bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating measures of family history of alcoholism: density versus dichotomy
Authors: Stoltenberg Scott F. , Mudd Sharon A. , Blow Frederic C. , Hill Elizabeth M.
Published: March 2003

Aims. Studies have used myriad measures of family history of alcoholism (FH) making it difficult to compare them directly. Commonly used FH measures partition samples into the well known positive (FH + ) and negative (FH ‐ ) dichotomy, although quantitative measures of density potentially provide more information. A standard FH measure would facilitate between‐study comparisons. The purpose of this study is to evaluate a quantitative FH measure, called Family History Density (FHD), that has theoretical and practical advantages over currently used measures. Design. Logistic regression equations were estimated for FHD and six commonly used FH measures on alcohol dependence diagnosis, and two measures of alcoholism severity (i.e. withdrawal and tolerance). Participants. Subjects recruited for studies (254 men and 97 women) completed a structured clinical assessment. Measurements. Alcoholism diagnosis and endorsement of tolerance or withdrawal symptoms were obtained using the alcohol module from the NIMH Diagnostic Interview Schedule III‐R (DIS III‐R). Family history of alcoholism was coded using the criteria from the Family Informant Schedule and Criteria (FISC). Findings. All FH measures were associated with alcohol dependence diagnosis, development of tolerance and experiencing withdrawal symptoms in men. In women, only FHD and Parent were significantly associated with all three outcomes. Conclusions. FHD is a good candidate to be a standard FH measure because it is quantitative, based on familial relatedness and capable of accounting for significant variation in alcoholism diagnosis and two indices of alcoholism severity in men and in women.
The assessment of young children's expectancies of alcohol versus a control substance
Authors: Query Lisa R. , Rosenberg Harold , Tisak Marie S.
Published: March 2003

Aims. The chief purpose of the current study was to assess whether young children endorse expectancies specific to alcohol. Design. In order to accomplish this aim, a 2 (gender of child) by 2 (gender of adult drinker) by 2 (grade level) by 2 (beverage type) repeated measure design was employed with beverage type as the repeated measure. Setting. Data were collected within elementary schools located in two Midwestern states. Participants. One hundred and twenty‐four second and third graders (42% male) participated in individually structured interviews. Measurements. The expectancy interview was based on the Children's Alcohol‐Related Expectancy Questionnaire and assessed each child's beliefs about the desirable and undesirable consequences which adult men and women might experience after drinking alcohol (beer) and a control beverage (iced tea). Findings. The results indicated that children endorsed significantly more undesirable expectancies for beer than for iced tea, and more desirable expectancies for iced tea than for beer. In addition, children's expectancies varied as a function of the gender of the drinker. Specifically, both second‐ and third‐graders expected more undesirable outcomes for women than for men, and second graders expected fewer desirable outcomes for women than for men, regardless of beverage. Conclusions. Prior to substantial experience with alcohol consumption, children have already developed expectancies for alcohol. Specifically, young elementary children endorse predominantly undesirable expectancies for beer.
Estimating changes in unrecorded alcohol consumption in Norway using indicators of harm
Authors: Norstrom Thor
Published: March 2003

Aim. To assess the value of using indicators of alcohol‐related harm to estimate changes in unrecorded per capita consumption of alcohol. Design. Unrecorded consumption was estimated from the discrepancy between the observed changes in a number of alcohol‐related harm indicators and the changes that would be expected from changes in recorded consumption. The results were compared with estimates of unrecorded consumption from survey data. Measurements. Four indicators of alcohol‐related harm were used: alcohol‐related mortality, assaults, drunken driving, and suicide. Estimates of unrecorded consumption from survey data for five different years were used as benchmarks. Findings. The best performing indicators were alcohol‐related mortality, suicide and assaults, in that order. Combining these indicators yielded a prediction error averaging 12% in comparison with the benchmarks. Conclusions. The method seems worthy of further applications, but it should be regarded as a supplement rather than as a substitute for other approaches.
Alcohol intake and severity of injuries on highways in Mexico: a comparative analysis
Authors: Hijar M. , Flores M. , Lopez M. V. , Rosovsky H.
Published: March 2003

Aims. To analyze the association between alcohol intake and the severity of injuries sustained from traffic accidents on a Mexican highway. Design. An observational unit evaluated drivers involved in auto accidents. Setting. Mexico‐Cuernavaca Highway, Mexico. A 60 km‐long road with many altitude variations and sharp curves. Participants. Three hundred and eighty‐six drivers involved in traffic accidents between March and September, 1994. Measurements. A questionnaire was applied to the driver, an occupant or witness at the site of the accident to collect information about the driver, vehicle characteristics, type of accident, day‐night occurrence, road section (Mexico‐Cuernavaca or CuernavacaMexico) and weather conditions. A physical examination was carried out to determine the presence and severity of injuries. Findings. There were 177 injured people, including 12 deaths, with rates of 67.5 injuries and 4.58 deaths per 10 000 km driven. Variables associated with alcohol intake ( p 0.05) included: severity of injuries, non‐use of seat belt, vehicle size and occurrence at night. Risk factors for severe injuries were: alcohol intake (adjusted OR 6.1 CI 95% 1.6‐24.0); non‐use of seat belt (OR 4.9 CI 2.2‐10.8), age 25 years (OR 3.6 CI 1.0‐12.7), age 54 years (OR 6.0 CI 1.4‐25.0), speed 90 km/h (OR 2.6 CI 1.1‐6.3) and occurrence at night (OR 2.6 CI 1.3‐5.3). Conclusions. Alcohol intake is a major risk factor for severe injuries from highway traffic accidents. Its association with other risk factors such as non‐use of seat belt and excessive speed suggests the importance of designing interventions aimed at reducing alcohol intake among automobile drivers.
Drug use pathways among high school students of Mexico
Authors: Villatoro Jorge A. , Medina‐Mora Elena , Juarez Francisco , Rojas Estela , Carreno Silvia , Berenzon Shoshana
Published: March 2003

