bluuebunny/crossref_metadata_2025 huggingface dataset:
The families of problem drug users: a study of 50 close relatives
Authors: VELLEMAN RICHARD , BENNETT GERALD , MILLER TONY , ORFORD JIM , RIGBY KATE , TOD ANNE
Published: January 2006

The research described in this paper resulted from a‐collaborative multi‐centre study of the relatives of problem drug users involving six practitioners and researchers, in four centres within the south‐west of England. The objective of this research was simply to interview 50 close relatives of identified problem drug users, with the identification occurring through clinics and self‐help groups. Quantitative and qualitative results show that large numbers of these relatives reported many negative experiences. The partners of illicit drug users reported both more and differently patterned problematic behaviours than those of prescribed tranquilliser users. The partners of illicit users also reported different problems to those of the parents. Relatives reported many negative effects in terms of how they viewed the drug user, and how the experiences had affected their health. They also described various coping mechanisms, and the extent of the support which they had received. The results are discussed in terms of coping, and similarity with research into the families of problem drinkers.
Influencing the labelling of alcoholic beverage containers: informing the public
Authors: STOCKWELL TIM
Published: January 2006

In 1990, a small research project costing about Aus. $4500 conducted in a Perth shopping centre directly influenced the development of a national policy within 4 months of its completion. The policy in question is a recommendation by Australia's Ministerial Council on Drug Strategy that all alcoholic beverage containers should many labels indicating the number of ‘standard drinks’ they contain. The purpose of this paper is to describe the events leading up to so unusual an event with a view to discerning what factors may have been critical or its occurrence. The paper attempts to analyse the nature of the interactions between the research team and the policy makers. It is argued that the critical factors included there being a favourable policy climate created by the National Campaign Against Drug Abuse, the support of influential public servants and, in turn, politicians, the consultative process which lead to the study's design and the manner in which the findings were disseminated.
Policies to halve smoking deaths
Authors: TOWNSEND JOY
Published: January 2006

Britain still has amongst the highest mortality rates in the world for all the major smoking diseases. A third of all adults smoke cigarettes regularly and smoking causes one third of UK deaths in middle age. This paper discusses factors related to changes in smoking levels and concludes that without the intervention of government policies, smoking prevalence and the amount smoked per smoker is likely lo rise, particularly for young people. Measures to reduce smoking are surveyed and estimates made of the maximum likely effects from health education, advertising control, general practitioner smoking cessation advice and public and work place policies. A pricing policy is suggested which, with the other policies could reduce cigarette consumption by a half so that only one in five adults smoke by the year 2000. Predictions are made of the effect of this policy package on lives and life years saved. Within twenty five years there would be 50 000 fewer deaths from smoking and half a million life years saved annually. This would rise to two thirds of a million within forty years. Deaths from lung cancer would fall by 38%. The quality of these life years saved would tend to the average for their age.
An evaluation of freestanding alcoholism treatment for Medicare recipients
Authors: LO ANNIE , WOODWARD ALBERT
Published: January 2006

The Health Care Financing Administration (HCFA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted a demonstration between 1982 and 1985 to test the feasibility of providing payments for alcoholism treatment services to Medicare and Medicaid recipients in specially selected freestanding facilities. This study of the Medicare part of the demonstration answers two questions: do freestanding facilities save money for Medicare and do their patients have lower health care utilization following imitation of treatment than patients treated in hospital‐bated facilities? The statistical methodology is a logit and cluster approach. The analysis begins with a logistic regression model to predict the probability of patients seeking alcoholism treatment in either the demonstration (freestanding facility) or hospital‐based cohort. The statistically significant variables from logit analysis are then used to form clusters. The health expenditure of freestanding and hospital patients are compared within homogeneous clusters. This study shows that the number of admissions, the average length of stay, and the average monthly health expenditures following the start of treatment are lower for the group treated in the freestanding facilities. The conclusion is that for some persons with alcohol problems, treatment in freestanding facilities is less costly and leads to lower subsequent health care utilization than treatment in hospitals.
The survival roles of children of alcoholics: their measurement and validity
Authors: DEVINE CINDY , BRAITHWAITE VALERIE
Published: January 2006

Scales to measure five survival rules proposed by Black (1979) and Wegscheider (1976) as characteristic of children of alcoholics were developed and tested among a sample of 112 adolescents. Scales representing the lost child, the acting out child, and the mascot were highly intercorrelated, but use of the placater role was relatively unrelated to other roles. The relationship between parental drinking and role use was examined using hierarchical multiple regression which controlled for sex, age and three family variables, intimacy, deliberateness and cohesiveness. Parental alcoholism contributed to children adopting the acting out role, did not contribute to explaining variation in the lost child and mascot roles, but was the sole predictor of the adoption of the responsible child role. In the case of the placater role, controlling family deliberateness led to the emergence of a previously masked relationship with parental alcoholism. The survival roles appear to be as much a response to family disorganization as to parental alcoholism.
Alcohol and violence‐related injuries: an emergency room study
Authors: CHERPITEL CHERYL J.
Published: January 2006

