Abstract: Im Winterthurer Projekt werden in einem familienfokussierten Ansatz die Belastungen und Bedürfnisse von Familien mit Kindern und Jugendlichen mit einem psychisch erkrankten Elternteil konkret benannt, Risiko- und Schutzfaktoren bestimmt sowie Handlungsmöglichkeiten im interdisziplinären Kontext von Medizin und psychosozialen Angeboten aufgezeigt.

Abstract: Concerns about the risks of HIV infection among drug injectors have eclipsed concerns about the prevalence and transmission of hepatitis, and in particular hepatitis B virus infection. Findings are reported from surveys undertaken with two separate community-recruited samples of drug injectors in London collected in 1992 (n = 505) and in 1993 (n = 507). Anonymized confirmed testing of saliva snows 51.5% of drug injectors in 1992 and 47.9% in 1993 to be antibody positive to the core antigen of hepatitis B virus (anti-HBc). Approximately half of the drug injectors confirmed as anti-HBc positive were unaware that they had been infected with hepatitis, Anti-HIV-1 prevalence was considerably lower at 7.0% in 1992 and 6.9% in 1993. Multivariate analyses showed anti-HBc positivity to be most likely among older injectors with longer injecting careers who had a history of having shared used needles and syringes. HIV-1 positivity was also associated with a history of having shared injecting equipment as well as with recent sharing (i.e. in the last 6 months). Unlike anti-HBc positivity, there were no associations between HIV-1 positivity and age or length of injecting career. Younger injectors with shorter injecting careers were more likely to report recent sharing of used injecting equipment than older injectors with longer injecting careers. We note the potential for continued transmission of HBV and HIV-1, particularly among younger injectors. We recommend an integrated strategy to maximize the health of drug injectors, of which HIV and HBV prevention is a part. There is a need to widen the availability of HBV vaccinations for HBV negative drug injectors and their sexual partners and for clear guidelines to drug injectors about the relative efficacy of bleach to disinfect injecting equipment of HBV and HIV.

Abstract: Imaging studies have revealed neurochemical and functional changes in the brains of drug-addicted subjects that provide new insights into the mechanisms underlying addiction. Neurochemical studies have shown that large and fast increases in dopamine are associated with the reinforcing effects of drugs of abuse, but also that after chronic drug abuse and during withdrawal, brain dopamine function is markedly decreased and these decreases are associated with dysfunction of prefrontal regions (including orbitofrontal cortex and cingulate gyrus). The changes in brain dopamine function are likely to result in decreased sensitivity to natural reinforcers since dopamine also mediates the reinforcing effects of natural reinforcers and on disruption of frontal cortical functions, such as inhibitory control and salience attribution. Functional imaging studies have shown that during drug intoxication, or during craving, these frontal regions become activated as part of a complex pattern that includes brain circuits involved with reward (nucleus accumbens), motivation (orbitofrontal cortex), memory (amygdala and hippocampus), and cognitive control (prefrontal cortex and cingulate gyrus). Here, we integrate these findings and propose a model that attempts to explain the loss of control and compulsive drug intake that characterize addiction. Specifically, we propose that in drug addiction the value of the drug and drug-related stimuli is enhanced at the expense of other reinforcers. This is a consequence of conditioned learning and of the resetting of reward thresholds as an adaptation to the high levels of stimulation induced by drugs of abuse. In this model, during exposure to the drug or drug-related cues, the memory of the expected reward results in overactivation of the reward and motivation circuits while decreasing the activity in the cognitive control circuit. This contributes to an inability to inhibit the drive to seek and consume the drug and results in compulsive drug intake. This model has implications for therapy, for it suggests a multi-prong approach that targets strategies to decrease the rewarding properties of drugs, to enhance the rewarding properties of alternative reinforcers, to interfere with conditioned-learned associations, and to strengthen cognitive control in the treatment of drug addiction.

Abstract: We examined the contribution of culturally relevant protective factors (i.e., adolescent religiosity, family connectedness, and perceived close friends’ substance use) to the probability of young adult binge drinking among African American males. Participants (n = 1,599) drawn from the National Longitudinal Study of Adolescent Health were high school age adolescents (14-18 years, M = 16) at Wave 1 and young adults (18-26, M = 22) at Wave 3. Adolescent binge drinking was associated with all three protective factors. Perceived close friends’ substance use in adolescence was a protective factor in later binge drinking during young adulthood, and was moderated by age such that the effect was stronger for younger adolescents. Implications for culturally relevant research and prevention are discussed.