bluuebunny/crossref_metadata_2025 huggingface dataset:
One‐year incidence rate of major depression and other psychiatric disorders in 239 alcoholic men
Authors: SCHUCKIT MARC A. , IRWIN MICHAEL , SMITH TOM L.
Published: January 2006

The rate of depressive symptoms among alcoholics is high, but many of these syndromes appear to be alcohol‐induced mood disorders and might not represent major depressive episodes independent of heavy drinking. The present study examines one aspect of the relationship between alcoholism and depression by evaluating the incidence of new episodes of major depressive disorders among alcohol‐dependent men during the year following treatment. One year following discharge from an alcohol treatment program, structured face‐to‐face interviews were carried out with 239 primary alcoholic men, as well as additional informants. Approximately 4% of the men developed depressive episodes while drinking heavily, but only 2.1% demonstrated major depressions independent of heavy alcohol intake. There was no evidence of an increased incidence of any other major psychiatric disorder during the year of follow‐up. These results are consistent with prospective studies of children of alcoholics and of longitudinal evaluations of general population samples. They do not indicate that in the present sample most primary alcohol‐dependent men have elevated rates for major depressive disorders independent of alcohol‐induced mood syndromes. However, it is likely that in the context of heavy drinking severe, although temporary, depressive episodes are likely to be observed.
The effect of intake procedures on performance in methadone maintenance
Authors: BELL JAMES , CAPLEHORN JOHN R. M. , McNEIL DONALD R.
Published: January 2006

The effect of assessment and intake procedures on the outcome of methadone maintenance treatment was investigated in a natural experiment in which a single methadone clinic admitted 89 patients by a rapid intake procedure, and 74 patients who had been on a waiting list and underwent formal assessment interviews. Outcome measures were frequency of illicit drug use as detected by urine tests, and risk of dropping out or being expelled from treatment. Subjects admitted after prolonged, formal assessment were more likely to be expelled, and were more than twice as likely to leave during the first 400 days of maintenance treatment (95% Cl relative risk 1.1 to 5.2). The odds of formally assessed subjects using heroin in the first 6 months of treatment were twice those of the rapid intake group (95% Cl odds ratio 1.5 to 2.2). The formal assessment process deterred half the initial applicants, yet seems to have either selected individuals with a worse prognosis or to have had a negative effect on in‐treatment performance
Social network, social support and heavy drinking in elderly men‐a population study of men born in 1914, Malmö, Sweden
Authors: HANSON BERTIL S.
Published: January 2006

We analysed whether there were associations among different aspects of social network and social support, on one hand, and heavy drinking and alcohol problems on the other. The study sample (h = 621) comprised a random half of all male residents bom in 1914 in Malmö, Sweden. Five hundred (80.5%) participated. Heavy drinking was defined as an alcohol consumption above 250 g alcohol per week and alcohol problems were assessed by a modified Michigan Alcoholism Screening test. Eight conceptually differential aspects of social networks and social support were measured. Four of five social network indices (social anchorage, social participation, contact frequency, spousal support) were associated with heavy drinking (OR 1.9–2.5) and two social network indices (social anchorage, spousal support) were associated with alcohol problems (OR 2.1–2.3). The results in this study are independent of social class, but based on a cross‐sectional study, so we do not know if heavy drinking has caused social isolation or the contrary. If these results can be verified in a prospective study, a strengthening of the social network of the individual could perhaps lead to more moderate alcohol habits and better health, a finding of potential importance in the field of health promotion.
Drug‐related deaths between 1985 and 1992 examined at the Institute of Forensic Medicine in Vienna, Austria
Authors: RISSER DANIELE , SCHNEIDER BARBARA
Published: January 2006

Considering the official figure on drug‐related deaths in Austria, the problem of substance abuse has dramatically worsened over the last years. There is a distinct lack of comprehensive information concerning drug‐related deaths in Austria, although deaths of drug users may be potentially important indicators of the extent of drug‐related problems in the population. The results of examinations performed on 372 deceased substance abusers at the Institute of Forensic Medicine in Vienna between 1985 and 1992 are presented. Drug‐related deaths are defined according to the official definition issued by the Austrian Federal Ministry of Internal Affairs. A distinction was made between injecting drug users and non‐injecting drug users with respect to infectious diseases transmitted by sharing of paraphernalia. Between 1985 and 1992 there was a distinct increase in drug‐related deaths. In approximately 30% an accidental single substance intoxication, mainly due to morphine, was found. A connection with a better quality of street drugs is assumed but not proven. In 207 corpses more than one drug, including alcohol, was detected. During the investigation there was an evident trend towards multi‐substance abuse patterns. Furthermore, blood alcohol concentration, an additional risk factor for narcotic overdose, was strongly associated with higher age. The small number of examined drug injectors found positive for the human immunodeficiency virus type–1 (HIV‐1) makes it difficult to draw any kind of conclusion regarding the HIV‐1 seroprevalence among injecting drug users in Vienna.
Mandated AA attendance for recidivist drinking drivers: ideology, organization, and California criminal justice practices
Authors: SPEIGLMAN* RICHARD
Published: January 2006

