bluuebunny/crossref_metadata_2025 huggingface dataset:
The long‐term effect of nicotine on the oral mucosa
Authors: Wallstrom Mats , Sand Lars , Nilsson Fredrik , Hirsch Jan‐M
Published: March 2003

Aims. Although nicotine replacement therapy (NRT) has been used to aid smoking cessation for the last 20 years, little information exists on the effect of nicotine products on the oral mucosa, particularly with regard to the direct effect at the site of application. This study aimed to assess the oral safety of a new sublingual tablet containing 2 mg nicotine with regard to lesions at the site of application. Design. Prospective follow‐up to 12 months of smokers using the 2‐mg sublingual tablet over a period of 3‐6 months. Setting. A smoking cessation programme Participants. Thirty smokers. Measurements. Oral mucosa was inspected and photographed at each visit. At 6 months, subjects were asked for consent to take a biopsy from the site of application. Findings. Spontaneous smoking cessation outcome at 12 months was 27% allowing for lapses. At baseline 21 mucosal lesions were diagnosed in 15 subjects. After 6 months eight lesions were observed in six subjects. The predominant diagnosis at all visits was melanin pigmentation. Eight subjects had lesions in the floor of the mouth during the 6‐month medication period, all of which appeared in the first 1‐6 weeks of treatment. By the 6‐month visit all such lesions had resolved. The local symptoms were all mild and tolerable. Conclusion. The sublingual tablet appears to be a safe form of administration of nicotine with mild and transient effects on the floor of the mouth.
Methadone‐maintained former heroin addicts, including those who are anti‐HIV‐1 seropositive, comply with and respond to hepatitis B vaccination
Authors: Borg Lisa , Khuri Elizabeth , Wells Aaron , Melia Dorothy , Bergasa Nora V. , Ho Ann , Kreek Mary Jeanne
Published: March 2003

Aims. To study the efficacy of standard hepatitis B (HB) vaccination in methadone‐maintained former intravenous drug users. Design. HB vaccine was administered to subjects at 0, 1 and 6 months. Setting. Two university‐affiliated methadone maintenance clinics. Participants. Forty‐three HB‐unexposed former heroin addicts in methadone maintenance treatment for heroin addiction. Measurements. HB surface antibody (anti‐HBs) response to the vaccine was assessed at 0, 1, 6 and 12 months; anti‐HIV‐1 status was also assessed. Findings. Thirty‐seven patients (86%) completed the 6‐month vaccination series. Of the 30 anti‐HIV‐1 seronegative patients who then completed the entire 12‐month protocol, 21 (70%) seroconverted (anti‐HBs ratio 2.1) and 19 (63%) were protected (anti‐HBs ratio 10). Two other subjects were anti‐HIV‐1 seropositive: one was HB‐protected at 12 months but later lost immunity. Ten anti‐hepatitis C antibody‐positive patients completed the 12‐month study and six were protected; thus, there was no significant relationship between hepatitis C status and HB vaccine response. Conclusions. Standard HB vaccination is both feasible and effective.
DSM‐IV substance abuse and dependence: are there really two dimensions of substance use disorders in adolescents?
Authors: Fulkerson Jayne A. , Harrison Patricia A. , Beebe Timothy J.
Published: March 2003

Aim. To examine the distinctness of the DSM‐IV substance abuse and dependence constructs in a large, general adolescent population. Design. Data were collected using the 1995 Minnesota Student Survey. Survey items were designed to correspond to DSM‐IV diagnostic criteria for substance abuse and dependence. Settings. Public schools, alternative schools and area learning centers. Participants. Of the 78 800 students between the ages of 14 and 18 years who completed the survey, 18 803 reported substance use and at least one substance use disorder diagnostic criterion during the previous 12 months and were used for the analyses. The sample was divided randomly into two groups in order to conduct data analyses on one group (n = 9490) and confirm the findings in the other group (n = 9313). Measurements. Confirmatory factor analyses were conducted to test three competing factor structure models consisting of a single factor model, a two‐factor model of distinct dimensions and a two‐factor model with interrelated dimensions. Findings. The single factor and correlated two‐factor models had similar parameter estimates and fit the data better than the competing two‐factor model with distinct dimensions. Findings were confirmed in a second sample. Conclusions. The study findings indicate that DSM‐IV substance abuse and dependence criteria may be more optimally structured as a unidimensional construct rather than as bidimensional constructs for adolescents.
Drink driving and criminal behaviours as risk factors for receipt of disability pension and sick leave: a prospective study of young men
Authors: Upmark Marianne , Karlsson Gunilla , Romelsjo Anders
Published: March 2003

