To review the available evidence, after treat the case of a 50-year-old man with addiction history whose addictive behaviour worsened after undergoing bariatric surgery, with decreased tolerance to alcohol effect and increase of the intake, as well as changes in the graduation of alcohol used (including antiseptic). As a result, a dangerous revolving door that led him to repeated admissions, including Intensive Care Unit.

The case is consistent with the literature that suggests that there is an increased risk of later alcohol-related problems after bariatric surgery. This risk is higher several years post surgery, in patients with previous history of problems related to alcohol, young, men, and Roux-en-Y Gastric Bypass procedure.

The indications for bariatric surgery should thoroughly consider the history of addiction, an adequate assessment of the patient's mental status and psychoeducation about the possible psychiatric side effects, in order to develop preventive strategies.

The authors have not supplied their declaration of competing interest.

Comorbidity of depression and opioid addiction is highly prevalent, but their outcome in MMT is not consistent.

To compare between depressed and non-depressed MMT patients.

Hamilton depression scale scores (taken during a psychiatric assessment) were studied among MMT patients on admission or during treatment (cutoff for depression > 18).

A total of 498 MMT patients were studied. Depression proportion was 22.5%, and 23.2% among 263 who were studied on admission; the depressed vs. non-depressed on admission did not differ in female proportion (19.7% vs. 25.6%), age of admission (43.2 ± 10.4), opiate use onset (21.8 ± 6.3) and education years (9.5 ± 2.8), but had higher proportion of cocaine (55.7% vs. 35.1%, P = 0.005), and benzodiazepine abuse (73.8% vs. 58.4%, P = 0.04). Retention was high and similar (80.3 vs. 82.9% P = 0.7) and of those who stayed one year, cocaine and benzodiazepine were still higher among the depressed patients (cocaine: 43.8% vs. 23.2%, P = 0.03; BDZ: 61.2% vs. 40%, P = 0.01). Compared to the non-depressed, among all study group (n = 498) the depressed patients presented higher proportion of rape history (25% vs. 9.5%, P = 0.001), of suicide attempts (43.8% vs. 25%, P = 0.001) with only a trend of shorter cumulative retention in MMT of mean 9.4y (95% CI 7.8–10.7) vs. 11.5 (95% CI 10.5–12.5, P = 0.07).

Despite cocaine and benzodiazepine abuse on admission, depressed succeeded similarly to the non-depressed in the first year retention in treatment. Intervention is recommended since admission, as their long-term retention seems to be shorter, later on, and their ability to discontinue cocaine and benzodiazepine abuse is clearly hampered.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Pregabalin is widely used in neurology, psychiatry and primary healthcare, and recently in literature different studies explain the possible misuse [1,2]. Pregabalin has shown greater potency in preclinical models of epilepsy, pain and anxiety, and may have potential in the treatment of cocaine addiction [3]. The purpose of this report is to review the clinical evidence for the potential of abuse and misuse of pregabalin. We propose ten different cases and literature review.

Ten inpatients with misuse of pregabalin were assessed with: the SCID-P, Anamnestic Folio, HAM-A and DAST. We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “pregabalin”, “misuse”.

All our patients present: cocaine, alcohol and/heroin positive in drugs urine screening at admission; a significant high level of total anxiety at the HAM-A Tot (P < .001), and especially at the item 7 (P < .001); the misuse of pregabalin is made for sniffing; the predominant symptoms assessed were euphoria, psychomotor activation and sedation.

Schifano F et al., [1,2] suggest that pregabalin should carefully prescribe in patients with a possible previous history of drug abuse. Our result identifies a particular population the misuse pregabalin that are abuser of cocaine, alcohol and/or heroin. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.

The authors have not supplied their declaration of competing interest.

