Download Programme and Abstract Book - Global Addiction Conference

Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Programme
and
Abstract Book
Prepared by:
Russ Pendleton
& Julie Ribeiro
Global Addiction
Conference Secretariat: Global Addiction Association,
Charitable Company No. 8204079 Registered in England and Wales
Tel: UK (+44) 208 878 8289 Mob: UK (+44) 7878 201 416 Email: [email protected]
1
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Contents
Page
Welcome and Introduction
3
Logistics
4
Programme
5
Oral Session Abstracts
13
Poster Abstracts
44
Welcome and Introduction
It is with great pleasure that we welcome you to the Global Addiction Rio 2014 meeting.
This represents the first meeting that Global Addiction has held outside of Europe and a great step forward in
helping to unite all organisations around the world trying to help deal with the problem of addiction in all its
forms. The conference has attracted a lot of interest from speakers in South America and the suggested talk
titles have been of the highest quality covering many aspects of addiction, from understanding the science
behind it through best practice in treatment to the social and political ramifications. The programme is
expected to be of the highest standard, and should prove exciting for all. We would like to take this
opportunity to thank all the speakers for their efforts in contributing to such an excellent programme.
Much of the conference will be recorded, and talks presented online for members of global addiction to view.
Please take the opportunity to take up your FREE one year membership of the organisation to be able to
access this resource once you have left the conference. The on-line learning library also includes talks from
many past Global Addiction conferences which are available for members to view and learn from. All are
CME accredited and offer the opportunity to see sessions which you may otherwise have missed.
This is a great first step, however with anything new, it will need time to grow. We want to try to bring Global
Addiction to South America again in the future. If you want to become involved, either through contribution to
the programme, or the scientific advisory committee or as a local chair suggesting a suitable academic or
other venue, please get in touch, we very much want to hear from you.
Enjoy the conference and please take the opportunity to participate.
With Kind Regards
Mr Russ Pendleton, Association Director
Prof Dartiu Da Silveira, Brasilian Chairman
Dr Luis Patricio, International Co-Chairman
2
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
The organisers wish to thank the following individuals for their commitment and contribution to the
conference:
Global Addiction Association - Brasilian Chairperson
Prof Dartiu Da Silveira
Global Addiction Association - International Co-Chairperson
Dr Luis Patricio
Global Addiction Association Regional Scientific Advisory Board
Dr Francisco Bastos
Prof Luciana Boiteux
Ms Maira Cabral
Prof Guilermo Castanno
Mr Francisco Cordeiro
Dr Benedikt Fisher
Ms Julita Lemgruber
Prof Denis Petuco
Dr Marcelo Santos Cruz
Prof Jairo Alfonso Tellez Mosquera
Dr Roberto Tykanore
With Special Thanks To:
Mr Sebastian Seville
Dr Chris Ford
In association with:
INTERNATIONAL DOCTORS FOR HEALTHIER DRUG POLICIES
www.idhdp.com
3
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Logistics
The conference will take place on the 5th floor of:
SHERATON RIO HOTEL & RESORT
Av. Niemeyer, 121 – Leblon, Rio de Janeiro, Brasil, 22450-220
The main Coordinator from the hotel perspective for the conference is:
Suzana Sasportes
Coordenadora de Eventos| Events Coordinator, Sheraton Rio Hotels & Resorts
t - 55 21 2529 1249 m - 55 21 9 9192 3548 f - 55 21 2294 0545
The main Coordinator for Global Addiction at the conference is:
Cleison de Oliveira
Diretor Comercial de Marketing e Eventos
tel:(021) 3529-7187/ 9683-92603 Email:[email protected]
The main sessions (on the left hand side of the programme and starting with the letter ‘C’) will take place in
the Copacabana room.
The parallel sessions (on the right hand side of the programme and starting with the letter ‘V’) will take place
in the Vigidais Room.
The Global Addiction Association requests that all speakers keep to time, and asks all chairs of sessions to
ensure that the timetable is adhered to. It is not fair on speakers later in the day if sessions run over earlier for
obviously reasons. The Global Addiction Association also requests that the audience respects the speakers
and keeps their mobile phones switched to silent during the sessions. Should your phone ring, and you need
to take the call, please leave the room before starting your conversation.
On the evening of the second day, there will be a one hour networking session which will take place after the
final session of the day. Refreshments will be provided in the form of cannapees and liquid refreshment. This
will take place in the conference area on the 5th floor of the Sheraton hotel.
The conference funds unfortunately do not extend to a conference dinner this time as costs for speakers were
high, delegate registration fees were kept low, and no external funding was forthcoming.
Rio is an exciting city. We recommend however that you are prudent and check with hotel reception staff
before getting into any taxis and going to any tourist destination that you wish to visit during your stay. Global
Addiction Association cannot be held responsible for anything that happens outside of the hotel to any
conference attendees.
4
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Key:
C = Sessions in Copacabana Room, V = Sessions in Vigidais Room, both on 5th floor
Policy, Society, Access & Infrastructure
Cocaine, Crack & Club Drugs
Clinical & Treatment
Alcohol
Criminality
Causes & Consequences
Workshops
Oral Platforms - Single Study Talks
E-Poster Schedule
Marijuana & Opioids
Day 1 - Monday 10 November 2014
08.00
Registration Opens
09.00
Introduction and Welcome Addresses
09.30
C1:
Ch:
Contentious vs Traditional Brazil - which way for the future?
Prof Da Silveira (BR)
1)
State responses to drug users in Brazil: a legal analysis of public policies (20 mins)
Dr L Boiteux (BR)
2)
All drugs should be legalised and regulated (20 mins)
Prof S Ribeiro (BR)
Prof Dartiu Da Silveira (BR), Dr Luis Patricio (PT)
10.10
Refreshments
10.40
C2:
Ch:
New Concepts for Broad-Based Intervention Strategies
Dr T Fidalgo (BR)
1)
Brazilian Drug Law and Global Trends in Drug Policy (20 mins)
Dr C Maronna (BR)
2)
Harm Reductions - New Horizons (20 mins)
Dr T Fidalgo (BR)
3)
Strategies and Actions to Reduce Problems Relating to Drug Use in Cities (20 mins)
Mr D Busse (BR)
4)
Treatment of Addicts Within or Outside of "Normal" Medicine – A Question of the Right Setting
and Attitude (20 mins)
Dr A Ulmer (DE)
OPEN DISCUSSION OF MORNING SESSIONS (20 mins)
12.20
Lunch & e-POSTER viewings
5
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Key:
C = Sessions in Copacabana Room, V = Sessions in Vigidais Room, both on 5th floor
Policy, Society, Access & Infrastructure
Cocaine, Crack & Club Drugs
Clinical & Treatment
Alcohol
Criminality
Causes & Consequences
Workshops
Oral Platforms - Single Study Talks
E-Poster Schedule
Marijuana & Opioids
Day 1 - Monday 10 November 2014
13.20
Speakers:
14.20
OP V1:
Wshop C3: PAI-PAD Workshop
OP C4:
Prof E Furtado (BR)
Dr J Duchnicky (BR)
Ms M Ayer-Abdalla (Br)
6x 8 Minute talks with 2 Minutes
discussion for each talk (see last
pages of programme for details)
Moderator: Dr C Ford (UK)
5x 8 Minute talks with 2 Minutes
discussion for each talk (see last
pages of programme for details)
Moderator: Dr L Patricio (Pg)
OP V2:
6x 8 Minute talks with 2 Minutes
discussion for each talk (see last
pages of programme for details)
Moderator: Prof I Maremmani (IT)
15.20
Refreshments
15.50
C5:
Ch:
New Concepts for Broad Based
Dr Luis Patricio (PT)
1)
Principles of the science of complexity could
be used in the design of more adequate
systems (20 mins)
Mr D Russo Burgierman (BR)
Access of drug users to health and social services (20 mins)
Dr M Cruz (BR)
Portugal and addictions: Myths, fantasies and realities. From 30 years of interventions to the
future (20 mins)
Dr L Patricio (PT)
2)
3)
Intervention Strategies
16.50
C6:
Ch:
1)
The increasing impact of Club Drugs on Individuals and Society
Dr Dartiu Da Silveira (BR)
Psychosocial Correlates of Sexual Risk Behaviors among Young Adult Women Multidrug Users in
the Club Scene (20 mins)
Dr S Kurtz (US)
17.10
C6:
Ch:
Day 1 Special Lectures
Dr Dartiu Da Silveira (BR)
1)
Stigmatization of people who use drugs and health care (20 mins)
Dr R Peyraube (BR)
17.30
Close of Day 1
6
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Key:
C = Sessions in Copacabana Room, V = Sessions in Vigidais Room, both on 5th floor
Policy, Society, Access & Infrastructure
Cocaine, Crack & Club Drugs
Clinical & Treatment
Alcohol
Criminality
Causes & Consequences
Workshops
Oral Platforms - Single Study Talks
E-Poster Schedule
Marijuana & Opioids
Day 2 - Tuesday 11 November 2014 - Main Track (Plenary Room)
09.00
C8: IDHDP Session: Harm Reduction Policies for Stimulant Users
Ch: Sebastian Saville (UK)
Speakers:
Dr Gady Zabicky (MX)
Dr Sergio Sanchez (CL)
Prof Carl Hart (US)
OPEN DISCUSSION
10.40
Refreshments
11.10
C9: IDHDP Session (Cont): Harm Reduction Policies for Producer/Transit Countries
Ch: Sebastian Saville (UK)
Speakers:
Snr Pedro Arenas (CO)
Snr Jorge Hernández Tinajero (MX)
OPEN DISCUSSION
12.30
Lunch & e-POSTER viewings
13.30
C10: Pharmacological Treatments of Alcohol
Use Disorder
Chs: Prof I Maremmani (IT)
1)
Pharmacological treatments of alcohol misuse
disorder - is it possible to use the same
philosophy of treatment with all current used
medications?
V11: Tailoring Addiction Services to Meet
Cultural and Gender-based Needs: An
International Perspective.
Chs: Prof D Svikis (US) and Ms F De Conto (BR)
1)
2)
OPEN DEBATE AND DISCUSSION
Prof I Maremmani (IT)
Dr A Ulmer (DE)
3)
4)
7
Tailoring Treatment to Meet the Needs of
Substance Dependent Women (20 mins)
Prof D Svikis (US)
Drug Abuse Treatment in Outpatient Centers
(CAPSad) in Brazil (20 mins)
Dr F De Conto (BR)
Opioid Substitution Therapy in Albania for
Pregnant Women (20 mins)
Ms E Ngjelina (AL)
Addiction Treatment for Women in Saudi
Arabia (20 mins)
Dr M Al-Sawaf (SA)
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Key:
C = Sessions in Copacabana Room, V = Sessions in Vigidais Room, both on 5th floor
Policy, Society, Access & Infrastructure
Cocaine, Crack & Club Drugs
Clinical & Treatment
Alcohol
Criminality
Causes & Consequences
Workshops
Oral Platforms - Single Study Talks
E-Poster Schedule
Marijuana & Opioids
Day 2 - Tuesday 11 November 2014
14.50
C12: Criminality & Incarceration
Ch: Prof A Kastelic (SI)
V13: Causes & Consequences
Ch: Dr M Fiore (BR)
1)
1)
2)
Adolescent drug use and offence (20 mins)
Prof A Gallassi (BR)
The prison health WHO guidelines: Harm
reduction & addiction treatment within
custodial settings (20 mins)
Prof A Kastelic (SI)
15.30
Refreshments
16.00
C14: An Update on Cocaine, Crack & Club Drugs
Ch: Dr F Bastos (BR)
1)
2)
3)
4)
Major findings from the National Crack
Cocaine survey (20 mins)
Dr F Bastos (BR)
Attitudes toward drug-related issues: the
case of the ’Cariocas’ (20 mins)
Ms J Lemgruber (BR)
Eleven Years of Cocaine - a follow up Study
of 11 cocaine users in São Paulo (20 mins)
Dr O Fernandez (BR)
Contingency Management is effective in
promoting abstinence and adherence o
outpatient treatment for crack dependent
individuals in Brazil (20 mins)
Dr A Miguel (Br)
2)
Social-cultural aspects versus
pharmacological determinants? Drug use
from social sciences perspective (20mins)
Dr M Fiore (BR)
Chronic pain and its relation to history of
sexual abuse among methadone
maintenance and non-addicted patients
(20 mins)
Dr E Peles (IL)
V15: Alternative Approaches and Comparisons
in Alcoholics
Ch: Dr A Michael (IL)
1)
2)
The difference between drug users and
alcoholics - a study (20 mins)
Dr A Michael (IL)
Acetaldehyde production capacity of salivary
microflora in alcoholics during early
recovery: Results of a preliminary study (20
mins)
Dr Paulina van Zyl (ZA)
17.20
C16: Day 2 New Opportunities to Overcome Obstacles
Ch: Dr I Krull (US)
1)
The Affordable Care Act: New Opportunities for Social Work to Take Leadership in Behavioral
Health and Addiction Treatment (20 mins)
Dr I Krull (US)
2)
Overcoming Obstacles to Providing Quality Addiction Treatment to Those in Need (20mins)
Dr C Scharff (US)
18.00
Cannapees and Refreshments - Informal Networking
8
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Key:
C = Sessions in Copacabana Room, V = Sessions in Vigidais Room, both on 5th floor
Policy, Society, Access & Infrastructure
Cocaine, Crack & Club Drugs
Clinical & Treatment
Alcohol
Criminality
Causes & Consequences
Workshops
Oral Platforms - Single Study Talks
E-Poster Schedule
Marijuana & Opioids
Day 3 - Wednesday 12 November 2014
09.00
C17: Underlying Mechanisms, Co-Morbidities and Prescription Drug Temptations
Ch: Dr B Rassmussen Chaves (BR)
1)
Reclassification of Impulse control disorders: Clinicans perspective (20 mins)
Prof P Dannon (IL)
2)
Treating drug dependence with the aid of ibogaine (20 mins)
Dr B Rassmussen Chaves (BR)
09.40
C18: New Therapy Regimens
Ch: Prof L F Tófoli (BR)
1)
Abstinence is not required: Support for Motivational Diversity in group treatment
(20 mins)
Dr J Bott (US)
2)
Efficacy of Personalized Feedback Intervention in reducing drug use among repeat-drug offenders
(20 mins)
Dr K Yokotani (JP)
3)
Therapeutic use of psychedelics (ayahuasca and ibogaine) for drug misuse (20 mins)
Prof L F Tófoli (BR)
10.40
Refreshments
11.10
C19: Improving Treatment of Alcohol Addiction in Special Populations
Ch: Prof E Furtado (BR)
1)
The Challenge of Alcohol and Drugs in Pregnancy (20 mins)
Prof E Furtado (BR)
2)
Caring for Pregnant Women who Misuse Drugs and Alcohol (20 mins)
Dr R Osorio (UK)
3)
An Outpatient Clinic for Drug Abusing Pregnant Women (20 mins)
Mr E Bono (BR)
12.10
C20: Dealing with Marijuana - Should we have Cause for Concern?
Ch: Dr R Malcher-Lopes (BR)
1)
What are the Real Concerns about Marijuana - Medical and Recreational use? (20 mins)
Dr R Malcher-Lopes (BR)
2)
How we have Regulated Marijuana in Brazil (20 mins)
Mr A Kiepper (BR)
3)
Self-Medication with Cannabis improves the quality of life of cocaine paste users in Chile (20 mins)
Ms I Tartakowsky (CL)
13.10
Conference Close
9
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
C = Sessions in Copacabana Room, V = Sessions in Vigidais Room, both on 5th floor
Key:
Policy, Society, Access & Infrastructure
Cocaine, Crack & Club Drugs
Clinical & Treatment
Alcohol
Criminality
Causes & Consequences
Workshops
Oral Platforms - Single Study Talks
E-Poster Schedule
Marijuana & Opioids
Oral Platform Session Details
OP V1:
Ch:
1)
2)
3)
4)
5)
6)
Hot Topics, Recent Breaking News, Single Study Summaries
Dr Chris Ford (UK)
Substance use among university students and assessment of severity of problems through the instrument DUSIR (10 mins)
Mrs M Ayer-Abdalla (BR)
Characterization of crack/cocaine users hospitalized in a general hospital between 2000-2010 (10 mins)
Mr I Souza (BR)
Clinical Profile of Women users of Alcohol of a Reference Center in the City of Sao Paulo (10 mins)
Mrs E Gisseth León Ramírez (BR)
Oral opportunistic infections in HIV infected methadone maintained drug abusers. A preliminary study in Jakarta
(10 mins)
Dr I Gracia (ID)
Perception toward Addiction among Medical Students in Indonesia: Lesson Learned from Addiction Medicine
Block in Atma Jaya Catholic University of Indonesia (10 mins)
Ms A Parawita Ayu (ID)
Psychiatric co-morbidity among patients treated in opioid substitution treatment (OST) programs in Slovenia (10
mins)
Dr N Segrec (SL)
OP C2:
Ch:
1)
2)
3)
4)
5)
6)
Hot Topics, Recent Breaking News, Single Study Summaries
Dr L Patricio (PT)
Liquid Prescription Opioid Misuse among a Sample of Diverse Club Drug Users in Miami, Florida, USA (10 mins)
Dr M Buttram (US)
How is prescription opioid misuse measured, and what is the extent of opioid misuse globally? A systematic
review of observational studies using routinely collected dispensing data (2000–2013) (10 mins)
Ms B Blanch (AU)
Substance misuse and pregnancy: measuring outcomes (10 mins)
Dr R Osorio (UK)
Evaluation of an alcohol underage prevention project (10 mins)
Dr B Grajcer (BR)
A multilevel study: Drinking motives and situational predictors of alcohol consumption among Vietnamese
students (10 mins)
Mrs D Pham (VN)
The Relationship between Internet Addiction and Sexual Knowledge Student of Notre Dame and Saint
Paul’s Junior High School in Jakarta (10 mins)
Dr E Suryani, Lie (ID)
10
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
C = Sessions in Copacabana Room, V = Sessions in Vigidais Room, both on 5th floor
Key:
Policy, Society, Access & Infrastructure
Cocaine, Crack & Club Drugs
Clinical & Treatment
Alcohol
Criminality
Causes & Consequences
Workshops
Oral Platforms - Single Study Talks
E-Poster Schedule
Marijuana & Opioids
Oral Platform Session Details
OP V3:
Ch:
Hot Topics, Recent Breaking News, Single Study Summaries
Prof I Maremmani (IT)
1)
Illicit use of fentanyl patches in rural Australia (10 mins)
Dr J Allan (AU)
2)
Measuring outcomes in opioid dependence care: expert consensus on need for improved outcome
measurement tools
Prof I Maremmani (IT)
3)
The prevalence of cognitive impairment in Australian rural substance treatment participants: The
implications for treatment approaches (10 mins)
Dr J Allan (AU)
4)
Evaluation of Psychosocial Care Centers on Alcohol and Other Drugs in the city of São Paulo in view of
the technical health professionals (10 mins)
Pr M O Pereira (BR)
Novel Psychoactive Substances in Young Adults with and without Psychiatric Comorbidities: an
observational study (10 mins)
Dr G Martinotti (IT)
5)
6)
''You’re Less Complete if You Haven’t Got a Can in Your Hand’: Alcohol Consumption and Related Harmful
Effects in Rural Australia: The Role and Influence of Cultural Capital (10 mins)
Dr J Allan (AU)
11
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Viewing Schedule
The e-Posters will be on view during the whole conference for all delegates to see. However there are two
specific times when authors are expected to stand near the screens to answer questions from any delegates.
Please stand by the television screens and be ready to answer questions on your posters following the
schedule drawn up in the table below:
DAY 1, 10 November 2014
Screen 1
Dr
N
Akbar
US Reduced Sleep Time Mediates the Relationship
Between Conflict at Home and Temperament in
Screen 1
Ms
J
Andrade
Screen 1
Ms
B
Blanch
Screen 1
Mr
Emi
Bono
BR Prevalence of psychiatric comorbidity in drug of abuse
addicts in treatment
AU Prescribed opioid misuse in Australia: Measurement in
routinely collected dispensing data.
BR The use of illicit substances among juvenile offenders
Screen 1
Ms
Emi
Carneiro
Bragiato
BR Women and addiction: epidemiology in specialized
clinic
Screen 2
Dr
R
Dotta Panichi BR The Right to Health: women in prison and mental health
Screen 2
Prof
T
Harada
Screen 2
Dr
M
Karuvetil
Screen 2
Ms
P
Koh
Screen 2
Dr
M
Pereira
JP The efficacy of cognitive-behavioral therapy for
Japanese Alcoholic Patients
SP L-Carnitine Induced Psychosis
SP Prescription drug abuse among heroin abusers seeking
treatment in Singapore
BR Situational Diagnosis of Psychosocial Care Center
Alcohol and Other Drugs II Jabaquara
DAY 2, 11 November 2014
Screen 1
Dr
H
Lahteenmaa
US Dextromethorphan use and abuse
Screen 1
Dr
G
Martinotti
IT
Screen 1
Ms
L
Martins de
Carvalho
BR Possible influence of hypercaloric diet in the ingestion
of ethanol and its relation on molecular mechanisms of
the reward system in C57BL/6 mice
Screen 1
Ms
J
Nichterwitz
Scherer
BR Prevalence of alcohol dependency and family history of
alcohol abuse and/or dependence in a sample of
Screen 1
Mr
F
Ornell
BR Oxidative stress and BDNF as possible markers for the
severity of crack cocaine use in early withdrawal.
Screen 2
Ms
W
Piedzia
PL Quantitative magnetic resonance imaging of white
Screen 2
Dr
K
Todadze
GE “Crocodile” use and treatment in Georgia
Screen 2
Dr
M
Wall
Screen 2
Mrs
C
Wallin
UK Studying the neural substrates of smoking with ecigarettes and fMRI: A feasibility study
SW A patient survey to show the misuse of medication
before entering treatment
12
Is there a potential for Nalmefene in alcoholics with
major depression? An open study on craving and
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
DR JULAINE ALLAN
DR JULAINE ALLAN
PO BOX 9374, ORANGE EAST, NSW 2800
AUSTRALIA
EMAIL: [email protected]
PO BOX 9374, ORANGE EAST, NSW 2800
AUSTRALIA
EMAIL: [email protected]
TITLE
TITLE
‘YOU’RE LESS COMPLETE IF YOU HAVEN’T GOT A CAN IN YOUR
HAND’: ALCOHOL CONSUMPTION AND RELATED HARMFUL EFFECTS
IN RURAL AUSTRALIA: THE ROLE AND INFLUENCE OF CULTURAL
CAPITAL
THE PREVALENCE OF COGNITIVE IMPAIRMENT IN AUSTRALIAN RURAL
SUBSTANCE TREATMENT PARTICIPANTS: THE IMPLICATIONS FOR
TREATMENT APPROACHES
AUTHORS
AUTHORS
JULAINE ALLAN
JULAINE ALLAN
ABSTRACT
ABSTRACT
COGNITIVE IMPAIRMENT (CI) INCLUDES ACQUIRED OR TRAUMATIC
BRAIN INJURY, INTELLECTUAL DISABILITY OR FETAL ALCOHOL
SPECTRUM DISORDER (FASD). COGNITIVE IMPAIRMENT IS A HIDDEN
DISABILITY WHICH, FOR EXAMPLE, AFFECTS ENCOUNTERS WITH
PEOPLE IN THEIR SURROUNDINGS, AND CAN LEAD TO DIFFICULTIES IN
RELATIONS AND CONTACTS WITH SOCIETY. A HIGH PREVALENCE OF
SUBSTANCE USE PROBLEMS HAS BEEN IDENTIFIED IN COGNITIVELY
IMPAIRED PEOPLE AND ALCOHOL USE IS A FREQUENT CONTRIBUTING
FACTOR TO ACQUIRED BRAIN INJURY. SOME OF THE BEHAVIOURS
DESCRIBED AS COMMON FEATURES OF CI SUCH AS POOR SELFMONITORING AND SELF-REGULATION AND DEPENDENCE/LACK OF
INITIATIVE ARE SEEN TO BE CAUSES AND CONSEQUENCES OF
ADDICTION THEREBY PRESCRIBING A MORAL RATIONALE TO
BEHAVIOUR THAT MAY HAVE A PHYSICAL CAUSE. TO INCREASE STAFF
AWARENESS OF THE PREVALENCE OF CI, SCREENING OF ALL
CONSENTING CLIENTS WITH THE ADDENBROOKS COGNITIVE
EXAMINATION – REVISED (ACE-R) FOR A 3 MONTH PERIOD WAS
CONDUCTED (N=50). ANALYSIS OF THE ACE-R TOTAL SCORES
INCLUDED QUALITATIVE VARIABLES (INDIGENOUS STATUS AND
GENDER) AND QUANTITATIVE VARIABLES (AGE AND EFFECTIVE YEARS
OF EDUCATION). LOGISTIC REGRESSION WAS USED TO ANALYSE THE
EFFECT OF ALL VARIABLES AT ONCE. THE ANALYSIS OF FIFTY
COMPLETED ACE-R SCREENS FOUND THAT 40% OF PARTICIPANTS
WERE LIKELY TO HAVE A COGNITIVE IMPAIRMENT (SCORED
AIMS: THIS STUDY AIMED TO EXPLORE RURAL AUSTRALIANS’
PERCEPTIONS OF SOCIAL AND CULTURAL FACTORS INFLUENCING
ALCOHOL USE IN THEIR COMMUNITIES. METHODS: SEMISTRUCTURED INTERVIEWS EXPLORING RURAL COMMUNITY KEY
INFORMANTS’ (N = 46) PERCEPTIONS OF SOCIAL AND CULTURAL
FACTORS INFLUENCING ALCOHOL CONSUMPTION IN THEIR
COMMUNITY WERE CONDUCTED. A NARRATIVE ANALYSIS IDENTIFIED
CULTURAL CAPITAL AS A SALIENT CONCEPT FOR EXPLAINING HOW
RURAL COMMUNITY LIFE IS CREATED AND SUSTAINED VIA DRINKING
PRACTICES. RESULTS: THEMES RELATING TO PARTICIPANTS’
ACCOUNTS OF LEARNING TO DRINK, NORMAL DRINKING; EXCLUSION
BECAUSE OF NOT DRINKING AND PROBLEMATIC DRINKERS ARE
DESCRIBED. CONCLUSION: IN RURAL COMMUNITIES, BELIEFS AND
VALUES ABOUT DRINKING AS A POSITIVE SOCIAL PRACTICE ARE
TRANSMITTED, REWARDED AND REPRODUCED ACROSS MULTIPLE
GROUPS AND SETTINGS, REINFORCING THAT DRINKING IS AN
INTEGRAL PART OF AUSTRALIAN RURAL CULTURE. DRINKING IS SO
IMPORTANT THAT ENGAGING IN DRINKING PRACTICES CREATES AND
SUSTAINS CULTURAL CAPITAL. AS A RESULT, ALCOHOL-RELATED
HARM IS OF LITTLE CONCERN TO RURAL DWELLERS.
