bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multilevel analysis of change in alcohol consumption in Québec, 1993–98
Authors: Demers Andrée , Kairouz Sylvia 
Published: March 2003

ABSTRACTAims  Changes in drinking are subgroup‐specific and vary by dimensions of drinking pattern. This study investigates changes in drinking patterns between 1993 and 1998 within various subgroups of Québec society.Design  A multilevel design was used in which respondents (level 1) were nested within demographic groups (level 2).Participants  Based on the 1993 and 1998 Québec Health and Social Surveys, 40 598 respondents (level 1) were nested within 220 groups (level 2) based on age, SES status, gender and the year of survey.Measurements  The effect of group characteristics were assessed for various dimensions of drinking pattern.Findings  A significant part of the variance in drinking pattern is attributed to group membership (ranging from 8.6% to 18.3%). Except for the frequency of heavy drinking episodes, the data revealed a significant increase between 1993 and 1998 on all drinking pattern dimensions, which was more marked for higher SES groups for current drinking status. However, the frequency of heavy drinking decreased among the lower SES groups and remained stable among the higher SES groups.Conclusions  These results call for an increase in public health vigilance in monitoring trends in drinking patterns and their potential acute and chronic consequences.
The National Treatment Outcome Research Study (NTORS): 4–5 year follow‐up results
Authors: Gossop Michael , Marsden John , Stewart Duncan , Kidd Tara 
Published: March 2003

ABSTRACTAims The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings.Design, setting and participants The study used a longitudinal, prospective cohort design. Data were collected by structured interviews at intake to treatment, 1 year, 2 years and at 4–5 years. The sample comprised 418 patients from 54 agencies and four treatment modalities.Measurements Measures were taken of illicit drug use, injecting and sharing injecting equipment, alcohol use, psychological health and crime.Findings Rates of abstinence from illicit drugs increased after treatment among patients from both residential and community (methadone) programmes. Reductions were found for frequency of use of heroin, non‐prescribed methadone, benzodiazepines, injecting and sharing of injecting equipment. For most variables, reductions were evident at 1 year with outcomes remaining at about the 1 year level or with further reductions. Crack cocaine and alcohol outcomes at 4–5 years were not significantly different from intake.Conclusions Substantial reductions across a range of problem behaviours were found 4–5 years after patients were admitted to national treatment programmes delivered under day‐to‐day conditions. The less satisfactory outcomes for heavy drinking and use of crack cocaine suggest the need for services to be modified to tackle these problems more effectively. Despite differences between the United Kingdom and the United States in patient populations and in treatment programmes, there are many similarities between the two countries in outcomes from large‐scale, multi‐site studies.
Prevalence of alcohol dependence in a town in Nepal as assessed by the CAGE questionnaire
Authors: Jhingan H. P. , Shyangwa Pramod , Sharma Avneet , Prasad K. M. R. , Khandelwal S. K. 
Published: March 2003

ABSTRACTBackground  In spite of a perception that alcohol use is rampant in Nepal, there has been no survey to assess the extent of alcohol dependence in the country.Aims  (i) To assess prevalence of alcohol dependence in the community of Dharan and (ii) to correlate this with various socio‐demographic characteristics.Design  The CAGE questionnaire was administered to all adult individuals in houses selected randomly in the township of Dharan.Findings  Among 2344 adults assessed, the prevalence of alcohol dependence was found to be 25.8%. The prevalence of alcohol dependence increased with age to peak in the age group 45–54 years and was more than twice as common in men as in women. Also, alcohol dependence was more common among those with lower level of education, widowers and divorcees and those belonging to the Matwali community. The extent of dependence was influenced by socio‐cultural sanctions.Conclusions  The prevalence of alcohol dependence is too high for comfort in Dharan, a town in eastern Nepal. There is an urgent need to formulate a policy for substance abuse in the country taking into account the findings of this study.
Concomitant drugs of misuse and drug using behaviours associated with fatal opiate‐related poisonings in Sheffield, UK, 1997–2000
Authors: Oliver Phillip , Keen Jenny 
Published: March 2003