Alcohol dependence (AD) is a major public health problem. Currently, three drugs for the treatment of AD have been approved: acamprosate, disulfiram and oral naltrexone. Quetiapine XR is an atypical antipsychotic has been shown to be a promising medication for the treatment of alcoholism [1,2]. The aim of our study is evaluate quetiapine efficacy on impulsivity in a sample of alcoholic patients.

A sample of alcoholic patients (n = 40) was assessed at the entrance and 2 months with: SCID-P, Brief-Temps, BIS-11, GSR, BPRS, SCI-DER, and CGI. The medium dosage of quetiapine is 300 mg.

Using the last observation carried forward, the mean total BIS score decreased from 60.8 at baseline to 40.2 at the final visit (P = .03). More pronounced improvement was observed in motor impulsiveness (P < .03) and attentional impulsiveness (P < .05) compared with non-planning impulsiveness (P = .09). We observed an improvement in SCI-DER total score (P = .02), in particular in derealization (P = .03) and autopsychic depersonalization (P = .04). A mean weight gain of 4.8 kg was observed. There is not significant different related to the different affective temperament.

Analyses revealed a significant effect of Quetiapine XR in improving impulsivity and dissociation, in particular motor and attentional impulsiveness, derealization and autopsychic depersonalization. Moreover, an improvement of dissociative symptoms is probably connected with the blockade of postsynaptic 5-HT1A receptors [3]. Methodological limitations, clinical implications and suggestions for future research directions are considered.

The authors have not supplied their declaration of competing interest.

Methylphenidate is a CNS stimulant approved for treatment of ADHD. It is generally considered well tolerated and exhibiting low dependence potential, although diversion for recreational use has been described. Provided that its effects are comparable to those of more popular drugs of abuse, such as cocaine and amphetamines, we hypothesized that it could be sold as such.

The aim of this study was:

– to describe the presence of methylphenidate from the samples handled to, and analyzed by, Spanish harm-reduction service energy control between August 2009 and August 2015;

– to determine whether it is being sold as other drugs.

All samples presented to energy control (EC) were analyzed. EC is a Spanish harm-reduction non-governmental organization that offers to users the possibility of analyzing the substances they intend to consume.

Samples in which methylphenidate was detected using Gas Chromatography–Mass Spectrometry were selected for this study.

From a total of 20062 samples, 17 contained methylphenidate (0,09%), with no clear variations among the years studied. The samples were mostly sold as amphetamine (29%), methylphenidate (23%) and ethylphenidate (18%).

Presence of Methylphenidate in the Spanish illegal drug market seems anecdotic and stable over the studied timeframe. Moreover, it was sold as substances with similar dosages, lowering potential for life-threatening intoxications. Therefore, our results suggest that diversion of methylphenidate into the drug market as adulterant is not a concerning phenomenon.

The authors have not supplied their declaration of competing interest.

Buprenorphine, a partial agonist of mu opioid receptors and an antagonist at kappa opioid receptors, is widely used in the treatment of the opioid addiction, as it reduces cravings and effects of opioid withdrawal, decreases opioid consumption and diminishes rewarding effects of it. In University Psychiatric Hospital Vrapče, the oldest psychiatric hospital in Croatia, buprenorphine maintenance therapy is a standard and important part of integrative psychiatric treatment offered to opioid drug users.

To show potential benefits of buprenorphine maintenance therapy as a pharmacological agent in psychiatric care for opioid drug users.

To describe series of clinical cases in which the introduction of buprenorphine in therapy of opioid drug users lead to reduced number of their hospitalizations.

Clinical cases from University Psychiatric Hospital Vrapče Addictions Treatment Department were identified and the course of patients’ treatment was analyzed. Summaries of cases, with the emphasis on protective factors for stabile maintenance, are presented.

After switching patients from various opiates to buprenorphine in a controlled in-patient environment, our patients became more functional and their integrative psychiatric treatment could then start. After discharge, an improvement was visible in different dimensions of their lives, and the re-admittance was the exception, since recidives were rare. They continued their treatment actively, in outpatient programmes of our clinic.

