Showing papers in "Addiction in 1999"
TL;DR: The present review sought to determine the magnitude and overall pattern of responses typically found in cue-reactivity research and which, if any, learning-based model of cue reactivity is best supported by the findings.
Abstract: Aims. The cue-reactivity procedure exposes addicts to a variety of drug-related stimuli while self-report of craving and physiological responses are monitored. The present review sought to determine the magnitude and overall pattern of responses typically found in cue-reactivity research and which, if any, learning-based model of cue reactivity is best supported by the findings. Design. Meta-analytical techniques were used to select and evaluate results from 41 cue-reactivity studies that compared responses of alcoholics, cigarette smokers, cocaine addicts or heroin addicts to drug-related versus neutral stimuli. Effect sizes were calculated, separately by addict type, for self-report of craving and physiological responses (heart rate, sweat gland activity and skin temperature). Findings. Across all addict groups, the effect size for craving was +0.92. Alcoholics had a significantly smaller craving effect size (+0.53) compared to other addict groups (+1.18 to +1.29). Relatively smaller effect sizes were found for physiological responses. The general profile of effect sizes across all addict groups was increased heart rate (+0.26) and sweat gland activity (+0.40) and decreased skin temperature (-0.24) when addicts were presented with drug-related stimuli. Conclusions. The cuereactivity paradigm can produce a stable profile of significant effects and, therefore, has a number of potential applications for investigating addictive phenomena. The implications of these findings for conditioning-based models of cue-reactivity phenomena are discussed.
1,493 citations
TL;DR: Results from this study and two previous studies which examined reliability indicate that the SSAGA is a highly reliable and valid instrument for use in studies of a variety of psychiatric disorders, including alcohol and drug dependence.
Abstract: Objective. This study examined the concurrent diagnostic validity of the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) across alcohol and drug dependencies, major depression, anxiety disorders and ASPD. The Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was selected as the comparison instrument because it arises from a different tradition and uses a different format for its administration. The SCAN has been shown to be valid and applicable cross-culturally. Method. Subjects included 38 men and 42 women volunteers from another study and from an outpatient psychiatry clinic. Selected sections of both the SSAGA and the SCAN interviews were administered to all subjects, approximately 1 week apart, in a randomized order. Because the SCAN does not assess Antisocial Personality Disorder (ASPD), the ASPD section of the Structured Clinical Interview for DSM-III-R (SCID) was substituted for this comparison. Results. The Kappa statistic was used to measure concordance between the two instruments. Kappa for alcohol dependence was in the acceptable range (0.63). Kappas were lower for sedative dependence (0.48) and for cannabis dependence (0.53), but higher for cocaine and stimulant dependence (0.85) and for opioid dependence (0.73). Kappa for major depression and the ASPD diagnoses were high (0.71 and 0.70), but slightly lower agreement was found for panic disorder (0.62). Kappa for social phobia was 0.47. Conclusion. These data, combined with results from two previous studies which examined reliability, indicate that the SSAGA is a highly reliable and valid instrument for use in studies of a variety of psychiatric disorders, including alcohol and drug dependence.
678 citations
TL;DR: Better understanding of the role of heroin metabolites, the metabolism of methadone, drug interactions and tolerance would all be of considerable value in knowing how best to respond to this problem.
Abstract: There has been increasing recognition of the problem of fatal opioid overdose. This review examines the pharmacological basis of respiratory depression following opioid administration. Respiration is controlled principally through medullary respiratory centres with peripheral input from chemoreceptors and other sources. Opioids produce inhibition at the chemoreceptors via mu opioid receptors and in the medulla via mu and delta receptors. While there are a number of neurotransmitters mediating the control of respiration, glutamate and GABA are the major excitatory and inhibitory neurotransmitters, respectively. This explains the potential for interaction of opioids with benzodiazepines and alcohol: both benzodiazepines and alcohol facilitate the inhibitory effect of GABA at the GABAA receptor, while alcohol also decreases the excitatory effect of glutamate at NMDA receptors. Heroin and methadone are the major opioids implicated in fatal overdose. Heroin has three metabolites with opioid activity. Variation in the formation of these metabolites due to genetic factors and the use of other drugs could explain differential sensitivity to overdose. Metabolites of methadone contribute little to its action. However, variation in rate of metabolism due to genetic factors and other drugs used can modify methadone concentration and hence overdose risk. The degree of tolerance also determines risk. Tolerance to respiratory depression is less than complete, and may be slower than tolerance to euphoric and other effects. One consequence of this may be a relatively high risk of overdose among experienced opioid users. While agonist administration modifies receptor function, changes (usually in the opposite direction) also result from use of antagonists. The potential for supersensitivity to opioids following a period of administration of antagonists such as naltrexone warrants further investigation. While our understanding of the pharmacological basis of opioid-related respiratory depression has advanced, better understanding of the role of heroin metabolites, the metabolism of methadone, drug interactions and tolerance would all be of considerable value in knowing how best to respond to this problem.
584 citations
TL;DR: There is a great need for well-conducted epidemiological studies performed in several countries, to examine the dose-response relationship between alcohol intake and the risk of several alcohol-related conditions, as well as the role of drinking pattern in determining the risk.
