bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing behavioural pattern of drug users in Hong Kong 1991‐1995
Authors: Lee S. S. , Hollinrake J. B. , Ng M. H.
Published: March 2003

Aims. To analyse the temporal changes in demography and drug‐taking behaviours of a cohort of drug users in Hong Kong . Design. An analysis of records of clients over a 5‐year period . Setting. Shek Kwu Chau Treatment and Rehabilitation Centre, a large residential service offering voluntary rehabilitation programmes for male drug users in Hong Kong . Measurements. The following parameters were analysed for all admissions between 1991 and 1995: duration of drug‐taking, route(s) of drug administration, type of drugs abused, practice of injection and needle‐sharing, time since last needle‐sharing, and expenditure on drugs . Findings. A total of 10 353 admissions were recorded in the 5‐year period from 1991 to 1995, of whom 2853 (27.6%) were new admissions. The mean age was 36 years. There was a significant increase in new admission in those between the age of 13 and 19. Almost all clients were heroin users. The needle‐sharing rates fell from over 20% in 1991 to 5% in 1995. Needle‐sharing was more common in younger clients. The decline in the rate of needle‐sharing was especially significant in those between the age of 20 and 39 . Conclusion. The proportion of young drug users in the study population in Hong Kong has risen over the 5‐year period. The prevalence of high‐risk drug‐taking behaviours had declined, which might have contributed to the low HIV rates in the community.
The relationship between ethnicity, gender and alcohol consumption: a strategy for testing competing models
Authors: Johnson Patrick B. , Glassman Marc
Published: March 2003

Aim. This study tested mediator, moderator and main effects models to determine the pattern of relationships between ethnicity, gender, temperament, and alcohol use . Design. A large‐scale survey was employed. Respondents were interviewed in their homes. Participants were 523 Puerto Rican and 490 Irish American adults residing in the New York metropolitan area . Measures. Quantity and frequency of alcohol consumption were assessed with standard measures, and recent drinking problems with the substance abuse module of the Composite International Diagnostic Instrument . Findings. Rather than supporting a complex, nested model, the findings supported a main effects model and indicated that each of the three predictors was related to one or more drinking measure. While gender strongly influenced each drinking behavior, ethnicity only influenced frequency, and temperament only influenced recent drinking problems . Conclusions. The results support previous studies indicating consistent male‐female drinking differences while highlighting a statistical strategy for comparing competing models of ethnic drinking behavior.
Problems encountered with opportunistic screening for alcohol‐related problems in patients attending an Accident and Emergency department
Authors: Peters Jean , Brooker Charlie , Mccabe Chris , Short Neil
Published: March 2003

Aims. To assess the value of opportunistic screening in Accident and Emergency (A&E) for patients with alcohol‐related problems and provision of an intervention . Design. Screening of A&E attendees for the purpose of recruitment to a randomized trial of a counselling intervention . Setting. A General Hospital A&E department . Participants. All 17 000 adult A&E attendees, during a 6‐month period and all nursing staff working within the department . Measurements. Patients' self‐reported alcohol consumption, responses to the CAGE questionnaire (four questions designed to identify problem drinking) and proportions offered, and taking up offer of help . Findings. Only 4663 (28%) adult attendees at A&E were actually screened and of these 2% declined and 25% were judged unable to answer. Of the rest, 86% drank alcohol, with 22% drinking in excess of current guidelines or with two or more positive answers to CAGE. Only 41% (264) of those drinking to excess were offered help and 88% of these declined it. This left 13 patients to be included in the trial . Conclusion. There is a significant need for an effective intervention in this area but considerable barriers exist to testing the efficacy of potential screening strategies and interventions.
Historical perspectives on the shifting boundaries around youth and alcohol. The example of pre‐industrial England, 1350‐1750
Authors: Warner Jessica
Published: March 2003

This study identifies some of the factors that account for why young males are permitted to drink in some cultures and not in others. The primary materials consulted in this study suggest that in the case of pre‐industrial England the same norms governed both adult and juvenile access to alcohol in the late medieval period, and that separate standards for adults and juveniles only emerged some time after 1500. The materials also suggest that the norms governing juvenile access to alcohol were at their most restrictive when adult and juvenile labour were both in low demand, and when childhood was a state from which an individual exited at an early age, but adulthood was a status that was postponed for a large proportion of the population. Apparent changes in the norms governing juvenile access to alcohol also coincided with two other developments in the early modern period. These were: (1) the gradual transformation of drinking into an essentially recreational activity conducted outside the home and among groups consisting largely or entirely of males; and (2) the introduction of new and potentially more intoxicating alcoholic beverages, first in the form of beer, and later in the form of cheap spirits distilled from grain.
Experience of non‐fatal overdose among heroin users in Adelaide, Australia: circumstances and risk perceptions
Authors: Mcgregor Catherine , Darke Shane , Ali Robert , Christie Paul
Published: March 2003

