Showing papers in "Addiction in 1994"
TL;DR: Although nicotine withdrawal may not produce medical consequences, it lasts for several weeks and can be severe in some smokers, like most other drug withdrawals, nicotine withdrawal is time-limited, occurs in non-humans, is influenced by instructions/expectancy and abates with replacement therapy and gradual reduction.
Abstract: Many of the symptoms of nicotine withdrawal are similar to those of other drug withdrawal syndromes: anxiety, awakening during sleep, depression, difficulty concentrating, impatience, irritability/anger and restlessness. Slowing of the heart rate and weight gain are distinguishing features of tobacco withdrawal. Although nicotine withdrawal may not produce medical consequences, it lasts for several weeks and can be severe in some smokers. Like most other drug withdrawals, nicotine withdrawal is time-limited, occurs in non-humans, is influenced by instructions/expectancy and abates with replacement therapy and gradual reduction. Unlike some other drug withdrawal syndromes, protracted, neonatal or precipitated withdrawal does not occur. Whether nicotine withdrawal is associated with tolerance, acute physical dependence, greater duration and intensity of use, rapid reinstatement, symptom stages, cross-dependence with other nicotine ligands, reduction by non-pharmacological interventions and genetic influences is unclear. Whether nicotine withdrawal plays a major role in relapse to smoking has not been established but this is also true for other drug withdrawal syndromes.
306 citations
TL;DR: The Leeds Dependence Questionnaire is a 10-item, self completion questionnaire designed to measure dependence upon a variety of substances and has been shown to be understood by users of alcohol and opiates.
Abstract: The Leeds Dependence Questionnaire (LDQ) has been developed as part of a treatment evaluation package. The LDQ is a 10-item, self completion questionnaire designed to measure dependence upon a variety of substances; it has been shown to be understood by users of alcohol and opiates. The questionnaire was designed to be sensitive to change over time and to be sensitive through the range from mild to severe dependence; the follow-up data are insufficient to demonstrate change over time, but are encouraging. It is expected that both clinicians and researchers will find it useful to have a single measure relating to substance use, but not limited by specific substances. All items are scored 0-1-2-3; there are no normative data. The procedure for establishing content validity is described and estimates of concurrent, discriminant and convergent validities are reported; these validities are thought to be satisfactory. A principal components analysis produced a single factor accounting for 64% of the variance. Cronbach's alpha was 0.94. Test-retest reliability was found to be 0.95.
275 citations
TL;DR: Improved recognition of MDMA-related syndromes is hoped to provide insight into the function of serotonin in the human brain, in health as well as disease.
Abstract: (±)3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”), a ring-substituted amphetamine derivative first synthesized in 1914, has emerged as a popular recreational drug of abuse over the last decade Pharmacological studies indicate that MDMA produces a mixture of central stimulant and psychedelic effects, many of which appear to be mediated by brain monoamines, particularly serotonin and dopamine In addition to its pharmacologic actions, MDMA has been found to possess toxic activity toward brain serotonin neurones Serotonergic neurotoxicity after MDMA has been demonstrated in a variety of experimental animals (including non-human primates) In monkeys, the neurotoxic dose of MDMA closely approaches that used by humans While the possibility that MDMA is also neurotoxic in humans is under investigation, other adverse effects of MDMA in humans have been documented, including various systemic complications and a number of untoward neuropsychiatric sequelae Notably, many of the adverse neuropsychiatric consequences noted after MDMA involve behavioral domains putatively influenced by brain serotonin (eg, mood, cognition and anxiety) Given the restricted status of MDMA use, retrospective clinical observations from suspecting clinicians will probably continue to be a primary source of information regarding MDMA's effects in humans As such, this article is intended to familiarize the reader with the behavioral pharmacology and toxicology of MDMA, with the hope that improved recognition of MDMA-related syndromes will provide insight into the function of serotonin in the human brain, in health as well as disease
274 citations
TL;DR: Data are presented on the 43 people who died over a 22-year follow-up period of a cohort of 128 heroin addicts drawn in 1969 from the newly opened London clinics, where the main causes of death were drug-related and the excess mortality was concentrated at younger ages.
