bluuebunny/crossref_metadata_2025 huggingface dataset:
European adolescent substance use: the roles of family structure, function and gender
Authors: McArdle Paul , Wiegersma Auke , Gilvarry Eilish , Kolte Birgitta , McCarthy Steven , Fitzgerald Michael , Brinkley Aoife , Blom Maria , Stoeckel Ingo , Pierolini Anna , Michels Ingo , Johnson Rob , Quensel Stephan
Published: March 2003

Objectives The aim of this study was, first, to explore family structure and measures of family functioning in relation to adolescent substance use and secondly, to establish if these relationships differed according to gender or according to the city of origin of the sample.

Design, setting, participants The study surveyed pupils aged 14–15 years in representative samples drawn from five European cities: Newcastle upon Tyne, Dublin, Rome, Bremen and Groningen. Data were obtained on 3984 participants in relation to their substance use, living with both biological parents, confiding in parents and grandparents, and supervision, as well as other variables representing delinquency, social class and drug availability.

Results Living with both parents was associated with reduced levels of drug use in four cities but not in Dublin, due perhaps to the high availability from peers in that city. It was not associated with reduced levels of regular drinking. The effect of confiding in mother was evident in all cities and in relation to substance use in general. However, when a delinquency variable was added to the logistic regressions, its significance in relation to polydrug use disappeared. Supervision was somewhat more important in relation to male than female drug use.

Conclusion Living with both parents is a less robust barrier to substance use than qualitative aspects of family life, particularly attachment to mothers. The latter is a robust inhibitor of substance use irrespective of regional differences in drug availability, weakening only in the face of more generally problematic behaviour. Perhaps because of their greater tendency to risk‐taking or rule breaking, supervision appears more important for male than female drug use. These findings underscore the role of families, but especially that of mothers, in regulating the substance‐related behaviour of young people.
Adolescent alcohol and tobacco use: onset, persistence and trajectories of use across two samples
Authors: Jackson Kristina M. , Sher Kenneth J. , Cooper M. Lynne , Wood Phillip K.
Published: March 2003

AimsWe examined the alcohol‐tobacco relationship using two prospective, ethnically diverse samples. Trajectories of alcohol and tobacco use are portrayed overall and by sex and ethnicity. Using prospective analyses, we examine directional influences between alcohol and tobacco use, and we characterize initiation versus persistence of drinking and smoking as a function of use of the other substance.

Design, settingData were from the National Longitudinal Study of Adolescent Health (AddHealth) and the Adolescent Health Risk Study (AHRS). Follow‐up intervals for AddHealth and AHRS were 1 and 5 years, respectively.

ParticipantsAddHealth respondents (n= 4831) were on average 14.8 years old (48% male, 23% black, 61% white) and AHRS respondents (n= 1814) were on average 16.7 years old (47% male, 44% black, 49% white).

MeasurementsTwo alcohol consumption variables and two smoking variables were used: drinking frequency and heavy drinking frequency, and regular (current) smoking and daily number of cigarettes.

FindingsAlcohol and tobacco use exhibited monotonic increases over adolescence and young adulthood. Men and white respondents reported more use than women and black respondents. Alcohol and tobacco were moderately associated at both times. Analyses revealed that prior alcohol use predicted tobacco use more strongly than the converse. Initiation of smoking was a function of prior drinking; to a lesser extent, initiation of drinking was a function of prior smoking. Persistence of smoking was a function of prior drinking and persistence of drinking was a function of prior smoking.

ConclusionsProvisional support exists for the claim that alcohol use predicts tobacco use more strongly than the converse. For both drinking and smoking, onset and persistence are predicted by prior use of the other substance, and these associations were robust across sex and ethnicity.
A randomized trial of a brief alcohol intervention for needle exchangers (BRAINE)
Authors: Stein Michael D. , Charuvastra Anthony , Maksad Jina , Anderson Bradley J.
Published: March 2003

Aims To test motivational interviewing (MI) as a brief intervention for reducing alcohol use among needle exchange clients.

Design Randomized clinical trial.

Setting Needle exchange program—Providence, Rhode Island, USA.

Participants Between 2/98 and 10/99, we recruited 187 AUDIT‐positive (>8) active injection drug users.

Intervention Those assigned to a brief motivational intervention (MI) condition received two 1‐hour therapist sessions following assessment visits, 1 month apart, focusing on alcohol use and HIV risk‐taking.

Measurements Control and MI subjects received identical research assessments at baseline, 1 and 6 months following study enrollment. At 6 months, study outcomes included days of alcohol use measured using the time‐line follow‐back method.

Findings Study retention was 96.8% at 6 months. Participants reported an average
of 12.0 drinking days at baseline and 8.3 at 6 months. Significant reductions in
drinking days were observed in both treatment conditions. We found significant treatment
× baseline drinking day interaction effects. Tests for simple main effects
were significant for subjects with above median (>9) baseline drinking day frequency,
but not for those with below median baseline drinking frequency. Comparisons on dichotomous
outcomes provided supporting evidence of treatment efficacy; those in MI were over
two times more likely than controls to report reductions of 7 days or more (P < 0.05).

