Alcohol use disorders (AUD) is a preventable cause of significant morbidity and mortality worldwide. AUD is a heterogeneous disorder stemming from a complex interaction of neurobiological, genetic, and environmental factors. To achieve treatment effectiveness this heterogenity should be considered, as well as safety.

Review mechanisms underlying alcohol addiction in order to work out new, more effective treatment strategies.

To update on treatment for alcoholism.

A literature search was performed on PubMed database.

Alcohol dependence is a chronic, relapsing condition in which there is evidence of significant change in the motivation and control systems in the brain. Increasingly drug therapy is focused not just on the treatment of the acute withdrawal syndrome, but on modifying these other dysregulated brain systems. Of the numerous neurotransmitter systems that have been identified for the development of new medicines, the most promising compounds appear to be those that modulate the function of opioids, glutamate with or without gamma-aminobutyric acid, and serotonin. Other putative therapeutic medications including direct modulators of dopamine function and enzyme inhibitors also shall be discussed. At present, only four medications are approved for the treatment of alcohol dependence in Europe, that is naltrexone, acamprosate, disulfiram and the most recent nalmefene. Among other promising strategies the following drugs are mentioned: baclofen, topiramate, ondansetron, aripiprazole, rimonabant and varenicline.

Pharmacological development remains a high priority in the alcoholism field. Drugs have different safety profiles that need to be balanced with the treatment objective, individual patient preferences and comorbid conditions.

The authors have not supplied their declaration of competing interest.

Among the psychosocial care network services and devices, highlights the Center of Psycho-Social Attention (CPSAad) aimed at building a comprehensive, regionalized care, based on the extended clinic and from Singular Therapeutic Project (STP).

Report a successful experience of building a Singular Therapeutic Project in Center of Psycho-Social Attention.

This is a descriptive/reflective study type experience report, held in CPSAad from experiences of Mental Health's Multidisciplinary Residency members linked to the Center for Studies in Public Health, João Pessoa, Paraíba, Brazil.

It was noted that the STP assists practitioners in the planning of interventions from the needs highlighted by the user and it promotes the knowledge exchange and the co-responsibility of those involved in the care. Therefore, was built a STP of a homeless alcoholic user who initially attended the service as its basic needs refuge (food, hygiene and rest) without showing any interest in participating of activities, little interaction with professionals and other users, difficulties in expressing himself, besides often arriving at the service under alcohol influence. The residents planned the STP from the user's admission through the qualified hearing and construction of bonds.

The Singular Therapeutic Project operationalization allowed the user to feel cared, attended in his needs and recognized by the staff; favoured its treatment co-responsibility, leading him to participate in the proposed activities, medical appointments and examinations, and consequently the improvement of his interpersonal relationships.

The authors have not supplied their declaration of competing interest.

Synthetic cathinones, the active component in “bath salts”, have surfaced as a popular alternative to other illicit drugs of abuse, such as cocaine, MDMA (ecstasy), and methamphetamine, due to their potent psychostimulant and empathogenic effects.

To describe the presence of Ethylone in samples delivered to energy control from 2014 to 2015 in Spain.

The total number of samples analyzed from 2014 to 2015 was 8324. Only those samples containing ethylone were studied. They were analyzed by energy control, a Spanish harm reduction NGO that offers the possibility of analysing the substances that users report. Analysis was done by gas chromatography-mass spectrometry.

From June 2014 to December 2015, 8324 samples were delivered to EC. From this samples 28 (0.336%) contained ethylone. Twelve (0.144%) were delivered as MDMA, representing a 0.783% of the samples delivered as such, and only one sample (0.012%) delivered as MDMA presented ethylene as an adulterant along with MDMA. Other 6 samples (0.072%) were delivered as ethylone and 10 samples (0.120%) were delivered as unknown pills.

Ethylone consumption is found to be an emerging issue according to the results of our samples, an increase of such is found during 2015. This might be traduced as an increase of ethylone in the drug market, but a sample selection bias should be considered as samples were voluntary delivered by consumers. An alarming phenomenon is that in some occasions ethylone is sold as MDMA, but effects take longer to occur and last longer, which may lead to an overdose if used as MDMA.

The authors have not supplied their declaration of competing interest.

