bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of cognitive reserve on neuropsychological functioning in Parkinson's disease
Authors: Sánchez Juan L , Rodríguez Marina , Carro Juan
Published: March 2003

Background:

In recent years, attention has been drawn to the association between a low level of education and dementia, an almost generalized finding in the majority of studies on the prevalence of dementia where the level of education of the population was highly diversified. The protective effect of education is not limited to Alzheimer's disease but is also seen in other types of dementia, Parkinson's disease (PD), and even in the cognitive deterioration linked to aging

Objective:

To evaluate neuropsychological performance in (PD) subjects and to evaluate the influence of cognitive reserve (RC) on their neuropsychological performance.

Subjects:

An extensive neuropsychological battery of tests was applied to a total of 79 subjects, 33 of whom were diagnosed with PD.

Measures:

RC scores were based on a combination of years of education, a measure of occupational attainment, and an estimate of premorbid intelligence.

Results:

As regards the specific disturbances found in the clinical group subjects, a lower performance in memory, attention, visuospatial, visuoconstructive, and perceptive skills was seen. With respect to our second objective, our results showed that patients diagnosed with PD who had a high RC reached a higher neuropsychological level of performance than those subjects with a low reserve.

Conclusions:

Early neuropsychological impairments in PD are most evident in individuals with lower RC. As has been found in other neurological disorders, individuals with greater RC may be less sensitive to the initial clinical effects of the underlying neuropathological process.
Stress, immunity, cytokines and depression
Authors: Anisman Hymie
Published: March 2003

The current issue ofActa Neuropsychiatricapresents a series of papers which together provide a broad overview relating stress, immunity, cytokine activity and depressive illness, as well as the influence of cytokines on other neurological disorders. This introduction to the issue presents a broad perspective of the impact of stressors on immune functioning in animal studies and in humans, considering the potential effects of acute, subchronic and chronic stressors, as well as the contribution of previous stressor experience in promoting neurochemical and immunological alterations. Given the supposition that cytokines may act as immunotransmitters, and immune challenge may be viewed as a stressor, a brief review is provided concerning the impact of stressors and cytokine challenges on central neurochemical functioning, with particular emphasis on the commonalties between the effects of these treatments. It is suggested that by virtue of the neurochemical changes imparted by cytokines, a depressive affect may be instigated, just as it is in response to psychogenic stressors. To this end, an overview is presented concerning the relationship between cytokines and depression, as well as the influence of cytokine treatments on behavioral changes in animal studies and among patients receiving immunotherapy. Provisionally, the data support the view that activation of the inflammatory response system may contribute to affective illness, and that cytokines may act as signaling molecules to activate central nervous system processes regulating mood states.
Early life environment: does it have implications for predisposition to disease?
Authors: Shanks Nola
Published: March 2003

Early life environmental factors have been associated with altered predisposition to a variety of pathologies. A considerable literature examines pre- and postnatal factors associated with increased risk of cardiovascular, metabolic (i.e. insulin resistance, hyperlipidemia) and psychiatric disease, and the importance of hormonal programming. The brain is exquisitely sensitive to environmental inputs during development and the stress responsiveness of the hypothalamic–pituitary–adrenal (HPA) axis has been shown to be both up- and down-regulated by early life exposure to limited nutrition, stress, altered maternal behaviors, synthetic steroids and inflammation. It has been suggested that peri-natal programming of HPA axis regulation might therefore contribute to metabolic and psychiatric disease etiology. In addition, glucocorticoids play modulatory roles regulating many aspects of immune function, notably controlling both acute and chronic inflammatory responses. Neuroendocrine–immune communication is bidirectional, and therefore it is expected that environmental factors altering HPA regulation have implications for stress effects on immune function and predisposition to inflammation. The impact of pre- and postnatal factors altering immune function, stress responsivity and predisposition to inflammatory disease are reviewed. It is also examined whether the early ‘immune environment’ might similarly influence predisposition to disease and alter neuroendocrine function. Evidence indicating a role for early life inflammation and infection as an important factor programming the neuroendocrine–immune axis and altering predisposition to disease is considered.
Antidepressant treatment of cytokine-induced mood disorders
Authors: Raison Charles L , Marcin Michael , Miller Andrew H
Published: March 2003

Significant evidence suggests that the immune system is capable of profoundly affecting central nervous system (CNS) functioning in ways that may contribute to the development and expression of neuropsychiatric disorders, including disorders of mood. This paper reviews evidence that the production of proinflammatory cytokines, whether in the context of therapeutic administration (e.g. interferon-α-2b for hepatitis C infection) or medical illness, induces a state of sickness behavior that closely resembles major depression. Antidepressants have been shown to abolish or attenuate cytokine-induced sickness behavior in laboratory animals and to protect against the development of major depression in the context of therapeutic cytokine administration in humans. Potential mechanisms by which antidepressants ameliorate depressive and/or sickness symptoms in the context of immune activation include direct effects on immune cell functioning, as well as modulatory effects on monoamine neurotransmitters, intracellular second messenger pathways and the neuroendocrine system, in particular the hypothalamic–pituitary–adrenal axis.
Nutritional manipulation and psychiatric conditions: focus on mood and cognition
Authors: Riedel W. J. , Jorissen B. L. , Hogervorst E.
Published: March 2003

