Alcohol and age.

Alcohol consumption constitutes a substantial burden of disease. Older people are being admitted to hospital for alcohol problems in increasing numbers. A recent systematic review reports cautious supportive evidence for primary prevention interventions in reducing excessive alcohol consumption in older drinkers, but does not focus on treatment of dependent drinkers. The evidence base for treatment interventions for dependent drinkers is comparatively limited, but it is growing. In addition to brief interventions, specialist outpatient treatment and inpatient treatment have been evaluated.The responses of older people to treatment are promising: they want to abstain, they have the capacity to change, they respond well to brief advice and motivational enhancement therapy, they achieve improvements at least as comparable to younger counterparts-and sometimes better-and they do have the prospect of long-term recovery.There is a need to develop services tailored to the needs of older substance misusers. Education of the workforce, including medical students and other health care professionals, is the key. Collaboration and coordination of services, training, research and policy are essential.There are very few designated services for older substance misusers in the UK and only 7% of older people who need treatment for alcohol problems access them. There is a massive gap in the whole gamut of research from basic to clinical research in this vulnerable patient population: this has to be developed if management is to be effective and up to date.

Psychopharmacological treatment of young people with substance dependence: a survey of prescribing practices in England.

BACKROUND: Prescribing for substance-dependent youth requires expert knowledge of developmental and contextual issues and use of largely unlicensed medicines. This first national survey aimed to determine the nature of pharmacological treatments delivered in England including the extent of maintenance therapy, supervised consumption and specialties prescribing. METHOD: Data were gathered regarding opiate substitutes & other medications prescribed for opiate, alcohol & benzodiazepine dependence, drug & alcohol relapse prevention and comorbidities. Evidence of distinct approaches to younger compared with older adolescents was sought. RESULTS: The overall response rate was 73%. The majority treated were over 16 years. 85% treatments were opiate substitute therapies; many received longer term maintenance therapy. Prescribing for alcohol dependence & comorbidity was low; the largest prescribing group were General Practitioners. CONCLUSIONS: Questions remain about the scale of youth dependence, the use of substitute agents in maintenance treatment and the number of adolescent addiction specialists in the treatment cadre.

Alcohol use and alcohol-use disorders among older adults in India: a literature review.

OBJECTIVES: With changing attitudes to alcohol and an increasing life span in India, the prevalence of alcohol use and misuse in successive cohorts of older people is likely to increase. In this paper, we attempt to review the most recent evidence covering alcohol use and alcohol-use disorders in the Indian elderly. METHODS: PubMed, PsycINFO and Indmed databases were searched using relevant keywords. Papers meeting eligibility criteria were selected through a sequential process of screening title, abstract and full text. Data were extracted into Excel sheets. RESULTS: There was a dearth of pan-national studies. There were several methodological issues with many studies especially related to measurement. A substantial proportion of individuals above the age of 50 years are current consumers of alcohol and the prevalence is generally higher in urban compared to rural areas. Older women are generally likely to be alcohol abstainers. The general trend appears to be a reduction in current drinking among successive age cohorts over the age of 50. Alcohol consumption in the older adults is associated with educational status, health status, chronic morbidity, employment status, socioeconomic status, auditory/locomotor impairment and asthma. CONCLUSION: Alcohol use and misuse is a problem among the Indian older adults. With socio-demographic changes that will further increase longevity, this problem is likely to increase and policy-makers need to plan for it. Future research needs to improve validity and reliability in study methodology, as well as add to the current evidence base.

Cannabis psychosis: examining the evidence for a distinctive psychopathology in a systematic and narrative review.

BACKGROUND: The term "cannabis psychosis" has become ubiquitous in the psychiatric literature. Few authors have described the precise psychopathology of this potentially distinct subtype of psychosis. Specifically, little attention has been paid to exploring whether cannabis psychosis is characterized by a psychopathology which is different from that of other types of psychosis. OBJECTIVE: The purpose of this paper was to systematically review the literature for evidence of a specific constellation of symptoms which are consistently characteristic of cannabis psychosis within an inpatient psychiatric setting and to determine whether these combine to create a psychopathology which is distinct from that of other types of psychosis. METHOD: Systematic review using Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. RESULTS: 13 studies of the 439 identified met the inclusion criteria. Only eight studies had sufficient internal and external validity to allow comparison in a narrative format of the psychopathology present, compared with controls. Of these eight selected studies, seven reported at least one significant difference (p < .05) in the psychopathology of the cannabis group to the control group used as a comparator. DISCUSSION AND CONCLUSION: This study should be interpreted with great caution and conclusions should not be generalized. These findings do not suggest that "cannabis psychosis" does not exist, only that from a psychopathological perspective it may not be qualitatively any different from other forms of psychosis. Future research in this area needs to focus on clarifying the definition or description of "cannabis psychosis" and the use of standardized robust experimental and/or observational designs to eliminate heterogeneity that may lead to inconclusive results.

The epidemiology of addiction in Sub-Saharan Africa: a synthesis of reports, reviews, and original articles.

Use of alcohol and other psychoactive substances is associated with serious social and public health problems, but the extent of the problem in Sub-Saharan Africa is not well known. We set out to review epidemiological publications on alcohol and other psychoactive substances in Sub-Saharan Africa by performing a systematic search of electronic databases and paper records. Ten Sub-Saharan African countries are among the 22 in the world with the highest increase in per capita alcohol consumption. Cannabis, tobacco, and khat are widely used, and use of cocaine, stimulants, and heroin is increasing. More epidemiological research and implementation and evaluation of interventions is needed. Collaboration between African researchers and those in developed countries could help.

