bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstinence and price effects on demand for cigarettes: a behavioral‐economic analysis
Authors: Madden Gregory J. , Bickel Warren K.
Published: March 2003

Aims. To examine the separate and combined effects of cigarette pricing and cigarette abstinence on smoking. Design. Within‐subject design in which participants experienced all levels of price and abstinence conditions. Setting. Laboratory conditions. Participants. Nine human cigarette smokers. Intervention. Cigarette prices were manipulated across a 60‐fold range (US$0.02‐$1.20) in separate abstinent (5+ hours of non‐smoking) and non‐abstinent conditions. Participants earned money by pulling a response plunger (US$0.10 per 100 pulls) and could either keep the money or spend it on cigarette puffs. Measurements. Total response output, cigarette consumption, price elasticity of demand and spending patterns. Findings. Participants spent their earnings on cigarette puffs more quickly when abstinent than when they had smoked ad libitum before the session, and latency to spend money on puffs was a linear increasing function of price. Effects of abstinence on rates of smoking were a function of the price at which cigarette puffs could be purchased. At low prices participants smoked more puffs per session when abstinent, but this difference was negligible at high puff prices. Abstinence and non‐abstinence effects were temporary, and tended to wane in the second 90 minutes of the sessions. During the first half of the sessions, demand for cigarettes was more inelastic during the abstinent condition than the non‐abstinent condition, indicating relative insensitivity to price increases when abstinent. Conclusions. Behavioral‐economic procedures and measures are sensitive to cigarette‐abstinence manipulations and the laboratory methods employed here may prove beneficial in evaluating the probable effects of public‐policy initiatives designed to reduce cigarette use.
Influence of pattern of drinking on cardiovascular disease and cardiovascular risk factors‐a review
Authors: Puddey I. B. , Rakic V. , Dimmitt S. B. , Beilin L. J.
Published: March 2003

There is an established inverse relationship between the regular light consumption of alcohol (5‐10 g/day) and the incidence of coronary artery disease (CAD). This association has several biologically plausible mechanisms with dose‐dependent effects of alcohol to increase HDL cholesterol, lower plasma fibrinogen and inhibit platelet aggregation. However, such a protective effect against atheroma cannot be considered in isolation from known adverse effects on blood pressure and triglycerides or possible detrimental effects of episodic or binge drinking on several other cardiovascular end‐points and risk factors. In subjects with pre‐existing CAD, an alcoholic binge can increase both silent myocardial ischaemia and angina. During withdrawal following binge drinking, marked fluctuations in blood pressure together with heightened platelet activation and adverse changes in the balance of fibrinolytic factors, may offer an explanation for the reported association between episodic heavy drinking and ischaemic stroke. This has been seen particularly in young males and extends further to an increase in both subarachnoid haemorrhage and intracerebral haemorrhage after binge drinking. Intervention studies in man have shown acute increases in blood pressure in men who drink predominantly at weekends, compared to longer‐term pressor effects in regular daily drinkers. We have been unable, however, to reproduce the finding of unfavourable effects of binge drinking on the lipid profile that have been reported in animal studies and man. Binge drinking may also induce cerebrovascular spasm or cause both ventricular and supraventricular arrhythmias, especially atrial fibrillation. Alcohol‐induced arrhythmia has been postulated as the basis for alcohol‐related sudden coronary death in those subjects with pre‐existing CAD. Hence, further exploration of any protective association of alcohol against CAD needs to carefully consider the implications of pattern of drinking for the relationship. The modulating influences of co‐timing of drinking with meals, cigarette smoking or illicit drug use also need to be evaluated. Without such vital information, public health advice on alcohol and CAD will be limited in its scope and potentially flawed in its impact.
Additional methadone increases craving for heroin: a double‐blind, placebo‐controlled study of chronic opiate users receiving methadone substitution treatment
Authors: Curran H. Valerie , Bolton Judi , Wanigaratne Shamil , Smyth Ciaron
Published: March 2003

Aims. To assess the acute‐on‐chronic effects of methadone on drug craving, mood and cognitive and psychomotor functioning in patients on long‐term methadone substitution treatment. Design and participants. A double‐blind, cross‐over design was used to compare the effects of a 33% increase in patient's daily dosage of methadone with a matched placebo linctus. Eighteen patients completed the study; all were assessed pre‐ and post‐drug on two separate testing days. Findings. Methadone significantly increased both positive craving (expected positive effects) and negative craving (expected relief of withdrawal discomfort) for heroin. Patients were unable to distinguish between methadone and placebo treatments. No differences between treatments emerged in cognitive or psychomotor effects. In terms of mood, patients were more alert and more contented following placebo than following methadone. Conclusions. Additional methadone may "prime" cravings for heroin in methadone substitution patients.
Cue exposure treatment for smoking relapse prevention: a controlled clinical trial
Authors: Niaura Raymond , Abrams David B. , Shadel William G. , Rohsenow Damaris J. , Monti Peter M. , Sirota Alan D.
Published: March 2003

