bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence and correlates of gamma‐hydroxybutyrate (GHB) overdose among Australian users
Authors: Degenhardt Louisa , Darke Shane , Dillon Paul
Published: March 2003

Aim  The aim of this study was to examine the correlates, context and risk perceptions regarding gamma‐hydroxybutyrate (GHB) overdose among a sample of recreational GHB users in Australia.

Design  A cross‐sectional survey of 76 GHB users who were administered a structured interview on GHB use. They were asked a series of questions regarding whether they had ever experienced a GHB overdose, the context of their most recent GHB overdose, and about their perceptions of the risks of GHB overdose.

Findings  This sample of GHB users had not had a long or extensive experience with GHB use; despite this, half (53%) had experienced a GHB overdose. This sample of GHB users appeared to be well‐educated, employed and a history of either drug treatment or incarceration was uncommon. There were no differences between those who had or had not overdosed in terms of socio‐demographic characteristics, extent of other drug use or typical patterns of other drug use when using GHB. However, those who had overdosed on GHB had used it more times during their life‐time, and had been using it for a longer period of time.

Conclusions  GHB‐related overdoses were common among a sample of GHB users who had only recently begun using the drug. The only apparent distinguishing factor between those who had and had not overdosed on GHB was the amount of experience with GHB use.
A flicker paradigm for inducing change blindness reveals alcohol and cannabis information processing biases in social users
Authors: Jones Barry T. , Jones Ben C. , Smith Helena , Copley Nicola
Published: March 2003

Aim  To apply a new paradigm using transient changes to visual scenes to explore information processing biases relating to ‘social’ levels of alcohol and cannabis use.

Participants  Male and female student volunteers (n = 200) not self‐reporting substance‐related problems.

Setting  Quiet testing areas throughout the university campus.

Design  A flicker paradigm, for inducing change blindness with lighter and heavier social users of alcohol (experiment 1, n= 100) and social users and non‐users of cannabis (experiment 2, n= 100), explored the associations between habitual level of use and the latency to detection of a single substance‐related or neutral change made to a scene of grouped substance‐related and neutral objects.

Measurements  Alcohol use was measured as the number of units of the heaviest drinking day from the previous week; cannabis use as the number of months of use in previous 12. Change–detection latency comparisons were used to evaluate processing biases.

Findings  In both experiments, (i) heavier social users detected substance‐related changes quicker than lighter and non‐users; (ii) lighter and non‐users detected substance‐neutral changes quicker than heavier users; (iii) heavier social users detected substance‐related quicker than substance‐neutral changes; and (iv) lighter and non‐users detected substance‐neutral changes quicker than substance‐related changes.

Conclusions  Alcohol and cannabis processing biases are found at levels of social use, have the potential to influence future consumption and for this reason merit further research.
Drug use patterns and infection with sexually transmissible agents among young adults in a high‐risk neighbourhood in New York City
Authors: Friedman Samuel R. , Flom Peter L. , Kottiri Benny J. , Zenilman Jonathan , Curtis Richard , Neaigus Alan , Sandoval Milagros , Quinn Thomas , Des Jarlais Don C.
Published: March 2003

Aims To determine relationships between drug use ‘hardness’ (defined in increasing order of hardness as no drug use, marijuana use, non‐injected heroin or cocaine use, crack smoking and injection drug use) and prevalences of several sexually transmissible infections among young adults in a high‐risk neighbourhood. Drug users, particularly injection drug users and crack smokers, may be a core group for some sexually transmitted infections.

Design Cross‐sectional survey and assays of young adults from (a) a household probability sample and (b) a targeted sample of youth who have used injected drugs, crack, other cocaine or heroin.

Setting Bushwick, an impoverished New York City minority neighbourhood with major drug markets.

Participants A total of 363 18–24‐year‐olds from a household probability sample; 165 Bushwick 18–24‐year‐olds who have used injected drugs, crack, other cocaine or heroin.

Measurements Drug use by self‐report; serum‐ and urine‐based assays for HIV, hepatitis B and C, syphilis, gonorrhoea, chlamydia and herpes simplex (type 2).

Findings Household‐sample prevalences: HIV, hepatitis C and syphilis, 1%; gonorrhoea 3%; chlamydia 5%; past or present hepatitis B infection 8%; herpes simplex (type 2) 18%. In combined household and targeted samples, hepatitis C and HIV were concentrated among drug injectors. Herpes simplex (type 2), syphilis and hepatitis B increased among women with ‘hardest drug ever used’.

Conclusions Using ‘harder’ drugs is associated with some but not all of these infections. Prevention efforts should help youth avoid unsafe sex and higher‐risk drugs.
A multilevel analysis of change in alcohol consumption in Québec, 1993–98
Authors: Demers Andrée , Kairouz Sylvia
Published: March 2003

Aims  Changes in drinking are subgroup‐specific and vary by dimensions of drinking pattern. This study investigates changes in drinking patterns between 1993 and 1998 within various subgroups of Québec society.

