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BACKGROUND: People who inject drugs (PWID) experience many health problems which result in a heavy economic and public health burden. To tackle this issue, France opened two drug consumption rooms (DCRs) in Paris and Strasbourg in 2016. This study assessed their long-term health benefits, costs and cost-effectiveness. METHODS: We developed a model to simulate two fictive cohorts for each city (n=2,997 in Paris and n=2,971 in Strasbourg) i) PWID attending a DCR over the period 2016-2026, ii) PWID attending no DCR. The model accounted for HIV and HCV infections, skin abscesses and related infective endocarditis, drug overdoses and emergency department visits. We estimated the number of health events and associated costs over 2016-2026, the lifetime number of quality-adjusted life-years (QALYs) and costs, and the incremental cost-effectiveness ratio (ICER). RESULTS: The numbers of abscesses and associated infective endocarditis, drug overdoses, and emergency department visits decreased significantly in PWID attending DCRs (-77%, -69%, and -65%, respectively) but the impact on HIV and HCV infections was modest (-11% and -6%, respectively). This resulted in savings of 6.6 (Paris) and 5.8 (Strasbourg) millions of medical costs. The ICER of DRCs was 30,600/QALY (Paris) and 9,200/QALY (Strasbourg). In scenario analysis where drug consumption spaces are implemented inside existing harm reduction structures, these ICERs decreased to 21,400/QALY and 2,500/QALY, respectively. CONCLUSIONS: Our findings show that DCRs are highly effective and efficient to prevent harms in PWID in France, and advocate extending this intervention to other cities by adding drug consumption spaces inside existing harm reduction centers.
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Análisis Costo-Beneficio , Abuso de Sustancias por Vía Intravenosa , Humanos , Francia/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Infecciones por VIH/epidemiología , Años de Vida Ajustados por Calidad de Vida , Hepatitis C/epidemiología , Femenino , Masculino , Sobredosis de Droga/prevención & control , Sobredosis de Droga/epidemiología , Sobredosis de Droga/economía , AdultoRESUMEN
Opioid use disorder (OUD) is characterized by a lack of control in opioid use, resulting in psychological distress and deficits in interpersonal and social functioning. OUD is often associated with psychiatric comorbidities that increase the severity of the disorder. The consequences of OUD are dramatic in terms of increased morbi-mortality. Specific medications and psychotherapies are essential tools not only in the treatment of OUD but also in the prevention of suicide and overdoses. In our review, we assess the different types of psychotherapies (counseling, motivational interviewing, contingency management, cognitive-behavioral therapy, and dialectical-behavior therapy) that are delivered to opioid users, either associated or un-associated with OUD medications and/or medications for psychiatric disabilities. We describe the application of these therapies first to adult opioid users and then to adolescents. This work led us to propose a stepped-care model of psychotherapies for OUD which provided information to assist clinicians in decision-making regarding the selection of psychotherapeutic strategies according to patients' OUD severity.
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Some studies have reported that repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) is able to induce changes in the hypothalamic-pituitary axis in subjects with major depression. The causes of these neuroendocrine effects are unknown and deserve to be studied. The authors monitored neuroendocrine hormones in 15 subjects with major depression treated by 1-Hz rTMS on the right DLPFC and explored a correlation with mood improvement. Unlike previous studies, no changes in serum cortisol, prolactin, and thyroid hormone levels were found. However, the authors did observe short-term changes in growth hormone levels in nonresponsive subjects.
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Trastorno Depresivo Mayor/sangre , Trastorno Depresivo Mayor/terapia , Hormonas/sangre , Estimulación Magnética Transcraneal/métodos , Adulto , Anciano , Femenino , Humanos , Sistema Hipotálamo-Hipofisario/fisiopatología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Sistema Hipófiso-Suprarrenal/fisiopatología , Escalas de Valoración Psiquiátrica , Resultado del TratamientoRESUMEN
Non-invasive brain stimulation (NIBS) might be a new approach to treat substance use disorders (SUD). A systematic review and critical analysis was performed to identify potential therapeutic effects of NIBS on addictions. A search of the Medline database was conducted for randomized sham-controlled trials using NIBS in the field of addiction and published until August 2016. Twenty-six studies in various SUD met the inclusion criteria. Converging evidence indicates that NIBS might be a promising mean to treat patients with alcohol and tobacco use disorders, by acting on craving reduction and other mechanisms such as improvement in cognitive dysfunctions.
