Is there any association between cognitive deficits and immune markers in Acute and Transient psychotic disorders? A pilot study.

BACKGROUND: There are studies to support association between immune function and cognition in patients with schizophrenia (SZ). However, there are no such study which had tried to explore the same in patients with Acute and transient psychotic disorders (ATPDs), which is considered to similar in presentation to SZ. METHODS: This is an extended analysis of the study published in which we had recruited 19 subjects with ATPDs in acute phase of illness were age-/gender-matched with patients schizophrenia in remission. Clinical assessment and immune-marker levels (IL-6,IL-8,IL-17) were carried out along with follow -up repeat immune-marker levels assessment in the ATPD group was conducted after remission status was ensured (at least 3 months after resolution of acute phase). Cognitive assessment was done on Montreal Cognitive Assessment Scale (MoCA) in both the groups (ATPD in both phases and in SZ). RESULTS: The mean MoCA total score was 12.05 (SD-5.0) in the acute phase and 27.05 (SD-2.46) in the remission phase in the ATPD group which was statistically significant. When compared with patients with SZ in remission, patients with ATPD in remission performed better in all domains of MoCA, however only statistically significant differences in the total MoCA score and in the visuospatial domain scores of MoCA. No significant association between any of the immune marker levels (IL-6, Il-8 and IL-17) with any domains of the MoCA in patients with ATPD neither in the acute phase nor in the remission phase was found. Additionally, no significant association between the cognitive scores in the MoCA domains of the patients with schizophrenia and immune marker levels was found too. CONCLUSION: To conclude, the present study's findings suggested that there existed definite cognitive deficits in patients with ATPDs in both acute and remission phase and in patients with SZ. However, the study could not establish any relationship/association between cognitive deficits/scores in patients with ATPDs in both phases as well as in patients with SZ with immune marker levels.

Assist-linked brief intervention to reduce risky pattern of substance use in male workers employed at a tertiary care hospital in India: A randomized controlled trial.

Background: Substance use in workplace leads to adverse effects both on the employees and on the workplace. Existing research focuses on alcohol-related harm, while workplace use of other substances has been neglected. There are no randomized controlled studies of brief interventions in Indian hospital settings. Aim: To evaluate the efficacy of World Health Organization (WHO) alcohol, smoking, and substance involvement screening test (ASSIST)-linked brief intervention (ALBI) for reducing risky patterns of substance use in male workers at a tertiary-care hospital in North India. Material and Methods: The study was conducted in two phases. In Phase-I, a random list of 400 employees was generated from the entire pool of male hospital workers, of which 360 participated. Data on the ASSIST risk categories (mild, moderate, and high) were generated from Phase I. In Phase-II, moderate- or high-risk subjects ('ASSIST screen-positive') were randomized into intervention and control groups, with 35 screen-positive subjects in each group. The intervention group was provided a 15-30-min structured session per ALBI protocol, while the control group was given a 15-30-min general talk on health-related consequences associated with substance use. The subjects were compared on ASSIST score, WHO quality-of-life brief version (WHOQOL-BREF) and readiness to change questionnaire (RCQ) at baseline and at 3-month follow up. Results: The prevalence of moderate-to-high-risk use of tobacco, alcohol, and cannabis in the total sample was 28.6%, 27.5%, and 6.9%, respectively. At 3-months postintervention follow-up of the randomized sample, recipients of ALBI had significant reduction of ASSIST scores for all substances compared to the control group (p < 0.001). More participants receiving ALBI were ready to change to RCQ action stage (p values for tobacco, alcohol, and cannabis <0.001, <0.001 and 0.007, respectively). WHOQOL-BREF scores significantly improved in ALBI group across all domains. Conclusion: ALBI was effective in reducing risky substance use, increasing readiness to change and improving the QOL of the subjects at workplace setting.

Digital screening and brief intervention for alcohol misuse in college students: A pilot, mixed-methods, cluster randomized controlled trial from a low-resourced setting.

