Arun Kandasamy

Background: Problematic Internet use (PIU) is an emerging entity with varied contents. Behavioral addictions have high comorbidity of attention deficit hyperactivity disorder and obsessive–compulsive spectrum disorders. Social networking site (SNS) addiction and role playing game (RPG) addiction are traditionally studied as separate entities. We present a case with excessive Internet use, with a particular focus on phenomenology and psychiatric comorbidities. Case presentation: Fifteen-year-old girl with childhood onset attention deficit disorder, obsessive– compulsive disorder, adolescent onset trichotillomania, and disturbed family environment presented with excessive Facebook use. Main online activity was creating profiles in names of mainstream fictional characters and assuming their identity (background, linguistic attributes, etc.). This was a group activity with significant socialization in the virtual world. Craving, salience, withdrawal, mood modification, and conflict were clearly elucidated and significant social and occupational dysfunction was evident. Discussion: This case highlights various vulnerability and sociofamilial factors contributing to behavioral addiction. It also highlights the presence of untreated comorbidities in such cases. The difference from contemporary RPGs and uniqueness of role playing on SNS is discussed. SNS role playing as a separate genre of PIU and its potential to reach epidemic proportions are discussed. Conclusions: Individuals with temperamental vulnerability are likely to develop behavioral addictions. Identification and management of comorbid conditions are important. The content of PIU continues to evolve and needs further study.

While poppy seed and poppy tea dependence has been described, it is unusual to see such patients actively seek treatment in India.We report the case of an 82-year-old client with dependent use of poppy for 55 years. She was brought for treatment as access to poppy became difficult following legal restrictions. She was successfully maintained on buprenorphine maintainence. [Subodh BN, Murthy P, Chand PK, Arun K, Bala SN, Benegal V, Madhusudhan S. A case of poppy tea dependence in an octogenarian lady. Drug Alcohol Rev 2009]

Background: Opioid Use disorders are emerging as a serious public health concern in India. Opioid substitution treatment
is one of the emerging forms of treatment in this population which needs more evidence to increase its availability and
address prejudices towards the same. Materials and Methods: This is a case control study with retrospective design
reviewing the charts of patients with opioid dependence syndrome registered between January 2005 to December
2012. Adherence to treatment was the outcome variable assessed in this study. Results: The odds of the Buprenorphine
Maintenance Treatment (BMT) group remaining in treatment is 4.5 (P < 0.005) times more than Naltrexone Maintenance
Treatment (NMT) group and 7 times (P < 0.001) more than Psychosocial intervention (PST) alone group. Discussion: We
believe that these study findings will help in reducing the prejudice towards BMT and encourage further research in this
field. Conclusion: BMT has a better adherence rate than other treatments in opioid use disorders.

Alcohol dependence is a global concern. Baclofen has shown promise as an anti-craving agent but its efficiency remains
to be settled. We reviewed 549 male cases diagnosed with alcohol dependence who received Acamprosate (201) or
Baclofen (348). ‘Time to first drink’ was compared between two groups and multiple regression analysis was done in
baclofen group to identify correlates of effectiveness. There was a significant difference in outcome measure between
Baclofen (M = 4.44, SD = 3.75) and Acamprosate group (M = 3.73, SD = 2.19); t (547) = 2.45, P = 0.01. Initial regression
analysis with six predictor variables (average daily alcohol units, current age, age at onset of dependence, family history,
duration of dependence and dose of baclofen in mg/day) showed significant correlation of outcome variable with only
two predictor variables — dose of baclofen and average daily intake. Using the hierarchical method it was found that
‘dose of baclofen’ and ‘average alcohol intake’ explain a significant amount of variance in ‘time to first drink’. [F (1, 345) =
182.8, P < 0.001, R2 = 0.52, R2 adjusted = 0.51]. This information can be used to select patients in long term longitudinal
studies and may explain variable results seen in clinical trials of baclofen done earlier.

Benzodiazepine (BZD) dependence is a significant public health problem. Apart from the long-term tapering doses of BZD, no others drugs are available for the maintenance treatment of BZD dependence. Baclofen has been used in alcohol and other drug dependence as long-term anti-craving agent. Since alcohol and BZD act through the GABA receptor, we attempted to study the effect of Baclofen as maintenance treatment in a series of five cases with BZD dependence.