bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Adolescent Drug Abuse Diagnosis instrument in a Swiss sample of drug abusers
Authors: Bolognini Monique , Plancherel Bernard , Laget Jacques , Chinet Léonie , Rossier Valérie , Cascone Pablo , Stéphan Philippe , Halfon Olivier
Published: March 2003

Objective. The aim of this study was to evaluate a French language version of the Adolescent Drug Abuse Diagnosis (ADAD) instrument in a Swiss sample of adolescent illicit drug and/or alcohol users.

 Participants and setting. The participants in the study were 102 French‐speaking adolescents aged 13‐19 years who fitted the criteria of illicit drug or alcohol use (at least one substance ‐ except tobacco ‐ once a week during the last 3 months). They were recruited in hospitals, institutions and leisure places.

 Procedure. The ADAD was administered individually by trained psychologists. It was integrated into a broader protocol including alcohol and drug abuse DSM‐IV diagnoses, the BDI‐13 (Beck Depression Inventory), life events and treatment trajectories.

 Results. The ADAD appears to show good inter‐rater reliability; the subscales showed good internal coherence and the correlations between the composite scores and the severity ratings were moderate to high. Finally, the results confirmed good concurrent validity for three out of eight ADAD dimensions.

 Conclusions. The French language version of the ADAD appears to be an adequate instrument for assessing drug use and associated problems in adolescents. Despite its complexity, the instrument has acceptable validity, reliability and usefulness criteria, enabling international and transcultural comparisons.
Adverse outcomes of alcohol use in adolescents
Authors: Bonomo Yvonne , Coffey Carolyn , Wolfe Rory , Lynskey Michael , Bowes Glenn , Patton George
Published: March 2003

Aims. To compare the occurrence of behaviours occurring under the influence of alcohol in 16‐17‐year‐olds and determine associated risk factors for the different behaviours.

 Design/setting. Cross‐sectional survey administered by laptop computers in secondary schools across the state of Victoria, Australia.

 Measurement/findings. The participation rate was 79%. Seventy per cent of participants drank alcohol; 17% of drinkers reported alcohol‐related violence (accidents or injuries) and 15% reported problems relating to sex under the influence of alcohol (having sex and later regretting it or having had unsafe sex) in the previous 12 months. Males were more likely to report alcohol‐related violence (20% compared to 14% females). Almost one in 10 young people reported having sex while under the influence of alcohol and later regretting it and 10% reported having had unsafe sex. There were no significant gender differences in the reporting rates of alcohol‐related sexual risk taking (prop. cum. OR 1.1, 95% CI 0.68‐1.9). For alcohol‐related injuries, strong independent associations were found with dose of alcohol consumed (prop. cum. OR 2.3, 95% CI 1.3‐4.0), frequency of alcohol consumption (prop. cum. OR 2.7, 95% CI 0.94‐7.5), antisocial behaviour (prop. cum. OR 2.4, 95% CI 1.4‐4.1) and peer drinking (prop. cum. OR 3.3, 95% CI 1.4‐8.1). For alcohol‐related sexual risk‐taking, psychiatric morbidity (prop. cum. OR 4.1, 95% CI 1.9‐9.0) and high frequency of alcohol consumption (prop. cum. OR 2.0, 95% CI 0.87‐4.6) had strong independent associations.

 Conclusions. Physical injury and high‐risk sexual behaviour under the influence of alcohol are common in teenagers. Alcohol‐related physical injury appears closely related to patterns of alcohol consumption whereas alcohol‐related sexual risk‐taking is most closely associated with symptoms of depression and anxiety.
Naltrexone for alcohol dependence: a randomized controlled trial
Authors: Morris Philip L. P. , Hopwood Malcolm , Whelan Greg , Gardiner John , Drummond Elizabeth
Published: March 2003

Aim. We examined the efficacy of naltrexone (an opioid antagonist) for alcohol dependence in a sample of alcohol‐dependent men.

 Design. A 12‐week randomized placebo‐controlled clinical trial.

 Setting. The outpatient clinic of a combined war veteran and general teaching hospital in Melbourne, Australia.

 Participants. Male alcohol‐dependent subjects recruited from the community and from veteran groups.

 Intervention. Alcohol‐dependent subjects were treated with 50 mg of naltrexone or placebo daily for 12 weeks. Both treatment groups attended a weekly education support group. Subjects were assessed weekly.

 Measurements. Primary study outcomes were the maintenance of abstinence and relapse to drinking.

 Findings. Fifty‐five subjects were randomized to naltrexone and 56 to placebo. Forty subjects did not complete 12 weeks of therapy (17 naltrexone, 23 placebo). In the intention‐to‐treat sample (

N = 111) fewer naltrexone treated subjects relapsed (

p = 0.001). Among patients who completed the 12‐week trial, naltrexone reduced the consumption of alcohol. Naltrexone was well tolerated and there were few adverse experiences.

