Heroin Addiction and Related Clinical Problems 2005; 7(1):7-18
Buprenorphine induction and stabilisation in the treatment of opiate dependence
Doran C., Holmes J., Ladewig D., Ling W.
Jeremy Holmes, PMSI Healthcare, White Lion House, 64 Highgate High Street, London N6 5HX, UK, Email: JHolmes@pmsi-consulting.com
Summary: Many early trials of buprenorphine in opiate dependence used fixed doses and slow induction protocols. However, more recent data show that subjects requiring higher doses need to be stabilised more rapidly. Analysis of ten trials suggests a relationship between days taken to reach a 6 mg buprenorphine tablet equivalent dose and retention of subjects at 4 weeks. Recent US studies show that dosage can be stepped up quickly, e.g. 8 mg on Day 1, 16 mg on Day 2. Maintenance dosage should then be adjusted to meet patients’ clinical needs; fixed dose studies ignore the breadth of buprenorphine’s effective dose range.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2005; 7(1):19-30
Clinical significance of electroencephalographic abnormalities in heroin addicts: Systematic review
Polunina A. G., Davydov D. M., Briun E. A.
Dr. Anna Polunina, 156-368 Leninsky pr-t Moscow 119571 Russia. E-mail anpolunina@mail.ru, Tel/Fax: + 7-095-438-7624
Summary: The present review is the result of a systematic attempt to collect and analyze all the available contemporary data on neurological and psychophysiological aspects of EEG changes in heroin addicts. These data offer valuable objective insights into clinically significant encephalopathic and/or disintegrative processes in these patients. Thirteen computer EEG studies published since 1995 have been analyzed. It can be concluded that the sensitivity of computer EEGs to heroin-induced brain alterations is comparable with other contemporary neuroimaging techniques. In any case, precise recommendations for their use in regular medical practice must await further extensive research in this field.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2005; 7(1):31-38
Alcohol abuse in heroin addicts: An unfolding metabolic destiny
Pacini M., Mellini A., Attilia M. L., Ceccanti M., Maremmani I.
Matteo Pacini, MD, PISA-SIA Group, Via di Pratale, 3 - 56127 Pisa, Italy. E-mail: paciland@virgilio.it
Summary: This paper deals with the issue of alcohol-abusing heroin addicts. On the basis of clinical and epidemiological findings, a view is presented which links the two kinds of abuse along a common metabolic pathway. Some data about the former history of opiate abuse in treatment-seeking alcoholics help to indicate which heroin-related features may influence the incidence and severity of alcohol abuse in heroin addicts. Observations point to alcohol abuse as one possible pathological outcome of the opioid metabolic impairment underlying heroin addiction. When alcohol is a surrogate for heroin, social adjustment improves, but the metabolic destiny does not change, and the medical outcome is worsened to some extent by the low chances of curing a possible actual alcoholism to come. Correctly handled agonist treatments are crucial in preventing that kind of negative outcome, whereas alcohol abuse as an opioid equivalent calls for greater attention, to allow adequate assessment of the effectiveness of treatment programmes for opiate addiction.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2005; 7(1):39-46
Fuscone A., Correale M., Romualdo M., Bianchi W.
Dr. Andrea Fuscone, ASL Napoli 1 DS 44 , U.O. Tossicodipendenze "Palomar" - Via Manzoni, 249 - 80123 Napoli, Italy, EU E-mail: Anfuscon@box.tin.it
Summary: The present study aims to assess the effectiveness of buprenorphine treatment in countering predictable withdrawal from street opiates in 68 opiate-addicts who requested admission to an in-patient opiate detoxification facility. Buprenorphine was administered at flexible doses, on a patient-blind clinical basis. Withdrawal was assessed by scoring a range of symptoms at the start of treatment (T0) and three more times during treatment (T1-T3). The dropout rate was 14.7% and was not predicted by baseline clinical features. The average duration of treatment was 7.5 days. By then, buprenorphine had provided patients with quick-acting, stable protection against withdrawal symptoms and was well tolerated. Additional drugs were successfully resorted to when non-specific symptoms such as anxiety and insomnia were prominent. Buprenorphine proved effective in soothing withdrawal-related symptoms in a subgroup of mildly ill subjects. The short-term dropout in this population did not seem to be related to the severity of baseline withdrawal or to the absence of earlier improvement under buprenorphine.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2005; 7(1):47-48
Payte J. T.