In this paper, several experimental models of human depression and cognitive dysfunction, which are designed specifically to mimic the proposed mechanisms of action of many nutritional supplements, are illustrated. These mechanisms of interest are antioxidant effects, glucose utilization, neuronal membrane function and neurotransmitter effects, with particular reference to nutrient-based amino acid manipulations of neurotransmission, such as tryptophan depletion. It is concluded that the application of experimental human models of altered mood and cognitive function may illuminate substantially the quest for nutritional enhancement of human mood and cognitive function.
Prader–Willi syndrome: cycloid psychosis in a genetic subtype?
Authors: Verhoeven W. M. A. , Tuinier S. , Curfs L. M. G.
Published: March 2003

Prader–Willi syndrome (PWS) is a genetically determined disorder associated with the loss of the paternal contribution to the proximal part of the long arm of chromosome 15. Its pathophysiology is dominated by hypothalamic dysfunctions. The psychopathological phenotype comprises affective and psychotic symptoms as well as an increase of pre-existent obsessive-compulsive behaviors. The present study comprises 19 PWS patients who were referred for neuropsychiatric evaluation because of psychotic deterioration. Patients were assessed by using the elements of semistructured symptom checklists. In the majority a genetic analysis was performed to detect the underlying chromosomal defect. In 16 of the 19 patients a diagnosis of cycloid psychosis could be established. The other three showed a bipolar affective disorder. Of the psychotic patients, 11 were diagnosed as UPD and one as del 15q11–13. The remaining four patients were diagnosed clinically. For various reasons the genetic etiology could not be established. In PWS patients with a psychotic disorder (cycloid psychosis) a disproportional number of UPD is found.
Stress, work and mental health: a global perspective
Authors: deVries Marten W , Wilkerson Bill
Published: March 2003

Background:

The United Nations, WHO and the World Bank have called the current prevalence rate of neuro-psychiatric disorder approaches of 1 in 4 individuals worldwide and ‘unheralded public health crisis’. Rates are driven by an early onset, high impairment and high chronicity of these disorders. Most importantly, detection and treatment rates are low, estimated at les than 10% worldwide resulting in 500 million people underserved. The related economic costs soared in 1999 to 120 billion dollars in Europe and North America, with over 60 billion dollars assigned to stress related disorders. Contributing factors are bio-psycho-social and include rapid social change as well as the time compression of modern life resulting in the experience of increased work-life stress that parallels a decade long intensification of activities in the workplace. Coping with the requirements of the new economy of mental performance has lagged behind at many individual and social levels as we cling to adjustments made during the industrial economy of the last century. A climate of transition, and more recently, terror and fear have stressed the landscape of mental health and work already ravaged by the destructive forces of stigma.

Aim:

This presentation will examine the other side of prosperity from the point of view of stress in the workplace as two global problems converge at this time in history, the escalation of neuro-psychiatric disorders and the increasing dependence on the mental faculties of the world's citizens.

In this paper we also discuss how the international community can work together to help reduce the burden of mental disorders worldwide and sketch the implications for research and policy.

Conclusions:

Ultimately the media will need to be enlisted to educate the public on the value of investments in mental health.
Prague women's drinking before and after the ‘velvet revolution’ of 1989: a longitudinal study
Authors: KUBIČKA LUDĚK , CSĚMY LADISLAV , KOŽENÝ JIŘÍ
Published: March 2003

Results are presented of a follow‐up study in which a representative sample of 608 Prague women aged 20–49 years in 1987 at first interview was re‐interviewed in 1992 3 years after the revolution that ended the 41 years of the Communist era in Czechoslovakia. The average yearly consumption of alcohol in the followed‐up female sample increased between 1987–92 from a reported 3.6 litres to 4.8 litres. The percentage of heavier drinkers (with average daily consumption of over 20 g alcohol) increased from 7.2% to 14.0%. The women expressed increased tolerance of drunkenness in their attitudes to drinking. The consumption increase was mainly due to increased drinking frequency of spirits and to increased quantity of beer consumed per occasion. The consumption increase was largest in women working as free‐lance and the newly emerging self‐employed women; economically inactive women did not increase their consumption. Women who reported a positive impact of the socio‐political changes on their personal lives and an expansion of social contacts also reported larger than average consumption increases. A coincidence of stressful, possibly self‐inflicted, life events and increased alcohol use was observed and interpreted as probably a two‐way influence.
Administration mode bias in a school survey on alcohol, tobacco and illicit drug use
Authors: BJARNASON THORODDUR
Published: March 2003

