bluuebunny/crossref_metadata_2025 huggingface dataset:
Six deaths linked to concomitant use of buprenorphine and benzodiazepines
Authors: Reynaud Michel , Petit Georges , Potard Denis , Courty Pascal
Published: March 2003

Aims. Buprenorphine at high dosage became available in 1996 for substitution treatment in France. This drug is considered particulary safe and has become widely available in general medical practice. We investigated the possible implication of a buprenorphine‐benzodiazepine association in six deaths of known abusers. Design. Full investigation of cause of death was conducted for six drug abusers. Setting. The deaths occurred in two regions of France (Auvergne and Lorraine). Assays were carried out by the Institut de Medecine Legale at Strasbourg, France, one of the few French laboratories equipped to assay buprenorphine. Measurement. First, the blood and urine underwent triple exhaustive screening. Secondly, buprenorphine and norbuprenorphine were analysed in all the autopsy samples by HPLC/MS. Findings. Benzodiazepine‐buprenorphine associations were found in every case; no other substances that could account for the death were found. The tissue concentrations were markedly higher than the blood levels. Conclusion. If the number of deaths linked to such drug misuse proves high, it may be necessary to review how buprenorphine is dispensed.
Risk factors for and knowledge of Mycobacterium tuberculosis infection among drug users in substance abuse treatment
Authors: Durante Amanda J. , Selwyn Peter A. , O'Connor Patrick G.
Published: March 2003

Objective. To determine the prevalence, incidence and risk factors for Mycobacterium tuberculosis infection, as well as to assess TB knowledge and attitudes, among a group of known drug users in a city with low TB incidence (11.3 per 100 000 in 1995). Methods. Patients of an urban drug treatment facility enrolled in opioid substitution, opioid antagonist and other drug treatment programs were screened for TB, including tuberculin skin testing and standardized data collection on TB risk factors. A subsample of clients was interviewed about TB knowledge and attitudes. Results. Between 1 June 1995 and 31 May 1996, 1055 individuals were screened. The prevalence of infection was 15.7% (CI: 13.2‐18.2%). PPD positivity was associated with older age (per annum, OR = 1.08, CI: 1.05‐1.11), non‐white race (OR = 2.81, CI: 1.72‐4.60), foreign birth (OR = 4.24, CI: 2.35‐7.62) and a history of injecting drug use (OR = 1.89, CI: 1.14,3.12). The incidence of infection was 2.9 per 100 person‐years (CI:1.8‐4.7). Thirty‐two per cent of 79 drug users interviewed about TB knowledge and attitudes thought TB could be prevented by bleaching or not sharing needles/syringes. Fifty‐one per cent thought anyone with a positive TB skin test was contagious. Conclusion. M. tuberculosis infection was common in this population and associated with injecting drugs and several demographic factors. The incidence of new infection was relatively low. In this non‐endemic environment, the detection and treatment of latent infection are important aspects of TB control. Misconceptions about TB transmission were also widespread in this population. Drug treatment programs can play a key role by undertaking screening programs that educate about TB and identify infected subjects who would benefit from preventive therapy.
Drug scene roles and HIV risk
Authors: Friedman Samuel R. , Furst R. Terry , Jose Benny , Curtis Richard , Neaigus Alan , Jarlais Don C. Des , Goldstein Marjorie F. , Ildefons Gilbert
Published: March 2003

Aims. Drug scenes (social and spatial drug‐using and drug‐selling environments) have complex role structures. Many drug injectors earn money or drugs as drug or syringe sellers, hit doctors (people who help others to inject) commercial sex workers, or in other roles. This paper aims to measure "role behaviors" of drug injectors; describe which drug injectors are more likely to engage in such role behaviors; and to determine whether roles are related to elements of HIV risk . Design. Cross‐sectional study of drug injectors . Setting. Bushwick, a section of Brooklyn, New York, a major location for injection drug use and drug sales . Participants. Seven hundred and sixty‐seven street‐recruited drug injectors . Measurements. Participants were interviewed about their roles, behaviors, socio‐demographics and risk networks; sera were collected and assayed for HIV and hepatitis B core antibody . Findings. Socio‐demographic variables are related to role‐holding in complex ways. Economic need is generally associated with engaging in drug‐scene role behaviors. Holders of these roles are at greater behavioral and network risk for HIV and other blood‐borne infections than are other drug injectors. They also engage in extensive communication with other drug users, including discussion of HIV risk reduction . Conclusion. Role behaviors can be measured in quantitative studies, and seem to be related to HIV risk. Role‐holders may be strategic targets for risk‐reduction campaigns. It seems feasible and advisable to measure drug scene role‐holding in research on drug users.
Alcohol consumption and alcohol‐related problems: Chinese experience from six area samples, 1994
Authors: Wei Hao , Derson Young , Shuiyuan Xiao , Lingjiang Li , Yalin Zhang
Published: March 2003

Aims. To understand the drinking frequency, mean yearly volume of consumption and drinking‐related problems in individuals living in six areas in China.

Design and measurements. By two‐stage sampling, 23 513 community household residents (15‐65 years old) were assessed with data collected by trained psychiatrists using structured questionnaires and DSM‐III‐R criteria.

