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CERGA Journal Title and Abstracts October 2013
Contents
PAGE
LIST OF JOURNALS CHECKED
2
LIST OF REFERENCES
Alcohol - Adolescents
3
Alcohol – Epidemiology and Demography
3
Alcohol – Liver
4
Alcohol - Miscellaneous
4
Alcohol Pricing
4
Alcohol Treatment
4
Blood Borne Viruses
5
Clinicians
5
Clinicians and service providers
5
Co-Morbidity
5
Drug Related Deaths
6
Epidemiology and Demography
6
Hepatitis C
6
Injecting Drug Use
7
Miscellaneous
7
New Psychoactive Substances
8
Opiate Treatment
8
Organisation of Services
10
Primary Care
10
LIST OF ABSTRACTS
11-53
1
Journal Title
Volumes and Issues Checked
Addiction
Volume 108 Issue 7[6], Issue 8[1],
Issue 9 [3]
Volume 38 Issue 10[2] Issue 11 [1]
Volume 48 Issue 4 [3], Issue 5[1]
Volume 37 Issue 8 [2], Issue 9 [1]
Addictive Behaviours
Alcohol and Alcoholism
Alcoholism Clinical &
Experimental Research
Drug and Alcohol Dependence
Drugs Education Prevention and
Policy
Drug and Alcohol Review
European Addiction Research
International Journal of Drug
Policy
Journal of Substance Abuse
Treatment
The American Journal of Drug
and Alcohol Abuse
Journal of Substance Use
Substance Use and Misuse
Scotland’s Public Health
Information Service
Number of issues
per year
Volume 131 Issue 3[2]
Volume 132 Issue 1-2[3]
Volume 132 Issue3 [7]
Volume 20 Issue 4[5]
Volume 32 Issue 4[5], Issue 5[2]
Volume 19 Issue 4[3], Issue 5[1]
Volume 24 Issue 4[1]
12
12
6
12
21
6
6
4-5
6
Volume 45 Issue 2[2], Issue 3[1]
8
Volume 39 Issue 4 [1]
Volume 18 Issue 4[1], Issue 5[2]
Volume 48 Issue 11[2],
Alcohol and Substance Misuse Alert
August 2013 [5]
6
6
# Items identified via Health Scotland
BMJ Alerts:
Alex Gatherer Managing the health of prisoners. BMJ2013;346doi:
http://dx.doi.org/10.1136/bmj.f3463(Published 29 May 2013) Cite this as:BMJ2013;346:f3463
Michael McCarthy Opioid overdose deaths rose fivefold among US women in 10 years
BMJ2013;347doi: http://dx.doi.org/10.1136/bmj.f4415(Published 8 July 2013) Cite this
as:BMJ2013;347:f4415
Nigel Hawkes Deaths from tramadol and legal highs reach new highs in England and Wales
BMJ2013;347doi: http://dx.doi.org/10.1136/bmj.f5336(Published 30 August 2013) Cite this
as:BMJ2013;347:f5336
Recent Reports:
Scottish Drug Strategy Delivery Commission: Independent Expert Review of Opioid Replacement
Therapies in Scotland. Kidd B, Lind C., Roberts K.
2
ALCOHOL – ADOLESCENTS
1.
The impact of school alcohol policy on student drinking
Tracy J. Evans-Whipp, Stephanie M. Plenty, Richard F. Catalano,Todd I. Herrenkohl,
John W. Toumbourou
Health Education Research 2013;28(4);651-662
2.
Brain Structure in Adolescents and Young Adults with Alcohol Problems:
Systematic Review of Imaging Studies
Killian A.Welch, Alan Carson, Stephen M. Lawrie
Alcohol and Alcoholism 2013:48(4);433-444
3.
A 26-Year Follow-Up Study of Heavy Drinking Trajectories from Adolescence to
Mid-Adulthood and Adult Disadvantage
Noora Berg1, Olli Kiviruusu, Sakari Karvonen, Laura Kestilä, Tomi Lintonen, Ossi
Rahkonen, Taina Huurre
Alcohol and Alcoholism 2013:48(4);452-457
4.
Young people talking about alcohol: Focus groups exploring constructs in the
prototype willingness model
Emma L. Davies, Jilly Martin, David R. Foxcroft
Drugs: Education, Prevention and Policy 2013:20(4);269-277
5.
The Impact of Parenting Styles on Adolescent Alcohol Use: The TRAILS Study
Visser L, de Winter A.F, Vollebergh W.A.M, Verhulst F.C, Reijneveld S.A
European Addiction Research 2013:19(4);165-172
6.
How do drug and alcohol use relate to parental bonding and risk perception in
university students?
Tomas Jurcik, Richard Moulding, Emma Naujokaitis
Journal of Substance Use 2013:18(4);254-261
ALCOHOL – EPIDEMIOLOGY AND DEMOGRAPHY
7.
Alcohol use disorders and mortality: a systematic review and meta-analysis
Michael Roerecke, Jürgen Rehm
Addiction 2013:108(9);1562-1578
8.
Alcohol-attributable mortality in France
Sylvie Guérin, Agnès Laplanche, Ariane Dunant and Catherine Hill
European Journal of Public Health 2013;23(4):588-593
9.
Reduction of Drinking in Problem Drinkers and All-Cause Mortality
J. Rehm, M. Roerecke
Alcohol and Alcoholism 2013:48(4);509-513
3
ALCOHOL – LIVER
10.
Prevalence of Hepatitis C Virus Infection in Alcoholic Patients: Cohort Study
and Systematic Review
Ignacio Novo-Veleiro, Cristina de la Calle, Susana Domínguez-Quibén, Isabel Pastor,
Miguel Marcos, Francisco-Javier Laso
Alcohol and Alcoholism 2013:48(5);564-569
ALCOHOL MISCELLANEOUS
11.
Overlooked and underestimated? Problematic alcohol use in clients recovering
from drug dependence
Petra K. Staiger, Ben Richardson, Caroline M. Long, Victoria Carr, G. Alan Marlatt
Addiction 2013:108(7);1188-1193
12.
Alcohol-selling outlets and mortality in Switzerland—the Swiss National Cohort
Adrian Spoerri, Marcel Zwahlen, Radoslaw Panczak, Matthias Egger, Anke Huss,
Swiss National Cohort
Addiction 2013:108(9);1603-1611
13.
A Qualitative Study of Alcohol, Health and Identities among UK Adults in Later
Life
Graeme B. Wilson, Eileen F. S. Kaner, Ann Crosland, Jonathan Ling, Karen McCabe,
Catherine A. Haighton
PloS One 2013:8(8);e71792
14.
Physiological and Endocrine Reactions to Psychosocial Stress in Alcohol Use
Disorders: Duration of Abstinence Matters
Katrin Starcke, Ruth J. van Holst, Wim van den Brink, Dick J. Veltman, Anna E.
Goudriaan
Alcoholism: Clinical and Experimental Research 2013:37(8);1343-1350
15.
Examining the Relationship Between Alcohol-Energy Drink Risk Profiles and
High-Risk Drinking Behaviors
Lindsey Varvil-Weld, Miesha Marzell, Rob Turrisi, Kimberly A. Mallett, Michael J.
Clevelan3
Alcoholism: Clinical and Experimental Research 2013:37(8);1410-1416
ALCOHOL - PRICING
16.
The role of alcohol price in young adult drinking cultures in Scotland
Pete Seaman, Fiona Edgar, Theresa Ikegwuonu
Drugs: Education, Prevention and Policy 2013:20(4);278-285
ALCOHOL – TREATMENT
17.
Understanding treatment delay among problem drinkers: What inhibits and
facilitates help-seeking?
Felix Naughton, Elena Alexandrou, Sarah Dryden, Julian Bath, Mark Giles
4
Drugs: Education, Prevention and Policy 2013:20(4);297-303
BLOOD BORNE VIRUSES
18.
Reducing heavy drinking in HIV primary care: a randomized trial of brief
intervention, with and without technological enhancement
Deborah S. Hasin, Efrat Aharonovich, Ann O'Leary, Eliana Greenstein, Martina
Pavlicova, Srikesh Arunajadai, Rachel Waxman, Milton Wainberg, John Helzer,
Barbara Johnston
Addiction 2013:108(7);1230-1240
19.
Self-reported alcohol abuse in HIV–HCV co-infected patients: a better predictor
of HIV virological rebound than physician's perceptions (HEPAVIH ARNS
CO13 cohort)
Fabienne Marcellin, Caroline Lions, Maria Winnock, Dominique Salmon, Jacques
Durant, Bruno Spire, Marion Mora, Marc-Arthur Loko, François Dabis, Stéphanie
Dominguez, Perrine Roux, Maria Patrizia Carrieri, ANRS CO13 HEPAVIH Study
Group
Addiction 2013:108(7);1250-1258
20.
Impact of Lifetime Alcohol Use on Liver Fibrosis in a Population of HIVInfected Patients With and Without Hepatitis C Coinfection
Daniel Fuster, Judith I. Tsui, Debbie M. Cheng, Emily K. Quinn, Carly Bridden,
David Nunes, Howard Libman, Richard Saitz, Jeffrey H. Samet
Alcoholism: Clinical and Experimental Research 2013:37(9);1527-1535
CLINICIANS
21.
Unintended effects of training on clinicians’ interest, confidence, and
commitment in using motivational interviewing
Suzanne E. Decker, Steve Martino
Drug and Alcohol Dependence 2013:132(3);681-687
22.
Meta-analysis of the effects of MI training on clinicians' behavior
Yves de Roten, Grégoire Zimmermann, Diana Ortega, Jean-Nicolas Despland
Journal of Substance Abuse Treatment 2013:45(2);155-162
CLINICIANS AND SERVICE PROVIDERS
23.
Working with substance use: Levels and predictors of positive therapeutic
attitudes across social care practitioners in England
Aisha Jane Hutchinson, Sarah Galvani, Cherilyn Dance
Drugs: Education, Prevention and Policy 2013:20(4);312-321
CO-MORBIDITY
24.
Characterizing the longitudinal patterns of substance use among individuals
diagnosed with serious mental illness after psychiatric hospitalization
Amber L. Bahorik, Christina E. Newhill, Shaun M. Eack
Addiction 2013:108(7);1259-1269
5
25.
Factor structure of PTSD symptoms in opioid-dependent patients rating their
overall trauma history
Madhavi K. Reddy, Bradley J. Anderson, Jane Liebschutz, Michael D. Stein
Drug and Alcohol Dependence 2013:132(3);597-602
26.
Hypertension, chronic obstructive pulmonary disease, diabetes and depression
among older methadone maintenance patients in British Columbia
Anna Maruyama, Scott Macdonald, Elizabeth Borycki, Jinhui Zhao
Drug and Alcohol Review 2013:32(4);412-418
27.
Impact of Addiction Severity and Psychiatric Comorbidity on the Quality of Life
of Alcohol-, Drug- and Dual-Dependent Persons in Residential Treatment
Colpaert K, De Maeyer J, Broekaert E, Vanderplasschen W
European Addiction Research0 2013:19(4);173–183
DRUG RELATED DEATH
28.
The contributions of viral hepatitis and alcohol to liver-related deaths in opioiddependent people
Sarah Larney, Deborah Randall, Amy Gibson, Louisa Degenhardt
Drug and Alcohol Dependence 2013:131:3);252-257
29.
Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS)
Scales for take-home naloxone training evaluation
Anna V. Williams, John Strang, John Marsden
Drug and Alcohol Dependence 2013:132(1-2);383-386
30.
All-cause mortality in criminal justice clients with substance use problems—A
prospective follow-up study
A. Hakansson, M. Berglund
Drug and Alcohol Dependence 2013:132(3);499-504
EPIDEMIOLOGY AND DEMOGRAPHY
31.
Substance use disorders in adolescents with attention deficit hyperactivity
disorder: a 4-year follow-up study
Annabeth P. Groenman, Jaap Oosterlaan, Nanda Rommelse, Barbara Franke, Herbert
Roeyers, Robert D. Oades, Joseph A. Sergeant, Jan K. Buitelaar, Stephen V. Faraone
Addiction 2013:108(8);1503-1511
32.
Personality traits and illicit substances: The moderating role of poverty
Angelina R. Sutin, Michele K. Evans, Alan B. Zonderman
Drug and Alcohol Dependence 2013:131(3);247-251
HEPATITIS C
33.
Low incidence of hepatitis C virus among prisoners in Scotland
Avril Taylor, Alison Munro, Elizabeth Allen, Karen Dunleavy, Sheila Cameron,
Laura Miller, Matthew Hickman
Addiction 2013:108(7);1296-1304
6
34.
Increased hepatitis C virus vaccine clinical trial literacy following a brief
intervention among people who inject drugs
Bethany White, Annie Madden, Margaret Hellard, Thomas Kerr, Maria Prins,
Kimberly Page, Gregory J. Dore, Lisa Maher
Drug and Alcohol Review 2013:32(4);419-425
INJECTING DRUG USE
35.
Patterns of injection drug use cessation during an expansion of syringe exchange
services in a Canadian setting
Dan Werb, Thomas Kerr, Jane Buxton, Jeannie Shoveller, Chris Richardson, Julio
Montaner, Evan Wood
Drug and Alcohol Dependence 2013:132(3);535-540
36.
The relationship between age and risky injecting behaviours among a sample of
Australian people who inject drugs
D. Horyniak, P. Dietze, L. Degenhardt, P. Higgs, F. McIlwraith, R. Alati, R. Bruno,
S. Lenton, L. Burns
Drug and Alcohol Dependence 2013:132(3);541-546
37.
Injecting practices in sexual partnerships: Hepatitis C transmission potentials in
a ‘risk equivalence’ framework
Magdalena Harris, Tim Rhodes
Drug and Alcohol Dependence 2013:132(3);617-623
MISCELLANEOUS
38.
Micromorphological changes in cardiac tissue of drug-related deaths with
emphasis on chronic illicit opioid abuse
Monika H. Seltenhammer, Katharina Marchart, Pia Paula, Nicole Kordina, Nikolaus
Klupp, Barbara Schneider, Christine Fitzl, Daniele U. Risser
Addiction 2013:108(7);1287-1295
39.
Clusters of personality traits and psychological symptoms associated with later
benzodiazepine prescriptions in the general population: The HUNT Cohort
Study
Trond Nordfjærn, Ottar Bjerkeset, Steven Moylan, Michael Berk, Rolf W. Gråwe
Addictive Behaviors 2013:38(10);2575-2580
40.
Binge drinking and sleep problems among young adults
Ioana Popovici, Michael T. French,
Drug and Alcohol Dependence 2013:132(1-2);207-215
41.
Catastrophic thinking and increased risk for prescription opioid misuse in
patients with chronic pain
M.O. Martel, A.D. Wasan, R.N. Jamison, R.R. Edwards
Drug and Alcohol Dependence 2013:132(1-2);335-341
7
42.
Promoting improvements in public health: Using a Social Norms Approach to
reduce use of alcohol, tobacco and other drugs
B. M. Bewick, D. Bell, S. Crosby, B. Edlin, S. Keenan, K. Marshall, G. Savva
Drugs: Eduction, Prevention and Policy 2013:20(4);322-330
43.
A systematic review of substance misuse assessment packages
Jennifer Sweetman, Duncan Raistrick, Noreen D. Mdege, Helen Crosby
Drug and Alcohol Review 2013:32(4);347-355
44.
Factors influencing pharmacy services in opioid substitution treatment
Betty B. Chaar, Holly Wang, Carolyn A. Day, Jane R. Hanrahan, Adam R. Winstock,
Romano Fois
Drug and Alcohol Review 2013:32(4);426-434
45.
In it for the long haul: developing recovery capital for long-term recovery
sustainment
Rowdy Yates
Journal of Substance Use 2013:18(5);339–339
NEW PSYCHOACTIVE SUBSTANCES
46.