Abstract: Objective. To compare the strength of the evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of six cancers (oral cavity, oesophagus, colorectum, liver, larynx, breast), hypertension, cerebrovascular diseases, gastric and duodenal ulcer, liver cirrhosis and other chronic liver diseases, pancreatitis and injures and adverse effects. Methods. A search of the epidemiological literature from 1966 to 1998 was performed by several bibliographic databases. Metaregression models were fitted considering fixed and random models and linear and non-linear effects of alcohol intake on the risk of each condition. The effects of some characteristics of the studies including an index of their quality were considered as putative sources of heterogeneity of the estimates. Publication bias was also investigated by asymmetry of funnel plots. Results. Of the 397 initially reviewed studies, 200 were selected for meta-analysis. Since qualitative characteristics of the studies were often significant sources of heterogeneity among them, the estimates of the pooled dose-response slopes were based only on the 123 studies with higher quality score and/or reporting adjusted estimates of relative risks. Higher alcohol-related risks were found for liver cirrhosis, neoplasms of the upper respiratory and digestive tracts, haemorrhagic stroke and injuries and adverse effects. Weaker but significant associations were found for colorectum, liver and breast cancers, essential hypertension and chronic pancreatitis. For all these conditions, low intakes, corresponding to daily consumption of two drinks or two glasses of wine (25 g/day), have shown significant risks. Ischaemic stroke and gastric and duodenal ulcer seem independent of alcohol intake. The area in which the study was performed, the study's design and the outcome variable differently affected the slopes. Conclusions. The small number of sufficiently reliable studies, the strong indications of heterogeneity across them and the suspicion of publication bias suggest that there is a great need for well-conducted epidemiological studies performed in several countries, to examine the dose-response relationship between alcohol intake and the risk of several alcohol-related conditions, as well as the role of drinking pattern in determining the risk.
384 citations
TL;DR: In a population of relatively light smokers, FTND and HSI seem to measure little more than the number of cigarettes per day, and a new and more broadly applicable test of addiction to cigarettes is a research priority.
Abstract: Aims To assess the validity of the Fagerstrom test for nicotine dependence (FTND, six items) and of a short-form of this questionnaire, the Heaviness of Smoking Index (HSI, two items), in a population of relatively light smokers. Design Comparison of item content with published definitions of addiction. Test-retest reliability and multiple tests of construct validity, based on a secondary analysis of a cohort study conducted between November 1995 and June 1996. Setting University of Geneva, Switzerland. Participants Students (82%), academic (12%) and administrative staff (6%): 643 smokers at baseline and 482 smokers at follow-up. Measurements French-language versions of the FTND and HSI, smoking status, saliva cotinine level, self-efficacy for quitting smoking and other variables related to addiction with cigarettes. Findings A literature review showed that both composite scales fail to assess several recognised aspects of tobacco dependence. In this population of relatively light smokers (average: 12 cigarettes per day), both tests had important floor effects with, respectively, 55% and 63% of participants with scores equal to 0 or 1 on these scales. In addition, two of the FTND items (Difficult-to-refrain and Hate-most-to-give-up) had poor psychometric properties. Even though FTND and HSI correlated about as expected with criterion variables, the number of cigarettes smoked per day performed better than either composite scale on most validation criteria. Conclusion In a population of relatively light smokers, FTND and HSI seem to measure little more than the number of cigarettes per day. Designing a new and more broadly applicable test of addiction to cigarettes is a research priority.
342 citations
TL;DR: This study provides further support for a cluster of withdrawal symptoms experienced following cessation of regular marijuana use, and the affective and behavioral symptoms reported were consistent with those observed in previous laboratory and interview studies.
Abstract: Aims. The clinical relevance of marijuana withdrawal has not been established. This study is the first to document the incidence and severity of perceived marijuana withdrawal symptoms in a clinical sample of marijuana-dependent adults. Measurements. Fifty-four people seeking outpatient treatment for marijuana dependence completed a 22-item Marijuana Withdrawal Symptom checklist based on their most recent period of marijuana abstinence. Findings. The majority (57%) indicated that they had experienced six symptoms of at least moderate severity and 47% experienced four symptoms rated as severe. Withdrawal severity was greater in those with psychiatric symptomatology and more frequent marijuana use. Conclusions. This study provides further support for a cluster of withdrawal symptoms experienced following cessation of regular marijuana use. The affective and behavioral symptoms reported were consistent with those observed in previous laboratory and interview studies. Since withdrawal symptoms are frequently a target for clinical intervention with other substances of abuse, this may also be appropriate for marijuana.
313 citations
TL;DR: Any protective association of alcohol against CAD needs to carefully consider the implications of pattern of drinking for the relationship, and the modulating influences of co-timing of drinking with meals, cigarette smoking or illicit drug use need to be evaluated.
Abstract: There is an established inverse relationship between the regular light consumption of alcohol (5-10 g/day) and the incidence of coronary artery disease (CAD). This association has several biologically plausible mechanisms with dose-dependent effects of alcohol to increase HDL cholesterol, lower plasma fibrinogen and inhibit platelet aggregation. However, such a protective effect against atheroma cannot be considered in isolation from known adverse effects on blood pressure and triglycerides or possible detrimental effects of episodic or binge drinking on several other cardiovascular end-points and risk factors. In subjects with pre-existing CAD, an alcoholic binge can increase both silent myocardial ischaemia and angina. During withdrawal following binge drinking, marked fluctuations in blood pressure together with heightened platelet activation and adverse changes in the balance of fibrinolytic factors, may offer an explanation for the reported association between episodic heavy drinking and ischaemic stroke. This has been seen particularly in young males and extends further to an increase in both subarachnoid haemorrhage and intracerebral haemorrhage after binge drinking. Intervention studies in man have shown acute increases in blood pressure in men who drink predominantly at weekends, compared to longer-term pressor effects in regular daily drinkers. We have been unable, however, to reproduce the finding of unfavourable effects of binge drinking on the lipid profile that have been reported in animal studies and man. Binge drinking may also induce cerebrovascular spasm or cause both ventricular and supraventricular arrhythmias, especially atrial fibrillation. Alcohol-induced arrhythmia has been postulated as the basis for alcohol-related sudden coronary death in those subjects with pre-existing CAD. Hence, further exploration of any protective association of alcohol against CAD needs to carefully consider the implications of pattern of drinking for the relationship. The modulating influences of co-timing of drinking with meals, cigarette smoking or illicit drug use also need to be evaluated. Without such vital information, public health advice on alcohol and CAD will be limited in its scope and potentially flawed in its impact.
