bluuebunny/crossref_metadata_2025 huggingface dataset:
Revising the preventive paradox: the Swiss case
Authors: Gmel Gerhard , Klingemann Sven , Müller Richard , Brenner Daniel
Published: March 2003

Aims. To examine Kreitman's preventive paradox of alcohol consumption and its revisions by Stockwell and colleagues and by Skog, with regard to alcohol‐related social harm in Switzerland, and to shed light on the reporting of alcohol‐related social harm in the low‐volume drinking, non‐bingeing subpopulation. The paper compares occurrence and severity of social harm in four subgroups defined by average consumption (volume) and binge drinking. Stage‐of‐change membership was used to further distinguish low‐risk drinkers who might have changed their drinking patterns from those who had not.

Design, setting, and participants. Telephone interviews were conducted with 1256 current drinkers of a probabilistic two‐stage sample of the general population of Switzerland. Moderate and hazardous mean consumption (volume) was defined by means of a quantity‐frequency instrument. Daily average consumption of 20 g was set as the cut‐off point for women, and 30 g for men. Binge drinking was defined as taking four or more drinks on an occasion for women, and five or more for men. Structural equation modelling was used to construct a severity scale of six alcohol‐related consequences: work problems, accidents and problems with the police, with friends, with a partner or with the family. Explanatory factor analysis was used to assign drinkers to motivational stages of change.

Findings. Moderate drinkers in terms of volume reported more problems than hazardous drinkers, which confirms Kreitman's view. Binge drinkers reported more problems than non‐binge drinkers, confirming the view of Stockwell and colleagues. Binge drinkers were more numerous in the moderate drinking group, which constituted the majority of drinkers, in accordance with Skog's view. Binge drinkers in the moderate‐volume and hazardous‐volume drinking groups did not differ significantly as to either severity or number of problems. Approximately 40% of moderate‐volume, non‐binge drinkers who reported alcohol‐related social harm had already changed their consumption pattern, which indicated that reported harm was related to an earlier drinking pattern.

Conclusions. As Skog has pointed out, the second‐order preventive paradox of binge drinking reappeared, in that most binge drinkers were found to occur in the drinker group with low average consumption. Findings also indicate that, with respect to social harm, a preventive strategy aimed at the majority of the population, but on heavy‐drinking occasions rather than on mean consumption, may be valuable.
Cognitive and behavioural factors as predictors of abstinence following treatment for alcohol dependence
Authors: Vielva Isabel , Iraurgi Ioseba
Published: March 2003

Aim. To assess how far causal attributions about abstinence and relapse, drinking self‐efficacy, drinking locus of control expectancy and coping behaviour discriminate abstainers from relapsers following treatment for alcohol dependence.

Design. A multicentre 6‐month follow‐up study.

Setting. Mental health centres and self‐help groups in Vizcaya (Spain).

Participants. The sample was formed by 201 alcoholics who were assessed at their centres and groups on two occasions: while they were in treatment and 6 months later.

Measurements. During treatment, participants completed several questionnaires related to cognitive and behavioural variables. Drinking problem and background variables were also assessed. Six months later their drinking status and treatment attendance were examined.

Findings. Multivariate tests showed that self‐efficacy expectancy and long previous time in abstinence independently discriminated alcoholics who maintained abstinence from those who did not. Other cognitive‐behavioural variables showed bivariate association with abstinence, but did not add predictive power to these two measures.

Conclusions. The results of this study are consistent with the extensive literature that confirms the predictor power of self‐efficacy. Unexpectedly, it did not find independent positive relationships between other psychological variables and abstinence. Given that self‐efficacy can predict outcome in the medium term, it is suggested that treatment could target this variable.
Determining the probability of future smoking among adolescents
Authors: Choi Won S. , Gilpin Elizabeth A. , Farkas Arthur J. , Pierce John P.
Published: March 2003

Aims. To determine whether the probability of future current established smoking among adolescents is related to both previous smoking experience and cognitions regarding future smoking.

Design, setting and participants. The analyses used two principal datasets: (1) a US longitudinal sample of 7960 adolescents 12‐18 years old in 1989 reinterviewed at 15‐22 years in 1993, (2) a California longitudinal sample of 3376 adolescents 12‐17 years old in 1993 reinterviewed at 15‐20 years in 1996.

Measures. Previous smoking experience was categorized as never smoked, puffed, non‐recent or recent experimenting, and non‐recent or current established smoking (≥ 100 cigarettes in life‐time). Smoking intentions and efficacy expectations were used to classify adolescents as having low‐ or high‐risk cognitions.

Findings. High‐risk cognitions (HRCs) increased the probability of future current established smoking (FCES) within each level of previous smoking experience over low‐risk cognitions (LRCs); the probability of FCES for those with LRCs was about the same as those in the previous experience group with HRCs. In the US sample, the 4‐year probability of FCES ranged from 5.6% for committed never smokers (with LRCs) to 83.0% for current established smokers with HRCs. Development of HRCs among middle‐school never smokers occurred rapidly through age 14 years. However, current established smoking did not increase until age 14 years and stabilized by age 19 years. Where sample size was sufficient, these findings were validated in the California sample.

