A descriptive survey of online gaming characteristics and gaming disorder in Ireland.

OBJECTIVES: The aim of this study was to carry out the first ever study of gaming characteristics of individuals engaging in online gaming in Ireland and to ascertain whether features of gaming disorder are present in this population. METHODS: An online survey (comprising 21 questions - 3 demographic questions and 18 questions related to gaming and gaming disorder) was distributed on numerous Irish online gaming forums and Irish online gaming communities. Participants were self-selected and invited to compete the online survey containing questions related to gaming behaviours (age of onset, hours played on weekdays/weekends, type of device used), mobile gaming, motives for online gaming, use of microtransactions, engagement in esports, and a screening tool for the presence of gaming disorder. RESULTS: A total of 166 participants engaged in the online survey. Among this study population of regular gamers in Ireland, 2.4% of the study population were classified as having gaming disorder, with up to 5.4% showing some evidence of disordered gaming. The main motivation for online gaming in the non-disordered gaming group was recreation (13.3, sd = 2.7) but only the fourth main motivation in the disordered gaming group behind competition (16.3, sd = 3.7), escape (16.2, sd = 4.3), and coping (15.1, sd = 3.7). Increased hours of gameplay on weekdays and weekends were noted in the disordered gaming group compared to non-disordered gamers. CONCLUSIONS: A small percentage of gamers in Ireland demonstrate disordered gaming characteristics and gaming disorder, consistent with data from other international studies. Epidemiological studies are required in Ireland to enhance our knowledge of this disorder.

Online gaming and gaming disorder: more than just a trivial pursuit.

Gaming disorder is set to be included in the International Statistical Classification of Diseases and Related Health Problems alongside other behavioural addictions (gambling disorder) and substance-related addictions. Given the popularity of online gaming, this is set to become an increasingly common presentation to general mental health professionals, addiction specialists, and general practitioners. This article briefly examines online gaming and describes the characteristics of gaming disorder. Some features of online gaming that have addictive potential and similarities to other addictive behaviours such as gambling disorder are discussed. Finally, the article examines treatment options available for gaming disorder and treatment going forward from an Irish perspective.

A descriptive pilot survey of behavioural addictions in an adolescent secondary school population in Ireland.

OBJECTIVES: The aim of the present study was to evaluate the levels of possible internet addiction, gaming addiction, gambling addiction and associated mental health difficulties in a secondary school population in Ireland. METHODS: An online survey containing questions related to internet addiction, gaming addiction, gambling addiction and associated mental health difficulties was administered to secondary school adolescents in Ireland. Participants were self-selecting and answered questions on the characteristics of each topic and screening questionnaires for addiction to each behaviour, as well as their respective effects on mental health. RESULTS: A total of 234 children participated in the survey (156 males; aged 12-18 years; average age of 14.2 years; S.D. 1.60). Internet addiction as assessed using the Chen Internet Addiction Scale was present for between 11.5% and 22.6% and levels of gaming addiction as assessed using by the Internet Gaming Disorder Scale-Short Form was present for between 0.5% and 1.6%. Weak positive correlations were found between time spent on the internet and time spent gaming with internet addiction and gaming addiction, respectively. There were weak positive correlations between higher internet addiction scores, higher gaming addiction scores, and increased depression and anxiety scores. Using the South Oaks Gambling Screen-Revised for Adolescents, two participants were classed as 'at-risk' for gambling addiction and one participant was classed as a problem gambler. CONCLUSIONS: The present study examined behavioural addictions and their effects on mental health on a self-selecting sample of schoolchildren at two schools in Ireland. A low number were identified as being at risk or problem gamblers.

The gambling control bill: time for action.

A modern regulatory framework for gambling in Ireland is urgently required. The Gambling Control Bill of 2013 represents a decent starting point in developing player protection and much needed treatment services and research facilities for Gambling Disorder. The drafting and enactment of the Gambling Control Bill of 2013 appears to have slipped from legislative priority. The sooner this bill is enacted the better.

Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice.

BACKGROUND AND AIMS: Bupropion was introduced for smoking cessation following a pivotal trial showing that it gave improved efficacy over the nicotine patch and also suggesting combination treatment was beneficial. We tested in clinical practice for an effectiveness difference between bupropion and nicotine replacement therapy (NRT), whether the combination improves effectiveness and whether either treatment might be more beneficial for certain subgroups of smokers. DESIGN: Open-label randomized controlled trial with 6-month follow-up. SETTING: Four UK National Health Service (NHS) smoking cessation clinics. PARTICIPANTS: Smokers (n = 1071) received seven weekly behavioural support sessions and were randomized to an NRT product of their choice (n = 418), bupropion (n = 409) or NRT plus bupropion (n = 244). MEASURES: The primary outcome was self-reported cessation over 6 months, with biochemical verification at 1 and 6 months. Also measured were baseline demographics, health history, smoking characteristics and unwanted events during treatment. FINDINGS: Abstinence rates for bupropion (27.9%) and NRT (24.2%) were not significantly different (odds ratio = 1.21, 95% confidence interval = 0.883-1.67), and the combination rate (24.2%) was similar to that for either treatment alone. There was some evidence that the relative effectiveness of bupropion and NRT differed according to depression (χ(2) = 2.86, P = 0.091), with bupropion appearing more beneficial than NRT in those with a history of depression (29.8 versus 18.5%). Several unwanted symptoms were more common with bupropion. CONCLUSION: There is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy and their combination when used with behavioural support in clinical practice. There is some evidence that bupropion is more beneficial than nicotine replacement therapy for smokers with a history of depression.

Association between DRD2/ANKK1 Taq1A genotypes, depression and smoking cessation with nicotine replacement therapy.

OBJECTIVES: Tobacco dependence and depression are believed to have a common familial component, most probably genetic, and mood disorders have been reliably associated with failure to stop smoking. Variant genotypes of the Taq1A (DRD2/ANKK1, 32806T, rs1800497) polymorphism have been associated with failure to stop smoking in some studies, but not others. We investigated the association between Taq1A genotypes and smoking cessation, while also considering mental health. MATERIALS AND METHODS: This was a prospective study in 419 smokers who attended a smoking cessation clinic and used standard doses of nicotine replacement therapy. DNA samples and baseline measures including demographics, severity of tobacco dependence, mental health history and history of drug misuse were taken. Smoking cessation at the end of treatment was biochemically verified using expired-air carbon monoxide. RESULTS: We found no simple relation between Taq1A genotype and smoking cessation, although the association between cessation and lifetime depression was significantly modified by genotype. The relationship was such that for those having only common alleles there was no association between depression and stopping smoking, whereas for those with at least one variant allele (A1A2/A1A1) depression was associated with a two-fold reduction in the likelihood of stopping. CONCLUSION: Those having a Taq1A variant allele and a history of depression are likely to experience particular difficulty when trying to stop smoking and may require treatment other than standard doses of nicotine replacement. This finding might explain previous conflicting results for Taq1A and smoking cessation in studies where depression history was not measured, and may help to explain the underlying link between depression and smoking.

Comorbid psychiatric diagnoses among individuals presenting to an addiction treatment program for alcohol dependence.

A retrospective patient record review was conducted to examine comorbid psychiatric diagnoses, and comorbid substance use, among 465 patients below 45 years of age, presenting to a national alcohol addiction treatment unit in Dublin, between 1995 and 2006. Rates were high for depressive disorder (25.3%) particularly among females (35.4%). Lifetime reported use of substances other than alcohol was 39.2%, and further analysis showed significantly higher rates of deliberate self-harm among this group. Lifetime reported use of ecstasy was also significantly associated with depression in this alcohol-dependent population using logistic regression analysis. Implications and limitations of the findings are discussed.

Association of the serotonin transporter gene, neuroticism and smoking behaviours.