INTRODUCTION: We examined the feasibility and acceptability of digital screening and brief intervention (d-SBI) for alcohol misuse in college students; the effectiveness of d-SBI was our secondary outcome. We also explored the barriers and facilitators of d-SBI. METHODS: The study design is a mixed-methods, pilot, and cluster randomized trial. Five colleges from a northern city in India were randomly allocated to d-SBI and control groups. One hundred and ninety-one students were screened, and 25 (male = 23 and female = 2) participants (age 19.62 ± 2.58 years) fulfilled eligibility. All participants completed follow-up assessments at 3 months. In-depth interviews were done with 11 participants. Alcohol Use Disorder Identification Test (AUDIT) based screening brief intervention was provided on a web portal- or mobile application in the d-SBI group. The control group received digital screening and brief education. Direct questions and usage statistics assessed the measurement acceptability of the intervention. We compared the change in AUDIT scores in the intervention groups over 3 months post-intervention. Thematic analyses of transcripts of interviews were done by inductive coding. RESULTS: Most participants reported that d-SBI was user-friendly (80%), advice was appropriate (80%), and perceived it to be useful (72%). Ninety-six percent of users, who logged in, completed screening. There was a significant decrease in AUDIT scores both in d-SBI (p < .001) and control groups (p < .001). Time and group significantly affected the mean AUDIT score, but time × group interaction was non-significant. Thematic analysis revealed six overarching themes. CONCLUSIONS: Digital SBI for alcohol misuse is acceptable, feasible, and possibly effective among college students from low-resource settings.

Neurocognitive Functions in Patients with Comorbid Hepatitis C and Opioid Dependence: A Comparative Study.

Background: Hepatitis C virus (HCV) infection is commonly comorbid with opioid dependence (OD). We wanted to compare the neurocognitive functions of OD subjects with or without HCV [HCV (+), HCV (-)] and healthy controls (HC). Methods: We recruited 40 adult subjects (age 18-55 years) in each group. HCV(+) group had a detectable viral load. Subjects with HIV or hepatitis B infection, head injury, epilepsy, or comorbid mental illness were excluded. We administered Standard Progressive Matrices (SPM), Wisconsin Card Sorting Test, Iowa Gambling Task (IGT), trail-making tests A and B, and verbal and visual N-back tests (NBT) one week after opioid abstinence. The group differences in cognitive performance were adjusted for age and years of education. Effect size (ES) is expressed as Cohen's D. Results: The HCV(+) and HCV(-) groups did not differ in potential effect modifiers (age and years of education) or confounders (age of opioid initiation, duration of use, dependence severity, tobacco use, and cannabis use) of neuropsychological functioning. HCV(+) showed significantly poorer performance than HCV(-) in SPM (P = 0.006; ES = 0.72). Both HCV(+) and HCV(-) performed worse than controls in IGT(P < 0.001; ES = 0.8) and visual NBT[P < 0.01 and ES > 1 for total errors]; HCV(+) had a larger ES of group difference than HCV(-). HCV(+) had higher error scores in verbal NBT than control. Conclusion: HCV(+) has poorer general intellectual ability and reasoning than HCV(-) persons and controls. Chronic HCV infection causes a higher magnitude of dysfunction in decision-making and visual working memory in opioid-dependent individuals.

Heroin use and neuropsychological impairments: comparison of intravenous and inhalational use.

