Addictive Behaviours Volume 52[1] 12Alcohol and Alcoholism Volume 50 Issue 6[2] 6Alcoholism Clinical & Experimental Research
Volume 39 Issue 9[3], Issue 10[3], Issue 11[2] 12
Drug and Alcohol Dependence Volume 155[3], Volume 156[2], 12
Drugs Education Prevention and Policy
Volume 22 Issue 4[1], Issue 5[1] 6
Drug and Alcohol Review Volume 34, Issue 5[3], Issue 6[3], Supplement Issue S1[1]
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European Addiction Research Volume 22 Issue 1[2], Issue 2[1],Issue 3[1]
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Harm Reduction Journal October 2015 Volume 12[1] 12International Journal of Drug Policy Volume 26 Issue 10[6], Issue 11[2] 6Journal of Substance Abuse Treatment
Volume 57[1], Volume 58[2], Volume 59[3]8
The American Journal of Drug and Alcohol Abuse
Volume 41, Issue 6[2] 6
Substance Use and Misuse Volume 50 Issue 8-9[8], Issue 11[2] 14
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LIST OF REFERENCES
ALCOHOL – BINGE
1. Alcohol Attributable Fraction for Injury Morbidity from the Dose-Response Relationship of Acute Alcohol Consumption: Emergency Department Data from 18 CountriesCheryl J. Cherpitel, Yu Ye, Jason Bond, Guilherme Borges, Maristela Monteiro, Patricia Chou, Wei HaoAddiction 2015:110(11);1724-1723
ALCOHOL EFFECTS
2. Risk Factors for Sudden Cardiac Death Among Patients with Alcohol Dependence: A Nested Case–Control StudyShu-I Wu, Shang-Ying Tsai, Ming-Chyi Huang, Robert Stewart, Chian-Jue Kuo, Chiao-Chicy ChenAlcoholism: Clinical and Experimental Research 2015:39(9);1797-1804
3. The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010 Michelle Hobday, Tanya Chikritzhs, Wenbin Liang and Lynn MeulenersAddiction 2015:110(12);1901-1909
4. A Mixed Hazard? Alcohol, Caffeinated Energy Drinks and the Consequences of Co-ingestion A. PeacockDrug and Alcohol Review 2015:34(S1);E1
5. The Effects of Alcohol Dependence on the Quality of Life and Sex Life of WomenMelike Dişsiz, Nezihe Beji & Ümran OskaySubstance Use and Misuse 2015:50(11);1373-1382
ALCOHOL EPIDEMIOLOGY AND DEMOGRAPHY
6. Risky Drinking, Alcohol Use Disorders, and Health Services Utilization in the U.S. General Population: Data from the 2005 and 2010 National Alcohol SurveysCheryl J. Cherpitel, Yu YeAlcoholism: Clinical and Experimental Research 2015:39(9);1698-1704
7. Lay epidemiology and the interpretation of low-risk drinking guidelines by adults in the United Kingdom Melanie Lovatt, Douglas Eadie, Petra S. Meier, Jessica Li, Linda Bauld, Gerard Hastings and John HolmesAddiction 2015:110(12);1912-1919
8. Sex and age differences in the early identification and treatment of alcohol use: a population-based study of patients with alcoholic cirrhosis Harmony E. Otete, Elizabeth Orton, Joe West and Kate M. FlemingAddiction 2015:110(12);1932-1940
ALCOHOL MISCELLANEOUS
9. QT interval prolongation associated with low magnesium in chronic alcoholicsStephanie Rezende Alvarenga Moulin, José Geraldo Mill, Werther Clay Monico Rosa, Silas Rubens Hermisdorf, Lunielle da Cruz Caldeira, e Maria da Penha Zago-GomesDrug and Alcohol Dependence 2015:155(195-2010
ALCOHOL POLICY
10. The effects of liquor licensing restriction on alcohol-related violence in NSW, 2008–13Patricia Menéndez, Fernando Tusell, Don WeatherburnAddiction 3025:110(10);1574-1582
11. The Public Health Dilemma in the Alcohol Intervention Area: Unfinished Business
Between Limits and FreedomFranca BeccariaSubstance Use and Misuse Journal 2015:50(8-9);1174-1177
ALCOHOL PRICING
12. The Dynamic Effects of Changes in Prices and Affordability on Alcohol Consumption: An Impulse Response AnalysisHeng Jiang, Michael LivingstonAlcohol and Alcoholism 2015:50(6);631-638
13. The Socioeconomic Differences in Alcohol-Related Harm and the Effects of Alcohol Prices on Them: A Summary of Evidence from FinlandPia Mäkelä, Kimmo Herttua, Pekka MartikainenAlcohol and Alcoholism 2015:50(6);661-669
ALCOHOL TREATMENT
14. Resistance to Temptation: The Interaction of External and Internal Control on Alcohol Use During Residential Treatment for Alcohol Use DisorderLeila M. Soravia, Katrin Schläfli, Sonja Stutz, Susanne Rösner and Franz MoggiAlcoholism: Clinical and Experimental Research 2015:39(11);2209-2214
15. The overexpression of Thioredoxin-1 suppressing inflammation induced by methamphetamine in spleen Xiao-Li Wu, Xiang Li, Ye Li, Ling-Pin Kong, Jiao-Long Fang, Xiao-Shuang Zhou, Mei Li, Jin-Jing Jia, Jie BaiDrug and Alcohol Dependence 2015: In Press, Accepted Manuscript, Available online 23 November 2015
16. Alcohol-Adapted Anger Management Treatment: A Randomized Controlled Trial of an Innovative Therapy for Alcohol DependenceKimberly S. Walitzer, Jerry L. Deffenbacher, Kathleen ShyhallaJournal of Substance Abuse Treatment 2015:59;83-93
BRIEF INTERVENTION
17. The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trialRanjita Dhital, Ian Norman, Cate Whittlesea, Trevor Murrells, Jim McCambridgeAddiction 2015:110(10);1586-1594
18. Brief in Person Interventions for Adolescents and Young Adults Following Alcohol-Related Events in Emergency Care: A Systematic Review and European Evidence SynthesisDiestelkamp S., Drechsel M., Baldus C., Wartberg L., Arnaud N., Thomasius R. European Addiction Research 2016:22(1);17-35
CO-MORBIDITY
19. A systematic review of interventions for co-occurring substance use and borderline personality disorders Nicole K. Lee, Jacqui Cameron and Linda JennerDrug and Alcohol Review 2015:34(6);663-672
20. Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric ComorbidityRichard A. Brown, Ana M. Abrantes, Haruka Minami, Mark A. Prince, Erika Litvin Bloom, Timothy R. Apodaca, David R. Strong, Dawn M. Picotte, Peter M. Monti, Laura MacPherson, Stephen V. Matsko, Jeffrey I. HuntJournal of Substance Abuse Treatment 2015:59;20-29
DRUG POLICY
21. Controlling, Modeling, Consensus, and Substance Use(r) Policy Intervention: Unfinished BusinessBrian FergusonSubstance Use and Misuse Journal 2015:50(8-9);1125-1130
22. Commonalities and Distinctions Among Mechanisms of Addiction to Alcohol and Other DrugsAngela R. Ozburn, Aaron J. Janowsky, John C. CrabbeAlcoholism: Clinical and Experimental Research 2015:39(10);1863-1877
23. Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects Dvora Shmulewitz, Emily R. Greene, Deborah HasinAlcoholism: Clinical and Experimental Research 2015:39(10);1878-1900
24. Heterogeneity of Mental Health Service Utilization and High Mental Health Service Use Among Women Eight Years After Initiating Substance Use Disorder TreatmentElizabeth Evans, Howard Padwa, Libo Li, Veronique Lin, Yih-Ing HserJournal of Substance Abuse Treatment 2015:59;10-19
HARM REDUCTION
25. “Drugs don’t have age limits”: The challenge of setting age restrictions for supervised injection facilitiesTara Marie Watson, Carol Strike, Gillian Kolla, Rebecca Penn, Ahmed M. BayoumiDrugs: Education, Prevention and Policy 2015:22(4);370-379
26. Assessing seasonality of travel distance to harm reduction service providers among persons who inject drugsSean Allen, Monica Ruiz, Amira Roess, Jeff Jones Harm Reduction Journal 2015:12:45
HEPATITIS C
27. Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugsJason Grebely, Philip Bruggmann, Carla Treloar, Jude Byrne, Tim Rhodes, Gregory J. Dore, on behalf of the International Network for Hepatitis in Substance UsersInternational Journal of Drug Policy 2015:26(10);893-898
28. Enhancing the detection and management of acute hepatitis C virus infectionMarianne Martinello, Gail V. MatthewsInternational Journal of Drug Policy 2015:26(10);899-910
29. Health-Related Quality of Life for individuals with hepatitis C: A narrative reviewDavid Whiteley, Lawrie Elliott, Sarah Cunningham-Burley, Anne WhittakerInternational Journal of Drug Policy 2015:26(10);939-949
30. Hepatitis C Virus seroconversion among persons who inject drugs in relation to primary care physician visiting: The potential role of primary healthcare in a combined approach to Hepatitis C preventionAndreea Adelina Artenie, Élise Roy, Geng Zang, Didier Jutras-Aswad, Jean-Marie Bamvita, Svetlana Puzhko, Mark Daniel, Julie BruneauInternational Journal of Drug Policy 2015:26(10);970-975
31. Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, AustraliaCarla Treloar, Jake Rance, Nicky Bath, Hope Everingham, Michelle Micallef, Carolyn Day, Sue Hazelwood, Jason Grebely, Gregory J. DoreInternational Journal of Drug Policy 2015:26(10);992-998
32. The effect of introducing point-of-care or dried blood spot analysis on the uptake of hepatitis C virus testing in high-risk populations: A systematic review of the literatureJosh T. Coats, John F. DillonInternational Journal of Drug Policy 2015:26(11);1050-1055
33. The effect of social functioning and living arrangement on treatment intent, specialist assessment and treatment uptake for hepatitis C virus infection among people with a history of injecting drug use: The ETHOS studyEmmanuel Fortier, Maryam Alavi, Michelle Micallef, Adrian J. Dunlop, Annie C. Balcomb, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber, Gregory J. Dore, Julie Bruneau, Jason Grebely, on behalf of the ETHOS Study GroupInternational Journal of Drug Policy 2015:26(11);1094-1102
HOMELESSNESS
34. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual careJulian M. Somers, Akm Moniruzzaman, Anita PalepuAddiction 2015:110(10);1605-1614
35. Comparison of Homeless and Non-Homeless Problem Drug Users Recruited
from Primary Care Safety-Net ClinicsAntoinette Krupski, Meredith C. Graves, Kristin Bumgardner, Peter Roy-ByrneJournal of Substance Abuse Treatment 2015:58;84-89
36. From initiating injecting drug use to regular injecting: Retrospective survival analysis of injecting progression within a sample of people who inject drugs regularlyDaniel O’Keefe, Danielle Horyniak, Paul DietzeDrug and Alcohol Dependence 2015:In Press, Accepted Manuscript, Available online 23 November 2015
LIVER DISEASE
37. Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife StudyA.D. Marshall, M. Micallef, A. Erratt, J. Telenta, C. Treloar, H. Everingham, S.C. Jones, N. Bath, D. How-Chow, J. Byrne, P. Harvey, A. Dunlop, M. Jauncey, P. Read, T. Collie, G.J. Dore, J. GrebelyInternational Journal of Drug Policy 2015:26(10);984-991
MISCELLANEOUS
38. Substance Use Disorders, Evidence-Based Practices and the Possible Nature of Deep FlawsRobert WalkerSubstance Use and Misuse Journal 2015:50(8-9);956-963
39. Ready for Retirement: The Gateway Drug HypothesisJohn KleinigSubstance Use and Misuse Journal 2015:50(8-9);971-975
40. Retire the Concept of “Relapse”William R. MillerSubstance Use and Misuse Journal 2015:50(8-9);976-977
NEW PSYCHOACTIVE SUBSTANCE
41. Predictions instead of panics: the framework and utility of systematic forecasting of novel psychoactive drug trendsJohn M. Stogner The American Journal of Drug and Alcohol Abuse 2015:41(6);519-526
OPIATE REPLACEMENT TREATMENT
42. Opioid Maintenance Treatment - A Call for a Joint European Quality Care ApproachBrandt L., Unger A., Moser L., Fischer G., Jagsch R. European Addiction Research 2016:22(1);36-51
43. The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert ConsensusReimer J., Wright N., Somaini L., Roncero C., Maremmani I., McKeganey N., Littlewood R., Krajci P., Alho H., D'Agnone O. European Addiction Research 2016;22(2):99-106
44. The characteristics of a cohort who tamper with prescribed and diverted opioid medicationsBriony Larance, Nicholas Lintzeris, Raimondo Bruno, Amy Peacock, Elena Cama, Robert Ali, Ivana Kihas, Antonia Hordern, Nancy White, Louisa DegenhardtJournal of Substance Abuse Treatment 2015:58;51-61
45. A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence Natasa Gisev, Marian Shanahan, Don J. Weatherburn, Richard P. Mattick, Sarah Larney, Lucy Burns and Louisa DegenhardtAddiction 2015:110(12);1975-1984
46. The introduction of buprenorphine-naloxone film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations Briony Larance, Paul Dietze, Robert Ali, Nicholas Lintzeris, Nancy White, Rebecca Jenkinson and Louisa DegenhardtDrug and Alcohol Review 2015:34(6);603-610
47. Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study Nancy White, Ian Flaherty, Peter Higgs, Briony Larance, Suzanne Nielsen, Louisa Degenhardt, Robert Ali and Nicholas LintzerisDrug and Alcohol Review 2015:34(6);623-629
48. Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological CorrelatesGerra G.; Manfredini M.; Somaini L.; Maremmani I.; Leonardi C.; Donnini C. European Addiction Research 2016:22;163-175
OPIATE TREATMENT SERVICES
49. Senior nurses' perspectives on the transfer of opioid substitution treatment clients from clinics to community pharmacy Jessica Bui, Carolyn Day, Jane Hanrahan, Adam Winstock, Betty ChaarDrug and Alcohol Review 2105:34(5);495-498
50. Impact of opioid substitution therapy for Scotland's prisoners on drug-related deaths soon after prisoner releaseSheila M. Bird, Colin M. Fischbacher, Lesley Graham, Andrew FraserAddiction 2015:110(10);1617-1624
51. Naloxone—does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdoseJoanne Neale, John StrangAddiction 2015:110(10);1644-1652
