bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing remission from alcohol dependence without formal help in a representative population sample
Authors: Bischof G. , Rumpf H.‐J. , Hapke U. , Meyer C. , John U. 
Published: March 2003

Aims.
To analyse factors related to remission without formal help by using a representative sample and standardized instruments.

Design. Two groups of untreated alcohol‐dependent subjects were compared.

Setting. General population survey.

Participants. Thirty‐two subjects fully remitted without formal help (NFH) and 26 current alcohol‐dependent individuals (CAD) according to DSM‐IV drawn from a representative general population sample in northern Germany (response rate: 70.2%,

n = 4075).

Measurements. Data focusing on the 2 years prior to remission from NFH were compared with past‐year data from CAD. Groups were compared on variables found to be associated with remission without formal help in previous research.

Findings. Logistic regression analysis revealed that individuals remitted from alcohol‐dependence without formal help reported a higher non‐physiological severity of alcohol dependence, less social pressure to quit drinking and more incidents of driving while intoxicated. Furthermore, they tended to report more satisfaction with work and financial situation and were more likely to live in a stable partnership.

Conclusions. Findings support the concept of psychosocial resources as important enabling factors in remission from alcohol dependence without formal help. Implications for brief interventions are discussed.
Dependent behaviours and beliefs: a qualitative study of older long‐term smokers with arterial disease
Authors: Parry O. , Thomson C. , Fowkes F. G. R. 
Published: March 2003

Aims.
To examine the reasons for continuing to smoke provided by a sample of long‐term older smokers who have arterial disease (a smoking‐related condition) and the implications of those beliefs for current smoking behaviour and future smoking intent.

Design. Qualitative semi‐structured interview study with face‐to‐face interviews using 'life grids'.

Setting and participants. Twenty‐two long‐term older smokers, with arterial disease, who were participants of a larger qualitative study of Life Course Influences on Patterns of Persistent Smoking.

Measurement. Qualitative semi‐structured interviews explored how respondents' described their relationship to smoking, using life grids to capture changes in patterns of cigarette usage across the life course.

Findings. Older smokers with arterial disease defined their relationship to smoking in either dependent terms or functional terms (to fulfil specific purposes). The two types of relationship appeared to be associated more with different degrees of control smokers described exercising over their habit than with their levels and patterns of usage. Some older smokers with arterial disease who showed dependent patterns of behaviour did not believe they were dependent, and some who showed non‐dependent patterns of usage did not think of themselves as smokers even though they smoked. The immediate, functional and material benefits which these smokers attributed to smoking appeared to outweigh anticipated immediate and/or long term health‐related benefits of quitting.

Conclusions. How smokers define their relationship to cigarettes does not necessarily correspond to levels and patterns of usage.
Social class and smoking at age 15: the effect of different definitions of smoking
Authors: Sweeting Helen , West Patrick 
Published: March 2003

Aim.
To explore whether the association between social class and smoking among teenagers varies according to the definition of smoking adopted.

Design, setting and participants. A survey of 2196 15‐year‐olds in 43 secondary schools in the West of Scotland.

Measures. Current smoking status and number of cigarettes smoked, and social class based on the occupation of the head of the household.

Findings. 'Current smoker' was the only category not significantly differentiated by class; the ratio of smokers from unskilled compared with professional backgrounds rose with increasingly stringent definitions of smoking.

Conclusion. The extent to which teenage smoking is patterned by social class depends on the definition of smoking adopted.
Fermenting fruit and the historical ecology of ethanol ingestion: is alcoholism in modern humans an evolutionary hangover?
Authors: Dudley Robert 
Published: March 2003

ABSTRACTIn the field of addiction research, the possibility of ancestral exposure to psychoactive compounds has generally been excluded. A paleobiological approach to the human diet, however, illustrates the potential utility of historical data in interpreting modern‐day addictive behaviors. Low‐level dietary exposure to ethanol via ingestion of fermenting fruit has probably characterized the predominantly frugivorous anthropoid lineage for about 40 million years. Potentially adaptive primate behaviors associated with the natural occurrence of ethanol include the olfactory use of ethanol plumes to localize fruit crops, the use of ethanol as an appetitive stimulant to facilitate rapid consumption of transient nutritional resources, and the physiological exploitation of the caloric benefits of ethanol. Such behavioral and energetic advantages probably pertain to all animal taxa that consume fermenting fruit, and may have been retained in modern humans in spite of considerable dietary diversification over the last several million years. In contemporary human environments, excessive consumption of ethanol would then represent maladaptive cooption of ancestrally advantageous behaviors given essentially ad libitum access to a compound otherwise found only within scarce nutritional substrates. Epidemiologically demonstrated health benefits of low‐level alcohol consumption are consistent with an ancient and potentially adaptive exposure of primate frugivores to this most common of the psychoactive substances.
The urge to smoke depends on the expectation of smoking
Authors: Dols M. , Hout M. van den , Kindt M. , Willems B. 
Published: March 2003

