Showing papers in "Addiction in 1995"

The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.

Abstract: The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. The SDS was given to five samples of drug users in London and Sydney. The samples comprised users of heroin and users of cocaine in London, and users of amphetamines and methadone maintenance patients in Sydney. The SDS satisfies a number of criteria which indicate its suitability as a measure of dependence. All SDS items load significantly with a single factor, and the total SDS score was extremely highly correlated with the single factor score. The SDS score is related to behavioural patterns of drug taking that are, in themselves, indicators of dependence, such as dose, frequency of use, duration of use, daily use and degree of contact with other drug users; it also shows criterion validity in that drug users who have sought treatment at specialist and non-specialist agencies for drug problems have higher SDS scores than non-treatment samples. The psychometric properties of the scale were good in all five samples, despite being applied to primary users of different classes of drug, using different recruitment procedures in different cities in different countries.

The AUDIT questionnaire: choosing a cut-off score

Abstract: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item questionnaire designed by the World Health Organization to screen for hazardous alcohol intake in primary health care settings. In this longitudinal study we examine its performance in predicting alcohol-related harm over the full range of its scores using receiver operating characteristic analyses. Three hundred and thirty ambulatory care patients were interviewed using a detailed assessment schedule which included the AUDIT questions. After 2-3 years, subjects were reviewed and their experience of alcohol-related medical and social harm assessed by interview and perusal of medical records. AUDIT was a good predictor of both alcohol-related social and medical problems. Cut-off points of 7-8 maximized discrimination in the prediction a trauma and hypertension. Higher cut-offs (12 and 22) provided better discrimination in the prediction of alcohol-related social problems and of liver disease or gastrointestinal bleeding, but high specificity was offset by reduced sensitivity. We conclude that the recommended cut-off score of eight is a reasonable approximation to the optimal for a variety of endpoints.

Final results from a meta-analysis of remedial interventions with drink/drive offenders.

Abstract: A meta-analysis of the efficacy of remediation with drinking/driving offenders included 215 independent evaluations identified through a comprehensive literature search. Study characteristics, including dimensions of methodological quality were coded using scales and protocols developed by expert panels. Better methodological quality (as indicated by group equivalence) was associated with smaller effect size and less variation in effect size. Among studies with adequate methods (as determined empirically through examination of effect size variation with quality), the average effect of remediation on drinking/driving recidivism was an 8-9% reduction over no remediation. A similar effect size was found for alcohol involved crashes. However, licensing actions tended to be associated with reduction in occurrence of non-alcohol events (e.g. non-alcohol crashes). Exploratory regression analysis and confirmatory within study analysis suggested that combinations of modalities--in particular those including education, psychotherapy/counseling and follow-up contact/probation--were more effective than other evaluated modes for reducing drinking/driving recidivism. Treatment effects are probably underestimated in the literature due to overemphasis on education as a treatment for all offenders and drinking/driving recidivism as the most frequent measure of outcome. Limitations of the primary literature and future research needs are discussed. Language: en

Relationship between alcohol and tobacco dependencies among alcoholics who smoke

Abstract: Outpatients followed in an alcoholic clinic and who fulfilled DSM-III-R criteria for alcohol dependence and had used both tobacco (at least one cigarette every day) and alcohol in the preceding week were studied. For each patient, two experimenters assessed: (1) the amount of tobacco and alcohol used; (2) the severity of dependence for each product. Results showed that: (a) The prevalence of smoking in this population of current alcohol dependents was 88%; (b) 91.6% of this sample of smoker alcoholics were dependent on nicotine; (c) the amount of tobacco smoked was correlated to the amount of alcohol consumed and the severity of alcohol dependence; and (d) there was a correlation between the severity of alcohol and nicotine dependencies. The results of this study may help to clarify the difficulty of treating tobacco dependence in alcoholics.

Acamprosate in alcohol dependence: how does it work?

Abstract: Acamprosate is a relatively new drug that appears to be clinically useful in the treatment of alcohol dependence. Although it has proved effective in reducing relapse into drinking in clinical trials its exact mechanism of action is uncertain. Evidence is presented that the drug does not act in any of the conventional ways to reduce alcohol intake and it is proposed that it may be a novel kind of agent that suppresses "craving". On the basis of its known pharmacological effects in pre-clinical studies it is suggested that acamprosate may reduce craving that is associated with conditioned withdrawal. In addition to the potential therapeutic value of acamprosate, the drug may be useful because work directed toward understanding its mechanism of action may shed light on some of the fundamental processes that govern alcohol abuse and relapse in weaned alcohol dependent patients.

