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RESÚMENES JUNIO 2004 |
Addictive Disorders
A Double-Blind, Placebo-Controlled Study of
Olanzapine in the Treatment of Alcohol-Dependence Disorder.
Guardia J, Segura L, Gonzalvo B, Iglesias L, Roncero C, Cardus M, Casas
M.
Alcohol Clin Exp Res. 2004 May;28(5):736-745.
BACKGROUND:: A 12-week, double-blind, randomized, parallel-group
clinical trial, comparing olanzapine and placebo treatment together with
cognitive-behavioral psychotherapy, was carried out to determine the efficacy,
safety, and tolerability of olanzapine in the treatment of alcoholism. METHODS:: A total of 60 alcohol-dependent patients were assigned to
12 weeks' treatment with either olanzapine or placebo. The primary variable
relapse to heavy drinking rate was evaluated by means of intention-to-treat
analyses. Alcohol consumption, craving, adverse events, and changes in the
biochemical markers of heavy drinking and possible toxicity were also
evaluated. RESULTS:: We did not find significant
differences in the survival analysis between placebo and olanzapine-treated
patients (Kaplan-Meier log rank = 0.46, df = 1, p = 0.50).
Eleven (37.9%) patients treated with olanzapine relapsed compared with 9 (29%)
of those receiving placebo (chi = 0.53, df
= 1, p = 0.5). Although some adverse events (weight gain, increased appetite,
drowsiness, constipation, and dry mouth) were found more frequently in the
olanzapine group, differences did not reach statistical significance in
comparison with the placebo group. CONCLUSIONS::
Olanzapine was well tolerated, as the rate of adverse events was low, and it
was safe, because it did not interfere with the normalization of biochemical
markers of heavy drinking or alter liver function markers. Alcohol-dependent
patients showed good adherence and compliance with the treatment protocol, but
we found no differences in relapse rate or other drinking variables when
comparing olanzapine with placebo-treated patients.
Olanzapine attenuates cue-elicited craving for
tobacco.
Hutchison KE, Rutter MC, Niaura R, Swift RM, Pickworth WB, Sobik L.
Psychopharmacology (Berl). 2004 Mar 20 [Epub ahead of print]
RATIONALE. Recent biological conceptualizations of craving and addiction have
implicated mesolimbic dopamine activity as a central
feature of the process of addiction. Imaging, and
pharmacological studies have supported a role for dopaminergic
structures in cue-elicited craving for tobacco.OBJECTIVE.
If mesolimbic dopamine activity is associated with
cue-elicited craving for tobacco, a dopamine antagonist should attenuate
cue-elicited craving for tobacco. Thus, the aim of the present study was to
determine whether an atypical antipsychotic (olanzapine, 5 mg) decreased
cue-elicited craving for tobacco.METHOD. Participants
were randomly assigned to 5 days of pretreatment with olanzapine (5 mg; n=31)
or were randomly assigned to 5 days of a matching placebo ( n=28).
Approximately 8 h after the last dose, participants were exposed to a control
cue (pencil) followed by exposure to smoking cues. Participants subsequently
smoked either nicotine cigarettes or de-nicotinized cigarettes.RESULTS. Olanzapine attenuated cue-elicited
craving for tobacco but did not moderate the subjective effects of smoking.DISCUSSION. This study represents one of the first
investigations of the effect of atypical antipsychotics on cue-elicited craving
for tobacco. The results suggest that medications with similar profiles may
reduce cue-elicited craving, which in turn, may partially explain recent
observations that atypical antipsychotics may reduce substance use.
Ana Navas-Acien, Armando Peruga, Patrick Breysse, Alfonso Zavaleta, Adriana Blanco-Marquizo,
Raul Pitarque, Marisol Acuña,
Katya Jiménez-Reyes, Vera
L. Colombo, Graciela Gamarra, Frances A. Stillman, Jonathan Samet
JAMA. 2004;291:2741-2745.
