bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol abuse by patients undergoing methadone treatment programmes
Authors: STASTNY D. , POTTER M.
Published: January 2006

To study the prevalence of problem drinking among patients undergoing methadone treatment programmes, 170 patients were assessed using the self‐administered alcohol screening test (mSAAST). Fifty‐three (31.9%) patients scored 7 or more on the mSAAST, indicating actual or potential drinking problems. There was a slight tendency for these to be male. Patients who abused alcohol also tended to use benzodiazepines irrespective of sex. The results of the study seem to indicate that the prevalence of dual alcohol and opiate use is high amongst patients attending drug dependency units. Furthermore comprehensive research is required in order to plan effective treatment for these dual addicted patients.
Suicide among hospital‐treated alcoholics in Scotland, 1974–83
Authors: KREITMAN N. B.
Published: January 2006

Two cohorts of suicide (and undetermined deaths) in Scotland for the quinquennia 1974–78, 1979–83 were investigated. A national record linkage exercise was carried out relating the deaths to admissions for alcoholism in the preceding 5 years (minimum) to 10 years (maximum). No differences were found between the cohorts in socio‐demographic or clinical characteristics at the time of initial admission. The survival lime as measured from either first admission or from last discharge to death was appreciably longer in the second quinquennium. This improvement might reflect changes in the patterns of services provided for alcoholics, especially the increased emphasis on the extra‐mural care.
The influence of stress on psychopharmacological responses to nicotine
Authors: BALFOUR DAVID J. K.
Published: January 2006

This essay considers the mechanisms which may mediate the apparent anxiolytic properties of nicotine and which are thought to be responsible for the ‘calming’ effect of tobacco smoke experienced by many smokers. It summarizes the evidence that, in many tests for anxiolytic activity, the effects of nicotine do not resemble those of established anxiolytic drugs such as diazepam and concludes that it is likely that neural systems other than those which mediate the responses to the benzodiazepines are responsible for the putative anxiolytic properties of nicotine. Circumstantial evidence which suggests that the increase in mesolimbic dopamine secretion evoked by nicotine may not only be rewarding per se but may also contribute to the ability of the drug to alleviate the effects of stress is presented. The essay also summarizes results which suggest that chronic nicotine evokes changes in the mesolimbic dopamine system which resemble those seen in animals treated chronically with antidepressant drugs and proposes that the mechanisms which mediate the ability of antidepressant drugs to alleviate the effects of stress may also mediate the apparent anxiolytic properties of nicotine. The possible consequences of this hypothesis for future research are considered.
Understanding brain mechanisms in nicotine reinforcement
Authors: CORRIGALL WILLIAM A.
Published: January 2006

Current understanding of the mechanisms through which nicotine acts to reinforce behavior is limited. Demonstrated interactions between nicotine and the mesolimbic dopamine system have provided the impetus for investigations of the role of this particular brain pathway in nicotine reinforcement, and preliminary studies do indeed suggest that the dopamine system might be involved in self‐administration of nicotine. However, there are clearly other possible brain sites and neurotransmitter mechanisms that could be critical to reinforcement processes for nicotine. This article proposes that a broadly‐based attack on the question of nicotine reinforcement would be the most fruitful; basic biological research should aim to verify the involvement of the mesolimbic dopamine system, but also to elucidate other candidate brain systems that may contribute to the reinforcing properties of nicotine.
Behavioural pharmacology of nicotine: multiple mechanisms
Authors: STOLERMAN IAN P.
Published: January 2006

It is widely accepted that nicotine serves as a major reinforcer of tobacco use, but how it does so is obscure. Little is known about the nature of the reinforcing effect of nicotine in psychobiological terms, or about the mechanism of reinforcement at the level of neuropharmacology. Several ideas about the nature of the reinforcement are current, including mood changes such as euphoria, learning, memory and attention improvements, ability to help smokers deal with or adapt to stressors, and capacity to terminate symptoms of a nicotine withdrawal syndrome. These psychobiological effects are not mutually exclusive; different effects may be important for different people, or for the same person under different circumstances. Similarly, the neuropharmacology of nicotine reinforcement remains largely unexplored; nicotinic‐cholinergic receptors seem to play a primary role but evidence implicating particular subtypes of nicotine receptor is not available. Evidence points to the release of dopamine as an important link in the chain of events that transduce effects at nicotinic receptors into behaviour and nicotine‐seeking responses, but the dopamine hypothesis addresses only one part of a complex system. The possibility has to be faced that neuropharmacologically, several mechanisms are involved that parallel the several psychobiological effects mentioned above; multiple types of receptor, brain structures and indirectly activated neurotransmitter systems may contribute to the maintenance of nicotine‐seeking behaviour.
Beneficial effects of nicotine
Authors: JARVIK MURRAY E.
Published: January 2006

