Sinkevičius, Liudas Vincentas

Įvadas. Istoriškai psichoaktyvių medžiagų vartojimas nebuvo vertinamas kaip reikšminga problema, tačiau tūkstantmečių sandūroje įvyko radikalus pokytis, kurio nematė nei viena mums žinoma civilizacija - tai mirtinų ligų kaita iš užkrečiamų į neužkrečiamas, o šiame procese priklausomybės ligos pasirodė tokiu mastu, jog kai kurios šalys jų paplitimą vadina epidemija. Priklausomybių ligos yra plačiai paplitęs reiškinys, kuris ne tik yra viena iš dominuojančių psichikos sveikatos problemų, ta- čiau skirtingai nuo kitų sutrikimų, įtakoja visą sociumą, dėl to susilaukia ne tik kliniki- nių sprendimų gairių, tačiau dažnai politinių ir visuomenės nuomone remtų įveikimo strategijų. Pranešimo turinys. Didžioji dalis klinikinių ir savipagalbos tradicijų priklauso- mybę apibrėžia kaip lėtinę, recidyvuojančią būklę, kuri dažniau valdoma ir kontro- liuojama, nei galutinai „išgydoma”. Toks požiūris pabrėžia, kad vien tik vartojimo nutraukimas ne visuomet reiškia psichologinės problemos sprendimą, nes priklau- somybės neretai „keičia formą“ ir pasireiškia kitais simptomais ar santykių sunku- mais. Šiuo metu galime aiškiai išskirti dvi kryptis priklausomybių valdymo temoje. Viena jų yra radikalus vartojimo nutraukimas ir gydymo taikymas. Visgi atsižvelgiant į milžinišką priklausomų asmenų skaičių visame pasaulyje suprantame, jog ilgalaikė abstinencija yra didelė prabanga ir jos prieinamumas gali pasiekti tik kelis procentus priklausomų asmenų. Būtent dėl to žvelgiame į žalos mažinimo modelius, kurie ne- žada utopinio gyvenimo, tačiau teikia psichoaktyvių medžiagų alternatyvas, kurios tikėtina mažiau kenks tiek pačiam vartotojui, tiek ir aplinkiniams. Išvados. Atsižvelgiant į besikeičiančią situaciją, priklausomybių gydymas turėtų būti grindžiami kompleksiniu, pragmatišku ir individualizuotu požiūriu, integruojant žalos mažinimo priemones. Žalos mažinimas yra didelis iššūkis psichikos sveikatos specialistams nes reikia ne tik naujų žinių ar psichoterapinių strategijų perkonstravi- mo, tačiau ir vidinių pokyčių, naujos realybės pripažinimo.

Background and Objectives: One of the strongest early factors influencing later psychoactive substance use is adverse childhood experiences (ACEs). Studies investigate a variety of adverse experiences in relation to substance use, yet not all adverse childhood experiences are equal in intensity and harm. Our study aimed to address this gap by examining in detail the associations between individual ACEs, broader ACE categories, and different forms of psychoactive substance use. Materials and Methods: The study included 709 participants who completed self-report questionnaires. ACEs were measured using the MACE questionnaire. Marijuana use was measured using the CUDIT-R, alcohol use using the AUDIT, and heavy psychoactive substance use using the ASSIST. Linear regression analyses were used to predict associations. As expected, only a small part of the sample reported hard drug use; some analyses are limited to substantially fewer observations. Results: All regression models were statistically significant and predicted all three categories of psychoactive substances, but if we count the individual adverse experiences, the results become different. Although the results showed that ACE is a significant predictor of hard drug use and explains 25% of the variance, it is separately only emotional neglect that is associated with hard drug use. The regression analysis also explains 14% of the variance in marijuana use, but when considered separately, we found associations only with emotional neglect. The severity of alcohol use explains 13% of the variance, but only a few ACEs reach statistical significance: peer physical bullying, physical violence, and sexual abuse. Conclusions: The findings of our study suggest that adverse childhood experiences may not be qualitatively equivalent and therefore may not be evaluated only as a cumulative risk score. Separate ACE evaluations, instead of aggregate calculation of ACEs, may be useful to understand better which specific negative experiences have the greatest impact on subsequent use of psychoactive substances. The regression models explain only a small portion of the variance, which suggests that other factors may contribute to a larger share.

Adverse childhood experiences (ACEs) are recognized risk factors for later substance use. Yet, data remain scarce—particularly regarding the differentiated effects of specific types of ACEs and their distinct associations with various psychoactive substances. The current study is one of the first in Lithuania to explore the associations between specific ACEs and psychoactive substance use in young adulthood (ages 18–29). This cross-sectional study included a total of 709 participants who completed an online survey. ACEs were measured using a combination of adapted ACEs items and the MACE questionnaire. Substance use was assessed using self-reported instruments: CUDIT-R (cannabis), AUDIT (alcohol), ASSIST (heavy psychoactive substances), and nicotine use. Structural equation modeling (SEM) was chosen to examine predictive relationships. Results revealed that experiences of sexual abuse and physical maltreatment in childhood predicted higher levels of alcohol use in young adulthood. Sexual abuse was positively associated with nicotine, cannabis, and heavy psychoactive substance use, while witnessing interpersonal violence was only associated with higher nicotine use. However, verbal abuse showed significant negative associations across several substance categories. No significant associations were found between family addiction history and substance use. The absence of an important relationship between family history of addiction and substance use indicates that genetic factors may be less decisive than environmental or psychosocial conditions. The main findings of this study are that ACEs are not qualitatively equivalent to one another, so it is worth examining them separately, rather than summing them. Furthermore, based on the negative associations with verbal abuse and the generally statistically negative associations, we can assume that ACEs may not be the most important factors increasing substance use. Further studies should look for other factors that influence substance use.

