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Literature Update for CERGA March 2011
Contents
LIST OF JOURNALS CHECKED
LIST OF REFERENCES
Alcohol
Alcohol Treatment and Screening
Alcohol Use
Benzodiazepines
Blood Borne Viruses
Co-Morbidity
Epidemiology and Demography
Harm Reduction
Hepatitis C
Homelessness
Injecting Behaviour
Methods
Miscellaneous
Opiate Treatment
Psychosocial Treatment and Interventions
Services and Professionals
Smoking
Stimulants
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LIST OF ABSTRACTS
Alcohol
Alcohol Treatment and Screening
Alcohol Use
Benzodiazepines
Blood Borne Viruses
Co-Morbidity
Epidemiology And Demography
Harm Reduction
Hepatitis C
Homelessness
Injecting Behaviour
Methods
Miscellaneous
Opiate Treatment
Psychosocial Treatment and Intervention
Services And Professionals
Smoking
17
17
31
36
37
39
43
45
53
54
58
59
60
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66
73
75
77
1
CERGA Journal Title and Abstracts March 2011
Journal Title
Volumes and Issues Checked
Addiction
Volume 105
issue 11 (November) [7]
issue 12 (December) [4]
Volume 106
Issue 1 (January) [6]
issue 2 (February) [7]
Volume 35 issue 12 [2]
Volume 36 issue 1-4 [6]
Volume 9 issue 4 (December) [2]
Addictive Behaviours
Addictive Disorders & Their
Treatment
Alcohol and Alcoholism
Alcoholism Clinical &
Experimental Research
British Medical Journal
Drug and Alcohol Dependence
Drug and Alcohol Review
Drugs: Education, Prevention,
and Policy
International Journal of Drug
Policy
Journal of Addictive Diseases
Journal of Public Health
Journal of Substance Abuse
Treatment
The American Journal of Drug
and Alcohol Abuse
Number of
issues per year
6
12
4
Volume 45 issue 6 (November –
December) [5]
Volume 46 issue 1 (January – February)
[4]
Volume 46 issue 2 (March-April) [3]
Volume 35 issues 1 (January) [3]
Volume 35 issue 2 (February) [2]
Volume 342 Issue7795 [3]
Volume 324 Issue 7796 [1]
Volume 113 (issues 1-3), [12]
114 (issues 1) [2]
Volume 30 issue 1 (January) [3]
Volume 18, issue 1 [1]
Volume 21 issue 6 (November) [3]
Volume 22 issues 1 (January) [5]
Volume 30 - issue 1 [2]
Volume 32 issue 4 (December) [1]
Volume 33 issue 1 (March)
Volume 40, issues 1&2 [4]
6
12
21
6
6
6
4
6
8
Volume 36 issue 6 (November) [2]
Volume 37 issues 1&2 (January, March)
[5]
2
6
List of References
Alcohol
1.
The acute effects of caffeinated versus non-caffeinated alcoholic
beverage on driving performance and attention/reaction time
Jonathan Howland, Damaris J. Rohsenow, J. Todd Arnedt, Caleb A. Bliss,
Sarah K. Hunt, Tamara Vehige Calise, Timothy Heeren, Michael Winter,
Caroline Littlefield, Daniel J. Gottlieb
Addiction 2011:106(2);335-341
2.
Prevalence of the metabolic syndrome in men and women with
alcohol dependence: results from a cross-sectional study during
behavioural treatment in a controlled environment
Kai G. Kahl, Wiebke Greggersen, Ulrich Schweiger, Joachim Cordes,
Christoph U. Correll, Jessica Ristow, Juliane Burow, Corinna Findel,
AnneStoll, Chakrapani Balijepalli, Laura Göres, Christian Lösch, Thomas
Hillemacher, Stefan Bleich, Susanne Moebus
Addiction 2010;105(11)1921-1927
3.
Response to alcohol in women: Role of the menstrual cycle and a family
history of alcoholism
Suzette M. Evans and Frances R. Levin
Drug and Alcohol Dependence 2011;114(1):18-30
4.
Alcohol and STI risk: Evidence from a New Zealand longitudinal birth
cohort
Joseph M. Boden, David M. Fergusson and L. John Horwood
Drug and Alcohol Dependence 2011;113(2-3):200-206
5.
Self-stigma in alcohol dependence: Consequences for drinking-refusal
self-efficacy
Georg Schomerus, Patrick W. Corrigan, Thomas Klauer, Philipp Kuwert,
Harald J. Freyberger and Michael Lucht
Drug and Alcohol Dependence 2011;114(1):12-17
6.
Reduction in alcohol consumption and health status
Wenbin Liang, Tanya Chikritzhs
Addiction 2011;106(1):75-81
7.
Area of residence and alcohol-related mortality risk: a five-year
follow-up study
Sheelah Connolly, Dermot O'Reilly, Michael Rosato, Chris Cardwell
3
8.
Addiction 2011;106(1):84-92
Mortality for Alcohol-related Harm by Country of Birth in Scotland, 2000–
2004: Potential Lessons for Prevention
Neeraj Bhala; Colin Fischbacher; Raj Bhopal
Alcohol and Alcoholism 2010;45(6):552-556
9.
A New Measure of Alcohol Affordability for the UK
Rachel Seabrook
Alcohol and Alcoholism 2010;45(6):581-585
10.
Perception of the Amount of Drinking by Others in A Sample of 20-YearOld Men: The More I Think You Drink, The More I Drink
Nicolas Bertholet, Jacques Gaume, Mohamed Faouzi, Jean-Bernard
Daeppen, Gerhard Gmel
Alcohol and Alcoholism 2011;46(1):83-87
11.
The Stigma of Alcohol Dependence Compared with Other Mental
Disorders: A Review of Population Studies
Georg Schomerus, Michael Lucht, Anita Holzinger, Herbert Matschinger,
Mauro G. Carta, Matthias C. Angermeyer
Alcohol and Alcoholism 2011;46(2):105-112
12.
Perception of Sleep and Dreams in Alcohol-Dependent Patients during
Detoxication and Abstinence
Jana Steinig, Ronja Foraita, Svenja Happe, Martin Heinze
Alcohol and Alcoholism 2011;46(2):143-147
13.
Vitamin D and Nutritional Status are Related to Bone Fractures in
Alcoholics
Emilio González-Reimers, Julio Alvisa-Negrín, Francisco SantolariaFernández, M. Candelaria Martín-González, Iván Hernández-Betancor,
Camino M. Fernández-Rodríguez, J. Viña-Rodríguez, Antonieta GonzálezDíaz
Alcohol and Alcoholism 2011;46(2):148-155
14.
Test of a Clinical Model of Drinking and Suicidal Risk
Kenneth R. Conner, Douglas Gunzler, Wan Tang, Xin M. Tu, Stephen A.
Maisto
Alcoholism: Clinical and Experimental Research 2011;35(1):60-68
15.
The Effects of Maternal Binge Drinking During Pregnancy on Neural
Correlates of Response Inhibition and Memory in Childhood
Matthew J. Burden, Alissa Westerlund, Gina Muckle, Neil Dodge, Eric
Dewailly, Charles A. Nelson, Sandra W. Jacobson, Joseph L. Jacobson
Alcoholism: Clinical and Experimental Research 2011;35(1):69-82
4
16.
Alcohol and Liver Cirrhosis Mortality in the United States:
Comparison of Methods for the Analyses of Time-Series Panel Data
Models
Yu Ye, William C. Kerr
Alcoholism: Clinical and Experimental Research 2011;35(1):108-115
17.
Knowledge, attitudes and practice relating to hazardous alcohol use
across the continuum of care in a community healthcare centre
Vimal Kishore, Sara Lynch, Jamilia Pichon, Katherine Theall, Sandy Johnson,
Emily Roberson, Susan Hinton
Drugs: Education, Prevention and Policy 2011;18(1):60-68
18.
Effects of alcohol consumption on iron metabolism
M. Lieb, U. Palm, B. Hock, M. Schwarz, I. Domke, M. Soyka
The American Journal of Drug and Alcohol Abuse 2011;37(1):68-73
19.
Prevalence of the metabolic syndrome in men and women with
alcohol dependence: results from a cross-sectional study during
behavioural treatment in a controlled environment
Kai G. Kahl, Wiebke Greggersen, Ulrich Schweiger, Joachim Cordes,
Christoph U. Correll, Jessica Ristow, Juliane Burow, Corinna Findel, Anne
Stoll, Chakrapani Balijepalli, Laura Göres, Christian Lösch, Thomas
Hillemacher, Stefan Bleich, Susanne Moebus
ADDICTION 2010;105(11):1921-1927
20.
Alcohol dependence and anxiety increase error-related brain activity
Arnt F. A. Schellekens, Ellen R. A. De Bruijn, Christa A. A. Van Lankveld,
Wouter Hulstijn, Jan K. Buitelaar, Cor A. J. De Jong, Robbert J. Verkes
ADDICTION 2010;105(11):1928-1934
21.
Drinking: messages for the beer mat
Jane Smith
BMJ 2011;342:d1231
22.
Diagnosis, assessment, and management of harmful drinking and
alcohol dependence: summary of NICE guidance
Stephen Pilling, Amina Yesufu-Udechuku, Clare Taylor
BMJ 2011; 342:d700
23.
A Patient’s Journey: Alcoholism
Anonymous, patient, Adrian M Raby
BMJ 2011; 342:d956
5
Alcohol Treatment and Screening
24.
Embedding routine alcohol screening and brief interventions in a
rural general hospital
PETER FAHY, GARY CROTON, STEVE VOOGT
Drug Alcohol Rev 2011;30;47–54
25.
Primary care-based intervention to reduce at-risk drinking in older
adults: a randomized controlled trial
Alison A. Moore, Fred C. Blow, Marc Hoffing, Sandra Welgreen, James
W. Davis, James C. Lin, Karina D. Ramirez, Diana H. Liao, Lingqi Tang,
Robert Gould, Monica Gill, Oriana Chen, Kristen L. Barry
Addiction 2011;106(1):111-120
26.
The Impact of Screening, Brief Intervention and Referral for Treatment in
Emergency Department Patients’ Alcohol Use: A 3-, 6- and 12-month
Follow-up
Robert H. Aseltine, Jr.
Alcohol and Alcoholism 2010;45(6):514-519
27.
Clinical Predictors of Outcome from an Australian Pharmacological
Relapse Prevention Trial
Kirsten C. Morley; Maree Teesson; Claudia Sannibale; Andrew Baillie; Paul S.
Haber
Alcohol and Alcoholism 2010;45(6):520-526
28.
Barriers to Implementing Screening and Brief Interventions in General
Practice: Findings from a Qualitative Study in Norway
Peter Nygaard, Olaf G. Aasland
Alcohol and Alcoholism 2011;46:52-60
29.
Alcohol Dependence: Analysis of Factors Associated with Retention of
Patients in Outpatient Treatment
Márcia Fonsi Elbreder; Rebeca de Souza e Silva; Sandra Cristina Pillon;
Ronaldo Laranjeira
Alcohol and Alcoholism 2011;46(1):74-76
30.
The Effects of Educational Intervention on Nutritional Behaviour in
Alcohol-Dependent Patients
Pamela Barbadoro; Elisa Ponzio; Maria Elisabetta Pertosa; Federica Aliotta;
Marcello M. D'Errico; Emilia Prospero; Andrea Minelli
Alcohol and Alcoholism 2010;46(1):77-79
6
31.
Impulsive or Depressive Personality Traits Do Not Impede Behavioral
Change After Brief Alcohol Interventions
Gabriel E. Ryb; Patricia C. Dischinger; Carlo DiClemente; Kimberly M. Auman,
Joseph A. Kufera; Carl A. Soderstrom
Journal of Addictive Diseases 2011;30(1):54-62
32.
Alcohol expectancy changes over a 12-week cognitive–behavioral
therapy program are predictive of treatment success
Ross McD. Young, Jason P. Connor, Gerald F.X. Feeney
Journal of Substance Abuse Treatment 2011;40(1):18-25
Alcohol Use
33.
Why do people drink at home?
John Foster, Donald Read, Sakthidaran Karunanithi, Victoria Woodward,
Journal of Public Health 2010;32(4):512-518
34.
Can parents prevent heavy episodic drinking by allowing teens to drink
at home?
Jennifer A. Livingston, Maria Testa, Joseph H. Hoffman, Michael Windle
Addictive Behaviors 2010;35(12):1105-1112
Benzodiazepines
35.
Benzodiazepine substitution for dependent patients—going with the
flow
Peter Tyrer
Addiction 2010:105(11);1875-1876
36.
To substitute or not substitute—optimal tactics for the management
of benzodiazepine dependence
Michael Soyka
Addiction 2010:105(11);1876-1877
37.
Benzodiazepine dependence: when abstinence is not an option
Michael Liebrenz, Lukas Boesch, Rudolf Stohler, Carlo Caflisch
Addiction 2010:105(11);1877-1878
7
38.
Benzodiazepine use among patients in heroin-assisted vs. methadone
maintenance treatment: Findings of the German randomized controlled
trial
Francisco José Eiroa-Orosa, Christian Haasen, Uwe Vertheina, Christoph Dilg,
Ingo Schäfer and Jens Reimer
Drug and Alcohol Dependence 2010;112(3):226-233
Blood Borne Viruses
39.
Commentary on Caiaffa et al. (2011): The renewed challenge of hepatitis
C virus epidemiology among non-injecting drug users
Francisco I. Bastos
Addiction 2011;106(1):152-153
40.
Gender differences in hepatitis C antibody prevalence and risk
behaviours amongst people who inject drugs in Australia 1998–2008
Jenny Iversen, Handan Wand, Andrea Gonnermann, Lisa Maher and on
behalf of the collaboration of Australian Needle and Syringe Programs
International Journal of Drug Policy 2010;21(6):471-476
41.
Treatment costs of hepatitis C infection among injection drug users in
Canada, 2006–2026
Daniel Werb, Evan Wood, Thomas Kerr, Neil Hershfield, Robert W.H. Palmer,
Robert S. Remis
International Journal of Drug Policy 2011;22(1):70-76
42.
Availability of body art facilities and body art piercing do not predict
hepatitis C acquisition among injection drug users in Montreal, Canada:
Results from a cohort study
Julie Bruneau, Mark Daniel, Yan Kestens, Michal Abrahamowicz and Geng
Zang
International Journal of Drug Policy 2010;21(6):477-484
43.
Syringe exchange in community pharmacies—The Portuguese
experience
Carla Torre, Raquel Lucas, Henrique Barros,
International Journal of Drug Policy 2010;21(6):514-517
8
Co- Morbidity
44.
The course of substance use disorders in patients with borderline
personality disorder and Axis II comparison subjects: a 10-year
follow-up study
Mary C. Zanarini, Frances R. Frankenbur, Jolie L. Weingeroff, D. Bradford
Reich, Garrett M. Fitzmaurice, Roger D. Weiss
Addiction 2011:106(2);342-348
45.
Psychiatric comorbidity in illicit drug users: Substance-induced versus
independent disorders
Marta Torrens, Gail Gilchrist, Antonia Domingo-Salvany and the
Drug and Alcohol Dependence 2011;1113(2-3):147-156
46.
Predictive Factors for Relapse after an Integrated Inpatient Treatment
Programme for Unipolar Depressed and Bipolar Alcoholics
Conor K. Farren and Sharon McElroy
Alcohol and Alcoholism 2010;45(6):527-533
Epidemiology and Demography
47.
Violence among men and women in substance use disorder treatment: A
multi-level event-based analysis
Stephen T. Chermack, Andy Grogan-Kaylor, Brian E. Perron, Regan L.
Murray, Peter De Chavez and Maureen A. Walton
Drug and Alcohol Dependence 2010;112(3):194-200
48.
Onset and course of alcoholism over 25 years in middle class men
Marc A. Schuckit and Tom L. Smith
Drug and Alcohol Dependence 2011;113(1):21-28
49.
Patterns of polydrug use in Great Britain: Findings from a national
household population survey
Gillian W. Smith, Michael Farrell, Brendan P. Bunting, James E. Houston and
Mark Shevlin
Drug and Alcohol Dependence 2011;113(2-3):222-228
50.
Areas of disadvantage: A systematic review of effects of area-level
socioeconomic status on substance use outcomes
Katherine J. Karriker-Jaffe
Drug Alcohol Rev 2011;30;84–95
9
51.
Mortality among regular or dependent users of heroin and other
opioids: a systematic review and meta-analysis of cohort studies
Louisa Degenhardt, Chiara Bucello, Bradley Mathers, Christina Briegleb,
Hammad Ali, Matt Hickman, Jennifer McLaren
Addiction 2011;106(1):32-51
52.
Child Physical and Sexual Abuse: A Comprehensive Look at Alcohol
Consumption Patterns, Consequences, and Dependence From the
National Alcohol Survey
E. Anne Lown, Madhabika B. Nayak, Rachael A. Korcha, Thomas K.
Greenfield
Alcoholism: Clinical and Experimental Research 2011;35(2):317-325
53.
Sex differences amongst dependent heroin users: Histories, clinical
characteristics and predictors of other substance dependence
Fiona L. Shand, Louisa Degenhardt, Tim Slade, Elliot C. Nelson
Addictive Behaviors 2011;36(1-2):27-36
54.
History of reported sexual or physical abuse among long-term heroin
users and their response to substitution treatment
Eugenia Oviedo-Joekes, Kirsten Marchand, Daphne Guh, David C. Marsh,
Suzanne Brissette, Michael Krausz, Aslam Anis, Martin T. Schechter
Addictive Behaviors 2011;36(1-2):55-60
55.
Childhood bullying behaviors at age eight and substance use at age 18
among males. A nationwide prospective study
S. Niemelä, A. Brunstein-Klomek, L. Sillanmäki, H. Helenius, J. Piha, K.
Kumpulainen, I. Moilanen, T. Tamminen, F. Almqvist, A. Sourander
Addictive Behaviors 2011;36(3):256-260
56.
Characteristics and consequences of heroin use among older adults in
the United States: A review of the literature, treatment implications, and
recommendations for further research
Daniel Rosen, Amanda Hunsaker, Steven M. Albert, Jack R. Cornelius,
Charles F. Reynolds III
Addictive Behaviors 2011;36(4)279-285
57.
Hospitalisation for an alcohol-related cause among injecting drug users
in Scotland: Increased risk following diagnosis with hepatitis C infection
Scott A. McDonald, Sharon J. Hutchinson, Sheila M. Bird, Chris Robertson,
Peter R. Mills, John F. Dillon, David J. Goldberg
International Journal of Drug Policy 2011;22(1): 63-69
10
58.
Social exclusion, personal control, self-regulation, and stress among
substance abuse treatment clients
Jennifer Cole, T.K. Logan, Robert Walker
Drug and Alcohol Dependence 2011;113(1):13-20
Hepatitis C
59.
Alcohol-Related and Viral Hepatitis C-Related Cirrhosis Mortality
among Hispanic Subgroups in the United States, 2000–2004
Young-Hee Yoon, Hsiao-ye Yi, Patricia C. Thomson
Alcoholism: Clinical and Experimental Research 2011;35(2):240-249
Harm Reduction
60.
Cessation of groin injecting behaviour among patients on oral opioid
substitution treatment
Richard Senbanjo, Neil Hun, John Strang
Addiction 2011:106(2);376-382
61.
Can Hepatitis C virus treatment be used as a prevention strategy?
Additional model projections for Australia and elsewhere
Peter Vickerman, Natasha Martin and Matthew Hickman
Drug and Alcohol Dependence 2011;113(2-3):83-85
62.
Needle exchange as a safe haven in an unsafe world
Joan Macneil, Bernadette Pauly
Drug Alcohol Rev 2011;30;26–32
63.
Impact of training for healthcare professionals on how to manage an
opioid overdose with naloxone: Effective, but dissemination is
challenging
Soraya Mayet, Victoria Manning, Anna Williams, Jessica Loaring, John
Strang
International Journal of Drug Policy 2011;22(1):9-15
64.
Infrequent opioid overdose risk reduction behaviours among young
adult heroin users in cities with wide coverage of HIV prevention
programmes
11
Montserrat Neira-León, Gregorio Barrio, María J. Bravo, M. Teresa Brugal,
Luis de la Fuente, Antonia Domingo-Salvany, José Pulido, Sara Santos, and
Project Itinere Group
International Journal of Drug Policy 2011;22(1):16-25
Homelessness
65.
The Role of Social Ties in Recovery in a Population of Homeless
Substance Abusers
Burkey, Matthew D.; A. Kim, Yeowon; Breakey, William R.
Addictive Disorders & Their Treatment 2011;10(1):14-20
Injecting Behaviour
66.
The self-reported personal wellbeing of a sample of Australian
injecting drug users
Paul Dietze, Mark Stoové, Peter Miller, Stuart Kinner, Raimondo Bruno,
Rosa Alati, Lucy Burn
Addiction Volume 2010;105(2):2141–2148
Methods
67.
How best to measure change in evaluations of treatment for
substance use disorder
John Marsden, Brian Eastwood, Craig Wright, Colin Bradbury, Jonathan
Knight, Paul Hammond
Addiction 2011; 106(2);294-302
Miscellaneous
68.
Continued cannabis use and risk of incidence and persistence of
psychotic symptoms: 10 year follow-up cohort study
Rebecca Kuepper, Jim van Os, Hans-Ulrich Wittchen, Michael Höfler, Cécile
Henquet,
BMJ 2011; 342:d738
69.
Using theories of behaviour change to inform interventions for
addictive behaviours
Thomas L. Webb, Falko F. Sniehotta, Susan Michie
Addiction 2010;105(11):1879-1892
12
70.
71.
