bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses
Authors: Gossop Michael , Stewart Duncan , Browne Nadine , Marsden John
Published: March 2003

Aims  This study investigates factors associated with abstinence, lapse or relapse to heroin use after residential treatment and, specifically, the extent to which changes in cognitive, avoidance and distraction coping responses were related to heroin use and other drug use outcomes.

Design, setting, participants  The sample comprised 242 clients from 23 residential programmes in the NTORS project, who used heroin before treatment and who were followed‐up after treatment during the first 12 months of the study.

Measurements  Data on client characteristics and problems, coping responses, drug use and other outcomes, were collected by structured face‐to‐face interviews.

Findings  Many clients (60%) used heroin after treatment, with the first occasion of heroin use usually occurring very soon after leaving treatment: 40% remained abstinent from heroin. Analyses were conducted for three groups based upon heroin outcome status (abstinent, lapsed, relapsed). Clients who avoided a full relapse to heroin use (abstinent and lapse groups) consistently made more use of cognitive, avoidance and distraction coping strategies at follow‐up than at intake. Treatment completion was related to better outcome. The lapse and relapse groups reported higher rates of use of illicit drugs other than heroin after treatment than the abstinent group.

Conclusions  Despite generally satisfactory drug use outcomes, the lapses and relapses to heroin use give rise to concern. Treatment services should develop further and strengthen relapse prevention and relapse coping skills among drug misusers.
Amphetamine usage and genital self‐mutilation
Authors: Israel Joshua A. , Lee Kewchang
Published: March 2003

Amphetamine usage has been associated with addiction, psychosis and self‐injurious behavior. We report on two patients who severely and repeatedly mutilated their own genitalia while intoxicated on amphetamines and consider possible diagnostic etiologies.
Young people and alcohol: an econometric analysis
Authors: Lundborg Petter
Published: March 2003

Aims  To analyse the determinants of youth drinking behaviour within an economic –theoretical framework. The paper focuses especially on the effects of (a) having parents willing to supply alcohol, (b) living in a single‐parent household, (c) having parents who are currently unemployed and (d) having received education about alcohol, narcotics and tobacco.

Design, setting and participants  A Swedish cross‐sectional survey data on 833 individuals aged 12–18 years was used to analyse the effects of the above variables on participation in drinking, frequency of drinking, intensity of drinking and binge drinking. Separate analyses were conducted for beer, wine and spirits. Care was taken in using appropriate econometric methods for the questions posed (negative binomial regression, censored regression and probit regression).

Findings  Having parents willing to supply alcohol increased frequency (P < 0.05) of beer, wine and spirits consumption, intensity (P < 0.05) of wine, spirits and illicit alcohol consumption, and increased probabilities (P < 0.10) of binge drinking and participation in drinking (P < 0.05). No effects were seen from living in a single‐parent household. Having received education about alcohol, narcotics and tobacco had a negative association only with intensity (P < 0.10) of beer consumption. Having a father who was currently unemployed was associated with an increased (P < 0.05) probability of binge drinking but a reduced (P < 0.05) frequency of wine consumption.

Conclusions  The positive effect of having parents willing to supply alcohol could reflect that these individuals face lower acquisition costs or lower psychological costs in consumption. It could also reflect a price effect, if the individual receives the alcohol free from his or her parents.
Alcoholism and somatic comorbidity among homeless people in Mannheim, Germany
Authors: Salize Hans Joachim , Dillmann‐Lange Cornelia , Stern Gerlinde , Kentner‐Figura Beate , Stamm Klaus , Rössler Wulf , Henn Fritz
Published: March 2003

Aims  To assess the prevalence of alcoholism and somatic codisorders of homeless people.

Design  Epidemiological cross‐sectional field study in a sample of the homeless in the area.

Setting  The study was conducted from 1997 to 1999 in the inner‐city area of Mannheim, Germany (approximately 320 000 inhabitants).

Participants  One hundred and two single homeless people (15–16% of the estimated total population of single homeless people in the city).

Measurement  Alcoholism, substance abuse and mental disorders were diagnosed with the SCID. Medical examinations were performed by an experienced physician. Blood samples were taken and urine samples collected. Further assessments were conducted for factors potentially correlating with mental or physical state.

Findings  Of the study probands, 63.7% presented with the alcohol dependence syndrome or harmful use, 61.7% had current somatic problems or disorders. Probands with alcohol dependence had significantly more frequent somatic disorders in total, more cerebral degeneration, liver disease or alcoholic polyneuropathies. Multiple stepwise regression identified alcoholism, life‐satisfaction, duration of homelessness and lacking social support as significant explanatory factors for having a somatic disorder. Alcoholism increased the risk of physical ill‐health more than fourfold.

