Current Drug Abuse Reviews - Volume 8, Issue 2, 2015

We reviewed the cognitive and neurobiological commonalities between chemical and behavioral addictions. Poor impulse control, limited executive function and abnormalities in reward processing are seen in both group of entities. Brain imaging shows consistent abnormalities in frontoparietal regions and the limbic system. In drug addiction, exaggerated risk taking behavior and temporal discounting may reflect an imbalance between a hyperactive mesolimbic and hypoactive executive systems. Several cognitive distortions are found in pathological gambling that seems to harness the brain reward system that has evolved to face situations related to skill, not random chance. Abnormalities in risk assessment and impulsivity are found in variety of eating disorders, in particularly related to eating behavior. Corresponding findings in eating disorder patients include abnormalities in the limbic system, i.e. orbitofrontal cortex (OFC), striatum and insula. Similarly, internet addiction disorder is associated with risky decision making and increased choice impulsivity with corresponding discrepant activation in the dorsolateral prefrontal cortex, OFC, anterior cingulate cortex, caudate and insula. Sexual addictions are in turn associated with exaggerated impulsive choice and suggestive evidence of abnormalities in reward processing. In sum, exploration of executive function and decision making abnormalities in chemical and behavioral addictions may increase understanding in their psychopathology and yield valuable targets for therapeutic interventions.

Ethanol is the most abused psychoactive substance. Accordingly to World Health Organization ethanol ranks among the top five risk factors for disease, disability and death (3.3 million/year) throughout the world. This manuscript highlights and critically analyses clinical and forensic signs related to hepatoxicity of ethanol that may lead to suspected of abuse. Namely, steatosis, jaundice, cirrhosis, hemorrhoids, esophageal varices caput medusae, ascites, petechiae, ecchymoses, splenomegaly, hemochromatosis, xanthelasma, nutritional deficiency, testicular atrophy, gynecomastia and dilated congestive cardiomyopathy are discussed and related to the toxic mechanism of ethanol.

The misuse of prescription opioids is a major public health problem in the United States, Canada, Australia and other parts of the developed world. Methods to quantify dimensions of the risk environment in relation to drug usage and law enforcement that are both structural and spatial, draw geography into traditional public health research even though there has been limited attempt to address the prescription opioid misuse problem from a geographic perspective. We discuss how geographic technologies can be utilized to study the landscape of prescription opioids and similar drugs, and target appropriate health services interventions. We use examples drawn from various jurisdictions to present our case and highlight through these examples how a geospatial perspective can help support research on prescription opioid misuse. The prescription drug misuse landscape can be studied through examination of the domains of demand, supply, harms and harm reduction. We discuss how each of these domains can benefit from a local geographic perspective, and subsequent geographic exploration and analyses.

Background. Alcohol misuse is a significant public health issue resulting in substantial morbidity, premature mortality and costs to the healthcare system. Although face-to-face interventions offered by health practitioners have been shown to be effective, they are not routinely offered due to lack of time, training and resources, and potential damage to rapport. Computerbased interventions may help overcome these implementation barriers. Approach. Suitable research databases were searched and studies were selected if they described digital or computer-based alcohol interventions used by primary care patients. Studies which did not report patient alcohol outcomes were excluded. Key findings. Fifteen trials were identified, eleven of which trialled brief interventions only while the remaining four trialled both brief and extended interventions. Nine trials were associated with a reduction in alcohol use at followup. Conclusion. This is the first systematic review of digital or computer-based alcohol intervention programs used by primary care patients. Although the number of trials in this area of research is relatively small, their findings indicate effectiveness in reducing alcohol consumption as well as drinking related consequences. Extended interventions which offer additional opportunities to monitor drinking over time appear no more effective than single occasion brief interventions. These findings suggest that digital and computer-based interventions in primary care may have the potential to increase alcohol intervention activities in the general population at a relatively low cost and low burden on practitioners.

High impulsivity in children with attention deficit/hyperactivity disorder (ADHD) plays a key role in their vulnerability to substance abuse disorders (SUDs). Although impulsivity is increasingly recognized as a multidimensional construct, efforts to describe the contribution of different impulsivity aspects to the development of SUD have been hindered by conceptual and experimental inconsistencies. This review seeks to map potential trajectories from childhood ADHD to SUD by examining the hypothesized mediating role of three different impulsivity-related constructs: disinhibition, impulsive choice, and sensation seeking. Integration of data from developmental, cognitive, and neurophysiological research suggests that childhood ADHD and SUD are both associated with behavioural and neurophysiological deficits in all three impulsivity-related constructs. Examination of brain mechanisms related to the three impulsivity-related constructs indicates that ADHD share neurophysiological deficits with SUD, such as abnormal brain activity in areas involved in inhibition and complex cognitive-emotional processes. We conclude that different impulsivity constructs operate independently and interact with each other to affect adult risk taking behaviour and SUD in patients with childhood ADHD. This review highlights the current theoretical and methodological challenges in the study of impulsivity and discusses clinical implications and directions for future research.

Adolescent alcohol and drug use disorders pose significant risks to adolescents’ future functioning. Unfortunately, relapse rates following treatment for these disorders are high. The newest generation of interventions, designed in part to address this problem, place greater focus on the developmental needs of adolescents. In this review, we highlight the importance and promise of this progress in the field. We also argue for a further, more complete, integration of development and treatment: Instead of a focus on developmental issues as part of the process of substance use treatment, we argue for an approach in which healthy development is an outcome of equal importance to changes in substance use and risk behaviors. From this perspective, treatment should address the skills necessary for social, emotional, achievement, and identity development, with substance abuse understood as one example of dysfunctional development. We argue that this approach holds the greatest promise for providing adolescents in treatment with the skills they need to maintain successful post-treatment trajectories. In this paper, we offer theory underlying this perspective, a definition of the outcomes of healthy development that can guide researchers and clinicians, as well as proposals for both researchers and clinicians to continue to push the developmental sensitivity of adolescent substance use treatment forward.