bluuebunny/crossref_metadata_2025 huggingface dataset:
Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders
Authors: Miller William R. , Wilbourne Paula L.
Published: March 2003

Aim A 3‐year update with 59 new controlled trials is provided for the ongoing Mesa Grande project reviewing clinical trials of treatments for alcohol use disorders. The project summarizes the current evidence for various treatment approaches, weighting findings differentially according to the methodological strength of each study.

Design The review includes 361 controlled studies that (1) evaluated at least one treatment for alcohol use disorders, (2) compared it with an alternative condition (such as a control group, a placebo, a brief intervention or an alternative treatment), (3) used a procedure designed to create equivalent groups before treatment and (4) reported at least one outcome measure of drinking or alcohol‐related consequences. Studies were rated by two reviewers on 12 methodological criteria, and outcome logic was analyzed for the specific treatment modalities tested.

Findings Methodological quality of studies was significantly but modestly correlated with the reporting of a specific effect of treatment. Among psychosocial treatments, strongest evidence of efficacy was found for brief interventions, social skills training, the community reinforcement approach, behavior contracting, behavioral marital therapy and case management. For the first time, two pharmacotherapies also appeared among the most strongly supported approaches: opiate antagonists (naltrexone, nalmefene) and acamprosate. Least supported were methods designed to educate, confront, shock or foster insight regarding the nature and causes of alcoholism.

Conclusions Treatment methods differ substantially in apparent efficacy. It would be sensible to consider these differences in designing and funding treatment programs.
The self‐perceived survival ability and reproductive fitness (SPFit) theory of substance use disorders
Authors: Newlin David B.
Published: March 2003

A new theory of substance use disorders is proposed—the SPFit theory—that is based on evolutionary biology and adaptive systems. Self‐perceived survival ability and reproductive fitness (SPFit) is proposed as a human psychobiological construct that prioritizes and organizes (i.e. motivates) behavior, but is highly vulnerable to temporary, artificial activation by drugs of abuse. Autoshaping/ sign‐tracking/feature positive phenomena are proposed to underlie the development of craving and expectations about drugs as the individual learns that abused drugs will easily and reliably inflate SPFit. The cortico–mesolimbic dopamine system and its modulating interconnections are viewed as the biological substrate of SPFit; it is proposed to be a survival and reproductive motivation system rather than a reward center or reward pathway. Finally, the concept of modularity of mind is applied to the SPFit construct. Although considerable empirical data are consistent with the theory, new research is needed to test specific hypotheses derived from SPFit theory.
Psychotropic substance‐seeking: evolutionary pathology or adaptation?
Authors: Sullivan R. J. , Hagen E. H.
Published: March 2003

According to a conventional evolutionary perspective, the human propensity for substance use is the product of a ‘mismatch’ between emotional mechanisms that evolved in a past without pure drugs or direct routes of drug administration, and the occurrence of these phenomena in the contemporary environment. The primary purpose of this review is to assert that, contrary to the conventional view, humans have shared a co‐evolutionary relationship with psychotropic plant substances that is millions of years old. We argue that this ‘deep time’ relationship is self‐evident both in the extant chemical–ecological adaptations that have evolved in mammals to metabolize psychotropic plant substances and in the structure of plant defensive chemicals that have evolved to mimic the structure, and interfere with the function, of mammalian neurotransmitters. Given this evidence, we question how emotional mechanisms easily triggered by plant toxins can have evolved. Our argument is also supported with archeological and historical evidence of substance use in antiquity suggesting that, for people in the past, psychotropic plant substances were as much a mundane everyday item as they are for many people today. Our second, and more speculative objective is to suggest provisional hypotheses of human substance‐using phenomena that can incorporate the evolutionary implications of a deep time relationship between psychotropic substances and people. We discuss hypotheses of selective benefits of substance use, including the idea that neurotransmitter‐analog plant chemicals were exploited as substitutes for costly, nutritionally constrained endogenous neurotransmitters. However, even if substance seeking was adaptive in the environment of our hominid ancestors, it may not still be so in the contemporary environment. Thus, the implications of our argument are not that the mismatch concept does not apply to human substance‐using phenomena, but that it must be reconsidered and extended to incorporate the implications of a substance‐rich, rather than substance‐free, evolutionary past.
A review of the published literature into cannabis withdrawal symptoms in human users
Authors: Smith Neil T.
Published: March 2003

