Download Alcoholism: Clinical and Experimental Research - Hi

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