Do Novel Psychoactive Substances Displace Established Club Drugs, Supplement
Them or Act as Drugs of Initiation? The relationship between Mephedrone,
Ecstasy and Cocaine
Moore K, Dargan P.I, Wood D.M, Measham F
European Addiction Research 2013:19(5);276-282
OPIATE TREATMENT
47.
Injectable extended-release naltrexone (XR-NTX) for opioid dependence: longterm safety and effectiveness
Evgeny Krupitsky, Edward V. Nunes, Walter Ling, David R. Gastfriend, Asli
Memisoglu, Bernard L. Silverman
Addiction 2013:108(9);1628-1637
48.
Stakeholders in Opioid Substitution Treatment Policy: Similarities and
Differences in Six European Countries
Betsy Thom, Karen Duke, Vibeke Asmussen Frank, Bagga Bjerge
Substance Use & Misuse 2013:48(11);933-942
49.
Substitution Treatment in the Era of “Recovery”: An Analysis of Stakeholder
Roles and Policy Windows in Britain
Karen Duke, Rachel Herring, Anthony Thickett and Betsy Thom
Substance Use & Misuse 2013:48(11);966-976
50.
Substitution Treatment in the Era of “Recovery”: An Analysis of Stakeholder
Roles and Policy Windows in Britain
Karen Duke, Rachel Herring, Anthony Thickett and Betsy Thom
Substance Use & Misuse 2013:48(11);966-976
8
51.
Treatment or “high”: Benzodiazepine use in patients on injectable heroin or oral
opioids
Marc Vogel, Bina Knöpfli, Otto Schmid, Mari Prica, Johannes Strasser, Luis Prieto,
Gerhard A. Wiesbeck, Kenneth M. Dürsteler-MacFarland
Addictive Behaviors 2013:38(10);2477-2484
52.
Primary care patient characteristics associated with completion of 6-month
buprenorphine treatment
Anne M. Neumann, Richard D. Blondell, Mohammadreza Azadfard, Ganon Nathan,
Gregory G. Homish
Addictive Behaviors 2013:38(11);2724-2728
53.
Benzodiazepine use during buprenorphine treatment for opioid dependence:
Clinical and safety outcomes
Zev Schuman-Olivier, Bettina B. Hoeppner, Roger D. Weiss, Jacob Borodovsky,
Howard J. Shaffer, Mark J. Albanese
Drug and Alcohol Dependence 2013:132(3);580-586
54.
Correlates of pain in an in-treatment sample of opioid-dependent people
Suzanne Nielsen, Briony Larance, Nicholas Lintzeris, Emma Black, Raimondo
Bruno, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt
Drug and Alcohol Review 2013:32(5);489-494
55.
Social Network Support for Individuals Receiving Opiate Substitution
Treatment and Its Association with Treatment Progress
Day E, Copello A, Karia M, Roche J, Grewal P, George S, Haque S, Chohan G
European Addiction Research 2013;19(4):211–221
56.
Profiles of quality of life in opiate-dependent individuals after starting
methadone treatment: A latent class analysis
Jessica De Maeyer, Chijs van Nieuwenhuizen, Ilja L. Bongers, Eric Broekaert,
Wouter Vanderplasschen
International Journal of Drug Policy 2013:24(4);342-350
57.
Community opioid treatment perspectives on contingency management:
Perceived feasibility, effectiveness, and transportability of social and financial
incentives
Bryan Hartzler, Carl Rabun
Journal of Substance Abuse Treatment 2013:45(2);242-248
58.
The role of abstinence and activity in the quality of life of drug users engaged in
treatment
David Best, Michael Savic, Melinda Beckwith, Stuart Honor, Justine Karpusheff,
Dan I. Lubman
Journal of Substance Abuse Treatment 2013:45(3);273-279
9
59.
QTc interval prolongation for patients in methadone maintenance treatment: a
five years follow-up study
Ayman Fareed, Sreedevi Vayalapalli, Kelly Scheinberg, Robin Gale, Jennifer
Casarella, Karen Drexler
The American Journal of Drug and Alcohol Abuse 2013:39(4);235-240
60.
Prevalence of tobacco, cocaine and alcohol use amongst patients attending for
methadone-maintenance therapy in a rural setting
Omar Henriquez-Gonzalez, Robert Patton
Journal of Substance Use 2013:18(5);340-348
ORGANISATION OF SERVICES
61.
Predictors of study setting (primary care vs. hospital setting) among studies of
the effectiveness of brief interventions among heavy alcohol users: A systematic
review
Noreen Dadirai Mdege, Judith Watson
Drug and Alcohol Review 2013:32(4);368-380
PRIMARY CARE
62.
Acceptability of screening for early detection of liver disease in
hazardous/harmful drinkers in primary care
Eyles, Caroline; Moore, Michael; Sheron, Nicholas; Roderick, Paul; O’Brien,
Wendy; Leydon, Geraldine M
British Journal of General Practice 2013:63(613);e516-e522(7)
63.
An examination of the influences on New South Wales general practitioners
regarding the provision of opioid substitution therapy
Simon Holliday, Parker Magin, Christopher Oldmeadow, John Attia, Janet Dunbabin,
Julie-Marie Henry, Nicholas Lintzeris, Susan Goode, Adrian Dunlop
Drug and Alcohol Review 2013:32(5);495-503
10
ALCOHOL – ADOLESCENTS
1. The impact of school alcohol policy on student drinking
Tracy J. Evans-Whipp, Stephanie M. Plenty, Richard F. Catalano,Todd I. Herrenkohl, John
W. Toumbourou
Health Education Research 2013;28(4);651-662
Abstract
Although it is common for secondary schools to implement alcohol policies to reduce alcohol
misuse, there has been little evaluation of the efficacy of these policies. The purpose of this
study was to test the impact of the degree and type of alcohol policy enforcement in state
representative samples of secondary students in Washington State, USA, and Victoria,
Australia (n¼1848). Multivariate logistic regressions were used to examine the prospective
association between student reports of school alcohol policy in Grade 8 and self-reported
alcohol use inGrade 9, controlling for age, gender, state, family socioeconomic status and
Grade 8 alcohol use. The likelihood of students drinking on school grounds was increased
when students perceived lax policy enforcement. Student perceptions of harm minimization
alcohol messages, abstinence alcohol messages and counselling for alcohol policy violators
predicted reduced likelihood of binge drinking. Students perceiving harm minimization
messages and counselling for alcohol policy violators had a reduced likelihood of
experiencing alcohol-related harms. Perceptions of harsh penalties were unrelated to drinking
behaviour. These results suggest that perceived policy enforcement may lessen drinking at
school 1 year later and that harm minimization messages and counselling approaches may
also lessen harmful drinking behaviours as harm minimization advocates suggest.
2. Brain Structure in Adolescents and Young Adults with Alcohol Problems:
Systematic Review of Imaging Studies
Killian A.Welch, Alan Carson, Stephen M. Lawrie
Alcohol and Alcoholism 2013:48(4);433-444
Abstract
Aims Alcohol-dependent people who are middle-aged or older have a widespread loss of
cortical grey and white matter, particularly in the prefrontal cortex (PFC). We examine if
brain abnormalities are detectable in alcohol use disorders before the fifthdecade (i.e. <40),
and the brain structural differences associated with alcohol abuse/dependence in adolescence.
Methods Case–control studies comparing brain structure in alcohol-abusing/-dependent
individuals with normal controls in which the mean age of participants was <40 were
identified using Medline, EMBASE and PsychInfo. Studies in which mean age was over and
under 21 were considered separately. Results Twelve papers fulfilled inclusion criteria, five
in the adolescent (14–21) and seven in the young adult age range. Two independent groups
reported hippocampal and prefrontal volume reductions in adolescents, although this was
consistently observed only in females. In young adults (aged 21–40), there were grey matter
deficits in the PFC in both sexes. Adult women appeared to, particularly, exhibit white matter
differences, evident as reduced area of the corpus callosum. Hippocampal volume reduction
was observed in one study of young adults study but not another. Conclusion The available
data suggest that quantitative structural abnormalities of the brain are detectable in young
alcohol abusers. There is overlap between the abnormalities seen in adolescents and young
11
adults, although hippocampal volume loss is most consistently seen in the former group. The
adolescent hippocampus may be particularly susceptible to alcohol, potentially because of an
interaction between adolescent brain development and alcohol exposure.
3. A 26-Year Follow-Up Study of Heavy Drinking Trajectories from Adolescence to
Mid-Adulthood and Adult Disadvantage
Noora Berg1, Olli Kiviruusu, Sakari Karvonen, Laura Kestilä, Tomi Lintonen, Ossi
Rahkonen, Taina Huurre
Alcohol and Alcoholism 2013:48(4);452-457
Abstract
Aims The aim of the study was to identify heavy drinking trajectories from age 16 to 42
years and to examine their associations with health, social, employment and economic
disadvantage in mid-adulthood. Methods Finnish cohort study’s participants who were 16
years old in 1983 were followed up at age 22, 32 and 42 (n = 1334). Heavy drinking was
assessed at every study phase and based on these measurements trajectories of heavy drinking
were identified. The trajectory groups were then examined as predictors of disadvantage at
age 42. Results Five distinct heavy drinking trajectories were identified: moderate (35%),
steady low (22%), decreasing (9%), increasing (11%) and steady high (23%). Frequencies of
the trajectory groups differed by gender. Using the moderate trajectory as a reference
category, women in the steady high trajectory had an increased risk of experiencing almost
all disadvantages at age 42. In men, increasing and steady high groups had an increased risk
for experiencing health and economic disadvantage. Conclusion Steady high female
drinkers and steady high and increasing male drinkers had the highest risk for disadvantage in
mid-adulthood. By identifying heavy drinking trajectories from adolescence to mid-adulthood
we can better predict long-term consequences of heavy alcohol use and plan prevention and
intervention programmes.
4. Young people talking about alcohol: Focus groups exploring constructs in the
prototype willingness model
Emma L. Davies, Jilly Martin, David R. Foxcroft
Drugs: Education, Prevention and Policy 2013:20(4);269-277
Abstract
Aim This study aimed to explore constructs in the prototype willingness model (PWM) to
establish if it provides a basis for understanding and preventing alcohol misuse in teenagers
in the UK. Methods Four focus groups were carried out with 11–13 and 16–17 year olds.
There were 13 males and 14 females. Transcripts of the focus groups were analysed using
thematic analysis in NVivo. Findings Three PWM relevant themes were identified. The first
theme brought together the alcohol prototypes described by participants. The second theme
addressed drinking contexts and contrasts evidence that suggests that some drinking is
planned and some is unplanned. The final theme looks at attitudes and norms including
participants’ attitudes towards alcohol education. Conclusions The findings from this study
show that young people in this sample held clear prototypes in relation to alcohol. The
evident difference between ‘planned’ and ‘unplanned’ drinking contexts suggests that the
PWM provides a more satisfactory explanation of young people's drinking than a decisional
model based on intentions alone. Drinking alcohol was reported by the participants as a
12
normative teenage behaviour. Implications for an intervention programme targeting alcohol
prototypes and future research are discussed.
5. The Impact of Parenting Styles on Adolescent Alcohol Use: The TRAILS Study
Visser L, de Winter A.F, Vollebergh W.A.M, Verhulst F.C, Reijneveld S.A
European Addiction Research 2013:19(4);165-172
Abstract
Aims To investigate the influence of parenting styles (overprotection, emotional warmth,
and rejection) in early adolescence on regular alcohol use in late adolescence. Methods We
analyzed data from the first three waves (mean ages: 11.09, 13.56, and 16.27 years,
respectively) of a population-based prospective cohort study of 2,230 adolescents, conducted
between 2001 and 2007. Adolescents reported on parental overprotection, emotional warmth,
and rejection (T1). Regular alcohol use was defined as six and seven glasses or more a week
for girls and boys, respectively. We further assessed family socioeconomic status, parental
divorce, parental alcohol use, educational level of the adolescent, and alcohol use at baseline.
Results Parental overprotection had the strongest relationship to regular alcohol use:
adolescents who perceived more parental overprotection were at increased risk of developing
regular alcohol use, even after adjustment for several confounders. Rejection was not related
to adolescents’ alcohol use and, after adjustment for the other variables, neither was
emotional warmth. Conclusion Overprotective parenting is a determinant of future regular
adolescent alcohol use and therefore health professionals should pay particular attention to
those adolescents who have overprotective parents. The role of adolescent characteristics in
the relationship between overprotection and alcohol use deserves further study
Keywords: Parenting styles; Alcohol use; Adolescents
6. How do drug and alcohol use relate to parental bonding and risk perception in
university students?
Tomas Jurcik, Richard Moulding, Emma Naujokaitis
Journal of Substance Use 2013:18(4);254-261
Abstract
Alcohol and drug use are major health concerns on university and college campuses. It has
previously been found that parental rearing patterns are related to the frequency of substance
use. Further, perceptions that drug use is dangerous have been found to be related to less
substance use. However, little research has directly examined the impact of parental rearing
patterns on substance use by university students, and no research has examined the effects of
both risk perception and parenting on substance use. Therefore, this research surveyed the
frequency and extent of alcohol, cigarette and illicit drug use by students (N = 336) at a
Canadian university residence, classes and health services and examined the relationship
between the results with parental bonding and risk perception. It was found that “affectionless
control” parenting patterns in the mother, but not the father, were related to greater drinking
and drinking problems and to the use of illicit substances. Lower perceptions of risk were
related to greater use of alcohol, cigarettes, cannabis and other illicit substances.
Unexpectedly, there was little relationship between parental rearing and risk perceptions,
suggesting that there are other avenues whereby parenting leads to greater alcohol use.
Implications are discussed.
Keywords: Substances, risk, parenting
13
ALCOHOL – EPIDEMIOLOGY AND DEMOGRAPHY
7. Alcohol use disorders and mortality: a systematic review and meta-analysis
Michael Roerecke, Jürgen Rehm
Addiction 2013:108(9);1562-1578
Abstract
Aims To conduct a systematic review and meta-analysis on all-cause mortality in people
with alcohol use disorders. Methods Using the Meta-analysis Of Observational Studies in
Epidemiology (MOOSE) guidelines, studies were identified through MEDLINE, EMBASE,
and Web of Science up to August, 2012. Prospective and historical cohort studies including a
comparison of alcohol use disorder with a control group investigating all-cause mortality risk
were included. Results This meta-analysis included 81 observational studies with 221 683
observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk
(RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98–3.84); in women
it was 4.57 (95% CI: 3.86–5.42). Alcohol use disorders identified in general population
surveys showed a twofold higher risk compared with no alcohol use disorder in men; no data
were available for women. RRs were markedly higher for those ≤40 years old (ninefold in
men, 13-fold in women) while still being at least twofold among those aged 60 years or older.
Conclusions Mortality in people with alcohol use disorders is markedly higher than thought
previously. Women have generally higher mortality risks than men. Among all people with
alcohol use disorders, people in younger age groups and people in treatment show
substantially higher mortality risk than others in that group.
Keywords: Alcohol use disorder; clinical studies; cohort studies; meta-analysis; mortality;
population studies; systematic review
8. Alcohol-attributable mortality in France
Sylvie Guérin, Agnès Laplanche, Ariane Dunant and Catherine Hill
European Journal of Public Health 2013;23(4):588-593
Abstract
Background Alcohol consumption is high in France. Aim Estimation of alcoholattributable mortality in France by sex, age and dose, for year 2009. Method We combined
survey and sales data to estimate the prevalence of alcohol consumption by age, sex and dose
category. For each cause of death, the relative risk of death as a function of dose was
obtained from a meta-analysis and combined with prevalence data to obtain the attributable
fraction; this fraction multiplied by the number of deaths gave the alcohol-attributable
mortality. Results A total of 36 500 deaths in men are attributable to alcohol in France in
2009 (13% of total mortality) versus 12 500 in women (5% of total mortality). Overall, this
includes 15 000 deaths from cancer, 12 000 from circulatory disease, 8000 from digestive
system disease, 8000 from external causes and 3000 from mental and behavioural disorder.