Aim. To examine the extent to which drink driving and criminal behaviour would predict receipt of disability pension and high sickness absence rates in young and middle‐aged men. Design and setting. A total of 8122 mandatory conscripts, born in 1950 or 1951, from the County of Stockholm were followed in a 22‐year longitudinal study. Information was collected at the time of conscription for military service in 1969 and 1970. Data were linked to records on driving while intoxicated (DWI) and other criminal offences between 1970 and 1991 and to information from the Social Insurance Board. Findings. A total of 211 (2.6%) conscripts were granted a disability pension during the follow‐up period between 1970 and 1991, and another 373 (4.6%) conscripts had high sickness absence (at least 180 sick days between 1989 and 1991). A total of 642 men had one or more DWI offences from the time of conscription until 1992. The median number of sick‐days/sick‐listed between 1989 and 1991 was 35.0 for men who were problem drinkers at conscription, 60.3 for drink drivers, 31.0 for men with less serious and 53.0 for men with serious crimes, compared to 21.0 days for the group as whole. In bivariate regression analysis, drink driving implied a relative risk (RR) of a disability pension/high sickness absence of 3.4 (95% CI: 2.8‐4.1), and criminality a RR of 3.6 (95% CI: 3.1‐4.1). In multivariate logistic regression analysis, controlling for psychosocial factors from conscription and for criminality, drink driving remained a strong predictor (RR 2.1, 95% CI: 1.7‐2.7). Conclusions. Problem drinking, drink driving and criminality are important risk factors for receipt of disability pension and high levels of sickness absence in young men. The findings suggest that preventive efforts undertaken at the time of conscription and during later military service may pay dividends in terms of preventing problems later in life.
Public opinions on alcohol policy issues: a comparison of American and Canadian surveys
Authors: Giesbrecht Norman , Greenfield Thomas K.
Published: March 2003

Aims. To study international and within country differences with regard to views by the general public on alcohol policy topics, describe associations with socio‐demographic characteristics and drinking practices, and contrast opinions with variations in actual policies. Design, setting, subjects. Large‐scale cross‐sectional household surveys were conducted in Canada (n = 11 550) and the United States (n = 4004) in 1989‐90, involving representative samples of adults aged 18 and older. Measures. Eleven alcohol policy topics were examined: alcohol taxes; hours of off‐premise sale; legal drinking age; alcohol sales in corner stores; government advertising against alcohol; warning labels on alcohol products; alcohol advertising on TV; industry sponsorship of cultural or sports events; efforts to prevent service to drunken customers; prevention and education; and treatment. Findings. Even after controlling for drinking levels and respondent characteristics, policy measures that control physical or economic access to alcohol are not as strongly supported as those that provide information or focus on the heavy drinker. There was greater polarization of opinion within both countries for policy items relating to promotion of alcohol or control of physical, demographic or economic access, and virtually no polarization with regard to items such as curtailing service to drunken customers or providing information or treatment. In the jurisdiction with less restrictive measures on a particular policy, there seems to be greater public support for curtailing access to alcohol and, in some instances, more restrictive policies are associated with lower support for increasing restrictions. Conclusion. Public opinion data are an important resource in determining whether actual policies are compatible with the views of those affected by them. Disjunctions between research on the most effective policy interventions and views by the public point to special agenda for information dissemination and prevention initiatives.
Factors associated with adolescent use of doping agents: anabolic‐androgenic steroids
Authors: Kindlundh Anna M.S. , Isacson Dag G.L. , Berglund Lars , Nyberg Fred
Published: March 2003

Aims. The purpose was to assess the importance of risk factors such as socio‐demographics, sports activities, tobacco use, alcohol consumption, use of certain psychotropic substances and violence in the use of doping agents in adolescents. Design. Cross‐sectional survey using anonymous closed response questionnaire. Setting. Eight senior high schools in Uppsala, Sweden. Participants. A total of 2742 senior high school students; 1592 were in their first year (aged 16‐17 years) and 1150 in their third (aged 18‐19 years). Findings. Multiple logistic regression analyses revealed that strength training, tobacco use, heavy alcohol consumption, truancy at least once a week and living alone were significantly independently associated in the use of doping agents. Further, the study showed that use of cannabis oil, LSD, amphetamine and opioids were related specifically to anabolic‐androgenic steroid use. Conclusions. Use of doping agents probably involves more than a desire to enhance appearance or sports performance and appears to have much in common with use of alcohol, tobacco and psychotropic drugs.
Risk factors among IDUs who give injections to or receive injections from other drug users
Authors: Kral Alex H. , Bluthenthal Ricky N. , Erringer Elizabeth A. , Lorvick Jennifer , Edlin Brian R.
Published: March 2003