Objective. This study surveyed high school student drug users in urban areas of Mexico to describe use patterns and drug‐related behaviors among adolescents and to develop predictor models of pathways to underage drug use. Subject/design. A National School Survey was conducted among high school students where data are provided by the State. Only urban sites were considered for this study ( n = 40 521). Stratified two‐stage cluster sampling was used; schools and groups within the schools were the sampling units. Conclusions. Male adolescents who have worked the previous year, have high exposure within the family and are affiliated with drug using peers are at increased risk of becoming drug users and subject to depression and suicidal ideation as well as drug‐related social problems.
Bloodborne viral infection in Irish injecting drug users
Authors: Smyth Bobby P. , Keenan Eamon , O'Connor John J.
Published: March 2003

Aims. In Dublin, harm reduction strategies have greatly expanded since 1990. We sought to determine the prevalence of, and factors associated with, hepatitis C (HCV), hepatitis B (HBV) and HIV infections among injecting drug users (IDUs) against this background. Design. Cross‐sectional survey. Setting. Addiction treatment clinic. Participants. Seven hundred and thirty‐five IDU tested for antibody to HCV (anti‐HCV) between September 1992 and September 1997. Measurements. Socio‐demographic and drug use characteristics. Serology tests for anti‐HCV, HBV surface antigen (HBsAg) and HIV. Findings. The vast majority (89%) commenced injecting since 1990. Prevalence of anti‐HCV was 61.8% (453/733), of HBsAg was 1.0% (7/729) and of HIV was 1.2% (7/600). Logistic regression analyses indicated that longer history of injecting and increased daily drug expenditure were the only independent variables associated with significantly increased risk of HCV. The only characteristic associated with increased prevalence of HBsAg was a history of injecting prior to 1990 (3.8%, 3/80). HIV prevalence was significantly higher when aged over 24 years (3.7%, 6/162), when injecting commenced prior to 1990 (6.3%, 4/64) and when injecting over 5 years (6.5%, 4/62). Conclusions. HIV prevalence has sustained a low level in this population. Interventions which aim to halt transmission of HCV are necessary and will need to target IDU very early in their injecting careers and also those at risk of commencing to inject.
Choosing a diagnostic cut‐off for cannabis dependence
Authors: Swift Wendy , Copeland Jan , Hall Wayne
Published: March 2003

Aim. While cannabis dependence has been increasingly recognized, there is little research on the measurement issues involved in operationalizing the dependence syndrome for this drug. This paper aimed to investigate the diagnostic utility and appropriate diagnostic cut‐offs of three short dependence measures among long‐term cannabis users. Setting and participants. Two hundred long‐term, regular cannabis users were recruited and interviewed in Sydney, Australia. Measurements. Receiver Operating Characteristic analyses compared the diagnostic performance of the short University of Michigan CIDI, a measure of ICD‐10 dependence and the Severity of Dependence Scale against the "gold standard" of moderate or more severe DSM‐III‐R cannabis dependence, as diagnosed by the Substance Abuse Module of the CIDI. Findings. The measures were of equal utility in diagnosing at least moderate DSM‐III‐R cannabis dependence. While the optimal diagnostic cut‐offs for the short University of Michigan CIDI and the ICD‐10 dependence measure remained unchanged from those conventionally applied, a more liberal cut‐off was optimal for the Severity of Dependence Scale. The amended prevalence of cannabis dependence was 77% using the short University of Michigan CIDI, 72% by the ICD‐10 measure and 62% by the Severity of Dependence Scale. Conclusions. The three instruments were able to diagnose cannabis dependence at levels substantially better than chance. They were generally robust in terms of the optimal diagnostic cut‐off in a population of long‐term cannabis users. This paper provides guidelines for choosing optimal cut‐offs within different contexts.
Changes in social roles as predictors of changes in drinking behaviour
Authors: Hajema Klaas‐Jan , Knibbe Ronald A.
Published: March 2003