Abstract Aims. To ascertain the prevalence and risk factors for non‐fatal overdose among heroin users to assist in the development of an effective intervention. Design. Cross‐sectional design. Setting. Community setting, principally metropolitan Adelaide. Participants. Current heroin users (used heroin in the previous six months). Measurements. A structured questionnaire including the Severity of Dependence Scale. Finding. Of 218 current South Australian heroin users interviewed in 1996, 48% had experienced at least one non‐fatal overdose their life‐time (median: two overdoses), and 11% had overdosed in the previous 6 months. At some time, 70% had been present at someone else's overdose (median: three overdoses). At the time of their own most recent overdose, 52% had been using central nervous system depressants in addition to heroin, principally benzodiazepines (33%) and/or alcohol (22%). The majority of overdoses occurred in a private home (81%) and in the presence of other people (88%). Unrealistic optimism regarding the risk of overdose was evident across the sample. Despite almost half the sample reporting having had an overdose, and the belief expressed by respondents that on average about 50% of regular heroin users would overdose during their life‐time 73% had, during the previous 6 months, "rarely" or "never" worried about possibly overdosing. Optimism regarding the possibility of future overdose was reduced in those with recent experience of overdose in comparison to the rest of the sample. A targeted intervention aimed at the reduction of overdose among heroin users is outlined.
Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram
Authors: Carroll Kathleen M. , Nich Charla , Ball Samuel A. , Mccance Elinore , Rounsavile Bruce J.
Published: March 2003

Aims. To evaluate disulfiram and three forms of manual guided psychotherapy for individuals with cocaine dependence and concurrent alcohol abuse or dependence. Design. Randomized controlled trial. Setting. Urban substance abuse treatment center. Participants. One hundred and twenty‐two cocaine/alcohol abusers (27% female; 61% African‐American or Hispanic). Interventions. One of five treatments delivered over 12 weeks: cognitive behavioral treatment (CBT) plus disulfiram; Twelve Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT plus no medication; TSF plus no medication. Measurements. Duration of continuous abstinence from cocaine or alcohol; frequency and quantity of cocaine and alcohol use by week, verified by urine toxicology and breathalyzer screens. Findings. Disulfiram treatment was associated with significantly better retention in treatment, as well as longer duration of abstinence from alcohol and cocaine use. The two active psychotherapies (CBT and TSF) were associated with reduced cocaine use over time compared with supportive psychotherapy (CM). Cocaine and alcohol use were strongly related throughout treatment, particularly for subjects treated with disulfiram. Conclusions. For the large proportion of cocaine‐dependent individuals who also abuse alcohol, disulfiram combined with outpatient psychotherapy may be a promising treatment strategy. This study underlines (a) the significance of alcohol use among treatment‐seeking cocaine abusers, (b) the promise of the strategy of treating co‐morbid disorders among drug‐dependent individuals, and (c) the importance of combining psychotherapy and pharmacotherapy in the treatment of drug use disorders.
Impaired Control Scale: cross‐validation and relationships with treatment outcome
Authors: Heather Nick , Booth Peter , Luce Anna
Published: March 2003

Aims. (1) To cross‐validate Australian findings on the Impaired Control Scale (ICS) in an English sample of problem drinkers. (2) To examine a possible improvement to the scoring of the ICS. (3) To explore the relationship of the ICS to treatment outcome . Design. In a repeated measures design, questionnaires and interviews were administered by trained staff during treatment and again at 6 months follow‐up . Setting. Two alcohol and drug treatment services in Newcastle and Liverpool (UK) . Participants. Two hundred and twenty‐nine problem drinkers attending as in‐ or outpatients, with abstinence or moderation treatment goals . Measurements. ICS scores; typical weekly alcohol consumption (units); degree of alcohol‐related problems; severity of alcohol dependence; and classification of outcome using consumption levels and current alcohol‐related problems, with collateral confirmation of self‐reports . Findings. The satisfactory reliability and validity of the ICS was confirmed in an English sample of problem drinkers in treatment. An improved "substitution method" of scoring was developed to give a single measure of impaired control for all subjects irrespective of degree of attempted control. ICS scores were significantly correlated with treatment outcome and, among a subgroup of subjects who had aimed at abstinence but failed, predicted outcome status after the effects of degree of dependence had been extracted . Conclusions. Impaired control over alcohol consumption can be measured in a reliable and valid fashion by the ICS. The ICS has potential uses in research on impaired control and as a clinical assessment tool.
A randomized controlled trial of a "buddy" system to improve success at giving up smoking in general practice
Authors: West Robert , Edwards Martin , Hajek Peter
Published: March 2003

