bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of monopoly privatization and market liberalization on smoking prevalence in Japan: trends of smoking prevalence in Japan in 1975–1995
Authors: Sato Hajime , Araki Shunichi , Yokoyama Kazuhito
Published: March 2003

Aims. In Japan, smoking prevalence in males has been among the highest among industrialized countries, while the prevalence in females has remained relatively low. There have been long‐term declining trends since the early 1970s. In the mid‐1980s, the public tobacco monopoly was privatized and the tobacco market was liberalized in Japan. This study examines whether the trends in smoking prevalence changed at the time of these market changes .

Design and measurements. Smoking prevalence data, tabulated by age group and sex, were plotted over the period 1975‐95. Trends of smoking prevalence were then analyzed by using linear regressions, and their changes at the time of monopoly privatization and market liberalization were examined by Chow tests.

Findings. The trends in smoking prevalence changed at the time of the monopoly privatization and trade liberalization in both males and females, except for the males in their twenties and thirties. Rates of decline in smoking prevalence diminished in many age groups and prevalence for younger females started to increase.

Conclusions. Market changes, that result from the privatization of a public tobacco monopoly and trade liberalization, may adversely affect smoking prevalence in many age groups and in both sexes, unless effective countermeasures are taken.
Bromocriptine reduces cigarette smoking
Authors: Jarvik Murray E. , Caskey Nicholas H. , Wirshing William C. , Madsen Damian C. , Iwamoto‐Schaap Paula N. , Elins Julie L.
Published: March 2003

Aims. Animal studies have shown that nicotine releases dopamine, a neurotransmitter implicated in drug reinforcement. We hypothesized that bromocriptine would decrease smoking behavior in humans.

Design. The study was conducted double blind and subjects' order of dose exposure was randomized.

Participants. The smoking behavior of 20 heavy smokers was recorded for 5 hours after ingesting placebo or one of two doses of bromocriptine (2.50 mg, 3.75 mg) over three sessions (one dose per session).

Findings. There was a significant negative linear trend by dosage indicating shorter total puffing time with increasing bromocriptine dosages ( p < 0.02). Other significant negative linear trends by increasing dosage include fewer number of puffs, fewer number of cigarettes smoked and mean latency to smoke after 3 hours (expected C

MAX on the drug (all p s < 0.05). There was a negative significant linear trend showing decreased plasma nicotine ( p < 0.02) and cotinine ( p < 0.005) with increasing dosages of bromocriptine. Shiffman/Jarvik Withdrawal Scale (SJWS) cigarette craving subscale scores decreased significantly across increasing dosages (linear trend p < 0.02). There was a significant negative linear trend ( p < 0.05) on the Profile of Mood States (POMS) Vigor and Depression subscales, with subjects reporting decreased vigor and depression with increasing bromocriptine doses. No other mood effects were observed.

Conclusion. These results support the hypothesis that dopaminergic mechanisms mediate cigarette smoking reinforcement.
Comparative efficacy of 24‐hour and 16‐hour transdermal nicotine patches for relief of morning craving
Authors: Shiffman S. , Elash C. A. , Paton S. M. , Gwaltney C. J. , Paty J. A. , Clark D. B.
Published: March 2003

Aims. To compare a transdermal nicotine patch designed for 24‐hour wear with one designed for 16‐hour wear for relief of craving and withdrawal, particularly in the morning hours.

Design. Smokers were randomly assigned to use one of two common patch regimens: NicoDerm/NiQuitin (24‐hour wear, 21 mg nicotine) or Nicotrol/Nicorette (16‐hour wear, 15 mg). In a double‐dummy design, participants wore two patches during the day, one active, one placebo and one patch while sleeping.

Setting. A smoking cessation research clinic.

Participants. Two hundred and forty‐four smokers who suffered morning cravings.

Intervention. Two patch formulations approved and marketed for over‐the‐counter use in the US‐ NicoDerm CQ (labeled as 21 mg over 24 hours) and Nicotrol (labeled as 15 mg over 16 hours)‐were each used according to its instructions. Smokers also received behavioral counseling.

Measurements. For a week of baseline and 2 weeks after quitting, smokers used palm‐top computers to assess craving and withdrawal symptoms several times each day.

Findings. The 21 mg/24‐hour patch yielded consistently better control of craving, not only during the morning hours, but throughout the day, and over the 2‐week period of abstinence. Additionally, the 21 mg/24‐hour patch yielded greater reductions in anxiety, irritability and restlessness. Smokers using the 21 mg/24‐hour dosing regimen also experienced longer abstinence than those using the 15 mg/16‐hour patch.

Conclusions. These findings demonstrate that 24‐hour dosing with a 21 mg patch affords superior relief of craving and withdrawal during the first 2 weeks of abstinence, when symptoms are at their peak, and when relapse is most likely. They confirm the importance of dosing parameters in nicotine replacement products.
Trends in treated opiate misuse in Dublin: the emergence of chasing the dragon
Authors: Smyth Bobby P. , O'Brien Mary , Barry Joe
Published: March 2003

Aims. To examine trends in treated opiate misuse and identify factors associated with route of heroin use.

