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CORK Bibliography: Review Articles

61 citations. December 2010 to present

Prepared: June 2011

Advokat C. What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD. (review). Neuroscience and Biobehavioral Reviews 34(8): 1256-1266, 2010. (104 refs.)

The relevant literature concerning cognitive effects of amphetamine and methylphenidate, was reviewed, with an emphasis on research conducted in adults diagnosed with attention-deficit/hyperactivity disorder. As first-line treatment for ADHD, stimulant drugs are well-known to improve attention and concentration. Yet, there is increasing evidence that (as with children and adolescents), they do not promote learning and academic achievement in adult college students with ADHD. A review of neuropsychological studies indicates that, although response latencies are reduced, performance of ADHD adults on tests of 'distractibility' and 'planning' is also not consistently improved by stimulants. Studies in non-ADHD adults suggest that stimulants do not promote acquisition of new information, might improve retention of previously acquired information, and facilitate memory consolidation, but may actually impair performance of tasks that require adaptation, flexibility and planning. It is still not clear if improvement only occurs when there is a baseline deficit. Stimulants may influence cognition by their effects on physiological arousal. Regardless, the evidence does not support the conclusion that stimulants are cognitive 'enhancers.

Baydala L. Inhalant abuse. (editorial review). Paediatrics and Child Health 15(7): 443-448, 2010. (51 refs.)

Inhalant abuse - also known as volatile substance abuse, solvent abuse, sniffing, huffing and bagging - is the deliberate inhalation of a volatile substance to achieve an altered mental state. Inhalant abuse is a worldwide problem that is especially common in individuals from minority and marginalized populations, and is strongly correlated with the social determinants of health. It often affects younger children, compared with other forms of substance abuse, and crosses social and ethnic boundaries. Inhalants are pharmacologically diverse products that are selected for their low price, legal and widespread availability, and ability to rapidly induce euphoria. Chronic abuse is associated with serious and often irreversible effects. Widespread screening and early referrals to treatment programs have resulted in significant improvements in the mental, physical and social conditions of those affected. The present statement reviews critical aspects of inhalant abuse, highlighting new information and data that pertain to Aboriginal children and youth, and provides recommendations for treatment and prevention.

Benyamina A; Kebir O; Blecha L; Reynaud M; Krebs MO. CNR1 gene polymorphisms in addictive disorders: A systematic review and a meta-analysis. (review). Addiction Biology 16(1): 1-6, 2011. (37 refs.)

The aim of the present work was to systematically review all association studies of cannabis receptor 1 (CNR1) polymorphisms with dependence syndrome and to perform a meta-analysis. Odds ratios (ORs) were estimated by contrasting the ratio of counts of the 'high risk' versus 'low risk' alleles in cases with dependence versus controls. Studies were analyzed by random-effects meta-analysis using pooled OR. Eleven full text articles met our eligibility criteria and nine meta-analyses were performed on three polymorphisms of CNR1: rs1049353, rs806379 and the AAT repeat. Of these, only the AAT polymorphism showed a significant association with illicit substance dependence but only in the Caucasian population samples and using a risk allele definition of >= 16 repeats. Our analysis showed a small effect size (OR = 1.55, P = 0.045), with strong heterogeneity (Q = 19.87, P < 0.01 with I2 = 85%). In line with the polygenic model, our meta-analysis supports a minor implication for CNR1 AAT polymorphism in illicit substance dependence vulnerability. Further studies in well-phenotyped samples and using more polymorphisms are needed to conclude on the actual influence of cannabinoid receptor polymorphisms.

Bergenstrom AM; Abdul-Quader AS. Injection drug use, HIV and the current response in selected low-income and middle-income countries. (review). AIDS 24(Supplement 3): S20-S29, 2010. (68 refs.)

Over half of the world's estimated opiate users reside in Asia, including an estimated 3.9 million injecting drug users (IDUs). Injection drug use is a significant factor in determining the course of HIV epidemics, particularly during the early stages of epidemics in Asian countries. Several countries report high HIV prevalence in this population and IDUs account for a large proportion of reported infections. The purpose of this review is to examine the current status of the epidemic, the availability and coverage of select interventions recommended by WHO, United Nations Office on Drugs and Crimes (UNODC) and United Nations Joint Programme on HIV/AIDS (UNAIDS), resource requirements for scaling-up harm reduction in Asia, gaps in the national response, barriers to implementation and recommendations for overcoming barriers to scaling up prevention, treatment and care services for IDUs in the region.

Brinn MP; Carson KV; Esterman AJ; Chang AB; Smith BJ. Mass media interventions for preventing smoking in young people. (review). Cochrane Database of Systematic Reviews 11: e-article CD001006, 2010. (164 refs.)

Background: The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community. Objectives: To evaluate the effectiveness of mass media interventions to prevent smoking in young people in terms of reduced smoking uptake, in addition to secondary outcomes including improved smoking outcomes, attitudes, behaviours, knowledge, self-efficacy and perception. Search strategy: We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of MEDLINE and EMBASE in July 2010. Selection criteria Randomized trials, controlled trials without randomization and time series studies that assessed the effectiveness of mass media campaigns (defined as channels of communication such as television, radio, newspapers, bill boards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person to person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years. Data collection and analysis: Information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risk of bias was abstracted by two independent reviewers. Studies were combined using qualitative narrative synthesis. Main results: Seven out of a total of 84 studies reporting information about mass media smoking campaigns met all of the inclusion criteria. All seven studies used a controlled trial design. Three studies concluded that mass media reduced the smoking behaviour of young people. All of the effective campaigns had a solid theoretical basis, used formative research in designing the campaign messages, and message broadcast was of reasonable intensity over extensive periods of time. Authors' conclusion: There is some evidence that mass media can prevent the uptake of smoking in young people, however the evidence is not strong and contains a number of methodological flaws.

Cahill K; Stead LF; Lancaster T. Nicotine receptor partial agonists for smoking cessation. (review). Cochrane Database of Systematic Reviews 12: e-article CD006103, 2010. (161 refs.)

Background: Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). Varenicline was developed as a nicotine receptor partial agonist from cytisine, a drug widely used in central and eastern Europe for smoking cessation. The first trial reports of varenicline were released in 2006, and further trials have now been published or are currently underway. Objectives: The primary objective of this review is to assess the efficacy and tolerability of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. Search strategy: We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('varenicline' or 'cytisine' or 'Tabex' or 'nicotine receptor partial agonist') and 'smoking' in the title or abstract, or as keywords. We also searched MEDLINE, EMBASE, PsycINFO and CINAHL using MeSH terms and free text, and we contacted authors of trial reports for additional information where necessary. The latest search was in September 2010. Selection criteria: We included randomized controlled trials which compared the treatment drug with placebo. We also included comparisons with bupropion and nicotine patches where available. We excluded trials which did not report a minimum follow-up period of six months from start of treatment. Data collection and analysis: We extracted data on the type of participants, the dose and duration of treatment, the outcome measures, the randomization procedure, concealment of allocation, and completeness of follow up. The main outcome measured was abstinence from smoking after at least six months from the beginning of treatment. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where they were reported. Where appropriate we performed meta-analysis to produce a risk ratio, using the Mantel-Haenszel fixed-effect model. Main results: We found 11 trials of varenicline compared with placebo for smoking cessation; three of these included a bupropion experimental arm. We also found one relapse prevention trial, comparing varenicline with placebo, and two open-label trials comparing varenicline with nicotine replacement therapy (NRT). We also include one trial in which all the participants were given varenicline, but received behavioural support either online or by phone calls, or by both methods. This trial is not included in the analyses, but contributes to the data on safety and tolerability. The included studies covered > 10,300 participants, 6892 of whom used varenicline. We identified one trial of cytisine (Tabex) for inclusion. The pooled risk ratio (RR) (10 trials, 4443 people, excluding one trial evaluating long term safety) for continuous abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.31 (95% confidence interval [CI] 2.01 to 2.66). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.09 (95% CI 1.56 to 2.78; 4 trials, 1272 people). The pooled RR for varenicline versus bupropion at one year was 1.52 (95% CI 1.22 to 1.88; 3 trials, 1622 people). The RR for varenicline versus NRT for point prevalence abstinence at 24 weeks was 1.13 (95% CI 0.94 to 1.35; 2 trials, 778 people). The two trials which tested the use of varenicline beyond the 12-week standard regimen found the drug to be well-tolerated during long-term use. The main adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Post-marketing safety data raised questions about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation. The labelling of varenicline was amended in 2008, and the manufacturers produced a Medication Guide. Thus far, surveillance reports and secondary analyses of trial data lend little support to a causal relationship. The one cytisine trial included in this review found that more participants taking cytisine stopped smoking compared with placebo at two-year follow up, with an RR of 1.61 (95% CI 1.24 to 2.08). Authors' conclusions: Varenicline at standard dose increased the chances of successful long-term smoking cessation between two-and threefold compared with pharmacologically unassisted quit attempts. Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events. More participants quit successfully with varenicline than with bupropion. Two open-label trials of varenicline versus NRT suggested a modest benefit of varenicline but confidence intervals did not rule out equivalence. Limited evidence suggests that varenicline may have a role to play in relapse prevention. The main adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time. Possible links with serious adverse events, including depressed mood, agitation and suicidal thoughts, have been reported but are so far not substantiated. There is a need for further independent community-based trials of varenicline, to test its efficacy and safety in smokers with varying co-morbidities and risk patterns. There is a need for further trials of the efficacy of treatment extended beyond 12 weeks. Cytisine may also increase the chances of quitting, but the evidence at present is inconclusive.

Cleary BJ; Donnelly J; Strawbridge J; Gallagher PJ; Fahey T; Clarke M et al. Methadone dose and neonatal abstinence syndrome-systematic. Review and meta-analysis. (review). Addiction 105(12): 2071-2084, 2010. (105 refs.)

Aim: To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). Methods: PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966-2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. Results: A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. Conclusions Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy.

Cole C; Jones L; McVeigh J; Kicman A; Syed Q; Bellis M. Adulterants in illicit drugs: A review of empirical evidence. (review). Drug Testing and Analysis 3(2): 89-96, 2011. (90 refs.)