School surveys have become the most common method for determining the general level of tobacco, alcohol and illicit drug use among adolescents in a large number of countries. The two most commonly applied field procedures in school surveys are teachers ‘and researchers’ administration of questionnaires. The impact of the difference between these two modes of administration has not been determined, although it has been argued that central involvement of teachers in data collection may decrease the perceived anonymity of the survey among students, and should thus be avoided. In a split‐half random sample of 3017 urban, Icelandic 16–20‐year‐old students, no statistically significant differences were found in reported use of licit or illicit drugs, not in the stated willingness to be honest between these two modes of administration. These results suggest that when students return their responses in sealed envelopes, the two modes of administration produce equally valid results.
Self‐reports of HIV risk behavior by injecting drug users: are they reliable“
Authors: GOLDSTEIN MARJORIE F. , FRIEDMAN SAMUEL R. , NEAIGUS ALAN , JOSE BENNY , ILDEFONSO GILBERT , CURTIS RICHARD
Published: March 2003

While most studies of AIDS risk behavior rely on self‐reports, few studies have assessed the reliability of these reports. The present study examines self‐reports of drug‐related and sexual risk behavior among pairs of injecting drug users (IDUs) recruited from the streets in New York City. Since both members of the pair were interviewed, it was possible to compare their responses in order to assess reliability. Subjects reported on their contacts' demographic data (age, gender, race/ethnicity) and on shared risk behaviors, including syringe sharing. Despite the private and/or illegal nature of AIDS risk behaviors, IDU subjects were generally reliable in their reports of both demographic and AIDS risk behaviors.
Risk functions for alcohol‐related problems in a 1988 US national sample
Authors: MIDANIK LORRAINE T. , TAM TAMMY W. , GREENFIELD THOMAS K. , CAETANO RAUL
Published: March 2003

To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5 +). Using data from the I98S National Health Interview Alcohol Supplement, risk curves were derived from data on 22 102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol‐related problem.
After antagonization of acute opiate overdose: a survey at hospitals in Vienna
Authors: SEIDLER DAN , STUHUNGER GEORG H. , FISCHER GABRIELE , WOISETSCHLAEGER CHRISTIAN , BERZLANOVICH ANDREA , SCHMID RAINER , HIRSCHL MICHAEL M. , LAGGNER ANTON N.
Published: March 2003

This study describes the clinical management and characteristics of people who, following acute opioid overdose, are taken to hospital after efficient antagonization by the pre‐hospital emergency service. In addition, it defines areas of interest for further research. Over a 4‐month period (September‐December 1993) we collected data by a structured protocol sheet on patients' characteristics, anamnestic data on abuse and emergencies, clinical presentation, treatment by specific antidote and routine laboratory investigations. Outcome leas verified by retrospective review of prehospital and forensic data. We studied 77 subjects, predominantly young males, who were involved in 83 emergencies, mostly occurring at weekends. In more than 60% of cases a single administration of specific antidote sufficed to stabilize the patients; 64% of patients left hospital against medical advice after an average stay of less than 6 hours; 46% denied daily opioid abuse and half the subjects, especially younger drug‐users, seemed interested in counselling. This hospital‐based study did not provide reliable data on the epidemiology of opioid overdose. Clinical management is determined by experience, pragmatism and beliefs. Efforts towards secondary prevention of drug problems at emergency departments might be warranted, and further research on pattern and management of opioid overdose is needed.
Agreement between DSM‐III, DSM‐III‐R, DSM‐IV and ICD‐10 alcohol diagnoses in US community‐sample heavy drinkers
Authors: HASIN DEBORAH , LI QUN , MCCLOUD STEPHEN , ENDICOTT JEAN
Published: March 2003

DSM‐III‐R, DSM‐IV and ICD‐10 definitions of alcohol dependence were all developed from the concept of the Alcohol Dependence Syndrome, and thus have a common theoretical link. This link is not shared by DSM‐III, and no link exists between definitions of abuse in the different classification systems. The level of agreement on diagnoses produced by the different systems has practical as well as theoretical implications. We tested this agreement in 962 US household residents randomly sampled and screened for heavier than average drinking in the last 12 months. Agreement for most comparisons involving diagnoses of current dependence ranged from good to excellent, with no clear pattern of lower agreement for DSM‐III. However, agreement on past dependence was sharply lower for comparisons involving DSM‐III than those involving the other classification systems. This appeared to be due to the DSM‐III requirement for physiological dependence and the apparently emerging nature of the disorder in this relatively young, non‐treatment sample. Comparisons for abuse were generally poor for current as well as past diagnoses. Implications of the findings are discussed.
Comparisons of alcohol and other drugs: experience from the WHO collaborative cross‐cultural applicability research (CAR) study
Authors: GUREJE OYE , VAZQUEZ‐BARQUERO J. L. , JANCA ALEKSANDAR
Published: March 2003