Conclusions This study provides the first direct evidence that brief MI can decrease alcohol use among active injection drug users with drinking problems. Heavier drinkers seem best suited for this intervention, but the optimal intensity of treatments and which components of brief intervention are most effective deserve further study.
Temporal progression of cocaine dependence symptoms in the US National Comorbidity Survey
Authors: Shaffer Howard J. , Eber Gabriel B.
Published: March 2003

Objective Cocaine dependence first appeared as a diagnostic category in 1987 with the publication of DSM‐III‐R. While the temporal sequencing of alcohol symptoms has a long history, little such attention has been focused on cocaine dependence. This paper examines the retrospective recall of DSM‐III‐R cocaine dependence symptom progression among a large sample of cocaine users and the relationship of these symptoms to psychiatric comorbidity.

Methods Using data from the US National Comorbidity Survey, DSM‐III‐R criterion ‘A’ cocaine dependence symptoms were sequenced temporally based on age of symptom onset. Each of these numerical symptom strings was examined to determine its prevalence and association to comorbid psychiatric disorders.

Results Cocaine users represented 16% of the sample. Although hundreds of symptom sequence permutations are possible, only a few are highly prevalent. Subjects whose early onset symptoms are neuroadaptive (e.g. tolerance and withdrawal) are more likely to develop cocaine dependence than subjects whose early symptoms are characterized by psychosocial consequences. Furthermore, certain temporal patterns were found to increase or decrease the presence or absence of cocaine dependence and psychiatric comorbidity. Finally, psychiatric comorbidity preceded rather than followed cocaine use onset disproportionately.

Conclusions Like alcohol users, cocaine users follow a limited array of symptom sequence pathways from first use to dependence. By better understanding and examining the temporal progression of drug use symptoms, clinicians might improve screening and assessment activities and determine more effectively the extent of risks associated with continued premorbid drug use and enhance treatment‐matching. We encourage clinicians to develop evaluation instruments that specifically ask patients to sequence their cocaine use‐related symptoms temporally.
Brief prevention for adolescent risk‐taking behavior
Authors: D’Amico Elizabeth J. , Fromme Kim
Published: March 2003

Aims Despite widespread prevention efforts to decrease adolescent risk‐taking, substance use and driving after drinking (DD) are prevalent in the United States. The current study compared the efficacy of an abbreviated version of Drug Abuse and Resistance Education (DARE‐A) to a new Risk Skills Training Program (RSTP).

Design Adolescent participation in drinking, drug use, DD and riding with a drunk driver was examined longitudinally. After baseline assessments, adolescents were randomly assigned to the RSTP, DARE‐A or a no intervention control group and then completed 2‐month post‐test and 6‐month follow‐up assessments.

Setting Adolescents attended a mid‐sized suburban high school.

Participants The sample (N = 300) was comprised of 58% females and the age range was 14–19 years.

Intervention The RSTP was developed to target several risk behaviors and to examine the feasibility of conducting a brief personalized prevention program in a group setting. DARE‐A focused on increasing knowledge and understanding the deleterious effects of substance use.

Measurements Risk‐taking behavior, perception of peer risk‐taking and positive and negative alcohol expectancies were assessed.

Findings RSTP participants decreased participation in several risk behaviors at post‐test, but reductions were not maintained at 6‐month follow‐up. The control and DARE‐A groups increased their positive and decreased their negative alcohol expectancies. The control group increased their alcohol consumption.

Conclusions Results suggest that a brief, personalized, group prevention program is a feasible approach to reducing adolescent risk‐taking. Strategies must be developed to solidify these positive changes so that they are longer‐lasting.
Determining a diagnostic cut‐off on the Severity of Dependence Scale (SDS) for cocaine dependence
Authors: Kaye Sharlene , Darke Shane
Published: March 2003

Aim The study aimed to assess the efficacy of the Severity of Dependence Scale (SDS) as a diagnostic measure of cocaine dependence and determine the cut‐off score that best discriminates between the presence and absence of a DSM‐IV diagnosis of cocaine dependence.

Design Cross‐sectional survey.

Setting Sydney, Australia.

Participants One hundred and forty‐two cocaine users.

Measurements The diagnostic performance of the SDS was measured via ROC analysis against DSM‐IV diagnoses of cocaine dependence, as measured by the Composite International Diagnostic Interview (CIDI).

Findings ROC analysis revealed the SDS to be a test of high diagnostic utility for the measurement of cocaine dependence. The cut‐off point on the SDS at which there is optimal discrimination between the presence and absence of a DSM‐IV diagnosis of cocaine dependence was found to be 3 (i.e. a score of 3 or more).

Conclusions The study statistically validated the utility of the SDS as a diagnostic measure of cocaine dependence and has determined an appropriate cut‐off point. The SDS is recommended as a brief screening instrument for cocaine dependence that can be used in addition to more comprehensive measures, such as the CIDI.
Differences in factors associated with first treatment entry and treatment re‐entry among cocaine users
Authors: Ferri Cleusa P. , Gossop Michael , Rabe‐Hesketh Sophia , Laranjeira Ronaldo R.
Published: March 2003

Aims

To investigate factors associated with first entry to treatment and with treatment re‐entry among cocaine users.

Design

Cross‐sectional study.

Setting, participants

Cocaine users (n = 313) recruited from community and treatment settings in Brazil.