Design  A multilevel design was used in which respondents (level 1) were nested within demographic groups (level 2).

Participants  Based on the 1993 and 1998 Québec Health and Social Surveys, 40 598 respondents (level 1) were nested within 220 groups (level 2) based on age, SES status, gender and the year of survey.

Measurements  The effect of group characteristics were assessed for various dimensions of drinking pattern.

Findings  A significant part of the variance in drinking pattern is attributed to group membership (ranging from 8.6% to 18.3%). Except for the frequency of heavy drinking episodes, the data revealed a significant increase between 1993 and 1998 on all drinking pattern dimensions, which was more marked for higher SES groups for current drinking status. However, the frequency of heavy drinking decreased among the lower SES groups and remained stable among the higher SES groups.

Conclusions  These results call for an increase in public health vigilance in monitoring trends in drinking patterns and their potential acute and chronic consequences.
The National Treatment Outcome Research Study (NTORS): 4–5 year follow‐up results
Authors: Gossop Michael , Marsden John , Stewart Duncan , Kidd Tara
Published: March 2003

Aims The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings.

Design, setting and participants The study used a longitudinal, prospective cohort design. Data were collected by structured interviews at intake to treatment, 1 year, 2 years and at 4–5 years. The sample comprised 418 patients from 54 agencies and four treatment modalities.

Measurements Measures were taken of illicit drug use, injecting and sharing injecting equipment, alcohol use, psychological health and crime.

Findings Rates of abstinence from illicit drugs increased after treatment among patients from both residential and community (methadone) programmes. Reductions were found for frequency of use of heroin, non‐prescribed methadone, benzodiazepines, injecting and sharing of injecting equipment. For most variables, reductions were evident at 1 year with outcomes remaining at about the 1 year level or with further reductions. Crack cocaine and alcohol outcomes at 4–5 years were not significantly different from intake.

Conclusions Substantial reductions across a range of problem behaviours were found 4–5 years after patients were admitted to national treatment programmes delivered under day‐to‐day conditions. The less satisfactory outcomes for heavy drinking and use of crack cocaine suggest the need for services to be modified to tackle these problems more effectively. Despite differences between the United Kingdom and the United States in patient populations and in treatment programmes, there are many similarities between the two countries in outcomes from large‐scale, multi‐site studies.
Prevalence of alcohol dependence in a town in Nepal as assessed by the CAGE questionnaire
Authors: Jhingan H. P. , Shyangwa Pramod , Sharma Avneet , Prasad K. M. R. , Khandelwal S. K.
Published: March 2003

Background  In spite of a perception that alcohol use is rampant in Nepal, there has been no survey to assess the extent of alcohol dependence in the country.

Aims  (i) To assess prevalence of alcohol dependence in the community of Dharan and (ii) to correlate this with various socio‐demographic characteristics.

Design  The CAGE questionnaire was administered to all adult individuals in houses selected randomly in the township of Dharan.

Findings  Among 2344 adults assessed, the prevalence of alcohol dependence was found to be 25.8%. The prevalence of alcohol dependence increased with age to peak in the age group 45–54 years and was more than twice as common in men as in women. Also, alcohol dependence was more common among those with lower level of education, widowers and divorcees and those belonging to the Matwali community. The extent of dependence was influenced by socio‐cultural sanctions.

Conclusions  The prevalence of alcohol dependence is too high for comfort in Dharan, a town in eastern Nepal. There is an urgent need to formulate a policy for substance abuse in the country taking into account the findings of this study.
Concomitant drugs of misuse and drug using behaviours associated with fatal opiate‐related poisonings in Sheffield, UK, 1997–2000
Authors: Oliver Phillip , Keen Jenny
Published: March 2003

Aims To examine the degree of involvement of concomitant drugs of misuse and other previously identified behavioural risk factors in acute accidental opiate‐related poisoning fatalities in Sheffield, 1997–2000.

Design Retrospective analysis of coroners’ records.

Setting Sheffield, UK.

Participants All those who died from an acute accidental opiate‐related poisoning in Sheffield between 1 January 1997 and 31 December 2000.

Measurements Coronial data were collated under the headings: demographic characteristics, circumstances of death and toxicological findings.

Findings Ninety‐four deaths occurred over the study period. The majority of cases were regular users of illicit drugs. Approximately 20% of deaths were preceded by a period of abstinence from drug use, with imprisonment and hospitalization as the most common reasons. Sixty‐one per cent of cases had concomitant drugs of misuse detected from toxicology most commonly benzodiazepines and/or alcohol. These were, however, found in relatively small concentrations and opiate blood concentrations were no lower in deaths where multiple substances were involved. Despite evidence to suggest that smoking is the preferred route of heroin administration in this region, the vast majority of cases involved injecting.

