bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk functions for frequency of alcohol‐related negative consequences: New Zealand survey data
Authors: Wyllie Allan , Zhang Jia‐Fang , Casswell Sally
Published: March 2003

Aims. To examine the dose‐response relationship between self‐reported alcohol consumption and levels of self‐reported negative consequences of drinking.

Design. Data from 10 general population random sample surveys over the years 1990‐1997 were combined and responses were plotted and subjected to regression analysis.

Setting. Auckland, a city of approximately 1 million people in the North Island of New Zealand. Participants were interviewed in their homes using a computer‐assisted telephone interviewing system.

Participants. General population sample of 11 817 aged 14‐65 years, representative of the Auckland population.

Measurements. Frequency of experience of 14 negative consequences; annual volume of alcohol consumed; frequency of drinking larger quantities of alcohol.

Results. Three different patterns of relationship between consequences and consumption were found for different consequences. These differed between the prevalence and the frequency of consequences but were similar for two different measures of consumption, annual volume and larger quantity drinking. Analysis of the frequency of experienced consequences found that the risk curves for the most common consequences approximated a straight line and the effects at low volume intake were due to those drinking larger quantities. Three less common consequences clearly showed a concave curve suggesting a threshold effect, with effects beginning at about 20 litres per annum of absolute alcohol.

Conclusion. The different relationships between consumption and consequences imply that some consequences occur only once a very heavy volume of drinking is reached, while others show a direct relationship with consumption, reflecting that volume of alcohol consumed is closely related to the quantities consumed.
Psychiatric symptoms and deviance in early adolescence predict heavy alcohol use 3 years later
Authors: Kumpulainen Kirsti
Published: March 2003

Objective. The aim of this study was to discover whether the heavy use of alcohol in adolescence is associated with earlier psychiatric symptoms and deviance, gender, family structure and socio‐economic situation of the family (SES). Methods. Questionnaires designed to reveal psychiatric symptoms and deviance were filled in by parents (Rutter A2 Scale), teachers (Rutter B2 Scale) and the children themselves (CDI) at the age of 12 years. The Rutter scales are behaviourally orientated questionnaires, and the CDI is a self‐report of depression. Information concerning alcohol use was obtained from the children at the age of 15 years.

Results. Both male and female heavy users of alcohol had more commonly displayed externalizing behaviour and hyperactivity at school 3 years earlier than had their same‐sex peers. Furthermore, female heavy users in particular had displayed hyperactivity at home. The probability that a boy who used alcohol excessively at the age of 15 years had already been deviant 3 years earlier was increased on the teachers' scale, and that of a girl was increased on the CDI. Logistic regression analysis using parent‐assessed symptoms and self‐reported depressive symptoms showed that externalizing behaviours and depression were the factors predicting the heavy use of alcohol in adolescence when gender, SES and family structure were controlled. When teacher‐assessed symptoms and self‐reported symptoms were used, externalizing behaviour predicted heavy alcohol use at the age of 15 years when gender, SES and family structure were controlled.

Conclusions. Children with behavioural deviance and depression are at risk of later excessive alcohol use. Further research is warranted to determine whether psychiatric treatment could reduce the risk of future heavy alcohol use.
The impact of programs for high‐risk drinkers on population levels of alcohol problems
Authors: Smart Reginald G. , Mann Robert E.
Published: March 2003

Aims. Historically, treatment programs and related activities for alcoholics or high‐risk drinkers have been viewed as not relevant to efforts to prevent alcohol problems, and in particular population‐based prevention efforts. In this review we consider evidence that high‐risk programs may have an impact on population or aggregate levels of these problems. Design. We first summarize recent reviews of the clinical impact of programs for high‐risk drinkers, since some level of effectiveness at the individual level is necessary for these programs to have an aggregate level impact. Following that, correlational evidence on the impact of high‐risk programs on aggregate problem levels is examined. Estimates of the potential impact of high‐risk programs on aggregate problem levels, based on available information on the impact of these programs and the numbers of individuals affected, are then considered, as are estimations of the comparative aggregate level impact of high‐risk and consumption reduction strategies. Findings. There is increasing evidence that high‐risk programs have beneficial effects for individuals. Available correlational evidence supports the proposal that increases in treatment and AA have contributed to the declines in alcohol‐related morbidity and mortality observed in some countries in recent years. Studies estimating the recent impact of increases in levels of treatment and AA membership support that interpretation, and studies comparing estimated effects of high‐risk and population strategies find similar potential for aggregate effects. Conclusions. Programs for high‐risk drinkers can have beneficial aggregate‐level effects and are thus a valuable component of population‐based efforts to reduce alcohol problems.
"I already stopped": abstinence prior to treatment
Authors: Rosengren David B. , Downey Lois , Donovan Dennis M.
Published: March 2003

