To define the nature and severity of substance abuse in patients attending detox cure and the importance of pain during the weaning.

This is a cross-sectional study done in March 2010 over 30 patients hospitalized in the “center of help and listening to Tina-Sfax”.

Through a questionnaire, we collected the biographical data, the drugs used and ways of administration, the association of toxic and the characteristics of pain: type, location, extension.

We spent the TDEA: test of alcohol dependency, the DAST: screening for drug abuse and the scale of overall pain intensity.

The mean age of patients was 24.5 years, 86.7% of our sample were men. 47% of our patients consulted by their own and 47% at the request of one third. 76.7% of patients consuming the Subutex. Poly drug was present in 50%. The intravenous way was present in 76.7% cases.

46.7% of our patients had twice-daily dosing, 33.6% consumed a daily basis and 100% were addicted.

The pain was constant among 63.3% of patients, it was in kind of burning and tearing in 60% of patients. She was paroxysmal and in type of electrical discharge in 63.3% of cases.

The cure of detox can cause various types of pain, which can lead to relapse or failure of the process of weaning.

Psychiatric comorbidities are very prevalence among heroin dependents yet many MMT sites do not have specific mental health services tailored to this dual diagnosis group. The prevalence rates are ranging from 30–90% depending on settings and tools use to measure the psychiatric morbidity. Both substance use disorder and psychiatric disorder need simultaneos treatment in dual diagnosis population. Failure to address any of the condition may affect and complicate each other condition.

To investigate the prevalence of psychiatric morbidity and their psychosocial correlates among heroin dependents seeking MMT treatment in UMMC.

To determine whether we need to suggest dual diagnosis services in MMT sites.

A cross sectional, face to face interview was conducted in UMMC from October to December 2008. We interview those stable MMT clients( > one month treatment) who are above 18 years old and consented and fulfilled diagnostic citeria for heroin dependence syndrome in according to DSM IV. MINI Neuropsychiatric Interview (MINI) was used to measure psychiatric morbidity among 100 MMT clients using convenience sampling. The data was analysed using SPSS 16.

Nearly half of the 100 clients (57 %) have at least one psychiatric illness. The most common psychiatric morbidity are the Anti Social Personality, Major Depressive Disorder, Suicidality and Psychotic Disorder Lifetime.

The prevalence of psychiatric morbidity is high as compared to general population.

Our finding is comparable with other studies which show similar result. There is a need for specific intervention for this dual diagnosis group for more effective treatment.

The purpose of our study is to survey the habits of teenagers concerning the use of internet and furthermore to investigate the frequency of internet addiction and its predisposing factors.

We investigated the habits of high school students (n = 154) in the county of Mureş using questionnaires (Internet Addiction Test).

Young people spend daily an average of 3 hours and 38 minutes in front of a computer. 45% of the boys spend daily more than two hours with computer games while 74, 53% of the girls chat daily. 3, 41% of the adolescents think that they spend a lot of time on the net and their learning and school problems are a result of this. 9,3% of the teenage boys spend daily more than 4 hours 20 minutes in front of a computer (weekly 30 hours), what is qualified as dependence according to the American specialists. There is a strong correlation between internet addiction and parents divorce.

The rate of young people addicted to internet gains considerable importance. Moreover this addiction is associated with other addictions so there would be a serious need for health education programs already in high schools.

For better understanding of the effective factors in tendency to addiction, the research aimed to survey this question what is the first cause of addiction? Psychological, Environmental or Physical causes.

80 addicted people were randomly selected and Abuse Drug Assessment Inventory (ADAI) was administered on them. Chi Square formula was used to analyze the results.

Findings showed 55 percent of tendency to addiction was psychological. Also more analyzing showed 65 percent of continuing causes of addiction were psychological factors such as fear, anxiety, sorrow.

In regard to results we should put more emphasis on psychological prevention and treatment methods so that both tendency to addiction and continuing causes of addiction decrease and control.