Drinking patterns, alcohol‐related problems and drinking‐in‐the‐injury event were compared between those admitted to the emergency room (ER) with and without injuries resulting from violence. A probability sample of 1770 adult casualty patients in four hospitals in a single California suburb county were breathalyzed and interviewed at the time of the ER visit. Among all males and females over 30, those with violence‐related injuries were more likely than those with other injuries to have positive breathalyzer readings and to report drinking prior to the event, frequent heavy drinking, consequences of drinking, experiences associated with alcohol dependence and loss of control and prior treatment for an alcohol problem. The data suggest a need for research to test whether a brief intervention at the time of the ER visit for problem drinking or a referral for more extensive alcohol treatment can effect a reduction in alcohol‐related violence and other alcohol‐related problems.
Methadone dose and heroin use during maintenance treatment
Authors: CAPLEHORN JOHN R. M. , BELL JAMES , KLEINBAUM DAVID G. , GEBSKI VAL J.
Published: January 2006

A retrospective study examined the association between methadone dose and in‐treatment heroin use as measured by fixed‐interval urine testing in a cohort of 62 patients admitted to an Australian maintenance program. Urinalysis and methadone dose data were collected on subjects for a maximum two years and were analysed using Zeger & Liang's (1986) method for modelling longitudinal data. While allowing for patient descriptors and the time period in which urine samples were collected, the relative odds of using heroin were reduced by 2% for every 1 mg increase in the maintenance dose of methadone. It is estimated that the odds of patients maintained on 40 nig of methadone using heroin mere 2.2 times those of patients maintained on 80 mg.
Relative frequency of heavy drinking and the risk of alcohol dependence
Authors: DAWSON DEBORAH A. , ARCHER LORAN D.
Published: January 2006

Data from a national representative sample of US adults were analyzed to determine the association between the relative frequency of heavy drinking (the proportion of drinking occasions on which 5 + drinks were consumed) and past‐year alcohol dependence, adjusting for the influences of average ethanol intake and sociodemographic factors. Fifty‐seven percent of current drinkers reported never drinking 5 + drinks, and 21% drank 5 + drinks at least once but on less than 10% of all drinking occasions. Nine percent reported drinking 5 + drinks on at least half of all drinking occasions. Average daily intake was positively correlated with the relative frequency of heavy drinking, and both consumption measures were positively associated with the risk of alcohol dependence. Increases in either relative frequency of heavy drinking or average ethanol intake reduced, but did not eliminate, the effect of the other on the risk of dependence. The excess risk of dependence associated with frequent heavy drinking varied among population subgroups and was increased by age, education, and female gender.
High risk drinking settings: the association of serving and promotional practices with harmful drinking
Authors: STOCKWELL TIM , LANG ERNIE , RYDON PHIL
Published: January 2006

A household survey of 1160 Western Australian adults was used as a basis for exploring drinkers' reports about the settings in which they drank alcohol and their experiences of alcohol related harm. Of the 873 drinkers identified, 7.9% had experienced some form of acute alcohol related harm over the previous 3 months. Violent incidents were the mat common of these and drink‐driving offences the least. Such harm was significantly more likely among drinkers who variously drank ‘heavily’, mere male, single, under 25 years of age and/or who drank on licensed premises. Regression analyses revealed that even when demographic characteristics of the drinkers were controlled for licensed premises were significantly more likely to be the settings used prior W harm occurring. Barstaff continuing to serve ‘obviously intoxicated’ customers was the most powerful predictor of harm. Premises which offered discounted drinks or permitted crowding also tended to be those where intoxication was permitted but these variables were not directly associated with an increased risk of harm. These findings lend further weight to the view that prevention efforts should focus on licensed drinking environments and, in particular, the practice of continuing to serve obviously intoxicated customers.
The importance of amount and location of drinking for the experience of alcohol‐related problems
Authors: CASSWELL SALLY , ZHANG JIA FANG , WYLLIE ALLAN
Published: January 2006

People's self report of a variety of alcohol‐related problems was collected as part of a national survey carried out in New Zealand in 1988. These problems included self perception of adverse effects of drinking on a number of life areas such as health, friendships and financial position; items covering tangible consequences of alcohol use and items suggestive of alcohol dependence. The experience of these problems was predicted from a number of socio‐demographic variables and respondent's reports of their typical drinking behaviour. Of the socio‐demographic variables only age was found to relate strongly to experience of problems. The overall frequency of drinking relatively large amounts and the typical quantity drunk in certain licensed premises (hotels, taverns and clubs) and the typical quantity drunk in others' homes predicted the experience of problems. These findings are similar to research from other countries using different methodologies and support the likely effectiveness of prevention strategies which reduce the access of young people to alcohol and which aim to influence the amounts consumed in drinking sessions on licensed premises.
HIV risk behaviours among female prostitute drug injectors in Glasgow
Authors: TAYLOR AVRIL , FRISCHER MARTIN , McKEGANEY NEIL , GOLDBERG DAVID , GREEN STEPHEN , PLATT STEPHEN
Published: January 2006