Aim. To assess the possible effects of changes in marital status, employment status and having children at home on alcohol consumption and the frequency of heavy drinking. With role theory as a starting point it was expected that a shift into more social roles would decrease consumption and heavy drinking while the shift away from social roles would be associated with an increase in consumption and heavy drinking. Design. Prospective cohort study. Setting. The province of Limburg, The Netherlands (1980‐89). Participants. 1327 men and women aged 16‐69 years at first measurement. Measurements. Weekly consumption of standard units (10 g ethanol) of alcoholic beverages; frequency of drinking six units or more; self‐reported social role. Findings. The acquisition of a spouse role and a parental role but not an employment role was associated with a decrease in consumption or heavy drinking. The loss of the spouse role among women was associated with an increase in heavy drinking. Otherwise, losing a role was not linked with a change in consumption and heavy drinking. Conclusions. Limited support was found for the expectation that role transitions influence drinking behaviour. Our study suggests that other theories must be sought to explain social differences in drinking behaviour.
ADDICTION HISTORY Ivan Bratt: the man who saved Sweden from prohibition
Authors: Nycander Svante
Published: March 2003

Abstract For forty years, until 1955, spirits were rationed in Sweden under a system of individual control. Local "System companies" had a monopoly on the retail trade in spirits and wine. Private profits on alcohol were also eliminated in the restaurants and the wholesale trade. Legislation was based on the proposals put forward by the physician Ivan Bratt (1878‐1956), who presented his ideas in 1909 as an alternative to prohibition. Bratt had the support of leading personalities in Swedish medicine, newspapers and politics, and he also enlisted the support of some of the leaders of the powerful temperance movement. In 1922, Swedes voted against prohibition in a referendum by 51% to 49%. The Bratt system substantially reduced alcohol abuse. When it was abolished, drunkenness in the streets doubled. By 1960, when high taxes had replaced rationing as the policy for controlling the consumption of alcohol, delirium tremens had increased since the Bratt period from 160 cases a year to 700 cases a year.
An analysis of alcohol policy in Hungary. Who is in charge?
Authors: Varvasovszky Zsusza , Mckee Martin
Published: March 2003

Aim. In the light of unprecedented increases in the levels of chronic liver disease and cirrhosis in Hungary, accompanied by other evidence of increasing health and social consequences of alcohol, this study aimed to identify alcohol policy actors at the national level, describe their understanding of alcohol policy, determine their position, interest and influence on the issue, and identify the inter‐relationships between these actors. Methods. A series of interviews with key actors identified through a snowball technique, supplemented by a telephone survey of local government authorities. Analysis was undertaken according to the principles of stakeholder analysis and political mapping. Findings and conclusions. The alcohol policy arena is fragmented. There is a lack of explicit and coherent goals and a shared vision by all actors is missing. Key actors do not seem to be aware of what they could do as a result of their position, and how. There is a failure to develop strategic alliances. Those actors with high and medium levels of support and interest in a comprehensive alcohol policy which would seek to control overall consumption have little influence. Those with influence in the policy arena have not mobilized themselves as regards public health in general and alcohol related policy in particular, with few notable exceptions. Considerable opposition can be expected from those working in retail and catering facilities.
An examination of next‐day hangover effects after a 100 mg/100 ml dose of alcohol in heavy social drinkers
Authors: Finnigan Frances , Hammersley Richard , Cooper Tracy
Published: March 2003

Aims. Carry‐over effects or the hangover hypothesis postulates that alcohol continues to impair performance the morning after drinking, even after low or moderate doses. Performance deficits have been attributed to the residual effects of recent drinking. The present study examined evidence for residual alcohol consumption on human performance when blood alcohol level has declined to zero. Design. A within‐subjects, repeated measures, placebo controlled experiment was conducted with double‐blind alcohol administration to investigate the effects of alcohol the morning after ingestion. Setting. All subjects were studied in Glasgow, Scotland, UK. Participants. Forty healthy male moderate to heavy social drinkers between 18 and 45 years of age. Measurements. Psychomotor performance, subjective state and quality of sleep were examined under alcohol and placebo with a 1‐week interval between test sessions. Enough alcohol was given to place subjects above the legal limit for driving at peak blood alcohol. Findings. There was no evidence for impaired performance the morning after ingestion. Effects were found for subjective state and sleep quality. Conclusions. The findings suggest that after a 100 mg/100 ml dose of alcohol people who: (a) have no alcohol left in their blood and; (b) do not feel hung over will generally be fit to drive.
Substance misusers remanded to prison‐a treatment opportunity?
Authors: Brooke Deborah , Taylor Caecilia , Gunn John , Maden Anthony
Published: March 2003

Aims. To describe self‐reported levels of substance misuse before arrest among remanded prisoners (unconvicted prisoners awaiting trial), to assess their degree of dependency on opiates and stimulants and to record their experiences of treatment in prison. Design. Random selection of subjects from prisons chosen to give a geographical spread across England and Wales; self‐report at semi‐structured interview, plus examination of the prison medical record. Setting. Thirteen male prisons, three Young Offenders' Institutions and three womens' prisons. Participants. Nine hundred and ninety‐five consenting, unconvicted prisoners, randomly selected from all locations within the prisons: 750 men (9.4% sample) and 245 women (82.2% of all remanded women). Measurements. CAGE Questionnaire, Severity of Dependence Scales (SDS) for daily users of opiates and/or stimulants. Findings. Before arrest, 145 (19.3%) men and 72 (29.4%) women had been dependent on street drugs; 91 (12.1%) men and 16 (6.5%) women were solely dependent on alcohol. Seventeen (2.3%) men and four (1.6%) women reported injecting drugs during this imprisonment. Mean SDS scores were 10.6 for opiate and 7.7 for stimulant users. 244 (25%) of all subjects described withdrawal symptoms on reception into custody; 157 (16%) reported being prescribed some symptomatic relief; 235 (24%) requested treatment at interview. Conclusions. By extrapolation, 1905 people‐23% of all unconvicted prisoners‐want treatment for substance misuse. This apparent shortfall in provision must be addressed; the rapidity with which remanded prisoners return to the community dictates that prison and community services should be closely linked.
The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome
Authors: Marsden John , Gossop Michael , Stewart Duncan , Best David , Farrell Michael , Lehmann Petra , Edwards Carolyn , Strang John
Published: March 2003

