bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized controlled trial of a smoking cessation intervention based in community pharmacies
Authors: Maguire T. A. , McElnay J. C. , Drummond A.
Published: March 2003

Aims. To evaluate whether a structured community pharmacy‐based smoking cessation programme (the PAS model) would give rise to a higher smoking cessation rate compared with

ad hoc advice from pharmacists.

Design. A randomized controlled trial comparing a structured intervention with usual care.

Setting. One hundred pharmacists working in community pharmacies in N. Ireland and 24 in London took part in the study and were each asked to enroll 12 smokers; 44% of pharmacists who were trained managed to recruit one or more smokers during the recruitment period of approximately 1 year.

Participants. A total of 484 smokers were enrolled by the pharmacists and individually randomized into the PAS intervention group (

N = 265) or the control group (

N = 219).

Intervention. The PAS intervention involved a structured counselling programme, an information leaflet and a follow‐up weekly for the first 4 weeks then monthly as needed.

Measurements. The primary outcome measure of this study was self‐reported smoking cessation for 12 months with cotinine validation at the 12‐month follow‐up.

Findings. Of smokers in the PAS group, 14.3% (38) were abstinent up to 12 months compared with 2.7% (6) in the control group (

p < 0.001 for the difference).

Conclusion. The community pharmacy‐based PAS smoking cessation service can be an effective method of helping people stop smoking when delivered by pharmacists willing to adopt this approach.
Sleep‐disordered breathing in stable methadone programme patients: a pilot study
Authors: Teichtahl Harry , Prodromidis Andy , Miller Belinda , Cherry Gaye , Kronborg Ian
Published: March 2003

Aims. To explore the possibility that stable MMP patients have sleep‐disordered breathing (SDB) and abnormal sleep architecture defined by nocturnal sleep stages and sleep efficiency.

Design. Observational.

Setting. Regional Methadone Service and sleep disorders laboratory in a university affiliated hospital.

Participants and measurements. Ten stable MMP patients and nine normal subjects were assessed clinically and with overnight polysomnography.

Findings. There were no differences in age, sex and body mass index between the groups. The methadone dose ranged between 50 and 120 mg/day. Six patients had central apnoea index (CAI) greater than 5, four had a CAI greater than 10 and three of these exhibited periodic breathing. No normal subject had central sleep apnoea. The patients had lower sleep efficiency (

p < 0.05), less slow wave sleep (

p < 0.01), less rapid eye movement sleep (

p < 0.05) and more Stage 2 sleep (

p < 0.05) than controls.

Conclusions. Stable MMP patients have more sleep architecture abnormalities than controls and a higher prevalence of central sleep apnoea. Further studies are needed to confirm these findings, to delineate the mechanisms for the abnormalities and to assess whether the SDB is related to sudden death in stable MMP patients. We recommend that MMP patients have awake and sleep respiration assessed to identify those potentially at risk.
Risk factors for HIV‐1 seropositivity in drug users under 30 years old in Haiphong, Vietnam
Authors: Nguyen Tuan Anh , Hoang Long Thuy , Pham Vinh Quoc , Detels Roger
Published: March 2003

Aims. To assess the prevalence of HIV infection among young drug users in Haiphong and, secondarily, to document the current patterns of drug use and sexual behavior in them.

Design, setting and participants. A cross‐sectional survey of drug users 15‐30 years old, identified from police lists and by the snowballing method between March 15 and May 30, 1999, was conducted in Haiphong City.

Measurements. Subjects (

n = 520: 514 males and six females) were interviewed and donated blood specimens for HIV‐1 antibody testing.

Findings. Mean age of the subjects was 25 years (range 15‐30 years). The prevalence of HIV among injecting drug users (IDUs) was 74% and among drug users not reporting injecting was 46% (92/201). Sixty‐one per cent (319) reported injecting drugs. Among injectors, 72% used heroin, and 68% had shared needles. Factors related to the presence of HIV antibody among IDUs were sharing needles (OR: 4.12) and injecting more than 31 times per month (OR: 2.37). Extramarital sex within the last 6 months was reported by 44% of single and 24% of married IDUs.

Conclusion. The high HIV‐1 prevalence in drug users and their frequent sexual mixing with the non‐drug‐using population suggests that preventive interventions for reduction of high‐risk drug taking and sexual activities are urgently needed in these populations. Interventions through public sexually transmitted infection (STI) clinics are unlikely to have much impact, as only 16% of IDUs with an STI attended a public STI clinic.
Back‐projection estimates of the number of dependent heroin users in Australia
Authors: Law Matthew G. , Lynskey Michael , Ross Joanne , Hall Wayne
Published: March 2003

Aims. To plan an appropriate response to heroin use in Australia, good estimates are needed of the numbers of dependent heroin users, the group who are most in need of treatment, most at risk of fatal opioid overdose and most at risk of contracting and transmitting blood‐borne viruses.