In substance – related disorders comorbidity refers to any preexisting or following psychological or psychiatric condition that influence the course and prognosis of a patient.

To determine the extent of comorbid substance use and psychiatric disorders among hospitalized in a General Hospital Psychiatric Unit patients and reveal the implications of treatment in such a unit.

All patients hospitalized during a year, were included in the study. Demographics, final diagnosis, substance of use and means of admission (voluntary or involuntary) were recorded.

7.4% of the total of 339 inpatients met the diagnostic criteria of comorbid substance use disorders. Eleven of them were diagnosed with alcohol use disorder comorbidity, 7 with illicit drug use comorbidity and 7 with both legal and illicit drug use comorbidity. Among inpatients with comorbid use disorders male patients had a significantly higher percentage versus females (x2 p < 0.05). Mean age of inpatients with comorbidity was significantly less than the mean age of the sample (t-test p < 0.05). Duration of hospitalization for inpatients with comorbidity was 15.16 ± 12.4 days versus 21.2 ± 18.4 days for the rest of patients (t-test p < 0.05). Concerning the way of admission, 72% of inpatients with comorbid use disorders were involuntary admitted (x2 p < 0.05).

Concerning age, sex and means of admission patients with a psychiatric disorder and substance use disorder comorbidity seem to vary from the rest of inpatients. These parameters are probably associated with serious difficulties in therapeutic compliance and with increased hazard.

For better understanding of the effective factors in tendency to addiction the research aimed to test this question that are there specific personality characters that lead to addiction?

153 addicted people and 153 nonaddicted people were randomly selected and Mochioly’s Characterlogy Inventory (MCI) was administered on them. The inventory assess personality based on eight characters: sanguine, indifferent, nervous, indolent, indignant, passionate, sentimentee, amorphous.

Findings showed addicted people are much more indifferent, sanguine and passionate than nonaddicted people.

In regard to people with these characters are much more at risk, they should be trained with special plans and be cared so that tendency to addiction in them decrease or control.

Co-morbidity between Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD) is considered to be about 25–50% in adults. Several studies show vulnerability factors to later SUD to be associated with childhood ADHD features, such as conduct problems, untreated ADHD and maltreatment.

To define childhood ADHD associated factors that predispose to SUD.

Specifically, comorbidity with oppositional defiant disorder (ODD) and conduct disorder (CD), temperamental traits, academic failure, familial SUD history, childhood maltreatment and subtype, severity and age of treatment of ADHD symptoms.

A comparative study was carried out in a sample of ADHD adults from the Department of Psychiatry H.U. Vall d’Hebron. Both groups, ADHD and ADHD+SUD subjects underwent the following assessment protocol: Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-I & II), Wender Utath Rating Scale (WURS), SCID-I, SCID-II and K-SDAS.

The total sample (n = 305) consisted of 201 men (66%) with age between 18–61 years. Two groups were compared: 162 ADHD subjects and 143 ADHD+SUD subjects. The ADHD+SUD group had significantly higher rates of comorbidity with ODD and CD, temperamental traits (obstinacy, bad temper, impulsive behavior), maladaptive behaviors at school, familial SUD history, childhood maltreatment, and major severity of the childhood ADHD symptoms. Neither ADHD subtype nor the non-treatment of ADHD during childhood were associated with later SUD.

An important percentage of ADHD children develop a SUD during their lifespan. This study shows that there are childhood factors that are strongly associated with SUD in ADHD subjects.

Current valid classification systems (ICD-10 and DSM-IV) of the alcohol-induced disorders include: acute intoxication, pathological intoxication, alcohol withdrawal syndrome, psychotic disorder with delusions or hallucinations, delirium tremens, amnesic syndrome, mood disorders and anxiety disorders caused by alcohol consumption (only in DSM-IV) and sexual dysfunction.

To consider adequacy of existing classifications of alcohol dependency and to offer more adequate suggestion for ICD-11 and DSM-V.