 Conclusions. These findings demonstrate that naltrexone is effective in preventing relapse to drinking in the setting of limited psychosocial treatment. Further studies should examine the duration of treatment needed to maintain the effect long term.
IQ and personality traits assessed in childhood as predictors of drinking and smoking behaviour in middle‐aged adults: a 24‐year follow‐up study
Authors: Kubička Luděk , Matějček Zdeněk , Dytrych Zdeněk , Roth Zdeněk
Published: March 2003

Aims. The identification of childhood personality predictors of drinking and smoking behaviour in adults.

 Design. A 24‐year follow‐up study.

 Setting. Prague, the Czech Republic.

 Participants. Combined cohorts of 220 males and females born of unwanted pregnancies, and 220 control subjects, examined with low attrition rates at ages 9‐10, 21‐23, 28‐31 and 32‐35.

 Measurements. In childhood IQ was assessed by the Wechsler Intelligence Scale, Children (WISC), and personality characteristics were rated by teachers, mothers and classmates. In adulthood questionnaires and face‐to‐face interviews were used to assess drinking and smoking.

 Findings. Unwanted pregnancy was not related to adult drinking and smoking. The ratings of childhood personality characteristics were condensed into three personality dimensions, i.e. conscientiousness, extroversion and neuroticism, interpreted as three of the Big Five personality dimensions, and found to show some stability into adulthood. Gender, IQ and the three childhood personality traits were used as predictors of adult drinking and smoking behaviour. Adult drinking behaviour was significantly predicted by the block of the three childhood personality traits, low conscientiousness predicting high drinking quantity per occasion (and heavy episodic drinking) whereas extroversion predicted subjects' average daily consumption. Smoking in adulthood was predicted by low IQ and low conscientiousness.

 Conclusions. IQ and personality traits in children explain to some degree the drinking and smoking behaviour of adult men and women, but the roles of the different components vary according to the form of substance use.
Back to the drawing board? A review of applications of the transtheoretical model to substance use
Authors: Sutton Stephen
Published: March 2003

The transtheoretical model (TTM) is still enormously popular with practitioners, clinicians and many researchers in the addictions field. However, in a recent years a number of commentators have criticized aspects of the model and the research based on it. This paper extends a recent critique of the TTM as applied to smoking cessation to include applications of the model to cessation or reduction of alcohol or drug use. The first section discusses measures of the central construct of stages of change and notes a number of serious problems. Staging algorithms are based on arbitrary time periods and some are logically flawed. In the case of multi‐dimensional questionnaires (the URICA, the SOCRATES and the RCQ), the pattern of correlations among the subscales shows that they are not measuring discrete stages of change. The one study to date that has compared the two different methods found low concordance, which is probably due to incompatible stage definitions. In the second section of the paper, the evidence base for the TTM is reviewed. The review is organized by the four research designs that have been used to test predictions from stage models: cross‐sectional comparisons of people in different stages; examination of stage sequences; longitudinal prediction of stage transitions; and experimental studies of matched and mismatched interventions. It concludes that current evidence for the model as applied to substance use is meagre and inconsistent. Researchers are urged to develop better stage models.
A 10‐year follow‐up study on the health status of heroin addicts based on official registers
Authors: Sánchez‐Carbonell Xavier , Vilaregut Anna
Published: March 2003

Aims. To determine the health status of a cohort of heroin addicts.

 Design. Longitudinal follow‐up study of a cohort for 10.5 years (March/July 1985‐December 1995) based on official registers.

 Setting. Catalonia, Spain.

 Participants. One hundred and thirty‐five heroin addicts who started treatment in four specialized drug addiction services in Catalonia in 1985.

 Measurements. (a) Total and annual numbers of AIDS and tuberculosis diagnoses and admissions to drug treatment; (b) annual morbidity rate; (c) average annual morbidity rate; and (d) standardized morbidity ratio. Kaplan‐Meier (log rank test) was used to assess predictive factors.

 Findings. During the follow‐up period, 34 heroin addicts were diagnosed with AIDS (25%), the average annual morbidity rate was 2.7% and the standardized morbidity ratio was 82. The most frequent diseases indicative of AIDS were Pneumocystis carinii pneumonia (11 cases) and tuberculosis (seven cases of disseminated or extrapulmonary tuberculosis and two cases of pulmonary tuberculosis). Twenty addicts were diagnosed with tuberculosis and 15 were co‐infected with AIDS and tuberculosis. Seventy‐six addicts were readmitted to treatment and generated 124 drug treatment episodes, 94 of whom were drug‐free and 30 on methadone maintenance.

 Conclusions. Follow‐up through registers is a novel, low‐cost technique that may provide important and comparable information on the long‐term evolution of drug addicts in different European regions. The measures of disease frequency and association obtained allow us to describe and compare the distribution of patterns of infectious complications (AIDS and tuberculosis) and relapses in such a pervasive disorder as heroin addiction. Other advantages of follow‐up based on official registers are efficiency, reliability, sensibility and comparability.
Heroin use, ethnicity and the environment: the case of the London Bangladeshi community
Authors: White Rupert
Published: March 2003

Aims. To describe the emergence of heroin use in the London Bangladeshi community, to delineate its key features and generate hypotheses to account for these.

