CERGA Journal Title and Abstracts March 2012 Contents PAGE LIST OF JOURNALS CHECKED 2 LIST OF TITLES Abstinence 3 Alcohol – Burden on Society 3 Alcohol – Epidemiology and Demography 3 Alcohol – Liver Disease 4 Alcohol – Miscellaneous 4 Alcohol – Treatment and Screening 5 Alcohol Use and Users 6 Alcohol Use – Binge Drinking 6 Blood Borne Viruses 6 Co-Morbidity 7 Drug Policy 7 Drug Related Deaths 7 Epidemiology and Demography 8 Miscellaneous 8 Older Drug Users 9 Opioid Pharmacology 9 Opiate Treatment 9 Smoking Cessation 10 Stimulants 10 Treatment and Service Use 10
Transcript
CERGA Journal Title and Abstracts March 2012
Contents PAGE
LIST OF JOURNALS CHECKED 2
LIST OF TITLES
Abstinence 3
Alcohol – Burden on Society 3
Alcohol – Epidemiology and Demography 3
Alcohol – Liver Disease 4
Alcohol – Miscellaneous 4
Alcohol – Treatment and Screening 5
Alcohol Use and Users 6
Alcohol Use – Binge Drinking 6
Blood Borne Viruses 6
Co-Morbidity 7
Drug Policy 7
Drug Related Deaths 7
Epidemiology and Demography 8
Miscellaneous 8
Older Drug Users 9
Opioid Pharmacology 9
Opiate Treatment 9
Smoking Cessation 10
Stimulants 10
Treatment and Service Use 10
Young People 11
LIST OF ABSTRACTS 12-59
Journal Title Volumes and Issues CheckedNumber of issues
1. Cue-induced craving and physiological reactions in recently and long-abstinent heroin-dependent patientsMin Zhao, Chenglu Fan, Jiang Du, Haifeng Jiang, Hanhui Chen, Haiming
SunAddictive Behaviours 2012:37(4);393-398
2. Facets of impulsivity in the relationship between antisocial personality and abstinenceMarsha N. Sargeant, Marina A. Bornovalova, Adria J.-M. Trotman, Shira
Fishman, Carl W. LejuezAddictive Behaviors 2012:37(3);293-298
ALCOHOL – BURDEN ON SOCIETY
3. The impact of small changes in bar closing hours on violence. The Norwegian experience from 18 citiesIngeborg Rossow, Thor NorströmAddiction 2011:107(3);530-537
4. Price Discounts on Alcohol in a City in Northern EnglandJean Adams, Jane BeenstockAlcohol and Alcoholism 2012:47(2);187-190
5. A Retrospective Analysis of the Nature, Extent and Cost of Alcohol-Related Emergency Calls to the Ambulance Service in an English Region N. Martin, D. Newbury-Birch, J. Duckett, H. Mason, J. Shen, C. Shevills, E.
KanerAlcohol and Alcoholism 2012:47(2);191-197
ALCOHOL – EPIDEMIOLOGY AND DEMOGRAPHY
6. Personality Traits and Coping Compensate for Disadvantageous Decision-making in Long-term Alcohol AbstinenceBálint Andó, Anita Must , Eszter Kurgyis, Andrea Szkaliczki, Gergely Drótos, Sándor Rózsa, Petronella Szikszay, Szatmár Horváth, Zoltán Janka, Péter Z. Álmos Alcohol and Alcoholism 2012:47(1);18-24
7. A Brief Report on Perceptions of Alcohol and Society among Scottish Medical StudentsH. Steed, M. Groome, P. Rice, K. Simpson, A. Day, J. Ker
8. General and Cancer Mortality in a Large Cohort of Italian AlcoholicsCalogero Saieva, Gabriele Bardazzi, Giovanna Masala, Andrea Quartini, Marco Ceroti, Adriana Iozzi, Elena Gelain, Andrea Querci, Allaman Allamani, Domenico PalliAlcoholism: Clinical and Experimental Research 2012:36(2);342-350
9. Hospital-Admitted Injury Attributable to AlcoholTed R. Miller, Rebecca S. SpicerAlcoholism: Clinical and Experimental Research 2012:36(1);104-112
ALCOHOL – LIVER DISEASE
10. Past and current alcohol consumption patterns and elevations in serum hepatic enzymes among US adults James Tsai, Earl S. Ford, Chaoyang Li, Guixiang ZhaoAddictive Behaviors 2012:37(1);78-84
11. Pharmacodynamic Effects of Intravenous Alcohol on Hepatic and
Gonadal Hormones: Influence of Age and SexVatsalya Vatsalya, Julnar E. Issa, Daniel W. Hommer, Vijay A. RamchandaniAlcoholism: Clinical and Experimental Research 2012:36(2);207-213
12. Housekeeping Gene Variability in the Liver of Alcoholic PatientsHédia Boujedidi, Laurence Bouchet-Delbos, Anne-Marie Cassard-Doulcier, Micheline Njiké-Nakseu, Sophie Maitre, Sophie Prévot, Ibrahim Dagher, Hélène Agostini, Cosmin S. Voican, Dominique Emilie, Gabriel Perlemuter, Sylvie NaveauAlcoholism: Clinical and Experimental Research 2012:36(2);258-266
ALCOHOL – MISCELLANEOUS
13. Do Media Messages Change People's Risk Perceptions for Binge Drinking?
Beverley Ayers, Lynn B. MyersAlcohol and Alcoholism 2012:47(1);52-56
14. Alcohol Dehydrogenase-1B Arg47His Polymorphism and Upper Aerodigestive Tract Cancer Risk: A Meta-Analysis Including 24,252 SubjectsHaipeng Guo, Guohong Zhang, Ruiqin MaiAlcoholism: Clinical and Experimental Research 2012:36(2);272-278
15. To Approach or Avoid Alcohol? Automatic and Self-Reported Motivational Tendencies in Alcohol DependenceHelen Barkby, Joanne M. Dickson, Louise Roper, Matt FieldAlcoholism: Clinical and Experimental Research 2012:36(2)361-368
16. Neuroendocrine Assessment of Serotonergic, Dopaminergic, and Noradrenergic Functions in Alcohol-Dependent IndividualsClaudia Fahlke, Ulf Berggren, Kristina J. Berglund, Henrik Zetterberg, Kaj
Blennow, Jörgen A. Engel, Jan BalldinAlcoholism: Clinical and Experimental Research 2012:36(1);97-103
ALCOHOL – TREATMENT AND SCREENING
17. Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysisJohn F. Kelly, Bettina Hoeppner, Robert L. Stout, Maria PaganoAddiction 2012:107(2);289-299
18. Sleep Disturbance in Alcoholism: Proposal of a Simple Measurement, and Results from a 24-Week Randomized Controlled Study of Alcohol-Dependent Patients Assessing Acamprosate Efficacy Pascal Perney, Philippe Lehert, Barbara J MasonAlcohol and Alcoholism 2012:47(2);133-139
19. Acamprosate for Alcohol Dependence: A Sex-Specific Meta-Analysis Based on Individual Patient DataBarbara J Mason, Philippe LehertAlcoholism: Clinical and Experimental Research 2012:36(3);497-508
20. Comparison of Alcoholism Subtypes as Moderators of the Response to Sertraline TreatmentHenry R. Kranzler, Richard Feinn, Stephen Armeli, Howard TennenAlcoholism: Clinical and Experimental Research 2012:36(3);509-516
21. Text-Message-Based Drinking Assessments and Brief Interventions for Young Adults Discharged from the Emergency DepartmentBrian Suffoletto, Clifton Callaway, Jeff Kristan, Kevin Kraemer, Duncan B.
ClarkAlcoholism: Clinical and Experimental Research 2012:36(3);552-560
22. Hepatic Safety and Antiretroviral Effectiveness in HIV-Infected Patients Receiving NaltrexoneJeanette M. Tetrault, Janet P. Tate, Kathleen A. McGinnis, Joseph L. Goulet, Lynn E. Sullivan, Kendall Bryant, Amy C. Justice, David A. Fiellin, For the Veterans Aging Cohort Study TeamAlcoholism: Clinical and Experimental Research 2012:36(2);318-324
23. Clinical measurement of addictionsRichard Cloutier, Alain Lesage, Michel Landry, Sylvia Kairouz, Jean-Marc
Menard Drug and Alcohol Review 2012:31(1);33-39
24. Reducing Dropout among Traumatized Alcohol Patients in Detoxification Treatment: A Pilot Intervention StudyMichael Odenwald, Peter SemrauEuropean Addiction Research 2012:18(2);54-63
ALCOHOL USE AND USERS
25. Positive alcohol expectancies mediate the influence of the behavioral activation system on alcohol use: A prospective path analysisJeffrey D. Wardell, Jennifer P. Read, Craig R. Colder, Jennifer E. MerrillAddictive Behaviors 2012:37(4);435-443
26. The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment samplePaul R. Stasiewicz, Clara M. Bradizza, Gregory D. Gudleski, Scott F. Coffey, Robert C. Schlauch, Sydney T. Bailey, Christopher W. Bole, Suzy Bird GulliverAddictive Behaviors 2012:37(4);469-476
27. Alexithymia and alcohol consumption: The mediating effects of drinking motives
28. Subjective measures of binge drinking and alcohol-specific adverse health outcomes: a prospective cohort studyTapio Palj rvi, Pia M kel, Kari Poikolainen, Sakari Suominen, Josip Car, Markku KoskenvuoAddiction 2012:107(2);323-330
BLOOD BORNE VIRUSES
29. The effect of hepatitis C treatment and human immunodeficiency virus (HIV) co-infection on the disease burden of hepatitis C among injecting drug users in AmsterdamAmy Matser, Anouk Urbanus, Ronald Geskus, Mirjam Kretzschmar, Maria Xiridou, Marcel Buster, Roel Coutinho, Maria PrinsAddiction 2012:107(3);614-623
30. Positive impact of hepatitis C virus (HCV) treatment on antiretroviral treatment adherence in human immunodeficiency virus–HCV coinfected
patients: one more argument for expanded access to HCV treatment for injecting drug usersPerrine Roux, Lionel Fugon, Maria Winnock, Dominique Salmon-Céron, Karine Lacombe, Philippe Sogni, Bruno Spire, François Dabis, Maria Patrizia Carrieri, for the ANRS-CO-13-HEPAVIH Study GroupAddiction 2012:107(1);152-159
31. Assessment of Risky Injection Practices Associated with Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus and Using the Blood-Borne Virus Transmission Risk Assessment QuestionnaireGrace L. Reynolds DPA, Dennis G. Fisher, Lucy E. Napper Journal of Addictive Diseases 2012:31(1);80-88
32. Hepatitis C treatment and injecting drug users in Perth, Western Australia: Knowledge of personal status and eligibility criteria for treatmentSusan J. Carruthers, Chrissy RyanJournal of Substance Use 2012:17(1);32-40
33. Identifying former injecting drug users infected with hepatitis C: an evaluation of a general practice-based case-finding intervention B.L. Cullen, S.J. Hutchinson S.O. Cameron, E. Anderson, S. Ahmed, E. Spence, P.R. Mills, R. Mandeville, E. Forrest, M. Washington, R. Wong, R. Fox, D.J. Goldberg Journal of Public Health 2012:34(1);14-23
CO-MORBIDITY
34. Psychiatric comorbidity and the persistence of drug use disorders in the United StatesMiriam C. Fenton, Katherine Keyes, Timothy Geier, Eliana Greenstein, Andrew Skodol, Bob Krueger, Bridget F. Grant, Deborah S. HasinAddiction 2012:107(3);599
35. Reasons for substance use among people with mental disordersLouise K. Thornton, Amanda L. Baker, Terry J. Lewin, Frances J. Kay-Lambkin, David Kavanagh, Robyn Richmond, Brian Kelly, Martin P. JohnsonAddictive Behaviors 2012:37(4);427-434
36. Treatment of substance abusing patients with comorbid psychiatric disorders
Thomas M. Kelly, Dennis C. Daley, Antoine B. DouaihyAddictive Behaviors 2012:37(1);11-24
37. Depression among regular heroin users: The influence of genderL. Sordo, M. Chahua, M.J. Bravo, G. Barrio, M.T. Brugal, A. Domingo-Salvany, G. Molist, L. De la Fuente, ITINERE Project GroupAddictive Behaviors 2012:37(1);148-152
38. A resounding success or a disastrous failure: Re-examining the interpretation of evidence on the Portuguese decriminalisation of illicit drugsCaitlin Elizabeth Hughes, Alex StevensDrug and Alcohol Review 2012:31(1);101-113
DRUG RELATED DEATHS
39. A procedure that differentiates unintentional from intentional overdose in opioid abusersPeter C. Britton, Amy S.B. Bohnert, James D. Wines Jr, Kenneth R. ConnerAddictive Behaviors 2012:37(1);127-130
EPIDEMIOLOGY AND DEMOGRAPHY
40. Early onset of drug and polysubstance use as predictors of injection drug use among adult drug usersRebecca C. Trenz, Michael Scherer, Paul Harrell, Julia Zur, Ashish Sinha, William LatimerAddictive Behaviours 2012:37(4);367-372
41. Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependenceChristine E. Grella, Katherine LovingerAddictive Behaviors 2012:37(3);306-312
42. Predictors of Repeated Emergency Department Visits among Persons Treated for AddictionHelen Hansagi, Barbro Engdahl, Anders RomelsjöEuropean Addiction Research 2012:18(2);47-53
43. Mortality of those who attended drug services in Scotland 1996–2006: Record-linkage studyElizabeth L.C. Merrall, Sheila M. Bird, Sharon J. HutchinsonInternational Journal of Drug Policy 2012:23(1);24-32
44. Personality Differences between Drug Injectors and Non-injectors among Substance-Dependent Patients in Substitution TreatmentJulie Saint-Lèbes, Rachel Rodgers, Philippe Birmes, Laurent Schmitt The American Journal of Drug and Alcohol Abuse 2012:38(2);135-139
MISCELLANEOUS
45. Eating patterns among heroin users: a qualitative study with implications for nutritional interventionsJoanne Neale, Sarah Nettleton, Lucy Pickering, Jan Fischer
46. A damage/benefit evaluation of addictive product useCatherine Bourgain, Bruno Falissard, Lisa Blecha, Amine Benyamina, Laurent Karila1, Michel ReynaudAddiction 2012:107(2);441-450
47. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic reviewJames D. Livingston, Teresa Milne, Mei Lan Fang, Erica AmariAddiction 2012:107(1)39-50
48. Chronic pain, Addiction severity, and misuse of opioids in Cumberland County, MaineRobert Heimer, Nabarun Dasgupta, Kevin S. Irwin, Mark Kinzly, Alison Phinney Harvey, Anthony Givens, Lauretta E. GrauAddictive Behaviors 2012:37(3);346-349
49. Paying Substance Abusers in Research Studies: Where Does the Money Go?
David S. Festinger, Karen Leggett DugoshThe American Journal of Drug and Alcohol Abuse 2012:38(1);43-48
OLDER DRUG USERS
50. Patterns of prescription opioid abuse and comorbidity in an aging treatment population Theodore J. Cicero, Hilary L. Surratt, Steven Kurtz, M.S. Ellis, James A.
