Adolescent gambling and substance use are viewed as a public health concern internationally. The early onset age of gambling is a known risk factor for developing gambling problems later in life. The aims of this study are: to evaluate the internal consistency reliability, factorial validity and classification accuracy of the Finnish version of DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) criteria measuring at-risk/problem gambling (ARPG); to examine gender differences in gambling participation, ARPG and substance use among first-year junior high school students; and to investigate the association of gambling and gaming (video game playing) participation, substance use and social variables with ARPG.
This study examined 988 adolescents (mean age 13.4 years) at 11 public schools in Finland between October-December 2013. The response rate was 91.6%. Chi-squared test and binary logistic regression analysis were used.
‘Illegal acts’ was the most endorsed and sensitive, but the least specific criteria identifying ARPG. During the past year, 51.6% of the respondents had gambled, 7.9% were identified as at-risk/problem gamblers (DSM-IV-MR-J score ≥ 2), 8.0% had smoked and 8.9% had been drinking for intoxication, and the first three were significantly more common among boys than girls. The odds ratio of being a male past-year at-risk/problem gambler was 2.27, 5.78 for gambling often or sometimes, 2.42 for video game playing weekly or more often and 6.23 for having peer gamblers.
Overall, the Finnish version of the DSM-IV-MR-J had acceptable internal consistency reliability and factorial validity. None of the DSM-IV-MR-J criteria were accurate enough to screen ARPG per se. ARPG past-year prevalence was relatively high with males gambling more than females. ARPG was as common as drinking alcohol for intoxication and smoking. Peer gambling was strongly associated with ARPG. Efficient strategies to minimise the risks of gambling problems, tools for prevention and identification of ARPG among the underage are needed.
Adolescents; At-risk/problem gambling; DSM-IV-MR-J; Gender; Smoking; Social variables; Substance use
Substance abuse and gambling problems are associated, however, studies on gambling problems among opioid substitution treatment (OST) patients are scarce. The aims of this study are to explore the association of gender, age, treatment medication and treatment program with gambling behaviour, including gambling participation and gambling problems, among OST patients.
All OST patients (n = 244) in three Finnish outpatient clinics were recruited in March - April 2014. The response rate was 64.3%. OST programs included two choices of orientation (rehabilitative/harm reduction) and two choices for treatment medication (methadone/buprenorphine-naloxone). Of 144 respondents, 70.1% had gambled during the past year and 12.5% were identified as potential past-year problem gamblers. Gambling was statistically significant more commonly among males (79.8%) compared with females (53.7%). Similarly patients in the rehabilitative program gambled (75.9%) more than those in the harm reduction program (50.0%). Gender, age, treatment medication or treatment program was not associated with past-year gambling problems.
Gambling participation of the OST patients seemed to be somewhat similar compared with the Finnish general population, but gambling problems were more common among OST patients. Gender and age may not be very strong indicators of risk while screening problem gamblers among OST patients. Institution of a problem gambling screening program is recommended, and additional intervention for gambling problems should be implemented for that need as a part of OST.
Gambling; Opioid substitution treatment; Buprenorphine-naloxone; Methadone; Substance abuse
Attitudes towards gambling influence gambling behaviour but also reflect the existing gambling policy in a society. However, studies examining general attitudes towards gambling at the population level are scarce. The first aim of this study was to investigate general attitudes of the Finnish population towards gambling. The second aim was to explore the association of socio-demographics, gambling behaviours, being a concerned significant other (CSO) of a problem gambler and perceived health and lifestyle with attitudes towards gambling among the Finnish population.
A cross-sectional study was performed by structured telephone interview on a random sample of 15-74-year-old Finns between October 2011 and January 2012. The data (n = 4484) was weighted based on age, gender and region of residence. Attitudes towards gambling were measured with the eight-item version of the Attitude Towards Gambling Scale (ATGS-8). A factor analysis was performed to test the structure of the Finnish version of the ATGS-8. The data were analysed using one-way ANOVA test, t-test and multiple regression analysis.
On average, attitudes of Finns towards gambling were negative. The most significant factors associated with positive attitudes towards gambling were male gender, young age, 12 years or more education and net income more than 2000€, low score on gambling severity, being a non-CSO of a problem gambler and high alcohol consumption
The association between young age, male gender, high net income and risky alcohol consumption, and favourable gambling attitudes was strong, and also reflects risky gambling behaviour. Experiencing gambling-related harms caused by one’s own or significant other’s excessive gambling seems to indicate unfavourable attitudes towards gambling.