Aims. To assess the effect on abstinence rates of pairing up smokers attending a general practice smokers, clinic to provide mutual support between clinic sessions. Design. Randomized controlled trial comparing a "buddy" condition with a "solo condition" in which smokers received the same treatment but were not paired up. Setting. A general practice smokers' clinic in London. Participants. One hundred and seventy‐two smokers recruited by mailshot. Intervention. Smokers attended a nurse‐led smokers clinic 1 week prior to their quit date, on the quite date, 1 week later and 3 weeks after that. Smokers in the buddy condition were paired with another smoker trying to give up at the same time to provide mutual support between clinic sessions. Measurements. The main outcome measure was the percentage of smokers still abstinent from cigarettes at end of treatment (4 weeks from quit date), verified by expired air carbon monoxide concentration. Findings. The percentage of smokers still abstinent at the end of treatment was significantly higher in the buddy condition than the solo condition (27% vs. 12%). Conclusions. A buddy system can provide an effective element of a smoking cessation intervention at minimal cost. Further research is needed to establish the long‐term efficacy of this approach and examine the effectiveness of incorporating social support into other types of smoking cessation programmes.
Assessing the relationship between maternal opiate use and neonatal mortality
Authors: Hulse G. K. , Milne E. , English D. R. , Holman C. D. J.
Published: March 2003

Aims/Design. We undertook a number of meta‐analyses to estimate more precisely the relationship between neonatal mortality and use of opiates in three groups of women. First, women who continued to use illicit heroin throughout pregnancy; secondly, women stabilized on methadone at the time of conception or shortly after and thirdly, women who use heroin well into pregnancy with late entry into methadone treatment, or who continued to use illicit heroin during pregnancy while receiving methadone. Findings. The pooled estimates of the relative risks of neonatal mortality for separate heroin and methadone use were both near unity: 1.47 (95% CI 0.88‐2.33) and 1.75 (95% CI 0.60‐4.59), respectively. The result for heroin may be due to the inclusion in the meta‐analysis of a particularly large study, which, unlike the two other smaller studies included, found a relative risk near unity. When this study was excluded from the meta‐analysis the pooled estimate of the relative risk of neonatal mortality for heroin use was 3.27 (95% CI 0.95‐9.60). In contrast to the results for use of methadone only, the pooled relative risk associated with heroin and methadone use was 6.37 (95% CI 2.57‐14.68). Conclusions. The increased relative risk for neonatal mortality associated with women using heroin and methadone during pregnancy, compared to those stabilized on methadone, is probably due to the chaotic and high‐risk life‐style associated with illicit heroin use and not solely to the use of heroin and methadone per se. It is recommended that women who use heroin well into pregnancy with late entry into methadone treatment, or who continue to use illicit heroin during pregnancy while receiving methadone, receive special attention over and above that provided to women stabilized on methadone.
Treatment level progress and time spent in treatment in the prediction of outcomes following drug‐free therapeutic community treatment
Authors: Toumbourou John W. , Hamilton Margaret , Fallon Barry
Published: March 2003

Previous research has suggested that time spent in treatment is the most important predictor of therapeutic community treatment outcomes. Although level divisions or treatment stages represent the basic structure for segmenting responsibility and authority within traditional therapeutic communities, the relationship of this treatment component to treatment outcome has not previously been investigated. Aim. To test the hypothesis that higher treatment level attainment, more time spent in treatment and additional time spent within a treatment level has a linear association with improvements at outcome. Design. Retrospective quasi‐experimental. Participants. Four hundred and twenty‐seven ex‐residents, stratified according to their highest level of treatment in the Melbourne Odyssey House therapeutic community between 1984 and 1988 were targeted for follow‐up and 60% were successfully located and interviewed an average of 5.6 years after their first Odyssey entry. Analysis of official records of methadone treatment, convictions and incarcerations demonstrated no post‐treatment differences comparing those interviewed with those not interviewed. Measurement. Drug use, criminal involvement and employment. Findings. Although both level attainment and time spent in treatment had a linear relationship to improved outcomes, level attainment was a better predictor of outcomes at treatment exit. An unexpected finding was that those who had spent the median time or longer in particular levels demonstrated worse outcomes on official conviction records and on self‐reports of employment compared to those remaining for less than the median time. Conclusion. The results suggest that it may be level progress rather than simply time spent in treatment that best explains improved functioning following exit from the therapeutic community.
A comparison of two alcohol craving questionnaires
Authors: Love Alix , James Darren , Willner Paul
Published: March 2003

