Addictive Disorders & Their Treatment

Can High Altitude Exacerbate a Remittent Alcohol Use Disorder in a Patient With a History of Panic Attacks? Background: Several studies have already investigated the brief and long-term neurological effects of exposure to high altitudes and the related sequelae of hypoxia on memory and cognition, but few authors have discussed the question of psychic symptoms during high-altitude activities. These authors suspect that the reexacerbation or worsening of psychiatric symptoms may well be the expression of maladaptive behaviors in response to changes in environmental conditions. Case Report: We describe the case of a patient with a history of sporadic Panic Attacks with elements of the panic-agoraphobic spectrum (social phobia and separation anxiety) who, in a specific social context during adolescence, tended to misuse alcohol for recreational and disinhibitory purposes to solve his relational problems in the social sphere. After many years of abstinence, this patient decided to accept exposure to high altitudes at work and developed a serious alcohol use disorder, including the progressive worsening of his functioning in the social and working dimensions. Discussion: We propose that, because of the daily experiencing of high altitudes at work, the patient’s anxiety levels rose sharply, but unconsciously and automatically, according to a mode of copying previously enacted in adolescence (through social phobia and the use of alcohol to become disinhibited); he also implemented binge drinking behaviors for self-medicative and antianxiety purposes, which gradually triggered a mechanism of alcohol dependence. I.M. served as a board member for Indivior, Molteni, Mundipharma, D&A Pharma, CT Sanremo, Lundbeck, Gilead, Merck & Co., Angelini. The remaining authors declare no conflict of interest. Reprints: Manuel Glauco Carbone, MD, Department of Experimental and Clinical Medicine, School of Psychiatry, University of Pisa, Via Roma, 67, 56100 Pisa, Italy (e-mail: manuelglaucocarbone@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Effectiveness of Neurolinguistic Programming in Reducing Sport Anxiety in Athletes This research was motivated by the phenomenon of anxiety experienced by athletes during exercise. Sport anxiety is a condition/nature/response associated with exercise, indicating anxiety, worry, and panic experienced by athletes before competing. Sport anxiety has the possibility of affecting the performance of athletes in competition. If proper attention is not given to this occurrence, it may limit the performance of athletes in competitions. One tool that can be used to reduce sport anxiety is neurolinguistic programming. Six athletes were used as athletes in this research. Sport Anxiety Scale-2 was the instrument used to analyze data using a single-subject research design A-B-A-B. The results of the study found that neurolinguistic programming can reduce an athlete’s sport anxiety. T.H.S. is a licensed counselor at the Indonesian Counselors Association and a private counselor, is a professional in sports counseling, mental health counseling and crisis counseling. The remaining authors declare no conflict of interest. Reprints: Tjung Hauw Sin, MPd, Kons, Department of Sport Coaching, Faculty of Sport Science, Universitas Negeri Padang, Jl. Prof. Dr. Hamka, Air Tawar Padang, West Sumatera 25131, Indonesia (e-mail:tjunghauwsin@konselor.org). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Implementing Medication-assisted Treatment For Opioid Use Disorder in Residential Programs No abstract available

FACES OF HPPD: Hallucinogen Persisting Perception Disorder Patient Survey Results and a Descriptive Analysis of Patient Demographics, Medical Background, Drug Use History, Symptoms, and Treatments Objective: The purpose of the present study was to obtain patient information across a wide geography about medical history, drug use, symptoms, and treatments of individuals diagnosed with hallucinogen persisting perception disorder (HPPD). Methods: The study was an internet survey that yielded 26 HPPD patients from North America (81%), Europe (12%), and South America (almost 8%), predominantly male (73%), white (92%), with a median age of 24.5 (range, 18 to 63) years, who have been living with HPPD from a period of <1 year to well over 10 years. Results: History of preexisting mood disorders was reported (100%). Previous hallucinogen drugs used include lysergic acid diethylamide, psilocybin, 3,4-methylenedioxymethamphetamine, and mescaline in highest frequencies. There is a high percentage of current use of benzodiazepines (34.6%) and dependency (78% of those using). Current marijuana use is present for 19%, of which all claim dependency. All patients reported experiencing long-term and ongoing symptoms such as depersonalization (92.3%), visual snow, floaters, trailing afterimages and anxiety (96.2% for each factor). Suicide ideation was pronounced (over 69%). HPPD treatments included benzodiazepines (50%), neuroleptics (23%), anticonvulsants (35%), and receiving counseling (62%). Conclusions: HPPD is an understudied mental disorder that has a complex and unpredictable nature with overlapping psychiatric, psychological, and neurological symptoms. Controlled, evidence-based clinical studies are needed for improvements in diagnosing and treating HPPD. There is concern for patients’ well-being, particularly concerning high reported suicide ideation and dependency on drugs currently used (even if they are prescribed). Improved education for health care professionals and patients is also needed. D.M.L.: ORCID ID: 0000-0002-3315-6357. The author declares no conflicts of interest. Reprints: Doreen M. Lewis, PhD, Vellichor Research, 12121 Little Road, Box 329, Hudson, FL 34667 (e-mail: doreen@vellichorresearch.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Peer Recovery Provides Sustainable Avenues for Addiction Treatment, but is Not a One-Size-Fits-All Proposition No abstract available