Aims. In an additive design, test the efficacy of cue exposure treatment for smoking relapse prevention as an adjunct to current standard cognitive behavioral and pharmacological treatments. Design. Randomized, controlled clinical trial. Setting. Outpatient behavioral medicine clinic. Participants. One hundred and twenty‐nine cigarette smokers recruited through newspaper advertisements. Intervention. After receiving an initial counseling session for cessation and setting a quit day, 129 smokers were randomly assigned to one of four relapse prevention treatment conditions: (1) brief cognitive behavioral; (2) cognitive behavioral and nicorette gum; (3) cognitive behavioral and cue exposure; and (4) cognitive behavioral and cue exposure with nicorette gum. All smokers met individually with their counselor for six RP sessions. Measures. Seven‐day, point‐prevalence abstinence rates (CO verified) taken at 1, 3, 6 and 12‐months post‐treatment and time to first slip. Findings. All manipulation checks and process measures suggested that the treatments were delivered as intended. There were no significant differences between conditions in point‐prevalence abstinence rates or in time to first slip. Conclusions. These results call into question the utility of cue exposure treatment for smoking relapse prevention.
An experimental study of the effect of prior alcohol consumption on a simulated gambling activity
Authors: Kyngdon Andrew , Dickerson Mark
Published: March 2003

Previous survey research with both clinical populations and random samples of the general population has established that individuals may experience harmful impacts arising from both their gambling and their consumption of alcohol. Experimental study of the interaction of alcohol consumption on gambling is notable for its absence from the literature. Aim. To experimentally study the interaction of alcohol consumption and gambling behaviour. Design. Participants were randomly allocated into two groups‐placebo administered and alcohol administered, thus making an independent samples experimental design. Setting. Laboratory. Participants. Forty young, male, regular EGM players, who also regularly consumed alcohol. Measurements. The NEO Personality Inventory; The Scale of Gambling Choices (Revised) (SGC); persistence at gambling while losing, as measured by the number of gambling trials played and amount wagered. Findings. Subjects either received a prior intake of three alcoholic drinks each containing approximately 10 g of pure alcohol (beer or wine) or an equal volume of an equivalent non‐alcoholic beverage. The alcohol group persisted for twice as many gaming trials as the placebo group with significantly more players who had consumed alcohol losing all their original cash stake (50% compared with 15% of the placebo group). Conclusions. The consumption of alcohol appeared to eliminate the strong associations found in placebo group between individual difference measures and persistence. The analogue game was accepted by participants as a valid form of gambling. The result showed that relatively small quantities of alcohol have a significant effect on the psychological processes that underpin self‐control over gambling. This finding challenges the conceptual research paradigm of studying co‐morbidity or dual‐addicted clinical populations as the most appropriate method of understanding how two addictive behaviours interact.
A comparison of the beliefs of Indian alcohol‐dependent patients and their close family members on their reasons for relapse
Authors: Malhotra Sameer , Malhotra Savita , Basu Debasish
Published: March 2003

Aims. To study and compare the perspectives of relapsed alcohol‐dependent patients and their family members regarding relapse precipitants. Design. Observational, cross‐sectional survey. Setting. An addiction centre in northern India. Participants. Thirty consecutive male patients attending the centre with relapse of alcohol dependence following previous inpatient treatment, and their repsective family members. Measurements. Relapse precipitants, as generated by a 25‐item, three‐factor, self‐report inventory eliciting the subjects' beliefs about events or circumstances leading to relapse. Findings. Both the patients and their families listed items related to 'reduced cognitive vigilance' as the most common relapse precipitants. Reasons pertaining to external situations and euphoric states as well as unpleasant mood states were also frequently reported by them. The rank order correlation between the items by patients and their families was positive and statistically significant (r=0.80, p 0.001). Individual item‐wise comparison by chi‐squared test yielded statistically significant difference in only one of 25 items. Conclusions. There was a high degree of concordance between the patients and their family members regarding beliefs about precipitants of alcoholic relapse.
The prevention paradox revisited
Authors: Skog Ole‐Jorgen
Published: March 2003

The contribution of heavy and moderate drinkers, respectively, to the rate of alcohol problems in society is evaluated for different types of risk functions. It is demonstrated that if the risk function is linear, the moderate drinkers will be responsible for the bulk of the problems. When the risk function is curved upwards, the heavy drinkers contribute a larger share of the problem. However, the risk function needs to be quite strongly curved before the majority of the problems can be attributed to the heavy drinkers. These calculations are based on certain empirically motivated assumptions about the distribution of the consumers along the consumption scale. The results suggest that the validity of the prevention paradox depends very much on the shape of the risk function, and hence that the role of the moderate drinkers may vary a lot across the spectrum of alcohol‐related disabilities. For disabilities where the risk curve has a pronounced threshold‐like form, the prevention paradox cannot be expected to apply. However, the role of the moderate drinker could be expected to be more significant for disabilities with a smoother and less convex risk curve. Accidents and social problems seem to fulfil the latter qualification, because the causal mechanism underlying such problems are connected to rates of acute intoxication, rather than to annual intake per se.
Young, wet & wild? Associations between alcohol intoxication and violent behaviour in adolescence
Authors: Rossow Ingeborg , Pape Hilde , Wichstrom Lars
Published: March 2003

