bluuebunny/crossref_metadata_2025 huggingface dataset:
The Stockholm County programmes for accident and alcohol prevention and injury surveillance‐initial experiences
Authors: ROMELSJÖ ANDERS , ALBERTS KARL AKKE , ANDERSSON RAGNAR
Published: January 2006

A comprehensive programme for accident prevention and injury surveillance was established in Stockholm County in 1988. Its main objective is to reduce the morbidity and mortality of unintentional injuries by 25% by the year 2000, and by more than 25% in the high‐incidence groups. An accident prevention unit has been assigned the task of planning and implementing an accident prevention programme, while a programme for prevention of alcohol‐related problems was set up later. An injury epidemiological unit at the Karolinska Hospital is responsible for coordinating injury surveillance, which is an important contribution for monitoring and evaluation of the prevention programmes. On injured patients information about type of injury, extent of injury, place, activity, injury mechanism, external cause of injury, treatment and other items is entered on a special registration form. In (10%) of 11 327 injury events alcohol was considered by the physician to be a main or contributory cause of the injury, with a predominance among males. An act of violence was approximately three times as common among mates and five times as common among females with alcohol involvement than among cases without alcohol involvement. The injury surveillance can be an important means for evaluation of programmes for prevention of injuries and alcohol‐related events.
HIV risks for women drug injectors: heroin and amphetamine users compared
Authors: KLEE HILARY
Published: January 2006

The incidence of HIV infection among women in Europe and the US is growing rapidly. Women who inject drugs are particularly vulnerable—they may acquire the infection through sharing injecting equipment and through sexual contact with an infected male. Opioids and stimulants are reputed to have different effects upon sexual activity and a sex life enhanced by drugs may increase the risk further. In the context of two larger studies of HIV‐related risk behaviours among opioid and amphetamine users in the North West of England, the sexual behaviour and sharing of two groups of female injectors were compared, one whose primary use was heroin, the other amphetamine. Reported incidence of sharing was similar and high. Marked differences were observed in sexual behaviour, amphetamine injectors reporting greater interest in sex and greater frequency of intercourse. However, more of them perceived their personal risk to infection through unprotected sex as negligible. Over 80% in both groups had engaged in unprotected sex in the 6 months prior to interview. Women injectors tend to have injecting partners–more research is needed if health education strategies are to be devised that will protect them.
Alcohol‐related problems among Aboriginal drinkers in the Kimberley region of Western Australia
Authors: HALL WAYNE , HUNTER ERNEST , SPARGO RANDOLPH
Published: January 2006

This paper reports on the prevalence of alcohol‐related problems among drinkers in a stratified random sample of the adult Aboriginal population of the Kimberley region of Western Australia. Subjects were 265 current drinkers who were identified in the total sample of 516 Kimberley Aboriginal men and women over the age of 15 years. Participants' reports were obtained on their frequency and quantity of alcohol consumption, and their lifetime experience of 16 alcohol‐related problems. The majority of Aboriginal drinkers in the Kimberley consumed harmful amounts of alcohol, and there was a high prevalence of the 16 alcohol‐related problems which showed a high degree of internal coherence, with the first principal component accounting for 45% of the total variance. The number of alcohol‐related problems which respondents reported was strongly related to the quantity and frequency of self‐reported alcohol consumption.
Book Reviews
Authors: GOSSOP MICHAEL
Published: January 2006

Books Reviewed in this Article:

Heavy Metal: The Social Meaning of Petrol Sniffing in Australia MAGGIE BRADY

Smoking: The Artificial Passion DAVID KROGH

More Revealed: A Critical Analysis of Alcoholics Anonymous and the Twelve Steps KEN RAGGE

Recent Developments in Alcoholism, Volume 10. Alcohol and Cocaine. Similarities and Differences MARC GALANTER (Ed.)

Risk Takers: Alcohol, Drugs, Sex and Youth MARTIN PLANT & MOIRA PLANT

Comprehensive Handbook of Drug and Alcohol Addiction NORMAN S. MILLER (Ed.)
Alcohol and suicide in Denmark 1911‐24–experiences from a ‘natural experiment’
Authors: SKOG OLE‐JØRGEN
Published: January 2006

In 1916‐17, prices of alcoholic beverages increased dramatically in Denmark, and alcohol consumption decreased strongly. On the basis of this ‘natural experiment’, the effect of variations in per capita alcohol consumption on suicide rates is estimated, and compared to Norström's analysis of Danish data from the period 1931‐80, as well as similar analyses from other countries. It is concluded that per capita alcohol consumption is probably related to the suicide rate in Denmark, but to a less extent than in some other countries.
Visiting public drinking places in Oslo: an application of the theory of planned behaviour
Authors: TPUEEN BENTE , NORDLUND STURLA
Published: January 2006