This paper focuses upon HIV‐related risk behaviours of 51 female drug injecting prostitutes, interviewed as part of a serial cross‐sectional study of injecting drug users in Glasgow. Forty‐five per cent injected with used needles and syringes in the 6 months prior to interview. Condom use in private sexual relations was low with only 9% of those with primary partners and 22% of those with casual partners reporting consistent use of condoms with these partners. In contrast, use of condoms for all commercial sexual encounters was almost universal. Prevalence of HIV was 2.2%. Despite this low prevalence, we conclude that the level of injecting‐related and private sexual risk behaviours reported here requires the continuing monitoring of drug injecting prostitutes in Glasgow.
Researching self help drug treatment: collaboration and conflict in the age of harm reduction1
Authors: TOUMBOUROU JOHN , HAMILTON MARGARET
Published: January 2006

Where there is evidence supporting the effectiveness of drug treatment in self help groups there are many points of divergence between the philosophies traditionally espoused by these groups and those advocated within harm reduction policies. In this paper we examine some of the differences between self help and harm reduction approaches. We argue that (in common with other treatment modalities) self help groups have altered and developed in response to changing community expectations and that this process should be expected to continue. We report on our ongoing exploration of research partnerships with self help group members focusing particularly upon research conducted in collaboration with self help groups in Victoria. We argue that research partnerships have advantages for both parties. These partnerships have the potential to better inform researchers of developments in the self help community (including the practices of active drug users). Research partnerships also encourage better understanding among self help group members of some of the potential problems that, as research has indicated, may be associated with certain self help group practices. We advocate such understanding as a potentially effective means of encouraging the appropriate development and refinement of self help group practices in line with harm reduction principals.
Alcohol and injuries resulting from violence: a review of emergency room studies
Authors: CHERPITEL CHERYL J.
Published: January 2006

This paper reviews emergency room (ER) studies from a number of countries which have reported findings related to the association of alcohol and injuries resulting from violence. Special attention is given to those studies which used probability samples of patients which were representative of the population served by the emergency room facility where the data were collected, and which compared those admitted to the ER with violence‐related injuries with those admitted to the same ER during the same period of time with injuries unrelated to violence. Those with violence‐related injuries were more likely to be admitted to the ER with a positive blood alcohol concentration, to report drinking prior to the event, to report more frequent heavy drinking and to report more alcohol‐related problems than those admitted with injuries from other causes.
Why has it proved so difficult to match drug abuse patients to appropriate treatment?
Authors: BALL JOHN C.
Published: January 2006

Why has it proved so difficult to match drug abuse patients to appropriate treatment? In seeking answers to this dilemma, attention is directed to the conceptual, semantic, substantive, methodological, political and cultural issues which need to be resolved. In particular, the lack of knowledge about the treatment domain as well as the corresponding dearth of instruments to measure program characteristics and the delivery of treatment services is noted. Although the importance of demographic and cultural determinants of both patient and treatment characteristics seems evident, numerous conceptual issues persist. Is matching patients to treatment and rehabilitation a one‐time event or a process? Is matching a simplistic concept? It is suggested that the principal questions to be resolved about matching drug abuse patients to treatment and rehabilitation are conceptual, or theoretical.
Predictors of injecting and injecting risk‐taking behaviour among methadone maintenance clients
Authors: DARKE SHANE , SWIFT WENDY , HALL WAYNE , ROSS MICHAEL
Published: January 2006

A sample of 222 methadone maintenance clients were interviewed regarding current injecting and needle risk‐taking in order to ascertain factors associated with these behaviours. Just over half (55%) of subjects had injected in the month preceding interview. Current injecting was associated with being female, having a regular sexual partner who was a current injecting drag user, polydrug use and higher levels of global psychopathology. Approximately 15% of subjects had shared needles in the month preceding interview, predominantly with one other person. Needle sharing was associated with having a regular sexual partner who was a current injecting drug user, current criminality and injecting at places other than home. Needle‐sharing episodes in the study period were considered safe by practically all sharers. The implications of these findings are discussed.
Prevalence of tobacco smoking among junior high school students in Japan and background life style of smokers
Authors: WADA KIYOSHI , FUKUI SUSUMU
Published: January 2006

In order to estimate the prevalence of tobacco smoking among junior high school students in Japan and to assess certain characteristics of smokers, the authors surveyed 5240 students aged between 12 and 15 years. In terms of both the number of subjects and of schools, this was the first major survey of Japanese junior high schools on the relationship between tobacco smoking and the background life styles of smokers. Of all students, 30.5% of males, 13.3% of females and 22.2% of the total were lifetime smokers; 3.3%, 0.8% and 2.2%, respectively, were daily smokers. As the frequency of tobacco smoking increased, the regularity of the life style routine was significantly more disturbed, and school and family life were significantly less relaxed. The authors suggest that the strengthening of family cohesion would be an effective preventive strategy in Japan.
Randomized response estimates for the purchase of smuggled liquor in Norway
Authors: NORDLUND STURLA , HOLME INGAR , TAMSFOSS STEINAR
Published: January 2006