52. The relation between risk-taking behavior and alcohol use in young adults is different for men and womenL. de Haan, A.C.G. Egberts, E.R. HeerdinkDrug and Alcohol Dependence 2015:155(222-227)
53. Predictors of Opioid-Related Death During Methadone TherapyPamela Leece, Christopher Cavacuiti, Erin M. Macdonald, Tara Gomes, Meldon Kahan, Anita Srivastava, Leah Steele, Jin Luo, Muhammad M. Mamdani, David N. JuurlinkJournal of Substance Abuse Treatment 2015:57;30-35
PRESCRIPTION MISUSE
54. Dynamic model of nonmedical opioid use trajectories and potential policy interventionsWayne Wakeland, Alexandra Nielsen, Peter GeissertThe American Journal of Drug and Alcohol Abuse 2015:41(6);508-518
PRIMARY CARE
55. Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care-based multi-component brief intervention to reduce risky drug useLillian Gelberg, Ronald M. Andersen, Abdelmonem A. Afifi, Barbara D. Leake, Lisa Arangua, Mani Vahidi, Kyle Singleton, Julia Yacenda-Murphy, Steve Shoptaw, Michael F. Fleming, Sebastian E. BaumeisterAddiction 2015:110(11);1777-1790
56. Together Achieving More: Primary Care Team Communication and Alcohol-
Related Healthcare Utilization and Costs Marlon P. Mundt, Larissa I. Zakletskaia, David A. Shoham, Wen-Jan Tuan, Pascale CarayonAlcoholism: Clinical and Experimental Research 2105:39(10);2003-2015
57. Health-care professionals’ attitudes across different hospital departments regarding alcohol-related presentationsNauman Iqbal, Orlagh McCambridge, Lauren Edgar, Ciara Young, Gillian W. ShorterDrug and Alcohol Review 2015:34(5);487-494
RECOVERY
58. You Can't Be in Recovery If You Are on Medication: A Concept Worth RetiringGeorge E. WoodySubstance Use and Misuse 2015:50(8-9);1020-1023
59. Addiction Treatment Professionals Are Not the Gatekeepers of RecoveryKeith HumphreysSubstance Use and Misuse 2015:50(8-9);1024-1027
60. Recovery Is A Reality: But What Is It?Carl LeukefeldSubstance Use and Misuse 2015:50(8-9);1028-1030
STIGMA
61. “Doing the devil’s work”: Emotional labour and stigma in expanding Needle and Syringe ProgramsCarla Treloar, Max Hopwood, Kenneth Yates, Limin MaoDrugs: Education, Prevention and Policy 2015:22(5);437-443
VAPING/E-CIGARETTES
62. Cannabis vaping and public health—some comments on relevance and implicationsBenedikt Fischer, Cayley Russell, Mark W. TyndallAddiction 2015:110(10);1705-1706
YOUNG PEOPLE AND ALCOHOL
63. Adolescents from affluent city districts drink more alcohol than othersWilly Pedersen, Anders Bakken, Tilmann von SoestAddiction 2105:110(10);1595-1604
64. Trajectories and correlates of reasons for abstaining or limiting drinking during adolescenceJennifer E. Merrill, Scott Martin, Caitlin C. Abar, Kristina M. JacksonAddictive Behaviors 2016:52;1-7
65. Adolescent Drinking Risks Associated with Specific Drinking ContextsChristina Mair, Sharon Lipperman-Kreda, Paul J. Gruenewald, Melina Bersamin, Joel W. GrubeAlcoholism: Clinical and Experimental Research 2015:39(9);1705-1711
66. Are homeschooled adolescents less likely to use alcohol, tobacco, and other drugs?Michael G. Vaughn, Christopher P. Salas-Wright, Kristen P. Kremer, Brandy R. Maynard, Greg Roberts, Sharon VaughnDrug and Alcohol Dependence 2015:155(97-104)
67. ‘I think other parents might. …’: Using a projective technique to explore parental supply of alcohol Sandra C. Jones, Christopher Magee, Kelly AndrewsDrug and Alcohol Review 2015:34(5);531-539
68. Alcohol Use Initiation is Associated with Changes in Personality Trait Trajectories from Early Adolescence to Young Adulthood Daniel M. Blonigen, C. Emily Durbin, Brian M. Hicks, Wendy Johnson, Matt McGue and William G. IaconoAlcoholism: Clinical and Experimental Research 2015:39(11);2163-2170
69. The Role of Moral Disengagement in Underage Drinking and Heavy Episodic DrinkingCatherine Angela Quinn & Kay BusseySubstance Use and Misuse 2015:50(11);1437-1448
1. Alcohol Attributable Fraction for Injury Morbidity from the Dose-Response Relationship of Acute Alcohol Consumption: Emergency Department Data from 18 CountriesCheryl J. Cherpitel, Yu Ye, Jason Bond, Guilherme Borges, Maristela Monteiro, Patricia Chou, Wei HaoAddiction 2015:110(11);1724-1723 AbstractAims To calculate the alcohol-attributable fraction (AAF) of injury morbidity by volume of consumption prior to injury based on newly reported relative risk (RR) estimates. Design AAF estimates based on the dose-response RR estimates obtained from previous pair-matched case-crossover fractional polynomial analysis of mean volume in volume categories were calculated from the prevalence of drinking prior to injury in each volume category. Setting Thirty-seven emergency departments (EDs) across 18 countries.Participants Probability samples of patients, with equal representation of each shift for each day of the week, totaling 14,026 who arrived at the ED within six hours of injury from ED studies conducted between 2001 and 2011. Measurements AAF was analyzed by gender, age (18-30; >30), cause of injury (traffic, assault, fall, other), and country detrimental drinking pattern (DDP). Findings For the EDs analyzed, 16.4% of all injuries were estimated to be attributable to alcohol, and the AAF did not vary by age but was over twice as large for males (20.6%; 19.3-21.8) than for females (8.6%; 7.5-9.7%). While females were at greater risk of injury than males at higher volume levels, lower prevalence of women drinking at higher levels contributed to overall lower AAF for women. Assault-related injuries showed the largest AAF (44.1%; 37.6-42.6). AAF was slightly higher for injuries from falls (14.3%; 12.9-15.7) than motor vehicle crashes (11.1%; 9.3-12.9). AAF was higher in those countries with a DDP of 3 (18.6; 17.5-19.7) and 4 (19.4%; 17.3-21.6) than those with a DDP of 2 (12.0%; 10.5-13.5). Conclusions Alcohol-attributable injuries presenting in emergency departments are higher for males than females, for violence-related injuries compared with other types of injury, and for countries with more detrimental drinking patterns compared with those with less detrimental patterns.Keywords: Alcohol; alcohol attributable fraction; dose-response; emergency department; gender; injury; motor vehicle; violence
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ALCOHOL EFFECTS
2. Risk Factors for Sudden Cardiac Death Among Patients with Alcohol Dependence: A Nested Case–Control StudyShu-I Wu, Shang-Ying Tsai, Ming-Chyi Huang, Robert Stewart, Chian-Jue Kuo, Chiao-Chicy ChenAlcoholism: Clinical and Experimental Research 2015:39(9);1797-1804
Abstract Background Excessive alcohol consumption causes a broad range of health problems, including premature mortality and sudden cardiac death (SCD). We identified potential clinical characteristics and laboratory indices associated with SCD among patients with alcohol dependence. Methods Patients with alcohol dependence (n = 2,793) admitted to a psychiatric center in northern Taiwan between 1985 and 2008 were linked with a national mortality database for causes of death. Of the 2,793 patients in the cohort, 67 cases died of SCD. The standardized mortality ratio (SMR) of SCD relative to the general population was calculated. Based on a nested case–control design, we selected a set of sex-, age-, and year-of-admission-matched two control subjects for each case derived from the cohort. We collated the clinical information through a standardized review of patients' medical records. Conditional logistic regressions were then conducted to explore potential exposures associated with SCD. Results The sample had substantially higher SCD mortality (SMR 12.8) compared to the general population. After adjustments in the multivariate analyses for the clinical profiles at the index (earliest) admission, both abnormal electrocardiography (ECG) (adjusted risk ratio = 16.97, 95% confidence interval (CI) 1.60 to 179.58, p = 0.019) and elevated aspartate aminotransferase levels (adjusted risk ratio = 1.01, 95% CI 1.00 to 1.02, p = 0.046) were significantly associated with SCD. Conclusions This study raises the question of whether intensive follow-up of patients with elevated AST and abnormal ECG findings should be evaluated as a strategy to prevent SCD in patients with alcohol dependence.Keywords: Sudden Cardiac Death; Risk Factor; Electrocardiography; Alcohol Dependence
3. The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010 Michelle Hobday, Tanya Chikritzhs, Wenbin Liang and Lynn MeulenersAddiction 2015:110(12);1901-1909
AbstractBackground and Aims Few studies have investigated the combined effects of alcohol sales, outlet numbers and trading hours on alcohol-related harms. This study aimed to test whether associations: (i) exist between alcohol-related emergency department (ED) injuries and alcohol sales and counts of outlets; (ii) vary between on- and off-premises outlets; and (iii) vary by trading hours conditions [extended trading permits (ETP) versus standard hours].Design Panel study using 117 postcodes over 8 years (2002–10): 936 data points.Setting Perth, Australia. Participants ED injury presentations, aggregated to postcode-level. Measurements Alcohol-related injuries were identified using time-based surrogate measures: night injuries (n = 51 241) and weekend night injuries (n = 30 682). Measures of alcohol availability included number of outlets with standard and extended trading hours and mean sales per postcode. Negative binomial regression modelling with random effects was used to examine associations between availability and alcohol-related injury, controlling for
socio-demographic characteristics. Findings (i) Night injuries were associated significantly with counts of on-premises outlets [incident rate ratio (IRR) = 1.046; 95% confidence interval (CI) = 1.014–1.078] and sales per off-premises outlet (IRR = 1.019; 95% CI = 1.004–1.035); (ii) counts of on-premises outlets were positively associated with alcohol-related injury while counts of off-premises outlets indicated a negative association; and (iii) weekend night injuries increased by about 5% per on-premises outlet with an ETP (IRR = 1.049; 95% CI = 1.015–1.084) and by less than 1% for outlets with standard trading hours (IRR = 1.008; 95% CI = 1.004–1.013). Conclusions Regions of Perth, Australia with greater off-premises alcohol sales and counts of on-premises alcohol outlets, particularly those with extended trading hours, appear to have higher levels of alcohol-related injuries.Keywords: Alcohol availability; alcohol consumption; alcohol sales; alcohol-related; outlet density; trading hours
4. A Mixed Hazard? Alcohol, Caffeinated Energy Drinks and the Consequences of Co-ingestion A. PeacockDrug and Alcohol Review 2015:34(S1);E1
No abstract available
5. The Effects of Alcohol Dependence on the Quality of Life and Sex Life of WomenMelike Dişsiz, Nezihe Beji & Ümran OskaySubstance Use and Misuse 2015:50(11);1373-1382
AbstractBackground Alcohol dependence is a multi-dimensional and chronic disorder which affects the physical, psychological, social, sexual health and thus the quality of life of the individual. Objectives This research was designed in order to determine the effect of alcohol dependence on the quality of life and sexual life of women. Methods The research was a cross-sectional and comparative relation study, consisting of a case study group constituted of women who consulted Prof. Dr. Mazhar Osman Mental Health and Disorders Training and Research Hospital's Alcohol and Substance Research, Treatment, Education Center between July 2009 and July 2010 and who were diagnosed as alcohol addicted and a healthy group, constituted of women who consulted the Gynecology Clinic of the same hospital (alcohol dependent group = 71, healthy group = 183). The data were collected using ‘World Health Organization Quality of Life Scale Brief Form’ (WHOQOL-BREF TR), Female Sexual Function Index (FSFI), Beck Depression Inventory (BDI). Data were analyzed by percentage, mean, chi-square, student's t-test, and multivariate analysis by use of SPSS 13.0 program. Results It was determined that the alcohol-dependent women presented lower WHOQOL-BREF-TR sub-dimensions and lower FSFI total scores and sub-dimensions but higher scores in BDI scale in comparison to the healthy group. Conclusions The alcohol dependence negatively affects the quality of life and sexual life in women.Keywords: women; alcohol dependence; quality of life; sexual life
6. Risky Drinking, Alcohol Use Disorders, and Health Services Utilization in the U.S. General Population: Data from the 2005 and 2010 National Alcohol SurveysCheryl J. Cherpitel, Yu YeAlcoholism: Clinical and Experimental Research 2015:39(9);1698-1704