Conclusions. Effective prevention programs should aim to convert HRCs to LRCs regardless of past behavior, particularly among middle‐school never smokers and high‐school experimenters.
Measuring alcohol consumption and alcohol‐related problems: comparison of responses from self‐administered questionnaires and telephone interviews
Authors: Kraus Ludwig , Augustin Rita
Published: March 2003

Aims. Compared with surveys using self‐administered questionnaires, telephone interviews generally yield higher coverage rates, have a lower proportion of missing values and result in fewer inconsistencies. Meta‐analyses, however, show that responses to sensitive questions by telephone tend to be biased by social expectations. The aim of the study is to examine whether responses on alcohol consumption and alcohol‐related problems differ with respect to mode of administration (self‐administered vs. telephone).

Design and participants. Data were analysed from the 1995 self‐administered survey among 6427 subjects and from telephone surveys conducted annually between 1994 and 1996 yielding a pooled sample of 6193 subjects.

Measurements. Alcohol consumption within the last 30 days was measured using a beverage‐specific quantity‐frequency index. For a summary measure responses were converted into pure alcohol (ethanol) per day and categorized into no alcohol consumption (0 g), non‐hazardous consumption (≤ 20 g for female and ≤ 40 g for males) and hazardous consumption (> 20 g for females and > 40 g for males). Alcohol‐related problems were assessed using the CAGE questionnaire with a cut‐off point of at least two positive responses.

Findings. Using (cumulative) logistic regression, a significant mode effect was found for both alcohol consumption and alcohol‐related problems. Lower beverage‐specific prevalences in the telephone mode were found to be responsible for the difference in the distribution of the summary consumption measure.

Conclusions. Results indicate that patterns of drinking and alcohol‐related problems are more easily reported in self‐administration questionnaires compared to telephone interviews.
Substance use and driving: the coexistence of risky and safe behaviors
Authors: Labouvie Erich , Pinsky Ilana
Published: March 2003

Aims. Two risky behaviors (driving after drinking/getting drunk, riding with drinking drivers) and two safe behaviors (deciding not to drive under the influence of alcohol (DUI), preventing someone else from DUI) were examined in relation to use frequency and friends' DUI to determine whether individuals tend to engage in both types of behaviors.

Design. Self‐report questionnaires were administered to a random sample of 1233 young adults in New Jersey (USA) on two occasions (mean age 21 and mean age 28). Structural equation modeling was used to assess the goodness of fit of a hypothesized model of cross‐sectional and longitudinal relationships.

Findings. Relationships between the four behaviors were strongly positive for men and women at both occasions and were substantially accounted for by use frequency and friends' DUI. At the later age, however, it was necessary to add non‐recursive pathways to the model, which were different for men and women.

Conclusions. Findings suggest that (1) riding with drinking drivers plays an important role in the maintenance of the other behaviors and (2) most individuals vacillate between risky and safe behaviors indicating that drinking contexts are best viewed as risky decision‐making situations requiring individuals to choose between riskier and safer courses of action.
Injectable opiate maintenance in the UK: is it good clinical practice?
Authors: Zador Deborah
Published: March 2003

This paper reviews the current practice of injectable opiate treatment (IOT) in the United Kingdom, i.e. the "British system" of prescribing injectable heroin and methadone, and considers some of the clinical and ethical issues it raises. There is very limited research evidence supporting either the safety or effectiveness of IOT as practised in Britain. In particular there is almost no evaluation of long‐term outcomes of IOT, which is of potential concern given the possibility of some patients remaining indefinitely in IOT, the risk of vascular complications, and its higher cost compared with oral maintenance. It would be easy to assess this controversial intervention as in need of further research. However, striving towards best practice in IOT involves more than generating evidence. The likelihood of a patient receiving IOT in the United Kingdom appears to be influenced more by the personal inclinations of prescribers than by outcome data (if any), or identified community needs for access to IOT. The author asks is this good clinical practice and is it sustainable? The "British system" needs to modernise itself consistent with international paradigms of continuous quality improvement, and the NHS's own agenda of clinical governance.
Street‐level drug law enforcement and entry into methadone maintenance treatment
Authors: Weatherburn Don , Lind Bronwyn
Published: March 2003

Aims. To test the hypothesis that drug law enforcement encourages entry into methadone maintenance treatment.

Design. Survey conducted as face‐to‐face interviews in methadone clinics, at needle exchange centres and on the street, in areas of widespread heroin dealing and use.

Setting. Sydney, Australia.

Participants. Heroin users.

Measurements. Self‐reported data on personal characteristics, and experience of drug law enforcement and methadone maintenance treatment.

Findings. Although keeping their relationship/family together emerged as the most important reason given by respondents for entering treatment, avoiding more trouble with police/courts was also rated by the majority of respondents as an important or very important reason for entering treatment. The results of logistic regression analysis show that, after controlling for other factors, heroin users who have had a friend or family member imprisoned are more likely to have tried methadone maintenance treatment. A heroin user's own experience of arrest and imprisonment was also found to increase the likelihood of having tried treatment but only when age and length of time as a regular user (which were related to the user's experience of arrest and imprisonment) were excluded from the set of control variables. Despite having extensive histories of contact with the police and criminal justice system, however, Asian, Middle Eastern and Aboriginal respondents showed less proclivity to enter treatment than Caucasian respondents.