Widespread public perception is that illicit drugs contain substances that are a serious risk to health, even though adulterants are often not considered in clinical or forensic toxicology. This review attempts to present an evidence-based overview of adulterants in illicit drugs, and their associated toxicity. Adulterants are deliberately added to increase bulk, enhance or mimic a pharmacological effect, or to facilitate drug delivery. Those present unintentionally are as a result of poor manufacturing techniques. From the reports gathered, adulterants are predominantly substances which are readily available, commonly being caffeine, procaine, paracetamol, and sugars. These are likely to have minimal impact on users' health at low dosages. Other adulterants, particularly in injectable drugs, have the potential to cause serious health issues, but the quantities reported, such as strychnine in heroin, are not life-threatening. The most commonly identified bacterial contaminants identified are Bacillus and Clostridium species. When death or serious illness due to adulteration occurs, circulation of information is particularly vital, such as in the USA regarding heroin and cocaine adulterated with fentanyl, and in Scotland recently regarding anthrax contaminated heroin. The complex interactions of supply, demand, and control of illicit drugs have a tangible impact on their adulteration. Continuing vigilance and the circulation of information is, therefore, desirable as a public health issue. As part of that strategy, analyses performed for adulterants needs to be encouraged, which are considerably limited in number and scope at the moment.

Comandini A; Marzano V; Curradi G; Federici G; Urbani A; Saltini C. Markers of anti-oxidant response in tobacco smoke exposed subjects: A data-mining review. (review). Pulmonary Pharmacology & Therapeutics 23(6, Special Issue): 482-492, 2010. (57 refs.)

Tobacco smoke exposure is the cause of exaggerated inflammatory responses and tissue destruction leading to chronic bronchitis and emphysema. A number of studies have used biochemical and immunological technologies to identify biomarkers of severity, risk and pharmacological target of disease. Recently, genomic and proteomic studies have been carried out to explore tobacco smoke-induced lung damage mechanisms. Eight of these studies, including 81 healthy non-smokers, 138 healthy smokers and 24 smokers with COPD, had open platform generated data available online and were reviewed in order to identify markers of smoke-induced damage by analyzing differential gene and protein expression in healthy individuals exposed to tobacco smoke in comparison with chronic obstructive pulmonary disease (COPD) smokers and healthy non-smokers. To this end the Ingenuity Pathways Analysis, a web-based application enables identifying the main biological functions and pathways, was used. The pathway most significantly associated with healthy smokers was the Nrf2-mediated Oxidative Stress Response (p-value < 0.01): out of the 22 genes/proteins identified in healthy smokers, 19 were up-regulated and three down-regulated, compared to non-smokers. Interestingly, four genes/proteins of the same pathway were differentially regulated in COPD, one up-regulated and three down-regulated, compared to healthy smokers. Moreover, in the comparison between COPD and healthy smokers, our analysis showed that the most relevant pathway was the Mitochondrial Dysfunction (p-value < 0.01) with 12 differentially regulated genes/proteins. This data-mining review supports the notion that Nrf2-regulated anti-oxidant genes play a central role in protection against tobacco smoke toxic effects and may be amenable to use as COPD risk biomarkers. Furthermore, this review suggests that mitochondrial dysfunction may be involved in the development of COPD.

Dar R; Frenk H. Can one puff really make an adolescent addicted to nicotine? A critical review of the literature. (review). Harm Reduction Journal 7: e-article 28, 2010. (60 refs.)

Rationale: In the past decade, there have been various attempts to understand the initiation and progression of tobacco smoking among adolescents. One line of research on these issues has made strong claims regarding the speed in which adolescents can become physically and mentally addicted to smoking. According to these claims, and in contrast to other models of smoking progression, adolescents can lose autonomy over their smoking behavior after having smoked one puff in their lifetime and never having smoked again, and can become mentally and physically "hooked on nicotine" even if they have never smoked a puff. Objectives: To critically examine the conceptual and empirical basis for the claims made by the "hooked on nicotine" thesis. Method: We reviewed the major studies on which the claims of the "hooked on nicotine" research program are based. Results: The studies we reviewed contained substantive conceptual and methodological flaws. These include an untenable and idiosyncratic definition of addiction, use of single items or of very lenient criteria for diagnosing nicotine dependence, reliance on responders' causal attributions in determining physical and mental addiction to nicotine and biased coding and interpretation of the data. Discussion: The conceptual and methodological problems detailed in this review invalidate many of the claims made by the "hooked on nicotine" research program and undermine its contribution to the understanding of the nature and development of tobacco smoking in adolescents.

Durazzo TC; Meyerhoff DJ; Nixon SJ. Chronic cigarette smoking: Implications for neurocognition and brain neurobiology. (review). International Journal of Environmental Research and Public Health 7(10): 3760-3791, 2010. (196 refs.)

Compared to the substantial volume of research on the general health consequences associated with chronic smoking, little research has been specifically devoted to the investigation of its effects on human neurobiology and neurocognition. This review summarizes the peer-reviewed literature on the neurocognitive and neurobiological implications of chronic cigarette smoking in cohorts that were not seeking treatment for substance use or psychiatric disorders. Studies that specifically assessed the neurocognitive or neurobiological (with emphasis on computed tomography and magnetic resonance-based neuroimaging studies) consequences of chronic smoking are highlighted. Chronic cigarette smoking appears to be associated with deficiencies in executive functions, cognitive flexibility, general intellectual abilities, learning and/or memory processing speed, and working memory. Chronic smoking is related to global brain atrophy and to structural and biochemical abnormalities in anterior frontal regions, subcortical nuclei and commissural white matter. Chronic smoking may also be associated with an increased risk for various forms of neurodegenerative diseases. The existing literature is limited by inconsistent accounting for potentially confounding biomedical and psychiatric conditions, focus on cross-sectional studies with middle aged and older adults and the absence of studies concurrently assessing neurocognitive, neurobiological and genetic factors in the same cohort. Consequently, the mechanisms promoting the neurocognitive and neurobiological abnormalities reported in chronic smokers are unclear. Longitudinal studies are needed to determine if the smoking-related neurobiological and neurocognitive abnormalities increase over time and/or show recovery with sustained smoking cessation.

Emory K; Saquib N; Gilpin EA; Pierce JP. The association between home smoking restrictions and youth smoking behaviour: A review. Tobacco Control 19(6): 495-506, 2010. (40 refs.)

Objective To review the available evidence for home smoking restrictions as a useful tool in the prevention of youth smoking and to make recommendations for further research. Methods: A PubMed search (1 January 1990 to 26 January 2010) identified studies involving youth <= 18 years using extensive criteria. In all, 17 studies relating home smoking restrictions to youth smoking behaviour were identified from titles, abstracts or the full text, as required. Two additional articles were identified by other means. KE, NS and EG reviewed the studies. Differences in interpretation were resolved by discussion, with ED making final decisions. Results Of the 19 studies, 16 (including the only 2 longitudinal studies) showed at least marginal evidence of an association of home smoking restrictions with reduced adolescent smoking behaviours. Associations were more numerous and stronger in homes without adult smokers, suggesting that even in such homes, lack of a smoke-free home may undermine the parental value of not smoking. Definitions of home smoking rules, adolescent smoking behaviour and treatment of parental smoking varied widely among studies. It is recommend that future research: (1) contrast smoke-free homes for everyone against all others, (2) included an interaction term for parental smoking and having a smoke-free home, or conduct separate analyses for homes with and without parental or other adults smokers and (3) examine early and later stages of the smoking uptake continuum. Conclusions While the evidence is suggestive for an effect, further research is required to establish causality using longitudinal designs.

Fareed A; Vayalapalli S; Casarella J; Amar R; Drexler K. Heroin anticraving medications: A systematic review. (review). American Journal of Drug and Alcohol Abuse 36(6): 332-341, 2010. (69 refs.)

Background: Heroin craving is a trigger for relapse and dropping out of treatment. Methadone has been the standard medication for the management of heroin craving. Objectives: We explored the medication options other than methadone which may have heroin anticraving properties. Methods: To be selected for the review, articles had to include outcome measures of the effect of the studied medication on subjective and/or objective opiate craving and be of the following two types: (1) randomized, controlled, and/or double-blind clinical trials (RCTs) examining the relationship between the studied medication and heroin craving; (2) nonrandomized and observational studies (NRSs) examining the relationship between the studied medication and heroin craving. Thirty-three articles were initially included in the review. Twenty-one were excluded because they did not meet the inclusion criteria. We present the results of 12 articles that met all the inclusion criteria. Results: Some new medications have been under investigation and seem promising for the treatment of opiate craving. Buprenorphine is the second most studied medication after methadone for its effect on opiate craving. At doses above 8 mg daily, it seems very promising and practical for managing opiate craving in patients receiving long-term opioid maintenance treatment. Conclusions and Scientific Significance: In doses higher than 8 mg daily, buprenorphine is an appropriate treatment for opiate craving. More research with rigorous methodology is needed to study the effect of buprenorphine on heroin craving. Also more studies are needed to directly compare buprenorphine and methadone with regard to their effects on heroin craving.

Fareed A; Vayalapalli S; Stout S; Casarella J; Drexler K; Bailey SP. Effect of methadone maintenance treatment on heroin craving, a literature review. (review). Journal of Addictive Diseases 30(1): 27-38, 2011. (61 refs.)

Despite agreement that methadone maintenance treatment (MMT) is an effective and safe option for treatment of heroin dependence, there have been controversies about its effect on heroin craving. A systematic literature review of the PubMed database was used to find studies eligible for inclusion in the study. The authors present the results of 16 articles that met all inclusion criteria. Overall, 7 studies reported that methadone could reduce heroin craving, 4 studies reported that patients in MMT are still at risk of having heroin craving, 1 study reported that methadone could increase heroin craving, and 4 studies reported that methadone has a neutral effect on heroin craving. One may speculate from these data that methadone may help with heroin craving, but patients in MMT may still be at risk of cue-induced heroin cravings. Methadone provides a helpful tool for reducing some components of craving and risk of relapse for patient receiving MMT.

Field CA; Baird J; Saitz R; Caetano R; Monti PM. The mixed evidence for brief intervention in emergency departments, trauma care centers, and inpatient hospital settings: What should we do? (review). Alcoholism: Clinical and Experimental Research 34(12): 2004-2010, 2010. (38 refs.)