 Design. Analysis of all reports of treatment‐related episodes to a central data base. Detailed interviews with 21 Bangladeshi heroin users and a comparison group.

 Setting. Treatment centres in three London boroughs with large Bangladeshi populations.

 Findings. For young Bangladeshi men living in London, the prevalence of problematic heroin use has increased from negligible levels in the early 1990s to levels proportionally higher than in the white population of the same age and sex. The proportion of first episode reports has remained constant during this time. Bangladeshi heroin use has certain distinct features: users are nearly all male, and are apparently less disadvantaged than comparable white users. They also have much greater contact with their non‐drug‐using families.

 Conclusions. Because the population of Bangladeshis continues to grow, the epidemic may continue to grow in step with this. However, Bangladeshis may represent a group of heroin users with a good prognosis, and treatment services should, arguably, be aiming for better outcomes for them. Greater involvement of families may help to achieve this.
Factors accounting for cocaine use two years following initiation of continuing care
Authors: McKay James R. , Merikle Elizabeth , Mulvaney Frank D. , Weiss Richard V. , Koppenhaver Janelle M.
Published: March 2003

Aims. To examine the relationship between various interpersonal, intrapersonal and situational factors assessed at 6, 12 and 18 months after entrance to continuing care, and cocaine use in subsequent periods.

Design. A randomized clinical trial with a 2‐year follow‐up. Setting. An outpatient US Veterans Administration substance abuse treatment program.

Participants. Cocaine‐dependent male veterans (N = 132) entering continuing care.

Interventions. 12‐Step focused group treatment vs. individualized relapse prevention continuing care.

Measurements. Motivation, coping and mood, social support, co‐morbid problem severity, treatment attendance, self‐help participation and cocaine use variables were assessed at each follow‐up.

Findings. During the 2‐year follow‐up, patients used cocaine on fewer than 8% of the days in each of the four 6‐month periods, which represented a highly significant decrease in relation to cocaine use prior to treatment. In univariate analyses, abstinence commitment, self‐efficacy, positive mood, support from family, employment, attendance in continuing care and self‐help participation at two or more of the follow‐ups predicted less cocaine use in subsequent 6‐month periods. Readiness to change and medical, psychiatric, legal and family/social problem severities either did not predict, or were inconsistently related to, subsequent cocaine use. In multivariate analyses, degree of self‐help participation emerged as the strongest and most consistent predictor of cocaine use. However, when current cocaine use at each follow‐up was controlled, none of the predictors was significant at more than one follow‐up point. There was little evidence of interactions between treatment condition and the predictor variables.

Conclusions. Continued self‐help participation and the early achievement of cocaine abstinence appear to be important factors in the maintenance of good cocaine use outcomes over extended periods. The results also highlight the importance of controlling for various post‐treatment factors when evaluating the relationship between any one factor and subsequent outcome, as many of the factors that were significant predictors in the univariate analyses were no longer significant when other factors were controlled.
Shattered childhood: a key issue in suicidal behavior among drug addicts?
Authors: Rossow Ingeborg , Lauritzen Grethe
Published: March 2003

Aims. To assess the relative importance of various adverse childhood experiences for the occurrence of later suicidal behavior in terms of experienced suicide attempts and suicidal ideation among drug addicts, and to assess possible gender differences in these associations.

Design. Cross‐sectional survey.

Setting. Residential and outpatient treatment units for drug addicts in Norway.

Participants. National sample of 800 drug addicts admitted to treatment in 1992‐93.

Measurements. Self‐reports of attempted suicide (life‐time prevalence) and suicidal ideation (1 month prior to admission). Data collected from structured interviews with therapists.

Findings. A total of 38.0% of the drug addicts reported having attempted suicide once or several times; the proportion was higher among those who reported various adverse experiences during childhood (sexual or violent assaults, bullying, parents' alcohol abuse, parents' psychiatric problems, school adjustment problems and own psychiatric problems), and increased with number of areas of such adverse childhood experiences. Forty‐two per cent of the clients reported suicidal ideation in the month prior to admission, displaying the same kind of associations with adverse childhood experiences, and also a significant association when controlling for previous suicide attempts. There were relatively small gender differences in self‐reported suicidal behavior, the proportion being somewhat higher among women, but only among those with no or few adverse childhood experiences.

Conclusions. Self‐reported suicidal behavior and ideation among drug addicts is highly prevalent and more so with increasing number of areas of childhood adversities.
An analysis of 15–19‐year‐old first attenders at the Dublin Needle Exchange, 1990–97
Authors: Mullen Louise , Barry Joseph
Published: March 2003

Aims. Identification of characteristics and trends over time in young injecting drug users at first attendance at needle exchange.

Design. Retrospective cross‐sectional survey of routinely collected data.

Setting. Dublin needle exchange programme which consists of 11 sites in the greater Dublin area.

Participants. First‐time attenders (

n = 1224) at the needle exchange from 1990 to 1997, between the ages of 15 and 19.

Measurement. Factors associated with a likelihood of needle sharing and condom use were tested using logistic regression.

