bluuebunny/crossref_metadata_2025 huggingface dataset:
Cue exposure with coping skills training and communication skills training for alcohol dependence: 6‐ and 12‐month outcomes
Authors: Rohsenow Damaris J. , Monti Peter M. , Rubonis Anthony V. , Gulliver Suzy B. , Colby Suzanne M. , Binkoff Jody A. , Abrams David B.
Published: March 2003

Aims. Cue exposure treatment (CET) has shown promise in preliminary studies with alcoholics, and Communication Skills Training (CST) has been found beneficial, especially in intensive treatment programs. The aim of the present study was to investigate the effects of CET and CST in a larger controlled study when both were added to intensive treatment programs.

 Design and interventions. A 2 × 2 design investigated the effects of CET with urge coping skills training compared to a meditation‐relaxation control, and CST compared to an education control when all were added to intensive treatment programs for alcoholics.

 Setting. The sites were the inpatient or partial hospital substance abuse treatment programs at a private psychiatric hospital, a state‐funded residential facility and a VA medical center.

 Participants. Patients diagnosed with alcohol dependence without active psychosis were eligible.

 Measurements. Participants were assessed for quantity and frequency of drinking, alcohol cue‐reactivity, responses to high risk simulations and urge specific coping skills.

 Findings. Of 100 treated patients, 86% provided 6‐month and 84% provided 12‐month follow‐up data. Patients who received either CET or CST had fewer heavy drinking days in the first 6 months than control patients. In the second 6 months, CET continued to result in fewer heavy drinking days among lapsers and interacted with CST to decrease quantity of alcohol consumed. CST resulted in fewer alcohol‐related problems reported at 12 months. CET resulted in greater reductions in urge to drink in a measure of simulated high‐risk situations. CET also resulted in greater reports of use of coping strategies during the follow‐up, and many of the urge‐specific strategies taught in CET were associated with reduced drinking.

 Conclusions. Both CET and CST continue to show promise as elements of comprehensive alcohol treatment programs. Limitations and directions for future research are discussed.
Pilot randomized controlled study of dexamphetamine substitution for amphetamine dependence
Authors: Shearer James , Wodak Alex , Mattick Richard P. , Van Beek Ingrid , Lewis John , Hall Wayne , Dolan Kate
Published: March 2003

Aims.
To test the feasibility of conducting a definitive randomized controlled trial of dexamphetamine substitution for amphetamine dependent people and provide preliminary data.

 Design. An open, two‐group pre‐post randomized controlled trial.

 Participants. Forty‐one long‐term, dependent amphetamine users seeking treatment.

 Intervention. Twenty subjects were offered weekly counselling. Twenty‐one subjects were, in addition, prescribed up to 60 mg dexamphetamine daily.

 Measurements. Immunoassay and mass spectrometric urinalysis techniques were used to identify the presence of amphetamine and methylamphetamine in urine. The Opiate Treatment Index and Severity of Dependence Scale were used to collect pre‐ and post‐self‐report data. Subjects were screened using the Composite International Diagnostic Interview.

 Findings. Reduced street amphetamine use and amphetamine dependence was observed both in subjects prescribed dexamphetamine and subjects receiving counselling only. Treatment subjects appeared more likely to attend counselling.

 Conclusions. A definitive randomized controlled trial of dexamphetamine substitution using the techniques and instruments piloted in this study is feasible. Users appeared to be attracted and retained in substitution treatment. The intervention also appeared to be acceptable to clinicians.
Factors influencing remission from alcohol dependence without formal help in a representative population sample
Authors: Bischof G. , Rumpf H.‐J. , Hapke U. , Meyer C. , John U.
Published: March 2003

Aims.
To analyse factors related to remission without formal help by using a representative sample and standardized instruments.

 Design. Two groups of untreated alcohol‐dependent subjects were compared.

 Setting. General population survey.

 Participants. Thirty‐two subjects fully remitted without formal help (NFH) and 26 current alcohol‐dependent individuals (CAD) according to DSM‐IV drawn from a representative general population sample in northern Germany (response rate: 70.2%,

n = 4075).

 Measurements. Data focusing on the 2 years prior to remission from NFH were compared with past‐year data from CAD. Groups were compared on variables found to be associated with remission without formal help in previous research.

 Findings. Logistic regression analysis revealed that individuals remitted from alcohol‐dependence without formal help reported a higher non‐physiological severity of alcohol dependence, less social pressure to quit drinking and more incidents of driving while intoxicated. Furthermore, they tended to report more satisfaction with work and financial situation and were more likely to live in a stable partnership.

 Conclusions. Findings support the concept of psychosocial resources as important enabling factors in remission from alcohol dependence without formal help. Implications for brief interventions are discussed.
Dependent behaviours and beliefs: a qualitative study of older long‐term smokers with arterial disease
Authors: Parry O. , Thomson C. , Fowkes F. G. R.
Published: March 2003

Aims.
To examine the reasons for continuing to smoke provided by a sample of long‐term older smokers who have arterial disease (a smoking‐related condition) and the implications of those beliefs for current smoking behaviour and future smoking intent.

