bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender differences in the psychological determinants of cigarette smoking
Authors: Etter Jean‐François , Prokhorov Alexander V. , Perneger Thomas V.
Published: March 2003

AimsTo compare the distributions of smoking‐related variables and the size of associations between these variables in men and women.

Design and participantsMail survey in 2934 daily smokers (1533 women and 1401 men) who volunteered for a smoking cessation trial. Follow‐up after 7 months in 2456 people (84%).

SettingCommunity setting (French‐speaking part of Switzerland, 1998).

FindingsWomen smoked less than men (18 versus 22 cigarettes per day,p< 0.001), had lower confidence in their ability to refrain from smoking, used more frequently the strategy defined as ‘coping with the temptation to smoke’ and reported more drawbacks of smoking (gender differences ranged between 0.1 and 0.3 standard deviation units on these scales). There was no gender difference in the distribution of smokers by stage of change. At follow‐up, smoking cessation rates were similar in men and women (6% versus 5%,p= 0.3). Intention to quit, quit attempts in the previous year and a more frequent use of self‐change strategies predicted smoking cessation and were associated with tobacco dependence in both sexes. A more frequent use by women of coping strategies suggests that some women are ‘self‐restrained’ smokers who control their smoking permanently. This could explain lower smoking rates in women. The size of associations between smoking‐related variables was similar in men and women.

ConclusionsEven though there were gender differences in the distributions of some smoking‐related variables, associations between these variables were similar in men and women. This suggests that smoking behaviour is regulated by similar psychological mechanisms in men and women.
Whose drinking does the liberalization of alcohol policy increase? Change in alcohol consumption by the initial level in the Finnish panel survey in 1968 and 1969
Authors: Mäkelä Pia
Published: March 2003

Aims To study how the annual volume of alcohol consumed changed among population groups in different categories of initial consumption in a situation where per capita consumption strongly increased due to a new alcohol law.

Design A post‐hoc quasi‐experiment with a two‐wave panel study. The regression to the mean effect was accounted for by using reference data from two auxiliary panel studies.

Setting Finland in 1968 and 1969, when per capita consumption increased by 46% in a year. Reference data come from Norway in 1975 and 1976, and the United States in 1993 and 1994.

Participants General population sample of 1720 (1292 men) aged 15–69 (response rate 91.4%).

Reference data

General population surveys in a Norwegian town (n = 254) and in the United
States (n = 658).

Measurements Annual volume of alcohol consumed.

Findings In Finland, the greatest change in observed consumption levels occurred among those with moderate consumption levels, but the same phenomenon was observed in the reference data. A comparison between the Finnish and the reference data indicated that in Finland consumption increased at all levels, and the higher the initial consumption level, the greater the increase.

Conclusions A best estimate for the differential impact of future increases in alcohol consumption is that moderate and particularly heavy drinkers will be affected to a greater extent than will light drinkers or abstainers.
Effects of concurrent use of alcohol and cocaine
Authors: Pennings Ed J. M. , Leccese Arthur P. , Wolff Frederik A. de
Published: March 2003

The combination of alcohol and cocaine is popular among drug users, perhaps because of more intense feelings of ‘high’ beyond that perceived with either drug alone, less intense feelings of alcohol‐induced inebriation and tempering of discomfort when coming down from a cocaine ‘high’. A review is presented of the medical literature on psychological and somatic effects and consequences of combined use of alcohol and cocaine in man. The search was carried out with Medline, the Science Citation Index/Web of Science and Toxline. Exclusion and inclusion criteria for this search are identified. There is generally no evidence that the combination of the two drugs does more than enhance additively the already strong tendency of each drug to induce a variety of physical and psychological disorders. A few exceptions must be noted. Cocaine consistently antagonizes the learning deficits, psychomotor performance deficits and driving deficits induced by alcohol. The combination of alcohol and cocaine tends to have greater‐than‐additive effects on heart rate, concomitant with up to 30% increased blood cocaine levels. Both prospective and retrospective data further reveal that co‐use leads to the formation of cocaethylene, which may potentiate the cardiotoxic effects of cocaine or alcohol alone. More importantly, retrospective data suggest that the combination can potentiate the tendency towards violent thoughts and threats, which may lead to an increase of violent behaviours.
Cigarette smoking is associated with increased severity of gambling problems in treatment‐seeking gamblers
Authors: Petry Nancy M. , Oncken Cheryl
Published: March 2003

Aims Cigarette smoking and gambling often co‐occur, but very little is known about smoking or its correlates in disordered gamblers. This study compared gambling and psychosocial problems in treatment‐seeking gamblers who smoke versus those who do not.

Methods At intake to gambling treatment programs, gamblers completed the addiction severity
index (ASI) and gambling questionnaires. Subjects were categorized into non‐daily
smokers (n = 107) and daily smokers (n = 210). Differences in demographics, gambling variables and ASI composite scores were compared between the groups.