InciardiJournal of Substance Abuse Treatment 2012:42(1);87-94
51. Treatment experience and needs of older drug users in Bristol, UKRachel M. Ayres, Lynne Eveson , Jennifer Ingram , Maggie TelferJournal of Substance Use 2012:17(1);19-31
OPIOID PHARMACOLOGY
52. Functional relevance of μ–δ opioid receptor heteromerization: A Role in novel signaling and implications for the treatment of addiction disorders: From a symposium on new concepts in mu-opioid pharmacologySteven D. Stockton Jr, Lakshmi A. DeviDrug and Alcohol Dependence 2012:121(3);167-172
53. The effect of methadone on emotional reactivitySteven M. Savvas, Andrew A. Somogyi, Addiction 2012:107(2);388-392
54. Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort studyAnne Bukten, Svetlana Skurtveit, Michael Gossop, Helge Waal, Per Stangeland, Ingrid Havnes, Thomas ClausenAddiction 2012:107(2);393-399
55. Premature ejaculation and other sexual dysfunctions in opiate dependent men receiving methadone substitution treatmentVenkat Chekuri, David Gerber, Adam Brodie, Rajeev KrishnadasAddictive Behaviors 2012:37(1);124-126
56. The Value of Clinical Case Management in a Methadone Maintenance Treatment ProgramCarolyn J. Plater-Zyberk, Michael Varenbut, Jeff Daiter, Andrew Worster The American Journal of Drug and Alcohol Abuse 2012:38(1)70-72
SMOKING CESSATION
57. Self-reported practices, attitudes and levels of training of practitioners in the English NHS Stop Smoking ServicesMáirtín S. McDermott, Robert West, Leonie S. Brose, Andy McEwenAddictive Behaviors 2012:37(4);498-506
58. Beyond fear appeals: Contradicting positive smoking outcome expectancies to influence smokers' implicit attitudes, perception, and behaviorSabine Glock, Dagmar Unz, Carrie KovacsAddictive Behaviors 2012:37(4);548-551
59. Differences in happiness between smokers, ex-smokers and never smokers: cross-sectional findings from a national household surveyLion Shahab, Robert WestDrug and Alcohol Dependence 2012:121(1-2);38-44
STIMULANTS
60. The diversion and misuse of pharmaceutical stimulants: what do we know and why should we care?Sharlene Kaye, Shane DarkeAddiction 2012:107(3);467-477
61. Opportunistic and continuing health care for injecting drug users from a nurse-run needle syringe program-based primary health-care clinicM. Mofizul Islam, Sharon E Reid, Ann White, Sara Grummett, Katherine M Conigrave, Paul S Haber Drug and Alcohol Review 2012:31(1);114-115
62. A multilevel approach to predicting community addiction treatment attitudes about contingency managementBryan Hartzler, Dennis M. Donovan, Carrie J. Tillotson, Solange Mongoue-
Tchokote, Suzanne R. Doyle, Dennis McCarty,Journal of Substance Abuse Treatment 2012:42(2);213-221
YOUNG PEOPLE
63. Psychological dysregulation, white matter disorganization and substance use disorders in adolescenceDuncan B. Clark, Tammy Chung, Dawn L. Thatcher, Stefan Pajtek, Elizabeth C. LongAddiction 2012:107(1);206-214
64. Outcome of heroin-dependent adolescents presenting for opiate substitution treatmentBobby P. Smyth, John Fagan, Kathy Kernan, M.R.C.PsychJournal of Substance Abuse Treatment 2012:42(1);35-44
1. Cue-induced craving and physiological reactions in recently and long-abstinent heroin-dependent patientsMin Zhao, Chenglu Fan, Jiang Du, Haifeng Jiang, Hanhui Chen, Haiming SunAddictive Behaviours 2012:37(4);393-398
AbstractObjective To understand the different patterns of cue-induced craving and physiological reactions among recently abstinent and long-abstinent heroin-dependent patients. Method 26 healthy adult controls (HC), 29 long-abstinent (more than 1 year, LA), and 26 recently abstinent (less than 1 month, RA) heroin-dependent individuals were exposed to heroin-related and neutral video cues, one video per session, on different days in random order. Self-reported heroin craving by a 10-point visual analog scale (VAS), physiological reactions [skin conductance (SC), muscle electromyography (MEG), skin temperature (TEMP)] and cardiovascular arousal [heart rates (HR), systolic blood pressure (HBP) and diastolic blood pressure (LBP)] were assessed at baseline and after exposure. Results Both heroin-abstinent groups showed increased heroin craving, SC, MEG, HR, SBP and LBP after exposure to heroin-related video, compared to the control group and compared to exposure to the neutral video. Except the RA group showed more HR changes, changes of heroin craving, SC, MEG, HR, SBP and LBP after exposure to the heroin cue video were not different between the LA and RA groups. Conclusions Abstinent heroin-dependent patients had elevated craving and physiological reactions after exposure to videos containing heroin-related cues and the cue induced responses still occurred in long-abstinent patients. This phenomenon should be addressed in treatment and recovery services for heroin dependence. Highlights Heroin group had increased craving and physiological reactions to heroin cue. Recently and long abstinent heroin groups had similar reactions to neutral cue. Normal controls had similar reactions to neutral and heroin cues. Recently and long abstinent heroin group had similar reactions to heroin cue.Keywords: Craving; Cue reactions; Heroin dependence; Long time abstinent
2. Facets of impulsivity in the relationship between antisocial personality and abstinenceMarsha N. Sargeant, Marina A. Bornovalova, Adria J.-M. Trotman, Shira Fishman, Carl W. LejuezAddictive Behaviors 2012:37(3);293-298
AbstractMost individuals who enter drug treatment programs are unable to maintain long-term abstinence. This problem is especially relevant for those presenting with Antisocial Personality Disorder (ASPD). In examining potential mechanisms underlying the relationship between ASPD and abstinence, one factor that may be especially useful is the personality variable of impulsivity. Thus, the current study examined ASPD status in relation to longest abstinence attempt among 117 substance use treatment-seeking
individuals, considering the mediating role of five facets of impulsivity: urgency, perseverance, premeditation, control, and delay discounting. Results indicated that individuals with ASPD evidenced shorter previous abstinence attempts and lower levels of perseverance and control than those without ASPD. Further, lower levels of control were associated with shorter abstinence attempts. Finally, control mediated the relationship between ASPD and longest quit attempt. These results suggest the potential value of multiple facets of impulsivity in efforts to understand relapse and subsequent treatment development efforts. Highlights Control mediated the relationship between ASPD and longest abstinence attempt. Lower levels of perseverance were associated with ASPD but did not mediate this relationship. Urgency, premeditation and delay discounting did not mediate this relationship.Keywords: Antisocial Personality Disorder; Impulsivity; Abstinence; Substance use treatment; Treatment dropout
ALCOHOL – BURDEN ON SOCIETY
3. The impact of small changes in bar closing hours on violence. The Norwegian experience from 18 citiesIngeborg Rossow, Thor NorströmAddiction 2011:107(3);530-537
AbstractAims To estimate the effect on violence of small changes in closing hours for on-premise alcohol sales, and to assess whether a possible effect is symmetrical. Design, setting, and participants A quasi-experimental design drawing on data from 18 Norwegian cities that have changed (extended or restricted) the closing hours for on-premise alcohol sales. All changes were ≤ 2 hours. Measurements Closing hours were measured in terms of the latest permitted hour of on-premise trading, ranging from 1 a.m. to 3 a.m. The outcome measure comprised police-reported assaults that occurred in the city centre between 10 p.m. and 5 a.m. at weekends. Assaults outside the city centre during the same time window should not be affected by changes in closing hours but function as a proxy for potential confounders, and was thus included as a control variable. The data spanned the period Q1 2000–Q3 2010, yielding 774 observations. Findings Outcomes from main analyses suggested that each 1-hour extension of closing hours was associated with a statistically significant increase of 4.8 assaults (95% CI 2.60, 6.99) per 100 000 inhabitants per quarter (i.e. an increase of about 16%). Findings indicate that the effect is symmetrical. These findings were consistent across three different modelling techniques. Conclusion In Norway, each additional 1-hour extension to the opening times of premises selling alcohol is associated with a 16% increase in violent crime.Keywords: Alcohol policy; closing hours; natural experiments; Norway; time–series analyses; violence
4. Price Discounts on Alcohol in a City in Northern EnglandJean Adams, Jane BeenstockAlcohol and Alcoholism 2012:47(2);187-190
AbstractAims To describe the extent and nature of price discounts on alcohol in Newcastle upon Tyne, England. Methods An observational survey in stores licensed for off-sales in December 2010 to January 2011. Results A total of 2018 price discounts in 29 stores led to a median saving of 25% and required a median purchase of 20 standard UK alcohol units. Median price per standard unit was £0.92 (US$1.49; €1.05) before discount and £0.68 (US$1.10; €0.78) after discount. Conclusions Restriction of price discounting should be considered as a public health policy.
5. A Retrospective Analysis of the Nature, Extent and Cost of Alcohol-Related Emergency Calls to the Ambulance Service in an English Region N. Martin, D. Newbury-Birch, J. Duckett, H. Mason, J. Shen, C. Shevills, E. KanerAlcohol and Alcoholism 2012:47(2);191-197
AbstractAims To measure the prevalence, pattern and associated financial cost of alcohol-related ambulance call outs in the North East of England using routinely collected data from the North East Ambulance Service (NEAS). Methods A retrospective cohort study over a 1-year time period (1 April 2009 to 31 March 2010) using NEAS patient record forms. Results In the North East, 10% of ambulance call outs were alcohol-related. Males were 2.5 times more likely than females to be attended by an ambulance on the street rather than at home. People aged 10–19 had the highest relative risk ratio (3.4) of an ambulance pick up being on the street compare with those aged over 60. These call outs and subsequent accident and emergency (A&E) attendances cost over £9 million in a 1-year period. When extrapolated to the whole country the cost could be as much as £152 million per year. Conclusion In a 1-year period, we estimated that over 31,000 ambulance call outs were alcohol-related. A large discrepancy was found between manual and electronic recording of alcohol-related ambulance attendances to A&E. The workload and cost of alcohol-related call outs is high and mostly preventable. Ambulance visits may present a teachable moment for brief intervention to reduce alcohol-related risk and harm.
ALCOHOL – EPIDEMIOLOGY AND DEMOGRAPHY
6. Personality Traits and Coping Compensate for Disadvantageous Decision-making in Long-term Alcohol AbstinenceBálint Andó, Anita Must , Eszter Kurgyis, Andrea Szkaliczki, Gergely Drótos, Sándor Rózsa, Petronella Szikszay, Szatmár Horváth, Zoltán Janka, Péter Z. Álmos Alcohol and Alcoholism 2012:47(1);18-24
AbstractAims High relapse rate and extreme difficulty to maintain abstinence are core characteristics of alcohol dependence (AD). Previous studies have demonstrated a persistent decision-making (DM) deficit in AD. We aimed to reveal specific personality features and stress-coping mechanisms presumed to compensate for ineffective DM skills. Methods Eighty-eight unmedicated patients with AD were enrolled. Intact general cognitive status was assured by IQ above 90. Forty-three patients had an average abstinence period of 12 weeks and were currently in an inpatient treatment program (short-term abstinence group, STA) and 45 patients were abstinent for at least 3 years (long-term abstinence group, LTA). The two groups were assessed using an integrative approach combining domains of DM, temperament and character dimensions and stress-coping measures. Results Both groups performed at chance level with no linear improvement tendency on the gambling task assessing DM adequacy. The LTA group scored significantly higher on scales of self-directedness and cooperativeness. In contrast, levels of harm avoidance, emotion-oriented coping and perceived stress were significantly higher in the STA group. Conclusion Our findings provide new evidence for a persistent DM deficit with no learning effect in AD. Despite the deficit, alcohol-dependent patients can achieve LTA. STA patients perceive higher levels of stress and use non-adaptive coping strategies. We propose that the more adaptive personality profile of LTA patients contributes to the compensation of the trait-like DM deficit in alcoholism. These compensatory features represent promising new targets for preventive measures and therapeutic interventions in AD.
7. A Brief Report on Perceptions of Alcohol and Society among Scottish Medical StudentsH. Steed, M. Groome, P. Rice, K. Simpson, A. Day, J. KerAlcohol and Alcoholism 2012:47(1);75-78
AbstractAims To assess perceptions on alcohol misuse and addiction among medical students prior to in-depth training in order to determine areas of the curriculum that need to be reshaped or focused on. Methods A questionnaire assessment of first- and second-year medical students' perceptions of alcohol misuse. Results Students had some misconceptions about current alcohol misuse rates, including a perception that addiction is common among health professionals, that the under-25s had the fastest increasing rate of alcohol addiction and that British women had a more rapidly increasing rate of alcohol addiction than British men. Conclusion Encouragingly, students overwhelmingly felt that alcohol addiction was something to which they
could make a difference. It highlights that early education about alcohol misuse is important in terms of teaching students how to recognize hazardous and harmful drinkers and how to manage them.