ADDITIONAL INFORMATION
JULAINE ALLAN,
ANTON CLIFFORD,
PATRICK BALL,
MARGARET ALSTON,
AND PETER MEISTER
ADDITIONAL INFORMATION
JULAINE ALLAN, MICHAEL KEMP & ANNETTE GOLDEN (2012): THE
PREVALENCE OF COGNITIVE IMPAIRMENT IN A RURAL IN-PATIENT
SUBSTANCE MISUSE TREATMENT PROGRAMME, MENTAL HEALTH
AND SUBSTANCE USE, DOI:10.1080/17523281.2012.711767
‘YOU'RE LESS COMPLETE IF YOU HAVEN'T GOT A CAN IN YOUR HAND’:
ALCOHOL CONSUMPTION AND RELATED HARMFUL EFFECTS IN RURAL
AUSTRALIA: THE ROLE AND INFLUENCE OF CULTURAL CAPITAL
ALCOHOL AND ALCOHOLISM (SEPTEMBER/OCTOBER 2012) 47 (5): 624
-629 FIRST PUBLISHED ONLINE JULY 4, 2012 DOI:10.1093/ALCALC/
AGS074
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
DR JULAINE ALLAN
Dr Mona Al-Sawaf
21 MARCH ST, ORANGE NSW
AUSTRALIA
EMAIL: [email protected]
Addiction Treatment for Women in Saudi Arabia
Authors
Al-Sawaf, M., MD
TITLE
Abstract
ILLICIT USE OF FENTANYL PATCHES IN RURAL AUSTRALIA
While the past decade has seen an increase in the number and types
of evidence-based programs (EBPs) available for the treatment of
addiction, much less is known about their effectiveness when
implemented in different countries and cultures. Further, women
often face additional stigma and associated barriers to care. Failure to
adapt and tailor interventions to meet unique cultural and genderspecific needs can result in disappointing outcomes that in turn
generate frustration and disillusionment. This symposium will focus
on several highly-respected EBPs for substance use disorders and
strategies being used to identify unique cultural and gender-based
needs so that interventions can be modified and tailored to address
such issues in a responsive and therapeutic manner. The fourth
speaker, Dr. Mona Al-Sawaf (Saudi Arabia) will discuss attitudes about
addiction in men vs women and her efforts to establish services for
substance abuse, particularly for women.
AUTHORS
JULAINE ALLAN, NICOLE HERRIDGE
ABSTRACT
FENTANYL IS A SYNTHETIC OPIATE WITH POWERFUL PAIN KILLING
AND TRANQUILLISING PROPERTIES. FENTANYL TRANSDERMAL
PATCHES ARE USED FOR THE MANAGEMENT OF CHRONIC PAIN.
AUSTRALIA HAS SEEN A STEADY INCREASE IN THE PRESCRIBING AND
NON-MEDICAL USE OF PRESCRIPTION OPIOIDS (RINTOUL, DOBBIN,
DRUMMER, & OZANNE-SMITH, 2010), MOST RECENTLY FENTANYL IN
THE FORM OF LONG-ACTING PATCHES. FROM 2000 ONWARDS, THE
DEATHS IN AUSTRALIA ASSOCIATED WITH FENTANYL HAVE
INCREASED (ROXBURGH ET AL., 2013). ADDITIONALLY, THESE DEATHS
APPEAR TO BE OVER-REPRESENTED IN RURAL AREAS (ROXBURGH ET
AL., 2013). NON-MEDICAL USE OF FENTANYL CAN INVOLVE HIGH RISK
PREPARATION AND ADMINISTRATION METHODS. FURTHER, NO
RURAL AUSTRALIAN DRUG USER-FOCUSED RESEARCH HAS BEEN
PUBLISHED TO DATE, AND THE DRUG AND ALCOHOL WORKFORCE IS
WITHOUT ADEQUATE RESOURCES TO ASSIST THEM TO DISCUSS RISK
REDUCTION OPTIONS WITH FENTANYL-INJECTING CLIENTS. THERE IS
AN URGENT NEED TO INCREASE THE CAPACITY OF FRONTLINE
WORKERS AND POLICY MAKERS TO UNDERSTAND FENTANYL and its
use by illicit drug users so that they can more effectively reduce
associated harms. Aim: The study aimed to investigate how and why
people use fentanyl for non-medical reasons in rural NSW, Australia
and; to identify strategies that may mitigate risks and associated
harms. Method: Semi-structured interviews exploring rural fentanyl
users’ (n = 14) experiences of obtaining, preparing and using fentanyl
were conducted. A narrative analysis identified key points around
participant’s harm reduction practices, perceptions and experiences
with using fentanyl. Results: Themes relating to participants’ accounts
of learning to use fentanyl, experiences of harms and benefits,
sources of information about harm reduction and strategies for
controlling or stopping use are described. Peer networks were
identified as key channels of information but rarely included internet
user groups or sharing of formal information. Conclusion: In rural
communities, beliefs and practices about obtaining and using fentanyl
are transmitted and reproduced across groups of illicit drug users,
amplifying and distorting information about methods and harms of
fentanyl use. Peer networks are critical sites of harm reduction action
that are challenging to infiltrate in the rural context where dispersed
populations, distance and risks associated with disclosing illicit drug
use are significant barriers to disseminating harm reduction
information.
Snr Pedro Arenas
Pedro Arenas is the Director of the Observatory on Illicit Cultivations
in Colombia. He served as Mayor of San José del Guaviare City in
Colombia from 2008-2011. He was also a congressman of Colombia.
A long-time social and community activist, Pedro has consistently
promoted the rights of both drug users and coca producers. He was a
member of the organizing committee of the first World Forum of
declared illicit cultivators and producers that took place in Barcelona
in 2009 as well as an organizer of the coca growers protests against
the US funded forced eradication campaign in southern Colombia.
Pedro is committed to finding pragmatic and peaceful solutions to the
devastation caused to producer countries like Colombia by the
insatiable appetite of the world’s richest countries for these illicit
products. He gives speeches about coca, poppy and marihuana
cultivation and is currently working on a new coca, poppy and
marihuana growers Association in Colombia. Pedro is also Advisor on
the Institute for Development and Peace of Colombia, INDEPAZ.
Abstract
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Global Addiction 2014
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06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Colombia is the world's largest producer of cocaine. Cocaine is only
produced in two other countries and it is highly valued in the richest
countries with the USA consuming nearly 40% of all the cocaine
produced every year. Only Brazil comes close consuming less than
20%. With Americans hungrily demanding this huge amount of the
world's cocaine - the USA simultaneously insists on highly punitive
sanctions for producers and distributers. This added risk factor drives
the price to a point where it generates billions of dollars each year.
With so much money at stake - market forces make it completely
unreasonable to expect anything else but a highly organised criminal
production/distribution network. This leads to corruption, violence,
stigmatisation and the undermining of any proper law and order.
sample of this study have already used, lifelong. Regarding the factors
that may be associated with the consumption of psychoactive
substances, the subscale or domain of DUSI-R oriented to the
assessment of problems related to peer relationships was evidenced
as a variable with statistically significant associations for almost all
patterns of consumption and regardless of gender. Conclusions:
Problematic peer relationships are a condition often associated with
more severe patterns of alcohol use, illicit drugs and medicaments of
abuse. In this sense, we observe the need for more knowledge on the
topic of substance use for university students, especially those who
will be future health professionals, raising questions about the risks
involved in the use of psychoactive substances, to their future
professional, personal and social life.
It is no longer acceptable for us, as poorer producer and/or transit
countries, to suffer the consequences resulting from the huge
appetite of the richest countries and the political fear they have of
even discussing new ways of dealing with this situation.
Mrs Marcella Ayer-Abdalla
PAI-PAD Workshop
This situation will be examined along with possible alternative ways
that would reduce the harm currently being caused to our countries.
Introducing a Family Based Approach
Ms Astri Parawita Ayu
Mrs Marcella Ayer-Abdalla
Metro Permata 2 Blok A4/7 Karang Tengah Karang Mulya Tangerang
15157
Indonesia
Email: [email protected]
Avenida BAndeirantes, 1.900, campus Usp
HCRP-USP. 3 ANDAR, Sala 333
Brazil
Email: [email protected]
Title
Title
Substance use among university students and assessment of severity
of problems through the instrument DUSI-R
Perception toward Addiction among Medical Students in Indonesia:
Lesson Learn from Addiction Medicine Block in Atma Jaya Catholic
University of Indonesia
Authors
Authors
Mrs Marcella Beatriz Ayer Abdalla
Dr Erikson Felipe Furtado
Astri Parawita Ayu, Michael Jaya
Abstract
Abstract
Background In the past years the concept of addiction as a brain
disease is become more prominent. But most medical doctors still
have negative perception towards patients with addiction problems.
Furthermore, medical doctors do not feel competent in dealing with
addicted patients. Lack of addiction medicine training is one of the
reasons that lead to those conditions. Atma Jaya Catholic University
of Indonesia developed addiction medicine training as an elective
block for third year medical students. The effectiveness of that
training in changing medical student’s perception towards addiction
needs to be evaluated. Method This is a quasi-experimental study
with pre and post evaluation. We used Illness Perception
Questionnaire revised version addiction to evaluate medical student’s
perception towards addiction. Result There were 87 students who
enrolled in three different elective blocks (addiction medicine, health
care entrepreneurship, palliative care). We found significant
difference of the perception towards addiction among medical
students who enrolled in addiction medicine block before and after
the block. After the block, medical students perceive that they
Recent epidemiological studies from different countries have shown a
high prevalence of substance use in the population of university
students. The severity and the problems associated with the
consumption patterns are influenced by different factors in the
context of the age and characteristics of student life and that can
modulate the behavior of substance use. Objectives: To assess the
profile of university students according to the behavior of
psychoactive substance use, in relation to the severity of different
problem areas through the instrument DUSI-R. Methods: Crosssectional study of a sample of 499 students of the seven graduate
courses of the Faculty of Medicine of Ribeirao Preto. We used
demographic data and scores of absolute density of the instrument
DUSI-R. Results: descriptive and inferential statistical analyzes were
performed with SPSS. Alcohol consumption has proved troubling, 96.5
% of the overall sample already used at some point in life, and 71% of
them had used in the last month. Regarding the use of marijuana or
hashish, we observed that 24.3 % of men and 9.2 % of women in the
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
understand more about addiction (p=.007) and they perceive more
that addiction have risk factor (p=.006), compare to their perception
before the block. Significant difference also found among medical
students who enrolled in addiction block, health care
entrepreneurship block, and palliative care block. Medical students
from addiction block perceive addiction more as a chronic disease
(p=.002), believe more that they understand about addiction.
leaderships, using both written sources (formal or informal) and oral
information provided by key informants. Information was entered
into digital maps of each one of the Brazilian capitals, selected
municipalities from the 9 federal Metropolitan areas, and a third
stratum composed by selected middle and small municipalities all
over the country. Over 1,500 digital maps were entered into the
project’s GIS, defining the sampling frame from which the scenes/
period of time of a given day (“shift”)/days of the week were
randomly selected (sampling frame); 2) The selected scenes/days/
shifts were then defined as selection units of a Time-Location
Sampling study. Over 7,300 crack cocaine users were recruited from
the selected scenes/shifts/days, interviewed, counseled and tested
for HIV/HCV and tuberculosis; 3) In parallel, an indirect estimation
study (using the Scale-up Network Method) was implemented in the
27 Brazilian capitals. 25,000 people were interviewed, using as the
sampling frame a representative sample of households (general
population). Interviewees were probed about several different
aspects of their social networks, including the absence/presence (and,
if yes, how many) of people who use alcohol and substances in their
personal networks; 4) Finally, a qualitative study was carried out,
targeting a non-representative convenience sample of people who
used crack cocaine in 9 large cities from Brazil’s 5 macro-regions. This
last component used in-depth interviews and focus groups. The main
findings of this large, multiphase study will be presented at the
Conference, as well as its mains caveats and limitations. The great
mobility of the drug scenes and the extreme violence found in most
settings represented a formidable challenge faced by the over 500
people involved in the second component of the study (i.e. the field
survey carried out in the drug scenes).
Dr Francisco Inácio Bastos
[email protected]
Dr Bastos is a Senior Researcher, physician, and former Chair of
Graduate Studies in Epidemiology and Biostatistics at the Oswaldo
Cruz Foundation (FIOCRUZ), with years of experience researching
substance misuse and associate harms and risks, such as HIV, viral
hepatitis and other STIs and blood-borne diseases, and working with
collaborators both in Brazil and abroad. He has been the Principal
Investigator on a number of large, multi-city studies on HIV and other
blood-borne infections and STIs, including the WHO Multicity Project
on HIV/AIDS and viral hepatitis among injection drug users, the
multicity study of HIV and syphilis in 10 Brazilian cities, and the
recently concluded national survey on crack cocaine and associated
harms. His research team has developed new methods for assessing
the needs and vulnerabilities of impoverished and marginalized
populations. He has published extensively on HIV among injection
drug users and within poor communities.
Ms Bianca Blanch
Faculty of Pharmacy
A15 - Pharmacy & Bank Building
University of Sydney, 2006
New South Wales, Australia
Email: [email protected]
Title
How is prescription opioid misuse measured, and what is the extent
of opioid misuse globally? A systematic review of observational
studies using routinely collected dispensing data (2000–2013).
Abstract
Authors
The Brazilian Survey on Crack Cocaine: A brief summary of its main
findings
Francisco I. Bastos on behalf of the Brazilian Survey on Crack Cocaine
Bianca Blanch, Leigh Mellish, Prof Nicholas A. Buckley, Prof Andrew H.
Dawson, Prof Paul S. Haber, A/Prof Sallie-Anne Pearson
The Brazilian Survey was the largest multicomponent, mixed methods
study ever carried out in Brazil on crack cocaine or any other licit or
illicit substance. It was implemented in 2011-2013 and comprised
four components, briefly described as follows: 1) As a first step, a
comprehensive mapping of crack cocaine scenes was carried out in
the first semester of 2011. The mapping component collected and
cross-compared data from all available sources of information,
including public and private institutions as well as community
Abstract
Background: Excessive prescribed opioid use increases the risk of
serious medical consequences including poisoning, hospitalisation or
death. Since the indications for prescribed opioids were extended to
include use in non-cancer pain, prescribed opioid-related harm has
increased; outnumbering heroin-related harms. Prescribed opioid
misuse is now considered an epidemic in the US. Routinely collected
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
health data such as dispensing claims provides opportunities to
explore and better understand patterns of prescribed opioid use.
However, there are inherent challenges in using data derived for
payment purposes with relatively limited clinical information.
Mr. Elvio Bono
PAI-PAD Workshop
An Outpatient Clinic for Drug Abusing Pregnant Women
Aim: To report the measures and extent of prescribed opioid misuse,
using routinely collected dispensing data; and predictors of opioid
misuse or dependence.
Dr Luciana Boiteux
[email protected]
Method: To identify articles we searched Medline, Embase, CINAHL
and Pre-Medline (January 1 2000-July 31 2013). We also searched
Scopus citations, Google Scholar and back references. We screened
10,803 abstracts and retrieved 281 full-text manuscripts. Inclusion
criteria: specific aim or method investigating opioid misuse; a
measure of opioid misuse derived from routinely collected dispensing
data in an adult population; peer-reviewed article and published in
English.
Results: 35 studies examined prescribed opioid misuse in over 57
million prescribed opioid users. The studies were set in either North
America (24) or Europe (11), with 23 published since 2010. Four
behaviours, either alone or in combination, were utilised to measure
misuse: number of prescribing doctors, overlapping prescriptions or
early refill(s), number of dispensing pharmacies, and amount of
medicine dispensed, respectively. Overall the extent of prescribed
medicine misuse varied between 0.01-63.2% of persons in a cohort,
primarily reflecting the heterogeneity in study design. Five key factors
impacted on the extent of misuse: measures utilised, 57 unique
measures of opioid misuse (only 9 were replicated in ≥2 studies);
cohort definitions and inclusion criteria; thresholds of misuse;
medicine(s) of interest, and time period assessed (range: 7 days to 4
years). These factors limited our ability to comment on the extent of
opioid misuse across studies or jurisdictions. The predictors of
measures of opioid misuse were younger age; female sex; visiting
multiple pharmacies or doctors, and number of prescribers or
pharmacies available near residence. Two studies investigated
predictors of an ICD diagnosis of opioid abuse or dependence, and
found two significant predictors: ≥6 previous opioid prescriptions and
previous diagnosis of non-opioid drug abuse. Further research is
required to understand the relationship between predictors of
measures of opioid misuse and opioid dependence.
Luciana Boiteux received her law degree from the State University of
Rio de Janeiro, and her J.D. at the University of São Paulo, and is
currently a Professor in Criminal Law at the Federal University of Rio
de Janeiro, Brazil, where she coordinates a Research Group on Drug
Policy and Human Rights. Her research interests include drug policy
and international human rights treaties, with a focus on the relation
between drug laws, penitentiary systems, and sentencing in criminal
cases involving illicit drugs. She is also a member of many advisory
boards of NGO's and professional societies in Brazil.
Abstract
State Responses to drug users in Brazil: a legal analysis of public
policies.
This presentation will address the results of the most recent study
released by the Research Consortium on Drugs and the Law (CEDD)
on State’s responses to the consumption of illicitly used drugs in
Brazil, focusing on two key areas: criminal justice and health.
One of the weakest links in the chain of government action on drugs
(especially illicitly used drugs) is the user, who is targeted by a
punitive State through the criminalization of drug-related behaviors.
Users are also the targets of a paternalistic State, which treats them
as sick people who must be “reintegrated into society” through
criminal law or made the objective of “assistance networks” simply
because they use drugs that are considered illicit. The regulatory
structure and operation of Brazil’s paternalistic approach to users of
some drugs, with an emphasis on practical outcomes identified
through official data will be analyzed.
Conclusion: Whole-of-population health data can be utilised to
explore prescribed opioid misuse. However, due to the heterogeneity
in measures utilised, cohort definitions and thresholds identifying
misuse, we are unable to determine the true extent of misuse or
compare findings across jurisdictions. To understand global patterns
of opioid misuse we need to develop minimum reporting standards
addressing these inconsistencies. These measures are vital to
understanding opioid use, misuse, and identify persons ‘at risk’ of
developing opioid dependence.
Treating drug use and drug possession as a criminal matter is
problematic for several reasons. First, responses that criminalize drug
users are often ultimately more hazardous for the users’ health than
the drug use itself and do not help decrease levels of use. Second, the
criminal justice response contributes to a climate of stigmatization of
and discrimination against users. Third, the criminalization of drug
users is a poor use of public resources in both the public security and
Key words: prescribed medicine misuse; pharmacoepidemiology;
opioid-related disorders
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
health sectors. Finally, this repressive action violates various
fundamental rights of users, including the rights to health,
information, personal autonomy and self-determination, all provided
for in the Brazilian Constitution and international human rights
conventions.
Dr Diogo Busse
[email protected]
Dr James Bott
St. Luke's/Roosevelt Hospital
Addiction Institute of New York
1000 10th Ave.
New York, New York 10019
United States
Email: [email protected]
Title
Dr Busse is a lawyer with masters in Social Relations Law from the
Federal University of Paraná, and LL.M. from IBMEC. Former Director
of Drug Policy matters of the municipality of Curitiba and former
President of the Municipal Council for Drug Policy matters of Curitiba
and of the Drug Policy Commission of the Brazilian Bar Association –
OAB. He is a member of the State Counsel for Drug Policy and a
researcher in the Federal University of Paraná, linked to CNPq.
Although always a prominent student, Diogo was involved with drugs
since a very early period of his life. He overcame three difficult times
in rehabilitation clinics and usually says that the birth of his son, now
a six year old little gift, had enlightened his life. With his family’s
support, and after a remarkable experience with a herb named
ibogaina (a bush found in Gabon, normally used in African tribal
rituals and, more recently, in drug addicted patients), Diogo is no
longer a drug user and started his volunteer work in institutions for
rehabilitation of drug users. In the Federal University of Paraná, Diogo
is dedicated to research of drug policies around the world and has
created a specific committee to study the subject in OAB (Parana
Section). In 2013 he was invited by the Mayor of Curitiba to be the
head of municipal policy related to drugs, a position which he still
holds to date.
Abstinence is not required: Support for Motivational Diversity in
group treatment
Authors
James Bott Psy.D.
Abstract
An initial review of large treatment programs in New York City found
that among agencies purporting to use Motivational Interviewing as a
cornerstone of group treatment, surprisingly few offer clients with
multiple diagnoses the opportunity to choose their drug-specific
treatment goals. While the rationale for programs to require
abstinence varies from agency to agency, most identify issues among
the clinical staff as the greatest influence on program rules and
guidelines. Specifically, fear and anxiety on the part of staff associated
with drug use by participants as well as more practical concerns about
how to manage motivationally diverse groups are major factors
shaping program policies. The objective of this workshop is to
highlight how one program in New York City has been able to conduct
group treatment in which clients themselves determine their drugspecific treatment goals. The benefits of this approach—cited in
existing research on treatment outcomes as well as benefits more
directly related to the field of ethics, such as the right to selfdetermination—will be discussed. Of particular relevance for those
involved in conducting group treatment, participants of this workshop
will hear about practical tools used to facilitate motivationally diverse
groups as well as ways to address the very real clinical anxieties
associated with such work.
Abstract
Strategies and Actions to Reduce Problems Relating to Drug Use in
Cities - Diogo Busse
Given the diversity of legal opinions regarding the use of both legal
and illegal drugs, local strategies to deal with the problems related to
drug consumption gain importance. The main reasons are the
following: (i) Municipalities are the public sphere where public
policies directed to users and their families are implemented; and (ii)
Municipalities do not have jurisdiction to enact laws prohibiting or
restricting substances, and such legal restrains, on the other hand,
allows them to focus on implementing measures to improve their
citizens’ life quality, including drug users and their family. This
presentation aims to analyze municipal strategies that can help to
reduce the major concerns and problems related to drug abuse and
proposes a shift on focus: from drugs to the human being.
18
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr Mance Buttram
Authors
2 NE 40th Street
Suite 404
Miami, FL 33140
United States
Email: [email protected]
André de Queiroz Constantino Miguel, Rodolfo Yamauchi, Viviane
Simões, Claudio Jeronimo da Silva, Ronaldo Laranjeira.
Abstract
Crack addiction has become a severe health problem in Brazil. Data
from the second Brazilian national epidemiologic survey points that
0.7% (over 1 million) of all Brazilians have at least once smoked crack
in the last year and that over 0.2% (about 300 thousand) are currently
crack abusers. This makes Brazil the biggest market in the world for
crack use. Although literature shows robust evidence that
Contingence Management (CM) is today the most effective outpatient
psychosocial treatment for stimulant addictions, this type of
treatment has never been applied in Brazilian population. Objective:
The objective of this study is to evaluate if CM plus Standard
Treatment (ST) can be effective in augmenting treatment adherence
and promotion of abstinence when compared to ST alone for crack
dependent individuals searching for outpatient treatment. Methods:
44 current crack dependence individuals (confirmed by DSM-IV); were
randomized in 2 groups for 12 weeks of treatment. 23 participants
were allocated to CM+ST group and 21 participants to ST alone group.
Both groups were encouraged to leave urine samples 3 times per
week. Only CM+ST participants could urn prizes for being abstinent.
Results: Baseline: Of the 44 participant assigned for both groups 86%
men of participants were; 84% were currently unemployed; 68.2% did
not complete high school; and 22.7% were currently leaving in the
streets. For what regard pattern of crack use; 66% were F19.2
diagnosed; with a mean for first crack use of 22.9 years of age (SD7.5); and a mean of years continued crack use of 11.5 years (SD- 6.9);
56.8% consumed crack at least 3 times per week; and 56.8% were
tested positive for crack/cocaine at treatment entrance. Both groups
did not present significant difference for these variables. Treatment
Adherence: 15 (65.2%) CM+ST participants were adherent to
treatment until the 4th week in comparison to 8 (38.1%) ST
participants (O.R. 3.04; p. < 0.1); 15 (65.2%) CM+ST participants were
adherent to treatment until the 8th week in comparison to 5 (23.8%)
ST participants (O.R.6.00; p. < 0.01); and 13 (56.5%) CM+ST
participants were adherent to treatment until the 12th week in
comparison to non ST participants (O.R. 55.285; p. < 0.01). Promotion
of Abstinence: 10 (43.5%) CM+ST participants achieved a period of 4
weeks or more continued abstinence in comparison to 2 (9.5%) ST
participants (O.R. 7.30; p. < 0.5); 9 (39.1%) CM+ST participants
achieved a period of 8 weeks or more continued abstinence in
comparison to 1 (4.8%) ST participants (O.R.12.85; p. < 0.05); and 7
(30.4%) CM+ST participants achieved 12 weeks of continued
abstinence in comparison non ST participants (O.R. 19.54; p. < 0.05).