Aims. To determine pre‐treatment abstinence rates among treatment seekers and identify factors associated with pre‐treatment abstinence. To evaluate the association between pre‐treatment abstinence and subsequent outcome. Design. An observational study using data collected for a randomized, experimental design. Setting. Conducted with participants immediately after assessment for publicly funded substance abuse treatment at the King County Assessment Center (KCAC) in Seattle. Participants. People referred for outpatient or inpatient treatment by KCAC who had illicit drug use in the previous 90 days (N=565). Participants waited a median of 12 days (range = 0‐108 days) until either treatment entry or waiting‐list dropout. Measurements. A modified Drug History Questionnaire quantified drug use at baseline, treatment entry or waiting‐list dropout and 3 months later. Other measurement methods: Stages of Change Readiness and Treatment Eagerness Scale, participant confidence ratings and KCAC chart review. Findings. Sample‐wide, 45% of participants reported abstinence from initial assessment to when they entered or failed to enter treatment. Higher rates of abstinence were associated with shorter waiting periods, less substance use prior to initial assessment and higher scores on change readiness. Pre‐treatment abstinence was not associated with either treatment entry or completion. There was a non‐significant trend towards less improvement in substance use with pre‐treatment abstinence, with the greatest effect observed for short waits. Conclusions. Participants can become abstinent prior to treatment, but this is not a good predictor of treatment entry, completion or outcome. A decisional balance strategy may be a more productive use of client and treatment program energy.
Communities Mobilizing for Change on Alcohol (CMCA): effects of a randomized trial on arrests and traffic crashes
Authors: Wagenaar Alexander C. , Murray David M. , Toomey Traci L.
Published: March 2003

Aims: We previously reported effects of the CMCA intervention in reducing social and commercial access to alcohol by youth, and reducing alcohol use by 18‐20‐year‐olds. This paper reports on effects of CMCA on arrests and car crashes. Design: CMCA was a group‐randomized trial that implemented and evaluated a community‐organizing effort to change community policies and practices to reduce youth access to alcohol. Seven Midwestern communities were randomly assigned to the intervention condition and eight communities were assigned to the control condition. Intervention: For 2.5 years, a part‐time community organizer worked in each of the seven intervention communities with local public officials, enforcement agencies, alcohol merchants, the media, schools and other community groups to reduce youth access to alcohol. Measurement: We collected annual arrest and quarterly traffic crash data for the years 1987‐1995, providing a 6‐year baseline and 3 years of data during the intervention. Data were stratified into two target age groups (15‐17 and 18‐20) and a control group (age 21 and over). Analyses used random‐coefficient models because we had repeated observations for each unit of assignment in a group‐randomized trial with heterogeneous trends across communities. Findings: We observed net declines in the intervention communities for all arrest and traffic crash indicators. The decline was statistically significant for DUI arrests among 18‐20‐year‐olds and approached significance for DUI arrests and disorderly conduct violations among 15‐17‐year‐olds. Conclusions: Together with previously published results from this study, the results reported here suggest that a community‐organizing approach to limit youth access to alcohol may be effective, at least for selected end‐points and subgroups. We conclude that this approach may be useful, but that a longer intervention period is required to increase effectiveness.
Dexamphetamine substitution in the treatment of amphetamine abuse: an initial investigation
Authors: White Rupert
Published: March 2003

Aims: Dexamphetamine substitution is a widely practised, yet under‐researched and controversial treatment for amphetamine abusers. This study aimed to evaluate the usefulness of substitute prescribing, to both oral and intravenous users, and to find out which factors predict doing well in treatment. In the absence of more rigorous controlled trials, it was hoped that this study would help make some inroads into what is a hitherto unexplored area. Design: The standardized records of 220 users receiving dexamphetamine prescriptions were examined retrospectively. Cross‐sectional socio‐demographic data, and longitudinal outcome data were obtained for 148 of them. Setting: The amphetamine users had all attended and received treatment by Cornwall Community Drug Team, in the far South‐West of England, during the period 1992‐96. Findings: Oral and intravenous users had remarkably similar outcomes, with intravenous users making more overall gains in treatment. Over half the injectors stopped injecting, and more than a third within 2 months of coming into treatment. Variables predicting a good outcome differed between oral and intravenous users; although for both groups being female was associated with a slower change in drug‐use behaviours, but a longer period in treatment. Conclusions: Dexamphetamine prescribing appears to be reasonably safe, and is associated with improvements in drug‐use. Randomized trials are warranted to determine the specific efficacy of the treatment.
Treatment of opioid‐dependent pregnant women with buprenorphine
Authors: Fischer Gabriele , Johnson Rolley E. , Eder Harald , Jagsch Reinhold , Peternell Alexandra , Weninger Manfred , Langer Martin , Aschauer Harald N.
Published: March 2003