Recent experimental papers have been published suggesting the appearance of withdrawal symptoms upon the cessation of cannabis use in human users and proposing the introduction of a diagnostic category for such symptoms. Research also continues to be published into the physiological effects of cannabis on animals via self‐administration paradigms and the use of cannabinoid antagonists. Animal research does not provide a clear picture of a consistent withdrawal effect. The literature on withdrawal symptoms appearing in human users following the cessation of cannabis is investigated in this paper to clarify this issue further and enhance the scientific and lay debate on the status of the drug. Methodological weaknesses in the literature are highlighted. These include variable levels of drug‐dose administered in laboratory conditions, lack of controlled studies and the absence of definitions of the withdrawal syndrome sought. It is suggested that the studies conducted to date do not provide a strong evidence base for the drawing of any conclusions as to the existence of a cannabis withdrawal syndrome in human users, or as to the cause of symptoms reported by those abstaining from the drug. On the basis of current research cannabis cannot be said to provide as clear a withdrawal pattern as other drugs of abuse, such as opiates. However, cannabis also highlights the need for a further defining of withdrawal, in particular the position that rebound effects occupy in this phenomenon. It is concluded that more controlled research might uncover a diagnosable withdrawal syndrome in human users and that there may be a precedent for the introduction of a cannabis withdrawal syndrome before the exact root of it is known.
α2‐Adrenergic agonists in opioid withdrawal
Authors: Gowing Linda R. , Farrell Michael , Ali Robert L. , White Jason M.
Published: March 2003

Objectives This paper presents the main findings of a systematic (Cochrane) review of the effectiveness of α2‐adrenergic agonists in managing opioid withdrawal.

Design The original systematic review included controlled trials that compared α2‐adrenergic agonists with another form of treatment (or placebo) in participants who were primarily opioid‐dependent.

Main findings Ten studies compared a treatment regime based on an α2‐adrenergic agonist with one based on reducing doses of methadone. Withdrawal intensity is similar to, or marginally greater with α2‐adrenergic agonists, but signs and symptoms of withdrawal occur and resolve earlier in treatment. Participants stay in treatment longer with methadone. The likelihood of completing withdrawal is similar, or slightly less, with clonidine or lofexidine. Clonidine is associated with more adverse effects than reducing doses of methadone. Three studies compared the α2‐adrenergic agonists, clonidine and lofexidine. Lofexidine does not reduce blood pressure to the same extent as clonidine, but is otherwise similar to clonidine.

Conclusions Participants stay in treatment longer with methadone regimes, which may provide greater opportunity for psychosocial intervention. Methadone regimes may be preferable for withdrawal in outpatient settings where the risk of relapse to heroin use is high. The use of methadone may also facilitate transfer to maintenance treatment should completion of withdrawal become unlikely. For those who are well prepared for withdrawal and seeking earlier resolution of withdrawal symptoms, α2‐adrenergic agonist treatment may be preferred. Clonidine and lofexidine appear equally effective for inpatient settings, but the lower incidence of hypotension makes lofexidine more suited to use in outpatient settings.
The effects of drug abuse prevention at school: the ‘Healthy School and Drugs’ project
Authors: Cuijpers Pim , Jonkers Ruud , De Weerdt Inge , De Jong Anco
Published: March 2003

Aims To examine the effects of the ‘Healthy School and Drugs’ project, a Dutch school‐based drug prevention project that was developed in the late 1980s and disseminated during the 1990s. This programme is currently being used by 64–73% of Dutch secondary schools and it is estimated that at least 350 000 high school students receive this intervention each year.

Design, setting and participants A quasi‐experimental study in which students of nine experimental (N = 1156) schools were compared with students of three control schools (N = 774). The groups were compared before the intervention, 1 year later, 2 years later and 3 years later.

Measurements Self‐report measures of tobacco, alcohol and marijuana use, attitudes towards substance use, knowledge about substances and self‐efficacy.

Findings Some effects on the use of tobacco, alcohol and cannabis were found. Two years after the intervention, significant effects could still be shown on alcohol use. Effects of the intervention were also found on knowledge, but there was no clear evidence for any effects on attitude towards substance use and on self‐efficacy.

Conclusions This study shows the Healthy School and Drugs project as implemented in Holland may have some effect on drug use in the children exposed to it.
Excess alcohol consumption and health outcomes: a 6‐year follow‐up of men over age 50 from the health and retirement study
Authors: Perreira Krista M. , Sloan Frank A.
Published: March 2003

Aims This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6‐year follow‐up period.

Setting We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51–61 and their spouses living in the United States in 1992.

Measurements Five types of health outcomes—mortality, general health, functional status, cognitive status, and mental health—were examined. Drinking categories were based on average drinks per day (0, <1, 1–2, 3–4, 5+), with 5 + defined as ‘very heavy drinking’. Problem drinking history was identified as 2+ affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline.

Findings Over the 6‐year follow‐up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95% CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95% CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47, 3.13) and memory problems (OR: 1.71 95% CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke).

Conclusion Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.
The long‐term effectiveness of brief interventions for unsafe alcohol consumption: a 10‐year follow‐up
Authors: Wutzke Sonia E. , Conigrave Katherine M. , Saunders John B. , Hall Wayne D.
Published: March 2003

Aims To examine the long‐term impact of brief and early interventions for hazardous and harmful alcohol consumption.

Design A 9‐month and 10‐year follow‐up of subjects recruited into a randomized controlled trial of a range of alcohol‐related brief interventions.

Setting General practices, the outpatient or acute care services of a major city hospital, and a privately run health screening programmeme.