Nicotine in tobacco brings illness and death to millions of people. Yet nicotine in its pure form has the potential to be a valuable pharmaceutical agent. Nicotine fairly specifically binds to the cholinergic nicotinic gating site on cationic ion channels in receptors throughout the body. This action stimulates the release of a variety of neurotransmitters including especially catecholamines and serotonin. When chronically taken, nicotine may result in: (1) positive reinforcement, (2) negative reinforcement, (3) reduction of body weight, (4) enhancement of performance, and protection against: (5) Parkinson's disease (6) Tourette's disease (7) Alzheimers disease, (8) ulcerative colitis and (9) sleep apnea. The reliability of these effects varies greatly but justifies the search for more therapeutic applications for this interesting compound.
The development of dependence on smoking in children
Authors: McNEILL ANN D.
Published: January 2006

The development of dependence on smoking has been largely unexplored and has theoretical importance and implications for interventions aimed at interrupting the early stages of smoking behaviour. Data are presented which indicate the importance of the first few cigarettes. The development of a regular smoking pattern had previously been reported to take about 2 years and involve a progression through a series of stages from smoking for psychosocial motives, to smoking for a positive nicotine effect and finally for some smokers, smoking to avoid withdrawal. Results from a small scale study with girls are described which give no support to the notion of any such well‐defined stages in the novice smoker's career. Inhalation was apparent from early on indicating that nicotine can play an active role in reinforcing smoking from a very early stage. Furthermore, the majority of the young smokers perceived themselves to be dependent on their cigarettes. The nature of any positive reinforcement was unclear, the dependence‐producing potential of smoking appearing to be largely due to relief of unpleasant feelings. These findings need to be replicated and the paper highlights other key areas in this field for future research.
Inter‐relationships between conditioned and primary reinforcement in the maintenance of cigarette smoking
Authors: ROSE JED E. , LEVIN EDWARD D.
Published: January 2006

Research on smoking cessation has increasingly focussed on pharmacological aspects of nicotine and nicotine withdrawal. However, cigarette smoking also provides a characteristic set of sensory cues. These sensory aspects of smoking are important to address in that they may be potent conditioned reinforcing stimuli linked to the actions of nicotine. The repetition of the smoking act thousands of times per year by a moderately heavy smoker leads to a strong conditioned association between the sensory aspects of smoking (the putative CS) and the pharmacological effects of nicotine (the putative UCS). Strategies for disrupting CS‐UCS associations may be useful in developing more effective smoking cessation treatments. These include: counterconditioning of the CS; presenting the CS alone; presenting the CS with the UCS but pharmacologically blocking the UCS; and presenting the CS and UCS in an unconnected fashion. The role of sensory cues in alleviating craving for cigarettes is discussed, and specific techniques for duplicating relevant sensory aspects of smoking without delivering significant doses of nicotine are described. The combination of nicotine and nicotinic antagonists to block primary reinforcement and hasten extinction of conditioned reinforcement is also considered.
Conceptual and methodological considerations for tobacco addiction research
Authors: GRUNBERG NEIL E. , ACRI JANE B.
Published: January 2006

The 1988 Surgeon General's Report on nicotine addiction has research and treatment implications. It focuses clinical treatments on tobacco use as an addiction and highlights the importance of examining actions of nicotine relevant to dependence. It also indicates the value of comparing the pharmacologic and behavioral processes underlying use of nicotine with other addictive drugs. This essay points out gaps that remain in our understanding of nicotine addiction. For example, the exact mechanisms underlying nicotine addiction are unknown. Also, the reasons for individual differences in initiation, withdrawal, relapse and reinforcing effects of tobacco use are not understood. Research designed to address these issues should be problem‐driven and multidisciplinary. Parallel human and animal studies that include unconditioned as well as conditioned behaviors are particularly valuable.
The focus and conduct of clinical trials
Authors: WEST ROBERT
Published: January 2006

This paper discusses some issues regarding how putative stop‐smoking treatments should be evaluated. Preliminary evaluations of treatments have used withdrawal symptoms as a surrogate for abstinence in an attempt to decide those treatments on which to carry out expensive full‐scale clinical trials. However, withdrawal symptom severity has not been shown to relate to long‐term abstinence in any prospective studies. Until a better understanding of the relationship between withdrawal symptoms and abstinence is obtained withdrawal symptoms cannot be considered an appropriate surrogate for abstinence. Research is needed into what pattern of short‐term abstinence provides the best predictor of long‐term abstinence. Evidence from carbon monoxide validation of short‐term abstinence raises doubts about whether minor lapses back to smoking are likely to lead to full blown relapse. Further research into the use of expired‐air CO in validation of claims of abstinence is required. Finally, the traditional clinical trials format is not well suited to evaluation of treatment programmes with a large behavioural component. An alternative based on the principles underlying biological evolution is proposed.
Superior outcome of females over males after brief treatment for the reduction of heavy drinking: replication and report of therapist effects
Authors: SANCHEZ‐CRAIG MARTHA , SPIVAK KAREN , DAVILA RAFAELA
Published: January 2006