Aims: To assess the maternal and fetal acceptability of buprenorphine and neonatal abstinence syndrome (NAS) in children born to buprenorphine‐maintained mothers. Design and setting: Open‐label, flexible dosing, inpatient induction with outpatient maintenance, conducted at the University of Vienna within the existing pregnancy and drug addiction program. Participants: Fifteen opioid‐dependent pregnant women. Intervention. Sublingual buprenorphine tablets (1‐10 mg/day). Measurements: Mothers: withdrawal symptoms (Wang Scale), nicotine dependence (Fagerstrom Scale: FTQ) and urinalysis. Neonates: birth outcome and NAS (Finnegan Scale). Findings: All subjects were opioid‐, nicotine‐ and cannabis‐dependent. Buprenorphine was well tolerated during induction (Wang Score \< = 4) and illicit opioid use was negligible (91% opioid‐negative). All maternal, fetal and neonatal safety laboratory measures were within normal limits or not of clinical significance. Mean birth outcome measures including gestational age at delivery (39.6 ± 1.5 weeks), Apgar scores (1 min = 8.9; 5 min = 9.9; and 10 min = 10), birth weight (3049 ± 346 g), length (49.8 ± 1.9 cm) and head circumference (34.1 ± 1.8 cm) were within normal limits. The NAS was absent, mild (without treatment) and moderate (with treatment) in eight, four and three neonates, respectively. The mean duration of NAS was 1.1 days. Conclusions: Buprenorphine appears to be well accepted by mother and fetus, and associated with a low incidence of NAS. Further investigation of buprenorphine as a maintenance agent for opioid‐dependent pregnant women is needed.
The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study
Authors: Cuevas Carlos De Las , Sanz Emilio J. , Fuente Juan A. De La , Padilla Jonathan , Berenguer Juan C.
Published: March 2003

Aims: To assess the validity of the Severity of Dependence Scale (SDS) as a screening test to detect benzodiazepine dependence in regular benzodiazepine users. Method: One hundred regular benzodiazepine users, recruited from neurotic benzodiazepine users attending the Mental Health Outpatient Services of the Canary Islands Health Service, were administered the SDS and responses were compared with the Composite International Diagnostic Interview (CIDI) diagnosis of benzodiazepine dependence. Receiver Operating Characteristic (ROC) analysis was used to determine which cut‐off score on SDS allowed the best trade‐off between sensitivity and specificity. Results: SDS was shown to have high diagnostic utility, and a score higher than six on the scale appears to be an appropriate threshold for problematic benzodiazepine use. The SDS had a specificity of 94.2% and a sensitivity of 97.9%, and the area under the curve was of 0.991. Conclusion: The SDS was found to be a valid brief self‐report questionnaire for the assessment of benzodiazepine dependence in patients using benzodiazepines.
Attachment in adult daughters of alcoholic fathers
Authors: Jaeger Elizabeth , Hahn Nancy Becker , Weinraub Marsha
Published: March 2003

Aim: This study was designed to explore the utility of attachment theory for explaining socio‐emotional outcomes in adult daughters of alcoholic fathers (ADAF). It was hypothesized that ADAF would have more insecure attachment organizations than daughters of non‐alcoholic parents (non‐ADAF), and that ADAF would describe themselves as more disposed towards compulsive care‐giving than non‐ADAF. Design: ADAF and a matched group of non‐ADAF were compared on measures of attachment security and compulsive care‐giving. Participants: From a larger sample of 251 female college students, 26 ADAF and a matched group of non‐ADAF were identified to participate in the study. Setting. A large, urban university in the northeastern US. Measurements: Participants completed the Adult Attachment Interview and a questionnaire assessing characteristics of compulsive care‐giving. Findings: As predicted, ADAF had less secure attachment organizations then did non‐ADAF. Although no group differences were observed for compulsive care‐giving scores, compulsive care‐giving was negatively correlated with attachment security for ADAF. Conclusions: Findings indicate that the concept of attachment may be useful for understanding the developmental consequences of parenting in alcoholic families.
Beverage‐specific alcohol consumption and cirrhosis mortality in a group of English‐speaking beer‐drinking countries
Authors: Kerr William C. , Fillmore Kaye Middleton , Marvy Paul
Published: March 2003

Aims. To compare beverage‐specific per capita consumption and total alcohol consumption's associations with cirrhosis mortality rates in multiple countries. Design. Pooled cross‐sectional time‐series analysis. Setting. Australia, Canada, New Zealand, the United Kingdom and the United States during the years 1953‐1993. Measurements. National level data on per capita total alcohol, beer, wine and spirits consumption and standardized all‐cause cirrhosis mortality rates. Findings. Significant associations with cirrhosis mortality are found for both total ethanol and spirits. Spirits consumption is found to make up the majority of the effect of alcoholic beverage consumption on cirrhosis mortality and the model including only spirits is found to fit the data at least as well as the model including only total ethanol consumption. The lag relationship between all alcohol types and cirrhosis is found to be short with only present and 1 year's lagged consumption having significant associations. Conclusions. Spirits consumption rather than beer or wine is associated with cirrhosis mortality in this group of primarily beer‐drinking countries. This finding offers important clues to understanding the drinking behaviors associated with cirrhosis mortality on the individual level.
Over‐serving patrons in licensed premises in Stockholm
Authors: Andreasson Sven , Lindewald Birgitta , Rehnman Charlotta
Published: March 2003