Context The success
of measures to restrict smoking in indoor environments and the
intensity of enforcement vary among countries around the world. In
2001, the Pan American Health Organization (PAHO) launched the
Smoke-Free Americas Initiative to build capacity to achieve smoke-free
environments in Latin America and the
Objective To assess secondhand smoke
concentrations in public places in the capital cities of Argentina,
Brazil, Chile, Costa Rica, Paraguay, Peru, and Uruguay in
conjunction with the Smoke-Free Americas Initiative.
Design and Setting Multicountry assessment of vapor-phase nicotine
concentrations using a common protocol in all 7 Latin American
countries. A total of 633 sampling devices were placed for 7 to 14
days in 1 hospital, 2 secondary schools, 1 city government building,
1 airport (2 in Argentina), and restaurants and bars in each
country.
Main Outcome Measure
Concentrations of airborne nicotine.
Results Airborne
nicotine was detected in most (94%) of the locations surveyed. By
country,
Conclusions The
finding of airborne nicotine in critical locations in
Jörg Daumann,
Thomas Fischermann, Ulrich Pilatus, Armin Thron, Walter Moeller-Hartmann and Euphrosyne
Gouzoulis-Mayfrank
Neuroscience Letters .Volume 362, Issue 2 , 20 May 2004, Pages
113-116
The
popular recreational drug 3,4-methylenedioxymethamphetamine
(MDMA, ecstasy) has well-recognized neurotoxic
effects upon central serotonergic systems in animal
studies. In humans, the use of MDMA has been linked to cognitive problems, particularly
to deficits in long-term memory and learning. Recent studies with proton
magnetic resonance spectroscopy (1H MRS) have reported relatively
low levels of the neuronal marker N-acetylaspartate
(NAA) in MDMA users, however, these results have been ambiguous. Moreover, the
only available 1H MRS study of the hippocampus reported normal
findings in a small sample of five MDMA users. In the present study, we
compared 13 polyvalent ecstasy users with 13 matched controls. We found no
differences between the NAA/creatine/phosphocreatine
(Cr) ratios of users and controls in neocortical regions, and only a tendency
towards lower NAA/Cr ratios in the left hippocampus of MDMA users. Thus,
compared with cognitive deficits, 1H MRS appears to be a less
sensitive marker of potential neurotoxic damage in
ecstasy users.
Network
therapy: Decreased secondary opioid use during buprenorphine maintenance
Marc Galanter , Helen Dermatis , Linda Glickman , Robert Maslansky , M. Brealyn Sellers , Erna Neumann and Claudia Rahman-Dujarric
J Subst Abuse Treat. Volume 26, Issue 4, Pages
313-318 (June 2004)
Network
therapy (NT) employs family members and/or friends to support compliance with
an addiction treatment carried out in office practice. This study was designed
to ascertain whether NT is a useful psychosocial adjunct, relative to a control
treatment, for achieving diminished illicit heroin use for patients on buprenorphine maintenance. Patients agreeing to
randomization to either NT (N = 33) or medication management
(MM, N
= 33) were inducted onto short-term buprenorphine maintenance
and then tapered to zero dose. NT resulted in significantly more urine toxicologies negative for opioids
than MM (65% vs. 45%) and more NT than MM patients (50% vs. 23%) experienced a
positive outcome relative to secondary heroin use by the end of treatment. The
use of NT in office practice may therefore improve the effectiveness of
eliminating secondary heroin use during buprenorphine
maintenance. It may also be useful in enhancing compliance with an addiction
treatment regimen in other contexts.
The
role of personality disorders on drug dependence treatment outcomes following
inpatient detoxification
G. Haro, C. Mateu, J. Martínez-Raga, J. C. Valderrama,
M. Castellano and G. Cervera
European Psychiatry .Volume 19, Issue 4 , June 2004, Pages
187-192
Aims. – The present 6 month
follow-up study was conducted to investigate the possible influence of comorbid personality disorders on drug treatment, as well
as associated psychopathology and HIV-related risk behaviors outcomes.
Subjects and methods. – Data were collected initially
from a consecutive sample of 74 patients with a diagnosis of opiate abuse
or dependence, admitted for inpatient detoxification.