ABSTRACTAims To examine the degree of involvement of concomitant drugs of misuse and other previously identified behavioural risk factors in acute accidental opiate‐related poisoning fatalities in Sheffield, 1997–2000.Design Retrospective analysis of coroners’ records.Setting Sheffield, UK.Participants All those who died from an acute accidental opiate‐related poisoning in Sheffield between 1 January 1997 and 31 December 2000.Measurements Coronial data were collated under the headings: demographic characteristics, circumstances of death and toxicological findings.Findings Ninety‐four deaths occurred over the study period. The majority of cases were regular users of illicit drugs. Approximately 20% of deaths were preceded by a period of abstinence from drug use, with imprisonment and hospitalization as the most common reasons. Sixty‐one per cent of cases had concomitant drugs of misuse detected from toxicology most commonly benzodiazepines and/or alcohol. These were, however, found in relatively small concentrations and opiate blood concentrations were no lower in deaths where multiple substances were involved. Despite evidence to suggest that smoking is the preferred route of heroin administration in this region, the vast majority of cases involved injecting.Conclusions Administration of an opiate via intravenous injection was the most consistent factor associated with these deaths over the period of this study. Co‐administration of other central nervous system depressants, at least in lower quantities appear to be a feature rather than a risk factorper sein such fatalities.
Does cannabis use predict poor outcome for heroin‐dependent patients on maintenance treatment? Past findings and more evidence against
Authors: Epstein D. H. , Preston K. L. 
Published: March 2003

ABSTRACTAims  To determine whether cannabinoid‐positive urine specimens in heroin‐dependent out‐patients predict other drug use or impairments in psychosocial functioning, and whether such outcomes are better predicted by cannabis‐use disorders than by cannabis use itself.Design  Retrospective analyses of three clinical trials; each included a behavioral intervention (contingency management) for cocaine or heroin use during methadone maintenance. Trials lasted 25–29 weeks; follow‐up evaluations occurred 3, 6 and 12 months post‐treatment. For the present analyses, data were pooled across trials where appropriate.Setting  Urban out‐patient methadone clinic.Participants  Four hundred and eight polydrug abusers meeting methadone‐maintenance criteria.Measurements  Participants were categorized as non‐users, occasional users or frequent users of cannabis based on thrice‐weekly qualitative urinalyses. Cannabis‐use disorders were assessed with the Diagnostic Interview Schedule III‐R. Outcome measures included proportion of cocaine‐ and opiate‐positive urines and the Addiction Severity Index (at intake and follow‐ups).Findings  Cannabis use was not associated with retention, use of cocaine or heroin, or any other outcome measure during or after treatment. Our analyses had a power of 0.95 to detect an r2 of 0.11 between cannabis use and heroin or cocaine use; the r2 we detected was less than 0.03 and non‐significant. A previous finding, that cannabis use predicted lapse to heroin use in heroin‐abstinent patients, did not replicate in our sample. However, cannabis‐use disorders were associated weakly with psychosocial problems at post‐treatment follow‐up.Conclusions  Cannabinoid‐positive urines need not be a major focus of clinical attention during treatment for opiate dependence, unless patients report symptoms of cannabis‐use disorders.
Cumulative adversity and drug dependence in young adults: racial/ethnic contrasts
Authors: Turner R. Jay , Lloyd Donald A. 
Published: March 2003

ABSTRACTAims To study cumulative exposure to stressors as a risk factor for drug dependence, and evaluate whether group differences in exposure contribute to differences in prevalence.Design Cross‐sectional community survey of life‐time adverse experiences and substance and psychiatric disorders.Setting Data collected between 1997 and 2000 in Miami–Dade County, USA.Participants A total of 1803 former Miami–Dade public school students, 93% between ages 19 and 21 years when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African‐Americans and non‐Hispanic whites are represented equally.Measurements Drug dependence disorder assessed by DSM‐IV criteria using the Composite International Diagnostic Interview, and a 41‐item checklist of life‐time exposure to major and potentially traumatic experiences. Both measures include age at time of first occurrence.Findings Life‐time rate of drug dependence disorder (total 14.3%) did not vary significantly (P > 0.05) by socio‐economic group. Male rate (17.6%) was significantly greater than female rate (10.9%). The African‐American rate (6.5%) was dramatically lower than non‐Hispanic white (17.0%), Cuban (18.1%) and non‐Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty‐eight of 33 individual adversities were associated with the subsequent onset of drug dependence (P < 0.05). Cumulative life‐time exposure was greatest for males and for African‐Americans, and was associated inversely with socio‐economic level. Multivariate discrete‐time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (P < 0.05), controlling for childhood conduct disorder, attention deficit hyperactive disorder and previous psychiatric disorder.Conclusions Life‐time cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, although it does not explain ethnic group differences in risk.
An evaluation of the Dartmouth Assessment of Lifestyle Inventory and the Leeds Dependence Questionnaire for use among detained psychiatric inpatients
Authors: Ford Peter 
Published: March 2003

