bluuebunny/crossref_metadata_2025 huggingface dataset:
Gambling problems in substance abusers are associated with increased sexual risk behaviors
Authors: Petry Nancy M.
Published: March 2003

Objectives. This study evaluated the association between gambling problems and HIV risk behaviors in substance abusers.

Participants and setting. One hundred and thirty‐four substance abusers were recruited from advertisements placed in newspapers and at social service agencies. Intervention. Gambling problems were assessed using the South Oaks Gambling Screen (SOGS). The Addiction Severity Index evaluated drug and psychosocial problems, and the HIV Risk Behavior Scale assessed risk behaviors.

Findings. Based on SOGS scores, 24% (n = 31) of substance abusers evidenced probable pathological gambling. Problem gambling substance abusers were more likely to be male than non‐problem gamblers, but no other differences in demographic characteristics or drug use variables were noted. Compared to non‐problem gamblers, problem gamblers reported more sex partners and less frequent use of condoms with casual and paid sex partners. Stepwise logistic regression confirmed the association between severity of gambling problems and more risky sexual behaviors; higher SOGS scores predicted having more than 50 sex partners, exchanging sex for drugs/money, and engaging in anal intercourse (p < 0.05). Participants with gambling problems were also less knowledgeable about HIV transmission.

Conclusions. These data suggest that gambling problems may be a risk factor for contracting HIV. Increased efforts are needed to screen for and treat gambling problems among substance abusers.
CASE REPORT   Psychosis in a methadone‐substituted patient during interferon‐alpha treatment of hepatitis C
Authors: Schäfer Martin , Boetsch Thomas , Laakmann Gregor
Published: March 2003

Interferon‐alpha (IFN‐α) is the only effective treatment for chronic hepatitis B and C. Over 2/3 of methadone‐substituted patients suffer from chronic hepatitis C but a history of psychiatric disorders or drug addiction is still seen as a contraindication for IFN‐α because of a possible increased risk of severe psychiatric side effects such as depression, suicide attempts or psychotic episodes. We report on the case of a 33‐year‐old patient with chronic hepatitis C and a positive psychiatric history (drug abuse, borderline personality and four suicide attempts). After 4 months of therapy with IFN‐α he developed a psychosis with persecution mania, complex thought disorder, disturbance of sexual identity, sleeplessness, anxiety, depression and increased irritability with suicidal thoughts. Symptoms did not disappear after discontinuation of interferon treatment. To our knowledge, there are no other reports of persistent psychosis with a possible association to interferon treatment. Development of psychosis and other psychiatric side‐effects may be an indication of possible neuromodulatory effects of IFN‐α with long‐term treatment. On the other hand, the treatment for hepatitis C was successful. Ideas for safer treatment in methadone patients with psychiatric co‐morbidity and chronic hepatitis C are needed.
RESEARCH REPORT   Alcoholism treatment and medical care costs from Project MATCH
Authors: Holder Harold D. , Cisler Ron A. , Longabaugh Richard , Stout Robert L. , Treno Andrew J. , Zweben Allen
Published: March 2003

Aims. This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality.

Design Longitudinal study with pre‐ and post‐treatment initiation.

Measurements. The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post‐treatment.

Setting. Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI).

Participants. Two hundred and seventy‐nine patients.

Intervention. Patients were randomly assigned to one of three treatment modalities: a 12‐session cognitive behavioral therapy (CBT), a four‐session motivational enhancement therapy (MET) or a 12‐session Twelve‐Step facilitation (TSF) treatment over 12 weeks.

Findings. Total medical care costs declined from pre‐ to post‐treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical‐care cost‐savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost‐savings potential with CBT and/or TSF.,

Conclusions. Matching variables have significant importance in increasing the potential for medical‐care cost‐reductions following alcoholism treatment.
A randomized, double‐blind, placebo‐controlled clinical evaluation of a nicotine sublingual tablet in smoking cessation
Authors: Wallström Mats , Nilsson Fredrik , Hirsch Jan‐M.
Published: March 2003

Aims. Evaluation of the clinical efficacy and safety of a nicotine 2‐mg sublingual tablet in smoking cessation.

Design. A randomized, double‐blind, placebo‐controlled study of smokers using the 2‐mg tablet for 3‐6 months with follow‐up to 12 months. Dosing was established according to baseline nicotine dependence, scored on the Fagerström Tolerance Questionnaire (FTQ): FTQ ≥ 7, two tablets/hour (maximum 40/day); FTQ < 7, one tablet/hour (maximum 20/day).

Setting. Smoking cessation programme in a department of oral and maxillofacial surgery.

Participants. A total of 247 adult smokers, smoking ≥ 10 cigarettes/day for ≥ 3 years, of whom 123 received active and 124 placebo treatment. The study was powered to detect difference at 6 months.

Measurements. Efficacy and safety were evaluated at 6 weeks and 3, 6 and 12 months. Self‐reported abstinence was verified by exhaled CO < 10 p.p.m.

