bluuebunny/crossref_metadata_2025 huggingface dataset:
A controlled field trial of group versus individual cognitive‐behavioural training for relapse prevention
Authors: Graham Kathryn , Annis Helen M. , Brett Pamela J. , Venesoen Philippe
Published: March 2003

Results are presented of a randomized field trial comparing two aftercare regimes, namely individual versus group delivery of a structured relapse prevention approach. Two addictions treatment programs (one a 12‐Step 26‐day residential program, the other an evening group counselling program) implemented structured relapse prevention in either group or individual format as part of the first three months of aftercare. Process measures (e.g. attendance, client satisfaction) indicated that both group and individual formats were delivered very successfully at both sites. Follow‐up rate at 12 months across both programs was 74%, and drinking and drug use at the 12‐month follow‐up was substantially less than use at entry into treatment. However, there were no significant differences in outcomes between individual and group delivery on any of the alcohol or drug use measures. Only one psychosocial outcome measure (social support from friends at 12‐month follow‐up) showed a significant difference for format and it favored the group format. These findings suggest some important directions for future research.
The first hit: circumstances surrounding initiation into injecting
Authors: Crofts Nick , Louie Robyn , Rosenthal Doreen , Jolley Damien
Published: March 2003

Initiation into injecting is a crucial event for continued reproduction of an injecting drug using (IDU) population and for exposure to blood‐borne viruses, but little is known about how this happens. Three hundred young injectors were interviewed in Melbourne by peer workers within the first few years of beginning to inject, about the circumstances surrounding their initiation. Most had indications of social disruption, including having left school early, unemployment, family disruption, homelessness and incarceration. First drug injected was most often amphetamines (average age 16 years), most having already used amphetamines by a different route of administration, but with a steady movement thereafter to heroin as the drug of choice. The most common scenario was one in which injecting was unplanned but the person was active in bringing about the initiation. Most identified a significant other who initiated them (few of whom were dealers), and over half had subsequently initiated others into injecting, on average 0.6 per year; after 5 years 237 young injectors had initiated at least 420 others. Those who initiated multiple others were more likely to be unemployed, to inject multiple drugs and to have dealt. Modelling injecting as a communicable phenomenon, where appropriate, may help estimate population dynamics among IDUs. Peer education programmes are likely to be the most effective harm reduction approach among new injectors.
Pre‐treatment characteristics, program philosophy and level of ancillary services as predictors of methadone maintenance treatment outcome
Authors: Saxon Andrew J. , Wells Elizabeth A. , Fleming Charles , Jackson T. Ron , Calsyn Donald A.
Published: March 2003

Predictors of methadone maintenance treatment outcome have not been extensively studied as they relate to variations in program philosophy, nor have such predictors received much examination among recently treated, older cohorts of opioid addicts for whom drug use patterns have changed. Predictors of outcome were examined at 18 months post‐treatment entry for 353 admissions to methadone maintenance who received random assignment to one of three counseling conditions: (1) medication only, (2) standard counseling and (3) enhanced services; and one of two contingency conditions: (1) no contingencies, and (2) contingency contracting in a six‐cell 3x2 design. Subjects in contingency contracting conditions were placed on contingency contracts for positive urine toxicology results and ultimately discharged for unremitting drug use. All subjects completed the Addiction Severity Index (ASI) and provided weekly urine specimens. Predictors of urinalysis results and treatment retention were determined using bivariate and multivariate techniques. Interactions between subject characteristics by experimental condition assignment were also examined as predictors. Higher rates of total positive urine specimens were predicted by younger age, greater pre‐treatment frequency of smoking cocaine, lower ASI psychiatric composite scores, and higher ASI legal composite scores. Higher rates of opiate positive specimens were predicted by younger age, lower pre‐treatment frequency of alcohol intoxication, higher ASI legal and lower ASI employment and psychiatric composite scores, and assignment to medication only/no contingencies condition. Higher rates of cocaine positives were predicted by younger age, black race, lower ASI psychiatric composite score, greater pre‐treatment frequency of intravenous and smoked cocaine use, less pre‐treatment frequency of marijuana use, and lower methadone dose level. Assignment to enhanced/contingency contracting predicted lower rates of cocaine positives. Treatment retention was predicted by older age, non‐black race, lower ASI legal composite score, higher methadone dose level and assignment to non‐contingent conditions. While subject variables over which treatment providers have little control were, thus, related to outcome, type of treatment provided and methadone dose also influenced outcome.
Cough mixture misuse in Hong Kong ‐ an emerging psychiatric problem?
Authors: Lam Linda C. W. , Lee Dominic T. S. , Shum Patrick P. S. , Chen C. N.
Published: March 2003

Cough mixture misuse has become a focus of concern in Hong Kong since the late 1980s. Psychiatric admissions related to cough mixture misuse have been reported with increasing frequency during the past 5 years. A retrospective chart review of psychiatric admissions related to cough mixture misuse for a 54‐month period was conducted in two psychiatric units in Hong Kong. Twenty‐seven subjects were identified. The main psychiatric presentations included acute organic brain syndrome, schizophreniform psychosis and affective episode. They appeared to be associated with the pharmacological activities of opiates, antihistamines and sympathomimetics, the main ingredients of most cough mixtures.
Science and alcohol policy at the local level: a respectful partnership
Authors: Holder Harold D. , Reynolds Robert
Published: March 2003

