Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids)

Background Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. Methods Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if “wanted to use so badly that could not think of anything else” (severe craving) or “felt a very strong desire or urge to use” (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. Results Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) – 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). Conclusion The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.

Addiction and Fair Opportunity

To decide whether and, if so, under what conditions addiction might excuse misconduct, we need to understand addiction. Three complementary models of addiction are examined—the conception in the Diagnostic and Statistical Manual of Mental Disorders, Ainslie’s hyperbolic discounting model, and Berridge’s and Holton’s model of impaired control. The law’s skepticism about an addiction excuse is examined and questioned. Duress models of how addiction might excuse are rejected. However, the cravings that are part of addiction might affect cognitive (attentional) competence or volitional control. This excuse would be at most partial, and it would be limited to those who are not substantially responsible for becoming or remaining addicted.

Problematic Pornography Use in Japan: A Preliminary Study Among University Students

BackgroundProblematic pornography use is considered an addictive behavior, which is an important clinical issue. Despite considerable research interest in problematic pornography use worldwide, to the best of our knowledge, there are no extant studies on the subject in Japan. Therefore, despite the fact that many people in Japan use pornography, the difference between problematic and non-problematic users among Japanese people is not known.ObjectiveThis study aimed to identify the characteristics of problematic pornography use among Japanese students, to the best of our knowledge. Specifically, we examined general psychopathological symptoms, sexual compulsivity, depression, anxiety, and low effortful control.MethodsThe participants were 150 college students aged 20–26 years (mean age = 21.5, SD = 1.21, males: n = 86, females: n = 64) at a university in midland Japan. An online questionnaire was administered that included items on pornography usage patterns, impaired control of pornography use, sexual compulsivity, depression, anxiety, and effortful control.ResultsMost men (97%) and approximately one-third of women (35.9%) used pornography at least once in the past month. Some users reported significant daily-life problems due to difficulty in controlling pornography use (5.7%). Participants with impaired control of pornography use had higher depression, anxiety, and sexual compulsivity, and lower effortful control than pornography users without impaired control.ConclusionSome Japanese students reported significant daily-life problems due to impaired control of pornography use. The characteristics of individuals with impaired control are consistent with previous studies. The results of this study suggest that individuals with impaired control may have poor mental health, and that there is need for further research and development of treatment systems to manage this issue in Japan. Further research exploring a more varied sample in Japan is required to effectively examine problematic pornography use.

Accelerating elimination of sleeping sickness from the Guinean littoral through enhanced screening in the post-Ebola context: A retrospective analysis

Background Activities to control human African trypanosomiasis (HAT) in Guinea were severely hampered by the Ebola epidemic that hit this country between 2014 and 2016. Active screening was completely interrupted and passive screening could only be maintained in a few health facilities. At the end of the epidemic, medical interventions were progressively intensified to mitigate the risk of HAT resurgence and progress towards disease elimination. Methodology/Principal findings A retrospective analysis was performed to evaluate the medical activities that were implemented in the three most endemic prefectures of Guinea (Boffa, Dubreka and Forecariah) between January 2016 and December 2018. Passive screening using rapid diagnostic tests (RDTs) was progressively resumed in one hundred and one health facilities, and active screening was intensified by visiting individual households and performing RDTs, and by conducting mass screening in villages by mobile teams using the Card Agglutination Test for Trypanosomiasis. A total of 1885, 4897 and 8023 clinical suspects were tested in passive, while 5743, 14442 and 21093 people were actively screened in 2016, 2017 and 2018, respectively. The number of HAT cases that were diagnosed first went up from 107 in 2016 to 140 in 2017, then subsequently decreased to only 73 in 2018. A progressive decrease in disease prevalence was observed in the populations that were tested in active and in passive between 2016 and 2018. Conclusions/Significance Intensified medical interventions in the post-Ebola context first resulted in an increase in the number of HAT cases, confirming the fear that the disease could resurge as a result of impaired control activities during the Ebola epidemic. On the other hand, the decrease in disease prevalence that was observed between 2016 and 2018 is encouraging, as it suggests that the current strategy combining enhanced diagnosis, treatment and vector control is appropriate to progress towards elimination of HAT in Guinea.