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  • ISSN: 2333-665X
    Early Online
    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.
    Collins E. Lewis*
    Opium is derived from the poppy, and its principal active ingredient is morphine. For more than 4000 years, it was highly praised as a folk medicine and euphoric. As its value in the medical community increased, commercial opium trade spread across Europe from 1640 to 1773; it became extremely popular during this time. It was transformed from a luxury drug to a commodity for mass consumption, and narcotics became integral to the economies and lifestyles of both Asian and Atlantic nations.
    Short Communication
    Razvodovsky YE*
    Background: Studies from many countries have shown an inverse relationship between alcohol prices and alcohol drinking and concluded that economic availability (affordability) of alcohol is one of the most important predictors of alcohol-related harm.
    Objective: The aim of the present study was to estimate the relationship between the affordability of vodka and alcohol-related outcomes in post-Soviet Russia. Methods: Trends in the affordability of vodka and mortality from external causes (violent mortality), fatal alcohol poisonings and incidence of alcoholic psychoses between 1991 and 2015 were compared.
    Results: A Spearman correlation analysis suggests a statistically significant negative association between the affordability of vodka and violent mortality (r = 0.51; p<0.009), including fatal alcohol poisonings (r =0.49; p<0.015). The association between vodka affordability and alcoholic psychoses incidence rates was also negative; but, statistically not significant (r = 0.03; p<0.895).
    Conclusions: The results from this study suggest an inverse aggregate-level relationship between vodka affordability and alcohol-related outcomes in Russia. These findings point to the complex relationship between alcohol affordability and alcohol-related outcomes. The major conclusion emerging from this study is that the estimation of the relationship between alcohol affordability and alcohol-related harm needs to take into account multiple confounding variables.
    Research Article
    Philip Sanford Zeskind*
    Maternal cigarette-smoking during pregnancy adversely impacts neonatal neurological integrity with far ranging developmental consequences. Neurobehavioral assessment scales have shown increased behavioral excitabilityin newborn infants with prenatal cigarette-exposure (PCE), suggesting dose-response signs of stress/abstinence. In contrast to increased excitability, depressant effects of PCE have been found on fetal heart rate variability (HRV) and power spectra of heart rate rhythms. This study further examined the utility of analyses of HRV to detect effects of PCE on neurobehavioral integrity in newborn infants. Participants were 51 term infants who varied by maternal report in the amount of cigarette-use per day during pregnancy: 10 infants with Mild Exposure (ME, <10 cigarettes/day), 15 infants with Moderate/Heavy exposure (MHE, >10 cigarettes/day) and 26 Non-Exposed (NE) comparison infants. Infant heart rate was time-sampled every 5 seconds for 15 minutes and subjected to standard, previously used methods of spectrum analysis. Analyses of Co-Variance with the amount of maternal marijuana and alcohol use during pregnancy statistically controlled found significant dual dimensions of effects of PCE on several measures of HRV and power spectra. Infants with ME showed lower heart rate variability and power of spectral peaks than NE infants; infants with MHE showed greater heart rate variability and power of spectral peaks than NE infants. Whereas lower HRV and spectral peaks of ME infants may reflect depressant effects of mild hypoxic-ischemia, the higher HRV and spectral peaks of MHE infants may reflect excitatory effects of withdrawal that supersede effects of hypoxia.
    Commentary
    Keith Klostermann1* and Theresa Mignone2
    Psychotherapy has been consistently shown to be effective. Results of numerous studies reveal that those treated with psychotherapy report better outcomes compared to those untreated or on waitlists. In the current climate of cost containment, limited resources, and increased accountability, therapists are being increasingly tasked with demonstrating effectiveness to clients and payors. This shift has resulted in an increased emphasis on continuous quality improvement efforts and a review of current methods of skill development and professional growth. Despite long-held beliefs that experience is related to effectiveness (i.e., the longer the amount of time in the field, the more effective the therapist), recent studies suggest that this is not the case. This finding has implications for continuing education models in that they may not be effective in improving therapist performance. Thus, new models are needed to ensure continued therapist growth and development which focus specifically on individual growth edges or areas in need of improvement. Deliberate practice is an emerging continuous improvement approach in which therapists challenge themselves to identify the edge of their ability by examining inconsistencies in performance and through consultation, reflection, and practice, refine skills to improve performance. This commentary briefly describes the deliberate practice approach and argues for its use in psychotherapy continuous quality improvement efforts and continuing education programming.
    Perspective
    Collins E. Lewis*
    The history of Narcotics Anonymous (NA) is best understood in the cultural context of the 1950s, the decade in which the notion of good and bad drugs crystalized. After World War II, heroin and cannabis were demonized with the opiate addiction epidemic. Harsh new anti-drug laws were enacted, addicts were arrested for internal possession and prohibited from associating due to loitering addict laws. Gatherings of recovering addicts for mutual support were subjected to police surveillance. From this inhospitable soil, NA emerged [1].
    Case Report
    Muhammad A. Ghazi* and Mustafa Mohmand
    We report the case of a 25-year-old man who developed acute neuropsychiatric sequelae after consuming a designer benzodiazepine (Clonazalam) with concurrent ingestion of over-the-counter (OTC) nasal decongestant Benzedrex (Propylhexedrine). The psychiatric and medical symptoms of extreme aggression, paranoia, visual hallucinations, and anterograde amnesia subsided within 24 hours of admission. The report highlights the fact that synthetic and OTC drugs abuse, including amphetamine-type stimulants and new psychoactive substances are drastically increasing. Moreover, with the growing number of new products, which are freely available on the internet, it is likely that drug users will innovate with unique formulations and experiment with combination of old and new drugs of abuse. Hence, the medical personnel should be educated and mindful of uncommon cases of co-occurring multiple drug use and be alert for unexpected responses to therapeutic interventions and to a rapid change in patient presentation.
    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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