Aims. To study the frequency of alcohol service to intoxicated patrons in licensed premises. Design. Actors were hired to simulate severe intoxication. Following a review of videotaped portrayals of drunken behaviour by the actors, an expert panel of bartenders and restaurant managers determined which scene was least consistent with responsible beverage service. The actors then enacted this scene in the licensed premises, while monitored by project staff. Setting. Ninety‐two licensed premises in Stockholm city were visited by the actors. Findings. The actors were served alcohol at 95% of the licensed premises. Conclusion. The results show that existing serving policies at licensed premises in Stockholm are very permissive regarding the degree of intoxication among patrons.
The use of antidepressants among injecting drug users in Sydney, Australia
Authors: Darke Shane , Ross Joanne
Published: March 2003

Aims. To ascertain the prevalence and patterns of antidepressant use among IDU in Sydney and to determine any harm associated with antidepressant use. Design. Cross‐sectional survey. Setting. Sydney, Australia. Participants. Two hundred and one Sydney injecting drug users (IDU) recruited through advertisements, needle exchanges, methadone maintenance clinics and by word of mouth. Findings. Forty per cent of subjects had used antidepressants, 21% in the preceding 6 months. Similar proportions of subjects had used tricyclics (26%) and selective serotonin reuptake inhibitors (SSRIs) (24%), with 8% reporting use of a monoamine oxidase inhibitor. Recent use favoured the SSRIs; however, there was still widespread use of tricyclics. The injection of antidepressants was rare, with only three subjects reporting ever having injected the drugs. Antidepressant use was associated with higher levels of polydrug use, poorer health, higher levels of psychiatric distress and a greater risk of heroin overdose. The excess risk of overdose was specifically associated with tricyclics, rather than SSRIs. Conclusions. The study confirmed that, like other pharmaceutical products, the use of antidepressants was common among IDU in Sydney. The prescription of tricyclics to heroin users would appear to increase their risk of overdose. If it is considered appropriate to prescribe antidepressants to IDU, it would appear safer to prescribe SSRIs.
Consistency of self‐administered and interview‐based Addiction Severity Index composite scores
Authors: Rosen Craig S. , Henson Brandy R. , Finney John W. , Moos Rudolf H.
Published: March 2003

Aims. This study assesses the viability of a self‐administered version of the Addiction Severity Index for monitoring substance abuse patients' functioning. Design and measurements. Patients completed the ASI interview and a self‐administered questionnaire containing ASI composite items an average of 4 days apart. Composite scores from both formats were compared using correlations and mean differences. Participants and setting. Participants were 316 veterans entering substance abuse treatment in a US Department of Veterans Affairs medical center. Findings. Composite scores for alcohol, drug, psychiatric, family, legal and employment problems correlated 0.59‐0.87 across formats. Patients endorsed more drug use and psychiatric symptoms by questionnaire than by interview. Medical composite scores correlated only 0.47 across formats. Conclusions. This study and previous research suggest that a self‐administered questionnaire can be a feasible alternative to ASI interviews for monitoring substance abuse patients' treatment outcomes.
A genetic analysis of smoking behavior in family members of older adult males
Authors: Cheng Li Shu‐Chuan , Swan Gary E. , Carmelli Dorit
Published: March 2003

Aims. To conduct a genetic study of smoking behavior in 493 three‐generation families. Design. Complex segregation analysis and maximum likelihood statistics were used to describe the familial clustering of ever‐smoking under several transmission models. Setting. The Western Collaborative Group Study, an ageing and health study currently in its 39th year of follow‐up. Participants. Probands were male participants who were of mean age 71.6 years at the time of the family history interview in 1986‐88. Measurements. Data were collected via an interview that focused on the family smoking history of participants. Smoking histories of all first‐degree relatives were obtained from probands. Findings. Evidence for genetic transmission was indicated by rejection of both the environmental and sporadic models in favor of a Mendelian genetic model with residual familial effects from spouses and both parents. Conclusions. The best‐fitting model was that of a dominant major gene with low estimated frequency and residual familial correlations. This is the first study to date to model the familial transmission of ever‐smoking in three‐generation families.
Does cannabis use encourage other forms of illicit drug use?
Authors: Fergusson David M. , Horwood L. John
Published: March 2003

Aims. To examine the relationship between cannabis use in adolescence and the onset of other illicit drug use. Method. Data were gathered over the course of a 21‐year longitudinal study of a birth cohort of 1265 New Zealand children. Measures analysed included: (a) frequency of cannabis use and other illicit drugs from 15‐21; (b) family, social, educational and behavioural backgrounds of cohort members prior to 15; and (c) adolescent life‐style variables. Findings. (i) By 21, nearly 70% of cohort members and used cannabis and 26% had used other illicit drugs. (ii) In all but three cases, the use of cannabis had preceded the use of illicit drugs. (iii) Those using cannabis on more than 50 occasions a year had hazards of other illicit drug use that were 140 times higher than non‐users. (iv)After adjustment for covariate factors, including childhood factors, family factors and adolescent life‐style factors, cannabis use remained strongly related to the onset of other forms of illicit drug use. Those using cannabis on more than 50 occasions per year had hazards of other illicit drug use that were 59.2 times higher than non‐users. Conclusions. Findings support the view that cannabis may act as a gateway drug that encourages other forms of illicit drug use. None the less, the possibility remains that the association is non‐causal and reflects factors that were not adequately controlled in the analysis.
The use of drinking places by gender, age and ethnic groups: an analysis of routine drinking activities
Authors: Treno Andrew J. , Alaniz Maria L. , Gruenewald Paul J.
Published: March 2003

