bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics associated with smoking cessation during pregnancy among working class women
Authors: WAKEFIELD MELANIE , GILLIES PAMELA , GRAHAM HILARY , MADELEY RICHARD , SYMONDS MALCOLM
Published: January 2006

Although smoking prevalence among pregnant women is highest among those of lower socio‐economic status, the factors associated with cessation in this high risk group are poorly documented. This paper reports on data from a survey of working class women in Nottingham and Coventry, who were interviewed 6 months after having delivered a baby. It compares the characteristics of the 32 women who quit smoking during their pregnancy and were still ex‐smokers at the 6 month post‐natal point, with 472 women who had continued to smoke during their pregnancy or had returned to smoking in the post‐partum period. A logistic regression analysis revealed three variables that were independently associated with long term cessation—having previously quit for more than 1 week, having a non‐smoking partner, and believing that the children of smokers are more likely to get infections. Among the most disadvantaged, an understanding of how close social ties and economic circumstances influence smoking behaviour is crucial, if we are to develop more effective smoking cessation intervention strategies for working class women.
The structure and correlates of alcohol dependence: WHO collaborative project on the early detection of persons with harmful alcohol consumption—III
Authors: HALL WAYNE , SAUNDERS JOHN B. , BABOR THOMAS F. , AASLAND OLAF G. , AMUNDSEN ARVID , HODGSON RAY , GRANT MARCUS
Published: January 2006

The cross‐cultural validity of the Alcohol Dependence Syndrome was tested on 13 symptoms of alcohol dependence which were assessed as part of a WHO collaborative study of the early detection of harmful drinking. The subjects were drinking patients in health care settings in Australia, Bulgaria, Kenya, Mexico, Norway, and the US. Principal Components Analyses were performed on the symptoms in each centre, and the degree of agreement between the results was assessed by calculating coefficients of congruence between the item loadings on the first principal component. In all six centres the first Principal Component accounted for at least half of the total variance and all symptoms had positive loadings greater than 0.40 on the first Principal Component. The coefficients of congruence were all 0.98 or more, and the 13 symptoms had internal consistency coefficients of 0.94 or more. An alcohol dependence score defined by the sum of positive responses to the 13 alcohol dependence symptoms was positively correlated with self‐reported alcohol consumption, alcohol‐related problems, serum gamma glutamyltransferase and a clinical examination assessment of alcoholism in all six samples.
Predictive validity of the Readiness to Change Questionnaire
Authors: HEATHER NICK , ROLLNICK STEPHEN , BELL ALISON
Published: January 2006

Following the development of the Readiness to Change Questionnaire described by Rollnick et al.,1 this article reports on the predictive validity of the questionnaire among a sample of 174 male excessive drinkers identified by screening on wards of general hospitals. Relationships between patients' “stage of change” derived from questionnaires administered prior to discharge from hospital and changes in drinking behaviour at 8 weeks and 6 months follow‐up are analysed. Allocated stage of change provided statistically significant relationships with drinking outcome. Multiple regression analysis showed that stage of change remained a significant predictor of changes in alcohol consumption when other possible predictors were taken into account. Two methods for allocating stage of change on the basis of questionnaire responses for use in different circumstances, a “quick” and a “refined” method, are described.
The origin of alcohol‐related social norms in the Saami minority
Authors: LARSEN SVEIN
Published: January 2006

The present paper addressed the problem of the origin of alcohol‐related social norms in the Saami minority in northern Norway. Based on data from studies of comparable ethnic minorities in Greenland, North America and Australia it could be expected that alcohol use‐ and abuse would be more prevalent in the Saami than in the Norwegian populations of northern Norway. No data to support this hypothesis exist. On the contrary, available data suggest that drinking problems in this group are similar to those of the majority in the area. The present paper developed the hypothesis that Saami alcohol‐related social norms originated in the Laestadian religious revival. The paper investigated the impact of the Laestadian culture in the formation of alcohol‐related social norms. It was concluded that the Laestadian sobriety norm, and the norm of abstinence from the use of adiafora, have influenced alcohol‐related behaviour in the Saami group in such a way that this group does not conform to the drinking behaviour found in comparable minorities.
Alcoholics anonymous, other 12‐step movements and psychotherapy in the US population, 1990
Authors: ROOM ROBIN , GREENFIELD THOMAS
Published: January 2006

The Data Note series is edited by Dr Bridget Grant, Chief of Biometry at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), USA.