According to the available data, treatment motivation and readiness are closely linked to retention. There are instruments for measuring the stages of motivation and readiness, and predicting treatment retention and outcome.

This study describes psychometric properties, while focusing on the reliability of the Slovenian version of the Circumstances, Motivation and Readiness (CMR) scales.

We included 109 male and female patients with opioid addiction at the Centre for Treatment of Drug Addiction, Ljubljana. The CMR was translated into Slovenian by using the “forward-backward” procedure by our team and its author. Data analysis addressed psychometric properties of the CMR. Internal consistency was examined by applying exploratory and confirmatory factor analysis, while reliability was examined with Cronbach's coefficient alpha.

Cronbach alpha coefficients of reliability were calculated for each of the three CMR subscales and for the total score. The total alpha was 0.842. Alpha for Motivation was 0.860, for Circumstances 0.372 and for Readiness 0.818. Exploratory factor analysis extracted a 3-factor solution with 56% explained total variance. The factors do not provide an exact match with the dimensions C, M and R.

On the basis of these results we can conclude that the Slovenian translation of the CMR is a valid instrument for evaluating patients’ motivation and readiness for treatment.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Rational emotive behavior therapy refers to a realistic time bound therapeutic approach, starting with activated concern model of emotional disturbance and change.

To set short-term goal and long-term goal for substance users by rational emotive behavior therapy.

The present study aims at ameliorating emotional disturbance among addicts.

A purposive sampling method was adopted. Therapy was administered on 50 substance users admitted in recovery hospital running by pioneer organization Human Development and Research Institute. Each day morning meeting was organized consisting of creed, narration from day by day; personal and interpersonal pull up, acknowledgement, newspaper reading, recreational activities, and serenity prayer. Quantitative and qualitative analysis was recorded.

Inferential statistics have shown that statistically significant differences were found among them those who have undergone counselling processes. They have found a proper orientation and significant qualities of life. Such therapy enabled them to find sobriety.

In conclusion, it could be stated that Rational Emotive Behaviour therapy was found to be effective among substance users. We can utter with Walen et al. that rational emotive behaviour therapy is ‘not merely working to dispel misery, but actively promoting happiness’.

The author has not supplied his/her declaration of competing interest.

Adolescence is frequently described as a golden time for prevention of substance abuse.

This study is aimed at determining the fit of structural equation modeling for change of attitude toward substance abuse based on the components of emotional intelligence (intrapersonal awareness, interpersonal awareness, adaptation, stress management, and general mood) and reasoning, critical thinking in female adolescents.

The data were collected in random multistage sampling from 800 senior high school students at 4 different regions of Tehran by using the Bar-on Emotional Intelligence Inventory, the adolescent-special revised inventory, Ricketts Critical Thinking Questionnaire, New Jersey Test of Reasoning Skills and Nazari's Questionnaire for Attitude toward Substance Abuse. In the 618 valid questionnaires were statistically analyzed.

Path analysis and path coefficients in the structural equation model suggested that the strongest relation belongs to the reasoning skill, directly predicting attitude with a 61% level and also, has indirect, significant impacts on attitude through intrapersonal awareness, adaptation and stress management. The weakest relation belongs to general mood which, with a 21% level, predicts attitude toward substance abuse. Results of the fit indices in the final model also indicate that all indices are at a desirable level and the model has good fit to the data, implying that there is a linear relation between independent variables and between the moderating variables and a dependent variable.

It is reasonable to show the importance of attitude toward substance abuse in prevention programs for students.

The authors have not supplied their declaration of competing interest.

Patients with dual pathology have worse clinical evolution and worse therapeutic response. Drugs modify the functioning of certain neurocerebral transmission systems, producing cognitive, emotional and behavioral changes. Vortioxetine (Brintellix®) is used as a treatment for major depressive disorder (MDD) and it is considered a new multimodal antidepressant. Preclinical data suggest that the effects on numerous serotonin receptors result in regional increases in noradrenaline and dopamine as well as glutamatergic transmission.

This analysis assessed the efficacy of vortioxetine (Brintellix®) in patients with affective disorders and abuse drugs (dual pathology).

Efficacy was assessed with a study of patients who were recruited in a qualitative and observational study. They were treated with vortioxetine (Brintellix®). Outcome measures included changes from baseline to endpoint in Hamilton Depresion Rating Scale (HDRS). They were also interviewed weekly about craving and substance use. Urine test controls were done to corroborate results.

