Salvia divinorum: An overview of the usage, misuse, and addiction processes.

Salvia divinorum, a sage plant with leaves that can produce a psychoactive high, has been used for hundreds of years for its psycho-mimetic effects in religious rituals in South America. Salvia has now become popular mainly with adolescents and young adults for the short-lived relatively pleasant experiences many consider a "legal high" and its ready availability through Internet purchases. The main (psycho)active compound in salvia is Salvinorin A, a potent κ-opioid agonist and although the short and long-term effects have not been examined in sufficient detail, it is widely believed to have low addictive potential and low toxicity. Recent findings, however, seem to suggest that Salvinorin A can precipitate psychiatric symptoms and negatively affect cognition. Its ready availability and increasingly widespread use requires clinicians to have knowledge and awareness of its effects.

Gambling in Singapore: an overview of history, research, treatment and policy.

AIMS: This paper describes the current situation regarding gambling in Singapore in relation to its historical and cultural context. METHODS: A computerized search was performed of two databases (PubMed and PsychINFO) and the reference lists from the papers searched manually to identify relevant studies. The findings were synthesized and their implications assessed. RESULTS: In addition to state lotteries and much informal gambling, Singapore has two large resort casinos, which rank third after Las Vegas and Macau in terms of gross revenues. The major ethnic subgroups in Singapore have different cultural connections to gambling, including the active involvement of the Chinese and religious prohibition among the Malay. A range of secondary prevention and treatment services has been developed to attempt to minimize potential negative impacts. Overall, the prevalence of pathological gambling and problem gambling has decreased in recent years: an estimated 0.2% are classified as probable pathological gamblers compared with 1.4% in 2011, 1.2% in 2008 and 2.1% in 2005. CONCLUSIONS: Singapore has experienced a reduction in problem gambling prevalence which may reflect the influence of multiple initiatives.

From divination to madness: features of acute intoxication with Salvia use.

Salvia divinorum is a psychoactive botanical plant that is increasingly used for the 'legal' highs that it can produce. It is readily available for purchase on the Internet, and most abusers are unaware of the toxicity and abuse potential associated with its use. As the use of novel compounds among abusers is not uncommon, physicians need to increase their awareness and recognition of these new substances. Herein, we report a case of an acute presentation of Salvia intoxication.

Stress-coping morbidity among family members of addiction patients in Singapore.

UNLABELLED: INTRODUCTIONS AND AIMS: Research from western countries indicates that family members of addiction patients report heightened stress and psychological morbidity. This current study aimed to examine stress, coping behaviours, related morbidity and subsequent resource utilisation among family members of patients attending a national treatment program in Singapore. DESIGN AND METHODS: The study used a matched case-control design. One hundred family members of addiction patients attending treatment and 100 matched controls completed a semi-structured interview with a researcher. This included the Beck Depression Inventory-II, Short-Form Health Survey-36, General Health Questionnaire-28, Perceived Stress Scale, Family Member Impact Scale and Coping Questionnaire, and also assessed service utilisation. RESULTS: T-tests revealed significantly greater depression, stress and psychiatric morbidity and poorer overall well-being (Short-Form Health Survey-36) among family members compared with controls. Despite the apparent negative impact on mental health, their physical morbidity did not differ from controls and services utilisation was low. Tolerant-inactive coping was found to be most strongly correlated with psychological well-being. Multivariate analysis indicated that perceived stress was the strongest predictor of overall strain (General Health Questionnaire), but this was not moderated by coping style. DISCUSSION AND CONCLUSIONS: Subjective appraisal of stress and coping responses are essential factors affecting the morbidity of family members. Family members demonstrated a need and willingness to engage in formal treatment/counselling for their own problems that were attributed to living with an addiction patient. This provides an opportunity for stress management and brief interventions to modify coping styles, thereby minimizing the potential negative mental health impact on family members.