Participants The cohort of 554 (non‐dependent) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption.

Intervention The effectiveness of three forms of intervention, ranging from 5 to 60 minutes in duration, were compared with a no‐treatment control condition.

Measurements Included drinking behaviour and biological markers of alcohol use. In addition, at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol‐related psychological, social and physical harm. Mortality was also assessed.

Findings Results provide further evidence for the short‐term effectiveness of alcohol‐related brief interventions. In comparison to controls, subjects offered intervention: (1) report significantly lower consumption; and (2) less unsafe drinking at 9‐month follow‐up. The intensity of intervention was not related to the amount of change in drinking behaviour. Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption, mean reduction in consumption from baseline to follow‐up, mortality and ICD‐10 diagnoses of alcohol dependence or harmful alcohol use.

Conclusions This study failed to find evidence that brief advice and counselling without regular follow‐up and reinforcement can sustain significant long‐term reductions in drinking behaviour at 10‐year follow‐up.
The Benzodiazepine Withdrawal Symptom Questionnaire: psychometric evaluation during a discontinuation program in depressed chronic benzodiazepine users in general practice
Authors: Couvée Jaap E. , Zitman Frans G.
Published: March 2003

Background The Benzodiazepine Withdrawal Symptom Questionnaire (BWSQ, Tyrer et al. 1990) has been developed to measure distinct features of the benzodiazepine withdrawal syndrome. However, psychometric evaluations of this questionnaire are scarce.

Aims, setting To evaluate the BWSQ during a discontinuation program carried out by general practitioners in 230 depressed chronic benzodiazepine users.

Findings Reliability coefficients during the program were between 0.84 and 0.88 and the test‐retest correlations were between 0.75 and 0.88 during withdrawal. Mean scores of the BWSQ during withdrawal differentiated between completers and failures (p = 0.036). The factor structure underlying the items consisted of perceptual and sensory disturbances, dysphoric mood, muscular pain and memory loss. Low scores during the last phase of tapering off predicted no, or limited, use of benzodiazepines in the first years following discontinuation (p = 0.003).

Conclusions We found the BWSQ to measure symptoms during benzodiazepine withdrawal in a reliable way. Our findings indicate some construct validity for BWSQ. Low scores during withdrawal predict more limited future use of benzodiazepines.
The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers
Authors: Dobkin Patricia L. , Civita Mirella De , Paraherakis Antonios , Gill Kathryn
Published: March 2003

Aims The goals of this study were: (1) to compare patients with high and low functional social support at intake and 6 months later on various risk factors; (2) to test the stress‐buffering role of functional social support on treatment outcomes, and (3) to determine whether levels of functional social support at intake predicted treatment retention.

Design Consecutive admissions to an outpatient treatment program were assessed at intake (n = 206) and at 6 month follow‐up (n = 172) using the Addition Severity Index (ASI). Patients completed questionnaires pertaining to social support, stress and psychological functioning both at intake and at 6 months.

Findings Both high and low social support groups experienced marked declines in negative affect and in the severity of substance abuse over time. There were some group differences: for example, symptoms of depression and psychological distress were higher among patients with low social support at intake and at 6 months. Patients with low social support at intake reported higher severity of alcohol and drug abuse at 6 months. Hierarchical regression analyses showed that functional social support was a modest predictor of reductions in the severity of alcohol abuse at follow‐up, after controlling for the number of days in treatment. Higher levels of social support explained a modest (6%) proportion of the variance in alcohol‐related outcomes, but did not predict reductions in drug abuse. Survival analysis demonstrated that the rate of dropping out of treatment was significantly higher for patients with low social support.

Conclusions Higher functional social support at intake is a positive predictor of retention in treatment, and a modest predictor of reductions in alcohol intake, but not in drug use. Overall, social support accounts for a small percentage of the variance in drug/alcohol‐related outcomes, underscoring the need for further research into variables accounting for treatment success and failure.
Patterns of association between alcohol consumption and symptoms of depression and anxiety in young adults
Authors: Caldwell T. M. , Rodgers B. , Jorm A. F. , Christensen H. , Jacomb P. A. , Korten A. E. , Lynskey M. T.
Published: March 2003

Aims Recent epidemiological findings indicate that non‐drinkers as well as hazardous/harmful drinkers experience higher levels of distress than moderate drinkers. Little is known about the age at which this develops. This paper examines levels of affect, depression and anxiety over the full range of alcohol consumption in young adults.

Design Cross‐sectional findings from the first wave of a prospective, longitudinal study are presented.

Participants The general population sample comprised of 2404 young adults (aged 20–24 years), living in the Canberra region. Measures included: the Goldberg Depression and Anxiety scales, the Positive and Negative Affect Schedule, and the Alcohol Use Disorders Identification Test.