BACKGROUND AND OBJECTIVES: Injection and inhalational heroin use are associated with different levels of brain exposure to heroin and its metabolites and differences in the severity of dependence, which might lead to differential impacts on neuropsychological functions. We examined the difference and the magnitude of difference in the neuropsychological functions between inhalational and injection heroin-dependent subjects and also compared them with healthy controls. METHODS: The study sample comprised three groups: 73 subjects with injection heroin dependence, 74 with inhalational heroin dependence, and 75 healthy controls (HC). We excluded patients with HIV, head injury, epilepsy, and severe mental illness. Neuropsychological assessments were done by Standard Progressive Matrices, Wisconsin Card Sorting Test (WCST), Iowa Gambling Task, Trail-Making Tests A and B (TMT), and Verbal and Visual Memory 1 and 2 Backtests (NBT). We estimated independent effects of the groups on various neuropsychological test parameters, adjusted for age and duration of dependence. RESULTS: In the WCST, the inhalational heroin-dependent group took more trials to complete the first category and had higher scores in the failure to maintain set than controls. The intravenous group had higher total errors than controls in verbal working memory tests and Visual Working Memory 2 Backtest. This group scored higher commission errors in the Verbal 2 Backtest than the controls. The two groups of heroin users differed in failure to maintain set and Verbal Working Memory 2 Backtests. The effect sizes of the group differences were modest. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Either route of heroin use is associated with cognitive impairments; inhalational and injection use involve different cognitive domains.

Digital screening and brief intervention for illicit drug misuse in college students: A mixed methods, pilot, cluster, randomized trial from India.

BACKGROUND: Adolescence and early adulthood are vulnerable periods for substance use-related disorders later in life. The use of internet-enabled interventions can be useful, especially in low-resource settings. AIMS: To examine the feasibility, acceptability, and preliminary effectiveness of single-session digital screening and brief intervention (d-SBI) for illicit drug misuse in college students and explore barriers and facilitators of d-SBI. METHODS: Design: Mixed-methods, pilot cluster randomized trial. SETTING: Four conveniently selected colleges were randomized into intervention and control groups. PARTICIPANTS: 219 students were screened, and 37 fulfilled eligibility. Twenty-four completed follow-ups. In-depth interviews were done with ten students. Intervention and Comparator: Following a digital screening, Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) based brief intervention was provided in the d-SBI group. The control group received brief education. MEASUREMENTS: Acceptability was assessed by direct questions and usage statistics. ASSIST scores of groups were assessed at baseline and 3 months. Inductive coding of the interview transcript was done. RESULTS: More than 50 % of participants found d-SBI user-friendly, appropriate, and useful. Eighty percent of users, who logged in, completed screening. Per-protocol analysis showed a reduction in cannabis-ASSIST score over 3 months. The mean ASSIST score for other drugs combined did not differ significantly between groups. The difference in risk transition (moderate to low) was not significant. Qualitative analysis revealed three overarching themes- recruitment, engagement, and behavior change. CONCLUSIONS: Digital SBI for drug misuse is feasible among college students. d-SBI might be effective in reducing cannabis use.

Federated Analysis in COINSTAC Reveals Functional Network Connectivity and Spectral Links to Smoking and Alcohol Consumption in Nearly 2,000 Adolescent Brains.

With the growth of decentralized/federated analysis approaches in neuroimaging, the opportunities to study brain disorders using data from multiple sites has grown multi-fold. One such initiative is the Neuromark, a fully automated spatially constrained independent component analysis (ICA) that is used to link brain network abnormalities among different datasets, studies, and disorders while leveraging subject-specific networks. In this study, we implement the neuromark pipeline in COINSTAC, an open-source neuroimaging framework for collaborative/decentralized analysis. Decentralized exploratory analysis of nearly 2000 resting-state functional magnetic resonance imaging datasets collected at different sites across two cohorts and co-located in different countries was performed to study the resting brain functional network connectivity changes in adolescents who smoke and consume alcohol. Results showed hypoconnectivity across the majority of networks including sensory, default mode, and subcortical domains, more for alcohol than smoking, and decreased low frequency power. These findings suggest that global reduced synchronization is associated with both tobacco and alcohol use. This proof-of-concept work demonstrates the utility and incentives associated with large-scale decentralized collaborations spanning multiple sites.

Cellulose paper sorptive extraction (CPSE): A simple and affordable microextraction method for analysis of basic drugs in blood as a proof of concept.

