bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impaired Control Scale: confirmation of factor structure and psychometric properties for social drinkers and drinkers in alcohol treatment
Authors: Marsh A. , Smith . , Saunders B. , Piek J.
Published: March 2003

Aims

To examine (1) the structure of the Impaired Control Scale using confirmatory factor analytical techniques and (2) the internal consistency and validity of the ICS subscales.

Design

Cross‐sectional data were collected on alcohol‐related variables using standard self‐completion scales.

Participants

Three hundred and fifty‐seven social drinkers (not in alcohol treatment) and 137 treatment drinkers (in alcohol treatment) who acknowledged experiencing impaired control over alcohol intake in the last 6 months. Impaired control was defined as drinking more than intended or more than one thinks one should.

Measurements

Self‐completion questionnaire consisting of demographic questions, Severity of Alcohol Dependence Data questionnaire (SADD), Impaired Control Scale (ICS) and three questions assessing alcohol consumption from the Alcohol Use Disorders Identification Test (AUDIT).

Findings

This first confirmatory factor analytical study of the ICS found that all three parts of the ICS were unidimensional for both social and treatment drinkers. These results confirmed previous exploratory principal components analysis findings. The excellent validity and internal consistency of all three parts of the ICS found here also confirmed results of previous research into the scale.

Conclusions

The confirmation of the structure and psychometric properties of the ICS suggest that the scale is a reliable and valid instrument, with a predictable and stable factor structure, for use with both clinical and non‐clinical samples.
Nimodipine in opiate detoxification: a controlled trial
Authors: Jiménez‐Lerma Juan Manuel , Landabaso Miguel , Iraurgi Loseba , Calle Ricardo , Sanz Juan , Gutiérrez‐Fraile Miguel
Published: March 2003

Objective

To evaluate the use of L‐type calcium channel blockers (CaCB) in out‐patient opiate detoxification.

Design

Controlled trial with sequential allocation of patients to groups.

Methods

Three groups of individuals subject to opiate detoxification were involved: (1) the experimental group (n = 30) received a course of nimodipine and dextropropoxiphen; (2) one control group (n = 20) was detoxified with a course of dextropropoxiphen and benzodiazepine; and (3) a second control group (n = 30) was treated with a standard course of α‐2‐adrenergic agents and naltrexone. In all cases, the detoxification course was scheduled to last 7 days.

Results

All the groups showed a significant opiate withdrawal syndrome (OWS) during detoxification (follow‐up effect: Λ = 0.04; F6.52 = 201.89; P < 0.001), but from the first day the group treated with CaCB manifested fewer symptoms than the control groups (treatment effect: F2.57 = 97.99; P < 0.001). From the start, the intensity of the OWS was reduced by half in the CaCB group (M = 6.67) compared with that manifested by the two other groups (M ≈ 13). The clinical impression of the evolution of the detoxification was that it was comfortable and free of complications (significant side‐effects were not observed).

Conclusions

The results of the study suggest that the use of calcium channel blockers (CaCB) may be an effective method in opiate detoxification. Full randomized trials are warranted.
Assessing ‘stage of change’ in current and former smokers
Authors: Etter Jean‐François , Sutton Stephen
Published: March 2003

Aims

The concept of ‘stage of change’ is widely used by researchers and clinicians in the field of smoking cessation. Our aim was to assess the validity of three staging questionnaires and of the concept of ‘stage of change’ itself.

Setting and participants

Survey on the Internet in 1025 ever smokers, retest after 8 days in 318 people (31%), follow‐up after 32 days in 451 people (44%).

Measurements

Three measures of ‘stage of change’.

Findings

Participants (83–93%) were classified in the same stage by all pairs of questionnaires, and 15% changed stage during an interval of 8 days. Including quit attempts in the ‘preparation’ stage had a large impact on stage distributions, because 18–24% of smokers who had decided to quit in the next 30 days were downgraded to the ‘contemplation’ stage as they had not made a quit attempt in the previous year. The ‘action’ stage included 5–7% of occasional smokers. Quit attempts during the past 7 days and 30 days were better predictors of smoking cessation than quit attempts during the past 12 months. Baseline stage and a continuous measure of intention predicted smoking abstinence at follow‐up.

Conclusions

These results reflect theoretical and methodological problems with the concept of stage of change. ‘Stage’ covers four different variables: current behaviour, quit attempts, intention to change and time since quitting. These variables are combined in a somewhat haphazard manner, none of them is measured comprehensively, and intention and time are continuous variables categorized by arbitrary cutpoints. Measuring each of these four variables independently may be preferable to using an incomplete mix of these elements.
Pharmacological treatment of cocaine dependence: a systematic review
Authors: Lima Maurício Silva de , Soares Bernardo Garcia de Oliveira , Reisser Anelise Alves Pereira , Farrell Michael
Published: March 2003

Aims Cocaine dependence is a common and serious condition, associated with severe medical, psychological and social problems, including the spread of infectious diseases. This systematic review assesses critically the efficacy of pharmacotherapy for treating cocaine dependence.