Aims. To assess risk factors associated with injection drug users (IDUs) who give injections to or receive injections from other IDUs. Design and setting. IDUs were recruited into a cross‐sectional study using targeted sampling methods in Oakland, Richmond, and San Francisco, California from August 1996 to January 1997. "Street docs" are IDUs who reported having given injections to other IDUs in the past month. "Injection recipients" are IDUs who reported having received injections from other people in the past month. Participants. Of 1166 IDUs interviewed, 283 (24%) reported being injection recipients and 427 (37%) reported being street docs. Measurements. Socio‐demographic characteristics and injection‐related risk behaviors. Findings. Injection recipients and street docs were significantly more likely (p<0.001) than other IDUs to report sharing syringes (33% of injection recipients, 21% of street docs and 7% of others), cookers (71% of injection recipients, 55% of street docs and 24% of others), rinse water (44% of injection recipients, 35% of street docs and 13% of others), and filters (60% of injection recipients, 47% of street docs and 20% of others). In a logistic regression model, injection recipients (adjusted odds ratio (AOR) = 4.29) and street docs (AOR = 1.91) were more likely than other IDUs to report having shared syringes. Conclusions. Giving and receiving injections is common among IDUs in the San Francisco Bay area. Qualitative and epidemiological studies are needed to understand better the infectious disease risks associated with giving and receiving injections. Interventions need to address these issues and provide practical solutions.
The validity of the CAGE scale to screen for heavy drinking and drinking problems in a general population survey
Authors: Bisson Jocelyn , Nadeau Louise , Demers Andree
Published: March 2003

Background. The CAGE scale is a short test developed in the 1970s to screen for alcoholism or covert drinking problems. The reliability and validity of the scale has been demonstrated in the majority of studies conducted in clinical settings, but the validity of the scale in general population surveys has not yet been shown conclusively. Aims. The goal of this study was to assess the criterion validity of the CAGE scale in a general population survey. Method. Data from a large general health survey conducted in 1992 in the province of Quebec (Canada) (N=23 564) were used to define various measures of heavy drinking and drinking problems and to calculate, for male and female drinkers separately, standard measures of sensitivity, specificity and positive predictive value at different cutoff scores on the CAGE. Findings. With respect to both male and female drinkers, with all operational definitions of heavy drinking and useful cutoff scores on the CAGE, the scale was shown to be unable to discriminate between heavy drinkers and non‐heavy drinkers. Prevalence of drinking problems among CAGE positive drinkers was also very low. Conclusion. These results do not support the use of the CAGE as a screening tool for heavy drinking and drinking problems in a general population survey or as a tool to estimate the prevalence of drinking problems in the population.
'When you were drinking' vs. 'in the past 12 months': the impact of using different time frames in clinical and general populations
Authors: Weisner Constance , Kaskutas Lee Ann , Hilton Michael E. , Barile Amelia L.
Published: March 2003

Aim. Different time frames have been used to ask about drinking in clinical and general populations. Surveys of clinical populations have asked about the quantity and frequency of drinking within the context of "when you were drinking". In general population surveys, the customary practice has been to ask about a period of time such as "the last 12 months". This paper compares answers to questions about drinking using both time frames. Design. Bivariate chi‐squares and multi‐variate logistic regression analyses were used to compare consumption estimates across the two time frames for different demographic and drinking categories of respondents. Setting and participants. In‐person interviews were conducted with general population (N=3069) and representative treatment samples (N=381) in a northern California county. Measurements. Respondents were asked about their drinking within the context of "the last 12 months" and only "when you were drinking". Findings. There were no meaningful differences in aggregate measures of drinking based on the time frame of assessment in either sample. Drinking five or more drinks weekly was a significant predictor of consistent reporting of frequency of drinking among the clinical sample, and of reporting inconsistent frequency of drinking 12 or more drinks among the general population. Being female or being age 46 or over also was predictive of a "consistent" response in the general population for drinking 12 or more drinks; while being 46 or older, married, and white was predictive of consistent responses for drinking to intoxication in that population. Conclusions. Survey respondents do not average their drinking across a 12‐month time frame that includes periods of abstinence; rather, they appear to answer only for the periods they were drinking.
Continuing injecting risk behaviour: results from the Amsterdam Cohort Study of drug users
Authors: Ameijden Erik J. C. Van , Langendam Miranda W. , Notenboom Jessica , Coutinho Roel A.
Published: March 2003

Aims. To give a detailed description of injection‐related risk behaviours, and to estimate the relative importance of these behaviours with regard to HIV transmission. Design. The present study was part of the Amsterdam Cohort Study of drug users. Setting. In Amsterdam, a city with extensive preventive measures, large HIV‐risk reductions have taken place, but no further decreases have occurred since 1991. Participants and measurements. A detailed questionnaire on injecting risk behaviour was completed by a cross‐section of participants in 1992/93 (n = 168). Among 48 HIV‐seroconverters, a questionnaire was completed concerning possible HIV‐transmission route. Findings. Of 96 HIV‐negative participants, 23% deliberately borrowed a used syringe, 18% reported possible "accidental" borrowing, 9% front/backloading, 4% simultaneous injection, and 32% possible sharing of ancillary equipment. Of deliberate borrowers, 64% borrowed from a person with unknown or positive HIV serostatus, and 81% did not appropriately clean the equipment; 79% borrowed in the absence of serious withdrawal symptoms. Risk factors differed for deliberate and 'accidental' borrowing. Among the HIV seroconverters, the most likely transmission route was borrowing in 29% of cases, front/backloading in 8%, borrowing or front/backloading in 21%, unprotected sexual contact in 23% (mainly with regular partner) and either injecting or sexual risk in 13%. Women were much more likely to report sexual transmission ( p = 0.016). Borrowing was admitted by 43% before, and 64% after awareness of HIV‐seroconverion. Conclusions. As the injecting risk is high, usually deliberate, and often in the absence of withdrawal symptoms, further prevention seems difficult. Although deliberate borrowing is the main risk for HIV seroconversion, unprotected sexual contacts and front‐ and backloading may be more important than previously thought in Amsterdam. Under‐reporting of borrowing is probably substantial, but does not alter the above conclusions.
Mechanisms of fatal opioid overdose
Authors: White Jason M. , Irvine Rodney J.
Published: March 2003