Drug-seeking behaviour of presented opioid users was avoided by buprenorphine maintenance therapy provided with intermittent psychotherapeutic interventions or usual psychiatric support in aftercare. In our experience, such integrative psychiatric care prevents re-admittances and recidives.

The authors have not supplied their declaration of competing interest.

Emerging drugs are a growing problem, of which we have little information and clinical experience and pose a challenge in everyday clinical practice because many are not detectable with the test at our disposal and its effect on cognition and behavior are not well known.

Conduct a thorough literature review of all the material in this regard has been published both in high impact journals and in the last International Congress of Dual Pathology.

There are many and varied new substances used for harmful/abuse consumption mainly for their sedative effects and/or hallucinogens, easily accessible since many are easily purchased online or can even be easily obtained at any pharmacy without a prescription.

There are more and more often consumed new substances with high harmful potential and very easy to obtain. It is therefore essential knowledge to identify, treat and educate not only our patients but to the general population.

The authors have not supplied their declaration of competing interest.

The most common psychiatric disorders associated with substance use in patients with dual diagnosis, personality disorders are followed by schizophrenic disorder. Among the substances used in patients with dual diagnosis, stands cocaine, followed by cannabis and alcohol.

Evaluate the differences in the frequency of sex for cocaine and cannabis consumed in a sample of patients undergoing follow Mental-Health Center for Drug Dependency Unit.

We conducted a cross-sectional study and analyze the differences by gender for the frequency and pattern of cocaine and cannabis, in a sample of patients in treatment at the Mental-Health Center for a year to present dual pathology.

There are significant differences in the frequency of cocaine use among men and women. Eight percent of men use cocaine compared to 0% of women. This monthly cocaine use is more common in women than in men at 45.5% versus 21.8%. Of women, 27.3% use cocaine fortnightly, which is not typical for men (0% of men in the sample). The weekly use of cocaine represents 55.2% among men compared to 27.3% of women.

There are no significant differences in the frequency of cannabis use among men and women. Both sexes consume cannabis daily.

The monthly cocaine use is more common in women. In men the most common is the use of cocaine weekly.

In both sexes cannabis use is more common daily.

The authors have not supplied their declaration of competing interest.

Cocaine use is prevalent in mental health consultations in both sexes. However, in men and women there are differences in the frequency of use of substances and on the employment situation.

Show the differences for the use of cocaine and employment status of men and women, in a sample of patients followed at the Mental Health Center in Drug Dependency Unit.

We conducted a cross-sectional study and analyze the differences according to sex for cocaine use and the employment situation, in a sample of patients who are undergoing treatment at the Mental Health Center for a year diagnosed with dual pathology.

In men in active employment status, the percentage of cocaine use is 19.5% and if we compare with women in the same job situation, the percentage of cocaine use is 0%.

Men who are unemployed use more cocaine than women in the same job situation. For retirees, the highest percentage of cocaine is found in women.

Hundred percent of women use cocaine by sniffing. Men use different ways of cocaine consume.

Snorted way 67.7%, 14.9% smoked and snorted, smoked 8% and 2.3% intravenous.

Men use cocaine more frequently unemployed while women do more it often being retired.

The route most used cocaine consume in both sexes is snorted.

The authors have not supplied their declaration of competing interest.

Alcohol use is a common behavior in most people in our society. A first episode of alcoholism can be fully recovered through specialized treatment and other protective factors and need not become a relapse later.

Whether there are differences in alcohol use after 1, 3 and 6 months after the administration of paliperidone palmitate extended-release injectable suspension in a sample of patients.

This is a descriptive study that analyzed the differences observed with respect to alcohol use after administration of paliperidone palmitate in a sample of 98 patients attending in a Mental Health Centre, in the Unit for drug dependency to present pathology dual.

The percentage of alcohol use at baseline is 56.1% of the total sample.

