives. Lay persons and experts have different concepts of risk which could complement each other. The purpose of this study was to elaborate drug abuse risk factors through the story of individuals who had become drug dependent. Design and Methods. In this qualitative research, 33 individuals attending treatment centres for drug abuse were interviewed about the story of their addiction in Kerman, Iran. Interview questions were around the story of the participants. Results. All participants were male and in the age range of 18–40 years. Narrative analysis identified five themes as the main risk factors: family factors, peer pressure, the effect of gateway drugs (especially waterpipe), individual characteristics, and the community factors. More emphasis was placed upon the role of family factors, peer influence, and gateway effect. Discussion and Conclusion. This study elicited information from drug dependent subjects regarding the risk factors of drug abuse. According to drug dependent individuals’ views, more attention should be devoted to family and peer influences by policy makers, in developing culture-based preventive strategies. Nadjme Jadidi and Nouzar Nakhaee Copyright © 2014 Nadjme Jadidi and Nouzar Nakhaee. All rights reserved. Choosing Money over Drugs: The Neural Underpinnings of Difficult Choice in Chronic Cocaine Users Thu, 14 Aug 2014 11:43:29 +0000 Addiction is considered a disorder that drives individuals to choose drugs at the expense of healthier alternatives. However, chronic cocaine users (CCUs) who meet addiction criteria retain the ability to choose money in the presence of the opportunity to choose cocaine. The neural mechanisms that differentiate CCUs from non-cocaine using controls (Controls) while executing these preferred choices remain unknown. Thus, therapeutic strategies aimed at shifting preferences towards healthier alternatives remain somewhat uninformed. This study used BOLD neuroimaging to examine brain activity as fifty CCUs and Controls performed single- and cross-commodity intertemporal choice tasks for money and/or cocaine. Behavioral analyses revealed preferences for each commodity type. Imaging analyses revealed the brain activity that differentiated CCUs from Controls while choosing money over cocaine. We observed that CCUs devalued future commodities more than Controls. Choices for money as opposed to cocaine correlated with greater activity in dorsal striatum of CCUs, compared to Controls. In addition, choices for future money as opposed to immediate cocaine engaged the left dorsolateral prefrontal cortex (DLPFC) of CCUs more than Controls. These data suggest that the ability of CCUs to execute choices away from cocaine relies on activity in the dorsal striatum and left DLPFC. Michael J. Wesley, Terry Lohrenz, Mikhail N. Koffarnus, Samuel M. McClure, Richard De La Garza II, Ramiro Salas, Daisy G. Y. Thompson-Lake, Thomas F. Newton, Warren K. Bickel, and P. Read Montague Copyright © 2014 Michael J. Wesley et al. All rights reserved. Effect of Religiosity and Dysfunctional Dating Attitudes on Youth Substance Use Tue, 05 Aug 2014 05:24:34 +0000 The current investigation examined the interactive effect of dysfunctional dating attitudes and religiosity on substance use in a large sample of youth () from the YouthStyles survey. Based on past research, we explored the possibility that religiosity buffered the association between dysfunctional dating attitudes and substance use. Because age was significantly associated with all study variables, we included age in our analyses. In support of our hypothesis we found an attitude by religiosity by age interaction among youth with moderate levels of dysfunctional dating attitudes. Among these youth, the buffering effect of religiosity increased with age. For youth with low and high dysfunctional dating attitudes, religiosity did not buffer the association. The results of this study are in line with past work that suggests that the association between relationship characteristics and substance use is complex. It also identifies religiosity as a protective factor for the effect of dating attitudes on substance use but suggests that these effects may be the most important for youth with moderate levels of dysfunctional dating attitudes. Andra Teten Tharp, C. Nathan DeWall, Stephanie B. Richman, and Rita K. Noonan Copyright © 2014 Andra Teten Tharp et al. All rights reserved. Predictors of Middle School Students’ Interest in Participating in an Incentive-Based Tobacco Prevention and Cessation Program in Connecticut Thu, 24 Jul 2014 09:20:11 +0000 Behavioral incentives have been used to encourage smoking cessation in older adolescents, but the acceptability of incentives to promote a smoke-free lifestyle in younger adolescents is unknown. To inform the development of novel, effective, school-based interventions for youth, we assessed middle school students’ interest in participating in an incentive-based tobacco abstinence program. We surveyed 988 students (grades 6–8) attending three Connecticut middle schools to determine whether interest in program participation varied as a function of (1) intrapersonal factors (i.e., demographic characteristics (sex, age, race), smoking history, and trait impulsivity) and/or (2) aspects of program design (i.e., prize type, value, and reward frequency). Primary analyses were conducted using