A total of 11 vortioxetine-treated patients improved their depressive and anxiety symptomatology. Seven of them (64%) were males and four of them (36%) were women. Cocaine was the main drug of abuse (n = 9, 82%). The doses were between 5 and 20 mg/day. After the clinical evaluation and 12 weeks of treatment, they achieved to reduce significantly the drug use and verbalized a decrease in craving. Two patients dropped out of the study.

Vortioxetine (Brintellix®) was shown as efficacious in reducing depressive and anxiety symptoms in patients with dual pathology.

The authors have not supplied their declaration of competing interest.

Alcoholic hallucinosis is a rare complication of chronic alcohol abuse and a prevalence of 0.6–0.7% in alcoholics has been reported.

A 54-year-old Indian immigrant in Barcelona was referred for psychiatric evaluation in April 2016 by due of his behavioral alterations. Evaluation revealed that he was apparently asymptomatic when he come to Spain, 18 years ago. He had been consuming alcohol since 1974 and gradually the frequency and quantity increased to 600 mL of rum daily by 1996. He complained of hearing voices of family members, being irritable even when he was alone and in catatonic phases. He was found to be gloomy, reclusive, not sleeping and talking to oneself. He used to have sleep disturbances; irritability and tremors when temporarily stopped alcohol consumption. He presented a clinical abstinence syndrome, with pharmacological resistance to benzodiazepine perfusion: it was necessary to use dexmedetomidine an Alpha2-agonist with sedative and analgesic properties. After 12 days of medical treatment on UCI, he recovered from abstinence syndrome and was transferred to psychiatry ward. Blood analysis showed raised aspartate amino transferase and alanine amino transferase. Computed tomography and magnetic resonance imaging brain revealed bilateral lateral ventricle enlargement with narrowing of lower end of Aqueduct of Sylvius. He was treated with oral paliperidone. The dose was gradually increased to 18 mg/day and he responded quickly. In the follow-up, he was abstinent from alcohol, compliant with treatment and free from all kinds of hallucinations after medication adherence and psychotherapy.

The authors have not supplied their declaration of competing interest.

Little is known about the epidemiology of smoking and substance use disorders (SUD) among psychiatric outpatients in south of Tunisia.

Examine the prevalence of smoking and SUD among adult psychiatric outpatients at the regional hospital of Gabes.

A survey was conducted to assess the extent of alcohol abuse, drug abuse and smoking among adult psychiatric outpatients (n = 115), with different psychiatric diagnoses (DSM−5), aged over 18 years, following the psychiatric department of the regional hospital of Gabes. Data collection was done through a semi-structured interview with the patient and a family member + review of medical records. SUD was defined as an abuse or dependence to alcohol or drug.

Smokers account for 29.6% of the patients. Smoking was significantly higher in male patients (97.1% vs. 43.2%, P < 10−3). Compared to nonsmokers, smokers patients had significantly more the diagnosis of schizophrenia (64.7% vs. 35.3%, P = 0.004), a higher level of education (52.9% vs. 32.1%, P = 0.03), a higher rate of alcohol (14.7% vs. 1.2%, P = 0.008) and drug use disorders (8.8% vs. 0%, P = 0.02), and a higher rate of relapses (3.5 vs. 2, P = 0.004). Alcohol use was noted in 6% of patients and cannabis in 4%. Patients with a SUD had significantly more the diagnosis of schizophrenia (100% vs. 36.2%, P = 0.05), a higher rate of smoking (100% vs. 27.7%, P = 0.02). Financial situation, education, marital status and age of onset of the disease were not associated with SUD.

Addictive behaviors are prevalent among psychiatric outpatients. This has implications in treatment and management of these patients.

The authors have not supplied their declaration of competing interest.

There is no evidence on influence of HBV/HCV co-infection on survival characteristics in population with dual disorders.

To determine the impact of HBV/HCV co-infection on the long-term survival of schizophrenic patients with co-occurring substance use disorders.