Findings. Success rates for complete abstinence (no slips after 2 weeks) for active vs. placebo were 50% vs. 29% at 6 weeks, 42% vs. 23% at 3 months, 33% vs. 18% at 6 months and 23% vs. 15% at 12 months ( p < 0.001, 0.001, 0.005 and p = 0.14), respectively. Craving during the first 8 days was significantly reduced among highly dependent smokers on active treatment compared to placebo. Baseline mucosal lesions among abstinent subjects were reduced during the treatment period and at the non‐treatment follow‐up. Adverse events were mild and tolerable, the most common being irritation and soreness in the mouth and throat.

Conclusion. The nicotine sublingual tablet increased the smoking cessation rate compared to placebo, reduced craving in highly dependent smokers and was well tolerated.
Routes of drug administration and multiple drug misuse: regional variations among clients seeking treatment at programmes throughout England
Authors: Gossop Michael , Marsden John , Stewart Duncan , Treacy Samantha
Published: March 2003

Aims. To investigate regional variations across England in routes of administration for heroin, nonprescribed methadone, non‐prescribed benzodiazepines, cocaine powder, crack cocaine and amphetamines.

Design, setting, participants. A survey of 1053 clients recruited to 54 residential and community drug misuse programmes.

Measurements. Structured face‐to‐face interviews conducted with clients at admission to treatment.

Findings. Routes of administration included injecting, smoking, snorting and oral use. For some drugs (methadone and benzodiazepines) one main route of administration was used. For other drugs (heroin, amphetamines and cocaine powder) there were marked variations in route. For all drugs except benzodiazepines, there were regional differences in routes of administration. Heroin injectors were more likely also to use other drugs by injection.

Conclusions. The differences in routes of administration of different drugs, and the regional differences in routes of use, have implications for the provision of preventive and treatment services. Interventions to prevent transitions to injecting may be especially appropriate in areas where injecting is not prevalent. Hepatitis B vaccination continues to be advisable in both areas of high and low injecting prevalence. Needle exchange schemes and interventions targeted at drug overdose may be more suitable in areas of high injecting prevalence. Further research into regional differences in routes of drug use should be conducted with non‐clinical samples.
Increasing access and providing social services to improve drug abuse treatment for women with children
Authors: Marsh Jeanne C. , D'Aunno Thomas A. , Smith Brenda D.
Published: March 2003

Aims. To assess the impact of a substance abuse treatment program for women with children designed to increase access to treatment through transportation, outreach and child‐care services. Also, to assess the impact of using access services on the use of other services and on treatment effectiveness.

Design. A quasi‐experimental non‐equivalent control group design was used with path analysis to examine the impact of participation in an enhanced services program that provided transportation, outreach and child‐care services on the use of other social services and on the use of alcohol and illicit drugs.

Setting. Treatment clients were interviewed in‐ person at enhanced treatment programs and regular substance abuse programs.

Participants. Study participants included a randomly selected sample of women with children who were clients of the Illinois Department of Children and Family Services. Participants were enrolled in enhanced or regular substance abuse treatment programs.

Measurements. Study participants completed in‐person interviews about their characteristics, services use and past and current substance use.

Findings. Participation in the enhanced program was negatively related to substance use. Further, use of access services was related to use of social services which in turn, was negatively related to substance use.

Conclusion. The study indicates that services that enhance access to treatment and respond to the range of social service needs of women are important for effective substance abuse treatment for women with children.
Trends in drinking habits among Finnish adolescents from 1977 to 1999
Authors: Lintonen Tomi , Rimpelä Matti , Ahlström Salme , Rimpelä Arja , Vikat Andres
Published: March 2003

Aims. Trends in adolescent drinking habits in Finland from 1977 to 1999 are studied with special attention to the onset of problem use and gender differences.

Design and setting. Biennial cross‐sectional mailed surveys (Adolescent Health and Lifestyle Survey).

Participants. Representative samples of 12, 14, 16 and 18‐year‐olds. The number of respondents varied from 2832 to 8390 and the response rate from 88% to 76%.

Measurements. The frequencies of alcohol use and perceived drunkenness obtained from self‐administered questionnaires.

Findings. Alcohol use remained rare among 12‐year‐olds. The overall trends in the frequencies of alcohol use and drunkenness increased considerably over time among the 14‐18‐year‐olds. Age‐adjusted monthly drunkenness among 14, 16 and 18‐year‐olds rose from 13% (1981) to 27% (1999) among boys and 6% to 22% among girls. Throughout the study period, the drinking style among boys became more drunkenness‐orientated with age, but the opposite was true among girls. Birth cohort investigation showed that the onset of drunkenness moved towards an earlier age. Earlier onset predicted higher prevalence of problem use at the age of 18. Boys developed a regular pattern of drunkenness steadily increasing between ages 14‐18 while among girls the increase of drunkenness started to level off between ages 16 and 18.