Measurements

Structured questionnaire including selected items from the addiction severity index (ASI), general health questionnaire, version 28 (GHQ‐28), CAGE and the severity of dependence scale (SDS).

Findings

Higher dose use, being a problematic drinker and increased awareness of their problem were associated with increased odds of making first contact with an agency. Greater severity of dependence, being involved in acquisitive crime and social support increased the chance of treatment re‐entry. Being involved in acquisitive crimes and concerns about confidentiality were associated with decreased odds of first treatment contact. Being a problematic drinker was associated with decreased odds of re‐entry treatment.

Conclusions

These findings suggest that the distinction between first treatment contact and subsequent entry to treatment is useful, clinically relevant and deserving of further investigation.
Morbidity associated with non‐fatal heroin overdose
Authors: Warner‐Smith Matthew , Darke Shane , Day Carolyn
Published: March 2003

Aims To estimate the range and severity of heroin overdose related morbidity.

Design Cross‐sectional survey.

Setting Sydney, Australia.

Participants 198 heroin users.

Findings Sixty‐nine per cent had experienced a heroin overdose, 28% in the preceding 12 months. Of those who had overdosed, 79% had experienced at least one overdose‐related morbidity symptom. An ambulance had attended overdoses for 59% of subjects, 33% had required hospital treatment for overdose, and 14% had experienced overdose‐related complications of sufficient severity to be admitted to a hospital ward. Indirect overdose‐related morbidity included: physical injury sustained when falling at overdose (40%), burns (24%) and assault while unconscious (14%). Direct overdose‐related morbidity included: peripheral neuropathy (49%), vomiting (33%), temporary paralysis of limbs (26%), chest infections (13%) and seizure (2%).

Conclusions There appears to be extensive morbidity associated with non‐fatal overdose. This is clearly an area that requires more research to document the prevalence and nature of these harms, and factors associated with them.
The South African Community Epidemiology Network on Drug Use (SACENDU): description, findings (1997–99) and policy implications
Authors: Parry Charles D. H. , Bhana Arvin , Plüddemann Andreas , Myers Bronwyn , Siegfried Nandi , Morojele Neo K. , Flisher Alan J. , Kozel Nicholas J.
Published: March 2003

Aims To (1) describe the South African Community Epidemiology Network on Drug Use (SACENDU), (2) describe trends and associated consequences of alcohol and other drug (AOD) use in South Africa for January 1997 to December 1999 and (3) outline selected policy implications identified by SACENDU participants.

Methods A descriptive epidemiological study of AOD indicators based on data gathered from multiple sources, including specialist treatment centres, trauma units and quantitative studies of target groups such as school students and arrestees. Networks were established in five sentinel sites to facilitate the collection, interpretation and dissemination of data.

Results Over time alcohol has been the most frequently reported primary substance of abuse across sites. Trauma and psychiatric data highlight the burden associated with alcohol abuse. Cannabis and Mandrax (methaqualone), alone or in combination, are the most frequently reported illicit drugs of abuse, generally comprising the largest proportions of drug‐related arrests, drug‐related psychiatric diagnoses and drug‐positive trauma patients. From 1997 to 1999, a significant increase in indicators for cocaine/crack and heroin occurred in two sites. Ecstasy (MDMA) use, alone or in combination with other substances, is reported among young people.

Conclusions A broad range of globally abused substances is present in South Africa and the use and burden of illicit substances appears to be increasing. This points to the importance of ongoing monitoring of AOD trends. Through regular, systematic data collection the SACENDU project has made available more evidence‐based information to direct AOD abuse policy and practice and has had an impact on research agendas.
‘Third‐party’ threats to research integrity in public–private partnerships
Authors: James Jack E.
Published: March 2003

This paper examines threats to scientific integrity posed by possible conflicts of interests that can occur when commercial entities participate in publicly funded research partnerships. Particular attention is given to the activities of the International Life Sciences Institute (ILSI), which presents itself as a society of learned individuals and groups working in the public interest. In reality, ILSI's members largely consist of commercial companies and corporate conglomerates involved in the manufacture of foods, beverages, chemicals and pharmaceuticals. The main conclusion is that conflicts of interest arising from third‐party involvement in research partnerships are a threat to scientific integrity. Urgent action is needed by the scientific community to find ways to safeguard against threats to scientific integrity due to undeclared involvement of commercial entities in seemingly independent research and scholarship.
Compliance with hepatitis B vaccination in 1175 heroin users and risk factors associated with lack of vaccine response
Authors: Quaglio Gianluca , Talamini Giorgio , Lugoboni Fabio , Lechi Alessandro , Venturini Luca ,   Gruppo Intersert di Collaborazione Scientifica (GICS), Jarlais Don C. Des , Mezzelani Paolo
Published: March 2003

Aims To investigate the feasibility of hepatitis B vaccination among heroin users, assessing adherence to the vaccination schedules and identifying factors associated with antibody response.

Design and participants A large cohort study in nine public centres for drug users (PCDUs) in north‐eastern Italy, with data collected between January 1989 and December 1998. A total of 1175 heroin users were selected and vaccinated with a recombinant vaccine using two schedules (0–1–6 months and 0–1–2 months).