The randomized response technique is applied on a voluntary basis for estimating the purchase of smuggled liquor in Norway. Of a total sample of 2330 respondents, aged 15 and over, about one half chose the protective option of the RR‐technique. The other half responded directly to the supposed sensitive questions. The estimates from the two groups were weighted together to give population estimates for the percentage of buyers, and the quantities bought, of smuggled liquor. The resulting estimates were found to be considerably higher than estimates from a contemporary survey based on direct response only.
Comparing usual quantity/frequency and graduated frequency scales to assess yearly alcohol consumption: results from the 1990 US National Alcohol Survey
Authors: MIDANIK LORRAINE T.
Published: January 2006

Data were used from the 1990 US national alcohol survey to compare two volume measures of alcohol consumption: usual quantity/frequency (QF) and graduated frequency (GF). The QF measure obtained global estimates of average alcohol intake per day; the GF measure is a series of questions on the frequency of consuming specific numbers of drinks which ranges from the most ever consumed in the last year to 1–2 drinks per occasion. The GF measure provided higher estimates of alcohol use. Respondents whose reports were inconsistent between the measures were more likely to be male, never married, and report getting drunk at least monthly and drinking five or more drinks on one occasion at least monthly during the last year.
Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review
Authors: Najavits Lisa M. , Weiss Roger D.
Published: January 2006

Despite the widespread use of psychotherapy for patients with substance use disorders, the effectiveness of psychotherapists conducting such treatment has received little research attention. In this paper, empirical studies of therapists' differences in patient outcome and dropout rates are comprehensively reviewed. The main conclusions are that therapists show diverse rates of effectiveness, and that such differences appear independent of both therapists' professional background and of patient factors at the start of therapy. The primary therapist characteristic thus far associated with higher effectiveness is the possession of strong interpersonal skills. Guidelines for research on therapist effectiveness are presented.
Drinking in California: theoretical and empirical analyses of alcohol consumption patterns
Authors: GRUENEWALD PAUL J. , NEPHEW THOMAS
Published: January 2006

A theoretical model is presented in which alcohol consumption patterns are expressed in terms of frequencies of initiation and probabilities of continued drinking once consumption has begun. The model is used to explicate the relationships between measures of drinking frequency, drinking quantity, modal or typical drinking and total alcohol consumption. A mathematical realization of this, model is developed and applied to data on quantities and frequencies of alcohol use obtained from a general population survey of California consumers. These data were used to estimate the basic parameters of the alcohol consumption model, obtain drinking pattern estimates derived from the model and analyse these measures in the context of background demographic variables. Pattern estimates from I fie model mere bench‐marked against, self‐reports available in the original data. The results of these analyses showed that: (1) frequencies of drinking were exponentially distributed; (2) probabilities of continued drinking were best characterized by a log‐logistic function; and (3) estimates of modal and total drinking levels derived from the model were substantively related to self reports. Estimates of total consumption obtained from the model were 28% greater than those obtained from standard quantity‐frequency estimates. This difference was consistent with expectations based upon the theoretical model.
What is the average price of an illicit drug?
Authors: CAULKINS JONATHAN P.
Published: January 2006

Estimates of the total dollar value of the markets for illicit drugs are valuable for policy making. Such estimates are usually produced by multiplying estimated consumption by price. This paper argues that the relevant price for such calculations is not simply the price of one standard unit. There are substantial quantity discounts for illicit drugs, and there is a distribution of retail purchase sizes. Hence, the average price paid per gram need not equal the price of one gram. This concept is illustrated with calculations for heroin and
The generalizability of the dependence syndrome across substances: an examination of some properties of the proposed DSM‐IV dependence criteria
Authors: MORGENSTERN JON , LANGENBUCHER JAMES , LABOUVIE ERICH W.
Published: January 2006

DSM‐III‐R and proposed DSM‐IV schemes for the diagnosis of psychoactive substance use disorders art‐based largely mi the dependence syndrome concept. However there is an absence of empirical support for the generalizability of the dependence syndrome across substances, flits study examines how consistently proposed DSM‐IV dependence criteria function to measure dependence across seven substances: alcohol, cannabis, cocaine, stimulants, hallucinogens, sedatives and opiates. Using structured research diagnostic interviews, dependence diagnoses were determined for 295 American subjects in treatment for alcohol/drug problems. Several factor analytic techniques were used la assess whether criteria fanned single dimensions and ham consistently individual criteria measured dependence across substances. The ability and consistency of criteria to measure a continuum of severity across substances were also assessed. Only subjects who used the substance at least six times were entered in the analyses. Overall, results provide strong support fur the DSM approach for alcohol, cannabis, cocaine, stimulants, sedatives and opiates, but not for hallucinogens. Results indicate that a single strong factor adequately described the criteria for these six substances. All criteria loaded strongly and uniformly on single factors indicating that all litre good measures of dependence. Criteria provided a dimensional measure of severity based on several indices for these substances. In addition, four criteria provided relatively stable indicators of high or tow severity across these substances. Results did not support the use of dependence criteria for Hallucinogens as these criteria did not form a single factor. Results suggest that very few hallucinogen users experience an inability to cut down or control use, a key indicator of loss of control.
Evaluation of two student and teacher involved alcohol prevention programmes
Authors: WILHELMSEN BRITT UNNI , LABERG JON CHRISTIAN , KLEPP KNUT‐INGE
Published: January 2006