 Design. Qualitative semi‐structured interview study with face‐to‐face interviews using 'life grids'.

 Setting and participants. Twenty‐two long‐term older smokers, with arterial disease, who were participants of a larger qualitative study of Life Course Influences on Patterns of Persistent Smoking.

 Measurement. Qualitative semi‐structured interviews explored how respondents' described their relationship to smoking, using life grids to capture changes in patterns of cigarette usage across the life course.

 Findings. Older smokers with arterial disease defined their relationship to smoking in either dependent terms or functional terms (to fulfil specific purposes). The two types of relationship appeared to be associated more with different degrees of control smokers described exercising over their habit than with their levels and patterns of usage. Some older smokers with arterial disease who showed dependent patterns of behaviour did not believe they were dependent, and some who showed non‐dependent patterns of usage did not think of themselves as smokers even though they smoked. The immediate, functional and material benefits which these smokers attributed to smoking appeared to outweigh anticipated immediate and/or long term health‐related benefits of quitting.

 Conclusions. How smokers define their relationship to cigarettes does not necessarily correspond to levels and patterns of usage.
Social class and smoking at age 15: the effect of different definitions of smoking
Authors: Sweeting Helen , West Patrick
Published: March 2003

Aim.
To explore whether the association between social class and smoking among teenagers varies according to the definition of smoking adopted.

 Design, setting and participants. A survey of 2196 15‐year‐olds in 43 secondary schools in the West of Scotland.

 Measures. Current smoking status and number of cigarettes smoked, and social class based on the occupation of the head of the household.

 Findings. 'Current smoker' was the only category not significantly differentiated by class; the ratio of smokers from unskilled compared with professional backgrounds rose with increasingly stringent definitions of smoking.

 Conclusion. The extent to which teenage smoking is patterned by social class depends on the definition of smoking adopted.
Fermenting fruit and the historical ecology of ethanol ingestion: is alcoholism in modern humans an evolutionary hangover?
Authors: Dudley Robert
Published: March 2003

In the field of addiction research, the possibility of ancestral exposure to psychoactive compounds has generally been excluded. A paleobiological approach to the human diet, however, illustrates the potential utility of historical data in interpreting modern‐day addictive behaviors. Low‐level dietary exposure to ethanol via ingestion of fermenting fruit has probably characterized the predominantly frugivorous anthropoid lineage for about 40 million years. Potentially adaptive primate behaviors associated with the natural occurrence of ethanol include the olfactory use of ethanol plumes to localize fruit crops, the use of ethanol as an appetitive stimulant to facilitate rapid consumption of transient nutritional resources, and the physiological exploitation of the caloric benefits of ethanol. Such behavioral and energetic advantages probably pertain to all animal taxa that consume fermenting fruit, and may have been retained in modern humans in spite of considerable dietary diversification over the last several million years. In contemporary human environments, excessive consumption of ethanol would then represent maladaptive cooption of ancestrally advantageous behaviors given essentially ad libitum access to a compound otherwise found only within scarce nutritional substrates. Epidemiologically demonstrated health benefits of low‐level alcohol consumption are consistent with an ancient and potentially adaptive exposure of primate frugivores to this most common of the psychoactive substances.
The urge to smoke depends on the expectation of smoking
Authors: Dols M. , Hout M. van den , Kindt M. , Willems B.
Published: March 2003

Aims An earlier study (Dols et al. 2000) suggested that cue‐induced urge to smoke depends on the expectation of smoking. The present study tried to replicate the findings under stringently controlled conditions.

Design A 2 (context) × 2 (cues) × 6 (trial) within‐subject design. Each smoker entered two different contexts; one context predicted the future occurrence of smoking (i.e. one puff of a cigarette) and one context predicted the non‐occurrence of smoking. In each context smokers were exposed to smoking cues (i.e. cigarettes and lighter) or not.

Setting Laboratory at Maastricht University.

Participants Thirty‐two daily smokers, smoking at least five cigarettes a day for at least 2 years.

Measurements. Participants reported their urge to smoke in each context in the presence and absence of smoking cues using a computerized visual analogue scale (VAS).

Findings The results revealed that the urge to smoke was higher in a context in which smoking was expected relative to a context in which it was not expected. As in the previous study the urge‐inducing effect of smoking cues was larger in the smoking context than in the non‐smoking context. Moreover, smoking cues did not have a significant effect in the non‐smoking context.

