Injecting drug users experience higher rates of death and poorer health than their non-injecting peers.

Accurate assessment of drug users physical health needs forms an essential precursor to treatment.

To determine the completeness of documentation and accuracy of medical evaluation for a sample of injecting drug users.

To establish the detection rate of medical co morbidity in injecting drug using patients.

20 injecting drug users were randomly selected from the computer database The case notes of each of these patients were then checked for any physical health documentation and the quality of the documentation.

The medical databases of the acute hospital were then checked to identify if these patients have presented there and the medical conditions with which they have presented.

The patients were then asked during their outpatient appointment about their physical health condition and the last time they have been checked by the GP.

80% of the patients had some health related information’s documented in the notes. However when these were compared with the history from the patients during the follow up OP appointments and medical notes, only 20% of the notes had good quality health documentation. 60% was found to meet standards.

50% of the patients had an acute hospital presentation with drug related complication. Of these 20% was in the previous 1 year. In terms of GP contact, 25% had seen the GP within the last 6 months and another 40% within the previous 1 year

Amphetamine is going to be speared among young people in recent decade in our region.

Amphetamine induced psychosis are frequently admitted in our psychiatric hospital in Kerman city (Located in south - east of Iran). Hallucinations and paranoid delusions are well - known symptoms of met - psychosis.

In this report we presented a 35 years old man with history of regular usage of drug in the past one year. He had persecutory delusions.

His paranoid symptoms were interesting from a point of view. He bought a second - hand car, one year prior to his illness’ and at the same time, he started using met - amphetamines, gradually he found small pieces of gold and diamonds in the car. He could find them anywhere in the car, so he had searched the car completely several times during nights. He collected a small box filled with severed small stones, glasses and other garbage and called them treasure, and claimed former owners of the car were following him and want to recapture the car, take the treasure and harm him. Paranoid symptoms are common in met - abuse but this type could be considered as a variant In this type patient had painful sensation of paranoid delusion, and in the same time he enjoied the feeling of being reach.

Polyfarmacy is frequent in patients with dual diagnosis.

To quantify the number and describe the treatments prescribed in a cohort of outpatients with dual diagnosis.

A descriptive and transversal study was performed. Patients with dual diagnosis treated at an Outpatient Drug Treatment Center from January 2005 to December 2009 were included. Data from demographic, clinical and therapeutical variables were gathered once. The instruments used for the diagnosis were EuropASI y SCID-I. The number and type of prescript drugs were related with protocol variables.

The study sample included 80 patients (71,6% men, average age 37,2 ± 9). Psychotic disorders (46.8%) and cocaine dependence/abuse (34.6%) were the most frequent comorbid psychiatric illnesses found. 40.8% of patients were polydrug users. The mean of prescript drugs was 3,06 ± 1,4 and only 14% of patients were on monotherapy. The frequency of drugs prescribed was: 68,4% antidepressant, 63,3% antipsychotic, 55,7% antiepileptic and 36,7% anxiolytic drugs. Older patients ( > 45years) took a major number of prescripted drugs (3,88 ± 1,1). Patients with psychotic disorders took the 43.9% of drugs prescripted (p = 0,042). Patients with benzodiazepine abuse took higher number of prescription drugs (5 ± 1,4;p = 0,003) compared with patients with other dependence or abuse.

Patients with dual diagnosis take high quantity of drugs. Older patients, diagnosis of psychosis and benzodiacepine abuse were related with polydrug prescription. Quantification of medication is recommended for treatment optimisation and avoiding yatrogenic.

The use of Internet-based communication tools has spread to multiple areas of life. E-mail is a fast and easy tool that can be used by the health care system to facilitate doctor-patient communication.

To assess the use and value of the e-mail for communication between physician and patient, from patients’ perspective.

To evaluate the use of e-mail as a potential therapeutic tool in patients with alcohol dependence.

The sample included patients who reported to have an e-mail account at their first visit in Alcohol Unit (n = 44 of 238 patients seen during one year). 23 patients were given the contact e-mail of the Alcohol Unit, and were instructed to contact their physician, if needed, by e-mail. The rest of the sample (n = 21) could contact their physician only by phone. Six months later, the whole sample received an electronic survey measuring their satisfaction of the communication with the physician.

