Substance Use Disorders Among Industry Workers in Egypt Background and Objective: Substance abuse in the workplace is a major public health problem. The objectives of this study are to: (1) to determine the prevalence and associated risk factors of substance abuse, drug-related problems, and drug dependence among industrial workers; (2) to identify patients' views of the pros and cons of their drug use and their treatment readiness; and (3) to assess the severity of substance abuse according to the Addiction Severity Index (ASI) scale in substance users. Subjects and Methods: A total of 353 industrial workers from 5 factories in 10th of Ramadan city in Egypt were included in the study. The participants were interviewed to collect sociodemographic and clinical data using the Structural Clinical Interview for DSM-IV-Axis I (SCID-I), the Drug Use Disorder Identification Test (DUDIT), DUDIT-Extended version and the Addiction Severity Index (ASI). The participants were screened for drug abuse by urine analysis. Results: The prevalence rates of smoking and substance abuse were 27.6% and 18.3%, respectively. The most commonly abused drugs were tramadol (66.2%), cannabis (55.4%), and alcohol (38.5%). Compared with controls, smokers and substance users were more likely to be males and were older. Smokers were 7 times more likely to use substances. Substance dependence was associated with a younger age of substance use onset and alcohol abuse. Conclusions: Smoking and substance abuse are common among industrial workers. Tramadol and cannabis are the most commonly abused substances. Smoking, older age, and male sex are correlates of substance abuse. Alcohol abuse is associated with dependence.

Familial Opioid Misuse and Family Cohesion: Impact on Family Communication and Well-being Objectives: This study aimed to understand family communication and overall well-being of young adults in the context of familial opioid misuse using the family systems framework. Methods: A cross-sectional, mixed-methods, online survey of young adults aged 18 to 30 years (n=137) was conducted. A cluster analysis was performed based on family organization and structural characteristics. MANCOVA was utilized to compare groups identified using the cluster analysis in terms of (1) family’s belief about opioid misuse, (2) worry regarding opioid misuse, (3) family communication, and (4) overall well-being of young adults. Results: A cluster analysis resulted in three groups (group 1: no familial opioid misuse with high family cohesion; group 2: familial opioid misuse with moderate family cohesion; group 3: those with/without familial opioid misuse and low family cohesion). Group 3 had the lowest family communication compared to group 1 and group 2 (P<0.001 and P=0.001, respectively) and had lower overall well-being compared to group 1 (P=0.008). Group 2 had a higher worry score than group 1 (P<0.001). Qualitative analysis using Labov’s narrative analysis elucidated that having someone misusing opioids with other substances (eg, alcohol) in the family can negatively impact the emotions of family members. Conclusions: Our findings indicated that family cohesion had a greater impact on family communication and overall well-being of young adults even in the presence of familial opioid misuse. This suggests that higher family cohesion may positively influence young adults to cope with issues related to familial opioid misuse.

Pregabalin Does Not Reduce Opioid Withdrawal Symptoms: A Randomized Controlled Trial Background and Aim: Controlling the symptoms of opioid withdrawal syndrome is important for the treatment of opioid addiction. There is very limited evidence on the effectiveness of pregabalin on opioid withdrawal syndrome. The present study examines the effectiveness of pregabalin in reducing opioid withdrawal symptoms. Methods: This double-blind clinical-trial was conducted on noninjecting opioid users diagnosed with opioid dependence and referred to the Addiction Treatment Center of Khorshid Hospital in Isfahan, Iran, in 2015 and 2016. The patients were divided into intervention and control groups, and both groups received Buprenorphine for the routine management of opioid withdrawal syndrome. The intervention group additionally received 450 mg/d of pregabalin while the control group received placebos. Opioid withdrawal symptoms were evaluated using the Short Opioid Withdrawal Scale (SOWS). Data were analyzed in SPSS-20. Descriptive data were reported as mean±SD. The analytic data were analyzed using the repeated-measures ANOVA. The level of statistical significance was set at P-value<0.05. Results: The mean age was 41.58±10.09 in the intervention group and 44±8.87 years in the control group (P=0.47). None of the assessed signs and symptoms differed significantly between the 2 groups. Conclusions: The results did not show the superiority of the 450-mg/day pregabalin regimen versus the placebo for controlling the symptoms of opioid withdrawal syndrome. Further studies administering higher doses of pregabalin are recommended.

The Effects of Repetitive Transcranial Magnetic Stimulation in Reducing Cocaine Craving and Use Given the scale and complexity of cocaine abuse in individual, social and public health terms, new forms of treatment are urgently needed. The therapeutic uses of Transcranial Magnetic Stimulation (TMS) for reducing consumption by those who abuse cocaine have been explored since 2003. This article reports an integrative review of seven trials carried out from 2007 to 2016, investigating the use of TMS on subjects abusing cocaine. The analysis was categorized into 5 different topics (1) area of intervention; (2) hemisphere; (3) number of pulses and intensity; (4) safety and adverse effects; and (5) other outcomes. Most of the trials found promising results of craving and/or use reduction with repetitive TMS (rTMS). Future interventions should consider the use of TMS as part of rehabilitation therapies.

Game Addiction Scale for Adolescents: Arabic Version Validation Objectives: This study is aimed to translate the game addiction scale for adolescents into Arabic language and to test reliability and validity of the Arabic version. The game addiction scale for adolescents was developed to measure computer and video game addiction based on the criteria of pathological gambling in DSM-IV. Methods: The scale has been translated into Arabic. The English and Arabic versions were compared by psychiatry experts to ensure consistency and then they were administered to bilingual individuals who played computer and video games. Finally, the Arabic version was distributed among 50 school students, aged 10 to 19 years, who played computer and video games. Results and Conclusions: The data were collected from school students. The statistical analysis of the Arabic version of game addiction scale for adolescents showed that the Arabic/English validity was satisfactory, with proper internal consistency and reliability.

Alcohol Consumption by Older People in Brazil: A Systematic Review of Population-based Studies Introduction: Given the rapid population aging taking place in countries like Brazil and in many other countries, understanding patterns of alcohol consumption by older people and the associated factors are important. Methods: The databases MEDLINE, Embase, and LILACS were searched for population-based studies on the prevalence of current alcohol consumption among Brazilians aged over 60. Results: Eight eligible studies were identified. Two studies reported data on binge drinking, with one national study finding a prevalence of 10.3%, while the other (male subjects only) found higher prevalences (27.1% and 13.7% at 2 sites). Heavy drinking was estimated in 4 studies with prevalences varying from 2.9% to 7.3%. Alcohol dependence was estimated in 3 studies, 1 used the DSM-IV diagnosis criteria and found a prevalence of 3.8%, while the other 2 used screening tools and found higher prevalences of 8.2% and 9.2%. Being male and younger were associated with several of the above patterns of alcohol consumption. Higher education was associated with binge and heavy drinking, and low education and socioeconomic status with alcohol dependence. Discussion/Conclusions: These findings show that in Brazil problems related to alcohol use by the elderly remain relatively unknown. There was a high heterogeneity of methodologies in the studies, making it difficult to summarize the findings and produce prevalence estimates for the different patterns of consumption. More homogenous studies using similar definitions of patterns of alcohol consumption are required to allow comparisons to be made between different Brazilian regions and other countries.

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.

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.