Survey to Mental Health Professionals on Problematic Drug Use Introduction: When discussing problematic drug use it is necessary to articulate both the legal and the health system to establish a coherent approach to address it. As the health system is formed in part by the Mental Health professionals who are usually those who respond to and receive this population for treatment, the aim of the present study was to learn their opinion with regard to problematic drug use approach both clinically and in the legal system. The results would help to stimulate discussion in the Mental Health field to better assist policy makers. Materials and Methods: This was a cross-sectional study with a convenience sample. During the 2017 Argentinian Conference on Psychiatry (Congreso Argentino de Psiquiatría XXXII from Asociación de Psiquiatras Argentinos), the attendees received an anonymous voluntary paper questionnaire designed by the research team that had 4 questions on demographic information and 9 Likert-like statements. Statistical analysis was performed. Results: A total of 642 attendees answered the questionnaire. As regards criminalization of drug use, 51.7% would decriminalize ≥1 drug, 42.5% disagreed that the aim of the treatment is total abstinence (those that disagreed had a statistically significantly lower mean age compared with those that agreed), and 64.5% disagreed with punishing drug possession for personal use. Conclusions: The debate taking place worldwide on how to address the drug use problem could also be found among the Mental Health professionals in Argentina, where almost half considered that ban is the best approach, whereas the other half was in favor of decriminalization. Creating consensus among Mental Health providers would allow better articulation of the health system, with the policy makers giving a comprehensive approach in these complex situations. The authors declare no conflict of interest. Reprints: Juan C. Tenconi, MD, Argentinian Psychiatry Association, 355 Rincón Street, Buenos Aires C1081ABG, Argentina (e-mail: juantenconi@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

