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  • ISSN: 2333-665X
    Early Online
    Research Article
    Boitumelo A. Nkoane-Kelaeng, Claire M. Lawley, and Gemma A. Figtree*
    Abstract: Cigarette smoking in pregnancy is a universal problem that compels us to continuously explore different strategies aimed at increasing high quit rates in this population group. Maternal smoking during pregnancy has been linked to increased risk of obstetric and foet al adverse outcomes. Barriers to quitting are multi-factorial and the approach needs to be versatile and patient specific, taking into consideration the dynamics of ethnicity, psychosocial and socioeconomic status.
    The aim of this paper is to highlight the different strategies that have been evaluated looking at ways of enabling pregnant women to quit smoking. Furthermore, smoking cessation in special population groups and global initiatives on smoking regulations are discussed. A database search of Ovid Medline, Pubmed, Embase and The Cochrane Library was undertaken to identify relevant articles. Searches were limited to clinical trials in humans and peer-reviewed articles in English Language, and reference lists were searched for other related articles.
    A multimodal approach is necessary to increase chances of smoking cessation during pregnancy, this encompasses pharmacological and non-pharmacological measures. The most effective non- pharmacological measures comprise of psychosocial interventions in the form of cognitive behavioral therapy and motivational strategies. In the case of pharmacological approaches, Nicotine Replacement Therapy (NRT) has been the most widely researched with studies showing mixed results in relation to the safety profile in pregnancy. As a result, there is currently no definite consensus as to the safety of NRT in pregnancy, part of the reason being issues with small sample sizes in trials and non- adherence to treatment. To date, Bupropion and Varenicline are not safe to use in pregnancy due to the lack of sufficiently powered randomised trials in the pregnant population. Effectiveness of Nicotine Vaccines in humans is still an area of much needed research.
    Case Report
    Camlia Laglaoui Bakhiyi*, Soundous Seddiki, and Meriem El Yazaji
    Abstract: Introduction: Chronic non-cancer pain is a major public health issue. Analgesics are widely prescribed to provide relief to patients. Misusing these medications or their long-term use may be harmful.
    Objective: To report one case of addiction to nefopam, a non opioid analgesic
    Observation: A 50 year-old physician woman, with history of celiac disease in childhood, depression, anorexia nervosa, dependence to benzodiazepine, carbamate and buprenorphine, osteoporosis and scoliosis was prescribed nefopam by intramuscular route for relieving back pain twelve years ago. She developed dependence to nefopam and reported depressive symptoms when attempting withdrawal. Nefopam consumption reached 600 mg per day. Numerous medications were attempted, with no improvement of patients state. Symptoms as manipulation, sex proposals with patients, requesting money to families of patients, a poor speech, blank stare, memory impairment and suicidal thoughts were noticed. During one period of nefopam abstinence, patient displayed geophagia. When withdrawal was obtained, she started tobacco consumption and became dependent to tobacco.
    Discussion: The patient meets DSM V criteria for nefopam substance use disorder. Few cases have been reported. Painful diseases are usually associated with nefopam substance use disorder. Amygdalas system and nefopam psychostimulant effect may be involved in dependence behavior.
    Conclusion: Prescription of analgesics in patients with chronic pain may require caution. Physicians, pharmacists and patients should be informed about risks related to nefopam. Non pharmacologic treatments and other non opioid medications should be promoted and integrated in multimodal and multidisciplinary care management to provide a biopsychosocial intervention.
    Tashima E. Lambert*, James M. Edwards, Maria Small, and Haywood Brown
    Abstract: Background: Approximately 4.6 11% of patients admit to marijuana use during pregnancy. Marijuana is used both medicinally and recreationally. Historically, marijuana has been used as an anti-emetic. However, the growing literature of Cannabinoid Hyperemesis Syndrome necessitates attention to the paradoxical pro-emetic effects of this drug. As marijuana use increases, the effect on pregnancy and neonatal outcomes is a topic of ongoing investigation.
    Case: We present a case of a 25-year-old female with twenty-eight hospital visits for hyperemesis during her pregnancy. On review of her case, she met criteria for diagnosis of Cannabinoid Hyperemesis Syndrome, which if diagnosed sooner, may have altered the course of her admissions and treatment.