Methods. Back‐projection methods were used to estimate the numbers of people starting dependent heroin injecting in Australia between 1960 and 1997. Separate analyses were based on national opioid overdose deaths and numbers of new entrants to methadone treatment in New South Wales (NSW). Estimates of the rates at which dependent heroin users cease heroin use, commence methadone treatment or die from opioid overdoses were estimated from external data sources.

Results. Back‐projection estimates derived from opioid overdose deaths indicated that there were 104 000 (lower limit of 72 000 and upper limit of 157 000) people who were heroin dependent in Australia between 1960 and 1997. Of these it was estimated that 67 000 (39 000‐120 000) were still heroin dependent at the end of 1997. Back‐projection estimates based on numbers of new entrants to methadone treatment in NSW indicated that there were 108 000 (82 000‐141 000) heroin‐dependent people in Australia between 1960 and 1997, of whom 71 000 (47 000‐109 000) were estimated to be heroin dependent at the end of 1997. Both analyses indicated that the number of heroin‐dependent people in Australia has increased substantially from the early 1970s onwards.

Conclusions. Back‐projection estimates based on analyses of treatment entries and opioid overdose deaths provide an additional method for estimating the numbers of heroin‐dependent people in the population. The addition of these methods to existing methods, using different data sources and statistical methods, should improve consensus estimates of the numbers of heroin‐dependent people.
Social dimensions of adolescent substance use
Authors: Sutherland I. , Shepherd J. P.
Published: March 2003

Objectives. The aim of this study was to explore in detail the relationship between various social aspects of young people's lives and substance use and differences in the degree of influence exerted by the different social factors as a function of age.

Design, setting, participants. The study was a survey of pupils aged 11‐16 in a stratified sample of five English schools. Data from 4516 participants were obtained in relation to their cigarette, alcohol and illicit drug use and their contact with the police, perceived academic achievements and future expectations, religious beliefs, family structure, the importance of family versus peer opinions and suspension from school.

Measures. Cumulative, age‐specific preferences of substance misuse were compared. Logistic regression was used to rank the various risk factors.

Results. Substantial differences were found between substance users and non‐users and the various risk factors being examined. For example, of those who had only been in trouble with the police, 18.8% used illegal drugs compared with 1.6% of those who had not had a police contact and who had no other risk factors. Many of these relationships were age‐sensitive. For instance, the negative relationship between belief in God and illicit drug use became stronger as age increased (non‐believers: y = 8.1886x ‐ 9.16

R2 = 0.9484; believers: y = 5.1514x ‐ 8.08

R2 = 0.9247). These results suggest that, within this sample of English adolescents, there was a strong relationship between substance use and the social factors examined. Although there were differences depending upon whether cigarette, alcohol or illicit drug use was being modelled, logistic regression indicated that the social factors could be ranked in the following order of importance: concurrent use of the second and third substances, having been in trouble with the police, perceived poor academic performance and low future academic expectations, a lack of religious belief, coming from a non‐intact family, favouring peer over family opinion and having been suspended from school. Many of these relationships were age‐sensitive with substance use peaking at age 15.

Conclusion. The models and relationships presented in this paper show that a constellation of behaviours are related to adolescent substance use. Also demonstrated is that behaviours cannot be considered in isolation, but need to be examined from an holistic or biopsychosocial standpoint. These relationships are complex and future research should consider not only causality of adolescent substance use, but also of the aetiology of the satellite behaviours.
Methadone prescribing to opiate addicts by private doctors: comparison with NHS practice in south east England
Authors: Strang John , Sheridan Janie
Published: March 2003

Aims. To compare National Health Service (NHS) and private practice in prescribing methadone to opiate addicts.

Design and participants. Survey of community pharmacies during 1995 (one in four random sample) and during 1997 (one in two random sample) in which data were collected on all methadone prescriptions currently being dispensed to opiate addicts.

Setting. Dispensing community pharmacies in south east England.

Units measured. 829 methadone prescriptions (785 NHS and 44 private) from 1995, and 761 (703 NHS and 58 private) from 1997.

Measurements. (i) The prescribed daily dose of methadone; (ii) the form (oral mixture, tablets or ampoules); and (iii) the pick‐up duration (daily collection of prescribed dose, through to weekly or fortnightly collection in a single pick‐up).

Findings. Private methadone prescriptions issued to addicts typically give twice the daily dose, are more than four times as likely to give the methadone in injectable form, and most commonly give prescriptions to be collected in a single large weekly or fortnightly instalment instead of through daily dispensing, compared with NHS methadone prescriptions.

Conclusions. The disparity between private and NHS methadone prescriptions is striking. The much higher doses, the lack of arrangements for instalment collection and the frequent choice of injectable forms of methadone increase greatly the risk of abuse and diversion to the black market. Regulatory scrutiny of this private practice in the United Kingdom is currently minimal. Independent research is required to explore more fully the different nature of such private methadone prescribing.
Risk domains associated with an adolescent alcohol dependence diagnosis
Authors: Kuperman Samuel , Schlosser Steven S. , Kramer John R. , Bucholz Kathleen , Hesselbrock Victor , Reich Theodore , Reich Wendy
Published: March 2003

Aims. To determine the contribution of familial, interpersonal, academic and early substance use factors to relative risk for an alcohol dependence (AD) diagnosis in adolescents.

