There is growing evidence that cognitive deficits play an important role in the development, course and relapse of substance use disorders. In particular, functions that involve control over one's own behaviour (impulsivity), and over behaviour when confronted with motivationally relevant drug cues (craving) are related to relapse in recent studies. So far, pharmacological manipulations of cognitive deficits are rare and relapses after treatment are the rule rather than the exception.

Therefore, we performed a randomized, double-blind, placebo-controlled trial with modafinil, which is a known cognitive enhancer and a wake-promoting agent.

At first, the interaction between impulse control, overall cognitive functioning, motivational strength of drug cues, and vulnerability to relapse, will be elucidated in order to disentangle new treatment possibilities. Second, the effectiveness of a long term treatment with modafinil on impulse control and relapse will be explored.

83 abstinent alcohol dependent inpatients were randomized to a single morning dose of modafinil (300 mg/d), or matching placebo, for 10 weeks. Both neurocognitive tests (on impulsivity, craving and overall cognitive functioning) and self-report questionnaires were administered before, during and after treatment. Patients were followed up 6 months after treatment, to measure relapse rate. Primary outcome variables are test performance, craving ratings and relapse.

Data will be unblinded after finalizing the follow-up data collection. Therefore, results will be available from January 2012.

It is expected that modafinil improves cognitive functioning, increases time to first relapse and reduces relapse rates and relapse severity, compared to placebo.

This study aimed to investigate and compare the social skills of students addicted to computer games with normal students. The dependent variable in the present study is the social skills.

The study population included all the students in the second grade of public secondary school in the city of Isfahan at the educational year of 2009–2010. The sample size included 564 students selected using the cluster random sampling methods. Data collection was conducted using Questionnaire of Addiction to Computer Games and Social Skills Questionnaire (The Teenage Inventory of Social Skill or TISS).

There was a significant difference between the social skills of students addicted to computer games and normal students. In addition, the results indicated that normal students had a higher level of social skills in comparison with students addicted to computer games.

Addiction to computer games may affect the quality and quantity of social skills. In other words, the higher the addiction to computer games, the less the social skills. The individuals addicted to computer games have less social skills.

Ghrelin plays an orexigenic role in regulating appetite and energy balance. Preclinical studies also provided support for an important role of ghrelin in the neurobiology of addiction-related reward pathways. In contrast, clinical data have failed to support an association between ghrelin and alcohol craving, possibly due to analysing the pharmacologically inactive, preprohormone ghrelin instead of ghrelin in its active, acetylated form.

In a sample of 61 alcohol-dependent male inpatients we assessed plasma concentrations of both active and total ghrelin, using blood samples taken at the onset of withdrawal and then again after 14 days of controlled abstinence. During this time, we also assessed the patients' alcohol cravings (applying the obsessive compulsive drinking scale, OCDS), symptoms of depression (Beck Depression Inventory; BDI) and anxiety (State Trait Anxiety Inventory; STAI). The severity of alcohol dependence was assessed using the alcohol dependence scale (ADS).

We found a significant positive correlation between the plasma concentration of active ghrelin and alcohol craving in both blood samples. In a linear regression model, the plasma concentration of active ghrelin on day one, the scores of the ADS, and the BDI explained 36% of the variance in OCDS sum score (p < 0.0001). By day 14, these same factors accounted for 54% (p < 0.0001). We did not detect any association between the plasma concentration of total ghrelin and patients' alcohol cravings.

Our results suggest that biologically active, acetylated ghrelin is involved in reward-associated craving during alcohol withdrawal and early abstinence in alcohol-dependent patients.

Depressive symptoms frequently co-occur in alcohol dependence. However, little is known about the relationship between depressive symptoms and personality functioning in alcohol dependence.

The aim of this study was to reveal the role of depressive symptoms in the adaptivity of personality functioning. Therefore, alcohol-dependent patients with and without depressive symptoms, depressed patients and normal controls were compared along the personality factors of the biosocial model.

Depressed patients (N = 57), alcohol-dependent individuals with (N = 41) and without (N = 41) depressive symptoms, and normal controls (N = 55) were involved. The Beck Depression Inventory was administered to determine the severity of depressive symptoms. Subjects were tested using Cloninger's Temperament and Character Inventory-Revised, which measures 4 temperament: novelty-seeking (NS); harm avoidance (HA); reward dependence (RD); persistence (P) and 3 character dimensions: self-directedness (SD); cooperativeness (C); self-transcendence (ST).