Current psychiatric classificatory systems commonly provide similar criteria for the identification of disorders relating to the use of alcohol and other drugs. However, since cultural views of substance use disorders are influenced by prevailing norms in the society, it is unlikely that a given culture wiH have identical threshold for the identification of disorders relating to the use of alcohol, commonly socially approved, and those relating to the use of other mood‐altering substances, commonly socially disapproved. Using data derived from the WHO nine‐country Cross‐Cultural Applicability Research (CAR) study, we studied the cultural views on the use and abuse of alcohol and other drugs. Our observations suggest that, viith a few notable exceptions, any use of addictive substances other than alcohol is commonly considered socially aberrant. Most cultures set a much lower threshold for the identification of disorders relating to these substances than they do for alcohol‐related ones.
Drinking and driving: drinking patterns and drinking problems
Authors: GRUENEWALD PAUL J. , MITCHELL PATRICK R. , TRENO ANDREW J.
Published: March 2003

Two perspectives guide examinations of alcohol‐related injury; studies of drinking behaviors which characterize the activities in which drinkers participate, and studies of drinking patterns which characterize individuals' likelihoods of intoxication. This paper presents a study of self‐reported drinking and driving using both perspectives. A theoretical model of the relationships of drinking patterns and drinking behaviors to drinking and driving is derived. This model is used as the basis for analyses of self‐reports of driving after drinking and driving while intoxicated. Using cross‐sectional data from a study of alcohol‐related injury in the United States, these self‐reports were related to measures of respondent socio‐demographics, drinking patterns, beverage preferences and routine activities. The results showed: (1) that the drinking pattern measures were significantly related to likelihoods of drinking and driving; (2) these measures were superior to alternate measures of drinking patterns in their ability to explain drinking and driving; (3) the measures of beverage preferences were unrelated to either measure of drinking and driving; and (4) that the utilization of certain venues for drinking (bars and restaurants) was significantly related to both measures of drinking and driving. It is concluded that observed socio‐demographic differences in drinking and driving (e.g. related to ethnicity and marital status) are due to related differences in drinking patterns and drinking behaviors.
Overview of studies on drinking patterns and consequences
Authors: BONDY SUSAN J.
Published: March 2003

Research on selected consequences of alcohol use are reviewed in terms of now alcohol use is measured and reported in research designs common to that area of study. In addition, evidence of the probable underlying mechanisms by which alcohol leads to the various consequences is examined, particularly in relation to the aspects of drinking pattern which are theoretically most relevant to the outcome. There is considerable variation in the degree to which research in these areas stresses pattern of drinking (as opposed to average amount consumed or total dose). Ideally, theoretical consideration of underlying causal links should determine data collection and analysis techniques.
Simplified quantitation of urinary benzoylecgonine in cocaine addiction research and for related pharmacotherapeutic trials
Authors: PETERS JULIE E. , CHOU JAMES Z. , HO ANN , REID KEVIN , BORG LISA , KREEK MARY JEANNE
Published: March 2003

In clinical trials of potential pharmacotherapies for cocaine addiction, objective determination of subject relapse relies on qualitative urine analysis for benzoylecgonine, the major metabolite of cocaine. Unlike qualitative analysis, quantitative measurement allows differentiation between continued cocaine use and a single use, as well as identification of changes in the quantity of cocaine used at different times. The only quantitative technique that has been used is expensive and not generally feasible. This study was performed to modify an existing qualitative technique for use as a new simple and readily available quantitative method for identifying cocaine use among research subjects. Benzoylecgonine levels in 24–hour urine specimens collected from 11 cocaine‐addicted subjects hospitalized in a research setting were measured semi‐quantitatively by fluorescence polarization immunoassay. Accurate results required thorough mixing of urine specimens prior to analysis. At admission, eight subjects had urinary benzoylecgonine levels 9 0.30 fig/ml, the standard positive/negative cut‐off used in qualitative analysis. The mean half‐life of benzoylecgonine during initial elimination was 0.46 ± 0.08 (SEM, n = 8) days. Benzoylecgonine (BE)/creatinine (C) levels remained ≥0.30 μgBE/mgC for 4. S ± 0.5 (n = 8) days and ≥ 0.03 μgBE/mgC for 10.5 ± 1.5 (n = 8) days. Relapses in three subjects could be identified by quantitative analysis. This study indicates that quantitation of benzoylecgonine in daily urine specimens provides a sensitive, objective index to cocaine use.
Non‐prescribed drug use during methadone treatment by clinic‐ and community‐based patients
Authors: WOLFF KIM , HAY ALASTAIR W. M. , VAIL ANDREW , HARRISON KEVIN , RAISTRICK DUNCAN
Published: March 2003

