Showing papers in "Drug and Alcohol Review in 2014"

Alcohol and substance use among transgender women in San Francisco: prevalence and association with human immunodeficiency virus infection.

Abstract: Introduction and Aims Alcohol and substance use can have negative health consequences among both human immunodeficiency virus (HIV)-positive and -negative individuals, and are associated with behaviors that facilitate HIV transmission and acquisition. The relationship of substance use and HIV is well documented among key populations at risk for HIV. However, although transwomen (male-to-female transgender) are disproportionately impacted by HIV, this overlap remains understudied in this population. We sought to evaluate the association between HIV, alcohol and substance use among transwomen. Design and Methods We conducted a secondary data analysis of Respondent Driven Sampling study which collected information on self-reported alcohol and substance use among 314 transwomen. We used multivariable logistic regression to assess relationship between HIV infection and classes and patterns of alcohol and substance use. Results We found that 58% of transwomen used alcohol, and 43.3% used substances. The most common substances used were: marijuana (29%), methamphetamine (20.1%), crack cocaine (13.4%), and ‘club drugs’ (13.1%). Transwomen who reported any methamphetamine use [adjusted odds ratio (AOR) 3.02 (95% confidence interval (CI) = 1.51–6.02)], methamphetamine use before or during anal intercourse [AOR 3.27 (95% CI = 1.58–6.77)], and at least weekly methamphetamine use [AOR 3.89 (95% CI = 1.64–9.23)] had significantly greater odds of testing positive for HIV. Discussion and Conclusions Transfemales have high prevalence of alcohol and substance use; those tested positive for HIV used significantly more methamphetamine in general, and in conjunction with sex. Given the disproportionate prevalence of HIV and substance use in this population, interventions aimed at addressing both substance use and HIV risk among transwomen are urgently needed. [Santos G-M, Rapues J, Wilson EC, Macias O, Packer T, Colfax G, Raymond HF. Alcohol and substance use among transgender women in San Francisco: Prevalence and association with human immunodeficiency virus infection. Drug Alcohol Rev 2014;33:287–295]

Restrictions in pub closing times and lockouts in Newcastle, Australia five years on

Abstract: INTRODUCTION AND AIMS.: In 2008 pub closing times were restricted from 5am to 3:30am in the central business district (CBD) of Newcastle, Australia. A previous study showed a one-third reduction in assaults in the 18 months following the restriction. We assessed whether the assault rate remained lower over the following 3.5 years and whether the introduction of a 'lockout' in nearby Hamilton was associated with a reduction in assaults there. DESIGN AND METHODS.: We used a pre-post design with comparison against two post-change periods. The setting was Greater Newcastle (population 530 000) and subjects were persons apprehended for assault in the CBD and nearby Hamilton, an area with late trading pubs where a lockout and other strategies were implemented in 2010. Cases were police-recorded assault apprehensions occurring from 10pm to 6am in one pre-change period: January 2001 to March 2008, and two post-change periods: (i) April 2008 to September 2009 and (ii) October 2009 to March 2013. Negative binomial regression with terms for secular trend and seasonal effects was used to estimate Post1: Pre and Post2: Pre Incidence Rate Ratios and confidence intervals. RESULTS.: In the CBD recorded assaults fell from 99/quarter before the restriction to 68/quarter in the first post-change period [incidence rate ratio (IRR) 0.67, 95% confidence interval (CI) 0.55-0.82] and 71/quarter (IRR: 0.68, 95% CI: 0.55-0.85) in the later post-change period. In the same periods in Hamilton, assault rates were 23, 24, and 22 per quarter respectively. DISCUSSION AND CONCLUSIONS.: The restriction in closing time was associated with a sustained lower assault rate in the Newcastle CBD. We find no evidence that lockouts and other outlet management strategies were effective in Hamilton. [Kypri K, McElduff P, Miller P. Restrictions in pub closing times and lockouts in Newcastle Australia 5 years on. Drug Alcohol Rev 2014]. Language: en

Using Facebook to deliver a social norm intervention to reduce problem drinking at university

Abstract: INTRODUCTION AND AIMS: University students usually overestimate peer alcohol use, resulting in them 'drinking up' to perceived norms. Social norms theory suggests correcting these inflated perceptions can reduce alcohol consumption. Recent findings by the current authors show portraying oneself as 'a drinker' is considered by many students to be a socially desirable component of their Facebook identity, perpetuating an online culture that normalises binge drinking. However, social networking sites have yet to be utilised in social norms interventions. DESIGN AND METHODS: Actual and perceived descriptive and injunctive drinking norms were collected from 244 university students. Ninety-five students screened positive for hazardous drinking and were randomly allocated to a control group or intervention group that received social norms feedback via personalised Facebook private messages over three sessions. RESULTS: At 1 month post-intervention, the quantity and frequency of alcohol consumed by intervention group during the previous month had significantly reduced compared with baseline and controls. Reductions were maintained 3 months post-intervention. Intervention group perceived drinking norms were significantly more accurate post-intervention. DISCUSSION AND CONCLUSIONS: This is the first study to test the feasibility of using Facebook to deliver social norms interventions. Correcting misperceptions of peer drinking norms resulted in clinically significant reductions in alcohol use. Facebook has many advantages over traditional social norms delivery, providing an innovative method for tackling problem drinking at university. These results have implications for the use of Facebook to deliver positive messages about safe alcohol use to students, which may counter the negative messages regarding alcohol normally seen on Facebook. [Ridout B, Campbell A. Using Facebook to deliver a social norm intervention to reduce problem drinking at university. Drug Alcohol Rev 2014]. Language: en