Results The daily smokers were more likely to have a history of treatment for a substance use disorder than the non‐daily smokers. After controlling for substance abuse treatment histories, gender and age, the daily smokers demonstrated more severe gambling, family/social and psychiatric problems. Compared to non‐daily smokers, the daily smokers gambled on more days and spent more money gambling; they also ‘craved’ gambling more and had lower perceived control over their gambling. The daily smokers were more likely to be taking psychiatric medications, and they experienced psychiatric symptoms, especially anxiety symptoms, on a greater number of days than non‐daily smokers.

Implications Results from this study suggest that about two‐thirds of treatment‐seeking gamblers are current daily cigarette smokers, and smoking status is associated with more severe gambling and psychiatric symptoms. These results warrant further investigation of smoking in gamblers and whether smoking adversely affects the course of treatment or outcomes among gamblers.
HIV risk behaviors in African‐American drug injector networks: implications of injection‐partner mixing and partnership characteristics
Authors: Johnson Robert A. , Gerstein Dean R. ,   Alfred Pach III, Cerbone Felicia Gray , Brown Jerry
Published: March 2003

Aims We explore the mechanisms by which ‘partnership‐level’ variables––the mix of characteristics of individuals who inject drugs together––affect the incidence of HIV risk behaviors, including receptive syringe sharing, and facilitate or impede the spread of HIV.

Design We apply multivariate analysis techniques to data on injection partnerships (pairs of individuals who inject drugs together) collected using a network sample of 401 African‐American IDUs in Washington, DC.

Findings Drug injectors tended to select injection partners of the same gender and similar age, but risk behaviors were most common in partnerships between individuals who are dissimilar in both gender and age. Partners who had a sexual relationship, injected drugs frequently together, smoked crack‐cocaine regularly, injected speedball (heroin mixed with cocaine) regularly and/or had close social ties were more likely to engage in risky injection practices than otherwise similar partners. These factors account largely for the association between the gender‐age mix of the partnership and injection risk behavior.

Conclusions Among African‐American IDUs in Washington DC, partnership‐level variables appear critical in the transmission of HIV.
Operation safe crossing: using science within a community intervention
Authors: Voas Robert B. , Tippetts A. Scott , Johnson Mark B. , Lange James E. , Baker James
Published: March 2003

Aims

To evaluate a large drunk‐driving enforcement program at the US/Mexican border to reduce the number of youths crossing the border to drink in Tijuana. This paper also describes the research data used to develop and manage the program. Data from a border breath‐test survey were used to dramatize the problem and gain public support for action. The data were also used to help design the enforcement effort and measure progress in reducing the cross‐border drinking problem.

Design

The number of news events generated around the occurrence of special enforcement efforts were used to measure project activity and to predict changes in the numbers of youths crossing into Mexico, their returning BACs and reductions in alcohol‐related crashes during a 3‐year period.

Setting

An urban county on the Mexican border.

Participants

Underage youths aged 18–20 years and young adults aged 21–30 years residing in San Diego County.

Measurements

Immigration and Naturalization Services provided population counts of the number of individuals crossing each weekend night from Tijuana into the United States through the San Ysidro border facility. Breath‐test surveys of a random sample of these returning crossers provided data on the number of US residents visiting bars and nightclubs in Tijuana and on alcohol consumption at Tijuana bars and nightclubs. Night‐time had‐been‐drinking crash data involving young drivers in several California counties served as an outcome measure of public health and safety.

Findings

Analysis of data involving more than 2 million pedestrians returning from Tijuana indicated that the Operation Safe Crossing program reduced the number of late‐night crossers by 31.6%.

Conclusions

Effective use of data through media advocacy programs to support an enforcement effort can reduce alcohol‐related crashes.
Alcohol dependence: a public health perspective
Authors: Caetano Raul , Cunradi Carol
Published: March 2003

AimsTo review epidemiological research on alcohol dependence and to propose a public health approach to address this problem.

Design and settingThe research under review is basically constituted by general population surveys.

ParticipantsIndividuals in the community 18 years of age and older.

MeasurementTwelve‐month rates of alcohol dependence are estimated using DSM criteria.

FindingsThe prevalence of alcohol dependence has been stable in the United States, at around 6% for men and 2% for women. The risk of alcohol dependence begins at low levels of drinking and increases linearly with alcohol consumption. Mean group level of consumption shows some relationship to prevalence of dependence. Alcohol‐dependent individuals are responsible for about 50% of the social, legal and interpersonal alcohol‐related problems in society.

ConclusionAlcohol dependence is present at relatively high levels in the community. Alcohol‐dependent individuals are responsible for a fair proportion of alcohol‐related problems in society. A public health approach to this problem, emphasizing prevention and group level interventions to lower prevalence levels, is warranted.
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility
Authors: Group WHO ASSIST Working
Published: March 2003

Aims

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed for the World Health Organization (WHO) by an international group of substance abuse researchers to detect psychoactive substance use and related problems in primary care patients. This report describes the new instrument as well as a study of its reliability and feasibility.