Abstract Background While alcohol-related problems have been found to be overrepresented in clinical samples of patients, less is known about health services utilization in the general population. Methods To explore the association of risky drinking and alcohol use disorders (AUD) with inpatient and outpatient services utilization, data are analyzed from a merged sample of 13,165 respondents in the 2005 and 2010 U.S. National Alcohol Surveys. Propensity score weighting was used to minimize potential bias associated with the heterogeneity in individual-level characteristics across respondents which might influence these relationships. Results No significant differences were found between risky and nonrisky drinkers on any of the utilization variables in the last year, with 11% reporting an emergency room (ER) visit, a third reporting a primary care visit, and 6.2 to 7.6% reporting hospitalization. Those with an AUD were significantly more likely than those without to report an ER visit in the last year (18.2% vs. 11.6%; p = 0.003) as well as a greater number of such visits (p = 0.007), and to report more primary care visits (p = 0.05) and any hospitalization (11.2% vs. 6.7%; p = 0.019). Conclusions The data suggest a significant and potentially costly increase in health services utilization due to AUD. ERs and primary care settings would benefit from devoting increased resources to addressing AUD, which could result in clinical benefits of improvement in overall health status as well as economic benefits in lowering healthcare costs for both patients and society as a whole.Keywords: Alcohol Use Disorders; Health Services Utilization
7. Lay epidemiology and the interpretation of low-risk drinking guidelines by adults in the United Kingdom Melanie Lovatt, Douglas Eadie, Petra S. Meier, Jessica Li, Linda Bauld, Gerard Hastings and John HolmesAddiction 2015:110(12);1912-1919
AbstractAims To explore how the concept of lay epidemiology can enhance understandings of how drinkers make sense of current UK drinking guidelines. Methods Qualitative study using 12 focus groups in four sites in northern England and four sites in central Scotland. Participants were 66 male and female drinkers, aged between 19 and 65 years, of different socio-economic backgrounds. Data were analysed thematically using a conceptual framework of lay epidemiology. Results Current drinking guidelines were perceived as having little relevance to participants' drinking behaviours and were generally disregarded. Daily guidelines were seen as irrelevant by drinkers whose drinking patterns comprised heavy weekend drinking. The amounts given in the guidelines were seen as unrealistic for those motivated to drink for intoxication, and participants measured alcohol intake in numbers of drinks or containers rather than units. Participants reported moderating their drinking, but this was out of a desire to fulfil work and family responsibilities, rather than concerns for their own health. The current Australian and Canadian guidelines were preferred to UK guidelines, as they were seen to address many of the above problems. Conclusions Drinking guidelines
derived from, and framed within, solely epidemiological paradigms lack relevance for adult drinkers who monitor and moderate their alcohol intake according to their own knowledge and risk perceptions derived primarily from experience. Insights from lay epidemiology into how drinkers regulate and monitor their drinking should be used in the construction of drinking guidelines to enhance their credibility and efficacy.Keywords: Alcohol; drinking practices; drinking guidelines; lay epidemiology; qualitative; units
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ALCOHOL LIVER DISEASE
8. Sex and age differences in the early identification and treatment of alcohol use: a population-based study of patients with alcoholic cirrhosis Harmony E. Otete, Elizabeth Orton, Joe West and Kate M. FlemingAddiction 2015:110(12);1932-1940
AbstractAim To estimate sex differences in health-care utilization among harmful/hazardous drinkers in the period before alcoholic cirrhosis diagnosis, and estimate sex differences in the extent to which alcohol use and brief alcohol interventions were documented for these individuals compared with a control cohort. Design Retrospective study using linked general practice and hospital admissions data in England. Setting Three hundred and fifty-seven general practitioner (GP) practices in England. Participants A total of 2479 individuals with alcoholic cirrhosis (mean age at diagnosis = 56years), of whom 67% were men; and 24 790 controls without the disease. Measurements Rates of primary care visits and hospital admissions prior to the diagnosis of alcoholic cirrhosis for men and women, and the proportion of men and women with alcohol consumption and/or alcohol brief intervention documented in their medical record. Findings Compared with the general population, patients with alcoholic cirrhosis used primary and secondary health-care services more frequently in the years leading up to their diagnosis. In the years prior to diagnosis, men used primary and secondary health-care services more than did women (P for sex interaction P < 0.0001). Men were more likely than women to have their alcohol use recorded [odds ratio (OR) men = 1.96, 95% confidence interval (CI) = 1.7–2.3; women = 1.63, 95% CI = 1.4–1.8, P for sex interaction P < 0.0017]. By contrast, alcohol interventions were recorded more commonly among women (OR men = 4.3, 95% CI = 3.7–4.9; women = 5.8, 95% CI = 4.7–6.9, P for sex interaction = 0.07), although less common with increasing age (P for age interaction = 0.009). Conclusions In the United Kingdom, prior to alcoholic cirrhosis diagnosis, excess health-care utilization is higher in men than women and men are more likely than women to have their alcohol use recorded. However, women appear to be more likely than men to receive alcohol brief interventions.Keywords: Alcohol interventions; alcoholic cirrhosis; primary care; secondary care
9. QT interval prolongation associated with low magnesium in chronic alcoholicsStephanie Rezende Alvarenga Moulin, José Geraldo Mill, Werther Clay Monico Rosa, Silas Rubens Hermisdorf, Lunielle da Cruz Caldeira, e Maria da Penha Zago-GomesDrug and Alcohol Dependence 2015:155(195-2010
AbstractBackground Alcoholism is a psychoactive drug-dependence with high prevalence throughout the world. Alcoholism has already been shown to be associated with electrical heart disorders, such as QT interval prolongation. Long QT, rare among healthy individuals (0.0017–0.31%), can trigger tachyarrhythmias and sudden death and might be caused by alcohol consumption itself and the resulting hypomagnesaemia.Methods This case-control study assessed active alcoholics and alcoholics who have been abstinent for at least seven days to compare changes in electrocardiographic, clinical and laboratory analyses among groups. Results A total of 166 alcoholics were evaluated, of which 62 were active and 104 abstinent alcoholics. Long QT was more prevalent among active alcoholics compared to abstinent alcoholics (16% vs. 2%, respectively, odds ratio (OR) 9.81, p = 0.011), as was hypomagnesaemia (23% vs. 10%, OR 3.11, p = 0.013). Serum magnesium levels were inversely proportional to the length of the corrected QT interval among active alcoholics (β = −35.1 ms, p = 0.005). Conclusions Active chronic alcoholics exhibited a higher association of long QT and hypomagnesaemia. Low serum magnesium levels were predictive of QT interval prolongation. Because the above changes potentially trigger fatal arrhythmias, it is of fundamental importance to consider the diagnostic possibility by routinely requesting electrocardiograms and serum magnesium level assessment during the treatment of chronic alcoholic patients.
10. The effects of liquor licensing restriction on alcohol-related violence in NSW, 2008–13Patricia Menéndez, Fernando Tusell, Don WeatherburnAddiction 3025:110(10);1574-1582 AbstractAim To estimate the effect on assault of a series of legislative reforms that restricted the trading hours and trading conditions of licensed premises in New South Wales (NSW), Australia. Methods We examine the effects of the legislative reforms introduced between July 2008 and January 2012 using time series structural models. These models are used to estimate the underlying long-term dynamics of the time series of police recorded domestic and non-domestic assaults occasioning actual bodily harm (ABH) and assaults occasioning grievous bodily harm (GBH) in NSW between January 1996 and December 2013. The effect of the legislative changes is captured by including terms in the models which reflect a smooth step change in the number of assaults. Results The reforms introduced between July 2008 and January 2012 were associated with a fall in levels of ABH and GBH assaults. The joint effect of all the interventions on ABH lasted until July 2013, accounting for a reduction of −31.27% over that period [parameter estimate −0.38 with 95% confidence interval (CI) = −0.65, –0.10)]. The same set of interventions had a greater effect on GBH assaults; achieving a −39.70% reduction over a shorter period of time July 2008 and July 2012 (parameter estimate −0.51 with 95% CI = −0.69, –0.33). Conclusion Legislative reforms introduced in New South Wales, Australia between July 2008 and January 2012 to restrict trading hours and trading conditions of licensed alcohol premises appear to have reduced the number of police-recorded assaults of ABH and GBH by 31.27% and 39.70% respectively.Keywords: Alcohol; assault; consumer sentiment index; liquor licensing; structural time–series
11. The Public Health Dilemma in the Alcohol Intervention Area: Unfinished Business Between Limits and FreedomFranca BeccariaSubstance Use and Misuse Journal 2015:50(8-9);1174-1177
12. The Dynamic Effects of Changes in Prices and Affordability on Alcohol Consumption: An Impulse Response AnalysisHeng Jiang, Michael LivingstonAlcohol and Alcoholism 2015:50(6);631-638
Abstract Aims To investigate how changes in alcohol price and affordability are related to aggregate level alcohol consumption in Australia to help to inform effective price and tax policy to influence consumption. Material and methods Annual time series data between 1974 and 2012 on price and per-capita consumption for beer, wine and spirits and average weekly income were collected from the Australian Bureau of Statistics. Using a Vector Autoregressive model and impulse response analysis, the dynamic responses of alcohol consumption to changes in alcohol prices and affordability were estimated. Results Alcohol consumption in Australia was negatively associated with alcohol price and positively associated with the affordability of alcohol. The results of the impulse response analysis suggest that a 10% increase in the alcohol price was associated with a 2% decrease in the population-level alcohol consumption in the following year, with further, diminishing, effects up to year 8, leading to an overall 6% reduction in total consumption. In contrast, when alcohol affordability increased, per-capita alcohol consumption increased over the following 6 years. Conclusions Our findings suggest that increasing alcohol prices or taxes can help to reduce alcohol consumption at the population level in Australia. However, the impact of affordability in our findings highlights that pricing policies need to consider increases in income to ensure effectiveness. Alcohol price policy should only cautiously focus on individual beverage types, because increasing the price of one beverage generally leads to an increase in consumption of substitutes.
13. The Socioeconomic Differences in Alcohol-Related Harm and the Effects of Alcohol Prices on Them: A Summary of Evidence from FinlandPia Mäkelä, Kimmo Herttua, Pekka MartikainenAlcohol and Alcoholism 2015:50(6);661-669
Abstract Aims We make a case study of Finland to study the connections between socioeconomic status, alcohol use, related harm and possibilities for intervention by means of alcohol pricing. Methods A review of Finnish studies on the topic. Results The socioeconomic differences in severe alcohol-related harm were great, and in the past two decades, these differences have widened. Alcohol-related mortality has also strongly contributed to both the level and widening of socioeconomic differences in life expectancy. Both in 2004, when alcohol prices were abruptly cut, and in the longer term with more gradual changes in lowest prices of alcohol, the lowest socioeconomic groups were most affected in absolute—but not so clearly in relative—terms, particularly among men. However, these effects are sometimes weak, not fully consistent by gender and across different measures of harm. Conclusions The large and increasing socioeconomic differences in alcohol-related harm in Finland underline the importance of reducing these differences. The finding that particularly among men the impact of reduced alcohol prices on health has often in absolute terms been the greatest in the lower socioeconomic groups suggests that policies aimed at keeping the
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price of alcoholic beverages high may help to both minimize the overall level of alcohol-related health problems and to reduce absolute inequalities.