    Conclusion: Marijuana use is associated with nausea and vomiting in pregnancy. However, whether it is the causative agent or the treatment option has yet to be established. Cannabinoid Hyperemesis Syndrome can be seen in pregnant patients and treatment during pregnancy remains the same as in the non-gravid state.
    Ed Wood*
    Abstract: Colorado has reported no increases in citations for Driving under the Influence of Drugs (DUID) since commercialization of marijuana in the state. That is no surprise, since Colorado does not issue any citations for DUID. The state has a single citation for Driving under the Influence (DUI), irrespective of cause, and does not separate alcohol, drugs, or a combination of alcohol and drugs in any of their data systems. There is therefore no means to determine the highway safety impact of the states current widespread and increasing use of marijuana. Some view Colorado as an experiment in marijuana legalization, but any scientific experiment requires both a control of input variables and a measurement of outcomes. Colorado does neither, and reports tax revenue from its marijuana "experiment," but little else.
    Colorado attempted to deal with DUID due to marijuana long after marijuanas commercialization began. Policy discussions that were conducted to deal with DUID were therefore dominated by marijuana users, growers, dealers, and their organized supporters. Consequently, Colorado now has the weakest DUID laws in the nation, as shown by the comparison of laws shown in this report.
    Legalizing and commercializing marijuana prior to having effective laws in place to identify and deal with its consequences is akin to skydiving without a parachute.
    Because of the great differences between alcohol and marijuana, DUI laws developed to deal with alcohol-impaired driving are ill-suited to dealing with marijuana-impaired driving. The following recommendations to deal with marijuana-impaired driving as well as other forms of drugged driving should be considered before legalizing or commercializing marijuana.
    Review Article
    Alexandra M. Franklyn, Joseph K. Eibl, Nancy E. Lightfoot, and David C. Marsh*
    Abstract: The prescribing of opioids is becoming increasingly more prevalent in Ontario, and the misuse of prescription opioids is on the rise. Prescription opioid abuse is of particular concern across Northern rural communities throughout Ontario, where access to addiction treatment is limited. These communities experience high rates of addiction along with decreased access to addiction treatment services. However, research suggests that these communities greatly benefit from alternative modes of care, such as telemedicine. This form of care mitigates the distance and isolation that people living in Northern, rural, and remote communities face when seeking health care services. Along with the geographic hindrance that people in Northern rural communities experience, the concurrent use of other substances may also negatively impact their treatment outcomes. This is of particular concern due to the high rates of concurrent drug use among patients receiving opioid addiction treatment, which is often associated with a more complex clinical course. In this paper, we discuss the various factors that impact opioid addiction treatment in Northern Ontario including geography, treatment modality, and substance use. It is necessary to better understand how these factors impact patient care in order to enhance treatment outcomes for people seeking addiction treatment in the North.
    Case Report
    Kim J. Penberthy*, Surbhi Khanna, Morgan Lynch, Dinesh Chhabra, Marie Lyse Turk, Yiqin Xu, and Christopher Gioia
    Abstract: Alcohol use disorders and persistent depression are highly prevalent, frequently co-occurring disorders, both of which pose significant burdens on the healthcare system in the United States. Treating both disorders concomitantly may significantly decrease health care demands, psychosocial disruption, and mortality rates, but effective treatment of this patient population is challenging and complex. Comorbid depression is associated with poorer prognosis during alcoholism treatment, and depressed mood may be an important trigger for relapse. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has empirical support in reducing depressive symptoms by increasing the patients emotional safety, decreasing their interpersonal avoidance, and improving their perceived functionality. The CBASP approach involves a unique case conceptualization and learning acquisition paradigm which emphasizes social learning and appears ideal for treating co-occurring depression and addiction. CBASP has only recently been employed for use in patients with comorbid depression and alcohol use disorders. We present a case of a 52-year-old male with diagnosed major depressive disorder, alcohol use disorder, and anxiety and describe implementation of CBASP with the goal of reducing both depressive symptoms and alcohol consumption. Outcomes and implications of this approach for treating comorbid depression and alcohol use disorder are presented.
    Review Article
    Michels II*, Bob Keizer, Franz Trautmann, Heino Stver, 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.
    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
    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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