Aim. To compare two multi‐dimensional questionnaires to measure cravings and urges for alcohol: the Alcohol Craving Questionnaire (ACQ: Singleton, Henningfield & Tiffany, 1994a) and the Desires for Alcohol Questionnaire (DAQ: Clark et al. , 1996). Design, setting and participants. Both questionnaires were administered, in a counterbalanced order, to a total of 380 recreational drinkers. In a further study, a shortened version of the DAQ was administered to a sample of 131 drinkers attending AA or a treatment centre. Exploratory factor analyses were carried out on the data and relationships between questionnaire score and other variables were assessed. Findings. In recreational drinkers both instruments appeared to have a three‐factor structure. The DAQ appeared superior to the ACQ in a number of respects: it produced more reliable factors; its structure accounted for a higher proportion of the variance; the factor inter‐correlations were somewhat lower; in a combined analysis of both instruments most of the factors retained came from the DAQ; and the DAQ discriminated better between binge and non‐binge drinkers and excessive and moderate drinkers. A similar factor structure was found for the DAQ in the alcoholic subjects with addition of a factor of "controllability". Conclusions. The results support a multifactorial account of alcohol craving, and indicate that the DAQ has some advantages over the ACQ as a research tool.
Researching the spiritual dimensions of alcohol and other drug problems
Authors: Miller William R.
Published: March 2003

Although religions have been far from silent on the use of psychoactive drugs, and spirituality has long been emphasized as an important factor in recovery from addiction, surprisingly little research has explored the relationships between these two phenomena. Current findings indicate that spiritual/religious involvement may be an important protective factor against alcohol/drug abuse. Individuals currently suffering from these problems are found to have a low level of religious involvement, and spiritual (re)engagement appears to be correlated with recovery. Reasons are explored for the lack of studies testing spiritual hypotheses, and promising avenues for future research are discussed. Comprehensive addictions research should include not only biomedical, psychological and socio‐cultural factors but spiritual aspects of the individual as well.
The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992
Authors: Single Eric , Robson Lynda , Xie Xiaodi , Rehm Jurgen
Published: March 2003

Aims, design and setting. The economic costs of alcohol, tobacco and illicit drugs to Canadian society in 1992 are estimated utilizing a cost‐of‐illness framework and recently developed international guidelines. Measurements. For causes of disease or death (using ICD‐9 categories), pooled relative risk estimates from meta‐analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs. The results are compared with other studies, and sensitivity analyses are conducted on alternative measures of alcohol consumption, alternative discount rates for productivity costs and the use of diagnostic‐specific hospitalization costs. Findings. The misuse of alcohol, tobacco and illicit drugs cost more than $18.4 billion in Canada in 1992, representing $649 per capita or 2.7% of GDP. Alcohol accounts for approximately $7.52 billion in costs, including $4.14 billion for lost productivity, $1.36 billion for law enforcement and $1.30 billion in direct health care costs. Tobacco accounts for approximately $9.56 billion in costs, including $6.82 billion for lost productivity and $2.68 billion for direct health care costs. The economic costs of illicit drugs are estimated at $1.4 billion. Conclusions. Substance abuse exacts a considerable toll to Canadian society in terms of illness, injury, death and economic costs.
Should alcohol consumption measures be adjusted for gender differences?
Authors: Graham Kathryn , Wilsnack Richard , Dawson Deborah , Vogeltanz Nancy
Published: March 2003

Because of biological differences between men and women, the same quantity of alcohol consumed over the same time period produces higher blood alcohol levels (BALs) in women than in men. Some alcohol researchers have proposed that quantity and volume measures of alcohol consumption (e.g. usual number of drinks per drinking day and overall amount of alcohol consumed) should be adjusted to reflect these biological differences. To date, no standard adjustment for biological gender differences has been adopted. In this paper, we review the literature on biological and behavioral differences related to alcohol consumption and effects and discuss the implications of these differences in terms of adjusting alcohol consumption measures. Our review suggests that adjusting measures of alcohol consumption to compensate for biological sex differences is most appropriate for research or policy applications involving the short and long‐term physiological effects of alcohol in contexts where gender differences in how alcohol is consumed can be assumed to be minimal. In other circumstances, non‐biological gender differences relating to alcohol use, such as pace of drinking, may moderate the relationship between alcohol consumption and biological gender differences, making an adjustment less defensible. We also identify areas where more knowledge is needed not only to address the issue of adjusting alcohol measures for gender differences but also to understand better the relationship between alcohol consumption and effects.
Drug use and injection risk‐taking among prison methadone maintenance patients
Authors: Darke Shane , Kaye Sharlene , Finlay‐Jones Robert
Published: March 2003