ABSTRACTAims An earlier study (Dols et al. 2000) suggested that cue‐induced urge to smoke depends on the expectation of smoking. The present study tried to replicate the findings under stringently controlled conditions.Design A 2 (context) × 2 (cues) × 6 (trial) within‐subject design. Each smoker entered two different contexts; one context predicted the future occurrence of smoking (i.e. one puff of a cigarette) and one context predicted the non‐occurrence of smoking. In each context smokers were exposed to smoking cues (i.e. cigarettes and lighter) or not.Setting Laboratory at Maastricht University.Participants Thirty‐two daily smokers, smoking at least five cigarettes a day for at least 2 years.Measurements. Participants reported their urge to smoke in each context in the presence and absence of smoking cues using a computerized visual analogue scale (VAS).Findings The results revealed that the urge to smoke was higher in a context in which smoking was expected relative to a context in which it was not expected. As in the previous study the urge‐inducing effect of smoking cues was larger in the smoking context than in the non‐smoking context. Moreover, smoking cues did not have a significant effect in the non‐smoking context.Conclusions It was shown that smoking cues elicit craving due mainly to a generated expectation of the occurrence of smoking and less due to salience or long history of associative learning. Theoretical and practical implications of the results are discussed.
The Brazilian Association for the Study of Alcohol and Other Drugs
Authors: Silva João Carlos Dias da , Ramos Sérgio de Paula , Luz Ernani Luz , De Oliveira Evaldo Melo , Requião Dagoberto Hungria , Campana Angelo Americo Martinez 
Published: March 2003

ABSTRACTThe Brazilian Association for the Study of Alcohol and other Drugs [Associação Brazileira de Estudos do Álcool e outras Drogas (ABEAD)] is a non‐profit entity with the purpose of encouraging discussions and exchanges on advances in the prevention, treatment and research of addition. It currently brings together 840 professionals from different areas, such as Psychiatry, Social Assistance, Nursing, Psychology, Sociology, Law, in addition to community leaders, thus having an innovative and dynamic character. It organises annual national congresses and regional meetings hosting foreign guests. The society has a style that is innovative and dynamic. After more than 20 years of work, ABEAD exerts significant national influence and its members have been invited to participate in the main decisions regarding issues linked to drug abuse in Brazil. Among other achievements, it has contributed to the proposals on prevention and treatment policies and the standardization of the different levels of assistance provided by public health‐care. In addition, its members have worked closely with the initiatives made by the government and medical entities in the search for a consensus on the treatment of the different types of dependence, including alcohol dependence and smoking. ABEAD's goal for the future is to broaden its participation in the national drug policy arena and to intensify the work with other medical organizations and with the community.
Smoking as a risk factor for Alzheimer’s disease: contrasting evidence from a systematic review of case–control and cohort studies
Authors: Almeida Osvaldo P. , Hulse Gary K. , Lawrence David , Flicker Leon 
Published: March 2003

ABSTRACTAims To investigate the risk of Alzheimer’s disease (AD) associated with smoking.Design Meta‐analyses of case–control and cohort studies. Data source: Index Medicus–Medline (1966–April 2000) and PsycINFO (1984–April 2000) databases were systematically consulted for the retrieval of references. This search was supplemented by manual search of relevant references quoted by other studies and reviews.Study selection Irrelevant abstracts and articles were identified by one of the authors. These papers were retrieved and examined by at least two of the authors, who initially assessed them for the relevance of the exposure (smoking), outcome (AD) and study‐design (case–control or cohort study).Data extraction Two reviewers rated independently the quality of selected papers. Whenever possible, raw data were extracted and the crude odds ratio (OR) calculated using the Cornfield method. The pooled risk ratios were estimated using a fixed‐effects model.Findings Twenty‐one case–control studies reported data on 5323 subjects. The estimated pooled odds ratio (OR) was 0.74 [95% confidence interval (CI) = 0.66–0.84]. In another analysis incorporating ORs adjusted for confounding variables (such as age, sex, schooling and alcohol use), the pooled odds ratio was 0.82 (95% CI = 0.70–0.97). Finally, in a analysis that included only the four case–control studies that used matched design the pooled odds ratio was 0.82 (95% CI = 0.53–1.27). Eight cohort studies reported data on 43 885 people at risk—the overall relative risk (RR) of AD among ever smokers was 1.10 (95% CI = 0.94–1.29). Restricting the analysis to the two cohort studies that described the number of subjects who were smokers at baseline and later developed AD produced a RR of 1.99 (95% CI = 1.33–2.98).Conclusions Case–control and cohort studies produce conflicting results as to the direction of the association between smoking and AD. Survival bias and other methodological problems associated with case–control studies may partly explain this difference. Access to information collected by ongoing follow‐up studies may contribute to clarify the role of smoking in AD. If new results confirm that smoking is associated with increased risk of AD, then smoking prevention and cessation should become public health priorities in the fight against dementia.
The role of brain emotional systems in addictions: a neuro‐evolutionary perspective and new ‘self‐report’ animal model
Authors: Panksepp Jaak , Knutson Brian , Burgdorf Jeff 
Published: March 2003