Conclusion. Drug law enforcement may have a role to play in heroin demand reduction but its effects are not evident for all ethnic groups and the separate effects of contact with police, age and time spent in the heroin market remain unclear.
Prevalence of HIV and hepatitis B and self‐reported injection risk behavior during detention among street‐recruited injection drug users in Los Angeles County, 1994–1996
Authors: López‐Zetina Javier , Kerndt Peter , Ford Wesley , Woerhle Theresa , Weber Mark
Published: March 2003

Aims. To describe injection risk behaviors while in detention in a sample of injection drug users (IDUs) in Los Angeles County.

Design and setting. Cross‐sectional, interviewer‐administered, face‐to‐face risk survey, and serological screening for HIV and hepatitis B conducted at four street locations in Los Angeles County between 1994 and 1996. All interviews were conducted in a non‐institutionalized setting.

Measurements. Ascertainment of self‐reported risk behavior during detention and screening for HIV and hepatitis B surface antigen (HBsAg) and antibody to the core (HBcAb) seromarkers.

Participants. Six hundred and forty‐two participants were street‐recruited during the study period. Seventy‐one per cent of the sample was male, the median age was 43 years, 61% were African‐American, 27% were Latino, 8% were white and 36% considered themselves homeless.

Findings. Overall HIV prevalence was 3.0%; 3.1% tested positive for the hepatitis B surface antigen marker (HBsAg), and 80.3% for antibody to hepatitis B core antigen (HBcAb). After adjustment for length of injection drug use and recency of release from detention, HIV seroreactivity was significantly associated with history of detention due to possession of IDU paraphernalia (OR = 1.9). The presence of the hepatitis B HBcAb seromarker was associated with injection drug use while in detention, (OR = 1.7), and having been ever arrested for possession of IDU paraphernalia (OR = 1.8).

Conclusions. IDU detainees constitute a high risk group for blood‐borne infections. Comprehensive prevention and health promotion efforts in the community need to include correctional facilities.
Unsafe injecting practices among attendees of syringe exchange programmes in France
Authors: Valenciano Marta , Emmanuelli Julien , Lert France
Published: March 2003

Aims. To describe syringe exchange programme attendees and their injection practices.

Design. Crosssectional study (one week in 1998). Data were collected through a standardized questionnaire.

Setting. 60/74 syringe exchange programmes (SEPs) in France.

Participants. Clients requesting syringes in 60 SEPs.

Measurements. Self‐reports of drug use, injecting behaviour, sexual behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injecting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia.

Findings. 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% were males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20.8%. The mean duration of drug use was 11 years. Eighty‐five percent were polydrug users and buprenorphine high‐dosage was the substance most used (73%). In the previous month, 45% of the participants had re‐used a syringe, 93% injected at least daily (mean 3.6 injections per day), 18% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated with heroin and cocaine use and with living in a couple. The cluster analysis identified five categories of IDUs: users of buprenorphine‐HD (45% of the responders), morphine‐sulphate (17%), benzodiazepines and other legal drugs (13%), methadone associated with other legal drugs (13%) and crack‐cocaine (13%). The buprenorphine–HD group had better social status and safer injection practices.

Conclusions. In France, despite an increase in the accessibility to syringes and substitution treatments, unsafe injecting practices persist among SEP attenders. Interventions should stress the importance of using sterile material for each injection, even with a steady sex partner.
The association between substance use, unplanned sexual intercourse and other sexual behaviours among adolescent students
Authors: Poulin Christiane , Graham Linda
Published: March 2003

Aims. To determine the prevalence of high‐risk sexual behaviours and the influence of substance use and unplanned sexual intercourse on multiple sexual partners, inconsistent condom use and reasons for not always using condoms among adolescent students.

Design. A standardized self‐reported anonymous questionnaire administered to a representative sample of students.

Setting. The Canadian provinces of Nova Scotia, New Brunswick, Newfoundland and Labrador, and Prince Edward Island in 1998.

Participants. 9997 students in grades 9, 10 and 12 in the public school system. Measurements. Items on sexual intercourse, unplanned sexual intercourse, number of sexual partners, condom use, alcohol use, episodes of binge drinking and drunkenness, cigarette smoking and cannabis use.

Findings. About 37.5% of males and 39.7% of females reported having engaged in sexual intercourse in the 12 months prior to the survey. Of those, 68.0% of males and 61.5% of females reported having engaged in unplanned sexual intercourse, 40.9% of males and 32.1% of females reported having more than one sexual partner, and 49.9% of males and 64.1% of females reported inconsistent condom use. Unplanned sexual intercourse under the influence of alcohol or other drug was found to be an independent risk factor for multiple sexual partners and inconsistent condom use.