The alcohol-attributable fractions are 22% and 18% in the population aged 15 to 34 and 35 to
64, respectively, versus 7% among individuals aged 65 or more. Alcohol is detrimental even
at a low dose of 13 g per day, causing 1100 deaths. Conclusion With 49 000 deaths in
France for the year 2009, the alcohol toll is high, and the effect of alcohol is detrimental even
at low dose. Alcohol consumption is responsible for a large proportion of premature deaths.
14
These results stress the importance of public health policies aimed at reducing alcohol
consumption in France.
9. Reduction of Drinking in Problem Drinkers and All-Cause Mortality
J. Rehm, M. Roerecke
Alcohol and Alcoholism 2013:48(4);509-513
Abstract
Alcohol consumption has been linked with considerable mortality, and reduction of drinking,
especially of heavy drinking, has been suggested as one of the main measures to reduce
alcohol-attributable mortality. Aggregate-level studies including but not limited to natural
experiments support this suggestion; however, causality cannot be established in ecological
analysis. The results of individual-level cohort studies are ambiguous. On the other hand,
randomized clinical trials with problem drinkers show that brief interventions leading to a
reduction of average drinking also led to a reduction of all-cause mortality within 1 year. The
results of these studies were pooled and a model for reduction of drinking in heavy drinkers
and its consequences for all-cause mortality risk was estimated. Ceteris paribus, the higher
the level of drinking, the stronger the effects of a given reduction. Implications
for interventions and public health are discussed.
15
ALCOHOL – LIVER
10. Prevalence of Hepatitis C Virus Infection in Alcoholic Patients: Cohort Study and
Systematic Review
Ignacio Novo-Veleiro, Cristina de la Calle, Susana Domínguez-Quibén, Isabel Pastor, Miguel
Marcos, Francisco-Javier Laso
Alcohol and Alcoholism 2013:48(5);564-569
Abstract
Aims Prevalence of chronic hepatitis C virus (HCV) infection among alcoholics is thought to
be higher than in the general population, although prevalence rates reported are quite
variable. Our study is aimed to analyze HCV prevalence in a cohort of alcoholics
and to perform a systematic review on this topic. Patients and methods: A total of 396
alcoholic patients consecutively referred to our Alcoholism Unit were included. HCV
infection status and other clinical variables were recorded for each patient. Variables
associated with HCV infection were analyzed by means of logistic regression. Additionally,
we performed a systematic review focused on previous studies on this topic. Results Among
our alcoholic patients, 14 of them (3.53%) had chronic HCV infection. Variables
independently associated with HCV infection were female gender, injection drug use (IDU)
and the presence of alcoholic liver disease (ALD). Twenty-four studies analyzing HCV
prevalence in alcoholic patients were included in our systematic review, showing prevalence
rates of HCV infection ranging from 2.1 to 51% and an average weighted prevalence of
16.32%. Conclusion In our series, the prevalence rate of chronic HCV infection among
alcoholic patients is lower than previously reported, which is probably explained by
the relatively low number of patients with ALD or IDU in our sample. Prevalence rates
previously published are quite different and the presence of ALD and/or IDU can act as
confounding factors for HCV prevalence among alcoholics.
16
ALCOHOL MISCELLANEOUS
11. Overlooked and underestimated? Problematic alcohol use in clients recovering
from drug dependence
Petra K. Staiger, Ben Richardson, Caroline M. Long, Victoria Carr, G. Alan Marlatt
Addiction 2013:108(7);1188-1193
Abstract
Aims Despite recognition of the harms related to alcohol misuse and its potential to interfere
substantially with sustained recovery from drug dependency, research evaluating drug
treatment outcomes has not addressed the issue comprehensively. It has been overlooked
possibly because treatment research has been framed according to the primary drug of choice,
rather than investigating the interactions between different combinations of drugs and/or
alcohol use. This paper reports on a systematic review investigating whether concurrent
alcohol use could impede recovery from illicit drug use in two potential ways: first, alcohol
could become a substitute addiction and/or secondly, alcohol misuse post-treatment may
place an individual at risk for relapse to their primary drug problem. Method A systematic
search of four relevant databases was undertaken to identify peer-reviewed, quantitative drug
treatment outcome studies that reported alcohol use pre-, post-treatment and follow-up.
Results The search revealed 567 papers, of which 13 were assessed as fulfilling the key
inclusion criteria.The review indicated inconsistent and therefore inconclusive support for the
substitution hypothesis. However, the data revealed consistent support for the hypothesis that
alcohol use increases relapse to drug use. Conclusions (i) The potential negative impact of
alcohol misuse on drug treatment outcomes remains under-researched and overlooked; (ii)
alcohol consumption post-drug treatment may increase the likelihood that an individual will
relapse to their primary drug; (ii) existing evidence regarding the substitution hypothesis is
inconclusive, although there was an indication that a subgroup of participants will be
vulnerable to alcohol becoming the primary addiction instead of drugs. We argue that future
drug treatment outcome studies need to include detailed analysis of the influence of alcohol
use pre- and post-drug treatment.
Keywords: Alcohol misuse; drug dependence; illicit drug use; longitudinal studies;
outcomes studies; recovery; relapse; residential drug treatment; substitution
12. Alcohol-selling outlets and mortality in Switzerland—the Swiss National Cohort
Adrian Spoerri, Marcel Zwahlen, Radoslaw Panczak, Matthias Egger, Anke Huss,
Swiss National Cohort
Addiction 2013:108(9);1603-1611
Abstract
Aim To examine the association of alcohol-related mortality and other causes of death with
neighbourhood density of alcohol-selling outlets for on-site consumption. Design, setting
and participants Longitudinal study of the adult Swiss population (n = 4 376 873) based on
census records linked to mortality data from 2001 to 2008. Measurements Sex-specific
hazard ratios (HR) for death and 95% confidence intervals (95%CI) were calculated using
Cox models adjusting for age, educational level, occupational attainment, marital status and
other potential confounders. The density of alcohol-selling outlets within 1000 m of the
residence was calculated using geocodes of outlets and residences. Findings Compared with
>17 outlets within 1000 m the HR for alcohol-related mortality in men was 0.95 (95%CI:
17
0.89–1.02) for 8–17 outlets, 0.84 (95%CI: 0.77–0.90) for 3–7 outlets, 0.76 (95%CI: 0.68–
0.83) for 1–2 outlets and 0.60 (95%CI: 0.51–0.72) for 0 outlets. The gradient in women was
somewhat steeper, with a HR comparing 0 with >17 outlets of 0.39 (95%CI: 0.26–0.60).
Mortality from mental and behavioural causes and lung cancer were also associated with
density of alcohol-selling outlets: HRs comparing 0 outlets with >17 outlets were 0.64
(95%CI: 0.52–0.79) and 0.79 (95%CI: 0.72–0.88), respectively, in men and 0.46 (95%CI:
0.27–0.78) and 0.63 (95%CI: 0.52–0.77), respectively, in women. There were weak
associations in the same direction with all-cause mortality in men but not in women.
Conclusions In Switzerland, alcohol-related mortality is associated with the density of
outlets around the place of residence. Community-level interventions to reduce alcohol outlet
density may usefully complement existing interventions.
Keywords: Alcohol-related mortality; cohort studies; density of alcohol outlets;
Switzerland
13. A Qualitative Study of Alcohol, Health and Identities among UK Adults in Later
Life
Graeme B. Wilson, Eileen F. S. Kaner, Ann Crosland, Jonathan Ling, Karen McCabe,
Catherine A. Haighton
PloS One 2013:8(8);e71792
Abstract
Increasing alcohol consumption among older individuals is a public health concern. Lay
understandings of health risks and stigma around alcohol problems may explain why public
health messages have not reduced rates of heavy drinking in this sector. A qualitative study
aimed to elucidate older people's reasoning about drinking in later life and how this interacted
with health concerns, in order to inform future, targeted, prevention in this group. In 2010 a
diverse sample of older adults in North East England (ages 50–95) participated in interviews
(n = 24, 12 male, 12 female) and three focus groups (participants n = 27, 6 male, 21 female).
Data were analysed using grounded theory and discursive psychology methods. When talking
about alcohol use older people oriented strongly towards opposed identities of normal or
problematic drinker, defined by propriety rather than health considerations. Each of these
identities could be applied in older people's accounts of either moderate or heavy drinking.
Older adults portrayed drinking less alcohol as an appropriate response if one experienced
impaired health. However continued heavy drinking was also presented as normal behaviour
for someone experiencing relative wellbeing in later life, or if ill health was construed as
unrelated to alcohol consumption. Older people displayed scepticism about health advice on
alcohol when avoiding stigmatised identity as a drinker. Drinking patterns did not appear to
be strongly defined by gender, although some gendered expectations of drinking were
described. Identities offer a useful theoretical concept to explain the rises in heavy drinking
among older populations, and can inform preventive approaches to tackle this. Interventions
should engage and foster positive identities to sustain healthier drinking and encourage at the
community level the identification of heavy drinking as neither healthy nor synonymous with
dependence. Future research should test and assess such approaches.
18
14. Physiological and Endocrine Reactions to Psychosocial Stress in Alcohol Use
Disorders: Duration of Abstinence Matters
Katrin Starcke, Ruth J. van Holst, Wim van den Brink, Dick J. Veltman, Anna E. Goudriaan
Alcoholism: Clinical and Experimental Research 2013:37(8);1343-1350
Abstract
Background Recent research findings suggest that heavy alcohol use is associated with
alterations of the hypothalamic–pituitary–adrenal axis and autonomic nervous system
function and that early abstinence is associated with blunted stress responsiveness.
Methods This study investigated abstinent alcohol-dependent participants (AADs; n = 31),
who had a drinking history of levels about 97 drinks per week (abstinence range: 2 weeks to
24 months), actively drinking problem drinkers (PRDs; n = 23), who reported drinking levels
about 47 drinks per week and who were abstinent for at least 24 hours, and healthy control
(HC) participants (n = 20). It was investigated how participants responded to a psychosocial
stress task. All of them were exposed to a modified Trier Social Stress Test. Salivary cortisol,
heart rate, skin conductance levels, and negative affect were assessed as stress indicators.
Results AADs showed stress reactions comparable to HC participants, whereas active PRDs
showed increased heart rate and cortisol stress responses. In the AAD group, duration of
abstinence was positively related to cortisol stress responses. Conclusions Active PRDs
showed increased responses to psychosocial stress. Results indicate that duration of
abstinence is a key factor when analyzing and interpreting stress responses in alcohol abuse
and dependence.
Keywords: Alcohol Dependence; Problem Drinking; Stress; Cortisol; Heart Rate
15. Examining the Relationship Between Alcohol-Energy Drink Risk Profiles and HighRisk Drinking Behaviors
Lindsey Varvil-Weld, Miesha Marzell, Rob Turrisi, Kimberly A. Mallett, Michael J.
Clevelan3
Alcoholism: Clinical and Experimental Research 2013:37(8);1410-1416
Abstract
Background The mixing of alcohol and energy drinks (AMEDs) is a trend among college
students associated with higher rates of heavy episodic drinking and negative alcohol-related
consequences. The goals of this study were to take a person-centered approach to identify
distinct risk profiles of college students based on AMED-specific constructs (expectancies,
attitudes, and norms) and examine longitudinal associations between AMED use, drinking,
and consequences. Methods A random sample of incoming freshmen (n = 387, 59%
female) completed measures of AMED use, AMED-specific expectancies, attitudes, and
normative beliefs, and drinking quantity and alcohol-related consequences. Data were
collected at 2 occasions: spring semester of freshmen year and fall semester of sophomore
year. Results Latent profile analysis identified 4 subgroups of individuals: occasional
AMED, anti-AMED, pro-AMED, and strong peer influence. Individuals in the pro-AMED
group reported the most AMED use, drinking, and consequences. There was a unique
association between profile membership and AMED use, even after controlling for drinking.
Conclusions Findings highlighted the importance of AMED-specific expectancies, attitudes,
and norms. The unique association between AMED risk profiles and AMED use suggests
AMED use is a distinct behavior that could be targeted by AMED-specific messages included
in existing brief interventions for alcohol use.
19
Keywords: Alcohol-Energy Drink Cocktails; College Students; High-Risk Drinking;
Alcohol-Related Consequences
20
ALCOHOL - PRICING
16. The role of alcohol price in young adult drinking cultures in Scotland
Pete Seaman, Fiona Edgar, Theresa Ikegwuonu
Drugs: Education, Prevention and Policy 2013:20(4);278-285
Abstract
Minimum Unit Pricing (MUP) is one of the Scottish Government's key policy options to
reduce alcohol consumption and related harm. Although strongly evidenced for efficacy in
reducing headline population level consumption, efficacy in changing the role of alcohol in
Scottish culture is unknown. Questions remain as to how MUP will play across population
subgroups with different sensitivities to price. In this paper we explore the views of the young
adult population and situate the influence of price paid for alcohol alongside broader cultural
drivers of consumption. Qualitative data from two studies investigating the role of alcohol in
the transition to adulthood from 130 participants (aged 16–30) are analysed to situate the
influence of price paid in shaping drinking styles and practices. Findings highlight how
considerations of price paid for alcohol compete with non-financial considerations associated
with choosing to drink excessively, moderately or not at all. Two broad categories of
response to potential price increases were anticipated by drinkers which indicate that young
adults are not a homogenous group in relation to price sensitivity. These differences highlight
the potential for variation in subgroup responses to a pricing policy conceived to be effective
at a population level.
21
ALCOHOL – TREATMENT
17. Understanding treatment delay among problem drinkers: What inhibits and
facilitates help-seeking?
Felix Naughton, Elena Alexandrou, Sarah Dryden, Julian Bath, Mark Giles
Drugs: Education, Prevention and Policy 2013:20(4);297-303
Abstract
Aims Problem drinkers are reported to take an average of nine years to seek specialist
alcohol treatment after recognizing they have a problem. We undertook an in-depth
qualitative study to better understand why this delay occurred. Methods In-depth semistructured interviews with problem drinkers with varying levels of treatment experience
(N = 19). The data were analysed using thematic analysis. Findings The resolution of
drinking-related interference on a number of life domains emerged as the primary motivator
for seeking help. These domains included social relationships, living conditions, criminality,
poor health and social stigma. Where there was an absence of interference, treatment seeking
behaviour was delayed. However, the influence of these domains was not always consistent;
a delay influence for one individual sometimes acted as a help-seeking influence for another.
The help-seeking pathway for many of these individuals was highly iterative and experience
of receiving professional help often occurred before they had accepted that help was needed.
Conclusion Problem drinkers primarily sought help to alleviate psychosocial, health and
situational problems rather than to stop drinking per se. The findings highlight the challenges
of engaging these individuals in professional support and the wider benefits of further
understanding treatment seeking pathways for early problem detection and treatment.
22
BLOOD BORNE VIRUSES
18. Reducing heavy drinking in HIV primary care: a randomized trial of brief
intervention, with and without technological enhancement
Deborah S. Hasin, Efrat Aharonovich, Ann O'Leary, Eliana Greenstein, Martina Pavlicova,
Srikesh Arunajadai, Rachel Waxman, Milton Wainberg, John Helzer, Barbara Johnston
Addiction 2013:108(7);1230-1240
Abstract
Aims In HIV-infected individuals, heavy drinking compromises survival. In HIV primary
care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown,
alcohol-dependent patients may need greater intervention and resources are limited. Using
interactive voice response (IVR) technology, HealthCall was designed to enhance MI via
daily patient self-monitoring calls to an automated telephone system with personalized
feedback. We tested the efficacy of MI-only and MI+HealthCall for drinking reduction
among HIV primary care patients. Design Parallel random assignment to control (n = 88),
MI-only (n = 82) or MI+HealthCall (n = 88). Counselors provided advice/education (control)
or MI (MI-only or MI+HealthCall) at baseline. At 30 and 60 days (end-of-treatment),
counselors briefly discussed drinking with patients, using HealthCall graphs with
MI+HealthCall patients. Setting Large urban HIV primary care clinic. Participants
Patients consuming ≥4 drinks at least once in prior 30 days. Measurements Using time-line
follow-back, primary outcome was number of drinks per drinking day, last 30 days.
Findings End-of-treatment number of drinks per drinking day (NumDD) means were 4.75,
3.94 and 3.58 in control, MI-only and MI+HealthCall, respectively (overall model χ2,
d.f. = 9.11,2, P = 0.01). For contrasts of NumDD, P = 0.01 for MI+HealthCall versus control;
P = 0.07 for MI-only versus control; and P = 0.24 for MI+HealthCall versus MI-only.
Secondary analysis indicated no intervention effects on NumDD among non-alcoholdependent patients. However, for contrasts of NumDD among alcohol-dependent patients,
P < 0.01 for MI+HealthCall versus control; P = 0.09 for MI-only versus control; and P = 0.03
for MI+HealthCall versus MI-only. By 12-month follow-up, although NumDD remained
lower among alcohol-dependent patients in MI+HealthCall than others, effects were no
longer significant. Conclusions For alcohol-dependent HIV patients, enhancing MI with
HealthCall may offer additional benefit, without extensive additional staff involvement.
Keywords: Alcohol dependence; brief intervention; drinking; HIV; interactive voice
response; IVR; motivational interviewing; primary care; randomized trial; technology
19. Self-reported alcohol abuse in HIV–HCV co-infected patients: a better predictor of
HIV virological rebound than physician's perceptions (HEPAVIH ARNS CO13 cohort)
Fabienne Marcellin, Caroline Lions, Maria Winnock, Dominique Salmon, Jacques Durant,
Bruno Spire, Marion Mora, Marc-Arthur Loko, François Dabis, Stéphanie Dominguez,
Perrine Roux, Maria Patrizia Carrieri, ANRS CO13 HEPAVIH Study Group
Addiction 2013:108(7);1250-1258
Abstract
Aims Studying alcohol abuse impact, as measured by physicians' perceptions and patients'
self-reports, on HIV virological rebound among patients chronically co-infected with HIV
and hepatitis C virus (HCV). Design Cohort study. Setting Seventeen French hospitals.
23
Participants Five hundred and twelve patients receiving antiretroviral therapy (ART) with
an undetectable initial HIV viral load and at least two viral load measures during follow-up.
Measurements Medical records and self-administered questionnaires. HIV virological
rebound defined as HIV viral load above the limit of detection of the given hospital's
laboratory test. Alcohol abuse defined as reporting to have drunk regularly at least 4 (for
men) or 3 (for women) alcohol units per day during the previous 6 months. Correlates of time
to HIV virological rebound identified using Cox proportional hazards models. Findings At
enrolment, 9% of patients reported alcohol abuse. Physicians considered 14.8% of all
participants as alcohol abusers. Self-reported alcohol abuse was associated independently
with HIV virological rebound [hazard ratio (95% confidence interval): 2.04 (1.13–3.67);
P = 0.02], after adjustment for CD4 count, time since ART initiation and hospital HIV
caseload. No significant relationship was observed between physician-reported alcohol abuse
and virological rebound (P = 0.87). Conclusions In France, the assessment of alcohol abuse
in patients co-infected with HIV and hepatitis C virus should be based on patients' selfreports, rather than physicians' perceptions. Baseline screening of self-reported alcohol abuse
may help identify co-infected patients at risk of subsequent HIV virological rebound.
Keywords: Alcohol abuse; HIV–HCV co-infection; physicians' perceptions; self-reports;
virological rebound
20. Impact of Lifetime Alcohol Use on Liver Fibrosis in a Population of HIV-Infected
Patients With and Without Hepatitis C Coinfection
Daniel Fuster, Judith I. Tsui, Debbie M. Cheng, Emily K. Quinn, Carly Bridden,
David Nunes, Howard Libman, Richard Saitz, Jeffrey H. Samet
Alcoholism: Clinical and Experimental Research 2013:37(9);1527-1535
Abstract
Background The effect of alcohol on liver disease in HIV infection has not been well
characterized. Methods We performed a cross-sectional multivariable analysis of the
association between lifetime alcohol use and liver fibrosis in a longitudinal cohort of HIVinfected patients with alcohol problems. Liver fibrosis was estimated with 2 noninvasive
indices, “FIB-4,” which includes platelets, liver enzymes, and age; and aspartate
aminotransferase/platelet ratio index (“APRI”), which includes platelets and liver enzymes.
FIB-4 <1.45 and APRI <0.5 defined the absence of liver fibrosis. FIB-4 >3.25 and APRI >1.5
defined advanced liver fibrosis. The main independent variable was lifetime alcohol
consumption (<150 kg, 150 to 600 kg, >600 kg). Results Subjects (n = 308) were 73% men,
mean age 43 years, 49% with hepatitis C virus (HCV) infection, 60% on antiretroviral
therapy, 49% with an HIV RNA load <1,000 copies/ml, and 18.7% with a CD4 count
<200 cells/mm3. Forty-five percent had lifetime alcohol consumption >600 kg, 32.7% 150 to
600 kg, and 22.3% <150 kg; 33% had current heavy alcohol use, and 69% had >9 years of
heavy episodic drinking. Sixty-one percent had absence of liver fibrosis and 10% had
advanced liver fibrosis based on FIB-4. In logistic regression analyses, controlling for age,
gender, HCV infection, and CD4 count, no association was detected between lifetime alcohol
consumption and the absence of liver fibrosis (FIB-4 <1.45) (adjusted odds ratio
[AOR] = 1.12 [95% CI: 0.25 to 2.52] for 150 to 600 kg vs. <150 kg; AOR = 1.11 [95% CI:
0.52 to 2.36] for >600 kg vs. <150 kg; global p = 0.95). Additionally, no association was
detected between lifetime alcohol use and advanced liver fibrosis (FIB-4 >3.25). Results were
similar using APRI, and among those with and without HCV infection. Conclusions In this
cohort of HIV-infected patients with alcohol problems, we found no significant association
between lifetime alcohol consumption and the absence of liver fibrosis or the presence of
24
advanced liver fibrosis, suggesting that alcohol may be less important than other known
factors that promote liver fibrosis in this population.
Keywords: Alcohol; HIV; Hepatitis C Virus; Liver Fibrosis
CLINICIANS
21. Unintended effects of training on clinicians’ interest, confidence, and commitment
in using motivational interviewing
Suzanne E. Decker, Steve Martino
Drug and Alcohol Dependence 2013:132(3);681-687
Abstract
Background Improving clinicians’ interest, confidence, and commitment in using evidencebased treatment (EBT) is often an aim of training clinicians in EBT. However, the degree to
which these areas actually improve through training and what their relationship is to
treatment integrity is unknown. Method Using data from a multi-site study (Martino et al.,
2010) comparing three methods of clinician training in motivational interviewing (MI),
changes in interest, confidence, and commitment over time and their relationship to MI
adherence and competence were assessed using mixed-effects regression models. Individual
patterns of change were examined through cluster analysis. Results Interest, confidence, and
commitment declined over time across training conditions with two distinct patterns: 76%
clinicians largely maintained strong interest in MI over time with only slight decreases in
confidence and commitment (the “maintainers”), while 24% began with lower initial interest,
confidence, and commitment, which subsequently declined over time (the “decliners”).
Interest and commitment were not associated with MI adherence and competence; confidence
was associated with increased competence in the use of advanced MI strategies. However,
decliners demonstrated greater use of MI-inconsistent techniques than maintainers overall
(d = 0.28). Conclusions Training in MI may have an unintended consequence of
diminishing clinicians’ interest, confidence, or commitment in using MI in practice. While
attitudinal variables in this study show mixed relationships to MI integrity, they may have
some utility in identifying less enthusiastic participants, better preparing them for training, or
tailoring training approaches to meet individual training needs.
Keywords: Clinician training; Treatment integrity; Adherence; Motivational interviewing;
Dissemination; Implementation
22. Meta-analysis of the effects of MI training on clinicians' behavior
Yves de Roten, Grégoire Zimmermann, Diana Ortega, Jean-Nicolas Despland
Journal of Substance Abuse Treatment 2013:45(2);155-162
Abstract
MI-based interventions are widely used with a number of different clinical populations and
their efficacy has been well established. However, the clinicians' training has not traditionally
been the focus of empirical investigations. We conducted a meta-analytic review of
clinicians' MI-training and MI-skills findings. Fifteen studies were included, involving 715
clinicians. Pre–post training effect sizes were calculated (13 studies) as well as group contrast
effect sizes (7 studies). Pre–post training comparisons showed medium to large ES of MI
training, which are maintained over a short period of time. When compared to a control
group, our results also suggested higher MI proficiency in the professionals trained in MI
than in nontrained ones (medium ES). However, this estimate of ES may be affected by a
publication bias and therefore, should be considered with caution. Methodological limitations
25
and potential sources of heterogeneity of the studies included in this meta-analysis are
discussed.
Keywords: Motivational interviewing; Training; Meta-analysis
26
CLINICIANS AND SERVICE PROVIDERS
23. Working with substance use: Levels and predictors of positive therapeutic attitudes
across social care practitioners in England
Aisha Jane Hutchinson, Sarah Galvani, Cherilyn Dance
Drugs: Education, Prevention and Policy 2013:20(4);312-321
Abstract
Aims To measure the attitudes of social care practitioners towards working with alcohol and
other drug (AOD) use and to identify the factors which can be used to predict positive
engagement. Methods A cross-sectional online survey was completed by 646 front-line
social care practitioners in 11 English Local Authorities. The survey included an adapted
version of the Alcohol and Alcohol Problems Perceptions Questionnaire to measure overall
therapeutic attitudes (OTAs). Using a principle component analysis, four attitudinal
components were identified within the tool; role adequacy, role support, role legitimacy and
role engagement. Findings Analysis of 597 responses (sub-sample excluding specialists
substance misuse workers) revealed an average OTA score of 4.68 (SD = 0.662; range: 1–7).
The majority of scores (69%) fell in the middle range indicating that practitioners were
neither positively nor negatively engaged with AOD-related work. Respondents reported
more positive perceptions of role support and legitimacy (56% and 54%, respectively) than
for role adequacy and role engagement (25% and 20%, respectively). A multiple regression
model revealed that perceived preparedness by qualifying training, employing directorate,
AOD-related practice experience and gender, were all predictors of OTAs. Conclusion For
these social care professionals, neither positive nor negative attitudes towards working with
AOD dominated. However, this research identifies several factors important for converting
the largely ambivalent attitudes of social care practitioners into positive engagement with
AOD use.
27
CO-MORBIDITY
24. Characterizing the longitudinal patterns of substance use among individuals
diagnosed with serious mental illness after psychiatric hospitalization
Amber L. Bahorik, Christina E. Newhill, Shaun M. Eack
Addiction 2013:108(7);1259-1269
Abstract
Aim To characterize longitudinal patterns of substance use across a large sample of
psychiatric patients discharged from inpatient admission, followed for 1-year posthospitalization. Design Prospective cohort study. Setting Kansas City, MO, USA;
Pittsburgh, PA, USA; Worcester, MA, USA. Participants Eight hundred and one
schizophrenia-spectrum (n = 204), bipolar (n = 137) and depressive disorder (n = 460) patients
from the MacArthur Violence Risk Assessment Study. Measurements Symptoms,
functioning, drug/alcohol use assessed by the Brief Psychiatric Rating Scale, the Global
Assessment of Functioning, and substance use interviews. Findings Patients used alcohol
(67.0%; n = 540) and cannabis (30.0%; n = 237) more frequently than other substances up to
30 days before admission, and those with depressive and schizophrenia-spectrum used heroin
more than individuals with bipolar (P = 0.023). Post-hospitalization, patients using alcohol
(B = −0.15, P < 0.001) and cannabis (B = −0.27, P < 0.001) decreased, but patterns varied
across diagnosis and genders. Patients using cannabis decreased at greater rates in depressive
and schizophrenia-spectrum compared with bipolar (all P < 0.05), and more men used alcohol
(B = 0.76, P < 0.001) and cannabis (B = 1.56, P < 0.001) than women. Cannabis (B = 1.65,
P < 0.001) and alcohol (B = 1.04, P = 0.002) were associated with higher symptomatology;
cannabis (B = −2.33, P < 0.001) and alcohol (B = −1.45, P = 0.012) were associated with
lower functioning. Conclusions Substance use is frequent and associated with poor recovery
in patients with serious mental illness recently discharged from psychiatric hospitalization.
Addiction treatments personalized by diagnosis and gender may be effective for improving
outcomes in people with serious mental illness.
Keywords: Addiction; alcohol use in serious mental illness; cannabis use in serious mental
illness; gender difference in substance use patterns; longitudinal research; serious mental
illness; substance abuse
25. Factor structure of PTSD symptoms in opioid-dependent patients rating their
overall trauma history
Madhavi K. Reddy, Bradley J. Anderson, Jane Liebschutz, Michael D. Stein
Drug and Alcohol Dependence 2013:132(3);597-602
Abstract
Background The current standard for posttraumatic stress disorder (PTSD) diagnosis is a 3factor model (re-experiencing, avoidance, and hyperarousal). Two 4-factor models of PTSD,
the emotional numbing model (re-experiencing, avoidance, emotional numbing, and
hyperarousal) and the dysphoria model (re-experiencing, avoidance, dysphoria, and
hyperarousal), have considerable empirical support in the extant literature. However, a newer
5-factor model of PTSD has been introduced that is receiving interest. The 5-factor model
differs from the four-factor models in its placement of three symptoms (irritability, sleep
disturbance, and concentration difficulties) into a separate cluster termed dysphoric arousal.
We empirically compared the theoretical factor structures of 3-, 4-, and 5-factor models of
28
PTSD symptoms to find the best fitting model in a sample of opioid-dependent hospitalized
patients. Methods Confirmatory factor analyses were conducted on the 17 self-reported
PTSD symptoms of the Posttraumatic Checklist – Civilian Version (PCL-C) in a sample of
151 men and women with opioid dependence. Results Both four-factor models fit the
observed data better than the three-factor model of PTSD; the dysphoria model was preferred
to the emotional numbing model in this sample. The recently introduced five-factor model fit
the observed data better than either four factor model. Conclusions PTSD is a
heterogeneous disorder comprised of symptoms of re-experiencing, avoidance, numbing, and
dysphoria. Three symptoms, irritability, sleep disturbance, and concentration difficulties, may
represent a unique latent construct separate from these four symptom clusters in opioiddependent populations who have experienced traumatic events.