Addiction and its sciences—philosophy
Bennett Foddy
Addiction Volume 2011;106(1):25–31
Substance use and motivation: a longitudinal perspective
Rachael A. Korcha, M.A., Douglas L. Polcin, Ed.D., Jason C. Bond, Ph.D,
William M. Lapp, Ph.D. Gantt Galloway, Pharm.D.
The American Journal of Drug and Alcohol Abuse 2011;37(1):48-53
72.
Predictors of addiction treatment providers' beliefs in the disease and
choice models of addiction
Christopher Russel, John B. Davies, Simon C. Hunter
Journal of Substance Abuse Treatment 2011;40(2):150-164
73.
Heavy use versus less heavy use of sedatives among non-medical
sedative users: Characteristics and correlates
Prasanthi Nattala, Kit Sang Leung, Arbi Ben Abdallah, Linda B. Cottler
Addictive Behaviors 2011;36(1-2):103-109
74.
A double-blind, placebo-controlled pilot trial of acamprosate for the
treatment of cocaine dependence
Kyle M. Kampman, Charles Dackis, Helen M Pettinati, Kevin G. Lynch, Thorne
Sparkman, Charles P. O'Brien
Addictive Behaviors 2011;36(3):217-221
Opiate Treatment
75.
Quality of life under maintenance treatment with heroin versus
methadone in patients with opioid dependence
A. Karow, J. Reimer, I. Schäfer, M. Krausz, C. Haasen and U. Verthein
Drug and Alcohol Dependence 2010;112(3):209-215
76.
Assessing sleep in opioid dependence: A comparison of subjective
ratings, sleep diaries, and home polysomnography in methadone
maintenance patients
Katherine M. Sharkey, Megan E. Kurth, Bradley J. Anderson, Richard P.
Corso, Richard P. Millman and Michael D. Stein
Drug and Alcohol Dependence 2011;113(2-3):245-248
77.
Methadone dose and neonatal abstinence syndrome—systematic
review and meta-analysis
Brian J. Cleary, Jean Donnelly, Judith Strawbridge, Paul J. Gallagher,
Tom Fahey, Mike Clarke, Deirdre J. Murphy
13
Addiction 2010;105(12):2071-2084
78.
Heroin anticraving medications: A systematic review
Ayman Fareed, M.D., Sreedevi Vayalapalli, M.D., Jennifer Casarella, M.D.,
Richard Amar, M.D. and Karen Drexler, M.D.
The American Journal of Drug and Alcohol Abuse 2010;36(6):332-341
79.
Pharmacokinetic drug interactions and adverse consequences between
psychotropic medications and pharmacotherapy for the treatment of
opioid dependence
Ali S. Saber-Tehrani, M.D., Robert Douglas Bruce, M.D., M.A., M.Sc. and
Frederick L. Altice, M.D, M.A.
The American Journal of Drug and Alcohol Abuse 2011;37(1):1-11
80.
Efficacy of mobile telephone contact for follow-up in injecting heroin
users
A. Hakansson, Ph.D., P. Isendahl, B.S.W., C. Wallin,B.S.W. and M. Berglund,
Ph.D.
The American Journal of Drug and Alcohol Abuse 2011;37(2):89-92
81.
Brain fMRI and craving response to heroin-related cues in patients on
methadone maintenance treatment
Wei Wang, Qiang Li, Yarong Wang, Jie Tian, Weichuan Yang, Wei Li, Wei
Qin, Kai Yuan, Jixin Liu
The American Journal of Drug and Alcohol Abuse 2011;37(2):123-130
82.
Effect of Methadone Maintenance Treatment on Heroin Craving, a
Literature Review
Ayman Fareed; Sreedevi Vayalapalli; Steven Stout; Jennifer Casarella; Karen
Drexler; Stephen P. Baile
Journal of Addictive Diseases 2011;30(1):27-38
83.
Alcohol use problem among patients in methadone maintenance
treatment in Taiwan
I.-Chun Chen, Wei-Chu Chie, Hai-Go Hwu, Sun-Yuan Chou, Yun-Chiang Yeh,
Chun-Yen Yu, Happy Kuy-Lok Tan
Journal of Substance Abuse Treatment 2011;40(2):142-149
84.
Characteristics and 9-month outcomes of discharged methadone
maintenance clients
Donna M. Coviello, Dave A. Zanis, Susan A. Wesnoski, Kevin G. Lynch,
Michelle Drapkin
Journal of Substance Abuse Treatment 2011;40(2):165-174
14
85.
“Should I stay or should I go?” Coming off methadone and
buprenorphine treatment
Adam R. Winstock, Nicholas Lintzeris, Toby Lea
International Journal of Drug Policy 2011;22(1):77-81
Psychosocial Treatment and Intervention
86.
Efficacy of brief motivational intervention in reducing binge drinking in
young men: A randomized controlled trial
Jean-Bernard Daeppen, Nicolas Bertholet, Jacques Gaume, Cristiana Fortini,
Mohamed Faouzi and Gerhard Gmel
Drug and Alcohol Dependence 2011;113(1):69-75
87.
Quality versus quantity: acquisition of coping skills following
computerized cognitive–behavioral therapy for substance use
disorders
Brian D. Kiluk, Charla Nich,Theresa Babuscio, Kathleen M. Carroll
Addiction 2010;105(12):2120-2127
88.
Biological and psychological interventions: Trends in substance use
disorders intervention research
Ryan Wessell, Carla Edwards Ryan Wessell, Carla Edwards
Addictive Behaviors 2010;35(12):1083-1088
Services and Professionals
89.
What They Want: Motivation and Treatment Choice in NontreatmentSeeking Substance Abusers
Katherine Michelle Peavy; Bryan N. Cochran, John Wax
Addictive Disorders & Their Treatment 2010; 9(4):150-157
90.
Service Use and Barriers to Care among Heroin Users: Results from a
National Survey
Orion Mowbray, Brian E. Perron, Amy S. B. Bohnert, Amy R. Krentzman,
Michael G. Vaughn,
The American Journal of Drug and Alcohol Abuse 2010;36(6):305-310
15
Smoking
91.
Anxiety diagnoses in smokers seeking cessation treatment:
relations with tobacco dependence, withdrawal, outcome and
response to treatment
Megan E. Piper, Jessica W. Cook, Tanya R. Schlam, Douglas E. Jorenby,
Timothy B. Baker
Addiction 2011:106(2);418-427
92.
A multi-level analysis of non-significant counseling effects in a
randomized smoking cessation trial
Danielle E. McCarthy, Thomas M. Piasecki, Douglas E. Jorenby, Daniel L.
Lawrence, Saul Shiffman, Timothy B. Baker
Addiction 2010;105(12):2195-2208
93.
Changes in smoking prevalence in 16–17-year-old versus older
adults following a rise in legal age of sale: findings from an English
population study
Jennifer A. Fidler, Robert West
ADDICTION 2010;105(11):1984-1988
Stimulants
94.
Mortality among cocaine users: A systematic review of cohort studies
Louisa Degenhardt , Jessica Singleton, Bianca Calabria, Jennifer McLaren,
Thomas Kerr, Shruti Mehta, Gregory Kirk and Wayne D. Hall
Drug and Alcohol Dependence 2011;113(2-3):88-95
Treatment
95.
Decreased bone density in men on methadone maintenance therapy
Andrew Grey, Karla Rix-Trott, Anne Horne, Greg Gamble, Mark Bolland,
Ian R. Reid
Addiction 2011:106(2);349-354
16
List of Abstracts
Alcohol
1. The acute effects of caffeinated versus non-caffeinated alcoholic
beverage on driving performance and attention/reaction time
Jonathan Howland, Damaris J. Rohsenow, J. Todd Arnedt, Caleb A. Bliss, Sarah K.
Hunt, Tamara Vehige Calise, Timothy Heeren, Michael Winter, Caroline Littlefield,
Daniel J. Gottlieb
Addiction 2011:106(2);335-341
ABSTRACT
Aims Marketing that promotes mixing caffeinated ‘energy’ drinks with alcoholic
beverages (e.g. Red Bull with vodka) targets young drinkers and conveys the
expectation that caffeine will offset the sedating effects of alcohol and enhance
alertness. Such beliefs could result in unwarranted risk taking (e.g. driving while
intoxicated). The aim of this study was to assess the acute effects of caffeinated
versus non-caffeinated alcoholic beverages on a simulated driving task and
attention/reaction time.
Design We conducted a 2 × 2 between-groups randomized trial in which participants
were randomized to one of four conditions: beer and non-alcoholic beer, with and
without caffeine added. Caffeine was added in the same proportion as found in a
commercially available caffeinated beer (69 mg/12 oz of beer at 4.8% alc. by vol).
Participants Participants were 127 non-dependent, heavy episodic, young adult
drinkers (age 21–30) who were college students or recent graduates. The target
breath alcohol level was 0.12 g%.
Measures Driving performance was assessed with a driving simulator; sustained
attention/reaction with the Psychomotor Vigilance Task (PVT).
Findings Across the driving and attention/reaction time we found main effects for
alcohol, with alcohol significantly impairing driving and sustained attention/reaction
time, with mainly large statistical effects; however, the addition of caffeine had no
main or interaction effects on performance.
Conclusion The addition of caffeine to alcohol does not appear to enhance driving
or sustained attention/reaction time performance relative to alcohol alone.
Keywords: Alcohol; attention; caffeine; driving; energy drinks; reaction time
2. Prevalence of the metabolic syndrome in men and women with alcohol
dependence: results from a cross-sectional study during behavioural
treatment in a controlled environment
Kai G. Kahl, Wiebke Greggersen, Ulrich Schweiger, Joachim Cordes,
Christoph U. Correll, Jessica Ristow, Juliane Burow, Corinna Findel, Anne Stoll,
Chakrapani Balijepalli, Laura Göres, Christian Lösch, Thomas Hillemacher, Stefan
Bleich, Susanne Moebus
Addiction 2010;105(11)1921-1927
ABSTRACT
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Aims Prevalence of metabolic syndrome (MetS) in men and women who use
alcohol has been inconsistent in the literature. The aim of this study is to compare the
prevalence of MetS in patients with a diagnosis of alcohol dependence who are
currently abstinent in a controlled environment, and in control subjects followed in
primary care from a similar region in Northern Germany.
Design Cross-sectional study.
Setting In-patient cognitive behavioural therapy.
Participants One hundred and ninety-seven men and women with alcohol
dependence during behavioural treatment in a controlled environment were
compared to 1158 subjects from primary care from a similar region in northern
Germany.
Measurements We used the American Heart Association/National Heart, Lung and
Blood Institute (AHA/NHBLI) criteria to determine the rate of MetS and each single
criterion of MetS in both groups.
Findings The prevalence of MetS was almost twice as high in men and women with
alcohol dependence compared to control subjects (30.6% versus 17.0%). With
respect to the single criteria, elevations were found for fasting glucose and blood
pressure in both genders and for triglycerides in women only. High density lipoprotein
(HDL)-cholesterol was higher in men and women with alcohol dependence.
Conclusions Our results demonstrate an increased rate of MetS, increased blood
pressure and dysregulation of glucose and lipid metabolism in alcohol-dependent
patients. Whether high HDL-cholesterol has cardioprotective effects in this context
remain doubtful.
Keywords: Alcohol dependence; GEMCAS; glucose metabolism; lipid metabolism;
metabolic syndrome
3. Response to alcohol in women: Role of the menstrual cycle and a family
history of alcoholism
Suzette M. Evans and Frances R. Levin
Drug and Alcohol Dependence 2011;114(1):18-30
ABSTRACT
The present study determined whether: (1) the response to alcohol varied as a
function of menstrual cycle phase and (2) women with a paternal history of
alcoholism (FHP) were less sensitive to the effects of alcohol compared to women
without a family history of alcoholism (FHN). The behavioral effects of alcohol (0.00,
0.25, and 0.75 g/kg) were evaluated in 21 FHN and 24 FHP women; each dose was
tested during both the midfollicular and late luteal phases of the menstrual cycle.
Baseline negative mood was increased during the luteal phase compared to the
follicular phase (increased Beck Depression scores and decreased Vigor, Arousal,
and Friendly scores). Alcohol increased ratings of Drug Liking and Good Drug Effect
more in the luteal phase than the follicular phase. FHP women had greater negative
mood during the luteal phase and some of these dysphoric effects were increased by
alcohol more in FHP women than FHN women. Alcohol impaired performance, with
no group or menstrual cycle differences. However, consistent with previous studies,
FHP women were less impaired by alcohol than FHN women on the balance task.
These data indicate that (1) the differences in response to alcohol across the
menstrual cycle are subtle, although alcohol is liked more during the luteal phase; (2)
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increases in dysphoric mood during the luteal phase are more pronounced in FHP
women compared to FHN women, particularly after alcohol; and (3) the differences
observed in response to alcohol between FHP and FHN women are less pronounced
than previously shown in men.
Keywords: Alcohol; Females; Menstrual cycle; Family history of alcoholism;
Subjective effects; Psychomotor performance
4. Alcohol and STI risk: Evidence from a New Zealand longitudinal birth cohort
Joseph M. Boden, David M. Fergusson and L. John Horwood
Drug and Alcohol Dependence 2011;113(2-3):200-206
ABSTRACT
Background
The present study examined the associations between involvement with alcohol and
risks of sexually transmitted infection (STI) during adolescence and early adulthood.
Methods
A 30-year prospective longitudinal study of the health, development, and adjustment
of a birth cohort of 1265 New Zealand-born individuals. Measures included repeated
assessments of frequency of alcohol use and number of symptoms of alcohol
disorder from ages 15 to 30 and rates of STI from ages 14 to 30. Conditional fixed
effects regression models augmented by observed time-dynamic covariate factors
were used to control for non-observed confounding in the associations between
alcohol and STI risk.
Results
There were clear and consistent trends for increasing involvement with alcohol to be
linked with increased risk of STI diagnoses. Adjustment of the associations for
sources of non-observed confounding and time-dynamic covariate factors reduced
the magnitude of these associations, but they remained statistically significant
(p < .05).
Conclusions
The results of the current study support the notion of the existence of a causal
pathway in which increasing levels of alcohol use and symptoms of alcohol
abuse/dependence led to increased risks of STI exposure. There was little evidence
to suggest that the links between alcohol involvement and STI risk could be fully
explained by an underlying predisposing factor that increased the risks of both
alcohol involvement and STI.
Keywords: Alcohol; Sexually transmitted infection; Longitudinal study; Fixed effects
regression
5. Self-stigma in alcohol dependence: Consequences for drinking-refusal selfefficacy
Georg Schomerus, Patrick W. Corrigan, Thomas Klauer, Philipp Kuwert, Harald J.
Freyberger and Michael Lucht
Drug and Alcohol Dependence 2011;114(1):12-17
ABSTRACT
Background
Public stigma and self-stigma are two facets of mental illness stigma. Self-stigma
denotes the internalization of negative public perceptions by persons with mental
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illness and has been shown to decrease general self-efficacy. To date, self-stigma
has not been examined in people suffering from alcohol dependence, a particularly
severely stigmatized mental disorder.
Methods
By adopting the Self-Stigma in Mental Illness Scale (SSMI), we developed the SelfStigma in Alcohol Dependence Scale (SSAD). The scale is based on a focus-group
derived list of 16 negative stereotypes about alcohol dependent persons. It consists
of four 16-item subscales measuring four hypothetical stages of self-stigma,
stereotype awareness (aware), stereotype agreement (agree), self-concurrence
(apply), and self-esteem decrement (harm). We employed the SSAD in a crosssectional study of 153 patients hospitalized for alcohol detoxification to examine its
reliability and validity.
Results
The four stages of self-stigma could be reliably measured with the SSAD (Cronbach's
alpha, 0.86–0.93). Each step in the process of self-stigmatization was most closely
associated with its preceding step. Other significantly related independent variables
in multiple regression analyses included desire for social distance (associated with
agree), duration of drinking problems (associated with apply) and depressive
symptoms (associated with apply and harm). Both apply and harm were significantly
related to reduced drinking-refusal self-efficacy in analyses controlling for depressive
symptoms and variables related to duration and severity of the drinking problem.
Discussion
The SSAD showed good validity and reliability measuring the stages of self-stigma in
this group. Self-stigma appears to be associated with lower drinking-refusal selfefficacy.
Keywords: Stigma; Discrimination; Substance abuse; Self-efficacy; Mental illness
6. Reduction in alcohol consumption and health status
Wenbin Liang, Tanya Chikritzhs
Addiction 2011;106(1):75-81
ABSTRACT
Aims This study investigated the association between alcohol consumption and
health status using cross-sectional national survey data.
Measurements and design This study relied upon self-report data collected by the
2004 and 2007 Australian National Drug Strategy Household (NDSH) surveys.
Households were selected using a multi-stage, stratified-area, random sample
design. Both surveys used combinations of the drop-and-collect and computerassisted telephone interview approaches. Respondents were questioned about their
current and past drinking, the presence of formal diagnosis for specific diseases
(heart disease, type 2 diabetes, hypertension, cancer, anxiety, depression) and selfperceived general health status. Associations between drinking status, the presence
of diagnoses and self-perceptions of general health status among respondents aged
18+ and 45+ were assessed using multivariate logistic regression.
Setting and participants Males and females aged 18 years or older and resident in
Australia. The sample sizes for the 2004 and 2007 NDSH surveys were 24 109 and
23 356, respectively.
Findings Respondents with a diagnosis of diabetes, hypertension and anxiety were
more likely to have reduced or stopped alcohol consumption in the past 12 months.
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The likelihood of having reduced or ceased alcohol consumption in the past 12
months increased as perceived general health status declined from excellent to poor.
Conclusions Experience of ill health is associated with subsequent reduction or
cessation of alcohol consumption. This may at least partly underlie the observed ‘Jshape’ function relating alcohol consumption to premature mortality.
Keywords: Alcohol; Australia; chronic disease; epidemiology; general population
7. Area of residence and alcohol-related mortality risk: a five-year follow-up
study
Sheelah Connolly, Dermot O'Reilly, Michael Rosato, Chris Cardwell
Addiction 2011;106(1):84-92
ABSTRACT
Aims To examine differences in alcohol-related mortality risk between areas, while
adjusting for the characteristics of the individuals living within these areas
Design A 5-year longitudinal study of individual and area characteristics of those
dying and not dying from alcohol-related deaths.
Setting The Northern Ireland Mortality study.
Participants A total of 720 627 people aged 25–74, enumerated in the Northern
Ireland 2001 Census, not living in communal establishments.
Measurements Five hundred and seventy-eight alcohol-related deaths.
Findings There was an increased risk of alcohol-related mortality among
disadvantaged individuals, and divorced, widowed and separated males. The risk of
an alcohol-related death was significantly higher in deprived areas for both males
[hazard ratio (HR) 3.70; 95% confidence interval (CI) 2.65, 5.18] and females (HR
2.67 (95% CI 1.72, 4.15); however, once adjustment was made for the characteristics
of the individuals living within areas, the excess risk for more deprived areas
disappeared. Both males and females in rural areas had a reduced risk of an alcoholrelated death compared to their counterparts in urban areas; these differences
remained after adjustment for the composition of the people within these areas.
Conclusions Alcohol-related mortality is higher in more deprived, compared to more
affluent areas; however, this appears to be due to characteristics of individuals within
deprived areas, rather than to some independent effect of area deprivation per se.
Risk of alcohol-related mortality is lower in rural than urban areas, but the cause is
unknown.
Keywords: Alcohol-related mortality; composition; context; deprivation; longitudinal
analysis; Northern Ireland; urban/rural
8. Mortality for Alcohol-related Harm by Country of Birth in Scotland, 2000–
2004: Potential Lessons for Prevention
Neeraj Bhala; Colin Fischbacher; Raj Bhopal
Alcohol and Alcoholism 2010;45(6):552-556
ABSTRACT
Aims: Deaths caused by alcohol have increased in the UK, and Scotland in
particular, but the change in the rates of alcohol-related deaths for migrants are
uncertain, and could yield insights for the general population.
Methods: Alcohol-related mortality in immigrants among Scotland's residents was
assessed using 2001 census data and mortality data from 2000 to 2004.
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Results: Mortality from direct alcohol-related causes accounted for nearly 1500
deaths per year in Scotland. Age-standardized mortality ratios were comparatively
low for people born in Pakistan, other parts of the UK (largely England and Wales)
and those from elsewhere in the world.
Conclusions: Scotland's propensity to alcohol-related deaths is not shared by all its
residents. Studying such variations in more depth could yield lessons for prevention.
9. A New Measure of Alcohol Affordability for the UK
Rachel Seabrook
Alcohol and Alcoholism 2010;45(6):581-585
ABSTRACT
Aims: To present revisions to the official UK measure of alcohol affordability
published by the National Health Service (NHS) Information Centre. The revisions
address the following problems in the official measure:
(a) The income measure used in the calculation is a measure of the income for the
whole population of the UK, not income per capita.
(b) The income measure includes ‘imaginary’ items, namely imputed rentals and
attributed income from insurance policies.
(c) The income measure is inconsistent in its treatment of housing costs.
(d) The adjustment for inflation makes the measure unnecessarily complex and can
have counter-intuitive effects.
Methods: The revised measure has the same essential structure as the NHS
measure, being the ratio of income to price of alcohol. Adjustments were applied to
official income figures, and adjustments for inflation were removed.
Results: The revised measure shows that affordability has levelled off since 2003, in
contrast to the NHS measure, which shows it continuing to rise until 2008.
Conclusion: The revised measure corrects a basic error of failing to divide total
income for the UK by number of people in the population. This alters the measure but
is more correct. Further improvements result in a measure that correlates more
closely with UK alcohol consumption over the last decade.
