bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol use and a safe environment
Authors: Holder Harold D.
Published: March 2003

Three areas are discussed which illustrate the potential for drinking to increase the threat to personal safety, i.e. family harm and disruption, violence and crime, and traffic safety. Such threats to safety are especially important in that they extend well beyond the individual drinker into the lives of family members, friends, work colleagues, and even strangers who can become injured or killed in a drinking and driving accident. Thus, alcohol policy is a concern for all citizens whose personal safety can be at risk. From this perspective, alcohol‐involved problems are public health and safety issues. Controlled evaluations of a number of strategies provide evidence of potential effectiveness to reduce problems related to safety.
Place of work, communities and municipalities
Authors: Ritson Bruce
Published: March 2003

The Paris conference recognized that although national social policy and international research were undoubtedly important, a local dimension to research action and planning was essential. The potential for community and municipal action was illustrated in a number of papers which are summarized here. It was also the subject of a publication in the series associated with the European Alcohol Action Plan. The work‐place was taken as a significant microcosm of a community, where healthy company policy and an enlightened approach to providing early help and support to individuals with alcohol‐related problems is particularly beneficial.
A community prevention trial to reduce alcohol‐involved accidental injury and death: overview
Authors: Holder Harold D. , Saltz Robert F. , Grube Joel W. , Voas Robert B. , Gruenewald Paul J. , Treno Andrew J.
Published: March 2003

The 5‐year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol‐involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on‐premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.
Community mobilization: evaluation of an environmental approach to local action
Authors: Treno Andrew J. , Holder Harold D.
Published: March 2003

"Community mobilization" in the Community Trials Project refers to organizing community members to support and implement policies to reduce alcohol‐involved trauma. This paper defines the conceptual model of mobilization used in the project. In evaluating the project, we were guided by the conceptual model and we used structured materials from interviews with local staff in all three experimental communities; we found that the overall goal of mobilization (implementation of policies) was achieved. Additional observations based on naturalistic case studies of the communities include: (1) the importance of an established research base, (2) the varying role and problematic nature of coalitions, (3) the strategic advantage of early project support among the general population, (4) the role played by key leaders in mobilization, (5) the advantages of a multi‐component design, and (6) the key role played by media advocacy.
Media advocacy in community prevention: news as a means to advance policy change
Authors: Holder Harold D. , Treno Andrew J.
Published: March 2003

Media advocacy within the Community Trials Project refers to the strategic use of news media to advance a social or public policy initiative. First, this paper presents a conceptual model that guided analyses of media advocacy. Secondly, it documents increases in alcohol‐related news coverage. Thirdly, it compares changes in perceived risk of arrest after drinking and driving that can be linked to increased DUI news coverage. Fourthly, it examines community awareness of enforcement efforts in terms of both media advocacy efforts and traditional public information campaigns. Results indicate that: (1) training in media advocacy can increase coverage of news events generated by local community members including volunteers, (2) increased news coverage can be generated for both electronic (television) and print media, (3) increased news coverage did focus public attention on specific issues in support of prevention components, (4) while there are differential audiences/readers for the print (newspaper) and electronic (TV) media, both audiences are affected and (5) media advocacy can be more effective than a paid public information campaign in increasing public awareness of alcohol issues.
The effect of drinking and driving interventions on alcohol‐involved traffic crashes within a comprehensive community trial
Authors: Voas Robert B. , Holder Harold D. , Gruenewald Paul J.
Published: March 2003

The Drinking and Driving Component, one of five elements of the Community Trials Project, involved the implementation of a special drink driving countermeasure in the three experimental communities, one in Northern California, one in Southern California and another in South Carolina. This intensified enforcement of driving under the influence (DUI) was designed to deter potential drinking drivers by increasing their perception of the risk of being arrested leading to a reduction in the consumption of alcohol before driving. See component detailed description in Voas (1997, this issue). The evaluation found that media advocacy training and technical assistance resulted in increased DUI news coverage and that additional police officer hours for DUI enforcement, greater use of breathalyzer equipment, increased officer training and more checkpoints produced increased DUI enforcement. The combined effects of increased DUI news coverage and DUI enforcement yielded increased public perceived risk of arrest and subsequently less drinking and driving. Overall the evaluation found that alcohol‐involved traffic crashes were reduced as a result of this component in the experimental communities as contrasted with the matched comparison communities.
A community‐wide Responsible Beverage Service program in three communities: early findings
Authors: Saltz Robert F. , Stanghetta Paula
Published: March 2003