Keywords: PTSD; Opiate dependence; Factor analysis
26. Hypertension, chronic obstructive pulmonary disease, diabetes and depression
among older methadone maintenance patients in British Columbia
Anna Maruyama, Scott Macdonald, Elizabeth Borycki, Jinhui Zhao
Drug and Alcohol Review 2013:32(4);412-418
Abstract
Introduction and Aims Risk factors in older methadone maintenance treatment (MMT)
patients may put them at a greater risk of acquiring chronic diseases; however, this group
might experience barriers to treatment resulting in reduced recommended prescriptions. The
research objective for this study was to assess whether MMT patients were significantly
different from a matched control group in terms of medications dispensed for hypertension,
chronic obstructive pulmonary disease (COPD), diabetes and depression. Design and
Methods The research design was a case-control study, where prescription claims data from
the British Columbia database were used. MMT patients 50 years of age and older were
randomly selected, and control subjects were individually matched in terms of age, sex, social
assistance coverage and geographic jurisdiction. Results Each group consisted of 199
participants. Odds ratios (OR) were calculated to compare the odds of MMT patients to nonMMT patients on a first-line medication for each chronic disease under investigation. The
MMT group was significantly more likely to receive medications for COPD (OR = 32.68,
P < 0.001) and depression (OR = 4.07, P < 0.001), and no significant differences for
hypertension (OR = 0.86) or diabetes (OR = 0.74). Discussion Higher rates of COPD among
MMT clients is likely explained by elevated smoking, and higher rates of depression may be
explained by multiple disadvantages associated with substance use. Although the groups were
similar for diabetes prescriptions, the MMT group likely experienced barriers to receiving
treatment since prior research suggests their rates should be elevated due to methadone use.
[Maruyama A, Macdonald S, Borycki E, Zhao J. Hypertension, chronic obstructive
pulmonary disease, diabetes and depression among older methadone maintenance patients in
British Columbia. Drug Alcohol Rev 2013;32:412–418]
Keywords: case-control study; methadone maintenance treatment; chronic disease; opioid
dependence; aged
29
27. Impact of Addiction Severity and Psychiatric Comorbidity on the Quality of Life of
Alcohol-, Drug- and Dual-Dependent Persons in Residential Treatment
Colpaert K, De Maeyer J, Broekaert E, Vanderplasschen W
European Addiction Research0 2013:19(4);173–183
Abstract
Background Substance users’ quality of life (QoL) is influenced by several variables,
including psychiatric comorbidity and addiction severity. Thus far, the impact of the type of
dependence (alcohol, drug or dual dependence) remains unclear. Therefore, the objectives of
the study were to evaluate QoL in a clinical sample of alcohol-, drug- and dual-dependent
patients and to assess the independent impact of psychiatric comorbidity, addiction severity
and type of dependence on QoL. Methods Face-to-face interviews with 274 patients
admitted to residential substance abuse treatment were conducted using the European
Addiction Severity Index (EuropASI), the Mini-International Neuropsychiatric Interview and
the Assessment of Personality Disorders self-report questionnaire. Results Multivariate
analyses showed that anxiety, mood or personality disorder, employment status and the
severity rating on the EuropASI domain alcohol use were associated with overall QoL.
Gender, anxiety disorder and the severity ratings on the EuropASI domains alcohol use, drug
use, physical health and emotional and psychological health were associated with overall
perception of health. Conclusion Addiction severity and psychiatric comorbidity explained
the greatest amount of QoL variance, whereas the type of dependence did not play a central
role.
Keywords: Substance dependence; Dual diagnosis; Personality disorders; Anxiety disorders;
Quality of life; Addiction severity; Polydrug use; Comorbidity; Alcohol
30
DRUG RELATED DEATH
28. The contributions of viral hepatitis and alcohol to liver-related deaths in opioiddependent people
Sarah Larney, Deborah Randall, Amy Gibson, Louisa Degenhardt
Drug and Alcohol Dependence 2013:131:3);252-257
Abstract
Background Mortality rates are elevated among heroin-dependent populations compared to
the general population. Liver disease is emerging as an important contributor to mortality as
the heroin-dependent population ages. Two major risk factors for liver disease are hepatitis C
virus infection and chronic heavy alcohol use. Both of these are highly prevalent among
heroin dependent people, but their relative contribution to liver-related mortality is poorly
understood. Methods Data recording all prescriptions of opioid substitution treatment in
New South Wales, Australia, 1997–2005, were linked to the National Death Index. Crude and
standardised mortality rates and standardised mortality ratios were calculated for liver-related
and other major causes of death. Frequency counts were obtained for viral hepatitis and
alcohol mentions in underlying liver deaths. Results There were 208 underlying liver deaths
for a CMR of 72.4 per 100,000 py (95% CI 62.9, 82.9), and liver deaths occurred at 9.8 times
the general population rate (95% CI 8.5, 11.2). There were increases in liver-related mortality
over time. Viral hepatitis was mentioned in three-quarters (n = 156, 76%), and alcohol in
43% (n = 90) of underlying liver deaths. Conclusions Liver-related deaths were shown to be
increasing in this heroin-dependent population, and the majority of these deaths involved
chronic viral hepatitis infection. Increased uptake of treatment for hepatitis C virus infection
is crucial to reducing the burden of liver-related mortality in this population. Hepatitis B
vaccination, and screening of OST patients for alcohol use disorders and delivery of brief
interventions as clinically indicated may also be of benefit.
Keywords: Heroin; Opioids; Mortality; Hepatitis C; Liver disease
29. Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales
for take-home naloxone training evaluation
Anna V. Williams, John Strang, John Marsden
Drug and Alcohol Dependence 2013:132(1-2);383-386
Abstract
Aims To develop an Opioid Overdose Knowledge Scale (OOKS) and an Opioid Overdose
Attitudes Scale (OOAS) to evaluate take-home naloxone training. Methods Psychometric
instrument development study conducted in England using convenience samples. Forty-five
items were selected for the OOKS organised in four sub-scales (risks, signs, actions and
naloxone use). The OOAS was formed initially of 32 items grouped in three sub-scales
(competence, concerns and readiness). Both scales were administered to 42 friends and
family members of heroin users and 56 healthcare professionals to assess internal reliability
and construct validity. The Brief Overdose Recognition and Response Assessment (BORRA)
and the General Self-Efficacy Scale (GSE) were also administered to family members to test
concurrent validity. Family members completed the OOKS and OOAS on a second occasion
to assess test–retest reliability. Results The OOKS and OOAS were internally reliable
(Cronbach's alpha = 0.83 and 0.90, respectively). Retest was completed by 33 participants
after 14 (SD 7) days (OOKS, ICC = 0.90 and OOAS, ICC = 0.82) with sub-scale item sets
from each measure falling within the fair-to-excellent range (ICC = 0.53–0.92). Professionals
31
reported significantly higher scores on both scales than family members. The OOKS total
score was positively correlated with the BORRA's Overdose Recognition (r = 0.5, P < 0.01)
and Naloxone Indication sub-scales (r = 0.44, P < 0.05), but the total score on the OOAS was
not associated with the GSE (r = 0.02, NS). Conclusion The 45-item OOKS and 28-item
OOAS are suitable as outcome measures of take-home naloxone training for friends and
family members of opioid users.
Keywords: Opioid; Heroin; Overdose; Naloxone; Knowledge; Attitudes
30. All-cause mortality in criminal justice clients with substance use problems—A
prospective follow-up study
A. Hakansson, M. Berglund
Drug and Alcohol Dependence 2013:132(3);499-504
Abstract
Background Mortality in previously incarcerated individuals is known to be elevated, with
high proportions of drug-related deaths. However, there is less documentation of whether
specific substance use patterns and other clinical characteristics predict increased mortality in
the group. Methods This is a follow-up study of mortality and causes of death in exprisoners with substance use problems prior to incarceration (N = 4081), who were followed
during an average of 3.6 years from release from prison until death or until data were
censored. Baseline predictors of mortality, derived from interviews with Addiction Severity
Index (ASI) in prison, were studied in a Cox regression analysis. Results During follow-up,
166 subjects (4.1%) died. Standardized mortality ratios were 7.0 (3.6–12.2) for females and
7.7 (5.6–9.0) for males. In 84% of cases, deaths were unnatural or due to substance-related
disease. Most common causes of death were accidental poisoning (27%), transport accidents
(13%), poisoning/injury with undetermined intent (12%), and suicide (10%). Death was
positively predicted by heroin use, overdose, and age, and negatively predicted by a history
of depression. Conclusions A vast majority of deaths after release from prison in
individuals with substance use are due to violent or substance-related causes. Significant
predictors identified were mainly related to patterns of drug use, and need to be addressed
upon incarceration as risk factors of death. The findings have implications for referral and
treatment upon release from prison.
Keywords: Substance use disorders; Criminal justice; Prison; Mortality
32
EPIDEMIOLOGY AND DEMOGRAPHY
31. Substance use disorders in adolescents with attention deficit hyperactivity disorder:
a 4-year follow-up study
Annabeth P. Groenman, Jaap Oosterlaan, Nanda Rommelse, Barbara Franke, Herbert
Roeyers, Robert D. Oades, Joseph A. Sergeant, Jan K. Buitelaar, Stephen V. Faraone
Addiction 2013:108(8);1503-1511
Abstract
Aim To examine the relationship between a childhood diagnosis of attention deficit
hyperactivity disorder (ADHD) with or without oppositional defiant disorder (ODD)/conduct
disorder (CD) and the development of later alcohol/drug use disorder [psychoactive
substance use disorder (PSUD)] and nicotine dependence in a large European sample of
ADHD probands, their siblings and healthy control subjects. Participantsdesign and setting
Subjects (n = 1017) were participants in the Belgian, Dutch and German part of the
International Multicenter ADHD Genetics (IMAGE) study. IMAGE families were identified
through ADHD probands aged 5–17 years attending out-patient clinics, and control subjects
from the same geographic areas. After a follow-up period (mean: 4.4 years) this subsample
was re-assessed at a mean age of 16.4 years. Measurements PSUD and nicotine
dependence were assessed using the Diagnostic Interview Schedule for Children, Alcohol
Use Disorders Identification Test, Drug Abuse Screening Test and Fagerström test for
Nicotine Dependence. Findings The ADHD sample was at higher risk of developing PSUD
[hazard ratio (HR) = 1.77, 95% confidence interval (CI) = 1.05–3.00] and nicotine
dependence (HR = 8.61, 95% CI = 2.44–30.34) than healthy controls. The rates of these
disorders were highest for ADHD youth who also had CD, but could not be accounted for by
this comorbidity. We did not find an increased risk of developing PSUD (HR = 1.18, 95%
CI = 0.62–2.27) or nicotine dependence (HR = 1.89, 95% CI = 0.46–7.77) among unaffected
siblings of ADHD youth. Conclusions A childhood diagnosis of attention deficit
hyperactivity disorder is a risk factor for psychoactive substance use disorder and nicotine
dependence in adolescence and comorbid conduct disorder, but not oppositional defiant
disorder, further increases the risk of developing psychoactive substance use disorder and
nicotine dependence.
Keywords: Age of onset; attention deficit hyperactivity disorder; conduct disorder; familial
association; nicotine dependence; oppositional defiant disorder; psychoactive substance use
disorder
32. Personality traits and illicit substances: The moderating role of poverty
Angelina R. Sutin, Michele K. Evans, Alan B. Zonderman
Drug and Alcohol Dependence 2013:131(3);247-251
Abstract
Background Illicit substances increase risk of morbidity and mortality and have significant
consequences for society. Personality traits are associated with drug use; we test whether
these associations vary by socioeconomic status. Method Participants (N = 412) from the
Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study
completed the Revised NEO Personality Inventory and self-reported use of opiates and
cocaine. 50% of participants were living below 125% of the federal poverty line. Mean-level
personality differences across never, former, and current opiate/cocaine users were compared.
33
Logistic regressions compared never versus current users and interactions between
personality traits and poverty status tested whether these associations varied by
socioeconomic status. Results High Neuroticism and low Agreeableness increased risk of
drug use. The association between low Conscientiousness and drug use was moderated by
poverty, such that low Conscientiousness was a stronger risk factor for illicit substance use
among those with relatively higher SES. For every standard deviation decrease in
Conscientiousness, there was a greater than 2-fold increase in risk of illicit substance use
(OR = 2.15, 95% CI = 1.45–3.17). Conscientiousness was unrelated to drug use among
participants living below 125% of the federal poverty line. Conclusions Under favorable
economic conditions, the tendency to be organized, disciplined, and deliberate is protective
against drug use. These tendencies, however, matter less when financial resources are scarce.
In contrast, those prone to emotional distress and antagonism are at greater risk for current
drug use, regardless of their economic situation.
Keywords: Personality traits; Conscientiousness; Substance use; Poverty; Cocaine; Heroin
34
HEPATITIS C
33. Low incidence of hepatitis C virus among prisoners in Scotland
Avril Taylor, Alison Munro, Elizabeth Allen, Karen Dunleavy, Sheila Cameron, Laura
Miller, Matthew Hickman
Addiction 2013:108(7);1296-1304
Abstract
Aims To estimate hepatitis C virus (HCV) incidence and HCV risk among Scottish
prisoners. Design National sero-behavioural survey; dried blood spots were collected in
order to identify recent HCV infections (i.e. HCV antibody-negative and HCV polymerase
chain reaction (PCR)-positive). Setting All 14 closed prisons in Scotland. Participants A
total of 5187 prisoners responded to the survey (79% of available prisoners on survey days)
comprising 5076 individuals (after removing incomplete returns and participants surveyed in
more than one prison); 95% men, 32% (1625) reported an injecting history (PWID) and
median sentence of 9.5 months. HCV antibody samples were available for 4904 participants;
there was sufficient sera for HCV PCR for 2446 prisoners who had been in prison for at least
75 days. Measurements The estimate of in-prison recent infections is based on prisoners
incarcerated for a sufficient period, i.e. at least 75 days, so that recent infections could be
attributed to prison. Findings Overall HCV prevalence was 19%; 53% among people who
reported an injecting history and 3% among other prisoners. Three recent infections probably
acquired in prison were detected. None of the cases reported injecting during their current
sentence or any other potential exposure. Estimated incidence was 0.6–0.9% overall and 3.0–
4.3% among PWID (assuming all infections acquired through injecting). Fifty-seven per cent
(929) of PWID were receiving opiate substitution treatment (OST) at the time of the survey.
Of all prisoners, 2.5% and 8% of PWID reported injecting during their current period of
incarceration. Conclusion The low incidence of HCV infections in Scottish prisons is due
most probably to the low occurrence of in-prison injecting and high coverage of OST. Low
HCV risk can be achieved in prisons without necessarily introducing needle exchange
programmes, but close monitoring of risk behaviours is essential. If risk increases, provision
of needle exchange should be considered.
Keywords: Harm reduction; HCV; incident infection; prison
34. Increased hepatitis C virus vaccine clinical trial literacy following a brief
intervention among people who inject drugs
Bethany White, Annie Madden, Margaret Hellard, Thomas Kerr, Maria Prins,
Kimberly Page, Gregory J. Dore, Lisa Maher
Drug and Alcohol Review 2013:32(4);419-425
Abstract
Introduction and Aims While people who inject drugs are at high risk of hepatitis C virus
(HCV) infection and will be the target population for future HCV vaccine trials, little is
known about clinical trial literacy (CTL) in this group. We assessed the impact of a brief
intervention (BI) designed to improve HCV vaccine CTL among people who inject drugs in
Sydney, Australia. Design and Methods People who inject drugs enrolled in a communitybased prospective observational study between November 2008 and September 2010
(n = 102) completed a CTL assessment followed immediately by the BI. Post-test assessment
was conducted at 24 weeks. Results The median age of the sample was 27 years, 73% were
35
male and 60% had 10 or less years of schooling. The median time since first injection was 5
years and 20% reported daily or more frequent injecting. The mean number of correct
responses increased from 5.3 to 6.3/10 (t = −4.2; 101df, P < 0.001) 24 weeks postintervention. Statistically significant differences were observed for three knowledge items
with higher proportions of participants correctly answering questions related to randomisation
(P = 0.002), blinding (P = 0.005) and vaccine-induced seropositivity (P = 0.003) postintervention. Discussion and Conclusions A significant increase in HCV vaccine CTL was
observed, suggesting that new and relatively novel concepts can be learned and recalled in
this group. These findings support the feasibility of future trials among this population.