Alcohol-dependent groups showed higher level of NS than depressed and control subjects (F = 6.33, p < 0.001). Alcohol addicted patients with depressive symptoms and depressed individuals scored lower level of HA than the other groups (F = 21.41, p < 0.001). In the case of P the lowest score was observed among alcohol-dependent individuals with depressive symptoms (F = 3.63, p = 0.014). On the SD (F = 25.25, p < 0.001) and C (F = 3.61, p = 0.014) all 3 patient groups showed significantly lower scores than normal controls.

Based on the severity of depressive symptoms, alcohol addicted persons show different personality profile. Our results suggest that depressive symptoms are related to maladaptive personality functioning in alcohol dependence; therefore it has to be considered during the treatment process. TÁMOP-4.2.1/B-09/1/KONV-2010-0005

Tramadol is one of the most prescribed centrally-acting analgesic in the world. It has been widely used in Iraq over the last few years. There are many contradicting studies about the potential risk of tramadol abuse in the world. In this piece of work we have tried to describe a group of patients referred to the main addiction unit in Baghdad with Tramadol Abuse.

41 patients referred to the addiction unit in Ibn-Rushed Mental Teaching Hospital in Baghdad with Tramadol abuse problems, were screened, and 36 were included in this Cross Sectional study.

78% were males & 22% were females. Their age were 16–57 y(mean27 y).90% of the sample were on Tramadol alone & 10% on polydrugs. About 92% of them were iatrogenic abusers. Most of the patients were without previous history of drug abuse. More than one fifth of the patients had at least one seizure. About one fifth of the sample were health professionals.

Tramadol is freely and widely used in Iraq. Tramadol has a clear risk of causing dependency syndrome and this has been nearly almost always iatrogenic in our study sample. Tramadol abuse seems to be a growing problem in Iraq.

ADHD is not only a risk factor to the beginning of substance abuse but also is a determining factor in terms of long-term use and difficult treatment. Therefore, detection of the presence of comorbidity is important in terms of treatment approach.

The aim of this study is to screen the presence of adult ADHD in patients diagnosed with substance abuse disorder.

120 patients who were diagnosed as substance abuse disorder according to DSM-IV were included in the study. Wender-Utah Rating Scale and Adult ADD/ADHD (attention deficit disorder/attention deficit hyperactivity disorder) inventory were performed to the patients. Patients who scored above the cut-off score of these scales were evaluated clinically in terms of adult ADHD.

16 of 120 patients (13.3%) included in the study were diagnosed as adult ADHD on the basis of scales and clinical evaluation. When the abused substances were evaluated; 36% alcohol, 21% cannabis, 11% cocaine or other stimulants and 5% multi-drug addiction have been identified.

Overall, 15%–25% of adults with drug and alcohol use disorders have current ADHD. ADHD itself appears to be a risk factor for later substance use disorders, with onset typically around 17–19 years of age.Individuals with both diagnoses have been reported to have an earlier onset, a longer course, and greater severity, with more relapses and greater difficulty remaining abstinen. In summary, the neuropsychological and neurobiological literature indicates important overlaps between ADHD and substance use disorders, and the two need to be treated in tandem.

The aim of the study is to assess graphomotor and psychomotor skills of people treated with substitution therapy in opiate addiction.

36 patients were examined twice, immediately before and about 1.5h after oral administration of therapeutic dose of methadone. The original test implemented on a tablet was used. A task in the first part was to map, as accurately as possible, geometric shapes printed on the sheet of paper by drawing on contour, and in the second part to sign up on the sheet. The patients used dominant hand. The software used allows to make analysis of the motion's parameters: time, force levels, speed and acceleration of the plot, amplitude and frequency of hand tremors.

The amplitude of tremors in the spectrum of variations in 13 of the 16 components analyzed in the drawing task and all the components in the spectrum of the instantaneous velocity tremors were reduced. In the signature task a significant reduction in the average amplitude of tremors for medium and higher spectral components (from the 4th up) and a reduction in the amplitude of tremors in the spectrum of instantaneous velocity for most precisely analyzed components was observed.

A single dose of methadone in opioid-addicted individuals reduces dominant hand tremors, particularly in the 1st spectrum component frequency for the drawing test. This indicates improvement in graphomotor and psychomotor function.

The burden and cost of alcohol problems are high, but their full personal, social and economic impact has yet to be accurately estimated.