This paper examines 2877 municipal court drunk driving cases sampled from 1982 to 1989 in four California sites. Recidivist drinking drivers were those charged with driving under the influence and having two or more drunk driving convictions on their records. In two sites, virtually no AA referrals were made. In the others, in addition to jail terms and fines, judges ordered attendance at meetings of AA for 37–41 % of cases. Referral to AA was unrelated to blood alcohol level or number of prior drinking driving convictions. In one AA‐referring site, the data indicate that over 75% of drinking drivers convicted in the 1988–89 period were referred to AA by a judge or county probation or parole officer. These findings suggest that, as a whole, California sentencing policies lack a coherent framework. Instead of reflecting information on program effectiveness and offenders' needs, variation in sentencing appears to mark differences in local fiscal circumstances, levels of jail crowding and ideological orientations of judges and other officials. It is suggested that referral practices could have an adverse impact on both individuals' alcohol problems and on recovery programs.
Evidence that the Type 1/Type 2 dichotomy in alcoholism must be re‐examined
Authors: VAILLANT GEORGE E.
Published: January 2006

Studies supporting Coloninger's original Type 1/Type 2 hypothesis for classifying the generic transmission of alcoholism have sometimes failed to control for important sources of potential bias. First, the environmental effects of parental alcoholism must be distinguished from the genetic effects of parental alcoholism. Secondly, antisocial personality disorder must be distinguished from alcohol dependence. Thirdly, to control for developmental effects a cohort of alcoholics should be followed into late mid‐life. The present report, a 50‐year prospective study of the development of alcoholism in two community samples of 456 disadvantaged youth and 204 Harvard graduates, addresses these three, potential sources of bias. In this report the age of onset of alcoholism and the degree of antisocial symptomatology was correlated with disturbed family environment but was quite independent of the presence or absence of a heredity positive far alcoholism. The reasons why such findings threaten the validity of the Type 1/Type 2 hypothesis are discussed.
Transitions between routes of administration of regular amphetamine users
Authors: DARKE SHANE , COHEN JULIA , ROSS JOANNE , HANDO JULIE , HALL WAYNE
Published: January 2006

A sample of 301 regular amphetamine users was interviewed regarding transitions between routes of administration of amphetamines. Use of amphetamines by injecting was widespread, with two‐thirds (67%) of subjects having injected the drug during tin preceding 6 months. Needle‐sharing was common, with 41% of injectors having shared a needle in the month preceding interview. A transition to regular amphetamine injecting from other mutes of administration was reported by 40% of subjects, with males being twice as likely to report such a transition. The median number of such transitions was line. The main reasons given by subjects for the transition to injecting mere It king the “rush” from injecting, and seeing it as a more economical and a healthier way to use. A small proportion of subjects (9%) reported a transition away from injecting amphetamines, with a median of one such transition. The most common reason given for abandoning injecting was concern about vascular damage. Interventions, to encourage safer use of amphetamines need to address the misconceptions that injecting is more economical and more healthy, and to emphasise the vascular problems associated with injecting.
A treatment system for combined psychiatric and addictive illness
Authors: GALANTER MARC , EGELKO SUSAN , EDWARDS HELEN , VERGARAY MILAGROS
Published: January 2006

Patients with combined general psychiatric and addictive disorders are a major public health problem in the US, and are being increasingly recognized as such world‐wide. The authors describe a model treatment system for such patients in one municipal hospital in New York. It is composed of three complementary units: a locked ward, a halfway house and a day program. Treatment is based on a peer leadership approach coupled with professional treatment, and provides multiple levels of care to address the needs of respective patients. Of 464 admissions evaluated and treated, most were from disadvantaged minorities, homeless and abusers of cocaine. All were admitted with acute psychiatric or perinatal presentations, and carried Axis I diagnoses in addition to their substance abuse. Clinical experience over 6 years is reviewed, suggesting the feasibility of reorganizing general hospital psychiatric services to address the needs of the dually diagnosed.
Development of the Leeds Dependence Questionnaire (LDQ): a questionnaire to measure alcohol and opiate dependence in the context of a treatment evaluation package
Authors: RAISTRICK DUNCAN , BRADSHAW JACKIE , TOBER GILLIAN , WEINER JEREMY , ALLISON JEFF , HEALEY CAROLYN
Published: January 2006

The Leeds Dependence Questionnaire (LDQ) has been developed as pan of a treatment evaluation package. The LDQ is a 10‐item, self completion questionnaire designed to measure dependence upon a variety of substances; it has been shown to be understood by users of alcohol and opiates. The questionnaire was designed to be sensitive to change over time and to be sensitive through the range from mild to severe dependence; the follow‐up data are insufficient to demonstrate change over time, but are encouraging. It is expected that both clinicians and researchers will find it useful to have a single measure relating to substance use, but not limited by specific substances. All items are scored 0‐1‐2‐3; there are no normative data. The procedure for establishing content validity is described and estimates of concurrent, discriminant and convergent validities are reported; these validities are thought to be satisfactory. A principal components analysis produced a single factor accounting for 64% of the variance. Cronbach's alpha was 0.94. Test‐retest reliability was found to be 0.95.
The alcohol content of self‐report and ‘standard’ drinks
Authors: LEMMENS PAUL H.
Published: January 2006