There has been increasing recognition of the problem of fatal opioid overdose. This review examines the pharmacological basis of respiratory depression following opioid administration. Respiration is controlled principally through medullary respiratory centres with peripheral input from chemoreceptors and other sources. Opioids produce inhibition at the chemoreceptors via mu opioid receptors and in the medulla via mu and delta receptors. While there are a number of neurotransmitters mediating the control of respiration, glutamate and GABA are the major excitatory and inhibitory neurotransmitters, respectively. This explains the potential for interaction of opioids with benzodiazepines and alcohol: both benzodiazepines and alcohol facilitate the inhibitory effect of GABA at the GABA receptor, while alcohol also decreases the excitatory effect of A glutamate at NMDA receptors. Heroin and methadone are the major opioids implicated in fatal overdose. Heroin has three metabolites with opioid activity. Variation in the formation of these metabolites due to genetic factors and the use of other drugs could explain differential sensitivity to overdose. Metabolites of methadone contribute little to its action. However, variation in rate of metabolism due to genetic factors and other drugs used can modify methadone concentration and hence overdose risk. The degree of tolerance also determines risk. Tolerance to respiratory depression is less than complete, and may be slower than tolerance to euphoric and other effects. One consequence of this may be a relatively high risk of overdose among experienced opioid users. While agonist administration modifies receptor function, changes (usually in the opposite direction) also result from use of antagonists. The potential for supersensitivity to opioids following a period of administration of antagonists such as naltrexone warrants further investigation. While our understanding of the pharmacological basis of opioid‐related respiratory depression has advanced, better understanding of the role of heroin metabolites, the metabolism of methadone, drug interactions and tolerance would all be of considerable value in knowing how best to respond to this problem.
Drug anticipation and drug addiction. The 1998 H. David Archibald Lecture
Authors: Siegel Shepard
Published: March 2003

Environmental cues associated with drug use become capable of eliciting withdrawal symptoms, craving and relapse to drug self‐administration. The phenomenon, although noted almost 150 years ago, has repeatedly been confirmed in epidemiological and experimental studies. Drug tolerance, which is closely correlated with withdrawal symptoms and craving, is also modulated by drug‐associated environmental cues. The contribution of predrug cues to withdrawal and tolerance is emphasized in a Pavlovian conditioning analysis of drug administration. Drug‐induced disturbances are modulated by homeostatic responses elicited by pharmacological stimulation. According to the conditioning analysis, we learn to anticipate the drug effect; corrective responses (conditional compensatory responses) occur in the presence of situations and events that have been associated with the drug in the past. These conditional responses, seen in anticipation of drugs, importantly contribute to drug tolerance, failures of tolerance (enigmatic overdoses), and withdrawal symptoms. I review evidence indicating that a complete analysis of drug withdrawal and tolerance requires an appreciation of the contribution of Pavlovian conditioning.
Privatizing alcohol sales and alcohol consumption: evidence and implications
Authors: Her Minghao , Giesbrecht Norman , Room Robin , Rehm Jurgen
Published: March 2003

Aim. To provide an overview of recent privatization/deregulation experiences in North America and other settings, in order to draw conclusions about the impacts that might be expected from such changes on rates of alcohol consumption and related problems. Methods. Critical review of research evidence on the effect of changes in availability, particularly changes in physical availability and economic availability that typically accompany privatization of alcohol retail monopolies. Findings. Deregulation/privatization experiences commonly involve higher density of outlets, longer hours or more days of sale, changes in price, a strong orientation to commercial aspects of alcohol sales and the introduction of new vested economic interests into alcohol management arrangements in the jurisdiction. In many instances these changes in access to alcohol are accompanied by an increase in the per capita rates of consumption. In the short term changes in prices are likely to either increase or demonstrate opposite patterns for beverages with different base prices. Longer‐term patterns point to a decline in real price with privatization, which very probably stimulates per capita alcohol sales. Conclusion. The existing evaluation literature on the subject of privatization has tended to focus on examining the net short‐term results in terms of alcohol consumption levels. Overall, there are too few studies employing adequate statistical methodologies to explore the underlying causes of changing alcohol consumption and alcohol‐related harm. Finally, seven specific suggestions that may assist future studies are discussed.
Accidental overdose among injecting drug users in Dorset, UK
Authors: Bennett Gerald A. , Higgins David S.
Published: March 2003