The procedures and findings of a previous study were replicated. Sixty‐one men and 35 women were randomized to one of three treatments: Manual: three sessions of instructions in use of a manual describing a step‐by‐step method for attaining abstinence or moderate drinking. Guidelines: three sessions of advice using a pamphlet summarizing the contents of the manual. Therapist: application of the step‐by‐step method in an indefinite number of sessions. At 3–month follow‐up, the number of Moderate drinkers was again significantly higher among women than men in the Guidelines (77% versus 24%) and Manual conditions (75% versus 33%), but not in the Therapist condition (50% versus 53%). Again, at 1–year more women than men were Moderate drinkers in all conditions (69% versus 31% overall). Changes from baseline in GOT, MCV, and the Digit Symbol Test corroborated the clients' reports of drinking. In this study the more experienced therapists had significantly lower rates of client dropout than the less experienced. Clinical and research implications of the findings are discussed.
Treatment of drug‐dependent patients, 1968–1969
Authors: CONNELL P. H.
Published: January 2006

Attention has been given from time to time to the question of what happened in drug‐dependence clinics in the early days of their operation. It has recently come to my attention that records of meetings of consultants, held at the Department of Health, during that period, have not been kept. The following memorandum was submitted by me to a meeting held on 8 September 1969 under the title ‘Practical matters relating to the treatment of drug‐dependent patients‘. Unfortunately, I have no record of the comments made on it, but I do not recall any major disagreement with this statement. I hope that this document, reprinted below in full, may be of historical interest.
Changes over time in heroin and cocaine use among injecting drug users in Amsterdam, The Netherlands, 1985–1989
Authors: HARTGERS CHRISTINA , VAN DEN HOEK ANNEKE (J.A.R.) , KRIJNEN PIETA , VAN BRUSSEL GIEL H. A. , COUTINHO ROEL A.
Published: January 2006

Three hundred and eighty six injecting drug users entered into an HIV study through methadone programs over a 40 month period. Differences in oral, intranasal and parenteral use of heroin and cocaine were assessed between four consecutive 10 month intake groups. Heroin smoking and cocaine freebasing were increased in the later intake groups, while there were no significant changes in injecting variables. No relationship between sexual risk behaviour and cocaine freebasing was found. HIV seropositivity was less among cocaine freebasers at 19% compared to 32% among non freebasers. The increase in heroin smoking and cocaine freebasing may have a favourable preventive effect on the spread of HIV among this high risk group.
The impact of school‐based drug education
Authors: COGGANS N. , SHEWAN D. , HENDERSON M. , DAVIES J. B.
Published: January 2006

Outcome evaluation of the impact of drug education on a representative sample of 1197 pupils revealed no effects of drug education on drug‐related behaviour or drug‐related attitudes. However, drug education raised levels of drug‐related knowledge. The long term implications of these findings would require further study. Comparison of process and outcome measures indicated that, with the exception of knowledge, teachers' positive views of drug education were misplaced. Critical aspects of good practice are discussed, both at the level of the individual teacher and in terms of whole‐school factors.
Some body‐related attitudes in women smokers and non‐smokers
Authors: BEN‐TOVIM DAVID I. , WALKER M. KAY
Published: January 2006

The body‐related attitudes of female current, ex, and never‐smokers were compared using a new questionnaire that assesses a wide range of attitudes towards the body. In a population survey, current smokers felt less attractive than those women who had never smoked, but they did not experience themselves as being less strong and fit than the non‐smokers. There were no significant inter‐relationships of smoking status, attitudes and body weight. The implications of these observations for anti‐smoking campaigns are briefly discussed.
A six country survey of the content and structure of heroin treatment programmes using methadone
Authors: GOSSOP MICHAEL , GRANT MARCUS
Published: January 2006

The use of methadone in the treatment of drug dependence has provoked a good deal of controversy. However, it is clear that there is considerable variation between methadone treatment programmes and relatively little detail is available about the organisation and operation of these programmes. This World Health Organization survey examines the content and structure of methadone treatment programmes, and particularly methadone maintenance programmes, in six countries. The six countries were Australia, Canada, France, the Netherlands, Thailand and the UK. The report presents information about the extent of national problems and about such issues as type of dispensing practices, dose‐ and time‐limits for prescribing methadone, programme entry criteria, staffing, integration with other services, and urine testing. Developments and trends during the decade 1980–1990 are discussed and implications for further research and programme development are presented.
Warlingham and Minnesota compared
Authors: Glatt M. M.
Published: January 2006

Abstract. The Minnesota Model approach used by private units during the past decade has come in for criticism because of various negative aspects. On the other hand it obviously also has many positive features. There are many similarities between the Minnesota approach and that of the NHS from the 1960s onwards, based largely on the 1952 Warlingham Park Hospital model. It should be possible to provide both NHS and private units which cut out the criticized aspects of the Minnesota Model whilst retaining its positive features. Community (outpatient) facilities should play a prominent part in all such units.
Switching on the work force–computerizing a drug team
Authors: CARNWATH TOM
Published: January 2006

