bluuebunny/crossref_metadata_2025 huggingface dataset:
E. M. Jellinek and the evolution of alcohol studies: a critical essay
Authors: PAGE PENNY BOOTH
Published: January 2006

The career of E.M. Jellinek and his impact on the evolution of the modern alcohol studies field is examined. Special attention is paid to his statistical and theoretical contributions, his work with the Yale Section of Alcohol Studies and the World Health Organization, and his own evolving perspective toward alcohol problems.
A comparison of ‘visible’ and ‘invisible’ users of amphetamine, cocaine and heroin: two distinct populations?
Authors: ROBSON PHILIP , BRUCE MALCOLM
Published: January 2006

Aim. To compare the characteristics of heroin, cocaine and amphetamine users having no history of contact with services with those of a group in contact. Method. Multiple agency sampling and field work which included ‘snowballing’ using ‘privileged access interviewers’. Each subject underwent a structured interview which included the Severity of Dependency Scale (SDS), and completed a confidential, self‐report questionnaire. Setting. Three contrasting provincial urban locations. Participants. Five hundred and eighty‐one regular users of the target drugs. Of these, 380 (65%) denied any contact with police or helping agencies in connection with drug use. Findings. Most zero‐contact users (79%) expressed little or no concern about their drug use, and no wish for help or advice. They were much more likely to use stimulants only; less likely ever to inject any drug or, for those that did, to share equipment; less likely to use opioids, amphetamine or cocaine powder on a daily basis; more likely to use Ecstasy; and yielded significantly lower SDS scores for all target drugs save crack. Prevalence of crack use was lower, but the proportion of daily users was the same as in the contact group. Most (69%) contact users remained concerned about their drug use, but 58% expressed little or no confidence that local services could meet their needs. In both groups, SDS scores for cocaine powder were comparable to those for cannabis, LSD and Ecstasy. Of the 495 cannabis smokers identified (85% of the sample), 72% reported daily consumption. Conclusions. The findings are consistent with the hypothesis that ‘visible’ and ‘invisible’ drug users are distinct populations in terms of behavioural characteristics, vulnerability to compulsive use, and prevalence of drug‐related problems or concern. Purchasers and providers with limited resources should concentrate on improving the range and quality of services for users already in contact rather than attempting to uncover invisible populations. On the basis of SDS scores, cocaine HCI seems to have a relatively modest addictive potential.
The transition from injecting to smoking heroin in three Spanish cities
Authors: DE LA FUENTE LUIS , BARRIO GREGORIO , ROYUELA LUIS , BRAVO MARIA J. ,   THE SPANISH GROUP FOR THE STUDY OF THE ROUTE OF HEROIN ADMINISTRATION
Published: January 2006

Aims. To measure the current prevalence of different routes of heroin administration among users and to describe the most frequent patterns in the evolution of the main route from the time of first use to the present and their implications for the control of the HIV epidemic. Design. Cross‐sectional study. Face‐to‐face interviews using a structured questionnaire. Setting and participants. Nine hundred and nine regular heroin users from Madrid, Barcelona and Seville (about 300 per city), half of them recruited in treatment centres and the other half out of treatment. Measurements. Socio‐demographic characteristics, current and historical behaviours related to route of administration. Findings. Before 1980 injection was the first main route of heroin administration for most users in Barcelona and Madrid; in Seville smoking already predominated, although 40% of users began by injecting. Sniffing subsequently became predominant in Barcelona, while smoking became the predominant first route in Madrid and Seville (smoking has been the only first route in Seville since 1991). The prevalence of injection as the main route of administration during the last 30 days was 77.3% in Barcelona, 24.3% in Madrid and 23.9% in Seville; smoking predominated in the latter two cities. The factors most strongly associated with injection as the preferred route were city of recruitment and having a partner who injected. Some 73% of those who stopped injecting in their last change of route stated that the results of their HIV test or fear of becoming infected had been important in making this decision. Conclusions. The change from injecting to smoking will greatly facilitate the control of HIV infection in Spain. However, the main causal factor does not appear to be the perception of HIV risk, but rather other, ecological factors (cultural or market‐related). The absence of these factors in some areas may impede the spread of smoking.
Treating grouped data as continuous in alcohol consumption measures
Authors: de BURGH SIMON , BERRY GEOFFREY
Published: January 2006