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Estimulación Encefálica Profunda/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos Relacionados con Sustancias/terapia , Resultado del Tratamiento , HumanosRESUMEN
BACKGROUND: Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal. CASE PRESENTATION: We describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms. CONCLUSION: Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal.
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Ketamina/uso terapéutico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Adulto , Analgésicos/uso terapéutico , Femenino , HumanosRESUMEN
BACKGROUND: Catatonia is a neuropsychiatric syndrome with motor and behavioural symptoms. Though usually occurring in patients with schizophrenia and mood disorders, this syndrome may also be associated with neurological diseases or general medical conditions. Few cases of catatonia associated with autoimmune disorders have been described. CASE PRESENTATION: Here, we report the case of a 27-year-old woman diagnosed with Hashimoto's encephalitis (HE) who attempted suicide and infanticide by defenestration. As she presented risk factors for postpartum psychosis, she was treated principally with antipsychotics. Despite adequate treatment for psychosis, symptoms worsened and she developed catatonia. Complementary investigations showed elevated titres of anti-thyroglobulin and anti-thyroperoxidase antibodies (200 and 10 times, respectively, as compared to normal levels) and electroencephalography were suggestive of encephalopathy. In the presence of an otherwise unexplained neuropsychiatric condition, HE was suspected and oral prednisolone was introduced. Psychiatric symptoms improved dramatically within 72 h and the patient was still free of any symptom 3 years later. CONCLUSION: Catatonia of organic aetiology should always be considered before a psychiatric aetiology especially in case of clinical worsening in spite of adequate psychotropic treatment. To our knowledge, this is the first description of catatonia associated with HE.
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Catatonia/complicaciones , Catatonia/psicología , Encefalitis/complicaciones , Encefalitis/psicología , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/psicología , Infanticidio/psicología , Suicidio/psicología , Adulto , Femenino , Humanos , LactanteRESUMEN
BACKGROUND: Low prevalence of substance-use disorder has been reported in adults with autism. However, on a superficial level, adults with high-functioning autism (HFA) display a 'normal' façade when they drink alcohol, which may explain why their alcohol dependency is not better diagnosed. CASE PRESENTATION: Here, we report two cases of HFA adults who use alcohol and psychostimulants to cope with their anxiety and improve their cognitive abilities and social skills. We analyze how neurocognitive traits associated with HFA may be potential triggers for substance-use disorder. CONCLUSION: Better identification of autism and its cognitive impairments, which may be vulnerability traits for developing substance-use disorders, could help improve the diagnosis and treatment of substance-use disorders among this population.
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Trastorno Autístico/diagnóstico , Estimulantes del Sistema Nervioso Central , Trastornos Relacionados con Sustancias/rehabilitación , Adaptación Psicológica , Disuasivos de Alcohol/uso terapéutico , Alcoholismo/diagnóstico , Alcoholismo/psicología , Alcoholismo/rehabilitación , Trastornos de Ansiedad/tratamiento farmacológico , Trastornos de Ansiedad/psicología , Trastorno Autístico/psicología , Trastornos del Conocimiento/psicología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
High-dose baclofen is a promising treatment for alcohol use disorder, with a specific action on craving. A more general action on craving in other addictive disorders has been suggested based on the hypothesis of a common neurobiological pathway in addictions. We report the case of a woman with both alcohol use disorder and bulimia nervosa. There was a positive response to high-dose baclofen on alcohol craving, but no response on food craving. The case illustrates that craving could be differentially responsive to anti-craving drugs.
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Alcoholismo/tratamiento farmacológico , Baclofeno/uso terapéutico , Bulimia Nerviosa/tratamiento farmacológico , Ansia , Adulto , Alcoholismo/complicaciones , Bulimia Nerviosa/complicaciones , Diagnóstico Dual (Psiquiatría) , Femenino , Humanos , Resultado del TratamientoRESUMEN
Problematic gaming is particularly prevalent in adolescent and young adult populations. While numerous studies have investigated the psychiatric comorbidities of Internet Gaming Disorder in young adults, few have focused specifically on adolescents who might be especially at risk because developmental particularities related to this developmental period. Here, we conducted a review of the literature, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in order to highlight the types of psychiatric comorbidities found in adolescents with problematic gaming.. We selected and analyzed 30 cross-sectional and longitudinal studies which correspond to 3683 adolescents (63,27% of boys) worldwide with problematic gaming. Our results highlight the high prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adolescents with problematic gaming and the links between this addiction and inattention, anxiety, depression, behavioural and emotional problems. These psychiatric comorbidities interact with problematic gaming and predict it throughout the adolescent's development. Moreover, this interaction involves personality profile and environment, including parental education. The complexity of this interaction argues in favor of the multi-level assessment that we are promoting.