Aims. To assess gender‐ and age‐specific associations between alcohol intoxication and engagement in violent behaviours in young people. Design, participants and measurement. Cross‐sectional study comprising a national sample of 12 000 Norwegian adolescents aged 12‐20 years. Data on violent behaviour, alcohol intoxication and various confounders were obtained by self‐administered questionnaires in school. Findings. 2.8% had been in fight with a weapon and 32.6% had been beating or threatening to beat someone during the past year. Violent behaviours were more often reported among boys, in the younger age groups, with increasing frequency of alcohol intoxication, among users of other drugs, among those engaged in criminal activities and among those in wet environments (friends drinking regularly and parents often being intoxicated). The impact of intoxication frequency on number of times engaged in violent behaviours was of modest magnitude. It was greater in the youngest age group compared to those in the middle and late teens and greater for boys than for girls. However, when criminal activities were controlled for, the adjusted effect of intoxication on violent behaviour was significantly reduced, the effect was then of the same magnitude for both genders, whereas there was no longer any significant effect in the youngest age group. Controlling also for parents' and friends' drinking and parental monitoring did not alter these findings. Conclusions. A small direct effect of alcohol intoxication on violent behaviour appears to remain after controlling for various relevant confounders in middle and late teens. However, possible indirect effects of alcohol intoxication, mediated by own deviant life‐style and wetness of environment, should also be taken into consideration.
Substance use among young people: the relationship between perceived functions and intentions
Authors: Boys Annabel , Marsden John , Griffiths Paul , Fountain Jane , Stillwell Garry , Strang John
Published: March 2003

Aims. To explore the relationship between young people's use of psychoactive substances, perceived functions for using, the experience of negative effects, and the influences of these variables on their intention to use substances again. Design. Cross‐sectional survey in which respondents were purposively recruited using snowballing techniques. Setting. Interviews were conducted in informal community settings. Participants. One hundred young drug and alcohol users (45 females) aged between 16 and 21 years. Measurements. Life‐time prevalence, current frequency and intensity of substance use and intentions to use again were assessed for four target substances (alcohol, cannabis, amphetamines and ecstasy) together with measures of the perceived functions for their use and peer substance involvement. Findings. The life‐time experience of negative effects from using the assessed substances was not found to correlate with current consumption patterns. Statistically significant associations were observed between the reported frequency of taking substances and the perceived social/contextual and/or mood altering functions cited for their consumption. The substance use function measures together with the reported extent of peer use were significant predictors of intentions to use again. Conclusions. If these findings are confirmed in larger studies, educational and preventative efforts may need to acknowledge the positive personal and social functions which different substances serve for young people. The results also call into question the extent to which the experience of negative effects influences future patterns of use.
Predicting tobacco use to age 18: a synthesis of longitudinal research
Authors: Derzon James H. , Lipsey Mark W.
Published: March 2003

Aims. To synthesize the available evidence on predictors of adolescent tobacco use. Design. Meta‐analysis was conducted on the empirical findings of published and unpublished studies of the natural development of tobacco use that used prospective multi‐wave panel designs. Participants. The research literature that was analyzed included 106 reports on 64 studies representing data from a total of 145 750 study subjects; 1261 prospective and cross‐sectional effect sizes were computed from these studies and used in the meta‐analysis. Measurements. Product‐moment correlations were analyzed examining the strength of the relationships between predictor variables and current and later tobacco use. In addition, findings reported as 2 x 2 contingency tables were analyzed to examine conditional relations and estimate the positive predicted values (PPV) and sensitivity indices for the predictive relationships. Findings. The mean correlations for 17 different categories of predictors and current or later tobacco use ranged from ‐ 0.08 for race to 0.52 for prior tobacco use and were significant and positive except for race. Analysis of the conditional relationships showed that PPV for tobacco use ranged from a mean of 0.18 for predictors related to personal skills and knowledge (i.e. 82% of those 'at risk' on this construct did not use tobacco) to 0.70 for use of tobacco or other substances by parents. Conclusions. Current use of tobacco and other substances by youths, and use among their peers, showed stronger relationships with later tobacco use than other examined predictors. Combined with other predictive risk factors, these relationships are sufficiently strong to be useful in identifying for intervention those children most likely to become habitual tobacco users.
Methadone injecting in Australia: a tale of two cities
Authors: Lintzeris Nicholas , Lenne Michael , Ritter Alison
Published: March 2003