Shortage of medical time and an increasing number of clients led to difficulties in handling the heavy prescribing load of a community drug team, A computer program was developed to help with this. The program was soon expanded and now plays a key role in the general administration of the team, and in data collection. Its enthusiastic use by team workers not accustomed to computers suggests that similar initiatives could play an important role in future research.
A short scale for predicting drug misuse using selected items from the MMPI
Authors: LAVELLE TARA , HAMMERSLEY RICHARD , FORSYTH ALASDAIR
Published: January 2006

The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 210 young people who either used no drugs, used non‐opioids, used opioids but did not inject and drug injectors. From the data collected a short scale of 37 items was derived which distinguished between non‐users and drug users. Validation was then attempted using 214 subjects who were either in drug treatment programmes or alcohol treatment programmes as well as appropriate control groups. The Drug Misuse Scale was able to distinguish between these groups. The MacAndrew Scale proved better at distinguishing subjects in alcohol treatment programmes. However, the Drug Misuse Scale proved to be significantly better at distinguishing the drug misusers. It is suggested that the Drug Misuse Scale may prove a valuable clinical tool.
Positive modification of injecting behavior among intravenous heroin users from Milan and Northern Italy 1987–1989
Authors: NICOLOSI ALFREDO , MOLINARI SILVIA , MUSICCO MASSIMO , SARACCO ALBERTO , ZILIANI NICOLETTA , LAZZARIN ADRIANO
Published: January 2006

The prevalence of risk behaviors in 933 intravenous drug users from Milan and other areas of Northern Italy was studied from 1 January 1987 to 18 April 1989. A preventive intervention, based on counseling with HIV antibody testing, was undertaken with i.v. drug users attending detoxication centers, and subjects were followed up in order to evaluate its effects. At enrollment all subjects reported heroin use, 18% also used cocaine and 6% morphine. Seventy‐two per cent reported sharing or having shared syringes, ‐with variation across geographical areas. Four hundred and sixty subjects were visited at least twice (mean follow‐up was 10.4 months): 30% of these stopped injecting altogether and the frequency of injecting as well as of syringe sharing decreased whereas no improvement was seen in sexual behaviour. Detoxication therapy, combined with HIV testing and counseling proved effective in reducing heroin assumption and the frequency of syringe sharing, whereas the prevalence of risk behaviors in i.v. drug users at recruitment over the years 1987–1988 showed no change, or even increased, despite of general information and health education campaigns against AIDS.
Can't treat, won't treat? Alcoholic liver disease
Authors: BIRD GEORGE
Published: January 2006

An alcohol intake of more than 35 units per week will predispose to alcoholic liver disease, although not all patients with alcohol‐induced liver damage have a dependency syndrome and only about 20% of those with an unremitting heavy alcohol intake will develop liver disease. In those with evidence of chronic liver disease, a liver biopsy is the most important investigation because it confirms the diagnosis and is indicative of the prognosis. Abstinence remains the mainstay of treatment and a multi‐disciplinary approach is the best way to achieve this in most cases. In patients with severe alcoholic hepatitis, specific therapies such as high dose corticosteroids and propylthiouracil have shown promising results but are still under evaluation. Liver transplantation has been used successfully in patients with recurrent complications arising from portal hypertension, but whether a minimum period of abstinence should be a requirement remains the subject of debate.
Tobacco prevention in hospitals needs prolonged and sustained effort From Hans Adriaanse & Jan van Reek (Rijksuniversiteit, Limburg).
Authors: Adriaanse Hans , Van Reek Jan
Published: January 2006

Abstract The smoking control, policy implemented at a Barcelona hospital over a 3‐year period resulted in a reduction of smoking in the hospital and a raised awareness of the exemplary role health professionals can have. However, participation by health professionals in the project decreased over the 3‐year period. Although reduced, the smoking rate in the hospital still is at a high level; this should trigger health professionals to further exploit their potential in smoking reduction efforts.
Hospital smoking policies: examples of good practice? From Amanda Amos (University of Edinburgh Medical School, Scotland).
Authors: Amos Amanda
Published: January 2006

Abstract Health services should be taking a lead in implementing smoking policies which promote smoke‐free environments for patients, visitors and staff, and ensure that patients and staff are provided with information and advice about smoking and how to give it up. Yet the evidence suggests that the implementation of such policies is patchy, particularly in countries where there are high smoking rates amongst health workers, including doctors. This article discusses, in the light of experience from Spain and the UK, some of the factors which are important in determining the success of such programmes. It is argued that such programmes will be of benefit to the future health of both patients and staff.
Tobacco prevention in hospitals: long‐term follow‐up of a smoking control programme
Authors: BATLLE ENRIC , BOIXET MERGE , AGUDO ANTONI , ALMIRALL JORDI , SALVADOR TERESA
Published: January 2006