Findings. The male, female and total drinking rates were 84.1%, 29.3% and 59.5%, respectively. More than half of male drinkers and 90.0% of female drinkers used alcohol once a week or less. More than 16.1% of male drinkers and 2.5% of female drinkers drank once a day or more. The males reported a greater amount of alcohol consumed per session. The mean yearly volume of consumption of pure alcohol per year for all sample was 3.60 l; males consumed 18.6 times more alcohol than females. The rate of alcohol‐related problems was higher in males than females. The male, female and total alcohol dependence point prevalence rates were 6.632%, 0.104% and 3.428%, respectively. Six‐month incidence rates of acute intoxication were 5.162%, 0.017% and 2.637%, respectively.

Conclusion. Drinking problems in China will continue to be a public health problem in the next century.
Quantitative and qualitative evaluations of brief interventions to change excessive drinking, smoking and stress in the police force
Authors: Richmond Robyn L. , Kehoe Linda , Hailstone Susan , Wodak Alex , Uebel‐Yan Merryl
Published: March 2003

Aims. To evaluate the effects of a brief intervention to reduce excessive drinking, smoking and stress among police.

Design. (1) Controlled intervention trial with pre and post‐intervention assessment approximately 8 months apart; (2) focus group identification of relevant factors).

Setting, participants. Assessment was carried out of 954 NSW (Australia) police at 19 stations within two matched districts in the Sydney metropolitan area. Five focus groups were carried out with 43 randomly selected police from the matched districts.

Measurements. Weekly alcohol consumption and binge drinking, smoking and symptoms of stress were measured by a self‐administered Health and Fitness Questionnaire. Recorded responses to set questions provided qualitative data.

Results. Participation was high (89%) at both quantitative assessments. Alcohol consumption, particularly among men, was high at both baseline and follow‐up assessments, although comparisons between groups across occasions showed no significant intervention effects. Excessive drinkers and those reporting moderate to severe stress levels reported more sick leave days ( p < 0.05, p < 0.05). A significant increase in awareness of alcohol policies in the work‐place showed in both experimental and control groups over time (p < 0.01). The percentage of smokers declined significantly in both intervention and control groups. Overall, women had significantly more symptoms of stress than men. Only 20% of police thought they would seek advice from work‐place staff about alcohol consumption, 14% for smoking and 61% for stress. In the qualitative study, employees generally distrusted their organization's involvement in health unless work performance was affected. Seeking professional assistance for life‐style issues was viewed as a sign of weakness. Alcohol use was seen as a way of obtaining information or group membership, self‐medication and socializing.

Conclusions. The brief interventions did not produce significant improvements in three life‐style factors beyond positive trends in alcohol consumption among women and general reductions in smoking among both study groups. Combining quantitative and qualitative approaches helped identify interactive individual and organizational factors which influence behavioural and cultural norms.
Ability of smokers to reduce their smoking and its association with future smoking cessation
Authors: Hughes John R. , Cummings K. Michael , Hyland Andy
Published: March 2003

Aims. We examined whether cigarette smokers in the United States can significantly reduce their smoking and maintain this reduction and, if so, whether this predicts an increase or decrease in the probability of smoking cessation in the future. Design. Longitudinal observation study. Setting. The 22 US cities of the Community Intervention Trial for smoking cessation (COMMIT). Participants. The 1410 subjects who smoked at both baseline and at 2‐year follow‐up. Intervention. Public health efforts to prompt cessation in half the communities. Measurements. Self‐reported cigarettes/day and abstinence at baseline, 2‐year and 4‐year follow‐ups. Findings. At 2‐year follow‐up. 60% of the subjects had either not changed or increased their smoking, 17% had decreased their smoking by 5‐25%, 15% by 24‐49% and 8% by 50%. Among the 40% who had reduced 5% at 2‐year follow‐up, 52% reported maintaining that reduction at 4‐year follow‐up. Reduction in smoking at year 2 did not prospectively predict an increase or decrease in the probability of making a quit attempt; nor did it predict eventually quitting by year 4. Conclusions. A substantial minority of US smokers are able to reduce their smoking and maintain this for long periods of time. Smoking reduction neither promotes nor undermines cessation.
Predictability of smoking in adolescence: between optimism and pessimism
Authors: Engels Rutger C. M. E. , Knibbe Ronald A. , Drop Maria J.
Published: March 2003

Aims. The present study aimed to assess how far associations between possible explanatory variables and smoking onset depend on the use of cross‐sectional versus prospective designs. Design and subjects. Data were analysed from a three‐wave 5‐year longitudinal survey among 1063 secondary schoolchildren (12‐18‐ year‐olds) in The Netherlands. Measurements. The survey questionnaire contained items on smoking history, smoking‐specific beliefs and attitudes, social influence variables and socio‐demographic variables in each wave. Findings and conclusions. The cross‐sectional analyses showed strong associations between explanatory variables and smoking behaviour (R2 varied from 0.50 to 0.71). However, only 8% of the variance in change of smoking status from non‐smoking to regular smoking over a period of 5 years and 14% of the variance over a period of 3 years could be predicted by the model variables. Factors believed to lead to smoking may result from smoking or they may change quickly in ways that make them of low predictive value even though they may be important aetiologically.
The relationship between alcohol consumption patterns and injury
Authors: McLeod Roberta , Stockwell Tim , Stevens Margaret , Phillips Mike
Published: March 2003