310 citations
TL;DR: Findings suggest that disinhibited individuals with response modulation deficits are at risk for problem gambling, thus supporting the DSM-IV classification of pathological gambling as an impulse control deficit.
Abstract: Aims. This study investigated whether impulsivity measured in 12-14-year-olds could predict problem gambling in late adolescence, above and beyond other personality factors such as aggressiveness and anxiety. Design. A prospective-longitudinal design was used, thus overcoming limitations of past studies which used concurrent or retrospective designs. Participants and measurements. The sample included 154 boys living in economically deprived neighborhoods. Impulsivity measures comprised self-reports, teacher ratings and laboratory tasks, and were administered during early adolescence. Gambling behavior was assessed at age 17 using a self-report measure. Early gambling behavior and socio-demographic information were also collected for control purposes. Findings. Results revealed that a self-report measure of impulsiveness and a card-sorting task significantly predicted problem gambling, even after controlling for socio-demographic variables, early gambling behavior and other personality variables such as aggressiveness and anxiety. Moreover, the predictive link held across all levels of aggressiveness and anxiety. Both impulsivity measures seemed to tap an inability to foresee negative consequences and an inability to stop responding despite unfavorable contingencies. Conclusion. These findings suggest that disinhibited individuals with response modulation deficits are at risk for problem gambling, thus supporting the DSM-IV classification of pathological gambling as an impulse control deficit.
298 citations
TL;DR: A mortality rate for illicit opiate users is approximately 13 times greater than for the general population, and the large number of years of life lost is reflective of the relatively young population (15-39 years of age) in which opiate-related mortality occurs.
Abstract: UNLABELLED AIMS/DESIGN: Estimates of mortality associated with illicit opiate use provide useful information to those directing and monitoring local, national and international policies and programmes. Most studies investigating the association have, however, been small with imprecise estimates of increased mortality. The current study combines data from a number of international studies in a meta-analysis to estimate more precisely mortality associated with illicit opiate use. Because HIV infection among injecting drug users differs dramatically between countries and localities, we excluded studies where AIDS was a major contributor to mortality. Studies were included only where AIDS-specific mortality accounted for less than 2% of total mortality. FINDINGS Our results show a mortality rate for people regularly using illicit opiates, which is more than 13 times greater than that observed for the general community. It is estimated that 9.4% of total mortality in Australians aged 15-39 years of age can be attributed to regular use of illicit opiates. Application of this aetiological fraction to Australian mortality data for 1992 indicate that approximately 401 male and 161 female deaths occurred as a result of opiate use. This represents some 15,429 and 6261 person-years of life lost (to age 70) for males and females, respectively. CONCLUSIONS The mortality rate for illicit opiate users is approximately 13 times greater than for the general population. The large number of years of life lost is reflective of the relatively young population (15-39 years of age) in which opiate-related mortality occurs. Relative risk estimates can also be applied to data on the prevalence of illicit opiate use in other countries to produce locally based aetiological fractions and estimates of person-years of life lost.
243 citations
TL;DR: The methodologies used to examine a link between alcohol and risk-taking (population-based, person- based, event-based and experimental methods) are described and the implications for alcohol policy and prevention are discussed.
Abstract: This paper discusses issues in applying concepts of "risk" to alcohol use. There is a wide variety of definitions of "risk," including dimensions of positive vs. negative aspects of risk-taking, short-term vs. long-term harm, generality vs. specificity of risk behaviors, knowledge of probability of harm, and objective vs. subjective risk. Alcohol can play a role in risky behavior on multiple levels. The paper describes the methods used to examine a link between alcohol and risk-taking (population-based, person-based, event-based and experimental methods) and illustrates these methods from research findings on the association of alcohol to risky driving, crime and violent behavior, and sexual risk-taking. Theoretical models of the association of alcohol and risk-taking are outlined, and the implications of these models for alcohol policy and prevention are discussed.
240 citations
TL;DR: People who try to quit addictive behaviours could be encouraged to make full use of the cultural stock of stories in creating an account that fits their own experience of defeating their particular addiction.
Abstract: Aims. The purpose of this study was to look for the ways in which people who have recovered from various addictions understand and present their change process. Materials. The research material consisted of 51 autobiographical stories of people who had been able to quit their addiction to alcohol, multiple drugs, binge eating, smoking, sex and gambling. Methods. The basic logic of each narrative was first defined. The narratives were then categorized according to what they presented as the key to recovery. Composite stories were then constructed and analysed with regard to their emotional, causal, moral and ethical meanings. Findings. The analysis revealed five different story types among these self-narratives: the AA story, the growth story, the co-dependence story, the love story and the mastery story. All of them helped to make the addiction and recovery understandable, they released the protagonist from guilt and had a happy ending by which the values of the story were realized. Each story type was told predominantly by representatives of a particular gender and addiction. Conclusions. As there are several ways out of addictive behaviours there are also several ways to construe the change. People who try to quit addictive behaviours could be encouraged to make full use of the cultural stock of stories in creating an account that fits their own experience of defeating their particular addiction.
TL;DR: The proportion of men who can be considered as "binge drinkers" was relatively high, and the absence of sizable socio-economic differences suggest that drinking may be spread relatively uniformly in Russia, especially among males.
