Snus and Snuff Use in Switzerland Among Young Men: Are There Beneficial Effects on Smoking?

Introduction: There are few recent longitudinal studies on smokeless tobacco (SLT) products and smoking outside the United States or European Nordic countries. The present longitudinal study tests whether Swedish-type snus and nasal snuff use decreases smoking incidence and prevalence in a central European country. Methods: The sample consisted of 5198 Swiss men (around 20 years of age). Retention rate was 91.5% over 15 months. Regression models, adjusting for a variety of psychosocial, smoking-related, and other risk factors, assessed whether no, low (less than weekly), and high (weekly or more) use baseline groups showed changes or maintenance in snus and snuff use related to smoking initiation, cessation, and reduction. Results: Among baseline nonsmokers, snus initiators (OR = 1.90, p = .003) and low baseline maintainers (OR = 4.51, p < .001) were more likely to start smoking (reference: persistent nonusers of snus). Among baseline smokers, initiators (OR = 2.79, p < .001) and low baseline maintainers (OR = 2.71, p = .005) more often continued smoking, whereas snus quitters less frequently continued smoking (OR = 0.57, p = .009). High baseline maintainers were non-significantly less likely to continue smoking (OR = 0.71, p = .315). Among continuing smokers, only snus quitters significantly reduced the number of cigarettes smoked per day (b = -1.61, p = .002) compared with persistent nonusers of snus. Results were similar for snuff. Conclusions: SLT use did not have any significant beneficial effects on young men in Switzerland but significantly increased the likelihood of smoking initiation and continuation, independent of whether the substance is legally sold (snuff) or not (snus). This does not exclude that there may be beneficial effects at older ages. Implications: Our research provides evidence that SLT use has no benefits for cigarette smoking initiation, cessation, or reduction among young men in a central European country, where SLT is not highly promoted or receives tax incentives. This is true for both legally sold nasal snuff and Swedish-type snus that cannot be legally sold. Results indicate that without incentives for using it, among young people shifts from smoking to SLT use are questionable and confirms the need for country-specific studies before the global public health community engages in promoting SLT.

Family-Related Stress versus External Stressors: Differential Impacts on Alcohol and Illicit Drug Use in Young Men.

Intense stress increases substance use (SU). However, little is known about the extent to which distinctive forms of stress should be weighted with regard to their effects on SU. This study aimed to determine whether family-related stress factors (FSF) influenced SU in a different way than external stress factors (ESF). Data was drawn from a Swiss cohort study on SU risk factors (C-SURF), involving 5,308 young adult men. Twelve month use of alcohol and of illicit substances was assessed. FSF and ESF for the time period preceding SU were measured. FSF and ESF were both significantly associated with SU. FSF had a greater impact on the use of most substances than did ESF. The FSF with the strongest association with SU was lack of parental monitoring. Regarding ESF, the cumulative number of stressful external events had a higher impact on SU than previous physical or sexual assault by a stranger. In contrast, physical or sexual assault by a family member was not found to be associated with subsequent SU. These findings have important implications for SU prevention programmes focusing on male teenagers, as it is difficult to screen and intervene in subtle forms of maltreatment in families.

Risk perception and emotional coping: a pathway for behavioural addiction?

This article summarizes current concepts of the working memory with regard to its role within emotional coping strategies. In particular, it focuses on the fact that the limited capacity of the working memory to process now-relevant information can be turned into an advantage, when the individual is occupied by dealing with unpleasant emotion. Based on a phenomenon known as dual-task interference (DTI), this emotion can be chased by intense arousal due to clearly identifiable external stressors. Thus, risk perception might be used as a 'DTI inductor' that allows avoidance of unpleasant emotion. Successful mastery of risk adds a highly relevant dopaminergic component to the overall experience. The resulting mechanism of implicit learning may contribute to the development of a behavioural addiction. Besides its putative effects in the development of a behavioural addiction, the use of DTI might be of a more general interest for the clinical practice, especially in the field of psychotherapy.

[Addiction]. / Addictions.