Based on the 1990 US National Alcohol Survey, this note provides the first available comprehensive findings on self‐reported utilization of a variety of sources of personal support and counselling for alcohol and other problems. Respondents were queried about lifetime attendance and number of times they went to identified sources of help in the prior year. Twelve‐step groups included Alcoholics Anonymous, Al‐Anon, Adult Children of Alcoholics, and other non‐alcohol‐oriented groups like Gamblers Anonymous, Narcotics Anonymous, and Overeaten Anonymous; additional questions inquired about support or therapy groups and individual counselling for non‐alcohol problems. Of the US adult population, 9% have been to an AA meeting at some time, 3.6% in the prior year, only about one‐third of these for problems of their own. About half these percentages, mostly women, have attended Al‐Anon. Of the same population, 13.3% indicate ever attending a 12‐step meeting (including non‐alcohol‐oriented groups), 5.3% in the last year. During the prior year a further 2.1% used other support/therapy groups and 5.5% sought individual counseling/therapy for personal problems other than alcohol. In contrast to this high reported utilization, only 4.9% (ever) and 2.3% (12‐months) reported going to anyone including AA for a problem (of their own) related to drinking.
The reversibility of alcoholic brain damage is not due to rehydration: a CT study
Authors: MANN KARL , MUNDLE GÖTZ , LÄNGLE GERHARD , PETERSEN DIRK
Published: January 2006

Alcoholic brain damage is reversible when the patients are continually abstinent. An increase of brain water content was the putative explanation for this phenomenon. We tested the rehydration hypothesis using CT density measurements in 29 alcohol‐dependent male inpatients. During a 5‐week period of controlled abstinence, CT density measures did not decrease in any of the investigated regions of the brain as one would expect with an increase in brain water. Although the volumetry of the ventricular system and the subarchnoidal spaces revealed a significant reduction of CSF volume, we found a slight increase in CT density measures. Thus, our results are in contradiction to the rehydration hypothesis. Under discussion is whether neuronal plasticity might be the explanation of the reversibility of alcoholic brain damage in abstinent patients.
The validity of injecting drug users' self‐reports about sexually transmitted diseases: a comparison of survey and serological data
Authors: KLEYN JEANNE , SCHWEBKE JANE , HOLMES KING K.
Published: January 2006

Researchers studying the validity of injecting drug users' self‐reports have often reported a high degree of correspondence between self‐reports and several types of criterion variables. In this study, injecting drug users' responses to questions about prior infection with four sexually transmitted diseases were compared with serological test data. For three of the four diseases studied, discrepancies between survey and serological results were quite large, especially when respondents said they had no previous history of infection. Limitations of serological testing, the questions asked, respondent knowledge and the more traditional concern with respondent veracity are discussed as possible explanations for the observed differences. Study data suggest that use of drug injectors' self‐reports to measure infection with sexually transmitted diseases or to validate other measures is a questionable practice. Problems encountered in interpreting study results provide support for more frequent use of experimental or quasi‐experimental designs and of multivariate analytic techniques when conducting research on response validity.
Risk factors for suicide and undetermined death among in‐patient alcoholics in Scotland
Authors: DUFFY JOHN , KREITMAN NORMAN
Published: January 2006

Approximately 32 000 patients, representing all those discharged alive from inpatient psychiatric care for alcoholism in Scottish hospitals between 1974 and 1983, were traced for up to 10 years by means of a national record‐linkage study in order to ascertain the frequency of suicide and undetermined deaths. The cumulative mortality from these causes was 1.17% at 5 years and 2.01% at 10 years. Several risk factors were investigated, using survival analysis techniques. Sex, age, social class (mates only) and marital status were not found to be useful predictors, but the different secondary diagnoses recorded at discharge were associated with major variations in outcome. Attention is drawn to the prognostic importance of a secondary diagnosis of both affective disorders and personality disorders, and some implications of the findings are noted concerning attempts to construct population models linking alcoholism, demographic characteristics and suicide.
The substance specificity of psychosocial correlates of alcohol, tobacco, coffee and drug use by Czech women
Authors: KUBIČKA LUDĚK , CSÉMY LADISLAV , KOŽENÝ JIŘI , NEŠPOR KAREL
Published: January 2006

The paper reports results of an analysis based on face‐to‐face interviews with two samples of Prague women aged 20‐49: (1) a probabilistic sample (h = 718) of the Prague female population; and (2) a sample of 152 inpatients treated for substance dependence/abuse. Of the inpatients, 79% were diagnosed as alcohol dependent only, 15% as both alcohol dependent and drug dependent/abusers, 6% as drug dependent only. With very few exceptions, those with drug problems among the inpatients abused analgesics, hypnotics, or anxiolytics. With data obtained from the general population sample, two‐stage hierarchical logistic regression was run with each of the eleven differently defined substance uses as dependent variables. Four demographic variables were entered as predictors into the regression equations in the first stage. From the seven potential risk factors of substance use statistically significant predictors were entered stepwise in stage two. The major result of the study is the specificity of the pattern of predictors related to each of the eleven considered substance uses. It is also found that in the general population the use of a particular substance is generally uncorrelated with the use of other substances. Alcohol use (even heavy alcohol use) has no relation to smoking, to the use of analgesics, hypnotics, anxiolytics‐and is connected with a specific pattern of predictors.
Alcohol in home and leisure injuries
Authors: HONKANEN RISTO
Published: January 2006