Aiming towards simplifying sample preparation procedure, the present work explores use of unmodified laboratory filter paper as sorbent for extraction of nine basic drugs (five antidepressants, four benzodiazepines, and ketamine) from human blood samples and their analysis by gas chromatography-mass spectrometry (GC-MS). The procedure termed as cellulose paper sorptive extraction (CPSE) is straightforward. It involves adsorption of target analytes from deproteinized diluted blood samples on the unmodified cellulose paper followed by elution into 2 mL of methanol. Multivariate optimization, consisting of Placket-Burman design (PBD) and central composite design (CCD), was used to screen and optimize significant factors for CPSE. The proposed method follows the principles of green analytical chemistry (GAC), as the unmodified filter paper used as the sorbent is inexpensive and biodegradable. The technique is easy to perform and requires only 2 mL of MeOH during the entire extraction procedure. Under the optimized conditions, the limit of detection and quantification for the target analytes were estimated to be in the range of 0.003-0.035 and 0.010-0.117 µg mL-1, respectively. In contrast, the relative standard deviations were consistently below 10 %. The calibration curves were linear in the range of 0.015-2 µg mL-1 with a coefficient of determination (R2) in the range of 0.995-0.999.Satisfactory recoveries ranging from 87 to 99 % was achieved. As proof of concept, the analysis of nine drugs in blood samples from the patients was performed to demonstrate the potential application of the proposed method.

Immune-mediated inflammatory markers in acute and transient psychotic disorders-comparison with schizophrenia: An exploratory comparative study.

AIM: Considering Acute and Transient psychotic disorders (ATPDs) to be a close entity to Schizophrenia (SZ) with a completely different course and outcome, studies evaluating the immunological abnormalities are scarce in ATPDs. We analysed immune-mediated inflammatory marker levels [Interleukin-2 (IL-2), Interleukin-4 (IL-4), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-17 (IL-17) and Tumour necrosis factor-alpha (TNF-α)] in patients with ATPDs (in the acute phase and after remission), and compared these with patients with SZ in remission and with healthy controls. METHODS: Ninteen subjects with ATPDs in acute phase of illness were age-/gender-matched with healthy controls and patients with schizophrenia in remission; recruited through purposive sampling. Clinical assessment and immune-marker levels were carried out in all the three groups. Follow -up repeat immune-marker levels assessment in the ATPD group was conducted after remission status was ensured. Immune-marker levels were compared across the three groups. RESULTS: Patients with ATPDs had elevated levels of the pro-inflammatory cytokines IL-6 and IL-17 and low levels of IL-8 in the acute phase and low levels of IL-6 and elevated levels of IL-8 during the remission phase. Compared to patients with SZ in remission, patients with ATPD in remission had low levels of all the three pro-inflammatory cytokines (with significantly low IL-6 levels and non-significant, yet low levels of IL-8 and IL-17) and had significantly low and high levels of IL-6 and IL-8 respectively than healthy controls. CONCLUSION: These findings suggest that there existed immunological abnormalities in the acute and remission phase of illness in patients with ATPDs compared to both patients with SZ in remission and healthy controls.

Impact of COVID-19 lockdown on substance availability, accessibility, pricing, and quality: A multicenter study from India.

Background and Aim: Pandemic and consequent lockdowns are likely to affect the drug market by the sudden disruption of the supply chain. We explored the change in the availability, access, purity, and pricing during lockdown from respondents seeking treatment for drugs, alcohol, and tobacco dependence. Materials and Methods: A cross-sectional survey was conducted among 404 respondents from seven treatment centers across India. A structured questionnaire assessed the change in availability, access, quality, and price of substances used during the first phase (March 24-April 14) and the second phase (April 15-May 3) of lockdown. Results: A majority of the respondents in treatment used tobacco (63%) and alcohol (52%). Relatively few respondents used opioids (45%) or cannabis (5%). Heroin (44%) was the most common opioid the respondents were treated for. Seventy-five percent, 65%, and 60% of respondents treated for alcohol, tobacco, and opioid problems, respectively, reported a reduction in the availability and access during the first phase of the lockdown. In the second phase, respondents with alcohol and tobacco dependence reported greater availability than those with opioid and cannabis dependence. The reported price of all substances increased more than 50% during the first phase of lockdown and remained higher throughout the second phase. Deterioration in purity was reported by more than half of the people who used opioid. Conclusion: Lockdown could have affected both licit and illicit drug markets, albeit to a varying degree. The observed changes seemed short-lasting, as suggested by the recovering trends during the second phase of lockdown.