multiple regression. A majority of students (61.8%) reported interest in program participation. Interest did not vary by gender, smoking risk status, or offering cash prizes. However, younger students, non-Caucasian students, behaviorally impulsive students, and students with higher levels of self-regulation were more likely to report interest. Inexpensive awards (e.g., video games) offered monthly motivated program interest. In sum, middle school students reported high levels of interest in an incentive-based program to encourage a tobacco-free lifestyle. These formative data can inform the design of effective, incentive-based smoking cessation and prevention programs in middle schools. Meghan E. Morean, Deepa R. Camenga, Grace Kong, Dana A. Cavallo, Ty S. Schepis, and Suchitra Krishnan-Sarin Copyright © 2014 Meghan E. Morean et al. All rights reserved. Substance Use and Associated Factors among University Students in Ethiopia: A Cross-Sectional Study Mon, 28 Apr 2014 07:18:05 +0000 Studies indicate that substance use among Ethiopian adolescents is considerably rising; in particular college and university students are the most at risk of substance use. The aim of the study was to assess substance use and associated factors among university students. A cross-sectional survey was carried out among 1040 Haramaya University students using self-administered structured questionnaire. Multistage sampling technique was used to select students. Descriptive statistics, bivariate, and multivariate analysis were done. About two-thirds (62.4%) of the participants used at least one substance. The most commonly used substance was alcohol (50.2%). Being male had strong association with substance use (AOR (95% CI), 3.11 (2.20, 4.40)). The odds of substance use behaviour is higher among third year students (AOR (95% CI), 1.48 (1.01, 2.16)). Being a follower of Muslim (AOR (95% CI), 0.62 (0.44, 0.87)) and Protestant (AOR (95% CI), 0.25 (0.17, 0.36)) religions was shown to be protective of substance use. Married (AOR (95% CI), 1.92 (1.12, 3.30)) and depressed (AOR (95% CI), 3.30 (2.31, 4.72)) students were more likely to use substances than others. The magnitude of substance use was high. This demands special attention, emergency preventive measures, and targeted information, education and communication activity. Gezahegn Tesfaye, Andualem Derese, and Mitiku Teshome Hambisa Copyright © 2014 Gezahegn Tesfaye et al. All rights reserved. Factor Structure of CIWA-Ar in Alcohol Withdrawal Sun, 06 Apr 2014 12:19:56 +0000 Objective. To identify the underlying factor structure of alcohol withdrawal syndrome, as measured with CIWA-Ar. Methods. Exploratory factor analysis was conducted on the items of CIWA-Ar. On 201 alcohol-dependent male patients seeking treatment for alcohol withdrawal at 36 hours of abstinence. Results. A three-factor solution was obtained that accounted for 68.74% of total variance. First factor had loading from four items (34.34% variance), second factor also had four items (24.25% variance), and the third had two items (10.04% variance). Conclusions. Factor analysis reveals the existence of multidimensionality of alcohol withdrawal as measured with CIWA-Ar and we found three factors that can be named as delirious, autonomic and nonspecific factors. Ajay Kumar Bakhla, Christoday R. J. Khess, Vijay Verma, Mahesh Hembram, Samir Kumar Praharaj, and Subhas Soren Copyright © 2014 Ajay Kumar Bakhla et al. All rights reserved. Contribution of Alcohol to Hypertension Mortality in Russia Sun, 23 Feb 2014 06:52:44 +0000 Background. Hypertension (HTN) is reported to be the leading contributor to premature death globally. Considerable research evidence suggests that excessive alcohol intake (binge drinking) is an independent risk factor for HTN. It was repeatedly emphasized that binge drinking is a major contributor to a high cardiovascular mortality rate in Russia. Objective. The aim of this study was to examine the aggregate-level relation between alcohol consumption and HTN mortality rates in Russia. Method. Age-standardized sex-specific male and female HTN mortality data for the period 1980–2005 and data on overall alcohol consumption were analyzed by means of ARIMA (autoregressive integrated moving average) time-series analysis. The level of alcohol consumption per capita has been estimated using the indirect method based on alcohol psychoses incidence rate and employing ARIMA time-series analysis. Results. Alcohol consumption was significantly associated with both male and female HTN mortality rates: a 1-liter increase in overall alcohol consumption would result in a 6.3% increase in the male HTN mortality rate and in a 4.9% increase in female HTN mortality rate. The results of the analysis suggest that 57.5% of all male HTN deaths and 48.6% of all female HTN deaths in Russia could be attributed to alcohol. Conclusions. The outcomes of this study provide support for the hypothesis that alcohol is an important contributor to the high HTN mortality rate in the Russian Federation. The findings from the present study have important implications with to regards HTN mortality prevention, indicating that a restrictive alcohol policy can be considered as an effective measure of prevention in countries with a higher rate of alcohol consumption. Y. E. Razvodovsky Copyright © 2014 Y. E. Razvodovsky. All rights reserved.