Methods. Information on 619 adolescents and their 390 sets of biological parents was obtained using the adolescent version of the Child Semi‐Structured Assessment for the Genetics of Alcoholism (C‐SSAGA) and the adult counterpart of this instrument, the Semi‐Structured Assessment for the Genetics of Alcoholism (SSAGA). The C‐SSAGA elicits a wide range of environmental, social, and psychiatric diagnostic information. Specific domain scale scores associated with an adolescent AD were computed, and generalized estimating equations (GEE) modeling was used to determine the odds ratio (relative risk) of the specified risk domains for an alcohol dependence diagnosis.

Findings. Risk factors for a DSM‐III‐R AD diagnosis included being at least 16 years of age, as well as negative parent‐child interactions, school and personal‐related difficulties (including the presence of an externalizing or internalizing DSM‐III‐R non‐alcohol‐related diagnosis), and early experimentations with a variety of substances.

Conclusions. An array of familial, interpersonal, academic and early substance use factors were strongly associated with adolescent AD. Given the findings of this study, further research to determine temporal relationships that might influence the onset of adolescent alcohol dependence is warranted.
Syringe borrowing persists in Dublin despite harm reduction interventions
Authors: Smyth Bobby P. , Barry Joe , Keenan Eamon
Published: March 2003

Aims. To measure the frequency of syringe borrowing in young Irish injecting drug users (IDUs) and identify associated characteristics.

Design. Cross‐sectional survey.

Setting. Addiction treatment services in Dublin.

Participants. Treated IDUs (N = 246).

Measurements. Data on drug injecting and syringe borrowing in the previous 6 months.

Findings. The median age was 22 years and the median length of injecting history was 19 months. Syringe borrowing was reported by 173 (70.3%) participants. A multivariate analysis identified seven characteristics significantly associated with syringe borrowing. These included early school leaving and parental unemployment. IDUs with long injecting histories who had injected less frequently were more likely to borrow. Injection of more than one substance was significantly associated with borrowing of syringes. Syringe borrowing was associated with having more intimate social relationships with other IDUs, less perceived risk in borrowing from acquaintances and usually opting to inject in the company of other IDUs.

Conclusions. Syringe borrowing is commonly practised by young IDUs. Those with a background of social deprivation are more likely to engage in this risk behaviour. IDUs who report borrowing are more intimately involved with other IDUs and tend to perceive less risk or dangerousness in borrowing. In addition to syringe exchange, there is a need to work cognitively with IDUs to identify and challenge assumptions that they may have regarding the safety involved in borrowing from others, particularly from those with whom they have close social relationships.
Examining the limits of the buprenorphine interdosing interval: daily, every‐third‐day and every‐fifth‐day dosing regimens
Authors: Petry Nancy M. , Bickel Warren K. , Badger Gary J.
Published: March 2003

Aims. Opioid‐dependent outpatients may be more likely to present for pharmacological treatment if less than daily dosing can be arranged. These studies compared opioid withdrawal symptoms during 24‐, 72‐, and 120‐hour buprenorphine dosing regimens and evaluated participants' preferences for these different dosing regimens.

Participants. Thirty‐three opioid‐dependent participants received daily sublingual maintenance doses of 4 mg/70 kg (

n = 14) or 8 mg/70 kg (

n = 19) of liquid buprenorphine.

Methods. In Study I participants received, in a random order, three dosing regimens for five repetitions of each: daily maintenance doses every 24 hours (4 or 8 mg/70 kg), triple the daily maintenance dose every 72 hours (12 or 24 mg/70 kg) and quintuple the daily maintenance dose every 120 hours (20 or 40 mg/70 kg). Doses were administered under double‐blind procedures, and placebos were administered on the interposed days during the latter two regimens. Subjective and observer ratings of opioid withdrawal symptoms were assessed daily prior to receipt of each dose. In Study II, a new group of participants received each of the three dosing regimens under open‐dosing procedures and then chose between the different dosing regimens.

Findings. Opioid withdrawal symptoms increased significantly during the every‐fifth‐day dosing regimen in both the blind‐ and open‐dosing studies. In the choice phase of Study II, only one participant (7%) chose quintuple‐every‐fifth‐day dosing over all other dosing options.

Conclusions. These results suggest that the maximum duration of action of buprenorphine is less than 5 days when five times the daily maintenance dose is provided.
Gender differences, physiological arousal and the role of winning in fruit machine gamblers
Authors: Coventry Kenny R. , Hudson Jennie
Published: March 2003

Aims. To examine gender differences in changes in physiological arousal as indexed by heart rate during fruit machine gambling while controlling for the confounding effect of movement and as a function of winning and losing, and to examine relationships between sensation‐seeking, self‐reported arousal during gambling, heart rate during gambling and loss of control of gambling behaviour.

Sample, design and measurements. Heart rate and subjective arousal were recorded in a sample of 22 male and 20 female fruit machine players before, during and after the gambling process. At baseline measures were taken of sensation seeking, self‐reported arousal during gambling and loss of control of gambling. A simulation of the behaviour used to operate fruit machines was used during baseline measurement.