The therapeutic relationships, empathy, and satisfaction in teleconsultation for substance use disorders: Better or worse than in-person consultation?

Context: Telemedicine has become one of the essential modes of healthcare delivery. Different aspects of the physician-patient relationship during tele and in-person consultation need to be studied. Aims: This study aimed to compare perceived empathy and therapeutic relationship between tele and in-person consultation and assess the patient's satisfaction during teleconsultation for substance use disorder (SUD). Methodology: We consecutively recruited 100 adult patients with SUD, registered to the tele-addiction service between June and September 2020, and experienced both video and in-person consultations. We assessed therapeutic relationships, perceived empathy (for teleconsultation and in-person consultation), and patients' satisfaction (with teleconsultation) with specific scales. We compared the scores of the therapeutic relationship and physician empathy scales for tele and in-person consultation. Results: The mean age of the patients was 35.5 (±10.4) years. Sixty percent had alcohol, followed by opioids (42%) and cannabis dependence (24%). Sixty percent of patients had comorbid tobacco dependence. Telehealth satisfaction (TSS) rating shows around 40% of patients had difficulty accessing the telehealth service and 7% felt their privacy was poorly respected. The mean total therapeutic relation (STAR) (t = -14.4; P <.001), positive collaboration (t = -12.8; P <.001), positive clinical input (t = -11.9; P <.001), and total Patient's Perceptions of Physician Empathy (PPPE) score (t = -8.4; P < .001) were lower in the teleconsultation than in-person consultation group. TSS was positively correlated with positive collaboration, positive clinician input, and STAR total score. Conclusions: Our study suggests a stronger therapeutic relationship and higher physician empathy during in-person consultations. Poor accessibility and privacy concerns were critical challenges in telehealth service. TSS and therapeutic relationships positively influence each other.

Screening and Brief Intervention for Cannabis Misuse in Individuals on Buprenorphine Treatment for Opioid Use Disorder: Double-Blind Randomized Clinical Trial.

Cannabis misuse and opioid use disorder (OUD) are highly comorbid but under-treated and associated with poorer outcomes. This paper reports a double-blind, parallel-group randomized controlled trial to determine the efficacy of single-session, clinician-delivered screening and brief intervention (SBI) for reducing cannabis risk. The primary outcome was the cannabis-specific Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) scores, measured at three-month post-intervention. The secondary objectives were to determine the efficacy of SBI in reducing the frequency of cannabis use, in risk transition from moderate to low risk, and in prescription and non-prescription opioid use. One hundred forty-three participants were randomly allocated to receive either SBI (n = 72) or control (n = 71) interventions. We performed Per-protocol (PP) (n = 125) and Intention-to-treat (ITT) analysis (n = 143). We adjusted our analysis for age, sex, and baseline ASSIST score. The ITT showed that the SBI group had a significant reduction (F = 39.46, p < .001, Effect size 0.22) in the mean ASSIST at follow-up. PP analyses too revealed a similar positive effect of SBI (F = 53.1; p < .001, Effect size 0.31). At follow-up, the SBI group had a higher number of days of cannabis abstinence. Care providers and policymakers may consider SBI for cannabis use in individuals on medications for OUD.

Course and Correlates of Stigma in Patients on Opioid Agonist Treatment: A Prospective Study from an Outpatient Treatment Program in India.