57% patients who received the contact e-mail of the Alcohol Unit answered the survey (n = 13). Of those, 54% used e-mail to contact their physician. 71% found e-mail easy-to-use; 86% reported being satisfied with e-mail communication.

E-mail contact with physician was considered useful by most patients, although they report using also other contact methods, such as phone call.

Mortality and morbidity due to smoking in people with mental illnesses are higher than in the general population. However, smoking continues to be allowed in psychiatric premises of many countries despite being prohibited in workplaces including health care services.

To describe tobacco control strategies undertaken in psychiatric inpatient services and day centers in Catalonia.

To study tobacco control strategies in psychiatric services in order to identify unmet needs.

A cross-sectional study including all psychiatric services offering public service in Catalonia (n = 192). The managers answered an on-line questionnaire with 24 items grouped in four dimensions: staff's training & commitment, clinical intervention, management of smoking areas, and communication of smoke-free policies.

186 of the managers (96.9%) responded to the questionnaire. Results showed low levels of implementation of tobacco control strategies, especially in the training and intervention dimensions. 41.0% of the services usually intervened in their patients’ tobacco use but an overall 65.9% didn’t have pharmacotherapy for smoking cessation available. 47.3% of the managers stated that their staff had not enough knowledge on smoking cessation interventions. 38.9% of the services had smoking indoor areas. Day Centers showed the lowest implementation of tobacco control measures while services belonging to the Network of Smoke-free Hospitals showed the highest implementation.

Current Spanish partial law has failed to promote a desirable tobacco control in psychiatric services. There is a need to extend tobacco control policies, specifically in terms of smoking intervention and training, together with a higher availability of resources.

In Morocco, as in other countries, the cannabis consumption by a great number of the population remains worrisome, in terms of its effects on “mental and physical” health and its social repercussions.

To determine the profile of the people poisoned by cannabis in Morocco in order to identify individuals and groups at high risk.

A retrospective study was conducted on chronic cannabis poisoning cases notified between 2000 and 2008 in the Morocco Poison Control Center.

During the study period, three hundred and one regular users of cannabis (28 women and 273 men) were poisoned, constituting 34 cases on average per year. The clinical symptoms presented by victims are different, depending on the quantity of inhaled and absorbed psychoactive substances (especially THC) and the frequency and method of use. The average age of victims is 22 years. Among the 225 patients for whom the evolution is known, a 23-year-old man died. The rest of the patients’ condition has improved under gut decontamination.

The influence of consumption of the increasingly high doses of cannabis on the quality of life of young people justifies a public information, particularly young people for better prevention of using of this psychoactive product.

The most modern medically assisted method of substitution treatment of opiate dependants with Buprenorphine+Naloxone (Suboxone) has been implemented in Department of Psychiatry in Tuzla from 27 July 2009. Suboxone offers possibility for achievement of prompt and effective results of detoxification and weaning of opiates in outpatient treatment. Treated opiate dependants become “clear minded”, qualified for the all professional and social activities, what improves significantly quality of family and social relationship. With this, the treatment in the institutions can be avoided, therefore it prevents social excluding of treated individuals.

To present medical assisted treatment of opiate dependence with substitution medicament Suboxone in Bosnia and Herzegovina, with which we may prevent social excluding of young opiate dependants.

With presentation of clinical vignettes, authors described how opiate dependants with social hazardous behavior avoided social excluding after they were included in the Suboxone maintenance treatment program.

All exemplars described with clinical vignettes showed that opiate dependants previously had open doubts in efficacy of this particular treatment, and after only three days they surprised with positive effects of Suboxone. Also they are very satisfied with life quality during treatment. Family members of dependant person show satisfaction with achieved efficacy of Suboxone.

Medically assisted treatment of opiate dependence with Suboxone is implementing outpatient with involvement of close family members who are not drug dependant, it brings back “clear mind” to treated addicts, it does not stigmatize but it re-socialize and in that way it preventing social excluding of young opiate dependants.

Although the harmful effects of alcohol have long been observed, organized social measures for the prevention of excessive consumption of alcoholic beverages were taken relatively late.

To present an historical overview of development of social, cultural aspects of alcoholism prevention in northeast Bosnia.