A stubborn problem in alcohol epidemiology is that of standardization of unit of measurement. Consistent use of the ‘standard drink’ in research reports is hampered by difficulties in the assessment of the alcohol content of, particularly, self‐reported drinks. Alcohol content of a drink depends on strength of the beverage and volume of the glass or container from which the beverage is taken. Both factors vary considerably between times, regions and individuals. Interview protocols and questionnaires rarely take into account the fact that people consume alcoholic beverages from a large variety of glasses and containers. In the present study the common presumption is tested of equality of alcohol content of standard and self‐reported drinks. The test consisted of measuring the amount of wine, fortified wine and spirits people usually pour in the glass typical for the beverage type. The sample was drawn from the general Dutch population in 1985. The results show that on average self‐reported drinks taken at home contained more than the presumed standard (10 g per drink). The deviation was highest for spirits (+26%), followed by fortified wines (+ 14%) and host for wine (+4%). There seemed to be a positive relationship between deviation from ‘standard’ and strength of the alcoholic beverage. This result is in line with data on the coverage of sales data: aggregate, survey‐based spirits consumption shows the lowest coverage of sales. The effect of the difference between actual and presumed content of drinks on estimates of consumption is an overall increase of 7.5%, higher for women (+ 12%) than for men (+6%). Results are discussed with respect to the use of the concept of ‘standard unit’ in research protocols and health education campaigns.
Abuse of inhalants: a review
Authors: DINWIDDIE STEPHEN H.
Published: January 2006

Inhalants, a chemically heterogeneous group of psychoactive substances found in adhesives, lighter fluids, spray paints, cleaning fluids and typewriter correction fluid, may be used by up to 10% of young people. This article reviews the health effects, epidemiology, risk of other substance use and addiction and psychiatric co‐morbidity associated with the practice of inhalant use.
Female alcoholism problems in Lesotho
Authors: MPHI MAMOLIEHI
Published: January 2006

This paper gives an overview of alcohol and alcohol‐related problems facing women in Lesotho, As in many other developing countries, the cultural position of women in Lesotho facilitates a vicious circle in which women are at one time brewers of alcohol, then sellers, then become excessive consumers due to the problems created by their drinking husbands. Married women encounter social censure if they drink, and termination of their marriages if they abuse alcohol. Culturally women are regarded as minors and depend on their husbands for economic survival, so that alcohol abuse can cause great hardship. Due to a lack of trained and specialized medical staff, women's particular and multi‐faceted treatment needs are largely unmet and no research is done on problems of female alcoholism.
Childhood exposure to alcohol and adolescent drinking patterns
Authors: FERGUSSON DAVID M. , LYNSKEY MICHAEL T. , HORWOOD L. JOHN
Published: January 2006

This paper examines the relationships between age at first exposure to alcohol and Jour measures of drinking behaviour (frequency of drinking, typical and most amount consumed, alcohol‐ related problems) at age 15 years in a birth cohort of New Zealand children. There were small but consistent correlations (r=− 0.10 to − 0.16) between self‐reported age at first exposure to alcohol and the four measures of alcohol consumption. These associations remained statistically significant (p<0.05) after control for a wide range of potentially confounding covariates including measures of family socio‐demographic background, parental alcohol use and attitudes to alcohol use and early childhood behaviour. After control for these factors, children who had been introduced to alcohol before the age of 6 yean were 1.9 to 2.4 times more likely to report frequent, heavy or problem drinking at age 15 years than children who did not drink alcohol before the age of 13. It is concluded that young people reared in home environments that have permissive attitudes to alcohol use and who are introduced to alcohol at an earlier age may be more vulnerable to alcohol‐related problems in adolescence.
Alcohol consumption, alcohol abuse and alcohol dependence. The United States as an example
Authors: GRANT BRIDGET F.
Published: January 2006

This paper presents national estimates of alcohol consumption and DSM‐IV alcohol abuse and dependence in the United States, Fifty‐nao percent of the adults surveyed were classified as current drinkers and nearly 9.0% met criteria for DSM‐IV akohol abuse or dependence. Greater percentages of males and whiles were classified as current drinkers and as alcohol abusers or dependent, compared with females and non‐whites., respectively. There is a need for future epidemiological research to collect belter data on drinking patterns as an aid to interpreting socio‐demographic differentials and to estimate more precisely the association between alcohol consumption and abuse and dependence in multivariate statistical environments. The critical need to examine the unprecedented reversal of the abuse‐to‐dependence ratio resulting from the application of the DSM.‐IV classification is emphasized. The role of future longitudinal alcohol epidemiological research in elucidating the initiation and maintenance of consumption patterns and alcohol use disorders is stressed.
Opiates: prevalence and demographic factors
Authors: HARTNOLL RICHARD L.
Published: January 2006