Background: Individuals with opioid dependence experience stigma and discrimination. Stigma can potentially reduce treatment-seeking and negatively affect treatment outcomes. We aimed to study the course of stigma and its correlates among patients receiving opioid agonist treatment (OAT). Methods: We recruited 51 subjects (aged between 18 and 45 years) registered in the OAT clinic from February to September 2019. We excluded subjects dependent on alcohol and other drugs (except for cannabis and tobacco), with severe mental illness, intellectual disability, and organic brain disease. We assessed the internalized and enacted stigma and quality of life at the treatment entry and after 3 months. Relationship of stigma with quality of life, socio-demographic, and other clinical variables were examined at the treatment entry. Results: Mean age of the subjects was 26.7 (± 5) years. At the end of three months, 33 (64.7%) patients were retained in the treatment. Internalized stigma correlated negatively with the social and environmental domains of quality of life. The strength of the correlations was modest. No significant correlation was found between demographic and clinical variables and internalized stigma and enacted stigma scores. Both internalized and enacted stigma scores reduced significantly at 3 months follow-up. The significance levels were retained even after controlling for the baseline quality of life scores. Stigma at the treatment entry did not predict early dropout. Conclusion: Despite higher severity at the treatment entry, the level of internalized and enacted stigma reduced significantly within three months of an outpatient-based OAT program.

Efficacy of screening and brief intervention for hazardous alcohol use in patients with mood disorders: A randomized clinical trial from a psychiatric out-patient clinic in India.

AIM: To determine the efficacy of individual-based, face-to-face screening and brief intervention (SBI) for hazardous alcohol use among treatment-seeking outpatients with mood disorders. METHODS: It was a parallel-group, single-blind, randomized controlled trial of 84 participants who met the selection criteria for hazardous alcohol use, defined by alcohol use disorder identification test (AUDIT) score 8-19. Participants were randomly allocated to either SBI or general advice group. Both groups had received a standard care for mood disorders. The outcome was assessed after 3 months. The primary outcome was a change in the mean AUDIT score and the secondary outcomes were a change in frequency of heavy episodic drinking and stages of motivation. RESULTS: Majority (60%) had major depressive episodes. There was no significant difference in baseline demography and clinical variables between the groups. Both intention to treat and per-protocol analyses showed a small but significant effect of SBI on mean AUDIT score. Age, baseline AUDIT, and motivation did not moderate the effect. SBI was associated with a significant decrease in the frequency of heavy drinking and improvement in stages of motivation. CONCLUSION: SBI among patients with mood disorders had a small but significant effect on alcohol use.

Decentralized Multisite VBM Analysis During Adolescence Shows Structural Changes Linked to Age, Body Mass Index, and Smoking: a COINSTAC Analysis.

There has been an upward trend in developing frameworks that enable neuroimaging researchers to address challenging questions by leveraging data across multiple sites all over the world. One such open-source framework is the Collaborative Informatics and Neuroimaging Suite Toolkit for Anonymous Computation (COINSTAC) that works on Windows, macOS, and Linux operating systems and leverages containerized analysis pipelines to analyze neuroimaging data stored locally across multiple physical locations without the need for pooling the data at any point during the analysis. In this paper, the COINSTAC team partnered with a data collection consortium to implement the first-ever decentralized voxelwise analysis of brain imaging data performed outside the COINSTAC development group. Decentralized voxel-based morphometry analysis of over 2000 structural magnetic resonance imaging data sets collected at 14 different sites across two cohorts and co-located in different countries was performed to study the structural changes in brain gray matter which linked to age, body mass index (BMI), and smoking. Results produced by the decentralized analysis were consistent with and extended previous findings in the literature. In particular, a widespread cortical gray matter reduction (resembling a 'default mode network' pattern) and hippocampal increase with age, bilateral increases in the hypothalamus and basal ganglia with BMI, and cingulate and thalamic decreases with smoking. This work provides a critical real-world test of the COINSTAC framework in a "Large-N" study. It showcases the potential benefits of performing multivoxel and multivariate analyses of large-scale neuroimaging data located at multiple sites.

Sexual dysfunction in men on buprenorphine - naloxone-based substitution therapy.