Aims. The injection of methadone syrup designed for oral consumption is potentially associated with increased morbidity and mortality. Previous reports from Sydney, Australia have suggested a high prevalence of methadone injecting by clients in methadone programmes and by heroin users not in methadone treatment. This study sought to estimate the prevalence of methadone injecting by clients in community based methadone programmes in Melbourne, Australia, which operate under different take away policies. Design. The study used a cross‐sectional survey of methadone clients using a self‐complete questionnaire. Subjects were recruited from randomly selected methadone dispensing pharmacies across Melbourne. Participation was voluntary. Participants. One hundred and sixty‐eight methadone clients were recruited to the study. The mean age was 34.2 years; 59% were male. Findings. Two of 168 methadone clients reported having injected methadone within the preceding 6‐month period. Conclusions. The lower prevalence of methadone injecting in Melbourne (compared to Sydney) is thought to be due to the less liberal take‐away policy, and the mandatory dilution of methadone take‐aways to 200 ml of liquid. Implications for methadone take‐away policies and procedures are discussed.
Attitudinal factors associated with community pharmacists' involvement in services for drug misusers
Authors: Matheson Catriona , Bond Christine M. , Mollison Jill
Published: March 2003

Aim. To assess the relationship between pharmacists' attitudes towards drug misusers and the availability and provision of services for drug misusers. Design. A cross‐sectional postal questionnaire survey. Setting. All community pharmacies in Scotland (n = 1142). Participants. A total of 864 pharmacists managing community pharmacies on a day‐to‐day basis (response rate 79%). Measurements. Descriptive data were collected on demography, drug misuse services provided and training in drug misuse. Attitude statements were used to measure attitudes to drug misusers, the role of the pharmacist in dispensing controlled drugs and providing injecting equipment, providing advice on drug misuse and financial aspects of service provision. Statements were incorporated into a scale which was correlated with behavioural data on whether and how services were provided. Results. The attitude scale had good internal reliability and was unidimensional. Pharmacists that provided needle/syringe exchanges, sold needles/syringes, dispensed methadone, supervised the consumption of methadone and provided health promotion services to drug misusers had significantly more positive attitudes towards drug misusers. Attitudes were associated with health board area, sex and number of years registered as a pharmacist. After controlling for these characteristics, attitude was an independent predictor of whether needles/syringes were sold, methadone was dispensed and methadone consumption supervised. Conclusions. Addressing negative attitudes could encourage more pharmacists to provide services and enhance the process of service delivery.
A validity study of the SSAGA‐a comparison with the SCAN
Authors: Hesselbrock Michie , Easton Caroline , Bucholz Kathleen K. , Schuckit Marc , Hesselbrock Victor
Published: March 2003

Objective. This study examined the concurrent diagnostic validity of the Semi‐Structured Assessment for the Genetics of Alcoholism (SSAGA) across alcohol and drug dependencies, major depression, anxiety disorders and ASPD. The Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was selected as the comparison instrument because it arises from a different tradition and uses a different format for its administration. The SCAN has been shown to be valid and applicable cross‐culturally. Method. Subjects included 38 men and 42 women volunteers from another study and from an outpatient psychiatry clinic. Selected sections of both the SSAGA and the SCAN interviews were administered to all subjects, approximately 1 week apart, in a randomized order. Because the SCAN does not assess Antisocial Personality Disorder (ASPD), the ASPD section of the Structured Clinical Interview for DSM‐III‐R (SCID) was substituted for this comparison. Results. The Kappa statistic was used to measure concordance between the two instruments. Kappa for alcohol dependence was in the acceptable range (0.63). Kappas were lower for sedative dependence (0.48) and for cannabis dependence (0.53), but higher for cocaine and stimulant dependence (0.85) and for opioid dependence (0.73). Kappa for major depression and the ASPD diagnoses were high (0.71 and 0.70), but slightly lower agreement was found for panic disorder (0.62). Kappa for social phobia was 0.47. Conclusion. These data, combined with results from two previous studies which examined reliability, indicate that the SSAGA is a highly reliable and valid instrument for use in studies of a variety of psychiatric disorders, including alcohol and drug dependence.
Drinking habits and prevalence of heavy drinking among primary health care outpatients and general population
Authors: Aalto Mauri , Seppa Kaija , Kiianmaa Kalervo , Sillanaukee Pekka
Published: March 2003

Aims. To identify the target group for brief alcohol intervention in primary health care and to compare the prevalence of heavy drinking in two different primary health care populations and the general population in the same geographical area. Design. Drinking data were collected from outpatients of primary health care by a questionnaire containing the CAGE test and quantity‐frequency alcohol consumption questions and from a sample of the general population by a telephone survey, including the CAGE. The index of heavy drinking was for men three, and for women two, affirmative answers in CAGE which though not specifically a consumption questionnaire is a good marker of heavy drinking. Setting. Two different primary health care populations (primary health care clinic and occupational health care clinic) and the general population in a Finnish health care area. Participants. Consecutive 1861 primary health care clinic and 2942 occupational health care clinic outpatients and 544 randomly selected adults in the general population, contacted by telephone. Findings. The primary health care clinic patients drank significantly more per occasion than the patients of the occupational health care clinic (75 vs. 66 g. in men; 33 vs. 27 g. in women) and fewer times per week (0.8 vs. 0.9 in men; 0.5 vs. 0.6 in women). The patients in the primary health care clinic also reported drinking more per week (76 vs. 67 g. in men; 23 vs. 19 g. in women); among women the difference was significant. Among men the prevalences of heavy drinking in the primary health care clinic, occupational health care clinic and general population were 20%, 17% and 16%, respectively ( p 0.05). Among women the corresponding figures were 9%, 6% and 13% ( p 0.05). Conclusions. The high prevalence of heavy drinking found in the study confirms the importance of brief intervention by general practitioners. The study also indicates that prevalence and drinking habits depend on the type of clinic and heavy drinkers in general may not be over‐represented in primary health care. This study raises the question, especially among women, of how to reach and to provide health advice to those heavy drinkers who do not attend primary health care facilities.
Cognitive–behavioral treatment for alcohol dependence: a review of evidence for its hypothesized mechanisms of action
Authors: Morgenstern Jon , Longabaugh Richard
Published: March 2003