Abstract: Data are presented on the 43 people who died over a 22-year follow-up period of a cohort of 128 heroin addicts drawn in 1969 from the newly opened London clinics The main causes of death were drug-related, with 18 deaths specifically determined as due to overdose, of which the great majority were among people being prescribed opiates at the time The mortality rate was a mean of 184% annually, and the excess mortality ratio was 119 This excess was highest at the beginning and varied over the period of study, appearing higher at the opening of the clinics and again in the mid-1980s No sex differences in mortality rates were demonstrated but the excess mortality was concentrated at younger ages No prediction of the 85 survivors could be made on the basis of length of heroin use prior to study intake, nor on age at intake
257 citations
TL;DR: The main conclusions are that therapists show diverse rates of effectiveness, and that such differences appear independent of both therapists' professional background and of patient factors at the start of therapy.
Abstract: Despite the widespread use of psychotherapy for patients with substance use disorders, the effectiveness of psychotherapists conducting such treatment has received little research attention. In this paper, empirical studies of therapists' differences in patient outcome and dropout rates are comprehensively reviewed. The main conclusions are that therapists show diverse rates of effectiveness, and that such differences appear independent of both therapists' professional background and of patient factors at the start of therapy. The primary therapist characteristic thus far associated with higher effectiveness is the possession of strong interpersonal skills. Guidelines for research on therapist effectiveness are presented.
236 citations
TL;DR: The results stress the need to consider chronotype as a contributory psychological factor in a multi-causal model of consumption of psychoactive substances.
Abstract: This paper analyses the influence of and possible interaction between chronotype (Morning-types, Neither-types and Evening-types} and personality dimensions (neuroticism, extroversion and psychoticism) in the daily consumption of alcohol and psychostimulants (nicotine and caffeine). In a sample of 537 subjects (257 men and 280 women), who were students and professionals with different but fixed work schedules, there were significant differences among the chronotypes regarding the consumption of all the above. Evening-types consumed more alcohol, nicotine and caffeine (coffee and cola), while Morning-types consumed more caffeine from tea. Personality was only related to the consumption of cola: the greater the neuroticism the higher the consumption of this beverage. Stimulant drinks showed various types of interaction with personality types, which revealed a complex pattern of group action. The results stress the need to consider chronotype as a contributory psychological factor in a multi-causal model of consumption of psychoactive substances.
222 citations
TL;DR: It is concluded that, in order to minimize heroin addicts' risk of death, they should be offered indefinite, high-dose methadone maintenance.
Abstract: A long-term follow-up was made of a cohort of 307 heroin addicts admitted into a high-dose, Australian methadone maintenance programme in the early 1970s. Using data from clinic records, official death records and methadone treatment histories, it was found that subjects were nearly three times as likely to die outside of methadone maintenance as in it (95% CI RR 1.45 to 5.61). Data were further analyzed using Cox regression to investigate the association of maximum daily methadone dose and a change in clinic policy with retention in maintenance treatment. It is estimated that subjects given a maximum daily dose of 80 mg were nearly twice as likely to be discharged during the first three years of maintenance as those given 120 mg (95% CI RR 1.3 to 2.2). The estimated median time in maintenance for subjects given a maximum dose of 120 mg was 1150 days while for 80 mg it was 660 days. It is further estimated that the change in clinic policy from abstinence to indefinite maintenance reduced to one-third subjects' risk of leaving after three years' of treatment (95% CI RR 0.19 to 0.54). It is concluded that, in order to minimize heroin addicts' risk of death, they should be offered indefinite, high-dose methadone maintenance.
211 citations
TL;DR: Major depression was associated specifically with nicotine dependence, an association explained in part by neuroticism, which suggests that the personality trait of neuroticism might constitute a common predisposition for major depression and nicotine dependence.
