bluuebunny/crossref_metadata_2025 huggingface dataset:
A bioinformational systems perspective on tobacco dependence
Authors: NIAURA RAYMOND , GOLDSTEIN MICHAEL , ABRAMS DAVID
Published: January 2006

Recent thinking about tobacco dependence has been influenced largely by a focus on the pharmacological effects of nicotine. We advocate a return to earlier views of dependence as comprising both pharmacological and non‐pharmacological aspects. Moreover, we suggest that it may be profitable to reformulate research on dependence in terms of a bioinformational process model. The basic tenets of such a model are outlined, as are the challenges in exploring the nature of dependence simultaneously across the cognitive, physiological and behavioral domains of function.
The future of nicotine replacement
Authors: RUSSELL MICHAEL A. H.
Published: January 2006

Following in the wake of progress forged by nicotine chewing gum, a new generation of nicotine replacement products will soon be available as aids to giving up smoking. These range from nicotine skin patches, which take 6–8 hrs to give very flat steady‐state peak blood levels, to nicotine vapour inhalers which mimic the transient high‐nicotine boli that follow within a few seconds of each inhaled puff of cigarette smoke. Other products undergoing clinical trials include a nasal nicotine spray and nicotine lozenges. It is argued here that it is not so much the efficacy of new nicotine delivery systems as temporary aids to cessation, but their potential as long‐term alternatives to tobacco that makes the virtual elimination of tobacco a realistic future target. Their relative safety compared with tobacco is discussed. A case is advanced for selected nicotine replacement products to be made as palatable and acceptable as possible and actively promoted on the open market to enable them to compete with tobacco products. They will also need health authority endorsement, tax advantages and support from the anti‐smoking movement if tobacco use is to be gradually phased out altogether.
High retention rates within a prospective study of heroin users
Authors: DESLAND MALCOLM , BATEY ROBERT
Published: January 2006

The process of achieving a high retention rate of subjects in a 12‐month prospective study of intravenous heroin users in Sydney, Australia is presented. Self‐referred heroin users were compared with heroin users from a court diversion programme. The retention rates throughout the prospective study interview schedules were high, ranging from 69 to 83% of the original sample. No statistical differences were detected between the proportions located at each interview, indicating a high retention rate was maintained despite the passage of time. It is argued that contact with State services, i.e. Methadone Maintenance Programmes and the legal system, particularly the prison service, contributed to this high maintenance. It is speculated that the effectiveness of location strategies reflect prominent characteristics of the populations studied.
Alcohol and other drugs: the response of the political and medical institutions
Authors: PITTMAN DAVID J. , STAUDENMEIER WILLIAM J. , KAPLAN ABE
Published: January 2006

Formal and informal social control in shaping individual behaviors toward the use of alcohol and other drugs is discussed. Emphasis is placed on formal social control as it occurs in two major institutions. The state, which embodies the political and legal structures of the society is discussed in terms of the social control of some of the consequences of drinking, such as public drunkenness, alcoholism, operating vehicles with specific blood alcohol levels, and crime and alcohol use. The medical institution's involvement in alcohol and drug control is discussed in terms of the physician's role in diagnosing alcohol and drug dependent individuals. Two contemporary cases, those of pregnant addicts and alcohol‐related organ transplant patients, illustrate the significant interactions between the responses of the political and medical institutions, and the broader influences that help shape these responses.
Addiction as an occupational hazard: 144 doctors with drug and alcohol problems
Authors: BROOKE DEBORAH , EDWARDS GRIFFITH , TAYLOR COLIN
Published: January 2006

Information was abstracted from the hospital notes of 144 doctors who had received treatment for drug and alcohol dependency. These problems affect those in every speciality, and at all degrees of seniority. Over half came into treatment following medical referral. Social morbidity was an important contributory reason for seeking help. The mean age at presentation was 43.1 years; the mean duration of problematic use prior to this was 6.4 years for drug misusers and 6.7 years for alcohol misusers. Alcohol was the current problem for 41.6% and drug misuse for 26.4%; 31.3% were misusing both alcohol and drugs at presentation. Of the 83 subjects who were misusing drugs, only four had ever used blackmarket supplies. Psychotropic agents are readily available to doctors, but the consequences of this are not addressed. Those who develop dependency suffer a delay of years before reaching help.
Cannabis psychosis following bhang ingestion
Authors: CHAUDRY HAROON RASHID , MOSS HOWARD B. , BASHIR AMIR , SULIMAN TAHIR
Published: January 2006

