Medical Treatment Options for Cannabis Use Disorder: An Updated Narrative Review

Background: Cannabis use disorder (CUD) is a common and growing condition in the United States and across the world. With the alteration of the legal landscape of the substance, normalization of the substance use in society, and a continual increase in frequency in recent years, more treatment options are desperately needed. CUD has been shown to be associated with various symptoms of mental illness. Most therapies to date have been psychotherapeutic in nature, involving theories such as cognitive-behavioral motivational-based methods. However, these are not always the most effective or accessible options for patients. Methods: Articles for this review were obtained by searching PubMed, Google Scholar, and the Cochrane Review database for key terms. All the studies included were human studies. Most of the included studies were randomized control trials (RCTs). Trials were prioritized for inclusion based on methodology, date, and outcome-based measures. Only papers after 2010 were considered for inclusion. Results: In recent years, many pharmacological agents have been studied, including antidepressants, mood stabilizers, GABA agents, THC-like compounds, and even some new novel agents such as N-Acetyl Cysteine (NAC), ketamine, and fatty acid amid hydrolase (FAAH) inhibitors. Of these drugs, research has found some more effective than others such as particular mood stabilizers, GABA agents, as well as THC agonists and antagonists. Newer drugs like ketamine, a FAAH inhibitor, and NAC have also been shown to be potential treatment candidates. Studies suggest other effective options may involve neuromodulation, as interventions such as transcranial magnetic stimulation (TMS) and transcranial direct-current stimulation (tDCS) have been shown to be relatively successful when targeting specific brain regions. Conclusions: While there is exciting research so far, much work must be done before there will be FDA-approved treatments on the market. Thus, we must work together to approach treatment in a multifactorial manner and prioritize the research of potential treatment options with more reliable and consistent evidence of safety and efficacy for CUD

Acculturation Stress and the Rise in Alcohol Use Among Latina Women in the U.S.

Background: Epidemiological surveys and world status reports consistently indicate the gap between alcohol consumption in men and women in the United States has been closing steadily over the past 25 years. Particularly, more women now than ever are engaging in alcohol-related risk behavior such as binge drinking, catching up to those of their male counterparts. Data from national surveys conducted between 2000 and 2016 suggests that the number of people above 18 who drink each year increased for women but decreased for men. This trend is consistent amongst Latina women. College-aged, American Latinas in are drinking more frequently and more in quantity at an increasing rate as opposed to American Latinos. There is prolific and extensive research investigating the reasons for higher rates of alcohol consumption and problematic drinking amongst Latina women in the US. Most commonly, this research addresses the socioeconomic and psychological effects of acculturation into U.S. culture. Methods: This study hypothesized that being more acculturated increases alcohol risk behavior and drinking in Latina women due to stressors such as language barriers, social isolation, career difficulties, and separation from family. A literature review was conducted of studies (conducted from 2007-2021) found on PubMed, Google Scholar, and the HOLLIS Harvard Library Catalog using the search terms “Latino, “alcohol use”, and “acculturation”. These studies directly measured the relationship between acculturation of Latinos and alcohol consumption habits. The differences between male and female acculturation were then analyzed, highlighting how acculturation may impact female alcohol consumption. Acculturation, here is measured by surveys including the Acculturation Rating Scale for Mexican Americans (ARSMA) and the Bi-dimensional Acculturation Scale for Hispanics, utilizing the proxies of English/Spanish proficiency and place of birth. Results: Our review revealed that high acculturation scores are more strongly related to increased drinking in Latino women than men. A national sample found that Latinas in the top tercile of acculturation are almost 6 times more likely to drink than Latinas in the bottom tercile. The studies labeled such drinking as a coping mechanism for previously mentioned acculturation stressors of academics and career matters. However, they also described the behavior as a sign of adjustment to new cultural norms and discovery. The discouragement of health-risk behavior such as excessive drinking in women is prevalent in Latino communities, where gender expectations stress female temperance and self-control. Young environment such as a bustling American college where drinking is normalized can cause these women to experiment and risk-take more frequently. Conclusions: The results of our review indicate that acculturation stress is related to increased alcohol use among young Latinas. Further research should aim at developing a comprehensive understanding of these stressors within the context of acculturation, as well as within the broader context of sociocultural and gender norm differences. This perspective is particularly relevant for studies focused on the Rio Grande Valley, a unique area in terms of acculturation and Latino/American cultural mixing. Future research should aim to develop targeted preventative interventions that address these nuanced factors to effectively reduce alcohol-related risk behaviors in this population

Human Papilloma Viruses Infection and Pre-Malignant Lesions in Women on the Texas Mexico Border

Background: In United States, 24-40 million women have had at least one Human Papillomavirus (HPV) infection. While HPV infection is responsible for over 93% of cervical cancer cases worldwide, it is relatively uncommon in US given screening programs and the introduction of the Papanicolaou test. In Texas, where cervical screening and uptake of the HPV vaccine is lower, the incidence of cervical cancer is 12 cases per 100,000 women. Along the border with Mexico the incidence of cervical cancer rises to 16 cases per 100,000 women, mirroring Mexico’s public health problem: cervical cancer is the leading cause of death in women. Despite successful screening programs and declining incidence of cervical cancer in the US and other high-income countries, HPV infection and cervical cancer are still very formidable public health issues in the lower income countries such as Mexico and the US-Mexico border. Methods: Women were recruited from a specialty clinic in Valle Hermoso, Tamaulipas, a border city in Mexico. Women were eligible to participate in the study if were over the age of 18, reported being sexually active, were not pregnant and had never had a hysterectomy or cervical cancer (n=212). Each participant was given a self-administered questionnaire to be completed prior to having the conventional Pap smear examination. The questionnaire obtained demographic, lifestyle and reproductive histories for participants and their partners. History of diabetes mellitus, tobacco, alcohol use. Examinations were performed using the standard method by placing the woman on an examination table in the lithotomy position. Results: Participants median age was 38 years old (91%), had greater than or equal to a high school education (54%), were married (84%), reported only having had only one sexual partner (93%), reported using at least one contraceptive method (96%), and approximately 14% reported having had a history of a sexually transmitted infection. For those women whose specimens were available for analyses (n=200), sixty-four percent were found to be HPV infected and 17% were found to have multiple types of HPV. Tested positive for an HPV infection, 39% were infected with high risk types 16 (n=45) and 18 (n=33). When including other HPV high-risk types associated with cancer, the percentage of women infected with a high-risk HPV jumped to 66%. Conclusion: These data raise important issues about the needs for cervical cancer screening and HPV vaccination Mexican women; particularly those living along the US-Mexico border. Data collected during the same time period among women working in a nearby maquiladora found that only 7% of employed woman were infected with a high-risk HPV type despite similar demographic, lifestyle and reproductive histories. Another area of concern is that high-risk HPV infections may be just as high among Hispanic women living along the US-Mexico border. More studies are needed to document the burden of HPV among these underserved populations

Substance Abuse and Schizophrenia: Impediments to Optimal Care

ABSTRACT With lifetime prevalence estimates of substance abuse among schizophrenics as high as 47.01 %, there is an increasing awareness of the importance of this dual diagnosis and the global deficiencies in our knowledge about this comorbid condition. Patients with substance abuse disorders and schizophrenia are problematic from a clinical, economic, and health care systems perspective. The lack of systematic research into phenomenology, etiology, and treatment approaches (both psychotherapeutic and psychopharmacologic) has hindered the development of an adequate strategy to care for the needs of these patients. Thus, these patients place a significant burden on the mental health delivery system through chronic disability, social dysfunction, frequent rehospitalizations, and poor overall treatment compliance. The authors critically review the contemporary literature relevant to concurrent substance abuse and schizophrenia, highlight major deficiencies in our knowledge, and call for research to reduce the individual, economic, and social costs of this condition

PERSON-CENTERED CARE PLANNING AND SHARED DECISION MAKING FOR MENTAL AND COMORBID CONDITIONS

Developments in person-centered coordinated care are essential given the challenges of the growing epidemic of physical comorbidity in the mentally ill population. Excessive deaths due to comorbidity, especially cardiovascular disease, continue to contribute to the significant reduction in life expectancy in people with mental health problems. Contemporary and proposed models are now available to provide evidence for a way forward in this field. Practical guidance on implementation using person-centered care planning has now been developed to promote a more collaborative and integrated approach as a solution to the current single disease focused model of care, which is failing this patient group. The WHO perspective supports this strategy with the recent global objectives outlining proactive and preventative strategies and interventions to tackle comorbidity. The emphasis is on a transformation of current systems using evidence-based approaches for more integration to support the delivery of more effective and efficient care for those with mental disorders and other comorbid chronic diseases. Coordinated, collaborative, system-wide strategies encompass transparent shared decision making in prevention, early intervention, treatment options, lifestyle management and pharmacological rationalization. Hence urgent action is required to help create the conditions to enable the delivery of person-centered coordinated care in health care systems by involving commissioning bodies, clinicians, patient groups along with voluntary and other community providers. Contemporary models of care for comorbidity emphasize the importance of coordination in the management of physical well-being from the onset of treatment of people with mental health problems in order to ensure better outcomes, improved overall well-being, and a longer life expectancy. Illustratively, no further funds are available to implement this shift in the model of care in the United Kingdom, so redesign and redistribution of current resources will be key to promote this more seamless coordinated system of care to improve the quality of life and life expectancy for this population

Psychiatric diagnosis: challenges and prospects

Psychiatric diagnosis is one of the most important topics within the broad field of psychiatry. Clear, accurate definitions of the various disorders are essential for clinicians around the world to be confident that they are classifying patients in the same way, thereby enabling comparisons of treatment regimens and their outcomes. There are two major classification systems in use, one produced by the World Health Organization, the WHO International Classification of Diseases, Mental Disorders Chapter, and one by the American Psychiatric Association, the well known Diagnostic and Statistical Manual of Mental Disorders. Both of these are being revised so this book from the prestigious World Psychiatric Association is especially timely. In this book, leading experts in the field provide a broad and integrated coverage of the concepts, structure and context of psychiatric diagnosis. It begins by addressing mental health and illness around the world from historical, philosophical and cultural perspectives. Health is approached comprehensively, to include such aspects as resilience, resources and quality of life. The book then covers major specific psychopathology topics in Section II, including new categorizations and dimensional approaches. Section III concentrates on the complex problem of comorbidity, a primary challenge for modern diagnostic classifications in psychiatry. Finally, Section IV reviews emerging international diagnostic systems in psychiatry, considering innovative models and adaptations. This book will be essential reading for anyone involved in the diagnosis of psychiatric disorders

Comorbidity, Positive Health, and Integration of Services

This chapter contains sections titled: Introduction Comorbidity Essentials Comorbidity and Positive Health The Need for Integrated Care Reference