Aims and design. A case‐control design was employed to quantify the risk of injury after the recent consumption of alcohol. Participants and setting. A total of 797 cases and 797 controls were interviewed throughout 1997. A response rate of 82% was calculated for eligible cases who were approached by an interviewer. The rate for interviews conducted of all people presenting with an injury during the study period was 67%. Cases were injured patients from a hospital emergency unit. Controls were matched on suburb and were interviewed at home regarding activities leading up to the time of their matched case's injury. Measurement. Cases and controls were questioned about the injury event and alcohol and other drug use consumed in the 6 hours prior to the injury. They were also breath‐tested and medical records were checked for validation purposes. Findings. Logistic regression analysis produced an odds ratio of 3.4 (95% CI: 1.8‐6.4) for the risk of sustaining an injury after consuming more than 60 g of alcohol in a 6‐hour period, after controlling for demographic variables. The risk of injury at different levels of alcohol use was substantially higher for females with a significant odds ration of 9.6 at greater than 60 g of alcohol compared to 2.1 for men. Conclusions. These results need to be interpreted cautiously, but provide additional support that the risk of injury increases with the quantity of alcohol consumed and that the risk of injury is significantly higher for women.
A confidential enquiry into methadone‐related deaths
Authors: Scott R. T. A. , Jay M. J. H. , Keith R. , Oliver J. S. , Cassidy M. T.
Published: March 2003

Aim. To assess the acceptability and usefulness of the confidential enquiry process in examining methadone‐related deaths. Design. An audit of patient care. Setting. Glasgow, Scotland, UK (population 915 000) Participants. All doctors who, in the final 14 days of the patient's life, had attended a patient who suffered a methadone‐related death. Measurements. The medical care of each case was assessed by peer review and the results of these assessments returned to the responsible clinician(s). Findings. (1) The audit cycle was completed in 32 of the 34 reported cases (94%). (2) Twenty‐eight of 33 doctors (85%) found the audit to be helpful. (3) As a result of the enquiry, the majority of doctors whose patient management had attracted criticism intended to amend their practice. (4) Shortcomings in clinical care were identified in 18 cases (56%) and problems in the organization of services in 22 (69%). Conclusions. (1) The model of audit piloted here was found to be highly acceptable to participants. (2) The episodes of substandard care that were uncovered provided useful opportunities to improve the future management of patients who were being prescribed methadone.
Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance‐specific coping to 1‐year outcomes
Authors: Moggi Franz , Ouimette Paige Crosby , Moos Rudolf H. , Finney John W.
Published: March 2003

Aims. This study examined general and substance‐specific coping skills and their relationship to treatment climate, continuing care and 1‐year post‐treatment functioning among dual diagnosis patients (i.e. co‐occurrence of substance use and psychiatric disorders). Design. In a prospective multi‐site study, dual diagnosis patients participating in substance abuse treatment were assessed at intake, discharge and at a 1‐year follow‐up. Setting. Patients were recruited from 15 substance abuse treatment programs, which were selected from a larger pool of 174 inpatient treatment programs in the Department of Veterans Affairs Health Care System. Participants. A total of 981 male dual diagnosis patients participated in the study. Measurements. Assessments included general and substance‐specific coping skills, treatment climate, continuing outpatient care, abstinence and clinically significant psychiatric symptoms. Findings. Dual diagnosis patients modestly improved on general and substance‐specific coping skills over the 1‐year follow‐up period. Patients who were in programs with a 'dual diagnosis treatment climate' and who participated in more 12‐Step self‐help groups showed slightly more gains in adaptive coping. Both general and substance‐specific coping were associated with abstinence, but only general coping was associated with freedom from significant psychiatric symptoms. Conclusions. Enhancing general and substance‐specific coping skills in substance abuse treatment may reduce dual diagnosis patients' post‐treatment substance use and improve their psychological functioning.
HIV risk behaviours among gay men who use anabolic steroids
Authors: Bolding Graham , Sherr Lorraine , Maguire Mark , Elford Jonathan
Published: March 2003

Aims. To examine the injecting and sexual risk behaviours of gay men in London who use anabolic steroids or other fitness‐enhancing substances (referred to as AS). Design. Cross‐sectional survey using self‐administered questionnaire. Setting. Five gyms in central London. Participants. 1004 gay men using the gyms during September‐October 1997. Measurements. Proportion of men who report (i) injecting AS, (ii) sharing needles and (iii) HIV status‐unknown unprotected anal intercourse (UAI). Findings. Of 1004 men, 136 (13.5%) were current users of AS (range across the five gyms, 2.7‐21.2%, p < 0.001), and 81 (8.1%) injected AS (range 0.4‐17.5%, p < 0.001). None said they shared a needle with other users and more than 90% said they always used disposable units from sealed packets. Among current AS users, 20.9% (28/136) reported status‐unknown UAI compared with 12.9% (107/827) of never‐users (p = 0.02), a differential which remained significant after adjusting for confounding factors (adjusted odds ratio = 1.75, 95% CI 1.05, 2.91 , p = 0.03). Conclusions. While nearly one in 10 gay men in this study injected anabolic steroids or other fitness‐enhancing substances, none reported sharing needles. Steroid users were, however, more likely to report status‐unknown UAI than other men, a differential that remained after adjusting for confounding factors. Since any change in injecting practice could dramatically increase the risk of HIV transmission in this population, behavioural surveillance to monitor risk behaviours among gay men using anabolic steroids is recommended, as are targeted HIV prevention programmes.
DSM‐III‐R co‐morbidity in benzodiazepine dependence
Authors: Martinez‐Cano H. , Gauna M. De Iceta Ibanez De , Vela‐Bueno A. , Wittchen H. U.
Published: March 2003

