thesis for drug and alcohol abuse

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Dissertations / Theses on the topic 'Drug- and alcohol addiction'

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King, William Alexander. "Teaching how to mentor people recovering from drug and alcohol addiction." Online full text .pdf document, available to Fuller patrons only, 2001. http://www.tren.com.

Yvona, Pabian Layla. "The Impact of Substance Abuse Training and Support on Psychologists' Functioning as Alcohol and Drug Counselors." Cleveland State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=csu1404164706.

Hardin, Melinda McKernan. "Issues women identify during their first three years of recovery from alcohol and drug addiction." Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/29697.

Stennett, Bethany Ann. "Novel Therapy for Nicotine Addiction in Alcohol Dependent Rats." UNF Digital Commons, 2013. http://digitalcommons.unf.edu/etd/465.

Robertson, Paul James, and n/a. "Korero te hikoi : Maori men talk the walk of addiction treatment." University of Otago. Christchurch School of Medicine & Health Sciences, 2005. http://adt.otago.ac.nz./public/adt-NZDU20070430.100135.

Blume, Jenna. "An Attitude of Gratitude| How a Grateful Disposition Impacts Relapse During Recovery from Drug and Alcohol Addiction." Thesis, The Chicago School of Professional Psychology, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1568606.

Consistent with the contemporary positive psychology movement, dispositional gratitude has gained considerable empirical evidence as a valuable emotion in increasing an individual's subjective well-being; however, gratitude has not yet been validated as a contributing factor to sobriety in individuals in recovery from drug and alcohol addiction. In the current study, participants were self-selected outpatients and staff members in recovery at a drug and alcohol addiction treatment center. The researcher assessed respondents' psychological symptoms, coping skills, dispositional gratitude, experience of relapse or abstinence, and demographic influences. Results indicated a significant negative correlation between gratitude and relapse, suggesting that a grateful disposition has emotional and psychological benefits for individuals in recovery from substance addiction. Additional findings revealed that the coping strategy of using alcohol or other drugs to feel better was statistically significant and made the strongest unique contribution to relapse; coping strategies including gratitude and religion/spirituality, although not statistically significant, each contributed less to the variance in relapse amongst participants. Finally, results suggest that education made the strongest unique contribution to relapse, which was statistically significant, while annual household income made less of a contribution and was not statistically significant. Research limitations, clinical implications, and future directions for the field are discussed.

Tallon, Valerie Patricia. "Healing the wounded self : a constructive grounded theory study on recovery from alcohol and drug addiction in Scotland." Thesis, University of the West of Scotland, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.627905.

Dodd, Dan D. "Is There a Relationship Between Alcohol/Drug Counselor's Strength of Belief in the Disease Concept of Addiction and Burnout?" Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1450817901.

McLachlan, Andre David. "Addiction Phenomenology In Substance Use And Non-Substance Use Disorders." The University of Waikato, 2008. http://hdl.handle.net/10289/2314.

Adams, Ruby Lee. "Long term drug and alcohol treatment program: An outcome study comparing secular-based treatment with faith-based treatment for addiction." CSUSB ScholarWorks, 2000. https://scholarworks.lib.csusb.edu/etd-project/1842.

Crosby, Helen Fiona. "Development of the Brief Addiction Therapist Scale (BATS) : a tool for evaluating therapist delivery of psychological therapies for alcohol and drug use problems." Thesis, University of Leeds, 2018. http://etheses.whiterose.ac.uk/22671/.

Lewis, J. Ben. "POLYAMINE MODULATION IN ALCOHOLISM: EXAMINATION USING A NOVEL SCREENING PROCEDURE DESIGNED TO PREDICT ANTI-RELAPSE AND NEUROPROTECTIVE EFFICACY." UKnowledge, 2011. http://uknowledge.uky.edu/gradschool_diss/851.

Clark, Marlene Fern. "Evaluating program and client characteristics associated with early dropout in an outpatient drug and alcohol clinic: A restrospective study." CSUSB ScholarWorks, 1998. https://scholarworks.lib.csusb.edu/etd-project/1560.

Ponder, Fred T. (Fred Thomas). "Alcohol and Drug Abuse Programs in Selected Universities in the South and Southwest." Thesis, North Texas State University, 1987. https://digital.library.unt.edu/ark:/67531/metadc330955/.

Merchant, Zain Farook. "A study on the depiction of drug usage, alcohol consumption and cigarette smoking in movies and its perceived effect on a young audience. A comparative study of American and Indian cinema and their respective Audiences." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4826.

Cantacorps, Centellas Lídia 1991. "Effects of maternal binge alcohol consumption on emotional, cognitive and addictive behaviour in mice." Doctoral thesis, Universitat Pompeu Fabra, 2019. http://hdl.handle.net/10803/667941.

Persson, Johanna, and Songhee Nordlander. "Sjuksköterskors erfarenhet av att vårda patienter som lider av drog- och alkoholmissbruk : En litteraturstudie." Thesis, Röda Korsets Högskola, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-854.

Irvin, Miriam, and Wilma Shepard. "A qualitative research study on fetal alcohol syndrome." CSUSB ScholarWorks, 1995. https://scholarworks.lib.csusb.edu/etd-project/978.

Attonito, Jennifer. "The Influence of Neurocognitive Impairment, Alcohol and other Drug (AOD) Use, and Psychosocial Factors on Antiretroviral Treatment Adherence, Service Utilization and Viral Load Among HIV-Seropositive Adults." FIU Digital Commons, 2013. http://digitalcommons.fiu.edu/etd/968.

Ambjörnsson, Erik, and Jimmy Fungmark. ""Vad du behöver göra är att bestämma dig för att bli drogfri och följa den planen" : En netnografisk studie om missbruksvård." Thesis, Linnéuniversitetet, Institutionen för socialt arbete (SA), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-75477.

Berglund, Amanda, and Linda Norman. "Att vårda personer med substansmissbruk - sjuksköterskors perspektiv." Thesis, Hälsohögskolan, Jönköping University, HHJ, Avd. för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-49115.

Haptén, Oscar, and Love Severin. "Återhämtning från alkohol och drogproblem : - en fenomenologisk studie av fyra människors återhämtningsprocesser." Thesis, Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-72372.

Kihlström, Jofen. "Böjelser & begär : en kritik av medicinens beroendebegrepp." Doctoral thesis, Örebro universitet, Samhällsvetenskapliga institutionen, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-1187.

Henriksen, Kari. "Å leve i en flyktig tilstand – og ønske seg et annet liv. : Hvordan kvinner med rusproblemer forstår sine rusproblemer og hvordan de opplever å fortelle om det. Hvordan opplever kvinnene at ansatte i helse- og sosialtjenesten møter dem og det de forteller." Thesis, Nordic School of Public Health NHV, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3309.

ISBN 91-7997-117-2

Merritt, Lindsay Nicole. "Exploring the Association of Victimization and Alcohol and Marijuana Use among American Indian Youth Living On or Near Reservations: a Mixed Methods Study." PDXScholar, 2018. https://pdxscholar.library.pdx.edu/open_access_etds/4396.

Santos, Mariana Martins Siqueira. "Avaliação do consumo de álcool e drogas em pacientes com Doença Falciforme (DF) em tratamento no Centro de Referência de Doença Falciforme do Hospital de Clínicas de Porto Alegre." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2016. http://hdl.handle.net/10183/164321.

Sjögren, Alexandra, and Ann-Sofie Frisk. "Processen av att lämna ett missbruk : En kvalitativ litteraturstudie av åtta självbiografier." Thesis, Linnéuniversitetet, Institutionen för socialt arbete (SA), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-87022.

Garcia, Angelica Silvia, and Coralyn Finlayson McCabe. "Depression and its causes in women recovering from substance abuse." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2149.

Santhanam, Priya. "Structural and functional neuroimaging of individuals with prenatal exposure to addictive substances." Diss., Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/37119.

Mayet, Aurélie. "Étude des trajectoires d’usage de substances psychoactives chez l’adolescent et l’adulte jeune : Exploration de la théorie de l’escalade." Thesis, Paris 5, 2012. http://www.theses.fr/2012PA05S008/document.

Hodgson, Maggie. ""Cross-addictions of gambling, alcohol and drugs in Aboriginal communities"." School of Native Human Services, 1997. http://142.51.24.159/dspace/handle/10219/468.

Pires, Ronaldo Rodrigues. "Implicacoes dos sentidos atribuidos pelos psicologos ao uso de alcool e outras drogas no tratamento de usuarios em CAPS ad e Comunidades Terapeuticas." Universidade Federal do CearÃ, 2013. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=10258.

Trávníček, Dušan. "Vliv alkoholu a jiných psychotropních látek na bezpečnost v dopravě." Master's thesis, Vysoké učení technické v Brně. Ústav soudního inženýrství, 2014. http://www.nusl.cz/ntk/nusl-232883.