Quality of life in pathological gamblers in a multiethnic Asian setting

<p><b>INTRODUCTION</b>Few studies have examined the impact of pathological gambling on quality of life especially in the Asian context. The aim of the current study was to examine the quality of life in pathological gamblers in a multiracial population in Singapore and we hypothesised that those with pathological gambling would have poorer quality of life as compared to controls.</p><p><b>MATERIALS AND METHODS</b>Forty subjects with "compulsive gambling behaviour" were recruited and matched (for gender and age) with 40 controls. Subjects with pathological gambling were compared with control subjects with regard to sociodemographic data as well as on the World Health Organization Quality of Life assessment - abbreviated version (WHOQOL-BREF).</p><p><b>RESULTS</b>A one-way MANOVA revealed that pathological gamblers had significantly diminished quality of life as compared with the healthy controls using the summary scores of the 4 domains of quality of life (Pillai's Trace = 0.338, F = 9.5, P <0.001). Univariate tests indicated subjects with pathological gambling scored significantly lower on physical health, psychological, social relationships and environment domains of quality of life compared with subjects without pathological gambling.</p><p><b>CONCLUSION</b>Our study found that those with pathological gambling had lower scores than the controls in all the domains of the quality of life scale. The impact and the extent of pathological gambling on the quality of life should be borne in mind -- not only as a consideration in the management but also as an important indicator of treatment outcome of pathological gamblers.</p>

Monthly take-home methadone maintenance regime for elderly opium-dependent users in Singapore.

INTRODUCTION: Research suggests that methadone maintenance treatment (MMT) effectively reduces opiate dependence and related health and social problems. However, few studies have examined its effectiveness among the elderly. This study examined a monthly MMT regime for elderly opium addicts attending the National Addictions Management Service, Singapore. MATERIALS AND METHODS: This study used a cross-sectional design and comprised 40 patients attending the addiction service and 40 caregivers who monitored methadone consumption (mostly patients' sons and daughters). Participants completed a semi-structured interview comprising measures of opiate craving and withdrawal, physical and psychological health. Objective measures were urine drug screens and blood tests. RESULTS: Participants who averaged 74.8 years old had been using opium for around 44 years and had been in MMT for an average of 35 months. The maintenance dose of methadone was 9.2 mg/day. At interview, no opiate usage (other than methadone) was detected in urine screens; however, clinical records indicated that 6 had tested positive during the previous 6 months of MMT. No major withdrawal symptoms, side effects, or incidents of diversion were reported. Quality-of-life scores were in the normal range and satisfaction with the treatment regime was expressed by caregivers. CONCLUSION: Whilst MMT is the predominant pharmacotherapy for opiate dependence for users of all ages elsewhere, our study group constitutes a unique population that differs markedly from younger opiate users who will eventually grow old. In Singapore, MMT appears to be an effective treatment for stable, elderly opium-dependent patients where families are fully engaged in the treatment regime.

Socio-demographic profile and psychiatric comorbidity of subjects with pathological gambling.

INTRODUCTION: Pathological gambling is defined as the failure to resist the impulse to gamble despite disruption to personal, family and vocational life. It appears to be highly comorbid with psychiatric disorders. This study aims to describe the socio-demographic profile and comorbidity of 40 pathological gamblers compared to controls. MATERIALS AND METHODS: Questionnaires were administered to 40 cases (90% male, mean age = 38.3, SD = 10.0) scoring 5 or more in the South Oaks Gambling Screen (SOGS) and verified to be pathological gamblers based on DSM-IV criteria and 40 age-and-gender-matched controls. RESULTS: Study results showed that the prevalence of lifetime DSM-IV diagnoses were significantly different between cases and controls (chi(2) = 16.4, P <0.001), with 67.5% of the cases and 22.5% of the controls meeting the criteria, respectively. Eighty percent of the cases had at least one personality disorder compared to 45% in the control (chi(2) = 10.5, P <0.005). The common lifetime disorders observed in the cases were substance abuse disorder and anxiety while common personality disorders were obsessive-compulsive, avoidant and paranoid. CONCLUSION: This study highlights the high rates of comorbidity in a largely Chinese sample in an Asian setting and the importance of assessing pathological gamblers for comorbidities.

Alcohol and aldehyde dehydrogenase polymorphisms in Chinese and Indian populations.