Aim, sample and measures. Co‐morbidity has been shown to influence the clinical course of mental disorders. This paper describes DSM‐III‐R 1‐month co‐morbidity across axes I, II and III in a sample of 153 benzodiazepine dependants. All patients were evaluated through several in‐depth clinical interviews across all five DSM‐III‐R axes. Results. Extensive co‐morbidity existed across three DSM‐III‐R axes. All patients had at least one diagnosis in axis I; 81 (52.9%) in axis II and 50 (32.7%) in axis III. The most prevalent diagnoses were: insomnia, anxiety disorders and affective disorders in axis I; obsessive‐compulsive, histrionic and dependent personality disorders in axis II and rheumatological, neurological and cardiovascular disorders in axis III. Conclusions. There were no cases of benzodiazepine dependence appearing alone. There were associations within and between axes, suggesting potential predisposing factors and a sequential model for benzodiazepine dependence is proposed. The findings reinforce the need for exhaustive diagnostic evaluation of patients prior to prescribing benzodiazepine.
Preventing opiate overdose fatalities with take‐home naloxone: pre‐launch study of possible impact and acceptability
Authors: Strang John , Powis Beverly , Best David , Vingoe Louisa , Griffiths Paul , Taylor Colin , Welch Sarah , Gossop Michael
Published: March 2003

Aims. Before proceeding with the introduction of an overdose fatality prevention programme including teaching in cardio‐pulmonary resuscitation and distribution of naloxone, a pre‐launch study of treatment and community samples of injecting drug misusers has been undertaken to establish (i) the extent of witnessing overdoses, (ii) the acceptability of naloxone distribution and training; and (iii) the likely impact of such measures. Design and setting. Structured interview of two samples: (a) a community sample of injecting drug misusers recruited by selected privileged access interviewers (PAI) and interviewed by them in community settings and (b) a treatment sample of opiate addicts recruited from our methadone maintenance clinic (interviewed by in‐house research staff). Participants. (a) Three hundred and twelve injecting drug misusers with a history of having injected and currently still using injectable drugs; and (b) 142 opiate addicts in treatment at our local catchment area methadone maintenance clinic in South London. Findings. History of personal overdose was found with 38% of the community sample and 55% of the treatment samplemainly involving opiates and in the company of friends. Most (54% and 92%, respectively) had witnessed at least one overdose (again mostly involving opiates), of whom a third had witnessed a fatal overdose. Only a few (35%) already knew of the existence and effects of naloxone. After explanation to the treatment sample, 70% considered naloxone distribution to be a good proposal. Of the 13% opposed to the proposal, half thought it may lead them to use more drugs. Eighty‐nine per cent of those who had witnessed an overdose fatality would have administered naloxone if it had been available. We estimate that at least two‐thirds of witnessed overdose fatalities could be prevented by administration of home‐based supplies of naloxone. Conclusions. Substantial proportions of both community and treatment samples of drug misusers have witnessed an overdose death which could have been prevented through prior training in resuscitation techniques and administration of home‐based supplies of naloxone. Such a new approach would be supported by most drug misusers. On the basis of these findings, we conclude that it is appropriate to proceed to a carefully constructed trial of naloxone distribution.
Reducing risks associated with drinking among young adults: promoting knowledge‐based perspectives and harm reduction strategies
Authors: Giesbrecht Norman
Published: March 2003

The situation with regard to drinking is particularly complex for young adults: they are typically faced with pressures on one hand to abstain or drink small quantities, and on the other hand there may be expectations to drink heroic amounts and engage in risk‐taking while drinking. Furthermore, in some cultures a very short transition period time is evident between condoned occasional experimentation with alcohol and the expectations of being able to manage alcohol use in a wide range of settings. Also, the perceived invincibility among youth stands in sharp contrast to their high rates of traumatic events involving alcohol. The paper by Barbara Leigh examines the nature and dimensions of risk‐taking particularly among young adults. For example, her analysis encourages us to look beyond preliminary associations about the proportion of certain events where drinking was involved, and consider whether drinking was a correlate or a contributing cause. The paper by James Mosher points to the importance of obtaining information about the population, situation and drinker as a basis for population‐level interventions, involving environmental changes in the promotion and distribution of alcoholic beverages. The papers point to a search for interventions that are distinguished by their effectiveness in reducing harm, and not necessarily by their faddish value. An essential step is drawing the younger drinker into an accurate documentation of risk‐taking experiences, and also in collaborating in developing humane, reasonable and effective approaches in reducing drinking‐related harm.
Subacute onset of oculogyric crises and generalized dystonia following intranasal administration of heroin
Authors: Schoser Benedikt G.H. , Groden Christoph
Published: March 2003