Design. Cross‐sectional survey.

Setting. Services providing addiction treatment in Dublin.

Participants. Individuals making their first ever contact seeking treatment for current opiate misuse, between January 1991 and December 1996.

Measurements. Data on socio‐demographics and current drug use.

Findings. The study population was 3981. Over the 6‐year period, there was a 330% increase in the number of new attenders. The proportion of females increased. The mean age of first opiate use declined and users began presenting earlier in their opiate‐using careers, causing a decline in the age profile of new attenders. Heroin users were more likely to smoke (chase) rather than inject after 1994 (odds ratio 3.3, 95% confidence interval 2.4‐4.5). Apart from year of presentation, the other significant independent predictors of chasing as the preferred route of heroin use were being in employment, shorter history of use, less frequent use, younger age, longer period in education and absence of polydrug use. Gender did not independently predict route of use.

Conclusions. Ireland has joined the growing number of European countries witnessing a movement towards heroin chasing. This has coincided with a surge in the number of people entering treatment. We are concerned that the greater acceptability of this route of use may be drawing increased numbers of individuals into heroin use.
Age and mortality among white male problem drinkers
Authors: Banks Steven M. , Pandiani John A. , Schacht Lucille M. , Gauvin Lisa M.
Published: March 2003

Aims. This study is designed to determine the relative risk of mortality for white male problem drinkers compared to white males in the general population, and to identify any variation in relative risk of problem drinking in three age groups (18‐29, 30‐49 and 50‐79 years).

Design. The research design is prospective, using historical administrative datasets from treatment programs in conjunction with vital records datasets.

Participants. Participants include all white men aged 18‐79 treated for alcohol‐related problems in community mental health substance abuse programs in Vermont during 1991. The treatment group includes 1853 service recipients; the comparison group includes 196 443 adult white male residents of Vermont.

Measurement. Measurement of mortality rates for problem drinkers was based on probabilistic determination of overlap between treatment and vital record datasets.

Findings. Mortality for problem drinkers is greater than the general population in all three age groups. The estimated relative risk of mortality in the oldest age group was lower than the other groups, but substantially higher than found in recently published research. The estimated relative risk of mortality in the youngest age group, which has rarely been addressed in previous research, was higher than the relative risk in the middle age group. application of a public health research model in which problem drinkers are compared to the general population has potential to inform public policy. In this case, the public health approach identified an elevated risk of mortality associated with problem drinking among older adults that had not been evident in the previous research.

Conclusion. The application of a public health research model in which problem drinkers are compared to the general population has potential to inform public policy. In this case, the public health approach identified an elevated risk of mortality associated with problem drinking among older adults that had not been evident in the previous research.
Opium use in Turkmenistan: a historical perspective
Authors: Kerimi Nina
Published: March 2003

This paper presents a picture of how the patterns of opium use have changed in Turkmenistan over more than 100 years and the relationship between these transformations and formal and informal social controls of drug use. From the late 18th century, when opium use began to become a social problem, informal control weakened. Eventually, in the late 19th century, formal control was introduced, aimed at the prohibition of drug trade and use. From that time, the intended and unintended outcomes of implemented policies led to changes in the demographic patterns of users and the social‐medical consequences of opiate use. The anti‐drug policies, where criminal prohibition coexisted with strategies aimed at raising the population's general living standards and at providing free access to health care, were effective up to the early 1980s. New political and social–economic realities in the 1980–90s have radically changed the drug scene in the country, with heroin trade and use as the main concerns. The government's reaction, while following the old paths, has included new elements, based mainly on ideas of national consolidation.
One‐year follow‐up of disulfiram and psychotherapy for cocaine‐alcohol users: sustained effects of treatment
Authors: Carroll Kathleen M. , Nich Charla , Ball Samuel A. , McCance Elinore , Frankforter Tami L. , Rounsaville Bruce J.
Published: March 2003

Aim. To evaluate outcomes 1 year after cessation of treatment for cocaine‐ and alcohol‐dependent individuals.

Design. Randomized controlled trial.

Setting. Urban substance abuse treatment center.

Participants. Ninety‐six of 122 subjects randomized to treatment.

Interventions. One of five treatments delivered over 12 weeks. Cognitive‐behavioral treatment (CBT) plus disulfiram; Twelve‐Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT without disulfiram; TSF without disulfiram.

Measurements. Percentage of days of cocaine and alcohol use during follow‐up, verified by urine toxicology screens and breathalyzer tests.

Results. First, as a group, participants reported significant decreases in frequency of cocaine, but not alcohol, use after the end of treatment. Secondly, the main effects of disulfiram on cocaine and alcohol use were sustained during follow‐up. Finally, initiation of abstinence for even brief periods of time within treatment was associated with significantly better outcome during follow‐up.