Attitudes; Cross-sectional; Gambling; Population study
Problem gambling not only impacts those directly involved, but also the concerned significant others (CSOs) of problem gamblers. The aims of this study were to investigate the proportion of male and female CSOs at the population level; to investigate who the CSOs were concerned about; and to investigate sociodemographic factors, gender differences, gambling behaviour, and health and well-being among CSOs and non-CSOs.
The data (n = 4484) were based on a cross-sectional population study. Structured telephone interviews were conducted in 2011–2012. The data were weighted based on age, gender and residency. The respondents were defined as CSOs if they reported that at least one of their significant others (father, mother, sister/brother, grandparent, spouse, own child/children, close friend) had had gambling problems. Statistical significance was determined by chi-squared and Fisher’s exact tests, and logistic regression analysis.
Altogether, 19.3% of the respondents were identified as CSOs. Most commonly, the problem gambler was a close friend (12.4%) of the CSO. The percentage of close friends having a gambling problem was larger among male CSOs (14.4%) compared with female CSOs (10.3%; p ≤ 0.001), while the percentage of partners with gambling problem was larger among females (2.6%) than among males (0.8%; p ≤ 0.001). In the best fitting model, the odds ratio (95% CI) of being a male CSO was 2.03 (1.24–3.31) for past-year gambling problems, 1.46 (1.08–1.97) for loneliness and 1.78 (1.38–2.29) for risky alcohol consumption. The odds ratio (95% CI) of being a female CSO was 1.51 (1.09–2.08) for past-year gambling involvement, 3.05 (1.18-7.90) for past-year gambling problems, 2.21 (1.24–3.93) for mental health problems, 1.39 (1.03–1.89) for loneliness and 1.97 (1.43–2.71) for daily smoking.
CSOs of problem gamblers often experience cumulating problems such as their own risky gambling behaviour, health problems and other addictive disorders. The clearest gender difference was seen in smoking by CSO. In order to develop efficient and targeted support and services for CSOs, it is necessary to understand the correlates related to different subgroups of CSOs.
Concerned significant others; Cross-sectional; Population study; Problem gambling
The purpose of this study was to compare the socio-demographic characteristics of non-problem gamblers, problem gamblers and pathological gamblers, to investigate the association between gambling related factors and perceived health and well-being among the three subgroups of gamblers, and to analyse simultaneously socio-demographic characteristics, gambling related factors and perceived health and well-being and the severity of disordered gambling (problem gamblers and pathological gamblers).
The data were collected through a nationwide telephone survey in 2011. Participants were selected through a random population sample of 15-74-year-old Finns. From that sample, persons with any past-year gambling involvement (N = 3451) were selected for a subsample for the descriptive and inferential analysis in the present paper. Gambling was assessed using the South Oaks Gambling Screen. Statistical significance was determined by chi-squared tests. The odds ratio and effect size were computed by using multivariate-adjusted multinomial logistic regression analysis.
The most significant socio-demographic characteristics (male gender, young age, education ≤12 years), gambling related factors (slot machine gambling, internet gambling) and perceived health and well-being (feeling lonely, smoking daily, risky alcohol consumption, mental health problems) explained 22.9 per cent of the variation in the severity of disordered gambling.
Male gender and loneliness were found to be associated with problem gambling in particular, along with smoking and risky alcohol consumption. Mental health problems and risky alcohol consumption were associated with pathological gambling. These identified associations between disordered gambling, mental health problems and risky alcohol consumption should be taken into consideration when implementing screenings of disordered gambling.
Disordered gambling; Pathological gambling; Population survey; Problem gambling; Public health; South Oaks Gambling Screen
Gambling problems currently affect approximately 100 000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied.
An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling.
A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling.
Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.
This article describes the socio-demographic characteristics and gambling behavior of 39 pathological gamblers who participated in our treatment study in 2009. The inclusion criteria of the study were: score of five or more on both the South Oaks Gambling Screen (SOGS) and a pathological gambling screen based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The first 39 patients meeting the inclusion criterion were recruited into the study. The average age of the subjects was 39 years, and 80 % were males. The lag-time between active gambling (at least three times per week) and the onset of a pathological gambling problem was short: within 2 years of active gambling, 62 % of the subjects reported having become pathological gamblers. Our results also indicated certain gender-specific differences in the age at initiation and in the severity of the gambling problem.