The purpose of this preliminary investigation is to systematically characterize the signs and symptoms of cannabis psychosis in individuals who presented for psychiatric treatment in Pakistan after ingestion of bhang; a beverage containing cannabis. In order to control for the behavioral effects of cannabis alone, symptoms produced by bhang ingestion among non‐patients consuming the same beverage were compared with those symptoms found among psychotic patients. Patients differed from controls in that a higher proportion of patients were found to be chronic users of bhang, and had a past history of psychotic episodes. Presenting symptoms of bhang‐induced psychosis found in patients included grandiosity, excitement, hostility, uncooperativeness, disorientation, hallucinatory behavior and unusual thought content. Neuroleptic treatment successfully attenuated psychotic symptoms within five days of the initiation of the episode. The presenting symptoms of bhang‐induced psychosis are consistent with a brief mania‐like disorder with paranoid psychotic features, and cognitive dysfunction. Several etiologic hypotheses are proposed.
Looking for Context
Authors: Hore B. D.
Published: January 2006

Abstract. This article should be considered not in isolation but in a context of private health provision in general, and examined from an international standpoint. In the UK there has been a growth of private health care and as pan of this growth, it is likely that patients with problems of alcohol and drug misuse will choose private facilities, which now increasingly exist. Patterns of treatment in any country are based on historical traditions. Thus in the UK the principle NHS response has been to provide specialised alcoholism treatment units, which increasingly provide out‐patient and day facilities, as well as in‐patients. Although there has been criticism of these units, they remain the principle approach. In West Germany in‐patient treatment has been the norm. In other countries in Northern Europe emphasis has been on out‐patient treatment with a strong social bias. More important, however, is that clearly patients with alcohol or drug problems, once they recognise such problems, wish to attend a treatment facility where they feel they will receive expert treatment. Their experience with non‐specialized agencies is often said to be negative and it is not surprising if they turn towards such specialized units, in the same way as patients with other medical conditions all seek specialist expertise. Patients are hardly likely to have analyzed research studies on effectiveness of treatment and it is questionable whether many studies alleging failure of treatment take into account poor compliance. Both on historical, traditional and common sense lines it is, therefore, likely that people will pursue private treatment, despite what so called experts say.
Look for simpler techniques of proven value
Authors: Ritson E. B
Published: January 2006

Abstract. Dr Curson understandably casts doubt on the cost effectiveness of many popular private residential treatments for substance misuse disorders. This re‐appraisal of the role of the private sector could provide an opportunity for treatments investment in early detection and simple intervention strategies, which could be marketed widely throughout the health care system.
Reply by Dr David Curson: Attacks exaggerated but questions asked
Authors: Curson David
Published: January 2006

Abstract. When invited to write this editorial it was suggested that I “stir up questions, challenge complacencies, and fly kites”. The responses suggest that I have achieved what I was asked to do. Dr Hore Interprets my editorial as an attack on in‐patient treatment. This was never my intention. Some patients certainly need to be hospitalized. Some do not. If Dr Hore blames the patient for treatment failure, who gets the credit for success and when will patients be asked to comment on the “value of their treatment”; on discharge, after 1 year, after 10 years, or after 20 years? Both the Ditzlers and Dr Bloom take exception to my terminology, my criticisms of lay counsellors, and my concerns about research methodology and claimed ‘success rates’. The term ‘brainwashing’ appears in Cook's review of the Minnesota Model (p. 744). Some years ago the National Council on Alcoholism had a strict qualifying rule for those ‘in recovery’ who applied for training as voluntary counsellors: they must have achieved 2 years of sorbriety before embarking on a 2 year period of closely supervised training. Dr Blume's experience in New York is similar to mine, and the Ditzlers and Dr Blume clearly share my views about professional standards. Alas, I remain to be convinced that such strict entry criteria, intensive training, and careful supervision are being applied in the private addiction units. No moral arguments are sufficient to excuse unsubstantiated claims that a particular treatment model is superior when it results in attracting patients who pay for it. I am not “engaged in a joyful anticipation of the demise of the private treatment system in Great Britain”. I wish it to flourish–but honestly and on a firmer scientific footing. When referring to studies of outcome Professor Edwards observes that “within that longitudinal perspective, it is absurdly medico‐centric to suppose that ‘treatment efficacy’ is the single important question. Treatment is more accurately conceived as being at best a timely nudge or whisper on a long life course”. The questions posed by my article are how big a nudge, how often, from whom, and how much should each nudge cost?
Increased severity of alcohol withdrawal in in‐patient alcoholics with a co‐existing anxiety diagnosis
Authors: JOHNSTON AMANDA L. , THEVOS ANGELICA K. , RANDALL CARRIE L. , ANTON RAYMOND F.
Published: January 2006