Background: This qualitative review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism (Baird et al., 2009; Field et al., 2009; Monti et al., 2009; Saitz et al., 2009a). The purpose is to describe the mixed evidence supporting brief interventions in the emergency department, trauma care, and in-patient medical care settings; examine potential moderators of treatment outcome in light of the mixed evidence; and identify methods to move the research and practice of brief interventions beyond their current state. Methods: By drawing upon existing reviews and selected individual studies, we provide examples that reflect the current complexity of research in this area and propose steps for advancing the field. Results: Emergency departments, inpatient hospital settings, and trauma care settings represent three unique contexts within which brief interventions have been tested. While the general efficacy of brief alcohol interventions in these settings has been recognized, the evidence is increasingly mixed. Recent studies investigating potential moderators of treatment outcomes suggest that a more sophisticated approach to evaluating the effectiveness of brief interventions across varying patient populations is needed to further understand its effectiveness. Conclusions: Current dissemination efforts represent a significant advance in broadening the base of treatment for alcohol problems by providing an evidence-based intervention in health care settings and should not be curtailed. However, additional research is required to enhance treatment outcomes, refine current practice guidelines, and continue to bridge the gap between science and practice. Given the current state of research, a multisetting clinical trial is recommended to account for potential contextual differences while controlling for study design.

Foulds J; Hooper MW; Pletcher MJ; Okuyemi KS. Do smokers of menthol cigarettes find it harder to quit smoking? (review). Nicotine & Tobacco Research 12(Supplement 2): S102-S109, 2010. (31 refs.)

Menthol cigarette smokers may find it harder to quit smoking than smokers of nonmenthol cigarettes. We conducted a systematic review of published studies examining the association between menthol cigarette smoking and cessation. Electronic databases and reference lists were searched to identify studies published through May 2010, and results were tabulated. Ten studies were located that reported cessation outcomes for menthol and nonmenthol smokers. Half of the studies found evidence that menthol smoking is associated with lower odds of cessation, while the other half found no such effects. The pattern of results in these studies suggest that the association between smoking menthol cigarettes and difficulty quitting is stronger in (a) racial/ethnic minority populations, (b) younger smokers, and (c) studies carried out after1999. This pattern is consistent with an effect that relies on menthol to facilitate increased nicotine intake from fewer cigarettes where economic pressure restricts the number of cigarettes smokers can afford to purchase. There is growing evidence that certain subgroups of smokers find it harder to quit menthol versus nonmenthol cigarettes. There is a need for additional research, and particularly for studies including adequately powered and diverse samples of menthol and nonmenthol smokers, with reliable measurement of cigarette brands, socioeconomic status, and biomarkers of nicotine intake.

George S; Ekhtiari H. Naltrexone in the treatment of opioid dependence. (review). British Journal of Hospital Medicine 71(10): 568-570, 2010. (13 refs.)

Naltrexone is an opioid antagonist that acts by preventing the reinforcing effects of addictive opioids. This article provides an overview of naltrexone, its pharmacology, treatment effectiveness and role as a relapse prevention agent in the treatment of opioid dependence.

Giglia RC. Alcohol and lactation: An updated systematic review. (review). Nutrition & Dietetics 67(4): 237-243, 2010. (37 refs.)

Aim: The aim of this paper is to provide a critical review of the most recent literature from 2005 onwards, on the effect of alcohol intake during lactation on the hormonal control of lactogenesis; breastmilk alcohol concentration; the breastfeeding infant, and on the breastfeeding outcomes of the mother and infant dyad. An update on public policy guiding alcohol consumption during lactation nationally and internationally is explored. Methods: The databases PubMedicine, CINAHL, Proquest Health and Medical Complete, ScienceDirect, Medline and ISI Web of Knowledge were searched from 2005 onwards. Results: Alcohol inhibits the role of oxytocin in breastfeeding women, resulting in an increased time to milk ejection and a decrease in total breastmilk yield. Breastfeeding women are less likely to consume alcohol at high-risk levels, and drinking at these levels is associated with the early cessation of breastfeeding. A higher level of education and a higher income level are the characteristics of the maternal drinker during lactation. Conclusion: Available public health policy in Australia provides direction for breastfeeding mothers who choose to drink alcohol during this important stage of infant development.

Go F; Dykeman M; Santos J; Muxlow J. Supporting clients on methadone maintenance treatment: A systematic review of nurse's role. (review) Journal of Psychiatric and Mental Health Nursing 18(1): 17-27, 2011. (42 refs.)

Accessible summary Nurses, regardless of where they practice need to play a major role in providing holistic care for persons who participate in methadone maintenance treatment programmes. Nursing tasks that were found to rank as the most important when caring for clients on methadone maintenance treatment were: to administer methadone, to observe the patient's general condition, to provide counselling, and offer ongoing support as needed. Nurses should be prepared to assess for drug dependency, screen for opiate use when high index of suspicion is present and assess for psychosocial factors. Furthermore, nurses should be also knowledgeable about appropriate dosage of methadone and its efficacy, as well as support case management and outreach interventions. Nurses need to know enough about addiction and methadone maintenance therapy to be able to gain an understanding of the client's attitude and perceptions regarding addiction and the treatment process. Abstract This paper discusses findings from a systematic review of literature pertaining to methadone maintenance in relation to the role of the nurse working in a general practice setting. Five electronic databases were searched for period of 2000-2008: Medline, CINAHL, Embase, PsycINFO and Cochrane Database of Systematic Reviews. Included studies were peer-reviewed literature articles that: (1) were dated no earlier than the year 2000; (2) represented a primary study (qualitative and quantitative), systematic review or meta-analysis; (3) focused on methadone maintenance for treatment of opiate dependence, not for pain; and (4) were published in English. In this review, three broad themes emerged as being significant to the role of the nurse in relation to methadone maintenance treatment (MMT) programming. These themes included: (1) identifying the client's personal characteristics; (2) having knowledge about methadone; and (3) supporting clients in MMT programmes. In conclusion, it is important to address the needs of health professionals working with clients on MMT, in order for them to provide the necessary care for this patient population. In particular, nurses need to gain knowledge about MMT to assist them in carrying out their nursing role competently when caring for this vulnerable population.

Hays JT; Ebbert JO. Adverse effects and tolerability of medications for the treatment of tobacco use and dependence. (review). Drugs 70(18): 2357-2372, 2010. (77 refs.)

Tobacco use is the leading cause of preventable death and disability in the world. Although gradually declining in most developed countries, the prevalence of tobacco use has increased among developing countries. Treatment for tobacco use and dependence is effective, although long-term abstinence rates remain disappointingly low. In response, new treatments continue to be developed. In addition, many of the pharmacotherapies that have been available for years have found new applications with the use of medication combinations, higher doses and a longer duration of therapy for approved medications. There are now seven medications (nicotine patch, nicotine gum, nicotine lozenge, nicotine inhaler, nicotine nasal spray, bupropion sustained release and varenicline) approved for tobacco dependence treatment in most countries, and many national and professional society practice guidelines recommend their use. Although each of the medications used for tobacco dependence treatment has been rigorously tested for efficacy and safety, broader experience in clinical trials and in observational population-based studies suggests that adverse events associated with these medications are relatively common. Since 2008, two of the medications (varenicline and bupropion) have come under increasing scrutiny because of reports of unexplained serious adverse events (SAEs), including behaviour change, depression, self-injurious thoughts and suicidal behaviour. To date, this association has not been shown to be caused by these medications, but concerns about medication safety continue. Prescribers require a working knowledge of the common adverse effects for all of these medications as well as a more detailed knowledge of the SAE potential. Nicotine replacement therapy (NRT) has been rigorously tested in clinical trials for over 30 years. A number of adverse effects are commonly associated with NRT use, although SAEs are rare. The adverse effects associated with NRT are due to the pharmacological action of nicotine as well as the mode and site of the NRT application. Bupropion has been tested in over 40 controlled clinical trials and has been associated with higher rates of treatment discontinuation due to adverse events than NRTs. A number of SAEs are associated with bupropion and new warnings were recently added to bupropion prescribing information because of observed neuropsychiatric symptoms including suicidal thoughts and behaviours. Varenicline is the most recently approved medication for tobacco dependence treatment and, although proven safe in clinical testing, new safety concerns have arisen based on post-marketing reports. Warnings have been added to the prescribing information for varenicline because of neuropsychiatric symptoms also including suicidal thoughts and behaviours. Informed decision making regarding the use of pharmacotherapy for the treatment of tobacco dependence requires knowledge about the risks of drug treatment that is weighed against the risks of continued tobacco use and the benefits of treatment. Over half of all long-term smokers will die of a tobacco-related disease and the risk of a serious or life-threatening adverse event with tobacco cessation pharmacotherapy is vanishingly small. Pharmacotherapy for tobacco dependence is also among the most cost-effective preventive health interventions. Given these factors, the benefit : risk ratio is strongly in favour of pharmacotherapy for tobacco dependence treatment in virtually all smokers who are motivated to quit.

Hearon BA; Calkins AW; Halperin DM; McHugh RK; Murray HW; Otto MW. Anxiety sensitivity and illicit sedative use among opiate-dependent women and men. (review). American Journal of Drug and Alcohol Abuse 37(1): 43-47, 2011. (26 refs.)

Objectives: Research has suggested that individuals with elevated anxiety sensitivity (AS) (the fear of benign bodily sensations associated with anxiety) are more likely to use substances to cope with distress, particularly substances with arousal-dampening effects such as benzodiazepines and other sedatives. Such coping motives may also vary as a function of gender, with women more likely to use substances for coping (self-medicating) purposes. Given these findings, we hypothesized that AS would be associated with illicit sedative use in an opioid-dependent sample and that gender would moderate this relationship, with a greater association among women. Method: Participants were 68 opioid-dependent patients recruited from a methadone maintenance clinic. A logistic regression was used to determine whether AS was associated with presence or absence of a history of illicit sedative use. Results: AS was significantly associated with sedative use and this relationship was moderated by gender; elevated AS was associated with greater sedative use only in women. Conclusions and Scientific Significance: The presence of elevated AS is related to greater illicit use of sedatives in women but not in men. Women may be more susceptible to seek sedatives as a means of coping with unpleasant, anxious sensations.