Setting

The study was conducted at participating sites in Australia, Brazil, Ireland, India, Israel, the Palestinian Territories, Puerto Rico, the United Kingdom and Zimbabwe. Sixty per cent of the sample was recruited from alcohol and drug abuse treatment facilities; the remainder was drawn from general medical settings and psychiatric facilities.

Methods

The study was concerned primarily with test item reliability, using a simple test–retest procedure to determine whether subjects would respond consistently to the same items when presented in an interview format on two different occasions. Qualitative and quantitative data were also collected to evaluate the feasibility of the screening items and rating format.

Participants

A total of 236 volunteer participants completed test and retest interviews at nine collaborating sites. Slightly over half of the sample (53.6%) was male. The mean age of the sample was 34 years and they had completed, on average, 10 years of education.

Results

The average test–retest reliability coefficients (kappas) ranged from a high of 0.90 (consistency of reporting ‘ever’ use of substance) to a low of 0.58 (regretted what was done under influence of substance). The average kappas for substance classes ranged from 0.61 for sedatives to 0.78 for opioids. In general, the reliabilities were in the range of good to excellent, with the following items demonstrating the highest kappas across all drug classes: use in the last 3 months, preoccupied with drug use, concern expressed by others, troubled by problems related to drug use, intravenous drug use. Qualitative data collected at the end of the retest interview suggested that the questions were not difficult to answer and were consistent with patients’ expectations for a health interview. The data were used to guide the selection of a smaller set of items that can serve as the basis for more extensive validation research.

Conclusion

The ASSIST items are reliable and feasible to use as part of an international screening test. Further evaluation of the screening test should be conducted.
Survey of doctors prescribing diamorphine (heroin) to opiate‐dependent drug users in the United Kingdom
Authors: Metrebian Nicky , Carnwath Tom , Stimson Gerry V. , Storz Thomas
Published: March 2003

Aim

To determine the scale and practice of diamorphine (heroin) prescribing for opiate dependence in the United Kingdom in 2000.

Design

Postal survey.

Setting

England, Scotland and Wales.

Participants

One hundred and eleven of the 164 doctors in the United Kingdom on the Home Office record as holding a licence to prescribe diamorphine (response rate 68%), and 59 of the 108 doctors in the United Kingdom eligible to hold a licence (working in drug clinics), but not doing so (response rate 54%).

Measurements

The characteristics of doctors (a) holding a licence and (b) currently prescribing; the number of opiate users receiving a prescription; current treatment delivery, clinical criteria for patient eligibility; and reasons for prescribing or not prescribing diamorphine.

Findings

Seventy of the 111 doctors actually held a licence. While the majority were consultant psychiatrists, five were general practitioners. Forty‐six were currently prescribing to 448 patients. The majority of prescribers reported that they had not initiated a prescription for diamorphine but had inherited patients already receiving such a prescription. Most of those who prescribed considered that in selected cases it could produce clinical and social improvement. There were great variations in clinical criteria for patient eligibility, prescribing practice, daily dose prescribed (range 5–1500 mg) and the daily dose‐equivalent of 100 mg methadone (range 50–900 mg). Many respondents cited lack of appropriate resources as a reason for not prescribing to more patients. Reasons for non‐prescribing varied from lack of resources to little evidence of its effectiveness.

Conclusions

The prescribing of diamorphine to opiate dependent drug users remains rare in the United Kingdom. Not all eligible doctors seek a licence to prescribe, and not all those with licences actually prescribe it. There is no clear consensus on who should be treated with diamorphine and in what way.
Dysregulation of the hypothalamic–pituitary–thyroid axis in alcoholism
Authors: Hermann Derik , Heinz Andreas , Mann Karl
Published: March 2003

Thyroid dysfunction is a prominent finding in alcoholism. Subclinical and clinical hypothyroidism have been associated with clinical depression and cognitive impairment and may increase the relapse risk among alcoholics. In spite of these important clinical associations, there is no consensus on thyroid dysfunction in alcoholism in the literature. In this paper, we present a review of the literature and develop a hypothesis that may explain dysfunction of the hypothalamic–pituitary–thyroid axis in alcoholism. Based on a Medline research of the years 1980–2001 we found 33 empirical studies that assessed thyroid function in alcoholism. The most consistent findings were a reduction in total thyroxine and total and free triiodothyronine concentrations during early abstinence. About one‐third of all alcoholics also displayed a blunted thyroid stimulation hormone (TSH) response in the thyrotrophin‐releasing hormone test (TRH‐test). Blunting was observed frequently during detoxification, but was also present in some alcoholics after several weeks of abstinence. We suggest that a reduction in peripheral thyroid hormones may be caused by a direct toxic effect of alcohol on the thyroid gland, which induces a central compensatory activation of the hypothalamic–pituitary axis with an increased TRH release. The TRH release induces a downregulation of pituitary TRH receptors, which manifest as a blunted TSH response to the TRH test. We discuss further additional effects of alcohol on thyroid‐hormone metabolizing deiodinases and on monoaminergic systems, which may interact directly with mood states among abstinent alcoholics.
The association between knowledge of hepatitis C virus status and risk behaviors in injection drug users
Authors: Kwiatkowski Carol F. , Fortuin Corsi Karen , Booth Robert E.
Published: March 2003

Aims  The three primary objectives of this study were (1) to document the prevalence of the hepatitis C virus (HCV) and awareness of one's status in a sample of street‐recruited injection drug users (IDUs); (2) to compare the drug use and HCV risk behaviors of IDUs who reported that they were HCV infected with those who were unaware of their status and subsequently tested positive for HCV antibodies; and (3) to assess associations between risk factors and HCV status by comparing those who tested positive with those who tested negative.