Conclusion  Alcoholism is a major contributor to the physical ill‐health of homeless people. Treatment or rehabilitation of addictive behaviour among the homeless should be of major concern for adequate service planning or provision.
Community pharmacy services for drug misusers in Scotland: what difference does 5 years make?
Authors: Matheson C. , Bond C. M. , Pitcairn J.
Published: March 2003

ABSTRACT Aims  To assess current levels of participation of community pharmacists in needle exchange provision, assess participation in dispensing any drugs for drug misuse, explore methadone dispensing practice, assess involvement in health promotion for drug misusers, assess levels of training in drug misuse and compare all of the above with data from 5 years previously.

Design   A cross‐sectional postal questionnaire.

Setting   All community pharmacies in Scotland (n = 1162).

Participants   A total of 969 pharmacists managing community pharmacies on a day‐to‐day basis (response rate 83.4%).

Measurements   Descriptive data were collected on demography, drug misuse services provided and training. Data were combined with a dataset from an identical survey conducted 5 years previously for statistical comparison.

Results   Levels of needle exchange provision has not changed significantly (9.7% in 2000 compared to 8.6% in 1995). Of all respondents, 71.5% now dispense drug for the management of drug misuse, 68.9% dispense methadone and 56.7% provide a supervised methadone consumption service. The number of methadone clients receiving methadone through pharmacies has increased from 3387 in 1995 to 8792 in 2000 and the mean number of clients dispensed methadone per pharmacy has increased from 7.3 in 1995 to 13.2 in 2000; 65.1% of all methadone clients now consume their methadone under pharmacist supervision. The proportion of pharmacists dispensing methadone who provide a supervised consumption service has increased significantly from 37% to 82.8%. Considerable changes in pharmacy practice are evident with significant increases in the number of pharmacists who always lay down ground rules, ask for identification on first visits, make up prescriptions in advance and provide verbal advice and leaflets on the management of drug misuse. Training in drug misuse doubled from 31.8% to 66.8%.

Conclusions   Community pharmacy involvement with drug misusers has increased dramatically in the last 5 years. However, this increase is largely in methadone dispensing and supervision. Pharmacists appear to be more proactive in providing advice and information, perhaps as a result of greater training.
Recent contact with health and social services by drug misusers in Glasgow who died of a fatal overdose in 1999
Authors: Jones Russell , Gruer Laurence , Gilchrist Gail , Seymour Alison , Black Marjorie , Oliver John
Published: March 2003

Aim  To explore the recent contact with health and social services by drug misusers who died of a fatal overdose and identify opportunities for preventive intervention.

Design  Retrospective case analysis.

Subjects  Eighty‐seven residents of the Greater Glasgow area who died of a drug misuse‐related overdose in 1999.

Methods  Analysis of matched data from several sources: Strathclyde Police; University of Glasgow Department of Forensic Medicine and Science; the Scottish Prison Service; general practitioners’ medical notes, including records of accident and emergency attendances and psychiatric assessments; and five specialist agencies for drug misusers or the homeless.

Findings  Most of those who died of an overdose were males, long‐standing heroin injectors and resident in a deprived area. Heroin caused most deaths, either alone or with other drugs. Twenty‐three per cent died within 2 weeks of release from prison. For the 77 whose medical records were available, 90% had seen their general practitioner (32% in the month before death), 48% had attended accident and emergency services and 22% had received a psychiatric assessment in the year before death. Over 40% of the 87 used a drug agency in the year before death and 20% had used more than one agency.

Conclusions  Previous suicidal ideation, attempted suicide and depression were common among those who died of an overdose, as was recent release from prison. Almost all had been in contact with and several were receiving specific treatment from health or specialist addiction services in their last weeks or months. The findings highlight both the numerous opportunities for intervention and the challenge of using them to prevent death.
Lazabemide, a selective, reversible monoamine oxidase B inhibitor, as an aid to smoking cessation
Authors: Berlin Ivan , Aubin Henri‐Jean , Pedarriosse Anne‐Marie , Rames Alexis ,   Lazabemide in Smoking Cessation Study Investigators, Lancrenon Sylvie , Gilbert Lagrue
Published: March 2003

Background  Previous research has shown that smokers have reduced brain and platelet monoamine oxidase B (MAOB) activity. This is probably due to some components of tobacco smoke. When smokers quit, MAOB activity returns to normal. Reduced MAO activity may increase nicotine's addictive potential.

Aims  To assess whether lazabemide, a reversible selective MAOB inhibitor, promotes smoking cessation.

Study design  Double‐blind, randomized, placebo‐controlled, multicenter phase II study. Placebo, lazabemide 100 mg/day and 200 mg/day were administered for 8 weeks. This was a dose finding, proof‐of‐concept, exploratory study.

Setting  General practices and anti‐smoking clinics in France and Belgium.

Participants  Smokers smoking ≥15 cigarettes per day and motivated to quit.

Main outcome measure  Sustained abstinence during the last 4 weeks of the study.