Methods The literature search strategy included: electronic searches of Cochrane Library holdings, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; scans of reference lists of relevant articles, personal communications, conference abstracts, unpublished trials from the pharmaceutical industry and book chapters on the treatment of cocaine dependence. Randomized controlled trials (RCTs) focusing on the use of antidepressants (ADs), carbamazepine (CBZ), dopamine agonists (DAs) and other drugs used in the treatment of cocaine dependence were included. The reviewers extracted data independently, and relative risks (RR) with 95% confidence interval (CI) were estimated. Qualitative assessments were carried out using a Cochrane validated checklist. Where possible, analysis was carried out according to ‘intention‐to‐treat’ principles.

Findings The search strategy generated 45 different trials. Most studied drugs were ADs (20 studies), DAs and CBZ. Data were very heterogeneous, with dropout rates within the studies between 0 and 84%. A non‐significant trend favoring CBZ was found in terms of dropouts (RR 0.88; 95% CI 0.75–1.03) and results from one trial suggest that fluoxetine patients are less likely to drop out. The main efficacy outcome reported in the studies was the presence of cocaine metabolites in the urine. No significant results were found, regardless the type of drug or dose used for all relevant outcomes assessed.

Conclusions There is no current evidence supporting the clinical use of CBZ, antidepressants, dopamine agonists, disulfiram, mazindol, phenytoin, nimodipine, lithium and NeuRecover‐SA in the treatment of cocaine dependence. Larger randomized investigation must be considered, while taking into account that these time‐consuming efforts should be reserved for medications showing more relevant and promising evidence. Given the high dropout rate among the test population, clinicians may wish to consider adding psychotherapeutic supportive measures aimed at keeping patients in treatment programs.
Witnessing heroin‐related overdoses: the experiences of young injectors in San Francisco
Authors: Davidson Peter J. , Ochoa Kristen C. , Hahn Judith A. , Evans Jennifer L. , Moss Andrew R.
Published: March 2003

Aims  Assessment of young injectors' exposure and response to others' heroin‐related overdose.

Design  Cross‐sectional survey.

Setting  San Francisco, CA, United States.

Participants  Nine hundred and seventy‐three street‐recruited current injectors under 30 years old.

Measurements  Self‐reported experiences of witnessing heroin‐related overdoses from structured interviews.

Findings  Seven hundred and nine of 973 (73%) had ever witnessed at least one heroin‐related overdose, and 491 of 973 (50%) had witnessed an overdose in the last 12 months. Fourteen per cent of those who had witnessed an overdose in the past year reported that the outcome of the overdose was death. Emergency services were called to 52% of most recent witnessed overdoses. Cardiopulmonary resuscitation (CPR) or expired air resuscitation (EAR or ‘rescue breathing’) was performed in 61% of cases. Inappropriate strategies such as injection with stimulants or application of ice were rare. In 67% of cases in which emergency services were not called the witness said this was because the victim regained consciousness. In the remaining 33%, 56% stated emergency services were not called due to fear of the police.

Conclusions  Respondents were willing to act at overdoses at which they were present, but frequently did not do so in the most efficacious manner. Fear of police was identified as the most significant barrier to the ideal first response of calling emergency services.
Suicide among heroin users: rates, risk factors and methods
Authors: Darke Shane , Ross Joanne
Published: March 2003

ABSTRACT The current paper examines critically the literature on suicide rates, suicide risk factors and methods employed for suicide among heroin users, and compares these to those of the general population. Heroin users have a death rate 13 times that of their peers, and deaths among heroin users attributed to suicide range from 3–35%. Overall, heroin users are 14 times more likely than peers to die from suicide. The prevalence of attempted suicide is also many orders of magnitude greater than that of community samples. The major general population risk factors for suicide also apply to heroin users (gender, psychopathology, family  dysfunction and social isolation). Heroin users, however, have extremely wide exposure to these factors. They also carry additional risks specifically associated with heroin and other drug use. Drugs as a method of suicide play a larger role in suicide among heroin users than in the general population. Heroin, however, appears to play a relatively small role in suicide among this group. Overall, suicide is a major clinical issue among heroin users. It is concluded that suicide is a major problem that treatment agencies face, and which requires targeted intervention if the rates of suicide among this group are to decline.
Measuring problem video game playing in adolescents
Authors: Tejeiro Salguero Ricardo A. , Morán Rosa M. Bersabé
Published: March 2003

Aims  Some researchers suggest that for some people, video game playing is an addictive behaviour similar to substance dependence. Our aim was to design and validate a scale to measure the problems associated with the apparently addictive use of all types of video games and video game systems, because there is no instrument at the present time that can be used for this purpose.

Design  We reviewed the DSM‐IV criteria for substance dependence and for pathological gambling, as well as the literature on the addictions in order to design a short scale (PVP; problem video game playing) that is quick and easy to apply.

Participants  The scale was administered to 223 Spanish adolescents aged between 13 and 18 years. The study was carried out in Granada and Algeciras, Spain.