Findings For men, both non/occasional and hazardous/harmful consumption were associated with lower levels of positive affect and higher levels of anxiety and depression. The higher levels of distress evident for male abstainers were related to being less extroverted and less healthy and not to past hazardous/harmful alcohol consumption, current tobacco or marijuana use. For women, only hazardous/harmful drinkers were found to have higher levels of depression and negative affect. Hazardous/harmful consumption was related to using marijuana, tobacco and recent stressful events in both men and women.

Conclusions Higher levels of distress are already evident in male non‐drinkers in early adulthood. The findings counter theories that distress in non‐drinkers is due to past hazardous/harmful alcohol consumption, marijuana or tobacco use, or characteristics in common with hazardous/harmful drinkers. Alcohol use disorders and mental health problems are pertinent issues for young adults. However, more understanding is needed of the experiences of non‐drinkers in an alcohol consuming culture.
Sedative use and misuse in the United States
Authors: Goodwin Renee D. , Hasin Deborah S.
Published: March 2003

Objective To determine the prevalence and correlates associated with sedative use and misuse in the general population.

Method Data were drawn from the National Comobidity Survey (n = 8098), a representative sample of adults in the community. Multivariate logistic regression analyses were used to identify correlates of sedative use, non‐prescription use and self‐perceived dependence.

Results The life‐time prevalence of self‐perceived sedative dependence was 0.5%, 7.1% reported non‐prescribed sedative use and 17.0% had been prescribed sedatives and denied misuse. Individuals who used sedatives without a prescription were more likely to be male (OR = 0.61 (0.44, 0.86)), have lower income (OR = 0.71 (0.54, 0.94)), more education (OR = 1.51 (1.17, 1.96)), major depression (OR = 1.47 (1.04, 2.08)), agoraphobia (OR = 1.59 (1.09, 2.32)), ASPD (OR = 5.29 (3.42, 8.20)) and suicide ideation (OR = 1.91 (1.23, 2.94)), compared with those who did not use sedatives. Individuals with self‐perceived dependence on sedatives were older (OR = 1.05 (1.02, 1.08)), had less education (OR = 0.2 (0.1, 0.7)) and were more likely to have a parent who abused prescription medications (OR = 4.3 (1.03, 18.03)), compared with those without sedative dependence.

Conclusions Almost one in 10 adults report misuse of sedatives in their life‐time. Sedative use and misuse are associated with high levels of psychopathology and suicide risk, and show a specific association with parental abuse of prescription medications in the general population. Future work to understand more effectively the nature of these associations may ultimately lead to improved effectiveness of preventive interventions.
Gender differences in help‐utilization and the 8‐year course of alcohol abuse
Authors: Timko Christine , Moos Rudolf H. , Finney John W. , Connell Ellen G.
Published: March 2003

Aims

The aim of this study was to compare initially untreated women and men problem drinkers on help‐utilization and outcomes over 8 years.

Design and participants

At the time of the 8‐year follow‐up, individuals (N = 466, 49% female) had self‐selected into four groups: no help, Alcoholics Anonymous (AA) only, formal treatment only or formal treatment plus AA.

Measurements

At baseline and 1, 3 and 8 years later, participants completed measures of drinking and functioning.

Findings

Women were generally worse off than men on baseline drinking and functioning indices. In keeping with their poorer baseline status, women were more likely to participate in AA, and had longer in‐patient stays during the next year. When women's baseline status was controlled, women had better outcomes than did men at 1 and 8 years. Generally, women and men did not differ on the extent to which obtaining help, or a particular type of help, was related to improved outcomes. Regarding drinking outcomes, women benefited more than did men from more AA attendance during years 2–8 of follow‐up.

Conclusions

The results suggest that although alcoholism interventions were designed primarily for men, they are currently delivered in ways that are also useful to women. Problem‐drinking women appear to benefit from sustained participation in AA, which emphasizes bonding with supportive peers to maintain abstinence.
Educational and occupational attainment and drinking behavior: an expectancy model in young adulthood
Authors: McCarthy Denis M. , Aarons Gregory A. , Brown Sandra A.
Published: March 2003

Aims The socio‐economic status (SES) variables of education level and occupational functioning have been found to be correlated negatively with alcohol use. The present study examined prospectively the relationship between these functioning measures, alcohol expectancies and alcohol involvement. We propose that expectancies function as a mediator of the relationship between educational/occupational attainment and drinking behavior. We hypothesized that changes in young adult functioning are linked to changes in social context and/or the availability of non‐alcohol reinforcers, which in turn affect the reinforcement expected from alcohol.

Participants and design Participants were 172 young adults from an ongoing longitudinal study of long‐term
clinical course of adolescent substance use treatment. Data from 6‐ and 8‐year follow‐ups
were used in the present analyses. The treated sample (n = 100) was recruited
from in‐patient substance abuse treatment programs for adolescents. A community sample
(n = 72) was matched on family history of substance abuse and SES at intake.

Findings A cross‐lag panel analysis indicated that education had a unique longitudinal relationship with expectancy for both the treated and community sample, over and above previous alcohol use and expectancy. Occupational variables did not have a longitudinal relationship with alcohol use and expectancy for either sample. Expectancies mediated the education/drinking relationship for the treated sample only.