This paper presents the results of a smoking control programme carried out in Sant Jaume i Santa Magdalena Hospital in Mataró (Barcelona, Spain) involving the entire hospital staff. The. general objective; of the programme were: (1) to reduce tobacco consumption among hospital staff and (2) to create an awareness of their exemplary role as health professionals. In order to achieve these aims, different activities were carried out: lectures on the consequences of smoking; restrictions on smoking in hospital areas; and smoking cessation kelp for those who wished to give up smoking. To measure the effectiveness of the intervention, a survey of smoking habits and attitudes among the hospital staff was conducted before the start of the programme in 1986 and repeated two and a half years later in 1989. The population studied in both surveys (n=298 and n=304) was similar by sex, age, and professional status. Regarding tobacco consumption there was the same proportion of never smokers, while the percentage of current smokers was reduced by 11 between the two surveys (51 to 40%), and the ex‐smokers group showed an increase (16 to 23%). These differences were significant. There was also a remarkable change in attitudes among the health professionals, especially with regard to their disposition to give advice to stop smoking. The results show a reduction of the prevalence of smoking among the hospital staff and a positive change in their attitudes towards smoking.
Symptoms and correlates of anabolic‐androgenic steroid dependence
Authors: BROWER KIRK J. , BLOW FREDERIC C. , YOUNG JAMES P. , HILL ELIZABETH M.
Published: January 2006

Forty‐nine male weight lifters, all users of anabolic‐androgenic steroids (AASs), completed an anonymous, self‐administered questionnaire to investigate addictive patterns of use. At least one DSM‐III‐R symptom of dependence was reported by 94% of the sample. Three or more symptoms, consistent with a diagnosis of dependence, were reported by 57%. Dependent users (n=28) could be distinguished from non‐dependent users (n=21) by their use of larger doses, more cycles of use, more dissatisfaction with body size, and more aggressive symptoms. Multiple regression analysis revealed that dosage and dissatisfaction with body size were the best predictors of dependent use. Patterns of other substances used, although not predictive of AAS dependence, revealed very low cigarette use and at the same time high alcohol consumption. These data support the notion that AASs are addicting, and suggest that dissatisfaction with body size may lead to dependent patterns of use. The implications for both prevention and treatment are discussed.
Letters to the Editor
Authors: Buckley Peter , Cannon Mary , Larkin Conall
Published: January 2006

The editor welcomes all letters whether they are short case reports, preliminary reports of research, discussion or comments on papers published in the journal. Authors should follow the same guidelines given for the preparation and submission of articles on the inside back cover of each issue.
Identification of alcohol‐related problems in a general hospital setting: a cost‐effectiveness evaluation
Authors: TOLLEY KEITH , ROWLAND NANCY
Published: January 2006

Alcohol is a major cause of morbidity and mortality. The prevention of alcohol problems would result in significant savings to the NHS and society. Screening is an important step in preventing problems. This study examines the costs of screening patients for alcohol problems. Over a 21‐month period doctors, nurses and a specialist worker screened medical and orthopaedic admissions to the York District Hospital. A cost‐effectiveness analysis of screening data was carried out. Costs were measured by time taken to screen and the relative costs of employing different occupational groups. Effects included the screening rates of each occupational group and those identified as at risk. Results suggested a greater positive case identification rate could be achieved by employing a specialist worker, but at greater cost. The cost‐effectiveness evaluation helps clarify the resource consequences of a screening programme and can be a useful aid in the decision‐making process.
Changing cocaine smoking rituals in the Dutch heroin addict population
Authors: GRUND JEAN‐PAUL C. , ADRIAANS NICO F. P. , KAPLAN CHARLES D.
Published: January 2006

Recently the use patterns, circumstances and consequences of cocaine have become of interest to both researchers and policy makers in Europe. Currently only a few studies have been conducted of the social epidemiology of cocaine. In this article, focus is placed upon the use of cocaine in one subpopulation, heroin addicts. Based mainly upon ethnographic research conducted in the city of Rotterdam it can be estimated that the prevalence of cocaine use in this population has reached a very high level. The mode of ingesting cocaine parallels that of heroin; Injecting Drug Users inject cocaine‐hydrochloride, heroin smokers smoke cocaine base. This cocaine base is mainly processed by users themselves. An exception to this rule of self‐processing can be found in the most marginalized addicts who do not have access to the house addresses where both heroin and cocaine‐hydrochloride are sold. In this group the selling of ‘cooked cocaine’, a crack‐like product, has occurred. The circumstances and potential consequences of the emergence of ‘cooked cocaine’ are discussed.
Intravenous drug use and HIV transmission amongst inmates in Scottish prisons
Authors: POWER K. G. , MARKOVA I. , ROWLANDS A. , McKEE K. J. , ANSLOW P. J. , KILFEDDER C.
Published: January 2006