The purpose of this study was to determine whether alcoholics with a co‐existing anxiety disorder (dual‐diagnosed group) experienced different withdrawal symptomatology from alcoholics without an anxiety disorder (alcohol‐only group). Symptoms of alcohol withdrawal were measured on admission to an in‐patient treatment program and throughout treatment (days 0, 2, 7, 14 and 21) using the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA‐Ar) scale. The dual‐diagnosed group exhibited more severe alcohol withdrawal, as indicated by higher total CIWA‐Ar scores, at all time points than the alcohol‐only group. The possibility that anxiety disorders and alcohol withdrawal share a common neurochemical basis and that the CIWA‐Ar scale may be useful as a screening instrument for anxiety disorders in alcoholics is discussed.
Sharing spoons: a risk factor for HIV‐1 infection in Vienna
Authors: LOIMER N. , WERNER E. , PRESSLICH O.
Published: January 2006

Sharing of needles and syringes plays a central role in HIV‐1 transmission among intravenous drug users (IVDUs). There have been several suggestions to protect the injecting population from further harm, but focused mainly on the use of sterile needles and syringes as well as information about safer sexual behavior. This study examined a total of 366 IVDUs at the drug dependence out‐patient ward of the Psychiatric University Clinic of Vienna. HIV‐1 antibodies were found in 29.7% (58) in 1989 and in 26.9% (42) in 1990. The results show that in 1989 14% and in 1990 5% IVDUs who never shared needles or syringes or other drug paraphernalia were found to be HIV‐1 positive. In spite of the high information standard among Viennese drug addicts on risk reduction, the underestimated co‐factors during drug administration might be responsible for a further HIV‐1 transmission. Educational interventions on this subject should address even IVDUs who do not share needles and have adjusted to ‘safer sex’ practices.
Cannabis use in a large sample of acute psychiatric admissions
Authors: MATHERS D. C. , GHODSE A. H. , CAAN A. W. , SCOTT S. A.
Published: January 2006

A sample of 908 patients drawn from two London Psychiatric Hospitals is described in terms of age, sex, self‐reported drug and alcohol history, drug urinalysis results and initial psychiatric diagnosis. Some (34.5%) of respondents admitted to using cannabis at least once in their lifetime and 13% of those tested had urines positive for cannabis on admission. Cannabis use is commoner in young males. These is a higher likelihood that an initial diagnosis of‘psychosis’will be made at admission if patients either report use of cannabis or present a urine sample positive for cannabis.
Determinants of teenage smoking, with special reference to non‐standard family background
Authors: ISOHANNI MATTI , MOILANEN IRMA , RANTAKALLIO PAULA
Published: January 2006

The prevalence of teenage smoking in a cohort of 12 058 subjects born in northern Finland in 1966 is discussed in terms of its social and family determinants, especially in “non‐standard” families (with one or more of the parents absent for at least pan of the child's upbringing). The prevalence of experimental or daily smoking was 67.4%, the rate being 65.5% in the standard, two‐parent families and 75.5% in the non‐standard families, the difference being statistically significant (p<0.001). The corresponding prevalence of daily smoking was 6.4%, but the rate was 5.1% in standard families and 12.1% in non‐standard families (p<0.001). An elevated risk of smoking existed among adolescents who had experienced death of their father or divorce of their parents and among girls who had experienced death of their mother. Maternal smoking during pregnancy and maternal age under 20 years at the time of delivery increased the risk, while being the first‐born child reduced it. Among family factors existing in 1980, paternal smoking increased the risk for both sexes, while more than three siblings, mother's unemployment or gainful employment (i.e. not a housewife) were associated with smoking by the boys as was urban living, and for the girls migration by the family to a town. The results suggest that juvenile smoking may be a kind of indicator of possible problems experienced by the parents and/or the adolescents themselves with respect to parenthood and family development.
A survey of pre‐arrest drug use in sentenced prisoners
Authors: MADEN ANTHONY , SWINTON MARK , GUNN JOHN
Published: January 2006

The paper presents the results of a retrospective, self‐report survey of pre‐arrest drug use in a representative sample of 1751 men serving a prison sentence. Reported drugs used were cannabis (34%), opiates (9%), amphetamine (9%) and cocaine (5%), including 1%‘crack’ users. Pre‐arrest injecting was reported by 11% of inmates, including 68% of all opiate users and 57% of amphetamine users.

Drug dependence was reported by 11%, including 7% dependent on opiates, 2% on amphetamines and l% on cocaine. Relative to other drugs, the figure for cocaine is higher than is suggested by a previous clinic survey.