10. Perception of the Amount of Drinking by Others in A Sample of 20-Year-Old
Men: The More I Think You Drink, The More I Drink
Nicolas Bertholet, Jacques Gaume, Mohamed Faouzi, Jean-Bernard Daeppen,
Gerhard Gmel
Alcohol and Alcoholism 2011;46(1):83-87
ABSTRACT
Background: The amount a person drinks can be influenced by their perception of
drinking by others.
Aim: We studied whether perception of the amount of drinking by others (same age
and sex) is associated with one's own current drinking, and the factors that are
related to this perception.
Methods: A random sample of drinkers (n = 404) from a census of 20-year-old Swiss
men (n = 9686) estimated the percentage of others who drink more than they do.
Using weekly alcohol consumption data of the census, we computed for each subject
the percentage of individuals drinking more than they do. We compared the
‘perceived’ to the ‘computed’ percentage and classified the drinkers as
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overestimating or not drinking by others. We compared the alcohol consumption of
those who overestimated drinking by others to those who did not, using analyses of
variance/covariance. We used logistic regression models to evaluate the impact of
age, education level, occupation, living environment and family history of alcohol
problems on estimations of drinking by others.
Results: Among the 404 drinkers, the mean (SD) number of drinks/week was
7.95(9.79); 45.5% overestimated drinking by others, while 35.2% underestimated it
and 19.3% made an accurate estimation. The likelihood of overestimating increased
as individual alcohol use increased. Those overestimating consumed more alcohol
than those who did not; the adjusted mean number of drinks/week (SE) 11.45 (1.12)
versus 4.50 (1.08), P < 0.0001. Except for current drinking, no other variables were
significantly associated with overestimating.
Conclusion: This study confirms prior findings within selective student populations. It
sets the stage for preventive actions, such as normative feedback based on social
norms theory.
11. The Stigma of Alcohol Dependence Compared with Other Mental Disorders:
A Review of Population Studies
Georg Schomerus, Michael Lucht, Anita Holzinger, Herbert Matschinger, Mauro G.
Carta, Matthias C. Angermeyer
Alcohol and Alcoholism 2011;46(2):105-112
ABSTRACT
Aims: Stigma is likely to aggravate the severe medical and social consequences of
alcohol dependence. We aim to explore the characteristics of the alcohol
dependence stigma by comparing it with the stigma of other conditions.
Methods: On the basis of a systematic literature search, we identified 17
representative population studies published before July 2010 that examine aspects of
the stigma of alcoholism and simultaneously of other mental, medical or social
conditions. Seven surveys were located in Europe, five in North America, three in
New Zealand and one each in Brazil and Ethiopia, respectively.
Results: Compared with people suffering from other, substance-unrelated mental
disorders, alcohol-dependent persons are less frequently regarded as mentally ill, are
held much more responsible for their condition, provoke more social rejection and
more negative emotions, and they are at particular risk for structural discrimination.
Only with regard to being a danger, they are perceived to be at a similarly negative
level to that of people suffering from schizophrenia.
Conclusion: Alcoholism is a particularly severely stigmatized mental disorder.
Cultural differences are likely, but under-researched. We discuss possible reasons
for the differences between the stigma of alcoholism and of other mental diseases
and the consequences for targeted anti-stigma initiatives.
12. Perception of Sleep and Dreams in Alcohol-Dependent Patients during
Detoxication and Abstinence
Jana Steinig, Ronja Foraita, Svenja Happe, Martin Heinze
Alcohol and Alcoholism 2011;46(2):143-147
ABSTRACT
23
Aims: This study aims to investigate sleep quality and the subjective dream
experience in alcohol-dependent patients during withdrawal and abstinence
compared with healthy controls.
Methods: Thirty-seven patients with alcohol dependency and 35 healthy control
subjects were asked to fill in several questionnaires and to give information about
their subjective sleep and dream experiences. Twelve patients participated in a
follow-up interview 4 weeks later.
Results: Sleep quality is impaired in alcohol-dependent patients during detoxication,
and the subjective dream experience is more negatively toned compared with healthy
controls. Both sleep quality and dream experience improves slightly after 4 weeks of
abstinence. Patients with alcohol dependency during withdrawal and abstinence
dream significantly more often about alcohol. However, none of the abstinent alcoholdependent patients dreamt about alcohol during withdrawal.
Conclusions: This study shows that the subjective sleep and dream quality is
strongly impaired in patients with alcohol dependency. Differences in the dream
experience between alcohol-dependent patients and healthy controls are in
accordance with the continuity hypotheses of dreaming. The hypothesis of dreaming
about alcohol as a compensatory effect, however, could not be confirmed.
13. Vitamin D and Nutritional Status are Related to Bone Fractures in
Alcoholics
Emilio González-Reimers, Julio Alvisa-Negrín, Francisco Santolaria-Fernández,
M. Candelaria Martín-González, Iván Hernández-Betancor, Camino M. FernándezRodríguez, J. Viña-Rodríguez, Antonieta González-Díaz
Alcohol and Alcoholism 2011;46(2):148-155
ABSTRACT
Background: Bone fractures are common in alcoholics.
Aims: To analyse which factors (ethanol consumption; liver function impairment;
bone densitometry; hormone changes; nutritional status, and disrupted social links
and altered eating habits) are related to bone fractures in 90 alcoholic men admitted
to our hospitalization unit because of organic problems.
Methods: Bone homoeostasis-related hormones were measured in patients and
age- and sex-matched controls. Whole-body densitometry was performed by a
Hologic QDR-2000 (Waltham, MA, USA) densitometer, recording bone mineral
density (BMD) and fat and lean mass; nutritional status and liver function were
assessed. The presence of prevalent fractures was assessed by anamnesis and
chest X-ray film.
Results: Forty-nine patients presented at least one fracture. We failed to find
differences between patients with and without fractures regarding BMD parameters.
Differences regarding fat mass were absent, but lean mass was lower among
patients with bone fracture. The presence of fracture was significantly associated
with impaired subjective nutritional evaluation (χ2 = 5.79, P = 0.016), lower vitamin D
levels (Z = 2.98, P = 0.003) and irregular eating habits (χ2 = 5.32, P = 0.02). Reduced
lean mass and fat mass, and altered eating habits were more prevalent among
patients with only rib fractures (n = 36) than in patients with multiple fractures and/or
fractures affecting other bones (n = 13). These last were more closely related to
decompensated liver disease. Serum vitamin D levels showed a significant
relationship with handgrip strength (ρ = 0.26, P = 0.023) and lean mass at different
parts of the body, but not with fat mass. By logistic regression analysis, only vitamin
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D and subjective nutritional evaluation were significantly, independently related with
fractures.
Conclusion: Prevalent fractures are common among heavy alcoholics. Their
presence is related more closely to nutritional status, lean mass and vitamin D levels
than to BMD. Lean mass is more reduced, nutritional status is more impaired and
there is a trend to more altered eating habits among patients with rib fractures,
whereas multiple fractures depend more heavily on advanced liver disease
14. Test of a Clinical Model of Drinking and Suicidal Risk
Kenneth R. Conner, Douglas Gunzler, Wan Tang, Xin M. Tu, Stephen A. Maisto
Alcoholism: Clinical and Experimental Research 2011;35(1):60-68
ABSTRACT
Background: There are few data on the role of drinking patterns in suicidal
thoughts or behavior among alcohol-dependent individuals (ADIs) and meager data
on variables that may influence the role of drinking in suicidal thoughts and behavior.
This study tested a heuristic model that predicts that drinking promotes suicidal
thoughts and behavior, the association is mediated (accounted for) by depressive
symptoms, and that anger moderates (increases) the risk associated with intense
drinking.
Methods: Data from Project MATCH, a multisite alcohol use disorders treatment
trial, were analyzed using structural equation modeling. There were 1,726
participants including 24% women and a mean age of 40.2 ± 11.0 years. Subjects
were assessed at baseline and at 3-, 9-, and 15-month follow-up. Two categorical
measures (presence/absence) of suicidal ideation (SI) were used that were analyzed
in separate models. Predictors of interest were continuous assessments of average
drinking intensity (i.e., drinks per drinking day or DDD), drinking frequency (i.e.,
percent days abstinent or PDA), depression, and anger.
Results: Both DDD and PDA were associated with SI at a statistically significant
level, with PDA showing an inverse association. Depression scores served as a
partial mediator or a full mediator of the drinking–SI relationship depending on the
measure of SI used in the analysis. The models testing anger scores as a moderator
fit the data poorly and did not support that anger serves as a moderator of the
drinking–SI association.
Conclusions: Greater drinking intensity and drinking frequency predict SI among
ADIs and depression serves as a mediator of these associations, but anger does not
appear to serve as a moderator. Further research is required to clarify whether
depression serves as a partial or full mediator and to see whether the results herein
extend to suicidal behavior (i.e., suicide attempt, suicide).
Keywords: Suicide; Alcohol Dependence; Drinking; Depression
15. The Effects of Maternal Binge Drinking During Pregnancy on Neural
Correlates of Response Inhibition and Memory in Childhood
Matthew J. Burden, Alissa Westerlund, Gina Muckle, Neil Dodge, Eric Dewailly,
Charles A. Nelson, Sandra W. Jacobson, Joseph L. Jacobson
Alcoholism: Clinical and Experimental Research 2011;35(1):69-82
ABSTRACT
Background: Although an extensive literature has documented a broad range of
cognitive performance deficits in children with prenatal alcohol exposure, little is
known about how the neurophysiological processes underlying these deficits may be
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affected. Event-related potentials (ERPs), which reflect task-specific changes in brain
electrical activity, provide a method for examining multiple constituents of cognitive
processing at the neural level.
Methods: We recorded ERPs in 217 children from Inuit communities in Arctic
Quebec (M age = 11.3 years) during 2 different tasks—Go/No-go response inhibition
and continuous recognition memory. Children were classified as either alcoholexposed (ALC) or controls (CON) depending on whether the mother reported binge
drinking during pregnancy.
Results: Both groups performed comparably in terms of accuracy and reaction time
on the tasks, and both tasks elicited the expected effects on ERPs when responses
were compared across conditions. However, the ALC group showed slower P2
latencies on Go/No-go, suggesting an altered neurophysiological response
associated with initial visual processing of the stimuli. On the memory task, the ALC
group showed reduced FN400 amplitude to New items, known as the familiarity
effect, and reduced amplitude for the late positive component, possibly reflecting
impairment in memory retrieval.
Conclusions: These findings show that, even in tasks in which alcohol-exposed
children exhibit behavioral performance that is comparable to controls, fetal alcohol
exposure is associated with altered neurophysiological processing of response
inhibition and recognition memory. The data suggest that fetal alcohol exposure is
associated with reduced efficiency in the initial extracting of the meaning of a
stimulus, reduced allocation of attention to the task, and poorer conscious, explicit
recognition memory processing.
Keywords: Prenatal Alcohol Exposure; Fetal Alcohol Spectrum Disorders; EventRelated Potentials; Response Inhibition; Recognition Memory
16. Alcohol and Liver Cirrhosis Mortality in the United States: Comparison
of Methods for the Analyses of Time-Series Panel Data Models
Yu Ye, William C. Kerr
Alcoholism: Clinical and Experimental Research 2011;35(1):108-115
ABSTRACT
Background: To explore various model specifications in estimating relationships
between liver cirrhosis mortality rates and per capita alcohol consumption in
aggregate-level cross-section time-series data.
Methods: Using a series of liver cirrhosis mortality rates from 1950 to 2002 for 47
U.S. states, the effects of alcohol consumption were estimated from pooled
autoregressive integrated moving average (ARIMA) models and 4 types of panel
data models: generalized estimating equation, generalized least square, fixed effect,
and multilevel models. Various specifications of error term structure under each type
of model were also examined. Different approaches controlling for time trends and for
using concurrent or accumulated consumption as predictors were also evaluated.
Results: When cirrhosis mortality was predicted by total alcohol, highly consistent
estimates were found between ARIMA and panel data analyses, with an average
overall effect of 0.07 to 0.09. Less consistent estimates were derived using spirits,
beer, and wine consumption as predictors.
Conclusions: When multiple geographic time series are combined as panel data,
none of existent models could accommodate all sources of heterogeneity such that
any type of panel model must employ some form of generalization. Different types of
panel data models should thus be estimated to examine the robustness of findings.
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We also suggest cautious interpretation when beverage-specific volumes are used
as predictors.
Keywords: Cirrhosis; Mortality; Alcohol Consumption; Time Series; Panel Data
17. Knowledge, attitudes and practice relating to hazardous alcohol use across
the continuum of care in a community healthcare centre
Vimal Kishore, Sara Lynch, Jamilia Pichon, Katherine Theall, Sandy Johnson, Emily
Roberson, Susan Hinton
Drugs: Education, Prevention and Policy 2011;18(1):60-68
ABSTRACT
Alcohol screening and intervention in community health settings places a great time
demand on practitioners. Thus, implementation of practitioner-delivered intervention
is challenging.
Aims: The aim of this study was to assess the feasibility of incorporating a brief
alcohol intervention into daily practices of a community health care centre by utilizing
assistance from non-practitioners and administrative staff.
Methods: In regard to alcohol use, the knowledge, attitudes and practice (KAP) of
the staff of a health care centre were assessed using a self-administered survey. The
57-item survey consisted of alcohol-relevant questions in four domains: clinical
practice, knowledge and self-assessment of skills and available resources.
Findings: The sample consisted of 70 individuals—23 practitioners, 21 medical
assistants and 26 administrative staff from two New Orleans’ clinics. Practitioners
were observed to be most confident in assessing alcoholism as well as in
implementing interventions for alcohol abuse. Medical assistants exhibited high selfrated scores, second to practitioners, in survey items regarding attitudes towards
patients, alcohol knowledge and alcohol-related clinical skills.
Conclusions: Based on KAP, it appears that healthcare workers other than
practitioners, particularly medical assistants, may serve as a useful resource to
practitioners in providing alcohol screening and prevention services. Education and
empowerment of medical assistants will however be needed to achieve this goal.
18. Effects of alcohol consumption on iron metabolism
M. Lieb, U. Palm, B. Hock, M. Schwarz, I. Domke, M. Soyka
The American Journal of Drug and Alcohol Abuse 2011;37(1):68-73
ABSTRACT
Background/objectives: Patients with alcohol abuse frequently suffer from
malnutrition which may result in insufficient iron distribution and iron overload or
deficiency. Iron metabolism can be described by a combination of biochemical
soluble transferrin receptor, ferritin, C-reactive protein (CRP), and hematological
parameters. Here, vitamin B12 and folic acid state were assessed. Results on iron
metabolism in patients with alcohol dependence in comparison with social drinkers
are presented.
Materials/methods: Samples from 101 patients with dependent alcohol consumption
were included. The control group comprised 115 social drinkers. Inclusion criteria for
patients with chronic regular drinking/social drinkers were positive/negative score of
the Alcohol Use Disorders Identification Test (AUDIT), and positive/negative score for
alcohol abuse/dependence (DSM-IV criteria).
27
Results: Absolute values for ferritin and sTfR are increased in patients with alcohol
dependence with current consumption (ALC) compared with social drinkers. No
major differences are observed in the ratio of sTfR/log ferritin in comparison with
social drinkers. Hemoglobin concentrations correlated between the two groups. Mean
corpuscular volume (MCV) was significantly increased in the ALC collective
compared to social drinkers. Eighty patients of the alcohol-dependent group had
sufficient iron repletion, 11 had iron overload, 6 are suspicious for functional iron
deficiency, and 4 are suspicious for reduced iron supply. No vitamin B12/folate
deficiencies are observed in alcohol-dependent patients.
Conclusions and Scientific Significance: No major abnormalities of iron
metabolism are seen in patients with chronic alcohol ingestion besides the wellknown macrocytic anemia. Iron overload is relatively frequent and observed in 9% of
cases. No differences in vitamin B12 and folate levels were found between
individuals with alcohol dependence and social drinkers.
Keywords alcohol, iron metabolism, vitamin B12, folate, macrocytic anemia
19. Prevalence of the metabolic syndrome in men and women with alcohol
dependence: results from a cross-sectional study during behavioural
treatment in a controlled environment
Kai G. Kahl, Wiebke Greggersen, Ulrich Schweiger, Joachim Cordes, Christoph U.
Correll, Jessica Ristow, Juliane Burow, Corinna Findel, Anne Stoll,
Chakrapani Balijepalli, Laura Göres, Christian Lösch, Thomas Hillemacher, Stefan
Bleich, Susanne Moebus
ADDICTION 2010;105(11):1921-1927
ABSTRACT
Aims Prevalence of metabolic syndrome (MetS) in men and women who use
alcohol has been inconsistent in the literature. The aim of this study is to compare the
prevalence of MetS in patients with a diagnosis of alcohol dependence who are
currently abstinent in a controlled environment, and in control subjects followed in
primary care from a similar region in Northern Germany.
Design Cross-sectional study.
Setting In-patient cognitive behavioural therapy.
Participants One hundred and ninety-seven men and women with alcohol
dependence during behavioural treatment in a controlled environment were
compared to 1158 subjects from primary care from a similar region in northern
Germany.
Measurements We used the American Heart Association/National Heart, Lung and
Blood Institute (AHA/NHBLI) criteria to determine the rate of MetS and each single
criterion of MetS in both groups.
Findings The prevalence of MetS was almost twice as high in men and women with
alcohol dependence compared to control subjects (30.6% versus 17.0%). With
respect to the single criteria, elevations were found for fasting glucose and blood
pressure in both genders and for triglycerides in women only. High density lipoprotein
(HDL)-cholesterol was higher in men and women with alcohol dependence.
Conclusions Our results demonstrate an increased rate of MetS, increased blood
pressure and dysregulation of glucose and lipid metabolism in alcohol-dependent
patients. Whether high HDL-cholesterol has cardioprotective effects in this context
remain doubtful.
28
Keywords: Alcohol dependence; GEMCAS; glucose metabolism; lipid metabolism;
metabolic syndrome.
20. Alcohol dependence and anxiety increase error-related brain activity
Arnt F. A. Schellekens, Ellen R. A. De Bruijn, Christa A. A. Van Lankveld, Wouter
Hulstijn, Jan K. Buitelaar, Cor A. J. De Jong, Robbert J. Verkes
ADDICTION 2010;105(11):1928-1934
ABSTRACT
Aims Detection of errors is crucial for efficient goal-directed behaviour. The ability to
monitor behaviour is found to be diminished in patients with substance dependence,
as reflected in decreased error-related brain activity, i.e. error-related negativity
(ERN). The ERN is also decreased in other psychiatric disorders with impaired
response inhibition, such as attention-deficit hyperactivity disorder and borderline
personality disorder, but increased in anxiety disorders. The objective of the current
study was to assess error monitoring in alcohol-dependent patients in relation to
psychiatric comorbidity. We expected decreased error monitoring in alcoholdependent patients with impulse control disorders and increased error monitoring in
anxious alcohol-dependent patients.
Design In a case–control design alcohol-dependent patients were compared with
healthy controls.
Setting and participants A consecutive series of 29 male alcohol-dependent
patients, between 18 and 55 years of age, applying for in-patient detoxification were
recruited at Novadic Kentron Center for Addiction Treatment. Fifteen age-matched
healthy controls were recruited through advertisements in regional newspapers.
Measurements Event-related potentials were recorded while performing a speeded
choice-reaction task, from which ERN amplitudes were calculated. Axis-I and -II
psychiatric comorbidity were assessed using the MINI International Neuropsychiatric
Interview and the Structured Interview for DSM-IV Personality disorders. All
participants completed the Temperament and Character Inventory and Profile of
Mood States.
Findings ERN amplitudes were increased for alcohol-dependent patients compared
to healthy controls, particularly in patients with comorbid anxiety disorders.
Conclusions Increased error monitoring in alcohol-dependent patients, particularly
those with comorbid anxiety disorders, is in contrast with previous studies that
suggested decreased error monitoring to be a general feature in substance use
disorders. Psychiatric disorders co-occurring with alcohol dependence, such as
anxiety disorders, may indicate subpopulations of alcohol-dependent patients, with
distinct neurobiological and genetic characteristics, possibly requiring different
treatment strategies.
Keywords: Alcohol dependence; anxiety; dual diagnosis; EEG; ERN; error
monitoring; error-related negativity
21. Drinking: messages for the beer mat
Jane Smith
BMJ 2011;342:d1231
ABSTRACT
No abstract for this article
29
22. Diagnosis, assessment, and management of harmful drinking and alcohol
dependence: summary of NICE guidance
Stephen Pilling, Amina Yesufu-Udechuku, Clare Taylor
BMJ 2011; 342:d700
ABSTRACT
No abstract for this article
23. A Patient’s Journey: Alcoholism
Anonymous, patient, Adrian M Raby
BMJ 2011; 342:d956
ABSTRACT
No abstract for this article
30
Alcohol Treatment and Screening
24. Embedding routine alcohol screening and brief interventions in a rural
general hospital
PETER FAHY, GARY CROTON, STEVE VOOGT
Drug Alcohol Rev 2011;30;47–54
ABSTRACT
Issues. Alcohol screening and brief intervention approaches (SBI) are strongly
supported by evidence, but few health-care facilities have successfully introduced
and sustained routine SBI.
Approach. This paper describes the first 2 years of implementing SBI in an
Australian rural general hospital. The SBI project aims were to universally screen
presentations to Northeast Health Wangaratta (NHW), to provide brief interventions
to people screening at medium risk of harm from drinking and enhanced referral for
persons screening at high risk.
Key Findings. In 2007 and 2008, the NHW SBI project conducted 11 079 screens
for alcohol use disorders using the Alcohol Use Disorders Identification Screening
Test screening tool. Eighty-five per cent of persons screened at low risk of alcoholrelated problems, 11% at medium risk and 4% at high risk.
Implications. Policy and planning bodies and hospital management's support and
the appointment of a dedicated project worker are critical to successful SBI
implementation.