The intravenous drug use behaviour and HIV risk reduction strategies used by a group of Scottish inmates prior to prison, during imprisonment and as expected after release was investigated. From a sample of 559 inmates (480 males and 79 females) 27.5% were involved in IVDU prior to imprisonment, 7.7% on at least one occasion during a period of imprisonment and 14.7% expected to do so after release. Prior to imprisonment 17,3% had shared needles, 5.7% at some time during imprisonment and 4.3% expected to do so after release. Some form of HIV risk reduction strategies were practised by the majority of IVDU inmates prior to imprisonment, during imprisonment and were expected to continue after release. The most at risk inmates were those who continued to share injecting equipment without reduction and without sterilizing. The reduction in IVDU and needle sharing during imprisonment in comparison to prior to imprisonment was paralleled by a self‐perceived reduction of personal risk from HIV during imprisonment.
The development of smoking in Finland from 1978 to 1990
Authors: RAHKONEN OSSI , BERG MARI‐ANNA , PUSKA PEKKA
Published: January 2006

The aim of this study was to analyse differences in smoking between men and women, and between different age groups of Finnish adults from 1978 to 1990. The data were collected by questionnaires from mail surveys of representative nationwide samples of 15–64–year‐olds from 1978, annually. Response rates varied between 68% (1985) and 86% (1978), averaging 79%. Those who were less than 20 years old were excluded from this study because smoking as a habit is well‐established in those aged 20 years and over. Male smoking decreased (from 37 to 33%) and female smoking increased (from 17 to 20%) during the study period. The proportion of smokers among the youngest men (20–29–year‐olds) had decreased clearly, and after the mid‐1980s the proportion of male smokers was highest in the middle‐age group (30–49–year‐olds). The proportion of smokers among the middle‐aged women increased, but the proportion of smokers was highest in the youngest age group. Gender difference in smoking was largest in the oldest age group.
Gender differences in alcohol consumption: effects of measurement
Authors: DAWSON DEBORAH A. , ARCHER LORAN
Published: January 2006

Data from a 1988 survey of US drinking habits and related problems revealed differences in male and female patterns of alcohol consumption. Men were more likely than women to be current drinkers (64 v. 41%), and beer accounted for a larger proportion of their overall intake. Men's average daily ethanol intake was about twice as high as that of women, 17.5 v. 8.9 g. Adjustment for differences in body weight and composition substantially reduced the male‐to‐female ratio of consumption. Men were more likely than women to be classified as heavy drinkers, and the excess proportion of males so categorized increased with the severity of the measure of heavy drinking.
A two‐year follow‐up study of alcohol dependent men rehabilitated at a special unit in a developing country
Authors: DE SILVA H. J. , PEIRIS M. U. P. K. , SAMARASINGHE D. S. , ELLAWALA N. S.
Published: January 2006

Two hundred and thirty‐four alcohol dependent men who had all failed to improve after previous hospital‐based interventions were admitted to an intensive 6‐week residential rehabilitation programme conducted at a special unit in Sri Lanka. Outcome was assessed at 2 years post‐treatment, and 36% of dependent persons remained totally abstinent. During an extended period of follow‐up (mean 39.2 months) a significant association was found between abstinence and having a life partner, stable family support, a higher income and regular employment. However, there was no significant association between abstinence and age, duration of alcohol dependence, level of education or type of employment. Although the majority of alcohol dependent persons did not benefit from the programme, our results compare favourably with those of similar studies done in developed countries.
Legislating responsible alcohol service: an inside view of the new Liquor Licence Act of Ontario
Authors: SINGLE ERIC , TOCHER BARRY
Published: January 2006

The Ontario Government has recently passed a new Liquor Licence Act, based on the recommendations of a special advisory committee. This paper describes how the advisory committee framed the issues and arrived at a lengthy document detailing 73 recommendations on issues such as licence classification, the control of special permit functions, days and hours of operation, legal drinking age, alcohol advertising, the civil liabilities of alcohol providers and server training. The key actors and considerations are discussed, as well as the subsequent Cabinet action on the report and the implementation process currently underway. The paper concludes with an assessment from both an administrative and a public health perspective, with particular attention to the limited role which research played in these policy decisions
The difference context makes: Americans' views on abstinence and impairment
Authors: TREND ANDREW J. , HENNESSY MICHAEL
Published: January 2006

While it is acknowledged that social norms play a role in determining acceptable drinking levels, there has been little research on the factors that determine approved or prohibited consumption levels in particular social contexts. This paper investigates the factors that influence the choice of abstention or impairment (as compared to ‘social drinking’) through an analysis of the 1984 survey of American drinking patterns using logistic regression, a method that allows the separate identification of social and demographic factors that encourage abstention or impairment. Results show that although the effects of drinking status variables (such as lifelong abstainer) are contextually neutral, most social and demographic characteristics have differential effects depending on the specific context and the choice of abstention or impairment.
The prevalence of illicit drug use in six metropolitan areas in the United States: results from the 1991 National Household Survey on Drug Abuse
Authors: HUGHES ARTHUR L.
Published: January 2006

National levels and trends of illicit drug use in the general population are well documented. However, little is known about how this phenomenon is distributed among various subnational areas such as state, metropolitan area, and other local areas. The sample design from the National Household Survey on Drug Abuse (NHSDA) was recently expanded such that estimates from several large metropolitan areas could be produced with reasonable precision. The prevalence of illict drug use is examined in six large metropolitan areas of the United States. These findings indicate that, in some cases, drug use varies considerably by metropolitan area.
Drug abuse research and HIV/AIDS: a national perspective from the US
Authors: SCHUSTER CHARLES R.
Published: January 2006