ABSTRACTAim  To examine the psychometric properties of the Dartmouth Assessment of Lifestyle Inventory (DALI) as a substance use disorder screening instrument, and the Leeds Dependency Questionnaire (LDQ) as a measure of severity of dependence among inpatients with severe mental disorders detained in hospital.Design  Comparison of DALI scores, LDQ scores and a clinical assessment of substance use disorder. Statistical analysis calculated Cronbach's alpha, receiver operator characteristics, anova and multivariate linear regression.Setting  An English medium secure psychiatric hospital.Participants  A random sample of 60 adult inpatients with one or more diagnoses of schizophrenia, personality disorder and mild to moderate learning difficulty.Measurements  All participants completed the LDQ, DALI and a clinical assessment of substance use disorder using ICD‐10 criteria.Findings  The diagnostic accuracy of the DALI instrument was 74% for alcohol disorders and 83% for drug disorders. The reliability of the LDQ and concurrent validity with the DALI were good (a = 0.915, R2 = 0.439, F (2, 57) = 22.3, P < 0.001).Conclusions  The DALI's overall accuracy for screening inpatients is good, but it under‐diagnosed substance use disorders, probably because the hospital environment moderates substance use. The results suggest that the LDQ has very good psychometric properties and is useful as a measure of substance dependence in this population. Furthermore, the validity of the LDQ in this clinical population provides evidence to suggest the same cognitive and behavioural processes of addiction operate among those inpatients with severe mental disorders detained in psychiatric hospital as in the general population.
The Finnish press's political position on alcohol between 1993 and 2000
Authors: Törrönen Jukka 
Published: March 2003

AbstractAims  To examine Finnish commentary on changes in alcohol policy between 1993 and 2000. Data. A corpus of newspaper editorials on alcohol issues from six daily newspapers published between 1993 and 2000.Method  The editorials were analysed as ‘pending narratives’ by examining how they used ‘morally loaded binary discourse’, ‘utopian discourse’ and ‘truth discourse’.Findings  Almost half the editorials discussed alcohol policy in terms of freedom from the restrictive alcohol policy of the state. Encouraging liberalization of alcohol policy peaked in 1996 and 1997. However, as problems of public order became more prominent in the media at the end of the 1990s, claims for the liberalization of alcohol policy died away and between 1998 and 2000 issues of public order dominated those of freedom. In addition, concern about the intoxication‐orientated drinking habits of the young and of children became prominent.Conclusions  The results suggest that, after advocating more liberalized alcohol policy and then seeing that there were some groups who responded irresponsibly to this, the middle‐class concern about freedom turned into concern about the security of public places and this was reflected in the media. This analysis highlights the dynamic nature of public opinion and media advocacy in response to changes in policy.
Cannabis use: consistency and validity of self‐report, on‐site urine testing and laboratory testing
Authors: Buchan Betty J. , L. Dennis Michael , Tims Frank M. , Diamond Guy S. 
Published: March 2003

AbstractAims  To evaluate the agreement between adolescent self‐reported cannabis use, “on‐site” qualitative urine screening, and quantitative laboratory testing.Design  A cross‐sectional study of intake and follow‐up data from 248 adolescents entering substance abuse treatment for cannabis use disorders (abuse or dependence). This is part of the multi‐site cooperative agreement Cannabis Youth Treatment study.Setting  Data collected from adolescents randomly assigned to one of five outpatient treatments at four sites: Operation PAR, Inc., Florida; Chestnut Health Systems, Illinois; University of Connecticut Health Center, Connecticut; and Children's Hospital of Philadelphia, Pennsylvania.Participants  The data represent 248 unique individuals from a sample of 297 adolescents ranging in age from 12 to 18 years.Measurements  Prevalence, agreement, kappa, sensitivity, specificity, positive and negative predictive value.Findings  The self‐report rates were higher at intake than either urine test (82.4% vs. 77.0% vs. 52.7%), but both lower and higher at the 3‐month follow‐up (55.5% vs. 70.0% vs. 47.3%) and 6‐month follow‐up (60.2% vs. 73.5% vs. 55.8%). The disagreements went in both directions and the kappa coefficients were only in the moderate range (0.4). Over two‐thirds of these frequent cannabis users tested positive when they said they had not used in 1 week and one‐third tested positive even though they said it had been more than 4 weeks since last use.Conclusions  The findings suggest both the advantages of multiple sources of information and the need for further work on the latency of cannabis metabolites in clinical populations.
The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans
Authors: Dennis Michael , Titus Janet C. , Diamond Guy , Donaldson Jean , Godley Susan H. , Tims Frank M. , Webb Charles , Kaminer Yifrah , Babor Thomas , Roebuck M. C. , Godley Mark D. , Hamilton Nancy , Liddle Howard , Scott Christy K. ,   The C. Y. T. Steering Committee
Published: March 2003