J. Thomas Payte, MD; Colonial Management Group, LP, Corporate Medical Director - 14050 Town Loop Blvd., Suite 204 • Orlando, Florida 32837- USA - Phone (407) 351-7080 • Fax (407) 351-6930
Summary: Not available
Publication Type: Letter to editor
Heroin Addiction and Related Clinical Problems 2005; 7(2):5-10
Dyer K. R.
Dr. Kyle R. Dyer, PhD, School of Medicine and Pharmacology MBDP M510, University of Western Australia, QEII Medical Centre, 35 Stirling Highway, Crawley WA 6009 Australia. E-mail kdyer@receptor.pharm.uwa.edu.au
Summary: The rationale for methadone maintenance is to stabilise the pharmacological condition of illicit opioid users, thereby providing an opportunity to normalise health and social functioning. The extent to which methadone is effective for any given individual may be governed by the degree to which methadone prevents opioid withdrawal symptoms, in the absence of significant opioid adverse effects. Mood and anxiety disorders are common within opioid-dependent patients, and there is some evidence to suggest that these disorders may affect the response to treatment. This paper will describe the relationship between plasma (S)- and (R)- methadone concentration, opioid withdrawal, and state and trait mood disturbance. A series of studies have demonstrated that significant mood changes occur in response to changes in plasma methadone concentration, and that these mood changes are more pronounced in those who experience opioid withdrawal. Concentration-effect relationships suggest that relatively small changes in plasma concentration result in significant mood change. An important implication from this research is that consideration of individual differences in methadone pharmacokinetics is necessary for understanding the aetiology of observed mood disturbance among methadone dependent patients. Implications for the clinical management of methadone patients, including the assessment of, and response to, mood disorders and the implications for therapeutic drug monitoring within methadone maintenance programs will be discussed.
Publication Type: Brief Communication
Heroin Addiction and Related Clinical Problems 2005; 7(2):11-18
Long-term treatment for patients with severe mental illness and substance abuse
Blix O., Eek U.
Olof Blix, MD. The “D.D.” Department of Psychiatry, County Hospital, Ryhov, SE-551 85 Jonkoping, Sweden, EU
Summary: Drug and alcohol addiction is common among patients with severe mental illness. Those patients often fall between different treatment systems. Since 1994 a long-term treatment for patients with this kind of “Dual Diagnosis” has been going on in the city of Jonkoping, Sweden. It is a joint programme with staff both from the local social services and the psychiatric clinic. A team of six people, three social workers and three nurses with special education in psychiatry, are working with a group of at most 35-40 patients. A stepwise treatment lasts for a minimum of 3 years, after a model constructed and evaluated in the U.S. (Meuser and Drake, New Hampshire). The aim of the treatment is enduring retention leading to the stabilization of both problem areas. The treatment goals are set by each client. Great attention is given to training in social skills. Between 1994 and 2004, 82 patients in all were in the treatment programme. The results of the treatment programme are presented.
Publication Type: Research report
Heroin Addiction and Related Clinical Problems 2005; 7(2):19-24
Good practice, good results. Maintenance treatment outcomes in France
Coppel A.
Dr. Anne Coppel: Association française de Réduction des risques (AFR) - 45 rue de Montreuil 75011, Paris, France, EU
Summary: In 2004, a public debate emerged on the misuse of, and trafficking in, prescribed drugs. Because of their positive outcomes, maintenance treatments were not officially questioned. A national evaluation showed that the decrease of 80% in fatal overdoses and of 67% in arrests for heroin use (1994-1999) were directly connected with treatment accessibility. This assessment resulted in a consensus among addiction and public health experts. These good results have not, however, been published by the mass media, and the general public still is unaware of them. Nor were the causes of these good results were not discussed among health professionals. They are not only due to the medications involved, but to good clinical practices. The first practitioners who started to prescribe maintenance treatment had followed extensive training, and were networking and building relationships of trust with their patients. Against the background of this public debate, a consensus conference on maintenance treatments organized in 2004 recommended that the prescribing GPs should be better trained, and that they should be included in professional networks. Although these recommendations gave priority to the improvement of clinical practices, the authorities have decided to implement control measures over patients. These measures might make access to treatment more difficult, and they fail to support the involvement of GPs and pharmacists. The effectiveness of substitution treatments could be affected.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2005; 7(2):25-30
The endogenous cannabinoid system: Physiological modulation of neuronal activity
Marsicano G.