Aims. This paper extends a prior analysis of drinking patterns to consider the influence of non‐economic variables on the selection of drinking locations. Design. Using data from a general population telephone survey conducted as a part of the Community Trials Project, Tobit models are estimated to determine the influence of background demographic characteristics upon the selection of drinking locations net of other model control variables. Participants and setting. 24 778 current drinkers from four California and two South Carolina communities. Findings. Distinct patterns of premise utilization are found to be associated with age, gender and ethnic subgroups. Additionally these patterns of utilization are differentially linked to drinking and driving, suggesting that patterns of outlet utilization are differentially linked to acute drinking problems (e.g. drunken driving and alcohol‐related car crashes). Conclusions. Observed differences in outlet utilization patterns between age, gender and ethnic subgroups imply that preventive interventions should take into account the manner in which these subpopulations make use of drinking venues.
A latent class analysis of antisocial personality disorder symptom data from a multi‐centre family study of alcoholism
Authors: Bucholz K. K. , Hesselbrock V. M. , Heath A. C. , Kramer J. R. , Schuckit M. A.
Published: March 2003

Aims. To determine if there are subtypes of Antisocial Personality Disorder (ASPD), as manifested by distinctive symptom profiles or by associations with alcohol, other drug dependence or other psychiatric disorders. Methods. Data on 38 symptoms of ASPD (including childhood conduct disorder) obtained from probands, their relatives and controls (2834 females and 3488 males) recruited for the Collaborative Study on the Genetics of Alcoholism (COGA) were analyzed using latent class analysis. Associations of the resulting latent classes with alcohol dependence (AD) and other psychiatric disorders were examined. Findings. Among women, a 4‐class solution was obtained in which conduct disorder and ASPD were found almost exclusively in the most severely affected class with two additional classes with mild and moderate behavior problems also identified. A strong linear trend (p < 0.001) for AD was observed, with each successive class manifesting a higher prevalence than the previous class. Milestones of drinking careers and dependence on other drugs also showed a strong association with class severity. Among men, a 5‐class solution was obtained and, like women, the highest prevalence of ASPD (74.6%) was found in the most severely affected class. Somewhat unexpected was the observation that prevalence of AD was equivalent in the two most severe classes. The data for men indicated a class with a milder spectrum of childhood misbehaviors but with an adult ASPD profile—as well as other psychiatric co‐morbidity—that was comparable to the most severe class. Conclusions. Overall, findings from both men and women did not support the existence of subtypes of ASPD, but rather indicated a disorder distributed on a severity spectrum.
Fatal heroin overdoses resulting from non‐injecting routes of administration, NSW, Australia, 1992–1996
Authors: Darke Shane , Ross Joanne
Published: March 2003

Aims. To document cases of fatal heroin overdose in New South Wales by non‐injecting routes of administration, and to compare the characteristics and toxicology of these cases with injecting fatalities. Design. Examination of coronial files. Setting. New South Wales, Australia. Participants. All fatal heroin overdose cases in NSW between 1992 and 1996. Findings. There were 10 cases of death resulting from non‐injecting routes of heroin administration between 1992 and 1996, representing 1% of cases. In three cases the route of administration was by inhalation, in five cases by nasal administration and in two cases by swallowing. The mean age of cases was 29.6 years, and nine of the cases were male. The median blood morphine concentration of non‐injectors was 0.31 mg/l (range 0.06–0.99 mg/l). Drugs other than morphine were also detected in seven cases. Conclusions. Heroin overdose deaths are not restricted to the injection of heroin. While injection may constitute a greater overdose risk‐factor, there is no safe, overdose‐free way to use heroin.
The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers
Authors: Winters Ken C. , Stinchfield Randy D. , Opland Elizabeth , Weller Christine , Latimer William W.
Published: March 2003