In quantity‐frequency methods used for self‐report measurement of alcohol intake (or other exposures), respondents mark the appropriate ranges, e.g. ‘5 to 8 drinks’, ‘5 or 6 times per week’. To calculate average consumption only single values, not ranges, can be multiplied, and midpoints are commonly used. This results in bias if the range lies in the tail of a distribution, as often happens with drinks per occasion. The same bias occurs when risk, for example, is plotted against consumption levels, which inevitably are grouped into ranges. Consequently, estimates of aggregate consumption can be exaggerated and curves of risk against exposure level can be misleading. A method is described to calculate a relatively unbiased representative value for a range, requiring only knowledge of the normal distribution table, the log‐normal distribution, and basic arithmetic. Part of the procedure is also useful for estimating percentile points in data that have been grouped differently, suck as income in dollar groups.
Cognitive impairment among the dually‐diagnosed: substance use history and depressive symptom correlates
Authors: CARPENTER KENNETH M. , HITTNER JAMES B.
Published: January 2006

The present study examined the effects of substance use history and depressive symptomatology on the cognitive functioning of 149 male and 72 female dually diagnosed inpatients. Logistic regression models examined the effects of life‐time alcohol and cocaine use, previous month's alcohol and cocaine use and depression on abstract reasoning as assessed by the Shipley Institute of Living Scale (SILS) and neuropsychological functioning as measured by the Screening Test for the Luria‐Nebraska Neuropsychological Battery (ST‐LNNB). Results indicated differential effects of substance use across the two cognitive outcome measures. Specifically, a significant relationship was demonstrated for previous month's alcohol use on Shipley classification. However, after adjusting for possible borderline cases, previous month's alcohol use dropped to non‐significance and in its stead an association between Shipley classification and life‐time use was demonstrated. No significant effects were demonstrated for cocaine use, recent alcohol use, depressive symptoms or any of the interaction terms. The Luria‐Nebraska performance classifications were significantly associated with both educational level and life‐time cocaine use. No significant relationships were obtained for previous month's cocaine use, the alcohol use variables, depressive symptoms, or any of the interaction terms. The degree of classification agreement between the two outcome measures was slightly better than chance (K = 0.24 for ST‐LNNB and traditional or full scale SILS; K = 0.35 for ST‐LNNB and modified SILS). These kappa coefficients suggest that the SILS and ST‐LNNB assess partially independent dimensions of cognitive functioning. The findings are discussed in light of previous research and implications for clinical assessment and treatment are outlined.
Treatment of substance abusers: single or mixed gender programs?
Authors: HODGINS DAVID C. , EL‐GUEBALY NADY , ADDINGTON JEAN
Published: January 2006

Single‐gender groups are advocated for women because substance abuse treatment programs tend to be male dominated both in numbers and in style. Although there is a paucity of empirical work that directly addresses this assumption, a body of literature that indirectly supports it is reviewed. Male and female substance abusers report different histories and courses for their disorders and display different needs and characteristics in treatment settings. Men and women may benefit from different treatment approaches with less structure required for women, particularly problem drinkers. Moreover, specific characteristics such as victimization, sexual orientation, sex‐role conflict and degree of antisocial traits may be important mediating factors in whether single‐gender groups are optimal. Social psychological research illustrates the effect of gender composition of groups for men and women. In general, mixed groups are associated with more variation in interpersonal style for men but are restrictive for women who show more variation in style in single‐gender groups. These findings are suggestive of testable hypotheses concerning the effects of single and mixed gender programming. Such investigations have the potential of enhancing treatment efficacy.
Reaching out beyond the hills: HIV prevention among injecting drug users in Manipur, India
Authors: HANGZO CHINGZANING , CHATTERJEE ANINDYA , SARKAR SWARUP , ZOMI* GINZAMANG T. , DEB B. C. , ABDUI‐QUADER ABU S.
Published: January 2006

Outreach interventions using ex‐IDUs to inform and educate their peers about HIV/AIDS prevention measures have been found to be effective in the United States and other developed countries. While HIV/AIDS prevention programmes targeting IDUs have also been implemented in a number of developing countries, very little information is available on the process of implementation of these programmes. This paper attempts to document some of this knowledge by describing the implementation process of an outreach intervention targeting IDUs in a small town—Churachandpur—with high injection drug use and high HIV infection rates, in the north‐eastern state of Manipur. The paper describes the barriers encountered in implementing the outreach and how these barriers were minimized. In conclusion, the paper makes the case for targeting outreach to the larger community before targeting the IDUs.
Concepts of drugs: differences in conceptual structure across groups with different levels of drug experience
Authors: FABRICIUS WILLIAM V. , NAGOSHI CRAIG T. , MACKINNON DAVID P.
Published: January 2006