Abstract: Aims. Alcohol has been suggested as an important determinant of mortality in Russia but survey data on individuals' alcohol consumption in Russia are sparse. We have analysed the levels and distribution of alcohol consumption in a national sample of the Russian population. Design. Cross-sectional survey. Participants. A multi-stage random sample of men and women of the Russian Federation (N = 1599, response rate 66%). Measurements. Data on frequency of drinking alcohol and the average amount consumed at one occasion were collected in an interview. Information was also collected on smoking, self-rated health and a broad range of socio-economic factors and political attitudes. Findings. Nine per cent of men and 35% of women reported that they never drink alcohol; 10% of men and 2% women drink several times a week; 44% of men and 6% of women reported that they drink an equivalent of 25 cl of vodka or more at one occasion and 31% of men and 3% of women would do so at least once a month (25 cl of vodka contains 78.5 g of absolute alcohol). There were differences in alcohol consumption between geographical areas. Material deprivation was not related to alcohol consumption. Among men, smokers, unmarried, unemployed and men reporting poor health consumed more alcohol; women with higher education, widows, non-smoking and with worse health consumed less alcohol. Variables related to reaction to economic and political changes, rating of family economic situation general satisfaction or political preferences were not related to alcohol consumption. Conclusions. While the overall levels of alcohol consumption appeared low, possibly due to under-reporting, the proportion of men who can be considered as "binge drinkers" was relatively high. The absence of sizable socio-economic differences suggest that drinking may be spread relatively uniformly in Russia, especially among males. Alcohol consumption seems unrelated to individuals' perception of the recent societal changes.
TL;DR: ITC treatment, especially when followed by residential aftercare, was effective for reducing post-release recidivism rates and Corrections-based treatment policy should emphasize a continuum of care model with high quality programs and services.
Abstract: Aims. This study examined the impact of residential aftercare on recidivism following prison-based treatment for drug-involved offenders. Design. A matched group quasi-experimental design. Survival regression analyses were used to predict time until rearrest. A logistic regression model was constructed for predicting aftercare completion. Setting. A 9-month in-prison therapeutic community (ITC) and several communitybased transitional therapeutic communities (TTCs). Participants. Data were collected from 396 male inmates (293 treated, 103 untreated). Measurements. Background information (gender, ethnicity, age, education level, criminal history and risk for recidivism) was abstracted from the state criminal justice databases and a structured interview led by clinical staff. During treatment process measures were based on inmate self-ratings of their counselors, program and peers. A post-treatment interview conducted by field research staff assessed satisfaction with transitional aftercare. Post-release recidivism was based on state-maintained computerized criminal history records. Findings. ITC treatment, especially when followed by residential aftercare, was effective for reducing post-release recidivism rates. Lower satisfaction with transitional aftercare treatment was associated with not completing the residential phase of community-based aftercare. Conclusions. Corrections-based treatment policy should emphasize a continuum of care model (from institution to community) with high quality programs and services .
TL;DR: Findings add to the growing behavioral genetic literature indicating that adolescent initiation of substance use, a powerful predictor of adult substance use diagnosis, is influenced primarily by environmental rather than genetic factors.
Abstract: Aims. We sought to estimate the contribution of genetic and environmental factors to adolescent tobacco, alcohol and other substance use. Design, setting and participants. The sample consisted of 327 monozygotic and 174 like-sex dizygotic twin pairs born in Minnesota and aged 17-18 years at time of assessment. Biometrical methods were used to estimate the contribution of additive genetic, shared and non-shared environmental factors to adolescent substance use. Measurements. As part of a day-long psychological assessment, adolescent twins completed a computerized substance use interview to determine whether they had ever used tobacco, alcohol or other illicit drugs. Findings. The heritability for the liabilities to tobacco, alcohol and other drug use was estimated to be 59%, 60% and 33% among males, and 11%, 10% and 11% among females. However, the gender difference was not statistically significant. Estimates of shared environmental effect were substantial and insignificantly higher among females (71%, 68% and 36%, respectively) than among males (18%, 23% and 23%, respectively). The covariation among the three substance use phenotypes could be accounted for by a common underlying substance use factor. Estimates of the contributions of genetic, shared environmental and non-shared environmental factors to variance in this factor were 23% 63% and 14%, respectively. Conclusions. These findings add to the growing behavioral genetic literature indicating that adolescent initiation of substance use, a powerful predictor of adult substance use diagnosis, is influenced primarily by environmental rather than genetic factors.
TL;DR: Ecstasy is used by adolescents who use other legal and illegal substances in a polydrug-use pattern and the substance is introduced late in a hypothesized drug use sequence, which is highly associated with cigarette smoking, alcohol use, alcohol problems and conduct problems, whereas the associations with internalizing mental health problems were of less magnitude.
Abstract: Aims. (i) To describe illegal drug use patterns in an adolescent normal population sample with special emphasis on MDMA, ecstasy; (ii) to investigate where ecstasy is introduced in a hypothesized drug use sequence, and (iii) to contrast the predictors of ecstasy use with those of other illegal substances. Special attention was given to the relationship to subcultural music preferences and house-party-going. Design. A school-based survey of the total cohort of adolescents enrolled in the school system in a city. Participants. 10 812 adolescents, age 14-17 years, response rate 94.3%. Setting. Oslo, the capital and only metropolitan town in Norway. Measurements. Social class was measured by the occupation standard ISCO 88, questions were posed as regards frequency of alcohol use and alcohol intoxication, cigarette smoking and use of cannabis, amphetamines, ecstasy and heroin. Alcohol problems were measured by a shortened version of Rutgers Alcohol Problem Index (RAPI), conduct problems were measured according to the four categories of acts forming the basis of the diagnosis conduct disorder in DSM-IV, internalizing mental health problems were measured using items from Hopkins Symptoms Checklist (HCL). A number of questions were asked as regards subcultural music preferences and house-party-going. Statistical models. A hypothesized cumulative sequence in drug use was investigated by means of latent class analysis, and the predictors of the various patterns of drug use were estimated and compared by means of multinominal logistic regression analysis. Findings. The use of ecstasy was often intermingled with the use of cannabis, amphetamines and heroin, in a pattern of polydrug use. The latent class analysis revealed the following drug use sequence: (1) alcohol, (2) cigarettes, (3) cannabis, (4) amphetamines, (5) ecstasy and (6) heroin. There was no significant association between ecstasy use and parental social class or residential area of the town. All patterns of illegal drug use were highly associated with cigarette smoking, alcohol use, alcohol problems and conduct problems, whereas the associations with internalizing mental health problems were of less magnitude. Multinominal logistic regression analysis revealed that the use of ecstasy (E) was significantly more weakly associated with cigarette smoking than were the use of cannabis only (C), amphetamines (A) and the combination of ecstasy and amphetamines (A + E). The association between E and conduct problems (CP) was weaker than the association between CP and A and A + E. Finally, there were associations between E and A + E and House/Techno preferences and house-party-going, which were not found for C and A. Conclusions. Ecstasy is used by adolescents who use other legal and illegal substances in a polydrug-use pattern. The substance is introduced late in a hypothesized drug use sequence. Even so, ecstasy use seems to differ from the use of, e.g. amphetamines, in that the association with smoking and conduct problems is weaker and that the associations with subcultural music preferences and house-party-going are much stronger.
