bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of heroin dose and route of administration on the severity of the opiate withdrawal syndrome
Authors: Smolka Michael , Schmidt Lutz G.
Published: March 2003

Aims. To determine the relationship between severity of opiate withdrawal and prior heroin dose and route of administration (smoking versus intravenous injection). Design. Retrospective analysis of withdrawal data and assessment of associations with baseline variables including heroin dose, route of administration, duration of use, concomitant use of cocaine, severity of opiate dependence, previous treatment, sex or age. Setting. Psychiatric inpatient unit specialized in withdrawal treatments. Participants. Twenty‐two opiate addicts injecting or smoking heroin who were abruptly withdrawn after admission. Measurements. Daily assessment of withdrawal severity with the Opiate Withdrawal Scale (OWS) during the first week after drug cessation. Findings. Severity and duration of withdrawal symptoms were greater in injectors compared to smokers (with comparable doses) and also in patients with higher heroin dose. Heroin dose and route of administration were related significantly to total and maximum withdrawal scores and together accounted for about 50% of variance. Similar levels of total withdrawal distress were associated with approximately five times higher heroin consumption in chasers than in injectors. Conclusions. The impact of heroin dose and route of administration on withdrawal severity is marked. The influence of the route of administration on withdrawal severity might be due to differences in bioavailability.
Association between gender and marital status and confidence in remaining abstinent among alcohol abusers in treatment
Authors: Skutle Arvid
Published: March 2003

Aims. To assess the importance of gender and marital status on self‐efficacy expectancies of alcohol abusers in treatment. Design, participants and setting. Cross‐sectional study with a group of alcohol abusers in treatment (n=259, 56 women) at the Bergen Clinics Foundation, Norway. Measurements. The Situational Confidence Questionnaire was applied for the self‐efficacy assessment. Findings. Self‐reports of significant life problems were associated with low self‐efficacy expectancies. Controlling for this, female abusers scored significantly higher than their male counterparts on risk of relapse in "positive emotional state" and "pleasant emotional states with others". Conclusions. Situations perceived as being at high risk for relapse were associated with gender and significant life problems. The findings have implications for a more differentiated approach in the relapse prevention treatment programmes.
A randomized trial of naltrexone for smoking cessation
Authors: Wong Gilbert Y. , Wolter Troy D. , Croghan Gary A. , Croghan Ivana T. , Offord Kenneth P. , Hurt Richard D.
Published: March 2003

Aims. To evaluate the efficacy and safety of orally administered naltrexone, alone or in combination with nicotine patches, as a treatment for cigarette smoking. Design. Randomized, partially‐blinded, 2 2 factorial trial using naltrexone (active vs. placebo) and nicotine patches (active vs. none). Participants. One hundred cigarette smokers. Intervention. Twelve weeks of either placebo‐only, naltrexone‐only, placebo with nicotine patches or naltrexone with nicotine patches. The naltrexone dose was 50 mg taken once daily, and the nicotine patch dose was 21 mg/24‐hour for the first 8 weeks and 14 mg/24‐hour for the remaining 4 weeks. Brief behavioral intervention was provided at each visit. Measurements. One‐week pointprevalence smoking abstinence rates confirmed by an expired air carbon monoxide level of 8 parts per million (ppm) or less, daily cigarette smoking and cigarette craving. Findings. At the end of treatment, there was no effect of naltrexone on smoking abstinence. The smoking abstinence rates were 19% and 22% for the placebo only and naltrexone only treatment groups, respectively, and 48% and 46% for the placebo with nicotine patch and naltrexone with nicotine patch groups, respectively. However, the effect of the nicotine patch at this time was significant (p=0.006), but not at the 6‐month follow‐up. No significant effect of naltrexone was observed on daily cigarette smoking or cigarette craving during the study. Conclusions. The opioid antagonist naltrexone was not found to be effective for smoking cessation and had no significant effect on daily cigarette consumption or craving. The results of the present study provide no support for the use of naltrexone, alone or in combination with nicotine patches, as a therapeutic treatment for smoking cessation.
A review of biological indicators of illicit drug use, practical considerations and clinical usefulness
Authors: Wolff K. , Farrell M. , Marsden J. , Monteiro M. G. , Ali R. , Welch S. , Strang J.
Published: March 2003

Aims. To examine a range of biological indicators of illicit drug use, including blood, urine, hair and saliva, addressing both technological and practical issues relating to their application and interpretation. Methods. The review process involved an examination of key reference texts and literature from the scientific fields of analytical and clinical toxicology. Findings. Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood. The growing sophistication of laboratory analysis may additionally make possible the routine use of hair sampling which can provide a much longer time frame for assessment. Breath, saliva, sweat or breast milk remain possibilities in the future. Conclusions. Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test.
Male‐female differences in the earliest stages of drug involvement
Authors: Etten Michelle L. Van , Neumark Yehuda D. , Anthony James C.
Published: March 2003