Conclusions Administration of an opiate via intravenous injection was the most consistent factor associated with these deaths over the period of this study. Co‐administration of other central nervous system depressants, at least in lower quantities appear to be a feature rather than a risk factorper sein such fatalities.
Does cannabis use predict poor outcome for heroin‐dependent patients on maintenance treatment? Past findings and more evidence against
Authors: Epstein D. H. , Preston K. L.
Published: March 2003

Aims  To determine whether cannabinoid‐positive urine specimens in heroin‐dependent out‐patients predict other drug use or impairments in psychosocial functioning, and whether such outcomes are better predicted by cannabis‐use disorders than by cannabis use itself.

Design  Retrospective analyses of three clinical trials; each included a behavioral intervention (contingency management) for cocaine or heroin use during methadone maintenance. Trials lasted 25–29 weeks; follow‐up evaluations occurred 3, 6 and 12 months post‐treatment. For the present analyses, data were pooled across trials where appropriate.

Setting  Urban out‐patient methadone clinic.

Participants  Four hundred and eight polydrug abusers meeting methadone‐maintenance criteria.

Measurements  Participants were categorized as non‐users, occasional users or frequent users of cannabis based on thrice‐weekly qualitative urinalyses. Cannabis‐use disorders were assessed with the Diagnostic Interview Schedule III‐R. Outcome measures included proportion of cocaine‐ and opiate‐positive urines and the Addiction Severity Index (at intake and follow‐ups).

Findings  Cannabis use was not associated with retention, use of cocaine or heroin, or any other outcome measure during or after treatment. Our analyses had a power of 0.95 to detect an r2 of 0.11 between cannabis use and heroin or cocaine use; the r2 we detected was less than 0.03 and non‐significant. A previous finding, that cannabis use predicted lapse to heroin use in heroin‐abstinent patients, did not replicate in our sample. However, cannabis‐use disorders were associated weakly with psychosocial problems at post‐treatment follow‐up.

Conclusions  Cannabinoid‐positive urines need not be a major focus of clinical attention during treatment for opiate dependence, unless patients report symptoms of cannabis‐use disorders.
Cumulative adversity and drug dependence in young adults: racial/ethnic contrasts
Authors: Turner R. Jay , Lloyd Donald A.
Published: March 2003

Aims To study cumulative exposure to stressors as a risk factor for drug dependence, and evaluate whether group differences in exposure contribute to differences in prevalence.

Design Cross‐sectional community survey of life‐time adverse experiences and substance and psychiatric disorders.

Setting Data collected between 1997 and 2000 in Miami–Dade County, USA.

Participants A total of 1803 former Miami–Dade public school students, 93% between ages 19 and 21 years when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African‐Americans and non‐Hispanic whites are represented equally.

Measurements Drug dependence disorder assessed by DSM‐IV criteria using the Composite International Diagnostic Interview, and a 41‐item checklist of life‐time exposure to major and potentially traumatic experiences. Both measures include age at time of first occurrence.

Findings Life‐time rate of drug dependence disorder (total 14.3%) did not vary significantly (P > 0.05) by socio‐economic group. Male rate (17.6%) was significantly greater than female rate (10.9%). The African‐American rate (6.5%) was dramatically lower than non‐Hispanic white (17.0%), Cuban (18.1%) and non‐Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty‐eight of 33 individual adversities were associated with the subsequent onset of drug dependence (P < 0.05). Cumulative life‐time exposure was greatest for males and for African‐Americans, and was associated inversely with socio‐economic level. Multivariate discrete‐time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (P < 0.05), controlling for childhood conduct disorder, attention deficit hyperactive disorder and previous psychiatric disorder.

Conclusions Life‐time cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, although it does not explain ethnic group differences in risk.
An evaluation of the Dartmouth Assessment of Lifestyle Inventory and the Leeds Dependence Questionnaire for use among detained psychiatric inpatients
Authors: Ford Peter
Published: March 2003

Aim  To examine the psychometric properties of the Dartmouth Assessment of Lifestyle Inventory (DALI) as a substance use disorder screening instrument, and the Leeds Dependency Questionnaire (LDQ) as a measure of severity of dependence among inpatients with severe mental disorders detained in hospital.

Design  Comparison of DALI scores, LDQ scores and a clinical assessment of substance use disorder. Statistical analysis calculated Cronbach's alpha, receiver operator characteristics, anova and multivariate linear regression.

Setting  An English medium secure psychiatric hospital.