Aim. To develop a brief, multi‐dimensional instrument for assessing treatment outcome for people with drug and/or alcohol problems. The Maudsley Addiction Profile (MAP) is the first instrument to be developed in the United Kingdom for this purpose. Design. Field testing with quota‐recruitment of problem drug users and problem alcohol users in treatment with researcher and clinician‐administered test‐retest interviews. Setting. Two community and two inpatient services at the Bethlem Royal and Maudsley Hospital, London. Participants. Subjects (160 drug users and 80 alcohol users) interviewed by eight interviewers (four researchers and four clinicians), each of whom interviewed 30 subjects on two occasions. Measures. Sixty items across substance use, health risk, physical/psychological health and personal/social functioning domains. Findings. Average completion time of the MAP was 12 minutes. The questionnaire was acceptable to a majority of subjects and performed well with both researcher and clinician interviewers. Internal reliability and feasible concurrent validity assessments of the scales and items were highly satisfactory. Test‐retest reliability was good, average intraclass correlation coefficients across eight substances were 0.94 and 0.81 across health risk, health problems, relationship conflict, employment and crime measures. Conclusions. The MAP can serve as a core research instrument with additional outcome measures added as required. The collection of a set of reliable quantitative measures of problems among drug and alcohol users by research or treatment personnel for outcome evaluation purposes need not be time‐consuming.
Is mental health in childhood a major predictor of smoking in adolescence?
Authors: Mcgee Rob , Williams Sheila , Stanton Warren
Published: March 2003

Aims. To test an extended version of Pomerleau's (1997) hypothesis that children with mental health problems are at higher risk of smoking in preadolescence and adolescence. Design. Information concerning mental health from 5 to 13 years, smoking at ages 11 and 15, and family disadvantage at age 7 was available for 773 children enrolled in a longitudinal study of children and adolescents. Participants. Participants were enrolled into the Dunedin Multidisciplinary Health and Development Study, which is a longitudinal investigation of the health, development and behaviour of a large group of New Zealand children born between 1 April 1972 and 31 March 1973. Measurements. Assessment of mental health problems in childhood was based upon parent and teacher reports of behavioural and emotional problems. In pre‐adolescence, mental health was assessed by self, parent and teacher report. Smoking was assessed by self‐report. Findings. None of the potential risk factors of gender, childhood disadvantage or childhood mental health problems predicted onset of smoking in pre‐adolescence. Daily smoking at age 15 was best predicted by smoking in preadolescence, being female and experiencing childhood disadvantage. Pre‐adolescent mental health was only weakly predictive of later smoking and this association appeared to be confounded with background disadvantage. Conclusions. We found little support for the extension of Pomerleau's (1997) hypothesis to childhood mental health. Our findings also run counter to recent suggestions for targeting smoking prevention at groups of children with mental health disorders.
REVIEW Nesbitt's Paradox resolved? Stress and arousal modulation during cigarette smoking
Authors: Parrott Andrew C.
Published: March 2003

Abstract Nesbitt's Paradox states that cigarette smoking generates which are normally incompatible, namely increased review confirms these changes, but shows that they are dependent upon various factors, particularly the degree of nicotine deprivation. Thus the relaxant properties of smoking reflect the relief of irritability which develops between cigarettes. The deleterious mood effects of abstinence explain why smokers suffer more daily stress than non‐smokers, and become less stressed when they quit smoking. Deprivation reversal also explains much of the arousal data, with deprived smokers being less vigilant and less alert than non‐deprived smokers or non‐smokers. Nicotine can, however, display genuine stimulant properties, although due to repeated abstinence effects the average arousal level of smokers is generally similar to non‐smokers. Mood normalization also explains why nicotine is so addictive, with regular smokers needing nicotine just to "function" normally. Finally, Nesbitt's Paradox also assumes that arousal and emotionality are associated with each other. Yet factor analysis of mood and personality questionnaires shows that these two dimensions are statistically independent, with the stress and arousal changes during smoking also generally uncorrelated. Nesbitt's Paradox is therefore not actually a paradox; it never was a paradox. physiological and psychological changes arousal together with decreased stress. This
RESEARCH REPORT Pre‐ and in‐treatment predictors of retention in methadone treatment using survival analysis
Authors: Magura Stephen , Nwakeze Peter C. , Demsky Sy
Published: March 2003