8. General and Cancer Mortality in a Large Cohort of Italian AlcoholicsCalogero Saieva, Gabriele Bardazzi, Giovanna Masala, Andrea Quartini, Marco Ceroti, Adriana Iozzi, Elena Gelain, Andrea Querci, Allaman Allamani, Domenico PalliAlcoholism: Clinical and Experimental Research 2012:36(2);342-350
AbstractBackground The consumption of alcohol is an underappreciated risk factor for a wide range of conditions. Overall, it is associated with high mortality rates and causes approximately 4% of all deaths worldwide. This study aimed to evaluate the general and cancer mortality in a cohort of subjects with alcohol addiction residing in Tuscany (Central Italy). Methods Overall, 2,272 alcoholics (1,467 men and 805 women; mean age at first examination 43.8 years ± 13.0), treated at the Alcohol Centre of Florence in the period April 1985 to September 2001, were followed until the end of the study period (median follow-up: 9.6 years). A total of 21,855 person-years were available for analyses. Expected deaths were estimated by using age, sex, and calendar-specific regional mortality rates. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated. Results Six hundred and thirty-six of the 2,272 patients (28.0%) died, yielding an SMR of 5.0 (95% CI: 4.6 to 5.4). The alcoholics had significantly elevated mortality risk from all malignant cancers (SMR = 3.8, 95% CI: 3.3 to 4.4) and a series of specific diseases (infections: SMR = 10.1, 95% CI: 4.8 to 21.1; diabetes: SMR = 3.6, 95% CI: 1.9 to 6.7; immunological system, including AIDS: SMR = 8.1, 95% CI: 4.1 to 16.2; nervous system: SMR = 3.5, 95% CI: 1.9 to 6.4; cardiovascular system: SMR = 2.4, 95% CI: 2.0 to 2.9; respiratory system: SMR = 5.8, 95% CI: 4.2 to 8.0; digestive system: SMR = 26.4, 95% CI: 22.6 to 30.8, including liver cirrhosis (SMR = 40.0, 95% CI: 33.9 to 47.1); violent causes: SMR = 6.6, 95% CI: 5.0 to 8.6). Among malignant cancers, the highest SMRs were found for cancers of the pharynx (SMR = 22.8, 95% CI: 9.5 to 54.8), oral cavity (SMR = 22.2, 95% CI: 13.2 to 37.6), liver (SMR = 13.5, 95% CI: 9.2 to 19.8), and larynx (SMR = 10.7, 95% CI: 5.8 to 19.9). Although women showed higher SMR in comparison with the general population of the area, their overall survival estimates during the follow-up were higher than those for male alcoholics.Conclusions This large series of Italian alcoholics showed a significant increase in total and cancer mortality in comparison with the general population, with female alcoholics reporting higher survival rates.Keywords: Alcoholism; Mortality; Cohort; Survival; Cancer
9. Hospital-Admitted Injury Attributable to AlcoholTed R. Miller, Rebecca S. SpicerAlcoholism: Clinical and Experimental Research 2012:36(1);104-112
Abstract
Background Primary data collection has established that alcohol causes injuries treated in the emergency department. No comparable data exist for injuries admitted to hospital. Data on the injury risks of heavy drinkers relative to other drinkers also are sparse. Methods We estimated (i) whether regular heavy drinkers have higher hospitalized injury risks than other people when alcohol-negative and (ii) how much hospitalized injury risk of regular heavy drinkers and other drinkers rises when alcohol-positive. We combined national alcohol consumption data with alcohol metabolism rates to estimate hours spent alcohol-positive versus alcohol-negative during a year for heavy drinkers versus other people. A literature review provided hospitalized nonfatal injury rates for these groups by alcohol involvement.Results Relative to other alcohol-negative people aged 18 and older, heavy drinkers have an estimated relative risk of hospitalized injury of 1.4 when alcohol-negative and 4.3 when alcohol-positive. Others have an estimated relative risk of 1.0 when alcohol-negative and 6.8 when alcohol-positive. Thus, alcohol greatly raises injury risk. The excess risk patterns persist for a wide range of sensitivity analysis values. Of hospitalized injuries, an estimated 21% are alcohol-attributable including 36% of assaults. Conclusions Drinking alcohol is a major cause of hospitalized injury. Heavy drinkers lead risky lifestyles. They tolerate alcohol better than most drinkers, but their injury risks still triple when they drink. Our approach to attribution is a valuable complement to more costly, more precise approaches that rely heavily on primary data collection. It works for any severity of injury. Applying it only requires an existing alcohol consumption survey plus data on alcohol involvement in targeted injuries.Keywords: Heavy Drinker; Burn; Spinal Cord; Assault; Cause
ALCOHOL – LIVER DISEASE
10. Past and current alcohol consumption patterns and elevations in serum hepatic enzymes among US adults James Tsai, Earl S. Ford, Chaoyang Li, Guixiang ZhaoAddictive Behaviors 2012:37(1);78-84 AbstractObjective The aim of this study was to examine the association between patterns of past and current alcohol consumption and elevations in serum hepatic enzymes among a nationally representative sample of adults in the United States. Method We estimated the age-adjusted prevalence of elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among 8993 adults aged 20 years or older who participated in the 2005–2008 National Health and Nutrition Examination Survey (NHANES). We produced prevalence ratios by using patterns of alcohol consumption as a predictor; elevations in serum ALT, AST, and GGT were used as an outcome variable while adjusting for covariates in multivariate regression models. Results The age-adjusted prevalence of elevated serum ALT, AST, and GGT in adults was 9.7%, 16.0%, and 8.6%, respectively. Male excessive current drinkers had 50%–71% and 75%–314% increased likelihoods of having elevated serum AST and GGT, respectively; female excessive drinkers with a history of consuming 5 or more drinks almost daily had a 226% increased likelihood of having elevated serum GGT, when compared to their respective counterparts who were lifetime abstainers. Conclusions The results of this study indicate that elevations in serum hepatic enzymes, especially AST and GGT, are common in adults who are excessive current drinkers. There is evidence to suggest that excessive current drinkers with a history of protracted drinking are especially vulnerable to potential liver injury. These findings lend further support to the early identification of excessive drinkers who may have an increased risk for alcohol-related morbidity and mortality in health care settings.Keywords: Alcohol consumption; Former drinkers; Aminotransferase; Alanine aminotransferase (ALT); Aspartate aminotransferase (AST); Gamma-glutamyl transferase (GGT)
11. Pharmacodynamic Effects of Intravenous Alcohol on Hepatic and Gonadal Hormones: Influence of Age and SexVatsalya Vatsalya, Julnar E. Issa, Daniel W. Hommer, Vijay A. RamchandaniAlcoholism: Clinical and Experimental Research 2012:36(2);207-213
AbstractBackground Growth hormone (GH)–insulin-like growth factor-1 (IGF-1) axis and gonadal hormones demonstrate extensively associated regulation; however, little is known about the effects of acute alcohol exposure on these hormones. This study examined the effects of intravenous alcohol on the GH–IGF-1 axis and gonadal hormone concentrations, and the influence of age and sex on their regulation. Methods Forty-eight healthy volunteers (24 men and 24 women each in the 21 to 25 and 55 to 65 year age groups) underwent a 2-session single-blinded study. Subjects
received in randomized counter-balanced order, alcohol infusions, individually computed based on a physiologically based pharmacokinetic model, to maintain a steady-state (“clamped”) exposure of 50 mg% or saline for 3 hours in separate sessions. Blood samples collected at baseline and postinfusion in each session were assayed for levels of GH, IGF-1, free testosterone, and estradiol. Results Acute alcohol administration resulted in changes in gonadal hormones that differed by sex. Change in free testosterone showed a significant treatment × baseline interaction (p < 0.001), indicating that alcohol-induced suppression of testosterone occurred predominantly in men. On the other hand, change in estradiol showed a significant treatment × sex interaction (p = 0.028), indicating that alcohol-induced increases in estradiol occurred predominantly in women. There was a trend for alcohol-induced decreases in IGF-1 levels. Change in GH showed a significant main effect of baseline (p < 0.001) and a trend for treatment by baseline interaction, suggesting an alcohol-induced decrease in individuals with high baseline GH values. There was also a significant main effect of sex (p = 0.046) indicating that men had greater changes in GH across treatment compared with women. Conclusions Alcohol induced a complex pattern of hormonal responses that varied between younger and older men and women. Some of the observed sex-based differences may help improve our understanding of the greater susceptibility to alcohol-related hepatic damage seen in women.Keywords: Age; Alcohol; Estradiol; Growth Hormone; IGF-1; Sex; Testosterone
12. Housekeeping Gene Variability in the Liver of Alcoholic PatientsHédia Boujedidi, Laurence Bouchet-Delbos, Anne-Marie Cassard-Doulcier, Micheline Njiké-Nakseu, Sophie Maitre, Sophie Prévot, Ibrahim Dagher, Hélène Agostini, Cosmin S. Voican, Dominique Emilie, Gabriel Perlemuter, Sylvie NaveauAlcoholism: Clinical and Experimental Research 2012:36(2);258-266
AbstractBackground Quantification of gene expression using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) requires normalization to an endogenous reference gene termed housekeeping gene (HKG). Many of the commonly used HKGs are regulated and vary under experimental conditions and disease stages. Alcoholic liver disease (ALD) is associated with several different liver histological lesions that may modulate HKG expression. We investigated the variability of commonly used HGKs (18S, β-actin, glyceraldehyde-3-phosphate [GAPDH], and arginine/serine-rich splicing factor [SFRS4]) in the liver of patients with ALD. Methods Fifty consecutive patients at different stages of ALD underwent liver biopsy. The stability of HKG was assessed according to liver histological lesions. Results β-actin had the highest coefficient of dispersion (COD) (23.9). β-actin tended to decrease with steatosis and to increase with alcoholic hepatitis; β-actin also increased in patients with both alcoholic hepatitis and cirrhosis. GAPDH and SFRS4 COD were 2.8 and 2.1, respectively. GAPDH was decreased with steatosis and increased with alcoholic hepatitis and fibrosis. 18S had the lowest COD (1.4). Both 18S and SFRS4 levels were not significantly modified with respect to all alcohol-induced liver histological lesions.Conclusions: In patients with ALD, the most constantly expressed HKGs are 18S and SFRS4. These genes are appropriate reference genes for normalization of RT-qPCR in
the liver of patients with ALD. The use of other HKGs such as β-actin or GAPDH would lead to misinterpretation of the results.Keywords: Alcoholic Liver Disease; Steatosis; Alcoholic Hepatitis; Liver Fibrosis; Cirrhosis; Housekeeping Gene; GAPDH; SFSR4; β-actin; 18S
ALCOHOL – MISCELLANEOUS
13. Do Media Messages Change People's Risk Perceptions for Binge Drinking?Beverley Ayers, Lynn B. MyersAlcohol and Alcoholism 2012:47(1);52-56
AbstractAims The current study investigated the effect of a media health message for drinking on risk perception estimates (comparative optimism). Methods Sixty-five young adults who regularly drink alcohol watched an anti-drinking scenario (having an accident due to drinking). There were two intervention conditions: 30 participants ‘imagined’ they were part of the scenario, and 35 ‘watched’ the scenario. They then completed four comparative optimism estimates comparing themselves to those the same age and gender with similar drinking habits. The four comparisons were of their likelihood of being involved in an accident due to drinking; having unprotected sex, when under the influence of alcohol; having a car accident due to drinking (drivers only) and developing cirrhosis. There was also a control group (n = 59) who just completed the questionnaires. Results Both intervention groups reported significantly lower comparative optimism for accident, unprotected sex and car accident than the control group. The ‘imagine’ group reported significantly lower comparative optimism than the ‘watch’ group for accidents. Conclusions These results highlighted that media messages can successfully change people's risk perception, and also that imagination can be a powerful tool in changing risk perceptions associated with binge drinking.
14. Alcohol Dehydrogenase-1B Arg47His Polymorphism and Upper Aerodigestive Tract Cancer Risk: A Meta-Analysis Including 24,252 SubjectsHaipeng Guo, Guohong Zhang, Ruiqin MaiAlcoholism: Clinical and Experimental Research 2012:36(2);272-278
AbstractBackground Cancers of the upper aerodigestive tract (UADT) include malignant tumors of the oral cavity, pharynx, larynx, and esophagus, account for approximately 4% of all new cancers in world. Alcohol drinking is an established risk factor for UADT cancers, and the rate of alcohol metabolism could significantly been influenced by genetic polymorphisms of alcohol dehydrogenase-1B (ADH1B) His47Arg (rs1229984). To evaluate whether combined evidence shows ADH1B His47Arg as a common genetic variant that influenced the risk of UADT cancers, we considered all available studies in a meta-analysis. Methods Eighteen studies were combined representing data of 8,539 cases and 15,713 controls for meta-analysis. Stratified analyses were carried out to determine the gene–environment interaction between ADH1B His47Arg and alcohol drinking and gene–gene interaction between ADH1B His47Arg and aldehyde dehydrogenase-2 (ALDH2) Glu/Lys related to UADT cancer risk. Potential sources of heterogeneity between studies were explored; sensitivity analysis and publication bias was also evaluated. Results The ADH1B 47Arg allele was found to be associated with increased risk of UADT cancers, the pooled odds ratios (ORs) being 1.66 (95% CI: 1.54 to 1.79) and 3.47 (95% CI: 2.76 to
4.36) for the His/Arg and Arg/Arg genotypes compared with the His/His genotype, respectively. An 18.48-fold increase in OR (95% CI: 12.95 to 26.40) for UADT cancers among alcohol drinkers with Arg/Arg genotype was found, when compared among nondrinkers with the His/His genotype. Significant interaction between carriers with ADH1B 47Arg and ALDH2 487Lys allele related to risk for UADT cancers was more evident, compared with noncarriers (OR = 10.31, 95% CI: 5.45 to 18.85). Conclusions ADH1B 47Arg allele is a common genetic variant that increased the risk of UADT cancers; furthermore, it modulates the susceptibility to UADT cancers coupled with alcohol drinking and interaction with the ALDH2 487Lys allele.Keywords: Upper Aerodigestive Tract Cancers; Alcohol Dehydrogenase-1B; His47Arg Polymorphism; Genetic Susceptibility
15. To Approach or Avoid Alcohol? Automatic and Self-Reported Motivational Tendencies in Alcohol DependenceHelen Barkby, Joanne M. Dickson, Louise Roper, Matt FieldAlcoholism: Clinical and Experimental Research 2012:36(2)361-368
AbstractBackground Motivational conflict is central to alcohol dependence, with patients reporting motivation to limit their drinking at the same time as urges to drink alcohol. In addition, dual process models of addiction emphasise the power of automatic cognitive processes, particularly automatic approach responses elicited by alcohol-related cues, as determinants of drinking behavior. We aimed to examine the strength of automatic and self-reported alcohol approach and avoidance tendencies among alcohol-dependent inpatients relative to matched controls. Methods:enbsp A total of 63 alcohol-dependent patients undergoing detoxification and 64 light-drinking controls completed a stimulus-response compatibility (SRC) task, which assesses the speed of categorization of alcohol-related pictures by making symbolic approach and avoidance movements. We also included modified versions of the SRC task to assess automatic motivational conflict, that is, strong approach and avoidance tendencies elicited simultaneously by alcohol-related cues. Results There were no differences between alcohol-dependent patients and controls on the SRC task, although individual differences in the quantity of alcohol consumed before entering treatment were significantly positively correlated with the strength of approach (but not avoidance) tendencies elicited by alcohol-related cues. Automatic approach tendencies were also positively correlated with self-reported “approach” inclinations and negatively correlated with self-reported “avoidance” inclinations. Conclusions Although alcohol-dependent patients and matched controls did not differ on automatic approach and avoidance tendencies elicited by alcohol-related cues, individual differences in the quantity of alcohol consumed before entering treatment were associated with the strength of automatic approach tendencies elicited by alcohol cues.Keywords: Implicit Cognition; Ambivalence; Motivational Conflict
16. Neuroendocrine Assessment of Serotonergic, Dopaminergic, and Noradrenergic Functions in Alcohol-Dependent IndividualsClaudia Fahlke, Ulf Berggren, Kristina J. Berglund, Henrik Zetterberg, Kaj Blennow, Jörgen A. Engel, Jan Balldin
Alcoholism: Clinical and Experimental Research 2012:36(1);97-103
AbstractBackground: Alcohol dependence has been associated with reduced function of serotonin, dopamine as well as noradrenaline activities in several neuroendocrine studies. To our knowledge, there is, however, no study investigating all these 3 systems with the use of neuroendocrine methods in one and the same alcohol-dependent individual. Methods Alcohol-dependent individuals (n = 42) and controls (n = 28) participated in the neuroendocrine test series. Central serotonergic neurotransmission was assessed by the prolactin (PRL) response to citalopram (CIT). The postsynaptic DRD2 function was measured by the growth hormone (GH) response to apomorphine (APO) and the postsynaptic 2-adrenoceptor function by GH response to clonidine (CLON). Results In the alcohol-dependent individuals, the PRL concentrations were significantly lower at the time points 240 minutes and 300 minutes after CIT administration and mean delta PRL value was significantly reduced by 45% in comparison with controls. There were no significant differences in APO-GH and CLON-GH concentrations at any time points or in mean delta GH values between the groups. An impaired monoaminergic profile, including all 3 systems, was significantly more frequent in alcohol-dependent individuals than controls (43% vs. 6% respectively). Conclusions The monoaminergic dysfunction was restricted to an impairment of the serotonergic system, suggesting that this system is especially vulnerable to long-term and excessive alcohol consumption. Moreover, impaired monoaminergic profiles, including low responses in 2 or 3 systems, were more frequently observed in alcohol-dependent individuals than in controls. Such impaired profiles may be of clinical importance, but further studies are needed.Keywords: Alcoholism; Alcohol Dependence; Monoaminergic Function; Serotonin; Dopamine; Noradrenaline
ALCOHOL – TREATMENT AND SCREENING
17. Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysisJohn F. Kelly, Bettina Hoeppner, Robert L. Stout, Maria PaganoAddiction 2012:107(2);289-299
AbstractAims Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self-efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways. Design Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders. Setting Nine clinical sites within the United States. Participants Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out-patient (n = 952) comparing three out-patient treatments (Project MATCH). Measurements AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. Findings Among out-patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self-efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%.Conclusion While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance.Keywords: Addiction; alcohol dependence; alcoholics anonymous; alcoholism; depression; self-help groups; social network; spirituality
18. Sleep Disturbance in Alcoholism: Proposal of a Simple Measurement, and Results from a 24-Week Randomized Controlled Study of Alcohol-Dependent Patients Assessing Acamprosate Efficacy Pascal Perney, Philippe Lehert, Barbara J MasonAlcohol and Alcoholism 2012:47(2);133-139
AbstractAims Sleep disturbance symptom (SDS) is commonly reported in alcoholic patients. Polysomnography studies suggested that acamprosate decreased SDS. We assessed this hypothesis by using data of a randomized controlled trial. As a secondary objective, we suggested and tested the validity of a simple measurement of SDS based
on the Hamilton depression and anxiety inventory subset. Methods We re-analysed a multi-center study evaluating the efficacy of acamprosate compared with placebos on alcohol-dependent patients in concentrating on SDS change in time. The Sleep sum score index (SAEI) was built from check-lists on adverse effects reported at each visit and constituted our main endpoint. We also tested the validity of the short sleep index (SSI) defined by the four sleep items of the Hamilton depression and anxiety scales. Statistical analyses were conducted on an intention to treat basis. Results A total of 592 patients were included, and 292 completed the 6-month trial. Compared with SAEI considered as our reference, the observed specificity and sensitivity of SSI were 91.6 and 87.6%. From 40.2% of patients experiencing SDS at baseline, this proportion decreased until 26.1% at M6 in the placebo group and 19.5% in the acamprosate group (relative risk placebo/acamprosate = 1.49, 95% confidence interval 1.10, 1.98, P = 0.04). Conclusion Treating alcoholic patients to enhance abstinence has a beneficial effect in reducing SDS, and the duration of abstinence during the treatment constitutes the main positive factor. An additional effect of acamprosate is conjectured from its effect on the glutamatergic tone. The SSI constitutes a simple, reasonably sensitive and specific instrument tool to measure SDS.