Participants  A random sample of 60 adult inpatients with one or more diagnoses of schizophrenia, personality disorder and mild to moderate learning difficulty.

Measurements  All participants completed the LDQ, DALI and a clinical assessment of substance use disorder using ICD‐10 criteria.

Findings  The diagnostic accuracy of the DALI instrument was 74% for alcohol disorders and 83% for drug disorders. The reliability of the LDQ and concurrent validity with the DALI were good (a = 0.915, R2 = 0.439, F (2, 57) = 22.3, P < 0.001).

Conclusions  The DALI's overall accuracy for screening inpatients is good, but it under‐diagnosed substance use disorders, probably because the hospital environment moderates substance use. The results suggest that the LDQ has very good psychometric properties and is useful as a measure of substance dependence in this population. Furthermore, the validity of the LDQ in this clinical population provides evidence to suggest the same cognitive and behavioural processes of addiction operate among those inpatients with severe mental disorders detained in psychiatric hospital as in the general population.
The Finnish press's political position on alcohol between 1993 and 2000
Authors: Törrönen Jukka
Published: March 2003

Aims  To examine Finnish commentary on changes in alcohol policy between 1993 and 2000. Data. A corpus of newspaper editorials on alcohol issues from six daily newspapers published between 1993 and 2000.

Method  The editorials were analysed as ‘pending narratives’ by examining how they used ‘morally loaded binary discourse’, ‘utopian discourse’ and ‘truth discourse’.

Findings  Almost half the editorials discussed alcohol policy in terms of freedom from the restrictive alcohol policy of the state. Encouraging liberalization of alcohol policy peaked in 1996 and 1997. However, as problems of public order became more prominent in the media at the end of the 1990s, claims for the liberalization of alcohol policy died away and between 1998 and 2000 issues of public order dominated those of freedom. In addition, concern about the intoxication‐orientated drinking habits of the young and of children became prominent.

Conclusions  The results suggest that, after advocating more liberalized alcohol policy and then seeing that there were some groups who responded irresponsibly to this, the middle‐class concern about freedom turned into concern about the security of public places and this was reflected in the media. This analysis highlights the dynamic nature of public opinion and media advocacy in response to changes in policy.
Application of random‐effects regression models in relapse research
Authors: Hedeker Donald , Mermelstein Robin J.
Published: March 2003

This article describes and illustrates use of random‐effects regression models (RRM) in relapse research. RRM are useful in longitudinal analysis of relapse data since they allow for the presence of missing data, time‐varying or invariant covariates, and subjects measured at different timepoints. Thus, RRM can deal with "unbalanced" longitudinal relapse data, where a sample of subjects are not all measured at each and every timepoint. Also, recent work has extended RRM to handle dichotomous and ordinal outcomes, which are common in relapse research. Two examples are presented from a smoking cessation study to illustrate analysis using RRM. The first illustrates use of a random‐effects ordinal logistic regression model, examining longitudinal changes in smoking status, treating status as an ordinal outcome. The second example focuses on changes in motivation scores prior to and following a first relapse to smoking. This latter example illustrates how RRM can be used to examine predictors and consequences of relapse, where relapse can occur at any study timepoint.
Replication and extension of Marlatt's taxonomy of relapse precipitants: overview of procedures and results
Authors: Lowman Cherry , Allen John , Stout Robert L. , Group The Relapse Research
Published: March 2003

The Relapse Replication and Extension Project (RREP) was a multisite study to replicate and extend Marlatt's taxonomy of relapse precipitants. In addition to replicating Marlatt's original taxonomic system, three independent research teams utilized prospective designs to identify additional predictors of relapse and developed and evaluated two alternative systems for assessing high risk relapse situations. This overview describes the replication methodology, summarizes seven RREP studies completed by the three research groups, and discusses five cross‐cutting conclusions emerging from the studies. These conclusions are: (1) reliability of Marlatt's taxonomic system was variable both within and across the three research sites; (2) Marlatt's taxonomic system showed little predictive validity in analyses that used pretreatment relapse data to predict post‐treatment relapse, but there are important unresolved issues; (3) an alternative taxonomy provided little more predictive validity than the original taxonomy even though it measured more dimensions of relapse
The reliability of Marlatt's taxonomy for classifying relapses
Authors: Longabaugh Richard , Rubin Amy , Stout Robert L. , Zywiak William H. , Lowman Cherry
Published: March 2003

