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CERGA Journal Title and Abstracts March 2016
Contents
PAGE
LIST OF JOURNALS CHECKED
3
LIST OF REFERENCES
Alcohol Brief Intervention
4
Alcohol Effects
4
Alcohol Epidemiology and Demography
4
Alcohol Injuries
4
Alcohol Miscellaneous
5
Alcohol Mortality Effects
6
Alcohol Parenting
6
Alcohol Policy
6
Alcohol Screening and Brief Intervention
6
Alcohol Treatment
6
Benzodiazepine
7
Blood Borne Viruses
7
Brief Intervention
8
Co-Morbidity
8
Epidemiology and Demography
8
Hepatitis C
8
Homelessness
8
Injecting Drug Use
9
Miscellaneous
9
Needle Exchange
10
New Psychoactive Substance
10
Opiate Replacement Treatment
10
Overdose and Drug Related Deaths
11
Parenting
12
Pharmacy
12
Public Interface
12
Recovery, Relapse and Prevention
12
Treatment Services
13
Young People & Alcohol
13
1
LIST OF ABSTRACTS
14-72
2
Number of issues
per year
Journal Title
Volumes and Issues Checked
Addiction
Volume 111, Issue 1[5], Issue 2[7],
Issue 3[1]
Volume 55[1], Volume 56[2]
Volume 51 Issue 2[4]
Volume 39 Issue 12[2],
Volume 40 Issue 1[2], Issue 2[2]
Volume 157[3], Volume 158[1],
Volume 159[8], Volume 160[3]
Volume 23 Issue 1[4]
12
Volume 35 Issue 1[3]
Volume 22 Issue 4[1]
February 2016 Volume 13[2]
Volume 26 Issue 12[3],
Volume 27[5], Volume 28[2]
Volume 61[2]
6
4-5
12
6
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
Harm Reduction Journal
International Journal of Drug Policy
Journal of Substance Abuse
Treatment
The American Journal of Drug and
Alcohol Abuse
Substance Use and Misuse
12
6
12
12
6
8
6
Volume 50 Issue 12[2], Issue 13[1]
Volume 51 Issue 1[1], Issue 2[2]
3
14
LIST OF REFERENCES
ALCOHOL BRIEF INTERVENTION
1.
A Systematic Review on the Effectiveness of Brief Interventions for Alcohol
Misuse among Adults in Emergency Departments
Meredith S.H. Landy, Caitlin J. Davey, David Quintero, Amanda Pecora, Kelly E.
McShane
Journal of Substance Abuse Treatment 2016:61;1-12
ALCOHOL EFFECTS
2.
A lifetime history of alcohol use disorder increases risk for chronic medical
conditions after stable remission
Tomoko Udo, Elizabeth Vásquez, Benjamin A. Shaw
Drug and Alcohol Dependence 2015:157;68-74
3.
Alcohol Dependence, Co-occurring Conditions and Attributable Burden
B.L. Odlaug, A. Gual, J. DeCourcy, R. Perry, J. Pike, L. Heron, J. Rehm
Alcohol and Alcoholism 2016:51(2);201-209
ALCOHOL EPIDEMIOLOGY AND DEMOGRAPHY
4.
Patterns of alcohol consumption and health-related quality of life in older adults
Rosario Ortolá, Esther García-Esquinas, Iñaki Galán, Fernando Rodríguez-Artalejo
Drug and Alcohol Dependence 2016:159;166-173
5.
Alcohol consumption in very old age and its association with survival: A matter
of health and physical function
Neda Agahi, Susanne Kelfve, Carin Lennartsson, Ingemar Kåreholt
Drug and Alcohol Dependence 2016:159;240-245
ALCOHOL INJURIES
6.
Relating off-premises alcohol outlet density to intentional and unintentional
injuries
Christopher Morrison, Karen Smith, Paul J. Gruenewald, William R. Ponicki, Juliet P.
Lee and Peter Cameron
Addiction 2016:111(1);56-64
4
ALCOHOL MISCELLANEOUS
7.
Health information on alcoholic beverage containers: has the alcohol industry's
pledge in England to improve labelling been met?
Mark Petticrew, Nick Douglas, Cécile Knai, Mary Alison Durand, Elizabeth Eastmure
and Nicholas Mays
Addiction 2016:111(1);51-55
8.
How to think about your drink: Action-identification and the relation between
mindfulness and dyscontrolled drinking
Laura Schellhas, Brian D. Ostafin, Tibor P. Palfai, Peter J. de Jong
Addictive Behaviours 2016:56;51-56
9.
Systematic Review of Fetal Alcohol Spectrum Disorder Interventions Across the
Life Span
Natasha Reid, Sharon Dawe, Douglas Shelton, Paul Harnett, Judith Warner, Eleanor
Armstrong, Kim LeGros and Frances O'Callaghan
Alcoholism: Clinical and Experimental Research 2016:39(12);2283-2295
10.
Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic
Literature Review Including Meta-Analysis
Sylvia Roozen, Gjalt-Jorn Y. Peters, Gerjo Kok, David Townend, Jan Nijhuis and
Leopold Curfs
Alcoholism: Clinical and Experimental Research 2016:40(1);18-32
11.
Alcohol Mixed with Energy Drink Use as an Event-Level Predictor of Physical
and Verbal Aggression in Bar Conflicts
Kathleen E. Miller, Brian M. Quigley, Rebecca K. Eliseo-Arras and Natalie J. Ball
Alcoholism: Clinical and Experimental Research 2016:40(1);161-169
12.
Adult Binge Drinking: Childhood Sexual Abuse, Gender and the Role of
Adolescent Alcohol-Related Experiences
Martie L. Skinner, Allison N. Kristman-Valente, Todd I. Herrenkohl
Alcohol and Alcoholism 2016:51(2);136-141
13.
Association of Alcohol Consumption with Perception of Attractiveness in a
Naturalistic Environment
Olivia M. Maynard, Andrew L. Skinner, David M. Troy, Angela S. Attwood, Marcus
R. Munafò
Alcohol and Alcoholism 2016:51(2);142-147
14.
Demographic Risk Factors for Alcohol-Related Aggression In and Around
Licensed Venues
Lucy Zinkiewicz, Ashlee Curtis, Hannah Meurer, Peter Miller
Alcohol and Alcoholism 2016:51(2);196-200
5
ALCOHOL MORTALITY EFFECTS
15.
Drinking and mortality: long-term follow-up of drinking-discordant twin pairs
Pyry Sipilä, Richard J. Rose and Jaakko Kaprio
Addiction 2016:111(2);245-254
ALCOHOL PARENTING
16.
Does parental drinking influence children's drinking? A systematic review of
prospective cohort studies
Ingeborg Rossow, Patrick Keating, Lambert Felix and Jim McCambridge
Addiction 2016:111(2);204-217
17.
Does promoting parents’ negative attitudes to underage drinking reduce
adolescents’ drinking? The mediating process and moderators of the effects of
the Örebro Prevention Programme
Metin Özdemir and Nikolaus Koutakis
Addiction 2016:111(2);263-271
ALCOHOL POLICY
18.
Developing and delivering local level partnership schemes with the alcohol trade
Fizz Annand
Drugs: Education, Prevention and Policy 2016:23(1);62-72
19.
Policy-Relevant Behaviors Predict Heavier Drinking in Both On and Off
Premises and Mediate the Relationship Between Heavier Alcohol Consumption
and Age, Gender, and Socioeconomic Status—Analysis from the International
Alcohol Control Study
Sally Casswell, Taisia Huckle, Martin Wall and Karl Parker
Alcoholism: Clinical and Experimental Research 2016:40(2);385-392
ALCOHOL SCREENING AND BRIEF INTERVENTION
20.
Which women are missed by primary health-care based interventions for
alcohol and drug use?
SCM Roberts, L.J. Ralph, S.C. Wilsnack, D.G. Foster
Addictive Behaviours 2016:55;32-37
ALCOHOL TREATMENT
21.
Studying an unreal world: incentives on internet-based interventions for alcohol
use
André Bedendo and Ana Regina Noto
Addiction 2016:111(2);373-374
6
22.
Hospital Stay and Engagement in Outpatient Follow-Up After Alcohol
Emergency Detox: A 1-Year Comparison Study
Julien Azuar, Frank Questel, Eric Hispard, Jan Scott, Florence Vorspan and Frank
Bellivier
Alcoholism: Clinical and Experimental Research 2016:40(2);418-421
23.
Exercise training – A beneficial intervention in the treatment of alcohol use
disorders?
Mark Stoutenberg, Chad D. Rethorst, Olivia Lawson, Jennifer P. Read
Drug and Alcohol Dependence 2016:160;2-11
BENZODIAZEPINE
24.
Prevalence, prescribed quantities, and trajectory of multiple prescriber
episodes for benzodiazepines: A 2-year cohort study
Yasuyuki Okumura, Sayuri Shimizu, Toshihiko Matsumoto
Drug and Alcohol Dependence 2016:158;118-125
25.
Attitudes towards a maintenance (-agonist) treatment approach in high-dose
benzodiazepine-dependent patients: a qualitative study
Michael Liebrenz, Marcel Schneider, Anna Buadze, Marie-Therese Gehring, Anish
Dube and Carlo Caflisch
Harm Reduction Journal 2016:13(1)
BLOOD BORNE VIRUSES
26.
Innovative community-based educational face-to-face intervention to reduce
HIV, hepatitis C virus and other blood-borne infectious risks in difficult-to-reach
people who inject drugs: results from the ANRS–AERLI intervention study
Perrine Roux, Jean-Marie Le Gall, Marie Debrus, Camélia Protopopescu, Khadim
Ndiaye, Baptiste Demoulin, Caroline Lions, Aurelie Haas, Marion Mora, Bruno Spire,
Marie Suzan-Monti and Maria Patrizia Carrieri
Addiction 2016:111(1);94-106
27.
Rates of HIV and Hepatitis Infections in Clients Entering Heroin-Assisted
Treatment between 2003 and 2013 and Risk Factors for Hepatitis C Infection
Dickson-Spillmann M., Haug S., Uchtenhagen A., Bruggmann P., Schaub M.P.
European Addiction Research 2016:22(4);181-191
28.
Dead space in over-the-counter syringes: The implications for HIV and HCV
transmission
Christine U. Oramasionwu, Stacy C. Bailey, Heather N. Moore, Christopher O.
Oramasionwu, Allison L. Russell, William A. Zule
International Journal of Drug Policy 2015:26(12);1282-1284
7
BRIEF INTERVENTION
29.
Is the quality of brief motivational interventions for drug use in primary care
associated with subsequent drug use?
Tibor P. Palfai, Debbie M. Cheng, Judith A. Bernstein, Joseph Palmisano,
Christine A. Lloyd-Travaglini, Tracie Goodness, Richard Saitz
Addictive Behaviours 2016:56;8-14
CO-MORBIDITY
30.
Treatment Access Barriers and Disparities Among Individuals with CoOccurring Mental Health and Substance Use Disorders: An Integrative
Literature Review
Mary Ann Priester, Teri Browne, Aidyn Iachini, Stephanie Clone, Dana DeHart,
Kristen D. Seay
Journal of Substance Abuse Treatment 2016:61;47-59
EPIDEMIOLOGY AND DEMOGRAPHY
31.
Tobacco and e-cigarette use amongst illicit drug users in Australia
Rachel Sutherland, Natasha Sindicich, Gavin Entwistle, Elizabeth Whittaker, Amy
Peacock, Allison Matthews, Raimondo Bruno, Rosa Alati, Lucy Burns
Drug and Alcohol Dependence 2016:159;35-41
32.
Predictors of transition to heroin use among initially non-opioid dependent illicit
pharmaceutical opioid users: A natural history study
Robert G. Carlson, Ramzi W. Nahhas, Silvia S. Martins, Raminta Daniulaityte
Drug and Alcohol Dependence 2016:160;127-134
HEPATITIS C
33.
Treatment for hepatitis C virus infection among people who inject drugs
attending opioid substitution treatment and community health clinics: the
ETHOS Study
Jason Grebely, Maryam Alavi, Michelle Micallef, Adrian J. Dunlop, Anne C.
Balcomb, Nghi Phung, Martin D. Weltman, Carolyn A. Day, Carla Treloar, Nicky
Bath, Paul S. Haber, Gregory J. Dore and on behalf of the ETHOS Study Group
Addiction 2016:111(2);311-319
HOMELESS
34.
A systematic review of interventions for homeless alcohol-abusing adults
Julie R. Adams-Guppy & Andrew Guppy
Drugs: Education, Prevention and Policy 2016:23(1);15-30
8
35.
In their own words: Content analysis of pathways to recovery among individuals
with the lived experience of homelessness and alcohol use disorders
Susan E. Collins, Connor B. Jones, Gail Hoffmann, Lonnie A. Nelson, Starlyn M.
Hawes, Véronique S. Grazioli, Jessica L. Mackelprang, Jessica Holttum, Greta Kaese,
James Lenert, Patrick Herndon, Seema L. Clifasefi
International Journal of Drug Policy 2016:27;89-96
INJECTING DRUG USE
36.
Exposure to injecting drug use and hepatitis C knowledge among an online
sample of young people
Toby Lea, Joanne Bryant & Carla Treloar
Drugs: Education, Prevention and Policy 2016:23(1);84-88
37.
Trends in sources and sharing of needles among people who inject drugs, San
Francisco, 2005–2012
Nathan J. Kim, Harry Jin, Willi McFarland, Henry F. Raymond
International Journal of Drug Policy 2015:26(12);1238-1243
38.
Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a
Syringe-Exchange Program in Malmö, Sweden
Disa Dahlman, Anders Håkansson, Per Björkman, Marianne Alanko Blomé & Alex
H. Kral
Substance Use and Misuse 2016:50(12);1529-1535
39.
Initiation Stories: An Examination of the Narratives of People Who Assist With
a First Injection
Gillian Kolla, Carol Strike, Élise Roy, Jason Altenberg, Raffi Balian, Rey
Silver & Neil Hunt
Substance Use and Misuse 2015:50(13);1619-1627
40.
Not in the vein: ‘missed hits’, subcutaneous and intramuscular injections and
associated harms among people who inject psychoactive drugs in Bristol, United
Kingdom
V.D. Hope, J.V. Parry, F. Ncube, M. Hickman
International Journal of Drug Policy 2016:28;83-90
MISCELLANEOUS
41.
An international systematic review of smoking prevalence in addiction treatment
Joseph Guydish, Emma Passalacqua, Anna Pagano, Cristina Martínez, Thao Le,
JongSerl Chun, Barbara Tajima, Lindsay Docto, Daria Garina and Kevin Delucchi
Addiction 2016:111(2);220-230
42.
Impact of the introduction of standardised packaging on smokers' brand
awareness and identification in Australia
James Balmford, Ron Borland and Hua-Hie Yong
Drug and Alcohol Review 2016:35(1);102-109
9
NEEDLE EXCHANGE
43.
Community attitudes towards harm reduction services and a newly established
needle and syringe automatic dispensing machine in an inner-city area of
Sydney, Australia
Bethany White, Paul S. Haber, Carolyn A. Day
International Journal of Drug Policy 2016:27;121-126
44.
Trust and people who inject drugs: The perspectives of clients and staff of
Needle Syringe Programs
Carla Treloar, Jake Rance, Kenneth Yates, Limin Mao
International Journal of Drug Policy 2016:27;138-145
NEW PSYCHOACTIVE SUBSTANCE
45.
Next generation of novel psychoactive substances on the horizon – A complex
problem to face
Jolanta B. Zawilska, Dariusz Andrzejczak
Drug and Alcohol Dependence 2015:157;1-17
OPIATE REPLACEMENT TREATMENT
46.
Risk of mortality on and off methadone substitution treatment in primary care:
a national cohort study
Gráinne Cousins, Fiona Boland, Brenda Courtney, Joseph Barry, Suzi Lyons and Tom
Fahey
Addiction 2016:111(1);73-82
47.
Characterizing pain and associated coping strategies in methadone and
buprenorphine-maintained patients
Kelly E. Dunn, Patrick H. Finan, D. Andrew Tompkins, Michael Fingerhood, Eric
C. Strain
Drug and Alcohol Dependence 2015:157;143-149
48.
Concomitant use of benzodiazepine and alcohol in methadone-maintained
patients from the ANRS–Methaville trial: Preventing the risk of opioid overdose
in patients who failed with buprenorphine
Perrine Roux, Caroline Lions, Laurent Michel, Antoine Vilotitch, Marion Mora,
Gwenaelle Maradan, Fabienne Marcellin, Bruno Spire, Morel Alain, Carrieri M.
Patrizia and and the ANRS Methaville Study Group
Drug and Alcohol Review 2016:35(1);61-69
10
49.
Treating codeine dependence with buprenorphine: Dose requirements and
induction outcomes from a retrospective case series in New South Wales,
Australia
Suzanne Nielsen, Raimondo Bruno, Bridin Murnion, Adrian Dunlop, Louisa
Degenhardt, Apo Demirkol, Peter Muhleisen and Nicholas Lintzeris
Drug and Alcohol Review 2016:35(1);70-75
50.
Buprenorphine Maintenance Treatment of Opiate Dependence: Correlations
Between Prescriber Beliefs and Practices
Kai MacDonald, Kristy Lamb, Michael L. Thomas & Wendy Khentigan
Substance Use and Misuse 2016:51(1);85-90
51.
Potential cost-effectiveness of supervised injection facilities in Toronto and
Ottawa, Canada
Eva A. Enns, Gregory S. Zaric, Carol J. Strike, Jennifer A. Jairam, Gillian Kolla and
Ahmed M. Bayoumi
Addiction 2016:111(3);475-489
52.