Objective. This review examined support for the hypothesis that cognitive‐behavioral treatment (CBT) for alcohol dependence works through increasing cognitive and behavioral coping skills.

Method. Ten studies were identified that examined the hypothesized mechanisms of action of CBT. These studies involved random assignment (or its near equivalent) of participants to CBT and at least one comparison condition.

Results. Although numerous analyses of the possible causal links have been conducted to evaluate whether CBT works through increasing coping, the results indicate little support for the hypothesized mechanisms of action of CBT.

Conclusions. Research has not yet established why CBT is an effective treatment for alcohol dependence. Negative findings may reflect methodological flaws of prior studies. Alternatively, findings may indicate one or more conceptual assumptions underlying CBT require revision.
Limitations in using existing alcohol treatment trials to develop practice guidelines
Authors: Finney John W.
Published: March 2003

In recent years, substantial efforts have been made to identify "best practices" and develop comprehensive practice guidelines for the treatment of various psychiatric disorders and medical conditions, based on systematic, often quantitative reviews of the existing intervention research. There probably are more than 300 comparative treatment trials that have been conducted in the alcohol field. With this large body of research, one might think the development of alcohol treatment guidelines would be a straightforward task. Unfortunately, that is not the case. Four problems are discussed with the "box‐score" reviews that have been conducted thus far to identify effective alcohol treatment modalities. At least two of these problems are fundamental barriers to determining the relative efficacy or effectiveness of alcohol treatment modalities even in "meta‐analyses" with "effect sizes". These impediments are discussed, as is how future alcohol treatment trials could be conducted so that their findings would more readily inform practice guidelines.
Alcohol and coronary heart disease: a meta‐analysis
Authors: Corrao Giovanni , Rubbiati Luca , Bagnardi Vincenzo , Zambon Antonella , Poikolainen Kari
Published: March 2003

Objective. To estimate parameters of the function relating alcohol consumption with the risk of coronary heart disease and to identify the sources of heterogeneity in the parameter estimates.

Methods. A search of the epidemiological literature from 1966 to 1998 was performed using several bibliographic databases. Meta‐regression models were fitted to evaluate non‐linear effects of alcohol intake on the relative risk. The effects of some characteristics of the studies, including an index of their quality, were considered as putative sources of heterogeneity of the estimates. Publication bias was also investigated.

Findings. Among the 196 initially reviewed articles, 51 were selected. Since qualitative characteristics of the studies were significant sources of heterogeneity, the pooled dose‐response functions were based on the 28 cohort studies with higher quality. Risk decreased from 0 to 20 g/day (RR = 0.80; 95% CI: 0.78, 0.83); there was evidence of a protective effect up to 72 g/day (RR = 0.96; 95% CI: 0.92, 1.00) and increased risk above ≥ 89 g/day (RR = 1.05; 95% CI: 1.00, 1.11). Lower protective effects and harmful effects were found in women, in men living in countries outside the Mediterranean area and in studies where fatal events were used as the outcome. Evidence of publication bias for moderate intakes and of heterogeneity of the estimates across studies for higher intakes were found.

Conclusions. The degree of protection from moderate doses of alcohol should be reconsidered. Further research investigating the effect of drinking patterns on the risk of coronary heart disease should be performed. Caution in making general recommendations is needed.
The role of competence factors in reducing the future risk of drug use among young Swedish men
Authors: Stenbacka Marlene
Published: March 2003

Aims. To investigate the importance of individual competences and risk factors at the age of 18 for future risk of substance misuse. Both behavioural and home‐background risk factors were studied.

Design and participants. The study group consisted of 7577 18‐year‐old Swedish conscripts followed for substance misuse up to the age of 36. Information on competence and risk factors was obtained from a survey at conscription. Records of drug use were obtained from official registers; 158 (2%) people were identified as serious adult substance misusers.

Findings. Good emotional control and cognitive and social capacity were significantly associated with reduced risk of adult drug use whereas early contact with the police or juvenile authorities and alcohol misuse were the most powerful predictors for increased risk of adult drug misuse in multivariate analyses. The proportion of registered adult drug misuse in conscripts with multiple behavioural risk factors was 13.3% in those with drug experiences in late adolescence, compared with 2.6% in those with no earlier drug‐experiences. Subjects with multiple behavioural and home‐background risk factors but more than one competence were less likely to develop future substance misuse than those with only one or no competence factor. When analysed in relation to behavioural risks, competence factors are most effective in reducing drug use among subjects belonging to the high‐risk category, whereas when analysed in relation to home‐background risks personal competences are effective in low, medium and high‐risk groups.