This paper focuses on the prevalence and profile of opiate use, primarily heroin, in the United States and Europe. Methods include representative population surveys, which understate prevalence, and targeted approaches, which reflect more problematic use. In the United States and Europe, the lifetime prevalence of opiate use reported in surveys remained stable over the 1980s (around 1%), though young adults report higher rates. Estimates for the early 1990s suggest that the prevalence of problematic heroin use in the United States was double the average for western Europe. However, in a few European countries prevalence is now approaching that of the United States. Rates in major cities are considerably higher, especially in the north‐east and south‐west of the United States. Higher prevalence is often, although not always, associated with socio‐economic deprivation. An important trend away from injecting is observed, notably in some European countries. Heroin availability and use, as well as serious heroin‐related consequences, are increasing again in many European countries after an apparent pause in the mid‐1980s. They are also increasing in parts of the United States. Heroin remains a public health priority, especially among vulnerable populations, including young people in central and eastern Europe.
Promoting benzodiazepine withdrawal
Authors: GABE JONATHAN
Published: January 2006

This paper presents a review of health promotion strategies to help people to stop using benzodiazepines. Four strategies are described and evaluated: health persuasion, personal counselling, state action and community development. It is argued that the first two strategies have been the most popular to date, especially among doctors, and have an important part to play in changing individual behaviour. Less consideration has been given to the other two strategies, but these are equally important if a comprehensive policy is to be developed concerned with social as well as individual change.
The treatment of benzodiazepine dependence
Authors: ASHTON HEATHER
Published: January 2006

Withdrawal of benzodiazepines is currently advised for long‐term benzodiazepine users because of doubts about continued efficacy, risks of adverse effects, including dependence and neuropsychological impairment and socio‐economic costs. About half a million people in the UK may need advice on withdrawal. Successful withdrawal strategies should combine gradual dosage reduction and psychological support. The benzodiazepine dosage should be tapered at an individually titrated rate which should usually be under the patient's control. The whole process may take weeks or months. Withdrawal from diazepam is convenient because of available dosage strengths, but can be carried out directly from other benzodiazepines. Adjuvant medication may occasionally be required (antidepressants, propranolol) but no drugs have been proved to be of general utility in alleviating withdrawal‐related symptoms. Psychological support should be available both during dosage reduction and for some months after cessation of drug use. Such support should include the provision of information about benzodiazepines, general encouragement, and measures to reduce anxiety and promote the learning of non‐pharmacological ways of coping with stress. For many patients the degree of support required is minimal; a minority may need counselling or formal psychological therapy. Unwilling patients should not be forced to withdraw. With these methods, success rates of withdrawal are high and are unaffected by duration of usage, dosage or type of benzodiazepine, rate of withdrawal, symptom severity, psychiatric history or personality disorder. Longer‐term outcome is less clear; a considerable proportion of patients may temporarily take benzodiazepines again and some need other psychotropic medication. However, the outcome may be improved by careful pharmacological and psychological handling of withdrawal and post‐withdrawal phases.
Suicide among drug addicts in Norway
Authors: ROSSOW INGEBORG
Published: January 2006

The impact of drug addiction in suicide with respect to gender and trend changes in drug addiction was assessed from Norwegian data on 1608 drug addicts admitted to treatment over the past three decades. The mean annual mortality rate was 2.3%, and 14.7% of those who died committed suicide. The incidence density of suicide was significantly higher among drug addicts than in the total population, and the excess mortality by suicide was higher for women, higher in the youngest age group, and higher for those who died during the 1970s. No differences in suicide intensity were found between male and female drug addicts, whereas an effect of admission period on suicide intensity zvas found for women but not for men. Hence, among female drug addicts, those admitted to treatment in the 1970s and 1980s tended to take their own lives during a shorter observation period than those admitted during the 1960s. The degree to which the elevated risk of suicide among drug addicts varies with gender and period is discussed with reference to the impact of gender roles and varying features of drug addicts in Norway over time.
Is the association between drug use and delinquency weakening?
Authors: ADLAF EDWARD M. , SMART REGINALD G. , WALSH GORDON W. , IVIS FRANK J.
Published: January 2006

In this paper we examine period or secular changes in the association between drug use and delinquency among Ontario adolescent students between 1983 and 1991. The results show that during this period drug use and drug‐setting declined significantly, whereas reported non‐drug‐related delinquency increased. In addition to differing secular trends in rates of drug use and delinquent behaviour, the association between the two behaviours weakened. There was a steady decline in the correlations between drug use and delinquency across time, and the typological patterning of drug use and delinquency changed significantly.
The use of benzodiazepines among regular amphetamine users
Authors: DARKE SHANE , ROSS JOANNE , COHEN JULIA
Published: January 2006