Two versions of a school‐based alcohol prevention programme for 7th grade students were evaluated against a non‐treated comparison condition. Both programme versions were based on a social‐cognitive theory approach to alcohol prevention, and differed in the level of role‐specifications for participating teachers and peer leaders. Twelve schools with 955 students m Bergen, Norway, participated in the study. Four schools were randomly assigned to each of the three conditions, and the programme was implemented during 10 class periods over 2 months in Spring, 1992. Pre‐ and post‐test surveys were conducted, assessing alcohol use, as welt as cognitive variables related to alcohol use in a specific context (intentions, attitudes, norms and self‐efficacy expectations). Results showed that the highly role‐specified (HRS) version had a higher degree of student involvement than the less role‐specified (LRS) version, indicating that the HRS programme was more successful in engaging students in alcohol prevention activities. A significant difference in programme effectiveness was found, as measured by an overall programme effect across all dependent variables. This effect was explained by significantly more positive outcomes in the HRS version compared to both the LRS and the non‐treated conditions, while the LRS version did not differ significantly from the non‐created condition.
“Physician heal thyself”: drink, temperance and the medical question in the Victorian and Edwardian Church of England, 1830–1914*
Authors: OLSEN GERALD WAYNE
Published: January 2006

This paper examines the connection between medical research and temperance from the point of view of the Anglican temperance movement in three periods: (1) 1830–55, when Anglican clergymen resisted teetotalism in favour of mideration, in keeping with accepted medical opinion; (2) 1855–73, when a miniority of Anglican teetotal clergymen attempted unsuccesfully to convert the Anglican Church to teetotalism and prohibition, as the medical profession in theory, but not always in practice, disoruaged excessive therapeutic reliance on alcohol; and (3) 1873–1914, when the prestigious Church of England Temperance Society, with a dual basis, promoted teetotalism among the majority but affirmed the legitimacy of moderate drinking among the British medical and social elite.
Evaluation of a mass media campaign on smoking and pregnancy
Authors: CAMPION PATRICK , OWEN LESLEY , MCNEILL ANN , McGUIRE CHRISTINE
Published: January 2006

Two surveys were conducted among pregnant women throughout England, before (n = 625) and after (n = 607) a mass media campaign on smoking and pregnancy targeted at women aged 15–24 years, in the social grade C2DE. The majority of the post‐campaign sample recalled having seen at least one of the campaign's series of press advertisements. There was a significant increase among this sample in those considering smoking to be very dangerous to the unborn child, in those understanding the term passive smoking and in those considering passive smoking to be very dangerous. During the campaign there was a 14% increase in the number of calls to a cessation helpline from pregnant women. Over the campaign there were no significant changes in smoking prevalence and consumption among pregnant women or partners or in the numbers of partners offering suggestions to pregnant women about their smoking behaviour.
Mortality in men with drinking problems: a 20‐year follow‐up
Authors: MARSHALL E. JANE , EDWARDS G. , TAYLOR C.
Published: January 2006

This study presents mortality data from a 20‐year follow‐up of 99 married men with drinking problems. Party‐four of the sample had died and death certificates were obtained on 43. Cause of death was classified according to the Ninth Revision of the International Classification of Diseases. Most of the mortality excess was in the 45–54 year age group. The observed/expected mortality ratio was 3.64 for the group as a whole, 2.93 for the moderately dependent group and 4.41 for the severely dependent group. The commonest causes of death were carcinoma of the bronchus and diseases of the circulatory system. Cause of death was analysed in terms of years of life lost. The number of yean of life lost per death was highest for injury and poisoning. Only four of the 43 death certificates obtained mentioned “chronic alcoholism”.
Death and survival in a cohort of heroin addicts from London clinics: a 22‐year follow‐up study
Authors: OPPENHEIMER EDNA , TOBUTT CLIVE , TAYLOR COLIN , ANDREW TOBY
Published: January 2006

Data are presented on the 43 people who died over a 22‐year follow‐up period of a cohort of 128 heroin addicts drawn in 1969 from the newly opened London clinics. The main causes of death were drug‐related, with 18 deaths specifically determined as due to overdose, of which the great majority were among people being prescribed opiates at the lime. The mortality rate was a mean of 1.84% annually, and the excess mortality ratio was 11.9. This excess was highest at the beginning and varied over the period of study, appearing higher at the opening of the clinics and again in the mid‐1980s. No sex differences in mortality rates were demonstrated but the excess mortality wan concentrated at younger ages. No prediction of the 85 survivors could be made on the basis of length of heroin use prior to study intake, nor on age at intake.
The prevalence of drug use in urban Aboriginal communities
Authors: PERKINS J. J. , SANSON‐FISHER R. W. , BLUNDEN S. , LUNNAY D. , REDMAN S. , HENSLEY M. J.
Published: January 2006