Dr. Giovanni Marsicano, Institute of Physiological Chemistry, Johannes Gutenberg-Universität Mainz, Duesbergweg 6, 55128 Mainz, Germany. E-mail: marsi@uni-mainz.de
Summary: The endogenous cannabinoid system in the brain consists of the seven transmembrane cannabinoid receptor type 1, its endogenous lipid ligands (endocannabinoids) and the enzymatic machinery for their synthesis and degradation. By genetic, pharmacological, biochemical and behavioural approaches, our group has recently described several physiological functions of the endogenous cannabinoid system, such as processing of aversive memories, neuroprotection against excitotoxicity and regulation of energy balance. These and other results indicate that the endogenous cannabinoid system is centrally involved in many physiological functions and that pathological alterations in defect or in excess of its activity might participate in the progress of several diseases
Publication Type: Short communication
Heroin Addiction and Related Clinical Problems 2005; 7(2):31-36
Hennebel L. C., Stöver
Dr. Laetitia Hennebel. Cranstoun Drug Services - ENDSP/ENDIPP, United Kingdom. E-mail: lhennebel@cranstoun.org.uk
Summary: The objective of this study was to examine policies in place for the provision of substitution treatment in prisons and existing practices in 18 European countries. The report presents findings per country through ‘country reports’, together with ‘emerging issues’ across the countries, which inform the recommendations made at the end.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2005; 7(2):37-48
Medical meaning of psychosocial issues of heroin addiction
Pacini M., Maremmani I.
Matteo Pacini, MD - "G. De Lisio" Institute of Behavioural Sciences, Via di Pratale 2, 56100 - Pisa, Italy, EU e-mail: paciland@virgilio.it
Summary: Drug addiction is often characterized by psychosocial highlights, so that it has been repeatedly depicted as a social disease, although to differing degrees. A variety of interventions have been proposed and applied as therapies, more on the basis of intentions than of scientific prospects of success: in fact, they all seem to share common roots in conceptions of addiction as being the outcome of a vicious social dynamic. The scientific vision of addiction as a medical issue allows a more reasonable evaluation of addiction-related social issues, both on pathophysiological and therapeutic grounds. To date, advisable first-line interventions for drug addiction have not been of a psychosocial kind. On the other hand, psychosocial markers have been crucial in assessing the effectiveness of pharmacological treatments since the very earliest stages of research in the field of methadone treatment. Furthermore, psychosocial adjustment and well-being should always be measured when newer approaches are tested, since they are crucial in allowing meaningful comparisons between treatment options. Lastly, a subgroup of heroin addicts, who suffer from severe psychosocial impairment, partly unrelated to addiction, should be offered psychosocial facilities as soon as they have been stabilized on an agonist treatment: predictably, their psychosocial well-being will not, as happens with others, follow the remission of drug abuse, but maintenance treatment will make them suitable for so-called pharmacologically assisted rehabilitation programmes.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2005; 7(3):5-20
Psychotherapy for patients in methadone treatment
Bignamini E., Zazza S.
UOA Patologie da Dipendenza, ASL 3, Corso Lombardia 187, 10149 Torino, Italy, EU. E-mail: bignamini@asl3.to.it
Summary: The management of methadone treatment requires the doctor to have a good level of relational and psychopathological competence. Drug addiction is a pathological condition, and may be defined as a “pleasure disorder” that comprises the following features: greed, compulsive mourning for the lost object, regrets for the fusional-heroic dimension. These features require psychotherapeutic treatment, which may be applied using the specific techniques developed by different schools (of psychodynamic, systemic relationship, behavioural-cognitive and group therapy).
Publication Type: Review Article
Heroin Addiction and Related Clinical Problems 2005; 7(3):21-26
Di Petta G., Leonardi C.