Cigarette consumption and smoking cessation are influenced in part by genes. Personality traits have also been implicated in the aetiology of smoking. Neuroticism, a personality trait with a heritable component, correlates well with anxiety and depression, increasing the risk of being a smoker and decreasing the chance of smoking cessation. Several prior studies in non-British populations have given conflicting results as to whether some genetic polymorphisms affect the relationship between smoking and neuroticism. This study investigated the influence of serotonin transporter (5HTTLPR) genotypes on a composite measure of neuroticism and cigarette consumption/smoking cessation in a British population. Although neuroticism was significantly associated with cigarette consumption and smoking cessation, genotype did not affect this relationship. Our results do not support initial interest in utilising 5HTTLPR genotypes in combination with neuroticism ratings for predicting outcome in smoking cessation clinical settings.

Association between dopamine transporter genotypes and smoking cessation: a meta-analysis.

This review assessed the evidence of an association between genotypes of the dopamine transporter (DAT1, SLC6A3) 3' untranslated region (3'UTR) variable number of tandem repeats (VNTR) and smoking cessation. Five studies (seven cohorts) comprising 2155 subjects were included in the meta-analysis. All gave data on the number of smokers who had stopped smoking and the number still smoking for those with one or more variant 9-repeat alleles and other genotypes. Three studies (comprising five cohorts) were cross-sectional population surveys and two were smoking cessation treatment programs with follow-up. Four of the five studies (six of the seven cohorts) showed a trend in favor of cessation when the variant 9-repeat allele was present, although only one study showed a statistically significant effect. The pooled odds ratio in favor of a greater likelihood of cessation for the variant 9-repeat allele was 1.15 [95% confidence interval (CI) = 0.97-1.37]. In a more refined analysis where cohorts within studies were treated as separate samples and adjusted odds ratios were used, the overall pooled odds ratio in favor of cessation with the 9-repeat alleles was 1.20 (95% CI = 1.01-1.43). These results support the hypothesis that the DAT1 3'UTR VNTR polymorphism is associated with smoking cessation. One or more variant 9-repeat alleles relative to the more common 10-repeat allele confers a greater likelihood of cessation, indicative of lower dependence on tobacco. The effect was a 20% increase in the odds of cessation for those with a variant allele.

Co-morbidity and cannabis use in a mental health trust in South East England.

AIM: The prevalence of co-morbidity (severe mental illness and substance) may be less in rural and semi-rural areas than inner cities. The aims were therefore to measure the prevalence of co-morbidity among patients of attending a mental health service in a semi-rural area South East England. DESIGN AND PARTICIPANTS: Cross-sectional prevalence survey of 1,808 patients with detailed assessments from a representative sample of 373 patients identified as having a combination of severe mental illness and substance misuse. Interviews with key workers were performed using validated methods from the COSMIC study. RESULTS: The response rates equalled or exceeded 90% for the various parts of the study. One-tenth of patients attending the Community Mental Health Teams (CMHTs) reported problematic use of illicit drugs and 17% reported alcohol problems in the past year. 22% of Community Drug and Alcohol Service (CDAS) clients reported a severe mental illness and 46% reported some other form of psychiatric disorder. Of patients with a combined diagnosis of mental illness and substance misuse, cannabis use was 4-fold more common amongst patients attending the CMHT than CDAS (33% vs. 8%) while use of amphetamine was five-fold higher in the CMHT group (10% vs. 2%). Patients with concurrent psychiatric and substance misuse problems represent a similar proportion of the aggregate caseload of both treatment services with observed prevalence amongst the CDAS and CMHT patients with a diagnosis for anxiety disorder (18% vs. 26%), minor depression (42% vs. 32%), personality disorders (32% vs. 36%), histories of self-harm (52% vs. 46%) and violence (33% vs. 30%) respectively. CONCLUSIONS: Co-morbidity is common in clients amongst CMHT and CDAS clients although use of cannabis was significantly more common in CMHT clients than in CDAS clients.

Dopamine transporter polymorphisms are associated with short-term response to smoking cessation treatment.