This paper describes the working exchange between scientists who designed a three‐community prevention trial in the United States (1990‐95) to reduce alcohol‐involved injuries at the community level, and community organizers and local policy‐makers in the experimental sites. We found that researchers brought scientific knowledge of potentially effective alcohol policies but had no experience with the local culture, priorities or processes; conversely, community organizers understood the local situation but were not knowledgeable about prevention strategies which, based on prior evidence, could work. We also found that communities are interested in science to aid the selection of local alcohol policies, but scientists do not understand local dynamics well enough to direct the implementation of these policies. This case study showed that both groups must respect each other and seek ways to work together for the mutually desired outcome of effective local prevention.
Supplemental social services improve outcomes in public addiction treatment
Authors: Mclellan A. Thomas , Hagan Teresa A. , Levine Marvin , Gould Frank , Meyers Kathleen , Bencivengo Mark , Durell Jack
Published: March 2003

Aims. To evaluate the effectiveness and value of social services added to standard addiction rehabilitation. Design. A controlled, quasi‐experimental, field study with repeated measures. Setting. Conducted in two groups of publicly supported outpatient addiction treatment programs. Control programs provided standard, twice‐weekly, outpatient group counseling. "Enhanced" programs provided standard counseling but also case managers to coordinate and expedite use of pre‐contracted medical screenings, housing assistance, parenting classes and employment services. Measurements. The Addiction Severity Index was used to record the nature and severity of patient problems in seven areas at treatment admission and at 6‐month follow‐up. Services provided during treatment were measured with the Treatment Services Review. Measures were taken on consecutive samples of patients admitted to all programs‐before enhancements (wave 1, N = 431)‐and at 12 months (wave 2, N = 710); and 26 months following enhancements (wave 3, N = 187). Findings. There were no significant differences in patient characteristics, treatment services or 6‐month outcomes of the two sets of programs in wave 1. Wave 2 and especially wave 3 enhanced programs provided significantly more social and medical services than control programs. Patients treated in enhanced programs showed significantly less substance use, fewer physical and mental health problems and better social function at 6‐months than Controls. Conclusions. Adding social services to public sector programs substantially improved the outcomes of addiction treatment. Changes in "real world" systems require time to implement; early evaluations may fail to capture the full impact of those changes.
Acute opiate overdose: characteristics of 190 consecutive cases
Authors: Cook Stephane , Moeschler Olivier , Michaud Katarzyna , Yersin Bertrand
Published: March 2003

Aims. To characterize the population of drug users consulting the Emergency Room (ER) of a university hospital with acute opiate overdose (AOO) and to assess rate of referral to specialized treatment programme. Design. Survey of a 12‐month sample of AOO patients. Measurements. Medical and psychosocial features of the drug users, details of emergency treatment and referral by a mobile resuscitation team (SMUR) and the ER of our hospital (CHUV‐Lausanne, Switzerland). In addition fatal AOO cases were collected by the Institute of Forensic Medicine (IFM) during the same period. Findings. One hundred and eighty‐four cases of AOO (134 patients) were treated. The files of the IFM detailed six additional deceased cases. This population of drug users was characterized by an over‐representation of men (73%), by young age (27.4 years), by a high rate of multi‐drugs use (90%) and by a high rate of multiple previous overdoses (2.6). Average length of stay was 20.1 hours but 41% of cases stayed less than 8 hours. Only one patient was readmitted within an 8‐hour period. When discharged, 78% returned home. Unexpectedly, 67% of patients were not referred to any therapeutic programme for drug addiction. Conclusion. This study shows the low mortality of AOO when treated but also demonstrates the need to improve psychosocial evaluation and referral of drug addicts admitted with AOO.
French general practitioners' attitudes toward maintenance drug abuse treatment with buprenorphine
Authors: Moatti J. P. , Souville M. , Escaffre N. , Obadia Y.
Published: March 2003

Aims . To assess attitudes of general practitioners (GPs) toward buprenorphine maintenance drug abuse treatment just after its introduction in French ambulatory care (February, 1996). Design. Cross‐sectional survey by telephone interviews in a national random sample of French GPs ( n = 1,186; response rate = 70.3%) carried out in April 1996. Measurements. GPs' experience with care for IDU patients and HIV infection during the last 12 months. Logistic regression model to identify GPs' characteristics associated with readiness to prescribe buprenorphine for maintenance treatment. Findings. A minority (24.0%) of GPs took care of IDU patients and 30.8% of these were prepared to prescribe buprenorphine (vs. only 7.5% in the rest of the sample). A positive attitude toward buprenorphine was related to GPs' experience with care for IDUs and with prescription of opiates for pain management and palliative care, tolerance toward drug use and personal characteristics such as tobacco use and interest in psychoanalysis. Conclusions. Giving general freedom of prescription of buprenorphine (rather than methadone) to all GPs did not lead to widespread acceptance of the drug's use in treating IDUs. The development of organized networks between specialist services for drug abuse treatment and motivated GPs may be necessary to maximize appropriate prescribing practices.
Comparison of the frequency and enjoyability of pleasant events in cocaine abusers vs. non‐abusers using a standardized behavioral inventory
Authors: Etten Michelle L. Van , Higgins Stephen T. , Budney Alan J. , Badger Gary J.
Published: March 2003

