Perceived benefits and negative consequences of alcohol consumption in cving with HIV: A qualitative study

BACKGROUND:

Women living with HIV have increased prevalence of medical and psychological comorbidities that could be adversely affected by alcohol consumption. Little is known about their unique motivations for drinking or perceptions of HIV-related consequences. In preparation for an alcohol intervention study, we sought to better understand reasons for drinking and perceived consequences of alcohol consumption among a sample of women living with HIV.

METHODS:

Four focus groups, with a total of 24 adult women (96 % African-American, 88 % HIV-positive), were conducted in Jacksonville, FL, Washington, DC and Chicago, IL. Focus group discussions were tape-recorded and transcribed verbatim; a conventional content analysis approach was used to identify themes, that were then grouped according to a biopsychosocial model.

RESULTS:

Regarding reasons for drinking, women described themes that included biological (addiction, to manage pain), psychological (coping, to escape bad experiences, to feel in control), and social (peer pressure, family). Themes related to consequences from alcohol included biological (damage to body, poor adherence to medications), psychological (risky or regrettable behavior, memory loss), and social (jail, loss of respect, poor choices). When discussing how their drinking impacted their health, women focused on broader issues, rather than HIV-specific issues.

CONCLUSION:

Many women living with HIV are drinking alcohol in order to self-manage pain or emotions, and their perceived consequences from drinking extend beyond HIV-specific medical issues. Most participants described themes related to psychological issues and situations that are common in women living with HIV. Interventions to address drinking should inquire more specifically about drinking to manage pain or emotion, and help women to recognize the potential adverse impact of alcohol on comorbid health issues, including their own HIV infection.

Full article at:   http://goo.gl/vA9COI

By:  Cook RL1, Cook CL2, Karki M3, Weber KM4, Thoma KA5, Loy CM6, Goparaju L7, Rahim-Williams B8.

• 1Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA. cookrl@ufl.edu.
• 2Department of Family, Community, and Health System Science, University of Florida College of Nursing, PO Box 100197, Gainesville, FL, 32610-0197, USA.
• 3Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, 32610, USA.
• 4Cook County Health and Hospital System and Hektoen Institute of Medicine, 2225 W Harrison St, Chicago, IL, 60612, USA.
• 5Clinical Research Specialist, UF CARES, University of Florida Center for HIV/AIDS, Research, Education & Service, 653-1 West 8th Street, LRC 3rd Floor L-13, Jacksonville, FL, 32209, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
• 7Women's Interagency HIV Study (WIHS), Georgetown University Medical Center, 2115 Wisconsin Ave NW, Suite 130, Washington DC, 20007, USA.
• 8Department of Public Health, Bethune-Cookman University, College of Health Sciences, 640 Dr. Mary McLeod Bethune Blvd., Daytona Beach, Florida, 32114, USA. 
• BMC Public Health. 2016 Mar 15;16(1):263. doi: 10.1186/s12889-016-2928-x.

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Management of Benzodiazepine Misuse and Dependence

There are well-recognised harms from long-term use of benzodiazepines. These include dependency, cognitive decline and falls. It is important to prevent and recognise benzodiazepine dependence. A thorough risk assessment guides optimal management and the necessity for referral. 

The management of dependence involves either gradual benzodiazepine withdrawal or maintenance treatment. Prescribing interventions, substitution, psychotherapies and pharmacotherapies can all contribute. Unless the patient is elderly, it is helpful to switch to a long-acting benzodiazepine in both withdrawal and maintenance therapy. 

The dose should be gradually reduced over weeks to lower the risk of seizures. Harms from drugs such as zopiclone and zolpidem are less well characterised. Dependence is managed in the same manner as benzodiazepine dependence.

Benzodiazepine and z-drugs half-life and conversion table

Drug	Approximate half-life (hours)	Dose of oral benzodiazepine approximately equivalent to diazepam 5 mg
Short- to intermediate-acting benzodiazepines
Triazolam	1–3	0.25 mg
Oxazepam	4–15	15 mg
Temazepam	5–15	10 mg
Lorazepam	12–16	1 mg
Bromazepam	20	3 mg
Alprazolam	6–25	0.5 mg
Flunitrazepam	20–30	0.5 mg
Nitrazepam	16–48	5 mg
Clobazam	17–49	10 mg

Long-acting benzodiazepines (includes effects of active metabolites)
Clonazepam	22–54	0.5 mg
Diazepam	20–80	5 mg

Z-drugs
Zolpidem	2.4	10 mg
Zopiclone	5.2	7.5 mg

Benzodiazepine withdrawal syndrome – clinical features

General

Headache

Palpitations

Sweating

Musculoskeletal

Tremor, fasciculations

Muscle pain, stiffness and aches (limbs, back, neck, jaw)

Neurological

Dizziness, light-headedness

Paraesthesia, shooting pains in neck and spine

Visual disturbances (blurred vision, diplopia, photophobia, vision lags behind eye movements)

Tinnitus

Faintness and dizziness, sense of unsteadiness

Confusion, disorientation (may be intermittent) – a common cause of confusion in older patients

Delirium (in the absence of autonomic hyperactivity) – particularly in older patients

Delusions, paranoia

Hallucinations (visual, auditory)

Grand mal seizures 1–12 days after discontinuing benzodiazepines

Gastrointestinal

Nausea

Anorexia

Diarrhoea (may resemble irritable bowel syndrome)

Psychological

Rebound insomnia, nightmares

Anxiety, panic attacks

Irritability, restlessness, agitation

Poor memory and concentration

Perceptual distortions – sensory hypersensitivity (light, sound, touch, taste), abnormal sensations (e.g. ‘cotton wool’ sensations)

Metallic taste

Distortions of body image

Feelings of unreality, depersonalisation, derealisation

Depression, dysphoria

Full article at:   http://goo.gl/radrfW

By:  Brett J1, Murnion B2.

• 1Clinical Pharmacology and Addiction Medicine, Drug Health Services, Royal Prince Alfred Hospital.
• 2Clinical Pharmacology and Addiction Medicine, Drug Health Services, Royal Prince Alfred Hospital ; Concord Repatriation General Hospital, Sydney. 
• Aust Prescr. 2015 Oct;38(5):152-5. Epub 2015 Oct 1.

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Researching Lived Experience of Drugs and Crime: A Phenomenological Study of Drug-Dependent Inmates

This study identified the main components of the drugs and crime experience of a sample of 25 drug-dependent inmates interviewed in prison. 

Text analyses were conducted using a phenomenological method. The sample was characterized by a disruptive childhood in multi-problematic families and deviant social contexts where drug use and crime were considered normal since early adolescence. 

Drug initiation involved recreational use of dance drugs and/or cocaine, and the pleasure experienced was identified as the cause of subsequent persistent use. 

Three pathways that led to dependence were identified: 

1. The narcissistic pathway was defined as involving uncontrolled cocaine and amphetamines to feel powerful and limitless. 
2. The posttraumatic pathway was defined as involving post-trauma self-destructive drug use, 
3. The pain relief pathway was defined as involving multiple substances to relieve pain. 

The second and third pathways were more directly associated with crime aimed at sustaining drug use

Purchase full article at:  http://goo.gl/zzSeKB

By:  Facchin F1, Margola D2.

• 1Catholic University of Milan, Italy federica.facchin@unicatt.it.
• 2Catholic University of Milan, Italy. 

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