The part that alcohol plays in non‐motor vehicle unintentional injuries is not well known. Injuries at home and during leisure form a very heterogeneous group. Alcohol involvement varies considerably from one subgroup to another: for example, all cases of alcohol poisoning involve alcohol by definition, whereas alcohol involvement is very infrequent in sports injuries. One‐third of falls, half of drownings and fire deaths and two‐thirds of hypothermia deaths involve alcohol. Young and middle‐aged males form a risk group of alcohol‐related trauma. Alcohol involvement varies also from country to country: deaths from alcohol poisoning are several times as common in Finland as in other Western countries. In contrast to experience in Western countries, in Dares Salaam, Tanzania, wealthier injured Africans were found to have alcohol involvement more often than poor Africans. Alcohols seems to increase the risk of falling, bicycle and motor vehicle injuries largely to the same extent. The relative importance of the two main components of alcohol‐related risk–risk‐taking and impaired psychomotor functions‐requires further exploration in each main external cause category of home and leisure injuries.
Multivariate models for predicting abstention following intervention to stop smoking by general practitioners
Authors: RICHMOND ROBYN L. , KEHOE LINDA A. , WEBSTER IAN W.
Published: January 2006

Predictors of successful smoking cessation were examined in a randomized controlled trial of 450 smokers who received an intervention by their general practitioner (GP). Pretreatment characteristics predicting outcome at 3, 6 and 12 months and for continuous abstinence lo 12 months were determined using logistic regression analyses. Results showed the variables that significantly predicted abstention at 3 months were age and motivation, whereas the predictors at 6 months were socio‐economic stains, motivation, level of dependence and time spent with smokers. No single predictor emerged at 12 months. Predictors far continuous abstinence to 12 months were age, nine spent with smokers and motivation. A model was developed which best describes the likelihood of patients achieving continuous long‐term abstinence. The results show that five factors (high motivation level, older age, less tune spent with smokers, low dependence level, and higher socio‐economic status) together have a 76% accuracy of predicting continuous abstinence to 12 months.
Does post‐withdrawal cue exposure improve outcome in opiate addiction? A controlled trial
Authors: DAWE SHARON , POWELL JANE , RICHARDS DAVID , GOSSOP MICHAEL , MARKS ISAAC , STRANG JOHN , GRAY JEFFREY A.
Published: January 2006

A controlled trial studied whether cue exposure prevented relapse in opiate addiction. Subjects were randomly allocated to one of two inpatient treatment settings: a drug dependence unit with a special 10 week program and 4 weeks in a behavioural/general treatment unit without such a program. In each setting, following drug‐withdrawal, subjects had either cue exposure for at least six sessions over 3 weeks, or a control condition. Subjects were followed up twice, at about 6 weeks and 6 months post‐treatment. 186 subjects were randomly allocated; 69 were assessed post‐detoxification, and of these 43 completed cue exposure or control treatments. Cue exposure and control subjects did not differ in cue reactivity. This was evaluated post‐treatment for cue exposure subjects and at a comparable time point for controls. All groups showed a significant decrement in cue‐elicited craving, withdrawal responses and negative mood. Cue exposure and control subjects did not differ at either of the two follow up interviews.
The negotiation of New Zealand alcohol policy in a decade of stabilized consumption and political change: the role of research
Authors: CASSWELL SALLY , STEWART LIZ , DUIGNAN PAUL
Published: January 2006

Significant changes in the key alcohol policy areas of availability, advertising and taxation have taken place in New Zealand from 1985 to 1991. These changes are described in the context of the social climate which was one of extreme fiscal crisis and an unprecedented swing to the right. The very limited role played by public health research in the process of policy development is viewed in part as a consequence of this social climate. The political changes affected the strength and extent of the public health voices in the debate and the reception they received. In each of the policy areas in which change occurred, the policy‐keeper was other than a public health agency and the utilization of research by public health advocates was, therefore, in response to already articulated positions. The dissemination of research relied too heavily on lengthy written submissions, and too little on media advocacy and interpersonal contact. There was also a lack of directly relevant local research to inform the policy debate. The case study illustrates the constraints on researchers' in the policy development process, but suggests that such involvement is important for the public's health.
The introduction of dram shop legislation in the United States and the advent of server training
Authors: SALTZ ROBERT F.
Published: January 2006