Heckman CJ; Egleston BL; Hofmann MT. Efficacy of motivational interviewing for smoking cessation: A systematic review and meta-analysis. (review). Tobacco Control 19(5): 410-416, 2010. (68 refs.)

Objective: A systematic review and meta analysis to investigate the efficacy of interventions incorporating motivational interviewing for smoking cessation and identify correlates of treatment effects. Data sources: Medline/PubMed PsycInfo and other sources including grey literature. Study selection Title/abstract search terms were motivational interview* OR motivational enhancement AND smok* cigarette* tobacco OR nicotine Randomised trials reporting number of smokers abstinent at follow up were eligible Data extraction Data were independently coded by the first and third authors We coded for a variety of study participant and intervention related variables Data synthesis A random effects logistic regression with both a random intercept and a random slope for the treatment effect. Results: 31 smoking cessation research trials were selected for the study eight comprised adolescent samples eight comprised adults with chronic physical or mental illness five comprised pregnant/postpartum women and 10 comprised other adult samples. Analysis of the trials (9485 individual participants) showed an overall OR comparing likelihood of abstinence in the motivational interviewing (MI) versus control condition of OR 1 45 (95% CI 114 to 1 83). Additional potential correlates of treatment effects such as study sample and intervention characteristics were examined. Conclusions: This is the most comprehensive review of MI for smoking cessation conducted to date. These findings suggest that current MI smoking cessation approaches can be effective for adolescents and adults. However comparative efficacy trials could be useful

Hettema JE; Hendricks PS. Motivational interviewing for smoking cessation: A meta-analytic review. Journal of Consulting and Clinical Psychology 78(6): 868-884, 2010. (71 refs.)

Objective: Motivational interviewing (MI) is a treatment approach that has been widely examined as an intervention for tobacco dependence and is recommended in clinical practice guidelines. Previous reviews evaluating the efficacy of MI for smoking cessation noted effects that were modest in magnitude but included few studies. The current study is a comprehensive meta-analysis of MI for smoking cessation. Method: The meta-analysis included 31 controlled trials with an abstinence outcome variable. Studies with nonpregnant (N = 23) and pregnant samples (N = 8) were analyzed separately. Results: For nonpregnant samples, combined results suggest that MI significantly outperformed comparison conditions at long-term follow-up points (d(c) = .17). The magnitudes of this result represented a 2.3% difference in abstinence rates between MI and comparison groups. All analyses investigating the impact of moderating participant, intervention, and study design characteristics on outcome were nonsignificant, with the exception of studies including international, non-U.S. samples, which had larger effects overall. Several subgroups of studies had significant combined effect sizes, pointing to potentially promising applications of MI, including studies that had participants with young age, medical comorbidities, low tobacco dependence, and, consistent with clinical practice guidelines, low motivation or intent to quit. Effects were smaller among pregnant samples. In addition, significant combined effect sizes were observed among subgroups of studies that administered less than 1 hr of MI and among studies that reported high levels of treatment fidelity. Conclusions: The results are interpreted in light of other behavioral approaches to smoking cessation, and the public health implications of the findings are discussed.

Javed F; Correa FOB; Chotai M; Tappuni AR; Almas K. Systemic conditions associated with areca nut usage: A literature review. (review). Scandinavian Journal of Public Health 38(8): 838-844, 2010. (66 refs.)

Aim: The adverse effects of areca nut (AN) chewing habit on oral health have been reported. However, the hazards related to the habit are not restricted to the oral cavity but they can also jeopardise the systemic health. Since no review reporting the harmful effects of AN chewing on systemic health is yet available, the aim of the present study was to review the systemic conditions associated with AN usage. Methods: To address the focused question ''What are the deleterious effects of AN usage on systemic health?'', the MEDLINE PubMed databases were explored from 1966 up to and including May 2010. The eligibility criteria included: human studies, individuals using AN, use of controls, and articles published in English. Hand-searching was also performed. Unpublished data was excluded. Results: The review included 28 articles. Seven studies associated AN chewing with cardiovascular disorders and three studies related the habit with cerebrovascular disorders. Eight studies related AN chewing with obesity, hyperglycaemia, metabolic syndrome, and type 2 diabetes mellitus. Five studies related AN chewing with the development of hepatic disorders. Two studies associated the chewing habit with oesophageal inflammation and fibrosis. Three studies associated AN chewing with respiratory discomfort. Renal disorders were related with the chewing abuse in two studies. Two studies showed an adverse effect of AN chewing on birth outcome. Conclusions: AN chewing adversely affects systemic health by damaging the vital organs.

Kalmakis KA. Cycle of sexual assault and women's alcohol misuse. (review). Journal of The American Academy of Nurse Practitioners 22(12): 661-667, 2010. (40 refs.)

Purpose: To describe the complex relationship between sexual assault and alcohol misuse by female assault victims. Data sources: Drawing on recent research and theoretical models from other social sciences, the author interjects a nursing perspective for this complex patient problem. Conclusions: This review of theories and models, and the evidence that supports them, provides a way for nurses to conceptualize the relationship between sexual victimization and alcohol misuse as bidirectional or reciprocal. Implications for practice: The evidence and models discussed here suggest that when patients present with sexual assault or alcohol misuse, nurses should assess and address the possibility of both conditions being present.

Konghom S; Verachai V; Srisurapanont M; Suwanmajo S; Ranuwattananon A; Kimsongneun N et al. Treatment for inhalant dependence and abuse. (review). Cochrane Database of Systematic Reviews 12: e-article CD007537, 2010. (13 refs.)

Background: Inhalants are being abused by large numbers of people throughout the world, particularly socio-economically disadvantaged children and adolescents. The neuropsychological effects of acute and chronic inhalant abuse include motor impairment, alterations in spontaneous motor activity, anticonvulsant effects, anxiolytic effects, sensory effects, and effects and learning, memory and operant behaviour (e. g., response rates and discriminative stimulus effects). Objectives: To search and determine risks, benefits and costs of a variety treatments for inhalant dependence or abuse. Search strategy: We searched MEDLINE (1966 - February 2010), EMBASE (Januray 2010) and Cochrane Central Register of Controlled Trials (CENTRAL) (February 2010). We also searched for ongoing clinical trials and unpublished studies via Internet searches. Selection criteria: Randomised-controlled trials and controlled clinical trails (CCTs) comparing any intervention in people with inhalant dependence or abuse. Data collection and analysis: Two reviewers independently selected studies for inclusion, assessed trial quality and extracted data. Main results: No studies fulfilling the inclusion criteria have been retrieved. Authors' conclusions: Implications for practice: due to the lack of studies meeting the inclusion criteria, no conclusion can be drawn for clinical practice. Implications for research: as a common substance abuse with serious health consequences, treatment of inhalant dependence and abuse should be a priority area of substance abuse research.

Lewis ET; Trafton JA. Opioid use in primary care: Asking the right questions. (review). Current Pain and Headache Reports 15(2): 137-143, 2011. (55 refs.)

Pain is one of the most common reasons that patients seek treatment from health care professionals, often their primary care providers. One tool for treating pain is opioid therapy, and opioid prescriptions have increased dramatically in recent years in the United States. This article will review recent research about opioids that is most relevant to treating chronic pain in the context of a typical primary care practice. It will focus on four key practices that providers can engage in before and during the course of opioid therapy that we believe will enhance the likelihood that opioids, when used, are an effective tool for pain management: avoiding sole reliance on opioids; using adequate opioid doses to address pain; mitigating the risk of opioid misuse by patients; and fostering collaborative relationships for treating complex patients.

Li Q; Li XM; Stanton B. Alcohol use and sexual risk behaviors and outcomes in China: a literature review. (review). AIDS and Behavior 14(6): 1227-1236, 2010. (73 refs.)

This review systematically examines the empirical evidence regarding the association between alcohol use and sexual risk behaviors and outcomes among the Chinese population in mainland, China. Articles published in English (n = 11) and in Chinese (n = 7) from 1980 to 2008 documented consistent associations between alcohol use and several sexual risk behaviors, sexual coercion, sexual violence, and HIV/STIs across both the general population and high-risk groups, except for men having sex with men. This review suggests that alcohol use is associated with diverse sexual risk behaviors and outcomes across a variety of social groups in China, consistent with the evidence from the Western countries and Sub-Saharan Africa. Alcohol use is an important but under-researched correlate of sexual risk behaviors and outcomes in China. This review indicates the importance of research assessing alcohol use among both genders and with standardized measures and suggests the importance of integrating alcohol use control in sexual risk reduction and prevention efforts in China

Li Y; Lin H; Li YF; Cao J. Association between socio-psycho-behavioral factors and male semen quality: systematic review and meta-analyses. (review). Fertility and Sterility 95(1): 116-123, 2011. (88 refs.)

Objective: To identify the factors associated with male semen quality from many socio-psycho-behavioral factors. Design: Medline/PubMedicine, EMBASE, and CNKI were searched to identify relevant publications for systematic review and meta-analysis. Patient(s): None. Intervention(s): None. Main Outcome Measure(s): Thirteen socio-psycho-behavioral factors in 57 cross-sectional studies with 29,914 participants from 26 countries/regions were involved in this review. Six factors (age, body mass index [BMI], psychological stress, smoking, alcohol, and coffee consumption) were included in meta-analyses. Result(s): Smoking can deteriorate all of the sperm parameters of both fertile and infertile men, but it is not risk factor for semen volume in Switzerland and Iran and for sperm density in the United States, Denmark, and Brazil; higher age and alcohol consumption are risk factors for lower semen volume; and psychological stress can lower sperm density and sperm progressive motility and increase abnormal sperm. Conclusion(s): This review further suggested that higher age, smoking, alcohol consumption, and psychological stress were risk factors for semen quality. These results indicated that health programs focusing on lifestyle and psychological health would be helpful for male reproductive health. Well-designed studies are needed to further identify the role of more socio-psycho-behavioral factors in male semen quality.

Lynskey MT; Agrawal A; Heath AC. Genetically informative research on adolescent substance use: Methods, findings, and challenges. (review). Journal of The American Academy of Child and Adolescent Psychiatry 49(12): 1202-1214, 2010. (104 refs.)