Abstract: We describe the epidemiology of nicotine dependence and its association with other substance use and psychiatric disorders. Data came from a random sample of young adults, 21-30 years of age, in the Detroit, Michigan metropolitan area. The NIMH Diagnostic Interview Schedule was used to ascertain DSM-III-R disorders. Lifetime prevalence of nicotine dependence was 20%. Higher rates were observed in whites, persons with low education and persons who were separated or divorced. Males and females with nicotine dependence had significantly increased odds for alcohol and illicit drug disorders, major depression and one or more anxiety disorder, as compared to non-dependent smokers and non-smokers combined. Among smokers, lifetime prevalence of illicit drug disorders other than marijuana alone, major depression and any anxiety disorder were significantly higher in dependent than non-dependent people. Major depression was associated specifically with nicotine dependence, an association explained in part by neuroticism. This finding suggests that the personality trait of neuroticism might constitute a common predisposition for major depression and nicotine dependence.
199 citations
TL;DR: The development of a form of the SADQ for community samples of drinkers (SADQ-C) and its relationship to a brief scale designed to measure impaired control over drinking are described, supporting the view that there is a single dimension of alcohol dependence upon which all persons who drink alcohol with any regularity may be located.
Abstract: The concept of the Alcohol Dependence Syndrome has been influential in the field of alcohol studies in the 1980s. The Severity of Alcohol Dependence Questionnaire (SADQ) is one of a generation of alcohol problem scales developed to measure degree of dependence rather than presence or absence of 'alcoholism'. This paper describes the development of a form of the SADQ for community samples of drinkers (SADQ-C) and its relationship to a brief scale designed to measure impaired control over drinking. In a sample of 52 problem drinkers, SADQ and SADQ-C correlated almost perfectly (r = 0.98). In a larger sample of 197 attenders at a controlled drinking clinic, Principal Components Analysis revealed one major factor accounting for 71.7% of the total variance. High internal reliability was indicated with a Cronbach's Alpha of 0.98. Application of this instrument in a random survey of Western Australian households is then described. It was necessary to remove items relating to 'reinstatement of dependence' for this sample. A single major factor was identified by principal components analysis, accounting for 69.1% of the total variance. In both the clinic and the community samples SADQ-C scores correlated highly with Impairment of Control scores. The findings are interpreted as supporting the view that there is a single dimension of alcohol dependence upon which all persons who drink alcohol with any regularity may be located.
191 citations
TL;DR: Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes.
Abstract: Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes. Instances are also reported within the high-dosage category of more serious developments such as seizures and psychotic reactions. Withdrawal from normal dosage benzodiazepine treatment can result in a number of symptomatic patterns. The most common is a short-lived "rebound" anxiety and insomnia, coming on within 1-4 days of discontinuation, depending on the half-life of the particular drug. The second pattern is the full-blown withdrawal syndrome, usually lasting 10-14 days; finally, a third pattern may represent the return of anxiety symptoms which then persist until some form of treatment is instituted. Physiological dependence on benzodiazepines can occur following prolonged treatment with therapeutic doses, but it is not clear what proportion of patients are likely to experience a withdrawal syndrome. It is also unknown to what extent the risk of physiological dependence is dependent upon a minimum duration of exposure or dosage of these drugs. Withdrawal phenomena appear to be more severe following withdrawal from high doses or short-acting benzodiazepines. Dependence on alcohol or other sedatives may increase the risk of benzodiazepine dependence, but it has proved difficult to demonstrate unequivocally differences in the relative abuse potential of individual benzodiazepines.
184 citations
TL;DR: There was a consistent positive relationship such that those who had recalled more alcohol advertisements at age 15 years drank larger quantities of beer at age 18 years, but young women who had watched more hours of television drank more wine/spirits.
Abstract: Data from a longitudinal study carried out in Dunedin, New Zealand, were used to investigate associations between alcohol consumption at age 18 years and alcohol-related mass media communications recalled at ages 13 and 15 years. The respondents' recall of alcohol-related mass media material were categorized as: commercial alcohol advertising, alcohol moderation messages or the portrayal of alcohol in entertainment. An additional media variable was the number of hours spent watching television. Non-media variables, such as peer approval of drinking, living situation and occupation (all at age 18 years) were also included in the analyses. The period between the interviews at ages 13 and 15 years saw an increase in the broadcast of commercial alcohol advertisements on television in New Zealand and this was reflected in an increase in the proportion of the mass media material recalled which was categorized as commercial advertising. At age 15 years television advertising, mostly for beer companies, was the predominant material recalled. No relationships were found between the commercial advertising and wine and spirits consumption, among either men or women, but young women who had watched more hours of television drank more wine/spirits. Among women there were two unexpected negative relationships between recall of alcohol in the media at age 13 years and beer consumption. However, among men there was a consistent positive relationship such that those who had recalled more alcohol advertisements at age 15 years drank larger quantities of beer at age 18 years.
