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Clinical Management of Substance Use Disorders: Future Trends

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 24111

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Dr. Anna Klimkiewicz

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Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
Interests: treatment in psychiatry; drug use disorders; cannabinoids; medical cannabis; alcohol use disorders
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Dear Colleagues,

Drug use is a huge social, medical and economic problem worldwide. Nowadays, increasingly younger people are turning to drugs, the choice of which is increasing. In the face of constantly appearing novel psychoactive substances, we remain powerless. Unfortunately, despite progress in many fields of medicine, addiction treatment remains relatively ineffective. Both harm reduction strategies and the pursuit of complete abstinence are not effective enough. For this reason, it is necessary to search for new solutions in the field of addiction treatment. On the other hand, it is important to avoid an epidemic of addiction but, in doing so, not to cause an epidemic of opioid phobia, which can lead to inadequate treatment and suffering for pain patients.

Undoubtedly, the search for mechanisms of addiction and new ways of treating addicts is necessary. This Special Issue of the Journal of Clinical Medicine will report on the current trends in drug-use-disorder prevention and treatment strategies, highlighting novel targets of therapeutic intervention as well as new therapeutic approaches.

Dr. Anna Klimkiewicz
Guest Editor

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Keywords

drugs
psychoactive
misuse
dependence
addiction
treatment
therapy
abstinence
harm reduction

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Published Papers (9 papers)

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Research

13 pages, 946 KiB

Open AccessArticle

Patients with Schizophrenia Showed Worse Cognitive Performance than Bipolar and Major Depressive Disorder in a Sample with Comorbid Substance Use Disorders

by Julia E. Marquez-Arrico, Alvaro Gonzalez-Sanchez, José Francisco Navarro, Rafael Penadés and Ana Adan

J. Clin. Med. 2022, 11(22), 6648; https://doi.org/10.3390/jcm11226648 - 9 Nov 2022

Cited by 7 | Viewed by 1807

Abstract

Comorbidity of substance use disorders (SUD) and severe mental illness (SMI) is highly frequent in patients, the most common diagnoses being schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD). Since comorbidity has its own clinical features, and neurocognitive functioning is not always similar to psychiatric symptoms the present study explores the cognitive performance of patients with dual disorders. A neuropsychological battery of tests was used to assess 120 under treatment male patients, 40 for each group considered (SZ + SUD, BD + SUD and MDD + SUD) who were mainly polyconsumers. Significant differences (with premorbid IQ as a covariate) were found among the groups, with SZ + SUD having a worse performance in attention, verbal learning, short term memory and recognition. The consideration of a global Z score for performance evidenced an impaired neurocognitive pattern for SZ + SUD compared with BD + SUD and MDD + SUD. According to norms, all patients showed difficulties in verbal learning, short-term memory and recognition. Our research indicated that the neurocognitive functioning of dual disorder patients was influenced by the comorbid SMI, with SZ + SUD presenting major difficulties. Future studies should thoroughly explore the role of such difficulties as indicators or endophenotypes for dual schizophrenia disorders, and their usefulness for prevention and treatment. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

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20 pages, 2484 KiB

Open AccessArticle

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists

by Michal Ordak, Daria Tkacz, Aniela Golub, Tadeusz Nasierowski and Magdalena Bujalska-Zadrozny

J. Clin. Med. 2022, 11(8), 2129; https://doi.org/10.3390/jcm11082129 - 11 Apr 2022

Viewed by 2087

Abstract

In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. The aim of this study was to explore the opinions and knowledge of psychiatrists from around the world on various aspects related to polypharmacotherapy. A total of 1335 psychiatrists from six continents were included in the study. The respondents’ opinion on the problem of hepatotoxicity in psychiatry was also examined. The greatest discrepancy among psychiatrists from different continents in the answers given concerned the definition of polypharmacotherapy (p < 0.001) and the approach to hepatotoxicity (p < 0.001). It is noteworthy that only about 20% of the psychiatrists surveyed (p < 0.001) believe that polypharmacotherapy is associated with a higher rate of patients’ hospitalisations. The most commonly used type of polypharmacy by psychiatrists was antidepressants and antipsychotics. Most of them also stated that polypharmacy was associated with reduced patient compliance with the doctor’s recommendations related to taking medications due to the increased complexity of the therapy. The continent that diversified the analysed questions to the greatest extent was Africa. Future educational activities for trainee psychiatrists should include more discussion of polypharmacotherapy in psychiatry. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