BACKGROUND: The literature on sexual dysfunction in patients on buprenorphine-naloxone (BNX) substitution is limited. MATERIALS AND METHODS: This research aimed to study the prevalence and correlates of sexual dysfunction in men on BNX substitution therapy. We recruited consecutive forty men from BNX clinic, who had received BNX for at least 6 months, who were free from any recent illicit drug use (confirmed by urine chromatographic immune assay), and who were either married or had a stable sexual partner. Men with other psychiatric and substance use disorders (except tobacco) were excluded from the study. Data for the control group were obtained from a published study (with similar selection criteria) from our center. We assessed sexual dysfunction with two cross-culturally validated instruments: Arizona Sexual Experience Scale (ASEX) and International Index of Erectile Function. RESULTS: The sample had a mean age of 31.6 (±8) years; the mean duration of BNX treatment was 9 (±4.2) months and the mean BNX dose was 4.5 (±1.6) mg. ASEX showed the prevalence of sexual dysfunction to be 40%. The IIEF demonstrated intercourse dissatisfaction (95%) and hypoactive sexual desire (92.5%) as almost universal, while 77.5% of the participants reported erectile dysfunction. In comparison to the published data, these figures were significantly more than among the controls. We found no correlation of sexual dysfunction with marital status, age, duration or dose of BNX, duration of illicit opioid use, the severity of opioid dependence, and tobacco dependence. CONCLUSION: All men on BNX maintenance therapy must be screened for sexual dysfunction. With the rapid scaling up of office-based BNX substitution, assessment and management of sexual dysfunction ought to be incorporated in the training curriculum.

Epidemiology of substance use and dependence in the state of Punjab, India: Results of a household survey on a statewide representative sample.

BACKGROUND: Despite its political sensitivity, little scientifically valid evidence on the prevalence, pattern and treatment need of substance use in the northern border state of Punjab, India is available till date. METHODOLOGY: The 'universe' for the survey was the entire house-dwelling population of Punjab, of both genders, aged 11-60 years. Stratified multistage sampling technique was used. Following a pilot study, data were collected by trained research workers by face-to-face interview using pre-tested survey instruments. RESULTS: From 6398 households, 13,925 respondents were interviewed. Prevalence of lifetime and current (12 month) dependence on any substance were 15.8% (95% confidence interval [CI] 15.1-16.4%) and 14.7% (95% CI 14.1-15.3%) respectively. Of the specific substances, current dependence was the highest on alcohol (10.9%; 95% CI 10.3-11.4%), followed by tobacco (8.1%; 95% CI 7.7-8.6%). Regarding opioids, lifetime use was 1.9% (95% CI 1.6-2.1%) and current dependence 0.8% (95%CI 0.7-1.0%). Use of and dependence on natural opioids was the highest. After projecting these figures to the entire source population of the state, number of currently dependent alcohol, tobacco and opioid users were 2.2, 1.6, and 0.17 million, respectively. Overall, substance use was predominant in men and significantly more common in rural areas. Majority (81%) of the tobacco users, and 51% each of alcohol and opioid users needed intervention. However, merely one in six subjects sought any professional help. CONCLUSION: Punjab has a substantive problem related to substance use. Though alcohol and tobacco are by far the major substances of use and dependence, the large number of opioid users also raises concern. Treatment services need scaling-up.

Substance use and dependence in the Union Territory of Chandigarh: Results of a household survey using a multistage stratified random sample.