Design  IDUs responded to structured interview questions assessing HCV risk behaviors and were offered a free HCV test.

Setting  Subjects were recruited through street outreach in Denver, CO, USA.

Participants  Participants were current, out‐of‐treatment IDUs.

Measurements  A modified version of the Risk Behavior Assessment (RBA) and HCV test results were used.

Findings  Of the 197 participants, 20% had been diagnosed previously with HCV. Of those who did not know their status, 61% tested positive for HCV antibodies. Those who knew they were positive had been injecting longer but engaged in fewer HCV risk behaviors than those who did not know their status. Compared to those who tested negative, those who tested positive were more likely to be male, non‐white and older. They also had been injecting longer, were more likely to use heroin and/or crack cocaine and consumed more alcohol.

Conclusions  In this study, a very large proportion of injection drug users who had hepatitis C were unaware of it, and they were engaging in more risk behaviors than those who were aware of their positive status. Risk factors associated with positive HCV status were identified so that those who are most at‐risk for HCV might be targeted for testing and subsequent prevention or care.
Persistence of cigarette smoking: familial liability and the role of nicotine dependence
Authors: Johnson Eric O. , Chase Gary A. , Breslau Naomi
Published: March 2003

Aims It has been suggested that high genetic vulnerability may explain why smoking persists in spite of general acceptance of the health risks of cigarette smoking. Indeed, heritability estimates for smoking persistence range from 27% to 70%. It has also been suggested that genetic influences on smoking persistence may operate through nicotine dependence, which epidemiological studies have found to be an important risk factor for smoking persistence. We examined alternative ways that familial liability to persistence, nicotine dependence and smoking persistence may be related.

Design Cohort study.

Setting South‐east Michigan, United States.

Participants A subset of 389 daily smokers informative for familial smoking characteristics from an epidemiological sample of young adults 26–35 years old (n = 979).

Measurements Nicotine dependence criteria were assessed using the NIMH‐DIS revised interview and diagnosed according to the DSM‐III‐R. Familial smoking characteristics were assessed by subject report.

Findings Absent nicotine dependence, daily smokers with medium and high familial density of persistence were at increased risk of smoking persistence (OR = 4.2 and 7.0, respectively). However, familial density of persistence was not associated with smoking persistence among nicotine dependent daily smokers. Level of education also appeared to limit the influence of familial liability, although nicotine dependence also modified this effect.

Conclusions Nicotine dependence does not appear to be in the causal pathway from familial liability to smoking persistence, but rather modifies the association between them.
The impact of regular ecstasy use on memory function
Authors: Simon Neil G. , Mattick Richard P.
Published: March 2003

Aim  To assess memory impairment in a group of regular users of ecstasy compared with a group of regular users of cannabis, after accounting for possible confounding factors such as other drug use, premorbid intelligence and psychopathology.

METHOD  Comparative and regression analysis was used to determine the presence or absence of a difference in memory function between 40 regular ecstasy users and 37 regular users of cannabis, who were interviewed at the National Drug and Alcohol Research Centre in Sydney, Australia. Regression analysis was used to find associations between life‐time exposure to ecstasy use and memory performance. Memory function was assessed using an age‐standardized memory test. Other scales were used to assess premorbid intelligence, physical and psychological health, drug withdrawal and other drug use.

Results  Initial comparative analysis showed a trend towards a significantly poorer performance by the regular ecstasy‐using group on the ‘auditory immediate memory’ and ‘auditory delayed memory’ indices. When regression analysis was performed an estimate of verbal intelligence was found to be the most predictive of most memory indices including ‘auditory immediate memory’ and ‘auditory delayed memory’. Life‐time exposure to ecstasy was not predictive of the memory indices. The current frequency of cannabis use was found to have some predictive effect for immediate and delayed visual memory.

Conclusion  This study does not show memory impairment in a group of ecstasy users relative to cannabis using controls. The previously reported association of life‐time exposure to ecstasy and memory was not found. The findings may indicate a confounding role of cannabis use, as has been recently reported.
A randomized controlled trial of buprenorphine in the management of short‐term ambulatory heroin withdrawal
Authors: Lintzeris Nicholas , Bell James , Bammer Gabriele , Jolley Damien J. , Rushworth Louise
Published: March 2003

ABSTRACT Aim  To determine whether buprenorphine is more effective than clonidine and other symptomatic medications in managing ambulatory heroin withdrawal.