Conclusions: The results achieved in this study supports that adding
Contingence Management to standard outpatient treatment can
increase significantly the effectiveness of treatment adherence and
the promotion of continued abstinence among crack dependent
individuals in Brazil. This data supports the implementation of CM
treatments in outpatient public services for crack/cocaine
dependence in Brazil. Further studies are warranted to evaluate CM’s
efficacy in different treatment settings as well as other types of
substance abuse populations.
Title
Liquid Prescription Opioid Misuse among a Sample of Diverse Club
Drug Users in Miami, Florida, USA
Authors
Mance E. Buttram, Steven P. Kurtz
Abstract
Study Objectives: This presentation examines demographics,
substance use, and HIV risk behavior associated with recent (past 90
days) misuse of liquid prescription (Rx) opioid medication, such as
codeine cough syrup. Methods: Data are drawn from participants
(N=435) who completed baseline assessments in an ongoing
substance use and sexual risk reduction intervention trial for young
adult club drug users in Miami, Florida, USA. Eligible participants were
18-39 and reported recent and regular use of club drugs (cocaine,
ecstasy, LSD, GHB, ketamine, or methamphetamine) and misuse of Rx
drugs. Results: Participants identified as 12% White, 19% Black, 66%
Hispanic, and 3% other. Mean age is 25 and 45% are female. Over
17% reported misuse of liquid Rx opioids. Compared to those who did
not, participants reporting liquid Rx opioid misuse were more likely to
be Hispanic (p
Additional Information
This research was supported by Grant DA019048 from the National
Institute on Drug Abuse. The content is solely the responsibility of the
authors and does not necessarily represent the official views of the
National Institute on Drug Abuse or the National Institutes of Health.
Dr André Constantino Miguel
Rua Araioses 46
Bairro: Sumarezinho
CEP:05442-010
São Paulo- SP
Brazil
Email: [email protected]
Title
Contingency Management is Effective in Promoting Abstinence and
Adherence to Outpatient Treatment for Crack Dependent Individuals
in Brazil
19
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Additional Information
Dr Osvaldo Francisco Ribas Lobos Fernandez
[email protected]
Study conducted by the Medical School of the Federal University of
São Paulo- UNIFESP.
Study founded by FAPESP process number 2011/01469-7
Prof Dartiu Da Silveira
[email protected]
Dr Fernandez obtained his Bachelor in Social Science from São Paulo
State University (UNESP_Araraquara:1987), Master’s in Sociology
from São Paulo Catholic Pontifice University (1993) and Doctorate in
Social Science from Bahia Federal University (2007). He has
experience in Urban and Health Anthropology and Sociology, acting
on the following subjects: gender, human rights, sexuality,
homosexuality, drug consumption and HIV/AIDS.
Abstract
Eleven Years of COCAINE - a follow up Study of 11 cocaine users in
São Paulo
Dartiu Xavier da Silveira graduated in Medicine and obtained his Ph.D.
degree in Psychiatry at the Federal University of Sao Paulo, Brazil, and
his specialization in Addictive Behaviors at the Centre Medical
Marmottan, Paris. He is Professor of Psychiatry at the Medical School
of the Federal University of Sao Paulo and has been coordinating the
Addiction unit of the institution for the last 25 years. He has been
conducting research on different themes, specifically in psychiatry
and neuroscience, such as: alcohol and other drugs misuse, impulse
control disorders, psychiatry co-morbidity, neuropsychiatry, harm
reduction, psychometrics (validation of diagnostic and screening
instruments), assessment of effectiveness of therapeutic
interventions, and systematic reviews and meta-analysis. An active
member of national and international organizations, he founded
PROAD (Program for the Orientation and Assistance for Drug
Dependents) in 1987 and ABRAMD (Brazilian multidisciplinary
association for studies on drug and alcohol) in 2003, and has been
director and president of both institutions. Following his Jung
Psychology studies, he was President of the Brazilian Association for
Analytical Psychology (SBPA). Dr. Dartiu’s broad areas of interest are
reflected in his clinical, teaching, and research activities,
encompassing general psychiatry, psychopathology, psychotherapy,
and neurobiology. Prof. da Silveira is the author of more than a
hundred papers (h = 17), 11 books, and 40 book chapters; his
innovative ideas have deeply influenced both governmental policies
and public health practices. He has received a number of national and
international awards.
The objective of this research is to understand the manner and
patterns of cocaine sniffing in São Paulo, taking into account the
users’ and their “careers” and the users’ life structures. The specific
object is to study the values and rules of conduct, as well as the social
rituals involved in “controlled use”. Qualitative methods were used
such as: ethnographic observations, in-depth interviews with an 11
year interval and autobiographical accounts. Eleven subjects were
interviewed who were contacted in different cocaine consuming
territories and circuits, taking into account different lifestyles and
social networks. The data was analyzed from perspectives of social
class, gender, sexual orientation, course of life and generation. The
main form of use found was recreational, although there was also a
minority detected that made instrumental use, mainly for work
purposes. In these two different forms of use a series of rules were
detected aimed at ensuring self-regulation on the part of the users.
Eleven years later follow up interviews detected that most of the
original interviewees had reduced their use (2) or abandoned it
altogether (6). A minority (2) had increased their use and one could
not be found for the follow-up interview. The research also
spotlighted the users´ ethos and a relationship between cocaine,
sexual behavior and gender performance.
Dr J Duchnicky
PAI-PAD workshop
Training and Supervising Primary Health Teams in the Public Health
System
20
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr Thiago M. Fidalgo
The main goal is to improve a fruitful dialogue with other areas of
knowledge without abandoning their methodological specificities.
[email protected]
Dr Erikson Furtado
[email protected]
Dr Thiago M. Fidalgo, psychiatrist, completed his MD and his PhD at
the Federal University of São Paulo (UNIFESP). He completed his
training in Psychiatry at the same university. He has been involved in
the treatment of addicted patients for the last decade and his work
was recognized by the Health Ministry of Brazil in 2005. In 2010 he
completed a research fellowship at Harvard University. Currently he is
the clinical coordinator of the Addiction Unit (PROAD) at UNIFESP. He
works as a consultant to the Brazilian Health Ministry and to the
United Nations Office for Drug and Alcohol Dependence.
Dr. Erikson Furtado, MD, PhD, started his medical career in 1984 as
pediatrician and became a child psychiatrist in 1986 and earned his
PhD in Child Psychiatry at the University of Heidelberg, Germany, in
1993. Since 1995, he has been a full-time tenured faculty member of
the University of Sao Paulo (USP, Brazil) as Assistant Professor of
Psychiatry with the Department of Neuroscience and Behavior, School
of Medicine at Ribeirao Preto (FMRP). He is responsible for the Child
and Adolescent Psychiatry Unit and its Residency and Fellowship
Program and is the founder and coordinator of the “PAI-PAD”
program (Program of Integrated Actions for Prevention and Attention
to Alcohol and Drugs in the Community). He opened an outpatient
unit devoted to the, from childbirth beginning, longitudinal
assessment and psychiatric care of FASD children and developed a
protocol for alcohol brief interventions for pregnant women as a
mean of FASD prevention. His “PAI-PAD” program, funded by the
State Health Department of Sao Paulo, is now promoting continuing
training and resources for the implementation of preventive and early
diagnosis and treatment for alcohol and drugs at the primary health
care level in Brazil.
Dr Mauricio Fiore
[email protected]
Dr. Mauricio Fiore is a researcher in the Brazilian Center for Analysis
and Planning and received a PhD in Social Sciences from University of
Campinas. He is author and editor of many works about different
aspects of drug use and he is a member of Interdisciplinary Group for
Psychoactive Studies (NEIP).
Prof Andrea Gallassi (BR)
[email protected]
Abstract
Social-cultural aspects X pharmacological determinants? Some notes
about drug use from social sciences perspective
The research about the use of psychoactive drugs is an ongoing
challenge for the social sciences. Drawing on their traditional
methodological tools, sociologists and anthropologists have produced
works that helped to understand important aspects of the
phenomenon. However, some challenges remain and continue to
feed the conflict between human and biological sciences. This
presentation will seek to discuss some perspectives from the social
sciences perspective beyond the boundary that divides socio-cultural
aspects and pharmacological determinants of psychoactive drug use.
Occupational Therapist, Master in Sciences by the Department of
Preventive Medicine of the Faculty of Medicine, University of Sao
Paulo (FMUSP). PhD in Sciences by the Department of Psychiatry of
21
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
the FMUSP; Assistant Professor of the Occupational Therapy Program
of the University of Brasilia (UnB)-Ceilândia campus. She was
seconded for two years for the National Secretariat of Policy on Drugs
(SENAD) in Brazil and was a consultant at the National Coordination of
Mental Health, Alcohol and Other Drugs of Ministry of Health. She is
the general coordinator of the Reference Centre on Drugs and other
Associated Vulnerabilities of UnB - Ceilândia campus. She completed
her postdoc at the Centre of Addiction and Mental Health (CAMH),
University of Toronto, Canada. She has experience in the area of
Mental Health and Public Health with an emphasis on alcohol and
other drugs and health policies, mainly in the following areas: public
policy in alcohol and other drugs, and adolescents and offense.
drug abusers. A preliminary study in Jakarta
Authors
Isadora Gracia, Rensa, Minawati, Teguh Sarry Hartono, Eva Suryani,
Surilena
Abstract
BACKGROUND Reports on the oral health status among drug abusers,
especially those on methadone maintenance treatment, was still
limited. The objective of our study was to investigate all oral
opportunistic infection among HIV drug abusers on methadone
treatment in Jakarta. MATERIAL AND METHOD This cross sectional
study was conducted in Jakarta. Subject were all HIV patients who
come regularly in a clinic to get ARV and agree to participate. Data
collected include: demographic data (sex, age), CD4 count, length
time use of ARV, dosage of methadone, type of addictive drug/
substance used. Data for oral condition were oral hygiene status
which determined by Oral Hygiene Index Simplified, and presence of
oral mucosal lesion. RESULTS Number of subjects were 46 (42 male, 4
female), age between 21-58 years old, received ARV regularly (n =
30/46, 65.2%, for less than 2 years and n = 16/46, 34.8%, for 2 years
or more). All subjects had been on methadone maintenance
treatment for more than 2 years. The methadone dosage taken in 25
subjects of this studied group (54.3%) was more than 200 mg/day.
According to Oral Hygiene Index –Simplified, all subjects had poor oral
hygiene. Oral opportunistic infection found in this population of study
was oral candidiasis (n = 24/48, 50%). Interestingly, the majority
subject with oral candidiasis had CD4 count 200-299 cells/mm3 (n =
14/46, 29.17%), received methadone more than 120 mg/day (n =
13/46, 28.26%). Twelve of 24 subjects (50%) with oral candidiasis
were still using addictive substance/drug (benzodiazepine, cannabis,
heroin, alcohol, etc.). The type of oral candidiasis were 5 subjects with
angular cheilitis, 3 subjects with erythematous type, 2 subjects with
median rhomboid glossitis, 10 subjects with pseudomembranous
type, 4 subject had more than one type of oral candidiasis.
CONCLUSION The oral opportunistic infection among this studied
population was dominated by oral candidiasis and found in HIV
subjects who had CD4 count 200-499 cells/mm3. These findings
indicate that there were other factors that played role in the onset of
oral candidiasis. The possibility of the other factors were presence of
other addictive drugs/substance, dosage of methadone, presence of
systemic condition (tuberculosis, hepatitis C, etc.). Keywords: Oral
opportunistic infection, drug abuser, methadone treatment
Abstract
Adolescent, drug use and offence
Prof. Andrea Gallassi, MS, MD., University of Brasilia (UnB), Brazil
Juvenile offenders constitute a growing population in the criminal
justice system, for which social rehabilitation and prevention of
recidivism is of key importance. Recidivism among juvenile offenders
has been found to be associated with various personal, behavioral,
social and environmental factors, however little is known about the
determinants of juvenile offender recidivism in Brazil. This
presentation is based in a study aimed to describe key offender
characteristics and to assess their potential association with
recidivism in a Brazilian sample of adolescent female offenders
(n=391, ages ≤15 – 18) admitted between 2004 and 2011 to a state
correctional institution (UI) in Brasilia, Federal District, Brazil. Crosssectional administrative data, obtained from institutional records, on
sociodemographics, drug use and offense characteristics were
examined by descriptive statistics; their potential association with
‘any recidivism’, and ‘frequency of recidivism’ (among recidivists) was
examined by way of negative binomial regression analyses. 32.5%
(n=127) of the sample were admitted as recidivists; the mean number
of recidivist occurrences was 2.16 (range: 1-8, SD:1.57). In the
multivariate analyses, ‘any recidivism’ was associated with age
[p<0.000]; offender’s own drug use [MR: 2.704; CI: 1.822-4.014;
p<0.000]; residence status [MR: 1.477; CI: 1.009-2.162 p<0.045]; and
negatively with type of offense [p<0.001]; ‘frequency of recidivism’
among recidivists was associated, before adjusted, only with home
situation [MR 1.724; CI: 1.096-2.713; p<0.018].The results indicate
several factors associated with recidivism among a sample of
adolescent female offenders in Brazil that confirm findings from other
jurisdictions and call for development of targeted interventions.
Dr Isadora Gracia
School of Medicine, Atma Jaya Catholic University of Indonesia,
Jl. Pluit Raya no 2, North of Jakarta
Indonesia
Email: [email protected]
Title
Oral opportunistic infections in HIV infected methadone maintained
22
Global Addiction 2014
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06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr Bettina Grajcer
Evaluation of an Alcohol Underage Prevention Project
implemented. The project has impacted a substantial number of
people, either through direct activities or through its communication
platform. Individualized NGO’s evaluations showed that the project
was able to promote changes in alcohol behavior, minimizing
consumption and therefore risks associated with early consumption.
Given the importance of the topic and the lack of alcohol prevention
projects systematization, the program has its continuity and constant
evaluation provided.
Authors
Keywords - alcohol prevention; alcohol consumption; ethanol
Rua Tavares Cabral 102 10 andar
Brazil
Email: [email protected]
Title
Bettina Grajcer, Stella Pereira de Almeida
Prof Carl Hart
Abstract
BACKGROUND Early alcohol consumption is a legitimate social
concern: it exposes young people to several risks and predisposes to
harmful drinking patterns in adulthood. Therefore, an alcohol
underage prevention project (in Brazil, legal age is 18) was
implemented in March 2010 in four nongovernmental organizations
(NGOs), expanding its coverage to a network of 23 NGOs over four
years. This network composes the “Projeto Jovens de Responsa” –
“Responsible Youth Program” (RYP) which is part of Ambev’s
Responsible Drinking program. The project aims at developing social
technologies for underage alcohol prevention. OBJECTIVE Evaluate
the results from the RYP between March 2010 and April 2014
METHODOLOGY Each NGO plans the activities they will develop using
content and format specific to the peculiarities of resources they have
and public they serve. To help them plan and develop the activities,
each NGO receives: group trainings, long distance and in person
individual supervision. This strategy guarantees the uniformity of the
theoretical background concerning alcohol and prevention. Although
the projects are customized by each NGO, they all have in common
the inclusion of alcohol consumption prevention theme in their
everyday activities. In addition, the RYP network utilizes a
communications platform that includes a quarterly magazine and
social media networks. The NGOs, as a strategy implement activities
in five areas: 1) activities with the youth; 2) training of educators and
community leaders; 3) activities with bars; 4) events; and 5)
communication actions. The RYP is regularly monitored by an external
team, and evaluated by independent researchers. RESULTS Between
March 2010 and June 2014 the RYP has directly impacted 93.055
people. In the communications platform, 50.000 magazines in five
editions have been distributed, and 158.000 fans have been
accumulated on Facebook. An independent researcher applied a selfadministered questionnaire with a sample of the directly impacted
youth. They considered themselves more knowledgeable about
alcohol effects and related a reduced consumption after the
prevention activities. A qualitative evaluation was also conducted
through focus groups. This evaluation showed that young people have
interest in the theme and reduced their frequency and/or quantity of
alcohol consumption after participating in prevention activities.
DISCUSSION All NGOs were very interested and open to the project,
having planned and implemented customized prevention activities.
Such interest highlights the relevance of including alcohol prevention
activities at NGOs that work with youth. Several practices that are
innovative, simple, low profile and able to be replicated were
Carl Hart is an associate professor of psychology at Columbia
University, a member of the National Advisory Council on Drug Abuse,
and the director of the Methamphetamine Research Laboratories at
the New York State Psychiatric Institute. His research focuses on the
neuropsychopharmacological effects of psychoactive drugs in
humans. In 2013, he published his best-selling book, “High Price: A
Neuroscientist’s Journey of Self-Discovery That Challenges Everything
You Know About Drugs and Society.” High Price was the 2014 winner
of the PEN/E.O. Wilson Literary Science Writing Award.
Abstract
Opioid assisted treatment refers to the prescribing of opioids (e.g.,
methadone, heroin) to individuals who meet criteria for an opioid
substance use disorder in an effort to facilitate better treatment
outcomes. This practice is almost universally accepted. By
comparison, there are no medications approved to assist with
stimulant substance use disorders, despite the fact that there are
promising data indicating that specific stimulants should be
recommended. These data as well as reasons for the apparent
reluctance to use stimulants in the treatment of stimulant use
disorders will be discussed in this presentation.
23
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Jorge Hernández Tinajero
democratic institutions, the rise of organized crime and the stigma
suffered by our countries is no longer acceptable.
Dr Andrej Kastelic
[email protected]
Jorge is the president of CuPIHD (www.cupihd.org). He is a
Politologist and internationalist, professor of the Political and Social
Sciences Faculty at UNAM; Jorge has specialised on drug policy for
more than ten years. He is the author of numerous articles and
essays about the subject; co-author of Social Democracy and Mexico
possible political platforms on illegal drugs; assessor of different law
initiatives on cannabis, and member of the Mexican Association of
Cannabis Studies. Jorge is also a member of the Mexican Association
of Risk and Harm Reduction.
Dr Andrej Kastelic, MD, PhD is a head of the National Center for the
Treatment of Drug Addiction in Ljubljana (Slovenia, EU) and president
of coordination of the Centers for the Prevention and Treatment of
Drug Addiction at the Ministry of Health of the Republic of Slovenia.
He earned his medical degree from the University of Ljubljana in
1981, with a specialization in psychiatry in 1989. He works as a
consultant expert specially for development addiction treatment
programs in communities and custodial setting for UNAIDS, UNODC,
WHO, EU, Council of Europe – Pompidou Group, OSCE, Global Found.
He has been involved as a consultant and/or principal trainer in
Albania, Azerbaijan, Bosnia and Herzegovina, Egypt, Kosovo,
Macedonia, Moldova, Montenegro, Romania, Serbia, Ukraine,
Tajikistan, Taiwan, Turkey and Baltic’s countries. He has served as
guest editor of European Addiction Research on Buprenorphine:
Current Perspectives, as well as editor-in-chief of SEEA Addictions, a
Slovenian magazine titled Reflection, and a series of books titled
Drugs Amongst Us and as a member of the editorial board of
European Addiction Research and Heroin Addiction and Related
Clinical Problems. He is the author of more than 300 books articles
on drug addiction and WHO guidelines for treating drug users in
custodial settings and several manuals and leaflets for drug users and
on prevention of drug use. Dr Kastelic has participated in more than
300 international conferences and has offered more than 1000
lectures on the same subject. He is a President of Global Addiction
Association and serves as Secretary General of the European Opiate
Addiction Treatment Association (EUROPAD), is a founding member
of the World Federation for the Treatment of Opiate Dependence
(WFO), is President of the South Eastern European and Adriatic
Society, and President of the SEE Adriatic Addiction Treatment
Network (SEEA net). He has received Dole – Nyswander Award in
2001 by American Association for Treatment of Opiate Dependence
(AATOD) Gold Reflection Award in 2002, Slovene Ministry Of Justice
Award 2005 and EUROPAD “Chimera” in 2008Kastelic
Abstract
”Unintended (or are they?)" consequences of unregulated products
from producer and transit countries?”
Global regulatory systems have never been as detailed as today. The
exact amount of alcohol in a beer must be written on the bottle and
we don’t allow people to drive without a license and insurance.
Why is this sensible way of doing things such an anathema to
politicians when it comes to three plants that grow abundantly in
many parts of the world; namely, cannabis, coca and opium? They
seem to attract a unique reaction when it comes to regulation – one
where politicians absolve themselves of all responsibility for products
that are consumed by hundreds of millions of people. How do they do
this? By saying all possession is illegal. This way of doing things has
become so engrained that to use the well developed risk assessment
and regulatory systems used for all other products has become
almost unthinkable for politicians.
Why is this so menacing for producer and transit countries? If the
richest countries in the world spend billions of dollars a year on these
products – market forces will demand their production and
distribution. Furthermore, bigger local markets for these products will
increase - especially in the transit countries. If certain groups control
the production and transport of these products, worth billions of
dollars, what happens when they have disagreements? Sadly, we
know only too well.
We now live in a free moving global economy completely governed by
the laws of supply and demand. It is inappropriate for the richest
countries that consume these products with voracious appetites to
persist in demanding punitive laws based on moral dogma. We, as
producer and transit countries, must pose key questions on how or
what we must change as we witness the outcomes of current global
drug policy on our doorstep. Violence, corruption, weakness of our
Abstract
The prison health WHO guidelines: Harm reduction & addiction
treatment within custodial settings
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Andrej Kastelic, Nuša Šegrec
Some of the harms associated with drug users in the criminal justice
system include:
Center for Treatment of Drug Addiction
University Psychiatric Hospital, Ljubljana, Slovenia
e-mail: [email protected]
Many people with mental disorders are arrested and imprisoned
importing their mental health problems from the community into the
prisons and people without mental disorders develop mental health
problems during their imprisonment due to the deprivation they
encounter in the prisons, as well.
•
High rates of HIV and viral hepatitis infection.
•
High rates of tuberculosis in some countries.
•
Restricted access to harm reduction services and treatment
for drug dependence and BBVs.
•
Increased risk of death by overdose on release.
•
Increased risks of passing on infections that were acquired in
prison.
•
Increased risk of reoffending on release.
Mental health, mental illness and drug dependence in prisons
About nine million people are detained in penal institutions around
the world, 30 million imprisoned annually.
Impact of opioid substitution maintenance therapy (OST)
At least half of these struggle with personality disorders, and one
million prisoners or more worldwide suffer from serious mental
disorders such as psychosis or depression. We can confidently
estimate that at least one third (10 million) of all are drug dependent
and many more have experienced drug use many with problematic
injecting drug use. In several prisons, this includes up to three
quarters of the inmate population.
•
IDUs who do not enter OST are up to six times more likely to
become infected with HIV than injectors who enter and
remain in treatment.
•
The death rate of people with opioid dependence in OST is
one-third to one quarter the rate for those not in treatment.
Mental Health
Key points
•
On release, prisoners with opioid dependence are at risk of relapse
and overdose. Relapses into drug use and fatal overdoses after
release are widespread. These risks need to be addressed during the
period of imprisonment. Prison staff and prisoners should be trained
in drugs and related (mental) health problems. Taken together, the
costs of law enforcement, court time and imprisonment make a major
contribution to the social costs associated with drug dependence.
Mental disorders and suicide are highly prevalent in prisons.
•
Several factors associated with imprisonment are intrinsically
hazardous for the mental health of prisoners.
•
Prisoners should receive the same level and quality of basic
health services as in the community (equivalence principle).
References:
•
It is vital that prisons cooperate with community agencies to
secure equality and continuity of treatment.
Blaauw E, van Marle H.J.C. (2007). Mental Health in Prisons. In: Health
in Prison. A WHO guide to the essentials in prison health. World
Health Organization: 133–44.
•
About 6–12% of all prisoners need to be transferred to
specialized institutions, 30–50% need assistance from health care
services and 40–60% would benefit most from mental health
promotion.
Kastelic A, Pont J, Stöver H. (2008). Opioid substitution treatment in
custodial settings – a practical guide. Oldenburg, BIS-Verlag.
Consequently, different levels of care are required when further
specialized medical examinations, interventions and aftercare are
needed, these should be applied in a special part of the prison in ways
that are equal to how they are applied in the community with close
cooperation between prisons and external agencies (continuity of
treatment).
Kastelic A.(2007). Substitution Treatment in Prisons. In: Health in
Prison. A WHO guide to the essentials in prison health. World Health
Organization: 113–32.
Evidence indicates that approximately 80% of IDUs have a history of
imprisonment, and WHO study of HIV risk behaviour among IDUs
found that between 60 and 90 percent of respondents reported a
history of imprisonment since commencing drug injection.
WHO Guidelines for the Psychosocially Assisted Pharmacological
Treatment of Opioid Dependence (2009). World Health Organization,
Geneve.
Stöver H, Kastelic A. (2014). Drug Treatment and Harm Reduction in
Prisons. In: Prison Health. World Health Organization.
25
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr André Kiepper
any issues pertaining to decriminalization of drug possession for
personal use or regulation of marijuana. On March 26, 2014, PLC
37/2013 was removed from agenda for reexamination of that
respective report. A public hearing about decriminalization of drug
possession for personal use and the unconstitutionality of Article 28
of Law nº. 11.343/2006 was held on May 20, 2014. This public hearing
was also demanded by a popular petition from my authorship,
recorded at e-Citizenship Portal with more than 10 thousand
supports, under number SUG 10/2014. The Brazilian Senate appears
to be getting aware of society’s evolving opinions on illicit drug issue.
