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  • ISSN: 2373-9363
    Volume 2, Issue 3
    Research Article
    Brent E Mancha1*, Damiya E Whitaker2, Stevan Geoffrey Severtson3, Arijit Nandi4 and William W Latimer1
    Abstract: Understanding the characteristics of those who use Syringe/Needle Exchange Programs (SEPs) and pharmacies is important for program planning. This study examined the factors associated with where injectors get sterile syringes and if distance to a SEP site is associated with syringe acquisition. Three hundred and four adult heroin and cocaine Injection Drug Users (IDUs) participated in an epidemiologic study of risk factors for HIV/AIDS. Multinomial logistic regression examined the association between where IDUs obtained most new syringes (a SEP, pharmacy, or other less safe source) and other key variables. Results indicated that the relative risk (RR) of getting most syringes from a pharmacy (versus another source) was higher for: males, whites (versus African-Americans [AA]), and those with at least a high school diploma and lower for: those reporting receptive sharing of injection equipment. Results also indicated that the RR of getting most syringes from a SEP (versus another source) was higher for: those injecting more frequently (1-2 times/day vs. <1 time/day and 3 times/day vs. <1 time/day), those who have been arrested for drug paraphernalia in the past six months, and those using syringes for 1-2 hits (vs. 3 or more hits) and lower for: those living farther away from a SEP and those reporting receptive sharing of injection equipment. Results also indicated that the RR of getting most syringes from a SEP (versus a pharmacy) was higher for: those injecting more frequently (1-2 times/day vs. <1 time/day and 3 times/day vs. <1 time/day) and lower for: whites (versus AA), those with at least a high school diploma, and those living farther away from a SEP. SEPs and pharmacies may serve different populations of IDUs and may play complementary roles in preventing infectious disease transmission. Distance to a SEP may be important for where IDUs acquire sterile syringes.
    Christine E Sheffer1*, Sharon Brackman1, Mark Mennemeier2, Ginger Brown2, Reid D Landes3, John Dornhoffer4, Timothy Kimbrell5 and Warren K Bickel6
    Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a new frontier in the examination of addictive behaviors and perhaps the development of new interventions. This study examined differences in recruitment, eligibility, and retention among smokers and nonsmokers in an rTMS study. We modeled participant eligibility and study completion among eligible participants accounting for demographic differences between smokers and nonsmokers. Nonsmokers were more likely than smokers to remain eligible for the study after the in-person screen (84.2% versus 57.4%; OR 4.0 CI: 1.0, 15.4, p=0.05) and to complete the study (87.5% versus 59.3%; OR=43.9 CI: 2.8, 687.2, p=0.007). The preliminary findings suggest that careful screening for drugs of abuse and brain abnormalities among smokers prior to administering rTMS is warranted. More research is needed concerning the prevalence of brain abnormalities in smokers. Smokers might need to be informed about a higher risk of incidental MRI findings.
    Antonio Pascale1, Adriana Sosa1, María José Moll1, Silvana Couto1, Darío Pose1, Amalia Laborde1 and Cristina Bares2
    Abstract:
    Background: Cross-sectional studies report associations between early lead exposure and behavior problems in childhood and adolescence, but little is known about later tobacco use.
    Objective: This study investigated the associations between lead level in childhood or adolescence and tobacco use.
    Methods: Children (n=89) with elevated lead levels in childhood were tested in adolescence using atomic absorption spectrometry. To examine the influence of lead levels in childhood and adolescence on tobacco use comparisons between lead levels in childhood and adolescence were conducted between smokers and non-smokers.
    Results: Over 90% of the sample had BLLs above 10 µg/dl in childhood (mean BLL's =14.2 µg/dl). Although adolescent smokers did not differ from non-smokers in childhood lead levels, adolescent lead levels were higher among those who were using tobacco.
    Conclusion: Adolescent tobacco use may contribute to levels of lead among adolescents previously exposed to environmental lead.
    Roshan Bhad1, Raka Jain2, Anju Dhawan3 and Manju Mehta4
    Abstract: Inhalant abuse is a serious problem worldwide, particularly in disadvantaged populations and among adolescents. However, very few studies are available on objective measurements of inhalant abuse among adolescents. A pilot study was conducted on twenty-three adolescent inhalant users with recent use within one month on self-report, with the aim of biochemical validation of inhalant use by objective method in a clinical setting. Urine hippuric acid level was measured using gas chromatography with NPD (Nitrogen Phosphorous Detector) detector as a part of biochemical validation. More than fifty percent of adolescents were confirmed positive for intentional exposure of toluene in urine. The study findings are indicative of feasibility of biochemical testing for assessment of inhalant use and envisage the development of screening test for inhalant abuse in near future. Such objective validation would be beneficial for management of inhalant abuse problem among adolescents.