This paper discusses the relationship of research to policy in the matter of dram shop liability and server training in the USA. The discussion is made difficult by the apparent lack of any such relationship. While research in the area has only just been published, dram shop liability in the USA actually dates to the nineteenth century, with its current form shaped by the repeal of prohibition in 1933. Because liability law and liability insurance vary from state to state, current movements for reform and server training arise somewhat spontaneously in different localities and with different emphases. Research constitutes only a minor influence among several others more salient to the political process of policy formation. The advent of mandatory server training in the state of Oregon is used to illustrate the somewhat capricious nature of progress in responsible beverage service.
The interaction between policy and research in the implementation of server training
Authors: SINGLE ERIC
Published: January 2006

This paper describes the relationship between research and policy in the development of server training policy in Ontario. With the emergence of civil liability for the conduct of intoxicated patrons, there has been a growing movement toward the training of managers and servers in licensed establishment in the responsible service of alcohol. As pan of a major government reform of alcohol regulations which has led to a new Liquor Licence Act, all persons who serve alcohol in licensed establishments in Ontario will be required to attend a server training course. The process leading to new alcohol regulations in Ontario is summarized with particular attention to the implementation of mandatory server training. The paper concludes with a discussion of the role of research in policy development. It is argued that the role of research in policy making is limited by an inherent conflict between the nature of scientific enquiry and the exigencies of policy development.
From large projects to case consultation—interaction of alcohol research and policy in Finland
Authors: KOSKI HEIKKI , Øterberg ESA
Published: January 2006

The interaction of Finnish social alcohol research and alcohol policy will be discussed in this paper. We will examine the history of alcohol research, focusing on the extent that problems related to alcohol policy have been covered in research. We also deliberate upon such questions as to what extent changes in alcohol policy can be linked to the findings of research. Researchers began their work in the 1950s, hoping to find a solution to the problems met in alcohol policy. In the 1960s the era of alcohol policy‐centred projects was followed by an era which aimed to increase the factual knowledge of alcohol not necessarily tied to alcohol policy questions. After 1969 alcohol policy questions gained renewed interest. Alcohol research has not directly caused many new measures, but it has influenced the public and private discussion about alcohol policy. Producing results and research reports has been an important way to affect both public discussions and policy making. However, participating in the decision making processes in its different stages has been an even more crucial way to affect alcohol policy. Particularly in the 1970s, the ideas and views presented in studies had fairly immediate and direct repercussions on both alcohol policy and practical measures.
The effect of food deprivation on alcohol consumption in bulimic and control women
Authors: BULIK CYNTHIA M. , BRINDED EMMA C.
Published: January 2006

The effect of food deprivation on alcohol self‐administration was examined in five women with bulimia nervosa and five healthy controls in a semi‐naturalistic experimental design. In this within‐subjects study, each individual underwent two food‐deprived and two non‐deprived sessions. The deprivation condition consisted of no food or caloric beverages for 19 hours prior to the experimental procedure. On each of the 4 days, subjects watched a 2–hour segment of an epic movie and were permitted to drink ad libitum. No differences were observed in the number of grams of alcohol consumed under deprived and non‐deprived conditions for either group. Breath alcohol levels were significantly higher under the non‐deprived condition despite equivalent amounts of alcohol consumed and similar ratings of the subjective sense of tipsiness. Bulimic women, consumed equivalent calories due to alcohol as control women but significantly fewer calories due to non‐alcoholic beverages. These results do not support the hypothesis that food deprivation leads to increased self‐administration of alcohol in women.
Research in general practice for smokers and excessive drinkers in Australia and the UK. I. Interpretation of results
Authors: RICHMOND ROBYN L. , ANDERSON PETER
Published: January 2006

This review examines the role of the general practitioner in assisting patients to stop smoking and in reducing levels of excessive drinking. After over a decade of clinical trials, vie discuss what interventions work in general practice and interpret the results of clinical trials conducted predominantly in Australia and the UK. Studies have generally found a superiority of GPs’ brief advice over non‐intervention groups. Very brief GP advice results in smoking abstinence rates from 5% to 10%, reduction in alcohol consumption of around 25–35% and reduction in proportions of excessive drinkers of around 45%. The greater investment of GPs’ time and the more comprehensive interventions which include follow up usually resulted in higher abstinence rates among smokers from between 20% to 36%, and reduction in proportions of excessive drinkers of up to 60–70%. The contributions of the adjuncts nicotine chewing gum, follow up visits and the personalisation of health effects are discussed. It is difficult to make comparisons between studies and toe examine some of the reasons. The predictors of successful outcome are presented as they are of particular interest to GPs in terms of targeting health promotion activities.
A comparison of alternative measures of alcohol consumption in the Canadian National Survey of alcohol and drug use
Authors: SINGLE ERIC , WORTLEY SCOT
Published: January 2006

