bluuebunny/crossref_metadata_2025 huggingface dataset:
The conditioning of aversions to familiar and preferred flavours: a new aversion therapy model
Authors: Clarke J. C. , Manza Lisa M. , Sclafani Anthony
Published: July 2006

The present study examined the ability of rats to develop aversions to familiar flavours and to flavours that they had previously acquired a preference for. Rats were first conditioned to prefer a CS+ flavour over a CS‐ flavour by pairing CS+ intake with the consumption of a starch solution (16% Polycose). A second group was exposed to the same training but preference conditioning was prevented by inhibiting starch digestion with the drug acarbose. The rats were next given aversion training; the CS+ flavour was now paired with toxicosis (LiCl injection) while the CS‐ flavour paired with a control treatment (NaCl injection). The results of two‐choice tests revealed that aversion training produced significant avoidance of the CS+ flavours in both the group that had acquired a preference for this flavour as well as in the no‐preference group. The value of using conditioned flavour preferences as targets for aversions to model the aversion therapy approach to alcoholism is discussed.
Kava use in Australia
Authors: Prescott John
Published: July 2006

The use of the traditional South Pacific beverage kava by Australian Aboriginal communities is discussed. There are few systematic data on the effects of kava, although there has been recent concern regarding its health consequences. The role of the traditional context in minimizing any adverse effects of kava is discussed. It is suggested that government intervention in prohibiting kava use is probably inappropriate particularly with our current state of knowledge.
Anthropological reflections on youth drug use research in Australia: what we don't know and how we should find out
Authors: Moore David
Published: July 2006

This paper outlines an anthropological/sociological view of youth drug use which complements the existing research paradigm. The limitations of the existing paradigm are identified and an argument is presented for the inclusion of ethnography as a fruitful research method and for a greater focus on the social context of drug use by youth. Finally, the implications of this re‐direction for future research and prevention are outlined.
Recent advances in health professional training on substance abuse disorders
Authors: LEWIS DAVID C.
Published: July 2006

The trainee health professional is influenced by many factors—personal and family experiences, the effectiveness of the teacher as role model, the attitudes in the institution in which training takes place and the cultural norms of society. Adverse experiences, if any, in these areas can negate the input from training programmes. This is particularly true for training in substance use disorders. In designing curricula in this field it is crucial to identify the core competencies expected at the end of training. ‘Project Adept’, a comprehensive compilation of curriculum materials, is based on such competencies. It emphasizes skills training and an adult learning mode of education. However, to achieve sustained curricular changes, development of a committed faculty is essential. Training must be complemented by systematic programmes of early diagnosis and treatment for substance use disorders in teaching hospitals. The need to train generalist physicians and to focus on early intervention have been endorsed by the recent Institute of Medicine report on the treatment of alcohol problems. [Lewis D. Recent advances in health professional training in substance use disorders. Drug Alcohol Rev 1991; 10: 45‐53]
Goals for medical education on drugs and alcohol for the year 2000
Authors: WEBSTER IAN W.
Published: July 2006

The issues involved in teaching about drug and alcohol issues in medical schools incorporate a wide range of concerns. Any attempt to raise the proficiency of doctors in dealing with drug and alcohol problems must begin during their basic training, and impart the skills to continue learning after graduation. The principles of community medicine are especially relevant to education in drug and alcohol problems, and basic teaching techniques must be examined as well as course content when reviewing current ideas about drug and alcohol education in medical schools. [Webster IW. Goals for medical education on drugs and alcohol for the year 2000. Drug Alcohol Rev 1991; 10: 55‐61]
Remedies for alcoholism and substance abuse; an overview
Authors: MILKMAN HARVEY
Published: July 2006

This paper represents an evolving interdisciplinary approach to addictive phenomena. As we enter the last decade of the twentieth century, it is clear that improved treatment outcomes can occur if remedial efforts are prescriptive. Clinicians must develop the skills to organize individually tailored treatment strategies around the constellation of biological, psychological and social factors that shape each person's unique style of chemical dependence and associated dysfunction. Based on a philosophy that rational clinical practice follows scientific theory solidly grounded in research, this article reviews the literature on individual differences and patterns of substance abuse and effective strategies for their change. In recognition of the multifactorial nature of addiction, the text is organized around a continuum of issues that affect clinical practice: biological factors, prevention and early intervention, multiproblem patients, treatment and the law, and treatment alternatives. [Milkman H. Remedies for alcoholism and substance abuse, an overview. Drug Alcohol Rev 1991; 10: 63‐74]
Alcohol and the brain: recent advances in biomedical research
Authors: SHANLEY BRIAN C.
Published: July 2006