Aims. To examine whether male‐female differences in rates of drug use could be traced back to differences in rates of exposure to initial opportunities to try drugs, rather than to sex differences in the probability of making a transition to use, once opportunity has occurred. Design. Cross‐sectional sample survey research with nationally representative samples and retrospective assessments. Setting. United States, 1979‐94. Participants. Respondents were 131 226 residents aged 12 years and older, recruited for the National Household Surveys on Drug Abuse by multi‐stage probability sampling at nine time points. Measurements. Estimated proportion of males and females with an opportunity to use marijuana, cocaine, hallucinogens and heroin; proportions reporting use among those having an opportunity to use each drug; proportion making a "rapid transition" from initial opportunity to initial use. Findings. For each survey year, males were more likely than females to have an initial opportunity to use drugs. However, few male‐female differences were observed in the probability of making a transition into drug use, once an opportunity had occurred. Conclusions. Previously documented male excess in rates of drug use may be due to greater male exposure to opportunities to try drugs, rather than to greater chance of progressing from initial opportunity to actual use. This suggestes that sex differences in drug involvement emerge early in the process. Implications of these findings are discussed in relation to the epidemiology and prevention of drug use, and future research on sex differences in drug involvement.
Alcohol abuse and crime: a fixed‐effects regression analysis
Authors: Fergusson David M. , Horwood L. John
Published: March 2003

Aims. To examine linkages between patterns of alcohol abuse and crime in a New Zealand birth cohort studied to the age of 21 taking into account confounding factors through the use of fixed‐effects regression methods.

Measurements. Over the period from age 15‐21 years assessments were made of: (a) involvement in violent and property crime; and (b) extent (if any) of alcohol abuse/dependence symptoms. In addition, information was gathered on a number of social and contextual factors that were likely to be related to alcohol abuse or crime.

Findings. Increasing alcohol abuse was associated with clear and significant (

p < 0.0001) increases in rates of both violent and property crime. Control for observed and non‐observed confounding through the use of fixed‐effects regression models indicated that much of this association was attributable to the effects of confounding factors that were associated with both alcohol abuse and crime. None the less, even after such control alcohol abuse remained significantly related to both violent and property offending.

Conclusions. The findings suggest the presence of a possible causal association between alcohol abuse and juvenile offending that is evident after control for both observed and non observed sources of confounding.
Pharmacy‐based needle exchange (PBNX) schemes in South East England: a survey of service providers
Authors: Sheridan Janie , Lovell Selina , Turnbull Paul , Parsons James , Stimson Gerry , Strang John
Published: March 2003

Aims. To describe the activities of service providers with regard to (i) the business operation and policies defining pharmacy‐based needle exchange (PBNX) in South East England; (ii) the day‐to‐day work of PBNX outlets from the provider perspective; and (iii) problems encountered by PBNX providers.

Design. (i) Postal self‐completion questionnaire to all participating PBNX community pharmacies in South East England; and (ii) postal self‐completion questionnaire to needle exchange coordinators.

Setting. Community pharmacy needle exchanges.

Participants. Pharmacists in charge of needle exchange; and needle exchange coordinators.

Findings. Data were collected (i) from 381/440 (86.7%) participating community pharmacists, and (ii) 32/36 (88.9%) of coordinators. The study found that PBNX was reaching injecting drug users (many of whom used PBNX regularly), and providing a wide range of injecting equipment. Although pharmacists reported that problems such as shoplifting occurred relatively frequently, more serious problems such as violence were relatively rare. However, PBNX pharmacists reported needing further training for themselves and their staff. Suggested improvements included better advertising of services and improving returns rates for used injecting equipment.

Conclusion. Needle exchange can reasonably be provided by non‐specialist health care professionals such as community pharmacists. However, attention should be paid to the educational needs of service providers who also require adequate support.
What works? A review of evaluated alcohol misuse interventions among Aboriginal Australians
Authors: Gray Dennis , Saggers Sherry , Sputore Brooke , Bourbon Deirdre
Published: March 2003

Aims. To identify which intervention strategies have been effective in reducing excessive consumption of alcohol, and related harm, among some segments of Australia's Aboriginal population. Design. Items dealing with 'alcohol' and 'evaluation' (27) were identified from the comprehensive electronic data base on Aboriginal alcohol and other drug issues, maintained by Australia's National Centre for Research into the Prevention of Drug Abuse. From these were selected all reports (14) dealing specifically with evaluation of particular intervention projects. These were grouped and systematically reviewed under the broad categories of treatment, health promotion education, acute interventions and supply reduction. Findings. A broad range of intervention strategies has been employed. However, few systematic evaluations have been undertaken and the methodologies employed have been generally insufficient to allow robust generalization. The impact of most interventions appears limited but, in part, this may be a function of inadequate resourcing and programme support. Conclusions. Despite the limitations of the evaluation reports, several conclusions can be tentatively drawn. It appears there is a need to employ a broader range of treatment models and complementary intervention strategies. Interventions are generally inadequately resourced. There is a suggestion that supply reduction interventions may be effective. Most importantly, there is a pressing need for more rigorous evaluation studies in cooperation with Aboriginal community organizations.
Risk factors for depression and anxiety in abstainers, moderate drinkers and heavy drinkers
Authors: Rodgers Bryan , Korten Ailsa E. , Jorm Anthony F. , Christensen Helen , Henderson Scott , Jacomb Patricia A.
Published: March 2003

Aims. To identify risk factors for depression and anxiety that are more prevalent in abstainers than in moderate drinkers and to estimate their contribution to U‐shaped relationships of depression and anxiety with alcohol consumption.

