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CERGA Journal Title and Abstracts June 2013
Contents
PAGE
LIST OF JOURNALS CHECKED
2
LIST OF REFERENCES
Abstinence and Recovery
3
Alcohol - Adolescents
3
Alcohol – Economics
3
Alcohol – Effects
3
Alcohol – Epidemiology and Demography
4
Alcohol – Liver Disease
4
Alcohol - Miscellaneous
5
Alcohol Pricing
5
Alcohol Services
5
Alcohol Treatment
5
Blood Borne Viruses
6
Co-Morbidity
6
Drug Education
7
Drug in Sport
7
Epidemiology and Demography
7
Intravenous Drug User
8
Miscellaneous
8
Opiate Treatment
8
Organisation of Services
10
Organisation of Treatment
10
Over the Counter
10
Pregnancy
10
Smoking
11
Stigma
11
LIST OF ABSTRACTS
12-58
1
Journal Title
Volumes and Issues Checked
Addiction
Volume 108 Issue 4[3], Issue 5[2],
Issue 6 [3]
Volume 38 Issue 5[1], Issue 6[1], Issue 7[1]
Volume 48 Issue 3[2]
Volume 37 Issue3 [5], Issue 4 [4],
Issue 5 [2], Issue 6 [4]
Volume 129 Issue 1-2[2], Issue 3[1]
Volume 130 Issue 1-3[4]
Volume 131 Issue 1-2[3]
Volume 20 Issue 2[3], Issue 3[1]
Addictive Behaviours
Alcohol and Alcoholism
Alcoholism Clinical &
Experimental Research
Drug and Alcohol Dependence
Drugs Education Prevention and
Policy
Drug and Alcohol Review
European Addiction Research
Volume 32 Issue 2[4], Issue 3[1]
Volume 18 Issue 2[1]
Volume 19 Issue 3[1]
Volume 24 Issue 2[2], Issue 3[1]
International Journal of Drug
Policy
Journal of Substance Abuse
Volume 44 Issue 4[1], Issue 5[4]
Treatment
Volume 45 Issue 1[2]
The American Journal of Drug
Volume 39 Issue 2[1]
and Alcohol Abuse
Journal of Substance Use
Volume 18 Issue 2[4]
# Items identified via Health Scotland
Special Issues:
Reports:
2
Number of issues
per year
12
12
6
12
21
6
6
4-5
6
8
6
6
ABSTINENCE AND RECOVERY
1.
The Assessment of Recovery Capital: Properties and psychometrics of a measure
of addiction recovery strengths
Teodora Groshkova, David Best, William White
Drug and Alcohol Review 2013:32(2);187-194
2.
Promoting recovery in an evolving policy context: What do we know and what
do we need to know about recovery support services?
Alexandre B. Laudet, Keith Humphreys
Journal of Substance Abuse Treatment 2013:45(1);126-133
ALCOHOL – ADOLESCENTS
3.
Alcohol use and cerebral white matter compromise in adolescence
Jonathan Elofson, Win Gongvatana, Kate B. Carey
Addictive Behaviors 2013:38(7);2295-2305
4.
The role of parenting styles and alcohol expectancies in teen binge drinking: A
preliminary investigation among Italian adolescents and their parents
Fiorenzo Laghi, Antonia Lonigro, Roberto Baiocco, Emma Baumgartner
Drug: Education, Prevention and Policy 2013:20(2);131-139
ALCOHOL - ECONOMICS
5.
The Economic Burden of Alcohol Dependence in Europe
Philippe Laramée, Jeanette Kusel, Saoirse Leonard, Henri-Jean Aubin, Clément
François and Jean-Bernard Daeppen
Alcohol and Alcoholism 2013:48(3);259-269
ALCOHOL – EFFECTS
6.
Alcohol and Sleep I: Effects on Normal Sleep
Irshaad O. Ebrahim, Colin M. Shapiro, Adrian J. Williams, Peter B. Fenwick
Alcoholism: Clinical and Experimental Research 2013:37(4);539-549
7.
Metabolic and Biochemical Effects of Low-to-Moderate Alcohol Consumption
John B. Whitfield, Andrew C. Heath, Pamela A. F. Madden, Michele L. Pergadia,
Grant W. Montgomery, Nicholas G. Martin
Alcoholism: Clinical and Experimental Research 2013:37(4);575-586
8.
Age of Onset and Neuropsychological Functioning in Alcohol Dependent
Inpatients
Leen Joos, Lianne Schmaal, Anna E. Goudriaan, Erik Fransen, Wim Van den Brink,
Bernard G. C. Sabbe, Geert Dom
Alcoholism: Clinical and Experimental Research 2013:37(3);407-416
3
9.
Determining the Threshold for Alcohol-Induced Brain Damage: New Evidence
with Gliosis Markers
Dayna M. Hayes, M. Ayumi Deeny, Carey A. Shaner, Kimberly Nixon
Alcoholism: Clinical and Experimental Research 2013:37(3);425-434
10.
Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum
Disorders
Sarah N. Mattson, Scott C. Roesch, Leila Glass, Benjamin N. Deweese, Claire D.
Coles, Julie A. Kable, Philip A. May, Wendy O. Kalberg, Elizabeth R. Sowell,
Colleen M. Adnams, Kenneth Lyons Jones, Edward P. Riley, CIFASD
Alcoholism: Clinical and Experimental Research 2013:37(3);517-528
ALCOHOL – EPIDEMIOLOGY AND DEMOGRAPHY
11.
Where the Individual Meets the Ecological: A Study of Parent Drinking
Patterns, Alcohol Outlets, and Child Physical Abuse
Bridget Freisthler, Paul J. Gruenewald
Alcoholism: Clinical and Experimental Research 2013:37(6);993-1000
12.
Motives to Drink or Not to Drink: Longitudinal Relations Among Personality,
Motives, and Alcohol Use Across Adolescence and Early Adulthood
Kristen G. Anderson, Kristen E. L. Briggs, Helene R. White
Alcoholism: Clinical and Experimental Research 2013:37(5);860-867
13.
Genetic and Environmental Predictors of Latent Trajectories of Alcohol Use
from Adolescence to Adulthood: A Male Twin Study
Marieke Wichers, Nathan A. Gillespie, Kenneth S. Kendler
Alcoholism: Clinical and Experimental Research 2013:37(3);498-506
ALCOHOL – LIVER DISEASE
14.
Fibrosis Progression in HCV Carriers with Mild Hepatitis Who Possess the
High-Repetition Variant of the DRD4 Gene, a Genetic Marker for BingeDrinking and Risk-Seeking Behavior: A Longitudinal Study
Rosalba Minisini, Elisa Boccato, Serena Favretto, Emanuele Alaimo, Carlo Smirne,
Michela E. Burlone, Simone Bocchetta, Carmen Vandelli, Cosimo Colletta,
Alessandro Colletta, Mario Pirisi
Alcoholism: Clinical and Experimental Research 2013:37(6);891-895
15.
Binge Ethanol and Liver: New Molecular Developments
Shivendra D. Shukla, Stephen B. Pruett, Gyongyi Szabo, Gavin E. Arteel
Alcoholism: Clinical and Experimental Research 2013:37(4);550-557
4
ALCOHOL – MISCELLANEOUS
16.
Physical Activity and Alcohol Use Disorders
Nadra E. Lisha,Steve Sussman, Adam M. Leventhal
The American Journal of Drug and Alcohol Abuse 2013:39(2);115-120
17.
Hospital and prehospital emergency service utilisation as an impact of acute
recreational drug and ethanol toxicity
J. R. H. Archer, P. I. Dargan, D. M. Wood, A. R. Winstock
Journal of Substance Use 2013:18(2);129-137
ALCOHOL PRICING
18.
The relationship between minimum alcohol prices, outlet densities and alcoholattributable deaths in British Columbia, 2002–09
Jinhui Zhao, Tim Stockwell, Gina Martin, Scott Macdonald, Kate Vallance, Andrew
Treno, William R. Ponicki, Andrew Tu, Jane Buxton
Addiction 2013:108(6);1059-1069
19.
Alcohol Outlet Densities and Alcohol Price: The British Columbia Experiment in
the Partial Privatization of Alcohol Sales Off-Premise
Andrew J. Treno, William R. Ponicki, Tim Stockwell, Scott Macdonald, Paul J.
Gruenewald, Jinhui Zhao, Gina Martin, Alissa Greer
Alcoholism: Clinical and Experimental Research 2013:37(5);854-859
ALCOHOL SERVICES
20.
Community alcohol detoxification: the challenge of changing service provision
Christos Kouimtsidis
Journal of Substance Use 2013:18(2);166-169
ALCOHOL TREATMENT
21.
Women's motivators for seeking treatment for alcohol use disorders
Justine A. Grosso, Elizabeth E. Epstein, Barbara S. McCrady, Ayorkor Gaba, Sharon
Cook, Lindsey M. Backer-Fulghum, Fiona S. Graff
Addictive Behaviors 2013:38(6);2236-2245
22.
The Declining Efficacy of Naltrexone Pharmacotherapy for Alcohol Use
Disorders Over Time: A Multivariate Meta-Analysis
A. C. Del Re, Natalya Maisel, Janet Blodgett, John Finney
Alcoholism: Clinical and Experimental Research 2013:37(6);1064-1068
23.
Self-Efficacy as a Predictor of Outcome After Residential Treatment Programs
for Alcohol Dependence: Simply Ask the Patient One Question!
Fabian Ludwig, Elvira Tadayon-Manssuri, Werner Strik, Franz Moggi
5
24.
Alcoholism: Clinical and Experimental Research 2013:37(4);663-667
Temptation to Drink as a Predictor of Drinking Outcomes Following
Psychosocial Treatment for Alcohol Dependence
Katie Witkiewitz
Alcoholism: Clinical and Experimental Research 2013:37(3);529-537
25.
Interventions for reducing alcohol consumption among general hospital
inpatient heavy alcohol users: A systematic review
Noreen D. Mdege, Debra Fayter, Judith M. Watson, Lisa Stirk, Amanda Sowden,
Christine Godfrey
Drug and Alcohol Dependence 2013:131(1-2);1-22
26.
The impact of training and delivering alcohol brief intervention on the
knowledge and attitudes of community pharmacists: A before and after study
Ranjita Dhital, Cate M. Whittlesea, Peter Milligan, Natasha S. Khan, Ian J. Norman
Drug and Alcohol Review 2013:32(2);147-156
BLOOD BORNE VIRUSES
27.
Decline in incidence of HIV and hepatitis C virus infection among injecting drug
users in Amsterdam; evidence for harm reduction?
Anneke S. de Vos, Jannie J. van der Helm, Amy Matser, Maria Prins, Mirjam E. E.
Kretzschmar
Addiction 2013:108(6);1070-1081
28.
Management of Hepatitis C Virus Infection in Heavy Drinkers
Charlotte E. Costentin, Jean-Baptiste Trabut, Vincent Mallet, Stéphane Darbeda,
Véronique Thépot, Bertrand Nalpas, Béatrice Badin de Montjoye, Béatrice Lavielle,
Anaïs Vallet-Pichard, Philippe Sogni, Stanislas Pol
Alcohol and Alcoholism 2013:48(3);337-342
29.
Concordance between self-reported and actual hepatitis C virus infection status
in a cohort of people who inject drugs
Daniel O'Keefe, Campbell Aitken, Peter Higgs, Paul Dietze
Drug and Alcohol Review 2013:32(2);208-210
30.
Review and meta-analysis of the association between self-reported sharing of
needles/syringes and hepatitis C virus prevalence and incidence among people
who inject drugs in Europe
Norah E. Palmateer, Sharon J. Hutchinson, Hamish Innes, Christian Schnier, Olivia
Wu, David J. Goldberg, Matthew Hickman
International Journal of Drug Policy 2013:24(2);85-100
CO-MORBIDITY
31.
Genetic Markers of Comorbid Depression and Alcoholism in Women
Daniela O. Procopio, Laura M. Saba, Henriette Walter, Otto Lesch, Katrin Skala,
Golda Schlaff, Lauren Vanderlinden, Peter Clapp, Paula L. Hoffman, Boris Tabakoff
6
Alcoholism: Clinical and Experimental Research 2013:37(6);896-904
32.
The prevalence of substance use disorders and psychiatric disorders as a
function of psychotic symptoms
William V. Lechner, Jennifer Dahne, Kevin W. Chen, Alison Pickover, Jessica M.
Richards, Stacey B. Daughters, C.W. Lejuez
Drug and Alcohol Dependence 2013:131(1-2);78-84
DRUG EDUCATION
33.
Internet content regulation, public drug websites and the growth in hidden
Internet services
Monica J. Barratt, Simon Lenton, Matthew Allen
Drugs: Education, Prevention and Policy 2013:20(3);195-202
DRUGS IN SPORT
34.
The Doping Myth: 100 m sprint results are not improved by ‘doping’
Aaron Hermann, Maciej Henneberg
International Journal of Drug Policy 2013:24(2);110-114
EPIDEMIOLOGY AND DEMOGRAPHY
35.
Childhood sexual abuse and early substance use in adolescent girls: the role of
familial influences
Carolyn E. Sartor, Mary Waldron, Alexis E. Duncan, Julia D. Grant, Vivia V.
McCutcheon, Elliot C. Nelson, Pamela A. F. Madden, Kathleen K. Bucholz, Andrew
C. Heath
Addiction 2013:108(5);993-1000
36.
Predictors of Repeated Emergency Department Visits among Persons Treated
for Addiction
Hansagi H, Engdahl B, Romelsjö A
European Addiction Research 2012:18(2);47–53
37.
Trends of heroin use and heroin injection epidemics in Europe: Findings from
the EMCDDA treatment demand indicator (TDI)
Gregorio Barrio, Linda Montanari, María J. Bravo, Bruno Guarita, Luis de la Fuente,
José Pulido, Julián Vicente
Journal of Substance Abuse Treatment 2013:45(1);19-30
38.
Weight-related concerns related to drug use for women in substance abuse
treatment: Prevalence and relationships with eating pathology
Cortney S. Warren, Anne R. Lindsay, Emily K. White, Kim Claudat, Sara C.
Velasquez,
Journal of Substance Abuse Treatment 2013:44(5);494-501
7
INTRAVENOUS DRUG USER
39.
Early life influences on the risk of injecting drug use: case control study based on
the Edinburgh Addiction Cohort
John Macleod, Matthew Hickman, Hayley E. Jones, Lorraine Copeland, James
McKenzie, Daniela De Angelis, Jo Kimber, James R. Robertson2
Addiction 2013:108(4);743-750
40.
The dynamic relationship between social norms and behaviors: the results of an
HIV prevention network intervention for injection drug users
Carl Latkin, Deborah Donnell, Ting-Yuan Liu, Melissa Davey-Rothwell, David
Celentano, David Metzger
Addiction 2013:108(5);934-943
MISCELLANEOUS
41.
Development of dependence following treatment with opioid analgesics for pain
relief: a systematic review
Silvia Minozzi, Laura Amato, Marina Davoli
Addiction 2013:108(4);688-698
42.
Update on tamper-resistant drug formulations
M.K. Romach, K.A. Schoedel, E.M. Sellers
Drug and Alcohol Dependence 2013:130(1-3);13-23
43.
Tuberculosis, injecting drug use and integrated HIV-TB care: A review of the
literature
Pippa Grenfell, Ricardo Baptista Leite, Richard Garfein, Smiljka de Lussigny, Lucy
Platt, Tim Rhodes
Drug and Alcohol Dependence 2013:129(3);180-209
44.
The stigmatization of problem drug users: A narrative literature review
Charlie Lloyd
Drugs: Education, Prevention and Policy 2013:20(2);85-95
45.
YouTube, ‘drug videos’ and drugs education
Paul Manning
Drugs: Education, Prevention and Policy 2013:20(2);120-130
OPIATE TREATMENT
46.
To enforce or engage: The relationship between coercion, treatment motivation
and therapeutic alliance within community-based drug and alcohol clients
Samantha Wolfe, Frances Kay-Lambkin, Jenny Bowman, Steven Childs
Addictive Behaviours 2013:38(5);2187-2195
8
47.