Objective: To provide an overview of the genetic epidemiology of substance use and misuse in adolescents. Method: A selective review of genetically informative research strategies, their limitations, and key findings examining issues related to the heritability of substance use and substance use disorders in children and adolescents is presented. Results: Adoption, twin, and extended-family designs have established there is a strong heritable component to liability to nicotine, alcohol, and illicit drug dependence in adults. However, shared environmental influences are relatively stronger in youth samples and at earlier stages of substance involvement (e.g., use). There is considerable overlap in the genetic influences associated with the abuse/dependence across drug classes, and shared genetic influences contribute to the commonly observed associations between substance-use disorders and externalizing and, to a lesser extent, internalizing psychopathology. Rapid technologic advances have made the identification of specific gene variants that influence risks for substance-use disorders feasible, and linkage and association (including genomewide association studies) have identified promising candidate genes implicated in the development of substance-use disorders. Conclusions: Studies using genetically informative research designs, including those that examine aggregate genetic factors and those examining specific gene variants, individually and in interaction with environmental influences, offer promising avenues not only for delineating genetic effects on substance-use disorders but also for understanding the unfolding of risk across development and the interaction between environmental and genetic factors in the etiology of these disorders.

Manzo-Avalos S; Saavedra-Molina A. Cellular and mitochondrial effects of alcohol consumption. (review). International Journal of Environmental Research and Public Health 7(12): 4281-4304, 2010. (168 refs.)

Alcohol dependence is correlated with a wide spectrum of medical, psychological, behavioral, and social problems. Acute alcohol abuse causes damage to and functional impairment of several organs affecting protein, carbohydrate, and fat metabolism. Mitochondria participate with the conversion of acetaldehyde into acetate and the generation of increased amounts of NADH. Prenatal exposure to ethanol during fetal development induces a wide spectrum of adverse effects in offspring, such as neurologic abnormalities and pre- and post-natal growth retardation. Antioxidant effects have been described due to that alcoholic beverages contain different compounds, such as polyphenols as well as resveratrol. This review analyzes diverse topics on the alcohol consumption effects in several human organs and demonstrates the direct participation of mitochondria as potential target of compounds that can be used to prevent therapies for alcohol abusers.

Marshall BDL; Wood E. Toward a comprehensive approach to HIV prevention for people who use drugs. (review). Journal of Acquired Immune Deficiency Syndromes 55(Supplement 1): S23-S26, 2010. (62 refs.)

Comprehensive HIV prevention interventions are increasingly recognized as critical in the global effort to reduce HIV transmission among people who use injection drugs. Scientific evidence clearly shows that a variety of biomedical, behavioral, and structural interventions can prevent and reduce injection drug user-driven HIV epidemics, yet social and structural barriers to their implementation remain. This review discusses the scientific evidence on the effectiveness of individual programs for reducing HIV incidence among people who use injection drugs and how, by integrating individual programs as complements within a comprehensive HIV prevention approach. It is possible to achieve, and to sustain, greater results than those of individual programs alone. The article concludes with a discussion of a critical research priority, namely, to improve the implementation of comprehensive HIV prevention interventions in settings of prevalent injection drug use and to overcome the often complex barriers that impede them. Such an effort will require more than research alone, however It will also require the ongoing commitment of policymakers, public health officials, and the affected communities themselves to use comprehensive HIV treatment and prevention as the most effective strategy to reduce new HIV infections

Mazzone P; Tierney W; Hossain M; Puvenna V; Janigro D; Cucullo L. Pathophysiological impact of cigarette smoke exposure on the cerebrovascular system with a focus on the blood-brain barrier: Expanding the awareness of smoking toxicity in an underappreciated area. (review). International Journal of Environmental Research and Public Health 7(12): 4111-4126, 2010. (98 refs.)

Recent evidence has indicated that active and passive cigarette smoking are associated, in a dose-dependent manner, with dysfunction of normal endothelial physiology. Tobacco smoke (TS) may predispose individuals to atherogenic and thrombotic problems, significantly increasing the risk for ischemic manifestations such as acute coronary syndrome and stroke. Despite the strong evidence for an association between smoking and vascular impairment, the impact of TS exposure on the blood-brain barrier (BBB) has only been marginally addressed. This is a major problem given that the BBB is crucial in the maintenance of brain homeostasis. Recent data have also shown that chronic smokers have a higher incidence of small vessel ischemic disease (SVID), a pathological condition characterized by leaky brain microvessels and loss of BBB integrity. In the brain TS increases the risk of silent cerebral infarction (SCI) and stroke owing to the pro-coagulant and atherogenic effects of smoking. In this article we provide a detailed review and analysis of current knowledge of the pathophysiology of tobacco smoke toxicity at the cerebrovascular levels. We also discuss the potential toxicity of recently marketed "potential-reduced exposure products".

McCambridge J; McAlaney J; Rowe R. Adult consequences of late adolescent alcohol consumption: A systematic review of cohort studies. (review). PLoS Medicine 8(2): e-article 1000413, 2011. (82 refs.)

Background: Although important to public policy, there have been no rigorous evidence syntheses of the long-term consequences of late adolescent drinking. Methods and Findings: This systematic review summarises evidence from general population cohort studies of drinking between 15-19 years old and any subsequent outcomes aged 20 or greater, with at least 3 years of follow-up study. Fifty-four studies were included, of which 35 were assessed to be vulnerable to bias and/or confounding. The principal findings are: (1) There is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems including dependence; (2) Although a number of studies suggest links to adult physical and mental health and social consequences, existing evidence is of insufficient quality to warrant causal inferences at this stage. Conclusions: There is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden that is consequent on late adolescent drinking, both in relation to adult drinking and more broadly. Reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harms.

Morasco BJ; Gritzner S; Lewis L; Oldham R; Turk DC; Dobscha SK. Systematic review of prevalence, correlates, and treatment outcomes for chronic non-cancer pain in patients with comorbid substance use disorder. (review). Pain 152(3): 488-497, 2011. (65 refs.)

Recent data suggest that comorbid substance use disorders (SUDs) are common among chronic non-cancer pain (CNCP) patients; however, prevalence rates vary across studies and findings are limited regarding treatment options for CNCP patients with comorbid SUD. The purpose of this systematic review is to assess the prevalence, associated demographic and clinical characteristics, and treatment outcomes for CNCP patients with comorbid SUD. We conducted searches from Ovid MEDLINE, PsychINFO, and PubMED from 1950 through February 2010 and retrieved the references. Thirty-eight studies met inclusion criteria and provided data that addressed our key questions. Three to forty-eight percent of CNCP patients have a current SUD. There are no demographic or clinical factors that consistently differentiate CNCP patients with comorbid SUD from patients without SUD, though SUD patients appear to be at greater risk for aberrant medication-related behaviors. CNCP patients with SUD are more likely to be prescribed opioid medications and at higher doses than CNCP patients without a history of SUD. CNCP patients with comorbid SUD do not significantly differ in their responses to treatment compared to CNCP patients without SUD, though the quality of this evidence is low. Limited data are available to identify predictors of treatment outcome. Although clinical experience and research suggests that SUDs are common among CNCP patients, only limited data are available to guide clinicians who treat this population. Research is needed to increase understanding of the prevalence, correlates, and responses to treatment of CNCP patients with comorbid SUDs.

Murin S; Rafii R; Bilello K. Smoking and smoking cessation in pregnancy. (review). Clinics in Chest Medicine 32(1): 75-+, 2011. (90 refs.)

Smoking during pregnancy is among the leading preventable causes of adverse maternal and fetal outcomes. Smoking prevalence among young women is the primary determinant of smoking prevalence during pregnancy. Smoking among women of childbearing age is associated with reduced fertility, increased complications of pregnancy, and a variety of adverse fetal outcomes. There is increasing evidence of lasting adverse effects on offspring. Guidelines for smoking cessation during pregnancy have been developed. This article reviews the epidemiology of smoking during pregnancy, the adverse effects of smoking on the mother, fetus, and offspring, and recommended approaches to smoking cessation for pregnant women.

Newman MG; Szkodny LE; Llera SJ; Przeworski A. A review of technology-assisted self-help and minimal contact therapies for drug and alcohol abuse and smoking addiction: Is human contact necessary for therapeutic efficacy? (review). Clinical Psychology Review 31(1): 178-186, 2011. (74 refs.)

Technology-based self-help and minimal contact therapies have been proposed as effective and low-cost interventions for addictive disorders, such as nicotine, alcohol, and drug abuse and addiction. The present article reviews the literature published before 2010 on computerized treatments for drug and alcohol abuse and dependence and smoking addiction. Treatment studies are examined by disorder as well as amount of therapist contact, ranging from self-administered therapy and predominantly self-help interventions to minimal contact therapy where the therapist is actively involved in treatment but to a lesser degree than traditional therapy and predominantly therapist-administered treatments involving regular contact with a therapist for a typical number of sessions. In the treatment of substance use and abuse it is concluded that self-administered and predominantly self-help computer-based cognitive and behavioral interventions are efficacious, but some therapist contact is important for greater and more sustained reductions in addictive behavior.

Opler M; Sodhi D; Zaveri D; Madhusoodanan S. Primary psychiatric prevention in children and adolescents. (review). Annals of Clinical Psychiatry 22(4): 220-234, 2010. (177 refs.)

BACKGROUND: Approximately 21% of US children age 9 to 17 have a diagnosable mental illness with some degree of impairment. As early-onset mental illness may persist throughout the life span, effective primary mental health prevention programs are of paramount importance. METHODS: We conducted a literature review of various preventive programs targeting childhood-onset psychopathology. We attempted to select those programs that present the strongest data on efficacy and those that are most commonly cited. RESULTS: Modifiable and nonmodifiable risk factors and different primary prevention strategies with positive outcomes have been identified for anxiety disorders, eating disorders, substance abuse, disruptive behavior disorders, and suicide in children. The reported results for attention-deficit/hyperactivity disorder (ADHD) and early-onset schizophrenia are neither uniform nor encouraging. CONCLUSIONS: Based on our review, there is ample evidence to conclude that primary preventive intervention has the potential to be effective for some mental health disorders, promoting positive development, particularly in children of all ages in high-risk environments. Additional research is needed to further investigate the validity and reliability of various preventive strategies.