Marlatt's focus on the relapse situation has had a major impact upon research and clinical practice in treating addictions. One component of his work was the development of a taxonomy for classifying precipitants of relapse. This taxonomy has been incorporated into the nomenclature of clinicians and clinical researchers as part of an explanatory framework for understanding relapses. Despite the taxonomy's influence it has never been examined for the reliability of its use across research studies. The present study compared the reliability of independent classifications of 149 relapse episodes by trained raters at three research laboratories. Despite considerable across‐laboratory training, reliability was found to be inconsistent for research purposes. It is concluded that comparability of results based on Marlatt's relapse taxonomy across independent studies must be subject to question, and assumptions necessary for the aggregation of a knowledge base are not supported. Recommendations are offered for improving the reliability of the taxonomy and the methods used to collect taxonomy data. More generally, questions regarding the value of the specific relapse categories, as well as the overall taxonomy, are raised.
Understanding relapse in the broader context of post‐treatment functioning
Authors: Connors Gerard J. , Maisto Stephen A. , Zywiak William H.
Published: March 2003

There exists much interest in developing more sophisticated conceptual and data analytic frameworks for evaluating and understanding the post‐treatment functioning of alcoholics. Much of this interest has been fostered by the systematic research endeavors of Moos and his colleagues, whose "systems model" of treatment outcome closely parallels multivariate models of illness and health. This article focuses on an extrapolation of the systems model to the study of relapse, viewing relapse as one outcome of a set of independent variables that include person and environmental factors. The subjects were 142 clients entering either inpatient or outpatient treatment for alcoholism. Preliminary assessments, using path analyses and multiple regression models, are presented on the interrelationships between background characteristics, pretreatment alcohol involvement/ symptomatology, treatment, coping skills/responses, stressors and relapse/outcome following treatment entry. The results overall showed a considerable amount of convergence in the sense that the composite "blocks" representing background characteristics, alcohol involvement/symptomatology and coping skills/responses generally were significant predictors of various relapse and other posttreatment functioning variables. However, the variables contributing to the predictive power of a particular composite varied as a function of the dependent variable being assessed. The conceptual model and associated analytic strategies guiding this research would appear to hold much potential for advancing knowledge in this area.
Looking forward and back to relapse: implications for research and practice
Authors: Connors Gerard J. , Longabaugh Richard , Miller William R.
Published: March 2003

In this commentary, the three principal investigators of the Relapse Replication and Extension Project (RREP) reflect on clinical and research implications of study findings from the three collaborating sites. A primary purpose of RREP was to study the reliability and validity of a taxonomy of relapse antecedents originally proposed by Marlatt two decades ago. Under the best of research conditions, with extensive training and practice, it was difficult to achieve reliability of coding with the original three‐level system, although with only two levels of classification more reasonable albeit variable reliability was found. Modifications may improve the taxonomy's reliability, but RREP data indicate that a more appropriate strategy is to measure possible antecedents of relapse by continuous scales such as those provided by Annis, Heather and Litman. There is reasonably consistent evidence for two common antecedents of relapse: negative emotional states, and positive emotional states in a social context. Antecedents of relapse show only modest consistency within individuals from one occasion to the next. The causes to which clients attribute relapses may exert a significant effect on future drinking episodes. Stable and internal attributions, such as are commonly associated with a dispositional disease model, may serve to perpetuate relapse. From the RREP studies, the availability of coping skills appears to be a potent protective factor, and ineffective coping a consistent predictor of relapse. Implications for clinical research and practice are considered.
Lost productivity and costs to society
Authors: Godfrey Christine
Published: March 2003

Having a single monetary amount that provides an indicator of alcohol misuse can be a powerful instrument for those advocating policy action. Existing studies suggest that alcohol use in any year may yield costs that are equivalent to 2‐5% of the gross national product. While useful, such figures do not indicate which combinations of policies could yield the greatest net benefits for their populations. There may also be interest in the effects of alcohol use on public finances or the fairness of both taxes and welfare payments across different groups of the population. Which items are identified as being relevant and how these effects are measured and valued will depend on which policy question is being addressed. There are, however, a number of common issues such as whether costing studies should be confined to the heaviest and problematic, how benefits of alcohol consumption should be measured, how future benefits in terms of health gains should be valued and whether the costs to the drinker are important or only those costs which are borne by third parties. There will not always be simple answers to these questions. However, even if costing studies are confined to third party effects and the most conservative assumptions are taken, it is clear that there is powerful evidence that many societies would be better off if action is taken to prevent alcohol problems. Research on the effects of alcohol use is becoming increasingly sophisticated and this will lead to improvements in costing studies. Productivity losses are likely to remain one of the most significant costs of alcohol misuse.
Trends in alcohol production, trade and consumption
Authors: Walsh Brendan
Published: March 2003