BACKGROUND: Substance misuse is a global health and social problem with major adverse consequences. A number of regional studies on prevalence of substance use and dependence have been carried out in India; but methodologically robust data from Chandigarh are sparse. METHODOLOGY: A house-to-house survey was carried out to estimate the prevalence of substance use and dependence in an adequate multistage-stratified random sample in the Union Territory (UT) of Chandigarh, using standardized instruments and predefined measures. Two thousand individuals (1000 each from urban and rural sites) from 743 households were interviewed. RESULTS: Lifetime use of any substance was reported in 21.26% households (8.01% of all respondents; 13.6% males and 1.01% females). Current use was reported in 6.55% of respondents. Prevalence rates of both lifetime and annual/current substance dependence were 2.96% (4.74% for males and 0.72% for females). Alcohol (6.72%) was the most common substance to be ever used by respondents, followed by tobacco (3.34%), opioids (0.17%), and hypnotics (0.04%). Lifetime dependence rates were found to be 1.76%, 2.28%, 0.04% and 0.17% for alcohol, tobacco, hypnotics, and opioids, respectively. None reported the use of cannabinoids, inhalants, or stimulants. Substance users were more likely to be married, employed, and in higher income group as compared to those who never used substance. Only 3.78% substance users had ever sought treatment for the same. CONCLUSION: Substance use is prevalent in the UT of Chandigarh, with a higher prevalence in males. Substance users hardly ever seek treatment for substance use. This highlights the need of awareness and community-level services for the treatment of substance use disorders.

Initial treatment dropout in patients with substance use disorders attending a tertiary care de-addiction centre in north India.

BACKGROUND & OBJECTIVES: Dropout from substance use disorders treatment is associated with poor outcomes. Although many factors have been associated with an early dropout of patients, the reasons for dropping out of treatment prematurely remain poorly understood particularly in the Indian context. This study was aimed to study socio-demographic and clinical variables predicting initial dropout of patients attending a tertiary care de-addiction treatment centre in north India. METHODS: Information was extracted from the records of consecutive newly registered patients from January 2011 to December 2014. The patients who did not come for follow up within 30 days of the first contact were defined as initial dropouts. RESULTS: Data of 7991 patients could be retrieved. Majority of the sample consisted of male, married and employed individuals. Of them, 4907 patients (61.3%) were considered initial dropouts. Multivariate analysis revealed that after controlling for other factors, greater age, being employed, lower educational status, lesser duration of substance use, use of alcohol, opiate, tobacco, cannabis or sedative-hypnotic use but the absence of multi-substance use predicted initial drop out. INTERPRETATION & CONCLUSIONS: This study identified some socio-demographic and clinical variables which might predict treatment attrition in substance use disorders. Clinician's awareness towards these factors and tailor-made intervention might improve initial treatment retention. Future research could be directed to find the validity of this assumption.

Use of Family CAGE-AID questionnaire to screen the family members for diagnosis of substance dependence.

BACKGROUND & OBJECTIVES: CAGE-AID questionnaire is a short, useful screening tool for substance dependence. Assessment of one family member for the screening of substance dependence in the family could be useful in clinical practice and research. In this study, we aimed to assess the validity of the Family CAGE-AID questionnaire for the diagnosis of substance dependence. METHODS: Cross-sectional assessments using CAGE-AID and Family CAGE-AID questionnaires were conducted both for the study participants (n = 210) and their family members. The participants were recruited from two different treatment settings: a treatment seeking population from a de-addiction centre, and non-treatment seekers for substance use disorders from the psychiatry outpatient department. ICD-10 criteria and subsequent detailed clinical interview by a trained psychiatrist were used for the final diagnosis of substance dependence. RESULTS: In the psychiatry outpatient group, the scores on CAGE-AID and Family CAGE-AID questionnaires were significantly correlated with the ICD-10 symptom score (r=0.81 and 0.70, respectively). In the same group, inter-rater agreement of the Family CAGE-AID was good with CAGE-AID and moderate with ICD-10 diagnosis of substance dependence (Cohen's kappa 0.78 and 0.61, respectively). A cut-off score of three on Family CAGE-AID was found to be 95·8 per cent sensitive and 100 per cent specific. INTERPRETATION & CONCLUSIONS: Family CAGE-AID questionnaire is a valid screening instrument for the diagnosis of substance dependence, with acceptable sensitivity and specificity of a cut-off score of three. The simplicity and the brevity of such an instrument can be valuable in the clinical settings of developing countries and also for epidemiological studies.