Associations between alcohol, smoking, socioeconomic status and comorbidities: evidence from the 45 and Up Study.

Abstract: INTRODUCTION AND AIMS.: Understanding how tobacco, alcohol and mental health are related is important for developing population-level policies and individual-level treatments that target comorbidities. The current study aimed to examine sociodemographic characteristics and mental health comorbidities associated with the odds of using tobacco and harmful levels of alcohol concurrently. DESIGN AND METHODS.: Data were drawn from the 45 and Up Study, a large cohort study with 267 153 adults aged 45 years and over in New South Wales, Australia. Participants completed a survey assessing alcohol, smoking, psychological distress, treatment for depression and anxiety, and a range of socioeconomic status indicators. Univariate analyses and three multiple-logistic regression models were used to determine associations with (i) tobacco but not alcohol use; (ii) alcohol but not tobacco use; and (iii) concurrent tobacco and risky levels of alcohol use. RESULTS.: Being female, younger, lower individual and area-level socioeconomic status (SES) and depression and psychological distress were associated with tobacco use alone. Factors associated with alcohol use alone were older age, male gender, higher SES, and lower psychological distress and no recent depression treatment. Factors associated with concurrent risky alcohol consumption and tobacco use included being 45-64, being male, less education, earning Language: en

The impact of spatial and temporal availability of alcohol on its consumption and related harms: A critical review in the context of UK licensing policies

Abstract: ISSUES: Reviews recommend controlling alcohol availability to limit alcohol-related harm. However, the translation of this evidence into policy processes has proved challenging in some jurisdictions. APPROACH: This paper presents a critical review of empirical spatial and temporal availability research to identify its features and limitations for informing alcohol availability policies. The UK is used as an example jurisdiction. It reviews 138 studies from a 2008 systematic review of empirical availability research and our update of this to January 2014. Data describing study characteristics (settings, measures, design) were extracted and descriptively analysed. KEY FINDINGS: Important limitations in current evidence were identified: (i) outlet-level temporal availability was only measured in three studies, and there has been little innovation in measurement of spatial availability; (ii) empirical analyses focus on acute harms with few studies of longer-term harms; (iii) outlets are typically classified at aggregated levels with little empirical analysis of variation within outlet categories; (iv) evidence comes from a narrow range of countries; and (v) availability away from home, online availability and interactions between availability, price and place are all relatively unexamined. IMPLICATIONS: Greater innovation in study and measure design and enhanced data quality are required. Greater engagement between researchers and policy actors when developing studies would facilitate this. CONCLUSIONS: Research and data innovations are needed to address a series of methodological gaps and limitations in the alcohol availability evidence base, advance this research area and enable findings to be translated effectively into policy processes.

Correlations between prescription opioid analgesic dispensing levels and related mortality and morbidity in Ontario, Canada, 2005–2011

Abstract: Introduction and Aims Prescription opioid analgesic (POA)-related harms constitute a major public health problem in North America. Ontario features above-average POA use levels in Canada and has seen consistent increases in related mortality and morbidity. Recent studies documented strong correlations between POA dispensing levels and related harm outcomes on population levels. We examined correlations between POA dispensing and key POA-related mortality and morbidity indicators in Ontario, 2005–2011. Design and Methods Correlations between (i) annual dispensing levels of four strong POA formulations (fentanyl, hydromorphone, morphine and oxycodone; from IMS Brogan's Compuscript converted to defined daily doses) and POA-related mortality (based on provincial coroner's data) and (ii) annual total POA dispensing and POA-related treatment caseload (from the Drug and Alcohol Treatment Information System) were examined for the study context. Results Strong and significant correlations were observed between POA dispensing and mortality for three formulations, namely hydromorphone: 0.98 [95% confidence interval (CI) 0.89–1.00; P < 0.001], fentanyl: 0.93 (95% CI 0.58–0.99; P = 0.003) and oxycodone: 0.93 (95% CI 0.57–0.99; P = 0.003), but not morphine (−0.29; 95% CI−0.86–0.59; P = 0.523), as well as for treatment when examining congruent years [0.99 (95% CI 0.92–1.00); P < 0.001] and when using a 1-year offset (1.00; 95% CI 0.96–1.00; P < 0.001). Discussion and Conclusions POA dispensing levels were found to be strongly correlated with mortality and morbidity (treatment) indicators. Targeted and sensible reductions of POA use level would likely constitute a primary measure to reduce POA-related harms on a population level, especially in a jurisdiction with high POA consumption levels. [Fischer B, Jones W, Urbanoski K, Skinner R, Rehm J. Correlations between prescription opioid analgesic dispensing levels and related mortality and morbidity in Ontario, Canada, 2005–2011. Drug Alcohol Rev 2014;33:19–26]