Predictive capacity of the AUDIT questionnaire for alcohol-related harm

Abstract: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item questionnaire designed to screen for hazardous and harmful alcohol consumption. We examined its ability to predict alcohol-related illness and social problems, hospital admission and mortality over a 2-3-year period. At initial interview, 330 ambulatory care patients were assessed using a detailed interview including the AUDIT questions and laboratory tests. After 2-3 years, 250 (76%) subjects were reassessed and their experience of alcohol-related harm determined. Of those who scored eight or more on AUDIT at initial interview, 61% experienced alcohol-related social problems compared with 10% of those with lower scores (p < 0.0001); they also had a significantly greater experience of alcohol-related medical disorders and hospitalization. AUDIT score was a better predictor of social problems and of hypertension than laboratory markers. Its ability to predict other alcohol-related illnesses was similar to the laboratory tests. However, gamma glutamyltransferase was the only significant predictor of mortality. We conclude that AUDIT should prove a valuable tool in screening for hazardous and harmful alcohol consumption so that intervention can be provided to those at particular risk of adverse consequences.

The AUDIT questionnaire: choosing a cut-off score. Alcohol Use Disorder Identification Test.

Abstract: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item questionnaire designed by the World Health Organization to screen for hazardous alcohol intake in primary health care settings. In this longitudinal study we examined its performance in predicting alcohol-related harm over the full range of its scores using receiver operating characteristic analyses. Three hundred and thirty ambulatory care patients were interviewed using a detailed assessment schedule which included the AUDIT questions. After 2-3 years, subjects were reviewed and their experience of alcohol-related medical and social harm assessed by interview and perusal of medical records. AUDIT was a good predictor of both alcohol-related social and medical problems. Cut-off points of 7-8 maximized discrimination in the prediction of trauma and hypertension. Higher cut-offs (12 and 22) provided better discrimination in the prediction of alcohol-related social problems and of liver disease or gastrointestinal bleeding, but high specificity was offset by reduced sensitivity. We conclude that the recommended cut-off score of eight is a reasonable approximation to the optimal for a variety of endpoints.

The impact of a brief motivational intervention with opiate users attending a methadone programme.

Abstract: During the 1980s Motivational Interviewing emerged as one of the memes of the addictions field. This occurred despite the lack of scientific evidence supporting its utility. In this paper findings of a controlled trial of a brief motivational intervention with illicit drug users (n = 122) attending a methadone clinic are reported. Clients who met the study's inclusion criteria were randomly allocated to either a motivational (experimental, n = 57) or educational (control, n = 65) procedure. Over the 6-month follow-up period the motivational subjects demonstrated a greater, immediate, commitment to abstention, reported more positive expected outcomes for abstention, reported fewer opiate-related problems, were initially more contemplative of change, complied with the methadone programme longer and relapsed less quickly than the control group. There was, however, no difference in terms of the severity of reported opiate dependence and the control group fared better on reported self-efficacy. It was concluded that motivational interventions of the type investigated are useful adjuncts to methadone programmes.

Entering treatment for alcohol abuse: a stress and coping model

Abstract: This study used a stress and coping model to examine the process of entering treatment among 515 problem drinkers without prior formal treatment for alcohol abuse who were recruited at alcoholism information/referral (I&R) and detoxification centers. Over a 1-year follow-up period, 76% of the individuals in the sample entered some form of treatment, including Alcoholics Anonymous. People were more likely to enter treatment if they perceived their drinking problem as more severe, had more dependence symptoms, experienced more adverse consequences as a result of drinking, had more symptoms of depression, were more self-derogating, experienced more negative life events in the past year, and/or experienced more stressors in various life domains. Facilitative factors also related positively to treatment entry: people who had sought help from non-formal treatment sources before, who recalled being referred to treatment programs by an I&R center, and/or who received detoxification at a center that had treatment services available on-site, also were more likely to enter treatment. For people with greater resources in multiple life domains the positive effects of days intoxicated, dependence symptoms and stressors on help-seeking were intensified. Overall, the findings suggest that perceived severity of drinking problem plays a central role in the treatment entry process and mediates the effects of many other intrapersonal and environmental variables in generating an impetus or readiness to seek treatment.

