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Dalgarno Institute Research Reports are a great resource that aims to provide current research to users. The reports take key up-to-date evidence-based data relating to Alcohol and Other Drug issues and deliver it in a format that is easier to use for reference purposes. The data may have some commentary, but is generally representative of source evidence, whilst culling the extraneous. All data in the reports is referenced and cited so as to enable the user to further investigate the topic/issue if required.

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Conditional probabilities of substance use disorders and associated risk factors: Progression from first use to use disorder on alcohol, cannabis, stimulants, sedatives and opioids

Highlights

• • Pre-existing mental disorders increases the risk of developing SUD.
• • Prior SUD increases the risk of transitioning from use to use disorder.
• • Highest rates of transition to SUD occurred among stimulant and opioid users.
• • Mood and anxiety disorders increased the risk of transitioning to AUD and CUD.
• • The rapidity of transition to SUD emphasizes the narrow opportunity to intervene.

Conclusion: The relative speed associated with the transition from use to SUD emphasizes the narrow window of time available to intervene, underscoring the urgency of early identification of mental health conditions and the timely provision of appropriate evidence-based interventions, which could potentially prevent the development of secondary SUDs.

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The interdependence of cigarette, alcohol, and marijuana use in the context of school-based social networks

Cheng Wang1 *, John R. Hipp2,3, Carter T. Butts3,4, Cynthia M. Lakon5 1 Department of Sociology, University of Notre Dame, Notre Dame, IN, United States of America, 2 Department of Criminology, Law and Society, University of California, Irvine, Irvine, CA, United States of America, 3 Department of Sociology, University of California, Irvine, Irvine, CA, United States of America, 4 Department of Statistics, University of California, Irvine, Irvine, CA, United States of America, 5 Program in Public Health, University of California, Irvine, Irvine, CA, United States of America

Abstract: The concurrent or sequential usage of multiple substances during adolescence is a serious public health problem. Given the importance of understanding interdependence in substance use during adolescence, the purpose of this study is to examine the co-evolution of cigarette smoking, alcohol, and marijuana use within the ever-changing landscape of adolescent friendship networks, which are a primary socialization context for adolescent substance use. Utilizing Stochastic Actor-Based models, we examine how multiple simultaneous social processes co-evolve with adolescent smoking, drinking, and marijuana use within adolescent friendship networks using two school samples from early waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We also estimate two separate models examining the effects from using one substance to the initiation and cessation of other substances for each sample. 

Based on the initial model results, we simulate the model forward in time by turning off one key effect in the estimated model at a time, and observe how the distribution of use of each substance changes. We find evidence of a unilateral causal relationship from marijuana use to subsequent smoking and drinking behaviors, resulting in the initiation of drinking behavior. 

Marijuana use is also associated with smoking initiation in a school with a low substance use level, and smoking cessation in a school with a high substance use level. In addition, in a simulation model excluding the effect from marijuana use to smoking and drinking behavior, the number of smokers and drinkers decreases precipitously. Overall, our findings indicate some evidence of sequential drug use, as marijuana use increased subsequent smoking and drinking behavior and indicate that an adolescent’s level of marijuana use affects the initiation and continuation of smoking and drinking

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More People Are Inhaling Heroin, And It's Destroying Brain Tissue

Ed Cara  Jul 10, 2018, 4:00pm

People living with opioid addiction are increasingly using the inhalation method to get high, warns a new review published Monday in JAMA Neurology. The technique known as “chasing the dragon”, which involves heating up heroin and inhaling its fumes through a pipe, may be safer in some ways than injection, but it comes with its own set of devastating side effects, including irreversible brain damage and dementia.

The doctors behind the study, led by neurologist Ciro Ramos-Estebanez of the University Hospitals Cleveland Medical Center in Ohio, were inspired to study the topic after coming across a strange case in 2015.

A young woman suffering from opioid intoxication had fallen into a coma. The coma was caused by a build up of spinal fluid in her brain, a condition known as hydrocephalus. The woman’s spinal fluid had become trapped by chronic inflammation in the brain caused by inhaling heroin.

She ultimately recovered from her coma, though with lasting cognitive impairment, after doctors performed emergency surgery that drained the lodged spinal fluid.

It was the first case of hydrocephalus linked to inhaled heroin ever reported, and it made Ramos-Estebanez and his team eager to understand the phenomenon better

Looking at more than 30 studies and case reports, which included the cases of two other patients at their hospital, the team settled on some basic observations.

For one, while there’s sparse information on how often addicts are inhaling heroin, the little data that does exist suggests it’s the fastest growing method of use, the team found.

In countries such as Sri Lanka, Norway and India, over two-thirds of heroin users admit inhaling it regularly. In the US, injection is still the most common method, but inhalation is increasing, especially in cities and areas east of the Mississippi.