Findings  Psychometric analyses show that the PVP seems to be unidimensional and has acceptable internal consistency (Cronbach's alpha) at 0.69. The pattern of associations between the scale scores and alternative measures of problem play supports its construct validity (higher total scores in the scale were associated with higher frequency of play, mean and longest times per session, self and parents' perception of playing to excess, and scores in the Severity of Dependence Scale).

Conclusions  Our results confirm that the excessive use of video games is associated with a number of problems which resemble a dependence syndrome, and the PVP appears as a useful instrument for the measurement of such problems.
The content of ecstasy tablets: implications for the study of their long‐term effects
Authors: Cole Jon C. , Bailey Mike , Sumnall Harry R. , Wagstaff Graham F. , King Les A.
Published: March 2003

Aims  To examine the variation in the content of ecstasy tablets seized in the north‐west of England during 2001 and to compare it to the UK average from 1991 to 2001.

Measurements  All tablets submitted to the Forensic Science Service in the north‐west of England during 2001 were analysed by high performance liquid chromatography with diode array detection (HPLC‐DAD). The mean MDMA content of these tablets are reported and compared to results from all Forensic Science Service laboratories in the United Kingdom from 1991 to 2001. Multiple samples (n= 80) from a single large seizure of White Dove tablets were analysed to determine the variation due to manufacturing.

Findings  All tablets submitted from the north‐west of England to the Forensic Science Service in 2001 were found to contain 3,4‐methylenedioxymethamphetamine (MDMA) and some also contained 3,4‐methylenedioxyethamphetamine (MDEA). The MDMA content of these tablets ranged from 20 to 109 mg and the mean was in the 60–69 mg range. Mitsubishi tablets were the most common type and they were found across the whole range. The low variation of MDMA content in the White Dove tablets suggests that these tablets were well manufactured. The data from the north‐west of England in 2001 are in agreement with tablet analyses over the past 10 years which show that the average MDMA content is falling.

Conclusions  The amount of MDMA in ecstasy tablets is axiomatic to the discussion of their long‐term effects. In order for the observed differences in ecstasy users to be the result of MDMA‐induced neurotoxicity it is necessary for them to have ingested one or more neurotoxic doses. These data indicate that the amount of MDMA in ecstasy tablets is dropping and that dose‐effect relationships need to take this into account.
More Canadian students drink but American students drink more: comparing college alcohol use in two countries
Authors: Kuo Meichun , Adlaf Edward M. , Lee Hang , Gliksman Louis , Demers Andrée , Wechsler Henry
Published: March 2003

Aims  To compare alcohol use among US and Canadian college students.

Design  Results of the 1999 College Alcohol Study and the 1998 Canadian Campus Survey are compared.

Setting  One hundred and nineteen nationally representative US 4‐year colleges and universities in 40 states and 16 nationally representative Canadian 4‐year universities.

Participants  Randomly selected students under 25 years (12 344 US and 6729 Canadian).

Measurements  Self‐reports of alcohol use and heavy alcohol use.

Findings  The prevalence of life‐time and past year alcohol use is significantly higher among Canadian students than US students (92% versus 86%, 87% versus 81%). The prevalence of heavy alcohol use (typically consuming five or more drinks in a row for males/four or more for females) among past‐year and past‐week drinkers is significantly higher among US students than Canadian students (41% versus 35%, 54% versus 42%). In both countries younger students and students living at home with their parents are less likely to be heavy drinkers; students who report first drunkenness before the age of 16 are more likely to be heavy drinkers in college.

Conclusion  Programs aimed at students' heavy alcohol use should target freshman at entry or earlier. Since students living with their parents are less likely to be heavy drinkers, parents may play a potentially important role in prevention efforts. The patterns of drinking in both countries may be influenced by the legal minimum drinking age. However, the relationship is complex and must be viewed in the context of other variables such as chronological age.
Children in fatal crashes: driver blood alcohol concentration and demographics of child passengers and their drivers
Authors: Voas Robert B. , Fisher Deborah A. , Tippetts A. Scott
Published: March 2003

ABSTRACT Aims  This study examines whether differences in two risk factors for crash‐related injury for children—riding with a drinking driver and failure to use restraints—are related to various driver characteristics such as age, gender, ethnicity and drinking.

Design, participants, measurements  Data on driver blood alcohol concentration (BAC), use of restraints and certain demographics were drawn from the Fatality Analysis Reporting System. Ethnicity data came from the Multiple Cause of Death File and socioeconomic information from the US Census. The use of restraints by child passengers and the drinking of alcohol by adult drivers are examined as a function of age, gender and membership of five racial/ethnic groups: White American, Black American, Native American, Asian/Pacific Islander American and Hispanic American. This study covers 160 770 drivers and 12 266 children younger than 16 years killed in motor vehicle crashes from January 1 1990 to December 31 1996.

Findings  As might be expected, analyses of fatally injured drivers showed that, compared with men, women were more likely to be accompanied by children at the time of their crash, but those children were more likely to be restrained than if travelling with men. Drivers who had been drinking at the time of their crash were less likely to be transporting children and those children were less likely to be restrained. Analyses of killed children indicated that some ethnic groups, compared with White drivers, were more likely to be BAC‐positive and children were less likely to be restrained.