Considerable progress has been made in our understanding of the cellular mechanisms of action of alcohol on the brain, particularly in relation to tolerance and dependence. Tolerance is associated with changes in the composition of the gamma‐aminobutyric acid‐benzodiazepine receptor, making it less sensitive to alcohol. An increased density of excitatory glutamate receptors may underlie certain withdrawal manifestations. Other neuroadaptive mechanisms include an increase in presynaptic calcium influx on depolarization and effects on adenylate cyclase. Alcohol also influences the expression of a proto‐oncogene which plays an important role in neural development. Further advances in neurobiology offer the prospect of elucidating the mechanisms of tolerance and brain damage. [Shanley B. Alcohol and the brain: recent advances in biomedical research. Drug Alcohol Rev 1991; 10: 75‐78]
The diagnosis of alcohol‐related brain damage: a retrospective study in alcoholics undergoing in‐patient rehabilitation
Authors: CANARIS CHRISTOPHER , JURD STEPHEN
Published: July 2006

Alcohol‐related brain damage (ARBD) is a common and prognostically relevant complication of alcohol dependence. Clinical sensitivity for ARBD by routine mental state examination (MSE) is important, but unlikely given the documented insensitivity of the MSE in detecting less subtle disorders. We sought to determine the predictive capacity of a well‐documented MSE in 32 detoxified alcohol‐dependent patients who had undergone neuropsychological testing. Seventeen patients were found to have impaired performance on neuropsychological testing. The initial medical diagnoses and short‐term memory tests did not correlate with neuropsychological findings. Ratings of the non‐memory component of the MSE were a weak predictor of neuropsychological impairment. In the absence of any adequate ‘screening’ procedure, we conclude that all alcohol‐dependent patients should be considered at high risk for ARBD and require full investigation. [Canaris C, Jurd S. The diagnosis of alcohol‐related brain damage: a retrospective study in alcoholics undergoing in‐patient treatment. Drug Alcohol Rev 1991; 10: 85‐88]
Detoxification: the basis of current practice
Authors: FOY AIDAN
Published: July 2006

With chronic use of a psychoactive drug the central nervous system undergoes a series of changes. These changes vary both in nature and in extent with each drug, but in general, they alter the responsiveness of the nervous system to the drug so as to reduce the perceived clinical effect, and also alter the innate responsiveness of the affected neurons to various stimuli. With cessation of drug use the nervous system undergoes a natural healing which consists of a restoration of normal responsiveness, but this process takes some time during which the patient's responses are abnormal and they are vulnerable to a variety of stressors. Detoxification is the safe negotiation of this period. [Foy A. Detoxification: the basis of current practice. Drug Alcohol Rev 1991; 10: 121‐125]
Biological markers of alcoholism
Authors: WHITFIELD J. B.
Published: July 2006

Biological markers are biochemical or physiological characteristics which may help to classify a person according to the presence or absence of some disease or risk of disease, either with respect to their current status or future susceptibility. Many biological markers related to alcoholism have been described; this review suggests a classification of them and indicates areas where they are well‐established and other areas where further investigation may be useful. [Whitfield JB. Biological markers of alcoholism. Drug Alcohol Rev 1991; 10: 127‐135]
Towards a model for the provision of comprehensive services for non‐English speaking communities
Authors: RISSEL CHRIS , ROWLING LOUISE
Published: July 2006

People from non‐English speaking backgrounds (NESB) tend to utilize Australian health and welfare services less than those people born in Australia. There is also evidence that migrants to Australia tend to increase their consumption of alcohol and other drugs once they have settled. Therefore, NESB people should be a priority focus for the provision of comprehensive services for the prevention and treatment of alcohol and other drug‐related problems. To date there has not been a co‐ordinated approach to the provision of alcohol and other drug services to NESB communities. This paper proposes a model for the provision of such services, and uses the Sydney Arabic‐speaking Lebanese community as an example. This model draws upon available literature and incorporates strategies of community development, namely networking and dissemination of information, and directs efforts at three levels of intervention. [Rissel C, Rowling L. Towards a model for the provision of comprehensive services for non‐English speaking communities. Drug Alcohol Rev 1991; 10: 137‐149]
Alcohol and driving: is the 0.05% blood alcohol concentration limit justified?
Authors: HOWAT PETER , SLEET DAVID , SMITH IAN
Published: July 2006

This paper reviews the findings of experimental and laboratory research to determine whether there is sufficient evidence to support a uniform 0.05% blood alcohol concentration (BAC) as the legal limit for driving. Statistically significant and meaningful decrements in driving‐related performance were identified at 0.05% BAC or below in many studies. Younger and inexperienced drinkers and drivers appear to be at greatest risk for alcohol‐related traffic crashes. It is concluded that on scientific grounds, there is support for setting the legal limit at 0.05%. The setting of a uniform 0.05% BAC statutory limit should be but one effort within a comprehensive approach including other legal, social, behavioural and environmental strategies to deal with the drink driving problem. [Howat P, Sleet D, Smith I. Alcohol and driving: is the 0.05% blood alcohol concentration limit justified? Drug Alcohol Rev 1991; 10: 151‐166]
Metabolism of ethanol and associated hepatotoxicity
Authors: LIEBER CHARLES S.
Published: July 2006