Conclusion. Competences can protect against the development of serious problematic drug use and thus must be considered in preventive efforts.
Prevalence of alcohol problems among elderly patients in a university hospital
Authors: Ganry Olivier , Joly Jean‐Paul , Queval Marie‐Paule , Dubreuil Alain
Published: March 2003

Aims. To assess the prevalence of alcohol abuse and the prevalence of alcohol‐related discharge diagnosis in an elderly general hospital population. Design. On a randomly selected day, all patients aged 65 years and over admitted to a university hospital were screened. Setting. University Hospital of Amiens, France. Participants. All patients aged 65 years and over were approached and requested to take part in the study. They were interviewed using the CAGE questionnaire and with a structured questionnaire regarding life‐style, and asked about their usual daily alcohol consumption. The medical history of each patient was taken. In total, 612 patients fulfilled the age criteria, but 205 patients (33.6%) had to be excluded owing to predefined exclusion criteria (e.g. dementia, aphasia, terminal illness) and 37 patients (6%) refused to participate. Findings. The data were derived from 370 patients. The median age was 79 years; 54% reported no alcohol consumption; 9% of patients scored positive on the CAGE questionnaire. The prevalence of patients with a CAGE questionnaire positive was significantly higher among male patients (17%) than female patients (2.5%). The prevalence of patients with alcohol‐related discharge diagnosis was 7%. The frequency of higher socio‐economic status or divorced status increased significantly with alcohol consumption. Conclusions. There may be a substantial prevalence of alcohol problems in elderly hospital patients. Research is needed to examine how generalized this problem is.
Effects of using recommended coping strategies on drinking outcome following a brief intervention
Authors: Davila Rafaela , Sanchez‐Craig Martha , Wilkinson D. Adrian
Published: March 2003

Aims. To explore the unique contribution to outcome drinking of clients' use of six strategies for moderating drinking, after statistically accounting for variance explained by some client and intervention variables. Design. An exploratory hierarchical regression analysis assessed the contributions to variance in drinking outcome of pre‐intervention (client characteristics, baseline drinking), assignment (level of assessment, therapist experience) and early follow‐up variables. Data came from an experimental trial which evaluated the effect of adding assessment to provision of a self‐help book to heavy drinkers. Setting Diverse Ontario communities. Participants. Heavy drinkers (99 males, 56 females) were selected from 185 media‐recruited applicants who were screened by telephone to exclude cases with severe alcohol‐related problems. Their mean (+/‐ SD) pre‐admission weekly quantity of alcohol consumed was 22+/‐15 drinks. Follow‐up rates at 3 and 12 months were 92% and 88%. Measurements. Regressed onto weekly quantity at follow‐up were: client characteristics, previous measures of weekly quantity, experimental condition and use of the menu of strategies (setting goals for drinking, keeping track of drinking, pacing drinking, planning ahead to avoid heavy drinking, developing free‐time activities and coping with problems without drinking). Findings. At 3 months the variables predicting lower weekly quantity were: pre‐intervention weekly quantity, developing free‐time activities, setting goals for drinking and condition. Lower weekly quantity at 12 months was predicted by lower 3‐month and pre‐intervention weekly quantity, and regular use of: coping with problems without drinking, setting goals for drinking and keeping track of drinking. Conclusions. This descriptive study revealed a positive association between level of use of recommended coping strategies at follow‐up and drinking outcome. Controlled studies of the effects of strategy use on drinking outcome are therefore warranted.
Lethal methadone intoxications in Geneva, Switzerland, from 1994 to 1998
Authors: Perret Guillaume , Déglon Jean‐Jaques , Kreek Mary Jeanne , Ho Ann , La Harpe Romano
Published: March 2003

Aims. To estimate the number of methadone lethal intoxications in Geneva from 1994 to 1998, where the number of patients in methadone treatment has more than doubled since 1990.

Design. Retrospective study of all toxicological, autopsy and clinical data.

Setting. The Geneva Department of Forensic Medicine.

Participants. All suspected overdose deaths in Geneva from 1994 to 1998. Cases were selected on the basis that the only cause of death was a potentially lethal drug concentration in the postmortem blood sample.

Measurement. Toxicology and autopsy findings, clinical and drug history.

Findings. There were 106 lethal drug intoxications over the period. The overall number of drug intoxication deaths went from 33 in 1994 to nine in 1998. Thirty‐six cases had methadone identified in their blood. All the 36 cases but one had medications or other drugs used illicitly present in the blood or urine. Of these 36 cases, 21 were attributed to methadone lethal intoxication. Only seven of these 21 decedents were enrolled in a methadone programmes. The number of deaths attributed to methadone intoxication ranged from three to five per year.