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Trastorno por Déficit de Atención con Hiperactividad , Comorbilidad , Trastorno de Adicción a Internet , Humanos , Adolescente , Trastorno de Adicción a Internet/epidemiología , Trastorno de Adicción a Internet/psicología , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Juegos de Video/psicología , Juegos de Video/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Masculino , Femenino , Conducta del Adolescente/psicología , Conducta Adictiva/epidemiología , Conducta Adictiva/psicologíaRESUMEN
AIMS: The primary aim of this study was to evaluate the impact of drug consumption rooms (DCRs) in France on injection equipment-sharing, while the secondary aims focused upon their impact on access to hepatitis C virus (HCV) testing and opioid agonist treatment (OAT). DESIGN: The COhort to identify Structural and INdividual factors associated with drug USe (COSINUS cohort) was a 12-month longitudinal study of 665 people who inject drugs (PWID), conducted in Bordeaux, Marseille, Paris and Strasbourg. We used data from face-to-face interviews at enrolment and at 6-month and 12-month visits. SETTING AND PARTICIPANTS: The participants were recruited in harm reduction programmes in Bordeaux and Marseille and in DCRs in Strasbourg and Paris. Participants were aged more than 18 years, French-speaking and had injected substances the month before enrolment. MEASUREMENTS: We measured the impact of DCR exposure on injection equipment sharing, HCV testing and the use of medications for opioid use disorder, after adjustment for significant correlates. We used a two-step Heckman mixed-effects probit model, which allowed us to take into account the correlation of repeated measures and to control for potential bias due to non-randomization between the two groups (DCR-exposed versus DCR-unexposed participants). FINDINGS: The difference of declared injection equipment sharing between PWID exposed to DCRs versus non-exposed was 10% (1% for those exposed versus 11% for those non-exposed, marginal effect = -0.10; 95% confidence interval = -0.18, -0.03); there was no impact of DCRs on HCV testing and OAT. CONCLUSIONS: In the French context, drug consumption rooms appear to have a positive impact on at-risk practices for infectious diseases such as human immunodeficiency virus (HIV) and hepatitis C virus.
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Consumidores de Drogas , Infecciones por VIH , Hepatitis C , Abuso de Sustancias por Vía Intravenosa , Humanos , Hepacivirus , Abuso de Sustancias por Vía Intravenosa/terapia , Estudios de Cohortes , Estudios Longitudinales , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Asunción de Riesgos , Hepatitis C/epidemiología , Hepatitis C/complicacionesRESUMEN
Purpose: Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context. Methods: We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination. Results: Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037). Conclusion: Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.
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Psychosis is more common in people with temporal lobe epilepsy than it is in the general population. Treatment can be difficult in these patients because of the complex interactions between antipsychotic and antiepileptic drugs. Some antipsychotic drugs also decrease the seizure threshold. We report the case of a 49-year-old man with a hypothalamic hamartoma, with a history of both gelastic and temporal lobe seizures. The patient was rendered seizure-free after three neurosurgical procedures but developed a drug-resistant paranoid psychosis. He was treated with electroconvulsive therapy (ECT). After two weeks with six stimulations that resulted in seizures, the psychiatric phenomena disappeared completely. There was no relapse of either the psychiatric symptoms or the seizures during the 42 months of follow-up. This case report suggests that ECT might be safe for psychosis in patients with a history of seizures that have previously been successfully treated with neurosurgery, although caution should be exercised in drawing general conclusions from a single case report.