A systematic review of computerised serious educational games about alcohol and other drugs for adolescents.

Abstract: Issues.Serious educational games (SEG) have been shown to be effective in educating young people about a range of topics, including languages and maths.This paper identifies the use of computerised SEGs in education about alcohol and other drugs and reviews their impact on the prevention of alcohol and drug use. Approach. The Cochrane Library, EMBASE, MEDLINE, ERIC, Scopus, psychINFO, pubMED and DRUG databases were searched in February 2013. Additional publications were obtained from the reference lists of the relevant papers. Studies were included if they described an evaluation of a computerised SEG that targeted alcohol and/or other drugs and had been trialled with adolescents. Key Findings.Eight SEGs were identified targeting tobacco, alcohol, cannabis, methamphetamine, ecstasy, inhalants, cocaine and opioids. Six reported positive outcomes in terms of increased content knowledge and two reported increased negative attitudes towards the targeted drugs. Only one reported a decrease in the frequency of drug use. Implications and Conclusion.This is the first review of the efficacy of computerised SEGs for alcohol and other drugs for adolescents.Results suggest that SEGs can increase content knowledge of alcohol and other drugs. Evidence concerning impacts on negative attitudes and alcohol and drug use is limited, with few studies examining these outcomes. [Rodriguez DM, Teesson M, Newton NC. A systematic review of computerised serious educational games about alcohol and other drugs for adolescents. Drug Alcohol Rev 2013]

The Global Burden of Disease projects: what have we learned about illicit drug use and dependence and their contribution to the global burden of disease?

Abstract: IntroductionThe Global Burden of Disease (GBD) 2010 study updated the findings of earlier exercises It provided regional and global estimates of the burden of disease attributable to diseases, injuries and risk factors Here we provide a brief summary of the work for illicit drug use

Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings

Abstract: Introduction and Aims The measurement of clinical outcomes is an important, but lacking, component of drug and alcohol treatment in Australia. This study aimed to psychometrically validate the Treatment Outcomes Profile under Australian conditions, examining implementation and feasibility issues in three public opioid treatment program clinics in NSW. Design and Methods The Treatment Outcomes Profile was modified to reflect Australian conditions and re-named the Australian Treatment Outcomes Profile (ATOP). The ATOP was introduced into the participating clinics and administered by clinic staff at 3-month intervals as part of routine clinical practice. Participants completed a research interview, consisting of the ATOP and a suite of ‘gold standard’ instruments assessing substance use and related health and welfare domains, in the 72 h following completion of a routine clinical ATOP. The researcher- and clinician-administered ATOPs were compared to assess interrater reliability, and the researcher-administered ATOP and ‘gold standard’ instruments were compared to assess concurrent validity. Implementation and feasibility issues were assessed using questionnaires and focus groups with clinician and clients. Results The ATOP demonstrated acceptable concurrent validity and interrater reliability. It was well received by clients and clinicians, particularly for its ease of use, applicability and brevity. Conclusions The ATOP is a psychometrically valid instrument for the measurement of treatment outcomes in Australian opioid treatment populations and can feasibly be implemented as part of routine clinical practice in specialist opioid treatment program clinics. The role of the ATOP to measure outcomes in other drug and alcohol treatment modalities requires exploration. [Ryan A, Holmes J, Hunt V, Dunlop A, Mammen K, Holland R, Sutton Y, Sindhusake D, Rivas G & Lintzeris N. Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings. Drug Alcohol Rev 2014;33:33–42]

An online daily diary study of alcohol use using Amazon's Mechanical Turk.

Abstract: Introduction and Aims. In recent years, unprecedented levels of Internet access and the widespread growth of emergent communication technologies have resulted in significantly greater population access for substance use researchers. Despite the research potential of such technologies,the use of the Internet to recruit individuals for participation in event-level research has been limited.The purpose of this paper is to provide a brief account of the methods and results from an online daily diary study of alcohol use. Design and Methods. Participants were recruited using Amazon’s Mechanical Turk. Eligible participants completed a brief screener assessing demographics and health behaviours,with a subset of individuals subsequently recruited to participate i na2w eekdaily diary study of alcohol use. Results.Multilevel models of the daily alcohol data derived from the Mechanical Turk sample (n = 369) replicated several findings commonly reported in daily diary studies of alcohol use. Discussion and Conclusions. Results demonstrate that online participant recruitment and survey administration can be a fruitful method for conducting daily diary alcohol research. [Boynton MH, Richman LS. An online daily diary study of alcohol use using Amazon’s Mechanical Turk. Drug Alcohol Rev 2014]

Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities.