Based on the results of the 1989 National Alcohol and Drug Survey in Canada, this paper compares alternative measures of alcohol consumption. Utilizing questions developed by Walter Clark, the volume of drinking in a variety of social situations is described. The results are presented in terms of aggregate consumption and the proportion of total consumption which occurs in different situations. It is found that anchoring self‐reported alcohol use in specific social contexts results in higher estimated consumption than the more commonly used quantity/frequency questions.
Chronotype and personality factors in the daily consumption of alcohol and psychostimulants
Authors: ADAN ANA
Published: January 2006

This paper analyses the influence of and possible interaction between chronotype (Morning‐types, Neither‐types and Evening‐types} and personality dimensions (neuroticism, extroversion and psychoticism) in the daily consumption of alcohol and psychostimulants (nicotine and caffeine). In a sample of 537 subjects (257 men and 280 women), who were students and professionals with different but fixed work schedules, there were significant differences among the chronotypes regarding the consumption of all the above. Evening‐types consumed more alcohol, nicotine and caffeine (coffee and cola), while Morning‐types consumed more caffeine from tea. Personality was only related to the consumption of cola: the greater the neuroticism the higher the consumption of this beverage. Stimulant drinks showed various types of interaction with personality types, which revealed a complex pattern of group action. The results stress the need to consider chronotype as a contributory psychological factor in a multi‐causal model of consumption of psychoactive substances.
Explanations for sharing injection equipment in injecting drug users and barriers to safer drug use
Authors: ROSS MICHAEL W. , WODAK ALEX , STOWE AARON , GOLD JULIAN
Published: January 2006

We examined the explanations given by a sample of 1245 injecting drug users in Sydney, Australia for accepting used injection equipment. Factor analysis of these reasons revealed three dimensions of sharing: not caring when withdrawing or intoxicated, unavailability of equipment, and not seeing it as high risk or ease of injecting. The most common reasons given were difficulty in obtaining sterile equipment (73% of cases), the dangers not seeming so important when in withdrawal (40%) and sharing being something done with friends or lovers (31%). Most common reasons for not sharing were related to health issues (91% citing AIDS and 67% hepatitis). These data suggest that interventions target provision of sterile equipment, and education which highlights risk situations such as intoxication and withdrawal.
The ability of young people to purchase alcohol without age identification in northeastern Minnesota, USA
Authors: FORSTER JEAN L. , McGOVERN PAUL G. , WAGENAAR ALEXANDER C. , WOLFSON MARK , PERRY CHERYL L. , ANSTINE PAMELA S.
Published: January 2006

The purpose of this study was to determine the rate at which young people can purchase alcohol without age identification in off‐premises businesses, and the factors which influence the rate of purchase. All retail outlets licensed to sell distilled spirits and/or full strength beer and wine in 28 northern Minnesota communities were visited on different occasions by three 21‐year‐old female buyers who appeared to be aged 19 or younger. These youthful buyers were able to purchase beer without age identification in 47% of the 336 purchase attempts. Almost four‐fifths of the businesses sold beer to these buyers at least once in three attempts. These results provide clear evidence that many commercial off‐sale businesses in the US supply alcohol to youthful buyers, and that practices vary significantly by community and by business. These results support the need for greater attention to availability as a factor in teenage drinking patterns.
Systemic absorption and abuse liability of snorted flunitrazepam
Authors: BOND ALYSON , SEIJAS DANIEL , DAWLING SHEILA , LADER MALCOLM
Published: January 2006

Benzodiazepine hypnotics are widely abused as pan of a polydrug misuse culture. This study set out to investigate some pharmacokinetic and pharmacodynamic characteristics of a novel method of abuse, snorting, of flunitrazepam. Twenty healthy volunteers took pan: three took 0.5 mg, three took I mg, three took l.5 mg, six took 2 mg and five took placebo. Blood was sampled and ratings of mood, bodily symptoms, strength and liking of drug effect were completed pre‐ and at 5, 15, 30, 60, 90, 120 and 240 minutes and at 24 hours post‐drug. It was found that flunitrasepam could be detected in venous blood 5 minutes after intake. As the dose increased, the peak plasma concentration was higher but also occurred progressively later, the levels reached being comparable to oral or intramuscular administration at 110 minutes. Subjects reported sedation but complained of few side‐effects. They liked the drug effects and subjective ratings of strength were correlated with liking and with plasma drug levels.
Mortality in alcoholic patients given inpatient treatment
Authors: FEUERLEIN W. , KÜFNER H. , FLOHRSCHÜTZ T.
Published: January 2006