Aims. To establish the prevalence and frequency of non‐fatal accidental overdose among Dorset injecting drug users (IDUs), map their response to it and their beliefs about protective and risk behaviours. Design. Survey of a community sample of IDUs. Setting. Ten Dorset towns. Participants. Two hundred and twelve IDUs, recruited through multisource sampling, who had injected in the 2 months before interview. Measurements. Structured interview, SDS and LDQ. Findings. In the previous year, 30% of interviewees had overdosed and 58% had witnessed another do so. Most (79%) had had a personal acquaintance die from an accidental overdose. Interviewees commonly attributed their own most recent overdose(s) to excessive consumption of drugs, mixing drugs and low tolerance, believed that these factors generally increased risk and described a repertoire of protective behaviours. Those who had overdosed in the previous year had significantly greater involvement with drug injecting. Virtually all who had witnessed another's overdose described peoples' attempts to help: many were appropriate, some dangerous. Avoiding seeking medical help was common. Half (52%) demonstrated the rudiments of putting people into the recovery position, and a minority (31%) cardio‐pulmonary resuscitation. Most interviewees (55%) said that they would "probably" or "definitely" attend a workshop on Overdose Aid. Conclusions. There is potential for preventing overdose by promoting protective behaviours. Since IDUs often witness overdose, training them in first aid may be valuable, and tackling the reasons that delay their seeking help is crucial.
Alcohol abuse and suicidal behaviour in young and middle aged men: differentiating between attempted and completed suicide
Authors: Rossow Ingeborg , Romelsjo Anders , Leifman Hakan
Published: March 2003

Aims. To establish whether alcohol abuse as a risk factor in suicidal behaviour would be different in parasuicide compared to completed suicide, and to explore the relative impact of alcohol abuse on completed suicide among parasuicides. Design. A 25‐year follow‐up study by linking data from military conscription, inpatient treatment and death register. Participants. A cohort of 46 490 Swedish male conscripts born in 1950‐51. Measurements. Psychiatric diagnosis was recorded at conscription, diagnoses related to alcohol abuse and suicidal behaviour were recorded at any inpatient treatment during follow‐up, and underlying cause of death was recorded for those who died during follow‐up. Findings. Bivariate analyses showed alcohol abusers to have an elevated risk of attempted suicide (OR=27.1) as well as completed suicide (OR=4.7), but in the latter case to a significantly lesser extent. Correspondingly, alcohol abusers constituted a significantly larger proportion of the parasuicides (33.3%) than of the completed suicides (10.0%). A relatively stronger impact of alcohol abuse on parasuicide than on completed suicide remained after controlling for psychiatric co‐morbidity, the adjusted odds ratios for attempted suicide and completed suicide being 8.8 and 2.4, respectively. Attempted suicide was a highly significant risk factor for completed suicide (OR=13.5). Among those who attempted suicide, alcohol abusers were found to have a significantly lower risk of completed suicide than other suicide attempters (OR=0.46). Conclusion. The significantly stronger association between alcohol abuse and attempted suicide compared to completed suicide may be viewed in the light of possible impact of intoxication and impulsiveness on non‐fatal suicidal behaviour in alcohol abusers.
Drink, illicit drugs and unsafe sex in women
Authors: Taylor Jenny , Fulop Naomi , Green John
Published: March 2003

Aims. To establish the extent and nature of linkages between illicit drug and alcohol use and sexual behaviour in women. Participants and Setting. One hundred women attending either a Genitourinary Medicine Clinic or a Family Planning Clinic. Design. Respondents were interviewed using a semi‐structured interview schedule covering the effect of drink/illicit drug use on the incidence of sex, on condom use, and on specific sexual activities, and deliberate use of drink/illicit drugs to affect sex. Interviews focused on the last three new male partners, from the beginning of the sexual relationship through its development. Data analysis was primarily qualitative, quantitative analysis was conducted where appropriate. Results. There were few cases in which women reported that consumption of drink/illicit drugs caused them to engage in sexual behaviour which they would not have engaged in if they had not had drink/drugs. Associations between drink and illicit drugs and sexual behaviour were, mainly, either because encounters took place in social situations where drugs or drink were being consumed or because the woman used drink or drugs instrumentally to engage in desired behaviours. There was some evidence to suggest that greater use of drugs and alcohol might be part of a wider pattern of social behaviour including more sexual partners. Conclusions. The women's self‐reported behaviour suggested that illicit drug and alcohol use in itself did not usually result in unsafe or undesired sexual behaviour.
Marijuana withdrawal among adults seeking treatment for marijuana dependence
Authors: Budney Alan J. , Novy Pamela L. , Hughes John R.
Published: March 2003