An investigation of self‐efficacy, partner support and daily stresses as predictors of relapse to smoking in self‐quitters

Abstract: Six hundred and thirty smokers who intended to quit smoking themselves completed pre-cessation measures of self-efficacy, partner support, daily stresses and demographics. Subjects were contacted at 2, 7, 14, 30, 90 and 180 days post-cessation to determine smoking status and to re-administer the measures at 7, 14 and 30 days post-cessation. A series of logistic regression examined which prospective factors best predicted relapse between 0-2 days, 3-7 days, 8-14 days, 15-30 days, 31-90 days and 91-180 days. Relapse was predicted by different variables at different times; however, self-efficacy was a consistent predictor of relapse over time.

The risk of harm to oneself from drinking, Canada 1989.

Abstract: In a national sample of 11 634 Canadians aged IS years and above, risk curves for harm to six life-areas from one's own drinking and for assault by another drinker rose steadily with the respondent's volume of alcohol consumption. While drinking five or more drinks on an occasion at least once a month substantially raised the risk at a given volume of drinking, the risk rose with volume even among those not regularly drinking Jive or more drinks. These relationships remained in logistic regressions which controlled for gender, age and educational level. Younger respondents, those without higher education and men reported more harm for a given level of their own drinking although differences by gender disappeared above one-third of one drink per day. Three sets of guidelines for low-risk drinking—two from Canada, and one generally used in Britain—were compared in terms of the proportions of respondents reporting harm from their own drinking among those who had kept within the guideline in the previous 7 days' drinking. More restrictiveness in the guidelines was associated with substantial reductions in reported drinking-related harm

The consistency of family and peer influences on the development of substance use in adolescence.

Abstract: Latent growth modeling (LGM) was used to analyse longitudinal data for adolescent substance use from five overlapping age cohorts (11, 12, 13, 14, and 15 years at first assessment) measured at four annual time points. An associative cohort-sequential model was tested for alcohol, cigarette and marijuana use with a sample of 345 adolescents (11-18 years old) from an urban area in the Pacific Northwestern region of the United States. Hypotheses concerning the shape of the growth curve, the extent of individual differences in the common trajectory over time, and the influence of family cohesion, peer encouragement and gender on initial substance use and shape of the growth curve were tested. Results indicated similarities between alcohol, cigarette and marijuana initial use and development, with peer encouragement and family cohesion predictive of initial levels of use, and changes in peer encouragement influencing the developmental trajectories of the three substances. Females were higher than males in initial status and developed less rapidly in their use of the substances than did males. Findings are discussed in terms of the similarities and differences in the developmental trajectories of the three substances and the importance of family and peer influences on these trends. Language: en

Dose effects and predictors of outcome in a randomized trial of transdermal nicotine patches in general practice

Abstract: The transdermal nicotine patch has proved an effective aid to smoking cessation The ease of securing good compliance gives it a potential advantage over nicotine gum as an adjunct to brief advice and support in primary care settings where the major public health impact is obtained In a preliminary report of half the sample of a randomized placebo controlled trial, we showed the patch to be effective in a general practice setting We report here the definitive results of the full sample, including dose effects, predictors of outcome and other issues of theoretical and practical interest A total of 1200 heavy smokers (> or = 15 per day), attending 30 general practices in 15 English counties received brief GP advice, a booklet and 16 hours per day patch treatment for 18 weeks Dose increase and abrupt vs gradual reduction of patch dosage were also randomized and follow-ups conducted at 1, 3, 6, 12, 26 and 52 weeks Outcome was measured by self-reported complete abstinence from week 3 to 52 with biochemical validation at all follow-up points Nicotine patch treatment doubled the rate of continuous abstinence up to 1 year (nicotine 96%, placebo 48%, p < 001); it most likely worked by reducing withdrawal symptoms It enhanced cessation during the first week and reduced relapse during the second week The dose increase after week 1 produced no sustained increase in cessation Gradual reduction was no better at preventing relapse than abrupt withdrawal of patches after week 12 Whether relapse would have increased by ending treatment at some point between weeks 3 and 12 was not tested Although pre-treatment dependence on cigarettes was prognostic of failure, the patches were equally helpful to both highly and less dependent smokers Patches were particularly helpful to smokers with pre-treatment subclinical dysthymic symptoms All but one of the 96 subjects eventually achieving long-term abstinence in the study quit during the first week of cessation