Decision-making deficits are still present in heroin abusers after short- to longterm abstinence
Xinyu Li, Feng Zhang, Ying Zhou, Meng Zhang, Xuan Wang, Mowei Shen
Drug and Alcohol Dependence 2013:130(1-3);61-67
48.
A randomized investigation of methadone doses at or over 100 mg/day,
combined with contingency management
Ashley P. Kennedy, Karran A. Phillips, David H. Epstein, David A. Reamer, John
Schmittner, Kenzie L. Preston
Drug and Alcohol Dependence 2013:130(1-3);77-84
49.
Corrected QT interval during treatment with methadone and buprenorphine—
Relation to doses and serum concentrations
Marianne Stallvik, Berit Nordstrand, Øistein Kristensen, Jørn Bathen, Eirik Skogvoll,
Olav Spigset
Drug and Alcohol Dependence 2013:129(1-2);88-93
50.
Utilization of communication technology by patients enrolled in substance abuse
treatment
Erin A. McClure, Shauna P. Acquavita, Emily Harding, Maxine L. Stitzer
Drug and Alcohol Dependence 2013:129(1-2);145-150
51.
Can Heroin-Dependent Individuals Benefit from a Methadone Maintenance
Treatment Program before They Drop Out against Medical Advice? A 12-Month
Follow-Up Study
Wang P.-W, Wu H.-C, Lin H.-C, Yen C.-N, Yeh Y.-C, Chung K.-S, Chang H.-C,
Yen C.-F.
European Addiction Research 2013:19(3);155–164
52.
Opioid substitution therapy clients' preferences for targeted versus general
primary health-care outlets
M. Mofizul Islam, Libby Topp, Katherine M. Conigrave, Carolyn A. Day
Drug and Alcohol Review 2013:32(2);211-214
53.
Non-prescribed use of substitution of medication among German drug users –
Prevalence, motives and availability
Christiane Sybille Schmidt, Bernd Schulte, Christian Wickert, Katja Thane, Silke
Kuhn, Uwe Verthein, Jens Reimer
International Journal of Drug Policy 2013:24(3):In Press, Corrected Proof,
Available online 31 May 2013
54.
Forced withdrawal from methadone maintenance therapy in criminal justice
settings: A critical treatment barrier in the United States
Jeannia J. Fu, Nickolas D. Zaller, Michael A. Yokell, Alexander R. Bazazi, Josiah D.
Rich
Journal of Substance Abuse Treatment 2013:44(5);502-505
9
55.
Effectiveness of drug tests in outpatients starting opioid substitution therapy
Julie Dupouy, Lise Dassieu, Robert Bourrel, Jean-Christophe Poutrain, Serge
Bismuth, Stéphane Oustric, Maryse Lapeyre-Mestre
Journal of Substance Abuse Treatment 2013:44(5);515-521
56.
Minimum recommended physical activity, and perceived barriers and benefits of
exercise in methadone maintained persons
Celeste M. Caviness, Jessica L. Bird, Bradley J. Anderson, Ana M. Abrantes, Michael
D. Stein
Journal of Substance Abuse Treatment 2013:44(4);457-462
ORGANISATION OF SERVICES
57.
The cost of providing primary health-care services from a needle and syringe
program: A case study
M. Mofizul Islam, Marian Shanahan, Libby Topp, Katherine M. Conigrave, Ann
White, Carolyn A. Day
Drug and Alcohol Review 2013:32(3);312-319
ORGANISATION OF TREATMENT
58.
Quality of clinical supervision and counselor emotional exhaustion: The potential
mediating roles of organizational and occupational commitment
Hannah K. Knudsen, Paul M. Roman, Amanda J. Abraham
Journal of Substance Abuse Treatment 2013:44(5);528-533
OVER THE COUNTER
59.
“I just wanted to tell you that loperamide WILL WORK”: A web-based study of
extra-medical use of loperamide
Raminta Daniulaityte, Robert Carlson, Russel Falck, Delroy Cameron, Sujan Perera,
Lu Chen, Amit Sheth
Drug and Alcohol Dependence 2013:130(1-3);241-244
60.
Over-the-counter medicine abuse – a review of the literature
Richard J. Cooper
Journal of Substance Use 2013:18(2);82-107
PREGNANCY
61.
Methadone dosing and prescribed medication use in a prospective cohort of
opioid-dependent pregnant women
Brian J. Cleary, Kieran Reynolds, Maeve Eogan, Michael P. O'Connell, Tom Fahey,
Paul J. Gallagher, Tom Clarke, Martin J. White, Christine McDermott, Anne
O'Sullivan, Deirdre Carmody, Justin Gleeson, Deirdre J. Murphy
10
62.
Addiction 2013:108(4);762-770
2-year prospective study of psychological distress among a national cohort of
pregnant women in opioid maintenance treatment and their partners
Ingunn Olea Lund, Svetlana Skurtveit, Monica Sarfi, Brittelise Bakstad, Gabrielle
Welle-Strand Edle Ravndal
Journal of Substance Use 2013:18(2);148-160
SMOKING
63.
‘Vaping’ profiles and preferences: an online survey of electronic cigarette users
Lynne Dawkins, John Turner, Amanda Roberts, Kirstie Soar
Addiction 2013:108(6);1115-1125
STIGMA
64.
Stigma among health professionals towards patients with substance use
disorders and its consequences for healthcare delivery: Systematic review
Leonieke C. van Boekel, Evelien P.M. Brouwers, Jaap van Weeghel, Henk F.L.
Garretsen
Drug and Alcohol Dependence 2013:131(1-2);23-35
11
ABSTINENCE AND RECOVERY
1. The Assessment of Recovery Capital: Properties and psychometrics of a measure of
addiction recovery strengths
Teodora Groshkova, David Best, William White
Drug and Alcohol Review 2013:32(2);187-194
Abstract
Introduction and Aims Sociological work on social capital and its impact on health
behaviours have been translated into the addiction field in the form of ‘recovery capital’ as
the construct for assessing individual progress on a recovery journey. Yet there has been little
attempt to quantify recovery capital. The aim of the project was to create a scale that assessed
addiction recovery capital. Design and Methods Initial focus group work identified and
tested candidate items and domains followed by data collection from multiple sources to
enable psychometric assessment of a scale measuring recovery capital. Results The scale
shows moderate test–retest reliability at 1 week and acceptable concurrent validity. Principal
component analysis determined single factor structure. Discussion and Conclusions The
Assessment of Recovery Capital (ARC) is a brief and easy to administer measurement of
recovery capital that has acceptable psychometric properties and may be a useful complement
to deficit-based assessment and outcome monitoring instruments for substance dependent
individuals in and out of treatment.
Keywords: addiction; recovery capital measure; assessment; psychometrics
2. Promoting recovery in an evolving policy context: What do we know and what do we
need to know about recovery support services?
Alexandre B. Laudet, Keith Humphreys
Journal of Substance Abuse Treatment 2013:45(1);126-133
Abstract
As both a concept and a movement, “recovery” is increasingly guiding substance use disorder
(SUD) services and policy. One sign of this change is the emergence of recovery support
services that attempt to help addicted individuals using a comprehensive continuing care
model. This paper reviews the policy environment surrounding recovery support services, the
needs to which they should respond, and the status of current recovery support models. We
conclude that recovery support services (RSS) should be further assessed for effectiveness
and cost-effectiveness, that greater efforts must be made to develop the RSS delivery
workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive,
integrated and patient-centered health care system. As the SUD treatment system undergoes
its most important transformation in at least 40 years, recovery research and the lived
experience of recovery from addiction should be central to reform.
Keywords: Substance use disorders; Recovery; Recovery services; Peer supports
12
ALCOHOL – ADOLESANTS
3. Alcohol use and cerebral white matter compromise in adolescence
Jonathan Elofson, Win Gongvatana, Kate B. Carey
Addictive Behaviors 2013:38(7);2295-2305
Abstract
Alcohol use is typically initiated during adolescence, a period known to be critical in
neurodevelopment. The adolescent brain may be particularly susceptible to the harmful
effects of alcohol. While the cognitive deficits associated with alcohol use during
adolescence have been well-documented, the neural substrates underlying these effects
remain inadequately understood. Cerebral white matter has been suggested as a primary site
of alcohol-related damage and diffusion tensor imaging (DTI) allows for the quantification of
white matter integrity in vivo. This review summarizes results from both cross-sectional and
longitudinal studies employing DTI that indicate that white matter tracts, particularly those
thought to be involved in executive functioning, continue to develop throughout adolescence
and into adulthood. Numerous DTI studies reveal a positive correlation between white matter
integrity and neurocognitive performance and, in adults, the detrimental effects of prolonged
alcohol-dependence on white matter integrity. We provide a comprehensive review of the
DTI studies exploring the relationship between alcohol use and white matter integrity in
adolescents. Results from most of these studies suggest that alcohol use is associated with
reduced white matter integrity, particularly in the superior longitudinal fasciculus (SLF), and
some evidence suggests that this relationship may be influenced by sex. We conclude by
highlighting confounds and limitations of the available research and suggesting directions for
future research. Highlights White matter continues to develop throughout adolescence and
into early adulthood. White matter compromise can relate to poor cognition. In adults, heavy
alcohol use is linked to white matter damage. The effect of alcohol use on white matter
integrity is less clear in adolescents. Better-designed and longitudinal studies are needed to
clarify this relationship.
Keywords: White matter; Adolescent; Alcohol use; Drinking; Brain
4. The role of parenting styles and alcohol expectancies in teen binge drinking: A
preliminary investigation among Italian adolescents and their parents
Fiorenzo Laghi, Antonia Lonigro, Roberto Baiocco, Emma Baumgartner
Drug: Education, Prevention and Policy 2013:20(2);131-139
Abstract
As adolescents’ alcohol abuse is more widespread almost everywhere, the aim of this study
was to better understand the influence of both alcohol expectancies and parenting styles on
this risky behaviour in order to allow the development of future prevention programmes, by
evaluating the correlation between these variables. A total of 1500 subjects participated in
this study: 500 high school students were asked to complete different questionnaires
concerning their consumption attitude, and their beliefs on alcohol, whereas their parents
(N = 1000) were asked to evaluate parenting styles. According to previous studies, the sample
was classified into non-drinkers, social, binge and heavy drinkers. Consistent with the
hypothesis, statistical analysis showed that both alcohol expectancies and parenting style
significantly differ within these groups, thus being powerful predictors of high-risk drinking
patterns.
13
14
ALCOHOL - ECONOMICS
5. The Economic Burden of Alcohol Dependence in Europe
Philippe Laramée, Jeanette Kusel, Saoirse Leonard, Henri-Jean Aubin, Clément François and
Jean-Bernard Daeppen
Alcohol and Alcoholism 2013:48(3);259-269
Abstract
Aims To determine the economic burden pertaining to alcohol dependence in Europe.
Methods Database searching was combined with grey literature searching to identify costs
and resource use in Europe relating to alcohol dependence as defined by the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV) or the World Health Organisation’s
International Classification of Diseases (ICD-10). Searches combined MeSH headings for
both economic terms and terms pertaining to alcohol dependence. Relevant outcomes
included direct healthcare costs and indirect societal costs. Main resource use outcomes
included hospitalization and drug costs. Results Compared with the number of studies of the
burden of alcohol use disorders in general, relatively few focussed specifically on alcohol
dependence. Twenty-two studies of variable quality were eligible for inclusion. The direct
costs of alcohol dependence in Europe were substantial, the treatment costs for a single
alcohol-dependent patient lying within the range €1591–€7702 per hospitalization and the
annual total direct costs accounting for 0.04–0.31% of an individual country’s gross
domestic product (GDP). These costs were driven primarily by hospitalization; in contrast,
the annual drug costs for alcohol dependence were low. The indirect costs were more
substantial than the direct costs, accounting for up to 0.64% of GDP per country annually.
Alcohol dependence may be more costly in terms of health costs per patient than alcohol
abuse. Conclusions This review confirms that alcohol dependence represents a significant
burden for European healthcare systems and society. Difficulties in comparing
across cost-of-illness studies in this disease area, however, prevent specific estimation of the
economic burden.
Keywords: alcohol dependence; alcoholism; economic burden; Europe
15
ALCOHOL – EFFECTS
6. Alcohol and Sleep I: Effects on Normal Sleep
Irshaad O. Ebrahim, Colin M. Shapiro, Adrian J. Williams, Peter B. Fenwick
Alcoholism: Clinical and Experimental Research 2013:37(4);539-549
Abstract
This review provides a qualitative assessment of all known scientific studies on the impact of
alcohol ingestion on nocturnal sleep in healthy volunteer's. At all dosages, alcohol causes a
reduction in sleep onset latency, a more consolidated first half sleep and an increase in sleep
disruption in the second half of sleep. The effects on rapid eye movement (REM) sleep in the
first half of sleep appear to be dose related with low and moderate doses showing no clear
trend on REM sleep in the first half of the night whereas at high doses, REM sleep reduction
in the first part of sleep is significant. Total night REM sleep percentage is decreased in the
majority of studies at moderate and high doses with no clear trend apparent at low doses. The
onset of the first REM sleep period is significantly delayed at all doses and appears to be the
most recognizable effect of alcohol on REM sleep followed by the reduction in total night
REM sleep. The majority of studies, across dose, age and gender, confirm an increase in slow
wave sleep (SWS) in the first half of the night relative to baseline values. The impact of
alcohol on SWS in the first half of night appears to be more robust than the effect on REM
sleep and does not appear to be an epiphenomenon REM sleep reduction. Total night SWS is
increased at high alcohol doses across gender and age groups.
Keywords: Alcohol Provocation Test; Alcohol Challenge; Polysomnography; Sleep
Physiology
7. Metabolic and Biochemical Effects of Low-to-Moderate Alcohol Consumption
John B. Whitfield, Andrew C. Heath, Pamela A. F. Madden, Michele L. Pergadia, Grant W.
Montgomery, Nicholas G. Martin
Alcoholism: Clinical and Experimental Research 2013:37(4);575-586
Abstract
Background Alcohol consumption has multiple biochemical consequences. Only a few of
these are useful as diagnostic markers, but many reflect potentially harmful or beneficial
effects of alcohol. Average consumption of 2 to 4 drinks per day is associated with lower
overall or cardiovascular mortality risk than either lower or higher intake. We have analyzed
the dose–response relationships between reported alcohol consumption and 17 biomarkers,
with emphasis on intake of up to 3 drinks per day. Methods Biochemical tests were
performed on serum from 8,396 study participants (3,750 men and 4,646 women, aged
51 ± 13 years, range 18 to 93) who had provided information on alcohol consumption in the
week preceding blood collection. Results Gamma glutamyl transferase, alanine
aminotransferase, aspartate aminotransferase, carbohydrate-deficient transferrin, urate,
ferritin, and bilirubin showed little or no change with alcohol consumption below 2 to 3
drinks per day, but increased with higher intake. High-density lipoprotein cholesterol and
albumin showed increasing results, and insulin showed decreasing results, across the entire
range of alcohol use. Biphasic responses, where subjects reporting 1 to 2 drinks per day had
lower results than those reporting either more or less alcohol use, occurred for triglycerides,
glucose, C-reactive protein, alkaline phosphatase, and butyrylcholinesterase. Increasing
alcohol use was associated with decreasing low-density lipoprotein cholesterol (LDL-C) in
16
younger women, but higher LDL-C in older men. Conclusions Some markers show
threshold relationships with alcohol, others show continuous ones, and a third group show
biphasic or U-shaped relationships. Overall, the biochemical sequelae of low-to-moderate
alcohol use are consistent with the epidemiological evidence on morbidity and mortality.
