Showing papers in "Addiction in 1993"
TL;DR: The AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
Abstract: The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
11,042 citations
TL;DR: There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs.
Abstract: Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.
1,561 citations
TL;DR: Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems.
Abstract: This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol-related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross-national use. One thousand, eight hundred and eighty-eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non-drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol-related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol-related problems scales. There were strong correlations between the various alcohol-specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.
487 citations
TL;DR: ERG studies which used probability sample of patients to represent the population of the emergency facility where the data were collected, and which separated injured patients from patients with medical conditions not due to injuries (the 'non-injured').
Abstract: This paper reviews emergency room (ER) studies from a number of countries which have focused on the association of alcohol and casualties. The review emphasizes studies which used probability sample of patients to represent the population of the emergency facility where the data were collected, and which separated injured patients from patients with medical conditions not due to injuries (the 'non-injured'). Reviewed here are studies concerned with: (1) estimated prevalence of positive blood alcohol at the time of the ER visit; (2) self-reported alcohol consumption prior to the event resulting in a need for ER treatment; (3) patients' descriptions of their usual drinking patterns and alcohol-related problems; (4) predictions of casualties and of alcohol-related casualties. Comparisons of findings from several countries are also presented. Comments on limitations of ER studies as well as other issues pertaining to the usefulness and interpretation of such data, and future directions for research in emergency room populations are discussed.
362 citations
TL;DR: The practical experiences of the group in using a privileged access interviewer team to interview more than 400 heroin users, many of whom were not in contact with treatment services, are discussed and this method is most appropriate for the quick collection of data, from diverse networks of drug users, by use of a structured instrument.
Abstract: The methodological issues surrounding the use of a privileged access interviewer team to generate a network sample of drug users are examined. Traditionally network samples have tended to be used by qualitative researchers. Privileged access interviewing provides a mechanism for the application of a structured instrument to a network sampling model. In doing so some problematic issues in this area for structured methodology are overcome, reduced or standardized. The use of this method is appraised in terms of meeting the methodological requirements of the Drug Transitions study. The practical experiences of our group in using a privileged access interviewer team to interview more than 400 heroin users, many of whom were not in contact with treatment services, are discussed. This method is most appropriate for the quick collection of data, from diverse networks of drug users, by use of a structured instrument. Success is likely to be dependent on careful implementation. The ongoing monitoring of data quality is of particular importance, as is good management practice and the establishment of supportive and non exploitative relationships with the interviewer team.
311 citations
TL;DR: Two methods for allocating stage of change on the basis of questionnaire responses for use in different circumstances, a "quick" and a "refined" method, are described.
Abstract: Following the development of the Readiness to Change Questionnaire described by Rollnick et al.,1 this article reports on the predictive validity of the questionnaire among a sample of 174 male excessive drinkers identified by screening on wards of general hospitals. Relationships between patients' “stage of change” derived from questionnaires administered prior to discharge from hospital and changes in drinking behaviour at 8 weeks and 6 months follow-up are analysed. Allocated stage of change provided statistically significant relationships with drinking outcome. Multiple regression analysis showed that stage of change remained a significant predictor of changes in alcohol consumption when other possible predictors were taken into account. Two methods for allocating stage of change on the basis of questionnaire responses for use in different circumstances, a “quick” and a “refined” method, are described.
284 citations
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TL;DR: There was evidence for a dose-response relationship between level of alcohol consumption and risk of harm for liver cirrhosis, cancers of the oropharynx, larynx and oesophagus, rectum, liver and breast, and blood pressure and stroke.