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Terapia Electroconvulsiva/métodos , Epilepsia/complicaciones , Hamartoma/complicaciones , Neoplasias Hipotalámicas/complicaciones , Trastornos Psicóticos/terapia , Anticonvulsivantes/uso terapéutico , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Clobazam , Deluciones/etiología , Deluciones/psicología , Resistencia a Medicamentos , Epilepsia/tratamiento farmacológico , Epilepsia/psicología , Hamartoma/psicología , Hamartoma/cirugía , Humanos , Neoplasias Hipotalámicas/psicología , Neoplasias Hipotalámicas/cirugía , Lamotrigina , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/tratamiento farmacológico , Radiocirugia , Lóbulo Temporal/cirugía , Triazinas/uso terapéuticoRESUMEN
BACKGROUND: Posttraumatic stress symptoms (PTSSs) and alcohol, tobacco, or nicotine use are frequently associated conditions. The COVID-19 pandemic has been a stressful situation globally and has worsened mental health conditions and addictions in the population. Our systematic review explores the links between PTSSs and (1) alcohol use and (2) tobacco or nicotine use during the COVID-19 pandemic. METHODS: We searched the PubMed, PsycINFO, and Web of Science databases for studies published between January 2020 and 16 December 2021. We included studies published in English concerning adults or adolescents. Included articles dealt simultaneously with the COVID-19 pandemic, PTSSs, and alcohol, tobacco, or nicotine use. The reports included were cross-sectional, longitudinal, or cohort studies. We categorized the reports according to the population explored. Our main outcomes are the impacts of PTSSs on (1) alcohol use and (2) tobacco and nicotine use and their relation to COVID-19-related stressors (worries, exposure, lockdown, and infection, either of self or relatives). RESULTS: Of the 503 reports identified, 44 were assessed for eligibility, and 16 were included in our review, encompassing 34,408 participants. The populations explored were the general population, healthcare workers, war veterans, patients with substance use disorders, and other vulnerable populations. Most studies were online surveys (14) with cross-sectional designs (11). Every study explored alcohol use, while only two assessed tobacco use. In most populations explored, a high level of PTSSs was associated with alcohol use increase. COVID-19-related stress was frequently correlated with either high PTSSs or alcohol use. In healthcare workers, PTSSs and alcohol use were not associated, while COVID-19 worries were related to both PTSSs and alcohol use. DISCUSSION: 1. PTSSs and increased alcohol use are frequently associated, while COVID-19 worries might trigger both conditions and worsen their association. Alcohol use increase may represent either an inadequate way of coping with PTSSs or a vulnerability amid the COVID-19 pandemic, leading to PTSSs. As most studies were cross-sectional online surveys, longitudinal prospective studies are needed to ascertain the direction of the associations between these conditions. These studies need to be sufficiently powered and control for potential bias and confounders. 2. Our review highlighted that research about PTSSs and tobacco or nicotine use is scarce.
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COVID-19 , Trastornos por Estrés Postraumático , Adulto , Adolescente , Humanos , COVID-19/epidemiología , Pandemias , Nicotiana , Nicotina , Trastornos por Estrés Postraumático/psicología , Control de Enfermedades Transmisibles , Uso de Tabaco/epidemiologíaRESUMEN
Regular cannabis using causes vision impairment by affecting human retinal neurotransmission. However, studies less considered its impact on the subsequent visual cortical processing, key feature for the integration of the visual signal in brain. We aimed at investigating this purpose in regular cannabis users using spatial frequencies and temporal frequencies filtered visual stimuli. We recruited 45 regular cannabis users and 25 age-matched controls. We recorded visual evoked potentials during the projection of low spatial frequency (0.5 cycles/degree) or high spatial frequency gratings (15 cycles/degree), which were presented statically (0 Hz) or dynamically (8 Hz). We analyzed the amplitude, latency, and area under the curve of both P100 and N170, best EEG markers for early visual processing. Data were compared between groups by repeated measures ANCOVA. Results showed a significant decrease in P100 amplitude among regular cannabis users in low spatial frequency (F(1,67) = 4.43; p = 0.04) and in dynamic condition (F(1,67) = 4.35; p = 0.04). Analysis also reported a decrease in P100 area under the curve in regular cannabis users to low spatial frequency (F(1,67) = 4.31; p = 0.04) and in dynamic condition (F(1,67) = 7.65; p < 0.01). No effect was found on P100 latency, N170 amplitude, latency, or area under the curve. We found alteration of P100 responses to low spatial frequency and dynamic stimuli in regular cannabis users. This result could be interpreted as a preferential magnocellular impairment where such deficit could be linked to glutamatergic dysfunction. As mentioned in the literature, visual and electrophysiological anomalies in schizophrenia are related to a magnocellular dysfunction. Further studies are needed to clarify electrophysiological deficits in both populations. CLINICAL TRIALS REGISTRATION: Electrophysiological Study of the Functioning of Magnocellular Visual Pathway in Regular Cannabis Users (CAUSA MAP). [NCT02864680; ID 2013-A00097-38]. https://clinicaltrials.gov/ct2/show/NCT02864680?cond=Cannabis&cntry=FR&draw=2&rank=1.