Conclusions These results suggest one means through which changes in functioning may alter alcohol involvement over time: alteration of the reinforcement expected from alcohol.
Process and outcome changes with relapse prevention versus 12‐Step aftercare programs for substance abusers
Authors: Brown Thomas G. , Seraganian Peter , Tremblay Jacques , Annis Helen
Published: March 2003

Aims Presumptive support was sought for mechanisms of action whereby two conceptually distinct aftercare programs, relapse prevention (RP) and 12‐Step facilitation (TSF), impact upon substance abusers.

Patients and design Adults who had just completed intensive treatment were assigned randomly to either
RP (n = 61) or TSF (n = 70) aftercare programs.

Setting Three residential treatment facilities.

Interventions Trained counselors delivered to small groups a manualized aftercare program which focused either upon the utilization of cognitive–behavioral processes to orchestrate change through an individualized treatment plan (i.e. RP) or which sought to facilitate utilization of AA’s 12 Steps (i.e. TSF).

Measurements Process measures developed specifically to quantify either: (a) the changes in self‐efficacy process in RP or (b) the utilization of AA’s principles in TSF, as well as psychosocial and substance abuse indices were administered to all patients pre‐ and post‐aftercare and at 6‐month follow‐up.

Findings A significant relationship between changes in measures of self‐ efficacy for RP participants as well as a trend for a relationship between process‐specific change for TSF participants partially satisfied the first condition for presumptive support. The fact that the intervention‐specific mediators covaried with several outcome indices, and that removal of such mediators attenuated prediction of outcome met, respectively, the second and third conditions for presumptive support.

Conclusion Carefully orchestrated RP and TSF aftercare programs yield process changes that are related positively to improved outcome.
Effect of a GP desktop resource on smoking cessation activities of general practitioners
Authors: McEwen Andy , Preston Andrew , West Robert
Published: March 2003

Objectives To evaluate an intervention aimed at increasing the quantity and quality of brief opportunistic general practitioner (GP) advice to smokers encouraging and supporting quit attempts.

Design Randomized controlled trial with two groups: (1) control and (2) GP desktop resource (GDR). Smoking cessation activities of GPs were assessed by an independent postal survey 1 month after distribution of resource.

Subjects and setting One hundred and seven GPs in West Dorset.

Main outcome measures GPs’ self‐reported rates of advising and counselling smokers on cessation over the previous week.

Results The rate of opportunistic advice per week in the GDR group was 4.9 (SD = 4.1), compared with 2.8 (SD = 1.8) in the control group, F = 8.2, p = 0.0025, one‐tailed. The rate of giving counselling was
also higher 2.2 (SD = 3.2) in the intervention group versus 1.0 (SD = 1.4) in the
control group, F = 4.0, p = 0.025, one‐tailed. The proportion who had
recommended or prescribed NRT was greater, although not significantly (54%
versus 46%, Fisher’s exact p = 0.1, one‐tailed).

Conclusions The findings indicate that the GDR can increase the rate of delivery of opportunistic advice and provision of counselling. Given the importance of this activity, a larger trial appears to be warranted to examine the long‐term effect and the effect on cessation rates in patients.
Beyond theU‐curve: the relationship between sport and alcohol, cigarette and cannabis use in adolescents
Authors: Peretti‐Watel Patrick , Beck François , Legleye Stéphane
Published: March 2003

AimsThis study aimed at increasing understanding of the relationship between sporting activities and alcohol, cigarette and cannabis use among adolescents, by examining gender, age and the context of sporting practice.

Design, setting, subjectsThe study was a national school survey (n= 10807; ages 14–19 years) conducted in France in 1999.

MeasuresRespondents were asked confidentially by self‐administered questionnaire (pen and paper) about their use of licit and illicit drugs and life‐style (including sporting activities outside school: hours per week, registration in a club, type of sport).

FindingsTheU‐shaped curve between the intensity of physical activities and licit and illicit drug use appeared not to be systematic. It depended mainly on the product and the level of use. It only remained significant for boys and heavy smoking once gender and age effect were taken into account.

ConclusionThe results stress the need to control for age and gender when the survey participants are teenagers. The relationship between drug use and sporting activity also depends on the type of sport.
Illicit drug initiation among institutionalized drug users in China
Authors: Li Xiaoming , Zhou Yong , Stanton Bonita
Published: March 2003

Aims To examine the circumstances and correlates associated with initiation of illicit drug use among institutionalized drug users in China.

Design Cross‐sectional, retrospective study.

Settings Six compulsory drug cessation programs in Yunnan Province and Gunagxi Zhuang Autonomous Region of China.

Participants A gender‐stratified random sample of 833 drug users (88% males and 12% females) enrolled in compulsory drug cessation programs in November 1996.

Measurements Circumstances of illicit drug initiation (age, type of drugs, routes of drug administration, social setting, source of drugs, reasons for drug use), the risk behaviors and risk perceptions prior to drug initiation.