Statistical data demonstrate a concurrent rise in smoking prevalence and mental disorders, such as depression and anxiety, which may be attributed to contemporary lifestyle factors, including social media and recent global events. This indicates a potential correlation between these trends, as individuals with mental disorders may engage in smoking as a form of self-medication to alleviate anxiety. However, smoking is harmful and increases the risk of many diseases. Therefore, smoking cessation strategies are increasingly being considered. Nicotine is a naturally produced alkaloid in plants that makes smoking so addictive. Unfortunately, the public’s lack of understanding of the effects of nicotine leads to misleading claims in the public and media about its biological effects. Thus, current narrative literature review is focused on the examination of the biological effects of organic nicotine from various angles, considering the psychological aspects of addiction and the immune system. Analysis of recent data showed that nicotine not only causes addiction but also has therapeutic benefits in certain diseases (depression, anxiety, schizophrenia) and has anti-inflammatory properties (autoimmunity, neurodegenerative diseases), and a deeper understanding and a broader approach to its effects is needed.

Introduction. Adverse childhood experiences (ACEs) are recognized risk factors for later substance use, yet data remain scarce – particularly regarding the differentiated effects of specific types of ACEs and their distinct associations with various psychoactive substances. Current study is one of the first in Lithuania to explore the associations between specific ACEs and substance use expression in young adulthood (ages 18–29), a developmental period defined by Arnett’s theory of emerging adulthood and full neurological maturation. Methods. This cross-sectional study included a total of 709 participants (26.5% male, 73.5% female) completed an online survey between September and November 2024. Substance use was assessed using validated instruments: AUDIT (alcohol), CUDIT-R (cannabis), ASSIST (other substances), and self-reported smoking behavior. ACEs were measured using a combination of adapted ACE questionnaire items) and the MACE scale, covering ten categories of childhood adversity. Structural Equation Modeling (SEM) was employed to examine predictive relationships. Results. Sexual abuse, physical neglect, emotional neglect, and physical abuse consistently predicted higher levels of alcohol, cannabis, and other substance use. Verbal abuse, conversely, showed significant negative associations across several substance categories. Smoking was positively associated with sexual abuse and negatively with witnessing interpersonal violence. Notably, a family history of addiction was not significantly related to substance use, suggesting that genetic predisposition may play a less central role than environmental or psychosocial factors. Conclusions. The findings underscore the differentiated impact of specific adverse childhood experiences on the use of various psychoactive substances. This highlights the necessity for further research that not only examines adverse experiences individually, but also explores the distinct associations between different types of psychoactive substances and these early life stressors. Such an approach is essential for uncovering substance-specific pathways and developing more targeted prevention and intervention strategies.

Visuomenėje vis dar nėra susiformavęs aiškus požiūris kas yra priklausomybė, ar tai liga ar valios trūkumas. Priklausomybė nuo psichoaktyvių medžiagų yra sudėtingas psichikos sutrikimas, pakeičiantis galvos smegenų sistemos veiklą taip, kad mesti vartoti sunku net ir tiems, kurie to nori. Priklausomybė yra lėtinė liga, kuriai būdingas psichoaktyvių medžiagų ieškojimas ir vartojimas, kuris yra kompulsyvus arba sunkiai kontroliuojamas, nepaisant žalingų pasekmių (Koob & Volkow, 2016). Atsižvelgiant į tai, jog šis sutrikimas pasireiškia su sąlyga, jog žmogus vartos psichoaktyvias medžiagas, lygiai taip pat kaip potrauminis streso sindromas, kuris pasireikš tik buvus trauminiam įvykiui, taigi turi būti pakankamai aiški patogenezė kuri yra nebūdinga daugeliui psichikos sutrikimų. Nepaisant priklausomybės sindromo susiformavimo „aiškumo“, praktikoje ir tyrimuose matome, jog vieni asmenys tampa priklausomi, o kiti ne. Pagal atliktus tyrimus (Volkow & Czernin, 2019) matome, jog iš tų, kurie pavartojo psichoaktyvias medžiagas, tik apie 10 - 20% (priklausomai nuo medžiagos) tampa priklausomi, tokiu atveju kyla klausimas, kas lemia būtent šios siauros grupės polinkį šiam sutrikimui. Iki šiol nėra aiškaus atsakymo, tačiau manoma, jog priklausomybės sindromą lemia sudėtingi biologiniai-genetiniai bei socialiniai veiksniai, kurie dinamiškai sąveikauja darydami įtaką sutrikimo rizikai, trajektorijai ir rezultatams. Norint suprasti šio sutrikimo rizikos ir apsaugos veiksnius, yra būtinas tarpdisciplininis požiūris, kuris apima biologiją, genetiką, psichologiją ir socialinį kontekstą. Rezoliucija/rekomendacijos. Priklausomybės sindromas kyla iš sudėtingų sąveikų tarp genetinių, biologinių, psichologinių ir aplinkos veiksnių. Rizikos veiksniai, tokie kaip smegenų raida, genetinė predispozicija, neigiamos vaikystės patirtys, psichikos sutrikimai ir bendraamžių įtaka yra vieni iš pagrindinių veiksnių prisidedančių prie priklausomybės formavimosi. Priklausomybės ligų formavimosi bei gydymo ateitis remiasi multidisciplininiu požiūriu, kuris leidžia matyti rizikos ir apsaugos veiksnių sąveikas bei laiku reaguoti.