Wpływ leczenia substytucyjnego na funkcjonowanie społeczne i stan zdrowia osób uzależnionych od opioidów

INTRODUCTION: Methadone maintenance treatment (MMT) is considered the most effective approach for opioid dependence. It improves social and health condition, especially in the first period of the treatment. The aim of the present study was to evaluate the influence of the MMT on the quality of life of opioid-dependent individuals in subsequent treatment periods. MATERIAL AND METHODS: During the phase I of this longitudinal study, 240 patients treated in MMT were included. The average time of the MMT at baseline was one and a half years. The participants were re-interviewed at 6-month follow up. Self-reported questionnaire and standardized measures were used to compare social and clinical characteristics observed in the first and second stage of the study. RESULTS: At the 6-month follow up, increased employment rates (p = 0.008) and decreased criminality (p < 0.0001) were observed. The prevalence of depressive symptoms (p < 0.0001) and sleep problems (p = 0.021) declined significantly during the follow-up period. High rate of alcohol relapse was noted (46%). The majority of the participants were satisfied with their treatment (70.6%). CONCLUSIONS: MMT is associated with improved quality of life of the opioid–dependent individuals not only in the first, but also in the subsequent periods of the therapy.WSTĘP: Leczenie substytucyjne jest najbardziej skutecznym postępowaniem w przypadku uzależnienia od opioidów. Wiąże się z poprawą funkcjonowania społecznego i zdrowotnego pacjentów, zwłaszcza w pierwszym okresie terapii. Celem prezentowanego badania była ocena wpływu leczenia w programie metadonowym na jakość życia osób uzależnionych od opioidów w kolejnych okresach leczenia. MATERIAŁ I METODY: Badanie miało charakter prospektywny. I faza projektu obejmowała 240 pacjentów leczonych w programie metadonowym. Średni czas trwania dotychczasowej terapii substytucyjnej na początku badania wynosił półtora roku. Po sześciu miesiącach przeprowadzono ponowne badanie. Stosując kwestionariusz samooceny i skale kliniczne, porównywano zmienne charakteryzujące funkcjonowanie pacjentów obserwowane na I i II etapie badania. WYNIKI: Po półrocznym okresie terapii substytucyjnej zwiększyła się aktywność zawodowa pacjentów (p = 0,008) przy jednoczesnym zmniejszeniu się przestępczości (p < 0,0001). Poprawił się stan psychiczny badanych w zakresie objawów depresyjnych (p < 0,0001) i zaburzeń snu (p = 0,021). Pacjenci często łamali abstynencję w okresie obserwacji, zwłaszcza nadużywając alkoholu (46%). Większość pacjentów pozytywnie oceniała swoje leczenie (70,6%). WNIOSKI: Leczenie substytucyjne wiąże się z poprawą jakości życia osób uzależnionych od opioidów nie tylko w pierwszych, ale także w kolejnych okresach terapii

An association between genetic variation in the glutamatergic system and suicide attempts in alcoholâ dependent individuals

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138265/1/ajad12571_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138265/2/ajad12571.pd

Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.Department of Veterans Affairs, Veterans Health Administration (VHA).A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 ( n  = 3 944 778), followed from the beginning of FY02 through the end of FY06.Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79146/1/j.1360-0443.2010.03024.x.pd

Molestowanie seksualne przed uzyskaniem pełnoletności a stan zdrowia i funkcjonowanie społeczne osób uzależnionych od opioidów leczonych substytucyjnie