TL;DR: The social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre-conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission.
Abstract: Aims. We review recent trends in HIV associated with injecting drug use (IDU) in the Newly Independent States (NIS) in eastern Europe, including Belarus, Moldova, Russia, Ukraine, and Kazakhstan in central Asia. We aim to draw attention to the social and economic "risk environments" in which rapid HIV spread among IDUs has occurred. Methods. Findings draw on centrally registered HIV surveillance data, published research studies and assessment reports funded by international development agencies. Findings. Since 1995, there is evidence of rapid HIV spread in Belarus, Kazakhstan, Moldova, Russia and Ukraine, with estimates suggesting between 50% and 90% of new HIV infections among IDUs. At the same time, there have been rapid increases in the incidence of syphilis and declines in health and welfare status, including outbreaks of diphtheria, tuberculosis and cholera. Findings emphasize the potential influence of the social and economic context in creating the "risk environments" conducive to HIV and epidemic spread. Key factors include: rapid diffusions in IDU; population migration and mixing; economic transition and decline; increasing unemployment and impoverishment; the growth of informal economies; modes of drug production, distribution and consumption; declines in public health revenue and infrastructure; and political, ideological and cultural transition. Conclusions. An understanding of the social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre-conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission. The "risk environment" may influence the efficacy of individual and community-level HIV prevention and highlights the concomitant urgency for interventions targeting social and environmental change.
TL;DR: One year after the experimental intervention, results indicate significant positive changes among parents, especially in the areas of parent skills, parent drug use, deviant peers and family management, helping to strengthen family bonding and to reduce parents' drug use.
Abstract: Aims. Children whose parents abuse drugs are exposed to numerous factors that increase the likelihood of future drug abuse. Despite this heightened risk, few experimental tests of prevention programs with this population have been reported. This article examines whether intensive family-focused interventions with methadone treated parents can reduce parents' drug use and prevent children's initiation of drug use. Design. Parents were assigned randomly into intervention and control conditions and assessed at baseline, post-test, and 6 and 12 months following the intervention. Children were assessed at baseline, and 6- and 12-month follow-up points. Setting. Two methadone clinics in Seattle, Washington. Participants. One hundred and forty-four methadone-treated parents, and their children ( n = 178) ranging in age from 3 to 14 years old. Intervention. The experimental intervention supplemented methadone treatment with 33 sessions of family training combined with 9 months of home-based case management. Families in the control condition received no supplemental services. Measurement. Parent measures included: relapse and problem-solving skills, self-report measures of family management practices, deviant peer networks, domestic conflict and drug use. Child measures included self-report measures of rules, family attachment, parental involvement, school attachment and misbehavior, negative peers, substance use and delinquency. Findings. One year after the family skills training, results indicate significant positive changes among parents, especially in the areas of parent skills, parent drug use, deviant peers and family management. Few changes were noted in children's behavior or attitudes. Conclusions. Programs such as this may be an important adjunct to treatment programs, helping to strengthen family bonding and to reduce parents' drug use. (Abstract Adapted from Source: Addiction, 1999. Copyright © 1999 by Blackwell) For more information on the Focus on Families Project, see VioPro record number 288. Family Based Drug Use Prevention Drug Use Intervention Substance Use Intervention Substance Use Prevention Adult Substance Use Adult Parent Intervention Program Prevention Program Parent Substance Use Parent as Risk Factor Family Risk Factors Child Substance Use Juvenile Substance Use Early Childhood Middle Childhood Late Childhood Early Adolescence Parent Substance Use Home Based Methadone Treatment Washington 10-00
TL;DR: The multi-dimensional results found among users with low to moderate symptomatology indicate that: (1) previous results from relatively homogeneous populations may have been biased towards lesser order solutions, and that (2) the DSM-IV substance disorder criteria describe at least two distinct phenomena, supporting the current DSM- IV organization of substance Disorder criteria.
Abstract: Aims. The factor structure of DSM-IV substance disorder criteria is examined among alcohol, cannabis, cocaine and opiate users to determine the dimensionality of abuse and dependence criteria within each of these drug classes and whether a common construct can be generalized across drug classes. Design. 12-month criterion prevalence was assessed as part of the World Health Organization's Study on the Reliability and Validity of the Alcohol and Drug Use Disorder Instruments in various settings at eight sites around the world using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). A majority of respondents were recruited from non-treatment settings. In addition to exploratory factor analysis, confirmatory factor analysis was used to analyse factor structures using weighted least square methods and tetrachoric correlation matrices. Multi-sample analysis techniques were used to model differences between drug-classes. Findings. In the full data analyses identified a single factor solution for each user population and across user populations. However, analyses of data from users reporting low to moderate symptomatology identified a two-dimensional construct among alcohol, cannabis and opiate users consisting of a major "dependence" factor and a lesser "abuse" factor. In addition, results showed that neither the abuse criterion "(A2) use in physical hazardous situations" or the dependence criterion "(D7) use despite knowledge of psychological/physical problems" were central to the latent construct in any of the user populations, except for D7 among alcohol users. Conclusions. The multi-dimensional results found among users with low to moderate symptomatology indicate that: (1) previous results from relatively homogeneous populations may have been biased towards lesser order solutions, and that (2) the DSM-IV substance disorder criteria describe at least two distinct phenomena, supporting the current DSM-IV organization of substance disorder criteria. Further work needs to evaluate whether prevalent symptoms are present in random or predictable combinations, whether combinations reflecting a specific hierarchy of severity can be identified, and whether incident symptoms are accumulated in a predictable pattern, within specific user populations and across user populations.