Last octuber, PLC 37/2013 was amended with two innovations: a 05
day threshold amount determining drug possession for personal use
and the authorization for importing marijuana derivates for severe
health conditions treatment. Althought needing improvements, these
are two other big steps for a broader reform in Brazilian drug policies,
urged by citizens’ plea.
[email protected]
André Kiepper works at Oswaldo Cruz Foundation as an Analyst of
Management in Public Health. He is in a master's program on Public
Health at the National School of Public Health (ENSP), researching the
medical marijuana regulatory landmark.
Dr Ivy Krull
Abstract
Boston University
School of Social Work
264 Bay State Road
Boston, MA USA 02067
United States
Email: [email protected]
Marijuana regulation by Federal Senate: a public health issue in Brazil
Brazilian Senate’s website provides a mechanism for citizens’
participation called e-Citizenship Portal, offering the possibility of
petitioning and supporting bills, amending existing laws and
improving the National Constitution, through automatically online
signatures. Registered petitions must receive at least twenty
thousand messages of support within a four-month period in order to
be formally submitted to Senate’s Committee on Human Rights and
Participatory Legislation. A petition to regulate recreational, medical
and industrial marijuana, I’ve registered at e-Citizenship Portal, was
lauched on January 30, 2014. With more than 20 thousand messages
of support received in just four days, the petition generated
proposition SUG 8/2014, forwarded to Federal Senate on February
11, 2014, with Senator Cristovam Buarque as the designated
rapporteur. This mass support for a petition to regulate marijuana
meant a major step forward in Brazilian drug policy reform, mirroring
an international trend: there is an emerging consensus that initiatives
to regulate marijuana highlight the need to revise international drug
treaties, making prohibition a matter of choice and no longer an
obligation for United Nations Member States. The Brazilian Executive
Branch prohibits marijuana by classifying it as a banned plant on the
National Health Surveillance Agency (ANVISA) Ruling nº. 344/98.
ANVISA is able to reschedule marijuana by a Collegiate Directorate
Resolution, an infra-constitutional act that would allow physicians to
issue special prescriptions and set precedents for legal import,
cultivation and research with marijuana in Brazil. Despite popular
demand, Brazil’s prevailing policy is still based on Law nº.
11.343/2006. This law devotes 23 articles to safeguarding the rights
of drug consumers (prevention, care and social rehabilitation), but
other 46 articles, or double the number, to criminal sanctions for drug
offenses. During 2013, Brazilian Federal Senate published the review
of PLC 37/2013, a Bill of Law under the Chamber of Deputies that
amends Law nº. 11.343/2006. PLC 37/2013 rules on Drug Public
Policies National System, conditions for care provided to problematic
drug users, and financing of drug policies, but was failling to modify
Title
The Affordable Care Act: New Opportunities for Social Work to Take
Leadership in Behavioral Health and Addiction Treatment
Authors
Ivy Krull, Ph.D., M.S.W./M.P.H.,
Lena M. Lundgren, Ph.D.
Abstract
An estimated 23 million individuals in the United States meet criteria
for a diagnosis of substance abuse or dependence. Yet, only about 4
million people enter care each year. The Patient Protection and
Affordable Care Act (ACA) is likely to increase access to addiction
treatment through the integration of behavioral health and health.
However, this integration effort is at risk of excluding the most
vulnerable population groups with substance use disorders. Further,
the Institute of Medicine (2006), the National Institute on Alcohol
Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse
(NIDA) and the Substance Abuse and Mental Health Services
Administration (SAMHSA) all report on the urgent need for health
professionals to be trained in empirically-supported alcohol and other
drugs (AOD) identification and treatment methods (Martino, 2010;
Warren & Hewitt, 2010). Yet, the shortage of social workers who are
sufficiently trained in these methods is a significant problem
(McCarty, Edmundson & Hartnett, 2006). This presentation argues
that in this era of implementing the ACA, it is key that social workers
become leaders in the addiction health services research field and
translate their knowledge to social work practice. Further, through
26
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
the utilization of the Swedish addiction treatment system as a model
where social workers implement a coordinated care model, research
findings using these Swedish national databases are discussed. These
findings are consistent with the framework that addiction is a bio/
psycho/social condition with multiple risk factors (biological/genetic,
familial, psychological (trauma and loss), peer influences) and other
environmental conditions that encourage early use (e.g., drug and
alcohol availability), and dependence (drug potency) (Fewell et al.,
2011), resulting in multiple consequences that are medical (e.g., liver
and heart problems), psychological (e.g., depression, anxiety) and
social/economic (e.g., job loss, homelessness, incarceration, child
neglect) (Baldwin, Marcus, & De Simone, 2010). The provision of
treatment and related medical and support services necessitates not
only multiple treatment episodes, but multi-care services responding
to each of the spheres, including addiction treatment, mental health
treatment, medical services, unemployment services, housing
services and family support services. The Swedish studies also confirm
that a health disparities framework is critical for understanding and
conducting research on access, use, and outcomes of addiction
treatment. The application of these findings and the ACA is discussed
within the framework of these findings. To be successful in this
transition, social workers in the United States need to: (1) expand
research on implementation of empirically-tested, culturally-adapted,
screening, assessment and treatment methods; (2) support the use of
an extensive range of health services by those with SUDs: (3) promote
the development of government policies and programs that ensure
that implementation of the ACA does not result in decreased access
to a comprehensive range of treatment options for those most in
need, including access to behavioral interventions, medications, social
support services, as well as both inpatient and outpatient treatment
options.
18 to 39; reported recent multidrug use; and endorsed regular
attendance at large nightclubs in Miami, Florida. Data were collected
using standardized health and social risk assessments. Past 90 day
sexual risk outcome measures included: 1) more than one sex
partner; 2) unprotected vaginal sex with a casual partner (UVSC); and
3) unprotected anal sex with a casual partner (UASC). Logistic
regression models examined relationships between demographics
and psychosocial risk factors and each outcome. Results: Median age
was 23; 65% were Latina, 18% Black, 13% White, 4% other race/
ethnicity. 60% reported clinically severe mental distress; 66% met
DSM-IVR substance dependence criteria; 60% experienced abuse as
minors. Over 90% endorsed recent use of marijuana, cocaine, MDMA,
and prescription opioids and benzodiazepines; 61% LSD and other
hallucinogens. 68% reported past 90 day UVSC; 29% UASC; and 57%
multiple sex partners. In regression analyses, demographics were not
associated with sexual risk behaviors, nor were early sexual debut or
early initiation of substance use. Using drugs for sex “almost all of the
time” (p=.003) and substance dependence (p=.003) were significant
predicators of UVSC, UASC and having multiple recent partners.
However, those with severe mental health problems (p=.028), high
levels of negative coping strategies (p=.025), and high levels of
trauma related to prior abuse (p=.036) had significantly higher odds
of having multiple sex partners and engaging in UASC, but not UVSC.
Conclusions: Our sample of women reported extensive and varied
drug use, as well as high levels of mental health problems, substance
dependence, and traumatic histories of abuse. Although UVSC is
commonly used as an HIV risk indicator in research among women,
multiple partner and UASC behaviors appear to be important
additional measures of risk that point to unique and critical targets for
intervention among this vulnerable population. Financial Support:
This research was supported by NIH Grant DA019048. The content is
solely the responsibility of the authors and does not necessarily
represent the official views of the National Institute on Drug Abuse or
the National Institutes of Health.
Dr Steven Kurtz
Nova Southeastern University
2 NE 40th Street, Ste. 404
Miami, FL 33137
United States
Email: [email protected]
Ms Julita Lemgruber
[email protected]
Title
Psychosocial Correlates of Sexual Risk Behaviors among Young Adult
Women Multidrug Users in the Club Scene
Authors
Steven P. Kurtz, Mance E. Buttram, Hilary L. Surratt
Abstract
Background: Young adults who participate in nightclub scenes are at
high risk for drug-related health problems. Women participants have
been shown to be especially vulnerable, but in-depth research on
sexual risk behaviors for HIV among this population is scant. Methods:
Participants (N=176) were: female; enrolled in a behavioral
intervention trial between September 2011 and January 2014; ages
Julita Lemgruber is a Brazilian sociologist who has held different
positions in public service. Among these she has been the General
Director of the Prison System (1991/1994) and the Police
Ombudsman (1999/2000) both in the State of Rio de Janeiro and a
member of the National Council for Criminal and Penitentiary Policy
in the federal government (1995/1998). Since the year 2000, she has
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Global Addiction 2014
10-12 November 2014
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www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
been the Coordinator of the Center for Studies on Public Security and
Citizenship at University Candido Mendes and is currently a board
member of the International Drug Policy Consortium and the Altus
Global Alliance.
data was stored and analysed by means of the software SPSSStatistical Package for the Social Sciences. Considering the 411 valid
records collected, the final result of the research shows that the
clinical profile of users who were looking for the health service,
compared the mood swings was 32.4% of users experiencing this
issue, had 39.7% depression, but only 6.8 % used remedies for the
problems cited. Already in relation to the usage profile, the main drug
used by women was 42% marijuana, followed by 38% cocaine, 38.25%
crack and 15.6% inhalants. When asked about sexual intercourse, it
was found that 33.8% don't make use of condom and 30.9% have sex
with injection drug users. Finally this study made it possible to
conclude that the use of alcohol in women is permeated by various
situations that increase their physical and psychological vulnerability,
among them depression most often without proper treatment, and
risky sexual behaviours that have specifically achieved this
population.
Abstract
Attitudes toward drug related legislation and policies: the case of the
“cariocas” is part of a larger study which is being developed in the city
of Rio de Janeiro, Brazil, by the Center for Studies on Public Security
and Citizenship, based in University Candido Mendes, and
coordinated by sociologist Julita Lemgruber. This study intends to
identify the main reasons, both cognitive and emotional, that lie
behind the public’s opposition to the ideas of decriminalizing,
legalizing and or regulating today illicit drugs. It is also an attempt to
map the different profiles of the population, according to sociodemographic characteristics and other variables associated with more
favorable and unfavorable attitudes towards those same issues. The
study encompasses quantitative and qualitative strategies. As far as
the quantitative approach, a survey interviewing two thousand
cariocas (people who live in the city of Rio) was done in 2013 and a
new one will happen in 2015. Results for the quantitative portion of
the study are not yet available. Presently, “Attitudes toward drug
related legislation and policies: the case of the cariocas” is a
discussion on the qualitative dimension of the work resulting from
thirteen focus groups, discussing the same general issues.
Keywords: Women, Alcohol, Drugs, Abuse of psychoactive substances
Dr Renato Malcher-Lopes
[email protected]
Mrs Erika Gisseth León Ramírez
Rua Angelo Cutrale 131
Brazil
Email: [email protected]
Title
Renato Malcher-Lopes holds a Bachelor's degree in biological sciences
from the University of Brasília (UnB, 1994), where he also completed
his Master’s in Molecular Biology in 1997. He obtained his PhD in
Neurosciences from Tulane University (New Orleans, USA, 2005). In
his research, he discovered the mutual modulatory control between
the endocannabinoid system and hormones involved in appetite
control, metabolism, immune response, inflammation, cognition,
emotion and adaptation to stress. His articles on the subject have
over 800 citations in scientific journals (Scopus author: MalcherLopes). Renato also specialized as a postdoc in Cellular
Neurophysiology at the École Polytechnique Fédérale de Lausanne
(Switzerland, 2005-6) and Analytical Biochemistry in the Laboratory of
Mass Spectrometry Embrapa (Center of Genetic Resources and
Biotechnology; Brasília, 2008-9). He is the author of the book
“Marijuana, Brain and Health” (Vieira & Lent, 2007), written with the
collaboration of the neuroscientist Sidarta Ribeiro. He was president
of the first "International Congress on Drugs, Law, Health and
Society", held in 2013 in Brasilia. Malcher-Lopes discovered the noninteraction between genomics and glucocorticoids hormones leptin to
control the synthesis of endocanabinoids and its synaptic effects on
the hypothalamus, in the regulation of homeostasis and in response
to stress. He is currently a professor and researcher in the Laboratory
of Neurobiology and Behavior at the University of Brasilia and a
Clinical Profile of Women Users of Alcohol of a Reference Center in
the City of Sao Paulo
Authors
Divane de Vargas,Caroline Figueira Pereira, Erika Gisseth León
Ramírez,Janaina Soares, Marina Nolli Bittencurt, Fernanda Matos
Fernandez
Abstract
Alcoholism configures itself as one of the biggest health problems of
today, reaching a large percentage of the population. In relation to
gender, there are differences in relation to consumption, in that the
abuse is more frequent among men, but the number of women users
is increasing, showing that the difference in consumption between
genders has decreased steadily in recent decades. The aim of this
study is to characterize the clinical and behavioral profile of women
addicted to alcohol and other drugs answered in a specialized service
in the city of São Paulo. This is a retrospective, descriptive study
carried out through active search on the charts of patients who have
been answered in this service between 2002 and 2010. The collected
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Global Addiction 2014
10-12 November 2014
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www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
member of the International Centre for Science in Drug Policy-ICSDP.
Prof Icro Maremmani is Professor of Addiction Medicine, University of
Pisa, Italy, and ‘Vincent P. Dole’ Dual Diagnosis Unit, Santa Chiara
University Hospital, Pisa. He is also the President of European Opiate
Addiction Treatment Association (EUROPAD) and World Federation
for the Treatment of Opioid Dependence (WFTOD) an NGO with
Special Consultative Status with Economic and Social Council
(ECOSOC). Icro Maremmani graduated at the Medical School of the
University of Pisa, Italy, in 1979, and went on to specialize in
Psychiatry, taking his second degree cum laude, in 1983. He is
currently on the Board of Directors of the Department of Psychiatry,
at the Santa Chiara Hospital of the University of Pisa, Italy. He is
Professor of Drug Addiction Medicine at the School of Psychiatry of
the University of Pisa. He has been President of the European Opiate
Addiction Treatment Association (EUROPAD) since its foundation in
Geneva (Switzerland) in 1994. As President of EUROPAD he has
organized international symposia in the USA, during the Conferences
of the American Association for the Treatment of Opiate Dependence
(AATOD), and Conferences in several European cities (Saint-Tropez,
1995; Ljubljana, 1997; Arezzo 2000; Oslo 2002; Paris, 2004; Bratislava,
2006; Sofia, 2008; Zagabria, 2010; Barcelona, 2012). He received the
Dole-Nyswander Award in Washington (DC), USA, in 1994; he was the
first non-American winner of that award. In 2004 he received the
“Chimera Award”, in Paris. In 1990 (Cagliari, Italy) he became a
founding member of the Società Italiana Tossicodipendenze - Italian
Society of Addiction Medicine (SITD-ItSAM), and is currently its
President. He is President of the World Federation for the Treatment
of Opioid Dependence (WFTOD), an NGO with Special Consultative
Status with Economic and Social Council (ECOSOC), since 2011. He is
author of the chapters on Drug Abuse and Aggression in the second
edition of the Trattato Italiano di Psichiatria. To date he has 500
scientific publications and has given over 300 scientific presentations.
He is Editor of Heroin Addiction and Related Clinical Problems, the
official journal of EUROPAD and WFTOD, and board member of
Journal of Maintenance in the Addictions, Italian Journal on
Addictions, Addictive Disorders and their Treatment, and Odvinosky.
Abstract
What are the real concerns about medical Cannabis regulation and its
impact on society?
In 1843 the western world received its first scientific report about the
medical properties of marijuana. In his article, the Irish physician
William Brook O'Shaughnessy describes several cases underscoring
the effectiveness of Cannabis indica for the treatment of rheumatism,
cholera, tetanus, hydrophobia and seizures – with results including
significant pain relief, improvement of both appetite and emotional
state for most patients. It is especially moving his account about a
forty days-old girl suffering from severe recurring seizures, which
didn't respond to any treatment available and was leading her to a
dramatic death. Some drops of Cannabis tincture, however, stopped
seizures, restored appetite and saved her life. Little after this article
was published in Europe, C. indica established itself as one of the
most important compounds in the western pharmacopeia. Its
protagonist status in the pharmaceutical industry spanned from the
late XIX century until around 1940, when its use was forbidden.
Banning medicinal Cannabis use immensely harmed scientific
development and the proper exploration of its unique pharmaceutical
resources. One can only imagine how many people had to suffer and
miserably die in vain because of that. Every day modern scientific
approaches corroborate traditional applications and find new ones.
Nevertheless, there are still many challenges on regulating medicinal
marijuana use with concomitant abuse prevention. Most difficulties
simply concern formal fulfillment of scientific and medical protocols,
which were delayed by the prohibition itself and are still necessary for
consistent and safe use. Fortunately, many specific methodological
tools are already available to take adequate advantage of the vast
versatility of this group of plants, which includes innumerous
varieties, each one containing an unique combination of cannabinoids
and medicinal properties. Still, cultural and political barriers, along
with economical disputes, are ultimately keeping people from getting
what may be the only relieve from their suffering. In this talk, I will
propose the use of the approaches that minimize side effects and risk
for abuse, and of those that maximize effectiveness, as a very straight
forward way to foster consensus in order to overcome regulation
issues.
Abstract
Role of Nalmefene in the treatment of Alcohol Use Disorder
Alcohol dependence is a major public health problem with a huge
social and economic burden. However, alcohol dependence is both
underdiagnosed and undertreated, as it is estimated that less than
10% of people diagnosed with alcohol dependence or abuse in
Europe receive any form of treatment. Among the factors that have
contributed to this undertreatment is the fact that the therapeutic
strategy has always been based on achieving and maintaining
abstinence from alcohol, a goal often difficult to achieve. Recently it
has been made available a new therapeutic approach to alcohol
dependence, nalmefene, based on the reduction of alcohol
consumption. In fact, nalmefene is the first drug to be approved in
Europe for as-needed use to reduce alcohol consumption in alcoholdependent adults with a high drinking risk level and who continue to
have a high drinking risk level 2 weeks after initial assessment.
Nalmefene reduces the reinforcing effects of alcohol, helping to
reduce alcohol consumption, through the modulation of the opioid
system.
Prof Icro Maremmani
[email protected]
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Global Addiction 2014
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www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Studies demonstrate the clinical efficacy and tolerability of nalmefene
in patients with alcohol dependence: the effect is larger in patients
with at least a high drinking risk level at the start of treatment.
Nalmefene has the potential to engage in treatment patients who
otherwise would not have sought help, thus representing a new
pharmacological treatment paradigm, in terms of treatment goal
(reduction of alcohol consumption) and dosing regimen (as-needed)
in alcohol dependent patients.
Email: [email protected]
will become increasingly important in my practice. 13% were
neutral • 81% strongly agreed/ agreed that there is a lack of a
universal tool to measure all aspects of care including aspects such as
recovery. 19% were neutral CONCLUSIONS This work demonstrates
an expert consensus that currently used outcome measures
(completions, readmissions) may be too simple to capture full benefit
of treatment and that being prepared by measuring outcomes can
ensure access to interventions, medicines, care tailored to patient
needs. It is important to address this as the consensus shows policy
makers, payers, providers may have different views on which
outcomes matter: this could lead to reduced access. The majority of
experts agree that measuring outcomes in opioid dependence care
will become increasingly important in daily practice and that there is a
need for a universal system for measuring treatment outcomes is a
useful advance. Specialists in the field agree that this would lead to
improvements in delivery of opioid dependence care.
Title
Additional Information
Measuring outcomes in opioid dependence care: expert consensus on
need for improved outcome measurement tools
Key words: Outcome measures, opioid dependence care, expert
consensus
Prof Icro Maremmani
Department of Psychiatry, Santa Chiara Hospital, University of Pisa,
Italy
Italy
Authors
Dr Cristiano Maronna
Icro Maremmani, Addiction Medicine - University of Pisa, Italy, Hannu
Alho, University of Helsinki, Finland, Richard Littlewood,
appliedstrategic, UK
[email protected]
Abstract
INTRODUCTION Review of evidence shows that there is no universal
tool for measuring outcomes in opioid dependence care. Existing
tools in opioid dependence care provide measures of progress at
patient level but not above the patient. Measuring outcomes is
important in the evolving environment for commissioning and
providers of services in many countries today whether there is access
or access is limited. There is increasing interest across different
countries in evidence to support decision making in opioid
dependence care METHOD An online survey to assess the current
level of preparedness for measuring outcomes in opioid dependence
care was operated. 45 healthcare professionals, specialists in opioid
dependence care, from countries including United Kingdom, Ireland,
Norway, Denmark, Sweden, Finland, Italy, Germany, Spain were
invited to take part in a survey. Participants were asked to indicate
whether their level of agreement or disagreement with statements
which described preparedness for measuring outcomes in opioid
dependence care. Participants recorded their opinion on a Likert-style
scale using an online tool. RESULTS All 45 participants recorded their
opinion for all statements provided: • 87% strongly agreed/ agreed
that being prepared by measuring outcomes can ensure access to
interventions, medicines, care tailored to patient needs. 11% were
neutral • 86% strongly agreed/ agreed that currently used outcome
measures may be too simple to capture full benefit of treatment. 14%
were neutral • 86% strongly agreed/ agreed that policy makers,
payers, providers have different views on which outcomes matter:
this could lead to reduced access. 14% were neutral • 87% strongly
agreed/ agreed that measuring outcomes in opioid dependence care
Cristiano Maronna Avila is a lawyer and Master and PhD in Criminal
Law, Faculty of Law, University of Sao Paulo. He is the 2nd VicePresident of the Brazilian Institute of Criminal Sciences (IBCCRIM). He
attended the 52nd Meeting of the Commission on Narcotic Drugs of
the United Nation Office of Drugs and Crime in Vienna in March 2009
as a member of the Commission for Drug Policy within IBCCRIM. His
main goal is to spread criticism of prohibition and to collaborate in
building the foundations for a fair, effective and humane drug policy.
His constant participation in campaigns and debates, ahead of
proposals aimed at drafting a bill that would regulate the production,
consumption and trade in cannabis, is referred to in the forums
seeking the decriminalization of drug consumption and market
regulation. Maronna is a respected voice in interviews with the press
for his belief that the use of psychoactive drugs should not be treated
as a problem of the criminal justice system and in defence of poor
defendants charged with trafficking.
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr Giovanni Martinotti
Novel Psychoactive Substances in Young Adults with and without
Psychiatric Comorbidities: an observational study
behavioral undercontrol 3) Lack of Accessibility to others, low-selfesteem, express emotions by the alcohol - (Kaufman, 2004) *
Cognitive Rigidity – no open-mind, without flexibility to change the
attitudes and thoughts, “black and white thinking”. * Deficiency of
trust and communication with others – that leave them lonely and
isolated. * High level of denial – that appears as “an exclusive addict”,
disconnectes them from the reality and from the therapeutic process.
* A Frog Fantasy- “one kiss to be a princess” – run away from meeting
and confronting the basic pains and hurts.
Authors
Additional Information
Martinotti Giovanni, Santacroce Rita, Lupi Matteo, Di Giannantonio
Massime
Research Objective –Compare personality traits of alcoholics and drug
addicts
Via del Forte Trionfale 36, Roma
Italy
Email: [email protected]
Title
Abstract
Dr Antonio Nery Filho
Objective. Comorbidities between psychiatric diseases and
consumption of traditional substances of abuse (alcohol, cannabis,
opioids, and cocaine) are common. Nevertheless, there is no data
regarding the use of novel psychoactive substances (NPS) in the
psychiatric population. The purpose of this multicenter survey is to
investigate the consumption of a wide variety of psychoactive
substances in a young psychiatric sample and in a paired sample of
healthy subjects. Methods. A questionnaire has been administered, in
different Italian cities, to 206 psychiatric patients aged 18 to 26 years
and to a sample of 2615 healthy subjects matched for sex, gender,
and living status. Results. Alcohol consumption was more frequent in
the healthy young population compared to age-matched subjects
suffering from mental illness (79.5% versus 70.7%; < 0.003).
Conversely, cocaine and NPS use was significantly more common in
the psychiatric population (cocaine 8.7% versus 4.6%; = 0.002) (NPS
9.8% versus 3%; < 0.001). Conclusions. The use of novel
psychoactive substances in a young psychiatric population appears to
be a frequent phenomenon, probably still underestimated. Therefore,
careful and constant monitoring and accurate evaluations of possible
clinical effects related to their use are necessary.
[email protected]
Antonio Nery Filho, Physician; Psychiatrist; PhD in Sociology and
Social Sciences from the University Lumière - Lyon 2, France.
Associate Professor IV of the Department of Pathology and Forensic
Medicine, Faculty of Medicine of Bahia / Center for Bioethics, Medical
Ethics and Humanistic Knowledge - UFBA. Professor of the Faculty Ruy
Barbosa. Founder and General Coordinator of the Center for the
Study and Therapy of Drug Abuse -CETAD / UFBA (1985-2013).
Consultant to the Municipal Health Secretariat of Salvador (Bahia).
Enkelejda Ngjelina
Dr Amnon Michael
Opioid Substitution Therapy in Albania for Pregnant Women
Yuvalim 216 D.N Misgav
Israel
Email: [email protected]
Authors
Ngjelina, E.