Conclusion. It is possible to establish a SBI service in a rural general hospital
setting. The NHW SBI project broadened the focus from treatment of persons with
severe dependency to detection, early intervention and prevention for the larger,
more easily treated, cohort of persons drinking at hazardous/harmful but nondependent levels. The challenge for any organisation is to maintain routine SBI
deployment over the long term.
25. Primary care-based intervention to reduce at-risk drinking in older
adults: a randomized controlled trial
Alison A. Moore, Fred C. Blow, Marc Hoffing, Sandra Welgreen, James W.
Davis, James C. Lin, Karina D. Ramirez, Diana H. Liao, Lingqi Tang, Robert
Gould, Monica Gill, Oriana Chen, Kristen L. Barry
Addiction 2011;106(1):111-120
ABSTRACT
Aims To examine whether a multi-faceted intervention among older at-risk drinking
primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12
months.
Design Randomized controlled trial.
Setting Three primary care sites in southern California.
Participants Six hundred and thirty-one adults aged ≥ 55 years who were at-risk
drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET) were
assigned randomly between October 2004 and April 2007 during an office visit to
receive a booklet on healthy behaviors or an intervention including a personalized
31
report, booklet on alcohol and aging, drinking diary, advice from the primary care
provider and telephone counseling from a health educator at 2, 4 and 8 weeks.
Measurements The primary outcome was the proportion of participants meeting atrisk criteria, and secondary outcomes were number of drinks in past 7 days, heavy
drinking (four or more drinks in a day) in the past 7 days and risk score.
Findings At 3 months, relative to controls, fewer intervention group participants
were at-risk drinkers [odds ratio (OR) 0.41; 95% confidence interval (CI) 0.22–0.75];
they reported drinking fewer drinks in the past 7 days [rate ratio (RR) 0.79; 95% CI
0.70–0.90], less heavy drinking (OR 0.46; 95% CI 0.22–0.99) and had lower risk
scores (RR 0.77 95% CI 0.63–0.94). At 12 months, only the difference in number of
drinks remained statistically significant (RR 0.87; 95% CI 0.76–0.99).
Conclusions A multi-faceted intervention among older at-risk drinkers in primary
care does not reduce the proportions of at-risk or heavy drinkers, but does reduce
amount of drinking at 12 months.
Keywords: Aged; alcohol; comorbidity; intervention; primary care; screening
26. The Impact of Screening, Brief Intervention and Referral for Treatment in
Emergency Department Patients’ Alcohol Use: A 3-, 6- and 12-month Follow-up
Robert H. Aseltine, Jr.
Alcohol and Alcoholism 2010;45(6):514-519
ABSTRACT
Aims: This study aims to determine the impact of Screening, Brief Intervention and
Referral for Treatment (SBIRT) in reducing alcohol consumption in emergency
department (ED) patients at 3, 6, and 12 months following exposure to the
intervention.
Methods: Patients drinking above the low-risk limits (at-risk to dependence), as
defined by National Institute of Alcohol Abuse and Alcoholism (NIAAA), were
recruited from 14 sites nationwide from April to August 2004. A quasi-experimental
comparison group design included sequential recruitment of intervention and control
patients at each site. Control patients received a written handout. The Intervention
group received the handout and participated in a brief negotiated interview with direct
referral for treatment if indicated. Follow-up surveys were conducted at 3, 6, and 12
months by telephone using an Interactive Voice Response (IVR) system. Results: Of
the 1132 eligible patients consented and enrolled (581 control, 551 intervention), 699
(63%), 575 (52%) and 433 (38%) completed follow-up surveys via IVR at 3, 6, and 12
months, respectively. Regression analysis adjusting for the clustered sampling
design and using multiple imputation procedures to account for subject attrition
revealed that those receiving SBIRT reported roughly three drinks less per week than
controls (B = −3.00, SE = 1.06, P < 0.05) and the level of maximum drinks per
occasion was approximately three-fourths of a drink less than controls (B = -0.76,
SE = 0.29, P < 0.05) at 3 months. At 6 and 12 months post-intervention, these effects
had weakened considerably and were no longer statistically or substantively
significant.
Conclusion: SBIRT delivered by ED providers appears to have short-term
effectiveness in reducing at-risk drinking, but multi-contact interventions or booster
programs may be necessary to maintain long-term reductions in risky drinking.
32
27. Clinical Predictors of Outcome from an Australian Pharmacological Relapse
Prevention Trial
Kirsten C. Morley; Maree Teesson; Claudia Sannibale; Andrew Baillie; Paul S. Haber
Alcohol and Alcoholism 2010;45(6):520-526
ABSTRACT
Aims: To assess which baseline characteristics of patients predict response to
treatment with acamprosate (ACAMP) and naltrexone (NTX) in alcohol dependence.
Methods: Outcome data from a 12-week randomized controlled trial of NTX, ACAMP
and placebo for alcohol dependence were analysed by multiple logistic regression
analyses to determine the predictive effects of gender and the baseline measures of
dependence severity, craving, depression, anxiety and readiness to change in
addition to NTX and ACAMP treatment. Moderators of the effect of each medication
on outcomes were also examined.
Results: Relapse was predicted by the interaction terms of ACAMP and alcohol
dependence severity, NTX and depression as well as NTX and the readiness to
change measure Taking Steps. Abstinence was similarly predicted by the interaction
term ACAMP and alcohol dependence severity.
Conclusion: The efficacy of NTX and ACAMP in reducing relapse or lapse is
influenced by different clinical characteristics.
28. Barriers to Implementing Screening and Brief Interventions in General
Practice: Findings from a Qualitative Study in Norway
Peter Nygaard, Olaf G. Aasland
Alcohol and Alcoholism 2011;46:52-60
ABSTRACT
Aims: The qualitative component of this mixed methods study aimed at obtaining
more in-depth information about the barriers of implementation of screening and brief
interventions (SBI) in general practice identified in the quantitative component by
giving general practitioners (GPs) the opportunity to discuss and report on the
particular difficulties they experience in relation to identification and treatment of
alcohol problems in their daily work.
Methods: Focus-group interviews were performed with seven groups of GPs in
different parts of Norway, encompassing 40 participants. The interviews were
transcribed and analyzed using the QDA Miner software.
Results: The analysis revealed five major groups of factors influencing GPs’
reluctance to use SBI for alcohol problems: (a) perception of alcohol problems, (b)
integration of SBI into existing routines, (c) prevention vs. treatment, (d) structural
issues and (e) the relationship between practitioner and patient.
Discussion: The analysis showed that problems of implementing SBI in general
practice are a complex issue. The quantitative part of the project revealed a strong
association between knowledge/self-efficacy and the use of SBI. However, in the
qualitative study, we were able to look in more detail at some of the findings from the
first part. Even if the lack of knowledge of SBI was still significant, the five factors
identified in this study appeared important for the GPs’ decisions to use SBI in
individual cases.
33
29. Alcohol Dependence: Analysis of Factors Associated with Retention of
Patients in Outpatient Treatment
Márcia Fonsi Elbreder; Rebeca de Souza e Silva; Sandra Cristina Pillon; Ronaldo
Laranjeira
Alcohol and Alcoholism 2011;46(1):74-76
ABSTRACT
Aims: To identify factors associated with retention in treatment of alcohol-dependent
individuals and to compare treatment retention between men and women.
Methods: Analysis of the treatment attendance records and baseline characteristics
of 833 men and 218 women who undertook to attend follow-up treatment in an
alcoholism treatment centre.
Results: Retention after 4 weeks of treatment is more likely to occur among those
using adjuvant medication (the most frequent of which was disulfiram), those
presenting severe alcoholism and those who are older and tend to be frequent
drinkers. There was no gender difference regarding treatment retention.
Conclusion: Such results suggest possibilities for developing specific strategies to
reduce the risk of early dropout from treatment.
30. The Effects of Educational Intervention on Nutritional Behaviour in AlcoholDependent Patients
Pamela Barbadoro; Elisa Ponzio; Maria Elisabetta Pertosa; Federica Aliotta;
Marcello M. D'Errico; Emilia Prospero; Andrea Minelli
Alcohol and Alcoholism 2010;46(1):77-79
ABSTRACT
Aims: To evaluate the nutritional status and the impact of an educational intervention
on nutritional behaviour in alcohol-dependent patients.
Methods: A pre-and post-intervention questionnaire and a follow-up interview were
administered to 58 patients of a residential alcohol treatment service.
Results: Females were at lower risk of being overweight than males, even after
adjusting for amount and preferred type of alcohol beverage. Before intervention,
19% consumed 3 meals/day. Following the educational intervention, 22.2% of
participants improved their knowledge. After 6 months, when 45 patients agreed to a
telephone interview of whom 80% reported continued abstinence, 70.7% reported
eating more than 3 meals/day.
Conclusions: Nutritional behaviour of alcohol patients after residential treatments
improved during follow-up, and it is possible that an educational intervention to
increase knowledge on healthy nutrition style may have contributed
31. Impulsive or Depressive Personality Traits Do Not Impede Behavioral
Change After Brief Alcohol Interventions
Gabriel E. Ryb; Patricia C. Dischinger; Carlo DiClemente; Kimberly M. Auman,
Joseph A. Kufera; Carl A. Soderstrom
Journal of Addictive Diseases 2011;30(1):54-62
ABSTRACT
The authors investigated whether impulsivity and depression affect the success of
interventions to reduce alcohol use. Unadjusted and adjusted regression models
34
were constructed to analyze the effect of impulsivity and depression on 12-month
outcomes of participants of a trauma center based randomized trial of brief
personalized motivational interventions versus information and advice. Of 497
problem drinkers enrolled in the program, 248 completed the 12-month follow-up.
Impulsivity, male gender, being older than 35, and intentional mechanism of injury
had a direct association with drinking. After interventions, a decrease in drinking was
found that was unaffected by the presence of impulsivity or depression indicators.
Keywords: Depression; impulsivity; brief intervention; alcoholism; alcohol abuse;
injury; trauma patients
32. Alcohol expectancy changes over a 12-week cognitive–behavioral therapy
program are predictive of treatment success
Ross McD. Young, Jason P. Connor, Gerald F.X. Feeney
Journal of Substance Abuse Treatment 2011;40(1):18-25
ABSTRACT
This study examines if outcome expectancies (perceived consequences of engaging
in certain behavior) and self-efficacy expectancies (confidence in personal capacity
to regulate behavior) contribute to treatment outcome for alcohol dependence. Few
clinical studies have examined these constructs. The Drinking Expectancy Profile
(DEP), a psychometric measure of alcohol expectancy and drinking refusal selfefficacy, was administered to 298 alcohol-dependent patients (207 males) at
assessment and on completion of a 12-week cognitive–behavioral therapy alcohol
abstinence program. Baseline measures of expectancy and self-efficacy were not
strong predictors of outcome. However, for the 164 patients who completed
treatment, all alcohol expectancy and self-efficacy factors of the DEP showed change
over time. The DEP scores approximated community norms at the end of treatment.
Discriminant analysis indicated that change in social pressure drinking refusal selfefficacy, sexual enhancement expectancies, and assertion expectancies successfully
discriminated those who successfully completed treatment from those who did not.
Future research should examine the basis of expectancies related to social
functioning as a possible mechanism of treatment response and a means to enhance
treatment outcome.
Keywords: CBT; Expectancy; Alcohol; Self-efficacy; Treatment
35
Alcohol Use
33. Why do people drink at home?
John Foster, Donald Read, Sakthidaran Karunanithi, Victoria Woodward,
Journal of Public Health 2010;32(4):512-518
ABSTRACT
Background The past 30 years have seen a shift in the culture concerning the
consumption of alcohol in the UK. One of these is the increasing trend for adults to
consume alcohol “at home”. To date this is a development that has received little
research attention.
Participants and Methods Four focus groups (FG) of current drinkers who drank at
home and reflected the views of both genders, differing age bands and living
arrangements were conducted. The setting for the study was an economically
deprived seaside resort in the North-West of England. Each focus group had two
facilators and was taped, transcribed and subject to thematic analysis. FG A: (n=15;
9 males, 6 females) young people aged 13–21. FG B (n=4, 1 male, 3 female)
volunteers aged 30–50 some of whom had children and were in relationships. FG C
(n=15, 6 males, 9 females) recruited from a residents association-aged 25–70. FG D
(n=4, 1 male, 3 female), aged 20–30 recruited through a local Lesbian and Gay
Group.
Results The principal reasons for drinking at home concerned convenience, these
included cost, safety, social occasions, fear of under age drinkers, child-care, relief of
stress. Lesser themes such as the smoking ban also emerged.
Conclusions These findings provide data of import to researchers and public health
professionals to allow them to produce and target public health messages that take
into account that the majority of drinking now takes place “at home”.
Key words alcohol consumption, public health, young people
34. Can parents prevent heavy episodic drinking by allowing teens to drink at
home?
Jennifer A. Livingston, Maria Testa, Joseph H. Hoffman, Michael Windle
Addictive Behaviors 2010;35(12):1105-1112
ABSTRACT
The current study examined whether permitting young women to drink alcohol at
home during senior year of high school reduces the risk of heavy drinking in college.
Participants were 449 college-bound female high school seniors, recruited at the end
of their senior year. Participants were classified into one of three permissibility
categories according to their baseline reports of whether their parents allowed them
to drink at home: (a) not permitted to drink at all; (b) allowed to drink with family
meals; (c) allowed to drink at home with friends. Repeated measures analysis of
variance was used to compare the drinking behaviors of the three groups at the time
of high school graduation and again after the first semester of college. Students who
were allowed to drink at home during high school whether at meals or with friends,
reported more frequent heavy episodic drinking (HED) in the first semester of college
than those who reported not being allowed to drink at all. Those who were permitted
to drink at home with friends reported the heaviest drinking at both time points. Path
36
analysis revealed that the relationship between alcohol permissiveness and college
HED was mediated via perceptions of parental alcohol approval.
Benzodiazepines
35. Benzodiazepine substitution for dependent patients—going with the
flow
Peter Tyrer
Addiction 2010:105(11);1875-1876
ABSTRACT
No abstract for this article
Keywords: benzodiazepines, clinical guidelines, dependance, prescription,
substitution
36. To substitute or not substitute—optimal tactics for the management of
benzodiazepine dependence
Michael Soyka
Addiction 2010:105(11);1876-1877
ABSTRACT
No abstract for this article
Keywords: Benzodiazepines; dependence; maintenance; withdrawal
37. Benzodiazepine dependence: when abstinence is not an option
Michael Liebrenz, Lukas Boesch, Rudolf Stohler, Carlo Caflisch
Addiction 2010:105(11);1877-1878
ABSTRACT
No abstract for this article
Keywords: Agonist treatment, benzodiazepine abstinence, benzodiazepine
withdrawal, high-dose benzodiazepine dependence, maintenance treatment,
substitution treatment
38. Benzodiazepine use among patients in heroin-assisted vs. methadone
maintenance treatment: Findings of the German randomized controlled trial
Francisco José Eiroa-Orosa, Christian Haasen, Uwe Vertheina, Christoph Dilg, Ingo
Schäfer and Jens Reimer
Drug and Alcohol Dependence 2010;112(3):226-233
ABSTRACT
Benzodiazepine (BZD) use has been found to be associated with poorer
psychosocial adjustment, higher levels of polydrug use and more risk-taking
behaviors among opioid dependent patients. The aim of this paper is to analyze the
correlation between BZD use, BZD prescription and treatment outcome among
37
participants in the German trial on heroin-assisted treatment. 1015 patients who
participated in the study comparing heroin-assisted and methadone maintenance
treatment (HAT & MMT) for 12 months were included in the analysis. Analyses were
carried out to assess the association of treatment outcome with baseline BZD use,
with ongoing BZD use and with different patterns of BZD prescription. Baseline BZD
use correlated with lower retention rates but not with poorer outcome. Ongoing BZD
use correlated with poorer outcomes. Significantly better outcomes were found in the
course of phobic anxiety symptomatology for those with regular prescription of BZD.
The percentage of BZD positive urine tests decreased more in HAT than in MMT.
Poorer outcome for benzodiazepine users may be mediated by a higher severity of
addiction. Cautious prescribing of benzodiazepines may be beneficial due to the
reduction of overall illicit use.
Keywords: Benzodiazepines; Prescriptions; Diamorphine; Heroin-assisted
treatment; Methadone maintenance; Opioid dependence
38
Blood Borne Viruses
39. Commentary on Caiaffa et al. (2011): The renewed challenge of hepatitis C
virus epidemiology among non-injecting drug users
Francisco I. Bastos
Addiction 2011;106(1):152-153
ABSTRACT
No abstract is available for this article.
40. Gender differences in hepatitis C antibody prevalence and risk behaviours
amongst people who inject drugs in Australia 1998–2008
Jenny Iversen, Handan Wand, Andrea Gonnermann, Lisa Maher and on behalf of the
collaboration of Australian Needle and Syringe Programs
International Journal of Drug Policy 2010;21(6):471-476
ABSTRACT
Background
Global prevalence of hepatitis C virus (HCV) is estimated to be around 3% with
approximately 170 million people affected. In Australia, and in many other resource
rich countries, injecting drug use is the single most important risk factor for acquiring
HCV, with around a third of diagnoses occurring in women. This study aims to
assess gender differences in hepatitis C antibody prevalence and associated risk
behaviours amongst a large sample of PWID in Australia.
Methods
During a one to two week period in October, PWID attending selected NSP sites are
invited to participate in the Australian NSP Survey. Between 1998 and 2008,
approximately 16,000 individuals completed a self-administered questionnaire and
provided a capillary blood sample for HIV and HCV antibody testing. We stratified our
sample by time since onset of injecting and analysed the demographic
characteristics, injecting behaviours and antibody test results to determine gender
differences.
Results
Women were found to be at increased risk of exposure to hepatitis C in all duration of
injection categories except those injecting for 17 or more years. In the early years of
injecting, women also reported higher rates of receptive sharing of needles and
syringe and ancillary equipment when compared to men. Last injecting heroin,
methadone or buprenorphine was significantly associated with HCV antibody
prevalence amongst both males and females injecting for less than 5 years.
Conclusion
Findings indicate that women are at greater risk than men of HCV infection during the
early years of injection through higher rates of receptive sharing of needles and
syringes and/or ancillary equipment. Our results suggest that women who are new to
injecting, and Indigenous women in particular, should be identified as priority
populations when developing and implementing harm reduction strategies that target
people who inject illicit drugs.
39
Keywords: Hepatitis C virus (HCV); Injection drug use (IDU); Gender
41. Treatment costs of hepatitis C infection among injection drug users in
Canada, 2006–2026
Daniel Werb, Evan Wood, Thomas Kerr, Neil Hershfield, Robert W.H. Palmer, Robert
S. Remis
International Journal of Drug Policy 2011;22(1):70-76
ABSTRACT
Background
Canadian injection drug users (IDUs) are at high risk of hepatitis C virus infection
(HCV). However, little is known about the costs associated with their HCV-related
medical treatment. We estimated the medical costs of treating HCV-infected IDUs
from 2006 to 2026.
Methods
We employed a Markov model of entry through birth or immigration to exposurerelated behaviours or experiences, HCV infection, progression to HCV sequelae and
mortality for active and ex-IDUs in Canada. We estimated direct and indirect
treatment costs using data from the Ontario Case Costing Initiative (OCCI).
Result
Approximately 137,000 IDUs will suffer from HCV-related disease each year until
2026. Applying the OCCI cost data to the prevalence of HCV-related disease from
2006 to 2026 yielded an estimated cost of $3.96 billion CND to treat HCV-infected
IDUs.
Conclusions
Substantial costs are associated with the treatment of HCV-related disease among
Canadian IDUs. Given the lack of effective HCV prevention strategies in Canada, we
must develop targeted evidence-based responses to prevent HCV transmission and
ensure appropriate allocation of medical resources to meet the present and future
treatment needs of HCV-infected IDUs.
Keywords: Hepatitis C; Injection drug use; Treatment; Costs; Canada
40
42. Availability of body art facilities and body art piercing do not predict
hepatitis C acquisition among injection drug users in Montreal, Canada:
Results from a cohort study
Julie Bruneau, Mark Daniel, Yan Kestens, Michal Abrahamowicz and Geng Zang
International Journal of Drug Policy 2010;21(6):477-484
ABSTRACT
Background
Cross-sectional associations suggest that body art piercing (BAP) is a risk factor for
hepatitis C (HCV) infection among injection drug users. The temporal basis of the
relationship has not been established.
Methods
Associations between HCV seropositivity, HCV incidence, recent BAP and BAP
facility availability were evaluated among IDUs followed biannually between 2004
and 2008 in Montreal, Canada. A geographic information system was used to
determine the availability of BAP facilities for each participant. Statistical models
included individual and neighbourhood covariates. Logistic regression was used for
analysis of HCV seropositivity. Cox proportional hazards regression was used for
analysis of HCV incidence.
Results
Of 784 IDUs, 73% were seropositive for HCV. In multivariable logistic regression,
HCV seropositivity was associated with BAP availability (OR: 1.32 95% confidence
interval (CI): 1.1, 1.6) but not recent BAP. Of 145 initially HCV-negative participants,
52 seroconverted to HCV for an incidence of 27.7/100 person-years (95%CI: 20.9,
36.0). Crude hazard ratios (HR) for the association between HCV infection and BAP
variables were: recent BAP, HR 0.98 (95%CI: 0.4, 2.7) and BAP facilities availability,
HR 1.43 (95%CI: 1.1, 1.9). After accounting for individual and neighbourhood factors,
crude associations between HCV infection and recent BAP and BAP facilities
availability were: HR recent BAP, 0.96, 95%CI: 0.3, 2.7; and HR BAP facility
availability, 1.21, 95%CI: 0.9, 1.7.