Charts of 223 subjects admitted from January 1, 2002 to May 31, 2006 were assessed. The Kaplan–Meier survival analysis was used to estimate the cumulative survival rates. The association between HBV/HCV and mortality was estimated using the Cox proportional-hazard regression models, with adjustments for potential confounders. The main outcome was all-cause mortality. Median observation time was 10.3 years.

Total all-cause 11 year, unadjusted mortality was 18.0% in population with no viral hepatitis (VH) infection (n = 185; 83.0%), 66.7% in population with HBV monoinfection (n = 3; 1.3%), 50.0% in population with HCV monoinfection (n = 28; 12.6%), and 64.3% in population with HBV/HCV co-infection (n = 7; 3.1%), P < 0.00001. In Cox regression, the adjusted hazard ratio was 4.22 (95% CI: 1.00–18.63; P < 0.05) for the HBV, 4.24 (95% CI: 2.13–8.47; P < 0.00001) for the HCV, 6.18 (95% CI: 2.01–19.01; P < 0.0015) for the HBV/HCV, all vs. no VH-infection.

The high mortality of schizophrenic dual disorders patients with HBV/HCV necessitates new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival. The strong adverse effect of HBV/HCV on survival should encourage clinical trials including schizophrenic dual disorders patients on whether patients benefit from treatment choices. It is essential that adequate resources and strategies are targeted to the schizophrenic dual disorders patients with HBV/HCV.

The authors have not supplied their declaration of competing interest.

Persons dependent on opioids often characterized by the coexistence of a whole range of dysfunctional behaviors, which may also lead to eating disorders.

Impulsive and risky behavior, conducive to the formation of polysubstance dependence, including food addiction, which manifests itself in the uncontrollable craving substances, that are quickly metabolized and turned into sugar in the bloodstream.

Aim of the study was to assess the nutritional status and carbohydrates consumption in opioid-dependent individuals treated with methadone substitution therapy.

Fourteen opioid addicts during methadone maintenance treatment were examined. Eighteen healthy individuals matched for age and gender were included to the control group. The 24 hour hour diet recalls interview was used. After the dietary recall, a special questionnaire was administered to ascertain frequency of refined carbohydrates consumptions during the past 30 days.

It was found the nutritional deficiencies in the diet and poor nutritional status in opioid-addicts compared to healthy ones. Opioid-dependent individuals significantly more often snack between meals. It was found increased consumption monosaccharides and disaccharides in foods and beverages in opioid-addicts compared to healthy ones (P < 0.05).

Investigation of dietary behaviors may facilitate understanding of dynamics of addiction, so that we can use more effective methods of treatment.

The authors have not supplied their declaration of competing interest.

After mephedrone's ban in March 2010 new cathinones proliferated widely, even a new branch of atypical derivatives was launched into the market, represented by MDPV. The cardiovascular and central nervous system toxicity draws attention to this new family of cathinones, also known as pyrovalerones. MDPV was scheduled in 2011, leading to the apparition of Alpha-PVP from which there is little information.

The aim of the present study is to describe the evolution of different cathinones in the samples delivered for analysis to the harm reduction NGO energy control from March 2009 to March 2016 in Spain.

Energy control is a Spanish harm reduction NGO that offers to drug users the possibility of analyzing the substances they intend to consume. From March 2009 to March 2016 a total of 24,528 samples were analyzed by the NGO from which 760 contained cathinones. Substance analysis was done by gas chromatography–mass spectrometry.

From 2009 to 2016, cathinones represented a 2.82% from all analyzed samples. From March 2009 to March 2010, only 5 different cathinones were detected, in this same period methylone (n = 16; 37.20%) and mephedrone (n = 17; 39.53%) represented 76% of analyzed cathinones (n = 43). From March 2015 to March 2016, 132 cathinones were detected: methylone and mephedrone represented only 19.69%, giving prominence to clephedrone (n = 25; 18.93%) and Alpha-PVP (n = 24; 18.18%).

The evolution of synthetic cathinones detected by energy control is consistent with the evolution described in the literature. From 2009 to 2016, the cathinones detected diversify and new substances with higher toxicity potential appear.

The authors have not supplied their declaration of competing interest.

Emotional disturbances are a central characteristic of many mental disorders, including alcohol addiction.

In this study we aimed to investigate the emotion disregulation among alcohol use disorders and to compare the emotion regulation difficulties with type 1 and type 2 alcoholism.