Findings Eighty‐eight per cent of patients completed the vaccination series and a protective antibody response occurred in 77% of subjects. Completion of the vaccination series was not related to the length of the vaccination schedule or whether the patient was still in drug abuse treatment at the end of the series, but was related strongly to the number of patients enrolled at each PCDU (Spearman correlation = – 0.93, P < 0.001). Four variables were significantly associated with lack of seroconversion in response to vaccination: older age (AOR = 0.91 per year, 95% CI 0.88–0.94, P < 0.001), 2‐month vaccination schedule (AOR = 3.10, 95% CI 2.06–4.68, P < 0.001), HCV seropositivity (AOR = 0.69, 95% CI 0.47–0.99, P = 0.04), HIV seropositivity (AOR = 0.27, 95% CI 0.10–0.77, P = 0.01).

Conclusions A large‐scale, multi‐site hepatitis B vaccination programme for heroin users proved feasible and effective. The factors associated with a lack of antibody response may be useful in identifying patients who would benefit most from routine post‐vaccination testing, with booster doses for non‐responders. These results suggest that hepatitis B vaccination for drug users should become a routine public health practice.
Hair morphine concentrations of fatal heroin overdose cases and living heroin users
Authors: Darke Shane , Hall Wayne , Kaye Sharlene , Ross Joanne , Duflou Johan
Published: March 2003

AimsTo compare heroin and other opiate use of heroin overdose fatalities, current street heroin users and drug‐free therapeutic community clients.

DesignHair morphine concentrations that assess heroin use and other opiate use in the 2 months preceding interview or death were compared between heroin overdose fatalities diagnosed by forensic pathologists (FOD) (n= 42), current street heroin users (CU) (n= 100) and presumably abstinent heroin users in a drug‐free therapeutic community (TC) (n= 50).

SettingSydney, Australia.

FindingsThe mean age and gender breakdown of the three samples were 32.3 years, 83% male (FOD), 28.7 years, 58% male (CU) and 28.6 years, 60% male (TC). The median blood morphine concentration among the FOD cases was 0.35 mg/l, and 82% also had other drugs detected. There were large differences between the three groups in hair morphine concentrations, with the CU group (2.10 ng/mg) having concentration approximately four times that of the FOD group (0.53 ng/mg), which in turn had a concentration approximately six times that of the TC group (0.09 ng/mg). There were no significant differences between males and females in hair concentrations within any of the groups. Hair morphine concentrations were correlated significantly with blood morphine concentrations among FOD cases (r= 0.54), and self‐reported heroin use among living participants (r= 0.57).

ConclusionsThe results indicate that fatal cases had a lower degree of chronic opiate intake than the active street users, but they were not abstinent during this period.
Substance abuse and fathering: adding poppa to the research agenda
Authors: McMahon Thomas J. , Rounsaville Bruce J.
Published: March 2003

Although a number of socioeconomic forces have converged across cultures to make fathering one of the more prominent social issues of the new millennium, the status of substance‐abusing men as fathers is rarely acknowledged in the conceptualization of public policy, service delivery or research focusing on the adverse consequences of drug and alcohol abuse. In this commentary, the authors call for the substance abuse research community to expand understanding of fathering occurring across cultures in the context of chronic substance abuse. Building upon research being undertaken with other populations of fathers, the authors argue there is need to clarify (a) the number of substance‐abusing fathers, (b) patterns of reproduction among substance‐abusing men, (c) ways in which substance abuse contributes to compromise of fathering, (d) ways in which compromise of fathering contributes to psychological distress in substance‐abusing men, (e) ways in which compromise of fathering affects developmental outcomes for children, and (f) ways in which clinical and preventive intervention might be used to minimize the harm associated with paternal substance abuse.
Too drunk for a beer? A study of overserving in Stockholm
Authors: Wallin Eva , Gripenberg Johanna , Andréasson Sven
Published: March 2003

Aims

To evaluate the effects of a community alcohol prevention programme on the frequency of alcohol service to intoxicated patrons at licensed premises.

Design

Pretest (1996)–post‐test (1999) design.

Setting

Licensed premises in Stockholm, Sweden.

Intervention

The community alcohol prevention programme, including server training in responsible beverage service (RBS) and policy initiatives in the community, has been conducted since 1996.

Participants and measurements

Actors were hired to enter licensed premises, enact a scene of severe intoxication and attempt to order a beer. At the baseline in 1996, actors visited 92 licensed premises, 47 from the central part of Stockholm and 45 from the southern part of Stockholm. At the follow‐up in 1999, 103 licensed premises were visited, 61 from the central part of Stockholm and 42 from the southern part of Stockholm. Observers monitored each visit.

Findings

At follow‐up the actors were denied service of alcohol at 47% of the licensed premises, a statistically significant improvement compared to 5% in the baseline study.

Conclusions

Licensed premises refused service of alcohol to intoxicated patrons to a much greater extent than in the baseline study. The improved results can probably be explained by a combination of policy initiatives in the community, changes in the overall enforcement environment and RBS training.
Drug injection among street youth: the first time
Authors: Roy Élise , Haley Nancy , Leclerc Pascale , Cédras Lyne , Boivin Jean‐François
Published: March 2003

Aims To describe the circumstances of the first drug injection among street youth.

Design A cohort study conducted in 1995–2000.