19. Acamprosate for Alcohol Dependence: A Sex-Specific Meta-Analysis Based on Individual Patient DataBarbara J Mason, Philippe LehertAlcoholism: Clinical and Experimental Research 2012:36(3);497-508
AbstractBackground It is unknown whether women derive comparable benefits and have a similar safety and tolerability profile as men from acamprosate, a widely prescribed drug for the maintenance of abstinence in alcohol dependence. The objective of this study was to assess sex-specific differences in the efficacy, safety, and tolerability of acamprosate in the treatment of women and men with alcohol dependence. Methods A sex-specific meta-analysis was conducted based on individual patient data (IPD). Data were obtained from double-blind, randomized controlled trials with quantitative drinking measures in patients with alcohol dependence receiving oral acamprosate or placebo. Sources included PubMed, PsychInfo, and Cochrane electronic databases; reference lists from retrieved articles and presentations at professional meetings; and direct access to authors and companies who provided IPD. Results Individual records were obtained from 1,317 women and 4,794 men who participated in 22 eligible studies conducted in 18 countries. IPD meta-analyses found a significant beneficial effect of acamprosate relative to placebo across all 4 efficacy end points: an incremental gain of 10.4% (95% CI 7.1 to 13.7, p < 0.001) in percentage of abstinent days, an incremental gain of 11.0% (7.4 to 14.6, p < 0.001) in percentage of no heavy drinking days, an odds ratio of 1.9 (1.6 to 2.2, p < 0.001) for rate of complete abstinence, and an odds ratio of 1.9 (1.6 to 2.3, p < 0.001) for rate of no heavy drinking, over the study duration. Acamprosate was also associated with significantly higher rates of treatment completion (p = 0.004) and medication compliance (p < 0.001) than placebo. Men and women did not differ on any measure of acamprosate efficacy, safety, or tolerability.Conclusions This sex-specific IPD meta-analysis provides evidence that acamprosate has a significant effect compared with placebo in improving rates of abstinence and
no heavy drinking in both women and men with alcohol dependence. Further, acamprosate was associated with significantly higher rates of treatment completion and medication compliance than placebo among both women and men and had a comparable safety and tolerability profile.Keywords: Acamprosate; Women; Alcoholism Treatment; Individual Patient Data; Meta-Analysis
20. Comparison of Alcoholism Subtypes as Moderators of the Response to Sertraline TreatmentHenry R. Kranzler, Richard Feinn, Stephen Armeli, Howard TennenAlcoholism: Clinical and Experimental Research 2012:36(3);509-516
AbstractBackground A variety of typologies have been used to categorize alcoholism’s diverse manifestations. Although the most widely studied typologies are dichotomous ones based on genetic epidemiologic findings or using cluster analytic methods, recent efforts have utilized a single item or the onset of a diagnosis of alcohol dependence to subtype individuals based on the age of alcoholism onset. We compared 3 different methods to subtype alcoholics.Methods This secondary analysis used data from 134 alcohol-dependent participants in a placebo-controlled trial of sertraline (Kranzler et al., 2011 ). We compared cluster analysis to distinguish 2 risk/severity subtypes (Babor et al., 1992 ) with 2 age-of-onset subtypes (i.e., based on the age of onset of problem drinking or the age at which alcohol dependence criteria were first met). Results Each method yielded subgroups that differed significantly from one another on demographic and clinical measures. Although concordance was high between the 2 age-of-onset methods, it was poor between the age-of-onset methods and the cluster analysis–derived approach. All 3 subtyping approaches significantly moderated the effects of sertraline or placebo, but only in the L’L’ genotype group, as originally reported (Kranzler et al., 2011 ). In all cases, sertraline treatment was superior to placebo in later-onset individuals and inferior to placebo in the earlier-onset groups. Conclusions Because age-of-onset subtypes can be defined retrospectively on an individual basis, they may be more clinically useful than cluster-derived subtypes, which require group data. Because the 2 age-of-onset measures we examined appear to have comparable validity, a single item is easier to use as a measure of the age of onset of problem drinking.Keywords: Age of Onset; Alcohol Dependence; Cluster Analysis; Sertraline
21. Text-Message-Based Drinking Assessments and Brief Interventions for Young Adults Discharged from the Emergency DepartmentBrian Suffoletto, Clifton Callaway, Jeff Kristan, Kevin Kraemer, Duncan B. ClarkAlcoholism: Clinical and Experimental Research 2012:36(3);552-560
AbstractBackground Brief interventions have the potential to reduce heavy drinking in young adults who present to the emergency department (ED), but require time and resources rarely available. Text-messaging (TM) may provide an effective way to collect drinking data from young adults after ED discharge as well as to provide immediate feedback and ongoing support for behavior change. The feasibility of
screening young adults in the ED, recruiting them for a TM-based interventional trial, collecting weekly drinking data through TM, and the variance in drinking outcomes remains unknown. Methods Young adults in 3 urban EDs (n = 45; aged 18 to 24 years, 54% women) identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption score were randomly assigned to weekly TM-based feedback with goal setting (Intervention), weekly TM-based drinking assessments without feedback (Assessment), or control. Participants in the Intervention group who reported ≥5 (for men) and ≥4 (for women) maximum drinks during any one 24-hour period were asked whether they would set a goal to reduce their drinking the following week. We describe the interaction with TM and goal setting. We also describe the heavy drinking days (HDDs), drinks per drinking day (DPDD) using timeline follow-back procedure at baseline and 3 months. Results We screened 109 young adults over 157 hours across 24 unique days and 52 (48%; 95% CI 38 to 50) screened positive for hazardous drinking. Of these, 45 (87%; 95% CI 74 to 94) met inclusion criteria, were enrolled and randomized, and 6 (13%; 95% CI 5 to 27) did not complete 3-month web-based follow-up; 88% (95% CI 84 to 91) of weekly TM-based drinking assessments were answered, with 77% (95% CI 58 to 90) of participants responding to all 12 weeks. Agreeing to set a goal was associated with a repeat HDD 36% (95% CI 17 to 55) of the time compared with 63% (95% CI 44 to 81) when not willing to set a goal. At 3 months, participants that were exposed to the TM-based intervention had 3.4 (SD 5.4) fewer HDDs in the last month and 2.1 (SD 1.5) fewer DPDD when compared to baseline. Conclusions TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED. TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy.Keywords: Brief Interventions; Primary Prevention; Alcohol Screening
22. Hepatic Safety and Antiretroviral Effectiveness in HIV-Infected Patients Receiving NaltrexoneJeanette M. Tetrault, Janet P. Tate, Kathleen A. McGinnis, Joseph L. Goulet, Lynn E. Sullivan, Kendall Bryant, Amy C. Justice, David A. Fiellin, For the Veterans Aging Cohort Study TeamAlcoholism: Clinical and Experimental Research 2012:36(2);318-324
AbstractBackground We sought to determine the impact of naltrexone on hepatic enzymes and HIV biomarkers in HIV-infected patients. Methods We used data from the Veterans Aging Cohort Study-Virtual Cohort, an electronic database of administrative, pharmacy, and laboratory data. We restricted our sample to HIV-infected patients who received an initial oral naltrexone prescription of at least 7 days duration. We examined aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and HIV biomarker (CD4 and HIV RNA) values for the 365 days prior to, during, and for the 365 days post-naltrexone prescription. We also examined cases of liver enzyme elevation (LEE; defined as >5 times baseline ALT or AST or >3.5 times baseline if baseline ALT or AST was >40 IU/l).Results Of 114 HIV-infected individuals, 97% were men, 45% white, 57% Hepatitis C co-infected; median age was 49 years; 89% of the sample had a history of alcohol dependence and 32% had opioid dependence. Median duration of naltrexone prescription was 49 (interquartile range 30 to 83) days, representing 9,525 person-
days of naltrexone use. Mean ALT and AST levels remained below the upper limit of normal. Two cases of LEE occurred. Mean CD4 count remained stable and mean HIV RNA decreased after naltrexone prescription. Conclusions In HIV-infected patients, oral naltrexone is rarely associated with clinically significant ALT or AST changes and does not have a negative impact on biologic parameters. Therefore, HIV-infected patients with alcohol or opioid dependence can be treated with naltrexone.Keywords: HIV; Naltrexone; Alcoholism; Opioid-Related Disorders
23. Clinical measurement of addictionsRichard Cloutier, Alain Lesage, Michel Landry, Sylvia Kairouz, Jean-Marc Menard Drug and Alcohol Review 2012:31(1);33-39
AbstractIntroduction and Aims To conduct a systematic review of instruments for the clinical measurement of addictive behaviours and to determine whether substance addictive behaviours (SAB) and non-substance addictive behaviours (NSAB) are similarly conceptualised in clinical research. Design and Methods The analytic strategy employed comprised three steps: (i) major search engines were used to take stock of available clinical instruments for assessing addictive behaviours; (ii) an analysis grid was developed and validated, covering 21 parameters under four heuristic categories: dependence, temperament, social handicap and cognitive behaviour; and (iii) all instruments were analysed and compared via the grid. Results The search yielded 157 questionnaires covering 14 addictive behaviours. The analysis grid allowed rating all questionnaire items on one parameter only; very good interrater agreement was maintained throughout. The categories most evaluated by the questionnaires were dependence and cognitive behaviour; temperament and social handicap were much less frequently considered. Patterns were generally similar in terms of categories, whether questionnaires concerned SAB or NSAB; however, differences within categories indicated a greater frequency of psychologically oriented parameters for NSAB.Conclusions The measurement of addictive behaviours appears clinically cohesive, as determined by a validated analysis grid applied to an exhaustive set of questionnaires identified through a systematic literature review.[Cloutier R, Lesage A, Landry M, Kairouz S, Ménard J-M. Clinical measurement of addictions. Drug Alcohol Rev 2012;31:33–39]Keywords: addictive behaviour; questionnaire; psychometrics; substance-related disorder
24. Reducing Dropout among Traumatized Alcohol Patients in Detoxification Treatment: A Pilot Intervention StudyMichael Odenwald, Peter SemrauEuropean Addiction Research 2012:18(2);54-63
Abstract
Dropout rates from detoxification treatment are high. We tested whether high trauma event load was related to a higher dropout from alcohol detoxification. Furthermore, we studied the feasibility and effects of a short psychoeducational tool to increase retention among traumatized alcohol in-patients. Retention and treatment length were compared between treatment as usual (TAU) and standard therapy plus a psychoeducational group intervention on alcohol drinking related to stress and trauma (PAST). Patients with high trauma load were identified with the Trauma History Questionnaire. Of the 159 in-patients treated during the study period, 66 were included in the analysis: 33 in TAU and 33 in PAST. Sociodemographic characteristics did not differ between the groups. During TAU, patients with high trauma load tended to drop out more often (p = 0.056). Among patients with high trauma load, retention level increased from 29 to 80% (p = 0.006), and among those with low trauma load from 63 to 83% (p = 0.250). Treatment length only tendentially improved among patients with lower burden (p = 0.056). The pilot study supports the idea that detoxification treatment dropout occurs more often among alcohol patients with high trauma load and that their retention can be increased by a psychoeducational group intervention.Key Words: Alcohol; Alcohol-addicted patients; Detoxification; Retention/dropout; Traumatic life events; Posttraumatic stress disorder; Psychoeducation; Group psychotherapy; Treatment motivation; Group-control study
ALCOHOL USE AND USERS
25. Positive alcohol expectancies mediate the influence of the behavioral activation system on alcohol use: A prospective path analysisJeffrey D. Wardell, Jennifer P. Read, Craig R. Colder, Jennifer E. MerrillAddictive Behaviors 2012:37(4);435-443
AbstractGray's (1975, 1987) behavioral activation (BAS) and behavioral inhibition systems (BIS) are thought to underlie sensitivity to reinforcement and punishment, respectively. Consistent with Gray's theory and the Acquired Preparedness model, BAS may facilitate the learning of positive alcohol expectancies (PAEs) over time, leading to increases in drinking. Yet, no prospective tests of this pathway have been reported. The present study investigated whether BAS prospectively predicted PAEs and whether PAEs mediated the association between BAS and subsequent alcohol use. We hypothesized that BAS would influence drinking specifically via enhancement-related PAEs. We also explored the role of BIS in PAEs and drinking. College students (N = 557) completed online BAS, PAE, and alcohol use measures in September of their first (T1), second (T2), and third (T3) years of college. We conducted autoregressive path analyses with three BAS subscales and BIS (T1) as predictors, four PAE types (T2) as mediators, and quantity and frequency of drinking (T3) as outcomes. The BAS Fun-Seeking scale was prospectively associated with PAEs, and there was a significant indirect path from Fun-Seeking to alcohol use mediated specifically through activity enhancement PAEs. BIS was positively associated with some PAE types, but did not have indirect effects on drinking. Findings are consistent with both the theory of the BAS and the Acquired Preparedness model, as individuals high on BAS Fun-Seeking may find the rewarding properties of alcohol more reinforcing, leading to stronger enhancement PAEs and increased drinking over time. The prospective design helps establish the temporal association between BAS and alcohol-related learning, and points to the need for prevention efforts that target these at-risk students. Highlights We examine prospective relations among temperament systems and alcohol use. We model positive alcohol expectancies as mediators. Fun-seeking indirectly affects alcohol use via activity enhancement expectancies. Other types of expectancies do not mediate the influence of temperament on drinking. Behavioral inhibition system predicts increases in several alcohol expectancies.Keywords: Behavioral activation system; Behavioral inhibition system; Alcohol expectancies; Alcohol use; Longitudinal data
26. The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment samplePaul R. Stasiewicz, Clara M. Bradizza, Gregory D. Gudleski, Scott F. Coffey, Robert C. Schlauch, Sydney T. Bailey, Christopher W. Bole, Suzy Bird GulliverAddictive Behaviors 2012:37(4);469-476