Over the last three decades, direct hepatotoxic effects of ethanol were established, some of which were linked to redox changes produced by NADH generated via the alcohol dehydrogenase (ADH) pathway and shown to affect the metabolism of lipids, carbohydrates, proteins, and purines. It was also determined that ethanol can be oxidized by a microsomal ethanol oxidizing system (MEOS) involving a specific cytochrome P‐450; this newly discovered ethanol‐inducible cytochrome P‐450 (P‐450IIE1) contributes to ethanol metabolism, tolerance, energy wastage (with associated weight loss), and the selective hepatic perivenular toxicity of various xenobiotics. Their activation by P‐450IIE1 now provides an understanding of the increased susceptibility of the heavy drinker to the toxicity of industrial solvents, anaesthetic agents, commonly prescribed drugs, over‐the‐counter analgesics, and chemical carcinogens. P‐450 induction also explains depletion (and toxicity) of nutritional factors such as vitamin A. As a consequence, treatment with vitamin A and other nutritional factors is beneficial, but must take into account a narrowed therapeutic window in alcoholics who have increased needs for nutrients and also display an enhanced susceptibility to some of their adverse effects. Acetaldehyde (the metabolite produced from ethanol by either ADH or MEOS) impairs hepatic oxygen utilization and forms protein adducts, resulting in antibody production, enzyme inactivation, and decreased DNA repair. It also stimulates collagen production by the vitamin A storing cells (lipocytes) and myofibroblasts, and causes glutathione depletion. Supplementation with S‐adenosyl‐L‐methionine partly corrects the depletion and associated mitochondrial injury, whereas administration of polyunsaturated lecithin opposes the fibrosis. Thus, at the cellular level, the classic dichotomy between the nutritional and toxic effects of ethanol has now been bridged. The understanding of how the ensuing injury eventually results in irreversible scarring or cirrhosis may provide us with improved modalities for treatment and prevention.
Pain and addiction
Authors: BELL JAMES
Published: July 2006

In a society which is drug‐orientated yet is committed to a ‘War on Drugs’, guidelines for prescribing narcotic analgesics are marked by division and inconsistency. A fear of engendering an addiction leads to anxiety in doctors about prescribing these analgesics and to the inadequate treatment of pain. The concept of ‘addiction’ is derived from an essentially moralistic view of drug use, and serves as a barrier to effective treatment of chronic non‐malignant pain. A biopsychosocial approach to disease provides a better basis for treatment of this type of pain.
Responding to drug and alcohol problems in health professionals, with special reference to Ontario
Authors: RANKIN JAMES G.
Published: July 2006

Concern has been expressed about alcohol and drug problems among health professionals because of the possibility of professional impairment, although there has been no evidence of increased legal suits by patients against such individuals. Alcohol and drug problems among health professionals were recognized but usually ignored by health professional organizations, except for sporadic disciplinary action, until the mid‐1970s. At that time, important initiatives took place, particularly in the USA. Approaches developed so far by health professional groups to help their members with alcohol and drug problems can be broadly categorized as either coercive/therapeutic/disciplinary or therapeutic. The former approach is exemplified by US programs for physicians, and the latter by the approach to that profession in Canada. It is suggested that the employee assistance model is an alternative approach that could be adopted by health professionals, and that this model could be expanded to a health promotion/prevention/assistance model. Although there has been significant progress in the development of programs in Ontario to help health professionals with alcohol and drug problems, this development is faltering because of lack of support from health professional organizations.
Morals, science and chance
Authors: DREW LES R. H.
Published: July 2006

The importance of paradigms (models, hypotheses) is emphasized. It is proposed that the reductionist model has dominated the addiction field to the exclusion of existentialist models. The limits of reductionism (typified by the 1980 WHO model of alcohol and other drug use) are explored. Attention is drawn to the characteristics of complex dynamic systems, including their sensitivity to small changes in any factor and the unpredictability of their outcomes. The importance of the capacity of individuals to make choices and the role of chance (both external and internal) is highlighted. The implications for therapy are explored. It is affirmed that therapy is, and will always be, an art, but the technical competence of the therapist can influence effectiveness.
Effect of television advertising of alcohol on alcohol consumption and intentions to drive
Authors: Wilks Jeffrey , Vardanega Angelo T. , Callan Victor J.
Published: July 2006

The alcohol consumption of 120 male and female college students was measured as they viewed a 90‐min videotape of popular prime‐time television programmes. Independent measures were the sex of the student, their drinker classification (light or moderate‐heavy) and the number of alcohol advertisements (0, 6, 12) shown during the screening of the television programmes. Dependent measures were the number of drinks consumed, and the intentions of students to drive a motor vehicle after viewing the videotaped programmes. As predicted, males consumed more alcohol than females, and moderate‐heavy drinkers consumed more than light drinkers. Male and female students who viewed six alcohol advertisements consumed more alcohol than students shown no alcohol advertisements or 12 alcohol advertisements. Analysis of intentions to drive after viewing the programmes revealed that the number of drinks consumed was not a significant covariate of driving intentions. Rather light drinkers of both sexes were less likely to intend to drive than moderate‐heavy drinkers. Males exposed to alcohol advertisements were less likely to intend to drive than males who did not view alcohol advertisements. Different levels of exposure to alcohol advertisements did not influence the driving intentions of college females.
Distinguishing primary and secondary disorders in studies of alcohol dependence and depression
Authors: Gorman D. M.
Published: July 2006