Development of a brief tool for monitoring aberrant behaviours among
patients receiving long-term opioid therapy: The Opioid-Related Behaviours
In Treatment (ORBIT) scale
Briony Larance, Raimondo Bruno, Nicholas Lintzeris, Louisa Degenhardt, Emma
Black, Amanda Brown, Suzanne Nielsen, Adrian Dunlop, Rohan Holland, Milton
Cohen, Richard P. Mattick
Drug and Alcohol Dependence 2016:159;42-52
53.
Comparison of methods to assess psychiatric medication adherence in
methadone-maintained patients with co-occurring psychiatric disorder
Kelly E. Dunn, Van L. King, Robert K. Brooner
Drug and Alcohol Dependence 2016:160;212-217
OVERDOSE AND DRUG RELATED DEATHS
54.
Impact of treatment for opioid dependence on fatal drug-related poisoning: a
national cohort study in England
Matthias Pierce, Sheila M. Bird, Matthew Hickman, John Marsden, Graham Dunn,
Andrew Jones and Tim Millar
Addiction 2016:111(2);298-308
55.
Exploring the life-saving potential of naloxone: A systematic review and
descriptive meta-analysis of take home naloxone (THN) programmes for
opioid users
Andrew McAuley, Lorna Aucott, Catriona Matheson
International Journal of Drug Policy 2015:26(12);1183-1188
56.
Trends in recreational poisoning in Newcastle, Australia, between 1996 and 2013
Kate M. Chitty, Nicholas J. Osborne, Rose Cairns, Andrew H. Dawson, Nicholas A.
Buckley
Drug and Alcohol Dependence 2016:159;17-25
11
57.
Correlates of overdose risk perception among illicit opioid users
Christopher Rowe, Glenn-Milo Santos, Emily Behar, Philip O. Coffin
Drug and Alcohol Dependence 2016:159;234-239
58.
Stakeholder perceptions and operational barriers in the training and
distribution of take-home naloxone within prisons in England
Arun Sondhi, George Ryan and Ed Day
Harm Reduction Journal 2016:13;5
59.
An Initial Evaluation of Web-Based Opioid Overdose Education
Stephanie S. Roe & Caleb J. Banta-Green
Substance Use and Misuse 2016:51(2);268-275
PARENTING
60.
The Parental Bond and Alcohol Use Among Adolescents: The Mediating Role of
Drinking Motives
Martina Smorti & Silvia Guarnieri
Substance Use and Misuse 2015:50(13);560-1570
PHARMACY
61.
Community pharmacy services for people with drug problems over two decades
in Scotland: Implications for future development
Catriona Matheson, Manimekalai Thiruvothiyur, Helen Robertson, Christine Bond
International Journal of Drug Policy 2016:27;105-112
PUBLIC INTERFACE
62.
Understanding Americans’ views on opioid pain reliever abuse
Colleen L. Barry, Alene Kennedy-Hendricks, Sarah E. Gollust, Jeff Niederdeppe,
Marcus A. Bachhuber, Daniel W. Webster and Emma E. McGinty
Addiction 2016:111(1);85-93
RECOVERY, RELAPSE AND PREVENTION
63.
Emerging consensus on measuring addiction recovery: Findings from a multistakeholder consultation exercise
Joanne Neale, Daria Panebianco, Emily Finch, John Marsden, Luke Mitcheson, Diana
Rose, John Strang & Til Wykes
Drugs: Education, Prevention and Policy 2016:23(1);31-40
12
64.
Personal support networks, social capital, and risk of relapse among individuals
treated for substance use issues
Daria Panebianco, Owen Gallupe, Peter J. Carrington, Ivo Colozzi
International Journal of Drug Policy 2016:27;146-153
TREATMENT SERVICES
65.
Telephone-based continuing care counseling in substance abuse treatment:
Economic analysis of a randomized trial
Donald S. Shepard, Marilyn C. Daley, Matthew J. Neuman, Aaron P. Blaakman,
James R. McKay
Drug and Alcohol Dependence 2016:159;109-116
66.
The effectiveness of compulsory drug treatment: A systematic review
D. Werb, A. Kamarulzaman, M.C. Meacham, C. Rafful, B. Fischer, S.A. Strathdee, E.
Wood
International Journal of Drug Policy 2016:28;1-9
67.
Parental Criminal Justice Involvement and Children's Involvement With Child
Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?
Elizabeth J. Gifford, Lindsey M. Eldred, Frank A. Sloan & Kelly E. Evans
Substance Use and Misuse 2016:51(2);179-192
YOUNG PEOPLE AND ALCOHOL
68.
Social Goals and Grade as Moderators of Social Normative Influences on
Adolescent Alcohol Use
Samuel N. Meisel and Craig R. Colder
Alcoholism: Clinical and Experimental Research 2015:39(12);2455-2462
69.
Effectiveness of a Dutch community-based alcohol intervention: Changes in
alcohol use of adolescents after 1 and 5 years
Sophia C. Jansen, Annemien Haveman-Nies, Inge Bos-Oude Groeniger, Cobi
Izeboud, Carolien de Rover, Pieter van’t Veer
Drug and Alcohol Dependence 2016:159;125-132
13
LIST OF ABSTRACTS
ALCOHOL BRIEF INTERVENTION
1. A Systematic Review on the Effectiveness of Brief Interventions for Alcohol Misuse
among Adults in Emergency Departments
Meredith S.H. Landy, Caitlin J. Davey, David Quintero, Amanda Pecora, Kelly E. McShane
Journal of Substance Abuse Treatment 2016:61;1-12
Abstract
Given the frequency with which individuals seek treatment for alcohol-related consequences
in emergency departments (EDs), they may be the optimal setting to deliver brief
interventions (BIs) for alcohol misuse. Studies examining the effectiveness of BIs for alcohol
misuse conducted in EDs have yielded mixed results, and new articles have been published
since the last review in 2008. The aim of this study was to provide an updated systematic
review on the effectiveness of BIs for alcohol misuse delivered to adults in EDs. Articles
published in June 2014 and earlier were identified from online databases (PsycInfo,
Healthstar, CINAHL, Medline, Nursing and Allied Health). Search terms included (1)
alcohol, (2) “alcohol screening”, “brief intervention”, “brief alcohol intervention” or
feedback and (3) “emergency department” or “emergency room”. Once duplicates were
removed, 171 abstracts were identified for review. Thirty-four studies were included in the
systematic review. All studies reported a significant reduction in alcohol consumption at
3 months post-BI, with some studies finding significant differences between the BI and
control groups, and other studies finding significant decreases in both conditions but no
between-groups differences. The majority of studies did not find significant between-group
differences at 6 and 12 months post-BI with regard to decreases in alcohol consumption.
Individuals who received a BI were significantly less likely to have an alcohol-related injury
at 6 or 12 months post-BI than individuals who did not receive a BI. BIs are unlikely to
reduce subsequent hospitalizations however, they may be effective in reducing risky driving
and motor vehicle crashes associated with alcohol use, which can result in hospitalization.
Beyond the effects generated by visiting EDs, BIs delivered in EDs may not be effective in
reducing alcohol consumption, or in reducing subsequent hospitalizations. BIs may be
effective in reducing some alcohol-related consequences. Future studies ought to investigate
for whom BIs are most effective, and the processes that lead to decreases in alcohol
consumption and alcohol-related consequences.
Keywords: Brief intervention; Alcohol; Emergency department; Adults; Systematic review
14
ALCOHOL EFFECTS
2. A lifetime history of alcohol use disorder increases risk for chronic medical
conditions after stable remission
Tomoko Udo, Elizabeth Vásquez, Benjamin A. Shaw
Drug and Alcohol Dependence 2015:157;68-74
Abstract
Background The long-term impact of a past alcohol use disorder (AUD) among those
who are currently in stable remission has not been well-explored. This study examined
whether a past history of AUD was associated with increased risk for chronic medical
conditions in a large U.S. nationally representative sample of adults ≥30 years old.
Methods Using 25,840 participants from Wave 1 and Wave 2 surveys of the National
Epidemiologic Survey on Alcohol and Related Condition (NESARC), multiple logistic
regression analysis was conducted to compare the risk for reporting metabolic,
cardiovascular, liver, gastrointestinal, and inflammatory conditions between those in fullremission from AUD for longer than 5 years and those without a history of AUD
diagnosis. Results Compared with a model adjusting only for age, a model adjusting for
other potential psychosocial confounders revealed fewer significant associations between
AUD history and chronic medical conditions, particularly for the middle-aged population
and for men. For the elderly, AUD history was associated with more chronic medical
conditions in fully adjusted models. AUD history was associated with severe medical
conditions such as liver diseases and myocardial infarction in women. In general, longer
AUD exposure and shorter remission were also associated with the risk for chronic
medical conditions. Conclusions Our findings suggest associations between past AUD
diagnosis and chronic medical conditions, particularly for the elderly individuals.
Screening for past alcohol use problems and associated health risks are important for the
promotion of aging and prevention of chronic medical conditions even when an individual
presents no current symptoms of AUD.
Keywords: Alcohol use disorder; Remission; Past diagnosis; Chronic medical conditions;
Age; Gender
3. Alcohol Dependence, Co-occurring Conditions and Attributable Burden
B.L. Odlaug, A. Gual, J. DeCourcy, R. Perry, J. Pike, L. Heron, J. Rehm
Alcohol and Alcoholism 2016:51(2);201-209
Abstract
Aims Alcohol dependence is associated with high rates of co-occurring disorders which
impact health-related quality of life (HRQoL) and add to the cost-of-illness. This study
investigated the burden of alcohol dependence and associated co-occurring conditions on
health and productivity. Methods A cross-sectional survey was conducted in eight European
countries. Physicians (Psychiatrists and General Practitioners) completed patient record
forms, which included assessment of co-occurring conditions, and patients completed
matching self-completion forms. Drinking risk level (DRL) was calculated and the
relationship between DRL, co-occurring conditions, work productivity, hospitalisations and
rehabilitation stays was explored. Results Data were collected for 2979 alcohol-dependent
patients (mean age 48.8 ± 13.6 years; 70% male). In total, 77% of patients suffered from
moderate-to-severe co-occurring psychiatric and/or somatic conditions. High DRL was
15
significantly associated with depression, greater work productivity losses, increased
hospitalisations and rehabilitation stays. Co-occurring conditions were significantly
associated with poorer HRQoL and decreased work productivity, with a statistical trend
towards an increased frequency of rehabilitation stays. Conclusions Alcohol-dependent
patients manifest high rates of co-occurring psychiatric and somatic conditions, which are
associated with impaired work productivity and HRQoL. The continued burden of illness
observed in these already-diagnosed patients suggests an unmet need in both primary and
secondary care.
16
ALCOHOL EPIDEMIOLOGY AND DEMOGRAPHY
4. Patterns of alcohol consumption and health-related quality of life in older adults
Rosario Ortolá, Esther García-Esquinas, Iñaki Galán, Fernando Rodríguez-Artalejo
Drug and Alcohol Dependence 2016:159;166-173
Abstract
Background Health-related quality of life (HRQOL) is a more powerful predictor of health
services use and mortality than many objective measures of health. However, in older adults
the association between main alcohol drinking patterns and HRQOL is uncertain.
Methods A prospective cohort with 2163 community-dwelling individuals aged ≥60 years
was recruited in Spain in 2008-2010 and followed-up through 2012. At baseline, participants
reported alcohol consumption. HRQOL was measured with the SF-12 questionnaire, at
baseline and in 2012. Results In cross-sectional analyses at baseline, compared to nondrinkers, better scores on the physical component summary (PCS) of the SF-12 were reported
in moderate (β = 1.59 [95% confidence interval 0.61–2.58]) and heavy drinkers (β = 2.18
[0.57–3.79]). Better scores on the PCS were also reported by drinkers who adhered to the
Mediterranean drinking pattern (MDP) (β = 1.43 [0.30–2.56]) as well as those who did not
(β = 1.89 [0.79–2.99]). However, no association was observed between average alcohol
consumption or the MDP and the mental component summary (MCS) of the SF-12; or
between beverage preference or drinking with meals and either the PCS or MCS scores. In
prospective analyses, women who reportedly drank exclusively with meals showed better
scores on the PCS than women who drank only outside of meals (β = 3.64 [0.79–6.50]).
Conclusions The small association between alcohol consumption and better physical
HRQOL found at baseline was not apparent after a few years of follow-up. Medical advice on
alcohol consumption cannot be grounded on its effects on HRQOL.
Keywords: Alcohol; Health-related quality of life; Ederly; Cohort study
5. Alcohol consumption in very old age and its association with survival: A matter of
health and physical function
Neda Agahi, Susanne Kelfve, Carin Lennartsson, Ingemar Kåreholt
Drug and Alcohol Dependence 2016:159;240-245
Abstract
Background Alcohol consumption in very old age is increasing; yet, little is known about
the personal and health-related characteristics associated with different levels of alcohol
consumption and the association between alcohol consumption and survival among the oldest
old. Methods Nationally representative data from the Swedish Panel Study of Living
Conditions of the Oldest Old (SWEOLD, ages 76–101; n = 863) collected in 2010/2011 were
used. Mortality was analyzed until 2014. Alcohol consumption was measured with questions
about frequency and amount. Drinks per month were calculated and categorized as abstainer,
light-to-moderate drinker (0.5–30 drinks/month) and heavy drinker (>30 drinks/month).
Multinomial logistic regressions and Laplace regressions were performed. Results
Compared to light-to-moderate drinkers, abstainers had lower levels of education and more
functional health problems, while heavy drinkers were more often men, had higher levels of
education, and no serious health or functional problems. In models adjusted only for age and
sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional
drink/month was associated with longer survival, while among heavy drinkers, each
additional drink/month was associated with shorter survival. However, after adjusting for
17
personal and health-related factors, estimates were lower and no longer statistically
significant. Conclusions The association between alcohol consumption and survival in very
old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter
survival compared to light-to-moderate drinking. To a large extent, differences in survival are
due to differences in baseline health and physical function.
Keywords: Alcohol; Oldest old; Survival; Mortality; Laplace
18
ALCOHOL INJURIES
6. Relating off-premises alcohol outlet density to intentional and unintentional injuries
Christopher Morrison, Karen Smith, Paul J. Gruenewald, William R. Ponicki, Juliet P. Lee
and Peter Cameron
Addiction 2016:111(1);56-64
Abstract
Aims This study investigated the hypotheses that (i) intentional and unintentional injuries
occur more frequently in areas with greater density of off-premises alcohol outlets; and (ii)
larger and chain outlets selling cheaper alcohol contribute more substantially to injury risk
than smaller and independent outlets. Design Ecological cross-sectional. Setting From the
256 Statistical Area level 2 (SA2) census units in Melbourne, Australia, we selected a random
sample of 62 units. There were 2119 Statistical Area level 1 (SA1) units nested within the
selected SA2 units. Participants The selected units contained 295 off-premises outlets.
Measurements Two independent observers conducted premises assessments in all offpremises outlets, assessing the volume of alcohol available for sale (paces of shelf space),
price (least wine price) and other operating characteristics (chain versus independent, drivethrough). Outlet counts, assessed outlet characteristics and other area characteristics
(population density, median age, median income, retail zoning) were aggregated within SA1
units. Dependent variables were counts of ambulance attended intentional injuries (assaults,
stabbings, shootings) and unintentional injuries (falls, crush injuries and object strikes).
Findings In univariable analyses, chain outlets were larger (r = 0.383; P < 0.001) and sold
cheaper alcohol (r = −0.484; P < 0.001) compared with independent outlets. In Bayesian
spatial Poisson models, off-premises outlet density was positively related to both intentional
[incidence rate ratio (IRR) = 1.38; 95% credible interval (CI) = 1.19, 1.60] and unintentional
injuries (IRR = 1.18; 95% CI = 1.06, 1.30). After disaggregation by outlet characteristics,
chain outlet density was also related to both intentional (IRR = 1.35; 95% CI = 1.11, 1.64)
and unintentional injuries (IRR = 1.20; 95% CI = 1.08, 1.38). Conclusions Greater offpremises outlet density is related to greater incidence of traumatic injury, and chain outlets
appear to contribute most substantially to traumatic injury risk.
Keywords: Alcohol outlets; availability; injury; outlet density; trauma
19
ALCOHOL MISCELLANEOUS
7. Health information on alcoholic beverage containers: has the alcohol industry's
pledge in England to improve labelling been met?
Mark Petticrew, Nick Douglas, Cécile Knai, Mary Alison Durand, Elizabeth Eastmure and
Nicholas Mays
Addiction 2016:111(1);51-55
Abstract
Aims In the United Kingdom, alcohol warning labels are the subject of a voluntary
agreement between industry and government. In 2011, as part of the Public Health
Responsibility Deal in England, the industry pledged to ensure that 80% of products would
have clear, legible health warning labelling, although an analysis commissioned by Portman
found that only 57.1% met best practice. We assessed what proportion of alcohol products
now contain the required health warning information, and its clarity and placement.
Design Survey of alcohol labelling data. Setting United Kingdom. Participants Analysis
of the United Kingdom's 100 top-selling alcohol brands (n = 156 individual products).
Measurements We assessed the product labels in relation to the presence of five labelling
elements: information on alcohol units, government consumption guidelines, pregnancy
warnings, reference to the Drinkaware website and a responsibility statement. We also
assessed the size, colour and placement of text, and the size and colouring of the pregnancy
warning logo. Findings The first three (required) elements were present on 77.6% of
products examined. The mean font size of the Chief Medical Officer's (CMO) unit guidelines
(usually on the back of the product) was 8.17-point. The mean size of pregnancy logos was
5.95 mm. The pregnancy logo was on average smaller on wine containers. Conclusions The
UK Public Health Responsibility Deal alcohol labelling pledge has not been fully met.