Conclusions It was shown that smoking cues elicit craving due mainly to a generated expectation of the occurrence of smoking and less due to salience or long history of associative learning. Theoretical and practical implications of the results are discussed.
The Research Society on Alcoholism
Authors: Israel Yedy , Lieber Charles S.
Published: March 2003

ABSTRACT Until the 1960s, the small amount of federal funding available
in the alcohol field in the USA was provided by a division of the Alcohol, Drug and
Mental Health Administration. In the late 1960s, the National Council on Alcoholism
(NCA) joined the American Medical Society on Alcoholism (AMSA, which accepted only
physicians). A group of physicians at NCA–AMSA felt that progress in our field
needed the concerted effort of both physicians and non‐physician scientists, creating
the Research Society on Alcoholism (RSA) in 1977. The National Institute on Alcohol
Abuse and Alcoholism (NIAAA) had been created a few years earlier. From 250 members
in 1978, the RSA has grown to 1500 in 2001, with a ratio of about three PhDs (with
specialities that range from gene therapy to social policy) to each MD. The society
holds yearly meetings—visitors can find more information on the web page (http://www.RSoA.org).
The society publishes the journal Alcoholism: Clinical and Experimental Research. RSA committees are active in presenting the most recent findings to the public and to elected representatives, and in making recommendations on areas of research that need funding.
The Brazilian Association for the Study of Alcohol and Other Drugs
Authors: Silva João Carlos Dias da , Ramos Sérgio de Paula , Luz Ernani Luz , De Oliveira Evaldo Melo , Requião Dagoberto Hungria , Campana Angelo Americo Martinez
Published: March 2003

The Brazilian Association for the Study of Alcohol and other Drugs [Associação Brazileira de Estudos do Álcool e outras Drogas (ABEAD)] is a non‐profit entity with the purpose of encouraging discussions and exchanges on advances in the prevention, treatment and research of addition. It currently brings together 840 professionals from different areas, such as Psychiatry, Social Assistance, Nursing, Psychology, Sociology, Law, in addition to community leaders, thus having an innovative and dynamic character. It organises annual national congresses and regional meetings hosting foreign guests. The society has a style that is innovative and dynamic. After more than 20 years of work, ABEAD exerts significant national influence and its members have been invited to participate in the main decisions regarding issues linked to drug abuse in Brazil. Among other achievements, it has contributed to the proposals on prevention and treatment policies and the standardization of the different levels of assistance provided by public health‐care. In addition, its members have worked closely with the initiatives made by the government and medical entities in the search for a consensus on the treatment of the different types of dependence, including alcohol dependence and smoking. ABEAD's goal for the future is to broaden its participation in the national drug policy arena and to intensify the work with other medical organizations and with the community.
A pathways model of problem and pathological gambling
Authors: Blaszczynski Alex , Nower Lia
Published: March 2003

ABSTRACT At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and ecological variables contributing to the development of pathological gambling. Advances in this area are hampered by imprecise definitions of pathological gambling, failure to distinguish between gambling problems and problem gamblers and a tendency to assume that pathological gamblers form one, homogeneous population with similar psychological principles applying equally to all members of the class. The purpose of this paper is to advance a pathways model that integrates the complex array of biological, personality, developmental, cognitive, learning theory and ecological determinants of problem and pathological gambling. It is proposed that three distinct subgroups of gamblers manifesting impaired control over their behaviour can be identified. These groups include (a) behaviourally conditioned problem gamblers, (b) emotionally vulnerable problem gamblers and (c) antisocial, impulsivist problem gamblers. The implications for clinical management are discussed.
Smoking as a risk factor for Alzheimer’s disease: contrasting evidence from a systematic review of case–control and cohort studies
Authors: Almeida Osvaldo P. , Hulse Gary K. , Lawrence David , Flicker Leon
Published: March 2003

Aims To investigate the risk of Alzheimer’s disease (AD) associated with smoking.

Design Meta‐analyses of case–control and cohort studies. Data source: Index Medicus–Medline (1966–April 2000) and PsycINFO (1984–April 2000) databases were systematically consulted for the retrieval of references. This search was supplemented by manual search of relevant references quoted by other studies and reviews.

Study selection Irrelevant abstracts and articles were identified by one of the authors. These papers were retrieved and examined by at least two of the authors, who initially assessed them for the relevance of the exposure (smoking), outcome (AD) and study‐design (case–control or cohort study).

Data extraction Two reviewers rated independently the quality of selected papers. Whenever possible, raw data were extracted and the crude odds ratio (OR) calculated using the Cornfield method. The pooled risk ratios were estimated using a fixed‐effects model.

Findings Twenty‐one case–control studies reported data on 5323 subjects. The estimated pooled odds ratio (OR) was 0.74 [95% confidence interval (CI) = 0.66–0.84]. In another analysis incorporating ORs adjusted for confounding variables (such as age, sex, schooling and alcohol use), the pooled odds ratio was 0.82 (95% CI = 0.70–0.97). Finally, in a analysis that included only the four case–control studies that used matched design the pooled odds ratio was 0.82 (95% CI = 0.53–1.27). Eight cohort studies reported data on 43 885 people at risk—the overall relative risk (RR) of AD among ever smokers was 1.10 (95% CI = 0.94–1.29). Restricting the analysis to the two cohort studies that described the number of subjects who were smokers at baseline and later developed AD produced a RR of 1.99 (95% CI = 1.33–2.98).