Costa, Maria de Lourdes Pereira. "Comorbidades de transtornos mentais e comportamentais entre pacientes com dependência química em diferentes períodos de abstinência." Universidade Federal de Uberlândia, 2011. https://repositorio.ufu.br/handle/123456789/12716.

Czuba, Céline. "Consommations de substances psychoactives : à la confluence entre les droits à la santé et à la vie privée au travail." Thesis, Lille 2, 2017. http://www.theses.fr/2017LIL20027/document.

Reagan, Andrew Shawn. "Drug Addiction and Personal Responsibility." Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/philosophy_theses/63.

Dendy, Amy Marie. "Exploring cybersex and alcohol addiction in college students." Diss., Mississippi State : Mississippi State University, 2008. http://library.msstate.edu/etd/show.asp?etd=etd-03312008-151003.

Rojo, Gonzalez Loreto. "The role of GABAB in drug addiction." Thesis, University of Surrey, 2018. http://epubs.surrey.ac.uk/844932/.

Rutter, Julie N. "Environmental Enrichment and Reinstatement of Alcohol Addiction in Mice." Marietta College Honors Theses / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=marhonors1336358606.

Hanpatchaiyakul, Kulnaree. "Barriers to alcohol addiction treatment in women and men experiencing alcohol addiction in a Thai context : Exploring lived experiences and healthcare providers’ perspectives." Doctoral thesis, Mälardalens högskola, Hälsa och välfärd, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-33431.

Yavorsky, William Christian. "Addiction : disturbing fixity and mobilising ambiguity." Thesis, Manchester Metropolitan University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271272.

Willard, Shauna. "Anger and Alcohol Use: A Model of Coping Styles, Alcohol Expectancies and the Experience and Expression of Anger." TopSCHOLAR®, 1999. http://digitalcommons.wku.edu/theses/763.

Kausar, Wasim. "Drug addiction syndrome : among university students in Pakistan." Thesis, University of Exeter, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324031.

Webb, Michael Blair. "Addiction and the law : a case-study of the Alcoholism and Drug Addiction Act." University of Canterbury. School of Law, 2001. http://hdl.handle.net/10092/2567.

Shewan, David. "Patterns of drug using behaviour : the importance of drug, set, and setting." Thesis, Glasgow Caledonian University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.480943.

Devine, Caroline M. "The relationship between stress and coping, threat appraisal and addiction." Thesis, Queen's University Belfast, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336736.

Pradier, Bruno [Verfasser]. "The role of the cannabinoid receptor 2 in alcohol-induced neuroinflammation and alcohol addiction / Bruno Pradier." Bonn : Universitäts- und Landesbibliothek Bonn, 2015. http://d-nb.info/1082732265/34.

Best, David W. "Seeking explanations about drug use : methodological issues around explaining self-reported drug behaviours." Thesis, University of Strathclyde, 1998. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=21402.

ROCHA, ERICA SILVA. "THE SOCIAL BOND IN CONTEMPORARY SOCIETY AND DRUG ADDICTION." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2004. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=4562@1.

Thirtamara, Rajamani Keerthi Krishnan. "Animal Models of Drug Addiction and Autism Spectrum Disorders." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1386011455.

149 Alcohol Abuse Essay Topic Ideas & Examples

🏆 best alcohol abuse topic ideas & essay examples, 💡 interesting topics to write about alcohol abuse, 📌 simple & easy alcohol abuse essay titles, 👍 good essay topics on alcohol abuse, ❓ questions about alcohol abuse.