    Case Report
    Shady S Shebak1, Robert J Varipapa2, Andrew D Snyder2, Megan D Whitham2 and Thomas R Milam3
    Abstract: Gabapentin is a commonly prescribed medication for neuropathic pain, seizure disorder, and anxiety. It is deemed a safer alternative to benzodiazepines, with lower abuse potential, but it has been misused. There is growing concern about gabapentin's abuse potential and withdrawal.A 20 year old man presented to the psychiatry inpatient unit after being medically cleared from the emergency room after ingesting a large amount of gabapentin and oxazepam in order to become intoxicated. He was monitored closely for signs of withdrawal, and was encouraged to take acetlycysteine solution, at the recommendation of poison control. Patient was subsequently discharged in stable condition after two days of inpatient treatment. He returned several hours later, having again ingested a large amount of gabapentin, but was discharged from the emergency room.
    Review Article
    Ivica Mladenovic1*, Goran Lazetic1 and Dusica Lecic-Tosevski1,2,3
    Abstract: In spite of significant problems related to alcohol consumption, there is no clearly defined system activity in Serbia, addressing the issue of prevention of alcoholism and alcohol-related disorders. The need to readjust the model of "zero tolerance" to the model of "moderate drinking" is more than necessary, since it offers acceptable and "nonaggressive solutions" to all categories of alcohol consumers. In March 2014 the Institute of Mental Health initiated the Project entitled "Responsible Drinking in Serbia". This Project is the first national project in the field dealing with the reduction of harmful alcohol consumption. "Manual for Responsible Alcohol Drinking" release is scheduled for the first year of the Project implementation, including Project promotion in the media and public debates to be organized in four largest cities in Serbia. The Project is being promoted with the idea to help the drinking population enjoy in alcohol use, eliminating the risk of developing alcoholism. A heavy-drinkers group is supported either to recognize the problems and reduce the drinking within "low-risk" limits or ask for professional support. Starting-alcohol consumption group should be warned to potential dangers accompanying alcohol drinking and acquainted with the postulates of "responsible drinking". Considering time-related and available funds limits, the Project "Responsible Drinking in Serbia" may be considered a "pilot project". Bearing in mind the potentials of the Project, it is more than evident that there is a need for continuous activities i.e. a new approach to harm reduction and prevention of alcohol-related problems should be systematically defined in the country, including adequate support strategies.
    Mini Review
    Deena M. Hamza and Peter H. Silverstone*
    Abstract: Currently, there is an increasing recognition of the importance of treatment for alcohol use disorder, and how this condition has major impacts on a large percentage of the population. Given current economic conditions, the move from inpatient treatment to outpatient treatment, and several different recommended approaches, it is appropriate to review the range of treatment available for alcohol use disorder to determine if there can be a single recommended treatment approach.
    Detoxification is the initial step toward recovery, and may be accompanied by brief interventions to effect changes in alcohol use through the harm reduction approach. For some individuals, this may be the final form of therapy while others will engage in therapy that increases in duration and intensity through a stepped care approach.
    From this review it is clear that there are multiple possible treatment modalities for alcohol use disorders. These include programs focusing on elements of social control, behavioural economics, behavioural choice, social learning, and stress and coping mechanisms.
    In addition, the length and duration of therapy varies; however, elements of motivational interviewing (MI), motivational enhancement therapy (MET), cognitive behavioural therapy (CBT), and mindfulness meditation (MM) are found in brief interventions during detoxification, harm reduction approaches, inpatient and residential care programs, and self-help programs. These therapies enable the individual to restructure their thought processes, perception of events, and enhance coping skills and self-efficacy. However, the research data for all of these proposed approaches is relatively limited, certainly in terms of frequent studies demonstrating significant improvements in abstinence at 12-months or longer.
    Nonetheless, despite a large variety of options, the current research evidence is not strong enough to identify optimal treatment strategies for diverse populations. For example, when discussing alcohol dependence, it is unclear what components of a treatment pathway are necessary and sufficient to produce positive outcomes for specific populations. Long term prospective studies including sustained remission as an outcome for each approach are lacking, with most literature reporting outcomes within the first year post-treatment. In addition, studies on alcohol use disorders do not always incorporate a control or comparator groups. Variations in design and demonstrated difficulties in reproducing results across study sites further contribute to the challenge of developing treatment guidelines from available research.
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