Showing papers in "Addiction in 2011"

Alcohol and depression

Abstract: Aims To examine the literature on the associations between alcohol use disorders (AUD) and major depression (MD), and to evaluate the evidence for the existence of a causal relationship between the disorders. Methods PsycInfo; PubMed; Embase; Scopus; ISI Web of Science database searches for studies pertaining to AUD and MD from the 1980 to the present. Random-effects models were used to derive estimates of the pooled adjusted odds ratios (AOR) for the links between AUD and MD among studies reporting an AOR. Results The analysis revealed that the presence of either disorder doubled the risks of the second disorder, with pooled AORs ranging from 2.00 to 2.09. Epidemiological data suggest that the linkages between the disorders cannot be accounted for fully by common factors that influence both AUD and MD, and that the disorders appear to be linked in a causal manner. Further evidence suggests that the most plausible causal association between AUD and MD is one in which AUD increases the risk of MD, rather than vice versa. Potential mechanisms underlying these causal linkages include neurophysiological and metabolic changes resulting from exposure to alcohol. The need for further research examining mechanisms of linkage, gender differences in associations between AUD and MD and classification issues was identified. Conclusions The current state of the literature suggests a causal linkage between alcohol use disorders and major depression, such that increasing involvement with alcohol increases risk of depression. Further research is needed in order to clarify the nature of this causal link, in order to develop effective intervention and treatment approaches.

Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys

Abstract: Aims This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers. Methods A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies. Results Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution. Conclusions Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates.

Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies

Abstract: Aims To review the literature on mortality among dependent or regular users of opioids across regions, according to specific causes, and related to a number of demographic and clinical variables. Methods Multiple search strategies included searches of Medline, EMBASE and PsycINFO, consistent with the methodology recommended by the Meta‐analysis of Observational Studies in Epidemiology (MOOSE) group; grey literature searches; and contact of experts for any additional unpublished data from studies meeting inclusion criteria. Random‐effects meta‐analyses were conducted for crude mortality rates (CMRs) and standardized mortality ratios (SMRs), with stratified analyses where possible. Meta‐regressions examined potentially important sources of heterogeneity across studies. Results Fifty‐eight prospective studies reported mortality rates from opioid‐dependent samples. Very high heterogeneity across studies was observed; pooled all‐cause CMR was 2.09 per 100 person‐years (PY; 95% CI; 1.93, 2.26), and the pooled SMR was 14.66 (95% CI: 12.82, 16.50). Males had higher CMRs and lower SMRs than females. Out‐of‐treatment periods had higher mortality risk than in‐treatment periods (pooled RR 2.38 (CI: 1.79, 3.17)). Causes of death varied across studies, but overdose was the most common cause. Multivariable regressions found the following predictors of mortality rates: country of origin; the proportion of sample injecting; the extent to which populations were recruited from an entire country (versus subnational); and year of publication. Conclusions Mortality among opioid‐dependent users varies across countries and populations. Treatment is clearly protective against mortality even in non‐randomized observational studies. Study characteristics predict mortality levels; these should be taken into account in future studies.

Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy

Abstract: Aims To assess the profile, utilization patterns, satisfaction and perceived effects among users of electronic cigarettes (‘e-cigarettes’). Design and Setting Internet survey in English and French in 2010. Measurements Online questionnaire. Participants Visitors of websites and online discussion forums dedicated to e-cigarettes and to smoking cessation. Findings There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used five refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them to quit smoking or reduce their smoking (92%). Reasons for using the e-cigaretteincludedtheperceptionthatitwaslesstoxicthantobacco(84%),todealwithcravingfortobacco(79%)and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawalandagreatereffectonsmokingcessationthanthoseusingnon-nicotinee-cigarettes.Conclusions E-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid tocutdownorquitsmoking.Furtherresearchshouldevaluatethesafetyandefficacyof e-cigarettesforadministration of nicotine and other substances, and for quitting and relapse prevention.

Online video game addiction: identification of addicted adolescent gamers.