Data on mortality during a 48‐month follow‐up period in a group of 1410 alcoholics who had received inpatient treatment were evaluated. In 1266 patients known to be either living or deceased the death rate was 7.6%. The percentage of deceased subjects was highest in the group over SO years of age. The mortality rate was higher for men (9.8%) than for women (4.8%); for those with more than one divorce (16.8%); for those who were not fit for work (18.1%) of were retired at the start of the treatment (43.3%); who were employed in the alcohol business (21. 7%); who had reduced their alcohol consumption before treatment (13.4%); who were unemployed 6 months after discharge (12.4%). The mortality rate was higher for those with high scores on a scale assessing calmness in a personality inventory (7.9%) and low scores on a questionnaire assessing motivation (10.9%) and insight into the need of change (12.4%). Alcohol‐related illness before the index treatment played an important role: the mortality rate was higher for those who had had Wemicke‐Korsakoff syndrome (40%), delirium tremens (15.3%), pancreatitis (13.9%) or cardiomyopathy (14.1%). The mortality rate was higher for treatment dropouls (12.9%) and for those who regularly or occasionally took sleeping pills (28.5%), psychoactive drugs (15.1%) or other drugs (11.5%) during treatment. In the follow‐up periods substance use had a great effect on mortality. The mortality rate or those patients who still abstained from alcohol after 6 months (4.4%) was only a third of that for the patients who had relapsed (12.4%). Patients who took drugs during the 18‐month follow‐up period also had higher mortality rates: sleeping pills, 9.6%; psychoactive drugs, 9.7%, analgesics 10.7%. Logistic regression identified significant variables at admission: not fit for work, retired, job related to alcohol, suffering from Wernicke‐Korsakoff syndrome and no insight for change.
Assessment of the alcohol withdrawal syndrome—validity and reliability of the translated and modified Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA‐A)
Authors: STUPPAECK C. H. , BARNAS C. , FALK M. , GUENTHER V. , HUMMER M. , OBERBAUER H. , PYCHA R. , WHITWORTH A. B. , FLEISCHHACKER W. W.
Published: January 2006

The alcohol withdrawal syndrome is a common phenomenon in psychiatric hospital care. Not only treatment strategies, but also the evaluation of the syndrome, are discussed controversially. The most widely used instrument is the Clinical Institute Withdrawal Assessment‐Alcohol (CIWA‐A) and the succeeding CIWA‐Ar. We modified the CIWA‐A and translated it into German. Validity and reliability of the modified and translated scale were analysed by several psychological tests as well as different somatic measures in 31 patients. The German version appears to be a valid and reliable instrument for the assessment of alcohol withdrawal syndrome useful for clinical routine as well as treatment trials.
Needle Park: what can we learn from the Zürich experience?
Authors: HUBER CHRISTIAN
Published: January 2006

Needle Park in Zürich existed as an open air drug scene from 1986 until February 1992. Within this six year period the City Government, City Parliament, governmental and non‐governmental organizations implemented a wide range of permissive and restrictive drug policies, from extensive harm reduction to closing the park. Police statistics and several studies suggest that tolerating an open air drug scene can have unforeseen and unfortunate consequences. Low drug prices, lack of law enforcement and lack of social control seem to attract drug users towards the open drug scene and the increase in problems appears to have been more rapid than the increase in the population of addicts.
Negative affect, alcohol expectancies and alcohol‐related problems
Authors: JOHNSON PATRICK B. , GURIN GERALD
Published: January 2006

Using data from the first epidemiological study of mainland Puerto Rican drinking, the authors explore the relationships between negative affect, alcohol expectancies and drinking problems. Results revealed that the co‐occurrence of depressed mood and drinking problems was strongly moderated by alcohol expectancies. More specifically, the co‐occurrence was strongest among those Puerto Ricans who most expected alcohol to elevate their mood. Findings are discussed in terms of their explication of the co‐morbidity of depressive symptomatology and alcohol abuse.
Correlates of sexual risk‐taking among gay male substance abusers
Authors: PAUL JAY P. , STALL RON D. , CROSBY G. MICHAEL , BARRETT DONALD C. , MIDANIK LORRAINE T.
Published: January 2006

This paper examines sexual risk‐taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n= 383), and identifies correlates of unprotected anal sex within this group. Sexual risk‐taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90–day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non‐primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non‐primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV‐tested, and used reappraisal/problem‐solving coping strategies showed greater risk with a primary partner only. Sexual risk with non‐primary partners was greater for those who used more drugs, reported more difficulty avoiding high‐risk sex when aroused and were HIV + The paper discusses the implications of these findings for the design of sexual risk‐reduction interventions.
Alcohol and drug intoxication during police interrogation and the reasons why suspects confess to the police
Authors: SIGURDSSON JON F. , GUDJONSSON GISLI H.
Published: January 2006