Aims. To examine the drug use and injection risk‐taking among incarcerated methadone maintenance (MM) patients; to determine the impact of a diagnosis of antisocial personality disorder (ASPD) on prison‐based MM treatment; to compare incarcerated patients with community patients. Design. Structured interview. Settings. New South Wales (NSW) prisons and community methadone maintenance (MM) units. Participants. One hundred incarcerated MM patients and 183 community MM patients. Measurements. Subjects were interviewed about drug use and needle risk‐taking in the previous 6 months, and assessed for a diagnosis of ASPD. Findings. Heroin had been used by 38% of prison MM patients in the 6 months prior to interview, on a median of 4.5 days. Forty‐four per cent of prison patients had injected a drug in the preceding 6 months. A third (32%) of prison subjects had borrowed used injecting equipment within the preceding 6 months, and 35% had lent used injecting equipment to others. Community patients were more likely to have injected a drug in the preceding 6 months (84% vs. 44%), to have used heroin (72% vs. 38%) and to have done so more frequently (20 vs. 4.5 days). Prisoners, however, were more likely to have borrowed (32% vs. 15%) and lent (35% vs. 21%) injecting equipment in that time. While injecting at lower rates than their community counterparts, the injecting occasions of prisoners were of much higher levels of risk. A diagnosis of ASPD was unrelated to both drug use and needle risk‐taking. Conclusions. Incarcerated patients injected less frequently than community patients, but had higher levels of needle risk‐taking.
Effects of readiness for drug abuse treatment on client retention and assessment of process
Authors: W. George , D. Joe , Simpson Dwayne , Broome Kirk M.
Published: March 2003

Aims. This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings represented in the third national drug abuse treatment outcome study (DATOS) conducted in the United States. Design. Sequential admissions during 1991‐93 to 37 programs provided representative samples of community‐based treatment populations. Based on this naturalistic non‐experimental evaluation design, hierarchical linear model (HLM) analysis for nested data was used to control for systematic variations in retention rates and client attributes among programs within modalities. Setting. The data were collected from long‐term residential (LTR), outpatient methadone (OMT) and outpatient drug‐free (ODF) programs located in 11 large cities. Participants. A total of 2265 clients in 18 LTR, 981 clients in 13 OMT and 1791 clients in 16 ODF programs were studied. Measurements. Pre‐treatment variables included problem recognition and treatment readiness (two stages of motivation), socio‐demographic indicators, drug use history and dependence, criminality, co‐morbid psychiatric diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome criteria. Findings. Pre‐treatment motivation was related to retention in all three modalities, and the treatment readiness scale was the strongest predictor in LTR and OMT. Higher treatment readiness also was significantly related to early therapeutic engagement in each modality. Conclusions. Indicators of intrinsic motivation‐especially readiness for treatment‐were not only significant predictors of engagement and retention, but were more important than socio‐demographic, drug use and other background variables. Improved assessments and planning of interventions that focus on stages of readiness for change and recovery should help improve treatment systems.
Impact of liking for advertising and brand allegiance on drinking and alcohol‐related aggression: a longitudinal study
Authors: Casswell Sally , Zhang Jia‐Fang
Published: March 2003

Aims. To test a hypothesized model of the effect of televised alcohol advertising and allegiance to specific brands of beer on subsequent beer consumption and self‐reports of aggressive behaviour linked with drinking. Design. Structural equation modelling was used to assess the fit between data collected as part of a longitudinal study of young people's health and development and a hypothesized model based on theoretical perspectives and previous research. Setting. A birth cohort has been assessed every few years, most of them in their home city of Dunedin, New Zealand. The questions about alcohol are asked as part of the day‐long assessment. Participants. Members of a longitudinal survey cohort at ages 18 and 21 years. Data from 630 beer drinking participants were analysed in this study. Measurements. Responses to questions about beer consumption, liking for advertising, favourite brand of beer and self‐reports of alcohol‐related aggressive behaviour. Findings. Our hypothesized model assumed a positive impact of liking of alcohol advertising and brand allegiance at age 18 on the volume of beer consumed at age 21 and self‐reports of alcohol‐related aggressive behaviour. This was found to be a good fit to the data from the longitudinal study. Conclusion. This measurable impact of alcohol advertising occurred during a time of decline in aggregate alcohol in New Zealand. While this effect was not large enough to halt the decline in aggregate alcohol consumption it does indicate a measurable, specific impact of broadcast alcohol advertising on alcohol consumption and related behaviour which is of relevance for public health policy.
Czech men's drinking in changing political climates 1983‐93: a three‐wave longitudinal study
Authors: Kubicka Ludek , Csemy Ladislav , Duplinsky Josef , Kozeny Jiri
Published: March 2003