This paper is concerned with the relationship between alcohol dependence and depression, and more specifically with the issue of which criteria should be used in distinguishing primary and secondary disorders. The data presented indicate that borderline or subclinical depression frequently precedes the onset of alcohol dependence. This finding is discussed in terms of previous studies, which show that depression is generally secondary to alcohol dependence. Such studies have focused almost exclusively on severe forms of depressive disorder, and, it is argued, used inappropriate criteria to designate the onset of alcohol dependence (e.g. withdrawal phenomena and alcohol‐related problems). In contrast to previous studies, the present paper indicates that subclinical episodes of depression should be assessed by clinicians as possible predisposing factors in the development of alcohol dependence. In addition, it is argued that research designed to establish whether alcohol dependence is a primary or secondary disorder when it occurs in the presence of an accompanying psychiatric disorder should measure onset in terms of changes in behaviour such as giving‐up existing interests in order to spend time drinking and consuming more alcohol than former companions.
Alcoholism and family interaction
Authors: Schweitzer Robert , Wilks Jeffrey , Callan Victor J.
Published: July 2006

In 16 families, half of which had an alcoholic parent, both parents and an adolescent were videotaped interacting with each other. Mothers, fathers and the adolescent in each family viewed the videotaped interaction and completed ratings of themselves and the other two family members on levels of anxiety, involvement, dominance and friendliness. In families with an alcoholic parent, adolescents and their mothers rated family members as less anxious than did adolescents and mothers in families without a drinking problem. Also mothers in the alcoholic families rated family members as being more involved, and their ratings were higher than mothers in other families. Alcoholic families rated parent‐adolescent interactions as more dominant and friendlier. At least in these videotaped interactions where alcohol was not being consumed, mothers in alcoholic families adopted a more positive view of family members than mothers in other families. In addition, possibly due to the efforts of fathers not to drink and memories of interactions when he was drunk, alcoholic families perceived their family interactions as more dominant and friendlier than families without an alcohol‐related problem.
‘Horse trading’: prescribing injectable opiates to opiate addicts. A descriptive study
Authors: Battersby Malcolm , Farrell Michael , Gossop Michael , Robson Phillip , Strang John
Published: July 2006

The clinical audit of 40 opiate‐dependent individuals who were prescribed injectable drugs (heroin or methadone) between June 1987 and June 1989 is described. These subjects were characterized by the chronicity of their injecting and dependent opiate use, and by their refusal to comply with a treatment programme involving oral‐only prescribing. The key aim was to attract entrenched injectors into contact with treatment services and to promote movement away from injecting drug use and reduce HIV risk behaviour. On review 35 of the original 40 were either still receiving an injectable prescription or injecting illicit drugs. Despite this 14 (35%) were rated as making positive life changes. Nine (22.5%) had been admitted to the in‐patient unit and became drug free during their stay. The stability of the lives of eight (20%) had deteriorated. The benefits and drawbacks of this form of intervention are discussed with comparison to the other studies of injectable drug prescribing.
A comparison of private and public methadone maintenance patients
Authors: Caplehorn John R. M.
Published: July 2006

A study was undertaken to examine claims that unsuitable individuals were being admitted into private methadone maintenance programs in New South Wales in late 1985, early 1986. A comparison was made of interview data collected by an independent team of researchers from 457 private and 91 public patients. Exhaustive attempts were made to identify individuals who failed current official admission criteria. While there were statistically and clinically significant differences between private and public methadone patients, there was no evidence that unsuitable individuals were being admitted into maintenance. The data and a review of the literature suggest that the rapid expansion of private sector methadone programs allowed suitable individuals more immediate and more equitable access to maintenance treatment.
Drug testing in the Australian workplace: overview of the issues
Authors: Blaze‐Temple Debra
Published: July 2006

This paper is an overview of the issues surrounding employee drug testing programs as they apply to the Australian workplace. Drug testing may be seen within a historical context of control over workers. Its practice is most prevalent in the USA, but it is also occurring in Australia, Canada and England. It is undeniable that alcohol and other drug use causes significant problems in many workplaces, though the apparently substantial costs to industry and the prevalence of drug use among workers are difficult to estimate with any degree of precision. Drug testing programs in the workplace appear to have majority public support in the USA and are even supported by some unions in Australia and the USA; there are, however, critics of the programs. The evaluation evidence to date is sparse, but is promising in that it suggests that drug testing programs can be responsible for reducing the prevalence of drug use among workers as well as dramatically reducing company costs for absenteeism, accidents and medical insurance claims. However, due to methodological shortcomings one cannot state conclusively that drug testing programs are as effective as they appear to be. Research using more rigorous designs and generating data that can be compared across studies is needed. Distasteful though drug testing is, we may see benefits in its use, similar in concept to random breath testing on our roads. Many of the procedural and legal problems in early US programs have been eliminated, refinements which should assist Australians. The legal issues, however, are quite different in Australia. A drug testing program should not be the sole remedy for reducing alcohol and other drug problems in the workplace and such a program must also be accompanied by rehabilitation and educational components. Ethical issues are briefly discussed.
The early alcoholism treatment movement in Australia, 1859‐1939
Authors: Lewis Milton J.
Published: July 2006