The use of both licit and illicit drugs has been identified as a major health issue for Australian Aborigines. However, data on the proportion of people who use such drugs is scant. This cross‐sectional survey of a randomly selected sample of urban Aboriginal people provides information on the use of the drugs alcohol, tobacco, marijuana, cocaine, heroin as well as petrol sniffing. Overall, a significantly smaller proportion of Aboriginal people were found to be current alcohol drinkers compared to non‐Aboriginal Australians. A larger proportion of these drinkers were, however, found to be drinking at levels that were hazardous to their health. A significantly greater proportion of people from the Aboriginal sample were also found to be smokers compared to their non‐Aboriginal counterparts. An examination of the use of the illicit substances revealed that a greater proportion reported they had ever used marijuana, compared to the other substances. The findings are discussed in terms of their implications for the health of Aboriginal people.
Alcohol consumption and insomnia in a sample of Japanese alcoholics
Authors: SHINBA TOSHIKAZU , MURASHIMA YOSHIYA L. , YAMAMOTO KEN‐ICHI
Published: January 2006

The amount of ethanol consumed by chronic alcoholics in a Japanese slum area with persistent insomnia (n = 40) and those without it (n = 40) was compared using a questionnaire. For both groups, the present habitual consumption (PHC) of ethanol per day was most frequently between 60 g and 150 g and no difference was observed between the two groups. In contrast, the maximum habitual consumption (MHC) of ethanol per day throughout the alcoholic history was found to be greater for the insomnia patients than the non‐insomniacs (p < 0.001). No difference between the groups was found in the kind of alcoholic drink consumed, with sake (Japanese rice wine) being the most popular in both groups. The results suggest that persistent insomnia in alcoholics is related to excessive alchol intake and persists even when drinking levels have fallen.
A profile of tobacco smoking
Authors: JARVIS MARTIN J.
Published: January 2006

Cigarette smoking has for years been declining slowly in a number of major Western countries. It nevertheless remains highly prevalent, with one‐quarter to one‐third of adults being current smokers in the USA and Britain, and only some 40 per cent of those who have ever smoked cigarettes regularly have given up. Smoking is increasingly becoming a marker for deprivation and for a stressful life‐style, and is also associated with consumption of other drugs. There is abundant and convincing evidence that, far from being confined to a minority of problem users, high levels of dependence on tobacco are experienced by a majority of smokers in the general population, with an onset early in the smoking career. The rewards which underpin continued smoking are unclear, but it may be that avoidance of the unpleasantness of not smoking is more significant than positively rewarding effects.
Biological processes in benzodiazepine dependence
Authors: LADER MALCOLM
Published: January 2006

The indications for the benzodiazepines include anxiety, insomnia, muscle spasm and epilepsy and each disorder has a variety of biological substrates. Limbic structures and the neurotransmitters noradrenaline, 5‐HT and GABA have all been implicated. Benzodiazepines act on alloosteric receptor sites and potentiate the actions of GABA in modulating chloride ionophores across nerve membranes. These effects can be blocked by the benzodiazepine antagonist, flumazenil. The molecular pharmacology of the benzodiazepine‐GABA‐chloride receptor is complex, with a wide range of different subunits. Animal models of dependence have suggested that the changes associated with long‐term benzodiazepine use are related more to receptor‐effector coupling than to the receptor characteristics themselves. Thus, benzodiazepine agonists on long‐term use lose their efficacy, antagonists become partial inverse antagonists, and inverse agonists increase in efficacy. Various clinical implications are explored, including the use of flumazenil to prevent and to treat benzodiazepine withdrawal syndromes.
Overview: The treatment of drug dependence
Authors: O'BRIEN CHARLES P.
Published: January 2006

Addictive disorders resemble other chronic medical disorders in that they are characterized by relapses and remissions. This central feature of the addictions is addressed by many of the contributors in their individual chapters. There are also several specific points raised in the chapters which merit further discussion. For instance, any assumption that long–term anti–anxiety treatment with benzodiazepines implies a form of dependence that requires treatment could be set against an alternative view that there may be appropriate medical/psychiatric indications for such prolonged treatment. There are also interesting questions which deserve discussion surrounding the debate over treatment setting for opiate dependence treatments. The paper by Johns presents a case for inpatient treatment whereas in the United States long–term methadone maintenance is seen as one of the most effective treatments. Given the complexity of the bio–psycho–social mechanisms involved in Addiction a combination of therapeutic approaches tailored to individual needs should probably continue to be the guiding principle.
The impact of alcohol beverage container warning labels on alcohol‐impaired drivers, drinking drivers and the general population in northern California
Authors: PARKER ROBERT NASH , SALTZ ROBERT F. , HENNESSY MICHAEL
Published: January 2006