This study was undertaken to describe and obtain better insight into pub‐going in the Norwegian capital applying the theory of planned behaviour (TPB). The sample comprised 1053 persons aged between 16 and 71 years who visited public drinking places in Oslo. Two thirds of the sample were men. Data were collected by means of anonymous self‐administered questionnaires. The majority of the respondents reported having visited a public drinking place at least once a week during the past 12 months. In the applied model, intention to visit a public drinking place during the next 14 days is considered to be a joint function of the attitude towards pub‐going (Aact), subjective norms (SN), and perceived control over the behaviour (PBC). The goodness of fit (R2) of the model was 22%. The relative importance of the model's components were in descending order (beta): PBC, Aact and SN. Previous behaviour was included as a predictor in the TPB, and had a stronger effect upon intention than the model's original components. In conclusion, the TPB provided an adequate understanding of why pub and cafe guests frequent public drinking places. However, it is possible that the model over‐simplifies the processes connected to pub‐going and fails to describe the dynamics of the relationship between the individual and the environment.
Initial and current drug use: how are they related?
Authors: RONALD PETER J. M. , ROBERTSON J. ROY
Published: January 2006

The present study examines how initial and current patterns of drug use are related among a group of drug users in Edinburgh. The study categorised individuals according to the year in which they first used illicit drugs. 1984 has been shown to be the year when patterns of drug use in this group began to change after high levels of heroin use in the late 1970s and early 1980s, Thus 1984 was used as the intercept point to create two groups: the epidemic group, comprising individuals who began using illicit drugs before 1984, and, the post epidemic group, who began using during or after 1984. Data from individuals were gathered from interviews and medical records. Statistical analysis revealed interesting differences between the groups, for example, the groups did not differ significantly in their use of methadone but the epidemic group used more methadone obtained on prescription. The post epidemic group was found to inject more often, but, did not share injecting equipment more than the epidemic drug users. A greater number of the epidemic group began using drugs by injecting and a greater number of the post epidemic group began by caking drugs orally. The issues raised by the results are discussed, and, it is suggested that the characteristics of the drug using community within which an individual begins using drugs may exert influence on patterns of drug use in later years.
Opiate and cocaine consumers attending Barcelona emergency rooms: a one year survey (1989)
Authors: DOMINGO‐SALVANY ANTÒNIA , HARTNOLL RICHARD L. , M ANTÓ JOSEP
Published: January 2006

Due la the limitations of standard epidemiological methods, indirect indicators have often been used to describe the characteristics of drug abusing populations and to assess prevalence trends in illegal drug use. In Barcelona (Spain), a study of emergency room (ER) attendance was carried out to describe the population of opiate/cocaine consumers across the whole city who use this service. Three thousand four hundred and five consumers of opiates and/or cocaine, aged 15‐44 years, who attended ERs during 1989, were identified. They accounted for 6807 episodes in the hospitals surveyed. Their mean age was 26 years, men (73%) being 1 year older than women (25.2 years). The drug of abuse was specified in the clinical records of 60% of individuals, heroin being the most frequently specified (56%). The main reason for attendance was ‘other medical condition’(OMC) (55% of episodes), followed by withdrawal (34%) and overdoses (6%). Seventy‐one percent of individuals were residents of Barcelona city, yielding a rate of 3.2 opiate/cocaine consumers attending ERs per thousand Barcelona residents aged 15‐44. The geographical distribution of the rates in the city showed a very large difference between districts, the most deprived ones having a higher rate of consumers attending ERs. ER data can provide valuable insights into the nature and dimensions of drug abuse problems.
The relevance of research to policy formulation: an Australian perspective
Authors: KINGDON TONY
Published: January 2006

This paper puts the role of research into perspective in the policy‐making context. It points out that there are differing ‘policy’ goals of government and the use of research might be vital for one element, e.g. health policy, but of lesser significance in, say, international policy. The paper then goes on to describe case studies of where research has had a major impact on government decision making in Australia in the past 2 years, notably in the area of proposed changes to the marketing and sale of alcoholic beverages.
Failures in alcohol policy: lessons from Russia, Kenya, Truk and history
Authors: PARTAKEN JUHA
Published: January 2006

The paper draws upon the recent developments of alcohol policy in the ex‐Soviet Union and in Africa, especially Kenya. According to the standard criteria of success, both are to be regarded as total or near‐total failures. The examination of these cases will, consequently, reveal some of the factors that are essential prerequisites for carrying out successful alcohol policies. It will lead to considerations concerning the approaches and problems of alcohol research; to a discussion about the marginalization of alcohol and drinking in our Western societies; to another look at the tasks of alcohol policies (based also on experiences in Truk, Federated States of Micronesia); and, finally, to a rather modest view about the role of alcohol policy in general.
Lessons to be learnt from Poland's attempt at moderating its consumption of alcohol
Authors: MOSKALEWICZ JACEK
Published: January 2006

