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      Substance abuse and rehabilitation: responding to the global burden of diseases attributable to substance abuse

      article-commentary
      Substance Abuse and Rehabilitation
      Dove Medical Press
      global burden of disease, rehabilitation, substance abuse, substance use disorders

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          Abstract

          Alcohol, tobacco, and illegal drug use are pervasive throughout the world. Substance use problems are among the major contributors to the global disease burden, which includes disability and mortality. The benefits of treatment far outweigh the economic costs. Despite the availability of treatment services, however, the vast majority of people with substance use disorders do not seek or use treatment. Barriers to and unmet need for evidence-based treatment are widespread even in the United States. Women, adolescents, and young adults are especially vulnerable to adverse effects from substance abuse, but they face additional barriers to getting evidence-based treatment or other social/medical services. Substance use behaviors and the diseases attributable to substance use problems are preventable and modifiable. Yet the ever-changing patterns of substance use and associated problems require combined research and policy-making efforts from all parts of the world to establish a viable knowledge base to inform for prevention, risk-reduction intervention, effective use of evidence-based treatment, and rehabilitation for long-term recovery. The new international, open-access, peer-reviewed Substance Abuse and Rehabilitation ( SAR) journal strives to provide an effective platform for sharing ideas for solutions and disseminating research findings globally. Substance use behaviors and problems have no boundaries. The journal welcomes papers from all regions of the world that address any aspect of substance use, abuse/dependence, intervention, treatment, and policy. The “open-access” journal makes cutting edge knowledge freely available to practitioners and researchers worldwide, and this is particularly important for addressing the global disease burden attributable to substance abuse.

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          Most cited references23

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          Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions.

          No information is available on the co-occurrence of DSM-IV nicotine dependence and Axis I and II psychiatric disorders in the US population. To present national data on the co-occurrence of current DSM-IV nicotine dependence and other psychiatric disorders by sex and to estimate the burden of all US tobacco consumption carried by nicotine-dependent and psychiatrically ill individuals. Face-to-face interviews. The United States. Household and group-quarters adults (N = 43 093). Prevalence and comorbidity of current nicotine dependence and Axis I and II disorders and the percentage of cigarettes consumed in the United States among psychiatrically vulnerable subgroups. Among US adults, 12.8% (95% confidence interval, 12.0-13.6) were nicotine dependent. Associations between nicotine dependence and specific Axis I and II disorders were all strong and statistically significant (P<.05) in the total population and among men and women. Nicotine-dependent individuals made up only 12.8% (95% confidence interval, 12.0-13.6) of the population yet consumed 57.5% of all cigarettes smoked in the United States. Nicotine-dependent individuals with a comorbid psychiatric disorder made up 7.1% (95% confidence interval, 6.6-7.6) of the population yet consumed 34.2% of all cigarettes smoked in the United States. Nicotine-dependent and psychiatrically ill individuals consume about 70% of all cigarettes smoked in the United States. The results of this study highlight the importance of focusing smoking cessation efforts on individuals who are nicotine dependent, individuals who have psychiatric disorders, and individuals who have comorbid nicotine dependence and other psychiatric disorders. Further, awareness of industry segmentation strategies can improve smoking cessation efforts of clinicians and other health professionals among all smokers and especially among the most vulnerable.
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            Substance abuse treatment entry, retention, and outcome in women: a review of the literature.

            This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.
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              Substance abuse in women.

              Gender differences in substance use disorders (SUDs) and treatment outcomes for women with SUDs have been a focus of research in the last 15 years. This article reviews gender differences in the epidemiology of SUDs, highlighting the convergence of male/female prevalence ratios of SUDs in the last 20 years. The telescoping course of SUDs, recent research on the role of neuroactive gonadal steroid hormones in craving and relapse, and sex differences in stress reactivity and relapse to substance abuse are described. The role of co-occurring mood and anxiety, eating, and posttraumatic stress disorders is considered in the epidemiology, natural history, and treatment of women with SUDs. Women's use of alcohol, stimulants, opioids, cannabis, and nicotine are examined in terms of recent epidemiology, biologic and psychosocial effects, and treatment. Although women may be less likely to enter substance abuse treatment than men over the course of the lifetime, once they enter treatment, gender itself is not a predictor of treatment retention, completion, or outcome. Research on gender-specific treatments for women with SUDs and behavioral couples treatment has yielded promising results for substance abuse treatment outcomes in women. Copyright 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Subst Abuse Rehabil
                Subst Abuse Rehabil
                Substance Abuse and Rehabilitation
                Dove Medical Press
                1179-8467
                2010
                16 November 2010
                : 1
                : 5-11
                Affiliations
                Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
                Author notes
                Correspondence: Dr Li-Tzy Wu, Sc.D, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center, Box 3419, Durham, NC 27710, USA, Tel +1 919-668-6067, Fax +1 919-668-5418, Email litzy.wu@ 123456duke.edu ; litzywu@ 123456yahoo.com

                *Li-Tzy Wu is the Editor-in-Chief of Substance Abuse and Rehabilitation

                Article
                sar-1-005
                10.2147/SAR.S14898
                3122477
                21709730
                80a5aaae-5514-450a-8f76-788b64510f30
                © 2010 Wu, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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                global burden of disease,rehabilitation,substance abuse,substance use disorders

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