A case is reported of a patient who experienced sudden onset of severe respiratory failure, shock and coma after first‐time intranasal heroin abuse. During the following days full consciousness was restored, revealing persistent oculogyric crises, axial retropulsive dystonia and ataxia. Initially computer tomography (CT) scans of the brain were normal and cerebral spinal fluid examination showed a slight elevation of lactate. Magnetic resonance imaging (MRI) scans of the brain demonstrated diffuse bilateral subcortical white matter hyperintensities, with sparing of the U‐fibres, symmetric bilateral hyperintensities of the globus pallidum and very hyperintensive subcortical foci in the right hemisphere. Differential diagnostic assessment, treatment, clinical and MRI course of a 6‐month follow‐up are discussed.
The structure of DSM‐IV alcohol dependence in a treatment sample of Mexican and Mexican American men
Authors: Caetano Raul , Mora Maria Elena Medina , Schafer John , Marino Maria Del Carmen
Published: March 2003

Aims. To examine the symptom profile and factorial structure of DSM‐IV alcohol dependence. Design. Subjects were interviewed in program facilities by trained interviewers using a standardized questionnaire. The response rate was 95% in Mexico and 90% in the United States. Setting. Two publicly funded inpatient facilities in Mexico and five in the United States. In Mexico the programs were located in Mexico City. In the United States the programs were located in Santa Clara County, California. Participants. Three hundred and ninety‐one Mexican and 212 Mexican American men in treatment for alcohol problems in Mexico and the United States. Measurement. Dependence criteria were assessed with the Composite Diagnostic Interview‐Substance Abuse Module (CIDI‐SAM). Findings. The unidimensional structure of alcohol dependence fits the Mexican American data but not the Mexican data. However, when Mexican clients were divided according to place of interview (treatment program), the unidimensional structure fits one of the groups but not the other. Conclusions. The test of unidimensionality must be seen as inconclusive with regard to the Mexican data. These results highlight the potential influence that client selection methods may have on study results, especially in cross‐cultural projects.
Inhalant use and delinquent behavior among adolescents: a comparison of inhalant users and other drug users
Authors: Mackesy‐Amiti Mary Ellen , Fendrich Michael
Published: March 2003

Aims. To evaluate the association between inhalant use and delinquent or criminal behavior. Design. A large statewide sample of high school students participated in a survey on drug use. Five groups were identified based on reported drug use: inhalant experimenters, other drug experimenters, inhalant users, other drug users and non‐users. Inhalant users were compared with other drug users and inhalant experimenters with other drug experimenters on three measures of problem behavior. Participants. Over 13 000 students in grades 7‐12 participated in the 1993 survey on drug use. Measurements. Three measures of problem behavior: drinking and drug‐taking, "trouble behavior" and minor criminal activity. Findings. Among upper (9‐12) grade level students only, both inhalant users and inhalant experimenters reported more minor criminal activity than other drug users and other drug experimenters, respectively. A similar trend was noted for trouble behavior. The same was not found for drinking and drug‐taking behavior. Conclusions. The findings suggest that inhalant use is categorically different from other drug use, and that it has more in common with general delinquency than with general drug use. Prevention and treatment strategies should take this into consideration.
Impulsivity predicts problem gambling in low SES adolescent males
Authors: Vitaro Frank , Arseneault Louise , Tremblay Richard E.
Published: March 2003

Aims. This study investigated whether impulsivity measured in 12‐14‐year‐olds could predict problem gambling in late adolescence, above and beyond other personality factors such as aggressiveness and anxiety. Design. A prospective‐longitudinal design was used, thus overcoming limitations of past studies which used concurrent or retrospective designs. Participants and measurements. The sample included 154 boys living in economically deprived neighborhoods. Impulsivity measures comprised self‐reports, teacher ratings and laboratory tasks, and were administered during early adolescence. Gambling behavior was assessed at age 17 using a self‐report measure. Early gambling behavior and socio‐demographic information were also collected for control purposes. Findings. Results revealed that a self‐report measure of impulsiveness and a card‐sorting task significantly predicted problem gambling, even after controlling for socio‐demographic variables, early gambling behavior and other personality variables such as aggressiveness and anxiety. Moreover, the predictive link held across all levels of aggressiveness and anxiety. Both impulsivity measures seemed to tap an inability to foresee negative consequences and an inability to stop responding despite unfavorable contingencies. Conclusion. These findings suggest that disinhibited individuals with response modulation deficits are at risk for problem gambling, thus supporting the DSM‐IV classification of pathological gambling as an impulse control deficit.
Serendipitous rapid detoxification from opiates: the importance of time‐dependent processes
Authors: Mannelli Paolo , Risio Sergio De , Pozzi Gino , Janiri Luigi , Giacomo Maria De
Published: March 2003