AbstractAims  This paper provides a description of the rationale, study design, treatments and assessment procedures used in the Cannabis Youth Treatment (CYT) experiment.Design  CYT was designed to (a) test the relative effectiveness, cost and benefit–cost of five promising treatment interventions under field conditions and (b) provide evidence based manual‐guided models of these interventions to the treatment field.Setting  The study involved two community‐based treatment programs and two major medical centers.Participants  Participants were 600 adolescents recruited from the regular intake who were between the ages of 12 and 18, had used marijuana in the past 90 days, and met one or more criteria of dependence or abuse.Interventions  Participants were randomly assigned to one of five interventions: Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT), Family Support Network (FSN), Adolescent Community Reinforcement Approach (ACRA), or Multidimensional Family Therapy (MDFT).Measurements  Self‐report data were collected at intake, 3, 6, 9 and 12 months post discharge using the Global Appraisal of Individual Needs (GAIN), as well as several supplemental self‐reports, collateral reports, urine testing, and service logs.Findings  This paper reports on the study's implementation including the psychometric properties of the measures (alphas over 0.8), validity of self‐report (kappa over 0.6), high rates of treatment completion (81% completed two or more months), and high rates of follow‐up (over 94% per wave).Conclusions  The feasibility of implementing the CYT manual‐guided treatment and quality assurance model in community‐based adolescent treatment programs is discussed.
Five outpatient treatment models for adolescent marijuana use: a description of the Cannabis Youth Treatment Interventions
Authors: Diamond Guy , Godley Susan H. , Liddle Howard A. , Sampl Susan , Webb Charles , Tims Frank M. , Meyers Robert 
Published: March 2003

AbstractThe five manual‐guided treatment models tested in the Cannabis Youth Treatment study funded by the Center for Substance Abuse Treatment are described. The five models include (a) a 6‐week intervention consisting of two sessions of individual motivational enhancement therapy plus three sessions of group cognitive behavioral therapy (MET/CBT5); (b) a 12‐week intervention consisting of two sessions of motivational enhancement therapy plus 10 sessions of group cognitive behavioral therapy treatment (MET/CBT12); (c) a 12‐week intervention consisting of MET/CBT12 plus the family support network (FSN), a multi‐component intervention that includes parent education, family therapy and case management; (d) a 12‐week intervention based on the adolescent community reinforcement approach (ACRA), an individual behavioral treatment approach designed to help adolescents and their parents reshape their environment and learn new skills; and (e) multi‐dimensional family therapy (MDFT), a multi‐faceted, developmentally and contextually oriented family‐based model targeting individual, family and social systems. For each model, we describe the treatment background and/or its empirical support, its theoretical underpinnings, its goals and proposed treatment mechanism and the structure and content of each treatment. Procedures used for maintaining treatment fidelity and monitoring quality assurance are also described. These interventions represent the first readily available, manual‐guided interventions to be evaluated in a large randomized field study for this population. Consequently, these manuals have the potential to advance treatment and research for adolescents with substance use disorders.
Tailoring cannabis dependence treatment for a diverse population
Authors: Steinberg Karen L. , Roffman Roger A. , Carroll Kathleen M. , Kabela Elise , Kadden Ronald , Miller Michael , Duresky David ,   The Marijuana Treatment Project Research Group
Published: March 2003

AbstractAccumulating evidence suggests that psychosocial treatment for cannabis dependence is effective. Earlier investigations were well designed and sought to evaluate efficacy of manual‐guided therapies with particular attention to protecting the independent variable. The Marijuana Treatment Project (MTP) represents an effort to build upon previous knowledge about cannabis dependence treatment through an evaluation of an integrative therapy, which was meant to allow for greater therapist latitude in its delivery, and to be more responsive to a potentially more diverse population of clients. The treatment intervention developed for delivery in the Marijuana Treatment Project (MTP) reflects an effort to find a true compromise between the needs of the scientific community to have clearly specified and measurable treatments, and the realities of the treatment community, which demand flexibility, appreciation of the multi‐determined nature of most problems, and individualized approaches. This paper will describe the clinical interventions used with the MTP participants, the theoretical rationale guiding their design and practical aspects related to implementation and treatment response.