Abstract: INTRODUCTION AND AIMS: Regulatory and collaborative intervention strategies have been developed to reduce the harms associated with alcohol consumption on licensed venues around the world, but there remains little research evidence regarding their comparative effectiveness. This paper describes concurrent changes in the number of night-time injury-related hospital emergency department presentations in two cities that implemented either a collaborative voluntary approach to reducing harms associated with licensed premises (Geelong) or a regulatory approach (Newcastle). DESIGN AND METHODS: This paper reports findings from Dealing with Alcohol-Related problems in the Night-Time Economy project. Data were drawn from injury-specific International Classification of Disease, 10th Revision codes for injuries (S and T codes) presenting during high-alcohol risk times (midnight-5.59 am, Saturday and Sunday mornings) at the emergency departments in Geelong Hospital and Newcastle (John Hunter Hospital and the Calvary Mater Hospital), before and after the introduction of licensing conditions between the years of 2005 and 2011. Time-series, seasonal autoregressive integrated moving average analyses were conducted on the data obtained from patients' medical records. RESULTS: Significant reductions in injury-related presentations during high-alcohol risk times were found for Newcastle since the imposition of regulatory licensing conditions (344 attendances per year, P Language: en

A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence.

Abstract: Introduction and AimsNaltrexone implants are used to treat opioid dependence, but their safety and efficacy remain poorly understood. We systematically reviewed the literature to assess the safety and efficacy of naltrexone implants for treating opioid dependence.

Recovery-oriented policy and care systems in the UK and USA.

Abstract: The concept of recovery has been an influence on addicted individuals for many decades.But only in the past 15 years has the concept had a purchase in the world of public policy.In the USA,federal and state officials have promulgated policies intended to foster ‘recovery-oriented systems of care’ and have ratified recovery-supportive laws and regulations.Though of more recent vintage and therefore less developed, recovery policy initiatives are also being implemented in the UK. The present paper describes recovery-oriented policy in both countries and highlights key evaluations of the recovery-oriented interventions. [Humphreys K, Lembke A. Recovery-oriented policy and care systems in the UK and USA. Drug Alcohol Rev 2013]

Factors associated with the timing and onset of cannabis use and cannabis use disorder: Results from the 2007 Australian National Survey of Mental Health and Well-Being

Abstract: P. B. is supported by an Australian Research Council Future Fellowship. L. D. is supported by a National Health and Medical Research Council Principal Research Fellowship.

Second-hand drinking may increase support for alcohol policies: New results from the 2010 National Alcohol Survey

Abstract: INTRODUCTION AND AIMS: The harms of second-hand smoke motivated tobacco control legislation. Documenting the effects of harms from others' drinking might increase popular and political will for enacting alcohol policies. We investigated the individual-level relationship between having experienced such harms and favouring alcohol policy measures, adjusting for other influences. DESIGN AND METHODS: We used the landline sample (n = 6957) of the 2010 National Alcohol Survey, a computer-assisted telephone interview survey based on a random household sample in the USA. Multivariable regression models adjusted for personal characteristics, including drinking pattern (volume and heavy drinking), were used to investigate the ability of six harms from others' drinking to predict a three-item measure of favour for stronger alcohol policies. RESULTS: Adjusting for demographics and drinking pattern, number of harms from others' drinking predicted support for alcohol policies (P DISCUSSION: Although cross-sectional data cannot prove a causal influence or directionality, the association found is consistent with the hypothesis that experiencing harms from others' drinking (experienced by a majority) makes one more likely to favour alcohol policies. Other things equal, women, racial/ethnic minorities, lower-income individuals and lighter drinkers tend to be more supportive of alcohol controls and policies. CONCLUSIONS: Studies that estimate the impact of harms from other drinkers on those victimised are important and now beginning. Next we need to learn how such information could affect decision makers and legislators. Language: en

Young women's risk of sexual aggression in bars: The roles of intoxication and peer social status