Opiate detoxification procedures aim to reduce intensity and duration of withdrawal. Ultra‐rapid opiate detoxification (UROD) methods attempt to obtain this goal by administering naltrexone under deep sedation or anaesthesia. We present a case study on accidental ingestion of naltrexone in a methadone maintenance patient, which shows close methodological similarities with UROD procedures. Naltrexone was effective in reducing withdrawal duration, but not as much as UROD studies report. The administration of naloxone after detoxification did not trigger withdrawal symptoms, even in the presence of methadone, as detected by urinalyses. These results suggest the importance of further developing detoxification methods based on protocols of administration of antagonists different from UROD, in absence of anaesthesia.
A brief measure for the assessment of coping self‐efficacy among alcohol and other drug users
Authors: Sklar Sherrilyn M. , Turner Nigel E.
Published: March 2003

Aims. To develop a reliable and valid brief measure of coping self‐efficacy for substance users to serve the needs of clinicians and researchers who desire a global measure of a client's confidence across high‐risk situations. The eight‐item global measure of self‐efficacy was derived from the Drug‐Taking Confidence Questionnaire (DTCQ), a 50‐item self‐report measure of situation‐specific coping self‐efficacy applicable to alcohol and other drug users. Design. The questionnaire was administered by trained staff to clients at intake to treatment. Items were selected using stepwise regression. Reliability and construct validity were assessed using alpha and correlation coefficients. Setting. An addiction treatment facility in Toronto, Ontario. Participants. Seven hundred and thirteen English‐speaking adults presenting for treatment with an alcohol or other drug problem. The sample was comprised of alcohol (344), cocaine (253), heroin (53), cannabis (43), other drug (20) users. Measurements. The DTCQ: perceived difficulty quitting, motivation to quit and confidence in quitting; depression score (SCL‐90‐R); and motivation scores (SOCRATES‐revised). Findings. An eight‐item version (DTCQ‐8) accounted for 95% of the variance in the total DTCQ‐50 scores and correlated 0.97 with the total DTCQ‐50 score. Reliability and validity for the DTCQ‐8 as a global indicator of coping self‐efficacy was confirmed. Conclusions. Clinically, the DTCQ‐8 is useful for the assessment and monitoring of confidence levels during treatment. The DTCQ‐8 is a promising research tool for inclusion in outcome evaluation batteries that require a brief, reliable and valid measure of coping self‐efficacy.
Reciprocal relations between stressors and drinking behavior: a three‐wave panel study of late middle‐aged and older women and men
Authors: Brennan Penny L. , Schutte Kathleen K. , Moos Rudolf H.
Published: March 2003

Aim. To examine reciprocal relations between stressors and drinking behavior among late‐middle‐aged and older women and men. Design, setting, and participants. A community sample of 621 women and 941 men (mean age="61)" provided information about their life stressors and drinking behavior at three times: initial assessment, 1 year later and 4 years later. Structural equation modeling with manifest variables was used to examine cross‐temporal relations between stressors and drinking behavior. Findings. Stressors did not predict heavier or more frequent drinking. In fact, among women, increased health stressors predicted a reduction of alcohol consumption; among men, increased financial stressors suppressed alcohol consumption. Higher stressor levels in some life domains did foreshadow later drinking problems. More initial drinking problems resulted in more subsequent financial and spouse stressors for both women and men. Contrary to expectation, more frequent alcohol consumption presaged fewer negative life events, health stressors, and financial stressors for women, and fewer health stressors for men. Conclusions. The findings suggest that among older adults there may be a harmful feedback cycle whereby problematic drinking and life stressors exacerbate each other, but also a benign feedback cycle in which moderate alcohol consumption and life stressors reduce each other.
The effects of fluoxetine combined with nicotine inhalers in smoking cessation‐a randomized trial
Authors: Blondal Thorsteinn , Gudmundsson Larus J. , Tomasson Kristinn , Jonsdottir Dagmar , Hilmarsdottir Holmfridur , Kristjansson Fjalar , Nilsson Fredrik , Bjornsdottir Unnur Steina
Published: March 2003

Aims. Nicotine replacement therapy (NRT) is an established aid in stopping smoking, while the role of antidepressants remains uncertain. Antidepressants added to NRT might improve abstinence rates. Our aim was to determine the efficacy of nicotine inhaler and fluoxetine vs. nicotine inhaler and placebo in attempts to quit smoking. Design. A randomized, double‐blind, placebo‐controlled trial. Setting. A smoker's cessation clinic. Participants. One hundred volunteers smoking 10 cigarettes/day or more. Interventions. Subjects were instructed to start taking a daily dose of 10 mg of fluoxetine or placebo 16 days before stopping smoking, then 20 mg 10 days before quitting, continuing for up to at least 3 months. Subjects were instructed to use 6‐12 units per day of nicotine inhalers after stopping smoking for up to 6 months. Measurements. Continuous abstinence rates recorded at various time points up to 12 months from the quit date. Findings. The sustained abstinence rate for the inhaler‐fluoxetine group was 54%, 40%, 29% and 21% after 1.5, 3, 6 and 12 months, respectively, compared to 48%, 40%, 32% and 23% for the inhaler‐placebo group. The differences were not significant at any time point. Abstinence up to 3 months was more likely in older smokers, those with a lower Beck Depression Inventory Score (BDI), lower Fagerstrom Test of Nicotine Dependence (FTND) score and no history of alcoholism. Fluoxetine appeared to increase abstinence rates among high BDI smokers compared to high BDI smokers assigned placebo. Serum levels of nicotine during treatment in the inhaler‐fluoxetine group were lower than in the inhaler‐placebo group so that fluoxetine may have reduced inhaler use through a common site of action. Conclusions. We found no evidence that fluoxetine treatment when used as an adjunct to NRT in unselected smokers is effective, but there may be an advantage to using it in depressed smokers.
Activation of alcohol‐related associative networks by recent alcohol consumption and alcohol‐related cues
Authors: Glautier Steven , Spencer Klair
Published: March 2003