Abstract: Aims To provide empirical data-driven identification of a group of addicted online gamers. Design Repeated cross-sectional survey study, comprising a longitudinal cohort, conducted in 2008 and 2009. Setting Secondary schools in the Netherlands. Participants Two large samples of Dutch schoolchildren (aged 13-16 years). Measurements Compulsive internet use scale, weekly hours of online gaming and psychosocial variables. Findings Thisstudyconfirmstheexistenceof asmallgroupof addictedonlinegamers(3%),representingabout1.5% of all children aged 13-16 years in the Netherlands. Although these gamers report addiction-like problems, relation- ships with decreased psychosocial health were less evident. Conclusions The identification of a small group of addicted online gamers supports efforts to develop and validate questionnaire scales aimed at measuring the phenom- enon of online video game addiction. The findings contribute to the discussion on the inclusion of non-substance addictions in the proposed unified concept of 'Addiction and Related Disorders' for the DSM-V by providing indirect identification and validation of a group of suspected online video game addicts.

Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review

Abstract: Aims To identify the predictors of attempts to stop smoking and the predictors of quit attempt success in adult general population samples. Methods We performed an electronic search of EMBASE, Pubmed, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group specialized register for articles that examined, in prospective adult general population samples, predictors of quit attempts and the success of quit attempts. Experts were contacted for knowledge of other relevant studies. Eight studies met the inclusion criteria and results were extracted independently by two researchers. Results There was considerable methodological heterogeneity between studies. Motivational factors dominated the prediction of quit attempts, whereas only cigarette dependence consistently predicted success after an attempt had been made. Social grade also appeared to predict success but was only examined in two studies. None of the other socio-demographic factors consistently predicted making a quit attempt or success. Conclusions Population-level studies from a number of countries show that past quit attempts and measures of motivation to stop are highly predictive of quit attempts, whereas only measures of dependence are consistently predictive of success of those attempts. Gender, age and marital status and educational level are not related consistently to quit attempts or quit success across countries.

Benzodiazepines revisited—will we ever learn?

Abstract: Aims To re-examine various aspects of the benzodiazepines (BZDs), widely prescribed for 50 years, mainly to treat anxiety and insomnia. It is a descriptive review based on the Okey Lecture delivered at the Institute of Psychiatry, King's College London, in November 2010. Methods A search of the literature was carried out in the Medline, Embase and Cochrane Collaboration databases, using the codeword ‘benzodiazepine(s)’, alone and in conjunction with various terms such as ‘dependence’, ‘abuse’, etc. Further hand-searches were made based on the reference lists of key papers. As 60 000 references were found, this review is not exhaustive. It concentrates on the adverse effects, dependence and abuse. Results Almost from their introduction the BZDs have been controversial, with polarized opinions, advocates pointing out their efficacy, tolerability and patient acceptability, opponents deprecating their adverse effects, dependence and abuse liability. More recently, the advent of alternative and usually safer medications has opened up the debate. The review noted a series of adverse effects that continued to cause concern, such as cognitive and psychomotor impairment. In addition, dependence and abuse remain as serious problems. Despite warnings and guidelines, usage of these drugs remains at a high level. The limitations in their use both as choice of therapy and with respect to conservative dosage and duration of use are highlighted. The distinction between low-dose ‘iatrogenic’ dependence and high-dose abuse/misuse is emphasized. Conclusions The practical problems with the benzodiazepines have persisted for 50 years, but have been ignored by many practitioners and almost all official bodies. The risk–benefit ratio of the benzodiazepines remains positive in most patients in the short term (2–4 weeks) but is unestablished beyond that time, due mainly to the difficulty in preventing short-term use from extending indefinitely with the risk of dependence. Other research issues include the possibility of long-term brain changes and evaluating the role of the benzodiazepine antagonist, flumazenil, in aiding withdrawal.

Mephedrone, new kid for the chop?

Abstract: The definitive version can be found at: http://onlinelibrary.wiley.com/ Copyright Society for the Study of Addiction [Full text of this article is not available in the UHRA]

Can Food be Addictive? Public Health and Policy Implications

Abstract: Aims Data suggest that hyperpalatable foods may be capable of triggering an addictive process. Although the addictive potential of foods continues to be debated, important lessons learned in reducing the health and economic consequences of drug addiction may be especially useful in combating food-related problems.Methods In the current paper, we review the potential application of policy and public health approaches that have been effective in reducing the impact of addictive substances to food-related problems. Results Corporate responsibility, public health approaches, environmental change and global efforts all warrant strong consideration in reducing obesity and dietrelated disease. Conclusions Although there exist important differences between foods and addictive drugs, ignoring analogous neural and behavioral effects of foods and drugs of abuse may result in increased food-related disease and associated social and economic burdens. Public health interventions that have been effective in reducing the impact of addictive drugs may have a role in targeting obesity and related diseases.