We investigated the efficacy of methadone maintenance treatment in clinic‐based (n= 10) and community‐based (n= 10) patients by studying the relationships between dose, plasma concentrations of methadone and non‐prescribed drug‐use using logistic regression. We found that clinic‐based patients had significantly reduced odds of having a urine sample test positive for illicit drugs when compared to community‐based patients (OR = 0.20; 95% confidence interval 0.10–0.38: p < 0.001). There was no relationship between either methadone dose or plasma methadone concentration and testing positive for non‐prescribed drugs (including cocaine, cannabis, amphetamine, ecstasy, benzodiazepines). We looked specifically at the misuse of opiate drugs. Location was again important and clinic‐based patients had significantly reduced odds of having a urine sample test positive for opiate drugs (OR= 0.36, 95% confidence internal 0.13–0.71: p∼0.004). Opiate drug use in our patients was also significantly related to plasma methadone concentration, increasing noticeably when the drug concentration < 0.48 nmol/L (p∼0.04). We found no relationship between methadone dose and odds of having a positive urine drug test in either clinic‐ or community‐based patients.
Predictors of brief smoking intervention in a midwifery setting
Authors: COOKE MARGARET , MATTICK RICHARD P. , BARCLAY LESLEY
Published: March 2003

The aims of this study were: to assess current practice in smoking cessation interventions by midwives and to examine the relationship between the use of smoking intervention, practitioner characteristics and organizational factors. A mail‐out survey was sent to a random sample of 500 midwives. The response rate was 85% (n = 425). The results indicated that most midwives used minimal interventions (advice and education) for at least some of their clients. However, the more skilled and more time‐intensive forms of intervention such as counselling about methods to quit, negotiating a quit date and follow‐up were infrequently utilized. Moreover, participants estimated that half their smoking clients were not offered any advice about smoking. Organizational factors such as: hospital policy for smoking intervention, type of hospital, size of hospital, cohesion of staff and work pressure predicted the use of smoking interventions. Self‐reported ability to intervene for smoking and the level of assessment undertaken were practitioner characteristics which predicted the use of smoking interventions. The barriers that inhibit the use of smoking intervention by midwives are discussed and methods for change canvassed.
The disadvantage of being advantaged?–on a social gradient in excess mortality among alcohol abusers
Authors: ROSSOW INGEBORG , AMUNDSEN ARVID
Published: March 2003

Do alcohol abusers from upper social classes have a more elevated excess mortality than alcohol abusers from lower social classes? This question was empirically assessed by analyses on data from a 40‐year prospective study of more than 40 000 Norwegian conscripts on whom data on social class(i. e. educational level), alcohol abuse (admission to treatment) and cause specific mortality before the age of 60 years were available. The results demonstrated a social gradient in excess mortality: relative risk of premature death was 2.7 among those with the lowest educational level (primary school only) increasing to 6.2 among those with the highest educational level at conscription (grammar school). Among the alcohol abusers the risk of premature death was slightly, but not significantly higher among those highly educated as compared to those with less education. Thus, alcohol abuse was not only found to elevate the individual's risk of premature death, but it also appeared to outweigh the advantages of those more socially privileged with respect to health and mortality. The question as to whether social class differences in selection to treatment could account for the observed social gradient in excess mortality is focused in the discussion.
Predicting underage drinking and driving behaviors
Authors: GRUBE JOEL W. , VOAS ROBERT B.
Published: March 2003

A social‐psychological model of underage drinking and driving (DUI) and riding faith drinking drivers (RWDD) was tested with data from a random digit dial telephone survey of 706 16‐20‐year‐old drivers from seven western states in the United States. Consistent with the model, a structural equations analysis indicated that DUI and RWDD were primarily predicted by (a) expectancies regarding the physical risks of DUI, (b) normative beliefs about the extent to which friends would disapprove of DUI, (c) control beliefs about the ease or difficulty of avoiding DUI and RWDD and (d) drinking. Expectancies concerning enforcement had a significant effect on RWDD, but not on DUI. Among the background and environmental variables included in the analysis, only night‐time driving and age had significant direct effects on DUI and RWDD. Drinking and involvement in risky driving had indirect effects on DUI and RWDD that were mediated through expectancies and normative beliefs. Males, European Americans, Latinos, respondents who drove more frequently and respondents who were less educated held beliefs that were more favorable toward DUI and RWDD, drank more and engaged more frequently in risky driving. As a result, such individuals may be at greater risk for DUI and RWDD.
WHO cross‐cultural applicability research on diagnosis and assessment of substance use disorders: an overview of methods and selected results
Authors: ROOM R. , JANCA A. , BENNETT L. A. , SCHMIDT L. , SARTORIUS N.
Published: March 2003