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ALCOHOL TREATMENT
14. Resistance to Temptation: The Interaction of External and Internal Control on Alcohol Use During Residential Treatment for Alcohol Use DisorderLeila M. Soravia, Katrin Schläfli, Sonja Stutz, Susanne Rösner and Franz MoggiAlcoholism: Clinical and Experimental Research 2015:39(11);2209-2214
Abstract Background There is evidence that drinking during residential treatment is related to various factors, such as patients' general control beliefs and self-efficacy, as well as to external control of alcohol use by program's staff and situations where there is temptation to drink. As alcohol use during treatment has been shown to be associated with the resumption of alcohol use after discharge from residential treatment, we aimed to investigate how these variables are related to alcohol use during abstinence-oriented residential treatment programs for alcohol use disorders (AUD). Methods In total, 509 patients who entered 1 of 2 residential abstinence-oriented treatment programs for AUD were included in the study. After detoxification, patients completed a standardized diagnostic procedure including interviews and questionnaires. Drinking was assessed by patients' self-report of at least 1 standard drink or by positive breathalyzer testing. The 2 residential programs were categorized as high or low control according to the average number of tests per patient. Results Regression analysis revealed a significant interaction effect between internal and external control suggesting that patients with high internal locus of control and high frequency of control by staff demonstrated the least alcohol use during treatment (16.7%) while patients with low internal locus of control in programs with low external control were more likely to use alcohol during treatment (45.9%). No effects were found for self-efficacy and temptation.Conclusions As alcohol use during treatment is most likely associated with poor treatment outcomes, external control may improve treatment outcomes and particularly support patients with low internal locus of control, who show the highest risk for alcohol use during treatment. High external control may complement high internal control to improve alcohol use prevention while in treatment.Keywords: Alcohol Dependence; Alcohol Use; Locus of Control; Alcohol Testing
15. The overexpression of Thioredoxin-1 suppressing inflammation induced by methamphetamine in spleen Xiao-Li Wu, Xiang Li, Ye Li, Ling-Pin Kong, Jiao-Long Fang, Xiao-Shuang Zhou, Mei Li, Jin-Jing Jia, Jie BaiDrug and Alcohol Dependence 2015: In Press, Accepted Manuscript, Available online 23 November 2015
AbstractBackground Methamphetamine (METH) is an addictive psychostimulant and has been shown to induce oxidative stress and inflammation in various tissues. Thioredoxin-1 (Trx-1) plays the roles in regulating redox and inhibiting inflammation. Whether Trx-1 is involved in METH-induced inflammation is still unknown. Methods The present study was designed to investigate inflammatory factors in spleen of wild type and Trx-1 overexpression transgenic mice after METH treatment. Results We found the mRNA level of Trx-1 was decreased and mRNA level of Trx-1 binding protein-2 (TBP-2) was increased. The mRNA levels of tumor necrosis factor-α (TNF-α), interferon-γ(IFN-γ), interleukin-2 (IL-2), T-bet and signal transducer and activators of transcription 4 (STAT 4) were increased and the mRNA levels of
IL-10, GA-TA-binding protein-3 (GATA-3) and STAT 6 were decreased. Overexpression of Trx-1 reversed the above effects induced by METH. Conclusion The present study showed for the first time that Trx-1 overexpression suppressed the inflammation induced by METH.Keywords: methamphetamine; inflammatory mediators; thioredoxin-1
16. Alcohol-Adapted Anger Management Treatment: A Randomized Controlled Trial of an Innovative Therapy for Alcohol DependenceKimberly S. Walitzer, Jerry L. Deffenbacher, Kathleen ShyhallaJournal of Substance Abuse Treatment 2015:59;83-93
AbstractA randomized controlled trial for an innovative alcohol-adapted anger management treatment (AM) for outpatient alcohol dependent individuals scoring moderate or above on anger is described. AM treatment outcomes were compared to those of an empirically-supported intervention, Alcoholics Anonymous Facilitation treatment (AAF). Clients in AM, relative to clients in AAF, were hypothesized to have greater improvement in anger and anger-related cognitions and lesser AA involvement during the 6-month follow-up. Anger-related variables were hypothesized to be stronger predictors of improved alcohol outcomes in the AM treatment condition and AA involvement was hypothesized to be a stronger predictor of alcohol outcomes in the AAF treatment group. Seventy-six alcohol dependent men and women were randomly assigned to treatment condition and followed for 6 months after treatment end. Both AM and AAF treatments were followed by significant reductions in heavy drinking days, alcohol consequences, anger, and maladaptive anger-related thoughts and increases in abstinence and self-confidence regarding not drinking to anger-related triggers. Treatment with AAF was associated with greater AA involvement relative to treatment with AM. Changes in anger and AA involvement were predictive of posttreatment alcohol outcomes for both treatments. Change in trait anger was a stronger predictor of posttreatment alcohol consequences for AM than for AAF clients; during-treatment AA meeting attendance was a stronger predictor of posttreatment heavy drinking and alcohol consequences for AAF than for AM clients. Anger-related constructs and drinking triggers should be foci in treatment of alcohol dependence for anger-involved clients.Keywords: Alcohol dependence; Outpatient treatment; Anger; Anger management treatment; Alcoholics Anonymous Facilitation treatment; Randomized controlled trial
17. The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trialRanjita Dhital, Ian Norman, Cate Whittlesea, Trevor Murrells, Jim McCambridgeAddiction 2015:110(10);1586-1594
AbstractBackground and Aims To undertake the first randomized controlled trial to evaluate the effectiveness of a brief intervention delivered by community pharmacists to reduce hazardous or harmful drinking. Design This parallel group randomized trial allocated participants individually to brief alcohol intervention (n = 205) or a leaflet-only control condition (n = 202), with follow-up study after 3 months. Setting Sixteen community pharmacies in one London Borough, UK. Participants A total of 407 pharmacy customers (aged 18 years or over) with Alcohol Use Disorder Identification Test (AUDIT) scores 8–19, inclusive.Intervention A brief motivational discussion of approximately 10 minutes’ duration, for which 17 pharmacists received a half-day of training. Measurements Hazardous or harmful drinking was assessed using the AUDIT administered by telephone by a researcher blind to allocation status. The two primary outcomes were: (1) change in AUDIT total scores and (2) the proportions no longer hazardous or harmful drinkers (scoring < 8) at 3 months. The four secondary outcomes were: the three subscale scores of the AUDIT (for consumption, problems and dependence) and health status according to the EQ-5D (a standardized instrument for use as a measure of health outcome). Findings At 3 months 326 (80% overall; 82% intervention, 78% control) participants were followed-up. The difference in reduction in total AUDIT score (intervention minus control) was –0.57, 95% confidence interval (CI) = –1.59 to 0.45, P = 0.28. The odds ratio for AUDIT ˂ 8 (control as reference) was 0.87, 95% CI = 0.50 to 1.51, P = 0.61). For two of the four secondary outcomes (dependence score: –0.46, 95% CI = –0.82 to –0.09, P = 0.014; health status score: –0.09, 95% CI = –0.16 to –0.02, P = 0.013) the control group did better, and in the other two there were no differences (consumption score: –0.05, 95% CI = –0.54 to 0.44, P = 0.85; non-dependence problems score: –0.13, 95% CI = –0.66 to 0.41). Sensitivity analyses did not change these findings. Conclusions A brief intervention delivered by community pharmacists appears to have had no effect in reducing hazardous or harmful alcohol consumption.Keywords: Alcohol; brief intervention; community pharmacist; community pharmacy; hazardous and harmful drinking
18. Brief in Person Interventions for Adolescents and Young Adults Following Alcohol-Related Events in Emergency Care: A Systematic Review and European Evidence SynthesisDiestelkamp S., Drechsel M., Baldus C., Wartberg L., Arnaud N., Thomasius R. European Addiction Research 2016:22(1);17-35
AbstractBackground Increasing numbers of youth in need of emergency medical treatment following alcohol intoxication have been a major public health concern in Europe in recent years. Brief interventions (BIs) in the emergency department (ED) could prevent future risky drinking. However, effectiveness and feasibility of this approach are currently unclear. Method A systematic literature search on controlled trials including
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participants aged 12-25 years treated in an ED following an alcohol-related event was conducted. Additionally, a grey literature search was conducted to support findings from the systematic review with evidence from practice projects and uncontrolled trials. Data on effectiveness, acceptance, implementation and reach were extracted. Results Seven randomised controlled trials (RCT), 6 practice projects, 1 non-randomised pilot study and 1 observational study were identified. Six RCTs found reductions of alcohol use for all participants. Four RCTs found effects on alcohol consumption, alcohol-related risk-behaviour or referral to treatment. Participation and referral rates varied strongly, whereas data on acceptance and implementation were rarely assessed. Conclusion Heterogeneity of study designs and effects limit conclusions on effectiveness of BIs for young ED patients following an alcohol-related event. However, the number of practice projects in Europe indicates a need perceived by practitioners to address this population.Keywords: Emergency department; Adolescents; Young adults; Brief Intervention; Alcohol-related event; Systematic review; Evidence synthesis
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CO-MORBIDITY
19. A systematic review of interventions for co-occurring substance use and borderline personality disorders Nicole K. Lee, Jacqui Cameron and Linda JennerDrug and Alcohol Review 2015:34(6);663-672
AbstractIssues The aim of this study was to undertake a systematic review on effective treatment options for co-occurring substance use and borderline personality disorders to examine effective treatments for this group. Approach A systematic review using a narrative analysis approach was undertaken as there were too few studies within each intervention type to undertake a meta-analysis. The inclusion criteria comprised of English language studies (between 1999 and 2014) and a sample of >70% borderline personality disorder, with measurable outcomes for substance use and borderline personality disorder. All abstracts were screened (n = 376) resulting in 49 studies assessed for eligibility, with 10 studies, examining three different treatment types, included in the final review. Key Findings There were four studies that examined dialectical behaviour therapy (DBT), three studies that examined dynamic deconstructive psychotherapy (DDP) and three studies that examined dual-focused schema therapy (DFST). Both DBT and DDP demonstrated reductions in substance use, suicidal/self-harm behaviours and improved treatment retention. DBT also improved global and social functioning. DFST reduced substance use and both DFST and DPP improved treatment utilisation, but no other significant positive changes were noted.Implications Overall, there were a small number of studies with small sample sizes, so further research is required. However, in the absence of a strong evidence base, there is a critical need to respond to this group with co-occurring borderline personality disorder and substance use. Conclusion Both DBT and DPP showed some benefit in reducing symptoms, with DBT the preferred option given its superior evidence base with women in particular. Keywords: review; substance use disorder; borderline personality disorder; therapy; intervention
20. Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric ComorbidityRichard A. Brown, Ana M. Abrantes, Haruka Minami, Mark A. Prince, Erika Litvin Bloom, Timothy R. Apodaca, David R. Strong, Dawn M. Picotte, Peter M. Monti, Laura MacPherson, Stephen V. Matsko, Jeffrey I. HuntJournal of Substance Abuse Treatment 2015:59;20-29
AbstractSubstance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13–17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of
21. Controlling, Modeling, Consensus, and Substance Use(r) Policy Intervention: Unfinished BusinessBrian FergusonSubstance Use and Misuse Journal 2015:50(8-9);1125-1130
AbstractThis article looks at certain aspects of unfinished business in substance use policy from the economist's perspective. It takes the view that in tackling a policy issue such as cigarette smoking, it is likely to be necessary to use a portfolio of policy tools, rather than on just one tool, and that it is likely to be necessary to accept that complete elimination of the activity being considered will almost certainly cost more than it is worth—we will probably always have to live with some nonzero level of such activities.Keywords: externalities; prohibition; Pigovian taxes; Coase theorem; second-best
22. Commonalities and Distinctions Among Mechanisms of Addiction to Alcohol and Other DrugsAngela R. Ozburn, Aaron J. Janowsky, John C. CrabbeAlcoholism: Clinical and Experimental Research 2015:39(10);1863-1877
Abstract Background Alcohol abuse is comorbid with abuse of many other drugs, some with similar pharmacology and others quite different. This leads to the hypothesis of an underlying, unitary dysfunctional neurobiological basis for substance abuse risk and consequences.Methods In this review, we discuss commonalities and distinctions of addiction to alcohol and other drugs. We focus on recent advances in preclinical studies using rodent models of drug self-administration. Results While there are specific behavioral and molecular manifestations common to alcohol, psychostimulant, opioid, and nicotine dependence, attempts to propose a unifying theory of the addictions inevitably face details where distinctions are found among classes of drugs. Conclusions For alcohol, versus other drugs of abuse, we discuss and compare advances in: (i) neurocircuitry important for the different stages of drug dependence; (ii) transcriptomics and genetical genomics; and (iii) enduring effects, noting in particular the contributions of behavioral genetics and animal models.Keywords: Alcohol; Cocaine; Drugs of Abuse; Animal Models; Addiction
23. Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects Dvora Shmulewitz, Emily R. Greene, Deborah HasinAlcoholism: Clinical and Experimental Research 2015:39(10);1878-1900
Abstract Background Although psychoactive substances vary in many ways, they have important commonalties, particularly in their ability to lead to an addiction syndrome. The field lacks an updated review of the commonalities and differences in the phenomenology of alcohol, cannabis, tobacco, stimulants, opioids, hallucinogens, sedatives/tranquilizers, and inhalants and their related substance use disorders (SUDs). Methods DSM-IV and DSM-5 SUD diagnostic criteria were reviewed, as was evidence from recent epidemiological and clinical research: psychometric studies (test–retest reliability, latent trait analysis); physiological indicators (tolerance, withdrawal); prevalence and age of onset. Information was incorporated from previous reviews, PubMed and Scopus literature searches, and data from large U.S. national surveys. Results Empirical evidence in the form of test–retest reliability and unidimensionality supports use of the same DSM-IV dependence or DSM-5 SUD diagnostic criteria across substances. For most substances, the criteria sets were generally most informative in general population samples at moderate-to-severe levels of SUD. Across substances, 2 criteria (tolerance and use in hazardous situations) were identified as functioning differently in population subgroups. Since substances have different pharmacological effects, withdrawal is assessed using substance-specific symptoms, while tolerance is not; issues remain with the assessment of tolerance. Alcohol, tobacco, and cannabis were consistently identified as the substances with earliest onset of use, highest prevalence of lifetime use, and highest prevalence of lifetime disorder. Conclusions Despite differences between psychoactive substances, the generic DSM criteria set appears equally applicable across substances. Additional studies of tolerance and hazardous use will be useful
for future nosologies. Alcohol, cannabis, and tobacco are the substances with the greatest public health impact due to the high prevalence and early onset of their use, and the potential all 3 substances have to lead to addiction.Keywords: Substance Use Disorders; Phenomenology; Item Response Theory; Reliability; DSM
24. Heterogeneity of Mental Health Service Utilization and High Mental Health Service Use Among Women Eight Years After Initiating Substance Use Disorder TreatmentElizabeth Evans, Howard Padwa, Libo Li, Veronique Lin, Yih-Ing HserJournal of Substance Abuse Treatment 2015:59;10-19
AbstractObjective The aim of this study was to determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use. Methods Data were provided by 4447 women treated for SUD in California during 2000–2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women's high use of services (> 6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns. Results In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (8.7%), increased immediately following SUD treatment and then decreased (9.3%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p < 0.05) and employment (OR 0.53, p < 0.05) and positively associated with older age (OR 1.04, p < 0.001), homelessness (OR 1.68, p < 0.05), public assistance (OR 1.76, p < 0.01), outpatient SUD treatment (OR 3.69, p < 0.01), longer SUD treatment retention (OR 1.00, p < 0.01), treatment desire (ORs 1.46, p < 0.001), and co-occurring disorder diagnosis (ORs 2.89–44.93, p < 0.001). Up to 29% of women with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years. Conclusions Mental health services utilization patterns among women treated for SUD are heterogeneous and dynamic. Understanding factors related to women's utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services.Keywords: Women with co-occurring mental health and substance use disorders; Utilization of mental health services; High use of mental health services; Latent class analysis; Longitudinal study design
25. “Drugs don’t have age limits”: The challenge of setting age restrictions for supervised injection facilitiesTara Marie Watson, Carol Strike, Gillian Kolla, Rebecca Penn, Ahmed M. BayoumiDrugs: Education, Prevention and Policy 2015:22(4);370-379
AbstractAims People under age 18 who inject drugs represent a population at risk of health and social harms. Age restrictions at harm reduction programmes often formally exclude this population, but the reason behind such restrictions is lacking in the literature. To help fill this gap, we examine the perspectives of people who use drugs and various other stakeholders regarding whether supervised injection facilities (SIFs) should have age restrictions. Methods Interviews and focus groups were conducted with a total of 95 people who use drugs and 141 other stakeholders (including police, fire and emergency services personnel, other city employees and officials, healthcare providers, residents and business representatives) in two Canadian cities without SIFs. Findings We highlight the following thematic areas: mixed opinions regarding specific age restrictions; safety as a priority; different experiences and understandings of youth, agency and drug use; and ideas regarding maturity, “help” and other approaches. We note throughout that a familiar vulnerability–agency dichotomy often surfaced in the discussions. Conclusions This paper contributes new empirical insights regarding youth access to SIFs. We offer considerations that may inform discussions occurring in other jurisdictions debating SIF implementation and may help remove or clarify age-related policies for harm reduction programmes.Keywords: Age; drugs; harm reduction; supervised injection facilities; qualitative research; youth
26. Assessing seasonality of travel distance to harm reduction service providers among persons who inject drugsSean Allen, Monica Ruiz, Amira Roess, Jeff Jones Harm Reduction Journal 2015:12:45
AbstractBackground Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC). FindingsA geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated the walking distance (via sidewalks) from the centroid point of zip code of home residence to the exchange site where PWID presented for services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by season. Differences in mean walking distance measures were statistically significant between winter and spring with PWID traveling approximately 2.88 and 2.77 miles, respectively, to access the SEP during these seasons. Conclusions The results of this study suggest that seasonal differences in SEP accessibility may exist between winter and spring. PWID may benefit from harm reduction providers adapting their SEP operations to provide a greater diversity of exchange locations during seasons in which inclement weather may negatively influence
engagement with SEPs. Increasing the number of exchange locations based on season may help resolve unmet needs among injectors.
