SY29-2CONTRASTING THE CONCEPTS OF COMPLIANCE AND ENGAGEMENT

Compliance has been defined as "the degree of constancy and accuracy with which a patient follows a prescribed regimen, and engagement can be thought of as the "emotional involvement or commitment of a person. Compliance is related to algorithmic tasks with well-defined rules of conduct and with a priori acknowledged outcomes. They follow (a) a set of established instructions, (b) down a single pathway, (c) to one conclusion. Algorithmic tasks, which require compliance to be successful, are best suited to routine work. Engagement, on the other hand, is related to heuristic tasks, for which no algorithm exists, where one has to experiment with possibilities and devise new solutions. Therapy, and even more specifically, psychotherapy with addicted patients, has continuously to be developed between these two pole

XNAT-PIC: Extending XNAT to Preclinical Imaging Centers

Molecular imaging generates large volumes of heterogeneous biomedical imagery with an impelling need of guidelines for handling image data. Although several successful solutions have been implemented for human epidemiologic studies, few and limited approaches have been proposed for animal population studies. Preclinical imaging research deals with a variety of machinery yielding tons of raw data but the current practices to store and distribute image data are inadequate. Therefore, standard tools for the analysis of large image datasets need to be established. In this paper, we present an extension of XNAT for Preclinical Imaging Centers (XNAT-PIC). XNAT is a worldwide used, open-source platform for securely hosting, sharing, and processing of clinical imaging studies. Despite its success, neither tools for importing large, multimodal preclinical image datasets nor pipelines for processing whole imaging studies are yet available in XNAT. In order to overcome these limitations, we have developed several tools to expand the XNAT core functionalities for supporting preclinical imaging facilities. Our aim is to streamline the management and exchange of image data within the preclinical imaging community, thereby enhancing the reproducibility of the results of image processing and promoting open science practices

SY30-3THE USE OF SOPHISMS IN SUSTAINING DISULFIRAM

Disulfiram's use is not supported by scientific evidence but nevertheless largely advocated and used. This would be less odd in case of lacking or just preliminary evidence. What is peculiar in the case of disulfiram's prescription is its persistence against evidence. Hence arise the question how it is possible that its use can be supported, i.e. by what type of arguments. The goal of an argument is to persuade, the goal of logic and argumentation is additionally to persuade for good reasons. In this sense, a good argument would give good reasons to believe the conclusion. Fallacies are bad arguments, either because they have weak logic, or because they rely on a false premise. Sophisms are intentionally used fallacies, an attempt to persuade opponents that a specific conclusion is true, by means other than by proposing relevant evidence. Proponents of fallacious arguments may use them either because they are incapable or because they are unwilling to accept their arguments to be fallacious. We therefore formulate the hypothesis that the frequency use of fallacious arguments within our otherwise supposedly evidence based discipline may be indicative of (a) a scientifically immature discipline, and/or (b) a moralistically intermingled disciplin

SY09-4TRANSLATING, HARM REDUCTION INTO POLICIES, THE SWISS EXPERIENCE

Aims. The aim of this presentation is to illustrate how Switzerland was able to play such a pioneering role in the field of addiction treatment, by creating a drug policy integrating the medical prescription of diacetylmorphine (heroin) in the therapeutic arsenal of addiction treatments. Discussion. The medical prescription of diacetylmorphine, introduced initially as a harm reduction measure, has been the exotic element of the Swiss drug policy of 1991 and probably still is one of the most controversial practices in clinical medicine despite its documented effectiveness. Coalitions of change actors, across stakeholder groups from many professions and politicians on various levels, succeeded in formulating and starting initiatives for a new drug policy and its innovations. Conclusion. In the case of Switzerland, the Swiss Confederation took a leading role by facilitating communication, encouraging scientific knowledge and bringing the various stakeholders on a platform to deliver a consensual political policymaking basis. This was facilitated by the Swiss direct democracy system. Sustained, dialogue between researchers and the users, of research enhances the likelihood of research affecting polic

SY30-1SIX YEARS AFTER STOPPING THE PRESCRIPTION OF DISULFIRAM FOR ALCOHOL DEPENDANCE, IS IT STILL POPULAR AMONG CAREGIVERS?