• Drug and Alcohol Abuse For along time now, drug and alcohol abuse in the society has been a problem that affects the youth and the society at large. This paper highlights the problems of drug abuse and alcohol drinking […]
• Alcoholism as a Social Problem The first attempt to tackle the problem was in the 1920s when the government passed the prohibition Act. This may cause them to turn to alcohol as a way of neutralizing the problem. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Alcoholism Causes and Curing In addition, professional counseling is equally important as the specialist can be able to access the level of alcoholism in the patient, how dependant that person is on alcohol and such information which would help […]
• Alcoholism and Sociological Imagination In the context of the alcoholism social problem, it is possible to use the concept of sociological imagination to unify individual characteristics of the alcoholic and historical contexts of the problem to illuminate the dynamics […]
• Underage Drinking and Teen Alcohol Abuse However, due to low legal driving age in America, many teenagers are prone to the risk of driving under the influence of alcohol than in other countries.
• Alcohol Abuse by Quentin McCarthy The aim of MAST is to determine the extent of alcohol consumption based on responses provided and formulate strategies of helping the agent with regard to excess consumption of alcohol.
• Concept and Treatment of Alcohol Abuse Alcoholism is the taking of alcoholic beverages to an extent that it can interfere with the physical behavior and activities of the alcoholic person.
• Alcoholism, Domestic Violence and Drug Abuse Kaur and Ajinkya researched to investigate the “psychological impact of adult alcoholism on spouses and children”. The work of Kaur and Ajinkya, reveals a link between chronic alcoholism and emotional problems on the spouse and […]
• Alcoholism and Treatment Options Even though alcohol has been inappropriately abused recently, it is safe to say that the consumption of alcohol is both a tonic and poison, depending on the dose. In India, several states prohibit the sale […]
• Drug and Alcohol Abuse Among Teenagers The thesis statement is: “Conviction is a better way to reduce drug and alcohol addiction among teenagers in the United States”.
• Awareness on Alcoholism: What Is It and How to Cope? The availability of these products is a major driver of individual and family problems that many people face. Alcoholism is a form of physical and mental addiction to drinks containing alcohol.
• Alcohol Abuse: Causes, Symptoms, Prevention, and Treatment Alcohol can additionally be the cause of brain damage manifested in the form of impairments in executive functioning, for example, weakening of visuospatial function and working memory.
• Screening Alcoholism With AUDIT Evaluation Method This tool, in turn, could provide some extra explanations for Brian’s drinking and help determine whether he was genetically predisposed to the condition. Thus, AUDIT happens to be the most suitable tool for reviewing Johnson’s […]
• Alcoholism Issue in Miami Gardens The new data also matches tendencies from the summer of 2020, when the coronavirus struck, when many Floridians resorted to alcohol and other narcotics in the face of unpredictable circumstances.
• Alcoholism Causes: Where Science and Religion Converge Although it is difficult to pinpoint a single cause of alcoholism, it is clear that many internal and external factors serve as raw material in the making of an alcoholic.
• Alcohol Abuse and Effective Prevention Technique The original presentation and this extended exploration for it discuss the community structure, the essence of the problem and the theory and practice behind the SBIRT approach.
• Media Influence on Alcohol Abuse Consequently, many people are likely to watch the advert, and the ad can increase consumption of the product and limit the fight against alcohol problems.
• Alcoholism Problem Overview Alcoholism is one of the major factors affecting the health of individuals and family relations due to the repercussions of the dependence.
• Alcoholism: A Female Patient’s Drinking Profile It had changed her perspective of reality and destroyed her family in a way that each of her children had a health problem leading to death of one child at the age of 10 years.
• Moderate Alcohol Abuse as DSM–IV–TR Diagnosis The DSM-IV-TR diagnosis in this case is a moderate alcohol abuse ), which requires a minimum of four symptoms as specified in the DSM.
• Alcoholism in Native Americans Theories suggest that the rate at which alcohol is absorbed in the body of a Native American is different from that of the rest of the U.S.population.
• Alcoholism Among the Adult Population in Wisconsin Alcohol dependency, which is an offshoot of excessive alcohol consumption, has been noted to lead to behaviours such as child abuse and neglect, poor dietary habits and absenteeism among the adult population in Wisconsin.
• Dual Illness – Depression and Alcohol Abuse The intention of the research paper is to assess if indeed there is an association between alcoholism as manifested by Jackson, and a case of depression.
• Teenage Depression and Alcoholism There also has been a demonstrated connection between alcoholism and depression in all ages; as such, people engage in alcoholism as a method of self medication to dull the feelings of depression, hopelessness and lack […]
• Alcohol Abuse, Behaviour, and Types of Personalities Personality type is a process that assists in the determination of people’s behavior; it however assists in the classification of people into distinct category types.
• The Main Problems of Alcoholism Despite the overall advance in treatment, alcoholism is still a challenge due to the lack of successful drug efficacy appraisals and pharmacotherapy personalization in patients with AUD.
• Alcoholism and Schizophrenia: Interconnection In addition to its physical effects on the chronic drinker’s body, alcohol is associated with a variety of mental impairments. Alcoholic dementia and Wernicke-Korsakoff syndrome are among the most prominent concerns in the matter. The former is a blanket term for a variety of cognitive deficiencies caused by the substance. The latter is a two-stage […]
• Alcoholism as a Disease Recently, the scientific and medical consensus regarding alcoholism has shifted as the understanding of the underlying causes of the condition has improved.
• Personality Issues Among Male People With Alcoholism The main message of the authors is that the personality degradation occurring during alcoholism is directly caused by problems of a socio-psychological nature.
• Drug and Alcohol Abuse Among Young People It is evident among drinkers that, when the BACs are low they develop a feeling of elation and when it rises, a feeling of friendliness begins to develop.
• Alcoholism as a Psychiatric and Medical Disorder He meets criteria A since he is unwilling to admit that he needs help to fight his dependence, which means that he requires the assistance of an expert to recognize the issue and, therefore, manage […]
• Intervention Techniques Focusing Drug Abuse and Alcoholism A technique of Family Intervention needs the concern, care and supremacy of love to penetrate the denial and start the treatment.
• Genetic Predisposition to Alcohol: The Appreciation and Therapy for Alcoholism Through family studies it has been established that the likelihood of alcohol dependence and similar complications happening is more in the families of the individuals who have been affected as compared to in the people […]
• Alcoholism: The Disease Is Often Progressive and Fatal According to the definition, the disease is a problem in society, but Colchado argues that if alcoholism is a problem, it cannot be considered a disease.
• Drinking and Alcoholism: Gender Divide in College In general, the purpose of the research was to arrive at evidence-based recommendations for university policy and guidance programs that could more holistically help students avoid binge drinking or alcoholism and systematically cope with the […]
• Drug & Alcohol Abuse Causes, Effects, Treatment First, it is necessary to indentify the age groups, most inclined to drug and alcohol addiction, and ascertain the major reasons for it. The research should discuss the problem of addiction from various standpoints therefore […]
• Alcoholism Is an Illness: Arguments in Favor Treating alcoholism as only a social problem is not enough because alcoholism is undeniably a very widespread and severe chronic illness that affects many people around the globe and thus should not be viewed as […]
• Genetic Basis for Alcoholism Further, Genetic studies will help you to understand more about the heritability of alcohol dependence and which will positively help you to explore the correlation of alcoholism to other disorders like major depression.
• Critical Issues in Education: Drug Abuse and Alcoholism For this case, the ministry concerned has a very hard task of ensuring there are no critical issues that are left unsolved that relate to education, failure to which will affect the performance of students […]
• Alcoholism: Its Causes and Effects This is because when the levels of CYP2E1 are high, there is a greater level of lipid peroxidation within the liver, thus a lower ability of the liver to fight against the toxins that have […]
• Reducing the Alcohol Abuse Among the Youth This paper includes a brief discussion of two possible ways to improve the problem and the justification for the use of one of the options.
• Alcoholism and Related Issues: Treatment Plan The patient is trying to get help to recover and rectify poor health conditions through medical treatment and the support of his family.
• Alcohol Abuse, Depression and Human Trafficking Patterson and Jeste point out that the high prevalence of alcohol abuse will increase in the future. Besides, Hanna indicates that domestic trafficking of girls in the US is a complex phenomenon to understand because […]
• Treatments for Alcohol Abuse in the Military It is also notable that the use of illicit drugs and alcohol is not high among military professionals in comparison with the other members of the society. Stress and the nature of the working environment […]
• Alcohol Abuse for Military-Connected It should also be pointed out that in the earlier conversation Wilson expressed interest in transferring to a base that would be closer to home and revealed his intention to terminate service in order to […]
• Alcoholism as a Social Issue and Its Effect on Families Such children tend to think that they are the causes of the problem, which would end up affecting them psychologically. Since children are not helped to get out of the horrifying scenarios, they end up […]
• Disease Concept of Alcoholism The universal definition of a disease is anything that is capable of causing an imbalance in the body’s nervous system thus, going by this definition then it is a disease, but in this century whereby […]
• Economic Tools: The Alcohol Abuse Problem Solving The four elements of an economic way of thinking are the use of assumptions, isolating variables, thinking at the margin, and the response of rational people to incentives.
• Social Article About Alcoholism Problem by Sanders Russell In his story “Under the Influence: Paying the Price of My Father’s Booze,” author Sanders Russell gives a deeply personal account of the effects of alcoholism in his family as he was growing up. Russell […]
• Social Issues: Alcoholism as a Mode of Addiction Every single case of alcoholic dependence described in the lecture is perfectly consistent with the existing model, each piece of evidence falling into its place and, therefore, allowing the audience to have an entire picture […]
• The Facts About Alcoholism The acetaldehyde reacts with the brain amines to produce isoquinolines which trigger the urge to drink more and more alcohol to combat the excess production of acetaldehydes in the body.
• Alcohol Abuse Among Elderly The effects of moderate consumption of alcohol are more beneficial to the elderly than to the younger generations. Thus, in the body of this report contains a deeper discussion of the causes, effects and solutions […]
• Reducing Drug and Alcohol Abuse: Europe vs. USA For instance, the needle and syringe exchange program has helped to reduce the rate of HIV infection among the injection drug users in the UK, which is the pioneer of needle and syringe exchange program.
• Effects of Alcohol Abuse on Women Among all these destructive substances, alcohol is the leading one and a significant companion of the 21st century people as well as a way of relaxing to escape the difficulties of posed by life. It […]
• Definition of Alcohol Misuse (Alcohol Abuse and Addiction) in Youth Population Age 18-29 Analyzing the article of Jiang, it is possible to define the alcohol misuse simply as the excessive consumption of alcohol where a number of the young drinkers is higher than any other group of age […]
• Social Influences on Behavior: Towards Understanding Depression and Alcoholism Based on Social Situations According to Smith & Mackie, dispositional variables entails the personalities, values, worldviews, and attitudes of the people that are interacting in a group, while situational variables comprise of the particular characteristics of the situation that […]
• Alcohol Abuse and the Contribution of Economists to Solving This Issue Analyzing the impact of a shift in supply, the researcher should consider the elasticity of demand as if the demand is elastic the price may be changed depending on the number of existing products at […]
• Alcoholism and the Impact Colonization Has Had on Aboriginals Once alcohol had become a part of the community, there was a gradual shift in the health of the people and they succumbed to illnesses.
• Diseases Caused by Alcohol Abuse and Its Preventions It is very important for the addicted person to feel all harmful consequences of the addiction and of alcohol in particular before giving up this bad habit.
• Alcoholism-Nature vs. Nurture Debate The analysis on physiological physiology regarding alcohol shows that, alcohol displays feelings of superiority and fearless behavior and also, it reduces an individual’s fear.
• Alcoholism: The Rough Road I was the only family he had and he had to move in with me in my apartment. Ken had nothing and he was willing to try anything to put his life back together.
• Alcoholism Disease or Self Will Alcoholism as a disease has serious physical effects to the body because it affects organs and systems such as the liver, the heart, and the nervous system amongst other critical organs in the body. Alcoholism […]
• Analysis of the Video “Effects of Alcoholism on Children: An Oral History Video” From the lecture, it is evident that individuals who grow in families with alcoholic members are highly likely to become alcoholic in future compared to their counterparts who have grown up in non-alcoholic environments.
• Teenage Alcoholism: Parental Influence and How to Get Rid of Vice The teenagers are in the process of emulating or declining the parental guidance since they need their freedom and at the same time are trying to win the parental support and acceptance.
• Three Generations of Alcohol Abuse in Relation to Client Therapy
• The Guidance Process of Providing Counsel to a Person with Alcohol Abuse
• The Role of the Family Physician in Stopping Alcohol Abuse
• The Issue of Alcohol Abuse by Teenagers in the United States
• The Issue of Employee Drug and Alcohol Abuse in the United States
• The Impact of Alcohol Abuse on Finance and Economy
• Solutions To Dealing With Alcohol Abuse
• Treating Alcohol Abuse with Alcohol Anonymous vs. Controlled Drinking
• The Psychological and Pharmacological Effects of Substance and Alcohol Abuse
• The Issue of Drug and Alcohol Abuse Among Teenagers in the United States
• The Truth About What Alcohol Abuse Does to a Fetus
• The Problem of Underage Alcohol Abuse in the UK and the Need to Enforce Age Limits
• The Connection Between Combat Exposure and Drug and Alcohol Abuse
• The Role Of Alcohol Abuse And Academic Performance
• The Threats and Damages of Alcohol Abuse in American Society
• The Problem of Teenage Alcohol Abuse in the United States
• The Negative Effects of Alcohol Abuse by Women During Pregnancy
• The Relationship between Adolescent Alcohol Abuse and Depression
• Understanding the Correlation Between Alcohol Abuse and Crime Rate
• Teenagers and Alcohol Abuse: A Study on the Effects and Treatment
• The Effect of an Absent Father Figure on the Risk of Drug and Alcohol Abuse, Mental Illness and Criminality
• Alcohol Abuse In Teenagers: Killing Teens And Hurting Society
• The Pathophysiology Of Alcohol Abuse And Addiction
• The Effects Of Alcohol Abuse On Sexual Behavior
• The Different Factors Contributing to the Development of Alcohol Abuse
• Alcohol Abuse: Physical and Emotional Injuries to People and Family Life
• The Role of Alcohol Abuse in the Occurrence of Date Rape
• Alcohol Abuse Cases in Aboriginal Communities
• The Dangers of Alcohol Abuse in the United States
• The Effects Of Drug And Alcohol Abuse On The United States
• Understanding the Cause of Alcohol Abuse Among Teenagers
• Alcohol Abuse, College Students and Public Health
• Coalitions and Partnerships Created to Address Alcohol Abuse On Campus
• Teenage Alcohol Abuse: Signs, Dangers & How You Can Help
• The Adverse Effects of Drug and Alcohol Abuse
• The Effects of Alcohol Abuse on Developing Fetal Alcohol Syndrome
• The Effects Of Drug Alcohol On The Biological Force Of Alcohol Abuse
• Substance Abuse Among Nurses And Alcohol Abuse
• Prevention Of Alcohol Abuse And Alcoholism
• The Consequences of Alcohol Abuse and Dependence
• An Analysis of the Issue of Alcoholism and Alcohol Abuse in Young Age
• Connection Between Depression and Alcohol Abuse in Adolescents
• Cause And Effects Of Drugs And Alcohol Abuse During The Vietnam War
• Definitions Of And Treatment For Alcohol Abuse
• The Causes, Treatments and Prevention of Alcohol Abuse
• The Methods of Prevention Alcohol Abuse by Young Adults in the United States
• Alcoholism And Alcohol Abuse Among Native Americans
• An Analysis of the Characteristics and Dangers of Alcohol Abuse in Australia
• Psychological Hardiness and Coping Style as Risk/Resilience Factors for Alcohol Abuse
• The Effects Of Alcohol Abuse On The Elderly Population
• Recovering From Alcohol Abuse Is A Serious Mental Illness
• Educating Teenagers About The Dangers Of Alcohol Abuse
• Effects Of Alcohol Abuse On Alcoholic Drinks And Alcohol
• How Long Term Alcohol Abuse Affects the Brain
• An Analysis of the Topic of the National Institute on Alcohol Abuse and Alcoholism
• What Are the Socioeconomic Effects of Alcohol Abuse?
• How Does Alcohol Abuse Affect Aging People?
• What Impact Does Alcohol Abuse Have on Women?
• Does Alcohol Abuse Differ From Alcoholism?
• What Are the General Effects of Alcohol Abuse on Teenagers?
• Has Alcohol Abuse Become Part of the Culture in Many Societies?
• What Does the Church Say About Alcohol Abuse?
• Is Alcohol Abuse the Same as Misuse?
• What Are the Main Causes of Alcohol Abuse?
• How Does Alcohol Abuse Affect the Body?
• What Are the Effects of Alcohol Abuse in Our Society?
• Why Does Alcohol Abuse Increase the Risk of Violence?
• How Can We Reduce Alcohol Abuse Among Teens?
• What Are the Steps Usually Involved in the Treatment of Alcohol Abuse?
• How Does Alcoholics Anonymous Help People Deal With Alcohol Abuse?
• What Is the Most Effective Treatment for Alcohol Abuse?
• Does Alcohol Abuse Affect the Fetus?
• What Are the Oral Implications of Alcohol Abuse?
• Is Alcohol Abuse Draining the US Economy?
• What Are the Legal Consequences of Alcohol Abuse?
• Is There a Link Between Depression and Alcohol Abuse?
• What Are the Statistics of Alcohol Abuse in the United States?
• How Does Alcohol Abuse Affect Adolescent Mental Health?
• What Is the Global Impact of Alcohol Abuse?
• What Country Is Most Affected by Alcohol Abuse?
• Are There Basic Strategies for Preventing Alcohol Abuse?
• What Is the Economic Cost of Alcohol Abuse in the United States?
• How Can We Solve the Problem of Alcohol Abuse in Modern Society?
• What Are the Social Causes of Alcohol Abuse?
• What Are the Major Physiological and Psychological Effects of Alcohol Abuse?
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Mental Health and Substance Use Disorders Often Go Untreated for Parents on Medicaid