Title
Abstract
The difference between drug users and alcoholics - a study
While the past decade has seen an increase in the number and types
of evidence-based programs (EBPs) available for the treatment of
addiction, much less is known about their effectiveness when
implemented in different countries and cultures. Further, women
often face additional stigma and associated barriers to care. Failure to
adapt and tailor interventions to meet unique cultural and genderspecific needs can result in disappointing outcomes that in turn
generate frustration and disillusionment. This symposium will focus
on several highly-respected EBPs for substance use disorders and
strategies being used to identify unique cultural and gender-based
needs so that interventions can be modified and tailored to address
Authors
Amnon Michael
Abstract
The professional literature 1) Self-medication Hypothesis – Drug-ofChoice- (Khantzian, 1985; 1997) * Alcoholics – disengaged. dettached
people vr. * Narcotic addicts – muting rage and aggression. 2) much
more depressed & anxious (Kendler et al., 1993, Teichman, 2000),
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06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
such issues in a responsive and therapeutic manner. The third
speaker, Enkelejda Ngjelina (Albania) will focus on challenges faced by
pregnant women on Opiate Substitution Therapy (OST) and her
efforts to address those barriers through specialized and tailored
treatment services. She will also discuss the importance of educating
physicians and other primary health providers about substance use
and abuse, with a focus on physician engagement and strategies they
can use to help people with addiction and improve local intervention
and prevention efforts.
percent required admission to a Special Care Baby Unit (SCBU) Social
Services involvement to safeguard the child was high (75%)
Breastfeeding was encouraged, when there were no
contraindications. Some challenges encountered included low
awareness of staff’s personal prejudice, stigmatisation of the woman
and her aspirations to be a mother and pressure on services to
provide high input care and support. − Conclusion: The proportion of
prematurity and level of pregnancy complications found was in
keeping with published reports for substance misuse. The majority of
women stabilised and reduced their drug use. Difficulties of the
women themselves include a low sense of self efficacy in their own
ability to make and sustain change and fear of children being
removed from their care. Delivering a service within a multiagency
context presents difficulties related to differences of practice and
objectives between the different agencies. − Key words: Substance
misuse, pregnancy, outcomes, multiagency
Dr Ruby Osorio
Pharmacia House
1 Prince Regent Road
Hounslow
Middlesex TW3 1NE
United Kingdom
Email: [email protected]
Dr Ruby Osorio
Title
Dr Ruby Osorio
Pharmacia House
1 Prince Regent Road
Hounslow
Middlesex TW3 1NE
United Kingdom
Email: [email protected]
Abstract
Title
− Introduction: In any pregnancy, a ‘normal’ outcome can never be
guaranteed. Spontaneous miscarriage and malformations are a
known risk. The use of illicit drugs carries its own risks: toxicity,
withdrawal syndromes in the mother and possible long-term neurobehavioural sequelae for the infant. Women who misuse drugs and/
or alcohol and are or become pregnant tend to attend antenatal
services erratically and frequently late in the pregnancy, frequently
drop out of treatment and miss out on the benefits of specialised
help. Being that pregnancy is time-limited, interventions during this
period need to be prompt, flexible, efficient and focussed in the short
term. Effective outcomes require the concerted efforts of multiple
agencies, such as substance misuse, antenatal and social services. A
Specialist Maternal Health Team (MHT) was developed within a
Substance Misuse Service (SMS) in central London to help improve
outcomes of pregnancy for drug using mothers and their babies and
to develop a treatment pathway/model. The main components were:
close liaison with Antenatal, Neonatal and Social Services and a rapid
and flexible response from the MHT. − Method: A specialist nurse,
midwife and social worker worked together with all pregnant women
who attended the service during a 3 year period. Pregnant women
were followed up and relevant information recorded using a
purposely designed outcome monitoring tool. − Results: A total of 61
pregnant women were followed up. They were all dependent on
heroin. There were 3 miscarriages. Of the 58 babies born, around 30%
were born before term and 30% were of low weight for their
gestational age. Also about 30% displayed opiate withdrawal
symptoms Twenty nine percent displayed opiate withdrawal
symptoms and 17% needed opiate prescribing to wean off. Thirty six
Caring for Pregnant Women who Misuse Drugs and Alcohol
Substance Misuse and Pregnancy: Monitoring Outcomes
Authors
Authors
Dr Ruby Osorio,Moira Marks
Abstract
The risks associated with the use of mind altering substances during
pregnancy can have serious consequences for the baby. No
psychotropic drug can be established to be completely safe in
pregnancy, because robust, prospective trials are not ethically
possible. Some of the shared concerns about helping women who
misuse substances and are pregnant refer to the difficulties in
attracting to and engaging women in Substance Misuse Services
(SMS), as well as to the need for those providing help to be well
acquainted with the effects of the use of illicit drugs and alcohol
during pregnancy. Partnership working amongst agencies including
health, addictions and social services is a key component in achieving
successful outcomes for both mother and baby. Treatment
interventions undertaken by a SMS working in partnership in an inner
London area working in partnership with Antenatal Clinics and Social
Services have aimed at facilitating proactive engagement, frequent
and regular follow ups and involve specialist assessments, joint
outpatient clinics and regular joint interagency meetings. Medical
aspects of interventions delivered include opiate replacement,
stabilisation, detoxification and intensive antenatal follow up An
introduction to the effects of the use of illicit drugs such as opiates,
stimulants, party drugs and alcohol during pregnancy will be offered,
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www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
in an attempt to give an integrated insight into some of the challenges
faced in caring for these women and their babies from the addictions
specialist perspective. Conclusions: a thorough assessment of the
benefits and risks of the use of or the discontinuation from mindaltering substances should be conducted and a treatment plan should
be agreed collaboratively between the woman and all the agencies
involved in her care. In general, women need to be encouraged to
stabilise and reduce or discontinue the use of illicit substances during
pregnancy because of the risks associated. This is not so easy for
women who are dependent on drugs or alcohol, but it is possible with
the support of well-informed professionals, to help stabilise drug use
and minimize harm, in order to create the space and develop the
trust to address the real issue: the woman’s addiction. Reference:
http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf
The first Portuguese hospital consultation for drug addicts dates from
1973. Only in 1977 the first organized addiction treatment system
started to be built, within the services of the Ministry of Justice. Three
NGO’s started the residential treatment approach up to 1986. In
1987, the increasing social impact of illegal drug abuse prompted the
government to start an inter-ministerial project with the engagement
of the Ministry of Health to provide treatment for drug addicts,
namely for heroin addicts, the main reason for referral to drug help
services. Nevertheless, alcohol misuse was, and still is, the most
damaging addiction in our society. In 1988 another separate network
was created to face alcoholism, also under the Health Ministry. In
1993, an important step was taken, with the first harm reduction
program to exchange needles and syringes. The late 1990’s brought
important changes in the national strategy on illegal drugs, with a
strong increase in pragmatic interventions and social health low
threshold programs. By the year 2000, the IDT, National Institute on
Drugs from the Health Ministry, included more than 40 centers and
hundreds of residential places under protocols with NGO. By then,
the social environment was good enough to support the harm
reduction law and the law of decriminalization of illegal drug
consumption.
Additional Information
Dr Ruby Osorio, Addictions Psychiatrist, SABP NHS Foundation Trust,
London, UK
Moira Marks; Specialist Midwife, Queen Charlotte’s & Chelsea
Hospital Imperial College Healthcare NHS Trust London, UK
The drugs demand was being faced with high and low threshold
interventions namely towards heroin addicts. This increasing offer in
treatment and harm reduction programs (with increasing methadone
and therapeutic community places) was associated with a
stabilization on demand of heroin, and a significant decline of HIV
notifications and lethal heroin overdoses. In the last twelve years, a
gradual shift in consumption was noted with a tendency for decline in
heroine consumption. However an increasing consumption of
cannabis (hashish and weed), cocaine (namely free base), alcohol
consumption (street misuse, adolescents binge drinking), and misuse
of BZD (midazolam) also occurred, and from 2007 to 2013, increasing
consumption of new synthetic drugs (smart shops legal deal).
Dr Luis Patricio
[email protected]
For the past 8 years, the public and NGO drugs treatment facilities
have faced several challenges such as important asymmetries in the
quality of treatments. There was a decline in the number of trained
physicians involved, and important gaps in physician training that
result in mistakes such as under-dosage of opioid therapy. Waiting
lists for methadone high threshold treatments were coming back and
behaviors such as open-scene consumption were also slowly coming
back. In 2006 the regional alcohol centers of the Health Ministry were
integrated on the IDT network. In 2012 this institute, IDT was
extinguished and the National Health Service, integrated all the public
facilities: the local teams have been integrated in the local health
centers, and the inpatients units were integrated in the local mental
health departments. With this integration it is intended to seek the
value resulting from the proximity of treatment resources and social
facilities. Primary health care systems must engage in screening, early
recognition and intervention for substance use disorders, and serve as
linkage to other treatment settings.
Dr Luis Patricio is the Psychiatrist Consultant Director at the Unidade
de Aditologia e Patologia Dual, Casa de Saúde de Carnaxide - Portugal
who has specialised in the treatment of drug addiction for many
years. During his career he has served as an advisor to the Portuguese
Ministry of Health on a number of occasions as well as co-founding
and later leading the Lisbon Centre for the Treatment of Drug Addicts
from 1987 to 2008. He has also served on the scientific committees of
both EMCDDA and Europad. In 2008 he was awarded the Portuguese
Ministry of Health Silver Medal for Distinguished Service. He is also
the author of several books on addiction and has spoken at a number
of international and national conferences on the subject of addiction
treatment.
http://drugpreventioncase.blogspot.pt/
http://drogaparaquesaiba.blogspot.pt/
http://www.cscarnaxide.pt/historia
Abstract
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr Einat Peles
Dr Maria Odete Pereira
1 Henreiatta Szold Street,
Tel Aviv, 64924
Israel
Email: [email protected]
Professora Adjunta do Departamento de Enfermagem Aplicada
Escola de Enfermagem da Universidade Federal de Minas Gerais
Pós-Doutoranda do Departamento Materno Infantil e Psiquiátrica
Escola de Enfermagem da Universidade de São Paulo
Brazil
Title
Email: [email protected]
Chronic pain and its relation to history of sexual abuse among
methadone maintenance and non-addicted patients
Title
Authors
Evaluation of Psychosocial Care Centers on Alcohol and Other Drugs
in the city of São Paulo in view of the technical health professionals
Peles Einat, Seligman Zivya, Potik David, Sason Anat, Schreiber Shaul,
Adelson Miriam.
Adelson Clinic for Drug abuse treatment & Research, Tel Aviv
Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv
University,Israel
Authors
Maria Odete Pereira,Paula Hayasi Pinho,Márcia Aparecida Ferreira de
Oliveira,Heloísa Garcia Claro,Rejane Aparecida de Abreu
Abstract
Abstract
Aims: To study the relation between chronic pain and sexual abuse
history, we compared former heroin addicts, current methadone
maintenance treatment, and patients with sexual abuse history from
a Sexual Abuse Treatment Center (SATC) without a history of opiate
addiction. Methods: Between November 2009 and March 2011, all
MMT females and a non-selective 25 female patients from SATC were
studied. Chronic Pain Questionnaire (Peles et al., 2005) was used –the
questionnaire deals with several aspects of pain symptomatology:
time of onset (before or after admission to the clinic), duration of pain
(dates) and severity (on an ordinal scale between 1 [mild] and 4 [very
severe]). Chronic pain was defined if pain had lasted for at least the
past 6 months and chronic severe pain was defined if severity was
severe or very severe pain. Clinical-OCD (Yale-Brown Obsessive
Compulsive Scale), dissociation (Dissociative Experiences Scale (DES),
complex-PTSD (Structured Interview for Disorders of Extreme StressNon Other Specify), sexual PTSD (the Clinician-Administered PTSD
Scale) and trauma events history (Life Event Inventory) were used.
Results: Chronic severe pain was most prevalent among sexual
abused non-addict (64%) followed by sexual abused MMT (30.3%),
and the lowest among MMT women with no history of sexual abuse
(25%, p=0.01). Supporting our previous report when compared the
first two groups (Peles et al., in press), we found that the sexual
abused non addict women had the highest proportion of high
dissociation score (DES≥30) (72.0%, 11.9% and 0.0% respectively, p
The World Health Organization states that 10% of the population of
urban centers use psychoactive substances excessively. With the
implementation of Psychosocial Care Centers on Alcohol and Other
Drugs – CAPS ad, in 2002, the outcome evaluation of these services
becomes a necessity. The aim of the study was to evaluate 12 units of
São Paulo through the Scale of Satisfaction with Mental Health
Services – SATIS-BR, in the perspective of the professionals who were
part of the staff and analyze the determinants of satisfaction of these
professionals. We conducted interviews with 288 workers obtaining
socio-demographic profile; problems faced at work; data on
treatment and structure of CAPSad. The dependent variable was the
overall scale score SATIS-BR and groups of independent variables
were related to the structure and process variables, under the
perspective of Donabedian. As a result, the final multiple model
pointed out that none of the socioeconomic variables on the workers
profile or on problems identified in the work had any statistically
significant impact on worker satisfaction. The other three classes of
variables, at least one of its components was significant. Variables
related to the Structure; working conditions and discomforts were
associated with job satisfaction, having the first one a positive
relationship and the last one, a negative relation and both had a value
of p ≤ 0.05. Between the variables of Work Processes, we have found
five variables statistically related to the degree of satisfaction of
workers, being these: Overload at Work; Competence of the clinicians
to deal with Families; General competence of the staff; Supervision of
staff; support among workers. Among these, as expected only
overload at work was negatively associated and all others were
positively associated. We may conclude from the multiple regression
model that a more developed physical structure of the service
increases worker satisfaction. A larger number of uncomfortable
situations reduces it. The greater the perception of professionals
concerning work overload, the greater is their dissatisfaction.
Working with a competent staff, cooperating, supporting and
supervising each other is a key component of professional
satisfaction.
Additional Information
Peles E, Schreiber S, Gordon J, Adelson M. Significantly higher
methadone dose for methadone maintenance treatment (MMT)
patients with chronic pain. Pain. 2005;113:340-6
Peles E, Adelson M, Seligman Z, Bloch M, Potik D, Schreiber S.
Psychiatry comorbidity differences between women with history of
childhood sexual abuse who are methadone maintained former
opiate addicts, and non-addicts. Psychiatry Research, in press 2014
34
Global Addiction 2014
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www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr Raquel Peyraube
treatments? How did it come to the situation where health
professionals can sign up or participate in the implementation of
many of the health care responses that violate the rights of patients,
not promote their entry into the health system and darken the
prognosis? How is it that there are not malpractice complaints against
these types of interventions and that there is no regulation of what is
possible to do and what is not possible in the name of treatment, as
with any other disease? Why are harm reduction treatments not
considered a legitimate approach to help PWUD? Moral definitions
and the warmongering logic that crosses all drug-related policies are
in the base of the answers.
[email protected]
Political issues and hegemonic concepts of problematic drug use and
chemical dependency are a starting point to think about the role
played by Medicine and Physicians in the construction of the stigma
and conventional treatment models.
Dr. Raquel Peyraube, Clinical Director of ICEERS (International Center
for Ethnobotanical Education Research and Service), MD graduated at
the Faculty of Medicine of the University of the Republic and
Specialist on Problematic Drug Use, trained in Psychiatry, Toxicology,
Psychoanalytic Psychotherapy, and also on issues of childhood,
adolescence and social exclusion and has over 27 years’ experience.
She founded Grupo de Cavia, an NGO that setup the first center
offering human-friendly treatment and harm reduction for people
with problematic drug use in Uruguay, and directed it for 18 years.
Throughout her career she was involved in training, prevention,
treatment and harm reduction, including innovative theoretical and
methodological developments with an emphasis on ethical issues,
which earned her regional and international recognition, as well as
invitations to outstanding treatment services as the Substance Abuse
Division of the Geneva University Hospital. She is advisor of the
National Board on Drugs (SND) of Uruguay in the reform of the public
drug policy and the Institute of Regulation and Control of Cannabis
(IRCCA), and a member of the Network of Experts and Consultants for
monitoring and evaluation of the Law of Cannabis Regulation.
Currently she is mainly dedicated to the development of protocols for
clinical trials including dependency treatment with medicinal
cannabis, advocacy work through conferences and working with
media, and consulting on Drug Policy Reform in different countries of
Latin America.
What it’s possible to do in order to change the scenario and the social
position of PWUD from exclusion to inclusion, and consequently
improve their health and social conditions? A five point proposal is
developed considering theoretical, ethical, communicational, legal
and communitarian aspects so that the process of social construction
of PWUD’s identity could achieve a new status.
Mrs Diep Pham
Institute for Preventive Medicine and Public Health, Hanoi Medical
University
No 1 Ton That Tung Street, Dong Da District, Hanoi City, Vietnam.
Viet Nam
Email: [email protected]
Title
A multilevel study: Drinking motives and situational predictors of
alcohol consumption among Vietnamese students
Authors
Pham Bich Diep1,3,*; Frans E. S. Tan2, Ronald A. Knibbe3; Nanne De
Vries3
1Institute of training of Preventive Medicine and Public Health, Hanoi
Medical University, Vietnam; 2 Department of Methodology and
Statistics, CAPHRI School for Public Health and Primary Care,
Maastricht University, The Netherlands. 3Department of Health
Promotion, CAPHRI School for Public Health and Primary Care,
Maastricht University, The Netherlands;
Corresponding author:
*Pham Bich Diep
Email: [email protected]
Abstract
Stigmatization of people who use drugs and health care
Looking through 20th century to the present, it’s possible to see not
only the different identities that have been applied to people who use
drugs (PWUD), but also a sort of story and proposed evolution: sinner,
criminal, sick and more recently human. Another Identity should
however be achieved.
From the first decades of the twentieth century, Medical Doctors and
other heath care and drug abuse treatments professionals have
contributed to the construction of stigma around PWUD, and it has
been reinforced while drug policies became inefficient and also more
and more inhuman, moralistic and violent.
Abstract
Using a multi-level approach, the aim was to examine the
contribution of individual characteristics (gender, age, drinking
motives) and characteristics of the drinking setting (time of drinking,
duration of drinking, location of drinking, type of drinking, drinking
What is the scenario related to clinical aspects and drug abuse
35
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
with food, number of drinking companies, gender of drinking
companies, relationship with drinking companies) on alcohol intake.
clinical diagnosis and treatment based on the latest researches and
data.
5. Pharmacological treatment possibilities includes opiate receptor
agonists, anti-addiction medications, mood stabilizers and SSRI's
6. Cognitive behavioral therapy seems to be the most effective
psychological intervention. However, interpersonal, group, family
and couple therapies are also important to deal with impulse
control disorders.
Dr Bruno Rassmussen Chaves
Additional Information
Since there is no theory available, which integrates motives and
situational characteristics, it is suggested to do further research in
different countries, to gain more clear understanding and enable
theory development.
[email protected]
Prof Dannon Pinhas
Tel Aviv University & Beer Yaakov Mental Health Center
Israel
Email: [email protected]
Title
Reclassification of Impulse control disorders: Clinicians perspective
Authors
Pinhas Dannon; Ronen Huberfeld
Bruno Rasmussen Chaves, physician, graduated in 1984 from the
Federal University of Sao Paulo and specialized in Internal Medicine in
1986 and in Clinical Gastroenterology in 1988 at the same university.
He has experience in treating intensive care patients, however he has
been working with Chemical dependency since 1994 and studying and
working with ibogaine since then. He has been a Colaborator of the
PROAD- UNIFESP (Program for the Orientation and Assistance for
Drug Dependents) since 2012. Dr. Bruno is responsible for taking care
of the patients under the effects of ibogaine medicine, during the
inpatient phase of the treatment. He is the Co-author of the paper
"Treatment of drug dependency with the aid of ibogaine: a
retrospective study", 2014, along with other papers. Currently, Dr.
Bruno is working at the Hermelino Agnes de Leao Institute, a chemical
dependency treatment facility in Sao Paulo state.
Abstract
Impulse Control Disorders is thought to represent up to 10% of all
psychiatric disorders, and remain under-diagnosed and under-treated
by clinicians. Researchers have suggested that the impulse control
disorders category is not a homogeneous one and that the vast
majority of the disorders, which classically belong to this category,
might have different characteristics and better resemble other
disorder such as behavioral addictions or obsessive compulsive
disorders. We suggest a re-classification of ‘impulse control
disorders’. Based on the latest data we propose to reclassify as: 1)
true impulse control disorders: Intermittent explosive disorder (IED)
and Pyromania (pathological fire setting). 2) Obsessive – Compulsive
(OC) spectrum: TTM, Kleptomania 3) behavioral addictions: PG,
Internet addiction, Sex addiction and Shopping addiction. We hope
that our new re-classification will help us as, clinicians, to better
understanding and better treatment of these disorders.
Abstract
Treating drug dependence with the aid of ibogaine
Additional Information
In this study, we followed 75 patients (67 men, 8 women) struggling
with drugs (mainly crack cocaine and cocaine) before and after taking
ibogaine. The patients were submitted for cognitive-behavioural
therapy for a variable amount of time, before taking ibogaine. After
this initial psychotherapeutic approach, the patients were referred to
a hospital where they were given medicinal ibogaine and followed by
medical and nursing staff and monitored for 24 to 48 hours. After this
inpatient phase, the patients were submitted to psychotherapy again,
for variable amounts of time, until being released. No serious
complications were observed and no fatalities. After 1 year of follow
up, 55% of the men and 100% of the women were found to be
abstinent. The study showed that in a hospital environment, with
proper medical care and using good quality GMP medication,
ibogaine treatments are effective and safe to treat an issue that does
not have many other therapeutic options.
1. Despite the fact that impulse control disorders are estimated to
comprise as high as 10% of psychiatric disorders, this field remains
under-diagnosed and miss-treated.
2. It has been suggested that at least some of the disorders better
resemble the obsessive compulsive (OC) spectrum or the addiction
spectrum concerning there treatment responsiveness and there
neurobiological aspects.
3. We propose a reclassification for the impulse control disorders: 1)
true impulse control disorders: Intermittent explosive disorder (IED)
and Pyromania (pathological fire setting). 2) Obsessive – Compulsive
(OC) spectrum: Trichotilomania (TTM), Kleptomania 3) behavioral
addictions: Pathological gambling (PG), Internet addiction, Sex
addiction and shopping addiction.
4. We believe that this reclassification will help us to achieve better
36
Global Addiction 2014
10-12 November 2014
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www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Prof Sidarta Ribeiro
leading to novel insights. The potential risks of Cannabis use have
been exaggerated, but its many potential benefits have never been
properly discussed by society. It is time to do it.
[email protected]
Denis Russo Burgierman
[email protected]
Professor of Neuroscience and Director of the Brain Institute of the
Federal University of Rio Grande do Norte (UFRN). Has a BS in
Biological Sciences from the University of Brasilia (1993), M.Sc. in
Biophysics from the Federal University of Rio de Janeiro (1994), PhD
in Animal Behavior from the Rockefeller University (2000),
postdoctoral training in Neurophysiology at Duke University (2005).
Has experience in the areas of neuroethology, molecular
neurobiology and systems neurophysiology, and has been engaged in
the debate about drug policy reform in Brazil.
Denis Russo Burgierman at 41, is a journalist and the editor-in-chief of
Superinteressante, Brazil’s most read monthly magazine. He is also
the author of 4 books, including "O Fim da Guerra" (The End of the
War), an onsite investigation on new systems to deal with drugs and a
discussion about the future of drug policy. He was a Knight fellow at
Stanford University, where he studied themes such as international
security, innovation, leadership, and non-violence. Denis was also the
head-curator of the conference TEDxAmazonia which took place on a
floating stage in the middle of the forest. He teaches complex systems
and storytelling at Eise, an innovation and entrepreneurship school in
São Paulo. Denis is the father of 1 year-old Aurora and this is one of
the reasons why he thinks drug policy must be changed urgently.
Abstract
Time to discuss the positive effects of Cannabis
We do not know exactly when our ancestors began to use drugs, but
it is safe to say that the religious, medical or recreational use of
substances extracted from nature is a fundamental human behavior.
Very recent, on the other hand, is the notion that some substances
must be entirely banned. As a global experiment, prohibition began in
the 20th century, creating many conflicts and generating a blatant
discrepancy between the biomedical classification and the legal
regulation of several drugs. This lack of isonomy is most evident in the
case of Cannabis, which causes less dependence and less physical
damage than alcohol, tobacco and benzodiazepines. The numerous
medicinal properties of Cannabis include anti-inflammatory, antitumoral, anxiolytic, analgesic and antiepileptic effects. Cannabinoids
are also able to promote neurogenesis, renewing the ability to form
memories. Most of the cognitive effects of Cannabis evaluated so far
are limited to reaction time, working memory, episodic memory, and
attention. Little importance has been given to the possible benefits to
other domains of cognition. Recent research supports what so many
artists knew intuitively: Cannabis increases creativity, by elevating
levels of originality, fluency and flexibility. This is not at all surprising.
Cannabis was artificially selected by countless human generations to
become what it is today, a complex mixture of dozens of
cannabinoids, which can generate many different types of therapeutic
and cognitive effects according to the specific proportions of
cannabinoids present in the plant. This "entourage effect" is probably
the basis for the extremely diverse effects attributed to Cannabis. The
mechanisms underlying the relationship between Cannabis and
creativity are probably related to the fact that cannabinoids reduce
the synchronization of neuronal activity. In rats, cannabinoid
antagonists prevent the forgetting of behavioral rules that are no
longer relevant. While cannabinoid antagonists crystallize memories
in the hippocampus, "freezing" the architecture of the neural
network, cannabinoid agonists promote memory restructuring,
Abstract
Complexity - Drug use is a complex issue and drug addiction is just
one among its many aspects. Global drug prohibition is a naive
attempt to find a simple solution to a complex problem. I will talk
about the principles of complex sciences and how they may help us
create better systems to deal with the issue.
Dr Sergio Sánchez-Bustos
Sergio was born in Santiago in 1973. As a medical doctor he obtained
a Master’s in Public Health, the thesis work was a study of
government media propaganda on drug prevention. He then
completed a Doctorate studying Leopoldo Maria Panero, madness
and literature. He is the former advisor to the Chilean Health Ministry
and Chilean medical association on drugs. Sergio has published the
book “Contributions to a New Drug Policy (2012)”, organized a
national seminar on medical cannabis in May 2013 and an
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
international conference on drugs policies in November 2013. He is
the founder of Latinoamerica Reforma, an NGO working on drugrelated issues in Chile and the Latin American region. He is the
technical secretary on the medical cannabis commission of the Public
Health Institute.
serology status for HIV and Hepatitis, access to social and health
services utilization, demands and barriers. The study also focused on
gender differences of behavior related to crack use, sex work, HIV and
Hepatitis serology, housing, income sources and social and health
services utilization.