The cross‐cultural applicability of criteria for the diagnosis of substance use disorders and of instruments used for their assessment were studied in nine cultures. The qualitative and quantitative methods used in the study are described. Equivalents for English terms and concepts were found for all instrument items, diagnostic criteria, diagnoses and concepts, although often there was no single term equivalent to the English in the languages studied. Items assuming self‐consciousness about feelings, and imputing causal relations, posed difficulties in several cultures. Single equivalent terms were lacking for some diagnostic criteria, and criteria were sometimes not readily differentiated from one another. Several criteria–narrowing of the drinking repertoire, time spent obtaining and using the drug, and tolerance for the drug–were less easy to use in cultures other than the United States. Thresholds for diagnosis used by clinicians often differed. In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent. The attitudes of societies to alcohol and drug use affects the use of criteria and the making of diagnoses.
Irish descent, religion, and alcohol and tobacco use
Authors: MULLEN KENNETH , WILLIAMS RORY , HUNT KATE
Published: March 2003

The West of Scotland has traditionally been a focus for Irish migration. Using data from two studies carried out in this region, one quantitative, the other qualitative, this paper shows little difference in drinking and smoking between Scots of Irish descent and other Scots. It does, however, show significant differences in these behaviours according to religious affiliation in adulthood. Rather than confirming the stereotype of Irish Catholics as heavy drinkers and smokers the present paper puts forward the hypothesis that drinkers and smokers are differentially retained in membership by different religious affiliations, and argues that this accounts for differences in reputation and in health‐related behaviours.
The effect of caffeine on cue exposure responses in ex‐smokers
Authors: HEPPLE JASON , ROBSON PHILIP
Published: March 2003

The responses of ex‐smokers to an experimental cue exposure trial, and the effect of caffeine on these responses, were compared with those of a matched group of control subjects in a placebo controlled single‐blind cross‐over design. In contrast to placebo, caffeine protected the ex‐smokers from a surge of anxiety and rise in blood pressure associated with exposure to smoking‐related cues. Caffeine had no significant effects on the control group at this dose (equivalent to a single cup of strong coffee). The results are discussed with reference to Stewart's conditioned appetitive motivational model of addiction. It is suggested that further work may identify caffeine as an adjunct to smoking relapse prevention measures.
Gender differences in drinking behaviour in the Netherlands: convergence or stability?
Authors: NEVE RUDIE J. M. , DROP MARIA J. , LEMMENS PAUL H. , SWINKELS HENK
Published: March 2003

Gender differences in drinking behavior are analysed with emphasis on their relationship with changes in roles and positions of men and women in society. The ‘convergence hypothesis’ is used as a starting point. From its implications, a number of specific hypotheses are derived and tested using data from six surveys of the general population of the Netherlands, held between 1958 and 1993. No convergence of gender differences is found for abstinence and heavy frequent drinking. Convergence of male‐female differences in average weekly consumption appeared in the 1980s, but it is no longer significant at 5% level after controlling for age, education and family situation. Further elaboration of the gender by year interaction shows that convergence is related to a decrease in consumption among higher educated men. Contrary to expectation, an increase in consumption has occurred among women over 40 years of age. No relationship appears with female employment and religion. Having a family is related to lower consumption among women, while it has no significant effect on men's consumption. Although some evidence for convergence was found, results are not in agreement with expectations formulated from the perspective of the convergence hypothesis.
Overdose among heroin users in Sydney, Australia: II. Responses to overdose
Authors: DARKE SHANE , ROSS JOANNE , HALL WAYNE
Published: March 2003

A sample of 329 heroin users were interviewed about their experiences at other peoples' heroin overdoses. The overwhelming majority (86%) had witnessed a heroin overdose, on a median of six occasions. Heroin users were reluctant to seek medical attention, with an ambulance being called on only half (56%) of the most recent overdose occasions. At only 17% of most recent overdoses was calling an ambulance the first action taken. Males reported taking significantly longer than females to call an ambulance. Nearly half (44%) of subjects reported that there were factors that had delayed or stopped them seeking medical assistance, the most common impediment being a fear of police involvement. The importance of interventions to encourage help‐seeking at overdoses are discussed.
Alcohol misuse and juvenile offending in adolescence
Authors: FERGUSSON DAVID M. , LYNSKEY MICHAEL T. , HORWOOD L. JOHN
Published: March 2003