Conclusions. These findings support the efficacy of disulfiram with this challenging population and suggest that comparatively brief treatments that facilitate the initiation of abstinence may have long‐term benefits.
Measuring injecting risk behaviour in the second decade of harm reduction: a survey of injecting drug users in England
Authors: Hunter Gillian M. , Stimson Gerry V. , Judd Ali , Jones Steve , Hickman Matthew
Published: March 2003

Aims. To measure risk behaviour among injecting drug users (IDUs) using the Injecting Risk Questionnaire (IRQ).

Methods. Data were analysed from the first multi‐site survey of injecting risk behaviour among IDUs not in contact with drug services in England. A total of 1214 IDUs were recruited from community settings in seven sites.

Findings. Fifty‐two per cent reported sharing injecting equipment in the previous 4 weeks in response to a single question on sharing. This rose to 78% when asked more detailed and multiple questions on injecting risk practices. Levels of injecting risk behaviour did not differ substantially by gender, age, length of injecting career, main drug of injection, previous treatment contact or geographical location. However, sharing partners were restricted to a median of two others.

Conclusion. These data raise questions concerning the extent to which levels of injecting risk behaviour have increased over recent years, or the extent to which previous monitoring systems underestimated levels of risk. None the less, the data confirm that the promotion of safer injecting continues to be an important public health issue with regard to reducing blood‐borne infections.
Prevalence of alcohol use and the association between onset of use and alcohol‐related problems in a general population sample in Germany
Authors: Kraus Ludwig , Bloomfield Kim , Augustin Rita , Reese Anneke
Published: March 2003

Aims. This paper examines the prevalence of alcohol use, alcohol‐related problems and onset of regular alcohol use, including its association with the prevalence of CAGE symptoms.

Design and participants. Data come from three nationally representative samples of the non‐institutionalized German general population aged 18‐59 years which were conducted annually between 1994 and 1996. Subjects (

n= 7501) were surveyed through telephone interviews.

Findings. Overall, men were more likely to drink alcohol, to be heavier drinkers and to experience more alcohol problems than women. Prevalence of 12‐month use was constant across age among males, but decreased with age among women. Prevalence of heavier drinking, however, increased with age in both sexes. While for both sexes the median age of onset decreased towards younger cohorts, the prevalence of regular use at younger ages increased more strongly among females compared to males. In all cohorts of both sexes, an association between early age of onset and negative consequences measured by the CAGE questionnaire could be observed. Odds ratios were significantly lower for life‐time experience of at least two CAGE symptoms among respondents if they had started regular alcohol use later than their peers.

Conclusions. The results indicate a narrowing of the gender gap due to an increasing prevalence of regular alcohol use for females across cohorts. Gender differences with regard to heavier drinking are still prominent. The findings confirm those of related studies in which early age of onset of regular alcohol use was found to be a significant predictor for life‐time alcohol‐related problems.
A multi‐dimensional analysis of cue‐elicited craving in heavy smokers and tobacco chippers
Authors: Sayette Michael A. , Martin Christopher S. , Wertz Joan M. , Shiffman Saul , Perrott Michael A.
Published: March 2003

Aims. This research examined the performance of a broad range of measures posited to relate to smoking craving.

 Design. Heavy smokers and tobacco chippers, who were either deprived of smoking or not for 7 hours, were exposed to both smoking (a lit cigarette) and control cues.

 Participants. Smokers not currently interested in trying to quit smoking (

n = 127) were recruited. Heavy smokers (

n = 67) averaged smoking at least 21 cigarettes/day and tobacco chippers (

n = 60) averaged 1‐5 cigarettes on at least 2 days/week.

 Measurements. Measures included urge rating scales and magnitude estimations, a rating of affective valence, a behavioral choice task that assessed perceived reinforcement value of smoking, several smoking‐related judgement tasks and a measure of cognitive resource allocation.

 Findings. Results indicated that both deprivation state and smoker type tended to affect responses across these measurement domains.

 Conclusions. Findings support the use of several novel measures of craving‐related processes in smokers.
Mortality among problem drug users in Rome: an 18‐year follow‐up study, 1980–97
Authors: Bargagli A. M. , Sperati A. , Davoli M. , Forastiere F. , Perucci C. A.
Published: March 2003

Aim. To analyse overall and cause‐specific mortality among problem drug users (PDUs) attending treatment centres in Rome and to evaluate differences in mortality between genders.

 Methods. A cohort of 11 432 PDUs entering treatment in Rome between 1980 and 1995 was enrolled and followed‐up as of May 31, 1997. Directly standardized mortality rates and standardized mortality ratios (SMRs) and their 95% confidence intervals (95% CI) were calculated. Results. The study population included mainly males (82%), heroin users (92%) and had a mean age of 26.6 (SD 5.9) at enrolment. At the end of the study period 1734 deaths were observed. Overall mortality rates began to increase in 1985‐86 and decreased slightly afterwards. AIDS mortality peaked in 1991‐92 (13.2/1000) and fell in the following years. A slight decrease in overdose mortality also occurred after 1989‐90. Mortality for causes other than AIDS and overdose remained high and relatively steady for the whole study period. Women showed higher mortality rates for AIDS but lower mortality rates for overdose than males. Overall mortality risk among drug addicts was about 15 times higher compared to the general population of the same age among men, and 38 times higher among women.

 Conclusions. AIDS mortality among drug addicts began to decrease earlier than expected; the decrease was particularly significant in the period 1993‐94 for both sexes. Afterwards a continuous but slight decrease was observed among males only. Even though overdose mortality has also decreased slightly in recent years, we still observe high mortality levels for both overdose and all other causes. These findings suggest that interventions directed specifically towards the reduction of baseline mortality are still needed.
Helping the female partners of men abusing alcohol: a comparison of three treatments
Authors: Halford W. Kim , Price John , Kelly Adrian B. , Bouma Ruth , Young Ross McD.
Published: March 2003

Aim. To evaluate the effectiveness of three approaches to assisting the female partners of male problem drinkers with the stress imposed by the male's drinking.

 Design. Participants were assigned randomly via random number tables to one of three treatment conditions: supportive counselling, stress management or alcohol‐focused couples therapy.

 Setting. The intervention took place at the Behaviour Research and Therapy Centre (BRTC), The University of Queensland. This research and training centre offers outpatient psychology services to the community.

 Participants. Sixty‐one married women whose husbands drank heavily. Participants reported protracted alcohol problems, severe impact of alcohol on social functioning and severe marital distress.

 Measurement. The women's stress, alcohol consumption by the male, and relationship functioning were assessed at pre‐ and post‐treatment and at 6‐month follow‐up.

 Interventions. All three treatments involved 15 1‐hour sessions with the woman. In the alcohol‐focused couple therapy, attempts were made to engage the man in these sessions.

 Results. Contrary to our predictions, there were few differences between the treatments. All three treatments were associated with reductions in the women's reported stress, with trends for somewhat greater reduction in the women's stress in the stress management and alcohol‐focused couples therapy conditions than for supportive counselling. None of the treatments produced clinically significant reductions in men's drinking or relationship distress.

 Conclusion. The treatments ease stresses and burden but do not improve drinking or relationships. Limited power in the design restricted the capacity to detect differential treatment effects.
Alcohol use, drug use and alcohol‐related problems among men who have sex with men: the Urban Men's Health Study
Authors: Stall Ron , Paul Jay P. , Greenwood Greg , Pollack Lance M. , Bein Edward , Crosby G. Michael , Mills Thomas C. , Binson Diane , Coates Thomas J. , Catania Joseph A.
Published: March 2003

Aims. To measure the prevalence and independent associations of heavy and problematic use of alcohol and recreational drugs among a household‐based sample of urban MSM (men who have sex with men).

 Design. Cross‐sectional survey.

 Participants. Men who identified as being gay or bisexual or who reported sex with another man in the prior 5 years were included in this analysis (

n = 2172).

 Setting. A probability telephone sample of MSM was taken within Zip Codes of four large American cities (Chicago, Los Angeles, New York and San Francisco) estimated to have total concentrations of at least 4% of all households with one resident MSM.

 Measurements. Standard measures of alcohol use, problems associated with alcohol use, and recreational drug use were administered by trained telephone interviewers.

 Findings. Both recreational drug (52%) and alcohol use (85%) were highly prevalent among urban MSM, while current levels of multiple drug use (18%), three or more alcohol‐related problems (12%), frequent drug use (19%) and heavy‐frequent alcohol use (8%) were not uncommon. The associations of heavy and/or problematic substance use are complex, with independent multivariate associations found at the levels of demographics, adverse early life circumstances, current mental health status, social and sexual practices and connection to gay male culture.

 Conclusions. The complex pattern of associations with heavy and/or problematic substance use among urban MSM suggests that heavy and/or problematic substance use is grounded in multiple levels: the individual, the interpersonal and the socio‐cultural.
Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis
Authors: Degenhardt Louisa , Hall Wayne , Lynskey Michael
Published: March 2003

Aim. To compare relationships between alcohol, cannabis and tobacco and indicators of mental health problems in the general population.

 Method. A survey of a nationally representative sample of 10 641 Australian adults (the National Survey of Mental Health and Well‐Being (NSMHWB)) provided data on alcohol, cannabis and tobacco use and mental health (DSM‐IV anxiety disorders, affective disorders, other substance use disorders and screening positively for psychosis).

 Findings. Alcohol showed a "J‐shaped" relationship with DSM‐IV affective and anxiety disorders: alcohol users had lower rates of these problems than non‐users of alcohol, while those meeting criteria for alcohol dependence had the highest rates. Tobacco and cannabis use were both associated with increased rates of all mental health problems examined. However, after controlling for demographics, neuroticism and other drug use, cannabis was not associated with anxiety or affective disorders. Alcohol dependence and tobacco use remained associated with both of these indicators of mental health. All three types of drug use were associated with higher rates of other substance use problems, with cannabis having the strongest association.

