The addiction is a social and universal phenomenon. Its coverage is quite recent in Tunisia. It requires a facilitation of the access to healthcare, with broadcasting of the policy of reduction of risks.

Raise a current situation of the addicting conducts of our patients.

Retrospective descriptive study, concerned the patients having an addiction in psychoactive substances followed in the external consultation of the hospital Razi between November 2014 and September 2016.

The average age was 34 ± 10.23 years.

Among the patients, 93.7% was of sex male.

Almost half immigrated in secret in Europe.

Seventy-five percent had criminal record.

The most used product was tobacco followed by alcohol, cannabis, benzodiazepines, Trihexyphenidyl and the opiates.

The buprenorphin is the most consummate opiate in misuse.

Target substances of the request of weaning are respectively: the buprenorphin (58.87%), benzodiazepines (12.63%), the trihexyphenidyl (7.71%), the alcohol (5.61%), the cannabis (5.26%).

A pathological personality was raised in 17.5%.

A psychiatric comorbidity was found to 8% of the patients.

The coverage is made on 3 shutters: biological by the symptomatic treatment of the weaning and the comorbidities, psychological and social by the social and occupational reintegration thanks to non-governmental organizations.

Addictology is a stigmatized speciality in Tunisia, by the peculiarity of the patients and the slowness of the results. Nevertheless the number of consultants does not stop increasing where from the interest to create more specialized services and structures of rehabilitation.

The authors have not supplied their declaration of competing interest.

Alcohol consumption represents a significant factor for mortality in the world: 6.3% in men and 1.1% in women. Alcohol use disorder is also very common: 5.4% in men and 1.5% in women. Despite its high frequency and the seriousness of this disorder, only 8% of all alcohol-dependents are ever treated. One potentially interesting treatment option is oriented toward reducing alcohol intake.

To describe one case who has improved his alcohol consumption after starting treatment with nalmefene, an opioid receptor antagonist related to naltrexone.

A 35-year-old male with alcohol use disorder since 2001 came to our consult in November 2015. He was in trouble with his family and he had a liver failure. We offer a new treatment option with nalmefene 18 mg to reduce alcohol consumption.

Before to start nalmefene he drank 21 drinks/week. Six-month later, he decreased alcohol intake until 5 drinks/week with better family relationship and liver function. After starting nalmefene he complained of nausea, so we recommend to take the middle of the pill for next 7 days. After this time he returned to take one pill with good tolerance and no more side effects or withdrawal syndrome.

Nalmefene appears to be effective and safe in reducing heavy drinking and in preventing alcohol withdrawal syndrome due to its opioid receptor antagonism. This case suggests nalmefene is a potential option to help patients, who do not want or cannot get the abstinence, in reducing their alcohol consumption.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Rat gambling task (rGT) is a recently developed animal model making translational research possible in psychiatric disorders related to decision-making deficits. Methiopropamine (MPA) is a structural analog to methamphetamine and a temporary controlled substance. Although increasing concerns have been raised regarding MPA's abuse, few sources of information exist regarding its psychopharmacology. Thus, we investigated whether MPA produces any changes in the choice of preference in rGT.

Rats were trained in a touch screen chamber to learn the relationships between 4 different light signals on the screen and accompanied reward outcomes and punishments set up with different schedules, for one session of 30 min each day. Once animals showed a stabilized pattern of preference, they were given a total of 5 IP injections (a single injection per day, every other day) with saline or MPA followed by 2 weeks of withdrawal. Upon MPA challenge injection, their preference of choice was re-tested in rGT chambers.

Depending upon their preference of choice, rats were separated as risk-averse or risk-seeking groups. When they were pre-exposed to and challenged with MPA, rats in the risk-averse group significantly changed their preference toward more disadvantageous choices. These effects were not shown when they were pre-exposed to saline and challenged with MPA.

These results indicate that MPA badly influences decision-making behavior as in gambling task, implying that it may aggravate pathological symptoms of bad choices, resulting in negative consequences, observed in the patients with behavioral addictions.

The authors have not supplied their declaration of competing interest.

To identify the relationship between marital adjustment and, sex roles and burnout rather than dependence features of the patient in wives of the patients with AUD.