The authors provide a historical overview of societal and professional institutions that fight against alcoholism in the area of northeast Bosnia and Herzegovina (BH) following the definition of the World Health Organization, that alcoholism is illness and alcoholic is a patient.

Teetotaler societies in BH began with the establishment and work at the late 19th and early twentieth century. Through the period before World War II, between the two world wars, the national liberation struggle period from 1941 to 1945, and the post-war socialist enthusiasm to the last war from 1992 to 1995 there were different levels of organizing struggle against alcoholism with different impact on the development of mental health protection of alcoholics and their families. During the 1992–95 war, due to high trauma of veteran and civilian population, a number of posttraumatic effects appeared, which lead to people seeking release in self-medication by alcohol abuse, worsening the issues of alcoholism and its aftermaths.

After the tragic war 1992–95, many of the socio-political relations and the issue of functional organization of health is redefined, this resulted in search for new formulas of successful dealing with very serious drinking problem in the postwar situation in the region of Tuzla Canton (northeast Bosnia).

Adolescents often experience their addictive experiences hidden from parents. Treatment begins when problems arise that adolescents cannt solve it alone.

To asses correlation between duration of silence about heroin addiction experience and certain epidemiological data collected with the Pompidou form.

The authors analyzed the group of 77 heroin addicts aged 26.4 ± 5.6 years, who were treated at the Department of Psychiatry Tuzla in the period 2006–2009 year. Pompidou standardized form was used for collecting the necessary data.

We found that the heroin addicts began to take the first drug of 17.2 ± 3.9 years, parents were informed about it 2.8 ± 1.3 years later. The duration of silence was positively associated with age of addicts (ρ = 0515, P > 0.001), length of addictive experience (ρ = 0463, P < 0.001), parent's divorce (ρ = 0432, P < 0.001), previous conflict with law (ρ = 0255, P = 0.028), powerty in the family (ρ = 0236, P = 0.045) and previous treatment (ρ = 0354, P = 0.002). On the other hand, it was negatively associated with living in community with other addicts (ρ = -0 363, P = 0.001), intravenous heroin use (ρ = -0 345, P = 0.003), detected hepatitis B (ρ = -0 262, P = 0.002), owning their own children (ρ = -0.280, P = 0.016) and with years of completed education of father (ρ = -0 245, P = 0.008) and of mother (ρ = -0 246, P = 0.036).

Silence about heroin addiction was positively associated with age of addicts, duration of addiction, parent's divorce, with trouble with law, with poverty in family, and previous treatment. Silence is negatively associated with living with other addicts, intravenous use, hepatitis B, owning children, and more years of parent's completed education.

1. 1. To present selfmedication of alcohol dependence related withdrawal symptoms with the plant powder kratom of Mitragynosa speciosa and treatment of kratom withdrawal symptoms.

2. 2. Pharmocological mechanisms of kratom.

1. 1. A alcohol and kratom dependent patient used kratom (15 g/d) to limit alcohol dependence related withdrawal symptoms and was admitted for withdrawal treatment. Kratom and urine was analysed by GCMS, withdrawal symptoms by Opioid Withdrawal Scale (OWS), sleep by Pittsburgh sleep quality index (PSQI), mood by MADRS. Medical treatment was done with doxepine with one additional diazepam dos.

2. 2. 3H-DAMGO radioligand binding assay of kratom, mitragynine and paynantheine with morphine transfected HEK 293 cells.

GCMS-urine screening on day 1: mitragynine, paynantheine, on day 3: monochlorbenzodiazepine, doxepine. The patient benefits regarding sleep quality and quantity (PSQI day 6 (12), day 20 (6) and mental symptoms (MADRS on day 6 (18) and on day 20 (5). The OWS Score shifts from 17 (day 1) to 2 (day 14). The blood pressure and heart rate decrease from 150/90 and 100/bpm (day 2) to 100/70 and 64/bpm (day 14). The GCMS analysis of kratom showed five indolalcaloids: mitragynine, 7-hydroxymitragynine, paynantheine, speciogynine, speciofoline, and unspecific plant contents. The 3H-DAMGO-radioligand-bindungsassay of kratom-powder showed 350-fold less affinity to μ-opiatereceptor than morphine.

The patient's selfmedication with kratom prevented alcohol withdrawal symptoms most probably by action on μ-opioidreceptors. 15 g of kratom seems to be equivalent to 45 mg of morphine. Withdrawl treatment with doxepine (and diazepam) clearly prevented withdrawal symptoms of dependence of kratom and alcohol.