The associations between alcohol misuse and juvenile offending during the period from 15 to 16 years of age were studied in a birth cohort of New Zealand adolescents. This analysis showed that young people who misused alcohol had significantly (p < 0.001) higher rates of both violent and property offences. These associations were similar for males and females. Further analysis suggested that a substantial component of the association between alcohol misuse and juvenile offending arose from shared risk factors that were common to both outcomes. These risk factors included measures of family social background, family and parental characteristics, individual characteristics and adolescent peer affiliations. After adjustment for antecedent risk factors there was no significant association between alcohol misuse and odds of property offences. However, young people who abused alcohol had odds of violent offending that were 3.2 times (p < 0.001) the odds of those offences for young people who did not misuse alcohol. It is concluded: (a) that a large component of the association between alcohol misuse and juvenile offending arises because of the effects of shared risk factors that are associated with both outcomes; (b) none the less, the unexplained association between alcohol misuse and violent offending may suggest the presence of a direct cause and effect association in which adolescent alcohol misuse is associated with increased risks of violent offending.
Places and patterns of drug use in the Scottish dance scene
Authors: FORSYTH ALASDAIR J. M.
Published: March 2003

Interviews were conducted with 135 participants in the Glasgow dance (rave) scene. Drug use in this group was varied and not merely restricted to drugs associated with dance events, such as MDMA (Ecstasy). The setting in which each drug was used varied greatly. Amphetamine, nitrites and Ecstasy were the drugs most commonly used at dance events. Pharmaceuticals were least likely to be used in such settings. However, some drugs, such as Temazepam, were sometimes used prior to or after attending rave events. It is suggested that dance drug users are polydrug users who use drugs in a setting specific fashion. As such it would be wrong to classify such users solely on the grounds of their very visible behaviour in the public arena (at dance events). Other forms of substance use engaged in by this group may have a greater potential for harm than that seen at raves. The implications of these findings are discussed.
Development of the Cocaine Relapse Interview: an initial report
Authors: McKAY JAMES R. , RUTHERFORD MEGAN J. , ALTERMAN ARTHUR I. , CACCIOLA JOHN S.
Published: March 2003

Although fine‐grained analyses of circumstances surrounding relapses have been conducted with alcoholics, smokers and opiate users, there is comparatively little information about the relapse process in cocaine abusers. The Cocaine Relapse Interview (CRI) is a structured interview that gathers information on the onset, course and termination of cocaine relapse episodes. This article describes the development of the CRI and presents initial data on its reliability and validity. Sections of the CRI assess experiences on the day of the relapse, experiences during the week prior to the relapse, attributions for the relapse, experiences following initial use of cocaine and factors in terminating the relapse. Most of the subscales in each section of the CRI had adequate internal consistency and test‐retest reliabilities. Validity studies indicated that most of the subscales that assess experiences prior to relapse differentiated relapsers from two control groups of non‐relapsers, and that several subscales and individual items from the sections that assess experiences following initial use and factors in termination differentiated “lapsers” from “relapsers”. Limitations of the CRI and recommendations for its use were also discussed.
Benzodiazepines in primary health care: a survey of general practitioners prescribing patterns
Authors: BOIXET MERCE , BATLLE ENRIC , BOLIBAR IGNASI
Published: March 2003

This paper presents the results of a survey carried out to investigate the benzodiazepine (BZD) prescribing patterns of the general practitioners (GP) in the catchment area of a Drug Dependence Unit located in a general hospital in Mataro (Barcelona, Spain). The aims of the survey were: (i) to obtain descriptive information on the knowledge of the GPs about BZD and its potential for dependence; (ii) to study the frequency of their prescribing; and (iii) to examine different factors linked to their prescribing. The study was carried out using a combination of a personal interview and a self‐administered questionnaire. A total of 68 doctors (88.3%) completed the questionnaire. The results show that the GPs have, in general, correct knowledge about the therapeutic indications for BZD prescribing, but are far less aware of their potential to induce dependence and how to manage withdrawal. The rate of prescribing seems to be high. Furthermore, the results of the external check of validity point out that doctors tend to underestimate the number of prescriptions. The majority of GPs express the need for alternative resources to BZD prescribing. No significant associations have been found between doctor's characteristics, such as postgraduate training and type of practice, and their knowledge about BZD and frequency of their prescribing. In our view, a more accurate knowledge about BZD and alternatives to its use, both factors closely linked to training, together with the availability of non‐pharmacological resources, are likely to improve the quality of doctors prescribing habits, thus preventing risks such as dependence of BZD.
Selection bias in national surveys due to screening: implications from a county general population survey
Authors: TAM TAMMY W. , MIDANIK LORRAINE T. , GREENFIELD THOMAS K. , CAETANO RAUL
Published: March 2003