Aims. To analyse the relationships between political developments in the Czech Republic and the drinking behaviour of Czech men. Design. A longitudinal (panel) design provided data collected on a cohort of 586 Czech men in three different political climates in 1983, 1988 and 1993. Setting. In 1986‐88 the ruling Communist party tried to reduce alcohol consumption in the country by a Gorbachev‐inspired anti‐alcohol campaign; after 1989 the re‐establishment of democracy and a market economy abolished all political control over drinking and deregulated prices of beverage alcohol. Participants. A representative cohort of Prague men born 1950‐61. Measurements. Beverage‐specific interview reports on drinking behaviour and questionnaire data on attitudes to drinking. Findings. In those followed‐up, mean alcohol consumption decreased between 1983 and 1988 by 26% and increased again by 16% between 1988 and 1993, mirroring per capita consumption in the Czech Republic. The same time trend was observed across all educational levels and also among men who were registered for alcohol abuse. Attitudes of the men to drinking changed minimally over the 10 years of follow‐up. Individual attitudes to drinking interacted with the period effects: men with strong positive attitudes to drinking decreased their consumption less than others during the anti‐alcohol campaign and such men increased their consumption more than the average during the liberalisation period. Conclusions. The downward and then upward in average alcohol consumption of the men during the 10 years of follow‐up can be interpreted as affected partly by price changes and partly by changes in political control over drinking.
The course of early smoking: a population‐based cohort study over three years
Authors: Patton G. C. , Carlin J. B. , Coffey C. , Wolfe R. , Hibbert M. , Bowes G.
Published: March 2003

Aims. To examine the uptake and course of smoking in a representative adolescent cohort. Design. Six‐wave cohort study. Participants. Secondary school students initially aged 14‐15 years at 44 schools in the state of Victoria, Australia. Measurements. Computerized questionnaire including 7‐day retrospective recall for tobacco use. Findings. Prevalence rates for smoking in the past month rose from 25% to 31% and daily smoking 9% to 18% across the 3‐year follow‐up. Forty‐five per cent of the sample smoked at some point but only 18% were daily smokers at the end‐point. High rates of short‐term cessation were observed for both experimental and daily smokers, but 70% of daily smokers relapsed within 12 months. Occasional smoking at the outset was the strongest predictor of later daily smoking and was also predictive of lower cessation and higher relapse rates. Parental divorce and parental daily smoking were associated with smoking at the outset and parental smoking was strongly predictive of the course of daily smoking. In contrast, prevalence rates of smoking in a subject's school did not significantly predict either smoking initiation or subsequent course. Female daily smokers were half as likely as males to cease smoking, a finding that accounted for gender differences in smoking prevalence in this sample. Conclusions. The strength of association between occasional and later daily smoking indicates the importance of primary prevention but the variability in the early course indicates that there should be much scope for promotion of adolescent efforts to quit. Both the diminished likelihood of smoking cessation in young women and parental influences on smoking course deserve further exploration.
Network support for drinking, Alcoholics Anonymous and long‐term matching effects
Authors: Longabaugh Richard , Wirtz Philip W. , Zweben Allen , Stout Robert L.
Published: March 2003

Aims. (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol‐dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. Design. Outpatients were re‐interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. Setting. Outpatients from five clinical research units distributed across the United States. Participants: Eight hundred and six alcohol‐dependent clients. Intervention. Clients were randomly assigned to one of three 12‐week, manually‐guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). Measurements. Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37‐39. Findings. (1) The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow‐up; (2) AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA; AA involvement was associated with better 3‐year drinking outcomes for such clients. Conclusions. (1) In the long‐term TSF may be the treatment of choice for alcohol‐dependent clients with networks supportive of drinking; (2) involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.
Alcohol and all‐cause mortality in Europe 1982‐1990: a pooled cross‐section time‐series analysis
Authors: Her Minghao , Rehm Jurgen
Published: March 2003

Aim. To test the relationship between alcohol consumption and all‐cause mortality. Design. Data: Yearly mortality rates and per capita consumption from 25 European countries between 1982 and 1990. Statistical models. This paper employs time‐series cross‐sectional data to model the relationships between alcohol consumption and all‐cause mortality. The data are derived from 25 European countries in the 1980s. The statistical analyses controlling cross‐sectional correlation and timewise autoregression were used to implement the econometric modelling. Findings. Increases (decreases) in the per capita consumption of 1 litre of pure alcohol were associated with increases (decreases) of 1.3% in all‐cause mortality rates. The beverage‐specific analyses indicated a significant relationship between consumption of beer and all‐cause mortality only. Conclusion. The data show that per capita alcohol consumption, according to reported levels in Europe, is related to all‐cause mortality and is thus of relevance to public health.
Parental substance use disorder, mediating variables and adolescent drug use: a non‐recursive model
Authors: Hoffmann John P. , Su S. Susan
Published: March 2003