TL;DR: The heavy drinking level of divorced young adults was not due to selection, and individuals who never marry appear to have a chronic heavy consumption pattern that may contribute to their increased mortality.
Abstract: AIMS: To investigate why alcohol consumption varies by marital status, assessing (i) differences in heavy consumption prior to changes in marital status (indicating selection) and increases or decreases in heavy consumption associated with changes in marital status (indicating causation), (ii) whether such increases or decreases are transient, and (iii) the possible mediating effect of parental status. DESIGN: Longitudinal cohort. SETTING: Great Britain. PARTICIPANTS: Data from the 23- and 33-year surveys of the 1958 British birth cohort (all born in England, Wales and Scotland, 3-9 March 1958). MEASUREMENTS: Heavy drinking, defined as more than 35 (men) and 20 (women) units/week; changes between ages 23 and 33 in consumption and marital status. FINDINGS: The divorced had the highest consumption levels at both ages, the married had the lowest. Selection effects were minimal in both sexes. Overall, heavy drinking declined between ages 23 and 33 (21.4-13.0% in men, 6.4-3.4% in women), but increased among individuals who divorced, compared to the continuously married (adjusted OR = 2.05, 95% CI = 1.49, 2.83 for men; OR = 2.61, 95% CI = 1.67, 4.09 for women), most strikingly for recent divorces (adjusted OR = 4.97, 95% CI = 2.86, 8.57 and OR = 5.25, 95% CI = 2.60, 10.65). High rates of heavy drinking persisted for never married men (19.1%) and women (5.2%). CONCLUSIONS: The heavy drinking level of divorced young adults was not due to selection. Marital separation was accompanied by increases in heavy drinking, with pronounced short-term effects. Adverse alcohol-related health consequences may occur in the immediate period around divorce. Individuals who never marry appear to have a chronic heavy consumption pattern that may contribute to their increased mortality. Language: en
TL;DR: Life-time smoking among older adolescents significantly increased the probability of future alcohol, cannabis, hard drug and multiple drug use disorders during young adulthood, illustrating additional risks associated with early cigarette smoking.
Abstract: Aims. This study examined the impact of adolescent cigarette smoking (life-time use, recency, frequency and age of onset) on the occurrence of substance use disorders during young adulthood. Design. Participants were assessed while in high school (T1), approximately I year later (T2) and then after they had turned 24 years of age (T3). Setting. Adolescents were randomly selected at T1 from nine senior high schools in western Oregon. Participants. A subset (n = 684) of 1709 adolescents who had been assessed regarding cigarette smoking during high school were evaluated for alcohol, cannabis and other drug abuse/dependence up to age 24. Measurements. Semi-structured interviews provided information regarding life-time use of cigarettes and chewing tobacco, age of smoking onset, frequency and quantity of cigarette smoking and quit efforts in adolescence. Diagnoses of substance abuse and dependence in young adulthood were made as per DSM-IV. Findings. Life-time smoking among older adolescents significantly increased the probability of future alcohol, cannabis, hard drug and multiple drug use disorders during young adulthood. Having been a former smoker did not reduce the risk of future substance use disorder, although having maintained smoking cessation for more than 12 months was associated with significantly lower rates of future alcohol use disorder. Daily smoking was associated with increased risk of future cannabis, hard drug and multiple drug use disorders. Among daily smokers, earlier smoking onset age predicted future substance use disorders. Conclusions. The results extend knowledge about relationships between cigarette smoking during adolescence and the development of substance use disorders during young adulthood, illustrating additional risks associated with early cigarette smoking. Future research is needed to examine potential causal associations.
TL;DR: In this paper, the importance of risk factors such as socio-demographics, sports activities, tobacco use, alcohol consumption, use of certain psychotropic substances and violence in the use of doping agents in adolescents was assessed.
Abstract: Aims. The purpose was to assess the importance of risk factors such as socio-demographics, sports activities, tobacco use, alcohol consumption, use of certain psychotropic substances and violence in the use of doping agents in adolescents. Design. Cross-sectional survey using anonymous closed response questionnaire. Setting. Eight senior high schools in Uppsala, Sweden. Participants. A total of 2742 senior high school students; 1592 were in their first year (aged 16-17 years) and 1150 in their third (aged 18-19 years). Findings. Multiple logistic regression analyses revealed that strength training, tobacco use, heavy alcohol consumption, truancy at least once a week and living alone were significantly independently associated in the use of doping agents. Further, the study showed that use of cannabis oil, LSD, amphetamine and opioids were related specifically to anabolic-androgenic steroid use. Conclusions. Use of doping agents probably involves more than a desire to enhance appearance or sports performance and appears to have much in common with use of alcohol, tobacco and psychotropic drugs.
TL;DR: The prevalence of substance use disorders in the Australian population is comparable to that in other English-speaking countries.