Evidence accumulating over the past 10 years or so suggests that commercial servers of alcoholic beverages will intervene to reduce levels of impairment among their patrons and will refuse service to intoxicated customers. While some Responsible Beverage Service (RBS) programs have had significant effects on server and patron behavior, others have not. This leads us to consider issues of implementation and program effectiveness. In the current paper, a community‐wide RBS program is described in some detail. The program was comprised by a larger comprehensive community intervention project in three sites across California and South Carolina. Process evaluation data, to track program implementation and proximal effects, provide early findings. Expressed support for RBS principles was high for both the public and the hospitality industry in all sites. A telephone survey of managers also suggests that prevention policies at bars and restaurants are beginning to show up, but a direct measure of server intervention with heavy drinkers does not yet demonstrate a program effect.
Preventing sales of alcohol to minors: results from a community trial
Authors: Grube Joel W.
Published: March 2003

This paper reports an evaluation of a community‐based approach to prevent underage sales of alcohol. The interventions focused on (a) enforcement of underage sales laws, (b) responsible beverage service (RBS) training and (c) media advocacy. The interventions were implemented in three experimental communities located in California and South Carolina. Purchase survey data were obtained before and after the interventions in each experimental community and in three matched comparison communities. Logistic regression analyses of the purchase survey data for the individual community pairs and for the combined communities showed that sales to apparent minors were significantly reduced in the experimental sites. The findings indicate that these environmental interventions are promising prevention tools for communities that seek to reduce underage drinking.
Use of spatial models for community program evaluation of changes in alcohol outlet distribution
Authors: Millar Alexander B. , Gruenewald Paul J.
Published: March 2003

Alcohol outlets have geographic and spatial characteristics which are important for researchers to consider when planning and evaluating community prevention programs. Community‐level data used in monitoring alcohol problems across community areas and over time exhibit spatial dependencies. Statistical procedures which depend on assumptions of independence may fail to give proper results in such a situation. Specific statistical techniques have been developed which adjust for the effects of spatial dependencies in measures across geography. This paper provides an example of the creation and use of computer Geographic Information Systems to display community alcohol outlets and alcohol‐involved problems and the use of statistical analysis techniques which account for such spatial dependencies over time. This paper introduces the concepts, terminology, and justification for considering spatial analysis in community prevention planning, research and evaluation. The selection of a geographical unit of analysis will be discussed. Finally, as a demonstration, a variety of spatial statistics are applied to community spatial data for evaluation.
Twenty‐five strategies for improving the design, implementation and analysis of health services research related to alcohol and other drug abuse treatment
Authors: Dennis Michael L. , Perl Harold I. , Huebner Robert B. , McLellan A. Thomas
Published: March 2003

While some aspects of addiction can be studied in laboratory or controlled settings, the study of long‐term recovery management and the health services that support it requires going out into the community and dealing with populations and systems that are much more diverse and less under our control. This in turn raises many methodological challenges for the health service researchers studying alcohol and other drug abuse treatment. This paper identifies some of these challenges related to the design, measurement, implementation and effectiveness of health services research. It then recommends 25 strategies (and key primers) for addressing them: (1) identifying in advance all stakeholders and issues; (2) developing conceptual models of intervention and context; (3) identifying the population to whom the conclusions will be generalized; (4) matching the research design to the question; (5) conducting randomized experiments only when appropriate and necessary; (6) balancing methodological and treatment concerns; (7) prioritizing analysis plans and increasing design sensitivity, (8) combining qualitative and quantitative methods; (9) identifying the four basic types of measures needed; (10) identifying and using standardized measures; (11) carefully balancing measurement selection and modification; (12) developing and evaluating modified and new measures when necessary; (13) identifying and tracking major clinical subgroups; (14) measuring and analyzing the actual pattern of services received; (15) incorporating implementation checks into the design; (16) incorporating baseline measures into the intervention; (17) monitoring implementation and dosage as a form of quality assurance; (18) developing procedures early to facilitate tracking and follow‐up of study participants; (19) using more appropriate representations of the actual experiment; (20) using appropriate and sensitive standard deviation terms; (21) partialing out variance due to design or known sources prior to estimating experimental effect sizes; (22) using dimensional, interval and ratio measures to increase sensitivity to change; (23) using path or structural equation models; (24) integrating qualitative and quantitative analysis into reporting; and (25) using quasi‐experiments, economic or organizational studies to answer other likely policy questions. Most of these strategies have been tried and tested in this and other areas, but are not widely used. Improving the state of the art of health services research and bridging the gap between research and practice do not depend upon using the most advanced methods, but rather upon using the most appropriate methods.
Multivariate modeling of missing data within and across assessment waves
Authors: Figueredo Aurelio José , McKnight Patrick E. , McKnight Katherine M. , Sidani Souraya
Published: March 2003