Aims. To investigate the influence of recent alcohol consumption and alcohol‐related cues on performance in a sentence generation task. Design. Two experiments were carried out. In the first, the performances of light, moderate and heavy drinkers were compared. In the second, subjects were randomly assigned to one of three experimental treatments (alcohol‐priming, non‐alcohol priming, and control) and classified as light, moderate or heavy drinkers. The effect of experimental treatment, drinking status, gender and the interaction between these factors was studied. Setting. The experiments were carried out in quiet research rooms in psychology departments. Participants. Volunteers recruited from university campuses. Measurements. Questionnaires were used to ascertain recent drinking histories. Subjects generated sentences incorporating ambiguous alcohol‐related words which were provided by the experimenter. The sentences were then classified as alcohol‐related or not, the dependent measure was the number of alcohol‐related sentences produced. Findings. In both experiments heavier drinkers produced more alcohol‐related sentences and males produced more alcohol‐related sentences than females. In the second experiment more alcohol‐related sentences were produced after subjects were exposed the alcohol priming condition. Conclusions. The alcohol‐related meaning of ambiguous words is more likely to be accessed by males and by heavier drinkers and after exposure to other alcohol cues.
HIV and HCV infection among drug users in Japan
Authors: Wada Kiyoshi , Greberman Sharyn Bowman , Konuma Kyohei , Hirai Shinji
Published: March 2003

Aims. To assess seroprevalence of human immunodeficiency virus (HIV), hepatitis C virus, injecting drug use, unsafe sexual behaviours, self‐mutilation and tattoos in patients attending a drug and alcohol treatment centre in Japan. Design. Cross‐sectional survey. Setting. The work was carried out at the National Sanitarium of Shimousa, Chiba, Japan, a 32‐bed inpatient centre specializing in drug and alcohol treatment. Measurements. Laboratory analyses for HIV antibody, hepatitis C antibody, hepatitis B antigen and antibody; questionnaires for history of sexual activities, needle and syringe use; physical examination with assessment of self‐amputated finger joints, tattoos, scars from lacerations and cigarette burns. Findings. No patients tested positive for anti‐HIV. The seroprevalence of anti‐HCV positives was 53.8% of methamphetamine‐dependent patients, 18.4% of solvent‐dependent patients and 5.6% of alcohol‐dependent patients. Past needle sharing was reported by 82.1% of methamphetamine‐dependent patients, 18.4% of solvent‐dependent patients and 5.6% of alcohol‐dependent patients. A history of syringe sharing was reported by 87.2% of methamphetamine‐dependent patients. More than two‐thirds of all patients reported contact with commercial sex workers. Casual sexual contacts were more common among solvent and methamphetamine‐dependent patients than those dependent on alcohol. Tattoos and cigarette burns were more common among methamphetamine and solvent‐dependent patients than among alcohol‐dependent patients. Among the methamphetamine‐dependent patients, 20.5% reported self‐amputated finger joints compared with none in the other patient groups. Conclusions. HCV prevalence is a significant problem among methamphetamine users in Japan, probably because of a high rate of needle and/or syringe sharing. Although HIV infection is currently negligible, the very high rate of needle and syringe sharing could give rise to a significant increase in the HIV rate among drug users in the future.
Tuberculosis chemoprophylaxis using a liquid isoniazid‐methadone admixture for drug users in methadone maintenance
Authors: O'Connor Patrick G. , Shi Julia M. , Henry Susan , Durante Amanda J. , Friedman Lloyd , Selwyn Peter A.
Published: March 2003

Background. Tuberculosis is common in drug users, although compliance with therapy may be difficult in this population. Objective. To evaluate an approach to enhancing compliance with tuberculosis chemoprophylaxis in drug users enrolled on methadone maintenance utilizing an isoniazid (INH)‐methadone admixture. Design. A prospective cohort study. Setting. A drug treatment program in New Haven, Connecticut, USA. Patients. Opioid‐dependent drug users enrolled in methadone maintenance. Intervention. Liquid isoniazid was mixed into subjects' daily dose of methadone. Vitamin B6 was given to subjects for self‐administration. Measurements and main results. Number of eligible subjects, reasons for not starting therapy, number starting therapy, proportion completing therapy and median duration of INH therapy were calculated. Thirty‐nine subjects were eligible for INH chemoprophylaxis: 34 (87%) received INH mixed directly in their methadone and five (13%) had their INH consumption supervised by a nurse. Among these subjects, 72% (28/39) completed therapy. Among the 11 subjects who discontinued INH, discharge from the methadone maintenance program was the most common reason‐73% (8/11). Thus, among the 31 subjects who were not discharged from methadone maintenance, 90% (28/31) successfully completed INH prophylaxis. The median duration of therapy was 182 days. Conclusions. Tuberculosis chemoprophylaxis using a liquid isoniazid‐methadone admixture appears to be an effective approach to enhancing compliance with this therapy in methadone‐maintained drug users.
Lifetime tobacco, alcohol and other substance use in adolescent Minnesota twins: univariate and multivariate behavioral genetic analyses
Authors: Han Cong , Mcgue Matthew K. , Iacono William G.
Published: March 2003

