Benzodiazepines are commonly prescribed since the 1960, when they replaced barbiturics. Although there is no doubt about their efficacy in treating anxiety, insomnia or other psychiatric disorders, we should also take into account the fact that these drugs are easily misused.

In this work we analyze the intake of benzodiazepines among patients hospitalized due to medical problems.

Retrospective review of clinical histories of patients attended by the Drug Unit of the Psychiatry Service in the last twelve months. Bibliographical review of the theme. Data analyzed using the SPSS software 15.0 version.

45 patients were subjected to our survey, 41 of them male. 66% were HIV Positive patients, and the most frequent cause of hospitalization was pneumonia (51’1%). Most of the patients attended were drug abusers (see the graphic below). When the benzodiazepines abusers were asked how they obtained them, 40’6% recognized the got them without prescription, 25% said they got them legally, and 34’4 answered that they got them legally but also without prescription. 62’5% of the patients usually took alprazolam.

Benzodiazepine abuse, in particular alprazolam, is quiet common among the patients we see.

In half of the cases the use of benzodiazepines could have worsen the prognosis of the patients.

The brain utilizing mechanisms of glucose for neuronal functions are still poorly understood. To identify a unified model of blood-brain glucose metabolism, we developed a model that incorporates the pancreatic β-cell and the fishbone models of glucose metabolism and called it the CoBBGluM Model (or the Convergence model of Blood-Brain Glucose Metabolism) and examined the role of addictive substances (alcohol, cocaine etc) on the functions of the model.

The databases of Pubmed, Elsevier were searched for peer reviewed literatures (from 1950-2009yy) on the mechanisms and models of blood-brain glucose metabolism.

The major concept of the unified model is based on the fact that the major regulators (leptin and insulin) of blood-brain glucose metabolism work synergistically, rather than individually. Addictive substances adversely affect the blood-brain glucose transport system by their stimulating and toxic action on the control mechanisms of leptin and insulin. The metabolic byproducts of addictive substances might acquire electron-transmitter properties across mitochondrial membranes. All these processes subsequently lead to total equilibrium disorder of the CoBBGluM Model, and is the etiopathogenetic basis of most addiction-associated neurodegenerative disorders. Adequate therapies for addiction might lie on the full understanding of the CoBBGluM Model, since it serves a classical tool for explaining the role of addictive substances in the nervous system.

Moderate alcohol use might be detrimental under certain conditions. We examined the efficiency of maintenance of blood glucose level (BGL) at normal range among non-alcohol and moderate alcohol users under intensive mental activities.

Fourth year medical students - male volunteers (5 non-alcohol and 8 moderate alcohol users who had abstained from alcohol for the last 7-10 days before the study) were involved in the study, which took 6 hrs on fasting. AUDIT, texts and questions, tests on visual, auditory short-term memory and attention were used as a measure. BGL was measured at 2hrs interval. Hypoglycemia was defined according to Galan ED et al (Neth J Med 2006; 64 (8): 269-279) as BGL ≤4.5mMole/L. The t-test was employed for statistical analysis.

Alcohol users on the average drank 23ml of pure ethanol/session and 1-2 times/month. Non-alcohol users had increased BGL (4.02 as initial to 5.76mMole/L after 6hrs) in all phases of the experiment (ð< 0.001). Alcohol users had increase in BGL (0.45mMole/L increase, initial - 4.20) within the first two hours and a significant fall in the 4-6 hrs (p< 0.05) up to 3.80mmole/L, and was accompanied by a significant decrease in mental work productivity coefficient.

Alcohol use even in moderate doses results in hypoglycemia, subsequently leading to low mental work productivity, especially under 4-6 hr intensive mental activities.

Alcohol use is a major public health problem in the general students’ population in Belarus. We therefore screen for the prevalence and trace the order of increase in alcohol use and related problems among students in Belarusian universities.