Design. Cross‐sectional general population sample.

Setting. Canberra, Australia.

Participants. 2725 subjects completed questionnaires, including 1128 men and 1258 women aged 18‐59 years.

Measurements. Consumption categories from AUDIT quantity/frequency items: (1) non‐drinkers (no alcohol in the past year), (2) occasional drinkers (monthly or less), (3) lower‐level drinkers (up to 14 standard drinks per week for men and seven for women), (4) higher‐level drinkers (up to 28 and 14 standard drinks per week, respectively), and (5) those drinking at hazardous or harmful levels (over 28 and 14 standard drinks per week, respectively). Goldberg and DSSI/sAD depression and anxiety scales. A range of demographic, socio‐economic, socio‐environmental and personality factors.

Findings. Non‐drinkers were more likely than lower‐level drinkers to have low status occupations, poor education, current financial hardship, poor social support and recent stressful life events, and scored lower on extraversion, fun‐seeking and drive. Many of these characteristics also applied to hazardous/harmful drinkers. In multivariate models, these risk factors accounted for a substantial part of the higher depression and anxiety scores of non‐drinkers and occasional drinkers relative to lower‐level drinkers.

Conclusions. Abstainers have a range of characteristics known to be associated with anxiety, depression and other facets of ill health, and these factors may contribute significantly to their elevated levels of depression and anxiety.
Opium in 20th‐century Britain: pharmacists, regulation and the people
Authors: Anderson Stuart , Berridge Virginia
Published: March 2003

Aims. To indicate how the system of pharmaceutical regulation of the sale and use of opium in Great Britain continued throughout the first half of the 20th century. Design. An oral history investigation of community pharmacy in Great Britain (n=50), together with an analysis of standard pharmaceutical texts. Setting. Community pharmacies in Great Britain during the 20th century. Participants. Retired community pharmacists with experience of the sale and use of opium during the period. Measurements. Oral testimony of retired community pharmacists about the use and sale of opium, and quantitative analysis of numbers of official preparations of opium available during the period. Findings. The popular use of opium continued well after the First World War, and its use as an ingredient of prescribed medicines continued well beyond the introduction of the National Health Service in 1948. Conclusions. Although the role of pharmacy in the regulation of opiates and other drugs was displaced by medicine following the passage of dangerous drugs legislation in the 1920s, pharmacists continued to play an important part in this regulation, exercising considerable discretion in the process.
Deaths in methadone maintenance treatment in New South Wales, Australia 1990‐1995
Authors: Zador Deborah , Sunjic Sandra
Published: March 2003

Aims. To determine the number and causes of deaths in methadone maintenance treatment (MMT). Design. Cross‐sectional survey. Setting. New South Wales (NSW), Australia. Participants. Two hundred and thirty‐eight patients who died while registered in MMT from 1990 to 1995. Measurements. Data on number and causes of death in MMT were obtained from data on file at the NSW Health Department, NSW Registry of Births, Deaths and Marriages, and NSW Department of Courts Administration. Findings. The most common cause of death was drug‐related (44%), followed by medical illness (24%). Fifty deaths (21%) occurred in the first week of MMT, 88% of which were drug‐related. In 92% of these drug‐related deaths, there was evidence of polydrug use. In all, 42% of all drug‐related deaths occurred during the first week of MMT. Nearly half the cases of drug‐related death (46%) in the first week were noted by the medical practitioner at assessment to have a history of polydrug abuse or dependence. Four (9%) drug‐related cases were prescribed doses of methadone in excess of the‐then current national methadone clinical guidelines. Conclusion. The first 7 days of MMT is a high‐risk period. Inadequate clinical review of subjects' tolerance to methadone and/or subjects' use of other central nervous system (CNS) depressant drugs probably contributed to most of these cases' deaths during induction. The findings from this study reinforce the importance of a thorough drug and alcohol assessment of people seeking MMT, cautious prescribing of methadone, frequent clinical review of patients' tolerance to methadone during induction and education about the dangers of additional drug use during this period.
Suicidal intent in non‐fatal illicit drug overdose
Authors: Neale Joanne
Published: March 2003

Aim. To explore suicidal intent among drug users experiencing non‐fatal overdose. Design. Semi‐structured interviews. Setting and participants. Seventy‐seven drug users experiencing non‐fatal overdose and attending six hospital accident and emergency departments in two Scottish cities during 1997 and 1998. Measurements. The extent of suicidal intent and motivations for intentional overdosing were examined. Findings. The incidence of suicidal intent was high, with 38 respondents (49%) reporting suicidal thoughts or feelings before overdosing. Suicidal actions were significantly associated with a self‐reported history of life‐time mental health problems and with not using heroin prior to overdosing, but not with other demographic or drug history data. Qualitative data indicated that intentional overdosing was frequently not driven by a clear and unambiguous desire to die. Furthermore, suicidal actions were motivated by a range of psychosocial factors, including: (i) predisposing personal circumstances; (ii) precipitating events; and (iii) poor individual coping strategies. Conclusions. The issue of suicidal intent needs to be addressed routinely in hospital wards and accident and emergency departments so that the need for support can be assessed.
The process of relapse in severely dependent male problem drinkers
Authors: Allsop Steve , Saunders Bill , Phillips Mike
Published: March 2003

