Patients with schizophrenia and with ADHD smoke cigarettes at a higher rate than normal subjects (Borland and Heckman 1976). Forty-two percent of men and 38% of women diagnosed with ADHD are current smokers, almost twice as high as the number in an unselected population (Milberger et al. 1997; Pomerleau et al. 1995). In this study we hypothesized that the allele 113bp in D15S1360 marker at CHRNA7 and the 2bp deletion allele at CHRFAM7A are associated with increased smoking in patients with schizophrenia and Adult ADHD. Our sample consisted of 78 DSM-IV patients affected by Adult ADHD and schizophrenia from the Toronto area. Current smoking status was assessed by a medical history questionnaire, and there were 29 current smokers and 49 non-smokers. We analyze the single marker association by chi-square and the CHRNA7-CHRFAM7A interaction by logistic regression, considering the 113bp and the –2bp deletion dominant. In our sample the 113bp allele in CHRNA7 does not confer risk for smoking in the ADHD (chi-sq=0.47, 1df, p=0.492). Finally, we compared the frequency of the 133bp genotype in schizophrenic smokers with non psychiatric smokers who started nicotine replacement treatment and we found significant difference in genotype distribution (p=0.0063). The analysis of a7 genes in ADHD showed no association with smoking. The molecular hypothesis of a7/a7like interaction and the number of a7like copy variation remains very interesting for psychiatric phenotype and nicotine addiction even though the a7/a7like showed no interaction in conferring risk for smoking in this sample.

The Asian Harm Reduction Network embarked upon a multi-site research conducted in four countries in Asia including Iran to gain insight in drug careers of young people and the impact of the environment. This article is the abridged synthesis of Tehran research report on description of the typical circumstances surrounding initial drug use in young people.

It was a qualitative research whose data were gathered through analysis of existing data; interviews with key informants; focus group discussions with family members, PUD (Person using drugs), service providers, policy makers, law enforcement officers; and a quantitative survey with 281 PUDs.

Curiosity, peer pressure and acceptance among friends are the most important factors that drive initiation. Having friends who use drugs is an important factor during the initiation stage. Mostly, the drug is given for free by friends and taking drugs is done with some good friends during initiation, as well as afterwards. The initial stage of one's drug use tends to be without any serious adverse effects or problems. Problems usually start -or become more serious- when dependency develops and money becomes an issue, which, in turn, can lead to criminal behavior. Financial consequences of one's drug use are often mentioned as the core problem. As expected, problems tended to become more pronounced, when people had switched towards injecting or towards an opiate.

Development community-building activities towards early detection of drug use might help young people not to continue their drug use.

The Asian Harm Reduction Network embarked upon a multi-site research conducted in four countries in Asia including Iran to gain insight in drug careers of young people and the impact of the environment. This article is the abridged synthesis of Tehran research report on knowledge on drug use and its related harms.

It was a qualitative research whose data were gathered through analysis of existing data; interviews with key informants; focus group discussions with family members, PUD (Person using drugs), service providers, policy makers, law enforcement officers; and a quantitative survey with 281 PUDs.

Mass media, governmental and non-governmental organizations can reach a large group of people, whereas school, parents and other family members fail to spread information on health issues such as AIDS and Hepatitis C. Drug related issues are commonly discussed with fellow PUD. Knowledge levels among PUDs in regards to HIV transmission are low. Knowledge on Hepatitis C is extremely low. The image of a drug does not significantly differ between PUDs who have used that particular drug and those who haven't. Most non-PIDs despite PIDs (People injecting drugs) are aware of health risks related to injecting and this is a major factor in the decision not to inject. The addictive nature of injecting is widely recognized amongst PIDs, yet PIDs remain optimistic about the possibility to be able to abstain.

Policy makers are urged to plan more towards youth in the field of education to reach the general population with information regarding HIV/AIDS and Hepatitis.

For health promotion policy purposes, switches towards and away from injecting as well as switches towards or away from an opiate are of great importance. The Asian Harm Reduction Network embarked upon a multi-site research conducted in four countries in Asia including Iran to gain insight in drug careers of young people and the impact of the environment. This article is the abridged synthesis of Tehran research report on description of the typical circumstances surrounding initial drug use in young people.

