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CERGA Journal Title and Abstracts March 2015 Contents PAGE LIST OF JOURNALS CHECKED 2 LIST OF REFERENCES Alcohol - Miscellaneous 3 Alcohol - Policy 3 Alcohol Treatment 4 Alcohol – Young People 4 Blood Borne Viruses 5 Co-Morbidity 5 Drug Related Deaths 6 Epidemiology and Demography 7 Harm Reduction 7 Hepatitis C 7 Miscellaneous 7 Opiate Treatment 8 Overdose and Drug Related Deaths 8 Parenting 9 Pharmacy 9 Primary Care 9 Recovery 9 Smoking Cessation 9 Young People 9 LIST OF ABSTRACTS 10-42 1 Number of issues per year Journal Title Volumes and Issues Checked Addiction Addictive Behaviours Alcohol and Alcoholism Alcoholism Clinical & Experimental Research Drug and Alcohol Dependence Volume 110, Issue 1[1], Issue 2[1] Volume 43 [5] Volume 50 Issue 1[2], Issue 2[3] Volume 38 Issue 12[3], Volume 39 Issue 1[2], Issue 2[1] Volume 146[6], Volume 147[6], Volume 148[6] Volume 22 Issue 1[4] 12 12 6 Volume 34 Issue 1[1] Volume 25 Issue 6[1], Volume 26 Issue 1[2], Issue 2[1], Supplement 1[2] Volume 50 [2] 6 6 Drugs Education Prevention and Policy Drug and Alcohol Review International Journal of Drug Policy Journal of Substance Abuse Treatment The American Journal of Drug and Alcohol Abuse Substance Use and Misuse 12 12 6 8 Volume 41 Issue 1[1], Issue 2[1] Volume 50 Issue 2[2], Issue 4[1] 2 6 12 LIST OF REFERENCES ALCOHOL MISCELLANEOUS 1. Evaluating implicit drinking identity as a mediator of drinking motives and alcohol consumption and craving Kristen P. Lindgren, Clayton Neighbors, Reinout W. Wiers, Melissa L. Gasser, Bethany A. Teachman Addictive Behaviors 2015:43;33-38 2. Social Cognition Deficits and Associations with Drinking History in Alcoholic Men and Women Mary M. Valmas, Susan Mosher Ruiz, David A. Gansler, Kayle S. Sawyer, Marlene OscarBerman Alcoholism: Clinical and Experimental Research 2014:38(12);2998-3007 3. Worsening of Health and a Cessation or Reduction in Alcohol Consumption to Special Occasion Drinking Across Three Decades of the Life Course Linda Ng Fat, Noriko Cable, Nicola Shelton Alcoholism: Clinical and Experimental Research 2015:39(1);166-174 4. Assessing and Treating Alcohol Relapse Risk in Liver Transplantation Candidates G. Dom, M. Wojnar, C.L. Crunelle, N. Thon, J. Bobes, U.W. Preuss, G. Addolorato, H.K. Seitz, F.M. Wurst Alcohol and Alcoholism 2015:50(2);164-172 5. Multiple Mechanisms Influencing the Relationship Between Alcohol Consumption and Peer Alcohol Use Alexis C. Edwards, Hermine H. Maes, Carol A. Prescott, Kenneth S. Kendler Alcoholism: Clinical and Experimental Research 2015:39(2);324-332 ALCOHOL POLICY 6. Underage Access to Online Alcohol Marketing Content: A YouTube Case Study Adam E. Barry, Emily Johnson, Alexander Rabre, Gabrielle Darville, Kristin M. Donovan, Orisatalabi Efunbumi Alcohol and Alcoholism 2015:50(1);89-94 7. Alcohol Consumption and Fatal Injuries in Australia Before and After Major Traffic Safety Initiatives: A Time Series Analysis Heng Jiang, Michael Livingston, Robin Room Alcoholism: Clinical and Experimental Research 2015:39(1);175-183 3 ALCOHOL TREATMENT 8. Mixed Methods Study of Help Seekers and Self-Changers Responding to an Online Recovery Survey Jane Witbrodt, Thomasina J. Borkman, Aina Stunz, Meenakshi Sabina Subbaraman Alcohol and Alcoholism 2015:50(1);82-88 9. Delay to first treatment contact for alcohol use disorder Cath Chapman, Tim Slade, Caroline Hunt, Maree Teesson Drug and Alcohol Dependence 2015:147;116-121 10. The impact of a stage tailored intervention on alcohol use trajectories among those who do not intend to change Sophie Baumann , Beate Gaertner, Inga Schnuerer, Katja Haberecht, Ulrich John, Jennis Freyer-Adam Drug and Alcohol Dependence 2015:147;167-174 11. A Pilot Study on the Feasibility and Acceptability of a Text Message-Based Aftercare Treatment Programme Among Alcohol Outpatients Severin Haug, Michael J. Lucht, Ulrich John, Christian Meyer, Michael P. Schaub Alcohol and Alcoholism 2015:50(2);188-194 12. Accuracy of Alcohol Use Disorders Identification Test for Detecting Problem Drinking in 18–35 Year-Olds in England: Method Comparison Study David R. Foxcroft, Lesley A. Smith, Hayley Thomas, Sarah Howcutt Alcohol and Alcoholism Volume 50, Issue 2 Pp. 244 – 250 ALCOHOL AND YOUNG PEOPLE 13. Alcohol and energy drink use among adolescents seeking emergency department care Erin E. Bonar , Rebecca M. Cunningham, Svitlana Polshkova, Stephen T. Chermack, Frederic C. Blow, Maureen A. Walton Addictive Behaviors 2015:43;11-17 14. Energy drink consumption and later alcohol use among early adolescents Elisa R. Miyake, Naomi R. Marmorstein Addictive Behaviors 2015:43;60-65 15. Increased Forebrain Activations in Youths with Family Histories of Alcohol and Other Substance Use Disorders Performing a Go/NoGo Task Ashley Acheson, Malle A. Tagamets, Laura M. Rowland, Charles W. Mathias, Susan N. Wright, L. Elliot Hong, Peter Kochunov, Donald M. Dougherty Alcoholism: Clinical and Experimental Researchn 2014:38(12);2944-2951 4 BLOOD BORNE VIRSUS 16. Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs Bruce R. Schackman, Jared A. Leff, Devra M. Barter, Madeline A. DiLorenzo, Daniel J. Feaster, Lisa R. Metsch, Kenneth A. Freedberg, Benjamin P. Linas Addiction 2015: 110(1);129-143 17. Perceived Medical Risks of Drinking, Alcohol Consumption, and Hepatitis C Status Among Heavily Drinking HIV Primary Care Patients Jennifer C. Elliott, Efrat Aharonovich, Ann O'Leary, Barbara Johnston, Deborah S. Hasin Alcoholism: Clinical and Experimental Research 2014:38(12);3052-3059 18. Trends in use of health care and HIV prevention services for persons who inject drugs in San Francisco: Results from National HIV Behavioral Surveillance 2005–2012 Phillip O. Coffin, Harry Jin, Emalie Huriaux, Ali Mirzazadeh, Henry F. Raymond, Drug and Alcohol Dependence 2015:146;45-51 19. Association between hepatitis C virus and opioid use while in buprenorphine treatment: preliminary findings Sean M. Murphy, Dana Dweik, Sterling McPherson, John M. Roll The American Journal of Drug and Alcohol Abuse 2015:41(1);88–92 CO-MORBIDITY 20. Familial factors associated with development of alcohol and mental health comorbidity Caroline L. Salom, Gail M. Williams, Jake M. Najman, Rosa Alati Addiction 2015:110(2);248-257 21. Psychophysiology of pain and opioid use: Implications for managing pain in patients with an opioid use disorder Amy Wachholtz, Simmie Foster, Martin Cheatle Drug and Alcohol Dependence 2015:146;1-6 22. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness Maritt Kirst, Suzanne Zerger, Vachan Misir, Stephen Hwang, Vicky Stergiopoulos Drug and Alcohol Dependence 2015:146;24-29 5 23. Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and causespecific mortality Karolina M. Bogdanowicz, Robert Stewart, Matthew Broadbent, Stephani L. Hatch, Matthew Hotopf, John Strang, Richard D Hayes Drug and Alcohol Dependence 2015:148;85-92 24. Trends in dual diagnosis of severe mental illness and substance use disorders, 1996– 2010, Israel Alexander M. Ponizovsky, Paola Rosca, Ziona Haklai, Nehama Goldberger Drug and Alcohol Dependence 2015:148;203-208 DRUG RELATED DEATHS 25. National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005–2009 Matthias Pierce, Sheila M. Bird, Matthew Hickman, Tim Millar Drug and Alcohol Dependence 2015:146;17-23 26. Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role? Andreea Adelina Artenie, Julie Bruneau, Geng Zang, François Lespérance, Johanne Renaud, Joël Tremblay, Didier Jutras-Aswad, Drug and Alcohol Dependence 2015:147;208-214 27. Drug-related deaths and the sales of needles through pharmacies Peter J. Davidson, Alexis Martinez, Alexandra Lutnick, Alex H. Kral, Ricky N. Bluthenthal Drug and Alcohol Dependence 2015:147;229-234 28. Take-home naloxone to prevent fatalities from opiate-overdose: Protocol for Scotland’s public health policy evaluation, and a new measure to assess impact Sheila M. Bird, Mahesh K. B. Parmar, John Strang Drugs: education, prevention, and policy 2015:22(1);66–76 29. Substance use and risk of death in young offenders: A prospective data linkage study Stuart A. Kinner, Louisa Degenhardt, Carolyn Coffey, Stephen Hearps, Matthew Spittal, Susan M. Sawyer, George C. Patton Drug and Alcohol Review 2015:34(1);46-50 30. Brief overdose education is sufficient for naloxone distribution to opioid users Emily Behar, Glenn-Milo Santos, Eliza Wheeler, Christopher Rowe, Phillip O. Coffin Drug and Alcohol Dependence 2015:148;209-212 6 EPIDEMIOLOGY AND DEMOGRAPHY 31. Unique factors associated with young women in substance use treatment: Craving, impulsivity, emotion regulation, and physiological response Christine Vinci, Julie Schumacher, Scott F. Coffey Drug and Alcohol Dependence 2015:146;e12 HARM REDUCTION 32. The cost-effectiveness of harm reduction David P. Wilson, Braedon Donald, Andrew J. Shattock, David Wilson, Nicole Fraser-Hurt International Journal of Drug Policy 2015:26(S1);S5-S11 HEPATITIS C 33. Opioid substitution therapy is associated with increased detection of hepatitis C virus infection: A 15-year observational cohort study Sarah Larney, Jason Grebely, Michael Falster, Alexander Swart, Janaki Amin, Louisa Degenhardt, Lucinda Burns, Claire M. Vajdic Drug and Alcohol Dependence 2015:148;213-216 34. Prevention, treatment and care of hepatitis C virus infection among people who inject drugs Philip Bruggmann, Jason Grebely International Journal of Drug Policy 2015:26(S1);S22-S26 35. Relative effects of heavy alcohol use and Hepatitis C in decompensated chronic liver disease in a hospital inpatient population Pavan Kumar Mankal, Jean Abed, Jose David Aristy, Khushboo Munot, Upma Suneja, Ellen S. Engelson, Donald P. Kotler The American Journal of Drug and Alcohol Abuse 2015:41(2);177–182 MISCELLANEOUS 36. Beyond risky alcohol use: Screening non-medical use of prescription drugs at National Alcohol Screening Day Mark M. Silvestri, Holly Knight, Jessica Britt, Christopher J. Correia Addictive Behaviors 2015:43;25-27 37. The stigmatisation of the provision of services for alcohol and other drug users: A systematic literature review Kim Eaton, Jeneva L. Ohan, Greg Dear Drugs: education, prevention, and policy 2015:22(1);19–25 7 38. “We are people too”: Consumer participation and the potential transformation of therapeutic relations within drug treatment Jake Rance, Carla Treloar International Journal of Drug Policy 2015:26(1);30-36 39. Lessons learned for follow-up phone booster counseling calls with substance abusing emergency department patients Dennis M. Donovan, Mary A. Hatch-Maillette, Melissa M. Phares, Ernest McGarry, K. Michelle Peavy, Julie Taborsky Journal of Substance Abuse Treatment 2015:50;67-75 40. Images by the Vineyard: Images of Addiction and Substance Users in the Media and Other Culture Sites/Sights Allaman Allamani, Silvia Mattiacci Substance Use & Misuse 2015:50(4);484–502 OPIATE TREATMENT 41. Mobile phone and text messaging in a public sector, office-based buprenorphine program Babak Tofighi, Ellie Grossman, Emily Buirkle, Joshua D. Lee Drug and Alcohol Dependence 2015:146;e4-e5 42. Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses Anne Line Bretteville-Jensen, Mats Lillehagen, Linn Gjersing, Jasmina Burdzovic Andreas Drug and Alcohol Dependence 2015:147;89-96 43. Changes in mental health during opiate replacement therapy: A systematic review Niamh Fingleton, Catriona Matheson, Mariesha Jaffray Drugs: education, prevention, and policy 2015:22(1);1–18 44. Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors Björn Johnson, Torkel Richert International Journal of Drug Policy 2015:26(2);183-190 OVERDOSE AND DRUG RELATED DEATHS 45. Associations between childhood trauma and non-fatal overdose among people who inject drugs Stephanie Lake, Kanna Hayashi, M.-J. Milloy, Evan Wood, Huiru Dong, Julio Montaner, Thomas Kerr Addictive Behaviors 2015:43;83-88 46. Wasted, overdosed, or beyond saving – To act or not to act? Heroin users’ views, assessments, and responses to witnessed overdoses in Malmö, Sweden Torkel Richert International Journal of Drug Policy 2015:26(1);92-99 8 PARENTING 47. Parental Rules, Parent and Peer Attachment, and Adolescent Drinking Behaviors Michael Thomas McKay Substance Use & Misuse 2015:50(2);184–188 PHARMACY 48. Community pharmacy services for drug misuse: Attitudes and practices of Finnish pharmacists Hanna Uosukainen, Juha H.O. Turunen, Jenni Ilomäki, J. Simon Bell, International Journal of Drug Policy 2014:25(6);1139-1142 PRIMARY CARE 49. A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: Outcomes through 12 months Jan Gryczynski, Shannon Gwin Mitchell, Arturo Gonzales, Ana Moseley, Thomas R. Peterson, Steven J. Ondersma, Kevin E. O’Grady, Robert P. Schwartz Journal of Substance Abuse Treatment 2015:50;3-10 RECOVERY 50. “You’re all going to hate the word ‘recovery’ by the end of this”: Service users’ views of measuring addiction recovery Joanne Neale, Charlotte Tompkins, Carly Wheeler, Emily Finch, John Marsden, Luke Mitcheson, Diana Rose, Til Wykes, John Strang Drugs: education, prevention, and policy Feb 2015, Vol. 22, No. 1: 26–34 51. How do recovery definitions distinguish recovering individuals? Five typologies Jane Witbrodt, Lee Ann Kaskutas, Christine E. Grella Drug and Alcohol Dependence 2015:148;109-117 SMOKING CESSATION 52. Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes Jean-François Etter , Thomas Eissenberg Drug and Alcohol Dependence 2015:147;68-75 53. Explaining the effects of electronic cigarettes on craving for tobacco in recent quitters Jean-François Etter Drug and Alcohol Dependence 2015:148;102-108 YOUNG PEOPLE 54. Competitive Sport Involvement and Substance Use among Adolescents: A Nationwide Study Philip Todd Veliz, Carol J. Boyd, Sean Esteban McCabe Substance Use & Misuse 2015:50(2);156–165 9 10 LIST OF ABSTRACTS ALCOHOL MISCELLANEOUS 1. Evaluating implicit drinking identity as a mediator of drinking motives and alcohol consumption and craving Kristen P. Lindgren, Clayton Neighbors, Reinout W. Wiers, Melissa L. Gasser, Bethany A. Teachman Addictive Behaviors 2015:43;33-38 Abstract Introduction Implicit drinking identity (i.e., cognitive associations between the self and drinking) is a reliable predictor of drinking. However, whether implicit drinking identity might mediate the relationship between other robust predictors of drinking and drinking outcomes is unknown. We hypothesized that implicit drinking would mediate the relationship between drinking motives and alcohol consumption and craving. Method We assessed drinking motives at Time 1, implicit drinking identity at Time 2 (on average, 11 days later) and self-reported alcohol consumption and craving at Time 3 (on average, 6 days later) in a sample of 194 US undergraduates (54% women) who reported at least one heavy drinking episode (4 drinks for women, 5 for men) in the past month. Participants completed self-report measures of drinking motives, daily alcohol consumption, and current craving. Results Implicit drinking identity uniquely mediated the relationship between social motives and alcohol consumption. It did not, however, mediate the relationship between motives and craving. Time 2 implicit drinking identity was positively associated with greater alcohol consumption and craving at Time 3, even after controlling for drinking motives. Subsequent analyses indicated significant indirect effects between social, enhancement, and coping motives (but not conformity) and consumption and craving when each motive was evaluated individually. Conclusions Implicit drinking identity continues to have promise as a predictor of drinking outcomes and as a target for interventions. Future experimental and prospective studies will be critical to establish the circumstances under which implicit drinking identity is strengthened and/or activated and the resulting effects on hazardous drinking. Keywords: Implicit cognition; Implicit drinking identity; Drinking identity; Alcohol consumption; Alcohol craving 2. Social Cognition Deficits and Associations with Drinking History in Alcoholic Men and Women Mary M. Valmas, Susan Mosher Ruiz, David A. Gansler, Kayle S. Sawyer, Marlene Oscar-Berman Alcoholism: Clinical and Experimental Research 2014:38(12);2998-3007 Abstract Background Previous studies have demonstrated the presence of a social cognition factor as an element of general cognition in healthy control and clinical populations. Recently developed measures of social cognition include the social perception and faces subtests of the Wechsler Advanced Clinical Solutions (ACS) Social Cognition module. While these measures have been validated on various clinical samples, they have not been studied in alcoholics. Alcoholism has been associated with emotional abnormalities and diminished social cognitive functioning as well as neuropathology of brain areas underlying social processing abilities. We used the ACS Social Perception and Faces subtests to assess alcoholism-related impairments in social cognition. Methods Social cognitive functioning was assessed in 77 abstinent alcoholic individuals (37 11 women) and 59 nonalcoholic control participants (29 women), using measures of the ACS Social Cognition module and subtests of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) that contain a social cognition component (Picture Completion and Comprehension). Group and gender differences in ACS and WAIS-IV performance were assessed, as well as relationships between measures of alcoholism severity and social cognitive functioning. Results Alcoholics performed significantly worse than nonalcoholics on the ACS measures of Affect Naming and Faces Content. Alcoholic men were impaired relative to alcoholic women on Prosody Face Matching and Faces Content scores. Among alcoholics, longer durations of heavy drinking were associated with poorer performance on Affect Naming, and a greater number of daily drinks were associated with lower Prosody Face Matching performance. For alcoholic women, a longer duration of abstinence was associated with better performance on Affect Naming. Conclusions Alcoholic men and women showed different patterns of associations between alcoholism indices and clinically validated social cognition assessments. These findings extend into the social cognition domain, previous literature demonstrating the presence of cognitive deficits in alcoholism, their association with alcoholism severity, and variability by gender. Moreover, because impairments in social cognition can persist despite extended abstinence, they have important implications for relapse prevention. Keywords: Social Cognition; Emotion; Alcoholism; Gender; Advanced Clinical Solutions 3. Worsening of Health and a Cessation or Reduction in Alcohol Consumption to Special Occasion Drinking Across Three Decades of the Life Course Linda Ng Fat, Noriko Cable, Nicola Shelton Alcoholism: Clinical and Experimental Research 2015:39(1);166-174 Abstract Background Ex-drinkers suffer from worse health than drinkers; however, whether a worsening of health is associated with a change in drinking status from early adulthood has not been previously investigated. We assess whether a worsening of health is associated with a cessation in consumption or reduction to special occasion drinking from early adulthood to middle age. Methods Multinomial logistic regression assessing whether a change in self-reported limiting longstanding illness (LLI) was associated with ceasing alcohol consumption, or a reduction to special occasion drinking compared with being a persistent drinker from age 23 in separate models at ages 33, 42, and 50. All models adjusted for sex, poor psychosocial health, education, marital status, and children in the household. Sample included participants from Great Britain followed longitudinally in the National Child Development Study from ages 23 to 33 (N = 5,529), 42 (N = 4,787), and 50 (N = 4,476). Results Developing an LLI from the previous wave was associated with ceasing alcohol consumption at ages 33 (odds ratio [ORs] = 2.71, 95% confidence interval [CI] = 1.16–4.93), 42 (OR = 2.44, 95%CI = 1.24–4.81), and 50 (OR = 3.33, 95%CI = 1.56–7.12) and a reduction to special occasion drinking at ages 42 (OR = 2.04, 95%CI = 1.40–2.99) and 50 (OR = 2.04, 95%CI = 1.18–3.53). Having a persistent LLI across 2 waves increased the odds of ceasing consumption at ages 42 (OR = 3.22, 95%CI = 1.06–9.77) and 50 (OR = 4.03, 95%CI = 1.72–9.44) and reducing consumption to special occasion drinking at ages 33 (OR = 3.27, 95%CI = 1.34–8.01) and 42 (OR = 2.25, 95%CI = 1.23–4.50). Persistent drinkers at older ages had the best overall health suffering less from previous poor health compared with those who reduced or ceased consumption at an earlier time point. Conclusions Developing an LLI was associated with a cessation in alcohol consumption and a reduction in consumption to special occasion drinking from early adulthood. Persistent drinkers who drank at least till 50 were the healthiest overall. Health selection is likely to influence nondrinking across the life course. Keywords: Alcohol; Life Course; Limiting Longstanding Illness; Nondrinking 12 4. Assessing and Treating Alcohol Relapse Risk in Liver Transplantation Candidates G. Dom, M. Wojnar, C.L. Crunelle, N. Thon, J. Bobes, U.W. Preuss, G. Addolorato, H.K. Seitz, F.M. Wurst Alcohol and Alcoholism 2015:50(2);164-172 Abstract In Europe between 30 and 50% of all liver transplantations (LTX) are done within the context of chronic end-stage alcoholic liver disease (ALD). However, post-operatively 20–25% of these patients lapse or relapse into heavy alcohol use. Thus, assessment of alcohol relapse risk before enlisting and therapeutic follow-up during and after LTX is of utmost importance. However, as yet there are enormous differences between European countries and between transplant centers, with regard to the assessment methods and criteria and the implementation of therapeutic follow-up. Only the so-called ‘6-month abstinence’ rule is widely used. However, there are not much scientific data validating its use in predicting relapse. Thus, there is a clear need of a more homogeneous approach, which was the focus of a symposium of the European Federation of Addiction Societies during the 14th conference of the European Society for Biomedical Research on Alcoholism, 2013 (ESBRA), entitled ‘Liver transplantation: A European perspective’. In a follow-up on this symposium, the authors aim to sum up the evidence of psychiatric assessment criteria and psychiatric treatment interventions relevant in the context of patient selection and patient follow-up within ALD transplantation procedures. Based upon these findings, we propose elements of a procedure that can serve as a first step toward a model of good practice regarding addictionspecialist input within the pre- and post-transplantation period. 5. Multiple Mechanisms Influencing the Relationship Between Alcohol Consumption and Peer Alcohol Use Alexis C. Edwards, Hermine H. Maes, Carol A. Prescott, Kenneth S. Kendler Alcoholism: Clinical and Experimental Research 2015:39(2);324-332 Abstract Background Alcohol consumption is typically correlated with the alcohol use behaviors of one's peers. Previous research has suggested that this positive relationship could be due to social selection, social influence, or a combination of both processes. However, few studies have considered the role of shared genetic and environmental influences in conjunction with causal processes. Methods This study uses data from a sample of male twins (N = 1,790) who provided retrospective reports of their own alcohol consumption and their peers' alcohol-related behaviors, from adolescence into young adulthood (ages 12 to 25). Structural equation modeling was employed to compare 3 plausible models of genetic and environmental influences on the relationship between phenotypes over time. Results Model fitting indicated that one's own alcohol consumption and the alcohol use of one's peers are related through both genetic and shared environmental factors and through unique environmental causal influences. The relative magnitude of these factors, and their contribution to covariation, changed over time, with genetic factors becoming more meaningful later in development. Conclusions Peers' alcohol use behaviors and one's own alcohol consumption are related through a complex combination of genetic and environmental factors that act via correlated factors and the complementary causal mechanisms of social selection and influence. Understanding these processes can inform risk assessment as well as improve our ability to model the development of alcohol use. Keywords: Alcohol Use; Social Influence; Social Selection; Twin Modeling 13 ALCOHOL POLICY 6. Underage Access to Online Alcohol Marketing Content: A YouTube Case Study Adam E. Barry, Emily Johnson, Alexander Rabre, Gabrielle Darville, Kristin M. Donovan, Orisatalabi Efunbumi Alcohol and Alcoholism 2015:50(1);89-94 Abstract Aims With the proliferation of the Internet and online social media use, alcohol advertisers are now marketing their products through social media sites such as YouTube, Facebook and Twitter. As a result, new recommendations have been made by the Federal Trade Commission concerning the self-regulation of digital marketing strategies, including content management on social and digital media sites. The current study sought to determine whether alcohol companies were implementing the self-imposed mandates that they have developed for online marketing. Specifically, we examined whether alcohol companies were implementing effective strategies that would prevent persons under the minimum legal drinking age in the USA from accessing their content on YouTube. Methods We assessed 16 alcohol brands (beer and liquor) associated with the highest prevalence of past 30 day underage alcohol consumption in the USA. Fictitious YouTube user profiles were created and assigned the ages of 14, 17 and 19. These profiles then attempted to access and view the brewer-sponsored YouTube channels for each of the 16 selected brands. Results Every underage profile, regardless of age, was able to successfully subscribe to each of the 16 (100%) official YouTube channels. On average, two-thirds of the brands' channels were successfully viewed (66.67%). Conclusion Alcohol industry provided online marketing content is predominantly accessible to underage adolescents. Thus, brewers are not following some of the self-developed and self-imposed mandates for online advertising by failing to implement effective age-restriction measures (i.e. age gates). 7. Alcohol Consumption and Fatal Injuries in Australia Before and After Major Traffic Safety Initiatives: A Time Series Analysis Heng Jiang, Michael Livingston, Robin Room Alcoholism: Clinical and Experimental Research 2015:39(1);175-183 Abstract Background The associations between population-level alcohol consumption and fatal injuries have been examined in a number of previous studies, but few have considered the external impacts of major policy interventions. This study aims to quantify the associations between per capita alcohol consumption and traffic and nontraffic injury mortality rates in Australia before and after major traffic safety initiatives (the introduction of compulsory seat belt legislation [CSBL] and random breath testing [RBT] in 1970s). Methods Using data from 1924 to 2006, gender- and agespecific traffic and nontraffic mortality rates (15 years and above) were analyzed in relation to per capita alcohol consumption using time series analysis. The external effects of policy interventions were measured by inserting a dummy variable in the time series models. Results Statistically significant associations between per capita alcohol consumption and both types of fatal injuries were found for both males and females. The results suggest that an increase in per capita alcohol consumption of 1 l was accompanied by an increase in traffic mortality of 3.4 among males and 0.5 among females per 100,000 inhabitants and an increase in nontraffic mortality of 3.0 among males and 0.9 among females. The associations between alcohol consumption and fatal injury rates varied across age groups. The introduction of CSBL and RBT was associated with significant reductions in traffic crash mortality in Australia, particularly for males and young people. 