Keywords: Alcohol; Biomarkers; Dose–Response Curve; Population Study
8. Age of Onset and Neuropsychological Functioning in Alcohol Dependent Inpatients
Leen Joos, Lianne Schmaal, Anna E. Goudriaan, Erik Fransen, Wim Van den Brink, Bernard
G. C. Sabbe, Geert Dom
Alcoholism: Clinical and Experimental Research 2013:37(3);407-416
Abstract
Background Differences in clinical characteristics between early and late onset alcohol
dependent patients have been examined intensively, but little is known about the differences
in neuropsychological functioning between these patient groups. Clinical characteristics and
neuropsychological functions of inpatients with early onset and late onset alcohol dependence
are therefore investigated in this study. Methods Ninety-three abstinent alcohol dependent
inpatients meeting a current diagnosis of DSM-IV alcohol dependence were divided into
early onset alcohol dependent patients (EOA; ≤25 years; n = 36) and late onset alcohol
dependent patients (LOA; >25 years; n = 57). Patients using psychoactive medication and
patients dependent on other substances than alcohol (and nicotine) were excluded. A
comprehensive neuropsychological test battery was administered. Results EOA reported
higher trait impulsivity, antisocial traits, and attention deficit hyperactivity disorder-related
traits and exhibited an impulsive reflection style, especially in a high-risk context, compared
with LOA. Against expectations, EOA performed significantly better on measures of
planning, cognitive control, visual memory, and delayed recognition memory than LOA,
whereas no significant group differences occurred on measures of delay discounting, digit
span, and attention. Better Stroop interference, better visual memory, and a more impulsive
reflection style was predictive of an early age of onset, and explained a significant and
additional amount of variance (18.8%) on top of the clinical characteristics, together
explaining 53.4% of the variance. Conclusions Both clinical characteristics and
neuropsychological variables contributed independently to the age of onset of problematic
alcohol use. Results indicate that especially an impulsive reflection style, besides higher trait
impulsivity, may be the core feature of early onset alcohol dependence. However, the
contribution of the neuropsychological variables is complex and more research is needed to
clarify the role of psychiatric comorbidity and poly-substance abuse in an unselected sample
of alcohol dependent patients.
Keywords: Age of Onset; Alcohol Dependence; Neuropsychological Functioning;
Impulsivity; Comorbidity
9. Determining the Threshold for Alcohol-Induced Brain Damage: New Evidence with
Gliosis Markers
Dayna M. Hayes, M. Ayumi Deeny, Carey A. Shaner, Kimberly Nixon
Alcoholism: Clinical and Experimental Research 2013:37(3);425-434
Abstract
Background Chronic intake of ethanol (EtOH) has been linked to serious health
consequences such as cardiac and liver problems, cognitive impairments, and brain damage.
17
Alcohol's detrimental effects depend upon the dose, duration, and pattern of exposure with
binge drinking as one of the most common, but most damaging, patterns of intake. Little is
known about the threshold of the damaging effects of alcohol. Therefore, these experiments
sought to determine a threshold for brain damage using various markers of
neurodegeneration. Methods Adult male Sprague–Dawley rats were administered
nutritionally complete liquid diet containing either EtOH (25% w/v) or isocaloric dextrose
every 8 hours for either 1 (mean dose, 13.4 ± 0.3 g/kg/d; mean blood EtOH concentration
(BEC), 336.2 ± 18.8 mg/dl) or 2 days (mean dose, 10.9 ± 0.3 g/kg/d; mean BEC,
369.8 ± 18.1 mg/dl). On the basis of a known time course of various neurodegenerationassociated events, rats were perfused transcardially immediately following, 2 days after, or
7 days post EtOH exposure. To label actively dividing cells, some animals were injected with
BromodeoxyUridine (BrdU) 2 hours prior to perfusion. Tissue was then analyzed for the
presence of BrdU (cell proliferation), FluoroJade B (degenerative neurons), and vimentin
(reactive astrogliosis) immunoreactivity. Results One or 2 days of EtOH exposure failed to
alter cell proliferation at any of the time points analyzed. However, significant 2- to 9-fold
increases in neuronal degeneration in limbic cortex and clear evidence of reactive gliosis as
indicated by a 2- to 8-fold upregulation in vimentin immunoreactivity in the hippocampus
were observed following as little as 1 day of binge EtOH exposure. Conclusions These
results indicate that as little as 1 day (24 hours) of high BEC, binge-like EtOH exposure is
enough to elicit signs of alcohol-induced brain damage in adult rats. Further, reactive gliosis
may be a more sensitive marker of alcohol-induced damage in the hippocampus.
Keywords: Alcoholism; Neurodegeneration; Binge; Ethanol
10. Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum
Disorders
Sarah N. Mattson, Scott C. Roesch, Leila Glass, Benjamin N. Deweese, Claire D. Coles, Julie
A. Kable, Philip A. May, Wendy O. Kalberg, Elizabeth R. Sowell, Colleen M. Adnams,
Kenneth Lyons Jones, Edward P. Riley, CIFASD
Alcoholism: Clinical and Experimental Research 2013:37(3);517-528
Abstract
Background Heavy prenatal alcohol exposure (AE) results in a broad array of
neurobehavioral deficits. Recent research has focused on identification of a neurobehavioral
profile or profiles that will improve the identification of children affected by AE. This study
aimed to build on our preliminary neurobehavioral profile to improve classification accuracy
and test the specificity of the resulting profile in an alternate clinical group. Methods A
standardized neuropsychological test battery was administered to 3 groups of children:
subjects with AE (n = 209), typically developing controls (CON, n = 185), and subjects with
attention-deficit/hyperactivity disorder (ADHD, n = 74). We assessed a large sample from 6
sites in the United States and South Africa, using standardized methodology. Data were
analyzed using 3 latent profile analyses including (i) subjects with fetal alcohol syndrome
(FAS) and controls, (ii) subjects with AE without FAS and controls, and (iii) subjects with
AE (with or without FAS) and subjects with ADHD. Results Classification accuracy was
moderate but significant across the 3 analyses. In analysis 1, overall classification accuracy
was 76.1% (77.2% FAS, 75.7% CON). In the second analysis, overall classification accuracy
was 71.5% (70.1% AE/non-FAS, 72.4% CON). In the third analysis, overall classification
accuracy was 73.9% (59.8% AE, 75.7% ADHD). Subjects that were misclassified were
examined for systematic differences from those that were correctly classified. Conclusions
The results of this study indicate that the neuropsychological effects of AE are clinically
18
meaningful and can be used to accurately distinguish alcohol-affected children from both
typically developing children and children with ADHD. Further, in combination with other
recent studies, these data suggest that approximately 70% of children with heavy prenatal
alcohol exposure are neurobehaviorally affected, while the remaining 30% are spared these
often-devastating consequences, at least those in the domains under study. Refining the
neurobehavioral profile will allow improved identification and treatment development for
children affected by prenatal alcohol exposure
Keywords: Fetal Alcohol Syndrome (FAS); Prenatal Alcohol Exposure; Neurobehavioral
Profile; Attention-Deficit/Hyperactivity Disorder (ADHD); Latent Profile Analysis (LPA)
19
ALCOHOL – EPIDEMIOLOGY AND DEMOGRAPHY
11. Where the Individual Meets the Ecological: A Study of Parent Drinking Patterns,
Alcohol Outlets, and Child Physical Abuse
Bridget Freisthler, Paul J. Gruenewald
Alcoholism: Clinical and Experimental Research 2013:37(6);993-1000
Abstract
Background Despite well-known associations between heavy drinking and child physical
abuse, little is known about specific risks related to drinking different amounts of alcohol in
different drinking venues. This study uses a context-specific dose–response model to examine
how drinking in various venues (e.g., at bars or parties) is related to physically abusive
parenting practices while controlling for individual and psychosocial characteristics.
Methods Data were collected via a telephone survey of parents in 50 cities in California,
resulting in 2,163 respondents who reported drinking in the past year. Child physical abuse
and corporal punishment were measured using the Conflict Tactics Scale, Parent–Child
version. Drinking behaviors were measured using continued drinking measures. Data were
analyzed using zero-inflated Poisson models. Results Drinking at homes, parties, or bars
more frequently was related to greater frequencies of physically abusive parenting practices.
The use of greater amounts of alcohol in association with drinking at bars appeared to
increase risks of corporal punishment, a dose–response effect. Dose–response relationships
were not found for drinking at homes or parties or drinking at bars for physical abuse nor for
drinking at home and parties for corporal punishment. Conclusions Frequencies of using
drinking venues, particularly bars and home or parties, are associated with greater use of
abusive parenting practices. These findings suggest that a parent's routine drinking activities
place children at different risks of being physically abused. They also suggest that
interventions that take into account parents’ alcohol use at drinking venues are an important
avenue for secondary prevention efforts.
Keywords: Dose–Response Alcohol Use; Drinking Venues; Child Physical Abuse;
Alcohol Outlets
12. Motives to Drink or Not to Drink: Longitudinal Relations Among Personality,
Motives, and Alcohol Use Across Adolescence and Early Adulthood
Kristen G. Anderson, Kristen E. L. Briggs, Helene R. White
Alcoholism: Clinical and Experimental Research 2013:37(5);860-867
Abstract
Background Adolescent selective intervention programs for alcohol have focused on the
identification of youth at risk as a function of personality and associated alcohol-related
cognitions. Research into the role of personality, drinking motivations, and alcohol-related
outcomes has generally focused exclusively on motives to drink. We expand on this literature
by focusing on both motives to drink and motives not to drink across time from adolescence
to early adulthood in a community sample. Methods Using 3 waves of data from 3 cohorts
from the Rutgers Health and Human Development Project (n = 1,380; 49.4% women), we
modeled the influence of baseline alcohol consumption, disinhibition (DIS), and harm
avoidance (ages 15, 18, and 21 years) on drinking motives and motives not to drink 3 years
later (ages 18, 21, and 24 years) and alcohol use and drinking-related problems 7 years
subsequently (ages 25, 28, and 31 years). Results Path analytic models were relatively
20
invariant across cohort. Across cohorts, DIS and baseline alcohol consumption related to later
positive reinforcement drinking motives, but less consistency was found for the prediction of
negative reinforcement motives to drink. While positive reinforcement motives were
associated with greater alcohol consumption and problems 7 years later, negative
reinforcement motives were generally associated with problems alone. Positive reinforcement
motives for drinking mediated relations between baseline consumption and later
consumption. However, results were mixed when considering DIS as a predictor and drinking
problems as an outcome. Similarly, personality and baseline consumption related to later
motives not to drink and such motives predicted subsequent alcohol-related problems.
However, mediation was not generally supported for pathways through motives to abstain.
Conclusions The results of this study replicate and extend previous longitudinal findings
with youth and add to the growing literature on motivations not to engage in alcohol use.
Keywords: Motives Not to Drink; Drinking Motives; Alcohol Use and Problems; Young
Adults
13. Genetic and Environmental Predictors of Latent Trajectories of Alcohol Use from
Adolescence to Adulthood: A Male Twin Study
Marieke Wichers, Nathan A. Gillespie, Kenneth S. Kendler
Alcoholism: Clinical and Experimental Research 2013:37(3);498-506
Abstract
Background Adolescence is characterized by higher levels of novelty-seeking and risktaking behavior, including initiation of alcohol use. Also, there is considerable heterogeneity
in the change and continuity of alcohol use over time, which emphasizes the need to examine
factors predicting alcohol use and the patterns of use over time. Methods Retrospective data
on average monthly alcohol use and risk and protective factors were obtained through
interviews and questionnaires in 1,560 adult male twins. Latent class growth analysis in
Mplus was performed on data of alcohol use over ages 15 to 36. Second, logistic regression
analyses were used to associate risk and protective characteristics with membership in
distinct latent trajectories of alcohol use. Results Six trajectories of alcohol use were
identified, varying in the level of alcohol use, the rate of change in use in early adolescence
and the persistence of use into adulthood. Genetic risk of externalizing disorder and peer
deviance showed the greatest risks for unfavorable alcohol trajectories with higher levels of
use and higher rates of early increase in use. Parental monitoring and involvement in social
activities showed protective effects. Involvement in religious activities was strongly
associated with reduced persistence of high-level drinking in univariate but not multivariate
regression analyses. Conclusions Risk and protective factors impacted differentially on
level of alcohol use, rate of increase in use during adolescence, and persistence of heavy
alcohol use over time. Insight into the different ways in which predictors impact on alcohol
use is relevant for the development of new intervention strategies. For this purpose, causality
of the associations should be further examined.
Keywords: Latent Class Growth Analysis; Adolescence; Alcohol Use; Genetic and
Environmental Risk Factors
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ALCOHOL – LIVER DISEASE
14. Fibrosis Progression in HCV Carriers with Mild Hepatitis Who Possess the HighRepetition Variant of the DRD4 Gene, a Genetic Marker for Binge-Drinking and RiskSeeking Behavior: A Longitudinal Study
Rosalba Minisini, Elisa Boccato, Serena Favretto, Emanuele Alaimo, Carlo Smirne, Michela
E. Burlone, Simone Bocchetta, Carmen Vandelli, Cosimo Colletta, Alessandro Colletta,
Mario Pirisi
Alcoholism: Clinical and Experimental Research 2013:37(6);891-895
Abstract
Background Alcohol is a major determinant of the outcome of chronic hepatitis C virus
(HCV) infection, but self-reported drinking habits lack reliability. We hypothesized that
carriage of high-repetition variants (HRV) of the variable number of tandem repeats (VNTR)
in exon III of the dopamine receptor D4 gene, linked to binge-drinking and risk-seeking
behavior, might be a proxy measure of alcohol consumption, and aimed to verify whether it
may affect histologic outcome. Methods A cohort of HCV patients with normal or nearnormal aminotransferases (N = 128) underwent a liver biopsy as part of diagnostic work-up.
None admitted to exceed low-risk alcohol consumption; most (90/128, 70%) described
themselves as teetotalers. They received advice on abstaining from alcohol, but not antiviral
treatment. After a median follow-up period of 10 years, all underwent a second liver biopsy.
HRV allele frequencies were compared with those of a group of healthy blood donors
(N = 128) and related to liver histology. Results HRV allele frequencies were 0.19 in
patients and 0.16 in controls (p = 0.182). In the subgroup of patients who admittedly had
consumed alcohol, 20/38 (53%) carried HRV, in comparison with 27/90 patients (30%) who
had denied to consume alcohol (p = 0.026 by Fisher's exact test). Carriage of HRV was
associated with higher histologic grade (p = 0.002) and stage (p = 0.009) at the final biopsy.
At multivariate analysis, among a set of variables also including viral genotype, viral load,
body mass index, gender, and history of alcohol consumption, only age (OR = 1.06, 95% CI
1.02 to 1.11) and HRV (OR = 3.13, 95% CI 1.28 to 7.68) were independent predictors of
significant fibrosis at the end of follow-up. Conclusions The link between HRV carriage
and histologic outcome in a subgroup of HCV patients at low risk of progression underlines
the need for intense scrutiny of alcohol habits in hepatitis C.
Keywords: DRD4 Allele; Alcohol Consumption; HCV
15. Binge Ethanol and Liver: New Molecular Developments
Shivendra D. Shukla, Stephen B. Pruett, Gyongyi Szabo, Gavin E. Arteel
Alcoholism: Clinical and Experimental Research 2013:37(4);550-557
Abstract
Binge consumption of alcohol is an alarming global health problem. Binge (acute) ethanol
(EtOH) is implicated in the pathophysiology of alcoholic liver disease (ALD). New studies
from experimental animals and from humans indicate that binge EtOH has profound effects
on immunological, signaling, and epigenetic parameters of the liver. This is in addition to the
known metabolic effects of acute EtOH. Binge EtOH alters the levels of several cellular
components and dramatically amplifies liver injury in chronically EtOH exposed liver. These
studies highlight the importance of molecular investigations into binge effects of EtOH for a
better understanding of ALD and also to develop therapeutic strategies to control it. This
review summarizes these recent developments.
22
Keywords: Acute Ethanol; Alcoholic Liver Disease; Binge Ethanol; Liver Injury
ALCOHOL – MISCELLANEOUS
16. Physical Activity and Alcohol Use Disorders
Nadra E. Lisha,Steve Sussman, Adam M. Leventhal
The American Journal of Drug and Alcohol Abuse 2013:39(2);115-120
Abstract
Background Prior research has documented a counterintuitive positive association between
physical activity and indices of alcohol consumption frequency and heaviness. Objectives: To
investigate whether this relation extends to alcohol use disorder and clarify whether this
association is non-linear. Methods This is a cross-sectional, correlational population-based
study of US adults (N = 34,653). The Alcohol Use Disorder and Associated Disabilities
Interview Schedule was used to classify past-year DSM-IV alcohol use disorder and selfreported federal government-recommended weekly physical activity cutoffs. Results After
statistically controlling for confounds, alcohol abuse but not dependence was associated with
greater prevalence of physical activity. Number of alcohol use disorder symptoms exhibited a
curvilinear relationship with meeting physical activity requirements, such that the positive
association degraded with high symptom counts. Conclusion There is a positive association
between physical activity and less severe forms of alcohol use disorder in US adults. More
severe forms of alcohol use disorder are not associated with physical activity.