Labelling information frequently falls short of best practice, with font and logos smaller than
would be accepted on other products with health effects.
Keywords: Alcohol; evaluation; labelling; marketing; public health policy; public health
responsibility deal
8. How to think about your drink: Action-identification and the relation between
mindfulness and dyscontrolled drinking
Laura Schellhas, Brian D. Ostafin, Tibor P. Palfai, Peter J. de Jong
Addictive Behaviours 2016:56;51-56
Abstract
Cross-sectional and intervention research have shown that mindfulness is inversely associated
with difficulties in controlling alcohol use. However, little is known regarding the
mechanisms through which mindfulness is related to increased control over drinking. One
potential mechanism consists of the way individuals represent their drinking behaviour.
Action identification theory proposes that self-control of behaviour is improved by shifting
from high-level representations regarding the meaning of a behaviour to lower-level
representations regarding “how-to” aspects of a behaviour. Because mindfulness involves
present-moment awareness, it may help to facilitate such shifts. We hypothesized that an
inverse relation between mindfulness and dyscontrolled drinking would be partially
accounted for by the way individuals mentally represent their drinking behaviour — i.e.,
reduced levels of high-level action identification and increased levels of low-level action
identification. One hundred and twenty five undergraduate psychology students completed
20
self-report measures of mindful awareness, action identification of alcohol use, and difficulty
in controlling alcohol use. Results supported the hypothesis that high-level action
identification partially mediates the relation between mindfulness and dyscontrolled drinking
but did not support a mediating role for low-level action identification. These results suggest
that mindfulness can improve self-control of alcohol by changing the way we think about our
drinking behaviour.
Keywords: Action identification; Addiction; Alcohol; Mindfulness; Self-control; Selfregulation
9. Systematic Review of Fetal Alcohol Spectrum Disorder Interventions Across the Life
Span
Natasha Reid, Sharon Dawe, Douglas Shelton, Paul Harnett, Judith Warner, Eleanor
Armstrong, Kim LeGros and Frances O'Callaghan
Alcoholism: Clinical and Experimental Research 2016:39(12);2283-2295
Abstract
Background Individuals with fetal alcohol spectrum disorders (FASDs) can experience
profound impairments and long-term adverse outcomes. This systematic review adopts a life
span perspective providing an extensive analysis of the available literature.
Methods Studies were identified from PsycInfo, PubMed, Scopus, Web of Knowledge,
CINAHL, ERIC, The Cochrane Central Register of Controlled Trials, and gray literature.
Two reviewers independently screened the title and abstract of each reference, and the
methodological rigor of the included studies was assessed using the Effective Public Health
Project assessment tool. Results Thirty-two studies met the inclusion criteria, of which the
vast majority targeted early to middle childhood. Two studies focused on early intervention in
the postnatal period, and 6 studies aimed to improve attention and/or self-regulation in
childhood. Three of these provided promising evidence on improving self-regulatory
difficulties for children with FASDs. Nine studies focused on improving specific areas of
dysfunction. Six studies addressed social skills; 3 of these used an adaptation of a wellvalidated social skills program. Three studies provided promising initial evidence that parents
and caregivers could benefit from support with child behavior and a further 4 studies
provided education and advocacy for parents/caregivers, teachers, or child welfare workers.
The final 2 studies were aimed at supporting parents who were themselves affected by
prenatal alcohol exposure. Conclusions There is growing evidence for interventions that
improve outcomes for early to middle childhood. However, a lack of research exists outside
of this developmental period. This lack of research is concerning given the potential positive
impact of early intervention, for individuals and, financially, for governments. In addition,
the lack of interventions for adolescents and adults further highlights the widening
developmental gap and the potential influence of secondary disabilities for this at-risk
population.
Keywords: Fetal Alcohol Spectrum Disorders; Prenatal Alcohol Exposure; Systematic
Review; Intervention; Treatment
21
10. Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic
Literature Review Including Meta-Analysis
Sylvia Roozen, Gjalt-Jorn Y. Peters, Gerjo Kok, David Townend, Jan Nijhuis and Leopold
Curfs
Alcoholism: Clinical and Experimental Research 2016:40(1);18-32
Abstract
Background Although fetal alcohol spectrum disorders (FASD) affect communities
worldwide, little is known about its prevalence. The objective of this study was to provide an
overview of the global FASD prevalence. Methods We performed a search in multiple
electronic bibliographic databases up to August 2015, supplemented with the ascendancy and
descendancy approach. Studies were considered when published in English, included human
participants, and reported empirical data on prevalence or incidence estimates of FASD. Raw
prevalence estimates were transformed using the Freeman–Tukey double arcsine
transformation so that the data followed an approximately normal distribution. Once the
pooled prevalence estimates, 95% confidence intervals and prediction intervals were
calculated based on multiple meta-analyses with transformed proportions using random
effects models, these estimates were transformed back to regular prevalence rates.
Heterogeneity was tested using Cochran's Q and described using the I2 statistic.
Results Among studies that estimated prevalence in general population samples,
considerable differences in prevalence rates between countries were found and therefore
separate meta-analyses for country were conducted. Particularly high-prevalence rates were
observed in South Africa for fetal alcohol syndrome (55.42 per 1,000), for alcohol-related
neurodevelopmental disorder (20.25 per 1,000), and FASD (113.22 per 1,000), For partial
fetal alcohol syndrome high rates were found in Croatia (43.01 per 1,000), Italy (36.89 per
1,000), and South Africa (28.29 per 1,000). In the case of alcohol-related birth defects, a
prevalence of 10.82 per 1,000 was found in Australia. However, studies into FASD exhibited
substantial heterogeneity, which could only partly be explained by moderators, most notably
geography and descent, in meta-regressions. In addition, the moderators were confounded,
making conclusions as to each moderator's relevance tentative at best.
Conclusions The worldwide pooled prevalence estimates are higher than assumed so far, but
this was largely explained by geography and descent. Furthermore, prevalence studies varied
considerably in terms of used methodology and methodological quality. The pooled estimates
must therefore be interpreted with caution and for future research it is highly recommended to
report methodology in a more comprehensive way. Finally, clear guidelines on assessing
FASD prevalence are urgently needed, and a first step toward these guidelines is presented.
Keywords: Fetal Alcohol Spectrum Disorder(s); Epidemiology; Prevalence; Systematic
Literature Review; Meta-Analysis
11. Alcohol Mixed with Energy Drink Use as an Event-Level Predictor of Physical and
Verbal Aggression in Bar Conflicts
Kathleen E. Miller, Brian M. Quigley, Rebecca K. Eliseo-Arras and Natalie J. Ball
Alcoholism: Clinical and Experimental Research 2016:40(1);161-169
Abstract
Background Young adult use of alcohol mixed with caffeinated energy drinks (AmEDs) has
been globally linked with increased odds of interpersonal aggression, compared with the use
of alcohol alone. However, no prior research has linked these behaviors at the event level in
22
bar drinking situations. The present study assessed whether AmED use is associated with the
perpetration of verbal and physical aggression in bar conflicts at the event level.
Methods In Fall 2014, a community sample of 175 young adult AmED users (55% female)
completed a web survey describing a recent conflict experienced while drinking in a bar. Use
of both AmED and non-AmED alcoholic drinks in the incident were assessed, allowing
calculation of our main predictor variable, the proportion of AmEDs consumed (AmED/total
drinks consumed). To measure perpetration of aggression, participants reported on the
occurrence of 6 verbal and 6 physical acts during the bar conflict incident. Results Linear
regression analyses showed that the proportion of AmEDs consumed predicted scores for
perpetration of both verbal aggression (β = 0.16, p < 0.05) and physical aggression (β = 0.19,
p < 0.01) after controlling for gender, age, sensation-seeking and aggressive personality traits,
aggressive alcohol expectancies, aggressogenic physical and social bar environments, and
total number of drinks. Conclusions Results of this study suggest that in alcohol-related bar
conflicts, higher levels of young adult AmED use are associated with higher levels of
aggression perpetration than alcohol use alone and that the elevated risk is not attributable to
individual differences between AmED users and nonusers or to contextual differences in bar
drinking settings. While future research is needed to identify motivations, dosages, and
sequencing issues associated with AmED use, these beverages should be considered a
potential risk factor in the escalation of aggressive bar conflicts.
Keywords: Aggression; Alcohol; Energy Drinks; Bar Conflict
12. Adult Binge Drinking: Childhood Sexual Abuse, Gender and the Role of Adolescent
Alcohol-Related Experiences
Martie L. Skinner, Allison N. Kristman-Valente, Todd I. Herrenkohl
Alcohol and Alcoholism 2016:51(2);136-141
Abstract
Aims This study examines gender differences in the pathway from childhood sexual abuse
(CSA) to adult binge drinking. Methods Using longitudinal data on 313 males and females
(31–41 years old, mean = 36.21) in the Lehigh Longitudinal Study, we test for gender
differences in the pathway from CSA to adolescent drinking, norms and pro-alcohol peers, to
adult binge drinking. Results Controlling for family history of alcohol problems,
socioeconomic status (SES) and ethnicity, we found that for females there was a significant
direct effect of CSA on adult binge drinking. For males there was no significant direct or
indirect effect. Significant effects of family alcohol problems and SES were also moderated
by gender. Conclusion There are gender differences in the impact of CSA on adult binge
drinking. Service providers and program developers should pay special attention to the
possibility that their female clients may have a history of sexual abuse which could have
implications for the course of prevention and treatment services related to binge drinking.
Early intervention could prevent alcohol-related risk in adolescence which in turn could
reduce, but not eliminate, the binge drinking consequences of CSA for females.
23
13. Association of Alcohol Consumption with Perception of Attractiveness in a
Naturalistic Environment
Olivia M. Maynard, Andrew L. Skinner, David M. Troy, Angela S. Attwood, Marcus R.
Munafò
Alcohol and Alcoholism 2016:51(2);142-147
Abstract
Aims To investigate the relationship between objectively-assessed alcohol consumption and
perception of attractiveness in naturalistic drinking environments, and to determine the
feasibility and acceptability of conducting a large-scale study in these environments.
Methods Observational study conducted simultaneously across three public houses in
Bristol, UK. Participants were required to rate the attractiveness of male and female face
stimuli and landscape stimuli administered via an Android tablet computer application, after
which their expired breath alcohol concentration (BrAC) was measured. Results Linear
regression revealed no clear evidence for relationships between alcohol consumption and
either overall perception of attractiveness for stimuli, for faces specifically, or for oppositesex faces. The naturalistic research methodology was feasible, with high levels of participant
engagement and enjoyment. Conclusions We found no evidence for a relationship between
alcohol consumption and perception of attractiveness in our large-scale naturalistic study.
Our study is important given the large sample size, the successful translation of an
experimental, laboratory-based paradigm to a naturalistic drinking environment and the high
level of public engagement with the study. Future studies should use similarly ecologicallyvalid methodologies to further explore the conditions under which this effect may be
observed and identify the mechanisms underlying any relationships.
14. Demographic Risk Factors for Alcohol-Related Aggression In and Around Licensed
Venues
Lucy Zinkiewicz, Ashlee Curtis, Hannah Meurer, Peter Miller
Alcohol and Alcoholism 2016:51(2);196-200
Abstract
Aims Few studies have examined the role of gender and both area-level and individual socioeconomic status (SES) as independent predictors of alcohol-related aggression (ARA) in and
around licensed venues. Methods The aim of the present study was to investigate the
relationship between gender, area-level SES and individual SES (operationalised as
occupational category) and ARA in and around licensed venues. The sample comprised 697
men and 649 women aged 16–47, who completed a patron intercept survey as part of a larger
study assessing trends in harm and stakeholders' views surrounding local community level
interventions in dealing with alcohol-related problems in the night-time economy.
Results Binary logistic regression analyses showed that age, gender, occupational category,
area-level SES and level of intoxication at time of interview were all significant predictors of
involvement in ARA. Being male doubled the odds of involvement in ARA, while age was a
protective factor. Blue collar workers had more than double the odds of ARA involvement of
professionals, while those living in the most socio-economically disadvantaged areas were
over twice as likely to report experiencing ARA compared to those living in the most
advantaged areas. However, assessment of the predictive model by gender revealed that
effects of age, occupational category and area-level SES were restricted to male participants,
with greater intoxication no longer predictive. Conclusions ARA among patrons was
significantly more likely to occur among men, those in blue collar occupations, and
24
individuals living in low SES areas, suggesting both individual and area-level disadvantage
may play a role in ARA.
25
ALCOHOL MORTALITY EFFECTS
15. Drinking and mortality: long-term follow-up of drinking-discordant twin pairs
Pyry Sipilä, Richard J. Rose and Jaakko Kaprio
Addiction 2016:111(2);245-254
Abstract
Aims To determine if associations of alcohol consumption with all-cause mortality replicate
in discordant monozygotic twin comparisons that control for familial and genetic confounds.
Design A 30-year prospective follow-up. Setting Population-based older Finnish twin
cohort. Participants Same-sex twins, aged 24–60 years at the end of 1981, without overt
comorbidities, completed questionnaires in 1975 and 1981 with response rates of 89 and
84%. A total of 15 607 twins were available for mortality follow-up from the date of returned
1981 questionnaires to 31 December 2011; 14 787 twins with complete information were
analysed. Measurements Self-reported monthly alcohol consumption, heavy drinking
occasions (HDO) and alcohol-induced blackouts. Adjustments for age, gender, marital and
smoking status, physical activity, obesity, education and social class. Findings Among
twins as individuals, high levels of monthly alcohol consumption (≥ 259 g/month) associated
with earlier mortality [hazard ratio (HR) = 1.63, 95% confidence interval (CI) = 1.47–1.81].
That association was replicated in comparisons of all informatively drinking-discordant twin
pairs (HR = 1.91, 95% CI = 1.49–2.45) and within discordant monozygotic (MZ) twin pairs
(HR = 2.24, 95% CI = 1.31–3.85), with comparable effect size. Smaller samples of MZ twins
discordant for HDO and blackouts limited power; a significant association with mortality was
found for multiple blackouts (HR = 2.82, 95% CI = 1.30–6.08), but not for HDO.
Conclusions The associations of high levels of monthly alcohol consumption and alcoholinduced blackouts with increased all-cause mortality among Finnish twins cannot be
explained by familial or genetic confounds; the explanation appears to be causal.
Keywords: Alcohol drinking; alcoholic intoxication; binge drinking; causality;
confounding factors; follow-up studies; mortality; twins
26
ALCOHOL PARENTING
16. Does parental drinking influence children's drinking? A systematic review of
prospective cohort studies
Ingeborg Rossow, Patrick Keating, Lambert Felix and Jim McCambridge
Addiction 2016:111(2);204-217
Abstract
Aims To evaluate evidence of the capacity for causal inference in studies of associations
between parental and offspring alcohol consumption in the general population.
Methods A systematic search for, and narrative analysis of, prospective cohort studies of the
consequences of drinking, except where assessed prenatally only, or with clinically derived
instruments. Primary outcome measures were alcohol use or related problems in offspring,
which were collected at least 3 years after exposure measures of parental drinking. The
systematic review included 21 studies comprising 26 354 families or parent–child dyads with
quantitative effect measures available for each study. Criteria for capacity of causal inference
included (1) theory-driven approach and analysis; (2) analytical rigour; and (3) minimization
of sources of bias. Results Four of the 21 included studies filled several, but not all, criteria
and were assessed to have some capacity for causal inference. These four studies found some
evidence that parental drinking predicted drinking behaviour in adolescent offspring. The
remaining 17 studies had little or no such capacity. Conclusions There is a fairly large and
consistent literature demonstrating that more parental drinking is associated with more
drinking in offspring. Despite this, existing evidence is insufficient to warrant causal
inferences at this stage.
Keywords: Alcohol; causal association; offspring drinking; parental drinking; prospective
studies; systematic review
17. Does promoting parents’ negative attitudes to underage drinking reduce
adolescents’ drinking? The mediating process and moderators of the effects of the
Örebro Prevention Programme
Metin Özdemir and Nikolaus Koutakis
Addiction 2016:111(2);263-271
Abstract
Background and aims The Örebro Prevention Programme (ÖPP) was found previously to
be effective in reducing drunkenness among adolescents [Cohen's d = 0.35, number needed to
treat (NNT) = 7.7]. The current study tested the mediating role of parents’ restrictive attitudes
to underage drinking in explaining the effectiveness of the ÖPP, and the potential moderating
role of gender, immigration status, peers’ and parents’ drinking and parent–adolescent
relationship quality. Design A quasi-experimental matched-control group study with
assessments at baseline, and at 18- and 30-month follow-ups. Participants Of the 895 target
youths at ages 12–13 years, 811 youths and 651 parents at baseline, 653 youths and 524
parents at 18-month and 705 youths and 506 parents at 30-month follow-up participated in
the study. Measurements Youths reported on their past month drunkenness, their parents’
and peers’ alcohol use and the quality of their relationship with parents. Parents reported on
their attitudes to underage drinking. Findings The mediation analyses, using latent growth
curve modeling, showed that changes in parents’ restrictive attitudes to underage drinking
explained the impact of the ÖPP on changes in youth drunkenness, which was reduced, and
onset of monthly drunkenness, which was delayed, relative to controls. Mediation effect
27
explained 57 and 45% of the effects on drunkenness and onset of monthly drunkenness,
respectively. The programme effects on both parents’ attitudes and youth drunkenness were
similar across gender, immigrant status, parents’ and peers’ alcohol use and parent–youth
relationship quality. Conclusions Increasing parents’ restrictive attitudes to youth drinking
appears to be an effective and robust strategy for reducing heavy underage drinking
regardless of the adolescents’ gender, cultural origin, peers’ and parents’ drinking and
relationship quality with parents.