Findings. Significant increases in heart‐rate over movement controlled baselines were observed within participants during gambling. However, for the losing group these differences were slight compared to the increases found when participants won during play. Furthermore, winning/losing was the only variable among a range of variables which was a significant predictor of heart‐rate increase during play over a baseline control. Additionally HR levels of males and females behaved the same way in relation to the manipulations. Significant correlations between HR during play and the measures of both subjective arousal and sensation seeking were also present.

Conclusions. Winning during gambling is essential in order to maintain increased HR levels over baseline after play. Subjective arousal and sensation seeking may be predictors of levels of arousal experienced during play.
The effectiveness of callback counselling for smoking cessation: a randomized trial
Authors: Borland Ron , Segan Catherine J. , Livingston Patricia M. , Owen Neville
Published: March 2003

Aims. The development of acceptable, widely available and effective smoking cessation methods is central to public health strategy for tobacco control. We examined the effectiveness of a telephone callback counselling intervention, compared to the provision of self‐help resources alone.

Methods. Participants were 998 smokers calling a state‐wide "Quitline" service randomly allocated to either callback counselling or ordinary care. The callback condition consisted of a series of brief counselling calls at strategic times in addition to ordinary care. The number of calls varied according to caller needs, and most occurred generally just before the person's quit day and in the week or two after it. The service was delivered by trained telephone counsellors.

Results. At the 3‐month follow‐up, significantly more participants in the callback group (24%) reported that they were quit, compared to those in the usual care comparison group (13%). The difference in point prevalence of smoking declined to 6% by the 12‐month follow‐up. Using sustained abstinence there was a significant benefit of callback counselling at 12‐month follow‐up. Treating dropouts as smokers reduced the overall magnitude of the effects somewhat. The benefit of callbacks was to marginally increase quit attempts and to significantly reduce relapse.

Conclusion. Our findings are consistent with those of other studies demonstrating benefits of callback telephone counselling to facilitate cessation. Such counselling provides a flexible, relatively inexpensive and widely available form of cessation service. It appears to encourage a greater proportion of quit attempts and to reduce the rate of relapse among those quitting. Further research is required to determine ways to enhance effectiveness, particularly studies of how to reduce relapse.
Smoking cessation and smoking patterns in the general population: a 1‐year follow‐up
Authors: West Robert , McEwen Andy , Bolling Keith , Owen Lesley
Published: March 2003

Objective. To assess the prevalence of motivation and behaviours relating to smoking cessation and attempts at harm minimization and the stability of these over a 1‐year period; to identify demographic, social, behavioural and psychological predictors of attempts to stop smoking and the success of these attempts.

Design. Face‐to‐face interviews were carried out with a national sample of UK smokers in April/May 1996 with follow‐up 1 year later.

Subjects. The original response rate was 61% (1478 of 1911 adult smokers), and of these 1012 were followed‐up 1 year later (68% of those who were originally contactable).

Results. Thirty‐one per cent of smokers reported making at least one quit attempt during the follow‐up period and 17% made a quit attempt in the first 9 months of that period. Of these 29% were still not smoking at least 3 months later. Fifty‐one per cent of smokers had tried to cut down in the year leading up to the first survey. There was a fair degree of consistency over time in individual smokers' desires and intentions to stop smoking across both surveys and in the incidence of quit attempts and attempts to cut down. Beliefs about the effects of smoking on future health and having a partner who disliked their smoking were positively associated with making a quit attempt at follow‐up while reporting enjoying smoking at baseline was negatively associated with making a quit attempt at follow‐up. Time to first cigarette of the day and age of starting smoking were positively associated with success of quit attempts.

Conclusions. Motivation and behaviours relating to smoking cessation are prevalent and fairly stable over time. Different factors appear to be related to attempts to stop and the success of those attempts. Interventions to increase smoking cessation in the population should take account of this.
The clinical course of alcohol dependence associated with a low level of response to alcohol
Authors: Schuckit Marc A. , Smith Tom L.
Published: March 2003

Aims. To evaluate the clinical course of specific alcohol‐related life problems and the risk for dependence on illicit drugs in individuals with relatively low and high levels of response (LR) to alcohol earlier in life.

Subjects. From among 439 men who were part of the 15‐year follow‐up of sons of alcoholics and controls, 108 were identified as having fulfilled criteria for DSM‐III‐R alcohol dependence.

Measures. The LR to alcohol was originally evaluated following the consumption of 0.61 g/kg of ethanol at age 20 by determining the levels of change in subjective feelings of intoxication, body sway and several hormones such as cortisol. From the 453 original subjects, 450 completed a face‐to‐face 10‐year follow‐up evaluation, and 439 completed the 15‐year protocol.