The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence.

Abstract: Aims To investigate whether opiate substitution therapy (OST) and needle and syringe programmes (NSP) can reduce hepatitis C virus (HCV) transmission among injecting drug users (IDUs). Design Meta-analysis and pooled analysis, with logistic regression allowing adjustment for gender, injecting duration, crack injecting and homelessness. Setting Six UK sites (Birmingham, Bristol, Glasgow, Leeds, London and Wales), community recruitment. Participants A total of 2986 IDUs surveyed during 2001-09. Measurement Questionnaire responses were used to define intervention categories for OST (on OST or not) and high NSP coverage (100% versus <100% needles per injection). The primary outcome was new HCV infection, measured as antibody seroconversion at follow-up or HCV antibody-negative/RNA-positive result in cross-sectional surveys. Findings Preliminary meta-analysis showed little evidence of heterogeneity between the studies on the effects of OST (I 2 = 48%, P = 0.09) and NSP (I 2 = 0%, P = 0.75), allowing data pooling. The analysis of both interventions included 919 subjects with 40 new HCV infec- tions. Both receiving OST and high NSP coverage were associated with a reduction in new HCV infection (adjusted odds ratios (AORs) = 0.41, 95% confidence interval (CI): 0.21-0.82 and 0.48, 95% CI: 0.25-0.93, respectively). Full harm reduction (on OST plus high NSP coverage) reduced the odds of new HCV infection by nearly 80% (AOR = 0.21, 95% CI: 0.08-0.52). Full harm reduction was associated with a reduction in self-reported needle sharing by 48% (AOR 0.52, 95% CI: 0.32-0.83) and mean injecting frequency by 20.8 injections per month (95% CI: -27.3 to -14.4). Conclusions There is good evidence that uptake of opiate substitution therapy and high coverage of needle and syringe programmes can substantially reduce the risk of hepatitis C virus transmission among injecting drug users. Research is now required on whether the scaling-up of intervention exposure can reduce and limit hepatitis C virus prevalence in this population.

Mephedrone: use, subjective effects and health risks

Abstract: Aims To assess the patterns of use, subjective effect profile and dependence liability of mephedrone, supported by corroborative urine toxicology. Design Cross-sectional structured telephone interview. Setting UK-based drug users associated with the dance music scene. Participants A total of 100 mephedrone users, recruited through their involvement with the dance music scene. Measurements Assessment of pattern of use, acute and after effects, DSM dependence criteria and gas chromatography-mass spectrometry urinalysis. Findings Mephedrone consumption results in typical stimulant-related subjective effects: euphoria, increased concentration, talkativeness, urge to move, empathy, jaw clenching, reduced appetite and insomnia. Thirty per cent of the sample potentially met criteria for DSM-IV dependence and there was evidence of a strong compulsion to use the drug (47% had used the drug for 2 or more consecutive days). Self-reported recent consumption of mephedrone was confirmed by toxicological analysis in all of the 14 participants who submitted a urine sample. Conclusion Mephedrone has a high abuse and health risk liability, with increased tolerance, impaired control and a compulsion to use, the predominant reported dependence symptoms.

Alcohol consumption and non-communicable diseases: epidemiology and policy implications

Abstract: Aims This paper summarises the relationships between different patterns of alcohol consumption and various on non-communicable disease (NCD) outcomes and estimates the overall impact of alcohol consumption on global mortality and burden of disease.

Addiction and dependence in DSM-V

Abstract: As preparations for the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) are under way, this paper focuses upon changes proposed for the substance use disorders section. It briefly outlines the history behind the current nomenclature, and the selection of the term 'dependence' over 'addiction' in earlier versions of the DSM. The term 'dependence', while used in past decades to refer to uncontrolled drug-seeking behavior, has an alternative meaning--the physiological adaptation that occurs when medications acting on the central nervous system are ingested with rebound when the medication is abruptly discontinued. These dual meanings have led to confusion and may have propagated current clinical practices related to under-treatment of pain, as physicians fear creating an 'addiction' by prescribing opioids. In part to address this problem, a change proposed for DSM-V is to alter the chapter name to 'Addiction and Related Disorders', which will include disordered gambling. The specific substance use disorders may be referred to as 'alcohol use' or 'opioid use' disorders. The criteria for the disorders are likely to remain similar, with the exception of removal of the 'committing illegal acts' criterion and addition of a 'craving' criterion. The other major change relates to the elimination of the abuse/dependence dichotomy, given the lack of data supporting an intermediate stage. These changes are anticipated to improve clarification and diagnosis and treatment of substance use and related disorders.