By Emily Baumgaertner

For parents struggling with mental health or substance use disorders, access to treatment can often mean the difference between keeping and losing their children. But a new analysis of health and child welfare records found that a significant portion of those who were eligible for Medicaid coverage for such treatment were not getting it.

The analysis, published Friday by researchers at the nonprofit institute RTI International and the Department of Health and Human Services, found that fewer than half of parents on Medicaid who had substance use disorders and had been referred to authorities over suspicions of child abuse or neglect had received treatment.

Some Context: Experts say bad situations can often be reversed with treatment.

Both mental health and drug addiction crises have been roiling the country, and the effects of parental drug use and mental illness can quickly trickle down to their children . Public health experts say substance use disorders can incapacitate a previously diligent parent and lead to the involvement of child protective services.

In 2021 alone, more than seven million children were referred to authorities over worries of maltreatment, according to a federal report , and more than 200,000 were removed from their homes. But research shows that when parents seek treatment for psychiatric and substance use disorders , they are far less likely to experience family separation.

The Numbers: What the researchers found.

To calculate treatment rates among parents on Medicaid, the health insurance program for low income people, Tami Mark, a health economist at RTI, who led the research, and her colleagues drew from a new publicly available data set that used de-identified social security numbers to link child welfare records in Florida and Kentucky with corresponding Medicaid claims records from 2020.

For comparison, they also analyzed a random sample of Medicaid recipients who had no records in the child welfare system. (The study didn’t capture any counseling or medication given outside the Medicaid system, nor any cases of mental health or substance use disorders that were undiagnosed.)

Among 58,551 parents who had a child referred to welfare services, more than half had a psychiatric or substance use diagnosis, compared to 33 percent of the comparison group. About 38 percent of those with referrals who had mental health disorders and 40 percent of those who had substance use disorders had received counseling; about 67 percent of people with mental health disorders and 38 percent of those with substance use disorders had received medication.

Norma Coe, an associate professor of medical ethics and health policy at the University of Pennsylvania, who was not involved in the research, said some of the rates were worse than general Medicaid treatment figures , suggesting that some barriers could be specific to parents.

“In general, the U.S. supports parents and caregivers less than many other countries,” Dr. Coe said, “which has numerous and lasting intergenerational effects on health and wealth.”

What Happens Next: Examining the barriers.

The study’s authors highlighted an array of roadblocks to receiving counseling and medication, including stigma, inconvenience and the fear of losing parental rights.

They called for better coordination between social programs, such as integrating the data systems of child welfare and Medicaid so that it would be clear when parents needed to be connected to specific services.

But Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University who studies inequity, said there was another challenge: a shortage of treatment providers that will accept patients on Medicaid, which pays lower reimbursement rates than private insurers.

“Access to behavioral health services is inadequate in the United States,” he said, “but it’s even worse for Medicaid beneficiaries.”

Emily Baumgaertner is a national health reporter for The Times, focusing on public health issues that primarily affect vulnerable communities. More about Emily Baumgaertner

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• Indian J Psychiatry
• v.52(Suppl1); 2010 Jan

Substance use and addiction research in India

Pratima murthy.

Department of Psychiatry, De-Addiction Centre, National Institute of Mental Health and Neuro Sciences, Bangalore - 560 029, India

N. Manjunatha

B. n. subodh, prabhat kumar chand, vivek benegal.

Substance use patterns are notorious for their ability to change over time. Both licit and illicit substance use cause serious public health problems and evidence for the same is now available in our country. National level prevalence has been calculated for many substances of abuse, but regional variations are quite evident. Rapid assessment surveys have facilitated the understanding of changing patterns of use. Substance use among women and children are increasing causes of concern. Preliminary neurobiological research has focused on identifying individuals at high risk for alcohol dependence. Clinical research in the area has focused primarily on alcohol and substance related comorbidity. There is disappointingly little research on pharmacological and psychosocial interventions. Course and outcome studies emphasize the need for better follow-up in this group. While lack of a comprehensive policy has been repeatedly highlighted and various suggestions made to address the range of problems caused by substance use, much remains to be done on the ground to prevent and address these problems. It is anticipated that substance related research publications in the Indian Journal of Psychiatry will increase following the journal having acquired an ‘indexed’ status.

INTRODUCTION

Substance use has been a topic of interest to many professionals in the area of health, particularly mental health. An area with enormous implications for public health, it has generated a substantial amount of research. In this paper we examine research in India in substance use and related disorders. Substance use includes the use of licit substances such as alcohol, tobacco, diversion of prescription drugs, as well as illicit substances.