Aims. The aim of the study was to investigate factors hypothesized to influence the relapse process, with a focus on the role of self‐efficacy, alcohol dependence and cognitive functioning. Design. The study was conducted in the context of a controlled trial of a relapse prevention programme. Subjects were assessed prior to treatment, at immediate conclusion of treatment and at 6‐ and 12‐month follow‐up. Setting. The study was conducted in an Alcohol Treatment Unit (ATU) in Scotland. Participants: Subjects were 60 male problem drinkers who were patients at the ATU. They were heavy drinkers, with corresponding high levels of alcohol dependence and alcohol‐related harm. Measurements. The independent variables were posttreatment self‐efficacy, alcohol dependence, cognitive functioning, level of depression and alcohol consumption prior to admission to treatment. The dependent variables were post‐treatment drinking behaviour and functioning and time to lapse and relapse. Findings. Although the methodology does not allow identification of causality, support was found for the hypothesis that post‐treatment self‐efficacy was an intervening variable between treatment and outcome. Higher post‐treatment self‐efficacy predicted better outcome at 6‐month follow‐up and was associated with a reduced risk of lapse and relapse over the 12‐month follow‐up. Poorer cognitive functioning was significantly associated with being categorized as a problem drinker at 6‐month follow‐up and with higher risk of a lapse over the 12‐month follow‐up. Level of alcohol dependence did not predict outcome. Conclusions. It was concluded that post‐treatment self‐efficacy rating is a predictor of treatment outcome and time to lapse and relapse and that cognitive functioning is a predictor of treatment outcome and time to lapse.
Disulfiram treatment for cocaine dependence in methadone‐maintained opioid addicts
Authors: Petrakis Ismene L. , Carroll Kathleen M. , Nich Charla , Gordon Lynn T. , McCance‐Katz Elinore F. , Frankforter Tami , Rounsaville Bruce J.
Published: March 2003

Aims: Cocaine use by patients on methadone maintenance treatment is a widespread problem and is associated with a poorer prognosis. Recent studies have evaluated disulfiram as a treatment for individuals with comorbid alcohol and cocaine abuse. We evaluated the efficacy of disulfiram for cocaine dependence, both with and without co‐morbid alcohol abuse, in a group of methadone‐maintained opioid addicts. Design: Randomized double‐blind, placebo‐controlled trial. Setting: Urban methadone maintenance clinic. Participants: Sixty‐seven cocaine‐dependent, methadone‐maintained, opioid‐dependent subjects (52% female; 51% Caucasian). Intervention: Study medication, either disulfiram or placebo, was placed directly in the methadone to ensure compliance for 12 weeks. Measurements: Primary outcome measures included weekly assessments of the frequency and quantity of drug and alcohol use, weekly urine toxicology screens and breathalyzer readings. Findings: Disulfiram treated subjects decreased the quantity and frequency of cocaine use significantly more than those treated with placebo. Alcohol use was minimal for all subjects regardless of the medication. Conclusions: Disulfiram may be an effective pharmacotherapy for cocaine abuse among methadone‐maintained opioid addicts, even in those individuals without co‐morbid alcohol abuse. Disulfiram inhibits dopamine beta‐hydroxylase resulting in an excess of dopamine and decreased synthesis of norepinephrine. Since cocaine is a potent catecholamine re‐uptake inhibitor, disulfiram may blunt cocaine craving or alter the "high", resulting in a decreased desire to use cocaine.
Gender differences in alcohol consumption and adverse drinking consequences: cross‐cultural patterns
Authors: Wilsnack Richard W. , Vogeltanz Nancy D. , Wilsnack Sharon C. , Harris T. Robert
Published: March 2003

Aims: To examine the consistency and/or variability of gender differences in drinking behavior crossculturally. Design, setting, participants: Women's and men's responses in 16 general population surveys from 10 countries, analyzed by members of the International Research Group on Gender and Alcohol. Measurements: Comparable measures of drinking, versus abstention, typical drinking frequencies and quantities, heavy episodic drinking, intoxication, morning drinking, and alcohol‐related family and occupational problems. Findings: Women and men differed little in the probability of currently drinking versus abstaining, but men consistently exceeded women in typical drinking frequencies and quantities and in rates of heavy drinking episodes and adverse drinking consequences, while women were consistently more likely than men to be life‐time abstainers. In older age groups, both men and women drank smaller quantities of alcohol and were more likely to stop drinking altogether, but drinking frequencies did not change consistently with age. Conclusions: A theoretical synthesis proposes that gender roles may amplify biological differences in reactions to alcohol, and that gender differences in drinking behavior may be modified by macrosocial factors that modify gender role contrasts.
Fiesta as tradition, fiesta as change: ritual, alcohol and violence in a Mexican community
Authors: Perez Ramona L.
Published: March 2003