Findings The majority of participants initiated drug use with heroin (90%). Initial drugs were frequently administered through sniffing/snorting (55%) and smoking cigarettes mixed with a drug (38%). First drug use occurred most commonly at a friend’s home (65%) and in the company of other drug users (83%). Drugs were generally provided free for first‐time use by other drug users (72%). Reasons for first drug use included experimentation (90%), being lured into drugs by other people (44%) and relaxation (42%). Most drug users had a history of regular cigarette smoking (89%), alcohol consumption (49%) and deviant behaviors (51%) prior to their drug initiation. The majority perceived that their friends (90%) and neighbors (88%) used illicit drugs.

Conclusions The findings are similar to studies in western countries with respect to the pattern and correlates of illicit drug initiation, and underscore the need for drug prevention efforts in China.
Treatment of out‐patients with complicated benzodiazepine dependence: comparison of two approaches
Authors: Vorma Helena , Naukkarinen Hannu , Sarna Seppo , Kuoppasalmi Kimmo
Published: March 2003

Aims

To evaluate whether gradual benzodiazepine taper combined with cognitive‐behavioural treatment is more effective than standard treatment for patients with dependence in out‐patient clinics.

Design

A randomized, controlled clinical trial, using standard questionnaires and serum and urine tests.

Settings

Four public‐sector out‐patient clinics for alcohol and drug abusers in Helsinki.

Participants

Seventy‐six patients with benzodiazepine dependence (DSM‐III‐R). Patients taking high doses of the drug or with alcohol use disorders were included to obtain a subject group representative of usual clinical practice.

Intervention

Subjects received gradual benzodiazepine taper combined with cognitive‐behavioural therapy (experimental group) or standard withdrawal treatment not scheduled by the researchers (control group).

Measurements

The outcome was measured in terms of attaining a state of abstinence or by a decrease in the dosage during the study period of up to 12 months’ duration.

Findings

No statistically significant differences in the outcomes were observed between the groups. A total of 13% of the experimental group and 27% of the control group were able to discontinue drug use. In addition 67% of the experimental group and 57% of the control group were able to decrease the dose.

Conclusions

The search continues for improved methods of helping patients with complicated benzodiazepine dependence.
Prevalence of and risk factors for methamphetamine use in northern Thai youth: results of an audio‐computer‐assisted self‐interviewing survey with urine testing
Authors: Sattah Martin V. , Supawitkul Somsak , Dondero Timothy J. , Kilmarx Peter H. , Young Nancy L. , Mastro Timothy D. , Chaikummao Supaporn , Manopaiboon Chomnad , Griensven Frits van
Published: March 2003

Aims

Data from drug treatment facilities, drug seizures and drug arrests suggest rapidly increasing methamphetamine use by adolescents in Thailand. However, limited quantitative data are available about the prevalence of its use or correlates of use. The purpose of our study was therefore to estimate the prevalence of methamphetamine use and to identify possible risk factors.

Design

Cross‐sectional survey using anonymous audio‐computer‐assisted self‐interview and urine specimen analysis.

Setting

Chiang Rai Province, Thailand.

Participants

1725 students, 15–21 years of age (893 male and 832 female) attending one of three vocational schools in Chiang Rai Province.

Findings

Three hundred and fifty male and 150 female students reported a history of having ever used methamphetamine. In addition, 128 male and 49 female students had positive urine test results, indicating recent methamphetamine use; 27 of these students denied having ever used methamphetamine. According to history, urine test, or both, 41.3% of male students and 19.0% of female students used methamphetamine. In multivariate analysis, methamphetamine use was highly correlated with the use of other substances, sexual activity, peer pressure, positive attitudes toward methamphetamine, and absence of a family confidant.

Conclusions

Methamphetamine use is common among adolescent students in northern Thailand. Demographic, behavioral and psychosocial correlates of methamphetamine use identified in this study may be helpful for the design and implementation of preventive interventions.
ERIT‐Italia, the Italian Federation for Professionals Working in the Field of Drug Abuse
Authors: Nizzoli Umberto , Foschini Vittorio
Published: March 2003

What is ERIT‐Italia? In what cultural context was it founded and in what state were the services for drug dependency at that time? What has it produced in recent years? Can a professional association successfully work alongside administrations and governments to contribute to the development of effective treatment for drug addiction? It is these questions which are addressed in this description of the major Italian professional body concerned with drug misuse.
Childhood and adolescent antecedents of substance use in adulthood
Authors: Ensminger Margaret E. , Juon Hee Soon , Fothergill Kate E.
Published: March 2003

Aims

To examine childhood antecedents of marijuana and cocaine use in adulthood.

Design

Epidemiological, longitudinal cohort study of African American first graders (age 6) followed to age 32.

Participants

Children (N = 1242) and families in the 57 first grade classrooms from Woodlawn, an inner‐city community in Chicago. First grade teachers, mothers and children provided assessments over the life course. During adulthood, 952 participants were re‐interviewed.

