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Conventional mental health legislation, England and Wales being an example, discriminates against people with a mental illness. The criteria governing involuntary treatment of patients with a 'mental' disorder are quite distinct from those governing involuntary treatment of patients with a 'physical' disorder. In the case of the former, two criteria operate: (1) the person has a 'mental disorder' - usually vaguely defined - And, (2) there is a risk of harm to the person or to others. For those with a 'physical disorder' the criteria are usually (1) a lack of 'decision-making capacity', and (2) the treatment must in the person's 'best interests'. Thus the autonomy of the person with mental illness is not accorded the same respect as other patients. Mental health legislation reflects deeply embedded cultural stigmatising stereotypes - That persons with a mental illness are incompetent and dangerous. We propose a non-discriminatory legal framework for legislation that is generic - covering all persons with impaired decision-making capacity, whatever the cause, whatever the diagnosis, and in any healthcare (and indeed, social care) setting. Termed a 'Fusion Law', it combines complementary, strengths of both incapacity and civil commitment schemes. We suggest that the fusion model is consistent with the UN Convention on the Rights of Persons with Disabilities. Such legislation would be an important step in reducing unfair legal discrimination against persons with mental disorder and in providing a sound basis for 'coercive' treatments in psychiatry. Consistent ethical principles would thus be applied across all medical law.

Cue reactivity is essential to the maintenance of addictive disorders. A useful way to study cue reactivity is by means of normative pictures, but few validated tobacco-related pictures are available. This study describes a database of smoking-related pictures: The Geneva Smoking Pictures (GSP). Sixty smoking-related pictures were presented to 91 participants who assessed them according to the classic emotional pictures validation provided by the International Affective Picture System (NIMH Center for the Study of Emotion and Attention, 2002). The pictures were rated according to three dimensions: (1) valence (from positive to negative), (2) emotional arousal (from high arousing to low arousing), and (3) dominance (from submissive to dominant). Participants were also screened with the Fagerström Test for Nicotine Dependence. Normative ratings for valence, arousal and dominance of the pictures are provided for the whole sample, as well as separately for dependent (n = 46) and nondependent smokers (n = 45). Arousal and dominance were associated with greater nicotine dependence, but valence ratings were not. The GSP is a normative database providing a large number of stimuli for investigators who are conducting nicotine and tobacco research.

Introduction: Studies of the users' engagement with smoking cessation application (apps) can help understand how these apps are used by smokers, in order to improve their reach and efficacy. Objective: The present study aimed at identifying the best predictors of the users' level of engagement with a smartphone app for smoking cessation and at examining the relationships between predictors and outcomes related to the users' level of engagement with the app. Methods: A secondary analysis of data from a randomized trial testing the efficacy of the Stop-Tabac smartphone app was used. The experimental group used the "full" app and the control group used a "dressed down" app. The study included a baseline and 1-month and 6-month follow-up questionnaires. A total of 5,293 participants answered at least the baseline questionnaires; however, in the current study, only the 1,861 participants who answered at least the baseline and the 1-month follow-up questionnaire were included. Predictors were measured at baseline and after 1 month and outcomes after 6 months. Data were analyzed using machine learning algorithms. Results: The best predictors of the outcomes were, in decreasing order of importance, intention to stop smoking, dependence level, perceived helpfulness of the app, having quit smoking after 1 month, self-reported usage of the app after 1 month, belonging to the experimental group (vs. control group), age, and years of smoking. Most of these predictors were also significantly associated with the participants' level of engagement with the app. Conclusions: This information can be used to further target the app to specific groups of users, to develop strategies to enroll more smokers, and to better adapt the app's content to the users' needs.