Abstract Aims. To determine the effects of pre‐ and in‐treatment variables on patient retention in methadone treatment. Design. Retrospective longitudinal study of an admission cohort sample for up to 3 years of treatment or until discharge. Setting. Six methadone maintenance programs operating 15 clinics in New York City. Participants. A sample of 1206 admissions to these clinics during 1989‐90. Measurements. Data were abstracted from patients' medical charts. Time in treatment for up to 3 years was the dependent variable, analyzed as a survival function. Pretreatment variables were: gender, race/ethnicity, age at admission, employment, education, marital status, living arrangements, child care responsibility, criminal justice status, life‐time arrests, referral source, age at first heroin use, polydrug use, route of drug administration, mental health status and methadone treatment history. In‐treatment variables were: patient problems during treatment, clinic response to patient problems, patient treatment strengths, methadone dosage, heroin use and cocaine use. Findings. The estimated median treatment duration was 23 months. Cox proportional hazards modeling determined that two pretreatment variables (older age and no criminal justice involvement) were associated with longer retention in treatment. Among in‐treatment variables, constructive clinic responses to patient problems, higher methadone dosage, more patient treatment strengths and less heroin and cocaine use during treatment were associated with longer retention. Conclusions. Events during treatment are crucial for patient retention in methadone treatment. Only two of 16 pretreatment variables, compared with five of six during‐treatment variables, had significant effects on length of stay in a multivariate model.
Why do people change addictive behavior? The 1996 H. David Archibald Lecture
Authors: Miller William R.
Published: March 2003

Although there are specialty journals and professions focusing on addictions treatment, the reasons why people change addictive behaviors are still not well understood. The simplistic account that people change because they receive treatment is wanting in many ways. Many people who recover do so without formal treatment. Even relatively brief interventions seem to trigger change, and the dose of treatment delivered is surprisingly unrelated to outcomes. Client compliance with many different approaches, including placebo medication, has been linked to better outcomes. Client outcomes also vary widely depending upon the therapist who delivers treatment. Various models are briefly considered that may help in understanding this intriguing puzzle of change.
Alcohol consumption and mortality. III. Studies of female populations
Authors: Fillmore Kaye Middleton , Golding Jacqueline M. , Graves Karen L. , Kniep Steven , Leino E. Victor , Romelsjo Anders , Shoemaker Carlisle , Ager Catherine R. , Allebeck Peter , Ferrer Heidi P.
Published: March 2003

Aims. This is the third of a set of three papers evaluating drinking status and mortality risk. Analysis of three general population surveys of women evaluated all‐cause mortality rates by drinking pattern. Design and participants. Raw data from three studies of adult women were evaluated. Logistic regression models controlled for confounding characteristics. Meta‐analysis combined study results. Measurements. Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (including long‐term abstainers and former drinkers) as well as age and other confounding variables. Models also evaluated interactions of age and, respectively, long‐term abstinence and former drinking. Findings. In models in which age was controlled, odds of death for long‐term abstainers and former drinkers (defined by volume or quantity) were greater than those for light drinkers; odds of death for moderate and heavy drinkers (defined by quantity) were greater than those for light drinkers. When other psychosocial attributes were controlled, odds of death were similar for abstainers and light drinkers. When other psychosocial attributes were controlled, odds of death for heavy drinkers (defined by volume and quantity) were greater than those for light drinkers. When interactions of age and the two forms of abstinence were introduced, one study showed a significant effect of age and former drinking. Conclusions. Results were consistent with the hypothesis that characteristics of abstainers other than their non‐use of alcohol may account for their higher mortality risk. With the exception of former drinkers compared to light drinkers, when interactions were introduced into models (for measures of quantity and frequency) findings were homogeneous across studies, lending generalizability to results.
Associations between work stress, alcohol consumption and sickness absence
Authors: Vasse R. M. , Nijhuis F. J. N. , Kok G.
Published: March 2003

Aims. To test an interactional model on the associations between work stressors, perceived stress, alcohol consumption and sickness absence. Design. Cross‐sectional survey. Setting. The study was part of a Worksite Health Project including an Employee Assistance Programme and a Health Promotion Programme in the Netherlands. Participants. Participants were blue‐collar workers from two Municipal Garbage Collecting Departments and white‐collar workers from a Pharmaceutical Company (N=471). Measurements. Measurements included socio‐demographic characteristics (gender, age, education, marital status), work stressors, perceived stress, alcohol consumption and sickness absence. Type of work‐site (blue‐ or white‐collar) and smoking behaviour were used as covariates. Findings. Regression analyses resulted in three major findings. First, in the presence of stress, abstinence increased the risk of sickness absence compared with moderate drinking. We failed to find a significant relationship between excessive drinking and sickness absence. Secondly, stress mediated the associations between stressor and alcohol consumption, and between stressor and sickness absence, although stressors also directly predicted sickness absence. Conclusions. The association between abstinence and sickness absence could reflect medical problems of abstainers or a lack of skills for coping with stress. The failure to find a significant detrimental effect of excessive drinking may have been due to use of a low threshold for excessive drinking and/or low power. Prospective studies are needed to gain insight in causal relationships between the variables concerned.
A survey of bloodborne viruses and associated risk behaviours in Greek prisons
Authors: Malliori M. , Sypsa V. , Psichogiou M. , Touloumi G. , Skoutelis A. , Tassopoulos N. , Hatzakis A. , Stefanis C.
Published: March 2003