AbstractDifficulties regulating emotions have implications for the development, maintenance, and recovery from alcohol problems. One construct thought to impede the regulation of emotion is alexithymia. Alexithymia is characterized by difficulties identifying,
differentiating and expressing feelings, a limited imagination and fantasy life, and an externally-oriented thinking style (e.g., prefer talking about daily activities rather than feelings). Given that poor emotion regulation skills have been found to predict posttreatment levels of alcohol use, and that several defining characteristics of alexithymia bear similarity to deficits in emotion regulation skills, it is possible that alexithymia may predict poorer alcohol treatment outcomes. Thus, the present study first examined the relationship of alexithymia to several other emotion regulation measures and then investigated the impact of alexithymia on attrition and alcohol treatment outcomes in men and women (N = 77) enrolled in a 12-week cognitive-behavioral intervention for alcohol dependence. At baseline, higher scores on alexithymia were associated poorer emotion regulation skills, fewer percent days abstinent, greater alcohol dependence severity, and several high-risk drinking situations. Alexithymia was unrelated to attrition and to level of alcohol consumption at posttreatment. Overall, the construct of alexithymia is shown to be related to several theoretically-related constructs (e.g., emotion regulation, mindfulness) but demonstrated a limited relationship to drinking outcomes in those seeking treatment for alcohol dependence. Highlights Pretreatment levels of alexithymia are associated with poorer emotion regulation skills. Alexithymia was unrelated to attrition and to levels of alcohol consumption at posttreatment. The alexithymic drinker may use alcohol to escape/avoid difficulties with emotional processing.Keywords: Alexithymia; Affect regulation; Alcohol use disorder; Emotion regulation; Mindfulness
27. Alexithymia and alcohol consumption: The mediating effects of drinking motivesGillian Bruce, Cindy Curren, Lynn WilliamsAddictive Behaviors 2012:37(3);350-352 AbstractThe association between alexithymia and alcohol consumption has been well documented. However, little research has investigated the mechanisms behind the association. In the present study, the relationship between alexithymia, drinking motives and alcohol consumption was examined in a group of social (non-problem) drinkers. In a cross-sectional study, 862 participants completed the Toronto Alexithymia Scale, Drinking Motives Questionnaire, and provided alcohol consumption information. Regression analyses revealed that alexithymia predicts alcohol consumption. Formal mediation analyses demonstrated that this relationship was fully mediated by social, enhancement and coping drinking motives, and partially mediated by conformity. Drinking motives may represent one mechanism to explain the association between alexithymia and alcohol consumption. Highlights Alexithymia is positively associated with alcohol consumption in social drinkers. This is fully mediated by social, coping and enhancement drinking motives. This is partially mediated by conformity drinking motives.Keywords: Alexithymia; Alcohol; Drinking motives
28. Subjective measures of binge drinking and alcohol-specific adverse health outcomes: a prospective cohort studyTapio Palj rvi, Pia M kel, Kari Poikolainen, Sakari Suominen, Josip Car, Markku KoskenvuoAddiction 2012:107(2);323-330
AbstractAim To determine the performance of subjectively defined intoxications, hangovers and alcohol-induced pass-outs in identifying drinkers at risk for adverse health outcomes.Design Prospective population-based cohort study. Setting Working-aged Finnish general population. Participants A total of 21 204 alcohol-drinking men and women aged 20–24, 30–34, 40–44 and 50–54 years at baseline who participated in the Health and Social Support (HeSSup) postal survey in 1998. Measurements Binge drinking was measured by subjectively defined intoxications/drunkenness, hangovers and alcohol-induced pass-outs. Hazardous drinking was defined according to Finnish guidelines as weekly total intake of >287 g of ethanol for men, and for women > 191 g of ethanol (≥24 and ≥16 standard drinks, respectively). Study participants were followed-up for 7 years for alcohol-specific hospitalizations and deaths. Proportional hazard models and areas under the receiver operating characteristics curves (AUC) were used to analyse the data. Findings Of the drinkers, 6.5% exceeded the weekly limit for hazardous drinking, and 1.5% experienced the alcohol-specific end-point during the follow-up. Subjective intoxications, hangovers and alcohol-induced pass-outs all predicted future alcohol-specific diagnoses independently of average intake and of several other potential confounders. In identifying baseline hazardous drinking, subjective intoxications had a superior performance in relation to other subjective measures of binge drinking. In identifying future alcohol-specific hospitalizations or death, subjective intoxications had also the best performance, but this was not significantly different from the other binge drinking measures, or average intake. Conclusions Subjectively defined intoxications, hangovers and alcohol-induced pass-outs are population-level proxy measures of at-risk drinking patterns.Keywords: Alcohol drinking; alcoholic intoxication; alcohol-related; drinking pattern;follow-up studies; hangover; hospitalization; mortality
BLOOD BORNE VIRUSES
29. The effect of hepatitis C treatment and human immunodeficiency virus (HIV) co-infection on the disease burden of hepatitis C among injecting drug users in AmsterdamAmy Matser, Anouk Urbanus, Ronald Geskus, Mirjam Kretzschmar, Maria Xiridou, Marcel Buster, Roel Coutinho, Maria PrinsAddiction 2012:107(3);614-623
AbstractAims The hepatitis C virus (HCV) disease burden among injecting drug users (IDUs) is determined by HCV incidence, the long latency period of HCV, competing mortality causes, presence of co-infection and HCV treatment uptake. We examined the effect of these factors and estimated the HCV disease burden in Amsterdam. Design A Markov model was developed, incorporating HCV and human immunodeficiency virus (HIV), and parameterized with data from the Amsterdam Cohort Studies, surveillance studies and literature. Setting IDU population of Amsterdam. Measurements HCV infection simulated from its acute phase to HCV-related liver disease (i.e. decompensated cirrhosis and hepatocellular carcinoma). Findings The HCV prevalence among IDUs in Amsterdam increased to approximately 80% in the 1980s. From 2011 to 2025, the HCV-related disease prevalence will accordingly rise by 36%, from 57 cases (95% range 33–94) to 78 (95% range 43–138), respectively. In total, 945 (95% range 617–1309) individuals will develop HCV-related liver disease. This burden would have been 33% higher in the absence of HIV, resulting in 1219 cases (95% range 796–1663). In Amsterdam, 25% of HIV-negative IDUs receive successful HCV treatment, reducing the cumulative disease burden by 14% to 810 (95% range 520–1120). Further reduction of 36% can be achieved by improving treatment, resulting in 603 cases (95% range 384–851). Conclusions The hepatitis C virus burden among injecting drug users in Amsterdam has been reduced by a high competing mortality rate, particularly caused by HIV infection, and to a smaller extent by hepatitis C virus treatment. Improved hepatitis C virus treatment is expected to contribute to reduce the future hepatitis C virus disease burden.Keywords: HCV; HCV disease burden; HCV treatment; HIV co-infection; injecting drug use; mathematical model
30. Positive impact of hepatitis C virus (HCV) treatment on antiretroviral treatment adherence in human immunodeficiency virus–HCV coinfected patients: one more argument for expanded access to HCV treatment for injecting drug usersPerrine Roux, Lionel Fugon, Maria Winnock, Dominique Salmon-Céron, Karine Lacombe, Philippe Sogni, Bruno Spire, François Dabis, Maria Patrizia Carrieri, for the ANRS-CO-13-HEPAVIH Study GroupAddiction 2012:107(1);152-159
Abstract
Aims Treatment for the hepatitis C virus (HCV) may be delayed significantly in human immunodeficiency virus (HIV)/HCV coinfected patients on antiretroviral treatment (ART) for fear that its burden could compromise ART adherence. However, the effect such treatment has on ART adherence in observational settings remains largely unknown. Longitudinal data were used to investigate the relationship between initiating HCV treatment and adherence to ART in HIV/HCV coinfected patients. Design The French national prospective cohort of patients coinfected with HIV and HCV (ANRS-CO-13-HEPAVIH) is a multi-centre cohort. Setting Seventeen out-patient hospital services delivering HIV and HCV care in France. Participants HIV/HCV coinfected patients on ART (n = 593 patients, 976 visits). Measurements Self-administered questionnaires and medical records. A mixed logistic regression model based on generalized estimates equations (GEE) to identify factors associated with non-adherence to ART. Findings Among the 593 patients, 36% were classified as non-adherent to ART at the enrolment visit and 12% started HCV treatment during follow-up. ART adherence was not associated statistically with HCV treatment initiation. The proportion of patients maintaining adherence or becoming adherent to ART for those starting HCV treatment was higher than in the rest of the sample (P = 0.07). After multiple adjustment for known correlates, such as poor housing conditions, binge drinking, recent drug use and depressive symptoms, patients who initiated HCV treatment were less likely to be non-adherent to ART [odds ratio (95% confidence interval) = 0.41 (0.24–0.71)].Conclusions Engaging human immunodeficiency virus/hepatitis C virus coinfected individuals in hepatitis C virus treatment is associated with high adherence to antiretroviral treatment. Physicians should prioritize hepatitis C virus treatment as part of a multi-disciplinary approach.Keywords: Adherence; antiretroviral treatment; hepatitis C; HIV; intravenous drug users
31. Assessment of Risky Injection Practices Associated with Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus and Using the Blood-Borne Virus Transmission Risk Assessment QuestionnaireGrace L. Reynolds DPA, Dennis G. Fisher, Lucy E. Napper Journal of Addictive Diseases 2012:31(1);80-88 AbstractRisky injection practices among injection drug users (IDUs) contribute to the spread of blood-borne infections such as human immunodeficiency virus, hepatitis B, and hepatitis C. The Blood-borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ). was developed in Australia to determine risk behaviors for specific infections. Blood testing for human immunodeficiency virus, hepatitis B, and hepatitis C was performed on all participants, and data on blood tests were linked to questionnaires. The BBV-TRAQ was administered to 242 current and former injection drug users in Long Beach, California, and the Long Beach data were compared with the original Australian data. In the comparison of the mean scores on the three subscales and total scores on the BBV-TRAQ between the samples, means for all three subscales and the total BBV-TRAQ score were significantly different, with Long Beach scores consistently lower than the Australian sample. The injecting and sexual risk subscales were significantly different across levels of AIDS risk perception for all three types of injectors; however, the other skin penetration
practices subscale had no significant association with AIDS risk perception for any of the injection drug user groups. Despite recent efforts to educate injectors about the risks associated with practices captured by the other skin penetration practices subscale, such as tattooing and sharing razors, this subscale does not have an association with AIDS risk perception. injection drug users in Australia may have better access to health care, giving their self-report of infection greater validity than the California sample.Keywords: Injection drug use; blood-borne pathogens
32. Hepatitis C treatment and injecting drug users in Perth, Western Australia: Knowledge of personal status and eligibility criteria for treatmentSusan J. Carruthers, Chrissy RyanJournal of Substance Use 2012:17(1);32-40
AbstractBackground Few injecting drug users (IDU) in Australia take part in antiviral therapy for chronic hepatitis C (HCV). To assess whether IDU are aware of the eligibility criteria for treatment and their personal HCV status, we surveyed 78 IDU attending the fixed-site needle exchange in the city of Perth. Method Participants were eligible for the study if they self-reported having ever been diagnosed as HCV antibody positive. Each participant completed a semi-structured questionnaire administered by a peer HCV educator at the needle exchange.Results Knowledge of personal HCV status was poor with more than half of the group not knowing the purpose of a polymerase chain reaction test. Knowledge of treatment eligibility was also poor especially around issues relating to alcohol consumption, the need for a liver biopsy, and treatment during pregnancy. Conclusion Up-to-date information about eligibility criteria for HCV treatment has not filtered down to this group of older IDU. Furthermore, knowledge of personal HCV status (chronic infection and infectivity) needs to be improved. Informed decisions about treatment cannot be made if knowledge of status is poor and IDU are not familiar with treatment eligibility.Keywords: Hepatitis C; antiviral treatment; knowledge; injecting drug users
33. Identifying former injecting drug users infected with hepatitis C: an evaluation of a general practice-based case-finding intervention B.L. Cullen, S.J. Hutchinson S.O. Cameron, E. Anderson, S. Ahmed, E. Spence, P.R. Mills, R. Mandeville, E. Forrest, M. Washington, R. Wong, R. Fox, D.J. Goldberg Journal of Public Health 2012:34(1);14-23
AbstractBackground In Scotland, a general practice-based case-finding initiative, to diagnose and refer hepatitis C virus (HCV) chronically infected former injecting drug users (IDUs), was evaluated. Methods Testing was offered in eight Glasgow general practices in areas of high deprivation and high HCV and IDU prevalence to attendees aged 30–54 years with a history of IDU. Test uptake and diagnosis rates were compared with those in eight demographically similar control practices. Results Of
422 eligible intervention practice attendees, 218 (52%) were offered an HCV test and, of these, 121 (56%) accepted. Poor venous access in 13 individuals prevented testing. Of 105 tested, 70% (74/105) were antibody positive of which 58% (43/74) were RNA positive by PCR. Of 43 chronically infected individuals identified in intervention practices, 22 (51%) had attended specialist care within 30 months of the study, while 9 (21%) had defaulted. In control practices, 8 (22%) of 36 individuals tested were antibody positive. Test uptake and case yield were approximately 3 and 10 times higher in intervention compared with control practices, respectively. Conclusions Targeted case-finding in primary care demonstrated higher test uptake and diagnosis rates; however, to optimize diagnosis and referral of chronically infected individuals, alternative means of testing (e.g. dried blood spots) and retention in specialist care (e.g. outreach services) must be explored. Keywords: epidemiology; primary care; screening
CO-MORBIDITY
34. Psychiatric comorbidity and the persistence of drug use disorders in the United StatesMiriam C. Fenton, Katherine Keyes, Timothy Geier, Eliana Greenstein, Andrew Skodol, Bob Krueger, Bridget F. Grant, Deborah S. HasinAddiction 2012:107(3);599