Design  Open label, prospective randomized controlled trial examining withdrawal  and 4‐week postwithdrawal outcomes on intention‐to‐treat.

Setting  Two specialist, out‐patient drug treatment centres in inner city Melbourne  and Sydney, Australia.

Participants  One hundred and fourteen dependent heroin users were recruited. Participants were 18  years or over, and with no significant other drug dependence, medical or psychiatric conditions or recent methadone treatment. One hundred and one (89%) participants completed a day 8 research interview examining withdrawal outcomes, and 92 (81%) completed day 35 research interview examining postwithdrawal outcomes.

Interventions  Participants randomized to control (n  =  56) (up to 8  days of clonidine and other symptomatic medications) or experimental (n  =  58) (up to 5  days of buprenorphine) withdrawal groups. Following the 8‐day withdrawal episode, participants could self‐select from range of postwithdrawal options (naltrexone, substitution maintenance, or counselling).

Measurements  Retention in withdrawal; heroin use during withdrawal; and retention in drug treatment 4  weeks after withdrawal.

Secondary outcomes  Withdrawal severity; adverse events, and heroin use in the postwithdrawal period.

Findings  The experimental group had better treatment retention at day 8 (86% versus 57%, P  =  0.001, 95% CI for numbers needed to treat (NNT)  =  3–8) and day 35 (62% versus 39%, P  =  0.02, 95% CI for NNT  =  4–18); used heroin on fewer days during the withdrawal programme (2.6  ±  2.5 versus 4.5  ±  2.3, P  <  0.001, 95% CI  =  1–2.5  days) and in the postwithdrawal period (9.0  ±  8.2 versus 14.6  ±  10, P  <  0.01, 95% CI  =  1.8–9.4); and reported less withdrawal severity. No severe adverse events reported.

Conclusions  Buprenorphine is effective for short‐term ambulatory heroin withdrawal, with greater retention, less heroin use and less withdrawal discomfort during withdrawal; and increased postwithdrawal treatment retention than symptomatic medications.
Trajectories of drinking from 18 to 26 years: identification and prediction
Authors: Casswell Sally , Pledger Megan , Pratap Sarah
Published: March 2003

ABSTRACT Objective  To identify developmental trajectories of drinking between the ages of 18 and 26  years and to identify variables, amenable to policy influence, which predict these trajectories.

Design  Longitudinal data were analysed using latent class mixture modelling.

Setting  Participants were interviewed in a central location.

Participants  Provincial city birth cohort, cross‐national studies suggest findings are generalizable to other similar market economies.

Measurements  The frequency of drinking over the past year and the typical quantity consumed per drinking occasion were computed from five location‐specific questions. Measures used to predict membership of trajectory groups were ease of access to alcohol, drinking on licensed premises, response to alcohol advertising, educational achievement, parental consumption, age of onset of regular drinking and living arrangements.

Results  Three trajectories of quantities consumed showed reduced consumption after age 21 but one trajectory showed marked increases. Three trajectories of frequency of drinking increased or remained stable over time. Access to licensed premises at age 18 had the most significant impact on membership of the trajectory groups and educational achievement had a significant impact on membership of the heavier quantity trajectory groups. Parental alcohol consumption, access to alcohol at 15  years, liking for alcohol advertising, living arrangement and age of onset of regular drinking also influenced trajectory membership.

Conclusions  Quantity and frequency of drinking in adolescence and early adulthood had different trajectories. Membership of heavier drinking groups was affected by environmental influences which are subject to policy change, particularly that of earlier access to licensed premises. In a small group high‐quantity consumption did not decrease at age 26.
Drug use and initiation in prison: results from a national prison survey in England and Wales
Authors: Boys A. , Farrell M. , Bebbington P. , Brugha T. , Coid J. , Jenkins R. , Lewis G. , Marsden J. , Meltzer H. , Singleton N. , Taylor C.
Published: March 2003

Aims  To investigate heroin and cocaine use in a sample of British prisoners, and to explore the characteristics of inmates who use these drugs for the first time while in prison.

Design, participants  A cross‐sectional survey of all prisons in England and Wales conducted as part of a major national study of psychiatric morbidity. A total of 3142 prisoners (88.2% of those selected) completed a structured interviewer‐administered questionnaire.

Measurements  Interview measures of personal demographics, social history, psychiatric morbidity and drug use. Personality disorders were diagnosed via the Structured Clinical Interview for DSM‐IV (SCID‐II) and neurotic symptoms were assessed using the revised Clinical Interview Schedule (CIS‐R).

Findings  More than 60% of the heroin users and cannabis users reported that they had used these drugs in prison compared with less than a quarter of the life‐time cocaine users. More than a quarter of the heroin users reported that they had initiated use of this drug in prison. The extent of an individual's experience of prison was related more consistently to heroin and/or cocaine use in and out of prison than other personal background, social history or psychiatric variables assessed.

