The aim of the research is to test this question what is the first cause of addiction? Psychological, Environmental or Physical causes.

80 addicted people were randomly selected and Abuse Drug Assessment Inventory (ADAI) was administered on them. Chi Square formula was used to analyze the results.

Findings showed 55 percent of tendency to addiction was psychological. Also more analyzing showed 65 percent of continuing causes of addiction were psychological factors such as fear, anxiety, sorrow.

In regard to results we should put more emphasis on psychological prevention and treatment methods so that both tendency to addiction and continuing causes of addiction decrease and control.

Relapse in patients of opiod addiction is very common. Dynamics of addiction relapse are not fully understood as yet. Psychiatrists would explain it on basis neurotransmitter mediated disorders like anxiety, depression, OCD, lack of impulse control and etc. For sociologist relapse is an outcome of contradictions with in society. For a psychologist it is due to maladaptive life style. In this study integrated approach has been adopted to find out relative importance of different factors implicated in relapse.

Team of psychiatrists, psychologists, addiction counselor identified different causes of relapse in patients with opiod addiction. They designed graded scale in which 10 factors were included. Study group was comprised of hundred relapsed patients. They filled Performa’s according to their personal experiences. Regression method was used for factor analysis.

Statistical analysis revealed that peer group pressure, anhedonia, and premature ejaculation are first, second and third, factors respectively. Factors like pains and aches, insomnia, impulsivity and etc followed.

Every relapse prevention program should adopt policy keeping in view relative importance of causes of relapse. For peer pressure narcotic anonymous meeting is the best solution. Anhedonia is due to reduction dopaminergic input at nucleus accumben. Dopamine agonist drugs like bupropion can be used for that. Inordinate sexual behavior and substance abuse are strongly associated. Premature ejaculation plays vital role in relapse of patients of opiod addiction. Sex therapy and drugs like SSRI,s and gabapentine can improve intra vaginal latency time.

Factor analysis can be helpful in relapse prevention program.

The relationship between sociodemographic data and characteristics of alcohol use has been analyzed in a sample of medical students from Romania.

A questionnaire containing sociodemographic data and aspects of alcohol use was completed by students from different universities of medicine from Romania.

A number of 156 subjects were questioned, with ages between 18 and 30 years. Of them 44.5% were female and 54.5% were male, and the majority were in their first university year of study. The number of alcohol units drank one time was less than 3 units for 70.5% of subjects and more than 3 units for 28.8% of subjects. Age and year of study were not significantly associated with the use of higher amount of alcohol units. Male subjects tend to have a significantly higher use of alcohol than female subjects. We found that the higher number of alcohol units used is associated with more somatic effects (nausea, vomiting, drowsiness) and with more risk behaviors with serious consequences (missing classes, driving, fighting, law problems). 73.7% of all subjects experienced at least one somatic effect and 43.6% of subjects had at least one risk behavior related problem. 15.38% of questioned subjects admitted that the alcohol use was a problem.

The use of more than 3 alcohol units was significantly associated with male gender, somatic effects and risk behaviors in our sample. Alcohol use is a major health problem worldwide with important social implications and apparently medical students also experience its unfavorable consequences.

Homosexual women are frequently described as particularly exposed to alcohol and drug abuse, depression and suicide attempts. Despite the modern trends of a complete social inclusion of homosexual population, it is important to deal with peculiar features in the process of social adaptation of these people. Psychosocial variables may account for substance use patterns.

The authors are presenting the case report on a twenty eight year female drug addict (according to criteria of ICD-X), who was observed for three times at the Department for women addicts. During the early adolescence period, she periodically consumed marijuana. She became aware of her sexual orientation at the age of 15 and experienced first homosexual activity at the age of 17. She disclosed her homosexuality to her parents 5 years ago, and their reaction was very negative. At that period, she started to consume heroin and became a heroin addict. Following two treatments at our Institute, she refrained from using heroin until the pressures at home became unbearable. Drug use patterns became the only means for her to cope with the pressures from her family and peers and the only way to ease the pain of loneliness and overcome isolation and depression.

Although homosexuality is neither a mental illness nor predisposition to mental illness, the psychosocial ramifications may create serious secondary emotional problems.

Homosexual women experience specific health problems. Communication between medical staff and homosexual women must be improved so as to better address the latter's specific health care needs.

The aim of this research is to test this question that are there specific personality characters that lead to addiction?

Method research is causative-comparative (Ex post facto). 153 addicted people and 153 nonaddicted people were randomly selected and MoKioly's Characterlogy Inventory (MCI) was administered on them. The inventory assess personality based on eight characters: sanguine, indifferent, nervous, indolent, indignant, passionate, sentimentee, amorphous.

