Clinical, social, and motility factors influencing transanal irrigation response in pediatric patients.

The abuse of substances is a global issue and a persistent health problem worldwide []. The United Nations Office on Drugs and Crime (UNODC) reported that 275 million people aged 15–64 have used substances at least once [], with the incidence of substance use disorder (SUD) rising dramatically between 2010 and 2019 []. Additionally, the World Health Organization (WHO) estimated that over 300 000 deaths in 2016 were due to alcohol and SUDs [, ]. South Africa is one of the world’s largest producers of several substances associated with SUD, such as cannabis [, ]. According to the South African Community Epidemiology Network on Drug Use (SACENDU) report, alcohol, cannabis, cocaine, and heroin/opiates were the most common substances of abuse in the North West province in South Africa from 2018 to June 2020 [], with polysubstance abuse representing 69% of all the SUD cases in the North West province []. Substance use disorder (SUD) involves a physical, mental, and emotional compulsion to use mind-altering substances like drugs or alcohol [], often leading to increased tolerance and higher doses to achieve the desired effect. Due to its complexity and associated medical conditions, SUD treatment is typically managed separately from general care []. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describe essential features of SUD during use and withdrawal as a collection of unwanted cognitive, behavioural, and physiological symptoms, ultimately causing the individual to continue using the substances despite negative consequences []. When substance use is abruptly stopped, unpleasant or even dangerous withdrawal symptoms follow, spurring further use to avoid withdrawal effects, eventually leading to a persisting cycle of continued use [, ]. Substance use disorder (SUD) is a condition that progresses through a deteriorating three-phase cycle: binge and intoxication, withdrawal and negative effects, and preoccupation and anticipation (craving) []. Ultimately, these three phases are mediated by complex neural circuits involving both the limbic system and the prefrontal cortex [, ]. Three key limbic regions including the amygdala, hippocampus, and nucleus accumbens are primarily involved in regulating reward, emotion, and punishment []. Furthermore, the mesocorticolimbic dopaminergic pathways, which project from the ventral tegmental area (VTA) to the nucleus accumbens and to the medial and dorsal prefrontal cortex, respectively, play a central role in the behavioural manifestations of addiction, including drug craving, dependence, and relapse [].