METHODOLOGY

For this review, we have carried out a systematic web-based review of the Indian Journal of Psychiatry (IJP). The IJP search included search of both the current and archives section and an issue-to-issue search of articles with any title pertaining to substance use. This has included original articles, reviews, case series and reports with significant implications. Letters to editor and abstracts of annual conference presentations have not been included.

Publications in other journals were accessed through a Medlar search (1992-2009) and a Pubmed search (1950-2009). Other publications related to substance use available on the websites of international and national agencies have also been reviewed. In this review, we focus mainly on publications in the IJP and have selectively reviewed the literature from other sources.

For the sake of convenience, we discuss the publications under the following areas: Epidemiology, clinical issues (diagnosis, psychopathology, comorbidity), biological studies (genetics, imaging, electrophysiology, and vulnerability), interventions and outcomes as well as community interventions and policies. There is a vast amount of literature on tobacco use and consequences in international and national journals, but this is outside the scope of this review. Tobacco is mentioned in this review of substance use to highlight that it should be remembered as the primary licit substance of abuse in our country.

The number of articles (area wise) available from IJP, other Indian journals and international journals are indicated in Figures ​ Figures1 1 and ​ and2. 2 . A majority of the publications in international journals relate to tobacco, substance use co-morbidity and miscellaneous areas like animal studies.

Publications in the area of substance use and related disorders

Break up of areas of publication

EPIDEMIOLOGY

Much of the earlier epidemiological research has been regional and it has been very difficult to draw inferences of national prevalence from these studies.

Regional studies

Studies between 1968 until 2000 have been primarily on alcohol use [ Table 1 ]. They have varied in terms of populations surveyed (ranged from 115 to 16,725), sampling procedures (convenient, purposive and representative), focus of enquiry (alcohol use, habitual excessive use, alcohol abuse, alcoholism, chronic alcoholism, alcohol and drug abuse and alcohol dependence), location (urban, rural or both, Slums), in the screening instruments used (survey questionnaires and schedules, semi-structured interviews, quantity frequency index, Michigan Alcohol Screening Test (MAST) etc). Alcohol ‘use/abuse’ prevalence in different regions has thus varied from 167/1000 to 370/1000; ‘alcohol addiction’ or ‘alcoholism’ or ‘chronic alcoholism’ from 2.36/1000 to 34.5/1000; alcohol and drug use/abuse from 21.4 to 28.8/1000. A meta-analysis by Reddy and Chandrashekhar[ 26 ] (1998) revealed an overall substance use prevalence of 6.9/1000 for India with urban and rural rates of 5.8 and 7.3/1000 population. The rates among men and women were 11.9 and 1.7% respectively.

Regional epidemiological studies in substance use: A summary

U - Urban; R - Rural; Sl - Slum; SR - Semi-rural; NM - Not mentioned

Regional studies between 2001 and 2007 continue to reflect this variability. Currently, the interest is to look at hazardous alcohol use. A study in southern rural India[ 27 ] showed that 14.2% of the population surveyed had hazardous alcohol use on the AUDIT. A similar study in the tertiary hospital[ 28 ] showed that 17.6% admitted patients had hazardous alcohol use.

The only incidence study on alcohol use from Delhi[ 17 ] found that annual incidence of nondependent alcohol use and dependent alcohol use among men was 3 and 2 per 1000 persons in a total cohort of 2,937 households.

National Studies

The National Household Survey of Drug Use in the country[ 29 ] is the first systematic effort to document the nation-wide prevalence of drug use [ Table 2 ]. Alcohol (21.4%) was the primary substance used (apart from tobacco) followed by cannabis (3.0%) and opioids (0.7%). Seventeen to 26% of alcohol users qualified for ICD 10 diagnosis of dependence, translating to an average prevalence of about 4%. There was a marked variation in alcohol use prevalence in different states of India (current use ranged from a low of 7% in the western state of Gujarat (officially under Prohibition) to 75% in the North-eastern state of Arunachal Pradesh. Tobacco use prevalence was high at 55.8% among males, with maximum use in the age group 41-50 years.

Nationwide studies on substance use prevalence

H-H - House to house survey; M - Male; F - Female; A - Alcohol, C - Cannabis; O - Opioids; T - Tobacco

The National Family Health Survey (NFHS)[ 30 ] provides some insights into tobacco and alcohol use. The changing trends between NFHS 2 and NFHS 3 reflect an increase in alcohol use among males since the NFHS 2, and an increase in tobacco use among women.

The Drug Abuse Monitoring System,[ 29 ] which evaluated the primary substance of abuse in inpatient treatment centres found that the major substances were alcohol (43.9%), opioids (26%) and cannabis (11.6%).

Patterns of substance use

Rapid situation assessments (RSA) are useful to study patterns of substance use. An RSA by the UNODC in 2002[ 31 ] of 4648 drug users showed that cannabis (40%), alcohol (33%) and opioids (15%) were the major substances used. A Rapid Situation and Response Assessment (RSRA) among 5800 male drug users[ 32 ] revealed that 76% of the opioid users currently injected buprenorphine, 76% injected heroin, 70% chasing and 64% using propoxyphene. Most drug users concomitantly used alcohol (80%). According to the World Drug Report,[ 33 ] of 81,802 treatment seekers in India in 2004-2005, 61.3% reported use of opioids, 15.5% cannabis, 4.1% sedatives, 1.5% cocaine, 0.2% amphetamines and 0.9% solvents.

Special populations

In the last decade, there has been a shift in viewing substance use and abuse as an exclusive adult male phenomenon to focusing on the problem in other populations. In the GENACIS study[ 34 ] covering a population of 2981 respondents [1517 males; 1464 females], across five districts of Karnataka, 5.9% of all female respondents (N =87) reported drinking alcohol at least once in the last 12 months, compared to 32.7% among male respondents (N = 496). Special concerns with women’s drinking include the fetal alcohol spectrum effects described with alcohol use during pregnancy.[ 35 ]

Abuse of other substances among women has largely been studied through Rapid Assessment Surveys. A survey of 1865 women drug users by 110 NGOs across the country[ 36 ] revealed that 25% currently were heroin users, 18% used dextropropoxyphene, 11% opioid containing cough syrups and 7% buprenorphine. Eighty seven per cent concomitantly used alcohol and 83% used tobacco. Twenty five per cent of respondents had lifetime history of injecting drug use and 24% had been injecting in the previous month. There are serious sexually transmitted disease risks, including HIV that women partners and drug users face.[ 36 , 37 ]

Substance use in medical fraternity

As early as 1977, a drug abuse survey in Lucknow among medical students revealed that 25.1% abused a drug at least once in a month. Commonly abused drugs included minor tranquilizers, alcohol, amphetamines, bhang and non barbiturate sedatives. In a study of internees on the basis of a youth survey developed by the WHO in 1982,[ 38 ] 22.7% of males ‘indulged in alcohol abuse’ at least once in a month, 9.3% abused cannabis, followed by tranquilizers. Common reasons cited were social reasons, enjoyment, curiosity and relief from psychological stress. Most reported that it was easy to obtain drugs like marijuana and amphetamines. Substance use among medical professionals has become the subject of recent editorials.[ 39 , 40 ]

Substance use among children

The Global Youth Tobacco Survey[ 41 ] in 2006 showed that 3.8% of students smoke and 11.9% currently used smokeless tobacco. Tobacco as a gateway to other drugs of abuse has been the topic of a symposium.[ 42 ]

A study of 300 street child laborers in slums of Surat in 1993[ 43 ] showed that 135 (45%) used substances. The substances used were smoking tobacco, followed by chewable tobacco, snuff, cannabis and opioids. Injecting drug use[ 44 ] is also becoming apparent among street children as are inhalants.[ 45 ]

A study in the Andamans[ 46 ] shows that onset of regular use of alcohol in late childhood and early adolescence is associated with the highest rates of consumption in adult life, compared to later onset of drinking.

Studies in other populations

A majority of 250 rickshaw pullers interviewed in New Delhi[ 47 ] in 1986 reported using tobacco (79.2%), alcohol (54.4%), cannabis (8.0%) and opioids (0.8%). The substances reportedly helped them to be awake at night while working. In a study of prevalence of psychiatric illness in an industrial population[ 48 ] in 2007, harmful use/dependence on substances (42.83%) was the most common psychiatric condition. A study among industrial workers from Goa on hazardous alcohol use using the AUDIT and GHQ 12 estimated a prevalence of 211/1000 with hazardous drinking.[ 19 ]

Hospital-based studies

These studies have basically described profiles of substance use among patients and include patterns of alcohol use,[ 49 – 53 ] opioid use,[ 54 – 56 ] pediatric substance use,[ 57 ] female substance use,[ 58 ] children of alcoholics[ 59 ] and geriatric substance use.[ 60 ]

Alcohol misuse has been implicated in 20% of brain injuries[ 61 ] and 60% of all injuries in the emergency room setting.[ 62 ] In a retrospective study of emergency treatment seeking in Sikkim between 2000 and 2005,[ 63 ] substance use emergencies constituted 1.16% of total psychiatric emergencies. Alcohol withdrawal was the commonest cause for reporting to the emergency (57.4%).