The aim of this systematic review is to compile existing data from literature (2005-10) on psychosocial difficulties (psd:s) related to alcohol dependence. We focus here on social consequences defined as restrictions of activities and participation according to the International Classification of Functioning, Disability and Health (ICF).

As part of PARADISE (Psychosocial fActors Relevant to BrAin DISorders in Europe), an EU funded project under the Seventh Framework Programme, a database search of MEDLINE and PSYCHINFO was conducted using a defined strategy. Identified literature was checked against predefined eligibility criteria. Using a standardized protocol, information was extracted from full papers about study characteristics and results, psd:s, their evolution, and determinants of onset.

Of the 260 papers included, 137 dealt with limitations in activities and participation. The most frequent social consequences were difficulties in interpersonal relationships, employment and looking after one's health. The most significant determinants of these difficulties were related to the course and severity of alcohol dependence and lack of social support.

General social functioning was measured in 25 papers. Improvement of social functioning was associated with treatment interventions that had a positive impact on the brain disorder (abstinence or reduced drinking).

Limitations of activities and participation are frequently reported in alcohol dependence. Interventions targeting alleviation of the underlying condition can contribute to reduction of these difficulties.

It is well known that alcohol consumption increases the risk for oropharyngeal malignancy. However, we have no systematic practice of detection and prevention of drug consumption by ORL professionals.

1. - Identify alcohol use in patients with oropharyngeal neoplasia and first-line approach of problematic drinking by ORL professionals.

2. - Identify the level of anxiety and depression

Cross-sectional study. 191 cancer patients treated sequentially in the Clinic Hospital (Barcelona, Spain) during two months by clinical interview, AUDIT, CAGE and Hamilton Depression Scale.

1. - 89% of the sample are long time smokers (more than 25 yrs) but 85% of them stop smoking once they are diagnosed with cancer.

2. - 85% consume alcohol out of whom 39% drink at risk. 12% of them persist with risky drinking after diagnosis.

3. - Only in 42% the doctor recommends to reduce or stop alcohol consumption. There is a statistically significant correlation between the existence of such a recommendation and the variation in consumption.

4. - Better prediction of risky drinking by Audit C than by Audit.

5. - Positive correlation between anxiety and newly diagnosed cancer,

1. - It is important to perform an alcohol screening and to give medical advice to reduce alcohol consumption.

2. - To be conscious of the anxiety levels of newly diagnosed patients.

Emergence of alternative treatment goals to abstinence in alcohol use disorder call for the development of an assessment instrument relevant to the different therapeutic objectives, especially those that meet patients' concerns. Although the measure of quality of life is now considered relevant in alcohol use disorders, reliability, content and sensitivity to change are still sensitive issues.

The purpose of this review is to clarify the concept of quality of life used in clinical trials in alcohol dependence. We described the instruments and identified the life domains explored.

After a systematic search on PubMed, clinical trials that aimed at improving the quality of life in alcohol dependent patients and used an instrument to measure the quality of life as specifically designated by the authors were included.

Of the 46 articles screened, 23 studies were included. Fourteen instruments were used as an outcome measure. Thirty-two life domains with high between-scale heterogeneity were explored. The scale used most frequently was the SF-36, a generic health status measure. The quality of life improved in more than three-quarters of the trials. However, only one-third of the comparative trials demonstrated a significant difference between groups.

The comparison of the trials on quality of life improvement is hindered by the variety of instruments. The instruments currently used may not collect information that is both relevant and accurate. The construction and validation of specific patient-reported outcomes would significantly progress the assessment of treatment efficacy.

Current treatments for alcohol dependence, aiming to keep patients abstinent, have shown limited treatment and success rates. Reduction of alcohol consumption is increasingly recognised as a valid and needed option that should be an integrated part of the management of alcohol-dependent patients.

The main objective was to evaluate the efficacy of as-needed use of nalmefene 18 mg (base) versus placebo in reducing the monthly number of heavy drinking days (HDDs) and the monthly total alcohol consumption (TAC; g/day) over 24 weeks in alcohol-dependent patients.

Drinking measures were derived from daily drinking estimates collected with the Timeline Followback method. Safety and additional efficacy data were collected throughout the study.