Measurements

First grade teacher behavior ratings, readiness for school tests, self‐reports of adolescent drug use, social bonds and adult self‐reports of drug use were the primary variables.

Findings

Males who were both shy and aggressive in first grade were more likely to be adult drug users compared to those who were neither. Shy females in first grade were less likely to be adult marijuana users than non‐shy females. Adolescent social bonds did not moderate the relationships of earlier childhood behavior to adult drug use. Males who had a ‘high/superior’ readiness to learn scores in first grade were less likely to be cocaine users as adults, even though in earlier work we showed that they were more likely to initiate adolescent drug use. Females scoring as poor performers in first grade were less likely to ever use cocaine compared to females with higher scores.

Conclusions

The combination of shy and aggressive behavior is an important antecedent for later male drug use and may help distinguish those who will be persistent users in adulthood from those who experiment in adolescence.
Real‐world efficacy of prescription and over‐the‐counter nicotine replacement therapy
Authors: Shiffman Saul , Rolf Clyde N. , Hellebusch Stephen J. , Gorsline Jane , Gorodetzky Charles W. , Chiang Yu‐Kun , Schleusener Debra S. , Marino Michael E. Di
Published: March 2003

AimsTo assess smoking cessation rates achieved with nicotine gum and patch in simulated over‐the‐counter (OTC) and actual prescription (Rx) settings.

DesignSeparate open‐label studies with gum and patch in OTC and Rx settings.

ParticipantsThere were multiple samples: OTC gum: 2981 smokers; OTC patch: 2367; Rx gum: 324; Rx patch: 669.

InterventionsAll smokers received active nicotine replacement. In the OTC setting, smokers self‐selected doses of nicotine gum (2 or 4 mg Nicorette®) or patch (21, 14 or 7 mg NicoDerm®CQ). No intervention was provided. In the Rx setting, smokers were prescribed gum or patch by their physician.

MeasurementsBiochemically verified continuous smoking abstinence was assessed at 6 weeks (28‐day abstinence) and 6 months.

FindingsOTC success rates were consistently higher than Rx rates: differences were significant at 6 weeks for both patch [OR = 1.45 (1.05–1.98)] and gum [OR = 2.92 (1.58–5.40)], and remained significant at 6 months for patch [OR = 3.63; (1.74–7.61)] but not gum [OR = 1.37; (0.73–2.58)]. Among OTC gum users, 16.1% were abstinent at 6 weeks and 8.4% at 6 months. For Rx gum users, abstinence rates were 7.7% at 6 weeks and 7.7% at 6 months. With OTC patch, 19.0% were abstinent at 6 weeks and 9.2% at 6 months. With Rx patch, abstinence rates were 16.0% at 6 weeks and 3.0% at 6 months.

ConclusionsSmoking cessation rates achieved with nicotine gum and patch under OTC conditions were as good as those under real‐world prescribing conditions.
Cohort effects on gender differences in alcohol dependence
Authors: Holdcraft Laura C. , Iacono William G.
Published: March 2003

Aims The present study investigated the presence of cohort effects on gender differences in the course, severity and symptomatology of DSM‐III‐R alcohol dependence in a community‐based sample.

Design A comparison of substance‐related variables among men and women divided into two groups based on the median birth year of the sample was conducted.

Participants Participants were 468 men and 132 women with life‐time alcohol dependence, the vast majority of whom were born between 1941 and 1960.

Measurements Substance use and DSM‐III‐R substance use disorders were assessed by a structured interview administered in person.

Findings Individuals born after 1951 had higher rates of alcohol dependence. Among individuals with alcohol dependence, those born after 1951 had an earlier onset and longer duration of alcohol‐related problems. Significant interactions indicated that these effects were stronger for women than men.

Conclusions Risk for alcohol dependence appears to be rising in younger generations, and particularly for younger women, making them an important target group for prevention and treatment programs.
Methamphetamine in Japan: the consequences of methamphetamine abuse as a function of route of administration
Authors: Matsumoto Toshihiko , Kamijo Atsushi , Miyakawa Tomohiro , Endo Keiko , Yabana Tatsuo , Kishimoto Hideji , Okudaira Kenichi , Iseki Eizo , Sakai Takeshi , Kosaka Kenji
Published: March 2003

Aims

To determine differences in life backgrounds and clinical features between methamphetamine (MAP) smokers and injectors in Japan.

Setting

Out‐patient clinic at a psychiatric centre.

Participants

Among 451 MAP abusers undergoing initial assessments, 116 subjects whom the first author had directly interviewed and treated were studied.

Design and Procedures

In this study, life backgrounds, clinical features and psychiatric symptoms were compared between three subgroups: 42 (36.2%) in group S (smoking only); 57 (49.1%) in group I (injection only); and 17 (14.7%) in group SI (initially smoking, later injecting).