Advancing ideas pioneered in the United States of America, Australian medical reformers and their lay supporters persuaded colonial governments in the late nineteenth century to recognize that alcohol dependence was a treatable disease. In practice, that recognition was only partial. While inebriates legislation was enacted, the state never provided sufficient resources for adequate specialized treatment facilities to be developed. By the 1930s, the first wave of enthusiasm for specific institutional treatment of alcohol dependence had receded, and the treatment movement was in decline. Reasons are suggested for the failure of the movement.
Alcohol and recreational drug use by HIV‐seropositive homosexual men
Authors: GUINAN JAMES J. , HALL WAYNE , CLARKE J. CHRISTOPHER , GOLD JULIAN
Published: July 2006

The objectives of this study were to describe the patterns of alcohol and recreational drug use of HIV‐seropositive homosexual men and to determine the effect of alcohol use on HIV risk‐taking behaviour. Of particular interest was the effect of knowledge of HIV status on these behaviours. Information on alcohol and drug use was obtained from 485 HIV‐seropositive homosexual and bisexual men presenting to a HIV‐antibody testing and medical management clinic. Heavy alcohol use was common, with 46.2% reporting consumtpion of six or more standard drinks on one day recently. Men who knew that they were HIV infected drank significantly more than those men who had yet to learn of their HIV status at the time of interview. There was clear evidence in this study for a role of alcohol use in HIV risk‐taking behaviour. Almost one‐third (27%) of the HIV‐seropositive men reported unprotected anal intercourse during the previous 3 months with approximately one‐third of these (27/76, 35.5%) nominating alcohol as contributing to their high HIV‐risk behaviour.
Establishing a drug and alcohol service in an Australian rural area
Authors: HELLIWELL DAVID , REILLY DAVID , RIPPINGALE CHRISTOPHER
Published: July 2006

The response to drug and alcohol problems in a small Australian rural community is described. The town of Nimbin, the centre of this community, is characterized by alternative life‐styles. The area has received considerable publicity over illicit drug use, particularly marijuana‐growing and a recent increase in injecting drug usage. The town has one medical practice with two general practitioners and this centre has been actively involved in the development of drug and alcohol services. This paper describes the development of a drug and alcohol service from the perspective of a local general practitioner. Reference is made to problems of community resistance, hospital issues and the steps taken to acquire knowledge and skills in the management of patients presenting to the practice. The importance of a multidisciplinary team approach in the development of services which included a needle and syringe exchange and a methadone treatment programme is emphasized.
Neurochemical studies of hepatic encephalopathy
Authors: MADDISON JILL E.
Published: July 2006

Despite intensive research, the neurochemical basis of hepatic encephalopathy (HE) has not been defined. Theories that are currently favoured to explain the cerebral dysfunction that accompanies acute or chronic hepatic failure include: (1) ammonia acting as the putative neurotoxin; (2) perturbed monoamine neutrotransmission as a result of altered plasmo amino acid metabolism; (3) an imbalance between excitatory amino acid neurotransmission, mediated by glutamate, and inhibitory amino acid neurotransmission, mediated by γ‐aminobutyric acid (GABA); and (4) increased cerebral concentrations of an endogenous benzodiazepine‐like substance. Studies of amino acid neurotransmitter receptors in HE have yielded conflicting results. The majority of studies in different animal models of acute and chronic HE and in patients have reported that brain GABA receptor density and affinity are unchanged. There have been fewer studies of excitatory amino acid receptors and these have also yielded conflicting results. However, the majority suggest that components of the glutamate receptor system are perturbed in HE. Further investigation is required to determine the significance of these findings to the pathogenesis of HE. [Maddison JE. Neurochemical studies of hepatic encephalopathy.
She who pays the piper calls the tune
Authors: Wodak Alex
Published: July 2006

Alex Wodak
A 12‐month prospective comparison of court‐diverted with self‐referred heroin users
Authors: DESLAND MALCOLM L. , BATEY ROBERT G.
Published: July 2006