[Correction added on 21 November 2012, after first online publication: T-score for mean
number of correct responses was corrected to ‘−4.2’ in the Results section.] [White B,
Madden A, Hellard H, Kerr T, Prins M, Page K, Dore GJ, Maher L. Increased hepatitis C
virus vaccine clinical trial literacy following a brief intervention among people who inject
drugs. Drug Alcohol Rev 2013;32:419–425]
Keywords: hepatitis C virus; injecting drug use; clinical trial literacy; brief intervention;
vaccine preparedness study
36
INJECTING DRUG USE
35. Patterns of injection drug use cessation during an expansion of syringe exchange
services in a Canadian setting
Dan Werb, Thomas Kerr, Jane Buxton, Jeannie Shoveller, Chris Richardson, Julio Montaner,
Evan Wood
Drug and Alcohol Dependence 2013:132(3);535-540
Abstract
Background Needle and syringe programmes (NSPs) have been shown to reduce HIV risk
among people who inject drugs (IDUs). However, concerns remain that NSPs delay injecting
cessation. Methods Individuals reporting injection drug use in the past six months in the
greater Vancouver area were enrolled in the Vancouver Injection Drug Users Study
(VIDUS). Annual estimates of the proportion of IDU reporting injecting cessation were
generated. Generalized estimating equation (GEE) analysis was used to assess factors
associated with injecting cessation during a period of NSP expansion. Results Between May
1996 and December 2010, the number of NSP sites in Vancouver increased from 1 to 29
(P < 0.001). The estimated proportion of participants (n = 2710) reporting cessation increased
from 2.4% (95% confidence interval [CI]: 0.0–7.0%) in 1996 to 47.9% (95% CI: 46.8–
48.9%) in 2010 (P < 0.001). In a multivariate GEE analysis, the authors observed an
association between increasing calendar year and increased likelihood of injecting cessation
(Adjusted Odds Ratio = 1.17, 95% CI: 1.15, 1.19, P < 0.001). Conclusion The proportion of
IDU reporting injecting cessation increased during a period of NSP expansion, implying that
increased NSP availability did not delay injection cessation. These results should help inform
community decisions on whether to implement NSPs.
Keywords: Injection drug use; Cessation; Needle exchange programme; Vancouver
36. The relationship between age and risky injecting behaviours among a sample of
Australian people who inject drugs
D. Horyniak, P. Dietze, L. Degenhardt, P. Higgs, F. McIlwraith, R. Alati, R. Bruno,
S. Lenton, L. Burns
Drug and Alcohol Dependence 2013:132(3);541-546
Abstract
Background Limited evidence suggests that younger people who inject drugs (PWID)
engage in high-risk injecting behaviours. This study aims to better understand the
relationships between age and risky injecting behaviours. Methods Data were taken from 11
years of a repeat cross-sectional study of sentinel samples of regular PWID (The Australian
Illicit Drug Reporting System, 2001–2011). Multivariable Poisson regression was used to
explore the relationship between age and four outcomes of interest: last drug injection
occurred in public, receptive needle sharing (past month), experiencing injecting-related
problems (e.g. abscess, dirty hit; past month), and non-fatal heroin overdose (past six
months). Results Data from 6795 first-time study participants were analysed (median age:
33 years, interquartile range [IQR]: 27–40; median duration of injecting: 13 years [IQR: 7–
20]). After adjusting for factors including duration of injecting, each five year increase in age
was associated with significant reductions in public injecting (adjusted incidence rate ratio
[AIRR]: 0.90, 95% confidence interval [CI]: 0.88–0.92), needle sharing (AIRR: 0.84, 95%
CI: 0.79–0.89) and injecting-related problems (AIRR: 0.96, 95% CI: 0.95–0.97). Among
37
those who had injected heroin in the six months preceding interview, each five year increase
in age was associated with an average 10% reduction in the risk of heroin overdose (AIRR:
0.90, 95% CI: 0.85–0.96). Conclusions Older PWID report significantly lower levels of
high-risk injecting practices than younger PWID. Although they make up a small proportion
of the current PWID population, younger PWID remain an important group for prevention
and harm reduction.
Keywords: Age; Injecting drug use; Australia; Overdose; Injury
37. Injecting practices in sexual partnerships: Hepatitis C transmission potentials in a
‘risk equivalence’ framework
Magdalena Harris, Tim Rhodes
Drug and Alcohol Dependence 2013:132(3);617-623
Abstract
Background Evidence indicates minimal hepatitis C (HCV) sexual transmission risk among
HIV negative heterosexual partners. Limited HCV literacy has been demonstrated among
people who inject drugs, yet there is a dearth of research exploring perceptions of HCV
heterosexual transmission risk among this high risk population. Methods We conducted a
qualitative life history study with people who had been injecting drugs for over six years, to
explore the social practices and conditions of long-term HCV avoidance. Participants were
recruited through London drug services and drug user networks. The sample comprised 10
women and 27 men (n = 37), of whom 22 were HCV antibody negative. Participants were
aged from 23 to 57 years and had been injecting for 6 to 33 years. Twenty participants were
in long term heterosexual partnerships. Findings The majority of participants in
relationships reported ‘discriminate’ needle and syringe sharing with their primary sexual
partner. Significantly, and in tension with biomedical evidence, participants commonly
rationalised syringe sharing with sexual partners in terms of ‘risk equivalence’ with sexual
practices in regard to HCV transmission. Participants’ uncertain knowledge regarding HCV
transmission, coupled with unprotected sexual practices perceived as being normative were
found to foster ‘risk equivalence’ beliefs and associated HCV transmission potential.
Conclusion HCV prevention messages that ‘add on’ safe sex information can do more harm
than good, perpetuating risk equivalence beliefs and an associated dismissal of safe injecting
recommendations among those already practicing unprotected sex.
Keywords: Hepatitis C; Sexual transmission; Injecting drug use; Harm reduction; Risk
38
MISCELLANEOUS
38. Micromorphological changes in cardiac tissue of drug-related deaths with emphasis
on chronic illicit opioid abuse
Monika H. Seltenhammer, Katharina Marchart, Pia Paula, Nicole Kordina, Nikolaus Klupp,
Barbara Schneider, Christine Fitzl, Daniele U. Risser
Addiction 2013:108(7);1287-1295
Abstract
Aims The main intention of this retrospective study was to investigate whether chronic illicit
drug abuse, especially the intravenous use of opioids (heroin), could potentially trigger the
development of myocardial fibrosis in drug addicts. Design A retrospective case–control
study was performed using myocardial tissue samples from both drug-related deaths (DRD)
with verifiable opioid abuse and non-drug-related deaths in the same age group.
Setting Department of Forensic Medicine, Medical University of Vienna, Austria (1993–94).
Participants Myocardial specimens were retrieved from 76 deceased intravenous opioid
users and compared to those of 23 deceased non-drug users. Measurements Drug
quantification was carried out using the enzyme-multiplied immunoassay technique (EMIT),
followed by [gas chromatography–mass spectrometry (GC–MS), MAT 112®], and analysed
using the Integrator 3390A by Hewlett Packard® and LABCOM.1 computer (MSS-G.G.).
The amount of fibrous connective tissue (FCT) in the myocardium was determined by using
the morphometric software LUCIA Net version 1.16.2©, Laboratory Imaging, with NIS
Elements 3.0®. Findings Drug analysis revealed that 67.11% were polydrug users and the
same proportion was classified as heroin addicts (6-monoacetylmorphine, 6-MAM)—32.89%
were users of pure heroin. In 76.32% of DRD cases, codeine was detected. Only 2.63%
consumed cocaine. The mean morphine concentrations were 389.03 ng/g in the cerebellum
and 275.52 ng/g in the medulla oblongata, respectively. Morphometric analysis exhibited a
strong correlation between DRD and myocardial fibrosis. The mean proportion of FCT
content in the drug group was 7.6 ± 2.9% (females: 6.30 ± 2.19%; males: 7.91 ± 3.01%) in
contrast to 5.2 ± 1.7% (females: 4.45 ± 1.23%; males: 5.50 ± 1.78%) in the control group,
indicating a significant difference (P = 0.0012), and a significant difference in the amount of
FCT between females and males (P = 0.0383). There was no significant interaction of age and
FCT (P = 0.8472). Conclusions There is a long-term risk of cardiac dysfunction following
chronic illicit drug abuse with opioids as a principal component. Regular cardiological
examination of patients receiving substitution treatment with morphine is strongly
recommended.
Keywords: Drug-related deaths; heroin addiction; micromorphological changes; myocard
fibrosis; opiates; opioids
39. Clusters of personality traits and psychological symptoms associated with later
benzodiazepine prescriptions in the general population: The HUNT Cohort Study
Trond Nordfjærn, Ottar Bjerkeset, Steven Moylan, Michael Berk, Rolf W. Gråwe
Addictive Behaviors 2013:38(10);2575-2580
Abstract
Objective The aim of this population-based study was to identify factors associated with
later benzodiazepine prescriptions, including clusters of personality traits, self-esteem
characteristics, sleep difficulties, depression and anxiety symptoms. Methods A 13 year
39
historical cohort study (n = 58,967) was carried out and baseline measures of self-reported
depression and anxiety symptoms, sleep difficulties, self-esteem and personality traits were
obtained from the second wave of the Nord-Trøndelag Health Study (HUNT 2, 1995–1997),
Norway. Data on benzodiazepine prescriptions were collected from the Norwegian
Prescription Database (NorPD, 2004–2008) for each case in the cohort.
Results and conclusions We found that a combined high extraversion and high neuroticism
personality score at baseline was associated with increased benzodiazepine prescription rates.
Further, sleep difficulties, low self-esteem and high depression and anxiety scores were also
linked to later prescriptions of benzodiazepines, in particular chronic and high dose
benzodiazepine prescriptions patterns. The findings are discussed in relation to prescription
practice and policy.
Keywords: Personality; Depression; Anxiety; Self-esteem; Sleep; Benzodiazepine
40. Binge drinking and sleep problems among young adults
Ioana Popovici, Michael T. French,
Drug and Alcohol Dependence 2013:132(1-2);207-215
Abstract
Objective As most of the literature exploring the relationships between alcohol use and sleep
problems is descriptive and with small sample sizes, the present study seeks to provide new
information on the topic by employing a large, nationally representative dataset with several
waves of data and a broad set of measures for binge drinking and sleep problems.
Methods We use data from the National Longitudinal Study of Adolescent Health (Add
Health), a nationally representative survey of adolescents and young adults. The analysis
sample consists of all Wave 4 observations without missing values for the sleep problems
variables (N = 14,089, 53% females). We estimate gender-specific multivariate probit models
with a rich set of socioeconomic, demographic, physical, and mental health variables to
control for confounding factors. Results Our results confirm that alcohol use, and
specifically binge drinking, is positively and significantly associated with various types of
sleep problems. The detrimental effects on sleep increase in magnitude with frequency of
binge drinking, suggesting a dose–response relationship. Moreover, binge drinking is
associated with sleep problems independent of psychiatric conditions. Conclusions The
statistically strong association between sleep problems and binge drinking found in this study
is a first step in understanding these relationships. Future research is needed to determine the
causal links between alcohol misuse and sleep problems to inform appropriate clinical and
policy responses.
Keywords: Alcohol use; Binge drinking; Sleep problems; National Longitudinal Study of
Adolescent Health (Add Health)
41. Catastrophic thinking and increased risk for prescription opioid misuse in patients
with chronic pain
M.O. Martel, A.D. Wasan, R.N. Jamison, R.R. Edwards
Drug and Alcohol Dependence 2013:132(1-2);335-341
Abstract
Background As a consequence of the substantial rise in the prescription of opioids for the
treatment of chronic noncancer pain, greater attention has been paid to the factors that may be
associated with an increased risk for prescription opioid misuse. Recently, a growing number
40
of studies have shown that patients with high levels of catastrophizing are at increased risk
for prescription opioid misuse. Objective The primary objective of this study was to
examine the variables that might underlie the association between catastrophizing and risk for
prescription opioid misuse in patients with chronic pain. Methods Patients with chronic
musculoskeletal pain (n = 115) were asked to complete the SOAPP-R, a validated self-report
questionnaire designed to identify patients at risk for prescription opioid misuse. Patients
were also asked to complete self-report measures of pain intensity, catastrophizing, anxiety,
and depression. Results Consistent with previous research, we found that catastrophizing
was associated with an increased risk for prescription opioid misuse. Results also revealed
that the association between catastrophizing and risk for opioid misuse was partially mediated
by patients’ levels of anxiety. Follow-up analyses, however, indicated that catastrophizing
remained a significant ‘unique’ predictor of risk for opioid misuse even when controlling for
patients’ levels of pain severity, anxiety and depressive symptoms. Discussion Discussion
addresses the factors that might place patients with high levels of catastrophizing at increased
risk for prescription opioid misuse. The implications of our findings for the management of
patients considered for opioid therapy are also discussed.
Keywords: Prescription opioid misuse; Catastrophizing; Anxiety; Depression; Chronic pain
42. Promoting improvements in public health: Using a Social Norms Approach to
reduce use of alcohol, tobacco and other drugs
B. M. Bewick, D. Bell, S. Crosby, B. Edlin, S. Keenan, K. Marshall, G. Savva
Drugs: Eduction, Prevention and Policy 2013:20(4);322-330
Abstract
There is increasing interest in implementing the Social Norms Approach outside the
university setting but a relative paucity of description of such projects. The approach offers
an alternative to traditional fear-based health education. The current article describes three
social norms projects, all driven by public health agendas, conducted in the United Kingdom
(UK). Projects reflect diversity of: settings; target substances; project team leadership and
team makeup. All projects were commissioned to address public health needs. The current
article uses these three projects to illustrate the practical implementation of the stages set out
by McAlaney et al. (2010) (i.e. preparation, data collection, data analysis, intervention,
follow-up and evaluation). A discussion of challenges and key learning outcomes is provided.
These projects illustrate that social norms interventions driven by public health agendas and
led from outside of academic institutions, can use the implementation advice available to
produce coherent and potentially successful campaigns to moderate use of alcohol, tobacco
and other drugs. There continues to be a need for outcome data to evaluate the short- and
long-term impact of using this approach. The potential for the approach to provide
opportunity for public engagement in shaping and delivering public health campaigns merits
further research.
41
43. A systematic review of substance misuse assessment packages
Jennifer Sweetman, Duncan Raistrick, Noreen D. Mdege, Helen Crosby
Drug and Alcohol Review 2013:32(4);347-355
Abstract
Issues Health-care systems globally are moving away from process measures of performance
to payments for outcomes achieved. It follows that there is a need for a selection of proven
quality tools that are suitable for undertaking comprehensive assessments and outcomes
assessments. This review aimed to identify and evaluate existing comprehensive assessment
packages. The work is part of a national program in the UK, Collaborations in Leadership of
Applied Health Research and Care. Approach Systematic searches were carried out across
major databases to identify instruments designed to assess substance misuse. For those
instruments identified, searches were carried out using the Cochrane Library, Embase, Ovid
MEDLINE® and PsychINFO to identify articles reporting psychometric data.
Key Findings From 595 instruments, six met the inclusion criteria: Addiction Severity
Index; Chemical Use, Abuse and Dependence Scale; Form 90; Maudsley Addiction Profile;
Measurements in the Addictions for Triage and Evaluation; and Substance Abuse Outcomes
Module. The most common reasons for exclusion were that instruments were: (i) designed for
a specific substance (239); (ii) not designed for use in addiction settings (136); (iii) not
providing comprehensive assessment (89); and (iv) not suitable as an outcome measure (20).