Via VI Trav. Indipendenza - 80026-Casoria (NA) E-mail: fabiodino@libero.it
Summary: In a large but neglected district north of Naples, Italy, the Department for Dependencies has adopted a new treatment strategy: high-dose sublingual buprenorphine tablets for broad-spectrum, long-term use against opiate dependency. The trial is still in progress. 650 patients in the study from three U.O.SER.T. branches were included and received long-term treatment with buprenorphine. At present, 600 patients remain in treatment. The following parameters were investigated: overdose, morphine in the urine, side-effects, social and occupational reintegration, compliance with psychotherapeutic and rehabilitational treatments and reduction in the costs of hospitalization. The results show how compliance with broad-spectrum, high-dose, long-term buprenorphine treatment proves beneficial both from a clinical viewpoint and from a socio-economic one. The data suggest that: buprenorphine is not only indicated for patients with mild-to-moderate drug dependency; patients receiving buprenorphine <16 mg may be at risk of relapse into heroin use or to dropping out, with a consequent need for re-initiation of treatments; high-dose, long-term buprenorphine was remarkably effective in terms of reducing withdrawal and craving, and maintaining patients in lasting programmes of psychosocial rehabilitation; high-dose buprenorphine offers a new innovative treatment strategy in the integrated approach to opiate dependency.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2005; 7(3):27-32
Peles E., Bodner G., Adelson M.
Adelson Clinic, 1 Henrietta Szold St. Tel-Aviv 64924 Israel
Summary: Methadone dosage has been widely related to the degree of enduring opiate use and polyabuse while on methadone, lower dosages favouring partial rather than complete response and a worse outcome. Up to certain threshold, methadone blood levels seem to be directly related to oral dosages, thus supporting the clinical evidence of a methadone-induced, dose-dependent remission of addictive behaviour through a serological marker. In order to assess the clinical meaning of methadone blood levels, and its relationship to oral dosages, we performed an evaluation of 114 methadone treated subjects, who were stable on methadone dosages ranging from 40 to 290 mg (mean 171.7±50.8 mg). Lower methadone dosages correspond to lower blood levels and a higher rate of opiate abuse while on treatment. Non-opiate substance abuse characterized patients on higher methadone dosages, whose methadone blood levels were in fact higher. Cocaine abusers had higher methadone dose regardless of concurrent opioid abuse, while benzodiazepine abuse plays a role in respect to dosage only in those who do not abuse opioids. Blood testing also showed an inverse relationship between methadone dose and blood sodium, which warrants further investigation
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2005; 7(3):33-46
Maremmani I., Pacini M., Perugi G.
"Santa Chiara" University Hospital, Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy, EU E-mail; maremman@med.unipi.it
Summary: Impulsiveness is a typical feature of mood elation states, with a double link: on one hand, impulsive behaviour is favoured by manic states, on the other manic states are accompanied by a drive towards pleasurable objects and situations, which are repeatedly sought after, and may become prominent in the life of the individual. Mood elation does not bring with it its own antidotes, but, conversely, brings exposure to increasing levels of pro-manic stimulation, in a self-regenerating circuit. On epidemiological grounds, some observations can be cited: 1) impulse control disorders can be viewed as closely linked with bipolar disorders, especially when minor excitement (hypomania) and the whole bipolar spectrum are taken into account, beyond full-blown bipolar I patterns; 2) impulse control disorders tend to cluster, suggesting common grounds of pleasure-seeking and reward, regardless of the specific objects that are craved for in different periods or moments. Substance abuse can be read as one kind of impulse control disorder, linked to others and to the bipolar spectrum by a self-regenerating dynamic. Addiction is an autonomous disorder which can be seen as the extreme degree of an impulse control disorder, with paroxysmal craving and a self-maintaining or relapse-inducing course. Impulse control disorders, the bipolar spectrum and substance abuse also share some distinctive symptoms displayed during depressive states or during protracted abstinence, described under the name “hypophoria” and probably underlying the impairment of the brain-rewarding system.
Publication Type: Review Article
Heroin Addiction and Related Clinical Problems 2005; 7(3):47-50
Bridging the preclinical - clinical gap
Nutt D. J., Lingford-Hughes A., Daglish M., Williams T., Taylor L., Wilson S., Davies S., Melichar J., Myles J.