Surveying the range and magnitude of alcohol's harm to others in Australia.

Abstract: Aims This study aims to document the adverse effects of drinkers in Australia on people other than the drinker. Design Cross-sectional survey. Setting In a national survey of Australia, responde ...

Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review.

Abstract: Aim To determine the effects of computer-based interventions aimed at reducing alcohol consumption in adult populations. Methods The review was undertaken following standard Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for systematic reviews. The literature was searched until December 2008, with no restrictions on language. Randomized trials with parallel comparator groups were identified in the form of published and unpublished data. Two authors independently screened abstracts and papers for inclusion. Data extraction and bias assessment was undertaken by one author and checked by a second author. Studies that measured total alcohol consumption and frequency of binge drinking episodes were eligible for inclusion in meta-analyses. A random-effects model was used to pool mean differences. Results Twenty-four studies were included in the review (19 combined in meta-analyses). The meta-analyses suggested that computer-based interventions were more effective than minimally active comparator groups (e.g. assessment-only) at reducing alcohol consumed per week in student and non-student populations. However, most studies used the mean to summarize skewed data, which could be misleading in small samples. A sensitivity analysis of those studies that used suitable measures of central tendency found that there was no difference between intervention and minimally active comparator groups in alcohol consumed per week by students. Few studies investigated non-student populations or compared interventions with active comparator groups. Conclusion Computer-based interventions may reduce alcohol consumption compared with assessment-only; the conclusion remains tentative because of methodological weaknesses in the studies. Future research should consider that the distribution of alcohol consumption data is likely to be skewed and that appropriate measures of central tendency are reported. Language: en

Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerström Test for Nicotine Dependence and its components.

Abstract: Aims Measuring the strength of urges to smoke during a normal smoking day among smokers in a culture where smoking is restricted could provide a good measure of the severity of cigarette dependence. An important criterion for a measure of cigarette dependence is how well it predicts failure of attempts to stop smoking. This study compared ratings of Strength of Urges to Smoke (SUTS) with the Fagerstrom Test of Nicotine Dependence (FTND) and its components, including the Heaviness of Smoking Index (HSI). Design A longitudinal study involving a household survey of a representative sample of adult smokers at baseline and 6-month follow-up by postal questionnaire. Setting England.Participants A total of 15 740 smokers aged 16 and over underwent the baseline interview; 2593 were followed-up 6 months later, of whom 513 reported having made a quit attempt following the baseline survey but at least 1 month prior to the follow-up.Measurements SUTS, FTND, HSI, cigarettes per day, time to first cigarette, age, social grade and gender were measured at baseline. Quit attempts since the baseline assessment and self-reported abstinence were measured at 6-month follow-up. Findings In logistic regressions, all dependence measures predicted success of subsequent quit attempts, but SUTS had the strongest association (beta for SUTS, FTND and HSI: 0.41: P < 0.001, 0.13:P = 0.005, and 0.19:P = 0.003, respectively). In multiple logistic regressions when SUTS was entered as a predictor of abstinence, together with other dependence measures, it remained as the only predictive dependence measure. Conclusions A simple rating of strength of urges on a normal smoking day appears to be a good predictor of at least short-term quit success in English smokers and as such may be a useful measure of cigarette addiction.

Risky single‐occasion drinking: bingeing is not bingeing

Abstract: Aims To review the concept of binge drinking as a measure of risky single occasion drinking (RSOD), to illustrate its differential impact on selected health outcomes and to identify research gaps. Methods Narrative literature review with focus on conceptual and methodological differences, trajectories of RSOD and effects of RSOD on fetal outcomes, coronary heart disease (CHD) and injuries. Results Effects ascribed commonly to RSOD may often be the effects of an undifferentiated mixture of risky single occasions and regular heavy volume drinking, constituted by frequent, successive RSOD. This leads to the problem that additional risks due to RSOD are mis‐specified and remain unidentified or underestimated in some cases, such as for injuries or CHD, but are probably overstated for some chronic consequences or for effects of maternal drinking on newborns. Conclusion A stronger focus should be placed upon methods that can differentiate the effects of RSOD from those due to frequent occasions of heavy drinking that result in heavy volume drinking.