Abstract: INTRODUCTION AND AIMS: Previous research suggests a link between women's drinking and sexual victimisation; however, little is known about other factors that influence risk and how risks are linked to drinking-in-the-event. We examined how amount of alcohol consumed and peer group factors were associated with whether young women were targeted for sexual aggression on a night out at a bar. DESIGN AND METHODS: One hundred and fourteen women recruited in small groups in the bar district reported how many drinks they had consumed and were breath-tested at recruitment and on their way home. At recruitment, they also ranked other members of their group in terms of status (e.g. popularity, group influence). In the exit survey, they reported any sexual aggression they experienced that night (i.e. persistence after refusal and unwanted sexual touching). RESULTS: Over a quarter (28.9%) of women reported persistence only, 5.3% unwanted touching only and 18.7% both. Sexual aggression was associated with consuming more alcohol on the survey night and whether other group members experienced sexual aggression that night. The relationship with amount consumed was stronger for touching than for persistence. Having a lower status position in the group was associated with increased risk of sexual aggression among women who had consumed five or more drinks. DISCUSSION AND CONCLUSIONS: Prevention should address social norms and other factors that encourage men to target specific women for sexual aggression, including perceptions by staff and patrons that intoxicated women are 'easy' or more blameworthy targets and the possible role of women's social status in their peer groups. Language: en

Solving the problem of non‐attendance in substance abuse services

Abstract: Issues Rates of non-attendance are among the highest in substance misuse services. Non-attendance is costly and results in the inefficient use of limited resources. Patients who frequently miss their appointments have worse outcomes including treatment dropout and decreased likelihood of achieving long-term abstinence. Approach This narrative review evaluates interventions targeting non-attendance in addiction services and draws upon the wider health-care literature to identify interventions that could be adapted for substance-abusing populations. Key Findings Both fixed value and intermittent reinforcement contingency management demonstrate potential for improving attendance. However, small sample sizes and heterogeneous populations make it difficult to draw firm conclusions. Appointment reminders by letter or telephone have demonstrated moderate evidence for improving attendance in substance-abusing populations. Text message appointment reminders are extensively utilised in general health-care settings and consistently improve attendance; however, there is a paucity of research examining the feasibility and effectiveness of text message reminders in addiction services. Implications A lack of evidence for methods to improve attendance is reflected in the continuing challenge faced by addiction services attempting to manage high rates of non-attendance. Conclusions Non-attendance remains a persistent issue for addiction services. While there is limited evidence that contingency management improves attendance, more rigorous research is needed to determine the optimal intervention components and effectiveness in different populations, particularly those receiving maintenance treatments. Multicomponent text message interventions incorporating different delivery and content strategies demonstrate a promise for improving non-attendance and poor engagement. [Milward J, Lynskey M, Strang J. Solving the problem of non-attendance in substance abuse services. Drug Alcohol Rev 2014;33:625–36]

Opioid‐related mortality and filled prescriptions for buprenorphine and methadone

Abstract: Introduction and aims To assess opioid-related mortality and correlation with filled prescriptions for buprenorphine and methadone. Design and methods A register study, including data from the Swedish Forensic Pathology and Forensic Toxicology databases 2003-2010, the Prescribed Drug Register and the National Patient Register. Results A total of 1301 deaths, assessed as related to buprenorphine, methadone or heroin, or a combination of them, were studied. The largest number of fatalities was related to intake of heroin (n = 776), followed by methadone (n = 342) and buprenorphine (n = 168). The total annual number of fatal cases related to the studied drugs more than doubled (116 to 255) during the study period. There were increases in mortality related to both buprenorphine and methadone: from 1 to 49 cases for buprenorphine, and from 19 to 81 cases for methadone. Only one-fifth of the fatal cases had a filled prescription for the maintenance drug assessed as the cause of death. Discussion and conclusion This study showed that most fatalities were not related to filled prescriptions of maintenance drugs, and a substantial illicit use of buprenorphine and methadone resulting in deaths was revealed. To prevent opioid toxicity deaths it is important to make efforts not only to reduce drug diversion from maintenance programs, but also to improve the control of drug trafficking and other illegal sources.

Steroid users and the unique challenge they pose to needle and syringe program workers.

Abstract: Introduction and Aims Needle and syringe programs (NSP), which provide sterile injecting equipment, are a cornerstone of Australia's drug harm reduction strategy and assist in reducing the spread of blood-borne virus infections, such as HIV and hepatitis C, among people who inject drugs. Some reports suggest that steroid users are an increasing proportion of clientele at NSPs. In this research, we investigate the experience of NSP workers who come into contact with people who use steroids and other performance- and image-enhancing drugs (PIED). Design and Method Thirteen NSP workers were recruited using purposive sampling strategies. Participants were interviewed using a semi-structured interview guide. Interviews were recorded, transcribed and coded for themes. Results There are three key findings of this study. Firstly, NSP workers do not feel well informed about the substances that PIED users are injecting. Secondly, they were unsure what equipment PIED users required. Thirdly, PIED users were perceived to differ from other client groups, and these differences impacted upon the level of rapport staff could build with this group. Discussion and Conclusion PIED users pose unique challenges for NSP workers compared with other NSP client groups. The PIEDs used and the way in which they are used are substantially different compared with other NSP clients, and there appears to be a lack of knowledge within the workforce about these substances. This study highlights the need to engage in workforce training, but also the need to more effectively engage with PIED users in relation to effective harm reduction strategies. [Dunn M, McKay FH, Iversen J. Steroid users and the unique challenge they pose to needle and syringe program workers. Drug Alcohol Rev 2014;33:71–77]