A total of 565 (1st-2nd courses, mean age - 19yrs); 537 (3rd - 4th courses, mean age - 21yrs); and 397 (5th - 6th courses, mean age - 23yrs) university students in Minsk, Belarus were administered questionnaire, containing the AUDIT, CAGE. The cut-off point on the AUDIT was set at 8. All statistical analyses were performed using SPSS 16.0 version for Windows; the criteria of Pearson, χ2 and Student's t testsñ. The probability value for significance was set at p< 0.05.

Alcohol use and related problems increased with increase in the average age and year of study. In the 1st - 2nd, 3rd - 4th, 5th - 6th, alcohol users were 83.6%, 85.6%, 94.2% respectively and problem drinkers were 14.5%, 17.9%, 20.9% respectively. The use of strong strength alcoholic beverages was linked to a high risk of alcohol problems.

The level of alcohol use and related problems in the general students’ population in Belarus are high and show increase in order of increase both in the average age and the year of study.

The UK NICE Guidelines recommends Contingency Manangement as “the only psychosocial intervention wIth clear evidence for effectiveness as an adjunct to drug detoxification”.

Most resarch has been done with money,vouchers as incentives,raising ethical issues.

The aim of this study is to analyze the subjective attitudes of clients and changes in their recovery process,when awarded certificates as incentives for giving clean drug screens and complying with care-plan.

Clients were awarded 3 tiered certificates on providing a specific number of random consecutive negative drug screens to Heroin and Cocaine. Screens were deemed positive, if the client did not attend their appointments.

Level 1- three negative drug screens.

Level 2- six negative drug screens

Level 3- ten negative drug screens.

Study questionnares were filled by key-workers and clients.

15 clients received certificates.

12 clients knew about certificates before their treatment began.

100% clients reported higher motivation to achieve subsequent certificates.

100% clients reported ‘encouragement’ to produce negative drug screens.

73% clients reported ‘encouragement’ to attend appointments with key-workers.

100% clients reported improved self-esteem.

100%clients reported positive responses from family, friends and clinicians.

100% reported a positive shift in their attitudes & behaviours towards drugs.

A few clients agreed that certificates enhanced their determination to give negative drug screens but would have done either ways.

Contingency management is a positive and effective adjunct to opiod detoxification. It should be incorporated into detox regimes more robustly and consistently.

Certificates as Contingency management raise no ethical issues,requires no staff training and requires low budget.

Through years of practice on Substance Abuse Word in Specialized Psychiatric Hospital Kotor in Montenegro, we had an opportunity to work with a significant number of addicts who were sentenced for mandatory treatment in psychiatric hospital. Patients came mainly from group who committed criminal acts either under influence of alcohol or whose actions were determined by heroin addiction.

To analyze the nature of criminal acts between forensic patients with alcohol and heroin abuse problem.

To distinguish characteristics between these two groups

These two groups were compared according to data collected for each patient individually. Data was based on court sentences, forensic evaluation reports, observation during treatment, psychologist's and psychiatric findings. This data gave a better insight into motives, circumstances, and nature of criminal acts for each patient. In this way, we were able to distinguish common aspects of criminal acts both for group of alcoholics and group of heroin addicts.

Our study has shown that nature of criminal acts among addicts significantly differs regarding type of addiction, in this case alcohol and heroin ones.

In general, criminal acts of alcoholics are more violent in nature, often are related to family violence, and are driven by interpersonal conflicts, which is not a case for majority of heroin addicts. Furthermore, while motive of heroine addicts is mostly to reduce abstinence crisis, we have found that in alcoholics it mostly deals with reckless behavior and acting - out behavior in state of intoxication.

According to 2008 data, there are 80.000 patients undergoing replacement opiate programs (RMP) in Spain. However, the clinical therapeutic management and the psychiatric and medical comorbidities have not been well described.

To describe the current therapeutic management and psychiatric comorbilities of opiate-dependent patients undergoing a RMP in Spain.

We carried out an observational, cross-sectional, multicenter study from September 2008 to February 2009. Patients > 18 years, with written informed consent, with a opiate-dependence according to DSM-IV-TR criteria and currently scheduled in a RMP in Spain were included.

624 patients (38.89±7.95 y.o.,84% men) were included in the study from 74 centers.