Conclusions Case–control and cohort studies produce conflicting results as to the direction of the association between smoking and AD. Survival bias and other methodological problems associated with case–control studies may partly explain this difference. Access to information collected by ongoing follow‐up studies may contribute to clarify the role of smoking in AD. If new results confirm that smoking is associated with increased risk of AD, then smoking prevention and cessation should become public health priorities in the fight against dementia.
The role of brain emotional systems in addictions: a neuro‐evolutionary perspective and new ‘self‐report’ animal model
Authors: Panksepp Jaak , Knutson Brian , Burgdorf Jeff
Published: March 2003

The evolutionary significance of neurochemical events in the brain has received minimal attention in the field of addiction research. Likewise, the general failure of neuroscientists to postulate how basic brain circuits might mediate emotional urges has retarded the development of scientific perspectives that could inform new inquiries into the underlying dynamics and treatment of addictions. In this paper, we revisit the argument that prototypically abused substances activate or alter specific emotional brain systems that were evolutionarily designed to signal potential increments or decrements in fitness. We then discuss two distinct emotional systems (reward seeking and separation distress) which may track different types of potential changes in fitness. Based on this evolutionarily inspired approach, we illustrate how a mammalian model of emotion (i.e. rodent ultrasonic vocalizations) may enable scientists to predict drug‐related phenomena such as abuse potential, anatomical location of mediating neural substrates, and the psychological impact of withdrawal. We conclude by discussing some therapeutic and social implications of examining drug addiction processes with multiple emotional brain systems in mind.
Factors associated with non‐fatal heroin overdose: assessing the effect of frequency and route of heroin administration
Authors: Brugal M. Teresa , Barrio Gregorio , Fuente Luis De La , Regidor Enrique , Royuela Luis , Suelves Josep M.
Published: March 2003

Aims To examine risk factors associated with non‐fatal heroin overdose, particularly frequency and route of heroin administration.

Design Data from cross‐sectional surveys were analysed as a case–control and as a case cross‐over design.

Setting and participants 2556 subjects treated for heroin dependence in 164 outpatient facilities in Spain.

Measurements Prevalence of overdose involving emergency care in the 12 months before treatment admission.

Case control design Odds ratio (OR) adjusted by logistic regression.

Case–crossover design

Estimated relative risk (RR) of transient risk of injecting heroin.

Findings The prevalence of overdose was 10%. In the case control analysis the cumulative risk of overdose increased as the frequency of heroin use decreased. However, among daily heroin users this risk increased as the frequency of heroin injection rose, with an OR of 6.0 (95% CI: 3.9–9.6) for daily injectors versus non‐injectors. Sniffers had a higher risk than smokers among non‐daily users, but not among daily users. Other factors associated with increased risk of overdose were: tranquillizers, alcohol or cocaine use, living in certain regions and being long‐term HIV+ 0. In the case–crossover analysis, the RR for injecting heroin versus using other routes immediately before overdose was 15.9 (95%CI: 9.5–26.6), and was much higher for non‐daily heroin users than for daily users.

Conclusions These findings suggest that the rapid entry of a large quantity of heroin into the blood (as occurs when injecting) involves a high risk of overdose, especially when the heroin tolerance level is low (as occurs in sporadic users).
Acceptability and availability of pharmacological interventions for substance misuse by British NHS treatment services
Authors: Rosenberg Harold , Melville John , McLean P. C.
Published: March 2003

Aims Despite their potential advantages, many of the pharmacological interventions available to treat substance misuse are controversial and their acceptability within the United Kingdom (and other countries) has only recently begun to be investigated.

Design A questionnaire mailed to British National Health Service (NHS) alcohol and drug treatment services asked respondents to rate the acceptability and availability of 11 pharmacological interventions for substance misuse employed to relieve withdrawal, reduce the likelihood of relapse and opiate overdose and substitute pharmaceuticals for illicit drugs.

Participants A sample of NHS substance misuse services (n = 265) listed in one or more directories of services in England, Wales and Scotland.

Findings Substitute methadone for opiate addiction, substitute benzodiazepines for benzodiazepine‐dependent patients, lofexidine for opiate detoxification, naltrexone for opiate relapse prevention and acamprosate for alcohol relapse prevention were widely acceptable and available interventions. Another subset of medications—buprenorphine for opiate detoxification, take‐home naloxone for overdose prevention and substitute prescribing of levo‐alpha‐acetyl‐methadol (LAAM), heroin and dexamphetamine—garnered less support, but the majority of participants rated even these therapies as acceptable. Ultra‐rapid detoxification under sedation was the intervention rated as least acceptable to, and was one of the two least frequently available from, responding NHS services.