Conclusions. Alcohol use among 12‐year‐olds remained rare, but became more prevalent and drunkenness‐orientated among 14‐18 year‐olds. Gender differences in problem use diminished. Nevertheless, notable differences persist in the onset and development of drunkenness‐orientated use.
Relationship between follow‐up rates and treatment outcomes in substance abuse research: more is better but when is "enough" enough?
Authors: Hansten Michelle L. , Downey Lois , Rosengren David B. , Donovan Dennis M.
Published: March 2003

Aims. To examine the effects of different follow‐up rates on estimates of treatment outcome and predictive models thereof, and to specify participant characteristics associated with tracking difficulty.

Design. An observational study using data collected for a randomized, experimental design.

Setting. The King County Assessment Center in Seattle, Washington, an organization responsible for referral to publicly funded substance abuse treatment.

Participants. Substance‐addicted individuals referred to publicly funded inpatient or outpatient treatment.

Measurements. Standardized self‐report instruments measuring substance use, substance use consequences and general functioning. Chart review was used to measure treatment entry and completion.

Findings. There was a significant association between follow‐up difficulty and outcomes related to addiction treatment and later substance use. However, outcome estimates based on 60% of the sample who were easiest to locate were only minimally different from those based on the 90‐100% ultimately captured, and predictive models of outcome based on the 60% group were reasonably similar to those based on the final sample. Of baseline characteristics examined, only age was associated with later tracking difficulty.

Conclusions. Studies reporting follow‐up rates below 70% may produce valid findings and study attrition may be largely unpredictable from participant characteristics at baseline. However, a number of factors such as type of population studied, geographical location of the sample, reasons for loss to follow‐up and sample size must be considered when attempting to generalize the findings of this study.
Acute subjective and physiological responses to smoking in adolescents
Authors: Corrigall William A. , Zack Martin , Eissenberg Tom , Belsito Laura , Scher Risa
Published: March 2003

Aims. To determine the topography of cigarette smoking and the subjective and physiological effects of abstinence and nicotine in adolescents who smoke on a daily versus a non‐daily basis.

 Design. Repeated measures experiment, non‐blinded, involving a single test session.

 Setting. Human psychopharmacology laboratory.

 Participants. Twenty‐one daily and 21 non‐daily adolescent cigarette smokers (21 females; 21 males; age 13‐18 years) with life‐time use greater than 10 cigarettes, responding to radio and print advertisements.

 Intervention. Overnight abstinence from cigarettes followed by smoking of a single cigarette furnished by the participant at test.

 Measurements. The Fagerstrom Test for Nicotine Dependence, saliva nicotine and cotinine, expired air carbon monoxide (CO), heart rate (HR), self‐report scales and smoking topography. Most measurements were performed before and after smoking.

 Findings. Saliva nicotine, CO and HR increased, and self‐reported intention and desire to smoke decreased, after smoking (

p < 0.001). Fagerstrom scores indicated greater dependence and desire to smoke in daily than in non‐daily smokers. HR increased substantially over pre‐smoking levels in both groups. Puff topography did not differ between the groups, although collectively these participants appeared to take smaller and more puffs than adult smokers tested under similar conditions.

 Conclusion. This study provides initial evidence that adolescent cigarette smokers self‐administer physiologically active doses of nicotine very early in their smoking careers. Nicotine dependence in adolescents appears to be a function of the current frequency of cigarette use, and subjective‐behavioral consequences of abstinence and smoking are evident even in non‐daily smokers.
The relationship between suicide and heroin overdose among methadone maintenance patients in Sydney, Australia
Authors: Darke Shane , Ross Joanne
Published: March 2003

Aims. To examine the relationship between attempted suicide and non‐fatal heroin overdose among methadone maintenance patients.

 Design. Cross‐sectional survey.

 Setting. Sydney, Australia.

 Participants. Two hundred and twenty‐three methadone maintenance patients.

 Findings. Forty per cent of participants reported a history of at least one suicide attempt. Females were significantly more likely than males to have attempted suicide (50% vs. 31%), and to have done so on more than one occasion (28% vs. 15%). There was a large difference between males and females in the onset of attempted suicide. Females reported an initial attempt, on average, 6 years earlier than males (18.3 vs. 24.7 years), and were significantly more likely than males to have attempted suicide prior to the onset of heroin use (69% vs. 11%). While heroin overdose was common among the sample (66%), the most common methods employed for suicide attempts were overdose of a non‐opioid drug (21%) and slitting of wrists (20%). A deliberate heroin overdose as a means of attempted suicide was reported by 10% of participants. Heroin overdoses appeared overwhelmingly to be accidental. Ninety‐two per cent of those who had overdosed reported that their most recent overdose was accidental.

 Conclusions. Attempted suicide presents a major clinical problem to staff at drug treatment programmes, but one distinct from heroin overdose. While both overdose and suicide present increasing clinical problems, they are separate problems, and require different responses.
A comparison of different methods for estimating the prevalence of problematic drug misuse in Great Britain
Authors: Frischer Martin , Hickman Mathew , Kraus Ludwig , Mariani Fabio , Wiessing Lucas
Published: March 2003

Aims. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has produced methodological guidelines for national drug prevalence estimation. This paper pilots the methods to estimate prevalence for Great Britain and provides a commentary on the methods and resulting estimates.