The Effect of Methadone Maintenance Treatment Method on Mental Health and Quality of Life in People With Opioid Addiction: A Longitudinal Study in Iran Objectives: Promoting recovery in mental health of patients with opioid addiction is an important aspect of the treatment plan, which can lead to continued improvement of health and promotion of quality of life (QoL) in these people. This study aimed to evaluate the effect of methadone maintenance treatment (MMT) method on mental health and QoL in people with opioid addiction. Methods: In this longitudinal descriptive study, 186 subjects with opioid addiction had the required criteria and were then selected on the basis of clustering and simple random sampling methods. First (a month after using methadone therapy), demographic, QoL, and mental health data were collected using General Health Questionnaire and health-related quality of life questionnaires. Second (12 mo after using methadone therapy), mental health and QoL of participants were again evaluated. Data were analyzed using SPSS Statistics 20, and Mann-Whitney U and Wilcoxon tests. Results: The results showed that there is no improvement after using MMT method (P=0.783), but the QoL scores of the participants increased to some extent, 12 months after using this therapeutic method (P=0.04). Conclusion: The results of this study showed that the MMT method does not significantly affect the health of the participants. Hence, screening programs for psychological disorders in patients should be arranged before the onset of a course of treatment; there should also be extensive and continuous therapeutic and counseling services for these patients and their families, to achieve therapeutic goals. The authors declare no conflict of interest. Reprints: Ghahraman Mahmoudi, PhD, Hospital Administration Research Center, School of Medicine, Sari Branch, Islamic Azad University, Sari 48161-19318, I R Iran (e-mail: Ghahraman48@yahoo.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Mu Opioid Receptor Gene (OPRM1) in Patients With Opiate Use Disorder Introduction: Genetics of opiate dependence has focused on the opioidergic system, which is the primary target for opiates. Human mu opioid receptor (OPRM1) is the most important site for the analgesic effect of opioids. Methods: A case-control study included 40 patients with opiate use disorder and 40 matching control subjects. Polymorphism in Mu opioid receptor gene (OPRM1') was investigated in both patients and healthy controls by a genetic study. Substance use was further assessed in patients using the Addiction Severity Index while urine screen was required for controls. The single nucleotide polymorphisms (SNP) was reviewed in the SNP database of the National Centre for Biotechnology Information, and the life technologies SNP database. Results: No significant difference was found between the 2 groups (P=0.348) as regards the presence of polymorphic Mu opioid receptor gene (GT). There was no significant difference in the frequency of G and T alleles between the 2 groups; however, the frequency of G allele in cases was higher than T allele. No significant difference in group A between males and females as regarding gene type. Moreover, no difference was found in patients between the subjects who had GT and GG genotype regarding clinical data and severity of addiction and the occurrence of seizures. Conclusion: The use of opiates is associated with OPRM1 and the presence of the polymorphic gene (GT) has no relation with the different clinical characteristics of the opiate use. The authors declare no conflict of interest. Reprints: Mohamed A. Khalil, MBBCH, MSc, MD, Faculty of Medicine, Cairo University, Giza 12311, Egypt (e-mails: maamska@kasralainy.edu.eg; maamska@yahoo.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Clinic Payment Options as a Barrier to Accessing Medication-assisted Treatment for Opioid Use in Albuquerque, New Mexico Objectives: For patients with opioid addiction seeking treatment, an effective option is Medication-assisted Treatment (MAT). In Albuquerque, the city with the greatest number of people who use opioids in New Mexico, the demand for MAT exceeds the number of patients receiving treatment. The authors hypothesized that a primary factor in patients’ ability to access treatment is clinic payment options, rather than the traditionally cited availability of providers. Methods: The authors conducted a survey assessing payment methods and corresponding availability in MAT programs for 53 of Albuquerque’s ~70 providers. Results: The authors found a statistically significant (P<0.01) imbalance in treatment availability between insurance-accepting clinics (10.1% had ≥1 openings) and cash clinics (100% had ≥1 openings). Conclusions: These findings suggest that a lack of clinics accepting Medicaid and third party insurance may pose a significant treatment barrier. The authors thus conclude that more focus should be placed on increasing the number of clinicians and clinics accepting insurance. Supported by Stanford University Undergraduate Advising and Research. Ethics approval: This research was approved by the Stanford University IRB. The authors declare no conflict of interest. Reprints: John Rees, Stanford University, P.O. 11821, 531 Lasuen Mall, Stanford, CA 94305 (e-mail: jrrees@stanford.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

Profile of Help-seeking Crack Cocaine Users in Brazil: A Comparison of 2 Cross-Sectional Studies From 1997 and 2013 Objective: The purpose of this study was to compare the characteristics of treatment-seeking crack cocaine users in Brazil in 1996/1997 and 2012/2013. Methods: We analyzed data from 2 cross-sectional studies conducted 16 years apart. The first study (performed 1996-1997) included 133 crack users. The second study (performed 2012-2013) included 577 crack users. An interview based on the Intake Questionnaire and the Maudsley Addiction Profile was performed to examine sociodemographic characteristics and patterns of drug use. In both surveys, criminal and treatment history were collected. Results: The mean age of users increased from 27.3 years (SD=7.9) in 1997 to 30.8 years in 2013 (SD=7.7). The number of individuals with a high school diploma was >3 times higher in 2013, (11.7% vs. 38.9%). The mean time elapsed since first use was 3.9 years (SD=2.8) in 1997 versus 9.3 years (SD=5.8) in 2013. Other differences included higher unemployment and incarceration rates in the 1997 study. Conclusions: A change was detected in the profile of treatment-seeking crack cocaine users over the past 2 decades. Current patients appear to be older and use the drug more chronically, in addition to having a higher level of schooling and lower unemployment rates when compared with 1997 users. The 2012 survey was funded by CNPq (Brazilian National Council for Scientific and Technological Development) through a grant awarded to R.L. for the project entitled “Sociodemographic profile and natural history of crack consumption among users of several Brazilian states.” Process number 402762/210-0 and Announcement 41/2010—Lane I. Total financial assistance of R$462,540.00. The project was executed at Federal University of São Paulo (CNPJ 60.453.032/0001-74). The authors declare no conflict of interest. Reprints: Luciane O. Perrenoud, BSc, Avenida Independência, 2373, Rua 1/Casa 154, Taubaté 12032-000, São Paulo, Brazil (e-mail: lucianeogataperrenoud@gmail.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved