bluuebunny/crossref_metadata_2025 huggingface dataset:
Heterosexual anal intercourse, health risks and drug use: a review with special attention to drug users
Authors: POWIS BEVERLY , GRIFFITHS PAUL , GOSSOP MICHAEL , STRANG JOHN
Published: October 2005

Research studying HIV risk‐taking behaviour has tended to focus on specific populations who are characterized by particular behaviours. Such practices include the extent of unprotected anal intercourse among homosexual men, the sharing of injecting equipment among drug users and unprotected vaginal intercourse among female sex workers. There is often a failure among both researchers and practitioners to address specific risk behaviours outside of the defined risk group. Reviewed here are studies of heterosexual anal intercourse, with special attention to drug users and female sex workers.

Among the general population, the reporting of heterosexual anal intercourse varies greatly across time and cultural groups. However, a body of recent research suggests that, despite some geographical differences, rates in most countries are relatively high. Many studies have also found that associated condom usage is low. Although unprotected anal intercourse is known to be an efficient method for the transmission of HIV and other viral infections, it has rarely been addressed outside cohorts of men who have sex with men. Of particular concern is the interaction of risk behaviours among drug users and women engaging in prostitution, many studies having found high levels of unprotected anal intercourse among these groups. Harm reduction interventions must address all the health risk behaviours their target groups are engaging in, if the challenge of reducing the transmission of HIV and other viral infections is to be met. [Powis B, Griffiths P, Gossop M, Strang J. Heterosexual anal intercourse, health risks and drug use: a review with special attention to drug users. Drug Alcohol Rev 1995; 14:223–229].
Harm reduction: what it is and is not
Authors: ERICKSON PATRICIA G.
Published: October 2005

The meaning of the term “harm reduction” has changed over the decades of its existence but it is now increasingly being aligned with public health approaches. An agreed meaning for the term would be helpful and should be sought. Antecedents are easy to find. Emphasis on small achievable steps is an important element; neither inherently supportive of prohibition nor of legalization, harm reduction is essentially pragmatic and tends to favour regulatory approaches. HIV has focused attention on harm reduction but even in the illicit drug field, a strong tradition of research and policy with an identical philosophical framework can be traced back well before the AIDS era. Harm reduction primary prevention educational approaches are more open, honest and respectful of responsible decision making processes. With current illicit drug users, harm reduction emphasizes the need to understand existing individual control mechanisms. The concept can be well understood if contrasted with prevailing approaches to drugs which generally emphasize punishment, lack of regulation and often augment harm.
Trends in hotel patronage and drink driving in Hobart, Tasmania
Authors: McLEAN STUART , WOOD LES J. , MONTGOMERY IAIN M. , DAVIDSON JODIE , JONES MICHAEL E.
Published: October 2005

From 1990 to 1991 in the Hobart region there was a marked fall in both hotel patronage and the proportion of patrons subsequently driving with their blood alcohol concentration above the legal limit. This was associated with smaller falls in the number of drink drivers charged and alcohol‐related road accidents, which continued in the following year. It appears that the pattern of drinking and driving is changing, presumably in response to random breath testing and tougher penalties for offences.
Effects of brief counselling among male heavy drinkers identified on general hospital wards*
Authors: HEATHER NICK , ROLLNICK STEPHEN , BELL ALISON , RICHMOND ROBYN
Published: October 2005

Although the prevalence of heavy alcohol consumption among patients of general hospitals is well documented, no study has yet reported an effect of counselling on the ward in reducing the level of consumption among such patients after discharge. This study was designed to evaluate brief counselling to reduce alcohol consumption among male heavy drinkers identified on general hospital wards. Male patients were screened on wards of four teaching hospitals in Sydney, Australia. Identified heavy drinkers (n=174) showing predominantly low levels of alcohol dependence were allocated to one of two forms of brief counselling (skills‐based counselling or brief motivational interviewing) or to a non‐intervention control group. Blind follow‐up for 123 patients (71%) was carried out approximately 6 months after discharge from hospital and self‐reports of alcohol consumption were compared with collateral sources of information. Patients who received counselling showed a significantly greater mean reduction in a quantity‐frequency measure of weekly alcohol consumption than controls but there were no significant differences in reduced consumption between the two intervention groups. However, patients who were deemed “not ready to change” showed greater reductions if they had received brief motivational interviewing than if they had received skills‐based counselling. The implications of these findings for counselling male in‐patients to reduce alcohol consumption are discussed.
Drinking and gambling: a comparison with implications for theories of addiction
Authors: ORFORD JIM , MORISON VICTORIA , SOMERS MARCIA
Published: October 2005

There is current concern about the level of excessive gambling in a number of countries, but problem gambling still occupies an uncertain place in the addictions field. The present paper presents results from a pilot study comparing 16 problem gamblers and 16 problem drinkers. Results from a new Attachment Questionnaire suggested that gamblers were just as strongly attached to gambling as drinkers to drinking, although they were significantly less likely to experience withdrawal symptoms. Interviews with the problem gamblers suggested that excessive attachment to gambling was maintained by cyclical processes involving strong, negative feelings associated with gambling losses, shortage of money and the need to keep the extent of gambling secret. It is proposed that these ‘secondary’ processes, along with primary incentive motivation and the tertiary effects of losses associated with excessive behaviour, are sufficient to explain addiction. It is further suggested that neuroadaptation, tolerance and withdrawal, often thought to be central to the process of addiction, may in fact be of comparatively little importance.
Correlates of the perceived health risks of marijuana use among Australian adults
Authors: HALL WAYNE , NELSON JOAN
Published: October 2005

A quota sample of 3272 people from the Australian population was surveyed by telephone about the health risks of marijuana use. Three‐fifths of the sample (62%) believed that there were health problems caused by marijuana use and one in four (27%) were uncertain. The most commonly cited health effects were: lung cancer, mental problems, memory loss and respiratory disease. The health risks of marijuana use were perceived to increase with increasing frequency of use, and to be greater when the user was a teenager rather than an adult. The perceived health risks of marijuana increased with age, were higher among women than men, decreased with increasing education and frequency and quantity of alcohol and were substantially lower among those who had used marijuana, and those who knew someone who had used marijuana.
What have population surveys revealed about substance use disorders and their co‐morbidity with other mental disorders?
Authors: HALL WAYNE
Published: October 2005

This paper reviews the epidemiology of alcohol and drug abuse and dependence as revealed in recent US general population surveys of the prevalence and correlates of mental disorders, the Epidemiologic Catchment Area (ECA) studies, and the National Comorbidity Study (NCS). These surveys indicate that mental disorders affect between a third and a half of people at some time in their lives, and around one in four in any year. Among the most common forms of mental disorder are phobias, alcohol use disorders, affective disorders and drug use disorders. There are marked gender differences in the prevalence of these disorders: substance use disorders and anti‐social personality disorders predominate in men while affective and anxiety disorders predominate in women. The co‐occurrence of substance use and other mental disorders is less common in the community than in the clinic because the presence of other mental disorders increases the chances of people with substance use disorders receiving specialist treatment. Only a minority of those with substance use and other mental disorders in the community are treated, with the more severe cases with multiple co‐morbid mental disorders and manifest distress the most likely to be treated.
Patterns of family responses to alcohol and tobacco problems
Authors: ROOM ROBIN
Published: October 2005

Patterns of family response to drinking and smoking were studied in a sample of 1034 adults in Ontario in 1993. Concerning tobacco smoking, 69% of respondents reported having said something to a relative and 82% to a friend; concerning drinking, 46% had said something to a relative and 65% to a friend. Having said something did not vary much with the respondent's age, educational level and smoking or drinking status, except that current smokers were less likely than others to have said something to a friend or acquaintance, while heavier drinkers were more likely to have said something to a friend or acquaintance, and ex‐drinkers were more likely to have said something to a relative. About half of all who had ever smoked reported a family member (57%) or a friend (47%) had said something to them about their smoking, compared with much smaller proportions of ever‐drinkers who reported that a family member (14%) or a friend (8%) had ever said anything about their drinking. Both drinking and smoking are recognized by many respondents as imposing burdens on the family. Family members often comment on drinking and smoking, and make suggestions about cutting down or quitting.
Hepatitis B
Authors: BATE R. G. , BOLLIPO S. J.
Published: October 2005

Hepatitis B remains a major public health problem around the world. The discovery of the hepatitis C virus has diverted interest from hepatitis B to this new virus and the epidemic associated with it, but hepatitis B remains a significant pathogen for millions of people worldwide. The World Health Organization has suggested that universal vaccination of children against hepatitis B should be implemented in an attempt to reduce the enormous morbidity and mortality associated with infection of this virus group. The review seeks to identify all the newer discoveries relating to hepatitis B that have been made in the past decade. Reference is made to the appearance of hepatitis B mutants which are able to infect patients previously infected with the wild strain of the virus. The implications of mutants on vaccination programmes is raised, as are issues relating to treatment of hepatitis B infection.
Dope busts in the West: minor cannabis offences in the Western Australian criminal justice system
Authors: LENTON SIMON , FERRANTE ANNA , LOH NINI
Published: October 2005

Proponents of cannabis law reform argue that many people who are convicted for minor cannabis offences have no prior criminal conviction and are otherwise law‐abiding citizens. This study of criminal justice system data in a strict prohibition jurisdiction (Western Australia) found that over 10% of all charges and 85% of all drug charges were for cannabis. Approximately 90% of these were for minor offences. Over 40% of those charged with cannabis possession/use as their most serious offence had never been arrested for any prior offence. Almost half of those first arrested for cannabis possession/use had not been arrested up to 10 years later. Younger first‐time arrested cannabis users were more likely to be re‐arrested than older offenders. Almost all adult cannabis offenders who went to court were convicted and fined. Nearly 95% of those imprisoned for possession/use of cannabis were gaoled for fine default. The findings accord with earlier research showing that the vast majority of these offenders are, in all respects apart from their cannabis use, a non‐criminal section of the community.
Economic and other views of addiction: implications for the choice of alcohol, tobacco and drug policies
Authors: BUCK DAVID , GODFREY CHRISTINE , SUTTON MATTHEW
Published: October 2005

It is the aim of this paper to provide an overview of developments in implicit and explicit economic views of addiction, to contrast these perceptions with the views of other disciplines and discuss the implications for policy. Addictive behaviours have received considerable attention from disciplines other than economics. The nature of addiction and the contribution of psychological, physiological and social factors have been strongly debated within the addictions field for many years. The views of economists are becoming increasingly important because economic studies of consumption, and tax revenue in the case of licit drugs, are one factor when framing policy. It is therefore crucial to know how economists have treated addiction. Have they neglected it and what are the implications if they have? This paper attempts to answer this question by reviewing and discussing the literature in depth and drawing out the implications for policy.
Programmes for tobacco and alcohol users in Australian work‐places
Authors: RICHMOND ROBYN , HEATHER NICK , HOLT PHOEBE
Published: October 2005

This article presents findings from a survey of programmes available for tobacco and alcohol users working in 455 of Australia's top 600 companies. Companies were twice as likely to have programmes for smokers (43%) as for problem drinkers (24%) and these programmes were more apparent in large companies. The majority of programmes for smoking were delivered within a health promotion context which included other life‐style issues, such as nutrition, exercise, weight management and stress management. Although Employee Assistance Programs (EAPs) were the most commonly available type of work‐place programme for excessive drinkers and other drug users, followed by Alcoholics Anonymous and local hospital clinics, only 6% had an EAP for alcohol. Only 21% of programmes for smokers and 12% for excessive alcohol users were evaluated. Around one‐quarter of companies knew the costs of smoking programmes, and 9% reported costs of conducting programmes for excessive alcohol consumers.
Opioid detoxification using naloxone
Authors: MERRILL JOHN , MARSHALL RUTH
Published: October 2005

A method of brief inpatient opioid detoxification using naloxone is described. Daily injections of naloxone were administered to 20 patients who were dependent on opioids until no physical withdrawal reaction occurred. A reducing regime of clonidine and diazepam was used to treat withdrawal symptoms. Seventy‐five percent of patients successfully completed detoxification within 6 days. Withdrawal symptoms were minimal and rapidly declined during treatment. Unlike other techniques using opioid antagonists detoxification with daily naloxone injections requires minimal medical supervision, enables full participation in a daily relapse prevention programme and results in discharge from hospital without medication for symptomatic relief.
Injection drug use in Calcutta: a potential focus for an explosive HIV epidemic
Authors: PANDA S. , CHATTERJEE A. , SARKAR S. , JALAN K. N. , MAITRA T. , MUKHERJEE S. , MUKHERJEE B. , DEB B. C. , ABDUL‐QUADER ABU S.
Published: October 2005

Our objective was to assess HIV risk perceptions, risk behaviours and factors that may facilitate an increase in injection drug use in Calcutta. Focus group discussions and in‐depth interviews were conducted with a selected group of drug users to delineate drug use patterns, languages used to express addictive and related experiences and acceptance of harm minimization messages. Results from these were used to develop a semi‐structured interview instrument which was used to interview 111 drug users (76 IDUs and 35 non‐IDUs) recruited from jails and detoxification centres. Secondary data of narcotic seizures for the last 5 years were collected from the Calcutta police department. Data on percentage of IDUs admitted to large detox facility in the city was also collected. Findings show that HIV/AIDS knowledge and risk perceptions were low; sharing of injection equipment was reported by 66% of the injectors; and condom use was insignificant. Non‐availability, rising cost and increasing tolerance to heroin were cited as factors contributing to switch to injection. Ecological association was found between intensified police activity and an increase in: the amount of smokable heroin seized; increased injection of buprenorphine; and admission to detoxification centres. In addition to HIV, IDUs were also found to be prone to hepatitis B and C. The findings suggest an urgent need for developing and implementing community‐based HIV prevention interventions targeting drug users in Calcutta.
Drug abuse in pregnancy: obstetric and neonatal problems. Ten years' experience
Authors: DAWKINS JUDITH L. , TYLDEN ELIZABETH , COLLEY NIGEL , EVANS CHRIS
Published: October 2005

Drug abuse is an increasing problem and approximately 80% of female drug abusers are of childbearing age. This retrospective case note study reviews 10 years' experience of the management of pregnant drug abusers (n = 57) in the obstetric hospital of a London teaching hospital. Surprisingly, in view of other reports of high morbidity, no significantly increased rates of obstetric and neonatal problems were found when this group was compared with case‐matched controls. Thirty‐nine per cent of drug abusers managed to reduce and stop their drug use. However, 56% of the infants of drug abusers had withdrawal symptoms. Concern for her unborn child can motivate the pregnant drug abuser to comply with treatment and thus improve the outcome of pregnancy.
Public perceptions of drugs causing most deaths in Australia 1986–93
Authors: BORLAND RON , DONAGHUE NGAIRE , HILL DAVID
Published: October 2005

Drug use is a major cause of preventable mortality and morbidity in Australia. Tobacco is by far the largest cause of drug‐related deaths. This paper reports changes in public awareness of the relative morbidity risks of different drugs between 1986 and 1993, a period of considerable activity for drug education and control. Broadly representative samples of Australians were surveyed in the two years using the same methods. Results indicate a significant increase in identification of tobacco as the largest cause of death, from a list of six drugs, although only a minority of respondents were correct in 1993. Alcohol was the second most identified drug, consistent with it being responsible for most drug deaths not attributable to tobacco. These results are discussed in the context of other studies. It is concluded that while improvement in knowledge has occurred, it is unlikely to be sufficiently strong to motivate action.
Acute effects of kava, alone or in combination with alcohol, on subjective measures of impairment and intoxication and on cognitive performance
Authors: Foo H. , LEMON J.
Published: October 2005

Kava (Piper methysticum) and alcohol were administered either separately or in combination to human subjects. Self‐reports of their levels of impairment and intoxication were collected, and performance skills on a number of cognitive and visuomotor tests were determined, before and three times after consumption of the experimental drink. Kava alone had no effect on reported condition. In contrast, alcohol produced marked changes in each of the five subjective measures, all of which were in the direction of lowered ability. The combination of these two substances produced even larger negative changes on these measures. In the cognitive tests, kava produced a decrement in performance on Digit Symbol Coding. Alcohol produced a significant decrease in performance on a divided attention test, which was almost entirely on the peripheral, discontinuous component of the test. The combination of kava and alcohol produced an even greater decrease in performance on this test, and in the same component. The present findings suggest that kava alone has little effect on reported condition and cognitive performance, but appears to potentiate both perceived and measured impairment when combined with alcohol.
Australia's public health response to HIV and HCV: a role for ‘affected’ communities
Authors: HULSE GARY K.
Published: October 2005

This paper identifies a number of the key elements that underpinned the success of Australia's public health response to minimizing the spread of HIV. It is argued that one major factor was the high level of collaboration between health care professionals and “affected” communities, such as injecting drug users, sex industry workers and gay men. This collaboration allowed for the negotiation, development and implementation of the range of innovative HIV initiatives that were ultimately responsible for keeping HIV in the injecting drug use and sex industry to low levels. Despite the central role played by injecting drug users and their peer based organizations, the significance of their activities has gone largely unacknowledged by senior health bureaucrats and politicians. As a consequence, advice from injecting drug users and their peer‐based organizations on the current hepatitis C epidemic has been largely ignored. Instead of learning from Australia's HIV experience and involving these groups in consultation and advisory roles, the Federal Government has reverted to accepting advice from only established mainstream organizations. It is argued that the success of infection control outside mainstream communities, such as among injecting drug users, can most effectively be achieved through the involvement of these “affected” communities. There is a need at the local, national and international levels to ensure both the involvement of “affected” communities and that recognition is given to them for the significant and essential role they play in infection control.
Heroin in the United Kingdom: different forms, different origins, and the relationship to different routes of administration
Authors: STRANG JOHN , GRIFFITHS PAUL , GOSSOP MICHAEL
Published: October 2005

Heroin exists in the United Kingdom in several different forms, which vary not only in their country of origin and purity, but also in their suitability for use by either injecting or by ‘chasing the dragon’. The availability of these different forms of heroin has varied considerably over time. A review of the characteristics and availability of these various forms of heroin in recent years is presented, accompanied by consideration of their probable intended use by injection or by ‘chasing the dragon’. Samples of black market heroin in the salt form are usually used by injection, whereas the base form is usually taken by ‘chasing the dragon’. The heroin yield to the drug user from samples of heroin taken by ‘chasing the dragon’ varies according to its base or salt format and according to the presence of other drugs in the sample. Heroin samples from different countries of production mostly conform to either base or salt form. Novel approaches at the macro level to prevention and control of heroin‐related problems through influence upon this complex heroin market‐place should now be considered.
Risk factors and medical follow‐up of drug users tested for hepatitis C—can the risk of transmission be reduced?
Authors: SERFATY MARC A. , LAWRIE ANDREW , SMITH BELINDA , BRIND ALISON M. , WATSON JOHN P. , GILVARRY EILISH , BASSENDINE MARGARET F.
Published: October 2005

Of 1728 patients attending a regional drug and alcohol clinic, 202 were considered at risk of hepatitis C virus (HCV). Forty‐nine per cent (99/202) agreed to testing—67% (67) were HCV antibody positive. Age and a history of needle sharing was the significant factor associated with positive HCV status. Patients on methadone maintenance medication were more‐likely to have been HCV positive, but significantly (p = 0.005) less likely to have shared needles in the previous year. Seventy‐three per cent (49/67) attended for follow‐up at a “liver clinic”. Fifty per cent were infected with genotype la. Eighteen patients were biopsied and all were abnormal, ranging from mild hepatitis to severe fibrotic hepatitis. Attendance for medical follow‐up was poor, which emphasizes the importance of preventative measures such as methadone maintenance programmes for reducing the spread of HCV.
Work‐place screening of mine employees using the alcohol use disorders identification test (AUDIT) and alcohol breathalyzation
Authors: LENNINGS C. J. , FEENEY G. F. , SHEEHAN M. , YOUNG R. McD. , McPHERSON A. , TUCKER J.
Published: October 2005

Although public health campaigns focusing on alcohol in the work‐place are receiving increasing attention, there is little empirical evidence regarding the use of screening. In this work‐place study, 152 mining personnel (67% of the work‐force) completed a self report screen using the Alcohol Use Disorders Identification Test (AUDIT). One hundred and thirty‐three of these (58.5% of the work‐force) also consented to be breathalysed and one (0.75%) recorded a BAC just over threshold for detection. Forty‐eight males (37.7% of the male work‐force) recorded AUDIT scores of eight or more consistent with hazardous alcohol use and one female registered a cumulative score above the female cut‐off level for hazardous alcohol use. Eighty males (67% of the work‐force), recorded binge drinking at least monthly and 81 males recorded a cumulative AUDIT score of less than eight; however, on item analysis, 64 (83%) of these recorded binge drinking at least sometimes. There is substantial hazardous alcohol use in this sample work group and younger males had higher alcohol consumption, more adverse consequences and higher total AUDIT scores identifying them as particularly at risk. The Cronbach & AUDIT was 0.72, confirming adequate internal consistency.
Abstinence and alcohol use among urban Aborigines in Western Australia
Authors: BLIGNAULT ILSE , RYDER CLIVE
Published: October 2005

Aboriginal males and females aged 15 years and over were recruited from patients attending community‐controlled health services in Perth and Carnarvon, Western Australia. Questions were asked about present and past use of alcohol. Rates of abstinence and drinking cessation were greater than in the general population. Both samples contained sizeable numbers of people whose weekly consumption of alcohol was within recommended limits. These are encouraging findings for Aboriginal health workers and others concerned to help those who continue to drink at hazardous and harmful levels.
Alcohol in the South Pacific: the mid‐1990s
Authors: MCDONALD DAVID , ELVY GEOFF , MIELKE JIM
Published: October 2005

In the mid‐1990s data were obtained on alcohol consumption in the Cook Islands, Fiji, Kiribati, Samoa, the Solomon Islands and Tonga. These data are reported together with a discussion of the nature of alcohol related problems in the island nations. Per capita consumption is highest in the Cook Islands, which compared with other countries has the highest ratio of liquor outlets and lowest alcohol taxation regime. As an alcohol problem prevention measure, it is concluded that the promotion of responsible consumption, together with the option of abstinence for those who wish it, is an acceptable strategy for the Pacific.
Tobacco prevention in the Federated States of Micronesia
Authors: MARSHALL MAC
Published: October 2005

The impact of tobacco‐related illnesses in the Federal States of Micronesia (FSM) is discussed and documented for the 1970–95 period using national government statistics and gleanings from the research literature. Based upon international data concerning tobacco‐related morbidity and mortality it is estimated that 15% of 1993 FSM mortality was smoking‐related and that tobacco use contributes heavily to the non‐communicable diseases that are the leading causes of death there. Sources and brands of cigarettes sold in the four FSM states are noted, as is the fact that cigarettes ranked among the top five import commodities in dollar value in the mid‐1980s and early 1990s. Trend data are provided on cigarette imports from 1984 to 1993, during which time FSM citizens spent over US$25.5 m on this legal drug. Brand‐price survey data of cigarettes and selected foodstuffs are presented as part of a discussion of the economic opportunity costs of smoking. Tax revenues from cigarettes are recorded, as are the steps toward smoking prevention and tobacco control taken by the FSM government. The article concludes with suggestions for additional controls that might be implemented.
Methadone maintenance treatment reduces heroin injection in New South Wales prisons
Authors: DOLAN KATE A. , WODAK ALEX D. , HALL WAYNE D.
Published: October 2005

The purpose of this study was to examine whether methadone maintenance treatment reduces injecting risk behaviour (and therefore transmission of blood‐borne viral infections) among prisoners in New South Wales (NSW), using comparison of retrospective reports of drug use in prisons for people who received standard drug treatment, time‐limited methadone treatment and methadone maintenance treatment. The setting for the study was the NSW prison system. One hundred and eighty‐five injecting drug users who had been recently released from NSW prisons were recruited in 1993. Self‐reported drug use and injecting risk behaviour were compared in inmates who received standard drug treatment (counselling), time‐limited methadone treatment and methadone maintenance treatment. HIV status was determined by serology. Intervention comprised high and low dose methadone treatment and counselling. The groups were similar in terms of most basic demographic characteristics but subjects who had been maintained on methadone reported a significantly lower prevalence of heroin injection, syringe sharing and scored lower on an HIV Risk‐taking Behavioural Scale than subjects who received standard drug treatment and time‐limited methadone treatment. This study suggests that methadone treatment is associated with reduced injecting risk behaviour in prison with adequate (greater than 60 mg) dose and duration in treatment. These treatment conditions are known to increase effectiveness in community‐based methadone programmes. Prospective studies are required to evaluate the effectiveness of methadone programmes in the prevention of HIV and other blood‐borne viral infections among IDU prisoners.
Physical and mental health problems in amphetamine users from metropolitan Adelaide, Australia
Authors: VINCENT NIKI , SHOOBRIDGE JODIE , ASK ALEX , ALLSOP STEVE , ALI ROBERT
Published: October 2005

Phase I of this study was designed to inform the development of a range of responses to hazardous and harmful amphetamine use. Research techniques from Rapid Assessment Methodology (RAM) were utilized to collect data. A survey of current amphetamine users included the Short Form 36 (SF36) Health Status Questionnaire, for which South Australian population norms were published in 1995. This facilitated comparisons of the health of this sample of amphetamine users with that of the general population. The sample were found to have significantly poorer health than the general population. The self‐reported prevalence of mental health problems in the sample was consistent with previous Australian research on amphetamine use. Approximately one‐third of the sample reported that they had experienced symptoms of anxiety, depression, mood swings and aggressive outbursts prior to their use of amphetamines. Two‐thirds of the sample reported symptoms of anxiety and depression since starting to use amphetamines, almost half reported mood swings and aggressive outbursts, and over a third reported panic attacks and paranoia. One of the most important findings was a strong association between mental and physical health problems and the severity of dependence on amphetamines. The implications of these results for interventions with amphetamine users are discussed.
Low detection rates, negative attitudes and the failure to meet the “Health of the Nation” alcohol targets: findings from a national survey of GPs in England and Wales
Authors: DEEHAN ANN , TEMPLETON LORNA , TAYLOR COLIN , DRUMMOND COLIN , STRANG JOHN
Published: October 2005

The appropriateness of the primary care setting to undertake the health promotional activities needed to meet ‘Health of the Nation’ alcohol targets has been acknowledged in UK government policy and the scientific literature. However, the latest data suggest these targets are not being met. A 20% random sample of all general practitioners in England and Wales were surveyed by postal questionnaire to examine their work in detecting alcohol misuse and their attitudes towards the work. Four mailing waves produced a 44% response rate. GPs had identified a mean of 3.2 patients per month drinking above recommended ‘sensible’ guidelines. These patients were mostly male (73%) and above 40 years of age (45%), with nearly half (45%) already dependent drinkers. Most GPs perceived alcohol misuse patients as a difficult group with whom to work. None the less, over half the respondents believed general practice was an appropriate setting for the detection of the problem. However, most did not feel trained or supported in this area of their work. More emphasis needs to be placed on the valuable contribution GPs can make with the larger number of patients who are drinking regularly above ‘sensible’ levels but not yet suffering adverse affects. Our findings point towards not an unwilling profession, but a profession lacking confidence. The provision of support and basic training are major factors in how GPs perceive alcohol misusers and their own role in this work. Twenty years after the Maudsley Alcohol Pilot Project research it is disappointing that, despite greater recognition by GPs of their potential impact, lack of training and lack of support are still so central to their continued low levels of therapeutic commitment.
How do general practitioners manage alcohol‐misusing patients? Results from a national survey of GPs in England and Wales
Authors: DEEHAN ANN , TEMPLETON LORNA , TAYLOR COLIN , DRUMMOND COLIN , STRANG JOHN
Published: October 2005

The appropriateness of the primary care setting to undertake health promotional activities has been emphasized, but little is known about the clinical work of GPs with patients misusing alcohol. This study examines how GPs managed alcohol‐misusing patients. A 20% random sample of all general practitioners in England and Wales were surveyed using a postal questionnaire. A 44% response rate was achieved. GPs reported managing different levels of severity of drinking problems differently. Basic interventions, such as reporting the alcohol misuse diagnosis and the provision of advice and information, were routine. Health promotion leaflets were not used uniformly, even with the less severe problem drinkers. Detoxification, prescribing of drugs and the management of medical complications were undertaken mainly with dependent patients. Dependent drinkers were the most likely group to be referred to specialist services, while internal practice referrals occurred with all drinking status categories. Anti‐depressants were the drugs most usually prescribed to alcohol‐misusing patients. The data point to a need for basic guidelines, not only on how to manage and refer dependent drinkers, but also on how to detect and manage those who are not yet manifesting problems but are drinking above recommended guidelines. One of the most evident areas in which there appears to be a need for guidelines is that of prescribing within primary care.
The interplay of drinking patterns and other determinants of health
Authors: BONDY SUSAN , REHM JÜRGEN
Published: October 2005

The health effects of alcohol are determined not only by level of intake but also by patterns of alcohol use and many other health determinants. This study seeks to identify groups of individuals who share various features in terms of drinking styles and other health indicators. Data used are a subset of the 1990 Ontario Health Survey, corresponding to men and women aged 20–64 with complete data in four substantive areas: alcohol use; demographic characteristics; current health status; and various behavioural risk factors for chronic disease. Cluster analysis was used to groups of male and female respondents who were similar in terms of their style of alcohol use, along with other constructs relevant to health risk and health status. For both sexes, clusters were identified which matched expectation in terms of drinking patterns and other relevant variables. For both sexes, clusters were found with generally higher social class indicators, generally positive health behaviours and health status and drinking patterns which did not include drinking to excess. Clusters were also found for which high‐volume drinking occasions corresponded with poor health status and high levels of risk factors for chronic disease. Other unanticipated patterns were also identified. This information may assist in identifying confounding effects in epidemiological studies as well as identifying the characteristics of unique sub‐populations which are likely to be the focus of primary prevention efforts.
Drinking patterns and problems and drinking in the injury event: an analysis of emergency room patients by ethnicity
Authors: CHERPITEL CHERYL J.
Published: October 2005

While a substantial literature exists on the association of alcohol consumption and injury, less is known about the context in which drinking occurs within specific ethnic groups in the United States. This paper analyzes drinking patterns, alcohol‐related problems and drinking‐in–the‐event variables among a probability sample of 359 black, 528 Hispanic and 458 white patients who were breathalyzed and interviewed after admission to the emergency room. Injured patients among both Hispanics and whites were more likely to be positive on the breathalyzer and to report heavy drinking and more frequent drunkenness during the preceding year than their non‐injured counterparts. Blacks were less likely than either Hispanics or whites to report a larger number of drinks prior to injury, feeling drunk at the time, or a causal association of alcohol and the injury event. These data suggest a differential role of alcohol in injury occurrence within ethnic groups, with alcohol possibly playing less of a role in the injury event for blacks than for Hispanics or whites.
The Australian Study of HIV and Injecting Drug Use. Part II: Predicting exposure to hepatitis C and hepatitis B
Authors: CARRUTHERS SUSAN J. , LOXLEY WENDY M. , PHILLIPS MIKE , BEVAN JUDE S.
Published: October 2005

Researchers agree that while hepatitis B maybe in control, hepatitis C is present in epidemic proportions among injecting drug users and that current HIV prevention strategies have not been sufficient to halt the spread of this hepatitis virus, although there is some evidence to suggest that incidence rates are stabilizing. Since there is no effective cure and it is unlikely that a vaccine will become available in the foreseeable future all efforts to control the spread of hepatitis C must rely on education and prevention strategies. The Australian Study of HIV and Injecting Drug Use is a cross‐sectional national study designed to investigate exposure to and risks for infection with blood‐borne viruses. Of those volunteering a usable blood sample for hepatitis C antibody and hepatitis B core antibody testing 55% and 19%, respectively, returned reactive test results. Logistic regression statistical models were used to identify risk factors for hepatitis C and hepatitis B. Risk factors for hepatitis C were identified as duration of use, use of opiates on last injecting occasion, education level, treatment status and having a history of sexually transmissible diseases. Risk factors associated with hepatitis B were duration of use, and use of opiates on last injecting occasion. The lack of identifiable risk factors for hepatitis B suggest that past rather than current injecting and sexual behaviour patterns are required to predict accurately risk of exposure to hepatitis B. In addition to this, one‐third of respondents reported being vaccinated against hepatitis B. Respondents perceived themselves to be at greater risk from hepatitis C than from hepatitis B or HIV. A discussion of strategies needed to prevent the spread of the hepatitis viruses will be presented along with recommendations for further research.
Work‐place alcohol and other drug testing: a review of the scientific evidence
Authors: MACDONALD SCOTT
Published: October 2005

In this paper, scientific evidence for alcohol and other drug testing programs is compared to determine whether each approach is justifiable for improving work‐place safety. Three types of studies are reviewed: laboratory, epidemiological and evaluation studies. Laboratory studies show that alcohol use decreases psycho‐motor performance; however, for other drugs, some drugs deteriorate performance while others have little effect. Epidemiological studies in the work‐place have not provided conclusive evidence that a strong causal link exists between either alcohol or other drug use and work‐place injuries/accidents. Evaluation studies have not shown that either drug or alcohol testing significantly reduces work injuries/accidents. Other types of scientific evidence provide some justification of alcohol testing, but not for other drug testing. Alcohol use is much more common than other drug use in industrialized countries, suggesting that alcohol may be more related to industrial accidents than other drugs. As well, epidemiological studies suggest that alcohol is a major factor for traffic collisions, but research is inconclusive for other drugs. Finally, alcohol testing is more justifiable than drug testing because the results of alcohol tests closely correlate with psycho‐motor performance while drug tests do not.
Changes in opiate treatment during attendance at a community drug service—findings from a clinical audit
Authors: MACLEOD JOHN , WHITTAKER ANNE , ROBERTSON J. ROY
Published: October 2005

To evaluate use of methadone and dihydrocodeine prescription in a group of opiate‐dependent patients attending a community/general practice drugs project data were recorded at enrolment in 1990 and at the beginning of 1995. Two hundred individuals were included, of whom 85% were receiving a prescription for an opiate and/or a benzodiazepine. There were no major differences between the groups receiving methadone and dihydrocodeine and retention in treatment, death rate and behaviour change was similar in both groups. Trends during the study period included an increase in methadone prescribing and towards longer‐acting benzodiazepines. The slightly different effects of dihydrocodeine compared to methadone made it the opiate of choice for many and may indicate a useful addition to the longer‐acting methadone. This may make it an alternative to the current experimenting with heroin, dextromoramide (palfium) and injectable methadone for opiate users resistant to control with oral methadone alone.
Can training bar staff in responsible serving practices reduce alcohol‐related harm?
Authors: LANG ERNIE , STOCKWELL TIM , RYDON PHILIP , BEEL ANDREA
Published: October 2005

A responsible service training programme aimed at reducing alcohol‐related harm was implemented in a popular entertainment area over several months in 1992–93. Another popular entertainment area provided a control site. A number of evaluation measures were used: breath tests on 872 patrons from selected venues; drink driving data; risk assessments; the use of ‘pseudo patrons’ and knowledge and attitude changes among trained bar staff (n= 88). Compared to control sites the intervention sites showed an immediate pre‐ to post‐test reduction in patrons rated by researchers as extremely drunk and an eventual reduction from pre‐test to follow‐up in patrons with blood alcohol levels > = 0.08. There was also a small but significant increase in knowledge among bar staff. There was no significant reduction in patrons with blood alcohol levels > = 0.15 or in the number of drink driving offences from intervention sites during the study period. Pseudo drunk patrons were rarely refused service, identification was rarely checked and non‐photographic identification was accepted on most occasions. The less than satisfactory outcome is attributed to poor implementation of the training and a lack of support among managers. The positive results from one venue, whose manager embraced the programme, served to highlight the importance of management support. It is suggested that mandatory training and routine enforcement of licensing laws are essential if the goals of responsible serving are to be met.
Expanding knowledge among Aboriginal service providers on treatment options for excessive alcohol use
Authors: BRADY MAGGIE , DAWE SHARON , RICHMOND ROBYN
Published: October 2005

Approaches to the prevention of alcohol problems among Aboriginal people in Australia have tended to emphasize primary and tertiary prevention, while neglecting secondary prevention or early intervention. In contrast, members of the wider Australian community can now access a variety of early interventions through general practice, in hospital settings and through drug and alcohol treatment agencies. As part of a survey of the use of brief interventions, 178 agencies throughout Australia were interviewed, and findings are presented from the 29 agencies in this sample which provided services primarily for Aboriginal people. Approximately half offered a variety of approaches including brief interventions, with goals of moderation; the other half were entirely abstinence‐orientated. These findings are discussed in the context of expanding the options that might be offered by Aboriginal‐run agencies.
Current perspectives on anabolic steroids
Authors: BEEL ANDREA , MAYCOCK BRUCE , MCLEAN NEIL
Published: October 2005

Steroids are used outside the realm of competitive athletics in Australia among a wide variety of groups with different motivations and goals. This paper provides an overview of the reasons for use; rates of usage; physical and psychological side effects; and sources of steroids. Issues associated with injecting steroids; their current legal status; and drug education and prevention programmes are reviewed briefly. Research involving identified sub‐populations is needed to determine user profiles and prevalence rates of users and potential users. Studies of Australian users are also needed to obtain baseline information on areas of potential harm associated with steroids use, e.g. aggressive behaviour, needle‐sharing behaviour, physical side effects and potential for dependency. It is concluded that future deterrence strategies should focus more on demand reduction, rather than supply.