Seventy‐seven college students varying in degree of drug use experience rated the perceived similarities of all possible combinations of 16 drug classes (cigarettes, other tobacco, alcohol, marijuana, barbiturates, minor and major tranquilizers, amphetamines, amphetamine derivatives, cocaine, heroin, opiates, hallucinogens, inhalants, PCP, anti‐depressants). Multidimensional scaling (INDSCAL) and network models (PFNET) indicated that abstainers had only one pharmacological category involving sedatives/depressants, and that they attached more importance to whether drugs were licit vs. illicit than to whether they were depressants vs. stimulants. Conceptions became more coherent, differentiated and based on pharmacological properties for more experienced drug users. In line with previous work, groups with greater experience with drugs had more sophisticated conceptions not only about the drugs they had used, but also about drugs they had not used. These findings suggest that early on in drug behavior sophisticated and interrelated concepts are developing that should be taken into account when designing interventions and information campaigns.
High‐ and low‐dose alcohol‐related expectancies and the differential associations with drinking in male and female adolescents and young adults
Authors: WIERS REINOUT W. , HOOGEVEEN KEES‐JAN , SERGEANT JOSEPH A. , GUNNING W. BOUDEWIJN
Published: January 2006

A Dutch questionnaire was developed consisting of positive and negative expectancies relating to low and high doses of alcohol. The associations of these four types of expectancies with current alcohol consumption were investigated in three samples: secondary school pupils of 11‐15 years old, secondary school pupils of 16 and older, and university undergraduate students (total n = 554). Using restrictive factor analyses, a common factor‐model of the expectancies was shown to fit adequately across subgroups. Which expectancies were associated with current alcohol consumption varied substantially across the subgroups. As expected from previous research, inclusion of high dose expectancies did not substantially improve the prediction of drinking in university students. However, positive and negative high‐dose expectancies were found to be powerful predictors of current alcohol consumption in secondary school boys of 16 and older, the subgroup with the highest average alcohol consumption on each occasion. Possible implications are discussed for future research and interventions.
A national household survey of drug misuse in Britain: a decade of development
Authors: RAMSAY MALCOLM , PERCY ANDREW
Published: January 2006

Like most other countries, Britain has lagged behind the United States in developing a fully‐fledged national household survey of drug misuse. Building on some initial efforts in the early 1990s, the 1994 British Crime Survey (BCS) and the 1995 National Drugs Campaign Survey (NDCS) and various other large‐scale household surveys have provided fresh insights into drugs prevalence and patterns of misuse. These developments—their achievements and their limitations—are reviewed here. Particular attention is paid to the development of self‐report methodologies: both the BCS and the NDCS rely on interviewees personally entering their responses on to laptop computers. Some of the main findings of these surveys are oho briefly discussed.
A community‐wide Responsible Beverage Service program in three communities: early findings
Authors: SALTZ ROBERT F. , STANGHETTA PAULA
Published: January 2006

Evidence accumulating over the past 10 years or so suggests that commercial servers of alcoholic beverages mill intervene to reduce levels of impairment among their patrons and will refuse service to intoxicated customers. While some Responsible Beverage Service (RBS) programs have had significant effects on server and patron behavior, others have not. This leads us to consider issues of implementation and program effectiveness. In the current paper, a community‐wide RBS program is described in some detail. The program was comprised by a larger comprehensive community intervention project in three sites across California and South Carolina. Process evaluation data, to track program implementation and proximal effects, provide early findings. Expressed support for RBS principles was high for both the public and the hospitality industry in all sites. A telephone survey of managers also suggests that prevention policies at bars and restaurants are beginning to show up, but a direct measure of server intervention with heavy drinkers does not yet demonstrate a program effect.
Use of spatial models for community program evaluation of changes in alcohol outlet distribution
Authors: MILLAR ALEXANDER B. , GRUENEWALD PAUL J.
Published: January 2006

Alcohol outlets have geographic and spatial characteristics which are important for researchers to consider taken planning and evaluating community prevention programs. Community‐level dam used in monitoring alcohol problems across community areas and over time exhibit spatial dependencies. Statistical procedures which depend on assumptions of independence may fail to give proper results in such a situation. Specific statistical techniques have been developed which adjust for the effects of spatial dependencies in measures across geography. This paper provides an example of the creation and use of computer Geographic Information Systems to display community alcohol outlets and alcohol‐involved problems and the use of statistical analysis techniques which account for such spatial dependencies over time. This paper introduces the concepts, terminology, and justification for considering spatial analysis in community prevention planning, research and evaluation. The selection of a geographical unit of analysis will be discussed. Finally, as a demonstration, a variety of spatial statistics are applied to community spatial data for evaluation.
The prepared mind: Marie Nyswander, methadone maintenance, and the metabolic theory of addiction
Authors: COURTWRIGHT DAVID T.
Published: January 2006