Findings. Increases in both the number and proportion of young injectors, particularly young female injectors, have occurred over the 8 years. Forty‐eight per cent of the young injectors were injecting for less than 1 year. Needle sharing prevalence in the year previous to first attendance was 39% and condom use was 61%. The proportion of females not using a condom during sexual relationships was significantly higher than males. Very few of the young attenders had received any treatment for drug dependance.

Conclusions. After the first year of injecting drug use the likelihood of needle sharing increased and we recommend that interventions occur early on and are targeted to the needs of young injecting drug users, in particular young females. It is essential that services are accessible to the young injecting drug user and that barriers to contact with services are minimized or eliminated. Some high‐risk behaviours are occurring in the context of the sexual relationship and this should be taken into account when designing prevention programmes, especially for young females.
The attendance pattern of clients at a Scottish needle exchange
Authors: Hay Gordon , McKeganey Neil
Published: March 2003

Aims. To examine the pattern of attendance at a Scottish needle exchange.

Design. Semi‐structured interviews and retrospective analysis of attendance patterns.

Setting. A needle exchange in a Scottish city which covers the whole of the city.

Participants. Clients and staff of the needle exchange.

Measurements. The attendance pattern of 1556 clients of the needle exchange over a 4‐year period 1995‐1998.

Findings. The average frequency of attendance over the 4‐year period was 12.7. In 1998, 23% had only visited the needle exchange once and 11% had only visited twice.

Conclusions. A significant minority of clients only attend the needle exchange once or twice a year. There is a need to include information on client retention in future evaluations of needle and syringe exchange clinics and to specify the kind of relationships needle and syringe exchange clinic staff are expected to develop with clients and what level of client retention they should be aiming towards in a well‐run clinic.
Conduct problems and early cannabis initiation: a longitudinal study of gender differences
Authors: Pedersen Willy , Mastekaasa Arne , Wichstrøm Lars
Published: March 2003

Aim. To investigate the relationship between early conduct problems and early onset of cannabis use, with special emphasis on possible gender differences.

Design. A prospective longitudinal study of a national sample of 2436 adolescents. The sample was followed up over a year and a half, when the adolescents were in their early teens.

Setting. Norway.

Measurements. On the basis of an earlier study, conduct problems (CP) closely related to the criteria for conduct disorder (CD) in DSM‐III‐R were decomposed into three dimensions, labelled serious, aggressive and covert. Further, information was collected about alcohol intoxication, daily smoking and use of cannabis. A number of questions were posed about sexual interactions and perceived puberty development. Parental socio‐economic status was measured according to the ISCO‐88. Separate information was collected as to whether the parents were on social welfare or unemployed. A parental bonding measure (PBI) was used to measure the emotional relationship between respondents and parents. Further, a measure of parental monitoring was used, and information was also collected on other aspects of the family milieu, and on the adolescents' peers.

Statistical models. Logistic regression analysis was employed. As the sample consisted of pupils clustered within classes within schools, a three‐level error structure for the logistic regression model was estimated.

Findings. There was a strong association between early conduct problems and subsequent cannabis initiation. Also conduct problems at a potential subclinical level seemed to have great impact. The effect was significantly stronger in girls than in boys. Serious CP was found to have a moderate effect upon cannabis initiation in boys, whereas aggressive and covert CP had strong effects in girls. Early onset of puberty and early sexual involvement had no impact, whereas early use of cigarettes proved an important precursor to cannabis use.

Conclusions. Conduct problems are important precursors of early onset cannabis use, but probably represent gender‐specific aetiologies. There might be an important potential for prevention of early onset drug use in the prevention of early conduct problems, in particular for girls.
Randomized controlled trial of a midwife‐delivered brief smoking cessation intervention in pregnancy
Authors: Hajek Peter , West Robert , Lee Anne , Foulds Jonathan , Owen Lesley , Eiser J. Richard , Main Nicole
Published: March 2003

Objective. To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives.

Design. Midwives were randomized to deliver the experimental intervention or usual care. The 10‐15‐minute intervention was based on brief counselling, written materials, arrangements for continuing self‐help support and feedback on expired‐air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex‐smokers) received a relapse prevention intervention.

Setting. Booking interviews with pregnant women in nine hospital and community trusts.

Subjects. A total of 1120 pregnant women in the third month of pregnancy (249 recent ex‐smokers and 871 current smokers).

Main outcome measures. Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post‐delivery, and continuous abstinence from 3 months pre‐delivery to 6 months post‐delivery.

Results. Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post‐delivery point prevalence abstinence rates for recent ex‐smokers (65% vs. 53%,

p < 0.05, one‐tailed), but not in other outcome measures. Overall, 54% of 'recent ex‐smokers' at booking and 7% of 'current smokers' at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post‐intervention). Smoking status at follow‐up was predicted by dependence indexed by time to first cigarette in the morning .