Abstract: Aims. To present the prevalence of substance use and ICD-10 substance use disorders in the adult Australian population using data from the National Survey of Mental Health and Well-Being (NSMHWB). Design. A cross-sectional survey assessing substance use and ICD substance use disorders (harmful use and dependence). Setting and participants. A household survey of a nationally representative sample of 10 641 Australian adults (aged 18 years or older). Measurements. Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). Findings. In the past 12 months 6.5% of the sample had an ICD-10 alcohol use disorder (95% CI: 6.2, 6.9), and 2.2% had another drug use disorder (95% CI: 2.0, 2.4). More males than females had substance use disorders: 9.5% of males (95% CI: 8.5, 10.5) and 3.6% of females (95% CI: 3.2, 4.0) met criteria for an alcohol use disorder, and 3.2% of males (95% CI: 2.8, 3.6) and 1.3% of females (95% CI: 0.9, 1.7) met criteria for another drug use disorder within the past 12 months. The prevalence of substance use disorders decreased with increasing age: 10.5% of respondents aged 18-34 years met criteria for an alcohol use disorder and 4.8% met criteria for a drug use disorder. The rates of these disorders among those aged 55 years or older were 1.8% and 0.1%, respectively. Substance use disorders were more prevalent among the unemployed, those who had never married and those who were Australian-born. Conclusions. The prevalence of substance use disorders in the Australian population is comparable to that in other English-speaking countries.
TL;DR: Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood.
Abstract: Aims. To examine a range of biological indicators of illicit drug use, including blood, urine, hair and saliva, addressing both technological and practical issues relating to their application and interpretation. Methods. The review process involved an examination of key reference texts and literature from the scientific fields of analytical and clinical toxicology. Findings. Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood. The growing sophistication of laboratory analysis may additionally make possible the routine use of hair sampling which can provide a much longer time frame for assessment. Breath, saliva, sweat or breast milk remain possibilities in the future. Conclusions. Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test.
TL;DR: Substantial proportions of both community and treatment samples of drug misusers have witnessed an overdose death which could have been prevented through prior training in resuscitation techniques and administration of home-based supplies of naloxone.
Abstract: Aims. Before proceeding with the introduction of an overdose fatality prevention programme including teaching in cardio-pulmonary resuscitation and distribution of naloxone, a pre-launch study of treatment and community samples of injecting drug misusers has been undertaken to establish (i) the extent of witnessing overdoses, (ii) the acceptability of naloxone distribution and training; and (iii) the likely impact of such measures. Design and setting. Structured interview of two samples: (a) a community sample of injecting drug misusers recruited by selected privileged access interviewers (PAI) and interviewed by them in community settings and (b) a treatment sample of opiate addicts recruited from our methadone maintenance clinic (interviewed by in-house research staff). Participants. (a) Three hundred and twelve injecting drug misusers with a history of having injected and currently still using injectable drugs; and (b) 142 opiate addicts in treatment at our local catchment area methadone maintenance clinic in South London. Findings. History of personal overdose was found with 38% of the community sample and 55% of the treatment samplemainly involving opiates and in the company of friends. Most (54% and 92%, respectively) had witnessed at least one overdose (again mostly involving opiates), of whom a third had witnessed a fatal overdose. Only a few (35%) already knew of the existence and effects of naloxone. After explanation to the treatment sample, 70% considered naloxone distribution to be a good proposal. Of the 13% opposed to the proposal, half thought it may lead them to use more drugs. Eighty-nine per cent of those who had witnessed an overdose fatality would have administered naloxone if it had been available. We estimate that at least two-thirds of witnessed overdose fatalities could be prevented by administration of home-based supplies of naloxone. Conclusions. Substantial proportions of both community and treatment samples of drug misusers have witnessed an overdose death which could have been prevented through prior training in resuscitation techniques and administration of home-based supplies of naloxone. Such a new approach would be supported by most drug misusers. On the basis of these findings, we conclude that it is appropriate to proceed to a carefully constructed trial of naloxone distribution.
TL;DR: SES is an important predictor of acute and chronic alcohol-related mortality, and social selection and drift are likely to contribute to the large differentials in respect to personal income, while their effect on other differentials is likely to be smaller.
Abstract: Aims. To describe the differences in acute, chronic and total alcohol-related mortality by several measures of socio-economic status (SES) and to unravel the influences of different dimensions of SES. Design. A register-based follow-up study of alcohol-related mortality. Setting. Finland. Participants. The dataset was formed by linking census records with death records for 1987-95 and included 21 922 alcohol-related deaths. Measurements. SES indicators include education, occupational class, personal income, net household income per consumption unit (spending power) and housing tenure. The judgement of whether death was alcohol-related was based on death certificates. Findings. Acute and chronic alcohol-related mortality were much higher in low SES groups for all SES indicators, including spending power, even when controlling for the remaining SES variables. Among men, personal income was a better predictor of alcohol-related death than spending power, while among women the situation was reversed. The effect of one SES measure was often stronger in low levels of another SES measure. Social selection and drift are likely to contribute to the large differentials in respect to personal income, while their effect on other differentials is likely to be smaller. Conclusions. SES is an important predictor of acute and chronic alcohol-related mortality. The total impact of SES cannot fully be captured using only one or two measures of SES .
TL;DR: The utility of cue exposure treatment for smoking relapse prevention is called into question, with results calling into question the utility of standard cognitive behavioral and pharmacological treatments.
Abstract: Aims In an additive design, test the efficacy of cue exposure treatment for smoking relapse prevention as an adjunct to current standard cognitive behavioral and pharmacological treatments Design Randomized, controlled clinical trial Setting Outpatient behavioral medicine clinic Participants One hundred and twenty-nine cigarette smokers recruited through newspaper advertisements Intervention After receiving an initial counseling session for cessation and setting a quit day, 129 smokers were randomly assigned to one of four relapse prevention treatment conditions: (1) brief cognitive behavioral; (2) cognitive behavioral and nicorette gum; (3) cognitive behavioral and cue exposure; and (4) cognitive behavioral and cue exposure with nicorette gum All smokers met individually with their counselor for six RP sessions Measures Seven-day, point-prevalence abstinence rates (CO verified) taken at 1, 3, 6 and 12-months post-treatment and time to first slip Findings All manipulation checks and process measures suggested that the treatments were delivered as intended There were no significant differences between conditions in point-prevalence abstinence rates or in time to first slip Conclusions These results call into question the utility of cue exposure treatment for smoking relapse prevention
TL;DR: The results support the superiority of methadone with respect to retention rate, but previous reports of buprenorphine use as an alternative in maintenance therapy for opiate addiction are suggested, suggesting that a speci® c subgroup may be bene® ting from bupenorphine.