AbstractAims DSM-IV drug use disorders, a major public health problem, are highly comorbid with other psychiatric disorders, but little is known about the role of this comorbidity when studied prospectively in the general population. Our aims were to determine the role of comorbid psychopathology in the 3-year persistence of drug use disorders. Design and setting Secondary data analysis using waves 1 (2001–02) and 2 (2005–05) of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants Respondents with current DSM-IV drug use disorder at wave 1 who participated in wave 2 (n = 613).Measurements Alcohol Use Disorders and Associated Disabilities Interview Schedule IV (AUDADIS-IV) obtained DSM-IV Axis I and II diagnoses. Persistent drug use disorder was defined as meeting full criteria for any drug use disorder between waves 1 and 2. Findings Drug use disorders persisted in 30.9% of respondents. No Axis I disorders predicted persistence. Antisocial [odds ratio (OR) = 2.75; 95% confidence interval (CI): 1.27–5.99], borderline (OR = 1.91; 95% CI: 1.06–3.45) and schizotypal (OR = 2.77; 95% CI: 1.42–5.39) personality disorders were significant predictors of persistent drug use disorders, controlling for demographics, psychiatric comorbidity, family history, treatment and number of drug use disorders. Deceitfulness and lack of remorse were the strongest antisocial criteria predictors of drug use disorder persistence, identity disturbance and self-damaging impulsivity were the strongest borderline criteria predictors, and ideas of reference and social anxiety were the strongest schizotypal criteria predictors. Conclusions Antisocial, borderline and schizotypal personality disorders are specific predictors of drug use disorder persistence over a 3-year period.Keywords: Axis I disorders; Axis II disorders; chronic drug use disorder; drug abuse; drug dependence; drug persistence; personality disorders
35. Reasons for substance use among people with mental disordersLouise K. Thornton, Amanda L. Baker, Terry J. Lewin, Frances J. Kay-Lambkin, David Kavanagh, Robyn Richmond, Brian Kelly, Martin P. JohnsonAddictive Behaviors 2012:37(4);427-434
AbstractBackground Comorbidity of mental disorders and substance use continues to be a major problem. To inform the development of more effective interventions for these co-existing disorders, this paper aimed to determine if there are clear variations in the reasons for tobacco, alcohol or cannabis use across people with different mental disorders. Methods Data from five randomized controlled trials on co-existing disorders that measured reasons for tobacco, alcohol or cannabis use using the Drug Use Motives Questionnaire, Reasons for Smoking Questionnaire or via free response are reported and combined. Two studies involved participants with depression, two involved participants with a psychotic disorder and one involved participants with a range of mental disorders. A series of logistic regressions were conducted to examine differences in reasons for tobacco, alcohol or cannabis use and to compare these reasons between people with psychotic disorders or depression. Results Participants had a mean age of 38 (SD = 12) and just over half (60%) were male. Forty-six percent of participants had a psychotic disorder and 54% experienced depression. Data from 976 participants across the five studies were included in the analyses. Tobacco and alcohol were primarily used to cope, while cannabis was primarily used for pleasure. People with psychotic disorders were more likely than people with depression to use tobacco for coping, pleasure and illness motives. People with depression, in contrast, were more likely to use alcohol for these reasons and social reasons. Conclusions It may be important to tailor interventions for co-existing mental disorders and substance use by substance type and type of mental disorder. For example, interventions might be improved by including alternative coping strategies to tobacco and/or alcohol use, by addressing the social role of alcohol and by helping people with mental disorders using cannabis to gain pleasure from their lives in other ways. Highlight Tobacco and alcohol used primarily to cope, cannabis used primarily for pleasure. Tobacco used more for all motives by people with psychotic disorders than depression. Alcohol used more for all motives by people with depression than psychotic disorders.Keywords: Mental disorder; Reasons for substance use; Tobacco; Alcohol; Cannabis
36. Treatment of substance abusing patients with comorbid psychiatric disordersThomas M. Kelly, Dennis C. Daley, Antoine B. DouaihyAddictive Behaviors 2012:37(1);11-24
AbstractObjective To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients. Method Articles were extracted from Pubmed using the search terms “dual diagnosis,” “comorbidity” and “co-occurring” and were reviewed for evidence of effectiveness for pharmacologic
and psychotherapeutic treatments of comorbidity. Results Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions.Conclusions Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatmentsHighlights Limited evidence exists that antidepressants reduce substance use. Pharmacotherapy of comorbidity should focus on non-substance related symptoms. Available medications specific for reducing substance use should be used as needed. Psychotherapy for comorbidity should initially target substance abuse. Treatment of comorbidity should use an integration of evidence-based therapies.Keywords: Substance use disorder; Comorbid; Psychiatric disorder; Treatment
37. Depression among regular heroin users: The influence of genderL. Sordo, M. Chahua, M.J. Bravo, G. Barrio, M.T. Brugal, A. Domingo-Salvany, G. Molist, L. De la Fuente, ITINERE Project GroupAddictive Behaviors 2012:37(1);148-152
AbstractThe aim of this study was to determine the prevalence of recent (last 12 months) depression in regular young heroin users and to ascertain factors associated with depression in this population, broken down by gender. A sample of 561 participants completed a cross-sectional survey. Eligibility criteria were: age 30 years or younger, and having used heroin for at least 12 days in the last 12 months and at least one day in the last 3 months. Participants were recruited outside of health-care facilities in the cities of Barcelona, Madrid and Seville by targeted sampling and chain referral methods. Depression was assessed using the World Mental Health Composite International Diagnostic Interview. The prevalence of recent depression was 22.3% (35.2% among women and 17.3% among men, p < 0.001). In the multivariate analysis, the factors positively associated with recent depression in the whole sample were female gender, age 25 or less, inability to work due to health problems and high risk consumption of alcohol. Among woman, the related variables were age 25 or less, cocaine dependence in the last 12 months, and alcohol consumption in that period. Among men, employment status was the only related variable. Analysis of an overall sample without the gender breakdown may hide important differences in the factors
associated with depression in men and women. Both prevention and treatment of depression should rely on specific gender analysis. Highlights Depression prevalence in heroin users was 35.2% in female and 17.3% in male. Cocaine addiction and alcohol use were depression related factors only in women. Sample analysis without breakdown by gender may hide relevant differences. Prevention and treatment of depression should rely on specific gender analysis.Keywords: Gender differences; Heroin; Depression; Substance abuse; Drugs users; Mental health
DRUG POLICY
38. A resounding success or a disastrous failure: Re-examining the interpretation of evidence on the Portuguese decriminalisation of illicit drugsCaitlin Elizabeth Hughes, Alex StevensDrug and Alcohol Review 2012:31(1);101-113
AbstractIn this Harm Reduction Digest two observers and scholars of the 2001 Portuguese drug policy reform consider divergent accounts of the reform which viewed it as a ‘resounding success’ or a ‘disastrous failure’. Acknowledging from their own experience the inherent difficulties in studying drug law reform, Caitlin Hughes and Alex Stevens take the central competing claims of the protagonists and consider them against the available data. They remind us of the way all sides of the drug policy debates call upon and alternatively use or misuse ‘evidence’ to feed into discussions of the worth, efficacy and desirability of different illicit drug policies. In doing so they provide pause for thought for those of us who operate as drug policy researchers and drug policy advocates.
DRUG RELATED DEATHS
39. A procedure that differentiates unintentional from intentional overdose in opioid abusersPeter C. Britton, Amy S.B. Bohnert, James D. Wines Jr, Kenneth R. ConnerAddictive Behaviors 2012:37(1);127-130
AbstractObjective The purpose of this study is to develop a procedure for assessing unintentional overdose (OD) in opiate abusers that differentiates it from intentional OD, and provides reliable information about the incident. Methods A sample of 121 patients in a methadone maintenance program at an urban university hospital completed a baseline assessment. A total of 70 participants completed an identical assessment at least 14 days later. The ability of an OD item to differentiate unintentional OD from intentional OD was tested, as was the test-retest reliability of questions assessing symptoms and treatment of OD. Results The procedure is reliable and differentiated unintentional OD from intentional OD. Questions assessing symptoms of OD were endorsed in almost every unintentional OD incident, although reliability was affected by loss of consciousness. The reliability of questions assessing emergency treatment and Narcan administration was outstanding. Conclusions Our procedure for assessing OD differentiates unintentional OD from intentional OD. The use of follow-up questions assessing acute treatment for OD is recommended. Items concerning symptoms of OD are not needed to confirm the presence of an OD, but may be used to clarify whether an event was an OD. Highlights We examined if a procedure could differentiate unintentional from intentional overdose (OD). We examined the test-retest reliability of items assessing OD symptoms and emergency treatment. The procedure differentiated unintentional from intentional OD. OD symptoms were valid as an aggregate, but reliability was affected by loss of consciousness. The emergency treatment items had outstanding reliability.Keywords: Opioid-related disorders; Methadone; Overdose; Attempted suicide; Reliability
40. Early onset of drug and polysubstance use as predictors of injection drug use among adult drug usersRebecca C. Trenz, Michael Scherer, Paul Harrell, Julia Zur, Ashish Sinha, William LatimerAddictive Behaviours 2012:37(4);367-372
AbstractEarly onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social–behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N = 651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ2 = 19.71, p < .01), cigarette (χ2 = 11.05, p < .01), marijuana (χ2 = 10.83, p < .01), and polysubstance use (χ2 = 23.48, p < .01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR = 1.47, 95% CI: 1.00–2.18) and early onset polysubstance users (AOR = 1.62, 95% CI: 1.10–2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR = 2.06, 95% CI: 1.07–3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.Keywords: Early onset; Polysubstance use; Injection drug use; Non-injection drug use; Heroin
41. Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependenceChristine E. Grella, Katherine LovingerAddictive Behaviors 2012:37(3);306-312
AbstractBackground This paper examines the health status and functioning of an aging cohort of individuals with a history of heroin dependence with a focus on gender differences.Method Study subjects were originally sampled from methadone maintenance clinics in California in the 1970s and completed follow-up interviews in 2005–09. Out of the
original study sample (N = 914), 343 participants (44.3% female) were interviewed (70.6% of those not deceased). Bivariate analyses examined gender differences in participants' overall health status and physical and mental health problems. Scores on SF-36 scales were compared with general population norms by gender and age, as well as between participants in the study sample who did and did not report past-year drug use. Results Average age of the study sample was 58.3 (SD = 4.9) years for males and 55.0 (SD = 4.1) years for females. There were no significant gender differences in past-year drug use (38% of sample) or injection drug use (19%). Women reported significantly more chronic health problems and psychological distress compared with men, and overall poorer health and functioning compared with general population norms. Men under 65 had poorer physical health and social functioning compared with population norms. Men in the study sample reporting past-year substance use had poorer physical functioning, but less bodily pain, than non-users, whereas women with past-year substance use had poorer mental health than other women.Conclusion Individuals with a history of heroin dependence have poorer health and functioning than their counterparts in the general population. At a younger age, women reported poorer overall health status and more chronic health and mental health problems than men. Study findings may inform interventions for this population, particularly related to gender-specific treatment needs. Highlights Heroin-dependent individuals have poorer overall health than the general population. Men who reported past-year drug use had poorer physical health status than other men. Men who reported past-year drug use had less bodily pain than other men. Women who reported past-year drug use had poorer mental health than other women. Women in the sample generally had poorer mental health than men.Keywords: Heroin dependence; Health outcomes; Physical health; Mental health; Gender differences; Follow-up study
42. Predictors of Repeated Emergency Department Visits among Persons Treated for AddictionHelen Hansagi, Barbro Engdahl, Anders RomelsjöEuropean Addiction Research 2012:18(2);47-53
AbstractBackground/Aims To determine whether frequent emergency department (ED) users who enter specialized treatment programs for alcohol and/or drug problems have any characteristics that predict their future ED use. Methods Adult patients (783 alcohol users, 405 illicit drug users) were interviewed. Data from the medical database on utilization of ED and the emergency departments’ specific units for addictive diseases (EDAD) 12 months before and 12 months after the interview were linked with patient characteristics in logistic regression models. Results Among alcohol users, prior ED/EDAD visits predicted repeat future visits to these sites (OR 11.6; 95% CI 6.5–20.5). Prior inpatient hospital care with addiction diagnosis was a predictor of future multiple visits to the EDAD only (OR 3.1; 95% CI 1.5–6.5). Among drug users, predictors of future ED/EDAD visits were use of heroin (OR 2.7; 95% CI 1.4–5.4) and prior ED/EDAD visits (OR 27.3; 95% CI 12.7–58.4). Drug users’ EDAD utilization was also predicted by inpatient hospital care with addiction diagnosis. Conclusion The strongest predictive factors of visiting ED repeatedly were previous repeat emergency care use and hospitalization with addiction diagnosis.