Dopamine release in ventral striatum during Iowa Gambling Task performance is associated with increased excitement levels in pathological gambling

Abstract: Aims Gambling excitement is believed to be associated with biological measures of pathological gambling. Here, we tested the hypothesis that dopamine release would be associated with increased excitement levels in Pathological Gamblers compared with Healthy Controls. Design Pathological Gamblers and Healthy Controls were experimentally compared in a non-gambling (baseline) and gambling condition. Measurements We used Positron Emission Tomography (PET) with the tracer raclopride to measure dopamine D 2/3 receptor availability in the ventral striatum during a non-gambling and gambling condition of the Iowa Gambling Task (IGT). After each condition participants rated their excitement level. Setting Laboratory experiment. Participants 18 Pathological Gamblers and 16 Healthy Controls. Findings Pathological Gamblers with dopamine release in the ventral striatum had significantly higher excitement levels than Healthy Controls despite lower IGT performance. No differences in excitement levels and IGT performance were found between Pathological Gamblers and Healthy Controls without dopamine release. Pathological Gamblers showed a significant correlation between dopamine release and excitement level, while no such interaction was found in Healthy Controls. Conclusions In pathological gamblers dopamine release in the ventral striatum appears to be associated with increased excitement levels despite lower IGT performance. The results might suggest a ‘double deficit’ function of dopamine in pathological gambling, where dopamine release reinforces maladaptive gambling through increasing excitement levels, reducing inhibition of risky decisions, or a combination of both. These findings may have implications for the understanding of dopamine in pathological gambling and other forms of addiction.

Reaching out towards cannabis: approach-bias in heavy cannabis users predicts changes in cannabis use

Abstract: Aims Repeated drug exposure can lead to an approach-bias, i.e. the relatively automatically triggered tendencies to approachratherthatavoiddrug-relatedstimuli.Ourmainaimwastostudythisapproach-biasinheavycannabisusers with the newly developed cannabis Approach Avoidance Task (cannabis-AAT) and to investigate the predictive relationship between an approach-bias for cannabis-related materials and levels of cannabis use, craving, and the course of cannabis use. Design, settings and participants Cross-sectional assessment and six-month follow-up in 32 heavy cannabis users and 39 non-using controls. Measurements Approach and avoidance action-tendencies towards cannabis and neutral images were assessed with the cannabis AAT. During the AAT, participants pulled or pushed a joystick in response to image orientation. To generate additional sense of approach or avoidance, pulling the joystick increased picture size while pushing decreased it. Craving was measured pre- and post-test with the multi-factorial Marijuana Craving Questionnaire (MCQ). Cannabis use frequencies and levels of dependence were measured at baseline and after a six-month follow-up. Findings Heavy cannabis users demonstrated an approach-bias for cannabis images, as compared to controls. The approach-bias predicted changes in cannabis use at six-month follow-up. The pre-test MCQ emotionality and expectancy factor were associated negatively with the approach-bias. No effects were foundonlevelsof cannabisdependence.Conclusions Heavycannabisuserswithastrongapproach-biasforcannabis aremorelikelytoincreasetheircannabisuse.Thisapproach-biascouldbeusedasapredictorof thecourseof cannabis use to identify individuals at risk from increasing cannabis use.

The inter-university consortium for political and social research.