 Conclusions. The use of alcohol, tobacco and cannabis are associated with different patterns of co‐morbidity in the general population.
Gender differences in syringe exchange program use in Oslo, Norway
Authors: Miller Maureen , Eskild Anne , Mella Inge , Moi Harald , Magnus Per
Published: March 2003

Aims. To examine gender differences in syringe exchange program (SEP) use, particularly frequent SEP use, within and across survey years.

 Design. Three consecutive, anonymous cross‐sectional surveys.

 Setting. The SEP in Oslo, Norway.

 Participants. Two hundred and eighty‐eight, 449 and 523 SEP participants interviewed during comparable 1‐week periods in 1992, 1994 and 1997, respectively.

 Measurements. Brief structured questionnaires assessed SEP use, HIV risk behaviors and self‐reported HIV status. Chi square statistics,

t‐tests and analysis of variance were used to identify gender differences; logistic regression was used to identify independent correlates of frequent SEP use.

 Findings. Women reported injecting more frequently than men, but neither reported more frequent SEP use nor acquiring more syringes during an exchange. Although syringe sharing decreased significantly over time, in 1997, 51% of SEP participants continued to share. HIV prevalence remained low (3‐5%) over time. After controlling for gender, age and HIV risk factors, frequent SEP use was significantly correlated with frequent injection for both women (OR = 1.4) and men (OR = 1.5). A lack of income or benefits independently increased the likelihood of being a frequent SEP user (OR = 3.0), while having shared a syringe at last injection independently decreased this likelihood (OR = 0.5).

 Conclusions. Gender was not associated with frequent SEP use; rather, the single most important correlate of frequent SEP use was injection frequency. Women's need for sterile syringes may not be fully addressed, despite the existence of a well‐established and well‐utilized SEP.
Cannabis‐induced Koro in Americans
Authors: Earleywine Mitchell
Published: March 2003

Aims. Koro, an acute panic reaction related to the perception of penile retraction, was once considered limited to specific cultures. The disorder has appeared as part of a panic response to cannabis, but only in citizens of India. This study looked for cannabis‐induced Koro in Americans.

 Design. Given the relative rarity of cannabis‐induced Koro, this work focused on individual case studies.

 Participants. Over 70 men responded by phone to report negative reactions to cannabis. Three of them (Caucasians aged 22‐26 with years of experience with cannabis) spontaneously mentioned experiencing symptoms of Koro after smoking marijuana.

 Findings. All three cases occurred after participants had heard about cannabis‐induced Koro and used the drug in a novel setting or atypical way. Two of the men had body dysmorphia, which may have contributed to symptoms. All three decreased their cannabis consumption after the Koro experience.

 Conclusions. Koro, particularly cannabis‐induced Koro, is not limited to Eastern cultures. Several factors may interact to create symptoms. These include previous knowledge of cannabis‐induced Koro, the use of marijuana in a way that might heighten a panic reaction, and poor body image. In addition, these cases confirm previous work that shows that negative reactions to drugs can attenuate their use.
Genetic factors in addiction: QTL mapping and candidate gene studies implicate GABAergic genes in alcohol and barbiturate withdrawal in mice
Authors: Buck Kari J. , Finn Deborah A.
Published: March 2003

Quantitative trait locus (QTL) mapping has allowed dramatic progress toward the detection and chromosome mapping of minor and major gene loci involved in murine responses to alcohol and other drugs of abuse. Here we focus on the identification of QTLs for one particular trait relevant to addiction, drug withdrawal following acute or chronic drug administration. To date, five significant QTLs ( p < 5 × 10

‐5) and six suggestive QTLs (

p < 0.001) have been mapped to specific murine chromosomes for alcohol and pentobarbital withdrawal, indicating the presence of a relevant gene or genes at each location. Overlapping QTLs for alcohol withdrawal and pentobarbital withdrawal are identified on murine chromosomes 1, 4, and 11, and may detect the influence of common genes. For many QTLs, candidate genes with relevant neurobiological function lie within the mapped region. Notably, several QTLs for alcohol and pentobarbital withdrawal are in proximity to genes that directly or indirectly affect GABA

A receptor‐mediated transmission, which has been implicated in some of the actions of alcohol and other drugs. These include a cluster of GABA

A receptor genes and genes encoding the enzymes steroid 5α‐reductase‐1 (involved in biosynthesis of the neuroactive steroid allopregnanolone) and glutamic acid decarboxylase‐1 (involved in GABA biosynthesis). This paper will discuss data that examines the involvement of GABAergic genes in withdrawal and other drug responses, including genetic variation in gene sequence, expression and function.
Addiction as excessive appetite
Authors: Orford Jim
Published: March 2003