Authors compared and analyzed the diagnostic criteria that are offered in the current classifications for these disorders.

There are many similarities and many differences between existing diagnostic criteria's. The former name of the DSM-IV (Substance related disorders, which include Alcohol related disorders) is inappropriate since it excludes other related disorders. Another important issue that is currently a subject of extensive discussions in the process of finalizing the DSM-V refers to the current distinction terms abuse and alcohol dependence. Scientific documents about the criteria of abuse and dependence in clinical samples and samples from the general population suggest that the DSM-IV criteria for abuse and dependence can be considered as part of a one-dimensional structure, thus for DSM-V it could be combined into a single disorder, with two criteria to make a diagnosis.

It is expected that the principles adopted by the WHO during the preparation for ICD-11, which includes bridging the differences between ICD and DSM and the introduction of the person centered integrative diagnosis (PID) will be an important step forward in understanding and distinction among alcohol induced mental disorders.

Tobacco craving is an intense desire to smoke. Cue-induced craving is considered the main responsible for relapse after smoking cessation. Cue Exposure Treatment (CET) consists of controlled and repeated exposure to stimuli associated with substance use in order to reduce craving associated.

To analyze the pattern of craving response of smokers exposed to Virtual Reality environments.

Forty-six smokers were exposed randomly to complex virtual scenes of 6 minutes long duration with smoking related cues that reproduce typical situations where people use to smokes. Craving was assessed before each exposure and 6 times during navigation with a visual analogic scale. For this secondary analysis the evolution of craving response were explored for the environments that produced the most and the least craving responses.

In the environment that produced the highest craving level, the pattern of response remains similar after the second assessment during the exposure, that is, after two minutes. For the environment that trigger the lowest levels, the responses gradually increased during the exposure and the highest level appeared in the last craving assessment, after 6 minutes.

This study has several implications. In the first place, virtual reality environments are able to elicit craving. In the second, we found that differents patterns of craving response exist in response to VR environments. Furthermore, the results obtained in the present study may be useful for cessation programs that include CET, in which is it necessary to know the pattern of desire during the exposure.

According to schema theory people have categorical rules or templates that they use to interpret the world and guide their behavior. A. T. Beck et al. (1990) and Young (1994) defined maladaptive or dysfunctional schemas as enduring, unconditional, negative beliefs about oneself, others, and the environment which organize one's experiences and subsequent behaviors. Because the early maladaptive schemas have been shown to predict psychosocial functioning and psychopathology it is reasonable to suspect that they might also impact substance abuse and substance dependence.

Examining the 3 addict subgroups in terms of EMS factors and comparison of addict patients with control group.

To determine whether there are particular schemas that may be underlying the addictive behavior.

Participants were 34 opiate dependent, 18 methamphetamine addicts, 30 subjects with heroin dependence and 48 healthy subjects as control group. Addict group had completed at least 6 months of treatment, all were in early full remission. Participants were given the Young Schema Questionnaire-Long Form in order to identify EMSs.

The results suggest that there are significant differences between the addict and control groups on 8 of the 18 schemas. There was not found any significant difference between opioid and methamphetamine groups regarding mean scores of EMSs or schema domains.

People with schema domains of impaired performance and impaired limits may be more likely to engage in substance dependence and these findings may have implications for drug abuse prevention programs.

The smoking rate among Malaysian aboriginal people is double the rate of other Malaysians. Smoking is a major cause of morbidity and mortality in aboriginal people but smoking cessation among this population is very low. At present, pharmacotherapy for smoking cessation is not subsidised in the health services.

The study aimed to explore potential reasons for the underutilisation of drug therapy for smoking cessation among aboriginal and non-aboriginal smokers.

A cross-sectional study was conducted among aboriginal and non-aboriginal smokers in the state of Selangor between March 2010-August 2010. Participants were asked to complete a questionnaire on demographics, smoking behaviour, physician counselling on smoking cessation and perceptions about drug therapy for smoking cessation.