This paper analyses the interplay between alcohol policy and research in Poland during the last two decades. It was a period of profound political and economic changes that strongly influenced the alcohol scene. In the 1970s alcohol was treated as a secret issue. Despite a rapid growth of alcohol consumption neither the authorities nor media expressed any concern about the growing wave of related problems. Funding allocated to research was very low and only a few devoted individuals continued their studies, albeit on a reduced scale. The beginning of the 1980s saw a sudden politicization of the alcohol issue. The government was blamed for pushing alcohol. In response to this challenge, alcohol controls were tightened. A huge programme of alcohol research was initiated to accumulate knowledge and evidence for further alcohol policy, as well as to symbolize a high priority of the alcohol issue. In following years, however, the political significance of alcohol decreased. The system established for its control was eroded, and finally collapsed in the late 1980s and early 1990s. The huge research evidence that was accumulated during the 1980s is not being applied to alcohol policy, which itself has virtually ceased to exist.
Differences between smokers and never‐smokers in sensitivity to nicotine: a preliminary report
Authors: POMERLEAU OVIDE F. , HARIHARAN M. , POMERLEAU CYNTHIA S. , CAMERON OLIVER G. , GUTHRIE SALLY K.
Published: January 2006

Sensitivity to nicotine was explored using test doses administered via intra‐nasal aerosol in 10 smokers and JO never‐smokers. Smokers received 1.50 mg nicotine (in 2 sprays, < 5 seconds apart, one spray per nostril); never‐smokers received either 0.50 mg (n = 3) or 0.25 (n = 7) nicotine. Accumulation of nicotine in plasma, per unit dose administered, was nearly four times greater in never‐smokers, than in smokers, indicating differences in pharmacokinetic tolerance. To examine sensitivity to nicotine without this confound, peak physiological reactivity (heart rate and blood pressure changes) was divided by peak plasma nicotine increment and the ratio was expressed as a function of cotinine level prior to dosing, thereby relating sensitivity to nicotine to history of exposure. In smokers, functional sensitivity to nicotine was inversely related to customary nicotine intake, replicating previous findings for light and heavy smokers. The observation that never‐smokers were not much more sensitive to nicotine than light smokers is notable given the disparity in previous history of exposure.
Severity of dependence: data from the DSM‐IV field trials
Authors: WOODY GEORGE E. , COTTLER LINDA B. , CACCIOLA JOHN , Grant Bridget
Published: January 2006

The concept of a dependence syndrome with graded levels of severity was originally derived from work with alcoholics. The applicability and clinical utility of the dependence syndrome across a wider range of substances was examined as part of the DSM‐IV field trials. When using a criterion count method to assess severity, it was found that persons cluster at different severity levels according to the drug on which they are dependent. Across all drug classes, severity correlated reasonably well with measures of quantity and frequency of use and with associated problems. The relationship between severity ratings and outcome was not tested, however data from other studies indicate that severity is only one of many factors that can influence outcome.
Why do some people recover from alcohol dependence, whereas others continue to drink and become worse over time?
Authors: MOOS RUDOLF H.
Published: January 2006

For more than three decades, my colleagues and I have examined factors that help people overcome adversity, in particular how personal and treatment factors and the broader social context influence recovery from alcoholism. Guided by a demanding Guardian Angel, we have formulated conceptual models that raise key issues, developed tentative measures of key constructs, and conducted long‐term naturalistic studies. In an ongoing odyssey of quest and discovery, we have identified interrelated factors that are important to predicting outcomes. These factors include personal resources and specific aspects of treatment, life context, and appraisal and coping. Such basic processes are also broadly relevant to remission and recovery from depression and other disorders. The answers to each question we have addressed point to more intriguing and complex issues to consider before vie with grasp the essence of why some people adapt to adversity so much better than others do.
Follow‐up study of young attenders at an alcohol unit
Authors: DOYLE H. , DELANEY W. , TOBIN J.
Published: January 2006

A follow‐up study of all under 21 year olds satisfying DSM‐III‐R criteria for alcohol dependence treated as in‐patients at an alcohol treatment unit over a 10‐year period was conducted. A total of 52 individuals were identified and of these 80% (44) were traced. The mean period of follow‐up was just over 4 years. A poor outcome (no abstinence or controlled drinking for the past 6 months) was adjudged in 61.4% (27) of the cases. This was associated with indicators of early personality difficulties and unsatisfactory schooling experiences. There was considerable concurrent illicit drug use associated with continuing problem drinking. Both good and poor outcome groups initially had striking forensic histories and significant differences developed over the follow‐up period Kith the poor outcome group continuing to have marked legal problems. In addition the poor outcome group continued to make heavy demands on the medical services over the period. One person died from an alcohol related cause. Greater attention to the specific needs of this group is required and specialized treatment units for young problem drinkers is suggested.
Substance use disorder: abuse, dependence and dyscontrol
Authors: WIDIGER THOMAS A. , SMITH GREGORY T.
Published: January 2006

The purpose of this paper is to review the diagnostic concepts of substance abuse and substance dependence provided in DSM‐III, DSM‐III‐R, and the forthcoming DSM‐IV. The review incorporates the principles that there are no infallible criteria for identifying taken a person lacks sufficient control over the usage of a drug, that dyscontrol exists on a continuum, that substance use dyscontrol shares many formal properties with behavioral dyscontrol within other domains, and that the diagnosis of a mental disorder should be free of moralistic connotations. We conclude the paper with an alternative proposal, wherein the DSM‐IV diagnoses of abuse and dependence are collapsed within one diagnosis of substance dyscontrol disorder and physiological substance dependence is placed with the diagnoses of substance intoxication and substance withdrawal.
A digest of memory phenomena for addiction research
Authors: HAMMERSLEY RICHARD
Published: January 2006