Effects of substance use disorders

Mortality and morbidity due to alcohol and tobacco have been extensively reviewed elsewhere[ 35 , 64 – 66 ] and are beyond the scope of this review. The effects of cannabis have also been reviewed.[ 67 ] Mortality with injecting drug use is a serious concern with increase in crude mortality rates to 4.25 among injecting drug users compared to the general population.[ 68 ] Increased susceptibility to HIV/AIDS and other sexually transmitted diseases has been reported with alcohol[ 69 ] as well as injecting drug use.[ 70 ]

Clinical issues

Harmful alcohol use patterns among admitted patients in general hospital has highlighted the importance of routine screening and intervention in health care settings.[ 71 ]

Peer influence is a significant factor for heroin initiation.[ 72 ] Precipitants of relapse (dysfunction, stress and life events) differ among alcohol and opioid dependents.[ 73 ] Chronologies in the development of dependence have been evaluated in alcohol dependence.[ 74 , 75 ]

Craving a common determinant of relapse has been shown to reduce with increase in length of period of abstinence.[ 76 ]

Alcohol dependence constitutes a significant group among the psychiatric population in the Armed Forces.[ 77 ] A study of personality factors[ 78 ] among 100 alcohol dependent persons showed significantly high neuroticism, extroversion, anxiety, depression, psychopathic deviation, stressful life events and significantly low self-esteem as compared with normal control subjects. Alcohol dependence causes impairment in set shifting, visual scanning and response inhibition abilities and relative abstinence has been found to improve this deficit.[ 79 , 80 ] Alcohol use has had a significant association with head injury and cognitive deficits.[ 81 , 82 ] Persistent drinking is associated with persisting memory deficits in head injured alcohol dependent patients.[ 82 ] Mild intellectual impairment has been demonstrated in patients with bhang and ganja dependence.[ 83 – 86 ]

Kumar and Dhawan[ 87 ] found that health related reasons like death/physical complications due to drug use in peers and patients themselves, knowledge of HIV and difficulties in accessing veins were the main reason for reverse transition (shift from parenteral to inhalation route).

Evaluation and assessment

Diagnostic issues have focused on cross-system agreement[ 88 ] between ICD-10 and DSM IV, variability in diagnostic criteria across MAST, RDC, DSM and ICD[ 89 ] and suitability of MAST as a tool for detecting alcoholism.[ 90 ] The CIWA-A was found useful in monitoring alcohol withdrawal syndrome.[ 91 ]

The utility of liver functions for diagnosis of alcoholism and monitoring recovery has been demonstrated in clinical settings.[ 92 – 94 ] A range of hepatic dysfunction has been demonstrated through liver biopsies.[ 95 ]

A few studies have focused on scale development for motivation[ 96 , 97 ] and addiction related dysfunction[ 98 ] (Brief Addiction Rating Scale). An evaluation of two psychomotor tests comparing smokers and non-smokers found no differences across the two groups.[ 99 ]

Typology research has included validation of Babor’s[ 100 ] cluster A and B typologies, age of onset typology,[ 101 ] and a review on typology of alcoholism.[ 102 ]

Craving plays an important role in persistence of substance use and relapse. Frequency of craving has been shown to decrease with increase in length of abstinence among heroin dependent patients. Socio-cultural factors did not influence the subjective experience of craving.[ 76 ]

In a study of heroin dependent patients, their self-report moderately agreed with urinalysis using thin layer chromatography (TLC), gas liquid chromatography (GLC) and high performance liquid chromatography (HPLC).[ 103 ] The authors, however, recommend that all drug dependence treatment centers have facilities for drug testing in order to validate self-report.

Comorbidity/dual diagnosis

Cannabis related psychopathology has been a favorite topic of enquiry in both retrospective[ 104 , 105 ] and prospective studies[ 106 ] and vulnerability to affective psychosis has been highlighted. The controversial status of a specific cannabis withdrawal syndrome and cannabis psychosis has been reviewed.[ 67 ]

High life time prevalence of co-morbidity (60%) has been demonstrated among both opioid and alcohol dependent patients.[ 107 ] In alcohol dependence, high rates of depression and cluster B personality disorders[ 54 , 108 ] and phobia[ 109 ] have been demonstrated, but the need to revaluate for depressive symptoms after detoxification has been highlighted.[ 110 ] It is necessary to evaluate for ADHD, particularly in early onset alcohol dependent patients.[ 111 ] Seizures are overrepresented in subjects with alcohol and merit detailed evaluation.[ 112 ] Delirium and convulsions can also complicate opioid withdrawal states.[ 113 , 114 ] Skin disease,[ 115 ] and sexual dysfunction[ 116 ] have also been the foci of enquiry. Phenomenological similarities between alcoholic hallucinosis and paranoid schizophrenia have been discussed.[ 117 ] Opioid users with psychopathology[ 118 ] have diverse types of psychopathology as do users of other drugs.[ 119 ]

In a study of 22 dual diagnosed schizophrenia patients, substance use disorder preceded the onset of schizophrenic illness in the majority.[ 120 ] While one study found high rates of comorbid substance use (54%) in patients with schizophrenia with comorbid substance users showing more positive symptoms[ 121 ] which remitted more rapidly in the former group,[ 122 ] other studies suggest that substance use comorbidity in schizophrenia is low, and is an important contributor to better outcome in schizophrenia in developing countries like India.[ 123 , 124 ]

The diagnosis and management of dual diagnosis has been reviewed in detail.[ 125 ]

Social factors

Co-dependency has been described in spouses of alcoholics and found to correlate with the Addiction Severity scores of their husbands.[ 126 ] Coping behavior described among wives of alcoholics include avoidance, indulgence and fearful withdrawal.[ 127 ] These authors did not find any differences in personality between wives of alcoholics compared to controls.[ 128 ] Delusional jealousy and fighting behavior of substance abusers/dependents are important determinants of suicidal attempts among their spouses.[ 129 ] Parents of narcotic dependent patients, particularly mothers also show significant distress.[ 130 ]

BIOLOGY OF ADDICTION

An understanding of the cellular and molecular mechanisms of drug dependence has led to a reformulation of the etiology of this complex disorder.[ 131 ] An understanding of specific neurotransmitter systems has led to the development of specific pharmacotherapies for these disorders.

Cellular and molecular mechanisms

Altered alcohol metabolism due to polymorphisms in the alcohol metabolizing enzymes may influence clinical and behavioral toxicity due to alcohol. Erythrocyte aldehyde dehydrogenase was demonstrated to be suitable as a peripheral trait marker for alcohol dependence.[ 132 ] Single nucleotide polymorphism of the ALDH 2 gene has been studied in six Indian populations and provides the baseline for future studies in alcoholism.[ 133 ] An evaluation of ADH 1B and ALDH 2 gene polymorphism in alcohol dependence showed a high frequency of the ALDH2*2/*2 genotype among alcohol-dependent subjects.[ 134 ] DRD2 polymorphisms have been studied in patients with alcohol dependence, but a study in an Indian population failed to show a positive association. Genetic polymorphisms of the opioid receptor µ1 has been associated with alcohol and heroin addiction in a population from Eastern India.[ 135 ]

Neuro-imaging and electrophysiological studies

Certain individuals may develop early and severe problems due to alcohol misuse and be poorly responsive to treatment. Such vulnerability has been related to individual differences in brain functioning [ Figure 3 ]. Individuals with a high family history of alcoholism (specifically of the early-onset type, developing before 25 years of age) display a cluster of disinhibited behavioral traits, usually evident in childhood and persisting into adulthood.[ 136 ]

Brain volume differences between children and adolescents at high risk and low risk for alcohol dependence

Early onset drinking may be influenced by delayed brain maturation. Alcohol-naïve male offspring of alcohol-dependent fathers have smaller (or slowly maturing) brain volumes compared to controls in brain areas responsible for attention, motivation, judgment and learning.[ 137 , 138 ] The lag is hypothesized to work through a critical function of brain maturation-perhaps delayed myelination (insulation of brain pathways).