Conclusions Differences among specific medications notwithstanding, a wide range of harm‐reduction and abstinence‐orientated interventions were acceptable to and available from NHS services. Acceptance and availability are probably limited by a combination of practical, economic, safety, efficacy and theoretical considerations.
Risk factors for symptom exacerbation among treated patients with substance use disorders
Authors: Moos Rudolf H. , Nichol Aran C. , Moos Bernice S.
Published: March 2003

Aims The purpose of this study was to develop an index of risk factors to identify patients prospectively with substance use disorders whose substance use symptoms exacerbate during or shortly after treatment, and to identify characteristics of care that may reduce the likelihood of exacerbation.

Design, setting, participants On the basis of data obtained from a nation‐wide outcomes monitoring system, a group of 2809 treated patients experienced an exacerbation of their substance use symptoms. These patients were matched on baseline substance abuse problems with 5618 patients who remained stable or improved.

Measurements and findings Risk factors for substance use symptom exacerbation included younger age, non‐married status and residential instability; long‐term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence and more severe self‐rated drug problems; and psychiatric problems. High‐risk patients who obtained a longer episode of mental health care were less likely to experience an exacerbation of symptoms.

Conclusions Clinicians can identify at treatment entry patients whose substance use symptoms are likely to exacerbate and, by providing these patients a longer duration of care, may reduce the likelihood of symptom exacerbation.
Would smokers with schizophrenia benefit from a more flexible approach to smoking treatment?
Authors: McChargue Dennis E. , Gulliver Suzy B. , Hitsman Brian
Published: March 2003

We evaluated literature that addresses the notion that flexible smoking treatment approaches are warranted for smokers with a diagnosis of schizophrenia. Understanding the biological and psychological mechanisms that increase the likelihood of smoking and decrease the motivation to quit for these individuals is addressed within the framework of a neurobiological model. We provide a brief overview of the limited smoking cessation treatment literature for patients with schizophrenia and compare abstinence‐focused versus reduction‐focused treatment modalities. The potential utility of the reduction‐focused approach to tobacco treatment for these smokers is evaluated. Suggestions for future research to address the utility and efficacy of reduction‐focused interventions for smokers with schizophrenia are put forth. We conclude with a consideration of the implications for the current understanding of smoking treatment among patients with co‐morbid psychiatric diagnoses.
Effects of depression and social integration on the relationship between alcohol consumption and all‐cause mortality
Authors: Greenfield Tom K. , Rehm Jürgen , Rogers John D.
Published: March 2003

AimsThis study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all‐cause mortality.

Design, participants and measurementRespondents from the 1984 US National Alcohol Survey (N= 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES‐D) scale and an eight‐item social isolation scale.

FindingsTheJ‐shaped risk curve for all‐cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life‐time abstainer.

ConclusionsThe relationship of alcohol consumption to 11‐year all‐cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex‐drinkers.
A prospective study of mortality among drug misusers during a 4‐year period after seeking treatment
Authors: Gossop Michael , Stewart Duncan , Treacy Samantha , Marsden John
Published: March 2003

Aims The opportunity to study deaths as they occur within the framework of a prospective cohort study is relatively uncommon. This study investigates deaths among drug misusers over a 4‐year period, with specific attention to the circumstances and causes of death, and risk factors for mortality. The study also critically examines the recording of drug‐related deaths.

Design, Setting, Participants Prospective cohort study of 1075 drug misusers recruited to 54 treatment programmes during 1995.

Measurements Data derived from interviews conducted with clients at intake, death certificates and post‐mortem examinations.

Findings The annual mortality rate was 1.2%, about six times higher than that for a general, age‐matched population. Fourteen per cent of the deaths were due to self‐inflicted injuries, accidents or violence and 18% were due to medical causes. The majority of deaths (68%) were associated with drug overdoses. Opiates were the drugs most commonly detected during post‐mortem examinations. In the majority of cases, more than one drug was detected. Polydrug use and, specifically, heavy drinking, and use of benzodiazepines and amphetamines, were identified as risk factors for mortality. Anxiety and homelessness were also predictive of increased mortality.