Conclusion
BAP facility availability is a marker of neighbourhood disadvantage associated with
HCV seropositivity. Longitudinal analyses accounting for behaviour risk factors and
neighbourhood characteristics do not support a temporal association between BAP
acquisition, BAP facility availability, and HCV infection among IDUs.
Keywords: Body piercing; Epidemiology; HCV; Incidence; Injection drug use
43. Syringe exchange in community pharmacies—The Portuguese experience
Carla Torre, Raquel Lucas, Henrique Barros,
International Journal of Drug Policy 2010;21(6):514-517
ABSTRACT
Background
Since 1993 the participation of Portuguese pharmacies to the national Syringe
Exchange Programme (SEP) has remained high. However, no national guidelines or
standard procedures are available regarding the provision of this service. We aimed
to describe practices and attitudes toward syringe dispensing and other harm
reduction strategies in Portuguese pharmacies.
Methods
41
A cross-sectional survey was conducted using an anonymous self-administered
questionnaire. All pharmacies in Portugal (n = 2775) were invited to participate. The
questionnaire addressed SEP ever involvement and discontinuation; injection
equipment policies; problems and needs in service provision.
Results
Participation rates were 69.6% among pharmacies involved in SEP and 42.7% in
those not involved in the programme. Among current providers, 64.3% followed a
strict “one-for-one” policy and 21.6% established limits on the number of syringes
distributed. Syringe selling was reported by 76.2%. One-tenth of pharmacies
supervised methadone consumption Problems in service provision were experienced
by 12.8% of respondents. Need for increased training and improvement of referral
pathways were frequently reported.
Conclusions
Pharmacy-based harm reduction interventions in Portugal have tended to follow strict
policies favouring conservative approaches. Training and feedback adaptation seem
indispensable to avoid service discontinuation and boost an activity with an essential
humanitarian dimension.
Keywords: Syringe-exchange programme; Community pharmacy; Injection drug use
42
Co- Morbidity
44. The course of substance use disorders in patients with borderline
personality disorder and Axis II comparison subjects: a 10-year follow-up
study
Mary C. Zanarini, Frances R. Frankenbur, Jolie L. Weingeroff, D. Bradford Reich,
Garrett M. Fitzmaurice, Roger D. Weiss
Addiction 2011:106(2);342-348
ABSTRACT
Aim The purpose of this study is to detail the course of substance use disorders
(SUDs) over 10 years of prospective follow-up among patients with borderline
personality disorder (BPD) and Axis II comparison subjects.
Design This study uses data from the McLean Study of Adult Development (MSAD),
a multi-faceted study of the longitudinal course of BPD using reliable repeated
measures administered every 2 years over a decade of prospective follow-up.
Setting All subjects were initially in-patients at McLean Hospital in Belmont
Massachusetts.
Participants A total of 290 patients with BPD and 72 Axis II comparison subjects
were assessed at baseline and five waves of follow-up.
Measurements The Structured Clinical Interview for DSM-III-R Axis I Disorders
(SCID-I), the Revised Diagnostic Interview for Borderlines (DIB-R) and the Diagnostic
Interview for DSM-III-R Personality Disorders (DIPD-R) were administered six times.
Generalized estimating equations were used to assess longitudinal prevalence of
SUDs. Kaplan–Meier analyses were used to assess time-to-remission, recurrence
and new onsets of SUDs.
Results The prevalence of SUDs among borderline patients and Axis II comparison
subjects declined significantly over time, while remaining significantly more common
among those with BPD. More than 90% of borderline patients meeting criteria for a
SUD at baseline experienced a remission by 10-year follow-up. Recurrences and
new onsets of SUDs were less common (35–40% and 21–23%).
Conclusions Remissions of alcohol and drug abuse/dependence among borderline
patients are both common and relatively stable. Results also suggest that new onsets
of these disorders are less common than might be expected.
Keywords: Alcohol abuse/dependence; borderline personality disorder; drug
abuse/dependence; longitudinal course; new onsets; recurrences; remissions
45. Psychiatric comorbidity in illicit drug users: Substance-induced versus
independent disorders
Marta Torrens, Gail Gilchrist, Antonia Domingo-Salvany and the
Drug and Alcohol Dependence 2011;1113(2-3):147-156
ABSTRACT
Background
Few studies have differentiated between independent and substance-induced
psychiatric disorders. In this study we determine the risks associated with
43
independent and substance-induced psychiatric disorders among a sample of 629
illicit drug users recruited from treatment and out of treatment settings.
Methods
Secondary analysis of five cross-sectional studies conducted during 2000–2006.
Independent and substance-induced DSM-IV psychiatric diagnoses were assessed
using the Psychiatric Research Interview for Substance and Mental Disorders.
Results
Lifetime prevalence of Axis I disorders other than substance use disorder (SUD) was
41.8%, with independent major depression being the most prevalent (17%). Lifetime
prevalence of antisocial or borderline personality disorders was 22.9%. In
multinominal logistic regression analysis (SUD only as the reference group), being
female (OR 2.45; 95% CI 1.59, 3.77) and having lifetime borderline personality
disorder (OR 2.45; 95% CI 1.31, 4.59) remained significant variables in the group
with independent disorders. In the group with substance-induced disorders, being
recruited from an out of treatment setting (OR 3.50; 95% CI 1.54, 7.97), being female
(OR 2.38; 95% CI 1.24, 4.59) and the number of SUD (OR 1.31; 95% CI 1.10, 1.57)
remained significant in the model. These variables were also significant in the group
with both substance-induced and independent disorders, together with borderline
personality disorder (OR 2.53; 95% CI 1.03, 6.27).
Conclusions
Illicit drug users show high prevalence of co-occurrence of mainly independent mood
and anxiety psychiatric disorders. Being female, recruited from an out of treatment
setting and the number of SUD, are risk factors for substance-induced disorders.
46. Predictive Factors for Relapse after an Integrated Inpatient Treatment
Programme for Unipolar Depressed and Bipolar Alcoholics
Conor K. Farren and Sharon McElroy
Alcohol and Alcoholism 2010;45(6):527-533
ABSTRACT
Aim: The aim of this study was to examine prospectively examined predictors of
relapse in alcohol dependence with comorbid affective disorder.
Methods: One hundred and eighty-three unipolar depressed or bipolar alcoholics
who completed an integrated inpatient treatment programme for dual diagnosis were
assessed at baseline, post-treatment discharge and at 3 and 6 months post
treatment. Backwards stepwise likelihood ratio multiple logistic regression was used
to investigate the impact of multiple covariates on relapse to alcohol in the 0–3- and
3–6-month period post discharge.
Results: The retention rate at 3 months post discharge was 95.3% (177 patients)
and at 6 months it was 87.4% (162 patients). Higher level of anxiety at baseline and
discharge was significantly associated with relapse at 3, but not at 6 months, in all
subjects. Higher baseline alcohol use disorder identification test scores were
associated with relapse at 3 and at 6 months. Intention and planning to attend
aftercare after discharge from the hospital were associated with non-relapse at 3 and
6 months, respectively. Levels of depression, of elation and of craving at baseline
were not significantly predictive of relapse. Those who had relapsed at 3 months
were significantly more likely to remain drinking at 6 months. Rehospitalization within
the first 3 months post discharge appeared to be protective against further relapse.
Conclusions: Baseline patient factors, including levels of anxiety, appear to play a
significant role in relapse to alcohol in this difficult to treat population.
44
Epidemiology and Demography
47. Violence among men and women in substance use disorder treatment: A
multi-level event-based analysis
Stephen T. Chermack, Andy Grogan-Kaylor, Brian E. Perron, Regan L. Murray, Peter
De Chavez and Maureen A. Walton
Drug and Alcohol Dependence 2010;112(3):194-200
ABSTRACT
Background
This study examined associations between acute alcohol and drug use and violence
towards others in conflict incidents (overall, partner, and non-partner conflict
incidents) by men and women recruited from substance use disorder (SUD)
treatment.
Methods
Semi-structured interviews were used to obtain details about interpersonal conflict
incidents (substance use, whether specific conflicts were with intimate partners or
non-partners) in the 180 days pre-treatment. Participants for this study were selected
for screening positive for past-year violence (N = 160; 77% men, 23% women).
Results
Multi-level multinomial regression models showed that after adjusting for clustering
within individual participants, the most consistent predictors of violence across
models were acute cocaine use (significant for overall, intimate partner and nonpartner models), acute heavy alcohol use (significant for overall and non-partner
models), and male gender (significant in all models).
Conclusions
This study was the first to explicitly examine the role of acute alcohol and drug use
across overall, partner and non-partner conflict incidents. Consistent with prior
studies using a variety of methodologies, alcohol, cocaine use and male gender was
most consistently and positively related to violence severity (e.g., resulting in injury).
The results provide important and novel event-level information regarding the
relationship between acute alcohol and specific drug use and the severity of violence
in interpersonal conflict incidents.
Keywords: Aggression; Injury; Alcohol; Cocaine; Drugs; Treatment
48. Onset and course of alcoholism over 25 years in middle class men
Marc A. Schuckit and Tom L. Smith
Drug and Alcohol Dependence 2011;113(1):21-28
ABSTRACT
Background: Patterns of drinking and alcohol problems change with age. However,
few studies use multiple data points and detailed history spanning early adulthood to
middle age. This study reports such data from 373 men in the San Diego Prospective
Study. Methods: Data were generated at baseline (T1) at age 20, and through faceto-face followup interviews every 5 years in >90% of these eligible Caucasian and
relatively higher educated men. Subjects were placed into 4 groups regarding their
course: 62.5% with no alcohol use disorder (AUD); 17.2% with AUD onset <age 30
and a chronic course; 6.7% with onset ≥age 30 and no recovery; and 13.7% with
45
AUD onset <age 30 and maintained remission for >5 years before the 25-year
followup. Results: On a univariate level, low level of response (LR) to alcohol, family
history of AUDs, and higher Novelty Seeking at age 20 predicted AUDs with onset
before age 30 (mean age 25), but among these only LR predicted later onset
(mean age 38) as well. Additional predictors of AUDs included demography (lower
education), and greater involvement with alcohol, drugs, and nicotine prior to T1.
Sustained remission from AUDs among alcoholics was predicted by lower T1 and
T10 drinking frequencies, and being separated or divorced at T10, along with a trend
for higher Reward Dependence. Conclusion: These data indicate that information
available in ages of the late teens to early twenties can help predict the future onset
and course of AUDs, and underscore the importance of longitudinal studies in
substance use disorders.
Keywords: Alcohol; Sensitivity; Alcoholism clinical course
49. Patterns of polydrug use in Great Britain: Findings from a national
household population survey
Gillian W. Smith, Michael Farrell, Brendan P. Bunting, James E. Houston and Mark
Shevlin
Drug and Alcohol Dependence 2011;113(2-3):222-228
ABSTRACT
Background
Polydrug use potentially increases the likelihood of harm. As little is known about
polydrug use patterns in the general population, it is difficult to determine patterns
associated with highest likelihood.
Methods
Latent class analysis was performed on nine illicit substance groups indicating past
year use of cannabis, cocaine, amphetamines, ecstasy, LSD, mushrooms, amyl
nitrate, tranquillisers and heroin or crack. Analyses were based on data from a large
multi-stage probability sample of the population of Great Britain (n = 8538) collected
in 2000. Multinomial logistic regression was performed highlighting associations
between classes, and demographic and mental health variables.
Results
A three class solution best described patterns of polydrug use; wide range, moderate
range, and no polydrug use. For males and young people, there was a significantly
increased chance of being in the wide and moderate range polydrug use groups
compared to the no polydrug use class. Hazardous drinking was more likely in the
wide and moderate polydrug classes with odds ratios of 9.99 and 2.38 (respectively)
compared to the no polydrug use class. Current smokers were more likely to be wide
and moderate range polydrug users compared to the no polydrug use class with
odds ratios of 4.53 and 5.85 respectively. A range of mental health variables were
also related to class membership.
Conclusions
Polydrug use in Great Britain can be expressed as three distinct classes. Hazardous
alcohol use and tobacco use were strongly associated with illicit polydrug use,
polydrug use appeared to be significantly associated with mental health, particularly
lifetime suicide attempts.
Keywords: Latent class analysis; Polydrug use; Mental health; Drug use;
Epidemiology
46
50. Areas of disadvantage: A systematic review of effects of area-level
socioeconomic status on substance use outcomes
Katherine J. Karriker-Jaffe
Drug Alcohol Rev 2011;30;84–95
ABSTRACT
Issues. This review examines whether area-level disadvantage is associated with
increased substance use and whether study results are impacted by the size of the
area examined, definition of socioeconomic status (SES), age or ethnicity of
participants, outcome variables or analytic techniques.
Approach. Five electronic databases and the reference sections of identified papers
were searched to locate studies of the effects of area-level SES on substance use
published through the end of 2007 in English-language, peer-reviewed journals or
books. The 41 studies that met inclusion criteria included 238 effects, with a
subsample of 34 studies (180 effects) used for the main analyses. Study findings
were stratified by methodological characteristics and synthesised using generalised
estimating equations to account for clustering of effects within studies.
Key Findings. There was strong evidence that substance use outcomes cluster by
geographic area, but there was limited and conflicting support for the hypothesis that
area-level disadvantage is associated with increased substance use. Support for the
disadvantage hypothesis appeared to vary by sample age and ethnicity, size of area
examined, type of SES measure, specific outcome considered and analysis
techniques.
Implications. Future studies should use rigorous methods to yield more definitive
conclusions about the effects of area-level SES on alcohol and drug outcomes,
including composite measures of SES and both bivariate and multivariate analyses.
Conclusion. Further research is needed to identify confounds of the relationship
between area-level SES and substance use and to explain why the effects of arealevel SES vary by outcome and residents' age
Keywords: socioeconomic disadvantage; neighbourhood; community; alcohol and
drugs; review
51. Mortality among regular or dependent users of heroin and other
opioids: a systematic review and meta-analysis of cohort studies
Louisa Degenhardt, Chiara Bucello, Bradley Mathers, Christina Briegleb,
Hammad Ali, Matt Hickman, Jennifer McLaren
Addiction 2011;106(1):32-51
ABSTRACT
Aims To review the literature on mortality among dependent or regular users of
opioids across regions, according to specific causes, and related to a number of
demographic and clinical variables.
Methods Multiple search strategies included searches of Medline, EMBASE and
PsycINFO, consistent with the methodology recommended by the Meta-analysis of
Observational Studies in Epidemiology (MOOSE) group; grey literature searches;
and contact of experts for any additional unpublished data from studies meeting
inclusion criteria. Random-effects meta-analyses were conducted for crude mortality
rates (CMRs) and standardized mortality ratios (SMRs), with stratified analyses
where possible. Meta-regressions examined potentially important sources of
heterogeneity across studies.
47
Results Fifty-eight prospective studies reported mortality rates from opioiddependent samples. Very high heterogeneity across studies was observed; pooled
all-cause CMR was 2.09 per 100 person-years (PY; 95% CI; 1.93, 2.26), and the
pooled SMR was 14.66 (95% CI: 12.82, 16.50). Males had higher CMRs and lower
SMRs than females. Out-of-treatment periods had higher mortality risk than intreatment periods (pooled RR 2.38 (CI: 1.79, 3.17)). Causes of death varied across
studies, but overdose was the most common cause. Multivariable regressions found
the following predictors of mortality rates: country of origin; the proportion of sample
injecting; the extent to which populations were recruited from an entire country
(versus subnational); and year of publication.
Conclusions Mortality among opioid-dependent users varies across countries and
populations. Treatment is clearly protective against mortality even in non-randomized
observational studies. Study characteristics predict mortality levels; these should be
taken into account in future studies.
Keywords: Cohort; dependence; heroin; mortality; opioid; review
52. Child Physical and Sexual Abuse: A Comprehensive Look at Alcohol
Consumption Patterns, Consequences, and Dependence From the National
Alcohol Survey
E. Anne Lown, Madhabika B. Nayak, Rachael A. Korcha, Thomas K. Greenfield
Alcoholism: Clinical and Experimental Research 2011;35(2):317-325
ABSTRACT
Background: Previous research has documented a relationship between child
sexual abuse and alcohol dependence. This paper extends that work by providing a
comprehensive description of past year and lifetime alcohol consumption patterns,
consequences, and dependence among women reporting either physical and sexual
abuse in a national sample.
Methods: This study used survey data from 3,680 women who participated in the
2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse
and its characteristics were assessed in relation to 8 past year and lifetime alcohol
consumption measures.
Results: Child physical or sexual abuse was significantly associated with past year
and lifetime alcohol consumption measures. In multivariate analyses, controlling for
age, marital status, employment status, education, ethnicity, and parental alcoholism
or problem drinking, women reporting child sexual abuse vs. no abuse were more
likely to report past year heavy episodic drinking (ORadj = 1.7; 95% CI 1.0 to 2.9),
alcohol dependence (ORadj = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences
(ORadj = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a
greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002).
Sexual child abuse was also associated with lifetime alcohol–related consequences
(ORadj = 3.5; 95% CI 2.6 to 4.8) and dependence (ORadj = 3.7; 95% CI 2.6 to 5.3).
Physical child abuse was associated with 4 of 8 alcohol measures in multivariate
models. Both physical and sexual child abuse were associated with getting into
fights, health, legal, work, and family alcohol–related consequences. Alcohol-related
consequences and dependence were more common for women reporting sexual
abuse compared to physical abuse, 2 or more physical abuse perpetrators,
nonparental and nonfamily physical abuse perpetrators, and women reporting injury
related to the abuse.
48
Conclusion: Both child physical and sexual abuse were associated with many
alcohol outcomes in adult women, even when controlling for parental alcohol
problems. The study results point to the need to screen for and treat underlying
issues related to child abuse, particularly in an alcohol treatment setting.
Keywords: Child Sexual Abuse; Child Physical Abuse; Alcohol Consequences;
Alcohol Dependence; Intoxication; Binge Drinking
53. Sex differences amongst dependent heroin users: Histories, clinical
characteristics and predictors of other substance dependence
Fiona L. Shand, Louisa Degenhardt, Tim Slade, Elliot C. Nelson
Addictive Behaviors 2011;36(1-2):27-36
ABSTRACT
Introduction and aims
To examine differences in the characteristics and histories of male and female
dependent heroin users, and in the clinical characteristics associated with multiple
substance dependence diagnoses.
Design and methods
1513 heroin dependent participants underwent an interview covering substance use
and dependence, psychiatric history, child maltreatment, family background, adult
violence and criminal history. Family background, demographic and clinical
characteristics were analysed by sex. Ordinal regression was used to test for a
relationship between number of substance dependence diagnoses and other clinical
variables.
Results
Women were more likely to experience most forms of child maltreatment, to first use
heroin with a boyfriend or partner, to experience ongoing adult violence at the hands
of a partner, and to have a poorer psychiatric history than men. Males had more
prevalent lifetime substance dependence diagnoses and criminal histories and were
more likely to meet the criteria for ASPD. Predictors of multiple substance
dependence diagnoses for both sexes were mental health variables, antisocial
behaviour, childhood sexual abuse, victim of adult violence, younger age at first
cannabis use and overdose. As the number of dependence diagnoses increased,
clinical and behavioural problems increased. Childhood emotional neglect was
related to increasing dependence diagnoses for females but not males, whereas
PTSD was a significant predictor for males but not females.
Discussion and conclusions
Mental health problems, other substance dependence, childhood and adult trauma
were common in this sample, with sex differences indicating different treatment
needs and possible different pathways to heroin dependence for men and women
54. History of reported sexual or physical abuse among long-term heroin users
and their response to substitution treatment
Eugenia Oviedo-Joekes, Kirsten Marchand, Daphne Guh, David C. Marsh, Suzanne
Brissette, Michael Krausz, Aslam Anis, Martin T. Schechter
Addictive Behaviors 2011;36(1-2):55-60
ABSTRACT
49
Opioid-dependent individuals with a history of abuse have exhibited worse mental
and physical health compared to those without such a history; however, the evidence
regarding the influence of abuse histories on addiction treatment outcomes are
conflicting.
In the present study, we identified history of physical or sexual abuse at treatment
initiation in relation to drug use and health among long-term opioid-dependent
individuals and we determined the relationship of abuse histories with treatment
outcomes following substitution treatment.
We analyzed data from a randomized controlled trial that compared the effectiveness
of opioid-agonists in the treatment of chronic opioid dependence. The North
American Opiate Medication Initiative (NAOMI) was conducted in Vancouver and
Montreal (Canada) and provided oral methadone, injectable diacetylmorphine or
injectable hydromorphone, the last two on a double blind basis, over 12 months.
A total of 112 (44.6%) participants reported a history of physical or sexual abuse at
baseline. Participants with an abuse history reported a significantly higher number of
chronic medical problems, suicide attempts, and previous drug treatments and had
poorer psychiatric, family and social relations, and quality of life status compared to
those without abuse histories. No differences in current and past substance use were
found between those with and without abuse histories. Following 12 months of
treatment, the participants with abuse histories improved to a similar degree as those
without a history of abuse in all of the European Addiction Severity Index sub-scales,
with the exception of medical status.
The findings suggest that individuals with abuse histories were able to achieve
similar outcomes as those without abuse histories following treatment despite having
poorer scores in physical and mental health, social status and quality of life at
treatment initiation. These findings suggest that the substitution treatments as
provided in this study can benefit the most vulnerable and access needs to be
expanded to reach this population.