The association between two functional polymorphisms in alcohol dehydrogenase (ADH2/ADH1B) and aldehyde dehydrogenase (ALDH2) genes and alcohol dependence was examined in 182 Chinese and Indian patients undergoing treatment for alcohol dependence and 184 screened control subjects from Singapore. All subjects were screened by the Alcohol Use Disorders Identification Test (AUDIT). Patients were also administered the Severity of Alcohol Dependence Questionnaire (SADQ). Polymorphisms were genotyped by allele-specific polymerase chain reaction and selected genotypes confirmed by DNA sequencing or restriction fragment length polymorphism. Our results showed that frequencies of ADH1B*2 and ALDH2*2 were higher in controls compared to alcohol-dependent subjects for both Chinese and Indians. Frequencies of these two alleles were also higher in the 104 Chinese controls compared to the 80 Indian controls. None of the eight Chinese who were homozygous for both protective alleles was alcohol dependent. The higher frequencies of the protective alleles could explain the lower rate of alcohol dependence in Chinese.

Prevalence and correlates of excessive Internet use among youth in Singapore.

INTRODUCTION: There has been an explosive growth of Internet usage worldwide and this is expected to continue with its use becoming an integral part of everyday life. The Internet provides tremendous educational benefits; however, excessive Internet use can lead to negative outcomes such as poor school performance and social isolation. MATERIALS AND METHODS: The survey consisted of a 69-item, anonymous, self-administered paper-and-pencil questionnaire. Data collected included demographic data, academic performance, social support and general wellbeing as well as questions pertaining to Internet use. For the purposes of our study, we defined Internet use of more than 5 hours a day as "excessive use". RESULTS: Of the 2735 adolescents who took part in the study, 1349 (49.3%) were male and 1383 (50.6%) were female. The mean age of the adolescents was 13.9 years [standard deviation (SD), 1.0]. A quarter of the adolescents surveyed (25%) reported that they did not access the Internet everyday, while 17.1% of adolescents reported using it for more than 5 hours every day. Excessive Internet use was associated with (i) no rules of Internet use at home (x2 = 313.1, P <0.001 ), (ii) less likelihood of having confidants (x2 = 15.8, P = 0.003), (iii) feelings of sadness or depression (x2 = 49.6, P <0.001) and (iv) perceived poorer grade/school work (x2 = 226.1, P <0.001). CONCLUSIONS: The high figures of excessive Internet use (17.1%) reported in our study is not equivalent to Internet addiction as no diagnostic instruments were used. However, school counsellors and teachers need to be made aware of the prevalence of and problematic behaviours associated with excessive Internet use. Training and resources should also be made available to parents and caregivers so that they can play a greater role in setting boundaries and detecting early warning signs.

Concomitant use of midazolam and buprenorphine and its implications among drug users in Singapore.

INTRODUCTION: The aim of this study was to determine the prevalence and characteristics of benzodiazepine (BZD) abuse among intravenous opioid users in Singapore. MATERIALS AND METHODS: Eligibility criteria for inclusion in this study were all intravenous buprenorphine abusers, who presented to the Community Addictions Management Programme (CAMP) over a 1-year period from February 2005 to January 2006. One hundred and twenty subjects, who consented to the study, completed an interviewer-administered questionnaire and underwent blood test for blood-borne viral infections. RESULTS: The age of the 120 subjects ranged from 20 to 64 years, with a mean age of 39.0 (SD 8.0) years. The majority of the participants were male (90.0%); 48.3% were Chinese. Ninety-eight (81.7%) patients were using BZDs concomitantly. Midazolam was the most commonly used BZD. Buprenorphine abusers who were concomitantly using BZDs were significantly younger and reported an earlier age of onset of illicit drug abuse as compared to those not using BZDs. Those abusing BZDs were more likely to share syringes (x 2 = 5.8, P = 0.02), and were more likely to be seropositive for hepatitis C virus (x 2 = 4.3, P = 0.04). CONCLUSIONS: This study highlights the extreme caution that needs to be exercised in prescribing BZDs to all patients in general and patients with injecting drug use or histories of drug abuse in particular. At a public health level, general practitioners (GPs) who prescribe buprenorphine should have compulsory training which highlights the potential dangers of abuse and concomitant abuse of BZDs.