Forty‐seven heroin users referred by the Drug and Alcohol Court Assessment Programme (DACAP) were compared with 45 self‐referred heroin users at 13 months post‐presentation. Data at presentation indicated distinct subpopulations were generated by each referral source. Differences were recorded in age, heroin use, marital status, educational level, employment history and age of onset of anti‐social behaviour. The DACAP scheme exerted an earlier health intervention effect in a sample experiencing dysfunction in other areas, principally legally and socially. Prospective data demonstrated that both samples reported significant reductions in the proportion using heroin. Differences between samples evident at presentation were expressed prospectively, in rates of employment, incarceration and involvement in methadone maintenance programmes. The limitations of diverting clientele from the legal system to the treatment system is discussed in light of these results.
Risk of benzodiazepine dependence resulting from hospital admission
Authors: HECKER ROBERT , BURR MICHAEL , NEWBURY GLORIA
Published: July 2006

Benzodiazepines may result in dependence after relatively brief periods of prescription. This study reports the continued use of either temazepam or nitrazepam as a hypnotic 3–4 months after the provision of the drug as a discharge prescription following an acute hospital stay. Of 160 patients contacted by telephone (out of 275 given such a prescription on discharge), 68 (42.5%) were still taking the hypnotic when contacted and 23 (14%) of these had not previously used a hypnotic regularly prior to hospital admission. The risks of the use of benzodiazepine hypnotics, particularly in the elderly, are discussed and recommendations made to restrict in‐patient hypnotic use to no more than 5 days at any one time. Patients should be counselled about the risks of the development of dependence and withdrawal insomnia. Discharge prescription of benzodiazepine hypnotics should not exceed three days duration and preferably be avoided altogether.
Injecting drug users and the Human Immunodeficiency Virus: what do we know?
Authors: DARKE SHANE
Published: July 2006

This article examines the results of 10 years of research on the relationship between injecting drug use and the Human Immunodeficiency Virus (HIV). The two main transmission modes of HIV among injecting drug users (IDU)—parenteral drug use and sexual behaviour—are examined in detail, as well as the efficacy of attempted interventions to reduce the spread of HIV among this population.
Mortality of intravenous drug users: attenders of the Wellington Drug Clinic, 1972‐89
Authors: DUKES P. D. , ROBINSON G. M. , ROBINSON B. J.
Published: July 2006

A mortality study of 997 patients registered for treatment at the Wellington Drug Clinic since 1971 was undertaken by examining the New Zealand death records. Sixty‐seven known deaths were reported. The mortality rates were increased 11.5 times under the age of 25 years, and 5.8 times for age 25–34 years, but not significantly thereafter. There were 7 deaths from trauma, 8 from suicide, and 28 accidental deaths. Myocarditis was the cause of death in four cases. In the 28 drug‐related deaths the principle drugs incriminated were dextropropoxyphene, barbiturates, chloral hydrate, methadone and other opiates. Twenty‐one deaths were due to unrelated diseases. It was considered important to document mortality in intravenous drug users in the 'pre‐HIV era. This study demonstrates quite low death rates from opioid drugs themselves.
Group therapy in a detoxification unit
Authors: POWELL JANET E.
Published: July 2006

The aim of this study was to discover residents' perceptions of supportive group therapy conducted as part of a week‐long alcohol and other drug detoxification programme. A brief questionnaire was adapted from Yalom's Q sort and administered to 105 residents at the end of group sessions. The instrument elicited ratings of the extent to which each of ten outcomes had occurred. Outcomes rated positively included universality, the instillation of hope, group cohesion and guidance.

The results are interpreted as providing support for the continuation of non‐confrontational group therapy in the detoxification unit, with an increased emphasis on brief advice‐giving.
Cognitive functioning in excessive drinkers: evidence for dissociable impairments
Authors: FOX ALLISON M.
Published: July 2006

This article reviews the evidence for neuropsychological impairments in excessive drinkers. The view that the neuropsychological impairments reflect clinically heterogeneous manifestations of a unitary ‘Wernicke‐Korsakoff complex’ resulting from thiamine deficiency is discounted on the basis of a variety of mediating factors which have been demonstrated to affect the pattern of cognitive abilities and deficits in excessive drinkers. In contrast, this article argues that detailed analysis of the apparent clinical heterogeneity in the cognitive status of these patients may provide a means for determining the most appropriate treatment regime and rehabilitation procedures for an individual. These impairments are applied to a theoretical model of information processing identifying dissociable impairments which have been described as the ‘frontal‐lobe’ and the ‘right hemisphere’ hypotheses of the effects of alcohol on cognitive functioning. Interpretation of research results in terms of functional characteristics rather than localization characteristics is proposed. Two mediating factors, thiamine deficiency and liver dysfunction, are discussed in relation to their differential involvement in these impairments.
Is there more than one neuropsychological disorder commonly associated with alcohol dependence?
Authors: BOWDEN STEPHEN C.
Published: July 2006