Pre‐arrest cannabis use was reported by 54% of black prisoners and 34% of white. White prisoners are more likely to report use of ‘hard’ drugs, drug dependence and injecting, but this masks a higher rate of cocaine use by black prisoners. Opiate use varied between health regions, from 3% of prisoners in the West Midlands to 25% of those from the Mersey region. These findings have implications for service provision and for an understanding of cultural influences on illicit drug use.
Correlates of human immunodeficiency virus infection in intravenous drug users: are treatment‐program samples misleading?
Authors: ALCABES PHILIP , VLAHOV DAVID , ANTHONY JAMES C.
Published: January 2006

Using a community‐based sample of 1632 intravenous drug users in Baltimore, Maryland, USA, this study evaluated a possible selection bias faced when studying risk factors for human immunodeficiency virus, type 1 (HIV‐1) in intravenous drug users drawn solely from treatment programs. Consenting subjects, recruited by extensive distribution of brochures and word‐of‐mouth, underwent confidential interviews about drug use behaviors in a setting that was independent of community service agencies. Of 1632 subjects, 275 (17%) were currently enrolled in treatment programs. These subjects were similar in many respects to those not currently in treatment, including HIV‐1 seroprevalence; however, they differed in that those not in treatment were more likely to be male, younger and black than those currently in treatment, and to have started injecting drugs more recently. However, associations between HIV‐1 seropositivity and a series of demographic and drug‐using characteristics were mostly similar in direction and magnitude among subjects currently in treatment and those not in treatment. These results suggest that one‐time samples of drug users enrolled in treatment programs do not necessarily present a misleading picture of correlates of HIV‐1 seropositivity.
The prices of alcoholic beverages in the Nordic countries
Authors: HORVERAK ØYVIND , ÖSTERBERG ESA
Published: January 2006

Apart from Denmark, all the Nordic countries have state‐owned monopolies which handle all of the off‐premise retail sales of wine and spirits. In some of the countries, the state monopoly also distributes strong and medium‐strong beer. This paper discusses how the prices of beer, wine and spirits are set in the Nordic countries and compares the setting of prices in each. The paper shows that there are great differences both between the prices of alcoholic beverages in the Nordic countries and between the price‐fixing mechanisms. The main pan of the price differential is due to differences in taxation, but substantial discrepancies still exist when we look at prices exclusive of alcohol taxes. The reason for this is to be found in differences in profits and in the efficiency of producing and distributing alcoholic beverages. According to our data, it seems that some of the state monopolies are more effective than firms in the Danish market.
What happens to drinking after therapeutic intervention?
Authors: DUCKERT F. , AMUNDSEN A. , JOHNSEN J.
Published: January 2006

Eighty‐four men and 51 women who had been recruited to treatment through newspaper advertisements were matched pairwise and randomly assigned to either brief counselling or short‐term group therapy. All participants were followed‐up after 3, 9, 15 and 21 months by personal interviews and medical examinations. The average reduction in alcohol consumption was greatest to start with in the group attending group therapy, but this group experienced greater set‐back during the following period. At 21 months there were no significant differences between the two groups as regards amount of alcohol consumed, GGT‐levels, deaths or number of alcohol‐related hospitalizations. The sample as a whole maintained a significant reduction in alcohol consumption throughout the follow‐up period. At 21 months half of the sample had reduced their consumption with more than 50%, one‐fourth had reduced 20–50%, one‐tenth changed less than 20% and only 18% of the sample had increased their consumption with more than 20% compared with their baseline consumption. The reductions took place mainly by way of less frequent drinking, fewer episodes of heavy drinking and reduced consumption during weeks of moderate drinking. When heavy drinking episodes did occur, there were only minor changes in the amounts consumed.
Tobacco smoking in Moscow school students
Authors: PROKHOROV ALEXANDER V. , ALEXANDROV ALEXANDER A.
Published: January 2006

A cross‐sectional study on tobacco smoking prevalence and related socio‐psychological parameters in Moscow school students aged 10–17 was performed. Data from an anonymous self‐report (n=4802) on smoking prevalence was confirmed by special technique–expert assessment. Widespread smoking was found: among male 5th graders (the youngest group) 14.4% are smokers (those who smoked at least 1 cigarette over the past 3 months); among male 10th graders (oldest group) 53.2% smoke; among females these figures were 0.8% for the youngest students and 28.2% for the oldest ones. A significant difference in awareness of smoking health hazards and attitudes towards the habit was shown among school students with various smoking statuses. Complaints about cough and shortness of breath after light physical stress were significantly more prevalent in regular smokers as compared to non‐smokers. The possible causal role of some psychological factors in early formation of smoking habit is discussed.
AIDS and the transition to illicit drug injection—results of a randomized trial prevention program
Authors: JARLAIS DON C. DES , CASRIEL CATHY , FRIEDMAN SAMUEL R. , ROSENBLUM ANDREW
Published: January 2006