The excessive appetite model of addiction is summarized. The paper begins by considering the forms of excessive appetite which a comprehensive model should account for: principally, excessive drinking, smoking, gambling, eating, sex and a diverse range of drugs including at least heroin, cocaine and cannabis. The model rests, therefore, upon a broader concept of what constitutes addiction than the traditional, more restricted, and arguably misleading definition. The core elements of the model include: very skewed consumption distribution curves; restraint, control or deterrence; positive incentive learning mechanisms which highlight varied forms of rapid emotional change as rewards, and wide cue conditioning; complex memory schemata; secondary, acquired emotional regulation cycles, of which 'chasing', 'the abstinence violation effect' and neuroadaptation are examples; and the consequences of conflict. These primary and secondary processes, occurring within diverse sociocultural contexts, are sufficient to account for the development of a strong attachment to an appetitive activity, such that self‐control is diminished, and behaviour may appear to be disease‐like. Giving up excess is a natural consequence of conflict arising from strong and troublesome appetite. There is much supportive evidence that change occurs outside expert treatment, and that when it occurs within treatment the change processes are more basic and universal than those espoused by fashionable expert theories.
Diffusion theory and drug use
Authors: Ferrence Roberta
Published: March 2003

This paper examines the applicability of the diffusion model to drug use. A variety of studies that employ the diffusion model to examine drug‐related behaviour, including the use of alcohol, tobacco and illicit drugs, are discussed. Studies include those that focus on "natural" or spontaneous diffusion and those in which diffusion of a drug or a drug‐related intervention is planned. Most studies examined support the application of the diffusion model in the study of drug use. The model is particularly valuable when new substances are introduced to a population or subgroup. The addition of economic and other forms of availability as a determinant of adoption would increase the power of the model. Recommended directions for research are outlined. The diffusion model has been used successfully in the study of drug use for several decades. More rigorous designs would strengthen this type of research and provide direction for policymakers and those involved in public health and education.
Predictors of hepatitis B and C infection in injecting drug users both in and out of drug treatment
Authors: Cook Penny A. , McVeigh Jim , Syed Qutub , Mutton Ken , Bellis Mark A.
Published: March 2003

Aims. To assess prevalence of, and behavioural risk factors for, hepatitis B and C in drug users both in and out of contact with drugs services.

 Design. Cross‐sectional survey of hepatitis B and C prevalence using blood samples and self‐completed risk factor questionnaires.

 Participants. Three hundred and sixty injecting drug users (IDUs) in treatment for their drug use, attending syringe exchange schemes (SES), and not in contact with any services in Wirral and Manchester between 1997 and 1999, for whom test results were available for 334 (hepatitis B) and 341 (hepatitis C).

 Findings. Hepatitis B prevalence differed between groups, from 19% of those not in contact to 41% of those presenting to request a test (

p = 0.040). Prevalence of hepatitis C ranged from 48% (SES) to 62% among those presenting for a test (

p = 0.233). After multivariate adjustment, hepatitis B was predicted by prison stays (

p = 0.030) and injecting for longer (

p = 0.003). For hepatitis C, length of injecting career (

p = 0.036), having been to prison (

p = 0.034), having injected more than one drug type (

p < 0.001) and being female (

p = 0.037) predicted infection. Overall, 38% had shared some form of injecting equipment in the previous 4 weeks. People recently starting injecting were more likely to share, and sharing was more likely to occur when injecting with only one other user rather than in larger groups. Those who had previously presented for a hepatitis C test, regardless of the result, were less likely to have recently shared injecting equipment.

 Conclusions. Behaviours associated with transmission of hepatitis B and C are common among IDUs. In particular, sharing of injecting equipment was more likely in small groups and in those recently beginning injecting. More broadly, chaotic drug use and time in prison were also risk factors for hepatitis infections. When assessing prevalence of hepatitis B and C, our results suggest that figures cannot be extrapolated from those in service contact to those in the wider drug‐using population.
Patterns of recent drug use among a sample of Australian detainees
Authors: Makkai Toni
Published: March 2003

Aims. To ascertain the prevalence of recent drug use among police detainees.

 Data. Data were gathered over a 1‐year period in 1999 from detainees in four Australian police stations. Measures analysed include: (a) urinalysis results for cannabis, amphetamines, benzodiazepines, cocaine and opiates; (b) socio‐economic and demographic backgrounds of detainees; and (c) arrest history and imprisonment.

 Setting. Bankstown and Parramatta police stations, Sydney, East Perth Lockup, Perth and Southport Watchhouse, Southport, Australia.

 Participants. 1408 adult males detained by police were approached. Eighty‐four per cent agreed to complete an interview and 70% provided a urine specimen.

 Findings. Cannabis was most likely to be detected, followed by opiates, benzodiazepines, and then amphetamines. Very little cocaine was detected. Around three‐quarters tested positive to at least one drug and around one‐third tested positive to multiple drug use. Significant predictors for recent drug use were age, reported involvement in illegal activities and prior arrest and imprisonment. Those who tested positive to opiates were more likely to be charged with property offences while those who tested positive to cannabis were more likely to be charged with a drug offence.