This paper is a survey of the structure and significance of international trade in alcoholic beverages in the contemporary world economy. It presents data on the level of trade in the main alcoholic beverages for the period since 1970. The constant‐dollar value of this trade grew by a factor of 2.1 between 1975 and 1992. It represents approximately one half of the one per cent of the value of world trade in all commodities. This proportion has remained very stable over the past 20 years. International trade in beer, wine and spirits has greatly extended the range of alcoholic beverages available around the world and reduced their cost. It has played a large part in the tendency for convergence in the patterns of alcohol consumption, as countries diversify away from their dependence on locally produced beverages. Traditional spirits‐drinking and beer‐drinking countries have witnessed very rapid increases in the consumption of wine, while heavy wine drinking countries have seen rapid growth of the consumption of beer. While imported beverages remain relatively unimportant in total consumption of alcoholic beverages, they have played a significant role in the growth and diversification of alcohol consumption in many countries.
Regulating unregulated markets
Authors: Tkiewicz Grazyna Swial
Published: March 2003

Ongoing political and economic changes in the ex‐socialist countries have proved to be very expensive socially. The sudden transition from a centrally planned to a market economy had led to an increase of social problems. One commonly observed danger is the rapid increase in alcohol consumption. The rates of total alcohol consumption are particularly high in those countries where spirit consumption dominates. Considerable pressure is being applied to liberate the alcohol market from all restrictions. Inadequate legislation in the new economic situation, modifications in value systems, and the general rejection of all legislative solutions developed under the previous regime have created a climate conducive to the development of an unregulated alcohol market. State administrations have lost control of the alcohol market. Previous data on consumption have ceased to be reliable sources of information. The dynamic increase in alcohol‐related problems is dangerous for public health. If this situation is to be corrected, the first step must be regulation of the alcohol market.
Alcohol and the future health of Europe
Authors: Lehto Juhani
Published: March 2003

The impact of alcohol consumption on trends in the European health situation is analysed. Particular attention is given to the impact of alcohol on the widening of the East‐West health gap in Europe. It is concluded that between 1950‐75 the negative health impact of a rapid increase in per capita alcohol consumption in most European countries was hidden behind a strong positive development in many other socio‐economic determinants of health. Between 1980 and 1995, health trends have been more closely parallel to trends in alcohol consumption. Changes in alcohol consumption explain a significant proportion of changes in life expectancy, particularly in the newly independent states of the former Soviet Union. Public health policy on alcohol, as part of a general development of public health policies outside the health sector, is important in reducing the East‐West health gap and sustaining the positive health trend in western Europe.
Educational approaches
Authors: Montonen Marjatta
Published: March 2003

Three papers were presented in the session focusing on educational approaches: Anu Narusk reported on an Estonian study on the influence of the family on adolescents' substance use, Bernadette Roussille presented a French mass media campaign aimed at reducing heavy drinking by young people, and Sally Casswell analysed the public discourse on alcohol, which is an important part of the social and political context in which decisions are taken about public policies. Each of the papers highlighted in its own way the complex relationships between people's behaviour, its social and cultural context, and the wider economic and political environment.
Inequality, deprivation and alcohol use
Authors: Marmot Michael
Published: March 2003

There are major social inequalities in health within societies. Alcohol and tobacco are major preventable causes of ill health. Using data from the United Kingdom, this paper examines the social distribution of tobacco and alcohol consumption; the role that tobacco and alcohol may play in mediating or modifying social inequalities in health; and the implications of social distribution for policies to reduce harm associated with consumption of alcohol and tobacco. In the United Kingdom, as in many other countries, there is clear inverse association between socio‐economic position and consumption of cigarettes. Over the past three decades, the decline in smoking has been more rapid in men and women in higher socio‐economic groups. United Kingdom suggest that among employed men and women, the prevalence of non‐drinking shows an inverse association with occupational status; heavy drinking differs little; and moderate drinking is more common among those of higher socio‐economic status. Smoking accounts for perhaps 25% of the social class difference in coronary heart disease (CHD) mortality, more for lung cancer, less for some other diseases. Healthier patterns of drinking may contribute to the lower CHD rates of higher social classes. Although other factors are clearly important in generating social inequalities, it is important to take the social distribution of alcohol and tobacco into account when formulating policy. For cigarette consumption, there is evidence that in lower socio‐economic groups demand is more sensitive to price; higher socio‐economic groups are more responsive to health education. There has been less research of this nature for alcohol. Available analyses suggest that price responsiveness of heavy drinking may be greatest in young men and in those with lower incomes. A pricing strategy has important equity implications.
Why has alcohol consumption declined in countries of southern Europe?
Authors: Gual Antoni , Colom Joan
Published: March 2003