Illicit drug injection is a major component of the AIDS epidemic in the United States, Europe and some developing countries. Prevention of illicit drug injection would not only reduce HIV transmission but would also reduce the other health, psychological and social problems associated with illicit drug injection. One hundred and four subjects who were using heroin intranasally (‘sniffing’) were recruited for a study of the transition to drug injection. Eligibility criteria included sniffing as the most frequent route of administration and no more than 60 injections in the past 2 years. All subjects received thorough basic information about AIDS, including HIV antibody test counseling. Subjects were then randomly assigned to a four‐session social learning based AIDS/drug injection prevention program or a control condition. Eighty‐three subjects were successfully followed at a mean time of 8.9 months. Twenty (24%) of the followed subjects reported injecting illicit drugs during the follow‐up period. Drug injection during follow‐up was associated with being in the control group, intensity of non‐injected drug use, prior injection, and having close personal relationships with current intravenous (IV) drug users.
Psychopathology, stress and HIV‐risk injecting behaviour among drug users
Authors: HARTGERS C. , VAN DEN HOEK J. A. R. , COUTINHO R. A. , VAN DER PLIGT J.
Published: January 2006

The relations between psychopathology (or psychological morbidity) and stress (measured by the GHQ‐30 and VOEG‐13) and HIV‐risk injecting behaviour were investigated among 151 and 166 drug users, respectively, participating in a HIV study in Amsterdam, The Netherlands. Scores indicative of psychopathology were obtained by 72% of respondents. Drug users with psychopathology are older, long‐term polydrug users and injectors, who experience considerable stress. Drug users in the sample also have higher stress levels than the general population, but, in contrast to the general population, stress does not increase with age. Stress is associated with long‐term polydrug use, with cocaine use and with the female sex. Among HIV‐positive injecting drug users (IDU's) no positive relation was found between psychopathology or stress and lending of used needles to others. Among HIV‐negative IDUs only psychopathology is associated with an increased HIV risk. Our findings suggest that HIV‐risk reduction programmes should consider more seriously the role of psychopathology in attempts to persuade drug users to reduce their risks.
Severity of dependence and route of administration of heroin, cocaine and amphetamines
Authors: GOSSOP MICHAEL , GRIFFITHS PAUL , POWIS BEVERLY , STRANG JOHN
Published: January 2006

This study investigates severity of dependence upon heroin, cocaine and amphetamines in a group of 200 heroin users, 75% of whom were not in contact with any treatment agency. For drug takers who were current users of more than one drug, heroin produced more severe dependence than either cocaine or amphetamine and many users of these stimulant drugs reported having experienced no problems of dependence. Severity of dependence was influenced by route of administration as welt as type of drug. Heroin taken by injection was associated with more severe dependence than smoked heroin. For cocaine, injection and smoking were associated with equivalent dependence ratings, and both of these routes were associated with more severe dependence than cocaine used intranasally. For amphetamine, there were no differences in severity of dependence ratings for injection, intranasal or oral use. Severity of dependence was correlated with dose and duration of drug use; it was also associated with previous attendance at a drug treatment agency, though dependence problems were also common among heroin users who had never received treatment. Implications of these findings are discussed.
Adolescent drug sellers: trends, characteristics and profiles
Authors: SMART REGINALD G. , ADLAF EDWARD M. , WALSH GORDON W.
Published: January 2006

This study examines drug setting among representative samples of High school students in Ontario. It involves three approaches, (i) examining the trend in drug selling between 1983 and 1989, (ii) assessing differences between sellers and non‐sellers on demographic characteristics, levels of alcohol and drug use, and problems, and (iii) drawing detailed profiles of drug seller types. Drug selling declined considerably between 1983 and 1989. Sellers were more likely to be males and to use alcohol and drugs more often than non‐sellers. Sellers also had more alcohol and drug problems and engaged in more delinquent acts. Drug sellers who sold cannabis only were less frequent users of drugs, less likely to have drug problems, and were also delinquent.
Unemployment and use of drug and alcohol among young people: a longitudinal study in the general population
Authors: HAMMER TORILD
Published: January 2006

A prospective study of a representative sample of nearly 2000 young people aged 17–20 years was started in 1985. It was followed up twice, in 1987 and in 1989. The Central Bureau of Statistics in Norway was responsible for the data collection. Sixty‐five per cent of the stratified sample (1985) participated in all the three surveys. The aim of this paper has been to explore the relationship between unemployment and the use of drugs and alcohol. The results show that unemployment does not appear to influence the consumption of alcohol. In a high consumption group, unemployment seems to lead to a decrease in alcohol consumption, though there was a clear tendency to increase use of cannabis. The results seem to indicate that there was no increase in use of alcohol or drugs in response to stress as a result of unemployment, though unemployment may lead to a stronger identification with or joining marginalized or deviant subcultures which in turn leads to an increased use of cannabis.
Smoking: a special need?
Authors: FIDLER WENDY , MICHELL LYNN , RAAB GILLIAN , CHARLTON ANNE
Published: January 2006