Aims. To explore the traditional Mexican religious fiesta as a primary locus for community‐based excessive drinking and violence against women. The research argues that the pattern of drinking and violence cannot be placed within explanations that tie a breakdown in social norms to drinking nor drinking to a breakdown in social norms. Design. The data were gathered over 14 continuous months of participant observation in 1995 and 1996, followed by two summer research projects in 1997 and 1998. The researcher documented the activities of the participants at each fiesta and followed‐up each event with interviews of the parties involved in violent confrontations. In addition, life stories and archival data on violence were conducted and used to situate current findings against historical data. Setting. All data were collected in the community of Santa Maria Atzompa. Atzompa is a cabacera or municipal seat, for six colonias (large neighborhoods), and three ranchos (agriculturally based communities) and has a population of just over 5200. The main community of Atzompa, where most of the research was conducted, has a population of 2700+. Participants. Over 1000 individuals participated in community religious fiestas that the researcher attended. More than half of these were men, and almost all the men present participated in the binge drinking. Measurements. Sixteen religious fiestas and 13 non‐religious fiestas were documented through participant observation and photographs. Findings. In every religious‐based fiesta, violence erupted and was directed primarily against women. Husband and wife abuse accounted for 10 of the 16 violent disruptions (63%) while male/male abuse accounted for six (38%). Conclusions. The perpetuation of binge drinking and violence are part of a historic cycle of male dominance that dates back to the introduction of alcohol distillation during colonization by the Spaniards in the 16th century, compounded today by frustration over their inability to control the economic and political aspects of their households and community. Women's acquiescence to the violence is a form of mediation over male frustrations that allow women to continue in their roles as economic providers.
Diversion of prescribed drugs by drug users in treatment: analysis of the UK market and new data from London
Authors: Fountain Jane , Strang John , Gossop Michael , Farrel Michael , Griffiths Paul
Published: March 2003

Aims. To review the available knowledge about the diversion to the illicit market of drugs prescribed to drug users in treatment in the United Kingdom, and to identify aspects of the London market in more detail. Method. An analysis of the literature and new data in terms of the extent and nature of the market, the practicalities of trade, motives for selling, reasons for demand and the influence of variations in prescribing practice on diversion. Prices of diverted prescription drugs and details of their availability in London are presented. Findings. The size of the market is substantial and appears to involve a large number of individuals, each diverting small amounts of their own prescribed drugs. Major motives for selling prescribed drugs are to raise funds to buy other, preferred, drugs and/or to pay for a private prescription. Buyers in treatment appear to be motivated by a desire to supplement their own prescriptions because they are dissatisfied with the particular drug prescribed, dosage and formulation. Drug users in treatment can exploit the variations in prescribing practice ‐ such as how much 'take‐home' medication they are allowed and whether tests are conducted to ascertain if they are using it themselves ‐ and divert their prescribed drugs. Prices of prescription drugs on the illicit market can fluctuate on a daily basis according to supply and demand. Conclusions. The results suggest that, to be effective, diversion control must simultaneously involve deterrents from prescribers, drug treatment services, law enforcement agencies and dispensing pharmacists. Finally, some suggestions for further research on this under‐studied issue are suggested.
The effects of cigarette consumption on the Sternberg visual memory search paradigm
Authors: Tait Robert , Martin‐Iverson Mathew , Michie Patricia T. , Dusci Leon
Published: March 2003

Aim. To examine the performance of non‐smokers (n = 24), light smokers (n = 22, mean 6.5 cigarettes per day) and heavy smokers (n = 19, mean 23 cigarettes per day) on the Sternberg memory search task. Design. A repeated‐measures, counterbalanced design was used with one between‐subject factor, status (heavy, light or non‐smoker) and two within‐subject factors, condition (12 hours abstinence or ad libitum smoking) X time (pre‐ or post‐cigarette). Findings. Heavy smokers in the pre‐cigarette abstinent session had significantly slower reaction times, movement times and higher intercepts (a measure of factors contributing to performance other than rate of memory scan) than non‐smokers. After smoking these differences were removed. Conclusions. This suggests that rather than improving performance smoking ameliorates a deficit in certain measures of the Sternberg task produced by abstinence. Under ad libitum conditions improvements in performance were attributed to practice. Across all within‐subject conditions, there were no significant main effects of smoking status, and this result was consistent with the lack of relationship between measures of saliva continine and expired air carbon monoxide and performance. These data do not support the view that non‐abstinent smokers differ from non‐smokers in the performance of the Sternberg memory search procedure.
A longitudinal study of cannabis use and mental health from adolescence to early adulthood
Authors: McGee Rob , Williams Sheila , Poulton Richie , Moffitt Terrie
Published: March 2003