Entering regular addiction treatment does not appear to alter the pattern of ED utilization.Key Words: Addiction; Emergency department visits; Alcohol consumption; Drug use; Social factors
43. Mortality of those who attended drug services in Scotland 1996–2006: Record-linkage studyElizabeth L.C. Merrall, Sheila M. Bird, Sharon J. HutchinsonInternational Journal of Drug Policy 2012:23(1);24-32
AbstractBackgroundWe examine major causes of death amongst persons in contact with drug-treatment services across Scotland during April 1996–March 2006, hereafter Scottish Drug Misuse Database (SDMD) cohort. Methods Drug-treatment records were linked to national registers of deaths and hepatitis C virus (HCV) diagnoses. For eras 1996/97–2000/01 and 2001/02–2005/06, we calculated cause-specific death-rates and standardised mortality ratios (SMRs) using age-, sex- and calendar-rates of the general Scottish population. Major causes of death were identified by high SMRs (>5 across eras) or rates (>50 per 100,000 person-years in either era), and their time-specific influences characterised by proportional hazards analyses.Results The SDMD cohort comprised 69,456 individuals, 350,315 person-years and 2590 deaths. The overall SMR reduced from 6.4 (95% CI: 6.0–6.9) to 4.8 (95% CI: 4.6–5.0) between eras. We identified five major causes of death: drug-related (1383 deaths), homicide (118) and infectious diseases (90) with high SMRs; suicide (269) and digestive system disease (168) with high rates. HCV diagnosis marked individuals with at least double the risk of cause-specific mortality, including adjusted hazard ratio (HR) for no HCV diagnosis of 0.46 (95% CI: 0.41–0.53) for drug-related deaths (DRDs) and 0.15 (95% CI: 0.10–0.22) for death from digestive system disease. Increased DRD risk at older age (>34 years) appeared specific to HCV-diagnosed individuals (interaction: , p = 0.01). Alcohol misuse increased HRs: for DRD (1.76, 95% CI: 1.50–2.06), suicide (1.88, 95% CI: 1.35–2.60), deaths from digestive system disease (3.19, 95% CI: 2.21–4.60) and non-major causes (1.87, 95% CI: 1.49–2.35). Stimulant misuse increased suicide risk: adjusted HR 1.91 (95% CI: 1.43–2.54). Conclusions Drug-users in Scotland are exposed to variously increased mortality risks. HCV-diagnosed individuals are particularly vulnerable, and may need additional support.Keywords: Street drugs; Substance-related disorders; Mortality; Overdose
44. Personality Differences between Drug Injectors and Non-injectors among Substance-Dependent Patients in Substitution TreatmentJulie Saint-Lèbes, Rachel Rodgers, Philippe Birmes, Laurent Schmitt
The American Journal of Drug and Alcohol Abuse 2012:38(2);135-139
Abstract Background Understanding personality differences between injectors and non-injectors in substitution treatment may provide new insights to help improve treatment programs. Objective The aim of this study was to compare drug injectors and non-injectors in terms of personality disorders and dimensions. Methods Forty participants recruited from substance abuse treatment centers (23 injectors and 17 non-injectors) completed the self-report Personality Diagnostic Questionnaire 4th version and Temperament and Character Inventory. Mann–Whitney U tests were used to compare means of personality disorder traits, temperament, and character differences between injectors and non-injectors. Results The mean (SD) age of the sample (72.5% male) was 36.5 (8.7) years. Injectors reported more borderline personality disorders and increased global personality disturbance (p < .05). Similarly, Anticipatory worry, Shyness, and Fatigability facet scores were higher among injectors (p < .01). Attachment, Purposeful, and Congruent second nature facet scores were higher among non-injectors (p < .01). Conclusion According to the route of drug administration, drug dependents differed in terms of personality disorders and dimensions. Scientific Significance: These results may have implications for the implementation of treatment programs. New research in this area may contribute to the understanding and prevention of intravenous drug use.Keywords: route of drug administration; personality; dimensions
45. Eating patterns among heroin users: a qualitative study with implications for nutritional interventionsJoanne Neale, Sarah Nettleton, Lucy Pickering, Jan FischerAddiction 2012:107(3);635-641
AbstractAim To provide new insights into heroin users' eating patterns in order to inform nutritional interventions. Design Seventy-seven audio-recorded in-depth interviews which elicited detailed data on eating patterns. Setting Community and residential drug services, pharmacies and peer support groups in Southern England, UK. Participants Forty current or ex-heroin users (21 men and 19 women), of whom 37 (20 men and 17 women) were re-interviewed after 3 months. Measurements Audio data transcribed verbatim, coded systematically and analysed inductively. Findings Heroin users' eating patterns were influenced by individual, social, cultural, economic and environmental factors. During active heroin use, participants consumed quick, convenient, cheap and sweet foods, ate infrequently and had little interest in food. Eating patterns often improved during stays in residential services and after heroin cessation. Ex-heroin users began to take pleasure in food preparation and eating and identified therapeutic benefits to cooking. Initially, weight gain was experienced positively, but subsequently generated anxieties as participants, particularly women, struggled to control their appetite and worried about becoming overweight. Findings complement and add to previous research and sociological and anthropological literatures.Conclusions Heroin users have dysfunctional eating patterns that are amenable to change and community and residential services could enable them to experience the many health, psychological and social benefits of improved eating practices. Nutritional interventions need to be tailored to individual needs and circumstances, but also monitored and evaluated so that there is a future evidence base.Keywords: Diet; eating disorders; eating patterns; heroin, methadone; nutritional interventions; qualitative; residential services
46. A damage/benefit evaluation of addictive product useCatherine Bourgain, Bruno Falissard, Lisa Blecha, Amine Benyamina, Laurent Karila1, Michel ReynaudAddiction 2012:107(2);441-450
AbstractAims To obtain damage/benefit assessments of eight commonly used addictive products and one addictive behaviour from French addiction experts and link these to overall evaluations.Design and setting Criteria-based evaluation by experts in addiction. Specific statistical modelling to estimate the relative contribution of various criteria to formulating expert general opinion on products. Participants Forty-eight French experts in addiction.Measurements Twelve criteria covering the whole spectrum of damages and benefits to users and to society evaluated using visual analogue scales (VAS). Direct
measure of expert overall subjective opinions on products from user and from social perspectives. Findings Damage scoring identified alcohol (damage score = 48.1), heroin (damage score = 44.9) and cocaine (damage score = 38.5) as the most harmful products to users and to society; gambling was considered the least harmful (score = 22.5), replicating previous results. Damage scoring correlated poorly with legal status or with overall subjective expert opinions of products. Benefit perception scores indicated alcohol as a clear outlier (benefit score = 45.5) followed by tobacco (benefit score = 34.3) and cannabis (benefit score = 31.1). Statistical modelling suggested that experts attributed 10 times more importance to benefit perception than to damages when making their subjective opinion from a user perspective and two times more importance to benefit perception than to damages in formulating their opinion from a social perspective. Conclusions The perceived benefits of addictive products appear to have a major impact on the opinion of those products expressed by a number of French addiction experts.Keywords: Criteria-based evaluation; damage evaluation; perceived benefit evaluation; subjective opinion
47. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic reviewJames D. Livingston, Teresa Milne, Mei Lan Fang, Erica AmariAddiction 2012:107(1)39-50
AbstractAims This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders. Methods A comprehensive review of electronic databases was conducted to identify evaluations of substance use disorder related stigma interventions. Studies that met inclusion criteria were synthesized and assessed using systematic review methods. Results Thirteen studies met the inclusion criteria. The methodological quality of the studies was moderately strong. Interventions of three studies (23%) focused on people with substance use disorders (self-stigma), three studies (23%) targeted the general public (social stigma) and seven studies (54%) focused on medical students and other professional groups (structural stigma). Nine interventions (69%) used approaches that included education and/or direct contact with people who have substance use disorders. All but one study indicated their interventions produced positive effects on at least one stigma outcome measure. None of the interventions have been evaluated across different settings or populations. Conclusions A range of interventions demonstrate promise for achieving meaningful improvements in stigma related to substance use disorders. The limited evidence indicates that self-stigma can be reduced through therapeutic interventions such as group-based acceptance and commitment therapy. Effective strategies for addressing social stigma include motivational interviewing and communicating positive stories of people with substance use disorders. For changing stigma at a structural level, contact-based training and education programs targeting medical students and professionals (e.g. police, counsellors) are effective.Keywords: Intervention studies; stigma; substance use disorders; systematic review
48. Chronic pain, Addiction severity, and misuse of opioids in Cumberland County, MaineRobert Heimer, Nabarun Dasgupta, Kevin S. Irwin, Mark Kinzly, Alison Phinney Harvey, Anthony Givens, Lauretta E. GrauAddictive Behaviors 2012:37(3);346-349
AbstractBackground Few studies have examined the relationship between chronic pain and opioid abuse in non-clinical populations. We sought to investigate this in a street-recruited sample of active opioid abusers in Cumberland County, Maine, USA, a locale that had experienced substantial increases in opioid abuse. Methods A community-based sample was recruited using respondent-driven sampling. Participants were screened to identify those who had consumed illicit opioids in the prior month and administered a structured survey that included the Addiction Severity Index (ASI) and Brief Pain Inventory® (BPI). Results More than 40% of the 237 individuals reported recurring pain that interfered with daily living. For more than three-quarters of those reporting chronic pain, opioid misuse preceded the onset of chronic pain. The order of onset was not associated with differences in sociodemographic, current levels of drug misuse, or ASI and BPI scores. BPI scores were associated with medical and psychological ASI domains. Compared to those not reporting chronic pain, those doing so were more likely to have a regular physician but were more likely to report difficulty gaining admission to substance abuse treatment programs. Conclusion Chronic pain was a common co-occurring condition among individuals misusing opioids. Better efforts are needed to integrate pain management and substance abuse treatment for this population. Highlights 41% of active opioid misusers in Cumberland County, ME reported chronic pain. 78% of these reported that opioid misuse preceded start of chronic pain. People with chronic pain were more likely to be denied entry into drug treatment. People with chronic pain did not report higher levels of opioid misuse.Keywords: Chronic pain; Drug misuse; Addiction Severity; Opioids
49. Paying Substance Abusers in Research Studies: Where Does the Money Go?David S. Festinger, Karen Leggett DugoshThe American Journal of Drug and Alcohol Abuse 2012:38(1);43-48
AbstractBackground Research involving substance-abusing participants is often hindered by low rates of recruitment and retention. Research suggests that monetary payment or remuneration can be an effective strategy to overcome these obstacles. Objectives This article provides a brief overview of these issues and provides data reflecting how substance-abusing participants in several of our studies used their baseline and follow-up payments. We also present research findings related to how the mode of payment (i.e., cash, check, gift card) may affect how payments are used. Conclusions and Significance Overall, our findings suggest that participants use their research payments in a responsible and safe manner. Limitations and recommendations for future research are discussed.
50. Patterns of prescription opioid abuse and comorbidity in an aging treatment population Theodore J. Cicero, Hilary L. Surratt, Steven Kurtz, M.S. Ellis, James A. InciardiJournal of Substance Abuse Treatment 2012:42(1);87-94
AbstractVery little is known about the impact of age and gender on drug abuse treatment needs. To examine this, we recruited 2,573 opioid-dependent patients, aged from 18 to 75 years, entering treatment across the country from 2008 to 2010 to complete a self-administered survey examining drug use histories and the extent of comorbid psychiatric and physical disorders. Moderate to very severe pain and psychiatric disorders, including polysubstance abuse, were present in a significant fraction of 18- to 24-year-olds, but their severity grew exponentially as a function of age: 75% of those older than 45 years had debilitating pain and psychiatric problems. Women had more pain than men and much worse psychiatric issues in all age groups. Our results indicate that a “one-size-fits-all” approach to prevention, intervention, and treatment of opioid abuse that ignores the shifting needs of opioid-abusing men and women as they age is destined to fail.Keywords: Opioid abuse; Prescription drug abuse; Opioid treatment centers; Age-related changes in treatment needs; Age and gender influences on opioid treatment
51. Treatment experience and needs of older drug users in Bristol, UKRachel M. Ayres, Lynne Eveson , Jennifer Ingram , Maggie TelferJournal of Substance Use 2012:17(1);19-31
AbstractRecent publications raise concerns about meeting the treatment needs of an ageing drug-using population. At Bristol Drugs Project (BDP) we noted the absence of older users attending services beyond health centre-based opiate substitution therapy (OST). Twenty drug-users aged 55 or over were interviewed about their experience of treatment, barriers to further treatment, and what might encourage participation in our community drugs project. Thematic analysis revealed barriers as reluctance to be associated with younger drug users and a sense of shame at ‘still using at this age’. Assumptions that health professionals would interpret asking for medical help with
other age-related symptoms as ‘merely seeking more medication’ prevented some from getting adequate pain relief and there was a tension between fear of detox and fear of drug dependency in old age. Most reported positive relationships with general practitioners (GPs) and BDP Shared Care workers in respect of their drug use, but others had felt stigmatized and inadequately treated within Tier 4 (mainly hospital) services which they attributed to their drug-user status. A focus group developed ideas for an age-specific support group to be piloted. Advocacy work and training for health professionals should be ongoing to improve treatment for older drug users.Keywords: Older drug users; treatment; qualitative interviews
OPIOID PHARMACOLOGY
52. Functional relevance of μ–δ opioid receptor heteromerization: A Role in novel signaling and implications for the treatment of addiction disorders: From a symposium on new concepts in mu-opioid pharmacologySteven D. Stockton Jr, Lakshmi A. DeviDrug and Alcohol Dependence 2012:121(3);167-172
AbstractMorphine and other opiates are among the most widely prescribed and clinically useful medications for the treatment of chronic pain. However, the applicability of these compounds has been severely hampered by the rapid development of tolerance and physical dependence that typically accompanies their repeated use. A growing body of evidence has implicated the regulated functioning of μ–δ opioid receptor heteromers in both the modulation of morphine-mediated antinociception, and in the limitation of undesirable side effects resulting from chronic opiate exposure. Moreover, μ–δ heteromers exhibit unique ligand binding characteristics and signaling properties, indicating that pharmacological targeting of the μ–δ heteromer may represent a novel therapeutic approach for the management of chronic pain and addiction disorders. Therefore, the present review will attempt to summarize the latest relevant findings regarding the regulation and functional characteristics of the μ–δ heteromer both in vitro and in vivo.Keywords: Opiate receptor; Endorphin; G protein coupled receptor; Heterodimer; Oligomerization; Opiate addiction; Opiate tolerance; Opiate dependence
53. The effect of methadone on emotional reactivitySteven M. Savvas, Andrew A. Somogyi, Addiction 2012:107(2);388-392
AbstractAims Opioids have been implicated in emotion regulation. Opioid users report decreased negative emotional response, but there has been no formal study on the effect of opioid administration on emotional reactivity. The aim of this study was to investigate the effect of methadone on emotional reactivity in methadone-maintained patients. Design Velten's mood induction procedures were used to induce elative and depressive emotional reactions in the subjects. Each group was administered both induction procedures at 0 hour and 3 hours (corresponding with trough and peak plasma methadone concentrations in methadone subjects). Setting A drug treatment clinic with an out-patient methadone maintenance treatment programme. Participants Twenty-one subjects currently on methadone maintenance treatment and 21 controls with no history of opioid dependence. Measurements Emotional reactivity was measured using mood visual analogue scales.Findings At 0 hour, methadone and control subjects showed similar elation (methadone 13.2 ± 3.1 mean ± standard error of the mean [SEM], control 14.4 ± 3.7) and depression reactivity (methadone 23.6 ± 5.0, control 25.1 ± 5.0). However, at 3 hours repeated measures showed that methadone subjects had significantly decreased depression reactivity (methadone 18.5 ± 4.6, control 36.7 ± 5.7; P = 0.021) and elation reactivity (methadone 4.4 ± 1.9, control 19.0 ± 2.4) compared to controls. Conclusions Opioid addicts on methadone maintenance appear to be less reactive to mood induction at times of peak plasma methadone concentration than non-addict controls; this suggests that methadone blunts both elative and depressive emotional reactivity.Keywords: Affect; depression; elation; emotional reactivity; methadone; mood; opioid
54. Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort studyAnne Bukten, Svetlana Skurtveit, Michael Gossop, Helge Waal, Per Stangeland, Ingrid Havnes, Thomas ClausenAddiction 2012:107(2);393-399
AbstractAims This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7-year period prior to, during and after treatment, particularly in relation to differences in treatment engagement. Design, setting and participants Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross-linked with national criminal records. The period of observation was divided into four phases; pre-treatment, in-treatment, between treatments and post-treatment. Findings During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting-list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest
convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre-treatment criminal convictions were associated with significantly (P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment. Conclusions Criminal activity appears to be reduced in Norway during opiate maintenance treatment. Younger age and prior history of criminal activity are important risk factors for continued criminal activity during treatment.Keywords: Buprenorphine; criminality; maintenance treatment; methadone; retention; opioid; treatment engagement
55. Premature ejaculation and other sexual dysfunctions in opiate dependent men receiving methadone substitution treatmentVenkat Chekuri, David Gerber, Adam Brodie, Rajeev KrishnadasAddictive Behaviors 2012:37(1);124-126
AbstractBackground A significant number of men with opiate misuse have sexual problems. Premature ejaculation (PE) occurs predominantly on discontinuation of the opiate but seems to persist in some cases. The aims of this study were to determine the rates of PE and other sexual dysfunctions in patients maintained on methadone; to determine the time of onset of PE in relation to onset of opiate misuse; and to look at the patients' perception of the effect of heroin and methadone on PE.Methods Sixty five men attending a tertiary referral clinic for methadone maintenance treatment were assessed cross-sectionally using a semi-structured questionnaire, clinical interview, review of clinical records and the International Index of Erectile Function (IIEF). Results Thirty eight (58.5%) subjects reported a “lifetime” history of PE. Twenty (30.76%) of them reported “current” history of PE. Eleven (16.9%) people reported that PE preceded opiate misuse. Twenty four (63.2%) felt that heroin helped their PE and 7 (18.4%) felt that heroin worsened it. Fourteen (36.8%) felt that methadone helped PE, while 10 (26.3%) felt methadone worsened PE. Only 2 out of 65 (3.07%) reported that they had been asked about their sex life by the addiction services. Conclusion Prevalence of “current” premature ejaculation was almost 3 times greater than reported in the general population. A significant number of patients perceived heroin to be beneficial on PE. Presence of sexual dysfunction could therefore be a risk factor for relapse into heroin misuse. Most clinicians avoid asking patients questions of a sexual nature. Nevertheless, managing sexual difficulties among patients with opiate misuse could be a significant step in relapse prevention. Highlights Prevalence of PE is 3 times greater in methadone users than general population. A significant number of patients perceived heroin to be beneficial on PE. Presence of sexual dysfunction may be a risk factor for relapse into heroin misuse. Clinicians avoid asking opiate users questions about sexual difficulties. Managing sexual difficulties in opiate users is important in relapse prevention. Abbreviations: PE, Premature ejaculation; GnRH, Gonadotrophin releasing hormone; LH, Leutinising hormoneKeywords: Opiate; Sexual dysfunction; Heroin; Methadone; Premature ejaculation
56. The Value of Clinical Case Management in a Methadone Maintenance Treatment ProgramCarolyn J. Plater-Zyberk, Michael Varenbut, Jeff Daiter, Andrew Worster The American Journal of Drug and Alcohol Abuse 2012:38(1)70-72
AbstractBackground/Objective This study sought to determine whether case management was positively associated with improved outcomes and treatment compliance in those enrolled in a methadone maintenance treatment (MMT) program. Methods An intervention group (n = 396) received case management while the other group (n = 1308) did not. Total N = 1704. Results Statistically significant reductions were seen in the intervention group, in the proportion of urine samples positive for drugs of abuse (relative risk reduction = −15.4% (95% confidence interval (CI): −17.7, −13.1)), missed daily methadone doses (−1.9% (95% CI: −2.4, −1.4)), and missed physician appointments (−40.1% (95% CI: −43.7, −36.3)). ConclusionsScientific Significance Case management appears to be a very valuable tool in MMT programs.Keywords: methadone; opioids; clinical case management; case management
57. Self-reported practices, attitudes and levels of training of practitioners in the English NHS Stop Smoking ServicesMáirtín S. McDermott, Robert West, Leonie S. Brose, Andy McEwenAddictive Behaviors 2012:37(4);498-506
AbstractThe primary aim of the current study is to investigate the self-reported practices, attitudes and levels of training of stop smoking practitioners (SSPs) working at the English National Health Service's (NHS) Stop Smoking Services (SSSs). A secondary aim was to investigate differences between ‘Specialist’ and ‘Community’ SSPs. An online survey was conducted with 484 SSPs. Most (94%) SSPs offered one-to-one appointments to smokers, only 43% always used the abrupt quit model and 30% reported ever recommending particular medication to clients. SSPs reported an average of 3.7 days training when starting work and 26% reported never observing an experienced practitioner before seeing clients of their own. Over half (56%) never received clinical supervision. SSPs reported having generally positive attitudes towards their jobs, but reported feeling less positive about their prospects for future employment within the field. ‘Specialist’ SSPs reported receiving more days training (4.1 vs. 3.0, p = 0.002), more days observing an experienced practitioner when starting work (12.9 vs. 6.6, p < 0.001) and were more likely to receive clinical supervision (48.9% vs. 34.9%, p < 0.05) than ‘Community’ SSPs. Gaps between SSPs' current practices and evidence-based guidelines may be due to inadequate training. Similarly, differences in training between specialist and community SSPs may contribute to the observed difference in these practitioners' success rates. As recommended by the Department of Health for England, standardized training in evidence-based smoking cessation interventions should be implemented for both specialist and community SSPs. Highlights An online survey was conducted with 484 Stop Smoking Practitioners (SSPs). We investigate their self-reported practices, attitudes and levels of training. Gaps were found between SSPs current practices and evidence-based guidelines. Differences in levels of training were found between specialist and community SSPs. Standardized training in evidence-based practice should be implemented for all SSPs.Keywords: Smoking cessation; Professional education; Stop smoking practitioner; Evidence-based guidelines; Online survey
58. Beyond fear appeals: Contradicting positive smoking outcome expectancies to influence smokers' implicit attitudes, perception, and behaviorSabine Glock, Dagmar Unz, Carrie KovacsAddictive Behaviors 2012:37(4);548-551
AbstractSmokers often have (implicit or explicit) positive smoking outcome expectancies that motivate them to smoke. For instance, they may feel that smoking is relaxing, that it improves concentration, or that it is seen as cool and attractive by peers. These expectations are, for the most part, illusory. In order to counteract these expectations, we designed cigarette package warning labels that contradicted common positive outcome expectancies. We investigated the effectiveness of our new warning labels in two experiments. We first measured smokers' implicit attitudes toward smoking using an affective priming method and found that our new warning labels changed positive attitudes into ambivalent attitudes. We then tested whether our warning labels changed smokers' self-reported positive outcome expectancies and smoking behavior. Smokers presented with the new warning labels immediately associated positive outcome expectancies less strongly with smoking and reported smoking fewer cigarettes in the 24 hours following the experiment. Explicitly taking the reasons for unhealthy behavior into account when trying to change people's habits could offer a valuable contribution to effective health campaigns.
Graphical abstract
Highlights Our anti-smoking warning labels contradict positive smoking outcome expectancies. The new labels decrease positive implicit attitudes toward smoking. They decrease social and coping-related positive outcome expectancies. They decrease short-term smoking behavior. Addressing the reasons people engage in unhealthy behavior can help change it.Keywords: Smoking; Outcome expectancies; Implicit attitudes; Warning labels; Public health
59. Differences in happiness between smokers, ex-smokers and never smokers: cross-sectional findings from a national household surveyLion Shahab, Robert WestDrug and Alcohol Dependence 2012:121(1-2);38-44
AbstractBackground Happiness has become established as an important psychological dimension and not merely the obverse of depression and anxiety. Ex-smokers report that they are happier than when they were smoking but this could reflect biased recall. To date, no studies have examined happiness as a function of smoking status in ex-smokers of varying length of abstinence compared with current and never smokers.
Methods A cross-sectional household study of a nationally representative sample of adults examined the association between smoking status (never smoker, smoker, ex-smoker < 1 year, ex-smoker ≥ 1 year) and two standard measures of happiness adjusting for sociodemographic characteristics (N = 6923).Results After adjusting for age, gender and social grade, ex-smokers of ≥1 year reported higher levels of happiness than smokers (p < 0.001) and similar levels to never smokers. Ex-smokers of <1 year had similar levels to smokers. Smoking to feel less depressed (p < 0.001) or anxious (p < 0.044) were the only smoking characteristics associated with lower happiness among current smokers.ConclusionsEx-smokers who have stopped for a year or more are happier than current smokers and similar to never smokers. Whilst these results are cross-sectional and have to be interpreted with caution, this adds to the evidence that smoking may decrease happiness and stopping may increase it.Keywords: Smoking; Smoking cessation; Happiness; Life satisfaction; Life enjoyment
STIMULANTS
60. The diversion and misuse of pharmaceutical stimulants: what do we know and why should we care?Sharlene Kaye, Shane DarkeAddiction 2012:107(3);467-477
AbstractAims To examine the literature pertaining to the diversion and misuse of pharmaceutical stimulants. Methods Relevant literature was identified through comprehensive MEDLINE, EMBASE and PubMed searches. Results The evidence to date suggests that the prevalence of diversion and misuse of pharmaceutical stimulants varies across adolescent and young adult student populations, but is higher than that among the general population, with the highest prevalence found among adults with attention deficit–hyperactive disorder (ADHD) and users of other illicit drugs. Concerns that these practices have become more prevalent as a result of increased prescribing are not supported by large-scale population surveys. Information on trends in misuse in countries where there have been recent increases in prescription and consumption rates, however, is limited. Little is known about the frequency and chronicity of misuse, or the extent of associated harms, particularly among those populations, i.e. adolescents, young adult student populations, those with ADHD and illicit drug users, where abuse may be more likely to occur. Conclusions Continued monitoring of the diversion and misuse of pharmaceutical stimulants is of major clinical importance. Despite recognition of the abuse liability of these medications, there is a paucity of data on the prevalence, patterns and harms of diversion and misuse among populations where problematic use and abuse may be most likely to occur (e.g. adolescents, young adults, illicit drug users). Comprehensive investigations of diversion and misuse among these populations should be a major research priority, as should the assessment of abuse and dependence criteria among those identified as regular users.Keywords: ADHD; attention-deficit hyperactive disorder; diversion; misuse; pharmaceutical; stimulants
TREATMENT AND SERVICE USE
61. Opportunistic and continuing health care for injecting drug users from a nurse-run needle syringe program-based primary health-care clinicM. Mofizul Islam, Sharon E Reid, Ann White, Sara Grummett, Katherine M Conigrave, Paul S Haber Drug and Alcohol Review 2012:31(1);114-115
AbstractNo abstract is available for this article.
62. A multilevel approach to predicting community addiction treatment attitudes about contingency managementBryan Hartzler, Dennis M. Donovan, Carrie J. Tillotson, Solange Mongoue-Tchokote, Suzanne R. Doyle, Dennis McCarty,Journal of Substance Abuse Treatment 2012:42(2);213-221
AbstractAdoption of contingency management (CM) by the addiction treatment community is limited to date despite much evidence for its efficacy. This study examined systemic and idiographic staff predictors of CM adoption attitudes via archival data collected from treatment organizations affiliated with the National Drug Abuse Treatment Clinical Trials Network. Multilevel modeling analyses evaluated potential predictors from organizational, treatment unit, and workforce surveys. Among these were individual and shared perceptions of staff concerning aspects of their clinic culture and climate. Modeling analyses identified three systemic predictors (clinic provision of opiate agonist services, national accreditation, and lesser shared perception of workplace stress) and five idiographic predictors (staff with a graduate degree, longer service tenure, managerial position, e-communication facility, and openness to change in clinical procedures). Findings are discussed as they relate to extant literature on CM attitudes and established implementation science constructs, and their practical implications are discussed.Keywords: Contingency management; Adoption attitudes; Organizational dynamics
63. Psychological dysregulation, white matter disorganization and substance use disorders in adolescenceDuncan B. Clark, Tammy Chung, Dawn L. Thatcher, Stefan Pajtek, Elizabeth C. LongAddiction 2012:107(1);206-214
AbstractAims Adolescents with substance use disorders (SUD) have difficulties with cognitive, behavioral and affective regulation. White matter (WM) disorganization has been observed in adolescents with SUD and may be related to psychological dysregulation. This study compared adolescents with SUD and control adolescents to investigate relationships among psychological dysregulation, WM disorganization and SUD symptoms. Design Cross-sectional observation. Setting Adolescents with SUD were recruited from SUD treatment programs. Controls were recruited from the community. Participants The 55 participants were aged 14–19; 35 with SUD and 20 controls without SUD. Measurements Psychological dysregulation was characterized by the Behavior Rating Inventory of Executive Function. WM disorganization was measured by diffusion tensor imaging, and fractional anisotropy, radial diffusivity and axial diffusivity were examined within cortical regions of interest. Findings Compared to controls, SUD adolescents showed significantly greater psychological dysregulation and prefrontal and parietal WM disorganization. WM disorganization was correlated positively with psychological dysregulation and cannabis-related symptoms. In multivariate mediation models, the results were consistent with both the neurodevelopmental immaturity model, in which WM disorganization leads to psychological dysregulation and cannabis-related symptoms, and with the substance effects model, in which cannabis-related symptoms lead to WM disorganization and psychological dysregulation.Conclusions In adolescents, substance use disorder and psychological dysregulation appear to be associated with reduced frontoparietal network white matter maturation.Keywords: Adolescents; alcohol; cannabis; diffusion tensor imaging; neuroimaging; substance use disorders
64. Outcome of heroin-dependent adolescents presenting for opiate substitution treatmentBobby P. Smyth, John Fagan, Kathy Kernan, M.R.C.PsychJournal of Substance Abuse Treatment 2012:42(1);35-44
AbstractBecause the outcome of methadone and buprenorphine substitution treatment in adolescents is unclear, we completed a retrospective cohort study of 100 consecutive heroin-dependent adolescents who sought these treatments over an 8-year recruitment period. The participants' average age was 16.6 years, and 54 were female. Half of the patient group remained in treatment for over 1 year. Among those still in treatment at 12 months, 39% demonstrated abstinence from heroin. The final route of departure from the treatment program was via planned detox for 22%, dropout for 32%, and
imprisonment for 8%. The remaining 39% were transferred elsewhere for ongoing opiate substitution treatment after a median period of 23 months of treatment. Males were more likely to exit via imprisonment (p < .05), but other outcomes were not predicted by gender. There were no deaths during treatment among these 100 patients who had a cumulative period of 129 person years at risk. Our findings suggest that this treatment delivers reductions in heroin use and that one fifth of patients will exit treatment following detox completion within a 1- to 2-year time frame.Keywords: Adolesence; Heroin dependence; Opiate substitution treatment; Methadone; Mortality; Hepatitis C; HIV