Psychiatric comorbidities were clinically detected in 68% of all valuable patients, most frequently anxiety (53%), mood (48%) and sleep disorders (41%). Patients receiving buprenorphine-naloxone suffered less sleep disorders (19% vs. 43%; p=0.0327) The proportion of patients with at least one psychiatric comorbidity was directly related to methadone dose (p=0.0066).

The most frequent replacement therapy was methadone (94%), usually in ≤ 40 mg/day (38%) and 40-80 mg/day doses (40%); mean follow up period being 45.88±51.86 months. Significant differences were found between methadone doses and retention. Patients with HIV and HCV infection received higher doses of methadone (HIV+ patients (p=0.0024) and HCV+/ HIV+ patients (p=0.0250) due to ARV treatment; and showed less PMM retention.

Patients present high rates of dual diagnosis, and infectious and non-infectious comorbidities, expecting higher doses of methadone than found (54.04±47.26 mg/day) in the study to assure a proper retention in the maintenance programs.

Describe the prevalence and characteristics of psychotic symptoms in the context of cocaine injection use in a harm reduction program.

To find associations between intravenous cocaine use and other drug use in cocaine dependent patients suffering from cocaine induced psychosis (CIP). Cannabis was found to be a risk factor for developing CIP in non-intravenous cocaine dependence.

During a period of 6 months professionals from our Outpatient Drug Clinic completed a confidential questionnaire to describe the adverse clinical effects following cocaine injection. It included age, gender, ethnic group, daily consumption rate and other drugs used in the last 30 days.

Survey was achieved with a sample of 75 Caucasians patients, 69 men and 6 women with an average age of 32 years old. Seventeen percent (13/75) had psychotic symptoms, of which 84% (11/13) had hallucinations (visuals 4/11, auditive 7/11 and kinaesthetic 2/11), 15% (2/13) illusions.

Eighteen percent (14/75) had stereotypy movements and 3% (2/75) had aggressive behaviour. Drugs used by CIP patients, the previous 30 days were: 61% (8/13) cannabis, 31% (4/13) opiates and 15% (2/13) alcohol.

Intravenous cocaine use produced acute psychotic symptoms in 17% of our patients, of which 61% used cannabis. Despite the ethical and practical implications of this type of study, it is necessary to do more observational studies with bigger surveys to conclude these results with statistically significance.

Investigation of mental disorders in 377 patients who met ICD-10 criteria for opioid dependence.

Clinical observation and psychological examination.

It was shown that mental disorders of opioid addicts consist of three types of psychopathological categories: pro-addictive phenomena (personality features and co-morbid disorders predisposing to drug abuse), meta-addictive disorders (psychopathological states gained due to drug abuse) and addictive disorders proper (craving and drug-seeking behavior). Anxiety and other neurotic symptoms are predominant types of mental disorders in opioid addicts. The core disorder of neurosis spectrum disturbances is fear of abstinence or withdrawal phobia. Withdrawal phobia determines largely negative reinforcement of drug. This phenomenon results in anticipating intake of drug and augmentation of daily drug dose. Opioid abuse leads to addictive personality deformation which including such features as constant and hypertrophied demand for positive emotional states, intolerance to frustration and other discomfort, low threshold of stress susceptibility and increased stress vulnerability, permanent urge to modulate the psychic and physical condition by dint of drug use, marked egocentricity and motivational collapse. Distorted motivational hierarchy can be illustrated by phenomenon of attractive taxis: opioid addicts show preference for the activities which lead to afford pleasure only. “Illegal exploitation” of reward system by means of drug abuse results in crucial extinction of non-rewarding routine activities (such as work or studies).

It appears that a stability of neurotic spectrum disorders and addictive personality deformation is the principal reason of low efficiency of opioid dependence treatment.

Study of a patient population with drug problems. Analyses of demographics and drug abuse data.

We examined medical files of all new patients who attended the outpatient clinic of the Drug and Drug Abuse Institute in Coimbra, Portugal, during a period of a year, in order to characterize this population.