There are two popular neuropsychological entities commonly attributed to the effects of alcohol dependence: the well‐known Wernicke‐Korsakoff syndrome, and the putative alcoholic encephalopathy. Wernicke‐Korsakoff syndrome is a highly variable neurological and neuropsychological disorder, which is frequently missed or misdiagnosed on clinical examination. The available prevalence figures suggest that Wernicke‐Korsakoff neuropathology probably occurs with a high incidence in hospitalized alcohol‐dependent people. Thus, Wernicke‐Korsakoff syndrome confounds clinical descriptions of the alcoholic encephalopathy and may account for most cases presumed to suffer from the latter disorder. Even if it is assumed that there is a specific alcoholic neurotoxicity, the clinical descriptions of this condition encompass features which are all attributable to Wernicke‐Korsakoff syndrome. In other words, the proponents of the alcoholic encephalopathy have failed to provide a distinctive description, thus precluding positive identification.
Treatment is an art to which science can contribute: the 2nd James Rankin Oration
Authors: DREW LES R. H.
Published: July 2006

Working models—beliefs—are an essential element of behaviour. Clients' models and non‐scientific treatment models, need to be respected. It is contended that, practically and theoretically, scientific models have little validity or relevance for understanding and managing addictive behaviour. The WHO model of drug use, with two added elements (the self and the functions of choice and decision making; and random variation of neurophysiological activities), is used as an example. The scientific method consists of dissecting a complex phenomenon into simpler parts, testing hypotheses about these parts, collecting and summating the data, and applying the conclusions to individual cases. It is presumed that if we know enough about a person then we can predict their future behaviour, including response to therapeutic interventions. Four major arguments are produced against that presumption. The scientific method depends upon the use of meaningful numbers (representing discrete, replicable categories) and its results are presented in statistical formats (with limited individual relevance). Measurement in the behavioural sphere is neither precise nor objective. This is critical with complex interactive systems (such as the WHO model) in which an apparently insignificant change in input can result in dramatic changes in output. Progress may have been made technically, e.g. to reduce relapse, but therapy remains an art. In future, scientific endeavours should be complemented by attention to other disciplines.
The effect of random breath testing on perception of likelihood of apprehension and on illegal drink‐driving
Authors: MOORE VIVIENNE , BARKER JENNIFER , RYAN ANTHONY , MCLEAN JACK
Published: July 2006

This study examines the links between random breath testing (RBT), driver perception of the likelihood of apprehension if illegally drink‐driving, and drink‐driving behaviour in Adelaide, South Australia. It is based on information gained from surveys of night‐time drivers in metropolitan Adelaide, during 1987, 1989 and 1991. Overall, about 25% of the sample in each year thought that illegal drink‐driving was likely to result in apprehension. This perception was consistently lower for males and for those aged less than 30 years than for their counterparts, however, there was evidence that it increased with exposure to RBT, notably when that exposure was recent. Also, compared with other drivers, fewer drivers who thought that apprehension was likely had an illegal blood alcohol concentration (BAC) when surveyed, or reported that they would be likely to drive if they thought that they had an illegal BAC. However, the majority of drivers who thought that detection was unlikely also reported that they would be unlikely to drink‐drive. These results suggest the need for some re‐direction of current RBT activities.
The genetic transmission of alcoholism: implications for prevention
Authors: NOBLE ERNEST P.
Published: July 2006

Evidence obtained from adoption and twin studies suggests an important hereditary component in alcoholism. Following our initial observation that the Al allele of the D2 dopamine receptor (DRD2) gene was associated with alcoholism, a number of studies, both in the United States and abroad, have attempted to replicate and extend this finding in different Caucasian populations. In eight independent studies containing a total of 444 heterogeneous alcoholics (less severe and severe) and 495 heterogeneous controls (alcoholics excluded or not excluded), the prevalence of the Al allele was 45.5% in the former group compared to 25.7% in the latter group (p < 10−7). In 176 severe alcoholics and 176 controls free of alcoholism, the prevalence of the Al allele was 49.4% in the former group compared to 17.0% in the latter group (p < 10−8). The severity of alcoholism and the types of controls used are key determinants in Al allelic association with alcoholism. The total evidence at hand suggests that the DRD2 Al allele may represent the most prominent single gene determinant of susceptibility to severe alcoholism. However, the larger role is still played by environmental factors and other genes.
Rites of passage: smoking and the construction of social identity
Authors: BANWELL CATHY L. , YOUNG DORIS
Published: July 2006

The following article, based on a qualitative study of young women from a Melbourne suburb, is concerned with the role smoking plays in the presentation of social identity. These women, in their early teens, are viewed as being in the liminal or transitional phase of a rite of passage to adulthood. The passage to adulthood is attained with the construction of a social identity corresponding to popular notions of the feminine, which fall into the familiar categories of the bad and good woman. Smoking is one of the props in the stereotypical representation of the bad woman. Conventional anti‐smoking health messages have little relevance for young women who have chosen such a social identity for themselves.
Multiple drug use by older people: exploring the health development and political economy perspectives
Authors: LEGGE DAVID G. , BAMMER GABRIELE
Published: July 2006