Conclusion. Most lethal methadone intoxication is due to diverted or illegal methadone in association with medications or other drugs used illicitly. Furthermore, the increase in methadone prescription under strict medical control with health measures aimed at drug abuse prevention did not lead, in our study, to an increase of methadone lethal intoxication and may have been partly responsible for the large decrease of overall drug intoxication deaths during the time of our study.
Increased use of marijuana and other illicit drugs at US colleges in the 1990s: results of three national surveys
Authors: Gledhill‐Hoyt Jeana , Lee Hang , Strote Jared , Wechsler Henry
Published: March 2003

Aims. To examine rates and patterns of marijuana and other illicit drug use among different types of students and colleges in 1999, and changes in use since 1993.

Design. Self‐administered mail survey (Harvard School of Public Health College Alcohol Study).

Setting. One hundred and nineteen nationally representative US 4‐year colleges.

Participants. A representative sample of 15 403 randomly selected students in 1993, 14 724 students in 1997 and 14 138 students in 1999.

Measurements. Self‐reports of marijuana and other illicit drug use in the past 30 days and in the past year, cigarette use, drinking behavior, and age of initiation of smoking, drinking and using marijuana.

Findings. The prevalence of past 30‐day marijuana use rose from 12.9% to 15.7% between 1993 and 1999, an increase of 22%. Almost all of this change occurred by 1997. An increase was observed at 66% of the 119 colleges. The prevalence of 30‐day and annual marijuana use increased in nearly all student demographic subgroups except for Hispanic students, and at all types of colleges except for colleges with low binge drinking rates. Rates of illicit drug use in the past 30 days increased slightly for other illicit drugs in the 4‐year interval except for LSD. Nine out of 10 students (91%) who used marijuana in the past 30 days used other illicit drugs, smoked cigarettes and/or engaged in binge drinking. Of students who used any other illicit drug in the past 30 days, 87% used another substance or binge drank. Twenty nine per cent of past 30‐day marijuana users first used marijuana and 34% began to use marijuana regularly at or after the age of 18, when most were in college.

Conclusions. Use of marijuana and other illicit drugs has increased on campuses across the United States in most student subgroups and all types of colleges. This may reflect earlier increases in middle schools and secondary schools among this cohort. However, nearly one‐third of students initiated marijuana use in college and one of three began to use it regularly. Intervention efforts should be directed at college students, as well as secondary school students.
Joint heavy use of alcohol, cigarettes and coffee and the risk of suicide
Authors: Tanskanen Antti , Tuomilehto Jaakko , Viinamäki Heimo , Vartiainen Erkki , Lehtonen Johannes , Puska Pekka
Published: March 2003

Aims. To estimate the relationship between joint heavy use of alcohol, cigarettes and coffee, and the risk of suicide in a general population with high rate of suicide.

Design. Prospective cohort analyses.

Setting. Finland.

Participants. Data from 36 689 adult (age range 25‐64 years) men and women who participated in the population surveys between 1972 and 1992.

Measurements. The mortality of the cohort was monitored for a mean of 14.4 years, which yielded 169 suicides. Criteria for heavy use of each psychoactive substance were defined as follows: alcohol (> 120 g/week), cigarettes (≥ 21/day) and coffee (≥ seven cups/day).

Findings. About half the men and 80% of the women did not use any of the psychoactive substances heavily. Every third man and every fifth woman used one substance heavily, and the prevalence for those who exceeded criteria for joint heavy use of two substances was 9% for men and 1% for women. Joint heavy use of all three substances was rare. The adjusted relative risk of suicide increased linearly with increasing level of joint heavy use of alcohol, cigarettes and coffee. Among subjects with heavy use of one substance the risk was 1.55 (95% CI = 1.10, 2.18), with joint heavy use of two substances 2.22 (95% CI = 1.37, 3.61), and with joint heavy use of all three substances 3.99 (95% CI = 1.80, 8.84) compared with no heavy use.

Conclusions. Clustering of the heavy use of alcohol, cigarettes and coffee could serve as a new marker for increased risk of suicide.
Population‐based pharmacokinetic approach for methadone monitoring of opiate addicts: potential clinical utility
Authors: Wolff K. , Rostami‐Hodjegan A. , Hay A. W. M. , Raistrick D. , Tucker G.
Published: March 2003

Aims. There is evidence that plasma methadone measurements may be of benefit in dosage adjustment during methadone maintenance treatment for opiate dependence. However, to date the kinetics of oral rac‐methadone have been poorly characterized. We describe plasma methadone concentration‐time data collected from 35 opiate addicts.

Subjects. Oral doses of rac‐methadone were given to 24 male and 11 female addicts attending a community‐based drug treatment centre.

Measurements. Plasma methadone concentrations were measured by liquid chromatography (HPLC).

Procedures. Plasma concentration‐time data were collected from patients prescribed oral rac‐methadone in order to describe the complex kinetics of the drug incorporating its long elimination half‐life.

Findings. Auto‐induction of methadone metabolism was demonstrated and it was observed that clearance of methadone was significantly lower (

p < 0.05) in opiate addicts at the start of treatment (median elimination half‐life, 128‐hours) than in those who had reached steady‐state (median elimination half‐life, 48 hours). Our data has provided the basis for a population‐based pharmacokinetic (POP‐PK) model which is intended for use as a clinical tool in association with plasma measurements in methadone maintenance patients.