A sample of 171 patients, predominantly male, age ranging from 15 to 54 years-old, was evaluated. Within our sample, low education predominates, with early school drop-out. The predominant initial drug (excluding alcohol and tobacco) was hashish. The age of onset of consumption varied between 7 and 38 years-old. The main drug of most patients is heroine (n=100), and most started their consumption between ages 15 and 18 years-old.

The best treatment of substance abuse is prevention. While there are well-controlled studies available for the treatment of substance use disorders in adults, no such studies are available for children or adolescents. Psychological, although not physical, dependence has been reported with cannabis use. Regular users may withdraw from the challenges of the external world into a state of chronic low motivation. Such individuals then become at risk for entering into more dangerous drug-taking activities. Earlier adolescent substance use and heavier adolescent substance use are associated with greater risk of later drug problems. In addition to providing a service to people with drug problems, it is necessary to focus on prevention and discourage the consumption of the so called mild drugs.

To benefit from the usefulness of ultrasonography in measurement of common bile duct in opiate addicts and to correlate between the common bile duct (CBD) diameter and the duration of addiction.

Fifteen addicts, diagnosed according to DSM IV diagnostic criteria, were examined by abdominal ultrasound. The common bile duct is measured and the results were analyzed with other factors like age, the period of addiction, laboratory findings.

According to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.01) and there was a positive significant correlation between the CBD diameter and the period of addiction (p < 0.05, r = 0.875); the multiple comparisons shows that the significant difference between the 3 age groups were due to a significance between group (1) & (2), and group (1) & (3) but no significance between group (2) & (3). So, with the increased length of the addiction period, the mean CBD diameter increases.

In opiate addicts, the common bile duct is found to be dilated; however with normal serum bilirubin and alkaline phosphatase level and no obstructive causes by ultrasound examination, no need for any further assessment.

Emotional intelligence (EI) can play crucial role in improving individuals’ performance in many aspects such as career prospects in organizations, employees, consulting centers and psychological health centers across the world. So for better and more understanding of emotional intelligence, this study investigated Emotional intelligence and personality traits in addicted people.

Participants were 42 addicted people that randomly selected and Mc Care & Costa's NEO PI-R inventory and Shutte's self report emotional intelligence test (SSREIT) were administered on them. The data were analyzed with Spearman correlation Coefficient formula.

Results showed that high emotional intelligence was related positive and significant with Extroversion, Openness to experience and Conscientiousness.

It is recommended to set the programs for enhancing the emotional intelligence to increase mental health, life satisfaction and social skills in order to have personality and psychological health and prevent tendency to abnormal behaviour specially tendency to addiction.

Over The Counter (OTC) medication abuse is an increasing yet under-researched public health concern, particularly in the UK and Ireland. Our study provides a descriptive analysis of the clinical profiles; treatment and prevalence of patients admitted with OTC opiate abuse.

Using a specially designed demographic form, the records of patients admitted to St. Patrick's Hospital, a 280 bed inpatient mental health and addiction treatment facility in Dublin, Ireland with a diagnosis of harmful OTC opiate abuse or opiate dependency as defined in ICD-10 were reviewed retrospectively. All patients diagnosed with OTC opiate abuse (ICD F11.1) or dependency (ICD F11.2) on admission to our centre were included in the study. Patients with a diagnosis of primary illicit opiate misuse were excluded. Diagnoses were established by a consultant psychiatrist.

Approximately 1% (n=20) of inpatients admitted in a year were diagnosed with OTC opiate abuse. The average daily codeine intake was 261.10 mg per person. Seventy five percent (n=15) of the inpatients experienced OTC opiate withdrawal and were treated with protocol driven withdrawal regimes for an average of 16.10 days. The female: male ratio was nearly 2:1 with an average age of 49.2 years. Patients tended to have comorbid psychiatric (n=19, 95%), physical (n=17, 85%) and polysubstance (n=13, 65%) illness. The relapse rate of re-admissions within six months of discharge was 35%.

OTC opiate abuse is a covert illness since abusers often have significant comorbid psychiatric, medical and polysubstance illness making its assessment, diagnosis and subsequent treatment challenging.