Conclusions  These findings underscore the continuing need to understand cultural factors in traffic safety and develop and disseminate culturally appropriate education programs.
Psychometric properties of the Blood‐borne Virus Transmission Risk Assessment Questionnaire (BBV‐TRAQ)
Authors: Fry Craig L. , Lintzeris Nick
Published: March 2003

Aims  To develop a standard measure of blood‐borne virus transmission risk behaviour, and examine the underlying psychometric properties.

Design  The Blood‐borne Virus Transmission Risk Assessment Questionnaire (BBV‐TRAQ) was developed over three consecutive phases of the original BBV‐TRAQ study in adherence to classical scale development procedures, culminating in the recruitment of a development sample of current injecting drug users via convenience and snowball sampling.

Setting  Needle and syringe programmes (NSPs), medical clinics, alcohol/drug agencies, peer‐based and outreach organizations across inner and outer metropolitan Melbourne.

Participants  Two hundred and nine current injecting drug users. The mean age was 27 years, 68% were male, 65% unemployed, 36% with prison history and 25% in methadone maintenance.

Measurements  BBV‐TRAQ items cover specific injecting, sexual and skin penetration risk practices. BBV‐TRAQ characteristics were assessed via measures of internal and test–retest reliability; collateral validation; and principal components analyses.

Findings  The BBV‐TRAQ has satisfactory psychometric properties. Internal (a=0.87), test–retest (r=0.84) and inter‐observer reliability results were high, suggesting that the instrument provides a reliable measure of BBV risk behaviour and is reliable over time and across interviewers. A principal components analysis with varimax rotation produced a parsimonious factor solution despite modest communality, and indicated that three factors (injecting, sex and skin penetration/hygiene risks) are required to describe BBV risk behaviour.

Conclusions  The BBV‐TRAQ is reliable and represents the first risk assessment tool to incorporate sufficient coverage of injecting, sex and other skin penetration risk practices to be considered truly content valid. The questionnaire is indicated for use in addictions research, clinical, peer education and BBV risk behaviour surveillance settings.
Impaired control over gambling in gaming machine and off‐course gamblers
Authors: O'Connor John , Dickerson Mark
Published: March 2003

Aim  To investigate and compare subjectively reported impaired control in two forms of gambling: off‐course Totalizator Agency Board (TAB) horse/dog racing and electronic gaming machines (EGMs). Additionally, gender differences in EGM play were investigated.

Design   A survey sample of 84 male TAB gamblers and 137 EGM players (73 females and 64 males) was recruited at gambling sites.

Setting  Hotels and clubs in Adelaide, South Australia, were used as recruiting venues. Interviews were either conducted on site if there was sufficient privacy, or relocated to nearby cafes.

Participants  The inclusion criteria were gambling at least weekly and being over the age of 18. Female off‐course gamblers were not approached given their scarcity.

Measurements  A general gambling involvement questionnaire was devised from pilot research. Impaired control was measured using a shortened version of The Scale of Gambling Choices.

Findings  Impaired control over gambling has a robust factor structure, with little difference between EGM and TAB gamblers. Concurrent validity for the impaired control measure was demonstrated against measures of gambling involvement.

Conclusion  Impaired control appears to be, in the main, a generic process across these two forms of gambling and for both sexes. Further refinement and application of the concept of impaired control to excessive gambling seems warranted given its strong face, construct and concurrent validity.
Understanding polydrug use: review of heroin and cocaine co‐use
Authors: Leri Francesco , Bruneau Julie , Stewart Jane
Published: March 2003

The use of cocaine by heroin‐dependent individuals, or by patients in methadone or buprenorphine maintenance treatment, is substantial and has negative consequences on health, social adjustment and outcome of opioid‐addiction treatment. The pharmacological reasons for cocaine use in opioid‐dependent individuals, however, are poorly understood and little is known about the patterns of heroin and cocaine co‐use. We reviewed anecdotal evidence suggesting that cocaine is co‐used with opioid drugs in a variety of different patterns, to achieve different goals. Clinical and preclinical experimental evidence indicates that the simultaneous administration of cocaine and heroin (i.e. ‘speedball’) does not induce a novel set of subjective effects, nor is it more reinforcing than either drug alone, especially when the doses of heroin and cocaine are high. There is mixed evidence that the subjective effects of cocaine are enhanced in individuals dependent on opioids, although it is clear that cocaine can alleviate the severity of symptoms of withdrawal from opioids. We also reviewed preclinical studies investigating possible neurobiological interactions between opioids and cocaine, but the results of these studies have been difficult to interpret mainly because the neurochemical mechanisms mediating the motivational effects of cocaine are modified by dependence on, and withdrawal from, opioid drugs. Our analysis encourages further systematic investigation of cocaine use patterns among opioid‐dependent individuals and in laboratory animals. Once clearly identified, pharmacological and neuroanatomical methods can be employed in self‐administering laboratory animals to uncover the neurobiological correlates of specific patterns of co‐use.
Possible age‐associated bias in reporting of clinical features of drug dependence: epidemiological evidence on adolescent‐onset marijuana use
Authors: Chen Chuan‐Yu , Anthony James C.
Published: March 2003

Aims To probe recent evidence on apparent excess occurrence of marijuana dependence when marijuana smoking starts in adolescence.