Using data collected in a random‐digit dial telephone survey in a northern California county, an examination of the impact of alcohol beverage container warning labels was conducted. In a broadly conceived approach to the possible impact of warning labels we examined recall and content as well as risk assessment and the use of warning labels as public policy to combat drunk driving. In a repeated measures pre‐ and post‐design, respondents reported significantly higher recall of labels and their content in the post‐introduction period. Evidence from a multivariate analysis of post‐introduction data indicate that both drinking drivers and impaired drivers (based on self‐reports) were more likely to recall the labels and their content, an indication that wanting labels are reaching “at risk” individuals. In addition, increases in the perceived risk of driving and drinking are consistent with the notion that warning labels, as one part of a larger social movement, are helping to create an atmosphere in which drinking and driving is less acceptable. However, our findings also indicate that, at least among at risk drinking and impaired drivers, increased use of public policies such as warning labels in an effort to reduce the negative consequences of drinking and driving may generate a public opinion backlash.
Negative alcohol expectancy predicts post‐treatment abstinence survivorship: the whether, when and why of relapse to a first drink
Authors: JONES BARRY T. , MCMAHON JOHN
Published: January 2006

Using survival analysis, the association was explored between positive and negative alcohol expectancies measured on admission to a non‐residential alcohol dependence treatment unit and post‐treatment relapse to a first drink (first slip). A reliable association between negative alcohol expectancy (but not positive) and relapse was found. The active negative alcohol expectancies were distal rather than proximal: proximal expectancies surround consumption (‘same day’ expectancies) and distal expectancies relate to the ‘next‐day’ following consumption or those longer term expectancies coming from ‘continued drinking’. Only the ‘next day’ component of distal expectancies formed a reliable association with relapse. The use to which negative alcohol expectancy as measured by the Negative Alcohol Expectancy Questionnaire might be put is discussed in terms of (i) a bottom‐up representation of motivation for recovery to help treatment match and (ii) a provisor of detailed, client‐specific information for structuring motivational interventions.
Pseudoaneurysm in injecting drug abusers: cases from India
Authors: BASU D. , MATTOO S. K. , ARORA A. , MALHOTRA A. , VARMA V. K.
Published: January 2006

Pseudoaneurysm, a known complication of arterial needle puncture, is also an uncommon complication of parenteral drug abuse. India is currently witnessing an upsurge of abuse of injectable drugs. Five cases of pseudoaneurysm developing as a complication of intra‐artenal drug abuse are reported. The need for early recognition and proper timely intervention is highlighted.
Predictors of patient retention in a newly established methadone maintenance treatment programme
Authors: DEL RIO MIGUEL , MINO ANNIE , PERNEGER THOMAS V.
Published: January 2006

Aims. To identify predictors of patient retention in methadone maintenance. Design. Prospective study. Setting. Methadone maintenance treatment programme newly established in Geneva, Switzerland. Participants. All patients who initiated treatment between February 1991 and January 1995. Measurements. Baseline patient characteristics, dose of methadone, year of enrollment and retention in treatment. Findings. Overall, 111 patients contributed 164.4 person‐yean of follow‐up. The retention rate was 84% after 12 months. In multivariate analysis, the risk of dropping out was significantly higher for patients who had been using opioids for 7 years (relative hazard (RH) 3.0, 95% confidence interval (CI) 1.2‐7.4), and for patients who had no stable income at baseline (RH 3.3, 95% CI 1.2‐9.1). Dropouts were less frequent at the highest doses of methadone (65‐110 mg/day, RH 1.0) than at middle doses (45‐60 mg/day, RH 2.0, 95% Cl 0. 7‐5.5) but, quite unexpectedly, dropouts were least likely at the lowest doses (15‐40 mg/day, RH 0.5, 95% CI O.J‐1.8). Dropouts were more likely among patients who enrolled in the first (RH 6.2, 95% CI 2.3‐16.7) and second (RH 1.9, 95% CI 0.6‐5.6) years of the programme, compared with subsequent years (RH 1.0). Conclusions. Patients who have a long history of drug use and who have a stable income were more likely to stay in methadone maintenance treatment. Independent of patient characteristics, retention improved dramatically in the first years of programme functioning, suggesting that patient retention is a sensitive indicator of programme performance.
The effect of changes in alcohol consumption on mortality and admissions with alcohol‐related diagnoses in Stockholm County‐a time series analysis
Authors: LEIFMAN HÅKAN , ROMELSJÖ ANDERS
Published: January 2006