Result. – During intake, 80.9% of patients reported at least one
HIV-related risk behavior in the previous 6 months. Not using condoms
during sexual intercourse was the most common and the only risk behavior that
showed a statistically significant reduction over the follow-up period. A total
of 58.1% of subjects had at least one personality disorder (PD). Borderline PD
was the most prevalent. However, antisocial PD was the only PD that influenced
substance use outcomes. The presence of this diagnosis increased the chance of
worse opiate use outcomes, but decreased likelihood of not using condoms.
Patients with low obsessive–compulsive PD dimensional scores showed a significant
increase in the number of risk behaviors. However, these influences were only
seen at the 3-month follow-up assessment.
Conclusions. – These results suggest that
personality disorders need to be considered when planning effective
interventions for opiate dependent individuals and when preparing and
evaluating HIV risk-reduction interventions, particularly for the more severe
substance dependent patients.
Relationship
of onset of cigarette smoking during college to alcohol use, dieting concerns, and
depressed mood: Results from the Young Women's Health Survey
Karen K.
Saules, Cynthia S. Pomerleau,
Sandy M. Snedecor, Ann M. Mehringer,
Minden B. Shadle, Candace Kurth
and Dean D. Krahn
Addictive Behaviors .Volume 29, Issue 5 , July 2004, Pages
893-899
To
investigate the issue of smoking initiation during college, we administered a
survey of women's health behavior to college women during freshman orientation,
at the end of their freshman year and again during their senior year. Never
smokers (NS; n=374), early-onset smokers (EOS; n=52), and late-onset smokers
(LOS; n=64) were compared on dieting concerns, mood problems, alcohol-related
problems, and frequency of binge drinking episodes. By the senior year of
college, 55% (64/116) of those who had smoked in the past month had started
smoking during college, although they were more likely than never smokers to
have experimented with cigarettes prior to college. Escalating depression
during the first year of college, dieting concerns, and alcohol-related
problems were significant risk factors for smoking initiation during college,
while binge drinking appeared to covary with
cigarette smoking. Results suggest that prevention efforts should target
nonsmokers with high dieting concerns and escalating depression early in
college, while intervention efforts may need to target not only smoking but
also problematic alcohol use among smoking college women.
Suzanne
M. Colby, Damaris J. Rohsenow,
Peter M. Monti, Chad J. Gwaltney,
Suzy B. Gulliver, David B. Abrams, Raymond S. Niaura
and Alan D. Sirota
Addictive Behaviors .Volume 29, Issue 5 , July 2004, Pages
879-892
Nicotine
and alcohol may have common neurobiological mechanisms of reinforcement.
Therefore, withholding one substance might result in compensatory increases in
self-administration of the other. This laboratory study investigated the
effects of brief tobacco deprivation on alcohol cue-elicited urges to drink,
corresponding psychophysiological reactions, and
alcohol consumption. Young adults (N=78) who were moderate to heavy smokers and
drinkers were stratified and randomized to a 2×2 design. Participants were
either deprived of tobacco for 5 h or not deprived and then exposed to in vivo
alcohol or control beverage cues. Subsequently, participants engaged in a
taste-rating task as an unobtrusive measure of alcohol consumption. Tobacco
deprivation resulted in increased urge to smoke and decreased cardiovascular
responses but did not increase alcohol urges or alcohol consumption. Results
indicate that brief tobacco deprivation does not result in compensatory
increases in alcohol consumption among young moderate to heavy drinkers.
Leptin,
hunger, and body weight: Influence of gender, tobacco smoking, and smoking
abstinence
Laura Cousino Klein, Elizabeth J. Corwin and Rachel M. Ceballos
Addictive Behaviors .Volume 29, Issue 5 , July 2004, Pages
921-927
Leptin is a hormone involved in body
weight and hunger regulation, and may contribute to the inverse relationship
between cigarette smoking and body weight. Leptin
levels, body mass indices (BMIs), and hunger ratings
were determined in 22 nonsmokers (12 male, 10 female) and 19 cigarette smokers
(11 male, 8 female). Smokers were tested after ad lib smoking and following a
24-h smoking abstinence period; nonsmokers came to the laboratory once. Leptin levels were not different among the groups. Hunger
ratings, however, were higher after smoking abstinence compared to after ad lib
smoking and nonsmokers (Ps<.05); levels of hunger did not differ between ad
lib smokers and nonsmokers. Men reported higher hunger levels than did women,
but women had higher serum leptin levels than did
men, regardless of smoking condition (P<.05). Leptin
levels were correlated with BMI (P<.05) among smokers only. This first study
on leptin responses in female smokers suggests that leptin levels do not change following a 24-h smoking
abstinence period and that leptin may not contribute
to increased hunger following smoking abstinence.