The relationship between benzodiazepine and regular amphetamine use was examined in a sample of 301 regular amphetamine users. Benzodiazepine use was widespread, with 37% of subjects having used them in the month preceding interview, and 55% in the preceding 6 months. Injectors of amphetamines were more likely to have ever used, and to be currently using, benzodiazepines. Comparisons of benzodiazepine users with other subjects indicated that benzodiazepine users had higher levels of polydrug use and psychopathology, as well as poorer health and social functioning than non‐users. The odds of benzodiazepine using injectors having injected with a borrowed used needle in the preceding month were 3.8 times those of non‐benzodiazepme‐using injectors. These results are consistent with studies of other groups of illicit drug users, such as heroin users, in indicating that benzodiazepine use is associated with greater levels of risk and psycho‐social dysfunction.
Book Reviews
Authors: GOSSOP MICHAEL
Published: January 2006

Books reviewed in this article:

Coca and Cocaine: An Andean Perspective FELIPE E. MACGREGOR (Ed.)

Developing School‐based Tobacco Use Prevention and Cessation Programs STEVE SUSSMAN, CLYDE W. DENT, DEE BURTON, ALAN W. STACY & BRIAN R. FLAY (Eds)

Methodological Issues in AIDS Behavioural Research D. G. OSTROW & R. C. KESSLER (Eds)

Handbook on Risk of AIDS: Injection Drug Users and Sexual Partners BARRY S. BROWN & GEORGE M. BESCHNER (with the National AIDS Research Consortium)

Therapy of the Substance Abuse Syndromes HENRY JAY RICHARDS

The Return of the Dangerous Classes. Drug Prohibition and Policy Politics DIANA R. GORDON
The life‐time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls
Authors: SCHUCKIT MARC A. , TIPP JAYSON E. , BUCHOLZ KATHLEEN K. , NURNBERGER JOHN I. , HESSELBROCK VICTOR M. , CROWE RAYMOND R. , KRAMER JOHN
Published: January 2006

Aims. While psychiatric symptoms are common in the general population and even more prevalent in alcoholics, their clinical implications are not clear. The goal of this study was to establish the life‐time rates of several independent and concurrent mood and anxiety disorders in alcoholics, controls and their relatives. Design. Structured interviews were administered to alcoholics entering treatment, their relatives, and controls. Setting. The study was carried out in six different centers in the United States as pan of the Collaborative Study on the Genetics of Alcoholism (COGA). Participants. Data were gathered from 2713 alcohol dependent subjects (probands and their alcoholic relatives) and 919 controls. Measurements. The timeline‐based Semi‐Structured Assessment for the Genetics of Alcoholism (SSAGA) interview teas administered face to face by trained, closely supervised interviewers. The life‐time rates for concurrent and independent disorders were determined for three DSM‐HI‐R major mood and four major anxiety disorders. Findings. Some form of independent mood disorder was seen during the life‐time in slightly fewer alcoholics than controls (14.0% and 17.1%), but alcoholics did show higher rates of independent bipolar disorder (2.3% vs. 1.0%). The life‐time rate for independent anxiety disorders was significantly higher in alcoholics than controls (9.4% vs. 3.7%), with most of the differential related to panic disorder (4.2% vs. 1.0%) and social phobia (3.2% vs. 1.4%), but no significant group differences for agoraphobia or obsessive‐compulsive disorder. In general, these findings regarding mood and anxiety disorders were reflected in close relatives. Conclusions. The large majority of alcohol‐dependent men and women in this sample did not have any of the independent mood or anxiety disorders evaluated here. However, there was evidence of enhanced risks among alcoholics for independent bipolar panic and social phobic disorders. Studies which do not distinguish carefully between independent and concurrent mood and anxiety disorders in alcoholics are likely to report much higher rates of co‐morbid psychiatric disorders than those that distinguish between the two types of syndromes.
Is crack cheaper than (powder) cocaine?
Authors: CAULKINS JONATHAN P.
Published: January 2006

Aims. To compare the prices of cocaine powder and crack cocaine in the United Stales, Design. Retail prices for crack and powder cocaine are compared for 14 US cities between 1986 and 1991 using regression analysis and t‐tests. Measurements. Prices are estimated from the United States Drug Enforcement Administration's System to Retrieve Information from Drug Evidence (STRIDE) database. Findings. On average, crack is neither more nor less expensive per pure unit than powder cocaine. Prices are not equal in every city in every year, but crack is equally likely to be more or less expensive, and the differences are not large relative to ‐variation in prices of both forms of cocaine between cities and over time. Conclusions. Crack has been widely believed to be cheaper than powder cocaine, and this “fact” has been used to help explain why US drug problems worsened in the 1980s. However, crack is not, in fact, cheaper per pure unit than powder cocaine. Other explanations must be sought for why crack spread so rapidly relative to powder cocaine.
Planned duration of residential drug abuse treatment: efficacy versus effectiveness
Authors: McCUSKER JANE , BIGELOW CAROL , VICKERS‐LAHTI MAUREEN , SPOTTS DIANE , GARFIELD FRANCES , FROST RAY
Published: January 2006