Marie Nyswander was the co‐discoverer of methadone maintenance. In the 1960s she and Vincent Dole carried out clinical trials and established the first officially sanctioned methadone clinics, which became models‐far maintenance programs throughout the world. In 1967 she and Dole theorized that heroin addicts had undergone a permanent metabolic change. They needed narcotics in a visceral way, which explained why abstinence was not a realistic goal—a claim that remains hotly disputed. Nyswander's work in the 1960s marked an abrupt shift in her chinking about addiction. Her previous approach had been centered on psychoanalysis. Her embrace of methadone maintenance and the metabolic theory amounted to an intellectual conversion. Nyswander was prepared for that conversion by years of patient relapse; she was frustrated with orthodox therapy. At the same time the success of such drugs as chlorpromazine suggested that psychiatric disorders might yield more readily to chemotherapy than talking therapy. Her own heavy smoking may have led her to question whether addiction was a psychiatric disorder in the first place. Finally, Nyswander had a long history of self‐reinvention, having previously changed her politics, her medical specialty, and even her name. She was temperamentally suited for a conversion experience.
Opium revisited: a brief review of its nature, composition, non‐medical use and relative risks1
Authors: KALANT H.
Published: January 2006

Unlike the pure opioids such as morphine and heroin, opium is a complex and variable mixture of substances reflecting differences in both the starting material and the traditional practices of the regions in which it is produced. Analytical methods have improved greatly in recent years, to the point that the source of a preparation can often be identified by its opioid content and its impurities. Daily amounts used, both by smoking and by mouth, vary widely from less than a gram to 30 g, equivalent to 75—3000 mg of morphine. The effects of opium are essentially those of morphine but unexpected toxicities, suck as oesophageal cancer associated with “dross opium” and polyneuropathy due to deliberate addition of arsenic, are problems in some specific regions. Prevalence of use in different areas and countries is governed by the same factors of ease of availability, price and social acceptance that apply to the use of alcohol and other drugs in western countries. The risk of addiction to opium smoking appears to be somewhat less than to parenteral use of heroin, but appreciably greater than to alcohol Even in countries where its use is traditional, opium smoking carries substantial risks of harm to health and social functioning.
The Dutch instant lottery: prevalence and correlates of at‐risk playing
Authors: HENDRIKS VINCENT M. , MEERKERK GERT‐JAN , VAN OERS HANS A. M. , GARRETSEN HENK F. L.
Published: January 2006

After a long and contentious political debate, the instant lottery was introduced in the Netherlands in 1994. One of the conditions for allowing the introduction was that an evaluation study should be conducted with regard to possible negative side effects of the instant lottery in terms of excessive playing or addiction. This article reports on the main results of this evaluation study. In a random sample of 4497 instant lottery players, at‐risk players were differentiated from recreative players on the basis of level of involvement in the instant lottery, impaired control and the experienced negative consequences of playing. Of the sample, 4.1% could be classified as an at‐risk player. Actual problems resulting from playing in the instant lottery were experienced by 0.7% of the players. At‐risk players and recreative players did not only differ substantially in their playing behaviour, but also with regard to their socio‐economic background, playing motivation, participation in other games of chance, and involvement in alcohol use and use of marijuana. To summarize, at‐risk players were more likely to come from a poor socio‐economic background, to play the instant lottery with a negative playing motivation, to be heavily involved in other forms of gambling, to have used marijuana and to drink alcohol excessively.
Saliva cotinine levels as a function of collection method
Authors: SCHNEIDER NINA G. , JACOB PEYTON , NILSSON FREDRIK , LEISCHOW SCOTT J. , BENOWITZ NEAL L. , OLMSTEAD RICHARD E.
Published: January 2006

Saliva cotinine is commonly used to estimate nicotine intake but laboratories use different methods of collection. In three small trials, comparisons were made between (1) sugar vs. unstimulated saliva production (n= 29), (2) wax chewing vs. unstimulated production (n= 15) and (3) between two consecutive unstimulated saliva samples (n = 10). Sugar‐stimulated saliva cotinine scores were 26% below unstimulated levels (p < 0.001); correlation between measures was high (r = 0.90; p < 0.001), Wax stimulated saliva yielded levels 6% below unstimulated (p < 0.05; correlation: r = 0.98; p < 0.001). No differences were observed between two unstimulated samples taken within a ∼ 20‐minute period (correlation: r = 0.99; p < 0.001). It is postulated that changes in salivary flow can account for the findings.
Health, Society and Alcohol
Authors: Anderson Peter
Published: January 2006

The European Conference, Health, Society and Alcohol held in Paris, 12–14 December 1995, was a meeting point between science and policy. Science informed the policy process. As a tool for policy implementation, the Conference adopted the European Charter on Alcohol, a set of ethical principles and strategies for action. Of a number of important issues that frame policy, three deserve mention. First, market forces, as opposed to health and social policy decisions are increasingly influencing the policy debate. Second, existing policy options to reduce alcohol‐related harm are unlikely to lead to an increased risk of coronary heart disease among older age groups. And third, policy developments and changes in drinking patterns in countries of southern Europe are an important driving force in European policy on alcohol.
Alcohol and European transformation
Authors: SIMPURA JUSSI
Published: January 2006