Alcohol, masculinity, honour and male barroom aggression in an Australian sample

Abstract: INTRODUCTION AND AIMS: The link between alcohol and men's aggression is well established, although growing evidence also points to individual and learned social factors. The aim of the present study was to investigate the relationships between male alcohol-related aggression (MARA) among young Australian men and heavy episodic drinking, trait aggression, masculinity, concerns about social honour and expected positive consequences of MARA. DESIGN AND METHODS: The total sample comprised 170 men aged 18-25 years who completed an online questionnaire exploring beliefs and attitudes towards MARA. RESULTS: Those who reported heavy episodic drinking were more likely to be involved in an incident of MARA. In addition, those who were involved in MARA had higher levels of trait aggression, concern for social honour and expected positive consequences of aggression in bars than did those without such involvement. The relationship between socially constructed masculinity factors (a combined variable reflecting masculinity, social honour and expected positive consequences) and MARA was mediated by heavy episodic drinking. Social honour accounted for almost all of the predictive power of masculinity factors. Heavy episodic drinking and trait aggression remained significant predictors of MARA in a multivariate model. DISCUSSION AND CONCLUSIONS: The findings from the current study may assist in developing preventative techniques for young men which target masculinity concerns and the consequences of participating in MARA. [Miller P, Wells S. Alcohol, masculinity, honour and male barroom aggression in an Australian sample. Drug Alcohol Rev 2014]. Language: en

The big night out: what happens on the most recent heavy drinking occasion among young Victorian risky drinkers?

Abstract: Introduction and Aims. In spite of the major focus on risky, single-occasion drinking by young people in Australia, littleis known about the specific circumstances of risky drinking occasions.This ...

Opioid overdose and the power of old myths: what we thought we knew, what we do know and why it matters.

Abstract: The past few decades have seen an explosion of research on opioid overdose, work that has dramatically recast our understanding of this phenomenon. Indeed, it is not stretching truth too far to opine that almost everything that we firmly believed to be the case regarding overdose was subsequently shown to be incorrect. As with many cherished beliefs, it was only in the harsh light of research that this was shown to be the case. Why should so much effort have been put into this field? Firstly, there is the sheer extent of mortality associated with the opioids. Of all commonly used drugs, opioids have by far the highest mortality risk [1–6]. Indeed, by the age of 50, approximately half of any cohort of opioid users will have died, overdose being the most common cause [3–5,7,8]. The harms associated with overdose, however, extend far beyond mortality: for every fatal overdose, we estimate that there are 25–50 ‘near misses’ [9–15]. Apart from the immediate harm deriving from near misses (e.g. anoxic brain damage, injury through fall), a history of non-fatal overdose is a significant predictor of subsequent overdose and, more particularly, of a subsequent fatal overdose [4,12]. Despite the extensive body of work that has accrued, old myths have proven remarkably powerful, particularly in the media. In this piece, I will examine what was believed to be the case, what turned out to be true and how this has informed our ideas on overdose prevention. The literature on opioid overdose is now extensive and covers the circumstances, toxicology and organ pathology of fatal case series, laboratory studies of the physical effects of drug interactions, longitudinal cohort studies and cross-sectional structured interviews with opioid users on non-fatal overdose histories. In reviewing this literature, I will address four of what I regard as the most prominent myths that have bedevilled the field. Broadly speaking, these relate to misapprehensions as to who is dying and why they are dying: Myth 1. It is the young, inexperienced user who overdoses; Myth 2. It is variation in the purity of illicit opioids that is the major cause of overdose; Myth 3. It is the opioid that is crucial in overdose, not other drugs; and Myth 4. Impurities in illicit opioids are the major cause of overdose. Myth 1: it is the young, inexperienced user who overdoses

Situational and mood factors associated with smoking in young adult light and heavy smokers.

Abstract: Introduction and Aims Antecedents of smoking have been widely researched in studies with older adults. However, less is known about the smoking patterns and antecedents of smoking in young adult smokers. Design and Methods In this study, we used ecological momentary assessment collected with an Internet-based survey instrument and used the participants' own mobile phones to contrast the smoking patterns of young adult light and intermittent smokers (n = 23) with heavy smokers (n = 18). Overall, 1543 smoking and non-smoking situations were analysed. By means of generalised estimating equations, we used a range of situational characteristics to predict smoking in both groups. Results Craving and smoking of others increased the odds of smoking, and smoking bans were associated with a decreased probability of smoking among both light and intermittent smokers and heavy smokers. Situational antecedents differed between both groups. Cue-associated smoking played a bigger role for light and intermittent smokers than for heavy smokers. Situational antecedents, such as craving, being at the home of others, drinking alcohol and smoking by others, were more strongly associated with the smoking of light and intermittent smokers compared with heavy smokers. Discussion and Conclusions Smoking among young adults is associated with both internal and external situational characteristics. Compared with heavy smokers, light and intermittent smoking seems to be under more stimulus control and more characterised by social smoking. These results are consistent with several findings from previous studies and provide further information on different subgroups of smokers in early adulthood. [Thrul J, Buhler A, Ferguson SG. Situational and mood factors associated with smoking in young adult light and heavy smokers. Drug Alcohol Rev 2014;33:420–427]