Implications The six packages are very different and suited to different uses. No package
had adequate evaluation of their properties and so the emphasis should be on refining a small
number of tools with very general application rather than creating new ones. An alternative to
using ‘off-the-shelf’ packages is to create bespoke packages from well-validated, singleconstruct scales. [Sweetman J, Raistrick D, Mdege ND, Crosby H. A systematic review of
substance misuse assessment packages. Drug Alcohol Rev 2013;32:347-355]
Keywords: alcohol; assessment; dependence; illicit drug; substance misuse
44. Factors influencing pharmacy services in opioid substitution treatment
Betty B. Chaar, Holly Wang, Carolyn A. Day, Jane R. Hanrahan, Adam R. Winstock,
Romano Fois
Drug and Alcohol Review 2013:32(4);426-434
Abstract
Introduction and Aim Heroin dependence is a serious health burden in Australia. Opioid
substitution treatment (OST) has been delivered in Australian community pharmacies since
1985. The effectiveness of pharmacy-based OST is evident and the demand is increasing;
however, the participation rate of community pharmacies is low, with over 60% nonproviders. While previous Australian studies have focused on perspectives of community
pharmacists providing the service, the views of non-providers have not yet been explored.
This study aimed to further investigate factors influencing pharmacists' participation in
provision of OST in the community pharmacy setting in New South Wales, Australia.
Design and Methods Semi-structured interviews were conducted with 35 NSW community
pharmacists (20 providers, 15 non-providers). Transcripts of interviews were thematically
analysed. Results Factors influencing non-providers were mainly stigma and fear, the nature
of an opt-in scheme, professionals' moral responsibilities, lack of awareness and knowledge,
disproportionate distribution of clients and lack of financial support for OST clients.
Providers were motivated by positive attitudes, functional relationships with OST
42
clients/stakeholders, professional satisfaction and financial rewards. Recommendations to
improve participation in OST services were offered by both groups. Discussion and
Conclusion This study explored views from both OST providers and non-providers,
revealing a number of previously undocumented barriers that affect the uptake of OST
provision in New South Wales community pharmacies. There were also profound ethical
issues raised for consideration. These findings may help inform future policies aimed at
encouraging pharmacists' provision of OST, to address the unmet needs of the everincreasing number of heroin-dependent clients in the community. [Chaar BB, Wang H, Day
CA, Hanrahan JR, Winstock AR, Fois R. Factors influencing pharmacy services in opioid
substitution treatment. Drug Alcohol Rev2013;32:426–434]
Keywords: pharmacy OST service; Australian pharmacist; providers' and non-providers'
perspective; professionals' moral responsibility; disproportionate distribution of clientele
45. In it for the long haul: developing recovery capital for long-term recovery
sustainment
Rowdy Yates
Journal of Substance Use 2013:18(5);339–339
No Abstract Available
43
NEW PSYCHOACTIVE SUBSTANCES
46. Do Novel Psychoactive Substances Displace Established Club Drugs, Supplement
Them or Act as Drugs of Initiation? The relationship between Mephedrone, Ecstasy and
Cocaine
Moore K, Dargan P.I, Wood D.M, Measham F
European Addiction Research 2013:19(5);276-282
Abstract
Background/Aims To assess whether novel psychoactive substances (NPS) displace
established club drugs, supplement them or act as drugs of initiation via a study of the
relationship between mephedrone, ecstasy pills, cocaine and MDMA powder amongst clubgoers considered to be ‘early adopters' of psychostimulant/club drug trends. Methods In situ
surveys were conducted with 308 customers in two south London gay dance clubs across 3
weekend nights in July 2010 to assess the prevalence and patterns of self-reported use of a
range of illegal drugs and NPS. Results Mephedrone was added to existing drug repertoires
amongst those surveyed and acted to supplement more established club drugs including
ecstasy pills, cocaine and MDMA powder, rather than replacing or displacing those drugs.
Conclusion This survey suggests that NPS are likely to be added to drug repertoires,
particularly amongst experienced users with consequent health risks for individuals and
resource implications for services. This study points to a complex relationship between NPS
and illegal drug availability, purity and regulatory control, one which is increasingly
important to understand given the global emergence of NPS and the challenges they present
to existing supply, demand and harm reduction strategies.
44
OPIATE TREATMENT
47. Injectable extended-release naltrexone (XR-NTX) for opioid dependence: long-term
safety and effectiveness
Evgeny Krupitsky, Edward V. Nunes, Walter Ling, David R. Gastfriend, Asli Memisoglu,
Bernard L. Silverman
Addiction 2013:108(9);1628-1637
Abstract
Aims To describe drug use and safety with intramuscular injectable extended-release
naltrexone (XR-NTX) in opioid dependence during a 1-year open-label extension phase.
Design Following 6 months of randomized, double-blind, placebo (PBO)-controlled
injections given every 28 days, patients receiving XR-NTX 380 mg continued and PBO
patients were switched to open-label XR-NTX, with monthly individual drug counseling, for
a further year. Setting Thirteen clinical sites in Russia. Participants Adult opioiddependent outpatients. Measurements Monthly urine samples; reports of craving and
functioning; adverse events. Findings For the open-label extension (n = 114), 67 continued
on XR-NTX and 47 switched from PBO during the double-blind phase to XR-NTX during
the open-label phase. Overall, 62.3% (95% CI: 52.7%, 71.2%) completed the extension.
Discontinuation occurred most commonly because of withdrawal of consent (18.4%) and loss
to follow-up (11.4%); two patients discontinued as a result of lack of efficacy and one
because of adverse events. Urine testing revealed that 50.9% (41.5%, 60.4%) were abstinent
from opioids at all assessments during the 1-year open-label phase. Adverse events reported
by 21.1% of patients were judged to be study drug-related. Injection site reactions were
infrequent (6.1%) and the majority were mild. Elevations in liver function tests occurred for
16.7% of patients, but none of these elevations was judged to be clinically significant. No
patients died, overdosed or discontinued as a result of severe adverse events.
Conclusions During a 1-year open-label extension phase of injectable XR-NTX for the
prevention of relapse in opioid dependence, 62.3% of patients completed the phase and
50.9% were abstinent from opioids. No new safety concerns were evident.
Keywords: Craving; depot naltrexone; extended-release naltrexone; heroin dependence;
injectable naltrexone; opioid dependence; long-term safety; naltrexone; sustained release
formulations
48. Stakeholders in Opioid Substitution Treatment Policy: Similarities and Differences
in Six European Countries
Betsy Thom, Karen Duke, Vibeke Asmussen Frank, Bagga Bjerge
Substance Use & Misuse 2013:48(11);933-942
Abstract
Based on the research papers within this special issue, this overview discusses similarities
and differences in stakeholding in drug user opioid substitution treatment policy in Britain,
Denmark, Italy, Austria, Poland, and Finland. It explores factors that have influenced
stakeholder activity, including the importance of crisis, the impact of evidence, the
availability of resources, the wider political context, the influence of moral frameworks and
ideologies, and the pressure of external influences. The paper highlights the important
differences in the emergence and evolution of stakeholder groups and in the political,
cultural, and economic circumstances, which both constrain and enable their activities.
45
Keywords: stakeholders; substitution treatment; drug user treatment policy; Europe;
abstinence; harm reduction; evidence-based policy; addictions; window of opportunity;
problem stream; policy stream; political stream
49. Substitution Treatment in the Era of “Recovery”: An Analysis of Stakeholder Roles
and Policy Windows in Britain
Karen Duke, Rachel Herring, Anthony Thickett and Betsy Thom
Substance Use & Misuse 2013:48(11);966-976
Abstract
Based on documentary analyses and interviews with twenty key informants in 2012, this
paper analyses the shift in British drugs policy towards “recovery” from the perspectives of
major stakeholders. The processes involved in reopening the debate surrounding the role of
substitution treatment and its re-emergence on to the policy agenda are examined. Drawing
on Kingdon's work on agenda-setting, the ways in which methadone maintenance was
challenged and defended by key stakeholders in the initial phase of policy development and
the negotiation of a “recovery” focus as the organizing concept for British drugs policy are
explored. Study limitations are noted.
Keywords: stakeholders; drug policy; substitution treatment; policy windows; recovery;
abstinence; harm reduction; policy entrepreneurs; agenda-setting
50. Substitution Treatment in the Era of “Recovery”: An Analysis of Stakeholder Roles
and Policy Windows in Britain
Karen Duke, Rachel Herring, Anthony Thickett and Betsy Thom
Substance Use & Misuse 2013:48(11);966-976
Abstract
Based on documentary analyses and interviews with twenty key informants in 2012, this
paper analyses the shift in British drugs policy towards “recovery” from the perspectives of
major stakeholders. The processes involved in reopening the debate surrounding the role of
substitution treatment and its re-emergence on to the policy agenda are examined. Drawing
on Kingdon's work on agenda-setting, the ways in which methadone maintenance was
challenged and defended by key stakeholders in the initial phase of policy development and
the negotiation of a “recovery” focus as the organizing concept for British drugs policy are
explored. Study limitations are noted.
Keywords: stakeholders; drug policy; substitution treatment; policy windows; recovery;
abstinence; harm reduction; policy entrepreneurs; agenda-setting
46
51. Treatment or “high”: Benzodiazepine use in patients on injectable heroin or oral
opioids
Marc Vogel, Bina Knöpfli, Otto Schmid, Mari Prica, Johannes Strasser, Luis Prieto, Gerhard
A. Wiesbeck, Kenneth M. Dürsteler-MacFarland
Addictive Behaviors 2013:38(10);2477-2484
Abstract
Benzodiazepine (BZD) use is widespread among opioid-maintained patients worldwide. We
conducted a cross-sectional survey to investigate motives and patterns of BZD use and
psychiatric comorbidity in a convenience sample of patients (n = 193) maintained on oral
opioid agonists or diacetylmorphine (DAM). Prolonged BZD use and high-risk behaviors like
parenteral use were common. After principal component analysis, motives were divided into
those related to negative affect regulation, positive affect regulation (i.e. reward-seeking) and
somato-medical problems. Negative affect regulation and somato-medical motives were
associated with prolonged use. Psychiatric comorbidity was associated with several selftherapeutic motives, most importantly to lose anxiety. Patients maintained on DAM were
more likely to be ex-users of BZD and report high positive affect regulation. Therefore,
patients maintained on different agonists may have deviating motives for BZD use, which
could be of importance when addressing this issue. Treatment of psychiatric comorbidity, in
particular anxiety, depressive and sleeping disorders, may be helpful in reducing BZD use,
particularly in patients maintained on oral opioids.
Keywords: Sedative; Diacetylmorphine; Opioid dependence; Motive; Psychiatric
comorbidity
52. Primary care patient characteristics associated with completion of 6-month
buprenorphine treatment
Anne M. Neumann, Richard D. Blondell, Mohammadreza Azadfard, Ganon Nathan,
Gregory G. Homish
Addictive Behaviors 2013:38(11);2724-2728
Abstract
Background Opioid addiction is prevalent in the United States. Detoxification followed by
behavioral counseling (abstinence-only approach) leads to relapse to opioids in most patients.
An alternative approach is substitution therapy with the partial opioid receptor agonist
buprenorphine, which is used for opioid maintenance in the primary care setting. This study
investigated the patient characteristics associated with completion of 6-month
buprenorphine/naloxone treatment in an ambulatory primary care office. Methods A
retrospective chart review of 356 patients who received buprenorphine for treatment of opioid
addiction was conducted. Patient characteristics were compared among completers and noncompleters of 6-month buprenorphine treatment. Results Of the 356 patients, 127 (35.7%)
completed 6-month buprenorphine treatment. Completion of treatment was associated with
counseling attendance and having had a past injury. Conclusions Future research needs to
investigate the factors associated with counseling that influenced this improved outcome.
Patients with a past injury might suffer from chronic pain, suggesting that buprenorphine
might produce analgesia in addition to improving addiction outcome in these patients,
rendering them more likely to complete 6-month buprenorphine treatment. Further research is
required to test this hypothesis. Combination of behavioral and medical treatment needs to be
investigated for primary care patients with opioid addiction and chronic pain.
Keywords: Buprenorphine; Opioid addiction; Opioid dependence; Treatment retention;
Primary care; Patient characteristics
47
53. Benzodiazepine use during buprenorphine treatment for opioid dependence:
Clinical and safety outcomes
Zev Schuman-Olivier, Bettina B. Hoeppner, Roger D. Weiss, Jacob Borodovsky, Howard J.
Shaffer, Mark J. Albanese
Drug and Alcohol Dependence 2013:132(3);580-586
Abstract
Background Prescribing benzodiazepines during buprenorphine treatment is a topic of
active discussion. Clinical benefit is unclear. Overdose, accidental injury, and benzodiazepine
misuse remain concerns. We examine the relationship between benzodiazepine misuse
history, benzodiazepine prescription, and both clinical and safety outcomes during
buprenorphine treatment. Methods We retrospectively examined outpatient buprenorphine
treatment records, classifying patients by past-year benzodiazepine misuse history and
approved benzodiazepine prescription at intake. Primary clinical outcomes included 12month treatment retention and urine toxicology for illicit opioids. Primary safety outcomes
included total emergency department (ED) visits and odds of an ED visit related to overdose
or accidental injury during treatment. Results The 12-month treatment retention rate for the
sample (N = 328) was 40%. Neither benzodiazepine misuse history nor benzodiazepine
prescription was associated with treatment retention or illicit opioid use. Poisson regressions
of ED visits during buprenorphine treatment revealed more ED visits among those with a
benzodiazepine prescription versus those without (p < 0.001); benzodiazepine misuse history
had no effect. The odds of an accidental injury-related ED visit during treatment were greater
among those with a benzodiazepine prescription (OR: 3.7, p < 0.01), with an enhanced effect
among females (OR: 4.7, p < 0.01). Overdose was not associated with benzodiazepine misuse
history or prescription. Conclusions We found no effect of benzodiazepine prescriptions on
opioid treatment outcomes; however, benzodiazepine prescription was associated with more
frequent ED visits and accidental injuries, especially among females. When prescribing
benzodiazepines during buprenorphine treatment, patients need more education about
accidental injury risk. Alternative treatments for anxiety should be considered when possible,
especially among females.
Keywords: Buprenorphine; Opioid dependence; Benzodiazepine; Accident; Female;
Utilization
54. Correlates of pain in an in-treatment sample of opioid-dependent people
Suzanne Nielsen, Briony Larance, Nicholas Lintzeris, Emma Black, Raimondo Bruno,
Bridin Murnion, Adrian Dunlop, Louisa Degenhardt
Drug and Alcohol Review 2013:32(5);489-494
Abstract
Introduction and Aims The limited literature on pain in opioid-treatment samples indicates
that it is highly prevalent. Understanding the implications of pain on treatment outcomes is
important, particularly in light of ageing opioid-treatment cohorts. This study explores
correlates of pain, including aberrant behaviours related to prescribed opioids. Our hypothesis
is that pain may increase aberrant opioid-related behaviours, including illicit substance use,
among opioid-dependent people. Design and Methods We examined pain in methadone or
buprenorphine patients (n = 141) from three treatment services. Measures included basic
demographics, Brief Pain Inventory, general mental health, physical health and quality of life
measures, pain history and treatments, and an aberrant opioid-related behaviour scale.
Univariate and multivariate analyses were used to examine correlates of pain. Results Forty
48
percent reported current pain, measured with the first question of the Brief Pain Inventory.
Correlates of pain were depression ratings [adjusted odds ratio (OR) 2.24, 95% confidence
interval (CI) 1.04, 4.83], anxiety ratings (adjusted OR 4.29, 95% CI 1.88, 9.80) and selfreported health ratings (adjusted OR 0.35, 95% CI 0.16, 0.76). Contrary to our hypothesis,
pain was not associated with greater use of illicit opioids, nor any aberrant opioid-related
behaviours. Pain was comparable among methadone and buprenorphine patients.