Abstract
Methods: N=160 regular and young adult (ages 18 – 24) crack users
were recruited locally in Rio de Janeiro and Salvador via communitybased methods. The anonymous assessments included an interviewer
-administered questionnaire on key social, drug use, health and
service characteristics, as well as serological testing of HBV, HCV and
HIV status, and were conducted in both sites between November
2010 and June 2011. Qualitative component of the study was based in
8 focus groups interviews and two in-depth interviews. Participants
provided informed consent. The study was approved by institutional
ethics review boards.
In 2013 the government allowed sativex ® for medical use. This year,
they allowed one crop of cannabis for medical survey. The health
minister also, has started a regulation process for medical cannabis.
The idea is to put pharmaceutical preparations and the cannabis itself
under the Chilean laws. For recreational uses, the Parliament have
also started a discussion to give regulation to domestic crop of
cannabis. This scene will provide spectacular possibilities to make
more changes in Chilean drug policy.
Results: The majority of participants were: male, with less than highschool education, unstably housed (Rio only); gained income from
legal or illegal work; arrested by police in past year (Salvador only);
had numerous daily crack use episodes and shared paraphernalia
(Salvador only); co-used alcohol, tobacco, marijuana and cocaine; had
no injection history; rated physical and mental health as ‘fair’ or lower
(Salvador only); had unprotected sex; were never HIV tested; were
not HIV, HBV or HCV positive; did not use existing social or health
services but desired access to crack user specific services. Social
assistance including help to find jobs and training as long as addiction
and general health treatment were reported as the main
characteristics of services demanded by participants. Barriers to
access social and health services described included stigma, lack of
services facilities, lack of needs-specific professional skills and
bureaucracy. Male and female presented different ways of developing
affective bonds, on the role attributed to crack as mediator in
conflicts, on the use of the body for as an exchange “currency”/
prostitution and for procreation and care of offspring. More women
than men were involved in sex work and tested for BBVs and HIV.
Both male and female reported similar physical and mental health
patterns. However women more commonly utilized social or health
services.
Dr Marcelo Santos Cruz
[email protected]
Marcelo Santos Cruz, MD, State University of Rio de Janeiro (1980);
MSc, Federal University of Rio de Janeiro (1996); PhD, Federal
University of Rio de Janeiro (2001); is the coordinator of the Drug
Addiction Research and Assistance Program of Institute of Psychiatry,
Federal University of Rio de Janeiro; coordinator of Reference Center
of National Secretariat on Drug Policy; a member of the National
Editorial Board of the Brazilian Journal of Psychiatry; a member of the
Institutional Review Board of Institute of Psychiatry, Federal
University of Rio de Janeiro and Vice-President of the Brazilian
Association of Multidisciplinary Studies on Drugs.
Conclusions: Crack users in the two Brazilian sites featured extensive
socio-economic marginalization, crack and poly-drug use as well
sexual risk behaviors, and compromised health status. Social and
health service utilization are low yet needs are high. There is an
urgent need for further research and for targeted interventions for
crack use in Brazil.
Abstract
Access of drug users to health and social services.
Marcelo S. Cruz
Dr Constance Scharff
Background: Crack use has expanded into a major problem in cities
across Brazil. Existing data suggest that crack use is concentrated
among disenfranchised young people, with extensive health problems
and crime involvement. Social and Health services network for drug
users have been extended in Brazil but still do not match the needs of
this vulnerable part of the population. Appropriate interventions for
crack use are currently controversially discussed at various levels. The
present study aimed to assess key socio-demographic characteristics
of crack users in Brazil, their drug use patterns, risk behaviors and
11605 Ironwood Circle, Austin, TX 78759
United States
Email: [email protected]
Title
Overcoming Obstacles to Providing Quality Addiction Treatment to
38
Global Addiction 2014
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06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Those in Need
Psychiatric co-morbidity among patients treated in opioid substitution
treatment (OST) programs in Slovenia
Authors
Authors
Constance Scharff, PhD
Segrec N, Kastelic A, Pregelj P
Abstract
Abstract
For centuries, addiction has been a disorder for which treatment was
largely ineffective. Though lauded as the “gold standard” of
treatment, 12-step programs have poor treatment outcomes,
estimated at between 5-10% abstinent at one year. Worse, while
addiction is considered a brain disorder, mental illness, genetic
disease or combination thereof, 12-step programs rely entirely on
“miracles” and prayer for recovery, “treatment” that is far outside the
scope of practice for physicians, social workers or psychotherapists.
Yet, the news for addicts and those who love them is no longer
dismal. Evidence-based therapies that have been developed or
applied over the past few decades have changed the face of addiction
treatment, giving addicts hope. Some treatment models have
recovery rates proven as high as 70% at one year, a great
improvement over 12-step treatment alone. However, despite these
efficacy rates and the wide distribution of the treatment model(s)
that provide them, there remain impediments to treatment. In the
United States, for example, it is believed that of the 33 million or so
addicts in the nation, only 13% will seek treatment and of that
number, less than 15% will remain sober at one year. Other nations
have even more abysmal addiction recovery rates. There are several
reasons why this may be the case. One, some treatment centers,
either to remain cost-effective or maximize profits or out of loyalty to
tradition and “what got me sober,” rely too heavily on ineffective, but
low cost treatments like 12-steps. Two, in many places in the world,
access to quality addiction treatment and other mental health
services is limited or nonexistent. This presentation will address these
two issues, looking first at the ethics of providing low-quality care as a
means of maximizing profits, but still helping some people recover,
and second at creative thinking and therapies that might allow those
with limited access to psychotherapeutic resources a real chance at
getting sober.
Background: The prevalence of mental disorders is higher among
patients with substance use disorders compared to general
population. Regarding prognosis in the treatment of patients with
comorbid disorders, both disorders have a poorer outcome when
unrecognised and undertreated. Poor medication compliance, high
level of recidivism, rehospitalisations, high degree of symptom
severity, impaired psychosocial functioning, increased risk of suicide
and risky behaviour are associated with untreated disease. People
who abuse drugs and people with mental disorders have a higher risk
for suicide attempt and suicide compared to general population. The
aim of the present study is to determine possible differences in
gender, marital status, parenting, education, employment, religion,
suicide in family, drug use among family members, overdoses,
victimisation, history of criminal behaviour and history of previous
suicide attempts among patients with comorbidity of substance use
disorder and mental disorder compared to patients with substance
use disorder without comorbid mental disorder in opioid addiction
treatment programs in Slovenia. Methods: 228 consecutive patients
voluntary fulfill the questionnaire in four different addiction
treatment centers in Slovenia. Results: More than half of participants
(53,1 %; 121/228) had comorbidity of substance use disorder and
other mental disorder. In the group of patients with comorbidity of
substance use disorder and other mental disorder there were
significantly more suicidal behaviour in family, previous suicide
attempts and imprisonments compared to the group with substance
use disorder without comorbid mental disorder. There were no
significant differences in gender, marital status, parenting, education,
employment, religiosity, drug use among family members and
probation between both groups. Conclusion: Comorbidity of mental
disorders is one of most important clinical issues in population
treated in addiction treatment programs. It seems from this study
that family history of suicidal behaviour, history of previous suicide
and history of imprisonment but not demographic characteristics,
drug use among family members and history of probation are
associated with comorbidity within this population.
Additional Information
Dr. Scharff will be happy provide, as a gift, all conference participants
with a copy of her bestselling book, "Ending Addiction for Good." As
an educator, her goal is to share the latest research and most
effective evidence-based therapies with all in the addiction treatment
community.
Mr Ildebrando Souza
Rua Manoel Achê, 444, Ap. 32 - Ribeirão Preto - SP
Brazil
Email: [email protected]
Dr Nusa Segrec
Center for Treatment of Drug Addiction, University Psychiatric Clinic
Ljubljana, Grabloviceva 48, 1000 Ljubljana, Slovenia, EU
Title
Email: [email protected]
Characterization of crack/cocaine users hospitalized in a general
hospital between 2000-2010
Title
Authors
39
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Souza I.M., Furtado E.F.
the relationship between internet addiction with sexual knowledge of
Notre Dame an Saint Paul’s Junior High School in Jakarta. This study
was done analytically descriptive and cross-sectional design. The
sampling method is proportional stratified random sampling using a
questionnaire. We collected data from 253 respondents. The
relationship between internet addiction with sexual knowledge of
Notre Dame and Saint Paul’s Junior High School students in Jakarta
has a significant relationship (p = 0.000 < α = 0.005) with the
percentage of respondents who experienced a mild internet addiction
is 33.2 %, 64 % of moderate internet addiction and 2.8% of heavy
internet addiction. The percentage of respondents with low
knowledge of sexuality is 88.9%, while moderate 10.7% and high
knowledge of sexuality is 0.4%. The number of respondents who have
Internet addiction with higher sexual knowledge is increased, but not
significant when compared with the number of respondents who still
have low knowledge. Sources of information about sexuality with the
highest percentage are the internet, parents and teachers. Parents
and teachers should provide sexual education for children. Sexual
education modules can be made to help parents and teachers.
Further research can be done on a larger population in order to
achieve more accurate research results. Keywords: internet, sexuality,
internet addiction, sexual knowledge, sexual education, junior high
school
Abstract
The crack and cocaine misuse is a growing public health problem that
is already reflected in the patients treated in the hospital routine.
Currently there are few studies on the profile of crack/cocaine users
admitted at general hospitals. Knowledge concerning the profile of
these patients can help health care services to improve the assistance
provided to this population. The objective of this study was to
characterize users of crack/cocaine hospitalized in a period of 11
years at a general university hospital. Two hundred medical records
from a total of 1950 patients hospitalized between 2000 and 2010
whose records indicated the use of crack and/or cocaine were
selected for the study. Using a protocol for data collection, we
analyzed the socio-demographic and morbidity profile of this
population. Our findings indicate an increase in the number of
hospitalizations of crack/cocaine users. Most patients identified were
male, with age between 19 and 29 years, low education,
unemployed/inactive or working in low-income activities and
characterized as dependents according to ICD-10 criteria. Also,
considering the total sample, about a quarter are female, 10% are
people up to age 17 and 2.5%, people over 50 years old. We conclude
that the major socio-demographic profile is similar to that found in
other Brazilian studies, however we observe emerging new profiles of
users of these drugs, especially in terms of sex and age; identification
of these patients in the hospital is scarce and it is needed more
involvement of health professionals for interventions with this
population.
Dr Dace Svikis
[email protected]
Tailoring Treatment to Meet the Needs of Substance Dependent
Women
Dr Eva Suryani, Lie
Authors
Svikis, D. and Velez, M.
Virginia Commonwealth University (VCU) and Johns Hopkins
University School of Medicine
School of Medicine Atma Jaya Catholic University of Indonesia
Pluit Raya No. 2 North Jakarta, Indonesia 14440
Indonesia
Email: [email protected]
Abstract
Title
While the past decade has seen an increase in the number and types
of evidence-based programs (EBPs) available for the treatment of
addiction, much less is known about their effectiveness when
implemented in different countries and cultures. Further, women
often face additional stigma and associated barriers to care. Failure to
adapt and tailor interventions to meet unique cultural and genderspecific needs can result in disappointing outcomes that in turn
generate frustration and disillusionment. This symposium will focus
on several highly-respected EBPs for substance use disorders and
strategies being used to identify unique cultural and gender-based
needs so that interventions can be modified and tailored to address
such issues in a responsive and therapeutic manner. The first
presenter, Dr. Dace Svikis (USA), will focus on gender differences in
addiction and her efforts to modify addiction treatment to address
barriers to care and unique treatment needs of women (including
pregnant women).
The Relationship between Internet Addiction and Sexual Knowledge
Student of Notre Dame and Saint Paul’s Junior High School in Jakarta
Authors
Hartono O, Suryani E
Abstract
Sexual education for children is still a taboo subject for most parents
and teachers as the primary educators causing a child trying to seek
information from other sources. Alongside with the changing times,
the internet becomes a solution for finding information easily and
quickly including information about sexuality, it can even lead to
dependence or addiction. However, the internet is often not properly
used so that information about sexuality is not right. Therefore, this
research conducted to know is there any relationship or influence of
internet addiction to knowledge of sexuality. This research is to know
40
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
Dr Luís Fernando Tófoli
teaching them how to use cannabis for improving their quality of life,
however they know it, because they have a knowledge founded in
their background related to their history of consumes, as all drug
users have. They already know that they can use cannabis in three
different ways: before, after or during they smoke cocaine paste. This
allows them to diminish the withdrawal symptoms and anguish
associated with the absence or with the ending of the episode of
consumption of cocaine paste. Also cannabis help them to avoid the
beginning of a consume episode or to diminish the cocaine paste’s
stimulating effects, counteracting them. Besides that, users can put a
limit to the amount of cocaine paste consumed, and can also make
shorter the consume episode in time. This allows them to stay at
home, sleep and eat after the diminishing of the acute effects of
cannabis, otherwise they would not have slept or eaten at all. This
means that the plant also helps decreasing those effects occurring as
a consequence of the frequent use of the stimulant, like the lost of
weight. It is important to realize how much knowledge about their
own consumes and health has people who use drugs, and how
relevant it is to consider this background in implementing adequate
drug policies, coherently aligned with what people are already doing
in the context of their daily lives. Keywords: cocaine paste, cannabis,
harm reduction References: Dreher, M., 2002. Crack Heads and Roots
Daughters: The Therapeutic Use of Cannabis in Jamaica. J. Cannabis
Ther. 2, 121–133. doi:10.1300/J175v02n03_08 Labigalini, E.,
Rodrigues, L.R., Da Silveira, D.X., 1999. Therapeutic Use of Cannabis
by Crack Addicts in Brazil. J. Psychoactive Drugs 31, 451–455.
doi:10.1080/02791072.1999.10471776 Tartakowsky, I., 2014. Cocaine
paste and cannabis in the field of mental health in Chile. Available
online at: http://www.druglawreform.info/en/country-information/
chile/item/5623-cocaine-paste-and-cannabis-in-the-field-of-mentalhealth-in-chile
[email protected]
Luís Fernando Tófoli graduated in Medicine at the University of São
Paulo (1996), completed his medical residency in Psychiatry (2000) at
the Institute of Psychiatry, University of São Paulo Medical School,
and his Ph.D. in Medicine (Psychiatry) at the University of São Paulo
(2004). He is currently a professor at the Department of Medical
Psychology and Psychiatry of the Medical Science School at the
University of Campinas (UNICAMP). He has experience in Mental
Health and Psychiatry, acting on the following subjects: mental health
policies, ayahuasca and medically unexplained symptoms (somatic
distress).
Ms Ingrid Tartakowsky
Pérez Valenzuela 1161 depto 304, Providencia, Santiago
Chile
Email: [email protected]
Title
Self-medication with cannabis improves the quality of life of cocaine
paste users in Chile
Dr Luís Fernando Tófoli
Departamento de Psicologia Médica e Psiquiatria / Department of
Medical Psychology and Psychiatry
Authors
Ingrid Tartakowsky López
UNICAMP (Universidade Estadual de Campinas / State University of
Campinas)
Abstract
Title: Therapeutic use of psychedelics (ayahuasca and ibogaine) for
drug misuse
In the clinical practice in mental health institutions its possible to
observe different meanings around the drug use. Commonly people
think that all substances use are concern to some kind of damage that
people makes to themselves, as a destructive practice, but what
mostly happens it is that some drug use are attempts for searching
physical or psychic wellbeing. Sometimes these attempts don’t work,
but other times it can produce benefits, also in contexts where there
is already a severe damage made from use of other drugs. This is
happening actually in Chile, where people who use cocaine paste, are
using cannabis for diminish the quantity and frequency of the
stimulant, as they gradually integrate the use of the plant over a
period of days. This means that they use cannabis for self-medicate,
reducing the risks and harms related to cocaine paste, and improve
their health and quality of life. This population usually lives in extreme
poverty conditions that lead them to a lot of social problems. They
don’t have any education in administrating their health and nobody is
The beginning of the 21st Century has seen the rebirth of the scientific
interest on psychedelics (here defined as 5HT2A receptor agonists) as
therapeutics. Early reports have described the potential of the potent
psychedelic LSD for the treatment of alcohol disorders, but despite
promising results, the research with psychedelics have been aborted
due to their prohibition. In Brazil, ayahuasca, a brew of two
Amazonian plants (Banisteriopsis caapi and Psychotria viridis) that
contains the psychedelic N,N-dimethyltryptamine (DMT) and harmala
alkaloids is legally consumed for religious purposes. Ibogaine, another
psychedelic substance that is originated in a plant (Tabernanthe
iboga) and is also part of a religious practice in Africa (the Bwiti
doctrine of Gabon and Cameroon) has different legal statuses around
the world, but is not prohibited in Brazil. This presentation focuses on
discussing the potential benefits, methods and risks involved in using
41
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
psychedelic substances in general – and ayahuasca and ibogaine in
particular – for the treatment of drug use disorders, and the
contribution of Brazil and other South American countries in this
encouraging research domain.
arguments are too undifferentiated. The establishment of agonistic
treatments is mainly declined with three arguments: danger of
addiction, abuse and small therapeutic margin.
This is a question of the adequate setting and attitude. In reality – and
that has been our daily experience for years, it is easy to keep these
problems minimal in comparison to the immense benefit.
Dr Albrecht Ulmer
[email protected]
Dr Albrecht Ulmer
Role of Agonist (Opioid) Medications in the treatment of Alcohol Use
Disorder
[email protected]
Abstract
Treatment of Addicts Within or Outside of "Normal" Medicine – A
Question of the Right Setting and Attitude
Treatment for alcohol dependent patients without medication is, for
many, virtually like effectively no treatment. The psychological
aspects alone run out. Social care is not effective either without
sufficient medical treatment.
Authors: Ulmer A
Abstract
In most countries, we are used to realizing the treatment of addiction
diseases in special centers or clinics. While addiction diseases are just
as chronic as other chronic diseases, it’s a central question of
discrimination to treat these patients for their whole lives or at least
for long period of time outside or within “normal” medicine.
Addiction itself is a discriminating disease. People keep distance,
nobody is trusting, and employers don’t give jobs, if they have
knowledge of the disease. Addicts meet other addicts, build scenes,
and leave normal society. Reintegration into normal society or
keeping someone in society is a central part of healing or of a
normalized life with a well-treated addiction. We have to ask
ourselves, if addiction treatment really needs to be organized in
special settings outside of normal medicine. In special centers, their
treatment never becomes part of normal care and they are never
classified as normal people like others with chronic diseases. They
remain stigmatized forever. This has been a therapeutic error for a
long time; based on permanent mistrust, wrong attitude and
consecutive mistakes. Covertness and mistrust are central symptoms
of the disease. The basis is that the addicts need or have a craving for
something, which is bad or forbidden. To help them to overcome this
craving completely and absolutely can dissolve all reasons for
mistrust. Therefore it is necessary not to limit the offer of the right
agonistic substances, neither for the individual nor for society.
Mistakes in the individual offer result in remaining or recurrent
demand for problematic things, inducing a vicious circle of mistrust –
our mistake! Limitation of the right treatment offer induces that the
treated ones have reasons to share what they have, with untreated
ones. Once more mistrust, vicious circle – our mistake! To increase
monitoring is the introduction of discrimination with all the negative
consequences of a permanent separation of the patients. If we stop
the limitation of the right medical substances and realize a really well
founded trustful treatment, just as in all the other medical fields, it’s
no longer necessary to operate with special settings. We can treat
addicted patients with absolutely normal trust, if we additionally clarify all factors which can lead to trust or mistrust - consider that
the patient himself can only trust in us, if our rules and our complete
attitude are trustworthy for him - help the patients with the adequate
and absolutely confident self-control of the dosage - share the high
Established and accepted medication is mainly antagonistic in most
countries. But the effects of Acamprosate, Naltrexone and even
Disulfiram remain marginal. None of these substances could reach
historic importance, like Methadone in the treatment of Opioide
addicts. The impression in specialized practice is accordingly. We
could nearly never develop a sustained perspective of a clearly better
life or even healing with any of these substances. The new and more
promoted opioide antagonist Nalmefene was not yet on the market
by the time of the submission of this abstract. Its study results don’t
promise very significant differences.
The results with agonistic substances are completely different. Italian
studies with GHB as well as our experiences with opioides and the
GABA ergic Clomethiazole produce quite another impression. With
such substances, we can adjust the disease like the most other
chronic diseases e.g. diabetes, and we are able to develop long term
perspectives of a clearly better life and even healing in many more
patients.
Alcohol dependent patients, for instance, who have been treated for
more than 8 years (mean 11.2 y, n=9) with Dihydrocodeine or who
remained under surveillance after successful termination of this
treatment, needed altogether one further inpatient and 6 outpatient
withdrawal treatments. Because of the failing establishment of the
agonistic treatment, we had many more patients without long-term
agonistic treatment: n = 32, mean observation 12.4 years. They
needed 105 outpatient and 331 inpatient withdrawal treatments and
underwent 41 therapies in special addiction clinics.
Even though the improvements are so clear, the experts remain
skeptical. There is the same mistrust as often against opioide
substitution therapy. The main reason is possibly the missing financial
power behind at least opioids and Clomethiazole. The compounds are
old and partly available as generics. They don’t promise enough profit
for essential research. This touches questions, if medical research is
too dependent on industrial sales expectancies and if medicine needs
more alternative funding for research. Arguments often follow
financial stimuli, even in medicine. Without these stimuli, many
42
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Oral Session Abstracts (Alphabetical order)
responsibility with the patient, similarly to many treatments like
Insulin, Phenprocoumon and, where we have to come to common
difficult decisions.
Dr Kenji Yokotani
Niigata Seiryo University
1-5939, suidocho, chuo-ku, niigata, 951-8121
Japan
Email: [email protected]
Dr Paulina van Zyl
Department of Pharmacology
Faculty of Health Sciences
PO Box 339, University of the Free State
Bloemfontein 9300
South Africa
Email: [email protected]
Title
Title
Kenji Yokotani
Acetaldehyde production capacity of salivary microflora in alcoholics
during early recovery: Results of a preliminary study.
Abstract
Efficacy of Personalized Feedback Intervention in reducing drug use
among repeated-drug offenders
Authors
Objective: Provision of feedback activates clients’ self-regulatory
processes through highlighting discrepancies between their current
behavior and ideal goals. Development of the discrepancies promotes
their actual behavior change to reduce the experienced discrepancies
(Miller & Rollnick, 2002; Prochaska & DiClemente, 1982). Personalized
Feedback Intervention (PFI) actually prevents addictive behaviors. PFI
was efficacious in reducing drinking behavior among high-risk
(Walters, Vader, & Harris, 2007) and low-risk university students
(Larimer et al., 2007). PFI was also effective in reducing smoking
behaviors (Becoña, & Vazquez, 2001). These findings implied that PFI
would be effective in reducing addictive behaviors. Still, few study
reported efficacy of PFI in reducing drug use. Few study about PFI
measured observable indexes. The present study aims to extend
previous findings of PFI into drug use and to use criminal record data,
instead of self-report questionnaire. Criminal record could reflect
their actual drug use more strictly. Method: Participants were 233
men who had been imprisoned as drug-related offenders in a
Japanese prison as of 2008 February and released as of 2013
December. They aged 43, imprisoned 4 times, had a 10-year of
education, and received a 1257-day sentence on average. Drugrelated offenders in Japanese prison has started to receive PFI since
2011 April. The PFI clarifies perceived risks and benefits of drug use
and provides options to abstain from drug use, like previous PFI
(Dimeff, Baer, Kivlahan,& Marlatt, 1999). The PFI includes 6 feedbacks
during three months. The 183 participants were not eligible to receive
PFI, because they did not have enough jail time to receive PFI. The 22
participants received PFI (PFI group), whereas 28 participants did not
(Non-PFI group). All participants were traced through Japanese
criminal record systems. When they reoffended crime, the system
recorded their crime and jail time. I checked their criminal records in
December 2013. Cox’s proportional hazard regression model was
used to obtain hazard ratios for PFI. Their age, previous sentence
days, number of imprisonment and years of education were used as
adjustment. Results: At 5 years, the 126 of them (54%) returned to
the prison. The 91 (39%) were imprisoned mainly because of drugrelated offence. Three of PFI group (13%) conducted drug-related
offence, whereas 88 of non-PFI group reoffended (41%). In analysis,
PFI was associated with decreased risk of drug reoffending (crude
hazard ratio = 0.43[0.34-0.55] p < .0001; adjusted crude ratio = 0.51
[0.38-0.67] p < .0001). The same analysis was conducted for those
Authors
PM van Zyl, G Joubert
Abstract
Introduction and aim: Chronic high intake of alcohol disturbs the
normal gastro-intestinal flora, creating a new internal microbiological
milieu with altered metabolic characteristics. The aim of our study
was to investigate whether the acetaldehyde production capacity of
salivary microflora in alcoholics is likely to contribute to the
experience of craving, and could predict early relapse in a population
of recovering alcoholics. Methodology: 30 adult male volunteers,
admitted to a rehabilitation centre for treatment of alcohol
dependence were recruited over a period of six months. Exclusion
criteria were: antibiotic use during the preceding month and
dependence on opioids or stimulants. Demographic information,
family and medical history, drinking and treatment history were
recorded. Salivary samples collected in duplicate on day 2, 4, 11 and
18 and stored at -20ºC. Acetaldehyde levels were determined on
batched samples of non-incubated samples and post-incubation with
alcohol, using gas chromatography. Craving was measured by means
of the Pen Alcohol Craving Scale in synchrony with the collection of
saliva samples. Telephonic follow-ups were done to determine
whether abstinence was maintained for 12 weeks or not. Results: The
daily average acetaldehyde production capacity (sAPC) of 28 of the 30
individuals in the study group was found to be consistently higher
than 135 µmol/L. There was no significant change in sAPC during the
18 days of observed abstinence, while craving measurements
decreased. 55% of the participants remained abstinent during the 12
weeks of observation. The number of sAPC recordings above 170
µmol/L was significantly correlated with maintained abstinence at 12
weeks. Conclusion: Salivary APC does not change during 18 days of
abstinence. It is not related to the experience of craving, but
individuals with more readings equal and above 170 µmol/L seem to
be more resistant to early relapse. The significance of sAPC needs to
be further investigated.