Keywords: Adolescents; heavy drinking; mediation; moderation; parental attitudes;
prevention
28
ALCOHOL POLICY
18. Developing and delivering local level partnership schemes with the alcohol trade
Fizz Annand
Drugs: Education, Prevention and Policy 2016:23(1);62-72
Abstract
This analysis of local partnership projects involving the alcohol trade draws on the work of
Michel Foucault to consider the extent to which these projects “responsibilise” the alcohol
trade and contribute to a reduction of problems in the night time economy. The key aims of
the research were: (1) to identify the multiple realities of the research subjects from their own
perspectives, about what works in local alcohol-related partnership schemes, and (2) to
identify the key drivers of change and understand the forces that influenced views of success
or failure of local public sector/alcohol trade partnership schemes. Interviews (n = 28) were
carried out in London boroughs (n = 8), over a two-year period between 2009 and 2011.
Partners included police, licensing teams, local authority staff, pub, club and bar managers
and a central government official. Post hoc “theories of change” diagrams illustrate the way
interviewees thought their projects worked and made links between activities, assumptions
and outcomes. In schemes thought of as successful there was a clear understanding of what
interviewees thought made them work. The essential common factor was “engagement”.
Partnership activities provided a vehicle through which partners could build trusting
relationships. Efforts to promote engagement incorporated enforcement actions, positive
publicity and generating a sense of competition. The priority of the trade to maximise profits
was found to over-ride the impact of some projects.
Keywords: Alcohol; binge drinking; crime reduction; drinking behaviour; industry;
partnership; policy; research
19. Policy-Relevant Behaviors Predict Heavier Drinking in Both On and Off Premises
and Mediate the Relationship Between Heavier Alcohol Consumption and Age, Gender,
and Socioeconomic Status—Analysis from the International Alcohol Control Study
Sally Casswell, Taisia Huckle, Martin Wall and Karl Parker
Alcoholism: Clinical and Experimental Research 2016:40(2);385-392
Abstract
Background Our goal was to investigate the role of behaviors amenable to policy change in
mediating the relationship between alcohol consumption in off and on premises, age, and 2
measures of socioeconomic status (education and income). Methods A cross-sectional
general population survey was analyzed by using Bayesian path analysis to understand direct
and mediating pathways. A total of 1,900 drinkers (past 6 months), aged 18 to 65 years,
living in households with landline phones participated in the study. Measures were as
follows: typical quantities of alcohol consumed per occasion, frequency of drinking, both off
and on premise; gender, age groups; and years of education, personal income, prices paid,
time of purchase, and liking for alcohol advertisements. Results Later times of purchase
predicted larger quantities consumed (on and off premise) and more frequent drinking (on
premise only). Younger people and males purchased later, and this mediated their heavier
consumption. Lower prices paid predicted larger quantities consumed (on premise) and
higher frequency of drinking (off premise). Younger and male respondents paid lower prices,
and this mediated larger quantities consumed on premise and more frequent drinking off
29
premise. Less well educated paid lower prices, and this mediated drinking more frequently
off premise among this group. Liking for alcohol ads predicted drinking larger quantities and
higher frequency both off and on premise. Younger and male respondents reported greater
liking for ads, and this mediated their consumption of larger quantities and more frequent
drinking both on and off premise. Those with higher income drank larger amounts on premise
and more frequently on and off, but there were no mediating effects from the policy-relevant
variables. Conclusions Heavier drinking patterns by young people and those less well
educated could be ameliorated by attention to alcohol policy.
Keywords: Alcohol Policy; Alcohol Consumption; Age; Socioeconomic Status
30
ALCOHOL SCREENING AND BRIEF INTERVENTION
20. Which women are missed by primary health-care based interventions for alcohol
and drug use?
SCM Roberts, L.J. Ralph, S.C. Wilsnack, D.G. Foster
Addictive Behaviours 2016:55;32-37
Abstract
Background Women of reproductive age who binge drink or have alcohol-related
problem symptoms (APS) and who do not use contraception are considered at risk of an
alcohol-exposed pregnancy (AEP). In the U.S., efforts to prevent AEPs focus largely on
delivering interventions in primary health care settings. While research suggests that these
interventions are efficacious for women reached, it is unclear to what extent these
interventions are likely to reach women at risk of AEPs. Methods Data are from the
Turnaway Study, a study of 956 women seeking pregnancy termination at 30 U.S.
facilities between 2008 and 2010, some of whom received and some of whom were denied
terminations because they were past the gestational limit. We examined associations
between binge drinking, APS, and drug use prior to pregnancy recognition and having a
usual source of health care (USOC). Results Overall, 59% reported having a USOC. A
smaller proportion with than without an APS reported a USOC (44 vs. 60%, p < .05) and a
smaller proportion using than not using drugs reported a USOC (51 vs. 61%, p < .05). This
pattern was not observed for binge drinking. In multivariate analyses, an APS continued to
be associated with lack of a USOC, while drug use was no longer associated with lack of a
USOC. Conclusions As more than 40% did not have a USOC, with higher proportions
among women with an APS, primary health-care based approaches to AEP prevention
seem unlikely to reach the majority of women who have an APS and are at risk of an
unintended pregnancy.
Keywords: Alcohol; Illicit drug use; Pregnancy
31
ALCOHOL TREATMENT
21. Studying an unreal world: incentives on internet-based interventions for alcohol use
André Bedendo and Ana Regina Noto
Addiction 2016:111(2);373-374
No abstract available
22. Hospital Stay and Engagement in Outpatient Follow-Up After Alcohol Emergency
Detox: A 1-Year Comparison Study
Julien Azuar, Frank Questel, Eric Hispard, Jan Scott, Florence Vorspan and Frank Bellivier
Alcoholism: Clinical and Experimental Research 2016:40(2);418-421
Abstract
Background Inpatient alcohol detoxifications are only proposed after motivational
outpatient encounters because detoxification directly from the emergency department (ED) is
believed to be associated with early dropout and poor adherence to outpatient follow-up. The
aim of this prospective follow-up study was to test the feasibility of unscheduled (UP)
alcohol detoxification directly from the ED and to compare the 1-year follow-up of these
patients to that of scheduled (SP) patients. Methods A quasi-naturalistic prospective followup study of 120 patients: 60 consecutively admitted patients referred directly by the ED for
alcohol detoxification (UP) were compared to 60 consecutively admitted patients who had
undergone the usual preparation for an inpatient detoxification program (SP). The length of
hospitalization (in days) and attendance to postdischarge outpatient visits during the first year
was compared. Results UP patients were older, less frequently employed, and had more
somatic comorbidities compared with SP patients. The UP length of stay was significantly
longer (20 ± 16 vs. 14 ± 6, p = 0.04). No difference in their postdischarge attendance was
observed; the number of patients attending 1 session (57% UP vs. 65% SP, p = 0.227) and 5
sessions (22% UP vs. 32% SP, p = 0.151) and the mean number of postdischarge visits
attended were comparable between the UP and SP groups (2.7 ± 6 vs. 4.5 ± 6; Mann–
Whitney U = 1,517, p = 0.124). Conclusions We did not find that UP patients who had been
admitted for alcohol detoxification had a significantly higher dropout rate or lower
postdischarge addiction treatment attendance. Because they may have several advantages,
detoxification programs directly linked with EDs should be further evaluated.
Keywords: Detoxification; Alcohol; Emergency; Inpatients; Engagement
23. Exercise training – A beneficial intervention in the treatment of alcohol use
disorders?
Mark Stoutenberg, Chad D. Rethorst, Olivia Lawson, Jennifer P. Read
Drug and Alcohol Dependence 2016:160;2-11
Abstract
Background
A growing body of evidence suggests that exercise training may have multiple beneficial
effects in individuals with mental health or substance use disorders. Yet, relatively little
knowledge exists regarding the benefits of exercise training to augment treatment for alcohol
use disorders (AUDs). Purpose The purpose of this narrative review is to present a
32
summary of the growing body of published literature supporting exercise training as a
treatment strategy for individuals with AUDs. We will provide evidence on the myriad of
ways in which exercise may exert a positive effect on AUD outcomes including stress,
anxiety, impulsivity, and depression. Further, we will explore how these mechanisms share
common neurobiological pathways. The role of exercise in enhancing the social environment
and increasing individual self-efficacy to reduce excess and/or inappropriate alcohol
consumption will also be discussed. Discussion We will conclude with a description of
completed investigations involving exercise training and provide suggestions for next steps in
this innovative field of study.
Keywords: Alcohol Anxiety Depression Exercise Impulsivity Neurobiology Stress
33
BENZODIAZEPINE
24. Prevalence, prescribed quantities, and trajectory of multiple prescriber episodes
for benzodiazepines: A 2-year cohort study
Yasuyuki Okumura, Sayuri Shimizu, Toshihiko Matsumoto
Drug and Alcohol Dependence 2016:158;118-125
Abstract
Background Little is known about the use of multiple prescribers for benzodiazepines,
which might reflect fragmented patient care and increases the risk of hospital admission
for drug dependence or poisoning. Therefore, we aimed to identify the prevalence,
prescribed quantities, and trajectory of multiple prescriber episodes for benzodiazepines.
Methods We conducted a 2-year cohort study of 1178,361 recipients aged 0–74 years
using a large health insurance claims database in Japan. We quantified multiple prescriber
episodes for benzodiazepines occurring in ambulatory care settings in a baseline and
subsequent year by (1) counting the number of unique providers within a 12-month period,
(2) calculating the maximum number of unique providers within a single month, and (3)
identifying consecutive overlapping prescriptions of over 30 days duration.
Results Among 58,314 patients with a benzodiazepine prescription during the baseline
year, 282 (0.5%) filled prescriptions from four or more providers within a 12-month
period, 439 (0.8%) filled prescriptions from three or more providers within a single month,
and 757 (1.3%) filled consecutive overlapping prescriptions. The odds for multiple
prescriber episodes were significantly higher among patients with multiple chronic
conditions. Consecutive overlapping prescriptions had the best accuracy to detect patients
with potentially questionable prescribed quantities as well as to predict those with multiple
prescriber episodes in the subsequent year. Conclusions These results highlight the need
for pharmacists to increase their involvement in prescription oversight and for health
insurance agencies to implement a prescription monitoring program to screen for patients
with multiple prescriber episodes for benzodiazepines.
Keywords: Abuse; Diversion; Doctor shopping; Pharmacoepidemiology; Prescription
monitoring
25. Attitudes towards a maintenance (-agonist) treatment approach in high-dose
benzodiazepine-dependent patients: a qualitative study
Michael Liebrenz, Marcel Schneider, Anna Buadze, Marie-Therese Gehring, Anish Dube and
Carlo Caflisch
Harm Reduction Journal 2016:13(1)
Abstract
Background High-dose benzodiazepine dependence constitutes a major clinical concern.
Although withdrawal treatment is recommended, it is unsuccessful for a significant
proportion of affected patients. More recently, a benzodiazepine maintenance approach has
been suggested as an alternative for patients’ failing discontinuation treatment. While there is
some data supporting its effectiveness, patients’ perceptions of such an intervention have not
been investigated. Methods An exploratory qualitative study was conducted among a
sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use
defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise
problematic use, such as mixing substances, dose escalation, recreational use, or obtainment
by illegal means. A qualitative content analysis approach was used to evaluate findings.
34
Results Participants generally favored a treatment discontinuation approach with abstinence
from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance
treatment approach with continued prescription of a slow-onset, long-acting agonist was
viewed ambivalently, with responses ranging from positive and welcoming to rejection.
Three overlapping themes of maintenance treatment were identified: “Only if I can try to
discontinue…and please don’t call it that,” “More stability and less criminal activity…and
that is why I would try it,” and “No cure, no brain and no flash…and thus, just for everybody
else!” Conclusions Some patients experienced slow-onset, long-acting BZDs as having
stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled
withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider
treatment alternatives if discontinuation strategies fail.
Keywords: Benzodiazepine dependence; Maintenance treatment; Attitudes; Withdrawal;
Qualitative; Explorative; Interview
35
BLOOD BORNE VIRUSES
26. Innovative community-based educational face-to-face intervention to reduce HIV,
hepatitis C virus and other blood-borne infectious risks in difficult-to-reach people who
inject drugs: results from the ANRS–AERLI intervention study
Perrine Roux, Jean-Marie Le Gall, Marie Debrus, Camélia Protopopescu, Khadim Ndiaye,
Baptiste Demoulin, Caroline Lions, Aurelie Haas, Marion Mora, Bruno Spire, Marie SuzanMonti and Maria Patrizia Carrieri
Addiction 2016:111(1);94-106
Abstract
Aims To study the effectiveness of an educational intervention on risks associated with drug
injection, comparing primary [unsafe HIV–hepatitis C virus (HCV) practices] and secondary
(local complications at injecting site) end-points in harm reduction (HR) programmes
offering this intervention versus HR programmes not offering it. Design This non-random
clustered intervention study was conducted in nine intervention groups (programmes offering
the intervention) and eight control groups (programmes not offering it). Each participant was
followed-up through a telephone interview at enrolment and at 6 and 12 months.
Setting The study took place in 17 cities throughout France. Participants Of the 271
participants, 144 were enrolled into the intervention group and 127 in the control group. Of
the latter, 113 received at least one educational session. Intervention A series of
participant-centred face-to-face educational sessions. Each session included direct
observation by trained non-governmental organization (NGO) staff or volunteers of
participants’ self-injecting the psychoactive product they used habitually; analysis by the
trained NGO staff or volunteers of the participant's injecting practices, identification of
injection-related risks and explanation of safer injecting practices; and an educational
exchange on the individual participant's injection practices and the questions he or she asked.
Measurements Primary and secondary outcomes were ‘at least one unsafe HIV–HCV
practice’ and at least one injection-related complication (derived from a checklist).
Findings The proportion of participants with at least one unsafe HIV–HCV practice in the
intervention group decreased significantly, from 44% at M0 to 25% at M6, as well as
complications at the injection site (from 66 to 39% at M12), while in the control group it
remained mainly stable. Multivariate probit analyses showed that the intervention group
experienced a significant reduction in unsafe HIV–HCV practices at M6 [coefficient, 95%
confidence interval (CI) = −0.73 (−1.47 to 0.01)] and in injection-related complications at
M12 [coefficient, 95% CI = −1.01 (−1.77 to −0.24)], compared with the control group.
Conclusions An inexpensive and easily implemented educational intervention on risks
associated with drug injection reduces significantly unsafe HIV–HCV transmission practices
and injection-related complications.
Keywords: Education; HCV; HIV; injecting drug user; intervention; local complications
27. Rates of HIV and Hepatitis Infections in Clients Entering Heroin-Assisted
Treatment between 2003 and 2013 and Risk Factors for Hepatitis C Infection
Dickson-Spillmann M., Haug S., Uchtenhagen A., Bruggmann P., Schaub M.P.
European Addiction Research 2016:22(4);181-191
Abstract
Background/Aims We report on the rates of hepatitis A virus (HAV), hepatitis B virus
(HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in 1,313
36
clients entering heroin-assisted treatment (HAT) in Switzerland from 2003 to 2013. We
identify predictors of HCV infection. Methods Data were collected using questionnaires
within 2 weeks of clients' first entry into HAT. Prevalence of HAV, HBV, HCV and H IV
was calculated using laboratory test results collected at entry or using reports of older
test results. Predictors of HCV status were identified through multiple logistic regression
analysis. Results Results show stable rates of HIV-positive clients and decreasing
proportions of HAV- and HBV-infected clients. In 2013, there were 12% (n = 8) HIV-,
20% (n = 12) HAV-, 20% (n = 12) HBV- and 52% HCV- (n = 34) positive clients.
Vaccination against HAV and HBV had become more frequent. Predictors of positive
HCV status included older age, female gender, earlier year of entry, having spent 1
month or more in detention or prison, use of injected heroin and more years of
intravenous use. Conclusion Our results highlight the fact that efforts to prevent and
test for infections and to promote vaccination against HAV and HBV in heroin users
need to be continued.
Keywords: HIV; Hepatitis; Heroin-assisted treatment; Heroin users; Risk factors
28. Dead space in over-the-counter syringes: The implications for HIV and HCV
transmission
Christine U. Oramasionwu, Stacy C. Bailey, Heather N. Moore, Christopher O.
Oramasionwu, Allison L. Russell, William A. Zule
International Journal of Drug Policy 2015:26(12);1282-1284
No abstract available
37
BRIEF INTERVENTION
29. Is the quality of brief motivational interventions for drug use in primary care
associated with subsequent drug use?
Tibor P. Palfai, Debbie M. Cheng, Judith A. Bernstein, Joseph Palmisano, Christine A.
Lloyd-Travaglini, Tracie Goodness, Richard Saitz
Addictive Behaviours 2016:56;8-14
Abstract
Background Although a number of brief intervention approaches for drug use are based
on motivational interviewing (MI), relatively little is known about whether the quality of
motivational interviewing skills is associated with intervention outcomes. Method The
current study examined whether indices of motivational interviewing skill were associated
with subsequent drug use outcomes following two different MI-based brief interventions
delivered in primary care; a 15 min Brief Negotiated Interview (BNI) and a 45 min
adaptation of motivational interviewing (MOTIV). Audio recordings from 351 participants
in a randomized controlled trial for drug use in primary care were coded using the
Motivational Interviewing Treatment Integrity Scale, (MITI Version 3.1.1). Separate
negative binomial regression analyses, stratified by intervention condition, were used to
examine the associations between six MITI skill variables and the number of days that the
participant used his/her main drug 6 weeks after study entry. Results Only one of the
MITI variables (% reflections to questions) was significantly associated with the frequency
of drug use in the MOTIV condition and this was opposite to the hypothesized direction
(global p = 0.01, adjusted IRR 1.50, 95%CI: 1.03–2.20 for middle vs. lowest tertile [higher
skill, more drug use]. None were significantly associated with drug use in the BNI
condition. Secondary analyses similarly failed to find consistent predictors of better drug
outcomes. Conclusion Overall, this study provides little evidence to suggest that the
level of MI intervention skills are linked with better drug use outcomes among people who
use drugs and receive brief interventions in primary care. Findings should be considered in
light of the fact that data from the study are from negative trial of SBI and was limited to
primary care patients. Future work should consider alternative ways of examining these
process variables (i.e., comparing thresholds of proficient versus non-proficient skills) or
considering alternative methods of coding intervention skills.