Discussion and Conclusions The lack of association with pain and aberrant behaviours
suggest that it should not be assumed that those in opioid treatment misuse medications in
response to pain. The high prevalence of depression/anxiety symptoms indicates a need for
further work with larger samples to explore pain and co-morbidity among opioid-dependent
people. [Nielsen S, Larance B, Lintzeris N, Black E, Bruno R, Murnion B, Dunlop A,
Degenhardt L. Correlates of pain in an in-treatment sample of opioid-dependent people.
Drug Alcohol Rev 2013;32:489–494]
Keywords: pain; opioid substitution treatment; methadone; buprenorphine
55. Social Network Support for Individuals Receiving Opiate Substitution Treatment
and Its Association with Treatment Progress
Day E, Copello A, Karia M, Roche J, Grewal P, George S, Haque S, Chohan G
European Addiction Research 2013;19(4):211–221
Abstract
Background/Aims Social networks have been hypothesized to protect people from the
harmful effects of stress, but may also provide dysfunctional role models and provide cues
associated with drug use. This study describes the range, type and level of social support
available to patients engaged in UK opiate substitution treatment (OST) programmes, and
explores the association between network factors and continued use of illicit heroin.
Methods A cross-sectional survey of a randomly selected sample of OST patients (n = 118)
utilised measures of current substance use and social network structure and support.
Results More than half of the participants had used heroin in the previous month, and most
described networks that were both supportive and positive about treatment. Multivariate
analysis showed that the substance use involvement of network members was higher in those
patients still using heroin, even when other treatment factors were controlled for.
Conclusion There was a strong association between ongoing contact with other drug users
and continued use of illicit heroin in this treatment sample. Whilst there is potential for the
involvement of social networks in treatment, future research needs to ascertain the exact
nature of the relationship between social support and drug use.
Keywords: Heroin; Opiate maintenance; Outpatient treatment; Social support; Social
network; Treatment research
56. Profiles of quality of life in opiate-dependent individuals after starting methadone
treatment: A latent class analysis
Jessica De Maeyer, Chijs van Nieuwenhuizen, Ilja L. Bongers, Eric Broekaert,
Wouter Vanderplasschen
International Journal of Drug Policy 2013:24(4);342-350
Abstract
Background This study aimed to identify classes of quality of life (QoL) among opiatedependent individuals five to ten years after starting methadone treatment in order to tailor
services to the needs of this population. Methods A cross-sectional study of 159 opiate49
dependent individuals who started outpatient methadone treatment in the region of Ghent,
Belgium, between 1997 and 2002. A face-to-face structured interview was administered
based on the Lancashire Quality of Life Profile, the EuropASI, Brief Symptom Inventory and
the Verona Service Satisfaction Scale for Methadone Treatment. Latent class analysis was
used to determine patterns of QoL. Analyses of variance and chi-square tests were used to
test whether class membership was related to socio-demographic, health- and drug-related
variables. Results Based on fit criteria, a three-class model was selected. Class Low
(14.5%), ‘opiate-dependent individuals living in marginal conditions’, is characterised by low
QoL scores on all domains. Class Intermediate (25.8%), ‘stabilized, but socially excluded
opiate-dependent individuals’ shows high scores on the domains ‘safety’ and ‘living
situation’, but low scores on all other QoL domains. Class High (59.7%), ‘socially included
opiate-dependent individuals’, is characterised by high QoL scores on all domains, except
‘finances’. Conclusion The findings of this study illustrate the existence of different profiles
of QoL among opiate-dependent individuals after starting methadone maintenance treatment
and demonstrate the need for a continuing care approach. Insight into distinct classes of QoL
can be used to design person-centred support, relevant to an individual's personal life.
Keywords: Methadone treatment; Opioid substitution treatment; Quality of life; Personcentred outcomes
57. Community opioid treatment perspectives on contingency management: Perceived
feasibility, effectiveness, and transportability of social and financial incentives
Bryan Hartzler, Carl Rabun
Journal of Substance Abuse Treatment 2013:45(2);242-248
Abstract
Treatment community reluctance toward contingency management (CM) may be better
understood by eliciting views of its feasibility, effectiveness, and transportability when social
versus financial incentives are utilized. This mixed method study involved individual staff
interviews representing three personnel tiers (an executive, clinical supervisor, and two frontline clinicians) at 16 opiate treatment programs. Interviews included Likert ratings of
feasibility, effectiveness, and transportability of each incentive type, and content analysis of
corresponding interviewee narrative. Multi-level modeling analyses indicated that social
incentives were perceived more feasible, more effective, and more transportable than
financial incentives, with results pervading personnel tier. Content analysis suggested that the
more positive perception of social incentives was most often due to expected logistical
advantages, positive impacts on patient quality-of-life, and philosophical congruence among
staff. Weaker perception of financial incentives was most often influenced by concerns about
costs, patient dissatisfaction, and staff philosophical incongruence. Implications for CM
dissemination are discussed.
Keywords: Contingency management; Innovation adoption; Treatment community views
58. The role of abstinence and activity in the quality of life of drug users engaged in
treatment
David Best, Michael Savic, Melinda Beckwith, Stuart Honor, Justine Karpusheff,
Dan I. Lubman
Journal of Substance Abuse Treatment 2013:45(3);273-279
Abstract
There is increasing interest in understanding factors that enhance the quality of life of
substance users in treatment, however limited research has been conducted to date. Measures
50
of physical and psychological health, overall quality of life, drug use, and meaningful activity
(education, training or employment) were collected at treatment entry and review in two areas
of England as part of routine monitoring. Analysis was performed on an initial sample of
10,470 cases in one site and a more targeted assessment of 783 cases (with repeated measures
for 528 of these) in the second site. Women reported lower satisfaction with their physical
and psychological health at treatment entry compared with men, but these differences were
not present at treatment review. Individuals who reported engagement in meaningful
activities had significantly higher quality of life than those that did not. Clients in treatment
who reported abstinence and engagement in meaningful activity demonstrated the highest
quality of life. A holistic approach to supporting problematic substance users that
acknowledges the importance of participation in meaningful activity is likely to be beneficial.
Keywords: Quality of life; Recovery; Gender; Employment; Abstinence; Treatment
59. QTc interval prolongation for patients in methadone maintenance treatment: a five
years follow-up study
Ayman Fareed, Sreedevi Vayalapalli, Kelly Scheinberg, Robin Gale, Jennifer Casarella,
Karen Drexler
The American Journal of Drug and Alcohol Abuse 2013:39(4);235-240
Abstract
Background QTc prolongation for patients in methadone maintenance treatment (MMT) has
been reported. In this study we wanted to identify the predictor factors for QTc prolongation
>500 ms and other medical risk factors for mortality in this population. Methods A
retrospective chart review study with 55 patients who had previously been included in our
performance improvement project and who were eligible to be reviewed. A linear regression
model with one-sided p value was used for data analysis. Results Over 5 years, 41% to 56%
of patients had QTc > 450 and <500 ms and 4% to 10% of patients had at least one reading of
QTc > 500 ms. This QTc prolongation from baseline showed statistical significance
(p < 0.0001). Being diagnosed with congestive heart failure (CHF), elevated HgA1c level and
recent cocaine use were significantly associated with QTc prolongation >500 ms. The model
as a whole showed statistical significance (F = 3.50, p = 0.02). Being diagnosed with CHF
and elevated HgA1c level was significantly associated with mortality. The model as a whole
also showed statistical significance (F = 4.63, p = 0.01). Conclusions This study confirms
that methadone may be associated with QTc prolongation. It identified three risk factors for
significant QTc prolongation for patients on MMT which are recent cocaine use, uncontrolled
blood glucose and CHF. Two of these three risk facts (uncontrolled blood glucose and CHF)
were associated with mortality in this cohort. Patients with these medical co-morbidities may
benefit from EKG screening and aggressive treatment of the medical risk factors while taking
MMT.
Keywords: Methadone maintenance; prolongation; QTc interval
60. Prevalence of tobacco, cocaine and alcohol use amongst patients attending for
methadone-maintenance therapy in a rural setting
Omar Henriquez-Gonzalez, Robert Patton
Journal of Substance Use 2013:18(5);340-348
Abstract
Background Patients receiving methadone-maintenance therapy appear more likely to have
other substance-use disorders than do people in the general population and often fail to
receive treatment for these conditions. Coexisting substance-use disorders are associated with
51
poor health outcomes amongst current or former heroin users. The aim of this study was to
establish the prevalence of the use of tobacco, cocaine and alcohol amongst patients attending
for community-based methadone-maintenance therapy. Methods Cross-sectional survey of
patients prescribed methadone for treating opiate dependence. Results Prevalences of
tobacco, cocaine and alcohol use in the sample were 91.18%, 11.18% and 42.01%,
respectively. Most respondents were found to be dependent on tobacco. In contrast, most
patients were found to have no dependence on alcohol. In total, 145 patients (85.80%) had
Alcohol Use Disorders Identification Test – Primary Care (AUDIT PC) version scores below
5, indicating lower risk drinking, while the remaining 24 (14.20%) had AUDIT scores of 5 or
above, indicating higher risk drinking. Conclusions There are higher rates of self-reported
tobacco, cocaine and alcohol use disorders amongst methadone-maintained individuals than
those reported in individuals from the general population. The findings illustrate the
importance of identifying coexisting tobacco, cocaine and alcohol use disorders in
methadone-maintained patients, since these issues can significantly impair patients’ quality of
life and affect treatment outcomes.
Keywords: Methadone, alcohol, tobacco, cocaine, prevalence
52
ORGANISATION OF SERVICES
61. Predictors of study setting (primary care vs. hospital setting) among studies of the
effectiveness of brief interventions among heavy alcohol users: A systematic review
Noreen Dadirai Mdege, Judith Watson
Drug and Alcohol Review 2013:32(4);368-380
Abstract
Issues The aim of this study is to compare studies by their setting in order to identify design
differences between studies on brief interventions (BI) for heavy alcohol use conducted in
primary care and those in hospital settings. Approach Potential studies were extracted from
16 reviews and from systematically searching literature up to October 2011. We assessed
whether the following factors were statistically significant predictors of study setting:
exclusion of very heavy/dependent drinkers; mean age of study sample; gender composition
of study samples; sample size; total intervention delivery time; number of sessions;
interventionist (physician vs. non-physician); various study design and intervention fidelity
aspects; accounting for screening/assessment reactivity; and control condition utilised.
Key Findings Seventy-six studies (30 in primary care and 46 in hospital settings) met the
inclusion criteria. The following factors were statistically significant predictors of study
setting: number of sessions {odds ratio [OR] = 0.281 [95% confidence interval (CI) 0.081,
0.979; P = 0.046]}, exclusion of very heavy/dependent drinkers [OR = 0.052 (95% CI 0.004,
0.716, P = 0.027)] and gender composition of study samples [OR = 1.063 (95% CI 1.005,
1.125; P = 0.033)]. Implications Researchers developing hospital setting BIs for excessive
alcohol consumption should take into account methodological issues that could explain
differences in the consistency of findings between hospital setting studies and primary care
setting studies where BIs have been more consistently found effective in reducing alcohol
use. Conclusion The observed study design differences between hospital and primary care
settings might partly explain the disparity in the consistency of findings on effectiveness of
BIs between these settings.[Mdege ND, Watson J. Predictors of study setting (primary care
vs. hospital setting) among studies of the effectiveness of brief interventions among heavy
alcohol users: A systematic review.Drug Alcohol Rev 2013;32:368–380]
Keywords: brief intervention; primary care; hospital; effectiveness; systematic review
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PRIMARY CARE
62. Acceptability of screening for early detection of liver disease in hazardous/harmful
drinkers in primary care
Eyles, Caroline; Moore, Michael; Sheron, Nicholas; Roderick, Paul; O’Brien,
Wendy; Leydon, Geraldine M
British Journal of General Practice 2013:63(613);e516-e522(7)
Abstract
Background It is estimated that one-quarter of adults in the UK drink at harmful/hazardous
levels leading to increased mortality and alcohol liver disease (ALD). The Alcohol Liver
Disease Detection Study (ALDDeS) aimed to test out in primary care the feasibility of
alcohol misuse screening in adults, using the AUDIT questionnaire, and to assess screening
harmful/hazardous alcohol users for ALD using newer non-invasive serum markers of
fibrosis. Aim To explore patients’ experiences of taking part in ALDDeS and understanding
of the delivery and process of screening for ALD using self-report questionnaires and
feedback of liver fibrosis risk using levels of non-invasive serum markers. Design and
setting A nested qualitative study based in five primary care practices in the UK.
Method From a sample of patients who were identified as drinking at harmful/hazardous
levels, 30 participants were identified by maximum variation sampling for qualitative indepth interviews. Using the principles of constant comparison the transcribed interviews were
thematically analysed. Results Receiving a postal AUDIT questionnaire was viewed as
acceptable by participants. For some completing the AUDIT increased awareness of their
hazardous alcohol use and a positive blood test indicating liver fibrosis was a catalyst for
behaviour change. For others, a negative blood test result provided a licence to continue
drinking at hazardous levels. A limited understanding of safe drinking and of ALD was
common. Conclusion Educational and training needs of primary care professionals must be
taken into account, so that patients with marker levels indicating low risk of fibrosis are
correctly informed about the likely risks of continuing to drink at the same levels.
Keywords: alcoholic liver disease; patient acceptance of health care; primary care;
understanding
63. An examination of the influences on New South Wales general practitioners
regarding the provision of opioid substitution therapy
Simon Holliday, Parker Magin, Christopher Oldmeadow, John Attia, Janet Dunbabin,
Julie-Marie Henry, Nicholas Lintzeris, Susan Goode, Adrian Dunlop
Drug and Alcohol Review 2013:32(5);495-503
Abstract
Introduction Few general practitioners (GP) prescribe opioid substitution therapy. Our aim
was to analyse their previously identified motivating factors by describing their frequency
and demographic associations. Methods An anonymous, cross-sectional questionnairebased survey on opioid prescribing in pain and dependency was distributed across five New
South Wales Divisions of GPs. Questions elicited opinions on 11 barriers and five facilitators
previously described in qualitative literature. Data were analysed against demographic
variables, including opioid substitution therapy prescriber (OSTP) status and postgraduate
training status. ‘Profiles’ of non-OSTPs were then constructed using latent class analysis.
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Results Of the 1735 surveys posted, there were 404 responses (23.3%), with 16%
respondents being OSTPs. Frequently reported barriers included: ‘negative experiences with
the opioid dependent’ (72%), ‘heavy workload’ (60%) and ‘lack of specialist support’ (58%),
with most barriers less frequent among OSTPs. Facilitating factors included: ‘more accessible
specialist support’ (75%), ‘more accessible training’ (67%) and ‘better evidence of safety and
efficacy’ (64%), with the latter two significantly less frequently among OSTPs. Latent class
analysis of the non-OSTPs revealed three distinct clusters. The smallest (‘class 3’) had the
least barriers and resembled OSTPs demographically. Discussion and Conclusions The
pattern of motivating factors towards the psychological, social and behavioural challenges of
the management of dependency has a predominantly negative bias. However, this lessens
with postgraduate training and OSTP experience. Structural and logistical options are
identified to promote OSTP recruitment and retention. GPs resembling class 3 may be more
amenable to becoming OSTPs and may be worth targeting for recruitment. [Holliday S,
Magin P, Oldmeadow C, Dunbabin J, Henry J-M, Lintzeris N, Attia J, Goode S, Dunlop A.
An examination of the influences on New South Wales general practitioners regarding the
provision of opioid substitution therapy. Drug Alcohol Rev 2013;32:495–503]
Keywords: general practitioners; opioid substitution therapy; dependency; pain; motivating
factors
55