Aims. To examine whether cocaine abusers differ from non‐abusers in their frequency and enjoyability of engaging in various "pleasant events", in order to approximate the density of positive reinforcement experienced in their natural environment. Design. Comparisons of cocaine abusers to normative data and matched controls. Setting. An outpatient substance abuse treatment center in Burlington, Vermont, USA. Participants. Subjects included 100 individuals enrolled in outpatient treatment for cocaine abuse or dependence and 50 community volunteers without histories of drug abuse or other major psychiatric illness and matched to cocaine‐dependent patients on age, sex and SES. Measurements. Diagnostic assessments were based upon clinical interviews using the DSM‐III‐R checklist. The primary focus of this study was the Pleasant Events Schedule (PES), a self‐rated behavioral inventory of the frequency and enjoyability of engaging in "pleasant" activities. Cocaine use history, treatment outcome and other relevant variables were also assessed. Findings. Cocaine abusers reliably reported lower frequency of non‐social, introverted, passive outdoor and mood‐related activities than controls. These differences remained after controlling for demographic and life‐style differences between groups, with the exception of mood‐related activities. Perceived enjoyability of the activities did not differ across groups. Intravenous cocaine use and prior treatment for cocaine abuse predicted particularly low frequency of pleasant activities. Greater frequency of non‐social activities predicted better treatment outcome. Conclusions. Drug abuse is associated with low density of certain types of non‐drug reinforcement. Systematic increases in these activities may improve treatment outcome.
Factors associated with marijuana use among American Indian adolescents
Authors: Novins Douglas K. , Mitchell Christina M.
Published: March 2003

Aim. To examine the characteristics of marijuana users among a large sample of American Indian high school students. Design. High school survey. Setting. Seven predominantly American Indian high schools in four communities west of the Mississippi. Participants. 1464 Indian adolescents who: (1) completed a survey in November, 1993, (2) were in grades 9 to 12, (3) were members of one of four Indian tribal groups; and (4) had a complete set of data for these analyses. Measurements. Logistic regression models were developed to predict the probability of low‐frequency (1‐3 times over the last month) and high‐frequency (11 or more times) marijuana use. Independent variables included measures of socio‐demographics, stressful life events, personal characteristics and beliefs, psychiatric symptomatology and other substance use. Findings. Forty per cent of these American Indian adolescents had used marijuana at least once in the last month. The prevalence of marijuana use varied across the four tribes. Males were no more likely than females to use marijuana at a low frequency, but were more likely to use at a high frequency. The factors associated with marijuana use varied with the frequency of use and by gender. In the final multivariate models, low‐frequency marijuana use among females was associated with reporting that peers encouraged alcohol use as well as use of alcohol and stimulants. Among males, low‐frequency use was associated with greater positive alcohol expectancies, lower grades in school and alcohol use. While high‐frequency marijuana use was associated with use of alcohol, stimulants and cocaine among females, such use was associated with higher scores on the antisocial behavior scale as well as the use of alcohol, stimulants and cocaine among males. Overall, the strongest associations were with the use of alcohol and other illicit substances. Conclusion. Low‐frequency and high‐frequency marijuana use are distinct patterns of use and have different correlates across genders. Marijuana use among American Indian adolescents is a complex phenomenon that is best understood within the context of other substance use.
A social marketing model for disseminating research‐based treatments to addictions treatment providers
Authors: Martin G. W. , Herie M. A. , Turner B. J. , Cunningham J. A.
Published: March 2003

Aims. Researchers must develop effective strategies for disseminating research‐based treatments. This study evaluates the application of a dissemination model based on principles of social marketing and diffusion theory. Design. A case study describes how the model was implemented. A qualitative design was employed to examine rates of adoption and adaptation of an early intervention program by a targeted system of addictions agencies. Setting. The interventions were developed at the Addiction Research Foundation in Toronto and disseminated to Assessment and Referral (A/R) Centres in Ontario, Canada. Participants. Study participants included the managers and a designated therapist for 33 participating A/R centres. Measurements. Managers were asked mainly open‐ended questions concerning whether their agency had made a formal decision to adopt the intervention and whether therapists in their agency were using the early intervention program. "Adoption" was operationalized as offering the complete four‐session intervention to at least one client. Findings. At 12 months after the completion of training workshops, 68% of 34 agencies in the target system had adopted the program while 85% of the agencies were using some components of the intervention with clients. Conclusions. The dissemination model appeared to be effective although its application proved to be time‐consuming and labour‐intensive. The "market analysis", systems focus and field‐test components of the model appeared to contribute to its success.
Do treatment process factors mediate the relationship between Type A‐Type B and outcome in 12‐Step oriented substance abuse treatment?
Authors: Morgenstern Jon , Kahler Christopher W. , Epstein Elizabeth
Published: March 2003