Ostini R; Jackson C; Hegney D; Tett SE. How is medication prescribing ceased? A systematic review. (review). Medical Care 49(1): 24-36, 2011. (60 refs.)

Background: Medication prescribing is a complex process where the focus tends to be on starting new medication, changing a drug regimen, and continuing a drug regimen. On occasion, a prudent approach to prescribing may necessitate ending an ongoing course of medication, either because it should not have been started in the first place; because its continued use would cause harm; or because the medication is no longer effective. Objective: To identify effective strategies for stopping pre-existing prescribing in situations where continued prescribing may no longer be clinically warranted. Research design: Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951-November 2009), EMBASE (1966 -September 2008), and International Pharmaceutical Abstract b (1970 -September 2008). A manual search for relevant review articles and a keyword search of a local database produced by a previous systematic search for prescribing influence and intervention research were also conducted. Study selection and data extraction: Following initial title screening for relevance 2 reviewers, using formal assessment and data extraction tools, independently assessed abstracts for relevance and full studies for quality before extracting data from studies selected for inclusion. Results: Of 1306 articles reviewed, 12 were assessed to be of relevant, high-quality research. A variety of drugs were examined in the included studies with benzodiazepines the most common. Studies included in the review tested 9 different types of interventions. Effective interventions included patient-mediated interventions, manual reminders to prescribers, educational materials given to patients, a face-to-face intervention with prescribers, and a case of regulatory intervention. Partially effective interventions included audit and feedback, electronic reminders, educational materials alone sent to prescribers, and distance communication combined with educational materials sent to prescribers. Conclusions: It appears possible to stop the prescribing of a variety of medications with a range of interventions. A common theme in effective interventions is the involvement of patients in the stopping process. However, prescribing at the level of individual patients was rarely reported, with data often aggregated to number of doses or number of drugs per unit population, attributing any reduction to cessation. Such studies are not measuring the actual required outcome (stopping prescribing), and this may reflect the broader ambiguity about when or why it might be important to end a prescription. Much more research is required into the process of stopping pre-existing prescribing, paying particular attention to improving the outcomes that are measured.

Palamar J. How ephedrine escaped regulation in the United States: A historical review of misuse and associated policy. (review). Health Policy 99(1): 1-9, 2011. (97 refs.)

Objective: Ephedrine is not only efficacious in the treatment of numerous ailments, but also has a long history of misuse. Research was needed to examine ephedrine policy over time in order to determine potential regulatory flaws that allowed misuse to continue. Methods: This review is based on primary literature derived from systematic searches of historical and scientific archives, as well as grey literature. Results: Ephedrine managed to pass through numerous regulatory loopholes within seventy years. Despite warnings of misuse over the latter half of the century, ephedrine, and its herbal source, ephedra, were regulated in a piecemeal fashion and remained easily available to the public. Health authorities have struggled to control ephedrine, as an amphetamine "look-alike," as a methamphetamine precursor, as a dietary supplement, and as a medication. Despite being a potentially dangerous stimulant, under-regulation was perhaps more problematic than the substance itself. Conclusions: Tighter control of all ephedrine products, drugs and dietary supplements alike, might have prevented adverse outcomes and allowed this substance to remain available in a safer manner. Stringent regulation of all ephedrine products is necessary to prevent misuse and to protect the public's health.

Peltzer K; Ramlagan S; Johnson BD; Phaswana-Mafuya N. Illicit drug use and treatment in South Africa: A review. (review). Substance Use & Misuse 45(13): 2221-2243, 2010. (45 refs.)

This review synthesizes available epidemiological data on current drug use and substance user treatment admissions in South Africa since 1994, and how changes in the political, economic, and social structures within South Africa, both before and after Apartheid, has made the country more vulnerable to drug use. Based on national surveys, current use of cannabis ranged among adolescents from 2% to 9% and among adults it was 2%, cocaine/crack (0.3%), mandrax/sedatives (0.3%), club drugs/amphetamine-type stimulants (0.2%), opiates (0.1%), and hallucinogens (0.1%). The use of primary illicit substance at admission to South African drug user treatment centers was cannabis 16.9%, methamphetamine (tik) 12.8%, crack/cocaine 9.6%, cannabis and mandrax 3.4%, heroin/opiates 9.2%, and prescription and OTC drugs 2.6%. An increase in substance user treatment admissions has increased. While the prevalence of illicit drug use in South Africa is relatively low compared to the United States and Australia, prevention and intervention policies need to be designed to reduce these levels by targeting the more risky subpopulations identified from this review.

Pierce RC; Vanderschuren LJMJ. Kicking the habit: The neural basis of ingrained behaviors in cocaine addiction. (review). Neuroscience and Biobehavioral Reviews 35(2, special issue): 212-219, 2010. (121 refs.)

Cocaine addiction is a complex and multifaceted process encompassing a number of forms of behavioral plasticity. The process of acquiring and consuming drugs can be sufficiently risky and complicated that the casual drug user may choose not to act on every motivation to use drugs. The repetition of drug seeking and taking, however, often results in the gradual development of drug craving and compulsive drug seeking associated with addiction. Moreover, the complex sets of behaviors associated with drug addiction can become ingrained to such an extent that, when activated by drug-associated stimuli or exposure to the drug itself, the processes underlying drug seeking and taking are automatically engaged and very difficult to suppress. Here, we examine the hypothesis that aspects of cocaine seeking and taking become ingrained with repetition, thereby contributing to continued drug use despite a conscious desire to abstain. We also review emerging evidence indicating that neuronal circuits including the dorsolateral striatum play a particularly important role in the habitual aspects of drug seeking and taking.

Radat F; Lanteri-Minet M. What is the role of dependence-related behavior in medication-overuse headache? (review) Headache 50(10): 1597-1611, 2010. (85 refs.)

Medication-overuse headache (MOH) can be viewed as an interaction between the worsening of the primary headache course and individual predispositions for dependence. We present here a review of the clinical and biological data raising the role of dependence-related behavior in MOH. Indeed, several clinical studies show that acute headache medications containing psychoactive components (barbiturates, opiates) are associated with an increased risk of MOH. Diagnostic and Statistical Manual of Mental Disorders, 4th edition substance dependence criteria were identified in a sub-group of MOH patients. Comorbidity between MOH and substance-related disorders has also been showed. Recent neuroimaging, biological, and pharmacogenetic studies suggest the existence of an overlap between the pathophysiological mechanisms of MOH and those of substance-related disorders. These data support the proposition of separating 2 sets of MOH patients: the first one in which the illness is mainly due to the worsening of the headache course, and the second one in which behavioral issues are a major determinant of the illness. Detection of a psychological dependence component in a sub-group of MOH patients should have direct relevance to disease management.

Richardson TH. Cannabis use and mental health: A review of recent epidemiological research. (review). International Journal of Pharmacology 6(6): 796-807, 2010. (117 refs.)

Cannabis is the most commonly used drug in the world. This review examines recent epidemiological research on the relationships between cannabis use and mental health problems. Relationships with depression, anxiety disorders, mania and psychosis are examined, with relevant issues such as the effect of confounding variables, temporal directions and causality being discussed. Factors which influence the relationship such as dose-response effects, age of first cannabis use and risk of mental health problems are also examined. Causality is often difficult to establish, as cannabis is often used by those with mental illness for self-medication. However, there is substantial evidence to suggest that cannabis may induce or exacerbate a number of mental health problems.

Rosner S; Hackl-Herrwerth A; Leucht S; Lehert P; Vecchi S; Soyka M. Acamprosate for alcohol dependence. (review). Cochrane Database of Systematic Reviews 2010(9): article CD004332, 2010. (142 refs.)

BACKGROUND: Alcohol dependence is among the main leading health risk factors in most developed and developing countries. Therapeutic success of psychosocial programs for relapse prevention is moderate, but could potentially be increased by an adjuvant treatment with the glutamate antagonist acamprosate. OBJECTIVE: To determine the effectiveness and tolerability of acamprosate in comparison to placebo and other pharmacological agents. CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW: We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, Embase and CINAHL in January 2009 and inquired manufacturers and researchers for unpublished trials. SELECTION CRITERIA: All double-blind randomised controlled trials (RCTs) which compare the effects of acamprosate with placebo or active control on drinking-related outcomes. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data. Trial quality was assessed by one author and crosschecked by a second author. Individual patient data (IPD) meta-analyses were used to verify the primary effectiveness outcomes. MAIN RESULTS: 24 RCTs with 6915 participants fulfilled the criteria of inclusion and were included in the review. Compared to placebo, acamprosate was shown to significantly reduce the risk of any drinking RR 0.86 (95% CI 0.81 to 0.91); NNT 9.09 (95% CI 6.66 to 14.28) and to significantly increase the cumulative abstinence duration MD 10.94 (95% CI 5.08 to 16.81), while secondary outcomes (gamma-glutamyltransferase, heavy drinking) did not reach statistical significance. Diarrhea was the only side effect that was more frequently reported under acamprosate than placebo RD 0.11 (95% 0.09 to 0.13); NNTB 9.09 (95% CI 7.69 to 11.11). Effects of industry-sponsored trials RR 0.88 (95% 0.80 to 0.97) did not significantly differ from those of non-profit funded trials RR 0.88 (95% CI 0.81 to 0.96). In addition, the linear regression test did not indicate a significant risk of publication bias (P = 0.861). AUTHORS' CONCLUSIONS: Acamprosate appears to be an effective and safe treatment strategy for supporting continuous abstinence after detoxification in alcohol dependent patients. Even though the sizes of treatment effects appear to be rather moderate in their magnitude, they should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment.

Ruff S; McComb JL; Coker CJ; Sprenkle DH. Behavioral couples therapy for the treatment of substance abuse: A substantive and methodological review of O'Farrell, Fals-Stewart, and colleagues' program of research. (review). Family Process 49(4): 439-456, 2010. (44 refs.)