The smoking behaviour of 665 children aged 12–15 years with special educational needs was compared with that of a control group of 842 children in mainstream education. Each child was interviewed using a structured questionnaire and reported smoking behaviour was validated against scores on a carbon monoxide monitor. We identified as the most at risk group children with emotional and behavioural disorders. They had the highest smoking rates and were the heaviest smokers. In contrast, children with learning difficulties had slightly lower smoking rates than those of the control. There were significant associations between the children's smoking behaviour and the smoking behaviour of siblings and ‘other adults’ in the household, belonging to single parent families, low self‐esteem and large friendship groups. The reported smoking rates of the families of both groups of special needs children was found to be considerably higher than that in the control group or in the general population.
Assessment of drug involvement: applications to a sample of physicians in training
Authors: CLARK DAVID C. , DAUGHERTY STEVEN R. , BALDWIN DEWITT C. , HUGHES PATRICK H. , STORR CARLA L. , HEDEKER DONALD
Published: January 2006

The investigators examined survey data of lifetime and recent drug use in national samples of 2036 senior medical students and 1772 resident physicians to lest whether patterns of lifetime drug use could be characterized adequately by a single underlying dimension of ‘drug involvement’. The data analysis was based on a two parameter normal item response theory (IRT) model using the marginal maximum likelihood estimation method. The result! showed that a single latent dimension of ‘drug involvement’ characterized individual drug use differences on the following measures: substances ever used, substances used in the previous year or previous month, and the sequential order of first use for each substance. The dimension was equivalent for students and resident physicians, and for both genders. Those who professed ‘no religion’ tended to be more drug involved. Physicians‐in‐training with a higher drug involvement score based on lifetime use were more likely: (a) to have used higher‐ranking drugs (such as LSD and prescription opiates) in the past year; and (b) to have used a greater number of different drugs during the past month. Subjects first began to use each of the substances in a relatively invarient sequence corresponding to that predicted by the model. The implications of this model for evaluating the drug use histories of physicians‐in‐craining, for identifying subgroups at greater risk for continued drug involvement after the beginning of medical training, and for further psychological, biological, and sociocultural research on the nature of ‘drug involvement’ are discussed.
Drinking amongst medical patients: levels of risk and models of change
Authors: ORFORD JIM , SOMERS MARCIA , DANIELS VICTORIA , KIRBY BRIAN
Published: January 2006

Results are reported of a study in which 547 general hospital medical in‐patients were screened, using a computer‐administered questionnaire, for alcohol consumption, problems and concerns. Of males, 22.5% were classified as “risk drinkers”, of women 6.5%. Rates of risk were particularly high amongst younger male patients. It was concluded that certain screening questionnaire items were more useful than others in the general hospital context, and that standard questionnaires developed for other populations should not automatically be used in general hospitals. Comparisons with items relating to other health behaviours suggested that the medical profession, the general public and the patients themselves might be relatively insensitive to the risks associated with heavy drinking in comparison to those associated with smoking, weight and lack of exercise. Data from initial screening and from 75% of patients who were asked to repeat the questionnaire six months later, were used to test certain assumptions of a model of change based in part upon that of Prochaska & DiClemente (1986). Results suggested that processes of change were more complex than the model supposed.
Why children start smoking cigarettes: predictors of onset
Authors: CONRAD KAREN M. , FLAY BRIAN R. , HILL DAVID
Published: January 2006

We review findings from 27 prospective studies of the onset of cigarette smoking conducted since 1980. Almost 300 measures of predictors of smoking onset were examined, and 74% of them provided multivariate support for predictors of onset derived from theory and previous empirical findings. Expected relationships were strongly supported for (a) socioeconomic status, with students with compromised status being more likely to try smoking; (b) social bonding variables, particularly peer and school bonding, with less support for family bonding; (c) social learning variables, especially peer smoking and approval, prevalence estimates, and offers/availability, with less consistent support for parent smoking and approval; (d) refusal skills self efficacy; (e) knowledge, attitudes and intentions, with the expected stronger predictions from intentions than from attitudes than from knowledge; and (f) broad indicators of self‐esteem. The few investigators who analyzed their data separately by age, gender, or ethnicity found many differences by these factors, though there were too few of them to detect any pattern with confidence. Though the 27 studies are far from perfect, we believe that they confirm the importance of many well‐accepted predictors and raise some questions about others. In particular, family smoking, bonding and approval each received unexpectedly low support, ft is not clear whether this lack of support reflects reality as it has always been, is due to a changing reality, reflects developmental changes, either in the age of subjects or the stage of onset, or is due to poor measurement and too few tests. Future prospective studies need to be theory‐driven, use measures of known reliability and validity, report analyses of scale properties, and use statistical methods appropriate to the hypotheses or theories under study. Finally, we encourage more investigations of the potentially different predictors of transitions to experimental or regular cigarette smoking. This will require multi‐wave studies and careful measurement of changes in smoking behavior.
Diminished responsibility and the drug scene
Authors: TROTT RONALD J.
Published: January 2006