Aims.Two randomized controlled trials of residential drug abuse treatment programs found the programs to be equally effective, based on outcomes among those assigned to the treatments. This study aimed to compare the relative efficacy of the programs, based on outcomes among those who received the specific treatment program as planned.Design.Secondary analyses of data from two concurrent randomized controlled trials, with stratification by actual length of stay.Setting.Two residential drug abuse treatment facilities in the United States.Participants.Six hundred and twenty‐eight clients were enrolled over a 2–year period, representing 85% of all clients admitted, 91% of all eligible clients, and 95% of those asked to participate.Interventions.At one facility, clients were randomized to 3‐month or 6‐month versions of a traditional therapeutic community program. At the second facility, clients were randomized to 3‐month or 6‐month versions of a modified therapeutic community program that emphasized relapse prevention and health education. Measurements. Time from admission to first drug use (except alcohol); and Addiction Severity Index (ASI) composite scores for severity of drug, alcohol, legal, and employment problems. Findings. Five hundred and thirty‐nine clients (86%) completed a follow‐up interview at least 16.5 months after admission. In the relapse prevention trial, benefits of the 6‐month program were generally limited to those who stayed at least 40 days. In the therapeutic community trial, among those who stayed at least 171 days, the 12‐month program had a beneficial effect on employment. Otherwise, there were inconsistent differences between the 6‐ and 12‐month programs.Conclusions.On average, clients who stayed in treatment at least 80 days benefited from continuing in treatment for up to 6 months, but not beyond. Conversely, those admitted to programs of longer planned duration who dropped out of treatment early had worse outcomes than those who dropped out of shorter programs. Thus, although longer planned duration of treatment may be efficacious, it is not effective.
Toward a stepped care approach to treating problem drinkers: the predictive utility of within‐treatment variables and therapist prognostic ratings
Authors: BRESLIN F. CURTIS , SOBELL MARK B. , SOBELL LINDA C. , BUCHAN GIAO , CUNNINGHAM JOHN A.
Published: January 2006

Aims. Cost containment, a central issue in current health planning, encourages the use of brief interventions. Although brief interventions for problem drinkers have proved successful, a portion of such individuals do not change their alcohol use during treatment. Design. Repeated measures design (pre‐treatment, within‐treatment and 6 months post‐treatment). Setting and participants. To identify individuals at risk for continued problem drinking, predictors of post‐treatment drinking were examined for 212 problem drinkers who presented for treatment in an outpatient treatment clinic. Intervention. All participants completed a brief cognitive behavioral motivational intervention. Measurements. At the pre‐treatment assessment demographic, drinking pattern, severity of dependence and other cognitive variables (e.g. self‐efficacy, goal choice) were collected. Within‐treatment, drinking pattern and cognitive variables such as self‐efficacy and goal choice were again measured. Findings. Regression analyses showed that therapist prognosis ratings contributed significantly to the prediction of outcome even when pre‐treatment variables were controlled. However, when within‐treatment variables were included in the prediction, variables such as within treatment drinking eliminated the predictive utility of therapist prognosis ratings. This pattern held for both percentage of days abstinent and drinks per drinking day at a 6‐month follow‐up. Conclusions. It is suggested that a stepped care approach based on prediction models that include clients' within‐treatment response can be applied to the treatment of problem drinkers who show little initial response to treatment.
Interpersonal factors and post‐treatment drinking and subjective wellbeing
Authors: BEATTIE MARTHA C. , LONGABAUGH RICHARD
Published: January 2006

Aims.A conceptual clarification of the domain of social relationships defines three aspects of social relationships (structure, function and quality), which have both alcohol‐specific and general components. We analyse the correlations among post‐treatment indicators of social relationships and the associations between these interpersonal variables and post‐treatment drinking and subjective wellbeing.Design.This is a secondary analysis of data from an alcohol treatment outcome study, in which subjects were randomly assigned to one of three treatment conditions and followed for 18 months.Setting.The outpatient treatment program is located within a private psychiatric hospital in the north‐eastern United States.Participants.We analyzed the 140 subjects who completed a social network instrument 12 months following treatment assignment.Intervention.This secondary analysis combined clients from three treatment conditions, all of which were based upon social learning theory.Measurements.Interview and questionnaire self‐report data were collected by trained interviewers.Findings.Indicators of social relationships are found to be relatively independent of one another. Only alcohol‐specific social relationship indicators are significantly associated with drinking outcomes, and only general indicators are significantly associated with subjective wellbeing. Functional indicators, addressing social interaction content, have stronger effects on outcomes than structural or quality indicators. General and alcohol‐specific support from friends have more influence than support from family; both surpass the influence of co‐workers.ConclusionsA better understanding of the roles of social relationships during the course of treatment and recovery or relapse may help clarify how treatment personnel can utilize clients' interpersonal relationships more effectively to maximize treatment effectiveness.
The relationship between maternal use of heroin and methadone and infant birth weight
Authors: HULSE G. K. , MILNE E. , ENGLISH D. R. , HOLMAN C. D. J.
Published: January 2006