Missing data constitute a common but widely underappreciated problem in both cross‐sectional and longitudinal research. Furthermore, both the gravity of the problems associated with missing data and the availability of the applicable solutions are greatly increased by the use of multivariate analysis. The most common approaches to dealing with missing data are reviewed, such as data deletion and data imputation, and their relative merits and limitations are discussed. One particular form of data imputation based on latent variable modeling, which we call Multivariate Imputation, is highlighted as holding great promise for dealing with missing data in the context of multivariate analysis. The recent theoretical extension of latent variable modeling to growth curve analysis also permitted us to extend the same kind of solution to the problem of missing data in longitudinal studies. Data simulations are used to compare the results of multivariate imputation to other common approaches to missing data.
Roles of commercial interests in alcohol policies: recent developments in North America
Authors: Giesbrecht Norman
Published: March 2003

This paper examines recent developments in Canada and the United States and the role of commercial interests in alcohol‐related policies bearing on taxes, outlet density, advertising, counter‐advertising, health messages and prevention. Case‐study material is drawn from published papers, project reports, government documents and newspaper accounts. The main focus is at the federal level, with some reference to provincial, state and local experience. Alcohol industries have as their primary agenda that of maintaining and expanding their markets and maximizing profits. In order to achieve this they typically oppose restrictions on access to alcohol, tax increases, controls on marketing and some counter‐advertising campaigns. They are powerful in influencing policy in both countries, at national and regional levels, and their efforts impact policy agenda and outcome of government deliberations. Their prevention efforts, which tend to be oriented to information and education, are mainly individualistic in focus and typically not supportive of environmentally based policy reforms. Governments appear to have a declining interest in policy issues, due partly to resistance by the industries to alcohol control policies. Governments are encouraged to apply an evidence‐based orientation to funding prevention, and facilitate evaluation of industry‐sponsored prevention efforts. Greatest attention and resources should be directed to interventions that are most likely to have the greatest impact in reducing drinking‐related problems, and funding for prevention from alcohol industries should involve arms‐length arrangements. Alcohol industries are encouraged to consider strategies that do not increase access to alcohol but rather reduce drinking‐related risks.
Marketing alcohol to young people: implications for industry regulation and research policy
Authors: Jackson Margaret C. , Hastings Gerard , Wheeler Colin , Eadie Douglas , MacKintosh Anne Marie
Published: March 2003

This paper focuses on the marketing of alcohol to young people in the United Kingdom, but the lessons that emerge have international significance. Alcohol is a global enterprise and recent consolidation means that it is controlled by a decreasing number of expanding multi‐nationals. Alcohol companies are able to allocate significant resources to researching consumer preferences, developing new products and promoting them on an international level. Recent years have seen a growth in the value that youth culture attaches to brand labels and symbols and a move away from the healthy‐living ethos. The alcohol industry's response to these trends has been to design alcoholic beverages that appeal to young people, using well‐informed and precisely targeted marketing strategies. This has led to growing concerns about the implications for public health and a demand for tighter controls to regulate alcohol marketing practices. In the United Kingdom, controls on alcohol are piecemeal and reactive and the current system of voluntary regulation appears ineffective. This paper argues for more research to establish current industry practice and inform the development of a comprehensive regulatory structure and system of monitoring.
The alcohol supply: its importance to public health and safety, and essential research questions
Authors: Edwards Griffith , Holder Harold D.
Published: March 2003

This paper seeks to identify the main questions which have emerged from the preceding papers concerning the supply side of alcohol. On any rational analysis these issues are of thoroughly legitimate concern to public health researchers. We list them under seven headings: (1) what drives the alcohol supply side? (2) What is the impact of alcohol supply on demand? (3) What are the benefits and risks to health and safety stemming from deregulation and what are the possibilities to avoid negative effects? (4) What is the size and significance of the alcohol supply which may derive from other than the officially approved channels? (5) Who are the important actors in the alcohol supply system? (6) What are local influences on alcohol supply and its distribution throughout communities? (7) What is to be learned from tobacco and other risky commodities about the importance of supply? Finally, we outline a series of possible next steps for a supply side initiative.
Applying commodity chain analysis to changing modes of alcohol supply in a developing country
Authors: Jernigan David H.
Published: March 2003