Findings  The study was discontinued prematurely by the sponsor before randomization of the planned 420 smokers because of liver toxicity observed in other indications. Data of 330 randomized subjects could be analysed. Sustained abstinence during the last 4 weeks of treatment was 9%, 11% and 17% in the intent‐to‐treat population [P for trend: 0.036 (one‐sided)]; 11%, 14% and 21% in the intent‐to‐treat population of smokers without those excluded because of discontinuation of the study [n = 262, P for trend: 0.02 (one‐sided)], and 19%, 27% and 35% in completers [P for trend: 0.03 (one‐sided)], in the placebo, lazabemide 100 mg/day and lazabemide 200 mg/day groups, respectively. Point prevalence abstinence (intent‐to‐treat population) at the end of treatment (week 8) was 17%, 19% and 30% in the placebo, lazabemide 100 mg/day and lazabemide 200 mg/day groups, respectively (placebo vs. lazabemide 200 mg/day: P = 0.01, one‐sided). No treatment emergent major adverse event occurred. More nausea and insomnia were reported with lazabemide than with placebo.

Conclusions  MAOB inhibitors are promising treatments as an aid in smoking cessation. There may be an interest to develop MAOB inhibitors with an acceptable toxicity profile. Further studies may associate MAOB inhibitors with nicotine replacement therapies to increase therapeutic efficacy.
An international comparison of tobacco smoking, beliefs and risk awareness in university students from 23 countries
Authors: Steptoe Andrew , Wardle Jane , Cui Weiwei , Baban Adriana , Glass Kelli ,   Karl Pelzer, Tsuda Akira , Vinck Jan
Published: March 2003

Aims  To assess the prevalence of current tobacco smoking, associations with beliefs about the health benefits of not smoking and awareness of risks for lung cancer and heart disease in university students sampled from 23 countries, and to explore the utility of the World Health Organization (WHO) model of the world‐wide tobacco epidemic in understanding differences between countries.

Design  Anonymous questionnaire survey.

Participants  A total of 19 298 university students (8482 men, 10 816 women) aged 17–30 years from 23 countries, studying courses unrelated to health.

Measurements  Standardized measures of smoking, wish to stop smoking, ratings of beliefs in the importance of not smoking for health and awareness of the influence of smoking on lung cancer and heart disease.

Findings  Prevalence varied widely, being highest in samples from South European countries and lowest in developing countries (Thailand, South Africa). The pattern of tobacco use and differences between men and women conformed largely to the WHO model. Health beliefs were associated strongly with smoking behaviour both within and between countries. Awareness of specific health risks of smoking was very variable, with particularly low levels in Asian, South American and developing country samples. Risk awareness was inconsistently related to behaviour.

Conclusions  The pattern of tobacco smoking in well‐educated young adults appears to conform with wider international patterns of tobacco use. Awareness of specific health risks is poor, and modifying attitudes must be a central element in modifying tobacco use world‐wide.
Attentional bias and addictive behaviour: automaticity in a gambling‐specific modified Stroop task
Authors: Boyer Morten , Dickerson Mark
Published: March 2003

Aims  This study examined the relationship between attention and gambling behaviour by measuring the level of Stroop interference towards gambling‐related words in a group of regular poker machine players.

Design  A 3 × 2 repeated measures experimental design was employed. The type of word presented (neutral, drug or gambling) was the within‐subjects factor and the level of impaired control (high or low) over gambling behaviour was the between‐subjects factor.

Participants  A sample of poker machine players (n= 60), varying in their frequency of play, were split into two groups based on their level of subjective impaired control over their gambling behaviour (high or low).

Measurements  A computerized gambling‐specific modified version of the Stroop task was used to assess response latencies. The test comprised three word categories: gambling, drug and neutral. The Scale of Gambling Choices (SGC) was used to assess participants' level of impaired control over gambling behaviour.

Findings  It was found that the participants who had difficulty in controlling their gambling behaviour (the low control group) took significantly longer to name the colour of the words relating to poker machine gambling, whereas those who had good control over their gambling behaviour (the high control group) did not show any significant differences across the three word categories.

Conclusions  Results support the previous finding that people with a problem behaviour or emotion take longer to colour‐name words relating to the area of their concern. The current study extends previous work that has investigated the role of cognitive distortions and biases in the area of addictive behaviour. The current study confirms McCusker & Gettings's findings, but by avoiding the mental disorder conceptualization facilitates theoretical understanding of addictive behaviour. Implications for past models and theories of the Stroop as well as future research directions are discussed.
Illicit drug‐related harm during the Sydney 2000 Olympic Games: implications for public health surveillance and action
Authors: Indig Devon , Thackway Sarah , Jorm Louisa , Salmon Allison , Owen Tim
Published: March 2003

Aims  To describe presentations to emergency departments during the Sydney 2000 Olympic Games for conditions related to the use of illicit drugs; to discuss the implications of such presentations for surveillance and public health action at similar events in the future.

Design  Identification of target presentations in sentinel emergency departments; entry of data into a purpose‐built database; and daily electronic transfer of data for central collation and analysis.

Setting  Fifteen sentinel emergency departments in the greater Sydney metropolitan area for a 38‐day period spanning the Sydney 2000 Olympic Games.