 Design. Three types of methodology were used to estimate prevalence: (a) the multiple indicator (MI) method, (b) multipliers applied to (i) drug‐treatment records (ii) HIV estimates and (iii) mortality statistics and (c) the British/Scottish Crime Surveys.

 Setting. England, Scotland and Wales.

 Participants. Aggregated data on people recorded on databases and respondents in household surveys.

 Measurements. Prevalence estimates of different forms of problematic drug use.

 Findings. The estimates are 161 133 (range: 120 850‐241 700) for people at risk of mortality due to drug overdose; 161 000‐169 000 for people who have ever injected drugs; 202 000 (range: 162 000‐244 000) problem opiate users and 268 000 problem drug users (all types).

 Conclusions. The multiple indicator method offers a comprehensive approach to estimating the prevalence of problematic drug use in the United Kingdom. Simple multiplier methods and household surveys also provide a range of estimates corresponding to different types of drug use in the United Kingdom. The current study suggests that previous national estimates of 100 000‐200 000 were conservative. The new estimate of 161 000‐266 000 should enable a more focused response. For further development of this method, reliable and timely estimates of anchor points are required for specific geographical areas such as cities or Drug Action Teams (DAT), as well as routine aggregation of drug indicators for these areas.
Incentive‐sensitization and addiction
Authors: Robinson Terry E. , Berridge Kent C.
Published: March 2003

The question of addiction concerns the process by which drug‐taking behavior, in certain individuals, evolves into compulsive patterns of drug‐seeking and drug‐taking behavior that take place at the expense of most other activities, and the inability to cease drug‐taking, that is, the problem of relapse. In this paper we summarize one view of this process, the "incentive‐sensitization" view, which we first proposed in 1993. Four major tenets of the incentive‐sensitization view are discussed. These are: (1) potentially addictive drugs share the ability to alter brain organization; (2) the brain systems that are altered include those normally involved in the process of incentive motivation and reward; (3) the critical neuroadaptations for addiction render these brain reward systems hypersensitive ("sensitized") to drugs and drug‐associated stimuli; and (4) the brain systems that are sensitized do not mediate the pleasurable or euphoric effects of drugs (drug "liking"), but instead they mediate a subcomponent of reward we have termed incentive salience (drug "wanting").
Nicotine replacement therapy in patients with cardiovascular disease: guidelines for health professionals
Authors: McRobbie Hayden , Hajek Peter
Published: March 2003

The causal relationship between cigarette smoking and cardiovascular disease (CVD) is well known and it is of great importance that smokers with CVD are encouraged to stop. Nicotine replacement therapy (NRT) is an effective aid to smoking cessation. However, its use in patients with CVD is often avoided because of warnings on product labelling. This is not justified, as NRT use in dependent smokers is much safer than smoking. Arguments are presented for the following guidelines which may be used when recommending NRT to patients with CVD; (i) NRT can normally be recommended to smokers with CVD who tried and failed to quit without such help; (ii) in patients who have experienced a serious cardiovascular event within the past 4 weeks, involve the patient's consulting physician. In less acute cases this is not needed; (iii) ensure dosing does not exceed the manufacturer's recommendation; (iv) warn patients to stop using NRT if they relapse to smoking; and (v) target motivated smokers (i.e. those seeking help), and where possible provide or arrange intensive behavioural support to accompany NRT. This advice is conservative, but will hopefully remove some obstacles faced by smoking cessation counsellors and other health professionals when considering the use of NRT in people with history of CVD.
Episodic heavy drinking in four Nordic countries: a comparative survey
Authors: Mäkelä Pia , Fonager Kirsten , Hibell Björn , Nordlund Sturla , Sabroe Svend , Simpura Jussi
Published: March 2003

Aims. The purpose of this study was to compare the phenomenon of episodic heavy drinking (binge drinking) and its different indicators in the Nordic countries.

 Design. A comparative survey of four Nordic countries.

 Setting. Telephone interviews in Denmark, 1997; Finland, 1996; Norway, 1996; and Sweden 1996‐97.

 Participants. Random samples of men and women aged 19‐71 years.

 Measurements. Episodic heavy drinking was measured by the frequency of subjective intoxication, of drinking six or more drinks at a time (6+), and of negative consequences (mainly hangover symptoms). Additionally, annual consumption and measures of intake per occasion were used.

 Findings. Annual consumption, overall frequency of drinking and frequency of drinking 6+ were highest in Denmark and lowest in Norway. Frequency of subjectively defined intoxication was highest in Finland. There it was clearly higher than the frequency of drinking 6+, whereas in Denmark the contrary was observed. Finnish and Norwegian men and Danish women reported the largest quantities drunk per occasion. Results on 6+ frequency and the prevalence of negative consequences, with annual consumption held constant, suggest that Danes have the least concentrated drinking pattern. With annual consumption held constant, Norwegians report as high a frequency of intoxication, as do Finns.