Controlled evaluation of a general practice-based brief intervention for excessive drinking

Abstract: In a controlled evaluation of general practitioner (GP)-based brief intervention, 378 excessive drinkers identified opportunistically by screening in 40 group practices in metropolitan Sydney were assigned to groups receiving: (i) a five-session intervention by the GP (the Alcoholscreen Program); (ii) a single session of 5 minutes' advice by the GP plus a self-help manual (minimal intervention); (iii) an alcohol-related assessment but no intervention; (iv) neither intervention nor assessment. Among all patients allocated to receive it, the Alcoholscreen Program did not result in a significantly greater reduction in consumption at follow-up than control conditions but patients offered Alcoholscreen reported a significantly greater reduction in alcohol-related problems in the period to 6 months follow-up. A greater proportion of patients who returned for the second Alcoholscreen visit were drinking below recommended levels at follow-up than in the remainder of the sample. There was no evidence that minimal intervention or alcohol-related assessment were effective in reducing alcohol consumption or problems. Implications for further research into GP-based brief interventions are discussed.

Alcohol consumption and all-cause mortality.

Abstract: Based on a large US representative cohort with detailed baseline interview and examination data, the relationship between alcohol consumption and all-cause mortality is examined over a period of 15 years follow-up. Results show a significant linear relationship for females and males under 60 years of age at baseline, and a non-significant U-shape for the older ones. Both results remain stable for different kinds of adjustment including adjustment for nutritional variables and smoking. Excluding people with heart disease history at baseline leads to an even more pronounced linear relationship for both males and females under 60 years of age. Furthermore, it is shown that the curvilinear relationship for men found in previous research is partly due to the age groups examined.

The histories of withdrawal convulsions and delirium tremens in 1648 alcohol dependent subjects

Abstract: Une faible proportion d'hommes et femmes alcoolodependants font des episodes de delirium tremens (DT) et/ou convulsions au cours du sevrage alcoolique. Bien que les auteurs aient decrit certaines caracteristiques individuelles davantage susceptibles de provoquer ces suites graves liees au syndrome d'abstinence, il n'est pas evident de dire si ces facteurs de risque operent independamment dans leur association avec un sevrage severe. L'entretien semi-structure SSAGA a ete utilise pour evaluer 1648 hommes et femmes (n = 540) alcoolodependants. Les caracteristiques individuelles, les antecedents medicaux et le parcours alcoolique de 161 hommes et 51 femmes (12,8% des sujets) qui declaraient avoir eu au moins un episode de delirium tremens et/ou des convulsions durant le sevrage, ont ete compares aux caracteristiques des autres individus alcoolodependants. Compare aux autres sujets alcoolodependants, ceux ayant des antecedents de sevrage difficile declaraient avoir bu un nombre maximum de verres plus eleve dans une periode de 24 heures (40,9 ± 25,71 control 24,9 ± 17,72), davantage d'episodes de manque (28,2 ± 33,74 contre 15,9 ± 26,84), une plus grande consommation non medicale de sedatifs (56,4% contre 32,9%), et un nombre plus important de problemes de sante. L'analyse de regression logistique de type hierarchique a revele que les differences les plus grandes entre ceux ayant des antecedents de sevrage plus ou moins graves etaient liees au nombre maximum de verres/jour et au nombre total d'episodes de manque. Les autres variables s'ajoutaient encore de maniere significative a la relation avec un sevrage plus severe. L'etiologie du delirium tremens et des convulsions est complexe et implique l'interaction de diverses caracteristiques representant des domaines relativemont uniques. Il serait souhaitable que ces donnees aident les medecins a identifier les individus les plus vulnerables et donc les plus susceptibles d'avoir de graves problemes lors du sevrage, et aident les chercheurs a mieux comprendre l'etiologie de ces problemes.