Functionally, this is thought to create a state of central nervous system hyperexcitability or disinhibition.[ 139 ] Individuals at risk have also been shown to have specific electro-physiological characteristics such as reduced amplitude of the P300 component of the event related potential.[ 140 , 141 ] Auditory P300 abnormalities have also been demonstrated among opiate dependent men and their male siblings.[ 142 ]

Such brain disinhibition is manifest by a spectrum of behavioral abnormalities such as inattention (low boredom thresholds), hyperactivity, impulsivity, oppositional behaviors and conduct problems, which are apparent from childhood and persist into adulthood. These brain processes not only promote impulsive risk-taking behaviors like early experimentation with alcohol and other substances but also appear to increase the reinforcement from alcohol while reducing the subjective appreciation of the level of intoxication, thus making it more likely that these individuals are likely not only to start experimenting with alcohol use at an early age but are more likely to have repeated episodes of bingeing.[ 143 ]

INTERVENTIONS, COURSE AND OUTCOME

Although there are a few review articles on pharmacological treatment of alcoholism,[ 144 , 145 ] there is a dearth of randomized studies on relapse prevention treatment in our setting.

Treatment of complications of substance use has been confined to case reports. A case report of thiamine resistant Wernicke Korsakoff Syndrome[ 146 ] successfully treated with a combination of magnesium sulphate and thiamine. Another case of subclinical psychological deterioration[ 147 ] (alcoholic dementia) improved with thiamine and vitamin B supplementation.

Pharmacological intervention

A randomized double blind study compared the effectiveness of detoxification with either lorazepam or chlordiazepoxide among hundred alcohol dependent inpatients with simple withdrawal. Lorazepam was found to be as effective as the more traditional drug chlordiazepoxide in attenuating alcohol withdrawal symptoms as assessed using the revised Clinical Institute Withdrawal Assessment for Alcohol scale.[ 148 ] This has implications for treatment in peripheral settings where liver function tests may not be available. However, benzodiazepines must be used carefully and monitored as dependence is very common.[ 149 ]

In a study closer to the real-world situation from Mumbai, 100 patients with alcohol dependence with stable families were randomized to receive disulfiram or topiramate. At the end of nine months, though patients on topiramate had less craving, a greater proportion of patients on disulfiram were abstinent (90% vs. 56%). Patients in the disulfiram group also had a longer time to their first drink and relapse.[ 150 ] Similar studies by the same authors and with similar methodology had earlier found that disulfiram was superior to acamprosate and Naltrexone. Though the study lacked blinding, it had an impressively low (8%) dropout rate.[ 151 , 152 ] A chart based review has shown there was no significant difference with regard to abstinence among the patients prescribed acamprosate, naltrexone or no drugs. Although patients on acamprosate had significantly better functioning, lack of randomization and variations in base line selection parameters may have influenced these findings.[ 153 ] Short term use of disulfiram among alcohol dependence patients with smoking was not associated with decrease pulmonary function test (FEV 1 ) and airway reactivity.[ 154 ]

Usefulness of clonidine for opioid detoxification has been described by various authors. These studies date back to 1980 when there was no alternative treatment for opioid dependence and clonidine emerged as the treatment of choice for detoxification in view of its anti adrenergic activity.[ 155 – 157 ] Sublingual buprenorphine for detoxification among these patients was reported as early as 1992. At that time the dose used was much lower, i.e. 0.6 -1.2 mg/ day which is in contrast to the current recommended dose of 6-16 mg/day. Comparison of buprenorphine (0.6-1.2 mg/ day) and clonidine (0.3-0.9 mg/day) for detoxification found no difference among treatment non completers. Maximum drop out occurred on the fifth day when withdrawal symptoms were very high.[ 158 ] A 24- week outcome study of buprenorphine maintenance in opiate users showed high retention rates of 81.5%, reduction in Addiction Severity Index scores and injecting drug use. Use of slow release oral morphine for opioid maintenance has also been reported.[ 159 ] Effectiveness of baclofen in reducing withdrawal symptoms among three patients with solvent dependence is reported.[ 160 ]

Psychosocial

Psychoeducational groups have been found to facilitate recovery in alcohol and drug dependence.[ 161 ] Family intervention therapy in addition to pharmacotherapy was shown to reduce the severity of alcohol intake and improve the motivation to stop alcohol in a case-control design study.[ 162 ] Several community based models of care have been developed with encouraging results.[ 163 ]

Course and outcome

An evaluation after five years, of 800 patients with alcohol dependence treated at a de-addiction center, found that 63% had not utilized treatment services beyond one month emphasizing the need to retain patients in follow-up.[ 164 ]

In a follow-up study on patients with alcohol dependence, higher income and longer duration of in-patient treatment were found to positively correlate with improved outcome at three month follow up. Outcome data was available for 52% patients; 81% of those maintained abstinence.[ 165 ] Maximum attrition was between three to six months. In a similar study among in-patients, 46% were abstinent. The drop out rate was 10% at the end of one year.[ 101 ] Studies done in the community setting have shown the effectiveness of continued care in predicting better outcome in alcohol dependence. In one study the patient group from a low socio-economic status who received weekly follow up or home visit at a clinic located within the slum showed improvement at the end of month 3, 6 and 9, and one year, in comparison with a control group that received no active follow-up intervention.[ 166 ] In a one-year prospective study of outcome following de-addiction treatment, poor outcome was associated with higher psychosocial problems, family history of alcoholism and more follow-up with mental health services.[ 167 ]

COMMUNITY INTERVENTIONS AND POLICIES

The camp approach for treatment of alcohol dependence was popularized by the TTK hospital camp approach at Manjakkudi in Tamil Nadu.[ 168 ] Treatment of alcohol and drug abuse in a camp setting as a model of drug de-addiction in the community through a 10 day camp treatment was found to have good retention rates and favorable outcome at six months.

Community perceptions of substance related problems are useful to understand for policy development. In a 1981 study in urban and rural Punjab of 1031 respondents, 45% felt people could not drink without producing bad effects on their health, 26.2% felt they could have one or two drinks per month without affecting their health. About one third felt it was alright to have one or two drinks on an occasion. 16.9% felt it was normal to drink ‘none at all’. Alcoholics were identified by behavior such as being dead drunk, drinking too much, having arguments and fights and creating public nuisance. Current users gave the most permissive responses and non-users the most restrictive responses regarding the norms for drinking.[ 169 ] The influence of cultural norms[ 170 ] has led the tendency to view drugs as ‘good’ and ‘bad’.

Simulations done in India have demonstrated that implementing a nationwide legal drinking age of 21 years in India, can achieve about 50-60 % of the alcohol consumption reducing effects compared to prohibition.[ 171 ] However, recently there are attempts to increase the permissible legal alcohol limit. This kind of contrarian approach does not make for coherent policy.

It has been argued that the 1970s saw an overzealous implementation of a simplistic model of supply and demand.[ 171 ] A presidential address[ 172 ] in 1991 emphasized the need for a multipronged approach to addressing alcohol-related problems. Existing programs have been identified as being patchy, poorly co-ordinated and poorly funded. Primary, secondary and tertiary approaches were discussed. The address highlighted the need for supply and demand side measures to address this significant public health problem. It highlighted the political and financial power of the alcohol industry and the social ambivalence to drinking. More recently, the need to have interventions for harmful and hazardous use, the need to develop evidence based combinations of pharmacotherapy and psychosocial interventions and stepped care solutions have been highlighted.[ 173 ] Standard treatment guidelines for alcohol and other drug use disorders have suggested specific measures at the primary, secondary and tertiary health care level, including at the solo physician level.[ 174 ] An earlier report in 1988 on training general practitioners on management of alcohol related problems[ 175 ] suggests that their involvement in alcohol and health education was modest, involvement in control and regulatory activities minimal, and they perceived no role in the development of a health and alcohol policy.

There have been reviews of the National Master Plan 1994, which envisaged different responsibilities for the Ministries of Health and the Ministry of Welfare (presently Social Justice and Empowerment) and the Drug Dependence Program 1996.[ 176 , 177 ] A proposal for adoption of a specialty section on addiction medicine[ 178 ] includes the development of a dedicated webpage, co-ordinated CMEs, commissioning of position papers, promoting demand reduction strategies and developing a national registry.

SUMMARY AND CONCLUSIONS

While epidemiological research has now provided us with figures for national-level prevalence, it would be prudent to recognize that there are regional differences in substance use prevalence and patterns. It is also prudent to recognize the dynamic nature of substance use. There is thus a need for periodic national surveys to determine changing prevalence and incidence of substance use. Substance use is associated with significant mortality and morbidity. Substance use among women and children is increasingly becoming the focus of attention and merits further research. Pharmaceutical drug abuse and inhalant use are serious concerns. For illicit drug use, rapid assessment surveys have provided insights into patterns and required responses. Drug related emergencies have not been adequately studied in the Indian context.

Biological research has focused on two broad areas, neurobiology of vulnerability and a few studies on molecular genetics. There is a great need for translation research based on the wider body of basic and animal research in the area.