A total of 604 patients (mean age 51.6 ± 9.6 years, 67% men) were randomised (298 to placebo and 306 to nalmefene). There was a significantly superior effect (mixed model repeated measures) of nalmefene compared to placebo in reducing the number of HDDs (−2.3 ± 0.8 [95% CI −3.8; −0.8]; p = 0.002) and TAC (−11.0 ± 3.0 [95% CI −16.8; −5.1]; p < 0.001). Improvements in Clinical Global Impression - Global Improvement and Severity of Illness scores and reductions in liver enzymes gamma-glutamyltransferase and alanine aminotransferase from baseline were statistically significantly larger in the nalmefene group compared to placebo at week 24. Adverse events (generally transient; most were mild or moderate) and withdrawals were more common with nalmefene than placebo.

Nalmefene was efficacious in reducing alcohol consumption. Nalmefene was safe and well tolerated and dosing on an as-needed basis was feasible.

It is considered that cocaine could be a risk factor for the development of alcohol dependence. Prospective studies in healthy subjects support the idea that alcohol and cocaine use decreases the subjective feeling of inebriation and increases the sense of being “high”. The consumption of both drugs may accentuate the reinforcing properties of both drugs, thus increasing the vulnerability of subjects for developing drug dependence. Our objective was to investigate whether the risk for the development alcohol dependence is related with the interaction of both drugs at reward brain mesolimbic centres or it depends on the effect of cocaine at that brain mesolimbic structures.

The final sample (n = 112) comprised 4 groups: sample 1(alcohol-group), n = 47; sample 2 (alcohol-cocaine group), n = 35; sample 3 (cocaine-group), n = 30. The control group (n = 61) was selected to have matching demographic characteristics. After detoxification, alcohol-related pictures were compared to standardised appetitive, aversive and neutral control scenes using an acoustic-startle test.

Alcohol-startle magnitudes were lower in cocaine-dependent patients (samples 2 and 3) than in alcohol patients (sample 1). Subjects with cocaine dependence also exhibited lower magnitudes than participants included in the OH-group after viewing appetitive and aversive slides.

Our findings support the hypothesis that effects of cocaine at dopamine mesolimbic structures provoke higher appetitive responses to alcohol-cues. It is tempting to speculate that cocaine use may induce significant reduction in dopamine D2 receptors, which would increase the likelihood of developing dependence for other substances as alcohol used at the same time than cocaine.

Epidemiologic Studies show consistent evidence about Psychiatric Comorbidity in Opioid dependent patients. High rates of affective, anxiety and antisocial personality disorders are described.

Describe the most prevalent psychiatric disorders in opioid dependent patients in harm reduction programs. Highlight the importance of complete psychiatric evaluations in people with substance use disorders.

Descriptive study that selected a sample of 39 opioid dependent (with DSM IV-TR criteria) of 356 harm reduction patients the outclinic for Addictive Disorders of Vall d’ Hebron Hospital in Barcelona Spain. The sample completed SCID I and SCID II interviews, and gave demographic information.

Of the total 71.8% men. Mean age 37.55 years with (SD of 8.4), Mean age at the first heroine use: 20.46 years (SD 6.26), mean age of regular use of heroine 13.09 years (SD 9.3). Twenty three (59%) were in MMP. Work status: unenployment benefit (56.4%), pensioner (15.4%), employed (12.8%), others (7.7%), temporal disability (5.1%). Patterns of drug use was: daily (28.9%), not using (30.8%). Most frequent axis I disorders were: Mood Disorder secondary of substance use (30.8%), anxiety disorder (20.5%), psychotic disorder secondary of substance use (20.5%). Axis II disorders were: Antisocial Personality Disorder (33.4%) y Borderline Personality Disorder (31.7%).

It is a high rate of psychiatric comorbidities in patients with opiod dependence. It is evident that is necessary to give and integral health approach to this group with the objective of improve life quality and mental health, both will have a great impact in substance use course.

We tried to measure intensity of internet addiction according to Internet Addiction Test of Polish middle and high school students.

We examined 175 middle school students and 357 high school students. Average age of examined students was 16,4 years.

Our own Sociodemographic Inventory, Internet Addiction Test by Young, based on which we distinguished the group of 170 students (60 girls and 101 boys) in the preliminary phase of internet addiction and those who are not internet dependent.

1. 1. Middle school students are significantly more internet dependent than high school students.

2. 2. Middle school students significantly tend to prolong the time of internet use, they believe that life without internet is empty and boring.

3. 3. Middle school girls significantly more often than high school girls prolong the internet time, try ineffectively to limit the time online, they have also more intensive abstinence symptoms.

4. 4. The boys significantly more often tend to prolong time online and tend to shortened the sleep time because of internet usage.