University of Bristol, Psychopharmacology Unit, Dorothy Hodgkin Building, Whitson Street, Bristol BS1 3NY, UK, EU E-mail: David.J.Nutt@bristol.ac.uk
Summary: Not available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2005; 7(3):51-52
Mortality and retention of drug users in GP Shared Care in Glasgow
Gilhooly T.
Dr T C Gilhooly Parkhead Health Centr 101 Salamanca Street Glasgow G31 5BH E-mail: Scivor@aol.com
Summary: Not available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2005; 7(3):53-56
Working with the patient for optimal treatment outcomes in UK General Practice
Ford C., Oliver J., Whitehead B.
Lonsdale Medical Centre, 24 Lonsdale Road, London, NW6 6RR, UK
Summary: Not available
Publication Type: Letetr to the Editor
Heroin Addiction and Related Clinical Problems 2005; 7(4):5-22
Finnegan L., Amass L., Jones H., Kaltenbach K.
Loretta P. Finnegan, MD - Office of Research on Women's Health, NIH - 1 Center Drive, Room 208 Bethesda, MD 20892, USA - ph: 301-496-7745 fax: 301-402-0005
Summary: Addiction during pregnancy contributes to maternal and infant morbidity including pre-term deliveries, low birth weight, neonatal withdrawal, lengthy neonatal intensive care and infant mortality. Combined use of pharmacological and behavioral treatment approaches in managing pregnant opioid-dependent women has been shown to be beneficial for improving treatment retention and reducing maternal drug use. Clinicians should understand the complex biopsychosocial factors that make the treatment of opioid-dependent pregnant women a challenge as well as the principles and the differences in using methadone or buprenorphine combined with behavioral treatment. Researchers should consider continued studies on the use of methadone during pregnancy, relationship of maternal dose and neonatal abstinence, the differences between methadone and buprenorphine, and the impact of pharmacological options on patients and treatment providers.
Publication Type: Review article
Heroin Addiction and Related Clinical Problems 2005; 7(4):23-30
Primary care physicians and addiction treatment in Germany. Decentralization and take-home policy
Ulmer A.
Albrect Ulmer, MD, Schwabstr. 26, D-70197 Stuttgart, Germany, EU. Phone +49-711- 626308 Fax +49-711-610074 E-mail: albrecht.ulmer@gmx.de
Summary: Medical knowledge is not always discovered in universities and laboratories, before finally trickling down to primary care physicians. In some cases, the very opposite is true. Even in Germany, primary care physicians have sometimes been the first to develop new methods of treatment and introduce them in day-to-day medical practice. Unfortunately, the German medical system is unaccustomed to listening to their voice. As a result, new treatment methods introduced by this route meet with specific difficulties. Maintenance therapy for drug addicts was introduced in Germany in the 1980s, mainly by primary care physicians in the face of major resistance from the medical establishment. The need to take action was high, however, and primary care physicians were the professionals who felt this most keenly. Increasing numbers of primary care physicians started putting patients on maintenance therapy. Dihydrocodeine was the agent most frequently chosen, as methadone was prohibited until 1992. Responses were excellent for committed physicians who ensured that the necessary arrangements were in place. However, because of the lack of integration in established medical practice, unstructured prescription was rife, leading to new problems and culminating in a series of deaths. The official reaction was to tighten the regulations, with the consequence that most primary care physicians have given up. Maintenance is now predominantly offered by special maintenance centers, leading to a strong concentration of these specific patients. France and Croatia, but also other countries show us ways out of this dilemma. Decentralized, very liberal maintenance policies in France make maintenance easy and successful. We can learn, that a good support system for the practitioners helps to avoid quality problems, crucially, from the Croatian model.
Publication Type: Report to EUROPAD
Heroin Addiction and Related Clinical Problems 2005; 7(4):31-42
Kozlov A. A., Dorovskih I. V., Doljanskaia N. A., Buzina T. S., Polunina A. G.