Aims. The clinical relevance of marijuana withdrawal has not been established. This study is the first to document the incidence and severity of perceived marijuana withdrawal symptoms in a clinical sample of marijuana‐dependent adults. Measurements. Fifty‐four people seeking outpatient treatment for marijuana dependence completed a 22‐item Marijuana Withdrawal Symptom checklist based on their most recent period of marijuana abstinence. Findings. The majority (57%) indicated that they had experienced six symptoms of at least moderate severity and 47% experienced four symptoms rated as severe. Withdrawal severity was greater in those with psychiatric symptomatology and more frequent marijuana use. Conclusions. This study provides further support for a cluster of withdrawal symptoms experienced following cessation of regular marijuana use. The affective and behavioral symptoms reported were consistent with those observed in previous laboratory and interview studies. Since withdrawal symptoms are frequently a target for clinical intervention with other substances of abuse, this may also be appropriate for marijuana.
HIV infection associated with drug injecting in the Newly Independent States, eastern Europe: the social and economic context of epidemics
Authors: Rhodes Tim , Ball Andrew , Stimson Gerry V. , Kobyshcha  , Fitch Chris , Pokrovsky Vadim , Marina  , Bezruchenko‐Novachuk  , Burrows Dave , Renton Adrian , Andrushchak Lidia
Published: March 2003

Aims. We review recent trends in HIV associated with injecting drug use (IDU) in the Newly Independent States (NIS) in eastern Europe, including Belarus, Moldova, Russia, Ukraine, and Kazakhstan in central Asia. We aim to draw attention to the social and economic "risk environments" in which rapid HIV spread among IDUs has occurred. Methods. Findings draw on centrally registered HIV surveillance data, published research studies and assessment reports funded by international development agencies. Findings. Since 1995, there is evidence of rapid HIV spread in Belarus, Kazakhstan, Moldova, Russia and Ukraine, with estimates suggesting between 50% and 90% of new HIV infections among IDUs. At the same time, there have been rapid increases in the incidence of syphilis and declines in health and welfare status, including outbreaks of diphtheria, tuberculosis and cholera. Findings emphasize the potential influence of the social and economic context in creating the "risk environments" conducive to HIV and epidemic spread. Key factors include: rapid diffusions in IDU; population migration and mixing; economic transition and decline; increasing unemployment and impoverishment; the growth of informal economies; modes of drug production, distribution and consumption; declines in public health revenue and infrastructure; and political, ideological and cultural transition. Conclusions. An understanding of the social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre‐conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission. The "risk environment" may influence the efficacy of individual and community‐level HIV prevention and highlights the concomitant urgency for interventions targeting social and environmental change.
Buprenorphine versus methadone maintenance for the treatment of opioid dependence
Authors: Fischer Gabriele , Gombas Wolfgang , Eder Harald , Jagsch Reinhold , Peternell Alexandra , Stuhlinger Georg , Pezawas Lukas , Aschauer Harald N. , Kasper Siegfried
Published: March 2003

Aims. To evaluate the effectiveness of buprenorphine compared with methadone maintenance therapy in opiate addicts over a treatment period of 24 weeks. Design. Subjects were randomized to receive either buprenorphine or methadone in an open, comparative study. Setting. Subjects were recruited and treated at the drug addiction outpatient clinic at the University of Vienna. Participants. Sixty subjects (19 females and 41 males) who met DSM‐IV criteria for opioid dependence and were seeking treatment. Intervention. Subjects received either sublingual buprenorphine (2‐mg or 8‐mg tablets; maximum daily dose 8 mg) or oral methadone (racemic D ‐/+ L‐methadone; maximum daily dose 80 mg). A stable dose was maintained following the 6‐day induction phase. Measurement. Assessment of treatment retention and illicit substance use (opiates, cocaine and benzodiazepines) was made by urinalysis. Findings. The retention rate was significantly better in the methadone maintained group (p< 0.05) but subjects completing the study in the buprenorphine group had significantly lower rates of illicit opiate consumption (p = 0.04). Conclusion. The results support the superiority of methadone with respect to retention rate. However, they also confirm previous reports of buprenorphine use as an alternative in maintenance therapy for opiate addiction, suggesting that a specific subgroup may be benefiting from buprenorphine. This is the first comparative trial to use sublingual buprenorphine tablets: previously published comparison studies refer to 30% solutions of buprenorphine in alcohol.
Maintaining change after conjoint behavioral alcohol treatment for men: outcomes at 6 months
Authors: Mccrady Barbara S. , Epstein Elizabeth E. , Hirsch Linda S.
Published: March 2003