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HEPATITIS C
27. Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugsJason Grebely, Philip Bruggmann, Carla Treloar, Jude Byrne, Tim Rhodes, Gregory J. Dore, on behalf of the International Network for Hepatitis in Substance UsersInternational Journal of Drug Policy 2015:26(10);893-898
No abstract available
28. Enhancing the detection and management of acute hepatitis C virus infectionMarianne Martinello, Gail V. MatthewsInternational Journal of Drug Policy 2015:26(10);899-910
AbstractAcute HCV infection refers to the 6-month period following infection acquisition, although this definition is somewhat arbitrary. While spontaneous clearance occurs in approximately 25%, the majority will develop chronic HCV infection with the potential for development of cirrhosis, end stage liver disease and hepatocellular carcinoma. Detection of acute HCV infection has been hampered by its asymptomatic or non-specific presentation, lack of specific diagnostic tests and the inherent difficulties in identifying and following individuals at highest risk of transmitting and acquiring HCV infection, such as people who inject drugs (PWID). However, recognition of those with acute infection may have individual and population level benefits and could represent an ideal opportunity for intervention. Despite demonstration that HCV treatment is feasible and successful in PWID, treatment uptake remains low with multiple barriers to care at an individual and systems level. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment, treatment and prevention in this group are urgently needed. As the therapeutic landscape of chronic HCV management is revolutionised by the advent of simple, highly effective directly-acting antiviral (DAA) therapy, similar opportunities may exist in acute infection. This review will discuss issues surrounding improving the detection and management of acute HCV infection, particularly in PWID.Keywords: Acute hepatitis C virus infection; People who inject drugs (PWID); Injecting drug use (IDU); HIV Men-who-have-sex-with-men (MSM); Treatment Directly-acting antiviral (DAA)
29. Health-Related Quality of Life for individuals with hepatitis C: A narrative reviewDavid Whiteley, Lawrie Elliott, Sarah Cunningham-Burley, Anne WhittakerInternational Journal of Drug Policy 2015:26(10);939-949
AbstractThere is considerable interest in determining the impact that increased uptake of treatment for hepatitis C virus (HCV) infection will have on the burden of HCV among people who inject drugs (PWID). An understanding of the size of the population of PWID, rates of injecting cessation and HCV prevalence and incidence within the PWID population is essential for such exercises. However, these parameters are often uncertain. In this paper we review methods for estimating the size of the population of PWID and related parameters, taking into account the uncertainty that exists around data on the natural history of injecting drug use;
consider issues in the estimation of HCV prevalence among PWID; and consider the importance of opioid substitution therapy and prisons as settings for the prevention and treatment of HCV infection among PWID. These latter two points are illustrated through examples of ongoing work in England, Scotland and Australia. We conclude that an improved understanding of the size of PWID populations, including current and former PWID and parameters related to injecting drug use and settings where PWID may be reached, is necessary to inform HCV prevention and treatment strategies.Keywords: Hepatitis C; Health-Related; Quality of Life; Lived experience; Injecting drug users
30. Hepatitis C Virus seroconversion among persons who inject drugs in relation to primary care physician visiting: The potential role of primary healthcare in a combined approach to Hepatitis C preventionAndreea Adelina Artenie, Élise Roy, Geng Zang, Didier Jutras-Aswad, Jean-Marie Bamvita, Svetlana Puzhko, Mark Daniel, Julie BruneauInternational Journal of Drug Policy 2015:26(10);970-975
AbstractBackground Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP). Methods A prospective cohort study, HEPCO, was conducted among active PWID in Montréal (2004–2013). Interviews scheduled at 3- or 6-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence. Results At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0–21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% CI: 0.31–0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection.Conclusion Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention.Keywords: Hepatitis C; Drug use; Injection; Primary care; Physician; Prevention;
31. Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, AustraliaCarla Treloar, Jake Rance, Nicky Bath, Hope Everingham, Michelle Micallef, Carolyn Day, Sue Hazelwood, Jason Grebely, Gregory J. DoreInternational Journal of Drug Policy 2015:26(10);992-998
AbstractAim Peer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few examples of these services exist in hepatitis C (HCV) care. This study examined the performance of two community-controlled peer support services operating within a larger study aimed at increasing access to HCV care and treatment for opiate substitution treatment (OST) clients, ETHOS. Methods Semi-structured interviews were conducted in two clinics with three groups of participants: clients (n = 31), staff (n = 8) and peer workers (n = 3) and examined the operation of the service in relation to process, outputs and impacts. Results There was a very strong positive response to the peer worker services reported by staff and clients who had and had not interacted with a peer worker. A number of changes were reported that were not explicit goals of the service including providing access to additional services for clients and staff, peer workers acting as mediators between clients and staff and a less tangible notion of a changing “feel” of the clinic to a more positive and client-friendly social and physical space. Explicit goals of the service were also reported in peer workers supporting clients to consider and prepare for treatment (via blood tests and other assessments) as well as provide information and support about treatment. Conclusions The peer support service was acceptable to clients and clinic staff. All groups of participants noted that the service met its goals of engaging clients, building trusting relationships and providing instrumental support for clients to access HCV treatment. Peer workers may also contribute to more effective deployment of health resources by preparing clients for clinical engagement with HCV health workers.Keywords: Hepatitis C; Peer support; People who inject drugs; Treatment Qualitative
32. The effect of introducing point-of-care or dried blood spot analysis on the uptake of hepatitis C virus testing in high-risk populations: A systematic review of the literatureJosh T. Coats, John F. DillonInternational Journal of Drug Policy 2015:26(11);1050-1055
AbstractBackground Testing for hepatitis C virus (HCV) infection typically relies upon blood samples taken by traditional phlebotomy for laboratory processing. Novel testing methods, including using dried blood spots (DBS) and point-of-care (PoC) testing enable easier access to high risk populations who have less frequent contact with healthcare professionals. Many of these individuals have been exposed to HCV but have not previously been tested. We aimed to establish whether the availability of these novel testing methods increased either uptake of testing or the number of new diagnoses of HCV. Methods The PubMed, Cochrane and SCOPUS databases were searched for terms relating to the study. References and associated bibliographies were also examined for further relevant articles. Studies were included if they contained quantitative data on frequency of testing and/or new diagnoses following the introduction of PoC and/or DBS testing of high-risk populations. Studies were then examined for findings and limitations and graded upon the quality of evidence provided.
Results No studies were found which introduced PoC testing and determined its effect on frequency of testing or new diagnoses. Six studies were identified in which DBS testing was introduced and its effect evaluated. Two of the studies were randomised controlled trials, two were prospective cohort studies, one was an ecological study and one was a clinical audit. Populations studied included those attending substance misuse clinics, prisons and needle exchanges. Injection drug use was the commonest risk factor for HCV. Five of the six studies provided evidence that the introduction of DBS testing increased the number of tests, new diagnoses or both. Conclusion Current evidence indicates that DBS testing availability may increase the uptake of testing for HCV in high-risk populations. There is currently no evidence regarding the efficacy of PoC testing in these populations.Keywords: Hepatitis C; Dried blood spot; Point of care; Testing
33. The effect of social functioning and living arrangement on treatment intent, specialist assessment and treatment uptake for hepatitis C virus infection among people with a history of injecting drug use: The ETHOS studyEmmanuel Fortier, Maryam Alavi, Michelle Micallef, Adrian J. Dunlop, Annie C. Balcomb, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber, Gregory J. Dore, Julie Bruneau, Jason Grebely, on behalf of the ETHOS Study GroupInternational Journal of Drug Policy 2015:26(11);1094-1102
AbstractBackground The objective was to assess social functioning and its association with treatment intent, specialist assessment and treatment uptake for hepatitis C virus (HCV) infection among people with a history of injecting drug use. Methods ETHOS is a prospective observational cohort evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from nine community health centres and opioid substitution treatment clinics (NSW, Australia). Social functioning was assessed using a short form of the Opioid Treatment Index social functioning scale. Those classified in the highest quartile (score >6) were considered having lower social functioning. Analyses were performed using logistic regression. Results Among 415 participants (mean age 41 years, 71% male), 24% were considered having lower social functioning, 70% had early HCV treatment intent (intention to be treated in the next 12 months), 53% were assessed by a specialist and 27% initiated treatment. Lower social functioning was independently associated with unemployment, unstable housing, recent injecting drug use and moderate to extremely severe symptoms of depression, anxiety and stress. Lower social functioning was independently associated with reduced early HCV treatment intent (aOR 0.51, 95% CI 0.30–0.84) and lower specialist assessment (aOR 0.48, 95% CI 0.29–0.79), but not HCV treatment uptake (aOR 0.76, 95% CI 0.40–1.43). Living with someone was independently associated with HCV treatment uptake (with someone and children: aOR 2.28, 95% CI 1.01–5.14; with someone and no children: aOR 2.36, 95% CI 1.30–4.31), but not early HCV treatment intent or specialist assessment. Conclusions This study highlights the need for the development and implementation of strategies targeting people who inject drugs with lower social functioning to enhance HCV treatment intent and specialist assessment. Further, strategies to enhance social support may play a role in increasing HCV treatment uptake.Keywords: HCV; Drug users; PWID; Treatment; Education; Therapy; Barriers
34. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual careJulian M. Somers, Akm Moniruzzaman, Anita PalepuAddiction 2015:110(10);1605-1614 AbstractAims Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU). Design Two concurrent randomized controlled trials with 24-month follow-up. Setting Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on-site supports (CONG); TAU in Vancouver, Canada. Participants Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either ‘high needs’ (HN; n = 297) or ‘moderate needs’ (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN-TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN-TAU (n = 100). Interventions and comparators All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness.Measurements DSU over 24 and 12 months was derived from the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing. Findings Compared with HN-TAU, neither CONG [adjusted odds (AOR) ratio = 0.73, 95% confidence interval (CI) = 0.39–1.37] nor ACT (AOR = 1.22, 95% CI = 0.61–2.45) differed on DSU at 24 months, and MN-TAU did not differ from ICM (AOR = 0.78, 95% CI = 0.37–1.63). There were no differences at 12 months, when analyses were restricted to participants who indicated substance use at baseline, or when considering the duration of stable housing.Conclusions Housing First, an intervention to support recovery for homeless people who have co-occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months.Keywords: Experiment; homelessness; Housing First
35. Comparison of Homeless and Non-Homeless Problem Drug Users Recruited from Primary Care Safety-Net ClinicsAntoinette Krupski, Meredith C. Graves, Kristin Bumgardner, Peter Roy-ByrneJournal of Substance Abuse Treatment 2015:58;84-89
AbstractIntroduction The present study of homeless non-treatment-seeking problem drug users was designed to complement and extend previous studies which focused exclusively on treatment-seeking homeless problem drug users. Method Data were available for 866 primary care patients with drug problems, 30% homeless and 70% housed. Results In the 2 years prior to baseline, homeless participants had less chronic medical co-morbidity than problem drug users who were housed yet were significantly more likely to have used emergency department services, to have used them more frequently, and at higher cost. Compared to their housed counterparts, homeless participants were also more likely to have been admitted
to specialized chemical dependency treatment and/or detoxification services, to have been arrested for a felony or gross misdemeanor, and to report having psychiatric problems in the prior 30 days. Conclusions Additional support may be necessary for homeless patients presenting in primary care to benefit from substance abuse treatment given their more severe drug use problems coupled with their co-morbid health, psychiatric, and psychosocial problems.Keywords: Homeless; Medical service utilization and costs; Arrests; Mental health problems; Primary care
36. From initiating injecting drug use to regular injecting: Retrospective survival analysis of injecting progression within a sample of people who inject drugs regularlyDaniel O’Keefe, Danielle Horyniak, Paul DietzeDrug and Alcohol Dependence 2015:In Press, Accepted Manuscript, Available online 23 November 2015
AbstractBackground The initiation of injecting drug use and the commencement of a pattern of regular injecting are key milestones in injecting careers. The progression from initiation to regular injecting is a poorly understood period in these careers. Methods Cross-sectional baseline data from a sample of people who inject drugs regularly (N = 691), recorded the age at which participants initiated injecting drug use and the age they became regular (at least once per month) injectors. Survival analysis compared the rapidity of progression to regular injecting across sub-groups within the sample using bivariate log-rank testing and multivariable Cox regression. Results Half of all participants progressed to regular injecting within one year of initiation and by the fourth year post-initiation, 91% had progressed. In bivariate analysis, there were significant differences in equality of hazards by sex (X2 = 7.75, p <0.01), from whom participants learnt to inject (X2 = 22.32, p < 0.01) and the drug of injection initiation (X2 = 18.36; p < 0.01). In the multivariable Cox model, only initiating injecting with heroin (HR = 1.28; 95% CI: 1.09-1.50) compared with other drugs (predominantly methamphetamine) showed a significantly greater hazard, suggesting a faster progression to regular injecting. Conclusion This study showed that among our sample of eventual regular injectors, progression from initiation to regular injecting was rapid. By gaining a greater understanding of the dynamics of this progression, the ability to appropriately target interventions and future research is subsequently informed.Keywords: Injecting drug use; Initiation; Long-term injecting; Drug use transition; Survival analysis
37. Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife StudyA.D. Marshall, M. Micallef, A. Erratt, J. Telenta, C. Treloar, H. Everingham, S.C. Jones, N. Bath, D. How-Chow, J. Byrne, P. Harvey, A. Dunlop, M. Jauncey, P. Read, T. Collie, G.J. Dore, J. GrebelyInternational Journal of Drug Policy 2015:26(10);984-991