Benzodiazepine dependence in Singapore.

The study, conducted in 2003-2005, was aimed at investigating the pattern of benzodiazepine (BZD) use and the attitudes and perceptions of doctors' prescribing practices by a hundred BZD-dependent patients in Singapore. Data on patients' demographic characteristics, psychiatric profiles, patterns of BZD use, and perceptions about doctors' prescribing practices were collected. A benzodiazepine dependence self-report questionnaire (Bendep-SRQ) was also administered. The mean age of the study participants was 39.4 years (SD = 9.7); 88% were Chinese, 58% were males, 46% were married, 48% had received secondary school education, and 48% were unemployed. BZD abuse in Singapore is contributed to by both doctor-shopping behavior and doctors' prescribing practices. Doctors need training on the assessment and management of BZD dependence. The study's limitations were noted. This project was supported by an institutional block grant received from the National Medical Research Council, Singapore.

Demographic and clinical features of 150 pathological gamblers referred to a community addictions programme.

INTRODUCTION: Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The present study reports on the sociodemographic features, gambling activity, comorbidity and legal problems in a sample of 150 pathological gamblers who sought treatment from the Community Addiction Management Programme (CAMP), Singapore over a 4-year period from 2002 to 2006. MATERIALS AND METHODS: Data were collected on 150 consecutive subjects who sought treatment at CAMP. Patients were administered a semi-structured interview to elicit demographic data, age of onset, family history, onset games and types of games ever played, largest debt incurred due to gambling, triggers, illegal activities and suicidal attempts by their counsellor. Patients were then assessed by the clinicians to establish the primary and comorbid diagnoses. RESULTS: The mean age of the subjects was 42.5 [standard deviation (SD) 10.2] years. The majority of them were males (87.3%) and of Chinese origin (97.3%). The most common comorbid disorders were mood disorders (n = 22, 14.7%), substance abuse (n = 11, 7.3%) and alcohol abuse or dependence (n = 7, 4.7%). Sixteen (10.7%) subjects had a history of suicidal attempts which had been precipitated by gambling-related issues. CONCLUSIONS: Pathological gambling in our subjects appears to be associated with significant comorbidity and financial problems. These are the preliminary findings and further research is needed regarding the phenomenology, profile, course and response to treatment of pathological gambling disorders.

Socio-demographic profile and help-seeking behaviour of buprenorphine abusers in Singapore.

INTRODUCTION: The US Food and Drug Administration (FDA) approved buprenorphine or Subutex for the treatment of opiate dependence in October 2002. Buprenorphine is a partial agonist of the mu-opioid receptor; although initial animal research suggested a low abuse potential for buprenorphine, it was subsequently shown to have an abuse potential similar to that of morphine or hydromorphone. The objectives of this study were to establish the sociodemographic profile and help-seeking behaviour of buprenorphine abusers attending the deaddiction treatment clinics of the Community Addictions Management Programme. MATERIALS AND METHODS: One hundred and twenty subjects, all buprenorphine abusers fulfilling the diagnostic criteria for opiate dependence, who consented to the study, completed an interviewer-administered questionnaire. RESULTS: The mean age of those participating in the study was 39.2 [standard deviation (SD) 8.0] years. The majority of the participants were male (90%), 52.5% were currently employed and 98% had at least primary education. A family history of drug abuse was reported by 27% of the subjects. Illicit drug abuse occurred at an early age with mean age of onset of illicit drug abuse being 16.9 (SD 4.8) years with gateway drugs like marijuana and glue. CONCLUSIONS: It is vital for our medical profession to be aware of the trend in the local population to move from the abuse of illicit substances, to the abuse of prescriptive medications. It makes it necessary to increase the understanding of addictions both amongst our practising medical fraternity, and amongst those training to enter the profession. At the hospital level, it necessitates a higher level of vigilance among our emergency room physicians and those treating infectious diseases.