Participants Subjects aged 14–25 years old were recruited in all major Montreal organizations offering free services to street youth.

Measurement Subjects who reported having ever injected drugs completed questions on the circumstances of their first injection (calendar time, location, type of relationship with the initiator, presence of others, drug first injected, source of needle and use of clean needle and other injection materials). Questions on characteristics of the initiator and prior use of the first injected drug were added during the course of the study.

Findings Of 980 participants, 530 (54%) had ever injected drugs. Questionnaires were completed by 505 subjects, including 77 who also answered the additional questions. The mean age at first injection was 17.7 years. First injection occurred mainly in public places (41%). It was performed by a close friend (41%), the youth himself/herself (27%), an acquaintance (15%), a lover (10%) or another person (7%). Overall, 84% of youth first injected with a clean needle; only 62% used clean drug preparation equipment. The first drug injected was generally cocaine (47%) or heroin (41%). Two‐thirds (53/77) had used the drug of first injection previously; however, the majority was not dependent upon it.

Conclusions Most street youth used clean needles at first injection, but use of other clean injection materials was less frequent. Factors other than dependence appear to play a significant role in initiation into injection.
A population‐based study of cigarette smoking among illicit drug users in the United States
Authors: Richter Kimber Paschall , Ahluwalia Harsohena K. , Mosier Michael C. , Nazir Niaman , Ahluwalia Jasjit S.
Published: March 2003

Aims

People who use illicit drugs are thought to have high rates of cigarette smoking; however, few population‐based studies have been reported. We describe smoking patterns among illicit drug users, assess whether cigarette smoking is more prevalent among illicit drug users than it is among non‐users and explore how smoking relates to level and type of drug use.

Design, setting, participants

We used adult responses to the 1997 National Household Survey on Drug Abuse (n = 16 661). Multivariate analyses used SUDAAN to adjust standard errors for the sampling design and controlled for age, race, sex, education, depression, treatment history and alcohol.

Measurements

Smoking rates, cessation rates and smoking levels.

Findings

Seventy‐one per cent of recent illicit drug users smoked cigarettes at least once in the past month. Their adjusted odds of being a smoker were much greater than for the general population (OR = 3.07, P < 0.0001). Their quit rate, although substantial, was half that of non‐users (23% versus 56%, P = 0.0001). Odds of being a smoker were higher for poly‐ versus monodrug users (OR = 2.35, P = 0.0020) and rose with increased drug use (OR = 1.36, P = 0.0374). Illicit drug users who perceived smoking to be risky were four times less likely to smoke (OR = 0.23, P = 0.0008).

Conclusions

Although most recent illicit drug users smoke, some are able to quit. Better understanding of concurrent cigarette and illicit drug use may provide impetus for policy change and shed light on underlying mechanisms of addiction. Clinicians, policy makers and user advocates should address tobacco use in drug treatment and in harm reduction interventions.
A multi‐site study of alcohol subtypes: classification and overlap of unidimensional and multi‐dimensional typologies
Authors: Epstein Elizabeth E. , Labouvie Erich , McCrady Barbara S. , Jensen Noelle K. , Hayaki Jumi
Published: March 2003

Aims The current study examined the usefulness of four prevailing alcohol typologies, assessed in terms of replicability of the multi‐dimensional schemas, percentage of the sample classified by each typology, distribution of subtypes by gender and treatment site and construct validity of Type 1/Type 2. In addition, overlap of classification systems was examined to determine whether the four typologies may be narrowed to a smaller set of meaningful, non‐redundant subtype schemas.

Design Baseline data from five treatment outcome studies were used to facilitate subtyping according to four alcohol typologies: antisocial (ASP) versus non‐ASP, early versus late onset, Type 1/Type 2 and Type A/Type B.

Setting The studies were conducted at several in‐patient and out‐patient treatment sites.

Participants

The sample included 342 participants (23% female) who met DSM‐III‐R criteria for alcohol abuse or dependence.

Measurements Subjects were assessed on substance use severity, family history, psychopathology, personality and psychosocial functioning.

Findings Type 1/Type 2 and Type A/B typologies were replicated. Type 1/Type 2 had poor construct validity due to symptom cluster overlap between the two subgroups. Only 14% of the subjects met criteria for ASP. The two strongest associations including that between early versus late onset and Type 1/Type 2 and that between ASP versus non‐ASP and Type A/Type B, were expected and reflect overlaps in conceptual definitions. In comparison, the relationship between early versus late onset and ASP versus non‐ASP and Type A/B was weak.

Conclusions Clinical utility of the ASP/non‐ASP typology is limited in non‐Veterans Administration (VA) samples, due to low prevalence. The Type 1/Type 2 subtyping schema was redundant with the age of onset schema, and was the least internally valid of all four typologies. In general, the Type A/B schema was most promising of prevailing typologies studied. It was relatively inclusive, and the A, B groups were distinct from one another. However, dichotomous typologies may not be complex enough to be clinically useful descriptors of alcoholic samples. Aside from ASP and Type B, there appears to be heterogeneity within groups typically considered homogeneous, such as ‘early versus late onset’ alcoholics.
A longitudinal study of the effects of tobacco and cannabis exposure on lung function in young adults
Authors: Taylor D. Robin , Fergusson David M. , Milne Barry J. , Horwood L. John , Moffitt Terrie E. , Sears Malcolm R. , Poulton Richie
Published: March 2003

Aim To assess the possible effects of tobacco and cannabis smoking on lung function in young adults between the ages of 18 and 26.