Keywords: physical activity, alcohol abuse, alcohol dependence, health promotion,
population-based survey, NESARC
17. Hospital and prehospital emergency service utilisation as an impact of acute
recreational drug and ethanol toxicity
J. R. H. Archer, P. I. Dargan, D. M. Wood, A. R. Winstock
Journal of Substance Use 2013:18(2);129-137
Abstract
Background Recreational drug use can cause significant acute toxicity and is typically
associated with the utilisation of hospital/prehospital emergency medical services and healthcare costs. Aims To determine the impact of recreational drug toxicity on the utilisation of
emergency medical services and subsequent drug use. Design and Methods A total of 2472
UK participants completed an anonymous online cross-sectional questionnaire. The use of
emergency medical services for acute recreational drug and/or ethanol toxicity and its impact
on drug use were surveyed. Results Four hundred and sixty-one (19%) had previously
utilised emergency medical services following drugs/ethanol; of these, 57% (259) attended a
hospital emergency department, out of which 59% (152) needed hospital admission. Fortythree percent (49 of 113 respondents) believed their most recent episode that required
medical assistance was due to using “too much drug”. Forty-five percent (50 of 112
respondents) stated they would continue to use or increase their drug use. Ten percent (11)
reported that the episode had resulted in them stopping use. Conclusions A significant
proportion of individuals used hospital/prehospital emergency services for acute toxicity after
recreational drugs and/or ethanol use. This caused little impact on behaviour in relation to
subsequent use. More work is needed to understand how to use these episodes to change
patterns of drug and/or ethanol use.
Keywords: Recreational drugs, toxicity, emergency department, prevalence
23
ALCOHOL PRICING
18. The relationship between minimum alcohol prices, outlet densities and alcoholattributable deaths in British Columbia, 2002–09
Jinhui Zhao, Tim Stockwell, Gina Martin, Scott Macdonald, Kate Vallance, Andrew Treno,
William R. Ponicki, Andrew Tu, Jane Buxton
Addiction 2013:108(6);1059-1069
Abstract
Aim To investigate relationships between periodic increases in minimum alcohol prices,
changing densities of liquor stores and alcohol-attributable (AA) deaths in British Columbia,
Canada. Design Cross-section (16 geographic areas) versus time–series (32 annual quarters)
panel analyses were conducted with AA deaths as dependent variables and price, outlet
densities and socio-demographic characteristics as independent variables. Setting and
participants Populations of 16 Health Service Delivery Areas in British Columbia, Canada.
Measurements Age–sex-standardized rates of acute, chronic and wholly AA mortality;
population densities of restaurants, bars, government and private liquor stores; minimum
prices of alcohol in dollars per standard drink. Findings A 10% increase in average
minimum price for all alcoholic beverages was associated with a 31.72% [95% confidence
interval (CI): ± 25.73%, P < 0.05] reduction in wholly AA deaths. Significantly negative
lagged associations were also detected up to 12 months after minimum price increases for
wholly but not for acute or chronic AA deaths. Significant reductions in chronic and total AA
deaths were detected between 2 and 3 years after minimum price increases. Significant but
inconsistent lagged associations were detected for acute AA deaths. A 10% increase in
private liquor stores was associated with a 2.45% (95% CI: ± 2.39%, P < 0.05), 2.36% (95%
CI: ± 1.57%, P < 0.05) and 1.99% (95% CI: ± 1.76%, P < 0.05) increase in acute, chronic and
total AA mortality rates. Conclusion Increases in the minimum price of alcohol in British
Columbia, Canada, between 2002 and 2009 were associated with immediate and delayed
decreases in alcohol-attributable mortality. By contrast, increases in the density of private
liquor stores were associated with increases in alcohol-attributable mortality
Keywords: Alcohol-attributable mortality; alcohol outlet density; cross-section versus
time–series design; minimum alcohol price; mixed model
19. Alcohol Outlet Densities and Alcohol Price: The British Columbia Experiment in
the Partial Privatization of Alcohol Sales Off-Premise
Andrew J. Treno, William R. Ponicki, Tim Stockwell, Scott Macdonald, Paul J. Gruenewald,
Jinhui Zhao, Gina Martin, Alissa Greer
Alcoholism: Clinical and Experimental Research 2013:37(5);854-859
Abstract
Background Alcohol beverage prices or taxes have been shown to be related to alcohol
sales and use and related problems. What is not clear are the mechanisms underlying these
relationships. Methods This study examines the relationship between alcohol outlet density
under conditions of the partial privatization of off-premise consumption in British Columbia
(BC) occurring over the past decade. Two hypotheses are tested. First, reflecting basic
supply–demand principles, greater geographic densities of alcohol outlets will be directly
related to reductions in beverage prices in response to greater competition. Second, reflecting
24
the effects of niche marketing and resulting market stratification, increased densities of
private liquor stores will be especially related to reductions in beverage prices within this
outlet category. Data were collected from: (i) a survey of BC private store prices and
practices, (ii) alcohol outlet location information, and (iii) data on demographic
characteristics. Multilevel models examine the relationships between prices at individual
private liquor stores and the densities of government liquor stores, private liquor stores, bars,
and restaurants, controlling for background demographics and geographic unit level effects.
Spatial dependencies were also examined. Results Increased densities of private liquor
stores were associated with lower mean prices of beer and all alcohol aggregated across
brands at the store level. There appeared to be no outlet level effect on discounting patterns,
however, with the mean price differences apparently reflecting differences in the quality of
brands carried rather than unequal prices for any given brand. Conclusions Increased
densities of private off-sale alcohol outlets appear to result in lower prices charged at said
establishments independently of other types of alcohol outlets suggesting that they represent
an emerging marketing niche in the context of off-sale outlet privatization.
Keywords: Alcohol Outlet Privatization; Alcohol Price; Alcohol Outlet Densities; Alcohol
Policy
25
ALCOHOL SERVICES
20. Community alcohol detoxification: the challenge of changing service provision
Christos Kouimtsidis
Journal of Substance Use 2013:18(2);166-169
Abstract
There is a need to develop effective and cost-effective interventions for the treatment of
alcohol dependence. In Hertfordshire, following the development and implementation of a
three-stage community programme, we aimed to increase the percentage of community
detoxifications and succeeded to achieve 69% at the end of the year 2010. This article
discusses the challenges and innovations required to achieve this positive result.
Keywords: Community alcohol detoxification
26
ALCOHOL TREATMENT
21. Women's motivators for seeking treatment for alcohol use disorders
Justine A. Grosso, Elizabeth E. Epstein, Barbara S. McCrady, Ayorkor Gaba, Sharon Cook,
Lindsey M. Backer-Fulghum, Fiona S. Graff
Addictive Behaviors 2013:38(6);2236-2245
Abstract
This study examined types of internal and external motivations for seeking treatment and the
predictive utility of different types of motivation among 180 women with an alcohol use
disorder (AUD) participating in a two-armed trial testing different individual and couple
therapies for AUDs. Reasons for seeking treatment were coded for type of internal or external
motivation. Most women (97%) cited internal reasons for seeking help, including: concern
about progression of AUD (61.1%), health (43.3%), mental health (38.9%), and family
(38.3%). Occupational concerns, an internal motivator cited by 6% of women, were
associated with better drinking outcomes; interpersonal-family concerns were associated with
poorer outcomes. Some motivators for seeking treatment may not be related to sustained
changes in drinking, suggesting that understanding motivators for treatment may be
inadequate to maintain change. Reasons for help-seeking may need to be addressed in
treatment to produce long-lasting change. Highlights We examined how motivation for
seeking alcohol treatment affects drinking outcomes. We developed a coding system for
women's reply to "what brought you to treatment?" Job concerns due to drinking were
associated with better drinking outcomes. Family concerns related to drinking were
associated with poorer drinking outcomes.
Keywords: Alcohol use disorders; Women; Motivation; Treatment; Outcome
22. The Declining Efficacy of Naltrexone Pharmacotherapy for Alcohol Use Disorders
Over Time: A Multivariate Meta-Analysis
A. C. Del Re, Natalya Maisel, Janet Blodgett, John Finney
Alcoholism: Clinical and Experimental Research 2013:37(6);1064-1068
Abstract
Background Oral naltrexone is an FDA-approved medication for treating alcohol use
disorders. Although its efficacy has been supported in multiple clinical trials, an earlier
review found that its effect sizes (ESs) on relapse to heavy drinking and, to a lesser extent,
percent days drinking were smaller in more recent trials and in multicenter than in single-site
studies. We examined whether these findings held when studies from 2004 to 2009 were
taken into account, and whether single-site versus multicenter trials, the use of placebo run-in
periods, and placebo group improvement accounted for variation in naltrexone effects and
decreasing effects over time. Methods A multivariate meta-analysis of naltrexone
pharmacotherapy trials for alcohol use disorders was conducted. All analyses simultaneously
modeled ESs on outcomes of percent days abstinent and relapse to heavy drinking. Potential
moderators of medication effects that were examined included publication year, multicenter
design (vs. single site), placebo run-in period, and placebo group improvement. Results
Statistically significant between-group differences on percent days abstinent (the inverse of
percent days drinking) and relapse to heavy drinking favored naltrexone over placebo. Year
of publication was a significant moderator for both outcomes, with more recent trials having
smaller ESs. Neither multi- versus single-site study, the interaction between multi- versus
27
single-site study and year of publication, nor placebo run-in period was a significant
moderator of naltrexone effects. Although placebo group improvement was modestly
associated with smaller between-group naltrexone versus placebo ESs, only 21 studies
provided usable information on placebo group improvement. Within those studies, there was
no relationship between naltrexone ESs and time, so placebo group improvement was not
examined as a moderator of that relationship. Conclusions Naltrexone ESs have attenuated
over time. Moderators that explain why effects have been decreasing remain to be
determined.
Keywords: Naltrexone; Multivariate Meta-Analysis; Alcohol Treatment Research
23. Self-Efficacy as a Predictor of Outcome After Residential Treatment Programs for
Alcohol Dependence: Simply Ask the Patient One Question!
Fabian Ludwig, Elvira Tadayon-Manssuri, Werner Strik, Franz Moggi
Alcoholism: Clinical and Experimental Research 2013:37(4);663-667
Abstract
Background Self-efficacy has been identified as one of the most consistent variables that
predict the outcome of alcohol treatment. However, many previous studies in this field failed
to control for other important predictors (e.g., dependences severity, psychiatric symptoms,
and treatment goal). Our study's first goal was to evaluate the predictive value of self-efficacy
when most other relevant variables were statistically controlled. The second goal was to
compare the predictive values of self-efficacy assessed with the Situational Confidence
Questionnaire (SCQ), and general self-efficacy assessed with a single question. Methods
Four hundred and fifteen patients with alcohol dependence from 12 residential alcohol use
disorder (AUD) treatment programs were assessed at treatment admission, discharge, and the
1-year follow-up. A stepwise logistic regression for abstinence was calculated using all
predictors. For those predictors that were significant, a Cox survival regression analysis was
performed to predict the time to the first drink after discharge. Results Only abstinence as
treatment goal, alcohol use during treatment, and general self-efficacy as measured by 1
question were revealed to be significant predictors in the stepwise regression, whereas all
other variables, including self-efficacy as measured by the SCQ, were not significantly
associated with abstinence at the 1-year follow-up. Cox survival regression analysis showed a
significant difference in the time to first alcohol use between patients with maximum general
self-efficacy and those with lower general self-efficacy, when the other 2 significant variables
were controlled for. Conclusions General self-efficacy, that is, the patients' own prognosis
of his success in remaining abstinent, was a central variable in predicting residential alcohol
dependence treatment outcome. Self-efficacy showed a more accurate prognosis of outcome
when it was assessed with just 1 question, than when assessed with the SCQ. With this
simplified assessment, knowledge of the prognostic value of self-efficacy could be made
applicable for everyday practice.
Keywords: Alcohol Dependence; Alcohol Treatment Outcomes; Predictors; Residential
Treatment; Self-Efficacy
28
24. Temptation to Drink as a Predictor of Drinking Outcomes Following Psychosocial
Treatment for Alcohol Dependence
Katie Witkiewitz
Alcoholism: Clinical and Experimental Research 2013:37(3);529-537
Abstract
Background Alcohol craving, defined as the subjective experience of an urge or desire to
use alcohol, has been identified in numerous settings as a significant predictor of alcohol use
and alcohol relapse following treatment for alcohol use disorders. Yet, numerous limitations
to the conceptualization and measurement of drinking temptation have led many researchers
to question whether self-reported drinking temptation is a useful construct for evaluating
treatments for alcohol use disorders. Methods Secondary analyses of data from Project
MATCH, a multisite randomized clinical trial, were conducted to examine the association
between a single-item measure of self-reported “temptation to drink” and drinking outcomes.
The first goal was to determine whether temptation to drink changed during the course of
treatment for alcohol dependence. The second goal was to assess the predictive validity of
temptation to drink, assessed during the fourth session of treatment, as a predictor of past 30day drinking rates and past 90-day drinking-related consequences at 1 and 3 years following
treatment. Results The temptation to drink decreased significantly during treatment, and
self-reported temptation to drink during the fourth session of treatment was significantly
associated with numerous drinking outcomes (including quantity, frequency, and
consequences) at 1 year posttreatment (R2 = 0.04 to 0.11) and number of drinks per drinking
day at 3 years following treatment (R2 = 0.02). A dichotomous measure of temptation to drink
(not at all tempted vs. all other levels of temptation) had greater sensitivity as a predictor of
drinking outcomes at 1 and 3 years posttreatment than alternative drinking measures (e.g.,
any drinking, any heavy drinking days) assessed during treatment. Conclusions A singleitem measure of temptation to drink was a reasonable predictor of short- and long-term
drinking outcomes following treatment and comparable to commonly used measures of
drinking outcomes for alcohol clinical trials.
Keywords: Craving; Drinking Temptation; Alcohol Use Disorder; Relapse; Treatment
25. Interventions for reducing alcohol consumption among general hospital inpatient
heavy alcohol users: A systematic review
Noreen D. Mdege, Debra Fayter, Judith M. Watson, Lisa Stirk, Amanda Sowden, Christine
Godfrey
Drug and Alcohol Dependence 2013:131(1-2);1-22
Abstract
Background There is growing interest in pro-active detection and provision of interventions
for heavy alcohol use in the general hospital inpatient population. We aimed to determine,
from the available evidence, the effectiveness of interventions in reducing alcohol
consumption among general hospital inpatient heavy alcohol users. Methods The following
databases were searched for completed and on-going randomised and non-randomised
controlled studies published up to November 2012: MEDLINE; C2-SPECTR; CINAHL; The
Cochrane Library; Conference Proceedings Citation Index: Science; EMBASE; HMIC;
PsycInfo; Public Health Interventions Cost Effectiveness Database (PHICED); and
ClinicalTrials.gov. Studies were screened independently by two reviewers. Data extraction
was performed by one reviewer and independently checked by a second. Results Twentytwo studies which met the inclusion criteria enrolled 5307 participants in total. All
29
interventions were non-pharmacological and alcohol focused. Results from single session
brief interventions and self-help literature showed no clear benefit on alcohol consumption
outcomes, with indications of benefit from some studies but not others. However, results
suggest brief interventions of more than one session could be beneficial on reducing alcohol
consumption, especially for non-dependent patients. No active intervention was found
superior over another on alcohol consumption and other outcomes. Conclusions Brief
interventions of more than one session could be beneficial on reducing alcohol consumption
among hospital inpatients, especially for non-dependent patients. However, additional
evidence is still needed before more definitive conclusions can be reached.