Henri Chabrol, Eve Massot and Etienne
Mullet
Addictive Behaviors .Volume 29, Issue 5 , July 2004, Pages
929-933
This
study evaluated 285 high school students (163 males, 122 females, with a mean
age of 17.5±1.1 years) using a questionnaire for the diagnosis of cannabis use
and dependence: 159 of them (55.7%) were cannabis users and, among users, 52
subjects (33%) met criteria for cannabis dependence. All subjects were assessed
with a self-report questionnaire derived from the questionnaire of
anticipatory, relief-oriented, and permissive beliefs for drug addiction
elaborated by Tison and Hautekeete
[J. Ther. Comport. Cogn. 2
(1998) 43] from the cognitive model of drug addiction formulated by Beck et al.
[Cognitive Therapy of Substance Abuse.
Gambling
participation and pathology in the
John W. Welte, Grace M. Barnes, William F. Wieczorek
and Marie-Cecile Tidwell
Addictive Behaviors .Volume 29, Issue 5 , July 2004, Pages
983-989
This
article describes an analysis of gambling
and gambling pathology from a
telephone survey of 2631
Richard Doll, Richard Peto, Jillian Boreham, Isabelle Sutherland
BMJ 2004;328:1519 (26 June)
Objective To compare the hazards of cigarette smoking in men who
formed their habits at different periods, and the extent of the
reduction in risk when cigarette smoking is stopped at different
ages.
Design
Prospective study that has continued from 1951 to 2001.
Setting
Participants
34 439 male British doctors. Information about their smoking habits was obtained
in 1951, and periodically thereafter; cause specific mortality was
monitored for 50 years.
Main
outcome measures Overall mortality by smoking habit, considering separately
men born in different periods.
Results The excess mortality associated with smoking chiefly involved
vascular, neoplastic, and respiratory diseases that
can be caused by smoking. Men born in 1900-1930 who smoked only cigarettes
and continued smoking died on average about 10 years younger than
lifelong non-smokers. Cessation at age 60, 50, 40, or 30 years
gained, respectively, about 3, 6, 9, or 10 years of life expectancy.
The excess mortality associated with cigarette smoking was less for
men born in the 19th century and was greatest for men born in the
1920s. The cigarette smoker versus non-smoker probabilities of dying
in middle age (35-69) were 42% 
24%
(a twofold death rate ratio) for those born in 1900-1909, but were
43% 15%
(a threefold death rate ratio) for those born in the 1920s. At older
ages, the cigarette smoker versus non-smoker probabilities of
surviving from age 70 to 90 were 10% 12%
at the death rates of the 1950s (that is, among men born around
the 1870s) but were 7% 33%
(again a threefold death rate ratio) at the death rates of the 1990s
(that is, among men born around the 1910s).
Conclusion
A substantial progressive decrease in the mortality rates among
non-smokers over the past half century (due to prevention and
improved treatment of disease) has been wholly outweighed, among
cigarette smokers, by a progressive increase in the smoker non-smoker
death rate ratio due to earlier and more intensive use of
cigarettes. Among the men born around 1920, prolonged cigarette
smoking from early adult life tripled age specific mortality rates,
but cessation at age 50 halved the hazard, and cessation at age 30
avoided almost all of it.