Keywords: Motivational interviewing; Mechanisms; Drugs; Substance use; Primary care;
Brief intervention
38
CO-MORBIDITY
30. Treatment Access Barriers and Disparities Among Individuals with Co-Occurring
Mental Health and Substance Use Disorders: An Integrative Literature Review
Mary Ann Priester, Teri Browne, Aidyn Iachini, Stephanie Clone, Dana DeHart, Kristen D.
Seay
Journal of Substance Abuse Treatment 2016:61;47-59
Abstract
The purpose of this integrative review is to examine and synthesize extant literature
pertaining to barriers to substance abuse and mental health treatment for persons with cooccurring substance use and mental health disorders (COD). Electronic searches were
conducted using ten scholarly databases. Thirty-six articles met inclusion criteria and were
examined for this review. Narrative review of these articles resulted in the identification of
two primary barriers to treatment access for individuals with COD: personal characteristics
barriers and structural barriers. Clinical implications and directions for future research are
discussed. In particular, additional studies on marginalized sub-populations are needed,
specifically those that examine barriers to treatment access among older, non-White, nonheterosexual populations.
Keywords: Co-occurring; Dual diagnosis; Substance use disorders; Mental health disorders;
Treatment barriers
39
EPIDEMIOLOGY AND DEMOGRAPHY
31. Tobacco and e-cigarette use amongst illicit drug users in Australia
Rachel Sutherland, Natasha Sindicich, Gavin Entwistle, Elizabeth Whittaker, Amy
Peacock, Allison Matthews, Raimondo Bruno, Rosa Alati, Lucy Burns
Drug and Alcohol Dependence 2016:159;35-41
Abstract
Objective To examine the rates and patterns of tobacco and e-cigarette use amongst two
samples of illicit drug users in Australia. Method Data were obtained from the 2015 Illicit
Drug Reporting System (IDRS) and the 2015 Ecstasy and Related Drugs Reporting System
(EDRS). These studies comprised cross-sectional samples of 888 people who inject drugs
(PWID) and 763 regular psychostimulant users (RPU). Results Tobacco was consumed by
the majority of both samples, however, use in the 6 months preceding interview was
significantly higher amongst PWID (92.2%) than RPU (82.4% [OR 2.53 95% CI 1.86–
3.44]).Inversely, PWID were less likely to have a history of e-cigarette use: 31.5% of PWID
reported lifetime use of e-cigarettes (vs. 57.0% of RPU [OR 0.35 95% CI 0.28–0.42]) and
18.1% reported use in the 6 months preceding interview (vs. 33.7% of RPU [OR 0.44 95% CI
0.35–0.55]). PWID were more than three times as likely than RPU to report using e-cigarettes
as a smoking cessation tool (OR 3.09 95% CI 2.03–4.71), but were less likely to use e-liquids
that contained nicotine (OR 0.52 95% CI 0.32–0.83). Higher levels of poly drug use, daily
tobacco use, recent use of synthetic cannabinoids and employment status were found to be
significantly associated with e-cigarette use. Conclusion The use of e-cigarettes was
relatively common amongst Australian samples of PWID and RPU. Whilst the majority of
PWID reported using e-cigarettes as a smoking cessation tool, it appears that RPU are using
them for experimental or recreational purposes.
Keywords: E-cigarettes; Electronic cigarettes; ENDS; Tobacco; Smoking; Illicit drugs
32. Predictors of transition to heroin use among initially non-opioid dependent illicit
pharmaceutical opioid users: A natural history study
Robert G. Carlson, Ramzi W. Nahhas, Silvia S. Martins, Raminta Daniulaityte
Drug and Alcohol Dependence 2016:160;127-134
Abstract
Background Increases in illicit pharmaceutical opioid (PO) use have been associated with
risk for transition to heroin use. We identify predictors of transition to heroin use among
young, illicit PO users with no history of opioid dependence or heroin use at
baseline.Methods Respondent-driven sampling recruited 383 participants; 362 returned for
at least one biannual structured interview over 36 months. Cox regression was used to test for
associations between lagged predictors and hazard of transition to heroin use. Potential
predictors were based on those suggested in the literature. We also computed population
attributable risk (PAR) and the rate of heroin transition. Results Over 36 months, 27 (7.5%)
participants initiated heroin use; all were white, and the rate of heroin initiation was 2.8% per
year (95% CI = 1.9%–4.1%). Mean length of PO at first reported heroin use was 6.2 years
(SD = 1.9). Lifetime PO dependence (AHR = 2.39, 95% CI = 1.07–5.48; PAR = 32%, 95%
CI = −2% to 64%), early age of PO initiation (AHR = 3.08, 95%; CI = 1.26–7.47;
PAR = 30%, 95% CI = 2%–59%), using illicit POs to get high but not to self-medicate a
health problem (AHR = 4.83, 95% CI = 2.11–11.0; PAR = 38%, 95% CI = 12%–65%), and
ever using PO non-orally most often (AHR = 6.57, 95% CI = 2.81–17.2; PAR = 63%, 95%
40
CI = 31%–86%) were significant predictors. Conclusion This is one of the first prospective
studies to test observations from previous cross-sectional and retrospective research on the
relationship between illicit PO use and heroin initiation among young, initially non-opioid
dependent PO users. The results provide insights into targets for the design of urgently
needed prevention interventions.
Keywords: Illicit pharmaceutical opioid use; Heroin initiation; Opioid dependence; Time-toevent analysis; Natural history study
41
HEPATITIS C
33. Treatment for hepatitis C virus infection among people who inject drugs attending
opioid substitution treatment and community health clinics: the ETHOS Study
Jason Grebely, Maryam Alavi, Michelle Micallef, Adrian J. Dunlop, Anne C. Balcomb, Nghi
Phung, Martin D. Weltman, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber,
Gregory J. Dore and on behalf of the ETHOS Study Group
Addiction 2016:111(2);311-319
Abstract
Aims To estimate adherence and response to therapy for chronic hepatitis C virus (HCV)
infection among people with a history of injecting drug use. A secondary aim was to identify
predictors of HCV treatment response. Design Prospective cohort recruited between 2009
and 2012. Participants were treated with peg-interferon alfa-2a/ribavirin for 24 (genotypes
2/3, G2/3) or 48 weeks (genotype 1, G1). Setting Six opioid substitution treatment (OST)
clinics, two community health centres and one Aboriginal community-controlled health
organization providing drug treatment services in New South Wales, Australia.
Participants Among 415 people with a history of injecting drug use and chronic HCV
assessed by a nurse, 101 were assessed for treatment outcomes (21% female).
Measurements Study outcomes were treatment adherence and sustained virological
response (SVR, undetectable HCV RNA >24 weeks post-treatment). Findings Among 101
treated, 37% (n = 37) had recently injected drugs (past 6 months) and 62% (n = 63) were
receiving OST. Adherence ≥ 80% was 86% (n = 87). SVR was 74% (75 of 101), with no
difference observed by sex (males: 76%, females: 67%, P = 0.662). In adjusted analysis, age
< 35 (versus ≥ 45 years) [adjusted odds ratio (aOR) = 5.06, 95% confidence interval
(CI) = 1.47, 17.40] and on-treatment adherence ≥ 80% independently predicted SVR
(aOR = 19.41, 95% CI = 3.61, 104.26]. Recent injecting drug use at baseline was not
associated with SVR. Conclusions People with a history of injecting drug use and chronic
hepatitis C virus attending opioid substitution treatment and community health clinics can
achieve adherence and responses to interferon-based therapy similar to other populations,
despite injecting drugs at baseline. Younger age and adherence are predictive of improved
response to hepatitis C virus therapy.
Keywords: Antiviral therapy; hepatitis C virus; injecting drug use; methadone; opioid
substitution treatment; people who inject drugs
42
HOMELESS
34. A systematic review of interventions for homeless alcohol-abusing adults
Julie R. Adams-Guppy & Andrew Guppy
Drugs: Education, Prevention and Policy 2016:23(1);15-30
Abstract
Aims To compile and critically analyse published research on interventions with alcoholabusing homeless adults. Methods A systematic review was conducted of research published
utilising the MEDLINE, EMBASE, PsycInfo, CINAHL and SocIndex databases from
inception to March 2015. A meta-analysis was performed on studies that met the inclusion
criteria, to determine if there were any significant pre- and post-intervention effects on
alcohol-use. Results Seventeen studies from three continents were included in this
systematic review. A meta-analysis of pre- and post-intervention effects on alcohol use across
the 17 studies found highly significant effects (p < 0.001). A smaller subset of studies
(n = 10), where the same specific alcohol use outcome measurement was employed across all
studies, also showed highly significant pre–post intervention effects (p < 0.001). Results
indicate that a range of interventions were effective in reducing alcohol use and abuse within
samples of homeless participants, although short-term effects are more apparent than longer
term ones. Conclusions There is a relative paucity of research into alcohol abusing homeless
adults, which has implications for evidence-based practice. This systematic meta-analytical
review demonstrates that a range of alcohol abuse interventions for homeless adults produces
improvements in alcohol use (p < 0.001).
Keywords: Alcohol abuse; homeless adults; interventions; meta-analysis; substance use;
systematic review
35. In their own words: Content analysis of pathways to recovery among individuals
with the lived experience of homelessness and alcohol use disorders
Susan E. Collins, Connor B. Jones, Gail Hoffmann, Lonnie A. Nelson, Starlyn M. Hawes,
Véronique S. Grazioli, Jessica L. Mackelprang, Jessica Holttum, Greta Kaese, James Lenert,
Patrick Herndon, Seema L. Clifasefi
International Journal of Drug Policy 2016:27;89-96
Abstract
Background Alcohol use disorders (AUDs) are more prevalent among homeless individuals
than in the general population, and homeless individuals are disproportionately affected by
alcohol-related morbidity and mortality. Unfortunately, abstinence-based approaches are
neither desirable to nor highly effective for most members of this population. Recent research
has indicated that homeless people aspire to clinically significant recovery goals beyond
alcohol abstinence, including alcohol harm reduction and quality-of-life improvement.
However, no research has documented this population's preferred pathways toward selfdefined recovery. Considering principles of patient-centred care, a richer understanding of
this population's desired pathways to recovery may help providers better engage and support
them. Methods Participants (N = 50) had lived experience of homelessness and AUDs and
participated in semi-structured interviews regarding histories of homelessness, alcohol use,
and abstinence-based treatment as well as suggestions for improving alcohol treatment.
Conventional content analysis was used to ascertain participants’ perceptions of abstinencebased treatment and mutual-help modalities, while it additionally revealed alternative
43
pathways to recovery. Results Most participants reported involvement in abstinence-based
modalities for reasons other than the goal of achieving long-term abstinence from alcohol
(e.g., having shelter in winter months, “taking a break” from alcohol use, being among “likeminded people”). In contrast, most participants preferred alternative pathways to recovery,
including fulfilling basic needs (e.g., obtaining housing), using harm reduction approaches
(e.g., switching from higher to lower alcohol content beverages), engaging in meaningful
activities (e.g., art, outings, spiritual/cultural activities), and making positive social
connections. Conclusions Most people with the lived experience of homelessness and
AUDs we interviewed were uninterested in abstinence-based modalities as a means of
attaining long-term alcohol abstinence. These individuals do, however, have creative ideas
about alternative pathways to recovery that treatment providers may support to reduce
alcohol-related harm and enhance quality of life.
Keywords: Pathways to recovery; Homelessness; Alcohol use; Drinking; Qualitative
analysis; Content analysis
44
INJECTING DRUG USE
36. Exposure to injecting drug use and hepatitis C knowledge among an online sample
of young people
Toby Lea, Joanne Bryant & Carla Treloar
Drugs: Education, Prevention and Policy 2016:23(1);84-88
Abstract
Aim Young people who are socially engaged with people who inject drugs are at higher risk
of transitioning to injecting drug use. We aimed to examine rates of exposure to injecting
among young people in an online survey, and whether exposure to injecting was related to
hepatitis C (HCV) knowledge. Methods A cross-sectional, online survey was completed by
827 young people (aged 16–26 years) in New South Wales, Australia. Exposure to injecting
in the preceding 12 months was measured by asking participants whether close friends and
romantic/sexual partners had injected, and whether somebody had offered them an injection.
HCV knowledge was measured using items adapted from a survey of Australian secondary
school students. Findings Eleven percent of participants reported recent exposure to
injecting. Participants exposed to injecting were significantly more likely than other
participants to report use of injectable drugs. Some aspects of HCV transmission were poorly
understood, and exposure to injecting was not significantly associated with higher HCV
knowledge. Conclusions While online methods were only moderately successful in
recruiting people exposed to injecting, higher rates of use of injectable drugs and HCV
knowledge deficits in this group suggests that they are an important target for HCV education
and prevention.
Keywords: Hepatitis C; injection drug use; knowledge; vulnerable groups; youth
37. Trends in sources and sharing of needles among people who inject drugs, San
Francisco, 2005–2012
Nathan J. Kim, Harry Jin, Willi McFarland, Henry F. Raymond
International Journal of Drug Policy 2015:26(12);1238-1243
Abstract
Background Globally, people who inject drugs (PWID) are disproportionately at risk for
HIV and HCV due to risky injection drug use behaviors, such as sharing used needles and
injection kits. In response, San Francisco, one of several cities with a sizable PWID
population that had quickly committed to stopping the spread of HIV/HCV, have
expanded needle access, including in pharmacies and hospitals, in order to ensure that
PWID inject with clean needles. However, there was no current research on whether each
source of needles is equally associated with always using new sterile needles in San
Francisco. Furthermore, no research in San Francisco had examined behavioral trends in
needle-sharing practices, the relationship between PWID and their injection partners, and
knowledge of their injection partners’ HIV or HCV status. Methods Therefore, we
analyzed data from three cycles of the National HIV Behavioral Surveillance studies from
2005 to 2012 in San Francisco among PWID. Results The results from our analysis
suggest that overall risky drug injection practices, such as injecting with used needles,
sharing used cookers or water, and dividing drugs with a used syringe, among PWID in
San Francisco has decreased from 2005 to 2012. An increasing proportion of PWID are
injecting with their friend/acquaintance than with their sex partner. Also, a declining
portion of PWID report knowing their last injection partner's HIV-positive or HCV45
positive status. In terms of sources of needles, less PWID are getting their needles from
friends and drug dealers while a greater proportion are using pharmacies and needle
exchanges. However, pharmacies as a source of needles are negatively associated with
always using new sterile needles. Conclusion From 2005 to 2012, overall high-risk
injection behavior among PWID in SF has decreased including PWID that are injecting
with others. However, our results suggest caution over the expansion of pharmacies as a
source of needles in San Francisco and in similar cities due to their negative association
with always using a new sterile needle. Since more PWID are injecting with their
friend/acquaintance, interventions at needle access programs at pharmacies, hospitals, and
needle exchanges should stress the potential to transmit HIV and HCV even in one-on-one
sharing situations. Furthermore, since a decreasing percentage of PWID know about their
injection partner's HIV/HCV status, such interventions should also highlight the
importance of having a conversation about HIV and HCV status with one's injecting
partner.
Keywords: PWID; Needle exchange; Needle sharing; HIV risk
38. Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a SyringeExchange Program in Malmö, Sweden
Disa Dahlman, Anders Håkansson, Per Björkman, Marianne Alanko Blomé & Alex H. Kral
Substance Use and Misuse 2016:50(12);1529-1535
Abstract
Background Injection drug users (IDUs) are at increased risk of various medical conditions,
including bacterial skin and soft tissue infections (SSTIs). SSTIs, which are painful and can
lead to life-threatening complications, are common but scarcely studied. Objectives To
investigate life time, past 12 month and past 30-day prevalence for SSTI related to injection
drug use, in IDUs at Malmö syringe exchange program (Malmö SEP). To investigate factors
associated with having ever had an SSTI. Methods IDUs were recruited from Malmö SEP
(N = 80). They participated in a survey with questions about demographics, drug use, and
experience of SSTIs. Factors independently associated with self-reported SSTI ever were
assessed using logistic regression analysis. Results The lifetime reported prevalence of SSTI
was 58%, past 12 months 30%, and past 30 days 14%. Factors independently associated with
SSTI ever were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] = 1.01–
1.18), female sex (AOR = 6.75; 95% CI = 1.40–32.47), having ever injected prescribed drugs
(AOR = 52.15; 95% CI = 5.17–525.67), and having ever injected in the neck (AOR = 8.08;
95% CI = 1.16–56.08). Conclusions/Importance SSTI is common among IDUs in Malmö.
Women and those injecting in the neck or injecting prescribed drugs (crushed tablets/liquids),
are more likely to have had an SSTI.
Keywords: injection drug use; skin and soft tissue infection; abscess; risk injection; syringe
exchange
46
39. Initiation Stories: An Examination of the Narratives of People Who Assist With a
First Injection
Gillian Kolla, Carol Strike, Élise Roy, Jason Altenberg, Raffi Balian, Rey Silver & Neil Hunt
Substance Use and Misuse 2015:50(13);1619-1627
Abstract
Background Research in the area of initiation to injection drug use that focuses on the
perspective of initiators, or those who help with a first injection, is rare. Objective To
explore the process of initiation to injection drug use from the point of view of initiators.