Abstract: We have reviewed 156 papers which provided sufficient information to relate individual alcohol consumption to risk for a variety of physical damage. Overall, there was evidence for a dose-response relationship between level of alcohol consumption and risk of harm for liver cirrhosis, cancers of the oropharynx, larynx, oesophagus, rectum (beer only), liver and breast, and blood pressure and stroke. An increased risk of cardiac arrhythmias, cardiomyopathy and sudden coronary death was associated with heavy drinking. There was evidence for a protective effect of alcohol consumption against risk of coronary heart disease, which could be achieved at consumption levels of less than 10 g alcohol a day. The mortality of non-drinkers was higher than that of moderate drinkers in some studies. Level of alcohol consumption and total mortality were dose-related when non-drinkers were excluded. The finding of a dose-relationship between alcohol and harm suggested causality. It was not possible to define individual risk for all harms at a given level of alcohol consumption because of variations in methodology, but some idea of the order of magnitude of the increased risk can be obtained from calculating trends of pooled log-odds ratios. At levels of alcohol consumption of more than 20-30 g a day, all individuals are likely to accumulate risk of harm. Current guidelines on upper limits of lower risk drinking in different countries (168-280 g of alcohol a week for men and 84-140 g a week for women) reflect levels at which the risk of total mortality is not greatly increased above one.
273 citations
TL;DR: The surprisingly low levels of readdiction and the rarity of addiction to narcotics alone as compared with poly-substance dependence are findings still not entirely incorporated into public and scientific views of heroin addiction.
Abstract: Between 1972 and 1974, the outcomes of army enlisted men who had served in Vietnam during 1970-71 were evaluated and compared with that of a matched group. This paper reports the major findings of that study with respect to frequency of narcotic addiction in and after Vietnam, and the major risk factors for Vietnam addiction and later relapse. Extraordinary access to records facilitated drawing the sample, locating it, and verifying interview responses. The surprisingly low levels of readdiction and the rarity of addiction to narcotics alone as compared with poly-substance dependence are findings still not entirely incorporated into public and scientific views of heroin addiction. Some defenses against that incorporation are examined.
251 citations
TL;DR: A model was developed which best describes the likelihood of patients achieving continuous long-term abstinence and shows that five factors together have a 76% accuracy of predicting continuous abstinence to 12 months.
Abstract: Predictors of successful smoking cessation were examined in a randomized controlled trial of 450 smokers who received an intervention by their general practitioner (GP). Pretreatment characteristics predicting outcome at 3, 6 and 12 months and for continuous abstinence to 12 months were determined using logistic regression analyses. Results showed the variables that significantly predicted abstention at 3 months were age and motivation, whereas the predictors at 6 months were socio-economic status, motivation, level of dependence and time spent with smokers. No single predictor emerged at 12 months. Predictors for continuous abstinence to 12 months were age, time spent with smokers and motivation. A model was developed which best describes the likelihood of patients achieving continuous long-term abstinence. The results show that five factors (high motivation level, older age, less time spent with smokers, low dependence level, and higher socio-economic status) together have a 76% accuracy of predicting continuous abstinence to 12 months.
215 citations
TL;DR: Results indicate that measures of social desirability may be used to ascertain sensitive areas of inquiry in interviews of intravenous drug users and suggest that self-deception and impression management were inversely related to self-reports of sharing injection equipment, injecting at shooting galleries, and injecting more than once a day.
Abstract: This study examined the extent to which self-report of human immunodeficiency virus (HIV) risk behaviors might depend upon socially desirable response tendencies, and whether socially desirable responding might serve as a confounding variable in the study of risk behaviors and HIV serostatus. The subjects were 2885 intravenous drug users participating in the ALIVE study in Baltimore, Maryland. Participants completed an interview and were tested for HIV serostatus. The interview covered HIV risk behaviors, and included established scales to measure ‘self-deception’ and ‘impression management’, two separate dimensions of socially desirable responding. Seven items for each scale were scored true/false, with a summary score used for analysis. Scores on self-deception and impression management were inversely related to self-reports of sharing injection equipment, injecting at shooting galleries, and injecting more than once a day. Neither self-deception nor impression management was associated with cocaine use. Self-reported receptive anal intercourse was associated inversely with self-deception but not with impression management. HIV serostatus was not associated with social desirability, and statistically controlling for social desirability had a negligible impact on the magnitude of associations between risk behaviors and HIV serostatus. The results indicate that measures of social desirability may be used to ascertain sensitive areas of inquiry in interviews of intravenous drug users.
212 citations
TL;DR: Findings lend further weight to the view that prevention efforts should focus on licensed drinking environments and, in particular, the practice of continuing to serve obviously intoxicated customers.