Aims/design. Reduction in mean birth weight and increased incidence of low birth weight are both associated with exposure to illicit heroin in pregnancy. Many studies examining neonatal outcomes in pregnant heroin users treated with methadone report improvements in birth weight. As a consequence, methadone treatment has become the ‘gold standard’ for the management of the pregnant heroin user. However, not all studies report significant birth weight increases associated with methadone. We undertook a number of meta‐analyses on reduction in mean birth weight, and incidence of low birth weight to estimate more precisely the effect of illicit heroin and methadone. Findings. Results showed mean reductions in birth weight associated with heroin use: 489 g (95% CI 284‐693 g), compared with methadone: 279 g (229‐328 g). Similarly, the pooled relative risk estimate for low birth weight for maternal heroin use was 4.61 (95% CI 2.78‐7,65), compared with 1.36 (0.83‐2.22) for methadone. Analysis of data on combined heroin and methadone use produced a pooled mean reduction in birth weight of 557 g (403‐710 g), with a pooled relative risk estimate for low birth weight of 3.28 (2.47‐4.39). Pooling ‘any’ methadone data, regardless of heroin use, produced an estimated reduction in birth weight of 395 g (311‐478 g) and a relative risk estimate for low birth weight of 1.90 (1.29‐2.81). Combining all data in an ‘any’ opiate use analysis also produced a mean reduction in birth weight of 483 g (386‐583 g) and a relative risk estimate for low birth weight of 3.81 (2,57‐5.65). Conclusions. The current findings suggest that heroin use while receiving methadone may counteract the birth weight advantage gained from methadone alone. Whether this is due to fetal exposure to heroin plus methadone, to reduced antenatal care, other behavioural and environmental factors associated with concurrent use of heroin and methadone or a combination of these is unclear. Nevertheless, these results challenge the current belief that the pregnant user is always better off receiving methadone than not, and suggests that methadone may not be the appropriate treatment for the pregnant women who continue to use illicit heroin.
Where to publish? Some considerations among English‐language addiction journals
Authors: ARCINIEGA LISA T. , MILLER WILLIAM R.
Published: January 2006

A search and survey of specialty periodicals in the addiction field identified 35 English‐language scientific journals that publish unsolicited research manuscripts. Among these, the typical addiction journal publishes a variety of types of articles in one of many different citation and referencing formats, releases four issues per year to about 100 subscribers, annually receives more than 100 manuscripts for scientific review, and accepts 53 of them to be published without payment of an author fee. Together these 35 addiction journals publish over 1700 new articles each year. Addiction journals vary widely in acceptance rates, ranging from 26% to 95%, and averaging 53%. For better or worse, these journals offer ample opportunity for the reporting of scientific data in the addiction field.
The influence of smoking on reward responsiveness and cognitive functions: a natural experiment
Authors: AL‐ADAWI SAMIR , POWELL JANE
Published: January 2006

Aims. To investigate the effects of (a) nicotine abstinence and (b) cigarette smoking after abstinence, on reward responsiveness and cognitive functions which are putatively dependent on activity in the dopaminergic system implicated in smoking. Design. During Ramadhan, Muslim smokers elected to abstain from smoking either for the whole month (RAMQUIT) or during daylight hours (DAYQUIT). These groups, and non‐smokers (NOSMOKE), were assessed on two occasions 6 hours apart (TEST1 and TEST2). DAYQUIT participants had abstained for 6 hours at TEST1 and smoked a single cigarette immediately prior to TEST2. RAMQUIT participants had abstained for at least 10 days prior to TEST1 and remained abstinent at TEST2. NOSMOKE and RAMQUIT participants ate a small snack prior to TEST2 to control for non‐specific consummatory effects. Setting. TEST1 was conducted at the mosque and TEST2 in participants' homes. Participants. All were male; mean age was 26.7years. Modal cigarette consumption prior to Ramadhan by both the 13 DAYQUIT and the 11 RAMQUIT smokers was 21‐30 per day. DAYQUIT subjects rated themselves as more dependent. Measurements. The Card Arranging Reward Responsivity Objective Test (CARROT), testing behavioural responsiveness to small financial incentive; digit span, measuring attention; verbal fluency, indexing frontal lobe function; and the two‐choice guessing test (2CGT; at TEST1 only), measuring response stereotypy. Findings, At TEST1, compared with non‐smokers, both smoking groups showed greater stereotypy (2CG) and lower reward responsiveness (CARROT). DA YQUIT participants improved on all measures after smoking a single cigarette. No marked changes were seen in the other groups. Conclusion. These data suggest that (i) abstaining smokers have impaired dopaminergic function and (ii) nicotine consumption may boost their dopaminergic activity.

During Ramadhan, muslims do not eat, drink or smoke between dawn and dusk. This prohibition, however, does not apply to the hours of darkness, when the faithful, understandably peckish, tend to raid the larder … By day, however, inertia and lethargy rein … In the long hours of Nil By Mouth chain smokers gnaw their fingernails.