Findings. A comparison of the clinical course of 50 alcohol‐dependent men with clearly low LR values at age 20 with that for 42 individuals whose LR scores were above the median revealed few differences. Those with a low LR had a slightly earlier age of onset of alcohol dependence (24.8 ± 3.41 vs. 26.6 ± 4.48 years), and this finding was unrelated to the presence of an alcohol‐dependent father. Otherwise the members of the two groups demonstrated a similar course of alcohol dependence. There was no relationship between a low LR at age 20 and either the pattern of substances used or the rate of dependence on illicit drugs.

Conclusions. The results indicate that for this sample a low LR to alcohol, while associated with a high risk for alcohol dependence, was not related to most aspects of the course of alcohol problems once dependence developed.
The effect of therapist/patient race‐ and sex‐matching in individual treatment
Authors: Sterling Robert C. , Gottheil Edward , Weinstein Stephen P. , Serota Ronald
Published: March 2003

Aims. Equivocal findings of the effect that therapist and patient similarity plays in treatment outcome led us to examine the impact of race‐ and sex‐matching on treatment retention and outcome for a sample of people seeking outpatient substance abuse treatment.

Design. Patient and therapist characteristics were crossed in a 2 × 2 factorial design. Matching effects were then tested using retrospective data.

Participants. Participants were 116 African‐American cocaine‐dependent people.

Setting. The study site was a university‐sponsored outpatient treatment facility located in an economically depressed area of a large Northeastern US city.

Measurements. Follow‐up data were drawn from the Addiction Severity Index, the Risk for AIDS Behavior Inventory and a questionnaire measuring post‐discharge need for treatment, employment and education. Retention was defined as the number of days inclusive between the last date of service and the date admitted.

Findings. No meaningful effects in favor of matching were observed on outcome measures.

Conclusion. While matching therapists and drug‐dependent people does not appear to be essential in promoting positive retention and outcome, limitations of this study that include sample size and the homogeneous demographic nature of those seeking therapeutic services at our facility lead us to conclude that replication with a larger number of therapists and patients is needed. In a different therapeutic setting, with a different population presenting for treatment, the mismatching of patients and therapists with respect to factors such as those explored here might well yield differing results.
Patterns of recreational drug use at dance events in Edinburgh, Scotland
Authors: Riley Sarah C. E. , James Charlotte , Gregory Danielle , Dingle Henry , Cadger Mike
Published: March 2003

Aims. To describe the patterns of drug use at dance (rave) events in terms of prevalence, frequency, type of drugs used, patterns of use, access and risk‐associated behaviours.

Design. Self‐selecting participant‐completed survey.

Setting. Three dance events in Edinburgh, Scotland, UK.

Participants. One hundred and twenty‐two drug users (57% males, 43% females), 90% of whom were in employment or education, with an age range of 16‐47, 80% between 18 and 23 years.

Measurements. Participants who answered 'yes' to the question 'Have you used drugs for dance events in the past year' reported (i) the prevalence, types and frequency of drugs used; (ii) prevalence and contents of mixing drugs; (iii) accessing drugs; and (iv) engagement with drug‐associated risk behaviours.

Findings. Over 80% of the participants had used ecstasy and amphetamine, over 30% cocaine and LSD; over 10% nitrites, psilocybin and ketamine and less than 5% had used crack or tranquillizers. Participants reported regular consumption of ecstasy and amphetamine (e.g. 35% used ecstasy and 25% amphetamine on a weekly basis) often taken in combination, with the occasional use of cocaine, LSD, ketamine and psilocybin. Poly‐ and mixing‐drug behaviours were significantly more likely than monodrug usage. Drugs were accessed through friends than from any other source. Eighty‐five per cent reported mixing drugs and/or alcohol, 35% driving on drugs, 36% having a bad experience on drugs; 30% unprotected sex; and 0.9% injecting drugs. Women in the sample reported higher consumption than men.

Conclusions. Dance‐drug use has a characteristic pattern that has implications for health promotion and criminal policy.
Substance abuse policy and peace in the Middle East: a Palestinian and Israeli partnership
Authors: Isralowitz Richard , Sussman Gary , Afifi Mohamed , Rawson Richard , Babor Thomas , Monteiro Maristela
Published: March 2003

This paper describes the working exchange between Israelis, Palestinians and international experts who engaged in a process to promote communications, cooperation and coordination of efforts directed toward peace as well as the prevention and treatment of drug abuse in the region. From 1997 to 1999, a program of training workshops and courses, drug prevention and treatment skills development and collaborative research was conducted on the basis of mutual respect and cooperation among Palestinians and Israelis. By tapping into the issue of substance abuse and by focusing on its professional and academic dimensions, this initiative engaged representative delegations of the police force, academia, treatment centers and various government ministries. While events of this period underscored the dependence of "bottom‐up" peace initiatives on the prevailing political situation, the experience revealed the vital role of NGO frameworks in providing a safety net for promoting and sustaining relations as well as addressing an issue of common concern. This case study shows that addiction professionals, both clinicians and researchers, can be instrumental in conflict resolution as well as the prevention and treatment of drug abuse.
General Practitioners' views on the English national smoking cessation guidelines
Authors: McEwen Andy , Akotia Niven , West Robert
Published: March 2003

Objectives. Several countries have followed the US example in publishing national guidelines on smoking cessation interventions. Gauging responses to these guidelines can provide important lessons for future implementation and revision internationally. This study sought to assess General Practitioners' (GPs') views on recently published English smoking cessation guidelines that form the foundation of the UK National Health Service's smoking cessation strategy.