Withdrawal and dependency symptoms among adolescent alcohol and drug abusers

Abstract: Due to differences in duration, intensity and topography of alcohol and drug use patterns, the withdrawal and dependency symptoms of adolescent substance abusers may differ from those of adult substance abusers. To explore these potential differences, 166 adolescents recruited from inpatient alcohol and drug treatment programs in the USA were assessed for alcohol and other drug withdrawal and dependency symptoms. Teens were administered the Customary Drinking and Drug Use Record following 2 weeks of abstinence and evaluated for recent (< 3 months) DSM-III-R psychoactive substance withdrawal and dependency symptoms. Adolescents were all multiple substance users with a life-time average of 4.27 drugs used in addition to alcohol. Amphetamines were the most frequently used drug (50% of sample) and the most prevalent withdrawal symptoms were those associated with central stimulant use. However, the number of different withdrawal symptoms (M = 11.27) was greater than expected for uncomplicated stimulant withdrawal or withdrawal from any single substance. On average, participants reported dependency symptoms more than DSM-III-R criteria for the diagnosis of alcohol dependency (M = 3.30), as well as dependency on their two most frequently used drugs. Heavy alcohol and cigarette use were found to exacerbate withdrawal symptoms of other drugs. These findings highlight the importance of assessing adolescent substance abusers for withdrawal from and dependency on multiple substances.

Stress modulation over the day in cigarette smokers

Abstract: This review summarizes the findings from a series of four published studies into the relationship between cigarette smoking and stress. In each study, feelings of anxiety/stress were significantly lower post-smoking than pre-smoking (p < 0.001). However, while moods improved immediately after smoking, mood impairments occurred between cigarettes. This repetitive cycle of mood reversals provides a clear rationale for repetitive/addictive cigarette use. The degree of stress modulation was significantly related to the sedative subscale of the Smoking Motivation Questionnaire (p < 0.01). However, high SMQ sedative subjects reported above-average stress prior to smoking, rather than below-average stress after smoking. Thus stress modulation represented mainly the relief of adverse moods, rather than the attainment of beneficial moods. Deprived smokers reported a diurnal pattern of increasing stress, confirming the deleterious effects of nicotine deprivation. These studies demonstrated the importance of mood control as a motive for smoking. They indicate that smokers gain little real advantage from cigarettes, but smoke mainly to forstall nicotine depletion. The deleterious mood effects of acute nicotine withdrawal also helps explain why, when smokers quit smoking, they experience reduced levels of daily stress.

The prevalence and risk factors associated with abusive or hazardous alcohol consumption in 16-year-olds.

Abstract: This paper examines the prevalence of abusive or hazardous alcohol consumption at age 16 years and the risk factors associated with such behaviour using data from a longitudinal study of a birth cohort of 953 children. Drinking behaviour was assessed on the basis of self-report measures of the frequency of alcohol consumption, reports of the typical and largest amounts of alcohol consumed and the frequency of alcohol-related problems. These measures were combined using latent class analysis methods to identify a group of adolescents (9.3% of the sample) who were characterized by high levels of abusive or hazardous drinking behaviour. Analysis of the risk factors associated with abusive/hazardous drinking identified three factors which were predictive of this behaviour at age 16 years: gender (p < 0.001); the largest amount of alcohol consumed at age 14 years (p < 0.05); and the extent of affiliation with substance using peers (p < 0.001). Further analysis suggested that the effects of other social, familial and individual risk factors on alcohol abuse were mediated via their effect on early drinking behaviour or via their influences on peer affiliations in adolescence. A tentative model of the pathways to adolescent alcohol abuse is discussed.

The 'pressures to change' approach to working with the partners of heavy drinkers

Abstract: The 'Pressures to Change' approach to working with the partners of drinkers is a structured procedure for promoting change in resistant drinkers. In this study 22 women and one man were randomly allocated to two treatment conditions and one no-treatment waiting list control condition in an experimental evaluation of the procedure. Group 1 was treated individually and Group 2 was treated as a group. Almost two-thirds of the drinking partners of clients in treatment made a significant move towards change, compared with none of the drinkers in the waiting list control condition.

Efficacy of a nicotine nasal spray in smoking cessation : a placebo-controlled, double-blind trial