The implications for addiction research of recent knowledge about human memory are described. It is important that research using self‐reported data understands the limits of suck data. The nature of human memory and the selective, constructive processes of remembering provide one set of limits. Abandoning retrospective data entirely is not feasible in addiction research, for it would require the abandonment of current and prospective self‐reported data as well, as they are also subject to memory biases. Because of memory distortions, self‐reports, even by rigorous questionnaire, are biased narratives rather than incomplete but otherwise accurate evocations of past events. These limits necessitate caution and humility in the interpretation of findings, and cannot be eliminated by any particular set of research methods. There will never be a philosophers’stone which will convert self‐reported data into absolutely accurate figures of quantity, frequency and timing. Nor is it straightforward to infer social and psychological causality from the organization and timing of events as remembered.
Time course of effects of brief inhalations of nitrous oxide in normal volunteers
Authors: ZACNY JAMES P. , LICHTOR J. LANCE , COALSON DENNIS W. , APFELBAUM JEFFREY L. , FLEMMING DAVID , FOSTER VANESSA
Published: January 2006

Nitrous oxide is commonly used (abused) recreationally by inhaling it in a bolus form (i.e. single or several breaths). The time course of the psychoactive effects of nitrous oxide, via this mode of inhalation, has not been adequately characterized and thus formed the basis for this study. Twelve healthy volunteers participated in four sessions, using a randomized, cross‐over, placebo‐controlled design. In each session one of the following four measures were assessed: self‐reported strength of drug effects, mood, memory and psyckomotor performance. Within sessions, subjects were exposed to four different concentrations of nitrous oxide in a randomized fashion: 0% (oxygen‐placebo), 40%, 60% and 80%. At each concentration, or “trial”, subjects took four deep breaths of the gas. Peak drug effects, as reported by our subjects, occurred within 30 seconds after the last inhalation of nitrous oxide, persisted for about a minute, and then gradually subsided to near‐baseline levels by 5 minutes post‐inhalation. Certain aspects of mood were briefly affected by nitrous oxide, generally in a dose‐related fashion with increases in visual analog scale ratings of “anxious”, “stimulated”, “coasting (spaced out)”, “lightheaded”, “confused”, and “high”. Free recall of words that had been presented between 30 and 60 seconds post‐inhalation was significantly reduced after 80% nitrous oxide, relative to oxygen‐placebo. There was a trend towards psychomotor impairment (Concentration x time: p – 0.08), as measured by the Digit Symbol Substitution Test, with peak decrements in performance (about a minute after inhalation) being greater after 80% nitrous oxide than after 0% nitrous oxide. Our results suggest that there arc acute, albeit brief, adverse effects of inhaling bolus concentrations of nitrous oxide.
The Manjakkudi experience: a camp approach towards treating alcoholics
Authors: RANGANATHAN SHANTHI
Published: January 2006

A new approach towards treating alcoholics in a rural population is discussed in this paper. This approach is referred to as the “camp approach”. The first such camp was organized in a rural place called Manjakkudi, a village located in Thanjavur District, Tamil Nadu, India. The first camp was held in 1989 and after that three more such camps were conducted in Manjakkudi over a period of 4 years. A total of 105 patients was treated in these camps, Though this treatment programme a similar to the main programme which we follow at T, T, Ranganathan Clinical Research Foundation in the dry, slight modifications were made to suit the rural environment. The details of the programme are discussed in this paper. Total abstinence is the goal. This paper examines the results of the Jour camps conducted at Manjakkudi and attempts to gain an insight into the factors responsible for such a gratifying outcome.
Sexual behaviour of drug injectors in London: implications for HIV transmission and HIV prevention
Authors: RHODES TIM , DONOGHOE MARTIN , HUNTER GILLIAN , SOTERI ANDROULLA , STIMSON GERRY V.
Published: January 2006

The importance of sharing infecting equipment in the transmission dynamics of HIV is well established. Comparatively less is known about the sexual behaviour of drug injectors and the risks posed to themselves and their sexual partners through the sexual transmission of HIV. Findings are reported from survey‐based interviews undertaken in 1991 which investigated the sexual behaviour of 516 drug injectors, both in and out of treatment in London. The majority of respondents (80%) were sexually active in the 6 months preceding interview. During this time, respondents had a mean of 2.1 non‐commercial opposite sex partners. Most (66%) had vaginal intercourse at least once a week, although 68% never used condoms with primary partners and 34% never used condoms with casual partners. Those having sexual intercourse most often were less likely to use condoms. Many had non‐injecting sexual partners, and 62% of respondents' primary and casual partners did not inject drugs. Confirmed saliva HIV test results show 10% of respondents to be antibody positive, with a higher rate of prevalence (14% positive) among those with no experience of treatment. This group were also more likely la report casual sexual intercourse. The average rate of partner change, the high proportion of drug injectors with non‐injecting partners and the infrequency of condom use within primary and casual relationships indicates the potential for HIV transmission between injectors and their non‐injecting sexual partners. The paper concludes by emphasizing the importance of outreach and community‐based intervention in safer sex health promotion.
Alcohol and depression in English and American lawyer disciplinary proceedings
Authors: GOODLIFFE JONATHAN
Published: January 2006