Design. Postal survey in which GPs were asked to judge the appropriateness, effectiveness and practicability of key recommendations for primary care in recent national smoking cessation guidelines.

Setting. General practice, England and Wales.

Subjects. Random national sample of GPs; 236 GPs completed the questionnaire; effective response rate: 62%.

Results. Only 16% of GPs accepted that all the recommendations in the guidelines were appropriate; 43% accepted that it was appropriate to check the smoking status of known smokers when they visit the surgery and only 30% thought it was practicable to advise smokers to stop at every opportunity. However, 77% of GPs thought that they should provide assistance for smokers wanting to stop; 74% believed that they should refer smokers to specialist services if appropriate and a similar proportion (77%) believed that it was appropriate to recommend nicotine replacement therapy.

Conclusions. There was greater acceptance by GPs that they should assist smokers wanting to stop than that they should routinely monitor smoking status and give opportunistic advice to patients to stop. Given that opportunistic advice is a cornerstone of the national guidelines there is a need to find ways of reconciling what is being recommended and what GPs feel is appropriate.
The influence of sensitivity to reward on reactivity to alcohol‐related cues
Authors: Kambouropoulos Nicolas , Staiger Petra K.
Published: March 2003

Aims. To investigate the role of sensitivity to reward in mediating social drinkers' reactivity to alcohol cues.

 Design. A standard cue‐reactivity paradigm was employed. Two groups of social drinkers (heavy and light) were assessed after exposure to the sight, smell and taste of a neutral cue (water) and then an alcohol cue (glass of beer).

 Setting. Sessions were conducted in a laboratory based environment.

 Participants. Twenty heavy (12 males, eight females) and 18 light social drinkers (seven males, 11 females) were recruited; mean age was 23.6 years.

 Measurements. The Card Arranging Reward Responsivity Objective Test (CARROT), assessing behavioural reponsiveness to a monetary incentive; urge to drink; positive affect; and the BAS scales, assessing sensitivity to reward.

 Findings. Heavy drinkers displayed a significant increase in responsivity to rewards (i.e. CARROT) and self‐reported urge to drink, but not positive affect, after exposure to alcohol. For the heavy drinkers, heightened sensitivity to reward (i.e. BAS scales) was significantly related to cue‐elicited urge to drink and positive affect.

 Conclusion. The results are consistent with a conditioned appetitive motivational model of alcohol use and suggest that Gray's theory of personality may be of some benefit in explaining variation in reactivity responses.
The reliability of self‐reported age of onset of tobacco, alcohol and illicit drug use
Authors: Johnson Timothy P. , Mott Joshua A.
Published: March 2003

Aims. To examine the reliability of self‐reported age of first substance use experiences among national samples of adult and child respondents.

 Design. Survey responses from seven waves of the National Longitudinal Survey of Youth (NLSY) were examined.

 Participants. Adult and child NLSY respondents reporting age of first tobacco, alcohol, marijuana, cocaine and/or crack use during two or more survey interviews.

 Measurements. Four indicators of reliability: intraclass correlation coefficients (ICC), mean and absolute mean differences in reported age and reports consistent within 1 year.

 Findings. The adjusted mean ICC for all comparisons was 0.69. The adjusted mean difference in self‐reported age of first substance use was ‐ 0.52 years and the adjusted absolute mean difference was 2.00 years. The adjusted percentage of all comparisons reporting ages consistent within 1 year was 55.28%. More consistent reports were provided by adults, and in response to questions posed over 2 years as opposed to longer time intervals. Respondent answers to questions concerned with first use of marijuana were generally found to be most reliable; questions concerned with first use of crack were least reliable and reports of tobacco, alcohol and cocaine were intermediate. Logistic regression analyses also identified age, race, gender, education and poverty status as predictors of consistent reporting.

 Conclusions. Self‐reports of age of first substance use experiences, as currently collected via survey questionnaires, are of sufficient reliability for most current epidemiological applications. For inquiries where age of substance use onset is itself a research focus, however, researchers should invest additional effort in improving the reliability of measurement.
Pre‐pregnancy drinking: how drink size affects risk assessment
Authors: Kaskutas Lee Ann , Graves Karen
Published: March 2003

Aims. We considered the role of drink size in determining average daily consumption among groups at risk for Fetal Alcohol Syndrome.

 Design. In‐person hour‐long interviews gathered cross‐sectional retrospective data about drinking before an index pregnancy.

 Setting. Subjects were recruited at public clinics in Los Angeles and the San Francisco Bay area. To reach those not necessarily seeking prenatal care, community outreach in the same urban areas was undertaken.

 Participants. Three hundred and twenty‐one pregnant women were interviewed: 102 Native Americans, 185 African Americans, and 34 Caucasians.