The study sample consisted of 33 wives of AUD patients (according to DSM-IV-TR criteria) who were applied to a University Hospital Alcohol Dependence Clinic to leave alcohol use. Sociodemographic questionnaire, Marital Adjustment Scale (MAS), Maslach Burnout Inventory (MBI), Bem Sex Role Inventory-Short Form (BSRI) and, Beck Depression Inventory (BDI) were applied to the wives of ADD patients.

Mean MAS score was under cut-off score (29.63 ± 10.33) and it shows that marital adjustment is lower in wives of ADD patients. It was shown that marriages longer than ten years, and higher emotional exhaustion scores were associated with lower marital adjustment in our study. Masculinity scores were higher in wives who perceived their income status higher. In contrast to previous studies, which examined marital adjustment, masculinity role was found to be associated with higher marital adjustment in our study.

Emotional exhaustion and depression are common in spouses of the patients with ADD in our study. There may be a distortion in expected roles of the spouses which cause a disequilibrium on the family relationship. Lower income status, having increased number of children was associated with severe depression in wives which found to reduce marital adjustment scores. Finally, most of the wives of ADD patients will need psychotherapeutic treatments during addiction period. So incorporating spouses into treatment of ADD patients is a necessity to improve marital adjustment and burnout.

The authors have not supplied their declaration of competing interest.

Patients with co-existence of psychiatric disorders and substance use have an increased risk of premature death. This is attributable to a higher prevalence of physical comorbidities and the lifestyle related to substance use. Furthermore, they experience low quality of life (QoL). Studies addressing lifestyle interventions for these patients are warranted.

To investigate the physical health and QoL in patients with co-existence of psychiatric disorders and substance use, and to analyse for changes in their (a) health, (b) substance use and (c) QoL after a 24-month health-promotion programme. Further aims were to investigate associations between (a) QoL and number of interventions, (b) QoL and patient characteristics and (c) QoL and length of participation in the intervention.

In this naturalistic cohort study, 64 non-selected patients were engaged in health-promoting interventions added to contemporary treatments. QoL and clinical variables were measured at the beginning of and continuously during the programme by means of the WHOQoL-Bref questionnaire.

At enrolment, the patients’ intake of cannabis and alcohol was high. During follow-up, patients consumed significantly fewer caffeinated beverages (P = 0.038) and fast-food meals (P = 0.018), and slept significantly less (P = 0.032). The average dose of antipsychotic medication increased significantly (P = 0.015). QoL was low at enrolment but improved significantly overall (P = 0.009) and in the psychological (P = 0.020) and environmental domains (P = 0.012) at follow-up. The difference in total QoL was positively associated with the number of interventions attended.

This programme shows promise in addressing health promotion for these patients and can easily be integrated into contemporary treatments.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Chronic excessive alcohol consumption may lead to structural and functional damage of the brain. Alcohol-related cognitive impairments are well-established and confirmed by neuropsychological and neuroimaging studies. However, the influence of each neuropathological mechanisms is still under discussion. This topic is increasingly becoming focus of attention in psychiatry.

Review the neuropathology, clinical features, neuropsychology and management of alcohol-related cognitive impairments.

Evaluate clinical impact, management and prognosis of alcohol-related cognitive impairments.

A literature search was performed on PubMed and Medscape database.

According to our literature research, there is a debate concerning the relative contributions of the direct toxic effect of alcohol and the impact of thiamine deficiency on the alcohol-related cognitive impairments. Research about this issue is challenging, considering the multiple patterns of alcohol abuse, the personal and lifestyle factors, and the vulnerability of specific brain regions. The cognitive decline is linked to neuroanatomical alterations and primarily affects executive functions, episodic memory, and visuospatial capacities. These deficits may range from mild to severe but usually remain undiagnosed, unless they are specifically investigated. Maintenance of lasting abstinence is associated with cognitive recovery, but some impairments may persist and interfere with the prognosis.

Recognizing and screening for alcohol-related cognitive impairments is crucial to offer significant benefits to patients by optimising management strategies.

The authors have not supplied their declaration of competing interest.

The Internet is commonly used in modern society; however, Internet use may become a problematic behaviour. There is an increasing need for research on problematic Internet use (PIU) and its’ associated risk factors.