Conclusions  The findings indicate that prisons are a high‐risk environment for heroin and other drug initiation and use. Although related to drug use, psychiatric variables were not generally associated with initiation in prison, which was dominated by prison exposure. There is a need to explore ways of reducing heroin initiation in prison as part of a broader risk‐prevention strategy.
Parental substance use as a modifier of adolescent substance use risk
Authors: Li Chaoyang , Pentz Mary Ann , Chou Chih‐Ping
Published: March 2003

Aims  A major question in national substance use prevention efforts is how much influence parents have on their children's substance use, answers to which could determine whether current school‐based prevention programs that address peer pressure are sufficient or whether parents need to be involved. The present study examines whether parents act as gatekeepers by testing the moderator effects of parents’ substance use on the relationships of friends’ substance use to adolescent substance use (cigarettes, alcohol and marijuana).

Design  A longitudinal school‐based trial for prevention of substance use in adolescents.

Setting  Indianapolis, Indiana, USA.

Participants  As part of a large substance use prevention trial, entering middle school students were surveyed prospectively at baseline, 6 months and 18 months (n = 1807 from 57 schools).

Measurements  A self‐reported survey was used to measure behaviors, attitudes and social influences related to adolescent substance use.

Findings  Results of logistic regression analyses and multiple group structural equation modeling showed that increasing numbers of parents and friends using substances were associated with greater risk of adolescent substance use, as were more substance offers and lower levels of refusal self‐efficacy. Additionally, refusal self‐efficacy mediated the effects of baseline use and substance offers on subsequent use. However, non‐using parents had a buffering effect on friends’ influences to use substances, such that friends’ use did not affect adolescent use when parents were non‐users, and the effects of substance offers on refusal self‐efficacy were weaker.

Conclusions  The findings suggest that parent substance use should be addressed in adolescent substance use prevention programs, and that continuing non‐use by parents should be reinforced.
Four cases of erectile dysfunction in substance abusers treated with sildenafil
Authors: Darwin Telias Isaac , Kadmon‐Telias Ana
Published: March 2003

ABSTRACT This case report describes four cases of substance abusers with sexual dysfunction, three of them with erectile dysfunction, and the fourth with erectile ­dysfunction and ejaculatia praecox. They were treated with sildenafil and their condition improved. There is a need to examine more fully the problem of sexual dysfunction in patients reporting for the treatment of addictions, given that it appears that their problem can be treated.
Alcohol urges in alcohol‐dependent drinkers: further validation of the Alcohol Urge Questionnaire in an untreated community clinical population
Authors: Drummond D. Colin , Phillips Thomas S.
Published: March 2003

ABSTRACTBackground Alcohol craving is a key element of the alcohol dependence syndrome. However, there is a lack of consensus about the precise nature of craving and the most appropriate method of measurement. Alcohol urges measured by the Alcohol Urge Questionnaire showed a unidimensional structure and evidence of validity and reliability in a US clinical population. The main aim of this study was to establish the validity of the AUQ in an untreated UK clinical population, and its relationships to drinking and personality factors.

Subjects All subjects (n = 80) were alcohol‐dependent (DSM‐IV) and presenting for pre‐treatment assessment at a community alcohol team in South‐west ­London.

Method All subjects completed the AUQ, Severity of Alcohol Dependence ­Questionnaire (SADQ), Spielberger's State Trait Anxiety Inventory (STAI) and Eysenck Personality Questionnaire (EPQ) and provided a breath specimen for alcohol analysis (BAL).

Results Principal components analysis of AUQ revealed one factor which accounted for 69% of variance with high interitem correlations, and an alpha reliability of 0.93. AUQ was significantly correlated with SADQ, BAC, state and trait anxiety and negatively correlated with time since last drink. There were no significant correlations between AUQ and any of the EPQ subscales. SADQ was correlated with neuroticism, but not other EPQ subscales. A regression analysis showed that only SADQ, time since last drink and BAL were significant predictors of alcohol urges.

Conclusions This study confirmed the AUQ factor structure and provided further evidence for the validity of AUQ. The relationship between BAL and urges deserves further research. The results did not support the contention that ­anxiety and personality factors predict urges when drinking‐related variables, which also predict urges, are controlled for. The AUQ is a useful measure for clinical and experimental alcohol craving research.
Alcohol‐related human losses in Russia in the 1980s and 1990s
Authors: Nemtsov A. V.
Published: March 2003

ABSTRACT Aims  The estimation of alcohol‐related human losses in Russia in the 1980s and 1990s.

Design  The  estimation  was  made   by  comparing  changes   in   the   total   number of deaths and in specific categories, and alcohol consumption in Russia during this time.

Setting  The anti‐alcohol campaign, launched in 1985, and the market reforms launched in 1992 were associated with large and rapid changes of alcohol ­consumption in Russia.