Aims. The treatment outcome of drug‐abusing adolescents treated with a 12‐Step approach. Design. The study compares drug use outcome data at 6 and 12 months post‐treatment among three groups of adolescents: those who completed treatment, those who did not and those on a waiting list. Also, among treatment completers, residential and outpatient samples were compared on outcome. Setting. The treatment site is located in the Minneapolis/St Paul area of Minnesota. Participants. Two hundred and forty‐five drug clinic‐referred adolescents (12–18 years old), all of whom met at least one DSM‐III‐R substance dependence disorder. One hundred and seventy‐nine subjects received either complete or incomplete 12‐Step, Minnesota Model treatment and 66 were waiting list subjects. Measurements. In addition to demographics and clinical background variables, measures included treatment involvement, treatment setting and drug use frequency at intake and follow‐up. Findings. Absolute and relative outcome analyses indicated that completing treatment was associated with far superior outcome compared to those who did not complete treatment or receive any at all. The percentage of treatment completers who reported either abstinence or a minor lapse for the 12 months following treatment was 53%, compared to 15 and 28% for the incompleter and waiting list groups, respectively. Conclusions. Favorable treatment outcome for drug abuse was about two to three times more likely if treatment was completed. Also, there were no outcome differences between residential and outpatient groups. Alcohol was the most common drug used during the follow‐up period, despite cannabis being the preferred drug at intake.
Development and validation of the Attitudes Towards Smoking Scale (ATS‐18)
Authors: Etter Jean‐Francois , Humair Jean‐Paul , Bergman Manfred Max , Perneger Thomas V.
Published: March 2003

Aim. To develop and test the validity of a scale measuring attitudes towards smoking in current and former cigarette smokers. Design and participants. In a first mail survey, we collected qualitative data from 616 smokers. In a second mail survey, we collected quantitative data from 529 smokers and ex‐smokers. We conducted a 16‐month follow‐up survey among 93 participants in the second survey. Setting. Geneva, Switzerland, 1995–98. Findings. The study resulted in a three‐dimensional, 18‐item scale: the “Attitudes Towards Smoking Scale” (ATS‐18). The scale was validated with reference to criteria of content‐, construct and predictive validity. The three subscales measure perceptions of adverse effects of smoking (10 items), psychoactive benefits (four items) and pleasure of smoking (four items). Internal consistency coefficients (0.85, 0.88 and 0.81) and test–retest correlations were high (0.90, 0.75, 0.89, respectively). Differences in attitude scores between smokers in the pre‐contemplation and preparation stages of change were ‐ 0.83, 0.71 and 1.23 standard deviation units, respectively. A differential score (advantages minus disadvantages of smoking) predicted smoking cessation in baseline smokers and relapse in baseline ex‐smokers. Conclusion. ATS‐18 is a valid and reliable instrument which can be used in both research and clinical settings.
Alcohol screening and brief intervention: dissemination strategies for medical practice and public health
Authors: Babor Thomas F. , Higgins‐Biddle John C.
Published: March 2003

This paper introduces the concept of risky drinking and considers the potential of alcohol screening and brief intervention (SBI) to reduce alcohol‐related problems in medical practice and in organized systems of health care. The research evidence behind this approach is reviewed. Potential strategies for the dissemination of SBI to systems of health care are then discussed within the context of a public health model of clinical preventive services. There is an emerging consensus that SBI should be promoted in general healthcare settings, but further research is needed to determine the best ways to achieve widespread dissemination. In an attempt to provide an integrative model that is relevant to SBI, dissemination strategies are discussed for three target groups: (1) individual patients and practitioners; (2) health care settings and health systems; and (3) the communities and the general population. Dissemination strategies are considered from the fields of social change, social science, commercial marketing and education in terms of their potential for translating SBI innovations into routine clinical practice. One overarching strategy implicit in the approaches reviewed in this article is to embed alcohol SBI in the more general context of preventive health services, the utility of which is becoming increasingly recognized as a critical supplement to more traditional clinical medicine.
The effects of offering free treatment to street‐recruited opioid injectors
Authors: Kwiatkowski Carol F. , Booth Robert E. , Lloyd Laura V.
Published: March 2003

Aims. The goal of this investigation was to assess the treatment entry impact of offering free treatment to street‐recruited injecting opioid users, and to determine which variables differentiated subjects who entered treatment when it was free, compared to those who entered when they had to pay for treatment. Design. Three hundred and sixty‐two out‐of‐treatment opioid injectors, recruited through street outreach, were randomly assigned to receive or not receive a coupon for 90 days of free substance abuse treatment. Demographics, desire for treatment, drug use and HIV risk behaviors were assessed prior to assignment. Findings. Subjects were characterized by frequent and long‐term drug use, numerous arrests, a variety of behaviors that placed them at risk for HIV, and ambivalence about entering substance abuse treatment. Offering free treatment led to significantly greater treatment entry (53% vs. 33%) and retention (155 days vs. 83 days). Entry into free treatment was particularly high, compared to those who had to pay for treatment, among subjects who had never been in treatment (43% vs. 23%) and those who reported that they did not want to enter treatment (24% vs. 6%). Subjects who entered free treatment were significantly less likely to have family problems than those who paid for their treatment. Conclusions. Opioid addicts recruited on the street and offered free methadone maintenance treatment are likely to enter and remain in treatment, even if they have never been in treatment before or claim not to want treatment. Different treatment approaches may be necessary if such subjects are motivated more by the removal of financial obstacles than other factors, such as family problems.
Effects of low‐dose alcohol exposure on simulated merchant ship handling power plant operation by maritime cadets
Authors: Howland Jonathan , Rohsenow Damaris J. , Cote Jennifer , Siegel Michael , Mangione Thomas W.
Published: March 2003