The overall response rate was 85% (250 Aboriginal smokers and 105 non-aboriginal smokers). Majority of smokers reported smoking cessation or reduction in the previous 6 months (Aboriginal 62% vs non-aboriginal 68%). Aboriginal participants were less likely to seek physician services (p = 0.001) and less willing to use nicotine replacement therapy (p = 0.01) or varenicline (p = 0.001). Among all smokers, having to buy the medication and price of the medication was the most important factor associated with less willingness to use the drugs but advice from physician was associated with willingness to use the drugs.

Regardless of ethnic origin, smokers were interested to quit smoking, but cost of medication may explain their lower uptake of drug therapy. Malaysian policy makers should consider making the drugs for smoking cessation freely available in the Malaysian health services.

Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. The term cocaine induced psychosis (CIP) has been used to describe this syndrome. Cocaine Induce Psichotic Disorder (CIPD) have been used to describe a full psychotic state. CIP and CIPD prevalences are not well described.

To evaluate risk factors for CIPD, in cocaine-dependents according to DSM-IV criteria.

We evaluated 150 patients (mean age 34 y.o, 81.8% men) of which 143 were included, using The PRISM (Psychiatric Research for Substance and Mental Disorders) interview. Exclusion criteria were: psychotic disorder or bipolar type I disorder, intoxication at interview, severe somatic disease at interview and language barrier. We compared three groups: group I: without any psychotic symptoms (33,33%); group II: with any psychotic symptoms (28,57%) and group III: with CIPD (38,77%).

Differences were found in Patients of Group III in the Age at onset of addiction p < .0001*, past history of imprisonment p < 0,01, Alcohol Use disorders p = .006, Cannabis use disorders P < .0001* and Hallucinogens use disorders p < 0,001.All remaining after Bonferroni corrections.

CIPD is common in this population (approximately 40%). Risk factor for suffering CIPD were described, in Cocaine-dependents. Finally, professionals who work with cocaine-dependents patients should incorporate these considerations into an integral approach.

We aimed to study the relationship between impulsivity and the addiction severity in 3 groups of outpatients attending our clinic, through the Barrat Impulsivity Scale (BIS-11) and the standarized, semistructured interview EuropAsi.

174 outpatients were analized (82.6% men, 113 cocaine-dependent as main drug (mean age 32.71 y.o. (31.45–33.96)), 43 cocaine and heroin-dependent (mean age 36.68 y.o. (33.52–39.85)) and 18 heroin dependent (mean age 37.94 (32.71–41.50)). 26.3% were cannabis-dependent and 10.9% abused of Cannabis. Statistical analysis used was the Kruskal-Wallis Test.

Differences in motor impulsivity were found between the 2 groups with cocaine dependency and the only heroin-dependent (mean = 20.59, ST ± 7.7 and mean = 17.11, ST ± 7.3, respectively; W: .019). EuropASI, showed intergroup differences in the medical, use of alcohol and legal areas. In the medical area the most affected were the heroin dependent group (mean score = .40), followed by cocaine and heroin group (mean score = .27) and the cocaine-dependent (Mean = .10). In the use of alcohol area the most affected were the cocaine group (Mean = .16) followed by the cocaine and heroin-dependent (mean = .11) and heroin dependent (Mean = .06). In the legal area the most affected were the the cocaine and heroin-dependent (Mean =.22) followed by heroin-dependent (Mean = .09) and cocaine-dependent (Mean = .07).

Patients suffering from stimulant dependency alone or together with heroin dependency show different impulsivity levels. The addiction severity varies depending on the substance of abuse. Treatment programs should be designed attending patients’ needs.

Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. This is typically prevented by abstinence. The term Cocaine-Induced Psychosis (CIP) has been used to describe this syndrome. Impulsivity has been hypothesised are likked with CIP.