Thirty-three treatment-seeking AUD individuals were recruited from addiction division of psychiatry department of Çanakkale Onsekiz Mart University. Patients who agreed to participate in the study and completed detoxification treatment were enrolled to the study. After describing the study and obtaining informed consent, participants were assessed with demographic questionnaires (including questions such as age, gender, income status, duration of alcohol use, amount of alcohol use, duration of abstinence were given to participants) followed by the semi-structured interview. Emotion regulation was assessed with the difficulties in emotion regulation scale.

Of the patients, 93.9% were male. The average age of participants was 41.21 ± 12.8 years. Of the participants, 60.6% were type 1 and 39.4% of type 2. There was statistically significant difference between type 1 and type 2 alcoholism in terms of emotion regulation. Type 2 alcoholism has more emotional regulation difficulties than type 1 alcoholism. This finding may be consistent with earlier onset of having more impulsive drinking pattern in type 2.

In conclusion alcohol use disorders are thought to be associated with emotion dysregulation. Emotion regulation difficulties, was higher in type 2 than type 1. Emotional regulation strategies should be considered in the interventions and may be evaluated as a new prognostic criteria.

The authors have not supplied their declaration of competing interest.

Childhood trauma has been found to be prevalent in treatment-seeking alcoholics.

We aimed to investigate the childhood trauma prevalence among alcohol dependent patients and the prevalence of psychiatric co-morbidity.

A total of 61 participants were assessed; 35 treatment-seeking alcohol dependent patients and 26 age-gender matched controls in the addiction division of psychiatry department of Çanakkale Onsekiz Mart University. After describing the study and obtaining informed consent, participants were assessed with demographic questionnaires, followed by the structured clinical interview for the DSM-IV-TR and childhood trauma questionnaire (CTQ-28).

The 91.4% of the patients were male, mean age was 42.03 ± 12.9. The overall prevalence of CTE of the alcohol dependent patients was (88.6%) higher than the control (42.3%) group. Respectively the prevalence of physical neglect was 80%, emotional neglect 74.3%, emotional abuse was 51.4%, physical abuse 40% and sexual abuse 28.6%. For psychiatric disorders 96.8% of the alcohol dependent patients with childhood trauma reported any of the psychiatric disorders, 64.5% ever having a mood disorder with 25.8% ever having any anxiety disorders, and 16.1% ever having attention and hyperactivity disorder. The most common psychiatric co-morbidity was found to be as depression (58.1%).

In conclusion alcohol use disorders are thought to be associated with childhood trauma. Patients with alcohol use disorders are exposed to have more childhood trauma. Childhood trauma is associated with psychiatric co-morbidity especially depression. We have to ask for childhood trauma in alcohol dependent patients with psychiatric co-morbidity.

The authors have not supplied their declaration of competing interest.

Smoking is a major healthcare issue. Evidence shows considerable comorbidity between nicotine dependence and depressive disorders.

We are interested in the correlation between Beck's depression inventory (BDI) scores and smoking cessation outcomes.

Retrospective, transversal and analytical study. Data were collected from 95 patients followed in the smoking cessation consultation of The military hospital of Tunis. The BDI was used to assess depressive symptoms and nicotine dependence evaluated by Fagerstrom test for nicotine dependence (FTND).

Population was composed of men (92%), married in 65% of cases, with a mean age of 45 ± 13 years. The mean age of smoking initiation was 18 ± 4.5 years. Regular smoking average was 37 ± 20 Packs/Year. The mean cigarette consumption was 30 ± 15 per day. Forty-two percent patients reported at least one attempt to quit smoking, with an average of 37.26 days of abstinence. The mean score of FTND test was 7 ± 2.31. The BDI score was higher than 3 in 86% of cases. Patients with severe depression (BDI > 15) had never attempted a withdrawal in 71% of cases (P = 0.009), had a high or very high dependence in 85.7% of cases (P = 0.016). The average of cigarettes per day was 40 (P = 0.035) and they had failed withdrawal in 79% of cases (P = 0.53).

There was a fairly consistent association between presence of depression and smoking severity. This suggests that for individuals with nicotine dependence who are interested in quitting smoking, assessment and treatment of depressive symptoms may improve smoking cessation outcomes.

The authors have not supplied their declaration of competing interest.