The news in addiction medicine in 2013 are presented according to the new version of the DSM (DSM-5); new data on cannabinoid, highlight hypotheses on self-medication; a current status about treatment of the addiction via the internet is shown; and new therapeutic perspectives emerge from the knowledge on traumatic antecedents in addictive populations.

Attention deficit hyperactivity disorder and future alcohol outcomes: Examining the roles of coping and enhancement drinking motives among young men.

OBJECTIVE: Although there is evidence that Attention Deficit Hyperactivity Disorder (ADHD) symptoms are positively related to alcohol use and related problems among young adults, little research has examined the mechanisms that might explain this association. In response, this study examined the mediating effects of coping and enhancement drinking motives on the prospective associations between ADHD symptoms and alcohol outcomes. METHOD: Participants (N = 4,536) were young men from the Cohort Study on Substance Use Risk Factors. Measures of ADHD symptoms and those of drinking motives, heavy episodic drinking (HED) and alcohol use disorder symptoms were used from the baseline and 15-month follow-up assessments. RESULTS: Findings indicated that the associations of ADHD-inattention symptoms with alcohol use disorder (AUD) symptoms and with HED were partially and completely mediated through drinking motives, respectively, whereas drinking motives did not mediate the ADHD-hyperactivity/impulsivity-symptoms-alcohol outcomes associations. CONCLUSION: Results indicated that coping and enhancement motives partially explained the ADHD-inattention symptoms-subsequent alcohol outcomes association. These findings suggest that interventions targeting enhancement and coping motives may help prevent problematic drinking among young men with elevated ADHD-inattention symptoms.

Comparing Mental Health across Distinct Groups of Users of Psychedelics, MDMA, Psychostimulants, and Cannabis.

Differences in mental health (MH) of users of distinct psychoactive substances have been shown. Both substance use (SU) and MH in users are influenced by stressful life events. This study compared MH parameters in distinct groups of substance users and evaluated the impact of stress factors on these outcomes. Data stem from the longitudinal Swiss Cohort Study on Substance Use Risk Factors (C-SURF) involving 4,475 young adult men. Distinct groups were created for the past 12 months' use of psychedelics, MDMA, psychostimulants, and cannabis. MH measurements (depressive symptoms, overall MH, perceived stress, life satisfaction) were used as outcome variables, while indicators of past family functioning and stressful life events served as covariates. The MH of psychedelics users was not significantly different from the no-drug-use group, whereas poorer MH was found in the other SU groups. Observed effects were influenced by the tested stress factors. The absence of association between use of psychedelics and worsening of MH deserves further investigation in male and female samples. Stressful life experiences must be considered when assessing the MH of users of illicit substances. These findings suggest that some men practice SU as self-medication to cope with life adversity.

Latent profiles of family background, personality and mental health factors and their association with behavioural addictions and substance use disorders in young Swiss men.

BACKGROUND: Recent theories suggest that behavioural addictions and substance use disorders may be the result of the same underlying vulnerability. The present study investigates profiles of family background, personality and mental health factors and their associations with seven behavioural addictions (to the internet, gaming, smartphones, internet sex, gambling, exercise and work) and three substance use disorder scales (for alcohol, cannabis and tobacco). METHODS: The sample consisted of 5287 young Swiss men (mean age = 25.42) from the Cohort Study on Substance Use Risk Factors (C-SURF). A latent profile analysis was performed on family background, personality and mental health factors. The derived profiles were compared with regards to means and prevalence rates of the behavioural addiction and substance use disorder scales. RESULTS: Seven latent profiles were identified, ranging from profiles with a positive family background, favourable personality patterns and low values on mental health scales to profiles with a negative family background, unfavourable personality pattern and high values on mental health scales. Addiction scale means, corresponding prevalence rates and the number of concurrent addictions were highest in profiles with high values on mental health scales and a personality pattern dominated by neuroticism. Overall, behavioural addictions and substance use disorders showed similar patterns across latent profiles. CONCLUSION: Patterns of family background, personality and mental health factors were associated with different levels of vulnerability to addictions. Behavioural addictions and substance use disorders may thus be the result of the same underlying vulnerabilities.