Conclusions We suggest that drug misusers and those working with drug misusers need to be more alert to the risks of polydrug use, including the combined use of alcohol with illicit drugs. The study revealed inconsistencies in the recording of drug‐related deaths on death certificates. The routine recording of all substances detected during toxicological examination would improve the accuracy of death certification.
Public–private partnerships to reduce tobacco dependence
Authors: Anderson Peter
Published: March 2003

Four‐fifths of the estimated one billion deaths that will be caused by tobacco dependence over the next 100 years will occur in low‐income countries. Along with other tobacco control policy measures, the treatment for tobacco dependence is a cost‐effective policy measure in low‐income countries. In public health, public–private partnerships for drugs and vaccines and incentives for commercial private sector engagement are proposed to tackle the communicable diseases of the poor. This paper will argue that public–private partnerships are also an appropriate and important vehicle to reduce the harm caused by tobacco. For the pharmaceutical sector to engage in the marketing of tobacco dependence treatment products in low‐income countries the incentives must be aligned, and a self‐sustaining market must be developed. A rational market would be large, characterized by high volumes and low margins. The framework convention on tobacco control of the WHO provides a global infrastructure for taking public sector action to reduce the harm caused by tobacco. The convention could call for a proportion of tobacco tax from high‐income countries to be used to fund tax credits and other incentives for increasing the access to tobacco dependence treatment in low‐income countries.
A placebo‐controlled study of high dose buprenorphine in opiate dependents waiting for medication‐assisted rehabilitation in Oslo, Norway
Authors: Krook A. L. , Brørs O. , Dahlberg J. , Grouff K. , Magnus P. , Røysamb E. , Waal H.
Published: March 2003

Aims To evaluate whether buprenorphine, even without additional control and psychosocial treatment and support, alleviates the problems faced by patients waiting for medication assisted rehabilitation (MAR).

Design A randomized, double‐blind, 12‐week study of Subutex® versus placebo without additional support as an interim therapy.

Participants One hundred and six patients, 70 males and 36 females, waiting for MAR in Oslo. The average age was 38 years with an average history of heroin use of 20 years. Fifty‐five patients were assigned to buprenorphine and 51 to a placebo.

Intervention Subutex® or placebo sublingual tablets were given under supervision in a daily dose of 16 mg with the exception of a double dose on Saturday and no dose on Sunday.

Measurement Retention, compliance, self‐reported drug‐abuse, wellbeing and mental health.

Findings The average number of days of participation was significantly higher in the buprenorphine
group, 42 (median: 29) compared to 14 (median: 11) for the placebo group (P
< 0.001). The retention of patients after 12 weeks was 16 patients in the buprenorphine
group and one patient in the placebo group. The buprenorphine group had a larger
decrease in reported opioid use (p < 0.001) and in reported use of other
drugs, tablets and alcohol abuse (p < 0.01). The group also showed a stronger
increase in wellbeing (p < 0.01) and life satisfaction (p < 0.05). None of the participants died.

Conclusion The patients waiting for MAR benefited significantly from the buprenorphine as an interim therapy according to retention, self‐reported use of drugs and wellbeing. However, the patients had difficulties in remaining in treatment over time without psychosocial support.
Adolescent part‐time work and heavy drinking in Finland
Authors: Kouvonen Anne , Lintonen Tomi
Published: March 2003

Aims To examine the relationship between part‐time work and heavy drinking among Finnish adolescents.

Design, setting The cross‐sectional survey data (the School Health Promotion Survey, n = 47 568) were collected in classrooms in 2000.

Participants Finnish lower‐level secondary school students from the 8th and 9th grades, aged 14–16 years. The response rate was 82%.

Measurements Work intensity, work type and the frequency of heavy drinking obtained from self‐administered questionnaires. The relationship between work and heavy drinking was studied using polychotomous logistic regression models.

Findings Compared with non‐workers, adolescents working more than 10 hours per week had an increased risk of heavy drinking, and also the frequency of heavy drinking was connected with this intensive working. When gender, grade level, parental education, the employment status of the parents, family structure, economic situation of the family, the degree of urbanisation, parental control, steady dating, GPA and disposable allowance were adjusted for, the odds of weekly drunkenness were almost three times the odds of not reporting drunkenness among intensive workers compared with non‐workers. When adjusted for other factors, some typical children’s jobs marginally decreased a likelihood of heavy drinking.

Conclusions Work does seem not protect adolescents from heavy drinking. Although many relevant factors were controlled for the effect may, however, be mediated through factors not covered in the survey. Therefore, further clarification of the causal chains linking adolescent working and drinking is needed.
Cannabis use and psychosocial adjustment in adolescence and young adulthood
Authors: Fergusson David M. , Horwood L. John , Swain‐Campbell Nicola
Published: March 2003

Aim

To examine the associations between frequency of cannabis use and psychosocial outcomes in adolescence/young adulthood.

Design

A 21‐year longitudinal study of the health, development and adjustment of a birth cohort of 1265 New Zealand children.

Measurements

Annual assessments of the frequency of cannabis use were obtained for the period from age 14–21 years, together with measures of psychosocial outcomes including property/violent crime, depression, suicidal ideation, suicide attempt and other illicit drug use.

Findings

The frequency of cannabis use was associated significantly with all outcomes, and particularly other illicit drug use. Statistical control for confounding by both fixed and time‐dynamic factors substantially reduced the strength of association between cannabis use and outcome measures. Nevertheless, cannabis use remained significantly (P < 0.05) associated with all outcomes and particularly other illicit drug use, after adjustment for confounding. For the measures of crime, suicidal behaviours and other illicit drug use there was evidence of age related variation in the strength of association with cannabis use, with younger (14–15 years old) users being more affected by regular cannabis use than older (20–21 years old) regular users. However, the association between cannabis use and depression did not vary with age.