This article sets out the provisions of S.2 (1)–(3) of the Homicide Act 1957 and the judicial interpretations placed thereon and relates the importance of this section to the offence of murder and considers the province of the expert in regard to the Act and the difficulties encountered when experts interpret the words ‘disease’ and ‘injury’. This is illustrated in relation to a recent Murder case where the Defendant had taken LSD and cannabis voluntarily, and deals with the question as to whether construction of the Act involves any assumption that permament injury and non‐self‐induced injury are necessary ingredients to bring the defendant within provisions of S.2 (1), i.e. abnormality of mind induced by injury substantially impairing mental responsibility. Similarities are suggested between persons suffering from hallucinations, due to delirium tremens, severe concussion cases and LSD trip cases, and the question is posed as to whether it would be logical to say that temporary injury to the brain by poisoning has occurred in situations where there is a motiveless and bizarre killing following ingestion of large quantities of alcohol or drugs.
Estimated prevalence of injecting drug use in Glasgow
Authors: FRISCHER MARTIN
Published: January 2006

The prevalence of injecting drug use in Glasgow during 1989 was derived using log‐linear analysis to model the relationship between unnamed identifier information obtained from Strathclyde Police, the Scottish HIV‐test Reporting Scheme and Treatment Agencies. Whereas previous attempts have required, although rarely demonstrated, independence between samples, the method adopted here did not necessitate this assumption. The best model resulted from taking the dependency between the HIV‐test and treatment samples into account, and yielded an estimate of 9424 (95% confidence interval ± 2460), which represents 11–19 per 1000 population aged 15–55 in Glasgow. The estimated male:female ratio was 2.64:1 and the modal injecting drug user (IDU) aged 20–24. While there are no indicators that prevalence has begun to decline, the extent of the hidden population suggests that around 1 in 7 were receiving some form of treatment for drug use. Available evidence suggests that buprenorphine, temazepam and amphetamines, rather than heroin, are the most commonly injected drugs. These findings should facilitate assessment of the service requirements of this group, and provide a basis from which the number of IDUs infected with HIV and the number likely to progress to AIDS can be determined.
Outreach to injecting drug users and female sexual partners of drug users on the Lower East Side of New York City
Authors: ABDUL‐QUADER ABU S. , DES JARLAIS DON C. , TROSS SUSAN , McCOY EDWARD , MORALES GREGORY , VELEZ IVETTE
Published: January 2006

In this specially commissioned BJA series experienced clinicians will be giving their personal and frontline views as to how the practical business of treating people with substance problems is best handled.

In 1984, outreach to injecting drug users and their female sexual partners was initiated as pan of HIV behavioral research projects. HIV, health, drug treatment and family planning information and services were provided in addition to recruiting subjects to the research program. Such outreach also poses certain problems—especially potential disruption of neighborhood day‐to‐day life and clashes with police. This paper discusses an outreach program to injecting drug users and their female sexual partners that was initiated in New York City to provide HIV‐related information and services. We examine the successes of the program and problems that were involved in conducting outreach to persons who are typically not accessible through formal institutional channels.
A statistical approach to an alcoholic drinking history
Authors: ALANKO TIMO , POIKOLAINEN KARI
Published: January 2006

The drinking history of a middle‐aged male was analyzed statistically on the basis of eight and a half years of notes on the number of drinks consumed per day. During the period his average number of drinks per drinking day increased from about 7 in 1974 to a peak of about 16 in 1980 while the number of abstinent days varied between 23% and 54% with no clear trend. These figures are of the same magnitude as published reports on drinking among alcoholics. Time‐series models of intake or drinking frequency could not describe adequately the time‐structure of annual or monthly consumption. Occurrence of drinking was analyzed as a random series of events. The time‐structure of the series was highly irregular and deviated greatly from the Poisson hypothesis which assumes that each day has an equal probability of becoming a drinking day indepedently of previous days. Instead, drinking days were clustered into sprees with an average length of 7 days, high variance and a very skew distribution, separated by abstinence periods with an average length of 4 days and a similarly shaped distribution. The entire history could be partitioned into 286 alternating drinking and abstinence intervals, one day intervals included. The drinking rhythm was very stable: no significant trends in the lengths of either type of interval could be found. The main findings are the surprising stability of the drinking rhythm, its independence of the growing amounts consumed, and the independently varying abstinence interval lengths. Even in the absence of reporting and memory bias, such a pattern of drinking may produce very inaccurate recall of the actual long‐term alcohol intake, if the recall period is short. The results suggest that periods shorter than one month should be avoided when asking questions about alcohol intake, for example, in research on the effects of treatment on alcoholism or alcohol intake on health.
Prevalence estimates of pathological gambling in Seville (Spain)
Authors: LEGARDA JUAN JOSÉ , BABIO REYES , ABREU JUAN MARIA
Published: January 2006