Conclusions. Using plasma monitoring in combination with the application of Bayesian forecasting it should be possible to predict trough levels of methadone during daily dosing. The model is able to utilize sparse sampling, and two blood samples are expected to be sufficient to define patient compliance. Random samples during treatment could be used to assess methadone dosing by comparing predicted with observed measurements for each individual. The clinical tool could therefore help to detect incomplete (failure to consume the whole daily dose as prescribed) and poor (due to ingestion of extra illicit methadone) compliance as well as therapeutic failure due to drug‐drug interactions. Targeting resources in this way could be a cost‐effective tool for supervision of methadone dosing.
The nature of benzodiazepine dependence among heroin users in Sydney, Australia
Authors: Ross Joanne , Darke Shane
Published: March 2003

Aims. To determine the extent to which heroin users meet criteria for benzodiazepine dependence, to examine the appropriateness of these criteria for assessing benzodiazepine dependence among this population, and to assess what other substance use, depressive and anxiety disorders are associated with benzodiazepine dependence.

Design. Cross‐sectional survey.

Setting. Sydney, Australia.

Participants. Two hundred and twenty‐two heroin injectors recruited through advertisements, needle exchanges, methadone maintenance clinics and by word of mouth.

Findings. Twenty‐six per cent (52/202) of those who had used benzodiazepines received a life‐time diagnosis of benzodiazepine dependence, with 22% of current benzodiazepine users being dependent. A principal components analysis revealed that a unidimensional construct underlies the benzodiazepine dependence syndrome. Those respondents with life‐time benzodiazepine dependence were more likely than others to meet criteria for anxiety or depressive disorders.

Conclusions. The inclusion of the benzodiazepine dependence syndrome in DSM‐III‐R (and DSM‐IV) is justified. A disturbingly high proportion of heroin users meet the criteria for benzodiazepine dependence, a condition that should be regarded as a significant marker for co‐morbidity among this group.
Capture–recapture estimates of drug misuse in urban and non‐urban settings in the north east of Scotland
Authors: Hay Gordon
Published: March 2003

Aims. To estimate the prevalence of opiate or benzodiazepine misuse in the Grampian Health Board area, Scotland and illustrate the use of the capture‐recapture method in both rural and urban settings.

Design. Capture‐recapture analyses on six distinct sources of data with unequal coverage of the geographical area.

Setting. Grampian Health Board area, including the City of Aberdeen.

Participants. Data were collated from the Police, Social Work Departments, GPs contributing to the Scottish Drug Misuse Database, statutory drug agencies, a voluntary sector drug agency and a needle/syringe exchange.

Measurements. In total 1770 individuals were identified as misusing opiates or benzodiazepines and residing in the Grampian Health Board area; 1129 individuals were resident in the City of Aberdeen.

Findings. The total number of opiate or benzodiazepine misusers in the City of Aberdeen was estimated to be 2519 (95% CI 2048‐3200). This figure corresponds to 2.0% (1.6‐2.5%) of the population aged 15‐54 years. In a town to the north of Aberdeenshire where high levels of heroin use had previously been reported in the media, 2.5% of the population aged 15‐54 (1.8‐3.8%) were estimated to be misusing opiates or benzodiazepines.

Conclusions. Although there may be difficulties in applying capture‐recapture methods in all settings, the methodology can give valuable information on the extent of drug misuse in both urban and non‐urban areas. This information is particularly important to assess the spread of drug misuse from cities to rural areas.
Chronicity of sexual harassment and generalized work‐place abuse: effects on drinking outcomes
Authors: Rospenda Kathleen M. , Richman Judith A. , Wislar Joseph S. , Flaherty Joseph A.
Published: March 2003

Aims. This study examined the impact of two forms of interpersonal conflict in the work‐place, sexual harassment (SH) and generalized work‐place abuse (GWA), on drinking outcomes. We hypothesized that SH and GWA would be associated more strongly with negative outcomes than task‐related work stressors, especially when SH and GWA were chronic problems.

Design. This was a two‐wave panel study.

Setting. The study was conducted at an urban university in the United States.

Participants. Participants were 2038 university employees in four occupational groups (faculty, student, clerical and service workers) who responded to both waves of the survey.

Measurements. Data on SH, GWA, task‐related stressors and drinking outcomes were gathered from self‐report mail questionnaires. Data from 1880 non‐abstaining respondents were included in the analyses.

Findings. SH and GWA experiences were widespread, typically chronic, and tended to co‐occur. In regression analyses controlling for demographics, occupational group, prior drinking and task‐related stress, GWA chronicity was linked to increased odds of reporting one or more indicators of problem drinking at time 2, in contrast to onset and remission. SH chronicity coupled with no GWA experiences was also significantly related to increased drinking variability. Task‐related stressors generally did not explain significant variance in drinking outcomes.

Conclusions. SH and GWA may be better predictors of drinking behavior compared to task‐related stressors, particularly when harassment is chronic. Increased attention to conflictual relationships in the work‐place, the relationship between SH and GWA and the dynamic nature of stressors in general is necessary in future research on drinking behavior.