Keywords: Substance use; Alcohol; Interventions; Hospital wards; Systematic review
26. The impact of training and delivering alcohol brief intervention on the knowledge
and attitudes of community pharmacists: A before and after study
Ranjita Dhital, Cate M. Whittlesea, Peter Milligan, Natasha S. Khan, Ian J. Norman
Drug and Alcohol Review 2013:32(2);147-156
Abstract
Introduction and Aims Alcohol misuse is the third leading cause of ill health in the UK.
Alcohol brief intervention can identify risky drinkers and motivate individuals to take action.
Community pharmacists have been identified as having a role in providing brief
interventions. This study aimed to evaluate: pharmacists' attitudes towards hazardous/harmful
drinkers and knowledge before training and after delivering brief intervention; and their
experience of training. Design and Methods Pharmacists' attitudes to alcohol problems
were assessed using Short Alcohol and Alcohol Problems Perception Questions before
training and after brief intervention delivery. Alcohol misuse knowledge was assessed by
questionnaire prior to and immediately after training, and after the delivery period. Following
brief intervention delivery, pharmacists' experience of training was obtained using a
questionnaire and focus groups. Qualitative thematic analysis identified experiences of brief
intervention training. Quantitative data were analysed using SPSS. Results One hundred and
thirty-nine alcohol interventions were delivered by 19 pharmacists over five months
(recruiters). Ten pharmacists completed no interventions (non-recruiters). Both groups
improved their alcohol knowledge between baseline and immediately following training; and
their knowledge decreased between the end of training and following service delivery.
Pharmacists who were initially more motivated recruited more participants and increased
their work satisfaction. Discussion and Conclusions This confirmed findings of previous
studies that pharmacists unfamiliar with brief intervention could be trained to deliver this
service. Pharmacists with positive attitude towards drinkers delivered a greater number of
alcohol interventions and experienced increased work satisfaction than those pharmacists
with less positive attitudes.
Keywords: attitude; alcohol brief intervention; community pharmacist; knowledge;
pharmacy
30
BLOOD BORNE VIRUSES
27. Decline in incidence of HIV and hepatitis C virus infection among injecting drug
users in Amsterdam; evidence for harm reduction?
Anneke S. de Vos, Jannie J. van der Helm, Amy Matser, Maria Prins, Mirjam E. E.
Kretzschmar
Addiction 2013:108(6);1070-1081
Abstract
Aims In Amsterdam, HIV prevalence has nearly halved among injecting drug users (IDU)
since 1990. Hepatitis C virus (HCV) prevalence also declined; HIV and HCV incidence
dropped to nearly zero. We examined possible explanations for these time trends, among
which the implementation of harm reduction measures aimed at reducing the risk behaviour
of IDU. Design We used individual-based modelling of the spread of HIV and HCV.
Information about demographic parameters was obtained from the Amsterdam Cohort Study
(ACS) among drug users. The model included changes in inflow of new IDU and death rates
over time, the latter dependent on age and time since HIV seroconversion. We considered
different scenarios of risk behaviour. Setting IDU in Amsterdam. Measurements
Simulated HIV and HCV incidence and prevalence were compared with ACS data. Findings
Assuming that harm reduction measures had led to a strong decrease in risk behaviour over
time improved the model fit (squared residuals decreased by 30%). However, substantial
incidence and HIV prevalence decline were already reproduced by incorporating
demographic changes into the model. In particular, lowered disease spread might be a result
of depletion of high-risk IDU among those at risk for disease, and a decrease in the number of
high-risk individuals in the population due to HIV-related mortality. Conclusions Marked
decreases in HIV and HCV in Amsterdam since 1990 could be due partly to harm reduction
measures; however, they may also be attributable largely to changes in the IDU population.
Future research aimed at quantifying the benefits of interventions should not neglect the
impact of natural epidemic progression and demographic changes.
Keywords: Demography; harm reduction; HCV; HIV; injecting drug use; theoretical
models
28. Management of Hepatitis C Virus Infection in Heavy Drinkers
Charlotte E. Costentin, Jean-Baptiste Trabut, Vincent Mallet, Stéphane Darbeda, Véronique
Thépot, Bertrand Nalpas, Béatrice Badin de Montjoye, Béatrice Lavielle, Anaïs ValletPichard, Philippe Sogni, Stanislas Pol
Alcohol and Alcoholism 2013:48(3);337-342
Abstract
Aim Optimal management of hepatitis C virus (HCV) infection is controversial in heavy
drinkers. We compared the management of HCV infection of heavy drinkers with that of
patients without a history of alcohol abuse. Methods: In a retrospective case–control study,
69 HCV-infected heavy drinkers [daily alcohol consumption at referral above 60 g/day,
hereafter ‘alcohol group’] were compared with matched HCV-infected patients with low
alcohol consumption (<40 g/day, ‘control group’). Results: Patients of the ‘alcohol group’
were younger (42 vs. 45 years, P = 0.05), more often male (69.6 vs. 56.5%, P = 0.11) and had
been infected by intravenous drug use (85.5 vs. 45.0%, P < 0.0001). The percentage of
patients with a recommendation for treatment according to the French 2002 consensus
31
(bridging fibrosis or genotype 2 or 3) was 52 of 69 (75.4%) in both groups, while the
proportion of patients treated was higher in the control group (71.0 vs. 44.9%, P = 0.002). In
the ‘alcohol group’, patients had better access to treatment if they were employed or
consumed 170 g/day or less at first referral. Sustained virological response (SVR) was
obtained in 10 of 31 patients (32.3%) of the ‘alcohol group’ vs. 8 of 31 patients (25.8%) of
the control group matched for genotype and type of treatment (P = 0.58). Conclusion Heavy
drinkers are less often considered for antiviral therapy compared with patients without a
history of alcohol abuse. However, once treatment is actually initiated, SVR rates are
comparable with those achieved in non-drinkers despite the continuation of alcohol
consumption during therapy in some patients.
29. Concordance between self-reported and actual hepatitis C virus infection status in a
cohort of people who inject drugs
Daniel O'Keefe, Campbell Aitken, Peter Higgs, Paul Dietze
Drug and Alcohol Review 2013:32(2);208-210
Abstract
Introduction and Aims Accurate knowledge of individual hepatitis C virus (HCV) status is
an important component of comprehensive health services for people who inject drugs
(PWID). In this paper we compare the perceived HCV status of PWID in a longitudinal
cohort study with their actual status, as verified by HCV-RNA testing. Methods Participants
who consented to blood testing at first follow up (352/688) were included. Self-reported HCV
status (positive/negative/don't know), was compared with serology test results for
participants. Results In comparing self-report with HCV-RNA results, 274 of 352
participants had valid serology and self-report results; of these, 220 (80%) accurately
reported their HCV status. Discussion and Conclusions The findings of this study suggest
that large proportions of PWID know their true HCV infection status, but the discordant
participants represent potential HCV infection risks. Despite the majority of participants
displaying concordance, this study reinforces the need for regular blood testing and the giving
of accurate, practical and comprehensive HCV result information.
Keywords: hepatitis C; injection drug use; self-report; validity; infectious disease
30. Review and meta-analysis of the association between self-reported sharing of
needles/syringes and hepatitis C virus prevalence and incidence among people who
inject drugs in Europe
Norah E. Palmateer, Sharon J. Hutchinson, Hamish Innes, Christian Schnier, Olivia Wu,
David J. Goldberg, Matthew Hickman
International Journal of Drug Policy 2013:24(2);85-100
Abstract
Background Although sharing needles/syringes (N/S) is a recognised risk factor for the
hepatitis C virus (HCV), epidemiological studies have shown inconsistent associations
between self-reported N/S sharing and biological markers of HCV infection. This review
aims to summarise, and explore factors that may explain the variation in, the measure of
association between self-reported sharing of N/S and HCV prevalence/incidence among
people who inject drugs (PWID). Methods Studies undertaken in Europe during 1990–2011
were identified through an electronic literature search. Eligible studies reported HCV
prevalence (or incidence) among those who reported ever/never (or recent/non-recent)
32
sharing of N/S. Meta-analysis was undertaken to generate a pooled estimate of the association
and heterogeneity was explored using stratified analyses. Results Sixteen cross-sectional
studies and four longitudinal studies were included. Pooled prevalence and incidence of HCV
was 59% and 11% among PWID who reported never and not recently sharing N/S,
respectively. Random effects meta-analysis generated a pooled odds ratio (OR) of 3.3 (95%
CI 2.4–4.6), comparing HCV infection among those who ever (or recently) shared N/S
relative to those who reported never (or not recently) sharing. There was substantial
heterogeneity between the study effect sizes (I2 = 72.8%). Differences in pooled ORs were
found when studies were stratified by recruitment setting (prison vs. drug treatment sites),
recruitment method (outreach vs. non-outreach), sample HCV prevalence and sample
mean/median time since onset of injecting. Conclusion We found high
incidence/prevalence rates among those who did not report sharing N/S during the risk
period, which may be due to a combination of unmeasured risk factors and reporting bias.
Study design and population are likely to be important modifiers of the size and strength of
association between HCV and N/S sharing.
Keywords: Hepatitis C; Needle sharing; Injecting drug use; Meta-analysis; Review
33
CO-MORBIDITY
31. Genetic Markers of Comorbid Depression and Alcoholism in Women
Daniela O. Procopio, Laura M. Saba, Henriette Walter, Otto Lesch, Katrin Skala, Golda
Schlaff, Lauren Vanderlinden, Peter Clapp, Paula L. Hoffman, Boris Tabakoff
Alcoholism: Clinical and Experimental Research 2013:37(6);896-904
Abstract
Background Alcohol dependence (AD) is often accompanied by comorbid depression.
Recent clinical evidence supports the benefit of subtype-specific pharmacotherapy in treating
the population of alcohol-dependent subjects with comorbid major depressive disorder
(MDD). However, in many alcohol-dependent subjects, depression is a reactive response to
chronic alcohol use and withdrawal and abates with a period of abstinence. Genetic markers
may distinguish alcohol-dependent subjects with MDD not tied chronologically and
etiologically to their alcohol consumption. In this work, we investigated the association of
adenylyl cyclase genes (ADCY1–9), which are implicated in both AD and mood disorders,
with alcoholism and comorbid depression. Methods Subjects from Vienna, Austria
(n = 323) were genotyped, and single nucleotide polymorphisms (1,152) encompassing the
genetic locations of the 9 ADCY genes were examined. The Vienna cohort contained alcoholdependent subjects differentiated using the Lesch Alcoholism Typology. In this typology,
subjects are segregated into 4 types. Type III alcoholism is distinguished by co-occurrence of
symptoms of depression and by affecting predominantly females. Results We identified 4
haplotypes associated with the phenotype of Type III alcoholism in females. One haplotype
was in a genomic area in proximity to ADCY2, but actually within a lincRNA gene, 2
haplotypes were within ADCY5, and 1 haplotype was within the coding region of ADCY8.
Three of the 4 haplotypes contributed independently to Type III alcoholism and together
generated a positive predictive value of 72% and a negative predictive value of 78% for
distinguishing women with a Lesch Type III diagnosis versus women designated as Type I or
II alcoholics. Conclusions Polymorphisms in ADCY8 and ADCY5 and within a lincRNA are
associated with an alcohol-dependent phenotype in females, which is distinguished by
comorbid signs of depression. Each of these genetic locations can rationally contribute to the
polygenic etiology of the alcoholism/depression phenotype, and the use of these genetic
markers may aid in choosing appropriate and beneficial treatment strategies.
Keywords: Genetics; Alcoholism; Depression; Lesch Typology; Adenylyl Cyclases
32. The prevalence of substance use disorders and psychiatric disorders as a function of
psychotic symptoms
William V. Lechner, Jennifer Dahne, Kevin W. Chen, Alison Pickover, Jessica M. Richards,
Stacey B. Daughters, C.W. Lejuez
Drug and Alcohol Dependence 2013:131(1-2);78-84
Abstract
Background Psychotic symptoms represent one of the most severe and functionally
impairing components of several psychological disorders. One group with particularly high
rates of psychotic symptoms is chronic substance users. However, the literature on psychotic
symptoms and substance use is quite narrow and has focused almost exclusively on druginduced psychosis, neglecting the population of substance users with psychotic symptoms
occurring independently of acute drug effects. Method The current study examined
34
demographics, substance dependence, and psychiatric comorbidities among substance users
with current (CurrSx), past (PastSx), and no psychotic symptoms (NoSx). Patients (n = 685)
were sequential admissions to a residential substance use treatment center from 2006 to 2009.
Results Compared to NoSx, those who endorsed CurrSx were significantly more likely to
meet criteria for lifetime alcohol dependence and lifetime amphetamine dependence. CurrSx
were more likely than PastSx to meet for lifetime cannabis dependence. Additionally, CurrSx
were more likely to meet criteria for a comorbid psychiatric disorder compared to NoSx, and
evidenced a greater number of current psychiatric disorders. NoSx were less likely than both
CurrSx and PastSx to meet criteria for Borderline Personality Disorder. Conclusion
Individuals with non-substance induced psychotic symptoms appear to meet criteria for
specific substance use disorders and psychiatric disorders at higher rates than those without
psychotic symptoms; these effects were most evident for those with current as opposed to
past symptoms. Findings suggest that these individuals may need specialized care to address
potential psychiatric comorbidities and overall greater severity levels relative to substance
users without psychotic symptoms.
Keywords: Substance dependence; Psychiatric disorders; Psychotic symptoms; Comorbidity
inpatient treatment
35
DRUG EDUCATION
33. Internet content regulation, public drug websites and the growth in hidden Internet
services
Monica J. Barratt, Simon Lenton, Matthew Allen
Drugs: Education, Prevention and Policy 2013:20(3);195-202
Abstract
Governments have traditionally censored drug-related information, both in traditional media
and, in recent years, in online media. We explore Internet content regulation from a drugpolicy perspective by describing the likely impacts of censoring drug websites and the
parallel growth in hidden Internet services. Australia proposes a compulsory Internet filtering
regime that would block websites that ‘depict, express or otherwise deal with matters of…
drug misuse or addiction’ and/or ‘promote, incite or instruct in matters of crime’. In this
article, we present findings from a mixed-methods study of online drug discussion. Our
research found that websites dealing with drugs, that would likely be blocked by the filter, in
fact contributed positively to harm reduction. Such sites helped people access more
comprehensive and relevant information than was available elsewhere. Blocking these
websites would likely drive drug discussion underground at a time when corporate-controlled
‘walled gardens’ (e.g. Facebook) and proprietary operating systems on mobile devices may
also limit open drug discussion. At the same time, hidden Internet services, such as Silk
Road, have emerged that are not affected by Internet filtering. The inability for any
government to regulate Tor websites and the crypto-currency Bitcoin poses a unique
challenge to drug prohibition policies.
36
DRUGS IN SPORT
34. The Doping Myth: 100 m sprint results are not improved by ‘doping’
Aaron Hermann, Maciej Henneberg
International Journal of Drug Policy 2013:24(2);110-114
Abstract
Background Doping is a very serious issue bedevilling the sporting arena. It has
consequences for athletes’ careers, perception of sports in the society and funding of sports
events and sporting organisations. There is a widespread perception that doping unfairly
improves results of athletes. Methods A statistical study of information on best lifetime
results of top 100 m sprinters (males better than 9.98 s, females 11.00 s), over the period of
1980–2011 was conducted. Athletes were divided into categories of ‘doped’ (N = 17 males
and 14 females), based on self admission, the confirmed detection of known doping agents in
their bodies or doping conviction, and ‘non-doped’ (N = 46 males and 55 females). Results
No significant differences (unpaired t-test) between dopers and non-dopers were found in
their average results: male ‘dopers’ 9.89 s identical with ‘non-dopers’ 9.89 s, females 10.84 s
and 10.88 s respectively. Slopes of regressions of best results on dates for both ‘dopers’ and
‘non dopers’ were not significantly different from zero. This indicates that no general
improvement as a group in 100 m sprint results over a quarter of a century occurred
irrespective of doping being or not being used. Conclusion Since there are no statistical
differences between athletes found “doping” and the others, one of the following must be
true: (1) “doping” as used by athletes so detected does not improve results, or (2) “doping” is
widespread and only sometimes detected. Since there was no improvement in overall results
during the last quarter of the century, the first conclusion is more likely. Objectively, various
“doping” agents have obvious physiological or anatomical effects. These may not translate
into better results due to the clandestine use of doping that prevents its scientific structuring.