 Conclusions. The relations between subjective and more objective measures of episodic heavy drinking vary considerably between the Nordic countries. The results suggest that the definition, acceptability and experience of intoxication vary even when a set of relatively homogeneous countries are compared.
Toxicant‐induced loss of tolerance
Authors: Miller Claudia S.
Published: March 2003

Drug addiction and multiple chemical intolerance (abdiction) appear to be polar opposites ‐ the former characterized by craving and dependency, the latter by aversion. However, when the two are viewed in juxtaposition similarities emerge, revealing a common underlying dynamic, one which appears to be a new paradigm of disease. TILT, or toxicant‐induced loss of tolerance, bridges the gap between addiction and abdiction and has the potential to explain a variety of illnesses, including certain cases of asthma, migraine headaches and depression, as well as chronic fatigue syndrome, fibromyalgia and "Gulf War syndrome". This paper argues that both addiction and chemical intolerance involve a fundamental breakdown in innate tolerance, resulting in an amplification of various biological effects, particularly withdrawal symptoms. While addicts seek further exposures so as to avoid unpleasant withdrawal symptoms, chemically intolerant individuals shun their problem exposures, but for the same reason ‐ to avoid unpleasant withdrawal symptoms. These observations raise critical questions: do addictive drugs and environmental pollutants initiate an identical disease process? Once this process begins, can both addictants and pollutants trigger symptoms and cravings? TILT opens a new window between the fields of addiction and environmental medicine, one that has the potential to transform neighboring realms of medicine, psychology, psychiatry and toxicology.
Induced mood and persistence at gaming
Authors: Hills Adelma M. , Hill Sandi , Mamone Natalie , Dickerson Mark
Published: March 2003

Aims. Using the affect infusion model (AIM), this study aimed to assess the impact of prior mood on gaming persistence in regular and non‐regular gamblers (assumed to be motivated and heuristic decision‐makers, respectively).

 Design, measures and setting. A 2 × 3 experimental design in a laboratory setting employed factors of gambler type (regular, non‐regular) and prior mood (happy, neutral, depressed). Measures were number of trials played on a gambling game, and mood ratings (post‐mood induction, during and after play).

 Participants and intervention. Sixty regular and 60 non‐regular gamblers (all male students) were assigned randomly to watch a video inducing one of the three mood conditions. They were then given AUD$10.00 to gamble in a computerized card‐cutting game.

 Findings. AIM predictions were supported: prior mood did not affect gaming persistence for regular gamblers, but non‐regulars showed reduced persistence across happy, neutral and depressed moods. After‐play mood ratings were related to winnings for regulars, and losing regulars were significantly more unhappy after‐play compared to during‐play, and compared to both their winning counterparts and non‐regulars. Mood and winnings were unrelated for non‐regulars, with little during‐ to after‐play mood change.

 Conclusions. The findings speak to depression as a causal factor in addictive gambling. Depressed mood did not enhance persistence in regular gamblers, but rather failed to have the inhibitory effect observed in non‐regular gamblers. Evidence of mood changes during gambling was obtained, although multiple measures (self‐report, physiological indicators, anticipated states) of both affective valence and arousal are advocated for future studies.
Is calculating pack‐years retrospectively a valid method to estimate life‐time tobacco smoking? A comparison between prospectively calculated pack‐years and retrospectively calculated pack‐years
Authors: Bernaards Claire M. , Twisk Jos W. R. , Snel Jan , Van Mechelen Willem , Kemper Han C. G.
Published: March 2003

Aims. To investigate the relative validity of retrospectively calculated pack‐years (py‐retro) by comparing py‐retro with prospectively calculated pack‐years (py‐pro).

 Design. A 23‐year ongoing cohort study (1977‐2000).

 Participants. One hundred and fifty‐four males and females, 13 years old in 1977 and 36 years old in 2000.

 Setting. Amsterdam, the Netherlands.

 Measurements. To calculate py‐pro, current smoking and quitting efforts were investigated nine times in a period of 23 years with the help of an interview or a questionnaire. At the age of 36, subjects filled out a comprehensive questionnaire about their smoking history, to calculate py‐retro. Individual differences between py‐pro and py‐retro were calculated. In addition, Cohen's kappa was calculated after categorising py‐pro and py‐retro into three groups.

 Findings. (1) Py‐retro does not under‐ or overestimate life‐time tobacco smoking. (2) The relative validity of py‐retro was moderate due to large individual differences between py‐pro and py‐retro. (3) The individual differences between py‐pro and py‐retro became larger, the higher the number of pack‐years. (4) Mean difference (and 95% limits of agreement) between py‐pro and py‐retro was ‐0.039 (‐5.23, 5.32) when average pack‐years was <5.2 and ‐1.17 (‐10.00, 14.65) when pack‐years ≥5.2. 5. Cohen's kappa between categorized py‐pro and py‐retro was 0.79.