Conclusion. The demonstration of an association between substance use, unplanned sexual intercourse and other sexual behaviours lends support to a harm minimization approach, including the provision of non‐judgemental information and interventions addressing unplanned sexual intercourse under the influence of a substance.
The prevalence of alcohol, cigarette and illicit drug use in a stratified sample of English adolescents
Authors: Sutherland I. , Shepherd J. P.
Published: March 2003

Objectives. The aim of this study was to assess current levels of regular cigarette, alcohol and illicit drug use in adolescents in light of reported research by Goddard & Higgins (1999).

Design, setting, subjects. Survey of 9742 pupils (aged 11‐16) in a stratified sample of 28 schools in four Local Education Authority areas in Northern England, the Midlands and London. Data were collected during the latter part of 1999 and the first 3 months of 2000.

Measures. Respondents were asked confidentially about their use, and extent of use, of psychotropic substances (cigarettes, alcohol and illicit drugs).

Results. The prevalence of reported daily cigarette use rose from 4.8% at age 11 to 24.1% at age 16. More girls than boys smoked (13.7%, 9.5%, χ2 = 39.1,

p < 0.0001). Reported monthly use of alcohol rose from 5.1% at age 11 to 36% at 16. Alcohol was drunk more by boys than girls (16.4% and 12.8% respectively, χ2 = 23.0,

p < 0.0001) Reported monthly illicit drug use rose from 0.9% at age 11 to 14.5% at age 16. No overall differences were found between boys and girls.

Conclusions. The results confirm that rates of cigarette smoking, alcohol and illicit drug use rise rapidly in the early teenage years, with higher rates of smoking in girls and drinking in boys.
Public opinion on the health benefits of moderate drinking: results from a Canadian National Population Health Survey
Authors: Ogborne Alan C. , Smart Reginald G.
Published: March 2003

Aims. To explore beliefs about the health benefits of drinking alcohol in the Canadian population.

Design. Secondary analysis of data from a national population health survey.

Participants. Canadians age 12 or older (weighted

n = 72375) in all provinces but Alberta excluding those living in remote regions, native reserves and armed forces bases.

Measures. Responses to questions concerning the definition of moderate drinking and the belief that moderate drinking can be good for health. Self‐reports of age, gender, province of residence, quantity and frequency of drinking, health problems and indicators of alcohol dependence.

Findings. Fifty‐seven per cent of respondents believed that moderate drinking has health benefits. Forty‐seven per cent defined moderate drinking as drinking less than one drink a day and believed this to be good for health. Twelve per cent defined moderate drinking as one or more drinks a day and believed this is good for health. Belief in the health benefits of moderate drinking was more common among men, those age 45 or older, residents of Ontario and Quebec, more frequent drinkers and those with ischaemic heart disease. Those who believed in the health benefits of at least one drink a day were more often males, older persons and frequent, heavy drinkers.

Conclusions. Belief in the health benefits of moderate drinking is generally associated with a conservative definition of moderate drinking. However, some drinkers at risk for alcohol problems may be influenced to drink by the belief that this can have health benefits or use this belief as an excuse for drinking.
A meta‐analysis comparing buprenorphine to methadone for treatment of opiate dependence
Authors: Barnett Paul G. , Rodgers John H. , Bloch Daniel A.
Published: March 2003

Background. The unique pharmacological properties of buprenorphine may make it a useful maintenance therapy for opiate addiction. This meta‐analysis considers the effectiveness of buprenorphine relative to methadone.

Methods. A systematic literature search identified five randomized clinical trials comparing buprenorphine to methadone. Data from these trials were obtained. Retention in treatment was analyzed with a Cox proportional hazards regression. Urinalyses for opiates were studied with analysis of variance and a common method of handling missing values. A meta‐analysis was used to combine these results.

Results. Subjects who received 8‐12 mg/day buprenorphine had 1.26 times the relative risk of discontinuing treatment (95% confidence interval 1.01‐1.57) and 8.3% more positive urinalyses (95% confidence interval 2.7‐14%) than subjects receiving 50‐80 mg/day methadone. Buprenophrine was more effective than 20‐35 mg/day methadone. There was substantial variation in outcomes in the different trials.

Conclusions. The variation between trials may be due to differences in dose levels, patient exclusion criteria and provision of psychosocial treatment. The difference in the effectiveness of buprenorphine and methadone may be statistically significant, but the differences are small compared to the wide variance in outcomes achieved in different methadone treatment programs. Further research is needed to determine if buprenorphine treatment is more effective than methadone in particular settings or in particular subgroups of patients.
Factors affecting the initiation of substance abuse treatment in managed care
Authors: Weisner Constance , Mertens Jennifer , Tam Tammy , Moore Charles
Published: March 2003

Aims. A long‐standing concern of clinicians in addiction treatment is that a large number of individuals who are admitted to treatment do not return to actually begin the program. We identified characteristics that predict treatment initiation.

Design. In‐person structured interviews were conducted with consecutive admissions to a large outpatient program (N = 1204), and the health plan's automated registration data were used to determine treatment attendance. We compared those who returned to begin treatment with those who did not.