<b><i>Background:</i></b> Apps for smartphones are opening an important range of opportunities for improving the care of people with alcohol use disorders (AUDs). <b><i>Aims:</i></b> This study aimed to evaluate the quality of English language apps for AUDs and to compare paid and free apps. The keywords 'alcohol', 'alcohol addiction', 'alcohol help' and 'stop drinking' were entered into the iTunes Store search engine. Apps were evaluated using a standardized assessment designed to rate the quality of apps in terms of accountability, interactivity, self-help score and evidence-based content. The Brief DISCERN score and the criteria of the 'Health on the Net' label were also used as content quality indicators. <b><i>Results and Conclusions:</i></b> Of the 137 unique apps identified, 52 met the inclusion criteria. Overall, the content quality and self-help scores of these AUD apps were poor. The main quality indicators were not linked to payment status. Multiple linear regressions showed that the Brief DISCERN score significantly predicted content quality. Poor content quality and self-help scores of AUD smartphone apps underline the gap between their potential promises and the overall quality of available products in stores. The quality indicators used in the present study may be used for further app developments.

Slow downtitration as a methadone discontinuation method is time-consuming and associated to high dropout rates. Whereas ultra-rapid opiate detoxification methods have recently gained some popularity, they are expensive and may be associated with particular problems in methadone patients. In the present study, a 3-day detoxification procedure accelerated with a unique dose of naltrexone was used in 10 methadone-substituted patients. Whereas the treatment resulted in a shortened withdrawal syndrome, which was satisfactorily controlled by the drugs used, a two-phase course was observed, some symptoms reappearing between the end of day 2 and the beginning of day 3. The first phase of withdrawal symptoms was attributed to the antagonistic effect of naltrexone, which possibly also improved under the weakening of naltrexone. The second phase of withdrawal symptoms may be related to falling methadone plasma levels.

Cannabis is the most popular psychoactive substance under international regulations, with more than 192 million users worldwide. It has been associated with an addictive pattern of use and negative social and health-related outcomes in a subgroup of users. Consequently, understanding the individual differences that contribute to cannabis use and problematic use is of much importance. The current study examined the impact of impulsivity traits (negative urgency, positive urgency, lack of premeditation, lack of perseverance, sensation seeking), delay reward discounting, and depressive mood on cannabis use status during the past 6 months as well as problematic use of cannabis in a representative sample of 635 French-speaking Swiss young men recruited during their conscription in a Swiss national military recruitment center. Binary logistic and multiple linear regressions indicated that cannabis use status was significantly associated with greater depressive mood, elevated sensation seeking, and lack of perseverance, whereas problematic cannabis use was significantly related to higher depressive mood and steeper delay reward discounting. The present study highlights the importance of emotional symptoms in cannabis use and misuse. Our results also shed light on the potential psychological processes related to problematic consumption of cannabis and open avenues for preventive actions and psychological interventions that target problematic use of cannabis.

Purpose: Substance use disorders (SUD) are an important health issue internationally. Traditional outpatient programmes often do not adequately address the substantial medical and social needs and in addition many patients have difficulties accessing the care needed. The assertive community treatment (ACT) model was originally developed for patients with a severe mental illness but has been adapted for patients with SUD by integrating specific SUD treatments into the traditional ACT model. This paper aims to assess the effectiveness of ACT for patients with SUD on a number of measures. Methods: We performed a systematic review of ACT interventions for patients with SUD by analyzing randomized controlled studies published before June 2017 found on the electronic databases PsychINFO, MEDLINE, PsychARTICLES. Eleven publications using 5 datasets were included in the analysis. Quality of studies was analyzed using the JADAD scale or Oxford quality scoring system. Outcome measures used were substance use, treatment engagement, hospitalization rates, quality of life, housing status, medication compliance and legal problems. Patients included in the studies had a diagnosis of SUD. Two datasets included homeless patients and 2 datasets included patients with high service use. Results and Conclusions: The results of the very few existing randomized control studies are mixed. Treatment engagement was higher for ACT in 4 datasets. One dataset reported higher service contact rates for the ACT group than for controls. In 2 datasets a positive effect on hospitalization rates was found. Higher fidelity to the ACT model appears to improve outcomes. Substance use reduced only in half of the datasets, of which only one showed a significant reduction in the ACT group. Overall, ACT is a promising approach that may be useful for promoting treatment engagement for patients with SUD. According to earlier studies on patients with severe mental illness, patients with high inpatient service use benefit most from this assertive approach. We hypothesize that a similar high need user group among patients with SUD might benefit most from ACT. Further research is needed to examine which types of clinical interventions might help difficult-to-engage patients with addictions.