 Conclusions. Future researchers in the field of smoking should be aware of the moderate relative validity of py‐retro. Categorizing py‐retro into smoking groups results in a misclassification error that is smaller than the quantitative error in continuous py‐retro, but goes together with a loss of information.
Economics of youth drug use, addiction and gateway effects
Authors: Kenkel Donald , Mathios Alan D. , Pacula Rosalie L.
Published: March 2003

The use of illicit drugs by American youth rose dramatically during the 1990s. Reducing these trends is an important policy objective. However, for policies to be effective it is important to understand the key causal links that lead to substance use and abuse. Policy makers must understand whether attempts to reduce the demand for one drug have impacts on the current and future use of other drugs. This paper overviews an economic approach to modeling drug use, addiction and gateway effects, emphasizing the potential of this method for identifying causal links in consumption. The paper demonstrates how this multi‐substance theory of drug use leads to empirical specifications that can identify the impact of consumption of one drug on the contemporaneous and future consumption of other drugs. This is followed by a discussion of what types of data would be needed to estimate these effects.
The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review
Authors: Dunn Chris , Deroo Lisa , Rivara Frederick P.
Published: March 2003

Aims. To examine the effectiveness of brief behavioral interventions adapting the principles and techniques of Motivational Interviewing (MI) to four behavioral domains: substance abuse, smoking, HIV risk and diet/exercise.

 Design. We conducted a systematic review of 29 randomized trials of MI interventions. Data on methodological quality were extracted and tabulated. Between‐group behavior change effect sizes and confidence intervals were calculated for each study.

 Findings. Due to varying intervention time lengths, targeted problem behaviors, settings and interventionists' backgrounds and skill levels, outcomes were not combined meta‐analytically. Sixty per cent of the 29 studies yielded at least one significant behavior change effect size. No significant association between length of follow‐up time and magnitude of effect sizes was found across studies. There was substantial evidence that MI is an effective substance abuse intervention method when used by clinicians who are non‐specialists in substance abuse treatment, particularly when enhancing entry to and engagement in more intensive substance abuse treatment treatment‐as‐usual. Data were inadequate to judge the effect of MI in the other domains. Client attribute‐treatment interactions were understudied and the sparse and inconsistent findings revealed little about the mechanism by which MI works or for whom it works best.

 Conclusion. To determine more effectively how well MI works in domains other than substance abuse and for whom it works best in all domains, researchers should study MI with risk behaviors other than substance abuse, while examining both interactions and the theoretical components of MI.
Exploring the relationship between alcohol consumption and non‐fatal or fatal stroke: a systematic review
Authors: Mazzaglia Giampiero , Britton Annie R. , Altmann Daniel R. , Chenet Laurent
Published: March 2003

Objective. Alcohol consumption has been reported to have both beneficial and harmful effects on stroke occurrence. Several studies have demonstrated a significant association with heavy drinking, but the evidence linking light‐to‐moderate alcohol consumption still remains unclear. This study, using a systematic review of the published literature, aimed to explore the dose‐response relationship between alcohol and stroke, the effect of irregular drinking and the effect of beverage types on the risk of stroke.

 Methods. A structured search for English‐language published literature since 1966 was made using several electronic databases. This was supplemented using a hand search of references in review articles and additional searches on key authors. From the 153 eligible articles, 41 studies were selected according to study design, categorization of the exposure and outcome measures.

 Findings. An association between recent alcohol use and stroke was consistently reported. There was also some evidence for a linear positive association for haemorrhagic stroke and alcohol consumption. Inconsistent results emerged on the

J‐shaped relationship between alcohol and ischaemic stroke, and the association between alcohol and non‐fatal or fatal stroke combined. The importance of the pattern of drinking was also demonstrated, indicating a higher risk for irregular drinkers.

 Conclusions. There is insufficient evidence to conclude that light‐to‐moderate alcohol drinking and wine intake have beneficial effects on stroke occurrence. On the contrary, findings from this review suggest the opportunity for a primary prevention regarding heavy drinking and binge drinking. More information regarding the risk of stroke associated with irregular alcohol drinking, and the joint effects of alcohol with other risk factors, would clarify the complex interaction between alcohol and stroke.
Regulation of nicotine replacement therapies (NRT): a critique of current practice
Authors: McNeill Ann , Foulds Jonathan , Bates Clive
Published: March 2003

Nicotine replacement therapy (NRT) describes a group of products delivering nicotine that are licensed for the relief of withdrawal as an aid to smoking cessation. This paper examines areas where public health considerations suggest changes should be made to the current indications and characteristics for NRT products. It is argued that the current regulatory framework restricts access to NRT without adequately considering that the likely consequence is continued dependent use of a far more harmful and widely available version of the same drug: tobacco. The paper argues that minors, pregnant smokers and smokers with cardiovascular disease (CVD) be allowed to use NRT. NRT use for smoking reduction, to support temporary abstinence, for long‐term use should also be enabled and NRT products should be made as widely available as cigarettes. This paper also recommends that regulators encourage the development of less harmful forms of nicotine delivery devices to compete with cigarettes. Although this paper is written largely with reference to the UK medicines regulatory framework, these issues also apply to many other countries.
Overdoses among cocaine users in Brazil
Authors: Mesquita Fábio , Kral Alex , Reingold Arthur , Haddad Ilham , Sanches Marta , Turienzo Giselda , Piconez Daniela , Araujo Paula , Bueno Regina
Published: March 2003

Aims. A survey of cocaine users was undertaken to study (i) the frequency of reported drug overdoses among cocaine users; and (ii) the frequency of witnessing drug overdoses in the same population.