(Steward, 1995)
Book Reviews
Authors: GOSSOP MICHAEL
Published: January 2006

Books Reviewed in this Article:

The Selfish Brain: learning from addiction ROBERT L. DUPONT

America's Drug War Debacle LEIF RODERICK ROSENBERGER

Drug Abuse and Social Policy in America—the War that must be Won BARRY STIMMEL

Women and Alcohol: contemporary and historical perspectives MOIRA PLANT

Drug Misuse: prevention, harm minimisation and treatment JAN KEENE

Alcohol and Speech STEVEN B. CHIN & DAVID B. PISONI
Alcohol misuse prevention for young people: a systematic review reveals methodological concerns and lack of reliable evidence of effectiveness
Authors: FOXCROFT DAVID R. , LISTER‐SHARP DEBORAH , LOWE GEOFF
Published: January 2006

In a systematic review we assessed the methodological quality of evaluations of alcohol misuse prevention programmes for young people, and recorded evidence of effectiveness. Studies were identified through systematic searches of electronic databases; hand searches of all obtained papers, existing reviews and several journals; and mailshots to key organizations, conferences and individuals. Relevant papers were checked and cross‐checked by members of the review team, and only those studies with an experimental or quasi‐experimental design and positive attributes on a number of other quality criteria were included in the review. After pre‐screening over 500 papers which reported prevention programmes, information was systematically abstracted from 155 papers. Only 33 studies merited inclusion in the review, and most of these had some methodological shortcomings. Twenty‐one studies reported some significant short‐ and medium‐term reductions in drinking behaviour. Of two studies which carried out longer‐term evaluations, only one reported a significant longer‐term effect, with small effect sizes. No factors clearly distinguished partially effective from ineffective or harmful prevention programmes. In conclusion, the lack of reliable evidence means that no one type of prevention programme can be recommended. In particular there is a need to carry out well‐designed scientific evaluations of the effectiveness of current or new prevention efforts which target young people's alcohol misuse.
Alcohol and aviation
Authors: HOLLAND COOK CHRISTOPHER CHARLES
Published: January 2006

Aviation accidents due to alcohol consumption by aircrew appear to be rare, especially in commercial aviation. However, a small proportion of general aviation accidents are attributable to alcohol use by aircrew, and aircrew are not well informed about the metabolism of alcohol and its effects on performance. Furthermore, there is evidence that aircrew performance may be impaired by alcohol consumption even after their Blood Alcohol Concentration has returned to “zero” (i.e. < 5 mg/dl). Accidents caused by impairment of aircrew performance by alcohol may therefore not be attributed to alcohol use at all. Aviation safety relies upon faultless human performance and is thus highly sensitive to alcohol‐related impairment of performance. This paper provides a review of research regarding aircrew alcohol consumption, impairment of aircrew performance by Alcohol, incidence of aviation accidents attributable to Alcohol use by aircrew, and other related subjects.
Adulthood functioning: the joint effects of parental alcoholism, gender and childhood socio‐economic stress
Authors: HILL ELIZABETH M. , ROSS LISA THOMSON , MUDD SHARON A. , BLOW FREDERIC C.
Published: January 2006

The popular literature has publicized the adjustment difficulties of adult children of an alcohol‐dependent parent (ACOAs); however, empirical studies do not provide consistent support. We examined the impact of parental alcoholism, degree of childhood socio‐economic stress and gender on three broad categories of adulthood functioning (psychopathology, socio‐economic attainment and marital stability). These effects were investigated with a heterogeneous sample of 400 men and 226 women participating in studies at the University of Michigan Alcohol Research Center. Parental alcoholism and childhood socio‐economic stress exerted significant independent effects on most adulthood functioning measures. Men and women differed substantially only on socio‐economic attainment measures, and effects of parental alcoholism and childhood economic stress on men and women were generally similar. For marital stability, parental alcoholism and childhood socio‐economic stress interacted. These results suggest that researchers who study the impact of family history for alcoholism on psychological functioning should consider other aspects of the family of origin that promote wellbeing. In addition, results of this study point to the need for more research on gender differences, protective factors that promote good adjustment and outcome measures reflecting general life adaptation.
The effects of physical attractiveness on gaining access to alcohol: when social policy meets social decision making
Authors: McCALL MICHAEL
Published: January 2006

Despite numerous legal interventions, minors continue to purchase and consume alcohol. Prior research had suggested that the decision to request identification to prove legal age was susceptible to various judgement and decision heuristics. This research examined whether the physical attractiveness of the potential consumer and the presence or absence of others were significant predictors of alcohol accessibility. Bartenders (n = 130) rated a target individual who was either high or low in attractiveness. Results indicated that attractiveness was a significant predictor of “proofing likelihood”. High levels of attractiveness were associated with a decrease in the likelihood of being asked to provide proof of legal age for the purchase of alcohol. Individuals presented alone were seen as significantly older than when grouped with others. Implications of these findings for the restriction of alcohol availability among minors are considered.