This study aims to explore the prevalence and health correlates of problematic Internet use among South Korean adults.

We recruited the participants aged between 18 and 84 years old among the online panel of an online research service. The sample size of the survey was 500. Of these 500 participants, 51.4% (n = 257) were men and 48.6% (n = 243) were women. A participant was classified as a problematic Internet use (PIU) if his/her total score of Young's Internet Addiction Scale (YIA) was above 50. Stress Response Index (SRI), Fagerstrom test for nicotine dependence, lifetime average caffeine consumption, and sociodemographic query form were used in the collection of data. The t test and chi-square test were used for data analysis.

One hundred ninety-seven (39.4%) of the participants was classified into the PIU group. There was no difference of gender and education between PIU and normal users. However, PIU group was younger (mean 39.5 years) than normal users (mean 45.8 years). PIU group was more likely to have high levels of perceived stress, nicotine dependence, and drink more often caffeinated beverages (P < 0.05).

These data indicate that problematic Internet use is associated with perceived stress level, nicotine and caffeine use in South Korean Internet users. More research is needed to better understand the relationship between Internet use and mental health issues.

The authors have not supplied their declaration of competing interest.

Exercise addiction is a condition described by a craving for physical training resulting in excessive exercise behaviour and withdrawal symptoms. It has not been accepted as a mental disorder and further research is needed to examine the pathology of the condition.

Exercise addiction is suggested to have links to other mental disorders and risks in terms of negative consequences such as injuries. Treatment for exercise addiction faces several challenges as the condition is associated with ambivalence, and studies based on controlled interventions are missing.

The aim of this study was to examine and interpret the existing research on links, risks and challenges faced in treatment interventions.

A literature review was conducted in the databases PubMed, PsycINFO and Scopus with the terms: “exercise addiction, excessive exercise” and/or “comorbidity, eating disorder, depression, anxiety, personality, pain, injury, illness, social isolation, stress, intervention, treatment”.

Exercise addiction seems to be associated with eating disorder pathology, obsessive-compulsive behaviour and personality traits characterized by perfectionism, narcissism and neuroticism. Overload injuries (e.g. stress fractures) and impaired interpersonal relations are reported. In a treatment context, low compliance is described as a challenge. Thus, motivational interviewing is recommended, and also cognitive behavioural therapy is suggested for treatment. None of these interventions have yet been scientifically evaluated in addicted exercisers.

This review concludes that exercise addiction has links to psychopathology and increases the risk of injuries. More research is needed to estimate the level of psychosocial and physiological distress in these athletes. Controlled treatment interventions have to be conducted.

The authors have not supplied their declaration of competing interest.

The psychoactive substances consumption modifies the users’ sense-perception.

Discuss the therapeutic workshop as a stimulation strategy of the sense organs.

The activities were developed at a Center of Psycho-Social Attention for alcohol and other drugs – CPSAad, located in north-eastern Brazil. The therapeutic workshop was divided into six sessions; being worked a sense organ in each meeting. Initially, the sessions were explained and they entered the room in silence. At first, vision and lastly, taste. The taste dynamic session was initiated by the pool where users experienced different flavours and made distinctions between them, including a food without flavour, experiencing feelings of pleasure and displeasure. This dynamic was finalized in the institute's kitchen with different ice cream flavours. The participants freely served themselves, being led to reflections on their choices of pleasure. The sixth session was constituted by listening about all Therapy Workshop Experience of the Senses, on which participants reported emotions and feelings experienced during the sessions, such as: fear, anxiety, craving, denial, pleasure and displeasure.

It was identified a universe of sensations that can be translated into a sense-perception reframing about themselves and their surroundings.

The participants presented a sensory dullness, relating the experienced stimuli to the consumption of psychoactive substances, demonstrating a strong equivalence between the proposed activity and substance dependence. This activity enabled an interdisciplinary approach, through knowledge and interventions exchange.

The authors have not supplied their declaration of competing interest.

There has been an escalation of therapeutic use and abuse of opioids. Aberrant drug related behaviors (ADRB) have prevalence between 2.8% and 62.2% in chronic pain patients treated with opioids and dependence is estimated around 3.27%.