Perception of the effectiveness of doping should be reconsidered. Policy changes may be
required to ensure the continued fairness and equity in testing, legislation and sports in
general.
Keywords: Athletes; Top sprinters; Performance enhancing substances; Sports policy; Track
and field
37
EPIDEMIOLOGY AND DEMOGRAPHY
35. Childhood sexual abuse and early substance use in adolescent girls: the role of
familial influences
Carolyn E. Sartor, Mary Waldron, Alexis E. Duncan, Julia D. Grant, Vivia V. McCutcheon,
Elliot C. Nelson, Pamela A. F. Madden, Kathleen K. Bucholz, Andrew C. Heath
Addiction 2013:108(5);993-1000
Abstract
Aim To assess the extent to which the association between childhood sexual abuse (CSA)
and early use of alcohol, cigarettes and cannabis in adolescent girls is mediated by risk
factors that tend to cluster in families where CSA occurs. Design An abridged version of the
Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) was administered by
telephone. Participants A total of 3761 female twins aged 18–29 (14.6% African
American, 85.4% European American). Measurements CSA experiences and history of
substance use were queried in the SSAGA-based interviews. Findings After controlling for
familial influences on early substance use by including co-twin early use status in models,
separate Cox proportional hazards regression analyses predicting onset of alcohol, cigarette
and cannabis use revealed a significant association with CSA. The effect was observed to age
19 years for cigarettes and to age 21 years for cannabis, but was limited to age 14 years or
younger for alcohol, with the most pronounced risk before age 10 [hazard ratio (HR) = 4.59;
confidence interval (CI): 1.96–10.74]. CSA-associated risk for initiation of cigarette and
cannabis use was also highest in the youngest age range, but the decline with age was much
more gradual and the hazard ratios significantly lower (HR: 1.70; CI: 1.13–2.56 for cigarettes
and HR: 2.34, CI: 1.57–3.48 for cannabis). Conclusions Childhood sexual abuse history is a
distinct risk factor for use of cigarettes and cannabis, and a very strong predictor of early age
at first drink.
Keywords: Alcohol; cannabis; cigarettes; sexual abuse; twins; women
36. Predictors of Repeated Emergency Department Visits among Persons Treated for
Addiction
Hansagi H, Engdahl B, Romelsjö A
European Addiction Research 2012:18(2);47–53
Abstract
Background/Aims To determine whether frequent emergency department (ED) users who
enter specialized treatment programs for alcohol and/or drug problems have any
characteristics that predict their future ED use. Methods Adult patients (783 alcohol users,
405 illicit drug users) were interviewed. Data from the medical database on utilization of ED
and the emergency departments’ specific units for addictive diseases (EDAD) 12 months
before and 12 months after the interview were linked with patient characteristics in logistic
regression models. Results Among alcohol users, prior ED/EDAD visits predicted repeat
future visits to these sites (OR 11.6; 95% CI 6.5–20.5). Prior inpatient hospital care with
addiction diagnosis was a predictor of future multiple visits to the EDAD only (OR 3.1; 95%
CI 1.5–6.5). Among drug users, predictors of future ED/EDAD visits were use of heroin (OR
2.7; 95% CI 1.4–5.4) and prior ED/EDAD visits (OR 27.3; 95% CI 12.7–58.4). Drug users’
EDAD utilization was also predicted by inpatient hospital care with addiction diagnosis.
Conclusion The strongest predictive factors of visiting ED repeatedly were previous repeat
38
emergency care use and hospitalization with addiction diagnosis. Entering regular addiction
treatment does not appear to alter the pattern of ED utilization
Key Words: Addiction, Emergency department visits, Alcohol consumption, Drug use,
Social factors
37. Trends of heroin use and heroin injection epidemics in Europe: Findings from the
EMCDDA treatment demand indicator (TDI)
Gregorio Barrio, Linda Montanari, María J. Bravo, Bruno Guarita, Luis de la Fuente, José
Pulido, Julián Vicente
Journal of Substance Abuse Treatment 2013:45(1);19-30
Abstract
We estimate trends and geographical differences in the heroin epidemic in the European
Union plus Croatia and Turkey by analyzing aggregated data on first heroin treatment
admissions (cases) during 2000–2009.
In 2005–2009 the proportion of drug injectors was higher in Central and Eastern European
countries (CEECs) than in Western European countries (WECs), whereas the opposite
occurred with mean age at first heroin use and first treatment. During this period, the number
of cases, cases per center, and proportion of injectors in WECs declined, whereas mean age at
first treatment and first heroin use increased. The opposite occurred in Turkey, except for
proportion of injectors, while trends were less clear in the other CEECs. In the 7 WECs with
data, trends in 2000–2005 and 2005–2009 were similar. This suggests that the number of
recent-onset heroin users and heroin injectors may have declined some years before the study
period, especially in WECs.
Keywords: Drug injection; Heroin use; Trends; Europe; Drug treatment demand
38. Weight-related concerns related to drug use for women in substance abuse
treatment: Prevalence and relationships with eating pathology
Cortney S. Warren, Anne R. Lindsay, Emily K. White, Kim Claudat, Sara C. Velasquez ,
Journal of Substance Abuse Treatment 2013:44(5);494-501
Abstract
Women in substance abuse treatment increasingly report weight-related concerns as
motivation for drug use. However, limited research has explored the nature of these concerns
or examined whether women in substance abuse treatment with weight-related concerns
related to drug use differ from those who do not on variables relevant to eating pathology.
Using a sample of 297 women in substance abuse treatment, this study examined two
intertwined issues: (1) the prevalence and nature of weight-related concerns related to drug
use and (2) whether women who endorse weight-related concerns related to drug use differ
from those without weight-related concerns on body dissatisfaction, eating pathology,
perceived pressure and internalization of thin-ideal media, and appearance-related drug-use
expectancies. Descriptive analyses indicated that the majority of participants were concerned
about gaining weight during treatment and/or that weight gain could trigger drug relapse.
Analyses of variance revealed that women who reported weight-based concerns (both with
regards to weight gain during treatment and relapse potential) endorsed higher levels of body
dissatisfaction, dieting, bulimic symptoms, and thin-ideal internalization than women who
did not endorse weight-related concerns. Results suggest that substance abuse treatment
39
programs should be aware of and address weight-related concerns around drug use for
women.
Keywords: Women's issues; Weight concerns; Body dissatisfaction; Eating pathology; Drug
expectancies
40
INTRAVENOUS DRUG USER
39. Early life influences on the risk of injecting drug use: case control study based on
the Edinburgh Addiction Cohort
John Macleod, Matthew Hickman, Hayley E. Jones, Lorraine Copeland, James McKenzie,
Daniela De Angelis, Jo Kimber, James R. Robertson2
Addiction 2013:108(4);743-750
Abstract
Aims To investigate childhood influences on onset of injection drug use. Design Matched
case–control study. Setting Edinburgh, Scotland. Participants A total of 432 individuals
presenting at a community health facility with injection drug use and 432 age- and sexmatched non-injecting controls recruited through the same facility. Measurements Main
exposures considered were family structure and experience of public care, carer substance
use, physical and sexual victimization and conduct problems, all measured at personal
interview. The outcome was history of adult injection drug use recorded in medical records
corroborated at personal interview. Findings Compared to two-parent families all other
family structures were associated with increased risk of injection drug use, the greatest
increased risk being associated with public care. Violence, criminality and financial problems
in the family were also associated with increased risk, as were all types of carer substance
use. The greatest increased risk was associated with markers of early conduct problems,
particularly school exclusion and childhood contact with the criminal justice system. In
multivariable analyses the strongest risk factors for later injecting were always having lived
with a relative or family friend (not always a parent) and in care/adopted/foster home at any
point [odds ratio (OR) = 2.66, 95% confidence interval (CI): 1.02–6.92 and OR = 2.17, 95%
CI: 0.91–5.17, respectively], experienced violence from parent or carer (OR = 2.06, 95% CI:
1.26, 3.38) and early evidence of conduct problems [ever excluded from school (OR = 2.73,
95% CI: 1.68, 4.45); childhood criminality (ever arrested by police pre-adult OR = 3.05, 95%
CI: 1.90, 4.89, ever been in borstal/young offenders/list D school OR = 4.70, 95% CI: 2.02,
10.94)]. After adjustment for family structure and conduct problems, sexual victimization
was associated weakly with injecting onset (OR = 1.29, 95% CI: 0.76–2.19). More than 70%
of injection drug use onset appeared attributable to the risk factors identified. Conclusions
Injection drug use in adults is associated strongly with prior childhood adversity, in particular
not living with both parents and early conduct problems. Prevention initiatives should also
consider these risk factors.
Keywords: Attributable risk; childhood adversity; conduct disorder; injection drug use
40. The dynamic relationship between social norms and behaviors: the results of an
HIV prevention network intervention for injection drug users
Carl Latkin, Deborah Donnell, Ting-Yuan Liu, Melissa Davey-Rothwell, David Celentano,
David Metzger
Addiction 2013:108(5);934-943
Abstract
Aims Social norms are a key source of influence on health behaviors. This study examined
changes in social norms and relationships between HIV injection risk behaviors and social
norms among injection drug users (IDUs) involved in an experimental intervention. Design
Randomized clinical trial. Setting An HIV Prevention Trials Network study, Philadelphia,
41
USA. Participants IDUs, called indexes, and their social network members, who were drug
or sex partners, were recruited for an HIV prevention intervention and followed for up to 30
months (n = 652). Indexes were randomized into a peer education intervention or control
condition. Measurements Outcomes of injection-related HIV risk behaviors (sharing
needles, sharing cookers, sharing cotton, front-/back-loading) were measured every 6 months
and the social norms of these four risk behaviors were assessed every 12 months. Findings
There was a statistically significant intervention effect on all four social norms of injection
behaviors, with participants in the intervention reporting less risky social norms compared
with controls (changes in mean score: needles, −0.24, P = 0.007; cookers, −0.33, P = .004;
cottons, −0.28, P = .0165; front-/back-loading, −0.23, P = .002). There was also a statistically
significant bidirectional association with social norms predicting injection risk behaviors at
the next assessment and risk behaviors predicting social norms at the subsequent visit.
Conclusions Through social network interventions it is feasible to change both injection risk
behaviors and associated social norms. However, it is critical that social network
interventions focus on publically highlighting behavior changes, as changing social norms
without awareness of behaviors change may lead to relapse of risk behaviors.
Keywords: Behavior change; HIV; injection drug users; opiates; prevention; social
diffusion; social networks; social norms
42
MISCELLANEOUS
41. Development of dependence following treatment with opioid analgesics for pain
relief: a systematic review
Silvia Minozzi, Laura Amato, Marina Davoli
Addiction 2013:108(4);688-698
Abstract
Aims To assess the incidence or prevalence of opioid dependence syndrome in adults (with
and without previous history of substance abuse) following treatment with opioid analgesics
for pain relief. Methods Medline, Embase, CINHAL and the Cochrane Library were
searched up to January 2011. Systematic reviews and primary studies were included if they
reported data about incidence or prevalence of opioid dependence syndrome (as defined by
DSM-IV or ICD-10) in patients receiving strong opioids (or opioid-type analgesics) for
treatment of acute or chronic pain due to any physical condition. The data were abstracted,
and the methodological quality was assessed using validated checklists. Results Data were
extracted from 17 studies involving a total of 88 235 participants. The studies included three
systematic reviews, one randomized controlled trial, eight cross-sectional studies and four
uncontrolled case series. Most studies included adult patients with chronic non-malignant
pain; two also included patients with cancer pain; only one included patients with a previous
history of dependence. Incidence ranged from 0 to 24% (median 0.5%); prevalence ranged
from 0 to 31% (median 4.5%). Conclusions The available evidence suggests that opioid
analgesics for chronic pain conditions are not associated with a major risk for developing
dependence
Keywords: Incidence; opioid analgesics; opioid dependence; pain relief; prevalence;
systematic review
42. Update on tamper-resistant drug formulations
M.K. Romach, K.A. Schoedel, E.M. Sellers
Drug and Alcohol Dependence 2013:130(1-3);13-23
Abstract
An expert panel convened in 2005 by the College on Problems of Drug Dependence (CPDD)
to consider strategies to reduce the risk of prescription medication abuse concluded that drug
formulation plays a significant role in determining risk of abuse. Efforts on the part of the
pharmaceutical industry to develop drugs that deter abuse have focused primarily on opioid
formulations resistant to common forms of tampering, most notably crushing or dissolving
the tablet to accelerate release. Several opioid formulations developed to be tamper resistant
have been approved, but the US Food and Drug Administration has not approved explicit
label claims of abuse deterrence and has stated that any such claim will require substantial
postmarketing data. Drug development efforts in this area raise questions about the relative
impact of abuse-deterrent formulations, not only on individuals who might abuse a
medication, but also on patients who are compliant with therapy. This review discusses
progress since the 2005 CPDD meeting with an emphasis on opioids. Articles cited in the
review were identified via a PubMed search covering the period between January 1, 2000,
and October 5, 2011. Scientific work presented by the authors and their colleagues at
meetings held through May 2012 also was included. Published literature suggests that
development of abuse-deterrent products will require broad public health support and
43
continued encouragement from regulatory authorities so that such products will become the
expected standard of care for certain drug classes.
Keywords: Abuse deterrent; Abuse liability; Drug formulations; Opioid; Tamper resistant;
Tampering
43. Tuberculosis, injecting drug use and integrated HIV-TB care: A review of the
literature
Pippa Grenfell, Ricardo Baptista Leite, Richard Garfein, Smiljka de Lussigny, Lucy Platt,
Tim Rhodes
Drug and Alcohol Dependence 2013:129(3);180-209
Abstract
Background People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and
reduced retention in treatment. There is a need to document strategies for integrated delivery
of HIV, TB and drug dependency care. Methods This article reviews the literature on rates
of TB mono- and co-infection, and published and grey literature descriptions of TB and HIVTB care, among PWID. Results Latent TB infection prevalence was high and active disease
more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections
among PWID were scarce. Models of TB care fell into six categories: screening and
prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within
needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB
treatment; TB service-led care with harm reduction/drug treatment programmes; and TB
treatment within drug treatment programmes. Co-location with NSP and opioid substitution
therapy (OST), combined with incentives, consistently improved screening and prevention
uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse
settings. Successful interventions involved collaboration across services; a client-centred
approach; and provision of social care. No peer-reviewed studies described models of
integrated HIV-TB care for PWID but grey literature highlighted key components: co-located
services, provision of drug treatment, multidisciplinary staff training; and remaining barriers:
staffing inefficiencies, inadequate funding, police interference, and limited OST availability.
Conclusions Integration with drug treatment improves PWID engagement in TB services but
there is a need to document approaches to HIV-TB care, improve surveillance of TB and coinfections among PWID, and advocate for improved OST availability.
Keywords: Injecting drug use; Tuberculosis; HIV; Opioid substitution therapy; Models of
care; Integration
44. The stigmatization of problem drug users: A narrative literature review
Charlie Lloyd
Drugs: Education, Prevention and Policy 2013:20(2);85-95
Abstract
Background A stigma is a long-lasting mark of social disgrace that has a profound effect on
interactions between the stigmatized and the unstigmatized. Factors governing the extent of
stigmatization attached to an individual include the perceived danger posed by that person
and the extent to which she/he is seen as being to blame for the stigma. Methods Systematic
database searches identified 185 papers for inclusion in the review, all of which were read
and findings analysed and compared. Results Stigmatizing attitudes towards problem drug
users (PDUs) are common among the general public and non-specialist professionals. The
44
impact on users is profound and represents a significant barrier to recovery. Reasons for this
extreme stigmatization include negative reactions to injecting and widespread attributions
concerning danger and blame. Advocacy and practice responses include challenging media
language and stereotypes, encouraging public figures to speak out about their personal
experiences, improved training for non-specialist staff and greater contact between PDUs and
the public. Conclusion Stigmatization has a profound effect on PDUs’ lives and their
chances of recovery. Efforts need to be made to diminish inflated fears about users and help
people to understand that PDUs are not simply and solely ‘to blame’ for their condition.
