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  • ISSN: 2333-665X
    Early Online
    Review Article
    Michels II*, Bob Keizer, Franz Trautmann, Heino Stöver, and Ernest Robello
    According to 20092013 and 2014 2020 Action Plans on Drugs between the European Union (EU) and the Central Asian states it is of common interest to address drug-related concerns, to intensify cooperation and to provide assistance in the field of drug prevention and drug treatment. Central Asian countries (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan) are experiencing drug use related problems, such as increasing numbers of drug dependents (approx. 400,000 injecting heroin users) and the threat of infection diseases such as HIV and Hepatitis among injecting drug users (with a prevalence of 4-20%, 50-70% respectively). Several harm reduction programmes had been launched, but mostly externally donor-driven.
    Although the model of "narcology", in the sense of social control rather than strengthening of self-support and respecting human rights of drug users, still exists, a common basis for improvement of drug prevention and treatment response is already on the way. Drug dependence is defined as a chronic illness and treatment is seen to be needed. The staff in the treatment and rehabilitation centres is qualified and highly motivated, but the structural barriers and lack of funding are omnipresent. There is an urgent need for exchange of experiences and trainings in psycho-social support and new methods of psychotherapy and implementing and scaling-up of Medication Assisted Treatment (MAT). Several bottlenecks and threats for further improvements of the services for drug users exist. Although detoxification and short term inpatient treatment facilities exists on the basis of the primary care system, only limited out-patient treatment facilities are working. There is only very limited access to Opiate Substitution Treatment (OST) and only limited co-operation of HIV, Hepatitis, and TB prevention services for injecting drug users and addiction treatment centres. The EU financed "Central Asia Drug Action Programme" (CADAP) is aiming at supporting the need for further qualification and trainings in psychotherapeutic methods for brief interventions, motivational interviewing, relapse prevention and social rehabilitation, and MAT. More than 2,000 experts and governmental representatives were trained between 2010 and 2012. Access to OST could be slightly increased in Kyrgyzstan, Tajikistan and Kazakhstan. In the current 6th phase of the programme the improvement of the institutionalisation of the treatment system and the WHO/UNODC International Standards of the Treatment of Drug Use Disorders will be trained and systematized, using EU best practices.
    Schuster R, Misselwitz B, and Künzel W*
    Smoking in women is a rapidly growing and serious public health problem worldwide. All tobacco products contain toxicants, so smoking increases risk for disease. Tobacco smoking is a risk factor for numerous disorders, including cancers affecting organs outside the respiratory tract. Nicotine readily crosses the placenta and the fetuses of mothers who smoke are exposed to relatively higher nicotine concentrations than their mothers. Cigarette abuse during pregnancy increases maternal health risks as well as mental and physical problems for the fetus, contributing to multiple adverse outcomes such as preterm delivery and stillbirth. Recent studies have suggested a direct contribution of nicotine the addictive component of tobacco and tobacco smoke to human carcinogenesis, and it remains the most common harmful substance to which pregnant women are exposed. Also, it has deleterious effects on the fetus. The newborns of smoking mothers have elevated frequencies of chromosome translocations and DNA strand breaks. It is known that cigarette smoking has genotoxic effects and causes mutations. The toxic substances from cigarette smoke induce structural and numerical chromosomal aberrations in vitro and could potentially increase levels of aneuploidy in the fetus. Moreover, increased levels of aneusomy in fetus are correlated with low implantation rates, spontaneous abortions and fetal losses. Due to the harmful effects of cigarette, pregnancy is one of the ideal times to quit smoking. Because, mothers should repeatedly be awared about the harmful effects of cigarette on their baby health and that the pregnancy period is perfect time to quit smoking for having a healthy baby. It is up to you.