TL;DR: Harm reduction interventions directed towards changing the risk behaviours of heroin users should take account of the different routes of current administration and the potential for future transitions within continued drug use.
Abstract: A community sample of 408 heroin users was interviewed about changes in their predominant route of heroin administration. Clear preferences for specific routes of drug administration were evident. Two predominant routes of administration were found: injection (54%) and 'chasing the dragon' (44%). More than a third of the sample had changed their predominant route of administration (a 'transition'). Most commonly, only one transition was reported, from chasing to injecting. However, transition to injection was not inevitable: the majority of 'chasers' had never moved to regular injecting despite often using at high doses for many years. Modelling suggests that many chasers give up heroin without moving to injecting. The results indicate, however, a continuing risk of switching from chasing to injecting for those who continued to use. Women were less likely to move from chasing to injecting. Some heroin users had made the transition from injection to chasing; 28 (16%) of the current chasers had previously been regular heroin injectors. This change in route is less well-known and to our knowledge has not been previously investigated. Multiple transitions in route were uncommon; predominant route of administration, once established appears robust. Harm reduction interventions directed towards changing the risk behaviours of heroin users should take account of the different routes of current administration and the potential for future transitions within continued drug use.
TL;DR: It is important that research using self-reported data understands the limits of such data, because of memory distortions, self-reports are biased narratives rather than incomplete but otherwise accurate evocations of past events.
Abstract: The implications for addiction research of recent knowledge about human memory are described. It is important that research using self-reported data understands the limits of such data. The nature of human memory and the selective, constructive processes of remembering provide one set of limits. Abandoning retrospective data entirely is not feasible in addiction research, for it would require the abandonment of current and prospective self-reported data as well, as they are also subject to memory biases. Because of memory distortions, self-reports, even by rigorous questionnaire, are biased narratives rather than incomplete but otherwise accurate evocations of past events. These limits necessitate caution and humility in the interpretation of findings, and cannot be eliminated by any particular set of research methods. There will never be a philosophers' stone which will convert self-reported data into absolutely accurate figures of quantity, frequency and timing. Nor is it straightforward to infer social and psychological causality from the organization and timing of events as remembered.
TL;DR: It was found that 59% of the inter-individual variation in smoking behaviour could be attributed to shared environmental influences and 31% to genetic factors, and environmental effects shared by male twins and female twins were imperfectly correlated in twins from opposite-sex pairs, indicating that different environmental factors influence smoking in adolescent boys and girls.
Abstract: In a study of 1600 Dutch adolescent twin pairs we found that 59% of the inter-individual variation in smoking behaviour could be attributed to shared environmental influences and 31% to genetic factors. The magnitude of the genetic and environmental effects did not differ between boys and girls. However, environmental effects shared by male twins and environmental effects shared by female twins were imperfectly correlated in twins from opposite-sex pairs, indicating that different environmental factors influence smoking in adolescent boys and girls. In the parents of these twins, the correlation between husband and wife for 'currently smoking' (r = 0.43) was larger than for 'ever smoked' (r = 0.18). There was no evidence that smoking of parents (at present or in the past) encouraged smoking in their offspring. Resemblance between parents and offspring was significant but rather low and could be accounted for completely by their genetic relatedness. Moreover, the association between 'currently smoking' in the parents and smoking behaviour in their children was not larger than the association between 'ever smoking' in parents and smoking in their children.
TL;DR: It is concluded that young people reared in home environments that have permissive attitudes to alcohol use and who are introduced to alcohol at an earlier age may be more vulnerable to alcohol-related problems in adolescence.