Design and participants A national sample of recent‐onset marijuana users was identified within public data files of the National Household Survey on Drug Abuse (NHSDA), 1995–98 (1866 adolescents and 762 adults).

Measurements Marijuana dependence was assessed via seven standardized questions about its clinical features, such as being unable to cut down. Multivariate response models (GLM/GEE and MIMIC) were used to evaluate adolescent excess risk and possible item biases.

Findings Among people who had just started to use marijuana, clinical features of marijuana dependence occurred twice as often among adolescents compared to adults, even with statistical adjustment for other covariates (P < 0.01 from GLM/GEE). MIMIC analyses suggest that adolescent‐onset users have somewhat higher levels of marijuana dependence, and they also provide evidence of age‐associated response bias for some but not all clinical features of marijuana dependence. That is, even with level of marijuana dependence held constant, adolescent recent‐onset users were more likely than adults to report being unable to cut down (P = 0.01) and tolerance (P = 0.029).

Conclusion Nosologic, methodological and substantive reasons for observed age‐related excess in occurrence of marijuana dependence problems among early onset users deserve more attention in future research.
Decreased heroin availability in Sydney in early 2001
Authors: Day Carolyn , Topp Libby , Rouen David , Darke Shane , Hall Wayne , Dolan Kate
Published: March 2003

Aim  To examine the veracity of reports of a substantial decrease in the availability of heroin in Sydney in January 2001.

Design  Cross‐sectional survey.

Setting  Sydney, Australia.

Participants  Forty‐one injecting drug users (IDUs) and 10 key informants (KIs).

Findings  Almost all IDUs (93%) reported that heroin was harder to obtain at the time of interview (mid‐February 2001) than it was before Christmas 2000 and KIs concurred. IDUs (83%) and KIs (70%) also reported that the price of heroin had increased since Christmas, and that the purity of heroin had decreased (IDUs 73%; KIs 80%). Almost all IDUs reported a reduction in their heroin use and a subsequent increase in other drug use, particularly cocaine, benzodiazepines and cannabis. Similar reports about IDUs came from nine of the 10 KIs. Over half the KIs reported an increase in both property and violent crime as a result of the heroin shortage. This crime was reportedly occurring mainly between heroin suppliers and/or IDUs. Reports from other Australian jurisdictions suggest that the shortage was not specific to Sydney.

Conclusions  The reduction in the availability of heroin provides a unique opportunity to investigate the impact of supply reduction.
Prevalence and correlates of alcohol use: a population‐based study in Hong Kong
Authors: Janghorbani Mohsen , Ho Sai Yin , Lam Tai Hing , Janus Edward Denis
Published: March 2003

Objective  To estimate the prevalence and pattern of alcohol use and to analyse the socio‐demographic and biological correlates of alcohol drinking in Hong Kong Chinese.

Design  A population‐based cross‐sectional study conducted from December 1994 to October 1996.

Setting and participants  2900 randomly selected subjects age 25–74 years who participated in the Cardiovascular Risk Factor Prevalence Study in Hong Kong.

Results  Alcohol consumers comprised 55.4% (95% CI: 52.8–58.0) of men and 19.4% (95% CI: 17.4–21.4) of women. The median weekly ethanol consumed by male and female drinkers were 9.6 g and 3.6 g, respectively. Beer was the main source of alcohol; 61.5% of drinkers consumed beer as their main drink. In stepwise multiple regression among drinkers, male sex, smoking, high density lipoprotein cholesterol, primary or below education, diastolic blood pressure and separated or widowed marital status were associated positively with weekly ethanol consumption.

Conclusion  In this representative sample of Hong Kong adults, the majority were either non‐drinkers or very light drinkers, which can be used as a benchmark to measure changes in drinking pattern in the future. The putative protective effect of alcohol on heart disease could be due to the higher level of HDL in moderate drinkers.
Cannabis condemned: the proscription of Indian hemp
Authors: Kendell Robert
Published: March 2003

Aims  To find out how cannabis came to be subject to international narcotics legislation.

Method  Examination of the records of the 1925 League of Nations’ Second Opium Conference, of the 1894 Report of the Indian Hemp Drugs Commission and other contemporary documents.