Abstract: Laboratory trials have demonstrated the efficacy of nicotine replacement in smoking cessation but absolute success rates are low For many, nicotine gum is hard to use and transdermal nicotine is slow-acting and passive A new, faster-acting nicotine nasal spray (NNS) can provide easily self-administered relief from cigarette withdrawal The NNS was tested for safety and efficacy in smoking cessation Two hundred and fifty-five smokers were randomized to NNS or a piperine placebo Drug use was limited to 8-32 doses/day for 6 months Subjects were tested while smoking and at post-cessation daily (week 1) with follow-up at weeks 2, 3, 6 and at 3 months, 6 months and 1 year Continuous abstinence analyses (CO < or = 8 ppm; no slips) showed that NNS significantly enhanced success rates over placebo overall (p < 0001) and at all test intervals Differences at key intervals between active and placebo were: 63% vs 40% (day 5), 51% vs 30% (week 3), 43% vs 20% (6 weeks), 34% vs 13% (3 months), 25% vs 10% (6 months) and 18% vs 8% (1 year) Side effects were common but tolerable Cotinine measures showed that replacement of nicotine approximated 30% of smoking levels Hazard functions revealed relapse risks peaked at day 1, day 5 and 3 weeks for strict abstinence It is concluded NNS is safe, efficacious and a viable alternative treatment for smoking cessation

A review of the literature examining the relationship between alcohol use and HIV-related sexual risk-taking in young people.

Abstract: Young people have been targeted as a potentially vulnerable population for the spread of HIV. The influence of alcohol on sexual behaviour is part of popular knowledge. More recently, studies have attempted to illuminate the relationship between alcohol use and sexual risk-taking in relation to HIV transmission. In our review of the literature three important points are highlighted for researchers in this area. First, methodological problems make establishing any relationship extremely difficult. Secondly, the concept of sexual risk-taking has to be developed to include acknowledgement of the context in which sex takes place rather than defining risk only in terms of sexual acts. Finally, populations of gay men and men who have sex with men and lesbians are sufficiently different from heterosexuals, with regard to the influence of alcohol on sexual behaviour, to make generalizations about one population inappropriate for the other.

The role of peer affiliations, social, family and individual factors in continuities in cigarette smoking between childhood and adolescence

Abstract: The continuity between early smoking experimentation and smoking at age 16 years was analysed for a birth cohort of New Zealand children. This analysis suggested that when due allowance was made for errors in reports of smoking behaviours, there was evidence of relatively strong continuity (r = 0.60) between early smoking experimentation and cigarette smoking at age 16 years. Further analysis suggested that the continuities between early smoking experimentation and later smoking arose from three pathways that linked early smoking experimentation to later smoking. First there was evidence to suggest that children who engaged in early smoking experimentation tended to affiliate with adolescent peer groups whose members smoked. In turn, these peer group affiliations reinforced pre-existing tendencies to cigarette smoking. Secondly, a small component of the apparent continuity between early smoking experimentation and later smoking arose because of common social, individual and contextual factors that were associated with both smoking experimentation and later smoking. Finally, there was evidence of moderate direct continuity in cigarette smoking behaviour over time. The implications of these findings for the development of smoking prevention programmes are discussed and it is concluded that effective programmes need to be embedded in a developmental approach which attempts to reduce both early smoking experimentation and the effects of peer pressure in adolescence on the development of cigarette smoking.

Alcohol abuse and suicide: a 40-year prospective study of Norwegian conscripts.

Abstract: Suicide mortality among alcohol abusers and the prevalence of alcohol abusers among suicides were assessed in a 40-year follow-up study of 40,000 Norwegian military conscripts. Alcohol abuse was operationalized as either admission to alcohol treatment clinic, alcohol related cause of death, or both. The relative risk of suicide among alcohol abusers was estimated to 6.9. The relative risk of committing suicide among alcohol abusers appeared to be higher in middle age (more than 40 years) than in younger age groups (RR = 12.8 and 4.5, respectively). The life-time risk of suicide, i.e. before the age of 60 years, was estimated to 0.63% for those not categorized as alcohol abusers and 4.76% for those categorized as alcohol abusers. Language: en

Social relationships and abstinence from cocaine in an American treatment sample

Abstract: In an extension of earlier work relating social-relationship variables to post-treatment abstinence from abused drugs, 104 cocaine users were studied for 6 months after completing drug treatment. Social-relationship variables included social integration, perceived support and social-network cocaine use. The effects of social relationships on cocaine abstinence tended to be conditional on race. Greater social integration predicted abstinence for Caucasian Ss (n = 54), but not African-Americans (n = 50). Similar results occurred for perceived support. Social network drug-use data also showed race differences: the absence of current cocaine users and the presence of former users predicted abstinence only for Caucasians. Interpretation of these findings is complicated by the relationship we observed between race and route of cocaine administration, with African-American Ss far more likely than Caucasians to be crack smokers or injection users as compared to intranasal users. The effects of race could not be disentangled from the effects of route. Future studies of social relationships and cocaine abstinence should focus on identifying social factors that are protective for African-Americans and for smokers/injectors. Such studies are critical precursors to designing successful social-support interventions.