Abstract: A household survey of 1160 Western Australian adults was used as a basis for exploring drinkers' reports about the settings in which they drank alcohol and their experiences of alcohol related harm. Of the 873 drinkers identified, 7.9% had experienced some form of acute alcohol related harm over the previous 3 months. Violent incidents were the most common of these and drink-driving offences the least. Such harm was significantly more likely among drinkers who variously drank 'heavily', were male, single, under 25 years of age and/or who drank on licensed premises. Regression analyses revealed that even when demographic characteristics of the drinkers were controlled for licensed premises were significantly more likely to be the settings used prior to harm occurring. Bar staff continuing to serve 'obviously intoxicated' customers was the most powerful predictor of harm. Premises which offered discounted drinks or permitted crowding also tended to be those where intoxication was permitted but these variables were not directly associated with an increased risk of harm. These findings lend further weight to the view that prevention efforts should focus on licensed drinking environments and, in particular, the practice of continuing to serve obviously intoxicated customers.
TL;DR: Looking at the social contexts within which needle sharing took place among a sample of Glasgow injectors shows that needle sharing is rarely random but instead highly patterned and influenced by circumstance and social relationships.
Abstract: This paper looks at the social contexts within which needle sharing took place among a sample of Glasgow injectors. The intention is to show that needle sharing is rarely random but instead highly patterned and influenced by circumstance and social relationships. Gender can also be seen to have an important influence on sharing patterns. Consideration of the reported instances of needle sharing provides some indication that women injectors may be at increased risk of HIV transmission relative to their male counterparts.
TL;DR: An analysis produced a cluster of variables among off-course bettors associated with impaired control of gambling, among which both SSS scores and chasing were prominent features.
Abstract: Male off-course bettors were assessed using: the Sensation-Seeking Scale (SSS) Form V, two measures of subjective arousal while betting, and questions concerning chasing, preferences for gambling activities and other aspects of betting behaviour. The SSS was also administered to a random sample of the male general population of Glasgow, together with questions concerning preferences for gambling activities to allow comparison between regular gamblers and the general population. In comparison with the general population and with non-gamblers, off-course bettors scored lower on SSS; gamblers preferring the casino and/or the race-track scored higher on SSS; gamblers betting on many different forms scored higher on SSS. A further analysis produced a cluster of variables among off-course betters associated with impaired control of gambling, among which both SSS scores and chasing were prominent features.
TL;DR: For each country of the EC total alcohol consumption, the frequency and the context of consumption of the new beverage type are examined, and whether subpopulations, defined by sex, age and educational level, differ in the adoption of thenew beverage type is analyzed.
Abstract: Within the European Community (EC) drinking patterns in the southern countries can be characterised by daily consumption of wine at meals, and in the northern countries by less frequent consumption of beer outside meals. Yet, as in past decades in the southern countries beer consumption and in the northern countries wine consumption strongly increased, the question is whether the distinction in drinking patterns still applies. This paper (1) describes for each country of the EC total alcohol consumption, (2) examines the frequency and the context of consumption of the new beverage type and (3) analyses whether subpopulations, defined by sex, age and educational level, differ in the adoption of the new beverage type. In all countries wine is consumed more often at meals compared to beer. Older people consume wine in greater numbers and more frequently than younger people, who consume beer in greater numbers. People of higher educational level consume the new beverage type more often compared to people of lower educational level, who consume the traditional beverage type more frequently. Finally, males and females differ less in the frequency of consumption of the new beverage type than in the frequency of the traditional beverage type.
TL;DR: Factor analyses to assess the dimensions underlying the DSM-III-R and DSM-IV dependence and abuse criteria as operationalized in the NHIS88 show that a two-dimensional model is required.
Abstract: Decisions on the final version of the DSM-IV alcohol abuse and dependence criteria will be determined largely by the APA's substance abuse field trials, conducted primarily in treated, clinical samples. Among the major objectives of the field trials are to study the boundaries between abuse and dependence, and to identify specific criteria that define the abuse category. The decisions on revisions of the abuse and dependence criteria in DSM-IV should, however, be informed by data from non-treated or general population samples as well. The present study addresses the field trial objectives using recent data from a large general population survey, the 1988 National Health Interview Survey (NHIS88). The paper reports on factor analyses to assess the dimensions underlying the DSM-III-R and DSM-IV dependence and abuse criteria as operationalized in the NHIS88. The focus of the analyses is on whether models with more than one dimension are needed and if so, the correspondence of the dimensions to criteria sets defined in the DSM-III-R and DSM-IV. The analyses show that a two-dimensional model is required. The dimensions are interpreted as abuse and dependence, but the sets of criteria that define each of the dimensions show important deviations from the criteria sets used in the DSM definitions.