Aim. To compare the effectiveness of standard behavioral couples therapy for alcohol problems to two maintenance enhanced therapies. Design. Randomized clinical trial. Setting. Outpatient substance abuse treatment clinic. Participants. Ninety males with alcohol abuse or dependence and their female partners. Interventions. Weekly, outpatient therapy in one of three randomly assigned conditions: Alcohol Behavioral Couples Therapy (ABCT), Alcoholics Anonymous plus ABCT (AA/ABCT) or Relapse Prevention plus ABCT (RP/ABCT). Findings. The men significantly reduced the frequency of drinking and heavy drinking during treatment. During the first 6 months post‐treatment, 65.7% of male subjects were classified as improved on a composite measure of drinking and drinking‐related consequences. Compared to baseline levels, the percentage of abstinent days increased and heavy drinking days decreased, but the three conditions did not differ. Two outcome variables favored the purely behavioral treatment conditions (ABCT and RP/ABCT) over the AA/ABCT condition: time to the first heavy drinking day was longer for subjects in the ABCT condition than subjects in the AA/ABCT condition, and subjects in the RP/ABCT condition tended to have shorter drinking episodes than subjects in the AA/ABCT condition. Subjects who complied with post‐treatment maintenance plans were more likely to be abstinent than subjects who did not. Conclusions. Results favored the two behavioral conditions and did not suggest additional benefit from combining AA with behavioral couples therapy, but those who did attend AA showed a positive impact.
Family and friends' influences on the uptake of regular smoking from mid‐adolescence to early adulthood
Authors: West Patrick , Sweeting Helen , Ecob Russell
Published: March 2003

Aims. To examine the effect of family and friends' smoking on uptake of regular smoking among young people from mid‐adolescence to early adulthood; whether such effects are time limited, vary by social class and gender, and the extent to which uptake precedes or follows friends' smoking. Setting. The West of Scotland. Design and participants. A longitudinal survey of 1009 15‐year‐olds interviewed at baseline, followed‐up at 16, 18, 21 and 23 years of age, using interviews and postal questionnaires. Measurements. Self‐reported measures of smoking were used, allowing analysis of the uptake of regular smoking (1 + cigarette per day) between 15 and 23, and in the periods 15‐16, 16‐18 and 18‐21 years. Measures of parental and sibling smoking and social class were obtained at baseline and respondents' reports of friends' smoking at 15 and 18 years. Findings. Regular smoking more than doubled between 15 (14%) and 23 (36%). Adjusted for other factors, no independent effect of parental smoking on uptake in any period was observed, an effect of sibling smoking being confined to uptake between 15 and 16. Friends' smoking at 15 increased the likelihood of uptake up to 10 times over the next year, but did not extend to later years; that at 18 increased it up to three times between 18 and 21. These effects did not vary by gender or social class. Further analysis revealed a strong effect of friends' smoking at age 18 on earlier as well as later uptake. Conclusions. Contrasting with prevalent assumptions, the period from mid‐adolescence to early adulthood is important for uptake of regular smoking, and in particular reveals friends' smoking to be of continuing significance, especially around school‐leaving when friendship networks often change markedly.
Maritally distressed women with alcohol problems: the impact of a short‐term alcohol‐focused intervention on drinking behaviour and marital satisfaction
Authors: Kelly Adrian B. , Halford W. Kim , Young Ross McD.
Published: March 2003

Aim. To evaluate the efficacy of a short‐term alcohol‐focused intervention for maritally distressed women, and to explore changes in relationship functioning.

Design. Participants were assigned randomly to an alcohol‐focused treatment or to a waiting‐list control group. The waiting‐list control group began the intervention at 1‐month follow‐up.

Setting. The intervention took place at a research and training centre offering outpatient psychology services to the community.

Participants. A sample of 32 women with alcohol and marital problems were recruited through the media. Participants reported protracted alcohol problems, moderate to severe impact of alcohol on social and occupational functioning, and moderate to severe marital distress.

Measurements. Measures of average alcohol consumption, marital distress, relational efficacy and depression were administered at pre‐ and post‐therapy, and at 1, 6 and 12‐month follow‐up.

Intervention. The intervention involved six 1‐hour sessions, consisting of clinical assessment, motivational interviewing, cognitive‐behavioural strategies and relapse prevention.

Results. At 1‐month follow‐up, the intervention was associated with statistically significant improvements in alcohol consumption, marital satisfaction, relational efficacy and depression, and these effects were sustained at 12‐month follow‐up.

Conclusions. At 1‐month follow‐up the intervention was associated with decreased alcohol consumption and depression, and increased marital satisfaction and relational efficacy, with evidence of maintained effects at 12‐month follow‐up. However, it is unlikely that reduced problem drinking and improved confidence in resolving problems were the only factors producing low marital quality in these couples. Further research is needed to identify those individuals who might benefit from marital interventions.
The characteristics of 'new users' of cocaine and heroin unknown to treatment agencies: results from the Swiss Hidden Population Study
Authors: Kuebler Daniel , Hausser Dominique , Gervasoni Jean‐Pierre
Published: March 2003

Aims. To examine the characteristics of 'new users' (i.e. first use not more than 5 years before interview) of heroin or cocaine currently unknown to treatment agencies in Switzerland, compared to 'new users' who are in treatment, as well as to 'experienced users' (i.e. first use more than 5 years before interview).

Method. A sample of 917 users of heroin and/or cocaine users were recruited outside treatment settings by 31 privileged access interviewers and interviewed face to face using a standardized questionnaire. The study group was composed of 95 'new users' of heroin and/or cocaine who had never been in treatment. It was compared to four control groups: control group 1 (

n = 48) consisting of 'new users' known to treatment agencies; control group 2 (

n = 443) of 'experienced users' who reported having never had any contact with treatment agencies; control group 3 (

n = 53) of 'experienced users' with some history of treatment but not in contact at the time of interview; and control group 4 (

n = 166) of 'experienced users' in contact with treatment agencies.