The alcohol hangover state (AHS) is characterized by range of symptoms (e.g., drowsiness, fatigue, gastro-intestinal problems, dry mouth, nausea, sweating) that remain after ones blood-alcohol level returns to zero following a recent bout of excessive drinking. Recent findings have revealed a range of cognitive deficits associated with an AHS, including memory deficits. It is less clear what impact the AHS has upon everyday remembering; of which prospective memory is an excellent example (PM: memory for future plans/actions; such as remembering to perform a task at a specific time).

The present study explored whether the AHS impairs everyday PM.

Twenty-one AHS participants were compared with 28 non-AHS controls using a between-groups design. All completed a prospective remembering video procedure (prvp), which measured event-based pm. the prvp required the participant first to memorise a series of specific action-locations combinations and then to recall these combinations whilst viewing a CD clip of a busy shopping high street. Drug use (alcohol, smoking, etc.) and mood (anxiety and depression) were also measured, as these have been shown to have a deleterious impact upon PM.

The AHS group recalled significantly fewer event-based PM combinations on the PRVP compared with the non-AHS control group (P < 0.05). There were no significant differences between the groups on age, smoking, alcohol use or mood.

These results confirm that a state of alcohol hangover impedes everyday prospective memory. The wider implications will be discussed at conference.

The author has not supplied his/her declaration of competing interest.

In the NHS Forth Valley (Central Scotland) substance misuse service (SMS), there is an arrangement whereby the details of individuals administered naloxone for overdose via the ambulance service are passed to the SMS. Each patient has an allocated keyworker (nurse). It is accepted that near fatal overdoses (NFOs) are possible precursors to fatal overdose and drug-related deaths.

To assess:

– if the information is being disseminated appropriately;

– service response and follow-up for individuals;

– patterns which might influence prescribing practice.

A list of NFOs of known patients for the previous two years was acquired from the ambulance service. There was a retrospective review of the SMS prescribing database and clinical casenotes.

Patterns:

– 81% male;

– 53% aged < 40;

– 14% of NFO's involved those in titration phase;

– 86% were prescribed methadone. Methadone average dose 57 mg (20–80 mg) and 54% were prescribed > 60 mg/day.

Receipts of information:

– sixty-one percent of keyworkers were notified.

Service response:

– in most cases when the keyworkers was informed, there was prompt action to contact and review patients (0–21 days). However, only 21% had a timely review (within 1 month) by a doctor following NFO.

There needs to be an improvement in the dissemination of information between the ambulance service, administrative staff and keyworkers. Most NFO patients were prescribed > 60 mg of methadone. There needs to better identification of “harm-reduction” prescribing whereby methadone doses should be reduced at times of ongoing drug use. Fourteen percent of NFO's involved those in titration phase (twice weekly reviews) which provides an opportunity to screen and intervene for potential NFOs.

The authors have not supplied their declaration of competing interest.

The drug addiction in the buprenorphin with high dosage (BHD) by injectable way, represents a real plague in Tunisia, consequently, we are confronted with diverse complications including the sexual dysfunctions.

Identify and determine prevalence of the sexual dysfunctions among this population.

It is a transverse, descriptive study. We looked for sexual dysfunctions by using the international index of the erectile function (IIEF 15), among a population of 52 male users of BHD by injectable way.

The average score in the IIEF-15 was 36.65 with a standard deviation of 20.87, a negative correlation with duration and the quantity of consumption was noted.

The average erectile function (EF) was 15.63 ± 9.26, which corresponds to a mild to moderate erectile dysfunction, whereas 31% had a severe dysfunction.

The average score of the orgasmic function (OF) was 6.35 ± 3.52.

The average score of the sexual desire (SD) was 4.27 ± 2.90.

The average score of the satisfaction with sexual intercourses (IS) was 5.77 ± 4.54, an alteration was noted in 96% of the cases, which was correlated with the severity of the consumption.

The average score of the global satisfaction (OS) was altered at 92% of the subjects.

The majority of the subjects brought back the chronology of their disorders in after the consumption of BHD. No patient consulted in sexology.

It is thus important to educate stakeholders, on the frequency of sexual dysfunctions and the importance of their screening to improve the management of this problem.

The authors have not supplied their declaration of competing interest.