The American journal of drug and alcohol abuse
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Am J Drug Alcohol Abuse · Jan 2019
Video game addiction, ADHD symptomatology, and video game reinforcement.
Up to 23% of people who play video games report symptoms of addiction. Individuals with attention deficit hyperactivity disorder (ADHD) may be at increased risk for video game addiction, especially when playing games with more reinforcing properties. ⋯ Gamers who have greater ADHD symptom severity may be at greater risk for developing symptoms of video game addiction and its negative consequences, regardless of type of video game played or preferred most. Individuals who report ADHD symptomatology and also identify as gamers may benefit from psychoeducation about the potential risk for problematic play.
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Am J Drug Alcohol Abuse · Jan 2019
Development of a Cascade of Care for responding to the opioid epidemic.
Amid worsening opioid overdose death rates, the nation continues to face a persistent addiction treatment gap limiting access to quality care for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and extended-release naltrexone) have high quality evidence demonstrating reductions in drug use and overdose events, but most individuals with OUD do not receive them. The development of a unified public health framework, such as a Cascade of Care, could improve system level practice and treatment outcomes. ⋯ Many currently employed interventions (prescriber guidelines, prescription monitoring programs, naloxone rescue) address prevention of OUD or downstream complications but not treatment of the underlying disorder itself. An OUD Cascade of Care framework could help structure local and national efforts to combat the opioid epidemic by identifying key targets, interventions, and quality indicators across populations and settings to achieve these ends. Improved data collection and reporting methodology will be imperative.
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Background: The smoke generated from cannabis delivers biologically active cannabinoids and a number of combustion-derived toxins, both of which raise questions regarding the impact of cannabis smoking on lung function, airway inflammation and smoking-related lung disease. Objectives: Review the potential effects of cannabis smoking on respiratory symptoms, lung function, histologic/molecular alterations in the bronchial mucosa, smoking-related changes in alveolar macrophage function and the potential clinical impact of cannabis smoking on chronic obstructive pulmonary disease, lung cancer and pulmonary infections. Methods: Focused literature review. ⋯ Evidence suggests that alveolar macrophages from cannabis smokers have deficits in cytokine production and antimicrobial activity not present in cells from tobacco smokers. Conclusions: Solid conclusions regarding the respiratory consequences of regular cannabis smoking are difficult to make due to a relative paucity of literature, confounding by concurrent tobacco smoking and reports of conflicting outcomes. Additional well-controlled clinical studies on the pulmonary consequences of habitual cannabis use are needed.
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Am J Drug Alcohol Abuse · Jan 2019
Comparative StudyThe case for a medication first approach to the treatment of opioid use disorder.
Background: The opioid addiction and overdose crisis continues to ravage communities across the U. S. Maintenance pharmacotherapy using buprenorphine or methadone is the most effective intervention for Opioid Use Disorder (OUD), yet few have immediate and sustained access to these medications. ⋯ Feedback from providers has been largely favorable, though clinical- and system-level obstacles to effective OUD treatment remain. Conclusion: Like the Housing First model, Medication First is designed to decrease human suffering and activate the strengths and capacities of people in need. It draws on decades of research and facilitates partnerships between psychosocial and medical treatment providers to offer effective and life-saving care to persons with OUD.
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Am J Drug Alcohol Abuse · Jan 2019
Associations between pain catastrophizing and clinical characteristics in adults with substance use disorders and co-occurring chronic pain.
Background: Pain catastrophizing refers to the tendency to interpret pain as harmful, intolerable, or uncontrollable. Greater pain catastrophizing is associated with more pain-related negative phenomena, such as pain reactivity, pain disability, and emotional distress related to pain. Several studies of patients seeking chronic pain treatment have identified an association between pain catastrophizing and misuse of opioids and alcohol; however, it is unknown whether this association would be similarly present in patients with chronic pain seeking substance use disorder treatment. ⋯ Methods: In a series of regression models, we tested the associations between pain catastrophizing and functioning, specifically pain interference, craving, anxiety, and days of mood difficulties in a cross-sectional sample of patients seeking substance use disorder treatment with co-occurring chronic pain (N = 244, 67.6% female). Results: Greater pain catastrophizing was associated with more pain interference, higher levels of craving, more anxiety symptoms and more days of mood difficulties, adjusted for demographic characteristics and pain severity. Conclusion: In patients with comorbid substance use disorder and chronic pain, pain catastrophizing may offer a potential therapeutic target to improve substance use treatment outcomes.