Stopping Marijuana Increases Alcohol Use: An Experimental Verification of Drug Substitution

Many, if not most, drug abuse counselors and treatment programs recommend abstinence from all psychoactive substances, in part, because of a fear that clients who decrease or stop their use of one drug will substitute another. Research to confirm this notion of substitution, however, mostly fails to show that abstinence from one drug increases use of another. A within-subjects study investigated whether consumption of alcohol and other substances changed during marijuana abstinence. Using an ABA design, 28 individuals who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV; American Psychiatric Association [APA], 2000) criteria for either cannabis dependence or abuse and were not trying to stop their marijuana use completed an 8-day baseline period in which they used marijuana and other drugs as usual, then a 13-day marijuana abstinence period, and finally a 7-day return-to-baseline period. Marijuana abstinence was induced by a previously-validated contingent compensation schedule. Participants called a voicemail system daily to provide self-report of marijuana and alcohol use and visited the laboratory twice per week to provide self-report of caffeine, cigarette, and other illicit drug use, to complete self-report measures on psychological symptoms such as withdrawal and craving, and to submit urine samples to biochemically verify marijuana abstinence. Alcohol use significantly increased from a mean of 2.6 drinks/day (SD=1.0) during the baseline period to 3.0 drinks/day (SD=1.0) during the marijuana abstinence period (p=0.03), a 15% increase. Alcohol use then significantly decreased to 2.5 drinks/day (SD=1.3) during the return-to-baseline period (p=0.03), a 17% decrease. Although alcohol substitution occurred during marijuana abstinence, substitution of cigarettes, caffeine, and non-marijuana illicit drugs did not occur. Individuals with a diagnosis of past alcohol abuse or dependence substituted alcohol to a greater degree (52% increase) than those without this past history (3% increase). Increases in alcohol drinks/day correlated with increases in marijuana withdrawal discomfort scores and with increases in alcohol craving scores from the baseline to the marijuana abstinence period. Problems related to alcohol did not significantly increase from baseline to marijuana abstinence. This study provides empirical validation of the clinical notion of drug substitution and suggests that clinicians’ concerns about drug substitution may be valid, but this study’s results need to be replicated in individuals who seek treatment for marijuana problems. Whether substitution reduces the ability to abstain from marijuana also needs to be tested. If alcohol substitution does occur and interferes with the ability to quit marijuana, this would be important empirical support for the clinical practice of recommending abstinence from all substances

The Effect of Olanzapine on Craving and Alcohol Consumption

Previous studies have indicated that olanzapine decreases craving after a priming dose of alcohol, that craving after a priming dose of alcohol is greater among individuals with the seven-repeat allele of the DRD4 variable number of tandem repeats (VNTR) polymorphism, and that the effect of olanzapine (a D2/D4 antagonist) is more pronounced among individuals with this allele. The present study tested the hypothesis that olanzapine may be differentially effective at reducing cue-elicited craving and differentially effective as a treatment for alcohol dependence over the course of a 12-week, randomized, placebo-controlled trial among individuals with and without the seven-repeat allele. Participants who met DSM IV criteria for alcohol dependence were randomly assigned to receive olanzapine (5 mg) or a placebo over the course of the trial. After 2 weeks of treatment, participants completed a cue reactivity assessment. The results suggested that participants who were homozygous or heterozygous for the seven (or longer)-repeat allele of the DRD4 VNTR responded to olanzapine with reductions in cue-elicited craving as well as reductions in alcohol consumption over the course of the 12-week trial, whereas individuals with the shorter alleles did not respond favorably to olanzapine

Marie-Paule Ha, French Women and the Empire: The Case of Indochina

Dans son nouveau livre, Marie-Paule Ha bouleverse les idées reçues sur le rôle des Françaises dans les colonies. Se concentrant sur l’Indochine, Ha affirme que les femmes françaises n’ont pas tracé une ligne de démarcation stricte entre les colonisateurs et les colonisés. Elles ont bien plutôt inventé des façons diverses de vivre aux colonies, en fonction de leur position sociale, de leur privilèges de « race » et de leur accès à l’administration coloniale. Dans l’introduction, M.-P. Ha situe..

Genetic variants in the MRPS30 region and postmenopausal breast cancer risk

Abstract{no abstract

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA

Thymidylate synthetase mRNA levels are increased in liver metastases of colorectal cancer patients resistant to fluoropyrimidine-based chemotherapy

BACKGROUND: Fluoropyrimidines such as 5-fluorouracil (5-FU) and 5-fluoro-2'deoxyuridine (FUDR) are among the most effective chemotherapeutic agents for treatment of metastatic colorectal cancer (CRC). Increased expression of thymidylate synthetase (TS) in CRC metastases has been proposed to be an important mechanism of resistance to fluoropyrimidine-based chemotherapy. METHODS: The present study investigated whether TS mRNA levels in liver metastases of 20 CRC patients before treatment with FUDR by hepatic arterial infusion (HAI) correlated with frequency of clinical response or survival duration. RESULTS: Median survival duration of patients with TS mRNA levels above and below the median was 15 and 18 months, respectively (p > 0.05). Clinical response was achieved in 40% of patients with low TS mRNA levels, but in only 20% of patients with high TS mRNA levels (p = 0.01). TS mRNA levels were also measured for liver metastases of 7 of the patients that did not achieve a clinical response. A statistically significant increase in expression of TS mRNA was observed for liver metastases resistant to chemotherapy (21 ± 14) in comparison to liver metastases of the same patients before chemotherapy (8 ± 4) (p = 0.03). CONCLUSION: This is the first report to demonstrate increased TS expression in liver metastases from CRC patients resistant to fluoropyrimidine based chemotherapy. These findings are consistent with previous studies indicating that increased TS expression is associated with resistance to fluoropyrimidine-based chemotherapy