Setting. The study was conducted at the Chemical Dependency program of a large group model health maintenance organization (HMO).

Participants. Study subjects were individuals age 18 or over admitted to the program.

Measurement. Study variables included DSM‐IV alcohol and drug dependence and abuse, Addiction Severity Index problem severity, motivation and treatment entry measures.

Findings. Those who were drug‐dependent were less likely to begin treatment than those dependent only on alcohol. Measures of motivation, such as work‐place pressures and the patient's perception of the importance of alcohol treatment, predicted starting treatment for individuals who were alcohol‐dependent only or alcohol‐ and drug‐dependent. Among patients who were dependent only on alcohol, women were more likely than men to start treatment, and for those who were drug‐dependent, being employed and having higher drug severity scores predicted starting treatment.

Conclusions. Screening at intake may identify those at risk of not returning after admission to start treatment. Clinicians may consider making additional efforts during the intake process to engage individuals who are unemployed and have drug (as opposed to alcohol) disorders and less motivation.
Causes of death of patients with substance dependence: a record‐linkage study in a psychiatric hospital in Taiwan
Authors: Chen Chiao‐Chicy , Kuo Chian‐Jue , Tsai Shang‐Ying M.
Published: March 2003

Aims. The causes of death among a series of patients with substance dependence were investigated.

Setting. A psychiatric teaching hospital in Taipei, Taiwan (Taipei City Psychiatric Center).

Participants. A total of 1698 patients with various diagnostic categories of substance dependence, who had been admitted to TCPC for detoxification were followed‐up from 1985 to 1996.

Design. A record‐linkage study was performed using the patient's national identification number to link between TCPC chart records and the mortality file compiled by the National Department of Health. Risk factor analyses for mortality included socio‐demographic data, clinical diagnosis and cause of death.

Findings. A total of 141 patients died during the study period. Among them, 83 had a diagnosis of alcohol dependence, 41 of heroin dependence and the remaining 17 cases of sedative, glue or hallucinogen dependence. The annual mortality rate of patients with heroin dependence was 1.94%. Accidental death is the leading cause of death among patients with heroin dependence. However, the patients with alcohol dependence had a higher mortality risk than those with heroin dependence (relative hazard = 1.91,

p < 0.001) in this study. The proportion of non‐violent death was significantly higher among the patients with alcohol dependence than those with heroin dependence (

p < 0.005).

Conclusion. The causes of death among patients with substance dependence found in this Taiwanese series were very similar to those reported in the western literature. However, differences included the absence of death among heroin addicts due to HIV‐related disease and a markedly high percentage of alcoholic patients who died of liver diseases.
Cannabis use and dependence among Australian adults: results from the National Survey of Mental Health and Wellbeing
Authors: Swift Wendy , Hall Wayne , Teesson Maree
Published: March 2003

Aims. To examine: (i) the prevalence of cannabis use and DSM‐IV cannabis dependence among Australian adults, and (ii) correlates of level of cannabis involvement.

Design. Cross‐sectional survey assessing substance use and DSM‐IV substance use disorders (abuse and dependence).

Setting and participants. A household survey of a nationally representative sample of 10 641 Australians aged 18 years and older.

Measurements. Trained interviewers administered a structured, modified version of the Composite International Diagnostic Interview (CIDI).

Findings. In the past 12 months, 2.2% (95%CI:1.8, 2.6) of adults were diagnosed with DSM‐IV cannabis use disorder, comprising cannabis dependence (1.5%; 95%CI: 1.2, 1.8) and cannabis abuse (0.7%, 95%CI: 0.6, 0.8). Almost one‐third of cannabis users (31.7%; 95%CI: 27.7, 35.7) met criteria for cannabis dependence (21%; 95%CI: 16.7, 25.3) and abuse (10.7%; 95%CI: 8.0, 13.4). Multinomial logistic regression revealed that compared to non‐dependent cannabis users, non‐users were more likely to be female, aged 25 + years, out of the labour force and married/

de facto, and displayed lower levels of co‐morbidity. In contrast, dependent cannabis users were more likely to be 18‐24 years old, unemployed, and displayed higher levels of co‐morbidity than non‐dependent users.

Conclusions. Cannabis use disorders affect approximately 300 000 Australian adults. A better understanding of the factors associated with cannabis dependence may help identify groups who have difficulties controlling use and aid the development of strategies for reducing cannabis‐related harm.
In and out of the K‐hole: a comparison of the acute and residual effects of ketamine in frequent and infrequent ketamine users
Authors: Curran H. Valerie , Monaghan Lisa
Published: March 2003

Aims. Ketamine, a non‐competitive NMDA receptor antagonist, produces acute impairments of working, episodic and semantic memory along with psychotogenic and dissociative effects when a single dose is given to healthy volunteers. In recreational users, Curran & Morgan (2000) showed that ketamine produced the same acute effects but that 3 days after ingestion, ketamine users showed persisting memory impairment and elevated psychotogenic symptoms compared with controls. To explore whether such persisting effects reflect chronic effects of ketamine use, the present study compared frequent with infrequent users of ketamine on the night of drug use and again 3 days later.