14 Conclusions The magnitude and distribution of the preventive effects from the reduction in population drinking on fatal injuries vary across different gender and age groups, with the strongest preventive impacts on fatal injuries among people aged 15 to 29 and 70 years and above. The mechanisms behind these effects are unclear from this study, but are likely to be due to the strong association between per capita consumption and heavy drinking. Keywords: Alcohol Consumption; Traffic Injury; Nontraffic Injury; Time Series Analysis; Intervention Event ALCOHOL TREATMENT 8. Mixed Methods Study of Help Seekers and Self-Changers Responding to an Online Recovery Survey Jane Witbrodt, Thomasina J. Borkman, Aina Stunz, Meenakshi Sabina Subbaraman Alcohol and Alcoholism 2015:50(1);82-88 Abstract Aims To compare self-changers (natural recovery) with help seekers on demographics, prerecovery problem severity, and recovery beliefs and behaviors; and to augment these quantitative findings with information extracted from the qualitative stories of a subset of self-changers to explore themes in recovery paths as informed by a nascent natural recovery literature. Methods Quantitative secondary analyses were conducted with persons who had responded to a US nationwide online survey called ‘What Is Recovery’ (WIR) and who reported a prior lifetime alcohol problem (n = 5495). Six men and six women (with longer-term recoveries) interviewed later were asked to tell their ‘recovery story from the beginning up to now’. These were coded using a narrative approach. Results Compared with help seekers, self-changers were younger and never married: they did not differ on problem severity, gender, ethnicity or education. Self-changers identified with ‘used to have a problem’ more than in recovery/recovered, reported fewer years in that status, and reported more current, non-problematic substance use. A new concept of shadow help and shadow obstacles to help-seeking emerged from the qualitative analysis. Though selfchangers believed that they had overcome their alcohol problem on their own, change actually occurred within a social context that allowed access to information, normative expectations, relationships, and other opportunities that provided important resources for change. Conclusion Findings imply that the concept of help-seeking needs to be re-conceptualized to include the informal help we found in this study. 9. Delay to first treatment contact for alcohol use disorder Cath Chapman, Tim Slade, Caroline Hunt, Maree Teesson Drug and Alcohol Dependence 2015:147;116-121 Abstract Background This study explored the patterns and correlates of time to first treatment contact among people with alcohol use disorder (AUD) in Australia. Specifically it examined the relationship between sex, birth cohort, onset of AUD symptoms, severity, comorbidity, symptom type and time to first treatment contact (treatment delay) among those with alcohol abuse and dependence in a large population sample. Methods Data came from the 2007 Australian National Survey of Mental Health and Wellbeing (N = 8841). A modified version of the World Health Organization's Composite International Diagnostic Interview was used to determine the presence and age of onset of DSM-IV AUD and other mental disorders and the age at which respondents first sought treatment for alcohol or other drug-related problems. 15 Results Median time to first treatment contact for an AUD was 18 years (14 years dependence, 23 years abuse). Projected lifetime treatment rates were 78.1% for alcohol dependence and 27.5% for abuse. Those with earlier onset and from older cohorts reported longer delay and were less likely to ever seek treatment compared to those with later onset or from more recent cohorts. Those with comorbid anxiety but not mood disorder, or who reported alcohol-related role disruption or recurrent interpersonal problems were more likely to ever seek treatment and reported shorter delay compared to those who did not report these symptoms. Conclusions Treatment delay for alcohol use disorder in Australia is substantial. Those with earlier onset and those with comorbid mood disorder should be a target for earlier treatment. Keywords: Alcohol abuse; Alcohol dependence; Treatment delay; Service utilization 10. The impact of a stage tailored intervention on alcohol use trajectories among those who do not intend to change Sophie Baumann , Beate Gaertner, Inga Schnuerer, Katja Haberecht, Ulrich John, Jennis FreyerAdam Drug and Alcohol Dependence 2015:147;167-174 Abstract Background Persons not intending to change are an important target population for public health efforts. The aim of this study was to investigate whether subgroups characterized by different trajectories of alcohol use frequency and quantity among persons with unhealthy drinking but no intention to change benefitted differently from a stage tailored intervention. Methods This study was part of a randomized controlled trial among job-seekers. The participants of the intervention group (n = 413) received feedback letters tailored to their motivational stage. The control group (n = 414) received minimal assessment only. Among all participants, 629 (76.1%) did not intend to change alcohol use and constitute the study sample (60.7% men; mean age = 29.7 years, SD = 10.8). 3-, 6-, and 15-month follow-ups were conducted. Growth mixture modeling was applied to identify classes representing the heterogeneity in the development of alcohol use frequency and quantity and the influence of the intervention on different trajectories. Results Four classes were identified: a class of persons who achieved abstinence (2%), a class with low-frequent drinking with declining quantity (35%), a class with high-frequent drinking with low but slightly increasing quantity (30%), and a class with constant heavy episodic drinking (33%). Although non-significant, there was a tendency of different intervention effects for different classes. Conclusions A sample of persons not intending to change unhealthy alcohol use was composed of subgroups characterized by different trajectories of alcohol use quantity and frequency. Trends towards beneficial intervention effects on motivation and drinking outcomes were not significant, possibly due to low power. Author Keywords: ClinicalTrials.gov: NCT01311245 Keywords: Growth mixture modeling; Stage tailored intervention; Alcohol use; Trajectory classes; Precontemplation 11. A Pilot Study on the Feasibility and Acceptability of a Text Message-Based Aftercare Treatment Programme Among Alcohol Outpatients Severin Haug, Michael J. Lucht, Ulrich John, Christian Meyer, Michael P. Schaub Alcohol and Alcoholism 2015:50(2);188-194 Abstract Aims To test the feasibility, acceptability and initial effectiveness of a text message-based aftercare treatment programme among alcohol outpatients. Methods Clients treated for alcohol use disorders from three Swiss outpatient alcohol treatment centres were invited by their counsellors to 16 participate in a study testing an interactive aftercare programme employing the use of text messages and personal phone calls. Fifty study participants were randomly assigned to either the 6-month aftercare programme (n = 25) or treatment as usual (n = 25). The intervention consisted of (a) monitoring of self-selected drinking goals at regular intervals, (b) motivational text messages to stick to self-selected drinking goals and (c) proactive telephone calls from counsellors when participants neglected to stick to their drinking goals or expressed a need for support. Follow-up interviews were conducted 6 months after randomization. Results Throughout the programme, participants received a total of 421 text message prompts. Out of these, participants provided valid replies to 371 (88.1%) within 48 h. Out of the 25 participants in the intervention group, 11 (44.0%) sent at least one call-for-help reply. Based on complete case data, at risk alcohol use at follow-up was 41.7% in the control group and 28.6% in the intervention group (OR = 0.56, 95% CI = 0.16– 1.95, P = 0.36). Conclusions The interactive low-intensive aftercare programme was well accepted by the participants. Testing its efficacy within an adequately powered randomized controlled trial might be reasonable. 12. Accuracy of Alcohol Use Disorders Identification Test for Detecting Problem Drinking in 18–35 Year-Olds in England: Method Comparison Study David R. Foxcroft, Lesley A. Smith, Hayley Thomas, Sarah Howcutt Alcohol and Alcoholism Volume 50, Issue 2 Pp. 244 – 250 Abstract Aims To assess the accuracy of Alcohol Use Disorders Identification Test (AUDIT) scores for problem drinking in males and females aged 18–35 in England. Methods A method comparison study with 420 primary care patients aged 18–35. Test measures were AUDIT and AUDIT-C. Reference standard measures were (a) Time-Line Follow-Back interview for hazardous drinking; World Mental Health Composite International Diagnostic Interview for (b) DSM-IV alcohol abuse, (c) DSM-IV alcohol dependence, (d) DSM-5 alcohol use disorders. Results Area under the curve (AUC) was (a) 0.79 (95% CI 0.73–0.85; males) and 0.84 (0.79–0.88; females); (b) 0.62 (0.54–0.72; males) and 0.65 (0.57–0.72; females); (c) 0.77 (0.65–0.87; males) and 0.76 (0.67–0.74; females); (d) 0.70 (0.60–0.78; males) and 0.73 (CI 0.67–0.78; females). Identification of threshold cut-point scores from the AUC was not straightforward. Youden J statistic optimal cut-point scores varied by 4–6 AUDIT scale points for each outcome according to whether sensitivity or specificity were prioritized. Using Bayes' Theorem, the post-test probability of drinking problems changed as AUDIT score increased, according to the slope of the probability curve. Conclusion The full AUDIT scale showed good or very good accuracy for all outcome measures for males and females, except for alcohol abuse which had sufficient accuracy. In a screening scenario where sensitivity might be prioritized, the optimal cut-point is lower than established AUDIT cut-points of 8+ for men and 6+ for women. Bayes' Theorem to calculate individual probabilities for problem drinking offers an alternative to arbitrary cut-point threshold scores in screening and brief intervention programmes. 17 ALCOHOL AND YOUNG PEOPLE 13. Alcohol and energy drink use among adolescents seeking emergency department care Erin E. Bonar , Rebecca M. Cunningham, Svitlana Polshkova, Stephen T. Chermack, Frederic C. Blow, Maureen A. Walton Addictive Behaviors 2015:43;11-17 Abstract Emergency department (ED) visits due to energy drinks rose drastically from 2007 to 2011. Consuming alcohol mixed with energy drinks by young people is particularly concerning. Among youth (aged 14–20 years) in the ED reporting past-year alcohol use, we assessed frequency, reasons, and medical consequences of consuming alcohol and energy drinks in the same beverage or on the same occasion, and relationships with other risk behaviors. The sample included 439 youth (Mage = 18.6 years, SD = 1.4; 41% male; 73% Caucasian): those who drank alcohol, but not energy drinks (Non-Users; 41%, n = 178), those who drank alcohol and energy drinks on separate occasions (Separate; 23%, n = 103), and those who combined alcohol and energy drinks in the same beverage or on the same occasion (Combined; 36%, n = 158). Common reasons for combining energy drinks and alcohol were hiding the flavor of alcohol (39%) and liking the taste (36%). Common consequences were feeling jittery (71%) and trouble sleeping (46%). Combined users had the highest rates of risk behaviors (e.g., drug use, sexual risk behaviors, driving after drinking) and alcohol use severity. Multinomial logistic regression indicated that men, those who had sex after substance use, those who had used drugs, and those with higher alcohol severity were more likely to be Combined users than Non-Users. Those with higher alcohol severity were also more likely to be Combined users than Separate users. Combining energy drinks and alcohol is associated with higher rates of other risk behaviors among young drinkers. Future studies are needed to determine longitudinal relationships of energy drink use on substance use problem trajectories. Keywords: Energy drinks; Alcohol; Adolescents; Emergency department 14. Energy drink consumption and later alcohol use among early adolescents Elisa R. Miyake, Naomi R. Marmorstein Addictive Behaviors 2015:43;60-65 Abstract Introduction Little is known about the association between energy drink and other substance use in early adolescence despite the fact that the consumption of energy drinks during this developmental period is becoming increasingly common. The aim of this study was to examine concurrent and longitudinal associations between energy drink and alcohol use among middle school students. In addition, sensation seeking and parental monitoring were examined as factors that could potentially explain any associations found. Methods A sample of 144 youth participating in the Camden Youth Development Study was utilized. Self-report questionnaire data was collected over a 16month period. Results Frequency of energy drink use at the initial assessment predicted increases in frequency of alcohol use 16 months later (adjusting for initial frequency of alcohol use). Levels of parental