Findings showed addicted people are much more indifferent, sanguine and passionate than nonaddicted people.

In regard to people with these characters are much more at risk, they should be trained with special plans and be cared so that tendency to addiction in them decrease or control.

The OCDS used for the assessment of obsessive and compulsive symptoms associated with alcohol intake and relapse may contribute significantly to the assessment of detoxification programmes.

The assessment of patients after therapy, using OCDS.

The OCDS was administered to 121 patients (94 males and 27 females) at the onset of treatment and upon its completion two months later. All patients were taking medication with naltrexone. Gender, age, education, years of alcohol use and abuse, alcoholism type (91 type I and 30 type II) were recorded.

The averages years were: age 43,1±7,9, education 11,1±3,3, alcohol use 21,2±8,9, abuse 9,9±7,1. The average of the initial measurement was 27,2±8,2 significantly higher (paired t-test p< 0.001) than the second, the average of which was 5,3±7,6. 95% showed improvement with average improvement rate 21,9 ± 9,9. No correlation with age, alcohol use and abuse or alcoholism type (Pearson correlation p> 0.05) was observed, but lower improvement rate among females is indicated (18,7±10,9 VS 22.9±9.5 t-test p=0.05). Negative correlation between education and alcohol use and abuse (Pearson correlation p< 0.05), and positive correlation between the first and the second measurement were observed (Pearson correlation p>0.05).

Although therapy seems effective in reducing symptoms, further studies must prove that positive results persist over time. The OCDS seems useful for assessing treatment and has follow-up reliability. The small number of females in the sample renders it unsafe to make any generalisations regarding gender related results in this study.

Benzodiazepines are commonly prescribed since the 1960, when they replaced barbiturics. Although there is no doubt about their efficacy in treating anxiety, insomnia or other psychiatric disorders, we should also take into account the fact that these drugs are easily misused.

In this work we analyze the intake of benzodiazepines among patients hospitalized due to medical problems.

Retrospective review of clinical histories of patients attended by the Drug Unit of the Psychiatry Service in the last twelve months. Bibliographical review of the theme. Data analyzed using the SPSS software 15.0 version.

45 patients were subjected to our survey, 41 of them male. 66% were HIV Positive patients, and the most frequent cause of hospitalization was pneumonia (51’1%). Most of the patients attended were drug abusers (see the graphic below). When the benzodiazepines abusers were asked how they obtained them, 40’6% recognized the got them without prescription, 25% said they got them legally, and 34’4 answered that they got them legally but also without prescription. 62’5% of the patients usually took alprazolam.

Benzodiazepine abuse, in particular alprazolam, is quiet common among the patients we see.

In half of the cases the use of benzodiazepines could have worsen the prognosis of the patients.

The brain utilizing mechanisms of glucose for neuronal functions are still poorly understood. To identify a unified model of blood-brain glucose metabolism, we developed a model that incorporates the pancreatic β-cell and the fishbone models of glucose metabolism and called it the CoBBGluM Model (or the Convergence model of Blood-Brain Glucose Metabolism) and examined the role of addictive substances (alcohol, cocaine etc) on the functions of the model.

The databases of Pubmed, Elsevier were searched for peer reviewed literatures (from 1950-2009yy) on the mechanisms and models of blood-brain glucose metabolism.

The major concept of the unified model is based on the fact that the major regulators (leptin and insulin) of blood-brain glucose metabolism work synergistically, rather than individually. Addictive substances adversely affect the blood-brain glucose transport system by their stimulating and toxic action on the control mechanisms of leptin and insulin. The metabolic byproducts of addictive substances might acquire electron-transmitter properties across mitochondrial membranes. All these processes subsequently lead to total equilibrium disorder of the CoBBGluM Model, and is the etiopathogenetic basis of most addiction-associated neurodegenerative disorders. Adequate therapies for addiction might lie on the full understanding of the CoBBGluM Model, since it serves a classical tool for explaining the role of addictive substances in the nervous system.

Moderate alcohol use might be detrimental under certain conditions. We examined the efficiency of maintenance of blood glucose level (BGL) at normal range among non-alcohol and moderate alcohol users under intensive mental activities.