Conclusions. A brief 'one‐off' smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self‐help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.
Differential uptake of a smoking cessation programme disseminated to doctors and midwives in antenatal clinics
Authors: Cooke Margaret , Mattick Richard P. , Walsh Raoul A.
Published: March 2003

Aims. Two methods of dissemination (simple and intensive) were used to disseminate a smoking cessation programme to doctors and midwives working in antenatal clinics. This paper describes the differential uptake of the smoking cessation programme by doctors and midwives. It investigates whether the number of smoking cessation interventions used differ due to the type of dissemination. It also examines the frequency with which doctors and midwives provide smoking cessation interventions after dissemination.

Design. Clinics were randomized to the method of dissemination (simple or intensive). Pre‐post test design was used to examine the relationship between dissemination method and professional status at baseline and follow‐up. A baseline survey collected data on the use of smoking cessation intervention in the clinics prior to dissemination. A follow‐up survey was conducted 18 months after the dissemination.

Setting. Twenty‐three public hospital antenatal clinics in NSW.

Participants. All clinical staff (midwives and doctors) working in the clinic during the 1‐2‐week survey period prior to dissemination and 18 months after the dissemination were asked to participate. The response rate was 63% (223) at baseline and 64% (182) at follow‐up. Only 48% of midwives and doctors at follow‐up were working in the original clinic.

Measures. The proportion of clinicians who initially adopted the programme; the proportion of clinicians who had used one or more programme components in the last week); the number of types of smoking cessation intervention provided (maximum = 13), and the estimated proportion of clients offered smoking cessation intervention.

Findings. More midwives than doctors 'ever used' the programme (76% vs. 25%) and continued to implement (58% vs. 22%) the programme 18 months after dissemination. Both midwives and doctors increased the number of types of smoking cessation intervention offered at follow‐up compared to baseline (mean difference 2.8). Midwives provided more smoking cessation interventions than doctors at baseline (mean difference 0.9) and at follow‐up (1.6), regardless of method used to disseminate the programme. Midwives' mean estimates of the proportion of clients offered interventions were greater than doctors' (midwives' 59% vs. doctors' 35%) at follow‐up.

Conclusion. The dissemination of a smoking cessation programme increased the level of smoking cessation interventions used by doctors and midwives. Doctors and midwives differ in their uptake of smoking cessation programmes. This information can be used to plan programme dissemination strategies in the future.
Closure of an open drug scene ‐ a case register‐based analysis of the impact on the demand for methadone maintenance treatment
Authors: Falcato Luis , Stohler Rudolf , Dürsteler‐MacFarland Kenneth M. , Eichenberger Adrian , Eich Dominique , Rössler Wulf
Published: March 2003

Aims. To assess the impact of the closure of an open drug scene on the demand for methadone maintenance treatment (MMT).

Design. Interrupted time series analysis of case register‐based data of all MMTs performed in the canton of Zurich (Switzerland) between June 16 1992 and July 7 1997.

Setting. Five private and 14 state‐controlled institutions as well as 330 general practitioners, 35 psychiatrists, and 79 other specialists offering outpatient MMT.

Participants. 5210 opiate users with 9042 MMT episodes.

Measurements. Monthly number of entries into MMT before, during and after the closure of the Letten scene in February 1995, MMT retention rates, participants' socio‐demographic and drug‐related data.

Findings. ARIMA modelling revealed 68 (95% CI = 31‐105;

p < 0.001) additional MMT admissions due to the dispersion of the open drug scene without a decrease in MMT retention rates. Socio‐demographic and drug‐related characteristics of patients entering MMT in the month of the closure did not significantly differ from other admissions.

Conclusions. Law enforcement strategies to eliminate open drug scenes may increase the demand for MMT. Sufficient treatment facilities for opioid dependence should be provided when law enforcement activities against open drug scenes are planned.
A view through the gateway: expectancies as a possible pathway from alcohol to cannabis
Authors: Willner Paul
Published: March 2003

Aim. The aim of this study was to test the hypothesis that cannabis outcome expectancies would be more positive in adolescents who drink alcohol than in non‐drinkers.

Participants and setting. The participants in the study were 4544 11‐16‐year‐olds attending eight secondary schools located in the north‐west midlands of England.

Procedure. Participants completed an anonymous self‐report questionnaire that incorporated sections designed to tap adolescents' expectancies of positive and negative outcomes of alcohol and cannabis use, together with other questions relating to substance use and associated issues.

Results. Four reliable six‐item scales were derived, and used to measure positive and negative alcohol and cannabis outcome expectancies. Negative expectancies were relatively stable across age and frequency of substance use, particularly for alcohol. However, positive expectancies for both substances increased markedly with age and, independently, with frequency of use. Positive alcohol and cannabis outcome expectancies were meaningfully related to expectancies of future substance use, and to measures of problem drug use and resistance to peer influence, supporting the validity of these expectancy measures, and their possible value as diagnostic screening instruments. The main hypothesis of the study was supported: among respondents who reported never using cannabis, positive cannabis outcome expectancies increased and negative cannabis outcome expectancies decreased with increasing frequency of alcohol use.