This paper gives a comparison of the approach of the US courts and of the Solicitor's Disciplinary Tribunal in England to disciplinary proceedings concerning lawyers suffering from alcohol dependence and/or depression. A richer case law in the USA indicates a more sophisticated approach, higher standards as to evidence and better support systems for lawyers in recovery. Useful lessons could be learned from the American experience and the experience of doctors and dentists by English lawyers.
The effect of parental alcohol problems on rates of adolescent psychiatric disorders
Authors: LYNSKEY MICHAEL T. , FERGUSSON DAVID M. , HORWOOD L. JOHN
Published: January 2006

The relationships between parental alcohol problems and risks of psychiatric disorders including substance abuse, conduct, attention deficit, mood and anxiety disorders were examined in a birth cohort of New Zealand children studied to the age of 15 years. This analysis showed that children exposed to alcoholic parents had risks of adolescent psychiatric disorders that were between 2.2 (95% Confidence Interval (CI) = 1.4; 3.3) to 3.9 (95% CI=2.40; 6.0) times higher than children whose parents did not report alcohol problems. After adjustment for a range of confounding factors these associations tended to reduce but even after adjustment, children of alcoholic parents had rates of disorder that were between 1.6 (95% CI = 1.1; 2.6) to 3.0 (95% CI= 1.8; 4.5) times higher than the offspring of parents who did not have alcohol problems. The analysis suggested approximately linear relationships between the extent of reported parental alcohol problems and risks of disorder. There was no evidence to suggest that, in general, males responded to parental alcohol problems in a way that differed from the response of females.
What if alcoholism had not been invented? The dynamics of American alcohol mythology
Authors: MULFORD HAROLD A.
Published: January 2006

This essay speculates on what might have been had alcoholism not been invented. The invention is viewed as a product of the ongoing myth‐making process whereby society continuously defines and redefines alcohol, seeking to integrate it into the culture in ways that allow enjoyment of its pleasures with minimum pain. Had alcoholism not been invented, (a) the myth‐making process might have yielded another simplistic explanation of drunkenness, but more likely alcohol would have remained the supposed cause; (b) the per capita alcohol consumption uptrend of some 50 years standing might not have reversed as it did in 1982; (c) chronic drunkards might still be denied life‐saving hospitalization which gains them more time for the natural reform process to work for them; and (d) local communities nationwide might have taken common‐sense actions to facilitate the natural rehabilitation process and provided more benefit to more alcoholics for less cost than treating alcoholism. It is expected that Americans will continue to drink and will continue to seek a more harmonious relationship with alcohol. The informal social controls will continue to largely constrain individual appetites for alcohol's pleasures, and most alcoholics will continue to gain control of their excessive drinking in the natural course of events with or without exposure to alcoholism treatment.
Prevalence of HIV and associated risk behaviour in attendees at a Dublin needle exchange
Authors: JOHNSON Z. , O'CONNOR M. , POMEROY L. , JOHNSON H. , BARRY J. , SCULLY M. , FITZPATRICK E.
Published: January 2006

The aim of this study was to measure the prevalence of HIV infection and assess the level of equipment‐sharing and unsafe sexual activity among attendees at a Dublin needle exchange. Using an anonymous unlinked approach, attendees were asked to complete a brief questionnaire and provide a sample of saliva for HIV testing. Of the 144 attendees eligible for inclusion during the study period, 106 agreed to participate and complete a questionnaire, a response rate of 74%. Of the 81 respondents who submitted a usable saliva sample, 14.8% were HIV positive. Half of the respondents claimed that they had not shared equipment during the preceding 28 days, but a third had shared with multiple partners. Half of the respondents claimed that they had multiple sexual partners during the preceding year, but only a quarter said that they always used condoms. The prevalence of HIV infection is similar to that found in routine linked testing of drug users in Ireland. The high level of unsafe injecting and sexual activity makes clear the need for more effective health promotion among drug users in Dublin.
Drinking problems and the position of women in Nigeria
Authors: IKUESAN BENSON A.
Published: January 2006

This paper examines, against the background of society's general attitudes toward women, the special problems that arise for women who misuse alcohol in Nigeria, Both traditional and contemporary Nigerian societies idealize women. Their roles are circumscribed and they are least expected to engage in certain socially unacceptable behaviours (alcohol misuse included) that could at best only be pardoned if males were to behave in this way. Women who misuse alcohol in Nigeria therefore suffer enormous psychological and social damage, besides the physical complications experienced by alcohol misusers. They are considered as social misfits, and would in many cases end up in prostitution. Their “sins” are visited upon their children and extended family, who in turn would be under pressure to salvage the family name and image. The nature of help available to such women, and recommendations for improving that help, are discussed.
Sexual behaviour and its relationship to drug‐taking among prostitutes in south London
Authors: GOSSOP MICHAEL , POWIS BEVERLY , GRIFFITHS PAUL , STRANG JOHN
Published: January 2006