OBJECTIVES: To examine the association between polymorphisms in the dopamine transporter gene (SLC6A3, DAT1) and treatment outcome in smokers attempting to quit using either nicotine replacement therapy or bupropion. METHODS: The sample consisted of 583 smokers recruited from a smoking cessation clinic, and followed throughout the 4 weeks of post-cessation treatment with behavioural support and either nicotine replacement therapy or bupropion. RESULTS: At 1 week after smoking cessation, the 3' untranslated region (3'UTR) variable number of tandem repeats (VNTRs) and the 30-bp intron 8 VNTR DAT1 genotypes were associated with the ability to stop smoking (3'UTR VNTR, odds ratio=2.0, 95% confidence interval=1.2-3.5, novel intron 8 VNTR, odds ratio=1.8, 95% confidence interval=1.0-2.9), controlling for potential confounders. The results were weaker and no longer significant at a 4-week follow-up. CONCLUSIONS: We find evidence, although modest, of a medium-sized effect of DAT1 genotype on the ability to stop smoking early in a smoking cessation attempt. If the effect is real, and is strongest in the very early stages of smoking cessation, this suggests that the primary utility of DAT1 screening in this field will be in the identification of those most at risk of early relapse after quitting.

Prevalence of childhood attention deficit hyperactivity disorder in opiate-dependent adults.

Background. There is a clear association between childhood attention deficit hyperactivity disorder and substance use disorders in adulthood. Symptoms of attention deficit disorder may also persist into adulthood. The study aimed to determine the prevalence of childhood ADHD in a sample of treatment seeking opiate-dependent adults. Methods. Treatment-seeking opiate-dependent subjects completed the Utah adult ADHD screening test and the self-report early delinquency scale. Results. A total of 15% were "likely" and 49 were "highly likely" to have suffered ADHD in childhood. The averages scores for the delinquency scales were over 6 times those reported from population norms. Conclusion. Symptoms of childhood ADHD is common in adults with opiate dependence. The residual symptoms in adults should be investigated as may be amenable to newer treatments for adult attention deficit disorder.

Nurse prescribing in addiction services: client benefits.

Recent changes to prescribing regulations mean that nurse independent prescribers and supplementary prescribers are now able to prescribe any licensed medicine for conditions within their competence, including some controlled drugs. This article discusses the anticipated benefits of these prescribing changes for patients receiving treatment for substance misuse.

A dopamine transporter gene functional variant associated with cocaine abuse in a Brazilian sample.

The dopamine (DA) transporter DAT1 is a major target bound by cocaine in brain. We examined the influence of functional genetic variants in DAT1 on cocaine addiction. Repeat polymorphisms, including a 30-bp variable-number tandem repeat (VNTR) in intron 8 (Int8 VNTR) with two common alleles, were genotyped in cocaine-dependent abusers (n = 699) and in controls with no past history of drug abuse (n = 866) from São Paulo, Brazil. Positive association was observed with allele 3 of the Int8 VNTR and cocaine abuse (allele odds ratio = 1.2, 95% confidence interval = 1.01-1.37, P = 0.036; 3/3 homozygote odds ratio = 1.45, 95% confidence interval = 1.18-1.78, P = 0.0008). Population stratification was assessed and did not affect the results. Haplotypic analyses using additional polymorphisms indicated that the Int8 VNTR is responsible for the observed association. Functional analyses in reporter-gene constructs, demonstrated that allele 3 mediates significant (P < 0.05) but small reduced expression compared with the "protective" allele 2. This difference increased when 1 and 10 muM cocaine was added to the cell culture ( approximately 40% reduction of the 3 allele expression versus the 2 allele). The 3 allele also demonstrated approximately 3-fold-increased expression over the 2 allele in response to KCl plus forskolin challenge. We demonstrate a robust association between cocaine dependence and a VNTR allele in SLC6A3, conferring a small but detectable effect, and we show that this VNTR may be functional. This study suggests that DAT1 gene variation may play a role in cocaine dependence etiology.