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19 pages, 15214 KiB

Open AccessArticle

Common Laboratory Parameters Are Useful for Screening for Alcohol Use Disorder: Designing a Predictive Model Using Machine Learning

by Juana Pinar-Sanchez, Pablo Bermejo López, Julián Solís García Del Pozo, Jose Redondo-Ruiz, Laura Navarro Casado, Fernando Andres-Pretel, María Luisa Celorrio Bustillo, Mercedes Esparcia Moreno, Santiago García Ruiz, Jose Javier Solera Santos and Beatriz Navarro Bravo

J. Clin. Med. 2022, 11(7), 2061; https://doi.org/10.3390/jcm11072061 - 6 Apr 2022

Cited by 2 | Viewed by 2872

Abstract

The diagnosis of alcohol use disorder (AUD) remains a difficult challenge, and some patients may not be adequately diagnosed. This study aims to identify an optimum combination of laboratory markers to detect alcohol consumption, using data science. An analytical observational study was conducted with 337 subjects (253 men and 83 women, with a mean age of 44 years (10.61 Standard Deviation (SD)). The first group included 204 participants being treated in the Addictive Behaviors Unit (ABU) from Albacete (Spain). They met the diagnostic criteria for AUD specified in the Diagnostic and Statistical Manual of mental disorders fifth edition (DSM-5). The second group included 133 blood donors (people with no risk of AUD), recruited by cross-section. All participants were also divided in two groups according to the WHO classification for risk of alcohol consumption in Spain, that is, males drinking more than 28 standard drink units (SDUs) or women drinking more than 17 SDUs. Medical history and laboratory markers were selected from our hospital’s database. A correlation between alterations in laboratory markers and the amount of alcohol consumed was established. We then created three predicted models (with logistic regression, classification tree, and Bayesian network) to detect risk of alcohol consumption by using laboratory markers as predictive features. For the execution of the selection of variables and the creation and validation of predictive models, two tools were used: the scikit-learn library for Python, and the Weka application. The logistic regression model provided a maximum AUD prediction accuracy of 85.07%. Secondly, the classification tree provided a lower accuracy of 79.4%, but easier interpretation. Finally, the Naive Bayes network had an accuracy of 87.46%. The combination of several common biochemical markers and the use of data science can enhance detection of AUD, helping to prevent future medical complications derived from AUD. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

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20 pages, 19788 KiB

Open AccessArticle

Comparison of LC-MS and LC-DAD Methods of Detecting Abused Piperazine Designer Drugs

by Anna Welz, Marcin Koba, Piotr Kośliński and Joanna Siódmiak

J. Clin. Med. 2022, 11(7), 1758; https://doi.org/10.3390/jcm11071758 - 22 Mar 2022

Cited by 2 | Viewed by 4211

Abstract

Recreational use of piperazine designer drugs is a serious threat to human health. These compounds act on the body in a similar fashion to illegal drugs. They induce psychostimulatory effects as well as visual and auditory hallucinations to varying degrees. In many cases of poisoning and deaths, the presence of two or even several psychoactive substances have been demonstrated. Piperazine derivatives are often found in such mixtures and pose a great analytical problem during their identification. Additionally, some piperazine derivatives can be detected in biological material as a result of metabolic changes to related drugs. Therefore, it is necessary to correctly identify these compounds and ensure repeatability of determinations. This article presents a comparison of the methods used to detect abused piperazine designer drugs using liquid chromatography in combination with a diode-array detector (LC-DAD) or mass spectrometer (LC-MS). Each of methods can be used independently for determinations, obtaining reliable results in a short time of analysis. These methods can also complement each other, providing qualitative and quantitative confirmation of results. The proposed methods provide analytical confirmation of poisoning and may be helpful in toxicological diagnostics. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

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19 pages, 329 KiB

Open AccessArticle

To Treat or Not to Treat? Polish Physicians’ Opinions about the Clinical Aspects of Cannabinoids—An Online Survey

by Martyna Joanna Hordowicz, Jerzy Jarosz, Anna Klimkiewicz, Małgorzata Czaplińska, Agnieszka Leonhard and Maria Wysocka