To estimate the prevalence of dependence, ADRB, risk of opioid abuse, and co-occurring disorders in patients with chronic pain in our environment.

A total of 115 (n = 115) patients attending our pain clinic were screened to evaluate the risk of opioid abuse and presence of dependence including a clinical interview, hamilton depression scale (HAD), opioid risk tool (ORT), diagnostic criteria for substance abuse and dependence (DSM IV-TR) and a checklist of ADRB.

Among the patients, 78.26% were taking opioids, aberrant opioid related behaviors were detected in 20% and 8.9% met criteria for abuse or dependence; 11.3% had high risk and 20% moderate risk of opioid abuse (ORT). The most prevalent substance use disorders were sedative (11.3%) and alcohol (5.2%). There was a significant difference in means (t = -3.20 P < 0.005) in ORT scores between patients with current opiod dependence (x = 7.70 [s.d. = 3.07]) and without it (x = 2.88 [s.d = 3.58]); 30.4% had anxiety, 20% depression and 3.5% adjustment disorders; 57.5% and 48.3% had a score > 10 on anxiety and depression respectively on the HAD.

A systematic screening of risk of opioid abuse and of dependence as well as psychotherapy to treat comorbid psychopathology should be part of the treatment protocol.

The authors have not supplied their declaration of competing interest.

Currently, cannabis remains the most widely used illicit psychoactive substance in the world. Its main pharmacological properties are known and its use for therapeutic purpose is still expanding. Also, its acute and chronic toxicity become more described, even if some mechanisms of pharmacotoxicology still remain to clarify as the cannabinoid hyperemesis syndrome (CHS).

To describe cases of CHS, to highlight the clinical presentation and all the complexity of the medical exploration for making an accurate diagnosis.

We present a case series of CHS related to cannabis use and notified to the Parisian addictovigilance center.

Eight cases were collected between 2011 and 2016. The users are almost exclusively men (7/8), with a median age of 31 years and some of them present a history of psychiatric disorder. All of them report important daily cannabis consumption (up to 15 joints by day) with duration of consumption averaged at 10 years. All patients present recurrences of clinical signs of the syndrome including vomiting (8/8) and abdominal pains (8/8) leading to repeated hospitalizations. Despite the presence of compulsive taking hot showers notion (7/8), specific sign of the CHS, its diagnosis were made by a physician in 5 cases. Carried out medical examinations are often complete, invasive, even going to an explorative laparotomy for one patient.

The CHS remains not well known. A better understanding of this syndrome will enable better patient care while avoiding costly spending unnecessary investigations.

The authors have not supplied their declaration of competing interest.

There is only little data regarding drug safety related to agents used for opioid maintenance therapy (OMT).

To study drug safety and the reporting behaviour of adverse drug reactions (ADR) related to OMT.

A cross-sectional questionnaire-based telephone survey among physicians providing outpatient OMT in a federal state of Germany (n = 176; response rate = 55.7%) was conducted.

Most of the respondents (n = 97/55.1%) reported that they observe ADR related to buprenorphine, [dihydro]codein and [levo]methdone rarely (n = 38/21.6%), very rarely (n = 39/22.2%) or never (n = 20/11.4%). Methadone was reported to be most frequently associated with the occurrence of ADR (n = 82/46.6%), followed by levomethadone (n = 33/18.8%), buprenorphine (n = 6/3.4%), and dihydrocodeine (n = 3/1.7%). Frequently observed ADR related to these agents were gastrointestinal, nervous system and psychiatric disorders, and hyperhidrosis. Methadone and levomethadone (not buprenorphine) were reported to be frequently associated with fatigue, weight gain, and sexual dysfunction. Only buprenorphine was reported to be frequently associated with withdrawal and rebound effects, and drug intolerance. Hundred twenty-nine participants (73.3%) stated that they never report ADR related to OMT, whereas n = 19 (10.8%) did so when referring to ADR related to their complete medical practice (Chi2 = 141.070; df = 1; P < 0.001).

Our data revealed similar patterns of ADR related to outpatient OMT as those reported in the product information or in pain therapy. Motivation to report ADR related to agents used for OMT may be reduced compared to ADR related to the general medical practice.