ABSTRACTThe evolutionary significance of neurochemical events in the brain has received minimal attention in the field of addiction research. Likewise, the general failure of neuroscientists to postulate how basic brain circuits might mediate emotional urges has retarded the development of scientific perspectives that could inform new inquiries into the underlying dynamics and treatment of addictions. In this paper, we revisit the argument that prototypically abused substances activate or alter specific emotional brain systems that were evolutionarily designed to signal potential increments or decrements in fitness. We then discuss two distinct emotional systems (reward seeking and separation distress) which may track different types of potential changes in fitness. Based on this evolutionarily inspired approach, we illustrate how a mammalian model of emotion (i.e. rodent ultrasonic vocalizations) may enable scientists to predict drug‐related phenomena such as abuse potential, anatomical location of mediating neural substrates, and the psychological impact of withdrawal. We conclude by discussing some therapeutic and social implications of examining drug addiction processes with multiple emotional brain systems in mind.
Factors associated with non‐fatal heroin overdose: assessing the effect of frequency and route of heroin administration
Authors: Brugal M. Teresa , Barrio Gregorio , Fuente Luis De La , Regidor Enrique , Royuela Luis , Suelves Josep M. 
Published: March 2003

ABSTRACTAims To examine risk factors associated with non‐fatal heroin overdose, particularly frequency and route of heroin administration.Design Data from cross‐sectional surveys were analysed as a case–control and as a case cross‐over design.Setting and participants 2556 subjects treated for heroin dependence in 164 outpatient facilities in Spain.Measurements Prevalence of overdose involving emergency care in the 12 months before treatment admission.Case control design Odds ratio (OR) adjusted by logistic regression.Case–crossover designEstimated relative risk (RR) of transient risk of injecting heroin.Findings The prevalence of overdose was 10%. In the case control analysis the cumulative risk of overdose increased as the frequency of heroin use decreased. However, among daily heroin users this risk increased as the frequency of heroin injection rose, with an OR of 6.0 (95% CI: 3.9–9.6) for daily injectors versus non‐injectors. Sniffers had a higher risk than smokers among non‐daily users, but not among daily users. Other factors associated with increased risk of overdose were: tranquillizers, alcohol or cocaine use, living in certain regions and being long‐term HIV+ 0. In the case–crossover analysis, the RR for injecting heroin versus using other routes immediately before overdose was 15.9 (95%CI: 9.5–26.6), and was much higher for non‐daily heroin users than for daily users.Conclusions These findings suggest that the rapid entry of a large quantity of heroin into the blood (as occurs when injecting) involves a high risk of overdose, especially when the heroin tolerance level is low (as occurs in sporadic users).
Acceptability and availability of pharmacological interventions for substance misuse by British NHS treatment services
Authors: Rosenberg Harold , Melville John , McLean P. C. 
Published: March 2003

ABSTRACTAims Despite their potential advantages, many of the pharmacological interventions available to treat substance misuse are controversial and their acceptability within the United Kingdom (and other countries) has only recently begun to be investigated.Design A questionnaire mailed to British National Health Service (NHS) alcohol and drug treatment services asked respondents to rate the acceptability and availability of 11 pharmacological interventions for substance misuse employed to relieve withdrawal, reduce the likelihood of relapse and opiate overdose and substitute pharmaceuticals for illicit drugs.Participants A sample of NHS substance misuse services (n = 265) listed in one or more directories of services in England, Wales and Scotland.Findings Substitute methadone for opiate addiction, substitute benzodiazepines for benzodiazepine‐dependent patients, lofexidine for opiate detoxification, naltrexone for opiate relapse prevention and acamprosate for alcohol relapse prevention were widely acceptable and available interventions. Another subset of medications—buprenorphine for opiate detoxification, take‐home naloxone for overdose prevention and substitute prescribing of levo‐alpha‐acetyl‐methadol (LAAM), heroin and dexamphetamine—garnered less support, but the majority of participants rated even these therapies as acceptable. Ultra‐rapid detoxification under sedation was the intervention rated as least acceptable to, and was one of the two least frequently available from, responding NHS services.Conclusions Differences among specific medications notwithstanding, a wide range of harm‐reduction and abstinence‐orientated interventions were acceptable to and available from NHS services. Acceptance and availability are probably limited by a combination of practical, economic, safety, efficacy and theoretical considerations.
Risk factors for symptom exacerbation among treated patients with substance use disorders
Authors: Moos Rudolf H. , Nichol Aran C. , Moos Bernice S. 
Published: March 2003