TL;DR: The research described in this paper resulted from a collaborative multi-centre study of the relatives of problem drug users involving six practitioners and researchers, in four centres within the south-west of England, showing that large numbers of these relatives reported many negative experiences.
Abstract: The research described in this paper resulted from a collaborative multi-centre study of the relatives of problem drug users involving six practitioners and researchers, in four centres within the south-west of England. The objective of this research was simply to interview 50 close relatives of identified problem drug users, with the identification occurring through clinics and self-help groups. Quantitative and qualitative results show that large numbers of these relatives reported many negative experiences. The partners of illicit drug users reported both more and differently patterned problematic behaviours than those of prescribed tranquillizer users. The partners of illicit users also reported different problems to those of the parents. Relatives reported many negative effects in terms of how they viewed the drug user, and how the experiences had affected their health. They also described various coping mechanisms, and the extent of the support which they had received. The results are discussed in terms of coping, and similarity with research into the families of problem drinkers.
TL;DR: While allowing for patient descriptors and the time period in which urine samples were collected, the relative odds of using heroin were reduced by 2% for every 1 mg increase in the maintenance dose of methadone.
Abstract: A retrospective study examined the association between methadone dose and in-treatment heroin use as measured by fixed-interval urine testing in a cohort of 62 patients admitted to an Australian maintenance program. Urinalysis and methadone dose data were collected on subjects for a maximum two years and were analysed using Zeger & Liang's (1986) method for modelling longitudinal data. While allowing for patient descriptors and the time period in which urine samples were collected, the relative odds of using heroin were reduced by 2% for every 1 mg increase in the maintenance dose of methadone. It is estimated that the odds of patients maintained on 40 mg of methadone using heroin were 2.2 times those of patients maintained on 80 mg.
TL;DR: For men the relation of alcohol intake to short spells of sickness absence appeared to be U-shaped, for long spells (> 7 days) increased rates of absence were found only in frequent drinkers, there was no clear relationship for women, however higher rates of sickness disappearance were found in non-drinkers.
Abstract: Previous studies suggest that problem drinkers have markedly increased sickness absence. However, it is not clear how more moderate alcohol consumption and abstinence relate to sickness absence. As part of the Whitehall II study the relationship between different drinking patterns and sickness absence is examined. A total of 10 314 male and female civil servants completed a baseline questionnaire about their drinking habits-the amount of alcohol consumed over the past 7 days and the frequency of drinking over the past 12 months. All sickness absence has been recorded prospectively. Drinking patterns and sickness absence are examined for short spells (less-than-or-equal-to 7 days) and long spells (> 7 days) adjusting for other causes of sickness absence: age, grade of employment, smoking, work characteristics and baseline health. Alcohol consumption was strongly related to employment grade, the lower the grade the higher proportion of men and women reporting no alcohol consumption. For men the relation of alcohol intake to short spells of sickness absence (less-than-or-equal-to 7 days) appeared to be U-shaped, for long spells (> 7 days) increased rates of absence were found only in frequent drinkers. There was no clear relationship for women, however higher rates of sickness absence were found in non-drinkers.
TL;DR: A review of the English language literature on alcohol and unintentional injury found that case control studies are needed to establish whether alcohol increases the risk of trauma and whether interventions to reduce the proportion of these injuries where alcohol is involved.