The role of autonomic arousal in problem gambling.

Abstract: The present study investigated the role of arousal in problem gambling. Three groups of subjects were recruited into the study corresponding to problem gamblers, high and low frequency social gamblers. For the two gambling groups, the preferred form of gambling was poker machine playing. Five different conditions were employed in order to determine under which conditions gambling related cues were related to increased autonomic arousal, as measured by skin conductance level (SCL), heart rate (HR) and frontalis electromyography (EMG). The five conditions were a neutral task, a videotaped poker machine gambling scenario presented with and without distraction, a personally relevant “win” situation and a videotaped horse race. Comparisons between responses for the videotaped poker machine gambling stimuli versus a horse‐racing video task demonstrated differences only for the problem gambling group and only for SCL. No differences between these tasks emerged on the HR and EMG indices and no differences were evident for either of the social gambling groups. No changes were observed in any group when subject's cognitions were prevented by asking patients to count the number of wins made during the video play period while watching the same poker machine video. However, when personally relevant situations were presented and compared to a neutral task, differences were observed in all three groups. However, the nature of these differences varied between the groups and the different indices of arousal. For problem gamblers, increases were evident in all three measures. Increases were also observed for the control groups in comparison to the neutral task, but only in HR and SCL and not for EMG. For HR, the increases were equivalent across all three gambling groups. However, for SCL the problem gambling group became significantly more aroused than the control groups, but no differences were observed between the high and low frequency gamblers. Only the problem gambling groups evidenced significant increases in the personally relevant task compared to the neutral task for EMG. Theoretical and clinical implications of these results for the development, maintenance and treatment of problematic levels of gambling are discussed. Copyright

Alcohol and suicide: a comparative analysis of France and Sweden

Abstract: The aim of this paper is to test the hypothesis that the effect of alcohol consumption on suicide risk is stronger in Sweden than in France. The rationale of the hypothesis is that we should expect a difference between the two countries with respect to: (i) the composition of alcohol abusers; and (ii) the degree to which heavy drinking is accepted. Analyses of time-series data provide support for the hypothesis: the effect of per capita consumption of alcohol is significantly stronger in Sweden than in France.

The economic costs of alcohol‐related absenteeism and reduced productivity among the working population of New Zealand

Abstract: Lost productivity accounts for a significant proportion of the total cost of alcohol. This study quantifies the costs associated with alcohol consumption using survey data collected from four alcohol surveys conducted in Auckland between November 1990 to May 1992. The total sample size was 4662, of which 2638 were drinkers in paid employment. A computer-assisted telephone interviewing system was used to interview a random sample that closely matched the Auckland population. Respondents gave information about their typical alcohol consumption and frequency of absences from paid employment which were a result of their drinking. They also gave a report of the number of times in the past 12 months when they felt their work had been impaired as a result of their drinking. The cost of absenteeism was recorded as the number of times a respondent reported time away from work multiplied by gross income. Estimates of reduced work efficiency were derived from US figures, which estimated a 25% reduction in work performance among heavy alcohol users; 3.7% of the sample reported alcohol-related absences and 12% reported reduced efficiency days. There was a significant difference in both the number and cost of absentee and reduced efficiency days reported between the top 10% and the bottom 10% drinkers. A conservative estimate of alcohol-related lost productivity among the working population of New Zealand (with a population of 3.4 million and a per capita absolute alcohol consumption of 9.7 litres) was found to be $57 million per year.

Self‐reports of HIV risk behavior by injecting drug users: are they reliable“

Abstract: While most studies of AIDS risk behavior rely on self-reports, few studies have assessed the reliability of these reports. The present study examines self-reports of drug-related and sexual risk behavior among pairs of injecting drug users (IDUs) recruited from the streets in New York City. Since both members of the pair were interviewed, it was possible to compare their responses in order to assess reliability. Subjects reported on their contacts' demographic data (age, gender, race/ethnicity) and on shared risk behaviors, including syringe sharing. Despite the private and/or illegal nature of AIDS risk behaviors, IDU subjects were generally reliable in their reports of both demographic and AIDS risk behaviors.