Positive psychology in the investigation of psychedelics and entactogens: A critical review.

RATIONALE: We reviewed the concepts and empirical findings in studies with psychedelics and entactogens related to positive psychology - the study of healthy human functioning, well-being and eudaemonia. It is an unresolved question how beneficial effects of psychedelics and entactogens are related to the potential risks of these substances - particularly in non-clinical settings. METHODS: We searched in PubMed, PsychINFO and the Cochrane Library for controlled clinical and epidemiological studies which applied concepts from positive psychology. We included N = 77 eligible studies with 9876 participants published before November 1st, 2017: (1) quantitative studies (N = 54), (2) preliminary or exploratory studies and reviews not including meta-analyses (N = 17), and (3) studies evidencing primarily negative results (N = 6). RESULTS: Positive psychology concepts have been applied for measuring effects of clinical trials, recreational and ceremonial use of psychedelics and entactogens. Psychedelics and entactogens were shown to produce acute and long-term effects on mood, well-being, prosocial behaviours, empathy, cognitive flexibility, creativity, personality factors like openness, value orientations, nature-relatedness, spirituality, self-transcendence and mindfulness-related capabilities. CONCLUSIONS: There is preliminary evidence for beneficial effects of psychedelics and entactogens on measures of positive psychology in clinical and healthy populations, however their sustainability remains largely unresolved. The reported results must be considered preliminary due to methodological restrictions. Since longitudinal data on both positive and adverse effects of psychedelics are lacking, more rigorous and standardized measures from positive psychology should be applied in less biased populations with prospective longitudinal designs to carefully assess the benefit-risk-ratio. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.

Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors.

Background: Non-medical use of prescription drugs (NMUPD) is an increasing phenomenon associated with physical and psychological consequences. This study investigated the effects of distinct forms of stress on NMUPD. Methods: Data from 5308 young adult men from the Swiss cohort study on substance use risk factors (C-SURF) were analysed regarding NMUPD of sleeping pills, tranquilizers, opioid analgesics, psychostimulants, and antidepressants. Various forms of stress (discrete, potentially traumatic events, recent and long-lasting social-environmental stressors) during the period preceding the NMUPD assessment were measured. Backward log-binomial regression was performed and risk ratios (RR) were calculated. Results: NMUPD was significantly associated with the cumulative number of potentially traumatic events (e.g. for opioid analgesics, RR = 1.92, p < .001), with problems within the family (e.g. for sleeping pills, RR = 2.45, p < .001), and the peer group (e.g. for tranquilizer use, RR = 2.34, p < .01). Factors describing family functioning in childhood showed very few significant associations. Sexual assault by acquaintances was associated only with use of sleeping pills (RR = 2.91, p p <.01); physical assault by acquaintances was not associated with NMUPD. Physical (e.g. for psychostimulants, RR = 2.01, p < .001) or sexual assaults (e.g. for antidepressants, RR = 4.64, p < .001) perpetrated outside the family context did show associations with several drug categories. Conclusion: NMUPD appears to be more consistently associated with discrete and potentially traumatic events and with recent social-environmental stressors than with long-lasting stressors due to family functioning during childhood and youth. Physical and sexual assaults perpetrated by strangers showed more associations with NMUPD than those perpetrated by a family member.