This study investigates the effects of alcohol, drug intoxication and withdrawal symptoms on the mental state of criminal suspects and the nature of their confession. A total of 359 sentenced prisoners were approached on admission and 96% agreed to participate in the study. They completed a specially designed Confession Questionnaire, which asked them questions about their reasons for confessing to the police, their attitude towards their confession, their mental state at the time of the confession and the extent to which they had been under the influence of alcohol and drug intoxication at the time of crime and police interview. The confession rate for the sample was very high (92%), with serious traffic violators having the highest confession rate (95%) and sex offenders the lowest (83%). The findings illustrate that the “perception of proof”, “internal need to confess” and “external pressure” are the main reasons why suspects confess. However, subjects were identified who had experienced a typical “prisoner's dilemma” phenomenon during the police interview because of a co‐defendant. Alcohol and drug intoxication was very commonly reported both at the time of the offence and the police interview, but these were related to the nature of their offence. Although intoxication and withdrawal symptoms did not appear to seriously impair their coping during the police interview it was consistently reported as having made them confused.
Current concepts of ethanol dependence
Authors: LITTLETON JOHN , LITTLE HILARY
Published: January 2006

Alcohol dependence is considered to be divisible into two types (although the divisions between these are indistinct). These are psychological dependence, in which the rewarding effects of alcohol play a primary role, and chemical dependence, in which adaptive changes in the brain initiate punishing effects on withdrawal of alcohol, and suppression of these becomes the primary motive for using the drug. The neurochemical basis for the rewarding effects of alcohol may be the potentiation of GABA at GABAA receptors (causing relaxation) and release of dopamine from mesolimbic neurones (causing euphoria). The adaptive changes which cause the alcohol withdrawal syndrome are not known for certain, but alterations in GABAA receptors, NMDA receptors and voltage‐operated calcium channels all have a claim. However, it is distinctly doubtful whether these all contribute to the negatively reinforcing effects of alcohol that are important in chemical dependence, although they may be important in other pathological effects of alcohol abuse. Current research badly needs better communication between basic scientists and clinicians to establish research goals and to improve current models.
Neural mechanisms underlying nicotine dependence
Authors: BALFOUR D. J. K.
Published: January 2006

There is little doubt that many habitual smokers find it difficult to quit the habit because they have become addicted to the nicotine present in the smoke. This paper addresses some of the pharmacological mechanisms underlying this addiction and discusses how an understanding of these mechanisms may contribute to the more effective use of nicotine replacement therapy during smoking cessation. It considers critically the evidence that the “rewarding” properties of nicotine, which serve to reinforce drug‐seeking behaviour, are related to stimulation of the mesolimbic dopamine system of the brain. The critique focuses specifically on the evidence that many central nicotinic receptors, including those which mediate the effects of the drug on dopamine secretion, are readily desensitized by chronic exposure to agonist and that hypotheses which assume that nicotine inhaled from tobacco smoke invariably results in stimulation of the receptors must be treated with caution. Nicotinic receptors in the brain are, however, heterogeneous in nature with different molecular structures and pharmacologies. It is concluded that the reinforcing properties of nicotine sought by smokers may reflect both stimulation and desensitization of the different nicotinic receptor populations, and that smokers may adjust their smoking habits to achieve the balance of receptor stimulation and desensitization which they find most reinforcing. It seems likely that the efficacy of the different nicotine formulations during the treatment of smoking cessation may also reflect their ability to stimulate or desensitize brain nicotinic receptors.
Alcohol withdrawal: an adaptation to heavy drinking of no practical significance?
Authors: STOCKWELL TIM
Published: January 2006

Markedly differing views can be found among both clinicians and researchers regarding whether alcohol withdrawal is a phenomenon of any practical or theoretical importance. Evidence has mounted that alcohol withdrawal, even in a severe form, is rarely life–threatening and the great majority of cases can be managed in non–medical settings, including the home. There is also a widely held view among clinicians that withdrawal symptoms have little motivational significance and may be best regarded as but epiphenomena of prolonged heavy drinking. There are also experimental data from both human and animal laboratory studies to the effect that withdrawal symptoms do not readily trigger further alcohol consumption. Against this most unpromising background a case is presented for alcohol withdrawal being but one manifestation of important biological and psychological adaptive processes which occur almost whenever alcohol is consumed with any regularity. It is proposed that understanding this more general phenomenon is critical to a better understanding of the factors which maintain heavy and problematic drinking. Recent evidence also suggests that minor alcohol withdrawal symptoms are far more common in the general population than had previously been realized, and that this has important implications for prevention policy.
The benzodiazepine withdrawal syndrome
Authors: PÉTURSSON H.
Published: January 2006

Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes. Instances are also reported within the high‐dosage category of more serious developments such as seizures and psychotic reactions. Withdrawal from normal dosage benzodiazepine treatment can result in a number of symptomatic patterns. The most common is a short‐lived “rebound” anxiety and insomnia, coming on within 1‐4 days of discontinuation, depending on the half‐life of the particular drug. The second pattern is the full‐blown withdrawal syndrome, usually lasting 10–14 days; finally, a third pattern may represent the return of anxiety symptoms which then persist until some form of treatment is instituted. Physiological dependence on benzodiazepines can occur following prolonged treatment with therapeutic doses, but it is not clear what proportion of patients are likely to experience a withdrawal syndrome. It is also unknown to what extent the risk of physiological dependence is dependent upon a minimum duration of exposure or dosage of these drugs. Withdrawal phenomena appear to be more severe following withdrawal from high doses or short‐acting benzodiazepines. Dependence on alcohol or other sedatives may increase the risk of benzodiazepine dependence, but it has proved difficult to demonstrate unequivocally differences in the relative abuse potential of individual benzodiazepines.
Preventive strategies for alcohol‐related problems
Authors: RITSON BRUCE
Published: January 2006

Preventive strategies for alcohol‐related problems need to be in keeping with their socio‐political context. Prohibition is inappropriate except where it has widespread support within the culture. Preventive strategies focus on the population and/or high risk groups and behaviours. Primary prevention can be achieved by control policies, education and provision of alternatives. Fiscal measures are of proven value. Legislative approaches influence availability and context of drinking, such as drinking and driving. Advertising control, server training and server liability are further approaches. Encouraging the provision of alternative beverages and promoting alcohol‐free environments is a further approach which should be seen as pan of an integrated community response. Secondary prevention linked with early recognition of hazardous drinking at primary level is of known efficacy and would form part of a coordinated strategy.
The prevention of tobacco‐related disease
Authors: RAW MARTIN , McNEILL ANN
Published: January 2006

The key components of a strategy to prevent tobacco–related disease are outlined. These measures aim to increase the cessation of tobacco use and reduce its uptake. Components are wide–ranging, including a taxation policy, a ban on advertising and promotion, a comprehensive health promotion programme including advice from primary health care professionals and the development of campaigning skills, particularly by the medical profession. The prevention of tobacco–related disease has moved into the domain of campaigners and lobbyists at political, economic and international levels. The key target is countering the activities, especially the unethical trade practices, of the wealthy and powerful tobacco industry.
Opiate treatments
Authors: JOHNS ANDREW
Published: January 2006

One of the greatest of challenges facing medicine is to devise effective and appropriate treatments for opiate problems. Such treatments are based on principles derived from the disciplines of pharmacology and psychology, but are also shaped by social issues and even by the views of practitioners. There are many misconceptions about opiate problems. In this review it is suggested that there are good reasons for stating that opiate users do change over time, treatment can also lead to change and psychological interventions are of great importance. However, current methods of opiate detoxification are of low efficacy and methadone maintenance, although of benefit for some, is not a panacea for opiate problems.
Trends in alcoholism among male doctors in Scotland
Authors: HARRISON DALE , CHICK JONATHAN
Published: January 2006

Alcohol abuse within the medical profession has long been an issue of concern. Recently, the General Medical Council reported that half of the doctors reported for health difficulties liable to affect professional competence were found to have an alcohol problem. This paper examines how rates of alcoholism among male doctors in Scotland have changed over the last three decades. Admission and discharge rates for doctors to psychiatric inpatienl beds with diagnoses of alcoholism are compared with non‐medical professions, for the years 1963–87. The results, assessed in the light of changing Standardized Mortality Rates for liver cirrhosis for the medical profession, suggest that doctors as a group remain at a higher risk of alcoholism compared to other professionals, but that this increased risk appears to be largely accounted for by a cohort of heavy‐drinking doctors over the age of 45 years.
Gender‐specific etiological differences in alcohol and drug problems: a behavioural genetic analysis
Authors: JANG KERRY L. , LIVESLEY W. JOHN , VERNON PHILIP A.
Published: January 2006

Although gender differences in the consumption and abuse of alcohol and drugs are frequently reported, the etiology of these differences has received limited attention. The present study applied biometric genetic analyses to determine whether self‐report questionnaire items assessing problem alcohol and drug use are influenced by gender‐specific genetic and environmental influences. The sample consisted of 693 volunteer general population twin pairs (209 monozygotic female, 138 monozygotic male, 170 dizygotic female, 82 dizygotic male, 94 dizygotic opposite‐sex twin pairs). Heritability analyses showed that most aspects of drug and alcohol problems were differentially heritable by gender. Significant additive genetic effects were found only in males, whereas in females, most substance use problems were wholly determined by environmental factors. In both genders, non‐shared environmental factors accounted for the largest proportion of the variance, and further gender‐by‐genotype analyses showed that these influences were not gender specific, but rather were common to males and females. Some preliminary evidence was also obtained that the use of illicit drugs may be etiologically distinct from the use of licit drugs in females and males.