Behavioral couples therapy (BCT) is an evidence-based couple therapy intervention for married or cohabitating substance abusers and their partners. This paper provides readers with a substantive and methodological review of Fals-Stewart, O'Farrell, and colleagues' program of research on BCT. The 23 studies included in this review provide support for the efficacy of BCT for improving substance use behavior, dyadic adjustment, child psychosocial outcomes, and reducing partner violence. This review includes a description of BCT, summaries of primary and secondary outcomes, highlights methodological strengths and weaknesses, notes barriers to dissemination, suggests future research directions, and provides clinical implications for couple and family therapists. Although there are several versions of BCT developed for the treatment of substance abuse this paper focuses on the version developed by O'Farrell, Fals-Stewart, and colleagues.

Santos C; Costa J; Santos J; Vaz-Carneiro A; Lunet N. Caffeine intake and dementia: Systematic review and meta-analysis. (review). Journal of Alzheimers Disease 20(Supplement 1): S187-S204, 2010. (40 refs.)

A recent meta-analysis of 4 studies published up to January 2004 suggests a negative association between coffee consumption and Alzheimer's disease, despite important heterogeneity in methods and results. Several epidemiological studies on this issue have been published since then, warranting an update of the insights on this topic. We conducted a systematic review and meta-analysis of published studies quantifying the relation between caffeine intake and cognitive decline or dementia. Data sources searched included Medline, LILACS, Scopus, Web of Science and reference lists, up to September 2009. Cohort and case-control studies were included. Three independent reviewers selected the studies and extracted the data on to standardized forms. Nine cohort and two case-control studies were included. Quantitative data synthesis of the most precise estimates from each study was accomplished through random effects meta-analysis. Heterogeneity was quantified using the I-2 statistic. The outcomes of the studies considered for meta-analysis were Alzheimer's disease in four studies, dementia or cognitive impairment in two studies, and cognitive decline in three studies. The summary relative risk (RR) for the association between caffeine intake and different measures of cognitive impairment/decline was 0.84 [95% Confidence Interval (95% CI): 0.72-0.99; I-2 = 42.6%]. When considering only the cohort studies, the summary RR was 0.93 (95% CI: 0.83-1.04, I-2 = 0.0%), and 0.77 (95% CI: 0.63-0.95, I-2 = 34.7%), if the most influential study was excluded. This systematic review and meta-analysis found a trend towards a protective effect of caffeine, but the large methodological heterogeneity across a still limited number of epidemiological studies precludes robust and definite statements on this topic.

Sarris J; LaPorte E; Schweitzer I. Kava: A comprehensive review of efficacy, safety, and psychopharmacology. (review). Australian and New Zealand Journal of Psychiatry 45(1): 27-35, 2011. (74 refs.)

Overview: Kava (Piper methysticum) is a South Pacific psychotropic plant medicine that has anxiolytic activity. This effect is achieved from modulation of GABA activity via alteration of lipid membrane structure and sodium channel function, monoamine oxidase B inhibition, and noradrenaline and dopamine re-uptake inhibition. Kava is available over the counter in jurisdictions such as the USA, Australia and New Zealand. Due to this, a review of efficacy, safety and clinical recommendations is advised. Objective: To conduct a comprehensive review of kava, in respect to efficacy, psychopharmacology, and safety, and to provide clinical recommendations for use in psychiatry to treat generalized anxiety disorder (GAD). Methods: A review was conducted using the electronic databases MEDLINE, CINAHL, PsycINFO and the Cochrane Library during mid 2010 of search terms relating to kava and GAD. A subsequent forward search was conducted of key papers using Web of Science cited reference search. Results: The current weight of evidence supports the use of kava in treatment of anxiety with a significant result occurring in four out of six studies reviewed (mean Cohen's d = 1.1). Safety issues should however be considered. Use of traditional water soluble extracts of the rhizome (root) of appropriate kava cultivars is advised, in addition to avoidance of use with alcohol and caution with other psychotropic medications. Avoidance of high doses if driving or operating heavy machinery should be mandatory. For regular users routine liver function tests are advised. Conclusions: While current evidence supports kava for generalized anxiety, more studies are required to assess comparative efficacy and safety (on the liver, cognition, driving, and sexual effects) versus established pharmaceutical comparators.

Schwartz BG; Rezkalla S; Kloner RA. Cardiovascular effects of cocaine. (review). Circulation 122(24): 2558-2569, 2010. (119 refs.)

The use of cocaine has evolved from chewing the leaves of the Erythroxylon coca bush thousands of years ago, to purification of cocaine hydrochloride over 100 years ago and its use in tonics and elixirs (at one time in popular cola drinks), to insufflating and injecting the fine, white, water-soluble, powder form, to a smokable freebase form called "crack," which became popular in the 1980s. In 2007, 2.1 million Americans had recent cocaine use; 1.6 million met criteria for cocaine dependence or abuse.1 Cocaine accounted for 31% of all visits to the emergency department related to drug misuse or abuse.1 From 1971 to 1987, the incidence of deaths caused by cocaine overdose increased 20-fold in Dade County, Florida. In a consecutive series of 233 emergency visits by cocaine-using patients, 56% presented with cardiovascular complaints, including 40% with chest pain. A minority of these patients have acute myocardial infarction (MI) ([almost equal to]6%), and overall mortality is low (<1%). However, cocaine is associated with a number of cardiovascular diseases, including MI, heart failure, cardiomyopathies, arrhythmias, aortic dissection, and endocarditis. Identifying patients with acute disease is challenging. This review describes the relationship between cocaine and various cardiovascular diseases, as well as appropriate diagnostic evaluation and therapies.

Seigers DKL; Carey KB. Screening and brief interventions for alcohol use in college health centers: A review. (review). Journal of American College Health 59(3): 151-158, 2011. (59 refs.)

Objectives: To provide a critical review of the efficacy of brief interventions for alcohol use in college health centers. Methods: Studies were included if (a) they examined brief intervention trials that were conducted in college- or university-based student health centers or emergency departments, and (b) they provided pre-post data to estimate change. Results: Twelve studies suggested that screening and brief interventions in these settings are acceptable, feasible, and promote risk reduction. Conclusions: Findings support continued use of time-limited, single-session interventions with motivational interviewing and feedback components.

Sinclair JMA; Nausheen B; Garner MJ; Baldwin DS. Attentional biases in clinical populations with alcohol use disorders: Is co-morbidity ignored? (review). Human Psychopharmacology: Clinical and Experimental 25(7-8): 515-524, 2010. (57 refs.)

Objective: To identify how psychiatric co-morbidity was identified and assessed, in studies of attentional bias in clinical samples of patients with alcohol use disorders (AUDs). Design: Systematic review methodology was used to identify studies and abstract data on alcohol-related attentional biases and measurement of psychiatric co-morbidity. Results: Seventeen papers were identified that met the criteria for inclusion. All but one study were in patients meeting criteria for alcohol dependence. In 10 of the 17 studies, either no mention or minimal statements were made pertaining to possible co-morbid conditions (including other substance use): five excluded patients with psychiatric diagnoses, (variously defined), and two excluded patients on 'psychotropic medication'. Slow response latencies to all word types were found in studies where co-morbid conditions were not considered. Conclusions Despite the high prevalence of psychiatric pathology in patients with AUDs (particularly depression), and the acknowledged impact that this has on aetiology, presentation and outcome, psychiatric co-morbidity has not been consistently measured or described in experimental studies on alcohol-related attentional biases in clinical samples. In order to have an accurate appreciation of the role of attentional biases in patients with AUDs, there needs to be a consistent approach to measuring the co-occurrence of other psychopathology. Further research is needed to assess the impact of co-morbidities on attentional biases in AUDs, to enable the development of more targeted psychological and pharmacological treatments.

Smith AJ; Tett SE. Improving the use of benzodiazepines-Is it possible? A non-systematic review of interventions tried in the last 20 years. (review) BMC Health Services Research 10: e-article 321, 2010. (69 refs.)

Background: Benzodiazepines are often used on a long term basis in the elderly to treat various psychological disorders including sleep disorders, some neurological disorders and anxiety. This is despite the risk of dependence, cognitive impairment, and falls and fractures. Guidelines, campaigns and prescribing restrictions have been used to raise awareness of potentially inappropriate use, however long term use of benzodiazepine and related compounds is currently increasing in Australia and worldwide. The objective of this paper is to explore interventions aimed at improving the prescribing and use of benzodiazepines in the last 20 years. Methods: Medline, EMBASE, PsychINFO, IPA were searched for the period 1987 to June 2007. Results: Thirty-two articles met the study eligibility criteria (interventions solely focusing on increasing appropriate prescribing and reducing long term use of benzodiazepines) and were appraised. Insufficient data were presented in these studies for systematic data aggregation and synthesis, hence critical appraisal was used to tabulate the studies and draw empirical conclusions. Three major intervention approaches were identified; education, audit and feedback, and alerts. Conclusions: Studies which used a multi-faceted approach had the largest and most sustained reductions in benzodiazepines use. It appears that support groups for patients, non-voluntary recruitment of GPs, and oral delivery of alerts or feedback may all improve the outcomes of interventions. The choice of outcome measures, delivery style of educational messages, and requests by GPs to stop benzodiazepines, either in a letter or face to face, showed no differences on the success rates of the intervention.

Sutherland ME; Ericson R. Alcohol use, abuse, and treatment in people of African descent. (review) Journal of Black Studies 41(1): 71-88, 2010. (71 refs.)

The use and abuse of alcohol is prevalent in many nations across the globe, but few studies have examined within-group differences found in people of African descent in the United States, in Africa, and in the Caribbean. A review of current research about alcohol use, abuse, and treatment in people of African descent is presented, including information about risk factors and contributors to alcohol use. Examples of education and prevention interventions are also described. Finally, conclusions based on the review of the research literature as well as recommendations for future research are explained.

Templeton L; Velleman R; Russell C. Psychological interventions with families of alcohol misusers: A systematic review. (review). Addiction Research & Theory 18(6): 616-648, 2010. (140 refs.)