Buprenorphine versus methadone for opioid dependence:
predictor variables for treatment outcome
G. Gerra, F. Borella, A. Zaimovic, G. Moi, M. Bussandri, C Bubici and S. Bertacca
Drug and Alcohol Dependence .Volume 75, Issue 1 , 15 July 2004, Pages
37-45
The
present study compared in a clinical non-experimental setting the efficacy of buprenorphine (BUP) and methadone (METH) in the treatment
of opioid dependence: all the subjects included in
the study showed severe long-lasting heroin addiction. Participants (154) were
applicants to a 12 weeks treatment program, who were assigned to either METH
(78) (mean doses 81.5±36.4 mg) or BUP (76) (mean doses 9.2±3.4 mg) treatment.
Aim of the study was to evaluate patient/treatment variables possibly
influencing retention rate, abstinence from illicit drugs and mood changes.
METH patients showed a higher retention rate at week 4 (78.2 versus 65.8)
(P<0.05), but BUP and METH were equally effective in sustaining retention in
treatment and compliance with medication at week 12 (61.5 versus 59.2).
Retention rate was influenced by dose, psychosocial functioning and not by
psychiatric comorbidity in METH patients. In
contrast, BUP maintained patients who completed the observational period showed
a significantly higher rate of depression than those who dropped out
(P<0.01) and the intention to treat sample (P<0.05). No relationship
between retention and dose, or retention and psychosocial functioning was
evidenced for BUP patients. The risk of positive urine testing was similar
between METH and BUP, as expression of illicit drug use in general. At week 12,
the patients treated with METH showed more risk of illicit opioid
use than those treated with BUP (32.1% versus 25.6%) (P<0.05).
Negative urines were associated with higher doses in both METH and BUP
patients. As evidenced for retention, substance abuse history and psychosocial
functioning appear unable to influence urinalyses results in BUP patients. Buprenorphine maintained patients who showed negative
urines presented a significantly higher rate of depression than those with
positive urines (P<0.05). Alternatively, psychiatric comorbidity
was found unrelated to urinalyses results in METH patients. Our data need to be
interpreted with caution because of the observational clinical methodology and
non-random procedure. The present findings provide further support for the
utility of BUP in the treatment of opioid dependency
and demonstrate efficacy equivalent to that of METH during a clinical
procedure. BUP seems to be more effective than METH in patients affected by
depressive traits and dysphoria, probably due to
antagonist action on 
-opioid receptors. Psychosocial functioning and addiction
severity cannot be used as valuable predictors of BUP treatment outcome. High
doses appear to predict a better outcome, in term of negative urines, for both
METH and BUP, but not in term of retention for BUP patients.
A randomised,
controlled trial of low dose naltrexone for the
treatment of opioid dependence
Felicity
Rea James R. Bell, Malcolm R. Young and Richard P. Mattick
Drug and Alcohol Dependence .Volume 75, Issue 1 , 15 July 2004, Pages
79-88
Aim: To
investigate the efficacy of low doses of naltrexone
in relapse prevention for heroin dependence. Design: Double blind, randomised comparison of three groups—Group 1 taking
50 mg per day, Group 2: 0.5 mg per day, and Group 3: 0.05 mg per
day. Participants: Sixty-six dependent heroin users. Interventions: After
detoxification followed by 1 week on 50 mg per day naltrexone,
participants were randomised to trial medication. All
were offered counselling and monitored with weekly
clinical reviews. Research interviews were conducted at three and 6 months.
Outcome measures: Retention in treatment and heroin use at 3 and 6 months.
Secondary outcome measures were side effects and craving. Findings: Mean days
retained in randomised treatment were—Group 1: 58.9
days; Group 2: 46.6 days; and Group 3: 47.8 days. Differences in retention were
not significant using survival analysis. However, nine of the first 60
participants, transferred to the 50 mg dose, and one transferred to a
lower dose (chi-square=0.142; P=0.018). At follow-up, there was no relationship
between abstinence from heroin and naltrexone dose, nor between level of heroin use and dose. There were no
differences between groups in craving or depression. Conclusion: Low doses of naltrexone had no discernible advantage, and participants
preferred 50 mg per day. Despite preference for blocking doses of naltrexone, outcomes appeared to be independent of naltrexone dose.