This study examined the relationship between CIP and substance consumption variables and impulsivity disorders including ADHD (Axis I) and Borderline personality disorders (BPD) (Axis II), and attempted to evaluated their link as a risk factors for CIP.

Trained psychiatrists systematically conducted a structured interview in which the conclusions from the psychotic symptoms were summarized. We used the CADDID to evaluate Adult ADHD, SCID II for axis II disorders, and the Barrat Impulsivity Scale (BIS-11).

We evaluated 163 (34,16 yo, 85,80% men) cocaine-dependent patients, according to DSM-IV criteria.

We found statistically significant association between CIP and Early age at onset of cocaine addiction (p = 0,04), cocaine use per day 6 months before starting treatment (p = 0,03), Barrat cognitive impulsivity subscale (p < 0,004), and Adult ADHD (p < 0,041). No relationship between BPD and CIP was found.

We confirm previous findings that Impulsivity disorders as ADHD or high impulsivity trails are liked to CIP. Coinciding with our previous findings, relationship between early age of onset cocaine dependence or high amounts of cocaine use and CIP was found. CIP are related with impulsivity disorders spectrum.

In Malaysia, MMT started with low regulated model since year 2002 to address increasing prevalence of HIV/AIDS among intravenous drug users. However, fear of widespread diversion and overdose death forced the government to implement high regulated MMT model. Universiti Malaya conducted both model among self-sponsored(low supervision) and government-sponsored(high supervison) program.

To investigate the biodemographic profiles, psychosocial correlates, pattern of substance use, methadone dosing and client satisfaction level among the two groups.

We conducted a cross sectional study involving 50 clients from each model. The inclusion criteria inludes opiates dependents age > 18 years and above with written consent using convenience sampling from October to December 2008. Semistructured questionare for demographic and pattern of substance use interview, MINI Neuropsychiatric interview for psychiatric morbidity and CSQ-8 for client satisfaction measurement. Analysis was done using SPSS version 16.

All the participants are males with the mean age of 40 years. 61% are married and 90% are employed during the interview. 80% received MMT more than one year and 65% achieved maintenance dose more than 50mg daily. 68% used substance more than 10 years prior to the MMT and 73% starts using heroin below age of 20 years old. 57% have comorbid psychiatric illness(anti-social personality, major depression and psychotic disorders) and 33% have medical illness(HIV+, Hepatitis B/C and tuberculosis). There were no significance difference in demographic profiles, pattern of substance use, psychiatric/medical comorbidities and clients satisfasfaction level between the two groups.

Both group are similar from the clients satisfaction perpectives.

In Malaysia, national methadone maintenance therapy program was started by the goverment in October 2005 as part of harm reduction approach in reducing HIV prevalence among drug users along with needles and Syringes exchange(NSEP) program. However, slow coverage of MMT treatment occurs due to limited resources in existing health facilities and lack of participation from general practioners(Gps). There is a need for another paltform to increase coverage and participation of GPs in national MMT program.

To compare the retention rate and other outcomes measures between SEDAR program and Standard MMT treatment in hospital.

To determine the feasability of MMT program in mosque environment.

The pilot MMT program known as SEDAR program was conducted in Ar-Rahman mosque involving 30 clients. Brief spiritual intervention(BSI) was given by mosque staffs on top of standard MMT treatment counseling. BSI include washing body parts with water or “wuduk”, praying in the mosque or “tahiyatul masjid” and recite “doa” in the mosque environment prior to direct observed therapy of methadone in the mosque by the pharmacist. The retention rate, % of urine drugs negative over time period, drug use and HIV risk behavior, quality of live and spiritual progress were measure using specific tools: OTI, WHO Qol, SF36, HIR96.

We expect the SEDAR group in Mosque has better outcomes or comparable with standard MMT treatment in hospital setting.

The SEDAR program is feasable to increase coverage of MMT program in Malaysia.