AbstractBackground The aim of this study was to assess factors associated with baseline knowledge of HCV and liver disease, acceptability of transient elastography (TE) assessment (FibroScan®), and willingness and intent to receive HCV treatment among persons with a history of injection drug use participating in a liver health promotion campaign.Methods The LiveRLife campaign involved three phases: (1) campaign resource development; (2) campaign resource testing; and (3) campaign implementation. Participants were enrolled in an observational cohort study with recruitment at four clinics – one primary health care facility, two OST clinics, and one medically supervised injecting centre – in Australia between May and October 2014. Participants received educational material, nurse clinical assessment, TE assessment, dried blood spot testing, and completed a knowledge survey. Results Of 253 participants (mean age 43 years), 68% were male, 71% had injected in the past month, and 75% self-reported as HCV positive. Median knowledge score was 16/23. In adjusted analysis, less than daily injection (AOR 5.01; 95% CI, 2.64–9.51) and no daily injection in the past month (AOR 3.54; 95% CI, 1.80–6.94) were associated with high knowledge (≥16). TE was the most preferred method both pre- (66%) and post-TE (89%) compared to liver biopsy and blood sample. Eighty-eight percent were ‘definitely willing’ or ‘somewhat willing’ to receive HCV treatment, and 56% intended to start treatment in the next 12 months. Approximately 68% had no/mild fibrosis (F0/F1, ≥2.5 to ≤7.4 kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4 kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4 kPa), and 9% had cirrhosis (F4, ≥12.5 kPa).Keywords: HCV Drug users; Hepatitis C; PWID; Knowledge; Willingness
38. Substance Use Disorders, Evidence-Based Practices and the Possible Nature of Deep FlawsRobert WalkerSubstance Use and Misuse Journal 2015:50(8-9);956-963
No abstract available
39. Ready for Retirement: The Gateway Drug HypothesisJohn KleinigSubstance Use and Misuse Journal 2015:50(8-9);971-975
AbstractThe psycho-social observation that the use of some psychoactive substances (“drugs”) is often followed by the use of other and more problematic drugs has given rise to a cluster of so-called “gateway drug hypotheses,” and such hypotheses have often played an important role in developing drug use policy. The current essay suggests that drug use policies that have drawn on versions of the hypothesis have involved an unjustified oversimplification of the dynamics of drug use, reflecting the interests of certain stakeholders rather than wise social policy. The hypothesis should be retired.Keywords: criminalization; dependency; drug use policy; gateway drug hypothesis; gateway metaphor; licit-illicit distinction; marijuana; Robert L. DuPont; Jr
40. Retire the Concept of “Relapse”William R. MillerSubstance Use and Misuse Journal 2015:50(8-9);976-977
41. Predictions instead of panics: the framework and utility of systematic forecasting of novel psychoactive drug trendsJohn M. Stogner The American Journal of Drug and Alcohol Abuse 2015:41(6);519-526
AbstractBackground Countless novel psychoactive substances have been sensationally described in the last 15 years by the media and academia. Though some become significant issues, most fail to become a substantial threat. The diversity and breadth of these potentialproblem substances has led policymakers, law enforcement officers, and healthcare providers alike to feel overwhelmed and underprepared for dealing with novel drugs. Objective Inadequacies in training and preparation may be remedied by a response that is more selective and more proactive. The current manuscript seeks to clarify how to most efficiently forecast the “success” of each newly introduced novel psychoactive substance in order to allow for more efficient decision making and proactive resource allocation. Methods A review of literature, published case reports, and legal studies was used to determine which factors were most closely linked to use of a novel drug spreading. Following the development of a forecasting framework, examples of its use are provided. Results The resulting five-step forecast method relies on assessments of the availability of a potential user base, the costs – legal and otherwise – of the drug relative to existent analogues, the subjective experience, the substance’s dependence potential and that of any existent analogue, and ease of acquisition. These five factors should serve to forecast the prevalence of novel drug use, but reaction should be conditioned by the potential for harm. Conclusions The five-step forecast method predicts that use of acetyl fentanyl, kratom, Leonotis leonurus, and e-cigarettes will grow, but that use of dragonfly and similar substances will not. While this forecasting approach should not be used as a replacement for monitoring, the use of the five-step method will allow policymakers, law enforcement and practitioners to quickly begin targeted evaluative, intervention, and treatment initiatives only for those drugs with predicted harm.Keywords: Acetyl fentanyl; Bromo-Dragonfly; drug policy; forecasting; novel drugs; novel psychoactive substances
42. Opioid Maintenance Treatment - A Call for a Joint European Quality Care ApproachBrandt L., Unger A., Moser L., Fischer G., Jagsch R. European Addiction Research 2016:22(1);36-51
AbstractAims The aim of this exploratory analysis of European Quality Audit of Opioid Treatment data was to identify areas of improvement for current opioid maintenance treatment (OMT) approaches. Methods Factors facilitating treatment entry, retention and refusal were compared between 8 European countries and between OMT patient (OMT-P) and active opioid user (AOU) sample groups. Both groups were divided into those who had never had OMT before (un-experienced OMT-P (n = 573) and AOU (n = 360)) and those who had been maintained at least once prior to this investigation (experienced OMT-P (n = 746) and AOU (n = 377)). Results The European comparison showed that motives for starting OMT vary distinctly between countries (p ≤ 0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p ≤ 0.05). Conclusion Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.Keywords: Opioid use disorder; Opioid maintenance treatment; Europe
43. The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert ConsensusReimer J., Wright N., Somaini L., Roncero C., Maremmani I., McKeganey N., Littlewood R., Krajci P., Alho H., D'Agnone O. European Addiction Research 2016;22(2):99-106
AbstractBackground/Aims Opioid substitution treatment (OST) improves outcomes in opioid dependence. However, controlled drugs used in treatment may be misused or diverted, resulting in negative treatment outcomes. This review defines a framework to assess the impact of misuse and diversion. Methods A systematic review of published studies of misuse and diversion of OST medicines was completed; this evidence was paired with expert real-world experience to better understand the impact of misuse and diversion on the individual and on society. Results Direct impact to the individual includes failure to progress in recovery and negative effects on health (overdose, health risks associated with injecting behaviour). Diversion of OST has impacts on a community that is beyond the intended OST recipient. The direct impact includes risk to others (unsupervised use; unintended exposure of children to diverted medication) and drug-related criminal behavior. The indirect impact includes the economic costs of untreated opioid dependence, crime and loss of productivity. Conclusion While treatment for opioid dependence is essential and must be supported, it is vital to reduce misuse and diversion
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while ensuring the best possible care. Understanding the impact of OST misuse and diversion is key to defining strategies to address these issues.Keywords: Misuse; Diversion; Buprenorphine; Methadone; Opioid substitution treatment
44. The characteristics of a cohort who tamper with prescribed and diverted opioid medicationsBriony Larance, Nicholas Lintzeris, Raimondo Bruno, Amy Peacock, Elena Cama, Robert Ali, Ivana Kihas, Antonia Hordern, Nancy White, Louisa DegenhardtJournal of Substance Abuse Treatment 2015:58;51-61
AbstractAims To describe the methods and baseline characteristics of a cohort of people who tamper with pharmaceutical opioids, formed to examine changes in opioid use following introduction of Reformulated OxyContin®. Methods Participants were 606 people from three Australian jurisdictions who reported past month injecting, snorting, chewing or smoking of a pharmaceutical opioid and had engaged in these practices at least monthly in the past 6 months. Baseline interviews were conducted prior to introduction of Reformulated OxyContin® in April 2014. Patterns of opioid use and cohort characteristics were examined according to whether participants were prescribed opioid medications, or exclusively used diverted medication. Results The cohort reported high levels of moderate/severe depression (61%), moderate/severe anxiety (43%), post-traumatic stress disorder (42%), chronic pain or disability (past 6 months, 54%) and pain (past month, 47%). Lifetime use of oxycodone, morphine, opioid substitution medications and codeine were common. Three-quarters (77%) reported ICD-10 lifetime pharmaceutical opioid dependence and 40% current heroin dependence. Thirteen percent reported past year overdose, and 70% reported at least one past month opioid injection-related injury or disease. The cohort displayed complex clinical profiles, but participants currently receiving opioid substitution therapy who were also prescribed other opioids particularly reported a wide range of risk behaviors, despite their health service engagement. Conclusions Findings highlight the heterogeneity in the patterns and clinical correlates of opioid use among people who tamper with pharmaceutical opioids. Targeted health interventions are essential to reduce the associated harms.Keywords: Abuse deterrent; Tamper resistant; Pharmaceutical opioids; Opioids; Abuse liability; Cohort
45. A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence Natasa Gisev, Marian Shanahan, Don J. Weatherburn, Richard P. Mattick, Sarah Larney, Lucy Burns and Louisa DegenhardtAddiction 2015:110(12);1975-1984
AbstractAim Although opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost-effectiveness of treatment has not been examined. Therefore, we undertook a cost-effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6 months post-release. Design Population-based, retrospective data linkage study using records of OST entrants (1985–2010), charges and court appearances (1993–2011), prison episodes (2000–11) and death notifications (1985–2011). Setting New South Wales, Australia. Participants A cohort of 16 073 people with
a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011. Intervention OST treatment compared to no OST treatment at prison release. Measurements Mortality and costs (treatment, criminal justice system—court, penalties, prison—and the social costs of crime) were evaluated at 6 months post-release. Analyses included propensity score matching, bootstrapping and regression. Findings A total of 13 468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post-release ($7206 versus $14 356). The incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500.Conclusion Opioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost-effective in reducing mortality in the first 6 months of release.Keywords: Cost-effectiveness; data linkage; mortality; opioid substitution treatment; opioid-related disorders; prisons
46. The introduction of buprenorphine-naloxone film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations Briony Larance, Paul Dietze, Robert Ali, Nicholas Lintzeris, Nancy White, Rebecca Jenkinson and Louisa DegenhardtDrug and Alcohol Review 2015:34(6);603-610
AbstractIntroduction and Aims Buprenorphine-naloxone (BNX) film for opioid dependence treatment was introduced in Australia in 2011. A key difference in State policy approaches saw transfer from BNX tablets to BNX film mandated in South Australia (SA) with New South Wales (NSW) and Victoria (VIC) having less stringent policies. This study examined (i) how initiations and transfers were implemented, (ii) the profile and predictors of adverse effects as self-reported by BNX film clients, and (iii) dosing issues. Design and Methods Survey of 334 buprenorphine (BPN), BNX tablet and BNX film clients and semi-structured interviews with 39 key experts (KEs) in 2012. Comparisons are made between clients interviewed in SA versus NSW and VIC combined. Results Among the 180 current BNX film clients, 23% started treatment on BNX film, 18% requested a transfer to BNX film and 59% (n = 106) reported their clinic/prescriber recommended transfer to BNX film. Among clients who were offered but refused a transfer to BNX film (n = 66), the most common reason was ‘I am happy with my current treatment and do not see a reason to change’ (53%). Some opioid substitution therapy clients and KE viewed transfers as ‘forced’ (i.e. no choice of buprenorphine formulation). Multivariable regression showed residing in SA (vs. NSW/VIC) and a shorter length of current treatment episode were associated with more BNX film-attributed adverse effects but clinic/prescriber-recommended transfer was not. Discussion and Conclusions The introduction of BNX film in Australia varied across States. A perception of restricted choice in medication may have undermined initial acceptance in SA.Keywords: opioid substitution therapy; buprenorphine; supervised dosing; transfer
47. Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study Nancy White, Ian Flaherty, Peter Higgs, Briony Larance, Suzanne Nielsen, Louisa Degenhardt, Robert Ali and Nicholas LintzerisDrug and Alcohol Review 2015:34(6);623-629
AbstractIntroduction and Aims Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or understood. We examined how people who inject BNX film seek and share information about this practice, document the methods used to prepare BNX film for injection, and report participants' experiences of this practice. Design and Methods Interviews were (n = 16) conducted with people who indicated that they had injected BNX film since its introduction onto the Australian market. Semistructured interviews were recorded and transcribed. NVivo10 program (QSR International) was used to analyse the data using qualitative description methodology. Results Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual (gluggy), and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described (including local and systemic issues); participants reported injecting the film to enhance its immediate effects, yet generally reported that sublingual administration provided longer-lasting effects. Discussion and Conclusions Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the ‘gelatine like’ texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices. Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Introduction of new formulations internationally requires more qualitative studies to inform safer practices.Keywords: patient non-adherence; buprenorphine-naloxone; qualitative research; harm reduction; intravenous drug abuse
48. Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological CorrelatesGerra G.; Manfredini M.; Somaini L.; Maremmani I.; Leonardi C.; Donnini C. European Addiction Research 2016:22;163-175
AbstractA variety of studies evidenced a relationship between drug use disorders and sexual dysfunction. In particular, heroin and opioid agonist medications to treat heroin dependence have been found to be associated with erectile dysfunction and reduced libido. Controversial findings also indicate the possibility of factors other than the pharmacological effects of opioid drugs concurring to sexual dysfunction. With the present study, we investigated the link between sexual dysfunction and long-term exposure to opioid receptor stimulation (heroin dependence, methadone maintenance treatment, methadone dosage), the potentially related hormonal changes reflecting hypothalamus-pituitary-gonadal axis function and prolactin (PRL) pituitary release, the role of adverse childhood experiences in the clinical history and the concomitant symptoms of comorbid mental health disorders in contributing to sexual problems. Forty
male patients participating in a long-term methadone treatment program were included in the present study and compared with 40 healthy control subjects who never used drugs nor abused alcohol. All patients and controls were submitted to the Arizona Sexual Experiences Scale (ASEX), Child Experiences of Care and Abuse-Questionnaire (CECA-Q) and the Symptom Check List-90 Scale. A blood sample for testosterone and PRL assays was collected. Methadone dosages were recorded among heroin-dependent patients on maintenance treatment. Methadone patients scored significantly higher than controls on the 5-item rating ASEX scale, on CECA-Q and on Symptoms Check List 90 (SCL 90) scale. Testosterone plasma levels were significantly lower and PRL levels significantly higher in methadone patients with respect to the healthy control group. ASEX scores reflecting sexual dysfunction were directly and significantly correlated with CECA-Q neglect scores and SCL 90 psychiatric symptoms total score. The linear regression model, when applied only to addicted patients, showed that methadone dosages were not significantly correlated with sexual dysfunction scores except for ‘erectile dysfunction', for which an inverse association was evidenced. Testosterone values showed a significant inverse correlation with ASEX sexual dysfunction scores, CECA-Q neglect scores and psychiatric symptom at SCL 90 among methadone patients. PRL levels were directly and significantly correlated with sexual dysfunction scores, psychiatric symptoms at SCL 90 and CECA-Q neglect scores. Both testosterone and PRL did not correlate with methadone dosages. The present findings appear to support the view of childhood adversities and comorbid psychiatric symptoms contributing to sexual dysfunction and related hormonal changes among methadone patients, challenging the assumption that attributes sexual problems entirely to the direct pharmacological effects of opioid agonist medications.Keywords: Methadone; Sexual dysfunctions; Childhood neglect; Psychiatric comorbidity; Prolactin; Testosterone; HPG axis