Development sociology has used global commodity chains as one way of analyzing the dynamics of power and profit‐taking in globalized production networks made up of multiple firms and occurring in multiple national settings. A substantial portion of the alcohol supply in developing countries is now produced through such production networks. Particularly in the beer and spirits trade, a small number of transnational firms control networks of local producers, importers, advertisers and distributors. These networks serve to embed transnational or transnationally backed brands in the local culture, using the tools of market research, product design and marketing to influence local drinking practices. Case materials from Malaysia's beer industry help to illustrate how the transnational firms dominate in those links of the commodity chain in which monopoly or oligopoly control is most likely to be found: the design/recipe and marketing/advertising nodes. Their control of the commodity chains and extraction of monopoly or oligopoly profits from them places substantial resources and influence over drinking settings and practices in foreign hands. The impact of this influence on state efficacy and autonomy in setting alcohol policy is an important subject for future research on the creation and implementation of effective alcohol policies in developing societies.
International issues in the supply of tobacco: recent changes and implications for alcohol
Authors: Chaloupka Frank J. , Nair Rima
Published: March 2003

This paper reviews international issues in the supply of tobacco and tobacco products, including trade liberalization and globalization. The paper begins with a brief discussion of the theoretical foundations for trade and trade restrictions. This is followed by a description of the treatment of tobacco and tobacco products in recent multi‐lateral, regional and bilateral trade agreements, as well as a short discussion of the recent globalization of the tobacco industry. Included in this description is a review of the empirical evidence on the impact of trade liberalization on tobacco use. The implications of two recently proposed international agreements ‐ the Multilateral Agreement on Investments and the Framework Convention for Tobacco Control ‐ are then discussed. The paper concludes by summarizing the theoretical and empirical evidence that shows clearly that trade liberalization has significantly increased tobacco use, particularly in low and middle‐income countries, and follows this with a discussion of the lessons learned from tobacco for controlling alcohol supply.
Impacts of international trade, services and investment treaties on alcohol regulation
Authors: Grieshaber‐Otto Jim , Sinclair Scott , Schacter Noel
Published: March 2003

There is an underlying incompatibility between government efforts to minimize the harm associated with alcohol, particularly by regulating its supply, and international commercial treaties that promote the freer flow of goods, services and investment. These treaties have already forced changes to many government measures affecting alcohol availability and control, primarily by constraining the activities of government alcohol monopolies and by altering taxation regimes. The North American Free Trade Agreement and the World Trade Organization agreements open new avenues for challenges against alcohol control measures. Some of these agreements extend beyond trade, border measures and differential taxation and allow challenges that intrude into areas of non‐discriminatory domestic regulation affecting market access, intellectual property, investment and services. Effective protection from these agreements for vital public health measures has rarely been obtained, although it is increasingly essential. The WTO "services" agreement, basically unknown to the public, is currently being re‐negotiated and poses the gravest new challenge to policies designed to influence patterns of alcohol use and minimize alcohol‐related harm. In future, these international agreements will probably affect adversely those alcohol approaches considered to be the most effective or promising. These include: maintaining effective state monopolies, restricting the number and locations of retail outlets, taxing and regulating beverages according to alcohol strength, restricting commercial advertising, and maintaining and enhancing public alcohol education and treatment programs. These effects can, in turn, be expected to increase the availability and access to alcohol, to lower alcohol taxes, and to increase advertising and promotion, resulting in increased alcohol consumption and associated health problems. Until more balanced international rules are developed, the challenge facing alcohol policy researchers is to defend national and local alcohol measures from further erosion. This will require greater coordination with researchers in other affected sectors, intervention with government representatives in health and related areas and the promotion of alternative approaches to current international commercial agreements.
Practical experiences in smoking reduction and cessation
Authors: Bolliger Chris T.
Published: March 2003