43
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
Name: Dr Nasreen Akbar
2508 W Texas
United States
Email: [email protected]
Research Center, Sleep and Chronophysiology Laboratory,
Department of Psychiatry; Behavioral Sciences Department at
Academic College of Tel-Aviv-Yafo, Israel; University of South Florida
Department of Psychiatry
Title
Name: Ms Joyce Andrade
Reduced Sleep Time Mediates the Relationship between Conflict at
Home and Temperament in Children of Alcoholics
Rua Eupídio Batista Nery
Brazil
Email: [email protected]
Title
Authors
Prevalence of Psychiatric Comorbidity in Drug of Abuse Addicts in
Treatment
Nasreen Z. Akbar, Deirdre A. Conroy Marissa Flores, Robert A. Zucker,
Kirk J. Brower, Ilana S. Hairston
Authors
Joyce Dalline Silva Andrade, Fernando José Malagueño de Santana,
Thomas Barboza da Silva.
Objective
Sleep/wake patterns have been scarcely examined in children of
alcoholics (COAs), a high-risk population compared to children of nonalcoholic families (NCOAs). The goal of this study was to compare
sleep measures between COAs and NCOAs using either objectively
scored actigraphy or actigraphy scored with the aid of self-reported
bedtimes (BTs) and rise-times (RTs) to assess family history effects on
the discrepancy between the two methodologies.
Objective
The main objective of this study is to quantify the prevalence and
factors associated with occurrence of psychiatric comorbidities of
patients addicted to drugs of abuse in treatment in AD CAPS state of
Sergipe/Brazil.
Method
This is a regional study, a multicenter, cross- sectional. The total
sample was composed of 103 patients distributed with proportional
allocation. It was conducted with four CAPS AD patients from January
2013 to October 2013. All patients over 18 years of age were
included, with clinical diagnosis of addiction to one or more
psychoactive substances and treatment in institutions for at least a
month. The epidemiological profile of population studied and the
variables: psychiatric symptoms and substance use Psychoactive were
assessed using standardized instruments.
Method
Participants included 32 COAs and 11 NCOAs, ages 7-12. Daily selfreported sleep diaries and actigraphy were recorded for 5-7 days
(COAs: N=214 nights, NCOAs: N=72 nights). Differences in sleep
patterns between the two groups were computed either using
objective actigraphy or in combination with sleep diary reported BTs
and RTs.
Results
Results
The total sample consisted of 103 patients and distributed with
proportional allocation was characterized by a predominance of male
patients (91.27%), the average age of the patients was 37.9 ± 9.1
years with age distribution between 30 and 59 years (80.55%).
Approximately 16.50% were illiterate and 75.73% had completed
elementary school, 61.16% were single, 30.09% were unemployed
and 33.0% had no formal employment relationship. The first
experience with drugs was in preadolescence (40.78%) and
adolescents (34.95%) and alcohol (70.87%) and nicotine (18.46%)
drugs of first contact. Approximately 27% were alcohol dependent,
11% of cocaine and / or crack and 62% were dependent on multiple
drugs. Major depressive episode (69.90%), suicide risk (66.01%) and
anxiety disorders (63.10%) were the most diagnosed disorders in this
population. The results indicate significant correlation (p < 0.05)
between alcohol dependence and major depressive disorder (63.10),
COAS had significantly shorter TIB (p
Conclusion
This systematic difference in the discrepancy between actigraphy
alone vs. actigraphy plus diary may reflect differences in the home
environment and underscores the importance of methodology when
deriving sleep measures from actigraphy data.
Additional Information
Relevant institutions include the University of Michigan Addiction
44
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
bipolar disorder (33.98%) and anxiety disorders (31.06%). It was
observed that the dependency on cocaine and/or crack is associated
statistically (p < 0.05) to major depressive disorder (25.24%) obsessive
compulsive disorder (16.50%) psychotic syndrome (26.21%) and
generalized anxiety disorder (33 percent). Among the dependents of
marijuana, there was correlation (p < 0.05) between bipolar disorder
(4.85 percent), panic disorder (7.76%), and obsessive compulsive
disorder (5.82%). Regarding nicotine, there was not association
between smoking and psychiatric disorders.
known misuse potential.
Method
Australian citizens and permanent residents access subsidised
prescribed medicines under the Pharmaceutical Benefits Scheme
(PBS). We used a dataset comprising the dispensing history of a
random 10% sample of PBS beneficiaries (n=1,064,892; JanuaryDecember 2013) supplied by the Department of Human Services
(DHS), the PBS administering agency.
Conclusion
Our cohort was restricted to concessional beneficiaries, aged ≥18 and
dispensed an opioid or statin in 2013. Until recently the DHS only
recorded dispensing claims for medicines costing more than the
patient co-payment threshold. In effect, low-cost medicines
dispensed to beneficiaries with the highest patient co-payment
threshold (referred to as general beneficiaries) have been underascertained; this issue does not impact on medicines dispensed to
beneficiaries with lower co-payment thresholds (PBS concessional
beneficiaries). In our study cohort, we established the number of
prescribers accessed by 99% of statin users and set the ‘doctor
shopping’ threshold for opioids above this benchmark. We then
calculated the proportion of opioid users defined as ‘doctor shoppers’
in 6 months (April 1 – September 30, 2013) and 12 months (January 1
–December 31, 2013).
After analyzing the results, we conclude that chronic drug use is
related to the development of psychiatric comorbidities, and major
depressive disorder and anxiety disorders the most diagnosed among
patients in treatment. Therefore, health professionals need to be
attuned to the possibility of coexisting diseases, regularly evaluating
its presence in all patients as well, be prepared to face the challenges
of treatment required to meet your special needs.
Name: Ms Bianca Blanch
A15 - Pharmacy & Bank Building
University of Sydney, 2006
Australia
Email: [email protected]
Results
Our cohort comprised 234,525 opioid and/or statins users (57%
female, median age 69). We identified 123,390 opioid users and
153,831 statin users. Our thresholds for potential opioid misuse were:
≥4 prescribers in 6 months and ≥5 prescribers in 12 months. Only
0.2% of statin users demonstrated access patterns at or above these
thresholds. In contrast, our estimates for the extent of potential
opioid misuse were 3.9% (3,352/86,713) in 6 months and 3.7%
(4,561/123,390) in 12 months.
Title
Prescribed opioid misuse in Australia: Measurement in routinely
collected dispensing data.
Authors
Bianca Blanch
Preeyaporn Srasuebkul
Sallie-Anne Pearson
Conclusion
Objective
We demonstrated that opioid misuse is likely to represent a small
proportion of overall use. However, our estimates are based on a sole
proxy of misuse. Our threshold was benchmarked against the number
of prescribers accessed routinely for a medicine with no misuse
potential; these thresholds are comparable with other studies basing
thresholds on expert opinion. Our benchmarking method can be
replicated across jurisdictions and expanded to other proxies of
misuse such as number of dispensing pharmacies.
Background:Prescribed opioid use and related harms have increased
considerably in Australia over the last decade. However, no Australian
studies have investigated potentially inappropriate opioid use or
misuse utilising national, routinely collected dispensing data. ‘Doctor
shopping’, the number of prescribers used by an individual to access
medicines in a specific time period, is commonly used in the global
literature as a proxy for misuse. However, there is no standard
definition regarding the minimum number of prescribers within a
defined period that is indicative of misuse.
Aim: To examine the extent of prescribed opioid misuse in Australia in
2013. We will measure misuse based on ‘doctor shopping’ and
establish the threshold of prescribing doctors in 6 and 12 months
likely to be indicative of misuse. The threshold will be established by
benchmarking opioid access activity against the number of
prescribers used to access statins, prescribed medicines with no
45
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
Name: Mr Elvio Bono
Additional Information
New research with larger samples must be implemented in order to
confirm such data.
Rua: Francisco Pereira Lima, 388
Nova Ribeiranea, Ribeirão Preto-SP
Brazil
Email: [email protected]
Name: Ms Emi Carneiro Bragiato
Rua Frei Caneca, 812 apto. 910 - Consolação
São Paulo-SP / Brazil
CEP: 01307-000
Email: [email protected]
Title
The use of illicit substances among juvenile offenders
Authors
Title
Bono, Elvio / Bazon, Marina Rezende
Women and addiction: epidemiology in specialized clinic
Objective
The purpose of this study was to analyze a sample of juvenile
offenders regarding the use of psychoactive substances, observing the
prevalence of the problem in the sample, the variety of substances
used, the frequency of usage and the pattern of consumption.
Authors
Bragiato, Emi Carneiro
Dallelucci, Claudia Chaves
Fidalgo, Thiago Marques
Mello, Maria Izabel Bandeira
de Luccia, Luana Morelli
Method
This is a transversal, exploratory study performed with a convenience
sample of 117 male adolescents under the custody of a branch of
Fundação CASA due to involvement in criminal activities. DUSI-R
(Drug Use Screening Inventory) was the instrument of choice for data
collection, since it can be used to characterize the use of psychoactive
substances by the respondents in terms of type, amount, frequency
and associated problems.
Objective
As there are several peculiarities in the treatment of women, this
article shows statistics to explore the particularities of women who
seek treatment, searching to draw the profile of dependent women in
an outpatient treatment at “Programa de Orientação e Atendimento
a Dependentes” (PROAD).
Results
Results show that 84% of the interviewed adolescents had already
used some kind of substance in their lives, and 72% had used some
sort of substance in the previous month. The drugs consumed more
often in the previous month were, in order of prevalence, marijuana
(72%), alcohol (50%), tobacco (24%), cocaine/crack (8%), inhalants
(7%) and “club drugs” (7%). The psychoactive substance consumed
most frequently was marijuana, since 62% of the adolescents
reported having used it over 20 times in the previous month. In the
total sample, the consumption patterns revealed that 15% of the
adolescents showed experimental consumption, 37% showed abusive
consumption and 15% showed a possible dependence (33% scored
below the level of consumption considered experimental)
Method
A initial interview covering demographic data, drug abuse and
psychiatry comorbidities is given to all patients that arrive in the
clinic, and these datas were used in this article.
Only patients active in the treatment were included. The diagnostic
criteria are the CID-10.
A total of 45 records were included, and was made average age and
percentage of psychiatric comorbidity and drug abuse. This work
excluded nicotine addiction.
Conclusion
Therefore, it can be said that the prevalence of the use of licit and
illicit substances among the juvenile offenders studied is effectively
high, higher than what is observed in the general population (around
24%, according to most studies). Marijuana is the substance of choice
among adolescents. However, it is worth noting that the consumption
pattern of substances for a significant part of the interviewed
adolescents, although relatively frequent, is not considered to be a
problem or abusive. As such, the population of juvenile offenders is
heterogeneous, with different consumption patterns, which raises the
need of further assessments and differential evaluations regarding
the problem.
Results
The age range of the patients included in this study ranged from 20 to
78 years old, with an average age of 43.2 years old. The standard
deviation is13.7.
We found that most women are addicted to alcohol (n: 37 - 88%)
followed by crack/cocaine (n: 21 - 47.7%), cannabis (n: 6 - 13.6%) ,
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Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
benzodiazepine (n: 3 - 6.8%), solvent and opioids (n: 2 - 4.5%), and
stimulants (n: 1 - 2.2%). In these women, the dependence of more
than one drug amount to a percentage of 40% (n: 18), but multiple
drug addiction was characterized in only one patient (2.2%).
Regarding comorbidities, the most prevalent are mood disorders (n:
18 - 40%). In these, 11 (25%) experience depression disorder, 4 (9%)
present affective bipolar disorder, three (6.8%) suffer from recurrent
depression disorder. The second most common diagnosis are
personality disorders (n: 13 -28.8%). Out of those, 7 (15.9%) have
histrionic personality disorder and 6 (13.6%) are on the borderline
personality disorder.
The percentage of anxiety disorders are 8.9% (n: 4). Three patients
were diagnosed with generalized anxiety disorder (6.8%) and one
with obsessive-compulsive disorder (2.2%). We have one patient with
a mental disorder due to brain damage and dysfunction caused by a
physical disease and one patient suffers from pathological gambling
(2.2%). We have a percentage of 27.2% of patients without
psychiatric comorbidity (n: 12).
Results
High rates of childhood sexual abuse and posttraumatic stress
disorder (PTSD) were found in the group of forensic patients. Serum
BDNF levels in the forensic group did not differ when compared to the
group of healthy controls and were significantly higher when
compared to the community mentally disordered women hospitalized
in a general hospital (p=0.015). The factors independently associated
with the group that presented the outcomes (mental disease and
crime) were: PTSD (odds ratio [OR]=5.88; 95% confidence interval
[95%CI]=1.06–32.6; p=0.043) and family history of crime (OR=6.45;
95%CI=1.59–26.3; p=0.009).
Conclusion
Our findings indicate that psychiatric disorders and traumatic events
are very common among imprisoned women and represent a major
public health problem. The association between PTSD and forensic
patients in the multivariate analysis may point out to a sum of effects
of cumulative vulnerabilities and traumatic events.
Conclusion
Additional Information
The numbers who were found are similar with those in the literature.
Most women have alcohol addiction and mood disorders as their
main psychiatric comorbidity. In our clinic, there are lower rates of
anxiety disorders than in the literature, as well as a greater number of
personality disorders than found in other statistics.
The epidemiological profile is an important tool to guide the
treatment of patients and can help in the understanding of how
women differ from men to what concerns chemical dependency.
* Psicóloga, Doutoranda da Universidade Federal de Ciências da
Saúde de Porto Alegre (UFCSPA). Professora da Faculdade do
Ministério Público. Coordenadora da Política Estadual de Atenção
Básica à Saúde Integral da Pessoa Privada de Liberdade no Sistema
Prisional, Secretaria da Saúde do Estado do Rio Grande do Sul.
Name: Prof Takayuki Harada
Name: Dr Renata Maria Dotta Panichi
Department of Psychology
Mejiro University
4-31-1 Naka-Ochiai, Shinjuku-ku
Tokyo 161-8539
Japan
Email: [email protected]
Av. Ijuí, 239/402
Brazil
Email: [email protected]
Title
The Right to Health: women in prison and mental health
Title
Authors
Renata Maria Dotta Panichi
The efficacy of cognitive-behavioral therapy for Japanese Alcoholic
Patients
Objective
Authors
The principal aim of this study was to analyze demographic, clinics
and neurobiological variables in incarcerated women.
Takayuki Harada (Mejiro University), Keiko Yamamura (Oishi Clinic),
Azusa Koshiba (Oishi Clinic), Hiroyo Oishi(Oishi Clinic), Masayuki Oishi
(Oishi Clinic)
Method
Objective
A case control study performed in 147 female subjects. The groups
were assessed for demographic, criminal, and clinical variables using
standardized instruments, Childhood Trauma Questionnaire (CTQ)
and the Mini International Neuropsychiatric Interview Plus (MINI
PLUS). The significance level was set up at 5%.
Alcoholism is one of the biggest public health issues in Japan. It is
estimated that there are more than one million alcoholic patients in
Japan. However, a treatment approach is predominantly focused on
pharmacotherapy and psychotherapy has not been widely used. The
aim of this study is to evaluate the efficacy of a group cognitivebehavioral treatment program for Japanese alcoholic patients.
47
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06/11/2014 06/11/2014 06/11/201406/11/2014
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Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
Method
Authors
Participants were 169 alcoholic patients (mean age = 50.50±10.42).
They were assigned either to a cognitive-behavioral treatment(CBT)based relapse prevention group or a treatment as usual (TAU) group.
The CBT group received 12-session CBT treatment with a structured
treatment manual once a week. The TAU group received
comprehensive daycare treatment including 12-step meeting,
vocational training and leisure activities. Drinking outcomes including
a relapse rate and psychological variables were measured at pre and
post treatment periods. Ethical approval was obtained from the
Mejiro University Internal Review Board prior to the study, and
written and oral informed consent was obtained from the
participants.
Dr Mohamed Zakir Karuvetil, Dr Richard Mellor, Dr Rajesh Jacob, Dr
Bong Yii Zhan, Ms Holly Renshaw
Objective
The objective of this report is to provide a case history of a 34 year
old Chinese male who presented with mania with psychotic
symptoms following use of legal highs (‘bath salts’) and slimming
dietary supplements which included the nutrient, L-carnitine which is
a derivative of amino acids (National Institutes of Health 2013)
Method
A single case report
Results
Results
Participants in the CBT group demonstrated significantly low relapse
rate at the end of treatment （χ2(1)＝7.66, p< .05）（OR=0.35, 95%
CI=0.16-0.74）. Moreover, coping skills of the CBT group participants
were significantly higher than those of the TAU group at the 6-month
follow-up period （F(2,275) =5.67, p
The psychotic symptoms initially developed following an escalation in
the use of legal highs, and re-emerged in full despite cessation of such
substances and a course of Risperidone, with the use of L-carnitine
during this two week period. Our patient presented twice with manic
and psychotic symptoms which included delusions of control,
persecution, grandiosity and of misidentification. His symptoms
remitted with cessation of legal highs and L-carnitine with treatment
with Risperidone. Interestingly our patient previously used stimulant
and hallucinogenic illicit substances some years before without any
adverse psychological effects.
Conclusion
The results suggested the efficacy of the CBT program for Japanese
alcoholic patients. However, follow-up care may be necessary to
maintain the treatment gain.
The effectiveness of CBT for alcoholics was well documented in
Western countries (Irving et al., 1999; Magill & Ray, 2005) but few
studies were conducted outside of the West. The results provide
support for use of CBT for Japanese alcoholics as well.
Conclusion
We believe that this is most likely the first reported case of bath salt
induced psychosis in South East Asia with possible exacerbating
factors in the form of L-carnitine use and other slimming compounds
containing high concentrations of caffeine (Hedges et al. 2009). In
addition to the best of our knowledge there have only been two
previous case reports of L-carnitine induced psychosis, one in the
context of pre-existing mental illness and one with L-carnitine toxicity
which both are not applicable in our case (Chelban et al. 2008;
Current Psychiatry 2014; Evcimen 2007). This case report also
highlights the need to routinely enquire regarding patients use of
dietary supplements and designer drugs / legal highs, particularly in
those presenting with manic or psychotic symptoms. There is a risk of
these causal factors being overlooked, particularly in significant
regions of Asia where use of such substances is thought to be
considerably less prevalent than that in the West.
Additional Information
Irving JE, Bowers CA, Dunn ME, Wang MC. (1999) Efficacy of relapse
prevention: A meta-analysiytic review. J Consult Clin Psych 67(4): 563570.
Magill M, Ray LA. (2009) Cognitive-behavioral treatment with adult
alcohol and illicit drug users: A meta-analysis of randomized
controlled trials. J Stud Alcohol Drugs 70: 516-527.
Key words: alcoholism, cognitive-behavioral therapy, relapse
prevention
Name: Dr Mohamed Zakir Karuvetil
References:
Chelben, J, Piccone-Sapir, A, Ianco, I, Shoenfeld, N, Kotler, M & Strous,
RD 2008. ‘Effects of amino acid energy drinks leading to
hospitalization in individuals with mental illness’, General Hospital
Psychiatry vol. 30, no.2, pp. 187-189.
Current Psychiatry 2014. A case of returning psychosis. Available
from: . [30th September 2014].
Evcimen, H, Mania, I, Mathews, M & Basil, B 2007. ‘Psychosis
precipitated by acetyl-L-carnitine in a patient with bipolar disorder’,
Primary Care Companion to the Journal of Clinical Psychiatry vol. 9,
10 Buangkok View
Buangkok Green Medical Park
Singapore 539747
Email: [email protected]
Title
L-Carnitine Induced Psychosis
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
no.1, pp. 71-72.
Hedges, DW, Woon, FL & Hoopes, SP 2009. ‘Caffeine-induced
psychosis’. CNS spectrums vol. 14, no.3, pp. 127-129.
National Institutes of Health 2013. Dietary supplement fact sheet:
carnitine. Available from: . [Accessed 30 th September 2014]
their standard of living, life achievements, community connectedness
and future security. No demographic differences were observed
between the two groups.
Conclusion
Our findings suggest that YPs are more susceptible to health issues
and drug related social and psychological problems as compared to
NPs. This is exacerbated by doctor-hopping behaviour in which
genuine health complaints may be mistaken for drug seeking
behaviour. More research should be done to understand the
mechanism behind drug seeking behavior and to address
comorbidities as needed. It is recommended that a central monitoring
system for prescription drugs reporting be put in place to help reduce
the problem of abuse.
Name: Ms Puay Kee Koh
55 Lorong Ong Lye S(536431)
Singapore
Email: [email protected]
Title
Prescription drug abuse among heroin abusers seeking treatment in
Singapore
Name: Dr Heidi Lahteenmaa
777 N. Ashley Drive #3201
Tampa, FL 33602
United States
Email: [email protected]
Authors
Puay Kee KOH, Andrew NG, Song GUO, Brenda GOMEZ, Kandasami
GOMATHINAYAGAM, Kim Eng WONG
Objective
Title
Benzodiazepines (BZDs) and opiate analgesics (OAs) are among the
more commonly abused prescription drugs that can be obtained from
both legal and illegal sources. In the literature, Midazolam is a
popular drug of choice for heroin substitution. (Hayashi et al., 2013).
Misuse of BZDs is also common among opiate users (Lintzeris &
Nielsen, 2010). We explore the abuse of prescription drugs among
heroin abusers seeking treatment at the National Addictions
Management Service in Singapore.
Dextromethorphan use and abuse
Authors
Dr. Daniel Garay
Dr. Heidi Lahteenmaa
Objective
In the 1950s, the FDA (Federal Drug Administration) approved DXM
(dextromethorphan) as a cough suppressant and it is now an active
ingredient found in nearly 90% of over the counter brands and
present in over a third of American households. While safe and
effective when used at recommended doses, DXM has the potential
to create and maintain abuse and dependency issues when used in
excess for recreational purposes. We address the problem of its easy
accessibility and explore the ensuing challenges and dangers that
misuse and overdose pose as a result. A solution to this problem is
relevant in order to minimize such dangers, particularly given the
public health risks posed by DXM, specifically to young adolescents,
who demonstrate the highest prevalence of abuse rates. Some of
dangers seen in overdose include, but are not limited to, vision
changes, gait instability, autonomic instability, serotonergic toxicity,
auditory/visual hallucinations, seizures, coma and even death.
Method
Using baseline self-reported data from two and a half years of
treatment outcome monitoring at NAMS from July 2009 to Dec 2012,
we examined differences between 342 heroin abusers who did not
abuse prescription drugs (NPs) versus 117 heroin users who abused
prescription drugs (YPs). Addiction severity was assessed using the
Addiction Severity Index (ASI) drug composite score and Quality of
Life was assessed using the Personal Well-being Index (PWI).
Results
The sample was predominantly male (90.8%), averaged 43.5 (±9.6)
years, comprised 38.6% Chinese, 18.7% Indian, 40.1% Malay and 2.6%
of other races. 38.3% were married and 85.9% educated up to
secondary level. Up to 93.4% had brushes with the law. The most
common prescription drug of abuse was Midazolam for BZDs, and
Tramadol for OAs. Significantly more YPs had ever taken drugs
intravenously (73.0% versus 57.5%), and were in debt (27.2% versus
15.7%), whereas significantly more NPs were employed (44.8% versus
25.6%). The YPs scored significantly higher in the ASI Medical domain
(0.153 versus 0.086) and Drug domain (0.360 versus 0.242). The NPs
had better PWI scores than YPs (45.65 versus 40.52), specifically in
Method
We performed an extensive literature review and information was
gathered from several government and national sources, including
but not limited to, the National Institute of Health, Center for
Substance Use Research at the University of Maryland, Partnership of
Awareness, DEA (Drug Enforcement Agency), U.S. Department of
Health and Human Services, as well as case reports published in
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Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
credible, peer-reviewed scientific journals.
to its abuse, as well as to educate the health care workers to learn to
recognize the signs and symptoms of possible overdose, as DXM has
been linked to the deaths of several teenagers. Survival is based
largely on identification of signs of overdose including changes in
vision, ataxia (unsteady gait), difficulty breathing, autonomic
instability, seizures, coma, serotonergic toxicity (especially with
concomitant use of SSRIs and MAOIs), hallucinations (a/v) and anticholinergic symptoms. Treatment may include the following:
activated charcoal, respiratory support (oxygen, breathing tube), IVFs,
narcotic antagonist, and/or gastric lavage. We hope that our
literature review helps to shed light on this increasingly important
drug of abuse that has many effects in our public health system.
Results
DXM is classified as a non-opioid antitussive, cough suppressant and
CNS (central nervous system) depressant at higher doses. Its
mechanism of action works through antagonism of NMDA receptors,
which lead to subsequent overall increases in dopamine reuptake and
serotonin activity. Its previous categorization as an opioid stems from
its sigma-1 receptor activity, and it is still considered a synthetic
analog of codeine. It is an over the counter medication, and as such, it
is easily available and accessible for widespread use for the public,
typically found either alone or in combination with other drugs, such
as analgesics, antihistamines, decongestants and expectorants.