SOGS; DSM-IV; Pathological gambling; Gambling
Cognitive deficits and multiple psychoactive drug regimens are both common in patients treated for opioid-dependence. Therefore, we examined whether the cognitive performance of patients in opioid-substitution treatment (OST) is associated with their drug treatment variables.
Opioid-dependent patients (N = 104) who were treated either with buprenorphine or methadone (n = 52 in both groups) were given attention, working memory, verbal, and visual memory tests after they had been a minimum of six months in treatment. Group-wise results were analysed by analysis of variance. Predictors of cognitive performance were examined by hierarchical regression analysis.
Buprenorphine-treated patients performed statistically significantly better in a simple reaction time test than methadone-treated ones. No other significant differences between groups in cognitive performance were found. In each OST drug group, approximately 10% of the attention performance could be predicted by drug treatment variables. Use of benzodiazepine medication predicted about 10% of performance variance in working memory. Treatment with more than one other psychoactive drug (than opioid or BZD) and frequent substance abuse during the past month predicted about 20% of verbal memory performance.
Although this study does not prove a causal relationship between multiple prescription drug use and poor cognitive functioning, the results are relevant for psychosocial recovery, vocational rehabilitation, and psychological treatment of OST patients. Especially for patients with BZD treatment, other treatment options should be actively sought.
Opioid-dependence; Opioid agonist therapy; Pharmacotherapy; Psychotropic drugs; Neurocognitive performance; Neuropsychological testing
Naltrexone has been proven to be an effective treatment option for the treatment of alcohol dependency. In this article we introduce a reliable and simple method developed for the simultaneous determination of naltrexone and 6-β-naltrexol in human serum by using high-performance liquid chromatography (HPLC).
Liquid-liquid extraction with butyl acetate from basic solutions (pH 9) was chosen for extraction with nalorphine as an internal standard (IS). Analytes were back-extracted from organic solvent into perchloric acid. The acid extract was chromatographed by HPLC with a reverse-phase ODS-column and electrochemical detector. The mobile phase was a NaH2PO4-solution with acetonitrile as an organic modifier and octanesulphonic acid and tetraethylammonium hydrogen sulphate as ion-pair reagents. The recovery of the extraction method was 48% for naltrexone and 75% for 6-β-naltrexol. The limit of quantification was 5.0 ng/ml for naltrexone and 1.0 ng/ml for 6-β-naltrexol. The analysed concentrations of naltrexone differed from the theoretic concentrations by 0.7 to 2.3% and those of 6-β-naltrexol by 2.6%. The relative standard deviation of within-day assay was from 0.9 to 5.7% for naltrexone and from 0.8 to 4.2% for 6-β-naltrexol; for the between-day assay it was 5.7% and 4.2%, respectively.
Our results indicate that the developed method is suitable for determination of naltrexone and 6-β-naltrexol in human serum.
Naltrexone; 6-β-naltrexol; High-performance liquid chromatography; Alcoholism
In many but not in all neuropsychological studies buprenorphine-treated opioid-dependent patients have shown fewer cognitive deficits than patients treated with methadone. In order to examine if hypothesized cognitive advantage of buprenorphine in relation to methadone is seen in clinical patients we did a neuropsychological follow-up study in unselected sample of buprenorphine- vs. methadone-treated patients.
In part I of the study fourteen buprenorphine-treated and 12 methadone-treated patients were tested by cognitive tests within two months (T1), 6-9 months (T2), and 12 - 17 months (T3) from the start of opioid substitution treatment. Fourteen healthy controls were examined at similar intervals. Benzodiazepine and other psychoactive comedications were common among the patients. Test results were analyzed with repeated measures analysis of variance and planned contrasts. In part II of the study the patient sample was extended to include 36 patients at T2 and T3. Correlations between cognitive functioning and medication, substance abuse, or demographic variables were then analyzed.
In part I methadone patients were inferior to healthy controls tests in all tests measuring attention, working memory, or verbal memory. Buprenorphine patients were inferior to healthy controls in the first working memory task, the Paced Auditory Serial Addition Task and verbal memory. In the second working memory task, the Letter-Number Sequencing, their performance improved between T2 and T3. In part II only group membership (buprenorphine vs. methadone) correlated significantly with attention performance and improvement in the Letter-Number Sequencing. High frequency of substance abuse in the past month was associated with poor performance in the Letter-Number Sequencing.
The results underline the differences between non-randomized and randomized studies comparing cognitive performance in opioid substitution treated patients (fewer deficits in buprenorphine patients vs. no difference between buprenorphine and methadone patients, respectively). Possible reasons for this are discussed.