monitoring partially accounted for this association; in contrast, there was no evidence that sensation seeking was related to this association. Conclusion Youth who consume energy drinks in early adolescence are at risk for alcohol use later; this may be partially related to low levels of parental monitoring being associated with the consumption of both substances. Future research is needed to further explain this association; this may lead to opportunities for early intervention for youth at high risk for alcohol use. 18 Keywords: Caffeine; Energy drinks; Alcohol; Early adolescence; Parental monitoring; Sensation seeking 15. Increased Forebrain Activations in Youths with Family Histories of Alcohol and Other Substance Use Disorders Performing a Go/NoGo Task Ashley Acheson, Malle A. Tagamets, Laura M. Rowland, Charles W. Mathias, Susan N. Wright, L. Elliot Hong, Peter Kochunov, Donald M. Dougherty Alcoholism: Clinical and Experimental Researchn 2014:38(12);2944-2951 Abstract Background Youths with a family history of alcohol and other drug use disorders (FH+) are at a greater risk of developing substance use disorders than their peers with no such family histories (FH−), and this increased risk may be related to impaired maturation of forebrain circuitry. FH+ individuals have shown altered forebrain activity at rest and while performing cognitive tasks. However, it is not fully understood how forebrain activity is altered in FH+ individuals, and ultimately how these alterations may contribute to substance use disorder risk. Methods In this study, we tested 72 FH+ and 32 FH− youths performing a go/no-go task and examined activations in blocks with only go trials (Go Only), blocks with 50% go and 50% no-go trials (Go/NoGo), and a contrast of those 2 blocks. Results FH+ youths had significantly greater cerebral activations in both the Go and Go/NoGo blocks than FH− youths in regions including the posterior cingulate/precuneus, bilateral middle/superior temporal gyrus, and medial superior frontal gyrus with no significant group differences in the subtraction between Go Only and Go/NoGo blocks. Additionally, FH+ youths had moderately slower reaction times on go trials in the Go Only blocks. Conclusions Our findings suggest that global activation increase in FH+ youths are modulated by FH density and are not specific to the inhibitory components of the task. This pattern of increased activations in FH+ youths may be at least partially due to impaired forebrain white matter development leading to greater activations/less efficient neural communication during task performance. Keywords: Functional Magnetic Resonance Imaging; Family History; Risk; Go/No-Go; Substance Use 19 BLOOD BORNE VIRSUS 16. Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs Bruce R. Schackman, Jared A. Leff, Devra M. Barter, Madeline A. DiLorenzo, Daniel J. Feaster, Lisa R. Metsch, Kenneth A. Freedberg, Benjamin P. Linas Addiction 2015: 110(1);129-143 Abstract Aims To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. Design We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody-positive and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV [Hepatitis C Cost-Effectiveness (HEP-CE)] and HIV [Cost-Effectiveness of Preventing AIDS Complications (CEPAC)]. Setting and participants Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the United States. Measurements Lifetime costs (2011 US$) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs). Findings On-site rapid HCV testing had an ICER of $18 300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64 500/QALY compared with on-site rapid HCV testing alone. In one- and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100 000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100 000/QALY in 91% of probabilistic sensitivity analyses. Conclusions On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100 000/quality-adjusted life year threshold. Keywords: Computer simulation model; cost-effectiveness; economic evaluation; hepatitis C testing; rapid HIV testing; substance abuse treatment 17. Perceived Medical Risks of Drinking, Alcohol Consumption, and Hepatitis C Status Among Heavily Drinking HIV Primary Care Patients Jennifer C. Elliott, Efrat Aharonovich, Ann O'Leary, Barbara Johnston, Deborah S. Hasin Alcoholism: Clinical and Experimental Research 2014:38(12);3052-3059 Abstract Background Heavy drinking poses significant risks to the health and survival of individuals infected with HIV, particularly those coinfected with hepatitis C virus (HCV). However, little is known about patients’ perceptions of these risks, and whether these perceptions relate to their alcohol consumption. Methods A sample of 254 heavily drinking HIV primary care patients (78% male; 94.5% minority; 31.8% with HCV) reported on their perceptions of the medical risks of drinking and on their alcohol consumption prior to participation in a drinking-reduction intervention trial. Results In the HIV-infected sample as a whole, 62.9% reported that they had a medical problem made worse by drinking, and 64.3% reported restricting drinking to avoid future medical problems. Although patients coinfected with HIV/HCV reported greater efforts to restrict drinking to avoid 20 future medical problems (adjusted odds ratio = 1.94), their reported drinking quantity and frequency did not differ from that of HIV mono-infected patients. Awareness of medical risk was not associated with drinking level. Effort to restrict drinking to avoid medical risk was associated with lower drinking quantity, frequency, and binge frequency (ps < 0.05), but the association with binge frequency was specific to patients without HCV. Conclusions Over one-third of HIV patients are unaware of the medical risks of drinking, and do not restrict use, suggesting the need for intervention in this group. Patients coinfected with HIV/HCV may report more effort to restrict drinking, but their reported drinking quantity and frequency suggest that they are actually drinking just as heavily as HIV mono-infected patients. Awareness of medical risk was unrelated to drinking, which suggests the need for interventions consisting of more than simple education. However, reported effort to restrict drinking did predict less drinking, suggesting the importance of patient commitment and initiative in change. Keywords: HIV; Alcohol; Drinking; Risk; Hepatitis C 18. Trends in use of health care and HIV prevention services for persons who inject drugs in San Francisco: Results from National HIV Behavioral Surveillance 2005–2012 Phillip O. Coffin, Harry Jin, Emalie Huriaux, Ali Mirzazadeh, Henry F. Raymond, Drug and Alcohol Dependence 2015:146;45-51 Abstract Background Multiple developments addressing health of people who inject drugs (PWIDs) in San Francisco were initiated from 2003 to 2012, including expanded health care coverage, syringe access, HIV testing and universal HIV treatment. Methods We evaluated 3 PWID cycles of the National HIV Behavioral Surveillance for several healthcare measures related to the expanded services. Using RDSAT estimators, we applied the Cochran–Armitage test for trend to evaluate signals of improvement during the time in which health system changes were made. Results Participant demographics were similar (n = 565, 535, and 570 in 2005, 2009, and 2012, respectively). There was a substantial increase in healthcare coverage (37.6 to 82.5%, P < 0.0001). Obtaining syringes from pharmacies (17.8 to 32.1%, P < 0.0001) increased substantially. Past year hepatitis C testing increased (16.5 to 33.1%, P < 0.0001) with stable self-reported prevalence (45.7– 54.2%, P = 0.8). Among those with known HIV, antiretroviral treatment was reported among 46.6% in 2005 and 66.3% in 2012. Past year HIV testing declined from 74.2 to 42.1%, (P < 0.0001) and the prevalence of unrecognized HIV among PWIDs was 42.2–42.7% in 2009 and 2012. Conclusions There is evidence of improvement in some health measures for PWIDs in San Francisco from 2005 to 2012. However, there are also some concerning findings, such as declining prevalence of HIV testing and high prevalence of undiagnosed HIV. There is a need for renewed attention and innovative ideas to track and address HIV and other medical sequelae among PWIDs. Keywords: People who inject drugs; San Francisco; Care; HIV; Hepatitis 19. Association between hepatitis C virus and opioid use while in buprenorphine treatment: preliminary findings Sean M. Murphy, Dana Dweik, Sterling McPherson, John M. Roll The American Journal of Drug and Alcohol Abuse 2015:41(1);88–92 Abstract Background The prevalence of hepatitis-C-virus (HCV) infections is high among opioiddependent individuals. Prior research on the simultaneous treatment of both conditions has primarily assessed success as it pertains to HCV. However, it has been noted that favorable substance use therapy outcomes may improve the likelihood of HCV-treatment initiation and success. Therefore, current guidelines for the treatment of HCV among illicit drug users suggest 21 that treatment for addiction be given the highest priority. Objectives To determine whether opioiddependent participants in a clinical trial of buprenorphine-treatment tapering regimens, who tested positive for the HCV antibody, experienced significantly different levels of opioid abstinence than those not infected. Methods Data came from the National Drug Abuse Treatment Clinical Trial Network study 0003. 516 eligible opioid-dependent participants were randomized to either a 7-day or 28-day buprenorphine tapering schedule following a 4-week buprenorphine stabilization period. Generalized estimating equations were used to test the research question. Results: Participants with the HCV antibody were significantly less likely to submit opioid-negative urine analyses during and/or immediately following active treatment [OR = 0.69; CI = 0.51–0.93], indicating a higher rate of opioid use among this group. Conclusion Individualized opioid-dependence treatment strategies may be required for opioid-dependent individuals who test positive for the HCV antibody in order to ensure resources for both opioid-dependence and HCV therapies are used efficiently. Keywords: Buprenorphine; hepatitis C; Opioid dependence 22 CO-MORBIDITY 20. Familial factors associated with development of alcohol and mental health comorbidity Caroline L. Salom, Gail M. Williams, Jake M. Najman, Rosa Alati Addiction 2015:110(2);248-257 Abstract Background and Aims Co-occurring mental health and alcohol problems appear to be associated with greater health burdens than either single disorder. This study compares familial and individual contributions to development of comorbid alcohol/mental problems and tests whether these differ from single disorders. Design Women (n = 6703) were recruited during pregnancy to the longitudinal Mater-University of Queensland Study of Pregnancy (MUSP). Mother/offspring dyads were followed over 21 years. Setting Mater-Misericordiae Public Hospital, Brisbane, Australia. Participants Primary offspring from the MUSP with full psychiatric information at 21 years and maternal information at age 14 (n = 1755). Measurements Structured interviews at age 21 yielded a four-category outcome using mental health and alcohol modules of the Composite International Diagnostic Interview (no disorder, alcohol only, mental health only and comorbid alcohol/mental health). Multinomial logistic regression models were adjusted for gender, maternal mental health and substance use, family environment and adolescent behaviour. Findings Maternal smoking [odds ratio (OR) = 1.56; 95% confidence interval (CI) = 1.09–2.22 versus no-disorder] and low mother–offspring warmth (OR = 3.19; 95% CI = 1.99–5.13) were associated with mental health/alcohol comorbidity in young adults, as were adolescent drinking (OR = 2.22; 95% CI = 1.25–3.96), smoking (OR = 2.24; 95% CI = 1.33–3.77) and attention/thought problems (OR = 2.04; 95% CI = 1.18–3.52). Some differences were seen from single disorders. In a subsample with paternal data, fathers' drinking problems (OR = 2.41; 95% CI = 1.10–5.29) were more associated strongly with offspring mental health/alcohol comorbidity than both single disorders (P < 0.05). Conclusions Maternal smoking and low mother–child warmth appear to be related to alcohol, mental health and comorbid disorders at age 21, possibly via constituent alcohol and mental health disorders. Adolescent drinking and attention/thought problems appear to be associated with comorbid disorders but not with individual alcohol and mental health disorders. Keywords: Adolescent behaviour; alcohol problems; comorbid; family factors; longitudinal; maternal drinking; mental health problems; parent closeness; paternal drinking 21. Psychophysiology of pain and opioid use: Implications for managing pain in patients with an opioid use disorder Amy Wachholtz, Simmie Foster, Martin Cheatle Drug and Alcohol Dependence 2015:146;1-6 Abstract Background Opioid therapy is one component of an effective pain management regimen for patients with chronic pain and the majority of these patients use their medications responsibly. However, there are a growing number of these patients who develop an opioid use disorder and in some cases require opioid replacement therapy. Managing these patients is complex and the underlying mechanisms of pain and addiction are not well understood. Developing an effective interdisciplinary treatment program for the individual with pain and an opioid use disorder will depend on enhancing our knowledge of the psychophysiology of pain and addiction. Method Authors gathered key empirical and theoretical papers examining the psychophysiology of comorbid pain and opioid misuse disorders. 