Commonly found as lozenges, capsules, tablets or syrups, it has no
significant analgesic or sedative properties at recommended antitussive doses (60-120 mg/day). Abuse and behavioral effects are
usually seen at higher doses, in excess of 120 mg/day. These effects
include stimulating effects ( 120-200 mg/day), intoxication likened to
being drunk or stoned, euphoria, a/v hallucinations or distorted visual
perceptions (300-500 mg /day), disturbances in thinking, senses or
memory similar to low-dose ketamine consumption (>500 mg/day)
and dissociative sedation/full dissociative effects with separation of
mind from body and creative dream-like experiences (>1000 mg/day).
The pharmacology of DXM is such that at higher doses, it is reported
to be similar to PCP and ketamine (which also antagonize NMDA
receptors) and may produce PCP behavioral effects that include
irritability and violence. There is even evidence that higher doses
produce a false positive for PCP with urine toxicology screens. One
example of the outcomes of such abuse was produced by the
California Poison Control center between 1999-2004. While the
majority of outcomes resulted in minor or moderate effects, 0.5%
caused major effects in the form of ICU (intensive care unit)
admission for observation of autonomic instability and/or serious
pulmonary complications requiring intubation or ICU admission.
Outcomes of serious overdose can include death, with survival largely
based on identifying signs of overdose and prompt treatment, which
usually consists of supportive care. Highest prevalence of DXM abuse
is in 12-17 year olds. 74.5% of all DXM abuse cases, are in people
aged 9-17. 5% of teens have reported abuse in the last year. Of these,
less than half used consistently. DXM leads to 2.6 ER visits/100,000
people and is estimated to result in > 4 million extra doctor’s visits per
year.
References:
1. Shulgin, A.T. (1975) Drugs of Abuse in the Future. Clinical
Toxicology 8: 405-56
2. DEA, Drugs and Chemicals of Concern: Dextromethorphan; Brands,
B., Sproule, B., and Marshman, J. (1998). Addiction Research
Foundation.
3. Jaffe, J.H. (ed) (1995). Encyclopedia of Drugs and Alcohol, Vol. 1.
Simon and Schuster Macmillan; New York
4. Cranston, J.W. and Yoast, R. (1999). Abuse of Dextromethorphan.
Archives of Family Medicine 8:99.
Keywords:
dextromethorphan; abuse; overdose; treatment
Name: Dr Giovanni Martinotti
Via Forte Trionfale 36, 00135, Rome
Italy
Email: [email protected]
Title
Is there a potential for Nalmefene in alcoholics with major
depression? An open study on craving and psychiatric symptoms
Authors
G. Martinotti(1), M. Di Giannantonio(1), M. Di Nicola(2), A. Martinotti
(3), L. Janiri(2)
(1)University "G. d'Annunzio", Neuroscience and Imaging, Chieti, Italy
(2)Catholic University of Rome, Neuroscience, Rome, Italy
(3)Casa di Cura Villa Maria Pia, Rome, Italy
Conclusion
A systematic literature review regarding the abuse of
Dextromethorphan was performed to educate the public about the
prevalence and dangers of this readily available substance. It is the
most frequently used FDA approved over the counter cough
suppressant and found in nearly 90% of all cough suppressants. In
2010, more than one in three households in the United States used
DXM containing medicines found in over 120 cold medications, either
alone or in combination with other drugs, such as: Analgesics
(Acetaminophen), Antihistamines (Chlorpheniramine), Decongestants
(pseudoephedrine) and expectorants (Guaifenesin). It is increasingly
important to educate the public about DXM and the dangers related
Objective
Introduction: Nalmefene is dual-acting opioid system modulator with
distinct µ, δ, and k-receptor profile. It acts restoring the balance of a
dysregulated motivational system by reducing the reinforcing effect
of alcohol, and thereby reducing the urge to drink alcohol. Nalmefene
as-needed significantly reduces total alcohol consumption, number of
heavy drinking days and improves liver function and clinical status
[1,2]. The effect in reducing alcohol consumption is larger in patients
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Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
with at least a high drinking risk level at both screening and
randomization [3].
Aims: To test the efficacy and safety of Nalmefene in alcoholdependent patients with comorbid psychiatric disorders. The
evaluation of Cloninger I and II alcoholism, typology of craving, were
also taken into account as covariates.
Name: Ms Luana Martins de Carvalho
Rua Rita Alves Castanheiras, n 106. Dona Clara
Brazil
Email: [email protected]
Title
Method
Possible influence of hypercaloric diet in the ingestion of ethanol and
its relation on molecular mechanisms of the reward system in
C57BL/6 mice
Twenty-five treatment seeking dually diagnosed alcohol dependent
subjects with high drinking risk level were recruited and treated with
Nalmefene, through the as-needed dosing principle: one tablet on
each day that patient perceived risk of drinking alcohol. Alcohol
drinking days, total amount of alcohol intake, and craving scores
(Visual Analogue Scale for Craving, VAS; Obsessive Compulsive
Drinking Scale, OCDS) were the main outcome measures assessed
after 28 and 56 days of treatment (8 weeks). The role of other
psychiatric diagnosis was evaluated in a regression model. Safety
parameters were evaluated.
Authors
LM Carvalho, ASB Pedersen, IM Menezes, RE Moreira Júnior, DA Silva
e Silva, D Correia, ALB Godard.
Objective
The reward systems (RS) has an important role in behavior’s
motivation. An important part of these systems is the mesolimbic
dopamine system, consisting of a dopamine projection from the
ventral tegmental area to nucleus accumbens. It is well known that
humans and animals can activate the RS artificially with addictive
drugs, such as ethanol, as well as by engaging in compulsive
behaviors, for example, compulsive overeating. Knowing that the
consumption of ethanol and a palatable diet is regulated by the RS,
our hypothesis is about the possibility of the consumption of such diet
change the pattern of consumption of ethanol, due to a previous
change in this system, which may be involved with epigenetics
mechanisms of gene regulation.
Results
During the study only 4 patients had major relapse. Craving (OCDS: F=
19.1; p
Conclusion
In this open study Nalmefene showed to be efficacious in a ‘real life’
sample of dually diagnosed alcoholics. Both alcohol use indices and
psychopathological phenomena appear to improve at the end of the
study. The partial agonistic interaction with k-receptors and the effect
of Nalmefene on depressive symptoms, might shed light to the
putative antidepressant action exerted by the interaction with the
opioid system. In this sample of Dual Diagnosis alcoholics Nalmefene
confirmed to be well tolerated and safe. Future studies should
investigate the relationship between clinically relevant phenotypes
such as comorbid phenomena, typologies of alcoholism, and
treatment response.
Method
To test our hypothesis, it has been done one experiment, with n=36
mice C57BL/6 divided into the following groups: Group 1 (AING +
H2O), Group 2 (AING + EtOH), Group 3 (HSF + H2O), Group 4 (HSF +
EtOH) e Group 5 (HSF constant + EtOH) in which AING consists in a
pattern diet, with normal percentages of sugar and lipids, and HSF
consists in a diet rich in sugar and lipids. In the first stage of the
experiment, that lasts 4 weeks, the animals were divided into the 5
groups described above, which group 1 and group 2 received AING
and groups 3, 4 and 5 received HSF, all of them had free access to
water. In the second stage, that occurred in the next four days after
the end of the fourth week, groups 1 and 2 were still receiving AING
and group 4 and 5 switched their diet from HSF to AING. Group 5 was
constantly receiving HSF. Additionally to that, we performed with the
murble-burying test (Deacon, 2006) to access the mice compulsive
behavior and the drinking in the dark protocol (Rhodes et al, 2005) in
groups 2, 4 and 5, which consists in replacing the water drinking with
water by another one with a 20% of ethanol solution. The
replacement occurred during the four days about three hours after
the dark cycle. In the first three days the water drinking with the 20%
of ethanol solution remained for 2 hours, and in the fourth day it
remained for 4 hours. In the fourth day after the 4 hours of ethanol
access the mice were euthanized
Additional Information
1. Gual, A., He, Y., Torup L, et al. 2013. A randomised, double-blind,
placebo-controlled, efficacy study of nalmefene, as-needed use, in
patients with alcohol dependence. Eur Neuropsychopharmacol. 2013
Apr 3. doi:pii: S0924-977X(13)00075-8.
2. Mann, K., Bladstrom, A., Torup, L., Gual, A., et al. 2013. Extending
the Treatment Options in Alcohol Dependence: A Randomized
Controlled Study of As-Needed Nalmefene. Biol Psychiatry; 73: 706–
713.
3. Van den Brink, W., Aubin, H.J., Bladstrom, A., et al. 2013. Efficacy of
As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a
High Drinking Risk Level: Results from a Subgroup Analysis of Two
Randomized Controlled 6-Month Studies. Alcohol Alcohol Sep–Oct; 48
(5): 570–8.
51
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
Results
observed in 5.6% of the sample, and 3.7% met criteria for alcohol
dependence (two patients). Just one participant revealed abuse of
substance other than alcohol. The family history of alcohol abuse
and/or dependence was seen in 48.1% of the sample, or in 20.4%
when only the parental history was considered.
These experiment data allow us to observe that the animals treated
with the HSF diet (18 ± 0 marble burying) developed a compulsive
behavior towards those treated with the AING diet (16 ± 1.082 marble
burying), which led to an overeating HSF diet (0.02429 ± 0.0009951g)
for AING diet (0.02970 ± 0.001666 g) leading to obesity in animals
consumed. Thus, animals treated with diet HSF (3.828 ± 0.6280 g /
kg / 2h; 3.555 ± 1.330 g / kg / 2h) showed a greater tendency to
consume ethanol when compared with animals treated with diet
AING (3.205 ± 0.8111 g / kg / 2h)
Conclusion
In this study we observed that the frequency of alcohol abuse among
obese subjects was high, but lower than the mean of alcohol
consumption in the Brazilian population (6,8% - II LENAD, 2012).
However, almost 50% of the sample had some relative with history of
alcohol abuse. These initial results corroborate with the hypothesis
that food occupies neurobiological pathways related to reinforcement
of alcohol. Findings in the literature suggest that when a pathway is
being utilized by one of the behaviors (i.e., psychoactive substance
consumption or food consumption), it would block the other, which
can be the reason why we had a low frequency of alcohol
dependency in our sample, even with high frequency of family history
being observed. In conclusion, further exploration is needed in order
to find specific evidences about the association of obesity and
alcoholism.
Conclusion
These data show that consumption of palatable diet can change the
pattern of ethanol consumption
Name: Ms Juliana Nichterwitz Scherer
Centro de Pesquisa em Álcool e Drogas - CPAD. Hospital de Clínicas de
Porto Alegre - Unidade Álvaro Alvim
Rua Álvaro Alvim, 400. Bairro Rio Branco.
CEP:90420-020
Porto Alegre, RS. Brazil
Email: [email protected]
Additional Information
This project was approved by the research ethics committee of the
Hospital de Clinicas de Porto Alegre (CEP/HCPA)under the record
number 11-0066.
Title
Prevalence of alcohol dependency and family history of alcohol abuse
and/or dependence in a sample of patients with severe obesity in
Brazil
Name: Mr Felipe Ornell
Rua Felipe Camarão, 230 apartamento 402
Bairro Bom Fim
Porto Alegre - RS- Brasil
90035-140
Brazil
Email: [email protected]
Authors
Scherer JN, Hartmann I, Czepielewski L, Burke K, Costanzi M, von
Diemen L , Kauer-Sant’Anna M.
Objective
Title
Investigate the prevalence of alcohol consumption and family history
of alcohol abuse and/or dependency among patients with severe
obesity waiting for bariatric surgery in a public hospital in Brazil.
Oxidative stress and BDNF as possible markers for the severity of
crack cocaine use in early withdrawal.
Method
Authors
In a consecutive sample, we selected 54 obese patients with BMI
greater than or equal to 35 referred for performing bariatric surgery
at Hospital de Clinicas de Porto Alegre. Patients were assessed using
the Structured Clinical Interview for Disorders from Axis I of DSM-IV
(SCID-I) and an evaluation protocol with socio-demographic and
clinical data.
Sordi AO, Pechansky F, Kessler FH, Kapczinski F, Pfaffenseller B,
Gubert C, de Aguiar BW, de Magalhães Narvaez JC, Ornell F, von
Diemen L.
Objective
This study aims to evaluate alteration of TBARS and BDNF levels
among crack cocaine users during early drug withdrawal and its
relationship to severity of drug use.
Results
Subjects (mean age, 42.8 years; SD, 10.6 years, 81.5% female) had a
mean BMI of 47.42 kg/m2 (SD, 6.36 kg/m2). The abuse of alcohol was
52
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
Method
and descriptive methods. Attended nine professionals, including the
coordinator, 21 users and 13 relatives. It used the Escala Brasileira de
Avaliação da Satisfação (SATIS - BR) and the Escala de Mudança
Percebida (EMP).
Forty-nine adults crack cocaine users were recruited at a public
psychiatric hospital with a specialized addiction treatment unit. Blood
sample was collected at intake and discharge for the analysis of
TBARS and BDNF measures. Information about drug use was assessed
by the Addiction Severity Index 6th Version (ASI-6). Detailed
information about crack cocaine use was obtained through the
"Profile of the crack cocaine user." Severity of crack use was
estimated using information from age of first crack use, years of crack
use, and crack rocks used in the previous 30 days.
Results
The Center for Psychosocial Care Alcohol and other Drugs II Jabaquara
was located on a large plot, but working in an old building with poor
facilities of the rooms that not to contribute with the dynamics of the
labor process. In general, professionals (77,8%), users (100%) and
families (84,6%) were satisfied with the service, however, this could
be improved, for example by increasing the number of professionals,
adapting infrastructure, realizing the dispensation of medication.
Results
There is a positive correlation between TBARS levels and severity of
crack cocaine use (R = 0.304, p = 0.04) and a negative correlation
between BDNF and severity of crack cocaine use (R = -0.359, p = 0.01)
at discharge. Also, we found an inverse correlation between TBARS
and BDNF levels (R = -0.294, p = 0.004) at discharge.
Conclusion
The Service showed as favorable factors: the staff competent , good
reception and satisfactory care, while the unfavorable factors were:
poor structure; a few human resource and a weak supervision.
Descriptors: Assessment; Community service; Mental Health.
Conclusion
Our findings suggest that BDNF and TBARS could be possible markers
for the severity of drug use. Further studies may show how those
markers could be related to staging, prognosis, and treatment in crack
cocaine dependence.
Additional Information
Institution: GEAD - Study Group on Alcohol and Others Drugs University of São Paulo - School of Nursing.
Name: Dr Maria Pereira
Name: Ms Weronika Piędzia
Rua Nestor Pestana, nº 237 apto 104
Consolação - São Paulo - Brasil
CEP 01303-010
Brazil
Email: [email protected]
Institute of Nuclear Physics PAN
ul. Radzikowskiego 152
31-342 Kraków
Poland
Email: [email protected]
Title
Title
Situational Diagnosis of Psychosocial Care Center Alcohol and Other
Drugs II Jabaquara
Quantitative magnetic resonance imaging of white matter
components.
Authors
Authors
Maria Odete Pereira
Isabela Alves Silveira Souza
Márcia Aparecida Ferreira de Oliveira
Paula Hayasi Pinho
Heloísa Garcia Claro
Rejane Dia Abreu Gonçalves
W. Piędzia, K. Jasiński, K. Kalita, W.P. Węglarz
Institute of Nuclear Physics, Polish Academy of Sciences, Kraków,
Poland
Objective
White matter (WM) degeneration is caused by many disorders.
Among many constituents of WM, myelin damage is the most
pronounced and affects brain function. Myelin deficiencies may be
also caused by alcoholism [1] and drug abuse [2].
Myelin changes can be evaluated by magnetic resonance imaging
(MRI). Myelin deficient WM exhibits changes in two MRI parameters:
T2 and T1 relaxation times. However accurate MRI of WM is
challenging using conventional MRI techniques [3-5].
Total acquisition time for these sequences is long, often preventing in
Objective
The present study aims to evaluate the assistance offered by the
Centers for Psychosocial Care Alcohol and other Drugs II Jabaquara,
through the structure, process and outcome of care to users.
Method
This is a prospective evaluation research, cross-sectional quantitative
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
vivo or clinical applications. In this study, we applied a 3D Variable Flip
Angle UTE (VFA-UTE) method to estimate T1 values for different brain
structures in shorter time than required for widely used sequences.
1043–1055 (2012)
Key words: White matter, MRI, Myelin
Method
Name: Dr Khatuna Todadze
Healthy C57BL/6J mice were scanned using a 9.4T/21cm horizontal
bore Bruker Biospec MRI system and a Bruker CryoProbe. Birdcage
standard coil was used for Signal-to-Noise Ratio (SNR) comparison. A
set of full 3D images of the brain were obtained using 3D VFA-UTE
method. The average signal intensities and Contrast-to-Noise Ratio
(CNR) for different brain regions representing white matter (WM),
gray matter (GM) and cerebro-spinal fluid (CSF) were calculated. Due
to inhomogeneous RF field produced by the surface cryo-coil the local
flip angle varied. Therefore, we applied a correction algorithm
expressed by the following formula: y = A*sin(C*x)*(1-exp(-TR/T1))/(1
-cos(C*x)*exp(-TR/T1)), where x is the flip angle and C is a correction
coefficient for variable flip angle x, and corresponds to mapping of the
local B1 field [5]. This procedure allowed accurate T1 measurements
for each structure.
21a Kavtaradze str.
Georgia
Email: [email protected]
Results
Illegal drug use is a big challenge for Georgian society. There are
45000 injecting drug users according to problem drug users size
estimation study conducted in 2012. For last several years main
injecting drugs of abuse have been home-made opioids and
stimulants. Although self-prepared stimulants containing
methamphetamines and methcathinons, so-called “Vint” and “Jeff”
cause serious medical, social and economic consequences, homemaid desomorphine still remains the biggest problem.
"Crocodile" is a self-prepared narcotic containing desomorphine. This
drug is highly addictive, extremely toxic and leads to severe mental,
neurological, somatic disorders and enhances significantly the risk of
HIV transmission in comparison with typical opioids. The aim of the
study was evaluation of methadone maintenance treatment (MMT)
effectiveness in "crocodile" users.
Title
“Crocodile” use and treatment in Georgia
Authors
Khatuna Todadze MD PHD, Sopio Mosia MPH, Tamar Qutateladze
MPH
Objective
Application of 3D VFA-UTE pulse sequence allowed the accurate
quantitative assessment of T1, resulting in values of approximately
1400 ms, 1700 ms and 2400 ms for WM, GM and CSF, respectively.
The fitted C values were > 1 near the cryo-coil surface and < 1 away
from the coil’s surface, which corresponded to decreasing B1.
Conclusion
We demonstrated benefits of using CryoProbe when compared to
other coils available in animal MRI system, which makes it a
preferable coil for contrasting different structures in mouse brain.
Combining the IR-prepared UTE sequence with the properly selected
TI and the cryo-coil enables significant positive enhancement of the
CNR from myelin rich WM regions. Utilizing 3D VFA-UTE allowed
precise T1 evaluation, making it a suitable method for in vivo MRI and
for accurate assessment of myelin. The non-uniform distribution of
the local flip angle within the slice can be overcome by mapping the
B1 field using the same pulse sequence.
Method
27 randomly selected "crocodile" injective user men undergoing MMT
have been studied in 2012-2013. Mean age was 36. Level of
depression (Beck Depression Inventory) , anxiety (Spielberger Anxiety
Inventory), quality of life (WHOQOL and other data were measured
before starting MMT and after 3 and 9 months of treatment. The
illegal use of psychotropic-narcotics was checked through random
urine-testing 2 times per patient per month.
Additional Information
[1] Harper C. The Neuropathology of Alcohol-Related Brain Damage
Alcohol & Alcoholism; pp. 1–5 (2009)
[2] Geibprasert S., Gallucci M., Krings T. Review Article: Addictive
Illegal Drugs: Structural Neuroimaging; AJNR Am J Neuroradiol 31:803
–08 (2010)
[3] Larson P.E.Z., Gurney P.T. Designing long-T2 suppression pulses for
ultrashort echo time imaging; Magn Reson Med; 56 (1): 94–103
(2006)
[4] Piędzia W., Jasiński K., Kalita K., Tomanek B., Węglarz W.P. White
and Gray matter contrast enhancement in MR images of the mouse
brain in vivo using IR UTE with a cryo-coil at 9.4 T; Journal of
Neuroscience Methods; 232: 30–35 (2014)
[5] Chavez S., Stanisz G.J. A novel method for simultaneous 3D B(1)
and T(1) mapping: the method of slopes (MoS). NMR Biomed., 25(9):
Results
The study showed significant improvement of patients’ status. The
remarkable decrease of depression and anxiety was observed
(dynamic of average scores of depression - 16, 10, 7 and anxiety - 49,
40, 40) as well as ascending dynamics for life quality (81, 82, 89). The
positive answers on psychotropic-narcotics was 12% on average.
Level of drop out from treatment was 26% during the first year.
Conclusion
The analyses of data showed that MMT is effective method for
54
Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
www.globaladdiction.org
RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
treatment of "crocodile" (desomorphine) users. The retention in
programs is high. MMT significantly improves mental status of the
patients, increases life quality and dramatically decreases use of
illegal psychotropic-narcotic drugs and therefore diminishes the risk
of HIV transmission among injecting population.
Results
Studying the neural substrates of smoking with e-cigarettes and fMRI:
A feasibility study
Safety and Image Quality Evaluation: The magnetic susceptibility (and
the concomitant effect on image quality) of different brands/types of
e-cigarettes varied widely. Several brands containing no ferrous metal
had no noticeable effect on functional image quality. No safety issues
were identified with any of the brands examined.
Cued Smoking Task: The cued smoking task produced an average
pattern of functional activation that conformed to expectations of
sensory and motor function and putative reward networks. Strong
activity was seen in the left dorsal (hand/arm area) and lateral (face/
mouth area) motor cortex, and right cerebellum, presumably
reflecting the hand and oro-facial movements associated with
smoking. Significantly heightened activity related to smoking events
was also seen in several thalamic and sub-cortical nuclei (principally
the putamen), the medial paracingulate gyrus, and the anterior insula
bilaterally. These areas may reflect the more sensory or physiological
effects of e-cigarette use (perception of flavour, reward processing,
and the pharmacological activity of nicotine). No obvious headmotion artefacts associated with smoking trials were present.
Authors
Conclusion
Matthew B. Wall
Alexander Mentink
Georgina Lyons
We have demonstrated the feasibility of using e-cigarettes in the MR
environment, particularly for functional MRI studies related to
smoking behaviour. We have also identified for the first time the
brain regions involved in the sensory and behavioural aspects of
smoking, using fMRI. E-cigarettes represent a promising new
paradigm for the study of smoking, and the brain processes involved
in addiction more generally.
Name: Dr Matthew Wall
Imanova Limited
Burlington Danes Building
Imperial College London
Hammersmith Hospital
Du Cane Road, London W12 0NN
United Kingdom
Email: [email protected]
Title
Objective
The behavioural and sensory aspects of smoking are important
factors in the maintainance of addictive behaviour, but their brain
effects have never been studied directly in humans. The practical and
safety issues associated with the use of combustible materials in the
MRI environment have presented numerous problems that have
prevented rigorous experimentation. Electronic cigarettes (ecigarettes) obviate many of these practical problems; and promise to
be a suitable paradigm for a direct evaluation of the effects of
smoking on human neurophysiology. Our objective was therefore to
test the feasibility of e-cigarette use in (f)MRI studies of smoking.
Name: Mrs Camilla Wallin
INM Laro
Helsingborgsgatan 7
211 54 Malmö, Sweden
Sweden
Email: [email protected]
Title
Method
A patient survey to show the misuse of medication before entering
treatment
Initial evaluation performed with an MRI phantom, and one healthy
volunteer assessed several brands of e-cigarette for safety in a very
strong magnetic field (3 Tesla) and their effect on MR image quality.
This procedure led to the selection of one brand (containing 3%
nicotine) which was tested in several volunteers (N=8) who
completed one MRI scan session. The session included a standard 10minute visual-cued smoking task (20 trials, inter-trial interval jittered
between 25, 30 and 35 seconds). A custom-built optical recording
device was used to record the light output of the LED at the tip of the
e-cigarette to log smoking onset, strength and duration, and
physiological data (pulse oximetry, respiration) were also recorded.
The resulting fMRI data were analysed using FSL, with statistical
images thresholded at p < 0.05 (cluster corrected for multiple
comparisons).
Authors
Medvedeo Alvaro and Wallin Camilla
Objective
The aim of the study is to ascertain the exact types of opioids used by
our clients prior to entering treatment. The study will collect the type
of opioid e.g. methadone, mono-buprenorphine or buprenorphine/
naloxone. The study will also look at how they came into possession
of the above opioids, for example, bought illicitly from other clients,
stolen, internet etc. We will find out how the illicit opioids were used
by the clients, for example were they used intravenously or as stated
in the products own guidelines.
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Global Addiction 2014
10-12 November 2014
06/11/2014 06/11/2014 06/11/201406/11/2014
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RIO
Chairs: Prof Dartiu Da Silveira (BR)
Dr Luis Patricio (PT)
Poster Abstracts (Alphabetical order)
The findings will be written up and made available for presentation
and publication with a view to increasing the depth of knowledge
surrounding the misuse and diversion of opioids within Sweden.
Method
The collation of the data will be by staff at the clinic. The clients will
be questioned by staff and will write up the answers to the questions
for the clients. At no point will the clients be writing the information
themselves. Most data will be prospective although the clinics
involved do already had retrospective data on certain clients. The
data pool will be 10 to 12 clinics across Sweden with an aim of 100
plus patients surveyed.
Results
To be generated and made available at the symposia
Conclusion
To be generated
56