Findings

Group I more often had parental absence (P < 0.001), a family history of alcoholism (P < 0.05), limited education (P < 0.001), or a criminal record (P < 0.001) than patients in the other two groups. Group S had the most cannabis use (P < 0.01), while group I had the most volatile solvents use (P < 0.01). Group S experienced their first psychotic episode sooner after first MAP use (P < 0.01), but showed fewer auditory hallucinations at intial assessment than patients in other groups (P < 0.001). Group SI was intermediate between groups S and I in life background, clinical features and psychotic symptoms, while they had lost control of their drug use most frequently (P < 0.02).

Conclusions

In Japan, MAP smokers have different life backgrounds from injectors. Smoking MAP does not appear to be a safer route as regards losing control of MAP use and inducing psychosis than injection.
Alcohol sales and fatal alcohol poisonings: a time‐series analysis
Authors: Poikolainen Kari , Leppänen Kalervo , Vuori Erkki
Published: March 2003

Aims To discover whether the number of fatal alcohol peaks during festivities characterized by unrestrained drinking and relates to sales of alcoholic beverages.

Design Time‐series and cross‐sectional.

Data Fatal alcohol poisonings and retail alcohol sales in Finland in 1983–99.

Findings Fatal alcohol poisonings were found to peak during weekends and in the May Day, Midsummer Day and Christmas celebrations. Regression analysis of quarterly series lead to a model showing that 1% increase in the sales of spirits increases the number of fatal alcohol poisonings by 0.4%.

Conclusions At the population level, increases in the sales of spirits and periods of hard drinking seem to increase deaths from alcohol poisoning. The findings could be of use in efforts to decrease hard drinking.
An increase in overdose mortality during the first 2 weeks after entering or re‐entering methadone treatment in Amsterdam
Authors: Buster Marcel C. A. , Brussel Giel H. A. van , Brink Wim van den
Published: March 2003

Aims It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment.

Design A dynamic cohort of 5200 Amsterdam methadone clients was observed during treatment and (a maximum of 1 year) after treatment.

Findings Between 1986 and 1998, 29 729 person‐years (py) and 68 overdose deaths were recorded, leading to an overdose mortality rate of 2.3/1000 py (2.2 during and 2.4 after treatment). A modest increase was observed during the first 2 weeks after (re)entering treatment; 6.0/1000 py (rate ratio: 2.9; 95% confidence interval 1.4; 5.8). Directly after leaving treatment no increase was observed.

Conclusions Inhaling heroin, common among Amsterdam heroin users, is thought to account for low OD mortality rates both during and after treatment. Accumulation of methadone, inadequate assessment of tolerance of known clients re‐entering treatment and concurrent periods of stress or extreme heroin use when entering treatment are mentioned as possible explanations of the increased risk within the first 2 weeks. An Australian study reported a much higher increase. The modest increase in Amsterdam is explained by low background risk of overdose mortality, low starting dosage and the low threshold to treatment.
Trends in opiate and opioid poisonings in addicts in north‐east Paris and suburbs, 1995–99
Authors: Gueye P. N. , Megarbane B. , Borron S. W. , Adnet F. , Galliot‐Guilley M. , Ricordel I. , Tourneau J. , Goldgran‐Toledano D. , Baud F. J.
Published: March 2003

Aims

(1) To assess the trends in the number, mortality and the nature of severe opiate/opioid poisonings from 1995 to 1999 in north‐east Paris and adjacent suburbs and (2) to examine the effects of the introduction of high‐dose buprenorphine on these parameters.

Design

Retrospective, 5‐year study with review of pre‐hospital, hospital and post‐mortem data.

Setting and participants

Eighty patients from the toxicological intensive care unit (TICU) in north‐east Paris, 421 patients from the pre‐hospital emergency medical service in a north‐east suburb of Paris (SAMU 93) and 40 deaths from the coroner's office in Paris.

Measurements and results

We found that the number of pre‐hospital opiate/opioid poisonings and deaths decreased over 5 years. During the same time frame, opiate/opioid poisoning admissions to our TICU remained steady, but the number of deaths declined. From 1995 to 1999, the detection of buprenorphine among opiate/opioid‐poisoned TICU patients increased from two to eight occurrences per year while detection of opiates diminished from 17 to 10 occurrences per year. Increased buprenorphine detection correlated directly with increasing sales over this time period. In spite of the increased use of buprenorphine, the mortality associated with opiate/opioid poisonings has diminished in the pre‐hospital environment from 9% in 1995 to 0% in 1999, and in the TICU from 12% in 1995 to 0% in 1997 and thereafter. We found a high frequency of multiple opiate/opioid use in severe poisonings, as well as the frequent association of other psychoactive drugs including ethanol.

Conclusions

The number and the mortality of opiate/opioid poisonings appear to be stable or decreasing in our region. The association of multiple opiates/ opioids appears nearly as common as the association with other psychoactive drugs. The introduction of high‐dose buprenorphine coincides with a decrease in opiate/opioid poisoning mortality. Further study will be necessary to clarify this observation.