The National Institute on Drug Abuse (NIDA), the lead Federal agency charged with research on reducing the demand for illicit drugs in the US, has actively pursued the associated challenge of reducing drugs‐related HIV transmission. Drug abuse‐related spread of the virus occurs not only through sharing contaminated needles but also sexually to partners and perinatally from infected mothers to their offspring. Through a national research and demonstration program, NIDA supports primary AIDS risk reduction activities focused on identifying effective drug abuse prevention and treatment strategies. AIDS is increasingly a disease found in women, children, minorities, and people who live in rural areas. NIDA's efforts are clearly responsive to the changing nature of this epidemic. Among the many promising initiatives currently underway are a medications development program to find new pharmacotherapies for treating drug addiction; an array of National AIDS Outreach Demonstration Projects implementing alternative control strategies for drug abusers not attracted to or successful in drug abuse treatment; establishment of several treatment research units for designing and conducting studies on treatment effectiveness; and a variety of programs aimed at identifying and potentially reducing the risks of prenatal drug use to both mother and child. Effective dissemination of our findings is particularly critical to the overall impact of our research efforts. Collaborative activities teaming NIDA with a multitude of organizations also addressing AIDS related issues are designed to provide a synergistic impact on this complex and multifaceted public health crisis.
Drug use contexts and HIV‐consequences: the effect of drug policy on patterns of everyday drug use in Rotterdam and the Bronx
Authors: GRUND JEAN‐PAUL C. , STERN L. SYNN , KAPLAN CHARLES D. , ADRIAANS NICO F. P. , DRUCKER ERNEST
Published: January 2006

Epidemiological data on HIV seroprevalence has been essential in assessing the (future) extent of the AIDS epidemic. By coupling these data with quantifiable variables related to injection drug use (frequency of injecting, number of needle sharing partners) specific ‘risk behaviors’ could be determined, accounting for the rapid spread of the virus in the injecting drug user (IDU) population. Yet, such data give little information on the social mechanisms and setting generating such risk behaviors. In order to understand the transmission of HIV among the IDU population one needs to study the micro settings and social context of drug use. This paper describes and explores certain patterns of drug use, sharing, and natural support systems found amongst IDUs in two very different cities, Rotterdam (The Netherlands) and the Bronx, New York City (USA). By specifying details of the micro‐settings of everyday drug use in both locales, it is possible to identify certain common elements and consequences of personal and social behavior driven by drug use per se (e.g. drug preference), and to differentiate these from behaviors and consequences determined by drug policy and the social context in which drug use actually occurs. These policies and the social context they create can in turn be shown to relate to risks for HIV transmission, e.g. the increased likelihood of sharing injection equipment. A more careful ethnographic approach, taking advantage of natural experimental opportunities, comparisons and controls, may be utilized to examine drug‐related behaviors in their social context and to better assess their relevance to public health–especially to AIDS
Research and the help‐seeking process
Authors: HARTNOLL RICHARD
Published: January 2006

Recognition of changes in the nature and extent of problem drug taking in the early 1980s led to changes in service provision and to an increased interest in help‐seeking. The advent of AIDS accelerated these changes. This paper introduces concepts from the wider field of help‐seeking and compliance with preventive health measures. It reviews the major conclusions of studies of help‐seeking by problem drug takers, and identifies areas for further research. These include the need to ‘unpack’ the concept of ‘drug problems’ and to differentiate dimensions of needs in different individuals and populations; to evaluate attempts to make services attractive and accessible and to contact out‐of‐treatment groups; to assess the role of ‘significant others’; to understand the demands that changing service roles place on agency staff; and to give greater prominence to studies of the process of help‐seeking in terms of drug users' perceptions of their drug use, of problems, of risks and of services within the wider context of their lifestyles.
Alcohol and drug abuse treatment at the University of Connecticut Health Center
Authors: KADDEN RONALD , KRANZLER HENRY
Published: January 2006

This article describes a multidisciplinary team approach to the treatment of alcohol and drug dependence and comorbid disorders. The principal aim of this approach is the identification and treatment of patients' chemical dependence, as well as the medical and psychiatric disorders that contribute to and/or stem from the chronic use of alcohol and drugs. The focus of treatment is on the identification of high risk and other problem situations, training coping skills to handle these situations, developing insight, and enhancing patients' motivation for sobriety and ongoing treatment. In this article we describe the features of our program that address these various goals.
Test‐retest stability of cardiovascular and subjective responses to intravenous cocaine in humans
Authors: NAGOSHI CRAIG , KUMOR KAREN M. , MUNTANER CARLES
Published: January 2006