    Mini Review
    Osman Demirhan*
    Smoking in women is a rapidly growing and serious public health problem worldwide. All tobacco products contain toxicants, so smoking increases risk for disease. Tobacco smoking is a risk factor for numerous disorders, including cancers affecting organs outside the respiratory tract. Nicotine readily crosses the placenta and the fetuses of mothers who smoke are exposed to relatively higher nicotine concentrations than their mothers. Cigarette abuse during pregnancy increases maternal health risks as well as mental and physical problems for the fetus, contributing to multiple adverse outcomes such as preterm delivery and stillbirth. Recent studies have suggested a direct contribution of nicotine the addictive component of tobacco and tobacco smoke to human carcinogenesis, and it remains the most common harmful substance to which pregnant women are exposed. Also, it has deleterious effects on the fetus. The newborns of smoking mothers have elevated frequencies of chromosome translocations and DNA strand breaks. It is known that cigarette smoking has genotoxic effects and causes mutations. The toxic substances from cigarette smoke induce structural and numerical chromosomal aberrations in vitro and could potentially increase levels of aneuploidy in the fetus. Moreover, increased levels of aneusomy in fetus are correlated with low implantation rates, spontaneous abortions and fetal losses. Due to the harmful effects of cigarette, pregnancy is one of the ideal times to quit smoking. Because, mothers should repeatedly be awared about the harmful effects of cigarette on their baby health and that the pregnancy period is perfect time to quit smoking for having a healthy baby. It is up to you.
    Research Article
    Riki Tesler*, Yossi Harel Fisch, Tanya Kolobov, Noa Shtainmetz, Irene Nebutovsky, and Ephraim Shapiro
    Cigarette smoking is one of the most dangerous behaviors affecting health. The World Health Organization (WHO) has stated that tobacco smoking is the second most common cause of death and is the fourth most dangerous risk factor for disease worldwide.
    Health promotion policies can help reduce health-related risk behaviors and policies targeting risk behaviors have been gradually implemented across schools in Israel. This study identified the most effective school health promotion policy components and their association with risk behaviors, specifically tobacco smoking among adolescents.
    Data from the random-sample Israeli 2011/12 Health Behavior in School-Aged Children (HBSC) survey was analyzed. This included interviews with 5,279 students in 95 Jewish public schools. In addition, 100 principals from the participating schools were interviewed to measure the extent of implementation of health promotion policies in their schools. A logistic hierarchical linear model (HLM) analysis was performed to simultaneously estimate the relationship between individual and school level factors with tobacco smoking.
    Most variance in adolescent smoking was explained by student level variables including negative perceptions of school, lack of parental support for school issues, and time spent with friends. Among the school level measures, parental participation in health promotion intervention programs proved to be associated with lower rates of Adolescents Tobacco Smoking, over and above student characteristics. School health promotion policies should focus on parents participation in intervention programs and should seek to improve students perceptions of school and their sense of well-being to promote resilience.
    Short Communication
    Tohar Rigler, Iris Manor, Adie Kalansky, ZamirShorer, Iris Noyman, and Yair Sadaka*
    Objectives: In recent years, there has been an increase in the use of ADHD medications among students who do not have a diagnosis of ADHD in an effort to improve their academic performance. How healthcare trainees perceive and use these medications without prescription deserves a special focus as their current attitudes and choices may influence their future practice in managing the care of children.
    Methods: Students were asked about symptoms of ADHD, about their attitudes towards the use of methylphenidate (MPH) and their personal use. Three hundred and twelve pediatric residents, and medical and psychology students and an additional 133 engineering students were sampled.
    Results: Overall, 22% of all healthcare trainees reported some MPH use. Healthcare trainees were far less likely to carry a formal diagnosis of ADHD than engineering students (9% vs. 23%), although they tended to meet DSM diagnostic criteria to the same level (20% vs. 21%).Healthcare trainees were more likely to use these medications without a formal ADHD diagnosis, and they were far more likely to believe that MPH has an effect on people without ADHD.
    Conclusions: Healthcare trainees should be educated about the importance of appropriate diagnosis of ADHD andof the risks of using of methylphenidate without appropriate diagnosis.