Against the background of papers and discussions from the East‐West seminar at the European Conference on Health, Society and Alcohol, the differences and similarities in eastern and western European transformation processes are discussed. After some remarks on the general nature of eastern transition and western integration, the two sides of Europe are compared with respect to various alcohol‐specific issues. It will be shown that the ongoing transition touches alcohol‐related phenomena on a broad spectrum, and no single characterization (e.g. commercialization and the rise of market interests) is sufficient alone. The changing balance between state, markets and civil society provides, however, an interesting perspective for comparing alcohol‐related changes in various European societies. Finally, the prospects for a common European alcohol agenda are discussed briefly from the point of view of international mobilization on the dimensions of state, markets and civil society. There are signs of increased cooperation along all dimensions, but an all‐European alcohol agenda seems unlikely.
Alcohol and the future health of Europe
Authors: LEHTO JUHANI
Published: January 2006

The impact of alcohol consumption on trends in the European health situation is analysed. Particular attention is given to the impact of alcohol on the widening of the East‐West health gap in Europe. It is concluded that between 1950–75 the negative health impact of a rapid increase in per capita alcohol consumption in most European countries was hidden behind a strong positive development in many other socio‐economic determinants of health. Between 1980 and 1995, health trends have been more closely parallel to trends in alcohol consumption. Changes in alcohol consumption explain a significant proportion of changes in life expectancy, particularly in the newly independent states of the former Soviet Union. Public health policy on alcohol, as part of a general development of public health policies outside the health sector, is important in reducing the East‐West health gap and sustaining the positive health trend in western Europe.
Alcohol and health: individual and population perspectives
Authors: REHM JÜRGEN , ASHLEY MARY JANE , DUBOIS GERARD
Published: January 2006

This paper summarizes the relationships between alcohol consumption and health from both the individual and the population perspectives. On the individual level adverse consequences of alcohol consumption on mortality, morbidity and social harm are summarized. The potential health benefits of drinking are listed next, especially in the context of trying to balance positive and negative consequences. Even though the final decision rests with the individual it is suggested that from a health perspective light drinking on a regular basis is most advisable. In terms of advice to populations it should be noted that, due to the mutual interdependence of drinking behaviour in a society, the average individual consumption associated with the lowest individual risk is not necessarily the average per capita consumption associated with the lowest population risk. Thus, research at the population level has to be integrated with individual epidemiological research in order to come up with the best advice for the population in any given society.
Place of work, communities and municipalities
Authors: RITSON BRUCE
Published: January 2006

The Paris conference recognized that although national social policy and international research were undoubtedly important, a local dimension to research action and planning was essential. The potential for community and municipal action was illustrated in a number of papers which are summarized here. It was also the subject of a publication in the series associated with the European Alcohol Action Plan. The work‐place was taken as a significant microcosm of a community, where healthy company policy and an enlightened approach to providing early help and support to individuals with alcohol‐related problems is particularly beneficial.
Where treatment and prevention merge: the need for a broader approach
Authors: HEATHER NICK
Published: January 2006

Four papers were presented in a Parallel Session chaired by Dr Jorge Gleser (Israel) and these are summarized here. The papers were: (1) “Supporting primary health care physicians” by Dr Galina A. Korchagina of the Medical Academy of Postgraduate Studies, St Petersburg, the Russian Federation; (2) “A new role for nurses” by Ms Iveta Kelle, Nursing Consultant, Riga, Latvia; (3) “Broadening the base of treatment” by Dr Nina Kerimi of the Research Institute of Preventive and Clinical Medicine, Ashgabat, Turkmenistan; and (4) “Primary health care and alcohol reduction strategies” by Dr Leo Pas of the Academic Centre of General Practice, Free University Brussels, Belgium. Following a discussion, participants agreed on the wording of a draft Policy for Primary Health Care and Community Action and this is also included here.
Impulsivity in pathological gambling: the antisocial impulsivist
Authors: BLASZCZYNSKI A. , STEEL Z. , McCONAGHY N.
Published: January 2006

The construct of impulsivity has to date remained relatively unexplored in the pathological gambling literature. This is in spite of recent claims suggesting that impulsivity may be an important feature characterizing a subgroup of pathological gamblers who are claimed to suffer from a Multi‐Impulse Personality Disorder. The present study examined the potential role of impulsivity using the Eysenck Impulsivity Scale among 115 pathological gamblers. Results indicate that heightened impulsivity is associated with the degree of severity of psychological and behavioural change in pathological gamblers. However, the findings also indicate that impulsivity closely mirrors components contained in Eysenck Personality Questionnaire Psychoticism Scale, the California Personality Inventory Socialization Scale and DSM‐III Antisocial Personality Disorder. This is manifest both in terms of high intercorrelations between the measures of psychopathy and impulsivity and in their predictive relationship to the level of psychological distress suggesting a uniform impulsivity/psychopathy construct. Thus, the research supports a model of pathological gambling in which the severity of associated behavioural and psychological disturbance is mediated by a impulsivity/psychopathy construct.
The Alcohol Use Disorders Identification Test (AUDIT) as a screen for at‐risk drinking in primary care patients of different racial/ethnic backgrounds
Authors: VOLK ROBERT J. , STEINBAUER JEFFREY R. , CANTOR SCOTT B. , HOLZER CHARLES E
Published: January 2006