Setting and participants A group of over 900 young adults derived from a birth cohort of 1037 subjects born in Dunedin, New Zealand in 1972/73 were studied at age 18, 21 and 26 years.

Measurements Cannabis and tobacco smoking were documented at each age using a standardized interview. Lung function, as measured by the forced expiratory volume in one second/vital capacity (FEV1/VC) ratio, was obtained by simple spirometry. A fixed effects regression model was used to analyse the data to take account of confounding factors.

Findings When the sample was stratified for cumulative use, there was evidence of a linear relationship between cannabis use and FEV1/VC (P < 0.05). In the absence of adjusting for other variables, increasing cannabis use over time was associated with a decline in FEV1/VC with time; the mean FEV1/VC among subjects using cannabis on 900 or more occasions was 7.2%, 2.6% and 5.0% less than non‐users at ages 18, 21 and 26, respectively. After controlling for potential confounding factors (age, tobacco smoking and weight) the negative effect of cumulative cannabis use on mean FEV1/VC was only marginally significant (P < 0.09). Age (P < 0.001), cigarette smoking (P < 0.05) and weight (P < 0.001) were all significant predictors of FEV1/VC. Cannabis use and daily cigarette smoking acted additively to influence FEV1/VC.

Conclusions Longitudinal observations over 8 years in young adults revealed a dose‐dependent relationship between cumulative cannabis consumption and decline in FEV1/VC. However, when confounders were accounted for the effect was reduced and was only marginally significant, but given the limited time frame over which observations were made, the trend suggests that continued cannabis smoking has the potential to result in clinically important impairment of lung function.
The social cost of illegal drug consumption in Spain
Authors: García‐Altés Anna , Ollé Josep Ma , Antoñanzas Fernando , Colom Joan
Published: March 2003

Aims

The objective of this study was to estimate the social cost of the consumption of illegal drugs in Spain.

Design

We performed a cost‐of‐illness study, using a prevalence approximation and a societal perspective. The estimation of costs and consequences referred to 1997. As direct costs we included health‐care costs, prevention, continuing education, research, administrative costs, non‐governmental organizations and crime‐related costs. As indirect costs we included lost productivity associated with mortality and the hospitalization of patients. Estimation of intangible costs was not included.

Findings

The minimum cost of illegal drug consumption in Spain is 88 800 million pesetas (PTA) (467 million dollars). Seventy‐seven per cent of the costs correspond to direct costs. Of those, crime‐related costs represent 18%, while the largest part corresponds to the health‐care costs (50% of direct costs). From the perspective of the health‐care system, the minimum cost of illegal drug consumption is 44 000 million PTA (231 million dollars). The cost of illegal drug consumption represents 0.07% of the Spanish GDP. This gross figure compares with 2250 million PTA (12.5 million dollars) invested in prevention programmes during the same year, and with 12 300 million PTA (68.3 million dollars) spent on specific programmes and resources for the drug addict population.

Conclusions

Although there are limitations intrinsic in this type of study and the estimations obtained in the present analysis are likely to be an underestimate of the real cost of this condition, we estimate that illegal drug consumption costs the Spanish economy at least 0.2% of GDP.
Evaluation of a motivational interview for substance use within psychiatric in‐patient services
Authors: Baker Amanda , Lewin Terry , Reichler Heidi , Clancy Richard , Carr Vaughan , Garrett Rachel , Sly Ketrina , Devir Holly , Terry Margarett
Published: March 2003

Aims

To assess the effectiveness of a motivational interview among hospitalized psychiatric patients with comorbid substance use disorder in reducing alcohol and other drug (AOD) use.

Design

Subjects were assigned randomly to receive an individual motivational interview (n=79) or a self‐help booklet (control condition; n=81).

Setting

Subjects were volunteers recruited from a major public psychiatric hospital.

Participants

Subjects met abuse or dependence criteria on the structured clinical interview for diagnosis (SCID) for alcohol, cannabis or amphetamine or they reported hazardous use during the last month of one or more of these drug types on the opiate treatment index (OTI).

Intervention

Either one 30–45‐minute motivational interview or brief advice.

Measurements

The SCID and OTI were the main measures.

Findings

There was a modest short‐term effect of the motivational interview on an aggregate index of alcohol and other drug use (polydrug use on the OTI). Cannabis use remained high among the sample over the 12‐month follow‐up period.

Conclusion

Although motivational interviewing appears feasible among in‐patients in psychiatric hospital with comorbid substance use disorders, more extensive interventions are recommended, continuing on an out‐patient basis, particularly for cannabis use.
South of the border: a legal haven for underage drinking
Authors: Lange James E. , Voas Robert B. , Johnson Mark B.
Published: March 2003

Aims The research describes the characteristics and motivations of youthful San Diego County residents who patronize the bars and nightclubs in Tijuana, Mexico.

Design Two random‐digit‐dial surveys of San Diego County residents—one group aged 18–20 years and one aged 21–30 years—was conducted during a 2‐year period. Those who reported having visited the bars in Tijuana in the last year were compared with those who had not.