    Review Article
    Johan Y. Cohen*, Gregoire Huguet, Julien Cohen, Luis Vera, and Roland Dardennes
    Objective: Methamphetamine use disorders are a matter of public health. The goal of this study was to conduct a systematic review of clinical trials concerning cognitive-behavioural therapies (CBTs) and motivational interviewing (MI) for methamphetamine use disorders.
    Method: We have conducted a systematic review of the literature on MEDLINE in order to include all controlled clinical trials that were published up to March 31th, 2017.
    Results: Of the 369 articles that were reviewed, six clinical trials (n=1578) fulfilled our inclusion criteria. Concerning CBTs, one clinical trial (n=978) found results in favour of the Matrix Model versus treatment-as-usual (but the results were not consistent over a six-month period), two clinical trials (n=231) found a significant increase of abstinence when the Matrix Model (p<0.05) was supplemented with contingency management (CM), and one clinical trial (n=104) found no significant difference between acceptance and commitment therapy (ACT) and classical CBT. Concerning motivational interviewing, one clinical trial (n=48) consisting of two motivational interviewing sessions found a significant decrease in the number of days of drug use compared to psychoeducation (p<0.04), and one trial (n=217) found there was no significant difference between nine sessions and a single session of MI supplemented with CBT group sessions.
    Conclusions: Few clinical trials have been carried out regarding cognitive-behavioural therapies and motivational interviewing for methamphetamine use disorders. Cognitive-behavioural therapy trials have higher statistical power than motivational interviewing trials. New clinical trials should be carried out.
    Eric Maltbie, Gopinath Kaundinya, and Leonard Howell*
    Sub-anesthetic ketamine infusion is the primary pharmacological model used to study schizophrenia and similar administration protocols of the drug are under investigation as a treatment for depression and other psychiatric disorders. However, the mechanisms underlying both the psychotomimetic and therapeutic effects of ketamine remain poorly understood. This review provides an overview of what is known of the neural mechanisms underlying the effects of ketamine and details what functional magnetic resonance imaging studies have revealed at the systems-level. Multiple analysis techniques show that ketamine produces robust and consistent effects at the whole-brain level. These effects are highly conserved across primate species, validating the use of nonhuman primate models for further investigations with ketamine. Regional analysis of functional connectivity suggests that the therapeutic potential of ketamine may be derived from a strengthening of executive control circuitry, making it an intriguing candidate for the treatment of drug abuse. However, there are still many questions about ketamine that can be answered using current functional imaging techniques that have yet to be addressed.
    Special Issue on Addiction & Mental Health
    Research Article
    Salameh P1*, Salamé J2, Waked M3, Barbour B4, Zeidan N4, Baldi I5, and the Lebanese National Conference on Health in University research group
    Abstract:
    Introduction: Psychological distress and addictive behaviors are both common in Lebanon. Although girls are more subject to distress, boys are known to be more prone to addictive behaviors. The objective of the article was to assess the relationship between psychological distress and addictive behaviors, looking particularly at differences between boys and girls among university students.
    Methods: A cross-sectional study was conducted among university students from all universities in Lebanon. Addiction to alcohol, cigarettes, and tranquilizers were evaluated according to the ASSIST total scale and subscales, while waterpipe dependence, cigarette dependence and psychological distress were measured using the Lebanese Waterpipe Dependence Scale (LWDS11), Young Adult Cigarette Dependence (YACD) scale and the Beirut Distress Scale (BDS22), respectively. The moderating effect of gender was particularly analyzed.
    Results: While boys were statistically more likely than girls to present substance addiction and dependence (p<0.001), a higher psychological distress was associated with higher risk to present these disorders (p<0.001), among both boys and girls and in both bivariate and multivariate analyses. Sex was not considered to be a moderator of the association between psychological distress and addiction. One exception was waterpipe dependence that was not associated with psychological distress (p>0.05) in multivariate analysis.
    Conclusion: University students of both sexes with psychological distress should be considered a high risk group for addiction and dependence; public health efforts should be particularly directed towards this subgroup to decrease their health risk behaviors and prevent further deleterious consequences.
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