Pathological gambling is becoming an increasing concern for the Spanish population. Governmental figures from 1989 show that in the Autonomic Region of Andalucia, with a population of 7 million inhabitants, more than three hundred billion pesetas (approximately UK£1,500 million) were spent during 1988 gambling in casinos, slot machines and at bingo. These figures represent an increase of 15% over the figures of the previous year and suggest that gambling may have come a very important problem in Spain. This paper presents the first epidemiological study carried out in Spain on gambling and the estimated prevalence of pathological gambling in Seville, political capital of Andalucia. A sample of 598 individuals were interviewed with an adapted screening instrument. The results suggest that further epidemiological studies are required at a national level. They also indicate that preventive and treatment measures should also be taken urgently.
Obstacles to effective alcohol policy in the workplace: a case study
Authors: AMES GENEVIEVE , DELANEY WILLIAM , JANES CRAIG
Published: January 2006

Based on a case study of an assembly plant in a large US corporation, this paper reports on cultural and environmental influences on the form and process of workplace alcohol policy. Utilizing both ethnographic and survey methods, research findings indicate that although alcohol policies are in place, management and union leaders are unclear about their source and content, and the general employee population perceives alcohol availability and on‐job drinking as poorly controlled. In grounded theory fashion, two conceptual themes are employed for organizing empirical explanations of the weakened policy and under‐controlled drinking. These are: (1) the dual alcohol policy dilemma, and (2) the union‐management debate over authority to discipline. The ambivalent nature of alcohol policy and organizational mechanisms involved in its implementation become risk factors for developing workplace‐related alcohol problems.
Alcohol consumption and related problems among primary health care patients: WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—I
Authors: SAUNDERS JOHN B. , AASLAND OLAF G. , AMUNDSEN ARVID , GRANT MARCUS
Published: January 2006

This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol‐related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross‐national use. One thousand, eight hundred and eighty‐eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non‐drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol‐related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol‐related problems scales. There were strong correlations between the various alcohol‐specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol‐related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.
Reduced alcohol use in pregnancy and changed attitudes in the population
Authors: IHLEN B.‐M. , AMUNDSEN A. , TRøNNES L.
Published: January 2006

The objectives of this study were to investigate (1) changes in consumption of alcohol among pregnant women over a period of 5 years (1984/85–1990), (2) changes of attitudes towards drinking during pregnancy in the general population over the same period of time, and (3) possible connections between (1) and (2). The investigation was designed as a cross‐sectional study. Our subjects were two representative samples of pregnant women in Oslo, n = 577 and 425, and two representative samples of the Norwegian population, n = 1004 and 1204. The main outcome measures were a self‐completed questionnaire for the pregnant women and a personal interview for the general population sample. There was a significant reduction (50% decrease) in alcohol consumption among the second cohort of pregnant women compared with the first. Furthermore, we found an increase during the 5‐year period in the number of persons with a restrictive attitude towards alcohol use during pregnancy. There seems to be a connection between these two phenomena, but with our present state of knowledge it is hard to say anything about the causal relationship between them.
Age group differences in response to treatment for problematic alcohol use
Authors: RICE CHRISTOPHER , LONGABAUGH RICHARD , BEATTIE MARTHA , NOEL NORA
Published: January 2006

That structural characteristics act as markers of modified treatment outcome is a long standing idea in the alcohol treatment field. In order to test whether patient age is a factor to be considered in making treatment assignments, we examined data collected under a clinical trial. Two hundred and twenty‐nine patients were randomly assigned to one of three treatment conditions: extended cognitive behavioral treatment (CB), relationship enhancement (RE), or relationship and vocational enhancement (VE). This paper reports on outcome (alcohol use) 3‐6 months after treatment assignment. Our question was, would different age groups assigned to the treatment conditions exhibit different outcomes? There were no significant main effects by either treatment condition or age group. There was a significant treatment condition by age group interaction. With increasing age, the differences in treatment seemed to increase. For the younger aged group (18‐29 years old) no statistically significant treatment differences were detected. Middle aged patients (30‐49 years old) did best in the RE condition. Older aged patients (50 + years old) did best when assigned to the CB condition. These findings lead us to conclude that patient age is a variable which should be considered when testing patient‐treatment matching hypotheses.
Women with alcohol problems: do they relapse for reasons different to their male counterparts?
Authors: SAUNDERS BILL , BAILY SALLY , PHILLIPS MIKE , ALLSOP STEVE
Published: January 2006

A sample of 44 women and 50 men attending an alcohol treatment facility were assessed on a range of demographic, social and psychological measures in order to determine whether women and men relapse for different reasons. Clients were monitored for a 3 month period after the initial intake interview whereupon follow‐up interviews were conducted. The data were analysed by the use of survival analysis techniques. The results indicated that there were different predictors of relapse across the three levels of post treatment alcohol use investigated. Gender differences were present at two of these levels. The implications of these differences are discussed.