Poor quality of sleep among alcoholics and persons undergoing alcohol withdrawal has been described as a possible cause of alcohol relapse. It has been suggested earlier that nitrous oxide gas has a significant effect on the signs of alcohol withdrawal syndrome (AWS) and thus might be expected to reduce sleep disturbance during withdrawal. The aim of the present study was to investigate sleep quality during alcohol withdrawal, to evaluate the correlation between sleep quality and the severity of AWS and alcohol craving, and to determine if nitrous oxide treatment does counteract withdrawal's effects on the quality of sleep. Voluntary patients (n = 105) admitted to the A-Clinic detoxification center with AWS were included in the study. The AWS patients were randomly assigned to one of the following 45-minute gas treatments: (1) nitrous oxide/oxygen; (2) normal air/O2; and (3) medical (normal) air. The study was single-blind by design. Sleep quality was assessed after these treatments during the inpatient period; sleep time, sleep efficiency and the fragmentation of sleep were recorded by wrist-worn actigraphs. Severity of AWS was evaluated by the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) and that of alcohol dependence and craving by the Obsessive Compulsive Drinking Scale [OCDS] and the Severity of Alcohol Dependence Data (SADD) questionnaire.
The fragmentation index and the time awake while in bed were both much above the reference values for the Finnish population. These values reflect the restless and disturbed night sleep of the subjects. The only statistically significant effects between the treatment groups were found in the correlations of CIWA-Ar (severity of AWS) scores, OCDS-scores (alcohol craving) and coffee consumption, all of which were positively associated with movement time and negatively with total sleep time and sleep efficiency. The sleep quality of patients treated with nitrous oxide gas did not differ from the sleep quality of those treated with normal air.
The severity of AWS and coffee consumption had the most significant negative impact on sleep quality. According to our results, nitrous oxide gas does not differ from placebo in its effect on sleep quality during alcohol withdrawal.
To examine local and systemic oxidative status of lung cancer (LC) and oxidant effects of radiotherapy (RT), this study evaluated antioxidants and markers of oxidative and nitrosative stress in bronchoalveolar lavage (BAL) fluid and in the blood of 36 LC patients and 36 non-cancer controls at baseline and during and after RT for LC. LC patients had higher baseline serum urate, plasma nitrite and lower serum oxidized proteins than controls (p = 0.016, p < 0.001 and p = 0.027, respectively), but BAL fluid oxidative stress markers were similar. RT tended to raise some antioxidants, however, significant increases were seen in serum urate, conjugated dienes and TBARS (p = 0.044, p = 0.034 and p = 0.004, respectively) 3 months after RT. High urate at baseline may compensate against the oxidative stress caused by LC. RT shifts the oxidant/antioxidant balance towards lipid peroxidation, although the antioxidant defense mechanisms of the body appear to counteract the increased oxidative stress rather effectively.
Oxidative stress; BAL fluid; lung cancer; radiotherapy; antioxidants; nitrosative stress
Opioid-substitution treatment (OST) for opioid dependence (OD) has proven effective in retaining patients in treatment and reducing illegal opiate abuse and crime. Consequently, the World Health Organization (WHO) has listed the opioid agonists methadone and buprenorphine as essential drugs for OD that should be available worldwide. In many areas of the world, OD is often associated with concomitant benzodiazepine (BZD) dependence and abuse, which complicates treatment. However, possible changes in the cognitive functioning of these patients are not well-known. The present study is the first to examine longitudinal stability of memory function in OST patients with BZD use, thus providing a new tool for health policy authorities in evaluating the usefulness of OST.
Within the first two months (T1) and between 6–9 months (T2) after OST admission, we followed the working memory, immediate verbal memory, and memory consolidation of 13 methadone- and 15 buprenorphine- or buprenorphine/naloxone-treated patients with BZD dependence or abuse disorder. The results were compared to those of fifteen normal comparison participants. All participants also completed a self-reported memory complaint questionnaire on both occasions.
Both patient groups performed statistically significantly worse than normal comparison participants in working memory at time points T1 and T2. In immediate verbal memory, as measured by list learning at T1, patients scored lower than normal comparison participants. Both patient groups reported significantly more subjective memory problems than normal comparison participants. Patients with more memory complaints recalled fewer items at T2 from the verbal list they had learned at T1 than those patients with fewer memory complaints. The significance of the main analyses remained nearly the same when the statistical tests were performed without buprenorphine-only patients leaving 12 patients to buprenorphine/naloxone group.