 Design and setting. A cross‐sectional study as part of the World Health Organization (WHO) Multi‐city Study among injecting drug users (IDUs), phase II, was conducted in Santos Metropolitan Region, State of São Paulo, Brazil, in 1999.

 Participants. Three hundred and ninety‐six exclusive users of cocaine in the Santos Metropolitan Region, São Paulo State, Brazil were surveyed concerning their past experience with drug overdoses.

 Findings. Eighty (20%) of the cocaine users reported having experienced one or more overdoses, and 50% reported that they knew one or more other cocaine users who had died of an overdose. On multivariate analysis, being female and having spent time in jail were associated with an increased likelihood of having had one or more overdoses.

 Conclusion. Cocaine overdoses are an important and under‐recognized health problem in the Santos Metropolitan Region, and possibly in other areas of Brazil.
Lack of effects of ethanol pretreatment on the abuse liability of nitrous oxide in light and moderate drinkers
Authors: Walker Diana J. , Zacny James P.
Published: March 2003

Aims. To determine effects of ethanol‐use history and ethanol pretreatment on abuse liability of nitrous oxide (N

2O).

 Design. Placebo‐controlled, double‐blind, cross‐over design evaluating effects of N

2O, 0% (100% O

2, placebo) and 30% (in O

2), in the presence of three doses of ethanol: 0 g/kg (placebo), 0.35 g/kg and 0.7 g/kg.

 Setting. Subjects sat in a reclining chair in a hospital laboratory.

 Participants. Eight healthy light drinkers (one drink or less/week) and eight healthy moderate drinkers (seven or more drinks/week) with no history of drug dependence completed the study.

 Intervention. On three sessions (1, 3, 5) subjects drank a beverage that contained one of the three ethanol doses, then sampled for 10 minute each 0% and 30% N

2O. During choice sessions (2, 4, 6), subjects received the same ethanol dose as in the previous session, then chose six times, once every 5 min, between 0% and 30% N

2O.

 Measurements. Subjective (self‐reported) drug effects, reinforcing effects of N

2O as assessed by choice, and psychomotor effects were measured.

 Findings. Choice of N

2O did not differ between light (mean = 3.4 choices) and moderate (mean = 3.2 choices) drinkers and was not influenced by ethanol dose (0 g/kg: 3.3 choices, 0.35 g/kg: 3.5 choices, 0.7 g/kg: 3.1 choices). Subjective effects of N

2O also did not depend on ethanol‐use history or ethanol dose. N

2O liking and desire to inhale the drug again were positively correlated with N

2O choice.

 Conclusions. Ethanol pretreatment and ethanol‐use history had no effect on the abuse liability of N

2O as assessed in the present study.
Epidemiology of cigarette smoking in Pakistan
Authors: Nasir Khurram , Rehan N.
Published: March 2003

Aims. To study the prevalence of smoking among Pakistani population with particular reference to regional differences and correlates of cigarette smoking.

 Design. Cross‐sectional survey based on representative national sample.

 Setting. Data collected through National Health Survey of Pakistan 1990‐94.

 Participants. 13 104 individuals (6337 males and 6767 females), aged ≥ 8 years.

 Outcome measures. Prevalence and correlates of smoking.

 Findings. Based on weighted estimates, the overall prevalence of cigarette smoking was 14.2% (95% CI: 13.6‐14.8) in individuals aged ≥ 8 years and 19.4% (95% CI: 19.08‐19.72) among those aged ≥ 15 years. The highest prevalence was seen in the province of Sindh (16.1%) and the lowest in North Western Frontier Province (7.1%). Nearly a quarter of males (25.4%) were smokers while only 3.5% of females smoked (p < 0.001). The smoking was slightly more prevalent in urban areas (15.2%) compared to rural areas (13.7%). This pattern was consistent in all provinces except the province of Sindh. The highest prevalence of cigarettes smoking among males (48.6%) was seen in those aged 25‐44 years. After this age, there was a decline in smoking among males in Punjab and North Western Frontier Province, whereas the other two provinces, Sindh and Balochistan, did not show any such trend.