 Measurements. Volume of drinking prior to pregnancy was assessed using the graduated frequency series, which asks respondents to specify their drinking in terms of standard drinks. Using vessel models and photographs, respondent‐defined drink sizes were then determined, and volume was recalculated accordingly.

 Findings. For most beverages, the difference in milliliters between self‐selected drink size and a standard size drink was significant, with the mean self‐selected drink sizes ranging from 49% above the standard size (for beer) to 307% above the standard size (for spirits). For women whose pre‐pregnancy average daily volume (ADV) was at the risk level of ≥ 1 standard drink per day, ADV increased from four to almost 10 standard drinks per day when self‐defined drink sizes were instead considered. Similarly, for women having three or more standard drinks a day, their daily dose of ethanol increased from 57 g to 153 g of ethanol per day.

 Conclusions. If risk levels have been based on underestimates that assume women with alcohol‐affected infants had standard drink sizes, then true risk levels may be higher than previously thought. Related, risk drinkers presenting at prenatal clinics may be missed if screening protocols do not ask about drink size.
SOCIDROGALCOHOL: the Spanish Scientific Society for the Study of Alcohol, Alcoholism and other Drug Dependencies
Authors: Gual Antoni , Rodríguez‐Martos Alicia , Torres Miguel Ángel
Published: March 2003

Founded in 1969, SOCIDROGALCOHOL is a reference point for professionals interested in drug dependencies, both for Spaniards and for professionals belonging to Spanish‐speaking areas. In its 32 years of existence SOCIDROGALCOHOL has spread to all the regions of Spain and most of the Latin‐American countries. In the past 5 years SOCIDROGALCOHOL has undergone notable growth, increasing the number of members (from 460 to 816), as well as the number of scientific activities carried out. The National Conferences represent an annual meeting point for the members, where multiple scientific sessions take place, as well as the ordinary general assembly. They are usually held in the spring and last 3 days, with an attendance of around 400 professionals. Within the field of ongoing training, SOCIDROGALCOHOL also carries out other activities: the Autumn School, the Latin‐American Virtual Congress of Drug Dependence, distance learning courses, etc. Special mention should be made to the official journal of the Society, Adicciones, founded in 1989.

Adicciones is published quarterly in Spanish and its articles are subjected to peer review; 2000 copies of each issue are published. The abstracts can be accessed free on the website of the Society, www.SOCIDROGALCOHOL.org. In this paper the most relevant historical aspects of SOCIDROGALCOHOL will be summarized, along with its current activities and future perspectives.
The cost–effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States
Authors: Barnett Paul G. , Zaric Gregory S. , Brandeau Margaret L.
Published: March 2003

Aims.
To determine the cost‐effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States, particularly its effect on the HIV epidemic.

 Design. We developed a dynamic model to capture the effects of adding buprenorphine maintenance to the current opiate dependence treatment system. We evaluated incremental costs, including all health‐care costs, and incremental effectiveness, measured as quality‐adjusted life years (QALYs) of survival. We considered communities with HIV prevalence among injection drug users of 5% and 40%. Because no price has been set in the United States for a dose of buprenorphine, we considered three prices per dose: $5, $15, and $30.

 Findings. If buprenorphine increases the number of individuals in maintenance treatment by 10%, but does not affect the number of individuals receiving methadone maintenance, the cost‐effectiveness ratios for buprenorphine maintenance therapy are less than $45 000 per QALY gained for all prices, in both the low‐prevalence and high‐prevalence communities. If the same number of individuals enter buprenorphine maintenance (10% of the number currently in methadone), but half are injection drug users newly entering maintenance and half are individuals who switched from methadone to buprenorphine, the cost‐effectiveness ratios in both communities are less than $45 000 per QALY gained for the $5 and $15 prices, and greater than $65 000 per QALY gained for the $30 price.

 Conclusions. At a price of $5 or less per dose, buprenorphine maintenance is cost‐effective under all scenarios we considered. At $15 per dose, it is cost‐effective if its adoption does not lead to a net decline in methadone use, or if a medium to high value is assigned to the years of life lived by injection drug users and those in maintenance therapy. At $30 per dose, buprenorphine will be cost‐effective only under the most optimistic modeling assumptions.
The validity of the interviewer severity ratings in groups of ASI interviewers with varying training
Authors: Alterman Arthur I. , Mulvaney Frank D. , Cacciola John S. , Cnaan Avital , McDermott Paul A. , Brown Lawrence S.
Published: March 2003

Aims.
This study evaluated the hypothesis that the subjective interviewer severity rating (ISR) summary indices of the intake Addiction Severity Index (ASI) of less trained interviewers are less valid than those of more highly trained interviewers.

 Design. Baseline ASIs from three completed studies whose interviewers varied in degree of initial ASI training and subsequent quality assurance monitoring were examined. Associations between baseline ISRs and three other sets of ASI summary indices not based on interviewer ratings—composite scores, clinical indices and evaluation indices—were compared for three groups of interviewers with varying amounts of training. The assumption underlying these analyses was that more reliable ISRs, found in more trained interviewers, would be more highly associated with the other more objective indices.