Findings  Although cannabis (Indian hemp) was not on the agenda of the Second Opium Conference, a claim by the Egyptian delegation that it was as dangerous as opium, and should therefore be subject to the same international controls, was supported by several other countries. No formal evidence was produced and conference delegates had not been briefed about cannabis. The only objections came from Britain and other colonial powers. They did not dispute the claim that cannabis was comparable to opium, but they did want to avoid a commitment to eliminating its use in their Asian and African territories.
Death following ingestion of MDMA (ecstasy) and moclobemide
Authors: Vuori Erkki , Henry John A. , Ojanperä Ilkka , Nieminen Raija , Savolainen Taru , Wahlsten Pia , Jäntti Matti
Published: March 2003

Four deaths following the ingestion of moclobemide and MDMA (‘ecstasy’) are described. The probable cause of death in each case was serotonin syndrome as a result of an interaction between the two drugs. As none of the victims had been prescribed moclobemide it seems that each had taken the drug to enhance the effects of MDMA, with fatal consequences. Warnings are needed against misinformed attempts to potentiate the pharmacological effects of illicit drugs.
A meta‐analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins
Authors: Li Ming D. , Cheng Rong , Ma Jennie Z. , Swan Gary E.
Published: March 2003

Background  Numerous twin studies on smoking behavior have shown that genetic and environmental factors play significant and approximately equal roles in the determination of smoking initiation (SI) and smoking persistence (SP). However, estimates of heritability (h2), shared (c2) and unique environmental effects (e2) from the literature display considerable variability for SI and SP, due most probably to differences in statistical analysis models, age, gender, sample size, origin of cohorts and measurement of smoking behavior.

Methods  A systematic literature search identified six studies for SI and 10 studies for SP. Data from these studies were obtained and re‐analysed by meta‐analytical techniques.

Results  For SI, our results indicate that the parameters h2, c2 and e2 are (mean ± SEM): 0.37 ± 0.04, 0.49 ± 0.04 and 0.17 ± 0.03 in male adults, and 0.55 ± 0.04, 0.24 ± 0.06 and 0.16 ± 0.01 in female adults, respectively. These values were weighted by a combination of original estimates of variance from studies reporting variances plus estimated variances from studies where variances were not reported (called the combined variance method). Using the same approach for SP, we found that the parameters h2, c2 and e2 weighted by the combined variance method for the phenotype are (mean ± SEM): 0.59 ± 0.02, 0.08 ± 0.04 and 0.37 ± 0.03 in male adults, and 0.46 ± 0.12, 0.28 ± 0.08 and 0.24 ± 0.07 in female adults, respectively.

Conclusions  Our results indicate that genetic factors play a more significant role for SI but a less significant role for SP in female adults compared to male adults. Significant gender difference was also detected in shared environmental factors for SI and SP. However, no significant gender difference was detected for e2 for either phenotype. These findings suggest that genetic and environmental factors may contribute differently to the determination of smoking initiation and persistence in male and female smokers.
A controlled trial of an expert system and self‐help manual intervention based on the stages of change versus standard self‐help materials in smoking cessation
Authors: Aveyard Paul , Griffin Carl , Lawrence Terry , Cheng K. K.
Published: March 2003

Aim  To examine the population impact and effectiveness of the Pro‐Change smoking cessation course based on the Transtheoretical Model (TTM) compared to standard self‐help smoking cessation literature.

Design  Randomized controlled trial.

Setting  Sixty‐five West Midlands general practices.

Participants  Randomly sampled patients recorded as smokers by their general practitioners received an invitation letter and 2471 current smokers agreed.

Interventions  Responders were randomized to one of four interventions. The control group received standard self‐help literature. In the Manual intervention group, participants received the Pro‐Change system, a self‐help workbook and three questionnaires at 3‐monthly intervals, which generated individually tailored feedback. In the Phone intervention group, participants received the Manual intervention plus three telephone calls. In the Nurse intervention group, participants received the Manual intervention plus three visits to the practice nurse.

Measurements  Biochemically confirmed point prevalence of being quit and 6‐month sustained abstinence, 12 months after study commencement.

Findings  A total of 9.1% of registered current smokers participated, of whom 83.0% were not ready to quit. Less than half of participants returned questionnaires to generate second and third individualized feedback. Telephone calls reached 75% of those scheduled, but few participants visited the nurse. There were small differences between the three Pro‐Change arms. The odds ratio (95% confidence intervals) for all Pro‐Change arms combined versus the control arm were 1.50 (0.85–2.67) and 1.53 (0.76–3.10), for point prevalence and 6‐month abstinence, respectively. This constitutes 2.1% of the TTM group versus 1.4% of the control group achieving confirmed 6‐month sustained abstinence.