One month after treatment with paliperidone palmitate the percentage of use is reduced to 31.6%. At 3 months of treatment the reduction is more significant assuming only the 6.1% of the total sample. Finally after 6 months of treatment the percentage of patients maintaining alcohol use is 4.1%, which represents a 52% reduction compared to the initial rate of use.

The data reflect a 92% reduction in alcohol use after 6 months of the administration of paliperidone palmitate.

We can say that paliperidone palmitate is effective in reducing alcohol use in patients with dual diagnosis.

The authors have not supplied their declaration of competing interest.

Substance use disorder is a growing phenomenon among the elderly. It is undervalued, misidentified, underdiagnosed and poorly treated.

Study prevalence, characteristics and risk factors associated with drug use among the elderly.

A 6-month prospective study of substance use in elderly patients (65+) who attended the addiction and dual diagnosis unit, Vall d’Hebron University Hospital.

Fifty-nine patients evaluated, mean age 70.04 years, 60% men. A total of 49.1% are married, 35.8% divorced and 53.8% live with a partner and/or children. A total of 67.3% have basic studies and 78.8% are pensioners. A total of 82.7% have no criminal record.

Medical comorbidity presents in 90.4% of the sample, psychiatric and addictive family background in 42.3% and 37.3%. A total of 67.3% have comorbid Axis I (mainly affective disorders) and 25% Axis II (cluster B most). A total of 7.7% attempted suicide at least once.

The main substance is alcohol (76.9%), followed by prescription drugs (19.3%). A total of 28.8% are multi-drug users. A total of 67.3% have used tobacco in their life and 63.5% are currently dependent. The average age of onset for a disorder for any substance consumption is 28.19, being lower for alcohol and illegal substances and higher for prescription drugs.

A total of 61.5% have gone through treatment before but only 32.7% has been admitted because of addiction. The adherence rate is 90.4% and the relapse rate 8.3% at first month and 13% at 6 months.

Old adults present differences compared to overall drug user population: prevalence by gender is almost equal, lower Axis II, less multi-drug consumption and both dropout and relapse rate are drastically lower.

The authors have not supplied their declaration of competing interest.

Dual diagnosis (DD) is the coexistence of a Psychiatric Disorder (PD), and Substance Use Disorder (SUD). The increase of DD observed in recent years has caused serious problems to both public and private services organization.

Our aim is to assess the prevalence and features (including clinical and sociodemographic ones) of DD over a decade, comparing the period 2003–2004 and 2013–2014.

We performed a retrospective study retrieving the medical records of DD patients at their first admission to the Psychiatry Ward AOU “Maggiore della Carità”, Novara, Italy. Sociodemographic and clinical features were recorded. The two groups of patients (2003–2004 vs. 2013–2014) were compared.

In both periods DD patients are usually Italian male, aged 19–40, single. They have usually attended middle school, live with parents, have two or more brothers and/or sisters but no kids. DD patients in 2003–2004 and 2013–2014 showed differences as far as employment and diagnosis are concerned. The first were more frequently employed than the latter: moreover the 2003–2004 patients were more frequently diagnosed with a personality disorder while the 2013–2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods, as well.

The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors which may be the target of prevention and treatment approaches.

The authors have not supplied their declaration of competing interest.

Although substance use is a well-known public health risk factor, European population-based studies reporting the substance use among adult migrant populations are scarce.

We aim to: (1) determine the prevalence of alcohol use, cigarette smoking and consumption cannabis and intravenous drugs in Russian, Somali and Kurdish migrants in Finland and compare them to those of the Finnish general population; (2) determine if socio-economic and migration-related factors are associated with substance use in migrants.

We used data primarily from the Finnish migrant health and well-being study. Alcohol use was measured with the AUDIT-C questionnaire, smoking habits and the lifetime cannabis and intravenous drug use were recorded. Age-adjusted prevalence rates were determined by ethnicity and sex. The associations between background factors and substance use were analysed using logistic regression analysis.

