Post-traumatic stress disorder (PTSD) is frequently associated with other psychiatric diagnoses, being substance use disorder (SUD) one of the most prevailing. Comorbid disorders in general and SUD ...in particular frequently complicate the course and outcome of PTSD, and vice versa. As with other dual disorders, comorbidity of PTSD and SUD is complex, having been proposed different theoretical models to explain it that will be discussed in the present paper, the first of a series of two. In addition, the present paper reviews data from epidemiological studies, as well as the clinical characteristics, the relevance of stressful life events as a vulnerability factor to PTSD as well as to SUD and the neurobiological basis of the association of both disorders with the aim of gaining a better understanding of this comorbidity, so that the treatment of this dual disorder will be discussed in the second part.
Background
Opioid addiction is a worldwide problem. Agonist opioid treatment (AOT) is the most widespread and frequent pharmacotherapeutic approach. Methadone has been the most widely used AOT, but ...buprenorphine, a partial μ-opiod agonist and a κ-opiod antagonist, is fast gaining acceptance. The objective was to assess the budgetary impact in Spain of the introduction of buprenorphine-naloxone (B/N) combination.
Methods
A budgetary impact model was developed to estimate healthcare costs of the addition of B/N combination to the therapeutic arsenal for treating opioid dependent patients, during a 3-year period under the National Health System perspective. Inputs for the model were obtained from the specialized scientific literature. Detailed information concerning resource consumption (drug cost, logistics, dispensing, medical, psychiatry and pharmacy supervision, counselling and laboratory test) was obtained from a local expert panel. Costs are expressed in euros (€, 2010).
Results
The number of patients estimated to be prescribed B/N combination was 2,334; 2,993 and 3,589 in the first, second and third year respectively. Total budget is €85,766,129; €79,855,471 and €79,137,502 in the first, second and third year for the scenario without B/N combination. With B/N combination the total budget would be €86,589,210; €80,398,259 and €79,708,964 in the first, second and third year of the analyses. Incremental cost/patient comparing the addition of the B/N combination to the scenario only with methadone is €10.58; €6.98 and €7.34 in the first, second and third year respectively.
Conclusion
Addition of B/N combination would imply a maximum incremental yearly cost of €10.58 per patient compared to scenario only with methadone and would provide additional benefits.
This 6-month follow-up study compared 64 men and 37 women hospitalized for cocaine dependence. Drug histories, sociodemographic characteristics, psychiatric diagnoses, and Addiction Severity Index ...(ASI) scores were compared during hospitalization; cocaine use and ASI scores were compared at 6 months. During hospitalization, women had significantly more severe family and social problems; men had more antisocial personality disorder. At follow-up, significantly more women had remained abstinent; family/social problem severity no longer differed. This replicates previous research showing better treatment outcome for cocaine dependent women. This may be related to specific characteristics of women who enter mixed-gender cocaine treatment programs.
Background: Opioid addiction is a worldwide problem. Agonist opioid treatment (AOT) is the most widespread and frequent pharmacotherapeutic approach. Methadone has been the most widely used AOT, but ...buprenorphine, a partial kappa-opiod agonist and a my-opiod antagonist, is fast gaining acceptance. The objective was to assess the budgetary impact in Spain of the introduction of buprenorphine-naloxone (B/N) combination. Methods: A budgetary impact model was developed to estimate healthcare costs of the addition of B/N combination to the therapeutic arsenal for treating opioid dependent patients, during a 3-year period under the National Health System perspective. Inputs for the model were obtained from the specialized scientific literature. Detailed information concerning resource consumption (drug cost, logistics, dispensing, medical, psychiatry and pharmacy supervision, counselling and laboratory test) was obtained from a local expert panel. Costs are expressed in euros ( , 2010). Results: The number of patients estimated to be prescribed B/N combination was 2,334; 2,993 and 3,589 in the first, second and third year respectively. Total budget is 85,766,129; 79,855,471 and 79,137,502 in the first, second and third year for the scenario without B/N combination. With B/N combination the total budget would be 86,589,210; 80,398,259 and 79,708,964 in the first, second and third year of the analyses. Incremental cost/ patient comparing the addition of the B/N combination to the scenario only with methadone is 10.58; 6.98 and 7.34 in the first, second and third year respectively. Conclusion: Addition of B/N combination would imply a maximum incremental yearly cost of 10.58 per patient compared to scenario only with methadone and would provide additional benefits.