Aims. Under current US Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having \>= 00.04 g% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between 0.04 and 0.05 g% BAC) on the simulated operation of a commercial ship’s power plant. Design. A balanced placebo design was used in which alcohol administration was fully crossed with expectancy that alcohol was administrated. Setting. The study was conducted at the Massachusetts Maritime Academy, Buzzards Bay, MA, USA. Participants. Participants were 18 volunteer engineering students in their senior year, at least 21 years of age, with previous experience on the diesel simulator. Intervention. Following a baseline trial on day 1, on day 2 participants were randomized to expectancy (told alcohol or placebo) and beverage (receive alcohol or placebo). The dosage was 0.6 g/kg for males and 0.5 g/kg for females. In both baseline and performance days, participants were randomized to one of four diesel simulator scenarios, each replicating a system failure in a power plant subsystem (e.g. main propulsion, electrical generating). Measurement. Performance was measured by time required for problem identification and remediation. Findings. A main effect for alcohol administration was found. In the alcohol condition, simulator performance time was almost twice as long (351 sec) as on the placebo condition (186 sec). The expectancy effect was not significant. Conclusion. These findings support the current federal policy on the hazards of this low alcohol level within the context of commercial shipping.
Relationships of drinking behaviour, gender and age with reported negative and positive experiences related to drinking
Authors: Klaus  , Mustonen Heli
Published: March 2003

Abstract Aims. To assess associations between drinking behaviour, gender and age with reported experiences related to drinking. Design. Cross‐sectional survey. Setting and participants. Interviews were performed in 1992 with a representative sample of the Finnish population between 15 and 69 years of age (N = 3446). Measurements. Annual intake of alcohol, frequency of drunkenness, and 14 negative and eight positive reported experiences related to drinking. Findings. Logistic regression models showed that overall intake and frequency of drunkenness were independently associated with almost all reported positive and negative consequences of drinking. Women more commonly reported that drinking had helped them to sort out interpersonal problems at home or in the work‐place, to feel more optimistic about life, and to express their feelings. Men more commonly reported that drinking had helped them to be funnier and wittier and to get closer to the opposite sex. Drunken driving was markedly male behaviour, but women more commonly reported other types of reckless behaviour and adverse consequences of drinking. However, men more commonly said they were criticized by family for their drinking. With the exception of health problems, both positive and negative consequences of alcohol were more common among younger drinkers. Conclusions. Once overall intake and frequency of drunkenness were controlled for, significant differences between men’s and women’s perceptions of the costs and benefits of alcohol consumption emerged. Men tended to perceive more hedonic benefits while women perceived more functional benefits. Women reported behaving more recklessly in drinking situations. In light of the results, women were not under selective social control.
Natural recovery from alcohol and drug problems: methodological review of the research with suggestions for future directions
Authors: Sobell Linda C. , Ellingstad Timothy P. , Sobell Mark B.
Published: March 2003

Aims. The methodology of studies that reported data on individuals who recovered from an alcohol or other drug problem (cigarette smokers were excluded) without formal help or treatment were reviewed. Design/ measurements. Potential studies were identified (a) through computerized literature searches, (b) by reviewing references from key publications and (c) by correspondence with researchers in the field. Studies had to (a) be in English, (b) be published, in press, or presented before the end of 1997, (c) report original results or be part of an original survey and (d) separately report respondents whose recoveries were and were not attributable to treatment. No case studies were included. Eligible studies were evaluated with respect to meeting criteria for (a) natural recovery, (b) methodological rigor and (c) reporting demographic and substance abuse history variables. Findings. Until 1997 only 38 articles (40 different respondent samples) met the inclusion criteria for this review. This small number of studies is not surprising, as natural recovery from substance abuse is a relatively new area of study. Moreover, the majority of the 38 articles were published in the past 8 years. For most studies, descriptions of the respondent samples at pre‐ and post‐recovery were seriously deficient. Alcohol was the most studied drug, with heroin a distant second. Low‐risk drinking (78.6%) and limited drug use (46.2%) were commonly reported outcomes in natural recovery studies. Conclusions. Based on this review, future natural recovery studies should: (a) report respondents’ demographic characteristics at the time of their recovery; (b) describe respondents’ pre‐recovery problem severity; (c) explore in some depth what factors, events or processes are associated with the self‐change process; (d) provide corroboration of respondents’ self‐reports; (e) examine factors related to the maintenance of recoveries; (f) conduct interviews with individuals who have naturally recovered from cocaine, marijuana and polydrug abuse; (g) include a second interview at a later time to examine stability of natural recoveries; and (h) require a minimum 5‐year recovery time frame.
Natural and treatment‐assisted recovery from gambling problems: a comparison of resolved and active gamblers
Authors: Hodgins David C. , El‐Guebaly Nady
Published: March 2003