Conclusions  There was no statistically significant benefit of the intervention apparent in this trial and the high relapse of quitters means that any population impact is small.
Assessment issues and domains in the prediction of relapse
Authors: Donovan Dennis M.
Published: March 2003

The present paper provides a brief overview of methodological issues involved in the process of assessment related to the classification and prediction of relapse. These include conceptual and operational definitions of relapse, retrospective versus prospective assessment, attributional biases in recalling relapse events, single versus multiple determinants of relapse, static versus dynamic assessment models, and the necessary level of specificity involved in the assessment of relapse categories. Additionally, general domains representing distal personal characteristics, intermediate background variables and factors proximal in time to relapse situations are reviewed. Potential variables appropriate for assessment within each of these domains are described. It is concluded that relapse is best understood as a complex process having multiple and interactive determinants that vary in their temporal proximity from and their relative influence on relapse. An adequate assessment model must be sufficiently comprehensive to include theoretically relevant variables from each of the multiple domains and different levels of potential predictors.
Taxonomy of high‐risk situations for alcohol relapse: evolution and development of a
Authors: Marlatt G. Alan
Published: March 2003

The purpose of this paper is to provide an historical overview of the development of the taxonomy of high‐risk situations for relapse in patients receiving abstinence‐based treatment for alcoholism. Research conducted during the 1970s on determinants of relapse is briefly reviewed, beginning with a preliminary analysis of relapse patterns in alcoholics treated with aversion therapy. Theoretical foundations underlying the development of the taxonomy are then discussed with an emphasis on social‐learning theory and its implications for cognitive‐behavioral interventions for relapse prevention. Findings supporting the efficacy of coping‐skills training for high‐risk relapse situations, based on a prospective treatment outcome study for inpatient alcoholics, are also presented in support of the clinical validity of the relapse model. The paper concludes with a description of the refined and extended taxonomy of high‐risk situations and the associated cognitive‐behavioral model of relapse described in the Marlatt & Gordon (1985) text on relapse prevention.
Conceptualizations of relapse: a summary of psychological and psychobiological models
Authors: Connors Gerard J. , Maisto Stephen A. , Donovan Dennis M.
Published: March 2003

While substance use disorders have long been recognized as chronic relapsing conditions, it has mainly been in the last two decades that clinical researchers have been systematically attending to the nature and processes of relapse. These efforts have led to the development of a variety of psychological and psychobiological models of relapse. These models are summarized in the present article, with particular attention placed on each model's basic principles and on the precipitants of relapse predicted by the respective models. The delineation of these models may help facilitate subsequent cross‐referencing and cross‐fertilization of thinking in this important area.
Construct validation analyses on the Marlatt typology of relapse precipitants
Authors: Maisto Stephen A. , Connors Gerard J. , Zywiak William H.
Published: March 2003

Marlatt's typology of relapse precipitants has had a major influence on clinical research and practice in the substance use disorders. The purpose of this study was to evaluate the construct validity of the typology, which was done in several ways. First, precipitants of the relapse coded at the baseline assessment and for the first drink post‐treatment admission were compared. In addition, baseline relapse precipitants were compared with the highest factor scores recorded in the baseline Inventory of Drinking Situations data. A third set of analyses concerned the relationship among Marlatt precipitant codes, psychiatric diagnoses, and Alcohol Dependence Scale scores. The subjects were 142 men and women who were recruited for this study upon their admission to inpatient or outpatient alcohol treatment programs. Participants completed a baseline assessment covering substance use, including information on the precipitants of a pretreatment "relapse", and other areas of functioning. Subjects then completed bimonthly follow‐up assessments during the course of 1 year. The results showed support for only one of the predictions regarding the construct validity of the Marlatt typology. Possible explanations for these findings and their implications for clinical research and practice are discussed.
Predictive validity of Marlatt's relapse taxonomy versus a more general relapse code
Authors: Stout Robert L. , Longabaugh Richard , Rubin Amy
Published: March 2003

Marlatt's system for classifying relapses involves integrating information about the context of a relapse into a judgment about the most critical aspects of the situation. Constraints in this taxonomy, however, may limit its validity. On a sample of 300 subjects drawn from six treatment facilities, we compared the predictive validity of Marlatt's taxonomy with that of a coding scheme with fewer constraints. Marlatt's taxonomy does not significantly predict drinking outcome, nor does it predict time to relapse. There is weak evidence, however, that under some circumstances Marlatt's taxonomy can predict the type of relapse subsequently observed. The alternative coding system also does not seem useful for predicting drinking outcome, although a possible association was found between internal attribution and time to return to heavy drinking. The alternative system does seem to be able to detect repetitive aspects of subsequent relapse situations; lack of social interactions, family setting, anxiety and depression were most likely to repeat. It may be useful to consider these relapse attributes in treatment planning. The minimal predictive validity for both the Marlatt and the alternative relapse code may be due to weaknesses in the relatively unstructured interview used to gather the data, or to failure to assess the most critical dimensions relating to subsequent relapse.
Marlatt's classification of relapse precipitants: is the Emperor still wearing clothes?
Authors: Donovan Dennis M.
Published: March 2003

The present paper provides comments on the series of papers dealing with the reliability and validity of Marlatt's taxonomy of relapse precipitants. The results of these papers suggest that the degree of reliability and predictive validity of the original relapse taxonomy, as operationalized and employed in the present studies, is lower than would be hoped for. Both methodological factors in the studies and limitations in the taxonomy are discussed. While the original taxonomic system has provided a useful heuristic model and a guide for clinical intervention, it is recommended that it be modified to improve its utility in research and practice. A number of specific recommendations are provided for modifying the system
Is Marlatt's relapse taxonomy reliable or valid?
Authors: Kadden Ronald M.
Published: March 2003