It was a qualitative research whose data were gathered through analysis of existing data; interviews with key informants; focus group discussions with family members, PUD (Person using drugs), service providers, policy makers, law enforcement officers; and a quantitative survey with 281 PUDs.

Drug careers of young people tend to be dynamic and changeable. 26% switched towards an opiate and 50% of the respondents switched towards injecting at some stage in one's career. Expectedly, the occurrence of positive switches is low, compared to negative counterparts, yet maybe not as low as one might have expected. Shifts from one drug to the other as well as from one mode of intake to the other occur regularly and sometimes very quickly. More than 40% of the respondents switched to injecting after having used other modes of intake for more than five years.

Effectively targeting the period between the onset of drug use and switching to injecting for secondary prevention and harm reduction interventions might help PUDs.

The objective of the authors is to make a reflection about the causes of tianeptine abuse and dependence. In the scientific literature we can find case studies of anti-depressive dependence, which show amphetaminergic effects. In what concerns other anti-depressives, the information is rare, specifically about tianeptine. The few case studies reported until now, focus the psychostimulant effect as being the cause of the abuse and dependence. Though, a study case is described of a female patient, with 40 years old, previous history of alcohol abuse, who takes approximately 40 cigarettes per day and 10 cofee per day. She presents an history of tianeptine abuse for several years, which has become more severe in the last six months (1286 mg/day) and resulted in the third psychiatric hospitalization. The patient experiences and seeks for a psychostimulant effect and physically energizing through the excessive consumption of the drug. This tianeptine abuse is also accompanied by an excessive consumption of benzodiazepines (30 mg/day of bromazepam). Over the course of the hospitalization, we did not find physical symptoms and signs of withdrawal. Hepatic parameters were not affected. The authors conclued that the abuse and dependence of tianeptine seems to be an important problem in patients with history of abuse and/or dependence of other substances. Thus, this treatment and the implications that it may have in this population need more investigation.

Kashmir has observed increase in number of Substance dependence patients due to various factors like easy availability of drugs, drugs smuggled across border, unemployment but most importantly present disturbed conditions for last two decades. Drug use appears to have an important role in vulnerability to development of psychiatric disorders and vice versa. Substance dependence Patients with comorbid psychiatric disorders are difficult to treat. A methodical, staged screening and assessment can ease the diagnostic challenge of distinguishing the symptoms of psychiatric disorders from manifestations of substance intoxication and withdrawal. This study was carried out on total of 300 substance dependence patients who were screened for psychiatric disorders by DSM IV based MINI Plus interview. The statistical analysis of the data was done by using Chi-square test χ2 test. The study revealed that 58% (n=174) had psychiatric comorbidity, Most of these patients with dual diagnosis of psychiatric Disorders and substance dependence 87.35% (n=152) belonged to < 38 year age group. Majority were males 95.40% (n=166) and unmarried/ divorced 64.36% (n=112), Illiterate patients out numbered educated 45.97% (n=80). Most of the patients in this study were unemployed 41.37% (n=72). Peer group pressure / curiosity (54.02%) were the most common precipitating factor followed by the traumatic stress (12.64%). Most common substances used by these dually diagnosed patients were cannabis (37.93%) followed by combination of Opioids & benzodiazepines (32.75%). Commonly associated psychiatric disorders were psychotic disorders (33.90%), mood disorders (32.18%) & post traumatic stress disorders (PTSD) in 11.49 %.

Substance dependence (SD) is one of the commonest comorbidities among patients with Anxiety Disorders (AD). Treating patients' co-occurring Anxiety disorders may reduce their substance craving and taking and enhance their over all outcomes. A methodical, staged screening and assessment can ease the diagnostic challenge of distinguishing the symptoms of anxiety disorders from manifestations of substance intoxication and withdrawal. This study was carried out on total of 561 substance dependence patients who were screened for Anxiety disorders by DSM IV based MINI Plus interview. The statistical analysis of the data was done by using Chi-square test χ2 test. The study revealed that 62.56% (n=351) had psychiatric comorbidity, with Anxiety disorders comorbid in 27.35% (n=96) dually diagnosed patients. Out of these 96 patients with comorbid anxiety disorders, 44.79% (n=43) had PTSD (Post Traumatic Stress disorder), 30.20% (n=29) had GAD (Generalized Anxiety Disorder), 13.54% (n=13) had OCD (0bsessive Compulsive disorder) and 11.45% (n=11) had panic disorder as comorbid diagnosis. Most of these patients with dual diagnosis of Anxiety Disorders and substance dependence 69.79% (n=67) belonged to < 35 year age group. Majority were males and unmarried. Illiterate patients out numbered educated. Most of the patients in this study were unemployed. Most common substances used by these dually diagnosed patients were cannabis followed by combination of opioids & benzodiazepines.