45. YouTube, ‘drug videos’ and drugs education
Paul Manning
Drugs: Education, Prevention and Policy 2013:20(2);120-130
Abstract
Aims This article reports on findings to emerge from a project examining YouTube ‘drug
videos’ in the light of an emerging literature on the relationship between YouTube and health
education. The aim of this article is to describe the variety of discourses circulated by the
‘drug videos’ available on YouTube and to consider the implications of these for mediated
drugs education. Method The method used is a content analysis of a sample of 750 ‘drug
videos’ in which both video text and loader comments are used to code ‘drug discourses’.
Findings: The findings point to the circulation of a variety of ‘drug videos’ of which official
drugs education materials represent only a small proportion. The ‘drug videos’ created by
YouTube users circulate a variety of ‘drug discourses’ including the ‘celebratory’ or
hedonistic but also ‘cautionary’ videos intended to ‘warn’ or ‘discipline’ but others offer an
‘amateur’ or ‘vernacular drugs education’ while still others develop ‘consumer discourses’
which evaluate substances and technologies of intoxication as commodities.
Conclusions The findings suggest that in the symbolic environment of YouTube drugs
education strategies based upon ‘old media’ assumptions become highly problematic. This is
firstly, because official drugs education material now has to compete with a variety of
alternative discourses circulated in the ‘drug videos’ created by YouTube users. Secondly,
some of these videos offer an alternative ‘vernacular drugs education’, or offer alternative
understandings of drug use. But thirdly, in the era of Web 2.0 technologies such as YouTube,
lines of communication are no longer characterized by simple linearity but multiple
directionality, which mean that official drugs agencies are now even less assured of
communicative control than in the past.
45
OPIATE TREATMENT
46. To enforce or engage: The relationship between coercion, treatment motivation and
therapeutic alliance within community-based drug and alcohol clients
Samantha Wolfe, Frances Kay-Lambkin, Jenny Bowman, Steven Childs
Addictive Behaviours 2013:38(5);2187-2195
Abstract
Three fundamental clinical issues are consistently associated with treatment engagement and
outcomes in substance using populations; coercion, motivation and therapeutic alliance. It is
accepted that these factors play an integral role in the success of substance use treatment and
particularly that higher motivation and therapeutic alliance are advantageous to treatment
outcomes. The impact of coercion on engagement and treatment outcome, on the other hand,
is less clear, and the relationship between these three issues has not been adequately explored.
The current study aimed to address this gap, by examining the presenting characteristics of
clients attending a community drug and alcohol counselling service in relation to coercion,
motivation, therapeutic alliance and substance use, as well as the effect that these variables
had on treatment outcomes 15 weeks later. A total of 77 clients recruited from the Central
Coast Drug and Alcohol Service participated in the study, completing a phone assessment
upon treatment entry and 15 weeks post-baseline. Results indicated that facets of motivation
and therapeutic alliance played a significant role in client's substance use upon presentation
for treatment, although coercion did not. Coercion was not associated with substance use
outcomes at 15 week follow up. However, due to a relatively small sample completing postbaseline assessments (n = 33), further research is needed to examine the predictive effects of
these variables in community drug and alcohol clients. Highlights Coercion does not
detrimentally affect the success of treatment for addiction. Age, therapeutic alliance and locus
of motivation exert more influence on treatment than coercion. With a focus on alliance and
motivation, coerced clients benefit from addictions treatment.
Keywords: Coercion; Substance use; Treatment motivation; Therapeutic alliance
47. Decision-making deficits are still present in heroin abusers after short- to long-term
abstinence
Xinyu Li, Feng Zhang, Ying Zhou, Meng Zhang, Xuan Wang, Mowei Shen
Drug and Alcohol Dependence 2013:130(1-3);61-67
Abstract
Background Substance dependent individuals (SDIs) consistently show deficits in decision
making with biased choices toward immediate rewards, even at the expense of future
consequences. However, relatively little evidence has been reported concerning the
population of drug abusers who are exclusively addicted to heroin. Methods The present
study tested 124 male abstinent “pure” heroin (AH) abusers (divided into short-term, midterm, and long-term groups based on their length of abstinence) and 43 healthy controls (HC)
intending to address this issue. Two decision-making tasks, the Delay Discounting Task
(DDT) and the Iowa Gambling Task (IGT) were employed to measure their decision-making
performance. Results Compared to HC participants, AH participants made significantly
poorer choices on both the DDT and the IGT and the poor decision-making performances
were not influenced by their lengths of abstinence. It is suggested that heroin-abuse-related
decision-making deficits that are demonstrated by rapidly discounting future rewards;
preferring incentives with large short-term gains while ignoring accompanying potential
46
risks; and being inflexible in adjusting decision-making behaviors in accordance with
outcome feedback, may not be compensated for even after a long period of abstinence from
heroin abuse. Conclusion Hence, this inability to recover should be taken into consideration
in the evaluation, prevention and intervention of heroin abuse and relapse.
Keywords: Addiction; Heroin; Decision-making deficits; Length of abstinence
48. A randomized investigation of methadone doses at or over 100 mg/day, combined
with contingency management
Ashley P. Kennedy, Karran A. Phillips, David H. Epstein, David A. Reamer, John
Schmittner, Kenzie L. Preston
Drug and Alcohol Dependence 2013:130(1-3);77-84
Abstract
Background Methadone maintenance for heroin dependence reduces illicit drug use, crime,
HIV risk, and death. Typical dosages have increased over the past few years, based on strong
experimental and clinical evidence that dosages under 60 mg/day are inadequate and that
dosages closer to 100 mg/day produce better outcomes. However, there is little experimental
evidence for the benefits of exceeding 100 mg/day, or for individualizing methadone dosages.
We sought to provide such evidence. Methods We combined individualized methadone
dosages over 100 mg/day with voucher-based cocaine-targeted contingency management
(CM) in 58 heroin- and cocaine-dependent outpatients. Participants were randomly assigned
to receive a fixed dose increase from 70 mg/day to 100 mg/day, or to be eligible for further
dose increases (up to 190 mg/day, based on withdrawal symptoms, craving, and continued
heroin use). All dosing was double-blind. The main outcome measure was simultaneous
abstinence from heroin and cocaine. Results We stopped the study early due to slow
accrual. Cocaine-targeted CM worked as expected to reduce cocaine use. Polydrug use
(effect-size h = .30) and heroin craving (effect-size d = .87) were significantly greater in the
flexible/high-dose condition than in the fixed-dose condition, with no trend toward lower
heroin use in the flexible/high-dose participants. Conclusions Under double-blind
conditions, dosages of methadone over 100 mg/day, even when prescribed based on specific
signs and symptoms, were not better than 100 mg/day. This counterintuitive finding requires
replication, but supports the need for additional controlled studies of high-dose methadone.
Keywords: Methadone maintenance; Methadone dose; Individualized dosing; Flexible
dosing; Polydrug dependence; Contingency management
49. Corrected QT interval during treatment with methadone and buprenorphine—
Relation to doses and serum concentrations
Marianne Stallvik, Berit Nordstrand, Øistein Kristensen, Jørn Bathen, Eirik Skogvoll, Olav
Spigset
Drug and Alcohol Dependence 2013:129(1-2);88-93
Abstract
Background Methadone and buprenorphine are widely used in the treatment of opioid
addiction. Some study results suggest that methadone can be associated with QT interval
prolongation and torsades de pointes ventricular arrhythmias, whereas no such risk has been
observed for buprenorphine. The aim of this study is to determine the risk of corrected QT
interval (QTc) increase among patients treated with these medications in an opioid
maintenance treatment (OMT) programme, and to study possible associations between QTc
47
changes and serum concentrations of methadone or buprenorphine. Methods Eighty patients
enrolled in the OMT programme were followed after start of treatment with methadone
(n = 45) or buprenorphine (n = 35). QTc interval was assessed by electrocardiography (ECG)
at baseline and after 1 month (n = 79) and 6 months (n = 66) in the OMT programme. Blood
samples were obtained for the analysis of serum concentrations of buprenorphine, (R)methadone, (S)-methadone and total methadone. Results No patients had QTc prolongation
(defined as a QTc value above 450 ms) at baseline or after 1 or 6 months. When analysed in a
linear mixed effects model, QTc was not associated with the serum concentrations of
buprenorphine or methadone. However, low serum potassium levels increased QTc
significantly. Conclusions These results support and extend previous findings that treatment
with methadone in modest doses (i.e. below 100 mg/d) is not associated with clinically
significant QTc increases, and that buprenorphine in commonly used doses is a suitable
alternative to methadone with regard to the risk of QTc prolongation.
Keywords: Buprenorphine; Methadone; Enantiomers; Serum concentration; QT interval
50. Utilization of communication technology by patients enrolled in substance abuse
treatment
Erin A. McClure, Shauna P. Acquavita, Emily Harding, Maxine L. Stitzer
Drug and Alcohol Dependence 2013:129(1-2);145-150
Abstract
Background Technology-based applications represent a promising method for providing
efficacious, widely available interventions to substance abuse treatment patients. However,
limited access to communication technology (i.e., mobile phones, computers, internet, and email) could significantly impact the feasibility of these efforts, and little is known regarding
technology utilization in substance abusing populations. Methods A survey was conducted
to characterize utilization of communication technology in 266 urban, substance abuse
treatment patients enrolled at eight drug-free, psychosocial or opioid-replacement therapy
clinics. Results Survey participants averaged 41 years of age and 57% had a yearly
household income of less than $15,000. The vast majority reported access to a mobile phone
(91%), and to SMS text messaging (79%). Keeping a consistent mobile phone number and
yearly mobile contract was higher for White participants, and also for those with higher
education, and enrolled in drug-free, psychosocial treatment. Internet, e-mail, and computer
use was much lower (39–45%), with younger age, higher education and income predicting
greater use. No such differences existed for the use of mobile phones however. Conclusions
Concern regarding the digital divide for marginalized populations appears to be disappearing
with respect to mobile phones, but still exists for computer, internet, and e-mail access and
use. Results suggest that mobile phone and texting applications may be feasibly applied for
use in program–client interactions in substance abuse treatment. Careful consideration should
be given to frequent phone number changes, access to technology, and motivation to engage
with communication technology for treatment purposes.
Keywords: Mobile phones; SMS text messaging; Internet; E-mail; Substance abuse
treatment; Digital divide
48
51. Can Heroin-Dependent Individuals Benefit from a Methadone Maintenance
Treatment Program before They Drop Out against Medical Advice? A 12-Month
Follow-Up Study
Wang P.-W, Wu H.-C, Lin H.-C, Yen C.-N, Yeh Y.-C, Chung K.-S, Chang H.-C, Yen C.-F.
European Addiction Research 2013:19(3);155–164
Abstract
Aim Little is known about whether heroin-dependent individuals receiving methadone
maintenance treatment (MMT) who were discharged involuntarily and against medical advice
(DAMA) get benefits before they left. The aims of this 12-month follow-up study were to
examine whether the effects of MMT on depressive symptoms, heroin dependence and
quality of life (QOL) are different among the non-DAMA group, the DAMA group, and the
involuntarily discharged group, as well as the time effect of receiving MMT on changes in
these three outcome indicators. Method A total of 266 individuals receiving MMT were
divided into the non-DAMA group, the DAMA group, and the involuntarily discharged
group. Participants were interviewed at baseline and at 3, 6, 9, and 12 months of treatment for
levels of depressive symptoms, heroin dependence and QOL. Results The levels of
depressive symptoms, heroin dependence and QOL in all three groups improved after
receiving MMT for 3 months and the improvement was maintained during the MMT period.
There were no significant differences in the three outcome indicators among the three groups.
Conclusion The results support the concept that heroin-dependent individuals benefit from
MMT, even if they do not want to stay in the program or drop out involuntarily.
Key Words: Abuse and dependence, Addiction, Adherence to treatment, Heroin,
Methadone, Against medical advice, Depression, Quality of life, Follow-up study
52. Opioid substitution therapy clients' preferences for targeted versus general primary
health-care outlets
M. Mofizul Islam, Libby Topp, Katherine M. Conigrave, Carolyn A. Day
Drug and Alcohol Review 2013:32(2);211-214
Abstract
Introduction and Aims Opioid substitution therapy (OST) ideally constitutes a window of
opportunity for the provision of essential primary health care (PHC) for OST clients. In the
absence of such opportunities, however, OST clients access PHC from existing outlets, either
general services or those targeted to specific groups. This study examined OST clients'
current main source and preferred future outlets of PHC services and correlates of
preferences. Design and Methods Anonymous interviews conducted with n = 257 clients of
two public OST clinics in Sydney's inner-west. Results Overall, 61% (n = 158) of
participants reported currently accessing PHC primarily from general outlets (general
practitioners or medical centres: 51%, hospital/emergence departments: 10%) and the
remainder (39%, n = 99) from outlets that target specific groups (e.g. Aboriginal Medical
Services, OST prescriber/clinics, drug user-targeted PHCs). Twenty-two percent reported
discomfort disclosing drug use to their current PHC providers. However, the majority were
satisfied with the care they received and reported a preference to remain with their current
PHC providers for a range of reasons, most commonly familiarity with and trust in staff
(56%) and not feeling judged about their drug use (49%). Nevertheless, 28% reported that
they would access PHC through their OST clinic if it were available. Discussion and
Conclusions PHC outlets that target specific groups appear to have an ongoing and
important role in providing accessible health care to OST clients
Keywords: primary health care; opioid substitution therapy; injecting drug use
49
53. Non-prescribed use of substitution of medication among German drug users –
Prevalence, motives and availability
Christiane Sybille Schmidt, Bernd Schulte, Christian Wickert, Katja Thane, Silke Kuhn, Uwe
Verthein, Jens Reimer
International Journal of Drug Policy 2013:24(3):In Press, Corrected Proof, Available
online 31 May 2013
Abstract
Background Beyond unquestioned merits of opioid substitution treatment (OST), nonprescribed use of substitution medication (NPU) and its availability on the black market still
constitute critical issues. Methods This cross-sectional study was conducted in lowthreshold drug services in 13 German cities. Clients were interviewed face-to-face, using a
structured questionnaire on drug use patterns, prevalence and motives for NPU, and
availability and prices of substitution medication on the black market. Results Our sample
of 753 drug users (74.5% male) had a mean age of 36.4 years, 42.4% were currently in OST
and 78.4% reported heroin use in the past 30 days. NPU prevalence for lifetime, past 30 days,
and past 24 h was 66.7%, 25.8%, and 9.3%. Access to substitution medication was
considered ‘easy’. Injection of substitution medication was reported by 9.5% of our sample
(i.e. 14.4% of injectors). Motives for NPU show large heterogeneity, with “lack of other
drugs” and “insufficient OST dosage” as the reasons stated most frequently. Conclusions
NPU represents a relevant source of opiates among German drug users. While OST is
associated with a reduction of illicit drug use and injection use, motives for NPU suggest that
the treatment services do not sufficiently attract opioid-addicted persons.
54. Forced withdrawal from methadone maintenance therapy in criminal justice
settings: A critical treatment barrier in the United States
Jeannia J. Fu, Nickolas D. Zaller, Michael A. Yokell, Alexander R. Bazazi, Josiah D. Rich
Journal of Substance Abuse Treatment 2013:44(5);502-505
Abstract
The World Health Organization classifies methadone as an essential medicine, yet methadone
maintenance therapy remains widely unavailable in criminal justice settings throughout the
United States. Methadone maintenance therapy is often terminated at the time of
incarceration, with inmates forced to withdraw from this evidence-based therapy. We
assessed whether these forced withdrawal policies deter opioid-dependent individuals in the
community from engaging methadone maintenance therapy in two states that routinely force
inmates to withdraw from methadone (N = 205). Nearly half of all participants reported that
concern regarding forced methadone withdrawal during incarceration deterred them engaging
methadone maintenance therapy in the community. Participants in the state where more
severe methadone withdrawal procedures are used during incarceration were more likely to
report concern regarding forced withdrawal as a treatment deterrent. Methadone withdrawal
policies in the criminal justice system may be a broader treatment deterrent for opioiddependent individuals than previously realized. Redressing this treatment barrier is both a
health and human rights imperative.