Clinical research has primarily focused on alcohol. An area which has received relatively more attention in substance related comorbidity. There is very little research on development and adaptation of standardized tools for assessment and monitoring, and a few family studies. Ironically, though several evidence based treatments have now become available in the country, there are very few studies examining the utilization and effectiveness of these treatments, given that most treatment is presently unsubsidized and dependent on out of pocket expenditure. Both pharmacological and psychosocial interventions have disappointingly attracted little research. Course and outcome studies emphasize the need for better follow-up in this group.

While a considerable number of publications have lamented the lack of a coherent policy, the need for human resource enhancement and professional training and recommended a stepped-care multipronged approach, much remains to be done on the ground.

Finally, publication interest in the Indian Journal of Psychiatry in the area of substance use will undoubtedly increase, with the journal having become indexed.

Source of Support: Nil

Conflict of Interest: None declared

More From Forbes

Do you know how to treat alcohol addiction chances are you don’t.

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Oscar-winning actor, Robert Downey, Jr., has openly shared his journey with addiction to alcohol, ... [+] cocaine and other substances, as well as his long-term recovery. Most people who are connected to proper treatment get better.

Did you know that you could buy the deadliest drug in America from your local grocery store any day of the week?

April is Alcohol Awareness Month, and according to the National Institute on Drug Abuse, alcohol addiction is the most common substance use disorder (SUD) in the United States and the second-most prevalent SUD globally (tobacco is first). From celebrities such as Billie Holiday and Amy Winehouse to people at your workplace, alcohol accounts for over 178,000 deaths each year in the U.S. More Americans die in one year from alcohol than total U.S. casualties from World War I and the Vietnam War combined. Careers, marriages and friendships have been destroyed by this simple but powerful liquid chemical.

Despite the heavy toll on individuals and society, alcohol use disorder (AUD) remains poorly understood, and people with AUD rarely receive evidence-based treatment and care. Less than 10% of people with AUD received treatment in the past year. Stigma and lack of education remain major barriers to people getting the therapeutic attention they need and deserve.

As an addiction medicine physician, I’ve cared for scores of patients experiencing SUDs including addictions to alcohol, opioids, tobacco and stimulants (cocaine, amphetamines), as well as behavioral addictions like gambling and eating. As with most chronic conditions such as heart failure and kidney disease, most people with addiction—including alcohol—get better once connected to treatment and care.

“One of the reasons that people still struggle is that alcohol is legal and socially acceptable so it can be hard to avoid at social gatherings, sporting events, office parties and fancy dinners,” explains Michael Weaver, MD, DFASAM, professor in the Department of Psychiatry , University of Texas Health Science Center.

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Bitcoin halving triggers unprecedented crypto chaos as price suddenly surges, gervonta davis next fight tank has an opponent for his return, it's a disease, not a moral failing.

Alcohol activates the brain's reward system, releasing pleasure chemicals like dopamine and ... [+] endorphins. But chronic alcohol use can kill neurons, shrink brain mass and impair memory and judgement.

The prevailing myth in society is that “problem drinkers” have a moral weakness. ‘ They’re not tough enough ’ or ‘ they don’t want to get better’ are commonly held misperceptions among family members, cops and doctors—myself included, until I learned about alcohol’s effects on the brain . In low to moderate amounts, wine or beer for instance can help people feel happier, relaxed and social. This is because alcohol activates the brain’s reward system by increasing the release of the “pleasure” neurotransmitter, dopamine.

Over time, however, dopamine’s effect declines, causing a person to drink more in order to achieve the same initial level of euphoria. Chronic alcohol consumption can lead to multiple changes in the brain including cognitive impairment (e.g. poor memory and judgement), dysregulated emotions and behavioral changes. Alcohol is also associated with brain atrophy and neuronal loss. In other words, too much whiskey or rum can kill brain cells and shrink gray and white matter.

Women And Alcohol

Alcohol use, addiction and alcohol-related death are rising among women. For the first time, women ... [+] are binge drinking more than women.

In a case of unwanted gender equity, over the past several decades, women have been closing the gender gap in alcohol consumption. Alcohol use and misuse are rising among women . While men are still 2.88 times more likely to die from alcohol-related causes than women, studies reveal an increase in alcohol consumption, alcohol use disorder and alcohol-related deaths among women. In addition, for the first time in history, women are binge drinking more than men. Alcohol-induced complications such as liver disease and gastric bleeding rose 33 to 56% among women aged 40 to 64 during Covid-19 compared to pre-pandemic life.

So, why are more women drinking? The reasons aren’t exactly clear, but experts believe that women are using alcohol to cope with increased stress. The pandemic disproportionately impacted women who were forced to quit their jobs, care for children and elderly relatives, and experienced an increase in domestic violence.

“Isolation and depression from the Covid-19 pandemic resulted in increases in alcohol consumption and alcohol-related harms requiring medical treatment,” reflects Dr. Weaver.

Beverage companies are also specifically targeting women. Branding strategies include making alcohol pink; advertising “low-calorie,” “organic” and “clean” options; and using messages of empowerment like “Believe in Yourself” in ads or earning your “mommy juice” after a hard day’s work. Holly Whitaker, author of the bestseller Quit Like a Woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol , debunks the notion of healthy alcohol and calls out these ads as predatory.

First-Line Treatment Is Medications

Medications such as naltrexone can reduce cravings and reduce alcohol consumption. But they are ... [+] underutilized. Talk to your doctor if you or someone you know is struggling with alcohol.

Most people falsely believe that alcohol addiction is treated through detox or Alcoholics Anonymous (AA). While detoxification using medications like benzodiazepines and phenobarbital reduces the risk of potentially fatal seizures (i.e. delirium tremens), it is considered acute management, not chronic treatment for what is clearly a chronic condition. While mutual support groups like AA can provide a valuable layer of support as adjunct therapy, first-line treatment for AUD remains three FDA-approved medications: naltrexone, disulfiram and acamprosate; as well as behavioral therapies led by health professionals. Several other medicines are currently off-label but can be very effective.

But too few individuals are receiving science-driven treatment. Among the nearly 30 million Americans with an AUD, only 8% received treatment and among them, only 2% got medications.

“AUD is treatable with both medications and behavioral therapy, and they’re generally covered by health insurance,” describes addiction medicine expert, Dr. Weaver. “The biggest barrier to treatment is that someone may not recognize that they have AUD so may not seek treatment until they are in a difficult situation with family or face work or legal troubles.”

We also need to reframe “failure” and “success.” Return to drinking (a.k.a. “relapse”) is not considered failure. In fact, return to use rates in addiction are similar to relapse rates in other chronic conditions. A shift in the addiction community helped us recognize that successful recovery does not necessarily mean abstinence. There is no ‘one-size-fits-all’ model for treatment. SAMHSA’s four dimensions of their updated definition of recovery include health, home, purpose and community. Many of my patients view recovery as having a sense of purpose: returning to school, caring for their kids, going to work or spending time with supportive friends and family. Recovery is 100% possible. Just look at the long list of sober celebrities including Samuel L. Jackson, Bradley Cooper, Drew Barrymore, Brad Pitt, Sir Anthony Hopkins and many more who are leading healthy, productive lives.

Harm Reduction Strategies

Harm reduction strategies can help keep people who drink and those around them safe. Safe ... [+] transportation, hydration and measuring drinks are a few methods to reduce alcohol-related harms.

‘Just say no’ is an ineffective approach for people who use addictive substances. What if, instead, we applied methods that kept people safe and alive? That’s the premise of harm reduction which is a set of practical strategies and ideas aimed at reducing negative consequences associated with substance use. It’s a spectrum of methods that include safer use, managed use and abstinence. The goal is to meet people where they’re at—not where you want them to be. Examples of harm reduction include clean syringes, naloxone, fentanyl test strips, condoms, overdose prevention sites, job services and clothes.

Similar strategies can and should be applied to reduce harm among people with AUD. Examples include setting goals or limits such as eating and hydrating before consuming alcohol on days you plan on drinking; setting timers to evenly distribute consumption; socializing with non-drinking friends; and increasing stress-relieving activities such as exercise, meditation and music. Medications, as listed previously, can reduce cravings for alcohol. Vitamin supplements (e.g. thiamine, vitamins B12 and folate) can be helpful for those at high risk for developing alcohol-induced vitamin deficiencies.

“Treatment for AUD works and can improve quality of life,” reinforces Dr. Weaver. “Help is available. Talk to a school counselor or nurse, primary care physician or minister/priest/rabbi to get connected to treatment resources for AUD.”

If you or someone you know is struggling with alcohol, please get help from a health professional. Think of it this way: if you had lupus, Strep throat or lung cancer, you would see a doctor, right? AUD needs to be viewed the same way. Remember the good news: most people with addiction—once connected to the appropriate treatment and recovery services—GET BETTER!

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