Abstract: This paper examines the relationships between age at first exposure to alcohol and four measures of drinking behaviour (frequency of drinking, typical and most amount consumed, alcohol-related problems) at age 15 years in a birth cohort of New Zealand children. There were small but consistent correlations (r = -0.10 to -0.16) between self-reported age at first exposure to alcohol and the four measures of alcohol consumption. These associations remained statistically significant (p < 0.05) after control for a wide range of potentially confounding covariates including measures of family socio-demographic background, parental alcohol use and attitudes to alcohol use and early childhood behaviour. After control for these factors, children who had been introduced to alcohol before the age of 6 years were 1.9 to 2.4 times more likely to report frequent, heavy or problem drinking at age 15 years than children who did not drink alcohol before the age of 13. It is concluded that young people reared in home environments that have permissive attitudes to alcohol use and who are introduced to alcohol at an earlier age may be more vulnerable to alcohol-related problems in adolescence.
TL;DR: The critique focuses specifically on the evidence that many central nicotinic receptors, including those which mediate the effects of the drug on dopamine secretion, are readily desensitized by chronic exposure to agonist and that hypotheses which assume that nicotine inhaled from tobacco smoke invariably results in stimulation of the receptors must be treated with caution.
Abstract: There is little doubt that many habitual smokers find it difficult to quit the habit because they have become addicted to the nicotine present in the smoke. This paper addresses some of the pharmacological mechanisms underlying this addiction and discusses how an understanding of these mechanisms may contribute to the more effective use of nicotine replacement therapy during smoking cessation. It considers critically the evidence that the "rewarding" properties of nicotine, which serve to reinforce drug-seeking behaviour, are related to stimulation of the mesolimbic dopamine system of the brain. The critique focuses specifically on the evidence that many central nicotinic receptors, including those which mediate the effects of the drug on dopamine secretion, are readily desensitized by chronic exposure to agonist and that hypotheses which assume that nicotine inhaled from tobacco smoke invariably results in stimulation of the receptors must be treated with caution. Nicotinic receptors in the brain are, however, heterogeneous in nature with different molecular structures and pharmacologies. It is concluded that the reinforcing properties of nicotine sought by smokers may reflect both stimulation and desensitization of the different nicotinic receptor populations, and that smokers may adjust their smoking habits to achieve the balance of receptor stimulation and desensitization which they find most reinforcing. It seems likely that the efficacy of the different nicotine formulations during the treatment of smoking cessation may also reflect their ability to stimulate or desensitize brain nicotinic receptors.
TL;DR: The health effects, epidemiology, risk of other substance use and addiction and psychiatric co-morbidity associated with the practice of inhalant use are reviewed.
Abstract: Inhalants, a chemically heterogeneous group of psychoactive substances found in adhesives, lighter fluids, spray paints, cleaning fluids and typewriter correction fluid, may be used by up to 10% of young people. This article reviews the health effects, epidemiology, risk of other substance use and addiction and psychiatric co-morbidity associated with the practice of inhalant use.
TL;DR: The results show that on average self-reported drinks taken at home contained more than the presumed standard, and there seemed to be a positive relationship between deviation from 'standard' and strength of the alcoholic beverage.
Abstract: A stubborn problem in alcohol epidemiology is that of standardization of unit of measurement Consistent use of the 'standard drink' in research reports is hampered by difficulties in the assessment of the alcohol content of, particularly, self-reported drinks Alcohol content of a drink depends on strength of the beverage and volume of the glass or container from which the beverage is taken Both factors vary considerably between times, regions and individuals Interview protocols and questionnaires rarely take into account the fact that people consume alcoholic beverages from a large variety of glasses and containers In the present study the common presumption is tested of equality of alcohol content of standard and self-reported drinks The test consisted of measuring the amount of wine, fortified wine and spirits people usually pour in the glass typical for the beverage type The sample was drawn from the general Dutch population in 1985 The results show that on average self-reported drinks taken at home contained more than the presumed standard (10 g per drink) The deviation was highest for spirits (+26%), followed by fortified wines (+14%) and least for wine (+4%) There seemed to be a positive relationship between deviation from 'standard' and strength of the alcoholic beverage This result is in line with data on the coverage of sales data: aggregate, survey-based spirits consumption shows the lowest coverage of sales The effect of the difference between actual and presumed content of drinks on estimates of consumption is an overall increase of 75%, higher for women (+12%) than for men (+6%) Results are discussed with respect to the use of the concept of 'standard unit' in research protocols and health education campaigns
TL;DR: Data from the National Adolescent Student Health Survey were used to study the interrelations among substance use, risky (dangerous) behaviors, and victimization among 8th and 10th graders, and the potency of risky behaviors as a predictor of victimization for male adolescents was indicated.