The precise manner in which the use of different types of drugs is related to prostitution has not been adequately researched. This study investigates patients of drug‐taking and sexual behaviour among a group of women working as prostitutes in south London; it also looks at prostitution in which sex is offered in return for drugs, at the links between heroin, cocaine and alcohol use and sexual behaviour, and at the association between severity of dependence and sexual behaviour. All of the women in our sample (n− 51) were actively working as prostitutes. More than half of them had given sex for drugs, though this was a relatively infrequent occurrence. The majority of them were using heroin and many of them were moderately or severely dependent upon heroin. More than one‐third had shared injecting equipment after it had already been used. Almost two‐thirds reported that they only worked as a prostitute in order to fund their use of drugs (predominantly heroin), and that they would not continue working as a prostitute if they were not still using drugs. The more severely dependent upon heroin they were, the more likely they mere to report these links between heroin use and prostitution. About half of the women in our sample said that they first started to work as a prostitute in order to pay for drugs. The women who began to use heroin prior to prostitution were more severely dependent on heroin and described themselves as being trapped in prostitution by the need to maintain a supply of heroin. Very few women regularly used cocaine in association with their prostitution. There are grounds for concent about the alcohol consumption of these women. About one‐quarter of the women said that they used alcohol every day; some of them reported drinking at levels which greatly exceed recommended limits for women, and some were drinking at levels which mere likely to be physically damaging.
Overview: Demography, epidemiology and psychopharmacology–making sense of the connections
Authors: BABOR THOMAS F.
Published: January 2006

This overview discusses the five papers covering demographic and prevalence issues in terms of the commonalities and differences across psychoactive substances, particularly as they pertain to the relationship between demographic factors and the prevalence of substance abuse. This overview also concerns itself with gaps in knowledge, methodological issues and future directions for research. It begins with some basic definitions and fundamental questions. A brief review of the salient points of each paper is then provided, followed by a more synthetic discussion of methodological and theoretical issues. It closes with some speculative ideas about the meaning of demographic variables for an understanding of substance abuse.
Opiate reinforcement processes: re‐assembling multiple mechanisms
Authors: BOZARTH MICHAEL A.
Published: January 2006

Opiate reinforcement processes can be described within the context of operant conditioning theory. Both positive and negative reinforcing effects may motivate drug‐taking behavior, although the strongest evidence attributes drug‐taking to a simple positive reinforcement process. Empirical research has focused largely on a positive reinforcement mechanism involving the ventral tegmental dopamine system, but three additional reinforcement mechanisms can be argued on logical grounds. These other mechanisms involve neuroadaptive changes produced by chronic opiate administration and may contribute to the strong motivational impact of opiates following long‐term drug use.
Biological effects of central nervous system stimulants
Authors: HOLMAN R. BRUCE
Published: January 2006

In both animals and man, stimulants such as the amphetamines and cocaine are reinforcing and thus motivate repeated drug‐taking behaviour and leading to abuse. Although this class of drugs seems to act by different biological mechanisms in the central nervous system, it has been suggested that their action to increase dopaminergic neurotransmission is crucial to the reinforcing properties of these compounds. However, increasing evidence suggests that a number of other neurotransmitters/neuroregulators, possibly in conjunction with dopamine, are pan of the complex neurochemical systems which underlies various aspects of stimulant abuse behaviours. Examples of possible influences of noradrenaline and corticosterone will be discussed.
Nicotine withdrawal versus other drug withdrawal syndromes: similarities and dissimilarities
Authors: HUGHES JOHN R. , HIGGINS STEPHEN T. , BICKEL WARREN K.
Published: January 2006

Many of the symptoms of nicotine withdrawal are similar to those of other drug withdrawal syndromes: anxiety, awakening during sleep, depression, difficulty concentrating, impatience, irritability/anger and restlessness. Slowing of the heart rate and weight gain are distinguishing features of tobacco withdrawal. Although nicotine withdrawal may not produce medical consequences, it lasts for several weeks and can be severe in some smokers. Like most other drug withdrawals, nicotine withdrawal is time‐limited, occurs in non‐humans, is influenced by instructions/expectancy and abates with replacement therapy and gradual reduction. Unlike some other drug withdrawal syndromes, protracted, neonatal or precipitated withdrawal does not occur. Whether nicotine withdrawal is associated with tolerance, acute physical dependence, greater duration and intensity of use, rapid reinstatement, symptom stages, cross‐dependence with other nicotine ligands, reduction by non‐pharmacological interventions and genetic influences is unclear. Whether nicotine withdrawal plays a major role in relapse to smoking has not been established but this is also true for other drug withdrawal syndromes.
Opiate withdrawal
Authors: FARRELL MICHAEL
Published: January 2006