The prevalence rate of risky drinking is lower and the proportion of abstainers is higher in migrants than in the general population. Current smoking is more common in Russian (31%, P < 0,05) and Kurdish (31%, P < 0,05) migrant men than in the general population (21%). Younger age was associated with risky drinking, socioeconomic disadvantage increased the odd for the daily smoking among migrants, and migration-related factors were associated with substance use.

Migrants report less substance use than the general population, but acculturation-related factors seem to be associated with higher levels of substance use among migrants. Substance use seems to be a gendered phenomenon in migrant populations in comparison to the general population, where lately the alcohol and tobacco consumption of women have been growing.

The authors have not supplied their declaration of competing interest.

Clinical and social improvement after treatment with nalmefene in an alcoholic 41-year-old male, with history of dependence during 20 years.

Our patient had been abusing alcohol for almost 20 years with short breaks of abstinence (one month). Before treatment he made a consumption of 105 g of alcohol per day. Serological examination showed hepatic alterations (GGT 2115, ALT 229) and a low amount of platelets (61,000). He also had no other relevant medical history and other possible clinical diagnoses were excluded. After a week detoxification program and alcohol consumption cessation during one month, the analytical values drastically changed: ALT 35, GGT 275, platelets 222,000.

Nalmefene is an opioid system modulator with antagonist activity at the μ and δ receptors and partial agonist activity at the κ receptor. Nalmefene as-needed has been shown to reduce the total amount of alcohol consumption and number of heavy drinking days and to improve liver function. The aim of this treatment is centered in decreasing consumption rather than achieving a total abstinence.

Against other pharmacologic approaches such as disulfiram an acamprosate, the options that allow acute consumption help patients in controlling drinking rampage and make them realize they will be able to afford alcohol cessation.

The authors have not supplied their declaration of competing interest.

Traumatic brain injury (TBI) can result in a variety of neuropsychiatric disturbances ranging from subtle deficits to severe intellectual and emotional disturbances, including cognitive impairments, mood and psychotic disorders and behavioral disturbances. Alcohol use disorder (AUD) and TBI are closely related. The reward-mediated behaviors central to alcohol addiction seem to interact with the cognitive dysfunction of TBI. First, a significant proportion of patients with TBI have a history of alcohol abuse. Second, AUD might jeopardize TBI recovery and trigger or lower seizures threshold. Third, both AUD and TBI share a negative impact on mental functioning (from memory and cognitive performance to mood impairment). Finally, there is some limited and recent evidence that TBI can increase AUD in patients with no history of substance use prior to the injury, by disrupting incentive-motivation neurocircuitry.

We aim to present a 27-year-old Portuguese male patient without prior psychiatric history who developed AUD and epilepsy after TBI (from a work-related fall).

After 3 years of treatment, the patient's hasn’t achieved abstinence. His treatment included pharmacological therapy with mood stabilizers, flufenazine injections and naltrexone, psychotherapy and rehabilitative interventions.

Given the sparse knowledge about this dual diagnosis, the approach of AUD after TBI is still challenging and the best treatment remains to be determined. Monitoring alcohol consumption should be considered in all patients presenting with TBI.

The authors have not supplied their declaration of competing interest.

The aim of this study is to evaluate the use of both legal and illegal substances, and see the difference in consumption patterns that occur in both men and women.

Surveys have been conducted on consumer habits in the past year among 84 inmates (60 women and 24 men) at the prison Brians 1, interrogating both the consumption of illegal drugs and consumer recreational drugs and routes of administration. Data were analyzed using SPSS program.

A total of 57.1% had used illegal drugs. The most frequent was cannabis, with 54.8% (62.5% men and 51.7% women), followed by heroin, with 23.8% (29.2% in men and 21.7% in women) and cocaine, with 14.3% (20.8% in men and 11.7% women).