Abstract: The Inter-university Consortium for Political and Social Research, one of the oldest and largest archives of digital social science data in the world, would like to make researchers aware of the upcoming new availability of important data in the fields of HIV/AIDS and alcohol and drug addiction. Under five subcontracts approved this spring, ICPSR will provide access to data from the following research projects through its National Addiction & HIV Data Archive Program (NAHDAP), via funding from the National Institute on Drug Abuse: the Center for Education and Drug Abuse Research (CEDAR) at the University of Pittsburgh the Oregon Youth Substance Use (OYSUP) project at the Oregon Research Institute the Older Drug User Study at Kennesaw State University in Georgia the Enhanced Linkage of Drug Abusers to Primary Medical Care project at Boston Medical Center the archiving of two Chicago NIDA-funded epidemiological surveys at the University of Wisconsin-Milwaukee. Each one-year subcontract involves the participating studies receiving funds to process and prepare their data for public distribution. At the end of the contracts, the data will be publicly available through the NAHDAP Web site. All of the studies were funded by the National Institutes on Drug Abuse, and will become part of the NAHDAP archive when completed. The data in these studies potentially contain hugely important insights into the dynamics of addiction and HIV. By making them available to the wider research community for secondary analysis, we hope to facilitate significant advancements in these fields. NAHDAP’s innovative subcontracting system advances the goal of promoting the wide dissemination of research data on drug and alcohol abuse by providing financial incentives as well as training in data processing to the participating studies. Typically, data would be processed by NAHDAP staff—under these contracts, staff from the participating research centers will be trained in data processing so that data from subsequent research projects can be more easily deposited with ICPSR and disseminated to the public. The hope is that these contracts will help build a sustainable infrastructure of data dissemination, while at the same time making important data available to the research community. NAHDAP is part of the Inter-university Consortium of Political and Social Rearch. Established in 1962, ICPSR is one of the oldest and largest archives of digital social science data. Providing a unique combination of data holdings, user support, and training in quantitative methods, ICPSR is a vital resource for fostering inquiry and furthering the social sciences. ICPSR, a membership-based organization with nearly 700 members, is a unit of the Institute for Social Research at the University of Michigan. More information on NAHDAP is available at www.icpsr.umich.edu/NAHDAP.

Anxiety diagnoses in smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome and response to treatment.

Abstract: Aims To understand the relations among anxiety disorders and tobacco dependence, withdrawal symptoms, response to smoking cessation pharmacotherapy and ability to quit smoking. Design Randomized placebo-controlled clinical trial. Participants received six 10-minute individual counseling sessions and either: placebo, bupropion SR, nicotine patch, nicotine lozenge, bupropion SR + nicotine lozenge or nicotine patch + nicotine lozenge. Setting Two urban research sites. Participants Data were collected from 1504 daily smokers (>9 cigarettes per day) who were motivated to quit smoking and did not report current diagnoses of schizophrenia or psychosis or bupropion use. Measurements Participants completed baseline assessments, the Composite International Diagnostic Interview and ecological momentary assessments for 2 weeks. Findings A structured clinical interview identified participants who ever met criteria for a panic attack (n = 455), social anxiety (n = 199) or generalized anxiety disorder (n = 99), and those who qualified for no anxiety diagnosis (n = 891). Smokers with anxiety disorders reported higher levels of nicotine dependence and pre-quit withdrawal symptoms. Those ever meeting criteria for panic attacks or social anxiety disorder showed greater quit-day negative affect. Smokers ever meeting criteria for anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit and showed no benefit from single-agent or combination-agent pharmacotherapies. Conclusions Anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke, elevated withdrawal, lack of response to pharmacotherapy and impaired ability to quit smoking. These findings could guide treatment assignment algorithms and treatment development for smokers with anxiety diagnoses.

A longitudinal analysis of alcohol outlet density and domestic violence.

Abstract: Aims: A small number of studies have identified a positive relationship between alcohol outlet density and domestic violence. These studies have all been based on cross-sectional data and have been limited to assess ecological correlations between outlet density and domestic violence rates. This study provides the first longitudinal examination of this relationship. Design: The study uses data for 186 postcodes from within the metropolitan area of Melbourne, Australia for the years 1996 to 2005. Alcohol outlet density measures for three different types of outlets (hotel/pub, packaged liquor, on-premise) were derived from liquor licensing records and domestic violence rates were calculated from police recorded crime data, based on postcode of the victim. The relationships between these three types of alcohol outlet density and domestic violence were assessed over time using a fixed-effects model. Controls for the spatial autocorrelation of the data were included in the model. Findings: Alcohol outlet density was significantly associated with rates of domestic violence, over time. In particular, the density of hotel (pub) licences and the density of packaged liquor licences were positively related to domestic violence rates and the density of on-premise licences was negatively related to domestic violence. Conclusions: In Melbourne, changes in density of hotel (pub) licenses and packaged liquor licenses have been positively associated with changes in rates of domestic violence whereas the rates of on-site liquor licenses have been negatively associated with domestic violence. Language: en

Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Abstract: Aim To estimate the general and racial-ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances.