Abstract: Data from the National Adolescent Student Health Survey were used to study the interrelations among substance use, risky (dangerous) behaviors, and victimization among 8th and 10th graders. Pearson correlations indicated significant associations between substance use and both higher levels of risky behaviors (e.g., hitchhiking, going on a blind date) and victimization among adolescents. Regression analyses indicated the potency of risky behaviors as a predictor of victimization for male adolescents, and a significant risky behavior by illicit drug use interaction for female adolescents. Results are discussed with regard to potential short- and long-term health consequences of risky behaviors and violent victimization for psychological development in adolescence and adulthood.
TL;DR: Interventions to encourage safer use of amphetamines need to address the misconceptions that injecting is more economical and more healthy, and to emphasize the vascular problems associated with injecting.
Abstract: A sample of 301 regular amphetamine users was interviewed regarding transitions between routes of administration of amphetamines. Use of amphetamines by injecting was widespread, with two-thirds (67%) of subjects having injected the drug during the preceding 6 months. Needle-sharing was common, with 41% of injectors having shared a needle in the month preceding interview. A transition to regular amphetamine injecting from other routes of administration was reported by 40% of subjects, with males being twice as likely to report such a transition. The median number of such transitions was one. The main reasons given by subjects for the transition to injecting were liking the "rush" from injecting, and seeing it as a more economical and a healthier way to use. A small proportion of subjects (9%) reported a transition away from injecting amphetamines, with a median of one such transition. The most common reason given for abandoning injecting was concern about vascular damage. Interventions to encourage safer use of amphetamines need to address the misconceptions that injecting is more economical and more healthy, and to emphasize the vascular problems associated with injecting.
TL;DR: Evidence is provided that many commercial off-sale businesses in the US supply alcohol to youthful buyers, and that practices vary significantly by community and by business, which support the need for greater attention to availability as a factor in teenage drinking patterns.
Abstract: The purpose of this study was to determine the rate at which young people can purchase alcohol without age identification in off-premises businesses, and the factors which influence the rate of purchase. All retail outlets licensed to sell distilled spirits and/or full strength beer and wine in 28 northern Minnesota communities were visited on different occasions by three 21-year-old female buyers who appeared to be aged 19 or younger. These youthful buyers were able to purchase beer without age identification in 47% of the 336 purchase attempts. Almost four-fifths of the businesses sold beer to these buyers at least once in three attempts. These results provide clear evidence that many commercial off-sale businesses in the US supply alcohol to youthful buyers, and that practices vary significantly by community and by business. These results support the need for greater attention to availability as a factor in teenage drinking patterns.
TL;DR: Withdrawal from all drugs of dependence appears to lead to mood disturbances although the extent to which these are due to the pharmacological actions of the drugs or to other physiological or psychological processes is unclear.