ABSTRACTAims The purpose of this study was to develop an index of risk factors to identify patients prospectively with substance use disorders whose substance use symptoms exacerbate during or shortly after treatment, and to identify characteristics of care that may reduce the likelihood of exacerbation.Design, setting, participants On the basis of data obtained from a nation‐wide outcomes monitoring system, a group of 2809 treated patients experienced an exacerbation of their substance use symptoms. These patients were matched on baseline substance abuse problems with 5618 patients who remained stable or improved.Measurements and findings Risk factors for substance use symptom exacerbation included younger age, non‐married status and residential instability; long‐term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence and more severe self‐rated drug problems; and psychiatric problems. High‐risk patients who obtained a longer episode of mental health care were less likely to experience an exacerbation of symptoms.Conclusions Clinicians can identify at treatment entry patients whose substance use symptoms are likely to exacerbate and, by providing these patients a longer duration of care, may reduce the likelihood of symptom exacerbation.
Would smokers with schizophrenia benefit from a more flexible approach to smoking treatment?
Authors: McChargue Dennis E. , Gulliver Suzy B. , Hitsman Brian 
Published: March 2003

ABSTRACTWe evaluated literature that addresses the notion that flexible smoking treatment approaches are warranted for smokers with a diagnosis of schizophrenia. Understanding the biological and psychological mechanisms that increase the likelihood of smoking and decrease the motivation to quit for these individuals is addressed within the framework of a neurobiological model. We provide a brief overview of the limited smoking cessation treatment literature for patients with schizophrenia and compare abstinence‐focused versus reduction‐focused treatment modalities. The potential utility of the reduction‐focused approach to tobacco treatment for these smokers is evaluated. Suggestions for future research to address the utility and efficacy of reduction‐focused interventions for smokers with schizophrenia are put forth. We conclude with a consideration of the implications for the current understanding of smoking treatment among patients with co‐morbid psychiatric diagnoses.
Effects of depression and social integration on the relationship between alcohol consumption and all‐cause mortality
Authors: Greenfield Tom K. , Rehm Jürgen , Rogers John D. 
Published: March 2003

ABSTRACTAimsThis study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all‐cause mortality.Design, participants and measurementRespondents from the 1984 US National Alcohol Survey (N= 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES‐D) scale and an eight‐item social isolation scale.FindingsTheJ‐shaped risk curve for all‐cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life‐time abstainer.ConclusionsThe relationship of alcohol consumption to 11‐year all‐cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex‐drinkers.
A prospective study of mortality among drug misusers during a 4‐year period after seeking treatment
Authors: Gossop Michael , Stewart Duncan , Treacy Samantha , Marsden John 
Published: March 2003

ABSTRACTAims The opportunity to study deaths as they occur within the framework of a prospective cohort study is relatively uncommon. This study investigates deaths among drug misusers over a 4‐year period, with specific attention to the circumstances and causes of death, and risk factors for mortality. The study also critically examines the recording of drug‐related deaths.Design, Setting, Participants Prospective cohort study of 1075 drug misusers recruited to 54 treatment programmes during 1995.Measurements Data derived from interviews conducted with clients at intake, death certificates and post‐mortem examinations.Findings The annual mortality rate was 1.2%, about six times higher than that for a general, age‐matched population. Fourteen per cent of the deaths were due to self‐inflicted injuries, accidents or violence and 18% were due to medical causes. The majority of deaths (68%) were associated with drug overdoses. Opiates were the drugs most commonly detected during post‐mortem examinations. In the majority of cases, more than one drug was detected. Polydrug use and, specifically, heavy drinking, and use of benzodiazepines and amphetamines, were identified as risk factors for mortality. Anxiety and homelessness were also predictive of increased mortality.Conclusions We suggest that drug misusers and those working with drug misusers need to be more alert to the risks of polydrug use, including the combined use of alcohol with illicit drugs. The study revealed inconsistencies in the recording of drug‐related deaths on death certificates. The routine recording of all substances detected during toxicological examination would improve the accuracy of death certification.