The Relapse Replication and Extension Project (RREP) has failed to provide empirical support for Marlatt's relapse taxonomy. Neither the reliability of the original Marlatt coding system nor its predictive or construct validity was supported by this group of studies. The present commentary explores a number of possible reasons for the generally negative outcomes. These findings should certainly lead to a re‐evaluation of Marlatt's relapse taxonomy and its operationalization. Nevertheless, despite the negative results, there are a number of reasons why the general Relapse Prevention concept is likely to survive in some form: it has been widely adopted and imitated clinically, key elements of the taxonomy are often focal points of treatment, and clinical research studies have repeatedly supported some elements of the taxonomy (e.g. negative emotional states, social pressure, interpersonal conflict, positive emotional states and temptations/urges). The RREP also evaluated some modifications of the original taxonomy as well as the use of more structured assessment instruments, and some of these provided more promising results. Further developments will need to take into account both research needs for greater precision, most likely through the use of more structured assessment instruments, and clinical needs for richness of detail and sensitivity to a wide variety of life circumstances.
What predicts relapse? Prospective testing of antecedent models
Authors: Miller William R. , Westerberg Verner S. , Harris Richard J. , Tonigan J. Scott
Published: March 2003

Predictors of relapse to drinking were examined in a clinical sample of 122 individuals seeking outpatient treatment for alcohol problems. Drinking status and a variety of predictor variables were measured every two months for one year following presentation for treatment. In addition to pretreatment characteristics, potential antecedents of relapse were assessed at each point within five domains: (1) the occurrence of negative life events; (2) cognitive appraisal variables including self‐efficacy, alcohol expectancies, and motivation for change; (3) client coping resources; (4) craving experiences; and (5) affective/mood status. Although the occurrence of adverse life events did not predict 6‐month relapse, all other domains singly accounted for significant variance in drinking outcomes. Proximal antecedents (from the prior 2‐month interval) significantly and substantially improved predictive power over that achieved from pretreatment characteristics alone. When analyzed jointly, these predictors accounted for a majority of variance in 6‐month relapse status. A prospective test supported Marlatt's developmental model of relapse, pointing to two client factors as optimally predictive of resumed drinking: lack of coping skills and belief in the disease model of alcoholism.
The role of non‐governmental organizations
Authors: Craplet Michel
Published: March 2003

Non‐governmental organizations (NGOs) intervening in the area of alcohol problems are varied and have different histories depending on their political, social and cultural contexts; some are long‐established and often bear a heavy heritage, while others have recently arisen from the upheavals in eastern Europe and the developing countries. All of them, however, must solve certain ethical problems if they are to move away from a hygiene‐based approach and focus on individual responsibility. The role of NGOs is located between dreaming of a better world and rising up against a market‐based system where health and the quality of life take second place to commercial interests. Furthermore, their role is to be found between the impulsive nature of action and the often demotivating process of scientific reasoning and analysis. NGOs can intervene flexibly in all the fields of information, training, advocacy and assistance. They can readily position themselves in the long time‐frame required for prevention and in a space freed from burdensome administrative procedures. Their actions often appear to entail criticism of the authorities; in fact, however, they complement the latter, by countering the "hands off" or fatalistic approach of certain communities in the face of the alcohol risk.
Alcohol, Europe and the developing countries
Authors: Saxena Shekhar
Published: March 2003

Although most of the developing countries currently have a lower overall per capita consumption of alcohol than the European countries, the rapid rate of increase in recent years is highly significant from a public health perspective. Excessive alcohol consumption in developing countries leads to substantial negative effects on the health and also on the quality of life of the drinking individuals and their families. It also causes massive direct and indirect costs to these countries that they can ill‐afford. Europe has played a major facilitatory role for alcohol consumption in the developing countries and its continues to have considerable influence directly and indirectly even now. Increased international cooperation on scientific as well as policy issues is likely to achieve the twin aims of limiting alcohol use and preventing alcohol‐related health and social problems not only in Europe but all over the world, including in the developing countries. Important initial steps in this direction may be increased exchange of information, developing compatible policies and evolving culturally relevant public health measures. In order to achieve any success in limiting alcohol related problems, the need to keep a global perspective on alcohol is paramount.
The economics of alcohol
Authors: Lehto Juhani
Published: March 2003

The use of economic arguments with regard to four aspects of alcohol policy is described and discussed. The first aspect is the impact of a potential reduction in alcohol consumption on employment by alcohol production and trade. It is shown that employment is quite independent of the level of consumption. The second aspect is the opportunity for serving the public health and state finance interests at the same time by developing alcohol taxation. The third aspect is the relationship between the public revenue from alcohol and the public costs for alcohol‐related problems. A "polluter pays" principle with regard to alcohol would mean higher taxation of alcoholic beverages. The fourth aspect is the need for cost‐effectiveness analyses to support the choices by the decision makers between different alcohol policy options. It is concluded that such analyses could have impact on the priorities in public health policy on alcohol.