Aims: To review the literature on psychological interventions for families affected by alcohol misuse, with a focus on outcomes for family members. Methods: A comprehensive and systematic literature review. A detailed search strategy was developed and implemented with no date, language or time restrictions. Two reviewers screened all identified titles and abstracts, and then independently assessed the eligibility and quality of all potential studies. The studies were analysed according to whether or not the alcohol misuser was involved in the primary intervention under investigation and analysed thematically. Results: Forty-three publications (34 studies) were included in the review. All were in English, covered the period 1979-2009, were mainly published articles in peer review journals and included 2500-3000 family members. Research with female family members (particularly spouses or partners), and 'white' family members dominated. The included studies show how the field has moved from primarily focussing on how family members can engage and support the user through treatment to adopting a wider holistic focus which considers the needs of family members in their own right. Studies in both categories demonstrated positive outcomes for family members across a range of domains. Conclusions: Adopting a broader review methodology has brought a fuller understanding of a field where few such reviews have been conducted, and offers direction for future research. Further work is needed in terms of broadening the reach of such interventions and embedding them more firmly into routine therapeutic practice.

Ungless MA; Argilli E; Bonci A. Effects of stress and aversion on dopamine neurons: Implications for addiction. (review). Neuroscience and Biobehavioral Reviews 35(2, Special Issue): 151-156, 2010. (53 refs.)

Stress plays a key role in modulating the development and expression of addictive behavior, and is a major cause of relapse following periods of abstinence. In this review we focus our attention on recent advances made in understanding how stress, aversive events, and drugs of abuse, cocaine in particular, interact directly with dopamine neurons in the ventral tegmental area, and how these interactions may be involved in stress-induced relapse. We start by outlining how dopamine neurons respond to aversive stimuli and stress, particularly in terms of firing activity and modulation of excitatory synaptic inputs. We then discuss some of the cellular mechanisms underlying the effects of cocaine on dopamine neurons, again with a selective focus on synaptic plasticity. Finally, we examine how the effects of stress and cocaine interact and how these cellular mechanisms in ventral tegmental area dopamine neurons may be engaged in stress-induced relapse.

Van den Oever MC; Spijker S; Smit AB; De Vries TJ. Prefrontal cortex plasticity mechanisms in drug seeking and relapse. (review). Neuroscience and Biobehavioral Reviews 35(2 (special issue)): 276-284, 2010. (132 refs.)

Development of pharmacotherapy to reduce relapse rates is one of the biggest challenges in drug addiction research. The enduring nature of relapse suggests that it is maintained by long-lasting molecular and cellular adaptations in the neuronal circuitry that mediates learning and processing of motivationally relevant stimuli. Studies employing the reinstatement model of drug relapse in rodents point to an important role of the medial prefrontal cortex (mPFC), with distinct contributions of the dorsal and ventral regions of the mPFC to drug-, stress- and cue-induced drug seeking. Whereas drug-induced neuroadaptations in the dorsal mPFC function to enhance excitatory output and drive expression of drug seeking, recent evidence suggests that plasticity in the ventral mPFC leads to reduced glutamatergic transmission in this region, thereby impairing response inhibition upon exposure to drug-conditioned stimuli. Treatments aimed at restoring drug-induced neuroadaptations in the mPFC may help to reduce cue-reactivity and relapse susceptibility.

White A; Kavanagh D; Stallman H; Klein B; Kay-Lambkin F; Proudfoot J et al. Online alcohol interventions: A systematic review. (review). Journal of Medical Internet Research 12(5): e-article 62, 2010. (57 refs.)

Background: There has been a significant increase in the availability of online programs for alcohol problems. A systematic review of the research evidence underpinning these programs is timely. Objectives: Our objective was to review the efficacy of online interventions for alcohol misuse. Systematic searches of Medline, PsycINFO, Web of Science, and Scopus were conducted for English abstracts (excluding dissertations) published from 1998 onward. Search terms were: (1) Internet, Web*; (2) online, computer*; (3) alcohol*; and (4) E\effect*, trial*, random* (where * denotes a wildcard). Forward and backward searches from identified papers were also conducted. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on moderating or stopping alcohol consumption, and (3) the study was a randomized controlled trial of an alcohol-related screen, assessment, or intervention. Results: The literature search initially yielded 31 randomized controlled trials (RCTs), 17 of which met inclusion criteria. Of these 17 studies, 12 (70.6%) were conducted with university students, and 11 (64.7%) specifically focused on at-risk, heavy, or binge drinkers. Sample sizes ranged from 40 to 3216 (median 261), with 12 (70.6%) studies predominantly involving brief personalized feedback interventions. Using published data, effect sizes could be extracted from 8 of the 17 studies. In relation to alcohol units per week or month and based on 5 RCTs where a measure of alcohol units per week or month could be extracted, differential effect sizes to posttreatment ranged from 0.02 to 0.81 (mean 0.42, median 0.54). Pre-post effect sizes for brief personalized feedback interventions ranged from 0.02 to 0.81, and in 2 multi-session modularized interventions, a pre-post effect size of 0.56 was obtained in both. Pre-post differential effect sizes for peak blood alcohol concentrations (BAC) ranged from 0.22 to 0.88, with a mean effect size of 0.66. Conclusions: The available evidence suggests that users can benefit from online alcohol interventions and that this approach could be particularly useful for groups less likely to access traditional alcohol-related services, such as women, young people, and at-risk users. However, caution should be exercised given the limited number of studies allowing extraction of effect sizes, the heterogeneity of outcome measures and follow-up periods, and the large proportion of student-based studies. More extensive RCTs in community samples are required to better understand the efficacy of specific online alcohol approaches, program dosage, the additive effect of telephone or face-to-face interventions, and effective strategies for their dissemination and marketing.

Young C; Skorga P. Reduction versus abrupt cessation in smokers who want to quit: A review summary. Public Health Nursing 28(1): 54-56, 2011. (0 refs.)

This synopsis is of a Cochrane systematic review by Lindson et al. ( 2010) containing meta-analysis of 10 clinical trials evaluating the effects and side effects of abruptly quitting smoking versus reducing and then quitting smoking. Side effects were described through narrative. A meta-analysis of 10 studies indicated that there were no statistically significant differences in abstinence from smoking between intervention (abrupt quit group) and comparison groups (reduced quit group). The results remained nonsignificant regardless of whether pharmacotherapy, self-help therapy, or behavioral support were included in the intervention. Researchers were unable to draw conclusions about the differences in adverse events between interventions due to the difference in reporting. Symptoms occurring related to the use of nicotine gum most frequently from both groups were malaise, constipation, and diarrhea.

Zanini B; Covolo L; Donato F; Lanzini A. Effectiveness and tolerability of combination treatment of chronic hepatitis c in illicit drug users: Meta-analysis of prospective studies. (review). Clinical Therapeutics 32(13): 2139-2159, 2010. (63 refs.)

Background: Hepatitis C virus (HCV) infection is a global health problem. In Western countries, illicit drug users (IDUs) constitute the largest proportion of HCV patients. International guidelines no longer regard ongoing illicit drug use as a contraindication to antiviral therapy for chronic hepatitis C (CHC). Nonetheless, in clinical practice, few IDUs have access to HCV treatment, likely because many physicians believe these patients will have poor adherence or a lack of treatment efficacy. Objective: The aim of this study was to assess effectiveness and tolerability of combination treatment with ribavirin plus recombinant or pegylated interferon-a in the treatment of CHC in IDUs. Methods: MEDLINE, EMBASE, and the Cochrane Library were searched for relevant studies published in English between 2000 and December 2008. The following terms were searched: chronic hepatitis C, interferons, antiviral agents, methadone, and substance-related disorders. Full-text articles and abstracts were searched using predefined criteria. A manual search of abstracts from 8 international meetings of hepatologists was also conducted. Only prospective studies with a sample size >15 and a homogeneous treatment schedule were included. Articles were extracted independently by 2 of the authors using an electronic standardized form including study quality indicators. Results: Sixteen prospective studies were included, and data from a cohort of 953 IDUs were analyzed. The estimated overall sustained virologic response (SVR) and dropout (DO) rates in IDUs were 52% (95% CI, 44%-60%) and 26% (18%-35%, 95% CI), respectively. The rate of psychiatric severe adverse events (SAEs) that led to treatment discontinuation was 2% (95% CI, 1%-3%). These prevalences were not significantly different from those reported in registration trials of treatment of CHC that excluded IDUs from the study population (SVR, 50% [95% CI, 39%-61%]; DO, 26% [95% CI, 12%-41%]; and psychiatric SAEs, 2% [95% CI, 0%-6%]). By subgroup analysis, active ongoing drug use negatively affected the rate of treatment success (39% [95% CI, 30%-49%] vs 55% [95% CI, 45%-64%]; P = 0.02). Conclusion: Based on data from 16 prospective clinical studies of CHC treatment in IDUs published in the past 10 years, findings on effectiveness and tolerability are comparable to those in the general population.

Zorick T; Mandelkern MA; Lee B; Wong ML; Miotto K; Shahbazian J; London ED. Elevated plasma prolactin in abstinent methamphetamine-dependent subjects. (review). American Journal of Drug and Alcohol Abuse 37(1): 62-67, 2011. (24 refs.)

Background: Methamphetamine (MA) use disorders are pervasive global social problems that produce large medical and public health burdens. Abnormalities in pituitary hormonal regulation have been observed in preclinical models of substance abuse and in human substance abusers. They have, however, not been studied before in MA-dependent human subjects. Objectives: To determine if MA-dependent research volunteers differ from healthy control subjects in plasma levels of adrenocorticotropic hormone (ACTH), cortisol, or prolactin, or in pituitary dopamine D-2 receptor availability during early abstinence from MA. Methods: MA-dependent subjects (N = 31), who were not seeking treatment, resided on an inpatient ward for up to 5 weeks. Abstinence was confirmed by daily urine drug screening. Venous blood was sampled for plasma hormone levels, and positron emission tomography with [F-18] fallypride was performed to determine dopamine D-2 receptor availability during the first week of abstinence. Venous blood was sampled again for hormone levels during the fourth week of abstinence. Matched healthy volunteers (N = 23) participated as a comparison group. Results: MA-dependent and healthy comparison subjects did not differ in plasma ACTH or cortisol levels, but had an elevated plasma prolactin at both the first week and fourth week of abstinence. There was no group difference in pituitary dopamine D-2 receptor availability. Conclusion: MA-dependent individuals have abnormalities in prolactin regulation, which is not likely due to alterations in pituitary dopamine D-2 receptor availability. Scientific significance: MA dependence is associated with elevated prolactin levels, which may contribute to medical comorbidity in afflicted individuals.