The authors have not supplied their declaration of competing interest.

Intoxications with alcohol are very frequent in clinical psychiatry and may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors as liver function, tolerance, comedication, etc. Death may occur due to ethanol-induced respiratory depression and/or aspiration of gastric content (due to an impaired gag reflex); thus, securing of the airway and ventilation are occasionally necessary.

To illustrate the broad range of clinical outcomes of alcohol intoxications and their adequate therapy.

We present the case of a 58-year female patient with depression who demonstrated a very high BAC of 8.68 g/L (representing the highest survived BAC in literature) due to ingestion of large amounts of alcohol with suicidal intent.

Intubation and ventilation were lifesaving and the patient did not develop any physical or mental consequential damage. As the patient had not regularly used alcohol or any other psychotropic agent tolerance could be ruled out.

This case emphasizes the necessity of rapid securing of the airway in patients with alcohol intoxication and respiratory depression and, furthermore, illustrates the large inter-individual differences regarding ethanol susceptibility.

The authors have not supplied their declaration of competing interest.

Decreased cognitive control over the urge to be involved in gambling activities is a core feature of gambling disorder (GD). Cognitive control can be conceptualized as the sum of high-order cognitive faculties interacting in the achievement of goal-oriented behaviors. As such, cognitive control can be differentiated into several cognitive sub-processes, such as response inhibition, conflict monitoring, decision-making and cognitive flexibility, all of which prove to be pivotal in GD clinical phenomenology.

Over the past few years, several studies and reviews have indicated a lack of cognitive control in GD through self-report questionnaires and neurocognitive tasks. Conversely, there are only a limited number of neuroimaging studies, which investigate the neural mechanisms underlying diminished cognitive control in GD.

This research aims to systematically review functional magnetic resonance imaging (fMRI) studies that target cognitive control in GD.

A literature search was conducted in order to find appropriate published articles on fMRI studies in GD.

Fourteen fMRI studies were included. Depending on which neurocognitive task was employed, the studies were divided into five different sections: conflict monitoring, response inhibition, delay discounting, cognitive flexibility and decision-making.

Impaired activity in prefrontal cortex may account for decreased cognitive control in GD, contributing to the progressive loss of control over gambling behaviors. However, the way in which cognitive control interacts with affective and motivational processes in GD is still matter of investigation. Among prefrontal areas, orbitofrontal cortex has been indicated as a possible nexus for sensory integration, value-based decision-making and emotional processing, thus contributing to both motivational and affective aspects of cognitive control.

The authors have not supplied their declaration of competing interest.

Due to the continuous search for new, legal, less expensive, and more powerful highs by drug users, the synthesis of novel cathinone derivatives has become a fruitful industry, leading to a fast emergence of new alternative substances every year. Methylone (3,4-methylenedioxy-N-methylcathinone) is one of the substances that rapidly emerged as the main ingredient of “bath salts”, becoming readily accessible on the Internet. This fact has raised concerns about its potential harmfulness.

The aim of the present study is to analyze the presence of methylone in samples delivered to energy control from 2014 to 2015 in Spain.

A total of 8324 samples were assessed from June 2014 to May 2015. Only those samples acquired as methylone were studied. They were analyzed by energy control, a Spanish harm reduction NGO that offers the possibility of analyzing the substances that users report. Analysis was done by gas chromatography-mass spectrometry.

Ten users reported to have acquired methylone (0.12%). The most used source for acquiring it was the Internet (60%). Other sources included a friend or relative (10%), home-delivered (10%) or undetermined (20%). There was no peak of consume as 50% were acquired in 2014 and 50% in 2015.

According to the results, the presence of methylone in our samples is extremely low. Therefore, despite the fact that methylone monitorization is ought to be carried out, this substance is not expected to be an emerging issue concerning Public Health and no further clinical research should be done.

The authors have not supplied their declaration of competing interest.

Portuguese young adults (15–34 years old) were more frequent engaged in substance abuse (1.2%) than the general population, according to the Portuguese substance use annual report (2014). Alcohol was the most frequent substance use on youth adults. Cannabis was the most frequent illicit substance used (23.9% of users were considered dependent), with higher prevalence than previously reported. LSD (0.4%) use was also higher among young adults than in previous studies. Cocaine (0.4%), heroine/opiates (0.4%), ecstasy (0.3%), and hallucinogenic mushrooms (1.1%) had their consumption lowered among young adults.