Aims. To develop and test a non‐recursive model that examines the effects of parental psychoactive substance use disorder (PSUD) on the reciprocal relationships among stressful life events, family attachment, peer drug use and adolescent drug use . Design. A 3‐year prospective cohort study followed adolescents from three types of families defined by a parental diagnosis of a psychiatric disorder. Setting. A large metropolitan area in the upper Midwestern United States . Participants. Seven hundred and seventy‐seven 10‐16‐year‐old adolescents from three groups of families: 214 who resided in families in which a parent was diagnosed with PSUD, 181 who resided in families in which a parent was diagnosed with an affective disorder (but no co‐morbid PSUD), and 382 who resided in families in which both parents were free of any diagnosable disorder . Measurements. Psychiatric disorder was defined by the Structured Clinical Interview for DSM‐III‐R (SCID). Two follow‐up interviews of adolescent respondents were used to measure stressful life events via the Junior High Life Experiences Survey, family attachment via FACES‐III and a child‐parent strain index, peer drug use, and two self‐reported drug use scales designed to measure past‐year alcohol use and illicit drug use (e.g. marijuana, cocaine, inhalants). Findings. Nested structural equation models with latent variables revealed that adolescents from PSUD families were at heightened risk of stressful life events, peer drug use, attenuated family attachments and drug use during the first follow‐up period. In turn, peer drug use was strongly associated with drug use during the second follow‐up period. However, drug use during the first follow‐up also led to greater peer drug use and attenuated family attachment during the second follow‐up period. The findings support a non‐recursive model describing relations among adolescent drug use, peer drug use and family attachment. Conclusions. Parental psychoactive substance use disorder puts adolescents at significant risk of becoming embedded in a cycle of drug use, associations with drug using peers, and poor family relations.
Sexual abuse and alcoholism in a female population
Authors: Spak Lena , Spak Fredrik , Allebeck Peter
Published: March 2003

Abstract Aims. (1) To study the prevalence of childhood sexual abuse before the age of 18 years (CSA) and life‐time sexual abuse (LSA) in a Swedish female, general population, (2) to analyse associations between CSA and life‐time alcohol dependence or abuse (ADA), and (3) to identify possible confounding factors . Design and participants. The study was conducted in two phases. Phase 1: an alcohol problem screening questionnaire was sent to 3130 women aged 25‐65. The answers were scored. Phase 2: based on the questionnaire scores, a randomly selected stratified sample of 479 women was invited for an interview. Of these, 316 women participated in a structured face‐to‐face interview . Setting. A sector of Goteborg city with 100 000 inhabitants . Measurements. The interviews focused on substance use and on social, psychological and behavioural characteristics, including experiences of sexual abuse. Clinical psychiatric diagnoses were made according to DSM‐III‐R. Bivariate analyses and multivariate logistic regression analyses were performed . Findings. The prevalence of CSA and LSA was 9.8% and 13.9%, respectively. CSA increased the risk for life‐time ADA and anxiety, but not for depression. When potential confounding factors (e.g. early background factors, depression and anxiety) were adjusted for, CSA under 13 years of age still predicted ADA in multivariate analyses, but CSA under 18 years of age did not . Conclusions. LSA, and especially CSA under 13 years of age, are factors that should be considered in treatment of women with ADA and in psychiatric treatment of women.
Familial influences on gambling behavior: an analysis of 3359 twin pairs
Authors: Lin Seth A. Eisen Nong , Lyons Michael J. , Scherrer Jeffrey F. , Griffith Kristin , True William R. , Goldberg Jack , Tsuang Ming T.
Published: March 2003

ackground. Pathological gambling is becoming an increasing problem in the United States as the number of legalized gambling establishments grows. To examine vulnerability to pathological gambling, we estimated the familial contributions (i.e. inherited factors and/or experiences shared by twin siblings during childhood) to DSM‐III‐R pathological gambling symptoms and disorder. Methods. Data were obtained from a telephone interview performed in 1991‐92 utilizing the Diagnostic Interview Schedule Version III‐Revised. Interviews were administered to 6718 members of the nationally distributed Vietnam Era Twin Registry of male‐male monozygotic and dizygotic twin pairs who served in the military during the Vietnam era. Results. Inherited factors explain between 35% (95% CI: 28%, 42%) and 54% (95% CI: 39%, 67%) of the liability for the five individual symptoms of pathological gambling behavior that could be estimated statistically. In addition, familial factors explain 56% (95% CI: 36%, 71%) of the report of three or more symptoms of pathological gambling and 62% (95% CI: 40%, 79%) of the diagnosis of pathological gambling disorder (four or more symptoms). Conclusions. Familial factors have an important influence on risk for pathological gambling behavior. The increasing access to legalized gambling is likely to result in a higher prevalence of pathological gambling behavior among individuals who are more vulnerable because of familial factors.
High rates of drug use, but low rates of HIV risk behaviours among injecting drug users during incarceration in Dutch prisons
Authors: Haastrecht Harry J. A. Van , Anneke Joke S. Bax , Hoek A. R. Van Den
Published: March 2003