<b><i>Aims:</i></b> The aim of this paper is to illustrate how Switzerland was able to play such a pioneering role in the field of addiction treatment, in creating a drug policy that includes the medical prescription of diacetylmorphine (heroin). The paper will also describe the role of knowledge brokering processes and coalition building in the different phases of the development of the Swiss drug policy. <b><i>Discussion:</i></b> The medical prescription of diacetylmorphine was the exotic element of the Swiss drug policy of 1991 and probably still is one of the most controversial practices in clinical medicine despite its documented effectiveness. Coalitions of change actors, across stakeholder groups from many professions and politicians on various levels, succeeded in formulating and starting initiatives for a new drug policy and its innovations. Clear, shared objectives and a common feeling of urgency brought the coalitions together. <b><i>Conclusion:</i></b> In the case of Switzerland, the Confederation took a leading role by facilitating communication, encouraging scientific knowledge and bringing the various stakeholders on a platform to deliver a consensual political policymaking basis. This was facilitated by the Swiss direct democracy system. Sustained dialogue between researchers and the users of research enhances the likelihood of research affecting policy.

<i>Background:</i> Several studies have linked massively multiplayer online role-playing games (MMORPGs) with possible problematic usage or internet addiction. <i>Aims:</i> The main goal of the present study was to assess links between motivations to play in MMORPGs and addictive involvement in such types of games. <i>Methods:</i> A total of 696 gamers responded to an online survey. <i>Results and Conclusion:</i> Five distinct motivations to play were identified in gamers: achievement, socializing, immersion, relaxing and escaping. Multiple regression analysis revealed that addictive MMORPG use patterns are predicted by achievement, escapism and socializing motives. Gender was also a significant predictor of problematic involvement in MMORPGs. Moreover, addictive MMORPG use positively correlated with the weekly time devoted to playing MMORPGs.

<b><i>Background:</i></b> Cyberchondria denotes excessive and repeated online health-related searches associated with an increase in health anxiety. Such searches persist in those with cyberchondria, despite the negative consequences, resembling a pattern of compulsive Internet use. <b><i>Objectives:</i></b> The aim of the present study was to assess compulsive health-related Internet use in relation to cyberchondria while controlling for related variables. <b><i>Method:</i></b> Adult participants (<i>N</i> = 749) were recruited from an online platform. They completed questionnaires assessing the severity of cyberchondria (via the Cyberchondria Severity Scale [CSS]), compulsive Internet use adapted for online health-related seeking (via the adapted Compulsive Internet Use Scale [CIUS]), and levels of intolerance of uncertainty and anxiety, as well as depressive, somatic, and obsessive-compulsive symptoms. A logistic regression analysis was carried out to identify predictors of scores above a cutoff value on the CIUS, indicating compulsive health-related Internet use. <b><i>Results:</i></b> The regression output showed that only the CSS total score and sex made a unique, statistically significant contribution to the model, leading to the correct classification of 78.6% of the cases. Of the CSS subscales, compulsion and distress were the most strongly associated with compulsive health-related Internet use. <b><i>Conclusions:</i></b> The finding that the adapted CIUS scores are associated with cyberchondria indicates that cyberchondria has a compulsive component, at least in terms of health-related Internet use. It also suggests that compulsive health-related Internet use persists despite the distress associated with this activity. Males may engage in cyberchondria more compulsively than females. These findings have implications for research and clinical practice.

This study describes a new database of alcohol-related pictures: The Geneva Appetitive Alcohol Pictures (GAAP). 60 alcohol-related pictures (beverages, drinking-related behaviors, alcohol-related cues) were presented to 101 participants (ranging from social drinkers to problem drinkers), who assessed them according to the classic emotional pictures validation provided by the International Affective Picture System (Center for the Study of Emotion and Attention (CSEA[-]NIMH), 2002). Participants were also screened with the Alcohol Use Disorders Identification Test. Normative ratings for valence, arousal and dominance of the pictures are provided separately for problem/risky users (n = 49) and non-risky drinkers (n = 52). The GAAP is a normative database that provides a large number of stimuli for investigators who conduct research on alcohol.