The use of multiple medications by a large number of older people provides grounds for concern in terms of quality of life as well as cost. We argue that problems faced by older people are being over‐medicalized in a manner that palliates and obscures social causes such as loss of income, the falling away of social support and a discounted role in society. Primary health care is a policy model for the development of health services which offers a credible strategy for addressing clinical problems associated with growing old in ways that also contribute to recognizing and addressing social and structural problems that may be expressed in people's private troubles.
Giving away the grog: an ethnography of Aboriginal drinkers who quit without help
Authors: BRADY MAGGIE
Published: July 2006

The paper presents preliminary findings from a qualitative study of Australian Aboriginal men who have stopped drinking without the assistance of residential treatment, counselling or other programs. Main reasons advanced by interviewees for ceasing drinking were one or more of: medical condition and/or doctor's warning; family factors; trauma from accidents; conversion to Christianity. The author concludes that employment both helps and hinders abstention from drinking, and that social ties often pose major difficulties for those trying to give up drinking. The paper also discusses the importance of Aboriginal beliefs regarding personal autonomy.
Predictors of unsafe injecting drug use
Authors: Crisp Beth R. , Barber James G. , Ross Michael W. , Wodak Alex , Gold Julian , Miller M. E.
Published: July 2006

This paper reports on the incidence of unsafe injecting and the factors which influence this practice in a sample of 1245 Sydney injecting drug users (IDUs). Using a needle and syringe after someone else at some time in the last six months was reported in 41.6% of the sample. Taking into account those who claimed always to clean used needles with virucidal methods, 32.9% had placed themselves at risk of HIV infection from shared needles in the six months prior to interview.

Seven factors were predictive of unsafe behaviour. These were (a) the amount spent per week on drugs, (b) the number of times a single needle was used prior to disposal, (c) having shared with a person who is now HIV infected, (d) having a regular sexual partner, (e) the proportion of times high, stoned or drunk when injecting, (f) being part of a group that injects together and (g) having been in prison.
Structure of the MAST with an Australian sample of alcoholics
Authors: Crook Gabrielle M. , Oei Tian P. S. , Young Ross Mac
Published: July 2006

The dimensionality of the Michigan Alcoholism Screening Test (MAST) was examined utilizing an Australian sample (n = 196) of alcoholics. This study was specifically designed to overcome some of the problems with sampling and analytic techniques used in previous studies. Three moderately intercorrelated factors were revealed which covered (a) alcohol‐related disabilities; (b) help‐seeking behaviour and (c) recognition of a drinking problem. These factors were found to be internally consistent as shown by moderate to high alpha coefficients. Results indicate that the additive system of scoring all 24 items may result in an underestimation of the information afforded by the MAST.
Young offender drug use: knowledge and perceptions of Juvenile Justice Centre youth workers
Authors: Howard John , Zibert Ernie
Published: July 2006

Juvenile Justice Centre youth workers in New South Wales (n = 106) were surveyed by questionnaire as to their knowledge and perceptions of alcohol and other drug issues of those in their care. Some background variables were also collected. About 30% of the sample reported having (had) a problem with alcohol and/or other drugs and approximately the same percentage came from families with such a problem. Over 50% had received some form of drug education. There was an overestimation of the level of use of narcotics, sedative/hypnotics, anti‐anxiety agents and hallucinogens of the youth workers and an underestimation of the level of use of analgesics, alcohol, cannabis and inhalants. Peer pressure was perceived as central in the initiation of use and “denial” in not gaining assistance; the style and belief systems of agencies were not seen as crucial in retaining young people in treatment. Youth workers, who are not required to have any specific education or training prior to employment, did not see themselves as well equipped to assist drug‐affected or detoxifying detainees and requested more training/education. It is recommended that this could be provided through tertiary courses and/or in‐service staff development.
Differences in assessment and treatment approaches for homosexual clients
Authors: MacEwan Ian
Published: July 2006

This study was undertaken to discover the similarities and the differences in assessment and treatment approaches for heterosexual and for homosexual clients. The purpose of the study was to investigate to what extent sexual orientation is incorporated into treatment plans and what effect this had for treatment outcomes. Responses to nine questions were obtained from 50 self‐reporting heterosexual and 50 self‐reporting homosexual clients of a range of treatment providers. Differences were found at each stage of the assessment and treatment process. There was evidence of sexual orientation not being utilized as a treatment factor. For both groups there was evidence of inadequate significant‐other involvement in treatment and post‐treatment planning.
The use of benzodiazepines among injecting drug users
Authors: Darke Shane
Published: July 2006

Benzodiazepine use among injecting drug users (IDUs) presents a major clinical and public health problem that may increase in importance. The current paper examines the research on the extent of benzodiazepine use among IDUs and the harmful consequences associated with such use. Numerous studies have found benzodiazepine use to be widespread among IDUs, and to be associated with greater levels of risk‐taking and polydrug use, and poorer psychosocial functioning than other IDUs. The injection of benzodiazepines has also been reported, and presents problems in itself. The implications of existing research for both clinical practice and research are discussed.