This study examined the operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) as a screen for “at‐risk” drinking in a multi‐ethnic sample of primary care patients, from a family practice center located in the southwestern United States. A probability sample of 1333 family medicine patients, stratified by gender and racial/ethnic background (white, African‐American and Mexican‐American) completed the AUDIT, followed by the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS) to determine ICD‐10 diagnoses. Indicators of hazardous alcohol use and alcohol‐related problems were included as measures of “at‐risk” drinking. Despite differences in the spectrum of alcohol problems across patient subgroups, there was no evidence of gender or racial/ethnic bias in the AUDIT as indicated by Receiver Operating Characteristic Curve analysis. Excluding abstainers from the analysis had little impact on screening efficacy. In this patient population, the A UDIT appears to be an unbiased measure of “at‐risk” drinking.
Ethical dilemmas in providing tobacco to developing countries: the case of China
Authors: Richmond Robyn
Published: January 2006

We should recognize that we have a responsibility to people who live outside our own borders, and view ourselves as part of the global community. Looking at China we are faced with ethical dilemmas which require consideration. First, there is the ethical dilemma of business versus health. The opening and development of the tobacco business in China, which includes vigorous marketing, is considered against the health consequences of tobacco use which is estimated to cost 600 000 lives annually in China, rising to 2 million by 2025 without effective tobacco control programmes. A second ethical dilemma is employment versus impoverishment, in which the opportunities for work in the tobacco industry are considered against a background of malnutrition caused in part by a proportion of household budgets used to buy tobacco, and the erosion of the land, as trees are used to produce tobacco. Gains have already been made in tobacco control in China, with the way open for much development in the future.
Opportunity costs of drug prohibition
Authors: Gable Robert S.
Published: January 2006

Psychoactive substances have benefits as well as risks. The benefits foregone by people who obey prohibition laws (as well as the costs of enforcing those laws against actual and would‐be users) should be acknowledged when considering the ethics of drug policies. Older or terminally ill people, who would most likely benefit from psychological or spiritual insights, currently have less access to psychoactive substances than younger people who tend to use the substances for entertainment. The principle of distributive justice suggests that law‐abiding citizens should not disproportionately suffer the opportunity costs of unenforceable policies of prohibition. A positive alternative policy would allow adult citizens access to certain psychoactive substances, comparable in safety and effectiveness to drugs now prescribed for medical purposes, as a valued resource for self‐actualization.
Denying treatment to drug and alcohol‐dependent patients
Authors: Batey Robert G.
Published: January 2006

There has been a concerted move in the West to reduce health care expenditure and multiple moves have been made to achieve these cost reductions. Many approaches have been taken including the restriction of services to subsets within the population. Drug and alcohol dependent patients have often been targeted as individuals and as groups who should not be seen as having equal access to certain forms of therapy. In this article it is argued that many of these decisions are inappropriate and in many instances they are not based on evidence which suggests that patients who are dependent may do just as well as non‐dependent patients with some forms of treatment. It is argued that clinicians should regard each individual patient separately and make decisions that are appropriate to the clinical setting rather than taking a policy decision to restrict treatment to dependent individuals.
The distribution of naloxone to heroin users
Authors: Darke Shane , Hall Wayne
Published: January 2006

Overdose deaths are a major contributor to excess mortality among heroin users. It has been proposed that opioid overdose morbidity and mortality could be reduced substantially by distributing the opioid antagonist naloxone to heroin users. The ethical issues raised by this proposal are evaluated from a utilitarian perspective. The potential advantages of naloxone distribution include the increased chance of comatose opioid users being quickly resuscitated by others present at the time of an overdose, naloxone's safety and its lack of abuse potential. The main problems raised by the proposal are: the medico‐legal complications of medical practitioners prescribing a drug that is most likely to be administered to and by people other than the one for whom it is prescribed; the economic costs of distributing naloxone sufficiently widely to have an impact on overdose morbidity and mortality; and the potentially greater cost‐effectiveness of simpler educational interventions. Given the possible benefits of naloxone distribution, it may be worthwhile considering a controlled trial of naloxone distribution to high‐risk heroin users.
Harm reduction: roads less travelled to the Holy Grail
Authors: Roche Ann M. , Evans Keith R. , Stanton Warren R.
Published: January 2006