Aims. One underutilized strategy for enhancing treatment research is to examine intervening factors that link client characteristics to endpoint outcomes. This study tested the hypothesis that Type B substance abusers would demonstrate difficulties engaging in the treatment process, and that these problems would mediate their poorer outcomes. Design. Longitudinal naturalistic study. Setting. Two intensive 12‐Step substance abuse treatment programs. Participants. A sample of 115 men and women seeking treatment. Measurement. Empirical clustering techniques were used to divide the sample, and the link between type, process factors, and 12‐month outcomes was examined. Findings. Hypotheses were not supported. Type Bs did not demonstrate difficulties with the treatment process, but had greater problems sustaining gains posttreatment. Contrary to prediction, Type Bs were better matched to self‐help affiliation than Type As. Conclusions. Findings argue for a more optimistic perspective on treating Type Bs, and for the utility of Type A‐Type B in informing treatment research.
RESEARCH REPORT A meta‐analysis of predictors of continued drug use during and after treatment for opiate addiction
Authors: Brewer Devon D. , Catalano Richard F. , Haggerty Kevin , Gainey Randy R. , Fleming Charles B.
Published: March 2003

Abstract Aims. Many people treated for opiate addiction continue to use drugs during and after treatment. It may be possible to improve outcomes by addressing patient characteristics that predict continued drug use. This review uses meta‐analytic techniques to identify risk factors for continued drug use in patients treated for opiate abuse. Design and Measurements. A thorough search of the published literature yielded 69 studies that reported information on the bivariate association between one or more independent variables and continued use of illicit drugs during and after treatment for opiate addiction. Findings. Most of the patient variables summarized have weak longitudinal relationships with continued drug use, although several variables display moderate longitudinal associations. Ten variables show statistically significant and longitudinally predictive relationships (average r 0.1) with continued use, including: high level of pretreatment opiate/drug use, prior treatment for opiate addiction, no prior abstinence from opiates, abstinence from/light use of alcohol, depression, high stress, unemployment/employment problems, association with substance abusing peers, short length of treatment, and leaving treatment prior to completion. Several other variables may be potentially longitudinally predictive. Conclusions. To prevent relapse, treatment interventions should address multiple variables because no single variable strongly predicts continued drug use.
RESEARCH REPORT Clinical significance of Cloninger's classification in a sample of alcoholic Spanish men
Authors: Rubio G. , Leon G. , Ferre F. , Pascual J. , Santo‐Domingo J.
Published: March 2003

Abstract Aims. To evaluate Cloninger's classification in a sample of alcoholic Spanish men. Design. A crosssectional study was carried out on subjects diagnosed as alcoholics. Setting. Out‐patient units specializing in the treatment of alcoholics and the psychiatry unit of a general hospital. Participants. One hundred and ninety‐eight males diagnosed as alcoholics. The mean age was 44.4 11.6 years and 98% were from urban areas. Measurements. Participants were interviewed using the Structured Clinical Interview for DSMIII‐R(SCID). They were classified using type 1 and type 2 criteria of Cloninger's classification. Findings. Only one‐third of our sample could be classified by Cloninger's type 1 and type 2 criteria. Patients classified as belonging to type 2 had an earlier onset of regular drinking compared to type 1 patients. Type 2 subjects presented a higher percentage of alcohol‐related problems as well as problems related to drugs other than alcohol and they also presented a higher percentage of antisocial personality disorder. No differences in alcoholism family history were found between the groups. Criteria showing the poorest discriminative ability between both groups were "failure to keep abstinent" and "benders lasting at least two days". Conclusions. Our results do not support Cloninger's etiological hypotheses for alcoholism. Cultural differences may be responsible for the different drinking patterns observed.
Alcohol consumption and mortality. I. Characteristics of drinking groups
Authors: Fillmore Kaye Middleton , Golding Jacqueline M. , Graves Karen L , Kniep Steven , Leino E. Victor , Romelsjo Anders , Shoemaker Carlisle , Ager Catherine R. , Allebeck Peter , Ferrer Heidi P.
Published: March 2003

Aims. This is the first of a set of three papers evaluating drinking status and mortality risk. Analyses of multiple studies describe associations of drinking patterns with characteristics hypothesized to confound the relationships between drinking status and mortality. Characteristics which both significantly differentiate drinking groups and are consistent across studies would suggest that mortality studies not controlling for them may be compromised. Design and participants. Associations are evaluated from the raw data of 10 general population studies which contained mortality data. Long‐term abstainers are compared to former drinkers, long‐term abstainers and former drinkers are compared to light drinkers (by quantity, frequency and volume in separate analyses) and moderate to heavy drinkers are compared to light drinkers. Tetrachoric correlation coefficients assess statistical significance; meta‐analysis determines if associations are homogeneous across studies. Measurements. Measures of alcohol consumption are quantity, frequency and volume; long‐term abstainers are differentiated from former drinkers. Multiple measures of health, social position, social integration and mental health characteristics are evaluated. Findings. Across studies, adult male former drinkers are consistently more likely to be heavier smokers, depressed, unemployed, lower SES and to have used marijuana than long‐term abstainers. Adult female former drinkers are consistently more likely to be heavier smokers, in poorer health, not religious, and unmarried than long‐term abstainers. Both types of abstainers tend to be of lower SES than light drinkers and report poorer health (not consistent). Female abstainers are more likely to be of normal or overweight than light drinkers. Conclusions. Characteristics of two groups of abstainers, other than their non‐use of alcohol, may confound the associations found between drinking and mortality risk.
Multi‐site samples of injecting drug users in Edinburgh: prevalence and correlates of risky injecting practices
Authors: Peters Andy , Davies Tony , Richardson Alison
Published: March 2003