National alcohol surveys using face‐to‐face interviews, such as the US 1988 National Health Interview Survey Alcohol Supplement and the 1990 US National Alcohol Survey, for reasons of efficiency often use screener items lo identify individuals who are likely lo have experienced alcohol‐related problems and only those individuals are chosen to respond to a list of alcohol‐related problem questions. The consequence of screening is that only a subset of the current drinkers have complete data on such items. This paper examines the bias introduced by the exclusion of cases with incomplete information due to screening. Data from a regional general population survey were used to investigate possible bias due to screening because it included the screening questions used in NHIS and NAS but did not screen on those items. Risk curves and estimated probabilities from logistic regressions of three alcohol dependence symptom items and two problem indices were compared by gender across three subsamples: (1) all current drinkers (without screening); (2) those who passed the screener item for the NHIS and (3); the NAS, respectively. Results indicate that the effect of the screener items on the estimated prevalence of the measures concerned are minimal, supporting the practice, judiciously applied, when greater survey efficiency is required.
The Amsterdam Methadone Dispensing Circuit: genesis and effectiveness of a public health model for local drug policy
Authors: Plomp H. Nico , Hek Hetty Van Der , Ader Herman J.
Published: March 2003

During the 1970s, the Methadone Dispensing Circuit (MDC) was initiated by the municipality of Amsterdam in order to cope with the heroin addiction epidemic that afflicted the city. In the MDC, methadone is dispensed to opiate addicts on a maintenance basis in low‐threshold public health programmes, as well as in high‐threshold treatment programmes. The MDC is an essential part of the local drug policy in the city. It is designed to get in touch with all opiate addicts who are not able to manage their lives in a proper way, and to stimulate them to regulate their addiction. This paper describes the genesis of the MDC as a result of a historical and political process. Determining factors in this process proved to be the urgency of the drug problem, the widespread consensus among local politicians, most of the general practitioners (GPs) and alternative relief institutions about the low‐threshold dispensing, and finally its success, particularly the lower rate of drug‐related death and less disruption of public order. In the second part of the paper, data on the functioning and effectiveness of the MDC are presented. It is concluded that the effectiveness of the MDC could be improved by better management and the application of more sensible diagnostic methods. The transferability of the 'Amsterdam model' to other places is discussed; besides the burden of the drug problem, it depends on the acceptance of the underlying value orientation.
Drug treatment in Switzerland: harm reduction, decentralization and community response
Authors: Klingemann Harald K. H.
Published: March 2003

This paper first outlines the history of illicit drug issues in Switzerland, and then describes drug treatment services and shifts in treatment concepts. In the last 15 years the drug treatment system in Switzerland has expanded considerably. In particular there has been an unprecedented growth of the non‐residential sector and of low‐threshold programmes, including methadone treatment, the establishment of injection rooms and controlled drug‐prescription pilot projects. In the second part, the paper considers some selected factors that promote or impede changes in drug treatment systems, such as treatment policy and the public response to treatment measures. This is manifested in the influence of community action groups on local programme development.
Psychopathoiogy and alcohol consumption among treatment‐seeking alcoholics: a prospective study
Authors: TÓMASSON KRISTINN , VAGLUM PER
Published: March 2003

The association between psychopathology and alcohol consumption was studied in a nation‐wide representative sample of inpatient alcoholics (n = 245) who were examined at intake and 15 months later. As regards baseline observations men and women with antisocial personality disorder or cognitive impairment had consumed more alcohol in the month prior to admission than those not so affected. In contrast, men with panic disorder drank less compared with those not so affected. The prognosis for men consuming more than the median amount of alcohol was worse than that of women. However, after controlling for psychiatric distress and alcohol consumption at baseline, the prognosis of women was worse. Women but not men who had stopped drinking had a higher degree of psychiatric distress at follow‐up compared with those still drinking at a low level. Regarding the prognostic significance of psychiatric disorders at baseline, among men panic disorder predicted continued drinking. Psychiatric distress and alcohol consumption at baseline interacted in the prediction of alcohol consumption at follow‐up. The study highlights the importance of a thorough assessment of psychopathology and course of drinking when evaluating the outcome of alcoholism treatment.
The role of coping in relapse crisis outcome: a prospective study of treated alcoholics
Authors: Moser Andrea E. , Annis Helen M.
Published: March 2003

This study investigates the influence of coping on the outcome of a relapse crisis for a sample of 125 treated alcoholics during the first 12 weeks following treatment completion. Both number and type of coping responses were examined. Results indicated that survival of a relapse crisis was most strongly related to the number of coping strategies used. Termination of a drinking episode was also related to number of coping responses. In addition, the type of coping strategy influenced survival, with the exclusive use of active coping strategies significantly associated with abstinence outcome compared with the exclusive use of avoidant strategies. Combining active and avoidant strategies appeared to be most effective for terminating a drinking episode. Results are discussed in the context of the cognitive‐behavioral model of relapse, the general literature on coping behavior and the findings of other relapse studies.