Tobacco use is a major cause of cardiovascular, respiratory and oncological disease. Quitting smoking significantly benefits health, but for highly dependent smokers, unable to overcome their nicotine dependence, the concept of smoking reduction as a method of harm reduction is gaining ground. The University Hospital of Basle, Switzerland, has run double‐blind, placebo‐controlled smoking cessation and smoking reduction studies: the CEASE trial evaluated the efficacy of the nicotine patch in achieving abstinence, and the Rosette study is evaluating the efficacy and tolerability of the nicotine oral inhaler in smokers who do not wish to quit. Smokers were instructed either to quit smoking (CEASE) or to reduce cigarette consumption by > 50% (Rosette). In both studies, success rates for active treatment versus placebo at 4 months demonstrated that nicotine replacement therapy (NRT) is effective in achieving both smoking cessation and reduction. Current approaches to smoking cessation and reduction at our clinic are discussed. Combination NRT rather than monotherapy is commonly used to achieve both smoking reduction and cessation. Treatment appears to be most effective if subjects are allowed to select their preferred NRT product. There are clear differences in patient populations aiming to quit or reduce, the cessation population being more motivated. Smoking cessation remains the ultimate aim but, if unfeasible, a significant reduction in cigarette consumption is a valid goal.
Regulatory imbalance between medicinal and non‐medicinal nicotine
Authors: Sweanor David
Published: March 2003

Cigarettes are very efficient, but exceedingly 'dirty', nicotine delivery systems. Although nicotine creates dependency, it is the contaminated delivery system that causes tobacco‐related harm. With an annual global tobacco market > USD$300 billion, and a large proportion of the > 1 billion tobacco users seeking to avoid the 50% risk of death, there should be a huge market for alternative nicotine delivery systems. A move towards risk reduction could significantly benefit public health, provide consumer choice and allow free market forces to combat the leading cause of preventable death. However, market forces are currently prevented from providing consumers with the risk‐reducing products they want because of existing regulatory systems. Tobacco products have been exempted from consumer protection laws, but there are no such exemptions for other nicotine delivery products, e.g. NRT. This has resulted in an exceedingly uneven playing field for nicotine products, with the most harmful products subject to little regulation while the least hazardous products are stringently regulated. In effect the world is upside‐down, and nicotine regulatory systems should be reformed in order to maximize the reduction in risk. In addition, regulatory bodies need to: develop nicotine‐ and tobacco‐specific expertise, rapidly evaluate which products should be permitted and decide how these products should be marketed. Appropriate regulatory structures could harness the power of free enterprise in global efforts to control the tobacco epidemic. This can be done through the development of regulatory processes designed to ensure that all nicotine delivery products are considered in relative terms (regardless of source), and ensuring that all regulatory action strives for the greatest practical reductions in risk.
Addressing regulatory barriers to licensing nicotine products for smoking reduction
Authors: West Robert
Published: March 2003

This paper examines the current regulatory obstacles to extending the permitted use of NRT, and to include smoking reduction ways of addressing these. There are major differences between different countries in regulations concerning NRT. These differences appear to be due to different attitudes to cigarette smoking as an issue and different preconceptions about nicotine as an addictive and potentially toxic drug. The paper considers how existing WHO and American Psychiatric Association definitions of mental disorders may be used in submitting proposals for use of NRT as an aid to smoking reduction and how concerns over safety and abuse and dependence liability can be addressed. It also examines what new evidence may be needed. Coordinating the efforts of the pharmaceutical industry, clinicians and researchers will probably be important in moving regulatory authorities further in the direction of accepting NRT for widespread use in smoking reduction.
Policy interventions to reduce the harm from smoking
Authors: Anderson Peter , Hughes John R.
Published: March 2003

The other papers in this series on reduced smoking discuss interventions focused on individuals. This paper illustrates possible smoking reduction interventions focused on policies rather than individuals. Target 12 of the new WHO Health For All Policy aims to significantly reduce the harm from addictive substances, including tobacco, in all member states by 2015, and the WHO Third Action Plan for Tobacco‐Free Europe focuses on reducing the harm from tobacco. These documents recommend five key policy strategies: market regulation, product liability, smoke‐free environments, support for smoking cessation and education, public information and public opinion. Interventions such as price increases, restricting availability, advertising bans and product control could all be used to achieve harm reduction. Research on reducing the harm of smoking needs to include policy as well as treatment research.
The tonic/phasic model of dopamine system regulation and its implications for understanding alcohol and psychostimulant craving
Authors: Grace Anthony A.
Published: March 2003