Opiate withdrawal is one of the longest studied and most well described withdrawal syndromes. Opiate withdrawal has been described as akin to a moderate to severe flu‐like illness. Opiate withdrawal is appropriately described as subjectively severe but objectively mild. This paper describes the mechanisms of opiate dependence and opiate withdrawal and reviews the available instruments for the measurement of withdrawal. The time course of assisted and unassisted withdrawal is described and the range of options for the management of assisted withdrawal are described. This review concludes that the most effective and least time‐ and resource‐consuming approach to opiate withdrawal will substantially contribute to the overall social management of opiate dependence.
Opiates: are there under‐utilized and unexplored areas of prevention?
Authors: STRANG JOHN
Published: January 2006

This paper explores the varied and potentially conflicting goals of preventive measures as applied to opiate use. These goals relate both to the overall extent of opiate use and the amount of harm arising from this drug use. Prevention involves the control both of the supply side and the demand for opiates. Particular targets may include sharing equipment, injecting, progression to more harmful routes of administration, prevention of development of dependence, harmful sequelae of opiate use and co‐morbidity. There may be a place for manipulating the black market for opiates to channel users in directions that achieve particular prevention goals, and being more selective about targeting particular groups of users at particular times. It is the role of scientists to quantify the dimensions of harm and the likely impact on these dimensions of particular interventions. It is then up to elected representatives to determine the priorities.
The treatment of stimulant dependence
Authors: SCHUCKIT MARC A.
Published: January 2006

Rehabilitation efforts offered to individuals with stimulant dependence incorporate a series of maneuvers to accomplish three major goals. Following active detoxification, most clinicians attempt to: (1) increase motivation for abstinence and maintain a high level of commitment to this goal; (2) help individuals to rebuild a stable life–style without substances; and (3) actively work toward ways of decreasing the probability of relapse (relapse prevention). While these activities incorporate education, counseling, outreach to families and exposure to self–help groups (e.g. Cocaine Anonymous), numerous pharmacological approaches have been tested. Each mode of drug therapy is based on a reasonable hypothesis, but appropriately controlled and structured clinical trials have not yet revealed any pharmacological approach for rehabilitation of stimulant–dependent individuals for which the risks have been shown to outweigh the assets.
Is having an alcoholic father hazardous for children's physical health?
Authors: DOBKIN PATRICIA L. , TREMBLAY RICHARD E. , DESMARAIS‐GERVAIS LYSE , DEPELTEAU LOUISE
Published: January 2006

Five hundred and ninety‐time French‐Canadian pre‐adolescent children for whom the alcoholic status of the parents was known were subdivided into eight groups, according to family structure (intact, non‐intact), alcoholic status of the father (alcoholic, non‐alcoholic) and gender of the target child (girl, boy). ANCOVAs were conducted (controlling for income, a factor which contributes to illness) for health‐related variables in order to test the hypothesis that children of alcoholic fathers have more physical health problems compared to children without alcoholic fathers. Data pertaining to use of medical services, serious and minor illnesses and pregnancy‐related events were analysed. It was found that overall, pre‐adolescent children of alcoholics were not more ill than children of non‐alcoholics. There were, however, some differences worthy of note. Children of alcoholics had significantly lower birthweights than the children of non‐alcoholics. Boys in non‐intact alcoholic families were of shorter stature than the other children. A three‐way interaction showed that daughters of alcoholics and sons of non‐alcoholics living in non‐intact families were more likely to have used psychologists' services, as were sons of alcoholics in intact families. The results were discussed in terms of the heterogeneity of alcoholic families as well as the need to identify subgroups of children of alcoholics who are at risk.
Unemployment and change of tobacco habits: a study of young people from 16 to 21 years of age
Authors: HAMMARSTRÖM ANNE , JANLERT URBAN
Published: January 2006

In a cohort study of 1080 pupils who were followed for 5 years from when they left compulsory school (from age 16 to age 21 years), smoking habits were found to correlate with unemployment among both boys and girls. Pupils who zuere smokers in school had a higher risk of becoming unemployed than non‐smokers. Irrespective of early smoking, smoking habits developed more unfavourably among unemployed young people than among those with no unemployment during the period studied. The odds ratio of being a smoker at the age of 21 years when unemployed more than 20 weeks during the observation period, compared with those without or with short unemployment, was 2.44 for men and 3.45 for women. When adjusted for the influence of socio‐economic background, education, economy and smoking habits at the start of the period, the odds ratio was 1.7 (95% CI 1.01 2.86) for men and 2.0 (1.13–3.53) for women. The adjusted odds ratio for increasing or starting smoking during the period was 1.5 (95% CI 0.89‐2.56) for men and 2.0 (1.18–3.35) for women. No significant correlation was found between snuffing and unemployment. Thus, it seems that unemployment is a risk factor for development of tobacco smoking in young people, especially among women.
Genetic and environmental contributions to smoking
Authors: TRUE WILLIAM R. , HEATH ANDREW C. , SCHERRER JEFFREY F. , WATERMAN BRIAN , GOLDBERG JACK , LIN NONG , EISEN SETH A. , LYONS MICHAEL J. , TSUANG MING T.
Published: January 2006