Participants  Four hundred and twenty‐four presentations to sentinel emergency departments with conditions related to illicit drug use.

Measurements  Patient's age, sex, country and region of residence, location of emergency department, types of illicit drugs involved and departure status.

Findings  The mean daily number of presentations for adverse events due to illicit drug use was significantly higher (13.3 versus 8.8 presentations, t = 2.2, P = 0.04) in the 2‐week Olympic Games period than in the lead‐up to the Games, culminating in a large peak following the closing ceremony. There was also a significant increase (5.1 versus 1.7 presentations, t = 2.8, P = 0.007) in the mean daily number of presentations related to use of ecstasy or amphetamines, whereas no change was noted in presentations related to heroin use. Over half (52%) of presentations occurred at two emergency departments in areas known as being ‘hot‐spots’ for illicit drug use.

Conclusions  Enhanced surveillance of adverse events following illicit drug use, possibly targeting known ‘hot‐spots’, should be considered for future mass events. Advance preparation of preventive strategies, such as ‘party‐safe’ messages, will enable rapid response to unusual patterns of illicit drug‐related harm during future mass events.
Neonatal outcome following buprenorphine maintenance during conception and throughout pregnancy
Authors: Schindler Shird Dieter , Eder Harald , Ortner Romana , Rohrmeister Klaudia , Langer Martin , Fischer Gabriele
Published: March 2003

Aims  To assess the effects of maternal buprenorphine treatment at conception and during pregnancy on neonates in terms of birth outcomes and neonatal abstinence syndrome (NAS).

Design and setting  Prospective, open‐label, out‐patient maintenance, case report study, conducted at the drug addiction out‐patient clinic at the University Hospital Vienna.

Participants  Two buprenorphine‐maintained pregnant women who had conceived during buprenorphine treatment. Both patients had previously given birth to healthy neonates following induction on to buprenorphine maintenance therapy in the second trimester.

Measurements  Mothers: urinalysis. Neonates: gestational age at delivery, Apgar scores, birth weight, length and NAS (Finnegan Scale).

Findings  Urinalyses were negative for both women for 25 and 38 months, respectively, during the pregnancy period. There were no complications during the course of the pregnancy. The newborns delivered by both women were healthy, birth outcomes were within normal ranges and there were no NAS symptoms requiring treatment.

Conclusions  To our knowledge this is the first report detailing the pregnancies of women treated with buprenorphine at the time of conception and investigated in a prospective study. The NAS noted in neonates born to buprenorphine‐maintained mothers appears to be less severe than the NAS observed in neonates born to methadone‐maintained mothers. These preliminary data indicate that, in our patient cohort, buprenorphine maintenance at the time of conception and during pregnancy did not seem to affect birth outcome measurements such as pregnancy complications, week of delivery, birth weight, length, umbilical pH or neurodevelopmental progress. Future prospective studies with larger study populations are warranted.
A randomized controlled trial of a brief intervention after alcohol‐related facial injury
Authors: Smith A. J. , Hodgson R. J. , Bridgeman K. , Shepherd J. P.
Published: March 2003

Aim  To evaluate the effectiveness of a brief motivational intervention on alcohol consumption and misuse in young males with alcohol‐related face injury.

Design  Randomized controlled trial.

Setting  Oral and maxillofacial surgery out‐patient clinic in an urban teaching hospital.

Participants  One hundred and fifty‐one participants were randomized to motivational intervention and control conditions.

Interventions  Control was treatment as usual. The intervention was treatment as usual plus a one‐session brief motivational intervention administered by a nurse.

Measurements  Three sets of measurements were taken at baseline, 3‐month and 1‐year follow‐up. Collateral measurements were also taken at 1‐year follow‐up. Primary outcome measures were total alcohol consumption, typical weeks consumption and days abstinent in preceding 3 months. Other outcome measures included the Alcohol Use Disorders Identification Test, a short form of the Alcohol Problems Questionnaire, and a measure of satisfaction with social relationships.

Results  There was a significant decrease in 84‐day total alcohol consumption across the year (P < 0.006) and further, a significant effect for the motivational intervention was demonstrated (P < 0.029). This pattern was repeated for days abstinent and alcohol consumption in a typical week as well as alcohol‐related problems. There was a significantly greater reduction in the percentage of hazardous drinkers in the motivational intervention group (from 60% to 27%, P < 0.009) compared to the control group (from 54% to 51%, NS).

Conclusion  A proportion of young men change their alcohol consumption following alcohol‐related injury. A nurse‐led psychological intervention adds significantly to the proportion and magnitude of response.
General practice management of illicit drug users in Scotland: a national survey
Authors: Matheson C. , Pitcairn J. , Bond C. M. , Van Teijlingen E. , Ryan M.
Published: March 2003

Aims  To describe the level of involvement of general practitioners (GPs) in the management of illicit drug dependency; nature of current practice in the management of illicit drug dependency; influence of guidelines on practice; GP training experience and needs; and to consider the policy implications of the findings.