Abstract: In a review of the English language literature on alcohol and unintentional injury we identified 21 studies on falls, 36 on drownings and 32 on burns from 1947-1986. The proportion of fatal and non-fatal fall victims who had been drinking ranged from 21-77%, and 18-53% respectively. In three more recent studies, 35-63% of persons fatally injured in falls had been drinking. In five other studies 13-37% of persons injured in non fatal falls had been drinking. In our earlier review of drowning studies with complete ascertainment and duration of submergence specified, 27-47% of those who drowned had positive BAC's. In eight subsequent studies, alcohol was identified in 21-47% of drowning deaths. In our earlier review alcohol was involved in 9-86% of burn deaths. In five more recent US studies, alcohol was found in 12-61% of fatally injured burn victims. Case control studies are needed to establish whether alcohol increases the risk of trauma. Studies are also needed of interventions to reduce the proportion of these injuries where alcohol is involved.
TL;DR: Based on the 1990 US National Alcohol Survey, this note provides the first available comprehensive findings on self-reported utilization of a variety of sources of personal support and counselling for alcohol and other problems.
Abstract: The Data Note series is edited by Dr Bridget Grant, Chief of Biometry at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), USA.
Abstract
Based on the 1990 US National Alcohol Survey, this note provides the first available comprehensive findings on self-reported utilization of a variety of sources of personal support and counselling for alcohol and other problems. Respondents were queried about lifetime attendance and number of times they went to identified sources of help in the prior year. Twelve-step groups included Alcoholics Anonymous, Al-Anon, Adult Children of Alcoholics, and other non-alcohol-oriented groups like Gamblers Anonymous, Narcotics Anonymous, and Overeaten Anonymous; additional questions inquired about support or therapy groups and individual counselling for non-alcohol problems. Of the US adult population, 9% have been to an AA meeting at some time, 3.6% in the prior year, only about one-third of these for problems of their own. About half these percentages, mostly women, have attended Al-Anon. Of the same population, 13.3% indicate ever attending a 12-step meeting (including non-alcohol-oriented groups), 5.3% in the last year. During the prior year a further 2.1% used other support/therapy groups and 5.5% sought individual counseling/therapy for personal problems other than alcohol. In contrast to this high reported utilization, only 4.9% (ever) and 2.3% (12-months) reported going to anyone including AA for a problem (of their own) related to drinking.
TL;DR: Current data confirm earlier findings of long lasting psychopathology arising in vulnerable individuals from the use of LSD, and a hypothetical long term molecular mechanism of adverse effects is proposed.
Abstract: The continued endemic use of hallucinogenic drugs, and of LSD in particular, raises concern regarding their short and long term adverse consequences. The epidemiology of LSD abuse is reviewed suggesting an increase in LSD use among the young as the prevalence rates for other substances continues to fall. Evidence supports the association of LSD use with panic reactions, prolonged schizoaffective psychoses and post-hallucinogen perceptual disorder, the latter being present continually for as long as 5 years. Evidence does not support claims of genetic disorders arising from hallucinogens. In light of the foregoing, current data confirm earlier findings of long lasting psychopathology arising in vulnerable individuals from the use of LSD. A hypothetical long term molecular mechanism of adverse effects is proposed.
TL;DR: The AUDIT was judged as a useful instrument both in a routine health examination and as an epidemiological tool for predicting return to employment in this sample.
Abstract: A representative sample of 310 long-term unemployed in Norway was followed for 2 years with clinical examinations and the AUDIT questionnaire. 30% of the men and 8% of the women scored over the cut-off point for an alcohol use disorder. This gives a probable prevalence of 16%. The test predicted return to employment in this sample. The AUDIT answers were also used as a basis for dividing into three groups:‘normal',‘hazardous’ and‘harmful'. At 2 year follow-up, 27% had changed group, 32 respondents to the worse and 24 to the better. This‘unstable’ group was characterized by weaker social network and more frequent drinking. The AUDIT was judged as a useful instrument both in a routine health examination and as an epidemiological tool.
TL;DR: Those with violence-related injuries were more likely than those with other injuries to have positive breathalyzer readings and to report drinking prior to the event, frequent heavy drinking, consequences of drinking, experiences associated with alcohol dependence and loss of control and prior treatment for an alcohol problem.