Aims. To determine HIV and hepatitis infection prevalence and correlates with risk behaviour. Design. Cross‐sectional study: voluntary. anonymous HIV, hepatitis (HCV, HBV and HDV) surveillance and questionnaire on risk factors. Setting. Korydallos Prison, Athens and Ag. Stefanos Prison, Patra, Greece. Participants. Of 544 drug users imprisoned for drug related offences, all completed the questionnaire and 533 blood samples were collected. Measurements. HIV (by anti‐HIV‐1), HCV (by antiHCV), HBV (by anti‐HBc, HBsAg) and HDV (by anti‐HDV) prevalence. Data on demography, legal status, drug use, sharing of injecting equipment. Findings. Of the 544 drug users, 375 (68.9%) had injected drugs (IDUs) at some time, 35% of whom had injected whilst in that prison. Of the 533 blood samples tested, one was positive for anti‐HIV‐1 (0.19%), 310 for anti‐HCV (58.2%), 306/531 (57.6%) for anti‐HBc, 34/527 (6.5%) for HBsAg and 12/527 (2.3%) for anti‐HDV. Prevalence rates for IDUs only were 0.27% for HIV‐1, 80.6% for hepatitis C, 62.7% for hepatitis B and 3.3% for hepatitis D. Ninety‐two per cent of IDUs injecting in prison shared needles, indicating that IDUs inject less but share more during incarceration. Multiple logistic regression revealed needle‐sharing as the most important risk factor for HCV infection in IDUs. Prior knowledge of a positive hepatitis result did not appear to inhibit IDUs from practising risky behaviours in prison. Conclusions. The epidemic of hepatitis B and C among imprisoned IDUs identified by this study constitutes a major public health problem. Prevention programmes, such as counselling, HBV vaccination, community‐based methadone maintenance treatment and syringe exchange schemes, are necessary in order to prevent a further spread. and correlates with risk behaviour.
Beyond stages of change: the quitting continuum measures progress towards successful smoking cessation
Authors: Pierce John P. , Farkas Arthur J. , Gilpin Elizabeth A.
Published: March 2003

Objective. To extend the quitting continuum to categorize smokers in the early stages of the process of smoking cessation. Design. A prospective computer assisted telephone interview study with initial interviews in 1990 and reinterviews in 1992. Setting and participants. In California, 2514 current smokers and quitters of less than 5 years duration, selected randomly from a large scale cross‐sectional survey in 1990. Results. We focus on smokers with high addiction (15 cigarettes/day) and without a strong quitting history (1 week in last year or 1 year ever) at baseline (N=822). Having an intention to quit and a limited quitting history (1‐6 days in last year) was predictive of progress at follow‐up into higher continuum levels ultimately associated with successful cessation. Furthermore, smokers with one trait were much more likely to progress than those with none. Accordingly, the lowest level of the earlier continuum was further subdivided into three subgroups (making eight levels overall). Over approximately a 2‐year period, most smokers either progressed or regressed only one or two levels along the quitting continuum. Conclusions. Better than expected progress along this expanded quitting continuum could be a criterion for a successful intervention. Tailored interventions that move smokers to a higher level on the continuum should be a priority for future research.
A short questionnaire (IRQ) to assess injecting risk behaviour
Authors: Stimson Gerry V. , Jones Steve , Sullivan Derek , Chalmers Colin
Published: March 2003

A bstract A im . To develop a short injecting risk questionnaire (IRQ) to measure sharing of injecting equipment. D esign. Matrix design with quota assignment, designed to compare the questionnaire when used by interview and self‐completion, in agency and community settings, by agency staff and fieldworkers, with different injectors (age 26 vs. 26 + ; male vs. female, opiate vs stimulant injectors), and in different geographical areas. Settings. Drug treatment and helping agencies, and community settings, in England. Participants. Drug users who had injected in the last 4 weeks. M easurem ents. Questions measured different aspects of equipment sharing. Questionnaire performance assessed by question acceptability, test‐retest (parallel forms) reliability, inter‐rater reliability, inter‐instrument reliability, internal reliability, construct validity and internal collateral validity. Statistical tests included product moment correlation, principal components analysis, and Cronbach's alpha. Findings. The questionnaire was highly acceptable. Test‐retest correlations were all high and significant, questions performed well in all conditions, with no differences by site (agency vs. out‐of‐contact), order (interview or self‐completion first), administration (staff vs. fieldworker), elapsed time or subject characteristics. The questionnaire had high internal reliability (Cronbach's alpha measured a similar domain with all questions loading highly ( 0.32) on a single factor which accounted for 42% of the variance. The complete IRQ elicited higher reports of equipment sharing (77%) than a single question (56%). C onclusions. IRQ performs well in a variety of settings, when administered in different ways to different kinds of IDUs. A single question on 'sharing' elicits fewer positive responses than the use of multiple questions about different sharing practices. + 0.86), and items
A n evaluation of D SM‐III‐ R benzodiazepine dependence criteria Rasch m odelling and IC D‐10 using
Authors: Kan Corneiis C. , Breteier Marinus H. M. , Ven Adrian H. G. S. Van Der , Zitman Frans G.
Published: March 2003