Aim. To study the effect of changes in per capita alcohol sales and indicators of alcoholism treatment on admissions to inpatient care and mortality for liver cirrhosis and alcoholism, alcohol intoxication and alcohol psychosis (AAA). Design. Bivariate and multivariate time series analyses was conducted by applying the ARIMA‐modelling technique. Setting and participants. All analyses were conducted on quarterly data from Stockholm County 1980‐94 with a population of 1.7 million people. Measurements. Data on sales of alcohol and disulfiram/calcium carbimide were used as input variables. Inpatient data (from the Stockholm Inpatient Care Register) and mortality dam (from the Cause of Death Register) on all cases with alcoholism, alcohol psychasis and alcohol intoxication (AAA) and liver cirrhosis as underlying or contributory diagnoses were used as output variables. Findings. Alcohol sales affected the cirrhosis rate. For cirrhosis mortality, but not for cirrhosis admissions, the effect was not only direct but also distributed over time. Significant direct and time lag effects of alcohol sales on both AAA series and cirrhosis admissions were found only during earlier, shorter periods, e.g. 1980‐90. All four output series showed significant effects of sales of disulfiram/calcium carbimide and were the only significant predictors for the two AAA endpoints for the whole study period. Conclusions. These results suggest that to reduce the rate of alcohol‐related problems caused by socially deteriorated and severely alcohol‐dependent subjects (i. e. AAA), reduction of overall consumption should be complemented by treatment of alcohol‐dependent subjects.
Acamprosate treatment in a long‐term community‐based alcohol rehabilitation programme
Authors: POLDRUGO F.
Published: January 2006

Aims. To evaluate the efficacy of acamprosate in maintaining abstinence in weaned acohol‐dependent patients. Design. A multicentre, double‐blind, randomized control trial. Patients were individually randomly allocated to active or placebo conditions. Abstinence was assessed during a 6‐month treatment period and after a 6‐month follow‐up period. Setting. A community‐based, outpatient alcohol rehabilitation programme. Participants. Two hundred and forty‐six alcohol‐dependent patients between the ages of 18 and 65 years were recruited immediately following acute, inpatient withdrawal treatment. Measurements. The primary outcome measure was self‐reported abstinence from alcohol since the previous sessions at 3, 6, 9 and 12 months following the start of treatment, with treatment taking place for a period of 6 months. Findings. A significantly higher proportion of patients in the acamprosate group were abstinent after 3 months and 6 months of treatment. The percentage of patterns with continuous abstinence at the end of the treatment period was almost double for the acamprosate group than for the placebo group (40.7% vs. 20.8%, respectively). Acarnprosate significantly increased the retention of patients in the treatment programme. Six months after drug treatment ceased, the criterion of abstinence since the previous visit was reached by significantly more patients from the acamprosate group (43.4%) than from the placebo group (29,8%), but Ms difference was not statistically significant at the 3‐month point after cessation of study medication. Conclusions. Acamprosate may be a useful pharmacological compound for the long‐term treatment of alcohol‐dependence when applied in a community‐based rehabilitation programme.
Assessing the relationship between maternal cocaine use and abruptio placentae
Authors: HULSE G. K. , MILNE E. , ENGLISH D. R. , HOLMAN C. D. J.
Published: January 2006

Abruptio placentae during pregnancy can result in significant morbidity and mortality to both mother and infant. A comprehensive literature search of publications from 1966 to April 1995 identified 11 studies on the association between maternal cocaine use and abruptio placentae. Their results were combined in a meta‐analysis. The pooled odds ratio for abruptio placentae and maternal cocaine use was 3.92 (95% confidence interval 2.77‐5.46). The strength and consistency of the association, its biological plausibility and the results of experimental studies in animals all suggest that cocaine use during pregnancy causes abruptio placentae.
Maternal cannabis use and birth weight: a meta‐analysis
Authors: ENGLISH D. R. , HULSE G. K. , MILNE E. , HOLMAN C. D. J. , BOWER C. I.
Published: January 2006

Aims. To estimate the effect of maternal cannabis use on birth weight. Design. Meta‐analysis of published observational studies adjusted for cigarette smoking. Separate analyses were performed for studies of low birth weight and mean birth weight. We used fixed and random effects models, but in all cases the results were identical. Setting. From the Medline database, we identified 10 studies in which the results were adjusted for cigarette smoking. In seven studies, information on cannabis use was collected prenatally. Five studies reported results for differences in mean birth weight associated with maternal cannabis use. Participants. 32 483 women giving birth to live‐bom infants. Measurements. Mean birth weight and odds ratio for low birth weight. Findings. Three analyses of the studies on mean birth weight were conducted to avoid double‐counting women from one study. The largest reduction in mean birth weight for any cannabis use during pregnancy was 48 g (95% confidence interval (CI) 83‐14 g), with considerable heterogeneity among the five studies. Mean birth weight was increased by 62 g (95% CI 8 g reduction‐132 g increase; p heterogeneity 0.59) among infrequent users (weekly) whereas cannabis use at least four times per week had a 131 g reduction in mean birth weight (95% CI 52‐209 g reduction; p heterogeneity 0.25). From the five studies of low birth weight, the pooled odds ratio for any use was 1.09 (95% CI 0.94‐1.27, p heterogeneity 0.19). Conclusions. There is inadequate evidence that cannabis, at the amount typically consumed by pregnant women, causes low birth weight.