Staff regard towards working with substance users: a European multi-centre study

Abstract: Aims To compare regard for working with different patient groups (including substance users) among different professional groups in different health-care settings in eight European countries. Design A multi-centre, cross-sectional comparative study. Setting Primary care, general psychiatry and specialist addiciton services in Bulgaria, Greece, Italy, Poland, Scotland, Slovakia, Slovenia and Spain. Participants A multi-disciplinary convenience sample of 866 professionals (physicians, psychiatrists, psychologists, nurses and social workers) from 253 services. Measurements The Medical Condition Regard Scale measured regard for working with different patient groups. Multi-factor between-subjects analysis of variance determined the factors associated with regard for each condition by country and all countries. Findings Regard for working with alcohol (mean score alcohol: 45.35, 95% CI 44.76, 45.95) and drug users (mean score drugs: 43.67, 95% CI 42.98, 44.36) was consistently lower than for other patient groups (mean score diabetes: 50.19, 95% CI 49.71, 50.66; mean score depression: 51.34, 95% CI 50.89, 51.79) across all countries participating in the study, particularly among staff from primary care compared to general psychiatry or specialist addiction services (P < 0.001). After controlling for sex of staff, profession and duration of time working in profession, treatment entry point and country remained the only statistically significant variables associated with regard for working with alcohol and drug users. Conclusions Health professionals appear to ascribe lower status to working with substance users than helping other patient groups, particularly in primary care; the effect is larger in some countries than others.

Effects of restricting pub closing times on night-time assaults in an Australian city

Abstract: Aims In March 2008 the New South Wales judiciary restricted pub closing times to 3 a.m., and later 3.30 a.m., in the central business district (CBD) of Newcastle, Australia. We sought to determine whether the restriction reduced the incidence of assault. Design Non-equivalent control group design with before and after observations. Setting Newcastle, a city of 530 000 people. Participants People apprehended for assault in the CBD and nearby Hamilton, an area with a similar night-time economy but where no restriction was imposed. Measurements Police-recorded assaults in the CBD before and after the restriction were compared with those in Hamilton. Cases were assaults occurring from 10 p.m.‐6 a.m. from January 2001‐March 2008, with April 2008‐September 2009 as the postrestriction period. We also examined changes in assault incidence by time of night. Negative binomial regression with time, area, time ¥ area interaction terms and terms for secular trend and seasonal effects was used to analyse the data. Autocorrelation was examined using generalized estimating equations. Findings In the CBD, recorded assaults fell from 99.0 per quarter before the restriction to 67.7 per quarter afterward [incidence rate ratio (IRR): 0.66, 95% confidence interval (CI): 0.55‐0.80]. In the same periods in Hamilton, assault rates were 23.4 and 25.5 per quarter, respectively (IRR: 1.02, 95% CI: 0.79‐1.31). The relative reduction attributable to the intervention was 37% (IRR = 0.63, 95% CI: 0.47‐0.81) and approximately 33 assault incidents were prevented per quarter. Conclusion This study indicates that a restriction in pub closing times to 3/3.30 a.m. in Newcastle, NSW, produced a large relative reduction in assault incidence of 37% in comparison to a control locality.

Alcohol's harm to others: reduced wellbeing and health status for those with heavy drinkers in their lives

Abstract: Aims: The impact of alcohol on those other than the drinker is an under- researched area with important policy implications. This study is a first step in investigating relationships between exposure to heavy drinkers in respondent's lives with measures of health status and wellbeing. Design, setting and participants: A cross-sectional general population survey was carried out among 3068 New Zealand residents aged 12 to 80 years (response rate - 64%) using an in house Computer Assisted Telephone Interviewing system. Measurements: Respondents' estimates of health status (EQ5 - D) and subjective wellbeing (Personal Wellbeing Index) were measured along with self reports of heavy drinkers in their lives, demographic variables and own drinking. Findings: More than one in four of the sample had experienced someone they considered to be a heavy drinker in their environment in the past 12 months. An index of exposure to heavy drinkers, reflecting numbers of heavy drinkers and co-habitation, predicted lower health status and personal wellbeing while controlling for demographic variables and respondent's own drinking Conclusions: There is a relationship between exposure to heavy drinkers and reduced personal wellbeing and poorer health status in this cross-sectional general population sample. Exposure to heavy drinkers may have negative impacts for others. Language: en

Drugs and addiction: an introduction to epigenetics.