Setting All respondents were residents of San Diego County, California, USA.

Participants The study comprised 2200 youths between 18 and 30 years of age.

Measurements The interview protocol included questions covering demographic characteristics, drinking and drug‐use history, experience with Tijuana bars, and ratings of bar features in San Diego and Tijuana.

Findings About half of the 18–20‐year‐olds and a third of the 21–30‐year‐olds reported visiting bars in Tijuana at least once in the past 12 months. Race, age, gender, heavy drinking and drug‐use history were significantly associated with visits to Tijuana bars. The price of alcohol and the perceived freedom to get drunk in Tijuana bars were considered attractive features leading to cross‐border drinking.

Conclusions The features of the alcohol service in Mexican bars that attract youthful drinkers (low cost and liberal availability of alcohol, lack of formal controls, and presence of heavy drinkers) are similar to those present in other drinking locales that lead to drunkenness. Thus, a better understanding of the characteristics and motivations of the US youths patronizing bars in Tijuana can lead to improved interventions to reduce heavy, risky drinking.
Multiple hospital presentations by adolescents who use alcohol or other drugs
Authors: Tait Robert J. , Hulse Gary K. , Robertson Suzanne I. , Sprivulis Peter
Published: March 2003

Aims

To investigate ‘all cause’ and the subset of ‘alcohol or other drug’ (AOD) related hospital emergency department (ED) presentations over 12 months by adolescents with a previously identified AOD ED presentation.

Design and setting

A retrospective review of medical records in four metropolitan hospitals in Perth, Australia.

Participants

One hundred and fifty‐two adolescents (13–19 years) identified during a previous 4‐week study. The median age was 17.5 (interquartile range (IQR) 16–19); 61 (40%) were female.

Method

Medical records were reviewed for the 6 months either side of a previously identified index AOD presentation. Hospital events in this period were collapsed as ‘all cause’ morbidity with a subclassification of AOD related.

Findings

Over half (n=87, 57%) had no additional hospital events and 10 (7%) had only ‘follow‐up’ treatment for their index event. The drug identified for both these groups was primarily alcohol or alcohol plus other drugs compared with mainly heroin or prescription drugs for those with multiple presentations. There were 55 (36%) adolescents who had 236 presentations, including 39 with 147 AOD presentations: six polydrug users accounted for 47% of multiple presentations. Polydrug users had more ‘all cause’ and AOD presentations (Mann–Whitney U=168.5, P < 0.001) than single drug users, as did ‘heroin users’ compared with other AOD users (U=177.5, P < 0.001). There were no significant gender differences in the total number of ‘all cause’ or AOD presentations.

Conclusions

Alcohol users were the largest group at index presentation, but accounted for few of the presentations over 12 months. Polydrug users typically had multiple presentations and may benefit from additional non‐medical hospital support. A more labour‐intensive and structured approach might help the small number of polydrug users who accounted for a large proportion of repeat presentations over the 12‐month period.
Patterns of smoking in Estonia
Authors: Pärna Kersti , Rahu Kaja , Rahu Mati
Published: March 2003

Aims

To describe the pattern of current smoking and its relation to socio‐demographic factors in Estonia.

Design

Nationwide cross‐sectional survey.

Setting

Estonia in 1996.

Participants

Stratified random sample of 2086 adults aged 30–59.

Measurements

Prevalence of current smoking; socio‐demographic factors related to smoking, investigated by logistic regression analysis.

Findings

The prevalence of current smoking was 57.9% among men and 25.7% among women. For both genders, smoking rates were consistently lowest in the age group 50–59 years and highest in the age group 30–39 years. Smoking was significantly more common among divorced and widowed people. Education was associated with smoking among men but not among women. No relationship, however, was established between smoking and ethnicity, type of residence, and household income.

Conclusions

Estonia needs an effective antismoking policy. Public health efforts need to be focused on quitting smoking in younger adults and prevention efforts should target less educated socio‐economic groups.
The second National Epidemiological Survey on illicit drug use at six high‐prevalence areas in China: prevalence rates and use patterns
Authors: Hao Wei , Xiao Shuiyuan , Liu Teiqiao , Young Derson , Chen Shanmei , Zhang Diran , Li Chao , Shi Jianguo , Chen Guoqiang , Yang Kun
Published: March 2003

Aims

This is the first part of the Second National Epidemiological Survey on Illicit Drug Use in six high‐prevalence areas in China in 1996. The scale of illicit drug abuse and patterns of use in the survey areas were assessed.

Design, setting and participants

67 319 registered permanent residents in the community and those who were at institutions at the point of the survey (15 years old and over, males 34 755, 51.6%; females 32 564, 48.4%) in selected areas in China were screened and interviewed by trained psychiatrists.

Measurements

Demographics and drug‐related data were assessed using the Epidemiological Inventory for Illicit Drug Use developed by the authors. Illicit drugs in this study were defined as a group of psychoactive substances controlled by international and national laws, used for non‐medical purposes, including opiate, cocaine, amphetamine‐type stimulants (ATS), cannabis, hallucinogens, etc.