The only randomized trial comparing the efficacy of disulfiram against placebo showed no differences in recovery time of alcohol consumption or total abstinence. Moreover, even if the potentially dangerous side effects are rare, their risks overcome the hypothetical benefits. Therefore, in December 2007 the division of addictology, department of psychiatry, decided to stop Disulfiram prescription. The healthcare team's perception of this decision was monitored.

An auto questionnaire (31 questions) was administered to the healthcare team in June 2009 for a 3 month period evaluating their perception of the utility of Disulfiram and of the pertinence of the decision.

Demographics: 55 participants (response rate 61.1%), 54.1% women, age (M = 43.7).

Professions: 54.8% nurses, 30.6% MD, 9.7% social workers, 4.8% psychologists.

78.7% participants already worked in the team in December 2007.

54.6% didn’t agree to stop Disulfiram prescription. While 72.2% think that the decision is based on evidence based medicine, 69.1% think that Disulfiram works because of the context of administration and 69.1% think it works because of the fear generated by its effects, 75.5% still believe that Disulfiram is useful for some patients (76.8% at the time of the decision).

Despite the fact that aversive treatments in addictology have failed to demonstrate an efficacy through EBM, the perception of its utility is still strong in caregivers. While most of them admit that it works mainly trough psychological constraints, they don’t support the fact that EBM could generate a practice change such as stopping Disulfiram prescription.

Most of brief instruments of evaluation of substance related disorders focuses on the dependence physical indexes and/or on compulsion, evaluating only incidentally the dependence-related social and psychological factors. Our aim is to create and validate a short questionnaire, easy to be distributed, exploring the dependence social and psychological indexes and to be used to evaluate the effectiveness of the therapeutic and rehabilitation treatments whose aim is to change lifestyle as well as abstinence.

The S.A.I.D. is an auto-evaluation questionnaire of 39 items that explore emotions, thoughts and behaviours in addictive subjects, thus providing patient's diagnostic profile in two areas: social area, divided into 4 scales (work/study, relationships, social interaction, cure/physical health); psychological area, divided into 5 scales (depression, hostility, lack of attention, anxiety, alexithymia).446 subjects have been examined: 256 with alcohol dependence diagnosis by using DSM-IV-TR, 70 with cocaine dependence diagnosis by using DSM-IV-TR, 120 not clinical subjects representing the control sample, that are not under psychiatric treatments.

The statistical analysis by Student's t test has showed that the instrument is able to discriminate between alcoholics, cocaine addicts and healthy control subjects; Cronbach's Alpha analysis has noticed a good internal validation in two main areas of the questionnaire, but a substantial unhomogeneity about single subscales.

These results indicate that the instrument is useful for the overall evaluation of social and psychological impairment in addictions, but also suggest the need for a revision of the instrument aiming to a better internal consistency of subscales.

Analysis of Rorschach inkblot responses of 22 alcohol-depended patients of the Acute Ward, Psychiatric Hospital of Petra Olympus, Greece.

The Acute Ward is a relatively small psychiatric ward that receives both voluntary and involuntary admissions of psychiatric patients of a catchment area of about 1000000 people.

The material used for this study was the Rorschach inkblot responses of 22 alcohol-depended patients (19 males, 3 females) that were hospitalized in the Acute Ward during the first semester of 2009. The test was administered once, 2-5 days after admission and scored according to J.E. Exner's Comprehensive System.

Rorschach profile was similar for most of the cases. 19 out of 22 Rorschach performances (with no significant differences among the sexes) revealed recurrent attempts to elucidate alcoholic ‘signs’ and put forward characteristic alcoholic perceptual style. These patients also produced more responses revealing greater interest in other people, marked though by ambivalence, feelings of aggression and withdrawal or isolation from social interaction. Dependency needs were also exhibited.

The Rorschach inkblot test is a psychological projective test of personality in which subjects’ interpretations of 10 standard abstract designs are analyzed as a measure of emotional and intellectual functioning and integration. It gets into the deepest recesses of patients’ psyche or subconscious mind. In the case of these alcohol-depended patients displayed specific problems of personality structure comprising a concrete Rorschach profile.