Abstract: Whereas early formulations of addictive behaviour placed great emphasis upon withdrawal as a defining feature, current views focus more upon compulsive use as as central characteristic. However, the withdrawal syndrome continues to occupy an important place in the study of the addictions. It is interesting both in its own right and in relation to the development and maintenance of the compulsive use of drugs. Despite the attention devoted to withdrawal phenomena over many years, precise demarcation of the withdrawal symptoms associated with drugs of dependence has proved difficult to achieve. Withdrawal from all drugs of dependence appears to lead to mood disturbances although the extent to which these are due to the pharmacological actions of like drugs or to other physiological or psychological processes is unclear. Sleep disturbance is also common, although again direct links with the pharmacological actions of the withdrawn drug are yet to be established. Withdrawal from alcohol, benzodiazepines and opiates is often associated with somatic symptoms. In the former two cases, these can involve sweating, tremor and occasionally seizures. Perceptual disturbances have also been reported. In the case of opiates, flu-like symptoms are often reported, including muscle aches and gastric disturbances. In the case of nicotine, heightened irritability has been established as a direct pharmacological withdrawal effect. Characterization of stimulant withdrawal is still uncertain. There is little evidence of somatic symptoms but depression may occur as a result of a physiological rebound. There is also uncertainty over what role pharmacological withdrawal symptoms play in maintaining compulsive use. Further advances in our understanding of the nature and significance of withdrawal symptoms will depend on using precise operational definitions of features of withdrawal.
TL;DR: Data were used from the 1990 US national alcohol survey to compare two volume measures of alcohol consumption: usual quantity/frequency (QF) and graduated frequency (GF), and the GF measure provided higher estimates of alcohol use.
Abstract: Data were used from the 1990 US national alcohol survey to compare two volume measures of alcohol consumption: usual quantity/frequency (QF) and graduated frequency (GF). The QF measure obtained global estimates of average alcohol intake per day; the GF measure is a series of questions on the frequency of consuming specific numbers of drinks which ranges from the most ever consumed in the last year to 1–2 drinks per occasion. The GF measure provided higher estimates of alcohol use. Respondents whose reports were inconsistent between the measures were more likely to be male, never married, and report getting drunk at least monthly and drinking five or more drinks on one occasion at least monthly during the last year.
TL;DR: A summary by Thomas Babor, Marcus Grant et al. of a WHO multi-national clinical trial on the treatment of alcohol problems in the primary care setting and comments from Canada, Australia, Scotland, Norway, Denmark and Sweden are published.
Abstract: Primary care interventions directed at drinking and alcohol problems today constitute a highly important issue for service development, training and research. WHO has clone much to encourage work in this area, and in this journal feature we publish a summary by Thomas Babor, Marcus Grant et al. of a WHO multi-national clinical trial on the treatment of alcohol problems in the primary care setting. This summary is followed by comments from, Canada, Australia, Scotland, Norway, Denmark and Sweden and a reply from THomas Babor. We are grateful to the WHO investigators and the expert group of commentators, and to Robert West who took responsibility for organizing this series of contributions
TL;DR: The utility of the bi-axial approach to distinguishing between types of alcohol problems was challenged, raising some questions about abuse/dependence distinctions in various nomenclatures.
Abstract: According to the "bi-axial" concept of alcohol dependence, the Alcohol Dependence Syndrome (ADS) constitutes an axis or dimension of alcohol difficulties, while other alcohol-related problems (social, legal, etc.) constitute one or more separate dimensions. The validity of the bi-axial distinction was investigated in a stratified probability sample of 3212 US current drinkers who were interviewed in their households. Indicators of the Alcohol Dependence Syndrome and potentially distinct alcohol-related problems were covered in a structured interview administered by carefully trained interviewers. This interview provided extensive coverage of drinking patterns and problems. Aspects of the ADS covered included narrowing, salience, tolerance, withdrawal, withdrawal relief/avoidance and compulsion/control. Other alcohol problems included difficulties with work, health, the law, general social difficulties and problems in marriage/home life. Confirmatory and exploratory factor analyses were used to determine whether a single factor (dimension) or two or more factors fit the data best. Using all methods, we found that one general factor explained the structure of the data better than a two-factor model or other models for males, females, blacks and whites. Thus, the utility of this approach to distinguishing between types of alcohol problems was challenged, raising some questions about abuse/dependence distinctions in various nomenclatures.
TL;DR: It is suggested that self-reported reasons for smoking represent more than bias in verbal report and support the description of the smoking career as a progressive transfer of reward from non-pharmacological to pharmacological factors.