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Encéfalo/efectos de los fármacos , Cannabis/efectos adversos , Potenciales Evocados Visuales/efectos de los fármacos , Percepción Visual/efectos de los fármacos , Adulto , Femenino , Humanos , Masculino , Retina/efectos de los fármacos , Trastornos Relacionados con Sustancias , Transmisión Sináptica/efectos de los fármacos , Vías Visuales/fisiopatologíaRESUMEN
BACKGROUND: The number of people with an alcohol use disorder (AUD) was recently estimated to be 63.5 million worldwide. The global burden of disease and injury attributable to alcohol is considerable: about 3 million deaths, namely one in 20, were caused by alcohol in 2015. At the same time, AUD remains seriously undertreated. In this context, alternative or adjunctive therapies such as brain stimulation could play an important role. The early results of studies using repetitive transcranial magnetic stimulation (rTMS) suggest that stimulations delivered to the dorsolateral prefrontal cortex significantly reduce cravings and improve decision-making processes in various addictive disorders. We therefore hypothesize that rTMS could lead to a decrease in alcohol consumption in patients with AUD. METHODS/DESIGN: We report the protocol of a randomized, double-blind, placebo-controlled, parallel-group trial to evaluate the efficacy of rTMS on alcohol reduction in individuals diagnosed with AUD. The study will be conducted in 2 centers in France. Altogether, 144 subjects older than 18 years and diagnosed with AUD will be randomized to receive 5 consecutive twice-daily sessions of either active or sham rTMS (10 Hz over the right DLPFC, 2000 pulses per day). The main outcomes of the study will be changes in alcohol consumption within the 4 weeks after the rTMS sessions. Secondary outcome measures will include changes in alcohol consumption within the 24 weeks, alcohol cravings, clinical and biological improvements, effects on mood and quality of life, and cognitive and safety assessments, and, for smokers, an assessment of the effects of rTMS on tobacco consumption. DISCUSSION: Several studies have observed a beneficial effect of rTMS on substance use disorders by reducing craving, impulsivity, and risk-taking behavior and suggest that rTMS may be a promising treatment in addiction. However, to date, no studies have included sufficiently large samples and sufficient follow-up to confirm this hypothesis. The results from this large randomized controlled trial will give a better overview of the therapeutic potential of rTMS in AUD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04773691. Registered on 26 February 2021 https://clinicaltrials.gov/ct2/show/NCT04773691?term=trojak&draw=2&rank=5 .
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Alcoholismo , Alcoholismo/diagnóstico , Alcoholismo/terapia , Corteza Prefontal Dorsolateral , Método Doble Ciego , Humanos , Corteza Prefrontal , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Estimulación Magnética Transcraneal , Resultado del TratamientoRESUMEN
INTRODUCTION: Given the extent of workaholism identified in the literature, it seems essential to consider effective preventive measures. The purpose of this article is to summarize literature data on possible collective and individual preventive measures against workaholism, especially in occupational medicine. METHOD: We conducted a systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: 155 articles were retrieved in March 2019, but only 15 well-designed studies providing concrete measures to prevent workaholism were included. The various measures were classified using the traditional distinction between three levels of prevention. At the first level of prevention, workaholism can be avoided by implementing a protective organizational culture. The second level of prevention rather focuses on individual training and counselling to address the negative consequences of workaholism. Finally, the third level of prevention combines cognitive and behavioral interventions that enable professional and social reintegration of workaholics. DISCUSSION: This literature review confirms the multifactorial origin of workaholism and the involvement of organizational factors, supporting the necessary contribution of companies in its prevention. This review also reinforces the growing perception of workaholism as a behavioral addiction. Occupational physicians play a key role in this preventive approach as they can influence both working conditions and individual care. The highlighted preventive measures seem to be not only favorable to workaholics, but also to companies. CONCLUSION: This review provides field tools that can be used at the various levels of workaholism prevention. Nevertheless, intervention studies are required to confirm the effectiveness of the measures presented.