Alcohol consumption seems to be decreasing in the traditional wine countries of southern Europe. This paper describes the evolution of alcohol consumption over the last 30 years in France, Greece, Italy, Portugal and Spain. For this purpose, data on alcohol production and per capita alcohol consumption in southern Europe are examined, and their reliability discussed. To analyse alcohol‐related mortality, liver cirrhosis death rates are also reviewed. Since 1980 overall alcohol production has increased by 10%, while wine production has decreased by 13%. The consumption of pure alcohol equivalent per capita has continually decreased, from a peak of 14 litres per year in 1974 to 10.4 litres in 1992. The reduction is dramatic for wine (42.3%) and slight for spirits (4.7%), while beer consumption has grown by 36.6%. These data seem to confirm a European trend towards the homogenization of drinking patterns. Marketing factors, public health policies, the evolution of prices and taxation, European Union agricultural policies, a growing awareness of public opinion about the toxicity of alcohol and competition from non‐alcoholic drinks are all factors that may partially explain these observed changes.
Summing up: lessons from a comprehensive community prevention trial
Authors: Holder Harold D. , Saltz Robert F. , Grube Joel W. , Treno Andrew J. , Reynolds Robert I. , Voas Robert B. , Gruenewald Paul J.
Published: March 2003

This paper presents the findings and lessons from a community prevention trial involving three experimental communities in the United States to reduce alcohol‐involved trauma. The paper provides recommendations for other community prevention efforts. Effectiveness was demonstrated by: (a) 78 fewer alcohol‐involved traffic crashes as a result of the Drinking and Driving Component alone (approximately a 10% reduction); (b) a significant reduction in underage sales of alcohol, i.e. off‐premise outlets sold to minors about one‐half as often as in comparison communities; (c) increased implementation of responsible beverage service policies by bars and restaurants; and (d) increased adoption of local ordinances and regulations to reduce concentrations of alcohol outlets.
Community prevention and alcohol retail access
Authors: Reynolds Robert I. , Holder Harold D. , Gruenewald Paul J.
Published: March 2003

This paper describes the design, rationale and implementation of the Alcohol Access Component within the Community Trials Project of the Prevention Research Center. The Alcohol Access Component was to reduce the concentration or density of alcohol outlets in each experimental community by a combination of local zoning and land‐use planning approaches which was an effect to occur over several years. During the time of this trial, local regulations of alcohol outlets and public sites for drinking were changed in all three experimental communities. The amount of such alcohol policy change exceeded the goals for this component.
State‐of‐the‐art methodologies in alcohol‐related health services research
Authors: Perl Harold I. , Dennis Michael L. , Huebner Robert B.
Published: March 2003

Many of the failures to replicate clinical findings of treatment efficacy in more realistic field and community settings can be attributed to inappropriate research designs and other methodological shortcomings. In order to increase research designers' awareness of existing methodologies that may be better suited to answer the critical questions inherent in health services research on alcohol‐related issues, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) convened an expert conference with three specific goals: (1) to identify the critical issues involved in alcohol services research; (2) to develop a primer that explicated each key area; and (3) to compile the resulting primers into an accessible resource for researchers, policy makers and consumers. The 9 papers in this special supplement are the product of that conference and are organized broadly around three phases of the research process: study design and implementation, data collection and use, and the analysis and interpretation of data. A final summary paper discusses the issues and offers a synthesis of key themes as well as some direction for the future.
Methods for evaluating policy changes in alcohol services
Authors: Kaskutas Lee A. , Schmidt Laura A. , Weisner Constance , Greenfield Thomas K.
Published: March 2003

Policy research assesses how outside forces affect alcohol treatment services. In this primer, we examine a range of effective methods that can be brought to bear by researchers and address the issues involved in conceptualizing and conducting studies of policy formation, implementation and policy implications. Because there is no single superior methodology for studying policy change, researchers have relied on five broad methodologies for studying policy context, formation, change and implications. We provide specific examples of each approach, addressing the following issues: data sources and samples; the problems, challenges, strengths, and limitations of the approach; and whether (and how) the method has been used in the alcohol field. The five methods are archival studies; key informant studies; ethnographic and observational studies; surveys; and meta‐analyses. The strongest research designs in alcohol services research often combine methods and sources to get different vantage points on questions about policy change.
Truth or consequences: the validity of self‐report data in health services research on addictions
Authors: Del Boca Frances K. , Noll Jane A.
Published: March 2003

This paper examines factors that influence the veracity of verbal self‐report data in health services research, using a cognitive social‐psychological model of the data‐gathering process as an organizing framework. It begins by briefly summarizing the consequences that can result from measurement error. Next, a cognitive social‐psychological model of the question‐answering process is presented. Common assumptions regarding the utility of specific assessment methods are evaluated with particular emphasis on the strengths and weaknesses of alternative data sources. The framework is then applied specifically to understanding the factors that may affect self‐report measures in health services research relating to alcohol and other substance use. Overall, self‐report procedures can provide useful estimates of consumption in clinical settings when conditions are designed to maximize response accuracy.
Analysis of longitudinal substance use outcomes using ordinal random‐effects regression models
Authors: Hedeker Donald , Mermelstein Robin J.
Published: March 2003