Aims. To estimate the frequency of injecting and prevalence of equipment sharing and other risky injecting practices among intravenous drug users (IDUs) and to identify correlates of these behaviours. Design. Three cross‐sectional surveys of IDUs by face‐to‐face interview in the years 1992‐94. Setting. Multiple treatment and non‐treatment sites throughout the city of Edinburgh, Scotland, UK. Participants. Six hundred and thirty‐four interviews of 480 IDUs who reported having injected a drug in the previous six months. Measurements. Self‐reports of drug‐taking behaviours, service contact, sexual behaviour and HIV knowledge, and anonymous testing of saliva for HIV antibodies. Findings. Only 18% had injected at least daily. Thirty‐five per cent had accepted or passed on used equipment. Eighty‐five per cent of subjects recruited from non‐treatment sites were receiving treatment for their drug taking. Multivariate analyses indicated that risky injecting was associated with a consistent history of sharing, polydrug injecting, injecting in prison, having recently started injecting, and recent experience of methadone detoxification. Conclusions. Injecting frequency and equipment sharing have declined substantially in Edinburgh during the past 10 years and are low compared to other cities in the United Kingdom and elsewhere. These improvements have occurred in the context of remarkably high levels of drug treatment service contact. Our findings support the international evidence indicating that IDUs have modified their injecting habits significantly without completely eliminating this form of HIV risk. High levels of service contact in Edinburgh provide ample opportunities to instigate further HIV prevention measures which target identifiable subgroups of IDUs who persist in risky injecting.
Clinical experience with antagonist‐induced opiate withdrawal under anaesthesia
Authors: Tretter F. , Burkhardt D. , Bussello‐Spieth B. , Reiss J. , Walcher S. , Buchele W.
Published: March 2003

Aims. The study describes experience with antagonist‐induced opiate withdrawal under anaesthesia in standard clinical conditions. Design. The study was restricted to patients who had undergone failed withdrawal treatments with usual methods over the past months. No control group was used. Setting and procedure. The patients were selected after history‐taking and examination. A multi‐axial diagnosis was performed. They were then admitted to an inpatient treatment unit for addicted patients. On the second day they were put into neurological intensive care. There they were intubated, ventilated and anaesthetized with propofol for 6 hours. Shortly after induction of anaesthesia, naloxone and naltrexone were administered. A high amount of fluid was used to balance changes in water and electrolytes. After anaesthesia the patients were transferred back to the addiction ward and sedated with clonidine. The patients were then fully mobilized. On discharge 50 mg naltrexone were given daily. Participants. Eighty‐eight patients were treated. They were long‐term opiate users. Preference was given to methadone‐substituted patients who were unable to rid themselves of methadone. Measurements. The account given is based solely on clinical observations. Findings. The first 14 patients were observed in detail and it is on them that this report is based. It was found that withdrawal from codeine and methadone can be shortened to approximately 2‐3 days. No patient was in a condition to go home immediately after anaesthesia. Twelve patients showed significant symptoms on the day following anaesthesia The majority of patients treated by this method will continue to suffer withdrawal symptoms for a few days after detoxification, after which time most can be treated in an outpatient setting. Dysfunction of the cardiovascular system, the lungs, the kidneys or other organs was not observed. Taking into account all the 88 patients, five had to stay in hospital for a longer period (up to 2 weeks) because of a prolonged withdrawal syndrome.
Psychiatric co‐m orbidity alcoholics: a prospective representative sam ple and aftercare am ong study of a nationwide
Authors: Tomasson Kristin N , Vaglum Per
Published: March 2003

A bstract A im s. To study prospectively the type and extent of aftercare sought by patients following their admission for alcohol and other substance abuse treatment as a function of psychiatric co‐morbidity . D esign. Prospective cohort study with follow‐up after 16 months . Setting and participants. A nationwide sample of alcoholics discharged from inpatient treatment ( N = 351) in Iceland . M easurem ents. The Diagnostic Interview Schedule was used to assign psychiatric diagnoses at the time of index admission. A questionnaire on the type and number of aftercare attendances was mailed to all participants to obtain information about aftercare . Findings. A combination of attendance at Alcoholics Anonymous (AA) and professional care was the most common aftercare (49%); while only 8% received no aftercare whatsoever. The mean number of AA attendances was over 24 while it was less than 3 for the various professional appointments. Patients with a diagnosis of schizophrenia had a lower rate of attendance at AA. Other types of co‐morbidity did not affect AA attendance but did increase rates of professional help‐seeking . C onclusions. Better professional treatment attendance might be gained by integrating AA concepts while AA might benefit from professional input to address the prevalent co‐morbid psychiatric disorders.
Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial
Authors: Ling Walter , Charuvastra Charles , Collins Joseph F. , Batki Steve , Brown Lawrence S. , Kintaudi Prudencia , Wesson Donald R. , Mcnicholas Laura , Tusel Donald J. , Malkerneker Usha , Renner John A. , Santos Erick , Casadonte Paul , Fye Carol , Stine Susan , Wang Richard I. H. , Segal Doralie
Published: March 2003