23 Results This article reviews the current theory of the effect of pain on patients with pain and concomitant addiction, the psychophysiology of pain, opioid use and addiction, and future research in this area. Conclusions Individuals with a history of opioid misuse have greater levels of hyperalgesia which may be due to alterations in psychophysiological pathways. More research is needed into the psychophysiological biomarkers among individuals with comorbid pain and addiction in order to develop better treatment approaches and improve outcomes among this difficult to treat population. Keywords: Pain; Opioids; Addiction; Psychophysiology 22. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness Maritt Kirst, Suzanne Zerger, Vachan Misir, Stephen Hwang, Vicky Stergiopoulos Drug and Alcohol Dependence 2015:146;24-29 Abstract Background There is strong evidence that Housing First interventions are effective in improving housing stability and quality of life among homeless people with mental illness and addictions. However, there is very little evidence on the effectiveness of Housing First in improving substance use-related outcomes in this population. This study uses a randomized control design to examine the effects of scatter-site Housing First on substance use outcomes in a large urban centre. Methods Substance use outcomes were compared between a Housing First intervention and treatment as usual group in a sample of 575 individuals experiencing homelessness and mental illness, with or without a co-occurring substance use problem, in the At Home/Chez Soi trial in Toronto, Canada. Generalized linear models were used to compare study arms with respect to change in substance use outcomes over time (baseline, 6, 12, 18 and 24 month). Results At 24 months, participants in the Housing First intervention had significantly greater reductions in number of days experiencing alcohol problems and amount of money spent on alcohol than participants in the Treatment as Usual group. No differences between the study arms in illicit drug outcomes were found at 24 months. Conclusions These findings show that a Housing First intervention can contribute to reductions in alcohol problems over time. However, the lack of effect of the intervention on illicit drug problems suggests that individuals experiencing homelessness, mental illness and drug problems may need additional supports to reduce use. Trial Registration: Current controlled trials ISRCTN42520374. Keywords: Homelessness; Substance use; Mental illness; Housing First 23. Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and causespecific mortality Karolina M. Bogdanowicz, Robert Stewart, Matthew Broadbent, Stephani L. Hatch, Matthew Hotopf, John Strang, Richard D Hayes Drug and Alcohol Dependence 2015:148;85-92 Abstract Background Opioid misusers have recognized high mortality but the influence of psychiatric comorbidity in excess cause-specific mortality is unclear. Methods Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Standard mortality ratios were calculated to compare mortality risk with the general population. Cox and competing risk regression models were used to investigate the effect of psychiatric comorbidity and psychological health on all-cause and cause-specific mortality (respectively) in OUD patients. 24 Results Of 4837 OUD patients, 176 had died. Mortality rates were substantially higher than the general population (SMR 4.23; 95%CI 3.63–4.90). Among those with OUD, comorbid personality disorder (PD) and comorbid alcohol use disorder (AUD) was associated with increased all-cause mortality in all models, including the fully adjusted model, controlling for socio-demographic factors, severity of drug use, risk behaviours and physical health (HR2.15, 95%CI 1.17–3.95; HR2.28, 95%CI 1.54–3.36). AUD was associated with increased risk of fatal overdose (HR2.57, 95%CI 1.26–5.26) and hepatic-related deaths (HR7.26, 95%CI 2.79–18.86). Individuals with OUD and comorbid PD had almost four times greater risk of liver related deaths compared to those without PD (HR3.76, 95%CI 1.21–11.74). Comorbid severe mental illness and poor psychological health were not associated with increased mortality. Conclusions This study highlights the importance of assessment for PD and AUD in OUD patients in order to identify individuals at substantially elevated mortality risk to enable a more personalized approach to their medical care. Keywords: Opioids; Mortality; Psychiatric co-morbidity; Personality disorder; Serious mental illness; Alcohol use disorder 24. Trends in dual diagnosis of severe mental illness and substance use disorders, 1996–2010, Israel Alexander M. Ponizovsky, Paola Rosca, Ziona Haklai, Nehama Goldberger Drug and Alcohol Dependence 2015:148;203-208 Abstract Objectives (1) To examine the trends in the incidence of dual diagnosis (DD) of severe mental illness and substance-related disorders among inpatients in Israel, and (2) the demographic and clinical correlates of DD patients. Method Using data from the National Psychiatric Case Register, we identified 56,774 inpatients aged 15–64 whose first psychiatric hospitalization occurred between 1996 and 2010. We compared the characteristics of inpatients having DD with drugs, alcohol or drug/alcohol abuse with those with mental disorder only. Results Over the period, DD with drugs decreased from 8.2% in 1996 to 6% in 2010; DD with alcohol increased from 3% to 4% and DD with drugs/alcohol from 2% to 4%. DD with drugs was highest, whereas DD with alcohol was lowest for the youngest age- group in 1996 but increased to the same as other age-groups in 2006–2010. Male gender, a previous suicide attempt, compulsory hospitalizations and marital status were positive predictors for all DD. Immigrant status was a positive predictor of DD with alcohol, but the opposite for DD with drugs; being Jewish and psychotic diagnosis was a positive predictor of DD with drugs, but negative for DD with alcohol. Conclusions Over the study period, DD with drugs has decreased among young patients, although it is still higher than among older groups. However, DD with alcohol or drugs/alcohol has increased in the younger group. The clinical-demographic profile of DD patients was similar to that from the relevant literature, except for immigrant status that was negatively associated with DD with drugs. Keywords: Dual diagnosis; Mental disorder; Substance related disorder; Temporal trends; Incidence; Israel 25 DRUG RELATED DEATHS 25. National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005–2009 Matthias Pierce, Sheila M. Bird, Matthew Hickman, Tim Millar Drug and Alcohol Dependence 2015:146;17-23 Abstract Background Globally, opioid drug use is an important cause of premature mortality. In many countries, opioid using populations are ageing. The current study investigates mortality in a large cohort of opioid users; with a focus on testing whether excess mortality changes with age. Methods 198,247 opioid users in England were identified from drug treatment and criminal justice sources (April, 2005 to March, 2009) and linked to mortality records. Mortality rates and standardised mortality ratios (SMRs) were calculated by age-group and gender. Results There were 3974 deaths from all causes (SMR 5.7, 95% Confidence Interval: 5.5 to 5.9). Drug-related poisonings (1715) accounted for 43% of deaths. Relative to gender-and-age-appropriate expectation, mortality was elevated for a range of major causes including: infectious, respiratory, circulatory, liver disease, suicide, and homicide. Drug-related poisoning mortality risk continued to increase beyond 45 years and there were age-related increases in SMRs for specific causes of death (infectious, cancer, liver cirrhosis, and homicide). A gender by age-group interaction revealed that whilst men have a greater drug-related poisoning mortality risk than women at younger ages, the difference narrows with increasing age. Conclusion Opioid users’ excess mortality persists into old age and for some causes is exacerbated. This study highlights the importance of managing the complex health needs of older opioid users. Keywords: Mortality; Opioid use; Addiction epidemiology; Drug related poisoning mortality; Ageing opioid users 26. Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role? Andreea Adelina Artenie, Julie Bruneau, Geng Zang, François Lespérance, Johanne Renaud, Joël Tremblay, Didier Jutras-Aswad, Drug and Alcohol Dependence 2015:147;208-214 Abstract Background While the elevated risk of suicide attempt among persons who inject drugs (PWID) is well documented, whether use of different substances is associated with varying degrees of risk remains unclear. We sought to examine the associations between substance use patterns and attempted suicide in a prospective cohort of PWID in Montreal, Canada. Methods Between 2004 and 2011, participants completed an interviewer-administered questionnaire eliciting information on socio-demographics, substance use patterns, related behaviors, and mental health markers. Generalized estimating equations were used to model the relationship between self-reported use of six common substances (cocaine, amphetamine, opioids, sedative-hypnotics, cannabis and alcohol), associated patterns of use (chronic, occasional and none), and a recent (past six-month) suicide attempt. Results At baseline, of 1240 participants (median age: 39.1, 83.7% male), 71 (5.7%) reported a recent suicide attempt. Among 5621 observations collected during follow-up, 221 attempts were reported by 143 (11.5%) participants. In multivariate analyses adjusting for socio-demographics and psychosocial stressors, among primary drugs of abuse, chronic [adjusted odds ratio (AOR): 1.97] and occasional (AOR: 1.92) cocaine use, and chronic amphetamine use (AOR: 1.96) were independently associated with attempted suicide. 26 Among co-used substances, chronic sedative-hypnotic use was independently associated with an attempt (AOR: 2.29). No statistically significant association was found for the remaining substances. Conclusion Among PWID at high risk of attempted suicide, stimulant users appear to constitute a particularly vulnerable sub-group. While the mechanisms underlying these associations remain to be elucidated, findings suggest that stimulant-using PWID should constitute a prime focus of suicide prevention efforts. Keywords: Suicide; Injection; Drug use; Risk factor; Epidemiology; Stimulant 27. Drug-related deaths and the sales of needles through pharmacies Peter J. Davidson, Alexis Martinez, Alexandra Lutnick, Alex H. Kral, Ricky N. Bluthenthal Drug and Alcohol Dependence 2015:147;229-234 Abstract Background Providing needles to people who inject drugs is a well-proven public health response to the transmission of HIV and other blood borne viruses. Despite over a quarter of a century of research, new concerns about potential unintended negative consequences of needle distribution continue to emerge. Specifically, a claim was recently made that the introduction of pharmacy sales of needles was followed by an increase in overdoses in pharmacy parking lots. If true, this would have serious implications for the design of needle access programs, particularly those involving pharmacy sales of needles. Methods We examine spatial relationships between drug-related deaths and pharmacies in Los Angeles County (population 9.8 million) before and after the 2007 enactment of a California law allowing pharmacy sales of needles without a prescription. Seven thousand and forty-nine drugs related deaths occurred in Los Angeles county from 2000 to 2009 inclusive. Four thousand two hundred and seventy-five of these deaths could be geocoded, and were found to be clustered at the census tract level. Results We used three methods to examine spatial relationships between overdose death locations and pharmacy locations for two years on either side of the enactment of the pharmacy sales law, and found no statistically significant changes. Among the 711 geocodable deaths occurring in the two years following the change in law, no death was found to occur within 50 m of a pharmacy which sold needles. Conclusion These results are consistent with prior studies which suggest pharmacy sales of needles improve access to needles without causing increased harms to the surrounding community. Keywords: Overdose; Pharmacy; Needle distribution; People who inject drugs; HIV 28. Take-home naloxone to prevent fatalities from opiate-overdose: Protocol for Scotland’s public health policy evaluation, and a new measure to assess impact Sheila M. Bird, Mahesh K. B. Parmar, John Strang Drugs: education, prevention, and policy 2015:22(1);66–76 Abstract Aims Scotland was the first country to adopt take-home naloxone (THN) as a funded public health policy. We summarise the background and rigorous set-up for before/after monitoring to assess the impact on high-risk opiate-fatalities. Methods Evidence-synthesis of prospectively monitored small-scale THN schemes led to a performance indicator for distribution of THN-kits relative to opiate-related deaths. Next, we explain the primary outcome and statistical power for Scotland’s before/after monitoring. Results Fatality-rate at opiate overdoses witnessed by THN-trainees was 6% (9/153, 95% CI: 2–11%). National THN-schemes should aim to issue 20 times as many THNkits as there are opiate-related deaths per annum; and at least nine times as many. Primary outcome for evaluating Scotland’s THN policy is reduction in the percentage of all opiate-related deaths with prison-release as a 4-week antecedent. Scotland’s baseline period is 2006–10, giving a denominator 27 of 1970 opiate-related deaths. A priori plausible effectiveness was 20–30% reduction, relative to baseline, in the proportion of opiate-related deaths that had prison-release as a 4-week antecedent. A secondary outcome was also defined. Conclusion If Scotland’s THN evaluation shifts the policy ground seismically, our new performance measure may prove useful on how many THN-kits nations should provide annually. Keywords: Effectiveness, overdose deaths, performance measure, prevention, public policy, Scotland, take-home naloxone 29. Substance use and risk of death in young offenders: A prospective data linkage study Stuart A. Kinner, Louisa Degenhardt, Carolyn Coffey, Stephen Hearps, Matthew Spittal, Susan M. Sawyer, George C. Patton Drug and Alcohol Review 2015:34(1);46-50 Abstract Introduction and Aims Young offenders are at increased risk of preventable death after release from custody, but risk factors for death in this population are poorly understood. Despite their poor health profiles, no studies have examined mortality outcomes in young people who have served community-based orders. The aims of this study were to describe the causes and identify risk factors for death in a cohort of young offenders in Victoria, Australia. Design and Methods We interviewed young people serving a custodial (n = 273) or communitybased order (n = 242) in Victoria, Australia in 2002–2003. Measures included demographics and family history, offence history, experience of victimisation, mental illness, self-harm and substance use. Deaths up to 31 December 2011 were identified through a probabilistic linkage with the National Death Index. Results The all-cause crude mortality rate was 4.2 (95% confidence interval 2.7–6.8) per 1000 person years and was not significantly different for those who had served custodial and community-based orders. Most deaths were due to drug overdose, traffic accidents or suicide. Adjusting for age, sex and order type, risk factors for death from the baseline interview included weekly use of opioids, sleeping pills or painkillers, polydrug use and injecting drug use. Discussion and Conclusions Young people who have served community-based and custodial orders are at an increased risk of preventable death. Those engaging in risky substance use, particularly injecting drug use and use of multiple central nervous system depressants, are at greatest risk. There is an urgent need to develop and rigorously evaluate preventive interventions. [Kinner SA, Degenhardt L, Coffey C, Hearps S, Spittal M, Sawyer SM, Patton GC. Substance use and risk of death in young offenders: A prospective data linkage study. Drug Alcohol Rev 2015;34:46–50] Keywords: mortality; youth offender; substance abuse; suicide; injecting drug use 30. Brief overdose education is sufficient for naloxone distribution to opioid users Emily Behar, Glenn-Milo Santos, Eliza Wheeler, Christopher Rowe, Phillip O. Coffin Drug and Alcohol Dependence 2015:148;209-212 Abstract Background While drug users are frequently equipped with naloxone for lay opioid overdose reversal, the amount of education needed to ensure knowledge of indications and administration is unknown. Methods We administered four instruments, assessing comfort and knowledge around opioid overdose and naloxone administration, to opioid users receiving naloxone for the first time (N = 60) and upon returning for a refill (N = 54) at community distribution programs. Participants completed the instruments prior to receiving naloxone; first-time recipients repeated the instruments immediately after the standardized 5–10 min education. Results Comfort with recognition of, 28 response to, and administration of naloxone for an overdose event significantly increased after brief education among first-time recipients (p < 0.05). Knowledge of appropriate responses to opioid overdose was high across all assessments; 96% of participants could identify at least one acceptable action to assess and one acceptable action to care for an opioid overdose. Facility with naloxone administration was high across all assessments and significantly increased for intranasal administration after education for first-time recipients (p < 0.001). First-time recipients (before and after education) and refillers demonstrated a high level of knowledge on the Brief Overdose Recognition and Response Assessment, correctly identifying a mean of 13.7 out of 16 overdose scenarios. Conclusions Opioid users seeking naloxone in San Francisco have a high level of baseline knowledge around recognizing and responding to opioid overdose and those returning for refills retain that knowledge. Brief education is sufficient to improve comfort and facility in recognizing and managing overdose. Keywords: Naloxone; Opioid overdose; Opioid safety; Overdose prevention; Syringe access program 29 EPIDEMIOLOGY AND DEMOGRAPHY 31. Unique factors associated with young women in substance use treatment: Craving, impulsivity, emotion regulation, and physiological response Christine Vinci, Julie Schumacher, Scott F. Coffey Drug and Alcohol Dependence 2015:146;e12 No abstract available HARM REDUCTION 32. The cost-effectiveness of harm reduction David P. Wilson, Braedon Donald, Andrew J. Shattock, David Wilson, Nicole Fraser-Hurt International Journal of Drug Policy 2015:26(S1);S5-S11 Abstract HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term. Keywords: Cost-effectiveness; HIV; Harm reduction; People who inject drugs 30 HEPATITIS C 33. Opioid substitution therapy is associated with increased detection of hepatitis C virus infection: A 15-year observational cohort study Sarah Larney, Jason Grebely, Michael Falster, Alexander Swart, Janaki Amin, Louisa Degenhardt, Lucinda Burns, Claire M. Vajdic Drug and Alcohol Dependence 2015:148;213-216 Abstract Background Strategies are needed to enhance screening of hepatitis C virus (HCV) infection among people who inject drugs to improve engagement in HCV treatment, and stem the growing burden of HCV-related morbidity and mortality. Methods We linked routinely collected data on enrolment in opioid substitution therapy (OST) and HCV notifications. We calculated rates of incident HCV notifications, and compared rates in and out of OST. Results Following adjustment for sex, age and calendar period, rates of incident HCV notification were significantly higher during periods of OST, compared to periods out of OST (adjusted incident rate ratio: 1.91; 95% confidence interval: 1.86, 1.97). This effect was seen across multiple treatment periods. Conclusions HCV screening in OST settings increases detection of HCV infection among people who inject drugs. Keywords: Hepatitis C virus; Opioid substitution therapy; Screening; Notification; People who inject drugs 34. Prevention, treatment and care of hepatitis C virus infection among people who inject drugs Philip Bruggmann, Jason Grebely International Journal of Drug Policy 2015:26(S1);S22-S26 Abstract People who inject drugs (PWID) represent the core of the hepatitis C virus (HCV) epidemic in many countries. HCV transmission continues among PWID, despite evidence demonstrating that high coverage of combined harm reduction strategies, such as needle syringe programs (NSP) and opioid substitution treatment (OST), can be effective in reducing the risk of HCV transmission. Among infected individuals, HCV-related morbidity and mortality continues to grow and is accompanied by major public health, social and economic burdens. Despite the high prevalence of HCV infection, the proportion of PWID who have been tested, assessed and treated for HCV infection remains unacceptably low, related to systems-, provider- and patient-related barriers to care. This is despite compelling data demonstrating that with the appropriate programs, HCV treatment is safe and successful among PWID. The approaching era of interferon-free directly acting antiviral therapy has the potential to provide one of the great advances in clinical medicine. Simple, tolerable and highly effective therapy will likely address many of these barriers, thereby enhancing the numbers of PWID cured of HCV infection. However, the high cost of new HCV therapies will be a barrier to implementation in many settings. This paper highlights that restrictive national drug policy and law enforcement are key drivers of the HCV epidemic among PWID. This paper also calls for enhanced HCV treatment settings built on a foundation of both prevention (e.g. NSP and OST) and improved access to health care for PWID. Keywords: Hepatitis C; PWID 35. Relative effects of heavy alcohol use and Hepatitis C in decompensated chronic liver disease in a hospital inpatient population 31 Pavan Kumar Mankal, Jean Abed, Jose David Aristy, Khushboo Munot, Upma Suneja, Ellen S. Engelson, Donald P. Kotler The American Journal of Drug and Alcohol Abuse 2015:41(2);177–182 Abstract Background Heavy alcohol use has been hypothesized to accelerate disease progression to endstage liver disease in patients with hepatitis C virus (HCV) infection. In this study, we estimated the relative influences of heavy alcohol use and HCV in decompensated chronic liver disease (CLD). Methods Retrospectively, 904 patients with cirrhotic disease admitted to our hospitals during January 2010–December 2012 were identified based on ICD9 codes. A thorough chart review captured information on demographics, viral hepatitis status, alcohol use and progression of liver disease (i.e. decompensation). Decompensation was defined as the presence of ascites due to portal hypertension, bleeding esophageal varices, hepatic encephalopathy or hepatorenal syndrome. Heavy alcohol use was defined as a chart entry of greater than six daily units of alcohol or its equivalent. Results 347 patients were included based on our selection criteria of documented heavy alcohol use (n = 215; 62.0%), hepatitis titers (HCV: n = 182; 52.5%) and radiological evidence of CLD with or without decompensation (decompensation: n = 225; 64.8%). Independent of HCV infection, heavy alcohol use significantly increased the risk of decompensation (OR = 1.75, 95% CI 1.11–2.75, p < 0.02) relative to no heavy alcohol use. No significance was seen with age, sex, race, HIV, viral hepatitis and moderate alcohol use for risk for decompensation. Additionally, doserelationship regression analysis revealed that heavy, but not moderate alcohol use, resulted in a three-fold increase (p = 0.013) in the risk of decompensation relative to abstinence. Conclusions While both heavy alcohol use and HCV infection are associated with risk of developing CLD, our data suggest that heavy, but not moderate, alcohol consumption is associated with a greater risk for hepatic decompensation in patients with cirrhosis than does HCV infection. Keywords: Alcohol, ascites, cirrhosis, end stage liver disease, varices 32 MISCELLANEOUS 36. Beyond risky alcohol use: Screening non-medical use of prescription drugs at National Alcohol Screening Day Mark M. Silvestri, Holly Knight, Jessica Britt, Christopher J. Correia Addictive Behaviors 2015:43;25-27 Abstract Introdcution Recent epidemiological data has indicated an increasing trend in the non-medical use of prescription drugs (NMUPD) among college students. NMUPD has shown a strong relationship with heavy alcohol use and associated negative consequences. Despite the trends and association with other risky behavior, there remain large gaps in the literature regarding this hazardous behavior. To date, no study has examined the prevalence of NMUPD among student attending National Alcohol Screening Day (NASD), and few studies have explored motives contributing to NMUPD, as well as the relationship between motives, NMUPD, and alcohol use. Methods The current study examined the prevalence and motives for NMUPD among undergraduate students (N = 128) attending NASD. Results Overall, 42% of the sample reported NMUPD at least once in their lifetime, 29.7% at least once in the past year, and 18.0% reported simultaneously engaging in alcohol consumption and NMUPD. Pain relievers were the most frequently used drug class for lifetime use, and stimulants were the most frequently reported for past year use. Most students reported NMUPD for functional reasons. Students that engaged in binge drinking were three times more likely to report NMUPD. Conclusions The findings from the current study suggest that events like NASD may provide a platform for screening and discussing NMUPD, and its associated risk with heavy alcohol use. Keywords: Alcohol; Prescription drugs; College students; National Alcohol Screening Day 37. The stigmatisation of the provision of services for alcohol and other drug users: A systematic literature review Kim Eaton, Jeneva L. Ohan, Greg Dear Drugs: education, prevention, and policy 2015:22(1);19–25 Abstract Alcohol and other drug (AOD) workers are often stigmatised. This article describes a systematic review of the existing literature that addresses three aims: (1) identify how stigma occurs for people working in the AOD field, (2) identify what the impacts of stigma are on AOD workers and AOD service provision more broadly and (3) identify what extent stigma occurs for AOD workers. The review involved a multi-phase database, journal and website search, with additional hand searching of relevant referenced articles. Seven studies were found, pertaining to stigma and working in the AOD sector. Findings indicate that AOD workers experience stigma and this impedes occupational functioning. Stigma is not clearly conceptualised in these studies. It is unclear if researchers used the same construct of stigma as in the broader psychological research on stigma. It is also unclear as to what conceptualisation of stigma research participants in these studies held (e.g. stigma of self, workplace, client or job role). This has important implications for determining the degree to which the worker personally experiences and is impacted by stigma. Research is needed to clarify the origins, manifestations and impacts of stigma in relation to working in the AOD field. Keywords: Addiction, AOD, associative, professionals, stigma, workers 33 38. “We are people too”: Consumer participation and the potential transformation of therapeutic relations within drug treatment Jake Rance, Carla Treloar International Journal of Drug Policy 2015:26(1);30-36 Abstract