Conclusions. The results are consistent with a version of the 'gateway hypothesis' for the relationship between alcohol and cannabis use (alcohol use leads to changes in cannabis expectancies and thereby to cannabis use), but a proper test of the hypothesis requires a longitudinal study.
Comparison of individual and group cognitive‐behavioral therapy for alcohol and/or drug‐dependent patients
Authors: Marques Ana Cecilia P. R. , Formigoni Maria Lúcia O. S.
Published: March 2003

Aims and design. A randomized clinical trial was performed to evaluate the influence of two formats of cognitive‐behavioral psychotherapy (individual vs. group) in the treatment of alcohol and/or drug dependent patients.

Setting. Public outpatient drug dependence service.

Participants. One hundred and fifty‐five alcohol and/or drug‐dependent patients.

Intervention. The patients were randomly assigned to individual (

n = 77) or group (

n = 78) treatment formats. The treatment was developed into two phases: acquisition (eight sessions) and maintenance (nine sessions), distributed over an 8‐month period.

Measurements. Alcohol and drug use, severity of dependence, and alcohol‐ and drug‐related problems were evaluated at pre‐treatment and 15 months after admission to treatment.

Findings. At follow‐up evaluation both groups of patients presented similar levels of drug consumption, dependence and associated problems. Although group‐treated patients reported slightly higher levels of alcohol consumption (both at baseline and follow‐up) differences between the formats disappear if baseline levels are included as covariates. Compliance with treatment and a measure of drug severity were predictors of success for the drug dependents. The number of sessions attended and high GGT levels at admission were positively correlated with success for the alcohol dependents.

Conclusions. The two modalities presented similar outcomes and, as the group format could present a better cost‐benefit ratio, it may be used without decreasing compliance with treatment or treatment effectiveness.
Potential risk factors for the transition to injecting among non‐injecting heroin users: a comparison of former injectors and never injectors
Authors: Neaigus Alan , Miller Maureen , Friedman Samuel R. , Hagen Debra L. , Sifaneck Stephen J. , Ildefonso Gilbert , Des Jarlais Don C.
Published: March 2003

Aims. To compare potential risk factors for the transition to injecting among non‐injecting heroin users (NIUs) with different injecting histories.

Design. Cross‐sectional data from baseline structured interviews with NIUs in a study on transitions to injecting. Sample recruited by outreach or chain‐referral in New York City (NYC), 1996‐1998.

Setting. Recruitment of sample and interviews conducted in a NYC neighborhood where many drug users reside and/or use drugs.

Participants. Of 575 NIUs, 67% had never injected; 16% had injected one to nine times (infrequent former injectors (IFI)); and 18% 10 or more times (frequent former injectors (FFI)).

Measurements. Controlling for age and race/ethnicity, adjusted odds ratios were estimated in multivariate logistic regression, and differences in means tested by ANCOVA.

Findings. FFI (compared to never injectors and IFI) were more likely: to be homeless; to be unemployed; to be long‐time users; to be younger at first heroin use; to not have initiated heroin use through non‐injected routes; to not be afraid of injecting themselves with needles; to sniff heroin with former IDUs; and, for both men and women separately, to have sex partners who were former IDUs. Both FFI and IFI were twice as likely as never injectors to perceive that their friends thought that it was "OK" to inject drugs.

Conclusions. FFI have multiple individual and network characteristics that may increase their risk of injecting drugs. Interventions among NIUs to prevent transitions to injecting need to ascertain NIUs' injecting history and address the many potential risks that FFI have for resuming injecting drug use.
Needle fixation, the drug user's perspective: a qualitative study
Authors: McBride Andrew J. , Pates Richard M. , Arnold Karin , Ball Nicola
Published: March 2003

Aims. Changing drug users' injecting behaviour is central to the project of drug services. Information about the idea of "needle fixation" is fragmentary and of uncertain relevance to contemporary injecting drug users. The aim of the study is to describe injecting drug users' ideas about needle fixation.

Participants and design. Twenty‐four participants, some of whom identified themselves as needle fixated, were recruited from four drugs agencies in south Wales. Participants took part in semi‐structured interviews, recorded, transcribed and qualitatively analysed using Atlas/ti software.

Findings. Participants describe a range of behaviours and experiences which fit with previous ideas of needle fixation, including ritualization, substitution of other drugs, injection of water and associations with deliberate‐self‐harm and sex. Participants describe high levels of needle aversion and add detail to previous partial descriptions of needle fixation.

Conclusions. Issues conveniently considered together as needle fixation are current among injecting drug users and may be relevant to the inability of some drug users to change from injecting drug use.
Study of 2708 heroin‐related deaths in north‐eastern Italy 1985–98 to establish the main causes of death
Authors: Quaglio Gianluca , Talamini Giorgio , Lechi Alessandro , Venturini Luca , Lugoboni Fabio , Mezzelani Paolo
Published: March 2003

Aims. To ascertain the causes of deaths among a very large cohort of heroin injecting drug users (IDUs) who, from 1985 to 1998, attended 36 Public Health Authority Centres for Drug Users (PCDUs) in north‐eastern Italy.

 Design. Retrospective analysis of data, obtained from the Annual Register of each Centre and the Municipal Registry Office of each local health district.