Abstract: Cigarette smokers (n = 387) completed a questionnaire measure of smoking motives, and subgroups of this sample provided external validation information. Seven factors emerged from a principal components' analysis: automatic, sedative, addictive, stimulation, psychosocial, indulgent and sensorimotor manipulation. A higher-order principal components analysis revealed the presence of two second-order factors. Inspection of the pattern of correlations between factor scores and criterion variables clearly indicated that the first four factors above and their underlying second-order factor are more closely related to nicotine pharmacology and mood-altering effects of nicotine than the latter three motives and their underlying second-order factor. Moreover, the positive correlations between these pharmacological motives and age, coupled with a negative relationship between age and the non-pharmacological motives, support the description of the smoking career as a progressive transfer of reward from non-pharmacological to pharmacological factors. These findings suggest that self-reported reasons for smoking represent more than bias in verbal report.
TL;DR: Depression and anxiety were strongly related, but anti-social behaviour was unrelated to personal distress, and personal distress levels were predicted by benzodiazepine use, poorer social functioning and poorer health.
Abstract: A sample of 222 methadone maintenance clients was tested for levels of depression, anxiety, and anti-social personality disorder. The prevalence of each type of psychopathology was high. There were large proportions of subjects exhibiting extremely severe depression, anxiety and a majority were classified as ''psychiatric cases''. Depression and anxiety were strongly related, but anti-social behaviour was unrelated to personal distress. Personal distress levels were predicted by benzodiazepine use, poorer social functioning and poorer health. Anti-social personality disorder was predicted by younger age, being male, poorer social functioning, and current criminality.
TL;DR: Investigation of patterns of drug-taking and sexual behaviour among a group of women working as prostitutes in south London finds that the women who began to use heroin prior to prostitution were more severely dependent on heroin and described themselves as being trapped in prostitution by the need to maintain a supply of heroin.
Abstract: The precise manner in which the use of different types of drugs is related to prostitution has not been adequately researched. This study investigates patterns of drug-taking and sexual behaviour among a group of women working as prostitutes in south London; it also looks at prostitution in which sex is offered in return for drugs, at the links between heroin, cocaine and alcohol use and sexual behaviour, and at the association between severity of dependence and sexual behaviour. All of the women in our sample (n = 51) were actively working as prostitutes. More than half of them had given sex for drugs, though this was a relatively infrequent occurrence. The majority of them were using heroin and many of them were moderately or severely dependent upon heroin. More than one-third had shared injecting equipment after it had already been used. Almost two-thirds reported that they only worked as a prostitute in order to fund their use of drugs (predominantly heroin), and that they would not continue working as a prostitute if they were not still using drugs. The more severely dependent upon heroin they were, the more likely they were to report these links between heroin use and prostitution. About half of the women in our sample said that they first started to work as a prostitute in order to pay for drugs. The women who began to use heroin prior to prostitution were more severely dependent on heroin and described themselves as being trapped in prostitution by the need to maintain a supply of heroin. Very few women regularly used cocaine in association with their prostitution. There are grounds for concern about the alcohol consumption of these women. About one-quarter of the women said that they used alcohol every day; some of them reported drinking at levels which greatly exceed recommended limits for women, and some were drinking at levels which were likely to be physically damaging.
TL;DR: Using survival analysis, the association was explored between positive and negative alcohol expectancies measured on admission to a non-residential alcohol dependence treatment unit and post-treatment relapse to a first drink (first slip).
Abstract: Using survival analysis, the association was explored between positive and negative alcohol expectancies measured on admission to a non-residential alcohol dependence treatment unit and post-treatment relapse to a first drink (first slip). A reliable association between negative alcohol expectancy (but not positive) and relapse was found. The active negative alcohol expectancies were distal rather than proximal: proximal expectancies surround consumption ('same day' expectancies) and distal expectancies relate to the 'next-day' following consumption or those longer term expectancies coming from 'continued drinking'. Only the 'next day' component of distal expectancies formed a reliable association with relapse. The use to which negative alcohol expectancy as measured by the Negative Alcohol Expectancy Questionnaire might be put is discussed in terms of (i) a bottom-up representation of motivation for recovery to help treatment match and (ii) a provisor of detailed, client-specific information for structuring motivational interventions.