Conclusions

Cannabis use, and particularly regular or heavy use, was associated with increased rates of a range of adjustment problems in adolescence/ young adulthood—other illicit drug use, crime, depression and suicidal behaviours—with these adverse effects being most evident for school‐aged regular users. The findings reinforce public health concerns about minimizing the use of cannabis among school‐aged populations.
What do citation counts count for in the field of addiction? An empirical evaluation of citation counts and their link with peer ratings of quality
Authors: West Robert , McIlwaine Ann
Published: March 2003

Aims This study investigated the value of citation counts as an index of quality in the field of addiction and examined factors that contribute to papers being cited more or less frequently.

Design The number of times papers published by the journal Addiction in 1995–98 that had been cited up to May 2000 were counted using the Science and the Social Science Citation Indexes. Articles in nine of the monthly issues from 1997 were rated by two independent expert raters for quality. Factors related to citation counts were also examined including: country of origin of the paper, substance type, solicited versus unsolicited papers and methodology used.

Findings A total of 417 unsolicited research reports were included in the citation analysis, of which 79 were also subjected to quality ratings. The experts showed a moderate level of agreement in their ratings (intraclass correlation = 0.39, p <
0.001). However, there was no correlation between number of citations and expert
ratings of article quality (R < 0.1). Papers from developing countries received significantly fewer citations than papers from other countries but substance type (e.g. nicotine, opiate, alcohol) and methodology (e.g. survey, treatment trial) were not related to number of citations.

Conclusions This study involved just one journal but raised an important issue: the number of citations received by papers on addiction appears to reflect the geographical region of study rather than what experts would consider as ‘quality’. If these findings are found to generalize they call into question the use of citation‐related indices as measures of quality in this field and perhaps in others as well. To our knowledge our methodology has not been used before and could be adapted to study the value of citations more widely.
Cigarette smoking and attention to signals of reward and threat in the Stroop paradigm
Authors: Powell Jane , Tait Samantha , Lessiter Jane
Published: March 2003

Aims

To test the prediction arising from the incentive–sensitization model of addiction that when tested immediately after smoking, smokers will show heightened attention to words with appetitive and aversive motivational significance compared with their performance during acute abstinence.

Design

Twenty‐one smokers were each tested twice, once just after smoking and once after overnight abstinence, on three versions of the modified Stroop task which required colour naming of words with either neutral, appetitive or aversive connotations. Ten non‐smokers were tested once.

Setting

All participants were tested in a quiet experimental cubicle within the psychology department.

Participants

Smokers comprised nine men and 12 women who had smoked at least 10 cigarettes per day for the last 6 months; non‐smokers comprised five men and five women who had never smoked. All were aged between 18 and 35 years. Three smokers were excluded from the analyses because their breath CO levels suggested they had not complied with the instructions to abstain on one occasion.

Measurements

A card‐based, blocked, format was used for the modified Stroop task. Time to colour‐name the words of the three motivational types, the order of which was counterbalanced across participants, was recorded.

Findings

Smoking was associated with greater interference from both threat and appetitive words than from neutral words; during abstinence there was no differential effect of word type. Non‐smokers performed more similarly to recent smokers.

Conclusions

This pattern suggests suppression of normal motivational responding during abstinence.
Social networks as mediators of the effect of Alcoholics Anonymous
Authors: Kaskutas Lee Ann , Bond Jason , Humphreys Keith
Published: March 2003

Aims

This study tested the hypothesis that the relationship between Alcoholics Anonymous (AA) involvement and reduced substance use is partially explained (or ‘mediated’) by changes in social networks.

Design

This is a naturalistic longitudinal study of the course of alcohol problems.

Setting

Study sites were the 10 largest public and private alcohol treatment programs in a northern California county.

Participants

Three hundred and seventy‐seven men and 277 women were recruited upon seeking treatment at study sites.

Measurements

At baseline and 1‐year follow‐up, we assessed alcohol consequences and dependence symptoms, consumption, social support for abstinence, pro‐drinking social influences and AA involvement.

Findings

In the structural equation model, AA involvement was a significant predictor of lower alcohol consumption and fewer related problems. The size of this effect decreased by 36% when network size and support for drinking were included as mediators. In logistic regression models predicting abstinence at follow‐up, AA remained highly significant after including social network variables but was again reduced in magnitude. Thirty‐day abstinence was predicted by AA involvement (OR = 2.9), not having pro‐drinking influences in one's network (OR = 0.7) and having support for reducing consumption from people met in AA (versus no support; OR = 3.4). In contrast, having support from non‐AA members was not a significant predictor of abstinence. For alcohol‐related outcomes other than abstinence, significant relationships were found for both AA‐based and non‐AA‐based support.