In recent years, a number of countries have embraced harm reduction as their principal philosophical stance and policy platform on alcohol and other drug‐related problems. Harm reduction, while argued by some as not being a new concept, has dramatically changed the overall orientation of many health and human service approaches. We argue that as a result many important considerations have been overlooked. This paper explores the merits of harm reduction and examines the limitations and potential pitfalls that may exist in its application in the real world. For instance, where do we position non‐drug‐use? Such questions are raised in light of the impression perpetuated by some leading practitioners in this field that harm reduction is a global panacea for alcohol and drug problems. Without exploring all possible paths, progress toward our holy grail of minimising the harms and maximising the potential benefits of drug use will be hampered. An integrated model is discussed, which we believe provides an opportunity for wider acceptance and ownership by alcohol and drug stakeholders, politicians and the community.
Trends in alcohol‐related harms and offences in a liberalized alcohol environment
Authors: Huckle Taisia , Pledger Megan , Casswell Sally
Published: January 2006

Aim  To assess alcohol‐related harms and offences in New Zealand from 1990 to 2003, a period of alcohol policy liberalization, that included the lowering of the purchase age from 20 to 18  years in 1999.

 Design, setting and participants  Time trend analyses were carried out on routinely collected data for prosecutions for driving with excess alcohol; alcohol‐involved vehicle crashes (all and fatal) and prosecutions for disorder offences. These were carried out separately for those aged 14–15, 16–17, 18–19, 20–24 and 25 years and over. 

Measurements  Rates of: prosecutions for driving with excess alcohol (1990–2003); rates of alcohol‐ involved vehicle crashes (all and fatal) (1990–2003); and rates of prosecutions for disorder offences (1994–2003). 

Findings  Effects of alcohol policy liberalization: positive trends were found in the rates of prosecutions for disorder in the 16–17, 18–19, 20–24 and 25 + age groups; with 18–19‐year‐olds and 16–17‐year‐olds having the largest rates and largest positive trend in rates. For 16–17‐year‐olds, there was a positive trend in the rates of prosecutions for excess breath alcohol. Negative trends in rates were found for alcohol‐related crashes (all and fatal) among all age groups. Negative trends for those over 16–17 years were found for prosecutions for driving with excess breath alcohol (this was prior to the lowering of the purchase age). Effects of lowering the minimum purchase age: the lowering of minimum purchase age coincided with an increase in the trend of alcohol‐related crashes for 18–19‐year‐olds; the next largest increase was among the 20–24‐year‐olds (all other age groups also increased but at a much lower rate). A similar result was found for driving with excess alcohol for those aged 18–19 (and those aged 20–24 years). An increase in the rates of prosecutions for disorder offences occurred for the 14–15‐year‐old group following the lowering of the purchase age.

Conclusion  The liberalization of alcohol throughout the 1990s may have influenced younger people more, as reflected in increases in their disorder offences and drink driving. The lowering of the minimum purchase age may have led to an increase in drink‐driving among the 18–19‐year‐olds (those directly affected by the change in purchase age).
Enforcing the minimum drinking age: state, local and agency characteristics associated with compliance checks and Cops in Shops programs
Authors: Montgomery Jacob M. , Foley Kristie Long , Wolfson Mark
Published: January 2006

Aims  To identify state, local and organizational characteristics associated with local law enforcement agencies’ implementation of two dramatically different approaches to enforcement of underage drinking laws: compliance checks and Cops in Shops programs. Compliance checks use underage decoys to attempt to purchase alcohol from retail merchants, while Cops in Shops programs deploy undercover law enforcement officers in alcohol outlets to detect and cite persons under the age of 21 who attempt to purchase alcohol.

Design  Cross‐sectional telephone interview conducted as part of the Tobacco Enforcement Study (TES), which examined enforcement of laws related to youth access to tobacco.

Setting  Data were collected in 1999 among law enforcement agencies in all 50 states of the United States.

Participants  Representatives of city police departments, departments of public safety, sheriffs or county police were included (n = 920 local agencies).

Measurements  Alcohol compliance checks and Cops in Shops programs were the primary outcomes. Covariates included state level policies (e.g. beer tax), agency resources (e.g. number of sworn officers) and community demographics (e.g. college dormitory population).

Findings  Local enforcement agencies were more likely to perform alcohol compliance checks than to have a Cops in Shops program (73.9% compared to 41.1% in cities > 25 000 and 55.7% compared to 23.9% in cities ≤ 25 000). Conducting compliance checks for tobacco age‐of‐sale laws was positively associated with alcohol compliance checks and Cops in Shops (OR 3.30, P < 0.001; OR 1.84, P = 0.001, respectively). Having a Drug Abuse Resistance Education (DARE) officer was negatively related to conducting compliance checks (OR 0.67, P = 0.03). Special community policing units were associated with departments having Cops in Shops programs (OR 1.80, P = 0.006).