Aims. To evaluate the safety and efficacy of an 8 mg/day sublingual dose of buprenorphine in the maintenance treatment of heroin addicts by comparison with a 1 mg/day dose over a 16‐week treatment period. As a secondary objective, outcomes were determined concurrently for patients treated with two other dose levels . Design. Patients were randomized to four dosage groups and treated double‐blind . Setting. Twelve outpatient opiate maintenance treatment centers throughout the United States . Participants. Two hundred and thirty‐nine women and 497 men who met the DSM‐III‐R criteria for opioid dependence and were seeking treatment . Intervention. Patients received either 1, 4, 8 or 16 mg/day of buprenorphine and were treated in the usual clinical context, including a 1‐hour weekly clinical counseling session . Measurement. Retention in treatment, illicit opioid use as determined by urine toxicology, opioid craving and global ratings by patient and staff. Safety outcome measures were provided by clinical monitoring and by analysis of the reported adverse events . Findings. Outcomes in the 8 mg group were significantly better than in the 1 mg group in all four efficacy domains. No deaths occurred in either group. The 8 mg group did not show an increase in the frequency of adverse events. Most reported adverse effects were those commonly seen in patients treated with opioids . Conclusions. The findings support the safety and efficacy of buprenorphine and suggest that an adequate dose of buprenorphine will be a useful addition to pharmacotherapy.
Relationship of plasma buprenorphine and norbuprenorphine to withdrawal symptoms during dose induction, maintenance and withdrawal from sublingual buprenorphine
Authors: Kuhlman James J. , Levine Barry , Johnson Rolley E. , Fudala Paul J. , Cone Edward J.
Published: March 2003

Aims. Examine the relationship between buprenorphine and norbuprenorphine plasma concentrations with subject‐reported withdrawalsymptomatology during buprenorphine dose induction, maintenance treatment (daily and alternate‐day dosing) and withdrawal . Design. Two groups of randomly assigned subjects inducted onto buprenorphine and maintained on 8 mg daily by the sublingual route for 18 days. Group 1 continued to receive daily buprenorphine to day 36. Group 2 subjects received alternate‐day dosing of buprenorphine and placebo on days 19 to 36. Both groups received placebo on days 37 to 52 . Setting. Inpatient facilities at the Addiction Research Center, Intramural Research Center, NIDA, Baltimore, MD . Participants. Eleven male, heroin‐dependent volunteers participating in a research study . Intervention. Medications for treatment of withdrawal symptoms were prescribed as needed after day 39 (72 hours after the last dose of buprenorphine) . Measurements. Plasma concentrations of buprenorphine and norbuprenorphine, withdrawal symptomatology and pupil diameter . Findings. The mean steady‐state buprenorphine plasma concentration (24 hours) after daily administration of sublingual buprenorphine for study days 21‐35 was 0.80 ng/ml, and the mean alternate day steady‐state buprenorphine plasma concentration (24 hours) was 0.77 ng/ml. Daily and alternate day steady‐state norbuprenorphine plasma concentrations were 1.10 and 0.90 ng/ml, respectively. Predicted alternate day steady‐state buprenorphine and norbuprenorphine plasma concentrations at 48 hours were 0.49 ng/ml and 0.57 ng/ml, respectively. Withdrawal scores varied inversely with plasma concentration. There were no significant differences between Groups 1 and 2 during steady‐state (days 21‐35) with regard to withdrawal scale scores or pupillary diameter. The overall, mean terminal elimination half‐lives for buprenorphine and norbuprenorphine were 42 and 57 hours, respectively . Conclusions. During daily buprenorphine maintenance, plasma concentrations greater than 0.7 ng/ml of buprenorphine and norbuprenorphine were associated with minimal withdrawal symptoms. The long elimination half‐life of buprenorphine suggested that increasing the buprenorphine dose with alternate‐day administration may provide an effective, flexible therapy regimen for the treatment of opioid dependence.
Blame and punishment for intoxicated aggression: when is the perpetrator culpable?
Authors: Wild T. Cameron , Graham Kathryn , Rehm Jurgen
Published: March 2003