 Conclusion. Smoking is common in Pakistan. There is no clear policy on tobacco control in Pakistan.
A review of expectancy theory and alcohol consumption
Authors: Jones Barry T. , Corbin Will , Fromme Kim
Published: March 2003

Research is reviewed on the association between alcohol outcome expectancies and consumption which has led many to argue that manipulating expectancies might be a route to manipulating consumption for problem prevention and treatment. Studies indirectly and directly evaluating this latter position are reviewed. Expectancies predicting treatment outcome: two studies have shown that the more positive expectancies held at treatment, the poorer is treatment outcome, but five other studies have failed to find this. Three related studies have shown that the more negative expectancies held at treatment, the better the treatment outcome. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited support for negative. Expectancy manipulations and ad libitum consumption: three studies in the laboratory have shown that increasing positive expectancies through word priming increases subsequent consumption and two studies have shown that increasing negative expectancies decreases it. A single study in the field showed a similar relationship. This evaluation provides evidence consistent with the main position but is limited by measuring consumption changes over only 1‐2 hours. Prevention programmes with expectancy components: seven projects are reviewed in which positive expectancies were targeted, but only two report an expectancy change analysis and in both cases the expectancy change did not relate to subsequent consumption. This evaluation provides evidence inconsistent with the main position. Expectancy challenge: two related studies are reviewed in which positive expectancy challenges reduce subsequent consumption but changes in expectancy were not evaluated as predictors of consumption change. Two studies are reviewed which found a reduction in positive expectancy following expectancy challenge but no reduction in consumption. One study is reviewed in which when negative expectancy was increased in treatment there was a better treatment outcome at 3 months follow‐up than when it was not. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited consistent evidence for negative. It is concluded that the research has still to be done that securely links expectancy manipulations with subsequent changes in consumption, and fulfils the early promise from association studies.
Toward a behavioral economic understanding of drug dependence: delay discounting processes
Authors: Bickel Warren K. , Marsch Lisa A.
Published: March 2003

Behavioral economics examines conditions that influence the consumption of commodities and provides several concepts that may be instrumental in understanding drug dependence. One such concept of significance is that of how delayed reinforcers are discounted by drug dependent individuals. Discounting of delayed reinforcers refers to the observation that the value of a delayed reinforcer is discounted (reduced in value or considered to be worth less) compared to the value of an immediate reinforcer. This paper examines how delay discounting may provide an explanation of both impulsivity and loss of control exhibited by the drug dependent. In so doing, the paper reviews economic models of delay discounting, the empirical literature on the discounting of delayed reinforcers by the drug dependent and the scientific literature on personality assessments of impulsivity among drug‐dependent individuals. Finally, future directions for the study of discounting are discussed, including the study of loss of control and loss aversion among drug‐dependent individuals, the relationship of discounting to both the behavioral economic measure of elasticity as well as to outcomes observed in clinical settings, and the relationship between impulsivity and psychological disorders other than drug dependence.
Selective attentional bias to alcohol related stimuli in problem drinkers and non‐problem drinkers
Authors: Sharma Dinkar , Albery Ian P. , Cook Chris
Published: March 2003

Aims. The issues explored in this study were whether a patient group of problem drinkers selectively attend to alcohol‐related stimuli and the time course of any interference from alcohol‐related stimuli in comparison with two control groups of non‐problem drinkers.

Design. A 3 × 2 × 2 × 5 factorial design was used. Drinking group (low, high and problem) and word order (alcohol‐neutral, neutral‐alcohol) were between‐participant factors, and word type (alcohol, neutral) and presentation block (1‐5) were within participant factors.

Participants. Three groups were used, 20 participants from a local community alcohol Service (CAS) and 40 participants (student volunteers) in two control groups. The two control groups were differentiated as scoring high or low on the Alcohol Use Disorders Identification Test (AUDIT).

Measurements. A modified computerized Stroop colour naming test was used to measure response latencies. Anxiety was measured using the State‐Trait Anxiety Inventory.

Findings. The CAS group showed significantly longer reaction times to respond to the colour of alcohol‐related words than to neutral category words. Although the interference was smaller for the high AUDIT group it was significant. No significant interference was found in the low AUDIT group. There was no statistical evidence that the interference habituated in the three groups.

Conclusions. The present study showed it is possible to use a modified Stroop task as a measure of implicit processing of alcohol stimuli. Despite the fact that all participants were asked to ignore the words, they were unable to do so. Alcohol‐related words produced more interference than neutral category words in a group of problem drinkers and a control group of high alcohol drinkers.
Primary health care nurses' and physicians' attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers
Authors: Aalto Mauri , Pekuri Petteri , Seppä Kaija
Published: March 2003

Aims. To identify barriers to healthcare providers carrying out competent brief interventions to help heavy drinkers to reduce their drinking.

Design and participants. A questionnaire on attitudes, skills, knowledge, training needs and suggestions for implementation of brief interventions was mailed to all nurses and physicians working in primary health care in two Finnish cities. One hundred and sixty‐seven primary health care nurses and 84 physicians returned the questionnaire.

Findings and conclusions. The response rates among nurses varied between 66 and 99% and among physicians between 76 and 95% depending on the issue. Factors related to knowledge seem to be a barrier to the adoption of brief intervention: only 18% of respondents reported having enough knowledge to provide competent brief intervention and half of the respondents reported wanting more training. Contrary to expectations, physicians consider themselves to be better equipped to do brief intervention than nurses. Practical training in using alcohol questionnaires and on the content of brief intervention would help promote it. Such training was seen as important by 90% of the respondents. Giving more information on the evidence in favour of brief intervention would also be useful.