In this paper we describe analysis of longitudinal substance use outcomes using random‐effects regression models (RRM). Some of the advantages of this approach is that these models allow for incomplete data across time, time‐invariant and time‐varying covariates, and can estimate individual change across time. Because substance use outcomes are often measured in terms of dichotomous or ordinal categories, our presentation focuses on categorical versions of RRM. Specifically, we present and describe an ordinal RRM that includes the possibility that covariate effects vary across the cutpoints of the ordinal outcome. This latter feature is particularly useful because a treatment can have varying effects on full versus partial abstinence, for example. Data from a smoking cessation study are used to illustrate application of this model for analysis of longitudinal substance use data.
Meta‐analyses in alcohol and other drug abuse treatment research
Authors: Wilson David B.
Published: March 2003

Meta‐analysis is a quantitative method of synthesizing empirical evidence across a collection of related studies and addresses many of the weaknesses of traditional narrative forms of reviewing. This paper describes the basic methods for conducting a state‐of‐the‐art meta‐analysis and criticizes 11 extant meta‐analyses of alcohol and other drug abuse treatment programs. Eight of these 11 meta‐analyses used questionable methods and contributed little to our understanding of the effects of these programs. The paper concludes with a proposal for an archive of alcohol and other drug services research to facilitate and improve the quality of future meta‐analyses.
Alcopops in Sweden ‐ a supply side initiative
Authors: Romanus Gabriel
Published: March 2003

This paper describes the introduction of alcopops and sweet ciders in Sweden in 1996, as a result of the membership of the European Union. Special attention is given to its effect on youth drinking. Surveys of young people show that alcopops and sweet ciders are perceived to be easy to drink and to have a sweet and pleasant taste, which tends to conceal the taste of alcohol. These results suggest that alcopops and sweet ciders should be regarded as one category of drinks. Alcopops and sweet ciders have penetrated the youth market rapidly. The introduction of these beverages accounted for approximately half of the increase in alcohol consumption by 15‐16‐year‐old boys from 1996 to 1999, and two‐thirds of the increase among girls, according to the surveys. A large proportion of the youth answered that alcopops and ciders did not replace any other alcoholic beverage. The paper also describes the public debate on alcopops and cider. The introduction of alcopops was criticized by the media and the responsible minister. Prominent spokesmen of the alcohol industry put themselves at a distance from these, primarily imported, products. The sales of alcopops have been declining since 1997. Sweet ciders, on the other hand, which in reality are synonymous with alcopops, have continued to increase during the whole period since 1996, and have not been subject to the same public criticism.
The ambiguous role of alcohol in economic and social development
Authors: Room Robin , Jernigan David
Published: March 2003

An increased and industrialized alcohol supply in a developing society is usually assumed to have positive effects on economic development, although it may be recognized that the effects on public health and order will be negative. There has been little attention to the potential for negative effects on the economic side. This paper directs attention to such factors as unemployment for cottage producers (often female heads of household) and reduced industrial employment as highly‐automated "turnkey" brewers are installed. On the other hand, changes in the mode of production of alcoholic beverages may have little impact on the much larger work‐force involved in serving or selling alcohol in retail trade. The net contribution of an increased and industrialized alcohol supply in terms of economic development is unclear, but industrialization and development bring with them increased demands for attention and sobriety, e.g. in motorized traffic and on the production line, which increased drinking may undercut. Decisions by international development agencies on investment in alcohol production and distribution should take account of both the positive and negative impacts on economic development as well as on public health. In line with this, the World Bank has recently decided to invest in alcohol industry projects only when there is a strong positive development impact and the project is "consistent with public health issues and social policy concerns".
The influence of economic interests on alcohol control policy: a case study from Finland
Authors: Alavaikko Mika , Österberg Esa
Published: March 2003

Finland's participation in the European Union has meant that Finnish markets have been opened to international competition and that the traditional alcohol policy decision‐making that revolved around Alko, the state alcohol monopoly company, has become impossible. The influence of private commercial interests increased in the 1990s but not in a straightforward manner. They had their biggest influence in the mid‐1990s when the 1994 Alcohol Act was drafted and accepted. After that the influence of commercial interests has declined, and nowadays the alcohol question is again discussed in terms of public health and safety and drinking among young people. Integration did not lead to the expected deregulation of alcohol control but to new forms of regulation, where EU authorities such as the Commission and the EU Court also play an important role. Alcohol policy‐making is now more transparent, and free trade and competition without interference are much more stressed than previously. These are the new frames of public intervention in the alcohol question, both in the trade of alcoholic beverages and in the taking care of individuals harmed by the use of alcohol.