Introducción: El uso no médico de fármacos recetados (UNMFR) es un fenómeno creciente asociado con consecuencias físicas y psicológicas. Este estudio investigó los efectos de distintas formas de estrés en el UNMFR.Métodos: Se analizaron los datos de 5,308 varones adultos jóvenes del estudio suizo de cohorte sobre los factores de riesgo del uso de sustancias (C-SURF) con respecto a UNMFR de pastillas para dormir, tranquilizantes, analgésicos opioides, psicoestimulantes y antidepresivos. Se midieron diversas formas de estrés (eventos discretos potencialmente traumáticos, estresores socioambientales recientes y duraderos) durante el período anterior a la evaluación del UNMFR. Se realizó una regresión logística- binaria hacia atrás y se calculó el riesgo relativo (RR).Resultados: UNMFR se asoció significativamente con el número acumulativo de eventos potencialmente traumáticos (e.g. para analgésicos opioides, RR = 1.92, p <.001), con problemas dentro de la familia (e.g. para pastillas para dormir RR = 2.45, p <.001). y el grupo de iguales (e.g. para el uso de tranquilizantes RR = 2.34, p <.01). Los factores que describen el funcionamiento familiar en la infancia mostraron escasas relaciones significativas. La agresión sexual por conocidos solo se asoció con el uso de pastillas para dormir (RR = 2.91, p = <. 01) mientras que la agresión física por conocidos no se asoció con UNMFR. La actividad física (e.g. para psicoestimulantes RR = 2.01, p <.001) o agresiones sexuales (e.g, para antidepresivos RR = 4.64, p <.001) perpretados fuera del contexto familiar mostraron asociaciones con varias categorías de fármacos.Conclusión: El UNMFR parece asociarse de forma más consistente con eventos discretos y potencialmente traumáticos y con estresores sociales y ambientales recientes que con factores estresantes de larga duración debidos al funcionamiento familiar durante la infancia y la juventud. Las agresiones físicas y sexuales perpetradas por extraños mostraron más asociaciones con el UNMFR que las cometidas por un miembro de la familia.

Cigarette and Cannabis Use in Young Swiss Men: Examination of the Bidirectional, Longitudinal Associations Between Frequency of Use and Descriptive Norms.

OBJECTIVE: Although several studies have investigated longitudinal associations between social norms and alcohol use behaviors, less is known about associations between social norms and use of other substances, such as cigarettes and cannabis. The present study aimed to examine the temporal ordering of descriptive norms and cigarette and cannabis use over time. METHOD: A sample of 5,158 young Swiss men from the Cohort Study on Substance Use Risk Factors (C-SURF) completed baseline and 15-month follow-up questionnaires assessing frequency of use and descriptive norms of cigarette and cannabis use. Bidirectional, longitudinal associations between descriptive norms and cigarette and cannabis use were examined using cross-lagged panel models. RESULTS: Descriptive norms for cigarette use at baseline predicted increased frequency of use at follow-up, whereas the opposite association, from frequency of cigarette use at baseline to descriptive norms at follow-up, was not significant. For cannabis, associations between descriptive norms and frequency of use were reciprocal. Descriptive norms at baseline predicted an increased frequency of cannabis use at follow-up, and frequency of cannabis use at baseline predicted a later increase in descriptive norms. CONCLUSIONS: For cigarette use, findings suggest that descriptive norms shape later cigarette use behaviors. For cannabis use, findings suggest that descriptive norms shape cannabis use, but cannabis use also shapes later descriptive norms.

Depressive symptoms, alcohol use and coping drinking motives: Examining various pathways to suicide attempts among young men.

BACKGROUND: Research has identified several correlates of suicidal behaviors including depressive symptoms, alcohol use and coping drinking motives. However, their associations and their role as possible causal mechanisms in the prediction of suicide attempt are not well understood. This study examined, both cross-sectionally and longitudinally, the potential pathways from alcohol use, drinking coping motives, and depression to suicide attempts. METHODS: Participants (N = 4617) were young Swiss men (mean age = 19.95) participating in the Cohort Study on Substance Use Risk Factors. Measures of depressive symptoms, alcohol use (total drinks per week, heavy episode drinking) and coping drinking motives were used from the baseline and/or 15-month follow-up assessments to predict follow-up suicide attempt. RESULTS: Main findings showed indirect associations through depressive symptoms, such that coping drinking motives were positively associated with depressive symptoms, which were in turn positively related to suicide attempts over time (for total drinks per week models, cross-sectional model: B = 0.130, SE = 0.035, 95% CI = 0.072, 0.207; longitudinal model: B = 0.039, SE = 0.013, 95% CI = 0.019, 0.069). Alcohol use was not significantly related to suicide attempt. LIMITATIONS: Main limitation includes a low prevalence rate for suicide attempt potentially reducing power effects in the analyses and our focus on distal-yet not proximal, role of alcohol use on suicide attempt. CONCLUSIONS: Findings of this study suggest that young men with depressive symptoms and/or those who use alcohol to cope with negative affect may benefit from programs targeting suicidal behaviors.