A comparative study of blood alcohol concentrations in Australian night-time entertainment districts

Abstract: Introduction and Aims There is little research describing how intoxication levels change throughout the night in entertainment districts. This research aims to describe levels of alcohol intoxication across multiple Australian metropolitan and regional nightlife districts. Design and Methods This study was conducted in the night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia. Data collection occurred approximately fortnightly in each city on a Friday or Saturday night between 8 pm and 5 am. Brief structured interviews (3–10 min) and breathalyser tests were undertaken in busy thoroughfares over six months. Results Of the 7037 individuals approached to participate in the study, 6998 [61.8% male, mean age 24.89 years (standard deviation 6.37; range 18–73)] agreed to be interviewed. There was a linear increase in blood alcohol concentration (BAC) levels throughout the night. Post hoc testing revealed significantly more highly intoxicated participants (i.e. BAC above 0.10 mg of alcohol per 100 mL of blood) after midnight (P < 0.05). The overall mean BAC was 0.06 mg/100 mL. Men were more intoxicated than women earlier in the night, but gender differences disappeared by 3 am. There was no age differences in intoxication earlier in the night, but after midnight, patrons over the age of 21 showed increasing BAC levels. Discussion and Conclusions There is a consistent trend across the cities of high to very high levels of intoxication later in the night, with trends after midnight being significantly different to those before. [Miller P, Pennay A, Droste N, Butler E, Jenkinson R, Hyder S, Quinn B, Chikritzhs T, Tomsen S, Wadds P, Jones SC, Palmer D, Barrie L, Lam T, Gilmore W, Lubman DI. A comparative study of blood alcohol concentrations in Australian night-time entertainment districts. Drug Alcohol Rev 2014;33:338–45]

Changes in Australian attitudes to alcohol policy: 1995-2010

Abstract: Introduction and AimsIn 2009 Wilkinson and colleagues reported a downward trend in support for alcohol policyrestrictions in Australia between 1995 and 2004. The aim of the current study is to exam ...

Environmental characteristics associated with alcohol intoxication among patrons in Brazilian nightclubs

Abstract: Introduction Few studies have investigated the association between environmental factors and patrons' binge drinking in nightclubs, and such studies are rare in developing countries. Objective To identify environmental factors associated with binge drinking among patrons in nightclubs in Sao Paulo, Brazil, using a mixed-methods design. Method The study used a two-stage cluster sampling survey design. Two levels of data were collected: observational data and portal survey data. Individual-level data were collected by a portal survey of 2422 subjects at the entrance and 1822 subjects at the exit of 31 nightclubs. Weighted multilevel analysis was used to investigate the association between patrons' binge drinking (as measured by breath alcohol concentration ≥0.38 mg L−1) at nightclub exit, with environmental-level variables collected through observation and controlled for individual-level data. Results Pre-drinking was the variable most strongly associated with binge drinking BrAC levels when exiting the venue [adjusted odds ratio (aOR) = 5.98, 95% confidence interval (CI) [4.37, 8.17], P < 0.001). The environmental variables significantly associated with binge drinking were ‘all you can drink’ service (aOR = 2.44, 95% CI [1.03, 0.79]; P = 0.043), two or more dance floors (aOR = 1.92, 95% CI [1.16, 3.18]; P = 0.011), and higher sound levels (aOR = 1.04 per each decibel increased, 95% CI [1.01, 1.08]; P = 0.048). Data triangulation showed an association between lower alcohol intoxication and ketamine use in three LGBT nightclubs. Discussion Pre-drinking showed that individual-level characteristics could be more important in binge drinking than the venues' environmental characteristics. Previous studies failed to include pre-drinking in environmental analysis. Conclusion Environmental control interventions, isolated from individual-level approaches, may have limited efficacy in the prevention of alcohol abuse in nightclubs. [Carlini C, Andreoni S, Martins SS, Benjamin MM, Sanudo A, Sanchez ZM. Environmental characteristics associated with alcohol intoxication among patrons in Brazilian nightclubs. Drug Alcohol Rev 2014;33:358–366]

Violence-related injury and gender: the role of alcohol and alcohol combined with illicit drugs.