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OPIATE TREATMENT SERVICES
49. Senior nurses' perspectives on the transfer of opioid substitution treatment clients from clinics to community pharmacy Jessica Bui, Carolyn Day, Jane Hanrahan, Adam Winstock, Betty ChaarDrug and Alcohol Review 2105:34(5);495-498
AbstractIntroduction and Aims There is unmet demand for opioid substitution treatment (OST) in New South Wales, Australia, with many public clinics reporting long waitlists. Recently, some community pharmacies have reported a lack of referrals from public clinics. To obtain insight into this apparent contradiction, this study explored the perspectives of senior nurses in public OST clinics regarding client transfers to community pharmacies.Design and Methods Semi-structured interviews were conducted with nine senior nurses from eight (20%) public OST clinics in New South Wales regarding: the nurses' experience in OST provision, factors affecting client transfer, opinions on pharmacy OST services and relationships with community pharmacies. Interviews were audio-recorded and transcribed verbatim. NVivo was used for initial analysis and coding of the transcripts. Emerging themes were repeatedly analysed and refined by consensus discussion. Results Most clinics reported being at or over capacity. Nurse identified barriers to transfer included: difficulty motivating reluctant clients, clients' unwillingness to pay for pharmacy supervised dispensing, lack of convenient pharmacy providers and unstable clients. Despite overall good collaborations with community pharmacies, some aspects could be improved, especially face-to-face visits and education around clinic procedures. Discussion and Conclusion This study highlights the complex barriers encountered by senior nurses in the transfer of OST clients from clinics to community pharmacies. Improved collaboration with pharmacies and subsidised or standardised dispensing fees may enhance the transfer of clients to pharmacies and improve clinics throughput. Keywords: opioid substitution therapy; community pharmacy; public clinic; nurse; transfer
50. Impact of opioid substitution therapy for Scotland's prisoners on drug-related deaths soon after prisoner releaseSheila M. Bird, Colin M. Fischbacher, Lesley Graham, Andrew FraserAddiction 2015:110(10);1617-1624
AbstractAim To assess whether the introduction of a prison-based opioid substitution therapy (OST) policy was associated with a reduction in drug-related deaths (DRD) within 14 days after prison release. Design Linkage of Scotland's prisoner database with death registrations to compare periods before (1996–2002) and after (2003–07) prison-based OST was introduced.Setting All Scottish prisons. Participants People released from prison between 1 January 1996 and 8 October 2007 following an imprisonment of at least 14 days and at least 14 weeks after the preceding qualifying release. Measurements Risk of DRD in the 12 weeks following release; percentage of these DRDs which occurred during the first 14 days.Findings Before prison-based OST (1996–2002), 305 DRDs occurred in the 12 weeks after 80 200 qualifying releases, 3.8 per 1000 releases [95% confidence interval (CI) = 3.4–4.2]; of these, 175 (57%) occurred in the first 14 days. After the introduction of prison-based OST (2003–07), 154 DRDs occurred in the 12 weeks after 70 317 qualifying releases, a significantly reduced rate of 2.2 per 1000 releases (95% CI = 1.8–2.5). However, there was no change in the proportion which occurred in the first 14 days, either for all DRDs (87: 56%) or for opioid-related DRDs. Conclusions Following the introduction of a prison-based opioid substitution therapy (OST) policy in Scotland, the rate of drug-related deaths in the 12 weeks following release fell by two-fifths. However, the proportion of deaths that occurred in the first 14 days did not change appreciably, suggesting that in-prison OST does not reduce early deaths after release.Keywords: Drugs-related deaths; release from prison; risk-reduction; opioid substitution therapy; opioid-related deaths
51. Naloxone—does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdoseJoanne Neale, John StrangAddiction 2015:110(10);1644-1652
AbstractAim To analyse drug users' views and experiences of naloxone during emergency resuscitation after illicit opiate overdose to identify (i) any evidence of harm caused by excessive naloxone dosing (‘over-antagonism’); and (ii) implications for the medical administration of naloxone within contemporary emergency settings. Design Re-analysis of a large qualitative data set comprising 70 face-to-face interviews conducted within a few hours of heroin/opioid overdose occurring, observations from hospital settings and a further 130 interviews with illicit opiate users. Data were generated between 1997 and 1999. Setting Emergency departments, drug services and pharmacies in two Scottish cities. Participants Two hundred illicit opiate users: 131 males and 69 females.Findings Participants had limited knowledge of naloxone and its pharmacology, yet described it routinely in negative terms and were critical of its medical administration. In particular, they complained that naloxone induced acute withdrawal symptoms, causing patients to refuse treatment, become aggressive, discharge themselves from hospital and take
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additional street drugs to counter the naloxone effects. Participants believed that hospital staff should administer naloxone selectively and cautiously, and prescribe counter-naloxone medication if dosing precipitated withdrawals. In contrast, observational data indicated that participants did not always know that they had received naloxone and hospital doctors did not necessarily administer it incautiously. Conclusions Opiate users in urban Scotland repeatedly report harm caused by naloxone over-antagonism, although this is not evident in observational data. The concept of contemporary legend (a form of folklore that can be based on fact and provides a means of communicating and negotiating anxiety) helps to explain why naloxone has such a feared reputation among opiate users.Keywords: Contemporary legend; naloxone; opiates; overdose; qualitative study
52. The relation between risk-taking behavior and alcohol use in young adults is different for men and womenL. de Haan, A.C.G. Egberts, E.R. HeerdinkDrug and Alcohol Dependence 2015:155(222-227)
AbstractObjective The present study examined the relationship of risk-taking behavior and alcohol use and the role of sex herein, while adjusting for age, depression, anxiety, stress and lifestyle. Methods Participants were 6002 university students. They were classified as either abstinent, drinker but non-binge drinker, or binge drinker based on self-reported alcohol consumption. Risk-taking and risk assessment were evaluated with the RT-18 and depression, anxiety and stress with the DASS-21. Results The odds of being a binge versus non-binge drinker increased with risk-taking as well as risk assessment for both men and women. The odds being a non-binge drinker versus abstinent were increased by risk-taking for women only. For binge drinking versus abstinence, risk-taking had a significant increasing effect for both sexes, but risk assessment was only significant in women.Conclusion These results may assist with alcohol use prevention techniques because risk-taking behavior exerts, even when corrected for age, lifestyle, depression, anxiety, and stress levels, a solid, sex-specific independent effect on alcohol use.
53. Predictors of Opioid-Related Death During Methadone TherapyPamela Leece, Christopher Cavacuiti, Erin M. Macdonald, Tara Gomes, Meldon Kahan, Anita Srivastava, Leah Steele, Jin Luo, Muhammad M. Mamdani, David N. JuurlinkJournal of Substance Abuse Treatment 2015:57;30-35
AbstractWe aimed to examine pharmacologic, demographic and medical comorbidity risk factors for opioid-related mortality among patients currently receiving methadone for an opioid use disorder. We conducted a population-based, nested case-control study linking healthcare and coroner's records in Ontario, Canada, from January 31, 1994 to December 31, 2010. We included social assistance recipients receiving methadone for an opioid use disorder. Within this group, cases were those who died of opioid-related causes. For each case, we identified up to 5 controls matched on calendar quarter. The primary analysis examined the association between use of psychotropic drugs (benzodiazepines, antidepressants or antipsychotics) and opioid-related mortality. Secondary analyses examined the associations between baseline characteristics, health service utilization, comorbidities and opioid-related mortality. Among 43,545 patients receiving methadone for an opioid use disorder, we identified 175 (0.4%)
opioid-related deaths, along with 873 matched controls. Psychotropic drug use was associated with a two fold increased risk of opioid-related death (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.2 to 3.5). Specifically, benzodiazepines (adjusted OR 1.6; 95% CI 1.1 to 2.5) and antipsychotics (adjusted OR 2.3; 95% CI 1.5 to 3.5) were independently associated with opioid-related death. Other associated factors included chronic lung disease (adjusted OR 1.7; 95% CI 1.2 to 2.6), an alcohol use disorder (adjusted OR 1.9; 95% CI 1.2 to 3.2), mood disorders (adjusted OR 1.8; 95% CI 1.0 to 3.2), and a history of heart disease (adjusted OR 5.3; 95% CI 2.0 to 14.0). Psychotropic drug use is associated with opioid-related death in patients receiving methadone. Mindfulness of these factors may reduce the risk of death among methadone recipients.Keywords: Methadone; Opioids; Mortality; Substance use disorder
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PRESCRIPTION MISUSE
54. Dynamic model of nonmedical opioid use trajectories and potential policy interventionsWayne Wakeland, Alexandra Nielsen, Peter GeissertThe American Journal of Drug and Alcohol Abuse 2015:41(6);508-518
AbstractBackground Nonmedical use of pharmaceutical opioid analgesics (POA) increased dramatically over the past two decades and remains a major health problem in the United States, contributing to over 16 000 accidental poisoning deaths in 2010. Objectives To create a systems-oriented theory/model to explain the historical behaviors of interest, including the various populations of nonmedical opioid users and accidental overdose mortality within those populations. To use the model to explore policy interventions including tamper-resistant drug formulations and strategies for reducing diversion of opioid medicines. Methods A system dynamics model was constructed to represent the population of people who initiate nonmedical POA usage. The model incorporates use trajectories including development of use disorders, transitions from reliance on informal sharing to paying for drugs, transition from oral administration to tampering to facilitate non-oral routes of administration, and transition to heroin use by some users, as well as movement into and out of the population through quitting and mortality. Empirical support was drawn from national surveys (NSDUH, TEDS, MTF, and ARCOS) and published studies. Results The model was able to replicate the patterns seen in the historical data for each user population, and the associated overdose deaths. Policy analysis showed that both tamper-resistant formulations and interventions to reduce informal sharing could significantly reduce nonmedical user populations and overdose deaths in the long term, but the modeled effect sizes require additional empirical support. Conclusion Creating a theory/model that can explain system behaviors at a systems level scale is feasible and facilitates thorough evaluation of policy interventions.Keywords: Drug take-backs; drug sharing; health policy; pharmaceutical opioids; system dynamics; tamper resistance
55. Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care-based multi-component brief intervention to reduce risky drug useLillian Gelberg, Ronald M. Andersen, Abdelmonem A. Afifi, Barbara D. Leake, Lisa Arangua, Mani Vahidi, Kyle Singleton, Julia Yacenda-Murphy, Steve Shoptaw, Michael F. Fleming, Sebastian E. BaumeisterAddiction 2015:110(11);1777-1790 AbstractAims To assess the effect of a multi-component primary care delivered brief intervention for reducing risky psychoactive drug use (RDU) among patients identified by screening.Design Multicenter single-blind two-arm randomized controlled trial of patients enrolled from February 2011 to November 2012 with 3-month follow-up. Randomization and allocation to trial group were computer-generated. Setting Primary care waiting rooms of five federally qualified health centers in Los Angeles County (LAC), USA. Participants A total of 334 adult primary care patients (171 intervention; 163 control) with RDU scores (4–26) on the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) self-administered on tablet computers. 261 (78%) completed follow-up. Mean age was 41.7 years; 62.9% were male; 37.7% were Caucasian. Intervention(s) and Measurement Intervention patients received brief (typically 3–4 minutes) clinician advice to quit/reduce their drug use reinforced by a video doctor message, health education booklet and up to two 20–30–minute follow-up telephone drug use coaching sessions. Controls received usual care and cancer screening information. Primary outcome was patient self-reported use of highest scoring drug (HSD) at follow-up.Findings Intervention and control patients reported equivalent baseline HSD use at 3-month follow-up. After adjustment for covariates, in the complete sample linear regression model, intervention patients used their HSD on 3.5 fewer days in the previous month relative to controls (P<0.001), and in the completed sample model, intervention patients used their HSD 2.2 fewer days than controls (P < 0.005). No compensatory increases in use of other measured substances were found. Conclusions A primary-care based, clinician-delivered brief intervention with follow-up coaching calls may decrease risky psychoactive drug use.Keywords: Brief intervention; community health centers; motivational interviewing; primary care; randomized controlled trial; risky drug use
56. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs Marlon P. Mundt, Larissa I. Zakletskaia, David A. Shoham, Wen-Jan Tuan, Pascale CarayonAlcoholism: Clinical and Experimental Research 2105:39(10);2003-2015
Abstract Background Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Methods Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated
the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Results Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: −$1,819, −$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Conclusions Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members.Keywords: Alcohol; Primary Care; Team; Social Network; Communication
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PROFESSIONALS AND SERVICES
57. Health-care professionals’ attitudes across different hospital departments regarding alcohol-related presentationsNauman Iqbal, Orlagh McCambridge, Lauren Edgar, Ciara Young, Gillian W. ShorterDrug and Alcohol Review 2015:34(5);487-494
AbstractIntroduction and Aims Attitudes to individuals presenting with alcohol-related issues are important in developing therapeutic relationships and applying alcohol-related interventions. This study explores staff attitudes to these individuals across a range of roles and departments. Design and Methods Data were gathered from 204 staff in the Southern Health and Social Care Trust in Northern Ireland. Regression models were used to predict attitudes as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Results Two hundred and four people participated in the study. The sample comprised doctors, nurses, allied health professionals and other staff who had face-to-face contact with patients. Staff worked in accident and emergency (A&E), medical, surgical, addiction or psychiatry departments. Staff working in addiction and psychiatry departments had significantly higher levels of role adequacy compared with those in A&E. Staff in addictions also demonstrated higher levels of role legitimacy, motivation and role satisfaction than those in A&E. Doctors had higher role adequacy and role legitimacy than nursing staff.Discussion and Conclusions There are critical differences in staff attitudes to patients presenting with alcohol-related issues in a range of hospital settings; training and working in a specialist setting have a significant positive influence on staff attitudes. This suggests that further training and support would positively enhance the attitudes of staff in a variety of professional roles and across a range of hospital settings in the management of patients presenting with alcohol-related difficulties.Keywords: alcohol drinking; alcoholism; attitude of health professional; medical staff; nursing staff