Design and participants. Eighteen frequent and 19 infrequent ketamine users were assessed on each test day on a range of cognitive tasks tapping memory and attentional function and on subjective scales (schizotypal symptomatology, dissociation, mood).

Findings. Groups were broadly matched for polydrug use apart from ketamine which frequent users took significantly more often and in larger quantities than infrequent users. Acute effects on day 0 replicated previous findings. On day 3 frequent users showed significant impairments on tasks tapping episodic and semantic memory but there was no evidence of persisting dissociative or schizotypal symptoms.

Conclusion. These findings indicate that frequent use of ketamine produces long‐lasting impairments in episodic memory and aspects of retrieval from semantic memory. Such effects accord with animal evidence of the effects of NMDA receptor blockade on memory. Those using, or contemplating using ketamine should be informed of these persisting, detrimental effects of the drug upon human memory.
Ways of coping and the health of relatives facing drug and alcohol problems in Mexico and England
Authors: Orford Jim , Natera Guillermina , Velleman Richard , Copello Alex , Bowie Nadia , Bradbury Colin , Davies Jill , Mora Jasmín , Nava Adriana , Rigby Kate , Tiburcio Marcela
Published: March 2003

Aims. To compare two contrasting socio‐cultural groups in terms of parameters relating to the stress ‐ coping ‐ health model of alcohol, drugs and the family, and to test hypotheses derived from the model in each of the two groups separately.

Design. Cross‐sectional, comparative and correlational, using standard questionnaire data, supplemented by qualitative interview data to illuminate the findings.

Participants. One hundred close relatives, mainly partners or parents, from separate families in Mexico City, and 100 from South West England.

Data sources. Coping Questionnaire (CQ), Family Environment Scale (FES), Symptom Rating Test (SRT), Semi‐structured interview.

Findings. Mean symptom scores were high in both groups, and not significantly different. The hypothesis that relatives in Mexico City, a more collectivist culture, would show more tolerant ‐ inactive coping was not supported, but there was support for the prediction that relatives in South West England would show more withdrawal coping. This result may be as much due to differences in poverty and social conditions as to differences in individualism ‐ collectivism. As predicted by the stress ‐ coping ‐ health model, tolerant ‐ inactive coping was correlated with symptoms, in both groups, after controlling for family conflict, but there was only limited support for a moderating role of coping. Wives of men with alcohol problems in Mexico City, and wives of men with other drug problems in South West England, reported particularly high levels of both engaged and tolerant ‐ inactive coping.

Conclusions. Tolerant ‐ inactive coping may be bad for relatives' health: causality may be inferred but is not yet proved. Certain groups are more at risk of coping in this way. Qualitative data help understand the nature of tolerant ‐ inactive coping and why it occurs despite the view of relatives themselves that it is counter‐productive.
Attention Deficit Hyperactivity Disorder and substance use disorders: is there a causal link?
Authors: Lynskey Michael T. , Hall Wayne
Published: March 2003

Attention‐deficit hyperactivity disorder (ADHD), characterized by restless, inattentive and hyperactive behaviours, is a relatively common childhood disorder that affects approximately 5% of the general population. There has been controversy about whether ADHD increases risks of developing substance use disorders. The available evidence suggests that, in the absence of conduct disorder, ADHD is not associated with an increased risk of substance use problems in males. There is only limited evidence on the role of ADHD in the aetiology of substance use disorders among females. While ADHD has traditionally been considered as a childhood disorder, it may also occur in adults; research needs to examine the extent to which ADHD in adulthood increases the risk of substance use disorders.
Psychopathology in adolescence predicts substance use in young adulthood
Authors: Ferdinand Robert F. , Blüm Marije , Verhulst Frank C.
Published: March 2003

Aims. To investigate prospective associations between psychopathology in adolescence and tobacco, alcohol and drug use in young adulthood.

Design. A sample of 787 10‐14‐year‐olds from the Dutch general population was prospectively followed‐up across an 8‐year interval. The Child Behavior Checklist (CBCL) was administered at initial assessment, and at 2‐ and 4‐year follow‐ups. Substance abuse was assessed with the Young Adult Self‐Report (YASR) at 8‐year follow‐up.

Findings. The Thought Problems scale of the CBCL was the strongest predictor of alcohol use, while smoking was predicted by the Thought Problems and Delinquent Behavior scales. The strongest association with drug use in young adulthood was for the CBCL Delinquent Behavior scale. Predictive value of predictors in early adolescence was as important as in late adolescence.

Conclusion. To investigate pathways towards substance use in young adulthood, studies assessing a broad range of possible predictors, including Thought Problems, at different developmental stages of adolescence, are needed.
Saliva cotinine as indicator of cigarette smoking in pregnant women
Authors: Owen Lesley , McNeill Ann
Published: March 2003

Objective. To assess use of saliva cotinine as a quantitative objective index of smoking in pregnant women .

Design. National survey using quota sampling of pregnant women in England. Face‐to‐face interviews were conducted in the respondents' own homes .

Setting. Respondents' homes.

Participants.