A 2009 survey of the Geneva Division of Addictology healthcare team monitored their perception of the decision in 2007 to stop the prescription of Disulfiram for alcohol dependence. The decision was supported by the lack of evidence based efficacy studies. At that time the majority did not agree with the decision to stop Disulfiram and 75% still believed that Disulfiram was useful for some patients, despite the fact that most of the caregivers acknowledged that aversive treatment works mainly through psychological constraints and that this decision was based on EBM. In 2014 the same slightly modified questionnaire was submitted to the healthcare team to assess if after 6 years of practice changes the results were comparable. An online questionnaire of 15 questions ask the participants about their perception of Disufliram efficacy, the impact of stopping Disulfiram on their clinical practices and the pertinence of the decision. The results of this questionnaire will be discussed in the presentatio

SY38-2IMPULSIVITY, MOTIVATIONS AND ADDICTION TO ONLINE GAMES

Introduction. Problematic engagement in online video gaming has been considered recently in the appendix of the DSM-5. Underpinning psychological factors are yet to be clarified, mostly in adult populations. We present data from two studies investigating links between motives to play and impulsivity in one hand and excessive gaming in another hand. Methods. Online studies have been conducted on adult gamers in France (n = 516) and Switzerland (n = 1057). Problematic engagement has been assessed in France by DSM-IV-TR adapted substance dependence criteria (DAS) and by IAT in Switzerland. Motivations have been investigated using Yee's model. Impulsivity has been evaluated using respectively BIS-10 and UPPS-P. The French sample has been compared to heroin users and to healthy controls regarding impulsivity. In the Swiss study, cluster analysis has been conducted to identify subgroups of players regarding their engagement in-game, their motivations to play and their impulsivity. Results. DAS has been found to be predicted by BIS high scores as well as by competition and advancement. Problematic gamers presented higher levels of impulsivity than controls but less than heroin dependents. Three of five clusters were identified to be problematic and linked to high levels of impulsivity, achievement and escapism. Conclusion. Achievement motives to play and high impulsivity have been linked to problematic engagement in online videogames in two different samples evaluated by two different methods. Addiction to online gaming showed a difference in impulsivity traits with substance dependence and healthy controls and subgroups of problem gamers has been characterized. These data could help to design tailored treatments for excessive online gamer

SY09-3HARM REDUCTION IN NON-SUBSTANCE RELATED ADDICTIONS

Behavioral addictions (gambling, gaming, internet use) are new challenges for policy makers, and the question arises if harm reduction is an applicable concept. Gambling addiction policies are trying to include harm reduction models (limitation of the amount of money you can bet, limitation in access to gambling venues). We will discuss if these models are valid in gaming addiction. I.E. If we only consider the classical policy models applied for reducing substances harm: supply reduction, demand reduction and harm reduction, limitations arise: for example: applying these concepts to gaming addiction is impossible. If heroin is an identified substance, games are heterogeneous in nature and are described from cognitive enhancers to highly addictive. The concept of supply should include the complex nature of video games. Reducing demand could be considered as a censure directly in conflict with human nature to produce the best and most attractive games (should unattractive cars be produced to reduce global warming). And finally harm reduction concepts in gaming will be discusse

SY09-2HARM REDUCTION IN SUBSTANCE RELATED ADDICTIONS

The concept of harm reduction has for a long time been discussed mainly related to opiate injection. The objective of the present paper is to review the application of the concept regarding several other substances: alcohol, tobacco, cannabis, and party drug

Oral administration of a low dose of midazolam (75 microg) as an in vivo probe for CYP3A activity.

OBJECTIVE: We investigated whether the oral administration of a low dose (75 micro g) of midazolam, a CYP3A probe, can be used to measure the in vivo CYP3A activity. METHODS: Plasma concentrations of midazolam, 1'OH-midazolam and 4'OH-midazolam were measured after the oral administration of 7.5 mg and 75 micro g midazolam in 13 healthy subjects without medication, in four subjects pretreated for 2 days with ketoconazole (200 mg b.i.d.), a CYP3A inhibitor, and in four subjects pretreated for 4 days with rifampicin (450 mg q.d.), a CYP3A inducer. RESULTS: After oral administration of 75 micro g midazolam, the 30-min total (unconjugated + conjugated) 1'OH-midazolam/midazolam ratios measured in the groups without co-medication, with ketoconazole and with rifampicin were (mean+/-SD): 6.23+/-2.61, 0.79+/-0.39 and 56.1+/-12.4, respectively. No side effects were reported by the subjects taking this low dose of midazolam. Good correlations were observed between the 30-min total 1'OH-midazolam/midazolam ratio and midazolam clearance in the group without co-medication (r(2)=0.64, P<0.001) and in the three groups taken together (r(2)=0.91, P<0.0001). Good correlations were also observed between midazolam plasma levels and midazolam clearance, measured between 1.5 h and 4 h. CONCLUSION: A low oral dose of midazolam can be used to phenotype CYP3A, either by the determination of total 1'OH-midazolam/midazolam ratios at 30 min or by the determination of midazolam plasma levels between 1.5 h and 4 h after its administration

Including gaming disorder in the ICD-11: the need to do so from a clinical and public health perspective

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it