Abstract: Drinking patterns, alcohol-related problems and drinking-in-the-injury event were compared between those admitted to the emergency room (ER) with and without injuries resulting from violence. A probability sample of 1770 adult casualty patients in four hospitals in a single California suburban county were breathalyzed and interviewed at the time of the ER visit. Among all males and females over 30, those with violence-related injuries were more likely than those with other injuries to have positive breathalyzer readings and to report drinking prior to the event, frequent heavy drinking, consequences of drinking, experiences associated with alcohol dependence and loss of control and prior treatment for an alcohol problem. The data suggest a need for research to test whether a brief intervention at the time of the ER visit for problem drinking or a referral for more extensive alcohol treatment can effect a reduction in alcohol-related violence and other alcohol-related problems.
TL;DR: Results of a field trial of Substance Use Disorders as defined by DSM-III-R, DSM-IV (proposed) and ICD-10 and factor analysis of Dependence criteria showed high loadings of all items on a single factor across the three diagnostic systems and for all categories of drugs.
Abstract: This report presents results of a field trial of Substance Use Disorders as defined by DSM-III-R, DSM-IV (proposed) and ICD-10. Diagnoses based on the three systems were derived from interviews using the Composite International Diagnostic Interview (CIDI) in a heterogeneous sample of 521 adults drawn from clinical and community settings. Two issues are addressed: (1) cross system agreement; and (2) syndrome coherence of proposed criterion sets for Substance Dependence in each of the three systems. Findings were as follows: (1) Cross system agreement for Dependence was generally high, especially between DSM-III-R and DSM-IV. (2) Cross system agreement was lower for DSM-III-R and DSM-IV Abuse and very low for DSM-IV Abuse and ICD-10 Harmful Use. (3) Agreement varied across drug categories with lowest DSM-III-R/DSM-IV agreement for alcohol abuse and DSM-IV/ICD-10 agreement for marijuana use disorders. (4) Overall prevalence differed for the three systems with DSM-IV yielding highest rates followed by DSM-III-R and ICD-10 in that order. (5) Factor analysis of Dependence criteria showed high loadings of all items on a single factor across the three diagnostic systems and for all categories of drugs. Implications for validity of the dependence syndrome construct and for revisions in DSM-IV are discussed.
TL;DR: A controlled trial studied whether cue exposure prevented relapse in opiate addiction, and found that all groups showed a significant decrement in cue-elicited craving, withdrawal responses and negative mood.
Abstract: A controlled trial studied whether cue exposure prevented relapse in opiate addiction. Subjects were randomly allocated to one of two inpatient treatment settings: a drug dependence unit with a special 10 week program and 4 weeks in a behavioural/general treatment unit without such a program. In each setting, following drug-withdrawal, subjects had either cue exposure for at least six sessions over 3 weeks, or a control condition. Subjects were followed up twice, at about 6 weeks and 6 months post-treatment. 186 subjects were randomly allocated; 69 were assessed post-detoxification, and of these 43 completed cue exposure or control treatments. Cue exposure and control subjects did not differ in cue reactivity. This was evaluated post-treatment for cue exposure subjects and at a comparable time point for controls. All groups showed a significant decrement in cue-elicited craving, withdrawal responses and negative mood. Cue exposure and control subjects did not differ at either of the two follow up interviews.
TL;DR: The programme appears to have been effective in changing behaviour, in that trained servers exhibited less inappropriate responses than did untrained servers, and the results suggested that the programme increased servers' knowledge about their obligations and potential strategies for dealing with these situations.
Abstract: Server intervention is a relatively new approach in the attempt to reduce the incidence of drinking and driving. Although a number of evaluations have suggested that the approach may be effective, there have been few comprehensive evaluations of such programmes. The present study utilized process evaluation techniques to assess reactions to a programme developed by the Addiction Research Foundation, and a quasi-experimental design to determine the impact of the programme on the serving practices of servers. Actors portrayed behaviours often faced by servers, and observers rated the reactions of the servers, who were unaware of the simulations, to these situations. The programme appears to have been effective in changing behaviour, in that trained servers exhibited less inappropriate responses than did untrained servers. In addition the results suggested that the programme increased servers' knowledge about their obligations and potential strategies for dealing with these situations. The implications of these findings for future implementations of such programmes are discussed.
TL;DR: The excess risk of dependence associated with frequent heavy drinking varied among population subgroups and was increased by age, education, and female gender.