55. Childhood bullying behaviors at age eight and substance use at age 18
among males. A nationwide prospective study
S. Niemelä, A. Brunstein-Klomek, L. Sillanmäki, H. Helenius, J. Piha, K.
Kumpulainen, I. Moilanen, T. Tamminen, F. Almqvist, A. Sourander
Addictive Behaviors 2011;36(3):256-260
Abstract
Childhood bullying behaviors (bullying and victimization) were studied as risk factors
for substance use among Finnish males. The study design was a nationwide
prospective general population study, where information was collected in 1989 and
1999. Bullying behaviors and childhood psychopathology at age eight were collected
from teachers, parents and boys themselves. At age 18, self-reports of frequent
drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or
more per day), and illicit drug use during the past six months were obtained from
78% of the boys attending the study at age eight (n = 2946). Being frequently
victimized at age eight predicted daily heavy smoking, and this was evident even
after adjusting for childhood family background, psychopathology at age eight and at
age 18, and other forms of substance use. In multivariate analysis, bullying others
frequently predicted illicit drug use, while being a victim of bullying associated with a
lower occurrence of illicit drug use. Bullying behaviors had no association with
frequent drunkenness independent of other factors. Accordingly, being a victim of
50
bullying predisposes in particular to subsequent smoking. Bullying others in
childhood can be regarded as an early indicator to illicit drug use later in life. The
screening and intervention possibilities in order to recognize the risk group for later
health compromising behaviors are emphasized.
56. Characteristics and consequences of heroin use among older adults in the
United States: A review of the literature, treatment implications, and
recommendations for further research
Daniel Rosen, Amanda Hunsaker, Steven M. Albert, Jack R. Cornelius, Charles F.
Reynolds III
Addictive Behaviors 2011;36(4)279-285
ABSTRACT
This review reports on the results of a comprehensive literature search of studies
examining the physical and mental health characteristics of older adults in the United
States who use heroin. Multiple databases were searched for papers meeting the
inclusion criteria of heroin users who were age 50 years or older. A total of 14 articles
covering 9 different studies met the review inclusion criteria. All of the studies were
convenience samples, and seven of the nine studies (77.8%) were entirely drawn
from substance abuse treatment programs, primarily methadone maintenance
programs. Findings from the qualitative studies suggest that the marginalization of
older heroin users was a predominant experience that impacted the intent to seek
treatment as well as treatment retention. While articles reported high levels of
physical and psychological/psychiatric comorbidities with substance misuse,
research on heroin use and methadone treatment among older adults is scant and
the quantitative findings are inconsistent. The articles reviewed in this study
demonstrate that the needs of this population will be significant, yet the development
of appropriate interventions and treatment for older adult heroin users will be
contingent on empirical research that adequately describes mental and physical
health problems.
57. Hospitalisation for an alcohol-related cause among injecting drug users in
Scotland: Increased risk following diagnosis with hepatitis C infection
Scott A. McDonald, Sharon J. Hutchinson, Sheila M. Bird, Chris Robertson, Peter R.
Mills, John F. Dillon, David J. Goldberg
International Journal of Drug Policy 2011;22(1): 63-69
ABSTRACT
Background
The rate of hepatitis C (HCV) related liver disease progression is known to be
strongly associated with alcohol consumption, yet there are very few data on alcohol
use in injecting drug users (IDUs), who represent 90% of Scotland's HCV-diagnosed
population. To investigate the extent of alcohol use in IDUs, we used hospitalisation
with an alcohol-related diagnosis as an indicator for problematic consumption levels,
and compared admission rates pre- and post-HCV diagnosis.
Methods
Data for 41,062 current/former IDUs attending drug treatment/support services in
Scotland from April 1995 to March 2006 were linked to the national hospital
discharge database to retrieve alcohol-related episodes, and to the national HCV
51
Diagnosis database to determine HCV-diagnosed status. Relative risks were
estimated using Cox proportional hazards regression for recurrent events.
Results
The proportion of IDUs with ≥1 alcohol-related admission following first attendance at
drug services was greater among those diagnosed with HCV by the end of follow-up
(16%) compared with those who were not (6%). For the 9145 IDUs who had been
diagnosed with HCV by 31 March 2006, there was a 1.5-fold increased relative risk of
an alcohol-related admission >30 days post-HCV diagnosis (95% CI: 1.2–1.7)
compared with >30 days pre-HCV diagnosis, adjusted for sex, age, and deprivation.
Conclusions
IDUs diagnosed with HCV infection have an increased risk of subsequent hospital
admission for an alcohol-related cause. Because of the synergistic effect of HCV
infection and excessive alcohol intake on the development of cirrhosis, it is
imperative that alcohol intake is addressed in the management of chronic HCV
infection in this population.
Keywords: Alcohol; Hospital admissions; Injecting drug users; Hepatitis C virus
58. Social exclusion, personal control, self-regulation, and stress among
substance abuse treatment clients
Jennifer Cole, T.K. Logan, Robert Walker
Drug and Alcohol Dependence 2011;113(1):13-20
ABSTRACT
The purpose of this study was to examine the relationship of social exclusion,
personal control, and self-regulation to perceived stress among individuals who
participated in publicly funded substance abuse treatment. Participants entered
treatment between June 2006 and July 2007 and completed a 12-month follow-up
survey by telephone (n = 787). The results of the OLS regression analysis indicate
that individuals with greater social exclusion factors (e.g. greater economic hardship,
lower subjective social standing, greater perceived discrimination), lower perceived
control of one's life, and lower self-regulation had higher perceived stress.
Furthermore, a significant interaction was found suggesting a stress-buffering effect
of personal control between subjective social standing and perceived stress.
Interestingly, income status was not significantly related to perceived stress, while
economic hardship, which assesses participants’ inability to meet basic expenses,
was significantly associated with perceived stress. Future research should examine
how to integrate the AA/NA teaching about powerlessness and its role in recovery
with the importance of increased personal control and self-control in decreasing
perceived stress. Implications for future research and substance abuse treatment are
discussed.
Keywords: Chronic stressor; Self-control; Discrimination; Economic hardship;
Substance use
52
Hepatitis C
59. Alcohol-Related and Viral Hepatitis C-Related Cirrhosis Mortality
among Hispanic Subgroups in the United States, 2000–2004
Young-Hee Yoon, Hsiao-ye Yi, Patricia C. Thomson
Alcoholism: Clinical and Experimental Research 2011;35(2):240-249
ABSTRACT
Background: Hispanics have much higher cirrhosis mortality rates than nonHispanic Blacks and Whites. Although heavy alcohol use and hepatitis C virus (HCV)
infection are two major risk factors for cirrhosis, no studies have systematically
assessed the contribution of alcohol- and HCV-related cirrhosis deaths to the total
cirrhosis mortality for Hispanics as a whole and its variations across Hispanic
subgroups. To fill this gap, this study presents the latest data on total cirrhosis
mortality as well as its component alcohol- and HCV-related cirrhosis mortality for all
Hispanics and for Hispanic subgroups.
Methods: The multiple-cause approach was used to analyze data from the U.S.
Multiple Cause of Death Data Files for 28,432 Hispanics and 168,856 non-Hispanic
Whites (as a comparison group) who died from cirrhosis as the underlying or a
contributing cause during 2000–2004. Four major Hispanic subgroups were defined
by national origin or ancestry, including Mexicans, Puerto Ricans, Cubans, and Other
Hispanics. The cirrhosis deaths were divided into four distinctive cause-of-death
categories: alcohol-related, HCV-related, both alcohol- and HCV-related, and neither
alcohol- nor HCV-related. Age-adjusted total cirrhosis death rates and percentage
shares of the cause-specific categories were compared across Hispanic subgroups
and non-Hispanic Whites.
Results: Compared with non-Hispanic Whites, all Hispanic subgroups except
Cubans had much higher cirrhosis mortality. The age-adjusted total cirrhosis death
rates were twice as high for Puerto Ricans and Mexicans as for non-Hispanic Whites.
Alcohol-related and HCV-related cirrhosis death rates also were higher for most
Hispanic subgroups than for non-Hispanic Whites.
Conclusions: Heavy alcohol use and hepatitis C viral infection are two important
factors contributing to the high cirrhosis mortality among Hispanics. However, their
relative contributions to total cirrhosis mortality varied by gender and Hispanic
subgroup. This information is useful for targeted prevention and intervention efforts to
address the excessive cirrhosis mortality in the Hispanic population.
Keywords: Ethnic Groups; Women; Health Status Disparities; Men; Risk Factors
53
Harm Reduction
60. Cessation of groin injecting behaviour among patients on oral opioid
substitution treatment
Richard Senbanjo, Neil Hun, John Strang
Addiction 2011:106(2);376-382
ABSTRACT
Aims To identify factors that might influence cessation of groin injecting (GI) among
patients receiving oral opioid substitution treatment (OST).
Design A cross-sectional survey.
Setting Drug treatment centres in South East England.
Participants Groin injectors (GIs) attending an ultrasound ‘health-check’ clinic.
Measurements Clinical data and ultrasound images; comparing 65 patients who
had injected drugs in the femoral vein (fv) in the previous month (current GIs) with 49
former groin injectors (former GIs).
Findings Most of the 114 clinic attendees were men (69.3%) and white European
(95.6%). Mean age, duration of GI and time in treatment were 36.4 years, 54.8
months and 20.5 months, respectively. Former GIs were significantly older
(P < 0.001) and had been injecting (P < 0.05) and in treatment (P < 0.05) for longer
than current GIs. History of deep vein thrombosis (DVT, P < 0.05) and septicaemia
(P < 0.05); moderate/severe chronic venous disease (CVD, P < 0.01); and ‘very
severe’ fv damage on ultrasonography (P < 0.05) were more common among former
GIs. A logistic regression model correcting for the effects of covariants revealed age
(B 0.08; Wald 7.1; P < 0.01) and severity of venous disease (B 1.1; Wald 4.1;
P < 0.05) as the strongest predictors of behaviour change.
Conclusions GI cessation is associated with longer time in treatment, increasing
age and the presence of CVD and severely damaged fv. GI appears to be an
intractable behaviour that often persists despite OST and severe health
complications. Persistent GI should prompt a review of whether OST is optimized
and whether other interventions are needed to promote behaviour change prior to the
development of serious harm.
Keywords: Chronic venous disease, femoral vein, heroine, injecting,
ultrasonography
61. Can Hepatitis C virus treatment be used as a prevention strategy?
Additional model projections for Australia and elsewhere
Peter Vickerman, Natasha Martin and Matthew Hickman
Drug and Alcohol Dependence 2011;113(2-3):83-85
ABSTRACT
Zeiler et al. (2010) use a simple model to project the potential prevention utility of
using pegylated interferon and ribavirin to treat active injecting drug users (IDUs) for
HCV infection. Their analysis shows that increasing the level of HCV treatment in
Australia could dramatically reduce the prevalence of HCV infection among IDUs. We
argue that their projections are under-estimating the possible impact of HCV
treatment because their assumed prevalence of active HCV infection in Australia is
54
too high (assumed prevalence of acute plus chronic is 60%) and their model
effectively assumes a treatment efficacy of 33%. We replicate their model and show
that if these issues are corrected (assuming 45% prevalence of active HCV infection,
i.e. 60% antibody prevalence and 50% treatment efficacy), then substantially
greater impact can be achieved. In addition, we show that the effect of HCV
treatment on the primary prevention of HCV increases in populations with lower
background HCV prevalence. We also query their finding that HCV treatment should
be preferentially targeted to IDUs not on methadone maintenance treatment.
Keywords: Treatment; Mathematical model; IDU; HCV
62. Needle exchange as a safe haven in an unsafe world
Joan Macneil, Bernadette Pauly
Drug Alcohol Rev 2011;30;26–32
ABSTRACT
Introduction and Aims. The purpose of this paper is to describe the meaning of
needle exchange programs from the perspectives of users who access such
programs.
Design and Methods. We conducted observations, 33 semistructured interviews
and two focus groups with users at four needle exchange sites. Qualitative
description was used to analyse the data.
Results. Participants described experiences of trauma, abuse, violence and physical
injuries that had damaged their lives and led to the use of drugs to numb the pain.
Respect for persons and the development of trust with outreach staff for clients who
use injecting drugs supported clients to feel safe in what for many was an unsafe
world. Participants described the important role that needle exchange services play
in reducing and countering negative stigma, as well as in providing access to clean
supplies and to other services.
Discussion and Conclusions. The findings attest to the benefits of having trusted,
safe needle exchange services that not only reduce risk behaviours that prevent
infections, such as HIV and hepatitis C, but also open the door to other services. This
finding is particularly important given that the majority of those interviewed were
homeless and living in poverty. The need for both fixed sites and the integration of
harm reduction services as part of a broader network of primary health-care services
was reinforced.
Keywords: needle exchange; qualitative research; harm reduction; trust; safe
haven
63. Impact of training for healthcare professionals on how to manage an opioid
overdose with naloxone: Effective, but dissemination is challenging
Soraya Mayet, Victoria Manning, Anna Williams, Jessica Loaring, John Strang
International Journal of Drug Policy 2011;22(1):9-15
ABSTRACT
Background
Opioid overdose has a high mortality, but is often reversible with appropriate
overdose management and naloxone (opioid antagonist). Training in these skills has
been successfully trialled internationally with opioid users themselves. Healthcare
professionals working in substance misuse are in a prime position to deliver
55
overdose prevention training to drug users and may themselves witness opioid
overdoses. The best method of training dissemination has not been identified. The
study assessed post-training change in clinician knowledge for managing an opioid
overdose and administering naloxone, evaluated the ‘cascade method’ for
disseminating training, and identified barriers to implementation.
Methods
A repeated-measures design evaluated knowledge pre-and-post training. A sub-set
of clinicians were interviewed to identify barriers to implementation. Clinicians from
addiction services across England received training. Participants self-completed a
structured questionnaire recording overdose knowledge, confidence and barriers to
implementation.
Results
One hundred clinicians were trained initially, who trained a further 119 clinicians
(n = 219) and thereafter trained 239 drug users. The mean composite score for
opioid overdose risk signs and actions to be taken was 18.3/26 (±3.8) which
increased to 21.2/26 (±4.1) after training, demonstrating a significant improvement in
knowledge (Z = 9.2, p < 0.001). The proportion of clinicians willing to use naloxone in
an opioid overdose rose from 77% to 99% after training. Barriers to implementing
training were clinician time and confidence, service resources, client willingness and
naloxone formulation.
Conclusions
Training clinicians how to manage an opioid overdose and administer naloxone was
effective. However the ‘cascade method’ was only modestly successful for
disseminating training to a large clinician workforce, with a range of clinician and
service perceived obstacles. Drug policy changes and improvements to educational
programmes for drug services would be important to ensure successful
implementation of overdose training internationally.
Keywords: Training; Opioid overdose; Naloxone; Implementation; Drug policy
64. Infrequent opioid overdose risk reduction behaviours among young adult
heroin users in cities with wide coverage of HIV prevention programmes
Montserrat Neira-León, Gregorio Barrio, María J. Bravo, M. Teresa Brugal, Luis de la
Fuente, Antonia Domingo-Salvany, José Pulido, Sara Santos, and Project Itinere
Group
International Journal of Drug Policy 2011;22(1):16-25
ABSTRACT
Background
Opioid overdose risk reduction behaviours include some preventive behaviours to
avoid overdoses (PB) and others to avoid death after overdose, such as never using
heroin while alone (NUA). Few studies have examined the prevalence and predictors
of these behaviours.
Aim
To establish the prevalence and predictors of PBs and NUA among heroin users,
both injectors and non-injectors, in three Spanish cities.
Methods
516 injecting and 475 non-injecting heroin users aged 18–30 were street-recruited in
2001–2003 and interviewed by face-to-face computer-assisted interview. PBs and
NUA in the last 12 months were explored using open-ended and precoded questions,
respectively. Specific predictors for three PB categories were investigated: control of
56
route of drug administration, control of quantity or type of heroin used, and control of
co-use of other drugs. Bivariate and logistic regression methods were used.
Results
Overall, the most prevalent PBs were: using a stable and not excessive amount of
heroin (12.7%), injecting or using the whole heroin dose slowly or dividing it into
smaller doses (12.4%), reducing or stopping heroin injection (8.3%), and not mixing
heroin with tranquillisers (5.1%). Most PBs were significantly more prevalent among
injectors than non-injectors. No one mentioned reducing the amount of heroin after
an abstinence period. Some 36.2% had NUA. In multiple regression analysis,
knowledge of risk factors for opioid overdose was a predictor of specific PBs,
although this was not always the case. Use of syringe exchange programmes was a
predictor of PB among injectors. However, attending methadone maintenance
treatment (MMT) or other drug-dependence treatment was not a predictor of any
opioid overdose reduction behaviour. Only ever having witnessed or experienced an
overdose predicted PB in both injectors and non-injectors.
Conclusions
The proportion of heroin users with opioid overdose risk reduction behaviours is very
low. Additional specific measures to prevent overdose are needed, as well as
increased emphasis on reducing the risk of overdose in programmes to prevent HIV
and other blood-borne infections in heroin injectors.
Keywords: Overdose prevention; Heroin injection; Harm reduction programmes
57
Homelessness
65. The Role of Social Ties in Recovery in a Population of Homeless Substance
Abusers
Burkey, Matthew D.; A. Kim, Yeowon; Breakey, William R.
Addictive Disorders & Their Treatment 2011;10(1):14-20
ABSTRACT
Objectives: Strong social ties are protective of substance abuse and predict greater
odds of recovery among those affected. However, social ties are often disrupted
among homeless men. The objective of this study was to determine the effects of
social ties on the decision among homeless men to enter and continue treatment for
substance use disorders.
Methods: Ten participants in a residential therapeutic community treatment program
were interviewed using a semi-structured format. Interview notes were divided into
discrete “data units”; common themes, concepts, words, and phrases were identified;
and, finally, relationships between categories were delineated.
Results: Qualitative analysis showed that, through confrontation and ongoing
emotional support, family members, specifically mothers, played the most significant
role in the participants' decision to enter treatment. Members of the recovery network
provided empathic emotional support; coworkers, outside friends, health
professionals, and romantic relationships were also mentioned, each possessing a
characteristic role. Several themes emerged suggesting mechanisms by which
relationships may affect the recovery process: effects on attitude, focus, and
motivation; emotional and instrumental support; knowledge; and preentry support.
Conclusions: Social ties among homeless substance abusers are complex and play
an important role in recovery. Understanding these relationships and their perceived
importance may help to leverage underutilized resources in the treatment of
substance abuse among homeless individuals.
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Injecting Behaviour
66. The self-reported personal wellbeing of a sample of Australian injecting
drug users
Paul Dietze, Mark Stoové, Peter Miller, Stuart Kinner, Raimondo Bruno, Rosa
Alati, Lucy Burn
Addiction Volume 2010;105(2):2141–2148
ABSTRACT
Aims To examine the self-reported personal wellbeing of a sample of Australian
injecting drug users (IDU) using a standardized instrument and determine the key
correlates of variations in self-reported personal wellbeing.
Design, setting and participants Cross-sectional survey of 881 Australian IDU.
Measurements Self-reported personal wellbeing collected using the Personal
Wellbeing Index (PWI).
Findings IDU scored significantly lower than the general Australian population on
the PWI and all subscales. Lower PWI scores were associated with a range of sociodemographic, drug use and other health and social characteristics. Across all PWI
subscales, lower personal wellbeing scores were associated with unemployment,
past 6-month mental health problems and more frequent injecting (all P < 0.05).
Conclusions The PWI is sufficiently sensitive to distinguish between IDU and the
general population, and to identify key correlates of PWI among IDU. Some domains
canvassed within the scale, such as health, standard of living and life achievements,
are well within the scope of current intervention strategies, such as pharmacotherapy
maintenance treatment and housing and employment support services. This
suggests that the PWI could be useful in clinical settings by allowing structured
identification of the areas of a person's life to be addressed as a part of a treatment
regimen. In order to inform targeted prevention and intervention efforts, longitudinal
studies of PWI and its correlates among IDU are required.
Keywords: Heroin use; injecting drug use; personal wellbeing index.
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Methods
67. How best to measure change in evaluations of treatment for substance
use disorder
John Marsden, Brian Eastwood, Craig Wright, Colin Bradbury, Jonathan Knight,
Paul Hammond
Addiction 2011; 106(2);294-302
ABSTRACT
Aims To compare the performance of the Jacobson & Truax (JT) reliable change
index (RCI) with three alternative methods, using data from individuals receiving
treatment for substance use disorders.
Design English National Treatment Outcome Monitoring Database for publicly
funded specialist community pharmacological and psychosocial interventions.
Participants New adult admissions to treatment across England (1 January–31
December 2008), with in-treatment clinic progress review conducted after an average
of 122.8 days for 18 163 individuals.
Measurements Self-reported days using heroin, crack, cocaine powder and alcohol
during the 4 weeks before admission and clinical review, recorded using the
Treatment Outcomes Profile and analysed using a multi-level, mixed-linear model,
with both observed and true scores to estimate the effect of regression to the mean
(RTM). Differences in performance among the JT RCI and the alternative methods
were assessed by the proportion assigned to a reliably ‘improved’, ‘unchanged’ or
‘reliably deteriorated’ category; level of agreement; difference in effect size for
observed and true scores; and receiver operating characteristic parameters.
Findings When compared to the alternative methods, the JT RCI was more
conservative in assigning individuals to the improved category, and it showed no
evidence of inferiority on any measure. For each method, all individuals categorized
as reliably deteriorated and the majority of those categorized reliably improved had
outcome scores which fell beyond that expected by RTM. Substituting true scores for
observed scores moderated the size of the change effect associated with reduced
use of the four substances, but this remained statistically significant.
Conclusions The Jacobson & Truax Reliable Change Index appears to be the
optimal measure of change for evaluations of treatment for substance use disorder,
in that it is the most conservative for assessing improvement and at least as accurate
on all other criteria. Any evaluation of change needs to take account of regression to
the mean.