A bstract A im s. To evaluate the homogeneity of the elements of the Substance Dependence Syndrome (SDS) as applied to benzodiazepines (BZDs) by Rasch modelling. M easurem ents. The Rasch scaling model was applied to data obtained by administering the SCAN (Schedules for Clinical Assessments in Neuropsychiatry) substance dependence sections. Subsequently, Rasch‐homogeneous sets of DSM‐III‐R and ICD‐10 BZD dependence criteria were assessed for subject and item discriminability. To support their construct validity a theoretical rationale was formulated based on the Rasch scale values. Participants. A heterogeneous sample of 599 outpatient BZD users. Findings. Only particular subsets of the DSM‐III‐R and ICD‐10 BZD dependence criteria met the requirements for Rasch‐homogeneity, which appears to be due to medical aspects of BZD use. The subject and item discriminability results were sufficiently good. C onclusions. The DSM‐III‐R and ICD‐10 BZD dependence constructs may need to be redefined. The use of a BZD dependence severity model based on a Rasch‐homogeneous scale appears to have greater clinical value than a dichotomous diagnostic model based on an arbitrary cut‐off point. We recommend Rasch modelling to investigate the homogeneity of the elements of the SDS across other psychoactive substances.
T wo‐year longitudinal study expectancies and drinking adolescents of alcohol am ong Norwegian
Authors: Natvigaas Henrik , Leigh Barbara C. , Anderssen Norman , Jakobsen Reidar
Published: March 2003

A bstract A im s. The potential importance of alcohol outcome expectancies in the initiation and maintenance of drinking has been supported by studies showing that these expectancies are present before drinking begins, and that they predict drinking both cross‐sectionally and longitudinally. Although initiation of drinking behavior may be influenced by expectancy, subsequent drinking experience may modify expectations. We used structural modeling techniques to investigate the relative influence of expectancy and drinking in a three‐wave longitudinal study of Norwegian adolescents . D esign. Survey incorporating self‐administered questionnaires . Setting. Twenty‐two schools in Hordaland County on the west coast of Norway . Participants. Nine hundred and twenty‐four seventh‐grade students; 45.7% female . M easurem ents. Alcohol use (frequency, quantity, drunkenness); the Norwegian version of the Alcohol Expectancy Questionnaire for adolescents . Findings. Among students who were already drinkers upon entry into the study, expectations of positive social effects of alcohol predicted drinking longitudinally. Among those who began drinking during the study, these social expectancies predicted drinking initiation, but drinking also influenced subsequent expectancy in the early stages of drinking . C onclusions. These results support a reciprocal relationship of drinking to positive expectancy, highlighting the importance both of expectancies on influencing drinking, and of early drinking experiences on the development of positive expectancies.
A lcohol education in licensed brief intervention strategies prem ises using
Authors: Reilly David , Beurden Eric Van , Mitchell Elayne , Dight Reyna , Scott Chris , Beard John
Published: March 2003

A bstract A im s. The aim of this feasibility study is to present a description of a new approach based on alcohol brief intervention strategies to intervene with at‐risk drinkers in licensed premises . D esign. The data presented are from a convenience sample of tavern patrons . Setting. The intervention called Operation Drinksafe was conducted on 75 occasions in 67 licensed premises in an Australian rural area . Participants. There were 2761 voluntary participants who were provided with a personal risk assessment of their alcohol use . M easurem ents. The main measurements were the Alcohol Use Disorders Identification Test (AUDIT) combined with a blood alcohol concentration (BAC) reading . Findings. The median AUDIT score was 11.0, with 53% scoring in the hazardous range and 25% in the harmful range. For binge drinking, almost two‐thirds (62%) of males drank six or more drinks once a week or more compared to 29% of females. Median BAC was 0.03 mg/100 ml with 11% of males above 0.10. Regression analysis revealed that significant predictors of alcohol‐related injury were being aged less than 30 years, forgetting the previous night, having had another person express concern about your drinking, and binge drinking weekly or more . C onclusions. The program had high acceptance among licensees and their patrons. Patrons who are ready to change their at‐risk drinking behaviour may benefit from this type of minimal intervention when presented in an interesting way in their drinking environments.
Predicting likelihood of seeking the em ployee assistance salaried and union hourly help through program am ong em ployees
Authors: Delaney William , Grube Joel W , Ames Genevieve M.
Published: March 2003