N = 1009 pregnant women, mean age = 27.9 years.

Main outcome measures. Saliva cotinine and current smoking status.

Results. Saliva cotinines revealed under‐reporting among pregnant women by about 3%.

Conclusions. Pregnant women under‐report current smoking status. The optimal cut‐off point for validating smoking status among this group requires further research. The results also highlight the need for an improved understanding of the effects of pregnancy on the metabolism of nicotine.
Influence of hepatitis C status on alcohol consumption in opiate users in treatment
Authors: McCusker Monica
Published: March 2003

Aims. To estimate the prevalence of (a) hazardous and/or harmful drinking, (b) alcohol consumption, (c) perceived hepatitis C status (HCV) in opiate users in treatment and (d) assess the influence of perceived HCV status on consumption and attitudes to risk.

Design. Cross‐sectional survey.

Setting. A methadone maintenance clinic and a drug treatment centre within a British substance misuse service in London.

Participants. A random sample of 93 opiate users in treatment .

Measurements. Hazardous and/or harmful drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Alcohol consumption was assessed using several indicators. Data on clinical and demographic characteristics, perceived HCV status, change in consumption and attitudes to alcohol consumption were also collected.

Findings. A third of the sample were identified as AUDIT cases, 17% drank more than one unit/day and 15% were drinking above the weekly, recommended units for safe drinking (21 for men, 14 for women). Perceived HCV positive status was estimated at 70%. HCV status influenced consumption with fewer HCV positive than HCV negative clients drinking any alcohol in the previous year. Also, more HCV positive clients than HCV negative clients, reduced their consumption after the HCV test result. HCV status had some influence on attitudes to drinking for HCV positive people, although most were aware that abstinence was important for those with HCV positive status.

Conclusion . Perceived HCV positive status has some influence on alcohol consumption. Despite these findings, training on harm reduction advice on alcohol consumption, particularly in HCV positive clients, should be extended. More intense interventions, within drug treatment services, may be required for those drinkers for whom advice is insufficient.
Marijuana Craving Questionnaire: development and initial validation of a self‐report instrument
Authors: Heishman Stephen J. , Singleton Edward G. , Liguori Anthony
Published: March 2003

Aims. To develop and validate a multi‐dimensional questionnaire on marijuana craving.

Design and measurements. Current marijuana smokers (

n = 217) not seeking treatment completed a 47‐item Marijuana Craving Questionnaire (MCQ) and forms assessing demographics, drug use history, marijuana quit attempts and current mood.

Findings. Exploratory and confirmatory factor analyses indicated that a four‐factor solution best described the item structure. Factor subscales derived from the 17 items with significant loadings had respectable internal consistencies and were stable across settings and subgroups. The subscales exhibited low to moderate, positive intercorrelations and were significantly correlated with marijuana use history and a wide range of single‐item measures of craving.

Conclusions. Findings suggested that four specific constructs characterize craving for marijuana: (1) compulsivity, an inability to control marijuana use; (2) emotionality, use of marijuana in anticipation of relief from withdrawal or negative mood; (3) expectancy, anticipation of positive outcomes from smoking marijuana; and (4) purposefulness, intention and planning to use marijuana for positive outcomes. These data indicate that the MCQ is a valid and reliable instrument for assessing marijuana craving in individuals not seeking drug abuse treatment and that marijuana craving can be measured in the absence of withdrawal.
Adolescent emergency department presentations with alcohol‐ or other drug‐related problems in Perth, Western Australia
Authors: Hulse Gary K. , Robertson Suzanne I. , Tait Robert J.
Published: March 2003

Aims. To identify the morbidity, type of substance used and the pattern of presentation by adolescents with problems related to alcohol or other drug (AOD) use.

Design. A 4‐week retrospective review of hospital records.

Setting. Four metropolitan hospitals in Perth, Australia.

Participants. There were 1064 presentations by people aged 12‐19 years of which 160 (15%) were related to AOD use. The median age of the AOD cases was 17 (interquartile range 16‐19) of whom 97 (61%) were male and 19 (12%) were Indigenous Australians.

Findings. Alcohol was the most frequent precursor to presentation (66, 41%) followed by heroin (24, 15%) and prescription/over‐the‐counter drugs (24, 15%). Injury was the most common diagnosis at presentation (50, 31%), followed by overdose/drug use (47, 29%). A diagnosis of injury was significantly more likely following the use of alcohol than other categories of substances (χ2 = 42.07, df = 3, p < 0.001). Deliberate self‐harm (DSH) occurred in more female than male cases (χ2 = 7.4, df = 1, p < 0.01). Presentations were more frequent over the weekend (102, 64%) than on weekdays, and the length of stay was significantly shorter for weekend cases (Mann‐Whitney U 2132, p < 0.05).