 Setting. Thirty‐six PCDUs in north‐eastern Italy and Medical Service for Addictive Disorders of the University of Verona.

 Participants. All IDUs who had sought medical care at least once in the PCDUs during the study period.

 Findings. Of 2708 deaths, overdose was found to be the major cause (37%), followed by AIDS (32.5%) and road accidents (9.4%). The percentage of deaths due to AIDS increased steadily from 2.7% in 1985 to 42.2% in 1996, and then decreased to 16.9% in 1998. Deaths due to overdose remained almost constant. The average age of death per year rose from 26 in the mid eighties to 34 in 1998. The mortality rate among IDUs proved much higher compared to the general population of the same age (13‐fold, 95% CI, 11.3‐14.6). The proportion of all deaths attributable to regular use of illegal opiates in the 15‐34 age group in the general population in 1991 was 16%. HIV prevalence was not a significant factor in suicides and deaths by overdose.

 Conclusions. The mortality rate was 13 times greater than in the general population. To be female and to have dropped out of any kind of treatment proved an important risk factor for overdose. The fall in deaths from AIDS enhances the problem to prevent and treat HCV infection. Decisions in drug projects, in research and in training should be influenced by the strikingly high percentage of deaths due to drug use.
Ecstasy pill testing: harm minimization gone too far?
Authors: Winstock Adam R. , Wolff Kim , Ramsey John
Published: March 2003

Harm reduction has become the focus of public health initiatives and therapeutic intervention in the management of dependent drug use over the last 20 years. The last decade has seen such approaches being extended to recreational drug use. Most harm reduction initiatives have aimed to inform users about risks and ways of minimizing risk. The concept of providing illicit drug users with quality assessment of their chosen drug is one possible harm reduction intervention that until recently has received little attention. In response to well‐publicized 'ecstasy'‐related deaths organizations in some European countries and the United States have chosen to provide a 'pill testing service' for users. There are two broad categories of pill testing offered. Simple colour reagent test kits (Marquis Reagent and colour charts) form the most widely used on‐site pill testing method. Less frequently, but more accurately, laboratory personnel with access to sophisticated chromatographic equipment (high performance liquid chromatography (HPLC) or gas chromatography–mass spectrometry (GC‐MS)) may provide analysis of a pill. Pill testing kits have been advocated as a 'tool to protect yourself against the polluted XTC market'. We refute this line of reasoning. Of the different tests only techniques such as GC‐MS can identify satisfactorily the psychoactive constituents present in ecstasy pills. Colour tests based on an interpretation of a colour response in the presence of a drug are, at best, subjective. Pill testing of any description does not guarantee safety, or protect the consumer against individual responses to pills. At best it gives an artificial 'shine of safety' to a group of diverse drugs that remain both illicit and potentially harmful. Other simpler harm reduction mechanisms are likely to be more effective.
Randomized controlled trial of brief cognitive‐behavioural interventions among regular users of amphetamine
Authors: Baker Amanda , Boggs Tracy G. , Lewin Terry J.
Published: March 2003

Aims.
To identify whether brief cognitive‐behavioural interventions are feasible among regular users of amphetamine, to assess the effectiveness of intervention overall and to pilot two‐ and four‐session interventions.

 Design. Subjects were assigned randomly to individually receive a cognitive‐behavioural intervention (

n = 32) of either two or four sessions' duration or a self‐help booklet (control condition;

n = 32).

 Setting. Subjects were volunteers recruited from needle exchange schemes and treatment centres in Newcastle, Australia.

 Participants. Regular (at least monthly) users of amphetamine were recruited.

 Intervention. Either four sessions of cognitive‐behaviour therapy, consisting of a motivational interview and skills training in avoidance of high‐risk situations, coping with craving and relapse prevention, or two sessions consisting of a motivational interview and discussion of skills.

 Measurements. The Opiate Treatment Index was the main measure at pre‐treatment and 6‐month follow‐up.

 Findings. There was a significant reduction in amphetamine use among the sample as a whole, with inconclusive differences between intervention subgroups. There was a moderate overall intervention effect, with the intervention group reporting over twice the reduction in daily amphetamine use as the control group. Significantly more people in the cognitive‐behavioural intervention condition abstained from amphetamine at 6‐month follow‐up compared to the control condition.

 Conclusion. Brief cognitive‐behavioural interventions appear feasible among regular users of amphetamine. A larger randomised controlled trial of the effectiveness of such interventions appears warranted.
For love or money? An exploratory study of why injecting drug users participate in research
Authors: Fry Craig , Dwyer Robyn
Published: March 2003

Aims.
To examine injecting drug user (IDU) motivations as research participants.

 Design. Convenience sampling facilitated by recruitment notices distributed through needle and syringe programmes (NSPs), and snowballing within peer networks.

 Setting. NSPs in six suburbs throughout the Melbourne metropolitan area.

 Participants. One hundred and fifty‐four current IDUs. The mean age was 28 years, 62% were male, and 80% nominated heroin as preferred drug.