Conclusions

The type of social support specifically given by AA members, such as 24‐hour availability, role modeling and experientially based advice for staying sober, may help to explain AA's mechanism of action. Results highlight the value of focusing on outcomes reflective of AA's goals (such as abstinence) when studying how AA works.
Does marijuana use have residual adverse effects on self‐reported health measures, socio‐demographics and quality of life? A monozygotic co‐twin control study in men
Authors: Eisen Seth A. , Chantarujikapong Sunanta , Xian Hong , Lyons Michael J. , Toomey Rosemary , True William R. , Scherrer Jeffrey F. , Goldberg Jack , Tsuang Ming T.
Published: March 2003

Aims

To assess the effects of former heavy marijuana use on selected aspects of health.

Design

A monozygotic co‐twin control design was used to compare the health of former heavy marijuana using male monozygotic twins to that of their co‐twins who never used marijuana significantly.

Setting

In‐person survey and questionnaires.

Participants

Fifty‐six marijuana use discordant monozygotic twin pair members of the Vietnam Era Twin (VET) Registry.

Measurements

Current socio‐demographic characteristics; current nicotine and alcohol use; life‐time nicotine and alcohol abuse/dependence; past 5‐year physical and mental health services utilization; and health‐related quality of life.

Findings

The mean number of days on which the marijuana user twin used marijuana in his life‐time was 1085, while the non‐marijuana user used marijuana a maximum of 5 days. Marijuana was last used a mean of 20 years previously. No significant differences were found between the former marijuana user twins and their siblings for current socio‐demographic characteristics; current nicotine or alcohol use; life‐time nicotine or alcohol abuse/dependence; past 5‐year out‐patient or emergency room visits, hospitalizations or medication use for medical problems; past 5‐year mental health out‐patient use or hospitalizations; or health‐related quality of life.

Conclusions

Previous heavy marijuana use a mean of 20 years earlier by a group of men who reported no other significant illicit drug use does not appear to be associated with adverse socio‐demographic, physical or mental health adverse effects. The conclusions of the study are limited by possible participation and recall biases, relatively small sample size and the absence of a physical health examination.
Over a decade of syringe exchange: results from 1997 UK survey
Authors: Parsons James , Hickman Matthew , Turnbull Paul J. , McSweeney Tim , Stimson Gerry V. , Judd Ali , Roberts Kay
Published: March 2003

Aims

To describe syringe exchange provision in the United Kingdom .

Design

Two‐phase cross‐sectional survey: phase I, establishing a sampling frame of syringe exchange coordinators (n = 420); phase II, surveying the coordinators seeking data on the number of syringe exchange outlets, visits and syringes distributed during April 1997 (68% response rate).

Setting

United Kingdom.

Findings

In 1997, nearly all Health Authorities in the United Kingdom (96%) operated some form of syringe exchange service, except Northern Ireland. In April 1997, 1 707 000 syringes were reported as being distributed. Assuming that non‐responders coordinated the median number of outlets and distributed the median number of syringes as responders, we estimate that 27 million syringes were distributed annually from over 2000 outlets in the United Kingdom. The number distributed in Scotland was 3–4 times less than in England when measured as a number per adult (15–44), drug user in treatment, or estimated injecting drug user.

Conclusions

Overall, there has been a 6.5‐fold increase in syringe distribution in England since 1991. The number of syringes distributed in the United Kingdom may be higher than the United States. However, there appears to be unequal distribution of syringes within the United Kingdom, which may be associated with higher levels of HCV among injectors in Scotland compared to England.
Blood alcohol content (BAC)‐negative victims in alcohol‐involved injury incidents
Authors: Levy David T. , Miller Ted R. , Mallonee Sue , Spicer Rebecca S. , Romano Eduardo O. , Fisher Deborah A. , Smith Gordon S.
Published: March 2003

Aims

To understand better how often BAC‐negative victims suffer fatal and non‐fatal alcohol‐involved injuries.

Design

We analyzed 1988–1993 data from Oklahoma surveillance systems that track all people killed or hospitalized due to burns, submersions and spinal cord injuries (SCIs) and investigate alcohol use by victims and any others who contributed to their injuries.

Measurements

Percentage of victims BAC‐positive and percentage of victims BAC‐negative in alcohol‐involved incidents.

Findings

Of 5107 cases studied, alcohol involvement was known for 4773 (93%), 1882 fire burns (93%), 1560 scald and other burns (97%), 698 submersions (92%) and 967 spinal cord injuries (89%). By type of injuries, BAC‐negative victims were 4%, 13%, 6% and 8% of alcohol‐involved cases, respectively.

Conclusion

A sizeable number of BAC‐negative victims suffer alcohol‐involved injuries. Although alcohol is not the cause of some of these injuries, alcohol policy changes probably could avert others.