Fourth year medical students - male volunteers (5 non-alcohol and 8 moderate alcohol users who had abstained from alcohol for the last 7-10 days before the study) were involved in the study, which took 6 hrs on fasting. AUDIT, texts and questions, tests on visual, auditory short-term memory and attention were used as a measure. BGL was measured at 2hrs interval. Hypoglycemia was defined according to Galan ED et al (Neth J Med 2006; 64 (8): 269-279) as BGL ≤4.5mMole/L. The t-test was employed for statistical analysis.

Alcohol users on the average drank 23ml of pure ethanol/session and 1-2 times/month. Non-alcohol users had increased BGL (4.02 as initial to 5.76mMole/L after 6hrs) in all phases of the experiment (ð< 0.001). Alcohol users had increase in BGL (0.45mMole/L increase, initial - 4.20) within the first two hours and a significant fall in the 4-6 hrs (p< 0.05) up to 3.80mmole/L, and was accompanied by a significant decrease in mental work productivity coefficient.

Alcohol use even in moderate doses results in hypoglycemia, subsequently leading to low mental work productivity, especially under 4-6 hr intensive mental activities.

Alcohol use is a major public health problem in the general students’ population in Belarus. We therefore screen for the prevalence and trace the order of increase in alcohol use and related problems among students in Belarusian universities.

A total of 565 (1st-2nd courses, mean age - 19yrs); 537 (3rd - 4th courses, mean age - 21yrs); and 397 (5th - 6th courses, mean age - 23yrs) university students in Minsk, Belarus were administered questionnaire, containing the AUDIT, CAGE. The cut-off point on the AUDIT was set at 8. All statistical analyses were performed using SPSS 16.0 version for Windows; the criteria of Pearson, χ2 and Student's t testsñ. The probability value for significance was set at p< 0.05.

Alcohol use and related problems increased with increase in the average age and year of study. In the 1st - 2nd, 3rd - 4th, 5th - 6th, alcohol users were 83.6%, 85.6%, 94.2% respectively and problem drinkers were 14.5%, 17.9%, 20.9% respectively. The use of strong strength alcoholic beverages was linked to a high risk of alcohol problems.

The level of alcohol use and related problems in the general students’ population in Belarus are high and show increase in order of increase both in the average age and the year of study.

The UK NICE Guidelines recommends Contingency Manangement as “the only psychosocial intervention wIth clear evidence for effectiveness as an adjunct to drug detoxification”.

Most resarch has been done with money,vouchers as incentives,raising ethical issues.

The aim of this study is to analyze the subjective attitudes of clients and changes in their recovery process,when awarded certificates as incentives for giving clean drug screens and complying with care-plan.

Clients were awarded 3 tiered certificates on providing a specific number of random consecutive negative drug screens to Heroin and Cocaine. Screens were deemed positive, if the client did not attend their appointments.

Level 1- three negative drug screens.

Level 2- six negative drug screens

Level 3- ten negative drug screens.

Study questionnares were filled by key-workers and clients.

15 clients received certificates.

12 clients knew about certificates before their treatment began.

100% clients reported higher motivation to achieve subsequent certificates.

100% clients reported ‘encouragement’ to produce negative drug screens.

73% clients reported ‘encouragement’ to attend appointments with key-workers.

100% clients reported improved self-esteem.

100%clients reported positive responses from family, friends and clinicians.

100% reported a positive shift in their attitudes & behaviours towards drugs.

A few clients agreed that certificates enhanced their determination to give negative drug screens but would have done either ways.

Contingency management is a positive and effective adjunct to opiod detoxification. It should be incorporated into detox regimes more robustly and consistently.

Certificates as Contingency management raise no ethical issues,requires no staff training and requires low budget.

Through years of practice on Substance Abuse Word in Specialized Psychiatric Hospital Kotor in Montenegro, we had an opportunity to work with a significant number of addicts who were sentenced for mandatory treatment in psychiatric hospital. Patients came mainly from group who committed criminal acts either under influence of alcohol or whose actions were determined by heroin addiction.

To analyze the nature of criminal acts between forensic patients with alcohol and heroin abuse problem.

To distinguish characteristics between these two groups

These two groups were compared according to data collected for each patient individually. Data was based on court sentences, forensic evaluation reports, observation during treatment, psychologist's and psychiatric findings. This data gave a better insight into motives, circumstances, and nature of criminal acts for each patient. In this way, we were able to distinguish common aspects of criminal acts both for group of alcoholics and group of heroin addicts.

Our study has shown that nature of criminal acts among addicts significantly differs regarding type of addiction, in this case alcohol and heroin ones.