All drugs of abuse have been shown to act either directly or indirectly by increasing dopamine neurotransmission within the limbic system. Thus, alcohol has been shown to increase dopamine transmission primarily by activating dopamine cell spike activity, whereas psychostimulants increase dopamine transmission by inhibiting the removal of dopamine from the synaptic space after its release. The spike‐dependent release of dopamine that is modulated by drugs of abuse to lead to their rewarding actions has been termed the phasic dopamine response. In contrast, with repeated drug administration, dopamine will also accumulate in the extracellular space of the nucleus accumbens in concentrations too low to stimulate postsynaptic receptors, but of sufficient magnitude to activate dopamine release‐inhibiting autoreceptors. In addition, the level of extracellular dopamine is proposed to be under the regulatory influence of cortico‐accumbens afferents. This steady‐state level of extrasynaptic dopamine has been termed the tonic dopamine response. In this paper it is proposed that several of the aspects of drug addiction, withdrawal and craving associated with the continued use of these drugs can be explained on the basis of their effects on tonic versus phasic dopamine system function. Thus, the increase in tonic dopamine levels that occurs with repeated drug administration would serve to oppose phasic dopamine release via stimulation of dopamine terminal autoreceptors, causing the subject to increase drug administration to restore the phasic response. Moreover, after withdrawal from the drugs, exposure to priming doses of drug or to drug‐related stimuli are proposed to increase tonic dopamine levels, again triggering drug‐seeking behavior in order to restore balance between the tonic and phasic dopamine systems. Therefore, one consequence of continued drug use is that these parameters of dopamine system function that normally serve to keep the system stable will enter into a new steady‐state homeostasis, from which the system is particularly susceptible to destabilizing influences that may precipitate relapse.
Transdisciplinary concepts and measures of craving: commentary and future directions
Authors: Abrams David B.
Published: March 2003

A new theoretical model of craving is needed that uses a common language and standardized measures. The new conceptual model must fully integrate discoveries from cellular biology, neuroscience, animal and human laboratory, cognitive‐behavioral social learning and socio‐cultural disciplines. A transdisciplinary synthesis can then guide methods and measurement development. Mapping the structural pathways and interactions among mediators and moderators of craving will improve the diagnostic and prognostic tools in order to inform new treatments and prevention strategies.
Animal models of craving for ethanol
Authors: Koob George F.
Published: March 2003

Craving has various meanings but can be defined generally in terms of a desire for the previously experienced effects of ethanol. Animal models provide a means by which to study the underlying mechanisms associated with craving and are most useful when they fulfill the requirements for predictive validity and reliability. Craving is a key part of the process of addiction that can lead to relapse and is conceptualized as having at least three components: preoccupation/anticipation, binge/intoxication and withdrawal/negative affect. Animal models of craving are hypothesized at this time to involve three domains of motivation to take drugs: excessive drinking, negative affective states and conditioned reinforcement. Excessive drinking includes the alcohol deprivation effect, drinking during withdrawal and drinking after a history of dependence. Models of the negative affective state include increases in brain reward thresholds, and conditioned reinforcement models include cue‐induced resistance to extinction or cue‐induced reinstatement. Experimental psychology is a rich resource of sensitive behavioral techniques by which to measure hypothetical constructs associated with the motivation to drink ethanol. Rigorous tests of predictive validity and reliability will be necessary to make them useful for understanding the neurobiology of craving and for the development of new medications for treating craving.
The psychology and neurobiology of addiction: an incentive–sensitization view
Authors: Robinson Terry E. , Berridge Kent C.
Published: March 2003

The question of addiction specifically concerns (1), the process by which drug‐taking behavior, in certain individuals, evolves into compulsive patterns of drug‐seeking and drug‐taking behavior that take place at the expense of most other activities and (2), the inability to cease drug‐taking; the problem of relapse. In this paper current biopsychological views of addiction are critically evaluated in light of the “incentivesensitization theory of addiction”, which we first proposed in 1993, and new developments in research are incorporated. We argue that traditional negative reinforcement, positive reinforcement, and hedonic accounts of addiction are neither necessary nor sufficient to account for compulsive patterns of drug‐seeking and drug‐taking behavior. Four major tenets of the incentive‐sensitization view are discussed. These are: (1) Potentially addictive drugs share the ability to produce long‐lasting adaptations in neural systems. (2) The brain systems that are changed include those normally involved in the process of incentive motivation and reward. (3) The critical neuroadaptations for addiction render these brain reward systems hypersensitive (“sensitized”) to drugs and drug‐associated stimuli. (4) The brain systems that are sensitized do not mediate the pleasurable or euphoric effects of drugs (drug “liking”), but instead they mediate a subcomponent of reward we have termed incentive salience (drug “wanting”). We also discuss the role that mesolimbic dopamine systems play in reward, evidence that neural sensitization happens in humans, and the implications of incentive‐sensitization for the development of therapies in the treatment of addiction.
Cognitive social learning and related perspectives on drug craving
Authors: Niaura Raymond
Published: March 2003