Alexander A. Kozlov, MD - National Research Center on Addictions (NRCA) - Stavropolskaya st. 27-7, Moscow, Russia, 109559
Summary: The topic of the present study is the clinical picture of psychopathological symptoms during post-withdrawal periods in heroin addicts. Craving symptoms can be compared to productive psychopathological symptoms, and their intensity usually corresponds to the severity of depressive disorders in heroin ex-addicts. Risperidone is therefore a preferred choice for craving control when opiate maintenance therapy is unavailable (as it is currently in Russia). This antipsychotic showed its effectiveness and safety during prolonged anti-relapse therapy in the out-patient treatment of heroin addicts.
Publication Type: Clinical practice
Heroin Addiction and Related Clinical Problems 2005; 7(4):43-48
Pacini M., Maremmani I.
Icro Maremmani, MD - Department of Psychiatry NPB, University of Pisa, Via Roma 67- 56100 PISA, Italy - E-mail: maremman@med.unipi.it
Summary: Clinicians are in agreement about the primary psychotropic properties of opiate drugs, but the issue of opioid abuse liability and physical dependence has hampered research. Despite this, the psychotropic properties of therapeutic opiates can be investigated indirectly in populations of dual diagnosis heroin abusers. We retrospectively evaluated the clinical files of 114 consecutive heroin addicts admitted for in-patient treatment of manic and/or acute psychotic episodes, in order to assess the relationship between methadone treatment during hospitalization and prescriptions at discharge. Regardless of the reasons for their hospitalization, subjects receiving increasing dosages of methadone were judged to be less in need of antimanic and antipsychotic drugs at discharge. These results support the idea that methadone has quick-acting anti-dysphoric and anti-impulsive properties which apply to a wide range of psychiatric disorders.
Publication Type: Research Article
Heroin Addiction and Related Clinical Problems 2005; 7(4):49-58
Methadone serum concentration and its relationship to methadone dose revisited
Okruhlica L., Valentova J., Devinsky F., Formakova S., Klempova D.
Lubomir Okruhlica, M.D., Ph.D., Centrum pre lieebu drogovych zavislosti, Hranicna 2, P.O. Box 51, 827 99 Bratislava 2, Slovack Republic. Phone/Fax +421 2 5341 7475 E-mail; okruhlica@cpldz.sk
Summary: The study sample included 64 patients, who were divided into two subgroups on the basis of their daily methadone dose: ´Group 1´: 29 patients with doses up to 80 mg; ´Group 2´: 35 patients with doses above 80 mg. The overall correlation in the whole group was: r = 0.570. A strong correlation was found between dose and serum concentration in ‘Group 1’: r = 0.799. Non-significant correlation close to zero was found in ‘Group 2’. Our findings suggest that the linear relationship between methadone dose and its serum concentration in lower doses cannot be extrapolated to higher doses.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2005; 7(4):59-66
Medical and social factors determining early poly-drug dependence
Chernobrovkina T. V., Igor A. Nikiforov I. A.
Dr. I.A. Nikiforov Institute of Post-Graduate Education, "Medbioextrem" Federal Board of the Russian Health Ministry, Moscow. E-mail: nikiforov@3psy.com
Summary: Adolescent narcotism has grown into an epidemic in Russia. Younger drug experimenters seem to run a higher risk of habitual involvement in drug use as a lifestyle, which also makes them liable to develop addictive diseases through enduring exposure to drugs. Moreover, polyabuse seems to be the rule among younger addicts, which increases the likelihood that physicians will have to deal with multiple addictive pictures, destined to a poor outcome and pervasive disruption. Upbringing, environmental ties and opportunities, economic status and family-related lifestyle may play a crucial role in supporting or discouraging a sensation-seeking lifestyle, although personality factors come first in establishing a risk disposition. In any case, on preventive grounds, the identification of stereotypes in drug user populations may offer a helpful means of impeding or reversing the transition from experimental drug use to habitual drug use and then addiction. The administration of a 20-item psychosocial questionnaire to a sample of 150 subjects aged between 7 and 18 helped us to ascertain the prevalence of social problems and drug use trends in a younger risk population. The handling of pleasure-seeking drives and needs by environmental facilities may reduce youngsters’ interest in substance use and provide them with other kinds of practical, spiritual and pleasurable habits.
Publication Type: Research Report