Findings

The lifetime prevalence of illicit drug use was 1.60% (male, 2.58%, female 0.57%), and 1‐year prevalence was 1.17% (male 1.80%, female 0.48%). There were 67 cases who used a drug initially before 1952; no new cases of illicit drug use could then be found during the period of 1952–86. However, the number of new drug users in each year has been rising steadily since 1986. The majority of drugs used were opiates in which heroin dominated, although there was some variability among the six sites. The main routes of administration were inhalation and intravenous injection. More than half the users (59.1%) took drugs on seven occasions or less per week, and 15.8% users used drugs on 21 occasions or more per week.

Conclusion

Compared with the data from the 1993 survey, illicit drug use has continued to escalate across the areas, calling for priority concern in various sections of the country.
Have we lost our way? The need for dynamic formulations of smoking relapse proneness
Authors: Piasecki Thomas M. , Fiore Michael C. , McCarthy Danielle E. , Baker Timothy B.
Published: March 2003

Current smoking cessation treatments seem to differ from one another in the proportion of ex‐smokers who survive the first few days of the quit attempt. After this initial effect, parallel relapse processes appear to unfold in all treatment groups; no available treatments seem to alter the nature of this late relapse process. True relapse prevention will require that we obtain a better understanding of the forces contributing to relapse across the span of the cessation attempt. A working model of dynamic relapse processes may be necessary before treatments can be improved. In this paper, we suggest that the conceptual model of relapse proneness (RP) described originally by the National Working Conference on Smoking Relapse can serve as an ecumenical organizational framework that may be used to integrate and conceptualize relapse data in ways that could generate new strategies for relapse research and inform treatment design. As an illustration, we sketch a preliminary model of RP which postulates that physical withdrawal, stressors/temptations, and cessation fatigue each make independent, time‐shifted contributions to relapse risk. A new round of descriptive research focused on relapse proneness processes may be a prerequisite for improving existing smoking cessation interventions.
A systematic review on the efficacy of naltrexone maintenance treatment in opioid dependence
Authors: Kirchmayer Ursula , Davoli Marina , Verster Annette D. , Amato Laura , Ferri Arica , Perucci Carlo A.
Published: March 2003

Aim

To evaluate the efficacy of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification.

Design

A systematic review according to the methodology developed by the Cochrane Collaboration based on either randomized controlled trials (RCTs) or controlled clinical trials (CCTs).

Participants

Seven hundred and seven heroin dependent in‐ and out‐patients, or former heroin addicts dependent on methadone and participating in a naltrexone treatment programme; 89% were male.

Intervention

Maintenance treatments on opiate dependent people after detoxification, comparing naltrexone with placebo, pharmacological or behavioural treatments.

Measurements

The outcomes considered were successfully completed treatment, opioid use under treatment (re)‐incarcerations during the study period, mean duration of treatment.

Findings

The outcomes tended to be slightly although not significantly in favour of the naltrexone groups. Use of naltrexone in addition to behavioural treatment significantly decreased the probability of (re‐)incarceration (OR=0.30; 95% CI 0.12, 0.76). The difficulties in producing a quantitative analysis were due mainly to the heterogeneity of the included studies.

Conclusions

From the available clinical trials performed up to this time, there is insufficient evidence to justify the use of naltrexone in maintenance treatment of opioid addicts.
Smoking cessation in methadone maintenance
Authors: Shoptaw Steve , Rotheram‐Fuller Erin , Yang Xiaowei , Frosch Dominick , Nahom Debbie , Jarvik Murray E. , Rawson Richard A. , Ling Walter
Published: March 2003

Aims  To evaluate relapse prevention (relapse prevention) and contingency management (contingency management) for optimizing smoking cessation outcomes using nicotine replacement therapy for methadone‐maintained tobacco smokers.

Design  Experimental, 2 (relapse prevention)×2 (contingency management) repeated measures design using a platform of nicotine replacement therapy featuring a 2‐week baseline period, followed by randomization to 12weeks of treatment, and 6‐ and 12‐month follow‐up visits.

Setting  Three narcotic treatment centers in Los Angeles.

Participants  One hundred and seventy‐five participants who met all inclusion and no exclusion criteria.

Intervention  Participants received 12weeks of nicotine replacement therapy and assignment to one of four conditions: patch‐only, relapse prevention + patch, contingency management + patch and relapse prevention + contingency management + patch.

Measurements  Thrice weekly samples of breath (analyzed for carbon monoxide) and urine (analyzed for metabolites of opiates and cocaine) and weekly self‐reported numbers of cigarettes smoked.

Findings  Participants (73.1%) completed 12weeks of treatment. During treatment, those assigned to receive contingency management showed statistically higher rates of smoking abstinence than those not assigned to receive contingencies (F3,4680=6.3, P=0.0003), with no similar effect observed for relapse prevention. At follow‐up evaluations, there were no significant differences between conditions. Participants provided more opiate and cocaine‐free urines during weeks when they met criteria for smoking abstinence than during weeks when they did not meet these criteria (F1,2054=14.38, P=0.0002; F1,2419=16.52, P<0.0001).

Conclusions  Contingency management optimized outcomes using nicotine replacement therapy for reducing cigarette smoking during treatment for opiate dependence, although long‐term effects are not generally maintained. Findings document strong associations between reductions in cigarette smoking and reductions in illicit substance use during treatment.