Abstract: Addiction is a debilitating psychiatric disorder, with a complex aetiology involving the interaction of inherited predispositions and environmental factors. Emerging evidence suggests that epigenetic alterations to the genome, including DNA methylation and histone modifications, are important mechanisms underlying addiction and the neurobiological response to addictive substances. In this review, we introduce the reader to epigenetic mechanisms and describe a potential role for dynamic epigenetic changes in mediating addictive behaviours via long-lasting changes in gene expression. We summarize recent findings from both molecular and behavioural experiments elucidating the role of epigenetic changes in mediating the addictive potential of various drugs of abuse, including cocaine, amphetamine and alcohol. The implications of these findings for molecular studies of addiction and the future development of novel therapeutic interventions are also discussed.

Epidemiology and alcohol policy in Europe

Abstract: Aims To describe three aspects of the epidemiology of alcohol‐attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation Design epidemiological and population health modeling Setting Europe Participants Based on country‐specific aggregate statistics Measurements Exposure: country‐specific adult per capita consumption triangulated with survey data; outcomes: mortality statistics Findings The absolute risk of dying from an alcohol‐attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10g alcohol per day, the first data point Over 2/3 of all alcohol‐attributable deaths occurring amongst the 20–64 year old population of the European Union (minus Cyprus and Malta) occur in the 45–64 year olds About 25% of the difference in life expectancy between western and eastern Europe for men aged 20–64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns Conclusions Any reduction in the dose of alcohol consumed, at least down to 10g/day, will reduce the annual and lifetime risk of an alcohol‐related death There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact Policy should strive to reduce alcohol‐related health inequalities, with the specific recommendations for policy depending on the cost‐effectiveness of interventions related to the epidemiological profile of the country or region under consideration Fortunately, there are evidence‐based policy options that reduce the amount of alcohol consumed and many alcohol‐related harms with immediate effect, that reduce the risk of an alcohol‐related death in middle age, and that would help to close the health gap between eastern and western Europe

The social norms of birth cohorts and adolescent marijuana use in the United States, 1976–2007

Abstract: Aims Studies of the relationship between social norms and marijuana use have generally focused on individual attitudes, leaving the influence of larger societal‐level attitudes unknown. The present study investigated societal‐level disapproval of marijuana use defined by birth cohort or by time‐period. Design Combined analysis of nationally representative annual surveys of secondary school students in the United States conducted from 1976 to 2007 as part of the Monitoring the Future study. Setting In‐school surveys completed by adolescents in the United States. Participants A total of 986 003 adolescents in grades 8, 10 and 12. Measurements Main predictors included the percentage of students who disapproved of marijuana in each birth cohort and time‐period. Multi‐level models with individuals clustered in time‐periods of observation and birth cohorts were modeled, with past‐year marijuana use as the outcome. Findings Results indicated a significant and strong effect of birth cohort disapproval of marijuana use in predicting individual risk of marijuana use, after controlling for individual‐level disapproval, perceived norms towards marijuana and other characteristics. Compared to birth cohorts in which most (87-90.9%) adolescents disapproved of marijuana use, odds of marijuana use were 3.53 times higher in cohorts where fewer than half (42-46.9%) disapproved (99% confidence interval: 2.75, 4.53). Conclusions Individuals in birth cohorts that are more disapproving of marijuana use are less likely to use, independent of their personal attitudes towards marijuana use. Social norms and attitudes regarding marijuana use cluster in birth cohorts, and this clustering has a direct effect on marijuana use even after controlling for individual attitudes and perceptions of norms.

Plain packaging increases visual attention to health warnings on cigarette packs in non-smokers and weekly smokers but not daily smokers.

Abstract: Aims To assess the impact of plain packaging on visual attention towards health warning information on cigarette packs Design Mixed-model experimental design, comprising smoking status as a between-subjects factor, and package type (branded versus plain) as a within-subjects factor Setting University laboratory Participants Convenience sample of young adults, comprising non-smokers (n = 15), weekly smokers (n = 14) and daily smokers (n = 14) Measurements Number of saccades (eye movements) towards health warnings on cigarette packs, to directly index visual attention Findings Analysis of variance indicated more eye movements (ie greater visual attention) towards health warnings compared to brand information on plain packs versus branded packs This effect was observed among non-smokers and weekly smokers, but not daily smokers Conclusion Among non-smokers and non-daily cigarette smokers, plain packaging appears to increase visual attention towards health warning information and away from brand information