Findings  In the early 1980s, the aggregate number of direct and indirect alcohol‐related life losses was more than 500 000 per annum, or 32% of total deaths. Half of the alcohol‐related human losses in Russia over the period studied were due to accidents, poisoning and violence. Following the anti‐alcohol campaign and reduction in annual per capita alcohol consumption from 14.2 (1984) to 10.5 l (1986), mortality decreased from 1161.6 to 1054.0 per 100 000   of   the   population.   It   is   estimated   that   from   1986   to   1991   the   lives of 1.22 million people were spared; that is, 11.4% of the number of deaths expected without the anti‐alcohol campaign. All categories of deaths were reduced with the exception of neoplasms, infectious and parasitic diseases. In the period of the so‐called market reforms both alcohol consumption and mortality increased sharply. The total number of alcohol‐related deaths for 1994 was 751 000 in the population, or 33% of all deaths (direct and indirect losses). In 1995 alcohol consumption started to decrease. A decrease in mortality was registered despite the sharp deterioration of the quality of life in the country. However, a new growth of total mortality, fatal alcohol poisonings and number of alcohol psychoses began in 1999–2000.

Conclusion  The results of this study show the enormous scale of alcohol‐related mortality in Russia. It has been revealed that alcohol‐related deaths are at the top of the hierarchy of all premature deaths in the country. Decreasing alcohol consumption is an important means of decreasing total mortality in Russia.
Reassessing the marijuana gateway effect
Authors: Morral Andrew R. , McCaffrey Daniel F. , Paddock Susan M.
Published: March 2003

Aims  Strong associations between marijuana use and initiation of hard drugs are cited in support of the claim that marijuana use per se increases youths’ risk of initiating hard drugs (the ‘marijuana gateway’ effect). This report examines whether these associations could instead be explained as the result of a common factor—drug use propensity—influencing the probability of both marijuana and other drug use.

Design  A model of adolescent drug use initiation in the United States is constructed using parameter estimates derived from US household surveys of drug use conducted between 1982 and 1994. Model assumptions include:

(1) individuals have a non‐specific random propensity to use drugs that is normally distributed in the population; (2) this propensity is correlated with the risk of having an opportunity to use drugs and with the probability of using them given an opportunity, and (3) neither use nor opportunity to use marijuana is associated with hard drug initiation after conditioning on drug use propensity.

Findings  Each of the phenomena used to support claims of a ‘marijuana gateway effect’ are reproduced by the model, even though marijuana use has no causal influence over hard drug initiation in the model.

Conclusions  Marijuana gateway effects may exist. However, our results demonstrate that the phenomena used to motivate belief in such an effect are consistent with an alternative simple, plausible common‐factor model. No gateway effect is required to explain them. The common‐factor model has implications for evaluating marijuana control policies that differ significantly from those supported by the gateway model.
Hepatitis‐associated knowledge is low and risks are high among HIV‐aware injection drug users in three US cities
Authors: Heimer Robert , Clair Scott , Grau Lauretta E. , Bluthenthal Ricky N. , Marshall Patricia A. , Singer Merrill
Published: March 2003

Aims  Injection drug use is a major risk factor for HIV and hepatitis infections. Whereas programs to prevent new infections have focused on HIV, they have generally neglected hepatitis B and C. This study was designed to examine the interrelationships among HIV and hepatitis knowledge, risky drug preparation and injection practices, and participation in syringe exchange programs (SEPs).

Design  Surveys of injection drug users (IDUs) collected data on socio‐demographics, medical history, drug use and injection practices, and HIV‐ and hepatitis‐related knowledge.

Setting  Inner‐city US neighborhoods in Chicago, IL, Hartford, CT and Oakland, CA.

Participants 

The study population was a convenience sample of 493 IDUs recruited using street outreach and snowball sampling strategies.

Measurements  HIV and hepatitis knowledge, injection‐related risks for virus transmission, associations between the two, and with SEP use.

Findings  HIV knowledge was significantly higher than hepatitis knowledge among SEP customers and non‐customers alike. Elevated hepatitis knowledge was associated with a history of substance abuse treatment, hepatitis infection, hepatitis B vaccination and injection practices that reduced contact with contaminated blood or water but not with SEP use. SEP customers were consistently less likely to engage in risk behaviors, with the notable exception of safely staunching blood postinjection.

Conclusion  Increased hepatitis awareness among IDUs is necessary for reducing hepatitis transmissions. Although SEPs continue to effectively disseminate HIV prevention messages—as evidenced by lowered risk behaviors among their customers—they must do more to prevent hepatitis transmissions.
Measuring therapeutic attitudes in the prison environment: development of the Prison Attitude to Drugs scale
Authors: Airey Nick , Marriott James
Published: March 2003

Aims  To develop and test the validity of a scale measuring therapeutic attitudes among prison staff working with drug misusers.

Design  A cross‐sectional postal questionnaire study using 27 statements with a five‐point Likert scale.

Setting  Four prisons in the south‐west of England

Participants  A total of 252 prison staff (response rate 70%), including 67 for test–retest (response rate 57%).