Sixteen male i.v. cocaine users were measured on their cardiovascular and subjective responses to placebo followed on a separate day by 40 mg i.v. cocaine injections. They were retested within 2 weeks, again receiving placebo and 40 mg i.v. cocaine injections in a random order on separate days. Significant increases in baseline (pre‐injection) heart rates during the later sessions were interpreted as possibly reflecting conditioning effects. There were no significant differences in post‐injection increases in cardiovascular or subjective responses between the initial and later 40 mg conditions, which might have been indicative of tolerance or sensitization development. Test‐retest correlations, indicative of response stability, were moderate to high for any particular timepoint for blood pressure, heart rate, and subjective responses, but pre‐ vs. post‐injection change scores were stable across testings on these measures only under placebo. With the possible exception of some subjective responses, there was little evidence of test‐retest stability in responses (change scores) to the 40 mg cocaine injection.
Establishment of a liaison service for pregnant opiate‐dependent women
Authors: DAWE SHARON , GERADA CLAIRE , STRANG JOHN
Published: January 2006

A pregnancy liaison and outreach service was developed as part of a community drug team to attract pregnant drug‐dependent women into treatment. Women were provided with information on harm reduction, safer drug use and offered treatment for drug dependence. In total, 43 women (45 pregnancies) presented to the service over a 30‐month period. Thirty‐four women began out‐patient treatment of opiate dependence. There was a significant reduction in maternal methadone dose by delivery. Of the 45 pregnancies, four women had therapeutic abortions, two first trimester and two second trimester spontaneous abortions and 34 live births (three women remained untraceable). All the pregnancies that continued to the third trimester proceeded uneventfully with a consequent live birth. Mean gestational age was 37.9 ±3.7 weeks, mean birth weight was 2863 ± 526 g, 10 of the babies were small for gestational age. Fifteen babies required medication for neonatal withdrawal symptoms; mothers whose babies exhibited withdrawal symptoms were using significantly higher doses of methadone at delivery than mothers whose babies did not withdraw. The importance of providing this type of service for women drug users in the 1990s is discussed.
Curative factors in alcohol and drug treatment: behavioral and disease model perspectives
Authors: MORGENSTERN JON , MCCRADY BARBARA S.
Published: January 2006

Unlike the general psychotherapy field which has been subjected to extensive process analysis, there are no systematic studies of treatment processes in the alcohol and drug treatment literature. As a necessary first step to study treatment process, the alcohol and drug literature was culled for references to treatment processes. Thirty‐five separate processes were identified and were broadly categorized as either disease model, behavioral or general psychotherapy processes. A national survey of treatment expert's views on treatment processes was conducted to determine whether certain processes would be considered as most important in the treatment of alcohol or drug problems. Results of this survey indicate that experts tend to rate certain processes as most important in the resolution of alcohol and drug problems. Results suggest that it is possible to identify core disease model and behavioral treatment processes. These processes might be used to assess the relative effectiveness of each therapeutic approach. Finally, results indicated that while disease model and behavioral experts tended to differ strongly on their ratings of the importance of some processes, there seems to be a trend toward integrating behavioral processes into a traditional disease model framework. The use of these results in constructing an instrument to measure processes used in alcohol and drug treatment is discussed.
Eating disorders and alcohol abuse in women
Authors: GOLDBLOOM DAVID S. , NARANJO CLAUDIO A. , BREMNER KAREN E. , HICKS LISA K.
Published: January 2006

Theory and empircal evidence support a relationship between the eating disorders (anorexia nervosa and bulimia nervosa) and alcoholism. This study examines the co‐prevalence and characteristics of these disorders among two populations of adult women: those presenting for treatment of alcoholism and those referred to a specialized eating disorders programme. Twenty‐two of 73 females (30.1%) with alcohol problems met psychometric cut‐off scores for eating disorder, while 25 of the 96 eating disorder females (26.9%) gave psychometric evidence of alcohol dependence. These rates exceed general population norms. While certain clinical and psychometric features distinguish subgroups with both disorders, the basis for co‐prevalence and the implications for treatment are unknown.
Do smokers of lower tar cigarettes consume lower amounts of smoke components? Results from the Scottish Heart Health Study
Authors: WOODWARD MARK , TUNSTALL‐PEDOE HUGH
Published: January 2006

Data on 1133 men and 1621 women who smoke solely cigarettes with a known tar yield are extracted from the baseline population survey of the Scottish Heart Health Study. The expired‐air carbon monoxide (CQ‐E), serum thiocyanate and serum cotinine values are compared between smokers in three tar groups: low (below 13 mg/cig.), middle (14–15 mg/cig.) and high tar (above 15 mg/cig.). An index of tar consumption is calculated assuming that the intake of different smoke components relative to one another is in proportion to their concentration in the smoke. CO‐E and cotinine are found to peak in the middle tar group. Thiocyanate only tends to increase from low to middle tar group for women and from middle to high tar group for men. Tar consumption increases with tar yield of the cigarette smoked, but the increase is much lower than would be expected. We conclude that the tar yield of a cigarette is not an accurate guide to the amount of smoke components consumed by its smoker. Health professionals should be aware of these limitations of tar yield as a measure of cigarette strength.