Background Victims of childhood sexual abuse (CSA) show higher rates of several psychiatric and substance abuse disorders in adulthood. High rates of CSA have been reported in alcohol- or ...drug-dependent patients presenting to treatment. However, there is a paucity of European research with regard to in-patient alcohol-dependent populations. Aims The aim was to describe the prevalence of CSA in a UK sample of alcohol-dependent in-patients admitted over a 3-year period to a specialist alcohol unit; also to identify sociodemographic, alcohol and other substance use-related variables, and co-morbid psychiatric disorders associated with CSA. Method Clinical and socio-demographic data and information on childhood sexual abuse (CSA) were collected from 414 admissions, between September 1995 and September 1998, to the Specialist Alcohol Inpatient Unit. Results In the total sample of 414 subjects, 52 had experienced CSA. Of the 311 male subjects included in the study, 20 (6.4%) had experienced CSA. Of the 103 female subjects in the study sample, 32 (31.1%) disclosed having a history of CSA (CSA-females). Women victims of CSA were more likely to be non-white, to have a positive family history of alcoholism and to have fewer years of excessive drinking prior to admission. They were also significantly more likely to a have a lifetime diagnosis of depressive, anxiety and eating disorders, as well as being more likely to have a co-morbid post-traumatic stress disorder and a borderline personality disorder. Male victims had significantly higher Alcohol Problems Questionnaire (APQ) scores, were more likely to live alone, to be single, separate, divorced or widowed and to have a post-traumatic stress disorder and a borderline personality disorder. Conclusions Very few alcohol and drug abuse treatment units have developed programmes specifically designed to meet the needs of patients, and particularly women, who have experienced sexual abuse during childhood. However, as reflected by the relationship between CSA and dual diagnosis shown in this study, victims of CSA may represent an important subgroup of alcohol-dependent patients with specific needs. They may require the combination of various forms of pharmacological and psychological treatments to match their clinical characteristics. Declaration of interest None.
The importance of genetic factors in the development of alcoholism has been demonstrated repeatedly. However, the impact of a family history of alcoholism on the development of other drug use has ...been less thoroughly studied.
The present study was conducted to investigate whether individuals with a positive family history of alcoholism (FHP) differ from individuals without a history (FHN) in their pharmacokinetic profile, subjective and physiological response to an acute intranasal dose of cocaine (0.9 mg/kg).
Nine FHP and nine FHN male occasional cocaine users provided informed consent and participated in this double-blind, placebo-controlled, two-visit study. Responses to cocaine were assessed via a joystick device, the Addiction Research Center Inventory, visual analog scales and heart rate. Plasma concentrations of cocaine and its metabolites, benzoylecgonine and ecgonine methylester also were measured.
There were no significant differences between FHP and FHN subjects in subjective reports of intoxication, physiologic responses or plasma cocaine and benzoylecgonine concentrations following cocaine administration. Plasma levels of the cocaine metabolite ecgonine methylester were significantly higher in FHP subjects from 50 to 120 min post-cocaine administration compared to FHN subjects.
Our findings indicate that family history of alcoholism does not appear to influence the behavioral and physiological responses to acute cocaine administration, but that some aspects of cocaine metabolism may be different between the two groups.
Objective: To determine the preference of substance misusers for the terms ‘patient’, ‘client’ and ‘service user’ in the context of their contact with health professionals, if they consider substance ...misuse problems to exist appropriately under the category of mental health problems and if they consider themselves to have mental health problems. Methods: A self-completion questionnaire was administered to 150 National Health Service and private in- and outpatients with alcohol, drug and smoking problems. Results: The majority (54%) preferred the term ‘patient’, felt substance misuse problems was a category of mental health problems (59%), even though the majority (62%) did not consider themselves to have a mental health problem. Broadly similar preferences were found for those attending drug services and alcohol services whilst those attending the smoking cessation service were less likely to consider it an appropriate location or description. Discussion: The majority of substance misusers preferred to be called ‘patients’. The location of substance misuse services within mental health provision was widely tolerated.
The COVID-19 pandemic has posed a great challenge for the existing health systems. The restrictions imposed across countries on the movement of people and the realignment of health care services in ...response to the pandemic are likely to negatively affect the health status and delivery of mental health services to persons with dual disorders (PWDD). Methods: An online survey was conducted among mental health professionals involved in providing care to PWDD to better understand the problems encountered and identify potential solutions in providing continued treatment for PWDD during the COVID-19 pandemic. Results: The findings confirmed significant disruption in the delivery of treatment services for PWDD during the COVID-19 pandemic. Dissatisfaction with personal protective equipment, inadequate COVID-19 testing services at treatment facility, and lack of guidelines on providing continued treatment services to PWDD by national authorities or professional bodies were identified as the likely reasons for this disruption. Conclusions: These concerns in turn need to be addressed by the policy-makers, hospital management staff, and other stakeholders. Specifically, there should be a focus on developing and disseminating guidelines to assist mental health professionals in setting-up and providing continued treatment services to PWDD via tele-psychiatry and other novel digital strategies.
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