We estimate the magnitude of genetic and shared environmental contributions to risk of initiation and maintenance of smoking. Genetic models were fitted to data from 2 204 male‐male monozygotic and I 793 male‐male dizygotic twin pairs from the Vietnam Era Twin Registry who responded to smoking questions on a 1987 mail and telephone survey. The best fitting model allowed for both genetic and shared environmental effects on smoking initiation, accounting for 50% and 30% of the variance in risk, but allowed for only genetic effects, (accounting for 70% of the variance in risk), on persistence in smoking among those who had become regular smokers. This finding of a major genetic influence on smoking persistence confirms similar results from studies in Scandinavia and Australia. The role of heritable traits such as nicotine sensitivity should be addressed in smoking prevention and cessation efforts.
The social costs of alcohol abuse in New Zealand
Authors: DEVLIN NANCY J. , SCUFFHAM PAUL A. , BUNT LORNA J.
Published: January 2006

Aims. This study updates and extends previous New Zealand research on the social costs of alcohol abuse. Design. This economic cost study used the human capital approach. Setting. New Zealand, 1991. Participants. The total New Zealand population. Measurements. The estimated costs of alcohol abuse for 1 year included direct and indirect costs. Costs such as lost production resulting from premature death and sickness, reduced working efficiency and excess unemployment comprised indirect costs. Direct costs included hospital costs, accident compensation payments, police and justice system costs. A range of social cost estimates was constructed based on various prevalence rates of alcohol abuse, discount rates for lost production and the excess unemployment rate. Findings. Using a range of assumptions regarding the proportion of each event attributable to alcohol, the sum of social costs ranged from $1045 million to $4005 million in 1991. The direct costs ranged from $341 million to $589 million, respectively. Conclusions. While providing an indication of the societal impact of alcohol abuse, these costs pertain to a relatively narrow range of alcohol‐related effects. The paper identifies a number of areas where further research is required.
Regional variations in deaths from volatile solvent abuse in Great Britain
Authors: ESMAIL A. , WARBURTON B. , BLAND J. M. , ANDERSON H. R. , RAMSEY J.
Published: January 2006

Aims. To assess geographical variations in mortality and the relationship of socio‐economic correlates to deaths from volatile substance abuse (VSA) in Great Britain. Design. Analysis of the National Register of deaths from VSA by linking the addresses (postcode) of the deceased to census enumeration districts and hence wards and counties. Setting and participants. All 775 deaths in Great Britain listed in the national register between 1985–91. Population counts from the 1991 census were used as denominators. Measurement. The Poisson heterogeneity test was used to test the null hypothesis that all standardized mortality ratios were from the same population. The t‐test was used to compare differences in Townsend Deprivation scores between wards with and without VSA deaths. Multiple regression was used to assess the relationship between indices of deprivation and deaths from VSA. Findings. One‐third of all VSA deaths occurred in six regions of Great Britain which accounted for 17% of the at risk population. There was considerable variation in age standardized mortality ratios (ASMR) across regions. A ward level analysis indicated that wards with a VSA death had significantly higher levels of deprivation. The Townsend deprivation index, showed mean deprivation scores of 2.8 and 0.2, respectively, for wards with and without a registered death (p < 0.0001). Multiple regression at county/region level found that 45% of the variation in ASMR was explained by the components of the Townsend deprivation index. Conclusions. Factors associated with deprivation are important in VSA deaths and this should be taken into account in planning public health measures to prevent mortality.
Do work‐place smoking bans cause smokers to smoke “harder”? Results from a naturalistic observational study
Authors: CHAPMAN SIMON , HADDAD SUZY , SINDHUSAKE DOUNGKAMOL
Published: January 2006

The purpose of this study was to investigate whether smokers outside buildings with work‐place smoking bans smoke “harder” than those smoking in social settings. An unobtrusive random observational study of smokers followed by structured interview was used, with 143 smokers taking smoking breaks outside their office buildings and 113 smokers in social settings. The main outcome measurements were number of puffs per cigarette and cigarette smoking duration. The mean number of puffs per cigarette for the office building group was 18.7% greater than that for the social settings group (10.7±3.2 vs. 8.7±2.7, t = 5.58, df= 253, p < 0.001); 74.8% of smokers outside offices took more than the mean number of puffs for the group compared to 42.5% of smokers in social settings (χ2 df 1 = 26.31, p < 0.0001). Mean cigarette smoking duration was 30.4% shorter for the work‐place group than the social settings group (3.9 ± 1.2 minutes vs. 5.6 ± 2.6 minutes). Of smokers outside offices, 55.2% had a cigarette smoking duration between 3 and 4.59 minutes, while 53.1% of smokers in social settings took ≥ 5 minutes to smoke the observed cigarette (χ2 df 2 = 31.55, p < 0.0001). Smokers who scored at the 75th percentile on the Fagerstrom Tolerance Scale took a mean 9.5 ±2.6 puffs per cigarette compared to 9.3 ± 2.7 puffs by those who scored in the 25th percentile on the scale (1 = 0.34, df= 145, p = 0.73). Regardless of degree of nicotine dependency, smokers leaving work‐stations to smoke outside buildings smoked their cigarettes nearly 19%“harder” than cigarettes smoked in social settings. The individual and public health benefits of reduced smoking frequency engendered by work‐place smoking bans may be lessened by policies which allow smokers to take smoking breaks.