Use of tramadol in psychiatric care: A comprehensive review and report of two cases.

Tramadol is widely prescribed for treating acute and chronic forms of pain. It is a weak mu-receptor opioid agonist and also increases concentrations of serotonin and noradrenaline within the limbic system of the brain. The therapeutic range of tramadol is relatively wide. Compared with other opioid agonists, there is little risk for developing tolerance and for abuse. Recent models of depression emphasise the subjective experience of a depressive mood as being, in part, a psychologically painful state. It is well established that psychological stress due to social separation/loss, disruption or be-trayal of pre-existent significant interpersonal bonds is mediated by the activation of the mammalian PANIC (separation-distress) system. It is also known that this kind of stress can be soothed very effectively by very low doses of endogenous or exogenous opioid receptor agonists. These observations raise the question of whether tramadol can be an effective and safe treat-ment option for some forms of anxiety and depression in which elements of social loss or betrayal are in-volved. In support of this possibility, two clinical cases are presented, and ideas for development of new ap-proaches targeting the endogenous opioidergic system in clinical practice are discussed.

Unconditioned responses and functional fear networks in human classical conditioning.

Human imaging studies examining fear conditioning have mainly focused on the neural responses to conditioned cues. In contrast, the neural basis of the unconditioned response and the mechanisms by which fear modulates inter-regional functional coupling have received limited attention. We examined the neural responses to an unconditioned stimulus using a partial-reinforcement fear conditioning paradigm and functional MRI. The analysis focused on: (1) the effects of an unconditioned stimulus (an electric shock) that was either expected and actually delivered, or expected but not delivered, and (2) on how related brain activity changed across conditioning trials, and (3) how shock expectation influenced inter-regional coupling within the fear network. We found that: (1) the delivery of the shock engaged the red nucleus, amygdale, dorsal striatum, insula, somatosensory and cingulate cortices, (2) when the shock was expected but not delivered, only the red nucleus, the anterior insular and dorsal anterior cingulate cortices showed activity increases that were sustained across trials, and (3) psycho-physiological interaction analysis demonstrated that fear led to increased red nucleus coupling to insula but decreased hippocampus coupling to the red nucleus, thalamus and cerebellum. The hippocampus and the anterior insula may serve as hubs facilitating the switch between engagement of a defensive immediate fear network and a resting network.

Altered processing of contextual information during fear extinction in PTSD: an fMRI study.

Medial prefrontal cortical areas have been hypothesized to underlie altered contextual processing in posttraumatic stress disorder (PTSD). We investigated brain signaling of contextual information in this disorder. Eighteen PTSD subjects and 16 healthy trauma-exposed subjects underwent a two-day fear conditioning and extinction paradigm. On day 1, within visual context A, a conditioned stimulus (CS) was followed 60% of the time by an electric shock (conditioning). The conditioned response was then extinguished (extinction learning) in context B. On day 2, recall of the extinction memory was tested in context B. Skin conductance response (SCR) and functional magnetic resonance imaging (fMRI) data were collected during context presentations. There were no SCR group differences in any context presentation. Concerning fMRI data, during late conditioning, when context A signaled danger, PTSD subjects showed dorsal anterior cingulate cortical (dACC) hyperactivation. During early extinction, when context B had not yet fully acquired signal value for safety, PTSD subjects still showed dACC hyperactivation. During late extinction, when context B had come to signal safety, they showed ventromedial prefrontal cortex (vmPFC) hypoactivation. During early extinction recall, when context B signaled safety, they showed both vmPFC hypoactivation and dACC hyperactivation. These findings suggest that PTSD subjects show alterations in the processing of contextual information related to danger and safety. This impairment is manifest even prior to a physiologically-measured, cue-elicited fear response, and characterized by hypoactivation in vmPFC and hyperactivation in dACC.