 Measurements. Interviewer‐administered survey including questions about socio‐demographics, drug use and main reasons for participating in research.

 Findings. IDU research participation reasons were consistent with motivational themes such as economic gain (46%), expression of citizenship (38%), altruism (19%), personal satisfaction (17%), drug user activism (16%) and seeking information or assistance (5%). Most respondents (58%) cited reasons where the primary beneficiaries of participation were other individuals or groups (citizenship, altruism, drug user activism) or both self and others.

 Conclusions. IDU motivations for research involvement appear to be multi‐dimensional, rarely motivated by economic gain alone, and not necessarily defined by direct benefits or gains to themselves. These findings are relevant to the question of IDU research payment ethics.
Brief interventions for alcohol problems: a meta‐analytic review of controlled investigations in treatment‐seeking and non‐treatment‐seeking populations
Authors: Moyer Anne , Finney John W. , Swearingen Carolyn E. , Vergun Pamela
Published: March 2003

Brief interventions for alcohol use disorders have been the focus of considerable research. In this meta‐analytic review, we considered studies comparing brief interventions with either control or extended treatment conditions. We calculated the effect sizes for multiple drinking‐related outcomes at multiple follow‐up points, and took into account the critical distinction between treatment‐seeking and non‐treatment‐seeking samples. Most investigations fell into one of two types: those comparing brief interventions with control conditions in non‐treatment‐seeking samples (n = 34) and those comparing brief interventions with extended treatment in treatment‐seeking samples (n = 20). For studies of the first type, small to medium aggregate effect sizes in favor of brief interventions emerged across different follow‐up points. At follow‐up after >3–6 months, the effect for brief interventions compared to control conditions was significantly larger when individuals with more severe alcohol problems were excluded. For studies of the second type, the effect sizes were largely not significantly different from zero. This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health‐care professionals to non‐treatment‐seeking samples. The results concur with previous reviews that found little difference between brief and extended treatment conditions. Because the evidence regarding brief interventions comes from different types of investigation with different samples, generalizations should be restricted to the populations, treatment characteristics and contexts represented in those studies.
Life‐history theory and risky drinking
Authors: Hill Elizabeth M. , Chow Krista
Published: March 2003

AimsLife‐history theory, a major theory related to evolutionary biology and behavioral ecology, is applied to analyze patterns in alcohol abuse and dependence. The life‐history approach examines how intensity of reproductive competition affects the benefits and costs of risk‐taking, which are typically greater for young men than for women or older men. We used this framework to predict demographic variation in hazardous patterns of alcohol use, assuming that they reflect risk‐taking in general.

DesignThis paper is a review of literature on demographic patterns in risky drinking and alcohol dependence. Predictions are generated using evolutionary analysis of risk‐taking. Existing surveys of drinking behavior are reviewed, and findings are compared to predictions.

FindingsResults were generally consistent with predictions. The frequency of risky drinking and dependence is higher for men, and people of younger age, single marital status, childless parental status or unstable environmental resources. An exception is the effect of educational attainment, which is inconsistent.

ConclusionsRisky drinking behavior, as with other forms of physical risk‐taking, is more frequently observed in young men, and it increases where environmental instability is higher. The utility of life‐history theory is compared to alternate conceptions of risky drinking and dependence. Implications of this perspective for research and clinical efforts are explored.
Evolution meets biopsychosociality: an analysis of addictive behavior
Authors: Lende Daniel H. , Smith E. O.
Published: March 2003

Evolutionary theory can inform the biopsychosocial approach to addictive behavior through the use of adaptationist thinking, or how natural selection has shaped the mechanisms and processes underlying addiction. Covering how evolutionary theory relates to biology, psychology and sociality, this paper examines three components to drug use and abuse: a biological mechanism (mesolimbic dopamine), a developmental trajectory (attachment) and a social phylogeny (dominance, submission, social dependence). The paper argues for a salience (or wanting) view of the function of dopamine; outlines how attachment affects time perspective, closure of internal models and self‐regulation; and examines how inequality affects drug abuse and how social dependence and manipulative behaviors can play a role in relationships with drugs. The article concludes with an analysis of how the adaptive approach applies to interventions against addictive behavior.
Evolutionary underpinnings of excessive alcohol consumption
Authors: Gerald Melissa S. , Higley J. Dee
Published: March 2003

Given our close phylogenetic relatedness, non‐human primates, in principle, could serve as an ideal model for alcoholism. Indeed, many studies in both humans and rhesus macaques show relationships between excessive alcohol consumption, aggression and serotonergic function, as measured by concentrations of the principal metabolite of serotonin, 5‐hydroxyindoleacetic acid (5‐HIAA) in the cerebrospinal fluid (CSF). An important behavioral predictor of excessive alcohol consumption in both humans and rhesus monkeys is the propensity toward impulsivity. Integrating behavioral and neuroendocrine data from captive and semi‐free‐ranging rhesus macaques, we posit that benefits derived from impulsive and aggressive behaviors in some contexts might contribute indirectly to the maintenance of traits involved in alcoholism and excessive alcohol intake.