Validation of the 13-Item Beck Depression Inventory in alcohol-dependent people.

Aims. To validate a self-administered questionnaire (the 13-item Beck Depression Inventory) as an instrument for assessing depressive symptoms in alcohol-dependent people. Design, setting and participants. One hundred and eight treatment-seeking alcohol-dependent patients were recruited from a teaching hospital substance misuse facility. Measures. The Beck Depression Inventory, Montgomery Asberg Depression Rating Scale and Hamilton Rating Scale for Depression were administered. Scores from each instrument were compared using correlation coefficients. Findings. Correlation between the Beck Depression Inventory and Montgomery Asberg Depression Rating Scale was 0.763. The Beck Depression Inventory achieved a high degree of consistency/reliability (Cronbach's α=0.8847). Receiver operated curve analysis gave an optimal cut-off on the 13-item Beck Depression Inventory of 18/19 out of 39 as a screening tool to identify cases with moderate or severe depression. This cut-off gave a sensitivity of 79% and a specificity of 79% compared to the Montgomery Asberg Depression Rating Scale. The diagnostic efficient was 82% for moderate to severe depression compared to the Montgomery Asberg Depression Rating and 85% compared to Hamilton Depression Rating Scale. Conclusions. The self-administered Beck Depression Inventory is a feasible, valid and reliable alternative to the interview for detecting change in depressive symptoms in alcohol-dependent people. This would be particularly useful in services with very limited staffing time such as primary care.

Dying for heroin: the increasing opioid-related mortality in the Republic of Ireland, 1980-1999.

BACKGROUND: Over the past 20 years there has been a steady rise in mortality associated with opioid misuse in several Western countries. We aimed to examine trends in opioid-related mortality over a 20-year period in the Republic of Ireland. METHODS: Retrospective analysis of deaths attributed to ICD-9 codes 304.0 (morphine-type dependence) and E850.0 (accidental poisoning by opiates and related narcotics) in the Republic of Ireland between 1980 and 1999. RESULTS: The Republic of Ireland has seen a rapid increase in the number of opioid-related deaths over the 20-year period studied, from 0.01% of total deaths in 1980 to 0.15% in 1999. This is most marked in the younger age groups where, for example, it rose to 23% of 15-19 year old male deaths for 1997. The opioid-related mortality rate in the 15-44 years age range increased by nearly 14 times between 1980-1984 and 1995-1999. Over the whole period, 87% of opioid-related deaths were amongst males. Outside Dublin there has been a considerable increase in opioid-related mortality, nearly doubling the percentage of the total from 6% in the 1980s to 11% in the 1990s. CONCLUSIONS: Opioid-related mortality is an increasing problem in the Republic of Ireland, as in other Western countries. Today, young people have a very low mortality rate, and hence this rapid increase may need specific targeted interventions. The spread of opioid-related mortality outside Dublin to rural and other urban areas will have implications for service planning and provision.

A GSTP1 functional variant associated with cocaine dependence in a Brazilian population.

Cocaine dependence aetiology is complex and genetically influenced. We hypothesize that, for many users, efficient metabolism of cocaine and its toxic byproducts aids persistent cocaine use, such as that leading to dependence. The glutathione-S-transferases - in particular, GST-Pi - may be important in preventing cocaine and alcohol-induced oxidative damage. We genotyped a GST-Pi functional polymorphism (Ile105Val) in 654 male cocaine users and 572 controls from Brazil. Genotype and allele frequencies of Ile105Val differed significantly (chi = 6.74; P=0.03 and chi = 6.54; P = 0.01, respectively). Ile/Ile cocaine dependents had an OR = 1.31 (95%CI: 1.04-1.65), and Ile/Ile dependents consuming >50 units alcohol weekly an OR of 1.44 (95% CI:1.06-1.96). Population stratification was assessed and did not affect the results. These data require replication but do suggest that the high activity Ile105 GST-Pi allele may influence the aetiology and development of cocaine dependence.