Triply troubled: criminal behaviour and mental health in a cohort of teenage pregnant substance misusers in treatment.

BACKGROUND: Teenage substance misuse and pregnancy are major public health problems in the UK, where the most recent figures on maternal deaths suggest that they have doubled among young substance misusers. In general, little is known about their pregnancy outcomes. AIMS: The aims of this study were to describe the characteristics of a sample of teenage pregnant drug users in the UK, to examine their psychosocial risk and complicating factors at presentation, to evaluate adherence to current national guidelines and to assess the adequacy of guidelines in relation to identified characteristics. METHODS: A six-year records survey of young people attending a specialist adolescent drug misuse service in the west midlands of the UK. RESULTS: Ten pregnant adolescents were identified from records. These girls have had unstable or abusive experiences through childhood, half having other substance misusers in the family. All were with substantially older partners, who were also substance misusers. All had required a mental health assessment and 90% had a history of self-harm. There were no maternal or neonatal deaths, and only one girl had a miscarriage, but in four cases, the child had to be fostered. CONCLUSIONS: To our knowledge, this is the first analysis of this kind in the UK. Available guidelines were followed, but our findings suggest that more detailed and comprehensive guidelines are required. Preventive measures through education are likely to be hampered by the early age at which these girls cease attending school.

Awareness of the need for safe storage of methadone at home is not improved by the use of protocols on recording information giving.

BACKGROUND: Methadone is a synthetic, narcotic analgesic used in the treatment of drug misuse. Tragedies involving children being poisoned by the accidental ingestion of methadone are no longer a rare occurrence. Following an audit of the effectiveness of the provision and recall of information to patients attending an NHS Methadone Clinic a protocol was introduced to ensure that staff documented the provision of such information and patients gave a written confirmation that they had received the information. METHODS: The study was undertaken in the setting of an NHS methadone clinic with the aim of re- auditing the storage of methadone at home following the introduction of the new protocols. 174 patients completed an anonymous questionnaire regarding where they store methadone at home and whether they recall being given advice about safe storage. Community pharmacists were contacted by telephone to assess the level of advice given to methadone patients regarding safety. RESULTS: Only 49 (28.2%) patients recalled being given advice about safe storage, 24 (13.8%) recalled that information was provided by clinic staff. 170 (97.7%) patients regard methadone as being dangerous. (28.2%). Methadone is most commonly stored in a cupboard (37.9%). All methadone is dispensed in a bottle with a child resistant cap on it. All patients reported they stored their methadone in the original bottle provided by the pharmacist. CONCLUSION: Recall of information on safety issues is very poor. Provision of written as well as verbal information is needed. The use of printed safety information cards which patients can take away for future reference may be of use. It is the responsibility of health professionals to ensure they provide information and advice to methadone users on the safe storage of their methadone at home.

An exploration of research into substance misuse and psychiatric disorder in the UK: what can we learn from history?

BACKGROUND AND AIM: This review explores UK-based research developments in substance misuse and mental illness over the last 25 years. The main body of work comprises policy-orientated projects funded by the Department of Health from the late 1990s. Early research tended to focus on alcohol, especially alcoholic hallucinosis: the relationship of the latter with schizophrenia-like illness was examined, with the finding that very few cases did develop into schizophrenia. METHOD AND IMPLICATIONS: Parallels are drawn with the current debate around the link between cannabis and psychosis, urging caution in too rapid an assertion that cannabis is necessarily 'causal'. The clinical and policy implications of the misinterpretation of evidence are discussed. A proposal is put forward that the genesis of psychotic illness in alcohol misuse be revisited using more sophisticated research methodologies. Given the changing landscape of substance use in the UK, particularly the fashion of polysubstance use and the recognition that this is associated with psychotic illness, other drugs that are associated with psychotic illness should be similarly investigated to determine whether there is a common mechanism that might throw light on understanding the relationship between substance use and psychotic illness or schizophrenia.

Epidemiology of drug and alcohol use in young women.

An understanding of the epidemiology of alcohol and drug use in young women is important for three main reasons: (1) to appreciate that substance use, misuse, harmful use and dependence are associated with considerable mortality and physical and psychological morbidity; (2) to understand the nature and extent of these problems and the likely impact on the fetus, neonate and infant through childhood to adolescence; and (3) to utilize this information as part of a needs assessment to develop effective services, which detect problems and deliver appropriate interventions. Although abstention rates are consistently higher among women than men in general, substance misuse is increasing in young women. Simultaneously, there is great variability in prevalence rates in different countries, regions of countries and in different ethnic groups. This can be explained in part by differences in definitions, measurement techniques, availability, price, social acceptability, seizure and arrest policies, and in patterns and modes of use. During pregnancy, up to 15% of women may be using alcohol and about 5% may be using illicit drugs. The proportion of women using substances is less at term than in the early stages of pregnancy. Despite this, substance use rises sharply in the first 6 months postpartum. Detection of substance use in obstetric units is low but perinatal substance misuse intervention reduces adverse neonatal outcomes. On the basis of the relatively high rate of substance use disorders during pregnancy, effective screening and intervention strategies should be implemented.