To characterize a population of young adult psychiatric outpatients, regarding substance use and associated risk.

Socio-demographic characterization of our young adult unit outpatient users between 1st January 2015–31st July 2016. Substance use was assessed with the Portuguese version of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

A total of 255 outpatients were observed during the timeframe; 58 outpatients were assessed with ASSIST: 44 females (75.9%) and 14 males (24.1%), aged between 16–33 years old (average: 20.95; median: 19.50). For tobacco, 3.5% had high risk, 37.9% moderate risk and 58.6% low risk; 22.4% had moderate risk of alcohol, 13.8% moderate risk of cannabis, and 20.7% moderate risk of tranquilizers. For others substances (cocaine, stimulants, inhalants, hallucinogens, and opiates) the risk was low.

In our sample, alcohol and cannabis use had the highest risk, as reported in the National Annual Report; however, we observed a moderate risk for tranquilizers use. In future care planning, youth mental health should address tobacco and alcohol abstinence, and preventive measures regarding anxiolytics should be undertaken, such as banning sale without medical prescription.

The authors have not supplied their declaration of competing interest.

With the rapid and intensive spread of marihuana abuse among youth, Japanese society is focusing on law enforcement against drug abusers. In 2016, a mass killing allegedly committed by a marihuana abuser was reported in Japan.

To consider that common recognition of the diverse process and potential risks of cannabis psychosis should be shared among psychiatrists.

Elicit differences between cannabis psychosis and methamphetamine psychosis, and determine whether specific guidelines for treatment of cannabis psychosis are required.

Intensive retrospective review of distinctive methamphetamine and cannabis psychosis through case studies in our hospital.

Major symptoms of methamphetamine psychosis include auditory hallucination and paranoia, however recovery is achieved soon after undertaking treatment. In cannabis psychosis, distinctive features are megalomania and by a pseud-enlightenment experience of supernatural existence, abusers stick to an unrealistic self-estimate of omnipotent, which leads them to refuse the fading away of this feeling and repeat abuse.

Psychological substances have strong suggestibility so abusers’ symptoms are easily modified by their mental state. Involvement of syndicate or perception of illegality reflects abusers’ drastic symptoms, but after dehospitalisation, recurrences are relatively fewer. Cannabis, however, grows wild and is admitted legally in some countries, so abusers lack awareness of guilt by mistaken perception of omnipotence and unrealistic optimism. Due to addiction and depersonalization, they rather enjoy gaining contact with supernatural power and fall into social withdrawal and are implicated to social problems. Considering the difficulty of rehabilitating and returning abusers to the community, we should not disregard the risks of cannabis abuse.

The author has not supplied his/her declaration of competing interest.

Government-funded research indicates the prevalence of substance use in this age group is decreasing. However, anecdotal evidence suggests otherwise.

Previous surveys have been limited by:

• — difficulty recruiting schools;

• — the range of substances included;

• — paper surveys.

To determine whether a secure online survey method improves substance use prevalence data collection in school age adolescents.

An online survey was created following literature review, and assessment of the reliability and validity of existing surveys. A comprehensive range of substances were included. A total of 750 students (11–16 yrs) from a mainstream school in Lancashire completed the survey during a supervised classroom session. Focus groups were conducted with students and teachers.

No technical problems were encountered and survey data was securely transferred to Excel allowing instant analysis.

Teachers felt the survey would be unproblematic to administer independently and found the inclusion of substances such as legal highs, and energy drinks, especially relevant.

Most students completed the survey within the session and reported a positive experience, although some difficulties understanding wording were mentioned. They felt an online survey improved confidentiality (and therefore honesty) and was easier to fill in. However, there was concern about teachers reading their responses.

A secure online survey may be acceptable to both teachers and students, and enables the collection of hundreds of surveys in a short time period. It also improves analysis techniques.

Further analysis of whether there is a teacher-versus-researcher supervision effect on the honesty of student responses is required.

The authors have not supplied their declaration of competing interest.