Design  A cross‐sectional postal questionnaire survey.

Setting  General practice in Scotland.

Participants  A 1 : 4 randomized sample (n = 926) of general practice principals, stratified according to age, gender and number of practice partners.

Measurements  A structured postal questionnaire.

Findings  A 63% response rate was achieved after two reminders (n = 583). Sixty per cent of respondents treated drug users, 51.5% provided methadone maintenance but only 58% used doses in the recommended range. Maintenance prescribing of dihydrocodeine and benzodiazepines was provided by 24% and 44.8% of respondents, respectively. While 79.3% had received the national clinical guidelines only 22.5% believed this had influenced their practice. Only a third of respondents had received drug dependency training. Beliefs about whether prescribing for drug misusers is part of a GPs professional remit was split.

Conclusions  There was relatively high involvement with drug users, with methadone maintenance being the most common treatment provided. Maintenance prescribing of dihydrocodeine and benzodiazepines were common despite a lack of clinical evidence supporting the effectiveness of these treatments. This may reflect the nature of the presenting drug problems and highlights the difficulties some GPs may face in managing multiple drug dependencies within current guidelines. Further local training to implement guidelines along with trials of alternative treatments currently outwith guidelines should be considered.
Gender and ethnic differences in smoking, drinking and illicit drug use among American 8th, 10th and 12th grade students, 1976–2000
Authors: Wallace John M. , Bachman Jerald G. , O'Malley Patrick M. , Schulenberg John E. , Cooper Shauna M. , Johnston Lloyd D.
Published: March 2003

Aims  This paper examines ethnic differences in licit and illicit drug use among American 8th, 10th and 12th grade students, with a particular focus on girls.

Design  The study uses cross‐sectional data from large, ethnically diverse, nationally representative samples of 8th, 10th and 12th grade girls.

Setting  Data were collected through questionnaires administered in schools.

Participants  A total of 40 416 8th grade girls and 37 977 8th grade boys, 35 451 10th grade girls and 33 188 10th grade boys, and 33 588 12th grade girls and 31 014 12th grade boys took part in the study.

Findings  Across ethnic groups, drug use is highest among Native American girls and lowest among black and Asian American girls. Trend data suggest that there have been important changes in girls’ drug use over time and that girls’ and boys’ drug use patterns are converging.

Conclusions  Drug use is widespread among American adolescent girls. Future research should examine further girls’ drug use and seek to identify whether risk and protective factors identified in past research, based on predominantly white samples, are also important predictors for drug use among non‐white girls.
A prospective study of the association between smoking and later alcohol drinking in the general population
Authors: Jensen Majken K. , Sørensen Thorkild I. A. , Andersen Anne T. , Thorsen Thorkil , Tolstrup Janne S. , Godtfredsen Nina S. , Grønbæk Morten
Published: March 2003

Aims  To address the possible prospective association between smoking habits and risk of later heavy drinking in the adult population.

Design  Pooled population‐based long‐term cohort studies with repeated assessments of smoking and alcohol habits.

Setting  Copenhagen, Denmark.

Participants  A total of 14 130 non‐ to moderate drinkers at baseline, who attended re‐examination.

Measurements  Among the non‐ to moderate drinkers we addressed the relation between smoking habits at first examination and the risk of becoming a heavy and excessive drinker at follow‐up.

Findings  Level of tobacco consumption at first examination predicted an increased risk of becoming a heavy and excessive drinker in a dose‐dependent manner. Men who smoked more than 25 g of tobacco per day had adjusted odds ratios of 2.12 (95% confidence interval (CI): 1.44–3.11) and 3.95 (95% CI: 1.93–8.95) for becoming heavy and excessive drinkers, compared to participants who had never smoked. Equivalent estimates among women were 1.76 (95% CI: 1.02–3.04) and 2.21 (95% CI: 1.00–4.58), respectively.

Conclusions  This study suggests that tobacco use is associated quantitatively with later risk of heavier drinking.
Prison‐based syringe exchange programmes: a review of international research and development
Authors: Dolan Kate , Rutter Scott , Wodak Alex D.
Published: March 2003

Journal publications and conference presentations on prison‐based syringe exchange (PSE) programmes were identified by a comprehensive search of electronic databases. Experts involved with development and evaluation of current PSE programmes or policy were contacted for reports, documents and unpublished material. Spanish information on PSE was translated for this review. We identified 14 papers specifically on PSE programmes in Switzerland (six papers), Germany (four) and Spain (four). The first PSE programme started in 1992 in Switzerland. As of December 2000, seven PSEs were operating in Switzerland, seven in Germany and five in Spain. There have been six evaluations of prison syringe exchange programmes and all have been favourable. Reports of drug use decreased or remained stable over time. Reports of syringe sharing declined dramatically. No new cases of HIV, hepatitis B or hepatitis C transmission were reported. The evaluations found no reports of serious unintended negative events, such as initiation of injection or of the use of needles as weapons. Staff attitudes were generally positive but response rates to these surveys varied. Overall, this review indicated that prison syringe exchange programmes are feasible and do provide benefit in the reduction of risk behaviour and the transmission of blood‐borne infection without any unintended negative consequences.
Measuring outcome in cocaine clinical trials: a comparison of sweat patches with urine toxicology and participant self‐report
Authors: Winhusen Theresa M. , Somoza Eugene C. , Singal Bonita , Kim Sunme , Horn Paul S. , Rotrosen John
Published: March 2003