Abstract: Data from a national representative sample of US adults were analyzed to determine the association between the relative frequency of heavy drinking (the proportion of drinking occasions on which 5 + drinks were consumed) and past-year alcohol dependence, adjusting for the influences of average ethanol intake and sododemographic factors. Fifty-seven percent of current drinkers reported never drinking 5 + drinks, and 21% drank 5 + drinks at least once but on less than 10% of all drinking occasions. Nine percent reported drinking 5 + drinks on at least half of all drinking occasions. Average daily intake was positively correlated with the relative frequency of heavy drinking, and both consumption measures were positively associated with the risk of alcohol dependence. Increases in either relative frequency of heavy drinking or average ethanol intake reduced, but did not eliminate, the effect of the other on the risk of dependence. The excess risk of dependence associated with frequent heavy drinking varied among population subgroups and was increased by age, education, and female gender.
TL;DR: Patients with antisocial personality disorder (ASPD) were at higher risk for an anxiolytic disorder as were women and the unemployed as well as recent users of benzodiazepines, who were more likely to have a lifetime DSM-III anxiety disorder.
Abstract: The prevalence and correlates of benzodiazepine use and anxiolytic abuse and dependence are examined in a sample of 427 patients in Toronto, Canada, who met lifetime DSM-III criteria for alcohol abuse or dependence. The patients were evaluated with the NIMH-DIS and other standard psychiatric and substance abuse rating scales. Forty per cent were recent users of benzodiazepines and 20% had abused or been dependent upon anxiolytics, including benzodiazepines, during their lifetime. Patients with antisocial personality disorder (ASPD) were at higher risk for an anxiolytic disorder as were women and the unemployed. Recent users of benzodiazepines showed more current psychological distress, depressive symptomatology and more severe substance abuse problems than other patients and were more likely to have a lifetime DSM-III anxiety disorder. Patients with anxiolytic disorders, even if ASPD was controlled for, showed more psychiatric impairment and drug abuse problems than the remaining patients. Of those with a positive urine screen, 46% did not report using benzodiazepines in the previous week. Nineteen per cent of the patients who did not report benzodiazepine use in the previous week had a positive urine screen and were more likely to be found in the detoxification unit.
TL;DR: If an homology can be established between humans and rodents then the changes observed in alcohol-fed rats can be regarded as underpinning some of the functional and behavioural alterations depicted under these circumstances.
Abstract: The effects of long-term alcohol consumption and withdrawal upon the structure of the rat hippocampal formation were studied by applying morphometric methods to material processed for light and electron microscopy. The somatostatinergic neurons of the hilus zvere aha studied. Groups of 6 rats were treated as follows: (a) given alcohol for 6, 12 and 18 months; (b) paired controls; and (c) rats switched to a normal diet in the 6 months after 6 and 12 month!, of alcohol intake. A progressive loss of hippocampal neurons after chronic alcohol consumption was found. The loss was aggravated during withdrawal from alcohol, with the exception of the hilar cells. The dendrites of granule cells front the alcohol-treated rats displayed signs of regrowing, but they did not do so in rats withdrawn from alcohol. The synapses between mossy fibre terminals and CA3 dendrites appear to be rather resistant to alcohol insult, and evidence of morphological plasticity mas found in withdrawn rats. If an homology can be established between humans and rodents then the changes observed in alcohol-fed rats can be regarded as underpinning some of the functional and behavioural alterations depicted under these circumstances, The peculiar changes found in some nerve cell populations after withdrawal of alcohol could be related to the deficient or incomplete functional recovery often seen after abstinence from alcohol.
TL;DR: Across all drug classes, severity correlated reasonably well with measures of quantity and frequency of use and with associated problems.
Abstract: The concept of a dependence syndrome with graded levels of severity was originally derived from work with alcoholics. The applicability and clinical utility of the dependence syndrome across a wider range of substances was examined as part of the DSM-IV field trials. When using a criterion count method to assess severity, it was found that persons cluster at different severity levels according to the drug on which they are dependent. Across all drug classes, severity correlated reasonably well with measures of quantity and frequency of use and with associated problems. The relationship between severity ratings and outcome was not tested, however data from other studies indicate that severity is only one of many factors that can influence outcome.