Impulsivity and decision making are impaired in cocaine addicts. However, most studies were performed in the USA.

To assess impulsivity and decision making in a sample of French cocaine addicts.

Compared to controls, cocaine addicts had a higher impulsivity score (BIS: 72 ± 11 vs 57 ± 8, U = 138, p < .001) and had more disadvantageous choices on the decision making test (IGT) (advantageous minus disadvantageous choices -4 ± 19 vs 24 ± 35, U = 234, p = .005). There was a significant correlation between high impulsivity scores on the BIS and high cocaine craving as well as heavy cocaine use (more than 4 times a week). No correlation was found between poor decision making and high craving or frequent cocaine use.

The discrepancy between impulsivity and poor decision making in cocaine addicts is discussed.

Repetitive transcranial magnetic stimulation (rTMS) affects neuronal circuits and neurotransmitter systems in the brain. Recent data suggest that this application could diminish ‘craving’ in patients with alcohol dependence.

Given these preliminary data, we examined whether one high frequency (HF)- rTMS session over the right dorsolateral prefrontal cortex (DLPFC) would reduce alcohol craving in alcohol dependent patients in their natural habitat.

After detoxification during hospitalization, 22 current alcohol dependent inpatients were included (8 female, 14 male; age = 49.95 ± 8.82y).

We used a sham-controlled between-subjects design where after randomization patients received under MRI guidance one right-sided DLPFC active HF-rTMS session or sham. In each high-frequency (20 Hz) stimulation session, patients received 1560 pulses at 110 % MT. The obsessive-compulsive drinking scale (OCDS) was collected at baseline, just before and just after the stimulation session on Friday after detoxification and on the three consecutive days following stimulation in patient's natural habitat.

Although the OCDS total score significantly decreased after the detoxification period, one sham-controlled stimulation session did not affect immediate craving measurements. Furthermore, no significant group differences were observed on OCDS total scores when patients were in their natural habitat.

Although the right DLPFC was targeted under MRI guidance, our preliminary results indicate that one sham-controlled HF-rTMS session does not affect craving in recently detoxified alcohol dependent patients. Besides the limited number of patients it could be possible that only one stimulation session could be insufficient to have a subjective effect on craving.

Emotional intelligence (E/I) consists of appraisal of emotion in the self and others, regulation of emotion in the self and others and utilization of emotion in solving problems. Subsumed under these branches are functions such as verbal and non verbal appraisal and expression of emotion and using emotions to motivate as part of the utilization of emotions. (Salovey & Mayer's, 1990). Emotional intelligence components are important in psychological functions such as problem-solving, happiness, stress-tolerance, self-actualization and interpersonal relationship. So the research aimed to investigate role of Emotional intelligence in tendency to addiction.

In sampling process a total of 73 addicted people and 73 non-addicted people were randomly selected. All participants were requested to complete Schutte’s Self- Report E/I Test (SSREIT) (33 item). The test measures ability of E/I in three fields: Appraisal of emotion, regulation of emotion and utilization of emotion. In order to analyzing the data independent T test was used to compare means of two groups.

Findings indicated significant differences between two groups in components of emotional intelligent. Nonaddicted people had more scores in appraisal of emotion, utilization of emotion and general score of emotional intelligence. But there was no significant difference in regulation of emotion in two groups.

Considering the results, it is recommended EI education programs and applying the plans for enhancing emotional intelligent components in order to increasing abilities and competencies in confronting with crisis and bad events and reducing risk of abnormal behaviors, specially addiction.

Since the introduction of DSM-III Third Edition in 1980,there has been a growing interest in the study of patients with substance use disorders (SUD). The driving force behind this field has been, and still is, the high clinical pessimism about the prognosis, and the difficulties in the clinical management of the characteristics of diagnosed patients. Also religion and to be religious can play an important role in human’s individual and social life. The religion can be entered in many aspects of human behavior and can affect on their behavior and reduce probably of abnormal functions. So the study was aimed to investigate personality traits and religious orientation in two groups of addicted and nonaddicted people.