Aims  To evaluate the advantages of using a sweat patch (PharmCheck™) for detecting cocaine abuse in cocaine‐dependent patients participating in a clinical trial. The utility of the sweat patch was assessed from the following perspectives: the reliability and validity of quantitative sweat patch results, the possible degradation of cocaine to benzoylecgonine (BE) as a function of the length of time that a patch is worn, the completeness of the dataset yielded by thrice‐weekly urine toxicology compared with thrice‐weekly and weekly sweat patches, and the relative costs associated with sweat patch versus urine measures.

Design  Data were collected during a 10‐week out‐patient clinical trial in which participants wore two sweat patches, one applied every visit and one applied weekly. Urine samples were collected thrice weekly, as were self‐reports of substance use.

Setting  A multi‐site clinical trial conducted in Boston, Cincinnati and New York, USA.

Participants  Twenty‐seven participants with comorbid diagnoses of cocaine dependence and adult attention deficit disorder completed the study.

Measurements  Sweat patch and urine samples were analyzed by standard methods for cocaine and cocaine metabolites.

Findings  Quantitative sweat patch measures had good reliability in that the correlation between the weekly and per‐visit patches was 0.96 (P < 0.0001). The concurrent validity, as judged by the correlation between quantitative urine BE levels and either weekly (0.76, P < 0.0001) or per‐visit (0.73, P < 0.0001) cocaine sweat patch levels was reasonable. The correlation between the self‐report of cocaine use and these same two patches, however, was lower (0.40, P < 0.05 and 0.30, P < 0.05, respectively). The results revealed no significant degradation of cocaine to BE associated with wearing the patch for a longer time. Finally, the per‐visit patch provided cocaine use data on 80.5% of all study days (a total of 70), while urine toxicology and the weekly patch provided 77.4% and 76.1%, respectively.

Conclusions  The present findings suggest that the PharmCheck™ patch might be an attractive alternative to urine toxicology for use as an outcome measure in cocaine clinical trials.
The Israel Society for the Prevention of Alcoholism
Authors: Weiss Shoshana , Gefen Lia
Published: March 2003

This paper describes the profile of the Israel Society for the Prevention of Alcoholism (ISPA), which is a nation‐wide, public, non‐profit association. It portrays various aspects of ISPA treatment and rehabilitation facilities—the residential treatment center, the rehabilitative hostel and the ‘warm home’ for homeless alcoholics. It depicts ISPA prevention activities, prevention materials and its usage of the media, and deals with ISPA involvement in policy issues. The paper also addresses the research reality of ISPA and its scientific journal, and refers to the society's structure and its future.
Long‐term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders
Authors: Moos Rudolf H. , Moos Bernice S.
Published: March 2003

Aims  This study examined the influence of the duration and intensity of the first episode of treatment for previously untreated individuals with alcohol use disorders on short‐term and long‐term outcomes, and the effect of additional treatment and delayed treatment on outcomes.

Design, setting, participants  A sample of alcoholic individuals (n = 473) was recruited at alcoholism information and referral centers and detoxification units and was surveyed at baseline and 1 year, 3 years and 8 years later.

Measurements  At each contact point, participants completed an inventory that assessed their treatment utilization since the last assessment and their current alcohol‐related, psychological and social problems.

Findings  Compared with individuals who remained untreated, individuals who entered treatment relatively quickly and who obtained a longer duration of treatment had better short‐ and long‐term alcohol‐related outcomes and better short‐term social functioning. Individuals who obtained a longer duration of additional treatment had better alcohol‐related outcomes than individuals who obtained no additional treatment but, among individuals who delayed treatment entry, the duration of treatment was not associated with treatment outcomes. In general, the intensity of treatment was not related to better outcomes.

Conclusions  Rapid entry into treatment and the duration of treatment for alcohol use disorders may be more important than the intensity of treatment. Treatment providers should consider structuring their programs to emphasize continuity, rather than intensity of care.
Gender differences in relapse situations
Authors: Rubin Amy , Stout Robert L. , Longabaugh Richard
Published: March 2003