 Conclusions. To monitor effectively patterns of drug use among at‐risk populations such as detainees data collections grounded at the local level are necessary.
Three decision‐making tasks in cocaine‐dependent patients: do they measure the same construct?
Authors: Monterosso John , Ehrman Ronald , Napier Kimberly L. , O'Brien Charles P. , Childress Anna Rose
Published: March 2003

Aims. Substance‐abusing populations perform poorly on decision‐making tasks related to delay and risk. These tasks include: (1) the Delay Discounting Procedure (DDP), in which choices are made between smaller‐sooner and later‐larger rewards, (2) the Gambling Task (GT), in which choices are made between alternatives varying in pay‐off and punishment, and (3) the Rogers Decision‐Making Task (RDMT) in which subjects choose between higher or lower probability gambles. We examine the interrelationship among these tasks.

 Design. A test battery was created which included the DDP, GT and RDMT, as well as measures of impulsivity, intellectual functioning and drug use.

 Setting. Subjects completed the test battery at an outpatient center, prior to beginning 12 weeks of treatment.

 Participants. Thirty‐two treatment‐seeking cocaine dependent individuals (primarily African‐American males) participated.

 Findings. Performance on the GT was significantly correlated with performance on the DDP (

r = 0.37;

p = 0.04). Reaction times on the RDMT correlated with performance on the GT (

r = 0.36,

p = 0.04) and DDP (

r = 0.33,

p = 0.07), but actual choices on the RDMT did not (

p > 0.9 for both). While no significant relationships were observed between task performance and impulsivity, IQ estimate was positively correlated with both the GT (

r = 0.44,

p = 0.01) and RDMT (

r = 0.41,

p = 0.021). Split half reliability data indicated higher reliability when using only data from the latter half of the GT (

r = 0.92 vs.

r = 0.80).

 Conclusions. These data offer preliminary evidence of overlap in the decision‐making functioning tapped by these tasks. Possible implications for drug‐taking behavior are discussed.
Theories of drug craving, ancient and modern
Authors: Drummond D. Colin
Published: March 2003

This paper reviews the principal theoretical models of drug craving and provides some directions for future research. The main models are classified broadly into three categories: (1) phenomenological models; based on clinical observation and description; these have been influential in classification systems of addictive disorders and in the development of pharmacological therapies; (2) conditioning models: based on conditioning theory; these have been influential in the development of cue exposure treatments; (3) cognitive theories; based on cognitive social learning theory: these have been influential in the development of cognitive therapies of addiction. It is concluded that no one specific theory provides a complete explanation of the phenomenon of craving. However, theories of craving grounded in general theories of human behaviour offer greatest promise, and generate more specific and testable research hypotheses. Theories that do not require craving to be present for relapse to occur have more empirical support than those that provide simplistic causal explanations. The cue‐reactivity model shows promise in the exploration of the relationship between craving and relapse. However, further attention to the phenomenology of craving could help to advise the future measurement and study of drug craving, particularly in the context of research in which drugs are available to human subjects, with adequate ethical safeguards. There is a need for further study of the temporal dynamics of craving and consensus in the field on the most appropriate methods of measurement. Finally, new psychotherapies such as cue exposure and pharmacotherapies that aim to attenuate drinking behaviour, such as naltrexone and acamprosate, provide opportunities to improve understanding of the nature and significance of craving. However, the relatively uncritical assumption that craving is the underlying basis of addiction and represents the most appropriate target for treatment is challenged.
Cognitive biases and addiction: an evolution in theory and method
Authors: McCusker Christopher G.
Published: March 2003

An evolution in theoretical models and methodological paradigms for investigating cognitive biases in the addictions is discussed. Anomalies in traditional cognitive perspectives, and problems with the self‐report methods which underpin them, are highlighted. An emergent body of cognitive research, contextualized within the principles and paradigms of cognitive neuropsychology rather than social learning theory, is presented which, it is argued, addresses these anomalies and problems. Evidence is presented that biases in the processing of addiction‐related stimuli, and in the network of propositions which motivate addictive behaviours, occur at automatic, implicit and pre‐conscious levels of awareness. It is suggested that methods which assess such implicit cognitive biases (e.g. Stroop, memory, priming and reaction‐time paradigms) yield findings which have better predictive utility for ongoing behaviour than those biases determined by self‐report methods of introspection. The potential utility of these findings for understanding "loss of control" phenomena, and the desynchrony between reported beliefs and intentions and ongoing addictive behaviours, is discussed. Applications to the practice of cognitive therapy are considered.
Receptor regulation as a unitary mechanism for drug tolerance and physical dependence ‐ not quite as simple as it seemed!
Authors: Littleton John
Published: March 2003

This review examines the development of the unitary hypothesis that both drug tolerance and the drug withdrawal syndrome arise from adaptive regulation of drug receptors in the brain. Although there is still considerable merit in this hypothesis, the author explains that careful evaluation of some of the changes that have been reported suggests that many of these are not good explanations for both aspects of drug dependence. In addition, modern developments in the understanding of receptor mechanisms show that the original hypothesis represents a gross oversimplification of the true situation. Adaptive changes in post‐receptor mechanisms are now believed to be at least as important as alterations in the receptors themselves. Equally some receptor proteins, by altering their subunit composition, may be able to adapt to the presence of drugs without producing major changes in the action of the natural transmitter. In conclusion, receptor regulation still seems to play an important role in drug dependence but this role is more complex than was once believed.
Geographical injecting locations among injecting drug users in Sydney, Australia
Authors: Darke Shane , Kaye Sharlene , Ross Joanne
Published: March 2003

Aims. To document the geographical injection locations of IDU, and the factors and harms associated with injecting in public places.