Conclusions. Given the small window of opportunity to provide AOD treatment to youth following hospital presentation, a number of suggestions are made. From a harm‐minimization perspective the focus of interventions should be on alcohol use by male youth and DSH associated with prescription/over‐the‐counter drug use by female adolescents. In addition, Indigenous youth are over‐represented in hospital presentations, but there is currently a lack of evaluated interventions designed for them.
Aggregate time‐series regression in the field of alcohol
Authors: Rehm Jürgen , Gmel Gerhard
Published: March 2003

Time‐series regression of successive aggregate data has been used widely to explore relationships between substance use and harm, or to measure effects of policy interventions. This paper suggests minimal standards to conduct such analyses with respect to validity and reliability of underlying data, statistical techniques and requirements and interpretation of results.
Alcohol consumption and binge drinking in Novosibirsk, Russia, 1985–95
Authors: Malyutina Sofia , Bobak Martin , Kurilovitch Svetlana , Ryizova Eva , Nikitin Yuri , Marmot Michael
Published: March 2003

Aims. It has been suggested that the effects of alcohol, and binge drinking in particular, contributed to the dramatic fluctuations in Russian mortality rates: rapid decline in 1985‐87, slow increase in 1988‐91 and sharp increase in 1992‐94. To date, there have been no data available to substantiate this claim. We examine for the first time the trends in alcohol intake and binge drinking in a Russian urban population.

Methods. Independent random samples of men and women aged 25‐64 in two districts of Novosibirsk city (Western Siberia) have been examined in 1985/86 (1535 men and 1296 women), 1988/89 (1700 men, no women), and 1994/95 (1539 men and 1511 women). Response rates ranged from 71% to 73%. The subjects reported frequency of drinking alcohol, average amount of alcohol consumed at a typical occasion, and their alcohol intake in the week preceding the interview. Two cut‐off points to define binge drinking were adopted: ≥ 80 g and ≥ 120 g at a single occasion.

Results. The proportion of men who drank at least once a week increased from 27% in 1985/86 to 38% in 1994/95; corresponding figures among women were 0.6% and 6.5%, respectively. The mean consumption of pure alcohol at a single occasion in men was 90 g in 1985/86, 119 g in 1988/89 and 112 g in 1994/95; in women, it was 33 g in 1985/86 and 32 g in 1994/95. Between the first and the last survey, the mean weekly intake of pure alcohol increased from 120 g to 184 g in men and from 31 g to 41 g in women. Prevalence rates of binge drinking (≥ 80 g at least once a month) in the three surveys were 36%, 52% and 51%, respectively, in men, and 0.4% in the first and 5% in the last survey among women.

Conclusion. Alcohol consumption and prevalence of binge drinking were high in men and low in women. The frequency of binge drinking among men increased between 1985/86 and 1988/89 and remained stable between 1988/89 and 1994/95. This is not consistent with trends in mortality. Shorter‐term fluctuations between surveys, however, cannot be excluded.
Heroin overdose: causes and consequences
Authors: Warner‐Smith Matthew , Darke Shane , Lynskey Michael , Hall Wayne
Published: March 2003

Over the past decade fatal opioid overdose has emerged as a major public health issue internationally. This paper examines the risk factors for overdose from a biomedical perspective. While significant risk factors for opioid overdose fatality are well recognized, the mechanism of fatal overdose remains unclear. Losses of tolerance and concomitant use of alcohol and other CNS depressants clearly play a major role in fatality; howeve, such risk factors do not account for the strong age and gender patterns observed consistently among victims of overdose. There is evidence that systemic disease may be more prevalent in users at greatest risk of overdose. We hypothesize that pulmonary and hepatic dysfunction resulting from such disease may increase susceptibility to both fatal and non‐fatal overdose. Sequelae of non‐fatal overdose are recognized in the clinical literature but few epidemiological data exist describing the burden of morbidity arising from such sequelae. The potential for overdose to cause persisting morbidity is reviewed.
Attrition prevention with individuals awaiting publicly funded drug treatment
Authors: Donovan Dennis M. , Rosengren David B. , Downey Lois , Cox Gary B. , Sloan Kevin L.
Published: March 2003

Aims. To evaluate the effectiveness of a motivational intervention to reduce attrition from a waiting list for substance abusers seeking publicly funded treatment.

 Design. Randomized clinical trial comparing an "attrition prevention" condition to standard care while awaiting treatment admission.

 Setting. A centralized substance abuse assessment and referral center in Seattle, Washington.

 Participants. Substance abusers (n = 654) eligible for publicly funded drug abuse treatment.

 Measurements. Alcohol and drug use, substance‐related negative consequences, areas in need of help, perceived need for help, emotional status, readiness to change, reasons for seeking and perceived barriers to entering treatment.

 Findings. Overall, approximately 70% of clients entered treatment, and of these approximately 70% completed their assigned treatment. Those who entered treatment showed significant reductions in substance use and improved psychosocial function at a short‐term 3‐month follow‐up. However, the attrition prevention intervention had no differential effect on treatment entry, completion or outcome compared to the standard waiting list. Further, there were no differences across therapists on these outcome measures.

 Conclusions. A motivational attrition prevention intervention did not enhance treatment entry, completion or outcome among treatment‐seeking substance abusers. It is suggested that alternative strategies, such as contingency management and case management, may help facilitate treatment entry for individuals seeking publicly funded treatment.