 Setting. Methadone maintenance patients in the Philadelphia and New York City areas.

 Participants. Thirty‐five interviewers with the most intense training who administered 295 interviews; 10 interviewers with an intermediate level of training who administered 763 interviews; and eight identified (and other unidentified) least trained interviewers who administered a total of 276 interviews.

 Measurements and methods. Four sets of summary indices from the above ASIs. Both bivariate and multivariate analyses were performed.

 Findings. The study found that the validity of the validity of ISRs was greater in more trained interviewers.

 Conclusions. Greater training and subsequent monitoring of ASI interviewers generally appears to be associated with increased ISR validity.
Intra‐ and extra‐familial influences on alcohol and drug misuse: a twin study of gene–environment correlation
Authors: Jang Kerry L. , Vernon Philip A. , Livesley W. John , Stein Murray B. , Wolf Heike
Published: March 2003

Aims.
Genotype‐environment correlation refers to the extent to which individuals are exposed to environments as a function of their genetic propensities. These correlations are important in the study of psychopathology because they identify environments that may maintain the expression of underlying genetic liabilities for a disorder. The present study examined the correlation between genetic liabilities for alcohol and drug misuse with perceptions of the social environments of the family of origin and the classroom.

 Design. Postal survey data were collected from monozygotic and dizygotic twin pairs.

 Setting. Twin pairs were recruited from Vancouver, British Columbia, Canada using newspaper advertisements and media stories.

 Participants. Eighty‐five monozygotic and 77 dizygotic twin pairs were recruited from the general population.

 Measurements. Twin pairs completed self‐report measures of alcohol and drug misuse contained in the Dimensional Assessment of Personality Pathology, the Family Environment Scale, the Classroom Environment Scale, and the Traumatic Events Questionnaire.

 Findings. Genetically indexed alcohol and drug misuse scores were regressed on the environmentally indexed FES and CES scales. Genetic liabilities for alcohol and drug misuse were associated with decreased perceived family moral‐religious emphases, family cohesion and classroom task orientation and increased perceptions of classroom order and organization (strictness).

 Conclusions. Genotype‐environment correlations, in particular, moral‐religious emphases in the home, appear to be important in the development of substance misuse.
No effect of cigarette smoking on attention or mood in non‐deprived smokers
Authors: Herbert Mireille , Foulds Jonathan , Fife‐Schaw Chris
Published: March 2003

Aim.
This study aimed (a) to assess whether smoking reduces anxiety when paired with a pleasant distractor and (b) to investigate the effect of smoking a cigarette on cognitive performance in non‐deprived smokers.

 Design. Participants were allocated randomly to four conditions in a 2 × 2 factorial design: 1, Smoke + Distractor; 2, Smoke + No Distractor; 3, No Smoke + Distractor; 4, No Smoke + No Distractor.

 Setting. University psychology department (University of Surrey, UK).

 Participants. Forty‐five volunteer cigarette smokers (mean consumption = 16 cigarettes per day) allowed to smoke normally prior to the study.

 Intervention. Participants were either allowed to smoke a cigarette of their choice in a manner of their choosing or not allowed to smoke, either with or without a concurrent distractor (a music video).

 Measurements. Rapid Visual Information Processing (RVIP) performance was measured via computer before and after a 10‐minute break (during which the interventions took place). Mood was measured by (a) State Anxiety Inventory (SAI) and (b) Feeling State Questionnaire (FSQ), before and after the first RVIP task and then immediately after the break/cigarette.

 Findings. The RVIP task produced a significant increase in both measures of anxiety (SAI and FSQ stress subscale). Smoking, when paired with a distractor, did not decrease anxiety compared with when no distractor was present. Furthermore, smoking did not decrease anxiety or increase attentional (RVIP) performance compared with not smoking.

 Conclusion. The findings of this study failed to support the idea that smoking has anxiety‐reducing or attention‐enhancing properties in non‐abstinent smokers.
Methodological characteristics and quality of alcohol treatment outcome studies, 1970–98: an expanded evaluation
Authors: Moyer Anne , Finney John W. , Swearingen Carolyn E.
Published: March 2003

Aims To examine the methodological quality of the research literature examining treatment for alcohol use disorders.

Design In total, 701 studies first reported between 1970 and 1998 were evaluated with a scoring system covering 19 areas of research quality.

Findings Methodological quality improved from a score of 8.2 out of a possible 28.5 in the 1970s, to 10.6 in the 1990s. Strengths included reporting the initial number of participants and conducting follow‐ups of 12 months or longer. Although the percentage of studies with adequate power also increased overall, the average statistical power of comparative studies to detect a medium‐sized treatment effect was low (0.54).

Conclusions Areas with room for improvement include: ensuring that follow‐up data are collected when respondents are not under the influence of alcohol, testing for differential dropout among treatment groups with respect to participant background characteristics, reporting the number of individuals being treated in the programs from which samples are drawn, noting the reliability and validity of measures used and conducting process analyses to examine potential mechanisms underlying treatment effects.