Use of legal drugs was 45.2% (50% in men and 43.3% women). In this case, the greatest differences were obtained in the use of bupropion (26.7% women versus 0% men), new generation anticonvulsants such as gabapentin and pregabalin (31.7% women and 12.5% men) and the use of intranasal route of administration (31.7% women versus 0% for men). At the other extreme we find more abuse benzodiazepines abuse in men (45.8 versus 20% in women) and sedative antipsychotics (37.5% vs. 8.3%)

Although there is a serious problem with the misuse of legal psychotropic drugs by inmates in prisons, there is still greater consumption of illegal substances.

Men's consumption pattern is more “traditional” (predominance of illegal substances and “classical” legal substances orally).

Women's consumption pattern is more experimental at both the use of new psychoactive drugs and the use of alternative routes of administration.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Neurobiological research describes one of mechanisms overlap in the Cortico-Striatal-Limbic Circuit (CSLC), which can be disrupted due to chronic stress and alcohol abuse that primarily modulated by the hypothalamic-pituitary-adrenal (HPA) axis, from which cortisol is an end-product.

To investigate the effects of chronic stimulant abuse on the CSLC. This was examined by relating cortisol levels with grey matter volume in brain structures associated with addiction and stress.

We hypothesized that stimulant-dependent individuals show increased cortisol levels and abnormalities in the CSLC. We further hypothesized relationships between altered grey matter volume and increased cortisol levels in the patients.

Twenty-two alcohol-dependent individuals, men only and 21 healthy volunteers (matched for age and gender) underwent an assessment session. Cortisol, DHEA and DHEA-S was assessed in blood plasma. Mood, impulsivity and compulsivity were measured by clinical instruments.

Alcohol-dependent individuals showed higher levels of cortisol in blood plasma, and decreased levels of progesterone and its metabolites DHEA and DHEA-S, which were associated with distinct expression in impulsivity and compulsivity in alcoholic patients. Indices of these steroids were changed compared with healthy persons. Plasma cortisol was positively correlated with the duration of alcohol use. The relationships observed between cortisol, progesterone and its metabolites: DHEA and DHEA-S may be explained by abnormal functioning of HPA axis.

Optimizing of disrupted homeostasis during chronic ethanol consumption being provided with specific mechanism by manipulation of endogenous neurosteroids activity may prove a beneficial pharmacotherapeutic strategy in the intervention of alcohol abuse.

The authors have not supplied their declaration of competing interest.

The problem of the treatment of alcohol addiction is very difficult due to the reoccurrence of relapses. One of the major concepts of the formation of alcohol addiction is the concept of epileptic origin of compulsive craving for alcohol.

We investigated therapeutic efficacy of long-term dosing of original anticonvulsant (m-ch-BHU) on symptoms of alcohol withdrawal syndrome (AWS) in patients with a compulsive craving for alcohol.

Sixty-eight male alcoholic patients aged from 24 to 53 years with different levels of alcohol abuse were examined. Type of course of alcoholism in examined patients was of middle-progressing character. Clinical evaluation of state of patients was carried out with traditional clinical description. Quantitative characterization was conducted according to Hamilton Anxiety Scale and Hamilton Depression Scale. m-ch-BHU was administered to alcoholic patients at dose from 300 mg a day during 21 days against the background of conventional medication as well as in post-withdrawal period under various degrees of severity of affective disorders.

Among affective disorders dysphoric symptoms have a marked tropism for m-ch-BHU. Of the other clinical manifestations in the structure of AWS cerebral diencephalic paroxysms, cardiovascular and myofascial symptoms have the most pronounced sensitivity to the drug. In patients with complicated forms of alcoholism application of m-ch-BHU is effective also in phase of remission in spontaneously arising symptom complex of neurovegetative manifestations of primary pathological craving for ethanol called “dry abstinence”.

Our data allows recommending the use of m-ch-BHU under outpatient conditions as an anti-recurrent and preventive agent.

The authors have not supplied their declaration of competing interest.