Working memory may be persistently affected in OST patients with BZD use. A high number of memory complaints among OST patients with BZD use may indicate memory consolidation impairment. These findings show that recovery of memory function in OD patients treated along with BZDs takes time, and their memory complaints may have practical relevance.
Alcohol dependence comorbid with major depressive disorder poses a major challenge in the clinical setting. The results in the treatment with selective serotonin re-uptake inhibitors have been conflicting. Thus, we compared in alcohol-dependent patients with co-morbid major depressive disorder the selective serotonin re-uptake inhibitor escitalopram to a compound that acts on different transporter system and may reduce craving, the glutamate receptor antagonist memantine.
Eighty alcohol-dependent patients comorbid with major depressive disorder in municipal alcohol clinics were randomized 1:1 to receive memantine 20 mg or escitalopram 20 mg in a double-blind manner. During the 26-week study period patients continued their routine treatment at the clinics. Abstinence was not required but encouraged. The patients attended visits weekly during the first month, and then at 3 and at 6 months. Outcome measures were Alcohol Use Disorders Identification Test (AUDIT), Obsessive Compulsive Drinking Scale (OCDS) and Drinking Diary.
The completion rate was high in both groups, especially among the patients who had been abstinent at the beginning of the study. However, among those patients who were not abstinent at baseline, 47% in both groups discontinued the study. Numbers of abstinent days were high in both groups throughout the study. Alcohol consumption measured by the AUDIT QF (quantity-frequency) score was significantly reduced in both groups, as was the craving for alcohol measured by the OCDS. Early age at first alcohol intoxication predicted poor treatment outcomes in patients treated with escitalopram, and the same was seen with the early onset of the first depressive episode. The same predictive effects were not found in patients treated with memantine.
Our results indicate that both memantine and escitalopram are useful adjunct medications for the treatment of alcohol dependence co-morbid with major depression. Memantine was at least as effective with regard to drinking as escitalopram. We believe that a direct comparison of memantine, with the commonly used escitalopram, can provide useful information for clinicians on the treatment of alcohol dependency co-morbid with MDD.
ClinicalTrials.gov Identifier # NCT00368862
In Finland, buprenorphine (Subutex) is the most abused opioid. In order to curb this problem, many treatment centres transferred ("forced transfer") their buprenorphine patients to the buprenorphine plus naloxone (Suboxone) combination product in late 2003.
Data from a retrospective study involving five different treatment centers, examining the effects of switching patients to Suboxone, were gathered from 64 opioid-dependent patients who had undergone the medication transfer.
Most patients (90.6%) switched to Suboxone at the same dose of buprenorphine that they had been receiving as Subutex (average 22 mg). The majority of these patients (71.9%) were maintained at the same dose of Suboxone throughout the 4-week study period. During the first 4 weeks, 50% of the patients reported adverse events and at the four month time point, 26.6% reported adverse events. However, due to adverse events one patient only discontinued treatment with Suboxone during the 4-week study period, and five during the four month follow-up period. Of the 26 patients in the follow-up period, Suboxone was misused intravenously once each by 4 patients and twice by 1 patient. These 5 patients all reported that injecting Suboxone was like injecting "nothing" with any euphoria, or that it was a bad experience.
We conclude that when patients are transferred from high doses (> 22 mg) of buprenorphine to the combination product, dose adjustments may be necessary especially in the later phase of the treatment. We recommend that a transfer from Subutex to Suboxone should be carefully discussed and planned in advance with the patients and after the transfer adverse events should be regularly monitored. With regard of buprenorphine IV abuse, the combination product seems to have a less abuse potential than buprenorphine alone.
Magnesium (Mg) deficiency is common among alcoholics. Earlier research suggests that Mg treatment may help to normalize elevated enzyme activities and some other clinically relevant parameters among alcoholics but the evidence is weak.
The effect of Mg was studied in a randomized, parallel group, double-blind trial. The patients were first treated for alcohol withdrawal symptoms and then received for 8 weeks either 500 mg of Mg divided into two tablets or matching placebo. Measurements were made at the beginning and in the end of the Mg treatment period. The primary outcome was serum gamma-glutamyltransferase (S-GGT) activity; secondary outcomes included aspartate-aminotransferase (S-AST) and alanine-aminotransferase (S-ALT) activity.