Abstract: INTRODUCTION AND AIMS: The positive relationship between alcohol use, gender and violence-related injury is well established. However, less is known about injuries when alcohol is used in combination with other drugs. DESIGN AND METHODS: Self-report information was collected on alcohol and illicit drug use in the 6 h before a violence-related injury in probability samples of patients presenting to emergency departments (n = 9686). RESULTS: Patients with violence-related injuries reported the highest rates of alcohol use (49% of men; 23% of women) and alcohol use combined with illicit drugs (8% of men; 4% of women) whereas non-violent injury patients reported lower rates of alcohol use (17% of men; 8% of women) and alcohol use combined with drugs (2% for men; 1% for women). Marijuana/hashish was the most commonly reported drug. The odds of a violent injury were increased when alcohol was used [men: odds ratio (OR) = 5.4, 95% confidence interval (CI) 4.6-6.3; women: OR = 4.0, 95% CI 3.0-5.5] or when alcohol was combined with illicit drug use before the injury (men: OR = 6.6, 95% CI 4.7-9.3; women: OR = 5.7, 95% CI = 2.7-12.2) compared with non-users. No significant change in the odds of a violent injury was observed for men or women when alcohol users were compared with alcohol and drug users. DISCUSSION AND CONCLUSIONS: The positive association between alcohol and violent injury does not appear to be altered by the added use of drugs. Additional work is needed to understand the interpersonal, contextual and cultural factors related to substance use to identify best prevention practices and develop appropriate policies. [Korcha RA, Cherpitel CJ, Witbrodt J, Borges G, Hejazi-Bazargan S, Bond JC, Ye Y, Gmel G. Violence-related injury and gender: The role of alcohol and alcohol combined with illicit drugs. Drug Alcohol Rev 2013]. Language: en

Recreational drug use and binge drinking: stimulant but not cannabis intoxication is associated with excessive alcohol consumption.

Abstract: Introduction and Aims Binge drinking is elevated among recreational drug users, but it is not clear whether this elevation is related to intoxication with recreational drugs. We examined whether stimulant intoxication and cannabis intoxication were associated with binge drinking among young adults. Design and Methods An online survey of 18- to 30-year-old Australians who had drunk alcohol in the past year (n = 1994) were quota sampled for: (i) past year ecstasy use (n = 497); (ii) past year cannabis (but not ecstasy) use (n = 688); and (iii) no ecstasy or cannabis use in the past year (alcohol-only group, n = 809). Binge drinking last Saturday night (five or more drinks) was compared for participants who took stimulants (ecstasy, cocaine, amphetamine or methamphetamine) or cannabis last Saturday night. Results Ecstasy users who were intoxicated with stimulants (n = 91) were more likely to binge drink than ecstasy users who were not (n = 406) (89% vs. 67%), after adjusting for demographics, poly-drug use and intoxication with cannabis and energy drinks (adjusted odds ratio 3.1, P = 0.007), drinking a median of 20 drinks (cf. 10 drinks among other ecstasy users). Cannabis intoxication was not associated with binge drinking among cannabis users (57% vs. 55%) or ecstasy users (73% vs. 71%). Binge drinking was more common in all of these groups than in the alcohol-only group (34%). Discussion and Conclusions Stimulant intoxication, but not cannabis intoxication, is associated with binge drinking among young adults, compounding already high rates of binge drinking among people who use these drugs. [McKetin R, Chalmers J, Sunderland M, Bright DA. Recreational drug use and binge drinking: Stimulant but not cannabis intoxication is associated with excessive alcohol consumption. Drug Alcohol Rev 2014;33:436–445]

The role of family, friends and peers in Australian adolescent's alcohol consumption

Abstract: Introduction and Aims This study examines factors associated with alcohol-related attitudes and behaviours among 888 Australians aged 12 to 17 years. Although these influences have been examined in other countries, notably the USA, Australia's legal drinking age of 18 years is lower and adolescent drinking rates are substantially higher than in the USA. Design and Methods This is a survey of 888 adolescents aged 12–17; they were recruited via a variety of methods (including school based, interception in public places and online) to obtain a cross-section of participants across metropolitan, regional and rural New South Wales. Results Most respondents believed that people their age regularly consumed alcohol; and more than half believed that their siblings and peers would approve of them drinking. Predictors of frequent alcohol consumption included having a sibling or a friend who consumed alcohol; believing parents, friends and/or siblings approved of drinking; drinking behaviours of parents, friends and/or siblings; and having a higher disposable income. Discussion and Conclusions The results support previous findings from the USA. We find an even stronger effect of family and friends' drinking behaviours and attitudes in a country with a lower legal drinking age and high adult alcohol consumption rates.[Jones SC, Magee CA. The role of family, friends and peers in Australian adolescent's alcohol consumption. Drug Alcohol Rev 2014;33:304–313]