A bstract A im s. This research investigated belief, social support and background predictors of employee likelihood to use an Employee Assistance Program (EAP) for a drinking problem . D esign. An anonymous cross‐sectional survey was administered in the home. Bivariate analyses and simultaneous equations path analysis were used to explore a model of EAP use . Setting. Survey and ethnographic research were conducted in a unionized heavy machinery manufacturing plant in the central states of the United States . Participants. A random sample of 852 hourly and salaried employees was selected . M easurem ents. In addition to background variables, measures included: likelihood of going to an EAP for a drinking problem, belief the EAP can help, social support for the EAP from co‐workers/others, belief that EAP use will harm employment, and supervisor encourages the EAP for potential drinking problems . Findings. Belief in EAP efficacy directly increased the likelihood of going to an EAP. Greater perceived social support and supervisor encouragement increased the likelihood of going to an EAP both directly and indirectly through perceived EAP efficacy. Black and union hourly employees were more likely to say they would use an EAP. Males and those who reported drinking during working hours were less likely to say they would use an EAP for a drinking problem . C onclusions. EAP beliefs and social support have significant effects on likelihood to go to an EAP for a drinking problem. EAPs may wish to focus their efforts on creating an environment where there is social support from coworkers and encouragement from supervisors for using EAP services. Union networks and team members have an important role to play in addition to conventional supervisor intervention.
Marijuana use and treatment outcome among opioid‐dependent patients
Authors: Budney Alan J. , Bickel Warren K. , Amass Leslie
Published: March 2003

Aims. Information concerning the association between marijuana use and opioid dependence and its treatment is needed to determine effective clinical guidelines for addressing marijuana use among opioid abusers . Setting and participants. Marijuana use was assessed in 107 people enrolled in treatment for opioid dependence . Design and measurement. Univariate comparisons of marijuana users and non‐users and multivariate regression analyses were performed to examine associations between marijuana use and socio‐demographic, psychosocial, medical and substance‐use variables. The relationship between marijuana use and treatment outcome was also explored in a subset of this sample who received treatment that included buprenorphine detoxification and behavior therapy (N = 79 ). Findings. Sixty‐six per cent of participants were current marijuana users and almost all (94%) continued to use during treatment. Users were less likely to be married than non‐users, and more likely to report financial difficulties, be involved in drug dealing and engage in sharing of needles ( p 0.05). A unique effect of marijuana use on drug dealing and sharing needles was retained after statistically controlling for the influence of heroin and alcohol use and other socio‐demographic variables. No significant adverse relations were observed between marijuana use and treatment outcome. Conclusion. Pending a more comprehensive understanding of the function and consequences of marijuana use on psychosocial functioning, it appears that progress in treatment for opioid dependence can be made without mandating that patients abstain from marijuana use.
The relationship between parental separation in childhood and problem drinking in adulthood
Authors: Hope Steven , Power Chris , Rodgers Bryan
Published: March 2003

Aims. To investigate the association between parental separation and alcohol consumption and problem drinking in early adulthood (at ages 23 and 33) . Design. The study used longitudinal data from the 1958 British birth cohort study, a large representative national sample followed to age 33 . Setting. Great Britain . Participants. 11 407 subjects were interviewed at age 33 in 1991 (69% of the target population). Analyses are based on 4606 men and 4892 women with data at ages 23 and 33 . Measurements. Units of alcohol consumed in the previous week at ages 23 and 33. Heavy drinking was defined as more than 20 units/week (women) and more than 35 units/week (men). Problem drinking was indicated by the four‐item CAGE measure. Information on parental separation was reported by subjects at age 33; parental deaths were ascertained from data recorded in childhood sweeps of the survey . Findings. At age 23, the relationship between parental separation and alcohol consumption was weak and inconsistent, but by age 33 a stronger and more consistent relationship had emerged. Higher levels of alcohol consumption, heavy drinking and problem drinking (odds ratios 1.29‐1.90) were found for those who had experienced parental divorce in childhood, but not later parental divorce or parental death. These results were not substantially attenuated by possible mediating factors, such as marital status or socio‐economic circumstances . Conclusions. The risk associated with early parental divorce appeared to strengthen between ages 23 and 33. Life‐course factors influencing the manifestation of alcohol problems in those from divorced families need to be identified.
A 3‐year progress report on the implementation of LAAM in the United States
Authors: Rawson Richard A. , Hasson Albert L. , Huber Alice M. , Mccann Michael J. , Ling Walter
Published: March 2003

Aims. LAAM, a long‐acting opioid agonist, was approved by the US Food and Drug Administration in 1993 for use in licensed narcotic treatment programs. These programs have the exclusive authority in the United States to dispense methadone and LAAM for the treatment of opiate dependence. The purpose of this report is to describe the course of LAAM's implementation and to document some of the factors that have influenced the time course and extent of this process . Design. Narcotic treatment programs approved for LAAM use were contacted by telephone at three timepoints following the FDA approval of LAAM in 1993 . Findings. Regulatory hurdles have been the most significant factor in slowing the use of LAAM. Some clinics have enthusiastically moved LAAM into mainstream use with great success. At other clinics LAAM implementation has been impeded by staff resistance and management reluctance. Some specific clinical practices, such as provision of adequate dose levels and flexible dosing practices, appear to be associated with superior clinical response, but issues of staff and organizational attitude toward the new medication are probably the most important impediments to a more positive response . Conclusions. The tasks involved with introducing a new opiate agonist treatment into mainstream use in the United States are numerous and complex. Clinical policies, fiscal issues and regulatory factors must all be addressed. The introduction of LAAM into the treatment system provides some useful lessons as other new addiction pharmacotherapies are moved into mainstream use.