Gender differences in variables relating to alcohol treatment are receiving increased attention. Most reports indicate gender differences in both intrapersonal, interpersonal and environmental trans‐situational variables that relate specifically to women's drinking. This study investigates gender differences in the immediate relapse situation itself. These differences are then examined in the context of trans‐situational (i.e. across time) affective and cognitive variables and social support. This report is part of a larger study designed to replicate Marlatt's taxonomy of high risk situations for relapse, and to examine alternative methods of describing relapse situations. Three hundred subjects (169 men, 131 women) were recruited from six different inpatient and outpatient programs. Subjects were asked to identify their last relapse before entering the index treatment. Details of the drinking episode itself were also obtained, e.g. number of drinking days in episode, drinking to intoxication, presence of others. Measures of state and trait affect, expectancies, and social support were also collected. There were no gender differences in Marlatt's taxonomy, or in drinking topography during relapse. At baseline, women reported drinking less, and drinking less often than men. However, women drank to intoxication more often than men. Surprisingly, men relapsed alone more often than did women. Men and women report relapsing frequently with same sex friends, and women showed a tendency to relapse in the presence of romantic partners. Men also tend to report more positive mood states during relapse than women, which is congruent with the finding that women report more depression. Severity of drinking pattern was found to be an important confounding variable in these analyses. It is suggested that gender differences found in individuals in treatment for alcohol problems may reflect societal differences between men and women, and that taking these differences into account in designing treatment programs may improve outcomes.
Latent transition analysis for longitudinal data
Authors: Velicer Wayne F. , Martin Rosemarie A. , Collins Linda M.
Published: March 2003

Assessing outcome is a critical problem for the study of addictive behaviors. Traditional approaches often lack power and sensitivity. Latent Transition Analysis is an alternative procedure that is applicable to categorical latent variable models such as stage models. The method involves four different types of parameters, each of which may be relevant to different research questions. Two examples that employ the Stages of Change construct are used to illustrate the method. In the first example, three different models of longitudinal change are compared. In the second example, the effects of an expert system intervention for smoking is compared to a control condition. The method permits the investigation of a series of specific comparisons: (1) the effectiveness of the intervention for individuals in different stages can be assessed; (2) the effectiveness of the intervention can be evaluated for different time intervals; and (3) the effects of intervention on both progression through the stages and regression through the stages or relapse can be assessed. Other potential applications of the method are also discussed.
Relapse research and the Reasons for Drinking Questionnaire: a factor analysis of Marlatt's relapse taxonomy
Authors: Zywiak William H. , Connors Gerard J. , Maisto Stephen A. , Westerberg Verner S.
Published: March 2003

A factor analysis (n=183) of Marlatt's relapse taxonomy as assessed by the Reasons for Drinking Questionnaire (RFDQ) (see Appendix I, this article) was conducted using a heterogeneous alcohol treatment sample. Results indicated that the predominant factor was negative emotions. The second factor consisted of social pressure and positive emotions, and a third factor consisted of physical withdrawal, wanting to get high, testing control, substance cues and urges to drink. Each of the 13 categories in the Marlatt taxonomy loaded on one of the three factors. Scores on the first factor for the first and second lapses were correlated. The same held true for the other two factors. The negative emotions factor was positively related to blood alcohol level on the first day of the lapse, the lapse duration (in days), and occurrence of a second lapse (even when controlling for alcohol dependence). The negative emotions factor in turn was related to client reports of alcohol dependence, trait anger, and depression (all positively). Women scored higher on the first factor, and men scored higher on the second factor. The third factor was inversely related to the number of days of abstinence preceding the lapse. Taken together, these analyses illustrate that different precipitants occur together, suggesting that clients might productively be trained in the use of specific relevant coping skills to address potential relapse precipitants. Focusing on the third RFDQ factor may be particularly important in the early stages of abstinence. The importance of anger and depression management during alcohol treatment is also highlighted by these results.
Lest taxonomy become taxidermy: a comment on the relapse replication and extension project
Authors: Marlatt G. Alan
Published: March 2003

In this commentary on the Relapse Replication and Extension Project, several points are addressed. First, the selection of the pretreatment "baseline relapse" as the key predictor variable for post‐treatment relapse in the predictive and construct validity studies is questioned. It is doubtful whether retrospective accounts of drinking episodes after 4 days of abstinence qualify as relapse episodes for the following reasons: clients may not have been committed to abstinence (e.g. weekend binge drinkers); treatment may have included coping skill training for pretreatment high‐risk situations (i.e. treatment intervention is viewed as a "nuisance variable"). By assuming that a client's retrospective report of a poorly defined pretreatment "relapse" is predictive of the type of relapse episode experienced during the post‐treatment follow‐up assessment is to commit an error of "taxidermy" in evaluating the reliability and validity of the taxonomy; i.e. the tendency for researchers to "stuff and permanently mount" distal baseline episodes as static predictor variables, thereby depriving them of their dynamic and fluid role as proximal determinants in the relapse process. The difference between researchers who assess distal trait predictors of relapse and clinicians who focus more on proximal state predictors in conducting relapse prevention therapy is discussed and illustrated by means of a case study. Finally, the metaphor of relapse as "falling off the wagon" is described as an example of a systems approach to relapse prevention.
What is a relapse? Fifty ways to leave the wagon
Authors: Miller William R.
Published: March 2003

