Determinants of risky substance use and risky gambling

First paragraph: That certain behaviour in a particular situation entails high risks is a perception that does not require human consciousness; indeed, perceiving or failing to perceive risk has been through the eons a sure means of Darwinian selection. A mouse that sees the shadow of an owl will take action ( or freeze to evade notice) because of the immediate risk. Throughout human history, people have taken risks into account in how they behave. The risks have sometimes been tangible, as in the risk of injury in falling off a cliff, and sometimes intangible and a matter of belief, as in the risk of eternal damnation for doing something sinful. Often the calculation of risk combines elements that are tangible and measurable, and elements that are a matter of morals or conviction. Positivist research in the field of substance use and gambling behaviour is driven to measure the inherent risk of such behaviours. This quantification uses statistical methods to estimate the probability of outcomes for a specific variable. For example, we can calculate 'relative risk: which is the ratio of the probability of an event occurring (e.g. developing liver cirrhosis or having a car crash) in an exposed group (e.g. heavy drinkers) to the probability of the event occurring in a comparison, nonexposed group (e.g. non- or moderate drinkers). However, the exact level of consumption at which use become risky or harmful has been modified over time, in response to changing knowledge and societal perspectives. For example, in the context of alcohol brief interventions (a short, structured conversation about alcohol consumption that seeks in a non-confrontational way to motivate and support an individual to think about and/or plan a change in their drinking behaviour) the definition of risky drinking was set by the WHO at an average of more than 20 (women) or 40 (men) grams of alcohol per day (Heather, 2006), even if more recent publications tend to lower such limits to around 12 and 25 grams (Schi.itze et al., 2011).  Additional co-authors: Rosie Lees, Gert-Jan Meerkerk, Laura Schmidt, Dike van de Mheen, and Reinout Wiers

Determinants of transitions from harmful to low-risk substance use and gambling

Understanding the factors that influence the transition from harmful to low-risk substance use and gambling or abstinence is important for reducing the societal burden of harm attributable to these behaviours. Following the same methodology used in Chapters 3 and 4, this chapter presents determinants within domains including social identity and social networks, economic and cultural changes, emotional and cognitive factors, life circumstances, and neurocircuitry. Analyses are limited to transitions without formal help like treatment (often named as ‘self-change’, ‘spontaneous remission’, or ‘natural recovery’), as such transitions are understudied, even though this is the most frequent pathway to full or partial remission. There is a particular lack of evidence on relevant factors for the transition from harmful to low-risk gambling or abstinence. As with psychoactive substances, most people change their problem gambling behaviour without formal interventions, but the underlying processes are not well understood

Do drug treatment variables predict cognitive performance in multidrug-treated opioid-dependent patients? A regression analysis study

<p>Abstract</p> <p>Background</p> <p>Cognitive deficits and multiple psychoactive drug regimens are both common in patients treated for opioid-dependence. Therefore, we examined whether the cognitive performance of patients in opioid-substitution treatment (OST) is associated with their drug treatment variables.</p> <p>Methods</p> <p>Opioid-dependent patients (N = 104) who were treated either with buprenorphine or methadone (n = 52 in both groups) were given attention, working memory, verbal, and visual memory tests after they had been a minimum of six months in treatment. Group-wise results were analysed by analysis of variance. Predictors of cognitive performance were examined by hierarchical regression analysis.</p> <p>Results</p> <p>Buprenorphine-treated patients performed statistically significantly better in a simple reaction time test than methadone-treated ones. No other significant differences between groups in cognitive performance were found. In each OST drug group, approximately 10% of the attention performance could be predicted by drug treatment variables. Use of benzodiazepine medication predicted about 10% of performance variance in working memory. Treatment with more than one other psychoactive drug (than opioid or BZD) and frequent substance abuse during the past month predicted about 20% of verbal memory performance.</p> <p>Conclusions</p> <p>Although this study does not prove a causal relationship between multiple prescription drug use and poor cognitive functioning, the results are relevant for psychosocial recovery, vocational rehabilitation, and psychological treatment of OST patients. Especially for patients with BZD treatment, other treatment options should be actively sought.</p

Mental Health in Burn Survivors

This chapter aims to identify the primary psychiatric and psychological issues touching burn survivors as well as the mental health interventions that can help facilitate the recovery of burn survivors and their loved ones