J. Clin. Med. 2022, 11(1), 236; https://doi.org/10.3390/jcm11010236 - 1 Jan 2022

Cited by 1 | Viewed by 2328

Abstract

Introduction: Medical cannabis’ importance in Poland increased dramatically following its legalization as the 12th country in Europe in 2017. However, no studies have been published to give insight into Polish physicians’ opinions about medical cannabis. Objectives: To investigate physician’s opinions about cannabinoids’ utility in clinical practice, concerns regarding their safety profile, and their clinical experience with cannabinoids. Methods: The survey using a self-developed tool was conducted online; participants were physicians with or without specialist training. Participation was voluntary. Physicians were recruited through personal networks, palliative care courses, and Medical Chambers. Results: From June to October 2020, we recruited 173 physicians from 15/16 voivodeships. The largest age group (43.9%; n = 76) was 30–39 year-olds. A similar proportion declared they never used cannabis and did not receive any training regarding cannabinoids (60% for both). Only 15 (8%) ever prescribed medical cannabis, although about 50% declared knowing suitable patients for such therapy, and 53.8% had at least one patient proactively asking for such treatment in the last 6 mo. The most common indication chosen was pain: chronic cancer-related (n = 128), chronic non-cancer (n = 77), and neuropathic (n = 60). Other commonly chosen conditions were alleviation of cancer treatment side-effects (n = 56) and cachexia (n = 57). The overall safety profile of THC was assessed as similar to most commonly used medications, including opioids; NSAIDs and benzodiazepines were, however, perceived as safer. Conclusions: Polish physicians favored the legalization of medical cannabis. However, it is of concern that a limited number have any experience with prescribing cannabis. The creation of clear guidelines to advise physicians in their routine practice and education about pain management and the risks related to the consumption of recreational cannabis for medical conditions are needed. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

15 pages, 282 KiB

Open AccessArticle

Polish Physicians’ Perspectives on Medical Cannabis Policy and Educational Needs: Results of An Online Survey

by Martyna Hordowicz, Jerzy Jarosz, Małgorzata Czaplińska, Agnieszka Leonhard and Anna Klimkiewicz

J. Clin. Med. 2021, 10(19), 4545; https://doi.org/10.3390/jcm10194545 - 30 Sep 2021

Cited by 6 | Viewed by 2392

Abstract

(1) Background: In November 2017, medical cannabis was legalized in Poland. Until now, there have been no studies conducted to examine the perspectives of Polish physicians about their preferences regarding medical cannabis legal status and educational needs. (2) Methods: The survey was a self-developed online questionnaire with 57 participants. Participation was voluntary. The link was shared through a personal network of medical doctors, regional medical chambers, and with doctors attending palliative care courses organized by our research group. Results: Between June and October 2020, 173 HCPs from Poland completed the survey. More than half of the study participants never received any education on medical cannabis (60.1%); 71.1% declared their knowledge was insufficient to counsel patients about medical cannabis use. The majority claimed that they would like to be able to answer patient questions (92.4%); 93.1% declared a need to create clear guidelines for using cannabinoids in clinical practice. Furthermore, 71.7% believed that medicines containing cannabinoids and 52.0% that herbal cannabis should be reimbursed (3). Conclusion: Most medical doctors do not feel prepared for patient counseling. They could benefit from targeted educational interventions. We have also identified physicians’ preferences that might inspire the stakeholders involved who are critical for shaping policies regarding cannabis-based therapeutics. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

11 pages, 268 KiB

Open AccessArticle

Psychoactive Substances Taken with Mephedrone and HCV Infection

by Michal Ordak, Tadeusz Nasierowski, Elzbieta Muszynska and Magdalena Bujalska-Zadrozny