Findings  The study resulted in a three‐dimensional, nine‐item scale: the Prison Attitude to Drugs scale (PAD). The three subscales measure confidence in skills (four items), personal rewards (three items) and job satisfaction (two items). Test–retest correlations for the questions were above 0.7, with each factor having an internal coherence (coefficient alpha) of greater than 0.7.

Conclusions  The PAD is a reliable tool that can be used in the prison environment.
Supply control and harm reduction: lessons from the Australian heroin ‘drought’
Authors: Weatherburn Don , Jones Craig , Freeman Karen , Makkai Toni
Published: March 2003

Aims  To examine the effects of supply‐side drug law enforcement on the dynamics of the Australian heroin market and the harms associated with heroin.

Setting  Around Christmas 2000, heroin users in Sydney and other large capital cities in Australia began reporting sudden and significant reductions in the availability of heroin. The changes, which appear to have been caused at least in part by drug law enforcement, provided a rare opportunity to examine the potential impact of such enforcement on the harm associated with heroin.

Design  Data were drawn from a survey of 165 heroin users in South‐Western Sydney, Australia; from the Drug Use Monitoring in Australia (DUMA) project; from NSW Health records of heroin overdoses; and from the Computerized Operational Policing System (COPS) database.

Findings  Heroin price increased, while purity, consumption and expenditure on the drug decreased as a result of the shortage. The fall in overall heroin use was accompanied by a significant reduction in the rate of overdose in NSW. However, the health benefits associated with the fall in overdose may have been offset by an increase in the use of other drugs (mainly cocaine) since the onset of the heroin shortage. There does not appear to have been any enduring impact on crime rates as a result of the heroin ‘drought’.

Conclusion  Supply control has an important part to play in harm reduction; however, proponents of supply‐side drug law enforcement need to be mindful of the unintended adverse consequences that might flow from successfully disrupting the market for a particular illegal drug.
Aggression involving alcohol: relationship to drinking patterns and social context
Authors: Wells Samantha , Graham Kathryn
Published: March 2003

Aims  The present study examines the relationships between: (1) alcohol involvement/perceived intoxication level of participants and aggression severity; (2) respondent drinking patterns and involvement in alcohol‐related aggression; and (3) social context and alcohol‐related aggression.

Design  Random digit dialing (RDD) with computer assisted telephone interviewing (CATI) was used to obtain a random sample of Ontario adults aged 18–60 (response rate of 67%).

Participants  Respondents who reported that they had been involved personally in physical aggression in the past 12 months were the focus of the present study.

Measurements  Questions were asked regarding the most recent incident of physical aggression, including whether the respondent and opponent drank alcohol prior to aggression, perceived intoxication levels at the time, number of participants, relationship to opponent, social context of aggression, time of day and day of week. Three items were used to assess aggression severity: injury to respondent, use of threats by respondent or opponent and police involvement.

Findings  (1) Injury to respondent and threats by respondent were not associated with alcohol involvement per se, but were significantly related to perceived level of alcohol intoxication; (2) drinking pattern of respondent was significantly associated with alcohol‐related aggression but unrelated to aggression that did not involve alcohol; and (3) a number of contextual factors (e.g. gender, number of participants, time of day) were found to be associated with alcohol involvement in aggression.

Conclusions  The results suggest that both drinking pattern and contextual factors are important in distinguishing between alcohol‐related aggression and non‐alcohol‐related aggression. As well, alcohol intoxication may be an important predictor of aggression severity.
Male drugs‐related deaths in the fortnight after release from prison: Scotland, 1996–99
Authors: Bird Sheila M. , Hutchinson Sharon J.
Published: March 2003

Aims  To assess if 15–35‐year‐old males released after 14 + days’ imprisonment in Scotland, 1996–99, had a higher drugs‐related death rate in 2 weeks after release than during subsequent 10 weeks; higher than expected death rate from other causes; and if drugs‐related deaths in the first fortnight were three times as many as prison suicides.

Design  Confidential linkage of ex‐prisoner database against deaths.

Setting  Scotland's male prisons and young offenders’ institutions during July to December 1996–99; 19 486 index releases after 14+ days’ incarceration.

Measurements  Relative risk of drugs‐related death in the first 2 weeks after release (34 deaths) versus subsequent 10 weeks (23). Other causes of death (21) relative to expectation. Drugs‐related deaths in first 2 weeks after release relative to suicides in prison (12).

Findings  Drugs‐related mortality in 1996–99 was seven times higher (95% CI: 3.3–16.3) in the 2 weeks after release than at other times at liberty and 2.8 times higher than prison suicides (95% CI: 1.5–3.5) by males aged 15–35 years who had been incarcerated for 14+ days. We estimated one drugs‐related death in the 2 weeks after release per 200 adult male injectors released from 14 + days’ incarceration. Non‐drugs‐related deaths in the 12 weeks after release were 4.9 times (95% CI: 2.8–7.0) the 4.3 deaths expected.

Conclusion  Investment in, and evaluation of, prison‐based interventions is needed to reduce substantially recently released drugs‐related deaths.