109 addicted people were randomly selected and compared with 109 nonaddicted people. Participants were asked to fill out Revised NEO Personality Inventory (NEO-FFM PI-R) and self-report questionnaire of Alport's E/I religious orientation. Mean scores were compared with T independent tests.

Analysis of means indicated significant differences among tow group. Compared to nonaddicted, addicted scored higher on Neuroticism, Openness to experience and External religious orientation, and lower on Extroversion, Agreeableness and Conscientiousness.

Based on results it is suggested that evaluating with reliable measures and with more attentions to intrinsic religious orientation related to personality traits can help the psychiatrists and psychologists to diagnose the cause of tendency to addiction and also reduce the psychological problems that is related with addiction before and in during drug treatment and can reduce duration of treatment and enhance efficacy of treatment methods.

The Counseling Center for Combating Drug Abuse offers an outpatient drug psychotherapeutic program, on an individual basis. Naltrexone is prescribed to selected heroin addicted users as part of this program.

Relapse is one of the most challenging problems.

Detection of factors which engage in the therapeutic process and hinder successful therapy leads to a better design of the therapeutic plan.

Administration of naltrexone aims at retention in therapy and avoidance of relapse. The program's design focuses on the right selection of users, and the therapist's suitability. Family or people in the user's environment engage actively in the observation of ingestion. Naltrexone administration continues for several months after stabilization and at least until user changes his attitude towards drug use. Relapse is considered as a stage of the withdrawal procedure. Manipulation focuses on user's rehabilitation in therapy. Therapist, user and family concentrate on factors which fostered relapse (parallel drug use, association with active users, co-morbidity, personal and family difficulties), and set new goals.

Development of a therapeutic alliance between therapist and addicted patient is one of the stronger predictors of treatment retention and success. Effective manipulation of the factors which foster relapse may lead to successful therapy.

Relapse must be seen not as a failure, but as a demanding stage of the procedure. Goal readjustment, and focusing on previously unresolved problems, may lead to an ultimate successful therapeutic outcome, and develop trust in naltrexone programs which are considered as particularly effective in open withdrawal programs.

Impulsiveness is considered to be an important symptom of many psychiatric disorders and is often treated as one of the diagnostic criteria. Relationship between impulsivity and severity of depressive symptoms in alcohol-dependent individuals hasn’t been investigated yet, although both are considered to be important risk factors of relapse.

The aim of this study was to analyze relationships between depressive symptoms and level of behavioral as well as cognitive impulsiveness among alcohol-dependent patients.

By means of Barratt's Impulsiveness Scale and stop-signal task the level of impulsivity among 304 alcohol-dependent patients was measured. Stop-signal task was used as an independent, manipulation-free method of estimating the level of behavioral impulsiveness, and the Barratt's Impulsiveness Scale - as a self report measure of global as well as cognitive impulsivity. Patients were asked to fill in a questionnaire to asses depressive symptoms (BDI, BHS).

The statistical analysis revealed significant association between impulsiveness and severity of depressive symptoms. Individuals with higher scores in BDI scale were more impulsive in Barratt Impulsiveness Scale (r = 0,473; p < 0,0005), whereas patients with higher scores in BHS appeared to be more impulsive in both: stop-signal task (r = 0,21; p = 0,001) and BIS (r = 0,281; p < 0,0005). Depressive symptoms in both measures correlated most with indicators of attention impulsivity in BIS (r = 0,541; p < 0,0005 for BDI and r = 0,312; p < 0,0005 for BHS).

High level of impulsiveness may be treated as an element of depressive disorder in alcohol dependent patients.

Previous studies have shown that African American youth are over-represented in the Criminal Justice System (CJS). Substance use problems are common among those with CJS involvement. However, less is known regarding racial disparities, among youth with CJS involvement, in receiving substance use treatment services.

To examine racial disparities with regard to receiving treatment services for substance use related problems, among youth with (CJS) involvement.

Data were obtained from the 2006–2008 United States National Survey on Drug Use and Health (NSDUH) in USA. Among White and African American adolescents (Ages 12–17) with recent CJS involvement and who met criteria for alcohol or illicit drug abuse or dependence (N = 602), racial differences in receiving treatment services for substance use problems were examined. Multiple logistic regression analyses were performed to identify predictors of service access among the adolescents, to see if the racial disparity could be explained by individual-level, family-level, and criminal justice system involvement factors.