Keywords: Methadone maintenance therapy; Forced methadone withdrawal; Criminal
justice settings; Human rights
50
55. Effectiveness of drug tests in outpatients starting opioid substitution therapy
Julie Dupouy, Lise Dassieu, Robert Bourrel, Jean-Christophe Poutrain, Serge Bismuth,
Stéphane Oustric, Maryse Lapeyre-Mestre
Journal of Substance Abuse Treatment 2013:44(5);515-521
Abstract
We aimed to assess the effectiveness of drug tests for treatment retention in outpatients
starting opioid substitution therapy. A retrospective cohort was created from the data of the
French health insurance system database for the Midi-Pyrenees region. Patients starting
opioid substitution treatment (OST) were included and followed for 18 to 30 months. Two
groups of patients were defined: the drug test group (at least one drug test reimbursement)
and a control group (no drug test reimbursement). The cohort included 1507 patients. During
follow-up, 39 subjects (2.6%) had at least one drug test reimbursement. Mean treatment
retention was 207 days in the control group and 411 days in the drug test group (p < 0.001).
With a multivariate Cox model, drug tests were associated with treatment retention: hazard
ratio 0.55 (95% CI: 0.38–0.80). Use of a drug test in follow-up of opioid substitution
treatment, although rarely prescribed, significantly improved treatment retention.
Keywords: Opioid-related disorders; Substance abuse detection; Opiate substitution
treatment; Ambulatory care; Cohort studies
56. Minimum recommended physical activity, and perceived barriers and benefits of
exercise in methadone maintained persons
Celeste M. Caviness, Jessica L. Bird, Bradley J. Anderson, Ana M. Abrantes, Michael D.
Stein
Journal of Substance Abuse Treatment 2013:44(4);457-462
Abstract
Methadone-maintained persons are at increased risk for many physical and mental health
disorders compared to the general population. Increased physical activity could offset these
risks. We assessed physical activity level, and perceived benefits and barriers to exercise in a
group of 305 methadone-maintained smokers. Mean participant age was 39.9 years, 50.2%
were male, 79.7% were non-Hispanic White, and mean body mass index was 29.8. Nearly
45% endorsed fair or poor physical health. Although participants perceived many benefits of
exercise and few barriers, only 38% of participants met weekly recommendations for
physical activity, and nearly 25% reported no physical activity. Those who met recommended
guidelines were significantly more likely to endorse relapse prevention as a benefit of
exercise. Motivating MMT patients to increase physical activity could have important
physical, mental health, and drug treatment benefits.
Keywords: Methadone; Exercise; Barriers; Benefits; Relapse prevention
51
ORGANISATION OF SERVICES
57. The cost of providing primary health-care services from a needle and syringe
program: A case study
M. Mofizul Islam, Marian Shanahan, Libby Topp, Katherine M. Conigrave, Ann White,
Carolyn A. Day
Drug and Alcohol Review 2013:32(3);312-319
Abstract
Introduction and Aims Targeted primary health-care services for injecting drug users have
been established in several countries to reduce barriers to health care, subsequent poor health
outcomes and the considerable costs of emergency treatment. The long-term sustainability of
such services depends on the resources required and the coverage provided. This study
assesses the additional cost required to operate a nurse-led primary health care in an existing
needle syringe program setting, estimates the costs per occasion of service and identifies key
factors influencing improved service utilisation. Design and Methods Using standard
costing methods and the funder perspective, this study estimates costs using the ‘ingredients’
approach where the costs of inputs are based on quantities and unit prices (the ingredients).
Results During the 2009–2010 fiscal year, the primary health-care clinic provided 1252
occasions of service to 220 individuals, who each made an average of 3.9 presentations. A
total cost of AU$250 626 was incurred, 69% of which was for personnel and 22% for
pathology. During the study period the average cost per occasion of service was AU$199.96,
which could be as low as AU$93.32 if the clinic reached its full utilisation level. Discussion
and Conclusions Although the average number of presentations per client was satisfactory,
the clinic was underutilised during the study period. Proactive engagement of clients at the
needle syringe program shopfront and an increased range of services offered by the clinic
may help to attract more clients.
Keywords: injecting drug use; primary health care; needle syringe program; cost analysis;
low-threshold health care
52
ORGANISATION OF TREATMENT
58. Quality of clinical supervision and counselor emotional exhaustion: The potential
mediating roles of organizational and occupational commitment
Hannah K. Knudsen, Paul M. Roman, Amanda J. Abraham
Journal of Substance Abuse Treatment 2013:44(5);528-533
Abstract
Counselor emotional exhaustion has negative implications for treatment organizations as well
as the health of counselors. Quality clinical supervision is protective against emotional
exhaustion, but research on the mediating mechanisms between supervision and exhaustion is
limited. Drawing upon data from 934 counselors affiliated with treatment programs in the
National Institute on Drug Abuse's Clinical Trials Network (CTN), this study examined
commitment to the treatment organization and commitment to the counseling occupation as
potential mediators of the relationship between quality clinical supervision and emotional
exhaustion. The final ordinary least squares (OLS) regression model, which accounted for the
nesting of counselors within treatment organizations, indicated that these two types of
commitment were plausible mediators of the association between clinical supervision and
exhaustion. Higher quality clinical supervision was strongly correlated with commitment to
the treatment organization as well as commitment to the occupation of SUD counseling.
These findings suggest that quality clinical supervision has the potential to yield important
benefits for counselor well-being by strengthening ties to both their employing organization
as well the larger treatment field, but longitudinal research is needed to establish these causal
relationships.
Keywords: Treatment workforce; Emotional exhaustion; Burnout; Organizational
commitment; Occupational commitment
53
OVER THE COUNTER
59. “I just wanted to tell you that loperamide WILL WORK”: A web-based study of
extra-medical use of loperamide
Raminta Daniulaityte, Robert Carlson, Russel Falck, Delroy Cameron, Sujan Perera, Lu
Chen, Amit Sheth
Drug and Alcohol Dependence 2013:130(1-3);241-244
Abstract
Aims Many websites provide a means for individuals to share their experiences and
knowledge about different drugs. Such User-Generated Content (UGC) can be a rich data
source to study emerging drug use practices and trends. This study examined UGC on extramedical use of loperamide among illicit opioid users. Methods A website that allows for the
free discussion of illicit drugs and is accessible for public viewing was selected for analysis.
Web-forum posts were retrieved using web crawlers and retained in a local text database. The
database was queried to extract posts with a mention of loperamide and relevant brand/slang
terms. Over 1290 posts were identified. A random sample of 258 posts was coded using
NVivo to identify intent, dosage, and side-effects of loperamide use. Results There has been
an increase in discussions related to loperamide's use by non-medical opioid users, especially
in 2010–2011 Loperamide was primarily discussed as a remedy to alleviate a broad range of
opioid withdrawal symptoms, and was sometimes referred to as “poor man's” methadone.
Typical doses ranged 70–100 mg per day, much higher than an indicated daily dose of 16 mg.
Conclusions This study suggests that loperamide is being used extra-medically to self-treat
opioid withdrawal symptoms. There is a growing demand among people who are opioid
dependent for drugs to control withdrawal symptoms, and loperamide appears to fit that role.
The study also highlights the potential of the Web as a “leading edge” data source in
identifying emerging drug use practices.
Keywords: Loperamide; Web-based research; Self-treatment; Illicit opiod use
60. Over-the-counter medicine abuse – a review of the literature
Richard J. Cooper
Journal of Substance Use 2013:18(2);82-107
Abstract
Background The sale of over-the-counter (OTC) medicines from pharmacies can help
individuals self-manage symptoms. However, some OTC medicines may be abused, with
addiction and harms being increasingly recognised. This review describes the current
knowledge and understanding of OTC medicine abuse. Approach Comprehensive search of
international empirical and review literature between 1990 and 2011. Findings OTC
medicine abuse was identified in many countries and although implicated products varied,
five key groups emerged: codeine-based (especially compound analgesic) medicines, cough
products (particularly dextromethorphan), sedative antihistamines, decongestants and
laxatives. No clear patterns relating to those affected or their experiences were identified and
they may represent a hard-to-reach group, which coupled with heterogeneous data, makes
estimating the scale of abuse problematic. Associated harms included direct physiological or
psychological harm (e.g. opiate addiction), harm from another ingredient (e.g. ibuprofenrelated gastric bleeding) and associated social and economic problems. Strategies and
interventions included limiting supplies, raising public and professional awareness and using
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existing services and Internet support groups, although associated evaluations were lacking.
Terminological variations were identified. Conclusions OTC medicine abuse is a
recognised problem internationally but is currently incompletely understood. Research is
needed to quantify scale of abuse, evaluate interventions and capture individual experiences,
to inform policy, regulation and interventions.
Keywords: Over-the-counter, abuse, medicines
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PREGNANCY
61. Methadone dosing and prescribed medication use in a prospective cohort of opioiddependent pregnant women
Brian J. Cleary, Kieran Reynolds, Maeve Eogan, Michael P. O'Connell, Tom Fahey, Paul J.
Gallagher, Tom Clarke, Martin J. White, Christine McDermott, Anne O'Sullivan, Deirdre
Carmody, Justin Gleeson, Deirdre J. Murphy
Addiction 2013:108(4);762-770
Abstract
Aims This study aimed to (i) describe methadone dosing before, during and after pregnancy,
(ii) to compare the incidence of neonatal abstinence syndrome (NAS) between those with
dose decreases and those with steady or increasing doses and (iii) to describe prescribed
medication use among opioid-dependent pregnant women. Design Prospective cohort study.
Setting Two Irish tertiary care maternity hospitals.
Participants A total of 117 pregnant women on methadone maintenance treatment (MMT)
recruited between July 2009 and July 2010. Measurements Electronic dispensing records
from addiction clinics and the Primary Care Reimbursement Service were used to determine
methadone doses and dispensed medications in the year preceding and the month following
delivery. The Finnegan score was used to determine need for medical treatment of NAS.
Findings Of the 117 participants, sufficient dosing data were available for 89 women treated
with MMT throughout pregnancy; 36 (40.4%) had their dose decreased from a mean prepregnancy dose of 73.3 mg [standard deviation (SD) 25.5] to a third-trimester dose of
58.0 mg (SD 26.0). The corresponding figures for those with increased doses (n = 31, 34.8%)
were 70.7 mg (SD 25.3) and 89.7 mg (SD 21.0), respectively. The incidence of medically
treated NAS did not differ between dosage groups. Antidepressants were dispensed for 29
women (25.7%) during pregnancy, with the rate decreasing from pre-pregnancy to
postpartum. Benzodiazepines were prescribed for 43 women (38.0%).
Conclusion In the Irish health service, opioid-dependent women frequently have their
methadone dose decreased during pregnancy but this does not appear to affect the incidence
of the neonatal abstinence syndrome in their babies.
Keywords: Dosage; dosing; methadone; neonatal abstinence syndrome; pregnancy;
withdrawal
62. 2-year prospective study of psychological distress among a national cohort of
pregnant women in opioid maintenance treatment and their partners
Ingunn Olea Lund, Svetlana Skurtveit, Monica Sarfi, Brittelise Bakstad, Gabrielle WelleStrand Edle Ravndal
Journal of Substance Use 2013:18(2);148-160
Abstract
Background The prevalence of psychological distress among persons in opioid maintenance
treatments (OMT) is high. It is important to assess psychological distress among OMT
mothers and their partners because such psychological distress increases the risk of relapse to
substance use. Methods A national cohort of pregnant women in OMT (n = 37) and their
partners (n = 23) were taking part in a prospective study. They were interviewed during third
trimester of pregnancy and 1 year after giving birth with the European Addiction Severity
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Index and completed Symptom Checklist 25 during the last month of pregnancy, 6 months
and 2 years after the children were born. Results Among the women there was a significant
reduction in depressive symptoms from pregnancy to 6 months after giving birth (p < 0.01)
and an increase in depressive symptoms from 6 months to 2 years after giving birth. Among
the partners there was a significant decrease in psychological distress from pregnancy to 1
year after the children were born (p < 0.05). Conclusion The overall results indicate a
reduction in psychological distress for both OMT women and their male partners during the
first period after birth, probably affecting parenting abilities and treatment outcome in a
positive way.
Keywords : Pregnant women, opioid maintenance treatment, psychological distress,
prospective, partners
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SMOKING
63. ‘Vaping’ profiles and preferences: an online survey of electronic cigarette users
Lynne Dawkins, John Turner, Amanda Roberts, Kirstie Soar
Addiction 2013:108(6);1115-1125
Abstract
Aims To characterize e-cigarette use, users and effects in a sample of Electronic Cigarette
Company (TECC) and Totally Wicked E-Liquid (TWEL) users. Design and setting Online
survey hosted at the University of East London with links from TECC/TWEL websites from
September 2011 to May 2012. Measurements Online questionnaire. Participants One
thousand three hundred and forty-seven respondents from 33 countries (72% European),
mean age 43 years, 70% male, 96% Causacian, 44% educated to degree level or above.
Findings Seventy-four percent of participants reported not smoking for at least a few weeks
since using the e-cigarette and 70% reported reduced urge to smoke. Seventy-two percent of
participants used a ‘tank’ system, most commonly, the eGo-C (23%). Mean duration of use
was 10 months. Only 1% reported exclusive use of non-nicotine (0 mg) containing liquid. Ecigarettes were generally considered to be satisfying to use; elicit few side effects; be
healthier than smoking; improve cough/breathing; and be associated with low levels of
craving. Among ex-smokers, ‘time to first vape’ was significantly longer than ‘time to first
cigarette’ (t1104 = 11.16, P < 0.001) suggesting a lower level of dependence to e-cigarettes.
Ex-smokers reported significantly greater reduction in craving than current smokers
(χ21 = 133.66, P < 0.0007) although few other differences emerged between these groups.
Compared with males, females opted more for chocolate/sweet flavours (χ21 = 16.16,
P < 0.001) and liked the e-cigarette because it resembles a cigarette (χ23 = 42.65, P < 0.001).
Conclusions E-cigarettes are used primarily for smoking cessation, but for a longer duration
than nicotine replacement therapy, and users believe them to be safer than smoking.
Keywords: E-cigarette; electronic cigarette; nicotine; smoking; survey; vaping
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STIGMA
64. Stigma among health professionals towards patients with substance use disorders
and its consequences for healthcare delivery: Systematic review
Leonieke C. van Boekel, Evelien P.M. Brouwers, Jaap van Weeghel, Henk F.L. Garretsen
Drug and Alcohol Dependence 2013:131(1-2);23-35
Abstract
Background Healthcare professionals are crucial in the identification and accessibility to
treatment for people with substance use disorders. Our objective was to assess health
professionals’ attitudes towards patients with substance use disorders and examine the
consequences of these attitudes on healthcare delivery for these patients in Western countries.
Methods Pubmed, PsycINFO and Embase were systematically searched for articles
published between 2000 and 2011. Studies evaluating health professionals’ attitudes towards
patients with substance use disorders and consequences of negative attitudes were included.
An inclusion criterion was that studies addressed alcohol or illicit drug abuse. Reviews,
commentaries and letters were excluded, as were studies originating from non-Western
countries. Results The search process yielded 1562 citations. After selection and quality
assessment, 28 studies were included. Health professionals generally had a negative attitude
towards patients with substance use disorders. They perceived violence, manipulation, and
poor motivation as impeding factors in the healthcare delivery for these patients. Health
professionals also lacked adequate education, training and support structures in working with
this patient group. Negative attitudes of health professionals diminished patients’ feelings of
empowerment and subsequent treatment outcomes. Health professionals are less involved and
have a more task-oriented approach in the delivery of healthcare, resulting in less personal
engagement and diminished empathy. Conclusions This review indicates that negative
attitudes of health professionals towards patients with substance use disorders are common
and contribute to suboptimal health care for these patients. However, few studies have
evaluated the consequences of health professionals’ negative attitudes towards patients with
substance use disorders.
Keywords: Substance-related disorders; Attitude of health personnel; Stigma; Delivery of
health care
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