Keywords: Jacobson & Truax; regression to the mean; reliable change index;
substance use disorder treatment effectiveness
60
Miscellaneous
68. Continued cannabis use and risk of incidence and persistence of psychotic
symptoms: 10 year follow-up cohort study
Rebecca Kuepper, Jim van Os, Hans-Ulrich Wittchen, Michael Höfler, Cécile
Henquet,
BMJ 2011; 342:d738
ABSTRACT
Objective To determine whether use of cannabis in adolescence increases the risk
for psychotic outcomes by affecting the incidence and persistence of subclinical
expression of psychosis in the general population (that is, expression of psychosis
below the level required for a clinical diagnosis).
Design Analysis of data from a prospective population based cohort study in
Germany (early developmental stages of psychopathology study).
Setting Population based cohort study in Germany.
Participants 1923 individuals from the general population, aged 14-24 at baseline.
Main outcome measure Incidence and persistence of subthreshold psychotic
symptoms after use of cannabis in adolescence. Cannabis use and psychotic
symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4
years)) over a 10 year follow-up period with the Munich version of the composite
international diagnostic interview (M-CIDI).
Results In individuals who had no reported lifetime psychotic symptoms and no
reported lifetime cannabis use at baseline, incident cannabis use over the period
from baseline to T2 increased the risk of later incident psychotic symptoms over the
period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1;
P=0.021). Furthermore, continued use of cannabis increased the risk of persistent
psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The
incidence rate of psychotic symptoms over the period from baseline to T2 was 31%
(152) in exposed individuals versus 20% (284) in non-exposed individuals; over the
period from T2 to T3 these rates were 14% (108) and 8% (49), respectively.
Conclusion Cannabis use is a risk factor for the development of incident psychotic
symptoms. Continued cannabis use might increase the risk for psychotic disorder by
impacting on the persistence of symptoms.
69. Using theories of behaviour change to inform interventions for
addictive behaviours
Thomas L. Webb, Falko F. Sniehotta, Susan Michie
Addiction 2010;105(11):1879-1892
ABSTRACT
Aims This paper reviews a set of theories of behaviour change that are used outside
the field of addiction and considers their relevance for this field.
Methods Ten theories are reviewed in terms of (i) the main tenets of each theory, (ii)
the implications of the theory for promoting change in addictive behaviours and (iii)
studies in the field of addiction that have used the theory. An augmented feedback
61
loop model based on Control Theory is used to organize the theories and to show
how different interventions might achieve behaviour change.
Results Briefly, each theory provided the following recommendations for
intervention: Control Theory: prompt behavioural monitoring, Goal-Setting Theory:
set specific and challenging goals, Model of Action Phases: form ‘implementation
intentions’, Strength Model of Self-Control: bolster self-control resources, Social
Cognition Models (Protection Motivation Theory, Theory of Planned Behaviour,
Health Belief Model): modify relevant cognitions, Elaboration Likelihood Model:
consider targets' motivation and ability to process information, Prototype Willingness
Model: change perceptions of the prototypical person who engages in behaviour and
Social Cognitive Theory: modify self-efficacy.
Conclusions There are a range of theories in the field of behaviour change that can
be applied usefully to addiction, each one pointing to a different set of modifiable
determinants and/or behaviour change techniques. Studies reporting interventions
should describe theoretical basis, behaviour change techniques and mode of delivery
accurately so that effective interventions can be understood and replicated.
Keywords: Addiction; behaviour change; intervention; theory
70. Addiction and its sciences—philosophy
Bennett Foddy
Addiction Volume 2011;106(1):25–31
ABSTRACT
Philosophers have been writing about addiction continually since the 1990s, and a
number of much older, broader philosophical theories are of direct relevance to the
study of addiction. Yet the developments in the philosophical study of addiction have
seldom been incorporated into the science of addiction. In this paper I focus upon
two issues in the scientific literature: the disease classification of addiction and the
claim that addictive behaviour is compulsive. While each of these views is open to
debate on empirical grounds, there is a long history of philosophical work which must
be engaged if these claims are to be justified in a philosophical sense. I begin by
showing how the conceptual work of philosophers such as Boorse and Nordenfelt
can be used to critique the claim that addiction is a disease. Following this, I
demonstrate how deep philosophical concepts of freedom and willpower are
embedded into scientists' claims about compulsion in drug addiction. These concepts
are paradoxical and difficult, and they have consumed numerous contemporary
philosophers of mind, such as Audi, Arpaly, Frankfurt, Mele, Wallace and Watson,
among many others. I show how problems can arise when scientists sidestep the
work of these philosophers, and I explain where scientists should seek to include,
and sometimes exclude, philosophical concepts.
Conclusions Many philosophical concepts and theories can be of use to addiction
science. The philosophical work must be understood and acknowledged if the
science is to progress.
Keywords: Addiction; compulsion; disease; philosophy
71. Substance use and motivation: a longitudinal perspective
Rachael A. Korcha, M.A., Douglas L. Polcin, Ed.D., Jason C. Bond, Ph.D, William M.
Lapp, Ph.D. Gantt Galloway, Pharm.D.
The American Journal of Drug and Alcohol Abuse 2011;37(1):48-53
62
ABSTRACT
Background: Motivation to change substance use behavior is an important
component of the recovery process that has usually been studied at entry into
treatment. Less studied, but equally important, is the measurement of motivation over
time and the role motivation plays in subsequent substance use.
Objectives: The present study sought to examine longitudinal motivation toward
sobriety among residents of sober living houses.
Methods: Sober living residents (n = 167) were followed at 6-month intervals over an
18-month period and assessed for motivation and substance use outcomes at each
study interview. Motivation was measured using the costs and benefits subscales of
the Alcohol and Drug Consequences Questionnaire (ADCQ) and substance use
outcomes included the Addiction Severity Index (ASI) alcohol scale, ASI drug scale,
and peak density of substance use (number of days of most use in a month).
Results: Participants reported higher benefits than costs of sobriety or cutting down
substance use at every study time point. Using lagged generalized estimating
equation models, the ADCQ costs predicted increased severity for alcohol, drugs,
and peak density, whereas the benefits subscale predicted decreased drug and peak
density.
Conclusion: Longitudinal measurement of motivation can be a useful clinical tool to
understand later substance use problems.
Scientific significance: Given the mixed findings from prior studies on the effects of
baseline motivation, a shift toward examining longitudinal measures of motivation at
proximal and temporal intervals is indicated.
Keywords motivation, recovery, sober living, alcohol, drug
72. Predictors of addiction treatment providers' beliefs in the disease and
choice models of addiction
Christopher Russel, John B. Davies, Simon C. Hunter
Journal of Substance Abuse Treatment 2011;40(2):150-164
ABSTRACT
Addiction treatment providers working in the United States (n = 219) and the United
Kingdom (n = 372) were surveyed about their beliefs in the disease and choice
models of addiction, as assessed by the 18-item Addiction Belief Scale of J. Schaler
(1992). Factor analysis of item scores revealed a three-factor structure, labeled
“addiction is a disease,” “addiction is a choice,” and “addiction is a way of coping with
life,” and factor scores were analyzed in separate hierarchical multiple regression
analyses. Controlling for demographic and addiction history variables, treatment
providers working in the United States more strongly believe addiction is a disease,
whereas U.K.-based providers more strongly believe that addiction is a choice and a
way of coping with life. Beliefs that addiction is a disease were stronger among those
who provide for-profit treatment, have stronger spiritual beliefs, have had a past
addiction problem, are older, are members of a group of addiction professionals, and
have been treating addiction longer. Conversely, those who viewed addiction as a
choice were more likely to provide public/not-for-profit treatment, be younger, not
belong to a group of addiction professionals, and have weaker spiritual beliefs.
Additionally, treatment providers who have had a personal addiction problem in the
past were significantly more likely to believe addiction is a disease the longer they
attend a 12-step–based group and if they are presently abstinent.
63
Keywords: Addiction; Treatment providers; Beliefs; Disease; Choice
73. Heavy use versus less heavy use of sedatives among non-medical sedative
users: Characteristics and correlates
Prasanthi Nattala, Kit Sang Leung, Arbi Ben Abdallah, Linda B. Cottler
Addictive Behaviors 2011;36(1-2):103-109
ABSTRACT
Non-medical use of sedatives is an ongoing problem. However, very little is known
about the characteristics of individuals who use sedatives non-medically, or the
motives behind such use. The present analysis, involving a sample of individuals
reporting non-medical use of sedatives in the past 12 months (N = 188), examined
the relationship between socio-demographic variables, past-year use of other licit
and illicit drugs, type of non-medical use (use in ways other than as prescribed, use
when not prescribed, or both), motives, and past 12-month sedative use. Past 12month sedative use was dichotomized as Heavy Use (> 90 pills in past 12 months)
and Less Heavy Use (≤ 90 pills), using a median split. Multivariate logistic regression
analyses indicated that Heavy Use of sedatives was significantly associated with
positive diagnoses for sedative use disorder and prescription opioid use disorder, a
higher number of motives for sedative use, and reporting ‘sedative use in ways other
than as prescribed’ and ‘both forms of non-medical use, namely, other than as
prescribed, and when not prescribed,’ compared to non-prescribed use. Although in
univariate analyses a positive diagnosis for past 12-month cocaine use disorder, and
individual motives for sedative use such as ‘to get high’ and ‘for pain relief’,
significantly predicted past 12-month Heavy Use, their effects diminished and
became non-significant after adjusting for other covariates. Findings underscore the
need for considering differential risk factors in tailoring preventive interventions for
reducing non-medical sedative use.
74. A double-blind, placebo-controlled pilot trial of acamprosate for the
treatment of cocaine dependence
Kyle M. Kampman, Charles Dackis, Helen M Pettinati, Kevin G. Lynch, Thorne
Sparkman, Charles P. O'Brien
Addictive Behaviors 2011;36(3):217-221
ABSTRACT
Background
Acamprosate is a medication shown to be effective for the treatment of alcohol
dependence. Although the exact mechanism of action of acamprosate is unknown,
evidence suggests that it decreases excitatory amino acid activity by post-synaptic
inhibition of the NMDA subtype of glutamate receptors. It is possible that the activity
of acamprosate via modulating glutamatergic activity could also reduce craving for
cocaine and impact abstinence in cocaine dependence. Therefore, we conducted a
double-blind placebo-controlled pilot trial of acamprosate for the treatment of cocaine
dependence.
Methods
Sixty male and female cocaine dependent patients were included in a nine week
double-blind, placebo-controlled trial. After a one-week baseline, patients were
randomized to receive acamprosate 666 mg three times daily or identical placebo
64
tablets for eight weeks. The primary outcome measure was cocaine use as
determined by twice weekly urine drug screens.
Results
Thirty-six patients (60%) completed the trial, with no significant between-group
difference in treatment retention. Percent cocaine positive urine drug screens did not
differ between the two groups. Acamprosate was no better than placebo in reducing
cocaine craving, reducing cocaine withdrawal symptoms, or improving measures of
drug use severity from the Addiction Severity Index. Adverse events in this trial were
generally mild and were evenly distributed between the two groups.
Discussion
Acamprosate was well tolerated but was no more efficacious than placebo in
promoting abstinence from cocaine in cocaine dependent patients. Acamprosate
does not appear to be a promising medication for the treatment of cocaine
dependence.
65
Opiate Treatment
75. Quality of life under maintenance treatment with heroin versus methadone
in patients with opioid dependence
A. Karow, J. Reimer, I. Schäfer, M. Krausz, C. Haasen and U. Verthein
Drug and Alcohol Dependence 2010;112(3):209-215
ABSTRACT
Background
There is increasing evidence that health-related quality of life (HRQOL) is associated
with a successful treatment and better outcome in opioid addiction. The aim of the
present study was the longitudinal investigation of HRQOL in patients with severe
opioid dependence, who were randomly assigned to four groups of medical and
psychosocial treatment: heroin (diacetylmorphine) versus methadone and case
management (CM) versus psychoeducation (PSE) respectively.
Methods
HRQOL (MSQoL) and physical health (OTI) were investigated in 938 subjects, who
participated in the German multi-centre study examining the effects of heroinassisted treatment in patients with severe opioid dependence. Data for the present
analysis were taken from baseline and 12-month follow up.
Results
Under both forms of maintenance and psychosocial treatment HRQOL improved
significantly during the observation period. HRQOL improvement under maintenance
with heroin exceeded improvement under methadone, especially with regard to
subjective physical health. HRQOL improvement was significantly associated with
better expert-rated physical health. Further analyses showed significant better
improvement of HRQOL in subjects treated with PSE compared with CM.
Conclusions
The advantage of heroin with regard to the improvement of HRQOL may be partially
explained by a better improvement of physical health under maintenance with heroin
compared with methadone, which highlights the importance of a comprehensive
model of health care for patients with severe opioid dependence. Future studies need
to investigate the benefits of PSE for patients in maintenance therapy.
Keywords: Quality of life; Opioid dependence; Heroin; Diamorphine; Methadone;
Psychosocial treatment
76. Assessing sleep in opioid dependence: A comparison of subjective ratings,
sleep diaries, and home polysomnography in methadone maintenance patients
Katherine M. Sharkey, Megan E. Kurth, Bradley J. Anderson, Richard P. Corso,
Richard P. Millman and Michael D. Stein
Drug and Alcohol Dependence 2011;113(2-3):245-248
ABSTRACT
Objectives: Comparisons of subjective and objective sleep measures have shown
discrepancies between reported sleep and polysomnography (PSG) in non-drug
dependent individuals with and without insomnia. Sleep may affect behavioral and
physiologic aspects of drug abuse and dependence; patients in methadone
66
maintenance therapy (MMT) for opioid dependence frequently report sleep problems.
Whether subjective sleep reflects objective sleep in MMT patients is unknown. We
undertook these analyses to establish the correlations among subjective and
objective sleep measures in MMT patients. Methods: We compared one week of
daily sleep diaries, one night of home PSG, a questionnaire completed the morning
after PSG, and the Pittsburgh Sleep Quality Inventory (PSQI) as well as
demographics and drug use measures in 62 MMT patients with disturbed sleep
(PSQI score > 5). Results: Subjective and objective sleep durations were similar in
this sample; average sleep times for the diary, morning questionnaire, and PSG were
340, 323, and 332 min, respectively. Average diary sleep time, subjective ratings of
feeling rested, and PSG sleep efficiency were correlated significantly with PSQI
score. Age was inversely correlated with PSG sleep time. Participants whose urine
toxicology showed benzodiazapine use reported significantly longer sleep times on
the morning questionnaire. Conclusions: Objective sleep measures confirm
subjective measures in MMT patients with disturbed sleep. The high prevalence of
sleep complaints in this population likely reflects pathology rather than sleep
misperception. Both objective and subjective measures are useful in research and
clinical settings for assessing sleep in opioid-dependent patients.
Keywords: Methadone; Opioid dependence; Sleep; Polysomnography; PSQI; Sleep
diaries
77. Methadone dose and neonatal abstinence syndrome—systematic
review and meta-analysis
Brian J. Cleary, Jean Donnelly, Judith Strawbridge, Paul J. Gallagher, Tom
Fahey, Mike Clarke, Deirdre J. Murphy
Addiction 2010;105(12):2071-2084
ABSTRACT
Aim To determine if there is a relationship between maternal methadone dose in
pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome
(NAS).
Methods PubMed, EMBASE, the Cochrane Library and PsychINFO were searched
for studies reporting on methadone use in pregnancy and NAS (1966–2009). The
relative risk (RR) of NAS was compared for methadone doses above versus below a
range of cut-off points. Summary RRs and 95% confidence intervals (CI) were
estimated using random effects meta-analysis. Sensitivity analyses explored the
impact of limiting meta-analyses to prospective studies or studies using an objective
scoring system to diagnose NAS.
Results A total of 67 studies met inclusion criteria for the systematic review; 29 were
included in the meta-analysis. Any differences in the incidence of NAS in infants of
women on higher compared with lower doses were statistically non-significant in
analyses restricted to prospective studies or to those using an objective scoring
system to diagnose NAS.
Conclusions Severity of the neonatal abstinence syndrome does not appear to
differ according to whether mothers are on high- or low-dose methadone
maintenance therapy.
Keywords: Meta-analysis; methadone; neonate; neonatal abstinence syndrome;
pregnancy; systematic review; withdrawal.
67
78. Heroin anticraving medications: A systematic review
Ayman Fareed, M.D., Sreedevi Vayalapalli, M.D., Jennifer Casarella, M.D., Richard
Amar, M.D. and Karen Drexler, M.D.
The American Journal of Drug and Alcohol Abuse 2010;36(6):332-341
Abstract
Background: Heroin craving is a trigger for relapse and dropping out of treatment.
Methadone has been the standard medication for the management of heroin craving.
Objectives: We explored the medication options other than methadone which may
have heroin anticraving properties.
Methods: To be selected for the review, articles had to include outcome measures of
the effect of the studied medication on subjective and/or objective opiate craving and
be of the following two types: (1) randomized, controlled, and/or double-blind clinical
trials (RCTs) examining the relationship between the studied medication and heroin
craving; (2) nonrandomized and observational studies (NRSs) examining the
relationship between the studied medication and heroin craving. Thirty-three articles
were initially included in the review. Twenty-one were excluded because they did not
meet the inclusion criteria. We present the results of 12 articles that met all the
inclusion criteria.
Results: Some new medications have been under investigation and seem promising
for the treatment of opiate craving. Buprenorphine is the second most studied
medication after methadone for its effect on opiate craving. At doses above 8 mg
daily, it seems very promising and practical for managing opiate craving in patients
receiving long-term opioid maintenance treatment.
Conclusions and Scientific Significance: In doses higher than 8 mg daily,
buprenorphine is an appropriate treatment for opiate craving. More research with
rigorous methodology is needed to study the effect of buprenorphine on heroin
craving. Also more studies are needed to directly compare buprenorphine and
methadone with regard to their effects on heroin craving.
Keywords heroin, anticraving, medications
79. Pharmacokinetic drug interactions and adverse consequences between
psychotropic medications and pharmacotherapy for the treatment of opioid
dependence
Ali S. Saber-Tehrani, M.D., Robert Douglas Bruce, M.D., M.A., M.Sc. and Frederick
L. Altice, M.D, M.A.
The American Journal of Drug and Alcohol Abuse 2011;37(1):1-11
ABSTRACT
Background: Psychiatric comorbidities among opioid-dependent patients are
common. Many medications used to treat both conditions are metabolized through
complimentary cytochrome P450 isoenzymes. When medication-assisted treatment
for opioid dependence is concurrently used with psychotropic medications,
problematic pharmacokinetic drug interactions may occur.
Methods: We reviewed relevant English language articles identified through the
MedLine, Scopus, and Embase databases from 1950 to December 2009 using the
specific generic names of medications and keywords such as pharmacokinetics and
drug interactions with buprenorphine, methadone, and naltrexone. Selected
references from these articles were reviewed. Additionally, a review was conducted
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of abstracts and conference proceedings from national and international meetings
from 1990 to 2009. A total of 60 studies were identified and reviewed.
Results: Clinical case series and carefully controlled pharmacokinetic interaction
studies have been conducted between methadone, buprenorphine, or naltrexone and
some psychoactive medications. Important pharmacokinetic drug interactions have
been demonstrated within each class of medications affecting either methadone and
buprenorphine or psychoactive drugs. Few studies, however, have been conducted
with naltrexone.
Conclusions: Several interactions between methadone, buprenorphine, or
naltrexone and psychoactive medications are described and may have important
clinical consequences. To optimize care, clinicians must be alerted to these
interactions.
Keywords methadone, buprenorphine, naltrexone, psychoactive medications, drug
interactions
80. Efficacy of mobile telephone contact for follow-up in injecting heroin users
A. Hakansson, Ph.D., P. Isendahl, B.S.W., C. Wallin,B.S.W. and M. Berglund, Ph.D.
The American Journal of Drug and Alcohol Abuse 2011;37(2):89-92
ABSTRACT
Background: Prospective follow-up of heroin users is known to be difficult due to
their unstable lifestyle, and high follow-up rates have usually demanded major
tracking efforts. In Sweden, mobile telephones are commonly used by heavy drug
users for drug trading.
Objectives: This methodology study aims to examine the efficacy of mobile
telephone contact for prospective follow-up interviews with injecting heroin users
recruited at the syringe exchange program of Malmö, Sweden.
Methods: Seventy-eight heroin users with mobile telephone numbers were included.
Subjects reported using heroin for 28 days of the previous 30 days, and only 8%
reported they had recently been engaged in work or studies. Clients were contacted
between 15 and 21 times over 2 years, with each contact attempt generally involving
two telephone calls on consecutive days.
Results: During follow-up, 68% of subjects had been successfully contacted for at
least one follow-up interview (on average 6.9 interviews), and 25% of follow-up
attempts were successful. In 23% of the sample (n = 18), at least 50% of follow-up
attempts were successful, and these subjects tended to be older (p = .05) and more
likely to be female (p = .07), whereas follow-up rates were unrelated to baseline
heroin use.
Conclusions and Scientific Significance: Despite limited effort, and despite the
severe situation of intravenous heroin users, mobile telephone contact can be used
with heavy drug users in the present setting.
Keywords heroin, mobile telephone, follow-up, syringe exchange
81. Brain fMRI and craving response to heroin-related cues in patients on
methadone maintenance treatment
Wei Wang, Qiang Li, Yarong Wang, Jie Tian, Weichuan Yang, Wei Li, Wei Qin, Kai
Yuan, Jixin Liu
The American Journal of Drug and Alcohol Abuse 2011;37(2):123-130
69
ABSTRACT
Objective: To investigate the subjective craving and brain response to heroin-related
cues in former heroin addicts on long-term methadone maintenance treatment.