In general, criminal acts of alcoholics are more violent in nature, often are related to family violence, and are driven by interpersonal conflicts, which is not a case for majority of heroin addicts. Furthermore, while motive of heroine addicts is mostly to reduce abstinence crisis, we have found that in alcoholics it mostly deals with reckless behavior and acting - out behavior in state of intoxication.

According to 2008 data, there are 80.000 patients undergoing replacement opiate programs (RMP) in Spain. However, the clinical therapeutic management and the psychiatric and medical comorbidities have not been well described.

To describe the current therapeutic management and psychiatric comorbilities of opiate-dependent patients undergoing a RMP in Spain.

We carried out an observational, cross-sectional, multicenter study from September 2008 to February 2009. Patients > 18 years, with written informed consent, with a opiate-dependence according to DSM-IV-TR criteria and currently scheduled in a RMP in Spain were included.

624 patients (38.89±7.95 y.o.,84% men) were included in the study from 74 centers.

Psychiatric comorbidities were clinically detected in 68% of all valuable patients, most frequently anxiety (53%), mood (48%) and sleep disorders (41%). Patients receiving buprenorphine-naloxone suffered less sleep disorders (19% vs. 43%; p=0.0327) The proportion of patients with at least one psychiatric comorbidity was directly related to methadone dose (p=0.0066).

The most frequent replacement therapy was methadone (94%), usually in ≤ 40 mg/day (38%) and 40-80 mg/day doses (40%); mean follow up period being 45.88±51.86 months. Significant differences were found between methadone doses and retention. Patients with HIV and HCV infection received higher doses of methadone (HIV+ patients (p=0.0024) and HCV+/ HIV+ patients (p=0.0250) due to ARV treatment; and showed less PMM retention.

Patients present high rates of dual diagnosis, and infectious and non-infectious comorbidities, expecting higher doses of methadone than found (54.04±47.26 mg/day) in the study to assure a proper retention in the maintenance programs.

Describe the prevalence and characteristics of psychotic symptoms in the context of cocaine injection use in a harm reduction program.

To find associations between intravenous cocaine use and other drug use in cocaine dependent patients suffering from cocaine induced psychosis (CIP). Cannabis was found to be a risk factor for developing CIP in non-intravenous cocaine dependence.

During a period of 6 months professionals from our Outpatient Drug Clinic completed a confidential questionnaire to describe the adverse clinical effects following cocaine injection. It included age, gender, ethnic group, daily consumption rate and other drugs used in the last 30 days.

Survey was achieved with a sample of 75 Caucasians patients, 69 men and 6 women with an average age of 32 years old. Seventeen percent (13/75) had psychotic symptoms, of which 84% (11/13) had hallucinations (visuals 4/11, auditive 7/11 and kinaesthetic 2/11), 15% (2/13) illusions.

Eighteen percent (14/75) had stereotypy movements and 3% (2/75) had aggressive behaviour. Drugs used by CIP patients, the previous 30 days were: 61% (8/13) cannabis, 31% (4/13) opiates and 15% (2/13) alcohol.

Intravenous cocaine use produced acute psychotic symptoms in 17% of our patients, of which 61% used cannabis. Despite the ethical and practical implications of this type of study, it is necessary to do more observational studies with bigger surveys to conclude these results with statistically significance.

Investigation of mental disorders in 377 patients who met ICD-10 criteria for opioid dependence.

Clinical observation and psychological examination.

It was shown that mental disorders of opioid addicts consist of three types of psychopathological categories: pro-addictive phenomena (personality features and co-morbid disorders predisposing to drug abuse), meta-addictive disorders (psychopathological states gained due to drug abuse) and addictive disorders proper (craving and drug-seeking behavior). Anxiety and other neurotic symptoms are predominant types of mental disorders in opioid addicts. The core disorder of neurosis spectrum disturbances is fear of abstinence or withdrawal phobia. Withdrawal phobia determines largely negative reinforcement of drug. This phenomenon results in anticipating intake of drug and augmentation of daily drug dose. Opioid abuse leads to addictive personality deformation which including such features as constant and hypertrophied demand for positive emotional states, intolerance to frustration and other discomfort, low threshold of stress susceptibility and increased stress vulnerability, permanent urge to modulate the psychic and physical condition by dint of drug use, marked egocentricity and motivational collapse. Distorted motivational hierarchy can be illustrated by phenomenon of attractive taxis: opioid addicts show preference for the activities which lead to afford pleasure only. “Illegal exploitation” of reward system by means of drug abuse results in crucial extinction of non-rewarding routine activities (such as work or studies).

It appears that a stability of neurotic spectrum disorders and addictive personality deformation is the principal reason of low efficiency of opioid dependence treatment.