58. You Can't Be in Recovery If You Are on Medication: A Concept Worth RetiringGeorge E. WoodySubstance Use and Misuse 2015:50(8-9);1020-1023
No abstract available
59. Addiction Treatment Professionals Are Not the Gatekeepers of RecoveryKeith HumphreysSubstance Use and Misuse 2015:50(8-9);1024-1027
AbstractAddiction treatment is beneficial to many individuals who have substance use disorders. However, only a minority of individuals who recover from addiction receive it. Despite this, addiction treatment is sometimes granted the status of the “gatekeeper of recovery.” The myth that treatment is necessary for recovery has no empirical support. It also undermines the confidence of individuals in their ability to change on their own and is unduly dismissive of the efforts of nonprofessional helpers.Keywords: addiction treatment; professionalism; mutual-help groups; natural recovery; pastoral counselling
60. Recovery Is A Reality: But What Is It?Carl LeukefeldSubstance Use and Misuse 2015:50(8-9);1028-1030
61. “Doing the devil’s work”: Emotional labour and stigma in expanding Needle and Syringe ProgramsCarla Treloar, Max Hopwood, Kenneth Yates, Limin MaoDrugs: Education, Prevention and Policy 2015:22(5);437-443
AbstractExpansion of Needle and Syringe Programs (NSPs) to non-specialised sites requires an NSP workforce with skills in engaging stakeholders who may have different opinions of NSP. This study examined the strategies used by NSP workers to develop and maintain NSP services and the emotional labour involved in performing this work. Qualitative interviews were undertaken with 12 staff of a NSP network in metropolitan Sydney, Australia. Participants had undertaken a range of activities to expand NSP sites, often in unwelcoming environments in which NSP was viewed as a “cowboy” service. Participants’ strategies included building positive, ongoing inter-group contact, being visible in external services, and maintaining their professionalism to promote NSP as a legitimate service and themselves as legitimate health workers. Some participants employed strategies which were at odds with their personal and professional values. Participants relied on cohesion within the NSP team to support and encourage each other. Dealing with external services to establish and maintain NSPs was a source of significant emotional labour for NSP workers and was grounded in the stigma attached to injecting drug use. NSP policies and procedures should account for this additional work undertaken by NSP staff and leadership is required to address stigmatisation of NSPs.Keywords: Needle and Syringe Program; workforce; emotional labour; qualitative research; Australia
62. Cannabis vaping and public health—some comments on relevance and implicationsBenedikt Fischer, Cayley Russell, Mark W. TyndallAddiction 2015:110(10);1705-1706 No abstract available
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YOUNG PEOPLE AND ALCOHOL
63. Adolescents from affluent city districts drink more alcohol than othersWilly Pedersen, Anders Bakken, Tilmann von SoestAddiction 2105:110(10);1595-1604
AbstractAims To estimate the level of alcohol consumption and problems among adolescents in city districts in Oslo, Norway with different socio-economic composition; to test whether differences in alcohol consumption are related to district differences in socio-demographic characteristics; and to analyse whether such associations remain significant after controlling for individual-level variables. Design Cross-sectional survey using multi-level linear regression analyses with individual responses at the lowest level and city-district data at the highest level. Setting Oslo, Norway. Participants A total of 6635 secondary school students, in 62 schools, living in 15 different city districts. Measurements Frequency of alcohol consumption and alcohol intoxication; alcohol problems; and individual characteristics such as immigrant status, religious involvement and parental norms with regard to alcohol. Socio-economic indicators in city districts, such as education, income and unemployment, were combined into a district-level socio-economic index (DLSI).Findings DLSI scores were related positively to alcohol use (r = 0.31, P < 0.01) and alcohol intoxication (r = 0.25, P < 0.01) but negatively to alcohol problems among alcohol users (r = –0.18, P < 0.01). DLSI scores remained significant for alcohol consumption and alcohol intoxication, after controlling for individual-level variables (P < 0.01), but this was not the case for alcohol problems. Conclusion Adolescents in affluent areas of Oslo, Norway report the highest levels of alcohol consumption and alcohol intoxication of all areas; neighbourhood characteristics such as education, income and unemployment levels seem to play a role in such drinking behaviour. Alcohol users in poorer districts reported more alcohol problems than those in other districts; however, here neighbourhood effects do not seem to play a role.Keywords: Adolescent; affluence; alcohol; alcohol problems; neighbourhood
64. Trajectories and correlates of reasons for abstaining or limiting drinking during adolescenceJennifer E. Merrill, Scott Martin, Caitlin C. Abar, Kristina M. JacksonAddictive Behaviors 2016:52;1-7
AbstractIntroduction Our aim was to enhance understanding of the trajectory of reasons for abstaining and limiting drinking (RALD) over the course of adolescence and how RALD levels or trajectories may differ based on lifetime experience with alcohol and/or gender.Methods Participants were 1023 middle school students (52% female) who completed online surveys at baseline and five follow-ups over a 3-year period, assessing lifetime sip and full drink of alcohol and RALD. Hierarchical linear models were used to estimate change over time in total RALD and RALD subscales (upbringing, performance/control). Between-person (gender and drinking status) correlates of average RALD and change in RALD over time were considered. Results RALD total and subscale scores significantly decreased over time (ages 10.5–16.5). Drinking experience in both milestones (sip, full drink) was found to be a significant moderator of change in RALD over time; decline was fastest among adolescents reporting lifetime experience with drinking. Boys reported lower RALD, though
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the pace of change in RALD across time did not differ by gender. Conclusions This was the first study to report prospective changes in the cognitive domain of RALD among young adolescents. That change over time in RALD is moderated by drinking experience suggests an increased risk among those with earlier drinking experience. Findings highlight the importance of considering sipping, not just consumption of a full drink, as a pivotal developmental milestone. Prevention efforts that target RALD are implicated and parent-based intervention strategies may be beneficial.Keywords: Adolescence; Reasons for abstaining/limiting drinking; Drinking milestones; Gender
65. Adolescent Drinking Risks Associated with Specific Drinking ContextsChristina Mair, Sharon Lipperman-Kreda, Paul J. Gruenewald, Melina Bersamin, Joel W. GrubeAlcoholism: Clinical and Experimental Research 2015:39(9);1705-1711
Abstract Background To identify drinking contexts toward which prevention efforts should be directed, associations of context-specific alcohol use (past-year frequency of drinking and heavier drinking in the context) with a range of alcohol-related problems were examined in a population sample of adolescents. Methods A sample of youths (ages 15 to 18) residing in 50 medium-to-large California cities (n = 473 drinkers) was obtained. Respondents provided information about 7 past-year alcohol-related problems in 3 domains (physiological consequences, alcohol-related violence, and conflict/trouble) and the number of times in the past year they used 6 distinct drinking contexts (parties, restaurants/bars, parking lots/street corners, beaches/parks, respondent's home without parents, and someone else's home without parents). Context-specific dose–response model was estimated for each context using censored Tobit models with heteroskedasticity corrections. Results Physiological problems were associated with more frequent drinking in 5 of 6 contexts. Heavier drinking in restaurants/bars/nightclubs (b = 0.22, SE = 0.10) and someone else's home without parents (b = 0.14, SE = 0.06) was associated with greater risk of violence. Conflict/trouble was associated with more frequent drinking in parking lots/street corners, declining at higher levels of drinking. Conclusions Certain drinking contexts are related to problems among youths, some because they are associated with frequent alcohol consumption and others because they are associated with heavier drinking. Identifying which drinking contexts are related to specific alcohol-related problems and why is an essential component of developing effective preventive interventions.Keywords: Context-Specific; Alcohol; Dose–Response; Alcohol-Related Problems; Youth Drinking
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66. Are homeschooled adolescents less likely to use alcohol, tobacco, and other drugs?Michael G. Vaughn, Christopher P. Salas-Wright, Kristen P. Kremer, Brandy R. Maynard, Greg Roberts, Sharon VaughnDrug and Alcohol Dependence 2015:155(97-104)
AbstractBackground Nearly two million school-aged children in US are currently homeschooled. This study seeks to examine homeschooled adolescents’ attitudes toward, access to, and use of alcohol, tobacco, and other drugs (ATOD) compared to their non-homeschooled peers. Methods The study uses data between 2002 and 2013 from the National Survey on Drug Use and Health (NSDUH) for school-attending respondents aged 12–17 (n = 200,824). Participants were questioned regarding peer use of licit and illicit substances, ease of accessing illicit substances, and past 12-month substance use. Survey adjusted binary logistic regression analyses were systematically executed to compare non-homeschooled adolescents with homeschooled adolescents with respect to views toward, access to, and use of substances. Results Findings indicate that homeschooled adolescents were significantly more likely to strongly disapprove of their peers drinking (AOR = 1.23) and trying (AOR = 1.47) and routinely using (AOR = 1.59) marijuana. Homeschooled adolescents were significantly less likely to report using tobacco (AOR = 0.76), alcohol (AOR = 0.50), cannabis (AOR = 0.56) and other illicit drugs and to be diagnosed with an alcohol (AOR = 0.65) or marijuana (AOR = 0.60) use disorder. Finally, homeschooled adolescents were also less likely to report easier access to illicit drugs and to be approached by someone trying to sell drugs compared to non-homeschooled peers. Conclusions Homeschooled adolescents’ views, access, use and abuse of ATOD are uniquely different from those of non-homeschooled adolescents. Findings point to the need to more extensively examine the underlying mechanisms that may account for these differences.
67. ‘I think other parents might. …’: Using a projective technique to explore parental supply of alcohol Sandra C. Jones, Christopher Magee, Kelly AndrewsDrug and Alcohol Review 2015:34(5);531-539
AbstractIntroduction and Aims A growing body of research indicates parental supply of alcohol to children and adolescents is common. The present study aimed to examine parents' reasons for supplying alcohol to adolescents that they may find hard to articulate or not be consciously aware of. Design and Methods A projective methodology was used, whereby respondents were asked to explain the thoughts and motivations of a gender-matched parent in a scenario in which the parent did or did not provide alcohol to their teenage child. Respondents were 97 mothers and 83 fathers of teenagers who completed an anonymous online survey. Open-ended responses were coded thematically; t-tests were used to compare quantitative responses between the scenarios. Results The quantitative analysis found the parent who provided alcohol was less likely to be seen as making sure their child was safe and educating them about boundaries, but more likely to be seen as being a friend as well as a parent and (for females only) making sure their child fits in with others. The open-ended responses showed explanations for not providing alcohol most commonly focused on ensuring the child's safety,
obeying the law, and setting rules and boundaries, and for providing alcohol focused on ensuring the child fit in with peers and beliefs about harm minimisation.Discussion and Conclusions The findings suggest that these respondents (parents) harboured a number of misperceptions about underage drinking and experienced conflicts in weighing up the perceived benefits of providing alcohol to their children against the risks of adolescent drinking.Keywords: alcohol consumption; adolescent; parent; projective technique
68. Alcohol Use Initiation is Associated with Changes in Personality Trait Trajectories from Early Adolescence to Young Adulthood Daniel M. Blonigen, C. Emily Durbin, Brian M. Hicks, Wendy Johnson, Matt McGue and William G. IaconoAlcoholism: Clinical and Experimental Research 2015:39(11);2163-2170
Abstract Background Recent work has demonstrated the codevelopment of personality traits and alcohol use characteristics from early adolescence to young adulthood. Few studies, however, have tested whether alcohol use initiation impacts trajectories of personality over this time period. We examined the effect of alcohol use initiation on personality development from early adolescence to young adulthood. Methods Participants were male (nmen = 2,350) and female (nwomen = 2,618) twins and adoptees from 3 community-based longitudinal studies conducted at the Minnesota Center for Twin and Family Research. Data on personality traits of Positive Emotionality (PEM; Well-being), Negative Emotionality (NEM; Stress Reaction, Alienation, and Aggression), and Constraint (CON; Control and Harm Avoidance)—assessed via the Multidimensional Personality Questionnaire (MPQ)—and age of first drink were collected for up to 4 waves spanning ages 10 to 32. Results Alcohol use initiation was associated with significant decreases in levels of Well-being and CON traits, most notably Control; and significant increases in levels of all NEM traits, particularly Aggression. In general, the effects of alcohol use initiation on personality traits were moderated by gender and enhanced among those with earlier age of first drink. Conclusions From early adolescence to young adulthood, alcohol use initiation predicts deviations from normative patterns of personality maturation. Such findings offer a potential mechanism underlying the codevelopment of personality traits and alcohol use characteristics during this formative period of development.Keywords: Personality Traits; Alcohol Use Initiation; Adolescence; Young Adulthood
69. The Role of Moral Disengagement in Underage Drinking and Heavy Episodic DrinkingCatherine Angela Quinn & Kay BusseySubstance Use and Misuse 2015:50(11);1437-1448
AbstractObjectives The current study had two aims. First, to develop a moral disengagement scale contextualized to underage drinking. Second, to investigate Bandura's (1986) self-regulatory model within the context of underage drinking. Method Two different samples of students participated in the study. The first sample included 619 (362 females) adolescents (Mage = 15.3 years, SD = 1.09 years) and the second sample 636 (386 females) adolescents (Mage = 15.3 years, SD = 1.03 years). Students in the first sample completed the Underage Drinking
Disengagement Scale (UDDS), and measures of engagement in underage drinking and heavy episodic drinking. Students in the second sample completed these measures as well as scales of general moral disengagement, personal standards, and anticipatory guilt associated with underage drinking. Results For the UDDS, exploratory and confirmatory factor analyses verified a single factor structure. The UDDS was more strongly associated with engagement in underage drinking and heavy episodic drinking than a general measure of moral disengagement. A moderated mediation analysis revealed that adolescents who negatively evaluated underage drinking reported more anticipatory guilt, and more anticipatory guilt was associated with less engagement in underage drinking and less heavy episodic drinking. This relationship was weaker at high compared to low levels of underage drinking disengagement. Conclusions/Importance Understanding how adolescents self-regulate their drinking, and ways that such self-regulation may be deactivated or disengaged, may help identify those adolescents at increased risk of drinking underage and of engaging in heavy episodic drinking.Keywords: underage drinking; moral disengagement; guilt; alcohol; adolescent