Design. Cross‐sectional survey.

Setting. Sydney, Australia.

Participants. Two hundred injecting drug users.

Findings. Nearly all subjects (96%) had injected in a public place, and 89% had done so in the preceding 6 months. Large proportions had injected in all locations studied, including cars (90%), public toilets (81%), the street (80%) and trains (55%). Injecting in public places also occurred frequently, with 53% of subjects having injected often in at least one public location during the preceding 6 months. Twenty‐seven per cent of subjects had injected often in the street over the preceding 6 months, 22% had injected often in cars and 17% had injected often in public toilets. Frequent injectors in public places were more likely to be male, and to have overdosed in the preceding 6 months, injected significantly more drug classes in the preceding 6 months, injected in more bodily injecting sites in the preceding 6 months and had more current injection‐related problems than other IDU.

Conclusions. Injecting in public places was practised by the overwhelming majority of the sample, and a pattern of increased harm was associated with frequent public injecting. In attempting to quantify the harm associated with injecting, and to reduce such harm, the locations injections take place in are of major importance.
The use of psychoactive substances among adolescent students in an area in the south‐west of China
Authors: Zhimin Liu , Weihua Zhou , Zhi Lian , Yue Mu , Zhiji Cai , Jiaqi Cao
Published: March 2003

Aim. To survey drug/psychoactive substance use among adolescent students in a south‐west province of China.

Design. A cluster sample was drawn from this province of nine districts or cities. Each district/city provided two schools from grade 11 senior high school, A total of 18 schools were selected randomly.

Findings. A total of 2649 students completed this self‐report questionnaire, mean age 17.1 ± 0.9 years. The response rate was 92.7‐95.6% for each of the specific substances or drugs. The 'life‐time prevalences of regular substance use' (at least 15 times during in any one month) were, in rank order of prevalence: tobacco 6.3%, non‐steroid anti‐inflammatory drugs (NSAID) 2.9%, alcohol 2.9%, solvent 0.3%, sedative/hypnotic 0.2% and cannabis 0.04%. The life‐time prevalences of at least some use were: alcohol 66.1%, NSAID 59.3%, tobacco 27.4%, sedative/hypnotic 5.2%, heroin 3.1%, solvents 2.8%, amphetamine‐type stimulants (ATS) 0,7% and cannabis 0.3%. The 'prevalences of current regular use' (at least 15 times in the past month) were: tobacco 4.2%, alcohol 1.6%, NSAID 0.8%, sedative/hypnotic 0.1%, solvents 0.1% and cannabis 0.1%. The 'prevalences of current use at any level' were: alcohol 15.2%, NSAID 9.6%, tobacco 7.1%, sedative/hypnotic 0.5%, solvents 0.4%, cannabis 0.1%, heroin 0.1%, and ATS 0.04%. The median age at onset substance use was between 10.7 and 13.4 9.6%.

Conclusions. Drug misuse has appeared among teenage students in this area. The most widely used substances were alcohol and cigarettes. The rates of solvent, tobacco and alcohol use among males were substantially higher than in females.
Injecting misuse of buprenorphine among French drug users
Authors: Obadia Yolande , Perrin Vincent , Feroni Isabelle , Vlahov David , Moatti Jean‐Paul
Published: March 2003

Aims. To evaluate the extent to which the introduction (February 1996) of ambulatory prescriptions of buprenorphine for drug maintenance treatment (DMT) has been associated with its intravenous illicit use by French injecting drug users (IDUs).

Design. Cross‐sectional survey (September 1997), using self‐administered questionnaires, in a sample of IDUs recruited at 32 pharmacies, four needle exchange programmes and three syringe vending machines.

Setting. Thirty‐nine sites where IDUs have access to sterile syringes in the city of Marseille (South‐Eastern France).

Participants. Sample of IDUs attending community pharmacies, vending machines and needle exchange programs to obtain equipment.

Measurement. To compare characteristics of IDUs who declared that they only injected buprenorphine in the prior 6 months versus the rest of the sample.

Findings. Among the 343 respondents (response rate = 70.7%), 33.8% were polydrug users who occasionally injected buprenorphine in parallel to heroin and/or cocaine, while 23.9% only injected buprenorphine in the previous 6 months. IDUs in this latter group were younger, injected more frequently, and were more frequently on buprenorphine DMT, but they were less likely to be HIV‐infected and to declare HIV‐related injecting risky behaviours.

Conclusions. Substantial risk of injecting misuse is associated with large‐scale diffusion of buprenorphine DMT. A more stringent regulation for medical dispensation of buprenorphine than the current French general freedom of prescription for all physicians, including general practicioners in ambulatory care, may be necessary in other countries which are considering the diffusion of buprenorphine DMT.