Methods Semi-structured, in-depth qualitative interviews were conducted at a harm
reduction program in Toronto, Canada. Twenty participants who had injected drugs in the last
30 days and who reported ever having initiated another person to injection drug use were
recruited. A narrative analytic approach was used to explore the spectrum of narratives
surrounding their experiences initiating others to injection drug use. Results Initiation events
arise in a complex interplay of individual circumstances and social contexts. People who
inject may assist with a first injection for a variety of reasons, from conceding to social
pressure, to wanting to help reduce a perceived risk of harm, to assisting because it provides a
sense of pride at possessing a skill or of having helped someone achieve a desired state, to
assisting to obtain drugs or to cope with withdrawal, or a mix of several of these reasons at
once. Conclusions/Importance Narratives reveal that preventing all instances of initiation is
unrealistic. Combining elements from existing interventions that focus on enhancing
reluctance to assist with initiation with safer injection training has the potential to reduce
initiations and perhaps reduce injection related harm for novices if initiation occurs.
Keywords: initiation; initiators; injection drug use; harm reduction; narrative analysis; HIV
prevention; peer injecting
40. Not in the vein: ‘missed hits’, subcutaneous and intramuscular injections and
associated harms among people who inject psychoactive drugs in Bristol, United
Kingdom
V.D. Hope, J.V. Parry, F. Ncube, M. Hickman
International Journal of Drug Policy 2016:28;83-90
Abstract
Background The extent of intentional or accidental subcutaneous and intramuscular
injections and the factors associated with these have rarely been studied among people who
inject drugs, yet these may play an important role in the acquisition bacterial infections. This
study describes the extent of these, and in particular the factors and harms associated with
accidental subcutaneous and intramuscular injections (i.e. ‘missed hits’). Methods People
who inject drugs were recruited using respondent driven sampling. Weighted data was
examined using bivariate analyses and logistic regression. Results The participants mean
age was 33 years (31% aged under 30-years), 28% were women, and the mean time since
first injection was 12 years (N = 329). During the preceding three months, 97% had injected
heroin, 71% crack-cocaine, and 16% amphetamines; 36% injected daily. Overall, 99% (325)
reported that they aimed to inject intravenously; only three aimed to inject subcutaneously
and one intramuscularly. Of those that aimed to inject intravenously, 56% (181) reported ever
missing a vein (for 51 this occurred more than four times month on average). Factors
associated with ‘missed hits’ suggested that these were the consequence of poor vascular
access, injection technique and/or hygiene. ‘Missed hits’ were twice as common among those
reporting sores/open wounds, abscesses, or redness, swelling and tenderness at injection sites.
47
Conclusion Intentional subcutaneous and intramuscular injections are rare in this sample.
‘Missed hits’ are common and appear to be associated with poor injection practice.
Interventions are required to reduce risk through improving injecting practice and hygiene.
Keywords: People who inject drugs; Subcutaneous; Intramuscular; Risk behaviours;
Infections
48
MISCELLANEOUS
41. An international systematic review of smoking prevalence in addiction treatment
Joseph Guydish, Emma Passalacqua, Anna Pagano, Cristina Martínez, Thao Le, JongSerl
Chun, Barbara Tajima, Lindsay Docto, Daria Garina and Kevin Delucchi
Addiction 2016:111(2);220-230
Abstract
Aims Smoking prevalence is higher among people enrolled in addiction treatment compared
with the general population, and very high rates of smoking are associated with opiate drug
use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are
observed internationally. Methods PubMed, PsycINFO and the Alcohol and Alcohol
Problems Science Database were searched for papers reporting smoking prevalence among
addiction treatment samples, published in English, from 1987 to 2013. Search terms included
tobacco use, cessation and substance use disorders using and/or Boolean connectors. For
4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met
inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies,
collectively comprising 37 364 participants, were included. For each paper we extracted
country, author, year, sample size and gender, treatment modality, primary drug treated and
smoking prevalence. Results The random-effect pooled estimate of smoking across people
in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled
estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%).
The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates
were higher in programs treating opiate use compared with alcohol use [odds ratio
(OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs
(OR = 1.42, CI = 1.19, 1.68). Conclusions Smoking rates among people in addiction
treatment are more than double those of people with similar demographic characteristics.
Smoking rates are also higher in people being treated for opiate dependence compared with
people being treated for alcohol use disorder.
Keywords: Addiction; co-substance use; global health; priority/special populations;
smoking; surveillance and monitoring; tobacco
42. Impact of the introduction of standardised packaging on smokers' brand awareness
and identification in Australia
James Balmford, Ron Borland and Hua-Hie Yong
Drug and Alcohol Review 2016:35(1);102-109
Abstract
Introduction and Aims The introduction of standardised packaging (SP) in Australia in
December 2012 has heightened interest in how image and branding might affect smoking.
This paper tests the hypothesis that brand awareness and identification among smokers will
decline after the introduction of SP. Design and Methods Longitudinal study of three
waves of smokers in Australia, conducted between October 2011–February 2012 (pre-SP)
(n = 1104), February–May 2013 (post-SP1) (n = 1093) and August–December 2014 (postSP2) (n = 1090). We explored the extent of changes in two variables, brand awareness
(noticing others with the brand of cigarettes you smoke) and brand identification (perceiving
something in common among smokers of your brand), and examined change in a number of
other measures of brand appeal, brand characteristics and determinants of brand choice.
49
Results Brand awareness ‘at least sometimes’ reduced from 45.3% pre-SP to 26.9% at postSP2 [odds ratio (OR) 0.35 (0.27–0.45)]. Brand identification also decreased from 18.2% to
12.7% [OR 0.62 (0.42–0.91)]. Significant decline was also found in measures of perceived
brand prestige [OR 0.51 (0.39–0.66)] and choice of brand for health reasons [OR 0.45 (0.32–
0.63)]. Liking the look of the pack was strongly associated with brand identification, but only
post-SP (P = 0.02 for interaction across the three waves). Discussion and Conclusions The
introduction of SP of tobacco products in Australia has been associated with reductions in
brand awareness and identification, and changes in related measures. The findings support the
notion that SP has reduced the capacity for smokers to use pack branding to create and
communicate a desired identity.
Keywords: Australia; plain packaging; tobacco; awareness; brand identification;
longitudinal study
50
NEEDLE EXCHANGE
43. Community attitudes towards harm reduction services and a newly established
needle and syringe automatic dispensing machine in an inner-city area of Sydney,
Australia
Bethany White, Paul S. Haber, Carolyn A. Day
International Journal of Drug Policy 2016:27;121-126
Abstract
Background Automatic dispensing machines (ADMs) are an inexpensive method of
increasing needle and syringe distribution to people who inject drugs but widespread
implementation has been limited. The operation of ADMs in Australia has been met with
apparent community opposition despite national data indicating support for harm reduction.
Key community concerns include perceived increases in crime and drug use. This study
aimed to examine community-level support for a newly implemented ADM in an inner-city
Sydney area known for high levels of drug use. Methods Attitudes to harm reduction and
ADMs were assessed via a brief face-to-face survey of local residents (n = 118) and
businesses (n = 35) located within the vicinity of needle and syringe program (NSP) services
including the ADM. Participation was voluntary and no reimbursement was provided.
Univariate analysis assessed statistically significant differences between residents’ and
businesses’ knowledge of, and support for, a range of harm reduction initiatives, both
generally and in the local area. Univariate logistic regression models were used to determine
factors associated with indicating support for an ADM locally. Results The response rate
was higher among businesses (60%) compared to residents living in street-accessible
dwellings (42%). Participants indicated support for fixed-site NSPs in general (83%) and
locally (77%). Support for ADMs was slightly lower – 67% indicated support for ADMs
generally and 60% locally. Negative opinions regarding ADMs (believing that they
encourage drug use, attract drug users to the area and increase drug-related crime) were found
to be significantly associated with a lower likelihood of indicating support for ADMs locally.
Conclusion Despite media reports suggesting widespread community concern, there was
general community support for harm reduction, including ADMs. While it is important that
harm reduction services are aware of community concerns and respond appropriately, such
responses should be considered and interpreted against a broader backdrop of support.
Keywords: Needle and syringe programs; Automatic dispensing machines; Community
opinion; Harm reduction; Household survey
44. Trust and people who inject drugs: The perspectives of clients and staff of Needle
Syringe Programs
Carla Treloar, Jake Rance, Kenneth Yates, Limin Mao
International Journal of Drug Policy 2016:27;138-145
Abstract
Aims Interest in health-care related trust is growing with the recognition that trust is
essential for effective therapeutic encounters. While most trust-related research has been
conducted with general patient groups, the experiences of people who inject drugs cannot be
understood without acknowledging the critical role social stigma plays in shaping (mis)trust,
both generally and in regards to health services specifically. This study examined the
experiences of trust among clients and staff of Needle and Syringe Programs (NSPs) in one
area of Sydney, Australia. Method In-depth interviews with 12 NSP staff and 31 NSP
51
clients were conducted. Analysis was informed by a five component model of trust, with
particular emphasis on the notion of “global trust” as encompassing experiences of stigma
and other negative social processes related to injecting drug use. Participant experiences of
trust in NSPs were compared with those within other drug-related health services. Particular
attention was paid to understanding the relationship between ‘identity’ (as a drug user) and
‘legitimacy’ (as a service user) and the centrality of this relationship to the experience of
global trust for PWID. Results Notions of identity and legitimacy were inextricably bound
up with the stigmatisation of drug use, shaping participants’ experiences and accounts of trust
in NSPs and drug treatment services. Client participants reported high levels of trust in NSPs,
especially when compared with drug treatment services, describing being treated like “any
other person” even when negotiating ‘sensitive’ issues. NSP staff participants described the
establishment of trust as not only underpinning their work with clients but as something that
required ongoing renewal and demonstration. Conclusion “Global trust” assists us to better
understand the complex experiences shaping PWID decisions to engage with and trust health
services. The high levels of trust reported between client and NSP need to be recognised as a
valuable resource for the delivery of effective health care for people who inject drugs,
including encouraging behaviours to support the prevention of blood-borne viruses.
Keywords: Needle and Syringe Program; Harm reduction; Australia; Qualitative research;
Trust
52
NEW PSYCHOACTIVE SUBSTANCE
45. Next generation of novel psychoactive substances on the horizon – A complex
problem to face
Jolanta B. Zawilska, Dariusz Andrzejczak
Drug and Alcohol Dependence 2015:157;1-17
Abstract
Background The last decade has seen a rapid and continuous growth in the availability
and use of novel psychoactive substances (NPS) across the world. Although various
products are labeled with warnings “not for human consumption”, they are intended to
mimic psychoactive effects of illicit drugs of abuse. Once some compounds become
regulated, new analogues appear in order to satisfy consumers’ demands and at the same
time to avoid criminalization. This review presents updated information on the second
generation of NPS, introduced as replacements of the already banned substances from this
class, focusing on their pharmacological properties and metabolism, routes of
administration, and effects in humans. Methods Literature search, covering years 2013–
2015, was performed using the following keywords alone or in combination: “novel
psychoactive substances”, “cathinones”, “synthetic cannabinoids”, “benzofurans”,
“phenethylamines”, “2C-drugs”, “NBOMe”, “methoxetamine”, “opioids”, “toxicity”, and
“metabolism”. Results More than 400 NPS have been reported in Europe, with 255
detected in 2012–2014. The most popular are synthetic cannabimimetics and
psychostimulant cathinones; use of psychedelics and opioids is less common.
Accumulating experimental and clinical data indicate that potential harms associated with
the use of second generation NPS could be even more serious than those described for the
already banned drugs. Conclusions NPS are constantly emerging on the illicit drug
market and represent an important health problem. A significant amount of research is
needed in order to fully quantify both the short and long term effects of the second
generation NPS, and their interaction with other drugs of abuse.
Keywords: Novel psychoactive substances Synthetic cannabimimetics Cathinones
Psychostimulants NBOMe compounds Methoxetamine Psychedelics Opioids
53
OPIATE REPLACEMENT TREATMENT
46. Risk of mortality on and off methadone substitution treatment in primary care: a
national cohort study
Gráinne Cousins, Fiona Boland, Brenda Courtney, Joseph Barry, Suzi Lyons and Tom Fahey
Addiction 2016:111(1);73-82
Abstract
Aim To assess whether risk of death increases during periods of treatment transition, and
investigate the impact of supervised methadone consumption on drug-related and all-cause
mortality. Design National Irish cohort study. Setting Primary care. Participants A total
of 6983 patients on a national methadone treatment register aged 16–65 years between 2004
and 2010. Measurement Drug-related (primary outcome) and all-cause (secondary
outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of
regular supervised methadone consumption. Results Crude drug-related mortality rates were
0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio
1.63 [95% confidence interval (CI) = 0.66–4.00]. Crude all-cause mortality rate per 100
person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio
3.64 (95% CI = 2.11–6.30). All-cause mortality off treatment was 6.36 (95% CI = 2.84–
14.22) times higher in the first 2 weeks, 9.12 (95% CI = 3.17–26.28) times higher in weeks 3–
4, compared with being 5 weeks or more in treatment. All-cause mortality was lower in those
with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years)
although, after adjustment, insufficient evidence exists to suggest that regular supervision is
protective (mortality rate ratio = 1.23, 95% CI = 0.67–2.27). Conclusions Among primary
care patients undergoing methadone treatment, continuing in methadone treatment is
associated with a reduced risk of death. Patients' risk of all-cause mortality increases
following treatment cessation, and is highest in the initial 4-week period.
Keywords: All-cause mortality; cohort study; drug-related deaths; maintenance treatment;
methadone; mortality; opioid; supervised consumption
47. Characterizing pain and associated coping strategies in methadone and
buprenorphine-maintained patients
Kelly E. Dunn, Patrick H. Finan, D. Andrew Tompkins, Michael Fingerhood, Eric C.
Strain
Drug and Alcohol Dependence 2015:157;143-149
Abstract
Background Chronic pain is common among patients receiving opioid maintenance
treatment (OMT) for opioid use disorder. To aid development of treatment
recommendations for coexisting pain and opioid use disorder, it is necessary to
characterize pain treatment needs and assess whether needs differ as a function of OMT
medication. Methods A point-prevalence survey assessing pain and engagement in
coping strategies was administered to 179 methadone and buprenorphine-maintained
patients. Results Forty-two percent of participants were categorized as having chronic
pain. Methadone patients had greater severity of pain relative to buprenorphine patients,
though both groups reported high levels of interference with daily activities, and
participants with pain attended the emergency room more frequently relative to
participants without pain. Only 2 coping strategies were being utilized by more than 50%
of participants (over-the-counter medication, prayer). Conclusions Results indicate that
54
pain among OMT patients is common, severe, and of significant impairment. Methadone
patients reported greater severity pain, particularly worse pain in the past 24 h, though
interference from pain in daily activities did not vary as a function of OMT. Most
participants with pain were utilizing few evidenced-based pain coping strategies.
Increasing OMT patient access to additional pain treatment strategies is an opportunity for
immediate intervention, and similarities across OMT type suggest interventions do not
need to be customized to methadone vs. buprenorphine patients.
Keywords: Buprenorphine; Chronic pain; Methadone; Coping; Opioida
48. Concomitant use of benzodiazepine and alcohol in methadone-maintained patients
from the ANRS–Methaville trial: Preventing the risk of opioid overdose in patients who
failed with buprenorphine
Perrine Roux, Caroline Lions, Laurent Michel, Antoine Vilotitch, Marion Mora, Gwenaelle
Maradan, Fabienne Marcellin, Bruno Spire, Morel Alain, Carrieri M. Patrizia and and the
ANRS Methaville Study Group
Drug and Alcohol Review 2016:35(1);61-69
Abstract
Introduction and Aims Concomitant elevated alcohol consumption and use of
benzodiazepines (BZD) during methadone treatment is widespread and particularly worrying
because of the increased risk of overdose. Using concomitant binge drinking and use of BZD
as a proxy of overdose risk, we aimed to study whether buprenorphine switchers were at
higher risk of overdose during methadone treatment. Design and Methods The French
National Agency for Research for Aids and Viral Hepatitis –Methaville multisite randomised
trial enrolled 195 patients to assess the feasibility of initiating methadone in primary care by
comparing it with methadone initiation in specialised centres. We selected 174 patients with
available data on BZD use and alcohol binge drinking at baseline and 12 months, accounting
for 318 visits. The outcome was defined to take into account an overdose risk gradient as
follows: no BZD use, BZD use without and with binge drinking during the previous month.
To identify factors associated with the outcome, we performed a mixed multinomial logistic
regression analysis. Results At baseline, 26% of the sample reported BZD use alone while
16% reported BZD use and binge drinking. Half of the sample (51%) was switching from
buprenorphine treatment. After multivariate analysis, employment, depressive symptoms and
switching treatment from buprenorphine to methadone [odds ratio (95% confidence interval)
5.38 (1.74–16.62)] remained associated with BZD use and binge drinking.
Discussion and Conclusions As well as the importance of identifying socially vulnerable
and depressed methadone-maintained patients, clinicians should be aware that patients who
fail buprenorphine treatment and switch to methadone require greater clinical monitoring and
management to avoid the risk of overdose.