Binary thinking has often guided research and practice in the addiction field. For example, emphasis has been given to identifying whether an individual is "alcoholic" or not, and the dichotomous judgement that a client is either drinking or abstinent has been used to judge treatment effectiveness. Research on the nature of alcohol problems, however, indicates that they lie along several modestly interrelated continuous dimensions of severity, rather than occurring as a single syndrome qualitatively distinct from normality. Similarly, changes in addictive behaviors in general, and treatment outcomes in particular, are complex phenomena not readily captured by dichotomous classification. The term "relapse" is itself seriously problematic in various ways, and its definition elusive. It represents a somewhat arbitrary binary judgement imposed on the flow of behavior, and carries negative evaluative overtones. A potentially detrimental abstinence violation effect is implicit in the very use of the term "relapse", which thereby may become a self‐fulfilling prophecy. Further, it implicitly pathologizes what is in fact a rather common event in the course of behavior change, and embodies an unrealistic and inaccurate conception of how successful change occurs over time. For these reasons, it may be useful in research and clinical practice to abandon the notion of "relapse" and focus instead on terminology that better describes the normal resolution process for addictive behaviors.
Alcohol, the individual and society: what history teaches us
Authors: Room Robin
Published: March 2003

Drinkers derive both pleasure and pain from drinking, but harm may come also to others. Through religious or secular rules, societies have sought to limit these "externalities" of drinking. Societal reactions have primarily focused on social harms from drinking; policy attention to casualties and chronic health effects is fairly recent. Drinking behaviour varies greatly according to the cultural framing of alcohol; societal policies tend to vary accordingly. Ecological constraints and social norms on preparation and use meant that alcohol was often available only sporadically in tribal and village societies. Alcohol production has been increasingly industrialized and marketing increasingly globalized in the modern era. Now, free trade agreements and the doctrine of consumer sovereignty increasingly limit the scope of national alcohol control policies. On the other hand, modern society demands exacting standards of attention and care incompatible with intoxication, for instance when driving a car or minding children. Managing the conflict between these and alcohol's ready availability is seen as a wholly individual rather than a societal responsibility. Those who fail the task are defined as alcoholics, and modern states have increasingly provided treatment for them. While there is a renewed public health concern about the externalities of drinking, substantial availability reductions have historically often required the mobilization of strong popular movements of remoralization.
Population level policies on alcohol: are they still appropriate given that 'alcohol is good for the heart'?
Authors: Casswell Sally
Published: March 2003

The research finding that a reduced risk of coronary heart disease is associated with alcohol use has been widely disseminated. This paper addresses the significance of this research finding for decisions about what kind of alcohol harm reduction policies it is appropriate to implement. The public policies of greatest concern to the vested interest groups are population‐based policies such as taxation and restrictions on availability. Other public policies which impact on the drinkers' environment are minimum drinking age laws, drink drive deterrence, prevention of intoxication in public drinking places and restrictions on advertising. A review of the effectiveness of the available strategies provided strong support for environmentally focused approaches rather than education targeting high‐risk drinkers. Many of these environmental strategies seem unlikely to have a significant direct effect of reducing 'heart healthy' drinking by older people. Furthermore, the impact of alcohol on premature mortality among the older sectors of the population has to be weighed against any possible impact on younger drinkers resulting in loss of or disability in many years of life. Given the relative effectiveness of environmental strategies for reducing harm and the likely low level of impact of these strategies on the heart healthy drinking of older people it is concluded that the evidence of reduced risk of coronary heart disease does not preclude their implementation.
What does science have to say?
Authors: Moskalewicz Jacek
Published: March 2003

This plenary session had particular character. Ten representatives of the research world briefly presented what science has to say on different aspects of alcohol policy. Major research‐based generalizations from a variety of policy experiences were brought to the discussion. The panel's composition reflected the global map of alcohol studies; the group consisted of four people from English‐speaking countries, four from northern Europe and the Nordic countries and two from the Mediterranean part of Europe. The session focused on population‐orientated strategies including political and economic controls on the availability of alcohol, advertising and public information campaigns. There was discussion of drink driving measures, and of how individual treatment interventions relate to the broad field of public health. Contributions from the world of nutrition and tobacco control policy were also drawn into the debate.
Alcohol and health: individual and population perspectives
Authors: Rehm Jurgen , Ashley Mary Jane , Dubois Gerard
Published: March 2003

This paper summarizes the relationships between alcohol consumption and health from both the individual and the population perspectives. On the individual level adverse consequences of alcohol consumption on mortality, morbidity and social harm are summarized. The potential health benefits of drinking are listed next, especially in the context of trying to balance positive and negative consequences. Even though the final decision rests with the individual it is suggested that from a health perspective light drinking on a regular basis is most advisable. In terms of advice to populations it should be noted that, due to the mutual interdependence of drinking behaviour in a society, the average individual consumption associated with the lowest individual risk is not necessarily the average per capita consumption associated with the lowest population risk. Thus, research at the population level has to be integrated with individual epidemiological research in order to come up with the best advice for the population in any given society.