It’s also becoming more popular among teens. In 2014, the team found, 21 per cent of all inpatient hospital visits due to heroin abuse among 12- to 19-year-olds involved inhalation.

The extent of damage caused by inhaling heroin also runs along a spectrum. At its mildest, it can cause memory loss and mild but long-lasting cognitive impairment; at its worst, it can kill off and create sponge-like holes in the brain’s white matter, the bundles of connective fibre that allow brain cells to talk to one another. That can lead to seizures, problems speaking, progressively worse dementia, coma and death.

Ramos-Estebanez and his team also developed a theory as how and why this damage happens. The high temperatures used to vaporise heroin, they speculate, metabolise it into a chemical that can cross the blood-brain barrier with greater ease. And because how fast it gets to the brain, these chemicals aren’t metabolised by the body into a relatively less toxic substance. The end result is a potent high that is more directly dangerous to the brain.

“Most people who take heroin intravenously don’t develop this condition,” Ramos-Estebanez said. “You’re actually washing out the dose a bit before it gets to the brain.”

Ultimately, Ramos-Estebanez wants doctors and the public to treat inhaled heroin as an emerging public health problem. Being able to recognise its signs in opioid users earlier might just be life-saving, too: Some small studies have identified a few drugs that seem capable of preventing further brain damage if administered quickly enough.

Outside of these sites, Ramos-Estebanez wants to dispel the notion that inhaling heroin is necessarily safer than other routes, such as injection. Many people, for instance, may inhale to avoid the risk of catching bloodborne diseases through contaminated needles.

“‘Chasing the dragon’ is not as safe as portrayed. And this isn’t something some doctor is saying to scare people away, it’s reality,” Ramos-Estebanez said. “It’s a heavy cost for patients, their families and society itself.”

In addition to creating accurate criteria that doctors can use to diagnose people who have brain damage caused by inhaled heroin, Ramos-Estebanez and his team are also currently trying to establish a registry so cases can be better tracked and studied.

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Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis

Results: Overall, 32.2% (95% CI=29.7–34.9) of patients with a substance-induced psychosis converted to either bipolar or schizophrenia-spectrum disorders. The highest conversion rate was found for cannabis-induced psychosis, with 47.4% (95% CI=42.7–52.3) converting to either schizophrenia or bipolar disorder. Young age was associated with a higher risk of converting to schizophrenia. Self-harm after a substance-induced psychosis was significantly linked to a higher risk of converting to both schizophrenia and bipolar disorder. Half the cases of conversion to schizophrenia occurred within 3.1 years after a substance-induced psychosis, and half the cases of conversion to bipolar disorder occurred within 4.4 years.

Conclusions: Substance-induced psychosis is strongly associated with the development of severe mental illness, and a long follow-up period is needed to identify the majority of cases.

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The Most Effective Drug Pusher Ever – Permission!

Drug Policy: Changing the Narrative

Getting enough sleep – Eating right – Little Bit of exercise, and cut down on sugar  and ‘screen time’ will all help Executive Function and reduce the potential for SUD? 

Adolescent Executive Dysfunction in Daily Life: Relationships to Risks, Brain Structure and Substance Use.

Abstract

During adolescence, problems reflecting cognitive, behavioural and affective dysregulation, such as inattention and emotional dyscontrol, have been observed to be associated with substance use disorder (SUD) risks and outcomes. Prior studies have typically been with small samples, and have typically not included comprehensive measurement of executive dysfunction domains. The relationships of executive dysfunction in daily life with performance based testing of cognitive skills and structural brain characteristics, thought to be the basis for executive functioning, have not been definitively determined. The aims of this study were to determine the relationships between executive dysfunction in daily life, measured by the Behaviour Rating Inventory of Executive Function (BRIEF), cognitive skills and structural brain characteristics, and SUD risks, including a global SUD risk indicator, sleep quality, and risky alcohol and cannabis use. In addition to bivariate relationships, multivariate models were tested. The subjects (n = 817; ages 12 through 21) were participants in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study. 

The results indicated that executive dysfunction was significantly related to SUD risks, poor sleep quality, risky alcohol use and cannabis use, and was not significantly related to cognitive skills or structural brain characteristics. In multivariate models, the relationship between poor sleep quality and risky substance use was mediated by executive dysfunction. While these cross-sectional relationships need to be further examined in longitudinal analyses, the results suggest that poor sleep quality and executive dysfunction may be viable preventive intervention targets to reduce adolescent substance use.

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A psychological perspective on addiction – Professor Robert West

Addiction is a chronic condition, learned through experience, involving repeated powerful motivation to engage in a behaviour to an extent that causes, or risks, significant unintended harm. Addiction cannot be adequately understood in terms of any one discipline, but each of the disciplines of the behavioural and social sciences, from neuroscience to anthropology, can provide valuable insights.

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