Conclusions  This study used a nationally representative sample of communities to better understand state and local factors that shape local law enforcement agencies’ use of two distinct approaches to underage drinking enforcement. The strong link observed between tobacco and alcohol compliance checks may indicate a culture within some law enforcement agencies supporting strict enforcement of age‐of‐sale laws.
Temporal expression of inflammatory mediators in brain basilar artery vasculitis and cerebrospinal fluid of rabbits with coccidioidal meningitis
Authors: Zucker K E , Kamberi P , Sobel R A , Cloud G , Meli D N , Clemons K V , Stevens D A , Williams P L , Leib S L
Published: January 2006

Strokes due to transmural vasculitis associated with coccidioidal meningitis result in significant morbidity and mortality. The immunological and inflammatory processes responsible are poorly understood. To determine the inflammatory mediators, i.e. cytokines, chemokines, iNOS, matrix metalloproteinase-9 (MMP-9), that possibly contribute to vasculitis, temporal mRNA expression in brain basilar artery samples and MMP-9 protein in the CSF of male NZW rabbits infected intracisternally with 6·5 × 104 arthroconidia of Coccidioides immitis were assessed. Five infected and 3 sham-injected rabbits at each time point were euthanized 4, 9, 14 and 20 days post infection. All infected rabbits had neurological abnormalities and severe vasculitis in the basilar arteries on days 9–20. In basilar arteries of infected animals versus controls, mRNAs encoding for IL-6, iNOS, IFN-γ, IL-2, MCP-1, IL-1β, IL-10, TNF-α, CCR-1, MMP-9, TGF-β, as well as MMP-9 protein in CSF, were found to be significantly up-regulated. Thus, this study identified inflammatory mediators associated with CNS vasculitis and meningitis due to C. immitis infection. Assessment of the individual contribution of each mediator to vasculitis may offer novel approaches to the treatment of coccidioidal CNS infection. This study also provides unique methodology for immunology studies in a rabbit model.
Factors affecting the intensity of epidermal papillomatosis in populations of roach,Rutilus rutilus(L.), estimated as scale coverage
Authors: Korkea‐aho T , Vainikka A , Taskinen J
Published: January 2006

Studies of epidermal papillomatosis in fish populations have only rarely focused on the intensity of the disease, i.e. the number and size of papillomas. Furthermore, the methods used to evaluate the intensity of papillomatosis have not been standardized. We tested the reliability of a method based on counting of scales covered by papilloma tumours in roach,Rutilus rutilus(L). In addition, we studied the frequency distributions of the number of scales covered by papillomas within populations, evaluated the correlation between the prevalence and mean intensity of the disease among populations and examined the intensity of papillomatosis in roach with respect to sex and size of fish. Reliability of the scale coverage method was high. Therefore, the method could offer an effective way to determine the intensity of papillomatosis in fish species with large scales. The frequency distribution of the scale coverage of papillomas was highly aggregated within all populations studied. The mean intensity of papillomatosis increased with the size of the fish and was higher in males than in females. However, there was no correlation between the mean intensity and prevalence of the disease among the 19 roach populations studied.
The eel immune system: present knowledge and the need for research
Authors: Nielsen M E , Esteve‐Gassent M D
Published: January 2006

The European eel, Anguilla anguilla, is one of the most important warm water fish species cultured in southern Europe and the Mediterranean as well as in northern countries including Germany, the Netherlands and Denmark. The Japanese eel, A. japonica, is an important cultured fish in several Asiatic countries including Japan, China and Taiwan. During recent decades, research has been performed to elucidate the immune response of these species against different pathogens (viruses, bacteria or parasites). Nevertheless, there is very limited information in terms of both cellular and humoral immune responses. This review summarizes the present knowledge relating to the eel immune system and includes new data.
A shared treatment decision‐making approach between patients with chronic conditions and their clinicians: the case of diabetes
Authors: Montori Victor M. , Gafni Amiram , Charles Cathy
Published: January 2006

In this paper, we discuss the Charles et al. approach to shared treatment decision‐making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of treatment decisions (e.g. end‐of‐life care, surgical treatment of cancer) that generated existing approaches of shared decision‐making for acute care conditions (including the Charles et al. model) and the treatment decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, treatment decisions in the chronic care setting are more likely to require a more active patient role in carrying out the decision and to offer a longer window of opportunity to make decisions and to revisit and reverse them without important loss than acute care decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self‐management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient–clinician relationship as one of partners in making difficult treatment choices and to add a new component to the shared decision‐making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research.