The number of randomized patients (completers) was 64 (27) in the treatment and 54 (31) in the control group. In intention-to-treat-analyses and in most analyses of study completers, there were no significant differences between the Mg-treated and placebo groups in the outcome variables. When baseline serum Mg level, coffee intake, and the number of unused Mg tablets were controlled for in a multivariate regression model, after-treatment serum Mg levels were found to be higher among the Mg-treated group than in the placebo group (t-test 3.334, df = 53, p = 0.002). After controlling for age, body weight, baseline alcohol intake, subsequent change in alcohol intake and baseline S-AST, the after-treatment S-AST levels were found to be lower among the Mg-treated group than in the placebo group (t-test 2.061, df = 49, p = 0.045).
Mg treatment may speed up the S-AST decrease in compliant patients. This might decrease the risk of death from alcoholic liver disease.
ClinicalTrials.gov ID NCT00325299
Both methadone- and buprenorphine-treated opioid-dependent patients frequently show cognitive deficits in attention, working memory, and verbal memory. However, no study has compared these patient groups with each other during early opioid substitution treatment (OST). Therefore, we investigated attention, working memory, and verbal memory of opioid-dependent patients within six weeks after the introduction of OST in a naturalistic setting and compared to those of healthy controls.
The sample included 16 methadone-, 17 buprenorphine/naloxone-treated patients, and 17 healthy controls matched for sex and age. In both groups buprenorphine was the main opioid of abuse during the recent month. Benzodiazepine codependence, recent use, and comedication were also common in both patient groups. Analysis of variance was used to study the overall group effect in each cognitive test. Pair-wise group comparisons were made, when appropriate
Methadone-treated patients, as a group, had significantly slower simple reaction time (RT) compared to buprenorphine/naloxone-treated patients. In Go/NoGo RT methadone patients were significantly slower than controls. Both patient groups were significantly debilitated compared to controls in working memory and verbal list learning. Only methadone patients were inferior to controls in story recall. In simple RT and delayed story recall buprenorphine/naloxone patients with current benzodiazepine medication (n = 13) were superior to methadone patients with current benzodiazepine medication (n = 13). When methadone patients were divided into two groups according to their mean dose, the patient group with a low dose (mean 40 mg, n = 8) showed significantly faster simple RT than the high dose group (mean 67 mg, n = 8).
Deficits in attention may only be present in methadone-treated early phase OST patients and may be dose-dependent. Working memory deficit is common in both patient groups. Verbal memory deficit may be more pronounced in methadone-treated patients than in buprenorphine/naloxone-treated patients. In sum, to preserve cognitive function in early OST, the use of buprenorphine/naloxone may be more preferable to methadone use of, at least if buprenorphine has been recently abused and when benzodiazepine comedication is used. Longitudinal studies are needed to investigate if the better performance of buprenorphine/naloxone-treated patients is a relatively permanent effect or reflects "only" transient opioid switching effect.
Age-associated deterioration of arterial function may result from long-lasting oxidative stress. Since coenzyme Q (Q10) has been suggested to protect the vascular endothelium from free radical-induced damage, we investigated the effects of long-term dietary Q10 supplementation on arterial function in senescent Wistar rats.At 16 months of age, 18 rats were divided into two groups. The control group was kept on a standard diet while the other group was supplemented with Q10 (10 mg kg−1 day−1). In addition, nine rats (age 2 months) also ingesting a standard diet were used as the young control group. After 8 study weeks the responses of the mesenteric arterial rings in vitro were examined.Endothelium-independent arterial relaxations to isoprenaline and nitroprusside (SNP) were attenuated in aged rats. Increased dietary Q10 clearly enhanced the relaxation to isoprenaline, but did not affect the response to SNP. In addition, vasodilation of noradrenaline-precontracted rings to acetylcholine (ACh), which was also impaired in aged vessels, was improved after Q10 supplementation. Cyclooxygenase inhibition with diclofenac enhanced the relaxation to ACh only in young rats, while it abolished the difference between the old controls and Q10 supplemented rats, suggesting that the improved endothelium-dependent vasodilation observed in Q10 supplemented rats was largely mediated by prostacyclin (PGI2).In conclusion, long-term Q10 supplementation improved endothelium-dependent vasodilation and enhanced β-adrenoceptor-mediated arterial relaxation in senescent Wistar rats. The mechanisms underlying the improvement of endothelial function may have included augmented endothelial production of PGI2, increased sensitivity of smooth muscle to PGI2, or both.
arterial smooth muscle; coenzyme-Q; cyclic adenosine monophosphate; endothelium; prostacyclin; ubiquinone; Wistar rat