Aims. To examine the longitudinal association between cannabis use and mental health. Design. Information concerning cannabis use and mental health from 15 to 21 years was available for a large sample of individuals as part of a longitudinal study from childhood to adulthood. Participants. Participants were enrolled in the Dunedin Multidisciplinary Health and Development Study, a research programme on the health, development and behaviour of a large group of New Zealanders born between 1 April 1972 and 31 March 1973. Measurements. Cannabis use and identification of mental disorder was based upon self‐report as part of a general assessment of mental health using a standard diagnostic interview. Daily smoking and alcohol use at age 15 were assessed by self‐report. Indices of family socio‐economic status, family climate and parent ‐ child interaction were formed using information gathered from parent report and behavioural observations over early childhood. Childhood behaviour problems were assessed by parent and teacher report. Attachment to parents was assessed in adolescence. Findings. Cross‐sectional associations between cannabis use and mental disorder were significant at all three ages. Both outcome variables shared similar pathways of low socio‐economic status and history of behaviour problems in childhood, and low parental attachment in adolescence. Mental disorder at age 15 led to a small but significantly elevated risk of cannabis use at age 18; by contrast, cannabis use at age 18 elevated the risk of mental disorder at age 21. The latter association reflected the extent to which cannabis dependence and other externalizing disorders at age 21 were predicted by earlier level of involvement with cannabis. Conclusions. The findings suggest that the primary causal direction leads from mental disorder to cannabis use among adolescents and the reverse in early adulthood. Both alcohol use and cigarette smoking had independent associations with later mental health disorder.
Natural disasters and alcohol consumption in a cultural context: the Great Hanshin Earthquake in Japan
Authors: Shimizu Shinji , Aso Katsuro , Noda Tetsuro , Ryukei So , Kochi Yoshiro , Yamamoto Noriya
Published: March 2003

Aims. To assess changes in alcohol consumption attributable to the Great Hanshin Earthquake to test the assumption that alcohol consumption increases after natural disasters. Methods. Quarterly alcohol sales figures were compared for three periods: before, immediately after and subsequent to the Great Hanshin Earthquake in three areas of the Hyogo prefecture: the severely affected area, the moderately affected area and the unaffected area. Possible confounding by population movement, damage to retail outlets and normal variation in sales, was assessed. Findings. The quantity of alcoholic beverages consumed in the heavily damaged areas as well as throughout the prefecture decreased from the 1994 pre‐disaster level, both immediately after the Great Hanshin Earthquake (January‐March 1995) and 2 years after the disaster. This finding remained once possible confounding factors were taken into consideration. Conclusions. More attention should be placed on drinking in the cultural context where a disaster occurs. It may sometimes deter, rather than encourage, drinking among the affected population.
Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study
Authors: Langendam Miranda W. , Brussel Giel H. A. Van , Coutinho Roel A. , Ameijden Erik J. C. Van
Published: March 2003

Aims. To assess relationships between characteristics of methadone maintenance treatment and long‐term cessation of injecting (\>= 1 year). Design and participants. The incidence of cessation of injecting and relapse from non‐injecting to injecting was estimated among 488 participants of the Amsterdam cohort study among drug users. We used a nested matched case–control design to identify methadone treatment characteristics significantly and independently related to cessation of injecting. To ensure detailed and valid assessment of methadone treatment, data of the Central Methadone Register were linked with cohort data. For 339 of 488 subjects of the initial study group methadone data were available. Findings. The incidence of cessation of injecting increased from 2.2 /100 person years in 1985–89 to 5.5 /100 per year in 1995–97 (p trend = 0.005). Relapse to injecting was high: 17.2 /100 person years (no trend). Methadone dosage and frequency of methadone programme attendance in themselves were not significantly related to cessation of injecting. However, an individual increase of 5 mg or more per year (OR 4.20, 95% CI 1.54–11.46) and receiving methadone mainly via the outpatient clinic for drug‐abusing prostitutes and foreigners (OR 0.18, 95% CI 0.05–0.59) were independent predictors of cessation of injecting. After cessation of injecting, there were no HIV‐seroconversions during the period of non‐injecting (129 person years). After relapse to injecting there was one seroconverter; however, follow‐up was small (23 person years). The HIV‐incidence of those who continued injecting was 3.2 /100 per year. Conclusions. Steadily increasing the methadone dosage in a harm reduction setting may be useful in supporting injecting drug users in the process of cessation of injecting and reducing the spread of HIV‐infection.
Cognitive impairment among methadone maintenance patients
Authors: Darke Shane , Sims Jamie , McDonald Skye , Wickes Wendy
Published: March 2003