Aim. To systematically test the hypothesis that intoxicated individuals are viewed as less culpable than relatively sober individuals for engaging in aggressive behaviour. Design. A series of experimental vignettes depicted alcohol use in the context of unwanted touching, date rape, assault and rape, vandalism and common assault. Each vignette manipulated drinking of the perpetrator and selected contextual variables using between‐subjects experimental designs. Setting. A stratified random sample of 994 Ontario residents responded to these scenarios in the course of a telephone interview. Measurements. Three measures were analysed in this study: (1) judgements of the causal role of the perpetrator's drinking in leading to each outcome, (2) perceived blameworthiness of the perpetrator, and (3) appropriate punishment for the perpetrator. Findings. Drinking was believed to play a greater causal role in leading to each outcome when the perpetrator was portrayed as "drunk" as opposed to merely "feeling the effects". However, intoxication did not attenuate perceived blameworthiness and only inconsistently reduced punishment assigned to perpetrators. Instead, intoxication interacted with premeditation, criminal history and gender to determine perceived culpability of perpetrators. In some scenarios, victim intoxication reduced perceived culpability of the perpetrator. Conclusions. Legal, anthropological, and attributional accounts may overestimate the extent to which perpetrator intoxication‐in and of itself‐determines perceived culpability for alcohol‐related aggression.
A randomized trial of adding fluoxetine to a naltrexone treatment programme for heroin addicts
Authors: Landabaso M. A. , Iraurgi I. , Jimenez‐Lerma J. M. , Sanz J. , Corres B. Fernadez De , Araluce K. , Calle R. , Gutierrez‐Fraile M.
Published: March 2003

Aims. The purpose of the study was to assess whether fluoxetine would enhance retention in a naltrexone (NTX) treatment programme . Design. Randomized clinical trial . Setting. The clinical trial was conducted in two Drug Dependence Centres (DCs) of the Basque Country, Spain over a 1‐year period. These DCs routinely used naltrexone as part of their treatment . Participants. A total of 112 heroin addicts included in a naltrexone treatment programme were randomly allocated to two groups of 56 patients each . Intervention. One group received 20 mg/24 h of fluoxetine for the first 6 months, while the remaining 56 patients were used as controls. No placebo was used . Measurements. Retention rates and hazard functions were estimated. The risk difference and relative risk were also calculated at 6 and 12 months . Findings. The survival functions showed significantly higher retention rates in the fluoxetine group than among the controls. The risk difference at both 6 months (RD6 = 0.23, CI 95% = 0.06‐0.42) and 12 months (RD12 = 0.21, CI 95% = 0.09‐0.39) favoured the fluoxetine group, with a greater dropout risk at both times among the controls (RR6 = 1.81, CI 95% = 1.11‐2.94; RR12 = 1.46, CI 95% = 1.04 = 2.04) . Conclusions. The study showed that the combination of fluoxetine and naltrexone produced significantly greater retention than in patients given only naltrexone. Placebo‐controlled trials are warranted to assess how far this reflects a specific pharmacological effect.
An association between the regular use of 3,4 methylenedioxy‐methamphetamine (Ecstasy) and excessive wear of the teeth
Authors: Redfearn P. J. , Agrawal N. , Mair L. H.
Published: March 2003

Aims. This study was established to determine if users of ecstasy had greater tooth wear than a comparison group of non‐users . Design. The study involved a direct comparison between two groups of young people gathered by a peer information network and divided by the response to the question "Do you take ecstasy? " Setting. The information network was established at the Maryland Centre in Liverpool (UK). Besides offering advice on drug and sex‐related problems this centre distributes free condoms and is therefore visited by many young people who would not consider themselves to have these problems . Participants. There were 30 users and 28 non‐users with no significant difference in the gender ratio. Age was not recorded to maintain absolute confidentiality, but all the participants appeared to be of student age . Measurements. Tooth wear was measured using the index of Smith & Knight. The social and drug‐taking profile of the two groups was ascertained by questionnaire . Findings. It was found that the mean ( STD) tooth wear score for the back teeth was 0.96 0.16 in the users compared with 0.12 0.08 for the comparison group. These values were significantly different ( p 0.001). The values for the front teeth were not significantly different. Many users were aware of clenching their teeth 12 or even 24 hours after taking the drug. Conclusion. Taking ecstasy results in an increased likelihood of tooth wear on the back teeth. This is likely to result from clenching the teeth in the acidic environment caused by carbonated (fizzy) drinks.
Socially desirable response tendency as a correlate of accuracy of self‐reported HIV serostatus for HIV seropositive injection drug users
Authors: Latkin Carl A. , Vlahov David
Published: March 2003

Aims. This study examined the accuracy of self‐reported HIV serostatus for injection drug users and the predictive validity of a measure of social desirability to detect inaccurate self‐reports. Design. Participants in the ALIVE study were provided testing for HIV antibodies and counseling every 6 months. In the separate SAFE study, the same volunteers were asked their HIV serostatus. Participants. The 348 active injection drug users recruited from the ALIVE study, a longitudinal study of the natural history of HIV among injection drug users, volunteered for an HIV prevention study (SAFE study). Measurements. The ALIVE baseline interview included a scale to measure "self‐deception", a dimension of socially desirable responding. Findings. Of one hundred and four HIV seropositive participants, 71 (68%) accurately reported their HIV status, 28 (27%) inaccurately reported their HIV serostatus, and five (5%) reported that they did not know or were not sure about their HIV serostatus. Of 242 HIV seronegative participants, 239 (98%) correctly reported their serostatus. Thus the sensitivity of self‐report was 72%, specificity 99%, positive predictive value 97%, and the negative predictive value was 90%. For individuals who scored at or below the median on self‐deception, the sensitivity of self‐reported HIV serostatus was 81%. Conclusions. The results suggest that high scores on some measures of social desirability may indicate questionable validity of self‐reported HIV serostatus.
Patterns of alcohol, cigarette and illicit drug use in English adolescents
Authors: Sutherland Ian , Willner Paul
Published: March 2003