Aim. An exploratory study was conducted to understand the process of recovery from gambling problems. Design. Media recruitment was used to identify a resolved ( n = 43) and a comparison group of active pathological gamblers (n = 63). Participants. Participants showed evidence of significant problems related to gambling as well as high rates of co‐morbid mood and substance use disorders. The median length of resolution was 14 months with a range of 6 weeks to 20 years. Findings. Resolved gamblers reported a variety of reasons for quitting gambling, related mainly to emotional and financial factors. They did not experience a greater number of precipitating life events compared with active gamblers but did report an increase in positive and a decrease in negative life events in the year after resolution. Both resolved and active gamblers who had relatively more severe problems were more likely to have had treatment or self‐help involvement, whereas those with less severe problems, if resolved, were “naturally recovered”. Conclusions. The results support the need for a continuum of treatment options for problem gamblers and provide helpful information about recovery processes.
Comparing the predictive validity of DUI risk screening instruments: development of validation standards
Authors: Anderson Bradley J. , Snow Ronald W. , Wells‐Parker Elisabeth
Published: March 2003

Aims. This study compares the predictive efficacy of driving under the influence (DUI) screening instruments validated in previous studies, illustrates how variations in base rates of failure and selection ratios affect conclusions concerning the efficacy of different instruments, and develops evaluation standards to ensure valid comparisons of risk prediction instruments.

Design. The study: (1) examines a sample of 4815 DUI offenders to illustrate how variations in base rates of failure and selection ratios affect traditional measures of predictive efficacy, (2) uses such measures to compare the predictive efficacy of 10 instruments validated in previous studies, and (3) demonstrates the use of a measure of predictive efficacy which is relatively insensitive to the aforementioned variations.

Findings. While three instruments examined at specific cut‐points consistently ranked highest on several measures of predictive efficacy, use of different evaluation standards produced substantively different conclusions regarding the efficacy of different instruments. Based on the analyses, standards for validation of risk prediction instruments were developed.

Conclusions. The findings illustrate how failure to use equivalent standards have led to erroneous conclusions concerning the relative predictive efficacy of different risk prediction instruments. The standards developed in this study should facilitate equivalent comparisons of the predictive efficacy of risk prediction instruments.
Ten‐year survival analysis of a cohort of heroin addicts in Catalonia: the EMETYST project
Authors: Sánchez‐Carbonell Xavier , Seus Laura
Published: March 2003

Aims. To determine mortality rates and immediate causes of death in a cohort of heroin addicts, and to compare them with other European samples.

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

Setting. Catalonia, Spain. Participants. One hundred and thirtyfive heroin addicts.

Measurements. (a) Number of total and annual events; (b) annual mortality rate; (c) average annual mortality rate; and (d) standardized mortality ratio (SMR). Kaplan–Meier (log rank test) was used to assess the predictive factors.

Findings. During this period, 41 heroin addicts died (30%), the average annual mortality rate was 3.4% and the SMR was 28.5. The most frequent causes of death fell in ICD‐9 chapter III (which includes AIDS) (51%) and in chapter XVII (which includes overdose) (30%). Neither the socio‐demographic characteristics nor the history of heroin consumption were predictors of survival or cause of death.

Conclusions. Compared to other European studies, the cohort in the EMETYST project has the highest SMR and members have a higher chance of dying due to AIDS. The predictors of survival in the long term must be interpreted with caution, with the exceptions of being HIV positive or being diagnosed with AIDS.
Prevalence of excessive gambling before and after introduction of a national lottery in the United Kingdom: another example of the single distribution theory
Authors: Grun Lucia , McKeigue Paul
Published: March 2003

Background. According to the single distribution theory advocated by Rose, the prevalence of a deviant condition such as excessive alcohol consumption depends upon the average level of the corresponding characteristic in the population. The objective of this study was to establish whether the single distribution theory applies to gambling behaviour.

Methods. Household gambling expenditure in the United Kingdom was examined using Family Expenditure Survey data collected before and after the introduction of a national lottery in November 1994.

Results. In cross‐sectional analyses, the mean (or median) household expenditure on gambling for each region predicted the prevalence of excessive gambling in that region: the slope of the relationship in 1995–96 was equivalent to an increase of 1.2 (95% CI 0.7–1.7) points in the percentage of households gambling more than 10% of income for every increase of £1 in mean household gambling expenditure. The introduction of the national lottery was associated with an increase in mean household gambling expenditure from £1.45 to £3.81 per week, and an increase in the proportion of households gambling more than 10% of total income four‐fold from 0.4% to 1.7%. Among households with income of less than £200/week, the proportion gambling more than 10% of their income increased from 0.6% to 3.2%.

Interpretation. The single distribution theory applies to gambling behaviour. The increase in average gambling expenditure associated with the introduction of a national lottery in the United Kingdom has led to a pronounced increase in the prevalence of excessive gambling, especially in low‐income households. This is likely to increase the prevalence of gambling disorders and to exacerbate social inequalities in health.