Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 13 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 14 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) 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 15 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 16 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 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 17 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 www.globaladdiction.org 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 www.globaladdiction.org 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 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 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 24 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 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) 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 27 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) 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 28 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) 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] 29 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) 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. 30 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), 31 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) 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, 32 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) 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 33 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 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 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 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 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) 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 37 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 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) 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 www.globaladdiction.org 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%) , 46 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) 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 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 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 48 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) 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 49 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) 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 50 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) 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 www.globaladdiction.org 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 53 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. 55 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) 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