Aims. The aim of this study was to describe associations between alcohol, tobacco and illicit drug use in adolescents and demographic factors associated with substance use. Design, setting, subjects. The study was a classroom survey of the total population of pupils (n=5383, ages 11‐16) in six schools selected from different locations around England. Measures. Respondents were asked confidentially about their use and extent of use of alcohol, cigarettes and illegal drugs. Findings. The prevalence of regular substance use within the sample rose from 30.4% at age 11 to 83.9% at age 16. The prevalence of alcohol use did not differ between girls and boys, but smoking was more prevalent in girls and illegal drug use was more prevalent in boys. Alcohol was used more frequently than any other substance, or combination of substances, and alcohol use almost invariably accompanied the use of other substances: exclusive use of cigarettes or illegal drugs was negligible. In addition, high levels of alcohol intoxication were associated with increased use of both illegal drugs and cigarettes. Overall, around half the drinkers (46.8%) preferred alcopops to other types of alcoholic drink; this figure was greater in girls (56.4%) than in boys (37.1%), but fell sharply with age (62.9% at age 11; 37.7% at age 16), particularly in boys. Preference for spirits increased with age, and was particularly marked in girls (28.4% in girls vs. 18.5% in boys at age 16). Spirits drinkers were more likely to use cigarettes and drugs, and had been more frequently drunk, than either beer/wine or alcopops drinkers; these measures also tended to be higher in alcopop drinkers than in beer/wine drinkers, particularly among 11‐13‐year‐old girls. Conclusion. The use of both tobacco and illicit drugs appears to be strongly associated with alcohol use, which is more prevalent, and the risk of smoking and illicit drug use is particularly high in adolescents who report high levels of drunkenness. Our results are consistent with a simple threshold model of substance abuse in which alcohol occupies a low threshold position relative to the higher threshold of cigarettes and illegal drugs. Smoking, drug use and drunkenness were lowest in beer/wine drinkers, intermediate in alcopop drinkers, and highest in spirits drinkers.
An evaluation of Cloninger's typology of alcohol abuse
Authors: Sannibale Claudia , Hall Wayne
Published: March 2003

Aims. To evaluate Cloninger's typology of "alcoholism" using the Alcohol Symptom Scale (Gilligan et al., 1987). Participants. A sample of 300 Australian men and women with a life‐time diagnosis of DSM‐III‐R alcohol abuse/dependence. Measures. The Alcohol Dependence Scale, the Short Alcoholism Screening Test, the Composite International Diagnostic Interview (CIDI) Substance Abuse Module, the Brief Symptom Inventory, the CIDI core modules, the Family History Questionnaire and the Sensation Seeking Scale . Findings. The Alcohol Symptom Scale classified only 18% of the sample into either type 1 or type 2. There was mixed support for the hypothesized differences between type 1 and type 2 problem drinkers in pattern of alcohol abuse, gender, personality characteristics and familial aggregation of alcohol abuse. More women than men were classified as type 1 (19% vs. 6%) but, contrary to expectations, similar numbers were classified as type 2 problem drinkers (7% vs. 4%). As predicted, type 2 problem drinkers had more symptoms of antisocial personality disorder, more social consequences of drinking and higher sensation‐seeking scores than type 1 problem drinkers. Conclusions. Cloninger's typology failed to classify two types of problem drinkers and it did not predict gender differences in symptoms of alcohol dependence, family history or personality. Schuckit, Irwin & Mahler's (1990) hypothesis that type 2 problem drinkers are more likely to have primary ASPD was supported.
Use of alcohol to cope with tension, and its relation to gender, years in medical school and hazardous drinking: a study of two nation‐wide Norwegian samples of medical students
Authors: Tyssen Reidar , Vaglum Per , Aasland Olaf G. , Gronvold Nina T. , Ekeberg Oivind
Published: March 2003

Aims. To study the association between the use of alcohol to cope with tension and hazardous drinking, and the prevalence and the predictors of such drinking behaviours . Design. Cross‐sectional surveys of two nation‐wide samples of medical students, one at the beginning and one at the end of medical training . Participants. Medical students entering Norwegian medical schools in 1993 (N = 379) or graduating in 1993 and 1994 (N = 522); 55.6% of the total sample were women . Measurements. Postal questionnaires including SCL‐5, Perceived Medical School Stress . Findings. Use of alcohol to cope was reported by 10.5% of the students with no significant gender difference. Hazardous drinking ('binge drinking' at least 2‐3 times per month) was reported by 14% of all the students, 24% among the men and 6% among the women. There was a strong association between use of alcohol to cope with tension and hazardous drinking, OR = 5.11, 95%CI (2.88‐9.07) when controlling for other possible predictors. Use of alcohol to cope was also associated with increasing age, mental distress and lack of religious activity. The senior students used alcohol as a way of coping less often, but not hazardous drinking. Male gender, religious inactivity, high self‐esteem and having no children were predictors of hazardous drinking . Conclusion. This study suggests that the use of alcohol to cope with tension is an independent risk factor connected with hazardous drinking among medical students, with no difference in prevalence between the genders.