Abstract: Aims. To evaluate the effectiveness of buprenorphine compared with methadone maintenance therapy in opiate addicts over a treatment period of 24 weeks. Design. Subjects were randomized to receive either buprenorphine or methadone in an open, comparative study. Setting. Subjects were recruited and treated at the drug addiction outpatient clinic at the University of Vienna. Participants. Sixty subjects (19 females and 41 males) who met DSM-IV criteria for opioid dependence and were seeking treatment. Intervention. Subjects received either sublingual buprenorphine (2-mg or 8-mg tablets; maximum daily dose 8 mg) or oral methadone (racemic D2 /1 L-methadone; maximum daily dose 80 mg). A stable dose was maintained following the 6-day induction phase. Measurement. Assessment of treatment retention and illicit substance use (opiates, cocaine and benzodiazepines) was made by urinalysis. Findings. The retention rate was signi® cantly better in the methadone maintained group (p, 0.05) but subjects completing the study in the buprenorphine group had signi® cantly lower rates of illicit opiate consumption (p5 0.04). Conclusion. The results support the superiority of methadone with respect to retention rate. However, they also con® rm previous reports of buprenorphine use as an alternative in maintenance therapy for opiate addiction, suggesting that a speci® c subgroup may be bene® ting from buprenorphine. This is the ® rst comparative trial to use sublingual buprenorphine tablets: previously published comparison studies refer to 30% solutions of buprenorphine in alcohol.
TL;DR: Male excess in rates of drug use may be due to greater male exposure to opportunities to try drugs, rather than to greater chance of progressing from initial opportunity to actual use, which suggests that sex differences in drug involvement emerge early in the process.
Abstract: Aims To examine whether male-female differences in rates of drug use could be traced back to differences in rates of exposure to initial opportunities to try drugs, rather than to sex differences in the probability of making a transition to use, once opportunity has occurred. Design Cross-sectional sample survey research with nationally representative samples and retrospective assessments. Setting United States, 1979-94. Participants Respondents were 131,226 residents aged 12 years and older, recruited for the National Household Surveys on Drug Abuse by multi-stage probability sampling at nine time points. Measurements Estimated proportion of males and females with an opportunity to use marijuana, cocaine, hallucinogens and heroin; proportions reporting use among those having an opportunity to use each drug; proportion making a "rapid transition" from initial opportunity to initial use. Findings For each survey year, males were more likely than females to have an initial opportunity to use drugs. However, few male-female differences were observed in the probability of making a transition into drug use, once an opportunity had occurred. Conclusions Previously documented male excess in rates of drug use may be due to greater male exposure to opportunities to try drugs, rather than to greater chance of progressing from initial opportunity to actual use. This suggests that sex differences in drug involvement emerge early in the process. Implications of these findings are discussed in relation to the epidemiology and prevention of drug use, and future research on sex differences in drug involvement.
TL;DR: The substantial co-variation between suicide attempts and drug overdose suggests some common underlying causal factors seem to be related to heavy drug use and poor social integration.
Abstract: AIMS: Assessment of prevalence of non-fatal overdoses and suicide attempts and predictors of and co-variation between such behaviours among drug addicts. DESIGN: Cross-sectional survey. SETTING: Inpatient and outpatient treatment units in Norway. PARTICIPANTS: National sample of 2051 drug addicts admitted to treatment in Norway in 1992-93. MEASUREMENTS: Self-reports of suicide attempts and of life-threatening overdoses from structured interviews with therapists. FINDINGS: Almost half (45.5%) the clients reported having experienced one or more life-threatening overdoses. A third (32.7%) reported one or more suicide attempts. Suicide attempts were more often reported among those who had overdosed (odds ratio (OR) = 6.3), and the number of life-threatening overdoses and number of suicide attempts were positively and moderately associated (Pearson's r = 0.39). Drug addicts who had exhibited both life-threatening behaviours were characterized by polydrug use, poor social functioning and HIV risk-taking behaviour. Suicide attempters were also characterized by psychiatric problems. CONCLUSIONS: The substantial co-variation between suicide attempts and drug overdose suggests some common underlying causal factors. These seem to be related to heavy drug use and poor social integration. Language: en
TL;DR: The importance of screening for prenatal alcohol use is underscored by the findings that any prenatal alcohol consumption increases the risk of continued antepartum drinking.
Abstract: Aims. To assess the impact of a brief intervention on antepartum alcohol consumption. Design. A randomized clinical trial. Setting. The obstetrics practices of the Brigham and Women's Hospital in Boston, MA, USA. Participants. Two hundred and fifty eligible women initiating prenatal care. Intervention. A comprehensive assessment of alcohol use (assessment only, AO) or the same comprehensive assessment with a brief intervention (BI). Measurement. Demographic background and obstetric history of subjects, current and lifetime use of alcohol and substances, composite Addiction Severity Index scores, and antepartum alcohol use. Findings. Of the 250, 247 (99%) subjects provided information on their antepartum drinking. Both the AO and BI groups had reductions in antepartum alcohol consumption, but differences in reductions by group were not statistically significant ( p > 0.05).Risk of antepartum drinking after either the AO or BI was increased nearly threefold if the subject had any prenatal alcohol consumption before assessment ( p = 0.0001). For the 143 subjects who were abstinent pre-assessment, however, those who received the BI maintained higher rates of abstinence (86% versus 72%, p = 0.04). Conclusions. After a comprehensive assessment of alcohol use, subjects in both the AO and BI groups reduced their antepartum alcohol consumption. The importance of screening for prenatal alcohol use is underscored by the findings that any prenatal alcohol consumption increases the risk of continued antepartum drinking.