Aims. We sought to estimate the contribution of genetic and environmental factors to adolescent tobacco, alcohol and other substance use. Design, setting and participants. The sample consisted of 327 monozygotic and 174 like‐sex dizygotic twin pairs born in Minnesota and aged 17‐18 years at time of assessment. Biometrical methods were used to estimate the contribution of additive genetic, shared and non‐shared environmental factors to adolescent substance use. Measurements. As part of a day‐long psychological assessment, adolescent twins completed a computerized substance use interview to determine whether they had ever used tobacco, alcohol or other illicit drugs. Findings. The heritability for the liabilities to tobacco, alcohol and other drug use was estimated to be 59%, 60% and 33% among males, and 11%, 10% and 11% among females. However, the gender difference was not statistically significant. Estimates of shared environmental effect were substantial and insignificantly higher among females (71%, 68% and 36%, respectively) than among males (18%, 23% and 23%, respectively). The covariation among the three substance use phenotypes could be accounted for by a common underlying substance use factor. Estimates of the contributions of genetic, shared environmental and non‐shared environmental factors to variance in this factor were 23% 63% and 14%, respectively. Conclusions. These findings add to the growing behavioral genetic literature indicating that adolescent initiation of substance use, a powerful predictor of adult substance use diagnosis, is influenced primarily by environmental rather than genetic factors.
Cannabis abuse and serious suicide attempts
Authors: Beautrais Annette L. , Joyce Peter R. , Mulder Roger T.
Published: March 2003

Aims. To compare the relationship between cannabis abuse/dependence and risk of medically serious suicide attempts in individuals making serious suicide attempts and randomly selected comparison subjects. Design. Case‐control comparison. Setting. Cases, a general hospital; controls, the local community. Participants. Cases were 302 consecutive individuals making medically serious suicide attempts; 1028 randomly selected control subjects. Measurements. DSM‐III‐R mental disorder diagnoses; measures of socio‐demographic characteristics and childhood and family experiences. Findings. Of those making serious suicide attempts, 16.2% met DSM‐III‐R criteria for cannabis abuse/dependence at the time of the attempt, compared with 1.9% of comparison subjects (OR=10.3; 95%CI, 5.95‐17.8, p 0.0001). Risks of serious suicide attempt were significantly related to a series of socio‐demographic and childhood characteristics, and to mental disorders that were co‐morbid with cannabis abuse/dependence. When the association between cannabis abuse/dependence and suicide attempt risk was controlled for socio‐demographic factors, childhood factors and concurrent psychiatric morbidity, there was a marginally significant association (OR=2.0; 95%CI, 0.97‐5.3, p 0.06) between cannabis abuse/dependence and serious suicide attempt risk. Conclusions. These results suggested that much of the association between cannabis abuse/dependence and suicide attempt risk arose because: (a) individuals who develop cannabis abuse/dependency tend to come from disadvantaged socio‐demographic and childhood backgrounds which, independently of cannabis abuse, are associated with higher risk of suicide attempt, or (b) because cannabis abuse/dependence is co‐morbid with other mental disorders which are independently associated with suicidal behaviour. Nevertheless, the possibility remains that cannabis abuse/dependence may make an independent contribution to risk of serious suicide attempt, both directly and through the possible effects of cannabis abuse on risk of other mental disorders.
Co‐infection with malaria and HIV in injecting drug users in Brazil: a new challenge to public health?
Authors: Bastos Francisco Inacio , Barcellos Christovam , Lowndes Catherine M. , Friedman Samuel R.
Published: March 2003

Aims. To describe AIDS and malaria geography in Brazil, highlighting the role of injecting drug users (IDUs) in malaria outbreaks occurring in malaria‐free regions, and the potential clinical and public health implications of malaria/HIV co‐infection. Design. Review of the available literature and original analyses using geoprocessing and spatial analysis techniques. Findings. Both HIV/AIDS and malaria distribution are currently undergoing profound changes in Brazil, with mutual expansion to intersecting geographical regions and social networks. Very recent reports describe the first clinical case of AIDS in a remote Amazonian ethnic group, as well as malaria cases in Rio de Janeiro state (hitherto a malaria‐free area for 20 years); in addition, two outbreaks of both infections occurred at the beginning of the 1990s in the most industrialized Brazilian state (Sao Paulo), due to the sharing of needles and syringes by drug users. Spatial data point to: (a) the expansion of HIV/AIDS towards malarigenic areas located in the centre‐west and north of Brazil, along the main cocaine trafficking routes, with IDU networks apparently playing a core role; and (b) the possibility of new outbreaks of secondary malaria in urban settings where HIV/AIDS is still expanding, through the sharing of needles and syringes. Conclusions. New outbreaks of cases of HIV and malaria are likely to occur among Brazilian IDUs, and might conceivably contribute to the development of treatment‐resistant strains of malaria in this population. Health professionals should be alert to this possibility, which could also eventually occur in IDU networks in developed countries.