Keywords: drug overdose; methadone; benzodiazepine; alcohol drinking; buprenorphine
55
49. Treating codeine dependence with buprenorphine: Dose requirements and
induction outcomes from a retrospective case series in New South Wales, Australia
Suzanne Nielsen, Raimondo Bruno, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt,
Apo Demirkol, Peter Muhleisen and Nicholas Lintzeris
Drug and Alcohol Review 2016:35(1);70-75
Abstract
Introduction and Aims Codeine dependence is an emerging public health concern, yet no
studies have specifically examined the treatment of codeine dependence. Given the lower
potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin
dependence will generalise to codeine. This is the first study to examine buprenorphine
treatment for codeine dependence. Design and Methods Retrospective case series of 19
codeine-dependent treatment entrants who received sublingual buprenorphine maintenance
treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine
doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on
general demographics, pain and mental health, substance use and outcomes after 28 days of
buprenorphine treatment. Results A significant linear relationship was found between initial
codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of
50–960 mg day−1 (mean: 564 mg; 95% confidence interval 431–696 mg). Median
buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4–32 mg) at day 7 and
16.0 mg (interquartile range 13.5 mg, range 4–32 mg) at day 28. Buprenorphine doses
received were markedly higher than estimated codeine doses based on standard dose
conversion tables. Discussion and Conclusions With increasing presentations relating to
codeine dependence, these findings provide important guidance to clinicians. Buprenorphine
doses were consistently higher than doses estimated based on the dose of codeine consumed,
and were comparable with doses used in the treatment of dependence with heroin and more
potent prescription opioids.
Keywords: codeine dependence; buprenorphine maintenance; induction; opioid analgesic
50. Buprenorphine Maintenance Treatment of Opiate Dependence: Correlations
Between Prescriber Beliefs and Practices
Kai MacDonald, Kristy Lamb, Michael L. Thomas & Wendy Khentigan
Substance Use and Misuse 2016:51(1);85-90
Abstract
Background Despite the existence of evidence-based guidelines, different prescriber
practices around buprenorphine maintenance treatment (BMT) of opiate dependence exist.
Moreover, certain prescriber beliefs may influence their practice patterns. Objective To
understand community BMT practice patterns and discern their relationship to practitioner
beliefs. Method: Survey of 30 local BMT prescribers about aspects of BMT, and analysis of
correlations between practices and practitioner beliefs. Results Practitioners generally
followed standard treatment guidelines, though the most-common maintenances dosages of
BMT (4–12 mg) were lower than recommended by some studies. Endorsement of belief in a
“spiritual basis” of addiction correlated with lower average BMT doses and less frequent
endorsement of the belief that BMT-treated patients are “in recovery.”
Conclusions/Importance These data suggest that relatively standardized, longer-term BMT
of opiate dependence is accepted among the majority of surveyed prescribers, and certain
provider beliefs about addiction may influence prescribing habits and attitudes. Future studies
should: (1) assess these findings in larger samples; (2) examine how prescriber beliefs about
56
addiction and BMT compare with those of other addiction treatment providers; and (3)
ascertain whether individual prescriber beliefs influence patient outcomes.
Keywords: Opiate dependence; buprenorphine; psychopharmacology; stigma
51. Potential cost-effectiveness of supervised injection facilities in Toronto and Ottawa,
Canada
Eva A. Enns, Gregory S. Zaric, Carol J. Strike, Jennifer A. Jairam, Gillian Kolla and Ahmed
M. Bayoumi
Addiction 2016:111(3);475-489
Abstract
Background and Aims Supervised injection facilities (legally sanctioned spaces for
supervised consumption of illicitly obtained drugs) are controversial public health
interventions. We determined the optimal number of facilities in two Canadian cities using
health economic methods. Design Dynamic compartmental model of HIV and hepatitis C
transmission through sexual contact and sharing of drug use equipment. Setting Toronto
and Ottawa, Canada. Participants Simulated population of each city. Interventions Zero
to five supervised injection facilities. Measurements Direct health-care costs and qualityadjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental costeffectiveness ratios. Findings In Toronto, one facility cost $4.1 million and resulted in a
gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of
$10 763 per QALY [95% credible interval (95CrI): cost-saving to $278 311]. Establishing
one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179 272). At
a $50 000 per QALY threshold, three facilities would be cost-effective in Toronto and two in
Ottawa. The probability that establishing three, four, or five facilities in Toronto was costeffective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in
Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no
facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in
Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of
the facilities was at least 50% and fixed operating costs were less than $2.0 million.
Conclusions Using a $50 000 per quality-adjusted life-years threshold for cost-effectiveness,
it is likely to be cost-effective to establish at least three legally sanctioned spaces for
supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa,
Canada.
Keywords: Harm reduction; HCV; HIV/AIDS; injection drug use; mathematical modeling;
supervised injection facility
57
52. Development of a brief tool for monitoring aberrant behaviours among patients
receiving long-term opioid therapy: The Opioid-Related Behaviours In Treatment
(ORBIT) scale
Briony Larance, Raimondo Bruno, Nicholas Lintzeris, Louisa Degenhardt, Emma Black,
Amanda Brown, Suzanne Nielsen, Adrian Dunlop, Rohan Holland, Milton Cohen, Richard
P. Mattick
Drug and Alcohol Dependence 2016:159;42-52
Abstract
Background Early identification of problems is essential in minimising the unintended
consequences of opioid therapy. This study aimed to develop a brief scale that identifies
and quantifies recent aberrant behaviour among diverse patient populations receiving longterm opioid treatment. Method 40 scale items were generated via literature review and
expert panel (N = 19) and tested in surveys of: (i) N = 41 key experts, and (ii) N = 426
patients prescribed opioids >3 months (222 pain patients and 204 opioid substitution
therapy (OST) patients). We employed item and scale psychometrics (exploratory factor
analyses, confirmatory factor analyses and item-response theory statistics) to refine items
to a brief scale. Results Following removal of problematic items (poor retest-reliability
or wording, semantic redundancy, differential item functioning, collinearity or rarity)
iterative factor analytic procedures identified a 10-item unifactorial scale with good model
fit in the total sample (N = 426; CFI = 0.981, TLI = 0.975, RMSEA = 0.057), and among
pain (CFI = 0.969, TLI = 0.960, RMSEA = 0.062) and OST subgroups (CFI = 0.989,
TFI = 0.986, RMSEA = 0.051). The 10 items provided good discrimination between
groups, demonstrated acceptable test–retest reliability (ICC 0.80, 95% CI 0.60–0.89;
Cronbach's alpha = 0.89), were moderately correlated with related constructs, including
opioid dependence (SDS), depression and stress (DASS subscales) and Social
Relationships and Environment domains of the WHO-QoL, and had strong face validity
among advising clinicians. Conclusions The Opioid-Related Behaviours In Treatment
(ORBIT) scale is brief, reliable and validated for use in diverse patient groups receiving
opioids. The ORBIT has potential applications as a checklist to prompt clinical discussions
and as a tool to quantify aberrant behaviour and assess change over time.
Keywords: Chronic pain; Opioid analgesics; Opioid substitution therapy; Addiction;
Medication non-adherence
53. Comparison of methods to assess psychiatric medication adherence in methadonemaintained patients with co-occurring psychiatric disorder
Kelly E. Dunn, Van L. King, Robert K. Brooner
Drug and Alcohol Dependence 2016:160;212-217
Abstract
Background Adherence with psychiatric medication is a critical issue that has serious
individual and public health implications. This is a secondary analysis of a large-scale clinical
treatment trial of co-occurring substance use and psychiatric disorder. Method Participants
(n = 153) who received a clinically-indicated psychiatric medication ≥30 days during the 12month study and provided corresponding data from Medication Event Monitoring System
(MEMS) and Morisky Medication Taking Adherence Scale (MMAS) self-report adherence
ratings were included in the analyses. Accuracy in MEMS caps openings was customized to
each participant’s unique required dosing schedule. Results Consistent with expectations,
MEMS-based adherence declined slowly over time, though MMAS scores of forgetting
58
medication remained high and did not change over the 12-month study. MEMS caps
openings were not significantly impacted by any baseline or treatment level variables,
whereas MMAS scores were significantly associated with younger age and presence of an
Axis I disorder and antisocial personality disorder, or any cluster B diagnoses.
Conclusions Results suggest that MEMS caps may be a more objective method for
monitoring adherence in patients with co-occurring substance use and psychiatric disorder
relative to the MMAS self-report. Participants in this study were able to successfully use the
MEMS caps for a 12-month period with <1% lost or broken caps, suggesting this comorbid
population is able to use the MEMS successfully. Ultimately, these data suggest that an
objective method for monitoring adherence in this treatment population yield more accurate
outcomes relative to self-report.
Keywords: MEMS; Medication adherence; Co-occurring; Opioid use disorder; Psychiatric
disorder
59
OVERDOSE AND DRUG RELATED DEATHS
54. Impact of treatment for opioid dependence on fatal drug-related poisoning: a
national cohort study in England
Matthias Pierce, Sheila M. Bird, Matthew Hickman, John Marsden, Graham Dunn, Andrew
Jones and Tim Millar
Addiction 2016:111(2);298-308
Abstract
Aims To compare the change in illicit opioid users’ risk of fatal drug-related poisoning
(DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support,
and investigate the modifying effect of patient characteristics, criminal justice system (CJS)
referral and treatment completion. Design National data linkage cohort study of the English
National Drug Treatment Monitoring System and the Office for National Statistics national
mortality database. Data were analysed using survival methods. Setting All services in
England that provide publicly funded, structured treatment for illicit opioid users.
Participants Adults treated for opioid dependence during April 2005 to March 2009:
151 983 individuals; 69% male; median age 32.6 with 442 950 person-years of observation.
Measurements The outcome was fatal DRP occurring during periods in or out of treatment,
with adjustment for age, gender, substances used, injecting status and CJS referral.
Findings There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval
(CI) = 3.2–3.6]. DRP risk increased while patients were not enrolled in any treatment
[adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55–1.92]. Risk when enrolled only in a
psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75–2.46).
The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67–
2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97–2.62) and those reporting problematic
alcohol use (aHR = 2.37, 95% CI = 1.90–2.98). Conclusions Patients who received only
psychological support for opioid dependence in England appear to be at greater risk of fatal
opioid poisoning than those who received opioid agonist pharmacotherapy.
Keywords: Drug-related poisoning; opiate dependence; opioid agonist pharmacotherapy;
overdose; psychosocial treatment; residential treatment
55. Exploring the life-saving potential of naloxone: A systematic review and
descriptive meta-analysis of take home naloxone (THN) programmes for opioid users
Andrew McAuley, Lorna Aucott, Catriona Matheson
International Journal of Drug Policy 2015:26(12);1183-1188
Abstract
Background The epidemic of drug-related mortality continues to endure. The most
common cause of death associated with drugs is overdose and opioids are consistently the
substances most prominently involved. As well as efforts to control the availability of
illicit drugs and increase engagement in treatment services, the use of naloxone for peer
administration has increasingly been championed as a mechanism for addressing the DRD
epidemic. Despite increasing adoption and use of take-home naloxone (THN) as a primary
response to DRD internationally the evidence base remains limited. Methods A
systematic review and descriptive meta-analysis of the international THN literature was
undertaken to determine an effect size for THN programmes. For each study, a proportion
of use (PoU) was calculated using the number of ‘peer administered uses’ and the ‘total
number of participant/clients’ trained and supplied with naloxone with a specific focus on
60
people who use drugs (PWUD). This was constrained to a three month period as the
lowest common denominator. As a percentage this gives the three month rate of use (per
100 participants). Results From twenty-five identified THN evaluations, nine studies
allowed a PoU to be determined. Overall, the model shows a range of 5.2–13.1 (point
estimate 9.2) naloxone uses every three months for every 100 PWUD trained.
Conclusion Our model estimates that around 9% of naloxone kits distributed are likely to
be used for peer administration within the first three months of supply for every 100
PWUD trained. Future evaluations should directly compare different training structures to
test relative effectiveness and use a series of fixed time periods (3, 6 and 12 months) to
determine whether time since training affects rate of naloxone use.
Keywords: Take-home naloxone; Drugs; Opioid; Mortality; Overdose
56. Trends in recreational poisoning in Newcastle, Australia, between 1996 and 2013
Kate M. Chitty, Nicholas J. Osborne, Rose Cairns, Andrew H. Dawson, Nicholas A. Buckley
Drug and Alcohol Dependence 2016:159;17-25
Abstract
Background Poisoning that occurs as the result using alcohol or drugs for recreational
purposes or to induce rewarding psychoactive effects (“recreational poisoning”) represents
significant harm attributed to drug use. There has been limited focus on recreational
poisoning separately from hospital admissions for general harms related to alcohol or drug
use. This study aims to detail the drug trends and patient population represented in
recreational poisonings in Newcastle, Australia. Methods Naturalistic analysis of
consecutive hospital presentations following poisoning between January, 1996 and
December, 2013 was conducted using data from the Hunter Area Toxicology Ser-vice
(HATS). 13805 patient records were included (aged 18–98), 1209 (8.8%) of those were
recreational poisonings. Results Compared to non-recreational poisonings, recreational
poisonings were more likely to occur in males than females (OR = 2.87, 95% CI: 2.44–3.40,
p < 0.001) and in patients under the age of 30 compared to their older counterparts (OR =
1.58, 95% CI: 1.35–1.85, p < 0.001). Hospital presentations for recreational poisonings were
more likely to occur between 0300 and 0600 h than 0900–1700 h (OR = 3.07, 95% CI: 2.29–
4.11, p < 0.001) and more likely to occur on the weekend than on a Monday. Overall,
recreational poisoning admissions declined over time. Conclusions Overall, the trends
reported in this analysis reflect general use and availability of alcohol and illicit substances in
Australia over the time period. Looking at specific sub-types of alcohol and drug-related
harm, like poisoning, is important for service planning and government initiatives.
Keywords: Recreational poisoning; Alcohol-related poisoning; Newcastle Australia;
Hospital trends
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57. Correlates of overdose risk perception among illicit opioid users
Christopher Rowe, Glenn-Milo Santos, Emily Behar, Philip O. Coffin
Drug and Alcohol Dependence 2016:159;234-239
Abstract
Background Opioid-related mortality continues to increase in the United States. The current
study assesses demographic and behavioral predictors of perceived overdose risk among
individuals who use opioids illicitly. By examining these correlates in the context of
established overdose risk factors, we aim to assess whether characteristics and behaviors that
have been associated with actual overdose risk translate to higher perception of risk.
Methods We conducted a cross-sectional survey of 172 adult illicit opioid users in San
Francisco, CA and used multivariable logistic regression to identify predictors of perception
of high risk for opioid overdose. Results Age (aOR = 0.96, 95%CI = 0.93–1.00) and
number of injection days per month (0.91, 0.86–0.97) were associated with a lower odds of
perceived high overdose risk. There was no independent association between use of opioid
analgesics, concurrent use of opioids and benzodiazepines or cocaine, or HIV status and
overdose risk perception. Conclusions Opioid users who injected more frequently and those
who were older were less likely to perceive themselves as being at risk of overdose,
notwithstanding that those who inject more are at higher risk of overdose and those who are
older are at higher risk overdose mortality. In addition, despite being established overdose
risk factors, there was no relationship between use of opioid analgesics, concurrent use of
opioids and cocaine or benzodiazepines, or self-reported HIV status and overdose risk
perception. These findings highlight key populations of opioid users and established risk
factors that may merit focused attention as part of education-based overdose prevention and
opioid management strategies.
Keywords: Opioid overdose; Risk perception; Substance use; Risk factors
58. Stakeholder perceptions and operational barriers in the training and distribution of
take-home naloxone within prisons in England
Arun Sondhi, George Ryan and Ed Day
Harm Reduction Journal 2016:13;5
Abstract
Background The aim of the study was to assess potential barriers and challenges to the
implementation of take-home naloxone (THN) across ten prisons in one region of England.
Methods Qualitative interviews deploying a grounded theory approach were utilised over a
12- to 18-month period that included an on-going structured dialogue with strategic and
operational prison staff from the ten prisons and other key stakeholders (n = 17). Prisoner
perceptions were addressed through four purposive focus groups belonging to different
establishments (n = 26). Document analysis also included report minutes and access to
management information and local performance reports. The data were thematically
interpreted using visual mapping techniques. Results The distribution and implementation
of THN in a prison setting was characterised by significant barriers and challenges. As a
result, four main themes were identified: a wide range of negative and confused perceptions
of THN amongst prison staff and prisoners; inherent difficulties with the identification and
engagement of eligible prisoners; the need to focus on individual prison processes to enhance
the effective distribution of THN; and the need for senior prison staff engagement.
Conclusions The distribution of THN within a custodial setting requires consideration of a
number of important factors which are discussed.
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Keywords: Naloxone; Opiate-related overdose; Prison
59. An Initial Evaluation of Web-Based Opioid Overdose Education
Stephanie S. Roe & Caleb J. Banta-Green
Substance Use and Misuse 2016:51(2);268-275
Abstract
Background Fatal opioid overdose is a significant public health concern in the United
States. One approach to reducing fatalities is expanding overdose response education to
broader audiences. This study examined responses to a web-based overdose education
tool. Methods The results of 422 anonymous surveys submitted
on www.stopoverdose.orgwere analyzed for participant demographics, knowledge of opioid
overdose recognition and response, and knowledge of Washington's Good Samaritan
overdose law. Characteristics, knowledge, and planned behavior of respondents with
professional versus personal interest in overdose education were compared. Results Most
respondents were age 35 or older (57%) and female (65%). The mean score on the knowledge
quiz for overdose recognition and response items was 16.2 out of 18, and 1.5 out of 2
possible points for items concerning the law. Respondents indicating professional interest
were significantly more likely to be 35 or older (p = .001) and to have received prior
overdose education (p < .001), but less likely to know someone at risk for opioid overdose
(p < .001) or report planning to obtain take-home naloxone (p < .001). No significant
differences were found in overdose knowledge scores between groups. Conclusions Online
training may be effective among individuals with professional and personal interest in
overdose, as general knowledge scores of overdose response were high among both groups.