The Counselling Center offers an outpatient drug counselling individual psychotherapeutic program. Specifically for cannabis users, the program allows the adjustment of the treatment intervention to the specific demands of this group, whereas treatment for other drug abuse does not always recognize or effectively treat cannabis abuse.

In , Greece, the great majority of the detoxification therapeutic programs addresses to heroin users and includes therapeutic communities and maintenance programs.

A primary problem is the difficulty to motivate users to seek treatment, because although they have already developed dependence to cannabis use, they often fail to make the association between their use and its symptoms. So they seek treatment after decompensation of academic, social and occupational performance or after involvement with the legal system.

Because of the high frequency of comorbidity among cannabis–dependant individuals, the users often seek treatment from a mental health service, where their abuse is ignored, and this results in rapid relapse while their dependence is still present.

Treating cannabis abuse without diagnosing and treating the underling disorder or symptomatology is not effective. Thus, treatment programs for cannabis dependence should include a dual diagnosis component in order to treat the user as a whole.

The establishment of such drug abuse programs offering treatment to people whose primary drug abuse is cannabis (or who are primarily addicted to cannabis) seems to be a necessity. Those addicts constitute a rapidly increasing population with particularities in recognition and in treatment of their dependence, something that is associated with physical and psychosocial consequences.

The Counselling Center applies drug abuse prevention programs for high school students, which aim at the development of basic skills for handling difficult situations and the encouragement of students to adopt a healthy way of life. Experiential techniques are used in the groups, which are coordinated by a specialist or a trained teacher.

The approach of this age group within the school and the incorporation of the meetings in the school program give the opportunity for an intervention which is regardless of socio-demographic characteristics.

The programs include 5–7 two hours sessions, but can be expanded since they are part of a broader health education program which includes creative activities and activation of students in the community by sensitizing others in issues such as drug abuse, racism, social exclusion, etc.

The active involvement of students in such activities reinforces effectiveness of prevention programs and willingness for participation. One more factor that plays positive role in the effectiveness of such programs is the participation not only of specialists, but of trained and sensitized teachers as well.

It seems that the careful planning of prevention programs, the incorporation of the interventions in the school program, and the active participation of the educational community contribute greatly to the achievement of the programs' objectives which are the change of the attitudes towards drug abuse through the development of social and personal skills, as well as the adoption of principles such as respect of self and others, cross-cultural communication and support.

Substance misuse in pregnancy is a complex issue requiring multi-agency working between drugs agencies and obstetric services.

The Confidential Enquiries into Maternal Deaths (2000-2002) found that, when all deaths up to 1 year from delivery were taken into account, psychiatric illness was not only the leading cause of indirect death, but also the leading cause of maternal deaths overall.

Moreover, misuse of alcohol and illicit substances during pregnancy has been associated with significant obstetric maternal, fetal and neonatal complications. These include low birth weight, prematurity, fetal alcohol syndrome, fetal loss, and antepartum haemorrhages. Substance misuse also increases the risk for other conditions, for example, sexually transmitted diseases, hepatitis B, hepatitis C, HIV, and domestic violence. These associated problems can present significant risk to the pregnant mother and her unborn child in themselves.

The National Treatment Outcome Study has provided substantial evidence that treatment for adult drug misuse does work in that it reduces drug use, improves health and reduces criminality which benefits individuals, families and communities. Data from our multidisciplinary PDU service demonstrated that there was a statistically significant association between antenatal attendance at the PDU clinic and birth weight centile possibly by enhancing the much needed stability in the often chaotic lives of these young women since it gives them the opportunity not only for substitute medication but also to resolve housing, employment and other social issues and so limit the untoward effects of these factors on pregnancy outcomes.