Aims. To determine levels of injecting drug use and sexual risk behaviours in injecting drug users during and immediately following imprisonment in The Netherlands. Design, setting and participants. Crosssectional survey of drug injectors attending methadone clinics, a sexually transmitted disease clinic and a central research site in Amsterdam. The mean age of the 188 participants was 35 years, 78% were male and 34% had HIV antibodies . Measurements. Self‐reported drug use and sexual behaviours during the last period of imprisonment in Dutch prisons within the previous 3 years and injecting drug use in the week following release from prison . Findings. A period of imprisonment in the preceding 3 years was reported by 188 (41%) of 463 interviewed drug injectors. The mean duration of last imprisonment was 3.6 months. Any use of cannabis, heroin or cocaine during imprisonment was reported by 55%, 37% and 20%, respectively. Five injectors (3%) admitted to having injected in prison, but no sharing of needles and syringes was reported. Vaginal or anal sex was reported by two (1%) of the men and none of the women. Relapse to drug injecting during the week following release from prison was reported by 78/186 (42%) participants, in most cases (34%) at the very first day of release. Drug use behaviours during imprisonment were similar for those who were designated current injectors at the time of imprisonment and those who were not, but injecting in the first week following release from prison was far higher among 'current' injectors (63%) than among those who were not (11%) . Conclusions. Contrary to findings from other countries, low levels of HIV risk behaviours occur among imprisoned drug injectors in The Netherlands. Intra‐prison HIV preventive measures should be considered taking into account the nationally, regionally or locally varying conditions within the existing prisons.
Nicotine absorption and dependence in unlicensed lozenges available over the counter
Authors: Foulds Jonathan , Russell Michael A. H. , Jarvis Martin J. , Feyerabend Colin
Published: March 2003

Aim. To demonstrate the nicotine absorption and dependence potential from unlicensed nicotine containing lozenges . Design. A single case report of dependence on nicotine lozenges, plus measurements of nicotine levels before and after consumption of eight nicotine lozenges over 2 hours in volunteers. Setting. Hospital Smokers' Clinic. Participants. One male patient suffering from schizophrenia who had consumed 150 "Stoppers" lozenges per day for the previous 5 years, plus seven non‐smoker volunteers . Measurements. Blood nicotine concentration . Findings. The patient's low expired carbon monoxide level (5 p.p.m.) and high plasma nicotine (32 ng/ml) and cotinine levels (947 ng/ml) were consistent with very heavy lozenge consumption. The non‐smoker volunteers obtained nicotine concentrations of around 11 ng/ml by consuming eight Stoppers lozenges over 2 hours. Other brands of nicotine lozenges produced lower initial levels, but also produced delayed intestinal absorption and vomiting after food consumption . Conclusion. Nicotine lozenges are a potential aid to smoking cessation but their safety, efficacy and abuse potential remain to be properly evaluated.
Community effects of the opening of the Niagara casino
Authors: Room Robin , Turner Nigel E. , Ialomiteanu Anca
Published: March 2003

Aims. The impacts on the community of the opening of a casino in Niagara Falls are studied.

Design. The study uses a pre/post design for the community data, with pre/post data from Ontario as a whole as a comparison.

Setting. The study site is the city of Niagara Falls, Ontario, where a casino opened in early December, 1996.

Participants. Using random‐digit dialing, telephone interviews were conducted with adult residents of Niagara Falls in 1996 and 1997, and with adult residents of Ontario in 1995 and 1997.

Measurements. Aside from demographic variables, measures included general attitudes to gambling, expectations about (1996) and experiences with (1997) the casino's opening, extent of participation in 11 types of gambling and 18 items on problems with gambling: five key items from a standard gambling problems score (SOGS), five life‐area problems items, and items on pressures from others concerning the respondent's gambling and on gambling problems among family and friends.

Findings. Attitudes to gambling remained stable in Niagara Falls, while there was some evidence of decline in approval in Ontario as a whole. While strong majorities of 1996 respondents had expected many positive and negative effects on The Community of the Casino's opening, Significantly fewer respondents in 1997 reported actually experiencing most of these effects. While a small increase in employment was found, it fell far below projections, a result probably reflecting displacement effects. The rate and level of casino gambling increased in Ontario, but increased even more in Niagara Falls, with little displacement of other gambling. Reported gambling problems increased significantly in Niagara Falls for two of 10 gambling problem items and for the short SOGS score, while rates were generally stable or declining in the province. Pressure from others about gambling rose significantly in Niagara Falls (in contrast to the province), and reported rates of family members or friends with gambling problems also rose substantially. There was an increasing trend in Niagara Falls for all 18 problem indicators.

Conclusions. The casino's opening brought more gambling by local residents, and an increase in reported gambling problems; yet support for the casino, already strong, if anything grew. At least in the short term, problems from the increased availability of gambling manifested themselves not in the public arena but rather in the arena of private life.