While 31.2% of White adolescent substance abusers with CJS involvement had received treatment for substance use related problems, only 11.6% of their African American counterparts had received such treatment (P = 0.0005). Multiple logistic regression analyses showed that access to treatment services can be predicted by substance use related delinquent behaviors, but that racial disparities in treatment still exist after adjusting for these factors (AOR = 0.24, 95%CI = (0.09,0.59), P = 0.0027).

There is an urgent need to reduce racial disparities in receiving substance use treatment among U.S. youth with CJS involvement.

Global socio-cultural and family context of Serbian society intensifies risks of marijuana use (MU).

Prevalence of MU in young population in Serbia and identification of family factors related to increased risk of MU.

Five indicators were examined: prevalence of MU, age of first MU, MU during one month before survey, motives for MU, family factors of risk for MU.

The study included 2987 participants aged between 16 and 35 years from different parts of Serbia. Collection of data was conducted in April 2007. Participants completed self-administered anonymous questionnaires (modified YOUTH RISK BEHAVIOUR SURVEY) that consisted of sociodemographic characteristics and experiences related to MU.

The prevalence of lifetime MU among participants was 32%. First use was reported by 14% to occur at the age of sixteen or younger. During one month before survey 10% of participants had smoked marijuana. Risk of MU in regular cigarette smokers is two-fold higher than in non-smokers. Key motives for MU are curiosity (59%), achieving “good mood” (12%), persuasion by persons of the same age (11%), the emotional crisis (8,5%). Alcoholism of both parents and family dysfunctionality - especially physical and verbal conflicts between parents - were related to significantly higher risk of marijuana use.

Early use of marijuana, history of family disorganization, parental alcoholism and conflicts were identified as factors significantly related to increased risk of marijuana use among young population in Serbia.

There is a long debate about putative cardioprotective effects of alcohol. However, prevalence of metabolic syndrome (MetS) in men and women that use alcohol has been inconsistent in the literature.

The aim of this study was to compare the prevalence of MetS in patients with a diagnosis of alcohol dependence, who are currently abstinent in a controlled environment, and in control subjects followed in primary care from a similar region in Northern Germany.

One-hundred ninety seven men and women with alcohol dependence during behavioural treatment in a controlled environment were compared to 1158 subjects from primary care from a similar region in northern Germany. We used the AHA/NHBLI criteria to determine the rate of MetS and each single criterion of MetS in both groups.

The prevalence of MetS was almost twice as high in men and women with alcohol dependence compared to control subjects (30.6% vs. 17.0%). With respect to the single criteria, elevations were found for fasting glucose and blood pressure in both genders and for triglycerides in women only. HDL-cholesterol was higher in men and women with alcohol dependence.

Our results demonstrate an increased rate of the MetS, increased blood pressure and dysregulation of glucose and lipid metabolism in alcohol dependent patients. Whether high HDL-cholesterol in this context has cardioprotective effects remain doubtful.

Several studies show that despite poor oral health substance users fail to access dental care. This was confirmed locally by audit in 2005; 63% (n = 82) were not registered with a dentist and 72% had dental problems, of whom 83% were not receiving treatment.

To examine issues affecting substance users use of dental services.

To identify factors influencing whether substance users visit the dentist, in particular whether having a ‘regular’ dentist is important. Secondly, to compare this with perceptions of dental care staff.

A cross sectional survey was conducted across Norfolk & Waveney Mental Health Trust's Alcohol and Drugs Service and Norwich dental practices. 87 substance users participated, half of Norwich dentists (n = 67) and 66 reception staff from Norwich dental practices.

Participants reported high levels of dental problems, most commonly toothache (71%). Those having a dentist they normally saw were more likely to have visited the dentist in the previous year (X2 = 14.06, p < 0.01). The most common reasons for not receiving treatment were difficulty finding a dentist, difficulty keeping appointments and few available appointments. Dental staff acknowledged similar dental problems, but were more likely to think lack of motivation caused non-attendance. Drug use, substitute prescribing or duration in treatment did not influence frequency of dental visits. Dentists hi-lighted remuneration issues for providing services to substance users.

Having a ‘regular’ dentist could improve use of dental services. Examining capacity and revisiting payments for this group under the new dental contract could improve treatment rates.