Aims. To compare the cognitive performance of methadone maintenance patients (MMPs) and a matched sample of non‐heroin‐using control subjects, and to ascertain risk factors for poorer cognitive performance. Design. Matched control study. Setting. Sydney, Australia. Participants. Thirty MMPs and 30 non‐heroin using controls, matched for age, gender and education. Findings. The MMP group had significantly higher rates than controls of alcohol dependence, heroin overdose and head injury. There was no difference between the groups on pre‐morbid functioning. The MMP group performed significantly poorer than controls on all of the neuropsychological domains measured: information processing, attention, short‐term visual memory, delayed visual memory, short‐term verbal memory, long‐term verbal memory and problem solving. A life‐time diagnosis of alcohol dependence and the number of non‐fatal heroin overdoses were independent significant predictors of poorer cognitive performance. Conclusions. In addition to high rates of psychiatric morbidity, MMPs also show cognitive deficits compared to matched controls. A history of alcohol dependence and repeated exposure to overdose increase the likelihood of cognitive impairment. The current study does not rule out the possibility of other factors, that were not measured, that may contribute to cognitive impairment among this MMPs.
Inpatient substance abuse care and the outcome of subsequent community residential and outpatient care
Authors: Moos Rudolf H. , Finney John W. , Moos Bernice S.
Published: March 2003

Aim. To compare participation in treatment and 1‐year substance use, symptom and functioning outcomes between patients with substance use disorders who did versus those who did not have an episode of inpatient care immediately prior to an episode of community residential and outpatient mental health care.

Design. Two matched groups of 257 patients each with substance use disorders were assessed at entry to and discharge from a community residential facility (CRF) and at a 1‐year follow‐up.

Findings. Patients in the two treatment groups received a comparable amount of CRF and outpatient mental health care. Nevertheless, patients who had prior inpatient care were more likely to be employed at 1‐year follow‐up. In addition, when they entered CRF care directly, patients with co‐morbid psychiatric disorders were more likely to continue use of alcohol and drugs in the CRF and less likely to complete the program. These patients also experienced more distress and psychiatric symptoms, and were less likely to be employed at the 1‐year follow‐up.

Conclusions. Among patients who seek treatment at Department of Veterans Affairs (VA) facilities, those who have both substance use and psychiatric disorders and enter CRF care directly have somewhat worse outcomes than those who have an immediately prior episode of inpatient care.
Personality disorder traits, family environment, and alcohol misuse: a multivariate behavioural genetic analysis
Authors: Jang Kerry L. , Vernon Philip A. , Livesley W. John
Published: March 2003

Aims. This study seeks to estimate the extent to which a common genetic and environmental basis is shared between (i) traits delineating specific aspects of antisocial personality and alcohol misuse, and (ii) childhood family environments, traits delineating broad domains of personality pathology and alcohol misuse.

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

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

Participants. Data obtained from 324 monozygotic and 335 dizygotic twin pairs were used to estimate the extent to which traits delineating specific antisocial personality traits and alcohol misuse shared a common genetic and environmental aetiology. Data from 81 monozygotic and 74 dizygotic twin pairs were used to estimate the degree to which traits delineating personality pathology, childhood family environment and alcohol misuse shared a common aetiology.

Measurements. Current alcohol misuse and personality pathology were measured using scales contained in the self‐report Dimensional Assessment of Personality Pathology. Perceptions of childhood family environment were measured using the self‐report Family Environment Scale.

Findings. Multivariate genetic analyses showed that a subset of traits delineating components of antisocial personality (i.e. grandiosity, attention‐seeking, failure to adopt social norms, interpersonal violence and juvenile antisocial behaviours) are influenced by genetic factors in common to alcohol misuse. Genetically based perceptions of childhood family environment had little relationship with alcohol misuse.

Conclusions. Heritable personality factors that influence the perception of childhood family environment play only a small role in the liability to alcohol misuse. Instead, liability to alcohol misuse is related to genetic factors common a specific subset of antisocial personality traits describing conduct problems, narcissistic and stimulus‐seeking behaviour.
Development and validation of a scale measuring self‐efficacy of current and former smokers
Authors: Etter Jean‐François , Bergman Manfred Max , Humair Jean‐Paul , Perneger Thomas V.
Published: March 2003

Aims. To develop and test the validity of a questionnaire measuring the confidence of current and former smokers in their ability to abstain from smoking in high‐risk situations.

Design and participants. We collected qualitative data in a first mail survey in 115 smokers and ex‐smokers, and used these data to develop survey items. We collected quantitative data in a second mail survey in 529 smokers and ex‐smokers to finalize the instrument.

Setting. General population in Geneva, Switzerland, 1995, 1997 and 1998.

Findings. The study resulted in a two‐dimensional 12‐item scale: the “Smoking Self‐Efficacy Questionnaire” (SEQ‐12). The two six‐item subscales measure confidence in ability to refrain from smoking when facing internal stimuli (e.g. feeling depressed) and external stimuli (e.g. being with smokers). Internal consistency coefficients were high (“internal stimuli”: alpha = 0.95; “external stimuli”: alpha = 0.94). Test–retest intraclass correlation coefficients were high (0.95 and 0.93 for the two scales, respectively). In smokers, baseline self‐efficacy scores predicted smoking cessation at 16‐month follow‐up. Finally, the scale respected criteria of content‐ and construct validity.