Background While there is growing recognition of the benefits of user involvement within drug treatment there is scant literature documenting the actual implementation of such initiatives. Nonetheless, the extant research is remarkably consistent in identifying poor relationships between service users and staff as a principal barrier to the successful implementation of consumer participation. Focussing on participants’ accounts of change within the ‘therapeutic alliance’, this paper investigates a consumer participation initiative introduced within three Australian drug treatment services. Methods In 2012, the New South Wales Users and AIDS Association (NUAA), a state-based drug user organisation, introduced a consumer participation initiative within three treatment facilities across the state. This paper draws on 57 semi-structured interviews with staff and service-user project participants. Approximately ten participants from each site were recruited and interviewed at baseline and six months later at evaluation. Results The enhanced opportunities for interaction enabled by the consumer participation initiative fostered a sense of service users and staff coming to know one another beyond the usual constraints and limitations of their relationship. Both sets of participants described a diminution of adversarial relations: an unsettling of the ‘them and us’ treatment divide. The routine separation of users and staff was challenged by the emergence of a more collaborative ethos of ‘working together’. Participants noted ‘seeing’ one another – the other – differently; as people rather than simply an identity category. Conclusion For service users, the opportunity to have ‘a voice’ began to disrupt the routine objectification or dehumanisation that consistently, if unintentionally, characterise the treatment experience. Having a voice, it seemed, was synonymous with being human, with having ones’ ‘humanness’ recognised. We contend that not only did the introduction of consumer participation appear to empower service users and enhance the therapeutic alliance, it may have also improved service quality and health outcomes. Keywords: Consumer participation; Drug use and treatment; Stigma and discrimination; Service users and providers; Qualitative interviews; Australia 39. Lessons learned for follow-up phone booster counseling calls with substance abusing emergency department patients Dennis M. Donovan, Mary A. Hatch-Maillette, Melissa M. Phares, Ernest McGarry, K. Michelle Peavy, Julie Taborsky Journal of Substance Abuse Treatment 2015:50;67-75 Abstract Background Post-visit “booster” sessions have been recommended to augment the impact of brief interventions delivered in the emergency department (ED). This paper, which focuses on implementation issues, presents descriptive information and interventionists' qualitative perspectives on providing brief interventions over the phone, challenges, “lessons learned”, and recommendations for others attempting to implement adjunctive booster calls. Method Attempts were made to complete two 20-minute telephone “booster” calls within a week following a patient's ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine. Results Over half (56.2%) of participants completed the initial call; 66.9% of those who received the initial call also completed 34 the second call. Median number of attempts to successfully contact participants for the first and second calls were 4 and 3, respectively. Each completed call lasted an average of about 22 minutes. Common challenges/barriers identified by booster callers included unstable housing, limited phone access, unavailability due to additional treatment, lack of compensation for booster calls, and booster calls coming from an area code different than the participants' locale and from someone other than ED staff. Conclusions Specific recommendations are presented with respect to implementing a successful centralized adjunctive booster call system. Future use of booster calls might be informed by research on contingency management (e.g., incentivizing call completions), smoking cessation quitlines, and phone-based continuing care for substance abuse patients. Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the ED setting. Keywords: Motivational interviewing; Brief intervention; Booster calls; Substance abuse; Emergency department 40. Images by the Vineyard: Images of Addiction and Substance Users in the Media and Other Culture Sites/Sights Allaman Allamani, Silvia Mattiacci Substance Use & Misuse 2015:50(4);484–502 Abstract This article constitutes a discovery journey into the world of drinking images, the pleasures and harms related to consuming alcoholic beverages, as well as the relationships between drinking and spirituality. These aspects are described historically and globally, over time through a series of snapshots and mini-discussions about both visual and mental images from art, classical literature and operatic music.The images are interpreted according to how they represent the drinking culture within which they were created and sustained, and how they are able to involve the spectator and the user in terms of either empathizing, accepting and including or distancing, stigmatizing and marginalizing the user. Keywords: Image, culture, alcoholic beverages, art, classical literature, opera music, exhibition 35 OPIATE TREATMENT 41. Mobile phone and text messaging in a public sector, office-based buprenorphine program Babak Tofighi, Ellie Grossman, Emily Buirkle, Joshua D. Lee Drug and Alcohol Dependence 2015:146;e4-e5 No abstract available 42. Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses Anne Line Bretteville-Jensen, Mats Lillehagen, Linn Gjersing, Jasmina Burdzovic Andreas Drug and Alcohol Dependence 2015:147;89-96 Abstract Background and aims Diversion of opioid substitution drugs (OSD) is of public concern. This study examined the prevalence, frequency, and predictors of illicit OSD use in a group of injecting drug users (IDUs) and assessed if such use was associated with non-fatal overdoses. Methods Semi-annual cross-sectional interviews conducted in Oslo, Norway (2006–2013), from 1355 streetrecruited IDUs. Hurdle, logistic, and multinomial regression models were employed. Results Overall, 27% reported illicit OSD use in the past four weeks; 16.8% methadone, 12.5% buprenorphine, and 2.9% both drugs. Almost 1/10 reported at least one non-fatal overdose in the past four weeks, and roughly 1/3 reported such experience in the past year. Use of additional drugs tended to be equally, or more prevalent among illicit OSD users than other IDUs. In terms of illicit OSD use being a risk factor for non-lethal overdoses, our results showed significant associations only for infrequent buprenorphine use (using once or less than once per week). Other factors associated with non-fatal overdoses included age, education, homelessness, as well as the benzodiazepines, stimulants, and heroin use. Conclusions Users of diverted OSD may represent a high-risk population, as they used more additional drugs and used them more frequently than other IDUs. However, illicit OSD use may be less harmful than previously assumed. After accounting for an extensive set of covariates, only infrequent illicit buprenorphine use, but not methadone use, was associated with non-fatal overdoses. Keywords: Diversion; Methadone; Buprenorphine; Injecting drug users; Opioid substitution treatment 43. Changes in mental health during opiate replacement therapy: A systematic review Niamh Fingleton, Catriona Matheson, Mariesha Jaffray Drugs: education, prevention, and policy 2015:22(1);1–18 Abstract Aim To determine whether changes in mental health occur over the course of opiate replacement therapy (ORT).Methods Medline, Embase, PsycINFO, CINAHL and the Cochrane Library were searched from 1996 to 2011. Reference lists of identified reviews were hand-searched. Randomized controlled trials (RCTs) and national cohort studies which measured an aspect of mental health at baseline and follow-up, and reported significance testing over time, for individuals receiving ORT were included. Double data extraction was conducted. Findings Twenty-two studies comprising 19 RCTs and three national cohort studies were included. Nineteen different instruments measuring various aspects of mental health were identified. Mental health significantly improved for all groups receiving ORT in 14 studies in either some or all of the domains assessed. There was tentative 36 evidence to suggest methadone is less effective at improving mental health than other types of ORT. Improvements occurred early in the treatment process and were not always sustained. Conclusions Mental health generally improves during ORT but this improvement may not continue beyond 12 months. Standardization of tools is recommended following comparative assessment of the sensitivity and specificity of different measures. 44. Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors Björn Johnson, Torkel Richert International Journal of Drug Policy 2015:26(2);183-190 Abstract Background Diversion—patients who sell or share their medication—is a hotly debated but relatively unresearched phenomenon. We have investigated the prevalence of self-reported diversion of methadone and buprenorphine at OST programs in Sweden. We have also examined if demographic, treatment, and social factors can be associated with an increased risk of diversion. Methods Structured interviews were conducted with 411 patients from eleven OST programs. A standardized questionnaire with 106 close- and five open-ended questions were used. 280 interviews were done on site, by the researchers, while 131 interviews were conducted by specially trained patients through privileged access interviewing. The data were analyzed through frequencyand averages-calculations, cross-tabulations, and logistic regression analysis. Results In total, 24.1% (n = 99) of the patients reported diversion in the past month. 67.6% (n = 277) stated that they had diverted at some point. The peer interviews showed significantly higher levels of diversion (37.4% past month) compared with the researcher interviews (17.2%). Neither demographic factors, dosages, nor collection routines were associated with diversion. The likelihood of diversion was higher for patients on mono-buprenorphine (OR = 5.64) and buprenorphine–naloxone (OR = 2.10), than among methadone patients. Other factors which increased the likelihood of diversion were current illicit drug use (OR = 5.60), having had patients as a primary source of illicit methadone or buprenorphine prior to treatment (OR = 3.39), and mainly socializing with active drug users (OR = 2.12). Conclusion Self-reported diversion was considerably higher than in previous studies. This is most likely due to the new methodological strategy we used, but may also partly be explained by low availability of OST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Efforts to decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, and expanded access to treatment, rather than on control measures. Keywords: Methadone; Buprenorphine; Diversion; Illicit use; Opioid substitution treatment 37 OVERDOSE AND DRUG RELATED DEATHS 45. Associations between childhood trauma and non-fatal overdose among people who inject drugs Stephanie Lake, Kanna Hayashi, M.-J. Milloy, Evan Wood, Huiru Dong, Julio Montaner, Thomas Kerr Addictive Behaviors 2015:43;83-88 Abstract Introduction Although people who inject drugs (IDU) remain at a high risk of accidental overdose, interventions that address overdose remain limited. Accordingly there is a continuing need to identify psychological and social factors that shape overdose risk. Despite being reported frequently among IDU, childhood trauma has received little attention as a potential risk factor for overdose. This study aims to evaluate relationships between non-fatal overdose and five forms of childhood maltreatment among a cohort of IDU in Vancouver, Canada. Methods Data was obtained from two prospective cohorts of IDU between December 2005 and May 2013. Multivariate generalized estimating equations (GEEs) were used to explore relationships between five forms of childhood trauma and non-fatal overdose, adjusting for potential confounders. Results During the study period, 1697 IDU, including 552 (32.5%) women, were followed up. At baseline, 1136 (67.0%) participants reported at least one form of childhood trauma, while 4–9% reported a non-fatal overdose at each semi-annual follow-up. In multivariate analyses, physical [adjusted odds ratio (AOR): 1.36, 95% confidence interval (CI): 1.08–1.71], sexual (AOR: 1.48, CI: 1.17–1.87), and emotional abuse (AOR: 1.54, CI: 1.22–1.93) and physical neglect (AOR: 1.28, CI: 1.01–1.62) were independently associated with non-fatal overdose (all p < 0.05). Conclusions Childhood trauma was common among participants, and reporting an experience of trauma was positively associated with non-fatal overdose. These findings highlight the need to provide intensive overdose prevention to trauma survivors and to incorporate screening for childhood trauma into health and social programs tailored to IDU. Keywords: Childhood abuse; Childhood neglect; Childhood maltreatment; Injection drug use; Non-fatal overdose 46. Wasted, overdosed, or beyond saving – To act or not to act? Heroin users’ views, assessments, and responses to witnessed overdoses in Malmö, Sweden Torkel Richert International Journal of Drug Policy 2015:26(1);92-99 Abstract Background Overdose is a significant cause of death among heroin users. Frequently, other heroin users are present when an overdose occurs, which means the victim's life could be saved. There is a lack of studies that, based on heroin users own stories, examine their views, assessments, and responses to witnessed overdoses. Methods The study is based on qualitative interviews