Lower scores reflecting knowledge of the law suggest that the web-based training may not
have adequately presented this information. Overall, results suggest that a web-based
platform may be a promising approach to basic overdose education.
Keywords: Heroin; opioid; overdose; online education
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PARENTING
60. The Parental Bond and Alcohol Use Among Adolescents: The Mediating Role of Drinking
Motives
Martina Smorti & Silvia Guarnieri
Substance Use and Misuse 2015:50(13);560-1570
Abstract
Background Alcohol use and alcohol-related problems represent a significant health
concern. Few empirical researches focused on understanding the interrelationships and links
between the parental bond, drinking motives, and alcohol use during adolescence.
Objectives: The present study examined the relationships between a supportive parental bond,
drinking motives, and alcohol use, with a focus on the role of mediation. Methods The
sample comprised 298 adolescents, aged from 16 to 20 years. The technique of structural
equation modelling (SEM) was used to assess the direct and indirect effects of the parental
bond on alcohol use among adolescents through motives for drinking. Results The
relationship between the parental bond and frequency of alcohol use by adolescents was not
mediated by any motives for drinking, neither for males nor females. Regarding the
relationships between the parental bond and quantity of adolescent alcohol consumption,
findings for females showed significant indirect effects of maternal bond on alcohol quantity,
when coping, enhancement, and social drinking motives were entered as mediator variables.
Rather, paternal bond did not predict drinking quantity, not even indirectly. On the contrary,
results for males indicated that the parental bond was neither directly nor indirectly
associated with adolescent alcohol use. Conclusions/Importance Mothers are the relational
fulcrum of the family, while fathers seem to maintain a more peripheral position. Gender
differences are discussed on the basis of the different cultural and parental socialisation
processes that operate for male and female adolescents.
Keywords: parental bond; drinking motives; alcohol use; adolescence; gender differences
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PHARMACY
61. Community pharmacy services for people with drug problems over two decades in
Scotland: Implications for future development
Catriona Matheson, Manimekalai Thiruvothiyur, Helen Robertson, Christine Bond
International Journal of Drug Policy 2016:27;105-112
Abstract
Background In Scotland community pharmacies are heavily involved in service delivery for
people with drug problems (PWDP) as documented through surveys of all community
pharmacies in 1995, 2000 and 2006. A further survey in 2014 enabled trends in service
demand/provision to be analysed and provides insight into future development.
Methods The lead pharmacist in every Scottish pharmacy (n = 1246) was invited to
complete a postal questionnaire covering attitudes towards PWDP and service provision and
level of involvement in services (needle exchange, dispensing for PWDP and methadone
supervision). Additional questions covered new services of take-home naloxone (THN) and
pharmacist prescribing for opioid dependence. Telephone follow-up of non-responders
covered key variables. A comparative analysis of four cross-sectional population surveys of
the community pharmacy workforce (1995, 2000, 2006 and 2014) was undertaken.
Results Completed questionnaires were returned by 709 (57%) pharmacists in 2014. Key
variables (questionnaire or telephone follow-up) were available from 873 (70%). The
proportion of pharmacies providing needle exchange significantly increased from 1995 to
2014 (8.6%, 9.5%, 12.2%, 17.8%, p < 0.001) as did the proportion of pharmacies dispensing
for the treatment of drug misuse (58.9%, 73.4%, 82.6% and 88%, p < 0.001). Methadone was
dispensed to 16,406 individuals and buprenorphine to 1777 individuals (increased from
12,400 and 192 respectively in 2006). Attitudes improved significantly from 1995 to 2014
(p < 0.001). Being male and past training in drug misuse significantly predicted higher
attitude scores (p < 0.05) in all four years. Attitude score was a consistently significant
predictor in all four years for dispensing for the treatment of drug misuse [OR = 1.1 (1995
and 2006, CI 1.1–1.3, and 2014 CI 1.1–1.4) and 1.2 (2000), CI 1.3–1.5] and providing needle
exchange [OR = 1.1 (1995 and 2006), CI 1.1–1.2, 1.1–1.3 and 1.2 (2000 and 2014), CI 1.1–
1.3 and 1.1–1.5]. In 2014, 53% of pharmacists felt part of the addiction team and 27.7% did
not feel their role was valued by them. Nine pharmacists prescribed for opioid dependence.
Conclusion It is possible for pharmacy workforce attitudes and service engagement to
improve over time. Training was key to these positive trends. Communication with the wider
addiction team could be further developed
Keywords: Pharmacy; Attitudes; Training; Workforce; Opiate replacement treatment; Drug
misuse; Naloxone
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PUBLIC INTERFACE
62. Understanding Americans’ views on opioid pain reliever abuse
Colleen L. Barry, Alene Kennedy-Hendricks, Sarah E. Gollust, Jeff Niederdeppe, Marcus A.
Bachhuber, Daniel W. Webster and Emma E. McGinty
Addiction 2016:111(1);85-93
Abstract
Aims Opioid pain reliever abuse rates have increased sharply in the United States. This study
examines Americans’ personal experience with opioid pain reliever use and abuse, and views
about the seriousness of the problem, factors causing it, responsibility for addressing it and
support for policies to resolve it. Design Public opinion survey.
Setting and Participants A nationally representative US adult sample (n = 1111).
Measures Experiences with opioid pain relievers and views about the seriousness, causes of
and responsibility for addressing the problem, and support for policies to reduce opioid pain
reliever abuse. Findings 28.2 per cent of Americans reported using opioid pain relievers in
the last 12 months, 69.5% have used them in their life-time and 17.3% reported using these
medications when not prescribed to them. Fifty-eight per cent ranked the problem as serious,
on a par with other major health concerns. Individual-orientated factors, including a lack of
understanding about how easy it is to become addicted (80.0%) and improper storage
(65.1%) and disposal (64.1%), ranked highest as causes, and those abusing opioid pain
relievers (83.8%) and their physicians (78.0%) were viewed as most responsible for solving
the problem. Of the policies recommended to curb the epidemic, 14 of 16 were supported by
a majority of Americans. Conclusions Americans view the problem of opioid pain reliever
abuse as serious, and support nearly all the policies recommended by medical, law
enforcement, disease control and public health experts to curb the epidemic.
Keywords: Addiction; opioid analgesics; policy; public opinion; substance abuse; surveys
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RECOVERY, RELAPSE AND PREVENTION
63. Emerging consensus on measuring addiction recovery: Findings from a multistakeholder consultation exercise
Joanne Neale, Daria Panebianco, Emily Finch, John Marsden, Luke Mitcheson, Diana
Rose, John Strang & Til Wykes
Drugs: Education, Prevention and Policy 2016:23(1);31-40
Abstract
Aim To identify indicators that diverse stakeholders believe are important when measuring
recovery from addiction. Methods Our previous work with service users had generated 28
indicators of recovery. Using Delphi group methodology (three rounds), we assessed the
extent to which stakeholders working in the addictions field agreed that the 28 indicators
were important on a scale of 1–10. Participants included 146 individuals with diverse job
roles in 124 organisations across the British Isles. Findings Round 1 scores were high. There
was evidence of greater scoring consensus in Round 2, but this trend was less certain in
Round 3. Participants scored 27/28 indicators ≥7/10 in Round 3, so confirming their
importance. The only Round 3 indicator with a mean score <7 was “experiencing cravings”.
There were statistical differences between the Round 3 indicator scores of some sub-groups
of participants, but absolute differences were small (never more than 1 point for any
indicator). Conclusions We have identified 27 recovery indicators that stakeholders working
within the addiction field in the British Isles consistently ranked as important. Replicating our
methods in other countries, and with additional stakeholder groups, will provide greater
clarity on the term “recovery”, its relevance and value, and how it can best be measured.
Keywords: Delphi group; measurement; recovery; service users; stakeholder consultation
64. Personal support networks, social capital, and risk of relapse among individuals
treated for substance use issues
Daria Panebianco, Owen Gallupe, Peter J. Carrington, Ivo Colozzi
International Journal of Drug Policy 2016:27;146-153
Abstract
Background The success of treatment for substance use issues varies with personal and
social factors, including the composition and structure of the individual's personal support
network. This paper describes the personal support networks and social capital of a sample of
Italian adults after long-term residential therapeutic treatment for substance use issues, and
analyses network correlates of post-treatment substance use (relapse). Methods Using a
social network analysis approach, data were obtained from structured interviews (90–120 min
long) with 80 former clients of a large non-governmental therapeutic treatment agency in
Italy providing voluntary residential treatments and rehabilitation services for substance use
issues. Participants had concluded the program at least six months prior. Data were collected
on socio-demographic variables, addiction history, current drug use status (drug-free or
relapsed), and the composition and structure of personal support networks. Factors related to
risk of relapse were assessed using bivariate and multivariate logistic regression models.
67
Results A main goal of this study was to identify differences between the support network
profiles of drug free and relapsed participants. Drug free participants had larger, less dense,
more heterogeneous and reciprocal support networks, and more brokerage social capital than
relapsed participants. Additionally, a lower risk of relapse was associated with higher socioeconomic status, being married/cohabiting, and having network members with higher socioeconomic status, who have greater occupational heterogeneity, and reciprocate support.
Conclusions Post-treatment relapse was found to be negatively associated with the
socioeconomic status and occupational heterogeneity of ego's support network, reciprocity in
the ties between ego and network members, and a support network in which the members are
relatively loosely connected with one another (i.e., ego possesses “brokerage social capital”).
These findings suggest the incorporation into therapeutic programming of interventions that
address those aspects of clients’ personal support networks.
Keywords: Substance abuse; Social network; Social support; Social capital; Relapse
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TREATMENT SERVICES
65. Telephone-based continuing care counseling in substance abuse treatment:
Economic analysis of a randomized trial
Donald S. Shepard, Marilyn C. Daley, Matthew J. Neuman, Aaron P. Blaakman, James R.
McKay
Drug and Alcohol Dependence 2016:159;109-116
Abstract
Purpose To investigate whether telephone-based continuing care (TEL) is a promising
alternative to traditional face-to-face counseling for clients in treatment for substance abuse.
Methods Patients with alcohol and/or cocaine dependence who had completed a 4-week
intensive outpatient program were randomly assigned through urn randomization into one of
three 12-week interventions: standard continuing care (STD), in-person relapse prevention
(RP), or telephone-based continuing care (TEL). This study performed cost, costeffectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from
the randomized clinical trial with two years of follow up (359 participants). In addition, the
study examined the potential moderating effect of baseline patient costs on economic
outcomes. Results The study found that TEL was less expensive per client from the societal
perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more
effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p < 0.05). Thus TEL
dominated STD, with a highly favorable negative incremental cost-effectiveness ratio
(−$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective.
Conclusions TEL proved to be a cost-effective and cost-beneficial contributor to long-term
recovery over two years. Because TEL dominated STD care interventions, wider adoption
should be considered.
Keywords: Alcohol and cocaine dependence; Continuing care alternatives; Telephone-based
continuing care; Relapse prevention
66. The effectiveness of compulsory drug treatment: A systematic review
D. Werb, A. Kamarulzaman, M.C. Meacham, C. Rafful, B. Fischer, S.A. Strathdee, E. Wood
International Journal of Drug Policy 2016:28;1-9
Abstract
Background Despite widespread implementation of compulsory treatment modalities for
drug dependence, there has been no systematic evaluation of the scientific evidence on the
effectiveness of compulsory drug treatment. Methods We conducted a systematic review of
studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate
of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities.
The following academic databases were searched: PubMed, PAIS International, Proquest,
PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete,
REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from
database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed
scientific studies presenting original data. Primary outcome of interest was post-treatment
drug use. Secondary outcome of interest was post-treatment criminal recidivism.
69
Results Of an initial 430 potential studies identified, nine quantitative studies met the
inclusion criteria. Studies evaluated compulsory treatment options including drug detention
facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, communitybased treatment, group-based outpatient treatment, and prison-based treatment. Three studies
(33%) reported no significant impacts of compulsory treatment compared with control
interventions. Two studies (22%) found equivocal results but did not compare against a
control condition. Two studies (22%) observed negative impacts of compulsory treatment on
criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient
treatment on criminal recidivism and drug use. Conclusion There is limited scientific
literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest
improved outcomes related to compulsory treatment approaches, with some studies
suggesting potential harms. Given the potential for human rights abuses within compulsory
treatment settings, non-compulsory treatment modalities should be prioritized by
policymakers seeking to reduce drug-related harms.
Keywords: Compulsory treatment; Addiction; Systematic review; Global; Policy
67. Parental Criminal Justice Involvement and Children's Involvement With Child
Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?
Elizabeth J. Gifford, Lindsey M. Eldred, Frank A. Sloan & Kelly E. Evans
Substance Use and Misuse 2016:51(2);179-192
Abstract
Background In light of evidence showing reduced criminal recidivism and cost savings,
adult drug treatment courts have grown in popularity. However, the potential spillover
benefits to family members are understudied. Objectives To examine: (1) the overlap
between parents who were convicted of a substance-related offense and their children's
involvement with child protective services (CPS); and (2) whether parental participation in an
adult drug treatment court program reduces children's risk for CPS involvement.
Methods Administrative data from North Carolina courts, birth records, and social services
were linked at the child level. First, children of parents convicted of a substance-related
offense were matched to (a) children of parents convicted of a nonsubstance-related offense
and (b) those not convicted of any offense. Second, we compared children of parents who
completed a DTC program with children of parents who were referred but did not enroll, who
enrolled for <90 days but did not complete, and who enrolled for 90+ days but did not
complete. Multivariate logistic regression was used to model group differences in the odds of
being reported to CPS in the 1 to 3 years following parental criminal conviction or,
alternatively, being referred to a DTC program. Results Children of parents convicted of a
substance-related offense were at greater risk of CPS involvement than children whose
parents were not convicted of any charge, but DTC participation did not mitigate this risk.
Conclusion/Importance The role of specialty courts as a strategy for reducing children's
risk of maltreatment should be further explored.
Keywords: Drug treatment courts, child maltreatment, convictions, substance use
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YOUNG PEOPLE AND ALCOHOL
68. Social Goals and Grade as Moderators of Social Normative Influences on
Adolescent Alcohol Use
Samuel N. Meisel and Craig R. Colder
Alcoholism: Clinical and Experimental Research 2015:39(12);2455-2462
Abstract
Background The literature distinguishes 2 types of social normative influences on
adolescent alcohol use, descriptive norms (perceived peer alcohol use) and injunctive norms
(perceived approval of drinking). Although theoretical formulations suggest variability in the
salience and influence of descriptive and injunctive norms, little is understood regarding for
whom and when social norms influence adolescent drinking. Strong agentic and communal
social goals were hypothesized to moderate the influence of descriptive and injunctive norms
on early adolescent alcohol use, respectively. Developmental changes were also expected,
such that these moderating effects were expected to get stronger at later grades.
Methods This longitudinal study included 387 adolescents and 4 annual assessments
(spanning 6th to 10th grade). Participants completed questionnaire measures of social goals,
social norms, and alcohol use at each wave. Results Multilevel logistic regressions were
used to test prospective associations. As hypothesized, descriptive norms predicted increases
in the probability of alcohol use for adolescents with strong agentic goals, but only in later
grades. Injunctive norms were associated with increases in the probability of drinking for
adolescents with low communal goals at earlier grades, whereas injunctive norms were
associated with an increased probability of drinking for adolescents with either low or high
communal goals at later grades. Although not hypothesized, descriptive norms predicted
increases in the probability of drinking for adolescents high in communal goals in earlier
grades, whereas descriptive norms predicted drinking for adolescents characterized by low
communal goals in later grades. Conclusions The current study highlights the importance of
social goals when considering social normative influences on alcohol use in early and middle
adolescence. These findings have implications for whom and when normative feedback
interventions might be most effective during this developmental period.
Keywords: Social Norms; Social Goals; Adolescent Alcohol Use
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69. Effectiveness of a Dutch community-based alcohol intervention: Changes in alcohol
use of adolescents after 1 and 5 years
Sophia C. Jansen, Annemien Haveman-Nies, Inge Bos-Oude Groeniger, Cobi Izeboud,
Carolien de Rover, Pieter van’t Veer
Drug and Alcohol Dependence 2016:159;125-132
Abstract
Background Underage alcohol drinking is a severe public health problem. The aim of this
study was to evaluate the short- and long-term effects of a Dutch community-based alcohol
intervention on alcohol use of adolescents in the second and fourth grade of high school.
Methods The community intervention integrated health education, regulation, and
enforcement in multiple settings, targeting adolescents as well as their environments. In order
to evaluate effectiveness, a quasi-experimental pretest posttest design was used based on
three independent cross-sectional surveys in 2003, 2007 and 2011, resulting in an analytical
sample of approximately 5700 and 3100 adolescents in the intervention and reference region,
respectively. For the main analyses, we compared the change in recent alcohol use and binge
drinking in the intervention region with the reference region. Linear regression was used to
obtain (adjusted) prevalence of alcohol use. Results During the study period, there was an
overall decline in the prevalence of alcohol use. After 1 year of intervention, the decline was
11% (P < 0.01) and 6% (P < 0.01) stronger in the intervention region as compared to the
reference region, for recent alcohol use and binge drinking respectively. This effect was
restricted to the second grade and remained after 5 years of intervention. No clear subgroup
effects or confounding were observed for ethnicity, gender or educational level.
Conclusions The Dutch community intervention appears to be effective on the short- and
long-term in reducing the prevalence of recent alcohol use and binge drinking of (underage)
adolescents in the second grade of high school.
Keywords: Alcohol reduction; Community-based intervention; Adolescents
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