J. Clin. Med. 2021, 10(15), 3218; https://doi.org/10.3390/jcm10153218 - 21 Jul 2021

Cited by 1 | Viewed by 1976

Abstract

Background: In recent years, the observed frequency of hospitalization of patients taking mephedrone with other psychoactive substances has increased. There are no data in the literature on the effect of mephedrone use on liver function in patients, including the frequency of HCV infection. We have analysed the impact of taking mephedrone together with other psychoactive substances on the incidence of HCV infection. We have also analysed the effect of taking mephedrone with heroin, alcohol, and benzodiazepines on liver enzyme levels. Methods: The study included patients taking mephedrone with: alcohol (n = 115), heroin (n = 85) and benzodiazepines (n = 130) hospitalized in 2010–2018. The control group consisted of patients addicted to alcohol (n = 180), heroin (n = 221) and benzodiazepines (n = 152). Clinical data and laboratory findings were collected from medical records. Results: Taking mephedrone together with benzodiazepines is a statistically significant predictor of HCV infection in this group of patients, OR (8.44); 95% CI 5.63–12.64; p < 0.001). A statistically significant interaction of the group with HCV infection was observed, i.e., for the level of alanine transaminase (p < 0.001) and aspartate transaminase (p < 0.001). Increased levels of liver enzymes in each of the studied groups was characteristic in patients with HCV infection (p < 0.001). Taking additional mephedrone by this group of patients did not increase the level of liver enzymes. Conclusion: HCV infection is a statistically significant factor affecting the increase in liver enzymes levels in the group of patients taking mephedrone. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

12 pages, 1125 KiB

Open AccessArticle

Increasing the Effectiveness of Pharmacotherapy in Psychiatry by Using a Pharmacological Interaction Database

by Michal Ordak, Tadeusz Nasierowski, Elzbieta Muszynska and Magdalena Bujalska-Zadrozny

J. Clin. Med. 2021, 10(10), 2185; https://doi.org/10.3390/jcm10102185 - 18 May 2021

Cited by 1 | Viewed by 1949

Abstract

Recent studies have shown that the knowledge of pharmacological interaction databases in global psychiatry is negligible. The frequency of hospitalizations in the case of patients taking new psychoactive substances along with other drugs continues to increase, very often resulting in the need for polypharmacotherapy. The aim of our research was to make members of the worldwide psychiatric community aware of the need to use a pharmacological interaction database in their daily work. The study involved 2146 psychiatrists from around the world. Participants were primarily contacted through the LinkedIn Recruiter website. The surveyed psychiatrists answered 5 questions concerning case reports of patients taking new psychoactive substances along with other drugs. The questions were answered twice, i.e., before and after using the Medscape drug interaction database. The mean percentage of correct answers given by the group of psychiatrists who were studied separately in six individual continents turned out to be statistically significantly higher after using the pharmacological interaction database (p < 0.001). This also applies to providing correct answers separately, i.e., to each of the five questions asked concerning individual case reports (p < 0.001). Before using the drug interaction database, only 14.1% of psychiatrists stated that they knew and used this type of database (p < 0.001). In the second stage of the study, a statistically significant majority of subjects stated that they were interested in using the pharmacological interaction database from that moment on (p < 0.001) and expressed the opinion that it could be effective in everyday work (p < 0.001). Using a pharmacological interaction database in psychiatry can contribute to the effectiveness of pharmacotherapy. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

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10 pages, 206 KiB

Open AccessArticle

Adherence to Prescribed Acamprosate in Alcohol Dependence and 1-Year Morbidities and Mortality: Utilizing a Data Linkage Methodology

by Serenella Tolomeo and Alex Baldacchino

J. Clin. Med. 2021, 10(10), 2102; https://doi.org/10.3390/jcm10102102 - 13 May 2021

Cited by 2 | Viewed by 2671

Abstract

Objectives: We tested the hypothesis that poor adherence is associated with a greater risk of alcohol-caused mortality and morbidities within the first year of discontinuing this medication. Materials and Methods: A retrospective cohort study of 3319 individuals who received acamprosate in the East of Scotland in a 10-year period was conducted using a health informatics approach with record linkage of dispensing data, hospital utilization (SMR) and General Register Office of Scotland (GROS) data. The primary outcome was adherence between one to six months after initiating acamprosate medication. The secondary outcome was all-cause morbidities and mortality. Results: Of the total 3319 individuals identified, a good adherence index of >80% was found in 59% of those prescribed acamprosate after three months and 6% after six months. There were significant linear trends of poorer adherence with increased risk of alcohol-caused mortality (Hazard Ratio, HR 1.2), medical morbidities especially neoplasm (HR 4.1) and poisoning (HR 1.4), and psychiatric morbidities especially stress (HR 35.1), psychotic (HR 5.6) and neurotic disorders, and directly alcohol induced conditions (7.4 HR) after adjustment for other factors within a one-year period of initiation of acamprosate treatment. Discussion and Conclusions: Further exploratory studies using this digitalized approach should be encouraged in order to capture role of compliance to acamprosate and other types of medication that are known to reduce relapse into alcohol dependence and its direct relationship to mortality and morbidities in this population. Full article

(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)

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