Introduction: A number of previous studies confirmed worse health and social conditions among opioid-dependent individuals with a childhood history of sexual abuse. To the best of our knowledge, this issue has not been investigated in the Polish population. We aimed to analyse the prevalence of sexual abuse in opioid-dependent individuals undergoing therapy in the methadone maintenance clinic and to assess the association of clinical and social characteristics with a history of sexual abuse. Method: The study included a sample of 240 opioid-dependent patients. Participants were interviewed using self-reported questionnaire and standardised measures on experience of childhood and adulthood abuse, physical and mental health, addictions, social functioning and family history. Results: About 35% of women reported sexual violence in childhood. Sexual abuse in this period was associated with family dysfunction, physical abuse, current more intensive depressive symptoms and pain, as well as suicide attempts with stronger morbid desires. Discussion: The present findings are consistent with previous research of other authors. Interestingly, the present study did not confirm the relationship between sexual abuse and severity of opioid or alcohol dependence and poor social functioning. Conclusion: The results of our study suggest the potential benefit to multifaceted treatment approach, which should specifically address sexual abuse and suicidal behaviour in opioid-dependent patients

Possible association between suicide committed under influence of ethanol and a variant in the AUTS2 gene.

rs6943555 in AUTS2 has been shown to modulate ethanol consumption. We hypothesized that rs6943555 might be associated with completed suicide.We genotyped rs6943555 in 625 completed suicides and 3861 controls using real-time TaqMan Allelic Discrimination Assay. All individuals were Polish Caucasians.We detected an association between suicide and rs6943555 A allele (OR = 1.17, P = 0.018 for allelic comparison, OR = 1.24, P = 0.013 for dominant, and OR = 1.18, P = 0.020 for co-dominant model of inheritance). The association remained significant after adjusting for age and gender (co-dominant: P = 0.002 and dominant model: P = 0.001). After stratifying suicides according to blood ethanol concentration (BAC≤ 20 mg/dl and BAC > 20 mg/dl) the association remained significant only for cases who committed suicide under influence of alcohol (co-dominant: OR  =  1.37, P = 0.004 and dominant model: OR = 1.45, P = 0.006). To validate this finding we genotyped another cohort of 132 cases. We reproduced the association between rs6943555 A allele and suicide under influence of ethanol (allelic comparison: OR = 1.55, P = 0.023; co-dominant : OR = 1.54, P = 0.031; dominant model: OR = 1.84, P = 0.015). Analyzing pooled suicides with BAC >20 mg/dl (N = 300) we found the association of rs6943555 A allele not only vs. controls (allelic OR = 1.41, P = 0.00029) but also vs. cases with BAC ≤ 20 mg/dl (N = 449, allelic OR = 1.33, P = 0.019).In our study rs6943555 A allele is associated with suicide committed after drinking ethanol shortly before death. The rs6943555 A allele may be linked to adverse emotional reaction to ethanol, which could explain the association with lower consumption in general population as well as the predisposition to suicide under influence of ethanol

Inverse association between obesity predisposing FTO genotype and completed suicide.

The A allele of rs9939609 in the FTO gene predisposes to increased body mass index (BMI) and obesity. Recently we showed an inverse association between the obesity related A allele of rs9939609 and alcohol dependence which was replicated by others. Since this finding raises a possibility that FTO may be associated with other psychiatric phenotypes, we aimed to examine association of rs9939609 with completed suicide. We genotyped rs9939609 in 912 suicide victims and 733 controls using TaqMan approach. We observed an inverse association between suicide and the rs9939609 A allele (OR = 0.80, P = 0.002, Pcor = 0.006) with genotype distribution suggesting a co-dominant effect. Given the link between alcoholism and suicide under influence of alcohol reported in Polish population, confounding by alcohol addiction was unlikely due to apparently similar effect size among cases who were under influence of ethanol at the time of death (OR = 0.76, P = 0.003, N = 361) and those who were not (OR = 0.80, P = 0.007, N = 469). The search for genotype-phenotype correlations did not show significant results. In conclusion, our study proves that there is an inverse association between rs9939609 polymorphism in FTO gene and completed suicide which is independent from association between FTO and alcohol addiction

Distribution of genotypes and analysis of the association between rs6943555 and suicide.

<p>P values <0.05 were <b>boldfaced</b>¹ comparison with all controls; ² comparison with controls with BDI ≤ 11, HWE - Hardy-Weinberg equilibrium, ³for 8 subjects from suicide cohort II there were no data on blood ethanol concentration</p