with thirty-five heroin users who witnessed someone else's overdose. Results The heroin users generally had a positive attitude towards assisting peers who had overdosed. A number of factors and circumstances, however, contribute to witnesses often experiencing resistance to or ambivalence about responding. The witness's own high, the difficulty in assessing the seriousness of the situation, an unwillingness to disturb someone else's high, uncertainty about the motive behind the overdose and whether the victim does or does not want assistance as well as fear of police involvement, were common factors that acted as barriers to adequate responses in overdose situations. Conclusion The fact that being high makes it difficult to respond to overdoses, using traditional methods, argues for simpler and more effective response 38 techniques. This can include intranasal naloxone programs for heroin users. The findings regarding the uncertainty about the intention of the overdose victim and the sensitivity to the experience of a good high argue for more up-front communication and discussion amongst using peers so that they can make their intentions clear to each other. Issues like this can be addressed in overdose education interventions. Overdose prevention measures also need to address the fact that fear of the police acts as a barrier to call emergency services. Keywords: Overdose; Heroin users; Overdose prevention; Heroin high; Qualitative interviews PARENTING 47. Parental Rules, Parent and Peer Attachment, and Adolescent Drinking Behaviors Michael Thomas McKay Substance Use & Misuse 2015:50(2);184–188 Abstract Background Physical illnesses frequently co-occur with depression and substance use disorders and may impact their improvement. Physical illness symptoms may overlap with or exacerbate somatic symptoms of depression. Individuals may use substances to cope with symptoms of physical illness. Objectives We examined whether chronic physical health problems moderated changes in depression and substance use among dual diagnosed individuals during and in the year following treatment. Methods Participants were recruited from a Veterans Affairs dual diagnosis outpatient program between March 2000 and November 2007 and were randomized to either Integrated Cognitive-Behavioral Therapy or Twelve-Step Facilitation Therapy. A total of 214 veterans with assessment data for the variables of interest were included in analyses. Participants completed quarterly depression, substance use, and health assessments over an 18 month period. We used linear-mixed effects models to analyze patterns of change for depression and substance use. Results Individuals with severe chronic health problems and higher intake depression showed slower improvements in both nonsomatic and somatic depression symptoms. Individuals with severe chronic health problems and higher midtreatment substance use showed less improvement in substance use. Conclusions Assessing and addressing physical health issues during depression and substance use disorder treatment may improve outcomes. Keywords: physical health, depression, substance use disorder, treatment 39 PHARMACY 48. Community pharmacy services for drug misuse: Attitudes and practices of Finnish pharmacists Hanna Uosukainen, Juha H.O. Turunen, Jenni Ilomäki, J. Simon Bell, International Journal of Drug Policy 2014:25(6);1139-1142 No abstract available PRIMARY CARE 49. A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: Outcomes through 12 months Jan Gryczynski, Shannon Gwin Mitchell, Arturo Gonzales, Ana Moseley, Thomas R. Peterson, Steven J. Ondersma, Kevin E. O’Grady, Robert P. Schwartz Journal of Substance Abuse Treatment 2015:50;3-10 Abstract This study examined outcomes through 12 months from a randomized trial comparing computerized brief intervention (CBI) vs. in-person brief intervention (IBI) delivered by behavioral health counselors for adult community health center patients with moderate-level drug misuse (N = 360). Data were collected at baseline, 3-, 6-, and 12-month follow-up, and included the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and laboratory analysis of hair samples. Repeated measures analyses examined differential change over time. There were no significant differences in drug-positive hair tests over time or by condition. Global ASSIST scores decreased in both conditions (p < .001), but there were no significant differences between conditions in overall change across 12 months of follow-up (p = .13). CBI produced greater overall reductions in alcohol (p = .04) and cocaine (p = .02) ASSIST scores than IBI, with initial differences dissipating over time. Computerized brief interventions present a viable alternative to traditional in-person brief interventions. Keywords: Brief intervention; Drug misuse; Primary care; Computerized intervention; SBIRT RECOVERY 50. “You’re all going to hate the word ‘recovery’ by the end of this”: Service users’ views of measuring addiction recovery Joanne Neale, Charlotte Tompkins, Carly Wheeler, Emily Finch, John Marsden, Luke Mitcheson, Diana Rose, Til Wykes, John Strang Drugs: education, prevention, and policy Feb 2015, Vol. 22, No. 1: 26–34 Abstract Aims To explore how service users’ views of measuring addiction recovery differ from those of service providers. Methods Five focus groups conducted in two English cities with (i) people currently using Class A drugs (n = 6); (ii) people currently using alcohol (n = 12); (iii) individuals in residential detoxification (n = 12); (iv) individuals in residential rehabilitation (n = 7); and (v) people who defined themselves as ex drug or alcohol users (n = 7). Each focus group reviewed 76 measures of recovery previously identified by senior service providers. Findings Service users identified multiple problems with the 76 measures. Difficulties could be categorized as expecting the impossible of service users; the dangers of progress; the hidden benefits of negative outcomes; 40 outcomes that negate the agency in recovery; contradictory measures; failure to recognise individual differences; entrenched vulnerabilities; the misattribution of feelings and behaviours; and inappropriate language. Conclusions Service users experience recovery as a process and personal journey that is often more about ‘coping’ than ‘cure’. Involving service users in designing measures of recovery can lessen the likelihood that researchers develop assessment tools that use inappropriate, contradictory or objectionable outcomes, and ambiguous and unclear language. People who have experienced drug or alcohol problems can highlight important weaknesses in dominant recovery discourses. Keywords: Focus groups, measurement, outcomes, recovery, service users, substance misuse 51. How do recovery definitions distinguish recovering individuals? Five typologies Jane Witbrodt, Lee Ann Kaskutas, Christine E. Grella Drug and Alcohol Dependence 2015:148;109-117 Abstract Background Six percent of American adults say they are “in recovery” from an alcohol or drug problem yet only a scant emergent literature has begun to ask how they define “recovery” or explored whether there is heterogeneity among their definitions. Methods Secondary analysis of the “What is Recovery?” online survey employed latent class analysis (LCA) to identify typologies of study participants based on their actual endorsement of 39 recovery elements and to compare the composition of these typologies in terms of distinguishing personal characteristics. Results A five-class solution provided the best fit and conceptual representation for the recovery definitions. Classes were labeled 12-step traditionalist (n = 4912); 12-step enthusiast (n = 2014); secular (n = 980); self-reliant (n = 1040); and atypical (n = 382) based on patterns of endorsement of the recovery elements. Abstinence, spiritual, and social interaction elements differentiated the classes most (as did age and recovery duration but to a lesser extent). Although levels and patterns of endorsement to the elements varied by class, a rankordering of the top 10 elements indicated that four elements were endorsed by all five classes: being honest with myself, handling negative feelings without using, being able to enjoy life, and process of growth and development. Conclusions The results of the LCA demonstrate the diversity of meanings, and varying degrees of identification with, specific elements of recovery. As others have found, multiple constituents are invested in how recovery is defined and this has ramifications for professional, personal, and cultural processes related to how strategies to promote recovery are implemented. Keywords: Recovery; Recovered; Remission; Help-seeking; Addiction; Treatment 41 SMOKING CESSATION 52. Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes Jean-François Etter , Thomas Eissenberg Drug and Alcohol Dependence 2015:147;68-75 Abstract Objective To assess dependence levels in users of e-cigarettes, and compare them with dependence levels in users of nicotine gums and tobacco cigarettes. Design Self-reports from cross-sectional Internet and mail surveys. Comparisons of: (a) 766 daily users of nicotine-containing e-cigarettes with 30 daily users of nicotine-free e-cigarettes; (b) 911 former smokers who used the e-cigarette daily with 451 former smokers who used the nicotine gum daily (but no e-cigarette); (c) 125 daily e-cigarette users who smoked daily (dual users) with two samples of daily smokers who did not use e-cigarettes (2206 enrolled on the Internet and 292 enrolled by mail from the general population of Geneva). We used the Fagerström test for nicotine dependence, the nicotine dependence syndrome scale, the cigarette dependence scale and versions of these scales adapted for e-cigarettes and nicotine gums. Results Dependence ratings were slightly higher in users of nicotine-containing ecigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (≤3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers. Conclusions Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive. Keywords: Electronic cigarette; Electronic nicotine delivery devices (ENDS); Smoking; Nicotine; Dependence; Addiction 53. Explaining the effects of electronic cigarettes on craving for tobacco in recent quitters Jean-François Etter Drug and Alcohol Dependence 2015:148;102-108 Abstract Objective To explore how e-cigarettes attenuate craving for tobacco, in e-cigarette users who recently quit smoking. Design Cross-sectional survey of recent quitters, Internet (French and English), 2012–2014. Participants were 374 daily users of e-cigarettes who had quit smoking in the previous two months, enrolled on websites dedicated to e-cigarettes and to smoking cessation. We measured perception that e-cigarettes attenuate craving for tobacco cigarettes, characteristics of ecigarettes, modifications of the devices, patterns of e-cigarette use, reasons for use, satisfaction with e-cigarettes, dependence on e-cigarettes, and personal characteristics. Results The strongest attenuation of craving for tobacco was obtained by using higher nicotine concentrations in refill liquids, modular systems (rather than unmodified devices), and high voltage batteries. The strength of the effect of e-cigarettes on craving was also associated with more intensive use (more puffs per day, more refill liquid). Stronger effects on craving were associated with satisfaction with ecigarettes, and with reporting that e-cigarettes helped to quit smoking. Participants who reported the strongest effects on craving for tobacco were the most dependent on the e-cigarette and had the strongest urges to vape. Conclusions From a public health perspective, there is a trade-off between e-cigarettes that provide high levels of nicotine, high satisfaction and more effects on craving for tobacco, but may also be addictive, and e-cigarettes that contain less nicotine and are less addictive, but are also less satisfactory and less efficient at relieving craving and at helping dependent smokers quit smoking. This trade-off must be kept in mind when regulating e-cigarettes. 42 Keywords: Tobacco use disorder; Electronic nicotine delivery devices (ENDS); Electronic cigarette; E-cigarette; Nicotine; Smoking YOUNG PEOPLE 54. Competitive Sport Involvement and Substance Use among Adolescents: A Nationwide Study Philip Todd Veliz, Carol J. Boyd, Sean Esteban McCabe Substance Use & Misuse 2015:50(2);156–165 Abstract Background The empirical research examining the impact of sports participation on alcohol and other drug use has produced mixed results. Part of this problem may be the result of how different types of sports participation create different experiences that shape certain types of behaviors that either facilitate or deter substance use. Objectives We examined the association between different types of competitive sports participation and substance use among a nationally representative sample of adolescents. Methods Two recent cross-sections from the Monitoring the Future were merged to capture a large subsection of adolescents who participate in either high-contact sports (football, wrestling, hockey, and lacrosse), semicontact sports (baseball, basketball, field hockey, and soccer), and noncontact sports (cross-country, gymnastics, swimming, tennis, track, and volleyball). Results Multivariate analyses revealed that adolescents who participated in high-contact sports had higher odds of using substances during the past 30 days and initiating substance use at early ages. Further, adolescents who participated in noncontact sports had lower odds to indicate smoking cigarettes and marijuana during the past 30 days. Conclusions Parents, educators, and policy makers need to consider that some sporting contexts may be a catalyst to engage in risky behaviors like substance use. Keywords: Sport participation, adolescents, substance use, alcohol use, illicit drug use 43