Conclusion. SEQ‐12 is a valid and reliable scale, which has applications in both research and clinical settings. It can also produce input data for computer systems that generate counselling reports tailored to the characteristics of each individual smoker.
Factors associated with injecting risk behaviour among serial community‐wide samples of injecting drug users in Glasgow 1990–94: implications for control and prevention of blood‐borne viruses
Authors: Hutchinson Sharon J. , Taylor Avril , Goldberg David J. , Gruer Laurence
Published: March 2003

Aims. To examine the association between recipient‐sharing of needles and syringes and demographic characteristics, injecting behaviour and needle and syringe exchange utilisation .

Design. Self‐report data from serial cross‐sectional surveys.

Setting. Multiple street, needle and syringe exchange and drug treatment sites throughout Glasgow.

Participants. 2576 current injecting drug users (IDUs) recruited during 1990–94.

Findings. In the multiple logistic regression analysis, a significantly lower level of recipientsharing was associated with respondents who resided within 1 mile of a needle and syringe exchange compared to those who lived further away (adjusted OR 1.3; 95% CI 1.0–1.6), and by IDUs who reported obtaining either 6–15, 16–30, or > 30 sterile needles and syringes in an average week from a needle exchange and/or pharmacist (adjusted ORs 0.55, 0.34, 0.25; 95% CIs 0.3–0.9, 0.2–0.6 and 0.2–0.4, respectively) compared to those who obtained no sterile equipment from these sources. Recipient‐sharing of needles and syringes in the previous 6 months reduced significantly between 1990 (43%) and 1991–94 (27–33%) (p < 0.0001); this decline was not explained by needle and syringe exchange utilization, suggesting that additional factors were influencing behavioural change at that time.

Conclusion. Our data indicate that improving injectors’ convenience of access to exchange facilities and increasing the numbers of sterile needles and syringes available to them is likely to result in further reductions in recipient‐sharing, and thus the potential for blood‐borne virus transmission, among IDUs.
One‐year follow‐up of opiate injectors treated with oral methadone in a GP‐centred programme
Authors: Hutchinson Sharon J. , Taylor Avril , Gruer Laurence , Barr Catherine , Mills Carl , Elliott Lawrence
Published: March 2003

Aims. To examine changes in drug‐related behaviour in opiate‐dependent injectors treated with oral methadone, in a shared care scheme where consumption of the daily dose is usually supervised by a community pharmacist.

Design. One‐year cohort study.

Setting. Recruitment from the main routes into methadone prescribing in Glasgow during 1996: General Practitioner Drug Misuse Clinic Scheme and the Drug Problem Service.

Participants. Current opiate injectors entering methadone treatment.

Findings. Among the 204 injectors recruited, 148 (73%) were re‐interviewed at 6 months and 118 (58%) at both 6 and 12 months. Twenty‐nine per cent of the cohort remained continuously on methadone for 12 months. In that group, over the 12‐month period, self‐reported daily opiate injecting reduced from 78% to 2%; overdose in the previous 6 months from 24% to 2%; mean daily drug spend from £50 to £4; and mean monthly number of acquisitive crimes reduced from 13 to three. Assuming participants lost to follow‐up were unchanged, significant improvements in the total cohort were seen in daily opiate injecting (from 80% at recruitment to 43% at 12 months), overdose (from 27% to 15%), mean daily drug spend (from £63 to £38) and mean monthly number of acquisitive crimes (from 18 to 11). Discontinuation of treatment was mainly due to imprisonment (39%) or sanctions by the prescriber (33%).

Conclusion. Treatment of opiate‐dependent drug injectors with methadone in a community‐wide general practitioner‐centred scheme, with supervised daily consumption, was associated with major beneficial change for a substantial proportion of patients.
A comparison of four buprenorphine dosing regimens using open‐dosing procedures: is twice‐weekly dosing possible?
Authors: Petry Nancy M. , Bickel Warren K. , Badger Gary J.
Published: March 2003

Aims. To compare opioid withdrawal symptoms during 24‐, 48‐, 72‐ and 96‐hour buprenorphine dosing regimens and to evaluate subjects' preferences for these different dosing schedules.

Subjects. Fourteen opioid‐dependent subjects participated in this study. They received daily sublingual maintenance doses of 4 mg/70 kg (n = 4) or 8 mg/70 kg (n = 10) of buprenorphine.

Intervention. In the first study subjects received, in a random order, four dosing regimens for five repetitions of each: daily maintenance doses every 24 hours (4 or 8 mg/70 kg), double the daily maintenance dose every 48 hours (8 or 16 mg/70 kg), triple the daily maintenance dose every 72 hours (12 or 24 mg/70 kg), and quadruple the daily maintenance dose every 96 hours (16 or 32 mg/70 kg). Measures of subjective and observer opioid withdrawal symptoms were assessed prior to receipt of each dose. In a second study, subjects chose between the different dosing regimens.

Findings. Some withdrawal ratings increased during the less frequent dosing schedules in the first study. In the second study, 46% of subjects preferred the quadruple‐every‐fourth‐day dosing regimen over every other option, and only 14% preferred to be dosed daily.

Conclusions. These results suggest that some opioid‐dependent outpatients are willing and able to endure the withdrawal symptoms associated with less than daily dosing, and a twice‐weekly dosing regimen may be possible.