Many modern theories of drug use and dependence assign central prominence to the role of craving in drug use and relapse. However, some continue to debate whether drug craving has any motivational significance in terms of drug‐using behaviors. Cognitive social learning theory adds additional perspective by imbedding craving within a network of cognitive processes that, as they inter‐relate, influence drug use and relapse. This paper reviews tenets of cognitive social learning theory as they relate to craving, focusing on theoretical models that have attempted to explain how craving fits our understanding of the process of drug relapse. In addition, cognitive social learning theory complements theories that emphasize more biological or information processing aspects of addictive behaviors. Studies of addiction that have assessed elements of social learning theory suggest the following: (1) there exists an inverse relationship between efficacy and craving; (2) there appears to be an association between affect and craving, but the precise nature and strength of this association is unclear; (3) the relationship between outcome expectations and craving is largely unknown; and (4) correspondingly little is known about relationships between coping and craving. More empirical study is needed to address the strengths and limitations of cognitive social learning theory as it relates to our understanding the motivational significance of drug craving.
Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries
Authors: Ramstedt Mats
Published: March 2003

Aim. To estimate the effects of changes in per capita alcohol consumption on liver cirrhosis mortality rates in various demographic groups across 14 western European countries.

Method. Yearly changes in gender‐ and age‐specific mortality rates from 1950 to 1995 were analysed in relation to corresponding yearly changes in per capita alcohol consumption, employing the Box‐Jenkins technique for time series analysis. Country‐specific estimates were pooled into three regions: northern, central and southern Europe.

Measurements. Cirrhosis mortality data for 5‐year age groups were converted into gender‐specific mortality rates in the age groups 15 +, 15‐44, 45‐64 and 65 + and expressed as the number of deaths per 100 000 inhabitants. Alcohol sales were used to measure aggregate consumption, which were calculated into consumption (litres 100% alcohol) per year per inhabitant over 14 years of age and weighted with a 10‐year distributed lag model.

Findings. The country‐specific analyses demonstrated a positive and statistically significant effect of changes in per capita consumption on changes in cirrhosis mortality in 13 countries for males and in nine countries for females. The strongest alcohol effect was found in northern Europe, due mainly to a large effect in Sweden. Moreover, when different age groups were analysed significant estimates were obtained in 29 of 42 cases for males and in 20 of 42 cases for females. Most of the non‐significant estimates were found in older age groups.

Conclusions. The results suggest clearly that a change in the overall level of drinking as a general rule affect cirrhosis mortality in different drinking cultures as well as among different demographic groups. Moreover, the findings correspond with what is expected from the collectivity theory of drinking cultures.
Alcohol and homicide: a cross‐cultural comparison of the relationship in 14 European countries
Authors: Rossow Ingeborg
Published: March 2003

Aims. To assess an empirical basis for cross‐national and cross‐cultural comparisons of four aspects of the association between alcohol consumption and homicide: the relative strength of the association, the fraction of homicide rates attributable to alcohol consumption, possible gender differences in the association between consumption and victim rates and possible variations in beverage‐specific effects on homicide rates.

Design, setting and participants. Time series analyses on differenced series of annual aggregate‐level data on alcohol sales and homicide rates for the period 1950‐95 were performed for each individual country. Estimates were pooled across countries within three regions of alleged differences in drinking pattern: southern Europe, central Europe and northern Europe.

Findings. Total alcohol sales were positively and statistically significantly associated with homicide rates in five countries. Beer sales were positively and statistically significantly associated with homicide rates in four countries, wine sales in another two countries, and spirits sales in two countries. The effect of alcohol sales was stronger for male homicide rates than for female homicide rates, and the estimated fraction of homicides that could be attributed to alcohol consumption appeared to be of the same magnitude in the three regions. When estimates were pooled across countries, the strongest association between total sales and homicides was found in the northern European countries and the weakest, but still statistically significant, in the southern European countries. Pooled estimates showed that beer sales were positively and significantly associated with homicide rates in all three European regions, whereas wine sales were positively and moderately associated with homicide rates only in the traditional wine drinking cultures in southern Europe.

Conclusion. The findings support the hypothesis that homicide rates are influenced by alcohol sales and more so in the northern European countries where the drinking culture is, to a larger extent, characterized by heavy drinking episodes. Moreover, the findings are suggestive of beverage‐specific effects on violent behaviour being contingent upon characteristics of the drinking culture.
Per capita alcohol consumption and ischaemic heart disease mortality
Authors: Hemström Örjan
Published: March 2003

Aim. To test the hypothesis that alcohol consumption is inversely related to ischaemic heart disease (IHD) mortality at the population level. Most individual‐level studies find a reduced risk of IHD with a moderate level of alcohol consumption, but it is as yet unknown whether this association also exists at the aggregate level.