Methods: Fourteen participants completed an event-related functional magnetic
resonance imaging task including heroin-related and nonheroin-related (neutral)
cues. Craving self-reports were collected before and after the task.
Results: Although no significant craving changes were associated with the task,
blood oxygen-level dependence intensity was significantly greater during exposure to
heroin-related cues, compared to neutral cues in brain areas studied.
Conclusions and Scientific Significance: The results indicate that the learned
brain response of former heroin addicts to drug-related stimuli may persist despite
long-term methadone maintenance treatment.
Keywords fMRI, heroin addiction, MMT, cravings, drug-related cues
82. Effect of Methadone Maintenance Treatment on Heroin Craving, a Literature
Review
Ayman Fareed; Sreedevi Vayalapalli; Steven Stout; Jennifer Casarella; Karen
Drexler; Stephen P. Baile
Journal of Addictive Diseases 2011;30(1):27-38
ABSTRACT
Despite agreement that methadone maintenance treatment (MMT) is an effective and
safe option for treatment of heroin dependence, there have been controversies about
its effect on heroin craving. A systematic literature review of the PubMed database
was used to find studies eligible for inclusion in the study. The authors present the
results of 16 articles that met all inclusion criteria. Overall, 7 studies reported that
methadone could reduce heroin craving, 4 studies reported that patients in MMT are
still at risk of having heroin craving, 1 study reported that methadone could increase
heroin craving, and 4 studies reported that methadone has a neutral effect on heroin
craving. One may speculate from these data that methadone may help with heroin
craving, but patients in MMT may still be at risk of cue-induced heroin cravings.
Methadone provides a helpful tool for reducing some components of craving and risk
of relapse for patient receiving MMT
Keywords: Methadone maintenance; craving; literature review
83. Alcohol use problem among patients in methadone maintenance treatment
in Taiwan
I.-Chun Chen, Wei-Chu Chie, Hai-Go Hwu, Sun-Yuan Chou, Yun-Chiang Yeh, ChunYen Yu, Happy Kuy-Lok Tan
Journal of Substance Abuse Treatment 2011;40(2):142-149
ABSTRACT
Aims
To examine the prevalence rate and predictors of alcohol use problems among
patients undergoing methadone maintenance treatment (MMT).
Design
This was a prospective follow-up study.
Participants
Study population included 438 patients who underwent more than 6 months of MMT.
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Measurements
Demographic and clinical characteristics were collected for each patient prior to
treatment, and treatment-related variables were collected during treatment process.
Hazardous drinking, alcohol abuse, and dependence were measured using a
Chinese version of the Alcohol Use Disorders Identification Test (AUDIT) and by
measuring breath alcohol concentration.
Findings
The prevalence rates of alcohol use problems, indicated by hazardous drinking are
31.4%. The protective predictors of alcohol use problems among MMT patients
include an attendance rate of more than 90% (odds ratio [OR] = 0.54, 95%
confidence interval [CI] = 0.30–0.97) and being older than 36 years (OR = 0.48, 95%
CI = 0.27–0.86), and alcohol drinking problem at intake of study is a risk factor (OR =
5.30, 95% CI = 2.87–9.76).
Conclusions
High attendance rate, which is regarded as a component of clinical policy and a key
component of therapeutic context, should be incorporated with brief interventions to
lower alcohol use problems among MMT patients.
Keyword: Alcohol use problems; Hazardous drinking; Methadone maintenance
treatment (MMT); Attendance rate
84. Characteristics and 9-month outcomes of discharged methadone
maintenance clients
Donna M. Coviello, Dave A. Zanis, Susan A. Wesnoski, Kevin G. Lynch, Michelle
Drapkin
Journal of Substance Abuse Treatment 2011;40(2):165-174
ABSTRACT
This study is a secondary data analysis of a clinical trial assessing the effectiveness
of outreach case management (OCM) in linking discharged methadone patients back
into treatment. The original trial assessed the effectiveness of the OCM intervention
compared to a passive referral among methadone clients who needed treatment
postdischarge but had not reengaged. The purpose of this study was to assess the
characteristics and long-term outcomes of all clients who were discharged from
methadone maintenance treatment including those who had reengaged in treatment.
A total of 230 methadone clients were interviewed 3 months and then again at 9
months following discharge from treatment. Compared with participants who needed
treatment but had not reengaged (NoTx: 56%), those who had successfully
reenrolled in treatment (Tx; 44%) were more likely to be female, not married, and
unemployed; had a longer history of sedative use; reported more psychiatric
hospitalizations; and were originally enrolled in a community-based rather than a
Veterans Administration program. Despite having more severe problems, the Tx
group had fewer opioid-positive urines and reported less IV drug use at 9 months
postdischarge compared to the NoTx group. The findings highlight the importance of
rapid treatment reengagement.
Keywords: Methadone maintenance treatment; Treatment discharge; Treatment
reengagement
85. “Should I stay or should I go?” Coming off methadone and buprenorphine
treatment
Adam R. Winstock, Nicholas Lintzeris, Toby Lea
71
International Journal of Drug Policy 2011;22(1):77-81
ABSTRACT
Background
This study aimed to investigate patient perspectives regarding coming off
maintenance opioid substitution treatment (OST). The study explored previous
experiences, current interest and concerns about stopping treatment, and
perceptions of how and when coming off treatment should be supported.
Methods
A cross-sectional survey was used. Participants were 145 patients receiving OST at
public opioid treatment clinics in Sydney, Australia.
Results
Sixty-two percent reported high interest in coming off treatment in the next 6 months.
High interest was associated with having discussed coming off treatment with a
greater number of categories of people (OR = 1.72), not citing concern about heroin
relapse (OR = 3.18), and shorter duration of current treatment episode (OR = 0.99).
Seventy-one percent reported previous withdrawal attempts and 23% had achieved
opioid abstinence for ≥3 months following a previous withdrawal attempt. Attempts
most commonly involved jumping off (59%), and doctor-controlled (52%) or selfcontrolled (48%) gradual reduction. For future attempts respondents were most
interested in doctor-controlled (68%) or self-controlled (41%) gradual reduction.
Concerns regarding coming off treatment included withdrawal discomfort (68%),
increased pain (50%), and relapse to heroin use (48%).
Conclusion
While some patients may require lifetime maintenance, the issue of coming off
treatment is important to many patients and should be discussed regularly throughout
treatment and where appropriate supported by a menu of clinical options.
Keywords: Maintenance; Buprenorphine; Detoxification; Methadone; Opioid
substitution treatment; Withdrawal
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Psychosocial Treatment and Intervention
86. Efficacy of brief motivational intervention in reducing binge drinking in
young men: A randomized controlled trial
Jean-Bernard Daeppen, Nicolas Bertholet, Jacques Gaume, Cristiana Fortini,
Mohamed Faouzi and Gerhard Gmel
Drug and Alcohol Dependence 2011;113(1):69-75
ABSTRACT
Background
Brief motivational intervention (BMI) is one of the few effective strategies targeting
alcohol consumption, but has not been tested in young men in the community. We
evaluated the efficacy of BMI in reducing alcohol use and related problems among
binge drinkers and in maintaining low-risk drinking among non-bingers.
Methods
A random sample of a census of men included during army conscription (which is
mandatory for 20-year-old males in Switzerland) was randomized to receive a single
face-to-face BMI session (N = 199) or no intervention (N = 219). A six-month followup rate was obtained for 88.7% of the subjects.
Results
Among binge drinkers, there was 20% less drinking in the BMI group versus the
control group (incidence rate ratio = 0.80, confidence interval 0.66–0.98, p = 0.03);
the BMI group showed a weekly reduction of 1.5 drinks compared to an increase of
0.8 drinks weekly in the control group. Among subjects who experienced one or more
alcohol-related consequences over the last 12 months, there was 19% less drinking
in the BMI group compared to the control group (incidence rate ratio = 0.81,
confidence interval 0.67–0.97, p = 0.04). Among non-bingers, BMI did not contribute
to the maintenance of low-risk drinking.
Conclusion
BMI reduced the alcohol use of binge drinkers, particularly among those who
experienced certain alcohol-related adverse consequences. No preventive effect of
BMI was observed among non-bingers. BMI is a plausible secondary preventive
option for young binge drinkers.
Keywords: Brief motivational intervention; Binge drinking; Army; Brief intervention
87. Quality versus quantity: acquisition of coping skills following
computerized cognitive–behavioral therapy for substance use disorders
Brian D. Kiluk, Charla Nich,Theresa Babuscio, Kathleen M. Carroll
Addiction 2010;105(12):2120-2127
ABSTRACT
Aims To evaluate the changes over time in quality and quantity of coping skills
acquired following cognitive behavioral therapy (CBT), and examine potential
mediating effects on substance use outcomes.
Design A randomized controlled trial (RCT) evaluating the effectiveness of a
computerized version of CBT (CBT4CBT) as an adjunct to standard out-patient
treatment over an 8-week period.
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Setting Data were collected from individuals seeking treatment for substance
dependence in an out-patient community setting.
Participants Fifty-two substance abusing individuals (50% African American), with
an average age of 42 years, and a majority reporting cocaine as their primary drug of
choice.
Measurements Participants' responses to behavioral role-plays of situations
associated with high risk for drug and alcohol use were audio-taped and rated
independently to assess their coping responses.
Findings There were statistically significant increases in mean ratings of the quality
of participants' coping responses for those assigned to CBT4CBT compared to
treatment as usual, and these differences remained significant 3 months after
treatment completion. Moreover, quality of coping responses mediated the effect of
treatment on participants' duration of abstinence during the follow-up period.
Conclusions These findings suggest that assignment to the computerized CBT
program improved participants' coping skills, as measured by independent ratings of
a role-playing task. It is also the first study to test and support quality of coping skills
acquired as a mediator of the effect of CBT for substance use.
Keywords: CBT; computer-assisted therapy; coping skills; mediator; substance
use.
88. Biological and psychological interventions: Trends in substance use
disorders intervention research
Ryan Wessell, Carla Edwards Ryan Wessell, Carla Edwards
Addictive Behaviors 2010;35(12):1083-1088
ABSTRACT
Substance use disorders (SUDs) cause serious medical, financial, and social
problems for individuals and society. Thus, understanding the large body of research
exploring biological and psychological intervention trends is important to researchers
and clinicians. Historically, psychological interventions have dominated the literature,
in spite of modest outcome data. Recently, a refocus on biological intervention
research has led to results suggested as efficacious in treatment of SUDs with
promising clinical potential. The current review indicates that there seems to be some
incongruence between this growing body of physiological research and psychological
clinical research and practice. The current review explores these trends and argues
for more solid integration of biological and psychological research and treatment
strategies for SUDs, as well as heightened efforts toward translation of research into
practice.
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Services and Professionals
89. What They Want: Motivation and Treatment Choice in Nontreatment-Seeking
Substance Abusers
Katherine Michelle Peavy; Bryan N. Cochran, John Wax
Addictive Disorders & Their Treatment 2010; 9(4):150-157
ABSTRACT
Objectives: Although a variety of therapies exist for the treatment of substance use
disorders, little emphasis is placed on allowing individuals to choose their own
treatment trajectories. Considering the preference of a person for the type of
substance abuse treatment; he or she would want to be made to feel important and
in allowing the person to feel autonomous, which may impact the overall motivation
for substance abuse behavior change.
The investigators assessed 51 country detention facility inmates recently arrested on
drug-related or alcohol-related charges, examining the motivational factors and
treatment preference when presented with 2 hypothetical treatments.
The findings showed that the group was relatively evenly split in terms of the percent
choosing each treatment. Furthermore, individuals who reported preferring an
abstinence-based philosophy of treatment had higher levels of readiness to change
than those choosing a harm reduction philosophy.
Conclusions: The results of this study have implications for developing brief
interventions that could help facilitate the entry of motivated substance users into 12step groups.
90. Service Use and Barriers to Care among Heroin Users: Results from a
National Survey
Orion Mowbray, Brian E. Perron, Amy S. B. Bohnert, Amy R. Krentzman, Michael G.
Vaughn,
The American Journal of Drug and Alcohol Abuse 2010;36(6):305-310
ABSTRACT
Background: Heroin use is associated with many serious consequences.While
effective treatments exist, barriers to services persist. Understanding service use
and barriers to treatment can structure treatment practice and target interventions
for those who are most at risk.
Objectives: To describe patterns and correlates of substance abuse service
utilization and treatment barriers among a nationally representative sample of heroin
users.
Methods: Data for this study were derived from the National Epidemiologic Survey
on Alcohol and Related Conditions. This study focused on lifetime heroin users (N =
150).
Results: Fifty-nine percent of heroin users reported receiving at least one treatment
service. The most common services used were 12-step programs, detoxification,
and rehabilitation. Approximately 44% reported at least one barrier to treatment.
The most common were lack of motivation and beliefs that it could be managed
alone. In a multivariate logistic regression, having a heroin use disorder was
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associated with a greater likelihood of receiving services (OR = 6.09) and
experiencing a barrier (OR = 11.11) compared to those without a disorder.
Conclusions and Scientific Significance: High rates of service use and barriers
were observed for all levels of heroin involvement. These findings underscore the
importance of improving access to services for this group, even when full criteria for
a drug disorder is not met. Integration of motivational approaches is also needed
within the most common services used. To our knowledge, this is the first study to
describe patterns and correlates of service use using a nationally representative
community sample of heroin users.
Keywords: disparities, drug treatment, heroin use, treatment utilization
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Smoking
91. Anxiety diagnoses in smokers seeking cessation treatment: relations
with tobacco dependence, withdrawal, outcome and response to treatment
Megan E. Piper, Jessica W. Cook, Tanya R. Schlam, Douglas E. Jorenby, Timothy B.
Baker
Addiction 2011:106(2);418-427
ABSTRACT
Aims To understand the relations among anxiety disorders and tobacco
dependence, withdrawal symptoms, response to smoking cessation
pharmacotherapy and ability to quit smoking.
Design Randomized placebo-controlled clinical trial. Participants received six 10minute individual counseling sessions and either: placebo, bupropion SR, nicotine
patch, nicotine lozenge, bupropion SR + nicotine lozenge or nicotine patch + nicotine
lozenge.
Setting Two urban research sites.
Participants Data were collected from 1504 daily smokers (>9 cigarettes per day)
who were motivated to quit smoking and did not report current diagnoses of
schizophrenia or psychosis or bupropion use.
Measurements Participants completed baseline assessments, the Composite
International Diagnostic Interview and ecological momentary assessments for 2
weeks.
Findings A structured clinical interview identified participants who ever met criteria
for a panic attack (n = 455), social anxiety (n = 199) or generalized anxiety disorder
(n = 99), and those who qualified for no anxiety diagnosis (n = 891). Smokers with
anxiety disorders reported higher levels of nicotine dependence and pre-quit
withdrawal symptoms. Those ever meeting criteria for panic attacks or social anxiety
disorder showed greater quit-day negative affect. Smokers ever meeting criteria for
anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit
and showed no benefit from single-agent or combination-agent pharmacotherapies.
Conclusions Anxiety diagnoses were common among treatment-seeking smokers
and were related to increased motivation to smoke, elevated withdrawal, lack of
response to pharmacotherapy and impaired ability to quit smoking. These findings
could guide treatment assignment algorithms and treatment development for
smokers with anxiety diagnoses.
Keywords: Anxiety; cessation; smoking; tobacco dependence; treatment;
withdrawal
92. A multi-level analysis of non-significant counseling effects in a
randomized smoking cessation trial
Danielle E. McCarthy, Thomas M. Piasecki, Douglas E. Jorenby, Daniel L.
Lawrence, Saul Shiffman, Timothy B. Baker
Addiction 2010;105(12):2195-2208
ABSTRACT
77
Aims To determine, in the context of a trial in which counseling did not improve
smoking cessation outcomes, whether this was due to a failure of the conceptual
theory identifying treatment targets or the action theory specifying interventions.
Design Data from a randomized clinical trial of smoking cessation counseling and
bupropion SR were submitted to multi-level modeling to test whether counseling
influenced real-time reports of cognitions, emotions and behaviors, and whether
these targets predicted abstinence.
Setting Center for Tobacco Research and Intervention, Madison, WI.
Participants A total of 403 adult, daily smokers without contraindications to
bupropion SR use. Participants were assigned randomly to receive individual
counseling or no counseling and a 9-week course of bupropion SR or placebo pill.
Cessation counseling was delivered in eight 10-minute sessions focused on
bolstering social support, motivation, problem-solving and coping skills.
Measurements Pre- and post-quit ecological momentary assessments of smoking
behavior, smoking triggers, active prevention and coping strategies, motivation to
quit, difficulty quitting and reactions to initial lapses.
Findings Counseling prompted avoidance of access to cigarettes, improved quitting
self-efficacy, reduced perceived difficulty of quitting over time and protected against
guilt and demoralization following lapses. Results also supported the importance of
limiting cigarette access, receiving social support, strong motivation and confidence
and easing withdrawal distress during cessation efforts. Quitting self-efficacy and
perceived difficulty quitting may partially mediate counseling effects on abstinence.
Keywords: brief counseling; mechanisms of change; mediation; randomized clinical
trial; smoking cessation; tobacco dependence
93. Changes in smoking prevalence in 16–17-year-old versus older adults
following a rise in legal age of sale: findings from an English population
study
Jennifer A. Fidler, Robert West
ADDICTION 2010;105(11):1984-1988
ABSTRACT
Aim To assess smoking prevalence before and after the rise in legal age of sale of
cigarettes in England and Wales from age 16 to age 18 in October 2007.
Design A series of monthly cross-sectional household surveys: the ‘Smoking Toolkit
Study’.
Setting England.
Participants A total of 53 322 adults aged 16 and over interviewed between
October 2006 and May 2009, 1136 of whom were aged 16 or 17 years.
Measurements Change in smoking prevalence from pre- to post-legislation,
assessed by self-reported smoking status, among the 16–17-year-old group and
older adults.
Findings The prevalence change following the legislation among those aged 16 and
17 was 7.1 percentage points (denominator = 1136) compared with 2.4 percentage
points (denominator = 52 186) for older adults (odds ratio 1.36, P = 0.024, 95%
confidence interval = 1.04–1.77 for the interaction). There was no difference within
older age categories.
Conclusions There was a greater fall in prevalence in 16–17-year-olds following an
increase in age of sale than in older age groups. This provides some support to the
78
view that raising the age of sale can, at least in some circumstances, reduce smoking
prevalence in younger age groups.
Keywords: Adolescent; legislation; prevalence; public health; smoking
79
Stimulants
94. Mortality among cocaine users: A systematic review of cohort studies
Louisa Degenhardt , Jessica Singleton, Bianca Calabria, Jennifer McLaren, Thomas
Kerr, Shruti Mehta, Gregory Kirk and Wayne D. Hall
Drug and Alcohol Dependence 2011;113(2-3):88-95
ABSTRACT
Aims
To conduct a systematic review of mortality among cohort studies of cocaine users.
Methods
Three electronic databases were searched (EMBASE, Medline and PsychINFO);
other online databases were searched using online libraries and repositories of
reports and literature in the drug and alcohol field, with requested contributions from
trained librarians and experts. Searches and extraction were undertaken using
protocols and cross-checking of decisions by two authors. Additional data were
requested from study investigators where studies did not report relevant data.
Results
1911 articles and 2 reports were identified from searches, with data from another four
studies located from review articles. Seven cohorts of “problem” or dependent
cocaine users reported data that permitted mortality rates to be estimated. Crude
mortality rates ranged from 0.53 (95% CI: 0.10–1.58) to 6.16 (95% CI: 5.21–7.11) per
100PY. Standardised mortality ratios (SMRs) reported in four studies suggested that
mortality was four to eight times higher among cocaine users than age and sex peers
in the general population.
Conclusions
There are limited data on the extent of elevated mortality among problematic or
dependent cocaine users and it is unclear how generalisable the results of these
studies may be to other populations of problematic cocaine users. Greater attention
to both the method of recruitment, and the characteristics of cocaine users, would
enhance our understanding of the mortality risks of problematic cocaine use.
Keywords: Cocaine; Mortality; Review; Dependence; Cohort
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Treatment
95. Decreased bone density in men on methadone maintenance therapy
Andrew Grey, Karla Rix-Trott, Anne Horne, Greg Gamble, Mark Bolland,
Ian R. Reid
Addiction 2011:106(2);349-354
ABSTRACT
Aims Opioid use may impact adversely upon skeletal health. Participants in
methadone maintenance programmes commonly have prolonged exposure to
opioids. We sought to determine whether participants in a methadone maintenance
programme have evidence of altered bone mineral density (BMD) and bone turnover.
Design Cross-sectional study of people taking methadone maintenance therapy
(MMT).
Setting Clinical research centre.
Participants Eighty-three people (48 men, 35 women) who had taken MMT for a
median (interquartile range) of 11 (6–16) years. Comparison data were from both a
normative database and control subjects recruited and assessed at the same
location as the participants taking MMT.
Measurements BMD at lumbar spine, total hip and total body; biochemical markers
of bone turnover.
Findings In men taking MMT, BMD was lower than normal at each skeletal site
[mean, 95% confidence interval Z-score −1.1 (−1.6 to −0.7) at the lumbar spine, −1.0
(−1.3 to −0.7) at the total hip, and −1.1 (−1.4 to −0.8) at the total body, P < 0.001 at
each site]. BMD in the women taking MMT was not different from control values.
Bone turnover was within the normal range in both genders. Serum testosterone was
lower in the men taking MMT than in controls.
Conclusions BMD is lower than normal throughout the skeleton in men, but not
women, taking MMT. Assessment of skeletal health, including estimation of absolute
fracture risk, should be undertaken in men participating in methadone maintenance
programmes.
Keywords: Bone density; bone formation; bone resorption; methadone; opioids;
osteoporosis
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