Findings. Compared with 'new' and 'experienced' users in treatment (control groups 1 and 4), 'new users' unknown to treatment agencies have a less problematic profile of drug use: they inject less, use drugs less frequently, more often report the impression of controlling their drug use, have fewer health problems and fewer social difficulties. However, compared to experienced users not in contact with treatment agencies (control groups 2 and 3), the profile of drug use in the study group is more problematic. Injection‐related HIV‐risk behaviour is lower in the study group than in all the control groups. The analysis showed no influence of duration of drug use, gender or education over getting in touch with treatment agencies in the first five years of drug use.

Conclusions. Some of the 'new users' unknown to treatment agencies can be considered as being in need of assistance. Efforts to enhance the treatment on offer should be continued. Drug users should be provided with better knowledge of how to identify signs for problem drug use and need for assistance.
The effects of adolescent cannabis use on educational attainment: a review
Authors: Lynskey Michael , Hall Wayne
Published: March 2003

This paper reviews research examining the link between cannabis use and educational attainment among youth. Cross‐sectional studies have revealed significant associations between cannabis use and a range of measures of educational performance including lower grade point average, less satisfaction with school, negative attitudes to school, increased rates of school absenteeism and poor school performance. However, results of cross‐sectional studies cannot be used to determine whether cannabis use causes poor educational performance, poor educational performance is a cause of cannabis use or whether both outcomes are a reflection of common risk factors. Nonetheless, a number of prospective longitudinal studies have indicated that early cannabis use may significantly increase risks of subsequent poor school performance and, in particular, early school leaving. This association has remained after control for a wide range of prospectively assessed covariates. Possible mechanisms underlying an association between early cannabis use and educational attainment include the possibility that cannabis use induces an 'amotivational syndrome' or that cannabis use causes cognitive impairment. However, there appears to be relatively little empirical support for these hypotheses. It is proposed that the link between early cannabis use and educational attainment arises because of the social context within which cannabis is used. In particular, early cannabis use appears to be associated with the adoption of an anti‐conventional lifestyle characterized by affiliations with delinquent and substance using peers, and the precocious adoption of adult roles including early school leaving, leaving the parental home and early parenthood.
Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6‐month outcome
Authors: Strang John , Marsden John , Cummins Michael , Farrell Michael , Finch Emily , Gossop Michael , Stewart Duncan , Welch Sarah
Published: March 2003

Aim. To assess the feasibility of a randomized clinical trial of supervised injectable versus oral methadone maintenance and to assess medium‐term treatment outcomes.

Design. Randomized clinical trial of supervised injectable versus supervised oral methadone maintenance treatment (MMT). Trial participants were dependent illicit opiate injectors allocated at intake to supervised injectable or oral methadone maintenance treatment.

Setting. Specialist addictions treatment centre in South London.

Subjects. Forty dependent illicit opiate injectors seeking methadone maintenance treatment.

Interventions. Daily supervised injectable and oral methadone maintenance, delivered at the treatment centre.

Main outcome measures. Frequency of illicit heroin use and frequency of illicit drug injecting during 30 days before intake to treatment and prior to 6‐month follow‐up. Secondary outcome measures: frequency of use of illicit methadone, crack cocaine, benzodiazepines and alcohol, physical and psychological health symptoms and acquisitive crime.

Results. Injectable and oral MMT were both generally acceptable to the study participants: there was a high level of agreement to enter the randomized trial, and subsequent retention in treatment was good. The average number of days of illicit heroin use reduced from 22.2 to 7.6 for the injectable MMT group and from 22.4 to 8.7 for the oral MMT group. The average number of days of illicit injecting reduced from 25.7 to 10.8 days for the injectable group and from 20.1 to 11.9 days for the oral group. Patients' physical and psychological health symptoms and involvement in acquisitive crime also reduced in both groups. Treatment satisfaction ratings at follow‐up were higher among patients in the injectable MMT group. The ratio for the actual medication costs between injectable and oral MMT was 6.8:1, and for the direct operational costs was 4.7:1. There was some evidence of a differential patient response with greater reductions in heroin use occurring among patients who were daily illicit injectors and had poorer psychological and physical health (at entry) who were allocated to injectable MMT.

Conclusions. Conduct of the trial has demonstrated that it is feasible to implement supervised injectable methadone maintenance treatment in the context of (although separate from) a specialist oral methadone maintenance service. Patients assigned to receive either supervised injectable or oral MMT had broadly equivalent, positive during‐treatment outcomes at 6‐month follow‐up. Future studies should seek to identify patient characteristics which are linked to good outcome in injectable MMT. Practical evidence‐based guidance to physicians about determining which patients are more suitable for injectable MMT is urgently needed.