Measurements. The study period was approximately 1950 to 1995; 14 EU countries and Norway were included. Time series analyses on differenced data were utilized, and age‐standardized IHD mortality for men and women in the age groups 30‐44, 45‐59, 60‐74 and 30‐74 years was measured. The effects of alcohol (sales per capita) were controlled for a weighted lag of per capita sales of cigarettes.

Findings. There was a random distribution of insignificant negative and positive alcohol effect estimates. A slight indication of a cardioprotective effect of alcohol among 30‐ to 44‐year‐old women in high consumption countries could be observed (significant for Italy). Mean alcohol effect estimates were nearly exactly zero (absent alcohol effect) among men and weakly positive among women. Because changes in cigarette consumption were often significantly and positively related to subsequent changes in IHD mortality, poor validity in the IHD time series cannot explain the unsystematic findings. Including a 6‐year weighted lag of alcohol consumption changed the weak positive effect among women to an absent alcohol effect. A brief analysis of abstinence rates indicated no particular relationship to IHD mortality.

Conclusion. The alleged cardioprotective alcohol effect is absent at the population level, and great caution should be taken concerning alcohol policies for cardioprotective purposes.
Changing the focus: the case for recognizing and treating cannabis use disorders
Authors: Dennis Michael , Babor Thomas F. , Roebuck M. Christopher , Donaldson Jean
Published: March 2003

During the late 1960s, cannabis emerged from relative obscurity to become the most common illicit drug used in the United States, and has remained so ever since. From an epidemiological perspective, three major waves of successively younger new users can be identified during the past 40 years. Contrary to popular opinion, cannabis use can be problematic for many people (particularly adolescents). Moreover, the drug has become increasingly more potent. Cannabis is currently one of the leading substances reported in arrests, emergency room admissions, autopsies and treatment admissions. Like alcohol and tobacco, the need for effective approaches to treating cannabis use disorders transcends debates about whether it should be legal. Moreover, the costs to society are continuing to mount from past neglect of this continuing public health problem. This paper provides background on the need to develop effective models for treating cannabis use disorders.
Moving from research to practice just in time: the treatment of cannabis use disorders comes of age
Authors: Westley Clark H. , MacNeill Horton Arthur , Dennis Michael , Babor Thomas F.
Published: March 2003

This supplement issue on the treatment of marijuana use disorders describes two large multi‐site field experiments: the Cannabis YouthTreatment (CYT) study with adolescents and the Marijuana Treatment Project (MTP) with adults. The papers cover multiple aspects ofthe treatment of cannabis users, including the rationale for studying cannabis use disorders, descriptions of the CYT and MTP studies,characteristics of adolescents and adults presenting for treatment of cannabis use disorders, court diversion issues, economic evaluationand confirmation of self‐reported cannabis use, among other topics. This Introduction provides background information and an overviewof the papers from the perspective of the funding agency.
The economic cost of outpatient marijuana treatment for adolescents: findings from a multi‐site field experiment
Authors: French Michael T. , Roebuck M. Christopher , Dennis Michael L. , Diamond Guy , Godley Susan H. , Tims Frank , Webb Charles , Herrell James M.
Published: March 2003

Aims Despite recent advances in the economic evaluation of adult substance abuse treatment, information and basic research is lacking on the cost of adolescent substance abuse treatment. The present study conducted an economic cost analysis of several outpatient adolescent treatment approaches.

Design The Cannabis Youth Treatment (CYT) study evaluated five structured treatments for cannabis‐using adolescents. One of the approaches was implemented by all of the four geographically and institutionally diverse treatment facilities collaborating in CYT; each of the other four approaches was implemented in two of the sites. Using the Drug Abuse Treatment Cost Analysis Program (DATCAP), the economic cost of each site‐specific treatment was determined.

Findings The average economic costs of the five types of outpatient treatments ranged from $837 to $3334 per episode, and varied by both direct factors (e.g. hours of treatment, treatment retention) and indirect factors (e.g. cost of living, staff level, case‐load variation).

Conclusions These adolescent treatment cost estimates are examined in terms of their calculation, variability by condition, variability by site within condition and comparability with previous DATCAP results from outpatient drug‐free programs for adults. Future research will integrate treatment outcomes and costs to complete cost‐effectiveness and benefit–cost analyses of the five therapies.