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Conducta Adictiva , Medicina del Trabajo , Conducta Adictiva/prevención & control , OcupacionesRESUMEN
BACKGROUND: Perception of treatment need (PTN), a component of clinical insight, is associated to negative addiction treatment outcomes when low. Our hypothesis was that lower PTN was associated with less craving when reported retrospectively, the most common measure of craving in clinical settings. OBJECTIVE: To explore the association between PTN and craving among a dataset of subjects with severe substance use disorders. METHODS: Participants were recruited from outpatient addiction clinic admissions or harm reduction program services. Good and low PTN were based on consistency between severe addiction (at least six DSM-5 criteria) and self-report need for addiction treatment from the Addiction Severity Index. Craving was retrospectively characterized over the past 30 days. Multiple regression analyses were conducted. RESULTS: Participants with low PTN (n = 97) retrospectively reported less frequent and intense episodes of craving, compared with participants with good PTN (n = 566) after controlling for sociodemographic factors, addiction type, and severity (p < 0.0001). CONCLUSION: Low perception of treatment need among subjects with severe addictions is associated to less retrospective report of craving, which may contribute to reduced efficiency of treatment. Further studies are needed to explore the mechanisms of the association.
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Encefalitis Antirreceptor N-Metil-D-Aspartato/complicaciones , Trastornos del Conocimiento/etiología , Trastorno Depresivo/etiología , Periodo Posparto , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Femenino , Fluorodesoxiglucosa F18/metabolismo , Humanos , Imagen por Resonancia Magnética , Tomografía de Emisión de PositronesRESUMEN
Widely used in industrialized countries, cannabis is a neuromodulator substance. The cannabinoid system is present at critical stages of retinal processing. We have recently shown a delay in bipolar and ganglion cell responses in regular cannabis users, as observed using flash (fERG) and pattern (PERG) electroretinogram. Although the results obtained during these tests provide information about global retinal responses, they do not give any indication about the spatial localization of the anomalies that were detected. The latter may be analyzed, however, by means of multifocal electroretinogram (mfERG). We recorded the mfERG responses in 49 regular cannabis users and 21 healthy subjects. The amplitudes and implicit times of the mfERG N1, P1 and N2 waves were recorded. The results showed that in regular cannabis users: in the <2° region, a significant increase in the N2 implicit time (pâ¯=â¯0.037); in the 2-5° region, a significant increase in the N2 (pâ¯=â¯0.018) and P1 (pâ¯=â¯0.046) implicit times; in the 5-10° region, a significant increase in the P1 (pâ¯=â¯0.006) and N1 (pâ¯=â¯0.034) implicit times; and in the 10-15° region, a significant increase in the P1 implicit time (pâ¯=â¯0.014). An isolated decrease in the N1 amplitude in the 2-5° region (pâ¯=â¯0.044) was also found. This indicates that there is a delay in the transmission of visual information from the central retina to the near periphery in cannabis users suggesting potential alterations in precise and color vision.
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Cannabis , Electrorretinografía , Neuronas , RetinaRESUMEN
Addictive disorders are characterized by impulsive behavior that leads to difficulties in preventing certain behaviors despite negative consequences. This symptom predisposes to a vulnerability in developing addictive disorders and is also aggravated by the addiction process itself. As such, understanding the underlying mechanisms of impulsivity is a challenge for understanding the pathophysiology of addiction. One common link between impulsivity and addiction is that both involve actions and decisions that are realized faster than they should be in time. Impulsive traits increase the tendency to choose immediate gratification instead of delayed gratification even when preferred. This observation suggests a relationship between impulsivity and time processing. To better understand this relationship, we reviewed the literature that describes the relationship between time processing and impulsivity in addictive disorders in humans. Despite a lack of literature concerning this question in alcohol, cannabis and gambling disorders, we highlight that addictive behaviors are a good model for understanding the pathophysiology of impulsivity, and could help us to better understand the relationship between time perception and impulsivity.